Immune Cell-Derived Exosomes in Inflammatory Disease and Inflammatory Tumor Microenvironment: A Review

Inflammation is a common feature of many inflammatory diseases and tumors, and plays a decisive role in their development. Exosomes are extracellular vesicles unleashed by assorted types of cells, and it is widely known that exosomes of different immune cell sources play different functions. Exosome production has recently been reported for immune cells comprising macrophages, T cells, B cells, and dendritic cells (DCs). Immune cell-derived exosomes are involved in a variety of inflammatory responses.Herein, we summarize and review the role of macrophages, T cells, B cells, and dendritic cells (DC) in inflammatory diseases, with a focus on the role of immune cell-derived exosomes in osteoarthritis, rheumatoid arthritis, and the inflammatory tumor microenvironment (TME).These findings are expected to be important for developing new treatments for inflammatory diseases and ameliorating tumor-related inflammation.

BCLAF1 is Expressed as a Potential Anti-oncogene in Bile Duct Cancer

Validating the role of BCLAF1 in the development of Bile Duct Cancer. Differential expression of BCLAF1 in Bile Duct Cancer and normal tissues was analyzed bioinformatically, and immuno-infiltration analysis was performed by R. We also derived the correlation between the expression of BCLAF1 and HIF-1α by bioinformatics analysis and validated it by Western Blotting, qRT-PCR and scratch assays before and after hypoxia. Through bioinformatics analysis, we found that BCLAF1 mRNA was significantly higher in the tumor tissues of Bile Duct Cancer. The high expression of BCLAF1 implied a more advanced stage but a lower mortality rate. KEGG and GO enrichment analysis showed that BCLAF1 overexpression in Bile Duct Cancer was mainly associated with histone modification, peptidyl lysine modification, and macromolecular methylation. We used the TIMER algorithm to show that BCLAF1 expression in Bile Duct Cancer is associated with immune cell infiltration, which affects tumor progression and patient prognosis. We confirmed by normoxia and hypoxia qRT-PCR, Western Blotting and scratch assays that BCLAF1 and HIF-1α expression are positively correlated and that BCLAF1 may be expressed as anti-oncogene in Bile Duct Cancer. These findings demonstrate that BCLAF1 may act as anti-oncogene in Bile Duct Cancer and may be involved in immune cell infiltration in Bile Duct Cancer, suppressing the expression of HIF-1α.

The Effect of PARP Inhibitor Radiosensitization on the mRNA Translational Regulation of T Cell Chemokines

PURPOSE/OBJECTIVE(S)

Immunotherapy has modestly improved survival for small cell lung cancer (SCLC) patients. Low response rate and rapid disease progression remain an intractable challenge. One of the factors that contribute to immunotherapy resistance is the lack of cytotoxic T cell infiltration. The expression of chemoattractant cytokines, like CCL5 and CXCL10, are essential for T cell infiltration. The control of chemokine expression is not fully understood, but both transcriptional and translational control pathways could play a major role. Previous studies have shown a correlation between DNA damage and chemokine expression and that PARP inhibitors (PARPi) are radiosensitizers for SCLC that increases DNA damage. The objectives of this study were to define this potential PARPi immunogenic radiosensitizing relationship.

MATERIALS/METHODS

We identified doses of olaparib+ radiation treatment (RT) that conferred radiosensitization in SCLC cell-lines by cell viability and/or clonogenic assays. Olaparib+RT induced CCL5 and CXCL10 mRNA expression was measured by qPCR across SCLC cell-lines. Protein level of chemokines was assessed by immunoblotting. SBC5 cells were treated with olaparib+RT and submitted for RNA sequencing analysis. Genes with adjusted p value<0.05 were considered significant. Protein level changes and target gene knock-out (KO) were confirmed by immunoblotting. Chemokine CXCL10 mRNA and protein level in wildtype (WT) and KO cells were measured by qPCR and western blot, respectively. A mRNA decay assay and dual-luciferase reporter assay was used to identify the region of CXCL10 mRNA that confers mRNA stability control. In vivo anti-tumor efficacy and tumor T cell infiltration studies were done in B6129F mice bearing KP1 tumors. And the T cell infiltration was measured by immune profiling.

RESULTS

In vitro, olaparib+RT significantly increased CXCL10 mRNA in all four SCLC subtype cell-lines in comparison to vehicle control. Consistently, the increase of CXCL10 protein levels (3-fold) was observed in SBC5 cells. By RNA-Seq, a top-ranking translational repressor was EIF4E2 (4EHP) mRNA. The downregulation of EIF4E2 protein by olaparib+RT was validated in four SCLC subtypes by western blot. EIF4E2 KO in HEK293 and SBC5 cells increased CXCL10 mRNA and protein level. By mRNA decay assay and western blot, the absence of EIF4E2 stabilized CXCL10 mRNA and increased CXCL10 protein levels. The dual-luciferase assay demonstrated EIF4E2 destabilizes CXCL10 mRNA via the 3'UTR of CXCL10. In vivo, immune profiling showed olaparib+RT significantly increased the total T cell and CD8+ T cell infiltration. Finally, anti-PD-L1 inhibition potentiated olaparib + IR to improve tumor control in KP1 allograft.

CONCLUSION

Our study demonstrated olaparib + RT increases CXCL10 protein levels through downregulating EIF4E2 to subsequently increase T cell infiltration. Olaparib + RT enhanced anti-PD-L1 immunotherapy efficacy and has therapeutic potential as an immunogenic radiosensitizer.

A head-to-head comparison of well-being of older people (WOOP) and EQ-5D-5L in patients, carers and general public in China

Recently, well-being of older people measure (WOOP) was developed and validated in a Dutch population. Although WOOP was developed targeting the older people, it has the potential for use in a wider population. In this study, we aimed to examine the relationship between WOOP and EQ-5D-5L and compared their psychometric properties in a sample of patients, carers and healthy general public covering a wider age group. We conducted a cross-sectional study in Guizhou Province, China between July and August 2022. Data was collected using paper and pencil. We analysed and reported the acceptability, item response distribution, the Spearman correlation coefficients of all items, the Exploratory Factor Analysis (EFA) of all items, the known-group validity and the convergent validity of EQ-5D-5L utility and WOOP utility. A total of 322 participants completed the survey with 105 patients, 101 carers and 116 healthy general public. 9% of participants had at least one missing response. Three items of WOOP did not have any level 5 responses and EQ-5D-5L had more level 1 responses. The correlations were low between EQ-5D-5L and WOOP items and the three-factor EFA showed these two instruments had only one shared factor and the other two factors were only related to WOOP items. Younger people had lower missing response rate and a different response distribution for three items. WOOP measures a broader construct beyond health while EQ-5D-5L is a more sensitive instrument when health is considered alone. There is a potential of using WOOP in a wider population.

Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy

AIM

To determine whether the injection of haemocoagulase into the biopsy tract can reduce pneumothorax and pulmonary haemorrhage after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB).

MATERIALS AND METHODS

A retrospective study was performed involving patients with undiagnosed pulmonary lesions scheduled for PTLB between January 2020 and March 2021. Patients were assigned to the haemocoagulase group or the non-haemocoagulase group. After CT-guided biopsies were performed with a 17 G coaxial system, patients in the haemocoagulase group received a haemocoagulase injection (0.2-0.5 units) in the biopsy tract as the sheath was withdrawn. Postoperative image studies were performed to evaluate complications, including pneumothorax and pulmonary haemorrhage. Factors, including the patient's position, lesion location, and pathological results, were evaluated to determine their associations with the complications.

RESULTS

A total of 100 patients were included, with 44 men and a mean age of 53 years old. The overall incidences of pneumothorax and pulmonary haemorrhage were 15% and 13%, respectively. The incidences of pneumothorax and pulmonary haemorrhage were statistically significantly lower in the haemocoagulase group (8% and 6%, respectively) than in the non-haemocoagulase group (22% and 20%, respectively; p=0.04 and 0.03, respectively). There was no statistically significant difference in haemoptysis between the haemocoagulase (6%) and non-haemocoagulase (2%) groups (p=0.23). There were also no statistically significant associations of pneumothorax or pulmonary haemorrhage with the patients' positions, lesion location, or pathological results.

CONCLUSION

Biopsy tract haemocoagulase injection reduced the incidences of postoperative pneumothorax and pulmonary haemorrhage after PTLB.

The Role of Zinc in Bone Mesenchymal Stem Cell Differentiation

Zinc is an essential trace element for bone growth and bone homeostasis in the human body. Bone mesenchymal stem cells (BMSCs) are multipotent progenitors existing in the bone marrow stroma with the capability of differentiating along multiple lineage pathways. Zinc plays a paramount role in BMSCs, which can be spurred differentiating into osteoblasts, chondrocytes, or adipocytes, and modulates the formation and activity of osteoclasts. The expression of related genes also changed during the differentiation of various cell phenotypes. Based on the important role of zinc in BMSC differentiation, using zinc as a therapeutic approach for bone remodeling will be a promising method. This review explores the role of zinc ion in the differentiation of BMSCs into various cell phenotypes and outlines the existing research on their molecular mechanism.

Developing metabolic gene signatures to predict intrahepatic cholangiocarcinoma prognosis and mining a miRNA regulatory network

Background

Metabolic disturbance is closely correlated with intrahepatic cholangiocarcinoma (IHCC), and we aimed to identify metabolic gene marker for the prognosis of IHCC.

Methods

We obtained expression and clinical data from 141 patients with IHCC from public databases. Prognostic metabolic genes were selected using univariate Cox regression analysis. Unsupervised cluster analysis was applied to identify IHCC subtypes, and CIBERSORT was used for immune infiltration analysis of different subtypes. Then, the metabolic gene signature was screened using multivariate Cox regression analysis and the LASSO algorithm. The prognostic potential and regulatory network of the metabolic gene signature were further investigated.

Results

We screened 228 prognosis‐related metabolic genes. Based on their expression levels, IHCC samples were divided into two subtypes, which showed significant differences in survival and immune cell infiltration. After LASSO analysis, eight metabolic genes including CYP19A1, SCD5, ACOT8, SRD5A3, MOGAT2, PFKFB3, PPARGC1B, and RPL17 were identified as the optimal genes for the prognosis signature. The prognostic model had excellent predictive abilities, with areas under the receiver‐operating characteristic curves over 0.8. A nomogram model was also established based on two independent prognostic clinical factors (pathologic stage and prognostic model), and the generated calibration curves and c‐indexes determined its excellent accuracy and discriminative ability to predict 1‐ and 5‐year survival status (c‐indexes>0.7). Finally, we found that miR‐26a‐5p, miR‐27a‐3p, and miR‐27b‐3p were the upstream regulators that mediate the involvement of gene signatures in metabolic pathways.

Conclusion

We developed eight metabolic gene signatures to predict IHCC prognosis and proposed potential upstream regulatory axes of gene signatures.

Effects of adenovirus-mediated knockdown of IRAK4 on synovitis in the osteoarthritis rabbit model

BACKGROUND

The use of interleukin-1 receptor-associated kinase 4 (IRAK4) inhibitor as a treatment for the inflammatory joint disease is a promising method. However, its underlying mechanism in osteoarthritis (OA) remains unclear. The purpose of this study is to look into the effects of adenovirus-mediated knockdown of IRAK4 on synovitis in the OA rabbit model.

METHODS

Ad-shIRAK4 was injected two weeks after anterior cruciate ligament resection. Six weeks later, the rabbits were killed. The expression of IRAK4, TNFR-associated factor 6(TRAF6), TGF-activated kinase 1(TAK1), p-IKB kinase (p-IKK), p-nuclear factor kappa-B (p-NFκB), p38, and p-p38 in the synovial membrane was detected by western blot, qRT-PCR, and immunohistochemistry analysis. Immunohistochemistry was to detect the expression of IRAK4 proteins in articular cartilage. H&E staining was to assess the pathological changes of synovium and cartilage. The levels of interleukin (IL)-1β, tumor necrosis factor-α(TNF-α), and MMP-13 in the synovial fluid were measured by ELISA. X-ray and micro-computerized tomography (μCT) scans were used to assess knee joint conditions and microstructure of subchondral bone.

RESULTS

IRAK4 expression levels in synovial tissues of the OA model group exhibited a significant upward trend. Ad-shIRAK4 significantly reduced IRAK4 mRNA expression in synovium tissues. Notably, Ad-shIRAK4 suppressed the Toll-like receptor/interleukin-1 receptor (TLR/IL-1R) signaling. In addition, in the Ad-shIRAK4 treatment group, we can see less inflammatory cell infiltration and reduced hyperplasia and angiogenesis. The levels of IL-1β, TNF-α, and MMP-13 in the synovial fluid in the OA model group were significantly higher than that in the control group, which were reduced by Ad-shIRAK4 treatment. Finally, Results of HE stains, immunohistochemistry, and μCT showed that Ad-shIRAK4 treatment has a protective effect on cartilage damage.

CONCLUSIONS

IRAK4 is significantly upregulated in the synovium from the osteoarthritis rabbit model. In addition, Ad-shIRAK4 reduced the expression of IRAK4 and suppressed TLR/IL-1R signaling in the synovium from the osteoarthritis rabbit model. Ad-shIRAK4 could alleviate synovitis and cartilage degradation in the osteoarthritis rabbit model, and thus alleviate the symptoms of OA and prevent the progression of OA.

Evaluating the efficacy of endoscopic sphincterotomy on biliary-type sphincter of Oddi dysfunction: A retrospective clinical trial

BACKGROUND

Although endoscopic sphincterotomy (EST) has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction (SOD), some patients still have little relief after EST, which implies that other functional abdominal pain may also be present with biliary-type SOD and interfere with the diagnosis and treatment of it.

AIM

To retrospectively assess EST as a treatment for biliary-type SOD and analyze the importance of functional gastrointestinal disorder (FGID) in guiding endoscopic treatment of SOD.

METHODS

Clinical data of 79 patients with biliary-type SOD (type I and type II) treated with EST at Affiliated Hospital of Guizhou Medical University from January 2014 to January 2019 were retrospectively collected to evaluate the clinical therapeutic effect of EST. The significance of relationship between FGID and biliary-type SOD was analyzed.

RESULTS

Seventy-nine patients with biliary-type SOD received EST, including 29 type 1 patients and 50 type 2 patients. The verbal rating scale-5 (VRS-5) scores before EST were all 3 or 4 points, and the scores decreased after EST; the difference was statistically significant (P < 0.05). After EST, the serum indexes of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and total bilirubin in biliary-type SOD were significantly lower than before (P < 0.05). After EST, 67 (84.8%) and 8 (10.1%) of the 79 patients with biliary-type SOD had obviously effective (VRS-5 = 0 points) and effective treatment (VRS-5 = 1-2 points), with an overall effectiveness rate of 94.9% (75/79). There was no difference in VRS-5 scores between biliary-type SOD patients with or without FGID before EST (P > 0.05). Of 12 biliary-type SOD (with FGID) patients, 11 had abdominal pain after EST; of 67 biliary-type SOD (without FGID) patients, 0 had abdominal pain after EST. The difference was statistically significant (P <0.05). The 11 biliary-type SOD (with FGID) patients with recurrence of symptoms, the recurrence time was about half a year after the EST, and the symptoms were significantly relieved after regular medical treatment. There were 4 cases of post-endoscopic retrograde cholangiopancreatography pancreatitis (5.1%), and no cholangitis, bleeding or perforation occurred. Patients were followed up for 1 year to 5 years after EST, with an average follow-up time of 2.34 years, and there were no long-term adverse events such as sphincter of Oddi restenosis or cholangitis caused by intestinal bile reflux during the follow-up.

CONCLUSION

EST is a safe and effective treatment for SOD. For patients with type I and II SOD combined with FGID, single EST or medical treatment has limited efficacy. It is recommended that EST and medicine be combined to improve the cure rate of such patients.

Study of cooling strategy for pressure vessel in pool research reactor at accident situation

Pressure vessel in pool layout is usually used in high power and middle pressure research reactor, Flow inversion and residual heat removal is important problem. The heat removal strategy at accident situation for a pressure vessel in pool layout research reactor was studied in the paper, many cases was researched for the ability of heat removal and safety of core.

Study of cooling strategy for pressure vessel in pool research reactor at accident situation

Pressure vessel in pool layout is usually used in high power and middle pressure research reactor, Flow inversion and residual heat removal is important problem. The heat removal strategy at accident situation for a pressure vessel in pool layout research reactor was studied in the paper, many cases was researched for the ability of heat removal and safety of core.

Clinical symptoms of COVID-19 pneumonia in children: A protocol for systematic review and meta-analysis

BACKGROUND

This meta-analysis aimed to compare the clinical symptoms of COVID-19 pneumonia in children.

METHODS AND ANALYSIS

Electronic databases including PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI) database, Wanfang Database, and Chinese Biomedical Literature Database (CBM) were searched from its inception to June 21, 2020. We only included studies that reported clinical symptoms of COVID pneumonia in children. Quality of the included studies was assessed by 2 authors. Pooled results were summarized by STATA 12.0 software.The heterogeneity was measured by I2 tests (I2 < 50 indicates little heterogeneity, I2≥50 indicates high heterogeneity). Publication bias was performed by funnel plot and statistically assessed by Begg test (P > .05 as no publication bias).

RESULTS

Results will be shown as figures or tables.

CONCLUSION

Our study aims to systematically present the clinical symptoms of COVID-19 pneumonia patients in children, so as to further provide guidance for clinical management.

CX3CR1 regulates angiogenesis and activation of pro-angiogenic factors and triggers macrophage accumulation in experimental hepatopulmonary syndrome model

OBJECTIVE

Prevalence of hepatopulmonary syndrome (HPS) ranges from 4% to 47% in patients with cirrhosis. This study aimed to explore possible relationship between CX3CR1 and angiogenesis or macrophage accumulation in pathological process of HPS.

MATERIAL AND METHODS

Wide-type C57Bl/6 mice were divided into WT-sham, WT-common bile duct ligation (WT-CBDL), WT-CBDL plus antibody (WT-CBDL+Ab) and WT-CBDL plus Bevacizumab. The CX3CR1^GFP/GFP mice were grouping into CX3CR1 GFP/GFP-sham, CX3CR1 GFP/GFP-CBDL and CX3CR1 GFP/GFP-CBDL+Bevacizumab group. Intrapulmonary expression of Akt, pAkt, ERK, pERK, iNOS, VEGF, PDGF was measured using biological technology. Hematoxylin-eosin (H&E) staining and immunohistochemical analysis were used to evaluate changes of pulmonary tissues including pathological abnormality, angiogenesis and macrophage accumulation.

RESULTS

Blockade CX3CR1 pathway inhibited angiogenesis, macrophage accumulation and pathological changes of lung tissues. Blockade of CX3CR1 pathway reduced pAkt, pERK, iNOS, PDGF and VEGF activation. CX3CR1 contributed to the process of angiogenesis and activate the pro-angiogenic factors. CX3CR1 deficiency obviously reduced the macrophage accumulation. Inhibition of VEGF by Bevacizumab improved intrapulmonary angiogenesis and pathological changes of lung tissues. Inhibition of VEGF by Bevacizumab retarded the production of pAKt, PDGF, and iNOS. Inhibition of VEGF by Bevacizumab reduced CX3CL1 production.

CONCLUSION

CX3CR1 could regulate the angiogenesis and activation of pro-angiogenic factors, including pAKT, pERK, iNOS, VEGF and PDGF in the process of hepato-pulmonary syndrome. Moreover, CX3CR1 could also contribute to the macrophage accumulation.

[Risk Factors of Death in Patients with Acute ST-segment Elevation Myocardial Infarction after PCI and the Combined Application of CTRP-1 with GRACE Score in Prognosis Evaluation of PCI Treated Patients]

OBJECTIVE

To explore the risk factors of 12-month mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to evaluate the combined use of inflammatory factor complement Cq1/tumor necrosis factor-related protein-1 (CTRP-1) with global acute coronary event registration (GRACE) score in the patients with STEMI after PCI in terms of prognostic prediction for 12-month mortality risk.

METHODS

326 acute STEMI patients were included retrospectively, with 33 patients in the death group and 293 patients in the survival group. Clinical data of patients and serum CTRP-1 concentration detected by enzyme-linked immunosorbent assay (ELISA) were collected, and all patients were evaluated by GRACE score. The cut-off point of CTRP-1 for predicting mortality was determined by receiver operating characteristic (ROC) curve. Cox regression model was used to analyze the risk factors of death. The predictive value of CTRP-1 combined with GRACE score was tested by Kaplan-Meier survival analysis.

RESULTS

Compared with the survival group, the average arterial pressure, left ventricular ejection fraction (LVEF) and left main lesion rate were lower, creatinine and troponin T were higher in the death group (P < 0.05). The mass concentration of CTRP-1 in the death group was higher than that in the survival group (P < 0.001). The proportion of patients in the high-risk group of GRACE score was 66.7% in the death group and 20.1% in the survival group. The area under the ROC curve of CTRP-1 was 0.874 (P < 0.001), and the sensitivity and specificity of predicting death were 92.5% and 73.6% respectively with the cut-off point of CTRP-1 187.9 ng/mL. Cox regression model showed that mean arterial pressure, LVEF, GRACE score and high CTRP-1 (>187.9 ng/mL) were independent risk factors for predicting death. Survival analysis showed that the cumulative survival rate of patients with high CTRP-1 level was lower than low CTRP-1 level in the high-risk group of GRACE score (P < 0.001).

CONCLUSIONS

Mean arterial pressure, LVEF value, GRACE score and CTRP-1 are risk factors for predicting mortality. Combined application of CTRP-1 with GRACE score has clinical value in prognostic evaluation of acute STEMI patients.

Association of PON1 gene polymorphisms with polycystic ovarian syndrome risk: a meta-analysis of case-control studies

PURPOSE

Evidences showed that paraoxonase 1 (PON1) gene polymorphism has an impact on women's susceptibility to polycystic ovarian syndrome (PCOS) by influencing the expression and activity of PON1. However, the effects of three PON1 polymorphisms (- 108 C>T, L55M and Q192R) on the incidence of PCOS have generated inconsistent results. Here, we conducted a meta-analysis to investigate the association between PON1 polymorphisms and PCOS risk.

METHODS

All eligible trials were identified via systematic searches of multiple literature databases. Outcome data were synthesized by using crude odds ratio with 95% confidence interval. Heterogeneity was assessed with the I² test. Publication bias and subgroup analyses were also performed.

RESULTS

A total of 2449 cases and 1977 controls from nine studies were selected for analysis. The pooled results showed a significant association between PCOS risk and PON1 - 108 C/T polymorphism in the following genetic models [allelic, 0.72 (0.56-0.92); homozygote, 0.51 (0.32-0.82); heterozygote, 0.44 (0.25-0.78); and dominant 0.47 (0.29-0.77)]. For the PON1 192 Q/R polymorphism, a significant relationship was found in the allelic model [0.62 (0.41-0.93)] and recessive model [0.61 (0.37-0.98)]. PCOS risk was also linked to PON1 L55M polymorphism in the heterozygote model [0.62 (0.39-0.98)] and dominant model [0.63 (0.41-0.96)].

CONCLUSIONS

Our study has shown that PON1 - 108 C/T polymorphism might be associated with increased risk of PCOS under the allelic, homozygote, heterozygote, and dominant models. Additionally, PON1 192 Q/R and L55M polymorphisms were significantly related only in the allelic and recessive model, and in the heterozygote and dominant model, respectively.

[Clinic pathological and ultrasonographic features of primary thyroid lymphoma]

Objective: To analyze the ultrasonographic and clinicopathological features of primary thyroid lymphoma(PTL). Methods: The ultrasonographic and clinicopathological featuresof 21 cases of pathologically-confirmed PTLs were analyzed retrospectively. Results: Of all 21 PTLs, 15 cases were diffuse large B-cell lymphoma, 4 were mucosal-associated lymphoid tissue extranodular marginal zone B-cell lymphoma, 1 was small B-cell lymphoma and 1 was classical Hodgkin lymphoma. Eight cases were proved by pathology with concomitant Hashimoto's thyroiditis. Ultrasonography observed bilateral or unilateral asymmetric goiter (21/21, 100.0%), marked hypoechogenicity (21/21, 100.0%) with posterior acoustic enhancement (19/21, 90.5%), heterogeneous echo texture with interspersed linear echogenic strands or intensive reticular echogenic strands or cloud echogenic, heterogeneous echo texture of thyroid gland (21/21, 100.0%), focal nodular hypoechoic(2/21, 9.5%) with regular or irregular shape, increased vascularity (13/21, 61.9%) and cervical lymphadenopathy (12/21, 57.1%). Two cases involved the anterior cervical muscle and 1 infiltrated trachea. Rapidly enlarging cervical mass were found in 13 cases (13/21, 61.9%)with associated compressive symptoms such as dyspnea, dysphagia and hoarseness. There was no any indisposed symptom in 3 cases. Conclusion: PTL has some common ultrasonographic and clinical features, core needle biopsy should be warranted to prove PTL.Surgical resection should be considered when needed to reduce misdiagnosis.

Lipoprotein-associated phospholipase A2 and risks of coronary heart disease and ischemic stroke in the general population: A systematic review and meta-analysis

BACKGROUND

This study investigated the associations between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risks of coronary heart disease (CHD) and ischemic stroke (IS) in the general population.

METHODS

PubMed, Embase, and the Cochrane Library databases were searched for prospective cohort studies published prior to June 2016. Multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for CHD and IS risks according to Lp-PLA2 activity or mass were extracted, pooled, and weighted using random-effects modeling.

RESULTS

Twelve studies examining Lp-PLA2 activity or mass and long-term risks of CHD and IS were included. Combined HRs for CHD and IS risks for the highest category referring to lowest category of Lp-PLA2 were 1.46 (95% CI: 1.20-1.78, P<0.001) and 1.58 (95% CI: 1.21-2.07, P=0.001), respectively. The same patterns were observed for both mass and activity, with the exception of those for CHD. For every 1-standard deviation (SD) increase in Lp-PLA2 activity, CHD risk increased by 12% (HR: 1.12, 95% CI: 1.05-1.22, P=0.002); no association between 1-SD increases in Lp-PLA2 activity and IS was observed. Lp-PLA2 mass was associated with CHD risk (HR: 1.02-1.24, 95% CI: 1.02-1.24, P=0.021). Lp-PLA2 mass per 1-SD increase was not associated with IS risk.

CONCLUSIONS

Greater Lp-PLA2 activity or mass was associated with an increased risk of CHD and IS; however, additional well-designed trials are warranted to confirm this association.

Multicentre randomized controlled trial with sensor-augmented pump vs multiple daily injections in hospitalized patients with type 2 diabetes in China: Time to reach target glucose

AIM

Sensor-augmented pump (SAP) technology, which combines continuous subcutaneous insulin infusion (CSII) and real-time continuous glucose monitoring (RT-CGM), has been available for several years in China. In this study, the time required to reach predefined glycaemic targets with SAP vs multiple daily injection (MDI) therapy was compared in hospitalized patients with type 2 diabetes mellitus (T2DM).

METHODS

Adults (aged 18-65 years) with T2DM treated with insulin and admitted to hospital for glucose management were randomized to either SAP (Medtronic MiniMed™ Paradigm™ 722 system) or MDI with blinded CGM (Medtronic MiniMed CGMS System Gold™) for a 2-week period. Glycaemic targets were defined as three preprandial measurements between 80 and 130mg/dL (4.4 and 7.2mmol/L) and three 2-h postprandial measurements between 80 and 180mg/dL (4.4 and 10.0mmol/L) within the same day.

RESULTS

When data from 81 patients (40 SAP, 41 MDI) were analysed, 21 patients using SAP therapy, compared with six using MDI therapy, achieved their glycaemic targets within 3 days, and their time to reach their glucose targets was significantly shorter (3.7±1.1 vs 6.3±3.1 days for MDI; P<0.001), while three MDI patients failed to reach glycaemic targets within 14 days. SAP vs MDI patients experienced significantly less hypoglycaemia [sensor glucose<50mg/dL (2.8mmol/L): 0.04% vs 0.32%, respectively; P<0.05] and significantly less hyperglycaemia [sensor glucose>180mg/dL (10mmol/L): 21.56% vs 35.03%, respectively; P<0.05].

CONCLUSION

SAP vs MDI therapy in hospitalized patients with T2DM significantly reduced the time required to achieve glycaemic targets, and such systems may be a cost-effective way to improve glucose control and reduce hospital stays in T2DM patients.

[Effects of Fluoxetine on Nogo Expression and Collagen Production with Decrease of Pulmonary Artery Pressure in Rats with Right Ventricular Failure.]

OBJECTIVES

To investigate the effect of fluoxetine on neurite growth inhibitor (Nogo) expession and collagen production of cardiac tissue in rats with right heart failure and pulmonary hypertension.

METHODS

Thirty one male SD rats were randomly divided into the treatment group,right heart failure group and normal control group.The rats in the treatment group and right heart failure group received intrapertioneal injection of monocrotaline (MCT,60 mg/kg) to induce pulmonary hypertension and right heart failure.After 21 days,the rats in treatment group were given fluoxetine of 10 mg/(kg×d) by gavage per day for 21 days,the rats in the other two groups were given saline.HE staining was used to observe the pulmonary artery and right ventricular myocardial tissue in rats.The collagen formation in right ventricular myocardium was observed by Masson staining.The expressions of Nogo-A, Nogo-B,type1collagen and type 3 collagen mRNA in myocardium were measured by real-time fluorescence quantitative PCR,while the semi quantitative measurement of Nogo protein level was detected by Western blot.

RESULTS

After the intervention of fluoxetine,pulmonary artery stenosis was significantly reduced,myocardial tissue lesion decreased,collagen synthesis decreased in right ventricular myocardium.RT-PCR showed that mRNA of Nogo-A decreased,and mRNA of Nogo-B increased (P<0.05).Western blot showed that the expression of Nogo-A protein decreased,while Nogo-B1 protein expression increased (P<0.05),Nogo-B2 expression was not significantly changed (P>0.05).

CONCLUSIONS

Nogo may affect the collagen synthesis in right heart failure,and partly involved in myocardial fibrosis.

Generation and Characterization of Patient-Specific iPSC Model for Cardiovascular Disease

Advances in differentiation of cardiomyocytes from human induced pluripotent stem cell (hiPSC) were emerged as a tool for modeling of cardiovascular disease that recapitulates the phenotype for the purpose of drug screening, biomarker discovery, and testing of single-nucleotide polymorphism (SNP) as a modifier for disease stratification. Here, we describe the (1) retroviral reprogramming strategies in the generation of human iPSC, (2) methodology in characterization of iPSC in order to identify the stem cell clones with the best quality, and (3) protocol of cardiac differentiation by modulation of Wnt signaling and β-catenin pathway.

Laparoscopic splenectomy for splenic littoral cell angioma

AIM: To establish the safety and feasibility of laparoscopic splenectomy (LS) for littoral cell angioma (LCA).

METHODS: From September 2003 to November 2013, 27 patients were diagnosed with LCA in our institution. These patients were divided into two groups based on operative procedure: LS (13 cases, Group 1) and open splenectomy (14 cases, Group 2). Data were collected retrospectively by chart review. Comparisons were performed between the two groups in terms of demographic characteristics (sex and age); operative outcomes (operative time, estimated blood loss, transfusion, and conversion); postoperative details (length of postoperative stay and complications); and follow-up outcome.

RESULTS: LS was successfully carried out in all patients except one in Group 1, who required conversion to hand-assisted LS because of perisplenic adhesions. The average operative time for patients in Group 1 was significantly shorter than that in Group 2 (127 ± 34 min vs 177 ± 25 min, P = 0.001). The average estimated blood loss in Group 1 was significantly lower than in Group 2 (62 ± 48 mL vs 138 ± 64 mL, P < 0.01). No patient in Group 1 required a blood transfusion, whereas one in Group 2 required a transfusion. Two patients in Group 1 and four in Group 2 suffered from postoperative complications. All the complications were cured by conservative therapy. There were no deaths in our series. All patients were followed up and no recurrence or abdominal metastasis were found.

CONCLUSION: LS for patients with LCA is safe and feasible, with preferable operative outcomes and long-term tumor-free survival.

Systemic lupus erythematosus patients in the low-latitude plateau of China: altitudinal influences

The current study was to investigate the features of hospitalized patients with systemic lupus erythematosus (SLE) at different altitudes. The correlation between SLE activity and altitudinal variations was also explored. Medical records of 1029 patients were retrospectively reviewed. Activity of SLE in each organ system was recorded using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). There was no significant correlation between SLE activity and altitudes (r = 0.003, p = 0.159). Age at onset for SLE patients at high altitudes was significantly younger than that at low and moderate altitudes (p = 0.022 and p = 0.004, respectively). Age at SLE admission at low altitudes was significant older than those at moderate and high altitudes (p = 0.011 and p < 0.001, respectively). Patients at high altitudes had shorter duration from disease onset to admission than those at moderate altitudes (p = 0.009). Incidence of Sm antibodies-positive for resident patients at high altitudes was 36.4%, which were higher than that at moderate altitudes (p = 0.003). We found increasing trends of CNS activity in active patients; immunological and renal activities in inactive patients were correlated with elevated altitudes (p = 0.024, p = 0.004, p = 0.005), while arthritis scores in active patients showed the tendency of decreasing with the rise of elevation (p = 0.002). Hemoglobin level, red blood cell and platelet counts at high altitudes were significantly lower than those at low altitudes (p < 0.05, respectively). There was no significant difference in hemoglobin level between moderate- and low-altitude groups (p > 0.05). No significant difference in platelet counts between moderate- and high-altitude groups was observed (p > 0.05). Our findings suggest that some clinical features, laboratory tests and activity of main organs in SLE are influenced by altitudes. Furthermore, organ activities of active and inactive SLE patients have different patterns of altitudinal variations. These distinctive variations likely reveal that peculiar environmental factors at high altitudes can affect the development of SLE.

Solid pseudopapillary tumor of the pancreas in male patients: Report of 16 cases

AIM: To investigate the clinical characteristics, surgical strategies and prognosis of solid pseudopapillary tumors (SPTs) of the pancreas in male patients.

METHODS: From July 2003 to March 2013, 116 patients were diagnosed with SPT of the pancreas in our institution. Of these patients, 16 were male. The patients were divided into two groups based on gender: female (group 1) and male (group 2). The groups were compared with regard to demographic characteristics, clinical presentations, surgical strategies, complications and follow-up outcomes.

RESULTS: Male patients were older than female patients (43.1 ± 12.3 years vs 33.1 ± 11.5 years, P = 0.04). Tumor size, location, and symptoms were comparable between the two groups. All patients, with the exception of one, underwent complete surgical resection. The patients were regularly followed up. The mean follow-up period was 58 mo. Two female patients (1.7%) developed tumor recurrence or metastases and required a second resection, and two female patients (1.7%) died during the follow-up period.

CONCLUSION: Male patients with SPT of the pancreas are older than female patients. There are no significant differences between male and female patients regarding surgical strategies and prognosis.

Surgical management and long-term follow-up of solid pseudopapillary tumor of pancreas: a large series from a single institution

OBJECTIVE

We summarized the diagnosis, surgical strategies, and long-term follow-up outcomes in our large series of solid pseudopapillary tumors (SPTs) of pancreas.

METHODS

In this retrospective analysis, we collected data pertaining to pancreatic SPTs diagnosed in 115 patients between July 2003 and February 2013.We analyzed the demographic characteristics, clinical presentations, operative strategies, perioperative details, and follow-up outcomes.

RESULTS

Abdominal pain was the most frequent symptom (40.0%). The most frequent location of SPT was pancreatic tail (36.5%). We performed 33 cases of pancreaticoduodenectomy, 15 cases of middle pancreatectomy, 19 cases of distal pancreatectomy with spleen preservation, 28 cases of distal pancreatectomy with splenectomy, and 18 cases of enucleation. Two patients suffered tumor recurrence and required a second resection of the recurrent tumor.

CONCLUSIONS

Complete resection of the tumor is associated with good survival, even in patients with vessel involvement or metastases. In patients with tumor recurrence, a second resection resulted in long-term survival.

Molecular imaging of pancreatic islet transplantation

Islet replacement therapy, pancreatic islet transplantation, is considered as a potential option for curing T1DM. However, the significant loss of implanted islets after islet transplantation prevents it from becoming a mainstream treatment modality. Due to the lack of reliable noninvasive real-time imaging techniques to track the survival of the islets, it is impossible to discover the specific causes for the loss of implanted islets, not to mention taking interventions in the early stage. Current achievements in molecular imaging has provided with several promising techniques, including optical imaging, PET and MRI, for noninvasive visualization, quantification and functional evaluation of transplanted islets in experimental conditions. Optical imaging seems to be the most convenient and cost-efficient modality, but the limited penetration distance hinders its application in large animal and human studies. PET combined with target-specific tracers is characterized by high specificity and sensitivity for detection of islet grafts, but observation time is rather short (i.e., several hours). MRI stands out for its long-term visualization of transplanted islet grafts with the aid of contrast agents. However, quantification of islets remains a problem to be solved. A novel technique, microencapsulation, provides a new perspective in multimodal imaging by optimizing the strengths of several modalities together. Although the application of molecular imaging in clinical settings is still limited, significant success and valuable information is achieved in the basic and clinical trials. However, islet transplantation still remains an experimental procedure, with ongoing researches focusing on islets availability, appropriate sites for implantation, new methods using biomaterials (e.g. microencapsulation), immune modulation and more.

Laparoscopic vs open total gastrectomy for gastric cancer: A meta-analysis

AIM: To conduct a meta-analysis comparing laparoscopic total gastrectomy (LTG) with open total gastrectomy (OTG) for the treatment of gastric cancer.

METHODS: Major databases such as Medline (PubMed), Embase, Academic Search Premier (EBSCO), Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched for studies comparing LTG and OTG from January 1994 to May 2013. Evaluated endpoints were operative, postoperative and oncological outcomes. Operative outcomes included operative time and intraoperative blood loss. Postoperative recovery included time to first flatus, time to first oral intake, hospital stay and analgesics use. Postoperative complications comprised morbidity, anastomotic leakage, anastomotic stenosis, ileus, bleeding, abdominal abscess, wound problems and mortality. Oncological outcomes included positive resection margins, number of retrieved lymph nodes, and proximal and distal resection margins. The pooled effect was calculated using either a fixed effects or a random effects model.

RESULTS: Fifteen non-randomized comparative studies with 2022 patients were included (LTG - 811, OTG - 1211). Both groups had similar short-term oncological outcomes, analgesic use (WMD -0.09; 95%CI: -2.39-2.20; P = 0.94) and mortality (OR = 0.74; 95%CI: 0.24-2.31; P = 0.61). However, LTG was associated with a lower intraoperative blood loss (WMD -201.19 mL; 95%CI: -296.50--105.87 mL; P < 0.0001) and overall complication rate (OR = 0.73; 95%CI: 0.57-0.92; P = 0.009); fewer wound-related complications (OR = 0.39; 95%CI: 0.21-0.72; P = 0.002); a quicker recovery of gastrointestinal motility with shorter time to first flatus (WMD -0.82; 95%CI: -1.18--0.45; P < 0.0001) and oral intake (WMD -1.30; 95%CI: -1.84--0.75; P < 0.00001); and a shorter hospital stay (WMD -3.55; 95%CI: -5.13--1.96; P < 0.0001), albeit with a longer operation time (WMD 48.25 min; 95%CI: 31.15-65.35; P < 0.00001), as compared with OTG.

CONCLUSION: LTG is safe and effective, and may offer some advantages over OTG in the treatment of gastric cancer.

[Effect of tetramethylpyrazine on Nogo gene regulation of the proliferation in cardiac fibroblast]

OBJECTIVE

To investigate the effects of different doses of Tetramethylpyrazine (TMP) on collagen synthesis and Nogo expression in cardiac fibroblasts and the potential role of Nogo in myocardial fibrosis.

METHODS

The cultured neonatal rat cardiac fibroblasts were induced by angiotensin II and TMP at the same time. The mRNA expression of Nogo-A, Nogo-B and collagen I were detected with real-time fluorescence quantitative PCR. And Nogo protein was semi-quantitatively detected by using Western blot method.

RESULTS

Under the intervention of TMP, the increased mRNA expression of Nogo-A and collagen I induced by angiotensin II were decreased, while the decreased mRNA expression of Nogo-B was increased. Compared with the control group, the expression of Nogo-A protein and Nogo-B protein showed similar changes as evaluated with Western blot.

CONCLUSION

TMP could inhibit collagen synthesis in cardiac fibroblast induced by angiotensin II. The accompanying differential expression of Nogo-A and Nogo-B indicated that the anti-fibrosis effect of TMP might be related to the regulation effects of Nogo gene.

The association of plasma free amino acids with liver enzymes in Type 2 diabetic patients

BACKGROUND

Elevated γ-glutamyl transpeptidase (GGT) and alanine aminotransferase (ALT) could predict the risk of Type 2 diabetes (T2D), but the reason for their elevation was unclear. GGT and ALT mediated the metabolism of many amino acids (AA). Up to now, it was not investigated whether abnormal AA concentration was associated with elevated liver enzymes.

AIM

This study was to investigate the status of AA in T2D and their relationship with liver enzymes.

SUBJECTS AND METHODS

A total of 132 T2D patients and 137 healthy controls were recruited. Plasma free AA were measured by high-performance liquid chromatography. The contribution of individual AA to liver enzymes was assessed by stepwise linear regression.

RESULTS

a) The levels of alanine, valine, leucine, isoleucine, phenylalanine, tyrosine, methionine, glutamate, and lysine were higher while the level of glycine was lower in T2D than in controls (all p<0.01). b) Glutamate contributed to GGT in T2D, and its contribution was even greater than that of waist circumference. Leucine, lysine, and glutamate contributed to ALT.

CONCLUSION

There were significant differences in plasma AA profile between T2D and controls. Abnormal AA might contribute to elevated liver enzymes. The interaction between AA, liver enzymes, and the risk of T2D should be further investigated by prospective studies.

Central pancreatectomy for benign or borderline lesions of the pancreatic neck: a single centre experience and literature review

BACKGROUND/AIMS

To investigate the effectiveness and safety of central pancreatectomy.

METHODOLOGY

We retrospectively studied 44 cases that underwent central pancreatectomy (CP), 55 patients who underwent distal pancreatectomy (DP), and 62 patients who underwent pancreatoduodenectomy (PD) for their benign or borderline pancreatic lesions; as well as the different management styles for pancreatic stumps in CP.

RESULTS

The duration of surgery and length of hospital stay were shorter in the CP group than that of PD group, and blood loss was also less in CP group. There were no differences between the CP and DP groups in duration of surgery, length of hospital stay, and blood loss. The incidence of common surgical complications was higher in the PD group. There were more pancreatic fistulas (grade B/C) in CP and PD groups compared to that of the DP group. New onset or worsening of diabetes occurred only in the CP and PD groups at 4.8% and 10.9%, respectively. A pancreaticogastrostomy for distal pancreatic stumps reduced the incidence of pancreatic fistula (p=0.038). Duct-to-mucosa anastomosis had less pancreatic fistula than invagination anastomosis (p=0.017). There was no difference in incidence of pancreatic fistula between pancreaticojejunostomy and oversewing of proximal pancreatic stumps (p=0.601).

CONCLUSIONS

CP is an available and safe operation for benign or borderline lesions located in the pancreatic neck. A pancreaticogastrostomy for distal pancreatic stumps or duct-to-mucosa anastomosis may reduce the risk of pancreatic fistula.

A clinical analysis of diabetic patients with hand ulcer in a diabetic foot centre

AIMS

The aim of the study was to explore the prevalence and clinical characteristics of hand ulcer in hospitalized patients with diabetes.

METHODS

We analysed 17 subjects with hand ulcer among diabetic inpatients, who were admitted to the Diabetic Foot Care Center, Department of Endocrinology and Metabolism at the West China Hospital of Sichuan University from April 2003 to December 2008.

RESULTS

The prevalence of diabetic hand ulcer among hospitalized patients (0.37%) was significantly lower than that of diabetic foot ulcers (9.7%, P = 0.000). The mean age was 62.1 +/- 9.4 years. The average known durations of diabetes and glycated haemoglobin (HbA(1c)) were 5.3 +/- 4.9 years and 10.9 +/- 2.4%, respectively. All patients lived in the subtropical zone. Fifteen patients (88.2%) were diagnosed with diabetic peripheral neuropathy. Ten patients had hand infection. After therapy, the ulcers healed in 13 patients (76.5%) and none of them experienced amputation. The average hospital stay for patients with local infection was characteristically longer than that for patients without infection (P = 0.012). The prognosis of the hand ulcer was poorer in the patients who had diabetes for > 3 years compared with those who had diabetes for < 3 years (P = 0.009).

CONCLUSIONS

Diabetic hand ulcer is a relatively rare complication of diabetes in South-West China. Long duration of diabetes, poorly controlled blood glucose, minor trauma and delayed treatment are the risk factors. Diabetic peripheral neuropathy may play an important role in the pathogenesis of hand ulcer. Early control of blood glucose with insulin and early anti-microbial therapy with appropriate antibiotics are crucial. Debridement and drainage are necessary for hand abscesses.

Aquaporin-1 expression and angiogenesis in rabbit chronic myocardial ischemia is decreased by acetazolamide

Aquaporin-1 (AQP1) is a water channel protein expressed in endothelial and epithelial cells of many tissues, including the vasculature, where it serves to increase water permeability of the cell membrane. Prior studies have also reported that AQP1 plays a central role in tumor angiogenesis by promoting endothelial cell migration. To investigate whether AQP1 might also influence vascular angiogenesis in ischemic myocardium, the expression level of AQP1 for 21 days post myocardial infarction in rabbit hearts was observed. Aquaporin-1 mRNA and protein levels in day 3, and peaked on day 7 post surgery. This correlated well with the pattern of neovascularization and increased water content of infarct border tissue, and suggested that AQP1 may be involved in myocardial angiogenesis in response to ischemia injury. These AQP1-induced changes were tempered by acetazolamide, a carbonic anhydrase inhibitor, which acted by downregulating AQP1 expression. Acetazolamide treatment did not significantly affect the expression of vascular endothelial growth factor in the tissues studied. Our findings indicate a novel role for AQP1 in postnatal angiogenesis, which has implications in diverse pathophysiological conditions including wound healing, tumor metastasis, and organ regeneration.