Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables.

INTRODUCTION: Recent evidence confirms that the treatment of acute appendicitis is not necessarily surgical, and selected patients with uncomplicated appendicitis can benefit from a non-operative management. Unfortunately, no cost-effective test has been proven to be able to effectively predict the degree of appendicular inflammation as yet, therefore, patient selection is too often left to the personal choice of the emergency surgeon. Our paper aims to clarify if basic and readily available blood tests can give reliable prognostic information to build up predictive models to help the decision-making process. METHODS: Clinical notes of 2275 patients who underwent an appendicectomy with a presumptive diagnosis of acute appendicitis were reviewed, taking into consideration basic preoperative blood tests and histology reports on the surgical specimens. Variables were compared with univariate and multivariate analysis, and predictive models were created. RESULTS: 18.2% of patients had a negative appendicectomy, 9.6% had mucosal only inflammation, 53% had transmural inflammation and 19.2% had gangrenous appendicitis. A strong correlation was found between degree of inflammation and lymphocytes count and CRP/Albumin ratio, both at univariate and multivariate analysis. A predictive model to identify cases of gangrenous appendicitis was developed. CONCLUSION: Low lymphocyte count and high CRP/Albumin ratio combined into a predictive model may have a role in the selection of patients who deserve appendicectomy instead of non-operative management of acute appendicitis.

Extramammary Paget's Disease in the Genital Area of a Male: A Case Report and Review of the Literature.

Extramammary Paget's disease (EMPD) is an uncommon intraepithelial malignancy that is rarely found in the male. Currently, there is very little knowledge pertaining to EMPD imaging, particularly in cases that involve the scrotum. Here, a 67-year-old man with lichenification on his left scrotum confirmed to be EMPD was reviewed. Bloodwork did not return a positive result, but syphilis-specific antibodies were found. Conventional high-frequency ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging were utilized to determine the lesion size and blood perfusion. In the present case, the lesion's size and involvement were vividly depicted by CEUS, while results obtained by conventional US were grossly underestimated. Consequently, multimodal imaging assessment is likely to provide more accurate diagnoses for uncommon diseases, such as EMPD, and to aid in clinical decision-making.

Effects of resveratrol on high-fat diet-induced hypertrophic obesity in elderly mice / 中华老年医学杂志

Objective:To investigate the effects and potential mechanisms of resveratrol on obesity in elderly mice.Methods:In this study, 3 groups were randomly formed for 32-week-old mice and for 48-week-old mice.The normal diet group received regular chow and 0.3 ml saline by gavage once a day, the high-fat diet group received a high-fat diet(containing 21% fat and 1.25% cholesterol)and 0.3 ml saline once a day, and the high-fat diet plus resveratrol group received a high-fat diet and resveratrol(22.4 mg/kg, dispersed in 0.3 ml saline)by gavage once a day.After 12 weeks, body weight and adipose tissues were measured.Plasma leptin concentrations were determined by an enzyme-linked immunosorbent assay(ELISA), and values for hypertrophic obesity-related indexes of mice were obtained by quantitative real-time PCR.Results:The body weight and the proportion of subcutaneous fat tissues were lower in the high-fat diet plus resveratrol group than in the high-fat diet group[(34.43±3.23)g vs.(53.16±2.16)g, (3.21±1.58)% vs.(4.86±0.64)%, P<0.01], and were similar to those in the normal diet group.Resveratrol had a more obvious inhibitory effect on leptin in elderly mice than in middle-aged mice.In elderly mice, the plasma leptin concentration was lower in the high-fat diet plus resveratrol group than in the high-fat diet group[(0.015±0.009)g/L vs.(0.100±0.027)g/L]and the normal diet group( F=19.85, P=0.001), and it was similar to that in the middle-aged mice on a normal diet.Resveratrol significantly increased the expression of peroxisome proliferator-activated receptor gamma(PPARγ)and glucose transporter 4(GLUT4)and reduced the expression of tumor necrosis factor-α(TNF-α)( F=10.79, 9.31 and 7.02, P=0.003, 0.006 and 0.010). Conclusions:Resveratrol can significantly improve hypertrophic obesity in elderly mice, and the inhibition of leptin secretion and up-regulation of PPARγ may be the key mechanisms.

Lithium chloride inhibits vascular smooth muscle cell calcification by increasing pyrophosphate levels / 中华老年医学杂志

Objective:To investigate the effects of lithium chloride on vascular smooth muscle cell calcification and the potential underlying mechanisms.Methods:Human aortic smooth muscle cells were cultured in vitro, and a smooth muscle cell calcification model was established by using a calcification medium(the concentration of inorganic phosphorus was 3 mmol/L). Cells in the drug treatment group were pretreated with lithium chloride(10 mmol/L)for 4 hours and then with inorganic phosphorus at 3 mmol/L.After several days in culture, calcium deposition in cells was measured by alizarin red S staining.The secretion of extracellular pyrophosphate was detected by measuring nicotinamide adenine dinucleotide hydrogen(NADH) consumption of pyrophosphate-coupled enzyme reactions, which were monitored spectrophotometrically at 340 nm.Real-time PCR and Western blotting were used to detect mRNA and protein expression of the human progressive ankylosis( ankh)gene.Human aortic smooth muscle cells were infected with the scramble control lentivirus and the sh- ankh lentivirus, respectively, to establish the control cell group and the ankh knockdown cell group.The effects of ankh knockdown on cell calcification were examined. Results:The calcification level in vascular smooth muscle cells increased in the high inorganic phosphorus group, compared with the control group[(65.00±2.11)ng/g vs.(12.39±0.38)ng/g, P<0.01)]. Compared with the high-phosphorus control group, lithium chloride evidently inhibited high phosphate-induced vascular smooth muscle cell calcification[(24.92±1.87)ng/g vs.(60.94±4.51)ng/g, P<0.01)]. Lithium chloride pretreatment clearly increased extracellular pyrophosphate levels under unstimulated conditions[(51.70±7.26)×10 -3mmol/g vs.(28.71±2.55)×10 -3mmol/g( P<0.01)]and under high phosphorus stimulation[(34.35±4.27)×10 -3mmol/g vs.(20.89±4.93)×10 -3mmol/g( P<0.05)], and increased the expression of ankh as well( P<0.01). In addition, ankh knockdown markedly enhanced the extent of inorganic phosphorus-induced vascular smooth muscle cell calcification(71.73±2.45 ng/g vs.56.19±3.59 ng/g, P<0.01). Conclusions:Lithium chloride inhibits high phosphorus-induced vascular smooth muscle cell calcification by enhancing the level of extracellular pyrophosphate via increased ankh expression.

Survivin-targeted tumor treatment strategy / 第二军医大学学报

Survivin, a new member of inhibitors of apoptosis proteins(IAP) family, regulates the essential cellular processes, including inhibition of cell apoptosis, promotion of cell proliferation and tumor stromal angiogenesis. Survivin is undetectable in most terminally differentiated tissues, but upregulated in almost all types of human malignancies and its aberrant overexpression positively correlates with chemotherapy resistance, increased tumor recurrence and shortened patient survival. Because of its key role in tumor formation and development, Survivin is considered as an ideal target for anticancer treatment. This review discussed the molecular function of Survivin, relationship between Survivin and cancer biological characteristics, as well as the research progress of cancer therapy targeting Survivin.

DEAD-box helicase DP103 defines metastatic potential of human breast cancers.

Despite advancement in breast cancer treatment, 30% of patients with early breast cancers experience relapse with distant metastasis. It is a challenge to identify patients at risk for relapse; therefore, the identification of markers and therapeutic targets for metastatic breast cancers is imperative. Here, we identified DP103 as a biomarker and metastasis-driving oncogene in human breast cancers and determined that DP103 elevates matrix metallopeptidase 9 (MMP9) levels, which are associated with metastasis and invasion through activation of NF-κB. In turn, NF-κB signaling positively activated DP103 expression. Furthermore, DP103 enhanced TGF-ß-activated kinase-1 (TAK1) phosphorylation of NF-κB-activating IκB kinase 2 (IKK2), leading to increased NF-κB activity. Reduction of DP103 expression in invasive breast cancer cells reduced phosphorylation of IKK2, abrogated NF-κB-mediated MMP9 expression, and impeded metastasis in a murine xenograft model. In breast cancer patient tissues, elevated levels of DP103 correlated with enhanced MMP9, reduced overall survival, and reduced survival after relapse. Together, these data indicate that a positive DP103/NF-κB feedback loop promotes constitutive NF-κB activation in invasive breast cancers and activation of this pathway is linked to cancer progression and the acquisition of chemotherapy resistance. Furthermore, our results suggest that DP103 has potential as a therapeutic target for breast cancer treatment.

HS3ST2 modulates breast cancer cell invasiveness via MAP kinase- and Tcf4 (Tcf7l2)-dependent regulation of protease and cadherin expression.

Heparan sulfate 3-O-sulfotransferase 2 (HS3ST2), an enzyme mediating 3-O-sulfation of heparan sulfate (HS), is silenced by hypermethylation in breast cancer. As HS has an important co-receptor function for numerous signal transduction pathways, the phenotypical changes due to HS3ST2 reexpression were investigated in vitro using high and low invasive breast cancer cell lines. Compared to controls, highly invasive HS3ST2-expressing MDA-MB-231 cells showed enhanced Matrigel invasiveness, transendothelial migration and motility. Affymetrix screening and confirmatory real-time PCR and Western blotting analysis revealed increased expression of several matrix metalloproteinases, cadherin-11, E-cadherin and CEACAM-1, while protease inhibitor and annexin A10 expression were decreased. Low invasive HS3ST2 -expressing MCF-7 cells became even less invasive, with no change in gelatinolytic MMP activity. HS3ST2 expression increased HS-dependent basal and FGF2-specific signaling through the constitutively active p44/42 MAPK pathway in MDA-MB-231 cells. Increased MAPK activation was accompanied by upregulation of ß-catenin in MDA-MB-231, and of the transcription factor Tcf4 in both cell lines. Dysregulation of Tcf4-regulated ion transporters and increased cytosolic acidification were observed in HS3ST2-expressing MDA-MB-231 cells, which is a possible underlying cause of increased chemosensitivity towards doxorubicine and paclitaxel in these cells. This study provides the first in vitro evidence of the involvement of HS3ST2 in breast cancer cell invasion and chemosensitivity.

Targeting heparan sulfate proteoglycans in breast cancer treatment.

Breast carcinoma is one of the leading causes of mortality among female cancers globally. Heparan sulfate proteoglycans, found predominantly on cell surfaces and in the extracellular matrix, are known to regulate breast cancer cellular behavior. Many studies have shown that these molecules serve as potential biomarkers for breast cancer. In addition, they have aberrant expression patterns and participate in various molecular signaling pathways in tumor progression. There is substantial interest in targeting heparan sulfate proteoglycans for cancer treatment, which needs to be tailored according to the roles that each proteoglycan plays in cancer biology. Current clinical trials using phosphomannopentaose sulfate, a heparan sulfate mimic, and various forms of heparin have produced promising results in breast cancer patients. Besides heparan sulfate chains, novel therapeutic agents could potentially be developed to regulate the proteoglycan core proteins as well as enzymes that modify heparan sulfation patterns. This review discusses the current use and future prospective applications of heparan sulfate proteoglycans, which have been recently patented, as therapeutic targets in breast cancer treatment.