Case Report: Niraparib as Maintenance Therapy in A Patient With Ovarian Carcinosarcoma.

Ovarian carcinosarcoma (OCS) is a rare, highly aggressive and rapidly progressing malignant tumor with an extremely poor prognosis. So far, due to the low incidence of OCS, there are no large-scale prospective studies exploring the standard care of OCS patients. There is no uniform and effective treatment for OCS. Within the development of precision medicine, targeted therapies (such as PARP inhibitors) have been widely used in epithelial ovarian cancer and various other solid tumors. Here, we report a BRCAwt patient with advanced OCS who experienced a second and a third cytoreductive surgery in June 2017 and October 2019 and has been on niraparib maintenance therapy for more than 20 months after receiving second-line and third-line chemotherapy.

Development and validation of prognostic scoring in primary intestinal diffuse large B-cell lymphoma: a single-institution study of 184 patients.

BACKGROUND: The incidence of primary intestinal diffuse large B-cell lymphoma (PI-DLBCL) is much lower than primary gastric DLBCL, and large-scale analyses on the clinical characteristics, molecular features, therapeutic strategies, and risk stratification have been seldomly performed in PI-DLBCL. METHODS: To assess prognostic model development, 107 PI-DLBCL patients diagnosed before 2014 were studied for prognosis factors including different primary involved sites and treatment strategies. For internal validation, a non-random split sample set with 77 PI-DLBCL patients after 2014 was included for validation of the prognosis factors. RESULTS: Patients with an ileocecal lesion presented with better survival time than those with non-ileocecal sites, with surgical resection significantly influencing the prognosis. Non-ileocecal patients who underwent surgery with lymphadenectomy had superior overall survival (OS) and progression-free survival (PFS) compared to those receiving surgery without lymphadenectomy or those not receiving (without) surgery. For ileocecal patients, surgery with or without lymphadenectomy resulted in better OS and PFS than those without surgery. For biomarker analysis, only BCL-2 >50% or Ki67 >80% on tumor cells indicated poor clinical outcome. In multivariate analysis, age, Eastern Cooperative Oncology Group (ECOG) score, and site of origin were independent prognostic factors for inferior OS in PI-DLBCL. A prognosis model was set up based on age, ECOG score, and site of origin, and validated well. CONCLUSIONS: The prognosis in patients with PI-DLBCL with ileocecal involvement showed was better than those with non-ileocecal involvement. Surgical strategy can impact the clinical outcome of PI-DLBCL patients.

Prognostic potential of layer-specific global longitudinal strain in patients with non-ST-segment elevated acute coronary syndrome and preserved left ventricular ejection fraction.

This study sought to investigate the prognostic potential of layer-specific global longitudinal strain (GLS) in predicting cardiac events among non-ST-segment elevated acute coronary syndrome (NSTE-ACS) patients with preserved LVEF. In this prospective study, we enrolled 160 consecutive NSTE-ACS patients with preserved LVEF (≥ 50%) who underwent successful percutaneous coronary intervention (PCI). Transthoracic two-dimensional echocardiography examinations were performed within 48 h of admission (before PCI). Cardiac events were defined as all-cause death, re-infarction, and hospitalization for heart failure. During a median follow-up of 30.2 months, 23 patients (14.4%) developed cardiac events. GLS for all three myocardial layers were reduced in patients with adverse outcome (all P < 0.001). Yet GLSendo (area under curves = 0.85) and GLSmid (area under curves = 0.83) showed relatively higher predictive power than GLSepi when identifying patients with cardiac events. The best cut-off value of GLSendo was - 20.8%, with a diagnostic sensitivity and specificity of 87% and 71% respectively. A significant increase in the risk of cardiac events development was shown among patients with impaired layer GLS (log-rank test, P < 0.001). In conclusion, NSTE-ACS patients with preserved LVEF, layer GLS assessed before PCI all had good abilities to predict cardiac events, which might provide more prognostic information against conventional echocardiographic risk factors.

[Spermine attenuates high glucose-induced myocardial fibrosis by regulating the cell cycle].

Objective: To investigate the protective effect of spermine (Sp) on diabetic cardiomyopathy (DCM) and high glucose-induced cardiac fibroblasts (CFs), and to explore its mechanism.Methods: ①Animal experiments: 24 male Wistar rats were randomly divided into control group, type 1 diabetes group (TID) and spermine group (TID+Sp, each group n=8). TID rats were induced by streptozocin (STZ, 60 mg/kg), and TID+Sp rat were pretreated with spermine (Sp, 5 mg/(kg·d)) for 2 weeks before STZ injection. After 12 weeks of modeling, blood glucose, insulin levels, ejection fraction (EF) and shortening fraction (FS) were measured, and Masson staining and Sirius red staining were performed in the rat cardiac tissues. ②Cell experiments: primary CFs were extracted from newborn (1-3 d) Wistar rat hearts, and were randomly divided into control group, high-glucose group (HG) and HG+Sp group (n=6 per group). HG group was treated with 40 mmol/L glucose, and the HG+Sp group was pretreated with 5 µmol/L Sp for 30 min before HG treatment. The cell viability of CFs was detected by CCK8, the content of collagen in culture medium was analyzed by ELISA, and protein expressions of cell cycle related proteins (PCNA, CyclinD1 and P27) were detected by Western blot. Results: Compared with control group, the blood glucose and collagen content were increased, and the insulin level and heart function were decreased in the T1D group. Meanwhile, HG induced an increasing of the cell viability, the collagen content in the medium and the expressions of PCNA and CyclinD1, while the expression of P27 was down-regulated. Spermine could reduce the above changes, manifested as improving the cardiac function, regulating the expression of cyclin and reducing the level of myocardial fibrosis. Conclusion: Spermine can alleviate myocardial fibrosis in diabetic cardiomyopathy, which mechanism is related to the regulation of cell cycle.

[Effect of exogenous spermine pretreatment on alleviating renal fibrosis in diabetic nephropathy mice and its related mechanism].

Objective: To observe the protective effects of exogenous spermine on renal fibrosis induced by diabetic nephropathy (DN) and to explore its mechanism.Methods: Twenty-four male C57 mice were randomly divided into control group, type 1 diabetes group (TID) and spermine pretreatment group (TID+Sp, n=8 in each group). TID mice were induced by STZ (60 mg/kg), and TID+Sp mice were pretreated with spermine (5 mg/(kg·d)) for 2 weeks before STZ injection. The mice were killed at the 12th week. The renal function was determined by serum creatinine and urea nitrogen. HE, PAS and Masson staining were used to evaluate renal tissue injury and fibrosis. The expressions of matrix metalloproteinase (MMP-2, MMP-9) and collagen IV (Coll-IV) in the kidney of mice were detected by Western blot. Results: Compared with the control group, the blood glucose (5.67±0.22 vs 28.40±0.57 mmol/L), creatinine (14.33±1.22 vs 30.67±4.73 µmol/L) and urea nitrogen (6.93±4.94 vs 22.00±1.04 mmol/L) in the T1D group were increased significantly (P＜0.05), the glomerular basement membrane was thickened, the collagen was significantly increased, the expressions of MMP-2, MMP-9 and Coll-IV protein were increased (0.57±0.07 vs 1.06±0.20, 47.00±0.04 vs 1.29±0.09 and 0.42±0.16 vs 0.95±0.18,P＜0.05). Exogenous spermine significantly alleviates the above-mentioned changes. Conclusion: Exogenous spermine pretreatment could significantly alleviate renal fibrosis in diabetic mice by regulating the balance between MMPs and collagen.

[The role of CaSR expression in diabetic cirrhosis injury and fibrosis in rats].

OBJECTIVE: To observe the role of calcium sensitive receptor (CaSR) in the pathogenesis of diabetic liver injury. METHODS: Forty Wistar rats were randomly divided into normal control group (control, n=10) and diabetes group (T1D, STZ 60 mg/kg intraperitoneal injection, n=30), and the samples were collected at the 2nd, 4th and 8th week. Rats hepatic stellate cells (HSC) were randomly divided into normal control group (Control, 10% FBS-DMEM culture, n=5), high glucose group (HG, 10% FBS-DMEM+40 mmol/L glucose, treated for 48 h, n=5) and CaSR inhibitor group (HG+Calhex 231, 10% FBS-DMEM+40 mmol/L glucose+2.5 µmol/L Calhex231 for 48h, n=5). The body weight, blood glucose, serum glutamic oxaloacetic transaminase (AST) and alanine aminotransferase (ALT) activities were measured dynamically. The changes of liver morphology and ultrastructure were observed by HE staining and Masson staining by transmission electron microscopy. The changes of CaSR and liver fibrosis related indexes were detected by Western blot. RESULTS: Compared with the control group, diabetic rats lost weight, while blood glucose, AST and ALT increased significantly, and the expression of CaSR, collagen 1(CO 1), collagen 3 (CO 3), matrix metalloproteinase(MMP)-1, -2 and -9 increased significantly. The results of the cell model were basically the same as those in vivo. Compared with the control group, the expression of α-smooth muscle actin (α-SMA) was increased, indicating that HSC differentiated into myofibroblasts in HG group. The expression of the main components of ECM (CO 1 and CO 3), and the key enzyme of ECM degradation (MMP9) were also increased, while CaSR inhibitor, Calhex231, could reduce the above changes. CONCLUSION: The up-regulation of CaSR expression is involved in the occurrence of diabetic liver injury and fibrosis.

Expression of CCL18 gene in ovarian cancer and its impact on the biologic function of ovarian cancer cells.

The aim of the present study was to evaluate the expression of the chemokine ligand 18 (CCL18) gene in ovarian cancer and to investigate the effects of its overexpression or suppression on growth, invasion, and metastasis in an ovarian carcinoma cell line (SKOV3) in vitro. CCL18 mRNA expression in epithelial ovarian carcinoma (EOC), benign ovarian tumor and normal ovarian tissues was measured by fluorescence quantitative polymerase chain reaction. A CCL18 restructuring plasmid was constructed, and SKOV3 cells were transfected with the plasmid DNA in vitro. A restructuring interference vector was also transfected into CCL18-positive SKOV3 cells. The growth curves, cell cycle distribution, and invasive, migrative and adhesive capacities of SKOV3 cells following overexpression and suppression of CCL18 were evaluated by MTT assay, flow cytometry, Transwell assay, migration assay, and the fibronectin adhesion method, respectively. The positive expression rate of CCL18 in EOC was significantly higher than in benign ovarian tumor (P = 0.002) and normal ovarian tissues (P = 0.003). However, there was no statistical significance in the expression of CCL18 with regard to clinical pathology (including histological classification, pathological grade and surgical pathological stage), and the median survival times of CCL18-positive and CCL18-negative patients did not differ significantly. The invasive, migrative, and adhesive capacities of SKOV3-CCL18 cells were significantly higher than those of SKOV3 and SKOV3-vector cells (P < 0.05). However, there was no significant difference in cell proliferation between the SKOV3-CCL18 and negative control cells. The invasive, migrative, and adhesive capacities of the pSilencer4.1-CCL18-small interfering RNA127 group were significantly lower than those of non-transfected pSilencer4.1-negative and pSilencer4.1 groups (P < 0.05). In conclusion, the overexpression and silencing of CCL18 affected invasion, adhesion, and migration in EOC cells; thus CCL18 may have potential as a clinical marker for early diagnosis of malignant ovarian tumors, and as a target molecule in the treatment of ovarian cancer.

Retracted: EBF1 gene promotes the proliferation and inhibits the apoptosis of bone marrow CD34+ cells in patients with myelodysplastic syndrome through negative regulation of mitogen-activated protein kinase axis.

The transcription factor, early B cell factor 1 (EBF1), plays a vital role in the lineage specification involving early B cell development and the onset of myelodysplastic syndrome (MDS). Therefore, to investigate whether or not EBF1 affects MDS as well as the transcription factor's underlying mechanism, we used CD34+ hematopoietic stem cells in bone marrow from patients with MDS. The extracted cells were then transfected with a series of EBF1, short hairpin RNA against EBF1 (shEBF1), and SB203580 (a specific mitogen-activated protein kinase [MAPK] axis inhibitor). The effects EBF1 gene and MAPK axis had on cell proliferation, apoptosis, and migration were determined by in vitro cell culturing. We made observations that involved EBF1 inhibiting the messenger RNA (mRNA) level of p38 MAPK, increasing the mRNA levels of extracellular-signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), extracellular-signal-regulated kinase 5 (ERK5), decreasing the protein expression of Bcl-2-associated X protein (Bax), and finally elevating the protein levels of B cell lymphoma/leukemia-2 (Bcl-2), stem cell factor (SCF), erythropoietin receptor (EpoR), p-ERK, p-JNK, p-ERK5, cyclin D, cyclin E, cyclin-dependent kinase 2 (CDK2), and CDK6, implying that EBF1 may very well have an inhibitory role in the MAPK axis. Another discovery found that EBF1 had a positive effect on the promotion of bone marrow CD34+ cell proliferation as well as its migration, but inhibited the apoptosis of cells. The results we obtained from this study indicated that the EBF1 gene suppresses the activation of the MAPK axis, thereby promoting both the proliferation and migration of bone marrow CD34+ cells as well as inhibiting the associating apoptosis. The effects of the EBF1 gene are likely to present a new therapeutic target in preventing the progression of MDS.

The significance of the change pattern of serum CA125 level for judging prognosis and diagnosing recurrences of epithelial ovarian cancer.

BACKGROUND: Ovarian cancer has the highest mortality rate of the three main malignant tumors of the female reproductive system, with a 5-year overall survival (OS) of only 20-30 %. Approximately 70 % of patients relapse without being cured. To explore the significance of serum CA125 level pre-treatment and the change pattern of CA125 post-treatment for judging prognosis and diagnosing recurrences of epithelial ovarian cancer (EOC). METHODS: A radioimmunoassay was used to continuously monitor levels of serum CA125 in 152 patients with EOC. The first test was done before surgery, then once a month after surgery for more than two consecutive years. The data were analyzed by using Kaplan-Meier curves and the log-rank test, stratified chi-square test, Pearson correlation analysis, and multivariate Cox regression analysis. RESULTS: (1) There was a relationship between patient outcomes and the serum CA125 levels before treatment and the extent and speed of serum CA125 decrease after treatment. The outcomes of patients with pre-treatment serum CA125 ≤ 35 U/ml were better than those with serum CA125 > 35 U/ml; the outcomes of patients with serum CA125 who had a logarithmic decrease or a decrease to normal within a month after treatment were also better than those with a non-logarithmic decrease or a decrease to normal that took longer than a month. (2) The results of multivariate Cox regression analysis showed that serum CA125 levels before treatment and a decreased speed of decline after treatment were independent prognostic factors; (3) The mean level of serum CA125 at relapse was 116.28 U/ml. The average time from serum CA125 increase to detection of a recurrent lesion by physical or imaging examination was 122 days. The correlation coefficient of serum CA125 level increase and tumor recurrence time was -0.674. (4) The area under the Receiver Operating Characteristic (ROC) curve of serum CA125 for diagnosing EOC recurrence was 0.879, and the sensitivity and specificity were 67.39 and 86.79 %, respectively. CONCLUSIONS: It is important to monitor serum CA125 levels pre-treatment and the change pattern of CA125 post-treatment for judging prognosis and diagnosing recurrences of EOC.

Serum BAFF and APRIL levels in patients with autoimmune hemolytic anemia and their clinical significance.

B cell-activating factor of the tumor necrosis factor family (BAFF) and a proliferation-inducing ligand (APRIL) play crucial roles in B cell development, survival, and antibody production. Autoimmune hemolytic anemia (AIHA) is an acquired autoimmune disease that occurs when antibodies target autologous red blood cells. Here, we analyzed the serum levels of BAFF and APRIL and their respective clinical associations in patients with AIHA. Serum BAFF and APRIL levels in patients with AIHA were significantly higher (P < 0.01) than in healthy individuals. Serum BAFF and APRIL levels were significantly augmented in patients with lower hemoglobin levels (hemoglobin was <8 g/dL) and higher LDH activity (LDH > 480 IU/mL). Glucocorticoid treatment dramatically reduced serum levels of BAFF and APRIL. Thus, serum BAFF and APRIL levels may reflect the clinical activity of this disease. Our results indicate that analysis of serum concentrations of BAFF and APRIL potentially represents a useful tool for the assessment of AIHA disease activity and progression.

[Experimental investigation of the chemical effect of direct current arc plasma igniter].

To study the chemical effect of direct current arc plasma igniter, the emission spectrum of plasma jet was measured, and the active particles produced by the interaction of plasma jet with atmospheric air were analyzed. The NO and CO volume fractions were measured quantificationally by smoke analyzer at the 8cm downstream the plasma igniter exit, and the changing law between arc current and NO, CO volume fractions was obtained. The results show that the plasma jet interacting with atmospheric air produced active particles (H, O, N), charged particles (O2 +, N2+), and excited particles (N2 (A3), N2 (B3), N2 (C3), N2 (a1), O2 (a1), O2 (b1)). The NO and CO volume fractions increased with rising of are current and feedstock argon flow rate.

[Prognostic analysis of non-cytogenetic factors in elderly adults with acute myeloid leukemia].

OBJECTIVE: To analyze the prognostic factors in elderly patients with acute myeloid leukemia (AML). METHODS: The clinical data of 211 AML patients with age 55 years or over and treated in Shanghai Jiaotong University Medical School affiliated Ruijin Hospital from 2007 to 2011 were collected and analyzed. Multivariate and univariate analysis of clinical data were performed using a Cox regression model and log-rank test, including age, subtype, performance status, white blood cell count, serum LDH and albumin level, and treatment strategy. RESULTS: Acute promyelocytic leukemia (APL) patients had longer survival than other subtypes. To rule out the impact of APL on the prognostic analysis, we conducted multivariate and univariate analysis excluding APL patients. The significant parameters of the univariate analysis were age (P = 0.003), achieving remission (P < 0.01), performance status (P < 0.01), organ dysfunction (P < 0.01), increased WBC counts (P = 0.022), increased LDH level (P = 0.006) and low albumin level (P < 0.01). Multivariate analysis showed that only failure of achieving remission (P < 0.01), poor performance status (ECOG 3-4) (P < 0.01) and increased WBC counts (P < 0.01) were independent prognostic factors. The patients aged 70 years or over had poor overall survival, and no significant difference of OS was observed among patients with age between 55 and 69 years. For patients aged 55 - 69 years received either DA/IA or CAG treatments had longer survival than those with palliative treatments. For those aged 70 years or over, only patients with CAG treatment had significantly longer survival than palliative treatment. For the patients with age less than 70 years and achieving complete remission after induction, intermediate-dose cytarabine consolidation might not improve survival. CONCLUSION: Elderly AML patients should be treated individually. The intermediate-dose cytarabine consolidation might not improve survival of elderly AML patients.

[Study of prognostic related factors of elderly patients with T/NK cell lymphoma].

OBJECTIVE: To analyze the prognostic related factors of elderly patients with T/NK cell lymphoma. METHODS: The clinical data of 62 T/NK cell lymphoma patients with age over 60 years and treated in Shanghai Jiaotong University Medical School affiliated Ruijin Hospital from 1999 to 2011 were collected and analyzed. Multivariate and univariate analysis of clinical data were performed using a COX regression model, including stage, performance status, extranodal infiltration, bone marrow involvement and LDH level. According to IPI or PIT systems, survival functions were estimated using the Kaplan-Meier method and compared by the log-rank test. RESULTS: Using the IPI system, the CR rate of the low risk (IPI = 1, n = 7), intermediate-low risk (IPI = 2, n = 22), intermediate-high risk (IPI = 3, n = 13) and high risk (IPI = 4-5, n = 20) groups were 85.7%, 59.1%, 0% and 5.0%, with the median overall survival (OS) of 90.0, 63.9, 10.1 and 5.0 months, respectively. The patients with IPI = 1-2 had significant longer OS than those with IPI = 3-5 (P < 0.01), but no significant difference of OS was observed between IPI = 1 and IPI = 2 (P = 0.3647). As for the PIT system, CR rate of patients with PIT = 1 (n = 18), PIT = 2 (n = 18) and PIT = 3-4 (n = 26) were 61.1%, 44.4% and 3.8%, with the median survival of 90.0, 46.9 and 5.0 months, respectively. Significant difference of OS was found among groups of PIT = 1, PIT = 2 and PIT = 3-4 (P < 0.01). Therefore, PIT index was more effective than IPI in predicting prognosis of elderly T/NK cell lymphoma patients. The significant parameters of the univariate analysis were B symptom (P = 0.025), increased LDH level (P = 0.004), bone marrow infiltration (P = 0.023) and extranodal involvements (P = 0.033). Multivariate analysis showed that only increased LDH level (P = 0.007) and bone marrow involvement (P = 0.016) were the two independent prognostic factors of survival. These two factors were included in PIT index. CONCLUSIONS: PIT is more effective than IPI to predict outcomes of elderly T/NK lymphoma patients.

[Experimental investigation on plasma assistant combustion actuator in argon/air].

In order to obtain the characteristics of argon/air plasma assistant combustion actuators, experiments of three different actuators with normal, paratactic and meshy electrode configurations were respectively performed in argon/air mixture firstly, the results showed that the shape of electrode has little influence on the discharge characteristics. Then normal electrode was applied to study spectrum and discharge characteristics under the condition of 100% air and 10% argon/90% air. The comparison showed that, though in mixture the law of discharge characteristic was the same as that of pure air, discharge current and emission spectrum were strengthened, and initial discharge voltage reduced from 27 to 24 kV.

[Biological effects of down-regulating of TIZ gene on ovarian cancer cells in vitro].

OBJECTIVE: To construct TIZ gene RNA interference plasmid, as well as study the biological effects of down-regulating of TIZ gene on ovarian cancer cells. METHODS: According to the mRNA sequence of TIZ on GenBank, 3 pairs of small interference RNA (siRNA) for TIZ gene expression were designed and introduced into SKOV3 cells by liposome transfection reagent; the real-time quantitative PCR (QRT-PCR) was used to detect the interference efficiency and selected the most efficiency siRNA segment; pGPU6/GFP/Neo carrier was used to construct pGPU6/GFP/Neo-siRNA-TIZ-573 restructured interference plasmid, introduced into SKOV3 cell (sh-TIZ-573/SKOV3). The cell growth curves were made by methyl thiazolyl tetrazolium (MTT) method. The clonogenicity efficiency was observed by clony formation test. The cell cycles were measured by flow cytometry (FCM). The ability of invasion, metastasis and adhesion of ovarian cancer cells were detected by the matrigel invasion assay, transwell migration assay and adhesion assay, respectively. RESULTS: QRT-PCR results showed that ovarian cancer SKOV3 cells which transfected by recombinant plasmids pGPU6/GFP/Neo-siRNA-TIZ-573 could down-express TIZ gene. The cell growth curves, FCM and clony formation tests showed that the growth and proliferation of sh-TIZ-573/SKOV3 cells were significantly speeded up compared with the control cells (P < 0.01). There was no significant difference in cell invasion, migration and adhesion between sh-TIZ-573/SKOV3 cells [(48.5 ± 1.7)%, (53.6 ± 3.4)%, (64.9 ± 5.0)%, respectively] and the control cells (P > 0.05). CONCLUSION: The growth of ovarian cancer cells could be speeded up by down-expressing of TIZ gene, which TIZ gene may be play a biological role as a tumor suppressor gene.