Notch Signaling Promotes Proliferation and Migration of SW982 Synovial Sarcoma Cells / 中国医科大学学报

Objective To investigate the effect of the Notch signaling pathway on the proliferation and invasion of human SW982 synovial sarcoma cells. Methods SW982 cells and normal human synovial cells were routinely cultured, and the expression of proteins related to the Notch pathway was compared. The Notch signaling pathway was manipulated by NICD1 overexpression, CFB1 shRNA lentivirus, and the γ-secretase inhibitor, DAPT. CCK-8 and wound healing assays were carried out to investigate the role of the Notch signaling pathway in SW982 cells. Results The Notch signaling pathway clearly showed higher activity in human SW982 synovial sarcoma cells than in normal human synovial cells (P ＜ 0.05). The proliferation and invasion of SW982 cells were significantly upregulated by overexpressing NICD1; however, were suppressed by downregulating the Notch signaling pathway using CFB1 shRNA or DAPT (P ＜ 0.05). Conclusion Our findings demonstrate that the proliferation and invasion of human SW982 synovial sarcoma cells are dependent on Notch signaling pathway activity.

Anlotinib hydrochloride capsules for advanced soft tissue sarcoma: single-center data analysis of a stageⅡmulticenter clinical trial / 中国肿瘤临床

Objective: To investigate the efficacy and safety of anlotinib hydrochloride capsules for the treatment of advanced soft tissue sarcoma based on the data from Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital&Institute. Methods: Patients were randomized allocated at 2:1 ratio for the anlotinib treatment and placebo group. The treatment group received 12 mg/day of anlotinib for 14 consecutive days in a 21-day cycle. The primary end-point was progression-free survival (PFS), and the secondary end-points were disease control rate (DCR), overall survival (OS), and adverse event rate. Results: A total of 46 patients were enrolled in this study; 7 of them were excluded from per protocol set (PPS). Among the remaining 39 patients, 28 were included in the anlotinib group and 11 in the placebo group. In the anlotinib group, 4 patients had partial remission and 13 had stable disease (SD), whereas in the placebo group, 3 patients had SD. The difference in DCR between the 2 groups was statistically significant (60.7% vs . 27.3%, P=0.082). The DCR of the advanced soft tissue sarcoma in the anlotinib group was 78.6% (11/14). The median PFS in the anlotinib group was 12.4 (95% confidence interval [CI]: 7.6 to 17.2) months, which was significantly longer than 4 months in the placebo group (95% CI: 1.7 to 6.3 months, P=0.043); however, the difference in OS between the 2 groups was not significant (19.4 vs . 17.6 months, P=0.961). Regarding the safety, 2 patients had severe adverse events (7.14%) possibly related with treatment in the anlotinib group; one of them had pneumothorax. The other adverse events were grade 1 to 2. Conclusions: Soft tissue sarcoma is highly responsive to anlotinib, with prolonged PFS. Anlotinib is well tolerated and can be used as a treatment option for advanced soft tissue sarcoma.

Notch signaling pathway regulates osteosarcoma stem cell characteristics by inhibiting Eph pathway / 中华骨科杂志

Objective To investigate the role of Notch signaling pathway to maintain the stem cell-like characteristics of osteosarcoma and its underlying mechanism.Methods Lentiviral NICD1 or Numb-shRNA was transduced into MG63 osteosarcoma cells to activate Notch activity in vitro.The impact of Notch on osteosarcoma stem cells were assessed by the tumor sphere formation assay and flow cytometry analysis of cell surface markers STRO-1/CD117.The expression of stem cell related genes (Sox2,Oct4) were evaluated by Western blot and qPCR.The nude mice were randomly divided into 3 groups:the NICD1 overexpression (NICD-OE) group,the DAPT group and the control (CON) group.The tumor growth was monitored for 8 weeks and the tumor volume and weight were recorded weekly.To investigate whether Notch regulates Eph pathway,Eph pathway related protein EphB,pEphB was measured by Western blot.The impact of ephrinB 1 on NICD overexpression cell were assessed by tumor sphere formation assay.The expression of Sox2 and Oct4 was evaluated by Western blot.Results NICD1 overexpression or Numb-shRNA increased the activity of Notch pathway.The Notch-activated osteosarcoma showed enhanced in vitro tumor spheroid formation capacity,increased Stro-1/CD117double positive ratio,and upregulated expression of Sox2 and Oct4 in vitro.In animal experiments,it was found that activation of Notch pathway promoted tumor formation in vivo and Notch inhibition decreased it.The primary osteosarcoma cells were obtained from mice xenograft treated with DAPT and its tumor sphere formation capacity was significantly reduced.Finally,The Notch pathway inhibits the phosphorylation of EphB,as well as the downstream signal pathway of EphB,but there is no significant change in total EphB.The activation of Eph pathway inhibited Notch induced up-regulation of tumor sphere formation and Sox2 and Oct4 expression.Conclusion Notch signaling pathway maintains the stem cell-like characteristics of osteosarcoma probably by inhibiting the Eph pathway.

Clinical features and prognosis of 25 cases of soft tissue sarcoma with soft tissue me-tastasis / 中国肿瘤临床

Objective:To explore the outcome of soft tissue sarcoma (STS) on patients with soft tissue metastasis. Methods:We ana-lyzed 25 STS patients with soft tissue metastasis primarily localized on extremity and trunk. The study was conducted from June 2010 to June 2016 by retrospective analysis of the clinical and pathological characteristics of the patients. The assessed endpoints were overall survival. Results:Six patients (24%) had synchronous soft tissue metastasis, and 19 patients (76%) had metachronous metasta-sis. The average time for primary tumor recession of metastatic lesions was 45.3 months. Metastases were most common in parts of the trunk in 18 patients (72%), followed by the head and neck in 5 patients (20%). Eleven patients (44%) with lung metastasis had poor prognosis. Conclusion:STS occurred more rarely in soft tissue metastasis than in pulmonary metastasis. Neoadjuvant chemotherapy and surgical treatment were the major therapies employed. Targeted therapy as a new treatment rendered good results.

Present perceptions and trends of surgical margin in soft tissue sarcoma in limbs and trunk / 中国肿瘤临床

Limb salvage surgery with comprehensive treatment is the standard care for soft tissue sarcoma in the limbs and trunk. Marginal status is a key factor in determining the quality of surgical treatment, as well as in guiding the selection of adjuvant therapies. The goal of surgery is to obtain an appropriately negative margin, although no consensus exists regarding the adequate thickness of normal tissue cuff. With the development of auxiliary treatments, surgery for soft tissue sarcoma is becoming less extensive. Marginal resection combined with adjuvant therapies may be necessary to preserve limb functions when the tumor is close to critical vessels, nerves, or bones. When preparing the preoperative plans, additional considerations should include histologic type, location, presence of barriers, and response to adjuvant therapies.

Low-dose methotrexate combined with vinorelbine for inoperable desmoid tumor: efficacy and the prognostic factors / 南方医科大学学报

<p><b>OBJECTIVE</b>To characterize the clinical features of desmoid tumor, assess the efficacy of conservative chemotherapy for inoperable desmoid tumor and analyze the prognostic factors.</p><p><b>METHODS</b>From August 2009 to December 2013, 52 patients with inoperable desmoid tumor were treated in our department and received chemotherapy with vinorelbine combined with low-dose methotrexate. The clinical data of the patients were analyzed retrospectively.</p><p><b>RESULTS</b>The patients studied included 22 male and 30 female patients with the age of disease onset ranging from 2 to 46 years (mean 18.7 years). The lesions occurred most frequently in the lower limbs (36.5%, 19/52) and the tumor size ranged from 2.7 to 37 cm (mean 9.5 cm). The patients were followed up for a median of 29 months (7 to 64 months). The chemotherapy lasted for 4 to 30 months (median 12 months). After completion of the chemotherapy, 1 patient had a complete response (CR), 18 showed partial responses (PR), 27 cases had stable disease (SD), and 6 had progressive disease (PD), with an overall response rate (ORR) of 88.5%. The progression-free survival (PFS) time of the patients ranged from 4 to 63 months (median 26.5 months) with a 2-year PFS rate of 76.7% and 5-year PFS rate of 41.9%. A longer chemotherapy duration (over 12 months) was associated with a more favorable prognosis. No significant differences in PFS were found between the patients stratified by gender, age of disease onset, age when receiving chemotherapy, tumor site, or tumor size.</p><p><b>CONCLUSION</b>For recurrent, inoperable and progressive desmoid tumor, long enough cycles of vinorelbine combined with low-dose methotrexate can be an effective and safe option for tumor control.</p>

External Fixation Using Femoral Less Invasive Stabilization System Plate in Tibial Proximal Metaphyseal Fracture

BACKGROUND: The locking plates are often used for internal fixation of closed tibial fractures. The use of a locking plate as an external fixator is still controversial, particularly for closed fractures. The purpose of this study is to evaluate the results of external fixation using the femoral less invasive stabilization system (LISS) plate in proximal metaphyseal fractures of the tibia. METHODS: We prospectively evaluated 35 patients (26 males and 9 females) with a mean age of 42 years (range, 21 to 62 years) who presented with fresh tibial proximal metaphyseal fractures. According to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, the fractures were identified as type 41-A2 in 18 cases and type 41-A3 in 17 cases, including 25 closed fractures and 10 open fractures. The femoral LISS plate was used to fix these fractures, which was placed on the anteromedial aspect of the tibia as an external fixator. The mean follow-up period was 18 months (range, 13 to 22 months). RESULTS: All fractures healed in a mean time of 14 weeks (range, 10 to 20 weeks). There was no case of nonunion, deep infection, and loosening of screws and plates. One month after the appearance of cortical bridging on biplanar radiographs, the locking plate was removed within 3 minutes in the clinic without any difficulty. According to the Hospital for Special Surgery (HSS) knee scoring system and American Orthopaedic Foot & Ankle Society (AOFAS) ankle scoring system, the mean HSS score was 91 (range, 85 to 100) and 98 (range, 93 to 100), and the mean AOFAS score was 94 (range, 90 to 100) and 98 (range, 95 to 100) at 4 weeks postoperatively and final follow-up, respectively. CONCLUSIONS: For proximal metaphyseal fracture of the tibia, external fixation using the femoral LISS plate is a safe and reliable technique with minimal complications and excellent outcomes. Its advantages include ease of performing the surgery, use of a less invasive technique, and convenience of plate removal after fracture healing.

Human electrocardiogram changes caused by exposure to arsenic through drinking water / 中华地方病学杂志

Objective Through studying the relationship between different concentrations of arsenic in drinking water and ECG changes,to investigate the effects of arsenic on human cardiovascular system.Methods During 2008-2013,people that over 20 years old and over 10 years of drinking arsenic water were investigated in 15 villages of Shanxi Province and Inner Mongolia according to the historical data of endemic arsenic poisoning through drinking water,who were divided into control group (＜ 0.01 mg/L),low arsenic group (0.01-＜ 0.05 mg/L),medium arsenic group (0.05-＜ 0.10 mg/L) and high arsenic group (≥0.10 mg/L) according to the concentration of water arsenic.Arsenic concentrations in drinking water samples were detected by the method of hydride generation atomic fluorescence spectrometry.ECG-site inspections were finished to record 12-lead ECG.The effect of different concentrations of arsenic in drinking water on ECG was studied.Results ECG of 1341 people were surveyed,and abnormal rate was 11.56％ (155/1 341),including abnormal rate of control group,low arsenic group,medium arsenic group and high arsenic group which was 5.7％ (9/158),12.85％ (59/459),12.02％ (28/233),and 12.02％ (59/491),respectively.The abnormal rate of control group was lower than that of low arsenic group,medium arsenic group and high arsenic group (x2 =6.141,4.391,5.090,all P ＜ 0.05).ECG changes were characterized by cardiac arrhythmias and ST-T changes.A variety of arrhythmias abnormal rate of control group [0(0/158)] was lower than that of low arsenic group,medium arsenic group and high arsenic group [4.58％ (21/459),3.86％ (9/233),3.46％ (17/491); x2 =7.483,6.247,5.618,all P ＜ 0.05].In addition,there were significant differences among the four groups in the rates of right ventricular enlargement and myocardial ischemia (x2 =9.525,9.848,all P ＜ 0.05).Conclusions ECG changes of the residents in the areas of water-borne-endemic arsenic poisoning are characterized by cardiac arrhythmias and ST-T changes.Water arsenic concentration exceeding 0.01 mg/L could significantly increase the ECG abnormal rate,indicating that arsenic in drinking water has a certain effect on heart tissue.

Analysis of prognostic factors and the effect of adjuvant radiother-apy and chemotherapy for liposarcoma of the extremities / 中国肿瘤临床

Objective:To analyze the clinical prognostic factors of liposarcoma on the extremities and trunk, as well as to retrospectively analyze the effect of adjuvant radiotherapy and chemotherapy on liposarcoma of the extremities. Methods:Patients with liposarcoma of the extremities treated in our hospital from July 1, 2007 to December 31, 2012 were followed up. The relationship of clinical prognostic factors with gender, age, location, depth, and size of the tumors, as well as the histological grade and admission status, were statistically analyzed. The effects of adjuvant radiotherapy or chemotherapy on overall survival (OS) and disease free survival (DFS) were evaluated. Results:A total of 82 patients with extremity liposarcoma received surgery-based comprehensive treatment in our hospital. Of the total patients, 73 received a 24-month to 88-month satisfied follow-up;the median follow-up time was 47 months. The OS rate was 83.6%(61/73), and the DFS rate was 68.5%(50/73). Multivariate Cox regression analysis showed that the tumor location, histological grade, and admission status were the independent correlative factors influencing DFS, and the age and pathologic grading were the independent correlative factors influencing the OS. Kaplan-Meier survival analysis showed that radiation therapy can significantly improve the DFS and OS of the G2 and G3-grade liposarcoma (DFS:59.1 months vs. 28.4 months, P<0.01;OS:70.8 months vs. 55.1 months, P<0.05). Significant difference was not found in the effect of chemotherapy on OS and DFS. Conclusion:The prognosis of liposarcoma was significantly associated with the pathologic grades and subtypes. Auxiliary radiotherapy could improve the survival and prognosis of G2 and G3 liposarcoma of the extremities, but the role of chemotherapy in treating liposarcoma remained unclear.

Current application of sentinel lymph node biopsy in cutaneous malignant melanoma / 中国肿瘤临床

Sentinel lymph node biopsy has a very important function in the accurate staging, diagnosis, and treatment of malig-nant melanoma. The operational technique of sentinel lymph node biopsy (SLNB) has been basically mature, but its indications remain unclear, especially for thin melanomas. Adequate evidence to show that SLNB combined with a complete lymph node dissection can prolong the survival of patients with metastasis is unavailable. Given the low incidence of malignant melanoma in the country, the use of SLNB has not been extensively investigated in China and the relevant methods are outdated. This review summarizes the current ap-plication of SLNB in cutaneous malignant melanoma by analyzing related studies conducted in recent years.

Xenograft and calcium sulphate in treating benign bone tumor / 中国组织工程研究

BACKGROUND:Autologous bone graft is the best method to repair bone defects after tumor curettage, but its shortcomings are as folows: increased surgical trauma, sequelae at bone graft site such as infection and pain, and a limited amount of autologous bone. OBJECTIVE:To analyze the effectiveness of xenograft and calcium sulphate artificial bone in treating bone defects after benign bone tumor removed. METHODS:Totaly 26 cases of benign bone tumor were selected, including 8 cases of giant celltumor, 5 of enchondroma, 4 of fibrous histiocytoma, 3 of bone fibrous dysplasia, 2 of non-ossifying fibroma, 2 cases of bone cysts, 1 of aneurysmal bone cyst and 1 of aneurysmal bone cyst and 1 case of chondroblastoma. Of the 26 cases, 12 cases underwent calcium sulphate pelets alone to fil bone defects after benign bone tumor removed, 6 cases were subjected to xenograft alone, and 8 cases were treated with calcium sulphate pelets combined with xenograft. The X-rays were taken at 1 week, 3 months, and 1 year after the operation in al patients to assess the bone healing process. RESULTS AND CONCLUSION:Al the patients were folowed up for 36-72 months. The absorption of calcium sulphate appeared to be absorbed earlier, the earlier absorption appearance could be observed as earlier as 1 month after the implantation, and most calcium sulphate was absolved and replaced by new bone at 3 months after the operation. The xenograft bone was degraded at 3 months post implantation and new bone formed. Osseo integration of the graft was observed at the periphery of the implant at 6 months post implantation. One year post implantation, trabecular bone was observed at the site with uniform bone density. In the combined group, thecalcium sulphate pelets were absorbed earlier and new bone formed earlier than the calcium sulphate alone group, and the xenograft absorbed later than the calcium sulphate pelets. Generaly, bony union was detectable 1 year after operation. These findings indicate that xenograft and calcium sulphate in treating benign bone tumor have acquired good results, which can be used as a substitute of autologous bone.

Application of sentinel lymph node biopsy assisted by 99Tcm-IT-Rituximab in cutaneous malignant melanoma of limbs / 中国肿瘤临床

Objective:To evaluate the accuracy and feasibility of sentinel lymph node biopsy (SLNB) marked by 99Tcm-IT-Ritux-imab and to discuss the clinical value of the method in diagnosis and treatment of cutaneous melanoma. Methods:A total of 67 patients with cutaneous malignant melanoma received 99Tcm-IT-Rituximab-tagged SLNB from March 2008 to March 2012. Lymphoscintigra-phy was conducted 30 min to 1 h after intra-dermal injection of 99Tcm-IT-Rituximab. Subsequently, the surgery of SLNB was carried out using gamma probe. The detection and positive rates of SLNB were counted. The relationship between the status and the clinical features of the sentinel lymph node (SLN) was analyzed, such as the T stage, ulceration, age, gender, and location. The influence of SLN status on overall survival (OS) and disease-free survival (DFS) was evaluated. Results:SLNs were detected in all the 67 patients by SPECT and gamma detector, with detection rate of 100%. Fifteen patients had SLN metastasis, and the positive rate was 22.4%. Chi-square indicates that SLN metastasis is associated with age, T stage, and ulceration (P<0.05). A total of 63 patients were followed up for 24-69 months, and the median follow up time was 43 months. Kaplan-Meier survival analysis shows that both OS and DFS in the SLN-negative group are better than those in the SLN-positive group (OS:93.9%vs. 57.1%, P<0.01;DFS:79.6%versus 28.6%, P<0.01). Cox-regression multiple factors analysis suggests that both SLN status and T stage are independent factors that affect the DFS of malignant melanoma. Conclusion:SLNB assisted by 99Tcm-IT-Rituximab can well reflect the state of lymph node metastasis and is es-sential for accurate staging, prognosis judging, and treatment guiding. Its operation procedure is simple with high accuracy, and the im-aging status is stable. Therefore, it is convenient and feasible as a means of SLNB.