Significance of radiologic extranodal extension in locoregionally advanced nasopharyngeal carcinoma with lymph node metastasis: a comprehensive nomogram

Abstract Objective We aimed to assess the significance of rENE and creat a predictive tool (nomogram) for estimating Overall Survival (OS) in locoregionally advanced Nasopharyngeal Carcinoma (NPC) patients with Lymph Node Metastasis (LNM) based on their clinical characteristics and Radiologic Extranodal Extension (rENE). Methods Five hundred and sixty-nine NPC patients with LNM were randomly divided into training and validation groups. Significant factors were identified using univariate and multivariate analyses in the training cohort. Then, the nomogram based on the screening results was established to predict the Overall Survival (OS). Calibration curves and the Concordance index (C-index) gauged predictive accuracy and discrimination. Receiver Operating Characteristic (ROC) analysis assessed risk stratification, and clinical utility was measured using Decision Curve Analysis (DCA). The nomogram's performance was validated for discrimination and calibration in an independent validation cohort. Results A total of 360 (63.2%) patients were present with radiologic extranodal extension at initial diagnosis. Patients with rENE had significantly lower OS than other patients. Multivariate analysis identified the five factors, including rENE, for the nomogram model. The C-index was 0.75 (0.71-0.78) in the training cohort and 0.76 (0.69-0.83) in the validation cohort. Notably, the nomogram outperformed the 8th TNM staging system, as evident from the higher AUC values (0.77 vs. 0.60 for 2 year and 0.75 vs. 0.65 for 3 year) and well-calibrated calibration curves. Decision curve analysis indicated improved Net Benefit (NB) with the nomogram for predicting OS. The log-rank test confirmed significant survival distinctions between risk groups in both training and validation cohorts. Conclusions We demonstrated the prognostic value of rENE in nasopharyngeal carcinoma and developed a nomogram based on rENE and other factors to provide individual prediction of OS for locoregionally advanced nasopharyngeal carcinoma with lymph node metastasis. Level of evidence: III.

Relatively anterior lens position in primary angle-closure glaucoma eyes with long axial length

Purpose: To evaluate the refractive status and ocular biometric parameters in primary angle?closure glaucoma (PACG) eyes with different axial lengths (ALs). Methods: In total, 742 Chinese PACG subjects with complete ophthalmic examinations were enrolled. The refractive status was categorized as myopia (spherical equivalent [SE] ??0.5 D), emmetropia (?0.5 D < SE < +0.5 D), and hyperopia (SE ?+0.5 D), whereas the AL was divided into short (AL <22.5 mm), regular (22.5 ? AL <23.5 mm), and long (AL ?23.5 mm). The refractive status and ocular biometric parameters were compared among different AL groups. Results: The mean AL of the PACG eyes was 22.53 ± 0.84 mm (range: 19.68–25.57 mm). The refractive status was significantly different among different AL groups (P < 0.001). Also, 92.6% of hyperopic PACG eyes showed AL <23.5 mm, and 19.0% of myopic PACG eyes showed AL ?23.5 mm. The SE showed significant differences among different AL groups only in the hyperopic subjects (P = 0.012). The AL was significantly longer in myopic eyes (P < 0.001). The PACG eyes with longer AL exhibited lower keratometry, longer central anterior chamber depth and corneal diameter, and lens position and relative lens position closer to the anterior (P < 0.001). Conclusion: Axial hyperopia was common in PACG eyes, and axial myopia was not uncommon. Relatively anterior lens position could explain the occurrence of PACG in the eyes with long AL.

Determinants of awareness of prevention and control of Norovirus outbreak among primary and middle school staffs in the Pearl River Delta region, Guangdong / 中国学校卫生

Objective@#To investigate factors associated with awareness of prevention and control of Norovirus outbreak among primary and middle school staffs in the Pearl River Delta region，to provide evidence for Norovirus outbreaks prevention and control.@*Methods@#A total of 320 primary and middle school staffs from 48 schools in 3 cities in the pearl river delta region were selected by multistage quota random sampling method and were interviewed face to face with questionnaire about knowledge of Norovirus and prevention and control of Norovirus outbreaks.@*Results@#The awareness rate of Norovirus knowledge and prevention and control of Norovirus outbreaks among primary middle school and the total school staffs in the pearl river delta region were 35.37%,57.63% and 48.42%,respectively. The results of univariate analysis showed that the awareness rate of prevention and control of Norovirus outbreaks was significantly affected by duties, the total awareness rate among teachers(OR =0.22，95%CI=0.09-0.55),cooks(OR=0.09，95%CI=0.04-0.23)and cleaners(OR=0.02，95%CI=0.00-0.07)were far lower than school doctors(P<0.05).@*Conclusion@#The awareness of prevention and control of Norovirus outbreak among primary and middle school staffs in the Pearl River Delta region was needed to be improved. Valid implements, such as operation procedure, to build up prevention and control capability should be carried out that focus on specific job responsibilities.

N-myc downstream-regulated gene 1 as a downregulated target gene of PTEN in the controlling of tumourigenesis in endometrioid carcinoma.

BACKGROUND & OBJECTIVE: Mutation/deletion of PTEN has been known to be involved in the development of many cancers including endometrial carcinoma. NDRG1 (N-myc downstream-regulated gene 1) is reported to be associated with tumourigenesis. PTEN expression has been shown to be correlated with NDRG1 in both prostate and breast cancer. In this study, we explored the possibility that PTEN alteration may cause carcinogenesis of endometrioid carcinoma by regulating the expression of the NDRG1 gene. METHODS: Tissue blocks of 103 patients with pathologically confirmed endometrioid carcinoma were included. All the carcinoma tissues were accompanied with varied degree of necrosis. Using two-step method and avidin-biotin peroxidase complex immunohistochemistry method, the correlation of the two genes expression in ischaemic area and the relationship of NDRG1 expression between ischaemic and non-ischaemic area in endometrioid carcinomas was evaluated. RESULTS: PTEN alteration and NDRG1 expressions were significantly increased in the ischaemic area of endometrioid carcinoma compared with their expressions in the normal endometrium respectively (P<0.001, P<0.001). A positive correlation was found between PTEN alteration and NDRG1 expression in the ischaemic area of endometrioid carcinoma. INTERPRETATION & CONCLUSION: We suggest that NDRG1 may be an important candidate gene in facilitating endometrium carcinogenesis in the adaptation of hypoxia for survival. Alteration of PTEN may upregulate NDRG1 expression, which plays an important role in the process leading to endometrial carcinogenesis.

The role of IGF-1 gene expression abnormality in pathogenesis of diabetic peripheral neuropathy / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To explore the role of insulin-like growth factor 1 (IGF-1) gene expression abnormality in neurotrophic causes of diabetic peripheral neurophathy.</p><p><b>METHODS</b>Diabetes was induced in Sprague Dawley rats by alloxan. The parameters were measured as follows: IGF-1 mRNA by revere transcriptase-polymer chain reaction (RT-PCR); IGF-1 peptide by enzyme-linked immunosorbent assay (ELISA); electrophysiological parameters of nerves by evoked electromyogram; morphometric evaluation of sciatic nerves under light microscope and transmission electron microscope.</p><p><b>RESULTS</b>During early diabetic stage, IGF-1 mRNA [(0.430+/-0.031) vs. (0.370+/-0.016), P<0.01, (0.430+/-0.031) vs. (0.280+/-0.010), P<0.001, respectively], IGF-1 peptide contents [(38.44+/-3.60) ng/mg vs. (30.06+/-2.41) ng/mg, P<0.01, (38.44+/-3.6) ng/mg vs. (3.71+/-2.70) ng/mg P<0.001, respectively] in sciatic nerve tissue reduced in diabetic rats with hyperglycemia and varied with severity of state when compared with non-diabetic control rats, and further gradually down-regulated in the diabetic rats with duration of diabetes [IGF-1 mRNA (0.320+/-0.021) to approximately (0.230+/-0.060); IGF-1 peptide (28.80+/-3.30) to approximately (19.51+/-1.80) ng/mg]. Furthermore, they correlated with nerve functional (sensory nerve conduction velocity: r=0.741, P<0.001; amplitude of evoked potential: r=0.716, P<0.001, respectively) and structural abnormality (axonal area r=0.81, P<0.001) of sciatic nerve. No difference was found in the above parameters between diabetic rats with euglycemia and non-diabetic control group.</p><p><b>CONCLUSION</b>IGF-1 gene expression in tissues was down-regulated from early diabetic stage, and varied with the severity and duration of diabetic state. The decrement in IGF-1 level might contribute to the initiation and development of diabetic neuropathy via autocrine or paracrine pathway.</p>