The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020) / 中华消化外科杂志

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

The clinicopathologic features and prognostic analysis of pancreatic metastasis from clear cell renal cell carcinoma / 中华肿瘤杂志

Objective@#To investigate the clinicopathologic features and prognosis of the patients who had clear cell renal cell carcinoma (CCRCC) with metastasis to the pancreas.@*Methods@#From Jan, 2000 to Dec, 2018, 18 patients with clear cell renal cell carcinoma (CCRCC) and had pathologically diagnosed metastasis to the pancreas were enrolled at Peking Union Medical College Hospital. The clinical and pathological data were retrospectively analyzed.@*Results@#11 out of 18 patients were male, and the other 7 were female. The average age of onset of CCRCC was 51.4 years. 8 cases (44.4%) occurred in the left kidney, and the other 10 cases (55.6%) with right kidney tumor. Three patients had synchronous pancreatic metastasis, and the other 15 patients had metachronous pancreatic metastasis. The median time from CCRCC onset to pancreas metastasis was 156 months. The main complaints of pancreas metastasis were abdominal pain, jaundice, gastrointestinal bleeding, nausea, weakness, loss of weight and so on. Seven patients (38.9%) had single lesion of pancreas, while 11 patients (66.1%) had multiple lesions of pancreas. Nine patients (50%) had other organs metastasis besides pancreatic metastasis at the same time. Five patients underwent pancreatic metastasis resection, while 15 patients received oral tyrosine kinase inhibitor(TKI). The mean follow-up was 171.7 months(1~361.5 months) and 5 patients died. The median overall survival (mOS) was 122 months, and the 5 year-survival rate was 81.4%. In univariate analysis, synchronous metastasis to the pancreas, relapse after 10 years, Memorial Sloan Kettering Cancer Center prognostic index, International Metastatic Renal Cell Carcinoma Database Consortium index were all significant parameters for patients′survival.@*Conclusions@#Metastasis to the pancreas from clear cell renal cell carcinoma were rare. These patients had better survival outcomes, especially those relapsing after ten years. Pancreatic metastasis resection had no significant benefit on patient′s survival.

Characteristics and outcomes of primary angiosarcoma / 中华肿瘤杂志

Objective@#The study was designed to analyze the clinicopanthologic characteristics, treatments and outcomes of a series of patients with primary angiosarcoma.@*Methods@#The clinical, surgical and pathological data and treatment of 68 patients with pathologically confirmed angiosarcoma admitted to Peking Union Medical College Hospital from January 1990 to June 2017 was retrospectively analyzed. Kaplan-Meier method and Log rank test were used for univariate survival analysis and Cox regression model was used for multivariate survival analysis.@*Results@#A total of 68 patients were enrolled, 38 were male, 30 were female. The median age at diagnosis was 50.5 years. The time from symptom onset to diagnosis was (7.5±7.5) months. The primary sites included face and scalp, breast, chest wall, lung, heart, liver, spleen, extremities, bones and so on. At diagnosis, the mean size of tumors were (7.4±7.3) cm, 28 patients (41.2%) had localized disease (stage Ⅰ+ Ⅱ) and 40 patients had metastatic disease (stage Ⅲ+ Ⅳ). There were 37 patients treated with surgery alone, three receiving radiotherapy alone, five receiving chemotherapy alone and sixteen receiving comprehensive treatment with 5 underwent surgery plus radiotherapy, three treated by surgery plus chemotherapy, four had surgery plus interventional therapy, two had chemoradiotherapy, one had radiotherapy and interventional therapy and 1 had surgery plus chemoradiotherapy and targeted therapy. Five patients received only palliative treatment, and 2 patients lost follow-up after diagnosed. Fifty patients were followed up with a median overall survival time of 8.5 months. The median survival time of patients with metastatic angiosarcoma was 6.6 months, significantly shorter than that of patients with localized disease (15.0 months, P=0.020). The median survival time of patients with cardiac angiosarcoma was 3.0 months, significantly shorter than that of patients with angiosarcoma at other sites (11.5 months, P=0.010). The median survival time of patients receiving comprehensive treatment was 31.0 months, significantly longer than that of patients without comprehensive treatment (5.6 months, P=0.007). Multivariate analysis showed that staging, heart occurrence and comprehensive treatment were independent factors for the prognosis of primary angiosarcoma (all P<0.05).@*Conclusions@#Angiosarcoma is a rare malignancy, and patients with metastatic disease or cardiac occurence have poor prognosis. Comprehensive treatment can improve the prognosis of patients with angiosarcoma.

Clinical and radiologic characteristics as well as outcomes of patients with primary cardiac angiosarcoma / 中华心血管病杂志

Objective@#To analyze the clinical, radiologic characteristics, and outcome of consecutive patients with primary cardiac angiosarcoma.@*Methods@#The medical records of patients with primary cardiac angiosarcoma diagnosed through pathology at Peking Union Medical College Hospital between January 2001 and May 2018 were obtained. The results of echocardiography, coronary artery CT angiography (CTA), cardiac magnetic resonance (CMR), positron emission computed tomography (PET-CT), operation, postoperative treatment and prognosis of the patients were analyzed.@*Results@#A total of 16 patients were included, 9 were male, 7 were female, the median age was 42.5 years (31.7, 52.5). The interval from symptoms onset to diagnosis was 4.5 months (0.5-18.0 months). Eight patients were diagnosed at non-metastatic phase, while 8 patients were in metastatic phase. The main complaints were dyspnea, short breath, chest pain, hemoptysis, syncope, edema, fever, fatigue, and cough. Three patients (18.8%) had pericardial tamponade in the course of the disease. Echocardiography was performed on all 16 patients, cardiac mass was found in 12 patients, and pericardial effusion or pericardial thickening was observed in 4 patients. In 8 cases with results of coronary CTA, 5 cases presented signs of right atrium occupation, 1 case presented sign of right ventricle occupation, and 1 case presented isolated massive pericardial effusion. None abnormality was found in 1 case. Of the 7 patients who underwent CMR, 6 presented with right atrium mass occupation and 1 mediastinal mass. Four patients received PET-CT examination and results showed that all presented with hypermetabolic lesions: 2 in right atrium, 1 in pericardium, and 1 in mediastinum, and lung metastasis was found in 2 cases. Among the 16 patients, 13 received surgical treatment, 2 received adjuvant chemotherapy, and 1 received chemotherapy and radiotherapy after biopsy. The median overall survival was 3.0 months.@*Conclusion@#Cardiac angiosarcoma is a rare malignancy with poor prognosis, and echocardiography has only limited diagnostic value for angiosarcoma. CMR, CTA or PET-CT examinations could provide valuable clues for the diagnosis of this rare disease.

Human Gut Microbiota and Gastrointestinal Cancer / 基因组蛋白质组与生物信息学报·英文版

Human gut microbiota play an essential role in both healthy and diseased states of humans. In the past decade, the interactions between microorganisms and tumors have attracted much attention in the efforts to understand various features of the complex microbial communities, as well as the possible mechanisms through which the microbiota are involved in cancer prevention, carcinogenesis, and anti-cancer therapy. A large number of studies have indicated that microbial dysbiosis contributes to cancer susceptibility via multiple pathways. Further studies have suggested that the microbiota and their associated metabolites are not only closely related to carcinogenesis by inducing inflammation and immune dysregulation, which lead to genetic instability, but also interfere with the pharmacodynamics of anticancer agents. In this article, we mainly reviewed the influence of gut microbiota on cancers in the gastrointestinal (GI) tract (including esophageal, gastric, colorectal, liver, and pancreatic cancers) and the regulation of microbiota by diet, prebiotics, probiotics, synbiotics, antibiotics, or the Traditional Chinese Medicine. We also proposed some new strategies in the prevention and treatment of GI cancers that could be explored in the future. We hope that this review could provide a comprehensive overview of the studies on the interactions between the gut microbiota and GI cancers, which are likely to yield translational opportunities to reduce cancer morbidity and mortality by improving prevention, diagnosis, and treatment.

Effect of Human Hepatocellular Carcinoma HepG2 Cell-derived Exosome on the Differentiation of Mesenchymal Stem Cells and Their Interaction / 中国医学科学院学报

Objective To investigate the effect of human hepatocellular carcinoma HepG2 cell-derived Exosome on the differentiation of mesenchymal stem cells(MSC)into cancer-associated myofibroblasts(CAF)and the impacts of CAF on liver cancer cell proliferation,migration,and invasion. Methods The protein expression of HepG2 cell-derived Exosome was detected by Western blotting. MSCs were separated from human adipose tissue and cultured with HepG2 cell-derived Exosome(100 ng/nl)to initiate differentiation. The expressions of mesenchymal markers and several interleukins were also detected by Western blotting. HepG2 cells were co-cultured with the conditioned media(CM),in which HepG2 Exosome induced the differentiation of MSC into CAF. The expressions of epithelial and mesenchymal markers were detected by real-time polymerase chain reaction(PCR)and Western blotting. Cell proliferation was assessed using MTS assay. Transwell chambers were used in the in vitro migration and invasion assay. Results HepG2 cell-derived particles expressed CD63,70 kilodalton heat shock proteins,and 90 kilodalton heat shock proteins. With the treatment of HepG2 cell-derived Exosome,the expressions of mesenchymal marker α-smooth muscle actin,fibroblast activation protein α,interleukin(IL)-6,IL-8,and IL-1β were up-regulated,while vascular endothelial growth factor had no significant change. The conditioned media which HepG2 Exosome induced MSC differentiation CAF(CAF-CM)could significantly promote HepG2 cells proliferation(1.075±0.104),compared to BSA control(0.874±0.066,P=0.023)and MSC-CM(0.649±0.034,P=0.0005). CAF-CM could significantly enhance cell migration [(42.5±9.1) cells vs.(18.5±3.1) cells,P=0.001] and invasion [(29.0±3.5) cells vs.(13.1±3.7) cells,P=0.009] compared to its control group. Moreover the conditioned medium which HepG2 Exosome induced MSC to differentiate into CAF could also promote the expressions of mesenchyme-related genes Smad interacting protein 1(P=0.040),β-catenin(P=0.038),fibronectin(P=0.029),and Vimentin(P=0.013)and inhibit the expression of epithelial related genes zonula ocdudens-1(P=0.010).Conclusions Exosome extracted from HepG2 cells can induce human adipose-derived MSC to differentiate into cancer-associated myofibroblasts. CAF-like cells can promote the migration of the liver cancer cell line HepG2.

Expression of microtubule-associated protein 2 correlates with better prognosis of pancreatic neuroendocrine tumors / 中国肿瘤临床

Objective: To determine whether microtubule-associated protein 2 (MAP2) and microtubule-associated protein 1B (MAP1B) could be prognostic biomarkers for patients with pancreatic neuroendocrine tumors (PNETs). Methods:With immunohisto-chemical staining, the expressions of MAP2 and MAP1B were examined in 193 and 120 primary tumors and peritumoral tissues, re-spectively. Then, the relationship between the expression of each protein and clinicopathological characteristics, including prognosis was analyzed. Results:MAP2 and MAP1B were expressed in 88 of 193 (45.6%) and 77 of 120 (64.2%) tumors, respectively. The expres-sion of MAP2 was significantly associated with the favorable overall survival of patients with PNETs (P=0.012). Moreover, MAP2 expres-sion was associated with the improved overall survival in a subset of patients with stageⅡand stageⅢtumors (P=0.017). The MAP1B expression did not correlate with other clinicopathological features and prognosis. Conclusion:MAP2 could be a novel, independent prognostcbiomarker for PNETs.

Diagnostic value of cerebral perfusion SPECT/CT combined with brain MRI in patients with ischemic cerebrovascular disease / 中华核医学与分子影像杂志

Objective To evaluate the diagnostic value of cerebral perfusion SPECT/CT combined with brain MRI in patients with ischemic cerebrovascular disease.Methods A total of 107 cases with ischemic cerebrovascular disease from August 2011 to August 2013 (71 males,36 females,age:33-84years) were retrospectively studied,including 31 cases with transient ischemic attack,40 cases with the first onset of cerebral infarction,36 cases with recurrent cerebral infarction.99Tcm-ECD SPECT/CT and brain MRI were performed within 7 d after attack.The interval between the two scans was within 5 d.The number of lesions and detection rate by SPECT/CT,SPECT,MRI,CT,and their combination were calculated respectively,and analyzed using x2 test.Results The detection rate was:SPECT/CT+MRI (97.20％,104/107)=SPECT+MRI (97.2％,104/107) ＞SPECT/CT (95.33％,102/107)＞SPECT (90.65％,97/107) ＞MRI (85.05％,91/107)＞CT (65.42％,70/107).No statistically significant difference was observed between the detection rate of SPECT/CT+MRI and SPECT+MRI,SPECT/CT (x2 =0.17,0.13;both P＞0.05),while there was statistically significant difference between SPECT/CT+MRI and SPECT,MRI,or CT (x2 =4.01,9.76,35.50;all P＜0.05).SPECT/CT detected more ischemic lesions located in brain gray matter and revealed crossed cerebellar diaschisis,while MRI was better for detecting small lacunar lesions in basal ganglia,brainstem and deep white matter.Conclusions SPECT/CT is valuable for the detection of ischemic cerebrovascular disease.hnproved assessment may be achieved by the combination of SPECT/CT and MRI.

Changes of exercise and the clinical effects among eldly non-small cell lung cancer survivors / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>Exercise can improve circulation, muscular strength and happiness of cancer survivors. But more data were needed to demonstrate both the exercise ability of cancer suivivors after pulmonary lobectomy and the influences of exercise on their survivals. The aim of this study was to examine changes of exercise and its clinical effects among eldly non-small cell lung cancer survivors.</p><p><b>METHODS</b>Elderly non-small cell lung cancer survivors who had progression-free disease after surgery, chemotherapy, radiation therapy or tyrosine kinase inhibitors were included. Their exercises and participation rates per week before cancer diagnosis, after 3 months anticancer therapy and 1 year after diagnosis as well as their exercise motivations and prevalences were investigated retrospectively.</p><p><b>RESULTS</b>Forty-eight elderly non-small cell lung cancer survivors were selected. Moderate-vigorous intensity exercise had by the elderly progressin-free non-small cell lung cancer survivors after diagnosis decreased, but the participation rate of light intensity exercise was higher in 1 year after diagnosis than before diagnosis. 75.9% (14/58) patients had exercise up to the standard and the cancer recurrence rate was 20.0% (7/35). The recurrence rate of the other group was 35.7% (5/14), and the risk ratio of recurrence was 2.14 (95% CI: 0.81-5.68, P = 0.26). The most common motivations of exercise were improving health, increasing physical activity, maintaining healthy life style and improving immunity. And the main disturbances were fatigue, discomfort and lack of motivation.</p><p><b>CONCLUSION</b>The exercise participation rate during anticancer treatment among the elderly non-small cell lung cancer survivors decreased and did not return to prediagnosis levels after treatments were completed. The relationship between exercise and recurrence of cancer was not clear and needed further work.</p>

Pulmonary X-ray Signs of Malignant Malaria(An Analysis of 86 Cases) / 实用放射学杂志

Objective To observe the pulmonary X-ray changes of malignant malaria.Methods The chest routine X-ray examination in 86 cases with malaria in company with respiratory tract symptoms such as fever was performed,the pulmonary changes were obsenved.Results Of 86 cases, 58 cases were abnormal on chest filmes,including lung framework marked in 33 cases,miliary,small or large patchy shadow in 24 cases and multiple round opaque mass lesion in one case.Conclusion The pulmonary X-ray changes of malignant malaria are varied,the common characteristic is that most of them are situated at middle and lower portion of the lungs.This may attribute to blood dynamic abnormality resulting from malaria protozoan and the pathological changes of involved tissues.

The Effects of Anticoagulant Proteins Defect in Maternal Plasma on Spontaneous Abortion / 中华围产医学杂志

Objective To investigate the mechanism of anticoagulant proteins defect in patients with unexplained miscarriage. Methods Fifty-seven patients with a history of unexplained abortion in Peking union hospital during may. 1999 to April 2000. were tested for protein S, protein C, and antithrombin(AT)Ⅲ, activated protein C resistance(APC-R).The control group consisted of 50 healthy women with a history of normal pregnancy and delivery. Blood samples were taken for measuring protein S, protein C, AT-Ⅲ and APC-R. Patients with APC-R positive were measured for FV Leiden gene mutation by PCR-RFLP method. Results Of the 57 patients, there were 21.1%?1.8% and 8.8% with protein S?protein C and AT-Ⅲ deficiency respectively. For APC-R 22.8% of the 57 patients were positive .In control group, 4.0% were protein S deficiency; None was protein C and AT-Ⅲ deficiency ; 6.0% were positive for APC-R .No FV Leiden gene mutation was found in all the patients with APC-R positive .The incidence of anticoagulant proteins defect is higher in late spontaneous abortion group than that in early abortion group. Conclusions This study demonstrate that anticoagulant protein defects may be associated with pregnancy loss, especially the late spontaneous abortion.