[Association of vitamin D deficiency with severity of symptoms in children with vasovagal syncope].

Objective: To investigate the correlation between vitamin D deficiency and the severity of symptoms in children with vasovagal syncope (VVS). Methods: A prospective study was conducted. One hundred and twenty-two children diagnosed with VVS by head up tilt test in Department of Pediatric Cardiology and 130 healthy children without symptoms who underwent physical examination in the outpatient department of Child Healthcare Department of Second Hospital of Lanzhou University from December 2019 to May 2021 were selected and assigned to VVS group and control group, respectively. According to the diagnostic criteria of vitamin D deficiency, children in the VVS group were assigned to three subgroups: non-vitamin D deficiency, vitamin D deficiency, and severe vitamin D deficiency. All children underwent detailed history taking, physical examination, and level determination of serum 25 (OH) D. Children in the VVS group were scored for orthostatic intolerance (OI) symptoms including 10 symptoms: syncope, dizziness, nausea, palpitation, headache, tremor, chest tightness, blurred vision, profuse perspiration, and attention deficit. The differences in the age, gender, body mass index, blood pressure, and serum 25 (OH) D levels between VVS group and control group, and the differences regarding the age, gender, body mass index, blood pressure, serum 25 (OH) D levels and symptom scores among the three VVS subgroups were compared. Comparisons were performed using independent sample t test, ANOVA analysis, Chi square test and rank sum test. Pearson correlation analysis was used to analyze the correlation between serum 25 (OH) D levels and OI symptom scores in children with VVS. Results: The serum 25 (OH) D levels were significantly lower in the VVS group than those in the control group ((31±11) vs. (46±10) nmol/L, t=10.89, P<0.001). Vitamin D deficiency was more frequent in the VVS group (73.0% (89/122) vs. 24.6% (32/130), χ²=58.91, P<0.001). There were significant differences among the severe vitamin D deficiency subgroup, vitamin D deficiency subgroup, and non-vitamin D deficiency subgroup regarding the serum 25 (OH) D levels ((9.8±0.4) vs. (26.6±6.5) vs. (45.8±5.9) nmol/L, F=142.77, P<0.001) and the OI symptom scores ((14±1) vs. (10±2) vs. (7±2) scores, F=44.97, P<0.001). The scores of syncope, nausea, profuse perspiration, blurred vision and dizziness among the severe vitamin D deficiency subgroup, vitamin D deficiency subgroup, and non-vitamin D deficiency subgroup were statistically significant (H=9.01, 7.52, 12.11, 7.07 and 9.54, respectively, all P<0.05). Pearson correlation analysis showed that the serum 25 (OH) D levels were negatively correlated with OI symptom scores in children with VVS (r=-0.769, P<0.001). Conclusions: VVS children have significant vitamin D deficiency. The severity of symptoms increases with decreasing of vitamin D level. Syncope, nausea, and profuse perspiration are more likely to occur in children with severe vitamin D deficiency, and dizziness and blurred vision are more likely to occur in children with vitamin D deficiency.

Comparative efficacy and safety of PD-1/PD-L1 immunotherapies for non-small cell lung cancer: a network meta-analysis.

OBJECTIVE: PD-1/PD-L1 inhibitors are a relatively new class of immunotherapeutic drugs approved for advanced non-small-cell lung cancer. The purpose of this study was to conduct a network meta-analysis to compare the safety and efficacy of these immune checkpoint inhibitors (ICIs). MATERIALS AND METHODS: We used Bayesian network meta-analysis methods to evaluate the efficacy and safety of the included treatments. We further analyzed subgroups based on PD-L1 expression level, histology type, and line of the treatment setting. RESULTS: We identified 19 RCTs, including 12,753 patients. In the analysis of all-comers, the pembrolizumab/chemotherapy combination ranked best for overall survival (OS) and progression-free survival (PFS). Durvalumab was the only ICI treatment that showed no benefit over chemotherapy. In the first-line setting only, in terms of OS, atezolizumab, pembrolizumab/chemotherapy, and nivolumab/ipilimumab ranked as the best treatments for patients with PD-L1 expression levels of ≥50%, 1-49%, and <1%, respectively. Nivolumab, atezolizumab, pembrolizumab, and durvalumab all had lower odds of grade 3 or greater treatment-related adverse events (TRAEs) compared to chemotherapy. With the addition of chemotherapy to any ICI regimen, the odds of TRAEs increased in a considerable and statistically significant way. CONCLUSIONS: While the pembrolizumab/chemotherapy combination was the most effective therapy in the overall cohort of all-comers, treatment preferences varied by treatment-line setting, tumor characteristics, and outcome of interest. In the first-line setting, the most effective treatments for patients with PD-L1 expressions of ≥50%, 1-49%, and <1% were atezolizumab, pembrolizumab/chemotherapy, and nivolumab/ipilimumab, respectively.

MiR-141 promotes cell proliferation and invasion in non-small cell lung cancer by targeting KLF9.

OBJECTIVE: Non-small cell lung cancer is the cancer with the highest mortality rate in the whole world. MicroRNA-141 (miR-141) has been reported to be an abnormal expression in multiple tumors including in non-small cell lung cancer. The aim of this study was to verify the potential roles of miR-141 in non-small cell lung cancer and evaluate the effects on cell proliferative and invasive abilities. PATIENTS AND METHODS: MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) and transwell assays were conducted to calculate the tissues and cell lines' proliferative and invasive abilities. Real Time-quantitative Polymerase Chain Reaction (RT-qPCR) and Western blotting were utilized to evaluate the mRNA and protein levels of specific genes. RESULTS: MiR-141 was significantly upregulated, while krüppel-like factor 9 (KLF9) downregulated in non-small-cell lung cancer (NSCLC) tissues and cell lines. MiR-141 and KLF9 mRNA levels had a negative correlation in NSCLC tissues. The overexpression of miR-141 promoted the proliferation and invasion of A549 cells, while caused contrast results when knockdown miR-141. In addition, KLF9 was a direct target gene of miR-141 and KLF9 partially reversed the roles of miR-141 in A549 cells. MiR-141 promoted the proliferation and invasion by binding to KLF9 in NSCLC. CONCLUSIONS: MiR-141 promoted the proliferation and invasion by targeting the KLF9 in non-small cell lung cancer, and the newly identified miR-141/KLF9 axis provides novel insight into the pathogenesis of non-small cell lung cancer.