Plasmacytoid variant urothelial bladder cancer: Is it time to update the treatment paradigm?

ObjectivesPlasmacytoid variant (PCV) urothelial cancer (UC) of the bladder is rare, with poor clinical outcomes. We sought to identify factors that may better inform expectations of tumor behavior and improve management options in patients with PCV UC.Materials and methodsA retrospective analysis of the Indiana University Bladder Cancer Database between January 2008 and June 2013 was performed comparing 30 patients with PCV UC at cystectomy to 278 patients with nonvariant (NV) UC at cystectomy who underwent surgery for muscle-invasive disease. Multivariable logistic regression was used to assess precystectomy variables associated with non–organ-confined disease at cystectomy and Cox regression analysis to assess variables associated with mortality.ResultsPatients with PCV UC who were diagnosed with a higher stage at cystectomy (73% pT3-4 vs. 40%, P = 0.001) were more likely to have lymph node involvement (70% vs. 25%, P<0.001), and positive surgical margins were found in 40% of patients with PCV UC vs. 10% of patients with NV UC (P<0.001). Median overall survival and disease-specific survival were 19 and 22 months for PCV, respectively. Median overall survival and disease-specific survival had not been reached for NV at 68 months (P<0.001). Presence of PCV UC on transurethral resection of bladder tumor was associated with non–organ-confined disease (odds ratio = 4.02; 95% CI: 1.06–15.22; P = 0.040), and PCV at cystectomy was associated with increased adjusted risk of mortality (hazard ratio = 2.1; 95% CI: 1.2–3.8; P = 0.016).ConclusionsPCV is an aggressive UC variant, predicting non–organ-confined disease and poor survival. Differentiating between non–muscle- and muscle-invasive disease in patients with PCV UC seems less important than the aggressive nature of this disease. Instead, any evidence of PCV on transurethral resection of bladder tumor may warrant aggressive therapy.     

变异性鼻炎应用通窍鼻炎片联合糠酸莫米松鼻喷雾剂治疗的效果观察

目的探究变异性鼻炎应用通窍鼻炎片联合糠酸莫米松鼻喷雾剂治疗的效果。方法本次研究资料选取时间段为2019年8月至2020年8月,患者为我院诊治的96例变异性鼻炎患者。经随机数字表法予以分组,其中参照组(48例)行糠酸莫米松鼻喷雾剂治疗,观察组(48例)行通窍鼻炎片联合糠酸莫米松鼻喷雾剂治疗。比较两组临床疗效及症状、体征情况与不良反应发生情况等。结果相较参照组,观察组治疗总有效率更高,不良反应发生率更低(P<0.05)。两组治疗后临床症状、体征评分均比治疗前低,且观察组比参照组低(P<0.05)。结论变异性鼻炎患者应用通窍鼻炎片联合糠酸莫米松鼻喷雾剂治疗效果确切,利于患者疗效提高、症状改善及不良反应发生率降低,可行推广。     

中国7个地区诺如病毒G II．4／Sydney 2012变异株分析

目的　分析2012--2013年冬季中国地区诺如病毒新流行株GII．4／Sydney 2012的衣壳蛋白区核苷酸与氨基酸变异特点。方法　对已获得的22份2012--2013年冬季北京地区GⅡ．4／Sydney2012株进行全衣壳蛋白区基因扩增。从GenBank检索中国其他地区的GⅡ．4／Sydney 2012株衣壳蛋白区核苷酸序列。对获得的GII．4／Sydney 2012株的衣壳蛋白区核苷酸及氨基酸序列与往年GⅡ．4流行株进行系谱分析。结果　获得中国7个地区（北京、上海、江苏、湖州、荆州、香港和台湾）的GⅡ．4／Sydney 2012株资料共38份（至少包含完整VPl核苷酸序列）。GH．4／Sydney 2012株之间VPl核苷酸差异为0．1％～3．3％,氨基酸差异为0～3．1％。系谱分析发现GⅡ．4／Sydney2012株与Apeldoorn 2008和NewOrleans 2009起自共同的分支。中国和悉尼GH．4／Sydney 2012代表株的A、D、E抗原表位氨基酸序列组合有两种：TSRN-GTT-SNT和TSRN-STT-SNT。结论　G II．4／Sydney 2012株已在中国多个地区出现,各地区病毒株同源性较高。G H．4／Sydney 2012株的抗原表位氨基酸组合发生明显改变。     

东莞地区16182名个体18个耳聋易感基因100个变异位点的测序筛查

目的确定东莞地区耳聋基因的变异类型和携带率。方法收集新生儿及门诊筛查的16182名个体,新生儿采集足跟血片,非新生儿采集外周静脉血样,对18个耳聋易感基因的100种变异进行检测。结果共检出1631例耳聋基因变异,总体检出率为10.08%,其中5例为纯合变异。SLC26A4基因变异的检出率最高(5.22%),共845例,其余依次为GJB2(673例,4.16%)、GJB3(100例,0.62%)、TMC1(12例,0.07%)、MYO15A(1例,0.01%)。GJB2基因c.235delC变异检出率最高(3.24%),共524例,其次为SLC26A4基因IVS7-2A>G变异(270例,1.67%)。33名个体(0.20%)同时携带两个变异,其中7例(0.04%)携带同一基因的复合杂合变异。结论扩大耳聋易感基因变异的筛查范围有助于了解携带情况及耳聋的遗传因素,对提早发现先天性耳聋、对受检者提供干预和遗传咨询具有重要的价值。     

A New High Affinity Variant Hb Aurillac (β141Leu→Val)

Hemoglobin (Hb) variant β141(H19)Leu→Val (HBB:c.424C>G), one of the two mutations defining Hb Kochi [the other one being β144(HC1)Lys-Tyr-His→0 (HBB:c.433A>T)], was found as an isolated mutation. In contrast to what was suggested for Hb Kochi, the new variant was not clinically silent. It displayed increased oxygen affinity and was associated with mild erythrocytosis.     

变异型心绞痛胸痛发作频率与细胞内镁离子浓度的相关性探讨

目的:探讨变异型心绞痛患者胸痛发作频率与细胞内镁离子浓度的相关性。方法:18例临床诊断为变异性心绞痛患者,男6例,女12例,分为两组:A组(n=9,胸痛发作频率≥4次/周),B组(n=9,胸痛发作频率4次/周),测定患者血清、尿、红细胞内镁离子浓度,通过镁离子负荷试验测定24小时镁离子潴留率。结果:A组24小时镁离子潴留率明显高于B组(58.2±9.1%vs31.1±4.4%,P0.01);红细胞内镁离子浓度A组却明显低于B组(3.1±1.1%vs5.0±0.8fg/cell,P0.05);胸痛发作频率与24h镁离子潴留率呈正相关(r=0.69,P0.01),与红细胞内镁离子浓度呈负相关(r=-0.70,P0.01)。结论:变异型心绞痛患者胸痛发作频率与细胞内镁离子浓度高低有一定相关性。     

Microdeletions and Microduplications in Patients with Congenital Heart Disease and Multiple Congenital Anomalies

Objective. Multiple genetic syndromes are caused by recurrent chromosomal microdeletions or microduplications. The increasing use of high‐resolution microarrays in clinical analysis has allowed the identification of previously undetectable submicroscopic copy number variants (CNVs) associated with genetic disorders. We hypothesized that patients with congenital heart disease and additional dysmorphic features or other anomalies would be likely to harbor previously undetected CNVs, which might identify new disease loci or disease‐related genes for various cardiac defects. Design. Copy number analysis with single nucleotide polymorphism‐based, oligonucleotide microarrays was performed on 58 patients with congenital heart disease and other dysmorphic features and/or other anomalies. The observed CNVs were validated using independent techniques and validated CNVs were further analyzed using computational algorithms and comparison with available control CNV datasets in order to assess their pathogenic potential. Results. Potentially pathogenic CNVs were detected in twelve of 58 patients (20.7%), ranging in size from 240 Kb to 9.6 Mb. These CNVs contained between 1 and 55 genes, including NRP1, NTRK3, MESP1, ADAM19, and HAND1, all of which are known to participate in cardiac development. Conclusions. Genome‐wide analysis in patients with congenital heart disease and additional phenotypes has identified potentially pathogenic CNVs affecting genes involved in cardiac development. The identified variant loci and the genes within them warrant further evaluation in similarly syndromic and nonsyndromic cardiac cohorts.     

Human follicle stimulating hormone receptor variants lacking transmembrane domains display altered post-translational conformations

Variant splicing of gonadotropin receptor mRNA commonly occurs, however expression of receptor protein variants and their trafficking has yet to be studied in detail. To determine receptor variant trafficking and intracellular processing in mammalian cells, the intracellular fate of intentionally truncated variants of human follicle stimulating hormone receptor (hFSH-R) expressed in CHO cells was examined. Monoclonal antibodies (mAbs) were made against the hFSH-R’s extracellular domain (ECD) expressed in insect cells. Four mAbs 106.156, 106.290, 106.318, and 106.263 were chosen as probes. Epitope mapping using synthetic peptides, and truncated hFSH-R variants revealed that mAb 106.156 bound to ECD residues 183–220, while mAbs 106.318, 106.290, 106.263 bound ECD residues 300–331. Immunofluorescence microscopy showed that mAbs 106.318 and 106.156 stained the surface of fixed, intact CHO cells expressing wild type hFSH-R. However, following cell permeabilization all four antibodies stained hFSH-R in Golgi and endoplasmic reticulum. Permeabilized cells expressing truncated variants ECD213 and ECD254 showed staining accumulated in the endoplasmic reticulum/nuclear envelope continuum. ECD335/His was found to accumulate in extended endoplasmic reticulum (ER). The ER location of ECD335/His was confirmed by double labeling experiments with concanavalin A and ECD mAb. Glycosidase digestion followed by Western blot analysis show ECD213 and ECD335/His to be glycosylated, but not ECD254. Both glycosylated truncated hFSH-R variants were sensitive to peptide-N-glycanase F and endoglycosidase H but insensitive to neuraminidase indicating that these variants possess high mannose type oligosaccharides. Thus truncated hFSH-R variants do not reach the medial or trans Golgi where high mannose oligosaccharides are trimmed and sialic acid is added. These data suggest that the conformation the ECD of the wild type receptor is different from the ECD alone expressed in the endoplasmic reticulum. This information suggests that the ECD serves two distinct roles; the first is to bind FSH and the other is likely to contact the endodomain of the receptor, which presumably leads to activation of the endodomain for signal transduction.     

A VARIANT FORM OF BRANCHED-CHAIN KETO ACIDURIA

A case of branched-chain keto aciduria is described. The boy's clinical picture was similar to that of patients with the intermittent form of this disorder, but severe mental retardation was present. It proved possible to treat him successfully with a diet low in branched-chain amino acids and, at the age of 3 years, after 18 months' treatment, his mental development corresponded with his age. Details are given of the clinical course and the dietary treatment. The findings in the patient's family are also described, with the results of oral loading tests with 1-leucine performed on all members of the family.     

耳蜗外毛细胞静纤毛束变异的判定标准与抵抗耳中毒的能力

目的建立耳蜗外毛细胞(OHC)静纤毛束变异的判定标准,观察毛细胞静纤毛束变异对庆大霉素耳中毒的抵抗能力.方法对豚鼠测定听性脑干反应(ABR)阈值和畸变产物耳声发射(DPOAE)振幅后,选取静纤毛束正常和变异豚鼠各5只,连续肌注庆大霉素(grntamicin,GM)12 d后,测定ABR阈值,扫描电镜观察耳蜗外毛细胞静纤毛束变异情况,耳蜗铺片计数毛细胞的损失数.结果耳蜗底回第一排外毛细胞静纤毛束转位超过45°、"W"变形数超过10%,作为豚鼠耳蜗外毛细胞静纤毛束变异的判定标准.5只静纤毛变异豚鼠GM注射12 d后平均ABR阈值51.0±8.76 dB SPL,外毛细胞损失约16%～39.96%,柯替器受损程度较轻;而外毛细胞(OHC)正常豚鼠GM注射12 d后ABR阈值上升到58.4～100 dB SPL,OHC基本消失,柯替器毛细胞破坏较为严重.结论耳蜗外毛细胞静纤毛束变异豚鼠较OHC正常者对GM中毒具有较大的耐受能力.