Transitory blocking of pulmonary artery and veins as a novel strategy in pulmonary surgery: an experimental study in a rabbit model

BACKGROUNDS

Transitory blocking of the pulmonary artery and veins is now being applied in the treatment of local advanced non-small cell lung cancer in our department. We performed this study to establish a pulmonary vessel blocking model in rabbits and investigate the features of lung ischemia-reperfusion injury.

METHODS

126 New Zealand rabbits were randomized into 3 groups: group I, sham group; group II, left pulmonary artery blocking, and group III, left pulmonary artery and veins blocking. The physiological data as well as the blood and tissue samples were harvested at the time of thoracotomy, at 1 h after ischemia and 1, 2, 4, 6 and 24 h after reperfusion, respectively. Lung injury was assessed histologically by determining the levels of malondialdehyde, superoxide dismutase, myeloperoxidase and water content.

RESULTS

The hemodynamics were stable in all three groups. The levels of malondialdehyde, myeloperoxidase, and water content of lung tissue were all significantly increased in groups II and III when compared with group I at 1, 2, 4 and 6 h after reperfusion. They almost all returned to baseline at 24 h after reperfusion. However, there was no significant difference observed between groups II and III at either time point. A similar change in the process of lung ischemia-reperfusion injury was observed under light and electron microscopes in group II and in group III.

CONCLUSIONS

The features of lung ischemia-reperfusion injury were similar when blocking the pulmonary artery and veins compared with blocking the pulmonary artery alone. Moreover, it might be safe to block the pulmonary vessels within 1 h during pulmonary surgery.

Age-related accumulation of 3-nitrotyrosine and nitro-A2E in human Bruch's membrane

Age-related macular degeneration (AMD) is a disease leading to severe visual loss and legal blindness in the elderly population. The pathophysiology of AMD is complex and may include genetic predispositions, accumulation of lipofuscin and drusen, local inflammation and neovascularization. Recently four independent research groups have identified a commonly inherited variant (Y402H) of the complement factor H gene in the genome from different groups of AMD patients. The Y402H variant of CFH significantly increases the risk of AMD and links the genetics of the disease with inflammation. During inflammation there is activation of inducible nitric oxide synthase and release of nitric oxide, which in principal could lead to non-enzymatic nitration within extracellular deposits and/or intrinsic extracellular matrix protein components of human Bruch's membrane. We have identified two biomarkers for non-enzymatic nitration in aged human Bruch's membrane, indicative of inflammation, that include 3-nitrotyrosine identified in Bruch's membrane preparations and nitrated A2E from the lipid soluble extract of the Bruch's membrane preparation. Approximately 30-40 times more A2E is observed in samples of the organic soluble extract of lipofuscin compared to the extract of Bruch's membrane. It is of interest to note that although A2E is a major constituent of RPE lipofuscin, nitrated A2E could not be detected in RPE extracts. We show here that nitro-A2E is a specific biomarker of nitrosative stress in Bruch's membrane and its concentration correlates directly with tissue age.

Radiation dose to the lens using different temporal bone CT scanning protocols

BACKGROUND AND PURPOSE

Temporal bone CT is performed frequently in clinical practice. At the same time, the eye lens are exposed to ionizing radiation without any useful diagnostic information delivered. Our aim was to investigate the radiation dose to the lens of the eye by using temporal bone CT scanning with different protocols.

MATERIALS AND METHODS

Direct axial and coronal CT by using a conventional sequential scanning mode (140 kV, 220 mAs/section, 1.25-mm thickness, 1.25-mm increment, 16 x 0.625 mm collimation, the glabellomeatal line as a scanning baseline), a routine helical scanning mode (140 kV, 220 mAs/section, 0.315 pitch, 0.67-mm thickness, 0.33-mm increment, 16 x 0.625 collimation, the orbitomeatal line as a scanning baseline), and a modified helical scanning mode (acanthiomeatal line as a scanning baseline; other parameters, same as above) was performed on an exsomatized cadaveric head. CTDI(vol) and DLP were recorded for each scanning mode, and effective doses were calculated. Organ doses for the lens were measured with TLDs.

RESULTS

When the sequential scanning mode was used, the gross effective dose was 1.21 mSv and the organ dose to the lens was 50.96 and 1.73 mGy, respectively, for direct axial and coronal imaging. The effective dose was 0.803 mSv in routine helical scanning, while the lens dose was 40.17 mGy. With the modified helical scanning mode, the effective dose was as same as that for the routine helical scanning, but the lens dose was reduced significantly to 10.33 mGy.

CONCLUSIONS

The effective doses resulting from sequential axial and coronal scanning were 1.51 times higher than the dose from helical scanning, and the lens dose was 1.31 times higher. With the modified helical scanning mode, thinner section images could be used to reformat axial, coronal, and sagittal images with a further 74.3% reduction in lens dose beyond that achieved with the conventional helical protocol.

Catalpol attenuates MPTP induced neuronal degeneration of nigral-striatal dopaminergic pathway in mice through elevating glial cell derived neurotrophic factor in striatum

The protective effect of an iridoid catalpol extracted and purified from the traditional Chinese medicinal herb Rehmannia glutinosa on the neuronal degeneration of nigral-striatal dopaminergic pathway was studied in a chronic 1-methyl-4-phenyl-1,2,3,4-tetrahydropyridine (MPTP)/probenecid C57BL/6 mouse model and in 1-methyl-4-phenylpyridimium (MPP(+)) intoxicated cultured mesencephalic neurons. Rotarod performance revealed that the locomotor ability of mice was significantly impaired after completion of model production and maintained thereafter for at least 4 weeks. Catalpol orally administered for 8 weeks (starting from the second week of model production) dose dependently improved the locomotor ability. HPLC revealed that catalpol significantly elevated striatal dopamine levels without changing the metabolite/dopamine ratios. Nor did it bind to dopamine receptors. Therefore it is unlikely that catalpol resembles any of the known compounds for treating Parkinsonism. Instead, catalpol dose dependently raised the tyrosine hydroxylase (TH) neuron number in substantia nigra pars compacta (SNpc), the striatal dopamine transporter (DAT) density and the striatal glial cell derived neurotrophic factor (GDNF) protein level. Linear regression revealed that both the TH neuron number and DAT density were positively correlated to the GDNF level. In the cultured mesencephalic neurons, MPP(+) decreased the dopaminergic neuron number and shortened the neurite length, whereas catalpol showed protective effect dose dependently. Furthermore, the expression of GDNF mRNA was up-regulated by catalpol to a peak nearly double of normal control in neurons intoxicated with MPP(+) for 24 h but not in normal neurons. The GDNF receptor tyrosine kinase RET inhibitor 4-amino-5-(4-methyphenyl)-7-(t-butyl)-pyrazolo-[3,4-d]pyrimidine (PP1) abolished the protective effect of catalpol either partially (TH positive neuron number) or completely (neurite length). Taken together, catalpol improves locomotor ability by attenuating the neuronal degeneration of nigral-striatal dopaminergic pathway, and this attenuation is at least partially through elevating the striatal GDNF expression.

The Presence of Hepatitis B Surface Antigen in the Ova of Pregnant Women and Its Relationship with Intra-Uterine Infection by Hepatitis B Virus

Vertical transmission of hepatitis B virus (HBV) has been proposed to play an important role in mother-to-child transmission, although the extent to which vertical transmission via oocytes contributes to neonatal HBV infection remains unknown. Ovarian biopsies were collected during caesarean sections in 68 clinically asymptomatic pregnant women who were carriers of HBV. The presence of hepatitis B surface antigen (HBsAg) in the ova of pregnant women was determined by immunohistochemistry. Serum markers of HBV infection in pregnant women and their neonates were analysed. It was found that, of 68 women, the ova were positive for HBsAg in only one woman and her neonate was negative for any serum HBV markers 3 days after birth. Of 68 neonates, one was positive for serum HBV markers 3 days after birth and his mother's ova were negative for HBsAg. These findings indicate that vertical transmission via oocytes may not be the major route of HBV intra-uterine infection.

The glycoprotein Ibalpha-von Willebrand factor interaction induces platelet apoptosis

BACKGROUND

The interaction of glycoprotein (GP) Ibalpha with von Willebrand factor (VWF) initiates platelet adhesion, and simultaneously triggers intracellular signaling cascades leading to platelet aggregation and thrombus formation. Some of the signaling events are similar to those occurring during apoptosis, however, it is still unclear whether platelet apoptosis is induced by the GPIbalpha-VWF interaction.

OBJECTIVES

To investigate whether the GPIbalpha-VWF interaction induces platelet apoptosis and the role of 14-3-3zeta in apoptotic signaling.

METHODS

Apoptotic events were assessed in platelets or Chinese hamster ovary (CHO) cells expressing wild-type (1b9) or mutant GPIb-IX interacting with VWF by flow cytometry or western blotting.

RESULTS

Ristocetin-induced GPIbalpha-VWF interaction elicited apoptotic events in platelets, including phosphatidylserine exposure, elevations of Bax and Bak, gelsolin cleavage, and depolarization of mitochondrial inner transmembrane potential. Apoptotic events were also elicited in platelets exposed to pathologic shear stresses in the presence of VWF; however, the shear-induced apoptosis was eliminated by the anti-GPIbalpha antibody AK2. Furthermore, apoptotic events occurred in 1b9 cells stimulated with VWF and ristocetin, but were significantly diminished in two CHO cell lines expressing mutant GPIb-IX with GPIbalpha truncated at residue 551 or a serine-to-alanine mutation at the 14-3-3zeta-binding site in GPIbalpha.

CONCLUSIONS

This study demonstrates that the GPIbalpha-VWF interaction induces apoptotic events in platelets, and that the association of 14-3-3zeta with the cytoplasmic domain of GPIbalpha is essential for apoptotic signaling. This finding may suggest a novel mechanism for platelet clearance or some thrombocytopenic diseases.

Aflatoxin-albumin adducts and correlation with decreased serum levels of vitamins A and E in an adult Ghanaian population

A study of aflatoxin (AF) exposure and the levels of vitamins A and E was carried out with a group of 507 Ghanaian participants. AFB(1)-albumin adducts (AFB-AA) were measured by radioimmunoassay and vitamins A and E were measured by high-performance liquid chromatography (HPLC). The average level of serum AFB-AA was 0.94 +/- 0.64 (range = 0.1-4.44) pmol mg(-1) albumin. Mean levels of vitamins A and E were 1.32 +/- 0.48 (range = 0.41-4.85) micromol l(-1) and 15.68 +/- 4.12 (range = 6.35-30.40) micromol l(-1), respectively. A significantly negative correlation was found between serum AFB-AA and vitamin A levels (r = -0.110, p = 0.013). An even stronger, significant negative, correlation was found between serum AFB-AA and vitamin E levels (r = -0.149, p < 0.001). Serum AFB-AA levels were statistically higher (median = 0.985 pmol mg(-1) albumin) in subjects who had low levels of both vitamins A and E as compared with the levels (median = 0.741 pmol mg(-1) albumin) subjects who had high vitamins A and E levels (p(trend) = 0.001). To verify these findings, blood samples were again collected from 165 of the 507 people 3 months after the initial collection. Significantly negative correlations were confirmed between levels of serum AFB-AA and both vitamins A (r = -0.232, p = 0.003) and E (r = -0.178, p = 0.023). Again, high serum AFB-AA concentrations (median = 1.578 pmol mg(-1) albumin) were found in subjects with low levels of vitamins A and E compared with the concentrations (median = 1.381 pmol mg(-1) albumin) in subjects with high levels of vitamins A and E (p(trend) = 0.002). These data show that AF exposure was associated with decreased levels of serum vitamins A and E in high-risk human populations, which may significantly influence the incidence of AF-related adverse health effects.

Effects of bone morphogenetic protein-2 on proliferation and angiogenesis in oral squamous cell carcinoma

Experimental data and limited patient experience suggest that rhBMP-2 can be used to regenerate bone in acquired segmental defects of the mandible. Most of these defects are caused by resection of oral squamous cell carcinoma (OSCC) and the biologic effects of rhBMP-2 on these carcinoma cells are unknown. The objective of this study was to determine whether rhBMP-2 produces adverse effects on proliferation and angiogenesis in OSCC, two biologic processes critical to tumor formation. In vitro studies included treating OSCC cells with rhBMP-2 or an adenoviral vector containing the cDNA for BMP-2. In vivo studies involved co-transplantation of OSCC cells with bone marrow stromal cells genetically modified to over express BMP-2, to mimic a clinically relevant scenario for regenerating bone using cell-based therapy in a wound containing microscopic residual disease. Proliferation, as measured by a MTT assay in vitro and tumor growth in vivo was not affected by treatment with BMP-2. Angiogenesis, measured by secretion of the proangiogenic molecules VEGF and IL-8 in vitro and microvessel density in vivo, was not affected. Exposure of OSCC cells to BMP-2 does not stimulate proliferation or angiogenesis. Further studies are needed before using rhBMP-2 for bone tissue engineering in oral cancer-related defects.

Bone regeneration in defects compromised by radiotherapy

Because bone reconstruction in irradiated sites is less than ideal, we applied a regenerative gene therapy method in which a cell-signaling virus was localized to biomaterial scaffolds to regenerate wounds compromised by radiation therapy. Critical-sized defects were created in rat calvariae previously treated with radiation. Gelatin scaffolds containing lyophilized adenovirus encoding BMP-2 (AdBMP-2) or freely suspended AdBMP-2 were transplanted. Lyophilized AdBMP-2 significantly improved bone quality and quantity over free AdBMP-2. Bone mineral density was reduced after radiotherapy. Histological analyses demonstrated that radiation damage led to less bone regeneration. The woven bone and immature marrow formed in the radiated defects indicated that irradiation retarded normal bone development. Finally, we stored the scaffolds with lyophilized AdBMP-2 at -80 degrees C to determine adenovirus stability. Micro-CT quantification demonstrated no significant differences between bone regeneration treated with lyophilized AdBMP-2 before and after storage, suggesting that virus-loaded scaffolds may be convenient for application as pre-made constructs.

MR imaging of adenomas of the nonpigmented ciliary epithelium of the eye

BACKGROUND AND PURPOSE

ANPCEs are rare benign tumors of the eye arising from the NPCE in adults, which may be clinically mistaken for melanoma. This study was undertaken to delineate clinical and MR imaging features of these tumors.

MATERIALS AND METHODS

Clinical presentation and MR imaging findings of 8 patients (6 women and 2 men; median age, 51 years) with pathologically confirmed ANPCEs were retrospectively reviewed. Location, size, shape, margin, signal intensity, and gadolinium-enhancement characteristics of all tumors were evaluated. Signal intensity and degree of enhancement were graded in comparison with the ipsilateral lacrimal gland.

RESULTS

MR imaging revealed a circumscribed enhancing mass within the ciliary body of the eye in all 8 patients. The mass was ovoid in 6 patients and spheric in 2. Gadolinium enhancement was marked in 4 lesions and moderate in the other 4. Both T1 and T2 relaxation times were qualitatively identical to those in the lacrimal gland in 2 tumors. In the remaining 6 tumors, the T1 was identical to and the T2 longer than that in the lacrimal gland.

CONCLUSIONS

ANPCE should be included in the differential diagnosis of a spheric or ovoid enhancing ciliary body mass with T1 similar to that in the lacrimal gland and T2 equal to or longer than that in the lacrimal gland.

Role of outer-membrane cytochromes MtrC and OmcA in the biomineralization of ferrihydrite by Shewanella oneidensis MR-1

In an effort to improve the understanding of electron transfer mechanisms at the microbe-mineral interface, Shewanella oneidensis MR-1 mutants with in-frame deletions of outer-membrane cytochromes (OMCs), MtrC and OmcA, were characterized for the ability to reduce ferrihydrite (FH) using a suite of microscopic, spectroscopic, and biochemical techniques. Analysis of purified recombinant proteins demonstrated that both cytochromes undergo rapid electron exchange with FH in vitro with MtrC displaying faster transfer rates than OmcA. Immunomicroscopy with cytochrome-specific antibodies revealed that MtrC co-localizes with iron solids on the cell surface while OmcA exhibits a more diffuse distribution over the cell surface. After 3-day incubation of MR-1 with FH, pronounced reductive transformation mineral products were visible by electron microscopy. Upon further incubation, the predominant phases identified were ferrous phosphates including vivianite [Fe(3)(PO(4))(2)x8H(2)O] and a switzerite-like phase [Mn(3),Fe(3)(PO(4))(2)x7H(2)O] that were heavily colonized by MR-1 cells with surface-exposed outer-membrane cytochromes. In the absence of both MtrC and OmcA, the cells ability to reduce FH was significantly hindered and no mineral transformation products were detected. Collectively, these results highlight the importance of the outer-membrane cytochromes in the reductive transformation of FH and support a role for direct electron transfer from the OMCs at the cell surface to the mineral.

Ultrasound urodynamic study of urinary tract dysfunction after radical hysterectomy and pelvic lymphadenectomy in women with cervical carcinoma

PURPOSE

To investigate the functional changes of the lower urinary tract after radical hysterectomy and pelvic lymphadenectomy node dissection using ultrasound urodynamics.

METHODS

Fifty-one women with cervical carcinoma underwent pre- and postoperative B-mode ultrasound imaging urodynamics.

RESULTS

Twenty-six women needed abdominal straining to void after radical surgery, and the urinary stream was intermittent. The maximum flow rate, average flow rate, and voiding volume significantly decreased, but the post-void residual volume significantly increased. Bladder sensory function deteriorated and maximum detrusor pressure decreased. The functional length decreased, but the maximum urethral pressure and urethral closure pressure did not change. Ultrasound measurement showed no significant changes regarding the depth of the bladder wall or the position of the bladder neck.

CONCLUSIONS

Lower urinary tract dysfunction after radical hysterectomy is characteristic. Measurement of ultrasound urodynamics may be used as a preliminary screening method to detect voiding dysfunction following surgery.

Effect of reflux ratio on COD and nitrogen removals from coke plant wastewaters

A laboratory-scale anaerobic-anoxic-aerobic-moving bed biofilm reactor (A1-A2-O-MBBR) system was undertaken to treat coke plant wastewaters from two different factories (wastewater A and B). Wastewater B had higher BOD5/COD ratio and COD/TN ratio than wastewater A. The effects of reflux ratios on COD, TN and NH3-N removals were studied. Results indicated that, with the reflux ratio increased from 2 to 5, COD removals of wastewater A and wastewater B increased from 57.4% to 72.6% and 78.2% to 88.6%, respectively. Meanwhile, TN removals were also increased accompanying reflux ratio rise, from 53.1% to 74.4% for wastewater A and 64.2% to 83.5% for wastewater B. At the same reflux ratio, compared with wastewater A, higher COD and TN removal efficiencies were observed in wastewater B, which had higher BOD5/COD and COD/TN ratio. Reflux ratio had no significant influence on NH3-N removal; 99.0% of the overall NH3-N removal efficiency was achieved by the system for both coke plant wastewaters at any tested reflux ratio. MBBR was effective in NH3-N removal, and about 95% of the NH3-N was removed in the MBBR.

Inpatient treatment of diabetic patients in Asia: evidence from India, China, Thailand and Malaysia

AIMS

The prevalence of Type 2 diabetes mellitus (DM) has grown rapidly, but little is known about the drivers of inpatient spending in low- and middle-income countries. This study aims to compare the clinical presentation and expenditure on hospital admission for inpatients with a primary diagnosis of Type 2 DM in India, China, Thailand and Malaysia.

METHODS

We analysed data on adult, Type 2 DM patients admitted between 2005 and 2008 to five tertiary hospitals in the four countries, reporting expenditures relative to income per capita in 2007.

RESULTS

Hospital admission spending for diabetic inpatients with no complications ranged from 11 to 75% of per-capita income. Spending for patients with complications ranged from 6% to over 300% more than spending for patients without complications treated at the same hospital. Glycated haemoglobin was significantly higher for the uninsured patients, compared with insured patients, in India (8.6 vs. 8.1%), Hangzhou, China (9.0 vs. 8.1%), and Shandong, China (10.9 vs. 9.9%). When the hospital admission expenditures of the insured and uninsured patients were statistically different in India and China, the uninsured always spent less than the insured patients.

CONCLUSIONS

With the rising prevalence of DM, households and health systems in these countries will face greater economic burdens. The returns to investment in preventing diabetic complications appear substantial. Countries with large out-of-pocket financing burdens such as India and China are associated with the widest gaps in resource use between insured and uninsured patients. This probably reflects both overuse by the insured and underuse by the uninsured.