OARSI-OMERACT initiative: defining thresholds for symptomatic severity and structural changes in disease modifying osteoarthritis drug (DMOAD) clinical trials

OBJECTIVE

Total joint replacement has been proposed as an endpoint in disease modifying osteoarthritis drug (DMOAD) randomized clinical trials (RCTs); however, disparities have generated concerns regarding this outcome. A combined Osteoarthritis Research Society International (OARSI)/Outcome Measures in Rheumatology (OMERACT) initiative was launched in 2004 to develop a composite index ['virtual total joint replacement' (VJR)] as a surrogate outcome for osteoarthritis (OA) progression in DMOAD RCTs. Our objective was to evaluate the prevalence of patients fulfilling different thresholds of sustained pain, reduced function, and X-ray change in existing DMOAD RCTs.

DESIGN

Post hoc analysis of summary data from the placebo arm of eight DMOAD RCTs.

RESULTS

Eight OA RCTs representing 1379 patients were included. Pain was assessed by WOMAC and/or VAS and function by WOMAC and/or Lequesne. Among six knee and two hip studies, 248 (22%) and 132 (51%) patients respectively had X-ray progression [decrease joint space width (JSW) ≥0.5 mm]. The prevalence of patients fulfilling clinical and radiographic criteria was highest (n = 163, 12%) in the least stringent scenario (pain + function ≥80 at ≥2 visits); with few patients (n = 129, 2%) in the most stringent scenario (pain + function ≥80 at ≥4 visits). Using these prevalence data, a sample size of 352-2144 per group would be needed to demonstrate a 50% difference between groups.

CONCLUSIONS

The prevalence of patients with sustained symptomatic OA of at least a moderate degree with X-ray progression is low. Even using lenient criteria to define VJR, large patient numbers would be required to detect differences between groups in DMOAD RCTs. Investigation of the optimal cutoff threshold and combination of symptoms and radiographic change should be pursued.

Efficacy and safety of embolization in iatrogenic traumatic uterine vascular malformations

AIM

To retrospectively evaluate the efficacy of embolotherapy in patients with iatrogenic traumatic uterine arteriovenous malformations (AVMs).

MATERIALS AND METHODS

A retrospective review of all patients who underwent uterine arterial embolization in Peking Union Medical College Hospital between January 2000 and December 2010 was performed. Forty-two patients were diagnosed with a uterine vascular malformation. All patients had obstetric manipulations before. Serial beta-human chorionic gonadotropin (β-HCG) levels were measured to exclude gestational trophoblastic neoplasia. All patients underwent transcatheter embolization of bilateral uterine arteries. The complications, control of haemorrhage, and outcome of subsequent pregnancies were assessed.

RESULTS

A total of 49 embolization procedures were performed in 42 patients. Seven patients required repeated embolizations for recurrence of bleeding. The technical success rate of embolization was 100%. Bleeding was controlled in 35 of 42 patients (83%) after the first embolization procedures, and bleeding was controlled in another two patients who underwent repeat embolization at a median follow-up of 29 months (range 3 months to 5 years). The overall clinical success rate was 88% (37/42). Thirteen patients subsequently became pregnant and eight of 13 patients had uneventful intrauterine pregnancies carried to term. Seven patients had post-embolization syndrome and no other complication occurred.

CONCLUSION

Percutaneous embolotherapy is a safe and effective treatment for traumatic AVMs. Future pregnancy is still possible after embolization.

Dedifferentiated liposarcoma of the neck: CT findings

We report a case of DDL with an osteosarcomatous component affecting the right neck. CT showed a lipomatous region with thick septa, a low-attenuation high-water-content component, and a sporadic heterogeneous high-attenuation calcified area.

A New Approach to the Detection of Lesions in Mammography Using Fuzzy Clustering

Breast cancer is a leading cause of female mortality and its early detection is an important means of reducing this. The present study investigated an approach, based on fuzzy clustering, to detect small lesions, such as microcalcifications and other masses, that are hard to recognize in breast cancer screening. A total of 180 mammograms were analysed and classified by radiologists into three groups ( n = 60 per group): those with microcalcifications; those with tumours; and those with no lesions. Twenty mammograms were taken as training data sets from each of the groups. The algorithm was then applied to the data not taken for training. Analysis by fuzzy clustering achieved a mean accuracy of 99.7% compared with the radiologists' findings. It was concluded that the fuzzy clustering algorithm allowed for more efficient and accurate detection of breast lesions and may improve the early detection of breast tumours.

Osteosarcoma of the jaws: demographic and CT imaging features

OBJECTIVE

The aim of this study was to evaluate the patient demographic and CT imaging findings of primary osteosarcoma of the jaws.

METHODS

88 primary osteosarcomas of the jaws histopathologically diagnosed during 1997-2007 were reviewed. 21 cases of CT images were reviewed.

RESULTS

Of 88 patients, 51 (58%) had tumours in the mandible and 37 (42%) in the maxilla. The mean age was 37.8 years (range 9-80 years). The male-to-female ratio was 1.32:1. The mean age of patients with mandibular lesions was 41.04 years and in those with maxillary lesions it was 33.3 years. CT imaging findings were available in 21 patients. In the maxilla (n = 9), all tumours (100%) arose from the alveolar ridge. In the mandible (n = 12), most tumours (9 cases, 75%), arose from the ramus and/or condyle. All except two lesions had the epicentrum within the medullary cavity of the involved bone. The presence of periosteal reaction was demonstrated in 13 cases (62%). Soft-tissue extension was present in 18 lesions (86%), with calcification identified in 13 (72%).

CONCLUSIONS

This study provides age, sex distribution, location and CT imaging features of primary osteosarcoma of the jaws.

Transplantation of non-visceral fat to the visceral cavity improves glucose tolerance in mice: investigation of hepatic lipids and insulin sensitivity

AIMS/HYPOTHESIS

Intra-abdominal transplantation of non-visceral adipose tissue in rodents, simulating increased abdominal fat in obesity, paradoxically improves glucose tolerance and insulin sensitivity. We hypothesised that this improvement is due to transplant-induced enhanced uptake of fatty acids by adipose tissue, thus reducing fatty acid flux into, and triacylglycerol storage in, the liver.

METHODS

In Experiment 1, mice were sham-operated or received heterologous epididymal white adipose tissue (WAT; EWAT) or visceral WAT (VWAT) transplantation to the portal and splanchnic circulation regions in the visceral cavity. In Experiment 2, inguinal WAT (IWAT) or EWAT was removed and subsequently transplanted to the visceral cavity of the same mouse (autotransplant). IWAT and EWAT autotransplants were repeated in Experiment 3 and compared with heterotransplants.

RESULTS

Heterotransplantation of VWAT did not alter glucose tolerance, whereas auto- or hetero-transplantation of EWAT or IWAT significantly improved glucose tolerance. Transplantation-induced improvements in glucose tolerance 4 weeks after surgery coincided with decreased liver triacylglycerol, decreased portal plasma lipids and increased hepatic insulin sensitivity. By 8 weeks, these changes were apparent only in mice with autotransplantation. Heterologous EWAT transplantation-induced glucose improvement persisted without altered liver metabolism.

CONCLUSIONS/INTERPRETATION

Increases in visceral fat, via transplantation of visceral or non-visceral adipose tissue, is not a major risk factor for glucose intolerance. In fact, there are dynamic metabolic improvements following transplantation that include decreased portal lipids and improved liver metabolism, but these improvements are transient under certain circumstances.

Assessment of correlation between CT angiographic clot load score, pulmonary perfusion defect score and global right ventricular function with dual-source CT for acute pulmonary embolism

OBJECTIVE

The purpose of this study was to prospectively investigate the correlation between CT angiographic clot load (CTACL) score, pulmonary perfusion defect (PPD) score and the global right ventricular function in the assessment of pulmonary embolism (PE) severity.

METHODS

49 patients with acute PE, who underwent dual-source CT scan, were included in the study. CT angiography and perfusion imaging were performed. Data from electrocardiogram-gated coronary angiography scanning protocol were used for right ventricular function analysis. Two readers evaluated the CTACL and PPD scores using the Qanadli and Chae methods, respectively.

RESULTS

The PPD score had a strong positive correlation with the CTACL score (r=0.72, p<0.001) and both scores in turn had a strong positive correlation with the right ventricular/left ventricular (RV/LV) diameter ratio (r=0.60, r=0.62, p<0.001). However, the PPD score had a strong negative correlation with ejection fraction (EF) (r=-0.63, p<0.001) while the CTACL score had a low negative correlation with EF (r=-0.33, p=0.02). Between the RV/LV<1 group (n=35) and the RV/LV >1 group (n=14), the PPD score, CTACL score, pulmonary artery trunk diameter, EF and reflux of inferior vena cava were significantly different, all with p<0.001. The end-systolic volume (p=0.01) was significantly different but the end-diastolic volume (p=0.11) and stroke volume (p=0.08) showed no statistically significant difference between the two groups.

CONCLUSION

Therefore, considering PPD scores, CTACL scores and cardiovascular manifestations together may be helpful in the evaluation of PE severity.

Secondary chondrosarcoma in the mandibular condyle

We report the case of a woman who had secondary chondrosarcoma in an osteochondroma in the left mandibular condyle, presenting as a large lobulated bone density mass in the left condyle process, to illustrate the clinical characteristics and imaging findings.

Ameloblastic fibro-odontosarcoma of the mandible: imaging findings

We report a histologically verified case of ameloblastic fibro-odontosarcoma (AFOS) affecting the right mandible. CT scanning showed an expansile intraosseous mass with ill-defined borders and slightly dense opacities.

Chicken adipocyte fatty acid-binding protein knockdown affects expression of peroxisome proliferator-activated receptor γ gene during oleate-induced adipocyte differentiation

Adipocyte fatty acid-binding protein (A-FABP) is expressed in both adipose cells and macrophages. As one of the downstream genes of peroxisome proliferator-activated receptor γ (PPAR-γ), A-FABP plays an important role in the lipid metabolism of adipocytes in mammal and poultry. However, studies in A-FABP null macrophages of mice showed that A-FABP was a critical regulator of PPAR-γ and could affect the expression of PPAR-γ. The current study was designed to investigate whether the same mechanism as that in macrophages exists in chicken adipocytes. After transfection with interference and overexpression plasmids of A-FABP in chicken adipocytes for 24 h, oleate was added to the medium. Then, lipid accumulation, nonesterified fatty acids (NEFA) in the medium, and expression of lipid metabolism-related genes were detected. The results showed that in the A-FABP knockdown adipocytes, lipid accumulation was decreased at 6 h and NEFA in the medium was higher at 1 and 6 h compared with that in the control group. Moreover, gene expression levels of lipoprotein lipase, perilipin, and PPAR-γ were higher than that of the control group (P < 0.05). In the A-FABP overexpression adipocytes, lipid accumulation and expression of lipid metabolism related genes were similar to that of the control group. However, NEFA in the medium was significantly lower in the A-FABP overexpression group 1 h after adding oleate (P < 0.05). The present study suggested that the A-FABP knockdown might lead to decreased lipid accumulation and upregulated expression of PPAR-γ in chicken adipocytes.

First measurement of kaonic helium-3 X-rays

The first observation of the kaonic (3)He 3d→2p transition was made, using slow K- mesons stopped in a gaseous (3)He target. The kaonic atom X-rays were detected with large-area silicon drift detectors using the timing information of the K+K- pairs of ϕ-meson decays produced by the DAΦNE e+e- collider. The strong interaction shift of the kaonic (3)He 2p state was determined to be -2±2(stat)±4(syst) eV.

Use of Glass-Forming Liquid Crystal Materials for Electroluminescent Diodes

Spin-coated thin films of cyclohexane-based liquid crystalline materials were used for the fabrication of electroluminescent diodes. Electroluminescence from single-component films of cyclohexane-based liquid crystalline materials was observed. Double component films composed of a cyclohexane-based liquid crystalline material and a conventional hole transport dye were shown to give improved electroluminescence performances, but emission was due to exciplexes composed of two components. Use of cyclohexane-based dye molecules was effective for suppressing the formation of inter-molecular complexes. The highest external quantum efficiency observed was 0.17%.

Overexpression of AEG-1 in renal cell carcinoma and its correlation with tumor nuclear grade and progression

The study was aimed at detecting the expression of a newly found oncogene, astrocyte elevated gene-1 (AEG-1), in renal cell carcinoma (RCC) and its correlation with histopathologic features and the survival of patients. Real-time reverse transcription-PCR and Western blot showed markedly higher expression of AEG-1 in 8 cases of RCC tissue compared with the paired normal tissue from the same patient. The expression level of AEG-1 was also increased in four RCC cell lines in contrast with normal tubular epithelial human kidney cells 2 (HK-2) at both mRNA and protein levels. Furthermore, immunohistochemistry analysis showed highly expressed AEG-1 in 96 of 102 (94.1%) cases of paraffin-embedded archival RCC tissue. Statistical analysis showed a significant correlation of AEG-1 expression with tumor grade (P <0.001), clinical staging (P = 0.003), T classification (P = 0.003) as well as metastasis classification (P=0.032). The means for survival time of low AEG-1 expression group was 76.98m<br />while high AEG-1expression group was 60.94m. Our results suggest that AEG-1 protein is overexpressed in RCC and plays an important role in tumor differentiation and progression. <br />High AEG-1 expression is closely associated with poor prognosis.

KEYWORDS

Astrocyte elevated gene-1, AEG-1, renal cell carcinoma, prognosis.

The alteration of extracellular signal-regulated kinase (ERK) activity of COS7 cells from interphase to mitosis

Although many reports have suggested that ERK1/2 activity is increased in interphase and inhibited in mitosis, the change of ERK1/2 activity from interphase to mitosis is largely undefined. In this study, we examined the alteration of ERK1/2 activity in COS7 cells in response to nocodazole. Nocodazole&mdash;treated or nocodazole&mdash;untreated COS7 cells were stimulated by EGF. We found that ERK1/2 activity of nocodazole&mdash;treated cells was decreased with prolonged time of cells treated with nocodazole while being increased in nocodazole&mdash;untreated cells. COS7 cells became round after being treated with nocodazole for 4 hr. And from the time point, ERK1/2 activity was gradually and significantly inhibited. Furthermore, we showed that MEK activity was greatly decreased compared with nocodazole&mdash;untreated cells after the cells were treated by nocodazole for 8 hr and then EGF. In addition, the migration of cells was inhibited in response to nocodazole. Taken together, we concluded that ERK1/2 activity was gradually inhibited from interphase to mitosis and the cell migration was affected by nocodazole.