Lymphadenectomy for high-grade endometrial cancer: Does it impact lymph node recurrence?

IntroductionThe diagnostic role of lymph node (LN) assessment is established in endometrial cancer. Our study assesses whether surgical removal of metastatic LNs has oncologic benefit in high-grade endometrial cancer.Materials and methodsHigh-grade endometrial cancer cases (2000–2010) were collected from two tertiary cancer centres. In patients with at least one positive LN, recurrence free survival (RFS) was compared by the number of LNs removed. Factors predicting nodal recurrence (NR) were explored. Univariate statistical analyses by log rank test and multivariable cox proportional hazards model were performed using SAS version 9.4.ResultsOf 570 patients identified, 334 patients underwent staging lymphadenectomy, 74 (22.2%) patients had at least one positive LN. The median RFS with at least one positive lymph node was 87.1 months (95% CI ≥ 14.3) when greater than 15 LNs were removed, compared to 16.9 months (95% CI, 13.6–35.6) and 17.3 months (95% CI, 8.5–39.8) when 5–15 and less than 5 LNs were removed, respectively (p = 0.02). In the cohort of 570 patients, there were 167 disease recurrences with location described on imaging, 98 (58.7%) had a NR and 69 (41.3%) recurred at other sites. Multivariable modeling identified that only positive LNs at surgical staging predicted NR (HR 3.8, 95% CI 1.4–10.2).ConclusionIn high-grade endometrial cancer, positive LNs predict NR, and RFS is longer with a more extensive LN dissection in women with positive LNs. Future prospective studies should evaluate the oncologic benefit of surgical removal of metastatic LNs in high-grade endometrial cancer.     

A novel classification in predicting prognosis and guiding postoperative management after R0 liver resection for patients with hepatocellular carcinoma and microvascular invasion

BackgroundMicrovascular invasion (MVI) is a significant risk factor affecting survival outcomes of patients after R0 liver resection (LR) for hepatocellular carcinoma (HCC). The current classification of MVI is not refined enough to prognosticate long-term survival of these patients, and a new MVI classification is needed.MethodsPatients with HCC who underwent R0 LR at the Eastern Hepatobiliary Surgery Hospital from January 2013 to December 2013 and with resected specimens showing MVI were included in this study with an aim to establish a novel MVI classification. The classification which was developed using multivariate cox regression analysis was externally validated.ResultsThere were 180 patients in the derivation cohort and 131 patients in the external validation cohort. The following factors were used for scoring: α-fetoprotein level (AFP), liver cirrhosis, tumor number, tumor diameter, MVI number, and distance between MVI and HCC. Three classes of patients could be distinguished by using the total score: class A, ≤3 points; class B, 3.5–5 points and class C, >5 points with distinct long-term survival outcomes (median recurrence free survival (mRFS), 22.6, 10.2, and 1.9 months, P < 0.001). The predictive accuracy of this classification was more accurate than the other commonly used classifications for HCC patients with MVI. In addition, the mRFS of class C patients was significantly prolonged (1.9 months vs. 6.2 months, P < 0.001) after adjuvant transcatheter arterial chemoembolization (TACE).ConclusionsA novel MVI classification was established in predicting prognosis of HCC patients with MVI after R0 LR. Adjuvant TACE was useful for class C patients.     

A brief history of testicular organoids: from theory to the wards

Journal of Assisted Reproduction and Genetics - In recent years, researchers have successfully generated many human and mammalian organoid models, including organoids representing the intestine,...     

Rational design of stapled peptides targeting phosphorylated GSK3β for regulating osteoclast differentiation

Glycogen synthase kinase-3β (GSK-3β), has been reported to show essential roles in osteoclast differentiation. Modeled after FRATtide, a peptide derived from a GSK-3 binding protein, here we designed and synthesized a series of stapled peptides targeting phosphorylated GSK3β, and evaluated the corresponding biological activities. The results indicated that stapled peptides with better helical contents and proteolytic stability than the linear ones showed improved biological activity in inhibiting osteoclast differentiation. Among them, FRC-2 and FRN-2 showed promising prospects for treating osteoporosis.

A series of stapled peptides targeting phosphorylated GSK3β were rationally designed and the corresponding biological activities were evaluated.     

Integrin αvβ6 predicts poor prognosis and promotes resistance to cisplatin in hilar cholangiocarcinoma

ObjectiveIntegrin αvβ6 is associated with an extremely aggressive cancer phenotype. However, little is known about the clinicopathological significance and prognostic value of integrin αvβ6 in human hilar cholangiocarcinoma.MethodsIn the present study, bioinformatics analysis demonstrated a significant increase of integrin β6 gene expression in cholangiocarcinoma tissues compared to non-tumorous tissues, which was further validated in clinical samples through RT-qPCR and western blotting analyses. Integrin αvβ6 was observed to be expressed in 48.6% of tumors, and its expression was related to a poor tumor differentiation (p = 0.002), lymph node metastasis (p<0.001) and advanced TNM stage (p=0.001). Furthermore, patients who were αvβ6-positive showed a significantly shorter overall survival period than those who were αvβ6-negative (p=0.004). Multivariate analysis confirmed that integrin αvβ6 was an independent prognostic factor (p=0.002). In addition, loss- and gain-of-function assays showed integrin αvβ6 not only played an important role in colony formation, but also protected cholangiocarcinoma cells from cisplatin-induced growth inhibition and apoptosis. ERK/MAPK signaling pathway was involved in integrin αvβ6-mediated resistance of cholangiocarcinoma cells to cisplatin.ConclusionsTaken together, the present findings revealed that integrin αvβ6 could serve as a potential prognostic predictor and contribute to cisplatin resistance, which might prove to be a promising target candidate for the clinical intervention of human hilar cholangiocarcinoma.     

Serum cystatin C and cerebral microbleeds in patients with acute cerebral stroke

Recent studies have shown that kidney dysfunction is associated with cerebral microbleeds (CMB). Cystatin C is a more useful measurement than creatinine-based estimating equations for evaluating kidney function. The purpose of this study was to clarify the relationship between cystatin C levels and CMB in patients with acute cerebral stroke. This cross-sectional study included a total of 485 patients with acute ischemic stroke and 129 patients with cerebral hemorrhage. The serum levels of cystatin C were significantly higher in acute cerebral stroke patients with CMB than in those without (p < 0.001). Multivariate logistic regression analyses showed that for each single standard deviation increase of cystatin C levels, there was a significant increase in the presence of CMB after adjusting for age and sex, and after additional adjustment for cardiovascular risk factors, silent lacunar infarction, and white matter hyperintensity in patients with acute stroke. The odds ratio (95% confidence interval) in patients with acute cerebral infarction and cerebral hemorrhage were 2.92 (1.81–6.93) and 2.98 (1.76–6.97), respectively. The present study suggests that elevated levels of cystatin C are associated with the presence of CMB in acute stroke patients, independent of conventional risk factors.     

Predictor of poor coronary collaterals in chronic kidney disease population with significant coronary artery disease

Background

Mineral and bone disorder (MBD) in patients with chronic kidney disease is associated with increased morbidity and mortality. Studies regarding the status of MBD treatment in developing countries, especially in Chinese dialysis patients are extremely limited.

Methods

A cross-sectional study of 1711 haemodialysis (HD) patients and 363 peritoneal dialysis (PD) patients were enrolled. Parameters related to MBD, including serum phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH) were analyzed. The achievement of MBD targets was compared with the results from the Dialysis Outcomes and Practice Study (DOPPS) 3 and DOPPS 4. Factors associated with hyperphosphatemia were examined.

Results

Total 2074 dialysis patients from 28 hospitals were involved in this study. Only 38.5%, 39.6% and 26.6% of them met the Kidney Disease Outcomes Quality Initiative (K/DOQI) defined targets for serum P, Ca and iPTH levels. Serum P and Ca levels were statistically higher (P?<?0.05) in the HD patients compared with those of PD patients, which was (6.3?±?2.1) mg/dL vs (5.7?±?2.0) mg/dL and (9.3?±?1.1) mg/dL vs (9.2?±?1.1) mg/dL, respectively. Serum iPTH level were statistically higher in the PD patients compared with those of HD patients (P?=?0.03). The percentage of patients reached the K/DOQI targets for P (37.6% vs 49.8% vs 54.5%, P?<?0.01), Ca (38.6% vs 50.4% vs 56.0%, P?<?0.01) and iPTH (26.5% vs 31.4% vs 32.1%, P?<?0.01) were lower among HD patients, compared with the data from DOPPS 3 and DOPPS 4. The percentage of patients with serum phosphorus level above 5.5 mg/dL was 57.4% in HD patients and 47.4% in PD patients. Age, dialysis patterns and region of residency were independently associated with hyperphosphatemia.

Conclusions

Status of MBD is sub-optimal among Chinese patients receiving dialysis. The issue of hyperphosphatemia is prominent and needs further attention.     

核苷酸内焦磷酸酶磷酸二酯酶1 基因 K121Q 多态性与2 型糖尿病的相关性研究

目的探讨中国黑龙江汉族人群核苷酸内焦磷酸酶磷酸二酯酶1（Ecto—nucleotidepyrophosphatase／phosphodies-terase1,ENPPl）基因第4外显子K121Q对糖尿病发病的影响及其两者之间的关系。方法运用聚合酶链反应一限制性片段长度多态性（PCR—RFLP）方法检测146例2型糖尿病（T2DM）患者（T2DM组）和238例糖耐量正常对照健康人（对照组）EN—PPl基因K121Q的多态性分布,同时检测其临床及生化指标,进行随机对照研究。结果①T2DM组XQ（KQ＋QQ）基因型频率高于对照组（21．23％VS10．50％,P=0．0038）,其Q等位基因频率亦高于对照组（10．96％VS5．25％,P=0．0034）,差异有统计学意义;②携带Q等位基因个体与携带K等位基因个体两组比较,在性别构成、年龄、身高、体重、体重指数（BMI）l、腰围、臀围、腰臀比（WHR）、收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）、空腹胰岛素水平（FINS）、HOMA—IR差异均无统计学意义（P〉0．05）;（④Logistic回归显示,ENPPl基因K121Q多态性与T2DM相关（OR=2．30,95％CI=1．29—4．08,P=0．0038）;④汉族人群Q等位基因携带频率低于其他人群（非西班牙裔白人、美国黑人和西班牙人）。结论①ENPPl基因K121Q位点Q等位基因与中国黑龙江省汉族人群T2DM发病相关;②T2DM患者中携带Q等位基因个体无明显胰岛素抵抗表现;（~）ENPPl基因K121Q位点的多态性有明显种族地域差异性。