Ischemia-reperfusion injury in an aortic dissection patient

Aortic dissection is a life-threatening emergency. Well-established risk factors include systemic hypertension, hereditary connective tissue diseases (Marfan syndrome and Ehlers-Danlos syndrome), coarctation of the aorta, bicuspid aortic valve, aortitis, and arch hypoplasia. Ischemia of the viscera, the kidneys, the spinal cord, or the lower extremities due to malperfusion constitutes life-threatening complications that have to be considered in the treatment strategy.We report a rare case of symptomatic ischemia of the lower extremities due to aortic dissection. This case demonstrates that the treating physician needs to be vigilant for ischemia reperfusion injuries such as osteofascial compartment syndrome and acute renal failure in aortic dissection.

[Clinical observation of haploidentical-hematopoietic stem cell transplantation combined with human umbilical cord-derived mesenchymal stem cells for severe aplastic anemia-II]

This study was purposed to investigate the efficacy and safety of haploidentical hematopoietic stem cells (allo-HSCT) transplantation combined with human umbilical cord-derived mesenchymal stem cell infusion (hUC-MSC) for severe aplastic anemia-II (SAA-II). Eight SAA-II patients received haploidentical allo-HSCT, the G-CSF mobilized peripheral hematopoietic stem cells and bone marrow haploidentical hematopoietic stem cells were selected as graft, the human umbilical cord-derived mesenchymal stem cells (hUC-MSC) were infused as the third party. Conditioning regimen consisted of rabbit anti-thymic lymphocytes protein(ATG), cyclophosphamide(CTX) and fludarabine(Flu). For two patients out of 8 SAA-II patients the conditioning regimen was combined with busulfan(BU). The graft versus host disease(GVHD) was prevented with CSA, MTX, ATG, CD25 and mycophenolate mofetil. The results showed that the average number of nucleated cells were 9.13×10(8)/kg, and number of CD34(+)cells were 3.76×10(6)/ kg. All the 8 SAA-II patients achieved hematopoietic reconstitution. The average time of neutrophils count>0.5×10(9)/L was 11.9 days, and average time of Plt level >20×10(9)/L was 14.6 days. The incidence of acute GVHD of I-II grade was 25%, and that of III-IVgrade was 12.5%, the transplantation-related mortality was 25%. It is concluded that haploidentical allo-HSCT combined with umbilical cord MSC infusion is an effective approach to cure SAA.

[Transplantation of umbilical cord mesenchymal stem cells combined with haploidentical hematopoietic stem cells for 36 patients with refractory/relapsed myeloid leukemia]

This study was purposed to analyse the clinical efficacy of transplantation of umbilical cord mesenchymal stem cells (UC-MSC) combined with haploidentical hematopoietic stem cells (haplo-HSCT) for patients with refractory/relapsed myeloid leukemia. The clinical data of 36 patients received transplantation of UC-MSC combined with haplo-HSCT from January 2007 to June 2013 were summarized retrospectively, the engraftment, GVHD and 2 years-overall survival (OS) were analysed. The results showed that the median times of neutrophil count>0.50×10(9)/L and platelet count>20×10(9)/L were 12.0 days and 14.0 days, respectively. Grade III to IV aGVHD occurred in 5 out of 36 patients (13.8%). cGVHD occurred in 12 out of 32 patients (37.5%) and extensive cGVHD occurred in 2 patients. Additionally, only 3 patients (8.3%) experienced relapse. The 2-year OS rate of patients was 76.9%. It is concluded that the transplantation of UC-MSC combined with haplo-HSCT has good therapeutic efficacy for patients with refractory/relapsed myeloid leukemia, and may be served as a therapeutic method especially for patients with high risk and without well matched donor.

Relationship between self-reported residential indoor remodeling and semen quality: a case-control study

The present study examined the association between residential indoor remodeling and poor semen quality. Sperm donors aged 18–45 years old were recruited in Shanghai, China. Semen specimens were collected and analyzed. An in-person interview was conducted to obtain information on the history of indoor remodeling and potential confounders. A total of 70 participants with abnormal semen quality (case group) and 68 controls were examined. A total of 20 subjects reported indoor remodeling in the recent 24 months, and among them 17 subjects reported indoor remodeling in the recent 12 months. Compared with participants with no history of indoor remodeling, participants with a history of indoor remodeling in the recent 24 months were more than three times as likely to have poor sperm quality (adjusted odds ratio = 3.8, 95% confidence interval: 1.3–12.0) after controlling for potential confounders. The association was strengthened when the analysis was restricted to those who had indoor remodeling in the recent 12 months. Our findings provide preliminary evidence that indoor remodeling has an adverse effect on semen quality.

Safety, tolerability, and pharmacokinetics of a single ascending dose of baicalein chewable tablets in healthy subjects

ETHNOPHARMACOLOGICAL RELEVANCE

The root of Scutellaria baicalensis Georgi has been used extensively in traditional Chinese medicine for the treatment of inflammation, fever, cough, dysentery, and hypertension. Baicalein is a flavonoid isolated from the root of Scutellaria baicalensis Georgi and is a novel neuroprotective agent under development for the treatment of Parkinson׳s disease. We aimed to investigate the pharmacokinetic (PK) properties of baicalein and its main metabolite, bacalin, after single-dose administration in healthy Chinese subjects. The safety and tolerability of baicalein were also assessed.

MATERIALS AND METHODS

This was a Phase I, randomized, double-blind, single-dose trial of baicalein (100-2800 mg) in 72 healthy adults. Samples of blood, urine and feces were collected at regular intervals up to 48 h after administration of the study drug. Baicalein and baicalin were then analyzed using liquid chromatography-tandem mass spectrometry (LC/MS/MS). The maximum concentration that the drug achieved after dosing (Cmax), time to Cmax (Tmax), terminal half-life (t₁/₂), area under the curve from time zero to time of last quantifiable concentration (AUC(0, t)), area under the curve from time zero to infinity (AUC(0, ∞)), apparent total plasma clearance (CL/F), and apparent total volume of distribution (V/F) were determined using non-compartmental models. Dose proportion was tested using a method combining the equivalence criterion and power model. Physical examinations, vital signs, ECG findings, hematology, and urinalysis were monitored before and at regular intervals after administration of the study drug.

RESULTS

The PK profile of baicelein and baicelin was characterized by a median Tmax of 0.75-3.5 h and 0.5-3 h, respectively, followed by a multiphasic profile with a t₁/₂ of 1.90-15.01 h and 4.22-10.80 h, respectively. The estimates of the proportionality coefficient (90% CI) for Cmax, AUC₀-t and AUC₀-∞ were 0.83 (0.70-0.96), 0.91 (0.81-1.00) and 0.92 (0.82-1.02), respectively. All values overlapped within the pre-specified range of (0.89-1.11), (0.93-1.07), and (0.93-1.07), respectively. Dose proportionality was inconclusive for a baicalein dose range of 100-2800 mg. The total urinary clearance of baicalein and baicalin was <1%. Approximately 27% of baicalein was eliminated as unchanged drug in feces. Baicalein was well tolerated. Eleven treatment-related adverse events were observed, and all were rated as "mild" and resolved without further treatment. No serious adverse events occurred.

CONCLUSIONS

Single oral doses of 100-2800 mg of baicalein were safe and well tolerated by healthy subjects. Clinical laboratory assessments showed no signs of toxicity in the liver or kidney. The favorable safety profile and PK properties warrant further clinical studies for baicalein.

A new subtype of crossed fused ectopia of the kidneys

Crossed fused renal ectopia is a rare congenital anomaly; here, we report a new subtype of crossed fused renal ectopia associated with the retroiliac megaureter and thoracic scoliosis deformity. It is beyond the traditional classification of crossed fused renal ectopia. There are 2 kidneys in the left and hydronephrosis of the upper kidney, the right kidney crossed over and fused with the lower kidney of the left. It is never seen in previous reports. Recurrent infection was cured by resecting the hydronephrosis of the upper kidney and retroiliac megaureter.

Bosentan protects the spinal cord from ischemia reperfusion injury in rats through vascular endothelial growth factor receptors

STUDY DESIGN

Experimental study.

OBJECTIVES

To investigate whether Bosentan, an endothelin-A/-B dual receptor antagonist, could protect neurons after spinal cord ischemia reperfusion (SCIR) injury in rats and its underlying signaling pathway.

SETTING

Department of Neurosurgery, the Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi Province, China.

METHODS

Sprague-Dawley rats were randomly divided into two groups, saline group (IRS, n=48) and Bosentan group (IRB, 5 mg kg(-1), n=48). After ischemia for 1 h with occlusion of the infrarenal aorta, spinal cord were reperfused for 6h, 12h, 24h, 3d, 5d, and 7d separately. Enzyme-linked immunosorbent assay was used to detect vascular endothelial growth factor (VEGF) in serum. Immunohistochemistry was performed to detect protein expression of VEGF, VEGF receptor 1 (FLT-1) and VEGF receptor 2 (FLK-1). Gene expressions of VEGF and its receptors were evaluated using the quantitative reverse transcription polymerase chain reaction.

RESULTS

Compared with the IRS group, gene and protein expressions of VEGF, FLT-1 and FLK-1 were significantly increased (P<0.05), so was the concentration of VEGF in plasma (P<0.05). FLK-1 was expressed on spinal cord neurons.

Minimising time to treatment: targeted strategies to minimise time to thrombolysis for acute ischaemic stroke

Time to thrombolysis is a critical determinant of favourable outcomes in acute ischaemic stroke. It is not infrequent that patient outcomes are compromised due to out-of-hospital and in-hospital time delays. On the other hand, time delays could be minimised through the identification of barriers and the implementation of targeted solutions. This review outlines the different strategies in minimising treatment delays and offers recommendations. Literature search in PubMed, Medline and EBSCO Host was conducted to identify studies that are relevant to reduction of time to treatment from January 1995 to December 2012. Strategies to reduce time to thrombolysis are categorised into pre-hospital strategies, in-hospital strategies and post-treatment decision strategies. Proposed pre-hospital strategies include public education on stroke symptoms awareness, prioritising stroke by emergency medical services, increasing ease of access to medical records, pre-hospital notification, and mobile computed tomography scanning. In-hospital strategies include a streamlined code stroke system, computed tomography scanner co-location with emergency department, 24/7 availability of stroke physicians, point-of-care laboratory testing and access to expert neuroimaging interpretation. Post-decision strategies include increasing availability of intravenous thrombolysis and simplification of informed consent procurement. Time to thrombolysis delays is multifactorial. Effective reduction of time delays for acute ischaemic stroke requires the correct identification of and targeted strategies to overcome time barriers.

Chromosome 12p13 variants predict recurrence of ischaemic stroke in a Chinese population

BACKGROUND AND PURPOSE

A recent genome-wide association study identified two genetic variants (rs12425791 and rs11833579) on chromosome 12p13 that confer risk of ischaemic stroke. The purpose of this study was to examine whether these two polymorphisms are associated with stroke onset and prognosis in a Chinese population.

METHODS

rs12425791 and rs11833579 were genotyped using the improved multiple ligase detection reaction in 913 patients with ischaemic stroke. Analyses of genotype association with onset and prognosis outcomes were evaluated by the Kaplan-Meier method, the log-rank test and Cox proportional hazards models.

RESULTS

rs12425791 and rs11833579 were not associated with age of stroke onset (P = 0.786 and 0.340, respectively). However, these two polymorphisms were significantly associated with risk of stroke recurrence, especially for the large-artery atherosclerosis (LAA) subtype, in recessive models [hazard ratio (HR) 2.52; 95% confidence interval (CI) 1.04-6.12 for rs12425791; HR 2.13; 95% CI 1.03-4.40 for rs11833579]. The combined genotype of these two single-nucleotide polymorphisms showed a locus-dosage effect on recurrence of LAA subtype and was an independent prognostic factor for LAA subtype in the final multivariate Cox regression model.

CONCLUSIONS

These findings indicated that rs12425791 and rs11833579 on chromosome 12p13 may be useful biomarkers for predicting the prognosis of patients with the LAA subtype of ischaemic stroke.

[Transplantation of haploidentical-hematopoietic stem cells combined with two kind of third part cells for chronic aplastic anemia: one case report]

This study was purposed to investigate the safety and effectivity of haploidentical stem cell transplantation for chronic aplastic anemia (CAA) by using two kind of third part cells: umbilical cord derived mesenchymal stem cells (hUC-MSC) and haploidentical umbilical cord blood cells. The patient is a girl of 12 year old with CAA for 11 years. The donor was her mother. Graft come from haploidentical hematopoietic bone marrow and peripheral blood mobilized with granulocyte colony-stimulating factor (G-CSF). The human umbilical cord derived mesenchymal stem cells and the haploidentical umbilical cord blood cells were transferred as third pard of cell. The graft-versus-host disease (GVHD) was prevented with CsA, MTX, ATG, CD25 and mycophenolate mofetil. The results indicated that the infused numbers of MNC and CD34(+) cells of donor were 7.92×10(8)/kg and 3.78×10(6)/kg, respectively. The numbers of neutrophils and platelets were over 0.5×10(9)/L and 20×10(9)/L on days 12 and 14, respectively. On day 35 the chimeras accounted for 94%. No serious complications appeared up to now. In conclusion, the preliminary results suggest that transplantation of haploidentical hematopoietic stem cells combined with two kind of third part cells is safe and satisfactory.

Relative filling time delay based on CT perfusion source imaging: a simple method to predict outcome in acute ischemic stroke

BACKGROUND AND PURPOSE

Collateral vessel status is strongly associated with clinical outcome in ischemic stroke but can be challenging to assess. The aim of this study was to develop a tomography perfusion source imaging-based assessment of collateral vessel status.

MATERIALS AND METHODS

Consecutive patients with ischemic stroke who received intravenous thrombolysis or intra-arterial reperfusion therapy after CTP were retrospectively analyzed. In those with middle cerebral artery or internal carotid artery occlusion, CT perfusion source imaging was used to identify the relative filling time delay between the normal MCA Sylvian branches and those in the affected hemisphere. Receiver operating characteristic analysis and logistic regression were used to assess the association of the relative filling time delay with the 24-hour Alberta Stroke Program Early CT Score based on noncontrast CT and the 90-day modified Rankin Scale score.

RESULTS

There were 217 patients treated in 2009-2011 who had CTP data, of whom 60 had MCA or ICA occlusion and 55 had 90-day mRS data. The intraclass correlation coefficient for relative filling time delay was 0.95. Relative filling time delay was correlated with 24-hour ASPECTS (Spearman ρ=-0.674; P<.001) and 90-day mRS score (ρ=0.516, P<.01). Increased relative filling time delay was associated with poor radiologic outcome (ASPECTS, 0-7) (area under the curve=0.79, P<.001) and poor functional outcome (mRS score, 3-6) (area under the curve=0.77, P=.001). In multivariate logistic regression, the association of longer relative filling time delay with poor outcome remained significant, independent of age, sex, and baseline National Institutes of Health Stroke Scale score.

CONCLUSIONS

Relative filling time delay is a useful independent predictor of clinical outcome after ischemic stroke.

The impact of arterial collateralization on outcome after intra-arterial therapy for acute ischemic stroke

BACKGROUND AND PURPOSE

Although intra-arterial therapy for acute ischemic stroke is associated with superior recanalization rates, improved clinical outcomes are inconsistently observed following successful recanalization. There is emerging concern that unfavorable arterial collateralization, though unproven, predetermines poor outcome. We hypothesized that poor leptomeningeal collateralization, assessed by preprocedural CTA, is associated with poor outcome in patients with acute ischemic stroke undergoing intra-arterial therapy.

MATERIALS AND METHODS

We retrospectively analyzed patients with acute ischemic stroke with intracranial ICA and/or MCA occlusions who received intra-arterial therapy. The collaterals were graded on CTA. Univariate and multivariate analyses were used to investigate the association between the dichotomized leptomeningeal collateral score and functional outcomes at 3-months mRS ≤2, mortality, and intracranial hemorrhages.

RESULTS

Eighty-seven patients were included. The median age was 66 years (interquartile range, 54-76 years) and the median NIHSS score at admission was 18 (interquartile range, 14-20). The leptomeningeal collateral score 3 was found to have significant association with the good functional outcome at 3 months: OR = 3.13; 95% CI, 1.25-7.825; P = .016. This association remained significant when adjusted for the use of IV tissue plasminogen activator: alone, OR = 2.998; 95% CI, 1.154-7.786; P = .024; and for IV tissue plasminogen activator and other confounders (age, baseline NIHSS score, and Thrombolysis in Cerebral Infarction grades), OR = 2.985; 95% CI, 1.027-8.673; P = .045.

CONCLUSIONS

We found that poor arterial collateralization, defined as a collateral score of <3, was associated with poor outcome, after adjustment for recanalization success. We recommend that future studies include collateral scores as one of the predictors of functional outcome.

[Occurrence and survival condition of lung cancer with different histologies among residents in Pudong new area]

背景与目的

不同组织学类型肺癌患者发病特点、预后情况不同。本研究旨在分析不同组织学类型肺癌患者发病情况、发病趋势、生存期及其影响因素，为病因学研究和临床防治提供参考依据。

方法

以2002年-2009年上海市浦东新区居民为研究对象，利用年度变化百分比进行肺癌发病趋势分析。通过寿命表法计算生存率，以Log-rank检验生存曲线差异。

结果

该地区同期肺癌男女标化发病率分别为52.28/10万和18.86/10万，明确组织学分型的肺癌患者中位生存期为410.72天。腺癌发病率最高并成上升趋势（P < 0.05）。小细胞癌生存情况最差。原南汇地区男性鳞癌生存情况较好。

结论

不同组织学类型肺癌发病趋势和生存期并不相同，性别、年龄、居住地对不同组织学类型肺癌患者生存期有影响。

Modelling and predicting the biological effects of nanomaterials

The commercial applications of nanoparticles are growing rapidly, but we know relatively little about how nanoparticles interact with biological systems. Their value--but also their risk--is related to their nanophase properties being markedly different to those of the same material in bulk. Experiments to determine how nanoparticles are taken up, distributed, modified, and elicit any adverse effects are essential. However, cost and time considerations mean that predictive models would also be extremely valuable, particularly assisting regulators to minimize health and environmental risks. We used novel sparse machine learning methods that employ Bayesian neural networks to model three nanoparticle data sets using both linear and nonlinear machine learning methods. The first data comprised iron oxide nanoparticles decorated with 108 different molecules tested against five cell lines, HUVEC, pancreatic cancer, and three macrophage or macrophage-like lines. The second data set comprised 52 nanoparticles with various core compositions, coatings, and surface attachments. The nanoparticles were characterized using four descriptors (size, relaxivities, and zeta potential), and their biological effects on four cells lines assessed using four biological assays per cell line and four concentrations per assay. The third data set involved the biological responses to gold nanoparticles functionalized by 80 different small molecules. Nonspecific binding and binding to AChE were the biological endpoints modelled. The biological effects of nanoparticles were modelled using molecular descriptors for the molecules that decorated the nanoparticle surface. Models with good statistical quality were constructed for most biological endpoints. These proof-of-concept models show that modelling biological effects of nanomaterials is possible using modern modelling methods.

Suppressing the loss of ultracold molecules via the continuous quantum Zeno effect

We investigate theoretically the suppression of two-body losses when the on-site loss rate is larger than all other energy scales in a lattice. This work quantitatively explains the recently observed suppression of chemical reactions between two rotational states of fermionic KRb molecules confined in one-dimensional tubes with a weak lattice along the tubes [Yan et al., Nature (London) 501, 521 (2013)]. New loss rate measurements performed for different lattice parameters but under controlled initial conditions allow us to show that the loss suppression is a consequence of the combined effects of lattice confinement and the continuous quantum Zeno effect. A key finding, relevant for generic strongly reactive systems, is that while a single-band theory can qualitatively describe the data, a quantitative analysis must include multiband effects. Accounting for these effects reduces the inferred molecule filling fraction by a factor of 5. A rate equation can describe much of the data, but to properly reproduce the loss dynamics with a fixed fillingfraction for all lattice parameters we develop a mean-field model and benchmark it with numerically exacttime-dependent density matrix renormalization group calculations.

Ultrasmall and monodisperse colloidal amorphous Nd–Fe–B–Na magnetic nanoparticles with high TC

Ultrasmall and monodisperse air-stable colloidal Nd–Fe–B nanoparticles have been synthesized by the solution phase colloidal method and characterized by TEM and SQUID. Their size can be controlled in the sub-5 nm regime. The critical temperature (T_C) of Nd–Fe–B nanoparticles with 3 nm diameter is surprisingly high, higher than 650 K.