A Nomogram Predicting Recurrence and Guiding Adjuvant Radiation for Thymic Carcinoma After Resection.

BACKGROUND: Resection is an effective treatment for thymic carcinoma. We aimed to develop a nomogram for postoperative prediction of recurrence-free survival for patients with thymic carcinoma and guide adjuvant radiotherapy. METHODS: A total of 198 patients who underwent surgery were divided into training cohort (n = 152) and validation cohort (n = 46). Clinicopathologic features and independent factors for postoperative recurrence were analyzed. A predictive nomogram was developed based on the prognostic factors. Discrimination and predictive accuracy of the model were measured using the concordance index (C-index), calibration curves, and validation study. RESULTS: The overall 1-, 3-, and 5-year recurrence rate of 198 patients was 7.6%, 27.9%, and 39.9%, respectively. Independent predictors of recurrence-free survival on multivariate analysis were incorporated into the nomogram. Calibration curves for the probability of 1-, 3-, and 5-year recurrence-free survival fitted well. The C-index of the nomogram for predicting recurrence-free survival was 0.862 (95% confidence interval: 0.804 to 0.919). Internal validation supported the results optimally. Adjuvant radiotherapy was effective for patients with a total score greater than 208. CONCLUSIONS: Our nomogram for predicting recurrence-free survival had good performance. Adjuvant radiotherapy should be recommended for patients with a total score greater than 208.

Clinical and pathology analysis of 1 case of adult pleural pulmonary blastoma: A case report.

RATIONALE: Pulmonary blastoma is a rare primary lung cancer that can be categorized into adult type and child type. The clinical symptoms and imaging features of pulmonary blastoma are nonspecific, making it difficult to diagnose preoperatively. Postoperative pathology with immunohistochemical staining can help diagnosis. PATIENT CONCERNS: A 53-year-old male had chest tightness and shortness of breath. DIAGNOSES: The patient was diagnosed as pleural pulmonary blastoma based on computed tomography (CT) scan, pathology, immunohistochemistry, and molecular pathology. CT examination showed solid mass on the upper lobe of the left lung Intraoperative observation found that tumor tissue was gray with tough texture. The surrounding lung tissue showed AE1/AE3 (+), Vimentin (+), and CD34 (+) staining. No epidermal growth factor receptor gene mutation was detected. INTERVENTIONS: The left lobe resection plus mediastinal lymph node dissection were performed. After the operation, patient received paclitaxel combined with nedaplatin chemotherapy for 4 times. OUTCOMES: Four months later, left pleural metastasis, and mediastinal lymph node metastasis was found. The patient died 15 months later. LESSONS: Pleural pulmonary blastoma is a malignant tumor with rare pathological features that is easy to relapse and metastasis with poor prognosis. Surgical treatment preferably, lobectomy plus mediastinal lymph node dissection, is the first treatment option. The overall prognosis is poor.

Differential expression of miR-21 and miR-75 in esophageal carcinoma patients and its clinical implication.

In Xinjiang, China, esophageal carcinoma has a high incidence in Kazak and Uighur populations. MicroRNA (miR)-21 and miR-375 are related to esophageal carcinoma. This study thus investigated their potencials in early diagnosis and prognosis in Kazak and Uighur populations, to provide evidences for serum markers of esophageal cancer. A total of 126 Kazak or Uighur esophageal cancer patients were enrolled as the disease group, along with 86 local Han patients as disease control cohort, and 80 healthy Kazak or Uighur individuals. MiRNA expression was detected by in situ hybridization in tissues and by qRT-PCR in serum. ROC approach was used to evaluate the diagnostic value of miRNA on esophageal carcinoma. Cox analysis was performed to screen factors governing prognosis. MiR-21 level was significantly elevated in both tissue and serum samples of esophageal cancer patients, while miR-375 was down-regulated. Such difference was more potent in disease group compared to disease control group. MiR expression was correlated with infiltration depth, TNM stage, vascular invasion, and lymph node metastasis. Elevated expression of miR-21 reduced the sensitivity of radio-therapy, and increased recurrence frequency. The diagnostic value of single assay for miR-21 or miR-375 was lower than the combined assay (AUC=0.812 or 0.739 vs. 0.858). They also affected patient prognosis (OR=1.53 or 0.652). MiR-21 and miR-375 presented abnormal expression in Kazak or Uighur esophageal carcinoma patients and were independent factors affecting prognosis. The combined assay of miR-21 and miR-375 may help to make early diagnosis of esophageal cancer.

Real-time polymerase chain reaction for the diagnosis of necrotizing herpes stromal keratitis.

AIM: To design, optimize and validate a rapid, internally controlled real-time polymerase chain reaction (RT-PCR) test for herpes simplex virus (HSV) in the diagnosis of necrotizing herpes stromal keratitis. METHODS: Tears alone or together with corneal epithelium scrapings from 30 patients (30 eyes) suspected of necrotizing herpes stromal keratitis were tested for HSV DNA by RT-PCR. The samples were collected during the first visit and then on the subsequent 7, 14, 28, 42, and 56d. The symptoms of the patients were scored before treatment to determine the correlation between HSV concentration in the corneal epithelium scrapings and clinical scores. RESULTS: The positive rate (46.4%) in the corneal epithelium group before the therapy was significantly higher than that (13.3%) in the tears group (P=0.006). There were 13 positive HSV patients before the therapy, the concentration of HSV DNA in corneal epithelium scrapings group was significantly higher than that in the tears group (paired t-test, P=0.0397). Multilevel mixed-effects model analysis showed that the difference between the corneal epithelium scrapings group and the tears group was statistically significant (P=0.0049). The Spearman rank correlation analysis indicated a positive correlation between the HSV concentration in the corneal epithelium scrapings and clinical scores before the treatment (r=0.844, P<0.0001). CONCLUSION: RT-PCR appears to be a powerful molecular tool for the diagnosis of necrotizing herpes stromal keratitis.

Haemoglobin A1c measurement in patients with chronic kidney disease.

OBJECTIVES: The aim of this study is to investigate the interference of carbamylated haemoglobin (cHb) to haemoglobin A1c (HbA1c) measurements in patients with chronic kidney disease (CKD) by three ion-exchange chromatography methods. DESIGN AND METHODS: We included three ion-exchange chromatography methods (Bio-Rad Variant II, G7 and HA-8160) and one affinity chromatography method (Primus Ultra2) to test HbA1c. In vitro carbamylation of haemoglobin was also performed to test interference of carbamylation. RESULTS: 152 CKD patients were diagnosed. The average HbA1c and urea levels of nondiabetic and diabetic patients were 5.24% (33.8 mmol/mol) and 7.36% (56.9 mmol/mol) and 16.2 mmol/L and 11.2 mmol/L, respectively. Repeated measures ANOVA showed that the difference of HbA1c values between four methods is not statistically significant (P=0.421 for non-DM and P=0.336 for DM). With the increase in blood urea concentration from stage 3 to stage 5, there was no corresponding increase in HbA1c values for both groups. In vitro carbamylation results showed that carbamylated Hb peaks could be clearly identified by the three ion-exchange methods. CONCLUSION: HbA1c measurement by these methods may not be impacted by carbamylated Hb. The results should be interpreted with caution in high carbamylated Hb patients.

Effect of exenatide on inflammatory and oxidative stress markers in patients with type 2 diabetes mellitus.

AIM: This study was designed to determine the effect of exenatide on inflammatory and oxidative stress markers in type 2 diabetes mellitus (T2DM) patients who were suboptimally controlled with metformin and/or sulfonylurea. SUBJECTS AND METHODS: Twenty-three patients with T2DM with inadequate glucose control were randomly divided into two groups: exenatide group (E group) (12 patients, 5 µg b.d. × 4 weeks followed by 10 µg b.d. × 12 weeks) and placebo group (P group) (11 patients). Glycosylated hemoglobin (HbA1c), the seven-point glucose profile, daily mean glucose, and glycemic excursion were determined. The effects of exenatide on 8-iso-prostaglandin F2α (PGF2α), monocyte chemoattractant protein-1 (MCP-1), and high-sensitivity C-reactive protein (hs-CRP) were investigated. RESULTS: Exenatide treatment reduced body weight and body mass index (BMI) and improved HbA1c, the seven-point glucose profile, and daily mean glucose compared with placebo (P < 0.05). Limited glycemic excursion was found in the E group compared with the P group (P < 0.05), including a smaller SD and postprandial glucose excursion. In addition, the oxidative stress maker PGF2α was significantly reduced by exenatide treatment (P < 0.05). The inflammatory markers hs-CRP and MCP-1 were also significantly reduced in the E group compared with the P group (P < 0.05). PGF2α was significantly correlated with glycemic excursion (P < 0.05), whereas MCP-1 was significantly correlated with body weight, BMI, glycemic excursion, and HbA1c (P < 0.05 for all). CONCLUSIONS: Exenatide treatment reduced patient body weight and BMI, improved HbA1c and the seven-point glucose profile, reduced daily mean glucose, limited glycemic excursion, and reduced oxidative stress and inflammatory markers in patients of T2DM having inadequate glucose control.