SPAG5 as a novel biomarker and potential therapeutic target via regulating AKT pathway in multiple myeloma.

SPAG5, as a spindle-associated protein in mitosis, has been observed to have oncogenic activities in solid tumors. Here, we identified that SPAG5 expression was correlated with the deterioration of plasma cell malignancy and SPAG5 overexpression (OE) predicted unfavorable outcomes in multiple myeloma (MM). SPAG5 knockdown led to anti-MM effects in MM cell lines and animal xenograft models by regulating cell growth and apoptosis. Furthermore, gene set enrichment analysis (GSEA) revealed that PI3K/AKT/mTOR pathway was enriched in MM samples with highly expressed SPAG5 from GSE datasets. There was a concurrent downregulation of phosphorylation levels in the AKT/mTOR pathway. Yet OE of SPAG5 could restore the cell growth and p-AKT levels in MM cells after treatment with the AKT inhibitor MK2206. Taken together, SPAG5 could serve as a novel biomarker, and targeting the SPAG5 might have therapeutic potential in MM.

Diagnostic value of using 18F-FDG PET and PET/CT in immunocompetent patients with primary central nervous system lymphoma: A systematic review and meta-analysis.

BACKGROUND: 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/CT have become two of the most powerful tools for malignant lymphoma exploration, but their diagnostic role in primary central nervous system lymphoma (PCNSL) is still disputed. The purpose of our study is to identify the usefulness of 18F-FDG PET and PET/CT for detecting PCNSL. RESULTS: A total of 129 patients, obtained from eight eligible studies, were included for this systematic review and meta-analysis. The performance of 18F-FDG PET and PET/CT for diagnosing PCNSL were as follows: the pooled sensitivity was 0.88 (95% CI: 0.80-0.94), specificity was 0.86 (95% CI: 0.73-0.94), positive likelihood ratio (PLR) was 3.99 (95% CI: 2.31-6.90), negative likelihood ratio (NLR) was 0.11 (95% CI: 0.04-0.32), and diagnostic odds ratio (DOR) was 33.40 (95% CI: 10.40-107.3). In addition, the area under the curve (AUC) and Q index were 0.9192 and 0.8525, respectively. MATERIALS AND METHODS: PubMed/MEDLINE, Embase and Cochrane Library were systematically searched for potential publications (last updated on July 16th, 2016). Reference lists of included articles were also checked. Original articles that reported data on patients who were suspected of having PCNSL were considered suitable for inclusion. The sensitivities and specificities of 18F-FDG PET and PET/CT in each study were evaluated. The Stata software and Meta-Disc software were employed in the process of data analysis. CONCLUSIONS: 18F-FDG PET and PET/CT showed considerable accuracy in identifying PCNSL in immunocompetent patients and could be a valuable radiological diagnostic tool for PCNSL.

Test anxiety and telomere length: Academic stress in adolescents may not cause rapid telomere erosion.

Academic stress (AS) is one of the most important health problems experienced by students, but no biomarker of the potential psychological or physical problems associated with AS has yet been identified. As several cross-sectional studies have shown that psychiatric conditions accelerate aging and shorten telomere length (TL), we explored whether AS affected TL.Between June 2014 and July 2014, we recruited 200 junior high school students with imminent final examinations for participation in this study. The students were divided into three subgroups (mild, moderate, and severe anxiety) using the Sarason Test Anxiety Scale (TAS). Saliva samples were collected for TL measurement via quantitative polymerase chain reaction (qPCR).Students from both a specialized and a general school suffered from anxiety (p > 0.05). A total 35% had severe anxiety (score: 26.09±3.87), 33% had moderate anxiety (16.98±2.64), and 32% had mild anxiety (7.89±1.92). The TAS values differed significantly (p < 0.05) among the three subgroups, but the TLs of saliva cells differed only slightly (p > 0.05): 1.14±0.46 for those with severe anxiety, 1.02±0.40 for those with moderate anxiety, and 1.12±0.45 for those with mild anxiety.Previous reports have found that AS is very common in Asian adolescents. We found no immediate telomere shortening in adolescents with AS. Longitudinal observations are required to determine if TL is affected by AS.

Cancer screening of asymptomatic individuals using 18F-FDG PET/CT in China: a retrospective study.

BACKGROUND: In recent years, the application of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for voluntary cancer screening of asymptomatic individuals is becoming more and more popular in China. However, the utility of such screening is still controversial. METHODS: This study enrolled a total of 1,572 asymptomatic individuals who underwent FDG PET/CT as a part of cancer screening program in Shanghai Ruijin Hospital, between January 2010 and December 2014. Whole set of clinical data of each case was retrospectively collected. The cancer detection rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FDG PET/CT were calculated, according to the cancer data obtained from histopathological examinations or at least 12-month clinical follow-up. RESULTS: Among the 1,572 subjects, malignant tumors were found in 27 cases (1.72%). The cancer detection rate was 2.74% among subjects who were older than 50 years, 4.72% among those who had a family history of malignant tumors, and 2.77% among those whose tumor markers were positive. These rates were higher than those among other subjects (p<0.05). The detection rate of FDG PET/CT in asymptomatic cancer screening was 1.44%, and the sensitivity, specificity, PPV, and NPV were estimated to be 85.19%, 99.68%, 82.14%, and 99.75%, respectively. CONCLUSION: Considering its less cost-efficient performance, we do not recommend using FDG PET/CT for cancer screening in asymptomatic population. Nevertheless, FDG PET/CT might be a powerful cancer screening modality with the selection of high-risk group, and an optimal combination of the modalities should be provided in order to maximize diagnostic performance with lower costs.

Two-thumb-encircling hands technique is more advisable than 2-finger technique when lone rescuer performs cardiopulmonary resuscitation on infant manikin.

OBJECTIVE: The 2010 guidelines recommend new requirements of the chest compression depth for infant. The compression technique recommendation for infant remains the 2-finger (TF) technique for lone rescuer and the 2-thumb-encircling hands technique for 2 rescuers. We hypothesized that the TF technique cannot result in an enough compression depth to meet the guideline requirements and that the 2-thumb-encircling hands technique will not affect the ventilation. DESIGN: Crossover experimental study randomizes 27 health care providers to perform 2 sets of 5-minute cardiopulmonary resuscitation using a 30:2 compression/ventilation ratio to compare TF and 2-thumb-encircling hands techniques. A Laerdal Resusci Baby QCPR manikin equipped with PC SkillReporting System was used for measuring and recording cardiopulmonary resuscitation data. Data (mean ± SD) were analyzed by using a paired t test. Significance was defined qualitatively as P ≤ .05. RESULTS: Mean compression depths were 39.25 ± 3.06 cm in the TF technique and 42.37 ± 1.15 cm in the 2-thumb-encircling hands technique, P < .001. Two-finger technique had significant lower fractions of correct hand position than 2-thumb-encircling hands technique (96.56% ± 6.74% vs 99.41% ± 2.52%, P < .05). The fatigue point appears much earlier in TF than in 2-thumb-encircling hands. No difference was identified on ventilation between 2 groups. CONCLUSION: The 2-thumb-encircling hands technique can produce a compression depth meeting the current guidelines recommendation without negative influence on ventilation, whereas the TF technique cannot. The 2-thumb-encircling hands technique generates a significant higher ratio of correct compression position than the TF technique. Furthermore, the 2-thumb-encircling hands technique is less fatiguing than the TF technique.

Rate at 120/min provides qualified chest compression during cardiopulmonary resuscitation.

OBJECTIVES: The quality of cardiopulmonary resuscitation (CPR) is a very important prognostic factor for cardiac arrest. Chest compression is thought to be one of the most important aspects of high-quality CPR. Recent studies have prompted that there may be an interaction between chest compression rate and other factors related to the quality of chest compression. We aimed to investigate the effect of different compression rates on chest compression depth, recoil, and rescuers' fatigue point during CPR. METHODS: Participants performed 2 minutes of chest compression-only CPR after the guiding sounds, at 3 rates (100, 120, and 140 compressions/min) in random sequence. A repeated-measures analysis of variance was used to compare the average chest compression depth and other factors related to the quality of chest compression among the groups. RESULTS: As the chest compression rate increases through all the 3 rates, the fractions of chest compressions with complete release and the fractions of chest compressions with sufficient depth were deteriorated at the rate of 140 compressions/min (P < .05), although the average compression depth was above the recommended 2010 guideline depth of 5 cm(P > .05). Of note, the fatigue point at 140 compressions/min happened significantly (P < .05) sooner. CONCLUSION: Our study supported the concern of some that there may be a risk of increasing recommended chest compression rate without providing an upper limit. An appropriate choice may be 120 compressions/min.

An Evaluation of Laboratory Efficiency in Shanghai Emergency by Turn Around Times Level.

OBJECTIVE: China launched a health care reform policy due to the aging population and rapid urbanization. However, emergency overcrowding is not improved. We assessed the laboratory efficiency of emergency department (ED) in Shanghai hospitals. METHODS: We recorded the turn around times for processing laboratory biomarkers to assess laboratory efficiency at 17 EDs in national/regional hospitals. We compared TAT between national and regional hospitals and between central and ED laboratories to analyze the relationship between the laboratory efficiency and the ED overcrowding. RESULTS: All the participating hospitals have an emergency laboratory. The median TAT for c-TNT was 61 min (46-76 min) at regional EDs compared with 64 min (46-87 min) at national EDs; therefore, the TAT at regional EDs were more efficient (P < 0.05). The TAT were longer (65 min (53-85 min)) at ED labs than (60 min (42-83 min)) at central labs (P < 0.05), independent of the hospital tier and working period. We discovered that only 9% of investigated samples at Tier II EDs and 5% at Tier III EDs were assayed by point-of-care (POC) instruments. CONCLUSION: Our TAT level is approaching the recommended international standard. However, the TAT evaluation from ED laboratories demonstrates that their existence does not decrease the waiting time for laboratory reports compared to central laboratory. Thus, they have not yet approached a level to share the burden of the ED overcrowding. Further arrangement should be assigned to separate the function of emergency laboratory and central laboratory. It is worth deploying the POC assay in the ED, which will save twice the TAT level. The idea of evaluating routine laboratory efficiency by TAT at ED is fast, convenient, although it does not represent the general level of laboratory efficiency.

The clinical situation of point-of-care testing and its future development at the emergency department in Shanghai.

We assessed the efficiency of point-of-care (POC) tests in the emergency department (ED) by comparing them with the international standard. We recorded the turnaround times (TATs) for processing laboratory biomarkers to assess laboratory efficiency from 17 EDs in national/regional hospitals. We also compared patient components between national and regional hospitals. Although the 17 enrolled hospitals expanded their EDs, they contained only five POC machines among them. The P50 (P25, P75) of the TATs for POC tests was 47 min (39, 55.5 min) for cardiac troponin T, which was much longer than the international standard (30 min). The TATs of other cardiac biomarkers were also longer than 30 min. The low efficiency of TATs for POC tests was a common feature in both regional and national hospitals (p > 0.05). Myocardial infarction was diagnosed in 61% of investigated ED patients who visited national hospitals, which is more frequently than those diagnosed at regional hospitals (46%, p < 0.05). Chronic heart failure was less frequent at national hospitals (28%) than at regional hospitals (41%, p < 0.05). The patient distribution in this study indicates that patients have the tendency to choose hospitals when they are affected with chest pain. However, the POC panel is rarely used in the ED, which delayed the TAT level and affected laboratory efficiency. This finding indicates a severe problem in the administrative management of EDs. This issue should be addressed in the next version of the medical reform policy.

Effect of temperature, pH and heme ligands on the reduction of Cygb(Fe(3+)) by ascorbate.

Cytoglobin (Cygb) plays a role in regulating vasodilation in response to changes in local oxygen concentration by altering the rate of nitric oxide (NO) metabolism. Because the reduction of Cygb(Fe(3+)) by a reductant is the control step for Cygb-mediated NO metabolism, we examined the effects of temperature, pH, and heme ligands on the Cygb(Fe(3+)) reduction by ascorbate (Asc) under anaerobic conditions. The standard enthalpy of Cygb(Fe(3+)) reduction by Asc was determined to be 42.4 ± 3.1 kJ/mol. The rate of Cygb(Fe(3+)) reduction increased ~6% per °C when temperature varied from 35°C to 40°C. The yield and the rate of Cygb(Fe(3+)) reduction significantly increases with pH (2-3 times per pH unit), paralleling the formation of the Asc ion (A(2-)) and the increased stability of reduced state of heme iron at high pH values. Heme ligand cyanide (CN(-)) decreased the yield and the rate of Cygb(Fe(3+)) reduction, but ligands CO and NO allowed the process of Cygb(Fe(3+)) reduction to continue to completion. Critical information is provided for modeling and prediction of the process of Cygb-mediated NO metabolism in vessels in a range of temperature and pH values.

Differences in oxygen-dependent nitric oxide metabolism by cytoglobin and myoglobin account for their differing functional roles.

The endogenous vasodilator nitric oxide (NO) is metabolized in tissues in an oxygen-dependent manner. In skeletal and cardiac muscle, high concentrations of myoglobin (Mb) function as a potent NO scavenger. However, the Mb concentration is very low in vascular smooth muscle, where low concentrations of cytoglobin (Cygb) may play a major role in metabolizing NO. Questions remain regarding how low concentrations of Cygb and Mb differ in terms of NO metabolism, and the basis for their different cellular roles and functions. In this study, electrode techniques were used to perform comparative measurements of the kinetics of NO consumption by Mb and Cygb. UV/Vis spectroscopic methods and computer simulations were performed to study the reaction of Mb and Cygb with ascorbate (Asc) and the underlying mechanism. It was observed that the initial rate of Cygb(3+) reduction by Asc was 415-fold greater than that of Mb(3+). In the low [O2] range (0-50 µM), the Cygb-mediated NO consumption rate is ~ 500 times more sensitive to changes in O2 concentration than that of Mb. The reduction of Cygb(3+) by Asc follows a reversible kinetic model, but that of Mb(3+) is irreversible. A reaction mechanism for Cygb(3+) reduction by Asc is proposed, and the reaction equilibrium constants are determined. Our results suggest that the rapid reduction of Cygb by cellular reductants enables Cygb to efficiently regulate NO metabolism in the vascular wall in an oxygen-dependent manner, but the slow rate of Mb reduction does not show this oxygen dependence.

Demographic analysis of emergency department patients at the ruijin hospital, shanghai.

Emergency medicine is an upcoming discipline that is still under development in many countries. Therefore, it is important to gain insight into the organization and patients presenting to the Emergency Department (ED). The aim of this cross-sectional study was to provide an epidemiological description of complaints and referrals of the patients visiting the ED of the Ruijin Hospital in Shanghai, China. A questionnaire was developed and completed for a convenience sample of all patients presenting to the Triage Desk of the ED. The study was performed in June 2008. A total of 2183 questionnaires were completed. The most common complaints were fever (15%), stomach/abdominal pain (15%), vertigo/dizziness (11%), and cough (10%). Following triage, patients were predominantly referred to an internist (41%), neurologist (14%), pulmonologist (11%), or general surgeon (9%). This study provides a better understanding of the reason for the ED visit and the triage system at the ED of the Ruijin Hospital. The results can be used in order to improve facilities appropriate for the specific population in the ED.

[A study of rate of compliance with sepsis bundle in patients with severe sepsis and septic shock in emergency department].

OBJECTIVE: To evaluate the occurrence of severe sepsis and septic shock and the rate of compliance with sepsis bundle in patients with severe sepsis and septic shock in emergency department. METHODS: A prospective study was conducted on consecutive adult patients who were sent to Emergency Department of Ruijin Hospital, Shanghai Jiaotong University School of Medicine by ambulance from May to June in 2009. The occurrence of severe sepsis and septic shock, and the number of the patients in whom who met the criteria of compliance with sepsis bundle were analyzed. RESULTS: Nine hundred and seventeen patients who were sent to the emergency department by ambulance in that period were enrolled in the study. The number of patients with severe sepsis and septic shock was 96. The incidence of severe sepsis and septic shock was 10.47%. Among these patients, the number of patients in whom the sepsis bundle was complied, i.e. sepsis bundle, appropriate cultures were taken before antimicrobial therapy, placement of central venous catheter and monitoring of central venous pressure (CVP) as well as central venous oxygen saturation (ScvO2) within 2 hours, antibiotic therapy within 3 hours, early goal directed therapy (EGDT) within 6 hours, and lactate clearance in 12 hours reached 1.04%, 3.12%, 2.08%, 83.33%, 1.04%, 23.96%. The Results were 1.19%, 3.57%, 2.38%, 83.33%, 1.19%, 26.19% and 0, 0, 0, 83.33%, 0, 8.33% in medical and surgical emergency department respectively. There was no statistical difference between the two divisions (all P>0.05). CONCLUSION: The incidence of severe sepsis and septic shock was high in emergency department, but the rate of recognition of it and the compliance with sepsis bundle were inadequate. It is urgently necessary to enhance the learning and implementation of the guideline.

Role of tissue disorder markers in the evaluation of disease progress and outcome prediction: a prospective cohort study in non-cardiac critically ill patients.

BACKGROUND: Acute Physiology and Chronic Health Evaluation (APACHE) has a remarkable association with clinical syndrome, life expectancy, and length of ward stay. But the defects are obvious. It is crucial to detect an effective and convenient evaluation method to monitor disease progress and predict outcome. OBJECTIVE: To determine whether myoglobin (Mb) and other five tissue disorder biomarkers, troponin-I, creatine-kinase, creatine kinase-muscle brain, aspartate aminotransferase, and lactate dehydrogenase are independent predictors of disease progress and mortality in non-cardiac critical illness. METHODS: A prospective study with 179 patients admitted to the Intensive Care Unit was conducted. All serum tissue disorder markers and APACHE-II score were measured within 24 hr of admission. RESULTS: All the six biomarkers were significantly correlated with disease severity stratified by APACHE-II and outcome. Serial blood samples were taken from 17 patients on detection of two new organs failure. The occurrence of organs failure was significantly associated with the elevation of Mb, troponin-I, and APACHE-II. Multivariate analysis demonstrated that elevated Mb was the principal risk factor related to mortality either during hospitalization or 180-day followup. Kaplan-Meier method and log-rank test also showed that patients with elevated Mb levels had significantly shorter survival. The mortality was higher in patients with both Mb>500 ng/ml and APACHE-II>20 than in those with only Mb>500 ng/ml or APACHE-II>20. CONCLUSION: All the six tissue disorder markers are predictors of disease severity, organ failure, and outcome in non-cardiac critically illness. Among them, Mb plays a pivotable role. The combined use of Mb and APACHE-II suggest an effective method to determine the outcome of critical ill syndrome.

[Clinical study on the correlation between high sensitivity C-reactive protein and risk factors in cerebral vessel [corrected] disease].

OBJECTIVE: To investigate correlation between high sensitivity C-reactive protein (hs-CRP) and risk factors of acute stroke and cerebrovascular disease. METHODS: Hs-CRP levels were determined in 118 hypertensive patients with acute stroke (86 patients with cerebral infarction and 32 patients with cerebral hemorrhage) and in 67 healthy volunteers as normal control group by scattered radiation immunoturbidimetry. The difference in hs-CRP was analyzed in these two groups, and the correlation between hs-CRP and the cerebrovascular disease risk factors were analyzed. RESULTS: Acute stroke patients had a significantly higher level of hs-CRP compared with healthy subjects (P<0.01). There was no significant difference of hs-CRP level between cerebral infarction group and cerebral hemorrhage group. Hs-CRP level was significantly correlated with cerebrovascular accident risks such as age, body mass index (BMI), abdominal circumference, systolic and diastolic pressure, serum total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and serum fasting blood glucose by Pearson correlation analysis (P<0.05 or P<0.01), and strong positive correlations were observed between the hs-CRP level and systolic pressure, the serum fasting blood glucose, total cholesterol, triglycerides, LDL-C and HDL-C by analysis using the multivariate stepwise regression model (all P<0.01). CONCLUSION: The high level hs-CRP is in close relation with acute stroke, and blood pressure, serum fasting blood glucose and cholesterol are significant and independent risk factors that might influence the level of hs-CRP.