Correlation between CK18 gene and gastric carcinoma micro metastasis

AIM: To explore the biological behavior of gastric carcinoma micrometastasis (MM) with a marker of cytokeratin 18 (CK18) and to evaluate the clinical stage of gastric carcinoma and its prognosis. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to examine the expression of CK18 mRNA in 298 lymph nodes from 35 patients with gastric carcinoma and 20 lymph nodes from 10 patients with chronic peptic ulcer and gastric perforation diagnosed by pathological examination and surgery.CK18 mRNA expression of peripheral blood from 54 patients with gastric carcinoma and 10 healthy people were also examined.RESULTS: Expression of CK18 mRNA was not found in 10 patients with benign pathological changes.CK18 mRNA expression in gastric carcinoma tissues was strongly positive. In gastric carcinoma patients,pathological examination revealed that 99 of 298 (33.2%)lymph nodes were positive, while RT-PCR showed that 133 of 298 (44.6%) lymph nodes had expression of CK18 mRNA. The difference was significant (P＜0.05).Among the 199 negative lymph nodes identified by pathological examinations, 34 (17.1%) displayed positive expression of CK18 mRNA by RT-PCR. The positive expression of CK18 mRNA was associated with lymph node micrometastasis (LMM) of gastric carcinoma. CK18 mRNA was negatively expressed in all 10 healthycases and positively expressed in 38.9% of 54 blood specimens from gastric carcinoma patients. The positive rate was not correlated with tumor invasion of gastric carcinoma,but was significantly associated with TNM stage, lymph node metastasis (P=0.0290, P＜ 0.05) and tumor differentiation (P= 0.2956, P＜0.05).CONCLUSION: RT-PCR with CK18 mRNA as a molecular marker is highly sensitive and specific in detecting LMM of gastric carcinoma. It can benefit the diagnosis of MM and guide studies on biological behavior, clinical phase,and therapy as well as relapse monitoring.

Characteristics of and management strategies for 54 suicidal inpatients in a general hospital

Objective： The aim of this study was to explore the characteristics of and preventive management strategies for suicidal inpatients in a general hospital.Methods： A total of 54 suicide victims were drawn from a patient safety adverse event network reporting system during hospitalization in a general hospital from November 2008 to January 2017.Results： Subjects who committed suicide in the general hospital were women and those who suffered from malignant neoplasms during general hospital treatment. Furthermore, most of the patients who committed suicide used more violent suicide methods. The most common and lethal means was jumping from heights at the windowsill.Conclusions： It is concluded that management straties for suicide prevention can be provided from the aspects of patients, medical staff and the hospital environment. It is not only urgent but also feasible to reduce the suicide rate of inpatients and further improve hospital safety management.

PERIPHERAL BLOOD CD34^+ CELL MOBILIZATION IN 42 PATIENTS WITH SEVERE AUTOIMMUNE DISEASE

Objective To evaluate the feasibility and safety of peripheral CD34+ cell mobilization in patients with severe autoimmune disease. Methods Forty-two patients underwent a total of 46 mobilizations by the regimen of cyclophosphamide 2-3 g/m2 +recombinant human granulocyte colony stimulating factor (rhG-CSF) 5 μg·kg-1·d-1. The positive selection of CD34+ cell was performed through the CliniMACS. Results In 8.1±2.3 days after administration of cyclophosphamide, the peripheral white blood cell and mononuclear cell (MNC) decreased to the lowest level. In 3.7±1.6 days after injection of rhG-CSF, the peripheral absolute MNC and CD34+ cell counts were 0.95×109/L and 0.035×109/L, respectively. After 2.4±0.6 times of leukapheresis, there gained 4.46×108/kg of MNC and 5.26×106/kg of CD34+, respectively. After mobilization, the underlying diseases were ameliorated more or less. In systemic lupus erythematosus (SLE) patients, SLE Disease Activity Index (SLEDAI) decreased from a median of 17 to 3 (P<0.01). In rheumatic arthritis patients, an American College of Rheumatology criteria for 20%(ACR20) response was achieved in all five patients. Totally, 17.4% of patients whose absolute neutrophil count <0.5×109/L suffered infection, and 31.0% of patients had bone pain after the injection of rhG-CSF. Two patients suffered severe complications, one with acute renal failure and recovered by hemodialysis, the other died of thrombotic thrombocytopenic purpura. Failed mobilization occurred in three patients. Conclusions Sufficient CD34+ cells can be mobilized by low dose of cyclophosphamide and rhG-CSF. CD34+ cell mobilization for treatment of severe autoimmune disease not only is appropriate in both effectiveness and safety but ameliorates disease also.

Prospective evaluation of heparin-induced thrombocytopenia expert probability and 4T scores in Chinese patients with suspected heparin-induced thrombocytopenia

Background: Diagnosis of heparin-induced thrombocytopenia (HIT) is challenging. This study aimed to compare the diagnostic performance of HIT expert probability (HEP) and 4T scores, and to evaluate the inter-observer reliability for the 4T score in a clinical setting. Methods: This prospective study included HIT-suspected patients between 2016 and 2018. Three hematologists assessed the HEP and 4T scores. Correlations between scores and anti-platelet factor 4 (anti-PF4)/heparin antibodies were evaluated. Receiver operating characteristic curves and area under the curve (AUC) were used to assess the predictive accuracy of these two scoring models. The intraclass correlation coefficient (ICC) was used to assess the inter-observer agreement of 4T scores between residents and hematologists. Results: Of the 89 subjects included, 22 (24.7%) were positive for anti-PF4/heparin antibody. The correlations between antibody titer and either HEP or 4T scores were similar (r = 0.392, P < 0.01 for the HEP score;r = 0.444, P < 0.01 for the 4T score). No significant difference in the diagnostic performance was displayed between these two scores (AUC for the HEP score: 0.778 vs. AUC for the 4T score: 0.741, P = 0.357). Only 72 4T scores were collected from the residents, with a surprisingly low percentage of observers (43.1%) presenting the four individual item scores which made up their 4T score. The AUC of 4T score assessed by residents and hematologists was 0.657 (95% confidence interval [CI]: 536–0.765) and 0.780 (95% CI: 0.667–0.869, P < 0.05), respectively. The ICC of 4T score between residents and hematologists was 0.49 (95% CI: 0.29–0.65, P < 0.01), demonstrating a fair inter-observer agreement. Conclusions: The HEP score does not display a better performance for predicting HIT than the 4T score. With the unsatisfactory completion rate, the inter-observer agreement of 4T score in a tertiary hospital is fair, underscoring the necessity for continuing education for physicians.

Advances of Coagulation Factor XIII

Objective： To provide a comprehensive literature review on roles of coagulation factor XIII （FXIII） in coagulation, wound healing, neoplasm, bone metabolism, and pregnancy. Data Sources： All articles in PubMed with key words ＂Coagulation factor XIII＂, ＂wound＂, ＂＇leukeraia＂, ＂tumor＂, ＂bone,＂ and ＂pregnancy＇＂ with published date from 2001 to 2016 were included in the study. Frequently cited publications before 2000 were also included. Study Selection： We reviewed the role of FXIll in biologic processes as documented in clinical, animal, and in vitro studies. Results： FXIII, a nlember of the transglutaminase （TG） family, plays key roles in various biological processes. Besides its well-known function in coagulation, the cross-linking of small molecules catalyzed by FXIII has been found in studies to help promote wound healing, improve bone metabolism, and prevent miscarriages. The study has also shown that FXIII concentration level differs in the blood of patients with leukemia and solid tumors and offers promises as a diagnostic indicator Conclusions： FXIII has many more biologic functions besides being known as coagulation factor. The TG activity of FXIII contributes to several processes, including wound healing, bone extracellular matrix stabilization, and the interaction between embryo and decidua of uterus. Further research is needed to elucidate the link between FXIII and leukemia and solid tumors.

Promotion of reactive oxygen species activated by nanosilver surface engineering for resistant bacteria-infected skin tissue therapy

Nanosilver has been regarded as a promising alternative to traditional antibiotics for fighting pathogenassociated infections due to its efficacy toward a broad spectrum of pathogens.However,bacterial resistance to nanosilver has emerged recently.In this contribution,a surface engineering strategy based on N-halamine chemistry to address bacterial resistance to nanosilver was proposed.Using 1,3-dichloro-5,5-dimethylhydantoin(DCDMH)as an N-halamine source,AgCI nanodots were deposited on the surface of Ag nano wires(Ag NWs)via in situ redox reaction to prepare AgCl-on-Ag NWs.After in vitro and in vivo tests,AgCl-on-Ag NWs effectively inactivated two antibiotic-resistant bacteria,ampicillinresistant Escherichia coli(AREC)and methicillin-resistant Staphylococcus aureus(MRSA)with the minimum bactericidal concentration(MBC)as low as 10μg·ml~(-1)and exhibited good biosafety against normal cells.The experimental and theoretical tests demonstrated that AgCl-onAg NWs worked on AREC and MAS A by generating high level of reactive oxygen species under visible light irradiation,coupled with the sustained Ag ion release.Meanwhile,the antibacterial mechanism of AgCl-on-Ag NWs against MRSA was verified at the gene level by transcriptome analysis(RNA sequencing).Moreover,the fullthickness defect model verified that AgCl-on-Ag NWs reduced inflammatory cell infiltration and dramatically accelerated wound healing.This work provides a synergistic mechanism based on nanosilver surface engineering to eradicate the resistant bacteria that can alleviate drug resistance and develop an innovative approach for the treatment of bacterial infections.