Metabolic consequences of body size and body composition in hemodialysis patients

Small body mass index is associated with increased mortality in chronic hemodialysis patients. The reasons for this observation are unclear but may be related to body composition. This study aimed to investigate the body composition in chronic hemodialysis patients. The difference between body mass and the sum of muscle, bone, subcutaneous, and visceral adipose tissue masses, measured by whole body magnetic resonance imaging, was defined as the high metabolic rate compartment representing the visceral mass. Protein catabolic rate was calculated from urea kinetics. Forty chronic hemodialysis patients (mean age 54.7 years; 87.5% African Americans; 45% females) were studied. High metabolic rate compartment expressed in percent of body weight was inversely related to body weight (r=-0.475; P=0.002) and body mass index (r=-0.530; P<0.001). In a multiple linear regression model, protein catabolic rate was significantly correlated only with high metabolic rate compartment (r=0.616; P<0.001). Assuming that protein catabolic rate in addition to protein intake reflects urea and uremic toxin generation, it follows that high metabolic rate compartment is the major compartment involved in their generation. Consequently, uremic toxin production rate may be relatively higher in patients with low body weight and low body mass index as compared to their heavier counterparts. The poorer survival observed in smaller dialysis patients may be related to these relative differences.

Measuring partial body potassium in the arm versus total body potassium

Skeletal muscle (SM), the body's main structural support, has been implicated in metabolic, physiological, and disease processes in humans. Despite being the largest tissue in the human body, its assessment remains difficult and indirect. However, being metabolically active it contains over 50% of the total body potassium (TBK) pool. We present our preliminary results from a new system for measuring partial body K (PBK) that presently are limited to the arm yet provide a direct and specific measure of the SM. This uniquely specific quantification of the SM mass in the arm, which is shielded from the body during measurement, allows us to simplify the assumptions used in deriving the total SM, thereby possibly improving the modeling of the human body compartments. Preliminary results show that PBK measurements are consistent with those from the TBK previously obtained from the same subjects, thus offering a simpler alternative to computed tomography and magnetic resonance imaging used for the same purposes. The PBK system, which can be set up in a physician's office or bedside in a hospital, is completely passive, safe, and inexpensive; it can be used on immobilized patients, children, pregnant women, or other at-risk populations.

Human platelet alloantigen systems in three Chinese ethnic populations

Knowledge of the prevalence of human platelet antigens (HPA) in different populations is important for effective diagnosis and management of immune-mediated platelet disorders. The purpose of this study was to determine HPA gene frequencies in the majority Han ethnic population of China and in ethnic She and Tajik minority populations. Using PCR sequence specific primers, HPA- 1, -2, -3, -4, -5, and -6, we determined genotypes for ethnic Han, She, and Tajik blood donors. HPA gene frequencies for Chinese Han were found to be similar to those of She, reflecting the historic affinities of these two populations. HPA gene frequencies for Tajik were closer to those for Caucasians than to Chinese Han, She, or other Asian populations, reflecting their disparate origin and historic geographic isolation. HPA gene frequencies in these Chinese populations reflect their historic origins. Knowledge of these findings may be used to better understand and treat immune-mediated platelet disorders in these populations.

Application of Bioimpedance Techniques to Peritoneal Dialysis

Peritoneal dialysis (PD) has been used as a home dialysis therapy for renal replacement for more than 30 years. In a recent assessment of treatment quality, the mortality of patients on PD was referenced as being higher than of those on hemodialysis. Several reports suggest that a high proportion of PD patients are overhydrated. Clinical assessment of dry weight in PD patients is difficult and further complicated by the paucity of signs and symptoms indicative of dehydration (such as intradialytic hypotension or muscle cramps). Monitoring tools used for fluid status estimation during hemodialysis, e.g. online blood volume and blood pressure measurement, are not readily available in PD patients. Bioimpedance analysis technique has been considered as a potential tool to measure body fluid non-invasively, inexpensively and simply. Although Bioimpedance analysis has been used in clinical studies for more than 20 years, the knowledge of the electrical properties of body tissues is still evolving. In this review we aim to clarify the principles of different bioimpedance techniques and to introduce their applications in PD patients.

Proving the concept of a data broker as an emergent alternative to supra-enterprise EPR systems

Electronic Patient Records systems configured into large enterprise models have become the assumed best route forward. In England, as in several other countries, this has expanded to a major meta-enterprise procurement programme. However, concerns are raised that such systems lack user ownership, and experience from other sectors shows difficulties with large enterprise systems. At a time of great change and once again shifting organizations, is this move simply building large and ponderous edifices with unstable materials? Latest software engineering research is now demonstrating the potential of an alternative model, enabling trusted information brokers to search out in real time at point of use data held in registered local and departmental systems. If successful, this could enable a new and less cumbersome paradigm. The data could move where needed whatever the service configuration. A concept demonstrator has been built set in the context of health and social care in England. It is important for all technological support to the health sector to be reviewed as new technologies emerge so as to identify and exploit new opportunities, and the results of this 3 year project show that the health record information broker route merits further investigative research.

Segment-specific resistivity improves body fluid volume estimates from bioimpedance spectroscopy in hemodialysis patients

Discrepancies in body fluid estimates between segmental bioimpedance spectroscopy (SBIS) and gold-standard methods may be due to the use of a uniform value of tissue resistivity to compute extracellular fluid volume (ECV) and intracellular fluid volume (ICV). Discrepancies may also arise from the exclusion of fluid volumes of hands, feet, neck, and head from measurements due to electrode positions. The aim of this study was to define the specific resistivity of various body segments and to use those values for computation of ECV and ICV along with a correction for unmeasured fluid volumes. Twenty-nine maintenance hemodialysis patients (16 men) underwent body composition analysis including whole body MRI, whole body potassium (40K) content, deuterium, and sodium bromide dilution, and segmental and wrist-to-ankle bioimpedance spectroscopy, all performed on the same day before a hemodialysis. Segment-specific resistivity was determined from segmental fat-free mass (FFM; by MRI), hydration status of FFM (by deuterium and sodium bromide), tissue resistance (by SBIS), and segment length. Segmental FFM was higher and extracellular hydration of FFM was lower in men compared with women. Segment-specific resistivity values for arm, trunk, and leg all differed from the uniform resistivity used in traditional SBIS algorithms. Estimates for whole body ECV, ICV, and total body water from SBIS using segmental instead of uniform resistivity values and after adjustment for unmeasured fluid volumes of the body did not differ significantly from gold-standard measures. The uniform tissue resistivity values used in traditional SBIS algorithms result in underestimation of ECV, ICV, and total body water. Use of segmental resistivity values combined with adjustment for body volumes that are neglected by traditional SBIS technique significantly improves estimations of body fluid volume in hemodialysis patients.

FCGR3B polymorphism in three ethnic Chinese populations

Fc gamma RIIIb receptor is expressed primarily on neutrophils as three polymorphic antigens (HNA-1a, HNA-1b, and HNA-1c) that are encoded by alleles FCGR3B*1, FCGR3B*2, and FCGR3B*3, respectively. These antigens play an important role in immune neutropenia; their absence predisposes individuals who lack them to life-threatening infections. This study investigated the FCGR3B gene frequencies in three ethnic Chinese populations: Han, She, and Tajik. FCGR3B*1, FCGR3B*2, and FCGR3B*3 were genotyped by PCR using sequence specific primers (PCR-SSP). The results showed the gene frequencies were 0.55 for FCGR3B*1 and 0.45 for FCGR3B*2 in 177 Han individuals, 0.69 for FCGR3B*1 and 0.31 for FCGR3B*2 in 87 She individuals, and 0.35 for FCGR3B*1 and 0.65 for FCGR3B*2 in 99 Tajik individuals, respectively. The FCGR3Bnull genotype was not found, but the FCGR3B*3 allele was identified in only three individuals in the Tajik population. DNA clone and sequencing confirmed that these individuals had the C ==>A mutation at position 266 on exon 3. This study found that the gene frequencies in Han and She ethnic groups were similar to those previously reported in the Asian population, but the FCGR3B allele frequencies in the Tajik population were more similar to that of Caucasians.

ABO, Rh, MNS, Duffy, Kidd,Yt, Scianna, and Colton blood group systems in indigenous Chinese

The frequencies of selected alleles in the ABO, Rh, MNS, Duffy, Kidd, Yt, Scianna, and Colton blood group systems were determined among four indigenous Chinese ethnic populations: Han, Tajik, She, and Yugu. Genotypes were determined by PCR or PCR with sequence specific primers (PCR-SSP). In the Han population, the frequencies of A1, A2, B, and O1 alleles were 0.189, 0.003, 0.170, and 0.638, respectively, and the O2 allele was not identified. Among D+ Hans, the frequencies of C and c alleles were 0.67 and 0.33 and the frequencies of E and e were 0.22 and 0.78, respectively. Among D- Hans, the frequencies of C and c alleles were 0.23 and 0.77 and the frequencies of E and e were 0.04 and 0.96, respectively. The frequencies of M and N alleles were 0.478 and 0.522 among Hans and 0.655 and 0.345 among Tajiks, respectively. The frequencies of Fya and Fyb alleles were 0.94 and 0.06 among Hans and 0.98 and 0.02 among Shes, respectively. The frequencies of Jka and Jkb alleles were 0.49 and 0.51 among Hans and 0.56 and 0.44 among Shes, respectively. The frequency of the Yta allele was 1.00 among Hans. The frequencies of Yta and Ytb alleles were 0.94 and 0.06 among Tajiks, respectively. The frequency of the Sc1 allele was 1.00 in both Han and Tajik ethnic populations. The frequency of the Coa allele was 1.00 in Han, She, and Tajik ethnic populations.

Adhesiveness of dental resin-based restorative materials investigated with atomic force microscopy

This study aimed to show that the polymerization contraction of dental methacrylate-based materials, when used as adhesives on hard substrate, produces voids at the material-substrate interface. This phenomenology is closely related with the nanoleakage and the sealing ability of these materials. One prime/bond system, three restorative composite resins, and one orthodontic bonding system were cured by using mirror-like glass slides as a compliance-free reference substrate. The adhesive surface was analyzed by atomic force microscopy, and the polymerization contraction of bulk material was tested by laser beam-scanning method. Nanoperiodic structure of three-dimensional (3D) images, section analysis, and roughness characteristics (R(a) and R(z)) indicated that polymerization contraction produced voids at the interface. When the adhesive surface was exposed to oral simulating fluids (water, ethanol, and lactic acid solutions), hydrolytic degradation involved some hundreds of nanometers in depth. In visible light-cured (VLC) materials, the interface porosity decreased when an irradiation pause ( approximately 2 min) was carried out during gelation.

Experimental studies of the material properties of the forewing of cicada(Homóptera, Cicàdidae)

Detailed investigations on the structural and mechanical properties of the forewing of the cicada were carried out. Measurement of the structures of the wings showed that the thickness of the membrane of each cell and the diameter of each vein were non-uniform in both the longitudinal and transverse directions, and their means were approximately 12.2 and 133.3 μm,respectively. However, the aspect ratios of the wings and the bodies were quite uniform and were approximately equal to 2.98 and 2.13, respectively. Based on the measured thickness, mass and area of the membranes of the cells,the mean density and the mean area density of the wing were approximately 2.3 g cm-3 and 2.8×10-3 g cm-2,respectively. In addition, the diameters of the veins of the wings, including the diameters of the holes in the vein of the leading edge, were examined. The mechanical properties of the wing were investigated separately by nanoindentation and tensile testing. The results indicated that the mean Young's modulus, hardness and yield stress of the membranes of the wings were approximately 3.7 GPa, 0.2 GPa and 29 MPa, respectively, and the mean Young's modulus and strength of the veins along the direction of the venation of wings were approximately 1.9 GPa and 52 MPa, respectively. Finally, the relevant results were briefly analyzed and discussed, providing a guideline to the biomimetic design of the aerofoil materials of micro air vehicles.

Current status of coronary multislice CT angiography

Multislice computed tomography (MSCT) is an emerging technique which has an enormous potential to improve the current practice of coronary artery imaging. This article reviews the current status of coronary MSCT angiography (MSCTA) with emphasis on the imaging techniques and clinical utilities of 16-slice CTA. Results and experiences gained from coronary MSCTA in the past few years have taught us that accurate diagnosis of coronary artery disease relies on good technical studies and can be achieved by optimizing image parameters including image timing and image reconstruction ECG-trigger delay. Current clinical applications of coronary MSCTA include: quantitative assessment of coronary artery stenosis, characterization of coronary atherosclerotic plaques, and follow-up of coronary artery stent and bypass graft. Furthermore, MSCT has brought an increasing awareness to the amount of radiation used in CT. This has prompted CT researchers and manufacturers to improve various techniques and develop new strategies to reduce radiation dose. It is anticipated that MSCT will become a sensitive and accurate tool for detecting coronary artery disease and monitoring outcomes after treatment for coronary artery disease.

Modified fast marching and level set method for medical image segmentation

In this paper, an interactive segmentation method that combines fast marching and level set method is proposed. Level set segmentation involves solving the energy-based active contour minimization problems by the computation of geodesics or minimal distance curves. First, by selecting the seed point, the fast marching method is used to extract rough boundaries of the interested object. We modified the traditional fast marching method to capture the weak edges by introducing watershed transform. Then, the contour obtained from the fast marching method mentioned above is regarded as an initialization and the level set method is used to finely tune the contour. The algorithm is demonstrated on some medical images: segmentation of knee tissues in CT image and segmentation of brain tissues in MR image. The results show that this method can remove the small regions obtained from fast marching method and converge the desired boundary.

[Clinical observation of misoprostol on induction in late pregnancy]

Eighty late pregnancy women were randomized into two groups. Misoprostol group and oxytocin group. We observed the different effects of misoprostol and oxytocin on induction, the different effects of misoprostol on induction which was given through rectum or through vagina. The results indicate that the rate of successful induction in misoprostol group is higher than that of oxytocin group, the rate of caesarean section in misoprostol group is lower than that of oxytocin group. There was no significant difference in the durations of misoprostol which was given through rectum or through vagina on induction. It is suggested that misoprostol is more effective on induction than that of oxytocin. We can choose misoprostol given through rectum to prompt delivery in conditions such as premature rupture of membranes and vaginitis.

[Relationship between TT virus infection and hepatocellular carcinoma]

OBJECTIVE

To clarify the relationship between TT virus (TTV) infection and the development of hepatocellular carcinoma (HCC).

METHODS

TTV was examined in sera of 112 patients with HCC and 95 patients with chronic liver disease (CLD) without HCC. 30 patients without liver disease were examined as control. TTV DNA was detected by the second generation of TTV PCR primers (NG059, NG061 and NG063) after extraction of DNA from 50 microliters serum. The relationship between TTV infection and clinical features of each group patients was analyzed.

RESULTS

TTV DNA was detected in 17.86% (20/112) of HCC patients, and this prevalence in HCC patients was not significantly higher than that of TTV DNA in CLD patients (15.78%, 15/95). There were no significant differences in age, gender, tumor factors (size, TNM classification and markers) and other hepatitis virus markers between TTV-positive and TTV-negative in HCC and CLD patients, except history of blood transfusion [(80.00% vs 35.87% (P < 0.05) in HCC patients and 73.33% vs 27.50% (P < 0.05) in CLD patients)] and ALT [(93 +/- 27) IU/L vs (68 +/- 31) IU/L (P < 0.05) in HCC patients]. It seemed that TTV did not do any harm to the liver function of patients who infected with HBV or HCV, except for elevating ALT level in such a kind of HCC patients.

CONCLUSION

Although TTV could do harm to the liver function of HCC patients, it does not contribute to the development of HCC from CLD.

Anticancer treatment of endostatin gene therapy by targeting tumor neovasculature in C57/BL mice

Antiangiogenesis strategy has been widely recognized as a viable approach to fight cancer. Considering the high cost and inconvenience of protein therapy of endostatin (ES), which is a potent antiangiogenic protein, we attempted to explore the inhibitory effect of ES gene therapy on tumor growth and metastasis. In this experiment, Lewis lung carcinoma (LLC)-bearing C57/BL mice were used to evaluate the antitumor effect of ES gene therapy and its impairment of tumor neovasculature. The data showed that the ectopic ES in circulation expressed by intramuscular administration of formulated ES-encoding plasmid DNA significantly suppressed primary tumor growth and lung metastasis in LLC-bearing C57/BL mice. Hence, our results demonstrated the inhibitory effect of ES gene therapy on angiogenesis-dependent tumor growth and metastasis.

Structure of dental glass-ionomer cements by confocal fluorescence microscopy and stereomicroscopy

The microstructure of four cements, setting by different mechanisms (acid-base, dual cure, triple cure), was studied. The porosity of unpolymerized materials was detected by stereomicroscopy. After polymerization and storage in water or lactic acid solution, the porosity, filler distribution and gel layer, which was formed at the filler/matrix interface of polymerized materials, were examined by confocal laser microscopy. For this purpose, the specimens were treated with fluorescent dye solution before the test. The results showed that hydrolytic degradation (pH 7) mainly involved the resin matrix, and the acid erosion (pH 3.5) involved the gel layer too. As regards the filler, materials with different setting mechanism released the glass particles in different times. The loss of the filler particles occurred quicker in acid-base setting cements, and slower in triple-cured material.

Molecular dynamics study of aquaporin-1 water channel in a lipid bilayer

The aquaporin-1 water channel was modeled in a palmitoyl-oleoyl-phosphatidyl-choline lipid bilayer, by means of molecular dynamics simulations. Interaction of the protein with the membrane and inter-monomer interactions were analyzed. Structural features of the channel important for its biological function, including the Asn-Pro-Ala (NPA) motifs, and the diffusion of water molecules into the channels, were investigated. Simulations revealed the formation of single file water inside the channels for certain relative positions of the NPA motifs.

[Cloning and phylogenetic analysis of hepatitis-associated TT virus subgenome]

Polymerase chain reaction (PCR) was utilized for the DNA amplification from transfusion transmitted virus (TTV) positive serum samples. Five TTV DNA fragments, overlapped about 90% of the genome, were amplified by long template PCR for the generation of TTV subgenome. Recombinant plasmids were obtained by directly inserting PCR products into pT-Adv vector, and DNA sequence analyses showed they were TTV DNA fragments. By using specific restriction enzymes, five TTV DNA fragments were ligated into a TTV DNA subgenome clone and named as TTV021. TTV021 has been deposited in GenBank database with the accession number AF254410. The results of computer analyses showed that TTV021, 3472 nt long, contains two open reading frames (ORF1, 785 aa; ORF2, 146 aa). Identity alignments between TTV021 and other TTV isolates indicated several high conserved regions existed. Phylogenetic analysis of 356 nt from TTV021 suggested that the isolate has close evolutionary relationship with CHN1 (type 1a), but has far relation with other TTV isolates.