Publications by authors named "De-Hua Wu"

53 Publications

Mutation in Non-Tyrosine Kinase Domain of as a Potential Predictor of Immune Checkpoint Inhibitors in Melanoma.

Front Oncol 2021 17;11:666145. Epub 2021 Jun 17.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Purpose: Despite the success of targeted therapy in c-ros oncogene 1 ()-rearranged cancers, especially non-small cell lung cancer (NSCLC), the clinical significance of mutation has not yet been understood. We sought to elucidate the predictive effect of mutation for immune checkpoint inhibitor (ICI) therapy in melanoma.

Methods: The Cancer Genome Atlas [TCGA ( = 10967)] and Memorial Sloan Kettering Cancer Center [MSK ( = 10,945)] datasets, as well as two clinical cohorts of melanoma received ICI [CA209-038 ( = 73) and MEL-IPI ( = 110)], were included to explore the prevalence, prognostic effect, and immunotherapeutic predictive effect of mutation in melanoma. Overall survival (OS) was defined as the primary outcome.

Results: Overall, melanoma accounted for the highest proportion of mutation (~20%) which made up the majority (~95%) of the -alterated cases. Remarkably, mutation yielded longer OS from ICI than the wild-type counterpart in the MSK melanoma population [hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.30-0.74], and two external melanoma cohorts (CA209-038: HR 0.42, 95% CI 0.20-0.89; MEL-IPI: HR 0.55, 95% CI 0.34-0.91), without affecting the prognosis of patients. Elevated tumor mutational burden and enrichment of DNA damage repair was observed in mutated patients, providing an explanation for the favorable responses to ICI therapy. Precisely, mutation in non-protein tyrosine kinase (PTK) domain but not PTK mutation was responsible for the immunotherapy-specific responses of the mutated patients in melanoma.

Conclusions: Collectively, mutation, specifically the non-PTK mutation, is a potential predictor of ICI therapy in melanoma, which is distinct from the well-established role of rearrangement for targeted therapy in NSCLC.
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http://dx.doi.org/10.3389/fonc.2021.666145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247586PMC
June 2021

Integrative evaluation of primary and metastatic lesion spectrum to guide anti-PD-L1 therapy of non-small cell lung cancer: results from two randomized studies.

Oncoimmunology 2021 Apr 26;10(1):1909296. Epub 2021 Apr 26.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

: Clinical benefits of immune-checkpoint blockade (ICB) versus standard chemotherapy have been established in unselected non-small cell lung cancer (NSCLC). However, the response to ICB therapy among patients is heterogeneous in clinical practice. : We retrospectively assessed the predicitive effect of the primary and metastatic lesion spectrum (baseline sum of the longest diameters [SLD], number of metastatic sites and specific organ metastases) on the efficacy of atezolizumab over docetaxel in OAK and POPLAR trial cohorts. A decision model, termed DSO (Diameter-Site-Organ), based on the spectrum was developed and validated for guiding ICB. : Higher SLD (>38 mm) and more metastatic sites (≥2) were characterized with pronounced overall survival (OS) benefits from atezolizumab versus docetaxel. Specifically, adrenal gland and brain metastases were identified as favorable predictors of atezolizumab treatment. The DSO model was developed in the discovery cohort to integrate the directive effect of the primary and metastatic lesion spectrum. Remarkably, a general pattern of enhanced efficacy of atezolizumab versus docetaxel was observed along with the increase of the DSO score. For patients with DSO score > 0, atezolizumab yielded a significantly prolonged OS than docetaxel, whereas OS was generally similar between two treatments in patients with DSO score ≤ 0. Equivalent findings were also seen in the internal and external validation cohorts. : The response to anti-PD-L1 therapy among patients varied with the primary and metastatic lesion spectrum. The DSO-based system might provide promising medication guidance for ICB treatment in NSCLC patients.
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http://dx.doi.org/10.1080/2162402X.2021.1909296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078693PMC
April 2021

Long noncoding RNA UPK1A-AS1 indicates poor prognosis of hepatocellular carcinoma and promotes cell proliferation through interaction with EZH2.

J Exp Clin Cancer Res 2020 Oct 29;39(1):229. Epub 2020 Oct 29.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.

Background: Dysregulation of long non-coding RNAs (lncRNAs) is responsible for cancer initiation and development, positioning lncRNAs as not only biomarkers but also promising therapeutic targets for cancer treatment. A growing number of lncRNAs have been reported in hepatocellular carcinoma (HCC), but their functional and mechanistic roles remain unclear.

Methods: Gene Set Enrichment Analysis was used to investigate the molecular mechanism of UPK1A antisense RNA 1 (UPK1A-AS1). Cell Counting Kit-8 assays, EdU assays, flow cytometry, western blotting, and xenograft assays were used to confirm the role of UPK1A-AS1 in the proliferation of HCC cells in vitro and in vivo. Bioinformatics analyses and quantitative polymerase chain reaction (qRT-PCR) were performed to explore the interplay between UPK1A-AS1 and enhancer of zeste homologue 2 (EZH2). RNA immunoprecipitation (RIP), RNA pull-down assays, western blotting, and qRT-PCR were conducted to confirm the interaction between UPK1A-AS1 and EZH2. The interaction between UPK1A-AS1 and miR-138-5p was examined by luciferase reporter and RIP assays. Finally, the expression level and prognosis value of UPK1A-AS1 in HCC were analyzed using RNA sequencing data from The Cancer Genome Atlas datasets.

Results: We showed that UPK1A-AS1, a newly identified lncRNA, promoted cellular proliferation and tumor growth by accelerating cell cycle progression. Cell cycle-related genes, including CCND1, CDK2, CDK4, CCNB1, and CCNB2, were significantly upregulated in HCC cells overexpressing UPK1A-AS1. Furthermore, overexpression of UPK1A-AS1 could protect HCC cells from cis-platinum toxicity. Mechanistically, UPK1A-AS1 interacted with EZH2 to mediate its nuclear translocation and reinforce its binding to SUZ12, leading to increased H27K3 trimethylation. Targeting EZH2 with specific small interfering RNA impaired the UPK1A-AS1-mediated upregulation of proliferation and cell cycle progression-related genes. Moreover, miR-138-5p was identified as a direct target of UPK1A-AS1. Additionally, UPK1A-AS1 was significantly upregulated in HCC, and the upregulation of UPK1A-AS1 predicted poor prognosis for patients with HCC.

Conclusions: Our study revealed that UPK1A-AS1 promotes HCC development by accelerating cell cycle progression through interaction with EZH2 and sponging of miR-138-5p, suggesting that UPK1A-AS1 possesses substantial potential as a novel biomarker for HCC prognosis and therapy.
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http://dx.doi.org/10.1186/s13046-020-01748-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596966PMC
October 2020

A nomogram based on pretreatment CT radiomics features for predicting complete response to chemoradiotherapy in patients with esophageal squamous cell cancer.

Radiat Oncol 2020 Oct 29;15(1):249. Epub 2020 Oct 29.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.

Purpose: To develop and validate a nomogram model to predict complete response (CR) after concurrent chemoradiotherapy (CCRT) in esophageal squamous cell carcinoma (ESCC) patients using pretreatment CT radiomic features.

Methods: Data of patients diagnosed as ESCC and treated with CCRT in Shantou Central Hospital during the period from January 2013 to December 2015 were retrospectively collected. Eligible patients were included in this study and randomize divided into a training set and a validation set after successive screening. The least absolute shrinkage and selection operator (LASSO) with logistic regression to select radiomics features calculating Rad-score in the training set. The logistic regression analysis was performed to identify the predictive clinical factors for developing a nomogram model. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of the predictive nomogram model and decision curve was used to analyze the impact of the nomogram model on clinical treatment decisions.

Results: A total of 226 patients were included and randomly divided into two groups, 160 patients in training set and 66 patients in validation set. After LASSO analysis, seven radiomics features were screened out to develop a radiomics signature Rad-score. The AUC of Rad-score was 0.812 (95% CI 0.742-0.869, p < 0.001) in the training set and 0.744 (95% CI 0.632-0.851, p = 0.003) in the validation set. Multivariate analysis showed that Rad-score and clinical staging were independent predictors of CR status, with p values of 0.035 and 0.023, respectively. A nomogram model incorporating Rad-socre and clinical staging was developed and validated, with an AUC of 0.844 (95% CI 0.779-0.897) in the training set and 0.807 (95% CI 0.691-0.894) in the validation set. Delong test showed that the nomogram model was significantly superior to the clinical staging, with p < 0.001 in the training set and p = 0.026 in the validation set. The decision curve showed that the nomogram model was superior to the clinical staging when the risk threshold was greater than 25%.

Conclusion: We developed and validated a nomogram model for predicting CR status of ESCC patients after CCRT. The nomogram model was combined radiomics signature Rad-score and clinical staging. This model provided us with an economical and simple method for evaluating the response of chemoradiotherapy for patients with ESCC.
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http://dx.doi.org/10.1186/s13014-020-01692-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597023PMC
October 2020

Reciprocal regulation of HIF-1α and Uroplakin 1A promotes glycolysis and proliferation in Hepatocellular Carcinoma.

J Cancer 2020 25;11(22):6737-6747. Epub 2020 Sep 25.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, GuangDong Province, 510515, China.

Uroplakin 1A (UPK1A) has recently been found dysregulation in many cancers. However, the functions of UPK1A and its underlying mechanisms in hepatocellular carcinoma (HCC) remain poorly understand. In the present study, we found that UPK1A was highly expressed in HCC tumor tissues compared with adjacent non-tumor tissues. Datasets from the Cancer Genome Atlas project (TCGA) and Gene expression Omnibus confirmed that UPK1A was highly expressed in HCC. High expression of UPK1A predicted poor overall survival (OS) in patients with HCC. Univariate and multivariate analysis showed that UPK1A was a significant and independent prognostic predictor for OS of patients with HCC. Functionally, silencing UPK1A suppressed HCC cell glycolysis and proliferation. Mechanistically, hypoxia-inducible factor 1α (HIF-1α) directly bound to the hypoxia response elements (HRE) of UPK1A promoter region, which led to the up-regulation of UPK1A under hypoxia. Furthermore, downregulation of UPK1A reduced key enzyme of glycolysis via regulating HIF-1α. Taken together, these data indicates the existence of a positive feedback loop between HIF-1α and UPK1A that modulates glycolysis and proliferation under hypoxia in HCC cells.
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http://dx.doi.org/10.7150/jca.48132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545691PMC
September 2020

Development and interpretation of a pathomics-based model for the prediction of microsatellite instability in Colorectal Cancer.

Theranostics 2020 2;10(24):11080-11091. Epub 2020 Sep 2.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Microsatellite instability (MSI) has been approved as a pan-cancer biomarker for immune checkpoint blockade (ICB) therapy. However, current MSI identification methods are not available for all patients. We proposed an ensemble multiple instance deep learning model to predict microsatellite status based on histopathology images, and interpreted the pathomics-based model with multi-omics correlation. Two cohorts of patients were collected, including 429 from The Cancer Genome Atlas (TCGA-COAD) and 785 from an Asian colorectal cancer (CRC) cohort (Asian-CRC). We established the pathomics model, named Ensembled Patch Likelihood Aggregation (EPLA), based on two consecutive stages: patch-level prediction and WSI-level prediction. The initial model was developed and validated in TCGA-COAD, and then generalized in Asian-CRC through transfer learning. The pathological signatures extracted from the model were analyzed with genomic and transcriptomic profiles for model interpretation. The EPLA model achieved an area-under-the-curve (AUC) of 0.8848 (95% CI: 0.8185-0.9512) in the TCGA-COAD test set and an AUC of 0.8504 (95% CI: 0.7591-0.9323) in the external validation set Asian-CRC after transfer learning. Notably, EPLA captured the relationship between pathological phenotype of poor differentiation and MSI ( < 0.001). Furthermore, the five pathological imaging signatures identified from the EPLA model were associated with mutation burden and DNA damage repair related genotype in the genomic profiles, and antitumor immunity activated pathway in the transcriptomic profiles. Our pathomics-based deep learning model can effectively predict MSI from histopathology images and is transferable to a new patient cohort. The interpretability of our model by association with pathological, genomic and transcriptomic phenotypes lays the foundation for prospective clinical trials of the application of this artificial intelligence (AI) platform in ICB therapy.
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http://dx.doi.org/10.7150/thno.49864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532670PMC
May 2021

Development and Validation of a Prognostic Nomogram Based on Residual Tumor in Patients With Nondisseminated Nasopharyngeal Carcinoma.

Technol Cancer Res Treat 2020 Jan-Dec;19:1533033820957035

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.

Objectives: To investigate the prognostic value of residual tumor based on Magnetic resonance imaging(MRI) and establish an effective prognostic nomogram model referring to clinical,pathological and other related factors for predicting prognosis in nasopharyngeal carcinoma.

Methods: Overall, 538 patients with non-metastatic, histologically-confirmed nasopharyngeal carcinoma were retrospectively examined. Data from 397 patients were used for the construction and validation of a nomogram based on the presence of residual tumor. A concordance index (C-index) was employed to assess the predictive accuracy and discriminative ability of the nomogram.

Results: The 3-year survival rates in the non-residual and residual tumor cohorts were as follows: progression-free survival, 73.4% vs. 61.0%, P = 0.009; locoregional recurrence-free survival, 81.9% vs. 72.0%, P = 0.02; and distant metastasis-free survival, 80.7% vs. 73.5%, P = 0.11. Nine significant factors were included in the nomogram model. The calibration curve for the probability of progression-free survival showed that the nomogram-based predictive values had good concordance with the actual observations.

Conclusion: The results showed that the patients in the residual tumor cohorts had a worse prognosis.The proposed nomogram may predict the prognosis and guide clinical decision-making concerning local residual tumors in nasopharyngeal carcinoma patients. Patients with a high risk of progression require more timely and aggressive treatment.
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http://dx.doi.org/10.1177/1533033820957035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506790PMC
September 2020

Development and validation of a genomic mutation signature to predict response to PD-1 inhibitors in non-squamous NSCLC: a multicohort study

J Immunother Cancer 2020 06;8(1)

Department of Radiation Oncology, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China

Background: Genetic variations of some driver genes in non-small cell lung cancer (NSCLC) had shown potential impact on immune microenvironment and associated with response or resistance to programmed cell death protein 1 (PD-1) blockade immunotherapy. We therefore undertook an exploratory analysis to develop a genomic mutation signature (GMS) and predict the response to anti-PD-(L)1 therapy.

Methods: In this multicohort analysis, 316 patients with non-squamous NSCLC treated with anti-PD-(L)1 from three independent cohorts were included in our study. Tumor samples from the patients were molecularly profiled by MSK-IMPACT or whole exome sequencing. We developed a risk model named GMS based on the MSK training cohort (n=123). The predictive model was first validated in the separate internal MSK cohort (n=82) and then validated in an external cohort containing 111 patients from previously published clinical trials.

Results: A GMS risk model consisting of eight genes (, , , , , , , and ) was generated to classify patients into high and low GMS groups in the training cohort. Patients with high GMS in the training cohort had longer progression-free survival (hazard ratio (HR) 0.41, 0.28-0.61, p0.0001) and overall survival (HR 0.53, 0.32-0.89, p0.0275) compared with low GMS. We noted equivalent findings in the internal validation cohort and in the external validation cohort. The GMS was demonstrated as an independent predictive factor for anti-PD-(L)1 therapy comparing with tumor mutational burden. Meanwhile, GMS showed undifferentiated predictive value in patients with different clinicopathological features. Notably, both GMS and PD-L1 were independent predictors and demonstrated poorly correlated; inclusion of PD-L1 with GMS further improved the predictive capacity for PD-1 blockade immunotherapy.

Conclusions: Our study highlights the potential predictive value of GMS for immunotherapeutic benefit in non-squamous NSCLC. Besides, the combination of GMS and PD-L1 may serve as an optimal partner in guiding treatment decisions for anti-PD-(L)1 based therapy.
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http://dx.doi.org/10.1136/jitc-2019-000381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328897PMC
June 2020

Combination of TMB and CNA Stratifies Prognostic and Predictive Responses to Immunotherapy Across Metastatic Cancer.

Clin Cancer Res 2019 12 12;25(24):7413-7423. Epub 2019 Sep 12.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Purpose: Although tumor mutation burden (TMB) has been well known to predict the response to immune checkpoint inhibitors (ICI), lack of randomized clinical trial data has restricted its clinical application. This study aimed to explore the significance and feasibility of biomarker combination based on TMB and copy-number alteration (CNA) for the prognosis of each tumor and prediction for ICI therapy in metastatic pan-cancer milieu.

Experimental Design: Non-ICI-treated MSK pan-cancer cohort was used for prognosis analysis. Three independent immunotherapy cohorts, including non-small cell lung cancer ( = 240), skin cutaneous melanoma ( = 174), and mixed cancer (Dana-Farber, = 98) patients from previous studies, were analyzed for efficacy of ICI therapy.

Results: TMB and CNA showed optimized combination for the prognosis of most metastatic cancer types, and patients with TMBCNA showed better survival. In the predictive analysis, both TMB and CNA were independent predictive factors for ICI therapy. Remarkably, when TMB and CNA were jointly analyzed, those with TMBCNA showed favorable responses to ICI therapy. Meanwhile, TMBCNA as a new biomarker showed better prediction for ICI efficacy compared with either TMB-high or CNA-low alone. Furthermore, analysis of the non-ICI-treated MSK pan-cancer cohort supported that the joint stratification of TMB and CNA can be used to categorize tumors into distinct sensitivity to ICI therapy across pan-tumors.

Conclusions: The combination of TMB and CNA can jointly stratify multiple metastatic tumors into groups with different prognosis and heterogeneous clinical responses to ICI treatment. Patients with TMBCNA cancer can be an optimal subgroup for ICI therapy.
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http://dx.doi.org/10.1158/1078-0432.CCR-19-0558DOI Listing
December 2019

CD36 inhibits β-catenin/c-myc-mediated glycolysis through ubiquitination of GPC4 to repress colorectal tumorigenesis.

Nat Commun 2019 09 4;10(1):3981. Epub 2019 Sep 4.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, 510515, China.

The diverse expression pattern of CD36 reflects its multiple cellular functions. However, the roles of CD36 in colorectal cancer (CRC) remain unknown. Here, we discover that CD36 expression is progressively decreased from adenomas to carcinomas. CD36 loss predicts poor survival of CRC patients. In CRC cells, CD36 acts as a tumor suppressor and inhibits aerobic glycolysis in vitro and in vivo. Mechanically, CD36-Glypcian 4 (GPC4) interaction could promote the proteasome-dependent ubiquitination of GPC4, followed by inhibition of β-catenin/c-myc signaling and suppression of downstream glycolytic target genes GLUT1, HK2, PKM2 and LDHA. Moreover, disruption of CD36 in inflammation-induced CRC model as well as Apc mice model significantly increased colorectal tumorigenesis. Our results reveal a CD36-GPC4-β-catenin-c-myc signaling axis that regulates glycolysis in CRC development and may provide an intervention strategy for CRC prevention.
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http://dx.doi.org/10.1038/s41467-019-11662-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6726635PMC
September 2019

Efficacy and safety of consolidation chemotherapy during the resting period in patients with local advanced rectal cancer.

Oncol Lett 2019 Feb 6;17(2):1655-1663. Epub 2018 Dec 6.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.

It remains controversial as to whether a long interval between neoadjuvant chemoradiotherapy (NCRT) and surgery may provide clinical benefits for patients with local advanced rectal cancer (LARC). The addition of consolidation chemotherapy during the resting period was recently considered as a treatment option. The present study aimed to verify the efficacy and safety of consolidation chemotherapy during the resting period in patients with LARC. A total of 156 patients with local advanced stage T3-4N0-2 rectal cancer were enrolled between January 2010 and July 2016. Patients were divided into two groups, those who received consolidation chemotherapy prior to surgery (n=76) and the control group who did not (n=80). Multivariate logistic regression and the Kaplan-Meier method were used to explore the predictors of pathological complete response (pCR) and survival. The demographic and tumor characteristics were comparable between the two groups. The consolidation group yielded significantly higher pCR and near pCR rates compared with the control group (P=0.015). Patients in the consolidation group who also underwent standard adjuvant chemotherapy displayed improved 3-year disease-free survival (DFS) compared with the control group (P=0.036). Notably, the addition of consolidation chemotherapy between NCRT and surgery did not significantly increase the incidence of surgical complications and grade 3 or 4 toxicities when compared with the control group. Consolidation chemotherapy was associated with increased pCR/near pCR rates and improved 3-year DFS, and displayed a manageable safety profile. The present study provided primary evidence for the efficacy and safety of consolidation chemotherapy in LARC. Further prospective studies are warranted in the future to verify these results.
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http://dx.doi.org/10.3892/ol.2018.9804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341791PMC
February 2019

Identification of miR-375 as a potential prognostic biomarker for esophageal squamous cell cancer: A bioinformatics analysis based on TCGA and meta-analysis.

Pathol Res Pract 2019 Mar 7;215(3):512-518. Epub 2019 Jan 7.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. Electronic address:

Accumulating evidence has demonstrated that aberrantly expressed miRNAs in cancer tissues regulated various cellular processes related to carcinogenesis. The present study aimed to identify the differentially expressed miRNAs between esophageal squamous cell cancer (ESCC) and adjacent normal esophageal tissue (ANET). In our present study, we identified 129 differentially expressed miRNAs between ESCC and ANET by analyzing high-throughput miRNA data downloaded from TCGA database. After investigating the prognostic value of the 129 differential expressed miRNAs, eight miRNAs were found to be associated with prognosis of patients with ESCC. The clinical significance and bio-function of miR-375 was further examined. We performed Gene Set Enrichment Analysis (GSEA) to identify the top three gene sets that significantly altered between the patients with miR-375 low expression and high expression. In order to explore the mechanism of the development and progression of ESCC, the role of miR-375 in ESCC and its four candidate target genes was examined. At last, we performed a meta-analysis to verify the prognostic value of miR-375 in ESCC. In conclusion, our findings suggest that miR-375 serves as a promising independent prognostic factor for ESCC and function as a tumor suppressor.
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http://dx.doi.org/10.1016/j.prp.2019.01.009DOI Listing
March 2019

Knockdown of inhibitsproliferation and invasion and promotes senescence of hepatocellular carcinoma cells.

Int J Clin Exp Pathol 2018 1;11(9):4666-4675. Epub 2018 Sep 1.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong, P. R. China.

Uveal autoantigen with coiled-coil domains and ankyrin repeats (UACA/Nucling), has been reported to be upregulated in various cancers. However, its expression and function have not been studied in hepatocellular carcinoma (HCC). In the present study, expression of UACA was detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and the results revealed that UACA was upregulated in 23 cases of HCC compared with paired corresponding non-tumor liver tissues. In addition, the upregulation of UACA in HCC was further validated by analyzing the datasets from The Cancer Genome Atlas-Liver Hepatocellular Carcinoma (TCGA-LIHC) and GSE36376. Furthermore, knockdown of UACA suppressed the proliferative and invasive ability as well as inducing senescence of HCC cells. Besides, the expression level of UACA was positively associated with Hif1α (hypoxia-inducible factor 1α) in HCC datasets from TCGA-LIHC and GSE54236. Moreover, treatment with CoCl led to the increased expression and the localization alteration of UACA in HCC cells. In summary, UACA is upregulated in HCC and knockdown of UACA ameliorated malignant behaviors of HCC cells, and UACA was correlated with and under control of Hif1α.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962967PMC
September 2018

Identification and Functional Characterization of Long Non-coding RNA as a Tumor Suppressor for Hepatocellular Carcinoma.

Theranostics 2018 13;8(14):3751-3765. Epub 2018 Jun 13.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Long non-coding RNAs (lncRNAs) have recently been identified as critical regulators in tumor initiation and development. However, the function of lncRNAs in human hepatocellular carcinoma (HCC) remains largely unknown. Our study was designed to explore the biological function and clinical implication of lncRNA in HCC. We evaluated expression in 52-patient, 145-patient, TCGA, and GSE14520 HCC cohorts. The effects of on HCC were analyzed in terms of proliferation, invasion, and metastasis, both and . The mechanism of action was explored through bioinformatics, luciferase reporter, and RNA immunoprecipitation analyses. expression was significantly down-regulated in 4 independent HCC cohorts compared to that in controls. Its low expression was associated with tumor progression and poor prognosis of patients with HCC. Forced expression of in HCC cells significantly suppressed proliferation, invasion, and metastasis and . Mechanistically, derived miR-22-3p to target high mobility group box 1 (HMGB1), thereby inactivating HMGB1 downstream pathways. Additionally, directly interacted with HuR and regulated its subcellular localization. competitively bound to human antigen R (HuR), resulting in weakened expression of HuR-stabilized oncogenes, such as β-catenin. Furthermore, miR-22-3p suppression, HuR or HMGB1 overexpression rescued the inhibitory effects caused by MIR22HG overexpression. Our findings revealed that plays a key role in tumor progression by suppressing the proliferation, invasion, and metastasis of tumor cells, suggesting its potential role as a tumor suppressor and prognostic biomarker in HCC.
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http://dx.doi.org/10.7150/thno.22493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071531PMC
August 2019

[Advances in the diagnosis and hormone replacement treatment of 46, XY disorders of sex development].

Zhonghua Nan Ke Xue 2016 Sep;22(9):843-849

Department of Urology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China.

Disorders of sex development (DSD) is defined as a congenital condition or atypical development of the chromosomal, gonadal, or anatomic sex. The diagnosis, gender assignment, and treatment of DSD require the guidance from experienced multidisciplinary teams. So far there has been no consensus about it in China. Due to dysgenetic gonads, defects in sex steroid biosynthesis or action, or gonadectomy during the prepubertal years, those with DSD suffer from hypogonadism. The hormone replacement therapy of DSD aims at general physiological health and long-term prognosis as well as the avoidance of unnecessary genital and gonadal surgery. This review focuses on the advances in the studies of the diagnosis and hormone replacement therapy of 46,XY DSD.
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September 2016

Neoadjuvant Intraarterial Chemotherapy for Treatment of Malignant Vaginal Tumors in Children: A Single-Center Experience.

J Vasc Interv Radiol 2016 Jul;27(7):996-1000

Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Zhugan Xiang 57, Hangzhou 310003, China; Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Zhugan Xiang 57, Hangzhou 310003, China.

Six patients (aged 3-36 mo) with vaginal tumors (rhabdomyosarcoma and endodermal sinus tumor [EST]; n = 3 each) received intraarterial chemotherapy (IAC) and intravenous chemotherapy. Patients underwent internal iliac artery infusion with cisplatin, pirarubicin, and vindesine. Intravenous chemotherapy with vindesine, ifosfamide, and etoposide was administered after 3 weeks. Vaginal tumors disappeared in all patients after 2 or 3 cycles of alternating therapy. Two patients underwent resection of pelvic metastases. Intravenous consolidation chemotherapy was applied. Four patients were disease-free at a median follow-up of 5.8 years. One patient had pelvic recurrence treated with "salvage" therapy with IAC and surgery and was disease-free for 2.5 years.
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http://dx.doi.org/10.1016/j.jvir.2016.03.025DOI Listing
July 2016

[An elevated pretreatment serum globulin level predicts a poor prognosis of nasopharyngeal carcinoma].

Nan Fang Yi Ke Da Xue Xue Bao 2016 Feb;36(2):151-6

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail:

Objective: To investigate the value of serum globulin levels before treatment in predicting the prognosis of patients with nasopharyngeal carcinoma (NPC).

Methods: A total of 127 patients with non-disseminated NPC were recruited between January, 2009 and December, 2013 at Nanfang Hospital. The pretreatment serum globulin levels were analyzed with the receiver-operating characteristic (ROC) curve analysis to select the cut-off point for low and high pretreatment serum globulin levels. Kaplan-Meier and multivariable analyses were used to evaluate the predictive value of serum globulin levels.

Results: The ROC curve analysis determined 30.05 g/L as the optimal cut-off value for pretreatment serum globulin level, which was significantly associated with gender (P=0.024) and N stage (P=0.016). Kaplan-Meier analysis showed that a high pretreatment serum globulin level (>30.05 g/L) significantly predicted poor progression-free survival (P=0.019), overall survival (P=0.034) and distant metastasis-free survival (P=0.049); multivariate analysis identified pretreatment serum globulin level as an independent prognostic factor for progression-free survival (HR=2.344, P=0.031).

Conclusion: Pretreatment serum globulin level may serve as a valuable marker to predict the prognosis of patients with NPC.
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February 2016

Platelet-to-lymphocyte ratio: a prognostic factor for patients with advanced hepatocellular carcinoma?

Tumour Biol 2015 Jul 30;36(7):4935-6. Epub 2015 May 30.

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic China.

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http://dx.doi.org/10.1007/s13277-015-3585-xDOI Listing
July 2015

Risk factors for intraoperative atrial fibrillation: a retrospective analysis of 10,563 lung operations in a single center.

Ann Thorac Surg 2012 Jul 16;94(1):193-7. Epub 2012 May 16.

Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.

Background: Risk factors of postoperative atrial fibrillation (AF) in patients undergoing general thoracic operations have been extensively studied. This study investigated risk factors for intraoperative AF. Identification of patients vulnerable for intraoperative AF during lung operations will benefit from improved preoperative and intraoperative management that will ultimately decrease intraoperative complications. This study retrospectively evaluated the risk factors for intraoperative AF during lung operations.

Methods: Medical records of 10,638 patients who underwent lung operations from January 1, 2006, to May 20, 2011, at the Shanghai Chest Hospital were reviewed. The analysis excluded 75 patients with preoperative AF or nonsinus rhythm or who were taking antiarrhythmic drugs before the operation. The final analysis included 10,563 patients. Univariate and multivariate analyses were performed to identify risk factors for intraoperative AF.

Results: The overall incidence of intraoperative AF was 3.27% (346 of 10,563). Multivariable logistic analysis identified increasing age, male sex, lung cancer, general anesthesia plus paravertebral block, open operation, resection of one or more lobes, and increased operation time as risk factors of intraoperative AF. In 40.73% of patients, intraoperative AF occurred during lymph node dissection.

Conclusions: We identified seven risk factors for intraoperative AF in patients receiving lung operations. These findings may eventually help us to improve preoperative and intraoperative management to minimize intraoperative AF.
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http://dx.doi.org/10.1016/j.athoracsur.2012.03.057DOI Listing
July 2012

[Correlation of casein kinase 2β overexpression to the metastatic ability of colorectal cancer cells in vitro].

Nan Fang Yi Ke Da Xue Xue Bao 2011 Apr;31(4):628-32

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Objective: To investigate the expression of casein kinase 2β (ck2β) in colorectal cancer in relation to the metastatic ability of the cancer cells.

Methods: The expression of ck2β in 46 normal colorectal mucosa, 20 colorectal adenomas and 66 colorectal cancers were detected immunohistochemically. In colorectal cancer cells, Ck2β protein expression was knockdown by RNA interference using ck2β-specific small interfering RNA (siRNA) and the interference efficiency was assessed by Western blotting. The effect of ck2β gene knockdown on the proliferation of the colorectal cancer cells was tested with colony formation assay, and the changes in the invasive ability of the cells were observed using Transwell chamber assay.

Results: Negative or weak ck2β expression was detected in normal colorectal mucosa, with nuclear positivity in 8.7% and cytoplasmic positivity in 13.0% of the cases. Colorectal adenomas showed moderate ck2β expression, with 60% cases showing positivity in the cell nuclei and 40% in the cytoplasm. In colorectal cancers, significantly stronger expression of ck2β was found than that in colorectal adenomas and normal colorectal mucosa (P<0.05), and 75.8% cases showed positivity in the cell nuclei and 62.1% showed cytoplasmic positivity; the expression of ck2β protein in colorectal cancers with lymph node metastasis was even higher (P<0.05). Ck2β knockdown obviously inhibited the proliferation and invasiveness of colorectal cancer cells in vitro.

Conclusion: The high expression of ck2β in colorectal cancer is closely correlated to the carcinogenesis and metastasis of the tumor.
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April 2011

A retrospective study of the preoperative treatment of advanced Wilms tumor in children with chemotherapy versus transcatheter arterial chemoembolization alone or combined with short-term systemic chemotherapy.

J Vasc Interv Radiol 2011 Mar;22(3):279-86

Division of Pediatric Surgical Oncology, Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.

Purpose: To evaluate the therapeutic effect of preoperative transcatheter arterial chemoembolization (TACE) combined with short-term systematic chemotherapy in the treatment of advanced Wilms tumor.

Materials And Methods: This was a retrospective study on 66 patients with unilateral advanced Wilms tumor, age 5 months to 11 years (median, 2.9 years; 30 boys and 36 girls), treated at our institution between 1995 and 2007. Characteristics of the patient population were maximal tumor diameter > 10 cm, or involvement of periaortic lymph nodes, or inferior vena cava invasion, or distal metastasis, or tumor with anaplastic histology. Patients were divided into three groups. Twenty patients were treated with conventional preoperative chemotherapy (PC group) using vindesine, actinomycin D, and pirarubicin for 4 weeks; 21 patients were treated in the TACE group with preoperative renal arterial chemoembolization using Lipiodol-pirarubicin-vindesine emulsion; and 25 patients were treated with preoperative chemoembolization combined with short-term systematic chemotherapy (T+S) for 2 weeks.

Results: No drug-induced cardiotoxicity, nephrotoxicity, or hepatic dysfunction was observed. Complete surgical removal of the tumor was achieved in 12 (65.0%), 17 (80.9%), and 22 (88.0%) patients in the PC, TACE, and T+S groups, respectively (T+S group vs PC group, P = .030). The 2-year relapse-free survival rates were 65.0%, 80.9%, and 100.0% in the PC, TACE, and T+S groups, respectively (T+S vs PC, P = .001).

Conclusions: From our experience, preoperative chemoembolization combined with short-term systematic chemotherapy is able to achieve higher rates of complete tumor resection and relapse-free survival in the treatment of advanced Wilms tumor.
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http://dx.doi.org/10.1016/j.jvir.2010.11.025DOI Listing
March 2011

[MicroRNA profiling in patients with hepatocellular carcinoma].

Nan Fang Yi Ke Da Xue Xue Bao 2010 May;30(5):976-7

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Objective: To investigate the differential expression of microRNAs between human hepatocellular carcinoma (HCC) and liver cirrhosis (LC).

Methods: The total RNA was extracted from 25 pairs of HCC and LC tissues. microRNA microarray was used to analyze the microRNA expression profiles, and validation of the microarray results was carried out by real-time quantitative RT-PCR (qRT-PCR).

Results: Three microRNAs exhibited higher expression in the HCC samples than in the LC samples. In comparison with the LC samples, the HCC samples showed down-regulated expressions of 9 microRNAs. qRT-PCR verified that has-miR-122a, has-miR-199a, and has-miR-199b were downregulated in HCC, which was in agreement with the microarray results.

Conclusion: HCC and LC samples have significantly different microRNA expression profiles. These differentially expressed microRNAs may be involved in the pathogensis of HCC.
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May 2010

[Effect of protein kinase CK2 gene silencing on radiosensitization in human nasopharyngeal carcinoma cells].

Nan Fang Yi Ke Da Xue Xue Bao 2009 Aug;29(8):1551-3

Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Objective: To investigate the effect of protein kinase CK2 gene silencing on the radiosensitization in human nasopharyngeal carcinoma (NPC) cells and its possible mechanism.

Methods: RNA interference (RNAi) technique was used to down-regulate the protein kinase CK2alpha expression in 5-8F cells, and clonogenic assay was employed to observe the changes in the radiosensitivity of the cells. DNA double-strand break was assessed by immunofluorescence staining of gamma-H2AX foci, and the cell apoptosis was examined using Annexin V-FITC/PI double-staining flow cytometry.

Results: CK2alpha protein was successfully silenced by siRNA. CK2alpha knockdown significantly decreased the clonogenic activity and increased the radiosensitivity of the NPC cells. After a 15-min exposure of the cells to 1 Gy radiation, significant difference occurred in the gamma-H2AX foci between CK2alpha knockdown cells and the control cells (P<0.01). CK2alpha silencing significantly increased the cell apoptosis after the exposure (P<0.01).

Conclusions: Protein kinase CK2 plays an important role in the radiosensitivity of the NPC cells, and suppression of its expression might be a potential therapeutic approach of cancer.
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August 2009

[Analysis of clinical characteristics of chronic rhinosinusitis in patients with postirradiated nasopharyngeal carcinoma].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2009 Apr;44(4):307-10

Department of Otorhinolaryngology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Objective: To study the characters of chronic rhinosinusitis in patients with irradiated nasopharyngeal carcinoma.

Methods: There were 65 cases of chronic rhinosinusitis after irradiated nasopharyngeal carcinoma (NPC, experimental group) and 65 cases of common chronic rhinosinusitis (CRS, control group) in the study. The visual analogue scale (VAS) was used to evaluate the intensity of subjective symptoms. Endoscopic finding was recorded and CT results were evaluated by Lund-Mackay scoring system.

Results: As to the VAS, nasal secretion was significantly more severe in experimental group (7.86+/-1.62), compared with control group (5.12+/-1.32, t=10.541, P<0.01). As to endoscopic finding, middle nasal meatus were clean in 35 (53.8%) cases in experimental group, and 23 cases (35.4%) in control group (chi2=4.483, P<0.05). CT score was (7.03+/-4.63) in experiment group, and (11.42+/-3.32) in control group (t=-6.207, P<0.05). The main reason lays in lower CT score and lower involved rate of ostiomeatal complex, frontal sinus, maxillary sinus, anterior ethmoid sinus.

Conclusions: The characters of chronic rhinosinusitis in patients with irradiated nasopharyngeal carcinoma is quite different from the common CRS and different therapeutic measures should be taken.
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April 2009

[Fascin expression in human epithelial tumors and its clinical significance].

Authors:
Xiang Gao De-Hua Wu

Nan Fang Yi Ke Da Xue Xue Bao 2008 Jun;28(6):953-5

Tung Wah Hospital Affiliated to Sun Yat-sen University, Dongguan 523110, China.

Objective: To investigate the expression of FSCN1 in human epithelial tumors and their clinical significance.

Methods: FSCN1 expression was examined immunohistochemically in specimens of human epithelial tumors, including 26 cases of lung cancer, 33 cervical cancer, 22 ovarian cancer, 38 esophageal cancer, 24 pancreatic cancer, 23 gastric cancer, 29 laryngocarcinoma, 17 primary hepatocellular carcinoma, 34 colorectal cancer, 33 breast cancer, 24 nasopharyngeal carcinoma and their corresponding normal tissues.

Results: The positivity rates of FSCN1 expression in epithelial tissues and epithelial tumors were 6.3% (5/80) and 58.7% (178/303), respectively. FSCN1 showed higher expressions in cervical cancer, ovarian cancer, esophageal cancer, pancreatic cancer, gastric cancer, laryngocarcinoma, colorectal cancer, breast cancer and nasopharyngeal carcinoma, but lower or no expression in the corresponding normal tissues (P<0.05). In gastric cancer and nasopharyngeal carcinoma, the edges of the tumors were more strongly stained for FSCN1 than the interior of the tumor.

Conclusion: FSCN1 expression is significantly upregulated in human epithelial tumors in close correlation with tumor occurrence and progression.
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June 2008

[CT manifestation in comparison with histopathological findings of radiation-induced liver disease in pigs: a pilot study].

Nan Fang Yi Ke Da Xue Xue Bao 2007 Aug;27(8):1231-5

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Objective: To study the pathological basis of radiological reaction types of radiation-induced liver disease on multiphasic CT scans.

Methods: Three pigs (tagged with A, B, and C) were subjected to single-dose radiation of 40, 40 and 30 Gy on the right or left lobe of the liver, respectively. At 42, 56, 133, and 168 days after irradiation, all pigs were examined with non-enhanced scan and contrast-enhanced scans at different time points after contrast injection. Hounsfield units (HU) were measured in each CT study to evaluate the density of irradiated and non-irradiated liver tissue to determine the reaction type. Liver tissues in the irradiation area obtained by needle biopsy with CT guidance were examined with electron microscopy, and specimens of the tissue corresponding to the region of interest on CT were obtained from necropsies for pathological examination.

Results: Radiologically, the 3 pig models presented with 3 reaction types on the multiphasic CT scans on days 133, 56, and 168 after radiation, respectively. Type 1 presented constant low-density change in all phases, the pathological basis of which was radiation hepatitis; type 2 showed pre-contrast phase isodense, arterial phase hyperdense, portal phase isodense and later phase hyperdense changes; type 3 was characterized by pre-contrast phase isodense, arterial phase hyperdense, portal phase hypodense and later phase hyperdense changes. The pathological basis of the last two radiological reaction types was radiation cirrhosis (postnecrotic cirrhosis).

Conclusions: Different radiological reaction types of radiation liver injury on multiphase CT have different pathological basis, and multiphase contrast-enhanced CT may help distinguish the radiation reactions from tumor recurrence.
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August 2007

[Expression of PCNA and GST-pi after stereotactic irradiation for liver cirrhosis and hepatocarcinoma in rabbits].

Nan Fang Yi Ke Da Xue Xue Bao 2007 Mar;27(3):279-82

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Objective: To observe the changes of the cytokines following stereotactic irradiation for hepatocarcinoma with cirrhosis in rabbits.

Methods: Sixteen rabbits with liver cirrhosis and hepatocarcinoma (experimental group) were randomized into two equal groups to receive stereotactic irradiation at single dose of 20 and 30 Gy, respectively. Eight rabbits with hepatocarcinoma (control group) were divided into two equal groups and treated in identical manner. All the rabbits were killed 3 weeks after irradiation, and EV two-step method was used to observe the cytokine changes of proliferating cell nuclear antigen (PCNA) and glutathione S-transferase pi (GST-pi) after irradiation.

Results: After irradiation, PCNA and GST-pi expression showed significant difference in the adjacent liver tissue between the experimental and control rabbits with irradiation at 20 Gy (P=0.010), but not with the irradiation dose of 30 Gy (P=1.000). Irradiation at different doses resulted in significant difference in the cytokine expression in the experimental rabbits (P=0.010). In the liver tissue exposed to irradiation, different irradiation doses resulted in significant difference in PCNA and GST-pi protein expression (P=0.010).

Conclusions: For hepatocarcinoma with cirrhosis in rabbits, radiation at the single dose of 30 Gy produces better response than 20 Gy, and PCNA and GST-pi may serve as good indexes for evaluating the therapeutic effect.
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March 2007

[Assessment of radiation-induced liver injury with computed tomography].

Nan Fang Yi Ke Da Xue Xue Bao 2007 Jan;27(1):109-12

Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Objective: To review the appearance of radiation-induced liver injury on computer tomography for quantitative assessment of dosimetric changes in different radiological reactions and the influence of time-effect.

Methods: The focal liver reactions of 35 patients treated with three-dimensional conformal radiation therapy (3-D CRT) for liver malignancies were evaluated, with the applied doses of 36-65 Gy in 4-28 fractions completed in 8-41 days. All patients received nonenhanced CT scan and arterial-dominant phase contrast-enhanced CT scan 1-6 months after therapy. The liver tissue density in irradiated and nonirradiated liver was compared, and the reaction type and the threshold dose determined radiologically.

Results: On at least one follow-up examination, 51.4% of patients were found to have a focal radiation reaction in the liver. The radiation reaction was hypodense in 43.75% of the follow-up nonenhanced CT examinations and in 19.23% of arterial-dominant phase contrast-enhanced CT scans. It was hyperdense in 42.31% of arterial-dominant phase contrast-enhanced CT scans. The median threshold dose inducing a radiation reaction was 30.8 Gy (range 18-42.8 Gy). The detected threshold dose was positively correlated with the time of detection of the reaction (P=0.041), with a correlation coefficient of -0.473. On arterial-dominant phase contrast-enhanced CT scans, the threshold dose was significantly higher for hyperdense than for hypodense changes (P=0.017). In additional follow-up, the reaction volume decreased and the reaction types changed on arterial-dominant phase contrast-enhanced CT scans.

Conclusions: The threshold dose can be different in different radiological reaction types on multiphase CT scans. The detected threshold dose is inversely correlated with the time of detection of the early reaction. Multiphase contrast-enhanced CT is helpful to distinguish radiation reactions from recurrent tumors.
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January 2007

[Surgical approaches to the correction of congenital penile curvature].

Zhonghua Nan Ke Xue 2006 Jul;12(7):622-4

Department of Urology and Oncology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China.

Objective: To evaluate some currently used surgical approaches to the correction of congenital penile curvature.

Methods: Seventy-six patients with congenital penile curvature underwent surgical correction, of whom 67 were accompanied with hypospadias, 5 with epispadias and 4 with normal urethral meatus. The methods for straightening the phallus included 5-week preoperative hCG treatment, complete degloving of penile skin, release of periurethral fibrous bands extending proximally to the meatus, plication of dorsal or ventral tunica albuginea, and embedding of dermis and tunica vaginalis grafts.

Results: All the cases were followed up for 2 months to 2 years, and the mean follow-up time was 9.3 months. Satisfactory phallus straightening was achieved in 67 cases (88%), mild residual chordee remained in 6 (8%), which needed no reoperation for the time being unless warranted by follow-up, and relapse occurred in 3 (4%), which needed further operation.

Conclusion: Most cases of congenital penile curvature can be corrected sufficiently with the above methods.
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July 2006
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