The trouble with investigating anaemia in young adults: bleeding from a giant Meckel's diverticulum without ectopic gastric mucosa

Giant Meckel's diverticulum is rare and usually presents in childhood with haemorrhage or bowel obstruction. Bleeding results from the presence of ectopic gastric mucosa causing peptic ulceration of adjacent mucosa. We discuss the case of a 21-year-old man with a giant Meckel's diverticulum who presented with rectal bleeding. A Meckel's scan was negative and histology following surgical excision ruled out the presence of ectopic gastric mucosa. There was however evidence of chronic inflammation and small bowel mucosal ulceration. We hypothesize that this arose from ischaemia and pressure necrosis because of the large size of the diverticulum and chronic distension by food debris. This case highlights the difficulties in investigating anaemia in young adults despite modern imaging techniques.

Phase I clinical experience of a targeted TCR-IL2 fusion protein in patients with metastatic malignancies

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Background: ALT-801 is recombinant human interleukin-2 (IL-2) genetically fused to a single-chain T-cell receptor specific to a peptide antigen of human p53 presented in the context of HLA-A2 positivity. In tumor xenografts in animal models, this fusion protein demonstrated potent and targeted antitumor activity. Methods: A phase I/IIa multicenter clinical study was initiated to assess safety and clinical response of ALT-801 in patients with various metastatic malignancies. Patients screened positively for HLA-A2 and tumors expressed p53 peptide/HLA-A2 complex. In this dose escalation trial, patients received ALT-801 as a daily intravenous infusion for 4 days followed by a 10-day rest period and 4 additional daily doses. Results: Data from three dosing cohorts (0.015, 0.04, and 0.08 mg/kg/dose) indicate that ALT-801 is well-tolerated up to 0.04 mg/kg/dose. The half-life of ALT-801 is 2.5–4 hours per pharmacokinetic analysis, depending on the dose. Even at the 0.015 mg/kg level, there were sufficient concentrations of ALT-801 in the patients’ serum to fully activate cell lytic activity in vitro. Treatment with ALT-801 also led to immune activation in patients as demonstrated by elevated serum IFN-γ levels as well as an increase in IFN-γ-producing immune cells in patients’ blood. Interestingly, serum TNF-α, a major inducer of hypotension in patients receiving high-dose IL-2 treatment, was not induced in patients receiving ALT-801. Evidence of antitumor activity (i.e., stable disease, tumor shrinkage) was observed in some patients after one or two courses of ALT-801. Conclusions: At a dose of 0.04 mg/kg, ALT-801 is a well-tolerated agent that generated a vigorous immune response and demonstrated clinical efficacy in a group of patients with various metastatic malignancies. An expansion cohort of patients is in progress at 0.04 mg/kg.

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Composition and strain measurements of Ge(Si)/Si(001) islands by HRTEM

The distributions of the composition and the strain in the Ge(Si)/Si(001) coherent islands grown by molecular-beam epitaxy are investigated by digital analysis of high resolution transmission electron microscopy (HRTEM) micrographs. Local composition and strain are obtained from the measurement of the lattice displacement based on the Poisson's formula and Vegard's law. The analysis suggests that the islands have high Ge content at the island's central region. The island is partially relaxed by the substrate deformation and strain concentrated around the edge of islands. The alloying of the islands was found due to the Si surface diffusion.

The impact of smoking and quitting on household expenditure patterns and medical care costs in China

BACKGROUND

Smoking remains very common in Chinese men, and the economic burden caused by cigarette consumption on smokers and their families may be substantial. Using a large nationally representative household survey, the third National Health Services Survey (NHSS, 2003), we estimated the economic impact of smoking on households.

METHODS

Smoking status of all household members (over 15 years) was collected by interview for the NHSS, and households classified into one of seven categories based on their smoking status. Information on household income and expenditure, and use of health services was also obtained. We assessed both the "direct" costs (reducing funds available for spending on other commodities such as food, education, medical care, etc, using a fractional logit model), and "indirect costs" (increasing medical expenditures, using a log-linear model).

RESULTS

Every five packets of cigarettes consumed per capita per month reduces household spending on other commodities, most notably on education (by about 17 yuan per capita per annum) and medical care (11 yuan). The effects are greatest among low-income rural households. Households with quitters spend substantially more on medical care than never-smoking households (64 yuan for households with two or more quitters).

CONCLUSIONS

If a household member smokes, there is less money available for commodities such as education and medical care. Medical care expenditure is substantially higher among households with quitters, as ill-health is the main reason for quitting smoking in China. Smoking impoverishes a substantial number of poorer rural households.

Identifying quantitative trait loci for resistance to Sclerotinia head rot in two USDA sunflower germplasms

Sclerotinia head rot is a major disease of sunflower in the world, and quantitative trait loci (QTL) mapping could facilitate understanding of the genetic basis of head rot resistance and breeding in sunflower. One hundred twenty-three F2:3 and F2:4 families from a cross between HA 441 and RHA 439 were studied. The mapping population was evaluated for disease resistance in three field experiments in a randomized complete block design with two replicates. Disease incidence (DI) and disease severity (DS) were assessed. A genetic map with 180 target region amplification polymorphism, 32 simple sequence repeats, 11 insertion-deletion, and 2 morphological markers was constructed. Nine DI and seven DS QTL were identified with each QTL explaining 8.4 to 34.5% of phenotypic variance, suggesting the polygenic basis of the resistance to head rot. Five of these QTL were identified in more than one experiment, and each QTL explained more than 12.9% of phenotypic variance. These QTL could be useful in sunflower breeding. Although a positive correlation existed between the two disease indices, most of the respective QTL were located in different chromosomal regions, suggesting a different genetic basis for the two indices.

Laparoscopic upper urinary tract surgery for benign and malignant conditions. Does aetiology have an effect on health-related quality of life?

INTRODUCTION

We present health-related quality of life (HRQoL) data on a cohort of patients undergoing upper urinary tract laparoscopy for a variety of benign and malignant conditions.

PATIENTS AND METHODS

The Short Form 8 (SF-8) Health Survey is a validated HRQoL questionnaire that calculates scores for physical (PCS8) and mental (MCS8) components of health. It was administered prospectively to 58 patients. Radical nephrectomy or nephroureterectomy was carried out for upper tract malignancy (n = 21). Laparoscopy for benign disease (n = 37) included simple nephrectomy for giant hydronephrosis and small non-functioning kidneys, de-roofing of renal cysts and pyeloplasty. Data were collected before and 6 weeks after surgery.

RESULTS

The mean pre- and postsurgery scores were 45.99; 47.43 and 43.93; 51.54 for PCS8 and MCS8 respectively. With regard to the PCS8 score, there was no significant difference before or after surgery (p = 0.585) or when analysing the benign (p = 0.343) or malignant (p = 0.509) groups individually. The MCS8 score, however, showed a significant increase after surgery (p < 0.0001). This remained significant when analysing just the benign (p < 0.0009) or the malignant (p < 0.0003) groups but neither group was more significant than the other (p = 0.750).

CONCLUSIONS

Laparoscopic upper urinary tract surgery significantly improves mental and does not appear to reduce physical HRQoL in patients regardless of aetiology, 4 weeks following surgery. Interestingly, those operated on for malignant conditions do not have a greater improvement in mental health when compared with benign disease.

Observation and simulation of net primary productivity in Qilian Mountain, western China

We modeled net primary productivity (NPP) at high spatial resolution using an advanced spaceborne thermal emission and reflection radiometer (ASTER) image of a Qilian Mountain study area using the boreal ecosystem productivity simulator (BEPS). Two key driving variables of the model, leaf area index (LAI) and land cover type, were derived from ASTER and moderate resolution imaging spectroradiometer (MODIS) data. Other spatially explicit inputs included daily meteorological data (radiation, precipitation, temperature, humidity), available soil water holding capacity (AWC), and forest biomass. NPP was estimated for coniferous forests and other land cover types in the study area. The result showed that NPP of coniferous forests in the study area was about 4.4 tCha(-1)y(-1). The correlation coefficient between the modeled NPP and ground measurements was 0.84, with a mean relative error of about 13.9%.

LAI inversion algorithm based on directional reflectance kernels

Leaf area index (LAI) is an important ecological and environmental parameter. A new LAI algorithm is developed using the principles of ground LAI measurements based on canopy gap fraction. First, the relationship between LAI and gap fraction at various zenith angles is derived from the definition of LAI. Then, the directional gap fraction is acquired from a remote sensing bidirectional reflectance distribution function (BRDF) product. This acquisition is obtained by using a kernel driven model and a large-scale directional gap fraction algorithm. The algorithm has been applied to estimate a LAI distribution in China in mid-July 2002. The ground data acquired from two field experiments in Changbai Mountain and Qilian Mountain were used to validate the algorithm. To resolve the scale discrepancy between high resolution ground observations and low resolution remote sensing data, two TM images with a resolution approaching the size of ground plots were used to relate the coarse resolution LAI map to ground measurements. First, an empirical relationship between the measured LAI and a vegetation index was established. Next, a high resolution LAI map was generated using the relationship. The LAI value of a low resolution pixel was calculated from the area-weighted sum of high resolution LAIs composing the low resolution pixel. The results of this comparison showed that the inversion algorithm has an accuracy of 82%. Factors that may influence the accuracy are also discussed in this paper.

Renal pathological change in patients with type 2 diabetes is not always diabetic nephropathy: a report of 52 cases

AIMS

The present study examined the relationship between clinical features and renal histological changes in the Type 2-diabetic patients and evaluated the usefulness of renal biopsy in the diagnosis of diabetic versus non-diabetic kidney disease.

METHODS

52 patients with Type 2-diabetic mellitus were retrospectively analyzed for differential clinical, laboratory features and pathological characteristics including overt proteinuria (> 0.5 g/day), elevated serum creatinine and/or the development of hematuria.

RESULTS

Of 52 patients, 20 cases (38.5%) showed no detectable diabetic lesions and, thus, were diagnosed as non-diabetic renal disease (NDRD), while 32 patients (61.5%) exhibited diabetic nephropathy. Interestingly, while 29 patients showed diabetic nephropathy (DN) alone, NDRD was also found in 3 patients with DN. Clinically, 24 out of 52 patients (46.16%) had a diagnosis consistent with the pathological findings, while 10 (19.23%) were diagnosed incorrectly. Compared to NDRD patients, patients with DN had prolonged diabetic history with or without retinopathy, while 25% of patients with NDRD exhibited mesangial proliferative glomerulonephritis.

CONCLUSIONS

NDRD was a common feature in Type 2-diabetic patients with renal involvement. The absence of retinopathy and short periods of diabetic history may be useful indicators for diagnosis of NDRD clinically.

Detection of emerging HIV variants in blood donors from urban areas of Cameroon

The U.S. Food and Drug Administration has licensed several assays for use in donor testing and management of persons with human immunodeficiency virus (HIV) infection. However, the performance of these assays for detection and quantitation of emerging HIV genetic variants has not been studied extensively. We tested 240 human plasma specimens collected from two urban blood centers in Cameroon where HIV genetic diversity and recombinant HIV strains are highly prevalent, using several FDA licensed assays. The testing record in Cameroon indicated that 149 specimens were HIV antibody positive and 91 specimens were negative using a rapid HIV-1/2 antibody assay in routine use in Cameroon blood centers. Both sets of samples were evaluated in the FDA laboratory using four ELISA tests for HIV-1 group M, HIV-1 group O, and HIV-2 antibodies, one IFA for HIV-1 antibody, one Western blot for HIV-1, one HIV-1 p-24 antigen assay, and three nucleic acid tests (NAT). Our results indicate that the assays had high sensitivity for detection of emerging genetic variants, although a small number of samples harboring circulating recombinant forms (CRFs) found in Cameroon were not always consistently detected by a few assays. These findings may be due to the evolving genetic diversity of HIV strains in Cameroon.

Pharmacokinetics and lung-targeting characterization of a newly formulated enrofloxacin preparation

A new lung-targeting and controlled releasing preparation, enrofloxacin microsphere, was formulated and its physical properties, stability, pharmacokinetics and lung-targeting characteristics were tested in this study. The enrofloxacin microsphere prepared was demonstrated round and regular, which was easy to be dispersed and stable in both light stability test and heat stability test. Following intravenous administration of a single dose in dog, the drug concentration-time data in the lung were fitted most suitably with three-compartment open model. Compared with enrofloxacin injection (Baytril, half-life of distribution phase in the lung was shortened from 0.72 to 0.16 h, half-life of elimination phase in the lung was prolonged from 5.15 to 33.86 h and clearance of drug concentration in the lung was decreased from 0.603 to 0.267 L/h/kg. Lung-targeting parameters, including the relative intake rate (Re), targeting efficacy (Te) and the ratio of peak concentration (Ce), were calculated according to the pharmacokinetic parameters. The results showed that Re (2.48) and Ce (4.27) of the lung was much greater than that of other tissues and the ratio of Te(microsphere) to Te(Baytril) increased by a factor of 1.77 (compared with liver) to 3.51 (compared with spleen). Therefore, the enrofloxacin microsphere prepared in this study had controlled releasing and lung-targeting effects in dog.

Levitation, lift, and bidirectional motion of colloidal particles in an electrically driven nematic liquid crystal

We study electric-field-induced dynamics of colloids in a nematic cell, experimentally and by computer simulations. Solid particles in the nematic bulk create director distortions of dipolar type. Elastic repulsion from the walls keeps the particles in the middle of cell. The ac electric field reorients the dipoles and lifts them to top or bottom, depending on dipole orientation. Once near the walls, the colloids are carried along two antiparallel horizontal directions by nematic backflow. Computer simulations of the backflow agree with the experiment.

Identification of a novel HLA-B*56 allele, B*5618 and an extension of B*2736 by sequence-based typing

We report the identification of a novel human leukocyte antigen (HLA)-B*56 allele, B*5618 and an extension of B*2736 that were found during routine high-resolution sequence-based typing in Chinese Han individual. The B*5618 allele has 4nt changes from B*5610 in exon 3, The B*2736 allele has 10nt changes from B*270401 in exons 3-4.

Role of acetylcholine transmission in nucleus accumbens and ventral tegmental area in heroin-seeking induced by conditioned cues

The involvement of cholinergic transmission in heroin self-administration and the reinstatement of heroin-seeking was examined in rats trained to nose-poke for i.v. heroin. Systemic treatment with physostigmine, an inhibitor of acetylcholinesterase, modestly reduced the acquisition and rate of heroin self-administration, and this suppression of heroin intake was reversed by pretreatment with scopolamine but not by mecamylamine. Following 10-14 days of self-administration, rats were left in the home environment for 14 days. Subsequently, rats were evaluated for extinction of nose-pokes during the first hour after being returned to the self-administration apparatus. One hour later a conditioned stimulus (house light, light in the nose-poke hole, sound of the infusion pump) was presented to initiate cue-induced reinstatement. Physostigmine produced a dose-dependent inhibition of cue-induced reinstatement, but only the dose of 0.5 mg/kg significantly decreased nose-poke responding in the extinction test. Chronic treatment with physostigmine (0.1 mg/kg) did not impair performance during acquisition of heroin self-administration. However, during a subsequent reinstatement test conducted in the absence of physostigmine pretreatment, heroin seeking was significantly below that of rats chronically pretreated with saline. To evaluate brain regions mediating the effects of systemic drug treatment on reinstatement, physostigmine was microinjected into the nucleus accumbens (NAc) or ventral tegmental area (VTA). Microinjection of physostigmine into the NAc prior to presenting conditioned cues inhibited the reinstatement of heroin-seeking, without affecting extinction responding. In contrast, microinjection of physostigmine into the VTA augmented the reinstatement induced by conditioned cues and extinction responding. Inactivation of either NAc or VTA by microinjecting tetrodotoxin blocked both extinction responding and cue-induced reinstatement. These data demonstrate that cholinergic transmission influences heroin self-administration and reinstatement. Moreover, cue-induced reinstatement was inhibited by physostigmine in the NAc and potentiated by cholinergic stimulation in the VTA.

The LRRK2 Gly2385Arg variant is associated with Parkinson’s disease: genetic and functional evidence

Evidence of LRRK2 haplotypes associated with Parkinson's disease (PD) risk was recently found in the Chinese population from Singapore, and a common LRRK2 missense variant, Gly2385Arg, was independently detected as a putative risk factor for PD in the Chinese population from Taiwan. To test the association between the Gly2385Arg variant in a large case-control sample of Chinese ethnicity from Singapore, and to perform functional studies of the wild type and Gly2385Arg LRRK2 protein in human cell lines. In a case-control study involving 989 Chinese subjects, the frequency of the heterozygous Gly2385Arg genotype was higher in PD compared to controls (7.3 vs. 3.6%, odds ratio = 2.1, 95% CI: 1.1-3.9, P = 0.014); these values yield an estimated population attributable risk (PAR) of approximately 4%. In a multivariate logistic regression analysis with the disease group (PD vs. controls) as the dependent variable and the genotype as an independent factor with adjustments made for the effect of age and gender, the heterozygous Gly2385Arg genotype remained associated with an increased risk of PD compared to wild type genotype (odds ratio = 2.67, 95% CI: 1.43-4.99, P = 0.002). The glycine at position 2385 is a candidate site for N-myristoylation, and the Gly2385Arg variant replaces the hydrophobic glycine with the hydrophilic arginine, and increases the net positive charge of the LRRK2 WD40 domain. In transfection studies, we demonstrated that both the wild type and Gly2385Arg variant LRRK2 protein localize to the cytoplasm and form aggregates. However, under condition of oxidative stress, the Gly2385Arg variant was more toxic and associated with a higher rate of apoptosis. Our study lends support to the contention that the Gly2385Arg is a common risk factor for PD in the Chinese population. Our bioinformatics and in-vitro studies also suggest that the Gly2385Arg variant is biologically relevant and it might act through pro-apoptotic mechanisms.