Assessing the utility of artificial intelligence throughout the triage outpatients: a prospective randomized controlled clinical study.

Currently, there are still many patients who require outpatient triage assistance. ChatGPT, a natural language processing tool powered by artificial intelligence technology, is increasingly utilized in medicine. To facilitate and expedite patients' navigation to the appropriate department, we conducted an outpatient triage evaluation of ChatGPT. For this evaluation, we posed 30 highly representative and common outpatient questions to ChatGPT and scored its responses using a panel of five experienced doctors. The consistency of manual triage and ChatGPT triage was assessed by five experienced doctors, and statistical analysis was performed using the Chi-square test. The expert ratings of ChatGPT's answers to these 30 frequently asked questions revealed 17 responses earning very high scores (10 and 9.5 points), 7 earning high scores (9 points), and 6 receiving low scores (8 and 7 points). Additionally, we conducted a prospective cohort study in which 45 patients completed forms detailing gender, age, and symptoms. Triage was then performed by outpatient triage staff and ChatGPT. Among the 45 patients, we found a high level of agreement between manual triage and ChatGPT triage (consistency: 93.3-100%, p<0.0001). We were pleasantly surprised to observe that ChatGPT's responses were highly professional, comprehensive, and humanized. This innovation can help patients win more treatment time, improve patient diagnosis and cure rates, and alleviate the pressure of medical staff shortage.

Effects of Cadmium Exposure on Oxidative Stress in Atherosclerotic Rats by Downregulating TopBP1 Expression to Induce Mitochondrial DNA Damage.

Objective: To explore the mechanism of the effect of cadmium exposure on TopBP1-induced mitochondrial DNA damage in atherosclerotic rats to affect oxidative stress. Methods: 50 rats were established atherosclerotic model, and they were divided into model control group (MC group), low-dose cadmium exposure group (LD group), medium-dose cadmium exposure group (MD group), high-dose cadmium exposure group (HD group), and positive control group, with 10 rats in each group. Rats in the LD group, MD group, and HD group were intraperitoneally injected with different doses of cadmium acetate solution for intervention, rats in the PC group were intraperitoneally injected with oxidized banking solution, and those in the MC group were injected with normal saline. 10 rats were taken as the normal control group (NC group). Human umbilical vein endothelial cells were taken for cell experiments, normal saline was added as the blank control group (group A), cadmium acetate solution was added (group B), oxidized bankning solution was added (Group C), and oxidized bankning solution and cadmium acetate solution were added (Group D). Western blot and fluorescence quantitative PCR were used to detect the protein and mRNA expressions respectively. ROS, MDA, and SOD were detected by ELISA, apoptosis of endothelial cells was detected by flow cytometry, and arterial plaque damage was observed by oil red O staining. Results: The relative expressions of TopBP, Bax, and Bcl-2 proteins in rat aortic tissues in each group were significantly different (all P < .05). The relative expressions of TopBP1 and Bcl-2 proteins in the aortic tissues of rats in NC group, MC group, LD group, MD group, HD group, and PC group decreased (all P < .05), while the relative expressions of Bax protein in those groups were increased (all P < .05). Similarly, the relative expression levels of Topbp1mRNA, BaxmRNA, and Bcl-2mRNA in the aortic tissues of rats in each group were significantly different (all P < .05). There were statistically significant differences in the expression levels of ROS, MDA, SOD, and mtDNA expression levels in the aortic tissues of rats in each group. There were statistically significant differences in TopBP1, Topbp1mRNA, and mtDNA among groups (all P < .05); while the relative expression of TopBP1 and Topbp1mRNA in groups A, B, C, and D decreased (all P < .05), the expression levels of mtDNA in those group increased (all P < .05), and the apoptosis rates of endothelial cells were also increased (all P < .05). Conclusion: Cadmium exposure can down-regulate the expression of TopBP1 in atherosclerotic rats, aggravate mitochondrial DNA damage, promote oxidative stress response, and then induce the development of atherosclerosis.

Bioinformatic identification reveals a m6A-binding protein, IGF2BP2, as a novel tumor-promoting gene signature in thyroid carcinoma.

N6-methyladenosine (m6A) modification plays a crucial role in thyroid carcinoma (THCA). Insulin-like growth factor 2 binding protein 2 (IGF2BP2) is a m6A-binding protein. We aimed to explore the effect of IGF2BP2 on the development of THCA. Differentially expressed genes (DEGs) were screened from GSE50901 and GSE60542 datasets. LinkedOmics, Genebank, and Sequence-based RNA Adenosine Methylation Site Predictor databases were employed to find potential m6A modification sites. Protein-protein interaction network and receiver-operating characteristic curves were applied to determine hub genes of THCA. ESTIMATE revealed the effect of IGF2BP2 on tumor immunity. The mRNA expression of IGF2BP2 was detected using real-time quantitative polymerase chain reaction. The viability, migration, and invasion were assessed by Cell Counting Kit-8, wound healing, and transwell assays. A total of 166 common DEGs were identified from GSE50901 and GSE60542 datasets. One m6A-related gene, IGF2BP2, was differentially expressed in THCA and selected as the research target. The hub genes (CD44, DCN, CXCL12, ICAM1, SDC4, KIT, CTGF, and FMOD) were identified with high prediction values for THCA. Subsequently, the target genes of IGF2BP2, SDC4, and ICAM1, which had potential m6A modification sites, were screened out based on the hub genes. IGF2BP2 was upregulated in THCA and IGF2BP2 expression was positively correlated with immune infiltration in THCA. Additionally, knockdown of IGF2BP2 inhibited the proliferation, invasion, and migration of THCA cells. IGF2BP2 has a contributory effect on the progression of THCA, which is a novel biomarker and a therapeutic target for THCA.

DNMT1/DNMT3a-mediated promoter hypermethylation and transcription activation of ICAM5 augments thyroid carcinoma progression.

Promoter methylation is one of the most studied epigenetic modifications and it is highly relevant to the onset and progression of thyroid carcinoma (THCA). This study investigates the promoter methylation and expression pattern of intercellular adhesion molecule 5 (ICAM5) in THCA. CpG islands with aberrant methylation pattern in THCA, and the expression profiles of the corresponding genes in THCA, were analyzed using bioinformatics. ICAM5 was suggested to have a hypermethylation status, and it was highly expressed in THCA tissues and cells. Its overexpression promoted proliferation, mobility, and tumorigenic activity of THCA cells. As for the downstream signaling, ICAM5 was found to activate the MAPK/ERK and MAPK/JNK signaling pathways. Either inhibition of ERK or JNK blocked the oncogenic effects of ICAM5. DNA methyltransferases 1 (DNMT1) and DNMT3a were found to induce promoter hypermethylation of ICAM5 in THCA cells. Knockdown of DNMT1 or DNMT3a decreased the ICAM5 expression and suppressed malignant properties of THCA cells in vitro and in vivo, which were, however, restored by further artificial ICAM5 overexpression. Collectively, this study reveals that DNMT1 and DNMT3a mediates promoter hypermethylation and transcription activation of ICAM5 in THCA, which promotes malignant progression of THCA through the MAPK signaling pathway.

Estrogen-related genes for thyroid cancer prognosis, immune infiltration, staging, and drug sensitivity.

BACKGROUND: Thyroid cancer (THCA) has become increasingly common in recent decades, and women are three to four times more likely to develop it than men. Evidence shows that estrogen has a significant impact on THCA proliferation and growth. Nevertheless, the effects of estrogen-related genes (ERGs) on THCA stages, immunological infiltration, and treatment susceptibility have not been well explored. METHODS: Clinicopathological and transcriptome data of patients with THCA from the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) were cleaned before consensus clustering. Differential expression analysis was performed on the genes expressed between THCA and paraneoplastic tissues in TCGA, and Wayne analysis was performed on the ERGs obtained from the Gene Set Enrichment Analysis MsigDB and differentially expressed genes (DEGs). Univariate Cox and least absolute shrinkage and selection operator (LASSO) analyses were used to identify the set of estrogen-related differentially expressed genes (ERDEGs) associated with progression-free intervals (PFI) and to establish a prediction model. Receiver operating characteristic curves were plotted to calculate the risk scores and PFI status to validate the predictive effect of the model. Enrichment analyses and immune infiltration analyses were performed to analyze DEGs between the high- and low-risk groups, and a nomogram plot was used in the risk model to predict the PFI of THCA. RESULTS: The expression of 120 ERDEGs differed significantly between the two groups (P < 0.05). Five (CD24, CAV1, TACC1, TIPARP, and HSD17B10) of the eight ERDEGs identified using univariate Cox and LASSO regression were validated via RT-qPCR and immunohistochemistry analysis of clinical tissue samples and were used for clinical staging and drug sensitivity analysis. Risk-DEGs were shown to be associated with immune modulation and tumor immune evasion, as well as defense systems, signal transduction, the tumor microenvironment, and immunoregulation. In 19 of the 28 immune cells, infiltration levels differed between the high- and low-risk groups. High-risk patients in the immunotherapy dataset had considerably shorter survival times than low-risk patients. CONCLUSION: We identified and confirmed eight ERDEGs using a systematic analysis and screened sensitive drugs for ERDEGs. These results provide molecular evidence for the involvement of ERGs in controlling the immunological microenvironment and treatment response in THCA.

Immunotherapy or targeted therapy: What will be the future treatment for anaplastic thyroid carcinoma?

Anaplastic thyroid carcinoma (ATC) is a rare and aggressive form of thyroid carcinoma (TC). Currently, there are no effective treatments for this condition. In the past few years, targeted therapy and immunotherapy have made significant progress in ATC treatment. Several common genetic mutations have been found in ATC cells, involving different molecular pathways related to tumor progression, and new therapies that act on these molecular pathways have been studied to improve the quality of life of these patients. In 2018, the FDA approved dabrafenib combined with trametinib to treat BRAF-positive ATC, confirming its therapeutic potential. At the same time, the recent emergence of immunotherapy has also attracted wide attention from researchers. While immunotherapy for ATC is still in the experimental stage, numerous studies have shown that immunotherapy is a potential therapy for ATC. In addition, it has also been found that the combination of immunotherapy and targeted therapy may enhance the anti-tumor effect of targeted therapy. In recent years, there has been some progress in the study of targeted therapy or immunotherapy combined with radiotherapy or chemotherapy, showing the prospect of combined therapy in ATC. In this review, we analyze the response mechanism and potential effects of targeted therapy, immunotherapy, and combination therapy in ATC treatment and explore the future of treatment for ATC.

Transcription Factor E2F1 Exacerbates Papillary Thyroid Carcinoma Cell Growth and Invasion via Upregulation of LINC00152.

Background: Papillary thyroid carcinoma (PTC) is the most common thyroid neoplasm, whereas transcription factor E2F1 has been previously implicated in PTC progression. The current study sought to elucidate the underlying mechanism of E2F1 in PTC cell biological activities via regulation of long intergenic noncoding RNA 152 (LINC00152). Methods: Firstly, the expression patterns of LINC00152 and E2F1 in PTC were determined. Besides, TPC-1 and IHH-4 cells were adopted to carry out a series of experiments. Cell proliferation was detected by means of a cell counting kit-8 assay and colony formation assay, while cell migration and invasion abilities were assessed using a Transwell assay. Next, the interaction between E2F1 and LINC00152 was certified. Lastly, xenograft transplantation was carried out to validate the effects of E2F1 depletion on PTC. Results: Both LINC00152 and E2F1 were highly expressed in PTC cells. Knockdown of LINC00152 led to reduced cell activity, while LINC00152 overexpression brought about the opposing trends. Likewise, E2F1 knockdown quenched cell proliferation, migration, and invasion. However, the combination of E2F1 knockdown and LINC00152 overexpression resulted in augmented cell growth. In addition, E2F1 induced LINC00152 overexpression, which accelerated cell proliferation, migration, and invasion by activating the PI3K/AKT axis, whereas the administration of LY294002, the inhibitor of PI3K, led to reversal of the same. Finally, xenograft transplantation validated that E2F1 inhibition could suppress LY294002, thereby discouraging tumor growth. Conclusion: Our findings highlighted that E2F1 augmented PTC cell proliferation and invasion by upregulating LINC00152 and the PI3K/AKT axis. Our discovery provides therapeutic implications for PTC alleviation.

CENPO regulated proliferation and apoptosis of colorectal cancer in a p53-dependent manner.

Colorectal cancer (CRC) is considered to be a leading cause of cancer-related death. Centromere protein O (CENPO) can prevent the separation of sister chromatids and cell death after spindle injury. Nevertheless, the role of CENPO in CRC has not been reported. The expression level of CENPO in CRC was revealed by TCGA database and immunohistochemical (IHC) staining. Subsequently, the loss-of-function assays were performed to identified the role of CENPO in CRC in vitro and in vivo. Our data demonstrated that CENPO was highly expressed in CRC. The expression of CENPO was positively correlated with the deterioration of CRC. Moreover, CENPO knockdown inhibited the malignant phenotypes of CRC cells, which was characterized by slowed proliferation, cycle repression at G2, promotion of apoptosis, reduced migration and weakened tumorigenesis. Furthermore, CENPO knockdown downregulated the expression of N-cadherin, Vimentin, Snail, CCND1, PIK3CA and inhibited AKT phosphorylation in CRC cells. Moreover, the function of CENPO in regulating proliferation and apoptosis depended on p53. In summary, CENPO may play a promoting role in CRC through the epithelial mesenchymal transition (EMT) and PI3K/AKT signaling pathway, which can be regarded as a molecular therapeutic target for CRC.

DPP3/CDK1 contributes to the progression of colorectal cancer through regulating cell proliferation, cell apoptosis, and cell migration.

At present, colorectal cancer (CRC) has become a serious threat to human health in the world. Dipeptidyl peptidase 3 (DPP3) is a zinc-dependent hydrolase that may be involved in several physiological processes. However, whether DPP3 affects the development and progression of CRC remains a mystery. This study is the first to demonstrate the role of DPP3 in CRC. Firstly, the results of immunohistochemistry analysis showed the upregulation of DPP3 in CRC tissues compared with normal tissues, which is statistically analyzed to be positively correlated with lymphatic metastasis, pathological stage, positive number of lymph nodes. Moreover, the high expression of DPP3 predicts poor prognosis in CRC patients. In addition, the results of cell dysfunction experiments clarified that the downregulation of DPP3 significantly inhibited cell proliferation, colony formation, cell migration, and promoted apoptosis in vitro. DPP3 depletion could induce cell apoptosis by upregulating the expression of BID, BIM, Caspase3, Caspase8, HSP60, p21, p27, p53, and SMAC. In addition, downregulation of DPP3 can reduce tumorigenicity of CRC cells in vivo. Furthermore, CDK1 is determined to be a downstream target of DPP3-mediated regulation of CRC by RNA-seq, qPCR, and WB. The interaction between DPP3 and CDK1 shows mutual regulation. Specifically, downregulation of DPP3 can accentuate the effects of CDK1 knockdown on the function of CRC cells. Overexpression of CDK1 alleviates the inhibitory effects of DPP3 knockdown in CRC cells. In summary, DPP3 has oncogene-like functions in the development and progression of CRC by targeting CDK1, which may be an effective molecular target for the prognosis and treatment of CRC.

Long Noncoding RNA CTC Inhibits Proliferation and Invasion by Targeting miR-146 to Regulate KIT in Papillary Thyroid Carcinoma.

Several lines of evidence have shown that long non-coding RNAs (lncRNAs) are dysregulated in many diseases. Nevertheless, the biological relevance of the lncRNAs in papillary thyroid carcinoma (PTC) has not been fully explored. We demonstrated that CTC was a negative regulator of PTC cell migration and invasion in vitro and in vivo. We found that microRNA-146 (miR-146) is an inhibitory target of CTC. We then demonstrated that CTC functioned as a miR-146 decoy to de-repress expression of KIT. Further study demonstrated that CTC modulated the progression and chemoresistance of PTC cells via miR-146 and KIT. The analysis of hundreds of clinical specimens revealed that CTC and KIT levels were downregulated, whereas miR-146 levels were greater in PTC tissues than in normal thyroid. Their expression levels correlated with one another. In conclusion, CTC functions as a competing endogenous RNA to inhibit the progression and chemoresistance of PTC cells, and identifies CTC serve as a potential therapeutic agent to suppress PTC progression.

Surgery for adrenal angiomyelolipoma: an individualized concept.

BACKGROUND: Because adrenal angiomyelolipoma (AAML) is rare and uniformly benign, the indications for surgery are ill defined. METHODS: Among a series of 156 patients with adrenal pathologies surgically treated between 2013 and 2018, 12 patients were operated with the diagnosis of an AAML. The clinical as well as imaging parameters forming the individual indications for surgery were analyzed. RESULTS: Preoperative diagnosis consistent with AAML was made in all 12 patients. The mean size of surgically removed AAML was 82.3 mm (45-150 mm). Gender and affected side were evenly distributed. Local symptoms but lack of radiological signs suspicious for malignancy or size increase were observed in 4 of 12 patients (group 1, 33%). In contrast, 4 of 12 patients (group 2, 33%) showed radiological signs suspicious for malignancy but lacked local symptoms. Additional 4 of 12 patients (group 3, 33%) showed both local symptoms and radiological signs suspicious for malignancy. Patients with local symptoms harbored significantly larger tumors compared to those patients that lacked local symptoms (93.9 mm ± 32.8 vs. 59.3 mm ± 2.7, p = 0.021). Patients with radiologically suspicious signs were older (60 years ± 9.9 vs. 53 years ± 5.4, p > 0.05), and time to surgery was shorter (4.4 months ± 3 vs. 6.0 months ± 3.0, p > 0.05). Importantly, surgical approach was not influenced by tumor size (p = 0.65). However, patients with suspicious imaging were more likely to be operated by conventional open approach (4 of 8 vs. 0 of 4, p = 0.08). The minimal invasive approach was associated with shorter hospital stay (7 days, ± 1.3 vs. 14.2 days, ± 8.8, p = 0.038). All lesions that showed radiological signs suspicious for malignancy proved benign in final histology. CONCLUSION: Large AAML present a clinical challenge. The presence of local symptoms and/or radiological signs suspicious for malignancy identifies three groups of patients that define the concept of an individualized indication for surgery in AAML. A minimal invasive approach can be advocated even for large AAML with radiological signs suspicious for malignancy.

[FTIR spectroscopic explorations of freshly resected thyroid malignant tissues].

In the present paper, 17 cases of freshly resected malignant thyroid tissue samples and 23 cases of benign thyroid tissue samples were characterized using FTIR spectroscopy with an ATR probe. Statistic analysis indicated that the FTIR spectra of cancerous tissue were significantly different from those of benign tissue. In comparison with normal tissues, the FTIR spectra of malignant thyroid tissues possess the following features: (1) Variation of bands related to protein: Amide I band shifted to lower wave number significantly (P<0.01), while amide II band shifted to higher wave number(P<0.05), and the ratios of I1640/I1460 and I1640/I1550 were raised (P<0.01). The authors can conclude that the amounts and the secondary structure of protein in malignant tissue changed. (2) The peaks at 2955, 2920, 2870, 2850 and 1740 cm(-1) appeared less frequently suggesting that the relative quantity of lipid in malignant tissue decreased significantly; (3) Variation of bands related to nucleic acid: The band of 1241 cm(-1) shifted to (1238.29+/-2.87)cm(-1), and the ratios of I1080/I1460 were raised significantly(P<0.05). The most possible reason for the changes was that the mutation of DNA and the amounts of nucleic acid had increased in malignant neoplasms. Experimental results show that the malignant thyroid tissues can be distinguished from the benign tissues by their infrared spectra. This approach proves that FTIR spectroscopy is a reliable and practicable method for thyroid cancer diagnosis in operations. The authors have expanded their research on detecting the thyroid cancer FTIR spectra via percutaneous and in vivo, and have achieved a positive result which is going to be reported in another paper.