Validation and comparison of models to predict non-sentinel lymph node metastasis in breast cancer patients.

Several models for predicting the risk of non-sentinel lymph node (NSLN) metastasis in breast cancer patients with positive sentinel lymph nodes (SLNs) have been developed. The purpose of this study was to validate and compare these models in Chinese patients. A total of 159 breast cancer patients with positive SLNs treated at our institution were included. Among them, 81 (50.9%) patients had at least one NSLN involvement. The Cambridge, Mou, Mayo, Tenon, MDA, Memorial Sloan-Kettering Cancer Center (MSKCC), Ljubljana, SNUH, Turkish, Louisville, Stanford, and Saidi models were evaluated and compared using receiver operating characteristic (ROC) curves, calibration plots, and false negative (FN) rates. The Cambridge and Mou models outperformed the others, both with area under the ROC curves (AUCs) of 0.73. The Mayo, Tenon, MDA, MSKCC, Turkish, Ljubljana, SNUH, and Louisville models had AUCs of 0.68, 0.66, 0.66, 0.64, 0.63, 0.62, 0.61, and 0.60, respectively. The Stanford and Saidi models did not present any discriminative capabilities, with AUCs of 0.54 and 0.50, respectively. The Cambridge, MSKCC, and Mayo models were well calibrated. With adjusted thresholds, the Mayo model outperformed the others by classifying the highest proportion of patients (20%) into the low-risk group. Our study revealed that the Cambridge and Mou models performed well in Chinese patients. The ROC curves, calibration plots, and FN rates should be used together for the accurate evaluation of prediction models. Selection of these models should be based on the clinicopathological features of the targeted population. The models specifically designed for patients with micrometastases or macrometastases of SLNs are needed in the future.

Musashi1 expression cells derived from mouse embryonic stem cells can be enriched in side population isolated by fluorescence activated cell sorter.

BACKGROUND: Purifying stem cells is an inevitable process for further investigation and cell-therapy. Sorting side population (SP) cells is generally regarded as an effective method to enrich for progenitor cells. This study was to explore whether sorting SP could enrich for the Musashi1 (Msi1) positive cells from Msi1 high expression cells (Msi1(high) cells) derived from mouse embryonic stem cells (ESCs) in vitro. RESULTS: In this study, Msi1(high) cell population derived from ESCs were stained by Hoechst 33342, and then the SP and non-SP (NSP) fractions were analyzed and sorted by fluorescence activated cell sorter. Subsequently, the expressions of Msi1 and other markers for neural and intestinal stem cells in SP and NSP were respectively detected. SP and NSP cells were hypodermically engrafted into the backs of NOD/SCID mice to form grafts. The developments of neural and intestinal epithelial cells in these grafts were investigated. SP fraction was identified and isolated from Msi1(high) cell population. The expression of Msi1 in SP fraction was significantly higher than that in NSP fraction and unsorted Msi1(high) cells (P< 0.05). Furthermore, the markers for neural cells and intestinal epithelial cells were more highly expressed in the grafts from SP fraction than those from NSP fraction (P< 0.05). CONCLUSIONS: SP fraction, isolated from Msi1(high) cells, contains almost all the Msi1-positive cells and has the potential to differentiate into neural and intestinal epithelial cells in vivo. Sorting SP fraction could be a convenient and practical method to enrich for Msi1-positive cells from the differentiated cell population derived from ESCs.

[Relationship of epidermal growth factor receptor gene mutations, clinicopathologic features and prognosis in patients with non-small cell lung cancer].

OBJECTIVE: To investigate epidermal growth factor receptor (EGFR) gene mutations in exons 19 and 21 of patients with non-small cell lung cancer (NSCLC) and to analyze the relationship of EGFR mutations with clinicopathological features and prognosis. METHODS: The EGFR gene exons 19 and 21 of paraffin-embedded tumor tissue were amplified by PCR, followed by direct sequencing in 282 surgically-removed specimens of NSCLC. The relationship of EGFR gene mutations in NSCLC with clinicopathological features and prognosis were analyzed. RESULTS: EGFR mutations were detected in 120 of 282 (42.6%) patients with NSCLC. There were 61 cases of the mutations in exon 19 and 66 cases of the mutations in exon 21, including 7 cases of the mutations both in exons 19 and 21. Mutations were more frequently observed in women (55.2%, 53/96) than in men (36.0%, 67/186), in 51 to 60-years-old (51.3%, 39/76) than ≤50-years-old (30.4%, 21/69) and >60-years-old (43.8%, 60/137), in non-smokers (54.3%, 69/127) than smokers (32.9%, 51/155), there was negative correlation of EGFR mutations with smoking status (P=0.000, rs=-0.216). EGFR mutations were more frequently observed in adenocarcinomas (47.8%, 64/134), bronchiolo-alveolar carcinomas (73.0%, 27/37), adenosquamous carcinomas (7/9) than squamous cell carcinomas (23.6%, 17/72) and other types (16.7%, 5/30). The EGFR mutation rate in the well differentiated, the middle differentiated, the poorly differentiated and the undifferentiated was 55.7% (68/122), 50.8% (30/59), 22.7% (17/75), 19.2% (5/26) respectively, the incidences of EGFR mutations decreased with the degrading of differentiation, there was positive correlation of EGFR mutations with differentiation of lung cancer (P=0.000, rs=0.296). The patients with EGFR mutations had better prognosis than those with wild-type EGFR (P=0.027). There was no association of EGFR mutations with clinical TNM stage. CONCLUSIONS: EGFR mutations occur frequently in females, non-smokers and adenocarcinomas, bronchioloalveolar carcinomas, and adenosquamous carcinomas. The patients with EGFR mutations have better prognosis. The results may offer a practical approach to select the patients who may benefit from anti-EGFR target therapy.

Visceral larva migrans associated with earthworm and gecko ingestion: a case report.

INTRODUCTION: Visceral larva migrans is a syndrome caused by an infection with larval helminths, which may result in partial or general pathological changes in host tissues. Due to the difficulty in finding the causative parasites, the diagnosis of visceral larva migrans is generally based on compatible clinical signs, epidemic history, marked eosinophilia and pathological examination, especially positive serological test results and the disappearance of symptoms after specific treatment. CASE PRESENTATION: We report here the case of a 21-year-old Chinese man who, having ingested living earthworms and geckos at a witch's suggestion, presented with fatigue and wordlessness lasting for one year along with elevated transaminase levels for one month. Clinical examination showed eosinophilia, elevated transaminase levels, nodular lesions in his liver and typical pathological characteristics of hepatic visceral larva migrans. After four courses of anthelmintic therapy, our patient presented with sustaining improvement of clinical manifestations and normalization of laboratory data. CONCLUSIONS: Because of the difficulty in making a definite diagnosis, anthelmintic therapy should be performed in patients with a suspected diagnosis of visceral larva migrans based on their epidemic history and presence of typical manifestations, especially when the serological test results are negative. Furthermore, patients with severe parasite infection may require multiple anthelmintic therapies in order to eliminate the parasites.

Expressions of connexin 32 and 26 and their correlation to prognosis of non-small cell lung cancer.

BACKGROUND AND OBJECTIVE: Gap junction intercellular communication (GJIC) plays an important role in regulating homeostasis and differentiation in many tissues. Connexins are gap junction proteins, whose expressions directly affect the function of GJIC. This study was to investigate expressions of connexin 32 and 26 proteins in non-small cell lung cancer (NSCLC), and their correlation to clinicopathological characters of NSCLC. METHODS: Immunohistochemistry was applied to detect expressions of connexin 32 and 26 in 77 NSCLC tissues. Correlations of connexin 32 and 26 expressions to smoking, tumor size, histological type, the degree of differentiation, lymph node metastasis and prognosis were analyzed. RESULTS: The positive rates of connexin 32 and 26 were 51.9% and 40.3% in the 77 samples, which were significantly higher than 20.3% and 30.5% in alveolar epithelium (p = 0.000, r = -0.322; p = 0.013, r = -0.215). Positive expression of connexion 32 was positively correlated with the differentiation degree of NSCLC tissues (p = 0.010, r = 0.345). The one- to five-year survival rates were higher in patients with positive connexion 32 expression than those without (p = 0.005). Moreover, the positive rate of connexin 26 was not correlated to smoking, tumor size, histological type, the degree of differentiation, lymph node metastasis and the postoperative survival time (p > 0.05). CONCLUSIONS: Expression of connexin 32 is closely correlated to the differentiation of NSCLC and affects the prognosis of NSCLC patients. Increasing the expression of connexin 32 may improve the prognosis of NSCLC.

[Expression and significance of CD44(+)ESA(+)CD24(-/low), stem cell markers for breast cancer, in non-small-cell lung carcinoma].

BACKGROUND & OBJECTIVE: Stem cells are found in all human tissues, while tumor stem cells (TSCs) are also detected in tumors. TSC of breast cancer has been separated and its markers have been affirmed. However, TSC of lung carcinoma has not been separated yet. This study was to investigate the expression and significance of stem cell markers for breast cancer (CD44(+)ESA(+)CD24(-/low)) in non-small-cell lung carcinoma (NSCLC). METHODS: Expressions of CD44,ESA and CD24 of tumor tissues in 77 cases of NSCLC patients were detected using immunohistochemistry. The correlations of the expression of the makers to tumor size, smoking, histological type, differentiation, lymphoid metastasis, and prognosis were analyzed. RESULTS: The expressive rates of CD44,ESA and CD24 were 63.6%, 66.2% and 7.8%, respectively in 77 NSCLC tissues. CD44-positive expression was significantly higher in poorly differentiated and undifferentiated group than in well differentiated group. ESA-positive expression was significantly higher in well differentiated group than in poorly differentiated and undifferentiated group. The ESA positivity was significantly higher in glandular carcinoma than in squamous carcinoma. The expressive rate of CD44(+)ESA(+)CD24(-/low) in 77 cases of NSCLC was 36.4%. No correlations were found in the expression of CD44(+)ESA(+)CD24(-/low) to smoking, tumor size, histological type, differentiation, lymphoid metastasis and prognosis (P>0.05). CONCLUSION: Expressions of stem cell markers for breast cancer (CD44(+)ESA(+)CD24(-/low)) are not associated with tumor size, histological type, differentiation, lymphoid metastasis and prognosis of NSCLC.