Inhibiting CMTM4 reverses the immunosuppressive function of myeloid-derived suppressor cells and augments immunotherapy response in cervical cancer

CKLF (chemokine-like factor)-like MARVEL transmembrane domain-containing family member 4 (CMTM4), belonging to the CMTM family of transmembrane domain proteins, plays a significant role in the initiation, progression, and metastasis of cancer. Nevertheless, its involvement in tumor immunity remains elusive. In the present investigation, we observed an upregulation of CMTM4 expression in patients with cervical cancer (CC), which also serves as a prognostic indicator for patients with CC. In vitro experiments and therapeutic models have demonstrated that CMTM4 upregulates the expansion of myeloid-derived suppressor cells (MDSCs) in the tumor microenvironment via the CCL2 (C-C motif chemokine ligand 2)/CCR2 (C-C motif chemokine ligand 2) and IL-6 (interleukin-6)/GP130 (glycoprotein 130) axes. This process exerts immunosuppressive effects and promotes the occurrence and progression of CC. Mechanistically, CMTM4 interacts and stabilizes PHB2 (prohibitin 2) through post-translational modification, which further induces activation of the STING (stimulator of interferon genes)/TBK1 (TANK-binding kinase 1)/STAT6 (signal transducer and activator of transcription 6) pathway, facilitating the nuclear translocation of STAT6 which binds to the CCL2/IL-6 promoter, leading to the upregulation of CCL2/IL-6 transcription expression. Importantly, targeting CMTM4 with CMTM4-small interfering RNA enhanced the effectiveness of anti-programmed cell death protein 1 (anti-PD-1) therapy. Our study identifies CMTM4 as a crucial determinant guiding the homing of MDSCs to CC, thereby contributing to MDSCs-mediated immune suppression and tumor progression. The combination of CMTM4 inhibition and anti-PD-1 treatment shows promising antitumor efficacy against CC. These findings offer novel insights into the tumor microenvironment and have the potential to inform the development of innovative immunotherapy approaches for CC.

Study of immunosenescence in the occurrence and immunotherapy of gastrointestinal malignancies

In human beings heterogenous, pervasive and lethal malignancies of different parts of the gastrointestinal (GI) tract viz., tumours of the oesophagus, stomach, small intestine, colon, and rectum, represent gastrointestinal malignancies. Primary treatment modality for gastric cancer includes chemotherapy, surgical interventions, radiotherapy, monoclonal antibodies and inhibitors of angiogenesis. However, there is a need to improve upon the existing treatment modality due to associated adverse events and the development of resistance towards treatment. Additionally, age has been found to contribute to increasing the incidence of tumours due to immunosenescence-associated immunosuppression. Immunosenescence is the natural process of ageing, wherein immune cells as well as organs begin to deteriorate resulting in a dysfunctional or malfunctioning immune system. Accretion of senescent cells in immunosenescence results in the creation of a persistent inflammatory environment or inflammaging, marked with elevated expression of pro-inflammatory and immunosuppressive cytokines and chemokines. Perturbation in the T-cell pools and persistent stimulation by the antigens facilitate premature senility of the immune cells, and senile immune cells exacerbate inflammaging conditions and the inefficiency of the immune system to identify the tumour antigen. Collectively, these conditions contribute positively towards tumour generation, growth and eventually proliferation. Thus, activating the immune cells to distinguish the tumour cells from normal cells and invade them seems to be a logical strategy for the treatment of cancer. Consequently, various approaches to immunotherapy, viz., programmed death ligand-1 (PD-1) inhibitors, Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors etc are being extensively evaluated for their efficiency in gastric cancer. In fact, PD-1 inhibitors have been sanctioned as late late-line therapy modality for gastric cancer. The present review will focus on deciphering the link between the immune system and gastric cancer, and the alterations in the immune system that incur during the development of gastrointestinal malignancies. Also, the mechanism of evasion by tumour cells and immune checkpoints involved along with different approaches of immunotherapy being evaluated in different clinical trials will be discussed.

T cell aging and exhaustion: Mechanisms and clinical implications

T cell senescence and exhaustion represent critical aspects of adaptive immune system dysfunction, with profound implications for health and the development of disease prevention and therapeutic strategies. These processes, though distinct, are interconnected at the molecular level, leading to impaired effector functions and reduced proliferative capacity of T cells. Such impairments increase susceptibility to diseases and diminish the efficacy of vaccines and treatments. Importantly, T cell senescence and exhaustion can dynamically influence each other, particularly in the context of chronic diseases. A deeper understanding of the molecular mechanisms underlying T cell senescence and exhaustion, as well as their interplay, is essential for elucidating the pathogenesis of related diseases and restoring dysfunctional immune responses. This knowledge will pave the way for the development of targeted therapeutic interventions and strategies to enhance immune competence. This review aims to summarize the characteristics, mechanisms, and disease associations of T cell senescence and exhaustion, while also delineating the distinctions and intersections between these two states to enhance our comprehension.

Role of artificial intelligence -based machine learning model in predicting HER2/neu gene status in breast cancer

Our study investigated the predictive efficacy of AI-based Machine Learning (ML) model for determining HER2 status in a population of 3424 breast cancer patients. Multivariate logistic regression analysis identified several independent variables that were predictive of HER2 positivity, namely age ≤ 40 years, tumor multicentricity, high tumor grade, high-grade DCIS, N3 stage disease, and negative ER status (p < 0.05). These findings suggest that patients presenting with these factors may benefit from more aggressive and targeted therapies. Furthermore, XGBoost ML model was trained using the dataset of 3324 patients, which was divided into an 80 % training set and a 20 % test set. The model achieved an impressive accuracy of 95 % on both training and test sets, as evidenced by the area under the curve (AUC) values of 0.95. The model ranked the presence of DCIS, DCIS component (major versus minor), DCIS grade, multiplicity of the tumor, and ER status as the top four variables for predicting HER2/neu status. To validate the performance of the proposed model, blind HER2 status data from an external validation cohort of 100 cases were utilized. Notably, the model demonstrated a sensitivity of 90.5 %, indicating its ability to accurately identify HER2-positive cases, and a specificity of 84.4 %, suggesting its capability to correctly classify HER2-negative cases. These results highlight the promising predictive efficacy of AI-based ML in determining HER2 status in breast cancer patients. The model's ability to accurately identify HER2-positive cases can assist in guiding treatment decisions, ensuring that patients receive appropriate and targeted therapies. However, further research with larger datasets is necessary to validate and generalize these findings.

Epigenetic reprogramming and antitumor immune responses in gliomas: a systematic review

Gliomas, particularly glioblastoma, are among the most aggressive and treatment-resistant brain tumors. Their immunosuppressive tumor microenvironment (TME) and intrinsic molecular heterogeneity hinder effective therapeutic responses. Epigenetic dysregulation in gliomas significantly impacts tumor progression and immune evasion, presenting an opportunity for therapeutic intervention. This systematic review evaluates the role of epigenetic reprogramming in modulating antitumor immune responses in gliomas and explores its potential to enhance treatment outcomes. A comprehensive literature search across major databases, adhering to PRISMA guidelines, identified preclinical and clinical studies examining the effects of epigenetic therapies on glioma-associated immune modulation. Inclusion criteria focused on studies involving DNA methylation inhibitors, histone deacetylase inhibitors, chromatin remodelers, and non-coding RNA-based therapies. Key outcomes included immune activation, tumor progression, survival, and TME modulation. Among 22 included studies, epigenetic therapies demonstrated substantial efficacy in reprogramming the glioma immune landscape. DNA methylation inhibitors such as decitabine enhanced antigen presentation and immune recognition, while histone deacetylase inhibitors improved T-cell-mediated cytotoxicity. Non-coding RNA-targeted interventions disrupted immune suppression and facilitated immune cell infiltration. These strategies showed synergistic potential with immune checkpoint inhibitors, leading to tumor growth inhibition and improved survival in preclinical models. Epigenetic therapies hold promise in overcoming glioma-induced immune resistance by modulating immune escape mechanisms and reprogramming the TME. Their integration with existing treatment modalities, including immunotherapy, represents a transformative avenue for glioma management. Further clinical validation is warranted to optimize their therapeutic potential and safety.

Breast cancer cell targeting of L-leucine-PLGA conjugated hybrid solid lipid nanoparticles of betulin via L-amino acid transport system-1

The aim of fabricating hybrid solid lipid nanoparticles (HSLN) was to enhance the delivery of betulin to triple negative breast cancer cells through the intravenous route via L-amino transporter system-1, using L-leucine-PLGA conjugate (Conj-HSLN) by hot high pressure homogenisation method. Betulin (BN), having potent anticancer and antioxidant activity, faces challenges due to poor water solubility and permeability, affecting its bioavailability. The results revealed Conj-HSLN with particle size 318.3 ± 0.25 nm. The percent cumulative BN release from Conj-HSLN was 57.763%, 24h. The cytotoxicity study in MB-MDA-231 cell depicts, LD50 67.73 µg/ml in Conj-HSLN. Pharmacokinetics study reveals enhanced Cmax and half-life in Conj-HSLN (32.12 ± 0.25 µg/ml, 4.72 ± 0.53 h) than raw BN (1.31 ± 0.21 µg/ml, 7.54 ± 0.34 h). Enhanced distribution at tumour site (11.5967% ID, 2h) in Conj-HSLN signifies the role of L-leucine in the transport system. Pharmacodynamic study shows mean tumour volume of 765.3 ± 85.884, and 1450.01 ± 219.361 mm3 in Conj-HSLN, and BN, respectively, at 3rd week of treatment. Standardised uptake value attributed reduced glucose uptake, due to inhibited tumour growth and proliferation, confirmed by tumour biomarkers assay, VEGF and Caspase-9. In conclusion, the targeted controlled release L-leucine conjugated-BN loaded HSLN is stable, safe, and effective against triple negative breast cancers.

Full consideration of the pollen exposure effect in clinical trial design for pollen-induced allergic rhinitis

INTRODUCTION

Allergic rhinitis (AR) is global health concern with an increasing prevalence. Among them, pollen-induced AR (PIAR) exhibits more severe and intense symptoms, decreased quality of life, prominent local inflammation, and is thus more challenging to control. Due to the difficulties in disease control, in recent years, an increasing number of treatment methods, including pharmacotherapy, allergen-specific immunotherapy, and newly developed biologics, have focused on PIAR. It has been shown that the pollen exposure has a significant impact on the symptoms of PIAR and the efficacy of intervention. From this perspective, clinical trials for PIAR need to take full account of pollen exposure, especially when assessing efficacy.

AREAS COVERED

This review summarized the effect of pollen exposure on PIAR, including immune responses, symptoms and clinic visits. Current definitions for the pollen season (PS) and the peak pollen season (PPS) are discussed. Based on the previous PIAR-related clinical studies and the available recommendations for clinical trial design, a detailed account of trial protocols which fully considered pollen exposure is provided.

EXPERT OPINION

Pollen exposure has a significant impact on PIAR. With fully considering the pollen exposure in the clinical trial design for PIAR, future protocols for PIAR-related studies may be more objective and better harmonized and, therefore, comparable.

Toxicity study of compound honeysuckle moisturizing Chinese herbal extract by oral gavage for 13 weeks in sprague dawley rats

To assess the safety of oral compound honeysuckle moisturizing Chinese herbal extract for eczema treatment, Sprague-Dawley (SD) rats were oral administered three doses (20.8, 41.6, and 83.3 g/kg, based on raw materials) of the extract daily for 13 consecutive weeks. The study aimed to identify potential toxic reactions, mortality due to accumulation, and recovery after discontinuation. By observing these factors, we sought to determine the target organs of toxicity and establish nontoxic doses for SD rats. The results indicated that during the administration period and subsequent recovery period, there were no significant abnormalities in weight gain, food intake, hematology, blood biochemistry, or urine indicators. Additionally, histopathological analysis of major organs (heart, liver, lungs, kidneys, spleen, and brain) revealed no significant extract-related lesions. Moreover, no significant local toxic lesions were observed in the oral buccal and tongue mucosa. Finally, under the experimental conditions of this study, the preliminary nontoxic response dose of oral gavage compound honeysuckle moisturizing Chinese herbal extract administered to SD rats for 13 weeks was 83.3 g/kg/day (calculated as raw medicine).

Chromatin modification abnormalities by CHD7 and KMT2C loss promote medulloblastoma progression

Medulloblastoma (MB), a common malignant pediatric brain tumor arising in the cerebellum, is characterized by mutations in chromatin modifiers, highlighting the significance of chromatin modification abnormalities in its progression. While animal models have effectively demonstrated this, a comprehensive evaluation of the oncogenic potential of these mutations remains incomplete. In this study, we use CRISPR-mediated gene editing to knock out chromatin modifier genes mutated in human SHH MB, along with the Ptch1 gene, in cerebellar granule neuron progenitors of neonatal mice. This reveals that depletion of Chd7 and Kmt2c accelerates tumor growth. Multi-layered omics analysis uncovers that inhibition of the neuronal differentiation program by chromatin dysregulation is a key signaling pathway in tumor progression. Additionally, forced expression of Neurod1, a common target of these chromatin modifiers, inhibits proliferation and promotes differentiation. These findings highlight converging chromatin modification abnormalities from distinct mutations in Sonic Hedgehog MB and suggest that epigenetic drugs activating neuronal genes have significant potential as novel treatments.

Precision enhancement of CAR-NK cells through non-viral engineering and highly multiplexed base editing

BACKGROUND

Natural killer (NK) cells' unique ability to kill transformed cells expressing stress ligands or lacking major histocompatibility complexes (MHC) has prompted their development for immunotherapy. However, NK cells have demonstrated only moderate responses against cancer in clinical trials.

METHODS

Advanced genome engineering may thus be used to unlock their full potential. Multiplex genome editing with CRISPR/Cas9 base editors (BEs) has been used to enhance T cell function and has already entered clinical trials but has not been reported in human NK cells. Here, we report the first application of BE in primary NK cells to achieve both loss-of-function and gain-of-function mutations.

RESULTS

We observed highly efficient single and multiplex base editing, resulting in significantly enhanced NK cell function in vitro and in vivo. Next, we combined multiplex BE with non-viral TcBuster transposon-based integration to generate interleukin-15 armored CD19 chimeric antigen receptor (CAR)-NK cells with significantly improved functionality in a highly suppressive model of Burkitt's lymphoma both in vitro and in vivo.

CONCLUSIONS

The use of concomitant non-viral transposon engineering with multiplex base editing thus represents a highly versatile and efficient platform to generate CAR-NK products for cell-based immunotherapy and affords the flexibility to tailor multiple gene edits to maximize the effectiveness of the therapy for the cancer type being treated.

Prognostic Significance of Elevated Platelet Count (>200 x 10^9 per L) in BCLC Stages B and C of Hepatocellular Carcinoma: A Retrospective Multicenter Analysis

Introduction

In hepatocellular carcinoma (HCC) comorbidities related to decreased liver function or to portal hypertension often limit treatment options. Traditionally, low platelet count has been considered a negative prognostic factor in HCC, especially in early stages. However, recent evidence suggests that elevated platelet count may also predict worse outcomes in advanced stages, suggesting a stage-dependent prognostic impact.

Aim

This study evaluated the prognostic role of platelet counts across BCLC stages, adjusted for portal hypertension, to improve individualized patient management.

Methods

In this retrospective, multicenter study, platelet count of 1112 patients with HCC in different tumor stages was analyzed. Various platelet count cutoffs (X to Y × 10^9/L) were tested to identify the optimal prognostic threshold. To isolate the effect of platelet levels from portal hypertension, spleen diameter was incorporated as an adjustment variable in multivariate analyses, with variceal status considered when available (in about two thirds of patients). Using an optimized cut-off, survival analysis was performed using univariate and multivariate Cox proportional hazards models. Bootstrapping was performed for internal validation.

Results

Platelet count outside 84-200 × 10^9/L was associated with poorer survival (HR = 0.66, 95% CI = 0.57-0.78, p < 0.0001). Bootstrapping showed robustness of the final model. Subgroup analysis revealed worse survival in BCLC stages B and C but not stage A for elevated platelet counts (>200 × 10^9/L) in multivariate analysis (including spleen diameter).

Conclusion

Platelet counts showed a stage-dependent prognostic impact in HCC. A platelet count above a cutoff of 200/µL at diagnosis was associated with poorer prognosis. Using this cutoff may improve survival prediction in BCLC B and C patients with potential usage for risk stratification and guidance of treatment decisions. Further external validation is required to confirm these findings and evaluate their clinical applicability.

An analysis of meteorological and environmental factors linked to Thunderstorm Asthma in China

BACKGROUND

Thunderstorm Asthma (TA) events are observed worldwide, but the precise triggering mechanisms remain elusive.

OBJECTIVE

This study aims to outline the environmental patterns associated with TA events in China.

METHODS

Environmental data was collected from Chinese cities that have experienced TA events, focusing on meteorological conditions in the seven days preceding the thunderstorms. This allowed for the identification of common environmental precursors to TA.

RESULTS

In China, TA events are primarily concentrated in the northwest plateau region. These locations have a temperate continental monsoon climate with infrequent rainfall, leading to a generally arid environment. The four cities that have reported TA incidents are situated predominantly in the vicinity of desert areas. The extensive cultivation of Artemisia arenaria exists in these areas, which are primarily used for windbreaks and sand stabilization. In early September, prior to the occurrence of thunderstorms, these cities typically experience higher temperatures, gentle breezes, and minimal rainfall. Under such environmental conditions, the concentration of Artemisia pollen in the urban areas is extremely high. Upon the arrival of thunderstorms, these allergens can trigger widespread asthma outbreaks among individuals sensitized to them.

CONCLUSION

The cities in China that experience TA events are primarily situated in the vicinity of deserts located on the plateau. Prior to the occurrence of TA, these cities are exposed to an environment characterized by elevated temperatures, gentle breezes, minimal rainfall, and exceptionally high concentrations of Artemisia pollen.

Long-Term Survival Following Cladribine Containing Pretransplant Regimen for Autologous Hematopoietic Stem Cell Transplantation in Disseminated Interdigitating Dendritic Cell Sarcoma: A Case Report and Literature Review

Interdigitating dendritic cell sarcoma (IDCS) is an exceedingly rare hematological neoplasm arising from dendritic cells that presents significant diagnostic and therapeutic challenges, particularly in cases of disseminated disease. Here, a 33-year-old woman presented with discomfort of the left pharynx accompanied by nasopharyngeal and cervical mass for 3 months. The histopathology confirmed the diagnosis of IDCS as the neoplastic cells were spindle or ovoid in shape, forming fascicles or whorls, and were positive for S-100, vimentin and CD163 but negative for CD21, CD23, CD35 and CD1a. The patient underwent autologous hematopoietic stem cell transplantation (auto-HSCT) after achieving partial remission (PR) from six courses of chemotherapy based on the ABVD regimen and one cycle of radiotherapy. Encouragingly, the mass disappeared after cladribine containing regimen pretreated auto-HSCT and the patient has been in complete remission (CR) state for over 5 years. Therefore, the long survival of this patient might suggest that ABVD regimen with a sequential cladribine-containing preparative regimen prior to auto-HSCT may improve the prognosis of disseminated IDCS. However, this represents only a single-case experience, and further studies with larger sample sizes are required for validation.

A novel combination mode for inhalant allergen screening based on 8-well microplates by LiCA

OBJECTIVE

Currently, allergen detection is primarily classified into two types: single detection and multiple combined detection. The challenges include large volume of serum required, high testing costs, and fixed combinations of test items. A cost-effective method that uses a small amount of serum and allows for the flexible combination of allergen screening is necessary. Light-initiated Chemiluminescence Assay (LiCA) requires no washing, only need little serum, and supports flexible combination detection of allergens.

METHODS

Based on the advantages of LiCA technology, which does not require washing, the '4 + 3X + 1' allergen detection mode was established in this study. The antigens are coated on chemibeads, which are selectively added into the detection wells to achieve flexible combination, supporting the simultaneous detection of eight allergens.

RESULTS

This study introduces a new allergen screening model termed "4 + 3X + 1", where "1" represents tIgE, "4" comprises four commonly encountered indoor inhalable allergens, and "3X" encompasses a variety of frequent inhalable allergens. Allergens from "3X" could be selected based on regional characteristics and patient-specific conditions. We tested the intermediate precision(3.59 %-9.71 %) and repeatability(2.81 %-9.31 %) of the four allergens in "4-fixed", and LoB(0.035-0.066 kUA/L), LoD(0.092-0.156 kUA/L), and LoQ(0.135-0.199 kUA/L) all showed good results. We compared the consistency of LiCA and ImmunoCAP/Dot-ELISA, each of which was greater than 0.8828. In addition, two allergens were selected from "4-fixed" and "3X-optional "respectively to detect the sensitivity(80 %-97.72 %) and specificity(93.75 %-100 %).

CONCLUSIONS

The proposed combined test model offers a new, economical, and rapid option for allergen screening that requires low blood volumes and can be customized for individual patients.

Adult Medulloblastoma: Clinicomolecular Spectrum, An Institutional Experience

Medulloblastoma is uncommon and molecularly lesser known in adults than their pediatric counterparts. This study aims to describe the clinicopathological and molecular characteristics of medulloblastoma in adults. Methods. The clinical, histopathological, and molecular features of 113 medulloblastoma patients of >18 years of age were reviewed. Molecular grouping (wingless pathway activated [WNT]-activated, sonic hedgehog activated [SHH]-activated, non-WNT/non-SHH, Group 3 and non-WNT/non-SHH, Group 4) was done by gene expression profiling. Results. The age-range was 19 to 59 years. The most common histoarchitecture was classic (64%), followed by desmoplastic/nodular (31%) and large cell/anaplastic (5%). The most common molecular group was SHH-activated (65%), followed by WNT-activated (14%), non-WNT/non-SHH, Group 4 (10%), and non-WNT/non-SHH, Group 3 (3%). All desmoplastic/nodular tumors were SHH-activated; while large cell/anaplastic had SHH-activated, WNT-activated and non-WNT/non-SHH, Group 3. TP53-mutant pattern of immunophenotype was observed in 7% (3 SHH-activated; 1 WNT-activated; 1 non-WNT/non-SHH, Group 3; 2 indeterminate). Within the SHH-activated group, TP53-mutant pattern immunophenotype was noted in 3 tumors and 1 was MYCN-amplified. In the WNT-activated group, both monosomy 6 and CTNNB1 mutation were seen in 3 tumors and 3 each had an isolated alteration. Conclusion. SHH-activated medulloblastoma is the most common group and WNT-activated is not rare in adults. Non-WNT/non-SHH, Group 3 though rare is not nonexistent in adults.

EZH2 inhibitor and Vismodegib synergistically inhibit the growth and metastasis of medulloblastoma

Resistance frequently arises when treating medulloblastoma (MB) patients with Vismodegib, markedly shortening their survival time. Consequently, the urgent problem to be solved is the discovery of a drug that can synergize with Vismodegib to improve its resistance in patients and enhance its efficacy. To validate the feasibility and efficacy of combining EZH2 (Enhancer of zeste homolog 2) inhibitor (EZH2i) with Vismodegib. A comprehensive assessment of their individual and combined effects on MB cell proliferation, migration, and invasion capabilities was conducted. The promising potential of EZH2i in inhibiting MB cell growth, migration and invasion was exhibited when used alone. Furthermore, when combined with Vismodegib, the inhibitory effect on MB was significantly potentiated. This synergy was further confirmed by SynergyFinder analysis, which revealed a remarkable highest single-agent score of 14.85 for the GSK126 and Vismodegib combination. Importantly, the enhanced efficacy of the combined EZH2i and Vismodegib therapy in suppressing tumor growth was also verified by the xenograft experiments in vivo. In summary, the combined use of EZH2i and Vismodegib demonstrated a remarkable synergistic effect in suppressing MB growth, presenting a promising treatment option for MB patients who had become resistant to Vismodegib.

Metformin-Based Combination Approaches for Triple-Negative Breast Cancer

Numerous anti-diabetic medications, including metformin, have been explored for their anticancer effects because of the substantial correlation between diabetes and cancer incidence. Metformin has recently gained interest for its anticancer effects against malignancies such as breast cancer, one of the leading causes of death among women worldwide. The cancer-related characteristics of cell proliferation, invasion, migration, and apoptosis are all targeted by metformin. Among breast cancer patients, triple-negative breast cancer (TNBC) is linked to an increased risk of early recurrence and metastases and has poor prognosis. In addition, TNBC has fewer treatment options compared to other breast cancer subtypes because it lacks hormone receptors and human epidermal growth factor receptor 2 (HER2), and it often develops resistance to available treatment options. The current review highlights the recent updates on the mechanistic insights and the efficacy of metformin and metformin-based approaches for the treatment of TNBC. We logically discuss the experimental evidence from the in vitro and in vivo studies exploring metformin's effects on metabolic pathways, and then its combination with other therapeutic agents, targeting cell signaling pathways, and approaches to enhance metformin's effects. We also present clinical studies that underscore the beneficial outcomes of metformin or its combination with other agents in TNBC patients.

Impact of climate change on aerobiology, rhinitis, and allergen immunotherapy: Work Group Report from the Aerobiology, Rhinitis, Rhinosinusitis & Ocular Allergy, and Immunotherapy, Allergen Standardization & Allergy Diagnostics Committees of the American Academy of Allergy, Asthma & Immunology

Climate change is imposing a profound effect on health conditions triggered by environmental exposures. Climate change has affected aeroallergens in numerous ways, including: (1) changes in the vegetation microbiome distribution, (2) increases in C4 grasses globally, (3) increased occurrence of acute weather events, (4) increases in ambient temperature that amplify fungal spore concentration and pollen season duration, and (5) increased allergenicity of pollen and fungi due to exposure to higher levels of carbon dioxide, ozone, and diesel exhaust particles. In addition, greenhouse gases and air pollutants disrupt the epithelial barrier, trigger eosinophilic inflammation, and serve as adjuvants that stimulate IgE-mediated responses. All of these factors have influenced the prevalence and morbidity of allergic rhinitis, nonallergic rhinitis, and chronic rhinosinusitis. Data regarding changes in aeroallergen exposures due to climate change are lacking, and longitudinal sensitization data are rarely available. Allergists need to adapt diagnostic and treatment strategies to limit aeroallergen and air pollutant exposure and facilitate desensitization. Steps needed to address these challenges include: (1) expanding local measurement of pollen and fungal spores, (2) increasing the intensity of allergen avoidance measures, (3) addressing supply chain issues, and (4) promoting collaboration between allergists, insurance companies, aeroallergen manufacturers, and regulatory agencies.

[Effect of CMTM6 on PD-L1 in Helicobacter pylori infected gastric epithelial cells]

OBJECTIVE

To explore the changes of CKLF-like MARVEL transmembrane domain-containing 6 (CMTM6) and programmed death-ligand 1 (PD-L1) expression in gastric mucosal epithelial cells after Helicobacter pylori infection and the regulation of CMTM6 on PD-L1, and to analyze the mRNA expression differences before and after CMTM6 gene knock-out in helicobacter pylori infected gastric epithelial cells by microarray analysis.

METHODS

The standard Helicobacter pylori strain ATCC 26695 was co-cultured with human gastric epithelial cell GES-1 for 6, 24 and 48 hours, and the mRNA and protein levels of CMTM6 and PD-L1 were detected by real-time quantitative PCR and Western blot. Using CRISPR/Cas9 to construct CMTM6 gene knockout plasmid and knockout CMTM6 gene of GES-1 cells. Helicobacter pylori was co-cultured with CMTM6 gene knockout and wild type GES-1 cells for 48 hours to detect PD-L1 transcription and protein level changes, and CMTM6 gene knockout GES-1 cells were treated with the proteasome inhibitor MG-132 to detect the changes in PD-L1 protein levels. Agilent Human ceRNA Microarray 2019 was used to detect the differentially expressed genes in CMTM6 gene knockout and wild-type GES-1 cells co-cultured with Hp for 48 hours, and the signal pathway of differentially expressed genes enrichment was analyzed by Kyoto Encyclopedia of Genes and Genomes (KEGG) database.

RESULTS

The mRNA and protein levels of CMTM6 and PD-L1 in GES-1 cells were significantly up-regulated after Helicobacter pylori infection, and CMTM6 mRNA was most significantly up-regulated 48 hours after infection. After CMTM6 gene knockout, the CD274 gene transcription level of Helicobacter pylori infected GES-1 cells did not change significantly, but PD-L1 protein level was significantly down-regulated, and the PD-L1 level increased after the application of proteasome inhibitor MG-132. After CMTM6 gene knockout, 67 genes had more than two times of differential expression. The transcription levels of TMEM68, FERMT3, GPR142, ATP6V1FNB, NOV, UBE2S and other genes were significantly down-regulated. The transcription levels of PCDHGA6, CAMKMT, PDIA2, NTRK3, SPOCK1 and other genes were significantly up-regulated. After CMTM6 gene knockout, ubiquitin-conjugating enzyme E2S (UBE2S) gene expression was significantly down-regulated, which might affect protein ubiquitination degradation. After CMTM6 gene knockout, adrenoceptor alpha 1B (ADRA1B), cholinergic receptor muscarinic 1 (M1), CHRM1, platelet activating factor receptor (PTAFR) gene expression was significantly up-regulated.

CONCLUSION

Helicobacter pylori infection up-regulates the expression level of CMTM6 in gastric mucosa cells, and CMTM6 can stabilize PD-L1 and maintain the protein level of PD-L1. CMTM6 gene knockout may affect biological behaviors such as protein ubiquitination and cell surface receptor expression.

Targeting cancer-induced skeletal damage: a holistic approach to understanding pathophysiology, mechanisms, and management solutions

Cancer's insidious reach extends far beyond its initial site, particularly manifesting in the skeleton, where it precipitates a spectrum of pathological conditions ranging from bone metastases and cachexia to primary bone cancers. This review highlights the critical impact of cancer on skeletal health, including the development of bone metastases, cachexia, and primary bone cancers, underscoring the importance of understanding the complex interaction between cancer and the bones. It emphasizes the global burden of cancer and its skeletal complications, which severely affect quality of life. The article reviews the prevalence of bone metastases in various cancers, such as breast, prostate, lung, renal cancers, and multiple myeloma, and stresses the need for targeted treatments. It also discusses the mechanisms behind tumor spread to bones and the systemic effects of cancer, including reduced bone mineral density and increased fracture risk, even without direct bone invasion. The challenges posed by primary bone cancers, which are rarer but highly aggressive, are also examined, highlighting the role of genetics and molecular research in treatment development. The review calls for a multidisciplinary approach to manage the severe symptoms of cancer-induced bone damage and explores the potential of personalized medicine to improve treatment outcomes. It concludes by advocating for continued research and collaboration to develop more precise and personalized therapies for cancer-related bone issues, aiming to improve the lives of those affected.

Troxerutin suppresses the stemness of osteosarcoma via the CD155/SRC/β-catenin signaling axis

BACKGROUND

Osteosarcoma is the most prevalent primary malignant bone tumor affecting pediatric and adolescent individuals. However, despite the passage of three decades, there has been no notable enhancement in the overall survival rate of patients with osteosarcoma. In recent years, CD155 has been reported to exhibit abnormal amplification in a range of tumors, yet the precise underlying mechanism remains elusive. The objective of this study is to investigate the role of CD155 in osteosarcoma, and to identify drugs that specifically target this molecule, thereby offering a novel direction for the treatment of osteosarcoma.

METHODS

The prognosis of patients with osteosarcoma with high and low expression of CD155 was verified by immunohistochemistry. CCK-8 and colony formation assays were used to detect cell proliferation and drug resistance. Transwell experiments were used to detect cell migration and invasion. The sphere formation experiment was used to evaluate the stemness of tumor cells. Additionally, in vivo animal models were utilized to assess the functional role of CD155 in a biological context. RNA-seq and co-immunoprecipitation methods were used to search for downstream target molecules and signaling pathways of CD155. Finally, virtual screening was used to find drugs targeting CD155.

RESULTS

In this study, we have established the significant amplification of CD155 in osteosarcoma. Utilizing a comprehensive array of experimental methods, including CCK-8 assay, colony formation assay, Transwell assay, and in vivo animal models, we unequivocally demonstrate that CD155 significantly potentiates the malignancy of osteosarcoma both in vitro and in vivo. Additionally, our findings reveal that CD155 promotes osteosarcoma stemness by modulating the Wnt/β-catenin signaling pathway. Advanced molecular techniques, such as RNA sequencing and co-immunoprecipitation, have been instrumental in elucidating the mechanism of CD155 in activating the Wnt/β-catenin pathway via the SRC/AKT/GSK3β signaling axis, thereby enhancing the stem-cell-like properties of osteosarcoma cells. To explore targeted therapeutic options, we conducted virtual screening and identified troxerutin as a promising CD155 inhibitor.

CONCLUSIONS

Our findings reveal that troxerutin effectively inhibits CD155, attenuates the SRC/AKT/GSK3β signaling cascade, diminishes the nuclear localization of β-catenin, and consequently mitigates osteosarcoma stemness. These discoveries position troxerutin as a promising candidate for targeted osteosarcoma therapy.

A randomized controlled trial evaluating prophylactic treatment of Artemisia pollinosis using azelastine hydrochloride and fluticasone propionate nasal spray

Background

Prophylactic treatment for pollinosis is advantageous for managing nasal symptoms in patients with seasonal allergic rhinitis. Inadequate control of rhinitis symptoms increases the risk of acute asthma attacks. Nevertheless, there is limited research on the use of nasal glucocorticoids and antihistamines for the preventive treatment of pollinosis.

Objective

This study aimed to assess the efficacy of prophylactic treatment for nasal symptoms and acute asthma attacks by enrolling patients with Artemisia pollinosis to use a combined device of azelastine hydrochloride and fluticasone nasal spray prior to the pollen season.

Methods

The study was registered at Chictr.org.cn (ChiCTR2300073758). A total of 120 patients with Artemisia pollinosis were randomly assigned to either a prophylactic treatment group or a control group at a 1:1 ratio. In the prophylactic treatment group, the nasal spray was initiated approximately two weeks before the onset of the pollen season.

Results

During both the pollen season and the concurrent medication period, the prophylactic treatment group presented significantly lower total nasal symptom scores (TNSS) (means of 5.97 and 5.94) than the control group (means of 7.86 and 7.80) (P = 0.015 and 0.016). Although the prophylactic treatment group had a lower asthma attack rate than the control group, the difference was not statistically significant (P = 0.284).

Conclusions

Prophylactic treatment with azelastine hydrochloride and fluticasone propionate nasal sprays can alleviate nasal symptoms and may reduce acute asthma attacks during the pollen season.

Clinical Trial Registration

[Chictr.org.cn], identifier (ChiCTR2300073758).

Correlation and consistency analysis between various indirect portal pressure gradients and actual portal pressure gradient

OBJECTIVE

To evaluate the correlation and consistency between hepatic venous pressure gradient(F-HVPG) calculated as the wedged hepatic venous pressure (WHVP) minus free hepatic venous pressure (FHVP), I-HVPG calculated as WHVP minus inferior vena cava pressure (IVCP) in the hepatic segment, and portal pressure gradient (PPG).

METHODS

Data were collected from 112 patients with portal hypertension undergoing transjugular intrahepatic portosystemic shunt (TIPS) along with HVPG measurement. FHVP, IVCP, WHVP, and portal venous pressure (PVP) were collected intraoperatively. Pearson's correlation and Bland-Altman method were used to assess correlation and consistency.

RESULTS

A total of 112 patients were retrospectively collected. The correlation coefficient (r) values (p < 0.001) between FHVP and IVCP, WHVP and PVP, F-HVPG and I-HVPG, F-HVPG and PPG, I-HVPG and PPG were 0.835, 0.717, 0.946, 0.667 and 0.698, respectively; the determination coefficient (R2) values were 0.697, 0.514, 0.895, 0.445 and 0.487, respectively. Bland-Altman plots showed that F-HVPG and I-HVPG had the narrowest 95% limits of agreement. Among patients with FHVP-IVCP > 2 mmHg, the (r) values (p < 0.05) between F-HVPG and I-HVPG, F-HVPG and PPG, I-HVPG and PPG were 0.907, 0.648 and 0.807, respectively; the (R2) values were 0.822, 0.420 and 0.651, respectively. Bland-Altman plots showed that I-HVPG had the narrower 95% limits of agreement with PPG.

CONCLUSION

F-HVPG and I-HVPG demonstrated high correlation and consistency. I-HVPG consistently correlates more closely with PPG than F-HVPG, both in the overall cohort and in patients with FHVP-IVCP > 2 mmHg. These results suggest that I-HVPG may serve as a more reliable alternative. Due to the significant underestimation of the PPG, HVPG measurement should not be used to exclude patients from a TIPS intervention.

Stem Cells in Cancer: From Mechanisms to Therapeutic Strategies

Stem cells have emerged as a pivotal area of research in the field of oncology, offering new insights into the mechanisms of cancer initiation, progression, and resistance to therapy. This review provides a comprehensive overview of the role of stem cells in cancer, focusing on cancer stem cells (CSCs), their characteristics, and their implications for cancer therapy. We discuss the origin and identification of CSCs, their role in tumorigenesis, metastasis, and drug resistance, and the potential therapeutic strategies targeting CSCs. Additionally, we explore the use of normal stem cells in cancer therapy, focusing on their role in tissue regeneration and their use as delivery vehicles for anticancer agents. Finally, we highlight the challenges and future directions in stem cell research in cancer.

Comprehensive analysis of CMTM family and immune infiltration in esophageal carcinoma

OBJECTIVE

Esophageal carcinoma (ESCA) is one of the most common malignant diseases and contributes to the annual burden of death worldwide. A better understanding of the underlying molecular changes is urgently required to identify early diagnostic biomarkers and effective therapeutics. The chemokine-like factor (CKLF)-like MARVEL transmembrane domain-containing family (CMTMs) is reported to be entangled in many human cancers. However, the role of CMTMs in ESCA remains unclear.

METHODS

The differential expressions of CMTMs between ESCA and normal tissues were analyzed using TCGA database. The relationships between CMTMs and immune infiltration in the tumor microenvironment (TME) were also evaluated to explore their underlying values in the diagnosis and prognosis of ESCA.

RESULTS

The results showed that ESCA showed significantly higher expressions of CMTM1,3,6,7 and lower expressions of CMTM4,5 than normal tissue (P < 0.05). Meanwhile, CMTM3,4,8 expressions were correlated with the tumor stage of ECSA patients. The analysis on immune infiltrations (CD8 + T, Tregs, NK and macrophages) showed that M2 macrophages was dominant in TME, with significantly higher levels than the other cells (F = 326.93, P < 0.001). The higher abundance of M2 macrophages and Tregs significantly shortened the survival time of patients with ESCA (P = 0.01). Interestingly, the expression levels of CMTM1,3,5,7 were comparable to the abundance of M2 macrophages (CMTM1: r = 0.172168; CMTM3: r = 0.313221; CMTM5: r = 0.130669; CMTM7: r = 0.119922; P < 0.05). CMTM2,4,5,7,8 positively correlated with Tregs (P < 0.05). Moreover, we found positive associations between the expression of CMTMs and the signatures of M2 macrophages (MS4A4A, VSIG4 and CD163).

CONCLUSION

There were differential expressions of CMTMs between ESCA and normal tissues. Furthermore, the expression of CMTMs was positively correlated with M2 macrophages, indicating a possibility that CMTMs may become a new immunotherapy target for ESCA.

The state of targeted therapeutic pharmacological approaches in pediatric neurosurgery: report from the European Society for Pediatric Neurosurgery (ESPN) Consensus Conference 2024

OBJECTIVE

The development of novel targeted therapies is opening new perspectives in the treatment of pediatric brain tumors. Their precise role in therapeutic protocols still needs still to be defined. Thus, these novel pharmacological approaches in pediatric neurosurgery were the topic of the European Society for Pediatric Neurosurgery (ESPN) Consensus Conference held in Lyon (France) in January 25-27, 2024.

METHOD

The paper reviews the current knowledge about targeted therapy as well as the current literature published on the topic. The conference aimed for an interdisciplinary consensus debate among pediatric oncologists and pediatric neurosurgeons on the following questions. Question 1: What is the current role for targeted therapies as neoadjuvant treatments before pediatric brain tumor removal? Question 2: What are the benefits, cost/efficiency, and long-term side effects of targeted therapies in the treatment of pediatric brain tumors? Question 3: Based on contemporary data, at which stage and in which pathologies do targeted therapies play a significant role?

RESULTS

Ninety-two participants answered consensus polls on the state of the art of targeted therapies, the ethical issues related to their use, and the evolving change in the role of pediatric neurosurgeons. The neoadjuvant role of targeted therapies is difficult to define as there are many different entities to consider. Despite the recently reported potential benefits, questions regarding the use of targeted therapies are manifold, in particular regarding sustainable benefits and long-term side effects. Additionally, challenging cost issues is a limiting factor for the broader availability of these drugs. Studies have demonstrated superiority of targeted therapy compared to chemotherapy both in randomized trials and compared to historical cohorts in the management of a subset of low-grade gliomas. The same drug combinations, BRAFi and MEKi, may be effective in HGG that have relapsed, progressed, or failed to respond to first-line therapy. Similar conclusions on efficacy may be drawn for mTORi in TSC and selumetinib in plexiform neurofibromas. For other tumors, the picture is still obscure due to the lack of data or even the lack of suitable targets. In conclusion, targeted treatment may not always be the best option even when a target has been identified. Safe surgery remains to be a favorable option in the majority of cases.

CONCLUSION

The constantly evolving drug technology and the absence of long-term safety and efficacy studies made it difficult to reach a consensus on the predefined questions. However, a report of the conference is summarizing the present debate and it might serve as a guideline for future perspectives and ongoing research.

Comparative safety analysis of coseasonal versus preseasonal Artemisia annua sublingual immunotherapy for allergic rhinitis

PURPOSE

Patients with seasonal allergic rhinitis (SAR) usually seek treatment when symptoms become unbearable during the pollen season. It remains unclear whether initiating sublingual immunotherapy (SLIT) during the pollen season affects patients' safety. This study aims to compare the tolerability of initiating Artemisia annua SLIT during the pollen season versus before the season.

METHODS

Ninety patients with Artemisia-induced SAR were recruited and equally randomized into the coseasonal initiation treatment (COS-SLIT) group and the preseasonal initiation treatment (PRE-SLIT) group. The COS-SLIT group started SLIT when allergic symptoms occurred during the 2022 pollen season, while the PRE-SLIT group began SLIT four months before the expected season in 2022. Patients were categorized as mild symptoms or moderate-severe symptoms group based on the level of visual analog scale (VAS) scores evaluated during the 2021 pollen season. The incidence, frequency, performance, and alleviating measures of adverse events (AEs) were analyzed after the up-dosing phase (5 weeks), at three months (13 weeks), six months (26 weeks), and twelve months (52 weeks).

RESULTS

A total of 72 patients (32 patients in the COS-SLIT group and 40 patients in the PRE-SLIT) were included in the analysis. Among these patients, 33 reported a total of 78 AEs. No significant difference was found in the frequency and number of patients experiencing AEs between the COS-SLIT and PRE-SLIT groups during the four follow-up periods (all p > 0.05). There were no significant differences in the symptoms or alleviating measures of AEs between the two groups in general (all p > 0.05). Furthermore, the most common AEs in the COS-SLIT group were nasal symptoms (n = 14), lip edema (n = 10), and cough (n = 4), while in the PRE-SLIT group were nasal symptoms (n = 12), lip edema (n = 8), and ocular pruritus (n = 6). Symptomatic drugs were the most common alleviating measures in both groups (61.29% in COS-SLIT and 64.52% in PRE-SLIT, p > 0.05). Patients with mild and moderate-severe symptoms showed comparable tolerability at different initiation timing (all p > 0.05).

CONCLUSION

This prospective study demonstrates the comparable safety and tolerability of initiating Artemisia annua SLIT during the pollen season and before the season.

Ethanolic extract of Momordica charantia L. fruits ameloriates TNBS and AA induced colitis in rats: a histological and electron microscopic study

The anti-inflammatory effect of the ethanol extract of Momordica charantia in two different chemically induced inflammatory bowel disease models, which are frequently used in experimental studies, was investigated. For this purpose, IBD models were created with acetic acid (AA) and 2,4,6 trinitrobenzene sulphonic acid (TNBS) in rats and 300 mg/kg M.charantia extract was given by oral gavage for 10 days. In the animal experiment phase, a total of 42 animals in six groups were arranged so that two different experimental models could be studied simultaneously. Colon tissues were examined at light and electron microscopy levels. In the microscopic examination, areas of inflammation extending to the muscularis externa were observed in the macroscopically severely damaged areas in both IBD model groups, and epithelial damage, mucosal inflammation, and crypt abscess were observed in the macroscopically less damaged areas. Microscopic large intestine damage was significantly reduced in M.charantia administered groups compared to disease models. TNF-α and IL-1β expression, which was determined to be increased in the AA and TNBS groups immunohistochemically, was observed to decrease in the treatment groups. The surface epithelium was evaluated by electron microscopic observations. This study demonstrates the positive effect of M.charantia ethanol extract on colon histopathology in two different IBD models and highlights the importance of considering inflammation-related cell populations in the treatment of this disease.

Toward the benefit and value of immune treatment beyond progression in lung cancer? Insights from a systematic review and meta-analysis

Objective

Immune treatment beyond progression (ITBP) has emerged as a novel therapeutic strategy in oncology. This systematic review and meta-analysis aim to evaluate the efficacy and safety of ITBP in patients with lung cancer, while also identifying characteristics of populations that may benefit most from this treatment approach.

Methods

This study adheres to the PRISMA guidelines. We searched PubMed, Embase, and the Cochrane Library for relevant literature on immunotherapy for lung cancer, using self-constructed databases up until February 1, 2024. The study includes real-world data from patients with lung cancer undergoing ITBP, categorized into two groups: non-ITBP (NTBP) and ITBP. Two authors independently conducted literature screening, quality assessment, and data extraction. The primary efficacy indicators include overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). The safety indicator assessed was the incidence of immune-related adverse events (irAEs).

Results

We included 9 studies with a total of 5,141 patients with lung cancer, comprising 2,051 patients in the ITBP group and 3,090 in the NTBP group. Patients receiving ITBP showed significantly better outcomes than those receiving NTBP, including superior OS and PFS following treatment beyond progression (OS: hazard ratio (HR) 0.72, 95% confidence interval (CI) 0.68-0.77, P < 0.05; PFS: HR 0.63, 95% CI 0.51-0.78, P < 0.05). Additionally, the ITBP group demonstrated higher ORR and DCR (ORR: odds ratio (OR) 0.48, 95% CI 0.31-0.75, P < 0.05; DCR: OR 0.37, 95% CI 0.24-0.57, P < 0.05). No significant difference in the incidence of irAEs was found between the two groups (OR 1.24, 95% CI 0.83-1.85, P > 0.05). Subgroup analysis revealed that factors such as age, gender, lung cancer subtype, and smoking history significantly influenced OS outcomes in the ITBP group.

Conclusion

Our findings suggest that ITBP is an effective treatment strategy for patients with lung cancer. Further research should focus on identifying specific patient populations that benefit from ITBP and exploring the potential efficacy of combining ITBP with other therapeutic regimens.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024513475.

CYP2B6 genetic variation in cyclophosphamide metabolism and hemorrhagic cystitis in Fanconi anemia patients undergoing allogeneic hematopoietic cell transplantation: A descriptive genetic association study

Fanconi anemia (FA) is an inherited disorder characterized by congenital malformations, bone marrow failure, and malignancies. Hematopoietic cell transplant (HCT) is the only proven cure for the hematological complications. FA patients have increased chromosomal instability and aberrant deoxyribonucleic acid repair and thus can only tolerate low doses of chemotherapy or radiation as part of conditioning prior to HCT. Yet, they are still prone to severe regimen related toxicities including hemorrhagic cystitis (HC) from cyclophosphamide (CY). As CYP2B6 is a primary enzyme responsible for the catalyzation of the prodrug form of CY, understanding the association between CYP2B6 genetic variants and HC in FA patients may predict which patients will be more susceptible to developing HC. A descriptive genetic association study was performed to identify genetic variants associated with HC in patients with FA who underwent HCT between 1999 and 2017. All patients received a CY-based preparative regimen and had pretransplant recipient deoxyribonucleic acid available for genomic analysis. Forty FA pediatric patients were eligible for this analysis. They had received HCT from matched sibling donors (n = 6) or alternative donors (n = 34) for marrow failure (n = 38) or myelodysplastic syndrome (n = 2). The incidence of HC was 32.5% which occurred at a median of 32 days (range 20-180) after HCT. 9 patients had a concomitant viral infection (BK virus, n = 8 both adenovirus and BK virus, n = 1). No genetic variants were significantly associated with HC. The top variants were rs2279343 (g.23060A > G), and rs2279344 (g.23280G > A) in the CYP2B6 gene. The incidence of HC among FA patients with the rs2279343 variant was 42% (CI 22%-62%) compared to 20% (CI 0%-40%) among those without the variant (P = .19). The incidence of HC among patients with the variant in rs2279344 was 40% (CI 22%-58%) compared to 10% (CI 0%-28%) among those without (P = .11). No variants in our analysis were statistically associated with HC. The data suggest that CYP2B6 variants may increase the risk for HC in FA patients who received a CY based preparative therapy but these risk variants must be further evaluated in a larger population.

Double-Multiplex Immunostainings for Immune Profiling of Invasive Breast Carcinoma: Emerging Novel Immune-Based Biomarkers

The role of tumor microenvironment in invasive breast cancer prognosis and treatment is highly appreciated. With the advent of immunotherapy, immunophenotypic characterization in primary tumors is gaining attention as it can improve patient stratification. Here, we discuss the benefits of spatial analysis employing double and multiplex immunostaining, allowing the simultaneous detection of more than one protein on the same tissue section, which in turn helps us provide functional insight into infiltrating immune cells within tumors. We focus on studies demonstrating the prognostic and predictive impact of distinct tumor-infiltrating lymphocyte subpopulations including different CD8(+) T subsets as well as CD4(+) T cells and tumor-associated macrophages in invasive breast carcinoma. The clinical value of immune cell topography is also appreciated. We further refer to how the integration of digital pathology and artificial intelligence in routine practice could enhance the accuracy of multiplex immunostainings evaluation within the tumor microenvironment, maximizing our perception of host immune response, improving in turn decision-making towards more precise immune-associated therapies.

Comparison of histochemical methods for the analysis of eosinophils and mast cells using a porcine model of eosinophilic esophagitis

Introduction

Accurate identification of eosinophils in tissue sections is required for diagnosis of eosinophilic esophagitis in humans and the assessment of severity of disease in allergy models. The pig may be a good model for sensitization and allergy models due to anatomical, physiological, and immunological similarities to humans. However, comparative studies on histochemical detection of eosinophils in fixed porcine tissue are lacking.

Methods

Qualitative and quantitative comparisons were performed for six histochemical methods previously reported for eosinophil and mast cell detection in other species. Astra Blue/Vital New Red, Congo Red, Luna, Sirius Red, Toluidine Blue, and modified regressive Hematoxylin & Eosin were applied to formalin-fixed paraffin embedded full-thickness sections of porcine esophagus. Specimens were collected from young, crossbred pigs sensitized to ovalbumin with or without subsequent oral exposure to ovalbumin to produce eosinophilic esophagitis lesions for comparison to non-allergic controls.

Results

Ease of eosinophil quantitation was analyzed, and varied by histochemical stain, to determine whether stain selection increased accuracy and efficiency of evaluation. Noticeable differences in color contrast between intracytoplasmic granules, surrounding tissue, and cellular components aided detection and identification of eosinophils and mast cells with Astra Blue/New Vital Red and Toluidine Blue, respectively. For eosinophils, Congo Red and H&E were adequate, while Luna and Sirius Red presented challenges for quantitation.

Discussion

In this case, rapid and reliable characterization of porcine esophageal allergy models was made possible by using Astra Blue/New Vital Red for eosinophils and Toluidine Blue for mast cells.

Does platelet to lymphocyte ratio predict the ultrasound stage in hepatosteatosis?

BackgroundThe prevalence of hepatosteatosis, or fatty liver disease, has been increasing globally in recent years largely due to increasing rates of obesity, diabetes, and metabolic syndrome.PurposeTo examine the platelet to lymphocyte ratio (PLR) reflection on the hepatosteatosis stage.Material and MethodsWe evaluated healthy individuals who applied to the check-up department in our hospital. The platelet and lymphocyte counts from blood tests, along with upper abdominal ultrasound results obtained as part of routine diagnostic check-ups, results recorded retrospectively, between November 2022 and April 2024.ResultsA total 748 participants were included in the study. All participants were divided in three groups according to hepatosteatosis stages.The PLR levels were highest in the stage 1 hepatosteatosis group. There was statistical significance in PLR levels between stage 1 and 3 hepatosteatosis (P = 0003). In addition, PLR levels were higher in stage 2 than in stage 3, which was also statistically significant (P = 0037).ConclusionThese results could help in early detection and monitoring of disease progression in patients with hepatoteatosis. Lower PLR values (<115.26) in advanced stages might prompt closer monitoring or more aggressive interventions to prevent progression to fibrosis.

Understanding air pollution dynamics of Antalya Manavgat forest fires: a WRF-Chem analysis

This study investigates the air pollution dynamics of the Antalya Manavgat forest fires in Turkey, using the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem v4.4.2) and Fire INventory from NCAR (FINN v2.5) boundary fire emission data for the period between 28 July 2021 and 6 August 2021. It focuses on the synoptic and microscale atmospheric conditions during the fire event. The research also delves into the micrometeorological factors, particularly examining the Foehn effect's influence in intensifying the initial fire conditions through 3D trajectory modeling and surface chart analysis. The study assesses the performance of the WRF-Chem model in predicting aerosol optical depth (AOD), particulate matter (PM10), and various meteorological variables. This assessment utilized diverse re-sampled and interpolated satellite products, including MODIS MAIAC and Sentinel-5P NRTI AER AI. The Manavgat air quality and meteorological station, situated near the fire, proved highly effective in modeling atmospheric parameters, with strong correlations in AOD (0.93), AAI (0.81), and ground-level PM10 (0.82), indicating accurate predictions of particulate pollution levels. The station was also ranked as the second most accurate in modeling overall meteorological conditions. The complex meteorological conditions led to significant discrepancies between ground-measured PM and AOD. The study attempts to elucidate these differences using 3D plume modeling and cross-sectional analysis. Notably, a low-pressure system was identified as a key factor in the vertical expansion of the fire plume, enabling it to reach heights of up to six kilometers above sea level (ASL). Lastly, satellite imagery from August 6 and 7, 2021, reveals persistent aerosol levels in eastern Antalya, driven by atmospheric transport of smoke and particulate matter from local and distant fires, including remnants from the extinguished Manavgat forest fire, as well as fires in Muğla and Greece, carried by cyclonic atmospheric movements over the gulf of Antalya.

The Predictive Value of Soluble Fms-Like Tyrosine Kinase-1 for Prognosis in COVID-19 Patients

Background

Coronavirus Disease 2019 (COVID-19), caused by the novel coronavirus, has posed a significant threat to global public health, leading to substantial morbidity, mortality, and strain on healthcare resources. Despite the availability of vaccines and treatments, effective biomarkers for predicting disease progression remain limited. This study aimed to investigate the prognostic value of soluble fms-like tyrosine kinase-1 (sFlt-1) in COVID-19 patients.

Methods

A prospective cohort study was conducted involving 154 COVID-19 patients, with comprehensive clinical data and laboratory parameters analyzed to evaluate the effectiveness of sFlt-1 in determining disease severity and prognosis.

Results

The results revealed that sFlt-1 levels correlated significantly with disease severity, showing higher levels in severe/critical cases compared to mild cases (P<0.05). In the deceased group, sFlt-1 levels were notably higher compared to survivors, with an area under the curve (AUC) of 0.840, showing good predictive power for 28-day mortality. Multivariable logistic regression identified sFlt-1, respiratory rate, and albumin as independent prognostic factors, with a combined AUC of 0.938 (95% CI: 0.886-0.991) for predicting mortality risk.

Conclusion

These findings underscore the potential of sFlt-1 as a valuable biomarker for clinical decision-making in managing COVID-19 patients. Future studies should focus on the clinical application of sFlt-1 and explore its underlying mechanisms to enhance patient management strategies.

Clinical Predictors and Prevalence of Enteral Nutrition Intolerance in Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Background: Acute pancreatitis (AP) leads to severe inflammation and nutritional deficits, with 80% of severe cases experiencing critical protein loss. Timely enteral nutrition is essential for recovery. This study systematically reviews and analyzes the incidence and predictors of enteral nutrition intolerance (ENI) in AP patients. Methods: Web of Science, Embase, Cochrane Library, and PubMed were searched up to May 2024. Studies reporting on ENI incidence and predictors in AP patients were included based on predefined criteria. Bias was assessed using standardized tools, and meta-analyses provided summary estimates with confidence intervals. Results: From the 2697 screened studies, 28 involving 4853 patients met the inclusion criteria. The pooled incidence of ENI was 26%. Significant predictors included comorbid diabetes, pancreatic necrosis, elevated pre-refeeding serum lipase levels, peri-pancreatic fluid collections, and systemic inflammatory response syndrome at admission. Higher ENI rates were observed in Europe, among patients with severe acute pancreatitis (SAP), those receiving nasoenteric feeding, and in prospective study cohorts. Conclusions: ENI affects approximately one-quarter of AP patients and is not significantly associated with age, sex, or the cause of AP. Its incidence varies by region, disease severity, feeding method and study design. Identifying predictors, such as comorbid diabetes and pancreatic necrosis, may help clinicians reduce the risk of ENI. The limitations of this study include the heterogeneity of the included studies and inconsistent ENI diagnostic criteria.

Transvaginal ovarian drilling for polycystic ovary syndrome prior to in vitro fertilization dramatically improves embryo yield, implantation, and ongoing pregnancy rates

PURPOSE

To evaluate the effect of transvaginal ovarian drilling (TVOD) on IVF outcomes in subjects with clomiphene-resistant PCOS and a history of IVF failure.

METHODS

Between 2008 and 2011, 19 subjects with sonographically PCOS and a history of failure to ovulate to high-dose clomiphene citrate were prospectively followed and underwent TVOD at a university hospital-based IVF program.

RESULTS

In 15 subjects who underwent 30 fresh paired IVF cycles TVOD resulted in a significantly higher number of oocytes retrieved (7.2 ± 5.9 vs. 13.2 ± 5.9, p = 0.007), mature oocytes retrieved (4.6 ± 3.4 vs. 9.5 ± 5.2, p = 0.002), embryos (3.8 ± 2.7 vs. 8.5 ± 4.5, p = 0.0002), and blastocysts (0.73 ± 1.33 vs. 2.77 ± 2.7, p = 0.037). Among all IVF cycles, 19 subjects underwent 23 fresh IVF cycles prior to TVOD and 21 fresh cycles within 6 months following TVOD lead to higher implantation (0.10 vs. 0.37, p = 0.001), clinical pregnancy (17.4% vs. 61.9%, p = 0.002), and ongoing pregnancy rates (4.4% vs. 47.6%, p = 0.014).

CONCLUSION

In this prospective cohort study, TVOD appears to markedly improve IVF outcomes in subjects with clomiphene resistant PCOS and a history of IVF failure.

CD155 promotes the advancement of hepatocellular carcinoma by suppressing the p53-mediated ferroptosis via interacting with CD96

This work researched the influence and mechanism of CD155 on hepatocellular carcinoma advancement. CD155 expression and its effect on survival of hepatocellular carcinoma patients were analyzed based on the GEPIA2 database. String software predicted the interacting between CD155 and CD96, which was further verified by co-immunoprecipitation experiment. The function of CD155 and CD96 on the proliferation, migration, and invasion of hepatocellular carcinoma cells (HCC) was explored by colony formation, wound healing, and transwell assays. To research the effect of CD155 and CD96 on ferroptosis, ferroptosis-related factors in HCC were investigated. CD155 and p53 were both silenced in HCC to explore whether CD155 regulates hepatocellular carcinoma progression by acting on p53. Xenograft tumor study was conducted to examine the impact of CD155 on the in vivo growth of HCC. It was discovered that, CD155 up-regulation predicted poor survival of hepatocellular carcinoma patients. CD155 could be interacted with CD96. The proliferation, migration, and invasion of HCC were heightened by CD155. However, ferroptosis was suppressed by CD155, as CD155 decreased p53 and iron but increased SLC7A11, GPX4 and GSH in HCC. In fact, CD96 silencing abolished these effects of CD155. The suppressed malignant behaviors and the enhanced ferroptosis in HCC induced by CD155 silencing were abrogated by p53 silencing. In vivo, CD155 silencing suppressed growth and enhanced ferroptosis of hepatocellular carcinoma, which were counteracted by p53 silencing. Thus, CD155 might facilitate hepatocellular carcinoma advancement through blocking the p53-mediated ferroptosis via interacting with CD96. CD155 might be a promising target for treating hepatocellular carcinoma. KEY MESSAGES: CD155 was up-regulated in hepatocellular carcinoma, predicting poor survival. CD155 protein could be interacted with CD96 protein. Proliferation and invasion of liver cancer cells were facilitated by CD155. Proliferation and invasion of liver cancer cells were decreased by CD96 loss. CD155 promoted liver cancer by suppressing p53-mediated ferroptosis via CD96.

Development and validation of dietary depression index in Chinese adults

OBJECTIVE

Previous studies have suggested diet was associated with depressive symptoms. We aimed to develop and validate Dietary Depression Index (DDI) based on dietary prediction of depression in a large Chinese cancer screening cohort.

METHODS

In the training set (n = 2729), we developed DDI by using intake of 20 food groups derived from a food frequency questionnaire to predict depression as assessed by Patient Health Questionnaire-9 based on the reduced rank regression method. Sensitivity, specificity, positive predictive value, and negative predictive value were used to assess the performance of DDI in evaluating depression in the validation dataset (n = 1176).

RESULTS

Receiver operating characteristic analysis was constructed to determine the best cut-off value of DDI in predicting depression. In the study population, the DDI ranged from -3.126 to 1.810. The discriminative ability of DDI in predicting depression was good with the AUC of 0.799 overall, 0.794 in males and 0.808 in females. The best cut-off values of DDI for depression prediction were 0.204 overall, 0.330 in males and 0.034 in females. DDI was a validated method to assess the effects of diet on depression.

CONCLUSION

Among individual food components in DDI, fermented vegetables, fresh vegetables, whole grains and onions were inversely associated, whereas legumes, pickled vegetables and rice were positively associated with depressive symptoms.

Patterns of Complementary Medicine Utilization in Patients With Breast Cancer and Colorectal Cancer: A Cross-Sectional Study at a Tertiary Referral Hospital in Yogyakarta, Indonesia

PURPOSE

The utilization of complementary medicine (CM) in patients with cancer brings substantial challenges to optimal cancer care by posing a risk of side effects and drug interaction, and might delay cancer care delivery. We aimed to characterize the patterns and predictors of CM utilization in patients with breast cancer (BC) and patients with colorectal cancer (CRC), and the impact on presentation and diagnosis interval.

METHODS

We interviewed patients with BC and patients with CRC using a semistructured questionnaire to gather sociodemographic, clinical, presentation and diagnosis interval, and CM utilization data. The domains of CM used were categorized according to the classification of the National Institutes of Health/National Center for Complementary and Integrative Health.

RESULTS

One hundred forty-two patients with BC and 227 patients with CRC (N = 369) were included. The prevalence of CM utilization was 69.9%, with biologically based therapies being the most commonly used type. Younger age, higher educational attainment, and a greater number of health facility visits before diagnosis were significantly associated with higher odds of CM utilization (odds ratio [OR], 2.05 [95% CI, 1.19 to 3.54]; P = .010; OR, 1.07 [95% CI, 1.02 to 1.11]; P = .007, respectively). The diagnosis interval was significantly longer in patients who used CM compared to nonusers (incidence rate ratio [IRR], 2.74 [95% CI, 1.77 to 4.26]; P < .001). A greater number of CM modalities used were significantly associated with longer presentation and diagnosis intervals (IRR, 1.68 [95% CI, 1.06 to 2.66]; P = .027; IRR, 1.62 [95% CI, 1.04 to 2.52]; P = .033, respectively).

CONCLUSION

A significant portion of the local patients with BC and patients with CRC used CM. CM utilization was associated with age, education, number of health facility visits, and prolonged diagnosis interval. These findings underscore the need for CM disclosure among patients for better patient education and monitoring.

Impact of Dietary Behavioural Changes on Prognosis of Postoperative Oesophageal Squamous Cell Carcinoma Patients: A Retrospective Cohort Study

OBJECTIVE

In recent years, the incidence of oesophageal squamous cell carcinoma has been increasing, becoming a major focus of public attention. Despite surgery being the primary treatment method, the long-term prognosis after surgery is also of significant importance. Therefore, this study aims to investigate the impact of dietary behaviour changes on the long-term prognosis of patients with oesophageal squamous cell carcinoma after surgery.

METHODS

A retrospective cohort study was adopted, involving patients with oesophageal squamous cell carcinoma who underwent surgery at the Department of Thoracic Surgery, Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University from January 1, 2018, to December 31, 2019. Data collected included characteristics of dietary behaviour, complications, postoperative quality of life scores and survival periods. Data were gathered through review of clinical pathological characteristics and patient survey questionnaires.

RESULTS

Patients with oesophageal squamous cell carcinoma who changed their dietary behaviours had a significant reduction in the risk of postoperative complications, higher quality of life scores (mean QoL score NDC: 9.8 vs. DC: 21.1; p < 0.001) and a slightly prolonged overall survival period (univariate hazard ratio: 0.58, 95% CI: 0.40-0.83, p = 0.003). Study findings also indicated age as a significant independent risk factor influencing patient prognosis.

CONCLUSION

To improve postoperative prognosis in patients with oesophageal squamous cell carcinoma, guidance and management of dietary behaviour should be emphasised. Appropriate changes in dietary behaviour are expected to reduce the risk of postoperative complications, improve the quality of life and extend the survival period of patients.

PATIENT OR PUBLIC CONTRIBUTION

The findings of this study have important implications for both patients and the public. By investigating the impact of dietary behaviour changes on the long-term prognosis of patients with oesophageal squamous cell carcinoma after surgery, this study provides valuable insights into potential strategies to improve patient outcomes. For patients, the study emphasises the importance of adopting healthy dietary behaviours after surgery. The results demonstrate that dietary behaviour changes can have a significant impact on the long-term prognosis of postoperative oesophageal squamous cell carcinoma patients. By following a healthy diet, patients may improve their overall quality of life, decrease complications and potentially increase their survival period.

Unraveling the role of macrophages in diabetes: Impaired phagocytic function and therapeutic prospects

The rising aging population and changing lifestyles have led to a global increase in diabetes and its complications, making it one of the most prevalent diseases worldwide. Chronic inflammation is a key pathogenic feature of diabetes and its complications, yet the precise mechanisms remain unclear, impeding the development of targeted therapies. Recent studies have highlighted the β cell-macrophage crosstalk pathway as a crucial factor in chronic low-grade inflammation and glucose homeostasis imbalance in both type 1 and type 2 diabetes. Furthermore, impaired macrophage phagocytic functions, including pathogen phagocytosis, efferocytosis, and autophagy, play a significant role in diabetes complications. Given their high plasticity, macrophages represent a promising research target. This review summarizes recent findings on macrophage phagocytic dysfunction in diabetes and its complications, and explores emerging therapies targeting macrophage phagocytic function. We also discuss the current challenges in translating basic research to clinical practice, aiming to guide researchers in developing targeted treatments to regulate macrophage status and phagocytic function, thus preventing and treating metabolic inflammatory diseases.

Oral cancer stem cells: A comprehensive review of key drivers of treatment resistance and tumor recurrence

Oral squamous cell carcinoma (OSCC) remains a major cause of morbidity and mortality worldwide with high recurrence rates and resistance to conventional therapies. Recent studies have highlighted the pivotal role of oral cancer stem cells (OCSCs) in driving treatment resistance and tumor recurrence. OCSCs possess unique properties, including self-renewal, differentiation potential, and resistance to chemotherapy and radiotherapy, which contribute to their ability to survive treatment and initiate tumor relapse. Several signaling pathways, such as Wnt/β-catenin, Hedgehog, Notch, and PI3K/Akt/mTOR, have been implicated in maintaining OCSC properties, promoting survival, and conferring resistance. Additionally, mechanisms such as drug efflux, enhanced DNA repair, epithelial-mesenchymal transition (EMT), and resistance to apoptosis further contribute to resilience. Targeting these pathways offers promising therapeutic strategies for eliminating OCSCs and improving treatment outcomes. Approaches such as immunotherapy, nanotechnology-based drug delivery, and targeting of the tumor microenvironment are emerging as potential solutions to overcome OCSC-mediated resistance. However, further research is needed to fully understand the molecular mechanisms governing OCSCs and develop effective therapies to prevent tumor recurrence. This review discusses the role of OCSCs in treatment resistance and recurrence and highlights the current and future directions for targeting these cells in OSCC.

Associations of temperament, family functioning with loneliness trajectories in patients with breast cancer: a longitudinal observational study

PURPOSE

Loneliness is a prevalent affective issue among patients with breast cancer, with its developmental trajectory being a contentious subject. Therefore, the aim of this study was to explore trends in loneliness in patients with breast cancer and identify predictors of different trajectory categories.

METHODS

Using convenience sampling, 176 patients planning to undergo breast cancer surgery in a university hospital in Shaanxi Province, China, were followed up six times over 12 months following surgery, and data from 144 patients were analyzed. The data were analyzed using a mixed growth model (GMM) and logistic regression.

RESULTS

Two latent classes of loneliness trajectory were identified among patients with breast cancer, namely "persistent high loneliness" and "persistent low loneliness." Patients who with education level of junior secondary and less (OR = 13.59, P = 0.002), had a melancholic temperament (OR = 12.07, P = 0.002) were more likely to be categorized in the "persistent high loneliness group", whereas the better family functioning (OR = 0.60, P < 0.001) and choleric temperament (OR = 0.16, P = 0.025) of the patients were more likely to be categorized in the "persistent low loneliness group".

CONCLUSION

Patients with breast cancer exhibit diverse trajectories of loneliness, with educational level, temperament type, and family functioning being predictive of these trajectories. Therefore, it is crucial to promptly identify populations at risk in a clinical setting and devise intervention strategies, grounded in identified trajectory characteristics and influencing factors, to enhance patient outcomes.

Peripheral blood PD-1+ T lymphocytes as biomarkers in liquid biopsies for solid tumors: Clinical significance and prognostic applications

A shift toward a T cell exhaustion phenotype is associated with the upregulation of expression of programmed cell death protein 1 (PD-1) on T lymphocytes in patients with malignant solid tumors. The interaction between PD-1 and programmed death-ligand 1 (PD-L1) inhibits PD-1+ T lymphocyte function, impacting their anti-tumor immune activity. Immune checkpoint inhibitors targeting PD-1/PD-L1 have revolutionized the treatment of various solid malignancies, improving therapeutic efficacy and survival outcomes. Peripheral blood analysis of liquid biopsies is being increasingly used to identify populations most likely to benefit from various treatment modalities. PD-1+ T lymphocytes represent the primary cell population responsive to immunotherapeutic interventions for patients with solid malignancies, as evidenced by the altered PD-1 expression levels and proportion of cells comprising the overall population of immunocytes. PD-1+ T cells in peripheral blood exert an associative and reciprocal predictive effect on homologous intratumoral cells. Distinct subpopulations of PD-1+ T cells exhibit differential ability to proliferate in the periphery and can be characterized by tumor antigen-specific and exhaustion phenotypes. These characteristics have prognostic implications, aiding in the prediction of the efficacy of antitumor therapy and predicting survival outcomes. We highlight distinct subpopulations of PD-1+ T cells, their exhaustion and antigen-specific phenotypes, and their dynamic changes over treatment, providing insights into their utility for tailoring personalized therapies. For the first time, this review discusses the role of peripheral PD-1+ T lymphocytes as prognostic biomarkers in liquid biopsies, focusing on their clinical significance, predictive value during therapy, and future research directions.

Spatial and temporal changes of breast-conserving surgery rates and its influential factors among Chinese patients with breast cancer from 2013 to 2019: a registry-based study

OBJECTIVE

Our study aims to evaluate the spatial and temporal changes of breast-conserving surgery (BCS) rates and influential factors of BCS in Guangdong Province, China.

DESIGN, SETTING AND PARTICIPANTS

This registry-based cohort study analysed the data of patients of all age groups, from the medical record cover page, which was mandatorily collected for inpatients by the Health Administrative Department of Guangdong Province, China. Patients with non-metastatic breast cancer, who underwent breast surgery between 2013 and 2019, were included.

MAIN OUTCOMES AND MEASURES

We analysed the BCS rate in Guangdong Province between 2013 and 2019. Logistic regression was applied to investigate the association between patient-level influential factors and BCS, respectively. We used restricted cubic spline regression to model the non-linear association between hospital volume rank with BCS rate. Linear regression was used to evaluate the association between city-level parameters with BCS rate of each city.

RESULTS

A total of 93 521 patients with non-metastatic breast cancer, who underwent breast surgery, were included in the analyses. Among them, 10 949 (11.7%) had BCS, with the BCS rates increasing from 0.8% in 2013 to 19.2% in 2019. Patients who were older (vs <40 years, 40-49 years: adjusted OR 0.72, 95% CI 0.68 to 0.76; 50-59 years: 0.51, 95% CI 0.48 to 0.54; ≥60 years: 0.37, 95% CI 0.35 to 0.40) and married (vs unmarried, 0.64, 95% CI 0.59 to 0.70) were less likely to undergo BCS. Patients who were employed (vs unemployed, 1.58, 95% CI 1.49 to 1.68), received cross-city surgery (vs local surgery, 1.37, 95% CI 1.31 to 1.44), lived in a high-income city (vs low-income city, β=4.40, 95% CI 1.55 to 7.24) or in a city with a higher number of physicians per 100 000 residents (0.57, 95% CI 0.31 to 0.82) were more likely to receive BCS.

CONCLUSIONS AND RELEVANCE

This study suggests a significant increase in BCS rates from 2013 to 2019 in Guangdong, China. Promotion of BCS is needed, particularly among older patients, lower-volume hospitals and economically underdeveloped areas. Healthcare system should be prepared to support the increased awareness of seeking BCS among younger patients with breast cancer by improving the availability of radiotherapy, multidisciplinary team and patients' education programme.

Numerical assessment of portal pressure gradient (PPG) based on clinically measured hepatic venous pressure gradient (HVPG) for liver cirrhosis patients

Portal hypertension (PH) is the initial and main consequence of liver cirrhosis. Hepatic venous pressure gradient (HVPG) measurement has been widely used to estimate portal pressure gradient (PPG) and detect portal hypertension. However, some clinical studies have found poor correlation between HVPG and PPG, which may lead to the misdiagnosis of portal hypertension. In this study, we provided a method to evaluate patients' PPG based on clinically measured HVPG with computational fluid dynamics (CFD). Twenty-five patients who underwent HVPG measurement were recruit for analysis. Results show that HVPG significantly correlates with PPG (R = 0.7499, P < 0.0001), with an accuracy to distinguish clinically significant portal hypertension (CSPH) as high as 92 %. However, PH severity classification was underestimated for 36 % patients, especially for patients with hepatic venous collateral formation and presinusoidal portal vein occlusion. It is concluded that HVPG is a relatively reliable diagnostic method for PH when PPG cannot be directly measured. For patients who have clinical symptoms of PH but their HVPG are within a normal range, numerical evaluation of PPG with CFD is an excellent way for their diagnosis.

Total parietal peritonectomy and multivisceral resection for extensive cytoreductive surgery in pseudomyxoma peritonei: En bloc "Rolled-up carpet" technique and perioperative and oncologic outcomes

BACKGROUND

Patients diagnosed with pseudomyxoma peritonei (PMP) of appendiceal origin typically present with high tumor burden and require extensive cytoreductive surgery (CRS) to achieve optimal cytoreduction. This study describes an en bloc "rolled-up carpet" surgical technique for total parietal peritonectomy and multivisceral resection while also analyzing the perioperative and tumor outcomes of this technique.

METHODS

The study reviewed the data of 7 patients underwent en bloc "rolled-up carpet" extensive CRS between August 2020 and April 2023. Perioperative and tumor outcomes were analyzed.

RESULTS

Seven patients underwent extensive treatment involving total peritoneal and multivisceral resection. Complete cytoreduction was successfully achieved in all patients. Six patients (85.7 %) successfully completed hyperthermic intraperitoneal chemotherapy (HIPEC). Three patients (42.9 %) had low-grade mucinous appendiceal neoplasm, while the remaining four patients (57.1 %) had high-grade. Two patients (28.6 %) experienced major morbidity, which was successfully treated, and they were discharged. There were no secondary surgery and no surgery-related mortality. During a median follow-up of 25 months (range, 12-46 months), no patient experienced recurrence. After 12 months postoperatively, the quality of life (QOL) of the 7 patients was assessed using the EORTC QLQ-C30, revealing scores similar to the reference values of the EORTC general population (p > 0.05).

CONCLUSION

En bloc "rolled-up carpet" extensive cytoreductive surgery is a feasible and safe technique for the treatment of appendiceal PMP with high tumor burden. This technique achieved complete cytoreduction with acceptable blood loss volume, operative time, and major morbidity. In short-term follow-up, no recurrence was noted, with patients having a satisfactory QOL.

Inequality in breast cancer: Global statistics from 2022 to 2050

This study evaluates the global inequalities of breast cancer incidence and mortality from 2022 to 2050 with the latest GLOBOCAN estimates. It focuses on disparities across continents, age groups and Human Development Index (HDI) levels. In 2022, Africa shows the highest positive slope values of age-standardized rates (world) of mortality vs. incidence, both for those under 40 (0.346) and those 40 and older (0.335). These values contrast with those for Asia (0.085, 0.208), Europe (0.002, -0.014), Latin America and the Caribbean (0.17, 0.303), Northern America (-0.078, -0.188), and Oceania (0.166, -0.001). In both age groups, lower HDI levels are correlated with higher slope values and vice versa. Projections to 2050 indicate significant increases in the burden of breast cancer, with persistent yet varied disparities and differences. This highlights the need for differentiated strategies in breast cancer prevention, early-stage diagnosis, and treatment.