[Impact of different surgical methods of radical cystectomy on the perioperative complications in patients over 75 years]

OBJECTIVE

To analyze the impact of different surgical methods on perioperative complication rate after radical cystectomy in patients over 75 years of age.

METHODS

A retrospective study reviewed 1 432 patients who received radical cystectomy from January 2003 to January 2015. A total of 239 patients were ≥75 years (median age: 78 years), of whom, 74 patients (31.0%) suffered one or more perioperative complications. According to the different operation methods, patients could be divided into ileal conduit group and cutaneous ureterostomy group. The ileal conduit group included laparoscopic and open radical cystectomy with ileal conduit. The cutaneous ureterostomy group included transperitoneal laparoscopic, transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy.

RESULTS

Perioperative complications were significantly associated with the patient's age (P=0.012), American Society of Anesthesiologists (ASA) score (P=0.001), node staging (P=0.043), and different surgical methods. Perioperative complications caused a prolonged hospital stay and delayed recovery (34 d vs. 21 d, P=0.002). For different surgical methods, the perioperative complication rate of ileal conduit was higher than cutaneous ureterostomy (P=0.013). However, there were no significant differences between transperitoneal laparoscopic and open radical cystectomy with ileal conduit in perioperative complication rate (P=0.836). The perioperative complication rate was statistically significant among transperitoneal laparoscopic, transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy (P=0.022). On multivariate analysis, age (hazard ratio=4.856, 95% CI: 1.465-16.103, P=0.010), ASA score (P=0.008), and different surgical methods (P=0.016) were significantly associated with the perioperative complication rate.

CONCLUSION

The perioperative complication rate after radical cystectomy in elderly patients was associated with the patients' age, ASA score, and different surgical methods. Patients who received extraperitoneal open radical cystectomy with cutaneous ureterostomy suffered fewer perioperative complications, which was an appropriate choice for elderly patients.

A smart core-sheath nanofiber that captures and releases red blood cells from the blood

A smart core-sheath nanofiber for non-adherent cell capture and release is demonstrated. The nanofibers are fabricated by single-spinneret electrospinning of poly(N-isopropylacrylamide) (PNIPAAm), polycaprolactone (PCL) and nattokinase (NK) solution blends. The self-assembly of PNIPAAm and PCL blends during the electrospinning generates the core-sheath PCL/PNIPAAm nanofibers with PNIPAAm as the sheath. The PNIPAAm-based core-sheath nanofibers are switchable between hydrophobicity and hydrophilicity with temperature change and enhance stability in the blood. When the nanofibers come in contact with blood, the NK is released from the nanofibers to resist platelet adhesion on the nanofiber surface, facilitating the direct capture and isolation of red blood cells (RBCs) from the blood above phase-transition temperature of PNIPAAm. Meanwhile, the captured RBCs are readily released from the nanofibers with temperature stimuli in an undamaged manner. The release efficiency of up to 100% is obtained while maintaining cellular integrity and function. This work presents promising nanofibers to effectively capture non-adherent cells and release for subsequent molecular analysis and diagnosis of single cells.

Long-term stability of novel double rhodanine indoline dyes having one and two anchor carboxyl group(s) in dye-sensitized solar cells

An indoline dye having both α-cyanoacrylic and rhodanine acetic acid anchor groups at the acceptor moiety exhibited improved stability upon fluorescence lamp irradiation.

Development of Diagnostic Biomarkers for Detecting Diabetic Retinopathy at Early Stages Using Quantitative Proteomics

Diabetic retinopathy (DR) is a common microvascular complication caused by diabetes mellitus (DM) and is a leading cause of vision impairment and loss among adults. Here, we performed a comprehensive proteomic analysis to discover biomarkers for DR. First, to identify biomarker candidates that are specifically expressed in human vitreous, we performed data-mining on both previously published DR-related studies and our experimental data; 96 proteins were then selected. To confirm and validate the selected biomarker candidates, candidates were selected, confirmed, and validated using plasma from diabetic patients without DR (No DR) and diabetics with mild or moderate nonproliferative diabetic retinopathy (Mi or Mo NPDR) using semiquantitative multiple reaction monitoring (SQ-MRM) and stable-isotope dilution multiple reaction monitoring (SID-MRM). Additionally, we performed a multiplex assay using 15 biomarker candidates identified in the SID-MRM analysis, which resulted in merged AUC values of 0.99 (No DR versus Mo NPDR) and 0.93 (No DR versus Mi and Mo NPDR). Although further validation with a larger sample size is needed, the 4-protein marker panel (APO4, C7, CLU, and ITIH2) could represent a useful multibiomarker model for detecting the early stages of DR.

Diagnostic accuracy of adenosine deaminase for tuberculous pericarditis: a meta-analysis

OBJECTIVE

Many studies suggest that adenosine deaminase is a marker for tuberculous pericarditis, while controversy exists as to its diagnostic utility. This study aims to summarize the overall diagnostic performance of adenosine deaminase for tuberculous pericarditis through a meta-analysis.

MATERIALS AND METHODS

Literatures published before May 2015 were searched in PubMed and EMBASE. The data were retrieved and the sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), diagnostic odds ratio (DOR) of adenosine deaminase for diagnosing tuberculous pericarditis were pooled, and the summary receiver operating characteristic (SROC) curves were used to examine the overall performance of adenosine deaminase.

RESULTS

In total, 11 studies with 938 subjects were included in the meta-analysis. The summary estimates of adenosine deaminase for diagnosing tuberculous pericarditis were listed as follows: sensitivity of 0.90 (95% CI: 0.86-0.93), specificity of 0.86 (95% CI: 0.83-0.89), PLR of 5.90 (95% CI: 4.46-7.82), NLR of 0.15 (95% CI: 0.09-0.26), and DOR of 42.55 (95% CI: 21.51-84.18). The area under the SROC curve was 0.92, and the Q value was 0.85. No publication bias was identified.

CONCLUSIONS

Adenosine deaminase is a valuable marker with both high sensitivity and specificity in the diagnosis of tuberculous pericarditis. Nevertheless, the results of adenosine deaminase assays should be interpreted in combination with other test results and clinical characteristics of patients.

TaqMan Real-Time Polymerase Chain Reaction and Pyrosequencing using Single Nucleotide Polymorphism Protocol for Rapid Determination of ALDH2 *2 in a Chinese Population

Purpose: To establish a rapid molecular method for the detection of aldehyde dehydrogenase 2 (ALDH2), and determine whether the polymorphic ALDH2 gene is associated with drinking behavior in a Chinese population.Methods: The gene polymorphism of ALDH2 *2 was detected using pyrosequencing and TaqMan realtime polymerase chain reaction (PCR) techniques. Genotyping of 176 volunteers were performed at The Third Hospital of Wuhan, Hubei, China. Genetic associations with alcohol use behavior was assessed.Results: Pyrosequencing and TaqMan real time PCR methods were successfully developed to identify ALDH2 *2 polymorphisms. The allele frequencies of ALDH2 *2 were 21.31 % in the Chinese population. While the genotype frequency of heterozygous ALDH2 *1/ *2 plus homozygous ALDH2 *2/ *2 was 46.67 % in non-drinkers, it was 30.17 % in the alcoholics group (p = 0.030). The allele frequency of ALDH2 *2 was 15.09 % in the alcoholics group and 28.33 % among non-drinkers (p = 0.011). There were  substantial differences in allele frequencies of ALDH2 genotypes between this study’s Chinese sample and other ethnic groups in Asia; the frequency of ALDH2 *2 allele was significantly higher than that in European and Americans.Conclusion: The developed pyrosequencing and TaqMan real time PCR methods are rapid, accurate, high-throughput, convenient, and reliable for detecting ALDH2 polymorphisms. ALDH2 *2 gene protects against the development of alcoholism. The frequencies of ALDH2 in this Chinese population differ from those of other  ethnic populations.Keywords: Aldehyde dehydrogenase 2, Polymorphism, TaqMan real time Polymerase Chain Reaction, Pyrosequencing, Allele, Alcoholics, Genotype frequency

Measurements of Elliptic and Triangular Flow in High-Multiplicity 3He+Au Collisions at √(s(NN))=200 GeV

We present the first measurement of elliptic (v(2)) and triangular (v(3)) flow in high-multiplicity (3)He+Au collisions at √(s(NN))=200  GeV. Two-particle correlations, where the particles have a large separation in pseudorapidity, are compared in (3)He+Au and in p+p collisions and indicate that collective effects dominate the second and third Fourier components for the correlations observed in the (3)He+Au system. The collective behavior is quantified in terms of elliptic v(2) and triangular v(3) anisotropy coefficients measured with respect to their corresponding event planes. The v(2) values are comparable to those previously measured in d+Au collisions at the same nucleon-nucleon center-of-mass energy. Comparisons with various theoretical predictions are made, including to models where the hot spots created by the impact of the three (3)He nucleons on the Au nucleus expand hydrodynamically to generate the triangular flow. The agreement of these models with data may indicate the formation of low-viscosity quark-gluon plasma even in these small collision systems.

Mechanism of Platelet Activation and Hypercoagulability by Antithymocyte Globulins (ATG)

T cell depletion with antithymocyte globulins (ATG) can be complicated by thrombopenia and hypercoagulability. The underlying mechanism is still unclear. We found that binding of ATG to platelets caused platelet aggregation, α-granule release, membrane phosphatidylserine exposure and the rapid release of procoagulant platelet microvesicles (MV). Platelet activation and MV release were complement-dependent and required membrane insertion of C5b-8 but not stable lytic pore formation by C5b-9. ATG also activated platelets via binding to the low-affinity Fc gamma receptor FcγRII. However, only complement inhibition but not blockade of FcγRII prevented MV release and subsequent thrombin activation in plasma. In 19 hematopoietic stem cell and kidney transplant patients, ATG treatment resulted in thrombopenia and increased plasma levels of d-dimer and thrombin-antithrombin complexes. Flow cytometric analysis of complement fragments on platelet MV in patient plasma confirmed dose-dependent complement activation by ATG. However, the rapid rise in MV numbers observed in vitro was not seen during ATG treatment. In vitro experiments suggested that this was due to adherence of C3b-tagged MV to red blood cells via complement receptor CR1. These data suggest a clinically relevant link between complement activation and thrombin generation and offer a potential mechanism underlying ATG-induced hypercoagulability.

Challenges and Opportunities for Quantitative Clinical Pharmacology in Cancer Immunotherapy: Something Old, Something New, Something Borrowed, and Something Blue

Cancer immunotherapy (CIT) initiates or enhances the host immune response against cancer. Following decades of development, patients with previously few therapeutic options may now benefit from CIT. Although the quantitative clinical pharmacology (qCP) of previous classes of anticancer drugs has matured during this time, application to CIT may not be straightforward since CIT acts via the immune system. Here we discuss where qCP approaches might best borrow or start anew for CIT.

The effects of nerve growth factor on endothelial cells seeded on different titanium surfaces

Angiogenesis is critical for peri-implant bone regeneration and osseointegration. Endothelial cells (ECs) play an important role in angiogenesis during the early stage of bone formation. Nerve growth factor (NGF) is also reported to function as an angiogenic growth factor. The effects of NGF on ECs seeded on titanium surfaces are unclear. This study was done to investigate the influence of NGF on peri-implant angiogenesis in vitro and in vivo. We used two different titanium surfaces. ECs seeded on these surfaces were treated with indicated concentrations of NGF or vascular endothelial growth factor (VEGF). Proliferation, differentiation, morphological features, and amounts attached were assessed. Chicken embryo chorioallantoic membrane (CAM) was adopted to evaluate the effect of NGF in vivo. The results showed that NGF could promote EC proliferation on both titanium surfaces (F1d=2.083, P=0.156; F3d=30.857, P=0.0002; F5d=4.440, P=0.041; F7d=11.065, P=0.001). NGF and the SLA surface upregulated mRNA of NGF, TrkA, and p75 expression (FNGF=11.941, P=0.003; FTrkA=28.514, P=0.004; Fp75=7.725, P=0.01). In vivo, the supernatants of the NGF-treated group could promote neovascularization in CAM (F=17.662, P=0.009). This study demonstrated that NGF could enhance EC proliferation, gene expression on different titanium surfaces, and neovascularization in CAM. This provides novel information in relation to the promotion of early dental implant osseointegration.

Effect of adjustable gastric banding on quality of life and weight loss in the Helping Evaluate Reduction in Obesity (HERO) registry study: 2 year analysis

OBJECTIVE

This report from the Helping Evaluate Reduction in Obesity (HERO) Study investigated weight loss, health-related quality of life (HRQOL), and factors predictive of HRQOL improvement during a 2 year period following Lap-Band AP implantation (post-LBAP).

RESEARCH DESIGN AND METHODS

This prospective, observational study included patients with 1 and 2 year follow-up data post-LBAP (N = 585). Changes in body mass index (BMI), percentage of weight loss (%WL), excess weight loss (%EWL) and HRQOL (Impact of Weight on Quality of Life [IWQOL]-Lite measure), and differences between <30% EWL and ≥30% EWL subgroups were assessed at 1 and 2 years post-LBAP. Multiple linear regression examined association of %EWL groups with IWQOL-Lite scores controlling for age, gender, region (US vs outside US), household income, employment status, and comorbidities.

RESULTS

Most patients were female (80.2%) and from the US (64.8%); overall mean (SD) age was 43.6 (11.28) years and 65.8% of patients had ≥30% EWL at year 2. At 2 years post-LBAP, mean %EWL was 43.5%; %EWL was 12.4% in the <30% EWL group and 59.6% in ≥30% EWL group (P ≤ 0.0001). Changes in IWQOL total and subscores were significantly greater in ≥30% EWL versus <30% EWL patients (all P < 0.0005) at years 1 and 2; Self-Esteem and Physical subscores had the largest changes. Multiple regression analysis showed that patients with ≥30% EWL had clinically meaningful improvements in HRQOL compared with patients having <30% EWL (P ≤ 0.001). Similarly, US patients and females had a clinically significant change in IWQOL score versus their counterparts (P ≤ 0.001). Conversely, income, comorbidities and employment status were not significant predictors of change in IWQOL scores at year 2.

CONCLUSIONS

These results support and extend findings regarding the effectiveness of LBAP for weight loss and illustrate the importance of ≥30% EWL as a significant factor in predicting clinically significant improvement in HRQOL 1 and 2 years post-LBAP.

CLINICAL TRIAL REGISTRATION

NCT00953173.