A Single-Institution Review of the Use of Radiation in the Adjuvant and Definitive Management of Keloids

AIMS

Many individuals suffer from keloids that are refractory to standard treatment modalities, including surgical excision alone. Radiation therapy can be used to reduce the risk of recurrent keloids post-operatively, as well as be used as primary treatment for keloids not amenable to surgical resection. The purpose of this study was to review our institutional experience of radiation therapy for keloid management.

MATERIALS AND METHODS

A retrospective review of patients treated with radiation therapy for keloids between 2014 and 2020 at our institution was performed.

RESULTS

A total of 70 keloids in 41 patients were treated. For the 55 keloids treated with post-operative radiation therapy (16Gy delivered in 2 fractions), 82.5% (33/40) of evaluable lesions did not recur. Among the 15 keloids treated with definitive radiation therapy (24Gy delivered in 3 fractions), 78.6% (11/14) of evaluable keloids showed complete flattening, and 14.3% (2/14) had partial flattening. Both acute and late toxicities were mild, with only a single instance of grade 3 toxicity (dermatitis).

CONCLUSION

Our study confirms that radiation therapy has a role in reducing the risk of keloid recurrence post-operatively, and plays an important role in the definitive management of unresectable keloids.

The Regulatory Role and Mechanism of Energy Metabolism in Vascular Diseases

Vascular diseases are amongst the most serious diseases affecting human life and health globally. Energy metabolism plays a crucial role in multiple vascular diseases, and the imbalance of energy metabolism in cells from the blood vessel wall can cause various vascular diseases. Energy metabolism studies have often focused on atherosclerosis (AS) and pulmonary hypertension (PH). However, the roles of energy metabolism in the development of other vascular diseases is becoming increasingly appreciated as both dynamic and essential. This review summarizes the role of energy metabolism in various vascular diseases, including AS, hemangioma, aortic dissection, PH, vascular aging, and arterial embolism. It also discusses how energy metabolism participates in the pathophysiological processes of vascular diseases and potential drugs that may interfere with energy metabolism. This review presents suggestions for the clinical prevention and treatment of vascular diseases from the perspective of energy metabolism.

Prognostic Value of Tumor Volume Reduction during Radiotherapy in Patients with Locally Advanced Cervical Cancer in Different Risk Groups

PURPOSE/OBJECTIVE(S)

To evaluate the risk factors of patients with locally advanced cervical cancer (LACC) undergoing radical radiotherapy (with or without concurrent chemotherapy) and to assess the prognostic value of tumor volume regression (TVR) based on magnetic resonance imaging (MRI) in different risk groups.

MATERIALS/METHODS

A retrospective analysis was performed on 176 individuals diagnosed with stage IIA-IVA cervical cancer (CC) who underwent radical intensity-modulated radiotherapy in our center between January 2012 and December 2020. The tumor volume before radiotherapy (TVp) and before brachytherapy (TVmid) were evaluated based on three-dimensional MRI images, TVR = (TVp -TVmid)/TVp × 100%. Kaplan-Meier curves were used to assess patient's overall survival (OS) and progression-free survival (PFS). Prognostic factors were identified using Cox proportional hazards models.

RESULTS

For the entire cohort, patients with TVR ≥ 94% had better 5-year OS (82.7% vs 49.8%, p<0.001) and 5-year PFS (82.5% vs 51.1%, p<0.001) compared to TVR < 94%. Patients with TVR ≥ 94% were more likely to receive concurrent chemoradiotherapy (CCRT) than those with TVR < 94% (70.1% vs 40.5%, p<0.05). Among patients undergoing CCRT, those with a TVR ≥ 94% had a better prognosis than those with a TVR < 94%. However, among patients who received RT alone, those with TVR ≥ 94% had better PFS but no statistically significant difference in OS. Likewise, among patients with CYFRA21-1 < 7.7 ng/ml, patients with TVR ≥ 94% had a better prognosis. However, TVR was not a prognostic factor in patients with CYFRA21-1 ≥ 7.7 ng/ml. Both CYFRA21-1 (OS, PFS interaction, p<0.001) and FIGO stage (PFS interaction, p = 0.035) were found to significantly impact predictive effects of TVR.

CONCLUSION

In LACC patients with CRYFA21-1 < 7.7 ng/ml who received CCRT, TVR was an important prognostic factor. However, in patients with CRYFA21-1 ≥ 7.7 ng/ml who received RT alone, the prognostic value of TVR needs to be further explored.

Management and Outcomes of Hodgkin Lymphoma Patients Who Achieve Partial Metabolic Response on PET Scans Post-Chemotherapy

PURPOSE/OBJECTIVE(S)

Optimal management of patients with Hodgkin Lymphoma (HL) who do not achieve PET (positron emission tomography) complete metabolic response after primary systemic therapy is unclear. Options vary significantly and include radiation therapy (RT) to localized sites of PET avid disease, salvage chemotherapy followed by autologous stem-cell transplantation (ASCT), or observation with serial imaging. This multi-center study sought to investigate the management approaches and outcomes for HL patients who achieved partial metabolic response after primary systemic therapy.

MATERIALS/METHODS

In this retrospective study, patients diagnosed with HL were identified from the electronic medical records database of two large academic centers between January 2009 and September 2021. PET scan results following initial chemotherapy were reviewed and responses were categorized using International Working Group (IWG) criteria, with the initial staging imaging being used as the reference against which response was evaluated. We performed descriptive analysis of demographic and clinical characteristics of the population and Kaplan-Meier estimates were used to determine progression-free survival (PFS).

RESULTS

The charts of 1,093 HL patients were reviewed. A total of 765 patients had a post chemotherapy PET scan with 57 of those showing partial metabolic response. Among these 57 patients, 31 (54%) were male, the median age at diagnosis was 31 (range:18-74), and the median length of follow up was 1.6 years (average 2.9 years). Five percent stage I, 32% stage II, 23% stage III, and 40% stage IV. Typical initial chemotherapy included ABVD, ABVD switched to BEACOPP due to abnormal interim PET, and AVD with Brentuximab. Among all patients with metabolic partial response to chemotherapy, the 2-year PFS was 72.8% (95% CI = 60.9-87%). Thirty-three of these patients (58%) were treated with planned radiation therapy alone, and 2-year PFS was 80.7% (95% CI = 66.6-97.9%). For those who did not receive radiation as part of their treatment, progression rate was 38% at 2 years.

CONCLUSION

To our knowledge, this is the largest series of HL patients with partial metabolic response following primary chemotherapy. Our preliminary analysis showed that treatment with radiation was associated with good PFS at 2 years and many of those treated with radiation alone were cured.

Reduced prescription of TNF-inhibitors in chronic arthritis based on therapeutic drug monitoring: A randomized controlled trial

OBJECTIVE

Dosing of tumour necrosis factor-α inhibitors (TNFis) is not personalized causing interindividual variation in serum drug levels; however, dose optimization is not widely implemented. We hypothesized that some patients are overdosed; thus, drug prescription could be reduced by therapeutic drug monitoring (TDM).

METHOD

Independent of disease activity, 239 adults treated for rheumatoid arthritis (n = 99), psoriatic arthritis 15 (n = 48), or spondyloarthritis (n = 92) were recruited for a 48-week prospective, randomized open-label trial. Standard care alone or plus TDM was applied in chronic arthritis patients treated with infliximab (IFX), (n = 81), etanercept (ETN) (n = 79), or adalimumab (ADA) (n = 79). Serum TNFi trough levels assessed at inclusion and every 4 months determined patients within/outside predefined therapeutic intervals, supporting change in prescription or drug switch. The primary endpoint was reduced drug prescription.

RESULTS

Compared to standard care, TDM reduced prescribed IFX [-12% (95% confidence interval -20, -3); p = 0.001] and ETN (-15% (-29, 1); p = 0.01], and prolonged the interdosing intervals of ETN [+235% (38, 432); p = 0.02] and ADA [+28% (6, 51); p = 0.04]. Time to drug switch was accelerated (χ2 = 6.03, p = 0.01). No group differences in adverse events, disease activity, or self-reported outcomes were shown, indicating equally sustained remission.

CONCLUSIONS

TDM reduced prescription of IFX, ETN, and ADA and identified patients benefiting from accelerated drug switch, thereby minimizing treatment failure, risk of toxicity, and unnecessary adverse events.

Dipsacoside B Inhibits the Migration and Proliferation of VSMCs and Blunts Neointimal Formation by Upregulating PTEN Expression

BACKGROUND

To investigate the effect and potential molecular mechanisms of Dipsacoside B (DB), an herb monomer extracted from Dipsacusasper or Lonicera macranthoides, on the migration and proliferation of vascular smooth muscle cells (VSMCs) and balloon-induced neointimal formation.

METHODS

In vivo, rat abdominal aorta balloon injury model was utilized to investigate the effect of DB on the neointimal formation. In vitro, cultured VSMCs were used to investigate the effect of DB on Angiotensin-II (Ang-II)-induced migration and proliferation of VSMCs. Western blot and immunofluorescence were used to measure PTEN expression.

RESULTS

As compared to vehicle control balloon-injury group, DB treatment significantly inhibited the neointimal formation together up-regulated the expression of phosphatase and tension homolog deleted on chromosome 10 (PTEN). Cell proliferations (MTT and Edu incorporation) assays and wound migration measurement further revealed that treatment with DB significantly blunted Ang-II-induced proliferation and migration potential of VSMCs. Western blot analysis exhibited that DB upregulated the expression of PTEN in vivo and in vitro.

CONCLUSIONS

DB treatment suppresses the proliferation and migration of VSMCs and reduces neointimal formation by the mechanisms involving regulating the phenotype switch of VSMCs via upregulating PTEN expression.

Wnt5a/Ror2 promotes vascular smooth muscle cells proliferation via activating PKC

INTRODUCTION

Abnormal proliferation of vascular smooth muscle cells (VSMCs) can cause various vascular diseases, such as atherosclerosis, restenosis, and pulmonary hypertension. However, the effect and underlying mechanism of Wnt5a on the proliferation of VSMCs remain unclear. Our study aimed to investigate whether Wnt5a/Ror2 promotes vascular smooth muscle cell proliferation via activating protein kinase C (PKC), thereby effectively alleviating vascular proliferative diseases.

MATERIAL AND METHODS

The proliferation of HA-VSMC cell line was evaluated by CCK-8, EdU, and Plate clone formation assays. The Wnt5a gene knockdown and overexpression were carried out by standard methods. The interaction between Wnt5a and Ror2 was explored by co-immunoprecipitation. Western blotting and immunofluorescence were used to determine the expression levels of key proteins in VSMCs.

RESULTS

The present study found that the expression of Wnt5a protein increased significantly in the proliferation of VSMCs stimulated by 10% serum in a time-dependent manner. Furthermore, the proliferative rate of VSMCs overexpressing Wnt5a was dramatically accelerated, whereas Wnt5a knockdown using siWnt5a reversed thisproliferative effect. Wnt5a up-regulated the expression of receptor tyrosine kinase-like orphan receptor 2 (Ror2) by binding to it. Further studies indicated that Wnt5a induces the PKC expression in VSMCs and knockdown of Wnt5a or Ror2 could inhibit PKC phosphorylation.

CONCLUSIONS

Wnt5a could effectively promote the proliferation of VSMCs, which might be related to the binding of Wnt5a and Ror2 to activate PKC.

Curcumin nicotinate decreases serum LDL cholesterol through LDL receptor-mediated mechanism

Curcumin nicotinate (Curtn) is a synthesized ester derivative of curcumin and niacin. Our previous study has shown that Curtn lowers serum low-density lipoprotein cholesterol (LDL-C) levels in apoE^-/- mice and promotes LDL-C uptake into HepG2 cells in vitro. The present study was to test the hypothesis that Curtn decreases serum LDL-C levels through decreased expression of pro-protein convertase subtilisin/kexin type 9 (PCSK9) and subsequent increase in LDL receptor expression. Male Wistar rats on high-fat diet (HFD) were treated with Curtn or rosuvastatin. Curtn or rosuvastatin treatment significantly decreased serum levels of total cholesterol (TC) and LDL-C in rats on HFD with increased liver LDL receptor expression. LDL-C-lowering effect of Curtn was not observed in LDL receptor deficient (LDLR^-/-) mice on HFD, while rosuvastatin still decreased serum lipid levels in LDLR^-/- mice, indicating that the reduction of serum LDL-C levels by Curtn treatment was LDL receptor-dependent. Curtn treatment also significantly decreased the protein expression of PCSK9 in Wistar rats and LDLR^-/- mice. In HepG2 cells with overexpression of human PCSK9, Curtn treatment significantly increased LDL-C uptakes into hepatocytes, and increased LDL receptor distribution on cell surface in association with decreased PCSK9 protein expression. RNAi-LDLR significantly attenuated the effect of Curtn on LDLR distribution on cell surface. These data indicates that Curtn would decrease serum LDL-C level at least partially through inhibition of PCSK9 expression, and subsequent increase in LDL receptor expression and distribution in hepatocytes, serving as a potential novel compound to treat hyperlipidemia.

Chronic stress-induced depression requires the recruitment of peripheral Th17 cells into the brain

Background

Depression is a recurrent and devastating mental disease that is highly prevalent worldwide. Prolonged exposure to stressful events or a stressful environment is detrimental to mental health. In recent years, an inflammatory hypothesis has been implicated in the pathogenesis of stress-induced depression. However, less attention has been given to the initial phases, when a series of stress reactions and immune responses are initiated. Peripheral CD4⁺ T cells have been reported as the major contributors to the occurrence of mental disorders. Chronic stress exposure-evoked release of cytokines can promote the differentiation of peripheral CD4⁺ cells into various phenotypes. Among them, Th17 cells have attracted much attention due to their high pathogenic potential in central nervous system (CNS) diseases. Thus, we intended to determine the crucial role of CD4⁺ Th17 cells in the development of specific subtypes of depression and unravel the underpinnings of their pathogenetic effect.

Methods

In the present research, a daily 6-h restraint stress paradigm was employed in rats for 28 successive days to mimic the repeated mild and predictable, but inevitable environmental stress in our daily lives. Then, depressive-like symptoms, brain–blood barrier (BBB) permeability, neuroinflammation, and the differentiation and functional changes of CD4⁺ cells were investigated.

Results

We noticed that restrained rats showed significant depressive-like symptoms, concomitant BBB disruption and neuroinflammation in the dorsal striatum (DS). We further observed a time-dependent increase in thymus- and spleen-derived naïve CD4⁺ T cells, as well as the aggregation of inflammatory Th17 cells in the DS during the period of chronic restraint stress (CRS) exposure. Moreover, increased Th17-derived cytokines in the brain can further impair the BBB integrity, thus allowing more immune cells and cytokines to gain easy access to the CNS. Our findings suggested that, through a complex cascade of events, peripheral immune responses were propagated to the CNS, and gradually exacerbated depressive-like symptoms. Furthermore, inhibiting the differentiation and function of CD4⁺ T cells with SR1001 in the early stages of CRS exposure ameliorated CRS-induced depressive-like behaviour and the inflammatory response.

Conclusions

Our data demonstrated that inflammatory Th17 cells were pivotal in accelerating the onset and exacerbation of depressive symptoms in CRS-exposed rats. This subtype of CD4⁺ T cells may be a promising therapeutic target for the early treatment of stress-induced depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12974-022-02543-6.

New dawn for cancer cell death: Emerging role of lipid metabolism

BACKGROUND

Resistance to cell death, a protective mechanism for removing damaged cells, is a "Hallmark of Cancer" that is essential for cancer progression. Increasing attention to cancer lipid metabolism has revealed a number of pathways that induce cancer cell death.

SCOPE OF REVIEW

We summarize emerging concepts regarding lipid metabolic reprogramming in cancer that is mainly involved in lipid uptake and trafficking, de novo synthesis and esterification, fatty acid synthesis and oxidation, lipogenesis, and lipolysis. During carcinogenesis and progression, continuous metabolic adaptations are co-opted by cancer cells, to maximize their fitness to the ever-changing environmental. Lipid metabolism and the epigenetic modifying enzymes interact in a bidirectional manner which involves regulating cancer cell death. Moreover, lipids in the tumor microenvironment play unique roles beyond metabolic requirements that promote cancer progression. Finally, we posit potential therapeutic strategies targeting lipid metabolism to improve treatment efficacy and survival of cancer patient.

MAJOR CONCLUSIONS

The profound comprehension of past findings, current trends, and future research directions on resistance to cancer cell death will facilitate the development of novel therapeutic strategies targeting the lipid metabolism.

Guanxin Xiaoban capsules could treat atherosclerosis by affecting the gut microbiome and inhibiting the AGE-RAGE signalling pathway

Introduction. Atherosclerosis is a chronic disorder in which plaque builds up in the arteries and is associated with several cardiovascular and cerebrovascular diseases such as coronary artery disease, cerebral infarction and cerebral haemorrhage. Therefore, there is an urgent need to discover new medications to treat or prevent atherosclerosis.Hypothesis/Gap Statement. The active components of Guanxin Xiaoban capsules may have an effect on the gut microbiome of patients with atherosclerosis and have a role in their therapeutic targets.Aim. The aim of this study was to identify genes and pathways targeted by active ingredients in Guanxin Xiaoban capsules for the treatment of atherosclerosis based on network pharmacology and analysis of changes to the gut microbiome.Methods. Mice were treated with Guanxin Xiaoban capsules. The 16S rDNA genome sequence of all microorganisms from each group of faecal samples was used to evaluate potential structural changes in the gut microbiota after treatment with Guanxin Xiaoban capsules. Western blotting and real-time quantitative PCR were used to detect gene targets in aortic and liver tissues. Haematoxylin and eosin staining was used to observe improvements in mouse arterial plaques.Results. The gut microbiota of atherosclerotic mice is disturbed. After Guanxin Xiaoban treatment, the abundance of bacteria in the mice improved, with an increase in the proportion of Akkermansia and a significant decrease in the proportion of Faecalibaculum. The main ingredients of Guanxin Xiaoban capsules are calycosin, liquiritin, ferulic acid, ammonium glycyrrhizate, aloe emodin, rhein and emodin. The core genes of this network were determined to be glutathione S-transferase mu 1 (GSTM1), vascular endothelial growth factor A (VEGFA) and cyclin-dependent kinase inhibitor 1A (CDKN1A). The compound-target gene network revealed an interaction between multiple components and targets and contributed to a better understanding of the potential therapeutic effects of the capsules on atherosclerosis. In addition, expression of the AGE-receptor for the AGE (RAGE) pathway was significantly inhibited and the mice showed signs of arterial plaque reduction. Guanxin Xiaoban capsules may improve atherosclerosis and reduce the plaque area by inhibiting the AGE-RAGE signalling pathway to delay the development of atherosclerosis. This mechanism appears to involve changes in the gut microbiota. Therefore, Guanxin Xiaoban capsules have potential value as a treatment for atherosclerosis.

[Application of indocyanine green fluorescence visualization in surgical resection of abdominal wall endometriosis]

Objective: To investigate the feasibility, effectiveness and safety of indocyanine green (ICG) navigation in the surgical resection of abdominal wall endometriosis (AWE). Methods: Seven women undergoing surgery for AWE in First Affiliated Hospital of Sun Yat-sen University (from July 1, 2021 to October 1, 2021) were collected. After exposure of the focus, ICG were used intravenously (0.25 mg/kg) as fluorescent dye for the intraoperative evaluation of AWE vascularization. Resection of the AWE was guided by direct visualization of the focus under standard laparoscopy with a near-infrared (NIR) camera head. Surgical margin around the AWE (3, 6, 9 and 12 point) and the margin under the focus were obtained for postoperative pathological examination of endometriosis. Time from injection to fluorescence visualization, the proportion of fluorescence visualization, time of fully resection of AWE, side effects related to the use of ICG, perioperative complications as well as the pathological result of the surgical margins were recorded. Results: ICG fluorescence of the AWE were seen in 5 patients (5/7). The mean time from injection to fluorescence visualization was (46.7±9.8) s. The mean time of fully resection of AWE was (16.4±7.0) minutes. There were no side effects related to the use of ICG. The rate of class-A wound healing was 7/7. All of the surgical margins were confirmed endometriosis-negative by postoperative pathological examination. Conclusion: ICG fluorescence visualization could conduct accurate resection of AWE, which is clinically safe and effective.

Investigation of toxicity attenuation mechanism of tetrahydroxy stilbene glucoside in Polygonum multiflorum Thunb. by Ganoderma lucidum

ETHNOPHARMACOLOGICAL RELEVANCE

The idiosyncratic hepatotoxicity of Polygonum multiflorum Thunb. (PM) has attracted great interest, and tetrahydroxy stilbene glucoside (TSG) was the main idiosyncratic hepatotoxicity constituent, but biological detoxification on idiosyncratic hepatotoxicity of PM was not well investigated.

AIM OF THE STUDY

This study aimed to illustrate biological detoxification mechanism on PM-induced idiosyncratic hepatotoxicity by Ganoderma lucidum (G. lucidum).

MATERIALS AND METHODS

G. lucidum was used for biological detoxification of tetrahydroxy stilbene glucoside (TSG)-induced idiosyncratic hepatotoxicity of PM. The TSG consumption and products formation were dynamically determined during transformation using high-performance liquid chromatography coupled with diode-array detection and electrospray ionization tandem mass spectrometry (HPLC-DAD-MSn). The transformation invertases (β-D-glucosidase and lignin peroxidase) were evaluated by using intracellular and extracellular distribution and activity assay. The key functions of lignin peroxidase (LiP) were studied by experiments of adding inhibitors and agonists. The entire TSG transformation process was confirmed in vitro simulated test. The cellular toxicity of TSG and the transformation products was detected by MTT.

RESULTS

A suitable biotransformation system of TSG was established with G. lucidum, then p-hydroxybenzaldehyde and 2,3,5-trihydroxybenzaldehyde can be found as transformation products of TSG. The transformation mechanism involves two extracellular enzymes, β-D-glucosidase and LiP. β-D-glucosidase can remove glycosylation of TSG firstly and then LiP can break the double bond of remaining glycosides. The toxicity of TSG after biotransformation by G. lucidum was attenuated.

CONCLUSIONS

This study would reveal a novel biological detoxification method for PM and explain degradation processes of TSG by enzymic methods.

Different Effects of Endothelial Extracellular Vesicles and LPS-Induced Endothelial Extracellular Vesicles on Vascular Smooth Muscle Cells: Role of Curcumin and Its Derivatives

Background: During the progression of atherosclerosis (AS), the vascular endothelial and smooth muscle cells are reciprocally regulated by extracellular vesicles (EVs). EVs have different effects on pathological and physiological processes due to the different cargoes contained in EVs.

Purpose: To study the effects of endothelial cells-derived EVs on normal and inflammatory conditions. To investigate the effects of curcumin and curcumin derivatives (Nicotinic-curcumin) on endothelial EVs.

Methods: EVs were isolated from human umbilical vein endothelial cells (HUVECs) by ultracentrifugation. To examined the effect of normal and LPS-induced endothelial cells-derived EVs on the proliferation of human aortic smooth muscle cells (HASMCs), the CCK-8 assay was performed. Transwell and wound healing assays were conducted to assess cell migration. The effects of EVs on lipid accumulation following treatment with oxidized low-density lipoprotein (Ox-LDL) were evaluated with the oil red O staining assay and HPLC. The number of EVs was calculated using the nanoparticle tracking analysis (NTA) and BCA. The expression levels of Rab27a and Rab27b that regulate the EVs secretion were measured by Western blotting assay. The differential expression of miRNAs in endothelial EVs and LPS-induced endothelial EVs was analyzed using miRNA-Sequencing (miRNA-Seq) and RT-PCR.

Results: Treatment with endothelial EVs reduced the proliferation and migration of HASMCs as well as lipid accumulation in HASMCs. However, treatment with LPS-induced endothelial EVs did not inhibit the migration of HASMCs or lipid accumulation, instead it promoted the proliferation of HASMCs. Treatment with the two types of EVs induced differential expression of several miRNAs, including miR-92a-3p, miR-126-5p, miR-125a-3p, miR-143-3p, etc. Moreover, 1 μg/mL LPS induction greatly increased secretion of endothelial EVs. Treatment with curcumin and nicotinic-curcumin reduced endothelial EVs secretion, possibly by inhibiting inflammation.

Conclusion: Endothelial EVs may confer beneficial effects on atherosclerosis by regulating vascular smooth muscle cell (VSMCs), whereas pro-inflammatory factors may disrupt this effect.

Maintenance treatment in advanced HER2-negative gastric cancer

Survival for patients with advanced gastric cancer (GC) remains poor. Systemic chemotherapy which has reached a plateau stays the standard first-line (1L) treatment for advanced human epidermal growth-factor receptor 2 (HER2)-negative GC. To maximize the benefit of 1L treatment, the concept of maintenance treatment is constantly being explored. In advanced HER2-negative GC, current clinical guidelines do not recommend a standard maintenance therapy strategy. In addition to the monotherapy maintenance with fluorouracil after 4-6 cycles of 1L chemotherapy, some agents that are active against novel targets have been evaluated in clinical trials for maintenance treatment. Whereas most of these trials do not reach their primary endpoints, they open new horizons for the 1L treatment of advanced HER2-negative GC. Therefore, we reviewed the clinical trials in the field of maintenance treatment in advanced HER2-negative GC and discussed some of the problems in clinical trials.

Comparative proteomic analysis of Prunella vulgaris L. spica ripening

Prunella vulgaris L., better known as 'self-heal', has been extensively used in the traditional system of medicines. To reveal the regulatory mechanism of its development, TMT-based quantitative proteome analysis was performed in the Prunella vulgaris L. spica before and during ripening (Group A and Group B, respectively). This analysis resulted in the identification of 7655 proteins, of which 1910 showed differential abundance between the two groups. Pronounced changes in the proteomic profile included the following: 1) Stress-responsive proteins involved in protecting cells and promoting fruit ripening and seed development were highly abundant during ripening. 2) The degradation of chlorophyll, inhibition of chlorophyll biosynthesis and increased abundance of transketolase occurred simultaneously in the spica of Prunella vulgaris L., resulting in the spica changing color from green to brownish red. 3) The abundance of protein species related to phenylpropanoid biosynthesis mainly increased during ripening, while flavonoid and terpenoid backbone biosynthesis mostly occurred before ripening. SIGNIFICANCE: This study establishes a link between protein profiles and mature phenotypes, which will help to improve our understanding of the molecular mechanisms involved in the maturation of Prunella vulgaris L. at the proteome level and reveal the scientific connotation for the best time to harvest Prunella vulgaris L. This work provides a scientific basis for the production of high-quality medicinal Prunella vulgaris L., as well as a typical demonstration of molecular research used for the harvest period of traditional Chinese medicine. BIOLOGICAL SIGNIFICANCE: This work provided a comprehensive overview on the functional protein profile changes of Prunella vulgaris L. spica at different growing stages, as well as the scientific rationale of Prunella vulgaris L. harvested in summer after brownish red, thus laid an intriguing stepping stone for elucidating the molecular mechanisms of quality development.

Celastrol suppresses lipid accumulation through LXRα/ABCA1 signaling pathway and autophagy in vascular smooth muscle cells

The uptake of modified low-density lipoprotein (LDL) and the accumulation of lipid droplets induce the formation of vascular smooth muscle cells (VSMCs)-derived foam cells, thereby promoting the development and maturation of plaques and accelerating the progression of atherosclerosis. Celastrol is a quinine methide triterpenoid isolated from the root bark of traditional Chinese herb Tripterygium wilfordii. It possesses various biological properties, including anti-obesity, cardiovascular protection, anti-inflammation, etc. In the present study, we found that celastrol significantly reduced lipid accumulation induced by oxidized LDL (ox-LDL) in VSMCs. Mechanistically, celastrol up-regulated adenosine triphosphate-binding cassette transporter A1 (ABCA1) expression through activating liver X receptor α (LXRα) expression, which contributed to inhibit lipid accumulation in VSMCs. Meanwhile, celastrol decreased lipid accumulation by triggering autophagy in VSMCs. Therefore, these findings supported celastrol as a potentially effective agent for the prevention and therapy of atherosclerosis.

0919 Health Disparities in the Persistence of Childhood Insomnia Symptoms in the Transition to Adolescence: The Penn State Child Cohort

Introduction

A strong body of cross-sectional evidence indicates that social determinants of health (SDH), such as race, ethnicity, socioeconomic status, and sex/gender, are linked to sleep problems, including insomnia symptoms. Few studies have examined the longitudinal association between SDH and the persistence and remission of insomnia symptoms in the transition between childhood and adolescence, a critical period for sleep health.

Methods

The Penn State Child Cohort is a random, population-based sample of 700 children (5-12y at baseline), of whom 421 were followed up as adolescents (12-23y at follow-up). All subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Childhood insomnia symptoms were defined as a parent- and/or self-report of difficulty falling and/or staying asleep. All subjects or their parents identified the subject’s sex, race, and ethnicity, and reported on socioeconomic status (SES) of the household.

Results

Females (32.7%) and racial/ethnic minorities (25.0%) were associated with a significantly lower remission rate as compared to males (53.3%) and non-Hispanic whites (48.3%), respectively. Non-Hispanic whites of low SES were associated with a significantly lower full remission rate (26.3%) as compared to non-Hispanic whites of higher SES (42.0%), while racial/ethnic minorities were associated with the lowest full remission rates regardless of whether they were of low (9.1%) or higher (11.1%) SES.

Conclusion

Our novel data indicate that gender-, racial/ethnic- and socioeconomic-related disparities in insomnia not only occur as early as childhood but are important determinants of insomnia’s chronic course throughout development.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

0936 Cardiometabolic Disorders are Independently Associated with Excessive Daytime Sleepiness in Young Adults

Introduction

Cardiometabolic risk factors (CMR), including obesity, hypertension, diabetes and hypercholesterolemia, have been associated with sleep apnea and insufficient sleep, both of which can lead to excessive daytime sleepiness (EDS). We hypothesized that CMR are associated with EDS in young adults independent of sleep apnea, sleep duration and mental health disorders (MHD).

Methods

The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) and 425 another 7.0 years later during young adulthood (24.4±2.6y). Subjects underwent a 9-h in-lab polysomnography in childhood and adolescence and parent- or self-reported standardized surveys at all time points. Self-reports in young adulthood and in-lab measurements in childhood were used to ascertain CMR and sleep apnea. Parent-reports in childhood and self-reports in young adulthood were used to ascertain the presence of MHD and EDS. Logistic regression models adjusted for age, race, sex, snoring/observed apneas, insomnia symptoms, and sleep duration in young adulthood as well as mean arterial blood pressure, body mass index percentile and apnea/hypopnea index in childhood.

Results

CMR (OR=2.71, 95%CI=1.69-4.36) and MHD (OR=4.61, 95%CI=2.79-7.62) were associated with EDS in univariate models. After adjusting for covariates in childhood and young adulthood, CMR and MHD remained independently associated with EDS (OR=2.32, 95%CI=1.29-4.16 and OR=2.78, 95%CI=1.59-4.87, respectively).

Conclusion

EDS in young adults with CMR or MHD does not solely arise from sleep apnea, insufficient sleep or other sleep disturbances. EDS may be the result of central pathophysiologic mechanisms or the functional impairment associated with cardiovascular, metabolic and mental health disorders. These data further support that youth with these disorders should be screened for EDS and appropriately managed.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

0920 Behavioral Profiles Associated with the Development of Insomnia Symptoms in Children with Known Mental Health Disorders

Introduction

Mental health disorders (MHD) are a known risk factor for the development of insomnia symptoms in youth. However, a number of children with MHD do not go on to develop insomnia symptoms later on in life. Little is known about possible childhood factors that exacerbate or mitigate the risk of developing adolescent insomnia symptoms (AIS) among children with MHD. The present study examined, in an at-risk group of children with MHD, the behavioral profiles associated with the development of AIS.

Methods

The Penn State Child Cohort is a random, population-based sample of 700 children (5-12y), of whom 421 were followed up as adolescents (12-23y). Absence of childhood insomnia symptoms was ascertained by parent-reports (n=312), while presence of AIS in this subgroup was ascertained by self-reports (n=97). Presence of MHD was ascertained based on the clinical history and physical exam at baseline (n=52). The Pediatric Behavior Scale (PBS) assessed multiple parent-reported behavioral domains.

Results

Children with MHD at baseline had greater levels of difficulty across a variety of internalizing (e.g., anxiety, depression) and externalizing (e.g., impulsivity, hyperactivity) behavioral domains than those without MHD, regardless of whether they developed AIS. However, children with MHD who went on to develop AIS had significantly greater levels of aggressive (p&lt;0.001) and oppositional (p=0.006) behaviors relative to children with MHD who did not develop AIS. In fact, these latter children did not differ from peers without any history of MHD or AIS on levels of aggressive (p=0.820) or oppositional (p=0.436) behaviors.

Conclusion

Children with MHD who present with normative aggressive and oppositional behaviors are less likely to develop AIS. Healthcare providers should consider providing preventative sleep interventions to youth with MHD who are exhibiting comorbid externalizing behaviors.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

0319 Sleep Architecture and Neurocognitive and Behavioral Functioning in Youth from the General Population

Introduction

The transition from childhood to adolescence is critical for the onset of psychopathology and reflects significant changes in the sleeping brain. Sleep deprivation studies have shown that rapid eye movement (REM) and non-rapid eye movement (NREM) sleep are differentially involved in specific cognitive functions. The aim of this study was to examine the association of sleep architecture with neurobehavioral outcomes in a population-based sample.

Methods

We studied 700 children (5-12y, 47.1% female, 23.7% minority) and 421 adolescents (12-23y, 46.1% female, 21.8% minority) from the Penn State Child Cohort. All subjects underwent a 9-hour polysomnography and a 4-hour neurobehavioral evaluation. Neurocognitive outcomes included the Stroop test, digit span backwards (DSB), and coding to measure high- and low-order cognitive functions. Behavioral outcomes included the Child/Adult Behavior Checklist to measure internalizing symptoms and externalizing behaviors. Correlation analysis examined the cross-sectional association between sleep architecture and neurocognitive and behavioral outcomes.

Results

In childhood, %REM sleep was negatively associated with DSB scores (r=-0.088, p=0.027), particularly in males (r=-0.167, p=0.002). Furthermore, %NREM sleep was positively associated with DSB scores in males (r=0.126, p=0.021). In adolescent females, %NREM and %REM sleep were positively (r=0.146, p=0.044) and negatively (r=-0.158, p=0.029) associated with DSB scores, respectively. In adolescence, %NREM sleep was negatively associated with internalizing symptoms (r=-0.109, p=0.026).

Conclusion

Male children and female adolescents who spent a higher proportion of the night in NREM sleep had better working memory performance. Adolescent females who spent a lower proportion of the night in NREM sleep had greater internalizing symptoms. This study suggests a role for sleep architecture in neurobehavioral deficits in youth. Future studies are necessary to determine the contributions of low- and high-frequency sleep EEG dynamics to these clinical outcomes.

Support

National Institutes of Health (R01MH118308, R01HL97165, R01HL63772, UL1TR000127)

0457 Insomnia and Cause-Specific Mortality in Men and Women

Introduction

The association of insomnia with an increased risk of mortality has remained inconsistent across studies, which contrasts with accumulating evidence linking this prevalent and chronic sleep disorder with cardiovascular, cerebrovascular, oncologic, and psychiatric morbidity. The higher prevalence of insomnia in women compared to men may be an important contributor to the different survival rates reported in large, population-based studies.

Methods

The Penn State Adult Cohort is a random, general population sample of 1,741 adults (48.8±13.6y, 52.2% women) who were studied in the sleep laboratory and followed-up for their cause of death up to December 31, 2018. Insomnia was defined as a chronic complaint lasting at least 1 year (n=199). We assessed the risk of all-cause mortality (n=664) and the two most common causes of death: cardiovascular/cerebrovascular (n=275) and cancer (n=161). Cox proportional hazard models adjusted for age, race, sex, education, smoking, alcohol, BMI, AHI, cognitive impairment, mental health problems and physical health problems, including hypertension, diabetes, heart disease, stroke and cancer at baseline.

Results

The risk of all-cause mortality associated with insomnia was significantly increased in men (HR=1.84, 95%CI=1.18-2.87) but not in women (HR=0.80, 95%CI=0.57-1.13; p for sex-interaction&lt;0.01). Insomnia was significantly associated with an increased risk of cardiovascular/cerebrovascular mortality in men (HR=2.11, 95%CI=1.14-3.99), but not in women (HR=0.98, 95%CI=0.59-1.63; p for sex-interaction=0.06). Insomnia was not significantly associated with an increased risk of cancer mortality either in men (HR=1.41, 95% CI=0.56-3.56) or in women (HR=0.90, 95% CI=0.45-1.80), after adjusting for hypertension, diabetes, heart disease, stroke and cancer at baseline.

Conclusion

Men with chronic insomnia are at an increased risk of mortality, particularly that of cardiovascular/cerebrovascular origin. There is a need for translational studies focused on sex-differences that can disentangle the biological and behavioral mechanisms underlying women’s resilience.

Support

American Heart Association (14SDG19830018), National Institutes of Health (R01HL51931, R01HL40916)

0878 Association of Obstructive Sleep Apnea with Internalizing Symptoms vs. Externalizing Behaviors in Adolescents with Attention Deficit Hyperactivity Disorder

Introduction

Attention deficit hyperactivity disorder (ADHD) in children has been associated with insomnia, obstructive sleep apnea (OSA), and abnormal periodic limb movements (PLMS). However, there is lack of data examining the contribution of OSA to ADHD-related internalizing symptoms and externalizing behaviors in adolescents.

Methods

We studied the Penn State Child Cohort, a random general population sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y, 53.9% male). All adolescents underwent a 9-hour PSG, clinical history and physical examination. ADHD was ascertained by a parent- or self-report of having been diagnosed with ADHD. OSA was defined as an apnea hypopnea index (AHI) of ≥2 events per hour of sleep, while a periodic limb movement index (PLMI) ≥5 events per hour of sleep was indicative of PLMS. Controls, OSA-alone, ADHD-alone and ADHD+OSA were identified. The Child or Adult Behavior Checklist were used to ascertain internalizing and externalizing behaviors. Multivariable-adjusted models controlled for sex, race, age, and body mass index (BMI) percentile.

Results

As compared to controls, adolescents with ADHD-alone or ADHD+OSA had significantly greater externalizing behaviors (p&lt;0.001), inattention (p&lt;0.001) and thought problems (p&lt;0.001). While adolescents with ADHD-alone had higher internalizing symptoms (p=0.021), specifically withdrawn-depression (p&lt;0.01), adolescents with ADHD+OSA had more somatic problems than controls (p=0.048). There were no statistically significant differences in behavioral outcomes between controls and adolescents with OSA-alone or between adolescents with ADHD-alone and ADHD+OSA.

Conclusion

Adolescents with comorbid ADHD and OSA do not present with worse behavioral outcomes than those with ADHD alone. Future studies should examine whether the progression of these adolescents into young adulthood differs in terms of their behavioral outcomes and development of mental health disorders.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

0890 Sleep Disordered Breathing is Associated With Endothelial Dysfunction and Atherosclerosis in Young Adults: Preliminary Longitudinal Findings in the Penn State Child Cohort

Introduction

Sleep disordered breathing (SDB) in middle-age is an established risk factor for cardiovascular disease. However, population-based studies supporting its cardiovascular contribution at earlier stages of development are lacking, particularly with long-term follow-ups.

Methods

The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) with in-lab polysomnography (PSG). To date, 425 have been followed-up another 7.4 years later during young adulthood (24.4±2.6y) via a standardized survey and 136 of them (55.1% female, 21.3% racial/ethnic minority) have undergone a repeat of their PSG to ascertain apnea/hypopnea index. Subjects (n=121) also underwent Doppler ultrasounds to assess flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT). Linear regression models stratified by body mass index in young adulthood.

Results

SDB was cross-sectionally associated with lower FMD (β=-0.239, p=0.008) and greater CIMT (β=0.330, p&lt;0.001) in young adulthood. Longitudinally, childhood (n=121) and adolescence (n=90) SDB were significantly associated with CIMT (β=0.327, p&lt;0.001 and β=0.286, p=0.006, respectively), but not with FMD (β=-0.158, p=0.08 and β=-0.101, p=0.35, respectively). These associations, particularly longitudinal ones between childhood and adolescence SDB with CIMT in young adulthood, were stronger in overweight than normal weight subjects (e.g., β=0.310, p=0.030 and β =0.089, p=0.582, respectively).

Conclusion

SDB and obesity appear to be synergistically associated with endothelial dysfunction and atherosclerosis in young adults from the general population. These data suggest that a childhood exposure to chronic SDB is associated with long-term atherosclerosis, while endothelial dysfunction may be a short-term outcome. This ongoing 16-year longitudinal study will test whether the natural history of SDB from childhood through adolescence into young adulthood shows differential trajectories for cardiovascular morbidity.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

GC-MS-based metabolomics research on the anti-hyperlipidaemic activity of Prunella vulgaris L. polysaccharides

Prunella vulgaris polysaccharides (PVPs) have a variety of biological activities, but the mechanism and extent of their anti-hyperlipidaemic effect remain unclear. In vitro, PVPs had a significant inhibitory effect on angiotensin (Ang II)-induced vascular smooth muscle cell (VSMC) proliferation. A metabolomics approach based on gas chromatography-mass spectrometry (GC-MS) and chemometrics was established in this study to evaluate the anti-hyperlipidaemic activity of PVPs in a high-fat Sprague-Dawley rat model. In vivo, PVPs could significantly reduce the weight gain and the increases in serum total cholesterol (TC), low-density lipoprotein (LDL)-C and non-high-density lipoprotein (HDL)-C levels observed in rats fed a high-fat diet; they could also significantly increase serum GSH-Px activity, reduce the content of MDA and TNF-α and decrease abdominal fat volume in rats. Furthermore, PVPs exerted a repairing effect on morphological and structural damage in liver tissue cells in hyperlipidaemic rats fed a high-fat diet. PVPs improved lipid metabolism disorder in rats. Alanine, threonine, succinic acid, proline, inositol and arachidonic acid levels in the serum were considered potential biomarkers involved in amino acid, glucose, energy and lipid metabolism. Therefore, PVPs may interfere with hyperlipidaemia through anti-lipid peroxidation effects, attenuation of inflammation and regulation of glucose, amino acid, energy and lipid metabolism.

Helicobacter pylori Infection Impairs Endothelial Function Through an Exosome-Mediated Mechanism

Background

Epidemiological studies have suggested an association between Helicobacter pylori (H pylori) infection and atherosclerosis through undefined mechanisms. Endothelial dysfunction is critical to the development of atherosclerosis and related cardiovascular diseases. The present study was designed to test the hypothesis that H pylori infection impaires endothelial function through exosome‐mediated mechanisms.

Methods and Results

Young male and female patients (18‐35 years old) with and without H pylori infection were recruited to minimize the chance of potential risk factors for endothelial dysfunction for the study. Endothelium‐dependent flow‐mediated vasodilatation of the brachial artery was evaluated in the patients and control subjects. Mouse infection models with CagA⁺H pylori from a gastric ulcer patient were created to determine if H pylori infection‐induced endothelial dysfunction could be reproduced in animal models. H pylori infection significantly decreased endothelium‐dependent flow‐mediated vasodilatation in young patients and significantly attenuated acetylcholine‐induced endothelium‐dependent aortic relaxation without change in nitroglycerin‐induced endothelium‐independent vascular relaxation in mice. H pylori eradication significantly improved endothelium‐dependent vasodilation in both patients and mice with H pylori infection. Exosomes from conditioned media of human gastric epithelial cells cultured with CagA⁺H pylori or serum exosomes from patients and mice with H pylori infection significantly decreased endothelial functions with decreased migration, tube formation, and proliferation in vitro. Inhibition of exosome secretion with GW4869 effectively preserved endothelial function in mice with H pylori infection.

Conclusions

H pylori infection impaired endothelial function in patients and mice through exosome‐medicated mechanisms. The findings indicated that H pylori infection might be a novel risk factor for cardiovascular diseases.

Shock-Induced Damage and Dynamic Fracture in Cylindrical Bodies Submerged in Liquid

Understanding the response of solid materials to shock loading is important for mitigating shock-induced damages and failures, as well as advancing the beneficial use of shock waves for material modifications. In this paper, we consider a representative brittle material, BegoStone, in the form of cylindrical bodies and submerged in water. We present a computational study on the causal relationship between the prescribed shock load and the resulting elastic waves and damage in the solid material. A recently developed three-dimensional computational framework, FIVER, is employed, which couples a finite volume compressible fluid solver with a finite element structural dynamics solver through the construction and solution of local, one-dimensional fluid-solid Riemann problems. The material damage and fracture are modeled and simulated using a continuum damage mechanics model and an element erosion method. The computational model is validated in the context of shock wave lithotripsy and the results are compared with experimental data. We first show that after calibrating the growth rate of microscopic damage and the threshold for macroscopic fracture, the computational framework is capable of capturing the location and shape of the shock-induced fracture observed in a laboratory experiment. Next, we introduce a new phenomenological model of shock waveform, and present a numerical parametric study on the effects of a single shock load, in which the shock waveform, magnitude, and the size of the target material are varied. In particular, we vary the waveform gradually from one that features non-monotonic decay with a tensile phase to one that exhibits monotonic decay without a tensile phase. The result suggests that when the length of the shock pulse is comparable to that of the target material, the former waveform may induce much more significant damage than the latter one, even if the two share the same magnitude, duration, and acoustic energy.

The biomechanical properties of the urethra in boys with hypospadias: a preliminary study

PURPOSE

The ventral aspect of the penis in boys with hypospadias is composed of dysplastic tissue of the skin and the urethra. The aim of this study was to assess the pre-operative size and biomechanical properties of urethrae in boys with and without hypospadias using a more objective catheter-based system.

MATERIALS & METHODS

In this non-blinded clinical observation study, the study population consisted of 19 boys with hypospadias-the case group (median age 13.9 months [range: 12.2-21.3])-and seven boys without hypospadias-the control group (median age 8.5 months [range: 3.8-18.1]). Modified measurements of impedance were used to assess the size, compliance and viscoelasticity of the urethrae under stepwise increased pressures (between 0, 40 and 60 cmH₂O) using a customised Endolumenal Functional Lumen Imaging probe (EndoFLIP®).

RESULTS

The sizes of the urethrae in boys with hypospadias are variable but tend towards being narrower and less compliant than those of the control subjects i.e. median diameter for meatus urethra was 3.2 mm (range: 2.98-3.92) in the hypospadias group compared with 3.64 (range: 3.22-4.44) in the control group at 40 cmH₂O, and the median change in diameter at meatus urethra was 0.08 mm (range: -0.02 to 0.52) in the hypospadias group compared with 0.23 mm (range: -0.02 to 0.34) when the pressure was increased from 40 to 60 cmH₂O. This biomechanical analysis found that there was no significant viscoelasticity of the urethral meatus in both the groups, whereas the remainder of the urethral structure generally had viscoelastic properties in the control group, seen as a creep on the time/diameter curves (Figure). In the group of boys with hypospadias, evaluations of the urethrae revealed varying viscoelastic abilities, ranging from abilities that were comparable with those of the control subjects to no sign of viscoelasticity at all.

CONCLUSIONS

This study is the first to measure the biomechanical properties of the urethra in children, which might help to provide an understanding as to the structural and functional changes associated with hypospadias. The urethrae in the subjects with hypospadias were variable in diameter but tended to be narrower overall, especially in the distal portion of the urethra. Furthermore, the urethrae in boys with hypospadias were frequently less viscoelastic than those of controls.

CLINICAL RELEVANCE

The EndoFLIP® system may be a future way of objectively estimating the severity of a urethral obstruction and could potentially be included in the postoperative assessment of patients with signs of hampered voiding.

Predictors of Early and Late Mortality in Older Kidney Transplant Recipients

BACKGROUND

Older kidney patients with chronic kidney disease benefit significantly from kidney transplantation. However, these older transplant recipients have greater mortality after transplantation than younger transplant recipients. Understanding the impact of comorbidities on post-transplant mortality can improve risk stratification and patient selection.

METHODS

A single-center analysis of 3105 kidney transplant recipients was performed over a 12-year period. Comorbidities associated with death were evaluated in older and younger transplant recipients.

RESULTS

The 2 most important factors associated with increased mortality in the first 100 days after transplant were recipient age ≥60 and receipt of deceased donor organs (adjusted odds ratios, 3.29 and 5.80, respectively), with no statistically significant impact of recipient comorbidities. In the later post-transplant period (after the first 100 days), recipient age ≥60 and receipt of deceased donor organs (adjusted hazard ratios [HR] of 2.14 and 2.29, respectively) remained predictors of mortality. We also found that donor age ≥60 and the recipient having cardiovascular disease and diabetes were independent predictors of increased mortality. There was a statistically significant interaction between diabetes and heart disease and recipient age ≥60, with a lesser impact on late mortality in older patients compared to younger patients.

CONCLUSIONS

This analysis suggests that comorbidities have a larger impact later after transplantation, with less effect on older recipients. These observations suggest that certain comorbid conditions should be evaluated differently in older patients compared to younger ones.

Childhood obesity, weight loss and developmental trajectories predict the persistence and remission of childhood sleep-disordered breathing

BACKGROUND

Obesity has been recognized as a risk factor for childhood sleep-disordered breathing (SDB), yet it remains unclear how obesity and weight change predict the course of childhood SDB.

OBJECTIVE

The objective of the study is to investigate the role of body weight, upper airway abnormalities and developmental trajectories on the persistence and remission of childhood SDB in the transition to adolescence.

METHODS

The Penn State Child Cohort is a representative population sample of 700 children (5-12 years), of whom 421 were followed up as adolescents (12-23 years). Participants underwent a clinical history, physical examination and polysomnography at both time points.

RESULTS

Obesity and enlarged tonsils were cross-sectionally associated with childhood SDB. Longitudinally, baseline obesity predicted the persistence of childhood SDB (OR = 3.75, 95% CI = 2.00-7.05), while weight loss predicted its remission (OR = 1.67, 95% CI = 1.11-2.50). Children with enlarged tonsils who remitted from SDB had not experienced significant weight loss and only 4.4% had undergone adeno/tonsillectomy. Body fat distribution/composition at follow-up was similar in those who had remitted from childhood SDB as compared with those who had never experienced SDB, while those who persisted with childhood SDB showed significant android distribution and visceral adiposity at follow-up.

CONCLUSIONS

Our data support a causal role for obesity and weight loss in the chronicity and remission, respectively, of childhood SDB in the transition to adolescence and suggest that remission of SDB is related to developmental trajectories of the upper airway in a significant proportion of children. Thus, targeting childhood obesity and weight gain should be a priority in the prevention and treatment of SDB during this critical developmental period.

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.

Dihydromyricetin improves type 2 diabetes-induced cognitive impairment via suppressing oxidative stress and enhancing brain-derived neurotrophic factor-mediated neuroprotection in mice

Type 2 diabetes mellitus (T2DM) leads to cognitive impairment (CI), but there have been no effective pharmacotherapies or drugs for cognitive dysfunction in T2DM. Dihydromyricetin (DHM) is a natural flavonoid compound extracted from the leaves of Ampelopsis grossedentata and has various pharmacological effects including anti-oxidant and anti-diabetes. Thus, we investigated the effects of DHM on CI in T2DM mouse model and its possible mechanism. To induce T2DM, mice were fed with high-sugar and high-fat diet for 8 weeks, followed by a low dose streptozotocin (STZ) administration. After the successful induction of T2DM mouse model, mice were treated respectively with equal volume of saline (T2DM group), 125 mg/kg/d DHM (L-DHM group), or 250 mg/kg/d DHM (H-DHM group). After 16 weeks of DHM administration, the body weight (BW), fasting blood glucose, blood lipids, intraperitoneal glucose tolerance (IPGT), and cognitive function were determined. Then, alterations in the expressions of oxidative stress markers and brain-derived neurotrophic factor (BDNF) in the hippocampus were investigated. Our findings demonstrated that DHM could significantly ameliorate CI and reverse aberrant glucose and lipid metabolism in T2DM mice, likely through the suppression of oxidative stress and enhancement of BDNF-mediated neuroprotection. In conclusion, our results suggest that DHM is a promising candidate for the treatment of T2DM-induced cognitive dysfunction.

Axl inhibitors as novel cancer therapeutic agents

Overexpression and activation of Axl receptor tyrosine kinase have been widely accepted to promote cell proliferation, chemotherapy resistance, invasion, and metastasis in several human cancers, such as lung, breast, and pancreatic cancers. Axl, a member of the TAM (Tyro3, Axl, Mer) family, and its inhibitors can specifically break the kinase signaling nodes, allowing advanced patients to regain drug sensitivity with improved therapeutic efficacy. Therefore, the research on Axl is promising and it is worthy of further investigations. In this review, we present an update on the Axl inhibitors and provide new insights into their latent application.

A Novel Assay Coupling Dephosphorylation and Blue/White Colony Screening for the G > A Hotspot Mutation at Codon 13 of KRAS Gene

Development of sensitive assay for detection of hotspot mutations of cancer driving gene is crucial for circulating tumor DNA analysis. This study tested the possibilities of applying restriction enzyme digestion and dephosphorylation coupled with blue/white screening technology for analyzing a hotspot point mutation in codon 13 of KRAS gene. The present study has documented that the combination of PCR with restriction digestion, dephosphorylation, blue/white screening and Sanger's sequencing can identify rare mutations with sensitivities at 0.003%. This novel assay with high sensitivity may have application in the diagnosis of early cancer targeting ctDNAs.

Sevoflurane activates hippocampal CA3 kainate receptors (Gluk2) to induce hyperactivity during induction and recovery in a mouse model

BACKGROUND

In addition to general anaesthetic effects, sevoflurane can also induce hyperactive behaviours during induction and recovery, which may contribute to neurotoxicity; however, the mechanism of such effects is unclear. Volatile anaesthetics including isoflurane have been found to activate the kainate (GluK2) receptor. We developed a novel mouse model and further explored the involvement of kainate (GluK2) receptors in sevoflurane-induced hyperactivity.

METHODS

Maximal speed, mean speed, total movement distance and resting percentage of C57BL/6 mice were quantitatively measured using behavioural tracking software before and after sevoflurane anaesthesia. Age dependence of this model was also analysed and sevoflurane-induced hyperactivity was evaluated after intracerebral injection of the GluK2 receptor blocker NS-102. Neurones from the hippocampal CA3 region were used to undertake in vitro electrophysiological measurement of kainate currents and miniature excitatory postsynaptic potential (mEPSP).

RESULTS

Sevoflurane induced significant hyperactivities in mice under sevoflurane 1% anaesthesia and during the recovery period, characterized as increased movement speed and total distance. The hyperactivity was significantly increased in young mice compared with adults (P<0.01) and pre-injection of NS-102 significantly prevented this sevoflurane-induced hyperactivity. In electrophysiological experiments, sevoflurane significantly increased the frequency of mEPSP at low concentrations and evoked kainate currents at high concentrations.

CONCLUSIONS

We developed a behavioural model in mice that enabled characterization of sevoflurane-induced hyperactivity. The kainate (GluK2) receptor antagonist attenuated these sevoflurane-induced hyperactivities in vivo, suggesting that kainate receptors might be the underlying therapeutic targets for sevoflurane-induced hyperactivities in general anaesthesia.

Esophagogastric junction in systemic sclerosis: A study with the functional lumen imaging probe

BACKGROUND

Fibrosis and atrophy of esophageal smooth muscle cells cause gastro-esophageal reflux and dysphagia in most patients with systemic sclerosis (SSc). Recent studies indicate that distensibility of the esophagogastric junction (EGJ), assessed with the Functional Lumen Imaging Probe (FLIP) may be a more sensitive and accurate measure of sphincter function than manometry. We aim to describe and compare distension parameters of the EGJ in a well-characterized group of patients with SSc.

METHOD

Twelve patients with SSc reporting reflux or dysphagia (11 women, median age 53 [range 35-72], duration of disease: 1-20 years) were investigated using distensibility testing of the EGJ. Patients were compared with 11 healthy volunteers (HV) (10 women, median age 53 [range 40-68]). The pressure and minimum diameter along the EGJ during ramp distension were used for distensibility analysis.

KEY RESULTS

Patients with SSc had significantly lower EGJ yield pressure (median: 4.0 mm Hg [Inter Quartile Range (IQR): 2.8-7.7]) than HV (median: 6.2 mm Hg [IQR: 9.4-26]) (P=.007). Likewise, the pressure-strain elastic modulus was lower in SSc patients (median 1.73 kPa [IQR: 1.16-2.15]) than in HV (median 2.41 kPa [IQR: 1.85-2.67]) (P=.03), indicating the reduced resistance to distension in SSc patient.

CONCLUSION & INFERENCES

Patients with SSc and symptoms of reflux and dysphagia have significantly reduced resistance to distension of the EGJ.

Low-residue diet fed to rabbits induces histomorphological and biomechanical remodeling of small intestine

BACKGROUND

The composition of ingested food is important for the gut microbiome and intestinal homeostasis. We have previously demonstrated that the structure and mechanical properties in the small intestine remodel significantly during fasting. However, it is not clear to what extent the intestinal mechanical properties changes when the composition of food is changed. This study aimed to investigate the passive biomechanical properties and intestinal tissue remodeling in rabbits fed a low-residue diet.

METHODS

New Zealand rabbits (control group n=6, intervention group n=7) were studied. Segments from duodenum, jejunum and ileum were excised. The intestinal diameter and length were obtained from digitized images of the segments at preselected luminal pressure levels and at no-load and zero-stress states. Circumferential and longitudinal stresses (force per area) and strains (deformation) were computed from the length, diameter and pressure data referenced to the zero-stress state geometry. Histomorphometric data were also obtained.

KEY RESULTS

The wet weight-per-unit length, wall thickness and wall area decreased in the intervention group (P<.05, P<.01). Histological measurement confirmed that the wall thickness decreased in all three segments, which was primarily due to mucosal thinning (P<.05). The opening angle tended to increase in all segments in the intervention group. Significant difference between the two groups was found for the jejunum (P<.05). Feeding the low-residue diet shifted the circumferential stress-strain curves in the intervention group to the right, indicating intestinal wall softening.

CONCLUSIONS & INFERENCES

Low-residue diet in rabbits for 1 month induces location-dependent histomorphometric and biomechanical remodeling of the intestine.