Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Proteasome inhibitors modulate anticancer and anti-proliferative properties via NF-kB signaling, and ubiquitin-proteasome pathways in cancer cell lines of different organs

Abstract Background Cancer is second most common cause of death in the United State. There are over 100 different types of cancer associated with different human organs, predominantly breast, liver, pancreas, prostate, colon, rectum, lung, and stomach. We have recently reported properties of pro-inflammatory (for treatment of various types of cancers), and anti-inflammatory (for cardiovascular disease and diabetes) compounds. The major problem associated with development of anticancer drugs is their lack of solubility in aqueous solutions and severe side effects in cancer patients. Therefore, the present study was carried out to check anticancer properties of selected compounds, mostly aqueous soluble, in cancer cell lines from different organs. Methods The anticancer properties, anti-proliferative, and pro-apoptotic activity of novel naturally occurring or FDA approved, nontoxic, proteasome inhibitors/activators were compared. In addition to that, effect of δ-tocotrienol on expression of proteasome subunits (X, Y, Z, LMP7, LMP2, LMP10), ICAM-1, VCAM-1, and TNF-α using total RNAs derived from plasmas of hepatitis C patients was investigated. Results Our data demonstrated that following compounds are very effective in inducing apoptosis of cancer cells: Thiostrepton, dexamethasone, 2-methoxyestradiol, δ-tocotrienol, quercetin, amiloride, and quinine sulfate have significant anti-proliferation properties in Hela cells (44% - 87%) with doses of 2.5–20 μM, compared to respective controls. Anti-proliferation properties of thiostrepton, 2-methoxyestradiol, δ-tocotrienol, and quercetin were 70% - 92%. However, thiostrepton, dexamethasone, 2-methoxyestradiol, δ-tocotrienol, quercetin, and quinine sulphate were effective in pancreatic, prostate, breast, lungs, melanoma, Β-lymphocytes, and T-cells (Jurkat: 40% to 95%) compared to respective controls. In lung cancer cells, these compounds were effective between 5 and 40 μM. The IC50 values of anti-proliferation properties of thiostrepton in most of these cell lines were between doses of 2.5–5 μM, dexamethasone 2.5–20 μM, 2-methoxyestradiol 2.5–10 μM, δ-tocotrienol 2.5–20 μM, quercetin 10–40 μM, and (−) Corey lactone 40–80 μM. In hepatitis C patients, δ-tocotrienol treatment resulted in significant decrease in the expression of pro-inflammatory cytokines. Conclusions These data demonstrate effectiveness of several natural-occurring compounds with anti-proliferative properties against cancer cells of several organs of humans. Thiostrepton, dexamethasone, 2-methoxyestradiol, δ-tocotrienol and quercetin are very effective for apoptosis of cancer cells in liver, pancreas, prostate, breast, lung, melanoma, Β-lymphocytes and T-cells. The results have provided an opportunity to test these compounds either individually or in combination as dietary supplements in humans for treatment of various types of cancers

δ-Tocotrienol feeding modulates gene expression of EIF2, mTOR, protein ubiquitination through multiple-signaling pathways in chronic hepatitis C patients

Abstract Background δ-Tocotrienol is a naturally occurring proteasome inhibitor, which has the capacity to inhibit proliferation and induce apoptosis in several cancer cells obtained from several organs of humans, and other cancer cell lines. Moreover, results of plasma total mRNAs after δ-tocotrienol feeding to hepatitis C patients revealed significant inhibition in the expression of pro-inflammatory cytokines (TNF-α, VCAM1, proteasome subunits) and induction in the expression of ICAM1 and IFN-γ after post-treatment. This down-regulation of proteasome subunits leads to autophagy, apoptosis of immune cells and several genes. The present study describes RNA-sequence analysis of plasma total mRNAs obtained from δ-tocotrienol treatment of hepatitis C patients on gene expression regulated by proteasome. Methods Pooled specimens of plasma total mRNAs of pre-dose versus post-dose of δ-tocotrienol treatment of hepatitis C patients were submitted to RNA-sequence analyses. The data based on > 1 and 8-fold expression changes of 2136 genes were uploaded into “Ingenuity Pathway Analyses (IPA)” for core analysis, which describes possible canonical pathways, upstream regulators, diseases and functional metabolic networks. Results The IPA of “molecules” indicated fold change in gene expression of 953 molecules, which covered several categories of biological biomarkers. Out of these, gene expression of 220 related to present study, 12 were up-regulated, and 208 down-regulated after δ-tocotrienol treatment. The gene expression of transcription regulators (ceramide synthase 3 and Mohawk homeobox) were up-regulated, and gene expression of 208 molecules were down-regulated, involved in several biological functions (HSP90AB1, PSMC3, CYB5R4, NDUFB1, CYP2R1, TNFRF1B, VEGFA, GPR65, PIAS1, SFPQ, GPS2, EIF3F, GTPBP8, EIF4A1, HSPA14, TLR8, TUSSC2). IPA of “causal network” indicated gene regulators (676), in which 76 down-regulated (26 s proteasomes, interleukin cytokines, and PPAR-ligand-PPA-Retinoic acid-RXRα, PPARγ-ligand-PPARγ-Retinoic acid-RARα, IL-21, IL-23) with significant P-values. The IPA of “diseases and functions” regulators (85) were involved with cAMP, STAT2, 26S proteasome, CSF1, IFNγ, LDL, TGFA, and microRNA-155-5p, miR-223, miR-21-5p. The IPA of “upstream analysis” (934) showed 57 up-regulated (mainly 38 microRNAs) and 64 gene regulators were down-regulated (IL-2, IL-5, IL-6, IL-12, IL-13, IL-15, IL-17, IL-18, IL-21, IL-24, IL-27, IL-32), interferon β-1a, interferon γ, TNF-α, STAT2, NOX1, prostaglandin J2, NF-κB, 1κB, TCF3, and also miRNA-15, miRNA-124, miRNA-218-5P with significant activation of Z-Score (P < 0.05). Conclusions This is first report describing RNA-sequence analysis of δ-tocotrienol treated plasma total mRNAs obtained from chronic hepatitis C patients, that acts via multiple-signaling pathways without any side-effects. These studies may lead to development of novel classes of drugs for treatment of chronic hepatitis C patients

Early-stage endometrial carcinoma; risk factors for recurrence

Background: Endometrial carcinoma (EC) is the most common gynecological malignancy in developed countries. The overall prognosis is excellent, as most cases are diagnosed at an early stage with low-grade histology, but once the recurrence occurs, the median survival decreases severely. Aims and Objectives: The aim of this study was to identify the risk factors associated with recurrence in early-stage EC and explore their impact on overall survival (OS) after recurrence. Materials and Methods: Records from patients diagnosed with EC were retrospectively reviewed. 220 patients were identified as early-stage, low-risk EC who underwent primary surgical treatment between January 2010 and December 2022, and their baseline characteristics were analyzed. Cox regression analysis was used to identify various factors for tumor recurrence. Survival analysis was done using the Kaplan-Meier method. Results: In a cohort of 220 patients, we observed tumor recurrence in 44 (20%) patients and 34 (15.45%) deaths over a median follow-up of 72 months (range, 12–144 months). Multivariate analysis confirmed two risk factors: myometrial invasion (MMI) of any depth and lymphovascular invasion (LVI) as independent predictors of recurrence. The prognosis was worse for patients with recurrence than for those without. The OS for the recurrent group was 38.6%, compared to 96.0% in the non-recurrent group. In our study, the median time to recurrence was 19 months (confidence interval 18–30) months. Conclusion: The presence of MMI and LVI are important predictors for recurrence in early-stage low-risk EC

Additional file 2: of δ-Tocotrienol feeding modulates gene expression of EIF2, mTOR, protein ubiquitination through multiple-signaling pathways in chronic hepatitis C patients

Table S2. Effect of d-tocotrienol on down-regulation of gene expression of "Molecules" (76-150) of IPA analyses in hepatitis C patients. (XLS 68 kb

Additional file 3: of δ-Tocotrienol feeding modulates gene expression of EIF2, mTOR, protein ubiquitination through multiple-signaling pathways in chronic hepatitis C patients

Table S3. Effect of d-tocotrienol on down-regulation of gene expression of "Molecules" (151-220) of IPA analyses in hepatitis C patients. (XLS 67 kb

Synthesis of DMEA-Grafted Anion Exchange Membrane for Adsorptive Discharge of Methyl Orange from Wastewaters

This manuscript describes the synthesis of dimethylethanolamine (DMEA)-grafted anion exchange membrane (AEM) by incorporating dimethylethanolamine as ion-exchange content into the polymer matrix via the solution casting method. The synthesis of the DMEA-grafted AEM was demonstrated by Fourier transform infrared (FTIR) spectroscopy. The prepared DMEA-grafted AEM exhibited higher thermal stability, homogeneous morphology, water uptake (WR) of 115%, and an ion exchange capacity (IEC) of 2.70 meq/g. It was used for the adsorptive removal of methyl orange (MO) from an aqueous solution via batch processing. The effect of several operating factors, including contact time, membrane dosage, initial concentration of aqueous dye solution, and temperature on the percentage discharge of MO and adsorption capacity, was evaluated. Experimental data for adsorption of MO onto the DMEA-grafted AEM was analyzed with two parameter and three parameter nonlinear adsorption isotherm models but fitted best using a nonlinear Freundlich isotherm. Adsorption kinetics were studied by using several models, and attained results showed that experimental data fitted well to pseudo-second-order kinetics. A thermodynamic study showed that adsorption of MO onto the prepared DMEA-grafted AEM was an endothermic process. Moreover, it was a feasible and spontaneous process

Synthesis of DMEA-Grafted Anion Exchange Membrane for Adsorptive Discharge of Methyl Orange from Wastewaters

This manuscript describes the synthesis of dimethylethanolamine (DMEA)-grafted anion exchange membrane (AEM) by incorporating dimethylethanolamine as ion-exchange content into the polymer matrix via the solution casting method. The synthesis of the DMEA-grafted AEM was demonstrated by Fourier transform infrared (FTIR) spectroscopy. The prepared DMEA-grafted AEM exhibited higher thermal stability, homogeneous morphology, water uptake (WR) of 115%, and an ion exchange capacity (IEC) of 2.70 meq/g. It was used for the adsorptive removal of methyl orange (MO) from an aqueous solution via batch processing. The effect of several operating factors, including contact time, membrane dosage, initial concentration of aqueous dye solution, and temperature on the percentage discharge of MO and adsorption capacity, was evaluated. Experimental data for adsorption of MO onto the DMEA-grafted AEM was analyzed with two parameter and three parameter nonlinear adsorption isotherm models but fitted best using a nonlinear Freundlich isotherm. Adsorption kinetics were studied by using several models, and attained results showed that experimental data fitted well to pseudo-second-order kinetics. A thermodynamic study showed that adsorption of MO onto the prepared DMEA-grafted AEM was an endothermic process. Moreover, it was a feasible and spontaneous process

Adsorption kinetic, equilibrium and thermodynamic studies of eosin-B onto anion exchange membrane

In this research, batch adsorption of anionic dye Eosin-B (EB) onto anion exchange membrane (AEM) (BI) from aqueous solution has been investigated at room temperature. The effect of some operating conditions such as contact time, membrane dosage, initial dye concentration and temperature on the percentage removal of EB from aqueous solution has been investigated in detail. Moreover, adsorption kinetics has been analyzed using different models such as pseudo-first-order, pseudo-second-order, Elovich, liquid film diffusion, modified Freundlich and Bangham models. Results show that adsorption data fits to the pseudo-second order kinetics very well. Non-linear isotherms containing two parameters and three parameters isotherms have been applied on experimental data. Different thermodynamic parameters such as Gibb’s free energy (DG°), enthalpy (DH°), and entropy (DS°) have been calculated, which shows that adsorption of EB onto anion exchange membrane (B1) is an exothermic process.The authors are highly thankful to the CAS-TWAS President's fellowship for PhD financial support.Scopu