[Study on Dynamic Changes of Human Papillomavirus 16 E5 Gene in the Occurrence of Cervical Cancer].

OBJECTIVE: To explore the dynamic changes of human papillomavirus (HPV) type 16 E5 gene in the development of cervical cancer and the significance of E5 mRNA in early screening of cervical cancer. METHODS: Paraffin specimens of cervical lesions were collected from 49 cases (HPV positive) during September 2015 to December 2017 According to the standard of FIGO, all cervical lesions were diagnosed as: 13 cases of cervicitis, cervical intraepithelial neoplasia disorders (CIN) Ⅰ in 5 cases, CIN Ⅱ in 18 cases, CIN Ⅲ in 5 cases, 8 cases of cervical cancer. Real-time fluorescence quantitative PCR was used to detect the integrity of E5 gene and the mRNA expression levels of E5, E6 and E 7in cervical tissues. RESULTS: All the 49 cases showed positive HPV16 infection. E5 genetic integrity in CINⅠwas higher than that in cervical inflammation, CIN Ⅱand cervical cancer (P < 0.05), which was also higher than that in CIN Ⅲ, but without statistically significance (P>0.05). The mRNA levels of E5, E6, E7 were the highest in CIN Ⅲ. Compared with E6 and E7, E5 presented superior expression in all types of cervical lesions (P < 0.05), while E 6and E7 mRNA expressions only increased in CIN Ⅲ and cervical cancer. CONCLUSION: In the patients with HPV16 infection, the integrity of E5 gene in cervical tissues may be related to the occurrence and development of cervical diseases. E5 gene is expected to be the target gene for early screening of cervical cancer.

Clinical characteristics and prognosis of primary Waldeyer's ring and lymph node diffuse large B-cell lymphoma in the rituximab era.

This study was to compare the clinical characteristics and prognosis of Waldeyer's ring diffuse large B-cell lymphoma (WR-DLBCL) and lymph node DLBCL (LN-DLBCL) in the rituximab era. Before propensity score-matched (PSM), WR-DLBCL group shows more favorable clinical characteristics than LN-DLBCL group. After PSM, there was no significant difference in the response rate and survivals between them. The 5-year PFS and OS rates were 65.0% and 78.6% for WR-DLBCL group, respectively, and 53.7% and 66.1% for LN-DLBCL group, respectively. In WR-DLBCL group, ECOG score, Ann Arbor stage, B symptoms and IPI were associated with poor PFS and OS. In LN-DLBCL group, ECOG score, Ann Arbor stage, LDH, and IPI were significant factors to PFS and OS. Multivariate analysis showed that Ann Arbor stage was the only significant factor to PFS for WR-DLBCL group, for LN-DLBCL group, Ann Arbor stage and IPI were independent factors to PFS, LDH was the only significant factor to OS. WR-DLBCL was associated with more favorable clinical characteristics compared with LN-DLBCL, whereas, WR involvement itself did not have a real favorable prognostic significance. The PFS and OS of DLBCL were largely dependent on other prognostic factors such as Ann Arbor stage, LDH or IPI.

The effect of remifentanil on the minimum alveolar concentration of isoflurane in children.

STUDY OBJECTIVE: To evaluate the effect of remifentanil on the isoflurane end-tidal concentration required to eliminate movement reaction upon surgical incision in children. DESIGN: Prospective, double blinded, serial study. SETTING: Operating room of a university-affiliated hospital. PATIENTS: Patients of ASA status 1 or 2, aged 4 to 7 years, scheduled for either inguinal hernia repair or orchidopexy surgery with general anesthesia. INTERVENTIONS AND MEASUREMENTS: After endotracheal intubation, 108 children serially received 1 of 6 dose (nil, 0.05, 0.10, 0.15, 0.20, or 0.25 µg kg(-1) min(-1)) of remifentanil. End-tidal isoflurane concentration was adjusted according to a Dixon's up-and-down approach. Twenty-five minutes after starting the remifentanil infusion, the surgical incision was performed. The response of patients was classified as either "response" or "no response." Response was defined as a purposeful response in response to skin incision. MAIN RESULTS: The MAC of isoflurane were 1.50 ± 0.16%, 1.33 ± 0.27%, 0.93 ± 0.13%, 0.73 ± 0.27%, 0.63 ± 0.19%, and 0.60 ± 0.15% for remifentanil infusion rates of nil, 0.05, 0.10, 0.15, 0.20, and 0.25 µg kg(-1) min(-1), respectively. CONCLUSION: The MAC of isoflurane decreased with increasing infusion rate of remifentanil, showing an initial step reduction followed by a ceiling effect.

Challenges in the modification of the M1 stage of the TNM staging system for nasopharyngeal carcinoma: A study of 1027 cases and review of the literature.

A series of modifications have been introduced to the TNM staging system over time for nasopharyngeal carcinoma (NPC), mainly focused on the T (primary tumor) and N (local node) components of the system. The M1 stage is a 'catch all' classification, covering a group of patients whose outlook ranges from potentially curable to incurable. Since the current M1 stage does not allow clinicians to stratify patients according to prognosis or guide therapeutic decision-making and allow comparison of results of radical and non-radical treatments, we aimed to subdivide the M1 stage according to a retrospective study of 1027 metastatic NPC patients and to review the relevant literature. Between 1995 and 2007, 1027 inpatients with distant metastasis from NPC were retrospectively analyzed. Various possible subdivisions of the M1 stage were considered, looking at different metastatic sites, the number of metastatic organs and the number of metastases. Survival rates were calculated using the Kaplan-Meier method and compared using the log-rank test. The most frequently involved metastatic sites were the bone, lung and liver. The incidence rates of solitary metastatic lesions and pulmonary metastasis were 16.2 and 41.3%. Despite the poor survival of these patients with a median survival of 30.8 months, patients in the metachronous metastatic group with metastases to the lung and/or solitary lesions, were defined as M1a, and were significantly associated with favorable median survival of 41.5 and 49.1 months in the univariate and multivariate analysis, respectively. Patients in the metachronous metastatic group with metastasis to the lung and/or solitary lesions (M1a) have a more favorable prognosis compared with those patients with multiple metastases located in other anatomic sites (M1b). These data, in one of the largest reported metastatic NPC cohorts, are the first to show the prognostic impact of metastatic status in NPC. As a powerful predictor, the potential clinical value of a modified M1 of the TNM system for NPC will facilitate patient counseling and individualize management.

Comparative survival analysis in patients with pulmonary metastases from nasopharyngeal carcinoma treated with radiofrequency ablation.

PURPOSE: The aim of this retrospective study was to evaluate technical efficacy and the impact of CT-guided pulmonary radiofrequency ablation (RFA) on survival in patients with pulmonary metastases from nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Between 2000 and 2009, 480 patients were pathologically or clinically confirmed pulmonary metastases from NPC. And ten included patients of them had a total of 23 pulmonary metastases treated with percutaneous RFA under the real-time CT fluoroscopy. Safety, local tumor progression, and survival were evaluated in our institutions. Matched-pair survival was compared using Kaplan-Meier analysis. RESULTS: A total of 25 ablations were performed to 23 pulmonary metastases in 13 RFA sessions. Pneumothorax requiring chest tube placement developed in 3 of 13 (23.1%) RFA sessions. The median metastatic overall survival was 36.1 months for all the 480 NPC patients with pulmonary metastases. Furthermore, matched-pair analysis demonstrated patients with RFA treatment had a greater metastatic overall survival than patients without RFA treatment (77.1 months vs 32.4 months, log-rank test, p=0.009). There were no statistically significant differences in the survival probability of patients with RFA treatment (n=10) and surgical resection of pulmonary metastases (n=27) (log-rank test, p=0.75). CONCLUSION: CT-guided pulmonary RFA is safe and offers a treatment alternative for local tumor control, providing promising survival in selected patients with pulmonary metastases from NPC.

[Effect of nitric oxide derived from endothelial nitric oxide synthase on tumor angiogenesis].

BACKGROUND AND OBJECTIVE: Studies have shown that nitric oxide (NO) derived from endothelial nitric oxide synthase (eNOS) is expressed widely in tumor tissues and regulates tumor angiogenesis. However, the results are controversial. This study was to investigate the effect of NO on tumor angiogenesis and its mechanism. METHODS: C57BL/6 mice inoculated with Lewis lung cancer cells were randomly divided into three groups. Mice in the NO group were inoculated with lung cancer cells transfected with eNOS gene, mice in the L-NAME group with L-NAME, an eNOS antagonist, and mice in the control group with normal saline. Plasma concentration of NO and the number of endothelial progenitor cells (EPCs) in peripheral blood were detected . Tumor vessel density, CD133+ cells, and the expression of VEGF-VEGFR in tumor tissues were also measured. RESULTS: Four weeks after inoculation of Lewis cells, tumor volume was significantly larger in control group [ (3022 +/- 401) mm(3)] than in the L-NAME group [ (1204 +/-97) ) mm(3)] and in the eNOS group [(1824 +/- 239) mm(3)] (P<0.01). eNOS protein and NO production increased significantly in Lewis lung cancer cells transfected with eNOS gene. But the number of CD133-positive cells and vessel density in tumors were significantly lower in the eNOS group than in the control group [(48+/-19) / HPF vs. ( 103 +/- 27)/ HPF, (19+/- 7) HPF vs. (31 +/- 9) HPF, P<0.05]. The number of EPCs in peripheral blood was not statistically different between each group. The levels of NO in blood and tumor tissue significantly decreased after the treatment of L-NAME, while the tumor vessel density reduced to 12+/- 5/ HPF (P<0.01, vs. the control group; P<0.05, vs the eNOS transfected group). The number of EPCs in blood and that of CD133-positive cells in tumor tissue were significantly smaller in the L-NAME group than in the control group (P<0.05). CONCLUSION: No derived from eNOS inhibits angiogenesis and tumor growth, which may be due to its suppression on either the mobilization or homing of EPCs via VEGF binding to VEGFR.