[Remodeling midwifery by introducing sterilization in childbirth in the period of Republic of China]

In the period of the Republic of China, the maternal and infant mortality rates were high, most of which were caused by puerperal fever and neonatal tetanus. In this sense, Chinese traditional midwives were often regarded as "dirty". After western obstetrics was introduced into China in the late Qing Dynasty and the early period of the Republic of China,the occurrence of postpartum infection was effectively reduced with childbirth disinfection. To improve the health status of women and infants, the government of the Republic of China put in place measures to develop midwifery. The training of the traditional midwives was included in midwifery education. The delivery basket was used to help promote the new method of delivery and popularise the concept of sterilization of delivery. Thus, midwifery was remodeled and the remodeled midwives played an important role in family midwifery education.

[Cheng Zhifan and the Chinese Journal of Medical History]

Professor Cheng Zhifan (1922-2018), was a famous contemporary Chinese medical historian and medical history educator, who successively served as the deputy editor in chief, editor in chief and honorary editor in chief for the Chinese Journal of Medical History. He developed the Chinese Journal of Medical History into an important academic journal in the field of Chinese medical history. He had his 46 papers published in the Chinese Journal of Medical History. The papers published in his youth and middle age focused on the study of western medical history. In his later years, he shifted the focus of his research into the education of medical history and the comparative study of Chinese and Western medicine. He devoted his life to teaching and research of medical history, paid close attention to the Chinese Journal of Medical History and made an important contribution to the development of medical history.

[The progress and challenges in immunotherapy for the difficulty- to- treat liver diseases]

As a digestive organ, the liver has the functions of metabolism, synthesis, and detoxification. It is also an immune organ and plays an important role in maintaining anti-infection, autoimmune stability, and anti-tumor. In particular, the liver has unique immunological advantages. Its immune cells can maintain the liver's immune homeostasis and participate in immunoregulation. A variety of immunotherapy is used in clinical trials for the treatment of difficult and critical liver diseases. This review mainly summarizes the recent clinical trials of immunotherapy in chronic hepatitis B, cirrhosis, hepatocellular carcinoma, and autoimmune liver disease.

[The evolution and development of palliative and hospice care]

Palliative and Hospice Care initially developed in Great Britain. It was founded by Cicely Saunders for the humane care of terminally ill cancer patients and her institution was established as the first modern hospice in England. The concept developed gradually into a systematic medical program for terminal ill patients and was subsequently been generalised worldwide. The palliative and hospice care model currently in Taiwan of China is characterised by the joint participation of the government and society. This experience and knowledge is expected to contribute to the system of palliative and hospice care in the process of being established in the mainland of China.

[Orexin-A inhibits γ-aminobutyric acid current of neonatal rat spinal cord ventral horn neurons by activating OX1R, OX2R and Ca2+-independent PKC]

OBJECTIVE

To investigate the effect of orexin-A on the functionality of ionotropic γ-aminobutyric acid (GABA) receptors in spinal cord ventral horn neurons and its mechanisms.

OBJECTIVE

The spinal cord containing the lumbosacral enlargement was isolated from neonatal SD rats (7-12 days old) and sliced. The slices were digested with papain (in 0.18 g/30 mL artificial cerebrospinal fluid) for 40-60 min, and the ventral horn neurons were separated acutely using fire-polished Pasteur pipettes. After the cells adhered to the bottom of Petri dishes, patch-clamp experiments combined with pharmacological methods were performed to test the effects of orexin-A on GABA currents of the neurons treated with SB334867 (a selective OX₁R antagonist), TCSOX229 (a selective OX₂R antagonist), Bis-Ⅳ (a PKC inhibitor), PMA (a PKC agonist), Rp-cAMP (a PKA inhibitor), or BAPTA (Ca²⁺ chelator).

OBJECTIVE

The isolated neurons maintained good morphologies with diverse shapes of cell body and long protrusions. Treatment with orexin-A significantly inhibited the amplitude of GABA-induced current (P < 0.001, n=49) with an inhibition rate of (67.48±12.50)%. SB334867 and TCSOX229, when applied simultaneously, completely abolished the suppressive effect of orexin-A on the GABA currents (P=0.93, n=6), and their separate use partially relieved the suppressive effect of orexin-A (P=0.001, n=8; P=0.02, n=8). The application of Bis-Ⅳ also abolished the suppressive effect of orexin-A on GABA currents (P=0.31, n=5). PMA mimicked the effect of orexin-A in these neurons and significantly inhibited GABA currents with an inhibition rate of (60.79±10.94)%, and the application of orexin-A did not cause further suppression of GABA currents in PMA-treated neurons (P=0.15, n=6). Orexin-A was still capable of suppressing GABA currents in Rp-cAMP-treated neurons (P=0.001, n=5). The extracellular Ca²⁺-free solution (P=0.004, n=8) or the presence of BAPTA (P=0.04, n=7) did not significantly affect the inhibitory effect of orexin-A on GABA currents.

OBJECTIVE

Orexin-A inhibits GABA currents in the ventral horn neurons of rat spinal cord probably by activating OX₁R, OX₂R and Ca²⁺-independent PKC.

[Reminiscing the pioneers of modern nursing during Covid-19 epidemic: 200th anniversary of Florence Nightingale's birth]

Before Florence Nightingale, nurses lacked special skills and training. The nursing mainly relied on nurse's religious passion and feelings to carry out nursing activities, and some vulgar and ignorant women took care of the job. Nightingale, who well-educated, born in an aristocratic family, devoted herself to nursing career despite the opposition of her family. She travelled around the world to investigate the hospital and nursing status. Nightingale practiced her concept of nursing work in the Crimean war. After the investigation of the wounded soldiers, she pointed out that the high mortality rate of British soldiers was related to poor nursing. She put forward suggestions to strengthen military nursing education; then she established modern nursing education institutions and created a new nursing education model, which was the beginning of modern nursing career.

HSP90 stabilizes B-cell receptor kinases in a multi-client interactome: PU-H71 induces CLL apoptosis in a cytoprotective microenvironment

Chronic lymphocytic leukemia (CLL) is characterized by the accumulation of B cells in the hematopoietic system and lymphoid tissues. Although inhibitors targeting the B-cell receptor (BCR) pathway have been successful in the treatment of the disease, the underlying mechanisms leading to BCR over-activity in CLL are not fully understood. In this study, we found that HSP90, a highly conserved molecular chaperone, is overexpressed in CLL compared with resting B cells. HSP90 overexpression is accompanied by the overexpression of several BCR kinases including LYN, spleen tyrosine kinase, Bruton tyrosine kinase and AKT. Chemical and immune-precipitation demonstrated that these BCR constituents are present in a multi-client chaperone complex with HSP90. Inhibition of HSP90 with PU-H71 destabilized the BCR kinases and caused apoptosis of CLL cells through the mitochondrial apoptotic pathway. Further, PU-H71 induced apoptosis in the presence of stromal co-culture or cytoprotective survival signals. Finally, genetic knockdown of HSP90 and its client AKT, but not BTK, reduced CLL viability. Overall, our study suggests that the chaperone function of HSP90 contributes to the over-activity of the BCR signaling in CLL and inhibition of HSP90 has the potential to achieve a multi-targeting effect. Thus, HSP90 inhibition may be explored to prevent or overcome drug resistance to single targeting agents.

Spinal protein kinase Mζ contributes to the maintenance of peripheral inflammation-primed persistent nociceptive sensitization after plantar incision

BACKGROUND

Previous studies suggest that persistent post-surgical pain (PPSP) is correlated with preoperative pain status and amplification of central sensitization. Protein kinase Mζ (PKMζ) is an essential substrate of the late long-term potentiation underlying central sensitization, which is one mechanism of pain memory formation. However, the potential contributions of spinal PKMζ to PPSP, a condition in which preoperative pain is prevalent, are not known.

METHODS

Here, a modified 'hyperalgesia priming' model was established to simulate the clinical situation. This model used intraplantar injections of carrageenan (Car) as priming stimuli to elicit persistent nociceptive sensitization after plantar incision in rats. Upon treatment with PKMζ inhibitor ZIP, Scr-ZIP or protein kinase Cs (PKCs) inhibitor NPC-15437, altered behaviour and spinal PKMζ/PKCs expression were observed.

RESULTS

A long-lasting hypersensitivity induced by Car-priming was identified and precipitated by subsequent plantar incision in this 'two-hit' paradigm. Post-treatment with ZIP, but not Scr-ZIP and NPC-15437, after the resolution of Car-priming selectively relieved hypersensitivity. In contrast, pre-priming NPC-15437 treatment only prevented Car-induced initial transient hyperalgesia. Immunoassays showed a significant decrease in spinal PKMζ expression after plantar incision with post-priming ZIP treatment as compared with Scr-ZIP and NPC-15437, but no notable differences in PKCs expression were observed.

CONCLUSIONS

Spinal PKCs solely contribute to the initial induction of persistent pain, whereas PKMζ plays an essential role in spinal plasticity storage. PKMζ is responsible for the maintenance of peripheral inflammation-primed PPSP. Therefore, spinal PKMζ may be a therapeutic target to prevent surgery-induced chronic pain in patients with preoperative pain.

Abstract P3-13-06: A prospective phase II trial of vinorelbine plus oxaliplatin in second- or third-line metastatic triple-negative breast cancer

Purpose: Patients with metastatic triple-negative breast cancer (mTNBC) typically have a poor prognosis and limited treatment options. Previous study showed biweekly combination of vinorelbine and oxaliplatin (NVBOX) at doses of 30 mg/m2 and 90 mg/m2, respectively, is highly active and well tolerated as first-line treatment for patients with metastatic breast cancer. The purpose of this study (NCT 01528826) was to prospectively evaluate the efficacy and toxicity of NVBOX in second- or third-line mTNBC.

Methods: Eligible patients were female with 18–70 years old and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1, and had mTNBC that had progressed after 1or 2 prior chemotherapy regimens in the metastatic setting. A period of 4 weeks (NVBOX twice) was considered as one treatment cycle and the maximum cycles were 6. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective response rate (ORR), and safety.

Results: Between Dec 2011 and Nov 2012, forty-four patients were recruited [median age 47; 77.3% with viceral metastasis, 100% had been exposed to anthracyclines and/or taxanes; 56.8% cis/carbo-platin pretreated for MBC; 38.6% with time to progression (TTP) of 1-2 previous regimens before recruitment ≤ 3 months]. The overall response rate was 31.6% (1 complete response, 11 partial responses) and 10 achieved stable diseases (7 lasting more than 6 months) in 38 evaluable patients. After a median follow-up of 12.8 months, the median PFS and OS were 4.3 (95% CI, 3.6–5.0) months and 12.6 (95% CI, 8.1–17.0) months, respectively. PFS was significantly shorter in patients with disease free interval (DFI) ≤ 1year (HR = 2.10; 95% CI, 1.05–4.21; P = 0.037) and TTP of 1-2 previous regimens before recruitment ≤ 3 months (HR = 3.39; 95% CI, 1.66–6.89; P &lt; 0.001). Also, these two factors were two independent predictors for the poor OS (HR = 5.45; 95% CI, 2.08–14.32; P &lt; 0.001 and HR = 4.09; 95% CI, 1.73–9.68; P &lt; 0.001). For 34 second line patients, prior platinum in the first line was a factor significantly compromise the PFS (HR = 2.29; 95% CI, 1.03–5.10; P = 0.043). Dose adjustment happened in 14 patients (31.8%) due to adverse events (AEs). Grade 3/4 hematologic toxicities were neutropenia (70.5%), thrombocytopenia (27.3%) and anemia (15.9%). Four patients experienced febrile neutropenia. The most frequent grade 3/4 non-hematologic toxicities were constipation (20.5%) and vomiting (11.4%). Two patients developed grade 3 NVBOX-related peripheral neurotoxicity. There were no treatment-related deaths.

Conclusion: We conclude that biweekly NVBOX regimen is effective with a good safety profile in the second- or third-line mTNBC, which warrants further investigation in a phase III study.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-13-06.

Gankyrin promotes breast cancer cell metastasis by regulating Rac1 activity

Tumor metastasis is responsible for most cancer patients' deaths. Understanding the mechanism of metastasis is crucial for improving the cure rate for cancer. Here, we report that Gankyrin, a chaperone of ubiquitin-proteasome, has an essential role in breast cancer metastasis. We find that Gankyrin is highly overexpressed in human breast cancers and the expression correlates strongly with lymph node metastasis. Knocking down Gankyrin expression in highly metastatic human breast cancer cells significantly decreases cancer cell migration and invasion. Furthermore, we demonstrate that depletion of Gankyrin inhibits intrinsic Rac1 activity and induces large focal adhesions. Overexpression of Gankyrin accelerates focal adhesion turnover and increases cell migration. Notably, reduction of Gankyrin expression in mouse mammary tumor cell significantly decreases tumor metastasis to lung in animal models. Therefore, our findings suggest that Gankyrin is crucial for breast cancer metastasis and highlight the potential of Gankyrin as a therapeutic target for tumor metastasis.

Protection of xenogeneic cells from human complement-mediated lysis by the expression of human DAF, CD59 and MCP

CD59 and membrane cofactor protein (MCP, CD46) are widely expressed cell surface glycoproteins that protect host cells from the effect of homologous complement attack. cDNAs encoding human CD59 and MCP cloned from Chinese human embryo were separately transfected into NIH/3T3 cells resulting in the expression of human CD59 and MCP protein on the cell surface. The functional properties of expressed proteins were studied. When the transfected cells were exposed to human serum as a source of complement and naturally occurring anti-mouse antibody, they were resistant to human complement-mediated cell killing. However, the cells remained sensitive to rabbit and guinea pig complement. Human CD59 and MCP can only protect NIH/3T3 cells from human complement-mediated lysis. These results demonstrated that complement inhibitory activity of these proteins is species-selective. The cDNAs of CD59 and MCP were also separately transfected into the endothelial cells (ECs) of the pigs transgenic for the human DAF gene to investigate a putative synergistic action. The ECs expressing both DAF and MCP proteins or both DAF and CD59 proteins exhibited more protection against cytolysis by human serum compared to the cells with only DAF expressed alone.

[Clinical medicine of the western medicine in the 18th century]

The 18th century is an important turning point not only in human history, but also in medical history. G. B. Morgagni was an Italian who founded the organic pathology in the 18th century, which was a bridge between basic medicine and clinical medicine of western medicine. H. Boerhaave called for "paying attention to the development of clinical medicine", and under this situation, western clinical medicine was attached importance and developed again in the 18th century. However, at the same time, the mechanical materialism was also infiltrated into western clinical medicine.

[History of nephritis]

The nephritis is one of the common and detrimental diseases. This paper reviews the history of knowledge of nephritis, ancient and modern, and western and Chinese medicine, demonstrating that the continuous development of treatment of TCM and western medicine are all effective measures to combat nephritis.

Biological activity and brain actions of recombinant rat interleukin-1alpha and interleukin-1beta

IL-1alpha and IL-1beta have potent effects on the central nervous system resulting in fever, activation of the hypothalamic-pituitary-adrenal axis and behavioural depression. These effects have mainly been studied in rats, using recombinant human and mouse IL-1. Because IL-1alpha and IL-1beta show some species specificity in the potency of their biological activities, the objective of the present work was to directly compare the effects of recombinant rat IL-1alpha and IL-1beta in the rat system as a first step to dissect out the mechanisms that are involved in these effects. In vitro, recombinant rat IL-1alpha and IL-1beta bound with the same affinity as human IL-1 to the rat insulinoma Rin m5F cell line that mainly expresses type I IL-1 receptors. This binding activated IL-1 receptors, as shown by induction of the synthesis of TNF-alpha mRNA. In vivo, recombinant rat IL-1alpha and IL-1beta enhanced body temperature, increased plasma levels of corticosterone and ACTH, and depressed social behaviour. All these effects were obtained at doses 100-1,000 fold lower when IL-1 was injected centrally than when it was administered peripherally, indicating that they are centrally mediated. The relative potencies of recombinant rat IL-1alpha and IL-1beta were not the same depending on the endpoint and the route of injection, indicating that different mechanisms are likely to be involved in the various effects of IL-1 on the brain.

[Application of laparoscopic technique in gastrointestinal surgery]

OBJECTIVE

To evaluate the feasibility of gastrointestinal procedures guided by laparoscopy in 42 patients aged from 18 to 86 years.

METHODS

We performed 10 Billroth II gastrectomies, 10 resections of gastric benign tumor, 11 repairs of duodenal perforation, 2 highly selective vagotomies, 5 resections of small bowel, 3 adhesiolyses of small bowel and 1 ileocolectomy. The operations were performed under general anesthesia with endotracheal intubation and through four portals (10mm). The omentum and mesentery were mobilized with an electrocautery and vessels controlled with either Endoclip or ELC. The reconstructions of the digestive tract were performed entirely intraabdominally with ELC.

RESULTS

Except one patient receiving Billroth II gastrectomy complicated with postoperative bleeding had to be reoperated, the remaining 41 patients were successfully treated. All the 41 patients could walk and take fluids on the second postoperative day. The average length of hospitalization after operation was 7.5 days.

CONCLUSIONS

Laparoscopic gastrointestinal procedures for selected cases can be carried out safely and effectively with decreased postoperative pain and rapid recovery. It may change the surgical management of some benign gastrointestinal diseases.