[Nomogram analysis of risk factors for diabetic neuropathy in primary type 2 diabetic mellitus patients in Zhejiang Province].

Objective: To investigate the risk factors of diabetic nephropathy (DN) in primary type 2 diabetes mellitus (T2DM) patients and to quantitatively analyze the risk of DN by nomogram modeling. Methods: A total of 1 588 primary T2DM patients from 17 townships and streets in Zhejiang Province were enrolled from June 2018 to August 2018 in this cross-sectional study, with an average age of (56.8±10.1) years (50.06% male) and a mean disease duration of 9 years. The clinical data, biochemical test results, and fundus photographs of all T2DM patients were collected, and logistic regression analysis was used to screen the risk factors of DN. Then, a nomogram model was used to quantitatively analyze the risk of DN. Results: DN occurred in 27.71% (440/1 588 cases) primary type 2 diabetes patients. Hemoglobin A1c (HbA1c) (OR=1.159, 95%CI 1.039-1.292), systolic blood pressure (OR=1.041, 95%CI 1.031-1.051), serum creatinine (Scr) (OR=1.011, 95%CI 1.004-1.017), serum globulin (GLOB) (OR=1.072, 95%CI 1.039-1.105), diabetic retinopathy (DR) (OR=1.463, 95%CI 1.073-1.996), education level of more than junior high school (OR=2.018, 95%CI 1.466-2.777), and moderate-intensity exercise (OR=0.751, 95%CI 0.586-0.961) were influencing factors of DN. Nomogram model analysis showed that the total score of each factor of DN ranged from 64-138 points, and the corresponding risk rate ranged from 0.1-0.9. The nomogram model also predicted a C-index value of 0.753 (95%CI 0.726-0.781) and an area under the receiver operating characteristic curve of DN of 0.753. Internal verification of the C-index reached 0.738. The model displayed medium predictive power and could be applied in clinical practice. Conclusions: HbA1c, systolic blood pressure, Scr, GLOB, DR, and more than a junior high school education are independent risk factors of DN. Nomogram modeling can more intuitively evaluate the risk of DN in primary T2DM patients.

[(68)Ga-exendin-4 PET-CT for the localization of occult insulinomas: a prospective cohort study].

Objective: To explore the accuracy in localizing occult insulinomas with Glucagon-like peptide-1 receptor(GLP-1R) PET-CT with (68)Ga-exendin-4. Methods: In this prospective cohort study, patients with biochemically proven endogenous hyperinsulinemic hypoglycemia and negative contrast-enhanced CT with pancreatic perfusion scans were enrolled consecutively at Department of Nuclear Medicine, Peking Union Medical College Hospital from February 2014 to June 2018.There were 37 males and 32 females, with age of (43.2±17.9)years. (68)Ga-exendin-4 PET-CT, MRI and endoscopic ultrasound(EUS) were done before elective surgery. Sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of the above imaging modalities were calculated. Results: A total of 69 patients were recruited. Thirty-two patients were diagnosed with insulinomas at histology. Four patients with positive (68)Ga-exendin-4 PET-CT findings did not undergo surgery so far. Twenty-eight patients were proven to be noninsulinoma induced hyperinsulinemic hypoglycemia. Five patients were unknown of etiology of hypoglycemia. The sensitivity, specificity, accuracy, PPV and NPV of (68)Ga-exendin-4 in localizing occult insulinomas were 96.9%(31/32), 100%(30/30), 98.3%(59/60), 100%(29/29), 96.8%(30/31), respectively.The sensitivity, specificity, accuracy, PPV and NPV of MRI were 74.1%(20/27), 9/11, 76.3%(29/38), 90.9%(20/22), 9/16, respectively. The sensitivity, specificity, accuracy, PPV and NPV of EUS were 75.0% (15/20), 2/2, 77.3%(17/22), 15/15, and 2/7. Conclusion: (68)Ga-exendin-4 PET-CT has a high sensitivity, specificity and accuracy for detection of occult insulinoma, which shows superiority to MRI and EUS.

Unusual amplification pattern by SSP HLA-B typing led to discovery of a novel HLA-C allele.

We report here the unique sequence of a novel human leucocyte antigen (HLA)-C allele resulted in amplification of a product with a primer pair used in sequence-specific primer (SSP) HLA-B typing, which led subsequently to identification of a new allele of Cw*0339 by sequence-based typing method. This new allele is closely related to Cw*031101 with only two nucleotide changes from T to G at position 97, and T to C at position 105 in the exon 2 region of HLA-C locus. The first nucleotide substitution causes an amino acid alteration from tyrosine to aspartic acid at amino acid residue 9 (Y to D), while the second one keeps alanine at residue 11 unchanged. Most interestingly, the nucleotide change from T to G at position 97 makes it identical to the 3' end sequence of one SSP of the commercial HLA-B SSP typing kit we were using. In this specific case, it resulted in amplification of a product of HLA-C gene instead of B gene.

The polymorphism and haplotype analysis of HLA-A, -B and -DRB1 genes of population in Jiangsu province of China.

The polymorphism of human leucocyte antigen (HLA)-A, -B and -DRB1 genes and their computed haplotype analysis results from a population of Jiangsu province of China are presented here. The data consist of 20 248 unrelated peripheral blood stem cell donors in Jiangsu Branch of Chinese National Marrow Donor Program registry. In total, 18 different HLA-A alleles, 34 different HLA-B alleles and 13 different HLA-DRB1 alleles were found in Jiangsu Han population. The most frequent alleles in HLA-A, -B and -DRB1 loci were A*02 (29.55%), B*15 (14.40%), and DRB1*09 (16.15%), respectively. The most common haplotype in A-B-DRB1 loci was A*30-B*13- DRB1*07 (6.92%), in A-B loci was A*30-B*13 (8.05%), in B-DRB1 loci was B*13-DRB1*07 (8.17%), and in A-DRB1 loci was A*02-DRB1*09 (8.30%). The dendrogram study indicated that the distribution of HLA genes in Jiangsu Han population, as expected, represented a mixture of Northern and Southern Han population in China. These findings could shade new lights in population genetics and anthropology studies of Han-Chinese.

Human leukocyte antigens in 295 Chinese patients with chronic myeloid leukemia.

Experimental studies using synthetic peptides identical to the bcr-abl fusion region in chronic myeloid leukemia (CML) patients have revealed that some specific peptides could bind to human leukocyte antigen (HLA) class I and class II molecules. Previous clinical observations have also reported some significant HLA associations with the development of CML in their populations. Due to high diversity of HLA alleles, the present study assessed the possibility of an association of HLA molecules in CML patients living in Jiangsu province, the eastern part of China. HLA-A, B and DRB1 allele distributions in 295 CML patients (aged 4-65 years) were analysed and compared with unrelated healthy hematopoietic stem cell donors from the same ethnic and geographic background. By comparison of the HLA gene distribution characteristics between CML and healthy donor populations, differences with statistical significance were found in HLA-A*30 (5.42% versus 9.13%) with odds ratio (OR) 0.57, DRB1*07 (8.14% versus 12.51%; OR = 0.62), and B*81 (0.51% versus 0.09%, OR = 5.44). These results suggest that expression of HLA-A*30, DRB1*07 might imply a protective effect on CML acquisition, while B*81 might be associated with CML susceptive factors in our population.

Co-culture of cord blood CD34(+) cells with human BM mesenchymal stromal cells enhances short-term engraftment of cord blood cells in NOD/SCID mice.

BACKGROUND: The major challenge for cord blood transplantation (CBT) is higher rates of delayed and failed engraftment. In an attempt to broaden the application of CBT to more candidates, ex vivo expansion of hematopoietic stem/progenitor cells in CB is a major area of investigation. The purpose of this study was to employ human BM mesenchymal stromal cells (hBM-MSC) as the feeding-layer to expand CB cells ex vivo. METHODS: In this study, hBM-MSC were isolated and characterized by morphologic, mmunophenotypic and RT-PCR analysis. The hBM-MSC at passage 3 were employed as the feeding-layer to expand CB CD34(+) cells in vivo in the presence of thrombopoietin, flt3/flk2 ligand, stem cell factor and G-CSF. The repopulating capacity of the ex vivo-expanded CB cells was also evaluated in a NOD/SCID mice transplant experiment. RESULTS: After 1 or 2 weeks of in vitro expansion, hBM-MSC supported more increasing folds of CB in total nucleated cells, CD34(+) cells and colony-forming units (CFU) compared with CB without hBM-MSC. Furthermore, although NOD/SCID mice transplanted with CB cells expanded only in the presence of cytokines showed a higher percentage of human cell engraftment in BM than those with unexpanded CB CD34(+) cells, expanded CB cells co-cultured with hBM-MSC were revealed to enhance short-term engraftment further in recipient mice. DISCUSSION: Our study suggests that hBM-MSC enhance in vitro expansion of CB CD34(+) cells and short-term engraftment of expanded CB cells in NOD/SCID mice, which may be valuable in a clinical setting.

Characterization of a novel DRB1*14 allele (DRB1*1449) in the Han-Chinese population.

We report here a novel human leukocyte antigen (HLA) allele, DRB1*1449, in the Han-Chinese population. The nature of the new allele was confirmed by the sequencing-based typing (SBT) method. Genomic DNA and six subclones containing DNA fragment of DRB1 exon 2 were sequenced in both forward and reverse directions. The exon 2 nucleotide sequence of DRB1*1449 is closely related to DRB1*1432 allele based on sequence homology. It has four nucleotide (nt) substitutions at positions 71, 196, 244 and 245 in exon 2, which lead to changes of amino acid sequences. The serological assignment of DRB1*1449 is DR14 based on the serological HLA typing result. This novel allele might be a result of recombination between DRB1*1402 and DRB1*140101 like alleles, which are very common among Chinese population.

A novel HLA allele, DRB1*1609, identified in the Chinese Han population*.

A novel human leucocyte antigen-DRB1*16 (HLA-DRB1*16) allele (DRB1*1609) has been identified by sequencing-based typing (SBT) in Chinese Han population. This new allele has identical nucleotide sequence to DRB1*160101 in exon 2, except for a single-nucleotide substitution from A to T at position 127. This change leads to an amino acid change from tyrosine to phenylalanin at residue 47 (Y47F). SBT was performed for cloned DRB1*16-specific polymerase chain reaction fragment. The serological phenotype of DRB1*1609 is equivalent to DR16 antigen.

Studies on esophageal cancer cells in vitro.

A number of studies on esophageal cancer cells in vitro have been reported since the establishment of a human esophageal epithelial cancer cell line (Eca 109) in China in 1972. Some of these are reviewed here; the heterogeneity of esophageal cancer cells, comparative cytochemical and ultrastructural studies on cancer cells and normal esophageal epithelial cells of primary culture, comparative cytomorphological observation of a cancer cell line and cancer cell smears from patients by balloon technique, establishment of spheroid culture for the study of cancer cell differentiation and invasiveness, and immunological study on esophageal cancer in vitro.

[Establishment of a spontaneously transformed human fetal lung cell line and its biological characteristics].

A spontaneously transformed human fetal lung cell line (HFLT) was derived from a human fetal lung diploid fibroblast cell line (2BS) by continuous culture. The biological characteristics of this cell line were studied and compared with those of 2BS cells. Accompanying the morphological alteration, the growth rate of the transformed cell was accelerated and the maximum cell density was increased. The anchorage-independent growth was shown by its ability to form colonies in soft agar. The collagen synthesis phenotype of 2BS cells was changed. In addition, the increased chromosome number and the nodule formation after heterotransplantation were pathognomonic of malignant transformation.