Chinese physician perception on the treatment of chemotherapy-induced anemia: online cross-section survey study.

BACKGROUND: The management of chemotherapy induced anemia (CIA) remains challenging. The potential risk and benefits in providing patient-centered care need to be balanced; the disease is multifactorial; and the major treatments including red blood cell (RBC) transfusions, erythropoiesis-stimulating agents (ESAs) and intravenous injection (i.v.)iron supplementation have a unique set of strengths and limitations. Also, most previous survey based on the patient data could not reveal the process of evaluation and decision-making for CIA treatment from a physician's perspective. As the comparison of China Society of Clinical Oncology (CSCO), National Comprehensive Cancer Network (NCCN) and European Society of Medical Oncology (ESMO) guidelines, the standard of CIA treatment in China will vary from United States and Europe, for example, the initial hemoglobin (Hb) for RBC transfusions. In order to understand the diagnosis, treatment, and unmet medical needs of CIA patients, the China Medical Education Association (CMEA), in conjunction with Cancer Hope Medium, initiated the first national survey of Chinese physicians regarding the diagnosis and treatment of CIA. METHODS: The CMEA sent an online, 12-item questionnaire (via wjx.cn) to physicians across China from September 1, 2022 to October 22, 2022. Two hundred and sixty-five samples were calculated usingsurveyplanet.com. The questionnaire evaluated the impact of anemia on chemotherapy interruption, initial treatment, the target Hb level of CIA in, and the current status of ESAs prescription in clinical practice. Respondents were asked to score their reasons for not using ESAs (including safety issues, drug access in practice or adherence) and the risk options of the current treatment including ESAs, RBC transfusion, and i.v.iron. RESULTS: A total of 331 questionnaires among 5,000 web visits were gathered, covering 247 hospitals in 29 provinces across China, of which 130 (53%) were tier IIIA hospitals, 50 (20%) were tier III B hospitals, 59 (24%) were tier IIA hospitals, and 8 (3%) were tier II B hospitals. The frequency of chemotherapy dose delay/reduction due to anemia was 24% [standard deviation (SD) 49%]. Most responding physicians rated an initial Hb level for ESAs treatment to be 80 g/L, with a favorable Hb level for chemotherapy being 100 g/L (60%), which would not limit treatment availability. The majority (67.6%, n=221) of physicians who responded indicated that they had used ESAs for anemia correction, while the others (32.4%, n=106) reported never using them. CONCLUSIONS: This is the first study in conducting a large-scale survey on the diagnosis and treatment of CIA in China from a physicians' perspective. We found that in China, nearly one-quarter of patients undergoing chemotherapy with concurrent anemia may experience interruption of chemotherapy and that the initiation of anemia treatment is not adequately timed. In treating CIA, most physicians prioritize the completion of chemotherapy via Hb level over treating the symptoms of anemia.

Exploring the formation mechanism of resistant starch (RS3) prepared from high amylose maize starch by hydrothermal-alkali combined with ultrasonic treatment.

In this study, type III resistant starch (RS3) was prepared from high amylose maize starch (HAMS) using hydrothermal (RS-H), hydrothermal combined ultrasonication (RS-HU), hydrothermal-alkali (RS-HA), and hydrothermal-alkali combined ultrasonication (RS-HAU). The role of the preparation methods and the mechanism of RS3 formation were analyzed by studying the multiscale structure and digestibility of the starch. The SEM, NMR, and GPC results showed that hydrothermal-alkali combined with ultrasonication could destroy the granule structure and α-1,6 glycosidic bond of HAMS and reduce the molecular weight of HAMS from 195.306 kDa to 157.115 kDa. The other methods had a weaker degree of effect on the structure of HAMS, especially hydrothermal and hydrothermal combined ultrasonication. The multiscale structural results showed that the relative crystallinity, short-range orderliness, and thermal stability of RS-HAU were significantly higher compared with native HAMS. In terms of digestion, RS-HAU had the highest RS content of 69.40 %. In summary, HAMS can generate many short-chain amylose due to structural damage, which rearrange to form digestion-resistant crystals. With correlation analysis, we revealed the relationship between the multiscale structure and the RS content, which can be used to guide the preparation of RS3.

Herbal NF-κB Inhibitors Sensitize Rituximab-Resistant B Lymphoma Cells to Complement-Mediated Cytolysis.

BACKGROUND: Drug resistance remains a serious challenge to rituximab therapy in B-NHL (B cell non-Hodgkin's lymphoma). CDC (complement-dependent cytotoxicity) has been proposed as a major antitumor mechanism of rituximab, and direct abrogation of CD59 function partially restores rituximab sensitivity with high efficacy. However, universal blockade of CD59 may have deleterious effects on normal cells. Sp1 regulates constitutive CD59 expression, whereas NF-κB and CREB regulate inducible CD59 expression. METHODS: Immunohistochemistry (IHC) assay was used to detect the expression levels of CD59 and other related molecules. Quantitative Real-time PCR (RT-PCR) analysis was used to explore the levels of transcripts in the original and resistant cells. We chose LY8 cells to test the effects of NF-κB and CBP/p300 inhibition on CD59 expression using flow cytometry (FACS). Immunoblotting analysis was employed to detect the effects of curcumin and POH. The in vitro and in vivo experiments were used to evaluate the toxicity and combined inhibitory effect on tumor cells of curcumin and POH. RESULTS: We demonstrated that herbal (curcumin and perillyl alcohol) blockade of NF-κB specifically suppresses the expression of inducible CD59 but not CD20, thus sensitizing resistant cells to rituximab-mediated CDC. Moreover, activation of NF-κB and CREB is highly correlated with CD59 expression in B-NHL tissues. CONCLUSIONS: Our findings suggest the potential of CD59 expression as a predictor of therapeutic efficacy of NF-κB inhibitors in clinical application as well as the rationality of a NF-κB inhibitor-rituximab regimen in B-NHL therapy.

Optimization of ultrasonic extraction of polysaccharides from Hovenia dulcis peduncles and their antioxidant potential.

An ultrasonic-assisted extraction of polysaccharides from the ripe peduncles of Hovenia dulcis (HDPs) was investigated. Response surface methodology along with a Box-Behnken design based on single-factor experiments was employed to optimize and model the extraction conditions of HDPs, namely extraction temperature (40-60 °C), ultrasonic power (320-480 W) and extraction time (35-65 min). The optimized conditions were extraction temperature 60 °C, ultrasonic power 362 W and extraction time 65 min. Under these conditions, the maximal yield of crude HDPs was 25.12±0.145 mg/g DW, which is consistent with the predictive yield of 25.33 mg/g DW. The polysaccharides were graded by an ethanol precipitation method and three fractions (HDPs1, HDPs2 and HDPs3) were harvested. These had final ethanol concentrations of 40%, 60% and 80%, respectively and were acidic polysaccharides. The preliminary characterization was mainly composed of Ara, Rha, Glu and Gal, and exhibited an almost similar characteristic absorption peak by gas chromatograph and infrared spectra analysis. The antioxidant activity assays in vitro revealed that HDPs can be used as natural antioxidants in functional foods and pharmaceutical industries.

Thermochemotherapy effect of nanosized As2O3/Fe3O4 complex on experimental mouse tumors and its influence on the expression of CD44v6, VEGF-C and MMP-9.

BACKGROUND: Both thermotherapy and arsenic have been shown to be active against a broad spectrum of cancers. To reduce the limitations of conventional thermotherapy, improve therapeutic anticancer activity, reduce the toxicity of arsenic on normal tissue, and increase tissue-specific delivery, we prepared a nanosized As2O3/Fe3O4 complex (Fe3O4 magnetic nanoparticles encapsulated in As2O3). We assessed the thermodynamic characteristics of this complex and validated the hyperthermia effect, when combined with magnetic fluid hyperthermia (MFH), on xenograft HeLa cells (human cervical cancer cell line) in nude mice. We also measured the effect on the expression of CD44v6, VEGF-C, and MMP-9 which were related to cancer and/or metastasis. RESULTS: The nanosized As2O3/Fe3O4 particles were approximately spherical, had good dispersibility as evidenced by TEM, and an average diameter of about 50 nm. With different concentrations of the nanosized As2O3/Fe3O4 complex, the correspondingsuspension of magnetic particles could attain a steady temperature ranging from 42 degrees C to 65 degrees C when placed in AMF for 40 min. Thermochemotherapy with the nanosized As2O3/Fe3O4 complex showed a significant inhibitory effect on the mass (88.21%) and volume (91.57%) of xenograft cervical tumors (p < 0.05 for each measurement, compared with control). In addition, thermochemotherapy with the nanosized As2O3/Fe3O4 complex significantly inhibited the expression of CD44v6, VEGF-C, and MMP-9 mRNA (p < 0.05 for each). CONCLUSION: As2O3/Fe3O4 complex combined with MFH had is a promising technique for the minimally invasive elimination of solid tumors and may be have anticancerometastasic effect by inhibiting the expression of CD44v6, VEGF-C, and MMP-9.