A short course of metformin does not reduce OHSS in a GnRH antagonist cycle for women with PCOS undergoing IVF: a randomised placebo-controlled trial

STUDY QUESTION

Does 'metformin' reduce the incidence of ovarian hyperstimulation syndrome (OHSS) for women with polycystic ovary syndrome (PCOS) undergoing a GnRH antagonist assisted conception treatment cycle?

SUMMARY ANSWER

A short course of metformin does not reduce the incidence of OHSS for women with PCOS undergoing a GnRH antagonist treatment cycle.

WHAT IS KNOWN ALREADY

Metformin does reduce the incidence of OHSS in a GnRH-agonist treatment cycle.

STUDY DESIGN, SIZE, DURATION

A randomised placebo-controlled trial (RCT) using metformin or placebo. Randomisation was blinded to both patient and investigator, using a random permuted blocks method with a 50:50 allocation ratio. The study was completed over 5 years (2009-2014) with 153 randomised patients. A sample size calculation based on the incidence of OHSS was completed prospectively suggesting a minimum of 146 recruits was required for the trial with a power of 80% and a type 1 error of 0.05.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All patients met the Rotterdam criteria for PCOS and were treated with a standard GnRH antagonist IVF/ICSI treatment cycle in a tertiary infertility clinic. The study medication was started prior to stimulation and continued to oocyte retrieval. Of the 153 patients, 77 received metformin and 76 placebo.

MAIN RESULTS AND THE ROLE OF CHANCE

There was no reduction in the incidence of moderate-severe OHSS (Placebo (PLA) 12.2%, metformin (MET) = 16%, 95% CI -0.08-0.16, P = 0.66). There was no difference in total gonadotrophin dose (PLA = 1200, MET = 1200, 95% CI -118.67-118.67, P = 0.75), oocytes retrieved (PLA = 15, MET = 14, 95% CI -2.37-4.37, P = 0.66) or fertilisation rate (PLA = 60.7%, MET = 53.3%, 95% CI -0.96-14.94, P = 0.07). However, using metformin resulted in a reduced clinical pregnancy rate (CPR) per cycle started (PLA = 48.7%, MET = 28.6%, 95% CI 0.04-0.35, P = 0.02) and live birth rate (PLA = 51.6%, MET = 27.6%, 95% CI 0.05-0.40, P = 0.02). Furthermore, when ethnicity was taken into account there was a significant reduction in pregnancy outcome for the South Asian population irrespective of metformin or placebo use (CPR per cycle started, White Caucasian = 44.4%, South Asian = 19.4%; 95% CI 0.06-0.39, P = 0.01).

LIMITATIONS, REASONS FOR CAUTION

This study was only undertaken on an infertility population with PCOS with a limited duration of study medication use.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first adequately powered RCT to assess the impact of metformin on OHSS in a high-risk group (women with PCOS) undergoing a GnRH antagonist cycle. It does not support the empirical prescribing of metformin as an adjunct to a GnRH antagonist treatment cycle.

STUDY FUNDING/COMPETING INTERESTS

None.

TRIAL REGISTRATION NUMBER

EudraCT number 2009-010952-81.

TRIAL REGISTRATION DATE

21 September 2009.

DATE OF FIRST PATIENT'S ENROLMENT

30 October 2009.

Postoperative care after varicose vein surgery: patient-based questionnaire

Objective: Practical advice given postoperatively to varicose vein patients remains subjective. They are encouraged to walk in their stockings or bandages as much as possible. The aim of this study was to investigate if this is a realistic request.

Methods: A postal questionnaire was given to all patients undergoing varicose vein surgery from July 2003. The questionnaire referred to the following issues: pain scores, walking ability, stairs, driving, return to work, dressings and stockings.

Results: A total of 93 patients replied, of which 55 (59%) were women and the mean age was 52 years (range 23–83). Of the patients who replied, 66 (71%) had a unilateral procedure and 13 (14%) had recurrent varicose veins. A total of 65 (70%) underwent a high tie, strip and avulsions, 16 (17%) underwent a short saphenous tie, nine (10%) underwent ligation of both saphenous systems and three (3%) underwent avulsions alone. Pain scores were low (3/10), resolving completely after nine days on average. Despite this, 89% of patients could only walk around the garden or block in the first week. After two weeks, normal activities were possible but most patients remained off work for three weeks. Stockings were a problem for 49 (53%) patients.

Conclusions: Although we would like all our patients to mobilize early after varicose vein surgery, the traditional long walk is unrealistic. Support stockings cause difficulties in over half the patients. Postoperative care and advice for varicose vein surgery need re-thinking.

Decreased miR-452 expression in human colorectal cancer and its tumor suppressive function

MicroRNA-452 (miR-452) is dysregulated in some human malignancies, and is correlated with tumor progression. However, its expression and function in human colorectal cancer (CRC) remain unclear. The aim of our study was to explore the effects of miR-452 in CRC tumorigenesis and development. Using reverse transcription quantitative real-time polymerase chain reaction, we detected miR-452 expression in CRC cell lines and primary tumor tissues. We also examined the association between miR-452 expression and clinicopathological factors. We then investigated the effects of miR-452 on the biological behavior of CRC cells. miR-452 expression was significantly downregulated in CRC compared with the adjacent noncancerous tissues. A low level of miR-452 was associated with larger tumor size, deeper invasion depth, and advanced TNM stage. Multivariate Cox regression analysis identified decreased miR-452 expression as an independent factor predicting poor prognosis for CRC patients. In addition, in vitro functional analysis showed that overexpression of miR-452 in HCT116 cells reduced cell proliferation, promoted cell apoptosis, and inhibited cell invasion and migration. These findings indicate that miR-452acts as a tumor suppressor in CRC, and would serve as a novel molecular therapeutic agent for the treatment of the disease.

How pinning and contact angle hysteresis govern quasi-static liquid drop transfer

This paper presents both experimental and numerical simulations of liquid transfer between two solid surfaces with contact angle hysteresis (CAH). Systematic studies on the role of the advancing contact angle (θa), receding contact angle (θr) and CAH in determining the transfer ratio (volume of the liquid transferred onto the acceptor surface over the total liquid volume) and the maximum adhesion force (Fmax) were performed. The transfer ratio was found to be governed by contact line pinning at the end of the transfer process caused by CAH of surfaces. A map based on θr of the two surfaces was generated to identify the three regimes for liquid transfer: (I) contact line pinning occurs only on the donor surface, (II) contact line pinning occurs on both surfaces, and (III) contact line pinning occurs only on the acceptor surface. With this map, an empirical equation is provided which is able to estimate the transfer ratio by only knowing θr of the two surfaces. The value of Fmax is found to be strongly influenced by the contact line pinning in the early stretching stage. For symmetric liquid bridges between two identical surfaces, Fmax may be determined only by θa, only by θr, or by both θa and θr, depending on the magnitude of the contact angles. For asymmetric bridges, Fmax is found to be affected by the period when contact lines are pinned on both surfaces.

JAK-STAT and G-protein-coupled receptor signaling pathways are frequently altered in epitheliotropic intestinal T-cell lymphoma

Epitheliotropic intestinal T-cell lymphoma (EITL, also known as type II enteropathy-associated T-cell lymphoma) is an aggressive intestinal disease with poor prognosis and its molecular alterations have not been comprehensively characterized. We aimed to identify actionable easy-to-screen alterations that would allow better diagnostics and/or treatment of this deadly disease. By performing whole-exome sequencing of four EITL tumor-normal pairs, followed by amplicon deep sequencing of 42 tumor samples, frequent alterations of the JAK-STAT and G-protein-coupled receptor (GPCR) signaling pathways were discovered in a large portion of samples. Specifically, STAT5B was mutated in a remarkable 63% of cases, JAK3 in 35% and GNAI2 in 24%, with the majority occurring at known activating hotspots in key functional domains. Moreover, STAT5B locus carried copy-neutral loss of heterozygosity resulting in the duplication of the mutant copy, suggesting the importance of mutant STAT5B dosage for the development of EITL. Dysregulation of the JAK-STAT and GPCR pathways was also supported by gene expression profiling and further verified in patient tumor samples. In vitro overexpression of GNAI2 mutants led to the upregulation of pERK1/2, a member of MEK-ERK pathway. Notably, inhibitors of both JAK-STAT and MEK-ERK pathways effectively reduced viability of patient-derived primary EITL cells, indicating potential therapeutic strategies for this neoplasm with no effective treatment currently available.

Fast Liquid Transfer between Surfaces: Breakup of Stretched Liquid Bridges

In this work, a systematic experimental study was performed to understand the fast liquid transfer process between two surfaces. According to the value of the Reynolds number (Re), the fast transfer is divided into two different scenarios, one with negligible inertia effects (Re ≪ 1) and the other with significant inertia effects (Re > 1). For Re ≪ 1, the influences of the capillary number (Ca) and the dimensionless minimum separation (H(min)* = H(min)/V(1/3), where H(min) is the minimum separation between two surfaces and V is the volume of liquid) on the transfer ratio (α, the volume of liquid transferred to the acceptor surface over the total liquid volume) are discussed. On the basis of the roles of each physical parameter, an empirical equation is presented to predict the transfer ratio, α = f(Ca). This equation involves two coefficients which are affected only by the surface contact angles and H(min)* but not by the liquid viscosity or surface tension. When Re > 1, it is shown for the first time that the transfer ratio does not converge to 0.5 with the increase in the stretching speed.

Electric field modification of magnetism in Au/La2/3Ba1/3MnO3/Pt device

The La_2/3Ba_1/3MnO₃ film is deposited in a CMOS-compatible Pt/Ti/SiO₂/Si substrate with the oxygen pressure of 10 Pa for investigating magnetoelectric effect. Bipolar resistive switching effect with excellent endurance and retention is observed in this Au/La_2/3Ba_1/3MnO₃/Pt device. Through this effect, a significant nonvolatile change of magnetization is obtained in this device as well. The change of magnetization can be understood by the break and repair of the -Mn³⁺-O²⁻-Mn⁴⁺- chains induced by the electric field through the oxygen vacancies migration. The resistance and magnetization of the Au/La_2/3Ba_1/3MnO₃/Pt device can be simultaneously manipulated by the electric field, which makes it to be a promising candidate for the multifunctional memory devices.

Association between two single nucleotide polymorphisms of interleukin-27 gene and increased cryptorchidism risk

Growing evidences have suggested the association between interleukin-27 and cryptorchidism. We aimed to investigate the relationship between IL-27 polymorphisms and cryptorchidism susceptibility. A total of 519 males were enrolled in a case-control study (150 cases and 369 normal subjects). The variants were discriminated using polymerase chain reaction-restriction fragment length polymorphism methods. The proportions of the major allele for rs153109 and rs17855750 were A and T with frequencies of 0.56 and 0.85 in cases and 0.51 and 0.91 in controls respectively (P values = 0.002, P value = 0.002). The heterozygous genotype of rs153109 and 17855750 was A/G and T/G with frequencies of 0.62 and 0.25 in cases and 0.39 and 0.17 in controls respectively (P values <0.001, P values <0.001). The A allele and A/G genotype of rs153109 polymorphisms contribute to increase cryptorchidism susceptibility, and G allele and T/G genotype of rs17855750 also contribute to increase cryptorchidism susceptibility, which implies that these allele and genotypes may be risk factors for the development of cryptorchidism.

Liquid transfer mechanism between two surfaces and the role of contact angles

The transfer ratio of quasi-static liquid transfer was found to strongly depend on the difference between the receding contact angles of the two surfaces. In contrast to traditional thinking, the transfer ratio was quite insensitive to the adhesion force between the solid and the liquid when the liquid bridge broke.

Production and repair of implant-induced microdamage in the cortical bone of goats after long-term estrogen deficiency

SUMMARY

By using an ovariectomized goat model, we found that estrogen depletion decreases bone quality and makes it susceptible to screw-induced mechanical microdamage. Both diffuse microdamage and linear cracks accumulated up to 3 weeks after screw implantation, and the microdamage was repaired gradually after 4-8 months.

INTRODUCTION

The aim of this study was to observe the effect of long-term estrogen deficiency on the creation and repair of microdamage in cortical bone adjacent to bone screw.

METHODS

Cortical bone screws were placed in the tibial diaphyses 28 months after ovariectomy (OVX) or sham operation (Sham-Op) in female goats. The goats were euthanized at 0 day, 21 days, 4 months, and 8 months after screw implantation. Microdamage morphology and repair were examined in peri-screw bone using histomorphometric method, and the nanomechanical properties of peri-screw bone were examined with nanoindentation testing.

RESULTS

Tibiae from ovariectomized goats in which screws had been placed had significantly higher levels of diffuse microdamage and significantly more linear cracks than those from sham goats, and the diffuse microdamage was more obvious than linear cracks in the region adjacent to the implant. Both diffuse microdamage and linear cracks accumulated up to day 21 and then gradually repaired at 4 and 8 months after surgery. The trend for bone remodeling in each group was consistent with changes in the level of microdamage. Nanoindentation testing showed that both elastic modulus and hardness in peri-screw bone were significantly decreased in OVX group compared to Sham-Op group. The hardness and elastic modulus also showed a downward trend up to 4 months after screw implantation and then exhibited some recovery after 8 months.

CONCLUSIONS

Estrogen depletion decreases bone quality and makes it vulnerable to screw-induced mechanical damage, which may compromise the initial stability of an orthopedic implant.

Investigating univariate temporal patterns for intrinsic connectivity networks based on complexity and low-frequency oscillation: a test-retest reliability study

Intrinsic connectivity networks (ICNs) are composed of spatial components and time courses. The spatial components of ICNs were discovered with moderate-to-high reliability. So far as we know, few studies focused on the reliability of the temporal patterns for ICNs based their individual time courses. The goals of this study were twofold: to investigate the test-retest reliability of temporal patterns for ICNs, and to analyze these informative univariate metrics. Additionally, a correlation analysis was performed to enhance interpretability. Our study included three datasets: (a) short- and long-term scans, (b) multi-band echo-planar imaging (mEPI), and (c) eyes open or closed. Using dual regression, we obtained the time courses of ICNs for each subject. To produce temporal patterns for ICNs, we applied two categories of univariate metrics: network-wise complexity and network-wise low-frequency oscillation. Furthermore, we validated the test-retest reliability for each metric. The network-wise temporal patterns for most ICNs (especially for default mode network, DMN) exhibited moderate-to-high reliability and reproducibility under different scan conditions. Network-wise complexity for DMN exhibited fair reliability (ICC<0.5) based on eyes-closed sessions. Specially, our results supported that mEPI could be a useful method with high reliability and reproducibility. In addition, these temporal patterns were with physiological meanings, and certain temporal patterns were correlated to the node strength of the corresponding ICN. Overall, network-wise temporal patterns of ICNs were reliable and informative and could be complementary to spatial patterns of ICNs for further study.

Low-dose risedronate sodium protects bone cells after abrupt oestrogen withdrawal

OBJECTIVE

To investigate the effects of low-dose risedronate sodium on the in vitro cellular profile of osteoblasts, adipocytes, osteocytes and osteoclasts in a rat model of abrupt oestrogen deficiency.

METHODS

Oestrogen deficiency was induced by ovariectomy in 24 female rats. The rats were treated with low-dose (0.24 μg/kg) or high-dose (2.4 μg/kg) risedronate sodium for 4 days presurgery, continuing every 3 days until 15 days postsurgery. Osteogenic and adipogenic differentiation were determined in cultured bone marrow cells by alkaline phosphatase and Oil Red O staining, respectively, and by osteogenic and adipogenic gene expression. Osteoclast formation was measured in bone marrow cells stimulated with macrophage colony-stimulating factor and receptor activator of nuclear factor κB ligand, and stained with tartrate-resistant acid phosphatase. Osteocyte apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labelling assay and B-cell lymphoma-2 (Bcl-2) immunohistochemistry.

RESULTS

Low-dose risedronate sodium enhanced osteoblast differentiation, suppressed adipocyte differentiation and osteoclast formation, and reduced osteocyte apoptosis through regulation of Bcl-2 and Bcl-2-associated X protein.

CONCLUSIONS

Low-dose risedronate sodium may have clinical benefit in protecting against bone loss after abrupt oestrogen deficiency.

Modeling liquid bridge between surfaces with contact angle hysteresis

This paper presents the behaviors of a liquid bridge when being compressed and stretched in a quasi-static fashion between two solid surfaces that have contact angle hysteresis (CAH). A theoretical model is developed to obtain the profiles of the liquid bridge given a specific separation between the surfaces. Different from previous models, both contact lines in the upper and lower surfaces were allowed to move when the contact angles reach their advancing or receding values. When the contact angles are between their advancing and receding values, the contact lines are pinned while the contact angles adjust to accommodate the changes in separation. Effects of CAH on both asymmetric and symmetric liquid bridges were analyzed. The model was shown to be able to correctly predict the behavior of the liquid bridge during a quasi-static compression/stretching loading cycle in experiments. Because of CAH, the liquid bridge can have two different profiles at the same separation during one loading and unloading cycle, and more profiles can be obtained during multiple cycles. The maximum adhesion force generated by the liquid bridge is found to be influenced by the CAH of surfaces. CAH also leads to energy cost during a loading cycle of the liquid bridge. In addition, the minimum separation between the two solid surfaces is shown to affect how the contact radii and angles change on the two surfaces as the liquid bridge is stretched.

Type II EATL (epitheliotropic intestinal T-cell lymphoma): a neoplasm of intra-epithelial T-cells with predominant CD8αα phenotype

In this multicentre study, we examined 60 cases of Type II enteropathy-associated T-cell lymphoma (EATL) from the Asia-Pacific region by histological review, immunohistochemistry and molecular techniques. Patients were mostly adult males (median age: 58 years, male:female 2.6:1), presenting with abdominal pain (60%), intestinal perforation (40%) and weight loss (28%). None had a history of coeliac disease and the median survival was only 7 months. Histologically, these tumours could be divided into (i) central tumour zone comprising a monotonous population of neoplastic lymphocytes, (ii) peripheral zone featuring stunted villi and morphologically atypical lymphocytes showing epitheliotropism, and (iii) distant mucosa with normal villous architecture and cytologically normal intra-epithelial lymphocytes (IELs). Characterized by extensive nuclear expression of Megakaryocyte-associated tyrosine kinase (MATK) (87%) and usually a CD8(+)CD56(+) (88%) cytotoxic phenotype, there was frequent aberrant expression of CD20 (24%). T-cell receptor (TCR) expression was silent or not evaluable in 40% but of the remainder, there was predominant expression of TCRαβ over TCRγδ (1.6:1). In keeping with the normal ratio of IEL subsets, CD8(+) cases showed predominant CD8αα homodimer expression (77%), regardless of TCR lineage. These tumours constitute a distinct entity from classical EATL, and the pathology may reflect tumour progression from IEL precursors, remnants of which are often seen in the distant mucosa.

Simulation of mRNA diffusion in the nuclear environment

A mathematical model is devised to study the diffusion of mRNA in the nucleus from the site of synthesis to a nuclear pore where it is exported to the cytoplasm. This study examines the role that nuclear structure can play in determining the kinetics of export by considering models in which elements of the nuclear skeleton and confinement by chromatin direct the mRNA movement. As a rule, a dense chromatin layer favours rapid export by reducing the effective volume for diffusion. However, it may also result in a heavy tail in the export time distribution because of the low mobility of molecules that accidentally find their way deep into the dense layer. An anisotropic solid-state transport system can also assist export. There exist both an optimal ratio of the anisotropy and an optimal depth of the solid-state transport layer that favour rapid export.

In the face of chronic aspiration, prolonged ischemic time exacerbates obliterative bronchiolitis in rat pulmonary allografts

Aspiration of gastric fluid into the lung mediates the development of obliterative bronchiolitis (OB) in orthotopic WKY-to-F344 rat pulmonary transplants that have been subjected to immunosuppression with cyclosporine. However, the contribution of ischemic time to this process remains unknown. In this study, the effect of long (n = 16) and short (n = 12) ischemic times (average of 6 h and of 73 min, respectively) on rat lung transplants receiving aspiration of gastric fluid was assessed. Long ischemic times (LIT) led to significantly (p < 0.05) greater development of OB (ratio of OB lesions/total airways = 0.45 ± 0.07, mean ± standard error) compared to short ischemic times (ratio = 0.19 ± 0.05). However, the development of OB was dependent on aspiration, as controls receiving aspiration with normal saline showed little development of OB, regardless of ischemic time (p < 0.05). These data suggest that LIT, while insufficient by itself to lead to OB, works synergistically with aspiration of gastric fluid to exacerbate the development of OB.

Quantitative analysis of rectal cancer by spectral domain optical coherence tomography

To quantify OCT images of rectal tissue for clinic diagnosis, the scattering coefficient of the tissue is extracted by curve fitting the OCT signals to a confocal single model. A total of 1000 measurements (half and half of normal and malignant tissues) were obtained from 16 recta. The normal rectal tissue has a larger scattering coefficient ranging from 1.09 to 5.41 mm⁻¹ with a mean value of 2.29 mm⁻¹ (std:±0.32), while the malignant group shows lower scattering property and the values ranging from 0.25 to 2.69 mm⁻¹ with a mean value of 1.41 mm⁻¹ (std:±0.18). The peri-cancer of recta has also been investigated to distinguish the difference between normal and malignant rectal tissue. The results demonstrate that the quantitative analysis of the rectal tissue can be used as a promising diagnostic criterion of early rectal cancer, which has great value for clinical medical applications.

Prospects for gene transfer for clinical heart failure

Congestive heart failure is an inexorable disease associated with unacceptably high morbidity and mortality. Preclinical results indicate that gene transfer using various proteins is a safe and effective approach for increasing function of the failing heart. In the current review, we provide a summary of cardiac gene transfer in general and summarize findings using adenylyl cyclase 6 as therapeutic gene in the failing heart. We also discuss the potential usefulness of a new treatment for congestive heart failure, paracrine-based gene transfer.

Deletion of estrogen receptor beta accelerates early stage of bone healing in a mouse osteotomy model

This study examined the role of estrogen receptor (ER) beta during mouse femoral fracture healing by employing ER knockout (KO) mice. The fracture healing in KO mice was enhanced in the early stage of neovascularization and the middle stage of endochondral ossification.

INTRODUCTION

This study was conducted to examine the role of ER beta during fracture healing.

METHODS

Female ERbeta knockout (KO) mice (18 weeks old) and age-matched female wild-type (WT) mice underwent open osteotomy on the right femur. They were sacrificed at 1, 2, 4 and 6 weeks post-fracture. The sera and callus samples were subjected to the following analyses: micro-computed tomography (CT)-based angiography, micro-CT evaluation, histological examination, histomorphometry examination, real-time polymerase chain reaction (PCR) analysis, biochemical marker, and mechanical testing.

RESULTS

Micro-CT-based angiography showed that the total vessel volume at the fracture site was larger in the KO group than the WT group at 1 and 2 weeks post-fracture. Micro-CT analysis revealed that the callus volume was significantly higher in the KO group from week 2 to week 4 post-fracture when compared with the WT group consistent with the histological data. Analysis of biochemical markers indicated that circulating P1NP levels in the KO mice were significantly higher than in the WT mice from week 2 to week 4 and that temporal expression of circulating C-terminal telopeptide of type I collagen (CTX) levels was also higher in the KO mice than in the WT mice. These results were consistent with quantitative real-time PCR analysis. The ultimate load, stiffness, and energy to failure were significantly higher in the KO mice than in the WT mice at week 4.

CONCLUSIONS

The fracture healing in KO mice was enhanced in the early stage of neovascularization and the middle stage of endochondral ossification, but not by the end of healing. Blockade of ERbeta can be considered as another therapeutic strategy for osteoporotic fracture and non-union fracture.

Effects of a single dose of methylprednisolone versus three doses of rosiglitazone on nerve growth factor levels after spinal cord injury

Acute spinal cord lesions result in dramatic changes in neuronal function. Studies have shown that the peroxisome proliferator-activated receptor-γ agonist, rosiglitazone, has neuroprotective properties. The effect of rosiglitazone after acute spinal cord injury was examined in the present study. Rats were subjected to laminectomy only; laminectomy with spinal cord contusion injury; laminectomy with contusion injury plus 30 mg/kg body weight methylprednisolone administered 5 min after surgery; or laminectomy with contusion injury plus 2 mg/kg body weight rosiglitazone administered intraperitoneally 5 min, 6 h and 24 h after surgery. Both drugs increased neurotrophin gene and protein expression 24 h after injury compared with injured rats without drug treatment. Rosiglitazone increased neurotrophin expression at 7 days to a greater extent than methylprednisolone. Early functional recovery was observed in rats treated with rosiglitazone. The greater increase in rosiglitazone-induced nerve growth factor expression soon after injury could explain, at least in part, the improved recovery of motor function compared with methylprednisolone or saline.

Identification and characterization of the cysteine protease inhibitor gene MdCPI from Musca domestica

Cysteine proteinase inhibitors (CPIs) are involved in many vital cellular processes such as signalling pathways, apoptosis, immune response and development; however, no CPIs have yet been reported from the housefly Musca domestica. Here we report the isolation and characterization of a housefly CPI gene designated MdCPI. The gene contains an open reading frame of 357 bp encoding a protein of 118 amino acid residues with a putative signal peptide of 17 amino acid residues. Protein alignment demonstrated a high homology to that of Sarcophaga crassipalpis (identity = 51%). Phylogenetic analysis suggested that all CPIs from dipterans, including the housefly, belong to the I25A family and may be descended from a single common ancestor. The gene was expressed in and purified from Escherichia coli. Biochemical studies showed that MdCPI exerts an inhibiting function on papain, which is a classical assay to confirm CPIs. Real-time quantitative PCR and immunolocalization analysis revealed that MdCPI is specifically expressed in haemocytes and fat bodies. It is highly down-regulated in larvae and markedly up-regulated in the pupal stage, suggesting that it may be related to development.

Humanized theta-defensins (retrocyclins) enhance macrophage performance and protect mice from experimental anthrax infections

Retrocyclins are humanized versions of the -defensin peptides expressed by the leukocytes of several nonhuman primates. Previous studies, performed in serum-free media, determined that retrocyclins 1 (RC1) and RC2 could prevent successful germination of Bacillus anthracis spores, kill vegetative B. anthracis cells, and inactivate anthrax lethal factor. We now report that retrocyclins are extensively bound by components of native mouse, human, and fetal calf sera, that heat-inactivated sera show greatly enhanced retrocyclin binding, and that native and (especially) heat-inactivated sera greatly reduce the direct activities of retrocyclins against spores and vegetative cells of B. anthracis. Nevertheless, we also found that retrocyclins protected mice challenged in vivo by subcutaneous, intraperitoneal, or intranasal instillation of B. anthracis spores. Retrocyclin 1 bound extensively to B. anthracis spores and enhanced their phagocytosis and killing by murine RAW264.7 cells. Based on the assumption that spore-bound RC1 enters phagosomes by "piggyback phagocytosis," model calculations showed that the intraphagosomal concentration of RC1 would greatly exceed its extracellular concentration. Murine alveolar macrophages took up fluorescently labeled retrocyclin, suggesting that macrophages may also acquire extracellular RC1 directly. Overall, these data demonstrate that retrocyclins are effective in vivo against experimental murine anthrax infections and suggest that enhanced macrophage function contributes to this property.

Quantification of intraventricular hemorrhage with electrical impedance tomography using a spherical model

We have developed a robust EEG-based current pattern which shows promise for the detection of intraventricular hemorrhage (IVH) in neonates. Our reconstructions to date are based on a layered spherical head model. In this study, the current pattern was used to gather data from three realistic-shaped neonatal head models and a physical phantom based on one of these models. We found that a sensitivity matrix calculated from a spherical model gave us satisfactory reconstructions in terms of both image quality and quantification. Incorporating correct geometry information into the forward model improved image quality. However, it did not improve quantification accuracy. The results indicate that using a spherical matrix may be a more practical choice for monitoring IVH volumes in neonates for whom patient-specific models are not available.

Effect of water-soluble P-chitosan and S-chitosan on human primary osteoblasts and giant cell tumor of bone stromal cells

Water-soluble phosphorylated chitosan (P-chitosan) and disodium (1 → 4)-2-deoxy-2-sulfoamino-β-D-glucopyranuronan (S-chitosan) are two chemically modified chitosans. In this study, we found that P-chitosan significantly promotes cell proliferation of both human primary osteoblasts (OBs) and the OB like stromal cell component of the giant cell tumor of bone (GCTB) cells at the concentration from 125 to 1000 µg ml⁻¹ at all time points of 1, 3, 5 and 7 days after treatment. Further investigation of the osteogenic effect of the P-chitosan suggested that it regulates the levels of osteoclastogenic factors, receptor activator of nuclear factor kappa B ligand and osteoprotegerin expression. An interesting finding is that S-chitosan at lower concentration (100 µg ml⁻¹) stimulates cell proliferation while a higher dose (1000 µg ml⁻¹) of S-chitosan inhibits it. The inhibitory effect of S-chitosan on human primary GCT stromal cells was greater than that of OBs (p < 0.05). Taken together, our findings elucidated the osteogenic effect of P-chitosan and the varying effects of S-chitosan on the proliferation of human primary OBs and GCT stromal cells and provided us the rationale for the construction of novel bone repair biomaterials with the dual properties of bone induction and bone tumor inhibition.

Neuraxial anesthesia for cardiac surgery: thoracic epidural and high spinal anesthesia - why is it different?

Anesthesiologists can offer much more then stable blood pressure and heart rate in the intraoperative period. By choosing appropriate anesthetic techniques they can tremendously influence perioperative stress. This may positively impact on the overall surgical outcome. One of the most intriguing aspects of neuraxial anesthesia is its ability to attenuate the stress response to surgery. At present there is no agreement on the clinical importance of such a response but there is substantial indirect evidence that it may play an important role in a patient's outcome. Neuraxial anesthesia supplemented by general anesthesia is justified and can be safely used in cardiac surgery. The authors of this expert opinion prefer spinal anesthesia to thoracic epidural anesthesia and have been using it routinely for the last 20 years without any neurological complications. The risk of spinal hematoma from a 27G spinal needle prior to full heparinization is unknown but in our opinion is remote. Both epidural and spinal techniques can and should have a place in modern cardiac anesthesia practice and should be further investigated.

Randomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis - a double-blind comparison with sustained release mesalazine

BACKGROUND

Andrographis paniculata is an herbal mixture used to treat inflammatory diseases. An extract of the herb, HMPL-004, inhibits TNF-α and IL-1β, and prevents colitis in animal models.

AIM

To determine the efficacy and safety of HMPL-004 in patients with mild-to-moderate ulcerative colitis.

METHODS

A randomised, double-blind, multicentre, 8-week parallel group study was conducted using HMPL-004 1200 mg/day compared with 4500 mg/day of slow release mesalazine (mesalamine) granules in patients with mild-to-moderately active ulcerative colitis. Disease activity was assessed at baseline and every 2 weeks for clinical response, and at baseline and 8 weeks by colonoscopy.

RESULTS

One hundred and twenty patients at five centres in China were randomised and dosed. Clinical remission and response were seen in 21% and 76% of HMPL-004-treated patients, and 16% and 82% of mesalazine-treated patients. By colonoscopy, remission and response were seen in 28% and 74% of HMPL-004-treated patients and 24% and 71% of mesalazine-treated patients, respectively. There was no significant difference between the two treatment groups.

CONCLUSION

HMPL-004 may be an efficacious alternative to mesalazine in ulcerative colitis.