[Application of short-course radiotherapy with total neoadjuvant therapy in the treatment of middle and low rectal cancer].

Objective: To compare the efficacy and safety of short-course radiotherapy with total neoadjuvant therapy (SCRT-TNT) and neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced middle and low rectal cancer. Methods: A retrospective cohort study was carried out. A of 126 patients with locally advanced middle and low rectal cancer who were treated in the Department of Gastrointestinal Cancer Surgery of Fujian Cancer Hospital from September 2016 to March 2020 were enrolled, including 73 males and 53 females, with a mean age of (56.5±9.8) (23-77) years. Based on neoadjuvant regimen (nCRT treatment was performed before December 2018 and SCRT-TNT treatment was carried out after January 2019), patients were divided into nCRT group (n=68) and SCRT-TNT group (n=58). There were no statistically significant differences in age, sex, distance from tumor to anal verge, Eastern Cooperative Oncology Group (ECOG) performance status and clinical TNM stage between the two groups (all P>0.05). Patients in both groups received pelvic intensity-modulated radiotherapy (IMRT). The radiotherapy dose of nCRT group was 50Gy/25 times/5 weeks. Patients in nCRT group received oral capecitabine chemotherapy during radiotherapy and underwent surgery 6-8 weeks after chemoradiation. However, patients in SCRT-TNT group received CapeOX regimen (oxaliplatin+capecitabine) for 2 cycles of induction chemotherapy, followed by short-course radiotherapy (25Gy/5 times/5 days), then underwent a radical surgery two weeks after completion of consolidation chemotherapy (4 cycles). The adverse reactions, perioperative safety and efficacy of neoadjuvant therapy were compared and analyzed between the two groups. Results: Both groups completed neoadjuvant therapy as planned. Patients in nCRT group and SCRT-TNT group had similar incidence of adverse reactions to radiotherapy and chemotherapy, however, there were no statistically significant differences in the incidence of surgical complications, operation time, intraoperative blood loss and postoperative length of hospital stay (all P>0.05). A total of 119 patients underwent total mesenterectomy (TME), including 64 patients in the nCRT group and 55 patients in the SCRT-TNT group, all with R0 resection. The pathological complete response (pCR) rate was 10.9% (7/64) in the nCRT group and 25.5% (14/55) in the SCRT-TNT group, respectively, with a statistically significant difference (P=0.038). Two years after surgery, there was no statistically significant difference in local recurrence rate and overall survival rate between the two groups (both P>0.05). However, the clinical metastasis rate of SCRT-TNT group was significantly lower than that of nCRT group (20.3% vs 9.1%), with a statistically significant difference (P<0. 05). Conclusion: SCRT-TNT do not increase the adverse reactions of radio chemotherapy and perioperative risks in the treatment of locally advanced middle and low rectal cancer, and the tumor regression effect is good, which is worthy of clinical promotion.

Orally administered resveratrol enhances the therapeutic effect of autologous transplanted adipose-derived stem cells on rats with diabetic hepatopathy.

Stem cell therapy is a promising treatment for hepatopathy due to diabetes mellitus (DM); oral resveratrol treatment exhibits protective effects. We investigated whether protective effects could be produced in liver of diabetic rats receiving autologous adipose-derived stem cell transplantation (ADSC) plus oral resveratrol administration. Male rats were divided into four groups: sham group; streptozotocin induced DM group; DM + ADSC group, in which DM rats were treated with 106 stem cells/rat; and DM + R + ADSC group, in which DM rats were treated with ADSC and oral resveratrol. The DM group exhibited apoptosis, inflammation and fibrosis, whereas Sirt-1 and survival signaling were suppressed. Pathological conditions other than survival signaling were improved in the DM + ADSC group. All pathological conditions were improved in the DM + R + ADSC group. Also, the oxidative stress level in the blood was reduced in the DM + R + ADSC group compared to the sham group. Oral resveratrol administration appears to reduce oxidative damage and enhances survival signaling in diabetic liver. The therapeutic response in the DM + R + ADSC group was better than in the DM + ADSC group.

[Association between Lipoprotein(a) and the characteristics of left main coronary artery plaque in patients with stable angina pectoris].

Objective: To investigate the relationship between Lipoprotein (LP) (a) level and the characteristics of tissue components of left main coronary artery (LMCA) plaque. Methods: A total of 102 patients with stable angina pectoris who underwent percutaneous coronary intervention (PCI) in the People's Hospital of Henan Province from June 2010 to October 2016 were included. We performed intravascular ultrasound-virtual histology (IVUS-VH) to their LMCAs and evaluated the tissue characteristics, and the blood level of total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), ApoB, ApoA1, LP(a) were measured. According to the value of their LP(a) level they were divided into 2 groups (high LP(a) group (>300 mg/L) (n=35) and low LP(a) group (≤300 mg/L) (n=67)), then the relationship between the above lipid values and the tissue characteristics of the LMCA plaque in the patients were evaluated. Results: Patients with a high LP(a) had a larger percentage of fibrolipid volume and a smaller percentage fibrous volume compared to patients with a normal LP(a) (25%±5% vs 13%±6%, P<0.01 and 50%±8% vs 61%±9%, P<0.01). Using multivariate linear regression analysis after adjustment for the above-mentioned confounding factors, LP(a) had a significantly positive correlation with fibrolipid volume percentage (r=0.645, ß=0.29, P<0.01), and had a negative correlation with fibrous volume percentage (r=-0.467, ß=-0.32,P<0.01), suggesting that the LP(a) was associated with the vulnerability of the LMCA plaque. Conclusion: For the patients with stable angina pectoris, the LP(a) has a significantly positive correlation with the percentage of fibrolipid volume and a negative correlation with the percentage of fibrous volume, suggesting that the LP(a) could predict the vulnerability of the LMCA plaque.

C-terminus of Hsc70-interacting protein (CHIP) enhances stemness properties of human Wharton's jelly mesenchymal stem cell.

Mesenchymal stem cells are an attractive source of multipotent cells in part because they are easy to obtain. Several E3 ligases regulate the stability and functions of various factors in different adult stem cells through the ubiquitylation pathway. We investigated the C-terminus of Hsc70-interacting protein (CHIP) E3 ligase that regulates pluripotency of human Wharton's jelly mesenchymal stem cells (hWJMSC). We found that CHIP increases protein kinase B (Akt) phosphorylation by decreased expression of phosphatase and tensin homolog (PTEN), which suggests improvement of the survival pathway by CHIP over-expression. We also found that increased CHIP expression induced Sox2 and NANOG, which can promote stem cell self-renewal and prevent oxidative stress-induced senescence of hWJMSC by decreased p21. We found that CHIP could be used to enhance the multiple functions of hWJMSC.

Acute renal injury induced by endotoxic shock in rats is alleviated via PI3K/Nrf2 pathway.

OBJECTIVE: To explore the effect of PI3K/Nrf2 pathway on acute kidney injury (AKI) induced by endotoxic shock in rats by construction of the endotoxic shock rat model. MATERIALS AND METHODS: A total of 30 Sprague Dawley (SD) rats were randomly assigned into three group, namely the control group (group C), endotoxic shock model group (group L) and wortmannin + endotoxic shock model group (group WL), with 10 rats in each group. Pathological lesions in renal tissues were evaluated by histological score of kidney (HSK). Biochemical indicators including blood urine nitrogen (BUN), creatinine (Cr) and urinary α1-microglobulin (α1-MG) in renal tissues were accessed. Activities of superoxide dismutase (SOD) and malondialdehyde (MDA) were detected by relative commercial kits. Expression levels of Nrf2, Heme oxygenase 1 (HO-1) and Akt in renal tissues were determined by Western blot and quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR), respectively. RESULTS: HSK, levels of BUN, Cr and α1-MG and activities of SOD and MDA were significantly increased in group L comparing to those in group C (p<0.05). The above-mentioned indicators were also remarkably higher in group WL than those of group L (p<0.05). There were significant differences in expression levels of Nrf2, HO-1 and Akt between group L and group WL (p<0.05). In particular, lower mRNA levels of Nrf2 and HO-1, as well as protein levels of p-Akt, Nrf2 and HO-1 were observed in group WL compared with those in group L (p<0.05). CONCLUSIONS: The present study showed that AKI induced by endotoxic shock in rats was regulated through PI3K/Nrf2 pathway. HO-1 acts as the effector protein, might serve as an essential factor in protecting AKI induced by endotoxic shock.

[Association between the ApoB/A1 ratio and the vulnerability of LMCA plaque in the patients with stable angina pectoris].

Objective: To investigate the relationship between ApoB/A1 ratio and the characteristics of tissue components of their left main coronary artery(LMCA)plaque. Methods: A total of 98 patients with stable angina pectoris who received chronic statin treatment underwentpercutaneous coronary intervention in the People's Hospital of Henan Province from June 2010 to June 2016 were included.We prospectively performed intravascular ultrasound virtualhistology (IVUS-VH) to their LMCA and evaluated the tissue characteristics, and the blood level of total cholesterol (TC) and low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), triglyceride(TG), LDL-C/HDL-C ratio, ApoB, ApoA1, ApoB/A1 ratio were measured, then the association of the tissue characteristics with the aboved lipids values were analyzed. Results: According to the median value of their ApoB/A1ratios (0.80), they were divided into 2 groups [high ApoB/A1 ratio (>0.80) (n=49) and low ApoB/A1 ratio (≤0.80) (n=49)]. The patients with a high ApoB/A1 ratio had alarger fibrolipid volume and a smaller fibrous volume compared to patients with a low ApoB/A1 ratio ( 17.5%±1.2% vs 9.0%±1.0%, P=0.03 and 55.1%±2.1% vs 63.9%±1.8%, P<0.01). Using multivariate linear regression analysis after adjustment for the above-mentioned confounding factors, the ApoB/A1 ratio had a significantly positive correlation with fibrolipid volume (r=0.445, ß=0.29, P=0.010)and had a negative correlation with fibrous volume (r=-0.567, ß=-0.32, P=0.011), suggesting that the ApoB/A1 ratio was associated with the vulnerability of the LMCA plaque. Conclusion: For the patients with stable angina pectoris and chronic treatment of statins, a high ApoB/A1 ratio is associated with a high percentage of fibrolipid volume and a low percentage of fibrous volume in LMCA lesions, suggesting that the ApoB/A1 ratios could predict the vulnerability of the LMCA plaque.

Predictive value of nodal maximum standardized uptake value of pretreatment [18F]fluorodeoxyglucose positron emission tomography imaging in patients with esophageal cancer.

We retrospectively reviewed 102 patients with esophageal cancer (97.1% squamous cell carcinoma, 96.1% stage III) received FDG-PET staging and were treated by chemoradiotherapy with or without resection to assess whether the pretreatment [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) maximum standardized uptake value (SUVmax) of the primary tumor and metastatic lymph nodes can predict the prognosis of patients with esophageal cancer. Receiver operating characteristic analysis was performed to find the cutoff values for primary tumor SUVmax and nodal SUVmax. The influence of clinical factors including primary tumor SUVmax and nodal SUVmax on local progression-free survival, nodal progression-free survival (NPFS), distant metastases-free survival (DMFS), and overall survival (OS) were evaluated using univariate and multivariate analyses. A total of 40 patients received esophagectomy after neoadjuvant chemoradiotherapy (trimodality), while 62 patients received definitive chemoradiotherapy (dCRT). The median follow-up was 26.4 months. The SUVmax of primary tumor had no significant predictive value on all outcomes, while the SUVmax of metastatic lymph nodes had predictive value on several outcomes. High nodal SUVmax (≥7) predicted for worse outcomes than low nodal SUVmax (<7) in the patients who received dCRT (two-year DMFS, 17% vs. 92%, P < 0.001; NPFS, 14% vs. 81%, P = 0.001; OS, 21% vs. 50%, P = 0.003), but not in those received trimodality. On multivariate analysis of patients receiving dCRT, nodal SUVmax was the strongest independent predictor on DMFS (hazard ratio [HR] 13.93, P < 0.001), NPFS (HR 3.99, P = 0.026), PFS (HR 2.90, P = 0.003), and OS (HR 3.80, P = 0.001). High pretreatment nodal SUVmax predicts worse treatment outcomes for the patients treated with dCRT.

Kidneys from standard-criteria donors with different severities of terminal acute kidney injury.

OBJECTIVES: High terminal serum creatinine level in a deceased donor has been reported as the second most frequent cause of refusal for kidney transplantation. A growing body of evidence has shown a comparable outcome of kidney transplantation from deceased donors with acute kidney injury (AKI). However, the influence of the severity of AKI on graft outcomes remains to be elucidated. METHODS: In this retrospective cohort study, 84 consecutive kidney transplants from 57 standard-criteria donors were classified into 4 groups by RIFLE (Risk, Injury, Failure, Loss of function, and End-stage renal disease) classification according to donor AKI severity before kidney procurement. The donor and recipient characteristics and graft outcomes were compared. RESULTS: Of 84 kidney transplants, 56, 11, 10, and 7 recipients were in the Non-AKI, Risk, Injury, and Failure groups. The mean terminal creatinine was 1.1, 1.6, 2.3, and 4.4 mg/dL in these 4 groups. However, the graft outcomes, including primary nonfunction rate, delayed graft function rate, acute rejection rate, renal function, graft survival and overall survival over the first 5 years had no statistical difference. A trend toward increasing delayed graft function rate as the severity of AKI increased was observed (Non-AKI, Risk, Injury, and Failure: 26.8%, 36.4%, 60.0%, and 57.1%, P = .099). CONCLUSIONS: Our study demonstrates that AKI before procurement does not cause adverse long-term graft outcomes. Standard-criteria donors with AKI are suitable for kidney transplantation, even with a high severity of AKI.

SUMOylation of ZFP282 potentiates its positive effect on estrogen signaling in breast tumorigenesis.

Estrogen receptor α (ERα) has critical roles in the development and progression of breast cancer, and the coiled-coil co-activator (CoCoA) is an important ERα co-activator for estrogen-induced gene expression. The small ubiquitin-like modifier (SUMO) pathway is hyperactivated in breast cancer, but the mechanism by which SUMOylation regulates ERα-mediated transcription remains poorly understood. Here, we identified ZFP282 as a CoCoA-binding protein. ZFP282 associates directly with ERα and cooperates synergistically with CoCoA to enhance ERα function. ZFP282 is required for estrogen-induced expression of ERα target genes and estrogen-dependent breast cancer cell growth and tumorigenesis. In addition, we found that ZFP282 is SUMOylated and that SUMOylation positively regulates the co-activator activity of ZFP282 by increasing its binding affinity to ERα and CoCoA, and consequently increasing recruitment of ZFP282-CoCoA complex to the promoter of ERα target genes. These findings reveal essential roles for ZFP282 and its SUMOylation in estrogen signaling and breast tumorigenesis.

The trifecta outcome in 300 consecutive cases of robotic-assisted laparoscopic radical prostatectomy according to D'Amico risk criteria.

BACKGROUND: To analyze the trifecta outcome (continence, potency, and cancer control) in 300 cases of robotic-assisted laparoscopic radical prostatectomy (RARP). METHODS: A prospective assessment of outcomes in 300 consecutive patients that underwent a RARP performed by a single surgeon. Patients were grouped according to D'Amico risk criteria: Group I consisted of 'low-risk' cases (n = 64), Group II consisted of 'intermediate-risk' cases (n = 88), and Group III consisted of 'high-risk' cases (n = 148). Patients were evaluated for perioperative complications and the trifecta outcome. RESULTS: The operation time, blood loss, post-operative stay, duration of urethral catheterization, and perioperative complication rate were similar among all groups. The incidence of bilateral neurovascular bundle (NVB) preservation was significantly decreased with the increasing risk of cases (P < 0.001). The continence rates at the 1-week, 1-month, 3-month, 6-month, and 12-month follow-ups did not differ significantly between groups. The potency rates at the 12-month follow-up were not significantly different. The positive surgical margin and positive lymph node metastasis rate increased with the increasing risk of cases (P < 0.001). The biochemical recurrence rate (BCR, PSA >0.2 ng/mL) was 3.1, 11.36, and 19.59% in Groups I, II and III, respectively (P = 0.004). The trifecta outcome for RARP with bilateral NVB preservation showed no significant differences among groups. CONCLUSIONS: Undergoing a RARP is safe and feasible in high-risk prostate cancer patients. Compared to low-risk and intermediate-risk groups, the high-risk group had a significant higher incidence of positive surgical margin, positive lymph node metastasis, and BCR rate.

Isolated right diaphragmatic eventration mimicking congenital heart disease in utero.

Diaphragmatic eventration is the upward displacement of the abdominal viscera secondary to a thin or paralytic diaphragm. Its clinical presentations and radiographic pictures are similar to those of diaphragmatic hernia. Prenatal diagnosis of diaphragmatic eventration is extremely rare. A pregnant woman was referred to us because of abnormal cardiac findings noted at 20 weeks of gestation. A diagnosis of partial anomalous pulmonary venous connection was made on the basis of our findings of right atrial enlargement with an abnormal vascular channel drainage to it. The infant was born via cesarean section at 40 weeks and developed complications of cyanosis immediately after birth. Postnatal imaging studies and surgical findings disclosed right side diaphragmatic eventration with liver and associated vasculature upward displacement into the right pleural cavity. The cardiac structure was otherwise normal. We conclude that when an abnormal vessel tracing and unexplainable cardiac chamber asymmetry is encountered, diaphragmatic eventration should be considered as one of the differential diagnoses. Correct recognition and transferral to the hospital for neonatal assistance may lead to timely and appropriate management of these fetuses.

Sociopsychiatric characteristics of adolescents who use computers to excess.

OBJECTIVE: This study attempted to investigate current computer use by Korean adolescents, consequences of its excessive use and its relationship to psychiatric symptoms. METHOD: Questions for computer use, Computer-Related Addictive Behavior Inventory (CRABI), computer-induced behavioral alterations and Symptom Checklist-90-Revision (SCL-90-R) were assessed in 1296 students (12-19 years). RESULTS: Students were divided into three group users: minimal users (63.4%), moderate users (30.5%) and excessive users (6.1%). Computer-induced behavioral alterations occurred most frequently to excessive users and it was significantly correlated with total CRABI score. Average score on nine symptom dimensions and three global indexes of SCL-90-R were able to discriminate four decreasing orders of subjective psychiatric complaints: most frequent in excessive users and then moderate, non- and mild users, in order. CONCLUSION: Those adolescents with excessive computer use were found to show serious sociopsychiatric problems.

Microbial ecology of soils surrounding nuclear and thermal power plants in Taiwan.

This paper reports a study of the effect of three nuclear and one thermal power plants on the microbial ecology of soils. Populations of bacteria, actinomycetes, fungi, cellulolytic microbes, phosphate-solubilizing microbes and nitrogen-fixing microbes in the soil in the vicinity of each plant were studied. Soils were acidic at three sites, and moisture contents of the power plant soils were lower than those of the surrounding areas. Microbial populations of the topsoils (0-20 cm deep) were higher than the subsoils (21-40 cm deep), and only 10-15% of them showed significant difference (P < .05). Thirty-three percent of the samples from the surrounding areas had higher microbial population than those from the power plant areas, but 19% was the reverse. Populations of cellulolytic, phosphate-solubilizing and nitrogen-fixing microbes varied with sampling locations, season and environmental conditions. Ratios of cellulolytic, phosphate-solubilizing and nitrogen-fixing microbes to total viable counts in some samples of the surrounding areas were significantly higher than in the power plant areas. Although the microbial populations of power plant soil and its surrounding area were somewhat different, it cannot be attributed as an effect of power plant operation, as the differences were not consistent.

[The effect of thermal power plant on microbial ecology and environmental quality].

To investigate the effect of thermal power plant on the microbial ecology and the environmental quality, the Hsieh-Ho Thermal Power Plant was chosen and the populations of microbes including bacteria, actinomycetes, fungi, and cellulolytic, phosphate-solubilizing and nitrogen-fixing microbes were selected as the parameters of microbial ecology. The pH values of the soil sample collected from inside and outside of the plant were 5.2-6.2 and 4.0-5.3, respectively. Moisture content in plant area was lower than that in the surrounding area. Microbial populations of the topsoils were higher than those of the subsoils. Each gram of soil contained 3.64 x 10(4)-5.16 x 10(7) colonies of bacteria, 1.75 x 10(3)-1.10 x 10(6) colonies of actinomycetes and 6.72 x 10(3)-8.78 x 10(6) colonies of fungi in the plant area; while they were 5.52 x 10(4)-2.14 x 10(7), 8.26 x 10(3)-7.25 x 10(5) and 3.49 x 10(3)-2.74 x 10(6) colonies of bacteria, actinomycetes and fungi, respectively, in the surrounding area. The effect of seasonal change on microbial populations was not significant. The ratio of cellulolytic, phosphate-solubilizing and nitrogen-fixing microbes to the total count in the plant area was also higher than that in the surrounding area, and some of them had significant differences. From the statistical analysis, the effect of thermal power generator on the population and distribution of microbes was significantly different.

[Management of ipsilateral femoral shaft and neck fracture].

From Oct. 1987 to Oct. 1993, 704 patients with femoral shaft fracture were managed at our hospital. Among these, 12 patients were with combined femoral shaft and neck fracture (2%). The age ranged from 17 years to 58 years (average 38.2 years). Eleven patients were victims of traffic accidents and another 1 fell from a height. Most of them had associated injuries, including fractures elsewhere, head injury, chest and abdominal trauma. Five of them were treated with open reduction and internal fixation with Huckstep intramedullary nail, 2 with Kuntscher nail and Knowles' pin, 2 with plate and compression hip screw, 2 with plate and Knowles' pin and one patient was managed with Kuntscher nail and traction. Ten patients were followed up for more than 3 years, and the other 2 lost follow-up at 5 months and 12 months. The fractures were all united with 2 malunions. Complications included 3 deep infections and one avascular necrosis.

Ascaris and Trichuris do not contribute to growth retardation in primary school children.

To access the effectiveness of the treatment of soil-transmitted helminthiasis (STH) on the growth of primary school children, 353 children were block stratified to receive either mebendazole plus pyrantel oxantel pamoate every three months or a placebo. The children were followed for two years with 89% completing the trial. Follow-up stools indicated that the treatment was efficacious for ascariasis and trichuriasis. There was virtually no hookworm infection. The children were malnourished as measured by the number below -2 SD of height and weight standards. There was no difference in height or weight between the treatment and control groups by sex initially or at the end of two years of follow-up. The treatment of Ascaris and Trichuris had no effect on growth parameters. The effect of STH on growth may be mediated through hookworm infections.

[Modified selective medium for isolation of Helicobacter pylori].

To improve the detection rate of Helicobacter pylori, many kinds of media were tried and other antibiotics were incorporated according to the antimicrobial susceptibility patterns of clinical isolates in our hospital. We found that brain heart infusion agar supplemented with 1% IsoVitaleX and 5% sheep blood, containing nalidixic acid 10 micrograms/ml, vancomycin 6 micrograms/ml, amphotericin B 2 micrograms/ml and polymixin B 16 micrograms/ml (BNVP) or colistin 5 micrograms/ml (BNVC) inhibited the growth of contaminants without significant influence on the growth of H. pylori. However, colonies of primary isolates of H. pylori on BNVP media were larger than those on BNVC media, and easier to detect, Both BNVP and BNVC media yielded the same isolation rate. The organism was isolated from 67 of 91 endoscopic biopsy specimens (73.6%) obtained from the area of peptic ulcers, and from 37 of 125 specimens obtained from the area without lesion. The data were much superior to those in the early day, when the organism was only isolated from 6 of the 27 specimens (22%) obtained from patients with peptic ulcer disease. Because the contaminants and their antimicrobial susceptibility patterns may be varied in different hospitals, it is mandatory to modify selective media suitable for recovering H. pylori.