Phenotype, Biomass, Carbon and Nitrogen Assimilation, and Antioxidant Response of Rapeseed under Salt Stress.

Salt stress is one of the major adverse factors affecting plant growth and crop production. Rapeseed is an important oil crop, providing high-quality edible oil for human consumption. This experiment was conducted to investigate the effects of salt stress on the phenotypic traits and physiological processes of rapeseed. The soil salinity was manipulated by setting three different levels: 0 g NaCl kg-1 soil (referred to as S0), 1.5 g NaCl kg-1 soil (referred to as S1), and 3.0 g NaCl kg-1 soil (referred to as S2). In general, the results indicated that the plant height, leaf area, and root neck diameter decreased with an increase in soil salinity. In addition, the biomass of various organs at all growth stages decreased as soil salinity increased from S0 to S2. The increasing soil salinity improved the distribution of biomass in the root and leaf at the seedling and flowering stages, indicating that rapeseed plants subjected to salt stress during the vegetative stage are capable of adapting their growth pattern to sustain their capacity for nutrient and water uptake, as well as leaf photosynthesis. However, as the soil salinity increased, there was a decrease in the distribution of biomass in the pod and seed at the maturity stage, while an increase was observed in the root and stem, suggesting that salt stress inhibited carbohydrate transport into reproductive organs. Moreover, the C and N accumulation at the flowering and maturity stages exhibited a reduction in direct correlation with the increase in soil salinity. High soil salinity resulted in a reduction in the C/N, indicating that salt stress exerted a greater adverse effect on C assimilation compared to N assimilation, leading to an increase in seed protein content and a decrease in oil content. Furthermore, as soil salinity increased from S0 to S2, the activity of superoxide dismutase (SOD) and catalase (CAT) and the content of soluble protein and sugar increased by 58.39%, 33.38%, 15.57%, and 13.88% at the seedling stage, and 38.69%, 22.85%, 12.04%, and 8.26% at the flowering stage, respectively. In summary, this study revealed that salt stress inhibited C and N assimilation, leading to a suppressed phenotype and biomass accumulation. The imbalanced C and N assimilation under salt stress contributed to the alterations in the seed oil and protein content. Rapeseed had a certain degree of salt tolerance by improving antioxidants and osmolytes.

Construction of algal-bacterial consortia using green microalgae Chlorella vulgaris and As(III)-oxidizing bacteria: As tolerance and metabolomic profiling.

Bioremediation became a promising technology to resolve arsenic (As) contamination in aquatic environment. Since monoculture such as microalgae or bacteria was sensitive to environmental disturbance and vulnerable to contamination, green microalgae Chlorella vulgaris and arsenite (As(III)) - oxidizing bacteria Pseudomonas sp. SMS11 were co-cultured to construct algal-bacterial consortia in the current study. The effects of algae-bacteria (A:B) ratio and exposure As(III) concentration on algal growth, As speciation and metabolomic profile were investigated. Algal growth arrested when treated with 100 mg/L As(III) without the co-cultured bacteria. By contrast, co-cultured with strain SMS11 significantly enhanced As tolerance in C. vulgaris especially with A:B ratio of 1:10. All the As(III) in culture media of the consortia were oxidized into As(V) on day 7. Methylation of As was observed on day 14. Over 1% and 0.5% of total As were converted into dimethylarsinic acid (DMA) after 21 days cultivation when the initial concentrations of As(III) were 1 and 10 mg/L, respectively. Metabolomic analysis was further performed to reveal the response of consortia metabolites to external As(III). The enriched metabolomic pathways were associated with carbohydrate, amino acid and energy metabolisms. Tricarboxylic acid cycle and glyoxylate and dicarboxylate metabolism were upregulated under As stress due to their biological functions on alleviating oxidative stress and protecting cells. Both carbohydrate and amino acid metabolisms provided precursors and potential substrates for energy production and cell protection under abiotic stress. Alterations of the pathways relevant to carbohydrate or amino acid metabolism were triggered by energy requirement.

As(III)-Oxidizing Bacteria Alleviate Arsenite Toxicity via Reducing As Accumulation, Elevating Antioxidative Activities and Modulating Ionome in Rice (Oryza sativa L.).

Paddy rice trends to accumulate more arsenic (As) from soils than other terrestrial crops. The toxicity and mobility of As mainly depend on its chemical species. Transformation of arsenite [As(III)] into arsenate [As(V)] would be a promising method to mitigate As toxicity. In the current study, As(III)-oxidizing strain SMS11 isolated from As-contaminated soils was employed for As remediation. Co-cultured with SMS11 alleviated As(III) stress to the rice plants by increasing the length and biomass of rice shoots up to 10% and 15%, respectively. Evaluation of oxidative stress indices showed that the activity of catalase in the rice shoots was weakened when exposed to As(III), increasing the risk of hydroxyl radical (·OH) formation. When co-cultivated with the bacteria, ·OH formation was significantly inhibited in the rice shoots. The ionomes of the rice plants were impacted by the external conditions. As(III) stress significantly disturbed ionome homeostasis in the rice plants. Uptake of As simultaneously elevated the levels of macro and nutrient elements such as Mg, P, K, Ca, and Zn in the rice shoots. The ionomic variation in the rice plants under As(III) stress was mitigated by inoculated with SMS11. The results represented that the As(III)-oxidizing bacteria alleviated external As(III) stress to the rice plants through elevating antioxidative activities and modulating ionome homeostasis.

Gene regulation and ionome homeostasis in rice plants in response to arsenite stress: potential connection between transcriptomics and ionomics.

Ionomics and transcriptomics were applied to demonstrate response of rice to arsenite [As(III)] stress in the current study. Rice plants were cultured in nutrient solutions treated with 0, 100 and 500 µg/L As(III) coded as CK, As1 and As5, respectively. The rice ionomes exhibited discriminatory response to environmental disturbances. Solid evidence of the effects of As(III) stress on binding, transport or metabolism of P, K, Ca, Zn and Cu was obtained in this work. Differentially expressed genes (DEGs) in the shoots were identified in three datasets: As1 vs CK, As5 vs CK and As5 vs As1. DEGs identified simultaneously in two or three datasets were selected for subsequent interaction and enrichment analyses. Upregulation of genes involved in protein kinase activity, phosphorus metabolic process and phosphorylation were detected in the rice treated with As(III), resulting in the maintenance of P homeostasis in the shoots. Zn and Ca binding genes were up-regulated since excess As inhibited the translocation of Zn and Ca from roots to shoots. Increased expression of responsive genes including HMA, WRKY, NAC and PUB genes conferred As tolerance in the rice plants to cope with external As(III) stress. The results suggested that As(III) stress could disturb the uptake and translocation of macro and essential elements by rice. Plants could regulate the expression of corresponding genes to maintain mineral nutrient homeostasis for essential metabolic processes.

Ionome profiling and arsenic speciation provide evidence of arsenite detoxification in rice by phosphate and arsenite-oxidizing bacteria.

Arsenite (As(III)) as the most toxic and mobile form is the dominant arsenic (As) species in flooded paddy fields, resulting in higher accumulation of As in paddy rice than other terrestrial crops. Mitigation of As toxicity to rice plant is an important way to safeguard food production and safety. In the current study, As(III)-oxidizing bacteria Pseudomonas sp. strain SMS11 was inoculated with rice plants to accelerate conversion of As(III) into lower toxic arsenate (As(V)). Meanwhile, additional phosphate was supplemented to restrict As(V) uptake by the rice plants. Growth of rice plant was significantly inhibited under As(III) stress. The inhibition was alleviated by the introduction of additional P and SMS11. Arsenic speciation showed that additional P restricted As accumulation in the rice roots via competing common uptake pathways, while inoculation with SMS11 limited As translocation from root to shoot. Ionomic profiling revealed specific characteristics of the rice tissue samples from different treatment groups. Compared to the roots, ionomes of the rice shoots were more sensitive to environmental perturbations. Both extraneous P and As(III)-oxidizing bacteria SMS11 could alleviate As(III) stress to the rice plants through promoting growth and regulating ionome homeostasis.

Characterization of physicochemical parameters and bioavailable heavy metals and their interactions with microbial community in arsenic-contaminated soils and sediments.

Mobility and toxicity of heavy metal contamination in the environment are highly dependent on its bioavailability. Most of previous studies focused on total heavy metal contents and their influence on microbial community in soils and sediments. Little were concerned about bioavailable fractions. In the current study, soil and sediment samples were collected near an abandoned realgar mine in Shimen County, China. Bioavailable heavy metals including Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Cd, Sb, and Pb in the samples were extracted using three-step sequential extraction method. Interactions among physicochemical parameters, total and bioavailable heavy metals, and microbial community in the collected samples were investigated. The study area has been severely contaminated by As with a concentration up to 2158 mg·kg-1 detected. The result of principal component analysis showed that the abundance of operational taxonomic units (OTUs) in the soils were obviously different from those in the sediments. In the soil samples, pH made a dominant contribution on the OTU abundance of microbial community. Correlation analyses revealed that the alpha diversity indices and microbial taxon were most correlated with bioavailable fractions of heavy metals in all the samples. That means bioavailable heavy metals rather than total heavy metals or physicochemical parameters played a more important role on richness and diversity of microbial community. Little connections were observed between microbial community and As no matter total concentration or bioavailable fraction. However, bioavailable Fe and Mn were recognized as the major driving force shaping the taxonomic structure of microbial community due to their relatively high concentrations and high affinity to other heavy metal contamination in soils and sediments.

Interactions among heavy metal bioaccessibility, soil properties and microbial community in phyto-remediated soils nearby an abandoned realgar mine.

Soil samples were collected from a representative arsenic (As) contaminated region under phytoremediation of hyperaccumulation plants. Relative abundance and diversity of microbial communities in the soil samples were characterized via 16S rRNA genes sequencing. At the phylum level, Proteobacteria, Actinobacteria, Acidobacteria, Bacteroidetes, Gemmatimonadetes and Firmicutes shows the highest abundance, accounting for more than 90 % of the classified sequences in the soil samples. Physicochemical parameters including pH, total organic carbon (TOC), cation exchange capacity (CEC), and electrical conductivity (EC), and heavy metal concentrations including total and bioaccessible contents in the soil samples were determined to investigate potential relationships between the microbial communities and the environmental factors. Principal component analysis (PCA) based on the operational taxonomic units (OTUs) matrix revealed distinct separation among the samples. The soil pH was confirmed as the dominant force to discriminate the soil samples with similar land use type and heavy metal contamination. There was little relevance between the total concentrations of heavy metals and the microbial communities. However, the bioaccessible concentrations of heavy metals were associated with the physicochemical parameters and relative abundances of bacterial genera according to correlation analyses. Although the soil samples were considerably contaminated by As, the abundances of bacterial phyla linked with As were lower than 1.0 % in most of the soil samples. The results indicated that the abundances of microbial communities in the soils were the consequence of concerted effects from all the environmental factors.

Rapid determination of multi-antibiotic residues in honey based on modified QuEChERS method coupled with UPLC-MS/MS.

Antibiotic residues in honey cause public health problems. To analyze multi-antibiotic residues in honey, a modified QuEChERS (quick, easy, cheap, effective, rugged and safe) extraction method coupled with ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) was developed for simultaneous quantification of 70 antibiotic residues in honey. Matrix-matched calibrations indicated the correlation coefficients were higher than 0.998. The recovery was in a range of 70.5%-119.8% with intra-day relative standard deviation (RSD) of ≤ 10.0% and inter-day RSD of ≤ 13.9%. The limits of detection ranged between 0.050 µg/kg and 1.02 µg/kg. Limits of quantification was 0.17 µg/kg to 3.40 µg/kg. The matrix effects were negligible in 71.4% of compounds and moderately in 24.3% of compounds. Methacycline, oxytetracycline, tetracycline and its metabolite 4-tetracycline residues were detected in the tested samples. Validation parameters were acceptable and were in line with the Codex guidelines. This method was effective for detecting multi-antibiotic residues in honey.

Multiple Endocrine Neoplasia Type 2B Associated Mixed Medullary and Follicular Thyroid Carcinoma in A Chinese Patient with RET M918T Germline Mutation.

BACKGROUND: Mixed medullary and follicular thyroid carcinoma (MMFC) displays heterogeneous morphological components and immunophenotypical features intermingled within the same lesion, which is rare and most described in the sporadic form. We report herein a Chinese patient with multiple endocrine neoplasia type 2B (MEN2B) harboring germline RET M918T and associated MMFC. METHODS: A case of a 39-year-old male patient with MEN2B presented palpable neck masses in both thyroid lobes (maximum sizes: left, 3.9 cm; right, 5.4 cm) and a definitive phenotype. Serum levels of calcitonin (Ctn; >2000pg/mL), carcinoembryonic antigen (CEA; 719.27ng/mL), and thyroglobulin (Tg; 98.54ng/mL) were high. Fine-needle aspiration cytology showed features positive for malignancy, suggesting the possibility of medullary thyroid carcinoma (MTC). Total thyroidectomy, along with extending bilateral neck lymph nodes dissection, and subsequently, genetics family screening were performed. RESULTS: The histopathological examination yielded a diagnosis of MMFC that showed immunohistochemical characteristic patterns of the component of MTC positive for Ctn and CEA, chromogranin A, and the follicular carcinoma components were positive for Tg. Lymph node metastasis was observed showing medullary tumoral cells positive for Ctn and follicular-like structures lacking tumor cells positive for Tg staining (T4bN1bM0). Genetics screening confirmed RET M918T (c.2753T>C) mutation manifested in the patient but was not detected in other family members. Follow up showed that the serum Ctn, CEA and Tg levels respectively dropped to 54.38pg/ml, 4.16ng/mL and 0.04ng/mL 16 months after the surgery. CONCLUSION: Particular and diverse patterns of MMFC should be recognized with immunostaining features. MMFC occurring in a patient with MEN2B harboring RET M918T may be unique biological behavior and the treatment is mostly radical surgery.

Clinical diagnosis, treatment and screening of the VHL gene in three von Hippel-Lindau disease pedigrees.

The present study aimed to investigate the clinical characteristics of von Hippel-Lindau (VHL) disease and the clinical significance of VHL gene detection. The clinical materials of patients with VHL disease were collected from 3 different families between May 1985 and October 2017. A systematic pedigree study and VHL gene detection at the germline level were performed together with a literature review. Of the 22 patients from 3 VHL pedigrees, 10 exhibited VHL gene mutations (3 genotypes) at the germline level. The genotypes of pedigree were VHL-p.R161Q (c.482G>A), VHL-p.N78S (c.233A>G), and VHL-p.R167Q (c.500G>A). During the follow-up period, the symptoms were stable in 10 patients, including 2 cases of central nervous system hemangioblastomas (CNS-HB), 3 cases of bilateral multiple renal cell carcinoma (RCC) and 5 cases of adrenal pheochromocytoma without local recurrence or distant metastasis. Patients with p.R161Q and p.N78S were not associated with CNS-HB, which was different from the clinical phenotype of previously reported families. RCC were Fuhrman II grade, which was consistent with the previous study. The results of the present study indicated that the standardization of early diagnosis and the improvement of long-term efficacy may be achieved by combining clinical screening and VHL gene detection.

Proximal humeral internal locking plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures: A randomized study.

OBJECTIVES: The aim of this study was to investigate the effectiveness of the proximal humeral internal locking system (PHILOS) plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures. METHODS: A total of 112 patients with proximal humerus fractures were assigned randomly into 2 groups. Group A (n = 56) was treated by open reduction and internal fixation (ORIF) with a PHILOS plate; group B (n = 56) was treated by ORIF with a PHILOS plate in combination with the use of a custom neutral-position shoulder and elbow sling for 30 days after surgery. The incidence of internal fixation failure, the Constant-Murley shoulder assessment, and Visual Analogue Scale (VAS) score were recorded and analyzed. RESULTS: Patients included were followed up for an average of 15 months (range, 6-24 months). No significant differences were observed in mean VAS scores and mean Constant-Murley shoulder assessment scores at 1-day preoperative and postoperative day 3 between groups A and B. However, mean VAS scores and mean Constant-Murley shoulder assessment in group B were significantly improved when compared with group A at postoperative day 30 and the final follow-up. No cases of postoperative infection, loss of reduction, PHILOS break, or vascular nerve injury occurred in either group. CONCLUSIONS: Proximal humerus fractures treated with the combination of the PHILOS and custom neutral-position shoulder and elbow sling for 30 days after operation was associated with a lower incidence of internal fixation failure. There was no increase in adverse events compared with open reduction and internal fixation with a PHILOS plate alone.

Immune Checkpoint Human Endogenous Retrovirus-H Long Terminal Repeat-Associating Protein 2 is Upregulated and Independently Predicts Unfavorable Prognosis in Bladder Urothelial Carcinoma.

BACKGROUND/AIMS: human endogenous retrovirus-H long terminal repeat-associating protein 2 (HHLA2) is highly expressed in multiple solid malignant tumors, making it a potential biomarker for tumorigenesis and invasion. However, the expression and clinical significance of HHLA2 in bladder urothelial carcinoma (BUC) have not been extensively studied. This study aimed to investigate the relationship between HHLA2 expression and clinicopathological characteristics of BUC. METHODS: A total of 212 patients pathologically diagnosed with BUC were included in this study. HHLA2 expression was analyzed by immunohistochemical staining and qRT-polymerase chain reaction. Correlations of HHLA2 expression and pathological characteristics, including 5-year recurrence-free survival (RFS) and overall survival (OS) were examined, and the diagnostic value of HHLA2 was estimated by using the receiver operating characteristic (ROC) curve. RESULTS: Immunohistochemical staining showed that the expression of HHLA2 was significantly upregulated in BUC tissues compared with normal bladder tissues. In BUC tissues, HHLA2 expression was significantly associated with tumor size, tumor stage, tumor grade, and lymph node metastasis (all p < 0.05). HHLA2 expression was an independent prognostic factor of tumor metastasis (p < 0.05). The Kaplan-Meier survival curve revealed that high HHLA2 expression was significantly correlated with the poor RFS and OS of BUC patients (both p < 0.05), and the ROC curve showed HHLA2 could be a good diagnostic marker. CONCLUSIONS: HHLA2 can independently predict unfavorable prognosis in BUC.

[The clinical comparison of double knee osteoarthritis patients undergoing unicompartmental knee arthroplasty and total knee arthroplasty].

OBJECTIVE: To study the differences in clinical outcome of double knee osteoarthritis patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). METHODS: From May 2009 to May 2012, 30 patients (60 knees) with isolated compartmental osteoarthritis of knees were enrolled. Each patient accepted UKA on one knee, TKA on the other. There were 9 male and 21 female patients, aged from 60 to 79 years, average 69 years. Patients evaluation focused on the hospital for special surgery(HSS) knee score, blood loss, hemoglobin 48 h after the operation, the time of knee being able to flex to 90° and patients' sensation after operation. Collection the UKA side and TKA side data and compare two groups of data. RESULTS: All patients were followed up for 13 to 35 months, average 20.5 months. There were no component loosening and revision. HSS knee score improved significantly in both two groups: UKA group was promoted from 61 ± 3 to 87 ± 3 (t = 11.21, P < 0.001) and TKA group from 59 ± 5 to 86 ± 3 (t = 17.64, P < 0.001). Compared with the TKA group, the UKA group had less blood loss (t = 11.56, P < 0.001), and a decrease of hemoglobin 48 h after the operation (t = 12.38, P < 0.001). The dates of knees being able to flex ≥ 90° after operation were less (t = 4.03, P < 0.05) in the UKA group. As to therapeutic effects, 70% patients found that UKA was better than TKA; 16.7% patients had opposite opinion; and 13.3% patients found no differences between their two knees. CONCLUSIONS: UKA for the treatment of isolated compartmental osteoarthritis of knee shows as well as TKA, and it has less trauma, less blood loss, more rapid postoperative recovery than TKA.

[Clinical application of Wallis interspinous dynamic stabilization in treating adjacent segment degeneration (ASD) after lumbar spinal fusion].

OBJECTIVE: To evaluate therapeutic effects of Wallis interspinous dynamic stabilization in treating ASD after lumbar spinal fusion. METHODS: Totally 40 patients (included 16 males and 24 females, aged 25 to 60 years old) with degenerative disc disease were treated with posterior interbody fusion. Among them, 20 cases (treatment group) were treated with posterior interbody fusion combined with Wallis interspinous dynamic stabilization, while other 20 cases (control group) only treated with posterior interbody fusion. JOA score and VAS score were compared after inserted Wallis interspinous dynamic stabilization at 1 month and 3 years, and changes of intervertebral disc height of adjacent segment and cross-sectional area of the canal were tested and compared. RESULTS: All patients were followed up from 3 to 5 years with an average of 3.6 years. All injuries were healed at stage I and the pain were released after treatment. There were no significant meaning in JOA score and VAS score at 1 month after treatment between two groups (P>0.05), while had meaning at 3 years (P<0.05). There were no statistical significane in intervertebral disc height of adjacent segment and cross-sectional area of the canal at 1 month after treatment (P>0.05), while had statistical meaning at 3 years (P<0.05). CONCLUSION: There is no difference in immediate effects between two groups. Both of them can obtain good results for effective decompression. Medial-term effectiveness of treatment group is obviously better than control group, which depends on Wallis interspinous dynamic stabilization to plays good biology effects and effective accelerate adjacent degeneration caused by lumbar fusion.

[Safty action of heat shock protein 27 in reperfusion after spinal marrow ischemia].

Heat shock protein 27 belongs to the heat shock protein family in the small molecular weight family. This review collected a number of literature to analyze the expression meaning and mechanism of HSP27,expounded HSP27 with inhibition of NO production, maintenance of cell protein stability and accelerated cell damage repair function. At the same time, HSP27 also has a resistance to apoptosis, protecting mitochondria, inhibiting activation of nuclear factor and other related functions. The heat shock protein 27 has protection in spinal cord ischemia-reperfusion.

[Detection of BK virus infection in renal transplant recipients and clinical application].

OBJECTIVE: To study the detection methods of BK virus infection in kidney transplant recipients, and to explore the clinical application. METHODS: 132 cases of renal transplant recipients were undertaken BK virus detection including presence of decoy cells in urinary sediment, urine and serum BKV-DNA to demonstrate the BK virus replication. RESULT: Among 132 cases of renal transplant recipients, urinary decoy cell was found in 37 (28.0%) patients and the median time was 12 months after surgery. 32 (24.2%) patients were diagnosed as BK viruria at a median of 11 months after surgery, and 16 (12.1%) recipients were diagnosed as BK viremia at a median of 15 months after surgery, 5 patients with BK viruria were diagnosed as BK virus associated nephropathy according to allograft biopsy. CONCLUSION: To make early diagnosis of BK virus infection, detection of urine decoy cells and BKV-DNA in urine and plasma sample is important,which provides an important basis for the prevention of BK virus associated nephropathy.

[Diagnosis and treatment of adrenal cyst: report of 15 cases].

OBJECTIVE: To discuss the diagnosis and treatment of adrenal cyst. METHODS: The clinical data of 15 patients with adrenal cyst, 9 males and 6 females, aged 42 (32 - 65), diagnosed and treated 1995 - 2005 were reviewed. The average size of the cyst was 5.3 cm in diameter. Nine cysts were in the left adrenal gland and 6 cysts in the right. The diagnostic accuracy rates of MR imaging, CT, and B-mode ultrasonography were 100% (4/4), 86.7% (13/15), and 73.3% (11/15) respectively. Thirteen patients underwent operation: unroofing in cyst via retroperitoneal laparoscopy (n = 9), adrenalectomy via laparoscopy (n = 1), or cystectomy via open surgery (n = 3). RESULTS: The average operative time of the 2 laparoscopy subgroups was (44 +/- 11) min, significantly shorter than that of the open surgery group [(75 +/- 40) min, P < 0.05]. The mean hospital stay after operation of the laparoscopy group was (5.1 +/- 1.1) days, significantly shorter than that of the open surgery group [(8.3 +/- 1.5) days, P < 0.05]. Pathological examination showed 3 cases of epithelial cyst,4 cases of endothelial cyst, and 6 cases of pseudocyst. CONCLUSION: MR is much more useful in diagnosis of adrenal cyst. The indications of surgery include the presence of symptoms, suspicion of malignancy, increase in the cyst size, and detection of functioning adrenal cyst. Unroofing in cyst via retroperitoneal laparoscopy may be the standard operation in treating this disease.

[Pseudoangiosarcomatous squamous cell carcinoma of the penis: a case report with clinicopathological and human papilloma virus analyses].

OBJECTIVE: To further understand the clinicopathological, ultrastructural and molecular features of penile pseudoangiosarcomatous squamous cell carcinoma (PASCC), and improve its diagnosis and treatment. METHODS: A 47-year-old male patient with penile PASCC was reported and the relevant literature reviewed. The main clinical manifestations of the patient were a typical surface ulceration with hemorrhage and purulent secretion with a foul smell, a papillary mass about 5.0 cm x 5.0 cm x 4.0 cm for 1 year on the foreskin of the penis, and 3 enlarged bilateral inguinal lymph nodes. CT scanning showed no enlarged lymph nodes in the abdomen and pelvis, and X-ray examination revealed no abnormality in the chest. RESULTS: The diagnosis was established by biopsy. Partial penectomy and bilateral inguinal lymphadenectomy (T2N2M0) were performed, followed by adjuvant pelvic radiotherapy. Two months later, total penectomy was necessitated by penile flap necrosis and local recurrence. Eleven months after the first surgery, the patient died of extensive metastasis to the pelvis and lungs. Under the light microsope, the tumor was mainly composed of vessel-like lacunar reticularis spindle cells and a few local squamous cancer cells. Careful examination revealed some focal areas with evident transition from squamous nests to the more acantholytic areas extending towards the pseudoangiosarcomatous spaces. Pathogenetically, it appeared to be the variant of acantholytic squamous cell carcinoma. Immunohistochemically, most tumor cells were strongly positive for keratin (AE1/AE3) and focally positive for EMA, with the typical squamous cells focally positive for 34betaE12 and vimentin. The vessels that proliferated in the tumor were decorated by CD31, CD34 and factor VIII-related antigens, but the tumor cells were negative for HMB45, SMA, Desmin and CEA. HPV DNA (HPVpan, HPV6B/11, HPV16/18, HPV31/33) was not detected by in situ hybridization in the primary and metastatic tumors. CONCLUSION: PASCC is a specific and extremely rare subtype of penile SCC with dramatic similarity to angiosarcoma under the microscope, with poor prognosis. Its diagnosis depends on histopathological, immunohistochemical and ultrastructural studies. Such a presentation underscores the importance of timely consultation, early diagnosis and prompt treatment.

[Efficacy and safety of different dosages of intravesical epirubicin instillation for prevention of primary superficial bladder carcinoma from recurrence].

OBJECTIVE: To investigate the efficiency and safety of different regimens by intravesical instillation of epirubicin, a derivative of adriamycin, for the prevention of primary superficial bladder carcinoma from recurrence. METHODS: Ninety patients supplemented with intravesical epirubicin instillation after operation were randomly divided into three groups: Group A--80 mg in one dose; Group B--repeated epirubicin 40 mg q wk x 4-8 sessions followed by q month to the end of the second year; or Group C--50 mg q month to the same duration. All patients were followed up for two years by observing the recurrence rates and side effects. RESULTS: The recurrence rate of groups A, B and C at one year was 16.7%, 13.3% and 16.7%, respectively, without any significant difference observed. However, it was 50.0%, 36.7% and 36.7% at two years, at which time the recurrence rate of group A was significantly higher than those of groups B and C. The side effects rate was 23.3%, 40.0% and 33.3% for groups A, B and C, respectively. The more instillations the patients had, the more severe side effects were. CONCLUSION: Early postoperative single high dose intravesical instillation of epirubicin combined with repeated lower doses of the same drug every month may be an efficient and safe regimen to prevent the primary superficial bladder carcinoma from recurrence.