Triple metachronous primary cancer of uterus, colon, and breast cancer: A case report and review of the literature

RATIONALE

Triple or more primary malignancies are rare, with only 23 previous cases including breast cancer reported in the English language studies between January 1990 and December 2019.

PATIENT CONCERNS

The patient was a 67-year-old woman with a mass in her right breast. She had a previous history of uterine and colon cancer. Both ultrasonography and mammography revealed a Breast Imaging Reporting and Data System (BI-RADS) category 3 breast lesion, in which proliferative nodules are more likely. Given her previous history of 2 malignancies, her doctors strongly recommended a biopsy.

DIAGNOSIS AND INTERVENTIONS

The biopsy pathology suggested intraductal breast cancer. Mastectomy and sentinel lymph node biopsy were performed. The postoperative pathological diagnosis was invasive ductal carcinoma, grade II, stage I. The sample was positive for estrogen receptor and progesterone receptor and negative for cerbB-2. No radiotherapy or chemotherapy was administered except for endocrine therapy. A follow-up at 19 months showed no breast recurrence or distant metastases.

OUTCOMES

No recurrence or distant metastasis occurred within the 19-month, 11-year, and 20-year follow-ups for breast, colon, and uterine cancers, respectively.

LESSONS

To our knowledge, this is the first review of triple or more primary malignancies including breast cancer. These malignancies occur predominantly in older female patients. The most prevalent tumors of triple or more primary malignancies including breast cancer occur in the colon, uterus, and lung. A favorable prognosis is associated with early-stage malignancies.

Immune cell infiltration features and related marker genes in lung cancer based on single-cell RNA-seq

PURPOSE

Immune cells in the immune microenvironment of lung cancer have a great impact on the development of lung cancer. Our purpose was to analyze the immune cell infiltration features and related marker genes for lung cancer.

METHODS

Single cell RNA sequencing data of 11,485 lung cancer cells were retrieved from the Gene Expression Omnibus. After quality control and data normalization, cell clustering was performed using the Seurat package. Based on the marker genes of each cell type from the CellMarker database, each cell was divided into G1, G2M, and S phases. Then, differential expression and functional enrichment analyses were performed. CIBERSORT was used to reconstruct immune cell types.

RESULTS

Following cell filtering, highly variable genes were identified for all cells. 14 cell types were clustered. Among them, CD4 + T cell, B cell, plasma cell, natural killer cell and cancer stem cell were the top five cell types. Up-regulated genes were mainly enriched in immune-related biological processes and pathways. Using CIBERSORT, we identified the significantly higher fractions of naïve B cell, memory CD4 + T cell, T follicular helper cell, T regulatory helper cell and M1 macrophage in lung cancer tissues compared to normal tissues. Furthermore, the fractions of resting NK cell, monocyte, M0 macrophage, resting mast cell, eosinophil and neutrophil were significantly lower in tumor tissues than normal tissues.

CONCLUSION

Our findings dissected the immune cell infiltration features and related marker genes for lung cancer, which might provide novel insights for the immunotherapy of lung cancer.

Circle RNA circABCB10 Modulates PFN2 to Promote Breast Cancer Progression, as Well as Aggravate Radioresistance Through Facilitating Glycolytic Metabolism Via miR-223-3p

Background: Breast cancer (BC) is a common tumor in women worldwide, and irradiation (IR) resistance is a major obstacle for BC therapy. Circle RNAs (circRNAs) were identified as implicated in the progression of cancer and IR resistance. However, the role of circABCB10 in BC progression and IR resistance is not well defined. Materials and Methods: The levels of circABCB10, miR-223-3p, and profilin-2 (PFN2) were detected by quantitative real-time polymerase chain reaction. The cell viability and survival rate were monitored by MTT assay. The glucose consumption, lactic acid production, LDH-A activity, and ATP production were evaluated to measure glycolysis. The protein levels of hypoxia inducible factor-1α (HIF-1α), hexokinase 2 (HK2), lactate dehydrogenase A chain (LDH-A), and PFN2 were estimated by Western blot assay. The colony formation rate was tested by colony formation assay. Dual-luciferase reporter assay was constructed to validate the interaction between miR-223-3p and circABCB10 or PFN2. The mice xenograft assay was performed to further verify the effects of circABCB10 on BC progression in vivo. Results: CircABCB10 and PFN2 were elevated, while miR-223-3p was reduced in BC tissues and cells. CircABCB10 sponged miR-223-3p, and PFN2 was a target of miR-223-3p in BC cells. CircABCB10 silencing inhibited cell proliferation, glycolysis, colony formation, and decreased IR resistance in BC cells by modulating miR-223-3p. Meanwhile, circABCB10 depletion restrained xenograft tumor growth in vivo. Also, miR-223-3p overexpression refrained cell proliferation, glycolysis, and colony formation while improving IR sensitivity in BC cells by regulating PFN2. Besides, circABCB10 knockdown declined PFN2 in BC cells via miR-223-3p. The glycolysis inhibitor 2-deoxy-D-glucose enhanced IR sensitivity in BC cells via circABCB10. Conclusion: CircABCB10 knockdown contributed to irradiation sensitivity by negatively regulating glycolysis via the miR-223-3p/PFN axis in breast cancer.

Novel microcapsules for internal curing of high-performance cementitious system

Conventional internal curing materials for high-performance cementitious system cannot easily have artificial modifications, such that the curing effect is difficult to control during the process. In this study, a novel microcapsule is proposed for controlled internal curing of cement-based materials. The microcapsules are synthesized by a double emulsion method to form a polymer shell-water core structure. The sensitivity of polymer shell to alkaline environments is used to trigger the release of core water. Thus, water release can be controlled by tailoring the shell thickness and microcapsules sizes by changing the polymer dosage and stirring rate during synthesis. The experimental results indicate that the novel microcapsules can effectively release water for internal curing of a cementitious matrix, which exhibits a high curing efficiency in terms of nearly autogenous shrinkage and increases the compressive strength. The novel microcapsules could be promising internal curing agents to enhance high-performance cement-based materials.

Comparison of nitrogen and phosphorus removal efficiency between two types of baffled vertical flow constructed wetlands planted with Oenanthe Javanica

The environmental problems related to rural domestic sewage treatment are becoming increasingly serious, and society is also concerned about them. A baffled vertical flow constructed wetland (BVFCW) is a good choice for cleaning wastewater. Herein, a drinking-water treatment sludge-BVFCW (D-BVFCW) parallel with ceramsite-BVFCW (C-BVFCW) planted with Oenanthe javanica (O. javanica) to treat rural domestic sewage was investigated, aiming to compare nitrogen and phosphorus removal efficiency in different BVFCWs. A removal of 23.9% NH₄ ⁺-N, 24.6% total nitrogen (TN) and 76.7% total phosphorus (TP) occurred simultaneously in the D-BVFCW; 56.4% NH₄ ⁺-N, 60.8% TN and 55.2% TP respectively in the C-BVFCW. The root and plant height increased by an average of 7.9 cm and 8.3 cm, respectively, in the D-BVFCW, and by 0.7 cm and 1.1 cm, respectively, in the C-BVFCW. These results demonstrate that the D-BVFCW and C-BVFCW have different effects on the removal of N and P. The D-BVFCW mainly removed P, while C-BVFCW mainly removed N.

Effects of Epichloë gansuensis Endophyte on the Root and Rhizosphere Soil Bacteria of Achnatherum inebrians Under Different Moisture Conditions

This study was conducted to explore effects of the systemic fungal endophyte Epichloë gansuensis on root and rhizosphere soil bacterial diversity of Achnatherum inebrians host plants growing under different moisture conditions. Soil properties of different treatments were compared using standard techniques. A total of 4371379 16S rRNA gene sequences were obtained and assigned to 5025 operational taxonomic units (OTUs). These OTUs in roots and rhizosphere soil were divided into 13 and 17 phyla, respectively, and the Actinobacteria and Proteobacteria were the most abundant phyla both in roots and rhizosphere soil. Shannon diversity and Chao1 richness index of bacteria in rhizosphere soil was significantly higher than in roots. E. gansuensis decreased the Shannon diversity of the root-associated bacterial community, and increased Shannon diversity and Chao1 richness index of the rhizosphere soil bacterial community of A. inebrians. Meanwhile, Chao1 richness of the rhizosphere soil bacterial community of A. inebrians significantly increased with the increase of the soil moisture level. Structural equation modeling also emphasized that E. gansuensis decreased the diversity of the root-associated bacterial community and increased the diversity of the rhizosphere soil bacterial community through decreasing soil available N. Additionally, soil moisture increased the diversity of the rhizosphere soil bacterial community through increased soil pH, C/N, and NN, and decreased soil AP. The E. gansuensis endophyte and soil moisture effects on root and rhizosphere soil bacterial diversity were likely to be from responses to modifications of the rhizosphere soil properties.

Shoulder imbalance treated with scapuloplasty surgery in scoliosis patients: a clinical retrospective study

BACKGROUND

To discuss the clinical efficacy and safety of scapuloplasty treating the shoulder imbalance in scoliosis patients.

METHODS

A retrospective analysis was made on 21 patients who underwent scoliosis corrective surgery combined with scapuloplasty from September 2013 to March 2015. The average follow-up was 31.4 ± 5.3 months (24-42 months). The shoulder vertical difference (SVD), adjusted Constant-Murley score, range of shoulder motion function, Cavendish grade, and the overall satisfaction were compared among the pre-surgery, post-surgery, and the final follow-up periods.

RESULTS

The shoulder vertical difference (SVD) significantly decreased at the time of post-surgery and the final follow-up, comparing the score of the pre-surgery. The SVD of all patients were decreased from preoperatively 3.2 ± 1.1 cm to 0.4 ± 0.3 cm, with the Cavendish grade improved to grade 1 at the final follow-up. The adjusted Constant-Murley score and range of shoulder motion function showed no significant difference during the three time periods (p > 0.05). And no severe complications had occurred over 2 years follow-up.

CONCLUSION

The scapuloplasty surgery shows to be an effective and safety procedure to improve the shoulder imbalance, cosmetic appearance, and the overall satisfaction in scoliosis patients without impairing the shoulder function, which can be widely applied in clinic.

Effect of carbamazepine on the bone health of people with epilepsy: a systematic review and meta-analysis

Importance

Objective

Methods

Results

[Preparation and characterization of a hemostatic porous platelet-rich plasma chitosan/silk fibroin wound dressing]

In order to further improve the hemostatic performance of wound dressings, human platelet-rich plasma (PRP) containing various growth factors was introduced into chitosan solution. The silk fibroin solutions with different volume ratios (1:1, 1:3, 3:1 and 1:0) were added to improve the porosity and hemostasis of materials. The hPRP-chitosan/silk wound dressings with different ratios was prepared by freeze-drying and pure chitosan dressing was considered as the control group to study the effects of PRP and silk fibroin in different proportions on the hemostasis properties and the growth factors burst release. The hemostasis of chitosan dressing was improved by introducing PRP, but the porous structure and water absorption were not significantly improved. If silk fibroin solution was added in the ratio of 1:1, the more uniform porous structure and better hemostatic performance could be obtained. The porosity and water absorption could reach 86.83%±3.84% and 1 474%±114% respectively. In addition, the dressings with ratio of 1:1 had positive effects on reducing the burst release of growth factors on initial stage. Therefore, PRP-chitosan/silk fibroin composite dressing can become a kind of wound dressing that can achieve rapid hemostasis and promote wound healing.

Interactions of Alginate-Deferoxamine Conjugates With Blood Components and Their Antioxidation in the Hemoglobin Oxidation Model

While deferoxamine (DFO) has long been used as an FDA-approved iron chelator, its proangiogenesis ability attracts increasing number of research interests. To address its drawbacks such as short plasma half-life and toxicity, polymeric conjugated strategy has been proposed and shown superiority. Owing to intravenous injection and application in blood-related conditions, however, the blood interactions and antioxidation of the DFO-conjugates and the mechanisms underlying these outcomes remain to be elucidated. In this regard, incubating with three different molecular-weight (MW) alginate-DFO conjugates (ADs) red blood cells (RBCs), coagulation system, complement and platelet were investigated. To prove the antioxidant activity of ADs, we used hemoglobin oxidation model in vitro. ADs did not cause RBCs hemolysis while reversible aggregation and normal deformability ability were observed. However, the coagulation time, particularly APTT and TT, were significantly prolonged in a dose-dependent manner, and fibrinogen was dramatically decreased, suggesting ADs could dominantly inhibit the intrinsic pathways in the process of coagulation. The dose-dependent anticoagulation might be related with the functional groups along the alginate chains. The complements, C3a and C5a, were activated by ADs in a dose-dependent manner through alternative pathway. For platelet, ADs slightly suppressed the activation and aggregation at low concentration. Based on above results, the cross-talking among coagulation, complement and platelet induced by ADs was proposed. The antioxidation of ADs through iron chelation was proved and the antioxidant activity was shown in a MW-dependent manner.

ZYZ-803, a novel hydrogen sulfide-nitric oxide conjugated donor, promotes angiogenesis via cross-talk between STAT3 and CaMKII

Endothelial angiogenesis plays a vital role in recovery from chronic ischemic injuries. ZYZ-803 is a hybrid donor of hydrogen sulfide (H2S) and nitric oxide (NO). Previous studies showed that ZYZ-803 stimulated endothelial cell angiogenesis both in vitro and in vivo. In this study, we investigated whether the signal transducer and activator of transcription 3 (STAT3) and Ca2+/CaM-dependent protein kinase II (CaMKII) signaling was involved in ZYZ-803-induced angiogenesis. Treatment with ZYZ-803 (1 μM) significantly increased the phosphorylation of STAT3 (Tyr705) and CaMKII (Thr286) in human umbilical vein endothelial cells (HUVECs), these two effects had a similar time course. Pretreatment with WP1066 (STAT3 inhibitor) or KN93 (CAMKII inhibitor) blocked ZYZ-803-induced STAT3/CAMKII activation and significantly suppressed the proliferation and migration of HUVECs. In addition, pretreatment with the inhibitors significantly decreased ZYZ-803-induced tube formations along with the outgrowths of branch-like microvessels in aortic rings. In the mice with femoral artery ligation, administration of ZYZ-803 significantly increased the blood perfusion and vascular density in the hind limb, whereas co-administration of WP1066 or KN93 abrogated ZYZ-803-induced angiogenesis. By using STAT3 siRNA, we further explored the cross-talk between STAT3 and CaMKII in ZYZ-803-induced angiogenesis. We found that STAT3 knockdown suppressed ZYZ-803-induced HUVEC angiogenesis and affected CaMKII expression. ZYZ-803 treatment markedly enhanced the interaction between CaMKII and STAT3. ZYZ-803 treatment induced the nuclear translocation of STAT3. We demonstrated that both STAT3 and CaMKII functioned as positive regulators in ZYZ-803-induced endothelial angiogenesis and STAT3 was important in ZYZ-803-induced CaMKII activation, which highlights the beneficial role of ZYZ-803 in STAT3/CaMKII-related cardiovascular diseases.

Effects of Betel Quid, Smoking and Alcohol on Oral Cancer Risk: A Case-Control Study in Hunan Province, China

Background: The high prevalence of betel quid chewing is associated with a serious burden of oral diseases. However, there is limitertd research on the effects of betel quid, smoking, and alcohol on oral cancer in the Hunan province, China. Objectives: We investigated the relationship between oral cancer and betel quid chewing, smoking, and alcohol consumption in the betel quid endemic area of Hunan province. Methods: A paired case-control study from January 2014 to September 2015 was conducted in the Hunan province, China. We recruited 304 oral cancer patients and 304 controls as subjects, and both groups were treated in the same provincial cancer hospital. Control subjects and cancer patients were matched by sex, age (3-year groups), education level, and residential district. Conditional logistic regression analyses were used to examine the associations between oral cancer and betel quid, smoking, and alcohol consumption. Results: A significantly increased risk of oral cancer was associated with smoking, alcohol consumption, and betel quid chewing (odds ratio [OR] of 1.49, 1.56, and 5.80, respectively; p < .05). The risk of cancer was significantly elevated at high levels of intake and prolonged duration of consumption of betel quid, smoking, and alcohol. After adjusting for confounders, betel quid chewers were found to have almost 5 times increased risk for oral cancer (OR = 5.41, 95% confidence interval: 3.32-8.80, p < .001). Conclusions: There was a positive correlation between betel quid chewing and risk of oral cancer in the Hunan Province.

The cell uptake properties and hyperthermia performance of Zn0.5Fe2.5O4/SiO2 nanoparticles as magnetic hyperthermia agents

Zn0.5Fe2.5O4 nanoparticles (NPs) of 22 nm are synthesized by a one-pot approach and coated with silica for magnetic hyperthermia agents. The NPs exhibit superparamagnetic characteristics, high-specific absorption rate (SAR) (1083 wg-1, f = 430 kHz, H = 27 kAm-1), large saturation magnetization (M s = 85 emu g-1), excellent colloidal stability and low cytotoxicity. The cell uptake properties have been investigated by Prussian blue staining, transmission electron microscopy and the inductively coupled plasma-mass spectrometer, which resulted in time-dependent and concentration-dependent internalization. The internalization appeared between 0.5 and 2 h, the NPs were mainly located in the lysosomes and kept in good dispersion after incubation with human osteosarcoma MG-63 cells. Then, the relationship between cell uptake and magnetic hyperthermia performance was studied. Our results show that the hyperthermia efficiency was related to the amount of internalized NPs in the tumour cells, which was dependent on the concentration and incubation time. Interestingly, the NPs could still induce tumour cells to apoptosis/necrosis when extracellular NPs were rinsed, but the cell kill efficiency was lower than that of any rinse group, which indicated that local temperature rise was the main factor that induced tumour cells to death. Our findings suggest that this high SAR and biocompatible silica-coated Zn0.5Fe2.O4 NPs could serve as new agents for magnetic hyperthermia.

A Novel Liposomal S-Propargyl-Cysteine: A Sustained Release of Hydrogen Sulfide Reducing Myocardial Fibrosis via TGF-β1/Smad Pathway

Purpose

S-propargyl-cysteine (SPRC; alternatively known as ZYZ-802) is a novel modulator of endogenous tissue H₂S concentrations with known cardioprotective and anti-inflammatory effects. However, its rapid metabolism and excretion have limited its clinical application. To overcome these issues, we have developed some novel liposomal carriers to deliver ZYZ-802 to cells and tissues and have characterized their physicochemical, morphological and pharmacological properties.

Methods

Two liposomal formulations of ZYZ-802 were prepared by thin-layer hydration and the morphological characteristics of each liposome system were assessed using a laser particle size analyzer and transmission electron microscopy. The entrapment efficiency and ZYZ-802 release profiles were determined following ultrafiltration centrifugation, dialysis tube and HPLC measurements. LC-MS/MS was used to evaluate the pharmacokinetic parameters and tissue distribution profiles of each formulation via the measurements of plasma and tissues ZYZ-802 and H₂S concentrations. Using an in vivo model of heart failure (HF), the cardio-protective effects of liposomal carrier were determined by echocardiography, histopathology, Western blot and the assessment of antioxidant and myocardial fibrosis markers.

Results

Both liposomal formulations improved ZYZ-802 pharmacokinetics and optimized H₂S concentrations in plasma and tissues. Liposomal ZYZ-802 showed enhanced cardioprotective effects in vivo. Importantly, liposomal ZYZ-802 could inhibit myocardial fibrosis via the inhibition of the TGF-β1/Smad signaling pathway.

Conclusion

The liposomal formulations of ZYZ-802 have enhanced pharmacokinetic and pharmacological properties in vivo. This work is the first report to describe the development of liposomal formulations to improve the sustained release of H₂S within tissues.

Chemotherapy combined with bevacizumab for the treatment of advanced lung adenocarcinoma cancer harboring EGFR-ANXA2, EGFR-RAD51, ATR and BRCA2 mutations: A case report

Here, we report a case of a 36‐year‐old female patient with metastatic non‐small cell lung cancer (NSCLC) harboring EGFR‐ANXA2 and EGFR‐RAD51 double fusion mutations with BRCA2 (nonsense mutation of exon 11) and ATR mutations (Exon 44 variable shear mutation) identified by next generation sequencing (NGS). The efficacy was significantly improved after lobaplatin combined with pemetrexed, temozolomide and bevacizumab. This is the first report of a novel mutation type EGFR‐ANXA2, as well as double EGFR fusion mutations in advanced lung adenocarcinoma. Furthermore, platinum‐based chemotherapy plus bevacizumab rather than targeted therapy showed favorable effects in this patient, providing a novel therapeutic conception for patients, even with multidriver mutations.

Unilateral curved versus bipedicular vertebroplasty in the treatment of osteoporotic vertebral compression fractures

Background

Vertebral compression fracture is one of the most common complications of osteoporosis. In this study an unilateral curved vertebroplasty device was developed, and the safety, effectiveness, and surgical parameters of curved vertebroplasty (CVP) in the treatment of painful osteoporotic vertebral compression fractures was investigated and compared with traditional bipedicular vertebroplasty (BVP).

Methods

We investigated 104 vertebral augmentation procedures performed over 36 months. CVP and BVP procedures were compared for baseline clinical variables, pain relief (Visual Analog Scale, VAS), disability improvement (Oswestry Disability Index, ODI), operation time, number of fluoroscopic images, volume of cement per level, and cement leakage rate for each level treated. Complications and refracture incidence were also recorded in the two groups.

Results

The VAS and ODI in both group had no significant difference preoperative (P > 0.05), and a significant postoperative improvement in the VAS scores and ODI was found in both group (P < 0.001). However, the CVP group had significantly lower operation time, number of fluoroscopic images, and cement leakage rate per level than the BVP group (P < 0.05); however, the volumes of cement per level were similar in the two groups (P > 0.05). Neither group had any serious complications. Five and two patients in the BVP group developed refractures at non-adjacent and adjacent levels, respectively, with one patient developing refractures twice; however, none of the patients in the CVP group developed refractures at any level.

Conclusions

Our findings revealed that both CVP and BVP were safe and effective treatments for osteoporotic vertebral compression fractures, and CVP entails a shorter operation time, less exposure to fluoroscopy, and lower rate of cement leakage.

Primary sclerosing cholangitis with increased immunoglobulin G4 levels: A case report

RATIONALE

Primary sclerosing cholangitis (PSC) is recognized as an autoimmune-mediated liver disease characterized by progressive biliary inflammation and fibrosis. Some PSC cases with elevated immunoglobulin G4 (IgG4) levels are likely to be misdiagnosed with immunoglobulin G4-related sclerosing cholangitis (IgG4-SC). Thus, distinguishing these 2 diseases is particularly important.

PATIENT CONCERNS

A 34-year-old male presented with right hypochondrium abdominal intermittent pain and jaundice lasting for 1 month. Here, we present a case of PSC with increased IgG4 levels with improvement of quality of life upon liver transplantation (LT).

DIAGNOSIS

The diagnosis of PSC was confirmed based on clinical symptoms, laboratory test results, imaging findings, pathologic results and a lack of response to steroid therapy.

INTERVENTIONS

LT surgery was performed successfully when his vital parameters were stabilized. Immunosuppressive agents were routinely used after LT.

OUTCOMES

Three years after LT, liver function values show that alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were in the normal range. An abdominal ultrasonography showed no obvious abnormalities.

LESSONS

There are similar biochemical characteristics and cholangiographic findings between PSC and IgG4-SC. Therefore, distinguishing these 2 diseases is particularly important. LT remains the only option for end-stage PSC. Early diagnosis and effective treatment can achieve a good prognosis.

Familial Hemiplegic Migraine With Progressive Cerebellar Ataxia Caused by a p.Thr666Met CACNA1A Gene Mutation in a Chinese Family

Here, we describe the first case of familial hemiplegic migraine type 1 (FHM1) resulting from a T666M mutation in the CACNA1A gene of a Chinese individual. A 54-year-old female patient demonstrated extensive clinical manifestations, including transient paropsia, hemianesthesia, logaphasia, hemiplegia, migraine, fever, impaired consciousness, and progressive cerebellar ataxia. At admission, neurological examination showed a fever of 38.6°C, coma, bilateral pupillary constriction, left-sided deviation of both eyes, meningeal irritation, and bilateral positive Chaddock's sign. Brain magnetic resonance imaging (MRI) displayed only cerebellar atrophy. The pressure and white blood cells of the cerebrospinal fluid (CSF) were elevated. Her nine relatives also had similar clinical spectra. To further clarify the diagnosis, we conducted a genetic analysis on the family. The results of genetic testing showed that all seven living affected members carried the T666M mutation in the CACNA1A gene. This case report indicates that the diagnosis of FHM should be taken into account when a patient manifests migraine accompanied with hemiplegia, acute encephalopathy, and abnormal CSF. In addition, genetic testing is indispensable for the identification of some atypical attacks of hemiplegic migraine.

Bone Mineral Density Loss in People With Epilepsy Taking Valproate as a Monotherapy: A Systematic Review and Meta-Analysis

Objective: Data on changes in bone mineral density (BMD) from valproate (VPA) therapy are ambiguous and conflicting. Thus, the aim of this study was to systematically review the existing data and carry out a meta-analysis to investigate the effect of VPA as a monotherapy on BMD in people with epilepsy (PWE).

Methods: We systematically searched PubMed, EMBASE, and MEDLINE for eligible studies. We calculated the standardized mean difference (SMD) with 95% confidence interval (CI) to investigate the statistical power of the association between VPA treatment and BMD.

Results: Nineteen studies were included in this systematic review and meta-analysis. We found that BMD was lower in the VPA group than in the control group (SMD: −0.44; 95% CI: −0.65 to −0.22). A significant association was found in adult patients (SMD: −0.57; 95% CI: −0.88 to −0.26; I² = 69.8%) and pediatric patients (SMD: −0.32; 95% CI: −0.60 to −0.03; I² = 67.8%) by subgroup analysis. This study indicated that BMD was significantly lower in patients treated for more than 36 months than in controls (SMD: −0.52; 95% CI: −0.76 to −0.27; I² = 61.8%). However, a significant difference was not found between patients who were treated for less than 36 months and controls (SMD: −0.36; 95% CI: −0.72 to 0.01; I² = 74.8%).

Conclusion and significance: The present study provided evidence that VPA treatment was significantly associated with BMD loss in PWE. Thus, for patients at a high risk of osteoporosis and fracture, especially for patients who need long-term treatment, VPA may not be a good choice.

Biomimetic phosphorylcholine strategy to improve the hemocompatibility of pH-responsive micelles containing tertiary amino groups

pH-responsive nanocarriers such as polymeric micelles that self-assemble from amphiphilic copolymers containing amino groups have been limited by their significant effects on the blood and thus compromise of their hemocompatibility due to the amino group-induced positive charges. Here we report a biomimetic phosphorylcholine strategy to improve the hemocompatibility of the pH-responsive micelles with positive charges. Amphiphilic copolymers containing different number of tertiary amino groups were synthesized in five steps through ring opening polymerization, azide reaction, thio-bromo "Click" chemistry, and atom transfer radical polymerization to self-assemble biomimetic phosphorylcholine micelles with pH-responsiveness, which shown no significant effects on red blood cells, coagulation, and platelet activation. Moreover, albumin adsorption on the micelles was significantly lower than that of polycaprolactone-methoxypolyethylene glycol (PCL-mPEG) control, and in terms of immune cells, the micelles showed controllable phagocytosis that dependent on the number of tertiary amino groups, in which the one containing four tertiary amino groups in its corresponding copolymer remains had a lower phagocytosis by whole blood leukocyte than that of PCL-mPEG. Based on these results, the hemocompatibility related mechanism of the micelles was discussed and proposed. Our findings demonstrated that this biomimetic phosphorylcholine is a promising strategy to improve the hemocompatibility of the positively charged nanocarriers.

Elevated Blood C-Reactive Protein Levels in Patients With Epilepsy: A Systematic Review and Meta-Analysis

Background: In recent years, increasing attention has been paid to the association between C-reactive protein (CRP) levels and epilepsy. However, studies concerning CRP levels in epilepsy have also yielded conflicting results. Thus, the objective of the present study is to systematically review the evidence and conduct a meta-analysis to investigate CRP levels in epileptic patients compared with healthy controls.

Methods: A systematic search of PubMed, EMBASE, and the Cochrane Library was performed for eligible studies. Standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were used as a measure to assess the association between CRP and epilepsy.

Results: In total, 16 case–control studies were included in the present meta-analysis, which comprised 1918 individuals. Combined results indicated that epileptic patients had significantly increased CRP levels in peripheral blood compared with healthy controls (SMD = 0.43; 95% CI: 0.19–0.67). In addition, subgroup analyses by age demonstrated that significant differences in blood CRP levels between epileptic patients and healthy controls could be found in adults (SMD = 0.47; 95% CI: 0.21–0.73) but not children (SMD = 0.26; 95% CI: −0.48–0.99).

Conclusion: The present meta-analysis shows that the CRP levels in peripheral blood were significantly increased in epileptic patients compared to healthy controls, indicating a significant association between inflammation and epilepsy. Epileptic seizures may be associated with the inflammatory response.

Association between interleukin-6 gene polymorphisms and febrile seizure risk: A meta-analysis

BACKGROUND

The association between plasma interleukin-6 (IL-6) levels and the development of febrile seizures (FS) has been reported in multiple previous studies, which showed significantly higher serum IL-6 levels in FS patients than in control patients. However, the mechanism underlying this association remains unclear. One previous study indicated an increased frequency of the -174 GG and -597 GG genotypes in FS patients. Although IL-6 gene polymorphisms may be associated with FS risk, this association remains a matter of debate.

OBJECTIVE

Considering the lack of meta-analyses addressing the possible association between IL-6 gene polymorphisms and the risk of FS, we aimed to perform a meta-analysis to determine the association of IL-6 gene polymorphisms (-572, -174, -597) with the risk of FS.

METHODS

We conducted a systematic literature search in the PubMed, EMBASE, and WANFANG databases to collect eligible articles. The associations of IL-6 gene polymorphisms with FS risk were evaluated by calculating the pooled odds ratios and 95% confidence intervals. The dominant, recessive, heterozygous, homozygous, and allele genetic models were used to calculate the combined ORs.

RESULTS

Our meta-analysis showed that IL-6 (-572, -174, -597) polymorphisms were significantly associated with susceptibility to FS.

CONCLUSION

This study provided knowledge regarding the association of IL-6 (572, 174, 597) polymorphisms with susceptibility to FS. The T allele and TT genotype may be associated with an increased risk for FS.

The valuation of concave-side thoracoplasty on the treatment of extremely severe scoliosis with severe pulmonary dysfunction on the base of halo-pelvic traction

Extremely severe scoliosis patients, especially main thoracic Cobb' s angle >150°, often have severe thoracic deformity and pulmonary dysfunction, even the scoliosis is reduced by halo-pelvic traction, the improvement of pulmonary function is not satisfactory, the risk of spinal osteotomy in the next stage is still very high and left with obvious thoracic deformity. How to further improve the pulmonary function and appearance of these patients is a difficult problem to be solved.Twenty extremely severe scoliosis patients with severe pulmonary dysfunction who underwent concave-side thoracoplasty in our hospital from September 2014 to September 2017 were included, data of thoracic volume and pulmonary function were collected before and after operation. The pulmonary function value reported was predicted forced vital capacity (FVC%), T-test was used to analyze the changes of the data by the statistical software SPSS21.0.The 20 patient's averaged Cobb's angle of main thoracic was 163° ± 8° at admission and all of them with severe pulmonary dysfunction before concave-side thracoplasty. After operation, the thoracic volume of patients increased by 500.9 ± 222.9 mL, FVC% increased by 8.9% ± 7.5%. Both the difference has statistical significance (P < .01).Concave-side thoracoplasty based on the halo-pelvic traction cannot only enlarge the volume of the concave thoracic cavity, lighten the compression of lung and further improve the pulmonary function of extremely severe scoliosis, but also can strengthen the correction of scoliosis and spinal rotation. Therefore, it is a safe and effective surgical approach.

The P300 Event-Related Potential Component and Cognitive Impairment in Epilepsy: A Systematic Review and Meta-analysis

Background: Epilepsy is one of the most prevalent chronic brain diseases worldwide and is often accompanied by cognitive impairment. Event-related potentials (ERPs) are an objectively non-invasive approach for studying information processing and cognitive functions in the brain. The P300 is an important and extensively explored late component of ERPs that has been widely applied to assess cognitive function in epilepsy in previous studies. However, consistent conclusions have not yet been reached for various reasons.

Objective: We conducted a comprehensive systematic review and meta-analysis of P300-related studies to assess the latency and amplitude of the P300 in epileptic patients.

Methods: PubMed, EMBASE, and Cochrane Library databases were systematically searched for eligible studies. The standard mean difference (SMD) and the 95% confidence interval (CI) were calculated as the effect size of the P300 component.

Results: The main results of the present meta-analysis indicated that epileptic patients have a longer P300 latency and a lower P300 amplitude than controls. Subgroup analysis based on age group demonstrated that these differences can be observed in both children and adult patients compared with healthy controls. In addition, the P300 latency was longer in patients with the five main types of epileptic seizures than in controls.

Conclusion: This study revealed that epileptic patients have abnormalities in the P300 component, which may reflect deficits in cognitive function. Thus, the P300 may be a potential objective approach for evaluating cognitive function in epileptic patients.

[Comparison of minimally invasive transforaminal lumbar interbody fusion between two approaches in treatment of single-segment lumbar spinal stenosis]

Objective

To compare the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches in the treatment of single-segment lumbar spinal stenosis.

Methods

Between February 2015 and January 2017, 70 cases of single-segment lumbar spinal stenosis were treated with MIS-TLIF. The bilateral decompression via unilateral approach (group U) was performed in 36 cases and bilateral decompression via bilateral approaches (group B) in 34 cases. There was no significant difference in age, gender, body mass index, disease duration, distribution of responsibility segments, preoperative visual analogue scale (VAS) score of low back pain and leg pain and Oswestry disability index (ODI) score ( P>0.05). The operation time, intraoperative blood loss, hospitalization stay after operation, complications related to operation, incidence of asymptomatic lateral root symptoms, VAS scores of low back pain and leg pain, and ODI score before and after operation were compared between the two groups. X-ray film and CT scan at 12 months after operation were used to assessted the intervertebral bony fusion.

Results

The operation time and intraoperative blood loss in group U were significantly less than those in group B ( P<0.05). There was no significant difference in hospitalization stay after operation between the two groups ( t=-0.311, P=0.757). During the operation, 1 case in group U and 2 cases in group B had dural tear. No screw placement related nerve injury or asymptomatic lateral root symptoms occurred after operation. The patients were followed up 24 to 38 months, with an average of 32.8 months in group U and 35.5 months in group B. The VAS scores of low back pain and leg pain at 2 days, 3, 6, and 12 months after operation were significantly lower than that before operation in the two groups ( P<0.05), and there was no significant difference between the two groups ( P>0.05). The ODI scores at 3, 6 and 12 months after operation were significantly lower than that before operation in the two groups ( P<0.05), and there was no significant difference between the two groups ( P>0.05). Radiographic examination showed interbody fusion at 12 months after operation in the two groups.

Conclusion

MIS-TLIF is safe and effective in the treatment of single-segment lumbar spinal stenosis with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches. Bilateral decompression via unilateral approach takes less operation time and has less intraoperative blood loss.

Prediction of Bone Metastasis in Breast Cancer Based on Minimal Driver Gene Set in Gene Dependency Network

Bone is the most frequent organ for breast cancer metastasis, and thus it is essential to predict the bone metastasis of breast cancer. In our work, we constructed a gene dependency network based on the hypothesis that the relation between one gene and the risk of bone metastasis might be affected by another gene. Then, based on the structure controllability theory, we mined the driver gene set which can control the whole network in the gene dependency network, and the signature genes were selected from them. Survival analysis showed that the signature could distinguish the bone metastasis risks of cancer patients in the test data set and independent data set. Besides, we used the signature genes to construct a centroid classifier. The results showed that our method is effective and performed better than published methods.

Association between methylenetetrahydrofolate reductase (MTHFR) polymorphisms and lung cancer risk in Chinese people: An updated meta-analysis

BACKGROUND

The association between Methylenetetrahydrofolate Reductase (MTHFR) polymorphisms and lung cancer risk in Chinese people has been widely explored; however, the results remain controversial. Thus, we conducted a meta-analysis to investigate the association between MTHFR gene polymorphisms and susceptibility to lung cancer in Chinese people.

OBJECTIVE

We performed an updated meta-analysis to investigate the association between MTHFR gene polymorphisms and susceptibility to lung cancer in Chinese people.

METHODS

PubMed, EMBASE, WANFANG database, and CNKI were searched to collect eligible articles. The associations of MTHFR gene polymorphism with lung cancer risk were evaluated by calculating the pooled odds ratios (ORs) and the 95% confidence interval (CI). The dominant, recessive, heterozygous, homozygous, and allelic genetic models were used to calculate the combined ORs.

RESULTS

A total of 16 eligible studies were identified in the present meta-analysis. Evidence from the pooled results indicated a significant association between the MTHFR C677T polymorphism and lung cancer susceptibility in Chinese people under the dominant, recessive, homozygous and allelic genetic models (T vs C: OR = 1.252, 95% CI, 1.090-1.437; TT vs CC: OR = 1.741, 95% CI, 1.252-2.420. (TT + CT) vs CC: OR = 1.227, 95% CI, 1.030-1.426. TT vs (CT + CC): OR = 1.606, 95% CI, 1.207-2.137).

CONCLUSION

The present updated meta-analysis demonstrated that the MTHFR C677T polymorphism was significantly associated with susceptibility to lung cancer in Chinese people. Additional case-control studies with large sample sizes are needed to validate our findings.

L-3-n-butylphthalide soft capsules in the treatment of Parkinson disease dementia: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

In recent years, L-3-n-butylphthalide (L-NBP) has been used for Parkinson disease dementia (PDD) to attenuate cognitive impairments in China. Therefore, we selected published and qualified clinical trials to conduct a systematic review and meta-analysis with the aim of assessing the effectiveness and safety of L-NBP in the treatment of PDD.

OBJECTIVE

This systematic review and meta-analysis aimed to assess the effectiveness and safety of L-NBP in the treatment of PDD.

METHODS

We searched PubMed, EMBASE, China National Knowledge Infrastructure, Chinese Scientific Journal Database (VIP database), and Wan-Fang Database to collect eligible articles. We calculated pooled estimates of odds ratios or the standard mean deviation with 95% confidence intervals.

RESULTS

Eight randomized controlled trials were included in our meta-analysis. Our meta-analysis showed that L-NBP combined with Western medicine (WM) had a better effect on improving cognitive dysfunction, the total effective rate, symptoms of Parkinson disease (PD), and activities of daily living function than WM alone. Regarding safety, no serious adverse events were observed in the experimental group.

CONCLUSION

We found that L-NBP as a complementary therapy may have a positive therapeutic effect for improving cognitive dysfunction, the total effective rate, symptoms of PD, quality of life, and the related serum factors in the treatment of PDD. Furthermore, L-NBP was a safe treatment for PDD. However, the findings of our meta-analysis may be influenced by the low quality of the included studies. We highlight the need to conduct trials with higher methodological quality.

A polymorphic MYC response element in KBTBD11 influences colorectal cancer risk, especially in interaction with an MYC-regulated SNP rs6983267

Background

MYC is a well-established cancer driver gene regulating the expression of numerous genes, indicating that polymorphisms in MYC response elements could affect tumorigenesis through altering MYC regulation. We performed integrative multistage study to evaluate the effects of variants in MYC response elements and colorectal cancer (CRC) risk.

Patients and methods

We systematically integrated ChIP-Seq, DNase-Seq and transcription factor motif data to screen variants with potential ability to affect the MYC binding affinity. Then, we conducted a two-stage case-control study, totally consisting of 4830 CRC cases and 4759 controls in Chinese population to identify risk polymorphisms and interactions. The effects of risk variants were confirmed by functional assays in CRC LoVo, SW480 and HCT15 cells.

Results

We identified a novel polymorphism rs11777210 in KBTBD11 significantly associated with CRC susceptibility (P = 2.43 × 10-12). Notably, we observed a significant interaction between rs11777210 and MYC nearby rs6983267 (P-multi = 0.003, P-add = 0.005), subjects carrying rs6983267 GG and rs11777210 CC genotypes showing higher susceptibility to CRC (2.83-fold) than those carrying rs6983267 TT and rs11777210 TT genotypes. We further demonstrated that rs6983267 T > G increased MYC expression, and MYC bound to and negatively regulated KBTBD11 expression when the rs11777210 C risk allele was present. KBTBD11 was downregulated in tumor tissues, and KBTBD11 knockdown promoted cell proliferation and inhibited cell apoptosis.

Conclusion

The rs11777210 is a potential predictive biomarker of CRC susceptibility, and KBTBD11 functions as a putative tumor suppressor in tumorigenesis. Our study highlighted the high CRC risk of people carrying rs6983267 G and rs11777210 C alleles, and provided possible biological mechanism of the interaction.

Conservative Management of Retroperitoneal Ectopic Pregnancy by Computed Tomographic-guided Methotrexate Injection in the Gestational Sac: 2 Case Reports and Literature Review

Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy. Currently, surgery is the most widely used treatment method although it involves a high likelihood of intraoperative hemorrhage. In this case report, we describe a safe and effective alternative method for managing epigastric REP. We conducted a retrospective analysis of the clinical data of 2 patients with REP in the epigastrium who were treated at our hospital using our nonsurgical method. The treatment involved conservative management by computed tomographic-guided methotrexate injection in the gestational sac. We also present a literature review of 26 case reports and discuss the clinical features and various methods for treating REP. Our experience with the successful treatment of 2 patients suggests that the novel approach of computed tomographic-guided methotrexate injection in the gestational sac may be a safe and effective approach to manage REP. Further studies are warranted to confirm our findings.

Chronic nodules of sigmoid perforation caused by incarcerated intrauterine contraception device

RATIONALE

It is extremely rare for an intrauterine contraception device (IUD) to cause uterine perforation and Sigmoid perforation for a long time without being detected.

PATIENT CONCERNS

We present a case of a patient who has suffered from abdominal pain after 4 years of placement of an IUD, and found that the IUD was incarcerated by ultrasound.

DIAGNOSES

Laparoscopic and hysteroscopic examination revealed that the incarcerated IUD caused uterine perforation and sigmoid perforation for a long time. One end of the intrauterine device completely penetrated the anterior wall muscle layer of the uterus and the full layer of the sigmoid colon, located in the intestinal lumen, and the perforated portion of the sigmoid colon formed a chronic nodule.

INTERVENTIONS

We extended the sigmoid colon perforation and uterine perforation by laparoscopy, removed the incarcerated IUD from the uterus through the vagina, trimmed the chronic nodules of the sigmoid perforation, repaired the sigmoid colon, and repaired the uterine perforation.

OUTCOMES

The patient was cured and discharged 22 days after surgery. The patient was naturally pregnant 3 months after surgery and delivered by cesarean section 12 months after surgery. We saw a good recovery of the uterus and sigmoid colon during cesarean section.

LESSONS

The patient was placed with an intrauterine device made of a special material and was not monitored after placement, causing the uterus and sigmoid perforation to be undetected for a long time. The IUD placed in the patient should be monitored regularly. If the IUD is found to be incarcerated or displaced, attention should be paid to uterine perforation and intestinal perforation.

Effects of Chitosan Oligosaccharides on Human Blood Components

Chitosan oligosaccharide (COS) is known for its unique biological activities such as anti-tumor, anti-inflammatory, anti-oxidant, anti-bacterial activity, biological recognition, and immune enhancing effects, and thus continuous attracting many research interests in drug, food, cosmetics, biomaterials and tissue engineering fields. In comparison to its corresponding polymer, COS has much higher absorption profiles at the intestinal level, which results in permitting its quick access to the blood flow and potential contacting with blood components. However, the effects of COS on blood components remain unclear to date. Herein, two COS with different molecular weight (MW) were characterized by FTIR and ¹H NMR, and then their effects on human blood components, including red blood cells (RBCs) (hemolysis, deformability, and aggregation), coagulation system [activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and the concentration of fibrinogen (Fib)], complement (C3a and C5a activation), and platelet (activation and aggregation), were comprehensively studied. In the case of RBCs, COS exhibited a low risk of hemolysis in a dose and molecular weight dependent manner and the irreversible aggregation was observed in their high concentration. For coagulation system, COS has a mild anticoagulation activity through blocking the intrinsic coagulation pathway. In addition, COS showed no effect on complement activation in C3a and C5a and on platelet activation while inhibition of platelet aggregation was evident. Finally, the mechanism that effects of COS on blood components was discussed and proposed.

Investigations on the mechanism of progesterone in inhibiting endometrial cancer cell cycle and viability via regulation of long noncoding RNA NEAT1/microRNA-146b-5p mediated Wnt/β-catenin signaling

Progesterone is often used to protect the endometrium and prevent endometrial cancer. An intensive study on its molecular mechanism in endometrial cancer would contribute to the development of more promising therapies. Relevant lncRNAs and mRNAs expression data in endometrial cancer cell line Ishikawa pretreated and post-treated with progesterone were derived from Gene Expression Omnibus (accession no. GSE29435), and then we analyzed long noncoding RNAs and mRNAs with differential expressions in two different conditions. The Cytoscape software, TargetScan, miRanda, and Human microRNA Disease Database (HMDD) websites were employed. Gene set enrichment analysis (GSEA) was used to determine related Kyoto Encyclopedia of Genes and Genomes pathways alteration in Ishikawa cells treated with progesterone. In addition to bioinformatics analysis, Reverse Transcription-Polymerase Chain Reaction (RT-PCR), Western blot, and dual-luciferase reporter assays were performed. The impact of progesterone on cell propagation and cell cycle was testified by colony formation and flow cytometry analysis. LncRNA nuclear enriched abundant transcript 1 (NEAT1) was the most significantly downregulated lncRNA in endometrial cancer cells treated with progesterone. Lymphoid enhancing factor 1 (LEF1) was positively associated with NEAT1, and eventually hsa_miR-146b-5p was validated to target both LEF1 and NEAT1. Wnt/β-catenin signaling pathway was identified to involve in endometrial cancer. NEAT1 or LEF1 was overexpressed in endometrial cancer cells while downregulated following post-treatment with progesterone. Conversely, miR-146b-5p was notably decreased in Ishikawa cells while upregulated after treatment with progesterone. Downstream gene c-myc or MMP9 regulated by upstream gene LEF1 in Wnt/β-catenin signaling pathway was remarkably increased in Ishikawa cells and positively related with NEAT1. Progesterone inhibited cell cycle and viability through regulating NEAT1/miR-146b-5p axis via Wnt/β-catenin signaling pathway. Progesterone exerted suppressive influence on endometrial cancer progression via regulation of lncRNA NEAT1/miR-146b-5p-mediated Wnt/β-catenin signaling pathway, which might reveal new strategies for developing more effective therapeutics. © 2018 IUBMB Life, 71(1):223-234, 2019.

Interactions of oligochitosan with blood components

Oligochitosan (OCHI) is known to have some specific biological activities. However, its interactions with blood components and related correlation with molecular structures remains to be clarified due to its growing use in biomedical areas. Herein, a series of OCHI were prepared by hydrogen peroxide induced degradation combined fractionation in ethanol solutions and their molecular structures were characterized by GPC, FTIR, ¹H and ¹³C NMR, and then the interactions of the prepared OCHI with blood components, including red blood cells (hemolysis, deformability, and aggregation), coagulation system, complement (C3a, and C5a activation), and platelet (activation, and aggregation), were investigated. For red blood cells, OCHI has a quite low risk of hemolysis in a dose- and MW-dependent manner and the deformability and aggregation were observed in its high MW fraction. The coagulation tests revealed that OCHI is capable of a mild anticoagulation through blocking the intrinsic pathway and the anticoagulation corresponding MW was identified. In terms of complement, OCHI could inhibit C3a in a dose-dependent manner and activate C5a with its high MW fraction. In addition, there is no significant effect of OCHI on platelet activation and aggregation. Based on above results, the interactions related mechanism was discussed and proposed.

[Advances on Recognizing and Managing Tumor Heterogeneity]

肿瘤异质性是恶性肿瘤的特征之一，可使肿瘤的生长速度、侵袭与转移、药物敏感性、预后等各方面产生差异。肿瘤驱动基因和靶向药物的发现发展开启了战胜肿瘤的希望之门，然而异质性的存在又让肿瘤治疗陷入了难以攻克的困境。在肿瘤复发、进展演化的过程中肿瘤异质性如影随形，纷繁复杂。凭借不断进步的检测技术认识和理解肿瘤异质性，针对肿瘤异质性的原因和表型，定制治疗方案已成为当今精准医疗领域的重点范畴。本综述对肿瘤异质性进行了分析和探讨，从而更好的帮助我们了解肿瘤异质性，有利于我们通过多种手段对抗肿瘤异质性。