[Study of immunophenotypic characteristics, clinicopathological parameters and prognosis in gastric cancer microenvironment].

Objective: To explore the immunophenotypic characteristics of gastric cancer microenvironment and analyze its correlation with clinicopathological parameters and prognosis of patients. Methods: The expression levels of leukocyte differentiation antigen (CD) 8, CD4, T lymphocyte immunoglobulin mucoprotein 3 (TIM3), human forkhead box protein P3 (Foxp3) and co-localized tumor infiltrating lymphocytes (TILs) were detected in 92 cases of gastric cancer tissue [58 males and 34 females; aged M(Q1, Q3), 70(59, 77) years ] and 84 cases of paracancer tissue [57 males and 27 females, aged 70(59, 77) years] purchased from Shanghai Xinchao Biotechnology Co., Ltd., and the samples were from 28 hospitals in the sample bank. Gastric cancer and adjacent tissues were divided into high expression group and low expression group according to the optimal cut-off value of positive lymphocytepercentage. The expression of immunophenotypes in gastric cancer and adjacent tissues was analyzed. Kaplan-Meier method was used for survival analysis. Cox proportional hazard model was used to explore the prognostic factors of gastric cancer patients. Results: The optimal cut-off values of CD8, CD4, TIM3 and Foxp3 positive cells in gastric cancer were 12.73%, 1.39%, 10.77% and 2.44%, respectively. The expression of Foxp3 in gastric cancer tissues was higher than that in paracancer tissues [M (Q1, Q3), 0.93 (0.45, 2.16) vs 0.31 (0.09, 0.86), P<0.001], and the expression of CD8 [4.92 (2.34, 8.80) vs 8.81 (6.61, 12.17), P<0.001], CD4 [4.79 (1.77, 11.36) vs 8.40 (4.84, 12.77), P=0.022] and TIM3 [5.68 (2.05, 11.58) vs 7.07 (3.13, 11.43), P=0.338] were lower than that in paracancer tissues. There were significant differences in TIM3 expression in gastric cancer patients with different lymph node metastasis and clinical stage (all P<0.05). The 5-year survival rate of patients with high CD4 expression, low TIM3 expression and low Foxp3 expression in gastric cancer tissues was poor, among which the high CD4 expression and low CD4 expression groups were 29.3% and 64.7%, respectively; The high and low TIM3 expression groups were 60.9% and 30.4%, respectively; The high and low Foxp3 expression groups were 64.3% and 33.3%, respectively (all P<0.05). The optimal cut-off values of CD8+TIM3+TILs, CD4+TIM3+TILs, CD8+Foxp3+TILs and CD4+Foxp3+TILs were 3.86%, 0.23%, 0.08% and 0.76%, respectively. Colocalization analysis showed that the expression of CD8+Foxp3+TILs in gastric cancer tissues was higher than that in adjacent tissues(all P<0.05). Multivariate Cox regression analysis showed that high expression of CD4 (HR=3.079, 95%CI: 1.350-7.024,P=0.008), low expression of TIM3 (HR=0.428, 95%CI: 0.208-0.879, P=0.021) and low expression of Foxp3 (HR=0.288, 95%CI: 0.121-0.687, P=0.005) were the influencing factor for the 5-year survival rate of patients with gastric cancer after operation. Conclusions: Gastric cancer tissues have complex immune microenvironment characteristics. The expression of CD4, TIM3 and Foxp3 is closely related to the prognosis of patients.

A rapidly fatal intracranial anaplastic hemangiopericytoma with de-novo dedifferentiation: emphasis on diagnostic recognition, molecular confirmation and discussion on treatment dilemma.

Solitary fibrous tumors/ hemangiopericytomas (SFT/HPC) are mesenchymal tumors that share a common genetic aberration and very rarely undergo dedifferentiation. We report a unique case of an intracranial anaplastic SFT/HPC with de-novo dedifferentiation, which pursued a rapidly fatal clinical course in a 41-year-old lady. The dedifferentiated component comprised a focal area of glandular formation with epithelial immunophenotype acquisition. The distinct biphasic pattern of the tumor imparted great diagnostic challenges to the pathologists. An increased awareness of SFT/HPCs with a diverse morphologic spectrum or even a biphasic histologic pattern is essential in working up such cases. We first attempted gamma knife radiosurgery in treating a recurrent dedifferentiated SFT/HPC; unfortunately it was to no avail. Although it is now known that SFT/HPC is characterized by NAB2-STAT6 gene fusion, the unavailability of targeted therapy against this molecular signature still results in a treatment dilemma.

Diagnostic performance of two mental status tests in the older chinese: influence of education and age on cut-off values.

AIMS: To (1) establish the clinical usefulness of the 10-item Abbreviated Mental Test (AMT) and the 18-item Chinese Mini-Mental Status Examination (CMMSE) for detecting cognitive impairment associated with dementia in the elderly Chinese; (2) determine how the tests' optimal cut-off scores varied with the patients' educational level and age; and (3) evaluate which was the more accurate test. METHODS: 151 cognitively-healthy, community dwelling elderly Chinese subjects and 95 elderly Chinese outpatients with dementia were administered the AMT and CMMSE. Receiver-Operating Characteristic (ROC) analysis was used to determine the tests' optimal cut-off scores for each of the education-by-age subgroups and their areas-under-the-curve were compared non-parametrically to evaluate which test was more accurate. RESULTS: Both the AMT and CMMSE could identify cognitive impairment accurately, but higher cut-off values were necessary for the younger and more educated cohort, while lower values were adequate for the older and less educated subgroup. The AMT appeared to reach a ceiling effect in the more educated categories. The diagnostic accuracies of the two instruments were statistically equivalent; there was a trend, however, for the CMMSE to be performing better in the more educated subgroups. CONCLUSIONS: To maximise the diagnostic efficiency of these two clinically useful mental status tests, it is important to adjust their cut-off scores for the patients' education and age. Though no clear superiority of either instrument was established in this study, we recommend the AMT for patients with 0-6 years of education, whereas for those with greater levels of literacy, we think it better to administer the CMMSE.

Neuroimaging guidelines in cognitive impairment: lessons from 3 cases of meningiomas presenting as isolated dementia.

We report three cases of large intracranial meningiomas who presented with dementia alone and no accompanying focal neurological deficits. The meningiomas were detected solely as a result of a policy of routinely scanning the brains of patients presenting with early dementia. Dramatic improvements in the cognitive functions were noted following the excision of the tumours in two of the patients (the third passed away in the perioperative period). The implications of these cases with regard to deciding when to order a brain scan for patients presenting with isolated dementia are discussed in this article and a brief review of the relevant medical literature on this topic is also presented.

Cognitive testing of elderly Chinese from selected community clubs in Singapore.

The aim of this study was to describe the psychometric performance of cognitively normal elderly Chinese on selected psychological tests. One hundred and fifty-five community-living, cognitively intact elderly Chinese, stratified according to age and gender were administered a selected neuropsychological assessment battery which comprised the Abbreviated Mental Test (AMT), the Chinese Mini-Mental Status (CMMS), the Short Blessed Test (SBT), the Word-List Immediate Memory (WL-i), the Word-List Delayed Memory (WL-d), the Word-List Recognition Memory (WL-r), the Set Test (ST), the modified Boston Naming Test (BNT), the Constructional Praxis Test (CPT), the Block Design Test (BDT) and the Object Assembly Test (OAT). The local median scores (ranges) of the above tests were as follows-AMT: 9 (6-10); CMMS: 25 (16-28); SBT: 2 (0-10); WL-i: 17 (8-27); WL-d: 5 (0-10); WL-r: 9 (1-10); ST: 13 (6-25); BNT: 14 (10-15); CPT: 1 (0-3); BDT: 19 (0-42); OAT: 20 (3-33). These results can assist in the clinical identification of cognitive abnormalities amongst the elderly Chinese in Singapore. Future work will attempt to adjust these overall scores for variables such as the subjects' education and age.

Cognitive testing of elderly Chinese people in Singapore: influence of education and age on normative scores.

AIM: to establish age- and education-adjusted mean psychometric test scores of cognitively normal elderly Chinese people in Singapore. METHOD: 155 community-living, cognitively intact elderly Chinese subjects, stratified according to age and education, were selected from the membership lists of senior citizens' clubs and were administered a neuropsychological assessment battery. The mean test scores were then analysed for correlations with demographic characteristics. RESULTS: only education and age were independent variables; gender and language spoken were strongly correlated with education by the chi2 method (P < 10[-5]). Subsequent statistical analysis of education and age on the psychological test scores by the general linear model procedure enabled the formulation of a table of age- and education-adjusted normative cognitive scores. CONCLUSION: the derivation of age- and education-adjusted normative scores of a selected neuropsychological assessment battery on elderly Chinese people enables a more accurate diagnosis of dementia to be made and may facilitate better international comparisons of this condition. As our subjects are representative of many others from China, these results may serve not only as a local, but also as a regional, reference source.

Epidemiology of penicillinase-producing Neisseria gonorrhoeae in Singapore.

The number of infections with penicillinase-producing Neisseria gonorrhoeae (PPNG) strains in Singapore has risen from three in 1976 to 1792 in 1979. In the latter year they formed 19.2% of all infections with gonorrhoea, and 1280 of the strains isolated were from female prostitutes. The prevalence of PPNG infections is analysed according to the different sections of the community and racial groups. Despite energetic control measures PPNG strains are not being contained within Singapore. Thus global dissemination from such a busy port and tourist centre is a real danger.

PIP: The incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) infections in Singapore increased alarmingly from 3 cases in 1976 to 1792 cases in 1979, in which year such strains comprised 19.2% of total gonorrhea infections. This increase was parallelled by a decrease in the number of non-PPNG cases from 8036 in 1978 to 7540 in 1979. Female prostitutes contributed 72.7% of PPNG infections in 1979. In that year, 32% of gonorrhea infections among women other than prostitutes were PPNG strains. This has implied an increased occurrence of ophthalmia neonatorum and pelvic infection. The group at highest risk of infection includes single men aged 15-29 years engaged in semiskilled or unskilled labor. 85% of patients cited Singapore as the place of contact. Professional prostitutes were the primary contact in 72% of cases in 1978 and 66.8% of cases in 1979. Boyfriends or husbands contributed 10% of infection in both years. Contact tracing has produced a 51% success rate. Non-PPNG strains have been isolated from 15% of primary contacts, suggesting concomitant infection with both PPNG and non-PPNG strains. Measures to control sexually transmitted diseases are vigorously pursued in Singapore. These include intensive bacteriologic surveillance, effective treatment, determined contact tracing, and control of infection in prostitutes. About 5000 prostitutes have been registered with a medical scheme to which they report for periodic examination. The success of this scheme is indicated by the reversal of the male-to-female ratio for gonorrhea from 3:1 in 1975 to 1:3 in 1979. All patients with suspected gonorrhea have smears and cultures performed, and N. gonorrhoeae isolates are screened for penicillinase production by the iodometric method. A 98% cure rate has been achieved through a single 2 gm dose of kanamycin. However, these measures have not been able to contain the spread of PPNG infection. As infection with these strains becomes more prevalent, it may be necessary to switch to more costly treatment methods, e.g., aminoglycosides. Such treatment would increase the risk of 8th nerve damage and renal toxicity, and might not abort incubating syphilis. Since Singapore is a busy port and a major tourist center, global dissemination of PPNG infection constitutes a serious danger.

Gentamicin in the treatment of infections due to penicillinase-producing gonococci.

Ninety-seven patients with infections due to penicillinase-producing Neisseria gonorrhoeae (PPNG) were treated with single doses of gentamicin 280 mg intramuscularly. The failure rate among those followed up was 3%. No significant side effects were recorded. Gentamicin is a valuable alternative in the treatment of infections due to PPNG strains.

HR 756--a new cephalosporin in the treatment of gonorrhoea caused by ordinary and penicillinase-producing strains of Neisseria gonorrhoeae.

HR 756, a new cephalosporin, was used in single intramuscular doses of 500 mg to treat 108 men and women with gonorrhoea caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) and non-PPNG. Of 102 patients followed up, 99 (97.05%) were cured. Cure rates for PPNG infections and non-PPNG infections were 98.18% and 95.74% respectively. Few adverse side effects were recorded but possible cross-sensitisation with penicillin was observed. Clinical and laboratory antibiotic susceptibility results correlated well. It is concluded that this drug is safe and effective in treating both PPNG and non-PPNG infectons.

Kanamycin in the treatment of penicillinase-producing gonococcai infections.

A retrospective study of 356 cases of bacteriologically proven penicillinase-producing gonococcal infections treated with a single dose of 2 g of kanamycin intramuscularly was carried out. It was found that 14 patients failed to complete followup examinations. Of the remaining 342 who were examined bacteriologically following treatment, 335 were found to be cured of the infection. The cure rate was 96%. No adverse reactions were noted after administration of the drug. Compared to the other drugs used, kanamycin was relatively cheaper. The authors conclude that kanamycin is safe, economical and very effective in the treatment of gonorrhoea caused by the strains of penicillinase-producing Neisseria gonorrhoeae in South East Asia.