Background::Highly expressed in various human cancers, circular RNA Protein Kinase C Iota (circPRKCI) has been reported to play an important role in cancer development and progression. Herein, we sought to reveal the prognostic and clinical value of circPRKCI expression in diverse human cancers.Methods::We searched the Pubmed, Web of Science, and the Cochrane Library databases from inception until May 16, 2021. The relationship between circPRKCI expression and cancer patients’ survival, including overall survival (OS) and disease-free survival (DFS), was assessed by pooled hazard ratios (HR) with corresponding 95% confidence interval (CI). The correlation between circPRKCI expression and clinical outcomes was evaluated using odds ratios (OR) with corresponding 95% CI. The data were analyzed by STATA software (version 12.0) or Review Manager (RevMan 5.3).Results::A total of 15 studies with 1109 patients were incorporated into our meta-analysis. The results demonstrated that high circPRKCI expression was significantly related to poor OS (HR = 1.96, 95% CI: 1.61, 2.39, P <0.001) when compared with low circPRKCI expression in diverse human cancers. However, elevated circPRKCI expression was not associated with DFS (HR = 1.34, 95% CI: 0.93, 1.95, P = 0.121). Furthermore, the patient with a higher circPRKCI expression was prone to have a larger tumor size, advanced clinical stage, and lymph node metastasis, but it was not significantly correlated with age, gender, and distant metastasis. Conclusion::Elevated circPRKCI expression was correlated with worse OS and unfavorable clinical features, suggesting a novel prognostic and predictive role of circPRKCI in diverse human cancers.

Objective:To evaluate the efficacy and safety of endoscopic ultrasound-guided selective varices devascularization (EUS-SVD) for the treatment of esophagogastric varices.Methods:A total of 43 cases of liver cirrhosis with esophageal and gastric varices at the First Affiliated Hospital of Anhui Medical University from February to December 2021 were included in a retrospective cohort study. The cases were divided into two treatment groups based on endoscopic treatment: EUS-SVD group ( n=22) and conventional endoscopic sclerosant injection group (conventional gastroscopy group, n=21). The doses of sclerosants and tissue glue, effective rate of esophageal varice treatment within 2 months after surgery, rebleeding rate within 3 months after surgery, and adverse reactions were compared. Results:The differences in terms of mean patient age, gender composition, etiology of liver cirrhosis, Child-Pugh classification of liver function, classification of esophageal varices, composition of endoscopic treatment indications, and mean maximum diameter of gastric varices were not statistically significant between the two groups ( P>0.05), indicating the comparability of baseline data. Perforating veins outside the gastric wall of gastric varices could be detected during the procedure in the EUS-SVD group, and disappearance of gastric varices after injection treatment could be determined, while these two indicators could not be detected in the conventional gastroscopy group. The amounts of sclerosing agents and tissue adhesives used in the EUS-SVD group were 7.54±3.10 mL and 1.30±0.57 mL, respectively, while the corresponding amounts in the conventional gastroscopy group were 7.57±3.50 mL ( t=0.026, P=0.980) and 1.38±0.67 mL ( t=-0.452, P=0.654), respectively. The effective treatment rate for esophageal varice within 2 months after surgery was 63.6% (14/22) in the EUS-SVD group and 52.4% (11/21) in the conventional gastroscopy group, but the difference was not statistically significant ( χ2=0.559, P=0.455). The rebleeding rate within 3 months after surgery was 4.5% (1/22) in the EUS-SVD group, significantly lower than the rate of 33.3% (7/21) in the conventional gastroscopy group ( P=0.021). Neither group experienced events of ectopic embolism or death. There was no statistically significant difference between the two groups in terms of postoperative pain, fever, nausea and vomiting, or rebleeding rate within 72 hours after surgery ( P>0.05). The incidence of gastric fundus ulcers was 9.1% (2/22) in the EUS-SVD group, significantly lower than the rate of 42.9% (9/21) in the conventional gastroscopy group ( χ2=6.435, P=0.011). Conclusion:EUS-SVD treatment for esophagogastric varices is safe and effective. It can clearly display the deep-seated intramural vessels of the gastric wall, measure the diameter of the blood vessels, accurately inject tissue glue, occlude the varicose veins and perforating vessels, and reduce the occurrence of postoperative ulcers and rebleeding.

Objective:To compare the accuracy of endoscopy and endoscopic ultrasonography (EUS) combined with Indian ink marking in locating injection sites for gastric varices, and to explore the influence of the features of gastric varices under endoscopy on the injection sites.Methods:Consecutive patients with gastric varices scheduled for EUS-guided glue injection therapy at the First Affiliated Hospital of Anhui Medical University from August 2021 to October 2022 were perspectively included. Firstly, gastric varices were assessed under endoscopy, where the size of the veins were estimated while the injection site was preliminarily judged during the procedure. Then EUS was used to identify perforating feeding veins and mark injection sites with Indian ink. After tissue adhesive was injected into identified varices, the change of varices after injection was observed and the marking was identified under endoscopy again. The clarity of the markinges was confirmed and the consistency between EUS-guided Indian ink mark and that under endoscopy was compared. Patients were divided into anastomosis group and non-anastomosis group based on marking consistency to investigate the effect of gastric varices features on the location of injection sites under endoscopy. Treatment efficacy and postoperative adverse events were counted.Results:Finally, 34 patients were included and all of them underwent successful marking under EUS guidance without complications. A total of 40 marker sites were clearly visible with Indian ink staining under endoscopy. The difference in distribution between the anastomotic group and non-anastomotic group marker points between EUS and endoscopy was statistically significant ( χ2=9.103, P=0.003). Vascular occlusion rate was 100.00% (40/40). There were 13 adverse events after operation, mainly fever, abdominal pain and nausea, and no serious adverse events such as allergy and ectopic embolization occurred. There was significant difference between the blood vessel diameter of the anastomotic group (10.84±4.02 mm) and that of the non-anastomotic group (8.80±1.61 mm, t=1.870, P=0.031). The percentage of raised vessels in the anastomotic group was 88.00% (22/25), higher than that in the non-anastomotic group [53.33% (8/15)], and the difference was statistically significant ( χ2=6.009, P=0.024). Conclusion:Accuracy in positioning under endoscopy is influenced by variceal diameter and bulge shape, being less precise in varices with smaller diameters and less pronounced bulges.

Objective:To investigated the clinical, biochemical, and immunohistological characteristics of patients with aldosterone producing adenoma(APA)and different gene mutations.Methods:The clinical and biochemical data of 206 patients with APA who received unilateral adrenalectomy were collected. Sanger sequencing was used to identify the mutation in the hot-point of KCNJ5 and other genes. The tumor samples were stained by 11β-hydroxylase(CYP11B1)and aldosterone synthase(CYP11B2), which was quantified by McCarty′s H-score system.Results:The gene mutations were identified in 166 out of 206(80.6%)patients with APA, of which 158 cases were KCNJ5 mutation, 2 ATP1A1 mutation, 5 ATP2B3 mutation, and 1 CTNNB1 mutation. Age, duration of hypertension, and serum potassium in APA patients with genetic mutant were significantly lower than those without genetic mutation( P<0.05) while the proportion of female, systolic blood pressure, diastolic blood pressure, aldosterone/renin ratio(ARR), and plasma aldosterone concentration(PAC)post saline infusion test(SIT)were significantly higher( P<0.05). Subgroup analysis showed that age, duration of hypertension, systolic blood pressure, and proportion of left ventricular hypertrophy in APA patients with ATP1A1 and ATP2B3 mutations were significantly higher than those with KCNJ5 mutation( P<0.05)while the PAC post SIT and tumor diameter were significantly lower( P<0.05). The positive rates of CYP11B2 in APA with different mutations were not significantly different. The H-score of CYP11B1 was significantly higher [160.0(127.5, 193.5) vs 80.0(27.5, 152.3), P=0.020] and the H-score of CYP11B2 was significantly lower [155.0(123.0, 190.0) vs 240.0(140.0, 270.0), P<0.01] in APA with KCNJ5 mutation compared with those with ATPase mutation. Conclusion:The types of genetic mutation are closely correlated with the clinical, biochemical, and immunohistological phenotypes in patients with APA.

Objective:To explore the clinical characteristics of hyponatremia associated with cyclophosphamide (CTX).Methods:The diagnosis and management of a breast cancer patient with severe hyponatremia after CTX treatment in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College was reported. The main clinical data of this patient and the relevant cases collected by searching PubMed, Embase, CNKI, and Wanfang database (as of January 26, 2021), including gender, age, indications of CTX, usage and dosage of CTX, time from the application of CTX to the occurrence of hyponatremia (latency), and clinical manifestations, treatment and outcome of severe hyponatremia, etc., was descriptively analyzed.Results:A total of 34 patients were included in the analysis, including 4 males and 30 females, aged from 27 to 87 years with the median age of 56 years. The primary disease were malignant tumor in 22 cases (17 cases of breast cancer), systemic lupus erythematosus in 6 cases, glomerulonephritis in 3 cases, scleroderma in 2 cases, and monoclonal gamma globulinosis in 1 case. Among the 34 patients, 22, 8 and 1 of 31 patients who received CTX intravenously developed severe hyponatremia after the first, second and seventh dose of treatments, respectively. Among them, 27 cases had latency records, which were 3-96 h (median time 24 h) and 25 cases had latency ≤48 h. The latency of severe hyponatremia induced by oral CTX was 1 d, 21 d and 30 d, respectively. The lowest value of blood sodium in 34 patients was 102-124 mmol/L, and in 30 patients (88.2%) were less than 120 mmol/L. The main clinical manifestations were disturbance of consciousness (20 cases), nausea and vomiting (17 cases), and epileptic seizures (15 cases). Twenty-two cases (64.7%) underwent hydration rehydration in a short time before and after CTX treatment, 1 case did not undergo hydration rehydration, and 11 cases had no relevant descriptions. After severe hyponatremia occurrence, CTX treatment was discontinued in all 34 patients. After sodium supplementation and water restriction, blood sodium returned to normal 8 h ~ 24 d (median time 48 h) after drug withdrawal, and returned to normal within 5 d in 27 cases (79.4%). Of them, one patient was still in coma after blood sodium returned to normal, and was diagnosed with central pontine myelinolysis one week later.Conclusions:CTX-associated severe hyponatremia mostly occurs within 48 h of intravenous administration and the latency of oral administration is longer. It occurs usually in patients with large amount of hydration and rehydration in a short time before and after medication. The prognosis in most patients is good when CTX is stopped, sodium is supplemented and water is limited.

A 1-year and 4 month-old boy with epilepsy received sodium valproate oral solution 2.5 ml twice daily, Shengxue Tiaoyuan decoction (升血调元汤) 6 ml twice daily and five vitamins and calcium gluconate oral solution 3 ml twice daily. On day 13 of treatments, the boy developed red maculopapular rashes and blisters all over the body, some of which fused into pieces; his bilateral conjunctiva slightly congested with secretions, mouth and lip mucosa congested and eroded, and a few maculopapular rashes appeared on the external genitalia. At the same time, the boy′s body temperature rose up to 40.0 ℃. Stevens-Johnson syndrome was diagnosed, which was considered to be related to sodium valproate oral solution. The drug was stopped immediately and treatments such as blood perfusion, infusion of plasma and red blood cells, anti-infection and hormone therapy, and eye and skin care were given. On the 17th day of treatments after drug withdrawal, the rashes on the whole body subsided, ulceration scabbed, erosion of oral and lip mucosa cured, and conjunctival congestion disappeared.

Objective:To explore the clinical characteristics of hyponatremia associated with cyclophosphamide (CTX).Methods:The diagnosis and management of a breast cancer patient with severe hyponatremia after CTX treatment in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College was reported. The main clinical data of this patient and the relevant cases collected by searching PubMed, Embase, CNKI, and Wanfang database (as of January 26, 2021), including gender, age, indications of CTX, usage and dosage of CTX, time from the application of CTX to the occurrence of hyponatremia (latency), and clinical manifestations, treatment and outcome of severe hyponatremia, etc., was descriptively analyzed.Results:A total of 34 patients were included in the analysis, including 4 males and 30 females, aged from 27 to 87 years with the median age of 56 years. The primary disease were malignant tumor in 22 cases (17 cases of breast cancer), systemic lupus erythematosus in 6 cases, glomerulonephritis in 3 cases, scleroderma in 2 cases, and monoclonal gamma globulinosis in 1 case. Among the 34 patients, 22, 8 and 1 of 31 patients who received CTX intravenously developed severe hyponatremia after the first, second and seventh dose of treatments, respectively. Among them, 27 cases had latency records, which were 3-96 h (median time 24 h) and 25 cases had latency ≤48 h. The latency of severe hyponatremia induced by oral CTX was 1 d, 21 d and 30 d, respectively. The lowest value of blood sodium in 34 patients was 102-124 mmol/L, and in 30 patients (88.2%) were less than 120 mmol/L. The main clinical manifestations were disturbance of consciousness (20 cases), nausea and vomiting (17 cases), and epileptic seizures (15 cases). Twenty-two cases (64.7%) underwent hydration rehydration in a short time before and after CTX treatment, 1 case did not undergo hydration rehydration, and 11 cases had no relevant descriptions. After severe hyponatremia occurrence, CTX treatment was discontinued in all 34 patients. After sodium supplementation and water restriction, blood sodium returned to normal 8 h ~ 24 d (median time 48 h) after drug withdrawal, and returned to normal within 5 d in 27 cases (79.4%). Of them, one patient was still in coma after blood sodium returned to normal, and was diagnosed with central pontine myelinolysis one week later.Conclusions:CTX-associated severe hyponatremia mostly occurs within 48 h of intravenous administration and the latency of oral administration is longer. It occurs usually in patients with large amount of hydration and rehydration in a short time before and after medication. The prognosis in most patients is good when CTX is stopped, sodium is supplemented and water is limited.

A 1-year and 4 month-old boy with epilepsy received sodium valproate oral solution 2.5 ml twice daily, Shengxue Tiaoyuan decoction (升血调元汤) 6 ml twice daily and five vitamins and calcium gluconate oral solution 3 ml twice daily. On day 13 of treatments, the boy developed red maculopapular rashes and blisters all over the body, some of which fused into pieces; his bilateral conjunctiva slightly congested with secretions, mouth and lip mucosa congested and eroded, and a few maculopapular rashes appeared on the external genitalia. At the same time, the boy′s body temperature rose up to 40.0 ℃. Stevens-Johnson syndrome was diagnosed, which was considered to be related to sodium valproate oral solution. The drug was stopped immediately and treatments such as blood perfusion, infusion of plasma and red blood cells, anti-infection and hormone therapy, and eye and skin care were given. On the 17th day of treatments after drug withdrawal, the rashes on the whole body subsided, ulceration scabbed, erosion of oral and lip mucosa cured, and conjunctival congestion disappeared.

Objective? To compare predicted incidence of chemotherapy induced nausea and vomiting (CINV) by doctors, nurses and patients with its actual incidence. Methods? We used the prospective paired design to select 320 patients with the induced vomiting plan of medicine department at Peking Union Medical College Cancer Hospital by convenience sampling, and we allocated 72 doctors and 48 responsibility nurses for patients. The predicted chemotherapy induced nausea and vomiting scale was filled in by doctors, nurses and patients as required to understand the incidence of CINV predicted by them. After patients completed their chemotherapy, the Chinese version of MASCC antiemesis tool (MAT) was filled out by nurses to investigate the actual incidence of CINV. Results? The paired chi-square test showed that the incidence of acute and delayed CINV were 38.75% and 61.25% respectively. There was no statistical difference between the incidence of acute CINV predicted by doctors, nurses as well as patients and the actual incidence (P＞0.05). There was also no statistical difference between the incidence of delayed CINV predicted by nurses and the actual incidence (P＞0.05). Doctors and patients all underestimated the incidence of delayed CINV with a statistical difference (P＜0.05). The consistency between the incidence of acute as well as delayed CINV predicted by doctors, nurses, patients and the actual incidence was poor with Kappa value ranging from 0.02 to 0.34. A total of 54.93% to 57.77% of doctors and nurses predicted that CINV could be controlled well lower than that (about 70%) of patients with statistical differences (P＜0.05). Conclusions? There is still much improvement space for control of delayed CINV. Medical staff should take effective measures to improve the level of estimate and the level of CINV symptom management, and to improve the quality of life among patients.

Objective To explore the clinical symptom clusters in breast cancer patients with anthracycline treatment, which could provide evidence for prevention. Methods The M.D.Anderson Symptom Inventory of Chinese version (MDASI-C) was applied to assess clinical symptoms in 506 breast cancer patients received anthracycline therapy during their 1stto 4thcycle chemotherapy.Thirteen symptoms were analyzed using main-component analysis and variance orthogonal rotation. The exploratory factor analysis was conducted to find factors value greater than 1. Results The number of symptoms with incidence rate more than 50% was 5, 6, 7 and 9 during the 1stto the 4thcycle, respectively. Fatigue, poor appetite, and nausea were the most common symptoms, and the incidence of these symptoms were 92.5% to 97.1% ,84.8% to 95.1% and 81.1% to 91.3% with the increasing cycle of chemotherapy.Three factors value greater than 1 were detected during the 1stto 2ndcycle chemotherapy by exploratory factor analysis.The cumulative variance contribution rates were 63.233% and 61.434% in the 1stand 2ndcycle, respectively. The main symptom clusters concentrate on fatigue and digestive tract symptoms, including fatigue, sleep disturbance, hypersomnia, nausea, vomit, poor appetite, dry mouth. Two factors value greater than 1 were detected during 3rdto4thcycle in chemotherapy. The cumulative variance contribution rates were 62.660% and 61.148% in the 3rdand 4thcycle, respectively. The main symptom clusters concentrate on psychological and nervous system symptoms including sadness, pain, dry mouth, numbness, hypersomnia, shortness of breath, amnesia and so on. The Cronbach α of cluster symptoms from the 1stto the 4thcycle chemotherapy was between 0.829 to 0.911. Conclusions Symptom clusters vary with the cycles of chemotherapy in breast cancer patients treated with anthracycline. Nurses should provide targeted intervention measures to improve symptom and enhance quality of life, according to specific situation.