Essential thrombocythemia with non-ST-segment elevation myocardial infarction as the first manifestation: A case report.

BACKGROUND: We report a case of essential thrombocythemia (ET) in a 44-year-old male who exhibited non-ST-segment-elevation myocardial infarction (NSTEMI) as the first manifestation without known cardiovascular risk factors (CVRFs). For the first time, we reported a left main trifurcation lesion in NSTEMI caused by ET, including continuous stenosis lesions from the left main to the ostial left anterior descending (LAD) artery and an obvious thrombotic lesion in the ostial and proximal left circumflex (LCX) artery. There was 60% diffuse stenosis in the left main (LM) that extended to the ostial LAD, thrombosis of the ostial LAD and proximal LCX, and 90% stenosis in the proximal LCX. During the operation, thrombus aspiration was performed, but no obvious thrombus was aspirated. Performing the kissing balloon technique (KBT) in the LCX and LM unexpectedly increased the narrowness of the LAD. Then, the single-stent crossover technique, final kissing balloon technique and proximal optimization technique (POT) were performed. On the second day after percutaneous coronary intervention (PCI), the number of platelets (PLTs) still increased significantly to as high as 696 × 109/L. The bone marrow biopsy done later, together with JAK2 (exon 14) V617F mutation, confirms the diagnosis of ET. Hydroxyurea was administered to inhibit bone marrow proliferation to control the number of PLTs. CASE SUMMARY: A 44-year-old male patient went to a local hospital for treatment for intermittent chest pain occurring over 8 h. The examination at the local hospital revealed elevated cTnI and significantly elevated platelet. Then, he was diagnosed with acute myocardial infarction and transferred to our hospital for emergency interventional treatment by ambulance. During the operation, thrombus aspiration, the single-stent crossover technique, final kissing balloon technique and POT were performed. Dual antiplatelet therapy comprising aspirin and ticagrelor was used after PCI. Evidence of mutated JAK2 V617F and bone marrow biopsy shown the onset of ET. Together with JAK2 (exon 14) V617F mutation, ET was diagnosed according to the World Health Organization (WHO) diagnostic criteria, and the patient was placed on hydroxyurea. During the one-year postoperative period, repeated examinations showed a slight increase in PLTs, but the patient no longer had chest tightness, chest pain or bleeding or developed new thromboembolisms. CONCLUSION: Routine physical examinations and screenings are conducive to the early detection of ET, and the risk for thrombosis should be assessed. Then, active antiplatelet therapy and myelosuppression therapy should be used for high-risk ET patients.

Prognostic value of the C-reactive protein to albumin ratio in esophageal cancer: A systematic review and meta-analysis.

In recent years, some studies suggested that the pretreatment C-reactive protein to albumin ratio (CAR) may be predictive for prognosis of esophageal cancer (EC), but their results were inconsistent. Therefore, the current meta-analysis was preformed to better determine the prognostic value of pretreatment CAR in EC. The PubMed, EMBASE, Web of Science, Cochrane Library, and PubMed Central databases were searched up to January 10, 2019 to identify studies evaluating the correlation between CAR and prognosis of EC. The primary outcome was the overall survival (OS) and secondary outcomes were disease-free survival (DFS) and cancer-specific survival (CSS). Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were used to estimate the predictive role of CAR for prognosis in EC. Based on the results of this research, a total of 11 studies with 2930 patients diagnosed as EC were included. Pooled results suggested that elevated pretreatment CAR was significantly associated with poor OS (HR = 1.80, 95% CI: 1.31-2.47, P < .001) with high heterogeneity (I2 = 86.5%, P < .001) and poor CSS (HR = 1.72, 95% CI: 1.33-2.22, P < .001) without heterogeneity (I2 = 0.0%, P < .323); however, no significant association was observed between pretreatment CAR and DFS (HR = 1.41, 95% CI: 0.60-3.34, P = .429) with high heterogeneity (I2 = 76.7%, P < .038). Subgroup analyses further manifested that EC patients with higher CAR had worse OS. An elevated pretreatment CAR may indicate poor survival in patients with EC. Thus, pretreatment CAR may serve as a promising biomarker in EC and could be used to predict prognosis and help decision-making in clinical work.

[Significance of Detecting Serum Complement C3 and C4 in Patients with Multiple Myeloma].

OBJECTIVE: To investigate the significance of detecting serum complement C3 and C4 in patients with multiple myeloma (MM) and to explore its correlation with myeloma bone disease (MBD). METHODS: The levels of serum complement C3 and C4 in 69 MM patients and 30 healthy people were examined by scatter nephelometry. The bone density of L1-4 vertebral body, bilateral femoral neck and bilateral hip joints were measured by dual energy bone density meter (DXA). RESULTS: The levels of serum complement C3 and C4 in MM patients significantly increased in comparison with that in healthy people (P＜0.01). The patients in advanced clinical stage exhibited a higher levels of C3 and C4 than those in stable stage (P＜0.01). In addition, the patients with grade C of MBD had a higher levels of serum complement C3 and C4 than those in patients with grade A and B of MBD (P＜0.01). The levels of serum complement C3 and C4 in MM patients negatively correlated with bone density in L1-4 vertebral body, bilateral femoral necks and hip joints. The correlation coefficients were r=-0.938, r=-0.659, r=-0.745, r=-0.748, r=-0.596 in complement C3 and r=-0.908, r=-0.623, r=-0.710, r=-0.714, r=-0.595 in complement C4, respectively. CONCLUSION: The levels of complement C3 and C4 positively correlate with the severity of bone disease and bone density in MM patients, which suggests that complement C3 and C4 plays important roles in the development of MBD. The levels of serum C3 and C4 may be the sensitive biomarkers of MBD.

Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy.

BACKGROUND: The purpose of our cohort study was to investigate the effects of pleural adhesions on perioperative outcomes in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC). METHODS: We performed a single-center retrospective analysis on the prospectively-maintained dataset at our unit from February 2014 to November 2015. Patients were divided into two groups (Group A: presence of pleural adhesions; Group B: absence of pleural adhesions) according to our grading system of pleural adhesions when entering the chest cavity. Demographic differences in perioperative outcomes between these two groups were initially estimated. A multivariate logistic-regression analysis was then performed to confirm the predictive value of the presence of pleural adhesions. RESULTS: A total of 593 NSCLC patients undergoing VATS lobectomy were enrolled. The conversion and postoperative morbidity rates were 3.2% and 29.2%, respectively. There were 154 patients with pleural adhesions (Group A) and 439 patients without pleural adhesions (Group B). Group A patients had significantly higher rates of conversion to thoracotomy (9.1% vs. 1.1%; P<0.001) and surgical complications (24.0% vs. 14.4%; P=0.006) than those of Group B patients. No significant difference was found in the overall morbidity and cardiopulmonary complication rates between these two groups. The presence of pleural adhesions was also significantly associated with the prolonged length of chest tube drainage (log-rank P<0.001) and length of stay (log-rank P=0.032). Finally, the presence of pleural adhesions was identified as an independent risk factor for conversion to thoracotomy [odds ratio (OR) =5.49; P=0.003] and surgical complications (OR =1.94; P=0.033) by multivariate logistic-regression analyses. CONCLUSIONS: Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing VATS lobectomy for NSCLC. Our study calls for an internationally accepted grading system for the presence of pleural adhesions to stratify the surgical risk.

Body surface area: a novel predictor for conversion to thoracotomy in patients undergoing video-assisted thoracoscopic lung cancer lobectomy.

BACKGROUND: The purpose of our study was to explore the value of body surface area (BSA) for predicting conversion to thoracotomy in patients undergoing video-assisted thoracoscopic (VATS) lobectomy for non-small cell lung cancer (NSCLC). METHODS: We performed a monocentric retrospective analysis based on a prospectively-maintained dataset of consecutive patients between March 2014 and August 2015 at our unit. The median value of BSA was used as the cut-off. Patients with BSA > median value were classified as the "large" group, while those with BSA ≤ median value were classified as the "non-large" group. The conversion rate and post-VATS morbidity between these two groups were evaluated. Finally, a multivariate logistic-regression analysis was performed to identify the predictors for conversion to thoracotomy. RESULTS: A total of 475 patients with a median BSA of 1.73 m2 were enrolled. There were 16 patients converted to thoracotomy (ratio =3.4%). The overall morbidity rate was 28.4%. The "large" group (BSA >1.73 m2) included 236 patients, while the "non-large" group (BSA ≤1.72 m2) included the remaining 239 patients. The conversion (5.5% vs. 1.3%; P=0.010) in the "large" patients was significantly higher than that in the "non-large" patients. No difference was found in the overall morbidity rate between these two groups (32.2% vs. 24.7%; P=0.069). The multivariate logistic-regression analysis demonstrated that BSA >1.73 m2 could be a strongly independent predictor for conversion to thoracotomy [odds ratio (OR): 7.17; P=0.028]. CONCLUSIONS: BSA is an excellent categorical predictor for conversion to thoracotomy in NSCLC patients undergoing VATS lobectomy. It may be considered when informing patients about intraoperative risks and selecting cases in the early learning curve of VATS techniques.

Efficacy of the fissureless technique on decreasing the incidence of prolonged air leak after pulmonary lobectomy: A systematic review and meta-analysis.

OBJECTIVE: The objective of our study was to evaluate the efficacy and safety of fissureless technique in pulmonary lobectomy by applying a meta-analysis of the current evidence. METHODS: We searched the PubMed, EMBASE and the Web of Science databases to recognize the eligible articles. The relative risk (RR) and weighted mean difference (WMD) with the corresponding 95% confidence interval (CI) served as the summarized estimates for dichotomous variables and continuous variables, respectively. Sensitivity analysis and publication bias tests were also performed to perceive potential bias risks. RESULTS: There were 6 studies with 843 surgical patients included into this meta-analysis. Finally, the meta-analysis demonstrated that fissureless technique could significantly reduce the incidence of prolonged air leak (PAL)[RR = 0.40; 95%CI=(0.24, 0.68); P = 0.001], the length of hospital stay [WMD = -0.52; 95%CI=(-0.87, -0.18); P = 0.003] and the duration of chest tube [WMD = -0.44; 95%CI=(-0.74, -0.14); P = 0.004]. Fissureless technique had also showed the benefit on decreasing the complication rate after lobectomy but without a statistical significance [RR = 0.77; 95%CI=(0.55, 1.07); P = 0.119]. In addition, no difference was observed in the operation time between the fissureless lobectomy and conventional lobectomy [WMD = 5.32; 95%CI=(-3.18, 13.83); P = 0.220]. CONCLUSIONS: Fissureless lobectomy is a superior alternative to conventional lobectomy in terms of preventing the PAL and shortening the length of hospital stay and chest tube duration. More multi-institution randomized controlled trials are required to confirm the validity of our findings in the future.

[In-situ Study on Effects of Combined Amendment on Translocation Control of Pb and Cd in Soil-Vegetable System].

An in-situ study aiming at remedying arid land complexly polluted with Pb and Cd by using combined amendment LS (a mixture of limestone and sepiolite with a ratio of 2 : 1) was conducted in a mining area in southern Hunan, China. The main objectives of this study were to discuss the effects of LS application at different amounts (0 , 2, 4, 8 g x kg(-1)) on the adsorption and accumulation of Pb and Cd in eggplant and amaranth, and to control the translocation and transportation of Pb and Cd among different parts of eggplant and amaranth. The results showed that: (1) Application of LS significantly increased soil pH values and decreased contents of exchangeable Pb and Cd in soil. (2) Application of LS led to an obvious reduction in contents of Pb and Cd in different parts of eggplant and amaranth. Compared with the control group, the contents of Pb and Cd in edible part of eggplant were decreased by 44.7% - 78.6% and 36.0%-78.7%, and those reductions for amaranth were 45.8%-59.1% and 40.0%-87.2%, respectively, when the LS applying ratios ranged 2-8 g x kg(-1). (3) Application of LS reduced the translocation factors of Pb and Cd among different parts of these two kinds of vegetables. The translocation ability of Cd among root, stem, and fruit (in eggplant) or leave (in amaranth) in these two vegetables was greater than that of Pb. However, application of LS with different amounts did not change the sequence of translocation factors of Pb and Cd among different parts of these two kinds of vegetables.

Preeclampsia does not alter vascular growth and expression of CD31 and vascular endothelial cadherin in human placentas.

Preeclampsia is characterized by maternal endothelial dysfunction (e.g., increased maternal vascular permeability caused by the disassembly of endothelial junction proteins). However, it is unclear if preeclampsia is associated with impaired vascular growth and expression of endothelial junction proteins in human placentas. Herein, we examined vascular growth in placentas from women with normal term (NT) and preeclamptic (PE) pregnancies using two endothelial junction proteins as endothelial markers: CD31 and vascular endothelial-cadherin (VE-Cad). We also compared protein and mRNA expression of CD31 and VE-Cad between NT and PE placentas, and determined the alternatively spliced expression of CD31 using PCR. We found that CD31 and VE-Cad were immunolocalized predominantly in villous endothelial cells. However, capillary number density (total capillary number per unit villous area) and capillary area density (total capillary lumen area per unit villous area) as well as CD31 and VE-Cad protein and mRNA levels were similar between NT and PE placentas. PCR in combination with sequence analysis revealed a single, full-length CD31, suggesting that there are no alternatively spliced isoform of CD31 expressed in placentas. These data indicate that preeclampsia does not significantly affect vascular growth or the expression of endothelial junction proteins in human placentas.

Effects of combined amendments on heavy metal accumulation in rice (Oryza sativa L.) planted on contaminated paddy soil.

Stabilization of heavy metals in situ was investigated. Two combined amendments (LS, limestone+sepiolite; HZ, hydroxyhistidine+zeolite) were applied at ratios of 0.2%, 0.4%, and 0.8% (w/w) to paddy soil with multi-metal (Pb, Cd, Cu, and Zn) contamination. The effects of these two combined amendments on heavy metal bioavailability in soil, and on uptake and accumulation of heavy metals in rice plants were investigated. Application of LS and HZ significantly increased soil pH values and cation exchange capacity contents, and resulted in a reduction in exchangeable fraction of metals and in extract metal concentrations of amended soils through toxicity characteristic leaching procedure (TCLP). LS and HZ obviously inhibited uptake and accumulation of Pb, Cd, Cu, and Zn in rice plants. Compared with the control soil, concentrations of Pb, Cd, Cu, and Zn in brown rice were decreased by 10.6-31.8%, 16.7-25.5%, 11.5-22.1%, and 11.7-16.3%, respectively, as a result of 0.2% to 0.8% addition of LS, and decreased by 5.1-40.8%, 16.7-20.0%, 8.1-16.2%, and 13.3-21.7%, respectively, as a result of 0.2-0.8% addition of HZ. Significant positive linear correlations were found between heavy metal concentrations in TCLP extracts and those in rice tissues except for Pb. Extracting heavy metals with TCLP was a more suitable method for estimating heavy metal bioavailability concentrations of amended soil than exchangeable fraction of heavy metals, because the latter underestimated heavy metal bioavailability. These results demonstrate that LS and HZ could be effective in reducing heavy metal bioavailability and accumulation in rice grown on multi-metal-contaminated soils.

Expression of G-protein subunit α-14 is increased in human placentas from preeclamptic pregnancies.

G-proteins mediate cellular function upon interaction with G-protein coupled receptors. Of the 16 mammalian G-protein α subunits identified, G-protein subunit α-11 (GNA11) and -14 (GNA14) have been implicated in modulating hypertension and endothelial function. However, little is known about their expression and roles in human placentas. Here, we examined GNA11 and GNA14 protein expression in first trimester (FT), normal term (NT), and severe preeclamptic (sPE) human placentas as well as in NT human umbilical cords. We found that GNA11 and GNA14 were immunolocalized primarily in trophoblasts, villous stromal cells, and endothelial cells in placentas as well as in endothelial and/or smooth muscle cells of the umbilical cord artery and vein. Western blotting revealed that the GNA14, but not GNA11, protein levels were increased (2.5-2.9 fold; p<0.01) in sPE vs. NT placentas. GNA11 protein was detected only in NT, but not FT, placentas, whereas GNA14 protein levels were increased (7.7-10.6 fold; p<0.01) in NT vs. FT placentas. Thus, GNA11 and GNA14 may mediate the function of several cell types in placentas. Moreover, the high expression of GNA14 in sPE placentas may also imply its importance in sPE pregnancies as in the other hypertension-related disorders.

P21 (waf1/cip1) is required for non-small cell lung cancer sensitive to Gefitinib treatment.

Lung cancer is the leading cause of death from cancer in the world. Gefitinib is known to its inhibition of EGFR tyrosine kinase and worldwide used for antitumor in non-small cell lung cancer (NSCLC). Here, we show that Gefitinib reduces p-Akt levels, concomitant with elevation of p21 levels and suppression of cdk2/4 and cyclinE/D1 activities which result in impaired cell cycle progression through G1 arrest only in NSCLC cells in which it inhibits growth. We find that Gefitinib-induced p21 protein stability, rather than increased RNA accumulation, was responsible for the elevated p21 levels. More, treatment of beta-elemene, a natural plant drug extracted from Curcuma wenyujin, restored sensitivity to Gefitinib via the mechanism modulated the elevation of p21 levels in the cells which are acquired resistance to Gefitinib. These data suggest that administration of Gefitinib in combination with beta-elemene may offer great opportunities for NSCLC which are acquired resistance to Gefitinib. The p21 effect on the cells to response to Gefitinib was further confirmed by p21 over-expression and knockdown studies pointing to a requirement of p21 for the cells sensitive to Gefitinib. Thus, we propose that p21 is required for Gefitinib-sensitive NSCLC cells.

Combined treatment with TNF-alpha/gefitinib alleviates the resistance to gefitinib in PC-9 cells.

Gefitinib has been approved for the treatment of patients with non-small cell lung cancer. However, its efficiency is limited by the development of drug resistance. Additional treatments for cases of non-small cell lung cancer relapsing with treatment with gefitinib are urgently required. To investigate the mechanisms of acquired resistance to gefitinib, we established PC-9-ZD, a human lung cancer cell line resistant to gefitinib after long-term exposure to the drug. PC-9-ZD cells showed more resistance to gefitinib than their parental PC-9 cells. We show that gefitinib reduces p-Akt levels, concomitant with elevation of p21 levels and suppression of cdk2/4 and cyclinE/D1 activities, which result in impaired cell cycle progression through G1 arrest only in parental PC-9 cells, in which it inhibits growth. Our present data suggested that after long-term exposure to gefitinib, the survival of PC-9-ZD cells with heightened levels of p-Akt and reduced levels of p21 resisted further gefitinib-induced inhibition of cell growth. To explore a new strategy to improve the efficacy of gefitinib, we treated the cells with tumor necrosis factor-alpha (TNF-alpha) and found that the cells with acquired resistance to gefitinib showed increasing sensitivity to TNF-alpha, which correlated with the low activation level of nuclear factor (NF)kappaB/p65 in PC-9-ZD cells. TNF-alpha treatment induced an elevated activated NFkappaB/p65, concomitant with induced p21 levels, which resulted in increased sensitivity to gefitinib in PC-9-ZD cells. Consistent with our earlier observation that p21 is induced in an NFkappaB/p65-dependent manner, we conclude that p21 plays an important role in mediating cell growth inhibition by gefitinib. Thus, we proposed that combined treatment with TNF-alpha/gefitinib is an efficient therapeutic strategy for tumors that develop resistance to gefitinib.