Anesthesia and perioperative management for giant adrenal Ewing's sarcoma with inferior vena cava and right atrium tumor thrombus: A case report.

BACKGROUND: Ewing's sarcoma of the adrenal gland with inferior vena cava (IVC) and right atrium thrombus is extremely rare. Here, we report a case of giant adrenal Ewing's sarcoma with IVC and right atrium tumor thrombus and summarize the anesthesia and perioperative management. CASE SUMMARY: A young female was admitted to the Department of Urology with intermittent pain under the right costal arch for four months. Enhanced abdominal computed tomography revealed a large retroperitoneal mass (22 cm in diameter), which may have originated from the right adrenal gland and was closely related to the liver. Transthoracic echocardiography showed a strong echogenic filling measuring 70 mm extended from the IVC into the right atrium and ventricle. After preoperative preparation with cardiopulmonary bypass, sufficient blood products, transesophageal echocardiography and multiple monitoring, tumor and thrombus resection by IVC exploration and right atriotomy were successfully performed by a multidisciplinary team. Intraoperative hemodynamic stability was the major concern of anesthesiologists and the status of tumor thrombus and pulmonary embolism were monitored continuously. During transfer of the patient to the intensive care unit (ICU), cardiac arrest occurred without external stimulus. Cardiopulmonary resuscitation was performed immediately and cardiac function was restored after 1 min. In the ICU, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) were provided to maintain cardiac, liver and kidney function. Histopathologic examination confirmed the diagnosis of Ewing's sarcoma. After postoperative treatments and rehabilitation, the patient was discharged from the urology ward. CONCLUSION: An adrenal Ewing's sarcoma with IVC and right atrium thrombus is extremely rare, and its anesthesia and perioperative management have not been reported. Thus, this report provides significant insights in the perioperative management of patients with adrenal Ewing's sarcoma and IVC tumor thrombus. Intraoperative circulation fluctuations and sudden cardiovascular events are the major challenges during surgery. In addition, postoperative treatments including ECMO and CRRT provide essential support in critically ill patients. Moreover, this case report also highlights the importance of multidisciplinary cooperation during treatment of the disease.

The complete chloroplast genome sequence of Lepidium perfoliatum L.

This study was based on the collection of the complete genome of Lepidium perfoliatum chloroplast (cp). The full cp genome is 154,264 bp long, containing 130 genes, in which 8 genes are specified for ribosomal RNA (rRNA), while 85 and 37 genes for protein-coding and transfer RNA (tRNA) respectively. Phylogenetic analyss revealed the closed cluster of Lepidium perfoliatum with other Lepidium species such as Lepidium apetalum, Lepidium sativum, Lepidium meyenii and Lepidium virginicum, which helps for the evaluation of how Lepidium perfoliatum is phylogenetically related to other species.

Disruption of Phaffia rhodozyma cells and preparation of microencapsulated astaxanthin with high water solubility.

A novel process was developed for encapsulation of astaxanthin from Phaffia rhodozyma. The yeast cells were disrupted by glass beads and the high shearing force partially emulsified the astaxanthin in aqueous phase. The enzymolysis method was then adopted to prepare the yeast extract for a full use of the cells. The gelatin and porous starch were used to microencapsulate the emulsified astaxanthin. Under optimized conditions, the recovery of amino nitrogen and solid reached 3.68 ± 0.32% and 49.22 ± 2.34%, respectively. The microencapsulation conditions were optimized through orthogonal experiment and the encapsulation efficiency, loading astaxanthin, and amino-nitrogen reached 88.56%, 1.55 mg/g, and 1.35 ± 0.14%, respectively. The water solubility of microcapsules reached 81.5 ± 0.35%. Color and storage stability analysis showed that microencapsulation of astaxanthin possessed higher thermal stability. The results demonstrated that the established process was effective and practical.

Investigation on hydrogen production from paper sludge without inoculation and its enhancement by Clostridium thermocellum.

The feasibility and performance of hydrogen production from paper sludge without inoculation was investigated under thermophilic conditions. The maximum hydrogen production reached 64.32 mM with 7.4% PS. The dynamic changes in bacterial community structures during hydrogen production were investigated by analyzing 16S rDNA gene sequences using high throughput sequencing technology. The results showed that microbial community was dominated by order Clostridiales and Thermoanaerobacterales. Genus Thermoanaerobacterium and Ruminiclostridium played a leading role in the fermentation process, which was responsible for the hydrolysis of PS and hydrogen production. Effect of inoculation with Clostridium thermocellum on hydrogen production from PS was also studied. The results showed that C. thermocellum supplement significantly increased hydrogen yield and holocellulose degradation rate by 96.80% and 32.95%, respectively. In addition, inoculation of C. thermocellum enhanced VFA generation and shortened the lag phase of hydrogen production. The present study lays the foundation on the valorization of waste lignocellulose.

TGF-ß signaling regulates DACT1 expression in intestinal epithelial cells.

DACT1, was first identified as a Dishevelled-associated antagonist of Wnt signaling pathway. It has been reported that DACT1 functions in embryonic development and tumorigenesis. However, the regulation of DACT1 still remains unclear. We found Wnt signaling has no effect on DACT1, but TGF-ß increases expression of DACT1 in intestinal epithelial cells. In addition, the minimal promoter is located in the region of -500bp to +1bp and the region between -3000bp to +1bp enhanced promoter activity. Site-directed mutation analysis was performed and indicated that potential regulatory elements was near -335bp. Our study provided the basic information for the exploration of DACT1 regulation and expression. Moreover, TGF-ß inhibits Wnt signaling to enhance the function of DACT1 inhibiting Wnt signaling.

TGFß induced factor homeobox 1 promotes colorectal cancer development through activating Wnt/ß-catenin signaling.

Colorectal cancer (CRC) is one of the most common cancers, but the mechanisms underlying its initiation and progression are largely unknown. TGIF1 (TGFB induced factor homeobox 1) is a transcriptional corepressor that belongs to the three-amino acid loop extension (TALE) superclass of atypical homeodomains. It has been reported that TGIF1 is highly expressed in mammary cancer and non-small cell lung cancer and can enhance tumor progression. However, the role of TGIF1 in colorectal cancer remains unknown. Here, we report that TGIF1 is significantly upregulated in colorectal cancers, and its high expression predicts poor prognosis. Overexpression of TGIF1 markedly promotes the proliferation of colorectal cancer cells both in vivo and in vitro. In addition, TGIF1 activates Wnt/ß-catenin signaling, and the homeodomain is indispensable for Wnt activation and ß-catenin interaction. Taken together, our results suggest that TGIF1 is a novel colorectal tumor promoter and indicate that TGIF1 enhances colorectal cancer tumorigenesis through activating Wnt signaling.

Combination therapy with lentinan improves outcomes in patients with esophageal carcinoma.

With a view to improving treatment response and the quality of life of cancer patients, this study investigated the clinical efficacy of combining lentinan, a flavonoid compound with antitumor abilities, with traditional chemotherapy in individuals with esophageal carcinoma (EC), with a particular focus on its effect on immune function. A total of 50 patients undergoing treatment for EC were evenly divided into two groups: control and experimental. Patients in the control group were treated with the chemotherapeutic agent tegafur (1,000 mg/day for 5 days); patients in the experimental group were treated with the same dosage of tegafur combined with 1 mg lentinan diluted in 250 ml normal saline. Patients were monitored for their general condition, symptoms and signs, quality of life and clinical efficacy (remission vs. progression). Additionally, the effects of lentinan on immune function were assessed through analysis of serum levels of pro-inflammatory and anti-inflammatory cytokines using enzyme-linked immunosorbent assay (ELISA) prior to and following the first and second course of treatment. The results of the scores showed that the general condition (Karnofsky performance scale; KPS), the symptoms and signs (Zubrod-ECOG-WHO score; ZPS) and the quality of life (QOL scale) of the patients following the first and second course of treatment were better in both groups compared to the scores prior to treatment; however, patients in the experimental group exhibited significantly greater improvement than those in the control group (P<0.05). Clinical efficacy was not significantly different between the two groups after 1 course of treatment, but after 2 courses of treatment, clinical efficacy was significantly greater in the experimental group than in the control group (P<0.05). Additionally, serum levels of IL-2, IL-6 and IL-12 increased, while levels of IL-4, IL-5 and IL-10 decreased, in patients of both groups after 2 courses of treatment (P<0.05). These changes occurred to a greater extent in the experimental group than in the control group (P<0.05). In conclusion, the addition of lentinan to the chemotherapy regimen improves the general condition, symptoms and signs, and quality of life of patients with EC. In particular, the patient's immune function may be enhanced by the combined treatment. The generalized application of lentinan is, therefore, recommended in the clinic.