The hsa_circ_0082152 maintains NF-κB mRNA stability by binding to MTDH to promote anti-tuberculosis drug-induced liver injury

Anti-tuberculosis drug-induced liver injury (ADLI) is a common adverse reaction during anti-tuberculosis treatment and often leads to treatment interruptions. Circular RNAs (circRNAs) have been identified as key modulators in liver diseases. CircRNAs is a special class of noncoding RNAs that have been found to have significant impacts on the progression of inflammation via various mechanisms. In the serum of ADLI patients, upregulation of the circular RNA hsa_circ_0082152 (derived from the host gene snd1) was observed, along with increased ALT and AST levels, as well as alterations in the levels of inflammation-related factors such as NF-κB, IL-1β and TNF-α. To elucidate the underlying mechanisms, we established an HL-7702-ADLI cell model and confirmed similar upregulation of hsa_circ_0082152. Downregulation of hsa_circ_0082152 significantly inhibited inflammatory injury in ADLI cells, while upregulation had the opposite effect. RNA immunoprecipitation showed that hsa_circ_0082152 functions by interacting with metadherin (MTDH). Our study further verified that the interaction of hsa_circ_0082152 with the MTDH protein binding to NF-κB mRNA to maintain NF-κB mRNA stability, which increases the expression of NF-κB and its targets IL-1β and TNF-α. Conversely, depletion of MTDH rescued the promotive effect of hsa_circ_0082152 overexpression on ADLI inflammation. Therefore, hsa_circ_0082152 overexpression promotes ADLI progression via the MTDH/NF-κB axis.

Case report: The diagnostic dilemma of indeterminate biliary strictures: report on two cases with a literature review

Background

It is still a challenging problem for clinicians to explore the nature of the indeterminate biliary strictures (IBSs). Approximately 20% of biliary strictures remain undetermined after a thorough preoperative assessment.

Case presentation

Here, we present two cases of indeterminate biliary strictures patients, whose cross- sectional imaging and endoscopic examination were nondiagnostic. The patients underwent exploratory laparotomy finally and were confirmed as malignancy. We also reviewed the recent reports in literatures regarding the evaluation of IBSs.

Conclusions

Given the majority of the biliary strictures are malignancy, preoperative differentiation between benign and malignant is critical for choosing the best therapeutic regimen. Thus, close follow-up, multiple multidisciplinary discussion, and prompt surgical exploration are necessary for some difficult diagnostic cases.

Structural insights into the catalytic mechanism of the AP endonuclease AtARP

Base excision repair (BER) is a critical genome defense pathway that copes with a broad range of DNA lesions induced by endogenous or exogenous genotoxic agents. AP endonucleases in the BER pathway are responsible for removing the damaged bases and nicking the abasic sites. In plants, the BER pathway plays a critical role in the active demethylation of 5-methylcytosine (5mC) DNA modification. Here, we have determined the crystal structures of Arabidopsis AP endonuclease AtARP in complex with the double-stranded DNA containing tetrahydrofuran (THF) that mimics the abasic site. We identified the critical residues in AtARP for binding and removing the abasic site and the unique residues for interacting with the orphan base. Additionally, we investigated the differences among the three plant AP endonucleases and evaluated the general DNA repair capacity of AtARP in a mammalian cell line. Our studies provide further mechanistic insights into the BER pathway in plants.

Analysis of Correlation between Rab1A Expression and its Prognosis in Cancers: a Meta-Analysis

BACKGROUND

Rab1A not only regulates eukaryotic secretion, autophagy and intracellular traffic, but also extensively participates in the development of cancer. Thus, we collected data to investigate the clinical value of Rab1A in cancers.

METHODS

English web database was searched for appropriate studies. The role of Rab1A in cancer patients was evaluated by combining hazard ratios and odds ratios.

RESULTS

There were 15 studies in 14 articles, including 1,791 cancer patients. The results showed that upregulated Rab1A led to poor prognosis in cancer patients (pooled HR = 2.545, 95% CI = 1.924 - 3.367, p < 0.001). Notably, a high level of Rab1A was associated with a poorer prognosis than patients with a low level of Rab1A in digestive system cancer (pooled HR = 2.484, 95% CI = 1.796 - 3.437, p < 0.001). In order to explore the possible carcinogenic mechanism, we further analyzed and confirmed that high expression of Rab1A was associated with worse histologic grade, deeper tumor invasion, higher TNM stage, positive LN metastasis, positive neural invasion, positive vascular invasion, and larger tumor size (p < 0.05).

CONCLUSIONS

Rab1A overexpression was associated with poor prognosis and adverse clinicopathological parameters in cancer patients and had the potential to be a target for future cancer therapy.

A Differential Protein Study on Bronchoalveolar Lavage Fluid at Different Stages of Silicosis

OBJECTIVES

In this study, by comparing the difference in protein expression in bronchoalveolar lavage fluid between silicosis patients in different stages and healthy controls, the pathogenesis of pneumoconiosis was discussed, and a new idea for the prevention and treatment of pneumoconiosis was provided.

METHODS

The lung lavage fluid was pretreated by 10 K ultrafiltration tube, Agilent 1100 conventional liquid phase separation, strong cation exchange column (SCX) HPLC pre-separation, and C18 reverse phase chromatography desalting purification, and protein was labeled with isotope. GO, KEGG pathway, and PPI analysis of differential proteins were conducted by bioinformatics, and protein types and corresponding signal pathways were obtained.

RESULTS

Thermo Q-Exactive mass spectrometry identified 943 proteins. T-test analysis was used to evaluate the different significance of the results, and the different protein of each group was obtained by screening with the Ratio≥1.2 or Ratio≤0.83 and P<0.05. We found that there are 16 kinds of protein throughout the process of silicosis. There are different expressions of protein in stages Ⅲ/control, stages Ⅱ/control, stage Ⅰ/control, stages Ⅲ/ stages Ⅱ, stages Ⅲ/ stage Ⅰ and stages Ⅱ/ stage Ⅰ groups. The results of ontology enrichment analysis of total differential protein genes show that KEGG pathway enrichment analysis of differential protein suggested that there were nine pathways related to silicosis.

CONCLUSION

The main biological changes in the early stage of silicosis are glycolysis or gluconeogenesis, autoimmunity, carbon metabolism, phagocytosis, etc., and microfibril-associated glycoprotein 4 may be involved in the early stage of silicosis. The main biological changes in the late stage of silicosis are autoimmunity, intercellular adhesion, etc. Calcium hippocampus binding protein may participate in the biological changes in the late stage of silicosis. It provides a new idea to understand the pathogenesis of silicosis and also raises new questions for follow-up research.

[Patient-reported outcomes of locally advanced gastric cancer undergoing robotic versus laparoscopic gastrectomy: a randomized controlled study]

Objective: To compare the patient-reported outcomes and short-term clinical outcomes between robotic-assisted and laparoscopic-assisted radical gastrectomy for locally advanced gastric cancer. Methods: This single-center prospective randomized controlled trial was conducted in the Department of Gastrointestinal Surgery,Affiliated Hospital of Qingdao University from October 2020 to August 2022. Patients with locally advanced gastric cancer who were to undergo radical gastrectomy were selected and randomly divided into two groups according to 1∶1, and received robotic surgery and laparoscopic surgery, respectively. Patient-reported outcomes and short-term clinical outcomes (including postoperative complications, surgical quality and postoperative short-term recovery) were compared between the two groups by t test, Mann-Whitney U test, repeated ANOVA, generalized estimating equation, χ2 test and Fisher's exact test. Results: A total of 237 patients were enrolled for modified intention-to-treat analysis (120 patients in the robotic group, 117 patients in the laparoscopic group). There were 180 males and 59 females, aged (63.0±10.2) years (range: 30 to 85 years). The incidence of postoperative complications was similar between the robotic group and laparoscopic group (16.7% (20/120) vs. 15.4% (18/117), χ2=0.072, P=0.788). The robotic group had higher patient-reported outcomes scores in general health status, emotional, and social domains compared to the laparoscopic group, differences in time effect, intervention effect, and interaction effect were statistically significant (general health status: χ2 value were 275.68, 3.91, 6.38, P value were <0.01, 0.048, 0.041; emotional: χ2 value were 77.79, 6.04, 6.15, P value were <0.01, 0.014, 0.046; social: χ2 value were 148.00, 7.57, 5.98, P value were <0.01, 0.006, 0.048). However, the financial burden of the robotic group was higher, the differences in time effect, intervention effect and interaction effect were statistically significant (χ2 value were 156.24, 4.08, 36.56, P value were<0.01, 0.043,<0.01). Conclusion: Compared to the laparoscopic group, the robotic group could more effectively relieve postoperative negative emotions and improve recovery of social function in patients.

Silencing SIRT1 promotes the anti-HBV action of IFN-α by regulating Pol expression and activating the JAK-STAT signaling pathway

PURPOSE

The purpose this study is to investigate the impact of SIRT1 on the anti-HBV activity of IFN-α and further elucidate its underlying mechanism.

METHODS

HepG2.2.15 cells stably transfected with HBV virus were chosen as the primary study subject. IFN-α was used to stimulate the cells and regulate the expression of SIRT1, and the JAK-STAT pathway and HBV-related indices were measured by qRT-PCR, Western blotting and ELISA. Immunofluorescence (IF) was used to detect the nuclear translocation of STAT1 and STAT2. Coimmunoprecipitation (Co-IP) was used to detect the binding of SIRT1 to HBV Polymerase (Pol).

RESULTS

In HepG2.2.15 cells, we found changes in SIRT1 expression. We show that silencing SIRT1 promotes the IFN-α-triggered Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway and consequently enhances the antiviral effects of IFN-α against HBV replication. Importantly, SIRT1 can interact with Pol and increase JAK-STAT activity by regulating Pol expression. Additionally, the inhibition of SIRT1 activity by treatment with the SIRT1 inhibitor selisistat enhanced the anti-HBV effect of IFN-α and JAK-STAT pathway activity.

CONCLUSION

In conclusion, our results demonstrate that silencing SIRT1 activates the JAK-STAT pathway and enhances the anti-HBV activity of IFN-α by inhibiting Pol expression. This would be a promising therapeutic target to improve the efficacy of IFN-α in the treatment of CHB.

Structural characterization of an isocytosine-specific deaminase VCZ reveals its application potential in the anti-cancer therapy

Non-natural nucleobase isocytosine (IC) is the isomer of cytosine; its chemical derivate 5-fluoroisocytosine (5-FIC) together with the isocytosine-specific deaminase (ICD) VCZ was suggested to be potential practical enzyme/prodrug pair for cancer therapy through gene-directed enzyme-prodrug therapy (GDEPT) method. In this study, we have determined the crystal structures of apo-VCZ and its complex with 5-FU. We identified the critical residues for substrate binding and catalytic reaction. We also captured the substrate-induced conformational changes of VCZ, then proposed the conjectural reaction procedures of VCZ for converting the IC into the uracil. Moreover, we evaluated the therapeutic effect of wildtype or the mutated VCZ protein in the colorectal cancer cell lines. Our studies will shed light on optimizing the ICD/5-FIC pairs by modifying either the enzyme or the prodrug based on the structural observations, thereby improving the possibility of applying the ICD/5-FIC pair in clinical trials.

Temporal course of attention bias toward emotional faces in individuals with autistic traits: an eye-movement study

Introduction

Similar attention patterns have been found in individuals with autism spectrum disorder (ASD) and autistic traits (ATs). The Intense World Theory and previous studies suggest that individuals with ASD may demonstrate a vigilance-avoidance attention pattern toward emotional faces. However, the attention patterns in individuals with ATs remain unclear. Therefore, this study employs eye-tracking technology to examine the characteristics and temporal course of attention bias toward emotional faces in individuals with ATs.

Methods

The Autism-spectrum Quotient (AQ) was used to evaluate the level of ATs among 2,502 college students. A total of 50 participants were selected from the 2,502 college students: 25 high-AQ group participants were randomly selected from the 10% of individuals with the highest AQ scores. Similarly, 25 low-AQ group participants were randomly selected from the 10% of participants with the lowest AQ scores. All selected participants completed an eye-tracking study while performing a dot-probe task with emotional faces (positive-neutral, negative-neutral, and negative-positive). By analyzing data from different time periods, the attention bias and time course of individuals with ATs toward emotional faces were investigated.

Results

The results show that compared to the low-AQ group, the high-AQ group detected negative faces faster in the early stages of emotional face processing. As the presentation time of emotional faces increased (at the 2-3 s mark), the fixation scores for negative-neutral faces of the high-AQ group were less than 0.5, which was significantly lower than those of the low-AQ group. Meanwhile, the high-AQ group showed brief attentional avoidance toward positive emotion at 3-4 s in the positive-neutral trials, indicating that the high-AQ group exhibited attention avoidance to both negative and positive faces during the middle and later stages of emotional processing.

Conclusion

This study suggests that individuals with ATs display a vigilance-avoidance pattern toward emotional faces. It contributes to a deeper understanding of the mechanisms of attention in persons with ATs and further supports the Intense World Theory.

A Cholangiocarcinoma Prediction Model Based on Random Forest and Artificial Neural Network Algorithm

OBJECTIVE

To construct a prognostic model using artificial neural network (ANN) approach, providing an idea for the prediction and diagnosis of cholangiocarcinoma (CCA).

STUDY DESIGN

Experimental study. Place and Duration of the Study: Department of General Surgery, Zhenjiang Hospital, Zhenjiang Province, China, between January and March 2022.

METHODOLOGY

Available datasets were obtained from the Gene Expression Omnibus (GEO) database to construct the train cohort and the test cohort of CCA, and screened out the differentially expressed genes (DEGs) of CCA. Next, an ANN model for CCA diagnosis was constructed based on the scores of the DEGs and evaluated its accuracy and efficiency using ROC curves. Finally, the immune infiltration and the function of extracellular matrix (ECM) protein SPACRL1 were analysed to reveal the characteristic alterations in CCA.

RESULTS

This analysis revealed 166 DEGs, mainly concentrated in the ECM organisation, neutrophil activation and other pathways. Then a set of 17 CCA disease signature genes scores were obtained to build an ANN prediction model and the ROC curve was plotted. The AUC in the train group (0.980) indicated that the accuracy of the diagnosis model is extremely high. Finally, there was a significant increase of B cells naïve (p=0.025), tregs (p=0.004), and macrophages M1 (p<0.001) in the tumour-microenvironment of CCA, while SPARCL1 was a protective factor on disease-specific survival (DSS) in CCA (p=0.009).

CONCLUSION

This study has developed an accurate prediction model for CCA diagnosis, and identified SPARCL1 as pivotal factor in CCA by modulating the tumour immune-microenvironment.

KEY WORDS

Cholangiocarcinoma, Artificial neural network, Immune microenvironment, Bioinformatics, Prognosis model, SPARCL1.

Antimicrobial activity of the recombinant peptide Melittin-Thanatin with three glycine to tryptophan mutations

The antimicrobial peptide was considered an important target for developing novel antibacterial drugs. However, the unstable biological activity and the low antibacterial activity are challenges for the application of recombinant proteins. In this study, the fusion peptide of Melittin-Thanatin (MT) was designed and produced, and its derivative sequence (MT-W) was obtained by replacing three glycines (Gly, G) with tryptophan (Trp, W). The MT-W peptide were synthesized in Bacillus subtilis WB700 by EDDIE self-cleavage protein fusion. Compared with MT, MT-W exhibited 2-4 times higher antibacterial rate against Escherichia coli K88. In addition, MT-W showed lower cytotoxicity (IC50 > 300 mg·L^-1) to the red blood cell, and more stable biological activities under the conditions of different temperatures (20, 30, 40, 50, 60, 70, 80, and 90 °C), pH values (2.0, 3.0, 4.0, 5.0, 6.0, 7.0, 8.0, and 9.0) and different proteases. Especially, MT-W showed a broader antibacterial effect on three drug-resistant strains than florfenicol and oxytetracycline calcium. In conclusion, compared with MT, the MT-W showed increased antibacterial activity, stability, lower cytotoxicity, and broader antimicrobial effect. Therefore, it would become a promising alternative to conventional antibiotics.

Prognostic and clinicopathological significance of CD155 expression in cancer patients: a meta-analysis

Background

It has been previously reported that CD155 is often over-expressed in a variety of cancer types. In fact, it is known to be involved in cancer development, and its role in cancer has been widely established. However, clinical and mechanistic studies involving CD155 yielded conflicting results. Thus, the present study aimed to evaluate overall prognostic value of CD155 in cancer patients, using a comprehensive analysis.

Methods

Online databases were searched, data was collected, and clinical value of CD155 was evaluated by combining hazard ratios (HRs) or odds ratios (ORs).

Results

The present study involved meta-analysis of 26 previous studies that involved 4325 cancer patients. These studies were obtained from 25 research articles. The results of the study revealed that increased CD155 expression was significantly associated with reduced OS in patients with cancer as compared to low CD155 expression (pooled HR = 1.772, 95% CI = 1.441–2.178, P < 0.001). Furthermore, subgroup analysis demonstrated that the level of CD155 expression was significantly associated with OS in patients with digestive system cancer (pooled HR = 1.570, 95% CI = 1.120–2.201, P = 0.009), hepatobiliary pancreatic cancer (pooled HR = 1.677, 95% CI = 1.037–2.712, P = 0.035), digestive tract cancer (pooled HR = 1.512, 95% CI = 1.016–2.250, P = 0.042), breast cancer (pooled HR = 2.137, 95% CI = 1.448–3.154, P < 0.001), lung cancer (pooled HR = 1.706, 95% CI = 1.193–2.440, P = 0.003), head and neck cancer (pooled HR = 1.470, 95% CI = 1.160–1.862, P = 0.001). Additionally, a significant correlation was observed between enhanced CD155 expression and advanced tumor stage (pooled OR = 1.697, 95% CI = 1.217–2.366, P = 0.002), LN metastasis (pooled OR = 1.953, 95% CI = 1.253–3.046, P = 0.003), and distant metastasis (pooled OR = 2.253, 95% CI = 1.235–4.110, P = 0.008).

Conclusion

Altogether, the results of the present study revealed that CD155 acted as an independent marker of prognosis in cancer patients, and it could provide a new and strong direction for cancer treatment.

SOX2 contributes to invasion and poor prognosis of gastric cancer: A meta-analysis

BACKGROUND

The sex-determining region Y-box 2 (SOX2) has been identified to be involved in tumor progression and prognosis in patients with gastric cancer (GC). However, its action is paradoxical. Thus, we conducted the first meta-analysis based on eligible studies to evaluate the clinical utility of SOX2 in GC only.

METHODS

A thorough electronic search was performed to collect eligible studies. The hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were generated from included studies to assess the strength of the association between SOX2 and prognosis and clinicopathological characteristics in GC.

RESULTS

A total of 10 studies comprising 1321 patients with GC were identified for the meta-analysis. The pooled results revealed that high SOX2 expression was significantly associated with poor overall survival compared to low SOX2 expression (pooled HR = 1.485; 95% CI: 1.022-2.160; 𝑃 = .04). The statistical significance between SOX2 expression and overall survival was also established in univariate analysis (pooled HR = 1.606; 95% CI: 1.134-2.274; 𝑃 < .01), as well as recruitment time exceeding 2010 (pooled HR = 1.873; 95% CI: 1.041-3.371; 𝑃 = .04), follow-up time more than 5 years (pooled HR = 1.642; 95% CI: 1.066-2.527; 𝑃 = .02), and cutoff value of more than 5% of cells stained (pooled HR = 1.730; 95% CI: 1.162-2.577; 𝑃 < .01). Moreover, we verified that positive SOX2 expression was correlated with advanced tumor invasion depth (pooled OR = 0.494; 95% CI: 0.362-0.675; 𝑃 < .01) and positive vascular invasion (pooled OR = 1.515; 95% CI: 1.078-2.130; 𝑃 = .02).

CONCLUSION

SOX2 could not only be an independent prognostic marker in GC but might also be a novel target for cancer therapy.

Hsa_circ_0093884 bound to RNA-binding protein RPS3 ameliorates hepatocyte inflammation in anti-tuberculosis drug-induced liver injury by competitively activating SIRT1

Anti-tuberculosis drug-induced liver injury (ADLI) is one of the main factors hindering the efficacy of routine chemotherapy against tuberculosis. Understanding the mechanism of ADLI will aid in the effective treatment of patients with tuberculosis. Recently, we found that the expression of hsa_circ_0093884, a circular RNA derived from the NAD-dependent deacetylase, sirtuin-1 (SIRT1), was down-regulated in ADLI. Hsa_circ_0093884 was negatively correlated with the NLR family pyrin domain containing 3 (NLRP3) inflammasome and its overexpression increased the expression levels of NLRP3, interleukin-1β, and caspase-1. Mechanistically, RNA immunoprecipitation and immunofluorescence assays revealed that the ribosomal protein S3 (RPS3) could bind to hsa_circ_0093884 and SIRT1. Additionally, the expression of hsa_circ_0093884 was positively correlated with that of SIRT1, and the upregulation of hsa_circ_0093884 expression was crucial for the upregulation of SIRT1 expression. We confirmed that the mRNA and protein expression levels of SIRT1 were influenced by hsa_circ_0093884 and RPS3. Furthermore, hsa_circ_0093884 recruited RPS3 to increase SIRT1 mRNA and protein levels. Importantly, we found a marked decrease in the upregulating effect of hsa_circ_0093884 on SIRT1 owing to RPS3 depletion. To the best of our knowledge, this study is the first to reveal that hsa_circ_0093884 regulates SIRT1 expression and inhibits the inflammatory response by binding to RPS3 in ADLI, which may be used to develop novel strategies for ADLI treatment.

Structure Characterization of Escherichia coli Pseudouridine Kinase PsuK

Pseudouridine (Ψ) is one of the most abundant RNA modifications in cellular RNAs that post-transcriptionally impact many aspects of RNA. However, the metabolic fate of modified RNA nucleotides has long been a question. A pseudouridine kinase (PsuK) and a pseudouridine monophosphate glycosylase (PsuG) in Escherichia coli were first characterized as involved in pseudouridine degradation by catalyzing the phosphorylation of pseudouridine to pseudouridine 5′-phosphate (ΨMP) and further hydrolyzing 5′-ΨMP to produce uracil and ribose 5′-phosphate. Recently, their homolog proteins in eukaryotes were also identified, which were named PUKI and PUMY in Arabidopsis. Here, we solved the crystal structures of apo-EcPsuK and its binary complex with Ψ or N¹-methyl-pseudouridine (m1Ψ). The structure of EcPsuK showed a homodimer conformation assembled by its β-thumb region. EcPsuK has an appropriate binding site with a series of hydrophilic and hydrophobic interactions for Ψ. Moreover, our complex structure of EcPsuK-m1Ψ suggested the binding pocket has an appropriate capacity for m1Ψ. We also identified the monovalent ion-binding site and potential ATP-binding site. Our studies improved the understanding of the mechanism of Ψ turnover.

POS0286 CAN PATIENTS WITH CONTROLLED RA RECEIVING ANY CLASS OF TARGETED THERAPY WITH METHOTREXATE (MTX) SUSTAIN DISEASE CONTROL AFTER TAPERING MTX? A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Patients with RA frequently struggle with intolerance of MTX and adherence to MTX remains highly variable. Guidelines conditionally recommend the tapering of MTX before tapering biologic (b)DMARDs, but acknowledge there is an absence of direct evidence. Prior reviews on this topic have focused on tapering of MTX from combination treatment with TNF-inhibitors(i) only1. There have been no updated reviews addressing MTX tapering from other targeted therapies such as IL6-i or JAK-i, nor has there been a systematic review addressing this question.

Objectives

To determine the feasibility of tapering MTX to targeted therapy (bDMARDs or JAKi) alone in patients whose RA is controlled (LDA or remission).

Methods

A systematic literature search combing MeSH terms and keywords was conducted in Medline, Embase and Cochrane Library for studies reporting remission outcomes after tapering MTX from targeted therapies in RA. Non-English and animal studies were excluded. Meta-analyses were conducted using random effects models. Forest and funnel plots were created and heterogeneity was calculated.

Results

Our search identified 5762 citations. After removal of duplicates and screening title/abstract using the COVIDENCE platform, 504 full-text articles were reviewed. Of the 10 articles meeting our inclusion criteria of tapering MTX to monotherapy with a targeted therapy, 3 studies tapered to etanercept, 3 to tocilizumab, 1 to tofacitinib, 1 to certolizumab pegol, 1 to adalimumab and 1 to abatacept monotherapy. Nine studies were RCTs and one was a long-term extension study (LTE) (Table 1). Disease duration was longer in 7 studies (6-11 years) and early in 3 studies (1-9 months). The MTX tapering strategy was gradual in 2 and rapid in 8 studies. Follow-up ranged from 3 -18 months in RCTs, and up to 3 years in the LTE. Studies reporting outcomes up to 1 year after tapering had remission rates ranging 48-76%, but this dropped to 40% in one study reporting 18- month remission outcomes. Our meta-analysis conducted in 2000 RA participants from 10 studies showed that patients who tapered MTX to targeted therapy alone could maintain remission with an overall pooled OR of 0.81 (0.68, 0.97) (Figure 1). There was no heterogeneity among the studies in this group (I2=0.0%, p=0.788). Our funnel plot indicated high precision and potentially less publication bias. No significant difference in remission outcomes between early RA [OR 0.63 (0.33, 1.18)] and established RA [OR 0.84 (0.69, 1.03)] was observed.

Table 1.

Included Studies

Author/ YearnEarly RABaseline treatmentMTX Taper StrategyREM measureFollow-upCurtis 2020253noETA+MTXStopSDAI48 wksEmery 2019147yesABA+MTXStopSDAI48 wksCohen 2019533noTOFA+MTXStopDAS28-CRP48 wksEmery 2019411yesETA+MTXTaper 4 wksDAS2852 wksPablos 2019165noTCZ+MTXStopDAS2828 wksPope 201988noCZP+DMARDStopDAS2818 mosKremer 2018296noTCZ+MTXStopDAS2852 wksEdwards 2017272noTCZ+MTXTaper 24 wksDAS2848 wksKeystone 2016205noETA+MTXStopDAS2818 mosKeystone 2018140yesADA+MTXStopDAS28-CRP3 years

ETA etanercept, ABA abatacept, TOFA tofacitinib, TCZ tocilizumab, CZP certolizumab pegol, ADA adalimumab, REM remission, wk week, mo month, DAS28 Disease Activity Score 28, SDAI Simplified disease activity index.

Conclusion

Patients with controlled RA have a high probability of maintaining disease control after tapering their MTX to targeted therapy alone, up to 18 months. This review may inform patients with controlled disease on any of a range of targeted therapies and MTX, but who are struggling with MTX-related adverse effects and wish to taper it. Longer follow-up studies with attention to radiographic, functional and patient reported outcomes are needed. The possibility of disease worsening must be discussed with the patient in advance with careful follow-up and prompt re-treatment of disease worsening.

References

[1]Subesinghe S, Scott IC. Expert Rev Clin Pharmacol 2015;8:751-60.

Disclosure of Interests

Charis Meng: None declared, Diviya Rajesh: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Cytodyn, Walgreens, Omar Bruce: None declared, Bridget Jivanelli: None declared, Vivian Bykerk Consultant of: Amgen, Bristol Myers Squibb, Genzyme, Gilead, Janssen, Pfizer, Sanofi-Aventis, UCB., Grant/research support from: NIH (NIAID/NIAMS) grant 1UH2AR067691-01 GRANT11652401 and The Cedar Hill Foundation; institution received grants from Bristol Myers Squibb and Amgen;

POS0642 THE PROBABILITY OF SUSTAINING RHEUMATOID ARTHRITIS REMISSION IN PATIENTS TAPERING TARGETED THERAPY USED AS MONOTHERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Up to 30% of RA patients receive monotherapy with biologic (b)DMARDs or JAK inhibitors (i), often due to intolerance of methotrexate (MTX). Monotherapy with IL-6i and JAK-i has been reported to be effective. The EULAR research agenda includes addressing the question of whether tapering of targeted therapy (bDMARDs and JAK-i) used as monotherapy (targeted monotherapy) is possible1.

Objectives

To assess if it is feasible to taper (stop or reduce) targeted monotherapy with controlled RA using existing clinical trial data.

Methods

A systematic review of the literature (2014-2021), cited in Medline, Embase and the Cochrane Library, was performed. Meta-analyses were conducted using random effects models. Forest and funnel plots were created and heterogeneity calculated.

Results

Our search yielded 5762 citations. After de-duplication, screening of titles/abstracts and review of full text articles, we identified 5 studies comparing tapering of targeted monotherapy (TNF-i, tocilizumab (TCZ), abatacept (ABA) and baricitinib) to continuing therapy or other tapering regimens (Table 1). In our meta-analysis of data from 800 patients we observed a trend for lower odds of remission when tapering of targeted monotherapy vs comparator treatment regimen [pooled OR 0.72 (0.35, 1.48)]. In one study comparing stopping monotherapy to continuing MTX, we saw the lowest OR 0.55 (0.20, 1.48). In studies comparing two tapering regimens the pooled OR was higher 2.17 (1.13, 4.16). There was no heterogeneity in the studies which compared tapering to continuing therapy (I2=0.0%, p=0.437) and moderate heterogeneity in the studies that tapered different treatments in both arms (I2=53.7%, p=0.115). Trials using a gradual tapering strategy had a numerically higher odds of remission [OR 2.15 (0.94, 4.92); 3.61(1.85, 7.04)] compared to a trial implementing abrupt withdrawal [OR 1.19 (0.53, 2.68)]. There was a trend for higher remission outcomes in studies of early RA [pooled OR 1.71 (0.72, 4.05)] compared to established RA [pooled OR 1.12 (0.29, 4.27)] (Figure 1). Funnel plots indicate a paucity of studies, and perhaps publication bias.

Table 1.

Included studies.

Author/yearnEarly RAMean Age RangeBaselineTapering strategyComparison arm interventionRemission OutcomeFollow uptreatmentvan Mulligen 2020189No56-57csDMARD + TNFiTaper csDMARD then TNFiTaper in reverse orderDAS44 < 1.624 mosKaneko102No54-58TCZ+MTXStop TCZContinue MTXDAS28 < 2.6104 wks2018vs TCZBijlsma299Yes54TCZ+MTXGradual taper MTX 1st then TCZGradual taper MTXDAS28 < 2.6+SJC≤4104 wks2016vs TCZvs MTXEmery176Yes45-49ABA+MTXStop ABAStop ABA Taper MTX offDAS28-CRP<2.618 mos2015vs ABAvs MTXTakeuchi69Yes48-53Bari 4mgReduce 2mgContinue 4mgCDAI < 2.848 wks2019

ABA abatacept, Bari baricitinib, CDAI Clinical disease activity index, csDMARDS conventional synthetic DMARDs, DAS28 Disease Activity Score 28, MTX methotrexate, SJC swollen joint count, TCZ tocilizumab, wks weeks, mos months.

Conclusion

There are no trials designed to compare tapering targeted monotherapy to continuing it, indicating a significant gap in knowledge in an area of increasing clinical relevance for our patients. There was insufficient evidence to demonstrate the significant effects of tapering targeted monotherapy in RA. Only one study out of 5 compared stopping targeted monotherapy to continuing therapy (MTX), and reported a low OR of remission. Three studies tapered therapy in both arms and one study performed a dose reduction. Our review suggests that stopping targeted monotherapy is unlikely to maintain disease control. More gradual tapering schemes, dose reduction and early treatment of disease may be associated with more successful tapering. More studies are needed to better inform our patients. Currently, we do not recommend stopping targeted monotherapy in RA.

References

[1]Smolen JS, Landewé RBM, Bijlsma JWJ, et al.Ann Rheum Dis 2020;79:685-99.

Disclosure of Interests

Charis Meng: None declared, Diviya Rajesh: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Cytodyn, Walgreens, Omar Bruce: None declared, Bridget Jivanelli: None declared, Vivian Bykerk Consultant of: Amgen, Bristol Myers Squibb, Genzyme, Gilead, Janssen, Pfizer, Sanofi-Aventis, UCB, Grant/research support from: NIH (NIAID/NIAMS) grant 1UH2AR067691-01 GRANT11652401 and The Cedar Hill Foundation; institution received grants from Bristol Myers Squibb and Amgen

Ecological and health risk assessment of heavy metals in soil and Chinese herbal medicines

As medicinal plants can accumulate harmful metals from the native soil, people's consumption of these materials may cause the human body to accumulate toxic metal elements. This has given rise to people's concerns about the quality and safety of Chinese medicinal materials. This research aims to determine the levels of Cr, Ni, Cu, Zn, As, Cd, Hg and Pb in four medicinal plant species (Aster tataricus L.f., Salvia miltiorrhiza Bge, Radix Aucklandiae, Scutellaria baicalensis Georgi) and their native soil. All samples were collected from Qian'an city, beside Yanshan Mountain Range in Tangshan city, east Hebei Province, north China. The contents of heavy metals we detected in the soil conformed to the current limits. However, the Cd and Hg in the soil had a very high potential ecological risk because of their contents higher than the base level of local soil. The contents of Cu, Cd, Hg and Pb in some medicinal herbs exceeded the standards. The content of Cu in Radix Aucklandiae exceeded the standard by 3 times, and others exceeded the standard by less than one time. The comprehensive health risk assessment of heavy metals with chronic non-carcinogenic effects for human body showed that none of the four medicinal herbs can create a health risk. Thus, there is no strong positive correlation between heavy metal pollution in medicinal herbs and that in the native soil. Further research should be investigated to the connection between the heavy metal levels in the soil and plants, and the comprehensive effects of soil, air and irrigation water on heavy metal pollution of Chinese herbal medicines. We also recommend that Chinese herbal medicines should be cultivated and gathered only from controlled or uncontaminated areas.

[The effects of robotic-assisted versus laparoscopic-assisted radical right hemicolectomy on short-term outcome and long-term prognosis based on propensity score matching]

Objective: To compare the short-term and long-term outcomes between robotic-assisted and laparoscopic-assisted radical right hemicolectomy in patients with adenocarcinoma of the right colon. Methods: Retrospective review of a prospectively collected database identified 288 right colon cancer patients who underwent either robotic-assisted (n=57) or laparoscopic-assisted right hemicolectomy (n=231) between October 2014 and October 2020 at Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University. There were 161 males and 127 females, aging (60.3±12.8) years (range: 17 to 86 years). After propensity score matching as 1∶4 between robotic-assisted and laparoscopic-assisted right hemicolectomy, there were 56 cases in robotic group and 176 cases in laparoscipic group. Perioperative outcomes and overall survival were compared between the two groups using t test, Wilcoxon rank sum test, χ² test, Fisher exact test, Kaplan-Meier method and Log-rank test, respectively. Results: The total operative time was similar between the robotic and laparoscopic group ((206.9±60.7) minutes vs. (219.9±56.3) minutes, t=-1.477, P=0.141). Intraoperative bleeding was less in the robotic group (50 (20) ml vs. 50 (50) ml, Z=-4.591, P<0.01), while the number of lymph nodes retrieved was significantly higher (36.0±10.0 vs. 29.0±10.1, t=4.491, P<0.01). Patients in robotic group experienced significantly shorter hospital stay, shorter time to first flatus, and defecation (t: -2.888, -2.946, -2.328, all P<0.05). Moreover, the overall peri-operative complication rate was similar between robotic and laparoscopic group (17.9% vs. 22.7%, χ²=0.596,P=0.465). The 3-year overall survival were 92.9% and 87.9% respectively and the 3-year disease-free survival rates were 83.1% and 82.6% with no statistical significance between the robotic and laparoscopic group (P>0.05). Conclusions: Compared to laparoscopic-assisted right hemicolectomy, robot-assisted right hemicolectomy could improve some short-term clinical outcomes. The two procedures are both achieving comparable survival.

Personal PM2.5-bound PAH exposure, oxidative stress and lung function: The associations and mediation effects in healthy young adults

Decreased lung function is an early hazard of respiratory damage from fine particulate matter (PM_2.5) exposure. Limited studies have explored the association between PM_2.5-bound polycyclic aromatic hydrocarbons (PAHs) and lung function, but studies at the personal level in healthy young adults are scarce. Here, we assessed personal PM_2.5 and PM_2.5-bound PAH levels in a panel of 45 healthy young adults by a time-weighted model. The aims were to investigate the relationship between personal exposure and lung function by a linear mixed effect model, and to explore the mediating effects of oxidative stress in this association. The results showed that personal exposure to PM_2.5 and PAHs had the greatest negative effect on forced expiratory volume in 1 s (FEV₁), peak expiratory flow rate (PEF) and forced expiratory flow between 25% and 75% vital capacity (FEF_25-75) at lag 3 days. An IQR increase in personal PM_2.5 exposure was associated with a change of 0.35% (95% CI: 0.27%, 0.42%) in FEV₁, 0.39% (95% CI: 0.29%, 0.47%) in PEF and 0.36% (95% CI: 0.27%, 0.45%) in FEF_25-75. An IQR increase in personal PAH exposure was associated with a decrease of 0.63% (95% CI: 0.55%, 0.69%) in FEV₁, 0.69% (95% CI: 0.61%, 0.75%) in PEF and 0.66% (95% CI: 0.57%, 0.72%) in FEF_25-75. Additionally, exposure to PM_2.5 and PAHs resulted in the strongest positive effects on urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-iso-prostaglandin-F_2α (8-iso-PGF_2α). Of these, 8-OHdG mediated 10.33%, 8.87% and 9.45% of the associations of personal PM_2.5 exposure with FEV₁, PEF and FEF_25-75, respectively. Our results revealed that personal exposure to PM_2.5 and PAHs was associated with lung function decline in healthy young adults, and urinary 8-OHdG mediated the association between personal PM_2.5 and lung function.

Stoichioproteomics study of differentially expressed proteins and pathways in head and neck cancer

Hypoxia is a prominent feature of head and neck cancer. However, the oxygen element characteristics of proteins and how they adapt to hypoxia microenvironments of head and neck cancer are still unknown. Human genome sequences and proteins expressed data of head and neck cancer were retrieved from pathology atlas of Human Protein Atlas project. Then compared the oxygen and carbon element contents between proteomes of head and neck cancer and normal oral mucosa-squamous epithelial cells, genome locations, pathways, and functional dissection associated with head and neck cancer were also studied. A total of 902 differentially expressed proteins were observed where the average oxygen content is higher than that of the lowly expressed proteins in head and neck cancer proteins. Further, the average oxygen content of the up regulated proteins was 2.54% higher than other. None of their coding genes were distributed on the Y chromosome. The up regulated proteins were enriched in endocytosis, apoptosis and regulation of actin cytoskeleton. The increased oxygen contents of the highly expressed and the up regulated proteins might be caused by frequent activity of cytoskeleton and adapted to the rapid growth and fast division of the head and neck cancer cells. The oxygen usage bias and key proteins may help us to understand the mechanisms behind head and neck cancer in targeted therapy, which lays a foundation for the application of stoichioproteomics in targeted therapy and provides promise for potential treatments for head and neck cancer.

Prognostic and clinicopathological importance of microRNA-140 expression in cancer patients: a meta-analysis

Background

MicroRNA-140 (miR-140) is one of the most widely investigated miRNAs in cell carcinogenesis and cancer development. Despite present proposals of employing miR-140 as a candidate biomarker for cancer prognosis, its effectiveness in predicting patient survival and clinicopathological outcome is still under debate.

Methods

A systematic search for English literature using online databases was performed with pre-established criteria. Odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were collected to delineate the correlation between miR-140 levels and cancer patient prognosis.

Results

For this meta-analysis, we selected 12 papers for analysis, involving 1386 participants. Based on our analysis, high levels of miR-140 were strongly correlated with enhanced patient overall survival (OS) (HR = 0.728, 95% CI = 0.601-0.882, P = 0.001). In addition, we also observed that elevated miR-140 levels significantly led to better OS in patients with cancers in different parts of the body like digestive system (HR = 0.675, 95% CI = 0.538-0.848, P = 0.001), digestive tract (HR = 0.709, 95% CI = 0.565-0.889, P = 0.003), and head and neck (HR = 0.603, 95% CI = 0.456-0.797, P < 0.001). Additionally, we verified that the low miR-140 levels was related to advanced TNM stage (OR = 0.420, 95% CI = 0.299-0.590, P < 0.001), worse histologic grade (OR = 0.410, 95% CI = 0.261-0.643, P < 0.001), and positive lymph node metastasis status (OR = 0.341, 95% CI = 0.144-0.807, P = 0.014).

Conclusions

Taken together, our results suggest that elevated miR-140 levels can be employed as a favorable biomarker for cancer patient prognosis. This information can greatly benefit in the formation of an individualized therapeutic plan for the treatment of cancer patients.

Inhalation bioaccessibility, health risk assessment, and source appointment of ambient PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) in Caofeidian, China

The inhalation bioaccessibility of polycyclic aromatic hydrocarbons (PAHs) is significant for accurately assessing the health risks posed by PM_2.5-bound PAHs. In this study, 96 PM_2.5 samples from Caofeidian, China, were investigated for PM_2.5-bound PAH source appointment and bioaccessibility assessment during four seasons. PAH₁₈ potential sources were identified by positive matrix factorization. The inhalation bioaccessibility of PAH₁₈ was investigated by simulated epithelial lung fluid extraction. The incremental lifetime cancer risk (ILCR) model was subsequently used to evaluate the carcinogenic risk posed by PM_2.5-bound PAHs in children, teenagers, and adults. Four potential sources of PM_2.5-bound PAH₁₈ were identified: industry emissions (44%), petroleum volatilization (30%), vehicle emissions (15%), and coal combustion (11%). The average inhalation bioaccessibility of PAHs ranged from 17.8% (dibenzo [a,h] anthracene) to 67.9% (fluorene). The ILCR values for children and teenagers were lower than the acceptable levels (10^-6) in the four seasons considering inhalation bioaccessibility. However, the ILCR value of adults was higher than the threshold in winter (1.26 × 10^-6). Source identification suggested that reducing industrial pollution was the primary measure for controlling PM_2.5-bound PAHs in Caofeidian. Additionally, the inhalation bioaccessibility of PM_2.5-bound PAHs was evaluated to precisely estimate the health risks caused by PAHs.

[Retracted] MicroRNA‑154 functions as a tumor suppressor in osteosarcoma by targeting Wnt5a

Following the publication of this paper, it was drawn to the Editors' attention by a concerned reader that the western blotting data featured in Fig. 5B and C, and also in Fig. 6B, were strikingly similar to data appearing in different form in other articles by different authors at different research institutes. Owing to the fact that the contentious data in the above article were already under consideration for publication, or had already been published, elsewhere prior to its submission to Oncology Reports, the Editor has decided that this paper should be retracted from the Journal. After having been in contact with the authors, they agreed with the decision to retract the paper. The Editor apologizes to the readership for any inconvenience caused. [the original article was published in Oncology Reports 35: 1851‑1858, 2016; DOI: 10.3892/or.2015.4495].

Processing of expressions by individuals with autistic traits: Empathy deficit or sensory hyper-reactivity?

Individuals with autistic traits display impaired social interaction and communication in everyday life, but the underlying cognitive neural mechanisms remain very unclear and still remain controversial. The mind-blindness hypothesis suggests that social difficulties in individuals with autistic traits are caused by empathy impairment in individuals; however, the intense world theory suggests that these social difficulties are caused by sensory hyper-reactivity and sensory overload, rather than empathy impairment. To further test these two theories, this study investigated event-related potentials (ERPs) to explore the cognitive neural processing of repetitive expressions in individuals with autistic traits. This study employed the Mandarin version of the autism-spectrum quotient (AQ) to assess autistic traits in 2,502 healthy adults. Two subset groups were used, e.g., the participants of a high-AQ group were randomly selected among the 10% of individuals with the highest AQ scores; similarly, the participants in the low-AQ group were randomly selected from the 10% of participants with the lowest AQ scores. In an experiment, three different facial expressions (positive, neutral, or negative) of the same person were presented successively and pseudo-randomly in each trial. Participants needed to define the expression of the face that was presented last. The results showed that compared with the low-AQ group, the high-AQ group exhibited higher P1 amplitudes induced by the second and third presented expressions, as well as higher P3 amplitudes induced by the third presented negative expressions. This indicates that individuals with autistic traits may experience overly strong perception, attention, and cognitive evaluation to repetitive expressions, particularly negative expressions. This result supports the intense world theory more strongly than the mind-blindness hypothesis.

[Clinical features and prognosis analysis of myelin oligodendrocyte glycoprotein antibody-positive optic neuritis]

Objective: To investigate the clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein (MOG) antibody-positive optic neuritis (ON). Methods: The data of 39 patients with MOG antibody-positive ON in the Department of Neurology of Beijing Tongren Hospital, Capital Medical University from January 1, 2017 to October 31, 2019 were retrospectively collected. There were 25 males and 14 females, aged from 15 to 80 (40±16) years. According to the recurrence, the patients were divided into two groups: the recurrence group (n=12) and the non-recurrence group (n=27). The clinical manifestations, relapse-related factors, magnetic resonance imaging (MRI) manifestations, treatment and prognosis of the two groups were analyzed. Results: A total of 63 eyes were involved, including 30 cases of optic perineuritis (OPN), accounting for 47.6% (30/63). The number of attacks ranged from 1 to 9, among which 12 patients had more than 2 attacks. There were 37 eyes [58.7% (37/63)] with severe visual loss (SVL) at the time of onset, and 7 eyes [11.1% (7/63)] with SVL at the final follow-up. Forty-eight eyes [76.2% (48/63)] had optic disc edema. Forty seven eyes [74.6% (47/63)] showed long-segment disease on optic nerve MRI. One case was complicated with aseptic meningitis and encephalitis. The recurrence group was younger than the non-recurrence group [(28.5±9.8) years vs (43.3±16.4) years, P=0.001]. There were no statistically significant differences between the two groups in gender, bilateral onset, initial visual acuity, final visual acuity, optic disc edema, head and spinal cord lesions, and immunosuppressant (all P>0.05). All patients were treated with methylprednisolone (MP) pulse therapy during the acute attack, and 16 of them were additively treated with immunosuppressive agents; the pain was alleviated or relieved significantly after the application of glucocorticoids. Conclusions: MOG antibody-positive ON often occurred in both eyes at the same time, often manifesting as OPN, often accompanied by optic disc edema, and SVL at the beginning of the disease, but most of the visual recovery was good, might be associated with meningitis and encephalitis. MRI of the optic nerve showed that the lesions often manifested as long-segment lesions. Glucocorticoids could alleviate pain and promote the recovery of visual function.

The role of amplified in breast cancer 1 in breast cancer: A meta-analysis

PURPOSE

Amplified in breast cancer 1 (AIB1) expression is known to be involved in the initiation and progression of malignant breast cancer (BC), but its prognostic role remains uncertain. This meta-analysis assessed reported studies to evaluate this relationship.

METHODS

Electronic databases were systematically reviewed to collect eligible studies using pre-established criteria. Hazard ratios (HRs) or odds ratios (ORs) and 95% confidence intervals (CIs) were pooled to estimate the impact of AIB1 protein expression on overall survival (OS) and clinicopathologic properties of BC cases.

RESULTS

Nine eligible studies, including 6774 patients, were finally assessed by the current clinical meta-analysis. AIB1 positivity correlated with reduced OS (pooled HR = 1.409, 95% CI 1.159-1.714, P = .001). AIB1 overexpression also impacted prognosis as shown by univariate (pooled HR = 1.420, 95% CI 1.154-1.747, P = .001) and multivariate (pooled HR = 1.446, 95% CI 1.099-1.956; P = .009) analyses. Notably, subgroup analyses also revealed that AIB1 overexpression was associated with poor OS in some subgroups, such as ER-positive group (pooled HR = 1.511, 95% CI 1.138-2.006, P = .004), ER-positive without tamoxifen administration group (pooled HR = 2.338, 95% CI 1.489-3.627, P < .001), and premenopausal women group (pooled HR = 1.715, 95% CI 1.231-2.390, P = .001). Additionally, high AIB1 protein levels were associated with HER2 positivity (pooled OR = 0.331, 95% CI 0.245-0.448; P < .001), poorly differentiated histological grade (pooled OR = 0.377, 95% CI 0.317-0.448; P < .001), high Ki67 (pooled OR = 0.501, 95% CI 0.410-0.612; P < .001), presence of lymph node metastases (pooled OR = 0.866, 95% CI 0.752-0.997; P = .045), and absence of progesterone receptor (pooled OR = 1.447, 95% CI 1.190-1.759; P < .001).

CONCLUSIONS

This analysis demonstrated that AIB1 overexpression is related to aggressive phenotypes and unfavorable clinical outcomes in BC, and might involve in tamoxifen resistance. AIB1 may be a new prognostic biomarker and therapeutic target in BC.

[Effectiveness and safety of holmium laser therapy via flexible bronchoscopy in 40 children with tracheobronchial tuberculosis]

Objective: To explore the effectiveness and safety of holmium laser treatment via flexible bronchoscopy in children with tracheobronchial tuberculosis (TBTB). Methods: The clinical data of 40 children with TBTB admitted in Qilu Children's Hospital of Shandong University from February 2016 to June 2019 were retrospectively analyzed. According to the treatment approach, they were divided into conventional treatment group (20 cases) and holmium laser treatment group (20 cases). The sex, age, course of disease and lesion location before treatment, and the time till relief of atelectasis and airway obstruction after treatment were compared between the two groups with t test and χ² test. Results: Among the 40 cases, 24 were males and 16 females, and 35 had lymph node fistula (87.5%) and 5 had granulation proliferation (12.5%). There was no statistically significamt difference between the conventional group and laser group in sex (male ratio: 50%（10/20） vs. 75%（15/20）, χ²=2.66, P=0.10), age （(3.2±2.2） years vs. （2.2±1.8） years, t=1.41, P=0.16), course of disease (<1 month ratio: 30%（6/20） vs. 35%（7/20）, χ²=0.11, P=0.73), lesion location (single lesion ratio： 45%（9/20） vs. 60%(12/20), χ²=0.90, P=0.34). The effectiveness was evaluated after 3 months, and the total effective rate were 100% in laser group and 40% in conventional group, the difference was significant (χ²=25.34, P<0.01). No serious adverse events occurred in the two groups during the observational period. Conclusions: Holmium laser treatment via bronchoscopy is an effective way to remove the tuberculosis foci in the trachea, which can reduce the incidence of further related complications, and could be applied in clinical approach.

[Five cases of optic neuropathy associated with varicella zoster virus infection]

Objective: To investigate the clinical characteristics, treatment and prognosis of optic neuropathy associated with varicella zoster virus (VZV). Methods: Five cases of optic neuropathy associated with VZV infection from Department of Neurology between January 1, 2014 and March 31, 2019 were retrospectively collected. The clinical manifestations, treatment and prognosis were analyzed. Results: There were 7 eyes involved in 5 cases, 3 cases (3/5) involved only one eye, and 2 cases (2/5) involved both optic nerves. During the follow-up time, no recurrence was found. Severe visual impairment occurred in 4 eyes (4/7) and non-severe visual impairment in 3 eyes (3/7). Visual acuity improved significantly in 1 eye (1/7), turned better in 2 eyes (2/7), and remained unchanged in 4 eyes (4/7). In acute phase, abnormal signals of optic nerve and/or sheath were observed on MR images. Case 3 received antiviral and hormone therapy on the second day after the onset of the disease, and the visual acuity recovered well; the other 4 cases had poor prognosis. Conclusions: Head and face VZV infection can cause serious optic neuropathy, leading to severe visual dysfunction, and poor prognosis, but recurrence is rare. Early intravenous administration of antiviral drugs (acyclovir is the best) and hormones are recommended for VZV infection in this area. It is best to use drugs within 72 hours in order to avoid and reduce secondary optic neuropathy as far as possible.

Molecular cloning and functional characterisation of duck (Anas platyrhynchos) tumour necrosis factor receptor-associated factor 3

1. Tumour necrosis factor receptor-associated factor 3 (TRAF3) is a key regulator of innate immunity and acquired immunity, and has a salient anti-viral role. 2. In this experiment, the duck TRAF3 (DuTRAF3) gene was cloned according to the Anas platyrhynchos TRAF3 sequence to explore its function. The TRAF3 open reading frame contains 1704 bp that encode a protein of 567 amino acids, which contain a RING finger domain, two zinc finger motifs, a coiled-coil region, and a MATH domain. 3. Reverse transcription-polymerase chain reaction showed that DuTRAF3 was expressed in all the examined tissues, with a comparatively higher expression in the spleen and brain tissues. 4. In HEK293T cells, DuTRAF3 overexpression resulted in a significantly increased NF-κB activity and interferon (IFN)-β promoter activation. 5. Following resiquimod (R848) and poly(I:C) stimulation of duck peripheral blood mononuclear cells (PBMCs), the expressions of TRAF3 and IFN-β were significantly upregulated; in addition, following R848 stimulation, the mRNA levels of IL-6, IL-8 and IL-10 were also significantly upregulated. After infection with the Newcastle Disease Virus LaSota vaccine strain, the mRNA levels of IL-6 and IL-10 were significantly upregulated, while that of TRAF3 was downregulated. 6. These results suggest that DuTRAF3 has an important role to play in innate antiviral immune responses.

[Value of serum HBV RNA in HBeAg-negative patients with chronic hepatitis B]

Objective: To analyze serum HBV-RNA levels in patients with chronic hepatitis B whose serum HBV-DNA has dropped to undetected levels after treatment with entecavir, and to explore the correlation between HBV-RNA level and liver biochemical parameters, which lay the research foundation for the clinical significance of new serological marker HBV-RNA. Methods: HBeAg negatively detected 107 cases with chronic hepatitis B whose serum HBV-DNA test results were lower than detection level for six consecutive months after receiving standard nucleoside therapy for more than 12 months were included. HBV-RNA level was detected by Perkin-Elmer reagent. HBV-DNA level was detected by Roche Cobas. Hitachi automatic biochemical analyzer was used to detect ALT and AST. Architect chemiluminescence analyzer was used to detect HBsAg, HBeAg, anti-HBe and anti-HBc. RStudio software was performed to analyze the correlation between HBV-RNA level and liver biochemical parameters. Logistic regression was used to analyze the independent factors influencing HBV-RNA level. Results: The positive detection rate of serum HBV-RNA in patients with chronic hepatitis B whose serum HBV-DNA had dropped to undetected levels after ETV treatment was 22.43%. HBsAg, ALT and AST levels in HBV-RNA positive group were slightly higher than HBV-RNA negative group, while anti-HBc levels were slightly higher in HBV-RNA negative group. There was no difference in the level of anti-HBe between the HBV-RNA negative and the positive group. Logistic regression analysis showed that anti-HBc was an independent factor influencing the level of HBV-RNA detection (P = 0.021). Conclusion: HBV-RNA can be detected in some patients with chronic hepatitis B whose serum HBV-DNA level has dropped to undetected levels after ETV treatment. Serum HBV-RNA only comes from the direct transcription of cccDNA, so it is better than HBV-DNA and HBsAg to reflect cccDNA level or activity. Anti-HBc, as an independent factor influencing the level of HBV-RNA, may be used in combination as a new marker to predict the efficacy of antiviral therapy.

[Clinical analysis of 36 cases of idiopathic intracranial hypertension complicated with iron deficiency anemia]

Objective: To investigate the clinical features, imaging findings and prognosis of idiopathic intracranial hypertension (IIH) patients complicated with iron deficiency anemia (IDA). Methods: A total of 307 cases of IIH patients hospitalized in Beijing Tongren Hospital were retrospectively screened between January 1, 2011 and February 28, 2018. There were 49 anemia cases (15.96%) and 45 IDA cases (14.66%), respectively. Finally, 36 IDA patients were enrolled. The clinical characteristics, imaging findings, treatment and prognosis of these patients were analyzed. Results: IIH combined with IDA was more common in women of childbearing age (34/36). There were 30 obese and overweight cases (83.33%), with multiple subacute or chronic course of disease. The visual symptoms in the early IIH patients were first diagnosed in the Department of Ophthalmology. The first symptom was headache with/without visual symptoms (27 cases (75%)). Head MRI detected empty sella or partial empty sella, and 2 cases of venous sinus thrombosis were found in DSA examination. Of the 34 female patients, 24 had simple menometrorrhagia or menstrual disorder. All patients were given methyl acetate to reduce the intracranial pressure and iron therapy. Five patients received low molecular weight heparin-warfarin sequential treatment, 5 cases underwent gynecologic surgery and 2 male cases received hemorrhoid operation. There were 7 cases underwent lumbar cisterna-peritoneal shunt for visual impairment. During the follow-up, intracranial pressure decreased and visual function of patients improved significantly. Conclusions: IIH is frequently found in obese or overweight women at childbearing age and IDA may be an important cause of IIH. IIH can cause serious irreversible visual impairment. Therefore, early identification and active treatment should be performed. Correction of anemia can significantly improve the clinical symptoms of IIH. Operation should be employed for IIH patients with poor visual function or rapid progress, in order to reduce intracranial pressure and improve prognosis as soon as possible.

Hepatitis B Virus cccDNA in Hepatocellular Carcinoma Tissue Increases the Risk of Recurrence After Liver Transplantation

BACKGROUND

High hepatitis B virus (HBV) DNA level is strongly associated with hepatocellular carcinoma (HCC) development in chronic HBV infection. The aim of this study was to investigate the association between intrahepatic HBV DNA titer and post-liver transplantation (LT) prognosis for HBV-related HCC (HBV-HCC) patients.

METHODS

A total of 60 patients with HBV-HCC who underwent LT were retrospectively studied. Using quantitative TaqMan fluorescent real-time polymerase chain reaction assay, HBV total DNA (tDNA) and covalently closed circular DNA (cccDNA) were both quantified in tumor tissue (TT) and adjacent non-tumor tissue (ANTT) from the explanted liver.

RESULTS

The loads of tDNA and cccDNA in ANTT were associated with serum HBV DNA levels. Multivariate analysis showed that the presence of vascular invasion and cccDNA in TT were independent risk factors for tumor recurrence. The group of patients with cccDNA titers ≥31og_l0 copies/μg in TT had significantly higher cumulative recurrence rates than those with <31og_l0 copies/μg group. The cccDNA titers predicted the tumor recurrence with an area under the receiver operating characteristic curve of 0.664.

CONCLUSIONS

Our findings would assist the clinical implementation of a more personalized therapy for tumor recurrence control and improve the prognosis of HBV-HCC patients.

Deleted in Breast Cancer 1 as a Novel Prognostic Biomarker for Digestive System Cancers: A Meta-Analysis

Deleted in Breast Cancer 1 (DBC1/CCAR2) is a regulatory protein involved in cell survival and cancer progression. Herein, we focused on summarizing the overall prognostic value of DBC1 for digestive system cancers. Therefore, we conducted a meta-analysis based on 9 studies with 2391 patients to generated combined hazard ratios (HR) or odds ratio (OR) with its 95% confidence intervals (CI) for overall survival (OS) and clinicopathological features. Positive DBC1 expression was significantly associated with poor OS of digestive system cancers (pooled HR=1.650, 95% CI=1.087-2.504, P<0.019). Stratified analysis also verified the potential prognostic prediction of DBC1 in some subgroups, such as digestive tract cancers (pooled HR=1.685, 95% CI=1.013-2.802, P=0.044), univariate analysis method (pooled HR=2.077, 95%CI=1.221-3.533, P=0.007), publication date within five years (pooled HR=1.609, 95%CI=1.097-2.358, P =0.015), study sample size smaller than 200 (pooled HR=2.304, 95%CI=1.716-3.093, P<0.001) and cutoff value for positive tumor cells more than 50% (pooled HR=1.944, 95% CI=1.479-2.556, P<0.001). Additionally, in terms of the association between DBC1 expression and clinicopathological characteristics, DBC1 expression was correlated to age (pooled OR=0.596, 95%CI =0.467-0.761, P<0.001), WHO classification (pooled OR =3.780, 95% CI=2.303-6.205, P <0.001), Lauren classification (pooled OR=2.000, 95%CI =1.492-2.680, P<0.001), and lymph node metastasis (pooled OR=0.405, 95%CI=0.203-0.806, P=0.010). In conclusion, DBC1 could not only be an independent prognostic factor for survival of patients with digestive system cancer, but might also be a novel target for cancer therapy.

Phenotypic analysis of atopic dermatitis in children aged 1-12 months: elaboration of novel diagnostic criteria for infants in China and estimation of prevalence

BACKGROUND

Atopic dermatitis (AD) is the most common skin disorder in infancy. However, the diagnosis and definite significance of infantile AD remains a debated issue.

OBJECTIVE

To analyse the phenotypes of AD in infancy, to establish diagnostic criteria and to estimate the prevalence of this condition in China.

METHODS

This is a multicentric study, in which 12 locations were chosen from different metropolitan areas of China. Following careful and complete history-taking and skin examination, the definite diagnosis of AD was made and the severity based on the SCORAD index was determined by local experienced dermatologists. Based on the detailed phenotyping, the major and representative clinical features of infantile AD were selected to establish the diagnostic criteria and evaluate their diagnostic efficacy.

RESULTS

A total of 5967 infants were included in this study. The overall point prevalence of AD was 30.48%. The infantile AD developed as early as at the second month of life, and its incidence peaked in the third month of life at 40.81%. The proportion of mild, moderate and severe AD was 67.40%, 30.57% and 2.03%, respectively. The most commonly seen manifestations in the infantile AD were facial dermatitis (72.07%), xerosis (42.72%) and scalp dermatitis (27.93%). We established the novel diagnostic criteria of infants, which included: (i) onset after 2 weeks of birth; (ii) pruritus and/or irritability and sleeplessness comparable with lesions; and (iii) all two items above with one of the following items can reach a diagnosis of AD: (i) eczematous lesions distributed on cheeks and/or scalp and/or extensor limbs, and (ii) eczematous lesions on any other parts of body accompanied by xerosis.

CONCLUSIONS

In China, the prevalence of AD in infancy is 30.48% according to clinical diagnosis of dermatologists. The novel Chinese diagnostic criteria for AD in infants show a higher sensitivity and comparable specificity.

TIMP-1 is a novel serum biomarker for the diagnosis of colorectal cancer: A meta-analysis

Purpose

Tissue inhibitor of metalloproteinase-1 (TIMP-1) is a glycoprotein involved in cell survival and tumorigenesis. There have been some promising results regarding the diagnostic value of TIMP-1 for patients with colorectal cancer (CRC). The aim of the present study was to assess the diagnostic accuracy and clinical utility of serum TIMP-1 in CRC patients through meta-analysis.

Methods

A systematic search of online databases was performed to collect eligible studies. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operator characteristic (SROC) curve were generated from accuracy data using the random-effects model. Fagan’s nomogram and the likelihood matrix were applied to estimate the clinical utility of TIMP-1.

Results

A total of 9 eligible studies with 1886 patients were included. Among the patients, 819 were pathologically diagnosed with CRC, whereas 1067 did not have adenomas or other cancers. The overall sensitivity, specificity, and DOR of TIMP-1 for the diagnosis of CRC were 0.65 (95% confidence interval (CI): 0.57–0.72), 0.87 (95% CI: 0.76–0.94), and 12.73 (95% CI 5.71–28.38), respectively. The area under the SROC was 0.77 (95% CI, 0.73–0.81), suggesting the potential diagnostic value of TIMP-1 in CRC patients. Among patients with a pretest CRC probability of 20%, posttest probabilities were 56% and 9% for positive and negative TIMP-1 results, respectively.

Conclusions

TIMP-1 expression exhibits an upper moderate diagnostic value in CRC, and TIMP-1 assessment may be useful as a noninvasive screening tool for CRC in clinical practice.

[Clinical and immunological characteristics and predicted factors of vision outcome in patients with acute severe bilateral optic neuritis]

Objective: To analyze the clinical and immunological characteristics of acute severe bilateral optic neuritis, and to explore the predictive factors of vision outcome and relapse so as to save visual function and avoid or alleviate vision disability. Methods: Forty-eight inpatients confirmed with acute severe bilateral optic neuritis from January 2013 to June 2015 were included and followed up. The clinical features, immunological findings, optic nerve imaging, visual function outcome and predictors of relapse were statistically analyzed. Results: Acute severe bilateral optic neuritis accounted for 7.3% of the total number of optic neuritis in the same period. There were 35 cases (72.9%) with monophasic course, and 13 cases (27.1%) with recurrence or other central nervous system involvement during the follow-up period; 11 (22.9%) in 48 patients with positive AQP4-IgG; AQP4-IgG-positive patients had a higher recurrence rate (P<0.001) and poorer visual function prognosis (P=0.034) than antibody-negative patients; the baseline visual acuity (P=0.004), early treatment response (P=0.012) and number of involved optic nerve segments (P=0.016) were associated with end point visual function. Positive AQP4-IgG(OR 13.486, 95% CI 1.971-16.263)and combining with other autoimmune antibodies (OR 5.591, 95% CI 1.502-15.621)were independently associated with relapse. Conclusions: Acute severe bilateral optic neuritis is not unusual and may cause blindness or visual disability. The positive rate of AQP4-IgG and the recurrence rate of the disease are low in our study. The necessity for long-term immunotherapy requires individual consideration. The baseline visual acuity, involved segment number of optic nerve and response to early treatment are associated with prognosis of visual function. Patients with AQP4-IgG positive and other autoimmune antibodies are easy to relapse. Whether the antibody-negative bilateral optic neuritis is a heterogeneous disease and the relationship with classic NMO or NMOSD deserve further research.

[Clinical features of chronic relapsing inflammatory optic neuropathy]

Objective: To explore the clinical characteristics and prognosis of chronic relapsing inflammatory optic neuropathy (CRION). Methods: A retrospective analysis was conducted. Clinical features, disease course, prognosis and magnetic resonance imaging (MRI) of patients with CRION who were admitted to Department of Neurology between 2014 and 2016 were reviewed and analyzed. Results: Totally, there were 27 patients (10 males and 17 females), with an age range of 17-59 years. The disease duration was between 40 days and 8 years. There were 2 to 9 CRION episodes. The mean frequency of CRION episodes was 3.30±1.56. The outcome of visual acuity showed that the more episodes frequency was, the worse outcome became. There was 25 abnormal optic nerve signals in MRI. And in 22 cases, the abnormal signals were in intraorbital segment or inner pipe section. The antinuclear antibodies (ANA) titers were elevated in 5 patients. Five cases relapsed during reduction or withdrawal of steroids, but steroids was not added in time. The final outcome of these 5 patients was poor. Conclusions: CRION was more common in female than male patients. Most patients were companied by pain, and the lesions were more common in the intraorbital segment of optic nerve. The more episode frequency was, the worse prognosis became. If a relapse happened, steroids or other immunosuppressive agents should be used.

[Clinical and genetic analysis of a family with Joubert syndrome type 10 caused by OFD1 gene mutation]

Objective: To investigate the genetic cause for a family with multiorgan dysplasia and "molar tooth sign" on MRI image. Method: The patient, a 3 months and 21 days old boy, was clinically examined and the medical history of his family was collected. Next generation sequencing was performed to analyze his clinical and genetic causes. Result: Clinical manifestation of the child displayed multiorgan dysplasia, such as six finger deformity, short limbs, coloboma of optic disc and choroid, situs inversus.Cranial MRI showed "molar tooth sign" . The gene sequencing confirmed that the child carried a de novo deletion of c. 2843_2844 delAA in OFD1 gene. Conclusion: The child has typical clinical features of Joubert syndrome, such as MRI "molar syndrome" , developmental abnormalities of ocular tissue and limb, visceral inversion, and so on.The OFD1 gene had a novel deletion mutation through gene detection. Combined clinical features with gene detection, it was clear that the child was a rare case of Joubert syndrome type 10 which was the first case of Joubert syndrome caused by OFD1 gene mutation in China.

Kinetic analysis of RNA editing of Newcastle disease virus P gene in the early period of infection

As a paramyxovirus, Newcastle disease virus (NDV) has the ability to edit its P (phosphoprotein) gene to synthesize three kinds of viral protein (P, V and W). It is technically very difficult to differentiate P, V and W mRNAs, and little was known about NDV regulation of RNA-editing frequency. To investigate the rules of NDV RNA editing, the ratio of the P gene-derived transcripts (P, V and W) was determined by sequencing at different time points post-infection. The results showed unstable ratio of V and W mRNA at different time points, and the frequency of NDV editing was significantly increased at the early period of infection (P 

KEYWORDS

Newcastle disease virus; phosphoprotein; RNA editing; G insertion.

HCV NS3Ag: a reliable and clinically useful predictor of antiviral outcomes in genotype 1b hepatitis C virus-infected patients

Since hepatitis C virus (HCV) non-structural 3 (NS3) protease inhibitor (PI) combined with pegylated interferon/ribavirin (PR) has been approved for chronic HCV genotype (GT) 1b infection, a reliable and clinically useful predictor combining with serum HCV RNA to predict early virologic response, breakthrough, and relapse is important during HCV antiviral treatment. We evaluated the role of HCV NS3 antigen (HCV NS3Ag) on the prediction of virologic response in patients with HCV GT1b during PR or PR/simeprevir (triple) therapy. Three hundred patients were recruited, and HCV RNA and HCV NS3Ag were tested at baseline and weeks 2, 4, 12, 24, 48, and 72. NS3Ag and HCV RNA were significantly related (r(2) = 0.67) in the whole patient selection. The kinetic pattern of HCV RNA and HCV NS3Ag during triple treatment was similar. HCV NS3Ag levels in the triple group closely followed those of HCV RNA; the r(2) values were 0.756 (baseline), 0.837 (2 weeks), 0.989 (4 weeks), and 0.993 (12 weeks), respectively. For patients treated with PR, the positive and negative predictive values (PPVs and NPVs) for viral response were 96.31 % and 67.19 %, respectively, at week 4 by using the decrease of NS3Ag (dHCV NS3Ag) combined with HCV RNA. At week 12, the PPV was similar at 94.16 %, while the NPV reached 87.26 %. The PPV and NPV for the prediction of relapse and breakthrough were 90.6 % and 76.7 %, respectively. HCV NS3Ag is a valuable marker and could be a supplementary predictor of HCV RNA for the prediction of antiviral response, breakthrough, or relapse during HCV antiviral treatment.

MicroRNA-154 functions as a tumor suppressor in osteosarcoma by targeting Wnt5a

MicroRNAs (miRNAs) are small non-coding RNAs that are involved in tumor initiation and development by suppressing target gene expression. miRNA-154 has been shown to be important in tumorigenesis in many types of cancers. However, its role in osteosarcoma (OS) remains unknown. In the present study, we focused on the roles and mechanisms of miR‑154 in OS development. The results of quantitative RT‑PCR showed that miR‑154 expression was decreased in primary OS tumor samples and cell lines compared to levels in the matched adjacent normal tissues and human normal osteoblast cells (NHOst). Restoration of expression in U2OS cells inhibited cell proliferation, colony formation, migration and invasion, as well as induced cell cycle arrest at the G1 stage. Bioinformatic prediction suggested that Wnt5a is a target gene of miR‑154. It was further verified that Wnt5a is a target gene of miR‑150 in OS cells using luciferase assay, mRNA and protein expression analysis. Wnt5a was upregulated in OS cell lines and primary tumor samples, and its mRNA expression level was negatively correlated with the miR‑154 level in the OS tissues. Restored expression of Wnt5a weakened miR‑154‑mediated suppression of tumor progression. Taken together, these findings suggest that miR‑154 functions as a tumor suppressor in OS by partially suppressing Wnt5a expression.