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1.
Int J Med Sci ; 18(16): 3652-3664, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34790037

RESUMO

Aim: In the late stage of atherosclerosis, the endothelial barrier of plaque is destroyed. The rapid deposition of oxidized lipids in the circulation leads to migration of numerous smooth muscle cells and macrophages, as well as foaming necrosis. The plaque progresses rapidly, and vulnerable plaques can easily induce adverse cardiovascular events. Here, we take the principle of gene editing to transfer the liver to express the LOX-1 receptor which is more sensitive to Ox-LDL by using AAV8 containing a liver-specific promoter. In this way, we want to explore whether the progress of advanced atherosclerosis and the stability of advanced plaque can be improved when the liver continues to clear Ox-LDL from the circulation. Methods and Results: In order to explore the effect of the physiological and continuous elimination of Ox-LDL through the liver on advanced atherosclerosis, we chose ApoE-/- mice in high-fat diet for 20 weeks. After 16 weeks of high-fat diet, the baseline group was sacrificed and the specimens were collected. The virus group and the control group were injected with the same amount of virus dilution and normal saline through the tail vein, and continued to feed until 20 weeks of high-fat diet, and then sacrificed to collect specimens. The results showed that LOX-1 was ectopically and functionally expressed in the liver as an Ox-LDL receptor, reducing the content of it in circulation. Compared with the control group, the degree of plaque progression in the virus group was significantly reduced, similar to the baseline group, the plaque necrosis core decreased, and the collagen fiber content increased. In addition, there are more contractile smooth muscle cells in the plaques of the virus group instead of synthetic ones, and the content of macrophages was also reduced. These data suggested that the virus group mice have greatly increased advanced plaque stability compared with the control group mice. Conclusions: Due to the destruction of endothelial barrier in advanced plaques, rapid deposition of Ox-LDL can result in fast plaque progression, increased necrotic cores, and decreased stability. Our research shows that the use of AAV8 through gene editing allows the liver to express LOX-1 receptors that are more sensitive to Ox-LDL, so that it can continue to bind Ox-LDL in the circulation and exploit the liver's strong lipid metabolism ability to physiologically clear Ox-LDL, which can inhibit the rapid progress of advanced plaque and increase the stability of plaque.

2.
Front Endocrinol (Lausanne) ; 12: 704496, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744996

RESUMO

Background: Insidious-onset acromegaly may easily be overlooked by non-specialists of acromegaly and cause diagnostic delay. This study aims to examine the association between diagnostic delay and advice from doctors before any confirmed diagnosis and subsequent comorbidities, and elicit patient-perceived reasons for misdiagnoses. Methods: An online nationwide cross-sectional study was conducted through China Acromegaly Patient Association. Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) levels at diagnosis and cancerous, endocrine-metabolic, musculoskeletal, cardiovascular, respiratory, and psychiatric comorbidities were reported by patients. The association between diagnostic delay and pre-diagnostic advice from doctors as well as subsequent comorbidities after diagnosis were examined. Results: In total, 447 valid responses were collected. Overall, 58.8% patients experienced misdiagnoses, and 22.6% had diagnostic delay. Before arriving at any diagnosis, patients without treatment (adjusted odds ratio [AOR]: 3.66, 95% confidence interval [CI]: 1.30-10.33) or receiving treatment to symptoms only (AOR: 7.05, 95%CI: 4.09-12.17) had greater chance of being misdiagnosed, and hence had diagnostic delay. Patients believed insufficient specialists, limited awareness of acromegaly of non-specialists and poor doctor-patient communications were major reasons of misdiagnosis. Diagnostic delay were associated with higher GH level at diagnosis and endocrine-metabolic, musculoskeletal and cardiovascular comorbidities (all P<0.05). Conclusions: Suboptimal pre-diagnostic advice for patients, reflecting limited awareness of acromegaly among non-specialists, may delay the diagnosis and increase comorbidities. Feedbacks on the patients' final diagnosis from specialists to non-specialists should be considered, and doctor-patient communication and clinical decision-making process should be improved. Comorbidities should be screened and monitored particularly for patients with diagnostic delay.

3.
Abdom Radiol (NY) ; 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34714376

RESUMO

OBJECTIVES: The purpose of this study was to evaluate the therapeutic efficacy and safety of endovascular treatment for patients with visceral and renal artery aneurysms (VRAAs). Twelve years of experience with interventional procedures and treatment options in our center were also worth discussing. METHODS: From January 2009 to December 2020, clinical data of 159 consecutive patients with VRAAs were retrospectively analyzed. Patients' demographic and clinical data were recorded, and the safety and efficacy of endovascular therapy were evaluated. In addition, interventional procedures were also described. RESULTS: A total of 159 patients underwent angiography, and 154 patients were successfully treated with endovascular therapy, with a technical success rate of 96.9%. Of the 154 patients with successful endovascular therapy, 3 patients died within 30 days of treatment, with a 30-day mortality rate of 1.9%, and the remaining patients were clinically successful, with a clinical success rate of 98.1%. Fifty-seven patients underwent emergency interventional treatment due to ruptured aneurysm. There were statistically significant differences in hemoglobin before and after emergency treatment (78.5 ± 22.0 g/dL vs. 93.8 ± 15.0 g/dL, P = 0.00). No other serious complications occurred except death in 3 patients. CONCLUSION: Endovascular treatment of VRRAs is safe and effective and can significantly improve the symptoms of patients, especially those with ruptured aneurysms.

4.
Front Oncol ; 11: 673378, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34414104

RESUMO

Objective: To compare the efficacy and safety of transarterial chemoembolization (TACE) combining with sorafenib or apatinib for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). Methods: From June 2015 to March 2020, a total of 89 consecutive advanced HCC patients with PVTT who were treated with sorafenib-TACE (S-TACE) or apatinib-TACE (A-TACE) in our center were enrolled. The overall survival (OS), time to progression (TTP), tumor response, and adverse events in the two groups were compared. Results: There were 32 and 41 patients included in the S-TACE group and A-TACE group, respectively. The median follow-up was 10.0 months (range, 3.0-36.0 months) in the whole study. The median OS (11.0 vs. 10.0 months, P = 0.419), median TTP (5.0 vs. 6.0 months, P = 0.073), and tumor response (P = 0.529) between the S-TACE group and the A-TACE group were not significantly different. The adverse events related to sorafenib or apatinib were tolerable. Conclusion: S-TACE and A-TACE exhibited comparable prognosis for HCC patients with PVTT, which provide another effective and safe method of A-TACE for these patients except for conventional S-TACE.

5.
Artigo em Inglês | MEDLINE | ID: mdl-34374021

RESUMO

This study attempts to analyze the impact of population, property, technology, energy factors, and spatial agglomeration in the logistics industry on carbon emissions. To achieve the goal of peak carbon and carbon neutrality, the relationship between influencing factors and carbon emissions was analyzed based on panel data from the logistics industry for 30 provinces in China from 2003 to 2017 using an improved STIRPAT (Stochastic Impacts by Regression on Population, Affluence, and Technology) model and a spatial lag model (SLM). The results show that population, property, technology, and energy factors in the logistics industry all have different degrees of influence on carbon emissions, wherein population, energy, and property have a greater influence, which implies that carbon emission reduction policies can be carried out considering the relevant aspects. In addition, under the influence of spatial agglomeration, the degree of influence of freight mileage (FM), total fixed-asset investment (TFAI), and industry population (IPOP) on carbon emissions decreases, and the degree of influence of energy intensity (EI) and industry per capita GDP (IPCG) increases. This suggests that corresponding emission reduction policies should be formulated for large urban areas based on technological innovation, infrastructure, and talent training, while smaller urban areas can focus on developing new energy and industrial economies. These findings help to complement the existing literature and provide policymakers with some insights related to urban logistics development.

6.
Front Bioeng Biotechnol ; 9: 609345, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34222207

RESUMO

Clostridium tyrobutyricum (C. tyrobutyricum) is a fermentation strain used to produce butyric acid. A promising new biofuel, n-butanol, can be produced by catalysis of butyrate, which can be obtained through microbial fermentation. Butyric acid has various uses in food additives and flavor agents, antiseptic substances, drug formulations, and fragrances. Its use as a food flavoring has been approved by the European Union, and it has therefore been listed on the EU Lists of Flavorings. As butyric acid fermentation is a cost-efficient process, butyric acid is an attractive feedstock for various biofuels and food commercialization products. 12C6+ irradiation has advantages over conventional mutation methods for fermentation production due to its dosage conformity and excellent biological availability. Nevertheless, the effects of these heavy-ion irradiations on the specific productiveness of C. tyrobutyricum are still uncertain. We developed non-structured mathematical models to represent the heavy-ion irradiation of C. tyrobutyricum in biofermentation reactors. The kinetic models reflect various fermentation features of the mutants, including the mutant strain growth model, butyric acid formation model, and medium consumption model. The models were constructed based on the Markov chain Monte Carlo model and logistic regression. Models were verified using experimental data in response to different initial glucose concentrations (0-180 g/L). The parameters of fixed proposals are applied in the various fermentation stages. Predictions of these models were in accordance well with the results of fermentation assays. The maximum butyric acid production was 56.3 g/L. Our study provides reliable information for increasing butyric acid production and for evaluating the feasibility of using mutant strains of C. tyrobutyricum at the pre-development phase.

7.
J Wound Ostomy Continence Nurs ; 48(4): 311-317, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34186549

RESUMO

PURPOSE: We constructed a self-management program for rectal cancer survivors with colostomies and evaluated the effect of the program on self-efficacy, self-management ability, and incidence of stomal and peristomal complications. DESIGN: A prospective, nonrandomized clinical trial. SUBJECTS AND SETTING: Participants were recruited from 4 proctology departments in a tertiary hospital in northeast China. Fifty-five were assigned to the intervention group and 56 were assigned to the control group; 26 were lost to follow-up. Therefore, data analysis was based on 43 participants in the intervention group and 42 in the control group. METHODS: Control group patients received the standard care where guidance and stoma care manuals were given the day before hospital discharge, and regular telephone follow-up twice a month for 3 months. Participants in the experimental group received, in addition to standard care, a self-management program delivered via a multimedia messaging app initiated after discharge available over a 6-week period. Primary outcomes were self-efficacy and self-management ability; we also analyzed the incidence of stomal and peristomal complications as a secondary outcome. Between-groups outcomes were analyzed via a repeated-measures analysis of variance. RESULTS: Analysis indicated intervention group participants had higher levels of self-efficacy and self-management of their colostomies than did control group participants. Analysis also revealed intervention group participants had a lower incidence of peristomal complications; no differences in the incidence of stomal complications were found. CONCLUSIONS: Study findings suggest that use of the multimedia messaging app-based self-management program enhanced self-efficacy and self-management, while reducing the incidence of peristomal complications in rectal cancer survivors with colostomies.


Assuntos
Neoplasias Colorretais/cirurgia , Colostomia , Educação de Pacientes como Assunto , Neoplasias Retais/cirurgia , Autogestão , China , Humanos , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos
8.
IEEE Trans Image Process ; 30: 5439-5451, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34081581

RESUMO

Deep learning-based in-loop filters have recently demonstrated great improvement for both coding efficiency and subjective quality in video coding. However, most existing deep learning-based in-loop filters tend to develop a sophisticated model in exchange for good performance, and they employ a single network structure to all reconstructed samples, which lack sufficient adaptiveness to the various video content, limiting their performances to some extent. In contrast, this paper proposes an adaptive deep reinforcement learning-based in-loop filter (ARLF) for versatile video coding (VVC). Specifically, we treat the filtering as a decision-making process and employ an agent to select an appropriate network by leveraging recent advances in deep reinforcement learning. To this end, we develop a lightweight backbone and utilize it to design a network set S containing networks with different complexities. Then a simple but efficient agent network is designed to predict the optimal network from S , which makes the model adaptive to various video contents. To improve the robustness of our model, a two-stage training scheme is further proposed to train the agent and tune the network set. The coding tree unit (CTU) is seen as the basic unit for the in-loop filtering processing. A CTU level control flag is applied in the sense of rate-distortion optimization (RDO). Extensive experimental results show that our ARLF approach obtains on average 2.17%, 2.65%, 2.58%, 2.51% under all-intra, low-delay P, low-delay, and random access configurations, respectively. Compared with other deep learning-based methods, the proposed approach can achieve better performance with low computation complexity.

9.
Eur J Health Econ ; 22(9): 1381-1391, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33988760

RESUMO

OBJECTIVE: This study aimed to develop a mapping function that links the acromegaly quality of life (AcroQoL) questionnaire to EQ-5D-5L to obtain a preference-based utility value to inform economic evaluation. METHODS: A nationwide cross-sectional questionnaire survey among patients with acromegaly was conducted online in China during 17 December 2019 to 6 January 2020. The study sample was randomly divided into a training set and a validation set. Ordinary least squares (OLS), Tobit, beta-based mixture, and adjusted limited dependent variable mixture models were tested for development of the function in the training set. Total and subscale scores and individual items of AcroQoL were included as predictors in the models along with their squared terms and demographic and clinical characteristics, and selected by backward stepwise selection. The root mean square error, mean absolute error, Akaike's information criterion, Bayesian information criterion and adjusted R-square were used to assess goodness of fit and predictive ability of the models. RESULTS: There were 424 adult patients with acromegaly eligible for this analysis. Average EQ-5D-5L index score and AcroQoL score for them was 0.82 (SD = 0.15) and 44.3 (SD = 22.9), respectively. A total of 60 candidate models were tested. Considering model simplicity and predictive ability in both training and validation set, the best model was the OLS model using scores of physical dimension and its square term as predictors. CONCLUSION: A validated mapping function was developed in this study for estimating EQ-5D scores using AcroQoL outcomes. Its external validity can be further tested in other population with Acromegaly.


Assuntos
Acromegalia , Qualidade de Vida , Adulto , Teorema de Bayes , Estudos Transversais , Humanos , Inquéritos e Questionários
10.
Oncol Rep ; 46(1)2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34013379

RESUMO

Following the publication of this article, an interested reader contacted the authors about some possible anomalies in the presentation of the data in Table I, and they have realized that this Table contained some errors. Two different entries for the miRNA hsa­miR­886­3p were inadvertently included in the Table, due to there being two different microarray IDs for this miRNA when performing differential analysis by GEO2R (Owing to an oversight, the repeated miRNA was not deleted; therefore, the row of data for the second has­miR­886­3p entry, comprising P­value 0.00235, t­value, 3.82, B­value, ­4.58 and logFC, 3.2 has been deleted, and the correct data row for the miRNA hsa­miR­513a­5p has been inserted.) A corrected version of the Table is shown opposite (the corrected data row entry is highlighted in bold). The authors sincerely apologize for the errors that were introduced during the preparation of this Table, and thank the reader of their article who drew this matter to their attention. Furthermore, they regret any inconvenience that this mistake has caused. [the original article was published in Oncology Reports 42: 533­548, 2019; DOI: /10.3892/or.2019.7173].

11.
Brief Bioinform ; 22(5)2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-33839757

RESUMO

Glioblastoma (GBM) is the most malignant and lethal intracranial tumor, with extremely limited treatment options. Immunotherapy has been widely studied in GBM, but none can significantly prolong the overall survival (OS) of patients without selection. Considering that GBM cancer stem cells (CSCs) play a non-negligible role in tumorigenesis and chemoradiotherapy resistance, we proposed a novel stemness-based classification of GBM and screened out certain population more responsive to immunotherapy. The one-class logistic regression algorithm was used to calculate the stemness index (mRNAsi) of 518 GBM patients from The Cancer Genome Atlas (TCGA) database based on transcriptomics of GBM and pluripotent stem cells. Based on their stemness signature, GBM patients were divided into two subtypes via consensus clustering, and patients in Stemness Subtype I presented significantly better OS but poorer progression-free survival than Stemness Subtype II. Genomic variations revealed patients in Stemness Subtype I had higher somatic mutation loads and copy number alteration burdens. Additionally, two stemness subtypes had distinct tumor immune microenvironment patterns. Tumor Immune Dysfunction and Exclusion and subclass mapping analysis further demonstrated patients in Stemness Subtype I were more likely to respond to immunotherapy, especially anti-PD1 treatment. The pRRophetic algorithm also indicated patients in Stemness Subtype I were more resistant to temozolomide therapy. Finally, multiple machine learning algorithms were used to develop a 7-gene Stemness Subtype Predictor, which were further validated in two external independent GBM cohorts. This novel stemness-based classification could provide a promising prognostic predictor for GBM and may guide physicians in selecting potential responders for preferential use of immunotherapy.


Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Glioblastoma/tratamento farmacológico , Aprendizado de Máquina , Células-Tronco Neoplásicas/efeitos dos fármacos , Temozolomida/uso terapêutico , Transcriptoma , Adulto , Idoso , Atlas como Assunto , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Feminino , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Glioblastoma/genética , Glioblastoma/mortalidade , Glioblastoma/patologia , Humanos , Imunoterapia/métodos , Masculino , Pessoa de Meia-Idade , Células-Tronco Neoplásicas/imunologia , Células-Tronco Neoplásicas/patologia , Seleção de Pacientes , Prognóstico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Receptor de Morte Celular Programada 1/genética , Receptor de Morte Celular Programada 1/imunologia , Análise de Sobrevida , Resultado do Tratamento , Microambiente Tumoral/efeitos dos fármacos , Microambiente Tumoral/genética , Microambiente Tumoral/imunologia
12.
Front Oncol ; 11: 553594, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33747903

RESUMO

Purpose: Glioblastoma (GBM) is one of the most aggressive brain tumors with high mortality, and tumor-derived exosomes provide new insight into the mechanisms of GBM tumorigenesis, metastasis and therapeutic resistance. We aimed to establish an exosome-derived competitive endogenous RNA (ceRNA) network for constructing a prognostic model for GBM. Methods: We obtained the expression profiles of long noncoding RNAs (lncRNAs), miRNAs, and mRNAs from the GEO and TCGA databases and identified differentially expressed RNAs in GBM to construct a ceRNA network. By performing lasso and multivariate Cox regression analyses, we identified optimal prognosis-related differentially expressed lncRNAs (DElncRNAs) and generated a risk score model termed the exosomal lncRNA (exo-lncRNA) signature. The exo-lncRNA signature was subsequently validated in the CGGA GBM cohort. Finally, a novel prognostic nomogram was constructed based on the exo-lncRNA signature and clinicopathological parameters and validated in the CGGA external cohort. Based on the ceRNA hypothesis, oncocers were identified based on highly positive correlations between lncRNAs and mRNAs mediated by the same miRNAs. Furthermore, regression analyses were performed to assess correlations between the expression abundances of lncRNAs in tumors and exosomes. Results: A total of 45 DElncRNAs, six DEmiRNAs, and 38 DEmRNAs were identified, and an exosome-derived ceRNA network was built. Three optimal prognostic-related DElncRNAs, HOTAIR (HR=0.341, P<0.001), SOX21-AS1 (HR=0.30, P<0.001), and STEAP3-AS1 (HR=2.47, P<0.001), were included to construct the exo-lncRNA signature, which was further proven to be an independent prognostic factor. The novel prognostic nomogram was constructed based on the exo-lncRNA signature, patient age, pharmacotherapy, radiotherapy, IDH mutation status, and MGMT promoter status, with a concordance index of 0.878. ROC and calibration plots both suggested that the nomogram had beneficial discrimination and predictive abilities. A total of 11 pairs of prognostic oncocers were identified. Regression analysis suggested excellent consistency of the expression abundance of the three exosomal lncRNAs between exosomes and tumor tissues. Conclusions: Exosomal lncRNAs may serve as promising prognostic predictors and therapeutic targets. The prognostic nomogram based on the exo-lncRNA signature might provide an intuitive method for individualized survival prediction and facilitate better treatment strategies.

13.
Appl Microbiol Biotechnol ; 105(6): 2455-2472, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33606076

RESUMO

Butanol inhibits bacterial activity by destroying the cell membrane of Clostridium acetobutylicum strains and altering functionality. Butanol toxicity also results in destruction of the phosphoenolpyruvate-carbohydrate phosphotransferase system (PTS), thereby preventing glucose transport and phosphorylation and inhibiting transmembrane transport and assimilation of sugars, amino acids, and other nutrients. In this study, based on the addition of exogenous butanol, the tangible macro indicators of changes in the carbon ion beam irradiation-mutant Y217 morphology were observed using scanning electron microscopy (SEM). The mutant has lower microbial adhesion to hydrocarbon (MATH) value than C. acetobutylicum ATCC 824 strain. FDA fluorescence intensity and conductivity studies demonstrated the intrinsically low membrane permeability of the mutant membrane, with membrane potential remaining relatively stable. Monounsaturated FAs (MUFAs) accounted for 35.17% of the mutant membrane, and the saturated fatty acids (SFA)/unsaturated fatty acids (UFA) ratio in the mutant cell membrane was 1.65. In addition, we conducted DNA-level analysis of the mutant strain Y217. Expectedly, through screening, we found gene mutant sites encoding membrane-related functions in the mutant, including ATP-binding cassette (ABC) transporter-related genes, predicted membrane proteins, and the PTS transport system. It is noteworthy that an unreported predicted membrane protein (CAC 3309) may be related to changes in mutant cell membrane properties. KEY POINTS: • Mutant Y217 exhibited better membrane integrity and permeability. • Mutant Y217 was more resistant to butanol toxicity. • Some membrane-related genes of mutant Y217 were mutated.


Assuntos
Butanóis , Clostridium acetobutylicum , 1-Butanol , Butanóis/toxicidade , Proteínas de Membrana
14.
Mol Ther Oncolytics ; 20: 34-47, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33575469

RESUMO

Pediatric gliomas (PGs) are the most common brain tumors in children and the leading cause of childhood cancer-related death. The understanding of the immune microenvironment is essential for developing effective antitumor immunotherapies. Transcriptomic data from 495 PGs were analyzed in this study, with 384 as a training cohort and 111 as a validation cohort. Macrophages were the most common immune infiltrates in the PG microenvironment, followed by T cells. PGs were classified into 3 immune subtypes (ISs) based on immunological profiling: "immune hot" (IS-I), "immune altered" (IS-II), and "immune cold" (IS-III). IS-I tumors, characterized by substantial immune infiltration and high immune checkpoint molecule (ICM) expression, had a favorable prognosis and were more likely to respond to anti-PD1 and anti-CTLA4 immunotherapies, whereas IS-III tumors, characterized by weak immune infiltration and low ICM expression, had a dismal prognosis and poor immunotherapy responsiveness. IS-II tumors represented a transitional stage. Immune classification was also correlated with somatic mutations, copy number alterations, and molecular pathways related to tumorigenesis, metabolism, and immune responses. Three predictive classifiers using eight representative genes were generated by machine learning methods for immune classification. This study established a reliable immunological profile-based classification system for PGs, providing implications for further immunotherapy strategies.

15.
Am J Transl Res ; 13(1): 360-371, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33527030

RESUMO

BACKGROUND: Radiotherapy has been widely used in the treatment of hepatocellular carcinoma (HCC). However, whether the patients should receive radiotherapy before or after surgical treatment has not been studied. The objective of the study was to compare the efficacy of the treatment in HCC patients who received pre-surgery and post-surgery radiotherapy. METHODS: Data from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Patients with surgery combined with radiotherapy were included into the study. The outcome measures were overall survival (OS) and cancer-specific survival (CSS). Propensity score matching (PSM) was used to reduce selection bias. RESULTS: Before PSM, the median OS (mOS: 82 months) and median CSS (mCSS: NA) in the pre-surgery group were longer than in the post-surgery group (mOS: 21 months; mCSS: 20 months; P<0.001 for both). After PSM, the mOS and mCSS in the pre-surgery group were longer than in the post-surgery group (mOS: 45 vs. 26 months, P=0.011; mCSS: 60 vs. 26 months, P=0.003). The subgroup analysis documented that patients with single tumor, liver resection, and American Joint Committee on Cancer (AJCC) stage I and II had longer mOS and mCSS if they received pre-surgery rather than post-surgery radiotherapy (all P<0.05). Multivariate regression analysis showed patients with post-surgery radiotherapy had a higher risk of mortality than patients with post-surgery radiotherapy. CONCLUSION: HCC patients with single tumor, AJCC stage I and II, or with liver resection who received pre-surgery radiotherapy have better survival benefits than patients receiving post-surgery radiotherapy, particularly if internal radiotherapy was used.

17.
J Neurooncol ; 151(2): 313-324, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33394265

RESUMO

PURPOSE: Acromegaly is a rare neuroendocrine condition that can lead to significant morbidity. Despite China's vast population size, studies on acromegaly remain sparse. This study aimed to investigate the clinical characteristics and predictors of biochemical remission after surgery for acromegaly using the China Acromegaly Patient Association (CAPA) database. METHODS: A retrospective nationwide study was conducted using patient-reported data from CAPA database between 1998 and 2018. The principal component analysis (PCA) and logistic regression analysis were employed to determine independent predictors of biochemical remission at 3 months in patients after surgery. RESULTS: Of the 546 surgical cases (mean age: 36.8 years; 59.5% females), macroadenomas and invasive tumors (Knosp score 3-4) were 83.9% and 64.1%, respectively. Ninety-five percent of patients were treated with endonasal surgery and 36.8% exhibited biochemical remission at 3-months postoperatively. The following independent predictors of biochemical remission were identified: preoperative growth hormone (GH) levels between 12 and 28 µg/L [odds ratio (OR) = 0.58; 95% confidence interval (CI), 0.37-0.92; p = 0.021], preoperative GH levels > 28 µg/L (OR = 0.55; 95% CI, 0.34-0.88; p = 0.013), macroadenoma (OR = 0.56; 95% CI, 0.32-0.96; p = 0.034), giant adenomas (OR = 0.14; 95% CI, 0.05-0.38; p < 0.001), Knosp score 3-4 (OR = 0.37; 95% CI, 0.24-0.57; p < 0.001), and preoperative medication usage (OR = 2.32; 95% CI, 1.46-3.70; p < 0.001). CONCLUSIONS: In this nationwide study spanning over two decades, we highlight that higher preoperative GH levels, large tumor size, and greater extent of tumor invasiveness are associated with a lower likelihood of biochemical remission at 3-months after surgery, while preoperative medical therapy increases the chance of remission.


Assuntos
Acromegalia/cirurgia , Procedimentos Neurocirúrgicos/métodos , Acromegalia/patologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Período Pós-Operatório , Prognóstico , Indução de Remissão , Estudos Retrospectivos
18.
World Neurosurg ; 149: 32-37, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33388461

RESUMO

Modern neurosurgery has been developing worldwide for more than a century, whereas in China, as stated in previous literature, only 7 decades have passed since the development of neurosurgery during the early 1950s after World War II and China's War of Liberation. However, as increasing evidence before the wars from medical records, annual hospital reports, and journal archives emerge, the history of neurosurgery in China, especially the initial stage, needs to be reassessed. The establishment of the Peking Union Medical College Hospital (PUMCH) in 1921, funded by the Rockefeller Foundation, marked the start of Western medicine in China. Meanwhile, modern neurosurgery started to take root in the nation. Chinese neurosurgeons at PUMCH, Song-Tao Guan, M.D. and Yi-Cheng Zhao, M.D., both of whom graduated from PUMC and received further training abroad, made great contributions to the initial growth of Chinese neurosurgery. Although neurosurgery experienced slow and even stagnant development in China during the wars that took place from 1941-1949, the prewar period from 1921-1940 witnessed substantial improvement in operative skills, bedside education, resident training, and scientific research in neurosurgery at PUMCH, providing indispensable contributions that have allowed Chinese neurosurgery to flourish during the past 7 decades.


Assuntos
Centros Médicos Acadêmicos/história , Neurocirurgia/história , Faculdades de Medicina/história , China , História do Século XX , Humanos
19.
J Clin Endocrinol Metab ; 106(1): 211-225, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33079177

RESUMO

CONTEXT: Quality of life (QoL) continues to be impaired in acromegaly after treatment. OBJECTIVE: We conducted the first nationwide survey assessing QoL status among Chinese patients with treated acromegaly and explored correlations with clinical parameters, treatment modalities, and outcomes. DESIGN: Cross-sectional study. SETTING: Survey via Chinese Association of Patients with Acromegaly (CAPA) online platform. PATIENTS: Treated patients from CAPA. MAIN OUTCOME MEASURES: QoL was assessed using acromegaly QoL questionnaire (AcroQoL), 5-level EuroQoL five-dimensional questionnaire (EQ-5D-5L), and 12-item short-form health survey questionnaire (SF-12). RESULTS: Complete, valid questionnaires from 327 patients (mean age: 39.2 years, 61.5% females) at a mean of 10 years after treatment were included. Biochemical control was satisfied in 52.9% of these patients. The controlled patients had significantly better QoL than the uncontrolled patients in all AcroQoL dimensions, most SF-12 dimensions, and pain/discomfort and anxiety/depression dimensions of the EQ-5D-5L. Patients with either controlled or uncontrolled acromegaly had significantly worse QoL than the age- and sex-adjusted population reference in most SF-12 dimensions except for physical functioning. More acromegaly-associated symptoms and comorbidities at follow-up were independent risk factors for decreased QoL across all questionnaires. Medical treatment, especially with somatostatin analogs (SSAs), and radiotherapy were predictors of worse QoL. Female patients had lower scores of physical-related QoL than male patients. CONCLUSIONS: Our study suggests that biochemical control improved but did not normalize QoL in acromegaly. Numbers of symptoms and comorbidities at follow-up, sex, radiotherapy, and medical treatment with SSAs were factors determining QoL of patients with treated acromegaly.


Assuntos
Acromegalia/epidemiologia , Acromegalia/terapia , Qualidade de Vida , Acromegalia/psicologia , Adulto , China/epidemiologia , Comorbidade , Estudos Transversais , Fatores Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Resultado do Tratamento
20.
J Clin Endocrinol Metab ; 106(1): e273-e287, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33031533

RESUMO

CONTEXT: The accumulation of aberrant lipids and abnormal lipid metabolism in silent corticotroph adenomas (SCAs) could contribute to changes in clinical phenotypes, especially sphenoid sinus invasion. OBJECTIVE: To systematically investigate lipidomic and transcriptomic alterations associated with invasiveness and their potential molecular mechanisms in SCAs and to provide candidate biomarkers for predicting invasiveness and novel treatment options for invasive SCAs by targeting lipids. METHODS: Fifty-four SCAs (34 invasive/20 noninvasive) were subjected to lipidomic analysis based on ultraperformance liquid chromatography mass spectrometry, and 42 clinically nonfunctioning pituitary adenomas (23 invasive/19 noninvasive) were subjected to transcriptomic analysis. Differential analysis was performed to determine differential lipids and genes between invasive and noninvasive tumors. A functionally connected network was constructed with the molecular pathways as cores. Multiple machine learning methods were applied to identify the most critical lipids, which were further used to construct a lipidomic signature to predict invasive SCAs by multivariate logistic regression, and its performance was evaluated by receiver operating characteristic analysis. RESULTS: Twenty-eight differential lipids were identified, and a functionally connected network was constructed with 2 lipids, 17 genes, and 4 molecular pathways. Connectivity Map (CMap) analysis further revealed 32 potential drugs targeting 4 genes and related pathways. The 4 most critical lipids were identified as risk factors contributing to the invasive phenotype. A lipidomic signature was constructed and showed excellent performance in discriminating invasive and noninvasive SCAs. CONCLUSIONS: The lipidomic signature could serve as a promising predictor for the invasive SCA phenotype and provide potential therapeutic targets for SCAs.


Assuntos
Adenoma Hipofisário Secretor de ACT/patologia , Adenoma/patologia , Lipídeos/fisiologia , Adenoma Hipofisário Secretor de ACT/diagnóstico , Adenoma Hipofisário Secretor de ACT/metabolismo , Adenoma/diagnóstico , Adenoma/metabolismo , Hormônio Adrenocorticotrópico/metabolismo , Adulto , Doenças Assintomáticas , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/fisiologia , Cromatografia Líquida de Alta Pressão , Estudos de Coortes , Feminino , Perfilação da Expressão Gênica , Humanos , Metabolismo dos Lipídeos/fisiologia , Lipidômica/métodos , Lipídeos/análise , Lipídeos/sangue , Masculino , Redes e Vias Metabólicas , Pessoa de Meia-Idade , Invasividade Neoplásica , Espectrometria de Massas em Tandem/métodos
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