[Reassessment of practice of Chinese surgeons since introduction of the watch and wait strategy after neoadjuvant therapy for rectal cancer].

Objective: To investigate perspectives and changes in treatment selection by Chinese surgeons since introduction of the watch-and-wait approach after neoadjuvant therapy for rectal cancer. Methods: A cross-sectional survey was conducted using a questionnaire distributed through the "Wenjuanxing" online survey platform. The survey focused on the recognition and practices of Chinese surgeons regarding the strategy of watch-and-wait after neoadjuvant therapy for rectal cancer and was disseminated within the China Watch-and-Wait Database (CWWD) WeChat group. This group targets surgeons of deputy chief physician level and above in surgical, radiotherapy, or internal medicine departments of nationally accredited tumor-specialist or comprehensive hospitals (at provincial or municipal levels) who are involved in colorectal cancer diagnosis and treatment. From 13 to 16 December 2023, 321 questionnaires were sent with questionnaire links in the CWWD WeChat group. The questionnaires comprised 32 questions encompassing: (1) basic physician characteristics (including surgical volume); (2) assessment methods and criteria for clinical complete response (cCR); (3) patients eligible for watch-and-wait; (4) neoadjuvant therapies and other measures for achieving cCR; (5) willingness to implement watch-and-wait and factors influencing that willingness; (6) risks and monitoring of watch-and-wait; (7) subsequent treatment and follow-up post watch-and-wait; (8) suggestions for development of the CWWD. Descriptive statistics were employed for data analysis, with intergroup comparisons conducted using the χ2 or Fisher's exact probability tests. Results: The response rate was 31.5%, comprising 101 responses from the 321 individuals in the WeChat group. Respondents comprised 101 physicians from 70 centers across 23 provinces, municipalities, and autonomous regions nationwide, 85.1% (86/101) of whom represented provincial tertiary hospitals. Among the respondents, 87.1% (88/101) had implemented the watch-and-wait strategy. The approval rate (65.6%, 21/32) and proportion of patients often informed (68.8%, 22/32) were both significantly higher for doctors in oncology hospitals than for those in general hospitals (27.7%, 18/65; 32.4%, 22/68) (χ2=12.83, P<0.001; χ2=11.70, P=0.001, respectively). The most used methods for diagnosing cCR were digital rectal examination (90.1%, 91/101), colonoscopy (91.1%, 92/101), and rectal T2-weighted magnetic resonance imaging (86.1%, 87/101). Criteria used to identify cCR comprised absence of a palpable mass on digital rectal examination (87.1%, 88/101), flat white scars or new capillaries on colonoscopy (77.2%, 78/101), absence of evident tumor signals on rectal T2-weighted sequences or T2WI low signals or signals equivalent to the intestinal wall (83.2%, 84/101), and absence of tumor hyperintensity on diffusion-weighted imaging with no corresponding hypointensity on apparent diffusion coefficient maps (66.3%, 67/101). As for selection of neoadjuvant regimen and assessment of cCR, 57.4% (58/101) of physicians preferred a long course of radiotherapy with or without induction and/or consolidation capecitabine + oxaliplatin, whereas 25.7% (26/101) preferred immunotherapy in combination with chemotherapy and concurrent radiotherapy. Most (96.0%, 97/101) physicians believed that the primary lesion should be assessed ≤12 weeks after completion of radiotherapy. Patients were frequently informed about the possibility of achieving cCR after neoadjuvant therapy and the strategy of watch-and-wait by 43.6% (44/101) of the responding physicians and 38.6% (39/101) preferred watch-and-wait for patients who achieved cCR or near cCR after neoadjuvant therapy for rectal cancer. Capability for multiple follow-up evaluations (70.3%, 71/101) was a crucial factor influencing physicians' choice of watch-and-wait after cCR. The proportion who patients who did not achieve cCR and underwent surgical treatment was lower in provincial tertiary hospitals (74.2%, 23/31) than in provincial general hospitals (94.5%, 52/55) and municipal hospitals (12/15); these differences are statistically significant (χ2=7.43, P=0.020). The difference between local recurrence and local regrowth was understood by 88.1% (89/101) of respondents and 87.2% (88/101) agreed with monitoring every 3 months for 5 years. An increase in local excision or puncture rates to reduce organ resections in patients with pCR was proposed by 64.4% (65/101) of respondents. Conclusion: Compared with the results of a previous survey, Chinese surgeons' awareness of the watch-and-wait concept has improved significantly. Oncologists in oncology hospitals are more aware of the concept of watch-and-wait.

Tissue eosinophilia and computed tomography features in paediatric chronic rhinosinusitis with nasal polyps requiring revision surgery.

BACKGROUND: Endoscopic sinus surgery (ESS) is an effective and safe treatment modality for medically recalcitrant chronic rhinosinusitis (CRS) in the paediatric population, especially in older children or those with nasal polyposis (CRSwNP). We aimed to elucidate the inflammatory pattern and clinical characteristics of CRSwNP related to revision surgery after ESS in a paediatric population. METHODS: We retrospectively enrolled 146 patients with bilateral CRSwNP. Twenty-two patients had recurrent nasal polyps that required revision surgery. The clinical characteristics, computed tomography (CT) features, tissue eosinophil count, and immunoactivity of signature cytokines in the two groups were analysed. RESULTS: Tissue eosinophil infiltration and immunoreactivity of eosinophilic cationic protein and IL-5 in the sinus mucosa were higher in patients that required revision surgery. The revision surgery group was significantly younger and had positive aeroallergen test results, higher total Lund-Mackay scores, and ethmoid/maxillary sinus ratio on CT images than those without revision surgery. A nomogram was developed to predict the probability of the requirement of revision surgery according to the logistic regression analysis results. CONCLUSIONS: We developed a nomogram model using clinical characteristics, tissue eosinophilia, and CT features for the preoperative identification of patients vulnerable to revision surgery in paediatric CRSwNP. This could help clinicians predict the probability of recurrence and perform intensive postoperative adjunct therapy and follow-up.

Impact of chemotherapy on surgical outcomes in ileostomy reversal: a propensity score matching study from a single centre.

PURPOSE: In patients with chemotherapy, there is no consensus on the timing of ileostomy closure. Ileostomy reversal could improve the quality of life and minimise the long-term adverse events of delayed closure. In this study, we evaluated the impact of chemotherapy on ileostomy closure and searched for the predictive factors for complications. METHODS: We retrospectively analysed 212 patients with rectal cancer who underwent ileostomy closure surgery during and without chemotherapy and were consecutively enrolled between 2010 and 2016. As a result of the heterogeneity of the two groups, propensity score matching (PSM) was performed with a 1:1 PSM cohort. RESULTS: A total of 162 patients were included in the analysis. The overall stoma closure-related complications (12.4% vs. 11.1%, p = 1.00) and major complications (2.5% vs. 6.2%, p = 0.44) were not significantly different between the two groups. Multivariate analysis demonstrated that chronic kidney disease and bevacizumab use are risk factors for major complications. CONCLUSION: Patients with oral or intravenous chemotherapy can safely have ileostomy closure with an adequate time delay from chemotherapy. When patients use bevacizumab, major complications related to ileostomy closure should still be cautioned.

Identifying a sphenoid sinus fungus ball using a nomogram model.

BACKGROUND: Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-specific symptoms. SSFB could potentially lead to serious orbital and intracranial complications. Computed tomography (CT) scan is usually the first imaging test of the diagnostic workup in patients with specific clinical symptoms. This study aimed to compare the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball) chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most common inflammatory diseases of the sphenoid sinus. METHODS: By retrospective database review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and histopathological diagnoses of USRS were enrolled as the control group. Clinical characteristics and CT features were evaluated. RESULTS: Headache, rhinorrhoea, nasal obstruction, postnasal dripping, and hyposmia were the most common symptoms in both groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface, bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the multivariate analysis. Based on the results of the regression analysis, a nomogram for predicting the probability of SSFB was plotted. CONCLUSIONS: We developed a nomogram model as a novel preoperative diagnostic tool for identifying SSFB according to the predictors both in clinical characteristics and on CT features. This could help the clinicians in predicting the probability of SSFB, to reduce ineffective or delayed treatment and occurrence of complications.

[Perpetuation of defunctioning stoma: risk factors and countermeasures].

Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage after rectal cancer surgery. It is of concern that about 1 in 5 defunctioning stomas will not be restored, that is, becoming permanent. And that is usually beyond expectation by physicians and patients, which deserves enough attention. The causes are complex, including anastomotic complications, tumor progression, perioperative death, poor anal function and patient willingness. Possible risk factors include symptomatic anastomotic leakage, age, tumor location, neoadjuvant therapy, anal function, TNM stage, ASA score, hospital factors, etc. Those factors may occur in various stages of patient referral such as before neoadjuvant therapy, prior to surgery, intra or post-operative period, and follow-up. Adequate physician-patient communication and shared decision-making, comprehensive tumor and patient function assessment, rational treatment strategy, careful manipulation during operation and good quality control, and meticulous perioperative management are important steps to reduce the permanent stoma. When shared decision-making, patients' needs should be fully considered while unnecessary expectations of anal preservation should be avoided. The risk of perpetuation of defunctioning stoma should be fully informed. Safe operation, especially anastomosis, is the key to avoid permanent stoma. And attention should be paid to the early detection and intervention of postoperative anastomotic stenosis.

[Current status and the necessity for enterostomy training: Results of a national survey in China].

Objective: To investigate the perceptions, attitudes, and surgical strategies of Chinese surgeons, toward stoma management. Methods: We conducted a nationwide, cross-sectional, questionnaire-based survey among individuals working at relevant departments in any tier of hospitals, including general surgery, gastrointestinal surgery, surgical oncology, emergency, and others, that was involved in managing enterostomies. We required that participants be senior surgeons who had participated in performing enterostomy surgery. The questionnaire consisted of five dimensions: personnel qualification and training, attitude toward ostomy complications, preoperative siting, the process of acquiring ostomy-related surgical skills, and awareness and adoption of relevant techniques. Descriptive statistical analysis was performed. Results: From July 2021 to July 2022, we sent 488 questionnaires through a WeChat link or two-dimensional barcode. We received 467 (95.7%) responses from 196 hospitals in 26 provinces. Among the respondents, 426 (91.2%) were from tertiary hospitals, the departments of which comprised general surgery (130, 27.8%), gastrointestinal surgery (210, 45.0%), surgical oncology (116, 24.8%), and other departments (11, 2.4%). Senior surgeons accounted for 311(66.6%) of the participants. We found that: (1) mentorship by senior surgeons was the primary source of knowledge about ostomies (83.3%, 389/467), followed by mentorship by others and surgical atlases (44.8%, 209/467), and self-education (42.0%, 196/467). (2) Concerns about correlations between complications and surgical procedures that were believed to be "closely" or "probably" related to complications (79.0%, 369/467) were expressed by 99.4% (464/467) of the surgeons. Stenosis and intestinal obstruction requiring unplanned surgery were not uncommon (61.0%, 285/467). Of the listed complications, 46.7% (218/467) were believed to be related to surgical procedures and 79.0% (369/467) avoidable. Only 58.7% (274/467) of surgeons had participated in training and discussion of stoma complications whereas 99.1% (463/467) believed that joint training and discussions between surgeons and enterostomal therapists were necessary. (3) The main reasons for creation of stomas that were not consistent with prior siting included: stoma site marked preoperatively not a suitable trocar site (56.1%, 262/467), defunctioning stoma marking according to standards for permanent stomas (50.7%, 237/467), and inappropriate marking (43.3%, 202/467). (4) The rate of awareness of relevant procedures was generally high; however, it was less than 75% for stoma creation by circular stapler (64.1%, 257/401) and parastomal drainage (44.1%, 177/401). Eversion suture of mucosa and supporting rods were utilized in 65.6% (263/401) and 56.4% (226/401), respectively. Peritoneum (or posterior rectus abdominis sheath) (68.3%, 274/401), anterior rectus abdominis sheath (54.4%, 218/401), and skin (80.6%, 323/401) were the most commonly used tissues for fixation and suture layers of defunctioning and permanent stomas. However, closure of subcutaneous tissue was controversial, suturing being advocated by 26.7% (107/401) and 32.7% (131/401) of surgeons, respectively. Complications were considered to depend mainly on technical skills rather than the amount of suturing by 81.5% (327/401) of the participating surgeons. Conclusions: The complications of stoma surgery are related to the awareness and technical skills of surgeons, indicating there are insufficient training, education, management, and research. Standardization of enterostomy technical strategies and stoma management are therefore imperative.

[Phenotypes and ATP7B gene variants in 316 children with Wilson disease].

Objectives: To summarize the clinical phenotypes and the variation spectrum of ATP7B gene in Chinese children with Wilson's disease (WD) and to investigate their significance for early diagnosis. Methods: Retrospective analysis was performed on the clinical data of 316 children diagnosed as WD in Guangzhou Women and Children's Medical Center during the period from January 2010 to June 2021. The general situations, clinical manifestations, lab test results, imaging examinations, and ATP7B gene variant characteristics were collected. The patients were divided into asymptomatic WD group and symptomatic WD group based on the presence or absence of clinical symptoms at the time that WD diagnosis was made. The χ2 test, t test or Mann-Whitney U test were used to compare the differences between groups. Results: Among the 316 children with WD, 199 were males and 117 were females, with the age of 5.4 (4.0, 7.6) years at diagnosis; 261 cases (82.6%) were asymptomatic with the age of 4.9 (3.9, 6.4) years; whereas 55 cases (17.4%) were symptomatic with the age of 9.6 (7.3, 12.0) years. The main symptoms invloved liver, kidney, nervous system, or skin damage. Of all the patients, 95.9% (303/316) had abnormal liver function at diagnosis; 98.1% (310/316) had the serum ceruloplasmin lever lower than 200 mg/L; 97.7% (302/309) had 24-hour urine copper content exceeding 40 µg; only 7.4% (23/310) had positive corneal K-F rings, 8.2% (23/281) had abnormal MRI signals in the lenticular nucleus, and all of them had symptoms of damage in liver, kidney or nervous system. Compared with the group of symptomatic WD, asymptomatic group had higher levels of serum alanine aminotransferase and lower levels ceruloplasmin and 24-hour urine copper [(208±137) vs. (72±78) U/L, (55±47) vs. (69±48) mg/L, 103 (72, 153) vs. 492 (230, 1 432) µg; t=9.98, -1.98, Z=-4.89, all P<0.001]. Among the 314 patients completing genetic sequencing, a total of 107 mutations in ATP7B gene were detected, of which 10 are novel variants, and 3 cases (1.0%) had large heterozygous deletion (exons 10 to exon 11) in ATP7B gene. The percentage of missense mutation in asymptomatic WD children was significantly higher than that in symptomatic WD (81.5% (422/518) vs. 69.1% (76/110), χ²=8.47, P<0.05). WD patients carrying homozygous variant of c.2 333G>T had significantly low levels of ceruloplasmin than those not carrying this variant ((23±5) vs. (61±48) mg/L, t=-2.34, P<0.001). Conclusions: The elevation of serum ALT is an important clue for early diagnosis of WD in children, while serum ceruloplasmin and 24-hour urine copper content are specific markers for early diagnosis of WD. In order to confirm the diagnosis of WD, it is necessary to combine the Sanger sequencing with multiplex ligation-dependent probe amplification or other testing technologies.

[Comparison of multi-tract PCNL and single-tract ECIRS in semisupine-lithotomy position for staghorn renal calculi].

Objective: To compare the outcomes of multi-tract percutaneous nephrolithotomy (PCNL) and simultaneous combined single-tract percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy (ECIRS) as treatment for staghorn stones. Methods: The clinical data of patients with staghorn stones who were treated with multi-tract PCNL or single-tract ECIRS in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2015 to December 2019 were retrospectively analyzed. Two group of patients were placed in semisupine-lithotomy position (Galdakao-modified supine Valdivia position). We punctured into the renal calyces guided by ultrasonography. A F6 double J stent and a nephrostomy tube were routinely inserted in both groups. Kidney-ureter-bladder radiography (KUB) or computed tomography (CT) were done within 24 hours and 1 month after procedure to determine stone free rate (SFR). Stone free was defined as no residual stones or residual stones of <4 mm in diameter. The SFR, operating time, intraoperative and postoperative complications, and hospitalization time of the two groups were compared and analyzed. Results: A total of 135 patients were included in the study, 70 patients were female, 65 patients were male. The average age were 50.8 years. A total of 74 patients were managed by multi-tract PCNL, while 61 patients were treated by single-tract ECIRS. The mean stone diameter was (58.5±11.4) mm in the PCNL group and (57.7±11.6) mm in the ECIRS group (P=0.658). Neither the 24-hour SFR (81.1% vs 80.3%) nor one-month SFR (91.9% vs 90.2%) after procedure was significantly different between the groups (both P>0.05). The operating time was significantly longer in PCNL group compared with ECIRS group [130(100,171) vs 105(90,135) min, P=0.015]. The rate of Clavien-Dindo grade 2 or higher were significantly higher in the PCNL group than the ECIRS group (18.92% vs 1.64%, P<0.01). The PCNL group required longer hospitalization time than the ECIRS group [8 (7, 9) vs 6 (5, 8) d, P<0.01]. Conclusions: Both multi-tract PCNL and single-tract ECIRS treating staghorn stones in semisupine-lithotomy position are safe and effective. The two procedures have comparable SFR. However, the ECIRS group has lower rates of postoperative complications, shorter operating time and hospitalization time.

[microRNA-30d can inhibit the proliferation, migration and invasion of human mesothelial cell MSTO-211H].

Objective: To investigate the inhibitory effect and molecular mechanism of microRNA-30d (miR-30d) in the process of proliferation, migration and invasion of malignant mesothelioma cell line MSTO-211H. Methods: In April 2017, the human MSTO-211H cells was used to establish miR-30d overexpressed MSTO-211H cell model by transfection of miR-30d mimics. The qRT-PCR was performed to detect the expression level of miR-30d in the cells transfected miR-30d mimics. The effects of miR-30d on the proliferation, apoptosis, migration and invasion of MSTO-211H cells were analyzed by CCK-8 experiment, flow cytometry, cell scratch experiment and Transwell method. Results: After transfection of miR-30d, the expression level of miR-30d in the MSTO-211H+miR-30d cells group was significantly higher than MSTO-211H+miR NC cells group (P<0.01) . The cell activity of MSTO-211H+miR-30d group (105.13%±2.35%) was significantly lower than MSTO-211H+miR NC cells group (115.40%±1.35%) , and the level of apoptosis (3.97%±0.36%) was significantly higher than MSTO-211H+miR NC cells group (1.47%±0.10%) (P<0.01) . The relative migration areas at 12 and 24 h of MSTO-211H+miR-30d cells group (9.35±3.16 µm(2) and 58.19±1.82 µm(2)) were significantly lower than MSTO-211H+miR NC cells group (54.42±5.26 µm(2) and 88.32±1.96 µm(2)) (P<0.01) . Compared with the MSTO-211H+miR NC cells group, the numbers of cell migration and cell invasion were reduced in the MSTO-211H+miR-30d cells group (P<0.01) . Conclusion: miR-30d can regulate the progression of malignant pleural mesothelioma by inhibiting the proliferation, apoptosis, migration and invasion of MSTO-211H cells.

[Study on malignant transformation of MeT-5A cells induced by chrysotile].

Objective: To study the cytotoxicity and malignant transformation ability of chrysotile on MeT-5A cells. Methods: In June 2016, lactate dehydrogenase (LDH) method was used to detect the cytotoxicity of chrysotile to MeT-5A cells. MeT-5A cells were treated with 5 µg/cm(2) chrysotile intermittently for 24 h a time, once a week and a total of 28 times. After the cells showed anchorage independent growth, the cell features of malignant transformation were identified by colony forming frequency in soft agar, and the soft agar colony formation rates were calculated. The activities of key speed limiting enzymes of glycolysis metabolism including hexokinase (HK) , phosphofructokinase (PFK) and pyruvate kinase (PK) were determined by UV colorimetry. Results: Chrysotile was cytotoxic to MeT-5A cells in a concentration-dependent decline. Compared with the control group, the relative survival rates of MeT-5A cells were significantly decreased after exposed to chrysotile at 10, 20, 40 and 80 µg/cm(2) (P<0.05) . After 28 times of exposure, the growth rate of the cells in chrysotile transformed MeT-5A cells was accelerated, the arrangement was disordered, the contact inhibition was lost, and the double layer growth appeared, which could grow on soft agar. The colony forming rate of the chrysotile transformed MeT-5A cells was 18.33‰±2.49‰. Compared with the control group (0) , the difference was statistically significant (P<0.01) . The activities of glycolysis related kinase including PK [ (19.51±1.52) U/L], PFK[ (0.12±0.02) U/10(4) cell] and HK[ (0.26±0.01) U/10(4) cell] were increased in the chrysotile transformed MeT-5A cells compared with control group [ (25.00±1.04) U/L、(0.15±0.01) U/10(4) cell and (0.33±0.01) U/10(4) cell] (P<0.01) . Conclusion: Chrysotile can induce malignant transformation of MeT-5A cells and increase the activities of glycolysis related kinases including PK, PFK and HK.

Comparison of four contrast medium delivery protocols in low-iodine and low-radiation dose CT angiography of the aorta.

AIM: To evaluate contrast medium delivery protocols for the optimal enhancement profile of the aorta with both a reduced dose of radiation and contrast medium, called double-low computed tomography (CT) angiography (DLCTA). MATERIALS AND METHODS: DLCTA was performed with 70 kVp and 200 mg iodine/kg in 205 patients following four protocols, namely slow rate (n=52), short duration (n=52), low concentration (n=50), and combined method (n=51), in comparison with a conventional group (120 kVp, 400 mg iodine/kg, n=51). The quantitative measurement of aortic attenuation, homogeneity, and subjective scores were evaluated. RESULTS: Overall, in the four DLCTA groups, the radiation dose was reduced by 62%, and the iodine dose was reduced by 50%. Among the four DLCTA groups, the signal to noise ratio (SNR) and contrast to noise ratio (CNR) of the thoracic aorta were similar, but a significant difference was noted in the abdominal aorta. The short-duration group had the highest peak enhancement, least homogeneity, and worst subjective scores. Good contrast enhancement and good homogeneity were significantly more frequent in the slow-rate (86.6% and 90.4%, respectively) and low-concentration groups (78% and 96.0%, respectively). Subjective scores exhibited a trend of higher scores in the low-concentration group and lower scores in the slow-rate group (p=0.071). CONCLUSION: DLCTA with 70 kVp and 200 mg iodine/kg is feasible for whole-aortic CT angiography. The low-concentration protocol is recommended owing to its most consistent optimal aortic enhancement profile. Alternatively, the slow-rate protocol can be considered for patients with limited venous access.

Metabolites of intestinal microflora upregulate miR-192-5p to suppress proliferation of colon cancer cells via RhoA-ROCK-LIMK2 pathway.

OBJECTIVE: The application of intestinal microflora is involved in various cancers; however, researches reporting the potential of metabolites of intestinal microflora (MIM) on biological activities of colon cancer (CC) cells are unavailable. This study was designed to testify the functions of MIM on CC cells and its mechanism. MATERIALS AND METHODS: qRT-PCR/Western blot were applied to test the expression levels of miR-192-5p and BMPR2 in human colonic epithelial cells and CC cells (HCT116, SW480). The effects of MIM, mimics-miR-192-5p or inhibitors-miR-192-5p on mRNA and protein expressions of miR-192-5p and BMPR2 were verified by qRT-PCR and Western blot. MTT assay for CC cell viability, flow cytometry for CC cells apoptosis rate, and cell scratch and cell chamber served for the analysis of invasion and migration ability of CC cells. The relationship between miR-192-5p and BMPR2 was validated employing Luciferase reporter gene assay. RESULTS: Compared with human normal colonic epithelial cells, HCT116 and SW480 cells had lower expression of miR-192-5p and higher expression of BMPR2 (p < 0.01). MIM and mimics-miR-192-5p could enhance cell apoptosis and suppress the migration and proliferation of CC cells. MIM were also found to up-regulate miR-192-5p and down-regulate the expression levels of BMPR2 and p-LIMK2 (p < 0.01). Transfection of inhibitors-miR-192-5p reversed the inhibitory effect of MIM on CC cells. CONCLUSIONS: MIM could up-regulate miR-192-5p to inhibit CC cell growth via down-regulating BMPR2 and inhibiting the activity of RhoA-ROCK-LIMK2 pathway.

DGCR5 suppresses the EMT of pediatric primary glioblastoma multiforme cell and serves as a prognostic biomarker.

OBJECTIVE: Pediatric primary glioblastoma multiforme (GBM) is a common brain tumor among childhood. Nevertheless, the underlying mechanism of glioblastoma progresses remains to be illuminated. The current study explores the potential functions of long noncoding RNA (lncRNA) DGCR5 in the aggressiveness of GBM. PATIENTS AND METHODS: The expression of DGCR5 was evaluated by quantitative real-time PCR (qRT-PCR). Immunoblotting was carried out to assess the protein expressions of N-cadherin and E-cadherin. Cell Counting Kit-8 (CCK-8), wound healing, transwell assay, and flow cytometry were applied to explore the roles of DGCR5 in glioblastoma cell malignant biological behaviors. RESULTS: LncRNA DGCR5 was down expressed in glioblastoma. Transfection of DGCR5 markedly repressed cell viability and colony formation ability of U87 and U251 cells. Additional, DGCR5 overexpression caused cell cycle arrest and increased cell apoptosis. Moreover, upregulation of DGCR5 suppressed the growth and promoted cell apoptosis of U87 cell in vivo. Finally, overexpression of DGCR5 impaired the migration, invasiveness, and reversed epithelial-to-mesenchymal transition (EMT) process of glioblastoma cell. CONCLUSIONS: LncRNA DGCR5 inhibited the proliferation, aggressiveness phenotypes, and EMT of glioblastoma cell.

A meta-analysis of influence of MSMB promoter rs10993994 polymorphisms on prostate cancer risk.

OBJECTIVE: The aim of this meta-analysis was to assess the association between beta-microseminoprotein gene (MSMB) rs10993994 polymorphism and prostate cancer (PCa) risk. MATERIALS AND METHODS: Relevant databases were searched to identify studies investigating the association between rs10993994 polymorphisms and the risk of PCa using allele contrast, recessive, dominant, and additive models. The assessment of the association was used by odds ratios (ORs) with 95% confidence intervals (CIs). Hardy-Weinberg equilibrium (HWE) was checked for each study. The sensitivity analysis and the assessment of publication bias were also performed. RESULTS: Six reports involving 13 eligible studies (a total of 11,385 PCa patients and 9,115 controls) were included in the meta-analysis. Our data revealed that the T allele of MSMB rs10993994 polymorphism was significantly associated with PCa in all subjects (allele contrast: OR=1.24, 95% CI=1.19-1.29, p<0.001). Similarly, for recessive, dominant, and additive genetic models, significant associations were also found (recessive: OR=1.40, 95% CI=1.30-1.51; dominant: OR=1.28, 95% CI=1.21-1.36; and additive: OR=1.56, 95% CI=1.44-1.70). Significant associations were also found in Caucasians. The data for Asians showed significant association in allele contrast and recessive, additive genetic models, whereas no statistical significance was found in the dominant genetic model. CONCLUSIONS: This study demonstrated a significant association between the MSMB rs10993994 polymorphisms and PCa risk. Further large-scale studies are warranted to confirm our findings.

[Quantitative evaluation of image quality of megavoltage computed tomography for guiding helical tomotherapy].

OBJECTIVE: To quantitatively analyze image quality of two sets of phantom (CatPhan504 and Cheese) Megavoltage computed tomography (MVCT) images acquired by Helical Tomotherapy with three scanning modes (Fine, Normal and Coarse), and to explore and validate a semi-automatic quality assurance procedure for MVCT images of Helical Tomotherapy. METHODS: On Helical Tomotherapy, CatPan504 and Cheese phantoms were scanned with three pitch levels (Fine, Normal, Coarse: 4 mm, 8 mm, 12 mm/circle) respectively. Pylinac, Matlab and Eclipse were used to calculate and compare spatial resolution, noise level and low contrast resolution of images obtained under three scanning modes respectively. The spatial resolution can be evaluated by the blurring of line-pair CT value in the images of CatPhan504's CTP528 module. The noise level can be evaluated by the integral non-uniformity in the images of Cheese's uniformity module. the low contrast resolution can be evaluated by contrast-to-noise ratio of both phantoms' plug-in module, or visibility of the region of interest (Supra-Slice) in the images of CatPhan504's CTP515 module. RESULTS: Analyses on CatPhan504's line pair module(CTP528 module) showed that the first three line pairs(the gap size are 0.500 cm, 0.250 cm and 0.167 cm respectively) could be clearly observed but blurring began to occur from the fourth line pair(the gap size is 0.125 cm) under Coarse mode. Meanwhile, the first four line pairs were all observable under the Normal and Fine modes. Integral non-integrity index(the value negatively correlated with the noise level) were 0.155 7, 0.136 8 and 0.122 9 for Coarse, Normal and Fine modes respectively. None of the Supra-Slice in CatPhan504's CTP515 module could be observed under three imaging modes. Low contrast contrast-to-noise ratio of Cheese phantom was similar under three modes and the insert visibility exhibited nearly linear growth with the increasing difference between CT average value of the insert material and background. CONCLUSION: Superiority and inferiority of three image modes in terms of the three image quality index was not consistent. Evaluation results above could provide reference for more rational decision on scanning modes selection of helical tomotherapy, which was based on image visualization demands in clinical practice. The proposed method could also provide guidance for similar image quality assessment and periodic quality assurance.

Long noncoding RNA DSCAM-AS1 is associated with poor clinical prognosis and contributes to melanoma development by sponging miR-136.

OBJECTIVE: Accumulating evidence suggests that long non-coding RNAs (lncRNAs) are playing critical roles in tumorigenesis. The present study aimed to investigate the expression pattern and effects of lncRNA DSCAM-AS1 (DSCAM-AS1) that was a newly discovered lncRNA in melanoma. PATIENTS AND METHODS: Real-time quantitative PCR (polymerase chain reaction) was performed to determine the expression of DSCAM-AS1 in melanoma tissues and cell lines. Kaplan-Meier and Cox regression analyses were utilized to assess the association between the DSCAM-AS1 and overall survival of patients in melanoma patients. The CCK-8 assay, colony formation assay, flow cytometry assays, transwell and wound scratch assays were performed to determine the biological function of DSCAM-AS1 in tumor cells behaviors. Then, DSCAM-AS1-specific miRNA was further confirmed using the dual-luciferase reporter assay and Western blotting. RESULTS: In this research, we showed that the expression of DSCAM-AS1 was significantly upregulated in melanoma samples and cell lines. Clinical investigation indicated that higher expression of DSCAM-AS1 was associated with ulceration and advanced stage and led to significantly poorer survival time. High DSCAM-AS1 expression in melanoma was confirmed to be an independent predictor of poor survival of patients using univariate and multivariate analysis. Functional investigations revealed that knockdown of DSCAM-AS1 inhibited the ability of cell proliferation, colony formation, migration, invasion, whereas promoted cell apoptosis. Furthermore, mechanistic investigations indicated that DSCAM-AS1 could interact with miR-136 and negatively influence the expression of miR-136. CONCLUSIONS: Our findings showed that DSCAM-AS1 is a novel tumor-related molecule involved in melanoma progression as well as a potential prognostic biomarker and therapeutic target.

MiR-490-3p inhibited the proliferation and metastasis of esophageal squamous cell carcinoma by targeting HMGA2.

OBJECTIVE: To identify the potential role of miR-490-3p in the development of esophageal squamous cell carcinoma (ESCC), and to explore the possible underlying mechanism. PATIENTS AND METHODS: Human ESCC tissues and cancer-adjacent normal tissues were collected. The mRNA expression level of miR-490-3p was detected by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). On-line target gene prediction software was applied to screen high-mobility group AT-hook 2 (HMGA2). Subsequently, MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide), qRT-PCR, Western blotting, transwell and scratch-wound assays were conducted to analyze the effect of miR-490-3p on the biological function of the ESCC cell line (EC-109). RESULTS: In our study, the mRNA expression level of miR-490-3p was remarkably reduced in ESCC tissues and cells. Molecular mechanism analysis confirmed that miR-490-3p could act on the 3'-UTR of HMGA2 and regulate its expression. Subsequent functional experiments indicated that decreased expression of HMGA2 resulting from the up-regulation of miR-490-3p could inhibit the proliferation, invasion, migration and epithelial-mesenchymal transition (EMT) of ESCC cells. CONCLUSIONS: We discovered the inhibitory effect of miR-490-3p on ESCC by targeting HMGA2, and revealed that miR-490-3p could be a potential therapeutic target for ESCC.

[Effects of sural nerve nutrition vess els-supported flap for reconstruction of distal lower leg and ankle soft tissue defects].

Objective: To observe the effects of sural nerve nutrition vessels-supported flap for reconstruction of distal lower leg and ankle soft tissue defects. Methods: From June 2014 to June 2017, 37 patients with calf distal and ankle soft tissue defect were repaired with sural nerve nutrition vessels-supported flap, of them 12 cases with calf distal soft tissue defect wounds and 25 cases with ankle soft tissue defect wounds.The scope of flaps was 9 cm×4 cm to 18 cm×9 cm, anti-infection, anti-freezing and dressing treatments were carried out after operation.The results of two-point discrimination among reexamination were recorded. Results: All the flaps survived without ulcer and effusion, only 1 flap for reconstruction of medial malleolus swelled and deactivated at the beginning while it recovered with proper dressings.During the follow-up periods, all the flaps kept favorable feelings, aspects and functions, and the two-point discrimination was 5 to 15 mm [averaged (11.2±1.7) mm]. Conclusion: Sural nerve nutrition vessels-supported flap brings significant effects with excellent safety and reliability in repairing calf and ankle soft tissue defects.