Adjuvant therapy provides no additional recurrence-free benefit for esophageal squamous cell carcinoma patients after neoadjuvant chemoimmunotherapy and surgery: a multi-center propensity score match study

Purpose

The need for adjuvant therapy (AT) following neoadjuvant chemoimmunotherapy (nICT) and surgery in esophageal squamous cell cancer (ESCC) remains uncertain. This study aims to investigate whether AT offers additional benefits in terms of recurrence-free survival (RFS) for ESCC patients after nICT and surgery.

Methods

Retrospective analysis was conducted between January 2019 and December 2022 from three centers. Eligible patients were divided into two groups: the AT group and the non-AT group. Survival analyses comparing different modalities of AT (including adjuvant chemotherapy and adjuvant chemoimmunotherapy) with non-AT were performed. The primary endpoint was RFS. Propensity score matching(PSM) was used to mitigate inter-group patient heterogeneity. Kaplan-Meier survival curves and Cox regression analysis were employed for recurrence-free survival analysis.

Results

A total of 155 nICT patients were included, with 26 patients experiencing recurrence. According to Cox analysis, receipt of adjuvant therapy emerged as an independent risk factor(HR:2.621, 95%CI:[1.089,6.310], P=0.032), and there was statistically significant difference in the Kaplan-Meier survival curves between non-AT and receipt of AT in matched pairs (p=0.026). Stratified analysis revealed AT bring no survival benefit to patients with pathological complete response(p= 0.149) and residual tumor cell(p=0.062). Subgroup analysis showed no significant difference in recurrence-free survival between non-AT and adjuvant chemoimmunotherapy patients(P=0.108). However, patients receiving adjuvant chemotherapy exhibited poorer recurrence survival compared to non-AT patients (p= 0.016).

Conclusion

In terms of recurrence-free survival for ESCC patients after nICT and surgery, the necessity of adjuvant therapy especially the adjuvant chemotherapy, can be mitigated.

MicroRNA-30a-5p Promotes Chronic Heart Failure in Rats by Targeting Sirtuin-1 to Activate the Nuclear Factor-κB/NOD-Like Receptor 3 Signaling Pathway

OBJECTIVE

MicroRNA-30a-5p (miR-30a-5p) has been identified as a marker of heart failure; however, its functional mechanisms in chronic heart failure (CHF) remain unknown. We aim to investigate the role of miR-30a-5p targeting sirtuin-1 (SIRT1) in myocardial remodeling in CHF via the nuclear factor-κB/NOD-like receptor 3 (NF-κB/NLRP3) signaling pathway.

METHODS

CHF rat models were established using aortic coarctation. The expression of miR-30a-5p, SIRT1, and the NF-κB/NLRP3 signaling pathway-related factors in CHF rats was determined. The CHF rats were then respectively treated with altered miR-30a-5p or SIRT1 to explore their roles in cardiac function, myocardial function, inflammatory response, pathological changes, and cardiomyocyte apoptosis. The binding relation between miR-30a-5p and SIRT1 was confirmed.

RESULTS

MiR-30a-5p was upregulated whereas SIRT1 was downregulated in myocardial tissues of CHF rats. MiR-30a-5p inhibition or SIRT1 overexpression improved cardiac and myocardial function, and suppressed the inflammatory response, alleviated pathological changes and inhibited cardiomyocyte apoptosis in CHF rats. MiR-30a-5p targeted SIRT1 to regulate the NF-κB/NLRP3 signaling pathway. In CHF rats, downregulated miR-30a-5p and silenced SIRT1 could reverse the beneficial effects of downregulated miR-30a-5p.

CONCLUSION

Inhibited miR-30a-5p inhibits CHF progression via the SIRT1-mediated NF-κB/NLRP3 signaling pathway.

[Diagnosis and treatment of new-onset or uncontrolled hyperthyroidism-induced liver injury]

The thyroid gland is the largest endocrine gland in the human body, which mainly secretes thyroid hormones. Thyroid hormone acts on almost all tissues and cells at different level regulating growth and development, metabolism and other functional activities of the body. Therefore, abnormal thyroid function can affect the multiple organs throughout the body. Liver, as the largest biochemical plant in the whole body, is widely regulated by thyroid hormones, and is one of the important target organs of the thyroid gland. Hyperthyroidism (HT for short) is a common disease of the endocrine system, which can cause liver injury, such as hepatomegaly, abnormal liver function, jaundice, cirrhosis, and liver failure. This phenomenon is also known as hyperthyroidism-induced liver injury, and it is more common in new or untreated or improperly treated patients with hyperthyroidism. The basic liver function test at the beginning of antithyroid drugs (ATD) treatment can clarify the degree of liver injury caused by hyperthyroidism itself, and further predict the additional liver injury with ATD therapy initiation. The core of treating hyperthyroidism-induced liver injury is to rapidly control hyperthyroidism, and restore normal liver function. This review briefly summarizes the incidence rate, possible mechanisms, pathological changes, clinical manifestations, laboratory, imaging and pathologic findings, and the recent advances in diagnosis and treatment of the hyperthyroidism-induced liver injury.

A two-year study of parental obesity status and childhood obesity in China

BACKGROUND AND AIMS

We evaluated the association between parental obesity and their children's obesity parameters [e.g., percentage of body fat (PBF)] over time.

METHODS AND RESULTS

The study included 2066 Chinese parents-children trios (n = 1001 girls and 1065 boys, aged 6-14 years). Children's height, weight, waist circumference (WC) and PBF (bioelectrical impedance analysis) were annually assessed from 2014 (baseline) to 2016. Information on parental height and body weight, and children's diet and physical activity was collected in 2014. The association between parental obesity and changes in their children's PBF during follow-up was analyzed using a mixed effects model. We also examined changes in children's BMI and WC in secondary analyses. Baseline mean BMI, WC, and PBF for children were 17.6 ± 3.5 kg/m², 60.5 ± 9.6 cm, and 16.6 ± 6.5%, respectively. We observed that maternal, but not paternal, obesity was associated with a greater increase in children's PBF during the follow-up. An adjusted mean difference in annual increase of PBF was 0.41% [95% confidence interval (CI): 0.01%, 0.84%] for children with obese mothers, compared with those with normal-weight mothers. Both maternal and paternal obesity was associated with a greater increase in their children's BMI and WC (p trend<0.01 for both); however, the associations were stronger in mother-children pairs than those in father-children pairs.

CONCLUSIONS

Maternal obesity was associated with a greater increase in PBF in Chinese school-aged children.

Body mass index, waist circumference, body fat mass, and risk of developing hypertension in normal-weight children and adolescents

BACKGROUND AND AIMS

We prospectively examined the association between three adiposity indices, including body mass index (BMI), waist circumference (WC), and percentage of body fat (PBF), and risk of hypertension in normal-weight Chinese children.

METHODS AND RESULTS

The current study included 1526 (713 boys and 813 girls) normal-weight Chinese children (age 6-14 years old), who were free of hypertension at baseline (2014). Heights, body weight, WC, and PBF (estimated by bioelectrical impedance analysis) were measured at the baseline. Blood pressure was repeatedly measured in 2014, 2015 and 2016. Hypertension was defined as either high systolic blood pressure and/or high diastolic blood pressure, according to age- and sex-specific 95th percentile for Chinese children. We used Cox proportional hazards model to calculate the association between exposures and hypertension. We identified 88 incident hypertension cases during two years of follow up. High BMI was associated with high risk of developing hypertension after adjusting for potential confounders. The adjusted hazard ratio for hypertension was 2.88 (95% CI: 1.24, 6.69) comparing two extreme BMI quartiles. Each SD increase of BMI (≈1.85 kg/m²) was associated with a 32% higher likelihood to developing hypertension (Hazard ratio = 1.32; 95% CI: 1.003, 1.73). In contrast, we did not find significant associations between WC or PBF and higher hypertension risk (p-trend >0.2 for both).

CONCLUSION

High BMI, but not WC and PBF, was associated with high risk of hypertension in normal-weight Chinese children.

A comparison of patient knowledge of clinical trials and trialist priorities

BACKGROUND

Recruitment to clinical trials remains poor, and patient knowledge of clinical trials is one barrier to recruitment. To identify knowledge deficits, we conducted and compared surveys measuring actual patient knowledge and clinical trialist priorities for patient knowledge.

METHODS

Consenting patients at a tertiary cancer centre answered a survey that included 2 opinion questions about their own knowledge and willingness to join a trial, and22 knowledge questions. Clinical researchers at the centre were asked 13 questions about the importance of various trials factors.

RESULTS

Of 126 patients surveyed, 16% had joined a clinical trial, and 42% had a secondary school education or less. The mean correct response rate on the knowledge questions was 58%. Higher rates of correct responses were associated with lower age (p = 0.05), greater education (p = 0.006), prior trial participation (p < 0.001), agreement or strong agreement with perceived understanding of trials (p < 0.001), and willingness to join a clinical trial (p = 0.002). Trialists valued an understanding of the rationale for clinical trials and of randomization, placebo, and patient protection, but those particular topics were poorly understood by patients.

CONCLUSIONS

Patient knowledge about clinical trials is poor, including knowledge of several concepts ranked important by clinical trialists. The findings suggest that when developing education interventions, emphasis should be placed on the topics most directly related to patient care, and factors such as age and education level should be considered.

Expression of CD24 and its relationship with angiogenesis and tumor cell proliferation in colorectal carcinoma

AIM: To investigate the expression of CD24 and its role in the angiogenesis and tumor cell proliferation in colorectal carcinoma.

METHODS: Direct immunofluorescence flow cytometry (FCM) was used to detect the expression of CD24 in 66 specimens of colorectal carcinoma and normal colorectal tissues. The expression of CD24 protein was shown by the percentage of positive cells (PPC) and mean fluorescence index (MFI). The expression of CD34 and proliferating cell nuclear antigen (PCNA) in colorectal carcinoma were detected by immunohistochemistry. Microvessel density (MVD) was figured out according to the positive staining for CD34. The proliferation index of carcinoma cells was figured out according to the expression of PCNA.

RESULTS: The values of PPC and MFI were significantly higher in colorectal carcinoma tissue than that in the normal colorectal tissue (PPC: 90.40% vs 36.15%, χ² = 6.877, P < 0.001; MFI: 18.10 vs 8.41, χ² = 6.934, P < 0.001). The values of MFI and PPC were significantly correlated with tumor stages (Dukes and pTNM), lymph noda metastasis and infiltration types (P < 0.05). The expression of PCNA was increased with the up-regulation of CD24 expression in CD24-positive cases (P < 0.05). There was a significant correlation between the positive rate of CD24 expression and the value of MVD in colorectal carcinoma (r = 0.243, P = 0.050). But the value of MFI had no marked correlation with that of MVD in colorectal carcinoma (r = 0.115, P = 0.358).

CONCLUSION: CD24 expression is obviously up-regulated in colorectal carcinoma, and it is correlated with the angiogenesis of tumor tissues and proliferation of tumor cells.

Inhibition of phosphatidylinositol 3-kinase activity blocks cellular differentiation mediated by glial cell line-derived neurotrophic factor in dopaminergic neurons

Glial cell line-derived neurotrophic factor (GDNF) is a potent survival factor for midbrain dopaminergic neurons. To begin to understand the intracellular signaling pathways used by GDNF, we investigated the role of phosphatidylinositol 3-kinase activity in GDNF-stimulated cellular function and differentiation of dopaminergic neurons. We found that treatment of dopaminergic neuron cultures with 10 ng/ml GDNF induced maximal levels of Ret phosphorylation and produced a profound increase in phosphatidylinositol 3-kinase activity, as measured by western blot analysis and lipid kinase assays. Treatment with 1 microM 2-(4-morpholinyl)-8-phenylchromone (LY294002) or 100 nM wortmannin, two distinct and potent inhibitors of phosphatidylinositol 3-kinase activity, completely inhibited GDNF-induced phosphatidylinositol 3-kinase activation, but did not affect Ret phosphorylation. Furthermore, we examined specific biological functions of dopaminergic neurons: dopamine uptake activity and morphological differentiation of tyrosine hydroxylase-immunoreactive neurons. GDNF significantly increased dopamine uptake activity and promoted robust morphological differentiation. Treatment with LY294002 completely abolished the GDNF-induced increases of dopamine uptake and morphological differentiation of tyrosine hydroxylase-immunoreactive neurons. Our findings show that GDNF-induced differentiation of dopaminergic neurons requires phosphatidylinositol 3-kinase activation.

Characterization of two distinct monoclonal antibodies specific for glial cell line-derived neurotrophic factor

Here we report the generation and characterization of two distinct monoclonal antibodies, G-90 and B-1531, specific to glial cell line-derived neurotrophic factor (GDNF). ELISA results confirmed that G-90 and B-1531 both recognize GDNF. Western blots showed that G-90 recognized only the GDNF dimer, whereas B-1531 recognized both the monomer and dimer. Peptide competition ELISA (PCE) and BIAcore data suggested that G-90 and B-1531 recognize different epitopes: PCE confirmed that B-1531 binds to NH2-terminal peptides between amino acids 18 and 37, whereas G-90 does not; BIAcore data showed that B-1531 binds to the NH2 terminus of GDNF, whereas G-90 does not. G-90, in a concentration-dependent manner, completely neutralized the GDNF-induced increases of choline acetyltransferase in cultured motoneuron and of dopamine uptake and morphological differentiation in dopaminergic neuron cultures. B-1531 had no neutralizing effects. GDNF-induced Ret autophosphorylation in NGR-38 cells was completely neutralized by G-90, whereas B-1531 had a moderate effect. These data show that G-90 and B-1531 are specific antibodies to GDNF. The data also suggest that the NH2 terminus of GDNF is not critical for activity. Partial inhibition of Ret phosphorylation is insufficient to down-regulate GDNF-induced biological activity.

Inhibition of glial cell line-derived neurotrophic factor induced intracellular activity by K-252b on dopaminergic neurons

The c-ret protooncogene encodes Ret, the functional tyrosine kinase receptor for glial cell line-derived neurotrophic factor (GDNF). K-252b, a known protein tyrosine kinase inhibitor, has been shown earlier to inhibit the trophic activity of brain-derived neurotrophic factor on dopaminergic (DAergic) neurons and nerve growth factor on basal forebrain cholinergic neurons while potentiating neurotrophin-3 activity on central cholinergic and peripheral sensory neurons and PC12 cells. We tested whether K-252b would modulate GDNF-induced differentiation in DAergic neuron cultures. Exposure to 1 ng/ml GDNF increased dopamine (DA) uptake 80% above control, whereas treatment with 5 microM K-252b decreased the efficacy of GDNF by 60%. Concentrations of GDNF of <100 pg/ml were completely inhibited, whereas concentrations of >100 pg/ml were moderately active, between 10 and 20% above control. In addition, K-252b shifted the ED50 from 20 to 200 pg/ml. GDNF treatment increased soma size and neurite outgrowth in tyrosine hydroxylase-immunoreactive neurons. K-252b inhibited differentiation of these morphological parameters induced by GDNF. Furthermore, GDNF stimulated Ret autophosphorylation at maximal levels, whereas the inhibition of DA uptake and morphological differentiation by K-252b correlated with a significantly decreased level of Ret autophosphorylation. Therefore, K-252b is able to inhibit intracellular activities induced by GDNF on mesencephalic DAergic neurons.

Expression and regulation of glial-cell-line-derived neurotrophic factor (GDNF) mRNA in human astrocytes in vitro

The expression and modulation of mRNA for glial-cell-line-derived neurotrophic factor (GDNF) in human glial cells was investigated. Astrocyte cell cultures were isolated from human fetal brains, characterized by immunocytochemistry and maintained in vitro in conditions of high purity; sister cultures were exposed to protein kinase C (PKC) inhibitors for 20 min. Total RNA was extracted from the cell pellets, reverse-transcribed into cDNA and amplified by the polymerase chain reaction (PCR) with primers specific for GDNF. A reverse-transcription/PCR procedure was also performed on mRNA extracted from human fibroblast and lymphocyte cell lines. Human astrocytes grown in the absence of neurons expressed detectable amounts of mRNA for GDNF but no amplification products were observed in fibroblasts and lymphocytes, thus confirming that GDNF production was cell-type specific. After exposure to PKC inhibitors, a dramatic down-regulation of GDNF mRNA was observed in astrocyte cell cultures. Thus, human astrocytes are constitutively capable of producing GDNF, such trophic activity is restricted to neural cells, and PKC plays key roles in signal pathways that regulate the gene activation and production of GDNF.

Expression and distribution of GAP-43 in human astrocytes in culture

By combining mRNA analysis and immunocytochemistry, we investigated the expression of the growth associated protein 43 (GAP-43) in enriched populations of astrocytes, obtained from mixed cultures of human fetal brains. Total cellular RNA was extracted from cell pellets and reverse transcribed into cDNA; cDNA was subjected to PCR amplification using primers specific for GAP-43 and PCR products were separated through polyacrylamide gels. Double immunofluorescence staining was performed on dissociated cell cultures using antibodies to glial fibrillary acidic protein (GFAP) and to GAP-43. Results showed that both transcription and translation for GAP-43 occur in cultured astrocytes. GAP-43 immunoreacting material was detected in the cell processes and diffusely in the cytoplasm of GFAP-positive astrocytes, during early stages of maintenance in vitro. In older cultures, GAP-43 immunoreactivity persisted in a large percentage of cells, with a tendency to accumulate in perinuclear areas. These observations provide evidence that GAP-43 is not restricted to neuronal cells. The close spatial association with cytoskeletal constituents, as observed in astrocytes, suggests a role for this protein in the control of cell shape, motility and adhesion processes.

Co-expression of mRNA for neurotrophic factors in human neurons and glial cells in culture

Enriched populations of neurons and astrocytes of 93-99% purity were obtained from mixed cultures of four human fetal brains. Total cellular RNA was extracted from cell pellets and reverse transcribed into cDNA. Five microliters of cDNA were subjected to PCR amplification using primers specific for sequences of NGF, BDNF, NT-3 and CNTF. PCR products were separated through 5% acrylamide gel and identified by DNA sequencing. Results showed that neurons expressed detectable levels of mRNA for NGF in all four cultures; BDNF and NT-3 mRNA was seen only in two cultures; CNTF mRNA was not detected in all four cultures. Astrocytes expressed mRNA for NGF, BDNF, and NT-3 but not for CNTF in all cultures examined. Astrocytic expression of mRNA for NGF, BDNF and NT-3 was found during the active cell proliferation as well as at a phase of mitotic quiescence. This study provides evidence that dissociated cell cultures of human neurons produce NGF, BDNF and NT-3 in early stages of their development and that astrocytes are constitutively committed to synthesize neurotrophic factors, NGF, BDNF and NT-3. The active synthesis of selected neurotrophic factors by neurons and astrocytes is relevant in supporting migration, survival and differentiation of developing neurons in vivo.

[Antifertility effects of mifepristone and epostane alone and in combination in rats]

A complete interceptive action on pregnancy was shown after ig mifepristone (RU-486) 16 mg.kg-1 or epostane 96 mg.kg-1 on d 10 of pregnancy in rats. The ig ED50 (95% fiducial limits) of RU-486 when given alone and in combination with epostane 12 mg.kg-1 were found to be 7.8 (5.3-10.0) and 2.6 (2.0-3.3) mg.kg-1, respectively (P < 0.05), while those of epostane when given alone and in combination with RU-486 4 mg.kg-1 were 25.5 (19.4-33.6) and 5.6 (4.7-7.4) mg.kg-1, respectively (P < 0.05). An absorption promotor, sodium dodecyl sulfate 24 mg.kg-1 ig, when given in combination with RU-486 8 mg.kg-1 or epostane 24 mg.kg-1, induced complete interceptive action on pregnancy. Levels of plasma progesterone declined significantly when epostane 12 mg.kg-1 was given in combination with RU-486 4 mg.kg-1 as compared with epostane 12 mg.kg-1 alone (P < 0.05). Results showed that drug combination therapy was of benefit both to RU-486 and epostane in their interceptive actions.

CD44 expression in human astrocytes and oligodendrocytes in culture

CD44 is a glycoprotein present on the surface of some lymphocyte cell populations and other non-lymphoid cells, and is involved in many functions related to cell-cell and cell-matrix interactions. In this study, expression of CD44 antigen in primary neural cell cultures derived from fetal and adult human brains was investigated. In cultures processed for double immunofluorescence staining, approximately 80% of fetal astrocytes and more than 95% of adult astrocytes expressed the CD44 antigen on the cell bodies and processes; CD44 was also detected in 50-60% of adult oligodendrocytes. Neurons in fetal brain cell cultures did not express CD44 at all. Western blot analysis performed in astrocyte- and in neuron-enriched cultures confirmed the results from immunostaining and showed that the antibody against CD44 reacted with a polypeptide, of approximately 80 kD, that is present exclusively in the astrocyte-enriched cultures, but absent in neuron-enriched cultures. Our results indicate that CD44 glycoprotein is constitutively expressed in the human cells of glial cell lineage and its role is likely to be associated with normal neuroglia-mediated adhesion/recognition processes.

Midkine is a mediator of retinoic acid induced neuronal differentiation of embryonal carcinoma cells

Midkine (MK) is a novel growth factor and is the product of a retinoic acid responsive gene. When P19 murine embryonal carcinoma (EC) cells were exposed to MK, they differentiated into neurons, and the neuronal differentiation was accompanied by expression of choline acetyltransferase activity. Synthesis and release of MK in the EC cells treated with retinoic acid were shown by Western blot analysis, and rabbit anti-MK antibody attenuated the action of retinoic acid to induce the neuronal differentiation. These results indicate that MK is one of the mediators of retinoic acid action to induce the neuronal differentiation in EC cells.

Peptidylglycine alpha-amidating monooxygenase (PAM) in Schwann cells and glia as well as neurons

We raised an antiserum against the synthetic peptide FKETTRSFSNECLGTTR corresponding to the amino terminus of the enzyme peptidylglycine alpha-amidating monooxygenase (PAM). Control experiments were performed to determine the specificity of the antiserum and its suitability for the immunohistochemical identification of PAM-containing cells. An immunoaffinity column made with the antibody coupled to Sepharose permitted the isolation of the active enzyme. Peptide-agarose immunoadsorbant removed the antibodies responsible for the characteristic staining patterns in immunohistochemical experiments. As expected from the widespread distribution of amidated peptides in the nervous system, PAM immunoreactivity was detected in perikarya in a variety of locations, including the pituitary, the hypothalamic periventricular and supraoptic nuclei, neocortex, and sensory ganglia. Punctate immunostained fibers, especially around neuronal perikarya, were observed in regions known to receive amidated peptidergic afferents. In addition, PAM immunoreactivity was observed in some neurons not known to produce amidated peptides (e.g., pyramidal cells of the hippocampus). This result suggests that these neurons also produce an amidated peptide. PAM immunoreactivity was also detected in several unexpected cell types, including ependyma, choroid plexus, oligodendroglia, and Schwann cells. The presence of enzymatically active PAM in Schwann cells was confirmed by measurements of amidating activity in ligated and control sciatic nerve. These results suggest that these non-neuronal cells may produce amidated peptides.

Identification of a novel protein (G210) specific to the Golgi apparatus

A monoclonal antibody, 3C9, has enabled the detection of a novel Golgi-specific protein in bovine tissues. Immunohistochemical studies at the light microscopic level have detected the 3C9 antigen only in certain cells: exocrine pancreas, gut epithelium, and thymus epithelium. Examination of gut and pancreas by immunoelectron microscopy showed a localization exclusive to the Golgi apparatus. The relative molecular weight of the antigen detected by immunoblotting is 210,000 daltons. The antigen is not extracted from microsomal membranes of bovine gut epithelium by sodium carbonate solutions. Furthermore, the 3C9 antigen enters into the detergent phase when Triton X-114 partitioning methods are used. These data strongly suggest that this novel antigen is an intrinsic membrane protein, resident in the Golgi apparatus of certain cells. Moreover, they enhance the hypothesis that the distribution of enzymes and polypeptides in the Golgi apparatus is cell specific.

Spermicidal effect in vitro by the active principle of garlic

The in vitro spermicidal effect of Allitridum, an active principle of garlic, was investigated. The data showed that sperm motility was inhibited with various concentrations of Allitridum at different intervals ranging from 20 seconds-200 minutes as compared to control. An obvious immobilization of spermatozoa occurred at 7.5 mg/ml of Allitridum. The effects on sperm motility appeared to be dose-dependent.