With the development of molecular pathology,many types of epidermal growth factor receptor (EGFR) mutations have been identified.The efficacy of EGFR tyrosine kinase inhibitors (EGFR-TKIs) in non-small cell lung cancer (NSCLC) patients with different types of EGFR mutations,especially in patients with single rare mutations or complex mutations (co-occurrence of two or more different mutations),has not been fully understood.This study aimed to examine the efficacy of EGFR-TKIs in NSCLC patients with different types of EGFR mutations.Clinical data of 809 NSCLC patients who harbored different types of EGFR mutations and treated from January 2012 to October 2016 at Renmin Hospital and Zhongnan Hospital,Wuhan,were retrospectively reviewed.The clinical characteristics of these patients and the efficacy of EGFR-TKIs were analyzed.Among these patients,377 patients had only the EGFR del-19 mutation,362 patients the EGFR L858R mutation in exon 21,33 patients single rare mutations and 37 patients complex mutations.Among these 809 patients,239 patients were treated with EGFR-TKIs.In all the 239 patients,the disease control rate (DCR) was 93.7％ with two patients (0.2％) achieving complete response (CR),the median progression free survival (PFS) was 13.0 months (95％ confidence interval [CI],11.6-14.4 months),and the median overall survival (OS) was 55.0 months (95％ CI,26.3-83.7 months).Subgroup analysis revealed that the DCR in patients harboring single rare or complex mutations of EGFR was significantly lower than in those with del-19 or L858R mutation (P＜0.001).Patients with classic mutations (del-19 and/or L858R mutations) demonstrated longer PFS (P＜0.001) and OS (P=0.017) than those with uncommon mutations (single rare and/or complex mutations).Furthermore,the patients with single rare mutations had shorter median OS than in those with other mutations.Multivariate Cox regression analysis identified that the type of EGFR mutations was an independent risk factor for PFS (hazard ratio [HR]=0.308,95％ CI,0.191-0.494,P＜0.001) and OS (HR=0.221,95％ CI,0.101-0.480,P＜0.001).The results suggest that the single rare or complex EGFR mutations confer inferior efficacy of EGFR-TKIs treatment to the classic mutations.The prognosis of the single rare EGFR mutations is depressing.EGFR-TKIs may be not a good choice for NSCLC patients with single rare mutations of EGFR.Further studies in these patients with uncommon mutations (especially for the patients with single rare mutations) are needed to determine a better precision treatment.

Objective We investigated the changes of the motorial network in patients suffered from brain tumors adjacent to the central sulcus occurred with reorganization of motor function using function connectivity MRI(fcMRI)technique in order to provide the new evidence for the compensational hypothesis of the reorganization caused by focal lesions.Methods Using 1.5 T MRI unit,14 patients with brain tumors in the vicinity of the central sulcus occurred with reorganization of motor function and 6 normal volunteers were examined with fcMRI technique while the subjects performed no task.By selecting seed voxels(region of interest)in the regions showing the most activation in M1 area on the activated map and cross correlating with every voxel within the brain,the fcMRI maps based on unilateral primary motor(M1)area were calculated.The location,extent and volume of the region showing significant connectivity to the several seed voxel,such as left/right M1 area in the health group and affected/unaffected M1 area in the patient group were evaluated on the fcMRI map.Results In healthy group,the extent and volume of the region showing significant connectivity to the left M1 area[(9514.17±186.92)mm3]were almost similar to those to the right M1 area [(9364.67±382.75)mm3].There showed no significant difference in motor connectivity between the two groups(P>0.05).In the tumor group,the volume of regions showing significant connectivity to the M1 area located in the affected hemisphere [(11193.14±811.29)mm3]was obviously higher than that of regions based on the seed voxel in the unaffected side[(6549.86±400.94)mm3](t=20.383,P＜0.01).The volume was significantly different among the regions showing high connectivity to the M1 of the affected side in patient group.those showing significant connectivity to the left M1 and fight M1 in health group(P＜0.01),the former was the biggest(P＜0.01).The extent of the regions showing connectivity to the affected M1 was consistent with the reorganization area of motor function revealed by fMRI.The volume of regions showing significant connectivity to M1 area of unaffected hemisphere in patient group showed significant difference compared with those showing significant connectivity to the left M1 and right M1 in health group(P＜0.01),the former was smallest(LSD,P＜0.01).especially in the affected hemisphere.It might mean the disrupted functional connectivity between the M1 area of unaffected hemisphere in patient group and motor area located in the collateral side.Conclusion The increased connectivity between the M1 area of the affected hemisphere and the other motor cortex might indicate that the reorganization in the motor pathway and the formation of the potential compensatory network second to the impairment of the normal motor pathway resulted in the functional reorganization of the motor cortex.The fcMRI technique might be a valuable approach to reveal the pathophysiological changes of nerve network caused by brain tumor.

OBJECTIVETo investigate the additive effects of uncoupling protein 2 (UCP2) gene Ala55Val variation and ADR beta(3) gene Trp64Arg variation on the obesity in Chinese Han population.

METHODSThe UCP2 gene Ala55Val variation and ADR beta(3) gene Trp64Arg variation were examined by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) in 119 obese subject with mean BMI (27.9+/-2.98)kg/m(2) and in 177 control subjects with mean BMI(21.9+/-1.9)kg/m(2). The additive effects of the two gene mutations were analyzed.

RESULTS(1) The frequency of ADR beta(3) gene Trp64Arg variation in obese subjects was not significantly different from that in control subjects. In control subjects, the Trp64Arg variation carriers had higher fasting glucose level and 2-hour-post-prandial glucose level than did non-carriers. (2) The frequency of homozygote of UCP2 gene Ala55Val variation in obese subjects was higher than that in the control subjects (OR=3.71, P=0.001). In control subjects the Ala55Val variation carriers had higher BMI. (3) When there was only UCP2 gene or ADR beta(3) gene mutation, the frequency of gene mutation in obese subjects was not significantly different from that in control subjects (P>0.05). But when there were simultaneously two gene mutations, the frequency of gene mutations was higher in obese subjects than in control subjects (OR=2.57, P=0.009). (4) The genotype carriers with Val/Val+ Trp/Arg were the greatest relation to obese obesity (OR=8.58, P=0.002).

CONCLUSIONThe homozygote of UCP2 gene Ala55Val mutation increases the risk of obesity. Though the UCP2 gene mutation alone or the ADR beta(3) gene mutation alone is not associated with obesity, the possible additive effects of the two micro-genes increase the occurring of obesity.

Adult ; Aged ; Female ; Humans ; Ion Channels ; Male ; Membrane Transport Proteins ; genetics ; Middle Aged ; Mitochondrial Proteins ; genetics ; Mutation ; Obesity ; genetics ; Receptors, Adrenergic, beta-3 ; genetics ; Uncoupling Protein 2

Objective To explore the material basis and mechanism of the Chinese medicine Dingqing tablets in the treatment of leukemia.Methods The potential active ingredients of Dingqing tablets were retrieved through TCMSP and HERB Database and the targets of herbs were screened by Swiss TargetPrediction databases.The treatment targets of leukemia were searched from the GeneCards,OMIM and Disgenet databases.The protein-protein interaction network was used to construct the interactive target regulation function of Dingqing tablets and leukemia by STRING software,and the core subnetworks were filtered by the MCODE plug-in.A component-target pathway network was constructed by GO and KEGG enrichment analysis of the highest scoring Gene cluster 1 gene in the DAVID database.Molecular docking of the active components and core targets of Dingqing tablets was performed by AutoDock and the results were visualized.Results A total of 82 active ingredients and 439 targets of action of Dingqing tablets,and 1 878 leukemia-related targets were obtained through database retrieval,in which 169 common targets of active ingredients and diseases were mapped.Based on the degree values,the main active ingredients were determined as quercetin,luteolin,kaempferol,etc.The PPI core network indicated that the key targets for treating leukemia included TP53,MMP9,TNF,AKT1,CASP3,etc.The gene enrichment analysis of sub-networks and the component-target pathway network diagram showed that Dingqing tablets might exert therapeutic effects on leukemia by regulating signaling pathways such as TNF and IL-17.The molecular docking results showed fairly strong binding activity between the active ingredients and the targets.Conclusion The active ingredients of Dingqing tablets may participate in TNF,IL-17,and other signaling pathways by regulating genes such as TP53,AKT1,and CASP3,thereby exerting therapeutic effects on leukemia.

Background:Reduced expression of tripartite motif-containing 3 (TRIM3) has been reported to be involved in the pathogenesis of human glioblastoma.In our previous research,we found that TRIM3 expression was markedly reduced in human primary hepatocellular carcinoma (HCC) tissues and that low TRIM3 expression was associated with short survival of HCC patients.However,the role of TRIM3 in liver cancer remains unknown.This study aimed to investigate the function of TRIM3 in liver cancer cells.Methods:The protein levels of TRIM3 in five liver cancer cell lines (SK-Hep1,Hep3B,Huh7,HepG2,Bel-7402) and one normal liver cell line (L02) were detected with Western blotting.HepG2 and Bel-7402 cells with IowTRIM3 expression were infected with recombinant lentiviruses overexpressing TRIM3 (LV-TRIM3),whereas Huh7 and Hep3B cells with high TRIM3 expression were transfected with TRIM3-targeted small interfering RNA (siTRIM3).The functions of TRIM3 in the proliferation,colony formation,cell cycle,migration,invasion,and apoptosis of the above cell lines were examined.The effect of TRIM3 on tumor growth and metastases in nude mice was also investigated.Results:TRIM3 was overexpressed in HepG2 and Bel-7402 cells with LV-TRIM3 infection,which further reduced proliferation,colony formation,migration,and invasion of both cell lines.Cell cycle analysis showed thatTRIM3 overexpression induced G0/G1 phase arrest in HepG2 and Bel-7402 cells.Moreover,apoptosis was not increased in HepG2 or Bel-7402 cells overexpressing TRIM3.Contrarily,silencing TRIM3 expression in Huh7 and Hep3B cells by siTRIM3 led to significantly decreased percentages of both cells in the G0/G1 phase and promoted cell proliferation,colony formation,migration,and invasion.In vivo experiment results confirmed thatTRIM3 overexpression suppressed tumor growth and metastasis.Conclusions:TRIM3 plays a tumor-suppressing role in the regulation of liver cancer development by reducing cell proliferation through cell cycle arrest at the G0/G1 phase.

BACKGROUNDKnee osteoarthritis (KOA) is a chronic joint disease that manifests as knee pain as well as different degrees of lower limb swelling, stiffness, and movement disorders. The therapeutic goal is to alleviate or eliminate pain, correct deformities, improve or restore joint functions, and improve the quality of life. This study aimed to evaluate the efficacy and safety of Zhuanggu joint capsules combined with celecoxib and the benefit of treatment with Zhuanggu alone for KOA.

METHODSThis multi-center, randomized, double-blind, double-dummy, parallel controlled trial, started from December 2011 to May 2014, was carried out in 6 cities, including Beijing, Shanghai, Chongqing, Changchun, Chengdu, and Nanjing. A total of 432 patients with KOA were divided into three groups (144 cases in each group). The groups were treated, respectively, with Zhuanggu joint capsules combined with celecoxib capsule simulants, Zhuanggu joint capsules combined with celecoxib capsules, and celecoxib capsules combined with Zhuanggu joint capsule simulants for 4 weeks consecutively. The improvement of Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and the decreased rates in each dimension of WOMAC were evaluated before and after the treatment. Intergroup and intragroup comparisons of quantitative indices were performed. Statistically significant differences were evaluated with pairwise comparisons using Chi-square test (or Fisher's exact test) and an inspection level of α = 0.0167.

RESULTSFour weeks after treatment, the total efficacies of Zhuanggu group, combination group, and celecoxib group were 65%, 80%, and 64%, respectively, with statistically significant differences among the three groups (P = 0.005). Intergroup pairwise comparisons showed that the total efficacy of the combination group was significantly higher than that of the Zhuanggu (P = 0.005) and celecoxib (P = 0.003) groups. The difference between the latter two groups was not statistically significant (P > 0.0167). Four weeks after discontinuation, the efficacies of the three groups were 78%, 95%, and 65%, respectively, with statistically significant differences (P < 0.0001). Intergroup pairwise comparisons revealed that the efficacy of the combination group was significantly better than that of the Zhuanggu and the celecoxib groups (P < 0.0001). The difference between the latter two groups was not statistically significant (P > 0.0167). The incidences of adverse events in Zhuanggu group, combination group, and celecoxib group were 8.5%, 8.5%, and 11.1%, respectively, with insignificant differences (P > 0.05).

CONCLUSIONSZhuanggu joint capsules alone or combined with celecoxib showed clinical efficacy in the treatment of KOA. The safety of Zhuanggu joint capsules alone or combined with celecoxib was acceptable.

TRIAL REGISTRATIONChinese Clinical Trial Registry, ChiCTR-IPR-15007267; http://www.medresman.org/uc/project/projectedit.aspx?proj=1364.

Adult ; Aged ; Celecoxib ; administration & dosage ; adverse effects ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; drug therapy

BACKGROUND: Immune eye diseases such as hyperthyroidism exophthalmos and uveitis seriously endanger the eye health of patients, which are common and difficult eye diseases. Current treatments for these diseases include oral administration of hormones and immunosuppressive agents, with poor efficacy, recurrent attacks and poor prognosis. Meanwhile, these treatments can induce systemic adverse reactions. Lymphocytes are directly or indirectly involved in these diseases. Therefore, we try to make papua eye patch carrying immunosuppressant, and deliver the drug through the topical use. Cyclosporin A microemulsion targeting lymphocytes can treat or control palpebral lymph nodes involved in the immune eye diseases. It is a topical method rather than the systemic medication, which is targeted and has small doses of drugs. If possible, this treatment can effectively treat immune eye diseases and avoid systemic drug adverse reactions and long-term adverse reactions induced by original drugs. OBJECTIVE: To study the preparation of cyclosporin A microemulsion papua cream eye patch, and its transdermal absorption characteristics in vitro. METHODS: Cyclosporine A microemulsion was fully mixed with water-soluble polymer materials at a ratio of 1 mg:1 mL, including sodium polyacrylate, polyvinyl alcohol, polyvinylpyrrolidone, gelatin, peach gum, sodium carboxymethylcellulose, hydroxypropylcellulose, and then coated onto the non-woven fabric to prepare Babu cream. Permeability of the Babu cream on the abdominal skin of ICR mice was determined by Franz diffusion cell method. High-performance liquid chromatography was used to detect the concentration of cyclosporine A, and skin irritation and anaphylaxis were also measured. RESULTS AND CONCLUSION: Cyclosporin A microemulsion papua cream eye patch was successfully prepared with appropriate viscosity, good permeability, good permeability, comfortable application, no skin irritation and allergic reaction. The content of cyclosporine A was 10 mg/tablet, and the concentration was 1 g/L. The concentration of cyclosporine A microemulsion increased with the increase of time, and it had good transdermal effect. This study proved that it is feasible to prepare cyclosporine A microemulsion into papua patch. It has good performance in skin permeability, adhesion and skin comfort.

OBJECTIVE: To analyze FOXC2 gene variant in a family affected with lymphodema-distichiasis syndrome (LDS). METHODS: Peripheral blood samples were collected for the extraction of DNA and protein. Whole-exome sequencing was carried out to detect variants in the proband. Suspected variant was validated by Sanger sequencing. Western blotting was used to detect changes in protein expression. RESULTS: The proband and his mother were both found to carry a heterozygous nonsense variant c.177C>G (p.Tyr59X) of the FOXC2 gene, which was previously unreported. Down-regulated expression of FOXC2 was detected by Western blotting. Prenatal ultrasonography of the fetus indicated increased nuchal thickness. Amniocentesis was performed at 21+1 weeks of pregnancy, genetic testing suggested that the fetus also carried the c.177C>G variant. CONCLUSION The patients' condition may be attributed to the heterozygous nonsense variant c.177C>G of the FOXC2 gene, which resulted in a significant decrease in FOXC2 expression. Increased nuchal thickness may also be related with decreased FOXC2 expression. Above finding has expanded the variant spectrum of the FOXC2 gene.
Codon, Nonsense ; Eyelashes ; abnormalities ; Female ; Forkhead Transcription Factors ; genetics ; metabolism ; Gene Expression ; Genetic Testing ; Genetic Variation ; Humans ; Lymphedema ; genetics ; Pedigree ; Pregnancy ; Prenatal Diagnosis

OBJECTIVETo evaluate the epidemiological and serological efficacy after 10 years of vaccination against hemorrhagic fever with renal syndrome (HFRS) vaccines in Zhejiang province.

METHODSOne county was randomly chosen as the research unit with all the healthy people between 16 and 60 years old were equally divided into study and control groups. The study group was vaccinated. Immunofluorescent antibody assay was used to test specific IgG antibody and Mcro-CPE method was used to test the titer of neutralizing antibody.

RESULTSTwo weeks after the full-course immunization, the seroconversion rate became 100% (67/67, with 95% CI as 96.3%-100%) by immunofluorescent antibody test (IgG) and 44.4% (8/18 with 95% CI as 22.0%-69.0%) by neutralization test with GMT titers as 72.1 and 4.6 respectively. Booster immunization was provided one year later. Time span as two weeks prior to, one year, one and half years, two years, three years and five years after booster immunization, the rates of seroconversion on immunofluorescent antibody using IFAT method, were 28.6%, 83.3%, 75.0%, 53.1%, 22.6%, 10.0% and 55.0% respectively, and rates of seroconversion of neutralizing antibody by Mcro-CPE method were 14.8%, 55.6%, 35.0%, 31.3%, 26.0%, 10.0% and 50.0% respectively. Nine years after the reinforcement, the rates of seroconversion of immunofluorescent antibody by IFAT method was only 7.1%. The vaccinated group had no patient seen but the control group appeared 34 patients including 3 deaths. According to the ten-year observation, the vaccine seemed effective with the protection rate in population reached 100%.

CONCLUSIONHFRS vaccine was effective on epidemiological, social and economical efficacy.

Adolescent ; Adult ; Animals ; Female ; Hemorrhagic Fever with Renal Syndrome ; epidemiology ; immunology ; prevention & control ; Humans ; Immunization, Secondary ; methods ; Male ; Middle Aged ; Rats ; Vaccination ; methods ; Viral Vaccines ; administration & dosage ; therapeutic use ; Young Adult

Objective To investigate the status of infection and distribution of rabies virus (RV) in different epidemic areas in China. Methods Brain specimens from animals and suspected patients were collected at the districts of high-, medium- and low incidence rates of human rabies and detected by both direct Immunofluorescence assay (DFA) and RT-PCR. Results 254 of 3007 specimens of dog brains showed RV positive by DFA (positive rate of 8.4% ). Among these 254 samples, 78 showed positive (positive rate of 30.7% ) by RT-PCR. 93 specimens from dogs and cats that had attacked human beings, 63 of them showed positive by DFA (positive rate of 67.7%) and all of them were also positive by RT-PCR. In addition, RV could also be detected in Apodemus agrarius,ferret badger, and suspected patients specimens from the districts under survey. There was no statistical difference between the infection rates of RV in different provinces and regions with different incidence of rabies. Conclusion There might be a relatively high infection rate of RV among the domestic dogs/cats in the endemic areas in China. Wild animals might have been infected with RV in the districts under survey.