Volume 93  ·   Issue 16  ·  2013

Stenotrophomonas maltophilia is a gram-negative conditional pathogen widely present in nature and in hospital settings. With the widespread application of broad-spectrum antibacterial drugs and immunosuppressants and the increasing number of invasive operations, the isolation rate of this bacterium is increasing year by year, and it has become one of the important pathogens of nosocomial acquired infections, ranking third in clinical isolation of non-fermenting bacteria. Stenotrophomonas maltophilia has weak pathogenicity, and its infection often appears in patients with low immunity and critical condition. It can cause lung infection, bloodstream infection, skin and soft tissue infection, abdominal infection, intracranial infection, urinary tract infection, etc. in patients with low immunity. At the same time, the bacteria are usually inherently resistant to a variety of antibacterial drugs, which brings challenges to clinical anti-infective treatment and infection prevention and control. At present, there are many confusions in the diagnosis, treatment, prevention and control of Stenotrophomonas maltophilia infection, and there is a lack of scientific, standardized and operational guiding literature. Formulating expert consensus on this problem will standardize and improve the diagnosis, treatment, prevention and control of Stenotrophomonas maltophilia infection in China.

To explore the clinical efficacy and prognosis of the patients with intermediate risk gastric stromal tumor (GST).

The data of intermediate risk GST patients confirmed by pathology and immunohistochemistry at Center of Gastrointestinal Surgery, West China Hospital, Sichuan University, between January 2007 and July 2011 were collected and retrospectively analyzed.And univariate and multivariate analyses were performed to assess the efficacy of imatinib mesylate (IM) according to recurrence-free survival (RFS).

A total of 46 intermediate risk GST patients were enrolled with a median follow-up period of 31 (9-64) months.Among them, 20 patients received IM treatment and 1 had hepatic metasis at 16 months after withdrawal.In contrast, 5 of 26 patients refusing IM treatment recurred or had a distant metastasis.The 1-, 2-, 3-year recurrence-free survival in IM treatment group and no IM treatment group were:20/20 vs 25/26, 14/14 vs 17/20 and 6/7 vs 10/14,respectively.Cox proportion hazards regression:hazard ratio (H R) =0.265,95% CI:0.025-2.761,P=0.267.Among 6 patients with recurrence and (or) metastasis, 5 had mitotic count>5/50 HPF.Cox proportion hazards regression (HR=0.059,95% CI:0.004-0.976,P=0.048) showed that IM can improve the progression free survival of mitotic count>5/50 HPF group versus mitotic count<5/50 HPF.The most common IM-related side effects were edema, nausea, abdominal discomfort, leukemia, etc. Most of them were Grade 1-2.

Intermediate risk GST has a low rate of recurrence or metastasis.And 1-year IM treatment may improve the prognosis of the patients with mitotic counts>5/50 HPF.Furthermore, IM treatment is safe in intermediate risk GST patients.

To evaluate the safety and efficacy of laparoscopic-assisted distal gastrectomy (LADG) for gastric cancer through a meta-analysis of LADG versus open distal gastrectomy (ODG).

Comparative studies of LADG and ODG wer collected from Pubmed, Cochrane library, Web of Science and Biosis Previews Databases between January 1995 and October 2012.The data of operative duration, blood loss volume, number of harvested lymph node, proximal and distal resection margins, time to flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity and 5-year survival rate were analyzed.And statistical analysis was performed with Rev Man 5.1 software.

A total of 16 articles were analyzed.There were 4 randomized controlled trials and 12 retrospective observational reports.Among a total of 2854 patients with gastric cancer, 1441 LADG and 1413 ODG subjects were included.Compared with ODG, LADG resulted in significantly prolonged operative duration (weighted mean difference (WMD) =49.09 min, P<0.01), less blood loss volume (WMD=-118.99 ml, P<0.01), less time to flatus (WMD=-0.58 d, P<0.01) and oral intake (WMD=-0.61 d, P<0.01), shortened postoperative hospital stay (WMD=-2.48 d,P<0.01) and less postoperative morbidity (relative risk (RR) =0.62,P<0.01).Distal resection margin did not differ significantly between LADG and ODG (WMD=-0.01 cm, P=0.94) while proximal resection margin was significantly shorter in the LADG group (WMD=-0.83 cm, P<0.01).The number of harvested lymph node was significantly lesser in the LADG group than that in ODG group (WMD=-2.17, P=0.05).However, no significant difference existed when only analyzing the papers published over the last 5 years or having over 50 LADG cases (all P>0.05).Furthermore, the 5-year survival rate did not differ significantly between two groups (RR=1.02, P=0.52).

As a safe and practical procedure with less blood loss volume, fewer overall complications and a quicker recovery, LADG may offer satisfactory longterm outcomes comparable to those of conventional open surgery.

To explore the functions of tumor susceptibility gene 101 (TSG101) in the invasion and metastasis of gastric cancer cells by cell culture.

The TSG101 eukaryotic expression and empty plasmids were transfected into gastric cancer cell line SGC7901.After screening with G418,single cell clone was selected and cultured.The expression of TSG101 was detected by reverse transcription (RT)-PCR and Western blotting.Cells were divided into TSG101 eukaryotic expression plasmid and blank control groups.Then the relationship was examined between TSG101 expression and tumor invasion and metastasis through the invasion, mobile, adhesion and damage scart experiment.

The expression levels of TSG101 in mRNA and protein in the TSG101 eukaryotic expression group were significantly higher than those of the plasmid and blank control groups (0.85±0.09 vs 0.55±0.07,0.45±0.07 and 29.4±1.2 vs 17.0±0.4,15.9±0.4,all P<0.05).The cell number of TSG101 eukaryotic expression group through Matrigel, laminin, type Ⅳ collagen protein (84±14, 128±10, 62±7) were significantly higher than those of the plasmid group (55±9,77±10,31±6) and blank control group (48±8,76±9, 24±5,all P<0.01).The number of cells adhereent to Matrigel, laminin, type Ⅳ collagen protein of the TSG101 eukaryotic expression group (0.97±0.04, 1.34±0.04, 0.90±0.01) were obviously higher than thoses of the plasmid group (0.53±0.03, 0.75±0.05,0.42±0.02) and blank control group (0.60±0.03,0.72±0.03,0.40±0.01,all P<0.01).The number of TSG101 eukaryotic expression group cell migrating to membrane lower surface was obviously higher than that of the plasmid group and blank control group (87±13 vs 54±8,48±7, all P<0.01).The fusion speed of the TSG101 eukaryotic expression group was faster than that of plasmid and blank control groups after cultivating for 24 and 48 h.

TSG101 expression increases significantly in SGC-7901 cells after a stable transfection of TSG101 eukaryotic expression plasmids.Also the capacities of invasion and metastasis become markedly enhanced.

To screen and collect the familial gastric cancer (FGC) kindreds for exploring its clinicopathological characteristics and prognosis.

A cross-sectional study was performed among 3640 patients with gastric cancer at 5 hospitals in Guangdong province between 2000 and 2007 and FGC kindreds were diagnosed according to the Amsterdam criteria.Their pedigree features and cancer incidence were analyzed.Clinical characteristics and prognosis were compared between FGC and sporadic gastric cancer (SGC) patients.Survival curves and overall five-year survival rates were established according to the Kaplan-Meier and Log-rank methods.Hazard ratios for death were calculated by Cox regression analysis.

A total of 112 FGC kindreds (3.1%) were diagnosed among 3640 gastric cancer patients.In these 112 FGC families,182 malignant tumors were diagnosed in the first- and second-degree relatives.Gastric cancer (n=154, 84.6%),esophageal cancer (n=8, 4.4%) and lung cancer (n=6, 3.3%) were most common tumors.Tumor types in male proband families did not differ from those in female counterparts (P=0.644).Most tumors occurred in the first-degree relatives and the ratio of male-to-female was 106∶44.The mean age of FGC patients at 54 years was 10 years younger than that of SGC patients.No differences existed in tumor size, tumor location, Borrmann type, pT or pN between the FGC and SGC patients.The overall 5-year survival was 56.0% for FGC patients and 48.8% for SGC patients.Univariable (P=0.287) and multivariable (HR=1.101, P=0.807) analyses demonstrated that FGC was not a significant prognostic factor.

Gastric cancer is the most common cancer in FGC families.The first-degree male relatives are at a high risk of developing gastric cancer.Not particular clinical characteristics but pedigree examination facilitates the diagnosis of FGC.

To explore the expression of Tau protein in breast invasive ductal carcinomas and examine the correlation between its expression and clinicopathological characteristics of breast cancer.

The clinicopathological data of 150 breast cancer patients at Third Municipal Hospital from October 2007 to June 2011 were collected and analyzed.Immunohistochemical method was used to detect the expressions of estrogen receptor (ER), progesterone receptor (PR), HER-2 and Tau protein.

No correlations existed between the expression of Tau protein and age, tumor size or node metastasis of breast cancer patients (χ²=0.02, P=0.88|χ²=0.55, P=0.46|χ²=1.02, P=0.31).The expressions of Tau in ER positive patients were significantly higher than ER negative patients.And this trend extended to PR positive and HER-2 negative patients (χ²=15.77,P=0.00|χ²=5.03, P=0.03|χ²=8.00, P=0.01).The expression of Tau protein in Luminal A subtype was significantly higher than in Luminal Bsubtype, HER-2 over-expression subtype and basal like subtype (χ²=7.26, P=0.01).

Over-expressed in breast cancer, Tau protein is associated with ER, PR and HER-2.However, the relation between Tau protein and prognosis of breast cancer requires further researches.

To explore the application feasibility of contrast-emhanced ultrasound (CEUS) plus methylene blue in sentinel lymph node biopsy (SLNB) for breast cancer and determine the ultrasonographic features of sentinel lymph node (SLN).

The microbubbles of Sono Vue were injected subcutaneously and intradermally into tumor side of areola.The images were observed to record the size, number, lymphatic door, aspect ratio, enhanced time and enhanced mode of SLN.Methylene blue was injected into SLN under the guidance of ultrasound.The marked SLNs were dissected for pathological examinations.Based upon the results, the specimens were divided into SLN metastasis and SLN non-metastasis groups.

A total of 34 breast cancer patients were recruited.Among them, SLN was detected preoperatively in 31 patients by CEUS and the rate was 91.2%.And the postoperative results showed that 14 were confirmed positive (metastasis group) and 17 negative (nonmetastasis group).The sensitivity, specificity,accuracy and false negative rate of CEUS for detecting SLNs were 93.3% (14/15),100% (16/16),96.8% (30/31) and 6.7% (1/15) respectively.The model of stepwise regression analysis showed that lymphatic door,aspect ratio and enhanced mode were helpful to differentiate SLN metastasis and SLN non-metastasis groups.

SLNB under the guidance of CEUS plus methylene blue offer prompt and accurate localization with a lower cost.It may enhance the detection rate of SLNB in breast cancer.

To evaluate the roles of Sysmex RD100i one-step nucleic acid amplification (OSNA) assay in the intraoperative assessments of breast cancer sentinel lymph nodes (SLNs).

A total of 552 consecutive prospective patients were enrolled from five centers nationwide from February to December 2010.And SLNs were sliced into alternating 2 mm blocks.The odd blocks were tested by the OSNA assay intraoperatively and the even ones assessed by postoperative histology.In addition, intraoperative histological assessments were performed on the even blocks of 211 patients by frozen section and all blocks by touch imprint cytology.

A total of 1188 SLNs were removed.The mean turnaround time of the assay was 37.3 min.There was no significant difference of turnaround time at each center (P=0.074).As compared to postoperative histology, the overall performance of the assay had an accuracy of 91.4% (1086/1188),a sensitivity of 83.7% (159/190) and a specificity of 92.9% (927/998).The sensitivity of the assay was higher than frozen section (77.6% (59/76) vs 69.7% (53/76),P=0.286) and was significantly higher than touch imprint cytology (83.6% (158/189) vs 76.2% (144/189), P=0.044).For nodes with micrometastases, the sensitivity of the assay was higher than frozen section (8/17 vs 4/17,P=0.289) and was significantly higher than touch imprint cytology (62.5% (30/48) vs 35.4% (17/48), P=0.007).

As an accurate and rapid intraoperative assay for assessing breast SLNs, the OSNA assay may replace frozen section and touch imprint cytology for clinical applications.

To explore the expression and significance of respiratory chain enzyme of cells in urine sediment in mitochondrial encephalopathy myopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome.

Through enzyme histochemistry, the authors analyzed the changes of respiratory chain enzyme in urine sediment in 20 MELAS patients due to mitochondrial A3243G mutation (MELAS group) and 20 health peoples (control group).And the impact on the expression of protein encoded by nuclear DNA (A21347) and mitochondrial DNA (A6404) was detected by immunochemistry.Image pro Plus 6.0 software was used for analysis of absorbance (A) of staining images as staining intensity.The data were expressed as M (Q₁, Q₃) and analyzed through statistical software.

The staining intensity of complexes Ⅰ in the MELAS group was lower than that in the control group (0.06 (0.01, 0.12) vs 0.12 (0.01, 0.62), P=0.010).The intergroup staining intensity of complex Ⅱ showed no marked difference.Increased density of blue particle and cytoplasmic gathering was found in 13 cased (65%) of the MELAS group under light microscope.The staining intensity of complexes Ⅳ was expressed at a low level in the MELAS group (0.14 (0.03, 0.32) vs 0.23 (0.06,0.43),P=0.038).The expression of protein encoded by nuclear DNA (A21347) was lower than that in the control group (0.05 (0.02,0.45) vs 0.17 (0.03,0.70),P=0.000).The expression of protein encoded by mitochondrial DNA (A6404) was also lower than that in the control group (0.03 (0.01, 0.07) vs 0.15 (0.09, 0.23), P=0.000).Conclusion Abnormal change of respiratory chain enzyme in urine sediment in MELAS due to mitochondrial A3243G mutation and a low expression of proteins encoded by two kinds of DNA in complexes Ⅳ can help to confirm the genetic diagnosis of mitochondrial encephalomyopathies so that different subtypes may be classified and its pathogenesis elucidated.

To explorethe effects of adrenergic beta-1 antagonists on hemodynamics of severe septic patients.

A total of 16 severe septic patients underwent mechanical ventilation from June 2012 to December 2012 at Fourth Affiliated Hospital of Nanchang University.There were 14 males and 2 females with a mean age of (58±6) years (range:48- 67 years).Among them, there were multiple trauma (n=4), acute severe pancreatitis (n=6) and recent tumorectomy for gastrointestinal cancer (n=6).The adrenergic beta-1 antagonist esmolol was injected through central venous catheter to reduce heart rate by 20% from baseline.Various indices (heart rate, systolic blood pressure, diastolic blood pressure, cardiac output, cardiac index, central venous pressure, pulmonary artery wedge pressure, pulmonary vascular resistance index, systemic vascular resistance index and stroke volume index) were monitored by a multifunctional and hemodynamic monitor connected to pulmonary artery catheter.And other indices of arterial pressure of carbon dioxide (PaCO₂), lactate (Lac) concentration, superior vena cava oxygen saturation (ScvO₂), superior vena cava carbon dioxide pressure (PcvO₂) and central venous-to-arterial carbon dioxide tension difference (Pcv-aCO₂) were measured by a blood-gas-analyzer before 10 minutes and after 3 hours of dosing.

Heart rate and cardiac index decreased significantly at 3 hours post-dosing compared with that at pre-dosing ( (91±13) vs (114±15) beats per minute, (3.4±0.7) vs (4.2±0.8) L·min^-1·m-2, P<0.05), but systolic blood pressure, diastolic blood pressure, central venous pressure,pulmonary wedge pressure, pulmonary vascular resistance index, systemic vascular resistance index and stroke index showed no significant changes ( (100±13) vs (108±14) mm Hg (1 mm Hg=0.133 kPa), (62±7) vs (64±6) mm Hg, (11.8±2.5) vs (12.1±2.4) mm Hg, (13±5) vs (14±4) mm Hg, (201±72) vs (179±95) dyn·s/(cm⁵·m²), (1360±520) vs (1366±538) dyn·s/(cm⁵·m²), (40±9) vs (38±6) ml/ (beat·m²), all P>0.05).ScvO₂, Lac and Pcv-aCO₂also showed no significant change ((72.8±5.3)% vs (70.1±4.0)%, (2.11±0.13) vs (2.31±0.23) mmol/L, (3.9±1.0) vs (4.5±0.8) mm Hg, all P>0.05).

Adrenergic beta-1 antagonist may reduce cardiac output in proportion to the percentage decreases in heart rate in severe septic patients without adverse effects upon cardiac function and systemic perfusion.

To analyze the characteristics of sleep structure, heart rate and arousal index (ArI) in children with primary snoring (PS) and mild, moderate or severe obstructive sleep apnea hypopnea syndrome (OSAHS).

A total of 113 children with sleep disorders were enrolled from January 2010 to March 2012 at Affiliated Children′s Hospital, Capital Institute of Pediatrics.All of them underwent polysomnogram (PSG) and the data were analyzed statistically by SPSS 19.0.

(1) No statistical difference existed in age, sleeping time or sleeping efficacy between PS and all OSAHS groups (all P>0.05). (2) The proportion of stageⅠsleeping was 2.6%±1.4% in PS group, 5.4%±3.2% in mild OSAHS group, 4.7%±1.9% in moderate OSAHS group and 8.9%±4.0% in severe OSAHS group (F=6.542, P=0.000).The proportion of stageⅣsleeping was 25.3%±5.6% in PS group, 32.4%±11.1% in mild OSAHS group, 30.6%±9.0% in moderate OSAHS group and 21.4%±10.8% in severe OSAHS group (F=7.544, P=0.000).The proportion of stage rapid eye movement (REM) sleeping was 21.1%±8.6% in PS group, 13.9%±4.0% in mild OSAHS group,14.5%±4.9% in moderate OSAHS group and 12.3%±6.9% in severe OSAHS group (F=11.204,P=0.000).The proportion of stageⅡandⅢsleeping had no statistical difference among four groups. (3) The average heart rate in stage REM sleeping of four groups was (85±11), (90±14), (95±10) and (101±18) beats per minute (F=6.452, P=0.000) and (79±10), (84±14), (86±7) and (93±16) beats per minute in stage NREM sleeping (F=5.369, P=0.002). (4) In four groups, the difference of total count of spontaneous arousal, the spontaneous arousal count in stage REM and non-rapid eye movement (NREM) sleeping were all statistically significant (F=56.379, 60.781, 44.061, all P=0.000).And the difference of total count of respiratory arousal, the median of respiratory arousal count in stage REM and NREM sleeping were all statistically significant (F=79.250, 36.137, 65.239, all P=0.000).Conclusions Heart rate is affected more obviously in moderate-severe OSAHS children.As compared with PS counterparts, OSAHS children had a reduction of spontaneous arousal and an increase of respiratory arousal.But the occurrence of spontaneous arousal of OSA HS children does not decrease with the progress of OSA HS in either stage REM or stage NREM.

To compare the efficacy of renal arterial sympathetic denervation (RSD) and continuous positive airway pressure (CPAP) in patients with coexisting moderate-to-severe obstructive sleep apnea syndrome (OSAS) and hypertension.

Retrospective analysis was conducted for patients with coexisting moderate to severe OSAS and hypertension for the efficacy of RSD (RSD group, n=15) and CPAP (CPAP group, n=16).Comparison was made for polysomnographic parameters and 24 hours ambulatory blood pressure (Bp) between two groups.

There was no significant difference in age, gender, body mass index, nocturnal apnea hypopnea index (AHI), mean and minimal pulse oxygen saturation (meanSpO₂ and miniSpO₂) between two groups.Compared with those at pre-treatment, the following changes were observed at Day 30 post-treatment:in RSD group, the nocturnal AHI and T90 statistically decreased (27±14 vs 32±12, 8.7%±7.8% vs 13.8%±13.1%, all P<0.05) with a significant increase in meanSp₂ (94.3%±2.2% vs 93.9%±2.0%, P<0.05) while miniSpO₂ showed no significant difference (80.1%±6.2% vs 79.5%±4.7%,P>0.05) |in CPAP group during treatment,nocturnal AHI and the ratio of duration SpO₂<90% to total sleep time (T90) were all significantly reduced (5±3 vs 35±12, 1.5%±1.2% vs 12.9%±6.3%, all P<0.05) while meanSpO₂ and miniSpO₂ became significantly elevated (95.6%±1.4% vs 93.6%±1.7%,89.2%±2.7% vs 79.1%±4.0%,all P<0.05).Compared with RSD group, there was a significantly lower AHI (P=0.000) but higher meanSpO₂ and miniSpO₂ (all P<0.05) at Day 30 in CPAP group.At Day 30 in RSD and CPAP groups, the mean systolic blood pressure (MSBp) were (122±9) and (130±12) mm Hg (1 mm Hg=0.133 kPa) respectively while the mean diastolic blood pressure (MDBp) (80±8) and (83±7) mm Hg respectively.All these were significantly lower than those at pre-treatment with MSBp (134±20) mm Hg and MDBp (88±14) mm Hg in RSD group and MSBp (136±14) mm Hg and MDBp (87±7) mm Hg in CPAP group.The extent of decrease in MSBp post-treatment was more remarkable in RSD group than that in CPAP group (P<0.05).

In moderate-tosevere OSAS patients with hypertension, both RSD and CPAP may improve sleep respiratory parameters and blood pressure to varying degrees.There is a more significant improvement of nocturnal AHI and SpO₂ in CPAP group and more lower MSBp in RSD group.

Epithelial-mesenchymal transition (EMT) has been implicated in the initiation and conversion of early stage tumors into invasive malignancies and is associated with the"stemness" of cancer cells.The present study was designed to identify whether EMT induces cancer stem cell generation and tumor progression in human thyroid cancer cells in vitro.

FTC133 cells, as EMT-negative cells, were used for EMT induction by hypoxia-inducible factor-1α (HIF-1α) transfection.And EMT features were then examined by Western blot,immunofluorescent staining,invasion and proliferation assays.Moreover, stem-like side population (SP) cells were sorted with flow cytometry from FTC133 cells before and after EMT.The proportion of SP was compared and stemness,self-renewal and tumorigenecity in vitro were identified in SP cells.

Overexpression of HIF-1α induced FTC133 cells to undergo EMT.And it down-regulated epithelial marker E-cadherin, up-regulated mesenchymal marker vimentin and caused nucleus translocation ofβ-catenin and highly invasive and metastatic properties.Most importantly, the induction of EMT promoted proportion of stem-like side population cells (0.70% vs 0.03%, P<0.05) with higher sphere formation and clone forming capability in contrast to non-side population cells.

EMT can induce cancer stem cell generation and tumor progression in thyroid cancers.Further understanding the role of EMT and cancer stem cells in cancer progression may reveal new preventive and therapeutic targets for thyroid cancers.