All HER2-negative breast cancer patients need gBRCA testing: cost-effectiveness and clinical benefits.

BACKGROUND: The OlympiA trial demonstrated the benefits of adjuvant usage of olaparib for high-risk patients with human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC) and germline BRCA (gBRCA) mutation. This provoked thoughts on the clinical criteria of gBRCA testing. This study aims to estimate the costs and benefits of gBRCA testing and adjuvant olaparib therapy for patients with triple-negative breast cancer (TNBC) and hormone-receptor (HR)-positive and HER2-negative BC in China and the United States of America (USA). METHODS: We used a Markov chain decision tree analytic model to compare three gBRCA screening policies in China and the USA: (1) no gBRCA testing; (2) selected gBRCA testing and (3) universal gBRCA testing for nonmetastatic TNBC and HR-positive HER2-negative BC patients. We modelled the benefit of systemic therapy and risk-reducing surgeries among patients identified with pathogenic or likely pathogenic variants (PVs) in BRCA1 and BRCA2. RESULTS: Changing from the selected gBRCA testing to the universal gBRCA testing in TNBC patients is cost-effective, with the incremental cost-effectiveness ratios (ICERs) being 10991.1 and 56518.2 USD/QALY in China and the USA, respectively. Expanding universal gBRCA testing to HR-positive HER2-negative BC and TNBC patients has ICERs of 2023.3 and 16611.1 USD/QALY in China and the USA, respectively. DISCUSSION: By performing gBRCA testing on all HER2-negative BC patients, adjuvant olaparib can be offered to high-risk patients with a PV in BRCA1 or BRCA2. These patients are also candidates for risk-reducing surgeries, an important aspect of their survivorship care, and these interventions can improve survival outcomes. With the willingness-to-pay thresholds being 31,500.0 and 100,000.0 USD per QALY gained in China and the USA, respectively, universal gBRCA testing is likely cost-effective for all HER2-negative BC patients. This simplified criterion of gBRCA testing for BC is recommended for adoption by current guidelines in China and the USA.

[Effects of dexmedetomidine on hypoxia/reoxygenation injury-induced cell apoptosis and caspase-12 expression in A549 cells].

To investigate the effects of dexmedetomidine (DEX) on hypoxia/reoxygenation (H/R) injury-induced cell apoptosis and caspase-12 expression, A549 cells were randomly divided into 4 groups: control group, DEX group, H/R group and DEX+H/R group. Cells of control and DEX groups were cultured in the normoxic incubator for 30 h. Cells of H/R and DEX+ H/R groups were incubated in the anoxic cultivation for 6 h, followed by normoxic culture for 24 h, and DEX (1 nmol/L) was added into the culture medium in DEX and DEX+H/R groups. Morphological changes were observed under the inverted microscope. Cell viability was detected by CCK-8. The apoptosis index (AI) of A549 cells was detected by TUNEL method. The activity of caspase-3 enzyme in cells was detected by using caspase-3 kit. The expressions of GRP78, caspase-12 protein and mRNA were determined by Western blot and RT-PCR respectively. Compared with control group, the morphological changes of the cultured cells were observed: some of the cell fusion occurred and the shape of the cells was multilateral; the cell viability was decreased significantly (P < 0.01), the number of apoptotic cells and the AI value, caspase-3 activity, and the expressions of GRP78, caspase-12 protein/mRNA were significantly increased (P < 0.01) in H/R group. While the administration of DEX alleviated the H/R injury-induced cell damage, obviously increased the cell viability (P < 0.01), significantly decreased the increment of apoptotic cells and the AI value induced by H/R injury (P < 0.01), and also dramatically decreased the H/R injury-induced high level of caspase-3 activity (P < 0.01) as well as high expression of caspase-12 protein and mRNA (P < 0.01). Taken together, the results suggest that DEX can effectively protect A549 cells from the H/R injury, which may be mediated by down-regulating the expression of caspase-12 and inhibiting cell apoptosis.

[Effect of dexmedetomidine on apoptosis and CHOP in hypoxia/reoxygenation injury A549 cell].

OBJECTIVES: To investigate the effects of dexmedetomidine (Dex) on injury of A549 cells induced by hypoxia/reoxygenation(H/R)and the influence of C/EBP homologous protein (CHOP) expression. METHODS: Logarithmic growth phase A549 cells(it originated from alveolar type Ⅱ epithelial cell line) were randomly divided into 4 groups (n=10):normoxic control group (N), Dex group (D), hypoxia/reoxygenation group (H), hypoxia/reoxygenation + Dex group(HD). At the beginning of modeling, 1 nmol/L Dex was puted into D and HD groups. N and D groups were cultured in the normoxic incubator for 30 h. H and HD group were incubated in the anoxic cultivation for 6 h, fo llowed by normoxic culture for 24 h. Then A549 cells were observed under the inverted microscope to observe the morphological changes. Cell activity was detected by cell counting Kit-8(CCK-8) and the apoptosis index(AI) was detected by in situ end labeling (TUNEL) method. The expression of CHOP、glucose-regulated protein of molecular weight 78 kDa (Grp78)、cysteinyl aspirate-specificprotease-3 (caspase-3) protein and CHOP、Grp78 mRNA were detected by Western blot and RT-PCR. RESULTS: Compared with N group, the number of adherent cells in H group decreased significantly, and cell morphology changed. The absorbance value in H group decreased obviously (P<0. 01). The AI value and expression of CHOP, Grp78, caspase-3 proteins and CHOP, Grp78 mRNA were significantly increased (P<0.01). Compared with H group, the cell damage in HD group was decreased, the absorbance value increased (P<0.01), the number of apoptosis cells decreased relatively (P<0.01), the expression of CHOP, caspase-3 protein and CHOP mRNA decreased (P<0. 01). CONCLUSIONS: Dex has notable effects against H/R injury, which may be related to effective inhibition of apoptosis mediated by the CHOP's signal path.

[Effects of Dexmedetomidine on the levels of proinflammatory mediators IL-1ßand TNF-α in pulmonary ischemia/reperfusion injury rats and the mechanisms].

OBJECTIVE: To evaluate the effects and mechanism of the Dexmedetomidine on the levels of proinflammatory mediators interleukin 1 beta (IL-1ß) and tumor necrosis factor-α(TNF-α) in ischemia/reperfusion(I/R)rats. METHODS: Fifty healthy SPF male SD rats, 250~310 g,8~12 weeks,were randomly divided into five groups(n=10):sham operation group(sham group),I/R group, dexmedetomidine group(Dex group), atipamezole group(Atip group), dexmedetomidine plus atipamezole(Dex+Atip group). The I/R model was established by clipping hilus of left lung for 30 min and then reperfusion for 2 h. Dex group, Atip group and Dex + Atip group were performed by intraperitoneal injection dexmedetomidine(20 µg/kg),atipamezole(250 µg/kg),Dexmedetomidine(20 µg/kg)+atipamezole(250 µg/kg)respectively 30 min in advance before hilus of left lung was clipped, the rest of the process was the same with I/R group. After the experiment the rats were killed and the left lung tissues to determine the lung wet/dry weight(W/D) and total lung water content(TLW); Ultra structure of lung tissues were observed under light microscope and electron microscope; IL-1ß and TNF-α levels were determined by using ELISA. RESULTS: Compared with the sham group, the W/D、TLW、IL-1ß and TNF-α in other groups were increased significantly (P<0.05). The structure damages of lung tissues observed under light microscope and electron microscope in other groups were more serious than that of sham group. Compared with I/R、Atip、Dex+Atip group, the levels of W/D、TLW,IL-1ß and TNF-α in Dex group were lower (P<0.05), the structure damages of lung tissues observed under light microscopy and electron microscope in Dex group were slighter. There was no significant difference of the above parameters among I/R、Atip、Dex+Atip group. CONCLUSIONS: Dexmedetomidine can alleviate ischemia/reperfusion injury in rat lung through lowering the level of proinflammatory mediators IL-1ß and TNF-α,the possible mechanism may be through stimulation of α2 adrenaline receptors.

[Effect of dexmedetomidine on renal injury induced by lung ischemia/reperfusion in mice].

OBJECTIVE: To evaluate the effect of dexmedetomidine(Dex) on renal injury induced by lung ischemia/reperfusion(I/R) in mice. METHODS: Fifty healthy SPF male C57BL/6J mice, weighing 20 g~24 g,aged 8~10 weeks,were randomly divided into five groups(n=10 each):sham operation group(sham group),lung ischemia/reperfusion group(I/R group), lung ischemia/reperfusion and normal saline group (NS group), dexmedetomidine group(Dex group), dexmedetomidine and atipamezole group (DA group). Lung ischemia/reperfusion model was established by occlusion of the left pulmonary artery for 30 min followed by 180 min reperfusion in mice. In Dex and DA groups, dexmedetomidine 20 µg/kg and dexmedetomidine 20 µg/kg plus atipamezole 250 µg/kg were injected intraperitoneally respectively at 30 min before establishment of the model, isopyknic normal saline instead of Dex were injected intraperitoneally in NS group. After the experiment the mice were killed and plasma IL-1 beta and tumor necrosis factor α(TNF-α) concentration were detected by ELISA; the renal tissues were harvested to observe ultra structure under electron microscope. RESULTS: Compared with sham group, the concentrations of IL-1ß and TNF-α in other groups were increased significantly and the structure damages of renal tissues observed under electron microscope in other groups were more serious than those of sham group. Compared with I/R group, NS groups and DA group, the concentrations of IL-1ß and TNF-α in Dex group were significantly lower(P<0.05)and the structure damages of renal tissues observed under electron microscope in Dex group were slighter. CONCLUSIONS: Dexmedetomidine pretreatment can attenuate renal injury induced by lung ischemia/reperfusion and the mechanism may be related to inhibition of inflammatory responses.

[The effects of YHTJF on lung ischemia/reperfusion injury in mice].

OBJECTIVE: To explore whether yiqi huoxue tongluo jiedu fang (YHTJF, Traditional Chinese Medicine) alleviates the injury during lung ischemia/reperfusion (I/R) in mice through inhibiting oxidative stress or not. METHODS: C57BL/6J male mice (n=70) were randomly divided into 7 groups:control (C), carboxyl methyl cellulose-Na(CMC·Na) + normal control (CC), carboxyl methyl cellulose-Na + sham (CS), carboxyl methyl cellulose-Na + I/R (CIR), carboxyl methyl cellulose-Na + YHTJF-Low, CMC-Na + YHTJF-Middle, CMC-Na + YHTJF-High (CYL, CYM, CYH). The mice in CYL, CYM and CYH group were treated with YHTJF by intraperitoneal injection every day, while the carboxyl methyl cellulose-Na was administered with the same volume of CYL in CC, CS and CIR group. After 3 h-reperfusion, the left lung tissues were harvested to determine the lung wet/dry weight (W/D), the total lung water content (TLW), and the index of quantita-tive evaluation for alveolar damage (IQA). Morphological observation and terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL) were applied to evaluate the structural changes and the apoptosis index (AI) of the lung tissues. The expressions superoxide of dis-mutase(SOD), malondialdehyde(MDA) and myeloperoxidase(MPO) in the lung tissues were detected by kits. RESULTS: Compared with group C, the W/D, TLW, IQA, AI, lung tissue structural changes, and the expressions of MDA and MPO in group I/R were increased obviously (P < 0.01), and the expression of SOD was decreased, while there was no significant difference between group CC and CS. Compared with group I/R, the parameters of these experiments in group CYL, CYM, CYH were all decreased, and the expression of SOD was increased, while the reduction in group CYM was the most remarkable among them (P < 0.01). CONCLUSIONS: YHTJF may attenuate the I/R injury of the lung by the inhibition of apoptosis via ROS pathway.

[Effects of xuebijing injection on cardiac function and structure in rats with myocardial hypoxia/reoxygenation injury].

OBJECTIVE: To investigate the protective effects of xuebijing (XBJ, Traditional Chinese Medicine Complex) injection on cardiac function in rats with myocardial hypoxia/reoxygenation(H/R) injury. METHODS: The isolated langendorff perfused rat heart model was established. One hundred and thirty SD rats were randomly divided into sham group, hypoxia/reoxygenation group, low dose XBJ(XBJL) group, middle dose XBJ(XBJM) group and high dose XBJ(XBJH) group. All groups except sham group were divided into three subgroups according to reoxygenation time(0.5 h,1 h, 2 h) (n=10). In sham group, left ventricular development pressure(LVDP), maximal rates of increase/decrease of the left ventricular pressure(±dp/dtmax), left ventricular pressure (LVP), and heart rates (HR) were recorded after 20 minutes balance perfusion. The creatine kinase-MB (CK-MB) in myocardium was detected by ELISA. In other groups, after 20 minutes balance perfusion, we perfused ThomasⅡto stop the hearts from beating for 30 minutes, then reperfused the K-H until hearts recover beating. The microstructure of myocardium was observed under light microscopy. LVDP, ±dp/dtmax, LVP and HR were continuously recorded in other four groups and the concentrations of CK-MB in myocardium were measured by ELISA at different time points after reoxygenation. Microstructure of myocardium in each group were observed under light microscopy. RESULTS: LVDP, ±dp/dtmax, LVP and HR of other groups were significantly lower than those of sham group(P<0.05). The levels of CK-MB were higher than that of sham group(P<0.05). LVDP, ±dp/dtmax, LVP and HR of XBJL, XBJM and XBJH groups were higher than those of I/R group at corresponding time points after reoxygenation(P<0.05). The levels of CK-MB were lower than that of I/R group(P<0.05) and the cardiac function was improved. The middle dose of XBJ had the best protective effect. CONCLUSIONS: Xuebijing injection can effectively improve cardiac function and structure in rats with myocardial hypoxia/reoxygenation injury, and middle dose of XBJ is the best.

[Effect of dexmedetomidine on expression of endoplasmic reticulum stress-related Caspase-12 in lung ischemia/reperfusion injury mice].

OBJECTIVE: To investigate the effect of dexmedetomidine (DEX) on expression of endoplasmic reticulum stress (ERS)-related cysteinyl aspirate specific proteinase-12 (Caspase-12) in lung ischemia/reperfusion (I/R) injury mice. METHODS: Forty C57BL/6J mice were randomly divided into 4 groups:sham operation group (sham group),ischemia/reperfusion injury group (I/R group), normal salinecontrol group (NS group), ischemia/reperfusion + dexmedetomidine group (DEX group). Dexmedetomidine was infused intraperitoneally into the mice to stablish situ left pulmonary I/R injury mouse model. In NS group, the isometric dexmedetomidine was replaced by normal saline,other operations were as the same as the DEX group. After reperfusion 3 hours, the lung tissue wet/dry weight (W/D), the total lung water content (TLW) of the left lung tissues were determined. The lung tissue morphology changes were observed by light microscopy and the damage assessment(IQA) was taken. The structure changes and the apoptosis index (AI) of the lung tissues were evaluated by TUNEL method. The protein and mRNA expression of Caspase-12 and grp78 in lung tissues were detected by Western blot and reverse translate-PCR. RESULTS: Compared with the sham group, the W/D, TLW, IQA, AI, lung tissue structure damages, and the expression of Caspase-12 and grp78 protein and mRNA obviously raised both in I/R group and NS group (P<0.01 or P<0.05). Compared with I/R group, the W/D, TLW, IQA, AI of DEX group were all decreased, the demaged lung tissue morphology changes were significantly reduced, the protein and mRNA expression level of Caspase-12 and grp78 in DEX group were decreased (P<0.01). CONCLUSIONS: DEX can effectively relieve the lung I/R injuries in mice, which maybe associated with inhibition of pneumocyte apoptosis induced by ERS-related Caspase-12 pathway.

[Dexmedetomidine prevents inflammatory responses in injured rat lung tissues induced by ischemia/reperfusion through inhibition of TLR4 expression].

OBJECTIVE: To investigate the effect of Dexmedetomidine (Dex) on Toll-like receptor 4(TLR4) expression in lung during lung ischemia/reperfusion(I/R) in rats and its possible protecting mechanisms. METHODS: In vivo I/R model in left lung of SD rats was estab-lished. Fifty adult healthy male SD rats were randomly divided into five groups (n=10):control group (Sham group), I/R group, Dex group, atipamezole group (Atip group) and Dex+Atip group. After the I/R experiment,rats were killed and the left lung tissues were harvest-ed to get the lung wet/dry weight(W/D); Ultrastructure of lung tissue were observed under light microscopy; The mRNA expression of TLR4 in lung tissues were determined by RT-PCR; The protein level of TLR4 in lung tissues was detected by Western blot. RESULTS: ①Compared with those in the Sham group, W/D and total lung water content (TLW) in other groups increased significantly (P<0.05), the mRNA and protein expression levels of TLR4 in lung tissues increased too. The structure damages of lung tissues observed under light microscopy in other groups were more than that of Sham group. ②Compared with those in the I/R group, W/D and TLW in the Dex group were lower (P<0.05, P<0.01), the mRNA and protein expression levels of TLR4 in lung tissues decreased (P<0.01), and reduced structure damages of lung tissues were observed under light microscopy in Dex group. ③Compared with those in the Dex group, W/D and TLW in the Dex+Atip group were higher (P<0.01), the mRNA and protein expression levels of TLR4 in lung tissues increased (P<0.01), and the structure damages of lung tissues observed under light microscopy were more serious. There was no significant difference of the above parameters among I/R、Atip、Dex+Atip groups. CONCLUSIONS: Lung ischemia/reperfusion caused high expression of TLR4 and finally induced damages of the lung. Dexmedetomidine could inhibit TLR4 expression and alleviate the lung ischemia/reperfusion injury, which was related to activation of α2-adreno receptor.

[Dynamic changes of IL-1ß in rat myocardium during hypoxia/ reoxygenation transition].

OBJECTIVE: To investigate the expression profile of interleuki-1ß (IL-1ß) in rat myocardium at different time points during hypoxia/reoxygenation(H/R)transition. METHODS: The isolated Langendorff perfused rat heart model was established.Forty SD rats were randomly divided into sham group (A group) and hypoxia/reoxygenation group (H/R group). The H/R group rats were subdivided into H/R 0.5 h group(B group), H/R 1 h group(C group), H/R 2 h group(D group)according to reoxygenation time. The left ventricular development pressure(LVDP), maximal rates of increase/decrease of the left ventricular pressure(±dp/dtmax) were continuously recorded. The concentration of interleukin-1ß(IL-lß) and creatine kinase-MB (CK-MB) in myocardium was measured by ELISA. The mRNA expression of IL-lß in myocardium was determined by RT-PCR. Microstructure of myocardium was observed under light microscopy. RESULTS: The value of LVDP and ±dp/dtmax in hypoxia/reoxygenation group rat were significantly lower than that in sham group(P < 0.05). The expression of IL-lß and CK-MB at protein level and the expression of IL-1ß at mRNA level in hypoxia /reoxygenation group were higher than that in sham group(P < 0. 05). There were significant differences of the above parameters among H/R 0.5 h, 1 h, 2 h group(P <0.05). The concentration of IL-1ß and CK-MB, the mRNA expression of IL-1ß were higher in H/R 2 h group than that of other groups(P < 0.05). CONCLUSION: The high expression of IL-Iß in myocardium after myocardial hypoxia /reoxygenation in rats might lead to. ischemia/reperfusion injury.