Body mass index's effect on CRSwNP extends to pathological endotype and recurrence

BACKGROUND

Elevated body mass index (BMI) has been recognized as an important contributor to corticosteroid insensitivity in chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to delineate the effects of elevated BMI on immunological endotype and recurrence in CRSwNP individuals.

METHODOLOGY

A total of 325 patients with CRSwNP undergoing FESS were recruited and stratified by BMI. H&E staining was employed for histological evaluation. Characteristics of inflammatory patterns were identified by immunohistochemical staining. The predictive factors for recurrence were determined and evaluated by multivariable logistic regression analysis and the receiver operating characteristic (ROC) curves across all subjects and by weight group.

RESULTS

In all patients with CRSwNP, 26.15% subjects were classified as overweight/obese group across BMI categories and exhibited a higher symptom burden. The upregulated eosinophil/neutrophil-dominant cellular endotype and amplified type 2/ type 3 coexisting inflammation was present in overweight/obese compared to underweight/normal weight controls. Additionally, a higher recurrent proportion was shown in overweight/obese patients than that in underweight/normal weight cohorts. Multivariable logistic regression analysis identified BMI as an independent predictor for recurrence. The predictive capacity of each conventional parameter (tissue eosinophil and CLCs count, and blood eosinophil percentage) alone or in combination was poor in overweight/obese subjects.

CONCLUSIONS

Overweight/obese CRSwNP stands for a unique phenotype and endotype. Conventional parameters predicting recurrence are compromised in overweight/obese CRSwNP, and there is an urgent need for novel biomarkers that predict recurrence for these patients.

Outcomes with Bridging Radiation Therapy Prior to CAR-T Cell Therapy in Pts with Aggressive B Cell Lymphomas

PURPOSE/OBJECTIVE(S)

Select patient (pts) with relapsed/refractory aggressive B cell lymphoma may benefit from bridging radiation (bRT) prior to anti-CD19-directed chimeric antigen receptor T cell therapy (CART). Here, we examined pt and treatment factors associated with outcome after bRT and CART.

MATERIALS/METHODS

We retrospectively reviewed adults with DLBCL who received bRT prior to axicabtagene ciloleucel 11/2017-12/2022. Clinical/treatment characteristics, response, and toxicity were extracted. Progression free survival (PFS), disease specific survival (DSS) and overall survival (OS) were modeled using Kaplan-Meier for events distributed over time, or binary logistic regression for disease response. Fisher's Exact Test or Mann-Whitney U methods were used.

RESULTS

Among 40 pts, 11 (28%) had limited stage disease at apheresis, and 14 (35%) received bRT in addition to bridging systemic therapy. Thirty-two (80%) pts received bRT post-leukapheresis. bRT was delivered with a median dose of 30 Gy (range: 4-46) in 10 fractions (range: 2-23). Eighteen (45%) pts received <30 Gy. Twenty-two pts (55%) received bRT comprehensively to all sites of disease, including 9 pts who had limited stage. Eleven pts had bulky disease (≥ 10 cm) at the time of bRT. After CART, 4 pts (10%) experienced Grade ≥3 cytokine release syndrome (CRS), 16 (40%) had Grade ≥2 CRS, and 16 (38%) had Grade ≥3 neurotoxicity. Twenty-three pts (57.5%) had CR at 30 days post-CART infusion. Nine had PR (22.5%), of whom 2 pts eventually developed CR at three months and 1 at nine months. Eight pts (20%) had either PD or SD. Of 23 pts who experienced CR, 11 relapsed-6 at three months and 5 at six months. At a median follow up of 9.6 months (95% CI: 6.6-16.2), 22 pts relapsed: 6 (27.3%) in-field, 10 (5.5%) out-of-field, 4 (18.2%) both, and 2 (9.1%) unknown. The median PFS was 8.87 months and median OS was 22 months. PFS at 1 year was 70% (53-82) and at 2 years was 42% (27-57). OS at 1 and 2 years was 72.5% (56-84) and 51% (34-65), respectively. Seventeen pts (42.5%) remain alive at last follow-up, 13 (76.5%) of whom have no evidence of disease (NED). On univariate analysis, OS and PFS at 1 year were 67% (43-83) and 49% (27-68) for those who received RT comprehensively (n = 22), and 41.9% (19-64) and 33.3% (14-54) for those who did not (n = 18; both p≤0.03). Disease bulk (≥10 cm) was associated with significant decrement in DSS (p = 0.03), but not PFS (p = 0.16) or OS (p = 0.24). Among pts treated comprehensively with bRT (n = 22), there was no association of tumor bulk with OS, PFS, or DSS (p>0.2). IPI ≥3 was associated with worse DSS (p = 0.045) and trended towards worse PFS (p = 0.054), but not OS (p = 0.23). There was no difference in PFS, OS, or DSS between pts who received bRT or chemoRT (p>0.3).

CONCLUSION

bRT and CART is a good treatment strategy for select pts with aggressive B cell lymphoma. When feasible, and with a caveat that other variables influence patient disposition, bRT for CART is associated with improved outcomes after comprehensive RT to all sites of disease.

Dorsal Column Myelopathy Following Intrathecal Chemotherapy for Leukemia

PURPOSE/OBJECTIVE(S)

Intrathecal (IT) methotrexate (Mtx) and/or cytarabine (AraC) improve CNS disease control in patients (pts) with hematologic malignancies. There are increasing number of case reports of irreversible, primarily dorsal column myelopathy in pts treated with IT chemotherapy. By describing the largest case series of myelopathy following IT chemotherapy, we aim to raise awareness about this devastating albeit rare complication.

MATERIALS/METHODS

We retrospectively reviewed 25 pts with leukemia who developed paraplegia following IT chemotherapy between 2/2006 and 9/2021. Clinical/treatment characteristics, response, and toxicity were extracted from the medical records.

RESULTS

Seventeen pts (68%) were male, 16 had B-cell ALL (64%), 4 had AML (16%), 2 had CML (8%), 2 had T-ALL (8%), and 1 had BPDCN (4%). The median age at diagnosis was 38 years (IQR 30-59). All pts required systemic salvage treatment after induction chemotherapy with a median number of 3 regimens received (IQR 2-5.5). In total, the median number of IT treatments was 19 per pt (IQR 14-27). Most pts (84%, n = 21) received single agent IT Mtx alternating with single agent AraC. Fifteen pts (60%) received triple IT therapy with a median of 3 treatments (IQR 0-8). Prior to the onset of myelopathy, 10 pts (40%) received allogeneic SCT and 9 pts (36%) were treated with radiation therapy. Median follow-up from diagnosis was 1.9 yrs (IQR 1.3-4.1). Myelopathy was progressive and irreversible in all pts (n = 25); 84% (n = 21) experienced sensory loss, and all pts had extremity weakness. Symptoms were ascending in 11 pts (44%) and descending in 4 pts (16%). Irreversible bowel/bladder incontinence developed in 12 pts (48%). CSF analysis at the time of symptom onset was negative for leukemia cells in most pts (n = 21, 84%) and showed malignant cells in 4 pts (16%). CSF studies showed elevated protein in 21 pts (84%). Myelin basic protein was elevated in all 13 assessed pts. On T2 weighted spinal MRI, all pts had enhancement of the dorsal columns, including 80% of pts with this dorsal column abnormality reported at the time of the study and 20% of pts (n = 5) with the dorsal enhancement noted retrospectively. Due to concern for occult disease, 20 pts (80%) received additional CNS-directed therapy after symptom onset. Twenty-two pts (88%) died at last follow-up. The time between neurological symptom onset and death was a median 3.5 months (IQR 2.6 and 5). Three pts (12%) are alive with paraplegia at a median of 4.4 years from symptom onset.

CONCLUSION

Dorsal column myelopathy is a rare but devastating condition that can occur after IT chemotherapy in heavily pre-treated leukemia pts. T2 weighted spinal MRI can be helpful in the evaluation of pts that present with unexplained weakness and sensory changes. We recommend delaying additional CNS-directed therapy until work-up to rule out alternative etiologies is complete. Future strategies are desperately needed to address this irreversible treatment complication.

Outcomes and Toxicities in Patients with Diffuse Large B-Cell Lymphoma of the Gastrointestinal Tract

PURPOSE/OBJECTIVE(S)

Diffuse large B-cell lymphoma (DLBCL) involving the gastrointestinal (GI) tract is rare and long-term outcomes are not well defined. Combined modality therapy (CMT) with radiotherapy (RT) in addition to systemic therapy in this setting is not commonly pursued. We aim to characterize outcomes in patients with GI DLBCL treated with systemic therapy, with or without RT.

MATERIALS/METHODS

Patients diagnosed with DLBCL of the GI tract (with or without mesenteric involvement) treated at a single institution from 1988-2022 were retrospectively reviewed on an IRB-approved protocol. Clinical and treatment data were collected including adverse events (AE; acute vs late defined as before or 4 weeks after therapy end). Kaplan-Meier and Cox regression models were used to estimate survival.

RESULTS

Of 207 patients, 62% were male and median age at diagnosis was 63 (IQR 52-73). Gastric involvement was most common (n = 130, 63%), followed by small intestines (n = 48, 23%) and colon/rectum (n = 24, 12%). Most presented with early-stage disease (n = 124, 60%), with a median IPI score of 1. All patients received chemotherapy. Of 182 treated with CHOP/EPOCH, 36 (20%) were treated in the pre-rituximab era while 146 (80%) received rituximab. 66 patients (32%) were treated with RT, 89% as part of first line CMT. 50 cases (76%) received consolidative RT, while 10 (15%) targeted residual gross disease and 4 (6%) targeted distant sites. Median dose and fractionation were 36Gy (IQR 30.6-39.6) in 18 fractions (IQR 17-22). Over half (n = 132, 64%) developed grade 3+ acute chemotherapy AEs, and the most common were anemia (n = 64), febrile neutropenia (n = 40), and neutropenia (n = 20). Grade 3+ late chemotherapy AEs occurred in 14 patients (7%). Acute grade 3+ radiation AEs were uncommon (n = 2, 3%; colitis, emesis). No grade 3+ late radiation AEs were noted. Median follow-up was 46 months (IQR 16-97). 169 (81.6%) had a complete response (CR), with 154 (91%) after first line chemotherapy, 9 (5%) after second line, and 6 (4%) after RT. CR was defined by PET (62%), endoscopy (22%), CT (9%), or other methods (7%). The 5-year progression-free survival for those treated with one line of chemotherapy with or without RT was 95%. Median overall survival (OS) was not reached. Improved OS was associated with early-stage disease (p = 0.003), low IPI (p = 0.001), fewer chemotherapy lines (p<0.001), and CR (p<0.001). OS did not differ by gender, age, immunophenotype, GI site, SUVmax, or RT. Patients with early stage DLBCL treated with RT in the post-rituximab era received fewer chemotherapy cycles compared to those treated without RT (p = 0.02; median of 4 (IQR 3-6) vs 6 cycles (IQR 4-6)), with no OS difference.

CONCLUSION

GI DLBCL patients have favorable outcomes after CMT with minimal late toxicity. CMT with RT to the GI tract is well tolerated with no OS difference compared to chemotherapy alone, and may mitigate risks from additional chemotherapy cycles for selected early-stage patients.

Ultra Low-Dose Radiation for Extranodal Marginal Zone Lymphoma of the Lung

PURPOSE/OBJECTIVE(S)

Definitive radiation treatment (RT) for extranodal marginal zone lymphoma (ENMZL) of mucosal associated lymphoid tissue historically involves treatment to 24-30 Gy. There is increasing data supporting the use of ultra-low dose RT as part of a response-adapted approach in the treatment of orbital and gastric ENMZL. With this approach, patients receive initial treatment with 4 Gy, and additional RT is considered for those with persistent or locally progressive disease. However limited data to date assesses the efficacy of 4 Gy in the management of ENMZL of the lung.

MATERIALS/METHODS

We performed an IRB-approved retrospective review of 17 patients with ENMZL of the lung treated with 4 Gy between 7/2015 and 12/2022 with response assessed after RT. Clinical/treatment characteristics, response, and toxicity were extracted from medical records. Statistics were performed using Mann-Whitney U and Fisher's Exact Test.

RESULTS

Eight patients (47%) were female, 15 (88%) white, and 1 (6%) Hispanic. Median age at RT was 66 (interquartile range (IQR) 59-77). All had disease limited to the lung at diagnosis and 15 had stage IE disease. Four patients (24%) were diagnosed incidentally on screening/surveillance imaging in the absence of symptoms. Sixteen patients received 4 Gy in 2 fractions, while one patient received a single fraction of 4 Gy. Median SUVmax prior to RT was 4.5 (IQR 3.2-7.2). Median planning target volume (PTV) was 74 cc (IQR 47-130cc). Six patients (35%) had respiratory symptoms prior to RT, which improved or resolved in 3 (50%). A larger PTV was associated with improvement in symptoms following RT with a median PTV of 266 cc (IQR 171-402) in those who experienced improvement vs. 64 cc (IQR 42-100) in those who did not (p = 0.032). One patient experienced toxicity following RT with pleuritic chest pain, which resolved with corticosteroids. At a median follow-up of 15 months following RT (IQR 7-43 months), the overall response rate (ORR) was 100% (CR, n = 15; PR, n = 2). Fourteen patients had follow-up PET/CT, of whom 13 had a complete metabolic response (CMR) at a median of 3 months following RT (IQR 3-5 months). Two additional patients had a complete response (CR) on CT while one had a partial response on CT. Achieving a CR was not associated with SUV prior to RT (p = 0.50) or PTV size (p = 0.62). In patients with stage IE disease, the ORR rate was 100% and there have been no distant failures to date. Fifteen of 17 patients were alive at last follow-up; two passed away of unrelated causes (one from Alzheimer's disease and one from recurrent squamous cell carcinoma).

CONCLUSION

Ultra-low dose radiation of 4 Gy is associated with excellent local control in the management of ENMZL of the lung and is very well tolerated. Four Gy was effective for local control and symptom palliation even for larger tumors and is an effective initial therapy as part of a response-adapted approach even in limited stage patients.

Characterization of Lymphopenia during Bridging Radiation Therapy Prior to CAR-T Cell Therapy in Patients with Aggressive B Cell Lymphomas

PURPOSE/OBJECTIVE(S)

Bridging RT (bRT) may be used as a strategy for disease control in patients with relapsed/refractory aggressive B cell lymphoma treated with anti-CD19-directed chimeric antigen receptor T-cell therapy (CART). The correlation of treatment-related lymphopenia with adverse outcomes in patients has been widely documented in several malignancies. Here, we assessed lymphocyte kinetics during bRT and impact on clinical outcome.

MATERIALS/METHODS

After IRB-approval, records were retrospectively reviewed for adults with DLBCL who received bRT for axicabtagene ciloleucel 11/2017-12/2022. Clinical/treatment characteristics, lab values, and outcomes were extracted. ALC Δ RT was computed by subtracting pre-RT ALC from post-RT ALC count. Survival was modeled using Kaplan-Meier for events distributed over time, or binary logistic regression for disease response. Fisher's Exact Test or Mann-Whitney U methods were used.

RESULTS

Forty patients met inclusion criteria. Fourteen (35%) received bRT with systemic therapy. Thirty-two (80%) patients received bRT that started post-leukapheresis. bRT was delivered with a median dose of 30 Gy (range: 4-46) in 10 fractions (range: 2-23). Twenty-three patients (57.5%) had CR at 30 days post-CART infusion. Nine had PR (22.5%), and 8 patients (20%) had PD or SD. Median PFS was 8.9 months and median OS was 22 months. The pre-RT ALC mean ± SD was 0.74 ± 0.49 K/µL, and post-RT was 0.43 ± 0.35 K/µL. The absolute ALC Δ RT was 0.31 ± 0.43 K/µL, and ratio post-RT/pre-RT was 0.74 ± 0.64. Stratifying by receipt of bRT alone or with systemic therapy, there was no statistically significant difference in ALC count post-RT (chemoRT: 0.33 ± 0.23 vs. RT: 0.48 ± 0.4, p = 0.2), but there was a lower ALC count pre-RT in the chemoRT group (0.5 ± 0.3 vs. 0.87 ± 0.52 for RT alone, p = 0.02). Post-RT ALC was not significantly associated with CR/PR vs. PD/SD, or with DSS, PFS, or OS. A greater drop in ALC Δ RT trended towards association with improved 90-day response (p = 0.066), without correlation with DSS, OS, or response at 30 days. Median dose per fraction was lower among patients that got pre-leukapheresis RT (2.25 vs. 2.5, p = 0.04), but total dose of bRT or number of fractions was not significantly different. Otherwise, the groups were similar in terms of stage, disease bulk, or comprehensive vs. focal bRT. The average decrease in ALC post-RT for patients who received bRT prior to apheresis was 0.215 K/µL, compared to 0.268 K/µL for patients who received bRT post-apheresis (p = 0.75). Treatment with pre-leukapheresis bRT or ALC Δ RT among these patients were not associated with worse DFS, PFS, or OS (p>0.15).

CONCLUSION

Post-bRT ALC and reduction in ALC during bRT is not associated with worse treatment response or survival outcomes after CAR-T cell treatment in aggressive B cell lymphoma. Pre-leukapheresis bRT did not appear to substantially impact ALC, and ALC Δ RT among these patients were not associated with worse outcomes.

Changes in clinical trials of endocrine disorder and metabolism and nutrition disorder drugs in mainland China over 2010-2019

With the improvements in relevant policies, laws, and regulations regarding drug clinical trials in China, the quantity and quality of drug clinical trials have gradually improved, and the development prospects of drug clinical trials for endocrine disorders and metabolism and nutrition disorders are promising. Based on information from the clinical trials from the online drug clinical trial registration platform of the National Medical Products Administration, we aimed to review and evaluate the development of clinical trials of drugs for endocrine disorders and metabolism and nutrition disorders in mainland China from 2010 to 2019, as well as the trends over time. A total of 861 trials were carried out on 254 types of drugs for endocrine disorders and metabolism and nutrition disorders, among which 531 (61.67%) involved endocrine disorders, and 330 (38.33%) addressed metabolism and nutrition disorders. The annual number of clinical trials has been increasing gradually, with a significant increase in 2017. Among them, the proportion of clinical trials with Chinese epidemiological characteristics was relatively large (Wu, Annual Report on Development Health Management and Health Industry in China, 2018). The largest number of trials were for diabetes drugs (55.63%), followed by trials of drugs for hyperlipidemia (19.4%) and those for hyperuricemia (7.9%). It was found that the geographical area of the leading units also showed obvious unevenness according to the analysis of the test unit data. Based on the statistics and evaluation of the data, comprehensive information is provided to support the cooperation of global pharmaceutical R&D companies and research units in China and the development of international multicenter clinical trials in China. This work additionally provides clinical trial units with a self‐evaluation of scientific research competitiveness and hospital development strategies. At the same time, it provides a reference with basic data for sponsors and stakeholders in these trials to determine their development strategy goals.

Activation of central galanin receptor 2 mitigated insulin resistance in adipocytes of diabetic rats

PURPOSE

Our and other's studies showed that administration of neuropeptide galanin may mitigate insulin resistance via promoting glucose transporter 4 (GLUT4) expression and translocation in rats. The objective of this study is to investigate whether galanin receptor 2 (GAL2-R) in brain mediates the ameliorative effect of galanin on insulin resistance in adipose tissues of type 2 diabetic rats.

METHODS

In this study galanin, GAL2-R agonist M1145 and GAL2-R antagonist M871 were respectively or cooperatively injected into intracerebroventricles of type 2 diabetic rats once a day for successive fifteen days. Then the plasma and fat tissues of rats were used to estimate the alterations of insulin resistance indexes.

RESULTS

The central administration of galanin enhanced 2-deoxy-[³H]-D-glucose, peroxisome proliferator-activated receptor γ and adiponectin levels, food intake and body weight, GLUT4 mRNA expression and GLUT4 concentration in plasma membranes, as well as homeostasis model assessment-insulin resistance index. Those effects of galanin may be blocked by M817, and imitated by M1145 except for food intake and body weight.

CONCLUSION

Those results suggest that central GAL2-R mediates the beneficial effects of galanin on insulin sensitivity in type 2 diabetic rats. GAL2-R agonist may be taken as a potential antidiabetic agent to treat insulin resistance and type 2 diabetes.

Long non-coding RNA DANCR induces chondrogenesis by regulating the miR-1275/MMP-13 axis in synovial fluid-derived mesenchymal stem cells

OBJECTIVE

The aim of this study was to examine the role of lncRNA-differentiation antagonizing non-protein coding RNA (DANCR) and its underlying mechanisms in chondrogenesis, more specifically in synovial fluid-derived mesenchymal stem cell (SFMSCs).

MATERIALS AND METHODS

The expression levels of DANCR in SFMSCs were measured by qRT-PCR. Luciferase reporter assay and RIP assay were used to investigate the direct target of DANCR and miR-1275 in SFMSCs. The expression of matrix metallopeptidase 13 (MMP13, also known as chondrogenic marker) protein was examined by Western blot. Cell proliferation was analyzed by Cell Counting Kit-8 (CCK-8) assay, while chondrogenic differentiation was explored by sGAG assay.

RESULTS

Our data indicated that DANCR can promote SFMSCs proliferation and chondrogenesis. In addition, miR-1275 was indicated as a direct target of DANCR. MiR-1275 was negatively regulated by DANCR via competing endogenous RNA (ceRNA) mechanism. Moreover, our data revealed that miR-1275 could bind to MMP13 and regulate its expression.

CONCLUSIONS

Our findings suggested that DANCR was involved in SFMSCs proliferation and chondrogenesis. Mechanistically, DANCR functions as a sponge RNA for miR-1275 that regulates the expression of target gene MMP13. These data provide a therapeutic option for Osteoarthritis (OA).

The Microbiome as a Modifier of Neurodegenerative Disease Risk

The gut microbiome is increasingly implicated in modifying susceptibility to and progression of neurodegenerative diseases (NDs). In this review, we discuss roles for the microbiome in aging and in NDs. In particular, we summarize findings from human studies on microbiome alterations in Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, and Huntington's disease. We assess animal studies of genetic and environmental models for NDs that investigate how manipulations of the microbiome causally impact the development of behavioral and neuropathological endophenotypes of disease. We additionally evaluate the likely immunological, neuronal, and metabolic mechanisms for how the gut microbiota may modulate risk for NDs. Finally, we speculate on cross-cutting features for microbial influences across multiple NDs and consider the potential for microbiome-targeted interventions for NDs.

Proteasomal degradation of the intrinsically disordered protein tau at single-residue resolution

Intrinsically disordered proteins (IDPs) can be degraded in a ubiquitin-independent process by the 20S proteasome. Decline in 20S activity characterizes neurodegenerative diseases. Here, we examine 20S degradation of IDP tau, a protein that aggregates into insoluble deposits in Alzheimer's disease. We show that cleavage of tau by the 20S proteasome is most efficient within the aggregation-prone repeat region of tau and generates both short, aggregation-deficient peptides and two long fragments containing residues 1 to 251 and 1 to 218. Phosphorylation of tau by the non-proline-directed Ca2+/calmodulin-dependent protein kinase II inhibits degradation by the 20S proteasome. Phosphorylation of tau by GSK3β, a major proline-directed tau kinase, modulates tau degradation kinetics in a residue-specific manner. The study provides detailed insights into the degradation products of tau generated by the 20S proteasome, the residue specificity of degradation, single-residue degradation kinetics, and their regulation by posttranslational modification.

Correlations of complication with coronary arterial lesion with VEGF, PLT, D-dimer and inflammatory factor in child patients with Kawasaki disease

OBJECTIVE

To investigate the correlations of complication with coronary arterial lesion (CAL) or not with vascular endothelial growth factor (VEGF), platelet (PLT), D-dimer, and inflammatory factor in child patients with Kawasaki disease (KD).

PATIENTS AND METHODS

A total of 60 KD child patients meeting the inclusion criteria diagnosed and treated from January 2016 to October 2017 were collected. There were 27 child patients complicated with CAL enrolled as observation group and 33 child patients not complicated with CAL selected as control group. The venous blood of the two groups of patients was acquired after admission to hospital. Enzyme-linked immunosorbent assay (ELISA) was utilized to detect the content of serum VEGF and interleukin-6 (IL-6); the content of serum PLT and D-dimer was measured using a fully automatic biochemistry analyzer, and the coronary artery diameter was determined through color Doppler ultrasound.

RESULTS

Compared with those in control group, the content of VEGF, IL-6, PLT, and D-dimer in the serum was increased remarkably in the observation group, and the differences were statistically significant (p<0.05). The thickness of the coronary artery in the observation group was markedly greater than that in the control group, with a statistically significant difference (p<0.05). The content of VEGF, IL-6, PLT, and D-dimer in the serum was positively correlated with the thickness of the coronary artery.

CONCLUSIONS

For KD child patients, the complication with CAL or not has a close correlation with VEGF, PLT, D-dimer, and inflammatory factor; and VEGF, IL-6, PLT, and D-dimer are the important risk factors for KD complicated with CAL.

Quantitative monitoring of a panel of stress-induced biomarkers in human plasma by liquid chromatography-tandem mass spectrometry: an application in a comparative study between depressive patients and healthy subjects

Using a metabolomic approach, we have found that stress can induce oxidative damage by disturbing the creatine/phosphocreatine shuttle system and purinergic pathway, leading to an excessive membrane breakdown. To further validate our findings and to monitor the biological impact of stress in research of clinical psychiatry, a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed to simultaneously determine a panel of biomarkers comprising choline, creatine, purinergic metabolites, neurosteroids, lysophosphatidylcholines, and phosphatidylethanolamines in human plasma. After optimization of the extraction protocol, all the 15 analytes plus 4 internal standards with distinct polarities were extracted into an organic phase using methyl tert-butyl ether/methanol (1:1, v/v). A reversed-phase C8 column under gradient elution consisting of aqueous phase A of 5 mM ammonium acetate buffer solution containing 0.1% formic acid and organic phase B of acetonitrile/2-propanol (3:7, v/v) was utilized for separation. Four sequential periods under positive or negative ion mode were combined for the determination of analytes with specific multiple reaction monitoring transitions. For all analytes, this method exhibited good linearity with coefficients of determination (R²) higher than 0.99. The lower limit of quantification (LLOQ) values ranged from 0.05 to 80.0 ng/mL. Recovery between 70.5 and 97.3% was obtained by spiking standards to plasma samples stripped by powdered activated carbon. The intra- and inter-assay relative standard deviations (RSDs) of the analyses varied between 2.0 and 13.3%. The mean accuracy ranged from 90.6 to 109.0%. The matrix effect ranged from 91.2 to 107.3% with variations less than 9.0%. Stability under different conditions was tested, with mean recoveries varying between 90.4 and 109.7%. Finally, the established method was successfully applied to analyze the plasma samples from a small cohort of 30 patients with major depressive disorder and 30 matched healthy controls. Graphical abstract.

[Endoscopic transnasal approach for surgical treatment of skull base clival area chordomas (Report of 2 cases)]

The case 1 performanced submandibular trauma because of the faint Suddenly. There were no obvious abnormality in physical examination. CT result showed that the tumour located in the lower clivus, and the atlas was infringed. MRI imaging showed the tumour located in the both sides of the internal carotid artery, infringed clivus and atlas front, forwarded into the nasal cavity and oral cavity. The case 2 performanced the left nose stuffy and increased gradually, nasopharyngeal mirror showed the left nasal cavity filled with new life. CT showed the lesions located in the cranial fossa under the sella turcica and sphenoid bone, down into the sphenoid sinus and the nasopharyngeal cavity. MRI imaging showed the lesions located in the front of clivus. According to the CT and MRI imaging features before surgery, the two cases adopted endoscopic transsphenoidal approach, and the postoperative pathology were chordoma in the central line of the skull base.

[Effects of ammonium pyrrolidine dithiocarbamate (PDTC) on osteopontin expression and autophagy in tubular cells in streptozotocin-induced diabetic nephropathy rat]

Objective: To investigate the effects of ammonium pyrrolidine dithiocarbamate (PDTC) on tubulointerstitial inflammatory molecules and autophagy in diabetic nephropathy (DN) rats. Methods: Twenty-four male Sprague-Dawley rats were assigned to DN group (n=6) and DN+ PDTC group (n=6, PDTC, ip, 100 mg·kg^-1·d^-1), all received streptozotocin (STZ) 60 mg/kg intraperitoneally, and the other 12 rats were randomly divided into control group (n=6) and PDTC group (n=6). At the end of 12 weeks, after serum creatine (Scr) and 24-hour urinary protein were determined, rats were sacrificed to determined the renal pathological damages and the changes of nuclear factor (NF)-κB p65, p62, osteopontin (OPN), microtubule associated protein 1 light chain 3 (LC3)-Ⅱ/LC3-Ⅰ, nuclear p-NF-κB p65 by immunohistological stainning and Western blot, and ultrastructural changes of autophagic process was observed by electron microscopy (EM). Results: Scr was similar among the four groups (P>0.05). The levels of urinary protein in DN group and DN + PDTC group were significantly higher than the other two groups (all P<0.01), but the level of urinary protein in DN + PDTC group was lower than that of DN group (P<0.05). DN + PDTC group had less tubulointerstitial damage compared with DN group (P<0.05). Among the four groups, expressions of p62, p65, OPN of tubulointerstitial area in DN group were significantly higher than that of the other groups (all P<0.05), and Western blot showed that DN+ PDTC group had less expressions of NF-κB p65, nuclear p-p65, OPN and more expresssion of LC3-Ⅱ/LC3-Ⅰ compared with DN group (all P<0.05), which were consistent with the decreased autophagic vacuoles and increased mitochondria dysfunction revealed by EM. Correlation analysis showed that renal LC3-Ⅱ/LC3-Ⅰ was negatively correlated the expressions of nuclear p-p65 and OPN (r=-0.45, P=0.02; r=-0.50, P=0.01), and p62 was positively correlated the expressions of nuclear p-p65 and OPN (r=0.33, P=0.01; r=0.41, P=0.01). Conclusion: Tubular NF-κB activation is closely related to autophagy dysfunction in DN rats, and PDTC may enhance autophagy activity in tubule cells by blocking NF-κB activity.

Low levels of plasma galanin in obese subjects with hypertension

BACKGROUND

Obesity is strongly linked to increased blood pressure, which increases the risk of cardiovascular diseases. To our knowledge, little literature reported the information about galanin levels in obese individuals with hypertension. Therefore, the aim of this study was to investigate the possible involvement of galanin in the pathogenesis of obese subjects with hypertension.

METHODS

We measured body mass index and blood pressure of 38 obese patients with hypertension, 44 obese controls with normal blood pressure and 44 lean controls with normal blood pressure. Blood samples from all cases were collected at 8:00 a.m. after an overnight fast to determine the fasting plasma concentration of galanin, glucose, insulin, triglyceride, total cholesterol, high- and low-density lipoprotein cholesterol.

RESULTS

We found that plasma galanin levels were significantly decreased in obese patients with hypertension compared with the obese control group, whereas the galanin levels were significantly increased in obese controls compared with lean controls. Furthermore, in both obese groups the galanin levels were negatively correlative to diastolic blood pressure and positively correlative to insulin and triglyceride levels, but not to heart rate.

CONCLUSIONS

Low galanin levels were one of characters of obese patients with high blood pressure, and this levels may be taken as a novel biomarker to predict the development of high blood pressure in obese patients.

Evaluation on the germplasm of maize (Zea mays L.) landraces from southwest China

Because of their local adaptation and economic factors that limit the adoption of commercial hybrids, farmer-saved maize landraces are still grown over a considerable area concentrated in southwest China. To evaluate the potential of using maize landraces, the germplasm characteristics of 96 landraces from southwest China were evaluated at phenotypic, cellular, and molecular levels. The existence of high phenotypic variation and elite germplasm tolerant to low-N, low-P, as well as drought stress was observed. Of the total landraces, 81.25, 7.29, 5.21, and 2.08% were found with 0, 1, 2, 3, and 4 B chromosomes. Using 42 microsatellite (simple sequence repeat) loci, 246 alleles were detected among the landraces. The number of alleles per SSR locus varied from 2 to 10, averaging 5.67 allele per locus, which revealed a high level of genetic diversity of maize landraces in southwest China. Cluster analysis showed that 96 landraces could distinctly be clustered into four groups, which tended to associate with their geographic origins. We propose that the genetic diversity center of maize landraces in southwest China might be in Sichuan. A sharp genetic deviation from Hardy-Weinberg equilibrium was observed from heterozygosity deficiency and a considerable genetic variation was revealed within, rather than among, the landraces. Based on their germplasm characteristics, the innovation and utilization of maize landraces in southwestern China for theoretical and applied research could be achieved by constructing heterosis groups, developing inbred lines with high combining ability, and maintaining the landraces with elite germplasm and B chromosomes using bulked pollen.

Prevalence and risk of diabetes based on family history in the Shanghai High-Risk Diabetic Screen (SHiDS) study

AIMS

To evaluate the prevalence and risk of diabetes based on family history in high-risk subjects and also to evaluate insulin sensitivity and insulin secretion in these subjects.

METHODS

Data were analysed from 9756 participants in the Shanghai High-Risk Diabetic Screen (SHiDS) Project. Family history of diabetes was classified according to parental and sibling diabetes status. The prevalence and odds ratios were calculated for each grouping after adjusting for other risk factors. Insulin resistance and sensitivity were evaluated using oral glucose tolerance test-derived indices that were validated by hyperinsulinaemic-euglycaemic and hyperglycaemic clamps.

RESULTS

A total of 30.4% of the subjects had a family history of diabetes in a first-degree relative. The proportions of subjects with a father, mother or sibling with diabetes were 7.5, 11.9 and 5.5%, respectively. The prevalence rates of diabetes in subjects with sibling history, maternal history or paternal history of diabetes were 39.3, 38.3 and 36.4%, respectively. Sibling history was a strong risk factor for diabetes (odds ratio 1.53, 95% CI 1.27-1.84; P < 0.05). Insulin secretion was significantly lower in those with a maternal or sibling history of diabetes; however, insulin sensitivity was not significantly different among subjects with a family history of diabetes.

CONCLUSIONS

Sibling history of diabetes was more strongly associated with diabetes risk than parental history among high-risk subjects. Subjects with a sibling or maternal history of diabetes had significantly lower insulin secretion. Sibling history is an important and independent risk factor for diabetes even among multi-risk populations. Those with a sibling history of diabetes warrant intensive care and follow-up screening.

Evolution of mustard (Brassica juncea Coss) subspecies in China: evidence from the chalcone synthase gene

To explore the phylogenetic relationship, genome donor, and evolutionary history of the polyploid mustard (Brassica juncea) from China, eighty-one sequences of the chalcone synthase gene (Chs) were analyzed in 43 individuals, including 34 B. juncea, 2 B. rapa, 1 B. nigra, 2 B. oleracea, 1 B. napus, 1 B. carinata, and 2 Raphanus sativus. A maximum likelihood analysis showed that sequences from B. juncea were separated into two well-supported groups in accordance with the A and B genomes, whereas the traditional phenotypic classification of B. juncea was not wholly supported by the molecular results. The SplitsTree analysis recognized four distinct groups of Brassicaceae, and the median-joining network analysis recognized four distinct haplotypes of Chs. The estimates of Tajima's D, Fu and Li's D, and Fu and Li's F statistic for the Chs gene in the B genome were negative, while those in the A genome were significant. The results indicated that 1) the Chs sequences revealed a high level of sequence variation in Chinese mustard, 2) both tree and reticulate evolutions existed, and artificial selection played an important role in the evolution of Chinese mustard, 3) the original parental species of Chinese mustard are B. rapa var. sinapis arvensis and B. nigra (derived from China), 4) nucleotide variation in the B genome was higher than that in the A genome, and 5) cultivated mustard evolved from wild mustard, and China is one of the primary origins of B. juncea.

[A clinical reaserch of endoscopic endonasal transsphenoidal surgery for pituitary macroadenoma]

Objective:To share our exprience with the surgical management of pituitary macroadenoma and giant adenoma excision technique through the endoscopic transsphenoidal approach. Method:A retrospective analysis data of 27 patients with pituitary macroadenoma and giant adenoma surgery methods, postoperative complications and follow-up results. Result:All patients have no postoperative complications happened such as: nasal bleeding, intracranial hemorrhage, cerebrospinal fluid leak, blood sugar increased. Tumors invaded cavernous sinus in 5 cases, surrounded internal carotid artery in 2 cases, compressed optic chiasma in 7 cases and encroached optic nerve in 1 case. Postoperative vision decline occurred in 2 cases: 1 case recovered to the preoperative level after being taken out nasal stuffing and with conservative treatment, 1 case (preoperative visual acuity 0.1) restored light perception after conservative treatment. Postoperative diabetes insipidus occurred in 4 cases, and recovered in next week with corresponding therapy. Conclusion:Endoscopic endonasal transsphenoidal surgery is a safe and effective surgical technique.

Development and evaluation of a standardized method and atlas for contouring primary and permanent dentition

OBJECTIVES

Radiation toxicity of the dentition may present significant treatment-related morbidity in the paediatric head and neck cancer population. However, clear dose-effect relationships remain undetermined and must be predicated upon accurate structure delineation and dosimetry at the individual tooth level. Radiation oncologists generally have limited familiarity or experience with relevant dental anatomy.

METHODS

We therefore developed a detailed CT atlas of permanent and primary dentition. After studying this atlas, five radiation oncology clinicians delineated all teeth for each of eight different cases (selected for breadth of dental maturity and anatomical variability). They were asked to record confidence in their contours on a per-tooth basis as well as the duration of time required per case. Contour accuracy and interclinician variability were assessed by Hausdorff distance and Dice similarity coefficient. All analyses were performed using R v. 3.1.1 and the RadOnc v. 1.0.9 package.

RESULTS

Participating clinicians delineated teeth with varying degrees of completeness and accuracy, stratified primarily by the age of the subject. On a per-tooth basis, delineation of permanent dentition was feasible for incisors, canines, premolars and first molars among all subjects, even at the youngest ages. However, delineation of second and third molars was less consistent, commensurate with approximate timing of tooth development. Within each tooth contour, uncertainty was the greatest at the level of the dental roots.

CONCLUSIONS

Delineation of individual teeth is feasible and serves as a necessary precursor for dental dose assessment and avoidance. Among the paediatric radiation oncology community in particular, this atlas may serve as a useful tool and reference.

A novel acrosomal protein, IQCF1, involved in sperm capacitation and the acrosome reaction

On the basis of the unknown tags in the mature human sperm serial analysis of gene expression library constructed by our laboratory, some transcripts were cloned, including Iqcf1 (IQ motif containing F1). To investigate the function of sperm-retained Iqcf1 in spermatogenesis and fertilization of mice, we investigated the spatial and temporal expression of IQCF1. By using the (transcription activator-like effector nuclease) strategy, Iqcf1-knockout mice were produced, and the phenotypes of the Iqcf1(-/-) mice were analyzed. The results showed that IQCF1 was localized in the acrosome of spermatozoa and spermatids; the expression of IQCF1 in testes was associated with spermatogenic capacity. The Iqcf1(-/-) mice were significantly less fertile than the wild-type mice (p = 0.0057) because of reduced sperm motility (p = 0.0094) and the acrosome reaction (AR) (p = 0.0093). In spermatozoa, IQCF1 interacted with calmodulin (CaM) and possibly participated in the tyrosine phosphorylation of sperm proteins during capacitation. In conclusion, a newly identified acrosomal protein, IQCF1, is closely related to sperm capacitation and AR; in particular, it is involved in tyrosine phosphorylation of sperm proteins through interaction with CaM. Research into the function of IQCF1 during fertilization could facilitate the investigation of the molecular mechanism of capacitation, which is unclear.

Changes in hematological parameters in α-thalassemia individuals co-inherited with erythroid Krüppel-like factor mutations

Phenotypic variations in α-thalassemia mainly depend on the defective α-globin gene number. Genetic modifiers of the phenotype of Hemoglobin H (HbH) disease were poorly reported, apart from β-thalassemia allele that was identified ameliorating the severity of α-thalassemia. Because erythroid Krüppel-like factor (KLF1) mutations can modulate the red blood phenotype, we evaluated its effect on the α-thalassemia phenotype. Overall, we identified 72 subjects with five different KLF1 heterozygous mutations in 1468 individuals, including 65 out of 432 α-thalassemia carriers with fetal hemoglobin (HbF) levels ≥1%, 0 out of 310 carriers with HbF levels <1% and 7 out of 726 HbH disease patients. We firstly established the link between KLF1 mutations and relatively elevated hemoglobin A2 (HbA2 ) and HbF levels, along with lower mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) values in a group of α-thalassemia carriers. However, we concluded that KLF1 mutations were not significantly linked to HbH disease severity. On the basis of HBA or HBB genotype and gender, clinical severity of patients with HbH disease was correctly predicted in 73.3% cases. It may improve the screening and diagnostic assessment of α-thalassemia.

Big endothelin-1 as a predictor of atrial fibrillation recurrence after primary ablation only in patients with paroxysmal atrial fibrillation

BACKGROUND

Atrial fibrillation (AF) recurrence after ablation is difficult to predict. The development of AF is associated with inflammation, and inflammatory markers such as big endothelin-1 (big ET-1) reflect inflammatory status. It is unknown, however, whether big ET-1 can be used as a predictor for AF recurrence. The aim of this study was to investigate the relationship between plasma levels of big ET-1 and AF recurrence.

METHODS

A total of 158 patients who had undergone primary ablation for symptomatic and/or drug-refractory AF, including 103 with paroxysmal and 55 with persistent AF, were included in this study. Left atrial diameter was measured with echocardiography and plasma big ET-1 levels with ELISA. All patients were followed up for at least 12 months and AF recurrence defined as an episode of AF lasting ≥ 30 s, with or without atrial flutter or atrial tachycardia.

RESULTS

The AF recurrence rate was 44.9% (71/158) during the median follow-up period of 22 (13, 40) months. Plasma levels of big ET-1 in the recurrence group were higher than those in the non-recurrence group in all patients [0.80 (0.54, 1.30) vs. 0.57 (0.48, 0.72) fmol·L(-) (1), p  = 0.001], in patients with paroxysmal AF [0.81 (0.46, 1.30) vs. 0.57 (0.48, 0.70) fmol·L(-) (1), p  = 0.009] as well as in patients with persistent AF [0.77 (0.57, 1.28) vs. 0.57 (0.49, 0.89) fmol·L(-) (1), p = 0.034]. Multiple logistic regression analyses showed that plasma levels of big ET-1 were associated with AF recurrence in patients with paroxysmal AF (p  = 0.037). Kaplan-Meier analysis demonstrated that the sinus rhythm maintenance rate was lower in patients with higher big ET-1 levels than those with lower levels (p  < 0.05).

CONCLUSIONS

Baseline plasma big ET-1 levels are associated with AF recurrence after primary ablation procedure in patients with paroxysmal AF, and may be used in the prediction of AF recurrence in these patients.

Genetic variant rs4982958 at 14q11.2 is associated with allergic rhinitis in a Chinese Han population running title: 14q11.2 is a susceptibility locus for allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) is one of the most common diseases caused by the combined effects of intrinsic factors (susceptibility genes and immunological status) and the external environment. Analyses of ascendant family history of atopic disease suggest that AR and atopic dermatitis might share a similar genetic background.

OBJECTIVE

To conduct a case-control study in a Chinese Han population to evaluate the potential influence of single nucleotide polymorphisms (SNPs) at FLG, 5q22.1, 11q13.5, 14q11.2 and 20q13.33 on AR.

METHODS

Ten SNPs--rs11204971 and rs3126085 at FLG, rs10067777, rs7701890, rs13360927, and rs13361382 at 5q22.1, rs6010620 at 20q13.33, rs7936562 and rs7124842 at 11q13.5, and rs4982958 at 14q11.2 were genotyped in 363 cases and 668 controls using the Sequenom MassArray system. Data were analyzed with PLINK 1.07 software.

RESULTS

The T allele of rs4982958 at 14q11.2 was observed to be significantly associated with AR (P = .002, OR = 0.73, P(Bonferront) = .02). Genotype-based association testing revealed that the recessive model might provide the best fit for rs4982958 (P(Bonferroni) = .01). In subphenotype analyses, the rs4982958 T allele was also significantly associated with persistent AR (P = .01) and more than 2 positive skin prick tests (P = .038).

CONCLUSION

We identified a novel susceptibility locus 14q11.2 for AR that might bear candidate genes conferring susceptibility to AR and affecting disease phenotypes.

Evidence for disease penetrance relating to CNV size: Pelizaeus-Merzbacher disease and manifesting carriers with a familial 11 Mb duplication at Xq22

The potential causes for the incomplete penetrance of Pelizaeus-Merzbacher disease (PMD) in female carriers of PLP1 mutations are not well understood. We present a family with a boy having PMD in association with PLP1 duplication and three females who are apparent manifesting carriers. Custom high-resolution oligonucleotide array comparative genomic hybridization (aCGH) and breakpoint junction sequencing were performed and revealed a familial complex duplication consisting of a small duplicated genomic interval (∼56 kb) and a large segmental duplication (∼11 Mb) that resulted in a PLP1 copy number variation gain. Breakpoint junction analysis implicates a replication-based mechanism underlying the rearrangement formation. X-inactivation studies (XCI) showed a random to moderate advantageous skewing pattern in peripheral blood cells but a moderate to extremely skewed (≥90%) pattern in buccal cells. In conclusion, our data show that complex duplications involving PLP1 are not uncommon, can be detected at the level of genome resolution afforded by clinical aCGH and duplication and inversion can be produced in the same event. Furthermore, the observation of three manifesting carriers with a large genomic rearrangement supports the contention that duplication size along with genomic content can be an important factor for penetrance of the PMD phenotype in females.