Systemic immune-inflammation index as a prognostic marker in HER2-positive breast cancer patients undergoing trastuzumab therapy

The prognostic value of SII (Systemic Immune-Inflammation Index) in HER-2-positive breast cancer (BC) patients, regardless of whether they receive trastuzumab treatment, and its potential value to distinguish patients who may benefit from trastuzumab therapy, warrant further investigation. Clinical data was collected from 797 HER-2-positive BC patients between July 2013 and March 2018. Baseline data differences were adjusted with propensity score matching. Univariate and multivariate analyses explored the correlation between clinical pathological factors, SII, and DFS. Four groups were established. Based on the baseline SII values of the participants, patients who did not receive trastuzumab treatment were divided into Group 1 (Low-SII) and Group 2 (High-SII), where SII had no predictive value for prognosis between groups. Participants who received trastuzumab treatment were also divided into two groups: the Low-SII group (Group 3) and the High-SII group (Group 4). The 5-year DFS was significantly higher in Group 3 than in Group 4 (91.76% vs. 82.76%, P = 0.017). Furthermore, multivariate analysis demonstrated a significant association between high SII and shorter DFS (HR = 3.430, 95% CI = 1.830-6.420, P < 0.001). In HER-2-positive BC patients treated with trastuzumab, those with lower SII showed a longer DFS, suggesting that SII may help in identifying patients who benefit from trastuzumab therapy.

[Longdan Xiegan Decoction and its interpretation from the perspective of meridians]

By systematically examing through Longdan Xiegan Decoction in medical books of the past dynasties, it was found that the Longdan Xiegan Decoction recorded in Lan Shi Mi Cang mainly targeted men's genital odor at frist. After Xue Ji's addition and subtraction, the scope of the prescription was gradually generalized and expanded, and confusion its name, composition and source of the prescription appeared, which was particularly prominent in Jingyue Quanshu and Yifang Jijie.Doctors used to interpret this prescription from the perspective of viscera. In order to better understand the main treatment rules of Longdan Xiegan Decoction, it is necessary to change the perspective and reinterpreted it from the perspective of meridians.Attributing the symptoms of the perineum to Liver Meridian of Foot-Jueyin,hypochondriac pain, deafness and other symptoms to the Gallbladder Meridian of Foot-Shaoyang, and adding or subtracting herbs according to the specific conditions, is not only conducive to a comprehensive and in-depth understanding of the prescription to achieve accurate clinical syndrome differentiation and medication, but also prompts modern researchers to rethink the important role of meridian theory in the formation and development of the theoretical system of traditional Chinese medicine.

Prognostic value of baseline neutrophil/lymphocyte ratio in HER2-positive metastatic breast cancer: exploratory analysis of data from the CLEOPATRA trial

PURPOSE

This study aimed to evaluate the prognostic role of the baseline neutrophil/lymphocyte ratio (NLR) in HER2-positive metastatic breast cancer (MBC) patients treated with trastuzumab/pertuzumab.

EXPERIMENTAL DESIGN

Data from 780 patients from the CLEOPATRA trial and 248 local patients were collected. Patients were divided into the low and high NLR subgroups by the NLR cutoff value. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) methods were used to control bias. Associations between the NLR and progression-free survival (PFS) and overall survival (OS) were analyzed.

RESULTS

The baseline characteristics of the subgroups were well balanced after PSM and IPTW. A low baseline NLR was associated with better PFS and OS in the trastuzumab and docetaxel (TH) group in the unadjusted, PSM and IPTW models. After IPTW, a low NLR, versus a high NLR, was associated with improved PFS (HR 1.35, 95% CI 1.07-1.70, P = 0.012) and OS (HR 1.47, 95% CI 1.12-1.94, P = 0.006) in the TH group. In patients undergoing treatment with trastuzumab and pertuzumab and docetaxel (THP), a low baseline NLR was also correlated with better PFS but not OS across the three models. After IPTW, a low NLR was associated with better PFS (HR 1.52, 95% CI 1.20-1.93, P = 0.001) than a high NLR in the THP group. Multivariate analyses showed that a low baseline NLR was a predictor for PFS and OS in the TH group and for PFS in the THP group in all three models. In the real-world setting, a low baseline NLR was a predictor of better PFS among patients treated with docetaxel plus trastuzumab without or with pertuzumab in the multivariate model (P = 0.015 and 0.008, respectively).

CONCLUSIONS

A low baseline NLR is associated with better survival outcomes among HER2-positive MBC patients receiving docetaxel plus trastuzumab/pertuzumab as first-line therapy.

Tislelizumab versus chemotherapy as second-line treatment for European and North American patients with advanced or metastatic esophageal squamous cell carcinoma: a subgroup analysis of the randomized phase III RATIONALE-302 study

BACKGROUND

The phase III RATIONALE-302 study evaluated tislelizumab, an anti-programmed cell death protein 1 antibody, as second-line (2L) treatment for advanced/metastatic esophageal squamous cell carcinoma (ESCC). This prespecified exploratory analysis investigated outcomes in patients from Europe and North America (Europe/North America subgroup).

PATIENTS AND METHODS

Patients with tumor progression during/after first-line systemic treatment were randomized 1 : 1 to open-label tislelizumab or investigator's choice of chemotherapy (paclitaxel, docetaxel, or irinotecan).

RESULTS

The Europe/North America subgroup comprised 108 patients (tislelizumab: n = 55; chemotherapy: n = 53). Overall survival (OS) was prolonged with tislelizumab versus chemotherapy (median: 11.2 versus 6.3 months), with a hazard ratio (HR) of 0.55 [95% confidence interval (CI) 0.35-0.87]; HR was similar irrespective of programmed death-ligand 1 score [≥10%: 0.47 (95% CI 0.18-1.21); <10%: 0.55 (95% CI 0.30-1.01)]. Median progression-free survival was 2.3 versus 2.7 months with tislelizumab versus chemotherapy [HR: 0.97 (95% CI 0.64-1.47)]. Overall response rate was greater with tislelizumab (20.0%) versus chemotherapy (11.3%), with more durable response (median duration of response: 5.1 versus 2.1 months). Tislelizumab had a favorable safety profile versus chemotherapy, with fewer patients experiencing ≥grade 3 treatment-related adverse events (13.0% versus 51.0%). Those on tislelizumab experienced less deterioration in health-related quality of life, physical functioning, and/or disease- and treatment-related symptoms (i.e. fatigue, pain, and eating problems) as compared to those on chemotherapy, per the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and QLQ-OES18 scores.

CONCLUSIONS

As a 2L therapy for advanced/metastatic ESCC, tislelizumab improved OS and had a favorable safety profile as compared to chemotherapy in European/North American ESCC patients in the randomized phase III RATIONALE-302 study.

[A comparative study on the depth of cure, hardness and microleakage applied to primary teeth of different types of bulk-fill resins]

Objective: To compare the depth of cure, surface hardness and microleakage applied to primary teeth of three types of bulk-fill resins, so as to provide reference for clinical application. Methods: Composite resin FiltekTM Z350 XT (group A) and giomer Beautifil Ⅱ (group B) were used as controls, high-viscosity bulk-fill resin FiltekTM Bulk Fill (group C), sonic-activated bulk-fill resin SonicFill 2 (group D) and flowable bulk-fill resin SDR® flow+(group E) were studied. The microstructure of each group was observed by scanning electron microscope (SEM). Specimens of each group were prepared (6 pieces per group), and the Vickers microhardness of the surface layer and different depths of each group were measured, and then the depths of cure were calculated. Twenty-five primary molars dentin were filled by resins of each group (5 teeth per group), sliced, then aged, slices of each group were developed by silver ion staining. SEM was used to observed the distribution of silver ions. Microleakage of each group were analyzed by Jonckheere-Terpstra rank sum test. Results: SEM showed that the filler particles in groups A and C were spherical and evenly distributed. The shape of the fillers in groups B, D and E were polygonal and unevenly distributed. The surface hardness of groups A, B, C, D and E were (84.97±6.30), (65.04±5.95), (57.80±1.18), (60.77±2.34), (33.32±1.83) MPa respectively. Group A had the highest hardness, while group E was the lowest, and the differences between the two groups and other groups was statistically significant (P<0.05). There were no statistically significant differences among groups B, C, and D (P>0.05). The curing depths of groups A, B, C, D and E were 2.6, 3.4, 5.8, 3.8 and 7.8 mm respectively. The largest microleakage was found in group E [2% (1/50) for grade 0, 22% (11/50) for grade 1, 30% (15/50) for grade 2, 24% (12/50) for grade 3, and 22% (11/50)for grade 4], which was statistically different from other groups (P<0.05). No statistically significant differences were found among other 3 groups (P>0.05). Conclusions: Both high-viscosity and sonic-activated bulk-fill resins have the greater depth of cure, the same hardness and microleakage as giomer, which might be an option for restoration in primary teeth.

[The value of a nomogram for predicting the outcome of intracerebral hemorrhage based on clinical characteristics and diffusion-weighted imaging of hyperintense lesions]

Objective: To investigate the value of a nomogram predicting the outcome of intracerebral hemorrhage (ICH) based on clinical characteristics and diffusion-weighted imaging (DWI) of hyperintense lesions. Methods: A case-control study. Consecutive patients, aged 30-88(59±13) years old, with ICH were recruited at the Stroke Center of Zhengzhou People's Hospital from January 2018 to August 2021. Patients were divided into a group with DWI lesions and a group without DWI lesions depending on whether there were DWI hyperintense lesions distant from the hematoma. Prognosis was evaluated at 90 days via the modified Rankin Scale (mRS). Univariate and multivariable logistic regression models were used to identify independent predictors of a poor ICH outcome (mRS score≥4), and a nomogram model was developed. The performance of the nomogram was validated via the area under the receiver operating characteristic curve (AUC) and a calibration chart. Results: Of the 303 patients included in the study, 24.8% presented with DWI lesions; 17.5% with asymptomatic DWI lesions and 7.3% with symptomatic DWI lesions. Poor outcomes were significantly more frequent in the group with DWI lesions than in the group without DWI lesions (χ2=21.32, P<0.001). In multivariable regression analysis, age [odds ratio (OR)=1.032, 95% confidence interval (CI) 1.002-1.063, P=0.035], hematoma volume (OR=1.050, 95%CI 1.011-1.090, P=0.012), hematoma location (OR=3.839, 95%CI 1.248-11.805, P=0.019), DWI lesions (OR=3.955, 95%CI 1.906-8.206, P<0.001), and baseline NIHSS scores (OR=1.102, 95%CI 1.038-1.170, P=0.001) were independent predictors of a poor outcome. In subgroup analysis patients with asymptomatic DWI lesions had a 3-fold greater risk of a poor outcome compared to those without DWI lesions (OR=3.135, 95%CI 1.382-7.112, P=0.006), and patients with symptomatic DWI lesions had a 7-fold greater risk of a poor outcome compared to those without DWI lesions (OR=7.126, 95%CI 2.279-22.277, P=0.001). A nomogram model was established based on the independent predictors for a poor outcome. The AUC of the nomogram was 0.846 (95%CI 0.795-0.898), and a calibration chart indicated good consistency between values predicted by the nomogram and actual observed values. Conclusions: DWI lesions are an independent risk factor for a poor outcome in patients with ICH-particularly symptomatic DWI lesions. A nomogram model based on clinical characteristics and DWI lesions exhibited good efficacy when predicting the outcome of ICH.

[Research progress of the application of methacrylic anhydride gelatin hydrogel in wound repair]

Wound repair is a common clinical problem, which seriously affects the quality of life of patients and also brings a heavy burden to the society. Hydrogel-based multifunctional dressing has shown strong potential in the treatment of acute and chronic wounds. In addition to its good histocompatibility, cell adhesion, and biodegradability, methacrylic anhydride gelatin (GelMA) hydrogel has also attracted much attention due to its low cost, mild reaction conditions, adjustable physicochemical properties, and wide clinical applications. In this paper, the characteristics of GelMA hydrogel and its research progress in wound repair are introduced, and the future development of multifunctional GelMA hydrogel dressing for wound treatment is prospected.

Associations of segment-specific pulse wave velocity with vascular calcification: the Atherosclerosis Risk in Communities (ARIC) Study

Background

Pulse wave velocity (PWV) is a non-invasive measure of arterial stiffness and a predictor of cardiovascular disease (CVD). Vascular calcification, especially coronary artery calcium (CAC) measured by computed tomography (CT), is one of the strongest predictors of CVD but requires radiation for measurement. PWV may be helpful to identify persons with vascular calcification who may benefit from formal assessment of vascular calcification with CT. However, the associations between PWV and vascular calcification across different vascular beds have not been fully investigated.

Purpose

The aims of this study were to quantify the association between PWV and calcification at different segments and to explore whether PWV can identify individuals with vascular calcification beyond traditional risk factors.

Methods

Among 1486 ARIC Study participants (mean age 79.3 [SD 4.2] years), we measured PWV by OMRON VP1000plus at the following segments: heart-carotid (hcPWV), heart-femoral (hfPWV), carotid-femoral (cfPWV), heart-ankle (haPWV), brachial-ankle (baPWV) and femoral-ankle (faPWV). Participants were stratified into four groups based on quartiles of each PWV measure. Dependent (i.e., outcome) variables were high calcium score (≥75th percentile of Agatston score by CT) of the following vascular beds (including valves): coronary arteries, aortic valve ring, aortic valve, mitral valve, ascending aorta, and descending aorta. We ran multivariable logistic regression models and assessed c-statistics as a measure of prediction discrimination.

Results

Only cfPWV was significantly positively associated with high CAC (adjusted odds ratio [OR] for the highest vs. lowest quartile: 1.73 [95% CI: 1.17–2.55]) (green dot in figure). The associations were overall most evident for descending aorta calcification, with significantly positive results for hfPWV (gold dot in figure), cfPWV (green dot), haPWV (emerald dot), and baPWV (blue dot). For example, adjusted OR for the highest vs. lowest quartile of cfPWV was 4.08 (2.70–6.24). hfPWV and cfPWV were significantly associated with mitral valve calcification as well. In contrast, faPWV (purple dots) was inversely associated with calcification of aortic valve ring, ascending aorta, and descending aorta. For descending aorta calcification, even the second highest quartile of the following measures demonstrated significant adjusted OR: hfPWV (3.21 [2.11–4.95]), cfPWV (2.11 [1.40–3.20]), and baPWV (1.75 [1.14–2.69]). Simultaneously adding cfPWV and hfPWV improved c-statistic for CAC (Δc-statistic 0.011 [0.0007–0.022]) and descending aorta calcification (0.035 [0.017–0.053]).

Conclusions

The associations of PWV with vascular calcification varied substantially across segments, with descending aorta calcification most closely linked to PWV measures and cfPWV most robustly associated with calcification of multiple vascular beds. cfPWV and hfPWV, together, improved discrimination of high CAC beyond traditional risk factors.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Heart, Lung, and Blood Institute, National Institutes of Health

Tislelizumab versus chemotherapy as second-line treatment of advanced or metastatic esophageal squamous cell carcinoma (RATIONALE 302): impact on health-related quality of life

Background

RATIONALE 302 (NCT03430843) an open-label, phase III study of second-line treatment of advanced/metastatic esophageal squamous cell carcinoma (ESCC), reported that tislelizumab, relative to investigator-chosen chemotherapy (ICC), was associated with improvements in overall survival and a favorable safety profile. This study assessed the health-related quality of life (HRQoL) and ESCC-related symptoms of patients in RATIONALE 302.

Methods

Adults with advanced/metastatic ESCC whose disease progressed following prior systemic therapy were randomized 1 : 1 to receive either tislelizumab or ICC (paclitaxel, docetaxel, or irinotecan). HRQoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items (EORTC QLQ-C30), the EORTC Quality of Life Questionnaire Oesophageal Cancer Module 18 items (QLQ-OES18), and the EuroQoL Five-Dimensions Five-Levels (EQ-5D-5L) visual analogue scale. Mixed effect modeling for repeated measurements examined changes from baseline to weeks 12 and 18. The Kaplan–Meier method was used to examine time to deterioration.

Results

Overall, 512 patients were randomized to tislelizumab (n = 256) or ICC (n = 256). The tislelizumab arm maintained QLQ-C30 global health status/quality whereas the ICC arm worsened at week 12 {difference in least square (LS) mean change: 5.8 [95% confidence interval (CI): 2.0-9.5], P = 0.0028} and week 18 [difference in LS mean change: 8.1 (95% CI: 3.4-12.8), P = 0.0008]. Physical functioning (week 18) and fatigue (weeks 12 and 18) worsened less in the tislelizumab compared with the ICC arm. The tislelizumab arm improved in reflux symptoms, whereas the ICC worsened at week 12 [difference in LS mean change: −4.1 (95% CI: −7.6 to −0.6), P = 0.0229]. The visual analogue scale remained consistent in the tislelizumab arm whereas it worsened in the ICC arm. The hazard of time to deterioration was lower in tislelizumab patients compared with ICC for physical functioning and reflux.

Conclusions

HRQoL, including fatigue symptoms and physical functioning, was maintained in patients with advanced or metastatic ESCC receiving tislelizumab compared with ICC-treated patients. These results provide additional support for the benefits of tislelizumab in this patient population.

•

Global health status and HRQoL remained consistent in the tislelizumab arm whereas the ICC arm experienced worsening.

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Fatigue and physical functioning worsened in both arms; however, the worsening was greater in the ICC arm.

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The tislelizumab arm was at lower risk of reaching the threshold for worsening in physical functioning and reflux.

[Pancreas multidisciplinary team optimizes the diagnosis and treatment of pancreas-related diseases and improves the prognosis of pancreatic cancer patients]

Objectives: To evaluate the role of pancreas multidisciplinary team(MDT) clinic in the diagnosis of pancreatic diseases,patient compliance with MDT advice,and the impact of MDT on the postoperative survival of patients with pancreatic cancer. Methods: The study included 927 patients(554 males,373 females,aged (58.1±13.3)years (range: 15 to 89 years)) that had visited the pancreas MDT clinic of Zhongshan Hospital from May 2015 to December 2021,and 677 patients(396 males, 281 females, aged (63.6±8.9)years(range: 32 to 95 years)) who underwent radical surgery and with pathologically confirmed pancreatic adenocarcinoma from January 2012 to December 2020,of whom 79 patients had attended the pancreas MDT. The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. The Kaplan-Meier method was used for drawing the survival curve and calculating the survival rate. The univariate analysis was done by Log-rank test and the multivariate analysis was done by COX proportional hazards model. Survival rates were compared using χ2 test. Results: Among the 927 patients that had visited the MDT clinic,233 patients(25.1%) were referred due to undetermined diagnosis. A direct diagnosis was made in 109 cases (46.8%,109/233) by the MDT clinic, of which 98 were consistent with the final diagnosis,resulting in an accuracy of 89.9%(98/109). The direct diagnosis rate in the recent years(36.6%(41/112),from June 2019 to December 2021) decreased compared to that in the previous years(56.2%(68/121),from May 2015 to May 2019),yet the accuracy in the recent years(90.2%,37/41) was basically the same as before (89.7%,61/68). The rate of compliance of the entire cohort was 71.5%(663/927), with the compliance rate in the recent two and a half years(81.4%,338/415) remarkably higher than that in the previous four years(63.4%,325/512). Patients with pancreatic cancer that attended the MDT exhibited a trend toward longer median postoperative survival than patients that did not attend the MDT,but the difference was not statistically significant(35.2 months vs.30.2 months,P>0.05). The 1-year and 3-year survival rates of patients that attended the MDT were significanly higher than patients that did not attend the MDT(88.6% vs. 78.4%,P<0.05;32.9% vs. 21.9%,P<0.05,respectively),but the 5-year survival rate was not statistically different(7.6% vs. 4.8%,P>0.05). Conclusions: The pancreas MDT clinic is an accurate and convenient way to diagnose intractable pancreatic diseases,and in the recent years the patients' compliance rate with MDT advice has increased. Pancreatic cancer patients that have attended the MDT have higher 1-year and 3-year postoperative survival rates,but the long-term survival benefits of MDT still needs to be proved by clinical studies on a larger scale.

Prognostic Roles of Neutrophil-to-Lymphocyte Ratio and Stromal Tumor-Infiltrating Lymphocytes and Their Relationship in Locally Advanced Triple-Negative Breast Cancer Treated with Neoadjuvant Chemotherapy

Introduction

The neutrophil-to-lymphocyte ratio (NLR) and stromal tumor-infiltrating lymphocytes (sTILs) are associated with immunogenicity and prognosis of patients with triple-negative breast cancer (TNBC).

Objective

To investigated the prognostic roles of NLR and sTILs and their rela-tionship of TNBC patients treated with neoadjuvant chemotherapy (NAC).

Methods

The clinical data of 170 patients with locally advanced TNBC who received NAC from January 2010 to December 2014 were collected. The difference among variables was calculated by χ² test. The association between essential clinicopathological characteristics, pathological complete response (pCR), NLR, and sTILs with disease-free survival (DFS) was analyzed. Kaplan-Meier and Cox analysis were performed to address the effects of clinical parameters on prognosis.

Results

There was a trend that TNBC patients with lower baseline NLR (NLR1) or higher sTILs scoring would obtain a better pCR rate. NLR1 and sTILs were not associated (p > 0.05). Patients with low NLR1 or high sTILs scoring had a significantly improved DFS compared to those with high NLR1 or low sTILs scoring (p = 0.002 and p = 0.001, respectively). The increased lymphocyte count in peripheral blood after NAC was associated with the improved DFS outcome in both high and low NLR1 groups. Cox analysis revealed that NLR1 and sTILs were independent prognostic predictors of DFS outcome (p < 0.001).

Conclusion

Low NLR1 and high sTILs were associated with better DFS outcome in locally advanced TNBC patients treated with NAC. Further studies are needed to explore the connection between systemic and local inflammatory/immune markers.

CUL4A promotes proliferation and inhibits apoptosis of colon cancer cells via regulating Hippo pathway

OBJECTIVE

The aim of this study was to investigate the effect of cullin 4A (CUL4A) on the proliferation and apoptosis of colon cancer (CC) cells, and to elucidate its regulatory relationship with the Hippo pathway.

PATIENTS AND METHODS

Paired CC tissues and adjacent normal tissues were obtained from patients. CC cells were isolated and cultured in vitro. CUL4A was interfered by small interfering ribonucleic acid (siRNA) (siR-CUL4A group) or overexpressed by overexpression vector (CUL4A-Vector group), with negative control (NC)-CUL4A or CUL4A -NC as the control group. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the expression level of CUL4A in CC tissues and cells. The proliferative ability of cells was detected by cell counting kit-8 (CCK-8) assay. Flow cytometry was applied to measure the apoptosis of cells in each group. Western blotting (WB) was conducted to determine the protein expression of CUL4A. In addition, the proliferative ability was examined in vivo through subcutaneous injection of cells into nude mice.

RESULTS

QRT-PCR showed that CUL4A was highly expressed in 66.67% of CC samples (p<0.01). In vivo and in vitro proliferative ability was significantly reduced in siR-CUL4A group (p<0.01), whereas the apoptosis rate was promoted (p<0.01). However, in vivo and in vitro proliferative ability increased significantly in CUL4A-Vector group (p<0.01), while the apoptosis rate was reduced (p<0.01). The protein expressions of MST1, LATS1 and p-YAP were significantly up-regulated in siR-CUL4A group (p<0.01), while they were remarkably down-regulated in CUL4A-Vector group (p<0.05, p<0.01).

CONCLUSIONS

CUL4A is highly expressed in CC and promotes the proliferation and inhibits the apoptosis of CC cells by regulating the Hippo pathway.

A novel CD74-ROS1 gene fusion in a patient with inflammatory breast cancer: a case report

BACKGROUND

CD74-ROS1 fusion genes have been detected in non-small cell lung carcinomas (NSCLC), but not in inflammatory breast cancer.

CASE PRESENTATION

Herein, we report a CD74-ROS1 fusion gene identified in a 64-year-old Chinese woman with inflammatory breast cancer (IBC). The patient initially presented with a rapidly growing mass in the left breast with diffuse erythema developing over a period of 2 months. Diagnosis of invasive breast carcinoma was made by core needle biopsy. Positron emission tomography-computed tomography (PET/CT) demonstrated multiple organ metastases. Genomic DNA was extracted from tumor tissue and analyzed using next-generation sequencing (NGS). The CD74-ROS1 fusion gene was detected in the genomic DNA. The patient refused crizotinib treatment, and could not tolerate the side effects of palliative chemotherapy. Unfortunately, the patient died 4 months after diagnosis.

CONCLUSION

We report the case of a CD74-ROS1 fusion gene in a patient with IBC. This may reveal, for the first time, a possible association between CD74-ROS1 gene fusion and rapid progression of inflammatory breast cancer. Multigene panel testing can be performed when rapidly progressive breast cancer occurs and could reveal potential therapeutic strategies.

Setting the new FRAX reference threshold without bone mineral density in Chinese postmenopausal women

PURPOSE

Despite the large number of osteoporosis patients in China, the diagnosis and treatment rates remain low. The Fracture Risk Assessment Tool (FRAX) can be used to effectively evaluate fracture risk. In this study, we explored the Chinese-specific thresholds of FRAX without the T-score.

METHODS

In all, 264 postmenopausal women aged > 50 years were randomly recruited from community-medical centers. All subjects completed self-reported questionnaires, BMD measurements, and spinal radiographs. The 10-year hip and major osteoporotic fracture risks were calculated by FRAX. A new threshold for both 10-year hip and major osteoporotic fracture risk was explored with receiver operating characteristic (ROC) curve analysis.

RESULTS

Overall, 92 subjects were diagnosed with osteoporosis. Among them, 14 participants with T-score > - 2.5 were diagnosed with osteoporosis based on clinical fractures. ROC analysis showed the cut-off value of the 10-year hip osteoporotic fracture for detecting osteoporosis was 0.95%, while that of 10-year major osteoporotic fracture was 4.95%. The sensitivity and specificity of the 10-year hip osteoporotic fracture probability for detecting osteoporosis were 0.86 and 0.59, respectively, while the guideline-recommended threshold had a sensitivity of 0.49 and specificity of 0.83. The sensitivity and specificity of the 10-year major osteoporotic fractures with the new threshold were 0.76 and 0.69, respectively, while the recommended threshold had a sensitivity of 0 and specificity of 1.

CONCLUSION

Current guideline-recommended FRAX thresholds without BMD showed low sensitivity. Therefore, 10-year osteoporotic hip fracture probability ≥ 0.95% and 10-year osteoporotic major fracture probability ≥ 4.95% are recommended as the new thresholds.

The association between vitamin D receptor gene polymorphism and susceptibility to hypertension: a meta-analysis

OBJECTIVE

Current studies reporting the association between VDR polymorphisms and susceptibility to hypertension are controversial. This meta-analysis aims to obtain a precise correlation estimate between VDR polymorphisms and susceptibility to hypertension.

MATERIALS AND METHODS

Relevant studies were searched in PubMed, Web of Science, CNRI, Wanfang, and VIP using the keywords as "Vitamin D receptor, hypertension", "Vitamin D receptor polymorphism, hypertension", and "VDR, hypertension". ORs and corresponding 95%CI of eligible studies were calculated using RevMan5.3 and STATA12.0.

RESULTS

Seven independent studies reporting the association between VDR gene polymorphisms and hypertension were enrolled. VDR rs1544410 (BsmI) was associated with susceptibility to hypertension. The frequency of VDR BsmI AA genotype decreased in hypertension patients compared with healthy controls. The population carrying VDR BsmI AA genotype had lower susceptibility to hypertension relative to those carrying GA or GG genotype (OR = 0.69, 95% CI = 0.54-0.89, p = 0.005). Meanwhile, the frequency of A allele was higher in the case group than that of control group (OR = 0.83, 95% CI = 0.69-0.99, p = 0.04). No significant correlation was found between VDR FokI or VDR ApaI with susceptibility to hypertension.

CONCLUSIONS

VDR BsmI gene polymorphism is closely related to the susceptibility to hypertension.

Low-dose CT of paediatric paranasal sinus using an ultra-low tube voltage (70 kVp) combined with the flash technique

AIM

To evaluate the radiation dose and diagnostic image quality of low-dose computed tomography (CT) of the paranasal sinus in children, with acquisition at an ultra-low tube voltage (70 kVp) combined with the Flash technique.

MATERIALS AND METHODS

Eighty paediatric patients underwent CT of the paranasal sinus and were divided into two groups according to different protocols (group A: 80 kVp protocol with conventional spiral mode [n=40] and group B: 70 kVp protocol with Flash scan mode [n=40]). For each examination, the CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED) were estimated. The image noise, signal-to-noise ratio (SNR), and overall subjective diagnostic image quality were also evaluated.

RESULTS

For radiation dose, the CTDIvol (mGy), DLP (mGy·cm), and ED (mSv) values of the 70 kVp protocol were significantly lower than those of the 80 kVp protocol (CTDIvol: 1.57±0.009 versus 0.39±0.004 mGy, p<0.001; DLP: 19.88±2.01 versus 6.31±0.52 mGy·cm, p<0.001; ED: 0.079±0.016 versus 0.024±0.005 mSv, p<0.001). Compared with those of the 80-kVp protocol, the image noise increased by 40.7% (p=0.113), the SNR_soft-tissue decreased by 48.9%, and the SNR_bone increased by 10.1% with the 70-kVp protocol (p=0.176 and 0.227, respectively). There was no significant difference in the overall subjective image quality grades between these two groups (p=0.15).

CONCLUSION

When imaging the paranasal sinus in children, an ultra-low tube voltage (70 kVp) combined with the Flash CT technique can reduce the radiation dose significantly while maintaining diagnostic image quality with clinically acceptable image noise.

The expression of overexpressed PTEN enhanced IR-induced apoptosis of myocardial cells

OBJECTIVE

Myocardial cell apoptosis is an important pathologic basis of ischemia-reperfusion injury (I/R). PI3K/Akt signaling pathway involves in cell growth, survival, and apoptosis regulation, thus playing an important role in the protection of I/R injury. PTEN is a negative regulatory factor of PI3K/Akt signaling pathway. This study established rat I/R injury model after AMI and myocardial cell I/R injury model to explore the regulatory role of PTEN-PI3K/Akt signaling pathway in myocardial I/R injury in vivo and in vitro.

MATERIALS AND METHODS

Rat myocardial I/R injury model was established. PTEN and p-Akt expressions in myocardial tissue were compared. H9C2 cells were incubated in I/R condition for 12 h, followed by reoxygenation for 12 h. H9C2 cells were divided into three groups, including I/R+pSicoR-Blank, I/R+pSicoR-PTEN, and I/R+pSicoR-PTEN+VO-Ohpic. PTEN, p-Akt, Bcl-2, and Bax expressions were detected. Cell apoptosis was measured by flow cytometry.

RESULTS

PTEN expression significantly increased, while p-Akt level markedly declined in myocardial tissue in I/R group compared with Sham group. Temporary PTEN downregulation and p-Akt elevation appeared at 2 h after I/R. I/R treatment markedly enhanced PTEN and Bax expressions, increased cell apoptosis, and reduced p-Akt and Bcl-2 levels. PTEN overexpression significantly enhanced Bax expression and cell apoptosis, while declined p-Akt and Bcl-2 in H9C2 after I/R. PTEN inhibited by VO-Ohpic markedly downregulated p-Akt and Bcl-2 expressions, whereas reduced Bax level and cell apoptosis.

CONCLUSIONS

The overexpression of PTEN aggravated myocardial cell apoptosis after I/R. The blockage of PTEN enhanced PI3K/Akt signaling pathway and attenuated cell apoptosis induced by I/R.

The expression of overexpressed PTEN enhanced IR-induced apoptosis of myocardial cells

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "The expression of overexpressed PTEN enhanced IR-induced apoptosis of myocardial cells, by Y.-B. Zhu, N. Ding, H.-L. Yi, Z.-Q. Li, published in Eur Rev Med Pharmacol Sci 2019; 23 (10): 4406-4413-DOI: 10.26355/eurrev_201905_17948-PMID: 31173315" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/17948.

[Clinical and genetic characteristics of children with STXBP1 encephalopathy]

Objective: To investigate the clinical and genetic characteristics of developmental and epileptic encephalopathy (DEE) caused by syntaxin-binding protein 1 (STXBP1) gene mutation. Methods: The clinical data, gene variation and treatment outcome of 15 children with STXBP1 encephalopathy admitted to Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2014 to June 2019 were analyzed retrospectively. Results: Among 15 patients, 11 were male and 4 were female, age ranged from 2 months to 69 months. The clinical manifestations of 14 children were epilepsy and developmental delay (DD) and the remaining one showed developmental delay without seizure. The onset age of epilepsy ranged from two days to 19 months and 11 of them experienced the first attack before 1 year of age. The common seizure types were epileptic spasms and tonic seizures. Seven patients were diagnosed with Ohtahara syndrome or West syndrome. Epileptic form discharges were observed in the interictal electroencephalograms (EEG) of 11 patients, including multifocal discharges, suppression-burst and hypsarrhythmia. The brain magnetic resonance imaging of 7 children were abnormal, including myelin dysplasia, less white matter, lack of corpus callosum or hypoplasia. The follow-up time ranged from 2 months to 57 months, after the last follow-up, 3 cases were seizure free, 6 children showed partial response and the other 5 patients had no response on multitherapy. Six of 8 patients showed good responses to levetiracetam (LEV) monotherapy or in combination with other antiepileptic drugs (AEDs). Vigabatrin (VGB) was applied to 5 patients with epileptic spasms and 4 of them showed response. All patients showed different degrees of developmental delay while four of them showed autistic features. STXBP1 gene mutations were identified in all cases and there were 15 types of gene variations, including 8 missense mutations, 1 nonsense mutation, 5 frame shift mutations and 1 complex mutation. Five novel mutations were unreported before, including c.1193A>G, c.172delG, c.1769C>T, c.1038_1039delCC, c.348_351dupTGAA. Conclusions: Development delay and epilepsy are the major and independent clinical phenotypes in children with STXBP1 encephalopathy. The variation of STXBP1 gene is mainly de novo. Levetiracetam and vigabatrin may be more effective in epilepsy control than other AEDs.

Roles of neutrophil/lymphocyte ratio in prognosis and in differentiation of potential beneficiaries in HER2-positive breast cancer with trastuzumab therapy

Background

The relationship of neutrophil/lymphocyte ratio (NLR) to prognosis of HER2-positive breast cancer (BC) is not well studied. We aimed to assess the prognostic role of NLR in HER2-positive BC patients treated with or without trastuzumab.

Methods

The clinical data of 843 HER2-positive BC patients from July 2013 to July 2018 were collected. The difference among variables was calculated by chi-square test. The associations between clinicopathological factors, NLR and disease-free survival (DFS) were analyzed by univariate and multivariate analyses.

Results

Patients were divided into three groups. In group 1 containing 255 patients without trastuzumab treatment, pretreatment NLR showed no predictive value. Patients with trastuzumab treatment were divided into two groups on equal, according to pretreatment NLR values, low NLR (group 2) and high NLR (group 3). Patients in group 2 showed significantly higher 3-year DFS rate than patients in group 1 and group 3 (95.3% vs. 91.6% vs. 90.5%, respectively, P = 0.011); patients in the group 1 and group 3 had a similar 3-year DFS outcome. Multivariate analysis showed high pretreatment NLR was significantly associated with shorter DFS (HR = 2.917, 95% CI = 1.055–8.062, P = 0.039) in HER2-positive BC patients treated with trastuzumab.

Conclusions

Among HER2-positive trastuzumab-treated BC patients, low pretreatment NLR value was associated with better DFS, and it might help to differentiate potential beneficiaries of trastuzumab treatment.

Platelet/Lymphocyte Ratio Is Superior to Neutrophil/Lymphocyte Ratio as a Predictor of Chemotherapy Response and Disease-free Survival in Luminal B-like (HER2-) Breast Cancer

BACKGROUND

The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been associated with the prognosis in breast cancer (BC). The relationship of the NLR and PLR with chemotherapy sensitivity and prognosis in luminal B-like (human epidermal growth factor receptor 2-negative [HER2^-]) BC are not well studied.

PATIENTS AND METHODS

The clinical data from 980 patients with luminal B-like (HER2^-) BC from June 2012 to June 2016 were collected. The differences among the variables were calculated using the χ² test. The associations among the clinicopathologic factors, pretreatment NLR, pretreatment PLR, and disease-free survival (DFS) were analyzed using Kaplan-Meier curves and Cox analyses.

RESULTS

The median follow-up was 37 months (range, 5-77 months). For the 480 patients who had received neoadjuvant chemotherapy, low pretreatment PLR values were associated with higher pathologic complete response (pCR) rates compared with the high PLR group (15.8% for low vs. 9.2% for high PLR group; P = .027). Multivariate analyses showed that larger tumors, a greater number of lymph nodes involved, a high Ki-67 score, and a high PLR were independent prognostic factors of worse outcomes for the patients with luminal B-like (HER2^-) BC. The risk of metastasis and/or recurrence was greater for the high PLR group than for the low PLR group (hazard ratio, 1.576; 95% confidence interval, 1.039-2.390; P = .032). The pretreatment NLR showed no such associations among this cohort of patients.

CONCLUSIONS

The results of the present study have shown that the pretreatment PLR is superior to the NLR as a predictor of pCR and DFS outcomes in patients with luminal B-like (HER2^-) BC. A low pretreatment PLR was associated with higher pCR rates after neoadjuvant chemotherapy and was an independent predictive factor for better DFS outcomes among patients with luminal B-like (HER2^-) BC.

Inflammation induced by incomplete radiofrequency ablation accelerates tumor progression and hinders PD-1 immunotherapy

Radiofrequency ablation (RFA) promotes tumor antigen-specific T cell responses and enhances the effect of immunotherapy in preclinical settings. Here we report that the existence of remnant tumor masses due to incomplete RFA (iRFA) is associated with earlier new metastases and poor survival in patients with colorectal cancer liver metastases (CRCLM). Using mouse models, we demonstrate that iRFA promotes tumor progression and hinders the efficacy of anti-PD-1 therapy. Immune analysis reveals that iRFA induces sustained local inflammation with predominant myeloid suppressor cells, which inhibit T cell function in tumors. Mechanistically, tumor cell-derived CCL2 is critical for the accumulation of monocytes and tumor-associated macrophages (TAMs). The crosstalk between TAMs and tumor cells enhances the CCL2 production by tumor cells. Furthermore, we find that administration of a CCR2 antagonist or the loss of CCL2 expression in tumor cells enhances the antitumor activity of PD-1 blockade, providing a salvage alternative for residual tumors after iRFA.

Radiofrequency ablation is used to treat metastatic colorectal cancer. In this study, the authors show that incomplete ablation of tumours results in metastases and show in mouse models that the chemokine CCL2 recruits myeloid cells to the partially ablated tumours, which can block T cell function.

MicroRNA-194 participates in endotoxemia induced myocardial injury via promoting apoptosis

OBJECTIVE

To investigate the expression level of microRNA-194 in myocardial injury induced by lipopolysaccharide (LPS) and its underlying mechanism.

MATERIALS AND METHODS

LPS-induced H9c2 cardiomyocytes injury model was established. The expression level of microRNA-194 at different treatment time points was detected. Survival and apoptosis of cardiomyocytes were detected after overexpression or knockdown of microRNA-194. The target genes of microRNA-194 were predicted by bioinformatics analysis. The relationship between microRNA-194 and target genes was verified by the dual luciferase reporter analysis and Western blot. The effects of microRNA-194 mimics and overexpression plasmid pcDNA3/Slc7a5 on the cardiomyocyte apoptosis were investigated by MTT assay. Expressions of relative genes involved in Wnt/β-catenin pathway during the process of LPS-induced cardiomyocytes injury were detected by qRT-PCR and Western blot.

RESULTS

The expression level of microRNA-194 was increased in LPS-induced H9c2 cardiomyocytes injury model in a time-dependent manner. Overexpressed microRNA-194 directly bound to the target gene Slc7a5 and inhibited its expression. Transfection of microRNA-194 mimics increased apoptosis of H9c2 cells, which was rescued by overexpression of pcDNA3/Slc7a5. MicroRNA-194 was capable of promoting cardiomyocyte apoptosis by activating Wnt/β-catenin pathway.

CONCLUSIONS

MicroRNA-194 promotes cardiomyocyte apoptosis and participates in myocardial injury induced by endotoxemia via activating Wnt/β-catenin pathway.

Association on polymorphisms in LncRNA HOTAIR and susceptibility to HNSCC in Chinese population

OBJECTIVE

More and more evidence has shown that the critical functions of long non-coding RNA (lncRNA) polymorphism in the carcinogenicity mechanism of a variety of cancers. The association between lncRNA HOX transcript antisense intergenic RNA (HOTAIR) polymorphism and the risk of head and neck squamous cell carcinoma (HNSCC) in Chinese population has not been reported. To investigated the effects of HOTAIR polymorphism on cancer susceptibility, the influence of HOTAIR variants on the risk of HNSCC was analyzed in this study.

PATIENTS AND METHODS

In this case-control study, the tagging SNPs (rs874945, rs4759314, and rs7958904) in HOTAIR gene were genotyped in Chinese population consisting of 366HNSCC cases and 732 controls.

RESULTS

It was found that rs4759314 was associated with a significantly increased risk of HNSCC in Chinese population [GG vs. AA: adjusted odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.01-1.50; additive model: OR = 1.21, 95%CI = 1.01-1.46]. However, there were no significant associations of rs874945 and rs7958904 with HNSCC risk.

CONCLUSIONS

HOTAIR rs4759314 may influence HNSCC susceptibility and serve as a diagnostic biomarker.

[Quantitative study on the development of fetal ventricles and cisterna magna in second and third trimesters with MRI]

Objective: To analyze the changes of growth and development of normal fetal ventricles and cisterna magna with gestational age(GA) and the correlation with fetal gender in the second and third trimester,and establish the MR prenatal diagnosis reference standards. Methods: A total of 633 fetuses (mean GA (27.0±4.1) weeks (18.9-40.6 weeks))without central nervous system abnormalities were retrospectively collected from the Obstetrics and Gynecology Hospital of Fudan University from June 2012 to August 2017. The lateral ventricle trigonometric width (LVTW), third ventricle width (TVW), fourth ventricle width (FVW), anterior-posterior diameter of the fourth ventricle(APDFV), cavum septum pellucidum width (CSPW) and cisterna magna width (CMW) were obtained in the standard measure planes on MR image.The correlation between the biometrics and GA and the correlation between the biometrics and fetal gender were analyzed respectively, and the normal reference values of the biometrics were calculated. Spearman correlation analysis, Pearson correlation analysis,linear regression analysis, independent samples t-test and paired samples t-test were used for statistic analysis. Results: (1)Fetal LLVTW,RLVTW,TVW,CSPW and CMW in second and third trimesters were correlated with GA at medium and low levels(the correlation coefficient r were 0.311, 0.277, 0.207, 0.226, 0.295, respectively, all P<0.01). FVW and APDFV were statistically correlated with GA, and the linear regression equations were as follows: y=0.022×GA-0.043 (adjusted R(2)=0.642); y=0.018×GA-0.159 (adjusted R(2)=0.690). (2)Fetal LLVTW,RLVTW,FVW,APDFV and CSPW were not correlated with fetal gender in second and third trimesters(r=-0.078,-0.057,-0.087,-0.004 and 0.024, P=0.124,0.258,0.085,0.931 and 0.618, all P>0.05). TVW and CMW were statistically correlated with fetal gender(r=-0.310, -0.180, P=0.000, 0.006, all P<0.05). (3) The mean values of LLVTW and RLVTW were (0.71±0.13) cm and (0.68±0.13) cm, respectively, and significant difference was found between them(t=3.180, P=0.002). The mean value of CSPW was (0.59±0.15) cm. And the mean values of male and female fetuses for TVW and CMW were (0.17±0.05) cm, (0.16±0.06) cm and (0.68±0.15) cm, (0.58±0.15) cm, respectively. The corresponding prenatal MRI diagnostic criteria were as follows: LLVTW 1.1 cm, RLVTW 1.0 cm, CSPW 1.0 cm, TVW 0.3 cm, CMW (male 1.1 cm, female 1.0 cm). Conclusions: The normal fetal ventricles and cisterna magna are increased with the GA in the second and third trimesters. TVW and CMW are related to fetal gender. The establishment of normal reference values of fetal ventricles and cisterna magna based on GA and fetal gender are conducive to enhance the accuracy of MRI prenatal diagnosis.

[Efficacy of magnetic levitation elastic mandibular elevator in treatment of mild or moderate obstructive sleep apnea]

Objectives: To investigate the clinical efficacy of magnetic levitation elastic mandibular elevator (MLEME) in treatment of mild obstructive sleep apnea (OSA). Methods: Twenty one patients with mild or moderate OSA confirmed by polysomnographic (PSG) examination were recruited from the First Affiliated Hospital with Nanjing Medical University between June of 2016 and June of 2017. Their PSG parameters, daytime Epworth sleepiness score (ESS) were compared before and on treatment of MLEME. In addition, any side effects and discomfort were observed during MLEME treatment. Results: Comparison of parameters during and before MLEME treatment revealed a significant decrease (all P<0.05) in apnea hypopnea index [(9.3±6.2) vs (15.6±7.8)/h], arousal index [(6.2±3.4) vs (10.3±5.4)/h], percentage of sleep time with less than 90% oxygen saturation (3.9%±2.7% vs 9.8%±3.5%), daytime ESS (6.3±2.3 vs 11.2±2.8); but a remarkable increase (all P<0.05) in mean and minimal pulse oxygen saturation (97.2%±0.9% vs 94.7%±1.1% and 87.6%±2.8% vs 81.7%±4.6% respectively). All patients could tolerate MLEME treatment well with no complain of discomfort. Following wearing of MLEME, X-ray lateral film of head and neck revealed a significantly longer distance than that before MLEME treatment from tip of uvula to posterior pharyngeal wall [(11.9±1.8) vs (9.6±1.5) mm](P<0.05). Conclusions: MLEME could significantly improve sleep respiratory parameters and daytime sleepiness of OSA without side effects. Its long-term efficacy for OSA remains to be further explored.

[The study of pleural effusion supernatant cell-free tumor DNA in tumor mutational burden assessment of advanced lung cancer]

Objective: To evaluate the feasibility of cell-free tumor DNA in pleural effusion supernatant for assessing the tumor mutational burden (TMB) of advanced lung cancers. Methods: From December 2016 to August 2018, 34 lung cancer patients (19 males and 15 females) with pleural effusion were enrolled at Zhongshan Hospital, Fudan University. The median age of the patients was 65 (range, 34-85) years. Before systemic or local antitumor therapy, tumor specific mutations in tumor tissue, pleural effusion supernatant, pleural effusion sediment, and plasma samples from these patients were examined using targeted next-generation sequencing, and TMB levels were calculated respectively. Subgroup analysis was based on smoking history and driver mutation status. Statistical differences were determined using SPSS 16.0 software, and individual groups were compared using the one-way analysis of variance (ANOVA) and LSD-t test. Results: The median TMB level of pleural effusion supernatant was 6.23 mutations/Mb, similar to that of tumor tissue (6.23 vs 6.86 mutations/Mb, t=1.174, P=0.245), but significantly higher than that of pleural effusion sediment (2.49 mutations/Mb, t=3.044, P=0.003) and plasma (2.49 mutations/Mb, t=2.464, P=0.016). Compared with tumor tissue in TMB assessment, pleural effusion supernatant had a positive percentage agreement of 52% (9/17), and a negative percentage agreement of 65% (11/17). Subgroup analysis showed that the TMB level was higher in smokers (n=11) than that in non-smokers (n=23, 14.4 vs 5.4 mutations/Mb, t=3.238, P=0.003). Conclusion: For advanced lung cancer patients with pleural effusion, pleural effusion supernatant is a promising substitute to tumor tissue for TMB assessment, which is a potential biomarker for immunotherapy.

MicroRNA-378 promotes the malignant progression of oral squamous cell carcinoma by mediating FOXN3

OBJECTIVE

This study aimed to detect the expression of microRNA-378 in OSCC, and further studies its effects on clinicopathology and prognosis of OSCC patients.

PATIENTS AND METHODS

Real-Time quantitative Polymerase Chain Reaction (RT-qPCR) was used to detect the expression levels of microRNA-378 in 96 pairs of OSCC tissues and paracancerous tissues. The relationship between microRNA-378 expression and pathological parameters and prognosis of OSCC patients was analyzed. The expression level of microRNA-378 in OSCC cells was detected by RT-qPCR as well. Also, microRNA-378 knockdown expression model was constructed using small interfering RNA in OSCC cell lines CAL-27 and Tca8113. Biological functions of OSCC cells were determined using cell counting kit-8 (CCK-8), colony formation, and transwell assay. Western blot was conducted to detect the protein expression of FOXN3 in OSCC cells.

RESULTS

RT-qPCR results showed that the expression level of microRNA-378 in OSCC tissues is remarkably higher than that in paracancerous tissues. Compared with OSCC patients with lower expression of microRNA-378, patients with higher expression of microRNA-378 had higher incidences of lymph node metastasis and distant metastasis, as well as shorter overall survival. MicroRNA-378 knockdown significantly decreased proliferative, invasive, and metastatic abilities of OSCC cells. Western blot results showed that microRNA-378 downregulates FOXN3 expression in OSCC cells. Rescue experiments found that microRNA-378 could regulate FOXN3, thus promoting the malignant progression of OSCC.

CONCLUSIONS

MicroRNA-378 is highly expressed in OSCC, which is significantly associated with tumor staging, distant metastasis, and poor prognosis of OSCC. It is shown that microRNA-378 may promote malignant progression of OSCC by regulating FOXN3.

EIF2A promotes cell survival during paclitaxel treatment in vitro and in vivo

The integrated stress response (ISR) is critical for cancer cell survival during stress stimuli and has been implicated in the resistance to cancer therapeutics, in which the mechanism, however, is poorly understood. Here, we showed that paclitaxel, the major chemotherapy drug for breast cancer, induced ISR and phosphorylated ser51 residue of EIF2S1 by EIF2AK3 and EIF2AK4. When exposed to paclitaxel, cancer cells activated the EIF2AK3/EIF2AK4-pEIF2S1-ATF4 axis and maintained redox homoeostasis by inducing expression of the major antioxidant enzymes HMOX1, SHMT2 and SLC7A11. Paclitaxel-mediated cell death was significantly increased following loss of ISR or ATF4 expression. This sensitizing effect could be partially rescued by Trolox, a ROS scavenger. We demonstrated that the alternative initiation factor EIF2A was essential for cancer cell survival after paclitaxel-mediated ISR both in vitro and in vivo. Moreover, patients with breast cancer exhibited higher ISR after chemotherapy, and the elevated mRNA levels of HMOX1, SHMT2 and EIF2A were correlated with poor prognosis. Collectively, our findings reveal a novel mechanism for paclitaxel resistance and suggest that targeting EIF2A combined with ISR agonist may be a potential treatment regimen to overcome drug resistance for breast cancer.

[The concomitant gene alterations impact the therapeutic efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors in advanced non-small cell lung cancer patients with epidermal growth factor receptor sensitive mutation]

Objective: To investigate if concomitant gene alterations impact the therapeutic efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) in advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) sensitive mutation. Methods: From November 2016 to December 2017, 51 patients (19 males and 32 females, age 37-85 years) with histology or cytology diagnosed,locally advanced or metastatic NSCLC from Zhongshan Hospital Fudan University were prospectively recruited in the study. All patients harboring EGFR sensitive mutation detected by a 123 lung cancer specific gene panel of next-generation sequencing(NGS) analysis were under treatment of EGFR-TKIs. Multi-factors analysis of the correlation between EGFR-TKIs efficacy and concomitant gene alterations were analyzed by multivariate Cox regression model. Results: 82% of the NSCLC patients with EGFR mutation presented concomitant gene alterations with an average number of 2.1. Patients not harboring concomitant gene alterations had a longer median progression free survival (mPFS: not reached vs 8.8 m, P=0.008). Those who had less than 2 concomitant genes had a higher objective response rate[ORR: 52% (17/33) vs 33% (6/18) , P=0.251]and better mPFS (13.8 vs 8.0 m, P=0.003). The top 3 concomitant gene alterations were TP53 gene mutation(55%, 28/51), EGFR gene amplification (26%, 13/51) and RB1 gene mutation (18%,9/51) respectively. The mPFS of EGFR-TKI treatment in patients with either one of these 3 concomitant genes was 8.0, 8.0, and 6.0 months respectively, significantly shorter than those without one of the 3 gene alterations (13.8, 13.1, and 10.8 months respectively). Multivariate Cox regression revealed that concomitant gene abnormalities (P=0.036) and accompanied by RB1 gene mutation (P=0.025) were independent risk factors for the survival benefit of EGFR-TKI in the treatment of advanced NSCLC with EGFR-sensitive mutation. Conclusions: The efficacy of EGFR-TKI decreased significantly in advanced NSCLC with EGFR-sensitive mutation who had concomitant gene abnormalities, especially accompanied by more than 2 of the 3 gene alterations (TP53 gene mutation, EGFR gene amplification or RB1 gene mutation). This study suggested that the concomitant gene alterations should be an important issue for consideration when applying a personalized combination therapy for advanced NSCLC harboring EGFR sensitive mutation.

Yes-associated protein expression in paired primary and local recurrent breast cancer and its clinical significance

Yes-associated protein (YAP) protein acts as tumorigenic factor in many solid tumors, but the situation in breast cancer is under debate. Here, we would analyze its status in breast cancer. YAP expression in the 110 primary breast cancer and their paired local recurrent tumors was investigated. Clinicopathologic data for age, histologic grading, hormone status, lymph nodes and HER2 status were also gathered and analyzed. 46.4% (51/110) primary breast cancer tissues were positive for total YAP expression which was significantly higher than that in the recurrent tissues (10.9%; P < 0.05). The expression of total YAP protein in the primary breast cancer tissues was positively associated with the tumor size, especially in triple negative breast cancer (TNBC) subtype (P < 0.05). Higher total or nuclear YAP expression in the primary tumor was correlated with poor disease-free survival among patients with TNBC (P < 0.05). In the multivariate models, nuclear YAP expression was an independently prognostic factor in TNBC. High total or nuclear YAP expression predicts poor prognosis among patients with TNBC. It might be a therapeutic target for TNBC in the future.

Genetic diversity, population structure and phylogenetic relationships of three indigenous pig breeds from Jiangxi Province, China, in a worldwide panel of pigs

Dongxiang Spotted, Pingxiang Two-End-Black and Yushan Black pigs are three indigenous breeds in Jiangxi Province, China, that have been listed in the national conservation program for Chinese indigenous livestock germplasm. Here, we investigated the genetic diversity and population structure of the nucleus populations of these three breeds in a worldwide context of European and Chinese pigs using Illumina Porcine 60K chips. Our data indicate that Dongxiang Spotted and Yushan Black pigs have recently experienced severe inbreeding. The two breeds show large runs-of-homozygosity values, long-range extents of linkage disequilibrium and reduced observed heterozygosity. In contrast, Pingxiang Two-End-Black pigs are rich in genetic diversity and have few inbred individuals. Both phylogenetic and admixture analyses illustrate that Dongxiang Spotted and Yushan Black pigs are genetically close to their geographical neighbors in East China and that Pingxiang Two-End-Black pigs have a close relationship with three other Two-End-Black breeds in central China. Finally, we reconstructed the family structures of the three breeds and propose a reliable breeding strategy to better conserve these breeds.

[Lentivirus media miR-1246 knockdown inhibits tumor growth and promotes apoptosis of SiHa cells]

Objective: To study the effect of lentivirus-mediated microRNA (miR) -1246 RNA interference (RNAi) on biological characteristics and behaviors in cervical cancer cells as well as to identify the downstream signaling pathways affected. Methods: MiR-1246 specific cDNA was synthesized and cloned into the recombinant lentiviral vector (LV-miR-1246-inhibitor) . The SiHa cells were devided into three groups: no viral infection (negative control, NC) , infection with control virus (LV-NC) , and infection with miR-1246-inhibitor virus (LV-miR-1246-inhibitor) . The expression of the miR-1246 was detected by reverse transcription (RT) -PCR. Cell growth was analyzed by cell counting kit 8 (CCK-8) assay. The invasion was dectected by transwell matrige gel. Cell apoptosis was detected by flow cytometer. The growth of xenograft tumors was also investigated. Expression of thrombospondin-2 (THBS2) , matrix metalloproteinase (MMP) 2, 9 were also evaluated in the cells. Results: (1) The expression level of miR-1246 in SiHa cells (0.11±0.13) was significantly lower in group LV-miR-1246-inhibitor than those in the group LV-NC and the group NC (1.14±0.86 and 1.30±0.73, respectively; P<0.01) . (2) The proliferation of SiHa was also markedly suppressed in CCK-8 at 96 hours (P<0.01) . (3) The number of group LV-miR-1246-inhibitor was significantly less than those in the LV-NC and NC groups in transwell invasion assay (71±4, 162±5 and 188±5, respectively; P<0.01) . (4) The apoptosis rate of SiHa cells in the group LV-miR-1246-inhibitor [ (16.10±3.37) %] was significantly lower than those of group LV-NC and group NC [ (5.67±0.89) % and (1.78±0.08) %,P<0.01]. (5) The tumor volume in the nude mice group LV-miR-1246-inhibitor [ (287±59) mm(3)] was significantly lower than those in the LV-NC and NC groups [ (571±137) and (657±144) mm(3), respectively; P<0.01]. (6) Compared with the LV-NC group and the NC group, THBS2 protein expression in the tumor tissue of the nude mice in the group LV-miR-1246-inhibitor was significantly increased (P<0.05) , while the expression levels of MMP-2 and MMP-9 protein were significantly decreased (P<0.01) . Conclusion: These results suggest that miR-1246 functions during cervical cancer pathogenesis and tumor formation via the THBS2, MMP signaling pathway.

[The expression and role of PLUNC, TLR2 and NF-κB in nasal polyps]

Objective:To investigate the expression of palate, lung, nasal epithelium clone (PLUNC), Tolllike receptor 2 (TLR-2) and nuclear factor-Kappa B (NF-κB) in nasal polyps tissues and normal inferior turbinate mucosa. To analysethe correlation of their expression and to provide a new treatment of nasal polyps.Method:The specimens were divided into two groups: nasal polyps tissues group (n = 46) and normal inferior turbinate mucosa group (n = 19). EOS and others inflammatory cells was detected by HE staining. performing immunohistochemistry, we investigated the expression and distribution of PLUNC, TLR2 and NF-κB. Meanwhile we evaluated the positive expression and correlation of PLUNC, TLR2 and NF-κB between experimental group and control group. All data were processed by using SPSS 21.0 software.Result:EOS infiltration was significantly higher than the control group (P< 0.05). The expression level of PLUNC in experimental group is significantly lower, there is a statistical significance (P< 0. 05). The expression of TLR2 and NF-κB in experimental group is obviously higher than the control group, with statistical significance (P< 0.05). Spearman correlation analysia showed that PLUNC in experimental group is negatively correlated with TLR2 and NF-κB (r= －0.675, r= －0.550, P< 0.05). TLR2 is positively correlated with NF-κB (r= 0.540, P< 0.05). EOS infiltration degree positive correlation with TLR2 and NF-κB exist (r= 0.417, r= 0.470, P< 0.05), degree negative correlation with PLUNC exist (r= －0.859, P< 0.05).Conclusion:PLUNC expression in nasal polyps is lower than the normal inferior turbinate group. TLR2 and NF-κB expression in nasal polyps are higher than the normal inferior turbinate group.suggesting that the formation of nasal nolyps may be associated with lower natural immunity and the existing of infectious agents.

Analysis of correlation between the mild cognitive impairment (MCI) and level of adiponectin in elderly patients with type 2 diabetes mellitus (T2DM)

OBJECTIVE

To investigate the correlation between the mild cognitive impairment (MCI) and serum level of adiponectin in elderly patients with Type II diabetes mellitus (T2DM), so as to provide evidence for early diagnosis of MCI and effective evaluation of the impairment of cognitive functions, thereby preventing the impairment of cognitive function as early as possible.

PATIENTS AND METHODS

Clinical data were collected from 260 T2DM patients (≥ 60 years old) in Endocrine Department and 120 healthy subjects (≥ 60 years old) who underwent physical examination in our hospital between June 2015 and June 2017. According to the evaluation results of MCI, these T2DM patients were further divided into the T2DM + MCI group (n = 138) and the T2DM + NMCI group (n = 122). General data, including gender, age, disease history and body mass index (BMI), and the laboratory indexes, including serum adiponectin, fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c) and blood fat, were collected for statistical analysis in T2DM + MCI group, T2DM + NMCI group and healthy control group.

RESULTS

Comparisons among T2DM + MCI group, T2DM + NMCI group and healthy control group, showed that the serum level of adiponectin in T2DM + MCI group was significantly lower than those in remaining two groups (p < 0.01). Spearman correlation analysis revealed that score of Montreal Cognitive Assessment (MoCA) was positively correlated with the serum level of adiponectin (r = 0.446, p < 0.01). Multivariate linear regression analysis indicated that education (standard β = 0.325, p = 0.003), age (standard β = -0.236, p = 0.016), disease course of hypertension (standard β = -0.242, p = 0.006), disease course of diabetes mellitus (standard β = -0.377, p < 0.001) and the level of adiponectin were correlated with the cognitive impairment. The results of itemized assessment in MoCA scale showed that in T2DM + MCI group, the scores in visuospatial and executive abilities, attention, language and orientation were significantly lower than those in other two groups (p < 0.01). As for the delayed recall, the score in T2DM + MCI group was significantly lower than those in other two groups (p < 0.01), while the score in T2DM + NMCI group was lower than that in the healthy control group (p < 0.01); in terms of the naming ability and abstraction, no statistically significant differences were identified among three groups (p > 0.05).

CONCLUSIONS

Age, poor education, disease course of hypertension, disease course of diabetes mellitus and a low level of adiponectin in serum are the risk factors in MCI of T2DM patients. Besides, the level of adiponectin in serum of T2DM patients is correlated with the development of MCI; elderly T2DM patients are afflicted by cognitive impairment, mainly in visuospatial and executive abilities, attention, language, delayed recall and orientation.

Effects of subpressure on the sealing ability of dental sealant in vitro

OBJECTIVES

Pits and fissures sealing with flowable materials is a popular method for preventing caries in preventive dentistry while there is still microleakage existed. This in vitro study aimed to explore the effects of subpressure technique on the sealing ability of pit and fissure sealant.

MATERIALS AND METHODS

One hundred and forty-one extracted human premolars were collected in this study and treated with different pressure (atmosphere pressure as group C, -0.04 MPa as group S₄ and -0.08 MPa as group S₈). Thermocycling (×5000) was also performed. Penetration percentage, microleakage, cross-sectional microhardness (Knoop, KMH) and mineral loss were evaluated. Kappa tests, Friedman nonparametric and two-way ANOVA were used for data analysis.

RESULTS

Penetration percentages of group S₄ and S₈ were significant higher compared to that of group C. Microleakage of groups was similar before thermocycling, while subpressure groups showed lower scale of microleakage after thermocycling. Data of KMH and mineral loss showed significant differences between subpressure and thermocycling groups.

SIGNIFICANCE

Subpressure technique could increase the penetration of pit and fissure sealant, decrease microleakage and increase resistance of demineralization after thermocycling. This novel technique may have great potential for preventing from secondary caries.

Eptifibatide is associated with significant cost savings and similar clinical outcomes to abciximab when used during primary percutaneous coronary intervention for ST-elevation myocardial infarction: An observational cohort study of 3863 patients

INTRODUCTION

Glycoprotein IIb/IIIa inhibitors are recommended by guidelines in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. There are few studies directly comparing these agents. The aim of this study was to assess whether eptifibatide is a safe and cost-effective alternative to abciximab in the treatment of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

METHODS

This was an observational cohort study of 3863 patients who received a GPIIb/IIIa inhibitor whilst undergoing primary percutaneous coronary intervention from 2007 to 2014. Patients who did not receive a GPIIb/IIIa inhibitor were excluded. Time to first major adverse cardiac event defined as death, non-fatal myocardial infarction, stroke or target vessel revascularization, and total hospital costs were compared between the groups.

RESULTS

In all, 1741 patients received abciximab with 2122 receiving eptifibatide. Patients who received eptifibatide had higher rates of previous MI/percutaneous coronary intervention and were more likely to undergo a procedure from the radial route. Unadjusted Kaplan-Meier analysis revealed no significant difference in the 1-year event rates between patients given eptifibatide versus abciximab (p = 0.201). Age-adjusted Cox analysis demonstrated no difference in 1-year outcome between abciximab and eptifibatide (hazard ratio: 0.83; 95% confidence interval: 0.73-1.39), which persisted after multivariate adjustment (hazard ratio: 0.92; 95% confidence interval: 0.79-1.56) including the incorporation of a propensity score (hazard ratio: 0.88; 95% confidence interval: 0.71-1.44). Eptifbatide was associated with significant cost savings being 87% cheaper overall compared to abciximab (on average £650 cheaper per patient and saving approximately £950,000).

CONCLUSION

This observational data suggest that eptifibatide is associated with similar outcomes and significant cost savings compared to abciximab when used in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

An analysis of the polymorphisms of the GLUT1 gene in urothelial cell carcinomas of the bladder and its correlation with p53, Ki67 and GLUT1 expressions

Frequencies of two glucose transporter 1 (GLUT1) single-nucleotide polymorphisms (SNPs) (XbaI G>T and HaeIII T>C) were studied with urothelial cell carcinomas of the bladder (UCC) and 204 normal persons. And the expression of the p53, Ki67 and GLUT1 was assayed by immunohistochemistry. The frequency of the TT genotype and T allele of the XbaI G>T SNP was decreased in the patients with UCC. The frequency of the CC genotype and C allele of the HaeIII T>C SNP was decreased in the patients with UCC. The GLUT1 XbaI genotype GG was more frequent in higher tumor stage and higher tumor grade patients. In the XbaI G>T SNP, the GG genotype was significantly related to higher Remmele immunoreactive score (IRS) of Ki67 and higher IRS of GLUT1. In conclusion, the TT genotype in XbaI G>T SNP and CC genotype of HaeIII T>C SNP may have protective effect in the carcinogenesis process of UCC. In the XbaI G>T SNP, the GG genotype of was positively related to tumor proliferation, glucose metabolism, tumor grade and stage. Therefore, the variant might become a possible proliferation-related prognostic factor for UCC.