Early assessment of chronic kidney dysfunction using contrast-enhanced ultrasound: a pilot study

OBJECTIVE

We performed a prospective study to evaluate the value of contrast-enhanced (CE) ultrasound in quantitative evaluation of renal cortex perfusion in patients with chronic kidney dysfunction (CKD Stage I-II).

METHODS

The present study was approved by the institutional ethics committee. The study focused on 41 consecutive patients (males, 32; females, 9; mean age, 55.0 ± 5.0 years) with clinical suspicion of CKD (Stages I-II). For both kidneys, CE ultrasound was performed after intravenous bolus injection of 1.0 ml SonoVue® (Bracco Imaging S.p.A., Milan, Italy). Time-intensity curves (TICs) and quantitative indexes were created with Qlab software (Philips, Bothell, WA). 45 healthy volunteers were included as control group. All statistical analyses were performed with SPSS® v. 15.0 software package (SPSS, Chicago, IL). A difference was considered statistically significant with p < 0.05.

RESULTS

Patients with CKD (Stages I-II) had no obvious change in the shape of TICs. Among all quantitative indexes, the changes of area under the curve (AUC), derived peak intensity (DPI) and slope rate of elevation curve (A) were statistically significant (p < 0.05). DPI <12 dB, A >2 and AUC >1300 dB s had high utility in the evaluation of CKD, with 81%, 73% and 78% specificities and 76%, 73% and 77% sensitivities.

CONCLUSION

CE ultrasound might be valuable in the early evaluation of CKD. AUC, A and DPI might be valuable quantitative indexes.

ADVANCES IN KNOWLEDGE

Quantitative CE ultrasound analysis can be used for the standardized and early evaluation of renal dysfunction.

Detection of fetal sex chromosome aneuploidy by massively parallel sequencing of maternal plasma DNA: initial experience in a Chinese hospital

OBJECTIVES

To evaluate the performance of a massively parallel sequencing (MPS)-based test in detecting fetal sex chromosome aneuploidy (SCA) and to present a comprehensive clinical counseling protocol for SCA-positive patients.

METHODS

This was a retrospective study in a large patient cohort of 5950 singleton pregnancies which underwent MPS-based testing as a prenatal screening test for trisomies 21, 18 and 13, with X and Y chromosomes as secondary findings, in Southwest Hospital in China. MPS-based SCA-positive women were offered the choice of knowing whether their SCA results were positive and those who did commenced a two-stage post-test clinical counseling protocol. In Stage 1, general information about SCA was given, and women were given the option of invasive testing for confirmation of findings; in Stage 2, those who had chosen to undergo invasive testing were informed about the specific SCA affecting their fetus and their management options.

RESULTS

Thirty-three cases were classified as SCA-positive by MPS-based testing. After Stage 1 of the two-stage post-test clinical counseling session, 33 (100%) of these pregnant women chose to know the screening test results, and 25 (75.76%) underwent an invasive diagnostic procedure and karyotype analysis, in one of whom karyotyping failed. In thirteen cases, karyotyping confirmed the MPS-based test results (two X0 cases, seven XXX cases, three XXY cases and one XYY case), giving a positive predictive value of 54.17% (13/24 cases confirmed by karyotyping). After post-test clinical counseling session Stage 2, seven women chose to terminate the pregnancy: one X0 case, two XXX cases, the three XXY cases and the single XYY case. Six women decided to continue with pregnancy: one X0 case and five XXX cases.

CONCLUSION

Our study showed the feasibility of clinical application of the MPS-based test in the non-invasive detection of fetal SCA. Together with a two-stage post-test clinical counseling protocol, it leads to a well-informed decision-making procedure.

Birth of a healthy child by a woman with inherited Xq duplications who had experienced stillbirths

A 23-year-old woman who had experienced repeated stillbirths, was found to carry an additional segment on the long arm of the X chromosome. Array comparative genomic hybridization (aCGH) confirmed the origin of the 2 duplications (about 17.11 Mb). Thus, her karyotype was 46, X, dup (X) (q13.2-q21.1), dup(X) (q21.32-q22.1). We demonstrate that aCGH is a useful complementary tool to cytogenetic analysis for accurately determining banding. To our knowledge, this is the first case with normal apparently phenotype who inherited 2 duplications on Xq. Notably, after 2 stillbirths, she bore a healthy, normal female infant via natural pregnancy. Thus, a carrier of this karyotype can birth a phenotypically normal child.

Effects of monochromatic light stimuli on the development and Muc2 expression of goblet cells in broiler small intestines during embryogenesis

The effects of monochromatic light on the ontogeny, differentiation, and Muc2 expression level in goblet cells were studied in the small intestines of late-stage broiler embryos. The embryos were exposed to blue light (B group), green light (G group), red light (R group), or darkness (D group) throughout the incubation period. On d 15 of incubation (E15), a few acidic goblet cells (only the sulfated subtype) were observed, and Muc2 mRNA expression was detected. On E18, however, neutral, acidic, and intermediate types, as well as the sulfated subtype, were observed in the small intestine, and a decreasing gradient of goblet cell density was found along the duodenum to ileum axis. Up to E21, 3 types of goblet cells and 3 acidic cell subtypes were found in all the small intestines. The goblet cell density increased along the duodenum to ileum axis. Monochromatic light stimulation resulted in no significant differences in the density and types of goblet cells between the different treatment groups on E15 and E18, but an increased Muc2 mRNA expression level was detected on E18 in the G group compared with the other treatment groups. On E21, the goblet cell density, proportion of acidic goblet cells, and Muc2 mRNA expression level increased in the G group compared with other treatment groups. These results suggest that the ontogeny and differentiation of goblet cells in broiler embryos display temporal and spatial differences. Green monochromatic light may have the potential to promote the proliferation and maturation of as well as the expression of Muc2 mRNA in goblet cells of broiler embryos.

Sevoflurane inhibits neurogenesis and the Wnt-catenin signaling pathway in mouse neural progenitor cells

Recent population studies suggest that children who receive anesthesia and surgery could be at an increased risk for developing learning disabilities. The underlying reason for this clinical observation is largely unknown. Whether undergoing anesthesia contributes to learning disability development, or if the need for anesthesia and surgery is a marker for other unidentified factors that contribute to the development of learning disabilities, remains to be determined. Neurogenesis, regulated by the Wnt-catenin signaling pathway, has been shown to be involved in learning and memory, and sevoflurane is the most commonly used inhalation anesthetic in children. We therefore set out to determine the effects of sevoflurane on neurogenesis and the Wnt-catenin signaling pathway in mouse neural progenitor cells (NPCs) using immunofluorescence and Western blot analysis. Here we show for the first time that 4.1%, but not 2.0%, sevoflurane reduced mouse NPC proliferation, increased Glycogen synthase kinase-3β(GSK-3β) levels, and decreased levels of β-Catenin in mouse NPCs. The GSK-3β inhibitor Lithium attenuated the sevoflurane-induced reduction in mouse NPC proliferation. The data suggest that sevoflurane may reduce neurogenesis through the Wnt-catenin signaling pathway. These findings would promote further studies to investigate the effects of anesthesia on neurogenesis and function of learning and memory, as well as the underlying mechanisms in vitro and in vivo. Ultimately these efforts would lead to safer anesthesia care and better postoperative outcomes in children.

Isoflurane induces endoplasmic reticulum stress and caspase activation through ryanodine receptors

BACKGROUND

Isoflurane has been reported to induce caspase-3 activation, which may induce neurotoxicity and contribute to the pathogenesis of Alzheimer's disease. However, the underlying mechanism is largely unknown, especially whether or not isoflurane can induce ryanodine receptors (RyRs)-associated endoplasmic reticulum (ER) stress, leading to caspase-3 activation. We therefore assessed the effects of isoflurane on RyRs-associated ER stress.

METHODS

We treated primary neurones from wild-type (C57BL/6J) mice with 1% and 2% isoflurane for 1, 3, or 6 h. We then measured levels of C/EBP homologous protein (CHOP) and caspase-12, two ER stress markers, using immunocytochemistry staining and western blotting analysis. Dantrolene (5 μM), the antagonist of RyRs, was used to investigate the role of RyRs in the isoflurane-induced ER stress and caspase-3 activation.

RESULTS

Isoflurane 2% for 6 h treatment increased the levels of CHOP (876% vs 100%, P=0.00009) and caspase-12 (276% vs 100%, P=0.006), and induced caspase-3 activation in the neurones. The administration of 2% isoflurane for 3 h (shorter duration), however, only increased the levels of CHOP (309% vs 100%, P=0.003) and caspase-12 (266% vs 100%, P=0.001), without causing caspase-3 activation. The isoflurane-induced ER stress (CHOP: F=16.64, P=0.0022; caspase-12: F=6.13, P=0.0383) and caspase-3 activation (F=32.06, P=0.0005) were attenuated by the dantrolene treatment.

CONCLUSIONS

These data imply that isoflurane might induce caspase-3 activation by causing ER stress through RyRs, and dantrolene could attenuate the isoflurane-induced ER stress and caspase-3 activation. Further investigations of the potential neurotoxicity of isoflurane are needed.

Sperm retrieval from patients with nonmosaic Klinefelter's syndrome by semen cytology examination

Successful sperm retrieval from ejaculates of nonmosaic Klinefelter's syndrome (KS) patients by using semen cytology examination was described in this report. The clinical parameters of KS patients with sperm compared to patients without sperm were described. One hundred and fifty-one patients were proven to suffer from KS by chromosomal analysis using G-banding. Spermatozoa were obtained from 10 patients (10/151, 6.6%) using semen analysis. After semen cytology examination, 32 patients (32/151, 21.2%) were found to have sperm or germ cell in their ejaculate. The patients with successful sperm retrieval were significantly younger (27.1 ± 3.7 years) than the patients for whom sperm retrieval failed (28.9 ± 4.2 years). The mean serum testosterone level and the mean T/LH ratio of KS patients with successful sperm retrieval were significantly higher in men with sperm than in men without sperm (testosterone: 3.2 ± 2.1 ng/mL vs 2.7 ± 1.5 ng/mL; T/LH ratio: 0.2 ± 0.3 vs 0.1 ± 0.1). In conclusion, semen cytology examination should be performed to identify sperm and germ cells in the ejaculate of KS patients if no sperm can be detected by traditional semen analysis. The serum testosterone level and T/LH ratio revealed an association between impaired Leydig cell function and impaired spermatogenesis in KS males. KS patients should receive earlier diagnosis and treatment.

Reproductive outcomes in recurrent pregnancy loss associated with a parental carrier of chromosome abnormalities or polymorphisms

The subsequent reproductive outcomes in couples with a history of recurrent pregnancy loss (RPL) associated with chromosome abnormalities or polymorphisms are generally not reported in China. Many RPL carrier couples have decided not to have children. The present study recorded the subsequent delivery, miscarriage, and unpregnancy outcomes of 113 RPL carrier couples and 226 non-carrier couples, and compared differences in reproductive outcomes between couples with different types of chromosome abnormalities or polymorphisms and chromosome normal couples. Our results showed that couples with RPL associated with parental chromosome abnormalities or polymorphisms did not have significantly lower live birth rates than non-carrier couples in China. These results suggest the current guidance given to Chinese RPL couples.

A case of adult-onset Still's disease presenting with multifocal central serous chorioretinopathy

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology with no specific histological features. In this study, we reported a 43-year-old woman who developed AOSD with multifocal central serous chorioretinopathy (CSC). Up to now, the patient is still on close follow-up. Besides, we reviewed the literature emphasized on the ophthalmological features of AOSD.

First Report of Meloidogyne javanica on Sacha Inchi (Plukenetia volubilis) in China

Sacha inchi (Plukenetia volubilis L.) is a plant native to the rain forest of the Peruvian Amazon region. Because of its high protein and oil content as well as general nutritional quality, it is regarded as a promising new crop. Successfully introduced from South America in 2006, Sacha inchi has been cultivated in Xishuangbanna, in the southwestern region of Yunnan Province, China. During an investigation from August to October of 2012, severely stunted and withered Sacha inchi plants with rotted and galled root were observed in fields. Dissection of galled root tissue revealed mature root-knot nematode (Meloidogyne sp) females with body cavity filled with red color contents. The population was extracted and quantified from soil and root samples and identified to species by morphology, esterase (EST) isozyme phenotypes, and molecular characterization (3). Mean populations of 774 ± 251 Meloidogyne second stage juveniles (J2) per 100 cm³ of soil were extracted from the rhizosphere of symptomatic plants. These juveniles (n = 20) were characterized by length (410 to 480 μm) and hyaline tail terminus length (11 to 17 μm). Females (n = 20) were characterized by stylet length (14.1 to 17.3 μm) and the perineal pattern (rounded with fine striae, low to moderately high dorsal arch, and a distinct lateral field clearly demarcated from striae by parallel lines). The distinct lateral lines of the perineal pattern are diagnostic for this species (3). Gravid females were used for esterase (Est) isoenzyme analysis, and showed the J3 phenotype (relative migration rate [Rm] = 1.0, 1.25, and 1.4), typical of M. javanica, a species-specific phenotype used to differentiate this species from other members of Meloidogyne (1). Additionally, three single egg masses associated with red body females were extracted from the field-collected Sacha inchi roots and inoculated onto three potted tomato plants (Solanum lycopersicum 'Rutgers') and maintained in the greenhouse for 8 weeks until root galls and egg masses were visible. The observation of root-knot nematodes from tomato roots showed that all females' bodies were normal white, and the nematode species was also identified as M. javanica based on the esterase phenotype and the perineal pattern. It is suggested that the red body contents associated with females on Sacha inchi is the result of an unknown chemical compound acquired from that host. Although undetermined to species, Meloidogyne has been reported on Sacha inchi in Peru (2). To our knowledge, this is the first detection of M. javanica on this plant. Since M. javanica is widely distributed throughout the tropics, this root-knot nematode could be an important threat to the commercial cultivation of Sacha inchi. References: (1) R. M. Carneiro et al. Nematol. 2:645, 2000. (2) P. D. P. de Bienes. Sacha inchi (Plukenetia volubilis L.). Base de datos, 2010. (3) R. N. Perry et al. Root-Knot Nematodes. CABI. Wallingford, UK, 2009.

Kinetics of serological responses in influenza A(H7N9)-infected patients correlate with clinical outcome in China, 2013

The novel avian influenza A(H7N9) infection has recently emerged to cause severe respiratory illness in China. The objectives of this study were to define the kinetics of the antibody responses in patients with influenza A(H7N9) disease and to correlate these kinetics with clinical outcome. Serial serum samples were obtained at intervals of three to four days from 18 patients with virologically confirmed A(H7N9) disease in Shanghai. We determined the kinetics of the haemagglutination inhibition (HI) and A(H7H9) pseudotype neutralisation antibody (Nab) responses and correlated these with clinical outcomes. Most patients had robust serological responses by both HI and Nab tests. Taking into account censoring due to time of testing and death, the median time from onset of illness to Nab titre ≥1:40 was 14 days (95% confidence interval (CI): 11–18 days) in the fatal cases and 10.5 days (95% CI: 7–12) in the survivors (p=0.003). The two groups did not differ in initial Nab titres, but the rate of increase in Nab titres was significantly faster for survivors by approximately 10-fold per 15 days (p=0.007). Early and rapid induction of Nab was correlated significantly with better clinical outcome.

Fundus autofluorescence in exudative age-related macular degeneration

The aim of this study was to investigate the characteristics of fundus autofluorescence (FAF) in patients with wet (exudative) age-related macular degeneration (AMD). Color fundus photographs, fundus fluorescein angiograms, indocyanine green angiograms, and FAF images were obtained from 61 patients (72 eyes) with exudative AMD. The FAF results for different patterns of exudative AMD were compared to those revealed by other fundus images. Of the 72 eyes evaluated, which were classified into three patterns based on the results of fundus fluorescein angiography, 68 had abnormal FAF. Forty-six eyes (63.9%) had classic wet AMD with abnormal FAF. Among these, 10 exhibited a slightly decreased FAF with near-normal or background FAF signal at the center of the lesion area; 36 demonstrated not only decreased FAF at the center of the lesion but also an increased FAF signal toward the lesion edge. Sixteen eyes (22.2%) had occult wet AMD, of which 12 exhibited heterogeneous fluorescence at the lesion site; 4 yielded normal FAF images. Ten eyes (13.9%) had a mixed pattern of wet AMD with abnormal FAF. FAF imaging suggested that the areas of blood and exudates decreased; however, fluorescence angiography revealed that lesions with hyperfluorescence had background or slightly increased FAF. These results showed that various patterns of wet AMD exhibit different autofluorescence characteristics. These represent the functional and metabolic features of retinal pigment epithelial cells. Therefore, FAF can be used to monitor disease development and evaluate the severity and prognosis of AMD.

Proteomic analysis of differentially expressed proteins in 5-fluorouracil-treated human breast cancer MCF-7 cells

BACKGROUND

5-Fluorouracil (5-Fu) is a commonly used chemotherapeutic agent in clinical care of breast cancer patients. However, the mechanism of how the 5-Fu works is complex and still largely unknown.

OBJECTIVE

The objective of this study was to understand the mechanism further and explore the new targets of 5-Fu.

METHODS

The differentially expressed proteins induced by 5-Fu in human breast cancer MCF-7 cells were identified by proteomic analysis. Four differentially expressed proteins were validated using Western blot and quantitative real-time reverse-transcription polymerase chain reaction analysis for protein and mRNA levels. The effect of 5-Fu on MCF-7 cells was determined by cell viability assay, transmission electron microscopy and flow cytometry analysis.

RESULTS

5-Fu dose-dependently inhibited cell proliferation with the IC50 value of 98.2 μM. 5-Fu also induced obviously morphological change and apoptosis in MCF-7 cells. Twelve differentially expressed proteins involved in energy metabolism, cytoskeleton, cellular signal transduction and tumor invasion and metastasis were identified.

CONCLUSION

These results may provide a new insight into the molecular mechanism of 5-Fu in therapy of breast cancer.

Diagnostic value of CT perfusion imaging for parotid neoplasms

OBJECTIVES

To assess the value of CT perfusion imaging in the differentiation of different histological categorization of benign tumours from malignant tumours in patients with parotid neoplasms.

METHODS

CT perfusion was successfully performed in 62 patients with parotid neoplasms whose diagnoses were confirmed by surgery or biopsy. The software generated a tissue time-density curve (TDC) and measured blood volume, blood flow, mean transit time and capillary permeability surface product. One-way ANOVA and receiver operating characteristic curves were used to analyse the difference and diagnostic efficacies of all perfusion data between each one of the benign tumours and malignancies. Statistical significance was assigned at the 5% level.

RESULTS

Pleomorphic adenomas mainly had a gradually ascending TDC. Warthin tumours showed a fast ascent followed by a fast descent. The TDC of basal cell adenomas had a fast ascension followed by a plateau, then a gradual descent. Malignant tumours mainly showed a rapidly ascending curve with a stable plateau. Significant differences were observed in blood flow, blood volume and mean transit time between pleomorphic adenomas and malignant tumours (p < 0.05) as well as in blood flow and blood volume between the Warthin tumours, the basal cell adenomas and the malignant tumours (p < 0.05). Differences in permeability surface between the basal cell adenomas and malignant tumours were significant (p < 0.01).

CONCLUSION

CT perfusion of parotid gland could provide TDC and perfusion data, which were useful in the differentiation of different histological benign tumours and malignant tumours in the parotid gland.

Melatonin receptor subtypes Mel1a and Mel1c but not Mel1b are associated with monochromatic light-induced B-lymphocyte proliferation in broilers

This study determined the effects of melatonin (MEL) and its receptors on monochromatic light-induced bursal B-lymphocyte proliferation in broiler chickens. In vivo, green light (GL) enhanced the proliferation of B lymphocytes in bursas by 16.49% to 30.83% and the expression of MEL receptor subtypes 1a (Mel1a), Mel1b, and Mel1c receptors in bursas by 6.91% to 366.98% than other light colors. However, pinealectomy reduced these parameters and eliminated the differences between GL and other light groups. In vitro, the MEL-induced bursal B-lymphocyte proliferation was most suppressed by prazosin (P = 0.001, selective Mel1c antagonist), followed by luzindole (P = 0.022, nonselective Mel1a/Mel1b antagonist), but not by 4-phenyl-2-propionamideotetralin (P = 0.144, selective Mel1b antagonist). Similarly, dibutyryl-cyclic adenosine monophosphate (cAMP; analog of cAMP; P = 0.017) but not 8-(4-chloro-phenylthio)-2'-O-methyladenosine-3',5'-cyclic monophosphate (P = 0.736; activator of exchange protein directly activated by cAMP) significantly inhibited bursal B-lymphocyte proliferation. These results suggest that MEL mediates GL-induced bursal B-lymphocyte proliferation through Mel1c and Mel1a receptors but not Mel1b receptors by activating the cAMP/protein kinase A pathway.

Biogeochemistry and community ecology in a spring-fed urban river following a major earthquake

In February 2011 a MW 6.3 earthquake in Christchurch, New Zealand inundated urban waterways with sediment from liquefaction and triggered sewage spills. The impacts of, and recovery from, this natural disaster on the stream biogeochemistry and biology were assessed over six months along a longitudinal impact gradient in an urban river. The impact of liquefaction was masked by earthquake triggered sewage spills (~20,000 m(3) day(-1) entering the river for one month). Within 10 days of the earthquake dissolved oxygen in the lowest reaches was <1 mg l(-1), in-stream denitrification accelerated (attenuating 40-80% of sewage nitrogen), microbial biofilm communities changed, and several benthic invertebrate taxa disappeared. Following sewage system repairs, the river recovered in a reverse cascade, and within six months there were no differences in water chemistry, nutrient cycling, or benthic communities between severely and minimally impacted reaches. This study highlights the importance of assessing environmental impact following urban natural disasters.

Isoflurane facilitates synaptic NMDA receptor endocytosis in mice primary neurons

Inhalation anesthetic isoflurane has been reported to induce caspase activation and accumulation of β-amyloid (Aβ), however, the down-stream consequences of these effects are largely unknown. Isoflurane has also been shown to impair learning and memory, however, the up-stream mechanisms of these effects remain largely to be determined. Facilitation of synaptic NMDA receptor endocytosis can reduce synaptic function, leading to learning and memory impairment. We therefore set out to determine the effects of isoflurane on synaptic NMDA receptor endocytosis. Primary neurons from wild-type and Alzheimer's disease transgenic mice were treated with 2% isoflurane for six hours. Synaptic surface levels of NMDA receptor 2B (NR2B) and NR2B internalization were determined by surface and cleavable biotinylation assay, western blot analysis and immunofluorescence. Here we show that isoflurane can induce caspase-3 activation, increase levels of β-site amyloid precursor protein-cleaving enzyme and cause accumulation of Aβ in the primary neurons. Isoflurane facilitates synaptic NR2B endocytosis as evidenced by reducing surface NR2B levels, increasing NR2B internalization, and decreasing the ratio of synaptic surface NR2B to synapsin in mice primary neurons. Moreover, caspase activation inhibitor Z-VAD and γ-secretase inhibitor L-685,458 attenuated the isoflurane-facilitated NR2B endocytosis. These results suggest that isoflurane induces caspase activation and Aβ accumulation, leading to facilitation of synaptic NMDA receptor endocytosis, which potentially serve as the upstream mechanism of the isoflurane-induced impairment of learning and memory. These findings will encourage further studies to determine the underlying mechanism by which isoflurane and other anesthetics promote Alzheimer's disease neuropathogenesis and induce cognitive dysfunction.

Patulin induces pro-survival functions via autophagy inhibition and p62 accumulation

Patulin (PAT) is one of the most common mycotoxins found in moldy fruits. Skin contact is one of the most likely exposure routes of PAT. Investigation of dermal toxicity of PAT is clearly needed and has been highlighted by WHO. In the present study, using human keratinocyte HaCaT cells as a model, we found that treatment with PAT caused an increased autophagosome accumulation. Measurements of autophagic flux demonstrated that the accumulation of autophagosomes by PAT was not directly due to enhanced autophagosome formation but due to inhibition of autophagosome degradation. Reductions in the activities of the lysosomal enzymes cathepsin B and cathepsin D by PAT might contribute to this inhibitory effect. Consistent with this, inhibition of autophagosome degradation by PAT resulted in accumulation of p62 that functioned as a pro-survival signal. The pro-survival function of p62 was found to be attributed to reactive oxygen species-mediated cytoprotective endoplasmic reticulum (ER) stress response. ER stress exerted cytoprotective effect via extracellular signal-regulated kinase1/2-dependent B-cell CLL/lymphoma 2-associated agonist of cell death inhibitory phosphorylation. Given the critical role of autophagy and its substrate p62 in carcinogenesis, our findings may have important implications in PAT-induced skin carcinogenesis.