Effect of remimazolam on electroencephalogram burst suppression in elderly patients undergoing cardiac surgery: Protocol for a randomized controlled noninferiority trial.

Background: Postoperative delirium (POD) is a common complication following cardiac surgery and increases postoperative morbidity and mortality. Intraoperative electroencephalogram (EEG) burst suppression suggests excessively deep anesthesia and predicts POD. Use of remimazolam provides a stable hemodynamic status and an appropriate depth of anesthesia. We aim to assess remimazolam administered for anesthesia and sedation in elderly patients having cardiac surgery. Methods: This is a randomized controlled clinical trial with noninferiority design. A total of 260 elderly patients aged equal to or greater than 60 years undergoing cardiac surgery will be randomly allocated to receive remimazolam or propofol (1:1) for general anesthesia and postoperative sedation until extubation. The primary outcome is the cumulative time with EEG burst suppression which is obtained from the SedLine system. The noninferiority margin is 2.0 min. The secondary outcomes include the POD occurrence within the first 5 days postoperatively and the duration of perioperative hypotension. Discussion: This noninferiority trial is the first to evaluate the effect of perioperative remimazolam administration on EEG burst suppression, POD occurrence, and duration of hypotension in elderly patients who undergo cardiac surgery. Trial registration: Chinese Clinical Trial Registry (ChiCTR2200056353).

Significance of LINC02082 and LOC105369812 in differentiating papillary thyroid cancer from benign nodules.

OBJECTIVE: To explore the significance of LINC02082 and LOC105369812 in the differential diagnosis of papillary thyroid carcinoma (PTC) and benign nodules. METHODS: Cancer tissues and benign nodules from 8 patients were sequenced and constructed using high-throughput sequencing. Differentially expressed mRNAs (DEmRNAs) and lncRNAs (DElncRNAs) with significant differences were screened. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on the mRNAs co-expressed by DEmRNAs and DElncRNAs. LncRNAs with significant differences, good consistency, and enrichment in the PI3K-AKt signaling pathway were selected as candidate lncRNAs, and the target lncRNAs were screened by correlation analysis. Target lncRNAs and co-expressed mRNAs enriched in the PI3K-AKt signaling pathway and microRNAs (miRNAs) interacting with each other were used to construct a competing endogenous RNA (ceRNA) network. Finally, the PTC-related gene set (GSE33630) was downloaded from the GEO database and the expression of the genes obtained by sequencing was compared. Differential expression was verified using quantitative real-time PCR (qRT-PCR). Finally, the receiver operating characteristic (ROC) curve was used to evaluate the value of the target lncRNAs in diagnosis, when used alone or in combination. RESULTS: A total of 1113 differential RNAs (DE RNAs) were identified, of which 338 were DElncRNAs and 775 were DEmRNAs. Three lncRNAs enriched in the PI3K-AKt signaling pathway, LINC02082, LOC105369812, and LOC105375170, were used as candidate lncRNAs. After correlation analysis with known biomarkers, LINC02082 and LOC105369812 were selected as the target lncRNAs. The qRT-PCR results showed that the target lncRNAs were significantly different among the 3 tissues. The ROC curve showed that LOC105369812 could be used to differentiate PTC from benign thyroid nodules, whereas LINC02082 and its combination had lower predictive value. CONCLUSIONS: LOC105369812 is valuable for differentiating benign from malignant thyroid nodules, whereas LINC02082 has lower diagnostic value.

A magneto-activated nanoscale cytometry platform for molecular profiling of small extracellular vesicles.

Exosomal PD-L1 (exoPD-L1) has recently received significant attention as a biomarker predicting immunotherapeutic responses involving the PD1/PD-L1 pathway. However, current technologies for exosomal analysis rely primarily on bulk measurements that do not consider the heterogeneity found within exosomal subpopulations. Here, we present a nanoscale cytometry platform NanoEPIC, enabling phenotypic sorting and exoPD-L1 profiling from blood plasma. We highlight the efficacy of NanoEPIC in monitoring anti-PD-1 immunotherapy through the interrogation of exoPD-L1. NanoEPIC generates signature exoPD-L1 patterns in responders and non-responders. In mice treated with PD1-targeted immunotherapy, exoPD-L1 is correlated with tumor growth, PD-L1 burden in tumors, and the immune suppression of CD8+ tumor-infiltrating lymphocytes. Small extracellular vesicles (sEVs) with different PD-L1 expression levels display distinctive inhibitory effects on CD8 + T cells. NanoEPIC offers robust, high-throughput profiling of exosomal markers, enabling sEV subpopulation analysis. This platform holds the potential for enhanced cancer screening, personalized treatment, and therapeutic response monitoring.

Deep learning radiomics for prediction of axillary lymph node metastasis in patients with clinical stage T1-2 breast cancer.

Background: This study investigates whether deep learning radiomics of conventional ultrasound images can predict preoperative axillary lymph node (ALN) status in patients with clinical stages T1-2 breast cancer (BC). Methods: This study retrospectively analyzed the preoperative ultrasound data of 892 patients with BC, who were classified into training (n=535), validation (n=178), and test (n=179) cohorts. Linear combinations of the selected features were weighted by their coefficients to obtain the predicted score. Then, deep learning radiomic features were extracted from the ultrasound images to evaluate the ALN status. Receiver-operating characteristic curves were drawn, followed by the calculation of the area under the curve (AUC) to assess the accuracy of the prediction model in predicting axillary lymph node metastasis (ALNM) in the three cohorts. Results: Deep learning radiomics combined with radiomics and clinical parameters was the optimal diagnostic predictor of the ALN status in the absence and presence of ALNM, with the AUC of 0.920 (95% confidence interval: 0.872 and 0.968, respectively). Additionally, this combination could also differentiate low-load ALNM [N + (1-2)] from heavy-load ALNM with ≥3 positive nodes [N + (≥3)] in the test cohort, with the AUC of 0.819 (95% confidence interval: 0.568 and 1.00, respectively). Conclusions: Conclusively, deep learning radiomics of ultrasound images is a non-invasive approach to predicting preoperative ALNM in BC.

Development and Validation of an MRI Radiomics-Based Signature to Predict Histological Grade in Patients with Invasive Breast Cancer.

Background: Histological grade is an important factor in the overall prognosis of patients with invasive breast cancer. Therefore, the non-invasive assessment of histological grade in breast cancer patients is an increasing concern for clinicians. We aimed to establish an MRI-based radiomics model for preoperative prediction of invasive breast cancer histological grade. Methods: We enrolled 901 patients with invasive breast cancer and pre-operative MRI. Patients were randomly divided into the training cohort (n=630) and validation cohort (n=271) with a ratio of 7:3. A radiomics signature was constructed by extracting radiomics features from MRI images and was developed according to multivariate logistic regression analysis. The diagnostic performance of the radiomics model was assessed using receiver operating characteristic (ROC) curve analysis. Results: Of the 901 patients, 618 (68.6%) were histological grade 1 or 2 while 283 (31.4%) were histological grade 3. The area under the ROC curve (AUC) of the radiomics model for the prediction of the histological grade was 0.761 (95% CI 0.728-0.794) in the training cohort and 0.722 (95% CI 0.664-0.777) in the validation cohort. The decision curve analysis (DCA) demonstrated the radiomics model's clinical application value. Conclusion: This is a preliminary study suggesting that the development of an MRI-based radiomics model can predict the histological grade of invasive breast cancer.

Local delivery of biocompatible lentinan/chitosan composite for prolonged inhibition of postoperative breast cancer recurrence.

Postsurgical localized chemotherapy for breast cancer recurrence (BCR) still faces many problems which dampen researchers' enthusiasm and discounted prognosis. Simple strategies with controllable toxicities are expected to address these hurdles. Lentinan (LNT) has excellent biocompatibility and notable antitumor activity but rather low bioavailability after intravenous or oral administration. Here, a sponge-like LNT/chitosan composite (LNT/CS sponge) was prepared for efficient local delivery to prevent postoperative BCR. The obtained sponges exhibit uniform porosity and sustained release of LNT in vitro and in vivo. Furthermore, the sponges were implanted and showed significant reduction of postsurgical recurrence and suppression of long-term tumor regrowth with favorable biocompatibility in a subcutaneous postsurgical recurrence mouse model. Subsequent studies revealed that LNT can restrain the stemness of breast cancer cells, which may account for the long-term inhibition of tumor relapse. Therefore, LNT/CS sponge has a great potential as a promising alternative for postsurgical BCR.

Dynamic evaluation of the protective effect of Dendrobium officinale polysaccharide on acute alcoholic liver injury mice in vitro and in vivo by NIR fluorescence imaging.

Acute alcoholic liver injury (AALI) is a threat to human health. Dendrobium officinale polysaccharide (DOP) has the potential to protect the liver by enhancing the anti-oxidative system to maintain the relative balance of ROS (active oxygen species) and antioxidants in AALI mice. However, the dynamic improvement effect of DOP on AALI is still not clear and accurate medication guidance is not available, which limits the clinical application of DOP. Because of the advantages of high sensitivity, noninvasiveness, and visualization, near-infrared (NIR) fluorescence imaging has been widely studied in biochemistry and biomedicine. As the glutathione (GSH) level in the liver is closely related to the progression of AALI, herein, an NIR fluorescent probe for GSH, HCG was used to dynamically evaluate the effect of DOP on AALI mice. In this study, DOP was proven to maintain the relative balance of GSH content in the liver to protect it from damage. To the best of our knowledge, it is the first time to assess the effect of DOP on AALI mice through a NIR fluorescence imaging technique. This study may also provide a potential NIR imaging agent for the clinical research to improve the management of liver injury-related diseases.

Age, Gender and Geographic Differences in Global Health Burden of Cirrhosis and Liver Cancer due to Nonalcoholic Steatohepatitis.

Objective: Recently, Nonalcoholic Steatohepatitis (NASH) has become a major contributor to cirrhosis and liver cancer. Therefore, the Global Burden of Disease (GBD) 2017 was used to comprehensively analyze the global, regional, and national burden of cirrhosis and liver cancer due to NASH between 1990 and 2017. Methods: Data for cirrhosis and liver cancer due to NASH were extracted from the GBD study 2017. Socio-demographic Index (SDI) in 2017 was cited as indicators of socioeconomic status. ARIMA model was established to forecast the future health burden. Kruskal-Wallis test and Pearson linear correlation were adopted to evaluate the gender disparity and association with socioeconomic level. Results: From 1990-2017, the global disability-adjusted life years (DALYs) numbers of liver cancer due to NASH increased from 0.71 million to 1.46 million. The age-standardized DALYs rates of liver cancer due to NASH were negatively associated with SDI levels (r=0.-409, p<0.001). Geographically, Australasia experienced the largest increase in the burden of liver cancer due to NASH, with the age-standardized DALYs rate increasing by 143.54%. The global prevalence number of liver cancer due to NASH peaked at 60-64 years in males and at 65-69 years in females. Globally, the burden was heavier in males compared with females. Male-female-ratio of age-standardized DALYs rates in liver cancer due to NASH were positively related to SDI (r=0.303, P=0.011). Conclusion: The global burden of NASH-associated liver cancer has increased significantly since 1990, with age, gender and geographic disparity. Public awareness of liver diseases due to NASH should be emphasized.

Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025.

Diabetes mellitus is a leading cause of mortality and reduced life expectancy. We aim to estimate the burden of diabetes by type, year, regions, and socioeconomic status in 195 countries and territories over the past 28 years, which provide information to achieve the goal of World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2025. Data were obtained from the Global Burden of Disease Study 2017. Overall, the global burden of diabetes had increased significantly since 1990. Both the trend and magnitude of diabetes related diseases burden varied substantially across regions and countries. In 2017, global incidence, prevalence, death, and disability-adjusted life-years (DALYs) associated with diabetes were 22.9 million, 476.0 million, 1.37 million, and 67.9 million, with a projection to 26.6 million, 570.9 million, 1.59 million, and 79.3 million in 2025, respectively. The trend of global type 2 diabetes burden was similar to that of total diabetes (including type 1 diabetes and type 2 diabetes), while global age-standardized rate of mortality and DALYs for type 1 diabetes declined. Globally, metabolic risks (high BMI) and behavioral factors (inappropriate diet, smoking, and low physical activity) contributed the most attributable death and DALYs of diabetes. These estimations could be useful in policy-making, priority setting, and resource allocation in diabetes prevention and treatment.

A multifunctional magnetic nanosystem based on "two strikes" effect for synergistic anticancer therapy in triple-negative breast cancer.

Multifunctional magnetic nanoparticles (MNPs) were widely used for ablation of cancer cells because of their potential on physical treatment. Herein, we developed the "cell targeting destructive" multifunctional polymeric nanoparticles (named as HA-Olb-PPMNPs) based on PEI-PLGA co-loaded with the anticancer drug Olaparib (Olb) and superparamagnetic iron oxide nanoparticles (Fe3O4 NPs), and further coated with a low molecular weight hyaluronic acid (HA) on its surface. Due to the high affinity between HA and CD44-receptor on cell surface of triple negative breast cancer (TNBC), an active targeting can be achieved. Under a rotating magnetic field (RMF), HA-Olb-PPMNPs produced a physical transfer of mechanical force by incomplete rotation. This mechanical force could cause the "two strikes" effect on the cells, in which "First-strike" was to damage the cell membrane structure (magneto-cell-lysis), another "Second-strike" could activate the lysosome-mitochondrial pathway by injuring lysosomes to induce cell apoptosis (magneto-cell-apoptosis). Therefore, the mechanical force and Olb exert dual anti-tumor effect to achieve synergistic therapeutic in the presence of RMF. This study proposes a novel multi-therapeutic concept for TNBC, as well as provided evidences of new anti-tumor therapeutic effects induced by the magnetic nanoparticles drug system.

A comparative study on the structures of Grifola frondosa polysaccharides obtained by different decolourization methods and their in vitro antioxidant activities.

Decolourization of polysaccharides is one of the crucial procedures that affects their structure, which is closely related to their bioactivity. Here, Grifola frondosa polysaccharide (GFP) was decolourized with H2O2 and AB-8 macroporous resin. Then, two main fractions, named DGFP and SGFP, were obtained by purification with Sepharose CL-4B. The molecular weights of these two polysaccharides were determined to be 6.306 × 106 (±0.410%) Da and 1.174 × 107 (±0.299%) Da by HPSEC. Monosaccharide analysis indicated that DGFP was composed of glucose, mannose, and galactose (32.20 : 1.00 : 1.75), while SGFP consisted entirely of glucose. Despite a backbone →4)-α-Glcp-(1→ in two polysaccharides, reducing ends Rα →3)-α-Glcp and Rß â†’4)-ß-Glcp were observed in DGFP by 1D/2D NMR. The results suggested that decolourization with low concentrations of H2O2 might alter the structure of GFP and generate new reducing ends. In vitro antioxidant results implied that DGFP exhibited a higher ability to scavenge DPPH and hydroxyl radicals and reduced the over-generated ROS levels in a concentration-dependent manner. These results suggested that the antioxidant effects of GFP could be activated by decolourization with H2O2. Therefore, DGFP might be a more promising natural antioxidant than SGFP.

Angelica sinensis polysaccharide nanoparticles as a targeted drug delivery system for enhanced therapy of liver cancer.

In recent years, the utilization of polysaccharides as targeted drug carriers has attracted considerable attention. Herein, Angelica sinensis polysaccharide (ASP), a plant polysaccharide with good biocompatibility, excellent aqueous solubility and intrinsic liver-targeted capability, was modified with hydrophobic group (deoxycholic acid) to fabricate amphiphilic conjugate (ASP-DOCA). Self-assembled nanoparticles were successfully developed for hepatoma-targeted delivery of therapeutic drug doxorubicin (DOX). The DOX loaded nanoparticles (DOX/ASP-DOCA NPs) were spherical in shape with a particle size of 228 nm and negatively charged around -17 mV. DOX was released from nanoparticles in a sustainable and pH-dependent manner. In vitro cellular uptake revealed that DOX/ASP-DOCA NPs were internalized into HepG2 cells through asialoglycoprotein receptor (ASGPR)-mediated endocytosis, resulting in a higher anti-proliferation effect than DOX-loaded dextran derivative DOX/DEX-DOCA NPs. Additionally, DOX/ASP-DOCA NPs showed higher inhibition on the growth of HepG2 multicellular spheroids (MCs) than DOX/DEX-DOCA NPs. In vivo imaging demonstrated that ASP-DOCA NPs specifically targeted HepG2 tumors via ASGPR, improving the accumulation of DOX/ASP-DOCA NPs in tumors and generating superior antitumor activity compared with free DOX and DOX/DEX-DOCA NPs. Taken together, ASP-DOCA NPs possess potential applications in drug delivery systems targeting liver cancer.

Correction of Anemia in Chronic Kidney Disease With Angelica sinensis Polysaccharide via Restoring EPO Production and Improving Iron Availability.

Given the limited efficacy and potential disadvantages of erythropoiesis-stimulating agents (ESAs) in treating anemia of chronic kidney disease (CKD), the development of better alternative therapies has become a priority. The primary purpose of this study is to investigate the effects of Angelica sinensis polysaccharide (ASP) and its underlying mechanism in the treatment of renal anemia. In the present study, we found that ASP could enhance hypoxic induction of EPO in Hep3B cells, with a mechanism that involved the stabilization of HIF-2α protein. In parallel, ASP rescued the inhibition of EPO, induced by proinflammatory factor TNF-α through blocking GATA2 and NF-κB activation. In a rat model of adenine-induced anemia of CKD, oral administration of ASP corrected anemia and alleviated renal damage and inflammation. By increasing the accumulation of HIF-2α protein and reducing the expression of NF-κB and GATA2 as well as pro-inflammatory cytokines, ASP stimulated both renal and hepatic EPO production, and resulted in an elevation of serum EPO. The restoration of EPO production and EPOR mRNA expression with ASP treatment activated EPOR downstream JAK2/STAT5 and PI3K/Akt signaling, induced their target genes, such as Bcl-xL, Fam132b and Tfrc, and increased Bcl-2/Bax ratio in bone marrow-derived mononuclear cells of CKD rats. Furthermore, we found that ASP suppressed hepatic hepcidin expression, mobilized iron from spleen and liver and increased serum iron. These findings demonstrate that ASP elicits anti-anemic action by restoring EPO production and improving iron availability in the setting of CKD in rats.

A functional insertion/deletion polymorphism in the proximal promoter of CD3G is associated with susceptibility for hepatocellular carcinoma in Chinese population.

Hepatocellular carcinoma (HCC) represents the most common primary malignancy of the liver with a worldwide increasing incidence. Although the risk factors for HCC are well characterized, the molecular mechanisms responsible for malignant transformation of hepatocytes are not well understood. In this study, a case-control study including 291 HCC patients and 294 healthy controls was conducted to investigate the association between HCC susceptibility and with a 4-bp insertion/deletion polymorphism (rs66465034) in the proximal promoter of CD3G. Logistic regression analysis showed that the heterozygote and the homozygote 4-bp ins/ins confer a significantly increased risk of HCC after controlling for other covariates (adjusted odds ratio [OR]=1.51, 95% confidence interval [C.I.] 1.01-2.27, p=0.040; OR=1.71, 95% C.I. 1.07-2.89, p=0.025, respectively). Carriage of the 4-bp insertion allele was associated with a greatly increased risk of developing the disease (OR=1.30, 95% C.I. 1.02-1.64, p=0.027). Moreover, hepatitis B virus (HBV) stratification analysis showed that the differences between cases and controls were more obvious in HBV-positive than in the HBV-negative population, suggesting a possible role of this polymorphism in the immune regulation during HBV infection. Further, luciferase-based transient transfection assays revealed that rs66465034 can affect promoter activity of CD3G, indicating its possible functional significance. Our data suggested that common genetic polymorphisms in CD3G may influence HCC risk in Chinese population. Considering the relative small sample size, replication in other populations with larger sample size and further functional analysis are required for fully understanding the roles of CD3G polymorphisms in predisposition for HCC.