Extending chemotherapy with capecitabine following CAPOX chemotherapy improves survival of Stage 3 gastric carcinoma after radical surgery: a 5-year analysis

OBJECTIVE

To assess the effectiveness and safety of treatment consisting of extending chemotherapy (ECT) with capecitabine following capecitabine plus oxaliplatin (CAPOX) chemotherapy for stage 3 gastric carcinoma (GC) after D2 gastrectomy.

PATIENTS AND METHODS

In this retrospective study, we included 214 patients with stage 3 GC who underwent D2 gastrectomy between January 2012 and April 2014. The CAPOX regimen chemotherapy was administrated to all of the patients as adjuvant therapy. The CAPOX regimen consisted of capecitabine (1000 mg/m2, in 2 divided doses for 14 d) and oxaliplatin (130 mg/m2 given on Day 1), repeated every 21 d for 8 cycles. Following CAPOX chemotherapy, 102 of these patients received extending chemotherapy (the ECT group) with capecitabine, whereas 112 patients (the control group) received no ECT. The ECT consisted of capecitabine (1000 mg/m2, in 2 divided doses for 14 d), repeated every 21 d for 8 cycles at most. The chemotherapy was discontinued if unacceptable toxicity or disease progression occurred or upon the request of the patient. All cases were followed up, and overall survival (OS), recurrence-free survival (RFS), and toxicities were compared.

RESULTS

The ECT group exhibited a distinctly higher 5-year OS (p=0.0468) and RFS (p=0.0483) than those of the control group. The incidence of hand-foot syndrome was markedly greater in the ECT group (p=0.0043). No toxicity-related death occurred.

CONCLUSIONS

Extending chemotherapy with capecitabine following the CAPOX regimen chemotherapy provides significant survival benefit for stage 3 GC after D2 gastrectomy.

[Analysis of the catastrophic health expenditure of HIV-positive maternal households in high AIDS endemic areas in Liangshan prefecture]

Objective: To analysis the income and expenditure of HIV-positive pregnant women and the catastrophic health expenditure of their households in high AIDS endemic areas in Liangshan prefecture. Methods: From December 2018 to January 2019, a total of 250 pregnant women were recruited from 2 of 17 counties in Liangshan Prefecture, including 133 HIV-positive pregnant women and 117 HIV-negative pregnant women. The data, including basic information of pregnant women, basic information of the family, annual family income in 2017, annual family health expenditure in 2017, and maternal and child-related expenditure in 2017, were collected for analyzing the incidence of catastrophic health expenditure in the family. Results: The average annual income and average annual health expenditure of HIV-positive pregnant women households were 7 000 CNY and 2 000 CNY, while those of HIV-negative pregnant women households were 10 000 CNY and 3 000 CNY, respectively. Based on the criteria of 15%, 25% and 40%, the incidence of catastrophic health expenditure of HIV-positive pregnant households was 39.10%, 33.83% and 27.82%, with average differences of 34.84%, 31.17% and 26.65%, respectively, while that of HIV-negative pregnant women households was 38.46%, 33.33% and 23.93%, with average differences of 31.68%, 28.35% and 24.22%, respectively. Conclusion: The incidence of catastrophic health expenditure of pregnant households in high AIDS endemic areas in Liangshan prefecture is high. The incidence of HIV-positive families is slightly higher than that of HIV-negative families. We suggest that medical insurance compensation in Liangshan prefecture should be improved to reduce the impact of catastrophic health expenditure.

[The analysis on the change and trend of the congenital heart disease mortality rate in children aged 0-1 in China from 2004 to 2018]

Objective: To analyze the trend of the congenital heart disease mortality rate in children aged under 1 year old from 2004 to 2018. Methods: The mortality rate and constituent ratio of congenital heart disease in different genders, urban and rural areas and regions were calculated by using the publicly available Dataset of National Mortality Surveillance in China from 2004 to 2018. The Joinpoint regression model was used to analyze the changing trend of mortality rate and constituent ratio, and calculate the annual percentage change (APC) in each time period, the average annual percentage change (AAPC) in all time period and their 95% values. Results: From 2004 to 2018, a total of 15 969 children aged 0 to 1 years died of congenital heart disease, of which 58.12% (9 281) were boys and 71.79% (11 464) were in rural areas. The deaths of congenital heart disease in eastern, central and western regions accounted for 34.30%, 37.06% and 28.64% of total deaths, respectively. From 2004 to 2018, the mortality rate of congenital heart disease in children decreased from 106.81 per 100 000 to 38.70 per 100 000, with an AAPC (95%) about -7.2% (-11.5%, -2.6%). The mortality rate of congenital heart disease showed a downward trend in girls [AAPC (95%) =-7.7% (-13.0%, -2.0%)], boys [AAPC (95%)=-6.8% (-12.0%, -1.2%)], urban areas [AAPC (95%) =-5.9% (-9.9%, -1.7%)], rural areas [AAPC (95%) =-7.4% (-10.5%, -4.2%)], eastern region [AAPC (95%)=-8.6% (-14.2%, -2.6%)], and central region [AAPC (95%)=-7.8% (-11.5%, -4.0%)]. The gaps of mortality rate gradually shrank in different genders, urban and rural areas and regions. From 2004 to 2018, the constituent ratio of congenital heart disease in children showed an upward trend [AAPC (95%) = 3.3% (1.7%, 4.9%)]. Conclusion: From 2004 to 2018, the mortality rate of congenital heart disease in children aged 0 to 1 years showed a downward trend, and the constituent ratio showed an upward trend.

[Application of "Internet +" technology in maternal and child health management and service of district at provincial level]

A survey was conducted on the application status of "Internet plus" technology in maternal and child health management in 31 provincial maternal and child health care institutions through the national comprehensive information platform for maternal and child health. 19 provincial institutions had realized one or more maternal and child health management and service functions under their jurisdiction through the regional health information platform, accounting for 61%. Among thirteen functions of management and service achieved in the regional health information platform, the top four were maternal system management (39%), high-risk maternal management (29%), high-risk newborn management (26%) and children system management (26%). Most functions were better in the eastern regions than those in the central and western regions. 15 provinces had established maternal and child health information platforms. 52% of provincial maternal and child health institutions provided telemedicine services, which were mainly for remote consultation. The main cooperative institutions of telemedicine services were subordinate health care institutions (39%).

MiR-370 functions as prognostic marker in patients with hepatocellular carcinoma

OBJECTIVE

Large body of evidence has shown that microRNAs (miRNAs) have the potential to serve as prognosis marker. This study is designed to investigate the expression of miR-370 in hepatocellular carcinoma (HCC) patients and to analyze its potential prognostic value.

PATIENTS AND METHODS

Quantitative real-time quantitative PCR (qPCR) was performed to examine the miR-370 level in HCC tissue and matched normal tissue from 83 HCC patients. The correlation of miR-370 level in HCC tissue with the clinicopathological characteristics was analyzed. Moreover, the Kaplan-Meier method and multivariable Cox regression were utilized to analyze survival data and independent prognostic factors, respectively.

RESULTS

Our results showed that low miR-370 level significantly correlated with tumor node metastasis stage (p=0.013) and vein invasion (p=0.0082). However, no significant relation was found between miR-370 expression and gender (p=0.1275), age (p=0. 0915), size of tumor (p=0.0823), liver cirrhosis (p=0.2508) and tumor grade (p=0.5377). Moreover, addition, survival analysis suggested that low expression of miR-370 linked shorter overall survival compared with high expression and multivariate Cox proportional hazards analysis also showed that miR-370 function as an independent prognostic marker.

CONCLUSIONS

Low level of miR-370 correlates with poor prognosis and miR-370 level can be considered as an independent prognostic marker in clinical evaluations.

[Percentile curves on growth among breastfed 1-4 year olds in 8 urban areas]

Objective: To construct the growth percentile curves of weight-, length/height-, head circumference and BMI for 1 to 4 year-olds who had been breastfed in urban areas. Methods: Data was from the longitudinal study on 1 025 breastfed children aged 1 to 4 years, in 8 urban areas during 2008-2012. MLwiN2.25 was selected to construct the multi-level models of weight-for-age,length for-age, head circumference-for-age and BMI-for-age. The models included many growth relevant factors including gender, age, family and social demographic characteristics, perinatal factors, parent biological characteristics, dietary patterns and diseases of childen. Based on these models, predicted values (P(3), P(15), P(50), P(85), P(97)) were estimated to fit the percentiles reference curves. Results: The percentiles reference curves of weight-, length/height, head circumferenceand BMI-for-age for the 1-4 year-olds who had been breastfed in the urban areas were developed. Differences of all the indicators between boys and girls were statistically significant (P<0.001). Weight, length/height, head circumference and BMI were higher in boys than those in girls, with an average differences as 0.56-0.76 kg, 0.89-1.12 cm, 0.64-0.91 cm and 0.31-0.52 kg/m(2). Conclusion: The percentiles reference curves on growth, constructed by the longitudinal observational data and scientific method, were important in reflecting the development of breastfed children in urban areas.

miRNA-370 acts as a tumor suppressor via the downregulation of PIM1 in hepatocellular carcinoma

OBJECTIVE

Hepatocellular carcinoma (HCC) is a primary malignancy of liver. Nowadays HCC is one of the most common and aggressive malignancies worldwide. This study shows the aberrant up-regulation or down-regulation of miR-370correlates with the development and prognosis of different human malignancies including HCC.

MATERIALS AND METHODS

The HCC cell lines were used as model cell lines and the anti-tumor effect of miR-370 in vitro were examined. The level of miR-370 in HCC cells was determined by qRT-PCR and restored in GC cells by using miR-370 mimic. Moreover, the target gene of miR-370 was then identified.

RESULTS

The expression of miR-370 in HCC cell lines was significantly lower than that in the other human liver cells. The miR-370 acted as a tumor suppressor in HCC. Moreover, it showed that miR-370 exerted anti-tumor effect by targeting PIM1 directly, a serine/threonine-specific kinase involved in the development and progression of HCC.

CONCLUSIONS

miR-370 acted as the tumor suppressor in HCC and was a potential therapeutic target for HCC treatment.

Anti-inflammatory effects of three kinds of traditional Mongolian medicine monomer and its combination on LPS-stimulated RAW264.7 macrophages

OBJECTIVE

Traditional Mongolian Medicine (TMM) exhibits useful biological activities including antifungal, antibacterial, and anti-inflammatory actions. The mechanisms of TMM in anti-inflammation were still unclear. The aim of this study was to investigate the effects of the three main monomers (geniposide, gallate, berberine hydrochloride and a mixture of them) of a traditional Mongolian medicine on cell survival and the proinflammatory cytokines signaling pathways which are activated by bacterial lipopolysaccharides (LPS).

MATERIALS AND METHODS

Mouse macrophage-like cell line RAW264.7 was used as a model of inflammation to investigate the anti-inflammatory effects of three TMM momomers and their combination. RT-PCR and Western blot was used to quantify the change of mRNA and protein levels of cytokines, Toll-like receptor-4 (TLR4) and Nuclear Factor-κB (NF-κB) and its inhibitor IκB. The non-radioactive electrophoresis mobility shift assay (EMSA) was used to evaluate the binding activity of NF-κB.

RESULTS

The monomers and their combination exhibited a potent anti-inflammatory effect for suppressing the LPS-evoked secretion of proinflammatory cytokines IL-1β, IL-6 and TNFα. Furthermore, the monomers and their combination attenuated activation of NF-κB and expression of TLR4 at both mRNA and protein levels, the upstream player of the LPS-TLR4-cytokines/ NF-κB signaling pathway.

CONCLUSIONS

The Mongolia herbal compound exerts a potent anti-inflammatory effect and could potentially be developed as a useful agent for the chemo-prevention of inflammatory diseases.

rpoB nested PCR and sequencing for the early diagnosis of tuberculous meningitis and rifampicin resistance

SETTING

The prognosis of tuberculous meningitis (TBM) is linked to early diagnosis and prescription of adequate treatment.

OBJECTIVE

To evaluate the efficacy of the rpoB nested polymerase chain reaction (PCR) and sequencing assay to detect and identify Mycobacterium tuberculosis complex (MTC) strains and strains resistant to rifampicin (RMP) in cerebrospinal fluid specimens (CSF) from patients with highly suspected TBM.

DESIGN

Retrospective blinded hospital-based study.

RESULTS

rpoB nested PCR and sequencing assay detected MTC in 31/36 CSF specimens from 16 patients with clinically suspected TBM. All of the control CSF specimens from 25 patients with non-TBM showed negative results. One of the 16 patients had a mutation at codon C526G as compared to the rpoB sequences in GenBank. This corresponds to a diagnostic sensitivity of 86% (95%CI 71-95) and a specificity of 100% (95%CI 86-100).

CONCLUSION

Our results suggest that rpoB nested PCR and sequencing assay can detect MTC and simultaneously determine its RMP susceptibility in CSF from patients with highly suspected TBM.

Differences of YMDD mutational patterns, precore/core promoter mutations, serum HBV DNA levels in lamivudine-resistant hepatitis B genotypes B and C

The aims of this study were to investigate the viral differences among lamivudine-resistant hepatitis B virus (HBV) genotypes B and C in vivo. Fifty-three patients carrying lamivudine-resistant HBV were enrolled in this study. HBV genotypes, Levels of alanine aminotransferase (ALT), HBV DNA levels were monitored during therapy. The polymerase and precore/core promoter genes were amplified by polymerase chain reaction and their products were sequenced directly. Among 53 patients resistant HBV genotypes B and C accounted for 41.50% and 58.50%, respectively. The occurrence of reverse transcriptase rt204I mutants was lower in genotype B (36.36%) than that in genotype C (87.10%), whereas rt204V mutants was higher in genotype B (63.64%) than that in genotype C (12.90%). The occurrence of precore mutation (nt1896A) was higher in genotype B (77.27%) than that in genotype C (32.26%). Serum HBV DNA levels after emergence of lamivudine resistance were higher in genotype C (7.71 +/- 0.80 Log copies/mL) compared with genotype B (6.97 +/- 0.77 Log copies/mL). Multivariate analysis identified pretreatment HBV DNA levels, HBeAg status and HBV genotype as independent factors associated with a shorter time to lamivudine resistance(P = 0.035, P = 0.006 and P = 0.001, respectively). Multivariate analysis showed that HBV genotype (P = 0.004) and pretreatment ALT levels (P = 0.01) was independently associated with YMDD mutational patterns. The results showed that the YMDD mutational patterns, precore mutation and serum HBV DNA levels differ between lamivudine-resistant HBV genotypes B and C in vivo. It is valuable for treatment of lamivudine-resistant HBV in clinic.

Evidence that miRNAs are different from other RNAs

An examination of 513 known pre-miRNAs and 237 other RNAs (tRNA, rRNA, and mRNA) revealed that miRNAs were significantly different from other RNAs (p < 0.001). miRNA genes were less conserved than other RNA genes, although their mature miRNA sequences were highly conserved. The A+U content of pre-miRNAs was higher than non-coding RNA (p < 0.001), but lower than mRNAs. The nucleotides in pre-miRNAs formed more hydrogen bonds and base pairs than in other RNAs. miRNAs had higher negative adjusted minimal folding free energies than other RNAs except tRNAs (p < 0.001). The MFE index (MFEI) was a sufficient criterion to distinguish miRNAs from all coding and non-coding RNAs (p < 0.001). The MFEI for miRNAs was 0.97, significantly higher than tRNAs (0.64), rRNAs (0.59), or mRNAs (0.65). Our findings should facilitate the prediction and identification of new miRNAs using computational and experimental strategies.

Short-term safety of live attenuated Japanese encephalitis vaccine (SA14-14-2): results of a randomized trial with 26,239 subjects

The short-term safety of an effective and inexpensive new live attenuated Japanese encephalitis vaccine (SA14-14-2) was studied in a randomized trial, using block randomization. Of 26,239 children who were enrolled, half received the vaccine and half served as controls. Subjects were prospectively followed for 30 days for severe adverse events, such as encephalitis, meningitis, and "all-cause" hospitalization. No cases of encephalitis or meningitis occurred in either group. The upper 95% confidence limit for adverse events not occurring among subjects receiving their first dose was 4.1/10,000. Risk ratios and 95% confidence intervals for other adverse events were 0.70 (0.43-1.15) for all-cause hospitalization, 0.91 (0.37-2.22) for seizure, and 0.79 (0.56-1.11) for fever lasting > or = 3 days. These data attest to the short-term safety of the SA14-14-2 virus strain and the hamster kidney cell substrate.

[The structural elucidation of new polyoxygenated cyclohexenes from Uvaria grandiflora]

Four new polyoxygenated cyclohexenes, named uvarigranol A(1), B(2), E(3) and F(4), along with the known zeylenol were obtained from the roots of Uvaria grandiflora Roxb (Annonaceae). Based on spectral and X-ray analysis as well as Mosher methodology, their structures and absolute configuration were established.

[Studies on new cytotoxic annonaceous acetogenins from Uvaria grandiflora and absolute configurations]

Two new cytotoxic annonaceous acetogenins, named uvarigrin(1) and uvarigrandin A(3), were obtained from the roots of Uvaria grandiflora Roxb(Annonaceae). Based on X-ray analysis and Mosher's methodology, the overall absolute configuration of 1 was established as 15S, 17R, 18R, 21R, 22R, 36S. The absolute configuration of 3 was also resolved by Mosher's methodology. The relative configuration of the previously reported uvarigranin (2) was revised. Compound 1 showed cytotoxicity against HCT-8, Bel7402 and A2780 human tumor cell lines at ED50 levels of 0.15, 0.21 and 0.41 microgram.ml-1, respectively.