High-intensity focused ultrasound combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: long-term follow-up and clinical analysis

OBJECTIVE

High-intensity focused ultrasound (HIFU) combined with transarterial chemoembolization (TACE) has been used to treat unresectable HCC, but its long-term effects and major prognostic factors remain to be determined. The purpose of this study was to assess its long-term effects and find major prognostic factors to help us select eligible patients in the future.

METHODS

73 patients with unresectable HCC received follow-up after HIFU+TACE. The variables of sex, age, AFP level, liver function, tumor location, tumor number, tumor size, TNM staging (5th edition), TNM staging (6th edition), portal vein invasion, ultrasonic pathway of HIFU, TACE session and ablation response were evaluated by univariate analysis. Those variables with significant difference were assessed by multivariate analysis.

RESULTS

The mean follow-up time was 11.7±11.1 months (range, 1-60 months). The median survival time and overall survival rates of 1, 2, 3-year were 12 months, 49.1%, 18.8%, 8.4%, respectively. 45.2% patients achieved complete ablation. At the end of follow-up, 51 patients (69.9%) died from tumor progression (27 patients), liver function failure (18 patients), hemorrhage of upper digestive tract (3 patients) and infection (3 patients). 1 with liver abscess, 2 with serious skin burns and 2 with rib fracture were observed after HIFU. On univariate analysis, age (P=0.017), tumor size (P=0.000), tumor number (P=0.039), the 5th edition of TNM staging (P=0.023), portal vein invasion (P=0.02) and ablation response (P=0.000) had significant difference. On multivariate analysis, ablation response (P=0.001) and tumor size (P=0.013) were major prognostic factors.

CONCLUSION

HIFU combined with TACE is a safe method with a low rate of severe complications. As major prognostic factors, ablation response and tumor size may help us predict the survival and select eligible patients clinically.

Feasibility of high temporal resolution breast DCE-MRI using compressed sensing theory

PURPOSE

To investigate the feasibility of high temporal resolution breast DCE-MRI using compressed sensing theory.

METHODS

Two experiments were designed to investigate the feasibility of using reference image based compressed sensing (RICS) technique in DCE-MRI of the breast. The first experiment examined the capability of RICS to faithfully reconstruct uptake curves using undersampled data sets extracted from fully sampled clinical breast DCE-MRI data. An average approach and an approach using motion estimation and motion compensation (ME/MC) were implemented to obtain reference images and to evaluate their efficacy in reducing motion related effects. The second experiment, an in vitro phantom study, tested the feasibility of RICS for improving temporal resolution without degrading the spatial resolution.

RESULTS

For the uptake-curve reconstruction experiment, there was a high correlation between uptake curves reconstructed from fully sampled data by Fourier transform and from undersampled data by RICS, indicating high similarity between them. The mean Pearson correlation coefficients for RICS with the ME/MC approach and RICS with the average approach were 0.977 +/- 0.023 and 0.953 +/- 0.031, respectively. The comparisons of final reconstruction results between RICS with the average approach and RICS with the ME/MC approach suggested that the latter was superior to the former in reducing motion related effects. For the in vitro experiment, compared to the fully sampled method, RICS improved the temporal resolution by an acceleration factor of 10 without degrading the spatial resolution.

CONCLUSIONS

The preliminary study demonstrates the feasibility of RICS for faithfully reconstructing uptake curves and improving temporal resolution of breast DCE-MRI without degrading the spatial resolution.

Simpler score of routine laboratory tests predicts liver fibrosis in patients with chronic hepatitis B

BACKGROUND AND AIM

In recent years, a great interest has been dedicated to the development of noninvasive predictive models to substitute liver biopsy for fibrosis assessment and follow-up. Our aim was to provide a simpler model consisting of routine laboratory markers for predicting liver fibrosis in patients chronically infected with hepatitis B virus (HBV) in order to optimize their clinical management.

METHODS

Liver fibrosis was staged in 386 chronic HBV carriers who underwent liver biopsy and routine laboratory testing. Correlations between routine laboratory markers and fibrosis stage were statistically assessed. After logistic regression analysis, a novel predictive model was constructed. This S index was validated in an independent cohort of 146 chronic HBV carriers in comparison to the SLFG model, Fibrometer, Hepascore, Hui model, Forns score and APRI using receiver operating characteristic (ROC) curves.

RESULTS

The diagnostic values of each marker panels were better than single routine laboratory markers. The S index consisting of gamma-glutamyltransferase (GGT), platelets (PLT) and albumin (ALB) (S-index: 1000 x GGT/(PLT x ALB(2))) had a higher diagnostic accuracy in predicting degree of fibrosis than any other mathematical model tested. The areas under the ROC curves (AUROC) were 0.812 and 0.890 for predicting significant fibrosis and cirrhosis in the validation cohort, respectively.

CONCLUSIONS

The S index, a simpler mathematical model consisting of routine laboratory markers predicts significant fibrosis and cirrhosis in patients with chronic HBV infection with a high degree of accuracy, potentially decreasing the need for liver biopsy.

Predictors of hepatic steatosis in HBeAg-negative chronic hepatitis B patients and their diagnostic values in hepatic fibrosis

OBJECTIVE

To investigate predictors of hepatic steatosis in HBeAg-negative chronic hepatitis B (CHB) patients and their diagnostic values in hepatic inflammation and fibrosis.

METHODS

A total of 106 HBeAg-negative CHB patients with clinically and pathologically proven steatosis and 98 patients without steatosis were recruited into this study. The levels of fasting blood glucose (FBG), fasting insulin (FINS), triglyceride (TG), cholesterol (CHOL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (Alb), globulin (Glb), HBV DNA, body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR) and pathological changes of the liver in inflammation, fibrosis and fatty deposition were examined in all patients.

RESULTS

The levels of BMI, HOMA-IR, FBG, insulin, TG, and CHOL were significantly higher in patients with steatosis than those without steatosis (all P<0.05). But ALT, AST and HBV DNA levels were significantly lower in patients with steatosis (all P<0.05). Logistic regression analysis showed that only FINS was a significant predictor for hepatic steatosis (P<0.05); FINS and Glb were significant predictors for hepatic inflammation (all P<0.05); BMI and TC were significant predictors for hepatic fibrosis (all P<0.05).

CONCLUSIONS

Hepatic steatosis, a common disease in HBeAg-negative CHB patients, was positively associated with BMI, FBG, FINS, TG, TC, GGT, ALP and HOMA-IR. In these patients, the prevalence of hepatic inflammation and fibrosis was also increased.

N-glycan based models improve diagnostic efficacies in hepatitis B virus-related hepatocellular carcinoma

The early diagnosis of hepatocellular carcinoma (HCC) is of great clinical desirable due to lack of specific and sensitive markers. Alterations in the sugar chains of glycoprotein synthesized by the liver contribute to the molecular basis of abnormalities in carcinogenesis. This study aims to construct and assess the diagnostic value of N-glycan based diagnostic model in HCC identification and follow-up. A total of 393 subjects including HBV-related HCC, liver fibrosis and healthy controls were recruited. Follow-up was carried out before and after surgical treatment in HCC. N-glycome of serum glycoprotein was profiled by DNA sequencer-assisted fluorophore-assisted carbohydrate electrophoresis (DSA-FACE). Multiparameters diagnostic models were constructed based on N-glycan markers. The result found that 2 N-glycan structure abundances (NG1A2F, Peak 4; NA3Fb, Peak 9) were useful as N-glycan markers. The diagnostic efficacy of the log ratio [log(p9/4)] was similar to that of AFP in differentiating HCC from fibrosis. The accuracy and sensitivity of the diagnostic model combining AFP and N-glycan markers (Cscore B) were increased 7-10% compared with that of AFP. Log(p9/4) was more efficient in monitoring the progression of HCC with regarding to vascular invasion at improved specificity (16%) and accuracy (8%) compared with that of AFP. The N-glycan markers were found to be changed significantly after surgical resection in HCC follow-up. We conclude that the branching alpha (1,3)-fucosylated triantennary glycan and a biantennary glycan are promising as N-glycan markers. The diagnostic models based on the N-glycan markers and AFP improve the efficacy in HCC diagnosis and progression monitoring.

Wnt and Notch signaling pathways selectively regulating hematopoiesis

Hematopoietic stem and progenitor cells (HSPCs) are the source of all blood cells in the adult body. The pool of HSPCs is formed during embryogenesis process through a well-characterized succession of intra-embryonic regions and organs. The spatial and temporal restrictions in definitive hematopoietic development and the signaling molecules involved are of great interest as these may prove useful for generating and expanding these clinically important cell populations ex vivo. To elucidate the mechanism by which definitive HSPCs expand during this limited developmental time frame, we analyzed the spatial and temporal programmed gene expression patterns of Wnt and Notch signaling members during hematopoietic development. Genes related to the Wnt signaling pathway were up-regulated in E10.5 aorta-gonad-mesonephros (AGM) and E14.5 fetal liver corresponding to the inherent proliferation potential of hematopoietic progenitors, whereas genes related to the Notch signaling pathway were identified as up-regulated in E10.5 AGM, and bone marrow coincides with the maintenance of undifferentiation state of hematopoietic progenitors. Our findings suggest that Wnt and Notch signalings are integrated and are selectively regulating hematopoiesis. The spatial and temporal balance between Wnt and Notch signaling orchestrates the precise progression of hematopoietic progenitors.

[Study on Wnt and Notch signalling involves in regulation of hematopoietic microenvironment.]

OBJECTIVE

To explore the mechanism of Wnt and Notch pathway involved modulating time and spatial restricted hematopoiesis.

METHODS

Murine hematopoietic stem and progenitor cells (HSPCs) were isolated from bone marrow (BM) by using c-kit microbeads. E10.5 aorta-gonad-mesonephros (AGM), E12.5, E14.5, E16.5 fetal liver (FL) and adult BM derived stromal cells (StroCs) were isolated and co-cultured with c-kit(+)HSPCs. The floating cells in co-culture system were sorted and counted by FACS. Gene expressions of Wnt and Notch pathway were detected by quantitative PCR and protein expressions by immunostaining.

RESULTS

Co-culturing HSPCs with AGM and FL-derived StroCs resulted in an expansion of c-kit(+)population from 0.4 x 10(5)/well to (19.2 +/- 3.2) x 10(5)/well and (26.8 +/- 5.4) x 10(5)/well, respectively, being greater than that with BM-derived StroCs (P < 0.05). The percentage of c-kit(+)cells detected in AGM- and BM- derived StroCs culture system was (75.2 +/- 7.1)%, (74.1 +/- 6.2)% respectively, being higher than FL- derived StroCs culture system (63.4 +/- 5.3)% (P < 0.05). Wnt and Notch pathway genes expression varied at different phases of hematopoiesis. Wnt was highly expressed in AGM and FL derived StroCs, and, Notch did in AGM and BM derived StroCs.

CONCLUSION

Wnt and Notch pathway are important modulators in regulating time and spatial restricted hematopoiesis.

[Biological characteristics of hematopoietic progenitor cells at different stages of hematopoietic development]

The aim of the present paper is to better understand the mechanism of hematopoietic development through studying the biological characteristics of hematopoietic progenitor cells at different stages of development. Firstly, the c-kit expression levels of the mononuclear cells from murine embryonic aorta-gonad-mesonephros (AGM) region at embryonic day (E)10.5 and E11.5, fetal liver (FL) at E12.5, E14.5, E16.5, E18 and bone marrow (BM) were assayed with fluorescence activated cell sorting (FACS). Secondly, hematopoietic progenitor cells derived from AGM at E10.5, FL at E14.5 and BM were isolated by using c-kit microbeads. Isolated c-kit(+) population cells from AGM, FL and BM were then co-cultured with E14.5 FL-derived stromal cells in transwell co-culture system in vitro. After 3, 7, 10 days of co-culture, numerous floating cells were generated. The floating cells generated in transwell inserts were collected for FACS cell count, migration activity detection and colony forming unit (CFU) formation assay. The results showed that the c-kit was highly expressed in E10.5 AGM, with the percentage of c-kit(+) cells declining during AGM development. c-kit expression was highly expressed again in E12.5 FL, declining along with the progressive development of the FL region. Co-cultured with FL-derived stromal cells, E10.5 AGM-derived c-kit(+) cells produced the highest number of hematopoietic cells, while BM-derived c-kit(+) cells produced the lowest number of hematopoietic cells. Compared with E10.5 AGM-derived c-kit(+) cells, E14.5 FL- and BM- derived c-kit(+) cells inclined to differentiate after 7 to 10 days of culture in vitro. E10.5 AGM and E14.5 FL-derived c-kit(+) cells exhibited a higher migration activity than BM-derived c-kit(+) cells. Moreover, E10.5 AGM-derived c-kit(+) cells showed a higher ability to form mixed colony-forming unit (CFU-Mix) colony. In conclusion, compared with FL- and BM-derived c-kit(+) cells, E10.5 AGM-derived c-kit(+) hematopoietic progenitor cells exhibit better proliferation, migration potential, and have a higher ability to maintain the undifferentiation state in vitro, providing an insight into their clinical manipulation.

[Establishment of a bone marrow failure mouse model by immune injury]

OBJECTIVE

To establish a mouse model for the study of pathophysiologic mechanism and treatment of bone marrow failure (BMF).

METHODS

Balb/c mice (recipient) were irradiated 5.0 Gy by gamma rays of (60)Co, and then infused 5 x 10(6) lymph node (LN) cells from DBA/2 mice (donor) in 4 hours. Pancytopenia was monitored by cell counting, bone marrow damage was assessed by histological staining and mononuclear cell counting. Serum IFN-gamma concentration was measured by ELISA. The proportion of Treg in spleen was detected by flow cytometry.

RESULTS

Irradiation and infusion of LN cells led to rapid development of severe pancytopenia and BM hypoplasia, which reached the most severity at d14. The pancytopenia remained at d28 and displayed no signs of recovery. The bone marrow was full of adipose cells with scarcity of hematopoietic cells at d14 and persisted at least for 28 days, being similar to the feature of aplastic anemia. Serum IFN-gamma concentration was 6.3 fold increased \[(170.0 +/- 17.0) vs (27.7 +/- 7.1) pg/ml\] at d6. Tregs were decreased after infusion, and then increased \[(3.38 +/- 0.52)%\] and recovered to normal \[(4.04 +/- 0.44)%\] at d21. The expression level of the specific transcription factor Foxp3 was similar to normal.

CONCLUSION

The MHC antigen of Balb/c mice is identical to that of DBA/2 mice, but their minor antigen differs. 5.0 Gy irradiation and then 5 x 10(6) lymphocyte infusion can induce BMF similar to the features of aplastic anemia.

Distribution of rDNA in the nucleus ofGiardia lamblia: detection by Ag-I silver stain

Previous investigations have proved that diplomonads have primitive cell nuclei and lack a nucleolus. We determined the distribution of ribosomal DNA (rDNA) in diplomonad nuclei that lacked a nucleolus. Giardia lamblia was used as the experimental organism with Euglena gracilis as the control. The distribution of rDNA was demonstrated indirectly by the modified Ag-I silver technique that can indicate specifically the nucleolus organizing region (NOR) by both light and electron microscopy. In ultrathin sections of silver stained Euglena cells, all silver grains were concentrated in the fibrosa of the nucleolus, while no silver grains were found in the cytoplasm, nucleoplasm, condensed chromosomes or pars granulosa of the nucleus. In the silver stained Giardia cells, no nucleolus was found, but a few silver grains were scattered in the nucleus. This suggests that the rDNA of Giardia does not form an NOR-like structure and that its nucleus is in a primitive state.

Biomaterials for spinal cord regeneration: outgrowth of presumptive neuronal precursors on electrospun poly(epsilon)-caprolactone scaffolds microlayered with alternating polyelectrolytes

The aim of this study was to assess the feasibility of electrospun poly(epsilon)-caprolactone (PCL) scaffolds treated with alternating paly-electrolytes as a controllable three-dimensional adhesive substrate for neuronal progenitors. Unmodified PCL surfaces were generally not supportive of mouse embryonic stem cell (mESC) colony adhesion. However, scaffolds surfaced using layer-by-layer (LbL) deposition of heparin/poly-L-lysine encouraged better local adhesion of mESC colonies, and networking of monolayers containing nestin-positive presumptive neurons, similar to laminin coated controls, as observed by immuno-fluorescence microscopy. Confocal microscopy further revealed depth-wise penetration of mESC nestin-positive cell populations, and orientation along grass topographical features in the LbL scaffolds. LbL deposition therefore appears to provide a satisfactory adhesive substrate for contact and mechanical guidance of neuronal outgrowth in three-dimensions.

[The significance of combined therapy of arsenic trioxide and all-trans retinoic acid in treating acute promyelocytic leukemia]

OBJECTIVE

To explore the significance of combined therapy of arsenic trioxide (As2O3) and all-trans retinoic acid (ATRA) in acute promyelocytic leukemia (APL).

METHODS

Retrospective study of 80 APL patients was performed and the complete remission (CR), the recovery time of peripheral hemoglobin and platelet, the early mortality, and the adverse reaction rates were analyzed between the ATRA group and the ATRA combined As2O3 group (combined group).

RESULTS

CR rate of the combined group and the ATRA group was 91.7% and 87.5% respectively, which showed no significant difference; time of reaching CR, hemoglobin recovery, and platelet recovery for the combined group were 28.0 +/- 7.8 days, 22.36 +/- 8.72 days and 19.38 +/- 9.52 days respectively, while those were 47.7 +/- 10.9 days, 28.40 +/- 8.95 days and 28.03 +/- 7.29 days for the ATRA group, which suggested a significantly shorter period of the combined group of achieving recovery. With 7.1% compared to 13.2%, the early mortality of the combined group seemed lower than that of the ATRA group but with no significance observed (P>0.05). The adverse reaction rates of the two groups also lacked any significant difference (P>0.05).

CONCLUSION

Compared with using ATRA alone, the combined therapy of AS2O3 and ATRA was dominant in achieving CR and recovery for APL. Besides, the combined therapy carries the promise of reducing the early mortality with no aggravation of the adverse reaction.

Assessment of fibrosis in chronic liver diseases

The assessment of liver fibrosis provides useful information not only for diagnosis but also for therapeutic decisions. Although liver biopsy is the current gold standard for fibrosis assessment, it has some risks and limitations, including intra-observer and inter-observer variation, sampling error and variability. In recent years, many studies and great interest have been dedicated to the development of non-invasive tests to substitute a liver biopsy for fibrosis assessment and follow up. Advances in serological and radiological tests such as serum marker panels, transient elastography and their combinations can assess fibrosis accurately and reduce the need for a liver biopsy. But at present, all have failed to completely replace a liver biopsy because of their respective limitations and an imperfect gold standard used in current researches. The searching for an ideal surrogate is still in progress.

Expression of recepteur d'origine nantais in pancreatic cancer and its significance

AIM: To examine the expression and significance of Tyrosine Kinase Receptor RON in pancreatic cancer and its significance.

METHODS: The expression of RON was detected in 31 pancreatic cancer tissue specimens and 31 adjacent pancreatic tissue specimens and 8 normal pancreatic tissues were using immunohistochemistry.

RESULTS: The expression of RON was detected in all the pancreatic cancer tissues, the normal pancreatic tissues and in adjacent tissues. The RON expression level in all the pancreatic cancer tissues and adjacent tissues was significantly higher than those of the normal pancreatic tissues; RON expression was higher in pancreatic cancer tissues than in adjacent tissues (P < 0.05). The expression level of RON in pancreatic cancer tissue was correlated with tumor differentiation and clinical stage and lymph node metastasis, and not correlated with age, tumor size, histological type or tumor location (P < 0.05).

CONCLUSION: Elevated RON expression may contribute to pancreatic carcinogenesis.

Association of ADHD with genetic variants in the 5'-region of the dopamine transporter gene: evidence for allelic heterogeneity

Multiple studies have reported an association between attention deficit hyperactivity disorder (ADHD) and the 10-repeat allele of a variable number tandem repeat (VNTR) polymorphism in the 3'-untranslated region (3'UTR) of the dopamine transporter gene (DAT1). Yet, recent meta-analyses of available data find little or no evidence for this association; although there is strong evidence for heterogeneity between datasets. This pattern of findings could arise for several reasons including the presence of relatively rare risk alleles on common haplotype backgrounds or the functional interaction of two or more loci within the gene. We previously described the importance of a specific haplotype at the 3' end of DAT1, as well as the identification of associated single nucleotide polymorphisms (SNPs) within or close to 5' regulatory sequences. In this study we replicate the association of SNPs at the 5' end of the gene and identify a specific risk haplotype spanning the 5' and 3' markers. These findings indicate the presence of at least two loci associated with ADHD within the DAT1 gene and suggest that either additive or interaction effects of these two loci on the risk for ADHD. Overall these data provide further evidence that genetic variants of the dopamine transporter gene confer an increased risk for ADHD.

Increased ROS generation and SOD activity in heteroplasmic tissues of transmitochondrial mice with A3243G mitochondrial DNA mutation

The mitochondrial A3243G tRNALeu(UUR) mutation associated with a variety of mitochondrial disorders results in a severe respiratory deficiency, an increase in reactive oxygen species (ROS) production and activities of anti-oxidative enzyme in vitro. However, the phenotypic implications of this mutation have not been described in vivo. Here, mitochondria carrying A3243G transition from the peripheral blood of diabetes mellitus patients were microinjected into zygotes. Influence of this mutation on mitochondrial respiratory enzyme activities, ROS generation, and anti-oxidative enzyme activities in the heteroplasmic tissues of transmitochondrial mice was evaluated. The chimeric mice exhibited a subtle impaired oxidative phosphorylation, reduced activity of complex I/IV, increased activity of superoxide dismutase, and in turn, enhanced ROS generation. Our results suggest that mitochondrial A3243G mutation may be responsible for the high ROS production in vivo. Increased generation of ROS caused by mtDNA mutation may also play a role in the pathogenesis of the A3243G mutation-associated diseases.

No association between two polymorphisms of the serotonin transporter gene and combined type attention deficit hyperactivity disorder

Several independent studies have reported association between serotonin transporter gene (SLC6A4) polymorphisms and attention deficit hyperactivity disorder (ADHD). Five studies found evidence for association between the long-allele of a 44-bp insertion/deletion polymorphism (5-HTTLPR) and ADHD. Another two studies corroborated this finding while a further six studies did not find such an association. For a second polymorphism within the gene, a variable number tandem repeat (VNTR) within intron 2, one study demonstrated that the 12/12 genotype was significantly less frequent in ADHD cases compared to controls, while a second study found that the 12-allele was preferentially transmitted to offspring affected with ADHD. To provide further clarification of the reported associations, we investigated the association of these two markers with ADHD in a sample of 1,020 families with 1,166 combined type ADHD cases for the International Multi-Centre ADHD Genetics project, using the Transmission Disequilibrium Test. Given the large body of work supporting the association of the promoter polymorphism and mood disorders, we further analyzed the group of subjects with ADHD plus mood disorder separately. No association was found between either of the two markers and ADHD in our large multisite study or with depression within the sample of ADHD cases.

The structure and absolute configuration of Shuangkangsu: a novel natural cyclic peroxide from Lonicera japonica (Thunb.)

A novel cyclic peroxide, shuangkangsu (1), has been obtained from the water extract of the buds of Lonicera japonica (Thunb.). The structure was elucidated as 5,8-divinyl-1,4-dihydro-1,4-di-O-beta-d-glucopyranosyl-2,3-dioxane (1) on the basis of the spectral data. Its absolute stereochemistry was determined to be (1S, 4S) by comparison of its CD curves with those of its optically pure analogs 2 and 3, which were synthesized from the phthalaldehyde. The absolute configurations of 2 and 3 were determined to be (1R, 4R) and (1S, 4S) by X-ray analysis and CD spectra, respectively. Compound 1 showed significant antiviral activities against influenza virus in chicken embryo and respiratory syncytial virus in cells.

A high-density SNP linkage scan with 142 combined subtype ADHD sib pairs identifies linkage regions on chromosomes 9 and 16

As part of the International Multi-centre ADHD Genetics project we completed an affected sibling pair study of 142 narrowly defined Diagnostic and Statistical Manual of Mental Disorders, fourth edition combined type attention deficit hyperactivity disorder (ADHD) proband-sibling pairs. No linkage was observed on the most established ADHD-linked genomic regions of 5p and 17p. We found suggestive linkage signals on chromosomes 9 and 16, respectively, with the highest multipoint nonparametric linkage signal on chromosome 16q23 at 99 cM (log of the odds, LOD=3.1) overlapping data published from the previous UCLA (University of California, Los Angeles) (LOD>1, approximately 95 cM) and Dutch (LOD>1, approximately 100 cM) studies. The second highest peak in this study was on chromosome 9q22 at 90 cM (LOD=2.13); both the previous UCLA and German studies also found some evidence of linkage at almost the same location (UCLA LOD=1.45 at 93 cM; German LOD=0.68 at 100 cM). The overlap of these two main peaks with previous findings suggests that loci linked to ADHD may lie within these regions. Meta-analysis or reanalysis of the raw data of all the available ADHD linkage scan data may help to clarify whether these represent true linked loci.

Experimental study on nonalcoholic fatty liver disease treated by medical instrument on hepatic diseases of type Ⅰ DSG in rats

AIM: To investigate the primary therapeutic efficacy of the medical instrument on hepatic diseases of type Ⅰ DSG in treating nonalcoholic fatty liver disease (NAFLD) of rats.

METHODS: Fifty male SD rats were randomly divided into 5 groups. The control groups (n = 20, N1 and N2 group) were fed with normal diet, and the model groups (n = 30, M1, M2 and T group) were fed with fat-rich diet consisting of 0.88 standard normal diet + 0.10 lard oil + 0.02 cholesterol. Therapeutic group (T group) was treated from wk 13 and finished at wk 20. The levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl-transpeptidase (GGT), alkaline phosphatase (ALP), total protein (TP), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high density lipoprotein (HDL) were measured. The hepatic histologic changes were observed with HE and Masson staining.

RESULTS: At the end of the experiment, compared with those in the normal control groups, the liver index (t = 8.65, P < 0.01) and serum ALT (t = 4.65, P < 0.01), AST (t = 4.74, P < 0.01), ALP (t = 3.56, P < 0.01), TP (t = 6.35, P < 0.01), TC (t = 8.41, P < 0.01), and LDL (t = 8.86, P < 0.01) levels were increased significantly in the model control groups, and the hepatic steatosis (Z = -4.135, P < 0.01), inflammation (Z = -3.752, P < 0.01) and fibrosis (Z = -4.156, P < 0.01) were more serious. Compared with those in the model control groups, the serum ALT, GGT, ALP, TP, TG, and TC levels were all down-regulated in the therapeutic group without significances, while AST (t = -2.404, P < 0.05) level was reduced significantly. The degrees of hepatic steatosis and inflammation were decreased without statistical significances, but fibrosis degrees were lightened markedly (Z = -3.101, P < 0.01).

CONCLUSION: The medical instrument on hepatic diseases of type Ⅰ DSG has some therapeutic effect in treating NAFLD of rats.

Co-transmission of conduct problems with attention-deficit/hyperactivity disorder: familial evidence for a distinct disorder

Common disorders of childhood and adolescence are attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD). For one to two cases in three diagnosed with ADHD the disorders may be comorbid. However, whether comorbid conduct problems (CP) represents a separate disorder or a severe form of ADHD remains controversial. We investigated familial recurrence patterns of the pure or comorbid condition in families with at least two children and one definite case of DSM-IV ADHDct (combined-type) as part of the International Multicentre ADHD Genetics Study (IMAGE). Using case diagnoses (PACS, parental account) and symptom ratings (Parent/Teacher Strengths and Difficulties [SDQ], and Conners Questionnaires [CPTRS]) we studied 1009 cases (241 with ADHDonly and 768 with ADHD + CP), and their 1591 siblings. CP was defined as > or =4 on the SDQ conduct-subscale, and T > or = 65, on Conners' oppositional-score. Multinomial logistic regression was used to ascertain recurrence risks of the pure and comorbid conditions in the siblings as predicted by the status of the cases. There was a higher relative risk to develop ADHD + CP for siblings of cases with ADHD + CP (RRR = 4.9; 95%CI: 2.59-9.41); p < 0.001) than with ADHDonly. Rates of ADHDonly in siblings of cases with ADHD + CP were lower but significant (RRR = 2.9; 95%CI: 1.6-5.3, p < 0.001). Children with ADHD + CP scored higher on the Conners ADHDct symptom-scales than those with ADHDonly. Our finding that ADHD + CP can represent a familial distinct subtype possibly with a distinct genetic etiology is consistent with a high risk for cosegregation. Further, ADHD + CP can be a more severe disorder than ADHDonly with symptoms stable from childhood through adolescence. The findings provide partial support for the ICD-10 distinction between hyperkinetic disorder (F90.0) and hyperkinetic conduct disorder (F90.1).

Point-by-point inscription of first-order fiber Bragg grating for C-band applications

The influence of the fiber geometry on the point-by-point inscription of fiber Bragg gratings using a femtosecond laser is highlighted. Fiber Bragg gratings with high spectral quality and strong first-order Bragg resonances within the C-band are achieved by optimizing the inscription process. Large birefringence (1.2x10(-4)) and high degree of polarization-dependent index modulation are observed in these gratings. Potential applications of these gratings in resonators are further illustrated.

Structure of Dicer and mechanistic implications for RNAi

Dicer is a specialized ribonuclease that processes double-stranded RNA (dsRNA) into small RNA fragments about 25 nucleotides in length during the initiation phase of RNA interference (RNAi). We previously determined the crystal structure of a Dicer enzyme from the diplomonad Giardia intestinalis and proposed a structural model for dsRNA processing. Here, we provide evidence that Dicer is composed of three structurally rigid regions connected by flexible hinges and propose that conformational flexibility facilitates dsRNA binding and processing. We also examine the role of the accessory domains found in Dicers of higher eukaryotes but absent in Giardia Dicer. Finally, we combine the structure of Dicer with published biochemical data to propose a model for the architecture of the RNA-induced silencing complex (RISC)-loading complex.

A retrospective exploratory study of the variability of radiologists’ measurements in a selected subgroup of subjects enrolled in a clinical trial

6523

A retrospective exploratory study of the variability of radiologists’ measurements in a selected subgroup of subjects enrolled in a clinical trial Background: Independent centralized review of imaging studies is an established means of validating data used in support of corporate ‘go-no go‘ decisions, regulatory approval, and post marketing claims. Despite best efforts at standardizing this process using the Response Evaluation Criteria in Solid Tumors (RECIST), there will be inherent differences in radiologic measurements. To define a concise value for the variation between a specific set of radiologists, the following study was performed. Methods: An experienced radiologist and a research intern reviewed digital Computerized Tomographic (CT) scans from 31 subjects to identify 150 primary and metastatic tumors. Tumors were categorized into 4 categories. [Category (Cat.) 1 - Defined Edge/Radially Symmetric, Cat. 2 - Defined Edge/Irregular Shape, Cat. 3 - Blurred Edge/Radially Symmetric, Cat. 4 - Blurred Edge/Irregular Shape] Fifteen radiologists independently measured each tumor. Mixed effects models controlling for different tumors were used to assess the variance. Results Overall, the between reader variations accounted for 4.15% percent of total errors for the length. The respective between reader and the random errors are 0.32 (95% CI: 0.14, 0.77) and 7.51 (95%CI: 7.08, 8.01). The data shows that the variances are smallest for category 1 tumors (total error: 1.45) and largest for category 4 tumors (total error: 20.79). The total error for categories 2 and 3 are listed in Table 1 below. Conclusions The (low reader error) / (total error) verifies that the radiologists were only responsible for a small portion of the total error, and suggests these 15 radiologists measuring a tumor will be comparable to one of these radiologists measuring the tumor many times.

No significant financial relationships to disclose.

[Table: see text]

Inter-observer variability in chemotherapy trials for pancreatic cancer

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Background: No studies have examined differences in imaging assessment of drug response for unresectable pancreatic cancer between investigators and independent central review panels. This study reports such discrepancies. Methods: 133 patients in two multi-center, randomized Phase II drug trials had their response assessed by measurement of tumor size or new lesions on serial CT scans. Protocols specified techniques for tumor measurement and defined responses as complete (CR) or partial responses (PR), stable (SD) or progressive disease (PD). Objective responses were confirmed by repeat imaging evaluations after an interval > 4 weeks. Cases of PR or SD withdrawn from the study <8 weeks after enrollment were scored as non-evaluable (NE). The same images were then blindly reviewed by protocol trained radiologists at an Independent Core Lab. Cases of discordance in the interpretation of best response between investigators and reviewers were then blindly re-reviewed by an independent adjudicator. Results: In 50/133 cases (38%), there was sufficient discrepancy between investigators and reviewers to result in a change in overall response. In 10 cases (8%), investigators reported responses inconsistent with protocol standards for their tumor measurements. In 40 cases (30%), reviewers disagreed with the radiological findings of the investigators. In 47 of the 50 cases, the films were available for a second review by the adjudicator who confirmed the reviewers’ assessment of response in 39/47 (83%) of cases. Discrepancies in assessment of response were not randomly distributed. Investigators reported significantly more confirmed objective responses (CR + PR) than reviewers even after investigators’ response coding errors were corrected. As shown in Table 1 , investigators reported favorable responses in 21/133 (16%) cases compared with 6/133 (5%) responses noted by reviewers (p=0.01). Conclusions: The results support the use of independent review of trial data when the endpoint of the trial (response rate) is based on imaging data.

[Table: see text]

Irradiation injury temporarily induces enhancement of APN/CD13 peptidase activity on aorta-gonads-mesonephros (AGM)-derived stromal cells

This study was designed to investigate the expression of aminopeptidase N (APN)/CD13 on intraembryonic AGM stromal cells, and the change of its enzymatic activity after irradiation injury. The expression of APN/CD13 on AGM stromal cells was assayed by RT-PCR and immunohistochemistry. After the stromal cells in AGM region were irradiated with 8.0 Gy of (60)Co gamma-rays, APN/CD13 enzymatic activity was measured by spectrophotometer at different time points. The result showed that AGM stromal cells strongly expressed APN/CD13. The enzymatic activity of APN/CD13 decreased temporarily after irradiation injury, then increased to higher level 4 h after irradiation, and it returned to the pre-irradiation level 24 to 48 h after the irradiation. The enzymatic activity of APN/CD13 was temporarily enhanced after irradiation injury, which might be one of the compensatory mechanisms that promote the hematopoietic recovery after irradiation.

[Treatment of multisegmental intramedullary cervical spinal cord ependymomas]

OBJECTIVE

To discuss the possibility of microneurosurgery techniques in the treatment of multisegmental intramedullary cervical spinal cord ependymomas.

METHODS

The clinical data of 26 cases of multisegmental intramedullary cervical spinal cord ependymomas patients was reviewed and analyzed.

RESULTS

There were 14 cases of cervical spinal cord ependymomas, 12 cases of cervical and thoracic spinal cord ependymomas. 4.5 spinal cord segments were involved in average. Incompletely inferior paraplegia was in 18 cases, incompletely high paraplegia in 8 cases, dyspnea in 6 cases, sphincter dysfunction in 10 cases. MRI detected syringomyelia formation in 24 cases. Vertebral lamina reposition were done in 20 cases. Muscle strength recovered in 21 cases, no change in 4 cases, aggravated in 1 case. All cases had total resection and 1 cases vertebral had instability in MRI.

CONCLUSIONS

Total resection of intramedullary cervical spinal cord ependymomas can be achieved by microneurosurgery. Most of the symptoms can be released after microsurgical treatment. After multisegmental laminotomy, the vertebral plate reposition should be done to ensure the stability.

Hypoxia-inducible factor 1alpha (HIF-1alpha)-mediated hypoxia increases BACE1 expression and beta-amyloid generation

The incidence of Alzheimer disease (AD) and vascular dementia is greatly increased following cerebral ischemia and stroke in which hypoxic conditions occur in affected brain areas. beta-Amyloid peptide (Abeta), which is derived from the beta-amyloid precursor protein (APP) by sequential proteolytic cleavages from beta-secretase (BACE1) and presenilin-1 (PS1)/gamma-secretase, is widely believed to trigger a cascade of pathological events culminating in AD and vascular dementia. However, a direct molecular link between hypoxic insults and APP processing has yet to be established. Here, we demonstrate that acute hypoxia increases the expression and the enzymatic activity of BACE1 by up-regulating the level of BACE1 mRNA, resulting in increases in the APP C-terminal fragment-beta (betaCTF) and Abeta. Hypoxia has no effect on the level of PS1, APP, and tumor necrosis factor-alpha-converting enzyme (TACE, an enzyme known to cleave APP at the alpha-secretase cleavage site). Sequence analysis, mutagenesis, and gel shift studies revealed binding of HIF-1 to the BACE1 promoter. Overexpression of HIF-1alpha increases BACE1 mRNA and protein level, whereas down-regulation of HIF-1alpha reduced the level of BACE1. Hypoxic treatment fails to further potentiate the stimulatory effect of HIF-1alpha overexpression on BACE1 expression, suggesting that hypoxic induction of BACE1 expression is primarily mediated by HIF-1alpha. Finally, we observed significant reduction in BACE1 protein levels in the hippocampus and the cortex of HIF-1alpha conditional knock-out mice. Our results demonstrate an important role for hypoxia/HIF-1alpha in modulating the amyloidogenic processing of APP and provide a molecular mechanism for increased incidence of AD following cerebral ischemic and stroke injuries.

Competing relaxation mechanisms in a disclinated nanowire: temperature and size effects

This Letter reports a molecular dynamics study of the temperature and size dependence of disclination relaxation in a bicrystalline titanium nanowire. The simulations show that an unstable disclination may relax via crack nucleation and/or structural transformation. The critical disclination strength to nucleate a crack decreases with the nanowire diameter at 0 K, but an inverse relation may exist at higher temperatures. Similar relaxation mechanisms are operative in other hcp materials. The results suggest that grain boundaries in nanostructured materials can be disordered through disclinations which relax via amorphization.

The analysis of 51 genes in DSM-IV combined type attention deficit hyperactivity disorder: association signals in DRD4, DAT1 and 16 other genes

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, starting in early childhood and persisting into adulthood in the majority of cases. Family and twin studies have demonstrated the importance of genetic factors and candidate gene association studies have identified several loci that exert small but significant effects on ADHD. To provide further clarification of reported associations and identify novel associated genes, we examined 1,038 single-nucleotide polymorphisms (SNPs) spanning 51 candidate genes involved in the regulation of neurotransmitter pathways, particularly dopamine, norepinephrine and serotonin pathways, in addition to circadian rhythm genes. Analysis used within family tests of association in a sample of 776 DSM-IV ADHD combined type cases ascertained for the International Multi-centre ADHD Gene project. We found nominal significance with one or more SNPs in 18 genes, including the two most replicated findings in the literature: DRD4 and DAT1. Gene-wide tests, adjusted for the number of SNPs analysed in each gene, identified associations with TPH2, ARRB2, SYP, DAT1, ADRB2, HES1, MAOA and PNMT. Further studies will be needed to confirm or refute the observed associations and their generalisability to other samples.

Microchannels in conventional single-mode fibers

Microchannels are fabricated into conventional single-mode fibers by femtosecond laser processing and chemical etching. Fabrication limitations imposed by the fiber geometry are highlighted and resolved through a simple technique without compromising fabrication flexibility. A microfluidic fiber device consisting of a 4 microm wide microchannel that intersects the fiber core for refractive index sensing is further demonstrated.

[Investigation of relationship between prehospital care for traumatic shock and postoperative acute lung injury/acute respiratory distress syndrome]

OBJECTIVE

To investigate and analyze the correlation and clinical significance of prehospital treatment for traumatic shock and postoperative acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).

METHODS

Six hundred cases in the last 10 years were enrolled for double-blind randomized control study. They were divided into 3 groups. Group A consisted of 184 cases who had received combined treatment, group B consisted of 305 cases who had received fluid replacement only and group C consisted of 111 cases with no treatment. The incidence of systemic inflammatory response syndrome (SIRS), ALI and ARDS of each group were analyzed and compared. SIRS was graded at 1 (T0) after admission, 24 (T1), 48 (T2), 96 (T3) and 144 hours (T4) after operation.

RESULTS

In 524 cases diagnosis of SIRS was made among 600 patients (87.33%). Among them 73.37% (135/184 cases) were in group A, 91.48% (279/305 cases) belonged to group B and 99.10% (110/111 cases) in group C. The scores of SIRS were notably lower in group A than B and C at each time point (all P<0.01), and they were lower in group B than those in group C (all P<0.01), they recovered at T3 after operation in group A while in group B patients recovered at 144 hours after operation. Eleven patients among 184 (5.98%) were diagnosed to have ALI including 1 case progressed to ARDS and 1 case to MODS and no one died, while in group B 32 cases in 305 (10.49%) had ALI with 7 cases progressed to ARDS and 3 cases to MODS while 3 deaths and in group C 23 among 111 (20.72%) had ALI, and 8 patients progressed to ARDS, 5 cases to MODS and 5 deaths.

CONCLUSION

Prehospital treatment is closely related with postoperative ALI, and combined treatment is beneficial in reducing the incidence of postoperative ALI/ARDS.