Clinical effect of pulmonary rehabilitation in patients with mechanical ventilation: A meta-analysis.

OBJECTIVE: To systematically evaluate the clinical efficacy of pulmonary rehabilitation in patients with mechanical ventilation in an intensive care unit (ICU). METHODS: Relevant studies were identified in the PubMed, Web of Science, National Library of Medicine, China National Knowledge Infrastructure and Wanfang databases. A meta-analysis was performed after screening based on the inclusion and exclusion criteria, data extraction and literature quality evaluation. RESULTS: In total, 19 studies involving 2181 participants were included. The results of the meta-analysis revealed that compared with patients with conventional rehabilitation measures, patients with pulmonary rehabilitation measures had a higher offline success rate (relative risk (RR) = 1.16; 95% confidence interval (CI): 1.09, 1.24; p < 0.00001) and higher arterial oxygen partial pressure levels (mean difference (MD) = 8.96; 95%CI: 5.98, 11.94; p < 0.0001) and these measures significantly shortened the duration of mechanical ventilation (standardised MD (SMD) = -1.08; 95%CI: -1.58, -0.59; p < 0.0001) and ICU stay (SMD = -1.41; 95%CI: -1.94, -0.88; p < 0.0001). Aspiration significantly reduced the incidence of ventilator-associated pneumonia (RR = 0.35; 95%CI: 0.24, 0.51; p < 0.00001) and deep vein thrombosis (RR = 0.32; 95%CI: 0.13, 0.76; p = 0.01) in ICU patients with mechanical ventilation. CONCLUSION: Pulmonary rehabilitation measures can improve the success rate of weaning from mechanical ventilation in ICU patients, shorten the time of mechanical ventilation and ICU hospitalisation and reduce the incidence of related adverse reactions, but the impact on mortality requires further study.

AneuGuide™ software-assisted vs. manual measurements in sizing for pipeline embolization device: An agreement study.

Sizing of flow diverters (FDs) is a challenging task in the treatment of intracranial aneurysms due to their foreshortening behavior. The purpose of this study is to evaluate the difference between the sizing results from the AneuGuide™ software and from conventional 2D measurement. Ninety-eight consecutive patients undergoing pipeline embolization device (PED) treatment between October 2018 and April 2023 in the First Medical Center of Chinese PLA General Hospital (Beijing, China) were retrospectively analyzed. For all cases, the optimal PED dimensions were both manually determined through 2D measurements on pre-treatment 3D-DSA and computed by AneuGuide™ software. The inter-rater reliability between the two sets of sizing results for each methodology was analyzed using intraclass correlation coefficient (ICC). The degree of agreement between manual sizing and software sizing were analyzed with the Bland-Altman plot and Pearson's test. Differences between two methodologies were analyzed with Wilcoxon signed rank test. Statistical significance was defined as p < 0.05. There was better inter-rater reliability between AneuGuide™ measurements both for diameter (ICC 0.92, 95%CI 0.88-0.95) and length (ICC 0.93, 95%CI 0.89-0.96). Bland-Altman plots showed a good agreement for diameter selection between two methodologies. However, the median length proposed by software group was significantly shorter (16 mm versus 20 mm, p < 0.001). No difference was found for median diameter (4.25 mm versus 4.25 mm). We demonstrated that the AneuGuide™ software provides highly reliable results of PED sizing compared with manual measurement, with a shorter stent length. AneuGuide™ may aid neurointerventionalists in selecting optimal dimensions for FD treatment.

Liddle syndrome presenting with normal aldosterone levels: A case report.

INTRODUCTION: Liddle syndrome is an autosomal dominant disorder characterized by hypertension, hypokalemia, low aldosterone levels, and reduced renin activity. Atypical Liddle syndrome can be easily misdiagnosed due to its clinical phenotypes resembling hyperaldosteronism. PATIENT CONCERN: The patient was diagnosed with primary aldosteronism due to hypertension and hypokalemia, and underwent left adrenalectomy. After the operation, the patient still had hypertension and hypokalemia that were not easy to control and correct, and had acute cerebral infarction. DIAGNOSIS: The genetic test showed that the base duplication in the coding region of SCN1B gene caused a frameshift mutation:c.1789dupC (p.Arg597fs), Liddle syndrome was diagnosed. INTERVENTION AND OUTCOMES: The patient was treated with a low-sodium diet and oral triamterene. The serum potassium level returned to normal and the blood pressure was controlled. LESSONS: Some Liddle syndrome may present with normal aldosterone levels, genetic testing is necessary for the diagnosis. If the diagnostic test of primary aldosteronism is positive, but the treatment with spironolactone is ineffective, we should actively search for other causes.

Role of apolipoprotein E in suppressing oxidative stress in gestational diabetes mellitus patients and mouse model.

OBJECTIVE: To address the relationship between apolipoprotein E (ApoE) and oxidative stress in gestational diabetes mellitus (GDM). METHODS: Fifty pregnant women diagnosed with GDM and normal pregnant women were recruited separately and their blood and placental tissue were collected. Western blot assay, qRT-PCR assay and ELISA were used to detect the expression levels of ApoE and other oxidative stress factors in these samples. ApoE-/- mice with a C57BL/6J background were used to evaluate the relationship between ApoE deficiency and oxidative stress during GDM. RESULTS: Serum and placental ApoE were both down-regulated in GDM patients (serum: 45.25 ± 19.27 µg/ml for GDM and 96.34 ± 24.05 µg/ml for control; placental: 14.49 ± 6.52 ng/mg tissue for GDM and 48.76 ± 13.59 ng/mg tissue for control). There was a statistical correlation between placental ApoE level and oxidative stress in GDM (r = -0.4904 with MDA, -0.4258 with NO, 0.4476 with SOD, 0.6316 with GSH). ApoE deficiency exacerbated blood glucose, insulin anomaly and oxidative stress in placenta in GDM mouse models. Placental Apo E deficiency correlates to oxidative stress in GDM. CONCLUSION: In conclusion, we innovatively revealed the relationship between ApoE and GDM oxidative stress among GDM patients in this study.

Diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging for breast cancer detection: An update meta-analysis.

OBJECTIVE: To evaluate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for breast cancer identification. METHODS: A comprehensive electronic systematic searching of Medline, Ovid, EMBASE, Web of Science, CNK, and Cochrane Library databases was performed up to 2 August 2021. Clinical studies associated with DCE-MRI for breast cancer detection were screened and inlcuded in the meta-analysis. The data of true positive(tp), false positive(fp), false negative(fn) and true negative(tn) was extracted from includded studies. The sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC) were pooled under fixed or random effect models. Publication bias was evaluated by Deek's funnel plot. RESULTS: A final set of 15 studies with 1321 breast lesions were included in the present work. The pooled diagnostic sensitivity, specificity, and DOR were 0.87 (95% confidence interval [CI] 0.81-0.92), 0.74 (95% CI 0.68-0.80), and 18.83 (95% CI 9.07-36.54), respectively, and the area under the SROC was 0.86 (95% CI 0.82-0.88). Given a pretest probability of 50%, the positive post-test probability was 77%, and the negative post-test probability was 14%. Deek's funnel plot indicated low publication bias (p = 0.61). CONCLUSION: DCE-MRI is a noninvasive method of breast cancer diagnosis for suspected malignant breast lesions with relative high diagnostic sensitivity and specificity.

AngioSuite-Assisted Volume Calculation and Coil Use Prediction in the Endovascular Treatment of Tiny Volume Intracranial Aneurysms.

METHODS: Thirty-three consecutive patients with 34 TVIAs were prospectively recruited and treated with endovascular techniques. The volume of TVIAs and the required length of coils were calculated by the AngioSuite software before embolization. The treatment efficacy of TVIAs was assessed using the Raymond scale (Rs) and the modified Rankin scale (mRs). RESULTS: Of the 34 aneurysms with an average volume of 7.16 mm3, 13 aneurysms were treated with sole coil embolization, 19 by stent-assisted embolization, and 2 by balloon-assisted embolization. The average coil length was 5.32 cm, and the average packing density was 41.21%. The immediate DSA showed that total occlusion (Rs = 1) was achieved in 15 aneurysms, subtotal (Rs = 2) in 9, and partial (Rs = 3) in 11. Total occlusion was achieved in 30 aneurysms and subtotal in the other 4 aneurysms at 6-month follow-up. Baseline volume and diameter of aneurysms were significantly correlated with the coil length (r = 0.801, P < 0.001; r = 0.711, P < 0.001). CONCLUSIONS: Coil embolization of TVIAs was easy to achieve high packing density. According to the data from AngioSuite, relative few coils can increase the safety in procedure and stenting may reduce risk of aneurysmal recurrence.

High expression of EZR (ezrin) gene is correlated with the poor overall survival of breast cancer patients.

BACKGROUND: To evaluate the EZR (ezrin) gene expression in breast cancer and correlation with the prognosis through bioinformatics analysis and immunohistochemistry assay. METHODS: EZR gene expression in breast cancer and corresponding normal breast tissue was compared in the TCGA database. Protein-protein interaction (PPI) network relevant EZR was established through the STRING database. The correlation between EZR expression and prognosis of breast cancer was analyzed by the log-rank analysis from the TCGA. Ezrin protein (coded by EZR) expression was also examined by immunohistochemistry assay in 120 breast cancer patients. RESULTS: EZR expression level in tumor tissue was significantly upregulated compared to that of normal breast tissue of breast cancer patients (P < 0.05). In the PPI analysis, there were 51 nodes and 455 edges in the network. The top 10 hub genes of the network were identified. High expression of EZR mRNA was correlated with poor overall survival (OS) of the breast cancer patients (HR = 1.40, P = 0.038). However, the disease-free survival (DFS) of breast cancer patients did not correlate with the EZR mRNA level (HR = 0.86, P = 0.44). The ezrin protein expression was positive with uniform brown-yellow granules in the cell membrane, cavity surface and cytoplasm of the breast cancer cells. Of the included 120 cancer samples, 98 cases were positive for ezrin expression and 22 were negative. No correlation was found between ezrin expression site and patients' clinicopathological features. CONCLUSION: EZR is upregulated in breast cancer and can be used as potential biomarker for overall survival.

Endovascular stenting for idiopathic intracranial hypertension with venous sinus stenosis.

OBJECTIVES: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure of unknown etiology and venous sinus stenting may be an optional treatment. We aimed to evaluate the effects of venous sinus stenting on visual function, intracranial pressure, and trans-stenotic pressure gradient of the patients with IIH and to determine effects of baseline BMI or weight changes on subjective vision outcome and intracranial pressure. METHODS: From July 2009 to Aug 2016, 88 eligible patients with IIH and venous sinus stenosis who underwent stenting were retrospectively studied. RESULTS: In this study, 67 women and 21 men were included with an average age of 39.01 (18-60) years. The average BMI was 26.75 kg/m2 . Here, 66 (75.9%) patients had papilledema, 39 had impaired vision before stenting; 57 patients were followed-up, 48 (84.2%) showed significant subjective improvement or recovery in visual acuity, 4 (7.0%) patients reported no significant change in visual functions, and 5 (8.8%) suffered permanent vision loss. The cerebrospinal fluid opening pressure and trans-stenotic pressure gradient were significantly decreased postoperatively. Baseline BMI was associated with pre-and postoperative trans-stenotic pressure gradients, as well as changes in cerebrospinal fluid opening pressure. However, baseline BMI and body weight changes during follow-up were not necessarily associated with subjective visual outcomes after stenting. Stenting efficacy was limited in patients with severe preoperative optic symptoms. CONCLUSIONS: Venous sinus stenting represented an effective treatment for resolving visual dysfunction and intracranial pressure associated with venous sinus stenosis. BMI seemed to be associated with intracranial pressure but not subjective visual outcomes after stenting.

Weighing in on the Off-Label Use: Initial Experience of Neuroform EZ Stenting for Intracranial Arterial Stenosis in 45 Patients.

Background: The role of stenting for intracranial arterial stenosis (ICAS) has been increasingly debated due to negative results of randomized trials. Thus, exploration of more appropriate devices may hopefully shed light on the endovascular approach, especially for patients with recalcitrant ICAS related to a high risk of stroke. We sought to present and analyze the data of Neuroform EZ stenting for medically refractory ICAS in a single-center series. Materials and methods: Between November 2016 and January 2018, 45 consecutive patients treated with the Neuroform EZ stent were included in our retrospective study. Outcomes evaluation included successful procedure rate, vascular event within 30 days and recurrent stenosis for at least 6 months after the procedure. Results: The technical success rate was 100% for all 46 stenotic lesions. Mean pre-stent stenosis was 86.5 ± 8.7%, improving to 23.7 ± 18.1% after stenting. Combined procedure related vascular event rate was 2.2% (n = 1) within 30 days after the procedure. No in-stent restenosis was observed during an average follow-up period of 7.3 months. Conclusion: The Neuroform EZ stent system could serve as an off-label but promising optional device for ICAS stenting in a carefully selected subgroup of patients. Further longer-term clinical follow-up is mandatory to validate our initial results.

The role of actin depolymerizing factor in advanced glycation endproducts-induced impairment in mouse brain microvascular endothelial cells.

Endothelial dysfunction is one of the most important pathological events during the development of several diabetic complications including stroke. The aim of this work was to investigate the role of actin depolymerizing factor (ADF) in advanced glycation endproducts (AGEs)-induced impairment in mouse brain microvascular endothelial cells (MBMECs). Incubation of MBMECs with AGEs led to downregulation of expression of ADF, which was reversed by treatment with soluble receptor of AGEs or tempol (an antioxidant). Incubation of MBMECs with AGEs enhanced ratio of F/G-actin, increased endothelial permeability and reduced vasculogenic property, which was attenuated by overexpression of ADF. Furthermore, overexpression of ADF attenuated AGEs-induced downregulation of zonula occludens-1 and dephosphorylation of vascular endothelial growth factor receptor 2. Incubation of MBMECs with AGEs downregulated dimethylarginine dimethylaminohydrolase 2, enhanced formation of asymmetric dimethylarginine and reduced formation of nitric oxide, which was attenuated by overexpression of ADF. Incubation of MBMECs with AGEs induced activation of NF-κB, upregulated RAGE and enhanced formation of reactive oxygen species, which was attenuated by overexpression of ADF. Additionally, knockdown of ADF aggravated AGEs-induced impairment in endothelial permeability and vasculogenic property in MBMECs. In conclusion, AGEs treatment increased endothelial permeability and reduced vasculogenic property of MBMECs, at least in part, via downregulation of ADF.

Association of ZEB1 and FOXO3a protein with invasion/metastasis of non-small cell lung cancer.

OBJECTIVE: The research was aimed to study the expression of ZEB1 and FOXO3a in NSCLC tissue, and to explore the effect of its expression on infiltration/metastasis of NSCLC. METHODS: Total of 130 pairs of NSCLC tumor tissue and adjacent normal tissue were collected from June 2013 to June 2015 in Cangzhou Central Hospital. The expression of ZEB1 and FOXO3a protein was detected by immunohistochemistry and Western blot, and mRNA by qPCR. We analyzed the relationship between clinical data of NSCLC and gene expression of ZEB1 and FOXO3a. RESULTS: The expression of ZEB1 protein in NSCLC tissues was significantly higher than that in adjacent normal tissue (P<0.05), but the FOXO3a was just opposite (P<0.05). The expression of ZEB1 and FOXO3a protein was significantly correlated with tumor size, differentiation degree, lymph node metastasis, distal metastasis and TNM staging (P<0.05). The expression of ZEB1 protein was significantly increased and the expression of FOXO3a protein was significantly decreased in NSCLC patients with lymph node metastasis or distant metastasis (P<0.05). The 2-year survival rate of patients with high expression of ZEB1 or low expression of FOXO3a was significantly lower than that of NSCLC patients with low expression of FOXO3a (P<0.05). Pearson analysis showed that the expression of ZEB1 mRNA in NSCLC was negatively correlated with FOXO3a mRNA expression (r = -0.705, P<0.05). CONCLUSION: ZEB1 is highly expressed in NSCLC tissues and FOXO3a is lowly, and they collaborate to promote NSCLC infiltration and metastasis.

Chromosome aberrations associated with centrosome defects: a study of comparative genomic hybridization in breast cancer.

Centrosome abnormalities occur frequently in various tumors and can cause chromosomal instability and eventually promote cancer development. We investigated the chromosome aberrations associated with centrosome abnormalities in 30 cases of breast cancer, combining immunohistochemical staining and comparative genomic hybridization. Except for some common chromosome alterations (including gains of 1q, 8q, 17q, 20q, and Xq and losses of 8p, 11q, 13q, 14q, 16q, 17p, 22q, and Xp) that have also been seen more frequently in other studies, we discovered some new changes that have rarely been reported, including gains at 2p, 5p, 10p, 15q, 16p, 18q, 21q, and 22q and losses at 6p, 8p23, 11p13-pter, 13q34, and 14q32-qter. We also identified some changes (such as gains of 17q, 20q, and Xq and losses of 17p, 13q, and 14q) harboring candidate genes. We also explored the expression of centrosome protein in different molecular subtypes of breast cancer. Our findings provide a new way to explore the molecular mechanisms of breast tumorigenesis and accordingly potential new targets for therapy for this disease.

[Diagnostic and prognostic significance of FOXA1 expression in molecular subtypes of breast invasive ductal carcinomas].

OBJECTIVE: To investigate the expression of FOXA1 in breast invasive ductal carcinomas, observe its expression in all molecular subtypes of breast invasive ductal carcinomas and understand its diagnostic and prognostic significance. METHODS: Tissue specimens were obtained from 213 cases of breast invasive ductal carcinoma (IDC) and their expressions of FOXA1 and Ki67 detected by immunohistochemistry. And the expressions of CK5/6 and CK14 were detected to distinguish between normal breast-like subtype and basal-like subtype. RESULTS: The expression of FOXA1 was observed in 150 cases (70.4%). It correlated positively with ER and PR. But there was a negative correlation with histological grade, Nottingham prognostic index, p53 and Ki67. The expression of FOXA1 had difference between luminal and non-luminal subtypes. In luminal subtype, the expression of FOXA1 was associated with histological grade, PR, NPI, Ki67 and A subtype. In terms of prognosis, the expression of FOXA1 predicted a long disease-free survival and overall survival. CONCLUSION: The expression of FOXA1 is associated with a good prognosis. FOXA1 is a promising candidate for clinical identification of luminal A subtype. Prognostic analysis of FOXA1 in low-risk breast cancers may prove to be useful in clinical treatment decision-making.