Real-time polymerase chain reaction for diagnosing infectious mononucleosis in pediatric patients: A systematic review and meta-analysis.

In this meta-analysis, we evaluated the diagnostic role of Epstein-Barr virus deoxyribonucleic acid detection and quantitation in the serum of pediatric and young adult patients with infectious mononucleosis. The primary outcome of this meta-analysis was the sensitivity and specificity of Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) detection and quantitation using polymerase chain reaction (PCR). A systematic review and meta-analysis was performed by searching for articles that were published through September 24, 2014 in the following databases: Medline, Cochrane, EMBASE, and Google Scholar. The following keywords were used for the search: "Epstein-Barr virus," "infectious mononucleosis," "children/young adults/infant/pediatric," and "polymerase chain reaction or PCR." Three were included in this analysis. We found that for detection by PCR, the pooled sensitivity for detecting EBV DNA was 77% (95%CI, 66-86%) and the pooled specificity for was 98% (95%CI, 93-100%). Our findings indicate that this PCR-based assay has high specificity and good sensitivity for detecting of EBV DNA, indicating it may useful for identifying patients with infectious mononucleosis. This assay may also be helpful to identify young athletic patients or highly physically active pediatric patients who are at risk for a splenic rupture due to acute infectious mononucleosis.

A single center clinical analysis of children with neuroblastoma.

In the present study, the cases of 59 children diagnosed with neuroblastoma (NB) were retrospectively analyzed to assess the association between the short-term efficacy of treatment and prognostic factors. In total, 59 patients with NB that were diagnosed between July 1, 2008 and June 30, 2013 at Shanghai Children's Hospital were enrolled in the present study. The follow-up was performed until December 31, 2013, and the data revealed that 43 patients (72.9%) achieved complete remission (CR) or partial remission (PR). The 3-year overall survival (OS) rate of patients with stage I, II, III, IV and IVs disease was 100, 100, 65.6, 34.8 and 85.7%, respectively (P=0.02). The 3-year OS and event-free survival rates were evidently increased in patients with favorable histology compared with the rates in the patients with unfavorable histology (P=0.046 and 0.030, respectively). Univariate statistical analysis revealed that the factors significantly associated with prognosis were patient age, tumor stage and risk group (P=0.004, 0.02 and 0.001, respectively). The present study identified that tumor stage, risk group and patient age are important prognostic factors for NB. An age of 18 months was also hypothesized to be the cut-off for the prognosis of patients.

Tumor-associated macrophages promote cancer stem cell-like properties via transforming growth factor-beta1-induced epithelial-mesenchymal transition in hepatocellular carcinoma.

Tumor-associated macrophages (TAMs), a crucial component of immune cells infiltrated in tumor microenvironment, have been found to be associated with progression and metastasis of hepatocellular carcinoma (HCC). In this study, we aimed to clarify the mechanism underlying the crosstalk between TAMs and cancer stem cells (CSCs) in HCC. Mouse macrophage cell line RAW264.7 cells were used to investigate the effects of TAMs on mouse hepatoma cell line Hepa1-6 cells in vivo and vitro. A total of 90 clinical samples had pathology-proven HCC were used to evaluate the distribution of TAMs and CSCs and analyze their value in predicting the prognosis. In the study, we have found that the number of TAMs has a positive correlation with the density of CSCs in the marginal of human HCC. Our results show that, cocultured with TAM-conditioned medium (CM) promoted CSC-like properties in Hepa1-6 cells, which underwent EMT and gained higher invasive capability. TAMs secreted more transforming growth factor- beta1 (TGF-beta1) than other phenotypes of macrophage. Furthermore, depletion of TGF-beta1 blocked acquisition of CSC-like properties by inhibition of TGF-beta1-induced EMT. High expression of CD68 in the EpCAM positive expression HCC tissues was strongly associated with both poor cancer-free survival and overall survival in patients. Our results indicate that the TAMs promote CSC-like properties via TGF-beta1-induced EMT and they may contribute to investigate the prognosis of HCC.

[Association between lymphangiogenesis and clinicopathological features and prognosis in laryngeal carcinoma].

OBJECTIVE: To detect lymphangiogenesis by labeling the lymphatic endothelial marker, lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1), and study the prognostic relevance of lymphangiogenesis in laryngeal squamous carcinoma. METHODS: Clinical files and specimens of 78 patients with histologically diagnosed laryngeal carcinoma were stained with LYVE-1 as a specific lymphatic endothelial marker. The lymphatic vessel density (LVD) was measured, and the correlation between LVD and clinicopathological features of the tumor cases was analyzed. RESULTS: The mean LVD in laryngeal carcinoma (13.24 ± 5.09) was significantly higher than that in adult laryngeal papilloma (5.54 ± 3.15) and squamous dysplasia (6.76 ± 4.45, P < 0.05). The LVD of poorly differentiated tumors (15.74 ± 5.24) was significantly higher than that in the moderately differentiated tumors (13.84 ± 6.20), and the LVD in the moderately differentiated tumors was significantly higher than that in the well-differentiated tumors (11.68 ± 6.34). The LVD in stage 0 to stage II group (10.66 ± 5.70) was significantly lower than that in the stage III to IV group (17.01 ± 6.35). The lymph node metastasis group (17.25 ± 7.37) was significantly higher than non-lymph node metastasis group (8.60 ± 5.23, P < 0.05). There was no significant association between LVD and age, sex, primary site and distant metastasis. The overall survival in the patients with a LVD higher than the mean value was 33.5 month, and that of cases with a LVD lower than the mean value was 81.6 month (P < 0.05). The multivariate survival analysis showed that the clinical stage and LVD were independent prognostic factors of laryngeal cancer. CONCLUSIONS: The LYVE-1 staining histochemistry demonstrates that the lymphangiogenesis occurrs mainly at the edge of the tumors, and lymphangiogenesis plays an important role in the carcinogenesis, cancer progression and lymph node metastasis in laryngeal cancer. LVD may be an independent indicator of poor prognosis of laryngeal cancer.

[Clinical significance of sequential monitoring minimal residual disease in childhood B-cell acute lymphoblastic leukemia].

OBJECTIVE: To study the clinical significance of sequentially monitoring minimal residual disease (MRD) in childhood B-cell acute lymphoblastic leukemia (B-ALL). METHOD: Eighty one B-ALL cases were enrolled in the study from January 2004 to December 2009. Leukemia cell markers were detected by flow cytometry at diagnosis, then regularly followed-up. RESULTS: Of 81 cases, 80 achieved complete remission (CR) after induction therapy, 5-year event-free survival (EFS) was (76.80 ± 5.70)%. Among them, the EFS was (89.40 ± 5.90)% in standard risk group and (66.99 ± 13.60)% in intermediate risk group. Eight cases were screened for leukemia markers for MRD monitoring and identified in 68; and 5-year EFS was (79.10 ± 6.20)% and (62.50 ± 15.10)% (P > 0.05, respectively). MRD detection at day 35 in induction therapy showed that 52 of 68 cases were MRD negative (leukemia cells < 0.01%), the 5-year EFS being (88.50 ± 4.90)%, and 16 were MRD positive (leukemia cells ≥ 0.01%), the 5-year EFS being (42.10 ± 20.10)% (P > 0.05). Univariate analysis confirmed that there was a correlation between MRD monitoring and risk stratification. MRD detection at day 55 showed that among the 52 day 35 MRD negative cases, 51 were still negative, 1 positive, among 16 day 35 MRD positive cases, 14 (87.50%) turned negative, 2 still positive. Of the 68 cases, 9 were MRD positive within one year after CR (3 relapsed), 4 MRD positive after one year (2 relapsed) and 55 MRD negative (4 relapsed) (P > 0.05). CONCLUSIONS: Sequential monitoring MRD can find out treatment outcome and adjust therapy in time.

[Vocal fold augmentation by injection of autologous fascia and fat].

OBJECTIVE: To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure. METHODS: A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold (group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection (group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients. RESULTS: All patients were followed up for 24 months. On the third day after operation, there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later. In all 20 cases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant (P < 0.01). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 - 24 months after operation and were not changed by the length of follow-up. And in the 6 cases, videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P < 0.05 or < 0.01), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P < 0.05 or < 0.01). The significant differences were not observed between 6 and 24 months (P > 0.05). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months (P < 0.05 or < 0.01). CONCLUSION: The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.

[Tubed pectoralis major myocutaneous flap for reconstruction of circumference pharyngoesophageal defects].

OBJECTIVE: To investigate the feasibility and efficacy of tubed pectoralis major myocutaneous flap in the reconstruction of circumferential defects following resection for locally advanced hypopharyngeal and cervical esophageal carcinoma. METHODS: From Dec. 2004 to Oct. 2008, 30 patients underwent immediate reconstruction by tubed pectoralis major myocutaneous flap for circumferential defects following resection of primary tumours. Among them, 22 were hypopharyngeal carcinoma, 7 were cervical esophageal carcinoma and one was recurrent laryngeal carcinoma involved the hypopharyngeal lumen. Five of 30 patients had received previous radiotherapy and three had failed in the previous surgical procedure. In this series, 12 patients had total pharyngolaryngectomy and 18 had total pharyngolaryngectomy and partial cervical esophagectomy. RESULTS: Postoperative pharyngocutaneous fistula formation occurred in 4 patients, 2 of them with previous radiotherapy and 2 with diabetes, and the fistulae healed later. Two patients developed anastomotic strictures at the upper junction, but they had good responses to dilatation treatment and had satisfactory oral intake. The postoperative follow-up time ranged from 8 to 56 months. Median follow-up was 18 months. One-year survival rate was 71.4% and three-year survival rate was 42.5%. CONCLUSIONS: The tubed pectoralis major myocutaneous flap is a reliable procedure to reconstruct hypopharyngeal circumferential defects following resection of advanced hypopharyngeal and cervical esophageal carcinoma. This method may be the optimal choice for the reconstruction of hypopharyngeal circumferential defects following resection of recurrent carcinoma. The incidence of fistula and stenosis could be kept at an acceptable level.

Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation.

BACKGROUND: Portal vein tumor thrombus (PVTT) is a common complication of hepatocellular carcinoma (HCC), and is associated with extremely poor prognosis. PATIENTS AND METHODS: In this retrospective study, we first evaluate the application of percutaneous laser ablation as a treatment for PVTT due to advanced hepatocellular carcinoma. 108 patients (2002.7-2005.12) that have adequate liver function and be in reasonably good general condition were enrolled at Eastern hepatobiliary surgery hospital. The thrombus was ablated via an optic fiber placed in the guide needle with the guiding of ultrasound. In the follow-ups, the serial imaging and laboratory routines were examined and the overall clinical progress was measured at regular intervals until time of death. In the clinical assessment, survival time and factors affecting survival time were analyzed. The changes of laboratory test (alanine transaminase and alpha fetoprotein) and clinical manifestation (ascites and diarrhea) of the PVTT patients before and after laser ablation were observed. RESULTS: Patency of the tumor-occluded portal vein branch is the only factor that affect the survival time, the longer the patency time, the longer the survival time. The long-term survivals of patients in our study are 55.56, 33.58 and 22.38% at 1, 2 and 3 years, respectively. Both laboratory test and clinical presentations were improved. Alphalpha fetoprotein in the positive patients decreased and alanine transaminase in the abnormal patients normalized at 1 month after the treatment. Ascites disappeared in 44.00% patients (11/25), and diarrhea ameliorated in 57.14% (12/21). CONCLUSION: Laser ablation might be a novel and effective treatment for PVTT associated with advanced HCC.

[Percutaneous laser ablation in the treatment of portal vein tumor thrombus in 93 hepatocellular carcinoma patients].

OBJECTIVE: To evaluate the efficacy of percutaneous laser ablation (LA) in the treatment for portal vein tumor thrombus (PVTT) of hepatocellular carcinoma (HCC). METHODS: The PVTT of HCC patients were treated through percutaneous transhepatic laser ablation (PTLA). The survival rate, thrombus size, blood flow of embolized portal vein by thrombus, liver function, ascites and clinical presentation were observed. RESULTS: The 6-month, 1-year and 2-year survival rate of these 93 patients were 82.8%, 53.0% and 34.1%, respectively. In 11 patients with partially occluded portal vein by PVTT, the cut-surface of the PVTT diminished significantly 6 months after LA. The color blood stream signal was seen again one day after LA in all of the other 82 patients with totally occluded portal vein by thrombus, and it could still be seen in 67 of those one month later, 57 (of 71) 3 months later, 40 (of 57) 6 months later, 27 (of 32) 1 year and 4 (of 6) 2 years later after LA. In the 38 patients who survived over 1 year, PVTT was gradually atrophied and disappeared eventually in 14, PVTT was atrophied and the portal vein changed into honeycomb-like appearance in 14. In the remaining 10 patients, PVTT continued to grow and made the portal vein enlarged. It was also observed that liver function, clinical symptom and ascites were improved in various degree after LA. CONCLUSION: Percutaneous laser ablation might be an effective and safe treatment method for controlling portal vein tumor thrombus of hepatocellular carcinoma.

Expression of SSX-1 and NY-ESO-1 mRNA in tumor tissues and its corresponding peripheral blood expression in patients with hepatocellular carcinoma.

BACKGROUND: Cancer-testis antigen (CTA) is a family of the most noticeable tumor antigens which could be potential tumor markers for cancer diagnosis. In this research we aimed to investigate the expression of SSX-1 and NY-ESO-1 mRNA, two members of the CTA family, in tissue and peripheral blood of patients with hepatocellular carcinoma (HCC) to assess their feasibility for the immunotherapy and diagnosis of HCC and the association of their expression levels with diverse clinical indicators. METHODS: Thirty-six north Chinese patients with HCC and 30 normal controls were enrolled in this study. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of SSX-1 and NY-ESO-1 mRNA in tumor tissues and corresponding levels in peripheral blood of patients. RESULTS: The positive rates of SSX-1 and NY-ESO-1 mRNA expression were 61.1% (22/36) and 11.1% (4/36), respectively, in cancer tissues; 38.9% (14/36) and 5.6% (2/36), respectively, in the corresponding peripheral blood samples. No positive expression of either SSX-1 or NY-ESO-1 mRNA was detected in the samples of cancer-adjacent tissues, cirrhotic tissues, normal liver tissue or the peripheral blood of control patients. No significant relationship was found between the expression of these two genes and clinical indicators such as age, gender, tumor size, extent of differentiation, serum a-fetoprotein (AFP) level or infection with hepatitis B virus (P > 0.05). The short term recurrence rate was 46.2% (6/13) in patients whose peripheral blood expressed SSX-1 mRNA, while the recurrence rate in patients with negative SSX-1 mRNA was 28.6% (4/14). CONCLUSIONS: SSX-1 and NY-ESO-1 antigens might be new potentially promising targets for antigen-specific immunotherapy for HCC. High specific expression of SSX-1 and NY-ESO-1 mRNA suggested that we could apply them as tumor markers. The short term recurrence rate was significantly higher in patients whose peripheral blood expressed SSX-1 mRNA, suggesting that SSX-1 mRNA could be used as indicator for recurrence, metastasis and prognosis of HCC.

[Recurrent laryngeal nerve decompression].

OBJECTIVE: To study the result of recurrent laryngeal nerve decompression in the treatment of functional disturbance of recurrent laryngeal nerve caused by thyroid surgery or thyroid benign tumors. METHODS: From October 2002 to June 2005, 9 cases of unilateral recurrent laryngeal nerve paralysis and 4 cases of glottic insufficiency were treated with recurrent laryngeal nerve decompression. Seven cases of the nerve paralysis were caused by the surgery of benign thyroid tumors resection which were done by general surgeons. The paralysis nerve were found ligated in 6 of the 7 cases, and nerve-scar adhesion was found in the other case. Beside nerve decompression, type I thyroplasty have been undertaken in the same time to 2 of the 7 cases with severe hoarseness. One case of thyroid adenoma and 1 case of nodular goiter with unilateral recurrent laryngeal nerve paralysis were treated with tumor resection and nerve decompression respectively. Four cases of glottic insufficiency, 3 cases of nodular goiter were treated with tumor resection and nerve decompression, and Hashimoto's thyroiditis in the other case was treated with partial lobe resection and nerve decompression. The recovery of function of recurrent laryngeal nerve were detected to the recovery of vocal cord mobility through electrolaryngoscope postoperatively. RESULTS: For the 7 cases of recurrent laryngeal nerve paralysis after thyroid surgery, the motion of the paralysed vocal cord restored within 3 months in 6 cases with the interval of 1 week to 3 months between the two operations, no restoration was found in the other patient with an interval above 4 months between the two operations after 1 year follow-up. For the thyroid adenoma and nodular goiter with unilateral recurrent laryngeal nerve paralysis, the motion of paralysed vocal cord restored within 3 months respectively after decompression. The glottic closure recovered within 1 week after decompression in the 4 cases of the glottic insufficiency patient. CONCLUSIONS: Exploration and decompression as soon as possible to the paralysed recurrent laryngeal nerve because of thyroid surgery are very important for the restoration of the function of the nerve. For the patient with serve hoarseness, nerve decompression and type I thyroplasty at the same time is recommended in an effort to relieve hoarseness as soon as possible. For the functional disturbance of recurrent laryngeal nerve with thyroid neoplasm patient, early exploration and decompression of the nerve is imperative.

[Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation].

OBJECTIVE: To introduce a newly developed procedure in the control of portal vein tumor thrombus (PVTT) of hepatocellular carcinoma (HCC), and evaluate the efficacy and indicate of this method. METHODS: The PVTT of HCC patients were treated by percutaneous transhepatic laser ablation (LA). The blood flow of PVTT embolized portal vein, live function, ascites and clinical presentation was observed. RESULTS: Twenty-four HCC patients, with a total of 30 PVTT portal vein and its main branch were treated with LA. There were no any blood flow signal in Doppler color Ultrasonography in these PVTT embolized portal vein before treatment. After treatment, blood flow was reappearance in all cases within one week. The continued patency blood flow was observed in 16 portal vein and continued but not patency blood flow in other 12 portal vein within 30 days. The continued patency blood flow was observed in 18 portal vein within 90 days. The improvement of liver function and clinical symptom. The reduction of ascites was observed in varying degrees. CONCLUSION: LA treatment might be a effective and safe procedure in the control of portal vein tumor thrombus of HCC.