Decline in pulmonary function during chronic hepatitis C virus therapy with modified interferon alfa and ribavirin

Rare interstitial lung disease cases have been reported with albinterferon alfa-2b (albIFN) and pegylated interferon alfa-2a (Peg-IFNα-2a) in chronic hepatitis C virus (HCV) patients. Systematic pulmonary function evaluation was conducted in a study of albIFN q4wk vs Peg-IFNα-2a qwk in patients with chronic HCV genotypes 2/3. Three hundred and ninety-one patients were randomly assigned 4:4:4:3 to one of four, open-label, 24-week treatment groups including oral ribavirin 800 mg/d: albIFN 900/1200/1500 μg q4wk or Peg-IFNα-2a 180 μg qwk. Standardized spirometry and diffusing capacity of the lung for carbon monoxide (DLCO) were recorded at baseline, weeks 12 and 24, and 6 months posttreatment, and chest X-rays (CXRs) at baseline and week 24. Baseline spirometry and DLCO were abnormal in 35 (13%) and 98 (26%) patients, respectively. Baseline interstitial CXR findings were rare (4 [1%]). During the study, clinically relevant DLCO declines (≥15%) were observed in 173 patients (48%), and were more frequent with Peg-IFNα-2a and albIFN 1500 μg; 24 weeks posttreatment, 57 patients (18%) still had significantly decreased DLCO, with a pattern for greater rates with albIFN vs Peg-IFNα-2a. One patient developed new interstitial CXR abnormalities, but there were no clinically relevant interstitial lung disease cases. The risk of persistent posttreatment DLCO decrease was not related to smoking, alcohol, HCV genotype, sustained virologic response, or baseline viral load or spirometry. Clinically relevant DLCO declines occurred frequently in chronic HCV patients receiving IFNα/ribavirin therapy and commonly persisted for ≥6 months posttherapy. The underlying mechanism and clinical implications for long-term pulmonary function impairment warrant further research.

Potentiation of GABAA receptor activity by volatile anaesthetics is reduced by α5GABAA receptor-preferring inverse agonists

BACKGROUND

Animal studies have shown that memory deficits in the early post-anaesthetic period can be prevented by pre-treatment with an inverse agonist that preferentially inhibits α5 subunit-containing γ-aminobutyric acid type A (α5GABA(A)) receptors. The goal of this in vitro study was to determine whether inverse agonists that inhibit α5GABA(A) receptors reduce anaesthetic potentiation of GABAA receptor activity.

METHODS

Cultures of hippocampal neurones were prepared from Swiss white mice, wild-type mice (genetic background C57BL/6J and Sv129Ev) and α5GABA(A)receptor null mutant (Gabra5-/-) mice. Whole-cell voltage clamp techniques were used to study the effects of the α5GABA(A) receptor-preferring inverse agonists L-655,708 and MRK-016 on anaesthetic potentiation of GABA-evoked currents.

RESULTS

L-655,708 (50 nM) reduced sevoflurane potentiation of GABA-evoked current in wild-type neurones but not Gabra5-/- neurones, and produced a rightward shift in the sevoflurane concentration-response plot [sevoflurane EC50: 1.9 (0.1) mM; sevoflurane+L-655,708 EC(50): 2.4 (0.2) mM, P<0.05]. Similarly, L-655,708 (50 nM) reduced isoflurane potentiation of GABA-evoked current [isoflurane: 4.0 (0.6) pA pF(-1); isoflurane+L-655,708: 3.1 (0.5) pA pF(-1), P<0.01]. MRK-016 also reduced sevoflurane and isoflurane enhancement of GABA-evoked current [sevoflurane: 1.5 (0.1) pA pF(-1); sevoflurane+MRK-016 (10 nM): 1.2 (0.1) pA pF(-1), P<0.05; isoflurane: 3.5 (0.3) pA pF(-1); isoflurane+MRK-016 (1 nM): 2.9 (0.2) pA pF(-1), P<0.05].

CONCLUSIONS

L-655,708 and MRK-016 reduced the potentiation by inhaled anaesthetics of GABAA receptor activated by a low concentration of GABA. Future studies are required to determine whether this effect contributes to the memory preserving properties of inverse agonists after anaesthesia.

The level and distribution of ²²⁰Rn concentration in soil-gas in Guangdong Province, China

In order to understand the level and distribution of (220)Rn concentrations in soil-gas in the high-radiation-background area, an (220)Rn survey was carried out for the first time using a RAD7 portable radon monitor at 67 locations covering a total area of 1800 km(2) in the South of China. (220)Rn concentrations were significantly different from that in the surface areas covered by the weathered granite of Yanshan Period or Quaternary sediments. The (220)Rn concentrations varied between 6.65 and 461 kBq m(-3) and the averages were 294.42 ± 81.36 and 23.30 ± 25.84 kBq m(-3) for weathered granite products and sediments, respectively. A high positive correlation between (220)Rn concentrations and (232)Th activity concentrations was found. (220)Rn concentrations had no statistically significant variations from depths of 20-140 cm with an interval of 20 cm. It is worth paying attention to the problem of such a high soil (220)Rn concentration in Zhuhai City and Zhongshan City.

Chiral kinetic theory

We derive the nonequilibrium kinetic equation describing the motion of chiral massless particles in the regime where it can be considered classically. We show that the Berry monopole which appears at the origin of the momentum space due to level crossing is responsible for the chiral magnetic and vortical effects.

TRBV kinetics and its association with HLA disparity and aGVHD following allogeneic hematopoietic stem cell transplantation

INTRODUCTION

The relative expression of T cell receptor (TCR) beta variable (TRBV) and TCR diversity was compared between recipients receiving human leukocyte antigen (HLA)-mismatched transplants and those receiving HLA-matched transplants, using granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood stem cells and bone marrow as grafts.

METHODS

The kinetics of the relative expression of TRBV family members were analyzed using real-time quantitative PCR. Additionally, the association of TRBV clonotype with acute graft-versus-host disease (aGVHD) was determined by cloning and sequence analysis of the CDR3 region.

RESULTS

The TCR diversity in recipients receiving HLA-mismatched transplants was significantly lower than in those receiving HLA-matched transplants at 1 month and 2 months after hematopoietic stem cell transplantation (HSCT) (both P < 0.05). However, these differences disappeared 3 months after transplantation. The relative expression of TRBV27 (n = 7 recipients) at the onset of aGVHD was higher than in corresponding donors (P = 0.025), but no significant differences were observed between recipients lacking aGVHD and their donors at serial time points after HSCT.

CONCLUSION

Our results suggest that HLA disparity may affect the relative expression of TRBV in the early phase after transplantation, and TRBV27 may be associated with the onset of aGVHD.

Identification of direct forkhead box O1 targets involved in palmitate-induced apoptosis in clonal insulin-secreting cells using chromatin immunoprecipitation coupled to DNA selection and ligation

AIMS/HYPOTHESIS

The transcription factor, forkhead box (FOX)O1, is involved in fatty acid-induced apoptosis in pancreatic beta cells, but the precise mechanism is poorly understood. We aimed to identify which direct downstream targets of FOXO1 are involved in palmitate-induced apoptosis in the pancreatic beta cell line MIN6.

METHODS

Chromatin immunoprecipitation (ChIP) coupled to a DNA selection and ligation technique (ChIP-DSL) was used to identify the direct targets of FOXO1. The mRNA level was examined by real-time PCR assay. The ChIP-DSL results were verified using ChIP-PCR and luciferase assay, respectively. The cell apoptosis rate was determined by TUNEL assay and by scoring cells with pycnotic nuclei.

RESULTS

We identified 189 target genes and selected 106 targets for expression analysis in MIN6 cells treated with palmitate. The results showed that six genes were significantly upregulated and four were downregulated. Binding of FOXO1 to the promoters was determined by ChIP-PCR and confirmed by luciferase assay. Among the ten up- and downregulated genes, mRNA expression of A930038C07Rik was significantly decreased and that of Ppa1 was increased in 8-week-old db/db mice. The apoptosis assay showed that overproduction of the protein 'RIKEN cDNA A930038C07' (A930038C07Rik) drastically enhanced palmitate-induced apoptosis, while pyrophosphatase (inorganic) 1 (PPA1) partially protected the cells from apoptosis. Knockdown of PPA1, moreover, significantly increased apoptosis.

CONCLUSIONS/INTERPRETATION

We identified for the first time FOXO1 targets in MIN6 cells treated with palmitate, thus revealing the important roles of A930038C07Rik and PPA1 in palmitate-induced cell apoptosis. These results shed light on the mechanisms of palmitate-induced apoptosis in pancreatic beta cells.

Randomized trial of albinterferon alfa-2b every 4 weeks for chronic hepatitis C virus genotype 2/3

Albinterferon alfa-2b (albIFN) is a fusion protein of recombinant human albumin/recombinant interferon (IFN)-α-2b, with ∼200-h half-life. Safety/efficacy of albIFN q4wk was evaluated in 391 treatment-naive patients with chronic hepatitis C virus (HCV) genotype 2/3. Patients were randomized 3:4:4:4 to one of four open-label treatment groups: pegylated IFN (Peg-IFN)-α-2a 180 μg qwk or albIFN 900, 1200 or 1500 μg q4wk, plus oral ribavirin 800 mg/day, for 24 weeks. Primary efficacy endpoint was sustained virologic response (SVR; HCV RNA <20 IU/mL 24 weeks post-treatment). SVR rates were as follows: 85%, 76%, 76% and 78% with Peg-IFNα-2a and albIFN 900, 1200 and 1500 μg, respectively (P = NS); corresponding rapid virologic response rates (HCV RNA <43 IU/mL at week 4) were as follows: 78%, 49% (P < 0.001), 60% (P = 0.01) and 71%. SVR rates were not influenced by interleukin 28B genotype, although rapid virologic response rates were greater with interleukin 28B CC (P = NS). Serious adverse event rates were as follows: 4%, 11%, 3% and 3% with Peg-IFNα-2a and albIFN 900, 1200 and 1500 μg, respectively. No increase in serious/severe respiratory events was noted with albIFN. Fewer absolute neutrophil count reductions <750/mm(3) occurred with albIFN (P = 0.03), leading to fewer IFN dose reductions. Haemoglobin reductions <10 g/dL were less frequent with albIFN 900 and 1200 μg vs 1500 μg and Peg-IFNα-2a (P = 0.02), leading to fewer ribavirin dose reductions. albIFN administered q4wk produced fewer haematologic reductions than Peg-IFNα-2a, but had numerically lower SVR rates (P = NS) in patients with chronic HCV genotype 2/3.

Diagnostic value of serum anti-C1q antibodies in patients with lupus nephritis: a meta-analysis

The autoantibodies against C1q (anti-C1q) have been reported in patients with systemic lupus erythematosus (SLE). In the past decade, though there were increasing studies suggesting it is relatively specific in lupus nephritis (LN), its overall diagnostic value in LN has not been evaluated. The meta-analysis was conducted to quantitatively evaluate the diagnostic accuracy of autoantibodies against C1q in patients with LN, and to provide more precise evidence of a correlation between anti-C1q antibodies and activity of LN. We searched Medline, Embase and Cochrane databases and contacted authors if necessary. A total of 25 studies including 2,502 patients with SLE and 1,317 with LN met our inclusion criteria for this meta-analysis. Among all 25 studies, 22 studies were available for comparison between SLE with and without LN, and 9 studies compared anti-C1q between patients with active and inactive LN. Summary receiver operating characteristic (SROC) curve was used to summarize comprehensive test performance. The QUADAS tool was used to assess the quality of the studies. For the diagnosis of LN, the pooled sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of anti-C1q were 0.58 (0.56-0.61, 95% confidence interval [95% CI]), 0.75 (0.72-0.77, 95% CI), 2.60 (2.06-3.28, 95% CI), 0.51 (0.41-0.63, 95% CI), and 6.08 (3.91-9.47, 95% CI) respectively. The area under the SROC curve (AUC) was 0.7941. For comparison between active and inactive LN, the weighted sensitivity, specificity, PLR, NLR and DOR were 0.74 (0.68-0.79, 95% CI), 0.77 (0.71-0.82, 95% CI), 2.91 (1.83-4.65, 95% CI), 0.33 (0.19-0.56, 95% CI), and 10.56 (4.56-24.46, 95% CI) respectively. The AUC was 0.8378. In conclusion, this meta-analysis indicates that anti-C1q antibodies have relatively fair sensitivity and specificity in the diagnosis of LN, suggesting that the presence of anti-C1q antibodies may be a valuable adjunct for predicting LN and assessing renal activity.

OS005. Treatment with magnesium sulphate reduced the serum level of IL-6in preeclamptic women

INTRODUCTION

Preeclampsia is one of the most common complications of pregnancy, affecting 2-7% of pregnant women. To prevent eclampsia from preeclampsia treatment with magnesium sulphate (MgSO4) is widely used. However the action of magnesium sulphate is unknown.

OBJECTIVES

Although a RCT compared magnesium supplementation with placebo suggested there is no effect on the incidence of preeclampsia, a study showed treatment with MgSO4 reduced the level of IL-6 secretion in maternal circulation of preeclamptic placenta not fetal side [1]. In addition, a most recent study suggests that treatment with MgSO4 inhibited inflammatory cytokines such as IL-6 secretion induced by LPS [2]. Taken together these data suggest MgSO4 may be able to normalise IL-6 actions and secretion. IL-6 level is elevated in preeclamtic women, therefore in this study we investigated whether maternal MgSO4 treatment inhibit IL-6 secretion in women with preeclampsia.

METHODS

Twenty two preeclamptic women and 71 gestation matched health women were included in this study. The definition of preeclampsia is followed by ACOG guideline. The gestation of preeclamptic women in this study was 26-38 weeks. The blood samples of preeclamptic women were taken before and after MgSO4 administration and the serum level of IL-6 was measured by ELISA kit (BD).

RESULTS

The serum level of IL-6 in preeclamptic women (24.59pg/ml) was significantly increased before MgSO4 administration compared to gestation matched health pregnant women (11.1pg/ml). However the serum level of IL-6 was significantly reduced after MgSO4 administration (19.8pg/ml), but sill higher than gestation matched health pregnant women.

CONCLUSION

Although the mechanism of magnesium sulphate is incompletely understood, our date consist with recent findings and suggest that it may act through the regulation of the level of IL-6 secretion which plays an important role in the pathogenesis of preeclampsia.

SU-E-T-596: Choroidal Metastases Irradiation with Volumetric Modulated Arc Radiotherapy

PURPOSE

Intraocular metastases are present in up to 10% of patients with systemic malignancies. With tumor cells spreading hematogenously, the posterior choroid is frequently involved because of its rich vasculature. We treated a woman who developed bilateral choroidal metastases from breast cancer. For the patient, we designed three radiotherapy techniques. The study was to find the dosimetric differences between them.

METHODS

For the patient with bilateral choroidal metastases, three-dimensional conformal radiotherapy (3D-CRT), inverse intensity-modulated radiotherapy (IMRT) and volumetric modulated arc radiotherapy (V-MAT) plans were designed. The prescription dose was 60 Gy in 30 fractions. The dose distribution in the target, the dose to the organs at risk, total MU and delivery time were compared.

RESULTS

In 3D-CRT, IMRT and V-MAT plans, the volume of target in 100% prescription dose were 92.5%, 93.3% and 92.0% respectively. V-MAT plan showed the best conformity and homogeneity in target. IMRT plan showed a better homogeneity than 3D-CRT plan. In 3D- CRT, IMRT and V-MAT plans, the max doses on left lens were 975.3 cGy, 739.9cGy, 870.2 cGy respectively. The max doses on right lens were 929.9 cGy, 802.9 cGy and 889.0 cGy respectively. V-MAT plan showed the lowest value for the max dose on left optic nerve and the lower value for the right one compared to 3D-CRT plan. The MUs were 386, 973, 709 and the delivery times were 10 min, 14min and 1.6 min respectively in 3D-CRT, IMRT and V-MAT. V-MAT could significantly reduce the delivery time.

CONCLUSIONS

V-MAT plan showed the best conformity and homogeneity in target. IMRT showed the lowest value in the max doses to lenses though the delivery time was longest. Overall, V-MAT showed a similar or better dose distribution, and most importantly, improved treatment delivery efficiency. With the results, V-MAT technology could be expected to choroidal metastases.

SU-E-J-188: Lung CT Density Changes during the Conformal Radiotherapy: A Prediction for Lung Radiation Pneumonitis

PURPOSE

Radiologic lung density changes are observed durng radiotherapy for lung cancer. We studied the relationship between dose and computed tomography (CT) density changes during the treatment, a prediction for lung radiation pneumonitis.

METHODS

30 Stage â…¢ lung cancer patients with CRT were thirty fractions of 2.0 Gy, prescribed at the 90% isodose. Follow-up CT scans performed at less than 3 weeks (n=15) and between 3 and 6 weeks (n=15) after CRT radiotherapy were reviewed. New CT scans were coregistered with baseline scans using CT-CT normalized mutual information registration algorithm. Voxel-Hounsfield unit histograms were created for doses between 0.5 and 50 Gy. Linear mixed effects models were used to assess the effects of CRT dose on CT density, and the influence of possible confounders was tested.

RESULTS

Increased mean CT density was associated with higher dose, increasing planning target volume size, and increasing time after CRT (all p <0.05). Density increases were apparent in areas receiving 20 Gy, but seemed to plateau above 40 Gy. In regions receiving >30 Gy, the reduction in air-filled fraction of lung during treatment was up to 20%. No increase in CT density was observed in the contralateral lung receiving less than 5 Gy.

CONCLUSIONS

A dose-response relationship seems to exist for quantitative CT density changes during CRT radiotherapy. The density between old and new CT during the treatment could be a prediction for lung injury.

SU-E-T-589: There was No Dosimetric Benefit in Sparing Bone Marrow in the Radiotherapy of Whole Pelvic Lymph Node Applying 6MV X-Ray RapidArc Plans

PURPOSE

To investigate the dosimetric difference in sparing bone marrow in the radiotherapy of whole pelvic node comparing 6MV and 15MV X-ray RaidArc plans.

METHODS

Twelve patients who had undergone radical surgery for cervical cancer and with demonstrated multiple pelvic lymph node metastases were treated with radiotherapy were selected. All pelvic bone was delineated to define the bone marrow, and the pelvic bones consisted of the hip bone, the sacrum, the vertebral body near planning target volume (PTV), and the upper parts of femur. RapidArc plans applying 6MV and 15MV X-ray with one single whole arc (counter-clockwise from 179° to 181°) were generated for each patient, and named RapidArc-6MV and RapidArc-15MV. The prescription dose was 2.0Gy/fractionx28fractions. The dosimetric differences were compared.

RESULTS

There were no significant differences in conformity index(0.90±0.03 Vs 0.89±0.04), homogeneity index(1.08±0.01 Vs 1.08±0.02) and external volume index(0.08±0.04 Vs0. 09±0.05) between RapidArc-6MV and RapidArc-15MV(P>0.05). Neither there were no significant differences in V5 (93.6±6.4Vs92.2±7.3), V10(88.6±9.3Vs88.3±9.2), V20(76.9±12.6Vs76.9±11.2), V30 (57.9± 10.5Vs55.9±11.5), V40(35.2±10.2Vs34.9±10.9) between RapidArc-6MV and RapidArc-15MV (P>0.05). The monitor untie of RapidArc-6MV (552±40Mu) was more than RapidArc-15MV (455±44 Mu) with significant difference (P<0.05).

CONCLUSIONS

Compared to 15MV X-ray RapidArc plans, there was no dosimetric benefit in sparing bone marrow in the radiotherapy of whole pelvic lymph node applying 6MV X-ray.