When chronic obstructive pulmonary disease meets small cell lung cancer: an unusual case report of rapid progression.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease and a risk factor for lung cancer. Small cell lung cancer is a neuroendocrine tumor with a high degree of malignancy and an overall five-year survival rate of less than 7%. CASES PRESENTATION: Herein, we report the case of an 68-year-old male presented to the respiratory department with cough, sputum, and dyspnea. He was diagnosed as community acquired pneumonia and treated with intravenous anti-infection. Previous pulmonary function was definitively diagnosed as COPD. About 7 months after discharge, the patient returned to the hospital for cough and dyspnea. After diagnosis of the tumor, cisplatin, etoposide and durvalumab were administered. Finally the patient died of respiratory failure approximately 9 months after his diagnosis. CONCLUSIONS: For COPD patients with immunocompromised manifestations, it is necessary to be alert to complications and shorten the follow-up interval of chest CT. COPD may accelerate the formation and progression of SCLC.

Crosstalk between septic shock and venous thromboembolism: a bioinformatics and immunoassay analysis.

Background: Herein, we applied bioinformatics methods to analyze the crosstalk between septic shock (SS) and venous thromboembolism (VTE), focusing on the correlation with immune infiltrating cells. Methods: Expression data were obtained from the Gene Expression Omnibus (GEO) database, including blood samples from SS patients (datasets GSE64457, GSE95233, and GSE57065) and VTE patients (GSE19151). We used the R package "limma" for differential expression analysis (p value<0.05,∣logFC∣≥1). Venn plots were generated to identify intersected differential genes between SS and VTE and conducted Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) Enrichment analysis. The protein-protein interaction (PPI) network of intersected genes was constructed by Cytoscape software. The xCell analysis identified immune cells with significant changes in VTE and SS and correlated them with significant molecular pathways of crosstalk. Finally, we validated the mRNA expression of crosstalk genes by qPCR, while Matrix Metalloprotein-9 (MMP-9) protein levels were assessed through Western blotting (WB) and Immunohistochemistry (IHC) in human umbilical vein endothelial cells (HUVECs) and mice. Results: In the present study, we conducted a comparison between 88 patients with septic shock and 55 control subjects. Additionally, we compared 70 patients with venous thromboembolism to 63 control subjects. Twelve intersected genes and their corresponding three important molecular pathways were obtained: Metabolic, Estrogen, and FOXO signaling pathways. The resulting PPI network has 194 nodes and 388 edges. The immune microenvironment analysis of the two diseases showed that the infiltration levels of M2 macrophages and Class-switched memory B cells were correlated with the enrichment scores of metabolic, estrogen, and FOXO signaling pathways. Finally, qPCR confirmed that the expression of MMP9, S100A12, ARG1, SLPI, and ANXA3 mRNA in the SS with VTE group was significantly elevated. WB and IHC experiments revealed that MMP9 protein was significantly elevated in the experimental group. Conclusion: Metabolic, estrogen, and FOXO pathways play important roles in both SS and VTE and are related to the immune cell microenvironment of M2 macrophages and Class-switched memory B cells. MMP9 shows promise as a biomarker for diagnosing sepsis with venous thrombosis and a potential molecular target for treating this patient population.

Tectoridin and PLK1 inhibitor synergistically promote the apoptosis of lung adenocarcinoma cells: Bioinformatic analysis of TCGA and TCMSP.

Lung cancer is still the most common cancer in the world, especially lung adenocarcinoma (LUAD). Despite years of effort, including the application of immunotherapy and targeted therapy, the survival rate of LUAD has not improved significantly. Exploring effective targets and combination drugs is crucial for the treatment of LUAD. We characterized differentially expressed genes between LUAD and normal lung tissue based on The Cancer Genome Atlas (TCGA) database and identified polo-like kinase 1 (PLK1) as the hub gene. Through an analysis using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), we obtained a combination of Chinese medicine with PLK1 inhibitor, whose biological function we confirmed by western blot and TdT-UTP nick-end labelling (TUNEL) assays. After combined analysis of protein expression with clinical characteristics, GNPNAT1, CCT6A, SMOX, UCK2, PLK1, HMMR and ANLN expression were significantly correlated with age, sex and stage. Among them, the survival rate was lower in patients with high PLK1 expression than in those with low PLK1 expression, making PLK1 a promising therapeutic target for LUAD. Stage and PLK1 expression could be used as independent prognostic factors for LUAD. By TCMSP analysis, tectoridin had the strongest correlation with PLK1. Tectoridin synergized with PLK1 inhibitor to suppress autophagy and ferroptosis but promoted caspase-3-mediated apoptosis in A549 cells. Our findings highlight a potential drug target and the combination therapy strategy of PLK1 inhibitor and tectoridin for LUAD patients.

Application of Adenosine Deaminase and γ-Interferon Release Assay in Pleural Fluid for the Diagnosis of Tuberculous Pleural Effusion in Patients Over 40 Years Old.

Background: In patients with tuberculous pleural effusion (TPE) of various ages, the diagnostic accuracy of pleural biomarkers varies, and there are insufficient studies specifically in different age groups. Therefore, we investigated the adenosine deaminase cut-off value and its combination with the gamma interferon release assay for the diagnosis of TPE among patients aged ≥40 years. Methods: A retrospective analysis of 198 patients who underwent medical thoracoscopy and were admitted to the hospital between 2015 and 2020 with exudative pleural effusion and either fever, night sweats, fatigue, cough, or other clinical manifestations was performed. The medical thoracoscopy, ADA, and T-SPOT results were analysed in the pleural fluid. The patients were divided into groups based on age: 18-39, 40-59, and 60-87. Results: The best cut-off values of ADA were 29.5, 31.5 and 19.5 U/L, respectively, for the aged 18-39, aged 40-87 and aged 60-87 groups. The accuracy of 31.5 U/L was higher than 40 U/L for aged ≥40 years (86 vs 83%). The ADA diagnostic accuracy was higher than that of people under 40 years (83 vs 77%) when cut-off value of ADA was 40 U/L, but the IGRA accuracy was lower than that of people under 40 (87 vs 91%). The sensitivity of ADA or IGRA detection in patients over 40 years was 99%, and the specificity was 78%. The ADA specificity combined with IGRA for TPE was the highest (100%) in the ≥40 age group, and the sensitivity was 69%. Conclusion: Our study revealed the best cut-off values of ADA for TBE in different age groups. Combining ADA and IGRA in pleural fluid improves the detection rate of TPE in patients over 40 years of age with exudative pleural effusion. ADA combined with IGRA increases specificity, and ADA or IGRA increases sensitivity substantially.

The relationship and optimal threshold of endometrial thickness with early clinical pregnancy in frozen embryo transfer cycles.

OBJECTIVE: To investigate the associations of endometrial thickness with pregnancy outcome in frozen embryo transfer (FET) cycles. METHODS: A retrospective cohort study was performed looking at 1627 FET cycles from the Reproductive Medicine Center of the study hospital between January 2017 and July 2018. Endometrial ultrasonographic characteristics were recorded on the embryo transfer day in FET cycles. RESULTS: A total of 1627 FET cycles were included. The endometrial thickness was independently associated with clinical pregnancy outcomes after adjusting for potential confounders (odds ratio 1.06; 95% confidence interval [CI] 1.01-1.12). A non-linear relationship was detected between endometrial thickness and pregnancy outcomes, whose point was 10.9 mm. The effect size of the left and right sides of the inflection point were 1.16 (95% CI 1.07-1.25) and 0.89 (95% CI 0.78-1.01), respectively. Subgroup analysis showed that the correlation between endometrial thickness and pregnancy outcome was consistent in all subgroups. CONCLUSION: The relationship between endometrial thickness and pregnancy outcome was non-linear and there is an inflection point. When endometrial thickness was less than 9.5 mm, it was positively related to clinical pregnancy rate. If it was beyond the inflection point, the pregnancy rate does not increase significantly.

Biologically active 1,25-dihydroxyvitamin D3 protects against experimental sepsis by negatively regulating the Toll-like receptor 4/myeloid differentiation primary response gene 88/Toll-IL-1 resistance-domain-containing adapter-inducing interferon-ß signaling pathway.

The hormonally active form of vitamin D (VD), 1,25­dihydroxyvitamin D3, has been reported to be a key immunoregulator in the reduction of inflammation. In this study, we investigated the effects of VD in an experimental sepsis cell model, and the underlying mechanisms. The sepsis cell model was first established in monocytes, isolated from newborns and healthy adults, which were stimulation with lipopolysaccharide (LPS). We observed that cell viability was significantly impaired in the monocytes after LPS stimulation, using a Cell Counting Kit­8 and trypan blue assays. Additionally, ELISA revealed that LPS stimulation significantly elevated the expression of interleukin 6 (IL­6), IL­10 and tumor necrosis factor­α (TNF­α). The expression levels of Toll­like receptor (TLR4), myeloid differentiation primary response gene 88 (MyD88), and Toll­IL­1 resistance­domain­containing adapter­inducing interferon­ß (TRIF) mRNA were also significantly elevated under LPS stimulation using reverse transcription­quantitative PCR and western blot analysis. VD treatment could significantly suppress the effects of LPS simulation on monocytes by negatively regulating inflammatory cytokines and TLR4/MyD88/TRIF signaling. Furthermore, a regulatory feedback mechanism was proposed to involve TLR4, MyD88 and TRIF in the sepsis cell model. In conclusion, VD may effectively decrease the release of inflammatory cytokines by inhibiting the TLR4/MyD88/TRIF signaling pathway, could be considered as a potential therapeutic agent for the treatment of sepsis.

Association between indel polymorphism (rs145204276) in the promoter region of lncRNA GAS5 and the risk of febrile convulsion.

BACKGROUND: This study aimed to explore the regulatory relationship between growth arrest special 5 (GAS5) and interleukin-1ß (IL-1ß) implicated in the development of febrile seizure (FS). METHOD: The presence of FS and the genotype of GAS5 were used as two different indicators to divide the 50 newborn babies, recruited in this study, into different groups. The potential regulatory relationship among GAS5, miR-21, and IL-1ß was identified by measuring their expression using quantitative reverse-transcription polymerase chain reaction and immunohistochemistry assays among different sample groups. Computational analyses and luciferase assays were also conducted to verify the interaction between GAS5, miR-21, and IL-1ß. RESULT: GAS5 and IL-1ß expression was upregulated in cells collected from FS patients or genotyped as INS/DEL and DEL/DEL, whereas the expression of miR-21 was decreased in above samples, indicating a negative relationship between miR-21 and GAS5/IL-1ß. Results of the computational analysis showed that miR-21 directly bound to and increased the expression of GAS5, whereas the expression of IL-1ß was suppressed by miR-21. In the presence of GAS5, the expression of miR-21 was lowered, whereas the expression of IL-1ß was increased. CONCLUSION: The results obtained in this study supported the conclusion that GAS5 negatively regulated the expression of miR-21, which in turn negatively regulated the expression IL-1ß. Therefore, the overexpression of GAS5 could decrease the magnitude of FS.

Differentiation expression of toll-like receptor4 (TLR4) caused by the dysregulation of microRNA-140-5p is responsible for the development of postoperation infection.

BACKGROUND: Toll-like receptor4 (TLR4) has proven to be an important factor that's responsible for the development of postoperation infection. MicroRNAs (miRNAs) are widely regarded as key mediators of gene expression. The objectives of our study were to identify miRNA(s) and the target genes differentially expressed in monocytes in the individuals with postoperation infection. METHODS: MiRNA microarrays were performed to identify and compare miRNA expression in monocytes from those with or without postoperative infection. In-silico analysis was used to further investigate the target miRNAs and finally, luciferase assay and real-time polymerase chain reaction (PCR) were performed to confirm the target miRNA identified. Enzyme-linked immunosorbent assay, real-time PCR and Western-blot were performed to explore the role of miR-140 involved in postoperation infection. RESULTS: MiRNA microarray results showed that ten miRNAs were upregulated in the postoperation infection group, while six miRNAs were downregulated, compared with those in the postoperation group without infection. Computational analysis was further performed to reveal that four miRNAs (miR-140, miR-7, miR-448, and miR-217) targeted the 3'-untranslated region (UTR) of TLR4 mRNA. The luciferase assay showed that only miR-140 inhibited luciferase activity of wild-type TLR4 3'-UTR and the luciferase activity of the cells cotransfected with miR-7, miR-448 or miR-217 and wild-type or mutant TLR4 3'-UTR was comparable with the control. Furthermore, only miR-140 levels were significantly lower in the postoperation infection group, while levels of miR-217, miR-7, and miR-448 showed no obvious difference between the postoperation infection and postoperation without infection groups. TLR4, tumor necrosis factor-α (TNF-α), and IL-6 levels were much higher in the postoperation infection group. In comparison with the control group, TLR4, TNF-α and Interleukin 6 (IL-6) levels in cells were decreased following transfection with miR-140 mimics and TLR4 small interfering RNA. However, the cells treated with lipopolysaccharides increased TLR4, TNF-α, and IL-6 levels. CONCLUSION: This study demonstrates that miR-140 is differentially expressed in monocytes collected from patients diagnosed with postoperation infection. The downregulation of miR-140 cause upregulation of toll-like receptor4 (TLR4), a proinflammatory factor, and is associated with infection risk in patients received surgery.

Effects of vitamin D on apoptosis of T-lymphocyte subsets in neonatal sepsis.

Effect of vitamin D on apoptosis of peripheral blood T-lymphocyte subsets in treatment of neonatal sepsis was investigated. A total of 150 neonatal patients with sepsis were randomly divided into vitamin D treatment group (observation group) and treatment control group, while 100 healthy newborns were selected as healthy control group. T-lymphocyte subsets were detected by flow cytometer, the levels of tumor necrosis factor-α, interleukin-1 and calcitonin were determined by double-antibody immunoluminometric assay, and the effect of vitamin D on the above indicators in the treatment of sepsis was observed. Serum 25(OH)D (22.52±5.56 mg/l) in the treatment group was obviously increased compared with that in the treatment group (14.85±6.14 mg/l) (P<0.05), but the levels in the two groups were remarkably lower than that in the normal control group (26.38±6.56 mg/l), and the differences were statistically significant (P<0.05). Cluster of differentiation 4 (CD4+) T-lymphocyte subset in sepsis patients was obviously reduced compared with that in the healthy control group (P<0.01); the difference in comparison of CD8+ T-lymphocyte subset between sepsis patients and healthy people was not statistically significant (P>0.05). After treatment for 72 h, CD4+ T-lymphocytes were increased, and the ratio of CD4+ to CD8+ was close to 1, suggesting that the effect was superior to that in the treatment control group. The inflammatory factor levels in children with sepsis were evidently higher than those in the healthy control group (P<0.01), and high-level states of inflammatory factors were significantly improved after treatment with vitamin D for 72 h, indicating that the effect was superior to that in the treatment group. The results indicated that the prognosis of sepsis patients treated with vitamin D is improved, and the mechanism may be achieved by regulating T-lymphocyte subsets and inflammatory factors.