Study of KDM1A and VEGF changes as the responsible genes in the angiogenesis of breast cancer

BACKGROUND

Recent developments regarding the contribution of microRNAs to tumor angiogenesis and the oncogenic effects of microRNAs point to their potential role in breast cancer angiogenesis. Tumor-derived exosomes are considered a rich source of microRNAs that can regulate the function of other cells in the tumor microenvironment, including vascular endothelial cells. This study analyzes the effect of tamoxifen chemotherapy on the expression of a key microRNA, miR-329, and introduces a regulatory link between this microRNA and the KDM1A gene associated with the vascular endothelial growth factor (VEGF) messaging pathway.

MATERIALS AND METHODS

MCF-7 breast cancer cells were purchased and cultured in a complete culture medium. These cells were treated with tamoxifen and then their exosomes were extracted from the culture medium. The RNAs of the exosomes were isolated and the expression of miR-329, VEGF, and KDM1A genes in the exosomes was investigated using the real-time polymerase chain reaction (PCR) method.

RESULTS

The results of this study showed that tamoxifen treatment increased the expression of miR-329 in exosomes derived from MCF-7 cancer cells. The expression of KDM1A and VEGF genes in drug-treated cell exosomes is downregulated.

CONCLUSION

The results of this experiment demonstrated that the treatment of breast cancer cells with tamoxifen reduces the expression of VEGF and KDM1A by increasing miR-329. The treatment therefore reduces angiogenesis, and thus its anti-tumor effects are applied.

Reconstruction and analysis of circRNA-miRNA-mRNA network in the pathology of lung cancer

BACKGROUND

The presented study aimed to gain insights into the pathogenesis of lung cancer (LC) and provide novel bio-markers for LC by building a regulatory circular (circ) RNAmicro (mi) RNAmRNA network.

MATERIALS AND METHODS

High-throughput sequencing data of circRNAs, miRNAs and mRNAs related to LC originated from GEO (Gene Expression Omnibus) database, and the differential expressions of circRNAs, miRNAs and mRNAs were screened with R language Limma. The circRNA-miRNA and miRNA-mRNA pairs were used to build the ceRNA network. The functions of differential expression circRNAs were elucidated by performing the functional enrichment analysis on GO and KEGG. Furthermore, the selected LC prognostic genes were verified by tissue chips and immunohistochemistry (IHC).

RESULTS

On the whole, 20 downregulated circRNAs, 55 upregulated miRNAs and 243 downregulated mRNAs were identified in LC. Lastly, a circRNA-miRNA-mRNA ceRNA network was built, which was composed of 2 circRNAs, 2 miRNAs, and 2 mRNAs. As indicated from the analysis based on public databases and IHC, the differential genes (i.e., FXYD1 and SEMA5A) in this network acted as LC prognostic factors. As confirmed by performing IHC and survival analyses, FXYD1 and SEMA5A expressions in LC were downregulated, and their expressions displayed a relationship to the overall survival (OS) of LC cases.

CONCLUSIONS

This study presents novel insights into the role of circRNAs in the development of LC via the ceRNA mechanism. The identified FXYD1 and SEMA5A gene could act as novel and vital LC prognostic indicators.

81 Integrating A Front Door Frailty Service in the Emergency Department: Results of A Pilot Study

Introduction

Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week.

Methodology

A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions.

Results

95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients.

Conclusion

The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.

14 Rational Prescribing in the Frail Elderly Population: A Quality Improvement Project to Reduce Inappropriate Prescribing Using STOPP-Frail Criteria

Introduction

2.5 million people in the UK are aged over 80 and up to 50% can be considered frail. Complex co-morbidities and polypharmacy are linked with adverse drug effects and negative outcomes. NICE recommends a medication review yearly, and a hospital admission provides an opportunity for this. STOPP-Frail is a screening tool designed to highlight medications that could be reduced/stopped with a view to improving quality of life. We conducted a quality improvement project to quantify levels of inappropriate prescribing at Croydon University Hospital (CUH), with a view to de-prescribing and reducing adverse drug effects.

Methods

A retrospective analysis was carried out on the Elderly Care wards at CUH. Data was collected from 60 consecutive patients discharged from 1st November 2018, utilising electronic Cerner records. Recorded medication on admission and discharge, noting any amendments in accordance with the STOPP-Frail criteria.

Results

Data collected from 60 patients; one exclusion for not meeting STOPP-Frail criteria (n=59). Median age 86 years (69 to 103 years). Mean number of medications on admission 7.42 (1 to 15). 93.2% patients had polypharmacy (defined as ≥ 4 medications). Mean number of medications on discharge 8.22; an increase of 0.8/patient.

19.4% admission medications met STOPP-Frail criteria for inappropriate prescriptions. Only 18.8% of these were reduced or stopped during admission. Gastrointestinal and cardiovascular medications were most commonly inappropriately prescribed (n=27 and 24 respectively). Most common medications not amended were lipid-lowering therapies (n=21) and proton-pump inhibitors (n= 20).

Conclusions

The opportunity to rationalise medication in the frailest patients admitted to CUH is missed in over 80% of cases. STOPP-Frail provides clear guidance to aid clinicians in reducing inappropriate prescribing. An educational programme is in place to highlight medication rationalisation and guide clinicians in the use of the STOPP-Frail tool. This includes doctors’ induction, departmental teaching, posters and computer flash cards.

Analysis of the cox1 gene in Echinococcus granulosus from sheep in northeast Iran using PCR high-resolution melting (qPCR-HRM) curve analysis

Echinococcus granulosus, the etiologic agent of echinococcosis, is one of the most important zoonotic helminthes worldwide. Knowledge of E. granulosus species and genotypes has important implications for epidemiology, control, and prevention of diseases as well as future vaccine and drug designs. There are many molecular methods developed to define genotypes of E. granulosus, among them high resolution melting (HRM) analysis, as a new approach, is a single step and closed tube method. It is appropriate for fast screening of large number of isolates. This technique is an accurate, user friendly, cost-effective, fast and simple method, which does not need post-PCR processes. Between March and lst august 2016, of 726 sheep examined in abattoirs in Razavi Khorasan province, Northeast Iran, 109 harboured cystic echincoccosis lesions (liver samples= 65 and lung samples= 44) which were collected for analysis. Total genomic DNA was extracted from each sample and amplified for the presence of polymorphism in the mitochondrial cox1 gene of Echinococcus granulosus using a high resolution melting curve (HRM) method. A total of 109 hydatid cyst samples analyzed by PCR high-resolution melting (qPCR-HRM) curve of the cox1 gene, all isolates were identified as G1 genotype (sheep strain). G1 is the predominant genotype in sheep in northeast of Iran. The high incidence of the G1 genotype (known to be the predominant E. granulosus genotype infecting humans globally) in sheep has considerable implications for hydatid disease control programs in this area.

PCR-RFLP diagnosis and characterization of Leishmania species causing human cutaneous leishmaniasis and evaluation of treatment times with glucantime in these patients

Antimony compounds are first line treatments for cutaneous leishmaniasis. The prognosis of the disease varies depending on the type of medicine and species. We aimed to determine the species responsible for cutaneous leishmaniasis in patients referred to Skin Diseases and Leishmaniasis Research Center in Isfahan and Bam Health Center (Kerman) in order to follow and assess the complete healing of the lesions. A total of 40 skin lesions samples were collected from patients with cutaneous leishmaniasis (CL) form January 2014 to 2015. Dermal scrapings were analyzed by examination of Giemsa-stained smears. Parasites were cultured and isolated in NNN and RPMI 1640 medium and DNA was extracted. We used PCR-RFLP assays of ITS1 genes for direct identification of Leishmania species. Treatment process was assessed after a treatment period with glucantime and healing of the studied cases was followed up. All the samples from Isfahan and Bam regions were L. major and L. tropica species respectively. In patients infected with L. major and L. tropica treated with glucantime, the shortest healing period was 40 days in 5(25%) and 60 days in 3(15.8%) patients, respectively and the longest healing period was 100 days in 1 (5%) and 160 days in 1 (5.3%) patient, respectively. The mean complete healing periods in patients with L. tropica and L. major were 100 and 58 days, respectively (P<0.001). Average recovery period for people with dry cutaneous leishmaniasis is longer than average recovery period for people with wet cutaeous leishmaniasis.

Transarterial Onyx Embolization of an Orbital Solitary Fibrous Tumor

Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm sometimes found in the orbit. We report a case of an aggressive orbital SFT with enlarged feeding vessels that was successfully resected immediately after transarterial embolization with Onyx (ethylene vinyl alcohol copolymer). To our knowledge, this is the first report showing the histopathology of Onyx embolization material in an orbital SFT.

Reform in medical and health sciences educational system: a Delphi study of faculty members' views at Shiraz University of Medical Sciences

Despite the strengths in the Iranian medical and health sciences educational system, areas in need of improvement have been noted. The purpose of this study was to understand the views of faculty members at Shiraz University of Medical Sciences about current and future needs for medical and health sciences education, with the goal of improving the quality of the educational system. The data were collected using a Delphi consensus method. Analysis of the findings identified the following key themes among the factors likely to contribute to medical and health sciences education and training: adding and/or increasing student numbers in higher degrees in preference to associate degrees; providing more interactive, student-centred teaching methods; improving the educational content with more practical and research-based courses tailored to society's needs; and an emphasis on outcome-based student evaluation techniques. These changes aim to respond to health trends in society and enhance the close relationship between medical education and the needs of the Iranian society.

Visual hallucinations (Charles Bonnet syndrome) associated with neurosarcoidosis

The Charles Bonnet syndrome (CBS) refers to lucid and complex visual hallucinations in cognitively normal patients with acquired vision loss. It can be associated with any type of vision loss including that related to macular degeneration, corneal disease, diabetic retinopathy, and occipital infarct. Neurosarcoidosis, a multi-systemic inflammatory granulomatous disease affecting both the central and peripheral nervous systems, is rarely associated with CBS. We report a patient with biopsy-confirmed neurosarcoidosis who experienced visual hallucinations following the development of a right seventh-nerve palsy, right facial paresthesia, and bilateral progressive visual loss. This case highlights the importance of recognizing that the CBS can occur in visual loss of any etiology.

Cerebrospinal fluid ferritin in children with viral and bacterial meningitis

Despite the fact that the prognosis of bacterial meningitis has been improved by the influence of antibiotics, this disease is still one of the significant causes of morbidity and mortality in children. Rapid differentiation between bacterial and aseptic meningitis, and the need for immediate antibiotic treatment in the former, is crucial in the prognosis of these patients. Ferritin is one of the most sensitive biochemical markers investigated in cerebrospinal fluid (CSF) for the early diagnosis of bacterial meningitis. The present study aims to evaluate the diagnostic capability of CSF ferritin in differentiating bacterial and viral meningitis in the paediatric setting. A cross-sectional study was carried out in the referral Children's Medical Center Hospital, Tehran, during 2008 and 2009. According to the inclusion criteria, CSF samples from 42 patients with suspected meningitis were obtained and divided into two meningitis groups, bacterial (n = 18) and viral (n = 24). Ferritin and other routine determinants (i.e., leucocytes, protein and glucose) were compared between the two groups. Ferritin concentration in the bacterial meningitis group was 106.39 +/- 86.96 ng/dL, which was considerably higher than in the viral meningitis group (10.17 +/- 14.09, P < 0.001). Mean CSF protein concentration and cell count were significantly higher in the bacterial meningitis group and showed a positive correlation with CSF ferritin. In conclusion, this study suggests that CSF ferritin concentration is an accurate test for the early differentiation of bacterial and aseptic meningitis; however, further investigation on a larger cohort of patients is required to confirm this finding.

Neuroimaging in ophthalmology

In the past three decades, there have been countless advances in imaging modalities that have revolutionized evaluation, management, and treatment of neuro-ophthalmic disorders. Non-invasive approaches for early detection and monitoring of treatments have decreased morbidity and mortality. Understanding of basic methods of imaging techniques and choice of imaging modalities in cases encountered in neuro-ophthalmology clinic is critical for proper evaluation of patients. Two main imaging modalities that are often used are computed tomography (CT) and magnetic resonance imaging (MRI). However, variations of these modalities and appropriate location of imaging must be considered in each clinical scenario. In this article, we review and summarize the best neuroimaging studies for specific neuro-ophthalmic indications and the diagnostic radiographic findings for important clinical entities.

A pox upon your house

Herpes zoster ophthalmicus (HZO) is a common viral infectious disorder affecting the ophthalmic division of the trigeminal nerve. A small subset of HZO patients present with the ophthalmic symptoms, but without an accompanied rash, a condition described as Herpes zoster sine herpete. Although HZO is well known to be associated with other central nervous system abnormalities, encephalitis and cerebral infarction are atypical and uncommon. We report an unusual case of presumed unilateral Herpes zoster ophthalmicus sine herpete that presented with trigeminal pain and uveitis and then progressed to encephalitis and bilateral cerebral infarctions despite treatment with acyclovir and corticosteroids. The diagnosis of HZV was confirmed by polymerase chain reaction testing on the cerebrospinal fluid.

Sub-tenon atracurium injection in rabbit eyes;a histopathologic study

PURPOSE

To evaluate early and late histopathologic changes following posterior sub-Tenon injection of atracurium in the rabbit eye.

METHODS

This study was performed on 39 healthy white New Zealand rabbits which received sub-Tenon injection of 0.05-0.08 mg/kg atracurium diluted in 0.5 ml normal saline (N/S) in the left and 0.5 ml N/S in the right eyes. Bilateral enuclation was performed one hour after the injection to evaluate early changes in 19 rabbits and one week later to determine late changes in the remaining 20 animals. After enucleation, the rabbits were euthanized. Enucleated eyes were sent in 10% formalin solution for histopathologic examination. After processing, the specimens were evaluated by light microscopy following staining with hematoxylin and eosin, and trichrome.

RESULTS

Congestion was more common in the control group 1 hour after injection.Liquifaction necrosis was seen in both groups but was significantly increased one week after the injection in the atracurium group.

CONCLUSION

Congestion is a transient complication related to injection which disappears after one week, but necrosis seems to be an important late complication of atracurium injection.

Outcome of treatment with 2nd and 3rd generation platinum-based chemotherapy in advanced non-small cell carcinoma (NSCLC): A single institute experience

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Background: The cornerstone of treatment in patients with advanced NSCLC is chemotherapy. During past years 3rd generation cytotoxic drugs have replaced 2nd generation drugs in combination with platinum. Although some trials suggest that newer agents are less toxic and with better response rates compared to older ones, but overall survival outcomes are similar. Methods: Between 1999- 2005, 275 patients with advanced NSCLC (unresectable IIIA, IIIB and IV) have been treated in our center with either frontline 2nd (204 pts.) or 3rd (71 pts.) generation, platinum-based regimens. Retrospectively we analyzed the outcome of treatment (i.e. response rate and overall survival) in these patients according to the generation of chemotherapy regimen. Results: Male/female ratio was 3.6/1 and mean age 58.9. Pathology subtypes includes: adenocarcinoma (49.8%), squamous cell carcinoma (28%), undiff. NSCLC (21.8%) and large cell carcinoma (0.4%). The RR was higher with 3rd generation protocols compared to 2nd generations (47.9% vs 26.5%, P = 0.001) but the median OS in both groups was statistically non-significant (12.07 vs 10.57 m). Analyzing RR and OS in different pathology subtypes shows that in adenocarcinoma and squamous cell ca. the RR is higher with 3rd generation compared to 2nd generation (40.5% vs 20%, P=0.01 & 72.8% vs 27.3%, P=0.005 respectively), but the OS between these two generations was not statistically significant in both pathology subtypes. In undiff. NSCLC the outcome between 2nd and 3rd generation is non-significant in terms of OS and RR. The distribution of different stages in both study groups was statistically similar. Conclusions: Based on this study the 3rd generation protocols in the treatment of advanced NSCLC is superior to 2nd generation protocols in term of RR, although the median OS is statistically non-significant.

No significant financial relationships to disclose.

Prevalence of work-related respiratory symptoms in Iranian farmers

BACKGROUND

Animal exposure may be an important trigger for work-related symptoms among farmers.

OBJECTIVE

To estimate the prevalence of work-related respiratory symptoms (WRS) in sheep breeders and agricultural farmers and to determine work-related risk factors.

METHODS

A family doctor used a questionnaire to interview a cohort of 173 farmers comprised of 127 sheep breeders and 46 agricultural farmers in the rural area of Rokh (northeast Iran). The questionnaire pertained to recurrent wheezing, cough, breathlessness or chronic phlegm while at work (these symptoms define WRS), flu-like illness and physician-diagnosed asthma.

RESULTS

There were 71 subjects (41%) with WRS: 10 of 46 agricultural farmers (21.7%) and 61 of 127 sheep breeders (48.0%). The proportions of sheep breeders with wheezing (16.5%), asthma (14%), cough (29%), breathlessness (31.5%) and flu-like illness (38%) were higher than in agricultural farmers. A significant dose-response relationship among the daily hours worked with animals, the number of animals and the prevalence of symptoms was established for sheep farmers. Sheep shearing and the use of pesticide were associated with an increased risk of wheezing and phlegm.

CONCLUSIONS

The results suggest that sheep farmers in general have higher rates of work-related symptoms than agricultural farmers. The severity of work-related symptoms will increase with an increase in frequency of animal contact; therefore, these results may underestimate the impact of this exposure.

Restoration of morphine-induced alterations in rat submandibular gland function by N-methyl-D-aspartate agonist

The effects of morphine, 1-aminocyclobutane-cis-1,3-dicarboxylic (ACBD; NMDA agonist) and 3-((R)2-carboxypiperazin-4-yl)-propyl-l-phosphoric acid (CPP; NMDA antagonist) and their concurrent therapy on rat submandibular secretory function were studied. Pure submandibular saliva was collected intraorally by micro polyethylene cannula from anaesthetized rats using pilocarpine as secretagogue. Intraperitoneal injection of morphine (6 mg/kg) induced significant inhibition of salivary flow rate, total protein, calcium, and TGF-beta1 concentrations. Administration of ACBD (10 mg/kg) and CPP (10 mg/kg) alone did not influence secretion of submandibular glands. In combination therapy, coadministration of CPP with morphine did not influence morphine-induced changes in salivary function while ABCD could restore all morphine-induced changes. In combination treatment, ACBD prevented morphine-induced reduction of flow rate, total protein, calcium, and TGF-beta1 and reached control levels. It is concluded that morphine-induced alterations in submandibular gland function are mediated through NMDA receptors.

Manometric evaluation of achalasia in the elderly

BACKGROUND

The effect of ageing on oesophageal motility in patients with achalasia is not well described. Oesophageal contraction amplitude is decreased in otherwise healthy elderly subjects.

AIM

To evaluate whether ageing influences the motor function of the oesophagus in achalasia.

METHODS

Initial manometry studies of patients with achalasia were reviewed and findings (lower oesophageal sphincter basal and residual pressures and oesophageal body contraction amplitudes) were compared between two groups of patients, those 65 years of age or older (49 patients) and those younger than 65 years (68 patients). The older group was further divided into those > or =70 years and those <70 years.

RESULTS

Patients 65 years and older had significantly higher lower oesophageal sphincter basal pressures compared with younger patients (65.6 +/- 4.9 vs. 52.3 +/- 2.7, P = 0.02). At an age cut-off of 70 years, older patients had significantly higher basal (70.7 +/- 1.6 vs. 53.0 +/- 2.4, P = 0.02) and residual (19.7 +/- 1.6 vs. 15.9 +/- 0.7, P = 0.03) lower oesophageal sphincter pressures compared with younger patients. Amplitude of oesophageal contractions was not different between the groups. Across all age groups, there was no linear correlation between age and basal or residual lower oesophageal sphincter pressures (r = 0.28 and 0.12, respectively).

CONCLUSIONS

Older patients with achalasia have higher lower oesophageal sphincter pressures, however there is no linear correlation between age and lower oesophageal sphincter pressures. Unlike healthy subjects, advanced age is not associated with a decrease in oesophageal contraction amplitude in patients with achalasia.

Supplementation of urban home visitation with a series of group meetings for parents and infants: results of a "real-world" randomized, controlled trial

OBJECTIVE

Home visitation has been shown to be effective in reducing rates of child maltreatment and in enhancing psychosocial outcomes in children and their parents. Even when available, however, it is underutilized by parents in some urban settings. We tested a supplemental 10-session group intervention for its ability to increase active participation in home visitation, enhance the quality of caregiving behavior of parents, and improve social developmental outcome in children.

METHOD

A randomized controlled design was utilized, involving two separate cohorts of parents of 3- to 18-month old infants, totaling 148 parent-child dyads. The intervention focused on practical experience in promoting parent-infant attachment relationships.

RESULTS

At 6 months follow-up, there was a substantial increase in the proportion of intervention group parents participating in home visitation, compared to parents in the control group (Fisher's exact p = .008). Parents in the intervention group exhibited a trend for improvement in their capacity to appropriately interpret infants' emotional cues (p = .08), independent of the effects of home visitation itself. Attrition in both the treatment and control groups was inversely associated with income and level of education.

CONCLUSIONS

Group meetings may constitute an effective means of engaging stressed urban families in home visitation.

Comparison of glucocorticoid-induced effects in prolactin-dependent and autonomous rat Nb2 lymphoma cells

Cultured Nb2 node rat lymphoma cells require lactogenic hormone for their proliferation. We reported previously that dexamethasone (Dex) inhibits prolactin (PRL)-induced mitogenesis and, in the absence of mitogen, induces apoptosis of Nb2 cells. Both antiproliferative and cytolytic effects of Dex on Nb2 cells appear to involve glucocorticoid (Type II) receptor mediation. In this study, we compared Dex effects in PRL-dependent Nb2 cells (Nb2) with SFJCD1 (SF), a clone of Nb2 cells that proliferates independently of exogenous PRL. Proliferative assays involved a 72-hr incubation in a chemically defined, serum-free medium where ovine PRL (1 ng/ml) was added to Nb2 cells but not to SF cells. Both cell lines were responsive to the antiproliferative effects of Dex in a dose (6.25-200 nM)-dependent fashion of comparable sensitivity and magnitude. Co-incubation with the glucocorticoid receptor antagonist, RU 486, prevented the antiproliferative effect of Dex in both cell lines. In the same medium devoid of PRL, Dex was cytolytic to Nb2 cells and fragmented DNA in a fashion reflective of apoptosis, but was ineffective in SF cells. A dual chamber incubation system revealed no evidence that SF cells produced cytokines that were mitogenic or anticytolytic to Nb2 cells. Both Nb2 and SF cells fragmented DNA in a fashion indicative of apoptosis in the presence of the Ca2+ ionophore, A23187 (1 microM). These studies reveal a basic difference in glucocorticoid responsiveness between the PRL-dependent Nb2 cell line and its PRL-independent subclone, SF. While both cell lines exhibit functional glucocorticoid receptors and the necessary intranuclear machinery for apoptosis, the pathway mediating the latter is inhibited or dysfunctional in SF cells.