[Retrospective analysis of mechanical thrombectomy for distal branch occlusion of middle cerebral artery].

Objective: To explore the necessity, feasibility, technical points, operative complications and prognosis of mechanical thrombectomy for distal branch occlusion of middle cerebral artery. Methods: Mechanical thrombectomy was performed on 42patients (28 males,14 females; age ranged from 43 to 88 years, mean 65.48years)with distal branch occlusion of middle cerebral artery (M2, M3), between May 2017 to July 2019. Theclinical feature was retrospectively analyzed. The NIHSS score before operation, 24 hours after operation and 1 week after operation, the recanalization of occluded vessels during operation, the complications and the recovery after 3 months (3 months mRS score) were analyzed. Results: Of the 42 patients, 38 patients were successfully recanalized, and the recanalization rate was 90.48%. Postoperative hemorrhage in 6 cases and vasospasm in 17 cases. At 90 days after operation, the mRS score was 0 in 13 cases, 1 in 11 cases, 2 in 6 cases, and 0 cases died. Conclusions: Mechanical thrombotomy is safe and feasible for patients with distal branch occlusion of middle cerebral artery (M2, M3). However, the risks and benefits of patients should be fully considered.

[Surgical treatment and prognosis of pancreatic neuroendocrine carcinoma].

Objective: Pancreatic neuroendocrine carcinoma (pNEC) is a highly malignant tumor.This study aimed to evaluate the role of surgery and the prognosis for patients with pancreatic neuroendocrine carcinoma (pNEC). Methods: We collected and reviewed all clinical data of patients who underwent radical surgery for pNEC from Jan 2000 through Jan 2016 in our hospital. Cox-regression analysis wasused to evaluate the factors potentially influencing survival. Results: Twenty patients including 11 males and 9 females (median age, 62.5 years) were included in this study. All patients underwent radical surgery and 17 cases received postoperative platinum-based chemotherapy.The median follow-up time was 41 months (range, 1 to 127 months). The 1-, 3-, and 5-year survival rates of the patients were 66.7%, 51.5% and 28.1%, with a median survival time of 75.3 months.The multivariate analysis indicated that tumor size and Ki-67 index were of prognostic significance. Conclusions: Pancreatic neuroendocrine carcinomas are rare but increasing in incidence. Patients with localized nonmetastatic primary tumors seem to benefit from surgery. Early diagnosis and multimodality therapy are key points of an improved survival.

[Evaluation of disease free survival after radical resection for primary duodenal adenocarcinoma].

Objective: To investigate the risk factors associated with the disease free survival (DFS) for primary duodenal adenocarcinoma patients undergoing radical resection. Methods: The clinicopathological data of 101 primary duodenal adenocarcinoma patients who underwent radical resection from January 2001 to October 2014 were retrospectively reviewed. Using SPSS 13.0 software, the survival curve was drawn by Kaplan-Meier method, and the survival rates were analyzed by Log-rank test.COX regression model was used to identify independent risk factors. Results: Among 101 patients, the main clinical manifestation were upper abdomen discomfort, abdominal pain, jaundice, gastrointestinal obstruction, hemorrhage, emaciation and so on. A total of 87 patients had the tumor located at the descending part of the duodenum. All the 101 patients underwent radical resection, and 85 patients received pancreatoduodenectomy while 16 patients underwent segmental resection. The median disease free survival time was 26 months and the postoperative 1, 3, 5 year DFS rate were 79.7%, 60.3% and 53.6%, respectively. The univariate analyses identified elevated preoperative CEA and CA19-9 level, T stage, lymph node state, vascular invasion and perineural invasion predicting a worse DFS(P<0.05). On multivariate analysis, positive lymph node state was an independent risk factor for DFS (RR=5.394, 95% CI: 1.624-17.913). Conclusion: Radical resection is the best therapeutic method for primary duodenal adenocarcinoma; the positive lymph node state is the independent risk factor affecting the disease free survival of patients after radical resection.

Plant lectins, from ancient sugar-binding proteins to emerging anti-cancer drugs in apoptosis and autophagy.

Ubiquitously distributed in different plant species, plant lectins are highly diverse carbohydrate-binding proteins of non-immune origin. They have interesting pharmacological activities and currently are of great interest to thousands of people working on biomedical research in cancer-related problems. It has been widely accepted that plant lectins affect both apoptosis and autophagy by modulating representative signalling pathways involved in Bcl-2 family, caspase family, p53, PI3K/Akt, ERK, BNIP3, Ras-Raf and ATG families, in cancer. Plant lectins may have a role as potential new anti-tumour agents in cancer drug discovery. Thus, here we summarize these findings on pathway- involved plant lectins, to provide a comprehensive perspective for further elucidating their potential role as novel anti-cancer drugs, with respect to both apoptosis and autophagy in cancer pathogenesis, and future therapy.

Epstein-Barr virus (EBV) load in cerebrospinal fluid and peripheral blood of patients with EBV-associated central nervous system diseases after allogeneic hematopoietic stem cell transplantation.

BACKGROUND: To evaluate the diagnostic and prognostic utility of monitoring the Epstein-Barr virus (EBV) load in the cerebrospinal fluid (CSF) and peripheral blood for the patients with EBV-associated central nervous system (CNS) diseases after allogeneic hematopoietic stem cell transplantation (allo-HSCT), 172 patients undergoing allo-HSCT were enrolled in the study. METHODS: The EBV DNA levels of blood were monitored regularly in recipients of transplants for 3 years post transplantation. The EBV DNA levels of CSF were monitored in patients with EBV-associated CNS diseases before the treatment and at different points following the treatment. RESULTS: Post-transplant EBV-associated diseases developed in 27 patients, including 12 patients with EBV-associated CNS diseases. The 3-year cumulative incidences of EBV-associated diseases and EBV-associated CNS diseases were 19.5 ± 3.5% and 8.6 ± 2.4%, respectively. Patients with EBV-associated diseases showed higher loads of EBV DNA in their blood compared with patients with EBV DNA-emia. No difference was seen between the EBV DNA levels of blood in patients with CNS involvement and patients without CNS involvement. The EBV DNA loads of blood increased 3-14 days before the clinical manifestations of EBV-associated diseases emerged. The EBV DNA loads of CSF were higher than that of blood in patients with EBV-associated CNS diseases. In 12 patients with EBV-associated CNS diseases, EBV DNA levels were declining in both blood and CSF with the control of diseases, and the EBV DNA loads of CSF decreased faster than that of blood in 5 patients who responded to treatment, and the EBV DNA levels of CSF increased in 5 patients who were unresponsive to treatment. On multivariate analysis, the use of anti-thymocyte globulin and intensified conditioning regimens were independent risk factors for EBV-associated diseases and EBV-associated CNS diseases. CONCLUSIONS: EBV-associated CNS diseases are not rare after allo-HSCT. The EBV DNA loads of CSF could act as an important indicator, but the EBV DNA loads of blood could not, for the diagnosis, prognosis, and therapeutic evaluation of EBV-associated CNS diseases.

Peripheral blood stem cell transplantation compared with bone marrow transplantation from unrelated donors in patients with leukemia: a single institutional experience.

We analyzed data for 89 patients with leukemia undergoing bone marrow transplantation (BMT) (n=44) or peripheral blood stem cell transplantation (PBSCT) (n=45) from unrelated donors between May 2000 and February 2009 in our institution. PBSCT resulted in faster hematopoietic engraftment, compared with BMT (P<0.001). There was no difference between BMT and PBSCT in infectious episodes and CMV antigenemia within the first 100 days post-transplantation. The frequency of acute graft-versus-host disease (GVHD) grades II-IV was 49.7% and 47.0% (P=0.838) and of chronic GVHD 42.4% and 43.9% (P=0.827) in BMT and PBSCT. The 5-year cumulative percent of relapse was 18.5 in BMT and 48.6 in PBSCT (P=0.041), and the transplant-related mortality (TRM) was 40% and 29.5% (P=0.800), respectively. The 5-year cumulative percent of disease-free survival (DFS) was 50.8 and 38.9 (P=0.439); overall survival (OS) was 55.3% and 48.5% (P=0.447) in BMT and PBSCT, respectively. The reconstitution of T and B cells at 1, 3, 6, 9, and 12 months post-transplantation was not different between BMT and PBSCT, except that the level of regulatory T cells (T-regs) was higher after PBSCT than after BMT at 1 month (P=0.001).

Identifying high-risk areas of schistosomiasis and associated risk factors in the Poyang Lake region, China.

The epidemiology of schistosomiasis japonicum over small areas remains poorly understood, and this is particularly true in China. We aimed to identify high-risk areas for schistosomiasis and associated risk factors in the Poyang Lake region, China. A cross-sectional study was conducted and 60 of 920 persons (6.5%) were found to be infected with Schistosoma japonicum. Locations of households and snail habitats were determined using a hand-held global positioning system. We mapped the data in a geographical information system and used spatial scan statistics to explore clustering of infection, logistic regression and Bayesian geostatistical models to identify risk factors for each individual's infection status and multinomial logistic regression to identify risk factors for living in a cluster area. The risk of schistosomiasis was spatially clustered and higher in fishermen and males, not in persons who lived in close proximity to snail habitats and infected water sources. This study has demonstrated significant spatial variation in the prevalence of schistosomiasis at a small spatial scale. The results suggest that demographic factors (gender, occupation) rather than the distance to infected water are driving human transmission at small-scale spatial levels. Such information can be used to plan locally targeted interventions based on anthelminthic drug administration, snail control and sanitation improvement.