Expression and Significance of fgl2 Prothrombinase in Cardiac Microvascular Endothelial Cells of Rats with Type 2 Diabetes

Microthrombosis may be involved in the pathogenesis of cardiac microangiopathy due to diabetes.Recent studies have shown that fibrinogen-like protein 2 (fgl2) plays a pivotal role in microthrombosis in viral hepatitis, acute vascular xenograft rejection and cytokine-induced fetal loss syndrome.The current study was designed to examine the expression of fgl2 in microvascular endothelial cells and investigate the effects of microthrombi due to fgl2 on cardiac function and structure in rats with type 2 diabetes.Following induction of type 2 diabetes, 24 rats were observed dynamically.Fgl2 expression and related cardiac microthrombosis were examined.Local or circulating TNF-α was measured.Coronary flow (CF) per min was calculated as an index of cardiac microcirculation.Cardiac function and morphology were evaluated.It was found that Fgl2 was highly expressed in cardiac microvascular endothelial cells of rats with type 2 diabetes, which was promoted by local or circulating TNF-α.The Fgl2 expression was associated with cardiac hyaline microthrombosis.In parallel with the fgl2 expression, CF per min, cardiac diastolic or systolic function and cardiac morphology were aggravated to some extent.It was concluded that in rats with type 2 diabetes, microthrombosis due to fgl2 contributes to the impairment of cardiac diastolic or systolic function and morphological changes.

Are Surgical Indications of Barcelona Clinic Liver Cancer Staging Classification justified?

Liver resection is the most effective treatment for hepatocellular carcinoma （HCC）. The Barcelona Clinic Liver Cancer （BCLC） staging system is commonly accepted as a guideline for HCC treatment, but it only recommends liver resection for the patients with HCC at stage 0 to A1. The surgical indications of the BCLC staging system need to be re-evaluated. 120 HCC patients undergoing curative liver resection were retrospectively stratified to the BCLC staging system, and the survival of the patients at stages A, B and C was analyzed. The justification of the BCLC staging system was re-evaluated. Fifty-two patients were classified at stage A, 51 at stage B and 17 at stage C respectively. The hospital mortality of this cohort was zero and the morbidity was 24.1%. The 1-, 2-, 3-year overall survival rate of this cohort was 81.6%, 68.3%, and 57.5% respectively. There was no signifi-cant difference in the survival rate between the patients at stage A and B （P〉0.05）. If the treatment guidelines of BCLC staging system were followed, the majority of the patients at stages A and B （77.7%, 80/103） would not have been treated surgically. Our data suggest that the surgical indications of the BCLC staging system are not justified for HCC treatment. More studies may be needed as for how to further broaden the surgical indications of the BCLC staging system in the future.

Prevalence of deep venous thrombosis in patients with acute exacerbation of chronic obstructive pulmonary disease

Background Acute exacerbation of chronic obstructive pulmonary disease （COPD） is always associated with a high incidence and mortality. Because of the presence of some concomitant risk factors such as immobilization, bronchial superinfection, patients who are admitted for acute exacerbations of COPD are generally considered to be at moderate risk for the development of venous thromboembolism. In this study, we investigated the prevalence and the clinical manifestations of deep venous thrombosis （DVT） in patients with acute exacerbation of COPD.Methods From March 2007 to March 2009, 520 consecutive patients were included in this study. On admission, color Doppler ultrasound of lower extremities in all cases was performed for diagnosing DVT. Patients with DVT were compared with those without DVT from such aspects as demographics, symptoms, physical signs and risk factors.Results Among the 520 patients, DVT was found in 46 cases （9.7%）. In patients with DVT, the duration of hospitalization was longer （P=0.01）, and the mechanical ventilation requirement increased （P 〈0.001）. Other indicators for patients with more possibility of DVT were immobility exceeding 3 days （P 〈0.001）; pneumonia as concomitance （P=0.01）; respiratory failure type Ⅱ （P=0.013）; current smoking （P=0.001）. Lower extremity pain was more common in DVT cases in comparison to those without DVT （34.8% vs. 15.2%, P=0.01 ）.Conclusions The acute exacerbation of COPD patients, who were immobilized for over 3 days, complicated by pneumonia and had respiratory failure type Ⅱ, had a higher risk of DVT. In addition, DVT detection awareness should be increased in cases that had a lower extremity pain.

Integrative Characterization of Immune-relevant Genes in Hepatocellular Carcinoma

Background and Aims:Tumor microenvironment plays an essential role in cancer development and progression.Cancer immunotherapy has become a promising approach for the treatment of hepatocellular carcinoma(HCC).We aimed to analyze the HCC immune microenvironment characteristics to identify immune-related genetic changes.Methods:Key immune-relevant genes(KIRGs)were obtained through integrating the differentially expressed genes of The Cancer Genome Atlas,immune genes from the Immunology Database and Analysis Portal,and immune differentially expressed genes determined by single-sample gene set enrichment analysis scores.Cox regression analysis was performed to mine therapeutic target genes.A regulatory network based on KIRGs,transcription factors,and immune-related long non-coding RNAs(IRLncRNAs)was also generated.The outcomes of risk score model were validated in a testing cohort and in clinical samples using tissue immunohistochemistry staining.Correlation analysis between risk score and immune checkpoint genes and immune cell infiltration were investigated.Results:In total,we identified 21 KIRGs,including programmed cell death-1(PD-1)and cytotoxic T-lymphocyte associated protein 4(CTLA4),and found IKBKE,IL2RG,EDNRA,and IGHA1 may be equally important to PD-1 or CTLA4.Meanwhile,KIRGs,various transcription factors,and IRLncRNAs were integrated to reveal that the NRF1-AC127024.5-IKBKE axis might be involved in tumor immunity regulation.Furthermore,the immune-related risk score model was established according to KIRGs and key IRLncRNAs,and verified more obvious discriminating power in the testing cohort.Correlation analysis indicated TNFSF4,LGALS9,KIAA1429,IDO2,and CD276 were closely related to the risk score,and CD4 T cells,macrophages,and neutrophils were the primary immune infiltration cell types.Conclusions:Our results highlight the importance of immune genes in the HCC microenvironment and further unravel the underlying molecular mechanisms in the development of HCC.

Distinguish Rare Dual Left Anterior Descending Artery with Anomalous Origins in Asymptomatic Patients

To the Editor Congenital coronary artery anomalies(CAAs)are characterized by abnormalities in the origins,course,or termination of the three main epicardial coronary arteries[1,2].These anomalies can result in a spectrum of clinical manifestations,from chest pain and angina to more severe conditions such as microcirculation disorders,heart failure,or even sudden cardiac death.Among CAAs,the duplication of the left anterior descending artery(LAD)is particularly rare and usually misdiagnosed[3].