Volume 30, Issue 1

Background: Evidence links Toxoplasma gondii (T. gondii), a neurotropic parasite, with schizophrenia, mood disorders and suicidal behavior, all of which are associated and exacerbated by disrupted sleep. Moreover, low-grade immune activation and dopaminergic overstimulation, which are consequences of T. gondii infection, could alter sleep patterns and duration. Methods: Sleep data on 833 Amish participants [mean age (SD) = 44.28 (16.99) years; 59.06% women] were obtained via self-reported questionnaires that assessed sleep problems, duration and timing. T. gondii IgG was measured with ELISA. Data were analyzed using multivariable logistic regressions and linear mixed models, with adjustment for age, sex and family structure. Results: T. gondii seropositives reported less sleep problems (p < 0.005) and less daytime problems due to poor sleep (p < 0.005). Higher T. gondii titers were associated with longer sleep duration (p < 0.05), earlier bedtime (p < 0.005) and earlier mid-sleep time (p < 0.05). Conclusions: It seems unlikely that sleep mediates the previously reported associations between T. gondii and mental illness. Future longitudinal studies with objective measures are necessary to replicate our findings.

Background: To investigate the clinical value of serum homocysteine (Hcy), folate, and ultrasonography detection of yolk sac in predicting the outcome of threatened abortion.Methods: Ninety-eight pregnant women within 12 weeks of gestation were included in the study. Of these subjects, 29 presented with threatened abortion and were considered the case group (n=29). The other 69 subjects showed as a normal pregnancy were the control group (n=69). The case group was followed up with at 28 weeks of gestation, and further divided into inevitable abortion group (IA, n=9) and successful fetus protection group (SFP, n=20). The yolk sacs of the included cases were measured by ultrasonography. The serum Hcy and folate levels of the included cases were measured by an enzyme cycling assay and chemiluminescent immunoassay, respectively. The yolk sac visualization rate and serum Hcy and folate levels were compared between the two case groups and used as a predicting reference for the outcome of threatened abortion. Results: The yolk sac visualization rates detected by ultrasonography were 97.1% (67/69) for the control group and 69.0% (20/29) for the threatened abortion group, with a statistical difference (p<0.05). For the IA and SFP groups, the visualization rates were 22.2% (2/9) and 90.0% (18/20) respectively, with a statistical difference (p<0.05). The serum Hcy levels in the threatened abortion group were significant elevated compared with control group (6.1±2.0 μmol/L vs 4.5±1.3 μmol/L), with a statistical difference (p<0.05). However, the serum levels of folat in the threatened abortion group were significantly decreased compared with the control group (15.5±4.2 nmol/L vs 19.1±4.7 nmol/L), with a statistical difference (p<0.05). The serum levels of Hcy and folate were 7.5±1.7 μmol/L and 12.7±4.2 nmol/L for the IA group, which were statistically different compared to the SFP group (p<0.05). The predictive sensitivity for the outcome of threatened abortion based on serum Hcy and folate levels were 85.0% and 75.0%, with a predictive specificity of 66.7% and 88.9% respectively. Conclusion: Serum Hcy and folate levels were quite different in threatened abortion pregnant woman compared to the control group. Serum Hcy and folate level detection combined with ultrasonography detection of yolk sac can provide useful information for threatened abortions

Background The aim of this study was to investigate serum neopterin levels in patients with acute pancreatitis (AP) and its predictive value for mortality in cases of severe acute pancreatitis (SAP). Methods Eighty-two patients with confirmed acute pancreatitis (AP) were included and divided into two groups, mild acute pancreatitis (MAP, n=51) and severe acute pancreatitis (SAP, n=31) according to severity of disease. From the SAP group, 8 cases went on to develop multiple organ dysfunction syndrome (MODS) and 6 subsequently died. Thirty healthy subjects from routine medical examination were included as the control group. The neopterin serum concentrations were determined and compared between groups. Results Serum neopterin concentrations from control, MAP, SAP, SAP_Non-MODS, MODS_survival and MODS_death groups were 6.85±2.42 (nmol/L), 0.91±4.83(nmol/L), 33.11±11.67(nmol/L), 30.39±9.97(nmol/L), 36.40±4.48(nmol/L) and 41.75±15.64(nmol/L) respectively, with statistical significant difference (p<0.05). The sensitivity and specificity for mortality risk were 66.67% (95%CI:22.28-95.67%) and 88.00%(95%CI:68.78-97.45%) respectively, with area under the ROC curve (AUC) of 0.71(95%CI:0.50-0.9), under the cut off value of 40.18. Conclusion: Serum neopterin levels in patients with acute pancreatitis were significantly elevated and correlated with the severity of disease. Neopterin may also be used a serological biomarker of mortality risk in patients with SAP.

Introduction: Neopterin, kynurenine and tryptophan can be used to measure activation of monocytes and macrophages during immunological events such as exercise inducing inflammation. Endurance exercise and high-impact sports have shown significant increases in these biomarkers. Measurement is typically conducted by high-performance liquid chromatography (HPLC) using C18 or SCX columns. However, kynurenine and tryptophan are not measured simultaneously to neopterin using these separation systems. Here we have used an amine column for separation and simultaneous determination of neopterin, kynurenine and tryptophan. Methods: Optimization and validation for the amine-HPLC method was conducted using plasma from 43 participants subjected to a short maximal exercise bicycling regime or rest period. The order of exercise and rest was randomized and separated by a 3-5 week washout period. Results: Using an amine column developed with ammonium acetate formic acid (33%) and acetonitrile (72%) provided optimal separation and run time for analysis. Neopterin increased significantly post-exercise and subsided to baseline by 30 minutes. Total neopterin remained elevated until 60 minutes following exercise. Conclusion: Amine-HPLC can be used for simultaneous determination of kynurenine, tryptophan and neopterin in plasma. Short intense exercise causes a significant increase in plasma neopterin suggesting a prolonged activation of monocytes and macrophages.

Riboflavin is built on an isoalloxazin ring, which contains three sixcarbon rings: benzoic, pyrazine and pyrimidine. Riboflavin is synthesized by some bacteria, but among humans and animals, the only source of flavin coenzymes (FAD, FMN) is exogenous riboflavin. Riboflavin transport in enterocytes takes place via three translocators encoded by the SLC52 gene. Deficiency of dietary riboflavin has wide ranging implications for the efficacy of other vitamins, the mechanism of cellular respiration, lactic acid metabolism, hemoglobin, nucleotides and amino acid synthesis. In studies it was found that, pharmacologic daily doses (100 mg) have the potential to react with light, which can have adverse cellular effects. Extrene caution should be exercised when using riboflavin as phototherapy in premature newborns. At the cellular level, riboflavin deficiency leads to increased oxidative stress and causes disorders in the glutathione recycling process. Risk factors for developing riboflavin deficinecy include pregnancy, malnutrition (including anorexia and other eating disorders, vegitarianism, veganism and alcoholism. Furthermore, elderly people and atheletes are also at risk of developing this deficiency. Widespread use of riboflavin in medicine, cancer therapy, treatment of neurodegenerative diseases, corneal ectasia and viral infections has resulted in the recent increased interest in this flavina.

Background : The aim of this study was to investigate the correlation between maternal serum homocysteine (Hcy), folate, vitamin B12 (VitB12) and the development of pre-eclampsia (PE). Methods: Seventy-eight normal pregnant women (without hypertension and proteinuria during their pregnancy (control group)), 66 cases of gestational hypertension (GH group) and 82 cases of pre-eclampsia (PE group, with 56 cases of mild disease and 26 cases of severe disease) were include in this study. The maternal serum Hcy, folate and VitB12 level of the included cases were examined between 11 to 13 weeks gestation and compared between each group. Results: The serum levels of VitB12 were significantly different between the control, GH and PE groups (p<0.05). The serum levels of Hcy in the PE group were significantly higher than those of the control group (p<0.05). However, the serum levels of folate in the PE group were significantly lower than those of control group (p<0.05). Significant statistical differences in the maternal serum Hcy and folate were found between mild and severe PE patient groups (p<0.05). A significant correlation was found between maternal serum Hcy and VitB12 (r=-0.34, p=0.001). Conclusion: Hcy, folate and VitB12 may play an important role in the development of PE and could be potential serological biomarkers for early PE diagnosis.

Objective The aim of this work was to investigate the serum homocysteine (Hcy) level and severity of hepatitis B virus (HBV). Methods 72 patients with chronic HBV and 28 healthy controls were included in this work. Of the included 72 chronic HBV hepatitis patients, 20 patients had mild disease, 31 had moderate disease and 21 had severe disease. The serum homocysteine (Hcy), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) were examined in both HBV hepatitis and control patients. Results Significant statistical difference was observed for serum Hcy, ALT, AST and TBIL in different groups (p<0.05). The serum Hcy, ALT, AST and TBIL in the severe group were significantly higher than those of other groups with statistical difference (p<0.05); significant correlation was observed between serum Hcy and AST in the moderate (r=0.43, p<0.05) and severe disease groups (r=0.63, p<0.05). However, the correlation between Hcy and ALT, and Hcy andTBIL were not statistically significant in any group (p>0.05). Conclusion The serum Hcy level in patients with hepatitis B reflects the damage to the of liver. The continuous increase of serum Hcy level can be regarded as a risk factor for the progression of hepatitis, and it can be used as serological marker for clinical diagnosis, treatment and prognosis.

Objective: To investigate the correlation between serum neopterin, homocysteine (Hcy) and the risk of developing ischemic stroke (IS) in patients with transient ischemic attack (TIA). Methods: Ninety-two TIA patients were prospectively recruited at the First Affiliated Hospital of the Medical College, Shihezi University, Xinjiang Autonomous Region China. Of the included patients, 27 developed ischemic stroke (IS group) and other 65 cases did not (TIA group). Peripheral venous blood was obtained within 24 hours of TIA diagnosis. Serum neopterin, Hcy and serum lipid levels were tested and compared between IS and TIA groups. Results: Serum neopterin (6.38±1.76 ng/mL vs 5.39±1.51 ng/mL), Hcy (17.95±4.10 μmol/L vs 15.30±3.66 μmol/L), TG (1.82±0.92 mmol/L vs 1.40±0.71 mmol/L) and LDL (3.31±0.67 mmol/L vs 2.69±0.62 mmol/L) of IS group were significantly higher than those of TIA group (p<0.05). The AUC of serum neopterin, Hcy, TG and LDL for predicting the risk of developing IS in patients with TIA were 0.68 (95%CI: 0.55-0.81, 0.68 (95%CI: 0.57-0.80), 0.64 (95%CI: 0.51-0.78) and 0.75 (95%CI: 0.63-0.86), respectively. Conclusion: Serum neopterin, Hcy, TG and LDL are promising serological markers for predicting the increased risk of developing IS for patients with TIA.

Objective: The aim of this study was to investigate the methylenetetrahydrofolate reductase ( MTHFR ) gene rs1801133 C>T polymorphisms and lung cancer susceptibility by pooling openly published data. Methods: Electronic databases of Medline, Web of Science, Embase, Google scholar, CBM and CNKI were systematic searched to find the relevant studies related to MTHFR gene rs1801133 C>T polymorphisms and lung cancer susceptibility. The odds of TT, CT and CC alleles in lung cancer patients compared with healthy controls was pooled by the effect size of odds ratio (OR) and corresponding 95% confidence interval (95%CI) under random or fixed effect model. Publication bias was analyzed by Begg’s funnel plot and Egger’s line regression test. Results: Overall, twenty-one studies relevant to MTHFR gene rs1801133 C>T polymorphisms and lung cancer susceptibility were included. The pooled data showed subject with T allele had significant increased risk of developing lung cancer in dominant (OR=1.14, 95%CI: 1.01-1.28, p<0.05), recessive (OR=1.26, 95%CI:1.08-1.48, p<0.01) and homologous (OR=1.36, 95%CI:1.12-1.65, p<0.01) genetic model. Begg’s funnel plot and Egger’s line regression test showed significant publication bias in all genetic models. Conclusion: Based on present data, subjects with TT or CT alleles may have increased susceptibility to lung cancer. However, due to significant publication bias, the conclusion should be drawn with caution and should be proved by further well-designed case-control or cohort studies relevant to MTHFR gene rs1801133 C>T polymorphisms and lung cancer risk.

Background: Neopterin, regarded as a marker of cellular immune activation, has been used in diagnosis of infection caused by intracellular pathogens. We have aimed to evaluate the clinical usefulness of serum neopterin (NPT) in acute bacterial diarrhea caused by group C enteropathogenic Escherichia coli (EPECs) and group D Salmonella spp. Methods: Serum concentration of NPT was determined by ELISA. The study group included 47 children with diagnosis of bacterial diarrhea: 32 caused by group C enteropathogenic Escherichia coli (EPECs) and 15 by group D Salmonella spp. 105 healthy children constituted the control group. Results: Serum concentration of NPT in children infected with group D Salmonella spp. turned out to be higher than in the other groups. The fraction of Salmonella -infected patients with serum neopterin above 11 nmol/l proved higher as compared to children with diarrhea caused by group C EPECs or to the healthy controls. The prevalence of a C-reactive protein (CRP) to NPT ratio of greater than 1 did not differ significantly between children with diarrhea of various etiology. Conclusions: Neopterin can be used as a non-specific marker differentiating between bacterial diarrhea of various etiology.

Background Serum homocysteine (Hcy) and vitamin B12 (VitB12) were investigated as serological markers for the prediction of pemetrexed induced haematological toxicity in patients with adenocarcinoma of the lung. Material and Methods A total of 35 lung adenocarcinoma patients who received pemetrexed chemotherapy as first-line treatment were included in the present study. The patients received pemetrexed 500 mg/m 2 once every three weeks until disease progression. Serum Hcy and VitB12 levels were analysed prior to chemotherapy. Haematological toxicities (leucopenia, neutropenia and thrombocytopenia) were graded for each cycle of chemotherapy. Serum Hcy and VitB12 concentrations were compared between grades 0-1 and 2-4 haematological toxicity groups. Results A total of 151 chemotherapy cycles were administered to 35 lung adenocarcinoma patients. However, the serum Hcy and VitB12 concentration were only examined and recorded in 61 out of the 151 chemotherapy cycles. For the 61 cycles, grade 2-4 leucopenia, neutropenia and thrombocytopenia were observed in 21, 20 and 10 cases, respectively. Serum Hcy levels were 14.91±4.67 μg/ml, 15.50±4.35 μg/ml and 16.04±4.90 μg/ml for grade 2-4 leucopenia, neutropenia and thrombocytopenia, respectively, which were significantly higher than those of grade 0-1 groups (p<0.05). However, serum VitB12 were not statistically different between grade 0-1 and 2-4 haematological toxicity groups (p>0.05). The area under the ROC curve (AUC) were 0.73 (0.58-0.88), 0.80 (0.66-0.94), 0.75 (0.57-0.93) for serum Hcy and 0.65 (0.50-0.79), 0.64 (0.49-0.78), 0.68 (0.49-0.87) for serum VitB12 as predictive biomarkers of grade 2-4 leucopenia, neutropenia and thrombocytopenia, respectively. Conclusion Pre-chemotherapy serum Hcy appeared to correlate with haematological toxicity and may be a useful biomarker for predicting severity of pemetrexed induced haematological toxicity.

Background: The aim of the present meta-analysis was to investigate the correlation of serum homocysteine (Hcy) concentration and ulcerative colitis (UC) through pooling all the relevant publications. Methods The electronic databases of PubMed, EMBase, Web of Science, Google Scholar, CBM, and CNKI were systematic searched with the text words of homocysteine/Hcy, ulcerative colitis/UC, and inflammatory bowel disease. The correlation between serum Hcy and UC were demonstrated by stand mean difference (SMD) and corresponding 95% confidence interval (95% CI). The publication bias was evaluated by Egger’s line regression test and Begg’s funnel plot. Results After systematic searching the related electronic databases of PubMed, EMBase, Web of Science, Google Scholar, CBM, and CNKI, eighteen publications relevant to serum Hcy and UC were included in the present meta-analysis. The serum Hcy leves were 14.01±2.76 and 10.31±1.59 μmol/L for UC groups and healthy controls respectively with statistical difference (p<0.05). Significant heterogeneity was found (I 2 =94.5%, p<0.001) among the included studies. Therefore, the SMD was pooled through the random effect model. The pooled SMD was 1.20 (95% CI: 0.89-1.51), indicating that serum Hcy levels were significant higher in UC groups compared to healthy controls with statistical difference (Z=7.52, P<0.001). Egger’s line regression test indicated no publications bias (t=1.45, p=0.17). Conclusion : Serum Hcy levels were usually elevated in UC patients, which indicates that Hcy may play an important role in UC development and may be used as a serological biomarker for UC diagnosis.

Background: The aim of the study was to evaluate the serum homocysteine (Hcy), vascular endothelial growth factor (VEGF) and transforming growth factor β1 (TGF-β1) dynamic change in colorectal cancer patients pre- and post-operation. Material and methods: One hundred and eighteen CRC patients treated with surgery (CRC group) and 56 healthy controls (Control group) were included in this work. The serum Hcy, VEGF TGF-β1 were examined by enzymatic cycle and enzyme-linked immunosorbent assay (ELISA) of the two groups. We followed patients for 12 months and out of the 118 CRC patients, 14 patients had recurrent disease. Serum Hcy, VEGF and TGF-β1 were measured before and after surgery and repeated every 2 months. Results Serum Hcy, VEGF and TGF-β1 were 16.20 ± 4.79 μmol/L, 492.36 ± 97.32 pg/ml, 29.23 ± 7.47 pg/ml for the CRC group and 8.98 ± 3.02 μmol/L, 315.21 ± 56.28 pg/ml, 7.69 ± 2.31 pg/ml for the control groups. Serum Hcy, VEGF and TGF-β1 was significantly (p<0.05) lower after surgery in both recurrent and nonrecurrent CRC patients (p<0.05). Interestingly, serum Hcy, VEGF and TGF-β1 gradually increased with time. Conclusion Serum Hcy, VEGF and TGF-β1 levels are elevated in CRC patients and may correlated with the post-operative disease recurrence.

Background: Methylene tetrahydrofolate reductase ( MTHFR ) catalyzes the conversion of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate, a cosubstrate for homocysteine remethylation to methionine. Single nucleotide polymorphisms (SNP) of MTHF rs1801133 C>T can influence susceptibility to colorectal cancer. However, an association between MTHFR rs1801133 C>T polymorphisms and response to 5-Fluorouracil (5-FU) based chemotherapy in patients with colorectal cancer was not clear. Methods: Studies relevant to MTHFR rs1801133 C>T polymorphisms and response to 5-FU based chemotherapy in patients with colorectal cancer were systematic searched in the electronic databases of PubMed, Web of Science, Embase, and China National Knowledge Infrastructure (CNKI). The genotypes of CC, CT, and TT were extracted from each included publication. The genotypes CC, CT, and TT distribution in 5-FU based chemotherapy response and resistance groups were calculated and pooled through random or fixed effect model by the effect size of odds ratio (OR) and 95% confidence interval (95% CI). The publication bias was evaluated through Begg’s funnel plot and Egger’s line regression test. Results: After searching the electronic databases, 16 studies related to MTHFR gene rs1801133 C>T polymorphisms and a response to 5-FU based chemotherapy in patients with colorectal cancer were included in the present meta-analysis. The pooled data showed no statistical difference in tumor response rate between CT+TT and CC groups in the dominant genetic model CT+CC vs CC (OR=1.21, 95% CI: 0.93~1.59, p>0.05) and recessive model TT vs CT+CC (OR=1.37, 95% CI: 0.91~2.06, p>0.05). The grade 3-4 adverse reaction rate between CT+TT and CC groups also had no statistical difference in the dominant genetic model CT+CC vs CC (OR=0.90, 95% CI: 0.76~1.07, p>0.05) and recessive model TT vs CT+CC (OR=1.12, 95% CI: 0.84~1.50, p>0.05). The Begg’s funnel plot and Egger’s line regression test demonstrated no publication bias. Conclusion: The response and adverse reaction of 5-FU based chemotherapy in colorectal patients were not different in terms of MTHFR rs1801133 C>T polymorphisms.

Background: Summer/spring-type seasonal affective disorder (S-SAD) is the less common subtype of seasonal affective disorder and evidence regarding potential triggers of S-SAD is scarce. Recent reports support association of airborne-pollen with seasonal exacerbation of depression (mood seasonality) and timing of suicidal behavior. Therefore, we hypothesized that Old Order Amish (OOA) with summer/spring pattern of seasonality (abbreviated as summer pattern) and S-SAD will have significant mood worsening on high pollen days. Methods: A seasonal pattern of mood worsening and SAD parameters were estimated using Seasonal Pattern Assessment Questionnaire (SPAQ). Age- and gender-adjusted ANCOVAs and post hoc analyses were conducted to compare mood worsening on days with high pollen counts between summer-pattern vs no-summer-pattern of mood worsening, S-SAD vs no-S-SAD, winter-pattern vs no-winter-pattern of mood worsening, and W-SAD vs no-W-SAD groups. Results: The prevalence of S-SAD was 0.4%, while 4.5% of individuals had a summer pattern of mood seasonality. A statistically significant difference for mood worsening on high pollen days was observed between summer-pattern vs no-summer-pattern of mood worsening ( p = 0.006). The significant association between S-SAD vs no-SAD groups ( p = 0.032) for mood worsening on high pollen days did not withstand Bonferroni adjustment for multiple comparisons. No significant association was found for winter-pattern vs no-winter-pattern of mood worsening ( p = 0.61) and for W-SAD vs no-W-SAD ( p = 0.19) groups. Conclusion: Our results are consistent with previous studies implicating links between aeroallergen exposure and summer pattern of seasonality, but not the winter pattern of seasonality.

Age-related cataracts (ARC) are the leading cause of visual impairment and blindness, affecting 16 million subjects globally. This work aimed to investigate the correlation of serum homocysteine (Hcy), folate, vitamin B6 (VitB6) and ARC. We prospectively enrolled 60 ARC, and 58 age-matched healthy controls in this study. The serum concentrations of Hcy were determined using a fully automatic biochemical analyzer and folate/VitB6 by enzyme-linked immunosorbent assay (ELISA). The diagnostic performance of serum Hcy, folate and VitB6 for ARC were evaluated by receiver operating characteristics (ROC). The mean serum levels of Hcy, folate and VitB6 from the control group were 9.8 ± 2.1 μmol/L, 17.4 ± 2.3 nmol/L, 42.3 ± 5.7 pmol/L, respectively. In comparison, the mean serum levels of Hcy, folate and VitB6 from the ARC group were 12.2 ± 2.5 μmol/L, 15.3 ± 2.6 nmol/L, 40.3 ± 5.1 pmol/L, respectively. Significant statistical difference (p<0.05) were found between the control and ARC groups. The diagnostic sensitivity, specificity and AUC of serum Hcy as a biomarker for ARC were 53.1%, 76.3% and 0.66 (95% CI:0.61-0.76), respectively, which were superior to that of serum folate and VitB6. Serum Hcy was significantly elevated in ARC patients and correlated with ARC development, thus may be used as a serological marker for ARC diagnosis.

Objective To investigate the effects of 5-hydroxytryptamine 3 receptor antagonists (ondansetron [OND]) versus dopamine receptor antagonists (droperidol [DRO]) in the prevention of postoperative nausea, vomiting (PONV) and headache by pooling data from open published studies. Methods Performed systematic electronic searches of PubMed, Embase, Google scholar and CNKI, to identify open-published prospective randomized controlled trials (RCTs) relevant to the comparison of OND versus DRO for preventing PONV and headache to be included in the present study. The pooled PONV, headache, dizziness and drowsiness were calculated based on the original data of each included study. The pooled data was presented with risk ratio (RR) and 95% confidence interval (95%CI). Results Thirteen prospective randomized clinical trials were included in this meta-analysis. The pooled PONV, post-operative nausea (PON) and positive operative vomiting (POV) were 0.67 (95%CI:0.48-0.93, p<0.05), 0.88 (95%CI:0.67-1.14, p>0.05) and 0.56 (95%CI:0.39-0.82,p<0.05) respectively for OND vs. DRO. And the overall pooled positive operative nausea and vomiting was 0.71(95%CI:0.60-0.86) by fixed effects model for OND vs. DRO. The pooled risk of postoperative headache, dizziness and drowsiness were 4.33 (95%CI:0.76-24.69, p>0.05), 0.63 (95%CI:0.21-1.87, p>0.05) and 0.48(0.28-0.81,p<0.05) respectively by fixed effect model for OND vs. DRO. Conclusion The post-operative nausea, vomiting and dizziness risks were significant decreased for patients receiving OND compared to patients receiving DRO.

Pterygium is an inflammatory, vascular and degenerative disorder with unknown aetiology. The aim of this study was to evaluate the changes in neopterin levels, reflecting T-cell immunity, and the kynurenine pathway, the main degradation process of tryptophan, in pterygium. For this purpose, neopterin concentrations were measured in serum and tear samples by enzyme-linked immunosorbent assay (ELISA) in pterygium patients (n=31) and control group (n=32). Kynurenine (KYN) and tryptophan (TRP) serum levels were simultaneously determined by high-performance liquid chromatography (HPLC) for evaluation of the kynurenine pathway. Serum neopterin concentrations and kynurenine to tryptophan ratio (KYN/TRP) as an index of tryptophan breakdown were found increased in pterygium compared to controls (p<0.05). Although there was a 3-fold difference observed between serum and tear neopterin levels, no significant relationship was found. It can be concluded that neopterin may be used as a nonspecific biomarker that reflects immunological activity in pterygium and has clinical potential for evaluation of pterygium pathogenesis. These immune- or inflammatory-mediated changes were also supported by an increased KYN/TRP ratio in pterygium patients.

Objective: To further explore folate receptor 1 ( FOLR1 ) gene expression in ovarian cancer and its association with patients’ prognosis by deep mining the Oncomine and Kaplan-Meier plotter databases. Methods: FOLR1 mRNA expression data of ovarian cancer were retrieved from the Oncomine database and further analyzed by comparing tumor to healthy tissue. The prognostic value of FOLR1 in ovarian cancer was analyzed by Kaplan-Meier Plotter, an online survival analysis database. Results A total of 439 studies were included in the Oncomine database in multiple types of cancers. Of the 439 studies, there were 54 with statistical differences for the expression of FOLR1 , 19 with increased expression of FOLR1 and 35 with decreased expression comparing ovarian cancer to normal ovary tissue. After searching the Oncomine database, six datasets were discovered comparing the mRNA expression in ovarian tumor to healthy tissue. FOLR1 mRNA expression in ovarian tumor was significantly higher than that of normal ovarian tissue (all p<0.05). The Kaplan-Meier Plotter database analyzed the correlation between FOLR1 expression and ovarian cancer patient’s prognosis. A significant difference of progression-free survival between FOLR1 high and low expressing groups was found in ovarian cancer patients (HR=1.14, 95%CI: 1.00-1.29, p=0.043). However, the overall survival was not statistically different between high and low FOLR1 expressing patients (HR=0.95, 95%CI: 0.84-1.09, p=0.48). Conclusion FOLR1 mRNA was found to be highly expressed in ovarian tumor compared to normal ovarian tissue. Elevated FOLR1 mRNA expression was associated with the poor progression-free survival.

Objective The aim of the present work was to investigate the prognostic value of serological ferritin, 100A12, procalcitonin (PCT) and APACHEII score in predicting death risk for patients with acute respiratory distress syndrome (ARDS). Methods Forty eight ARDS patients were recruited from Feb. 2016 to Jan. 2019 from Lishui People’s Hospital. According to their prognosis (survival or death within 28 days), these 48 patients were further divided into the survival group (n=28) and death group (n=20). The serological levels of S100A12, PCT and ferritin of the 48 ARDS patients were examined within 24 hours after hospitalization. Demographic characteristics, serum S100A12, PCT and ferritin were compared between the two groups, and diagnostic analysis was performed to evaluate the clinical efficacy of these markers in predicting the death of ARDS patients. Results The serum S100A12, ferritin and APACHEII scores of the death group were significantly higher than those of the survival group (p<0.05). However, serum PCT levels were not statistically different between the two groups (p>0.05). The death prediction sensitivity for serum S100A12, PCT, ferritin and APACHEII score were 65.0 (40.78-84.61)%, 60.00(36.05-80.88) %,75.0(50.90-91.34)% and 85.0(62.11-96.79)% respectively. The death prediction specificity for serum S100A12, PCT, ferritin and APACHEII score were 75.0(55.13-89.31)%, 60.00(36.05-80.88)%, 64.29(44.07-81.36)% and 82.14(63.11-93.94)%, respectively. The area under the ROC curve (AUC) for serum S100A12, PCT, ferritin and APACHEII score were 0.68(0.51-0.84), 0.63(0.46-0.79), 0.71(0.56-0.86) and 0.91(0.83-0.99) respectively. Conclusion Serological ferritin, 100A12, PCT and APACHEII scores can be used as biomarkers to predict the death risk of ARDS patients.

Objective To investigate the clinical efficacy and toxicity of Pemetrexed versus Gefitinib as second-line treatment for advanced non-small cell lung cancer (NSCLC). Methods By systematically searching the electronic databases of Pubmed, CENTRAL, Cochrane, EMBASE, ASCO, and CBM, open published randomized clinical trials (RCTs) relevant to clinical efficacy and toxicity of Pemetrexed versus Gefitinib as second-line treatment of advanced NSCLC were included in the meta-analysis. Data of objective response rate (ORR) and drug related toxicity were extracted from the original publications and pooled by random or fixed effect method. Results Fourteen clinical trials related to Pemetrexed versus Gefitinib as second-line treatment for advanced NSCLC fulfilled the inclusion criteria and were included in the meta-analysis. The pooled results show that the ORR (RR=0.81, 95% CI:0.56–1.16, p=0.25) and DCR (RR=1.11, 95% CI:0.94–1.31, p=0.24) were not statistical different for Pemetrexed versus Gefitinib as second-line treatment of advanced NSCLC. However, the pooled data demonstrated the risk of developing skin rash (RR=0.10, 95% CI:0.03–0.30, p=0.00) and diarrhea (RR=0.31, 95% CI:0.15–0.67, p=0.003) in patients with Pemetrexed was significantly lower than that of Gefitinib through random effect model analysis, but the incidence of neutropenia in Pemetrexed group was significantly higher than that of Gefitinib with statistical difference (RR=7.62, 95% CI:3.71–15.66, p=0.00). Conclusion Pemetrexed was not inferior as second-line treatment for advanced NSCLC compared to Gefitinib for tumor response. However, Pemetrexed had higher incidence of neutropenia but lower risk of developing skin rash and diarrhea.

OBJECTIVE To investigate the correlation between serum homocysteine (Hcy) and cognitive impairment (CI) in patients with Parkinson’s disease (PD). METHODS Eighty-one PD patients were prospectively recruited in this study from Feb 2015 to Jan 2018 in Gansu Provincial Hospital. Of the subjects, 41 were diagnosed with cognitive impairment (PD-CI) vs. the 40 others without PD (PDN). The clinical characteristic and demographic features were recorded for the two groups. The serum Hcy, folate and vitamin B12 (VitB12) were examined by high-performance liquid chromatography (HPLC) and enzyme-linked immunosorbent assay (ELISA). RESULTS The serum Hcy, folate, VitB12 concentration were 21.7±6.2 (μmol/L), 9.2±3.7 (ng/mL), 354.1±123.5 (pg/mL) for PD-CI group and 14.1±5.7 (μmol/L), 12.4±4.5 (ng/mL), 378.7±128.2 (pg/mL) for PDN group respectively. The serum level of Hcy in PD-CI group was significantly higher than that of PDN group (p<0.05), serum folate was significantly lower than PDN group (p<0.05). The diagnostic sensitivity, specificity and AUC were 77.5% (95%CI:61.6%-89.2%), 78.1% (95%CI:62.4%-89.4%), 0.82 (95%CI:0.73-0.91) for serum Hcy and 72.5% (95%CI:56.1%-85.4%), 63.4% (95%CI:46.9%-77.9%), 0.71(95%CI:0060-0.83) for serum folate respectively as serological markers for cognitive impairment diagnosis in patients with PD. Conclusion Serum Hcy and folate were different between PD-CI and PDN patients, which may play an important role in cognitive impairment development in patients with PD and can be used as promising serological diagnostic marker.

Objective To investigate the clinical efficacy of serological level homocysteine (Hcy) and cystatin C (Cys-C) as biomarkers for progression of diabetic nephropathy (DN). Methods Seventy-five patients with type 2 diabetes mellitus (DM) hospitalized in Lishui People’s Hospital from January 2015 to May 2018 were included in the present study. Of the 75 cases, 28 were simple DM, 25 were early stage DN (DNe) and other 22 subjects were clinical stage DN (DNc). The serum level of Hcy and Cys-C were detected and compared among the DM, DNe and DNc groups. The efficacy of serological levels of Hcy, and Cys-C as biomarkers for diagnosis of early stage diabetic nephropathy was calculated. Results The serological levels of Hcy were 11.53±3.05 μmol/L, 15.39±4.58 μmol/L and 18.14±7.03 μmol/L for DM, DNe and DNc groups respectively (P<0.001). Serum level of Cys-C, were 0.89±0.23 mg/L, 1.51±0.60 mg/L and 2.63±0.90 mg/L respectively for DM, DNe and DNc groups respectively (P<0.001). Significant positive correlation between serum Cys-C and Hcy was detected in DNe (r pearson =0.55, P=0.004) and DNc (r pearson =0.44, P=0.04) groups. However, there was no significant correlation of serological Cys-C and Hcy in DM group (r pearson =0.08, P=0.70). The sensitivity and specificity in diagnosis of early stage DN were 76.0 (95%CI:54.87-90.64)%, 64.29 (544.07-81.36)% for serological Hcy and 80.0 (559.30-93.17)%, 89.29 (571.77-97.73)% for serum Cys-C respectively. The diagnostic area under the ROC curve (AUC) was 0.76 (0.63 to 0.90) and 0.84 (0.72-0.96) respectively for serum Hcy and Cys-C in detection early stage DN. Conclusion : Serum levels of Hcy and Cys-C in diabetic nephropathy patients were elevated compared to that of simple DM cases, making them potential biomarkers for diagnosis of early DN from DM patients.