Abnormal regulation of gene expression is essential for tumorigenesis. Recent studies indicate that regulation of oncogene expression and neoplastic transformation are controlled by subunits of eukaryotic translation initiation factors (eIFs). Here we focused on eIF3 performing a pivotal role in protein synthesis and the differential expression of its subunits in cancer. The most uncharacterized non-core subunit eIF3m was confirmed to be highly expressed in human cancer cell lines and colon cancer patient tissues. By expression silencing with eIF3m-specific small interfering RNA (siRNA), we confirmed that eIF3m influences cell proliferation, cell cycle progression and cell death in human colon cancer cell line HCT-116. Using a ribonomics approach, we identified a subset of elF3m-influenced genes and showed that the expression of two highly represented tumorigenesis-related genes, MIF and MT2, were affected by eIF3m at the mRNA level. We also confirmed eIF3m-dependent regulation of MT2A downstream molecule CDC25A, which is necessary for cell cycle progression in HCT-116 cells. These results suggest that eIF3m mediates regulation of tumorigenesis-related genes in human colon cancer. Further investigations on tumorigenesis-related genes and their regulation by eIFs will provide clues for designing targeted therapy for cancer.
This study compared demand-valve nitrous oxide (Entonox) with intravenous regional anaesthesia (IVRA) as analgesia in adults with distal radius fractures requiring manipulation and reduction (M&R) in the Emergency Department. Materials and methods: All adults presenting to the Emergency Department of Changi General Hospital, Singapore between August to December 2000 with closed distal radius fractures requiring M&R were enrolled. Five parameters were measured: pain perception using visual analogue scale (VAS), patient acceptance, procedure time, complication rate and failed manipulation. Results: Of the 67 patients enrolled, 32 received IVRA and 35 received Entonox. The average VAS was 2.2 cm for the IVRA group and 5.8 cm for the Entonox group (p<0.0001). The average procedure time was 25.6 minutes for the IVRA group and 11.1 minutes for the Entonox group (p<0.0001). Twenty-seven IVRA patients (84.4%) and 24 Entonox patients (68.6%) would agree to the same analgesia given similar circumstances (p=0.159). Four patients who received Entonox (11.4%) experienced minor complications, while no complications were noted in the IVRA group (p=0.115). Two patients who received IVRA (6.3%) and 8 patients who received Entonox (22.9%) required more than a single attempt at M&R (p=0.086). Conclusion: The use of Entonox, compared to IVRA, was associated with significantly shorter procedure time but significantly higher pain scores, with no significant difference in terms of patient acceptance, complication rate or failed manipulation rate. Entonox is an effective analgesic alternative to IVRA in adult patients requiring M&R for distal radius fractures in the Emergency Department. Its use is ideal in situations where IVRA is unsuitable or contraindicated.
Isolated posterior acute myocardial infarction (AMI) is rare and possibly underdiagnosed. The incidence of misdiagnosis in the emergency department (ED) is unknown. Delayed diagnosis may prevent timely treatment, particularly emergent fibrinolytic therapy. We describe the experience of an urban ED on this rare condition. Methodology: A six years and seven months case series of isolated posterior AMI of initial presentation (as identified by inpatient discharge/death ICD-9-CM diagnosis code) was studied. Patients not admitted from the ED, those who developed isolated posterior AMI only after admission and/or those with concomitant ST segment elevation AMI involving other anatomical locations of the heart (e.g. inferior or lateral walls), were excluded. Results: Eleven cases were included in the study. All the nine cases with electrocardiograms available for review demonstrated features consistent with isolated posterior AMI. Eight out of the eleven (72.7%) cases were correctly diagnosed as isolated posterior AMI in the ED. The other three cases were treated as non-ST elevation myocardial infarction (NSTEMI). Nevertheless, their lack of the typical symptoms of acute coronary syndrome and delayed presentation (more than 12 hours) precluded them from fibrinolytics. Three of the eleven cases received fibrinolytics (all streptokinase). All three cases survived to discharge and there were no haemorrhagic complications. None of the cases underwent emergent percutaneous coronary intervention. Conclusion: The majority of cases with isolated posterior AMI (72.7%) were diagnosed in the ED. Although three cases were interpreted as NSTEMI, the use of fibrinolytic reperfusion therapy was not affected.
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