The role of piRNAs in predicting and prognosing in cancer: a focus on piRNA-823 (a systematic review and meta-analysis)

INTRODUCTION

This article examines the potential of using liquid biopsy with piRNAs to study cancer survival outcomes. While previous studies have explored the relationship between piRNA expression and cancer patient outcomes, a comprehensive investigation is still lacking. To address this gap, we conducted a systematic review and meta-analysis of existing literature.

METHODS

We searched major online databases up to February 2024 to identify articles reporting on the role of piRNA in cancer patient survival outcomes. Our meta-analysis used a random-effects model to pool hazard ratios with 95% confidence intervals (CI) and assess the prognostic value of deregulated piRNA-823. For survival analysis, the Kaplan-Meier method and COX analysis were used.

RESULTS

Out of 6104 articles screened, 20 met our inclusion criteria. Our analysis revealed that dysregulated piRNA expression is associated with cancer patient survival outcomes. Specifically, our meta-analysis found that overexpression of piR-823 is significantly linked with poorer overall survival in patients with colorectal cancer and renal cell cancer (HR: 3.82, 95% CI = [1.81, 8.04], I2 = 70%).

CONCLUSION

Our findings suggest that various piRNAs may play a role in cancer survival outcomes and that piRNA-823 in particular holds promise as a prognostic biomarker for multiple human cancers.

IMPLICATIONS FOR CANCER SURVIVORS

Our systematic review and meta-analysis of piRNA-823 has important implications for cancer survivors. Our findings suggest that piRNA-823 can be used as a prognostic biomarker for predicting cancer recurrence and survival rates. This information can help clinicians develop personalized treatment plans for cancer survivors, which can improve their quality of life and reduce the risk of recurrence.

Oleuropein induces apoptosis in gastric cancer cell lines by regulating mir-34a, mir-21, and related genes: An experimental and bioinformatic study

Gastric Cancer (GC) is one of the most prevalent malignancies worldwide. Oleuropein, as a natural phenolic compound with anti-cancer characteristics, is a good option with low side effects to overcome the adverse impact of conventional treatments in cancer. This research evaluated Oleuropein's anti-cancer and apoptotic activities and the anti-migratory effects by modulating potential target genes in epithelial-mesenchymal transition (EMT). Bioinformatic analysis was performed to predict possible Oleuropein's target genes. Then the importance of these genes was shown by UALCAN, Gene Expression Omnibus (GEO), and The Cancer Genome Atlas (TCGA) datasets in gastric cancer. Finally, the association between the selected genes was shown by Cytoscape network analysis. The MTT assay, DAPI staining, flow cytometry, and real-time PCR were applied in the current study. The results showed that the viability of cells was decreased, and the apoptosis rate increased in the Oleuropein-treated group. These findings revealed that Oleuropein regulated the expression of the apoptotic and metastatic genes and microRNAs in GC cells.

The frequency of colorectal lesions in the first-degree relatives of patients with colorectal lesions among PERSIAN Guilan Cohort Study population (PGCS)

BACKGROUND

This study aimed to investigate the frequency of colorectal lesions in the first-degree relatives of patients with colorectal lesions among the Prospective Epidemiological Research Studies in Iran (PERSIAN )Guilan Cohort Study (PGCS) population.

METHODS

In this cross-sectional study, 162 first-degree relatives with a history of colorectal lesions were randomly selected from 52 participants in PGCS. All subjects underwent total colonoscopy by a gastroenterologist, and a pathologist evaluated colorectal biopsies. Also, individuals' demographic information, clinical data, and dietary habits were recorded.

RESULTS

The mean age of the participants was 56.55 ± 7.04. Of 86 colon polyps, 52 neoplastic and 34 non-neoplastic polyps were observed in 56 patients (34.6%). Individuals with age > 60 years had 3.29-fold increased odds of developing colorectal polyps (OR = 3.29, 95% CI: 1.13-9.56, P = 0.029). The smokers were 2.73 times more susceptible to developing colorectal polyps than non-smokers (OR = 2.73, 95% CI: 1.24-6.02, P = 0.013). Moreover, consumption of vegetables more than three times per day was associated with decreased OR of colorectal polyp development (OR = 0.43, CI: 0.19-0.98, P = 0.045).

CONCLUSIONS

Considering the high prevalence of neoplastic colorectal polyps among the first-degree relatives of patients with colorectal lesions, early screening is recommended for individuals with a family history of colorectal lesions.

BDNF/CREB signaling pathway contribution in depression pathogenesis: A survey on the non-pharmacological therapeutic opportunities for gut microbiota dysbiosis

Emerging evidence supports the gut microbiota and the brain communication in general health. This axis may affect behavior through modulating neurotransmission, and thereby involve in the pathogenesis and/or progression of different neuropsychiatric disorders such as depression. Brain-derived neurotrophic factor and cAMP response element-binding protein known as CREB/BDNF pathway plays have critical functions in the pathogenesis of depression as the same of mechanisms related to antidepressants. However, the putative causal significance of the CREB/BDNF signaling cascade in the gut-brain axis in depression remains unknown. Also interventions such as probiotics supplementation and exercise can influence microbiome also improve bidirectional communication of gut and brain. In this review we aim to explain the BDNF/CREB signaling pathway and gut microbiota dysfunction and then evaluate the potential role of probiotics, prebiotics, and exercise as a therapeutic target in the gut microbiota dysfunction induced depression. The current narrative review will specifically focus on the impact of exercise and diet on the intestinal microbiota component, as well as the effect that these therapies may have on the microbiota to alleviate depressive symptoms. Finally, we look at how BDNF/CREB signaling pathway may exert distinct effects on depression and gut microbiota dysfunction.

Reported side-effects following Oxford/AstraZeneca COVID-19 vaccine in the north-west province, Iran: A cross-sectional study

While the vaccination was introduced as a promising tool to control the Coronavirus disease 2019 (COVID-19) pandemic, concerns about vaccine-related side effects had grown. Due to the widespread administration of the COVID-19 vaccine worldwide for the first time, it was necessary to evaluate the safety and potential side effects in recipients. This study aims to assess, the incidence of adverse effects following Oxford-AstraZeneca vaccination and identify their related factors. In this cross-sectional survey-based study, 453 volunteers participated, including 235 men and 218 women. The reported adverse reactions from recipients of the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine were collected by using a questionnaire. The findings showed that the incidence of adverse reactions, such as neurological, systematic, gastrointestinal, respiratory, and local symptoms were significantly higher after the first dose compared to the second dose. Systematic symptoms were the most prevalent reported side effects after the first and second dose injection. The demographical study of participants showed that individuals aged 18-34 and females were more prone to present adverse events following vaccination. However, no significant relationship was found between the occurrence of side effects and the recipients' body mass index. Despite the life-saving role of vaccination against SARS-CoV-2, it may have some adverse reactions in recipients. The severity and frequency of side effects were different. So, they were dependent on several factors, including gender and age. Altogether, post-vaccination adverse reactions were mild and tolerable.

The evaluation of the MMP-2/TIMP-1 ratio in peptic ulcer and its association with refractory helicobacter pylori infection

BACKGROUND

Helicobacter pylori (H. pylori) is one of the leading causes of peptic ulcers, and its treatment is a worldwide challenge. Matrix metalloproteinases and their inhibitors influence the development and healing of peptic ulcers. This study aimed to evaluate the ratios of matrix metalloproteinase-2 (MMP-2) to tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients with peptic ulcers that are sensitive or resistant to H. pylori treatment and compare them with healthy individuals.

METHODS

In this study, 95 patients were included and divided into two groups sensitive (41 patients) and resistant to treatment (54 patients). The results were compared with a control group of 20 participants with normal endoscopy and H. pylori-negative. After obtaining written informed consent, five ml of venous blood was taken to determine their serum MMP-2 and TIMP-1 levels using an enzyme-linked immunosorbent assay.

RESULTS

In patients with H. pylori-induced peptic ulcers, the MMP-2/TIMP-1 ratio was significantly higher than the healthy controls (P < 0.05). MMP-2 level was associated with patients' response to treatment (P < 0.05). The MMP-2/TIMP-1 ratio was higher in patients with simultaneous gastric and duodenal ulcers (P < 0.05).

CONCLUSION

It seems that peptic ulcer disease caused by infection with H. pylori increases the MMP-2/TIMP-1 ratio in patients with peptic ulcers. However, it might not be a good predictor of refractory H. pylori-induced peptic ulcer disease.

A case of a Young Multiple Myeloma Patient With Poor Prognostic Cytogenetics

Multiple myeloma is a hematologic malignancy and a subtype of plasma cell dyscrasias, which accounts for 13% of all hematologic malignancies. It mainly affects older adults and is diagnosed in only 2% of the young population under the age of 40 years. This report presents a 33-year-old man diagnosed with Multiple myeloma with 4 poor prognostic specifications consisting of amplification of the 1q21, Translocation of t(4;14), deletion of the 6q21 and 13q14, along with decreased chromosome count to 44, X,-Y. Even though the combination of 4 poor prognostic cytogenetics in young patients is rare, he responded significantly to the Bortezomib regimen. He was selected as a candidate for bone marrow transplantation. The treatments get interrupted 2 days after the first session of the fifth cycle due to an undesirable COVID-19 infection. After 20 days, the symptoms return, and paraclinical findings show signs of MM relapse.

The effect of convalescent plasma on the treatment of COVID-19 patients in Ardabil, Iran

BACKGROUND

Infection with COVID-19 has resulted in considerable mortality all around the world. This study aimed to investigate the effect of convalescent plasma on the treatment of hospitalized patients with COVID-19 in Imam Khomeini Hospital at Ardabil, Iran.

MATERIALS AND METHODS

In this quasi-experimental clinical trial, patients over 18 years of age with polymerase chain reaction-positive COVID-19 were admitted based on the clinical criteria of respiratory distress with hypoxia (O₂ saturation <90) and tachypnea (R Relative Risk (RR) >24) with moderate-to-severe lung involvement and in the 1^st week of respiratory disease who were not intubated were nonrandomly assigned to two groups: convalescent plasma therapy (CPT) group (197 cases) and control group (200 cases). We used the Chi-square, t-test, Fisher's exact test, and Pearson's correlation coefficient for statistical analysis.

RESULTS

Analyses revealed that length of stay in hospital was significantly lower in the CPT group as compared to the control group (P = 0.001). Twenty-four cases (22.0%) in the CPT group and 85 cases (78.0%) in the control group needed intubation. Furthermore, mortality was 17 cases (18.3%) in the CPT group and 76 cases (81.7%) in the control group, the difference of which was also found to be statistically significant (P < 0.05).

CONCLUSIONS

It seems that CPT can be used as an alternative treatment at the early stages of COVID-19 to prevent the progress of the disease, reduce the need for intubation and consequently the length of stay in hospital, and finally, decrease mortality.

Evaluation serum levels of Insulin Growth Factor-1 (IGF-1) and its association with clinical parameters in severe COVID-19

Background

Severe coronavirus disease-2019 (COVID-19) is associated with dysregulated immune response and extreme inflammatory injury. Considering the role of insulin growth factor-1 (IGF-1) in immune-mediated and inflammatory reactions, this study was conducted to investigate the IGF-1 contribution to the pathogenesis of severe form of COVID-19.

Material and methods

Sixty-two patients with severe COVID-19 and 52 healthy subjects were enrolled in this study. The serum levels of IGF-1 were measured using a solid-phase enzyme-linked chemiluminescent immunoassay on an Immulite 2000 system (Siemens Healthcare Diagnostics.

Result

The serum levels of IGF-1 had no significant difference in COVID-19 patients compared to the healthy subjects (p = 0.359). There was a positive correlation between IGF-1 and age in the severe COVID-19 patients, while a negative correlation was observed for the serum levels of IGF-1 and age in the control group (r = 0.364, p = 0.036, r = − 0.536, p = 0.001, respectively). Moreover, IGF-1 was remarkably associated with hypertension, neurogenic disease, shock, and nausea in patients with the severe form of COVID-19 (p = 0.031, p = 0.044, p = 0.01, p = 0.03, respectively).

Conclusion

Our results pointed to the complex role of IGF-1 in the severe form of COVID-19, and its association with clinical parameters, and some risk factors in the severe form of COVID-19.

Hematological Parameters as Diagnostic Factors: Correlation with Severity of COVID-19

Bachground and aim: Coronavirus disease 2019(COVID-19), which is the pandemic of 21st century, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Prognostic factors play an essential role in predicting the patients who need more care. Therefore, the current study aimed to investigate the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) ratio as discriminated indexes in prognosis of patients with COVID-19.

METHODS

Age, NLR, PLR, white blood cell (WBC), neutrophil count, lymphocyte count and platelet from 1007 hospitalized patients with COVID-19, who were admitted to two referring hospitals  in Ardabil, North Western Iran. All confirmed cases divided into non-severe and severe groups.

RESULTS

534 (53.4%) males and 473 (47.3 %) females with mean age of 52 years were enrolled in this study. Patients with severe COVID-19 have lower counts of lymphocyte, but have higher NLR, comparing to non-severe patients (P = 0.001).

CONCLUSION

Elevated NLR can be assumed as an independent biomarker, which could provide a crucial indicator in the monitoring patients with COVID-19 on admission. Increased NLR was correlated with the severity of COVID-19. Assessment of NLR could be proposed to identify high risk individuals with COVID-19.

The sufficient vitamin D and albumin level have a protective effect on COVID-19 infection

There is limited information regarding the protective factors of SARS-CoV-2 infection. This research is focused on analyzing the role of vitamin D and albumin in the severity, progression, or possible prevention of COVID-19 infection. In this case–control study, 191 patients and 203 healthy individuals were enrolled. Blood samples were taken to test the albumin and vitamin D levels of both groups. Our results show a direct association of vitamin D deficiency with the infection of COVID-19 and severity. According to our findings, 84.4% of patients with COVID-19 in this study had vitamin D deficiency. Moreover, the average level of albumin was significantly decreased in those infected patients who had respiratory symptoms. In the present study, a considerable negative correlation was established between the levels of vitamin D and the severity of COVID-19 infection. This reflects on the immunomodulatory and inhibitory nature of vitamin D to the viral replication.

Investigating the relationship between occupation and SARS-CoV2

BACKGROUND

Coronaviruses are a large family of viruses that have symptoms ranging from simple symptoms of colds to severe respiratory syndromes. In December 2019, cases of unknown pneumonia first appeared in Wuhan, China.

OBJECTIVE

The purpose of this study was to investigate the relationship between occupation and COVID-19 in the Ardabil Imam Khomeini hospital.

METHODS

This research was conducted as a cross-sectional and descriptive study. The questionnaires used in this study included demographic information to obtain the required information such as age, sex, clinical symptoms, underlying disease, type of drug used, smoking, occupation, hours of work, number of daily clients, use of mask or shield, type of working hours, weight and height and body mass index, number family, place of residence, role in the family, presence of an infected person in the family, communication with the suspect, observance or non-observance of health protocols. Our sample size consisted of 774 subjects, all patients at the Ardabil Imam Khomeini Hospital. The subjects were selected randomly.

RESULTS

The results of this study showed that the mean age of patients was 56.70 years, with a standard deviation of 18.20 years. Three hundred and sixty participants (46.5%) were female, and 414 (53.5%) were male. In terms of occupation distribution, 317 patients (41%) were housewives. In addition, 57 people (7.4%) were farmers or ranchers.

CONCLUSION

In general, it can be concluded that due to severity of infection and threat posed by Coronavirus and the risk of infections between different occupations like the taxi driver and medical staff, it is very important to find out what jobs are in the big threat.

NT-Pro-BNP levels during spontaneous breathing test and its association with successful weaning in patients undergoing mechanical ventilation in the Intensive Care Unit: Original Article

Introduction: Weaning of the patient is one of the important medical challenges. One of the most important causes of failure in weaning is cardiovascular disorders. NT-Pro-BNP is a serum marker for cardiac dysfunction. This study conducted to evaluate the level of NT-Pro-BNP during the spontaneous breathing test (SBT) in patients undergoing mechanical ventilation in ICU and its association with successful weaning. Methods: In this cross-sectional study, we enrolled 42 intubated patients who were admitted to the ICU ward of Imam Reza Hospital and were clinically weaned. After obtaining informed consent, SBT was started for the patient. One and a half hours after SBT onset, a venous blood sample was obtained and the patients were followed for SBT test success and the results were recorded. Patients were extubated in stabilized condition or continued mechanical ventilation if needed. Then Data were analyzed. Results: SBT was successful in 45.2% of patients. 54.8% of patients were male. The most common cause of hospitalization was COPD (35.7%). The mean age of patients with successful SBT was 67.53±6.14 years and in patients with unsuccessful SBT was 68.70±5.44 years. There was a significant difference between NT-Pro-BNP levels half an hour after SBT between two groups of patients with successful (7.15±31.18) and unsuccessful (59.61±196.51) SBT. NT-ProBNP changes before and half an hour after SBT in both groups were statistically significant. Conclusion: NT-Pro-BNP is a predictor criteria of success in weaning in patients and as the level of NT-Pro-BNP increases, the rate of failure in weaning increases.

Oxidative stress and its association with ST resolution and clinical outcome measures in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention

Objective

Reperfusion of ischemic myocardium generates oxidative stress, which itself can mediate myocardial injury. So, in this study, we investigated the level of oxidative stress markers and its association with clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.

Results

As indicated in the results, Post MI (Myocardial Infarction) heart failure was significantly higher in the group A (11% vs 4%, p = 0.047). Complete STR (ST-segment resolution) was observed to be significantly higher in the group B (36% vs 17%, p = 0.006). The SOD (Superoxide dismutase) and GPX (Glutathione peroxidase) levels were significantly higher in the group B compared to the other group (1547.51 ± 328.29 vs. 1449.97 ± 246.06, p = 0.019 and 60.62 ± 11.95 vs 57.41 ± 10.14, p = 0.042). The levels of GPX and SOD were shown to be directly related with complete STR and post PCI (Percutaneous coronary intervention)TIMI(Thrombolysis in Myocardial Infarction) flow 3 in the group A (p = 0.002 and p < 0.01, p = 0.005 and p < 0.02, respectively).

Periodontal Status, Its Treatment Needs, and Its Relationship with Airflow Limitation and Quality of Life in COPD Patients

Objective

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent respiratory diseases in the world. There is an impressive relationship between periodontal status and airflow limitation in patients with COPD. Therefore, in this study, we aimed to investigate the periodontal status, its treatment needs, and its relationship with the severity of airway obstruction and quality of life in patients with COPD.

Materials and Methods

In this case-control study, 36 healthy men (control group) and 35 men afflicted with COPD (case group) were investigated. On the basis of spirometry results and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, patients with COPD were further divided into 4 groups. The participants' quality of life was evaluated using COPD Assessment Test (CAT) questionnaire. Thereafter, both groups of participants were referred to a dentistry clinic so that the related specialist could investigate their periodontal health status. The relationship between the periodontal indices and the variables under study including GOLD stage, CAT score, Forced Expiratory Volume in first second and Forced Vital Capacity (FEV1/FVC) ratio, Forced Expiratory Volume in first second (FEV1), and the exacerbation rate were statistically analyzed using independent t-test, one-way analysis of variance, Tukey's test, and Pearson correlation coefficient.

Results

The results revealed that probing pocket depth (PDD), bleeding on probing (BOP), and loss of attachment (LOA) are negatively correlated with FEV1% (r=-0.53, p=0.001), (r=-0.62, p=0.001), and (r=-0.72, p=0.001) as well as FEV1/FVC ratio (r=-0.45, p=0.007), (r=-0.47, p=0.004), and (r=-0.61, p=0.001), respectively. The results showed that PDD, BOP, and LOA are positively correlated with CAT score (r=0.51, p=0.002), (r=0.47, p=0.004), and (r=0.71, p=0.001), respectively.

Conclusion

Periodontal problems are positively associated with COPD severity as determined by GOLD criteria and negatively associated with quality of life of patients with COPD.

Copper as a potential adjunct therapy for critically ill COVID-19 patients

COVID-19 is a major health problem affecting all people worldwide and has a high mortality rate especially in critically ill patients. Although much is known about its different clinical symptoms, there are significant knowledge gaps about its pathology and cellular responses to the virus. Copper plays an essential role in respiration, immune function and free-radical defense. Despite its important action in physiochemical properties, only small amount of copper is presented in biological fluid, none of which presents as free ion form that readily affirms its depletion in critically ill patients. Recent studies confirmed its anti-viral capacity. Closer understanding of copper signaling, its vulnerability, method of assessment and interpretation, administration rout and dosage opens up new perspectives regarding therapeutic copper administration against critically ill COVID-19 patients. So, it seems that physicians should consider copper insufficiency in their critically ill COVID-19 patients. However, an attention should be paid to copper toxicity and estimating the adverse responses depending on copper dose or severity of copper limitation, as well as the duration of copper misbalance.

Study of the K-S distance on skulls from different modern populations for sex and ancestry determination

In forensic science determination of the origin and sex of skeletal remains is an important task for identification purposes. In this study we investigated the krotaphion-sphenion distance (K‑S distance) in the pterion region of German, Euro-American, African-American and Rwandan skulls of modern individuals from the nineteenth to the twenty-first century to look for statistically significant differences in sex and ancestry. We found a statistically significant sex-specific difference in the K‑S distance, which was greater in male skulls than in female skulls for both sides of the skull. Our study also showed that there is a statistically significant difference in the K‑S distance between the four populations studied. Landmarks and morphometric parameters measured in our investigations, which were not used for the present examination were provided to the software program Fordisc for its reference data to enhance the range of its usability for identification of unknown skulls or partial skulls of European individuals.

Fluid-structure interaction of blood flow around a vein valve

Introduction: Venous valves are a type of one-way valves which conduct blood flow toward the heart and prevent its backflow. Any malfunction of these organs may cause serious problems in the circulatory system. Numerical simulation can give us detailed information and point to point data such as velocity, wall shear stress, and von Mises stress from veins with small diameters, as obtaining such data is almost impossible using current medical devices. Having detailed information about fluid flow and valves' function can help the treatment of the related diseases. Methods: In the present work, the blood flow through a venous valve considering the flexibility of the vein wall and valve leaflets is investigated numerically. The governing equations of fluid flow and solid domain are discretized and solved by the Galerkin finite element method. Results: The obtained results showed that the blood velocity increases from inlet to the leaflets and then decreases passing behind the valve. A pair of vortices and the trapped region was observed just behind the valves. These regions have low shear stresses and are capable of sediment formation. Conclusion: The von Mises stress which is a criterion for the breakdown of solid materials was obtained. It was also observed that a maximum value occurred at the bottom of the leaflets.

Case report: a report of a rare case tumoral calcinosis syndrome in a patient afflicted with psoriatic arthritis

In this report, we describe the case in which tumoral calcinosis occurs in a patient afflicted with psoriatic arthritis.

INTRODUCTION

Tumoral calcinosis is a benign disease which occurs quite rarely. It is similar to a neoplasm and appears as the result of calcium deposition in the soft tissues around large joints. This disease can develop as a primary or secondary disease in patients.

CASE REPORT

In this report, the authors describe the case in which tumoral calcinosis occurs in a female afflicted with psoriatic arthritis. We review the patient's clinical and para clinical findings.

CONCLUSIONS

Our report is the first one in which an Iranian patient with psoriatic arthritis has been diagnosed to have tumoral calcinosis. Imaging and pathological examinations are the common diagnostic methods. The main treatment for that is tumor resection.

Prognosis in children with traumatic injuries referring to the emergency department

PURPOSE

Trauma may lead to serious complications in children patients. The purpose of this study was to investigate prognosis in children with traumatic injuries.

METHODS

This cross-sectional study was conducted on all of the children (<18 years old) who had suffered traumatic injuries and transferred to the emergency department of Imam Hussein Hospital by emergency medical services. After selecting the children, a checklist including information such as demographic characteristics, trauma type, consciousness level, and final outcome was recorded. Finally, the data were analyzed using t-test, Chi-square test and ANOVA.

RESULTS

In total of 564 children were investigated. Among them, 70% were males, and 33.2% were in the age range of 5-12 years. The mechanism of injuries in 97.9% of the cases was blunt trauma. The most common chief complaint among the affected children was nausea. The majority of them had stable vital signs and normal neurological tests results. However, 1.06% of them died during hospitalization. The results indicated that the final outcome in the children affected by traumatic injuries is significantly related to the type of trauma, the location of traumatic event, the vehicle used to transport them to emergency departments and their Glasgow coma scale score (p < 0.05).

CONCLUSION

Considering the young age of the child patients and over half of trauma happened at home, it is important to raise parents' awareness about the risky places and activities, which were likely to result in traumatic injuries for children.

The pulmonary artery-aorta ratio: Is it related to quality of life in chronic obstructive pulmonary disease?

INTRODUCTION

Little is known about the relationship between health status and pulmonary artery diameter in chronic obstructive pulmonary disease (COPD) patients. The aim of this study was to evaluate correlation between pulmonary artery-aorta ratio (P-A ratio) and health status of the individuals, using COPD assessment test (CAT).

MATERIALS AND METHODS

In a cross-sectional study, 112 COPD patients were recruited. The severity of COPD was determined by global initiative for obstructive lung disease (GOLD). After digital chest CT scan, the P-A ratio was measured at the level of bifurcation and compared with CAT score, GOLD stage, exacerbation rate and Modified Medical Research Council (MMRC) score.

RESULTS

The average P-A ratio was 0.89 ± 0.16 and 62.5% of patients had ratio less than one. The P-A ratio correlates significantly with different GOLD stages, CAT score and MMRC score (P < .001, P < .001, P < .001, respectively). Compared patients with low P-A ratio (<1), those with high P-A ratio (≥ 1) showed higher CAT score [11.94 ± 5.94 vs 25.17 ± 5.84] (P < .001). The P-A ratio was significantly higher in frequent (≥2) comparing low (<2) exacerbations [1.07 ± 0.07 vs 0.77 ± 0.06] (P < .001).

CONCLUSION

Significant correlations were found between P-A ratio and GOLD, exacerbation rate and health status, using CAT of patients with COPD. These findings also may suggest the potential role of P-A ratio, in the management of COPD patients.

The effect of conjugated linoleic acid on oxidative stress and matrix metalloproteinases 2 and 9 in patients with COPD

Background

Natural antioxidants in foods may be used in prevention and treatment of oxidative stress and inflammation in COPD. Therefore, this study aimed to evaluate the effect of conjugated linoleic acid (CLA) supplement as natural antioxidants on oxidative stress levels, and MMP2 and MMP9 serum levels in COPD patients.

Materials and methods

This clinical trial study was conducted on 90 (supplement group=45 and control group=45) COPD patients in Ardabil city, Iran, in 2015. After obtaining written consent, general information was collected from each patient using a validated and reliable questionnaire. Supplement group received 3.2 g of CLA and those in the control group were given 3.2 g of placebo for 6 weeks on a daily basis. Fasting blood samples were taken from all of the patients for testing of malondialdehyde (MDA), MMP2, and MMP9 levels at the beginning and end of the study. Data were analyzed using Kolmogorov–Smirnov test, independent samples t-test, paired sample t-test, chi-square test, and ANOVA.

Results

There were no significant differences between the two groups with regard to mean age, smoking status, and serum level of MDA at the beginning of the study. In the supplement group, the serum level of MDA decreased significantly at the end of the 6th week compared to that in the beginning of the study (p=0.0004), while in the placebo group, the difference was found to be insignificant. The serum level of MMP9 decreased significantly in the supplement group, while in the placebo group its level increased significantly as compared to that at the beginning of the study (p<0.05). The serum levels of MMP2 indicated no significant differences between the two groups neither at the beginning nor at the end of the study.

Conclusion

These findings indicated that CLA supplementation may be helpful for COPD patients through inhibiting the production of oxidative stress and controlling MMP9 serum levels.

The effect of conjugated linoleic acid supplementation on the nutritional status of COPD patients

BACKGROUND

COPD patients are susceptible to anorexia, reduction of caloric intake, weight loss, and malnutrition. One of the possible mechanisms is the increase of inflammatory markers such as interleukin 1β (IL_1β), is highly correlated with anorexia. Considering the anti-inflammatory role of conjugated linoleic acid (CLA), this study aimed to investigate the effect of CLA supplementation on the nutritional status of COPD patients.

PATIENTS AND METHODS

In a double-blind clinical trial, 93 COPD patients who volunteered to participate in the study and who filled out a written consent form, were randomly assigned to control or supplementation groups. The patients in the supplementation group received 3.2 g of CLA on a daily basis for 6 weeks, while those in the control group received placebo on a daily basis for 6 weeks. For IL_1β assessment, the patients' anthropometric indices and appetite score were checked and their blood samples were collected both before and after the treatment. Moreover, in order to investigate the changes in the caloric intake trend during the study, their dietary intake levels were assessed using 24-hour dietary recall, 3 days a week at the onset, in the 4th week, and at the end of the study. Eventually, 90 patients completed the study.

RESULTS

The results demonstrated a significant increase in appetite score (P=0.001), average caloric intake (P=0.01), and macronutrient intake (P<0.05), while a significant decrease was observed in the serum level of IL_1β among the patients of the supplementation group (P=0.008). Meanwhile, although the supplementation group's body mass index was also higher on completion, compared to their own initial state as well as to that in the control group, the differences were not significant (P=0.13).

CONCLUSION

The findings of this research indicate that the consumption of CLA supplementation can be effective in regulating the appetite and improving the nutritional status of patients suffering from COPD through adjusting the serum level of IL_1β.

Von Hippel-Lindau gene mutation status is associated with a dichotomous response in primary and metastatic tumors in patients receiving bevacizumab and erlotinib for metastatic renal cell carcinoma

15522

Background: A single arm phase II study is underway evaluating the safety and clinical benefit of presurgical bevacizumab and erlotinib in the management of patients with untreated conventional renal cell carcinoma (RCC). It is not known how the presence or absence of von Hippel Lindau (VHL) mutations affect the response to therapy in the primary or metastatic site, and whether VHL mutational status is predictive for either. Methods: Patients enrolled had conventional RCC, measurable metastatic disease, a primary tumor in place, no prior systemic therapy, a PS of 0 or 1 and no brain metastases. A total of 35 patients were enrolled as of January 8, 2007. Patients were treated with bevacizumab for 4 cycles and erlotinib for 8 weeks, and underwent cytoreductive nephrectomy at week 10 (4 weeks after the last dose of bevacizumab). A VHL gene mutation and methylation analysis was completed on nephrectomy specimens from the first 18 evaluable patients. Patients were grouped according to the presence or absence of functional VHL gene inactivation (mutation and/or methylation). Two-sample T-test and Fisher’s exact test were performed. Results: Ten patients (55%) demonstrated either VHL mutation or methylation ( table 1 ). Patients with no VHL gene inactivation demonstrated more robust primary tumor shrinkage, but did not demonstrate partial responses (PRs). Table 1 . Conclusions: These findings, although preliminary, suggest a dichotomous response in the primary and metastatic disease sites according to VHL functional status. Ongoing evaluation of new treatment strategies using antivascular/targeted agents in RCC may benefit from molecular stratification.

[Table: see text]

No significant financial relationships to disclose.

Adjuvant thalidomide improves disease specific survival for patients with renal cell carcinoma at high risk for relapse following surgery

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Background: Observation is the standard of care for locally advanced renal cell carcinoma (RCC) after surgery. No adjuvant therapy for RCC exists. Thalidomide has shown activity in metastatic RCC. We studied thalidomide in the adjuvant setting for patients with locally advanced RCC. Methods: This phase III trial has enrolled 46 patients to date. All patients underwent resection of all disease. Eligible patients included T2N0M0 grade 3–4, T3a-cN0M0, T4N0M0, TanyN1–2M0, and TanyN0M0 bilateral disease completely resected. All RCC histologies were included. Patients were randomized to observation or thalidomide, 300 mg daily for 2 years. Dose reductions were allowed for toxicity. The primary endpoint was recurrence free survival. Secondary endpoints were disease specific survival and toxicity. Results: Twenty-three patients randomized to thalidomide and 23 were observed. In the thalidomide arm, one patient refused therapy and two stopped within one month due to toxicity. Only 1 patient tolerated therapy for 2 years without dose reduction. With a median follow-up of 18 months, there were 6 recurrences and 5 disease related deaths in the observation arm and 7 recurrences and 2 disease related deaths in the thalidomide arm. Using an intent to treat principle in our multivariate analysis, adjusting for grade, stage, and nodal status, we noted no significant difference in recurrence free survival between observation (mean 31 months; median not reached (NR)) and the thalidomide arm (mean 24.7 months; median NR) (Hazard ratio = 1.04, 95% CI 0.34 to 3.14, p = 0.945). Interestingly, disease specific survival was significantly better in the thalidomide arm (mean 40.1 months; median NR), as compared to the observation arm (mean 37.1 months; median NR) (Hazard ratio = 0.086, 95% CI 0.008 to 0.981, p = 0.048). Conclusions: In this limited experience with surgically resected RCC at high risk for relapse, thalidomide did not impact time to recurrence but significantly improved disease specific survival in the adjuvant setting. Despite this clinical benefit, significant toxicity limited tolerability of the drug. These data suggest that derivatives of thalidomide, with different toxicity profiles, might warrant testing in the adjuvant setting for RCC.

No significant financial relationships to disclose.

Cytoreductive nephrectomy for metastatic renal cell carcinoma in the presence of nonconventional histology

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Background: While randomized trials show a survival benefit for cytoreductive nephrectomy in the setting of metastatic conventional (clear cell) renal cell carcinoma (mRCC), the benefit of cytoreductive surgery for patients with mRCC of nonconventional histology (papillary, chromophobe, unclassified) is unknown. We evaluated our experience with cytoreductive nephrectomy for nonconventional mRCC at M. D. Anderson. Methods: From 1990–2004, 464 patients with mRCC underwent cytoreductive nephrectomy; of these, 89 patients had nonconventional mRCC and form the basis of this report. The remaining 375 patients with conventional mRCC formed a comparative group. Overall survival (OS) and disease-specific survival (DSS) data were evaluated by Kaplan and Meier analysis, with univariate and multivariate log rank tests. Results: Compared to patients with conventional histology, patients with nonconventional mRCC were younger (p < 0.045), more likely to have nodal metastases (p < 0.0001), and more likely to have sarcomatoid dedifferentiation (21.2 versus 13.2%, p = 0.056). In multivariate analysis, the median survival for nonconventional histology was significantly worse than for conventional mRCC (11.1 versus 19.5 months, p = 0.0081), even after adjusting for stage, grade, performance status, age, and presence of sarcomatoid dedifferentiation. Although positive nodal status was associated with a decreased survival in nonconventional histology (p < 0.0001) in our multivariate analysis, even node negative patients demonstrated a worse survival when compared to those with conventional histology (p = 0.03). Interestingly, patients with nonconventional mRCC who had complete resection of their retroperitoneal nodal metastases with cytoreduction showed a trend towards improved survival, as has been reported in patients with conventional mRCC and nodal disease. Conclusions: Patients with nonconventional mRCC have a higher incidence of nodal metastases and demonstrate a worse prognosis than those with conventional histology, who undergo cytoreductive surgery. Aggressive cytoreduction with removal of all nodal disease may improve outcomes. More effective systemic therapies are needed to improve upon the results seen with aggressive surgery.

No significant financial relationships to disclose.

Nonessential amino acids are not necessary to stimulate net muscle protein synthesis in healthy volunteers

The present study was performed to test the hypothesis that orally administered essential amino acids, in combination with carbohydrate, will stimulate net muscle protein synthesis in resting human muscle in vivo. Four volunteers ingested 500 mL of a solution containing 13.4 g of essential amino acids and 35 g sucrose (EAA). Blood samples were taken from femoral arterial and venous catheters over a 2-hour period following the ingestion of EAA to measure arteriovenous concentrations of amino acids across the muscle. Two muscle biopsies were taken during the study, one before administration of the drink and one approximately 2 hours after consumption of EAA. Serum insulin increased from normal physiologic levels at baseline (9.2 +/- 0.8 microU/mL) and peaked (48 +/- 7.1 microU/mL) 30 minutes after EAA ingestion. Arterial essential amino acid concentrations increased approximately 100 to 400% above basal levels between 10 and 30 minutes following drink ingestion. Net nitrogen (N) balance changed from negative (-495 +/- 128 nmol/mL) prior to consumption of EAA to a peak positive value (416 +/- 140 nmol/mL) within 10 minutes of ingestion of the drink. EAA resulted in an estimated positive net N uptake of 307.3 mg N above basal levels over the 2-hour period. Muscle amino acid concentrations were similar prior to and 2 hours following ingestion of EAA. We conclude that ingestion of a solution composed of carbohydrates to stimulate insulin release and a small amount of essential amino acids to increase amino acid availability for protein synthesis is an effective stimulator of muscle protein anabolism.

Analysis of surgical success in preventing recurrent acute exacerbations in chronic pancreatitis

OBJECTIVE

To determine whether surgical intervention prevents recurrent acute exacerbations in chronic pancreatitis (CP).

SUMMARY BACKGROUND DATA

The primary goal of surgical intervention in the treatment of CP has been relief of chronic unrelenting abdominal pain. A subset of patients with CP have intermittent acute exacerbations, often with increasing frequency and often unrelated to ongoing ethanol abuse. Little data exist regarding the effectiveness of surgery to prevent acute attacks.

METHODS

From 1985 to 1999, all patients identified with a diagnosis of CP were recruited to participate in an ongoing program of serial clinic visits and functional and clinical evaluations. Patients were offered surgery using standard criteria. Data were gathered regarding ethanol abuse, pain, narcotic use, and recurrent acute exacerbations requiring hospital admission before and after surgery. Patients were broadly categorized as having severe unrelenting pain alone (group 1), severe pain with intermittent acute exacerbations (group 2), and intermittent acute exacerbations only (group 3).

RESULTS

Two hundred fifty-nine patients were recruited. One hundred eighty-five patients underwent 199 surgical procedures (124 modified Puestow procedure [LPJ], 29 distal pancreatectomies [DP], and 46 pancreatic head resections [PHR; 14 performed after failure of LPJ]). There were no deaths. The complication rate was 4% for LPJ, 15% for DP, and 27% for PHR. Ethanol abuse was causative in 238 patients (92%). Mean follow-up was 81 months. There were 104 patients in group 1 (86 who underwent surgery), 71 patients in group 2 (64 who underwent surgery), and 84 in group 3 (49 who underwent surgery). No patient without surgery had spontaneous resolution of symptoms. Postoperative pain relief (freedom from narcotic analgesics) was achieved in 153 of 185 patients (83%) overall: 106 of 124 (86%) for LPJ, 19 of 29 (67%) for DP, and 42 of 46 (91%) for PHR. The mean rate of acute exacerbations was 6.3 +/- 2.1 events per year before surgery in group 2 and 7.8 +/- 1.8 events per year in group 3. After surgery, no acute exacerbations occurred in 42 of 64 (66%) group 2 patients and in 40 of 49 (82%) group 3 patients. The mean number of episodes of acute exacerbation after surgery was 1.6 +/- 2.3 events in group 2 and 1.1 +/- 1.9 events in group 3. Only four patients in group 2 and one patient in group 3 had an equal or increased frequency of attacks after surgery. Preventing attacks was most effective with LPJ (58/64, 91%) and least effective for DP (6/18, 33%).

CONCLUSIONS

Surgical intervention prevents recurrent acute exacerbations. The overall frequency of events was reduced in nearly all patients. Therefore, surgical intervention is indicated in patients with CP whose disease is characterized by recurrent acute exacerbations.

Increased small bowel epithelial turnover in interleukin-1 receptor knockout mice

OBJECTIVE

To determine whether interleukin-1 (IL-1) affects the cellular homeostasis of small bowel mucosa, the authors studied apoptosis and proliferation in small bowel epithelium in two groups of C57 mice: an IL-1 receptor knockout group, and a control wild-type group.

SUMMARY BACKGROUND DATA

Gut mucosal integrity is maintained by a balance of cell proliferation and cell death. Recent reports suggest that IL-1, a proinflammatory cytokine, increases cell death by apoptosis in some epithelial cells.

METHODS

Twenty-four male C57BL6 IL-1 receptor (type I) knockout mice were killed, and small bowel was removed for study. Twenty-four wild-type mice (C57-BL6) served as controls. Body weights, bowel length, and mucosal morphology were examined for phenotypic differences. Apoptosis was quantified by terminal deoxyuridine nick-end labeling (TUNEL) immunohistochemical staining and cellular proliferation by proliferation cell nuclear antigen staining. Whole mucosal protein was analyzed for nuclear factor-kappaB expression. Groups were analyzed by t test.

RESULTS

The absence of IL-1 type I receptor in knockout mice was verified by reverse transcriptase-polymerase chain reaction. IL-1 receptor null mice were larger than wild-type controls, with a longer small bowel; however, the index of small bowel length to total body weight did not differ between groups. The percentage of apoptotic cells was higher in IL-1 receptor null mice than in wild-type mice; the proliferation index also increased. Mucosal height and other measures of mucosal morphology were not different. Genotypic absence of IL-1 receptors was associated with decreased expression of nuclear factor-kappaB in whole mucosal protein extracts.

CONCLUSIONS

Both apoptosis and proliferation increased in gut epithelial cells of mice without IL-1 receptors, suggesting increased cell turnover with no change in net balance. This model represents an opportunity to examine potential mechanisms of gut epithelial turnover in vivo, under both normal conditions and in conditions of mucosal proliferation and atrophy.

A submaximal dose of insulin promotes net skeletal muscle protein synthesis in patients with severe burns

OBJECTIVE

To investigate the hypothesis that a submaximal insulin dose reverses the net muscle catabolism associated with severe burns, and to determine its effects on amino acid kinetics.

SUMMARY BACKGROUND DATA

The authors previously showed that a maximal dose of insulin administered to patients with severe burns promoted skeletal muscle glucose uptake and net protein synthesis. However, this treatment was associated with caloric overload resulting from the large quantities of exogenous glucose required to maintain euglycemia, and hypoglycemia was a potential problem.

METHODS

Thirteen patients were studied after severe burn injury (>60% total body surface area). Patients were randomly treated by standard care (n = 5) or with exogenous insulin (n = 8). Data were derived from an arteriovenous model with primed-continuous infusions of stable isotopes and biopsies of the vastus lateralis muscle.

RESULTS

Net amino acid balance was significantly improved with insulin treatment. Skeletal muscle protein synthesis was significantly greater in the group receiving insulin, whereas muscle protein breakdown was not different between the groups. This submaximal dose of insulin did not affect glucose or amino acid uptake or require a greater caloric intake to avoid hypoglycemia.

CONCLUSIONS

Submaximal insulin can promote muscle anabolism without eliciting a hypoglycemic response.

Cutaneous burn increases apoptosis in the gut epithelium of mice

BACKGROUND

Gut mucosal homeostasis depends on a balance between cell proliferation and cell death. After cutaneous burn injury, gut mucosal weight has been shown to decrease. This decrease in weight was paradoxically associated with an increase in gut proliferative factors. For mucosal weight to decrease in the presence of increased proliferation, there must be an even greater increase in cell death. We postulate that cutaneous burn injury causes an increase in gut epithelial cell death primarily by apoptosis.

STUDY DESIGN

We produced a 30% full-thickness scald burn in the dorsum of anesthetized male C57BL6 mice and collected the proximal small bowel at 12, 24, 36, 48, and 60 hours after injury. Sham burned animals served as controls. Apoptosis and proliferation were measured by immunohistochemical assays (terminal deoxyuridine nick-end labeling for apoptosis and proliferative cell nuclear antigen assay for proliferation). Apoptosis was also measured by ELISA for cytoplasmic histone-associated DNA fragments. Mucosal height was determined on histologic sections. The two groups were compared at each time point using Wilcoxon two-sample test and t-test with Bonferroni's correction where appropriate.

RESULTS

The percentage of apoptotic cells (number of cells stained by terminal deoxyuridine nick-end labeling per 100 villus cells) was significantly higher at 12, 24, and 48 hours after injury. This increase was corroborated by an increase in the ELISA at 12 hours. Proliferation as measured by immunostaining for proliferative cell nuclear antigen significantly increased at 12, 24, 48, and 60 hours. Mucosal height as a gross measure of mucosal atrophy was not different between the groups.

CONCLUSIONS

We have shown an increase in apoptosis coupled with an increase in proliferation after a burn injury. These results imply an increase in cell turnover in the gut epithelial cells after a burn. Impaired bowel function has been demonstrated repeatedly after burn injury, and this increase in cell turnover may be related.

Acute dichloroacetate administration increases skeletal muscle free glutamine concentrations after burn injury

OBJECTIVE

To investigate the hypothesis that the stimulation of pyruvate oxidation by dichloroacetate (DCA) administration would increase the level of intramuscular glutamine in severely burned patients.

SUMMARY BACKGROUND DATA

The level of intramuscular glutamine decreases in response to severe injury, and the rate of intramuscular glycolysis and pyruvate oxidation is elevated. Intramuscular glutamine concentrations have been correlated to muscle protein synthesis.

METHODS

Six studies were conducted on five patients with burns >40% total body surface area. Patients were studied in the fed state during an 8-hour stable isotope infusion. After 5 hours, DCA (30 mg/kg) was administered for 30 minutes.

RESULTS

Analysis of muscle biopsy samples taken at 5 and 8 hours of the study revealed a 32% increase in intracellular glutamine levels after DCA administration. Increased intracellular glutamine concentrations did not affect skeletal muscle protein synthesis as determined by a three-pool arteriovenous model or by the direct incorporation of isotope into skeletal muscle protein. DCA administration resulted in a decrease in plasma lactate but no change in alanine de novo synthesis or intracellular concentration.

CONCLUSIONS

These results suggest that acute DCA administration can increase intramuscular glutamine concentration, but that this acute elevation does not affect muscle protein metabolism.

Effects of therapy with recombinant human growth hormone on insulin-like growth factor system components and serum levels of biochemical markers of bone formation in children after severe burn injury

Burn injury in children is associated with low bone formation and long-term bone loss. Because recombinant human GH (rHGH) may accelerate burn wound healing, and because rHGH increases bone formation and density in GH-deficient patients, we studied the short-term effects of rHGH on bone fomation, reflected by osteocalcin and type I procollagen propeptide levels in a randomized, double-blind, placebo-controlled study. Nineteen patients were enrolled and received either rHGH (0.2 mg/kg.day) or an equal volume of saline. Mean burn size and age were not different between the groups, and test substances were given from admission to time of wound healing (mean: 43 +/- 22 days). At wound healing, serum levels of insulin-like growth factor (IGF)-1 and IGF binding protein (IGFBP)-3 in the rHGH group rose to mean values of 229% and 187% of the respective means of the placebo group (P < 0.025). Serum osteocalcin concentrations remained below normal in both groups, and type I procollagen propeptide levels achieved a low normal level IGFBR-4 levels were twice that of normal on admission and doubled further at wound healing; IGFBP-5 levels were low on admission but rose to normal at wound healing. We conclude that large doses of rHGH were ineffective in improving disordered bone formation despite increasing serum IGF-1 and IGFBP-3. The rHGH-independent rise in serum levels of the inhibitory binding protein IGFBP-4 suggests a mechanism by which improved bone formation is prevented despite successful elevation of IGF-1 and IGFBP-3 in the burned child.