Primary Surgery Followed by Selective Chemoradiotherapy Versus Preoperative Chemoradiotherapy Followed by Surgery for Locally Advanced Rectal Cancer: A Randomized Clinical Trial.

PURPOSE: The aim of this work was to determine whether locally advanced rectal cancer (LARC) with negative mesorectal fascia (MRF) predicted by magnetic resonance imaging (MRI) can be excluded from preoperative radiation therapy treatment. METHODS AND MATERIALS: This multicenter, open-label, non-inferiority, randomized clinical trial enrolled patients with LARC within 6 to 12 cm from the anal verge and with negative MRI-predicted MRF. Participants were randomized to the intervention group (primary surgery, in which the patients with positive pathologic [CRM] circumferential margins were subjected to chemoradiotherapy [CRT] and those with negative CRM underwent adjuvant chemotherapy according to pathologic staging) or the control group (preoperative CRT, in which all patients underwent subsequent surgery and adjuvant chemotherapy). The primary endpoint was 3-year disease-free survival (DFS). RESULTS: A total of 275 patients were randomly assigned to the intervention (n = 140) and control (n = 135) groups, in which 33.57% and 28.15% patients were at clinical T4 stage and 85.92% and 80.45% patients were at "bad" or "ugly" risk in the intervention and control groups, respectively. There were 2 patients (1.52%) and 1 patient (0.77%) with positive CRM in the intervention and control groups, respectively (P > .05). The non-adherence rates for the intervention and control groups were 3.6% and 23.7%, respectively. After a median follow-up of 34.6 months (IQR, 18.2-45.7), 43 patients had positive events (28 patients and 15 patients in the intervention and control groups, respectively). There were 6 patients (4.4%) with local recurrence in the intervention group and none in the control group, which led to the termination of the trial. The 3-year DFS rate was 81.82% in the intervention group (95% CI, 78.18%-85.46%) and 85.37% in the control group (95% CI, 81.75%-88.99%), with a difference of -3.55% (95% CI, -3.71% to -3.39%; hazard ratio, 1.76; 95% CI, 0.94-3.30). In the per-protocol data set, the difference between 3-year DFS rates was -5.44% (95% CI, -5.63% to -5.25%; hazard ratio, 2.02; 95% CI, 1.01-4.06). CONCLUSIONS: Based on the outcomes of this trial, in patients with LARC and MRI-negative MRF, primary surgery could negatively influence their DFS rates. Therefore, primary surgery was an inferior strategy compared with preoperative CRT followed by surgery and cannot be recommended for patients with LARC.

Sintilimab plus bevacizumab, oxaliplatin and capecitabine as first-line therapy in RAS-mutant, microsatellite stable, unresectable metastatic colorectal cancer: an open-label, single-arm, phase II trial.

Background: Microsatellite stable (MSS) and RAS-mutant metastatic colorectal cancer (mCRC) patients are characterized by an immunosuppressive microenvironment and a low response rate to immunotherapy. Chemotherapy and anti-angiogenesis therapy have been reported to potentially promote immunotherapy response. This study aims to assess the preliminary anti-tumor activity and safety of sintilimab plus bevacizumab, oxaliplatin and capecitabine as a treatment option for patients with RAS-mutant MSS mCRC. Methods: This study was an open-label, single-arm, phase II trial in China. Patients with unresectable, RAS-mutant and MSS metastatic colorectal adenocarcinoma received treatment by intravenous sintilimab (200 mg, day 1) plus bevacizumab (7.5 mg/kg, day 1), oxaliplatin (135 mg/m2, day 1) and oral capecitabine (1 g/m2, day 1-14) in each 21-day cycle. The primary endpoints included objective response rate (ORR) and adverse events. Biomarker analysis was performed to identify potential predictors of good response to treatment. This study is registered with ClinicalTrials.gov, number NCT04194359. Findings: Between April 2021 and December 2021, 25 patients were enrolled. Two (8%) patients showed complete response (CR), 19 (76%) had partial response (PR) and 4 (16%) presented with stable disease. ORR reached 84% (95% CI, 63.9-95.5) and the disease control rate was 100% (95% CI, 86.3-100). The median progression-free survival (PFS) was 18.2 months for the full analysis set. The most common treatment-related adverse events (TRAEs) in all grades were anemia (21/25, 84%), neutropenia (20/25, 80%), and hand-foot syndrome (14/25, 56%). The most frequent grade 3 or 4 TRAEs were neutropenia (3/25, 12%) and increased alanine transaminase (2/25, 8%). No grade 5 adverse events occurred. In the exploration of biomarkers, 5 patients could be characterized as TTN/OBSCN "double-hit" after treatment, and the copy number variants burden was significantly decreased in tumor tissues after treatment compared with the baseline. Nanostring panel RNA sequencing analysis indicated a better tumor immune microenvironment cell infiltration in CR/PR patients compared with non-CR/PR patients as well as the PFS-long (≥12.5 months) group compared with the PFS-short group. Interpretation: Combination treatment with sintilimab plus bevacizumab, oxaliplatin and capecitabine as first-line treatment demonstrated a promising antitumor activity and a manageable safety profile in RAS-mutant, MSS and unresectable mCRC. Exploratory biomarker assessment analysis showed that some RAS-mutant and MSS patients changed into "immune-hot" subtype after the treatment. Funding: This study was supported by the Key R&D Program of Zhejiang Province (2021C03125 to Ying Yuan), the National Natural Science Foundation of China (81872481 to Ying Yuan, 82072624 to Kefeng Ding), the Fundamental Research Funds for the Central Universities (No. 226-2022-00009 to Kefeng Ding), and the Zhejiang Provincial Natural Science Foundation of China (No. LY22H160024 to Hanguang Hu).

FOSL2 promotes intertumoral infiltration of T cells and increases pathological complete response rates in locally advanced rectal cancer patients.

The outcome of neoadjuvant chemoradiotherapy (nCRT) remains highly unpredictable for individuals with locally advanced rectal cancer (LARC). We set out to characterize effective biomarkers that promote a pathological complete response (pCR). We quantified the abundances of 6483 high-confidence proteins in pre-nCRT biopsies of 58 LARC patients from two hospitals with pressure cycling technology (PCT)-assisted pulse data-independent acquisition (PulseDIA) mass spectrometry. Compared with non-pCR patients, pCR patients achieved long-term disease-free survival (DFS) and had higher tumor immune infiltration, especially CD8+ T cell infiltration, before nCRT. FOSL2 was selected as the candidate biomarker for predicting pCR and was found to be significantly upregulated in pCR patients, which was verified in another 54 pre-nCRT biopsies of LARC patients by immunohistochemistry. FOSL2 expression was able to predict pCR by multiple reaction monitoring (MRM) with high efficiency (Area under curve (AUC) = 0.939, specificity = 1.000, sensitivity = 0.850), and high FOSL2 expression was associated with long-term DFS (p = 0.044). When treated with simulated nCRT, FOSL2 sufficiency resulted in more significant inhibition of cell proliferation, and more significant promotion of cell cycle arrest and cell apoptosis. Moreover, CXCL10 secretion with abnormal cytosolic dsDNA accumulation was found in FOSL2-wildtype (FOSL2-WT) tumor cells over nCRT, which might elevate CD8+ T-cell infiltration and CD8+ T-cell-mediated cytotoxicity to promote nCRT-induced antitumor immunity. Our study revealed proteomic profiles in LARC patients before nCRT and highlighted immune activation in the tumors of patients who achieved pCR. We identified FOSL2 as a promising biomarker to predict pCR and promote long-term DFS by contributing to CD8+ T-cell infiltration.

Phase II study of anlotinib in combination with oxaliplatin and capecitabine for patients with RAS/BRAF wild-type metastatic colorectal adenocarcinoma as the first-line therapy.

BACKGROUND: Anlotinib, an oral small molecule tyrosine kinase inhibitor targeting VEGFR 1/2/3, FGFR 1-4, PDGFR a/ß, and c-kit, had demonstrated prolonged progression-free survival (PFS) in refractory metastatic colorectal cancer (mCRC). This multicenter, single-arm, phase II, exploratory study was conducted to evaluate the efficacy and safety of anlotinib combined with capecitabine and oxaliplatin as first-line treatment for unresectable RAS/BRAF wild-type mCRC. METHODS: Patients aged 18-75 with RAS/BRAF wild-type unresectable mCRC, without prior systemic treatment, and ECOG performance status ≤1 were enrolled. Eligible patients received capecitabine (850 mg/m2, p.o., bid, on day 1-14 every 21 days), oxaliplatin (130 mg/m2, i.v., on day 1 every 21 days), and anlotinib (12 mg, p.o., qd, on days 1-14 every 21 days) as induction therapy. Following 6 cycles of therapy, patients who achieved response or stable disease received capecitabine and anlotinib as maintenance therapy until tumor progression. The primary endpoint was objective response rate (ORR) according to RECIST (version: 1.1), and the secondary endpoints were PFS, disease control rate (DCR), duration of response (DOR), and safety. RESULTS: Between November 2019 and February 2021, 31 patients were enrolled. One patient was excluded for refusing treatment. The primary endpoint of ORR was 76.7% (95% CI, 57.7-90.1) with 1 patient achieving a complete response and 22 patients partial response. DCR was 93.3% (95% CI, 77.9-99.2). At a median follow-up of 14.1 months (95% CI, 9.9-18.3), median PFS was 11.3 months (95% CI, 7.1-14.1), and DOR was 7.9 months (95% CI, 5.5-12.7). Twenty-five (83.3%) patients experienced grade 3 or 4 treatment-emergent adverse events (TEAEs). No grade 5 TEAE was reported. The most common grade 3 or 4 TEAEs (>10%) were hypertension (15/30; 50%), neutrophil count decreased (8/30; 26.7%), and diarrhea (4/30; 13.3%). A total of 18 (60%) patients had TEAEs that resulted in dose reduction, interruptions, or delays. CONCLUSIONS: Anlotinib combined with capecitabine and oxaliplatin showed considerable ORR, DCR, PFS, and DOR in the first-line therapy of mCRC with manageable toxicity profiles. TRIAL REGISTRATION: ClinicalTrials.gov : NCT04080843.

Vemurafenib effectively controlled Chemotherapy-refractory Intrahepatic Cholangiocarcinoma with BRAF V600E Mutation: a case report and literature review.

HINTERGRUND: Die Chemotherapie ist die erste Behandlungsoption für das lokal fortgeschrittene oder metastasierte intrahepatische Cholangiokarzinom (ICC). Nach einer Erstlinien-Chemotherapie gibt es jedoch keine Standardzweitlinienbehandlung oder zielgerichtete Wirkstoffe für diese Patienten. FALLPRäSENTATION: Hier stellen wir einen fortgeschrittenen ICC-Patienten vor, der eine radikale Entfernung und eine adjuvante Chemotherapie (Gemcitabin + Cisplatin) erhalten hat. Aber der Patient bleibt nur 6 Monate frei von Krankheitsanzeichen (No Evidence of Disease) nach dem Ende der Chemotherapie. Dann erhielt er eine palliative Operation, Strahlentherapie und systemische Chemotherapie (Tegafur+Oxaliplatin (SOX) und Nab-Paclitaxel+Gemcitabin (AG)). Leider war die Krankheit immer noch nicht unter Kontrolle. Als eine BRAF-V600E-Mutation im Tumorgewebe durch eine Next Generation Sequencing Analyse (NGS) gezeigt wurde, begann dieser Patient mit der Einnahme von Vemurafenib in einer Dosierung von 720-960 mg zweimal täglich und erreichte ein progressionsfreies Überleben von 7 Monaten mit signifikanter Remission der klinischen Symptome. SCHLüSSELWöRTER: Die BRAF V600E Mutation ist bei ICC ziemlich selten, daher wird sie in der Klinik nicht routinemäßig untersucht. Allerdings kann Präzisionsmedizin durch die NGS-Technologie verwirklicht werden, sodass die Ärzte bei der Behandlung der auf Chemotherapie-refraktären ICC die personalisierten genomischen Informationen nutzen können.

Associations between human bacterial pathogens and ARGs are magnified in leachates as landfill ages.

Landfills constitute the largest treatment and disposal reservoirs of anthropogenic waste on earth and they are continuously releasing antibiotic resistance genes (ARGs) to the environment for decades via leachates. Little is known about the association between ARGs and human bacterial pathogens as a function of time. Here, we quantified 10 subtypes of ARGs, integrons, and human bacterial pathogens (HBPs). Except for the ARGs encoding resistance to sulfonamides, the subtypes encoding resistance to beta-lactams, macrolides, and aminoglycosides were not related to integrons (Spearman, P > 0.05). Over time presence of ARGs became increasingly more correlated with the presence of human bacterial pathogens (Procrustes test; R = 0.81, P < 0.05), which were primarily identified as the Proteobacteria, Actinobacteria, and Firmicutes. Rather than the prevalence of integrons, dynamics of the bacterial community, including the increased nitrogen metabolism activity of Proteobacteria and decreased bacterial diversity were assumed to lead to a magnified association between HBPs and target ARGs (Varpart; > 13%).

[Therapeutic effect of chlorhexidine combined with mechanical debridement on peri-implantitis and its influence on patients' SF-36 score].

PURPOSE: To study the effect of chlorhexidine combined with mechanical debridement on peri-implant inflammation and the influence on SF-36 score of patients. METHODS: One hundred patients with peri-implantitis admitted to Zhejiang Provincial People's Hospital from January 2015 to January 2019 were selected and randomly divided into control group and combined group with 50 cases in each group according to random number table method.Patients in both groups were treated with mechanical debridement, and patients in the combined group were gargled with chlorhexidine gargle apart from mechanical debridement. Plaque biofilm average activity and modified plaque index (mPLI), bleeding on probing (BOP), modified sulcus bleeding index (mSBI), probing the depth (PPD), clinical attachment level(AL) were measured before and after treatment. Sf-36 scale and VAS visual pain score were used to evaluate the quality of life and pain degree of patients, and the therapeutic effect and incidence of complications were assessed. The data were analyzed with SPSS 20.0 software package. RESULTS: There was no significant difference in average activity, mPLI, mSBI, AL, PPD, BOP, VAS and SF-36 scores between the two groups before treatment(P>0.05); after treatment, the average activity, mPLI, mSBI, AL, PPD, BOP and VAS scores of plaque biofilm in the combined group were significantly lower than those of the control group, and the total effective rate of SF-36 score was significantly higher than that of the control group. The total effective rate of the combined group was significantly higher than that of the control group(P<0.05). The incidence of complications in the combined group was significantly lower than that in the control group(P<0.05). CONCLUSIONS: Chlorhexidine combined with mechanical debridement is an effective treatment of peri-implantitis, which can effectively inhibit plaque biofilm activity and plaque formation, alleviate pain and improve the quality of life of patients.

Controlled attenuation parameter by vibration-controlled transient elastography for steatosis assessment in members of the public undergoing regular health checkups with reference to magnetic resonance imaging-based proton density fat fraction.

AIM: Controlled attenuation parameter (CAP) measured by vibration-controlled transient elastography (FibroScan) allows repeatable and reliable assessment of liver steatosis for screening of patients at risk of non-alcoholic steatohepatitis development among asymptomatic individuals at a community level. However, this has never been compared with another quantitative method, such as magnetic resonance imaging-based proton density fat fraction, among the Chinese health checkup population. METHODS: A multicenter prospective study was conducted with Chinese individuals undergoing regular health checkups. Steatosis grading by magnetic resonance imaging-based proton density fat fraction was used as the reference to evaluate the diagnostic performance of CAP. RESULTS: A total of 173 individuals were included with mean age of 45 ± 11 years and body mass index of 25.8 ± 4.0 kg/m2 . A linear correlation was found between CAP and log10 -transformed magnetic resonance imaging-based proton density fat fraction results (Pearson's coefficient 0.772, P < 0.001). The areas under the receiver operating characteristic curve for distinguishing ≥S1 and ≥S2 steatosis were 0.88 (95% confidence interval 0.83-0.93) and 0.89 (95% confidence interval 0.83-0.95), respectively. When optimized for ≥90% sensitivity, the CAP cut-off for staging ≥S1 steatosis was 244 dB/m. CAP could classify patients with ≥S1 steatosis with similar performance as an ultrasound examination. CONCLUSIONS: As a non-invasive and quantitative method, CAP is highly adapted for population screening at a community level. With the integration of liver stiffness and CAP results in risk stratification scores for non-alcoholic steatohepatitis, vibration-controlled transient elastography can be useful in regular health checkups.

Accuracy of Magnetic Resonance Imaging in Staging Rectal Cancer with Multidisciplinary Team: A Single-Center Experience.

Purpose: To investigate the accuracy of magnetic resonance imaging (MRI) in preoperative staging diagnosis for rectal cancer with multidisciplinary team (MDT) discussion. Methods: The retrospective study included 377 patients of rectal cancer with preoperative MRI staging from February 2015 to April 2018, in which 137 patients (36 received MDT discussion) received neoadjuvant therapy, 240 did not (97 received MDT discussion) and direct surgery was given. With postoperative pathological stage as the standard, the accuracy of MRI in preoperative staging for rectal cancer with MDT discussion was compared with non-MDT. Results: For direct surgery group, 21 out 97 (21.6%) patients changed their therapy strategy due to the change of the stage assessment after MDT. The accuracy of MRI for the diagnosis of preoperative N stage with MDT was significantly higher than those without MDT (56.2% vs. 42.1%, P=0.021). And for those without lymph node metastasis, the accuracy of MRI was higher after MDT (61.2% vs. 37.8%, P=0.009). For neoadjuvant therapy group, 7 out of 36 (19.4%) patients altered their therapy after MDT because of the changed stage. MDT improved the accuracy of restaging N stage with MRI (70.0% vs. 33.3%, P=0.003). The accuracy of MRI in staging T stage seemed not improved after MDT in both groups. Conclusions: In conclusion, MDT discussion increased the accuracy of MRI in preoperative staging diagnosis for rectal cancer. This mode could give a more accurate clinical stage of patients, which was in favor of choosing a preferable therapy strategy.

Succession of the functional microbial communities and the metabolic functions in maize straw composting process.

Illumina MiSeq sequencing and phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) were applied to study the dynamic changes and effects of microbial community structures as well as the metabolic function of bacterial community in maize straw composting process. Results showed that humic acid contents in loosely combined humus (HA1) and stably combined humus (HA2) increased after composting and Staphylococcus, Cellulosimicrobium and Ochrobactrum possibly participated in the transformation of the process. The bacterial communities differed in different stages of the composting. Firmicutes, Proteobacteria, Bacteroidetes and Actinobacteria were reported the dominant phyla throughout the process and the relative abundance of the dominant phyla varied significantly (p < 0.05) over time. Moreover, the total phosphorus (TP) had the greatest influence on the microbial community structure among C/N ratio, available phosphorus (AP) and humic substances. Metabolism, cellular processes and environmental information processing might be the primary functions of microbial community during the composting.

[Analysis of factors affecting soft tissue infection after oral and maxillofacial debridement].

PURPOSE: To explore the factors affecting soft tissue infection after oral and maxillofacial debridement. METHODS: Fifty hundred patients with debridement were enrolled in this study from January 2013 to June 2016. The patients were divided into 2 groups according to soft tissue infection, 18 cases in infection group and 482 cases in non-infection group. Age, mean time to surgery, average length of stay, duration of antibiotics use, abbreviated injury scale (AIS), combined injuries, maxillofacial fractures, soft tissue injury, type of fracture, and history of diabetes were recorded and analyzed using SPSS 19.0 software package. RESULTS: The factors influencing soft tissue infection after oral and maxillofacial surgery were the aged, longer hospital stay, longer operation time, longer antibiotics use time, higher AIS score, Jaw bone injury and diabetes. CONCLUSIONS: The factors influencing soft tissue infection after oral and maxillofacial debridement are various. The aged, longer operation time, higher AIS score, jaw bone involvement lip and chin injury as well as diabetes might be the independent factors. Health care providers should give preventive measures to reduce the incidence of infection, according to specific factors.

The paradigm of tumor shrinkage and rapid liver remnant hypertrophy for conversion of initially unresectable colorectal liver metastasis: a case report and literature review.

BACKGROUND: For colorectal liver metastasis (CRLM) patients, hepatic resection is currently the sole cure offering the chance of long-term survival. Tumor shrinkage and planned liver remnant hypertrophy are the two key strategies for conversion of initially unresectable CRLM. First conducted in 2012, associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows rapid liver growth. As a means to induce hypertrophy, portal vein embolization (PVE) has been widely applied before extending hepatectomy. Recently, Peng et al. present a new approach of terminal branches portal vein embolization (TBPVE), offering an efficient way to amplify FLR and making chances for surgery in 2 weeks. CASE PRESENTATION: We reported a 61-year-old woman with synchronous hepatic metastasized carcinoma of the colon sigmoideum underwent TBPVE after 6 cycles of neoadjuvant therapy in order to perform a planned right trisectionectomy. Rapid liver remnant hypertrophy and remarkable tumor shrinkage were achieved, and laparoscopic sigmoidectomy and right trisectionectomy were successfully performed. The postsurgical course was uneventful and 7 months of recurrence-free survival have been witnessed. CONCLUSIONS: The dual tactics of tumor shrinkage and planned rapid liver remnant hypertrophy will make concerted efforts to further increase the clinical candidacy for curative resection, which are valuable for further investigation.

Giant cell tumor of the tendon sheath: Magnetic resonance imaging findings in 38 patients.

The present study aimed to investigate the value of magnetic resonance imaging (MRI) in the diagnosis of giant cell tumor of the tendon sheath (GCTTS), including localized (L-) and diffuse (D-) types. A total of 38 patients with GCTTS, including 31 with L-GCTTS and 7 with D-GCTTS, diagnosed by surgery and pathology, were retrospectively analyzed. All patients underwent MRI examination. Of the 31 patients with L-GCTTS, the tumors were located in the hand and wrist (18 patients), the ankle and foot (10 cases), the knee joint (2 cases) and the temporomandibular joint (1 case). All 31 lesions were either located in relation to a tendon or were partially/completely enveloping it and all were well marginated. With respect to the 7 D-GCTTS patients, the tumors were located in the ankle and foot (6 cases) or the hand and wrist (1 cases). All 7 lesions presented as an aggressive soft tissue mass infiltrating the tendon sheath and adipose tissue around the joint. The characteristic internal signal of GCTTS, including L-GCTTS and D-GCTTS, was demonstrated by MRI examination. MRI is currently the optimal modality for preoperative assessment of tumor size, extent and invasion of adjacent joint and tenosynovial space.

Preoperative Gross Classification of Gastric Adenocarcinoma: Comparison of Double Contrast-Enhanced Ultrasound and Multi-Detector Row CT.

The aim of this study was to compare the accuracy of multi-detector computed tomography (MDCT) with double contrast-enhanced ultrasound (DCEUS), in which intravenous microbubbles are used alongside oral contrast-enhanced ultrasound, in determining the gross classification of patients with gastric carcinoma (GC). Altogether, 239 patients with GC proved by histology after endoscopic biopsy were included in this study. DCEUS and MDCT were performed pre-operatively. The diagnostic accuracies of DCEUS and MDCT in determining the gross classification were calculated and compared. The overall accuracy of DCEUS in determining the gross appearance of GC was higher than that of MDCT (84.9% vs. 79.9%, p < 0.001). There was no significant difference in accuracy between DCEUS and MDCT for Borrmann I and IV classifications of advanced gastric cancer (χ(2), p = 0.323 for Borrmann type I, p = 0.141 for Borrmann type IV). The accuracy of DCEUS for early GC and Borrmann II and III classifications of GC was higher than that of MDCT (χ(2), p = 0.000 for all). DCEUS may be regarded as a valuable complementary tool to MDCT in determining the gross appearance of gastric adenocarcinoma pre-operatively.

Assessment of liver fibrosis in the early stages with perfusion CT.

OBJECTIVES: This work aims to assess the feasibility of perfusion CT in diagnosis of liver fibrosis in the early stage. MATERIALS AND METHODS: Solutions of carbon tetrachloride (CCL4) were injected into the peritoneum of 45 rabbits to establish rabbit models of liver fibrosis. Perfusion CT were performed at 4-, 8-, 12- and 16- week after injection. The parametric perfusion indices of blood flow (BF), blood volume (BV), arterial liver perfusion (ALP), portal venous perfusion (PVP), and hepatic perfusion index (HPI) on perfusion maps were measured. Liver samples were scored as F0, F1, F2, F3, F4 for fibrosis. RESULTS: In 50 rabbits, 23 rabbits survived. Of these survival rabbits, 5 rabbits were histopathologically scored as F0, 7 rabbits were F1, 8 rabbits were F2, and 3 rabbits were F3. For relatively small number of F3, multiple comparisons were made for F0 vs. F1, F1 vs. F2 and F0 vs. F2. A statistically significant difference was observed in PVP, BV, BF, ALP and HPI between F1 vs. F2 and F0 vs. F2, whereas a significant statistical difference was only achieved in PVP between F0 vs. F1. In the early stage of liver fibrosis PVP decreased with the progression of liver fibrosis, whereas HPI, ALP and BF increased with the progression of liver fibrosis. BV had no marked change. CONCLUSIONS: Perfusion CT is feasible in diagnosis of early stage of liver fibrosis. PVP appears to be the most promising parametric perfusion index.

Metachronous Primary Adenocarcinoma of Lung During Adjuvant Imatinib Mesylate Therapy for Gastrointestinal Stromal Tumor of Stomach: A Case Report.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in gastrointestinal tracts; however, the synchronous or metachronous coexistence of GIST with additional primary malignancy is not common.Here, we present an unusual case of gastric GIST with metachronous primary lung adenocarcinoma diagnosed during his adjuvant treatment with oral receptor tyrosine kinase inhibitor imatinib mesylate (400 mg daily). After 6-month use of imatinib, the patient suffered from dry cough and dyspnea. Subsequent lung biopsy demonstrated adenocarcinoma with diffuse interstitial changes.Our research emphasizes the possibility of an additional primary tumor with GIST, and reminds the clinicians to strengthen the surveillance of the additional cancer during the follow-up of GIST patients.

High fever and multi-nodular lung consolidations after whole lung lavage in a patient with pulmonary alveolar proteinosis.

INTRODUCTION: Whole lung lavage is the most effective method to treat pulmonary alveolar proteinosis (PAP), and most potential complications occur often during the lavage process, but few happen after lavage. Theoretically, pulmonary edema would be more common after whole lung lavage. However, no such case was reported in the literature. CASE DESCRIPTION: A 47-year-old Chinese male patient with PAP was referred to our hospital for whole lung lavage treatment. Although the clinical manifestations of PAP were improved, high fever was happened and multi-nodular consolidations in chest CT scan were occurred after whole lung lavage. Secondary lung infection was suspected, but the patient was not treated with antibiotics immediately. After therapies like liquid limitation, glucocorticoid administration and diuretic treatment, the patient was improved gradually. Namely, newly nodular consolidations were almost completely absorbed in three days, along with the complete recovery of body temperature and associated inflammatory biomarkers. The diagnosis of secondary infection was excluded, and the final diagnosis of lavage fluid-induced pulmonary edema was confirmed. DISCUSSION AND EVALUATION: No such case has been reported that lavage fluid-induced pulmonary edema is manifested by high fever and multi-consolidations in chest CT scan, which is similar to the secondary infection. CONCLUSIONS: For the first time, we described a rare complication of lavage fluid-induced pulmonary edema after whole lung lavage. As the obvious differences in treatments, it is very important for physicians to differentiate it from secondary infection.

Evaluation of a novel array-based toxoplasma, rubella, cytomegalovirus, and herpes simplex virus IgG enzyme linked immunosorbent assay and its comparison with virion/serion enzyme linked immunosorbent assays.

BACKGROUND: The dramatic increase in use of the IgG test for toxoplasma, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV) [TORCH] has led to the requirement for a high-efficiency method that can be used in the clinical laboratory. This study aimed to compare the results of BGI-Array ELISA TORCH IgG (BGI-GBI, China) screening method to those of Virion/Serion TORCH IgG ELISA (Virion/Serion, Germany). METHODS: Serum specimens (n=400) submitted for routine IgG testing by Virion/Serion ELISA were also tested using the BGI-Array ELISA method. The agreements of these two kinds of method were analyzed by κ-coefficients calculation. RESULTS: Following repeat testing, the BGI-Array ELISA TORCH IgG assays demonstrated agreements of 99.5% (398/400 specimens), 98% (392/400 specimens), 99% (396/400 specimens), and 99.5% (398/400 specimens), respectively. The BGI-Array ELISA IgG assays provided results comparable to Virion/Serion ELISA results, with κ-coefficients showing near-perfect agreement for the HSV (κ=0.87), rubella (κ=0.92) and CMV (κ=0.93) and substantial agreement for the toxoplasma (κ=0.80) IgG assays. The use of the BGI-Array ELISA TORCH IgG assays could reduce the turnaround time (1.5 hr vs. 5 hr by Virion/Serion ELISA for 100 specimens) and were easy to use. CONCLUSIONS: BGI-Array ELISA TORCH IgG shows a good agreement with Virion/Serion ELISA methods and is suitable for clinical application.

Use of digital subtraction angiography for assessment of digital replantation.

OBJECTIVE: To assess the blood flow of the proper digital artery using digital subtraction angiography (DSA) in the early stage after replantation. METHODS: From January 2006 to October 2010, 27 anastomosed arteries in 27 replanted digits were included in the study. The patients included nine males and four females. The patients received DSA at 48 to 96 h after digital replantation. Based on DSA image, the blood flow was classified into normal, slow-running, and flow-stopping types. The patients with normal digital blood flow were given continuous routine treatments; the patients with slow-running flow were given the conservative treatments, such as release of the tight dressings, removal of stitches, keeping warm, the use of massage, and the use of anticoagulants and anti-inflammatory drugs; the patients with flow-stopping received immediate surgical re-exploration. RESULTS: In this series, 23 digits in 11 patients showed a normal blood flow, and these digits all survived. In one of 13 patients, two digits which displayed slow-running flow also survived after conservative treatments. In two of 13 patients, two digits showed flow stopping, with one surviving and one failing after re-exploration and arterial revision. CONCLUSIONS: The DSA can be used to assess the blood flow of the proper digital artery in the early stage after replantation. It provides essential information for salvaging the replanted finger.