[Application of recurrent neural network in prognosis of peritoneal dialysis].

OBJECTIVE: Deep learning models, including recurrent neural network (RNN) and gated recurrent unit (GRU), were used to construct the clinical prognostic prediction models for peritoneal dialysis (PD) patients based on routine clinical data. The performance of the RNN and GRU were compared with logistic regression (LR), which is commonly used in medical researches. The possible underlining clinical implications based on the result from the GRU model were also investigated. METHODS: We used the clinical data from the PD center of Peking University Third Hospital as the data source. Both the baseline data at the beginning of dialysis, and the follow-up and prognostic data of the patients were used by the RNN and GRU prediction models. The hyper-parameters were tuned based on the 10-fold cross-validation. The risk prediction performance of each model was evaluated via area under the receiver operation characteristic curve (AUROC), recall rate and F1-score on the testset. RESULTS: A total of 656 patients with the 261 occurrences of death were included in the experiment. The total number of all diagnostic records were 13 091. The results on the testset showed that the AUROC of the LR model, RNN model, and GRU model was 0.701 4, 0.786 0, and 0.814 7, respectively. The predictive performances of the GRU and RNN models were significantly better than that of the LR model. The performances of the GRU and RNN models assessed by recall rate and F1-score were also significantly better than that of the LR model, in which the GRU model reached the best performance. In addition, the recall rates were different among different causes of death or by different prediction time windows. CONCLUSION: The recurrent neural network model, especially the GRU model, is more effective in predicting PD patients' prognosis as compared with the LR model. This new model may be helpful for clinicians to provide timely intervention, thus improving the quality of care of PD.

[Mortality trend and age-period-cohort analysis of colorectal cancer among residents in Yangpu District of Shanghai from 1975 to 2014].

Objective: To describe the 40-years trend for the mortality of colorectal cancer (CRC) in Shanghai and to estimate the effect of age, period, and birth cohort with Age-Period-Cohort (APC) model. Methods: Data on tumor-releated death from 1975 Janurary 1 to 2014 December 31 was derived from the Yangpu District of Shanghai Center for Diseases Prevention and Control tumor registration system. Colonrectal cancer cases (C18.2-C18.9 and C20 in ICD10) were selected for analyses. Crude mortality, age-adjusted mortality, and Average Annual Percent Changes (AAPCs) were calculated for colon cancer and rectal cancer. The difference of AAPCs between male/female and different age groups were tested. An APC model (reference cohort and period were 1900 and 1975, respectively) was constructed to estimate the age-effect, period-effect, and cohort-effect on the colorectal cancer death. Results: During 1975-2014, 6 725 cases died of colorectal cancer (the cased of colon and rectal cancer were 3 684 and 3 041, respectively). The crude mortality and age-adjusted mortality of colon cancer was 8.83/100 000 and 6.76/100 000, respectively. The crude mortality and age-adjusted mortality of rectal cancer were 7.32/100 000 and 5.67/100 000, respectively. For population in Yangpu District, the crude mortality and age-adjusted mortality of colon cancer increased with time, and the crude mortality of rectal cancer increased with time (P<0.001). AAPC of the crude mortality rate (5.6%) and age-adjusted mortality rate (2.3%) of colon cancer were higher than those in rectal cancer (3.0% and -0.3%), respectively (both P values <0.001). AAPC of the crude mortality rate (males vs. females was 6.2% vs. 5.0%, P<0.05) and age-adjusted mortality rate (males vs. females was 2.7% vs. 1.7%, P<0.05) of colon cancer were higher in males than in females. APC model indicted that CRC-related death increased with age. During 1901 to 1941, the RR values of cohort effects for colon and rectal cancer death were 1.09-5.57 and from 1.04-2.28, respectively; During 1946 to 1991, the RR values of cohort effects for colon cancer and rectal cancer were 5.51-4.32 and 2.16-0.89. Conclusion: From 1975 to 2014, the mortality of CRC in Yangpu District increased gradually, and colon cancer mortality in males increased faster than that in females. The risk of death from colorectal cancer in the 1946-1991 birth cohort declined.

[Epidemic characteristics and prophylaxis/control measures of infectious diseases caused by hydrological disasters].

Hydrological disasters are associated with infectious disease outbreaks and epidemics. Hydrological disasters will lead to water pollution, increased vulnerability to diseases, and increased density of vectors. These factors will facilitate the outbreaks of water-borne/food-borne diseases, vector-borne diseases, and air-borne/contagious diseases. Pre-event preparedness for disasters and post-event reconstruction of both disease surveillance system and water-supply system are key measures to prevent infectious disease outbreaks caused by hydrological disasters. This study reviews the domestic and overseas experiences of controlling infectious diseases after hydrologic disasters, outlines the spectrum of post-disaster infectious disease as well as their epidemiological characteristics, and provides practicable suggestions accordingly.

[Hepatocellular carcinoma: co - evolution of hepatocytes and hepatitis B virus].

Chronic hepatitis B virus (HBV) infection is a major cause of hepatocellular carcinoma (HCC). In the process from chronic HBV infection to the development of HCC, there is a phenomenon of co-evolution of hepatocytes and HBV. The evolution of hepatocytes includes dedifferentiation and reverse evolution, while the evolution of HBV is mainly "telemorphosis" . Since HBV evolution occurs earlier than the development of HCC, the interaction between them is mainly reflected in the promotion of HCC evolution by HBV mutation. This article briefly summarizes the novel theory termed as cancer evolution and development and elucidates the molecular mechanism of HCC caused by HBV from the perspective of evolution.

Relationship between the angle of vertebral screws and spinal lateral angulation after fixation of thoracolumbar fractures via an anterior approach.

This study investigated possible contributors to lateral spinal angulation after surgical fixation of thoracolumbar fractures via an anterior approach. We retrospectively examined lateral angulation in 172 cases of thoracolumbar fractures treated in this manner. The coronal Cobb angle and angles of the screws relative to the endplates were determined from radiographs. The patients completed the Short Form 36, Oswestry Disability Index, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, and Visual Analogue Scale at the final follow-up visit. The mean coronal Cobb angle was 0.75° ± 3.91° (-14.25° to 14.55°) preoperatively, 3.17° ± 4.07° (-8.18° to 14.01°) immediately postoperatively, and 3.46° ± 4.21° (-1.05° to 17.27°) at the final follow-up visit. The superior posterior and inferior anterior screws were more parallel to their respective endplates when the approach was made ≥2 vs ≤1 vertebral levels above the fracture (P < 0.001). Lateral angulation was more likely when the approach was made ≤1 vs ≥2 levels above the fracture (P < 0.001). The coronal Cobb angle differed significantly (P < 0.01) between patients with lumbar and thoracic fractures. The immediate postoperative coronal Cobb angle correlated tightly with the sum of the screw angles (superior plus inferior posterior and/or inferior plus superior anterior). Lateral angulation may occur after surgical fixation of thoracic and lumbar fractures via an anterior approach. Non-parallelism between the vertebral screws and their corresponding endplates may predict postoperative lateral spinal angulation. Postoperative lateral angulation does not correlate with low back pain, quality of life, or preoperative lateral angulation.

LncRNA HCG11 accelerates the progression of hepatocellular carcinoma via miR-26a-5p/ATG12 axis.

OBJECTIVE: Hepatocellular carcinoma (HCC) is one of the most commonly diagnosed cancers globally. LncRNA HLA complex group 11 (HCG11) has been reported to play an oncogenic role in multiple cancers. Nevertheless, the role and regulatory mechanism of HCG11 in HCC are not fully addressed. PATIENTS AND METHODS: The abundance of HCG11 and miR-26a-5p was measured by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) in HCC tissues and cells. Cell proliferation, apoptosis, metastasis, and autophagy were detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), flow cytometry, transwell migration, invasion assays, and Western blot assay, respectively. The binding sites between miR-26a-5p and HCG11 or autophagy-related 12 (ATG12) were predicted by starBase bioinformatic software, and the combination was confirmed by Dual-Luciferase reporter assay. The abundance of ATG12 was examined by Western blot assay. Murine xenograft model was established to validate the function of HCG11 in vivo. RESULTS: The enrichment of HCG11 was enhanced in HCC tissues and cells and was negatively related to the prognosis of HCC patients. The abundance of miR-26a-5p was inversely correlated with the level of HCG11 in HCC tissues. HCG11 interference suppressed the proliferation, metastasis, and autophagy while promoted the apoptosis of HCC cells. MiR-26a-5p bound to lncRNA HCG11 and ATG12. The depletion of miR-26a-5p or the accumulation of ATG12 could alleviate the suppressive effects induced by HCG11 intervention on the proliferation, metastasis, autophagy, and the promoting impact on the apoptosis of HCC cells. HCG11 promoted the growth of murine xenograft tumor and autophagy through miR-26a-5p/ATG12 axis in vivo. CONCLUSIONS: LncRNA HCG11 accelerated the proliferation, metastasis, and autophagy while impeded the apoptosis of HCC cells via HCG11/miR-26a-5p/ATG12 axis. HCG11 might be a potential therapeutic target for the treatment of HCC.

[Risk factors analysis and a new risk scoring system predicting hepatocarcinogenesis for chronic genotype C HBV infected patients].

Objective: To investigate the effects of hepatitis B virus (HBV) genotype and mutations on the development of hepatocellular carcinoma (HCC) and to establish a new qualified HCC risk scores. Methods: A cohort study enrolling patients with chronic HBV infection was conducted. HBV genotypes were identified by nested multiplex PCR. HBV mutations in the basic core promoter region and PreS region were sequenced after PCR amplification. Scores on risk factors were set based on nomogram. Results: Totally, 1 525 patients were followed-up in this research. A total of 1 110 patients infected with genotype C were followed-up for 8.52 (Q(R): 5.36-11.68) years on average, of whom the incidence of HCC was 11.93/1 000 person-years. In genotype C HBV infected patients, male gender, aged 40 years and over, and four DNA mutations (T1674CG, A1762T/G1764A, A3120T, and A2962G) can increase the risk of HCC (P<0.05); interferon therapy can reduce the risk of HCC (P<0.05). A new HCC predicting model was established according to the results. After validation, the predicted disease-free survival rate was consistent with the real one. Conclusions: Hepatitis B virus genotypes and mutations were closely associated with HCC. The new risk scoring system can well predict HCC occurrence in genotype C HBV infected patients.

Pre-operative chemotherapy for squamous cell carcinoma of the oesophagus: do histological assessment and p53 overexpression predict chemo-responsiveness?

Pre-operative chemotherapy is increasingly used in the treatment of oesophageal carcinoma. However, no features have been identified which can reliably predict a positive response to chemotherapy. The aim of this study was to examine whether histological features and p53 overexpression could predict such response. Prechemotherapy endoscopic biopsies from 55 patients, who subsequently completed two courses of chemotherapy followed by surgical resection, were studied. Patients were classified into responders and non-responders according to clinical and pathological findings. Pathological features of the endoscopic biopsies examined included adequacy of the tumour tissue, histological grade, degree of keratinisation, histologic patterns, mitotic rates and nuclear pleomorphism. Biopsy specimens were also tested for p53 overexpression using p53 protein specific mouse monoclonal antibody DO-7 on paraffin sections. Histologic features and p53 expression were correlated to chemoresponsiveness. 76% (42 of 55) of patients had sufficient biopsy tissue for assessment. Response to chemotherapy was evident in 64% (n = 27) of patients. None of the non-responders had tumours with high-grade nuclear pleomorphism compared with 37% (10 of 27) of responders (P = 0.01). All patients with high-grade nuclear pleomorphism responded to chemotherapy. No significant differences were found between the responders and non-responders with respect to tumour differentiation (P = 0.7), degree of keratinisation (P = 0.3) and mitotic rates (P = 0.8). Overall, p53 overexpression was noted in 67% (28 of 42) of patients. This was more prevalent in non-responders (12/15) compared to responders (16/27), but this was not statistically significant (P = 0.08). The degree of p53 overexpression had no significant relationship with responsiveness to chemotherapy. High-grade nuclear pleomorphism, identified on pretreatment biopsy specimens, correlated with response to chemotherapy, whereas p53 overexpression did not correlate with response. Improved tissue sampling and further investigations should be done so that the assessment of prechemotherapeutic endoscopic biopsies can have significant impact on clinical decision making.

Substrate specificity of bleomycin hydrolase.

Bleomycin (BLM) hydrolase is believed to protect both malignant and normal tissue from the toxicity of the antitumor drug BLM. Little is known about the substrate specificity of BLM hydrolase. Thus, we developed ion-paired reverse phase high speed liquid chromatography systems to assay for the metabolism of several BLM analogs. We found that BLM A2, BLM B2, tallysomycin S10b (TLM S10b), peplomycin (PEP), butylamino-3-propylamino-3-propylamine bleomycin (BAPP), deglyco bleomycin A2 (dgBLM A2) and bleomycinic acid were each metabolized by rabbit lung BLM hydrolase to a single metabolite. When compared to their corresponding parent compounds, these metabolites were 6- to 35-fold less potent in their ability to inhibit the proliferation of A-253 human head and neck squamous carcinoma cells in culture. Furthermore, we found that substitutions in various regions of the BLM molecule greatly affected the kinetic parameters of BLM hydrolase. For example, the Km with BLM B2 (0.056 +/- 0.005 mM) was 15-fold lower than that seen with BLM A2 (0.83 +/- 0.11 mM). In contrast, the Vmax was not affected markedly by these terminal amine substitutions but was influenced greatly by deletion of the carbohydrate groups of BLM. For example, a 4-fold higher Vmax was observed with dgBLM A2 compared to BLM A2. Thus, these results demonstrate that BLM hydrolase can recognize and metabolize a broad spectrum of BLM analogs regardless of their structural features. This enzymatic conversion resulted in the inactivation of the BLMs as demonstrated by a substantial decrease in their cytotoxicity. Furthermore, the terminal amine and carbohydrate regions, respectively, dictate the apparent affinity and the rate of metabolism of BLM hydrolase substrates.

Squamous cell carcinoma of the esophagus with mucin-secreting component. Mucoepidermoid carcinoma.

Among 1058 patients with cancer of the esophagus, 20 patients with mucoepidermoid or adenosquamous cell carcinoma of the esophagus and cardia, together defined as squamous cell carcinoma with a mucin-secreting component, were seen over a 10-year period. Their records were reviewed and appropriate comparisons were also made with the more common squamous cell carcinomas and adenocarcinomas. Squamous cell carcinoma with mucin-secreting component comprised 1.9% of all tumors encountered. Clinical features including age, male predominance, symptoms at presentation, length of tumor, and appearance of tumor did not differ from those of squamous cell and adenocarcinoma. The location of these tumors, however, followed that of squamous cell carcinomas, with 55% in the middle third and 25% in the lower third. Adenocarcinomas were found predominantly at the cardia (83%). Operability and resectability rates were higher than those of squamous cell and adenocarcinomas. Primary treatment consisted of resection in 19 of the 20 patients (95%); 18 of them had a one-stage resection and 1 patient had a two-stage resection. Postresection staging showed that 5% had stage I disease, 16% had stage II, and 79% had stage III disease. None of the patients who underwent resection died within 30 days of the operation. The mortality after 30 days was 10.5%. The 1 patient in whom intubation was the primary treatment had distant metastases at the time of presentation (stage IV). The overall median survival was 9.2 months. The median survival for patients who had their tumors resected was 9.5 months. The survival improved to 33 months for curative resection but was only 8.7 months for palliative resection. The 1-, 2-, and 5-year survivals were 46%, 39%, and 0%, respectively. This prognosis was not significantly different from that of patients with squamous cell carcinoma or adenocarcinoma.

Measurement of extent of spread of oesophageal squamous carcinoma by serial sectioning.

OBJECTIVES: (1) To examine the prevalence and extent of intramural metastasis in squamous cell carcinomas of the oesophagus so as to delineate the resection margins for these tumours; (2) to devise an appropriate method for measurement of these lesions which takes into account of the contraction of the specimens after resection. METHODS: Oesophagectomy specimens were prospectively collected from 96 patients (87 males, nine females) with primary oesophageal squamous cell carcinoma over a two year period. The sizes of the tumours were measured in situ, after resection and after application of muscle relaxant (to regain their in situ length). The specimens were then serially sectioned for histological examination. RESULTS: The sizes of the tumours measured after application of muscle relaxant roughly corresponded to those measured in situ. Intramural metastasis was observed in 26% of the cases. Sixty four per cent (16 cases) of these were on the oral side, 72% (18 cases) on the gastric side, and 25% (nine cases) on both sides of the tumours. The most distant extent of intramural metastasis from the primary tumour was from 0.5 cm to 7.7 cm (mean = 3.4 cm) on the oral side, and 0.5 to 9.5 cm (mean 4 cm) on the gastric aspect of the tumour. Intramural metastasis was seen only in patients in whom the primary cancer had deep muscle infiltration. Multiple neoplastic lesions could be detected in 33% of the patients. Both intramural metastasis and multiple neoplastic lesions were associated with extensive lymph node infiltration. However, they had different histological features and extent of infiltration. CONCLUSIONS: Intramural metastasis was frequently observed in oesophageal squamous cell carcinoma. This implies that excision with wide margins should be considered for local control of the disease.

Histochemistry of mucin secreting components in mucoepidermoid and adenosquamous carcinoma of the oesophagus.

AIMS: To determine the direction of differentiation of the mucin secreting components in a rare group of oesophageal tumours--oesophageal squamous cell carcinomas with prominent mucin secreting components (mucoepidermoid carcinomas and adenosquamous carcinomas). METHODS: In a review of 617 cases of primary carcinoma of the oesophagus, 16 cases of squamous cell carcinoma with prominent mucin secreting components were studied using a battery of histochemical techniques. RESULTS: The mucin produced by these tumours was mixed and included a variable content of enzyme labile sialomucin (positive for mucicarmine, periodic acid Schiff, and alcian blue, and sensitive to sialidase digestion and negative for high iron diamine-alcian blue). Retrospective analysis of endoscopic biopsy specimens taken from these tumours showed that mucin was present in five (42%) cases. CONCLUSIONS: The glandular component of this group of tumours histochemically differentiated in the direction of oesophageal glands: examination of the mucin secreting component in squamous cell carcinoma in resected specimens is therefore required for recording the true incidence of this type of tumour.

Cytokeratin expression in non-neoplastic oesophageal epithelium and squamous cell carcinoma of the oesophagus.

The expression of cytokeratins (CK) 19, 8, 18, 13, 10 and 7 was examined in 35 cases of squamous cell carcinomas of the oesophagus (10 well-differentiated, 13 moderately-differentiated, and 12 poorly-differentiated) and the adjacent mucosa by means of a panel of monoclonal antibodies on frozen sections. The study was undertaken to assess the pattern of expression of these keratins in oesophageal tumours and its relation to the degree of differentiation. The normal oesophageal epithelia expressed CK19 in 86%, CK18 in 17% and CK13 in 14% of cases. CK8, CK10 and CK7 immunoreactivity was not observed. The tumours expressed CK19 in 86%, CK8 in 46%, CK18 in 97%, CK13 in 83%, CK10 in 34% and CK7 in 29% of cases. Thus, the so-called simple epithelial markers CK18 and CK19 occurred in the majority of oesophageal squamous cell carcinomas. CK13 (the so-called non-keratinizing squamous epithelial marker) was only infrequently demonstrated in the non-neoplastic oesophageal mucosa, and its expression was more frequent in carcinomas. CK10 was not demonstrated in non-neoplastic mucosa, but was mostly associated with well-differentiated carcinomas. We therefore conclude that the pattern of expression of cytokeratins in oesophageal carcinomas is different from that in normal oesophageal epithelia and varies with differentiation.

Paraplegia due to extramedullary hematopoiesis in thalassemia. Case report.

Surgical excision followed by radiotherapy has been the recommended treatment for paraplegia due to extramedullary hematopoiesis in patients with beta-thalassemia. The authors report the successful treatment of such a case by partial excision and repeated blood transfusions.

Recurrent dedifferentiated liposarcoma of the spermatic cord simulating malignant fibrous histiocytoma: an immunohistochemical and ultrastructural study.

A case of recurrent dedifferentiated liposarcoma simulating malignant fibrous histiocytoma, with complete absence of lipoblastic differentiation, is described. The tumour cells showed strongly positive immunostaining for alpha-1-antichymotrypsin. Electron microscopy revealed a mixture of fibroblasts and histiocytes. Our findings suggest that the dedifferentiated component reflects an altered differentiation pathway of the primitive mesenchymal cells in the original liposarcoma.

Double sarcomatoid carcinomas of the oesophagus.

Sarcomatoid carcinoma of the oesophagus is uncommon. A case of double sarcomatoid carcinomas was identified in the oesophagus of a 48-year-old man. This is the fourth case of multiple primary sarcomatoid carcinomas of the oesophagus and the first case with detailed pathological features presented. The clinicopathological features of multiple primary tumours and sarcomatoid carcinoma of the oesophagus are also reviewed.

Eosinophilic granular cells in a cryptorchid testis.

Intratubular cells with numerous refractile eosinophilic cytoplasmic granules were identified in a cryptorchid testis from a 17-year-old boy. The staining properties of the granules and the ultrastructural features were studied. The accumulation of lipid or lysosomal inclusions accounted for the observed cytoplasmic granules. These granular cells were probably altered Sertoli's cells, the exact nature and significance of which need further study.

[Synthesis of analogues of carbocyclic nucleoside].

The derivatives of 5'-dehydroxymethyl carbocyclic nucleoside were synthesized by condensation of cyclopentenyl chloride and corresponding pyrimidines followed by epoxidation and substitution. All compounds were screened for anticancer and antiviral activities and no activity was found.

[Transcatheter injection of silk particulates and line segments in the treatment of cerebral arteriovenous malformations].

The treatment of cerebral arteriovenous malformations (AVM) is difficult in neurosurgery. In recent years, intravascular treatment has been used with embolic material of IBCA or NBCA. We treated 51 patients by injecting silk particulates and line segments. Forty-eight of them were cured and 3 died from hemorrhage of malformed angiorrhexis: intraoperation (1), 14th day postoperation (1), and obstructive hydrocephalus complicated by intracranial infection after shunt (1). Silk particulates and line segments, which are safe, reliable, and inexpensive can be used instead of IBCA and NBCA. Intracranial AVM, especially in the recesses and domain may be treated operatively by intravascular embolization, It is important that microcatheter should be flow-guided into the deformed vascular mass of intracranial arteries.

[Clinical treatment of traumatic false aneurysm and arteriovenous fistula].

In this article, treatment of 41 cases of traumatic false aneurysms and arteriovenous fistulas are reported. The methods consist of arterial ligation in 6 cases, end-to-end anastomosis in 5 cases, prosthesis or autogenous vein grafts in 9 cases, "Flying Kite" technique by muscular embolism in 5 cases, vascular embolism by means of the spring-coil in 14 cases, direct operation combined with vascular embolism in 1 case, and breaking blood stream by the balloon catheter at first, then embolism by the spring-coil through retrograde catheterization and finally removal of false aneurysm in 1 case. Indications and advantages of the varied methods are discussed.