Objective To investigate the value of split-bolus dual-phase contrast-enhanced computed tomography (CT) in preoperative staging of clear cell renal cell carcinoma (ccRCC), and to analyze its effect on radiation dose. Methods From June 2021 to July 2024, 118 patients with suspected renal space occupying lesions admitted to Changsha Fourth Hospital were initially selected. Using a random number table, these patients were assigned to a single-bolus group (single-bolus three-phase enhancement program) and a split-bolus group (split-bolus dual-phase enhancement program), with 59 patients in each group. According to the postoperative pathological results, 100 patients with ccRCC were selected as the study subjects, including 48 patients in the single-bolus group and 52 patients in the split-bolus group. The CT values of ccRCC tissues in various phases were compared between the two groups. The accuracy of preoperative ccRCC staging was analyzed using postoperative pathological staging as the gold standard, and the effective dose (ED) was compared between the two groups. Results There was no significant difference in ccRCC staging between the two groups (P > 0.05). The CT value in the parenchyma-excretion phase of the split-bolus group was (88.24 ± 18.34) HU, which was lower than that of the single-bolus group in the parenchyma phase [(102.43 ± 20.66) HU, P < 0.05]. The accuracy of preoperative staging of ccRCC was 86.54% in the split-bolus group, which was not significantly different from 87.50% in the single-bolus group (P > 0.05). The mean ED was (14.54 ± 1.42) mSv in the split-bolus group, which was lower than (20.43 ± 1.18) mSv in the single-bolus group (P < 0.05). Compared with the single-bolus group, the ED of the split-bolus group decreased by 28.83%. Conclusion Split-bolus dual-phase contrast-enhanced CT provides similar accuracy compared to single-bolus CT in evaluating the preoperative staging of ccRCC, and can reduce the radiation dose.

BACKGROUND:Osteoporosis is a common comorbidity in patients with knee osteoarthritis.The impact of osteoporosis on the prognosis of unicompartmental knee arthroplasty is a trending topic of current research. OBJECTIVE:To investigate the effect of different bone densities on the stress value and stress distribution of each structure in the joint after unicompartmental knee arthroplasty using finite element analysis,and to evaluate the correlation between osteoporosis and complications. METHODS:CT and MRI were adopted to obtain the lower limb image data of a volunteer.Geomagic Studio,Ansys workbench,and Mimics were used to establish a finite element model of the knee joint with normal sclerotin condition(T-value≥-1.0).The finite element model of the knee joint with osteopenia(-2.5can cause biomechanical abnormalities of the internal structure of the knee joint after the treatment of unicompartmental knee arthroplasty,which may increase the incidence of complications and the risk of re-surgery.

Aim To evaluate the effectiveness and safety of remimazolam tosylate for administering general anesthesia in morbidly obese patients.Methods This clinical trial was conducted at a single center from De-cember 2021 to October 2023.It assessed 108 morbid-ly obese patients(body mass index,BMI≥40)who underwent laparoscopic sleeve gastrectomy.Patients were randomly assigned to either the remimazaolam group(Group R)or the propofol group(Group P)for general anesthesia induction and maintenance.The primary outcome was to compare the incidence of ad-verse events and postoperative recovery characteristics between the two groups.Results During induction pe-riod,the incidence of adverse events was higher in group P,including hypotension(P＜0.01),hypox-emia(P＜0.05),bradycardia(P＜0.01),and in-creased vasopressor requirement(P＜0.05).The time to loss of consciousness and BIS falling to 60 was shor-ter in group P than in group R(P＜0.01).There were no statistically significant differences between the two groups in terms of postoperative quality of recovery(QoR-40 score),24-hour postoperative pain visual an-alogue scale(VAS)scores and morphine consump-tion.In conclusion,remimazolam tosylate,utilized for anesthesia induction in morbidly obese patients,signif-icantly reduced hypotension and hypoxemia compared to propofol,while it could also maintain similar postop-erative recovery quality.Conclusions Remimazolam is effective in reducing the incidence of hypotension and hypoxaemia during the induction period of general anaesthesia in morbidly obese patients and it is compa-rable to propofol in terms of quality of postoperative re-covery.

Aim To study the effects of Taohong Siwu Tang(TSD)on serum lipid metabolites in rats with abnormal uterine bleeding(AUB),and to analyze the mechanism of action of TSD in improving lipid metabo-lism disorders in AUB.Methods The rat model of AUB was replicated by the method of incomplete abor-tion with drugs,and the lipid metabolites of serum were detected by applying UPLC-Q-Exactive Orbitrap/MS technology,and combined with the principal com-ponent analysis and orthogonal partial least squares-discriminant analysis to screen for differential lipids,the changes of lipids in serum before and after the in-tervention of TSD were clarified.Results A total of 11 differential lipids were screened,mainly phosphati-dyl inositol,phosphatidic acid,phosphatidyl ethanola-mine,phosphatidyl serine,sterol lipids,ceramide,acrylolipids and fatty acids.The screened differential lipids all tended to regress to normal after the adminis-tration of TSD intervention.Conclusion Improvement of AUB by TSD may be related to lipid metabolism such as phosphatidic acid,phosphatidyl inositol,phos-phatidyl ethanolamine,phosphatidyl serine,and ce-ramide.

Objective:To determine the expression of adenylate cyclase genes ADCY2/4/5/8 in cutaneous melanoma, to explore their roles and mechanisms of action, and to verify their effect on the proliferation and migration of the melanoma cell line A375.Methods:Data on the mRNA and protein expression of ADCY2/4/5/8, as well as the correlation between gene expression and prognosis, were analyzed through the Gene Expression Profiling Interactive Analysis (GEPIA) and Human Protein Atlas (HPA) databases; ADCY2/4/5/8 gene methylation and mutation status were analyzed through the UALCAN, DeMth, and cBioPortal databases; Gene Ontology analysis and Kyoto Encyclopedia of Genes and Genomes pathway analysis were performed on the ADCY2/4/5/8 genes using the DAVID and STRING databases. qPCR was conducted to determine the relative mRNA expression of ADCY2/4/5/8 in the A375 melanoma cells and FF pigmented nevus cells. Cultured A375 cells were divided into experimental groups and control groups to be transfected with ADCY2/4/5/8 overexpression plasmids and empty vectors, respectively. Cell counting kit (CCK8) and Transwell assays were performed to evaluate the effect of ADCY2/4/5/8 overexpression on the proliferation and migration of A375 cells, qPCR was conducted to determine the relative mRNA expression of genes related to the proliferation and migration of A375 cells, and Western blot analysis to determine the expression of cyclic adenosine monophosphate (cAMP) signaling pathway-related proteins in A375 cells after the overexpression of ADCY2/4/5/8. One-way analysis of variance and repeated measures analysis of variance were used for the comparison among multiple groups, and least significant difference- t test was used for multiple comparisons. Results:Bioinformatics analysis based on the GEPIA database showed that the mRNA expression of ADCY2, ADCY4, ADCY5, and ADCY8 was down-regulated in melanoma tissues ( n = 461) compared with normal tissues ( n = 558, P < 0.01) ; stratified analysis showed that the mRNA expression of ADCY2 ( P = 0.015) and ADCY8 ( P = 0.038) was correlated with tumor staging, and the lower the mRNA expression, the later the tumor stage. In the HPA database, the ADCY2/4/5/8 protein expression was reduced in 30 melanoma tissues compared with 30 normal tissues ( P < 0.001). Analysis of the UALCAN and DeMth database data showed elevated methylation levels of ADCY2/4/5/8 in melanoma tissues and metastatic melanoma tissues compared with normal tissues ( P < 0.001). Analysis of the DAVID and STRING database data demonstrated that the ADCY2/4/5/8 gene may inhibit cell proliferation and migration by activating the cAMP signaling pathway. qPCR showed that the relative mRNA expression of ADCY2/4/5/8 was lower in A375 cells than in FF cells. CCK8 assay showed that the survival rates of A375 cells were significantly lower in the ADCY2/4/5/8 overexpression groups than in the corresponding control groups at 48 and 72 hours (all P < 0.05). Transwell assay showed that the number of migratory A375 cells was significantly lower in the ADCY2/4/5/8 overexpression groups than in the corresponding control groups (all P < 0.01). As qPCR revealed, the ADCY2/4/5/8 overexpression groups showed significantly upregulated relative mRNA expression of epithelial cadherin, but significantly downregulated relative mRNA expression of Ki67, vimentin, neural cadherin, and matrix metalloproteinase 2 compared with the corresponding control groups (all P < 0.001). Western blot analysis showed that the protein expression of cAMP and phosphorylated protein kinase A (p-PKA) in A375 cells was significantly higher in the ADCY2/4/5/8 overexpression groups than in the corresponding control groups (all P < 0.001), but there were no significant differences in the PKA protein expression levels between the ADCY2/4/5/8 overexpression groups and the corresponding control groups (all P > 0.05) . Conclusion:The expression of ADCY2/4/5/8 was downregulated in melanoma tissues, and overexpressed ADCY2/4/5/8 could inhibit the proliferation and migration of melanoma cells, suggesting that ADCY2/4/5/8 may serve as potential tumor suppressor genes in the progression of melanoma.

Objective To evaluate the efficacy of femoral neck system (FNS) and cannulated screw (CS) in the treatment of femoral neck fracture in adults during perioperative and conjunctional periods. Methods By searching CNKI, Wanfang, VIP, CBM, PubMed, Embase and Cochrane databases, relevant literatures on the efficacy comparison of the two internal fixation regimens were collected. Review Manager 5.3 software was used to conduct a meta-analysis of the literature finally included in the study. Results A total of 24 retrospective cohort studies were included in this study, with a total of 1 661 participants, including 783 participants in the FNS group (FNS treatment) and 878 participants in the CS group (CS treatment). In the FNS group, intraoperative fluoroscopy times (MD=-9.69, 95%CI, -11.27 to -8.11, P < 0.01), complete weight-bearing time (MD=-1.69, 95%CI, -2.88 to -0.50, P < 0.01), fracture healing time (MD=-1.15, 95%CI, -1.57 to -0.73, P < 0.01), Harris score at last follow-up (MD=-1.5, 95%CI, 2.30 to 4.59, P < 0.01) and femoral head necrosis rate (OR=0.48, 95%CI, 0.26 to 0.91, P=0.02) were superior in the CS group; however, intraoperative blood loss (MD=17.72, 95%CI, 9.88 to 25.55, P < 0.01) and incision length (MD=0.39, 95%CI, 0.04 to 0.73, P=0.03) in the FNS group were higher than those in the CS group. There were no significant differences between the two groups in terms of operation time (MD=-3.78, 95%CI, -7.95 to 0.39, P=0.08) and total hospitalization days (RR=-0.14, 95%CI, -0.43 to 0.14, P=0.32). Conclusion FNS in the treatment of adult femoral neck fractures has the advantages of less intraoperative fluoroscopy, earlier complete weight-bearing time, faster fracture healing and higher hip Harris score, but compared with CS, it has more intraoperative blood loss and larger incision area.

This study aimed to compare the predictive value of six selected anthropometric indicators for benign prostatic hyperplasia (BPH). Males over 50 years of age who underwent health examinations at the Health Management Center of the Second Xiangya Hospital, Central South University (Changsha, China) from June to December 2020 were enrolled in this study. The characteristic data were collected, including basic anthropometric indices, lipid parameters, six anthropometric indicators, prostate-specific antigen, and total prostate volume. The odds ratios (ORs) with 95% confidence intervals (95% CIs) for all anthropometric parameters and BPH were calculated using binary logistic regression. To assess the diagnostic capability of each indicator for BPH and identify the appropriate cutoff values, receiver operating characteristic (ROC) curves and the related areas under the curves (AUCs) were utilized. All six indicators had diagnostic value for BPH (all P ≤ 0.001). The visceral adiposity index (VAI; AUC: 0.797, 95% CI: 0.759-0.834) had the highest AUC and therefore the highest diagnostic value. This was followed by the cardiometabolic index (CMI; AUC: 0.792, 95% CI: 0.753-0.831), lipid accumulation product (LAP; AUC: 0.766, 95% CI: 0.723-0.809), waist-to-hip ratio (WHR; AUC: 0.660, 95% CI: 0.609-0.712), waist-to-height ratio (WHtR; AUC: 0.639, 95% CI: 0.587-0.691), and body mass index (BMI; AUC: 0.592, 95% CI: 0.540-0.643). The sensitivity of CMI was the highest (92.1%), and WHtR had the highest specificity of 94.1%. CMI consistently showed the highest OR in the binary logistic regression analysis. BMI, WHtR, WHR, VAI, CMI, and LAP all influence the occurrence of BPH in middle-aged and older men (all P ≤ 0.001), and CMI is the best predictor of BPH.
Middle Aged ; Male ; Humans ; Aged ; Prostatic Hyperplasia ; Obesity/epidemiology* ; Body Mass Index ; China/epidemiology* ; Waist-Height Ratio ; ROC Curve ; Waist Circumference ; Risk Factors

OBJECTIVE: Physical exercise, a common non-drug intervention, is an important strategy in cancer treatment, including hepatocellular carcinoma (HCC). However, the mechanism remains largely unknown. Due to the importance of hypoxia and cancer stemness in the development of HCC, the present study investigated whether the anti-HCC effect of physical exercise is related to its suppression on hypoxia and cancer stemness. METHODS: A physical exercise intervention of swimming (30 min/d, 5 d/week, for 4 weeks) was administered to BALB/c nude mice bearing subcutaneous human HCC tumor. The anti-HCC effect of swimming was assessed in vivo by tumor weight monitoring, hematoxylin and eosin (HE) staining, and immunohistochemistry (IHC) detection of proliferating cell nuclear antigen (PCNA) and Ki67. The expression of stemness transcription factors, including Nanog homeobox (NANOG), octamer-binding transcription factor 4 (OCT-4), v-Myc avian myelocytomatosis viral oncogene homolog (C-MYC) and hypoxia-inducible factor-1α (HIF-1α), was detected using real-time reverse transcription polymerase chain reaction. A hypoxia probe was used to explore the intratumoral hypoxia status. Western blot was used to detect the expression of HIF-1α and proteins related to protein kinase B (Akt)/glycogen synthase kinase-3β (GSK-3β)/β-catenin signaling pathway. The IHC analysis of platelet endothelial cell adhesion molecule-1 (CD31), and the immunofluorescence co-location of CD31 and desmin were used to analyze tumor blood perfusion. SMMC-7721 cells were treated with nude mice serum. The inhibition effect on cancer stemness in vitro was detected using suspension sphere experiments and the expression of stemness transcription factors. The hypoxia status was inferred by measuring the protein and mRNA levels of HIF-1α. Further, the expression of proteins related to Akt/GSK-3β/β-catenin signaling pathway was detected. RESULTS: Swimming significantly reduced the body weight and tumor weight in nude mice bearing HCC tumor. HE staining and IHC results showed a lower necrotic area ratio as well as fewer PCNA or Ki67 positive cells in mice receiving the swimming intervention. Swimming potently alleviated the intratumoral hypoxia, attenuated the cancer stemness, and inhibited the Akt/GSK-3β/β-catenin signaling pathway. Additionally, the desmin⁺/CD31⁺ ratio, rather than the number of CD31⁺ vessels, was significantly increased in swimming-treated mice. In vitro experiments showed that treating cells with the serum from the swimming intervention mice significantly reduced the formation of SMMC-7721 cell suspension sphere, as well as the mRNA expression level of stemness transcription factors. Consistent with the in vivo results, HIF-1α and Akt/GSK-3β/β-catenin signaling pathway were also inhibited in cells treated with serum from swimming group. CONCLUSION Swimming alleviated hypoxia and attenuated cancer stemness in HCC, through suppression of the Akt/GSK-3β/β-catenin signaling pathway. The alleviation of intratumoral hypoxia was related to the increase in blood perfusion in the tumor. Please cite this article as: Xiao CL, Zhong ZP, Lü C, Guo BJ, Chen JJ, Zhao T, Yin ZF, Li B. Physical exercise suppresses hepatocellular carcinoma progression by alleviating hypoxia and attenuating cancer stemness through the Akt/GSK-3β/β-catenin pathway. J Integr Med. 2023; 21(2): 184-193.
Humans ; Animals ; Mice ; Carcinoma, Hepatocellular/drug therapy* ; Proto-Oncogene Proteins c-akt/metabolism* ; Proliferating Cell Nuclear Antigen/therapeutic use* ; Mice, Nude ; Glycogen Synthase Kinase 3 beta/genetics* ; beta Catenin/therapeutic use* ; Liver Neoplasms/drug therapy* ; Desmin/therapeutic use* ; Ki-67 Antigen ; Cell Line, Tumor ; Hypoxia ; RNA, Messenger/therapeutic use* ; Cell Proliferation

This study aimed to provide scientific evidence for predicting quality markers(Q-markers) of Elephantopus scaber by establishing UPLC fingerprint of E. scaber from different geographical origins and determining the content of 13 major components, as well as conducting in vitro anti-cancer activity investigation of the main components. The chromatographic column used was Waters CORTECS UPLC C_(18)(2.1 mm×150 mm, 1.6 μm), and the mobile phase consisted of acetonitrile and 0.1% formic acid solution(gradient elution). The column temperature was set at 30 ℃, and the flow rate was 0.2 mL·min~(-1). The injection volume was 1 μL, and the detection wavelength was 240 nm. The UPLC fingerprint of E. scaber was fitted using the Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine(2012 edition) to determine common peaks, evaluate similarity, identify and determine the content of major components. The CCK-8 assay was used to explore the inhibitory effect of the main components on the proliferation of lung cancer cells. The results showed that in the established UPLC fingerprint of E. scaber, 35 common peaks were identified. Thirteen major components, including neochlorogenic acid(peak 1), chlorogenic acid(peak 2), cryptochlorogenic acid(peak 3), caffeic acid(peak 4), schaftoside(peak 6), galuteolin(peak 9), isochlorogenic acid B(peak 10), isochlorogenic acid A(peak 12), isochlorogenic acid C(peak 18), deoxyelephantopin(peak 28), isodeoxyelephantopin(peak 29), isoscabertopin(peak 31), and scabertopin(peak 32) were identified and quantified, and a quantitative analysis method was established. The results of the in vitro anti-cancer activity study showed that deoxyelephantopin, isodeoxyelephantopin, isoscabertopin, and scabertopin in E. scaber exhibited inhibition rates of lung cancer cell proliferation exceeding 80% at a concentration of 10 μmol·L~(-1), higher than the positive drug paclitaxel. These results indicate that the fingerprint of E. scaber is highly characteristic, and the quantitative analysis method is accurate and stable, providing references for the research on quality standards of E. scaber. Four sesquiterpene lactones in E. scaber show significant anti-cancer activity and can serve as Q-markers for E. scaber.
Humans ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal/chemistry* ; Asteraceae/chemistry* ; Lung Neoplasms/drug therapy*

Objective To investigate the pharmacodynamic effects of Poria triterpenes on tumor suppression in mice with ascites tumors,and to detect and identify the chemical components of Poria triterpenes using HPLC-LTQ-Orbitrap method,and to explore the potential mechanism of action of Poria triterpenes on tumor suppression in mice with ascites tumors based on both of them using non-labeled definitive proteomics techniques.Methods Poria triterpene parts were extracted by solvent method,and the main components were detected and identified by HPLC-LTQ-Orbitrap liquid mass spectrometer;mice were randomly divided into model group,Poria triterpene group and positive control group(mushroom polysaccharide group),after 21 days of continuous administration,to establish After continuous administration for 21 days,the H22 ascites tumor mouse model was established,and the effect of each drug group on the amount of ascites,spleen index,thymus index,liver index,serum TNF-Alpha and IL-2 in H22 ascites tumor mice was observed after one week of continued administration;then H22 cells were extracted from the ascites of mice,and the H22 cells in the model group and Poria triterpene group were detected by non-lable-free quantitative proteomics technique.The differentially expressed proteins(DEPs)were screened out by using GO,KEGG and other analyses.Results The abdominal water volume in the mouse Poria triterpene group was significantly lower than that in the model group(P<0.05);the thymus index in the mouse Poria triterpene group was significantly higher than that in the model group(P<0.05);the serum levels of TNF-Alpha in the mouse Poria triterpene group were significantly different from those in the model group(P<0.01),and the serum levels of IL-2 in the mouse Poria triterpene group were significantly different from those in the model group(P<0.01).Through the analysis of the chemical composition of Poria triterpene parts,a total of 19 triterpenoids were identified,with four main structural types.A total of 188 differentially expressed proteins were identified in the Poria triterpene group compared with the model group,of which 86 differentially expressed proteins were up-regulated and 102 differentially expressed proteins were down-regulated;GO database analysis showed that the differentially expressed proteins in the Poria triterpene group were mainly involved in the regulation of interleukin-1 production The KEGG database analysis showed that the differentially expressed proteins in the Poria triterpene group were involved in signaling pathways closely related to tumor,mainly MAPK,Apoptosis,mTOR,Wnt and p53 pathways,etc.The genes coding for the seven representative differential proteins were validated at the mRNA level by RT-qPCR.Conclusion The pharmacodynamic study found that Poria triterpenes had tumor suppressive effect on H22 ascites tumor mice,then by proteomics found Poria triterpenes group ascites H22 cell protein compared to the model group changed significantly,the study thus showed that Poria triterpenes for mice ascites tumor mechanism of tumor suppressive effect mainly involves apoptosis,inflammatory response and immune process.