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Objective: To compare and analyze the MRI features of different renal cell carcinoma (RCC) subtypes., Methods: The MR images of 81 surgically and pathologically confirmed renal cell carcinomas from 79 patients were reviewed retrospectively. The MR imaging features of lesions in plain scan, the degree and patterns of lesion enhancement (homogeneous, heterogeneous, peripheral), and tumor spreading patterns were analyzed. In order to evaluate the diagnostic validity of differentiating RCC subtypes using signal enhancement, receiver operating characteristic curves (ROC) were generated. The cutoff value of post-contrast signal intensity to noise ratios (SNR) of the tumor parenchyma were also generated in order to differentiate clear cell RCC from other subtypes., Results: Of the 81 lesions, 58 were clear cell carcinomas, 10 chromophobe cell carcinomas, 8 papillary cell carcinomas, and 5 unclassified RCC. All the chromophobe cell subtype tumors showed a homogeneous density (P < 0.05). The clear cell subtype tumors were likely heterogenous, and also showed heterogenous enhancement with mixed signal than other subtypes (P < 0.05). The cutoff value of SNR, which was used to differentiate clear cell subtype from the other subtypes, were 616 (corticomedullary phase), 579 (nephrographic phase) and 278 (excretory phase), retrospectively. The nephrographic phase is the most appropriate for differentiation, with a sensitivity of 62.1%, specificity of 91.3%, positive predictive value of 94.7%, negative predictive value of 48.8% and an accuracy value of 70.3%. No significant difference was found in tumor spreading patterns among all subtypes of RCC., Conclusion: MR imaging features, particularly tumor heterogeneity and degree of enhancement are useful in differentiation of the renal cell carcinoma subtypes, and in choosing an individualized therapy.

Objective: To study the frequency of certain specific genetic aberrations, including t (11; 18)/API2-MALT1, t (1; 14)/IgH-bcl-10 and t (14; 18)/IgH-MALT1, in mucosa-associated lymphoid tissue (MALT) lymphoma of different sites., Methods: One hundred and ninety-six cases of MALT lymphoma from Cancer Hospital of Fudan University were enrolled into the study. The samples consisted of MALT lymphomas from stomach (53 cases, including 44 cases of low-grade MALT lymphoma and 9 cases of MALT lymphoma with diffuse large B-cell lymphoma component), ocular adnexa (50 cases), salivary gland (20 cases), lung (20 cases), intestine (17 cases), skin (17 cases), liver (8 cases), thyroid (5 cases) and other sites (2 cases from tongue, 1 case from pancreas, 1 case from larynx, 1 case from vocal cords and 1 case from kidney). Fluorescence in-situ hybridization for API2-MALT1 fusion gene, bcl-10, MALT1 and IgH genes was performed on paraffin sections., Results: Among the 196 cases of MALT lymphoma, 25 cases (12.8%) possessed API2-MALT1 fusion gene. The positive rates in various sites were significantly different (P = 0.002), as follows: 45.0% (9/20) in lung, 22.7% (10/44) in stomach (without large cell component), 15.0% (3/20) in salivary gland, 2 of 17 cases in intestine and 2.0% (1/50) in ocular adnexa. The fusion gene was not detected in the 9 cases of gastric MALT lymphoma with large cell transformation. It was also negative in the MALT lymphomas from skin, thyroid and other sites. One of the pulmonary MALT lymphoma cases showed simultaneous aberrations of IgH and MALT1 genes, such as t (14; 18)/IgH-MALT1. Two of the gastric MALT lymphoma cases without large cell transformation and one of the pulmonary MALT lymphoma cases showed aberrations in both IgH and bcl-10 genes, such as t (1; 14)/IgH-bcl-10. Six cases of MALT lymphoma, including 2 cases from salivary gland, 2 cases from liver, 1 case from thyroid and 1 case from stomach (large cell transformation), showed trisomy 18. On the other hand, 3 cases, including 2 cases from stomach and 1 case from intestine, showed MALT1 gene amplification., Conclusions: In general, specific genetic aberrations have a relatively low frequency of occurrence in MALT lymphomas. The positive rates however show a remarkable difference in tumors of different anatomic sites. This phenomenon may suggest that MALT lymphomas in different sites, though sharing similar morphologic features, may have a divergent tumorgenesis.

Aim: To investigate human epidermal growth factor receptor type 2 (HER2) protein expression and gene amplification in Chinese metastatic prostate cancer patients and their potential value as prognostic factors., Methods: Immunohistochemistry (IHC) was performed to investigate HER2 protein expression in prostate biopsy specimens from 104 Chinese metastatic prostate cancer patients. After 3-11 months of hormonal therapy, 12 patients underwent transurethral resection of the prostate (TURP). HER2 protein expression of TURP specimens was compared with that of the original biopsy specimens. Of these, 10 biopsy and 4 TURP specimens with HER2 IHC staining scores >or=2+ were investigated for HER2 gene amplification status by fluorescent in situ hybridization (FISH)., Results: Of the 104 prostate biopsy specimens, HER2 protein expression was 0, 1+, 2+ and 3+ in 49 (47.1%), 45 (43.3%), 8 (7.7%) and 2 (1.9%) cases, respectively. There was a significant association between HER2 expression and Gleason score (P = 0.026). HER2 protein expression of prostate cancer tissues increased in 33.3% of patients after hormonal therapy. None of the 14 specimens with HER2 IHC scores >or= 2+ showed HER2 gene amplification. Patients with HER2 scores >or= 2+ had a significantly higher chance of dying from prostate cancer than those with HER2 scores of 0 (P = 0.004) and 1+ (P = 0.034). Multivariate Cox regression analysis showed that HER2 protein expression intensity was an independent predictor of cancer-related death (P = 0.039)., Conclusion: An HER2 IHC score >or= 2+ should be defined as HER2 protein overexpression in prostate cancer. Overexpression of HER2 protein in cancer tissue might suggest an increased risk of dying from prostate cancer. HER2 protein expression increases in some individual patients after hormonal therapy., ((c) 2008, Asian Journal of Andrology, SIMM and SJTU. All rights reserved.)

Aim: To investigate the inhibition features of the natural product juglone (5- hydroxy-1,4-naphthoquinone) against the three key enzymes from Helicobacter pylori (cystathionine gamma-synthase [HpCGS], malonyl-CoA:acyl carrier protein transacylase [HpFabD], and beta-hydroxyacyl-ACP dehydratase [HpFabZ])., Methods: An enzyme inhibition assay against HpCGS was carried out by using a continuous coupled spectrophotometric assay approach. The inhibition assay of HpFabD was performed based on the alpha-ketoglutarate dehydrogenase-coupled system, while the inhibition assay for HpFabZ was monitored by detecting the decrease in absorbance at 260 nm with crotonoyl-CoA conversion to beta -hydroxybutyryl-CoA. The juglone/FabZ complex crystal was obtained by soaking juglone into the HpFabZ crystal, and the X-ray crystal structure of the complex was analyzed by molecular replacement approach., Results: Juglone was shown to potently inhibit HpCGS, HpFabD, and HpFabZ with the half maximal inhibitory concentration IC50 values of 7.0 +/-0.7, 20 +/-1, and 30 +/-4 micromol/L, respectively. An inhibition-type study indicated that juglone was a non-competitive inhibitor of HpCGS against O-succinyl- L-homoserine (Ki=alphaKi=24 micromol/L), an uncompetitive inhibitor of HpFabD against malonyl-CoA (alphaKi=7.4 micromol/L), and a competitive inhibitor of HpFabZ against crotonoyl-CoA (Ki=6.8 micromol/L). Moreover, the crystal structure of the HpFabZ/juglone complex further revealed the essential binding pattern of juglone against HpFabZ at the atomic level., Conclusion: HpCGS, HpFabD, and HpFabZ are potential targets of juglone.

Aim: To evaluate the best individualized prostate biopsy strategies for Chinese patients with suspected prostate cancer., Methods: The present study included 221 Chinese patients who underwent transrectal ultrasound guided prostate biopsies for the first time. All patients underwent the same 10-core biopsy protocol. In addition to the Hodge sextant technique, four more biopsies were obtained from the base and middle regions of bilateral peripheral zones. The differences between 10-core and sextant strategies in cancer detection among patients with different prostate specific antigen (PSA) levels were evaluated. The relationship between PSA level, number of positive biopsy cores and organ-confined cancer rate in prostate cancer patients was also analyzed., Results: The overall prostate cancer detection rate was 40.7% in the 221 patients. The 10-core strategy increased cancer detection by 6.67% (6/90) in our patients (P < 0.05). The increased cancer detection rates decreased significantly when the patient PSA level increased from 0-20 ng/mL to 20.1-50 ng/mL and > 50 ng/mL (P < 0.01). The number of positive biopsy cores in prostate cancer patients increased significantly with increasing patient PSA level (P < 0.01). The rate of organ-confined prostate cancer decreased significantly with increasing patient PSA level (P < 0.01)., Conclusion: The extended 10-core strategy is recommended for Chinese patients with PSA = or < 20 ng/mL and the sextant strategy is recommended for those with PSA > 50 ng/mL. For patients with PSA ranging from 20.1 ng/mL to 50 ng/mL, the 10-core strategy should be applied in patients with life expectancy = or > 10 years and the sextant strategy should be applied in those with life expectancy < 10 years.

Filamentous overgrowth has been observed after aerobic granulation in shaking sequencing batch reactors (SSBR). The factors affecting the filamentous overgrowth in aerobic granules and its possible control methods were investigated. It was found that both the influent and sludge inoculation largely influenced the filamentous overgrowth in aerobic granules. With the same activated sludge inoculation, the filamentous overgrowth in R3 treating fresh wastewater was much more severe than that in R1 treating saline wastewater. The filamentous overgrowth in R2 was the least among the three reactors, which was inoculated anaerobic granules and treated saline wastewater. When the filamentous overgrowth happened at the outer aerobic granules, Delta referring the degree of filamentous overgrowth achieved DeltaR1 = 1.4, DeltaR2 = 1.2 and DeltaR3 = 2.0, respectively. Filamentous identification showed that the filamentous microorganisms in R1 mainly composed of Eikelboom 0092 and Nocardia spp., Fungi spp. and Nocardia spp. in R2, S. natans and H. hydrossis in R3. The identified filamentous microorganisms likely occurred in conditions with long SRT, low dissolved oxygen and biodegradable substrates. However, due to the fact that filamentous overgrowth in aerobic granules initiated in the inner part of the granules and acted as frameworks with rod-shape or coccoid bacteria entrapping into in the granulation period, various strategies effectively in dealing with conventional bulking problems including shorting SRT, changing organic loading rate and enhancing aeration et al, could not effectively inhibit the filamentous growth in aerobic granules. The filamentous overgrowth was ultimately controlled through changing the substrate from synthetic glucose-rich wastewater to non-biodegradable wastewater.

Complete aerobic granulation could be achieved in shaking sequencing batch reactors (SSBR) with saline wastewater respectively inoculated conventional activated sludge and anaerobic granules. Pretty good specific TOC removal rates could be achieved without inoculating the halo-bacteria at the start-up time. When the salinity was less than 10 g/L NaCl with the synthetic glucose-rich wastewater as substitute, the TOC removal efficiency was in the range of 70.3%-97.6%. After the salinity was 35 g/L NaCl and the influent was completely changed to Vc wastewater as substrate, similar TOC removal efficiency about 70% could be achieved compared with the performance of fresh Vc wastewater treatment under the same condition. The granules in saline wastewater had a diameter of 0.5-3 mm, and saline aerobic granules had much higher settling velocity, higher oxygen utilization rate (OUR), lower sludge production and better structural integrity than those of the granules from fresh wastewater. Saline aerobic granules showed perfect protecting-ability against the saline shock and could quickly recover from long term sharp saline change. Due to the different sludge inoculation, the aerobic granules from aerobic flocs had superior TOC removal performance and inferior saline shock protecting-ability compared with the aerobic granules from anaerobic granules.

Objective: To investigate the factors influencing on the ephedrine contents in different compositions of Maxingshigan decoction., Method: Adopt mixed uniform design to dismantle recipes, employ the stepping regression analysis to deal with experimental statistics, use the partial correlational analysis to analyze the correlation coefficients and the results were validated., Result: The regressive equation was of significance, that is Y = 4.36719347 + 7.752707437X1 + 1.2557197041X3 (r = 0.85564, P = 0.0189). The main influencing factors on ephedrine content in Maxingshigan decoction were gypsum and amygdalin. The influent factor of amygdalin on ephedrine content had great significance, and gypsum had significance., Conclusion: The collective effects of amygdalin and gypsum affect the content of ephedrine in Maxing Shigan decoction which the content-effect relationship was in direct correlation.

Objective: To determine the contents of amygdalin in traditional and granular decoctions of Maxingshigan decoction., Methods: The determination was carried out by HPLC with an ODS column and a mobile phase of water-methanol (23:77) at 215 nm., Results: The content of amygdalin in traditional decoction of Maxingshigan Decoction was 17.74 mg/g and 24.80 mg/g in granular one., Conclusion: The content of glycyrrhizic acid in traditional decoction of Maxingshigan decoction is obviously higher than that in granular one.

Purpose: We determined whether histological factors of primary penile squamous cell carcinoma could predict the risk of regional lymph node metastasis., Materials and Methods: The clinical records of 72 consecutive Chinese patients with squamous cell carcinoma of the penis were analyzed retrospectively. Of the patients 58 underwent bilateral inguinal lymph node dissection, of whom 9 also underwent unilateral or bilateral pelvic lymph node dissection. Primary lesions were evaluated according to recently revised standards. The variables recorded were histopathological classification, histological grade, pathological tumor stage, invasion depth, vascular invasion, and the number and position of metastatic lymph nodes., Results: No patients with verrucous carcinoma had regional lymph node metastasis. However, 100% of patients with basaloid, 33.3% with warty and 30% with typical squamous cell carcinoma had lymph node metastasis (p = 0.002). The rate of lymph node metastasis was 18.8% in patients with pT1, as compared with 53.1% in patients with pT2 or pT3 (p = 0.004). The mean depth of invasion was 9.3 (range 2 to 22) vs 3.2 mm (range 1 to 6) in patients with and without lymph node metastasis, respectively (p < 0.001)., Conclusions: Histopathological classification, pathological tumor stage and depth of invasion of the primary lesion are significant predictors of regional lymph node metastasis in Chinese patients with penile squamous cell carcinoma. Combining these predictors can be used to select patients who are the best candidates for regional lymphadenectomy.

Objective: To investigate the clinicopathologic feature, immunophenotype and differential diagnosis of cutaneous Rosai-Dorfman disease (CRDD)., Methods: Clinical manifestation, morphologic features and immunohistochemical staining were studied in 8 cases of CRDD., Results: All 8 patients presented with multiple papules, nodules and/or coalescent patches or plaques distributing over the extremities or trunk, without lymphadenopathy or other systemic abnormalities. Microscopically, the lesions were located intradermally and/or subcutaneously. CRDD was characterized by the presence of S-100 positive histiocytic cells exhibiting emperipolesis, accompanying with infiltration of mixed inflammatory cells. Fibrosis, somewhere in vague storiform pattern due to stromal responses, with distribution of individual neutrophil microabscess was seen in cases with a long course of illness. Dilated vascular spaces in dermis containing numerous large typical histiocytes were seen in 2 cases., Conclusions: CRDD is a benign, persistent proliferative disease of histiocytes. Systemic involvement is rare, outcome favorable. It should be differentiated from other types of histiocytosis, dermatofibrosarcoma protuberans, xanthoma and lymphoproliferative disorders. Immunohistochemical staining for S-100 protein and CD68 is helpful in making a correct diagnosis.

Background/aims: Hepatocellular carcinoma (HCC) is heterogenous in terms of its glucose metabolism. Positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) shows various levels of FDG uptake for patients with HCC. This study was designed to assess the usefulness of FDG-PET for predicting the outcome of the patients with HCC., Methods: FDG-PET was performed for 27 patients with HCC. The standardized uptake value (SUV) and SUV ratio (defined as the tumor-to-nontumor ratio of SUV) was calculated for each patient. The clinical factors of the outcome were analyzed by regression analysis using Cox's multivariate proportional hazard model. The survival rate was calculated by the Kaplan-Meier method., Results: Among the analyzed clinical factors including tumor size, number of tumors, AFP, involvement of major vessels, presence of systemic metastases, Child-Pugh class the SUV and SUV ratio, only the SUV was the only significant independent prognostic factor (p=0.001). On the basis of the SUV, the patients were divided into two groups of roughly equal size: group A, SUV of <7; group B, SUV > or =7. The cumulative survival rate was significantly lower for group B than for group A, and the median survival time was significantly different (4 months vs 15 months, respectively) (p=0.003)., Conclusions: These results suggest that FDG-PET is useful to predict the outcome for patients with hepatocellular carcinoma.

Objective: To raise the vigilance not to believe easily the diagnosis of a primary branchial cleft carcinoma., Methods: Four cases of cystic metastatic squamous cell carcinoma in the neck misdiagnosed as branchiogenic carcinoma from 1993 to 2002 in our hospital were analyzed retrospectively., Results: The primary sites of these 4 cases were later discovered, 2 in the aryepiglottic fold, 1 in faucial tonsil and 1 in the skin of the head, respectively. The discovery of the primary sites ranged from the day of initial surgery to 41 months., Conclusion: None of the cases reviewed in this study was a branchiogenic carcinoma. Therefore, the diagnosis of a primary branchial cleft carcinoma requires the fulfillment of strict criteria both clinically and pathologically.

Activated sludge plants designed to remove phosphorus microbiologically often perform unreliably. One suggestion is that the polyphosphate-accumulating organisms (PAO) are out-competed for substrates by another group of bacteria, the glycogen-accumulating organisms (GAO) in the anaerobic zones of these processes. This study used fluorescence in situ hybridization (FISH) and denaturing gradient gel electrophoresis (DGGE) to analyse the communities from laboratory-scale anaerobic : aerobic sequencing batch reactors. Members of the genus Sphingomonas in the alpha-Proteobacteria were present in large numbers in communities with poor phosphorus removal capacity where the biomass had a high glycogen content. Their ability to store poly-beta-hydroxyalkanoates anaerobically, but not aerobically, and not accumulate polyphosphate aerobically is consistent with these organisms behaving as GAO there. No evidence was found to support an important role for the gamma-Proteobacteria as possible GAO in these communities, although these bacterial populations have been considered in other studies to act as possible competitors for the PAO.

Objective: To investigate the clinicopathological features and the immunohistochemical phenotype of perianal Paget's disease (PPD) associated with internal anorectal adenocarcinoma, with emphasis on the histogenesis of Paget's cells., Methods: The clinical and pathologic features of three cases of PPD with rectal adenocarcinoma were investigated. Periodic-acid-Schiff (PAS), alcian-blue and mucicarmine staining with and without diastase digestion were performed. The immunohistochemical study was performed on selected sections by a panel of antibodies including carcinoembryonic antigen (CEA), CK7, CK8, CK10/13, CK20 and gross cystic disease fluid protein 15 (GCDFP15)., Results: All three cases occurred in middle to old age male patients complaining of anal bleeding. Digital physical examination revealed ulcerated or cauliflower-like masses in the anus just distal to the dentate line. Perianal skin erythematous patches were found in two cases, and small discrete granules in one case. Histologically, the anorectal neoplasm was either a moderately or poorly differentiated adenocarcinoma. Two types of Paget's cells were noted, namely the classical type characterized by a polygonal shape with vesicular nuclei and abundant pale cytoplasm, and the signet ring type characterized by eccentrically displaced nucleus. Both the rectal adenocarcinoma cells and Paget's cells showed strong positivity for PAS, AB and mucicarmine, which were resistant to the diastase digestion. Immunohistochemically, they were both positive for CEA, CK7, CK8 and CK20, but negative for CK10/13 and GCDFP15., Conclusions: The CK20(+)-GCDFP15(-) type Paget's cells in PPD were derived from the direct intraepithelial Pagetoid spread of anorectal adenocarcinomas. PPD was more frequently associated with internal carcinomas than any other type of extramammary Paget's disease. It is recommended that clinicians should carefully examine the anus or rectum in the presence of PPD to ascertain if it is associated with an internal carcinoma.