Case report: Highly response to low-dose brachytherapy in recurrent retroperitoneal leiomyosarcoma with FANCD2 frameshift mutation: a unique case study.

We report a case of recurrent retroperitoneal leiomyosarcoma in a male who achieved a rapid and robust but transient clinical response to low-dose iodine-125 brachytherapy. A FANCD2 frameshift mutation was detected by gene sequencing in the cancerous tissue.

Tetrahedral DNA nanostructure-corbelled click chemistry-based large-scale assembly of nanozymes for ratiometric fluorescence assay of DNA methyltransferase activity.

Ligation efficiency in a surface-based DNA click chemistry (CuAAC) reaction is extremely restricted by the orientation and density of probes arranged on a heterogeneous surface. Herein, we engineer DNA tetrahedral nanostructure (DTN)-corbelled click chemistry to trigger a hybridization chain reaction (HCR) assembling a large-scale of nanozymes for ratiometric fluorescence detection of DNA adenine methyltransferase (Dam). In this study, a DNA tetrahedron structure with an alkynyl modifying pendant DNA probe (Alk-DTN) is designed and assembled on a magnetic bead (MB) as a scaffold for click chemistry. When a CuO NP-encoded magnetic nanoparticle (CuO-MNP) substrate was methylated by Dam, CuO NPs were released and turned into a mass of Cu+. The Cu+ droves azido modifying lDNA (azide-lDNA) to connect with the Alk-DTN probe on the MB through the click reaction, forming an intact primer to initiate the HCR. The HCR product, a rigid structure double-stranded DNA, periodically assembles glucose oxidase mimicking gold nanoparticles (GNPs) into a large-scale of nanozymes for catalyzing the oxidation of glucose to H2O2. NH2-MIL-101 MOFs, a fluorescent indicator and a biomimetic catalyst, activated the product H2O2 to oxidize o-phenylenediamine (oPD) into visually detectable 2,3-diaminophenazine (DAP). The change of the signal ratio between DAP and NH2-MIL-101 is proportional to the methylation event corresponding to the MTase activity. In this study, the DTN enhances the efficiency of the surface-based DNA click reaction and maintains the catalytic activities of gold nanoparticle nanozymes due to the intrinsic nature of mechanical rigidity and well-controlled orientation and well-adjusted size. Large-scale assembly of nanozymes circumvents the loss of natural enzyme activity caused by chemical modification and greatly improves the amplification efficiency. The proposed biosensor displayed a low detection limit of 0.001 U mL-1 for Dam MTase due to multiple amplification and was effective in real samples and methylation inhibitor screening, providing a promising modular platform for bioanalysis.

Retrospective evaluation of lymphatic and blood vessel invasion and Borrmann types in advanced proximal gastric cancer.

BACKGROUND: The Borrmann classification system is used to describe the macroscopic appearance of advanced gastric cancer, and Borrmann type IV disease is independently associated with a poor prognosis. AIM: To evaluate the prognostic significance of lymphatic and/or blood vessel invasion (LBVI) combined with the Borrmann type in advanced proximal gastric cancer (APGC). METHODS: The clinicopathological and survival data of 440 patients with APGC who underwent curative surgery between 2005 and 2012 were retrospectively analyzed. RESULTS: In these 440 patients, LBVI+ status was associated with Borrmann type IV, low histological grade, large tumor size, and advanced pT and pN status. The 5-year survival rate of LBVI+ patients was significantly lower than that of LBVI- patients, although LBVI was not an independent prognostic factor in the multivariate analysis. No significant difference in the prognosis of patients with Borrmann type III/LBVI+ disease and patients with Borrmann type IV disease was observed. Therefore, we proposed a revised Borrmann type IV (r-Bor IV) as Borrmann type III plus LBVI+, and found that r-Bor IV was associated with poor prognosis in patients with APGC, which outweighed the prognostic significance of pT status. CONCLUSION: LBVI is related to the prognosis of APGC, but is not an independent prognostic factor. LBVI status can be used to differentiate Borrmann types III and IV, and the same approach can be used to treat r-Bor IV and Borrmann type IV.

Combination of preoperative plasma fibrinogen and AJCC staging improves the accuracy of survival prediction for patients with stage I-II gastric cancer after curative gastrectomy.

This study aimed to determine the prognostic value of preoperative plasma fibrinogen concentration (PFC) in patients with stage I-II gastric cancer after curative gastrectomy. The preoperative PFC and clinicopathological data of 793 patients with stage I-II gastric cancer who underwent curative gastrectomy were analyzed retrospectively. PFC of <4.0 g/L and ≥4.0 g/L were considered as PFC0 and PFC1, respectively. The association between PFC and the clinicopathological features of gastric cancer and the value of PFC in survival prediction were investigated. PFC1 indicated poorer overall survival and cancer-specific survival among patients with tumor-node-metastasis (TNM) stage I-II, and PFC was identified as an independent indicator of survival via multivariate analysis. Importantly, PFC stage was proven to be an independent prognostic factor for stage I and T1-4aN0 gastric cancer. PFC stage combined with the American Joint Committee on Cancer (AJCC)-TNM stage has better accuracy for predicting disease prognosis than AJCC-TNM stage alone. The prognosis of patients with stage I-II gastric cancer can be further stratified by PFC level. For patients with stage I gastric cancer, PFC1 can be considered a high-risk prognostic factor, and adjuvant chemotherapy should be recommended for patients with PFC1.

Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department.

BACKGROUND: Community acquired pneumonia (CAP) is one of the most common infectious disease in emergency department. In 2005 the concept of healthcare associated pneumonia (HCAP) was proposed by the ATS/IDSA guidelines. The clinical features and microbiology of HCAP are different from CAP, however, the initial antimicrobial treatment is still controversial. We aimed to compare the clinical efficacy between HCAP patients treated initially with HCAP guideline-concordant antimicrobial agents and those with CAP guideline-concordant antimicrobial agents. METHODS: We conducted a retrospective observational study on HCAP patients who were admitted to emergency department between December 2011 and December 2012. Patients were divided into 2 groups according to their different initial antimicrobial treatment. We compared clinical features, distribution of pathogen, severity, days and spending on intravenous antimicrobial, length and charge of hospitalization and clinical outcomes, and meanwhile analyzed the clinical efficacy as well. RESULTS: Of the 125 HCAP patients, 55 patients received CAP guideline-concordant antimicrobial agents and 70 received HCAP agents. The major pathogens were Klebsiella pneumoniae, methicillin-resistant staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Escherichia coli. The 2 groups were similar at baseline, including old age, comorbidities, Pneumonia Severity Index scores, APACHE scores, and length of intravenous antimicrobial use and hospitalization duration, and in-hospital mortality. Overall efficacy rate occurred in 70.0% of HCAP agent patients and 50.9% of CAP agent patients (P = 0.029). Antimicrobial charge and total hospital charge for HCAP agent patients were significantly higher than that for CAP agent patients. CONCLUSIONS: Initial treatment of HCAP patients in emergency department with HCAP guideline-concordant antimicrobial could increase clinical efficacy rate, as well as antimicrobial charge and total hospital charge, but was not associated with shortening the length of stay, or lowering in-hospital mortality.