Efficacy and safety of intrathecal pemetrexed for TKI-failed leptomeningeal metastases from EGFR+ NSCLC: an expanded, single-arm, phase II clinical trial

BACKGROUND

This study aimed to evaluate the efficacy and safety of intrathecal pemetrexed (IP) for treating patients with leptomeningeal metastases (LM) from non-small-cell lung cancer (NSCLC) who progressed from epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) treatment in an expanded, prospective, single-arm, phase II clinical study (ChiCTR1800016615).

PATIENTS AND METHODS

Patients with confirmed NSCLC-LM who progressed from TKI received IP (50 mg, day 1/day 5 for 1 week, then every 3 weeks for four cycles, and then once monthly) until disease progression or intolerance. Objectives were to assess overall survival (OS), response rate, and safety. Measurable lesions were assessed by investigator according to RECIST version 1.1. LM were assessed according to the Response Assessment in Neuro-Oncology (RANO) criteria.

RESULTS

The study included 132 patients; 68% were female and median age was 52 years (31-74 years). The median OS was 12 months (95% confidence interval 10.4-13.6 months), RANO-assessed response rate was 80.3% (106/132), and the most common adverse event was myelosuppression (n = 42; 31.8%), which reversed after symptomatic treatment. The results of subgroup analysis showed that absence of brain parenchymal metastasis, good Eastern Cooperative Oncology Group score, good response to IP treatment, negative cytology after treatment, and patients without neck/back pain/difficult defecation had longer survival. Gender, age, previous intrathecal methotrexate/cytarabine, and whole-brain radiotherapy had no significant influence on OS.

CONCLUSIONS

This study further showed that IP is an effective and safe treatment method for the EGFR-TKI-failed NSCLC-LM, and should be recommended for these patients in clinical practice and guidelines.

Survival impact of post-operative immunotherapy in resected stage III cutaneous melanomas in the checkpoint era

BACKGROUND

Checkpoint inhibitors have shown improvement in recurrence-free survival in the post-operative setting for node-positive melanoma and were first approved in late 2015. However, single-agent checkpoint therapies have yet to show benefit to overall survival (OS) for lower-risk stage III cancers. We evaluated the OS benefit of post-operative immunotherapy in the National Cancer Database (NCDB).

PATIENTS AND METHODS

Patient cases were selected from the NCDB 2020 Participant Use File. Patients diagnosed with stage III cutaneous melanoma between 2016 and 2019 who underwent definitive resection for their melanoma were included. OS between those who received post-operative immunotherapy within 84 days of surgery and those who did not was analyzed by the Kaplan-Meier method. Demographic and clinical characteristics between the two groups were compared via Cox proportional hazard models.

RESULTS

14 978 patients with stage III melanoma were included. Of those, 34.9% (n = 5234) received post-operative immunotherapy and 65.1% (n = 9744) did not. Using the American Joint Committee on Cancer version 8 (AJCCv8) staging, 36-month survival was significantly higher in patients who received post-operative immunotherapy compared to no post-operative systemic therapy in those diagnosed with stage IIIB (88.0% versus 84.7%, P = 0.011), IIIC (75.6% versus 68.1%, P < 0.001), or IIID (59.2% versus 48.4%, P = 0.002). No significant improvement in 36-month survival was seen in patients who received post-operative immunotherapy in patients with stage IIIA disease (93.0% versus 92.2%, P = 0.218).

CONCLUSIONS

Post-operative immunotherapy had an OS benefit in patients with AJCCv8 stage IIIB, IIIC, and IIID disease, but had no significant survival benefit for patients with stage IIIA melanomas.

Value of dual-layer spectral detector CT in predicting lymph node metastasis of non-small cell lung cancer

Background

The accurate assessment of lymph node metastasis (LNM) is crucial for the staging, treatment, and prognosis of lung cancer. In this study, we explored the potential value of dual-layer spectral detector computed tomography (SDCT) quantitative parameters in the prediction of LNM in non-small cell lung cancer (NSCLC).

Methods

In total, 91 patients presenting with solid solitary pulmonary nodules (8 mm < diameter ≤30 mm) with pathologically confirmed NSCLC (57 without LNM, and 34 with LNM) were enrolled in the study. The patients' basic clinical data and the SDCT morphological features were analyzed using the chi-square test or Fisher's exact test. The Mann-Whitney U-test and independent sample t-test were used to analyze the differences in multiple SDCT quantitative parameters between the non-LNM and LNM groups. The diagnostic efficacy of the corresponding parameters in predicting LNM in NSCLC was evaluated by plotting the receiver operating characteristic (ROC) curves. A multivariate logistic regression analysis was conducted to determine the independent predictive factors of LNM in NSCLC. Interobserver agreement was assessed using intraclass correlation coefficients (ICCs) and Bland-Altman plots.

Results

There were no significant differences between the non-LNM and LNM groups in terms of age, sex, and smoking history. Lesion size and vascular convergence sign differed significantly between the two groups (P<0.05), but there were no significant differences in the six tumor markers. The SDCT quantitative parameters [SAR40keV, SAR70keV, Δ40keV, Δ70keV, CER40keV, CER70keV, NEF40keV, NEF70keV, λ, normalized iodine concentration (NIC) and NZeff] were significantly higher in the non-LNM group than the LNM group (P<0.05). The ROC analysis showed that CER40keV, NIC, and CER70keV had higher diagnostic efficacy than other quantitative parameters in predicting LNM [areas under the curve (AUCs) =0.794, 0.791, and 0.783, respectively]. The multivariate logistic regression analysis showed that size, λ, and NIC were independent predictive factors of LNM. The combination of size, λ, and NIC had the highest diagnostic efficacy (AUC =0.892). The interobserver repeatability of the SDCT quantitative and derived quantitative parameters in the study was good (ICC: 0.801-0.935).

Conclusions

The SDCT quantitative parameters combined with the clinical data have potential value in predicting LNM in NSCLC. The size + λ + NIC combined parameter model could further improve the prediction efficacy of LNM.

Quantitative parameters in novel spectral computed tomography for assessing gastric cancer and cell proliferation

OBJECTIVES

To investigate the diagnostic ability of novel spectral CT-derived parameters for gastric cancer histological types and Ki-67 expression.

METHODS

A total of 72 patients with histologically proven gastric cancer (GC) were retrospectively included in this study. All patients underwent dual-phase enhanced abdominal spectral CT. The arterial (AP) and venous phase (VP) slope of the spectral curve (λHU), iodine concentration (IC), normalized IC (NIC), effective atomic number (Zeff) and iodine-no-water concentration were retrospectively compared between patients with low and high Ki-67 expression levels and with different histological types in GC patients. The ROI was outlined independently by two senior physicians, and the average of three measurements at the largest level was taken. In addition, interobserver reproducibility was assessed by Bland-Altman analysis. Correlations between quantitative parameters and Ki-67 expression levels were assessed by Spearman's correlation coefficients.

RESULTS

The values between the mucinous group and nonmucinous carcinoma group were significantly different in both phases. The IC, NIC, and iodine-no-water concentration in the VP were significantly different among the Ki-67_L, Ki-67_M, and Ki-67_H groups. Spearman rank correlation analysis demonstrated a positive correlation between Ki-67 expression levels and IC, NIC, and iodine-no-water concentration in the VP, with correlation coefficients of 0.304, 0.424, and 0.322, respectively.

CONCLUSION

Quantitative spectral parameters can discriminate between low and high Ki-67 expression and different histological types in GC. The NIC, IC and iodine-no-water concentration can be useful parameters for evaluating of Ki-67 expression levels.

The Clinical Practice and Dosimetric Outcome of the Manual Adaptive Planning during Definitive Radiotherapy Treatment for Cervical Cancer

PURPOSE/OBJECTIVE(S)

Organ motion is challenging during primary definitive external beam radiotherapy in locally advanced cervical cancer (LACC). Our study evaluated the manual adaptive planning approach three weeks after the treatment started, compared the dosimetric consequences of the manual adaptive plans to the scheduled plans, and explored the clinical factors predicting patients suitable for this replanning strategy.

MATERIALS/METHODS

We analyzed 82 patients receiving primary definitive external beam radiotherapy with weekly online cone-beam computed tomography (CBCT)-based monitoring. The re-CT simulation was performed during treatment to develop a new plan (manual adaptive plan) due to a significant deviation of the clinical target volume (CTV). To evaluate the dosimetric benefit, D98, homogeneity index (HI) and conformity index (CI) for the planning target volume (PTV), as well as D2cc of the bowel, bladder, sigmoid and rectum were compared between the manual adaptive plans and the scheduled ones. The clinical factors influencing target motion throughout treatment were analyzed by chi-square test and logistic regression analysis.

RESULTS

The re-CT simulation was performed after 15 fractions during treatment to develop the manual adaptive plan in 41 patients. The median CI and HI of the manual adaptive plan were significantly superior to the scheduled one (P = 0.001, 0.003, respectively), demonstrating a better dose coverage of the target volume. Compared to the scheduled plans, D98 of the manual adaptive plans increased by 3.3% (P = 0.0002), the average of D2cc to the rectum, bladder decreased 0.267Gy (P = 0.0049) and 0.321Gy (P = 0.0146), respectively. In addition, the chi-square test demonstrated that age (P = 0.024), primary tumor volume (P = 0.015), and parametrial infiltration (P = 0.022) were the clinical factors influencing target motion throughout treatment. Multivariate analysis further identified the large tumor volume (≥50cm3, OR = 3.254, P = 0.039) and parametrial infiltration (OR = 3.376, P = 0.018) as the independent risk factors.

CONCLUSION

We found the most significant organ motion happened after 15 fractions during treatment. The manual adaptive planning of definitive radiotherapy improved the dose coverage and decreased the volume of organs at risk of receiving clinically significant doses of RT in patients with LACC. Patients with bulky mass or with parametrial infiltration were highly suggested to receive manual adaptive planning after 15 fractions during definitive radiotherapy, a timesaving strategy compared to the daily online adaptive radiotherapy without compromising the target dose coverage.

Investigation of the Enhancement Mechanism of Electrochemically Deposited Ni-Co-W Coatings via Laser Irradiation: Effect of W Contents on Corrosion Resistance

Ni-Co-W is an alloy with excellent overall performance and wide application prospects. Electrochemical deposition of Ni-Co-W alloys is currently the most promising process for replacing hexavalent chromium plating. Variations in the W content of the Ni-Co-W coating significantly affect its surface morphology, internal structure, and mechanical properties. Considering the numerous defects with conventional electrochemical deposition, a laser was introduced to enhance the quality and rate of deposition. Using a multienergy composite field, the deposition technique enhanced various properties at room temperature. Ni-Co-W alloy coatings were fabricated through electrochemical deposition and laser electrochemical deposition using electrolytes containing Na₂WO₄·2H₂O at concentrations of 12, 15, 18, and 24 g/L in this investigation. This study aimed to examine how laser irradiation strengthens the corrosion resistance of the coatings. The corrosion resistance could be enhanced with an initial W content increase, but the corrosion resistance did not depend entirely on the W content. Variations in the W content of the electrochemically deposited coatings affected the surface morphology, residual internal stresses, and crystal structure, changing the corrosion resistance. In contrast, the laser electrochemical deposition coating was caused by the combined effect of the W content and laser irradiation (concentration of <18 g/L). Laser electrochemical deposition of the Ni-Co-W coating resulted in a higher W content than electrochemical deposition (≥3.5%), improved the residual internal stresses, and refined the grain size of the coating, resulting in better corrosion resistance (corrosion rate decreased by 74% and R_ct increased by 109.1% at most).

Value of spectral computed tomography-derived quantitative parameters based on full volume analysis in the diagnosis of benign/malignant and pathological subtypes of solitary pulmonary nodules

Background

Conventional dynamic computed tomography (CT) has a low specificity for the distinction between benign and malignant solitary pulmonary nodules (SPNs), and spectral CT has been proposed as a potential alternative. We aimed to investigate the role of quantitative parameters based on full-volume spectral CT in the differential diagnosis of SPNs.

Methods

This retrospective study included spectral CT images of 100 patients with pathologically confirmed SPNs (78 and 22 in the malignant and benign groups, respectively). All cases were confirmed by postoperative pathology, percutaneous biopsy, and bronchoscopic biopsy. Multiple quantitative parameters derived from spectral CT were extracted from whole-tumor volume and standardized. Differences in quantitative parameters between groups were statistically analyzed. Diagnostic efficiency was evaluated by generating a receiver operating characteristic (ROC) curve. Between-group differences were evaluated using an independent sample t-test or Mann-Whitney U test. Interobserver repeatability was assessed using intraclass correlation coefficients (ICCs) and Bland-Altman plots.

Results

Spectral CT-derived quantitative parameters, except attenuation difference between the SPN in the 70 keV and arterial enhancement [Δ_{S-A(70 keV)}], were significantly higher for malignant SPNs than for benign nodules (P<0.05). In the subgroup analysis, most parameters could distinguish between the benign and adenocarcinoma groups, and between the benign and squamous cell carcinoma groups (P<0.05). Only 1 parameter could differentiate the adenocarcinoma and squamous cell carcinoma groups (P=0.020). ROC curve analysis indicated that normalized arterial enhancement fraction in the 70 keV (NEF_{70 keV}), normalized iodine concentration (NIC), and Δ70 keV had high diagnostic efficacy for differentiating SPNs between the benign and malignant SPNs [area under the curve (AUC): 0.867, 0.866, and 0.848, respectively] and between the benign and adenocarcinoma groups (AUC: 0.873, 0.872, and 0.874, respectively). The multiparameters derived from spectral CT exhibited satisfactory interobserver repeatability (ICC: 0.856-0.996).

Conclusions

Our study suggests that quantitative parameters derived from whole-volume spectral CT may be useful to improve discrimination of SPNs.

[Network meta-analysis comparing the clinical outcomes and safety of robotic, laparoscopic, and transanal total rectal mesenteric resection for rectal cancer]

Objective: To methodically assess the clinical effectiveness and safety of robot-assisted total rectal mesenteric resection (RTME), laparoscopic-assisted total rectal mesenteric resection (laTME), and transanal total rectal mesenteric resection (taTME). Methods: A computer search was conducted on PubMed, Embase, Cochrane Library, and Ovid databases to identify English-language reports published between January 2017 and January 2022 that compared the clinical efficacy of the three surgical procedures of RTME, laTME, and taTME. The quality of the studies was evaluated using the NOS and JADAD scales for retrospective cohort studies and randomized controlled trials, respectively. Direct meta-analysis and reticulated meta-analysis were performed using Review Manager software and R software, respectively. Results: Twenty-nine publications comprising 8,339 patients with rectal cancer were ultimately included. The direct meta-analysis indicated that the length of hospital stay was longer after RTME than after taTME, whereas according to the reticulated meta-analysis the length of hospital stay was shorter after taTME than after laTME (MD=-0.86, 95%CI: -1.70 to -0.096, P=0.036). Moreover, the incidence of anastomotic leak was lower after taTME than after RTME (OR=0.60, 95%CI: 0.39 to 0.91, P=0.018). The incidence of intestinal obstruction was also lower after taTME than after RTME (OR=0.55, 95%CI: 0.31 to 0.94, P=0.037). All of these differences were statistically significant (all P<0.05). There were no statistically significant differences between the three surgical procedures regarding the number of lymph nodes cleared, length of the inferior rectal margin, or rate of positive circumferential margins (all P>0.05). An inconsistency test using nodal analysis revealed no statistically significant differences between the results of direct and indirect comparisons of the six outcome indicators (all P>0.05). Furthermore, we detected no significant overall inconsistency between direct and indirect evidence. Conclusion: taTME has advantages over RTME and laTME, in terms of radical and surgical short-term outcomes in patients with rectal cancer.

[Electroencephalographic microstates in vestibular schwannoma patients with tinnitus]

OBJECTIVE

To explore the biomarkers of tinnitus in vestibular schwannoma patients using electroencephalographic (EEG) microstate technology.

METHODS

The EEG and clinical data of 41 patients with vestibular schwannoma were collected. All the patients were evaluated by SAS, SDS, THI and VAS scales. The EEG acquisition time was 10-15 min, and the EEG data were preprocessed and analyzed using MATLAB and EEGLAB software package.

RESULTS

Of the 41 patients with vestibular schwannoma, 29 patients had tinnitus and 12 did not have tinnitus, and their clinical parameters were comparable. The average global explanation variances of the non-tinnitus and tinnitus groups were 78.8% and 80.1%, respectively. The results of EEG microstate analysis showed that compared with those without tinnitus, the patients with tinnitus had an increased frequency (P=0.033) and contribution (P=0.028) of microstate C. Correlation analysis showed that THI scale scores of the patients were negatively correlated with the duration of microstate A (R=-0.435, P=0.018) and positively with the frequencies of microstate B (R=0.456, P=0.013) and microstate C (R=0.412, P=0.026). Syntax analysis showed that the probability of transition from microstate C to microstate B increased significantly in vestibular schwannoma patients with tinnitus (P=0.031).

CONCLUSION

EEG microstate features differ significantly between vestibular schwannoma patients with and without tinnitus. This abnormality in patients with tinnitus may reflect the potential abnormality in the allocation of neural resources and the transition of brain functional activity.

Synergistic effects of electroacupuncture and bone marrow stromal cells transplantation therapy in ischemic stroke

OBJECTIVE

Animal studies and clinical trials demonstrated the effectiveness of a combination of transplanted bone marrow stromal cells (BMSC) and electroacupuncture (EA) treatment in improving neurological deficits. However, the ability of the BMSC-EA treatment to enhance brain repair processes or the neuronal plasticity of BMSC in ischemic stroke model is unclear. The purpose of this study was to investigate the neuroprotective effects and neuronal plasticity of BMSC transplantation combined with EA in ischemic stroke.

MATERIALS AND METHODS

A male Sprague-Dawley (SD) rat middle cerebral artery occlusion (MCAO) model was used. Intracerebral transplantation of BMSC, transfected with lentiviral vectors expressing green fluorescent protein (GFP), was performed using a stereotactic apparatus after modeling. MCAO rats were treated with BMSC injection alone or in combination with EA. After the treatment, proliferation and migration of BMSC were observed in different groups by fluorescence microscopy. Quantitative real-time PCR (qRT-PCR), Western blotting, and immunohistochemistry were performed to examine changes in the levels of neuron-specific enolase (NSE) and nestin in the injured striatum.

RESULTS

Epifluorescence microscopy revealed that most BMSC in the cerebrum were lysed; few transplanted BMSC survived, and some living cells migrated to areas around the lesion site. NSE was overexpressed in the striatum of MCAO rats, illustrating the neurological deficits caused by cerebral ischemia-reperfusion. The combination of BMSC transplantation and EA attenuated the expression of NSE, indicating nerve injury repair. Although the qRT-PCR results showed that BMSC-EA treatment elevated nestin RNA expression, less robust responses were observed in other tests.

CONCLUSIONS

Our results show that the combination treatment significantly improved restoration of neurological deficits in the animal stroke model. However, further studies are required to see if EA could promote the rapid differentiation of BMSC into neural stem cells in the short term.

Association between hepatitis C infection during pregnancy with maternal and neonatal outcomes: a systematic review and meta-analysis

OBJECTIVE

Studies of possible implications of the maternal hepatitis C virus (HCV) infection in terms of intrauterine fetal growth restriction (IUGR), preterm birth (PTB), low birth weight (LBW) infants, premature rupture of membranes (PROM), maternal and neonatal mortality are limited and inconclusive. Our study aims to assess the impact of HCV on maternal and neonatal outcomes.

MATERIALS AND METHODS

Systematic literature search was done in PubMed, Scopus, and Google Scholar, Cochrane Library, and TRIP databases for all observational studies published from 1st January 1950 to 15th October 2022. The pooled odds ratio (OR) or risk ratio (RR) with a 95% confidence interval (CI) was estimated. STATA version 12.0 software was used for analysis. Heterogeneity among the included articles was evaluated by sensitivity, meta-regression, and publication bias analyses.

RESULTS

A total of 14 studies involving 12,451 HCV (+) and 56,42,910 HCV (-) pregnant women were included in our meta-analysis. Maternal HCV during pregnancy was significantly associated with the increased risk of PTB (OR=1.66, 95% CI: 1.59-1.74), IUGR (OR=2.09, 95% CI: 2.04-2.14) and LBW (OR=1.96, 95% CI: 1.63-2.36) as compared to healthy pregnant women. Subgroup analysis based on ethnicity also suggested a strong association between maternal HCV infection and a higher risk of PTB in Asian and Caucasian populations. Maternal (RR=3.44, 95% CI: 1.85-6.41), as well as neonatal (RR=1.54, 95% CI: 1.18-2.02) mortality was significantly higher in HCV (+) cases.

CONCLUSIONS

Mothers with HCV infection had a markedly increased probability of PTB and/or IUGR and/or LBW. In clinical practice, standard care of treatment and proper monitoring are needed for the pregnant population with HCV infection. Our findings may provide useful information for selecting appropriate therapy methods for HCV-positive pregnant women.

Correlation between capsule endoscopy classification and CT lymphangiography of primary intestinal lymphangiectasia

AIM

To investigate the correlation between capsule endoscopy (CE) classification of primary intestinal lymphangiectasia (PIL) and computed tomography (CT) lymphangiography (CTL).

MATERIALS AND METHODS

A total of 52 patients with diagnosed PIL were enrolled. All patients were examined using CTL and small intestinal CE before surgery. CE assessments included the morphology, scope, colour, and size of lesions. CTL assessments included intestinal wall, lymphatic vessel dilatation, lymph fluid reflux, and lymphatic fistula. Patients were divided into three groups according to type diagnosed by CE, and the CTL characteristics were analysed among the groups.

RESULTS

CE showed 15 patients with type I, 27 with II, and 10 with type III. Intestinal wall thickening was observed in 15 type I, 21 type II, and seven type III. Pericardial effusion was observed in only three type I patients; the difference among types was statistically significant (p=0.02). Abnormal contrast agent distribution in the intestinal wall and mesentery was observed in 15 type II patients, and the difference was significantly greater than that of types I and III (p=0.02). Abnormal contrast agent distribution in the abdominal cavity was observed in 12 type II, and the difference was statistically significant (p=0.03).

CONCLUSION

The CE PIL classification reflects the extent and scope of intestinal mucosa lesions; CTL more systematically demonstrates abnormal lymphatic vessels or reflux, and its manifestations of PIL are related to the CE classification. The combination of CTL with CE is useful for accurately evaluating PIL, and provides guidance for preoperative assessment and treatment management of PIL patients.

Value of dual-layer spectral detector computed tomography in the diagnosis of benign/malignant solid solitary pulmonary nodules and establishment of a prediction model

Objective

This study aimed to investigate the role of spectral detector computed tomography (SDCT) quantitative parameters and their derived quantitative parameters combined with lesion morphological information in the differential diagnosis of solid SPNs.

Methods

This retrospective study included basic clinical data and SDCT images of 132 patients with pathologically confirmed SPNs (102 and 30 patients in the malignant and benign groups, respectively). The morphological signs of SPNs were evaluated and the region of interest (ROI) was delineated from the lesion to extract and calculate the relevant SDCT quantitative parameters, and standardise the process. Differences in qualitative and quantitative parameters between the groups were statistically analysed. A receiver operating characteristic (ROC) curve was constructed to evaluate the efficacy of the corresponding parameters in the diagnosis of benign and malignant SPNs. Statistically significant clinical data, CT signs and SDCT quantitative parameters were analysed using multivariate logistic regression to determine the independent risk factors for predicting benign and malignant SPNs, and the best multi-parameter regression model was established. Inter-observer repeatability was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots.

Results

Malignant SPNs differed from benign SPNs in terms of size, lesion morphology, short spicule sign, and vascular enrichment sign (P< 0.05). The SDCT quantitative parameters and their derived quantitative parameters of malignant SPNs (SAR_40keV, SAR_70keV, Δ_40keV, Δ_70keV, CER_40keV, CER_70keV, NEF_40keV, NEF_70keV, λ, NIC, NZ_eff) were significantly higher than those of benign SPNs (P< 0.05). In the subgroup analysis, most parameters could distinguish between benign and adenocarcinoma groups (SAR_40keV, SAR_70keV, Δ_40keV, Δ_70keV, CER_40keV, CER_70keV, NEF_40keV, NEF_70keV, λ, NIC, and NZ_eff), and between benign and squamous cell carcinoma groups (SAR_40keV, SAR70_keV, Δ_40keV, Δ_70keV, NEF_40keV, NEF_70keV, λ, and NIC). However, there were no significant differences between the parameters in the adenocarcinoma and squamous cell carcinoma groups. ROC curve analysis indicated that NIC, NEF_70keV, and NEF_40keV had higher diagnostic efficacy for differentiating benign and malignant SPNs (area under the curve [AUC]:0.869, 0.854, and 0.853, respectively), and NIC was the highest. Multivariate logistic regression analysis showed that size (OR=1.138, 95% CI 1.022-1.267, P=0.019), Δ_70keV (OR=1.060, 95% CI 1.002-1.122, P=0.043), and NIC (OR=7.758, 95% CI 1.966-30.612, P=0.003) were independent risk factors for the prediction of benign and malignant SPNs. ROC curve analysis showed that the AUC of size, Δ_70keV, NIC, and a combination of the three for differential diagnosis of benign and malignant SPNs were 0.636, 0.846, 0.869, and 0.903, respectively. The AUC for the combined parameters was the largest, and the sensitivity, specificity, and accuracy were 88.2%, 83.3% and 86.4%, respectively. The SDCT quantitative parameters and their derived quantitative parameters in this study exhibited satisfactory inter-observer repeatability (ICC: 0.811-0.997).

Conclusion

SDCT quantitative parameters and their derivatives can be helpful in the differential diagnosis of benign and malignant solid SPNs. The quantitative parameter, NIC, is superior to the other relevant quantitative parameters and when NIC is combined with lesion size and Δ_70keV value for comprehensive diagnosis, the efficacy could be further improved.

Transcriptome dissection of candidate genes associated with lentil seed quality traits

Lentils provide a rich plant-based protein source and staple food in many parts of the world. Despite numerous nutritional benefits, lentil seeds also possess undesirable elements, such as anti-nutritional factors. Understanding the genetic networks of seed metabolism is of great importance for improving the seed nutritional profile. We applied RNA sequencing analysis to survey the transcriptome of developing lentil seeds and compared this with that of the pod shells and leaves. In total, we identified 2622 genes differentially expressed among the tissues examined. Genes preferentially expressed in seeds were enriched in the Gene Ontology (GO) terms associated with development, nitrogen and carbon (N/C) metabolism and lipid synthesis. We further categorized seed preferentially expressed genes based on their involvement in storage protein production, starch accumulation, lipid and suberin metabolism, phytate, saponin and phenylpropanoid biosynthesis. The availability of transcript profile datasets on lentil seed metabolism and a roadmap of candidate genes presented here will be of great value for breeding strategies towards further improvement of lentil seed quality traits.

CT Features of Stage IA Invasive Mucinous Adenocarcinoma of the Lung and Establishment of a Prediction Model

Objective

To investigate computed tomography (CT) features of stage IA invasive mucinous adenocarcinoma (IMA) of the lung and establish a predictive model.

Methods

Fifty-three lesions from 53 cases of stage IA IMA between January 2017 and December 2019 were examined, while 141 lesions from 141 cases of invasive non-mucinous lung adenocarcinoma (INMA) served as control cases. Univariate analysis was performed to compare differences in demographics and CT features between the two groups, and multivariate logistic regression analysis was performed to determine primary influencing factors of solitary nodular IMA. A risk score prediction model was established based on the regression coefficients of these factors, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the model.

Results

Univariate analysis showed that age, nodule type, maximum nodule diameter, tumor lung interface, lobulation, spiculation, air bronchogram or vacuolar signs, and abnormal vascular changes differed significantly between the two groups (p < 0.05). Compared to INMA, spiculation of IMA was relatively longer and softer. Multivariate logistic regression analysis showed that nodule type, indistinct tumor lung interface, air bronchogram or vacuolar signs, and abnormal vascular changes were the primary influencing factors. A prediction model based on the regression coefficients of these factors was established. ROC curve analysis indicated that the area under the curve was 0.882 (p < 0.05).

Conclusion

Compared to INMA, solitary peripheral stage IA nodular IMA were more common in older patients; they more frequently had indistinct tumor lung interface and air bronchogram or vacuolar signs on CT; spiculation was relatively longer and softer; our risk score prediction model based on nodule type, tumor lung interface, air bronchogram or vacuolar signs, and abnormal vascular changes was established with good predictive efficacy for solitary nodular IMA.

The prevalence of Type-1 Brugada pattern in African American: a large population study from the United States

Funding Acknowledgements

Type of funding sources: None.

Background

The prevalence of Type-1 Brugada pattern in Caucasians and Asians have been estimated to be 20 and 180 per 100,000. However, the prevalence of Type-1 Brugada pattern in African Americans has never been studied.

Purpose

This study aims to identify the prevalence of Type-1 Brugada pattern in African Americans.

Methods

Medical records of African American patients ages 18 years old or older with at least one 12-lead electrocardiogram (ECG) performed at 16 hospitals from 5 states in a single healthcare system between January 1, 2011 to December 31, 2020 were included. The search engine software was used to identify patients with keywords (Brugada pattern, Brugada ECG, Brugada Type-1, or Brugada syndrome) documented in the electronic medical record. The 12-lead ECGs were retrospectively analyzed by 2 cardiologists. Any inconsistencies were reviewed by a third cardiac electrophysiologist. Type-1 Brugada pattern was diagnosed according to the recent Heart Rhythm Society Expert Consensus Statement.

Results

Among 43,116 African American patients, (46.9% males), 6 patients (mean age 44.8±13.9 years, 100% males) had Type-1 Brugada pattern documented on at least one 12-lead ECG. The prevalence of Type-1 Brugada pattern in this large patient population of African American was 13.9 per 100,000. None of the patients had major arrhythmic event at 6.7±4.7 years follow-up.

Conclusions

The prevalence of Type-1 Brugada pattern in African American is lower than Caucasian and Asian populations. The risk of major arrhythmic event of Type-1 Brugada pattern in African American appears to be low; however longer follow-up data is needed.

In premenopausal women with idiopathic osteoporosis, lower bone formation rate is associated with higher body fat and higher IGF-1

We examined serum IGF-1 in premenopausal IOP, finding relationships that were opposite to those expected: higher IGF-1 was associated with lower bone formation and higher body fat, and lower BMD response to teriparatide. These paradoxical relationships between serum IGF-1, bone, and fat may contribute to the mechanism of idiopathic osteoporosis in premenopausal women.

INTRODUCTION

Premenopausal women with idiopathic osteoporosis (IOP) have marked deficits in bone microarchitecture but variable bone remodeling. We previously reported that those with low tissue-level bone formation rate (BFR) are less responsive to teriparatide and have higher serum IGF-1, a hormone anabolic for osteoblasts and other tissues. The IGF-1 data were unexpected because IGF-1 is low in other forms of low turnover osteoporosis-leading us to hypothesize that IGF-1 relationships are paradoxical in IOP. This study aimed to determine whether IOP women with low BFR have higher IGF-1 and paradoxical IGF-1 relationships in skeletal and non-skeletal tissues, and whether IGF-1 and the related measures predict teriparatide response.

METHODS

This research is an ancillary study to a 24 month clinical trial of teriparatide for IOP. Baseline assessments were related to trial outcomes: BMD, bone remodeling.

SUBJECTS

 Premenopausal women with IOP(n = 34); bone remodeling status was defined by baseline cancellous BFR/BS on bone biopsy.

MEASURES

 Serum IGF-1 parameters, compartmental adiposity (DXA, CT, MRI), serum hormones, and cardiovascular-risk-markers related to fat distribution.

RESULTS

As seen in other populations, lower BFR was associated with higher body fat and poorer teriparatide response. However, in contrast to observations in other populations, low BFR, higher body fat, and poorer teriparatide response were all related to higher IGF-1: IGF-1 Z-score was inversely related to BFR at all bone surfaces (r =  - 0.39 to - 0.46; p < 0.05), directly related to central fat (p = 0.05) and leptin (p = 0.03). IGF-1 inversely related to 24 month hip BMD %change (r =  - 0.46; p = 0.01).

CONCLUSIONS

Paradoxical IGF-1 relationships suggest that abnormal or atypical regulation of bone and fat may contribute to osteoporosis mechanisms in premenopausal IOP.

Clinical Features and CT Imaging Analysis of Hepatic Sinuscase-Syndrome and Budd–Chiari Syndrome

Objective

This study aimed to analyze the clinical features and computed tomography (CT) manifestations of hepatic sinusoidal obstruction syndrome (HSOS) induced by Gynura segetum, a Chinese herbal medicine, so as to improve the clinical understanding and diagnosis of the disease.

Methods

Relevant clinical and laboratory parameters and CT imaging data of 20 patients with HSOS confirmed by liver biopsy were retrospectively analyzed and compared with 16 patients with Budd-Chiari syndrome (BCS).

Results

Levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and glutamyl transpeptidase increased significantly (p < 0.05) in HSOS patients compared to the BCS patients, while the albumin level and prothrombin time, which are indicators of liver synthesis function, decreased and prolonged significantly, respectively. All 20 patients with HSOS had manifestations of ascites and heterogeneous hypoattenuation on CT, including 18 cases (90%) with heterogeneous enhancement (characteristic map-like enhancement), 17 (85%) with hepatomegaly, 18 (90%) with gallbladder wall oedema, and 16 (80%) with stenosis of main hepatic veins and characteristic “clover-like” enhancement at the second porta hepatis.

Conclusion

Both HSOS and BCS are post-sinusoidal portal hypertension, but have different etiologies and durations. Although they both cause liver congestion, the clinical manifestation of HSOS is acute liver injury. The CT manifestations are characterized by ascites, map-like enhancement and heterogeneous hypoattenuation of the liver parenchyma, and stenosis of the main hepatic veins. BCS is often found in the stage of decompensated liver cirrhosis, resulting in liver shrinkage, splenomegaly, and ascites.

Dynamic contrast-enhanced magnetic resonance imaging: A novel approach to assessing treatment in locally advanced esophageal cancer patients

Aims

This study aims to investigate the potential application of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict concurrent chemoradiation (CRT) in locally advanced esophageal carcinoma.

Patients and Methods

This study involved 33 patients with locally advanced esophageal cancer and treated with CRT. The patients underwent DCE-MRI before CRT (pre) and 3 weeks after starting CRT (mid). The patients were categorized into two groups: complete response (CR) and non-complete response (non-CR) after 3 months of treatment. The quantitative parameters of DCE-MRI (K^trans, Kep, and Ve), the changes and ratios of parameters (ΔK^trans, ΔKep, ΔVe, rΔK^trans, rΔKep, and rΔVe), and the relative ratio in the tumor area and a normal tube wall (rK^trans, rKep, and rVe) were calculated and compared between two timeframes in two groups, respectively. Moreover, the receiver operating characteristics (ROC) statistical analysis was used to assess the above parameters.

Results

We divided 33 patients into two groups: 22 in the CR group and 11 in the non-CR group. During the mid-CRT phase in the CR group, both K^trans and Kep rapidly decreased, while only Kep decreased in the non-CR group. The pre-K^trans and pre-Kep in the CR group were substantially higher compared to the non-CR group. Moreover, the rK^trans was also apparently observed as higher at pre-CRT in the CR group compared to the non-CR group. The ROC analysis demonstrated that the pre-K^trans could be the best parameter to evaluate the treatment performance (AUC = 0.74).

Conclusion

Pre-K^trans could be a promising parameter to forecast how patients with locally advanced esophageal cancer will respond to CRT.

[Effect of PPAR-γ agonist pioglitazone on the prolifeiration of malignant nesothelionma cells induced by HMGB1]

Objective: To investigate the effect and mechanism of PPAR-γ agonist Pioglitazone (PGZ) on the proliferation of malignant mesothelioma (MM) cells. Methods: In December 2019, MM cell lines MSTO-211H and NCI-H2452 were incubated with different final concentrations of PGZ (0, 10, 50, 100, 150, and 200 μmol/L) for different periods of time (24 h, 48 h, and 72 h) , and then the cell proliferation level was detected by CCK8 assay. After given various final concentration of PGZ (0, 10, 50, 100, 150, 200 μmol/L) the for 72 hours, the changes of number and morphology of MM cells were observed under an inverted microscope. The expressions of PPAR-γ and HMGB1 mRNA were determined by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (qRT-PCR) after treatment of MM cells with PGZ of 0, 10, 50, 100 μmol/L for 72 h. The MM cells were treated with PGZ at concentration of 0, 100 μmol/L for 72 h, and the protein expressions of HMGB1 were examined using Western blotting and immunofluorescence; the protein expressions of Ki67 were assessed by immunohistochemistry. Results: The cell viability rate of MM cells was decreased after treated with PGZ (P<0.05) . Cell number in PGZ-treated group was significantly less than that in control group and morphology changes were observed under light microscope. QRT-PCR results revealed significantly increased PPAR-γ mRNA expression in the PGZ-treated group compared to the control group (P<0.05) . There was a significant decrease in the mRNA expression level of HMGB1 in the PGZ-treated group (100 μmol/L) as compared to the control group in MSTO-211H (P<0.05) ; however, the expression level of HMGB1 in NCI-H2452 was an increase or no significant differences (P>0.05) . Western blotting and immunofluorescence results showed that the protein expression of HMGB1 was reduced in the PGZ-treated group compared with the control group in MSTO-211H (P<0.05) , but the protein expression of that in NCI-H2452 was no significant differences (P>0.05) . Immunohistochemistry results showed increased expression of proliferation marker Ki-67. Conclusion: Pioglitazone suppresses the proliferation of MM cells through inhibition of HMGB1 by the activation of PPAR-γ.

Therapeutic efficacy of dexmedetomidine on chronic obstructive pulmonary disease via downregulating lncRNA PACER

OBJECTIVE

The aim of the study was to clarify the therapeutic mechanism of Dexmedetomidine (DEX) on the chronic obstructive pulmonary disease (COPD) and its regulatory effect on long non-coding RNA (lncRNA) PACER.

PATIENTS AND METHODS

Serum level of PACER in COPD patients was detected by quantitative real-time polymerase chain reaction (qRT-PCR). The diagnostic potential of PACER in COPD was assessed by plotting ROC curves. The in vivo COPD model was generated in rats by cigarette smoking exposure. Primary rat alveolar epithelial cells were isolated, purified and cultured. After overexpression of PACER in primary rat alveolar epithelial cells, proliferative and migratory abilities were assessed by cell counting kit-8 (CCK-8) and transwell assay, respectively. Subsequently, we detected changes in PACER expression, viability and migratory potentials in primary rat alveolar epithelial cells harvested from control rats, and those harvested from COPD rats and induced with either DEX or not. Rescue experiments were conducted to uncover the involvement of PP2A in PACER-regulated cell phenotypes.

RESULTS

PACER was upregulated in serum of COPD patients, which was a potential biomarker for diagnosing COPD. Overexpression of PACER in primary rat alveolar epithelial cells enhanced proliferative and migratory abilities. Compared with primary rat alveolar epithelial cells harvested from control rats, proliferative and migratory abilities were stronger in those harvested from COPD rats and induced with either DEX or not. Notably, DEX induction decreased PACER expression, and proliferative and migratory abilities in primary rat alveolar epithelial cells harvested from COPD rats. Overexpression of PP2A could partially abolish the promotive effects of PACER on proliferative and migratory abilities in DEX-induced primary rat alveolar epithelial cells harvested from COPD rats.

CONCLUSIONS

PACER drives the proliferative and migratory abilities of alveolar epithelial cells through activating PP2A. Dexmedetomidine is conducive to COPD treatment by downregulating PACER.

Prognostic value of late gadolinium enhancement in arrhythmogenic right ventricular cardiomyopathy: a meta-analysis

AIM

To assess systematically the prognostic value of cardiac magnetic resonance imaging (CMRI) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).

MATERIALS AND METHODS

The full text of studies of the clinical efficacy of late gadolinium enhancement (LGE) in ARVC was retrieved in multiple databases. Stata 14 was adopted for meta-analysis and bias analysis. Heterogeneity was assessed with the I² statistic.

RESULTS

After exclusions, 561 patients were included in five studies, and the eligibility criteria were met. The meta-analysis suggested that there was a significant difference between LGE positive and negative patients with ARVC in all-cause mortality (relative risk [RR] = 4.78, 95% confidence interval [CI] = 1.41, 16.23, p=0.012; p for heterogeneity = 0.692, I² = 0%); major adverse cardiovascular events (MACE) (RR=2.48, 95% CI = 1.24, 4.96, p=0.010; p for heterogeneity = 0.596, I² = 0%); ventricular tachycardia (RR=3.13, 95% CI = 1.69, 5.78, p<0.001; p for heterogeneity = 0.825, I² = 0%); implanted cardiac defibrillators (RR=3.15, 95% CI = 1.69, 5.87], p<0.001; p for heterogeneity = 0.353, I² = 9.4%).

CONCLUSION

LGE in ARVC patients is a predictor of all-cause mortality and MACE.

Differences in hypertension and prehypertension among people living with and without HIV in China: role of HIV infection and antiretroviral therapy

OBJECTIVES

Hypertension is a growing health concern in people living with HIV (PLWH). However, association between HIV infection and hypertension is equivocal.

METHODS

In all, 1472 PLWH and 2944 HIV-negative individuals frequency-matched by age and sex were derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China. Prehypertension was defined as systolic blood pressure (BP) of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg.

RESULTS

Despite the fact that prevalence of hypertension was overall lower among PLWH than among HIV-negative people (21.1% vs. 29.1%, P < 0.001), it was similar at ages 18-29 (7.6% vs. 8.5%) and 30-44 years (17.1% vs. 18.5%) but significantly lower in PLWH at ages 45-59 (26.1% vs. 40.7%) and 60-75 years (37.1% vs. 57.3%). Prehypertension prevalence was consistently higher in PLWH across all age groups. In the model adjusting for traditional risk factors, HIV infection was associated with hypertension (adjusted odds ratio [aOR] = 1.27, 95% confidence interval: 1.04-1.55) and prehypertension (aOR = 1.77, 95% CI: 1.51-2.08), and attenuated after additional adjustment for abdominal obesity. Age-stratified analysis showed that these associations of HIV with hypertension were observed at ages 18-29 and 30-44 years and associations with prehypertension were observed at ages 18-29, 30-44 and 45-59 years only. Years since HIV diagnosis and stavudine use were the HIV-specific factors independently associated with hypertension or/and prehypertension.

CONCLUSIONS

HIV infection is independently associated with prehypertension and hypertension especially at younger ages, and this risk may increase as treatment becomes prolonged. Our findings reinforce the urgent necessity for active BP screening and control strategies be adopted for PLWH in China.

Carbonized zein nanosheets with intrinsic enzyme-mimicking activities and high photothermal conversion efficiency for synergistic cancer therapy

With the rapid development of biology and nanotechnology, designing nanomaterials with intrinsic enzyme-like activities has attracted huge attention in recent years. Herein, for the first time, we use zein as a new protein precursor to prepare N-rich carbonized zein nanosheets (C-Zein) via facile pyrolysis. Zein is an inert, biodegradable and sustainable natural biopolymer. After high-temperature carbonization, zein can be converted into highly catalytically active C-Zein, which can possess excellent peroxidase- and oxidase-like catalytic activities. Such intrinsic enzyme-like activities of C-Zein are closely related to its graphitization degree, the ratio of graphitic nitrogen and the formation of disordered graphene. Intriguingly, C-Zein also exhibits high photothermal conversion efficiency in the near-infrared (NIR) region. Coupling their unique photothermal and catalytic properties, the as-prepared C-Zein can act as a robust agent for synergistic photothermal-catalytic cancer treatment under the irradiation of NIR light. We expect that this work paves the way to use zein for designing efficient artificial enzymes and accelerate further growth in exploring its new biomedical and pharmaceutical applications.

FHOD3 promotes carcinogenesis by regulating RhoA/ROCK1/LIMK1 signaling pathway in medulloblastoma

PURPOSE

Medulloblastoma (MB) is a malignant brain disease in young children. The overall survival of MB patients is disappointing due to absence of effective therapeutics and this could be attributed to the lack of molecular mechanism underlying MB. FHOD3 was an important gene during cardio-genesis and was reported to promote cell migration in cancer. However, its role in MB is not clear to date.

METHODS

RT-qPCR and IHC analysis were used to determine expression of FHOD3. Survival curve was drawn by K-M analysis. FHOD3 was knocked down by RNAi technology. The effects of FHOD3 on medulloblastoma cells were determined by CCK-8 assay, colony formation assay, transwell assay and FACs analysis.

RESULTS

FHOD3 expression increased by 1.5 fold in tumor tissues compared to the control and IHC analysis further confirmed strong expression of FHOD3 in medulloblastoma tissues. Then higher FHOD3 expression was associated with shorter survival time in MB patients (13.0 months versus 43.8 months). In medulloblastoma cells such as Daoy and D283med, FHOD3 also displayed abundant expression. When FHOD3 was knocked down, the ability of cell proliferation and colony formation was reduced over greatly. The capability of cell migration and invasion was also inhibited significantly. However, cell apoptotic rate increased significantly reversely. Mechanistically, the phosphorylation level of RhoA, ROCK1, and LIMK1 was decreased when FHOD3 was knocked down but increased reversely when FHOD3 was over-expressed in Daoy cells.

CONCLUSIONS

FHOD3 was associated with overall survival time in medulloblastoma patients and was essential to cell proliferation, growth and survival in medulloblastoma and might regulates activation of RhoA/ROCK1/LIMK1 signaling pathway.

MiR-30 suppresses lung cancer cell 95D epithelial mesenchymal transition and invasion through targeted regulating Snail

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "MiR-30 suppresses lung cancer cell 95D epithelial mesenchymal transition and invasion through targeted regulating Snail, by M.-J. Fan, Y.-H. Zhong, W. Shen, K.-F. Yuan, G.-H. Zhao, Y. Zhang, S.-K. Wang, published in Eur Rev Med Pharmacol Sci 2017; 21 (11): 2642-2649-PMID: 28678320" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/12883.

Rectal clear cell sarcoma-a case report

Gastrointestinal clear cell sarcomas (GICCSs) are malignant mesenchymal tumour that occur in the wall of gastrointestinal tract, mostly in the ileum and rarely in the rectum. These tumours are highly invasive, and often have metastasized via the lymphatic system or bloodstream by the time of diagnosis. In this case, the patient was admitted for gastric fundus mass, who was subsequently found and confirmed by biopsy as clear cell sarcoma of rectum. Computed tomography (CT) and magnetic resonance imaging (MRI) showed multiple metastatic lesions in lymph node, lung, liver and bone. Furthermore, energy spectrum CT was used to confirm that the nature of gastric fundus mass and rectal lesion were consistent. So, this case may be multiple clear cell sarcomas in the rectum and stomach or clear cell sarcoma in the rectum with gastric fundus metastasis. Unfortunately, after several days of immunotherapy, the patient died due to abnormal liver function. At present, GICCS mainly relies on surgical resection, and the effect of radiotherapy and chemotherapy is not good. Therefore, how to find lesions as earlier as possible and make accurate diagnosis is particularly important. CT and MRI are essential examinations in the diagnosis of tumors. Whether they are helpful for the diagnosis of GICCS is the focus of our attention.

MicroRNA-101-5p inhibits the growth and metastasis of cervical cancer cell by inhibiting CXCL6

OBJECTIVE

The objective of this study is to explore the biological roles of microRNA-101-5p (miR-101-5p) in the growth and metastasis of cervical cancer.

PATIENTS AND METHODS

The levels of miR-101-5p and chemokine (C-X-C motif) ligand 6 (CXCL6) in cervical cancer tissues and cells were detected using the quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) assay. The proliferation, colony formation, migration, and invasion assays were conducted using miR-101-5p transfected cervical cancer cell. The expression of CXCL6 was measured by the immunoblotting assay. Xenograft model was constructed to reveal the precise roles of miR-101-5p in the growth of cervical cancer cell in vivo.

RESULTS

MiR-101-5p was down-regulated in cervical cancer tissues when compared to the normal controls. The levels of miR-101-5p were higher in cervical cancer cells (SiHa, Caski, C-4-I, C-33 A) than that in the human cervical surface epithelial cell line, HcerEpic. Over-regulation of miR-101-5p inhibited the aggressiveness phenotypes of a cervical cancer cell in vitro. Furthermore, over-regulation of miR-101-5p reduced the tumor growth of cervical cancer cell in vivo. CXCL6 was the target protein of miR-101-5p in cervical cancer as demonstrated by luciferase reporter assay. The mRNA level of CXCL6 was negatively associated with the miR-101-5p level in cervical cancer tissue. Finally, the rescue experiments suggested that the inhibitory role of miR-101-5p was mediated by regulating the expression of CXCL6 in cervical cancer.

CONCLUSIONS

These findings indicated that the over-regulation of miR-101-5p suppressed the progression of cervical cancer by targeting CXCL6 and might function as a potential therapeutic target for cervical cancer.

Silencing of HIF-1α inhibited the expression of lncRNA NEAT1 to suppress development of hepatocellular carcinoma under hypoxia

BACKGROUND

We aimed to explore the relationship between hypoxia-inducible factors-1α (HIF-1α) and lncRNA nuclear-enriched abundant transcript 1 (NEAT1), and their functions on hepatocellular carcinoma (HCC) under hypoxia.

METHODS

HIF-1α and NEAT1 levels in HCC tissues and corresponding non-tumor tissues were determined by qRT-PCR, and the correlations of their levels in HCC tissues were analyzed by Pearson test. The relationship between overall survival and the two genes (HIF-1α and NEAT1) for HCC patients was detected by log-rank test. Clinicopathological features of NEAT1 in HCC patients were collected. HIF-1α and NEAT1 levels in HCC cells were measured by qRT-PCR and Western blot, and their relationship was determined by co-immunoprecipitation (Co-IP) assay. Cell viability, migration and invasion were detected by CCK-8, scratch wound healing and transwell assay, respectively. The interaction of NEAT1 with HIF-1α in tumor development was determined by xenograft tumor assays in nude mice.

RESULTS

NEAT1 and HIF-1α were highly expressed and showed a positive relationship in HCC tissues, and specifically, higher NEAT1 expression was positively associated with advanced TNM stage and metastasis in HCC patients. Up-regulated NEAT1 or HIF-1α in HCC patients had poorer prognosis. NEAT1 was induced by HIF-1α and suppressed by siHIF-1α. NEAT1 overexpression further promoted development of HCC under hypoxia while promoting cell viability, migration and invasion and suppressing apoptosis, and such effects were reversed by down-regulating HIF-1α. NEAT1 overexpression promoted tumor growth, which was reversed by down-regulating HIF-1α.

CONCLUSION

HIF-1α knockdown inhibits NEAT1 expression, which suppresses progression of HCC and improves its prognosis.

An exploratory study of PD-1 inhibitor for high-risk multiple ground-glass nodules (mGGNs) in synchronous stage I non-small cell lung cancer patients

e21068

Background: Surgical resection is recommended for the stage I NSCLC patients. However it is lack of standard therapies for synchronous mGGNs. This study aims to explore the feasibility of a PD-1 inhibitor (sintilimab) in high-risk residual mGGNs in post-surgery synchronous stage I NSCLC patients. Methods: This is a single arm phase I trial intending to recruit 20 subjects. Eligible patients contained at least one high-risk residual mGGN (confirmed by MDT discussion) after surgical resection of stage I NSCLC. Patients received sintilimab (200mg i.v., Q3W) for 10 cycles since 6 weeks post-surgery. Radiological evaluations were performed at every 3 cycles in treatment period and every 3 months during follow-up. Whether re-operation is needed depends on MDT evaluation. The primary endpoints were safety and ORR. The secondary endpoints included DOR, MPR of re-operated GGNs, and the one-year PFS. Results: As data cutoff (23 Jan 2020), 20 patients (9 males and 11 females) were enrolled. The pathological results revealed that all were lung adenocarcinoma. The median treatment cycles was 6 (range 3 to 10). All lesions were evaluated as stable disease by RECIST 1.1. Six patients underwent re-operation safely and12 GGNs were resected. Pathology showed that 1 had no tumor cells residue, 4 had 20-35%, and 7 had over 80% residues. Whole-exome sequencing of 12 GGNs showed 6 harboring EGFR and 2 harboring KRAS mutations. Interestingly, 3 out of 6 with EGFR-mut showed less tumor cells residues (23.3%, 30%, and 80%). The highest TMB (15.7 mut/Mb) was observed in the complete response GGN. 65% patients experienced treatment-related 1-2 grade AEs. Conclusions: The PD-1 inhibitor showed well tolerability and a certain degree anti-tumor activity was seen from the pathologic results of re-operated GGNs. Radiological evaluation using RECIST 1.1 might be unsuitable for mGGNs. Further studies are needed to demonstrate the clinical benefits. ChiCTR: 1900022159 Clinical trial information: 1900022159 .

HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort

OBJECTIVES

To investigate the prevalence of various electrocardiogram (ECG) abnormalities among HIV-positive and HIV-negative individuals.

METHODS

This cross-sectional evaluation included 1412 HIV-positive and 2824 HIV-negative participants aged 18 to 75 years and frequency matched by age and sex, derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China, between February and December 2017.

RESULTS

HIV-positive individuals had higher prevalence of sinus tachycardia (5.6% (79/1412) vs. 1.3% (36/2824), p < 0.001) and ST/T wave abnormalities (14.9% (211/1412) vs. 9.4% (264/1412), p < 0.001) but lower prevalence of sinus bradycardia (4.8% (68/1412) vs. 7.5% (211/2824), p 0.001); such associations remained statistically significant after adjusting for traditional risk factors (respectively, adjusted odds ratio (aOR) 4.68, 95% confidence interval (CI) 3.06-7.17; aOR 1.89, 95% CI 1.54-2.34; aOR 0.60, 95% CI 0.44-0.80). In adjusted models, being in higher carotid intima-media thickness categories was significantly associated with ST/T abnormalities in HIV-positive individuals only (0.78-1.00 mm: aOR 1.46, 95% CI 1.01-2.12; >1.00 mm: aOR 2.18, 95% CI 1.39-3.42), whereas being in higher blood pressure categories was significantly associated with both sinus tachycardia (prehypertension: aOR 5.61, 95% CI 1.76-17.91; hypertension: aOR 12.62, 95% CI 3.60-44.27) and ST/T abnormalities (hypertension: aOR 2.04, 95% CI 1.41-2.95) in HIV-negative individuals only. Longer duration of known HIV infection was the only HIV-specific factor of ST/T abnormalities (aOR 1.61, 95% CI 1.17-2.22), with none for sinus tachycardia.

CONCLUSIONS

HIV infection is independently associated with sinus tachycardia and ST/T abnormalities. Further research is needed to investigate specific mechanisms by which HIV infection leads to ECG abnormalities and to evaluate whether inclusion of ECG parameters improves cardiovascular disease prediction. Integrating ECG screening into routine HIV care is recommended in China.

A progressive ground-glass opacity occupied the lower left lung in a postoperative colon cancer patient, what it will be?—a case report

Primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a type of non-Hodgkin lymphoma, and it occurs frequently in the stomach and rarely in the lungs. They are rarely taken into consideration in the differential diagnosis of lung lesions. MALT lymphomas affecting the lung show various styles on chest CT, which range from typical nodules or areas of consolidation to findings that are extremely rare, such as a progressive ground glass opacity (GGO) that never been reported before especially in a postoperative colon cancer patient. The postoperative pathologic diagnosis of the progressive GGO was extranodal marginal zone B-cell lymphoma of MALT. And during 2-year follow-up, the patient was in good condition and there was no sign of recurrence. This case would enrich the manifestations and increase the understanding in MALT, and inappropriate treatment would be avoided.

A retrospective study on the clinical characteristics and radiological features of primary pulmonary lymphoma

Background

The retrospective study was mainly performed to determine the clinical symptoms and radiological characteristics of primary pulmonary lymphoma (PPL) to improve the recognition and diagnosis of the disease.

Methods

Between June 2007 and June 2019, the clinical data and radiological images of the 16 patients with PPL confirmed by pathology were retrospectively analyzed.

Results

Among the 16 patients with PPL (6 males and 10 females, aged 32 to 72 years, with a median age of 55.13 years), 9 patients were mucosa-associated lymphoid tissue lymphoma (MALT) and 7 patients were diffuse large B-cell lymphoma (DLBCL); all of the patients did not suffer from autoimmune disease [such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or Sjogren’s syndrome (SSS)]; and 11 patients had a long-term smoking history from 10 to 40 years. The common clinical symptoms were as follows: chest discomfort (n=8), cough (n=10), chest pain (n=7), fever (n=6), apnea (n=1), fatigue (n=4) and weight loss (n=3), however, 6 cases did not show clear symptoms at the time of diagnosis. Blood tests revealed anemia (n=6), thrombocytopenia (n=2), lactate dehydrogenase (LDH) level (n=7), C-reactive protein (CRP) (n=9), erythrocyte sedimentation rate (ESR) (n=8) and no tumor-related indexes were detected abnormal. The chest radiological images showed a total of 8 cases with multiple masses, 2 cases with different types of nodes, 4 cases with patchy infiltration or consolidation shadow, with or without an air bronchogram, and 2 cases with a mixed manifestation. All the lesions were only involved in unilateral lung (13 right, 3 left), none of them located on bilateral lung fields. At the time of admission, the patients were misdiagnosed as lung cancer (n=9), pneumonia (n=5), tuberculosis (n=1), and diffuse interstitial lung disease (n=1). Then final pathological diagnosis was confirmed by surgery (n=9), percutaneous lung biopsy (n=5), and bronchoscopic biopsy (n=2).

Conclusions

PPL is a rare disease, though clinical symptoms and radiological characteristics are not typical, they serve as significant clues for the diagnosis and differential diagnosis. Accurate diagnosis mainly depends on histopathological examination, however, conducting a retrospectively study could improve and enrich our knowledge to the disease and reduce inappropriate treatments.

Altered hippocampal functional connectivity in primary Sjögren syndrome: a resting-state fMRI study

Structural and metabolic abnormalities in the hippocampus have been associated with the pathophysiological mechanism of central nervous system involvement in primary Sjögren syndrome (pSS). Nevertheless, how hippocampal function is altered in pSS remains unknown. The purpose of our study is to investigate the alterations in hippocampal functional connectivity (FC) in pSS by using resting-state functional magnetic resonance imaging (rs-fMRI). Thirty-eight patients with pSS and 38 age- and education level-matched healthy controls (HCs) underwent magnetic resonance imaging examination. Prior to each MRI examination, neuropsychological tests were performed. Left and right hippocampal FCs were analyzed by using seed-based whole-brain correlation and compared between pSS and HCs. Spearman correlation analysis was performed between the z-value of hippocampal FC in brain regions with significant difference between the two groups and neuropsychological tests/clinical data in pSS. Compared with the controls, the patients with pSS showed decreased hippocampal FC between the left hippocampus and the right inferior occipital gray (IOG)/inferior temporal gray (ITG), as well as between the right hippocampus and right IOG/middle occipital gray (MOG), left MOG, and left middle temporal gray. In addition, increased hippocampal FCs were detected between the left hippocampus and left putamen, as well as between the right hippocampus and right cerebellum posterior lobe. Moreover, the visual reproduction score positively correlated with the FC between right hippocampus and right IOG/MOG. The white matter hyperintensity score negatively correlated with the FC between left hippocampus and right IOG/ITG. In conclusion, patients with pSS suffered decreased hippocampal FC mainly sited in the occipital and temporal cortex with right hippocampal laterality. Altered hippocampal FC might be a potential biomarker in detecting brain function changes and guiding neuroprotection in pSS.

Immediate early response protein 2 promotes the migration and invasion of hepatocellular carcinoma cells via regulating the activity of Rho GTPases

Human immediate early response 2 (IER2) has been implicated in tumor cell motility and metastasis; however, the underlying mechanisms in hepatocellular carcinoma (HCC) metastasis remain to be clarified. In this study, we demonstrate that dysregulation of IER2 was shown in HCC clinical samples, and IER2 expression resulted in the promotion of cell migration and invasion in vitro, and HCC tumor growth and pulmonary metastasis in vivo. Moreover, we showed that IER2 expression altered assembly of the actin cytoskeleton rearrangement. Furthermore, MAPK and PI3K/Akt signaling pathways induced by IER2 were confirmed to be probably involved in regulating the activity of Rho GTPases, such as RhoA, Rac1 and Cdc42. Collectively, our results indicated a significant role of IER2 in the HCC cell motility and metastasis through MAPK and PI3K/Akt signaling pathways to regulate the activity of Rho GTPases, thereby modulating actin cytoskeleton rearrangement, unveiling a novel mechanism of cell motility regulation induced by IER2.