[Safety analysis of definitive surgery for chronic radiation intestinal injury].

Objective: To investigate the safety of definitive surgery for chronic radiation intestinal injury. Methods: A descriptive case series study was performed. Clinical data of 105 patients who were diagnosed as chronic radiation intestinal injury, had complete data and received definitive surgery (the radiation-induced intestinal segment and digestive tract reconstruction) at Department of Gastrointestinal Surgery of Beijing Tsinghua Changgung Hospital from June 2016 to May 2020 were retrospectively analyzed. There were 30 males (28.6%) and 75 females (71.4%) with the median age of 58 years (P25, P75: 52, 64 years). Patients who had tumor recurrence or refused surgical treatment were excluded. According to the preoperative evaluation and clinical manifestations, to select the resection range. Outcome parameters: (1) preoperative evaluation (nutrition risk assessment and status of obstruction or fistula); (2) clinical manifestations and treatment strategies; (3) details of surgical parameters; (4) postoperative complications, and Clavien-Dindo classification III to V was defined as main moderate-severe complication. Results: (1) Preoperative evaluation: Eighty-eight patients (83.8%) developed symptoms of chronic radiation intestinal injury more than 1 year after the end of radiotherapy. Ninety-eight patients (93.3%) had preoperative NRS-2002 score ≥3, 74 patients (70.5%) received preoperative parenteral nutritional support, and the median time of nutritional support was 10.5 (7.0, 16.0) days. Sixteen patients (15.2%) received small intestinal decompression tube implantation due to severe obstruction. (2) Clinical manifestations and treatment strategies: Among 105 patients, 87 (82.9%) presented with obstruction and received definitive resection of the radiation-induced intestinal segment plus one-stage digestive tract reconstruction; 18 (17.1%) presented with intestinal fistula and all of them received definitive resection of the radiation-induced intestinal segment, intestinal fistula plus one-stage digestive tract reconstruction. Among above 18 patients with fistula, 3 patients with ileorectal stump fistula received pedicled pelvic closure of greater omentum at the same time; 4 patients had ileal vesical fistula, of whom 2 patients received cystectomy and bladder repair due to preoperative nephrostomy decompression, and the other 2 patients received transection of the small intestine proximal and distal to the fistula and anastomosis of the intestinal loop without fistula resection, intestinal fistula or bladder fistula repair. (3) The details of surgical parameters: Median operative time and intraoperative blood loss was 230 (180, 300) minutes and 50 (20, 50) ml respectively. Ninety-two patients (92/105, 87.6%) underwent ileocolonic anastomosis, and anastomosis on the hepatic flexure or splenic flexure colon were performed in 88 (83.8%) and 4 (3.8%) patients respectively. Ileoileal anastomosis was performed in 13 patients (12.4%). The anastomotic site of 92 patients (87.6%) was strictly located in the contralateral quadrant of the radiation field, and the anastomotic site of 13 patients (12.4%) was far from the radiation field. Nine patients (8.6%) had more than one anastomosis, 5 patients (4.8%) had less than 180 cm of residual small intestine, 7 patients (6.7%) underwent retrograde intestinal permutation, 4 patients (3.8%) underwent abdominal wall reconstruction surgery due to abdominal wall defects, and 87 patients (82.9%) had severe abdominal pelvic adhesions (grade 3-4 adhesions). Intraoperative complications occurred in 3 patients (2.9%), which were found in time and handled properly. The median postoperative hospital stay was 13.0 (12.0, 24.5) days, and all the patients had resumed oral feeding upon discharge. (4) Postoperative complications: Fourteen patients (13.3%) had 18 major complications (grade III to V). The incidence of postoperative anastomotic leakage was 5.7% (6/105), and the incidence of anastomotic leakage for ileocolon anastomosis and ileoileal anastomosis was 2.2% (2/92) and 4/13, respectively (χ(2)=17.29, P<0.001). The incidence of postoperative anastomotic leakage of intestinal fistula and intestinal obstruction was 3/18 and 3.4% (3/87), respectively (χ(2)=4.84, P=0.028). The mortality at 30 days after operation was 1.0% (1/105), after abdominal infection and septic shock caused by postoperative anastomotic leakage resulting in multiple organ failure. Conclusion: For chronic radiation intestinal injury patients with obstruction or fistula, definitive surgical treatment is feasible and safe with acceptable major complications.

[Efficacy and safety of Nocardia rubra cell wall skeleton for the treatment of erosive oral lichen planus].

OBJECTIVE: To observe the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) for the treatment of erosive oral lichen planus (EOLP). METHODS: Sixty patients with clinically and pathologically diagnosed EOLP were randomly divided into the experimental group and control group according to the random number. Patients in the experimental group were treated with lyophilized powder containing Nr-CWS combined with normal saline. Patients in the control group received topical placebo without Nr-CWS combined with normal saline. Changes in the EOLP lesion area and the patient's pain level were recorded at the timepoints of weeks 1, 2, and 4 after the two different treatments, respectively. The changes of the patient's REU scoring system (reticulation, erythema, ulceration), the visual analogue scale and the oral health impact score (OHIP-14) were compared between the experimental group and control group after treatment, and the safety indicators of the two groups at the initial diagnosis and after 4 weeks' treatment were also observed, respectively. RESULTS: Totally, 62 patients with clinically and pathologically diagnosed EOLP were enrolled, 2 of whom were lost to the follow-up, with 31 in the experimental group, and 29 in the control group. The mean age of the experimental group and control group were (52.9±12.4) years and (54.07±12.40) years, respectively. There was no significant difference in the oral periodontal index between the experimental group and control group. In the experimental group, the erosive area of oral lichen planus was significantly reduced 1, 2, and 4 weeks after the Nr-CWS's treatment (P < 0.05), the reduction rate was 81.75%, the patient's pain index was also decreased (P < 0.05), and in addition, the OHIP-14 was reduced (P < 0.05). The changes of the REU scoring system, the visual analogue scale and the OHIP-14 were significantly different between the experimental group and control group after treatment. There was no significant difference in the safety index between the two groups. CONCLUSION: The priliminary data show that the Nr-CWS is effective and safe to treat EOLP.

Genetic differentiation and diversity of Callosobruchus chinensis collections from China.

Callosobruchus chinensis (Linnaeus) is one of the most destructive pests of leguminous seeds. Genetic differentiation and diversity analysis of 345 C. chinensis individuals from 23 geographic populations using 20 polymorphic simple sequence repeats revealed a total of 149 alleles with an average of 7.45 alleles per locus. The average Shannon's information index was 1.015. The gene flow and genetic differentiation rate values at the 20 loci ranged from 0.201 to 1.841 and 11.0-47.2%, with averages of 0.849 and 24.4%, respectively. In the 23 geographic populations, the effective number of alleles and observed heterozygosity ranged from 1.441 to 2.218 and 0.191-0.410, respectively. Shannon's information index ranged from 0.357 to 0.949, with the highest value in Hohhot and the lowest in Rudong. In all comparisons, the fixation index (F ST ) values ranged from 0.049 to 0.441 with a total F ST value of 0.254 among the 23 C. chinensis populations, indicating a moderate level of genetic differentiation and gene flow among these populations. Analysis of molecular variance revealed that the genetic variation within populations accounted for 76.7% of the total genetic variation. The genetic similarity values between populations varied from 0.617 to 0.969, whereas genetic distances varied from 0.032 to 0.483. Using unweighted pair-group method using arithmetical averages cluster analysis, the 23 geographic collections were classified into four distinct genetic groups but most of them were clustered into a single group. The pattern of the three concentrated groups from polymerase chain reactions analysis showed a somewhat different result with cluster.

Association between growth differentiation factor-15 and chronic heart failure in coronary atherosclerosis patients.

We explored the association between plasma growth differentiation factor 15 (GDF-15) levels and chronic heart failure (CHF) in coronary heart disease patients. We measured plasma GDF-15 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in 269 untreated coronary heart disease patients (98 with CHF, 84 without CHF, and 87 control patients) using an enzyme-linked immunosorbent assay. All subjects were examined by echocardiography and left ventricular ejection fraction. We found that plasma GDF-15 levels in coronary atherosclerosis patients with CHF [median 1622.48 (25-75th percentile: 887.53-1994.93) ng/L] were higher than those in coronary atherosclerosis patients without CHF [944.99 (856.12-999.78) ng/L] and control patients (P < 0.05). NT-proBNP showed the same trend as GDF-15. We also used the New York Heart Association functional classification to subgroup CHF patients and found that the GDF-15 level was higher in all subgroup patients with CHF. After adjusting for covariates, plasma GDF-15 levels were found to be positively related to NT-proBNP (r = 0.861, P < 0.001) and negatively related to left ventricular ejection fraction (r = -0.936, P < 0.001). Furthermore, receiver operating characteristic curves of GDF-15 and NT-proBNP were constructed and the area under the curve for the untransformed GDF-15 and NT-proBNP was 0.804 and 0.795, respectively. Plasma GDF-15 levels and NT-proBNP are associated with CHF in coronary atherosclerosis patients and can be used as biomarkers.

First Report of Neocosmospora vasinfecta var. vasinfecta Causing Soybean Stem Rot in South Korea.

In September 2010, stem rot symptoms were observed on soybean plants (cv. Daepungkong) growing in a field located at Daegu (35.52° N, 128.35° E), South Korea. The first noticeable symptoms, observed on the top leaves, were difficult to distinguish from those of sudden death syndrome (SDS). However, after splitting the stems of symptomatic plants, typical stem rot symptoms appeared as reddish-brown to dark-brown discoloration of the pith. Stem lesions extended 15 to 20 cm upward from the soil surface. To isolate the causal agent, sections of diseased stems were surface disinfected with 1% sodium hypochlorite, placed on potato dextrose agar (PDA) containing streptomycin sulfate, and incubated at 25°C with a 12-h light regime. Two isolates were obtained (SSLNV17 and SSLNV18). Mycelia were white and floccose. Conidia (4.5 to 11.2 × 2.2 to 3.4 µm) were cylindrical to oblong-ellipsoidal, hyaline, and one-celled. Both isolates produced abundant perithecia after 3 to 4 weeks. Perithecia (205 to 331 mm in diameter) were orange to red, globose and ostiolate, with a short neck (80 to 126 mm in diameter). Unitunicate asci (88.6 to 115.3 × 14.5 to 17.3 mm) were cylindrical to clavate, with a short stalk (6.0 to 9.5 × 5.0 to 6.8 mm), and eight spores. Ascospores (13.3 to 17.5 × 10.7 to 12.7 mm) were uniseriately arranged, globose to oval, one-celled, and hyaline to pale brown, with walls with a rugose ornamentation. These morphological features are consistent with those of Neocosmospora vasinfecta var. vasinfecta (1). The internal transcribed spacer (ITS) region, partial translation elongation factor 1-alpha (EF1-α), and ß-tubulin genes of rDNA of the two isolates were sequenced using primers ITS4/ITS5 (GenBank Accession Nos. KF662732 and KF662733), EF1-728F/EF1-986R (KF758839 and KF758840), and Bt2a/Bt2b (KF771004 and KF771005), respectively. Sequences of the ITS region, EF1-α, and ß-tubulin genes of both isolates showed 99% similarity with several reported N. vasinfecta strains by BLAST analysis. Both morphological and sequence analyses confirmed that the two isolates were N. vasinfecta var. vasinfecta. Pathogenicity tests of both isolates were performed on 15 three-week-old seedlings of soybean cv. Williams inoculated with a spore suspension containing 1.0 × 106 spores/ml, using stem puncture inoculation procedure under controlled conditions (4). Control plants were inoculated in the same way with sterile water. The results were observed by splitting the stem longitudinally and checking for discoloration of the pith 4 to 5 weeks after inoculation. Reddish-brown to dark-brown discoloration was observed in the stem pith of inoculated plants, with occasional chlorosis of the leaves. Moreover, numerous orange-red perithecia were produced on the inoculated stems. However, no symptoms were visible on control plants. The pathogen was re-isolated from the diseased plants, confirming Koch's postulates. Neocosmospora stem rot of soybean was first discovered in Japan and since then it has been reported in the United States and China (2,3,4). To our knowledge, this is the first record of soybean stem rot caused by N. vasinfecta var. vasinfecta in Korea. Our report indicates that Neocosmospora stem rot is a new threat to soybean production in Korea. References: (1) P. F. Cannon and D. L. Hawksworth. Trans. Br. Mycol. Soc. 82:673, 1984. (2) Y. Gai et al. Plant Dis. 95:1031, 2011. (3) F. A. Gray et al. Plant Dis. 64:321, 1980. (4) D. V. Phillips. Phytopathology 62:612, 1972.

First Report of Charcoal Rot Caused by Macrophomina phaseolina on Mungbean in China.

Mungbean (Vigna radiata L.), an important leguminous food crop in China, is popularly grown in arid regions. The total area of mungbean production is 8.0 × 105 ha. In August and September 2010, wilted symptoms were observed in mungbean plants in Yulin, Shaanxi Province and Datong, Shanxi Province. Infected plants had silvery gray coloration of stems and lateral branching with senesced leaves still attached to the plant. Dark brown necrotic areas were observed on the exterior of the taproot underneath the epidermis and in the pith of the lower stems of wilted plants. Black spherical microsclerotia, 43.9 µm, were present in infected plant tissues. Six fungal isolates were cultured on potato dextrose agar at 25°C and the mycelium was initially hyaline but later became gray. Black microsclerotia, 60 to 80 × 75 to 123 µm, were observed in culture after 2 to 7 days of incubation. On the basis of field symptoms, colony color, and the size of microsclerotia, the fungus was identified as Macrophomina phaseolina (Tassi) Goid (3). To confirm the morphological identification, the rDNA internal transcribed spacer (ITS) regions of the six isolates were amplified with universal primers ITS1 and ITS4. The resulting ITS sequences of the six isolates (GenBank Accession Nos. HQ660589, HQ660590, HQ660591, HQ660592, HQ660593, and HQ660594) were aligned in GenBank, which showed 97 to 99% identity with 60 M. phaseolina isolates (e.g., Accession Nos. GU046867, FJ415067, and FJ960441). Using the PCR primers MpKF1 (5'-CCGCCAGAGGACTATCAAAC-3') and MaKR1 (5'-CGTCCGAAGCGAGGTGTATT-3') specific for M. phaseolina (1), a 350-bp PCR fragment was obtained, indicating that these isolates were M. phaseolina. Pathogenicity tests of six isolates were performed by inoculation of 3-week-old seedlings of cv. Zhonglv 8 using the hypocotyl inoculation technique, respectively (2). Each isolate was transferred to petri dishes containing PDA 2 days prior to inoculation. On the day of inoculation, an inoculum slurry was prepared by cutting agar with the pathogen into small strips and passing the strips through a 5-syringe until uniform. A small quantity of inoculum extruded into the vertical cut in each hypocotyl of at least eight seedlings in each pot, and the PDA was used as the control to extrude into the vertical cut in each hypocotyl of at least eight seedlings in another pot. The inoculated and control plants were incubated in the mist chamber at 25°C and 90 to 100% relative humidity for 48 h before growing in a greenhouse at 30°C. Six days after inoculation, all inoculated plants, wilted or dead, showed dark brown-toblack lesions. No symptoms were observed on the control plants. For each isolate tested, M. phaseolina was reisolated from inoculated plants, but was not isolated from the control plants. The fungus has been detected in 29 plant species of 23 genera in China, including the major crops Arachis hypogaea, Helianthus annuus, and Glycine max. Although M. phaseolina has caused great yield reduction of mungbean in many areas of Asia, to our knowledge, this fungus as a causal agent of mungbean charcoal rot has not previously been reported in China. Reference: (1) B. K. Babu et al. Mycologia 99:797, 2007. (2) D. L. Pazdernik et al. Plant Dis. 81:1112, 1997. (3) G. S. Smith and T. D.Wyllie. Charcoal rot. Page 29 in: Compendium of Soybean Diseases. 4th ed. G. L. Hartmann et al., eds. The American Phytopathological Society, St. Paul, MN, 1999.

The gene expression profiling of sporadic pheochromocytoma and novel full-length cDNAs cloning.

Pheochromocytoma is a chromaffin cell neoplasm that typically causes symptoms and signs of episodic catecholamine release. Pheochromocytoma can be divided into two types: familial and sporadic. The molecular mechanisms involved in familial pheochromocytoma have been unraveled, but the detailed molecular mechanism of sporadic pheochromocytoma remains unknown. The present study thus aimed at characterization of gene expression profiling of sporadic pheochromocytoma using expressed sequence tags (ESTs), and established a preliminary catalog of genes expressed in the tumor. In total, 4115 ESTs were generated from the tumor library. The gene expression profilings of the pheochromocytoma and the normal adrenal gland were compared, and 341 genes were identified to be significantly expressed differently between the two libraries. Interestingly, 16 known genes participating in cell division or apoptosis were notably differently expressed between the tumor and the normal adrenal gland. Twenty-four novel full-length cDNAs were cloned from the tumor library and five of them were significantly up-regulated in the tumor. Some of them may be involved in the tumorigenesis of pheochromocytoma. The sequence data of ESTs and novel full-length cDNAs described in this paper have been submitted to the GeneBank library.

Insight into hepatocellular carcinogenesis at transcriptome level by comparing gene expression profiles of hepatocellular carcinoma with those of corresponding noncancerous liver.

Human hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. In this work, we report on a comprehensive characterization of gene expression profiles of hepatitis B virus-positive HCC through the generation of a large set of 5'-read expressed sequence tag (EST) clusters (11,065 in total) from HCC and noncancerous liver samples, which then were applied to a cDNA microarray system containing 12,393 genes/ESTs and to comparison with a public database. The commercial cDNA microarray, which contains 1,176 known genes related to oncogenesis, was used also for profiling gene expression. Integrated data from the above approaches identified 2,253 genes/ESTs as candidates with differential expression. A number of genes related to oncogenesis and hepatic function/differentiation were selected for further semiquantitative reverse transcriptase-PCR analysis in 29 paired HCC/noncancerous liver samples. Many genes involved in cell cycle regulation such as cyclins, cyclin-dependent kinases, and cell cycle negative regulators were deregulated in most patients with HCC. Aberrant expression of the Wnt-beta-catenin pathway and enzymes for DNA replication also could contribute to the pathogenesis of HCC. The alteration of transcription levels was noted in a large number of genes implicated in metabolism, whereas a profile change of others might represent a status of dedifferentiation of the malignant hepatocytes, both considered as potential markers of diagnostic value. Notably, the altered transcriptome profiles in HCC could be correlated to a number of chromosome regions with amplification or loss of heterozygosity, providing one of the underlying causes of the transcription anomaly of HCC.