Receptor interacting protein kinase 3 promotes cisplatin-induced necroptosis in apoptosis-resistant HepG2/DDP cells

Hepatocellular carcinoma is the most common primary malignancy of the liver. The chemotherapeutic drug cisplatin is widely used for advanced liver cancer. However, the development of cisplatin resistance in cancer cells, which is related to the decreased cellular susceptibility to apoptosis, results in a major limitation of cisplatin-based chemotherapy. Recently, triggering necroptosis has been proposed to be a novel therapeutic strategy to eradicate apoptosis-resistant cancer cells. In this study, we provided evidence that cisplatin could induce cell death in HepG2 cells, but not in the apoptosis-resistant HepG2/DDP cells. Ectopic expression of RIP3 promoted cisplatin-induced HepG2/DDP cells death, HMGB1 and LDH release. Moreover, we demonstrated that this type of cell death was necroptosis and depended on RIP1-RIP3-MLKL signaling pathway because inhibition of MLKL activity by necrosulfonamide (NSA) or knockdown of RIP1 significantly attenuated cisplatin-induced cell death in HepG2/DDP-RIP3 cells. Finally, we found that ectopic expression of RIP3 sensitized HepG2/DDP cancer cells to cisplatin treatment in vivo. The findings offer new insights into the molecular mechanisms underlying cisplatin-induced necroptosis in liver cancer cells and suggest that combination of cisplatin with other drugs which can restore RIP3 expression in cancer cells maybe a better choice for therapy of apoptosis-resistant cancer.

Functional, histological and molecular characteristics of human exstrophy detrusor

INTRODUCTION

Bladder exstrophy is a congenital anomaly involving foetal exposure and protrusion of the open bladder through an incomplete lower abdominal wall. Techniques to surgically correct exstrophy after birth have greatly improved, but it still presents a major challenge to achieve continence and a good quality of life for patients and their families as the pathophysiology of bladder dysfunction is unknown.

OBJECTIVES

A multimodal approach was used to characterise the histological and biomechanical properties of exstrophy detrusor. These were correlated with myocyte responses to agonists and an evaluation of developmental signalling pathways to evaluate the cause of bladder dysfunction in exstrophy.

STUDY DESIGN

Detrusor muscle specimens were obtained during corrective surgery from four exstrophy groups: neonatal (1-3 days, n = 8), younger children (7 months-5 years, n = 13) and older children (8-14 years, n = 11) undergoing secondary procedures and cloacal exstrophy (16 days-9 years, n = 9); control specimens were obtained from children (3 months-9 years, n = 14) undergoing surgery for other pathologies but with normal bladder function. Five lines of experiments were undertaken: measurement of connective tissue to detrusor muscle ratio, contractile responses to electrical and agonist stimulation; in vitro biomechanical stiffness, intracellular Ca²⁺ responses to contractile agonists and immunohistochemistry for proteins (MMP-7, cyclinD1, β-catenin and c-myc) involved in fibrosis generation. Exstrophy data were compared with those from the control group.

RESULTS

Exstrophy tissue demonstrated reduced smooth muscle compared with connective tissue, reduced contractile responses and greater mechanical stiffness. However, intracellular Ca²⁺ responses to agonists were maintained. These changes were greatest in neonatal and cloacal exstrophy samples and least in those from older paediatric bladders. Immunolabelled MMP-7, β-catenin and c-myc were reduced in exstrophy samples.

DISCUSSION

These results highlight the reality that newborns with exstrophy have significantly reduced compliance and bladder underactivity, which may persist or return to normal values with surgery and age. The primary cause of underactivity is increased connective tissue in relation to detrusor muscle; however, detrusor myocyte function remains normal. Finally, the increase of the smooth muscle content in the paediatric bladder group indicates a remodelling response of the bladder to surgical correction and time. Excess gestational fibrosis is associated with changed expression of key proteins in the Wnt-signalling pathway, a potential aetiological factor and therapeutic target.

CONCLUSION

Results point to connective tissue deposition as the primary pathological process that determines bladder function with normal myocyte function. Future research that reduces connective tissue deposition may lead to improvement in outcomes for these children.

[Therapeutic efficacy of ultraviolet combined with riboflavin for the rabbit bacterial keratitis]

Objective: To study the effects of ultraviolet light combined with riboflavin treatment (corneal collagen-crosslinking, CXL) on infectious control and stromal reconstruction of bacterial keratitis. Methods: Experimental Study. A Staphylococcus aureus rabbit keratitis model was established by injecting Staphylococcus aureus broth into the shallow stromal layer of the right eye cornea of New Zealand white rabbits. Forty-four rabbits that successfully established the model were randomly divided into four groups: corneal collagen cross-linking (CXL) group, antibiotic group, CXL+ antibiotic group and untreated group, with 11 rabbits in each group. Before the treatment and at 3, 7, 14 and 28 days after treatment, slit lamp corneal examination, AS-OCT and in vivo confocal microscopy (IVCM) were performed. Clinical efficacy of different treatments were evaluated at different time points. Parameters including conjunctival hyperemia, corneal ulcer, infiltration, edema, and neovascular. Histopathological examinations of corneal lesions were performed in order to detect the infiltration, inflammatory cells and repair in corneal tissue. Normal data were compared with paired t-test and non-normal data were compared with paired rank sum test before and after treatment. Kruskal-Wallis rank sum test was used to compare 4 groups of data and the generalized estimation equation is used to compare the repeated measurement data at each time point and the comparison between the groups of the treatment groups. Results: After treatment, different time points and specimens for pathological observation, we obtained the following results:Conjunctival hyperemia: in CXL and CXL+ antibiotic groups after treatment for 3 days from treatment before 3 (2, -4) and 3 (2, -3),The reduction was 2 (1, -3) and 2 (1, -2), the difference was statistically significant (Z=-3.91, -5.50; P<0.008); 14 days, the antibiotic group changed from 3 (3, -4) to 2 (1, -2) after treatment, the difference was statistically significant (Z=-5.11, P<0.008); the untreated group had no statistical significance before and after treatment. After 14 days of treatment, the area of corneal ulcer (0.08±0.11) cm(2), (0.07±0.05) cm(2) in CXL group and CXL+ antibiotic group was significantly lower than that before treatment (0.40±0.18) cm(2), (0.49±0.24) cm(2). The difference was statistically significant. Significance (Z=-3.29, -3.64; P<0.008); after 14 days of treatment, after 14 days of treatment, neovascularization in the CXL and CXL+ antibiotic groups began to resolve, 1 (1, -2) and 1 (0, -2) at 7 days of treatment. decreased to 1 (1, -1) and 0 (0, -1), the difference was statistically significant (Z=4.57, 3.80; P<0.012 5); The degree of corneal edema was significantly reduced in the CXL group and the CXL+ antibiotic group at 14 days after treatment, which was reduced from (650±154) μm and (785±255) μm before the treatment to (432±95) μm and (455±109) μm, the difference was statistically significant (t=4.50, 4.92; P=0.00); The density of corneal stromal cells was also reduced from (446±257)/mm(2), (321±145)/mm(2) to (107±66)/mm(2), (114±94)/mm(2), the difference was statistically significant (t=4.15, 4.76; P<0.05). Histopathological observation under light microscope showed that most of the corneal ulcers healed in the CXL group and the CXL+ antibiotic group at 7 days of treatment. The epithelial cells were clearly visible and misaligned, and a small amount of neutrophils in the stromal layer. The upper epithelial layer was treated for 14 days. The cells are arranged neatly, the structure is clear, and the inflammatory cells are significantly reduced. Conclusion: Ultraviolet light combined with riboflavin corneal collagen cross-linking has a certain therapeutic effect on rabbit bacterial keratitis infection control and ulcer repair, and can be used as an auxiliary treatment for antibiotics. (Chin J Ophthalmol, 2018, 54:902-910).

[Genetic typing and susceptibility testing of strains from Staphylococcus aureus keratitis or conjunctivitis patients]

Objective: To study the relationship between genetic typing and the antibiotic susceptibility of staphylococcus aureus (SA) isolated from keratitis or conjunctivitis patients. Methods: Experimental study. Thirty-four (34) strains of Staphylococcus aureus were isolated from 34 cases of keratitis or conjunctivitis. The genomic DNA was extracted and amplified with PCR. With the method of multi locus sequences typing (MLST), gene fragments from 7 house-keeping genes were amplified and the products were sequenced. The results were submitted to the MLST website (www.pubmlst.org). In comparison with the allele of the corresponding gene, the allele spectrums of the strain were obtained with 7 housekeeping genes. At last, the MLST genotypes of the isolated strains were determined. With the START software, the evolutionary tree was established with UPGMA method. With the microdilution method, the MIC(90) of 13 antimicrobial agents was determined. The MIC(90) value of antimicrobial agents among different genotypes of Staphylococcus aureus was comparatively analyzed. Results: Ten (10) genotypes were obtained from 34 strains of Staphylococcus aureus. The dominant types were ST239, ST2592 and ST188. The clustering of genotyping was relatively concentrated, mainly in group Ⅰ (25 strains of SA, 83.3% of the total), and followed by group Ⅱ (5 strains of SA, 16.7%). The conjunctival isolates were distributed in the subgroup A of group Ⅰ. The cornea isolates were concentrated in subgroup B and group Ⅱ. With the exact probability method, the R×C chi square tests were used as statistic analysis method. The difference between the bacterial genotyping of two sources was statistically significant (P=0.011). Twenty-four strains of SA in group Ⅰ was sensitive to Vancomycin, Rifampicin and Amikacin (sensitivity ratio was 24/24, 20/24 and 20/24, respectively), and was generally resistant to other antibiotics. The values of MIC(90) of ciprofloxacin, ofloxacin, gatifloxacin and moxifloxacin to Staphylococcus aureus in subgroup A (0.16±0.07, 0.51±0.42, 0.31±0.14, 0.22±0.33) were significantly lower than the values in subgroup B(0.74±0.11, 0.84±0.45, 0.67±0.03, 0.68±0.26). The difference was statistically significant (P=0.004, 0.026, 0.034, 0.001). There was no significant difference between the MIC(90) values of the other 9 kinds of antibiotics in the subgroup A and in the subgroup B of Staphylococcus aureus (P value 0.047-0.561). Conclusion: The genotype of Staphylococcus aureus of corneal isolations and conjunctival isolations were different. The conjunctival isolates were distributed in the subgroup A of group Ⅰ and the corneal isolates were concentrated in subgroup B and group Ⅱ. There is a significant correlation between the MLST genotypes and antibiotic sensitivity. (Chin J Ophthalmol, 2018, 54:767-774).

The rare case of an extraperitoneal ureteral herniation into the inguinal canal of a 12-year-old boy

Ureteric herniation into the inguinal canal is a rare condition in adults and even more so in the paediatric population. These hernia types can be categorised as paraperitoneal or extraperitoneal. The former are the only varieties encountered in the paediatric literature, where patients are generally infants, while the latter phenomenon is seen in 20% of ureteric herniations in adults. We present a case of an extraperitoneal ureteric herniation into the inguinal canal in a 12-year-old boy with previous surgery for cloacal exstrophy, analyse the existing literature on the condition and make the speculation that the extraperitoneal variety is an adult variant seen in this child because of weakness in the surrounding structures as a result of previous surgery.

[Histopathology manifestation and imaging characteristics of in vivo confocal microscopy for diagnosis of ocular surface squamous neoplasia]

Objective: To study the histopathology manifestation and imaging characteristics of in vivo confocal microscopy (IVCM) for diagnosis of ocular surface squamous neoplasia (OSSN) and analyze the reliability of IVCM in differential diagnosis from OSSN cases. Methods: A prospective study. Twenty-three patients (23 eyes) with OSSN were collected from September 2015 to November 2017 in Beijing Tongren Eye center. They were underwent the examinations sequentially as follows: visual examination; slit-lamp microscope examination and ocular surface photography; color fundus image; anterior segment optical coherence tomography examination; IVCM examination and histopathology examination after surgery. With histopathology diagnosis, all subjects were divided into two groups: conjunctival intraepithelial neoplasm (CIN) and squamous cell carcinoma (SCC). Compared with histopathological findings, the IVCM results (cell morphology, cytoplasm and nucleus) of OSSN were analyzed. The difference analysis between the count data of two groups was carried out by the chi square test or Fisher's exact test. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the accuracy of each parameter to differentiate SCC from OSSN. Results: There were 12 males and 11 females among the 23 patients aged (62±15) years. With the histopathological diagnosis, there were 15 cases (15 eyes) in the CIN group and 8 cases (8 eyes) in the SCC group. Eye redness, pain, foreign body sensation and tears were the symptoms of OSSN. There was no significant difference in clinical symptoms between the CIN and SCC groups. The size of tumors and the incidence of trophoblastic vessels in the SCC group were greater than those in the CIN group [8.5(6.5-15.5) mm vs. 5.8(4.0-8.5)mm, Z=4.702,P=0.029; 7/8 vs. 5/15, χ²=6.135, P=0.013). In histopathology, multilayered epithelia with cellular polymorphism, varied cytoplasm staining, and slightly thicker nuclei were observed in the CIN group. The corneal epithelial cells of SCC patients were markedly heterogeneous, and the intercellular bridge structure can be detected. Proliferative cells appeared with spindle shaped cells, nuclear mitotic figures and syncytial cells in the SCC group. The IVCM examination in the CIN group and SCC group showed that the cytoplasm was high and the ratio of nuclear plasma increased. There was no significant difference between the two groups in the size of epithelial cells, cytoplasm reflectivity, and nuclear cytoplasm ratio (P=0.053, 0.108, 0.067). The proportions of nuclear mitotic figures, spindle or chimeric cells, nests of whirlpool cells and the abnormal cells of the superficial stroma layer (8/8, 8/8, 8/8 and 8/8) in the SCC group was higher than those (2/15, 1/15, 4/15 and 0/15) in the CIN group, and the difference was statistically significant (P=0.001, 0.001, 0.003; P<0.001). Among these IVCM parameters, the abnormal cells of the superficial stroma layer had the highest diagnostic ability with the AUC value of 1.000, and the following AUC values were 0.933 for mitotic or double nuclei, 0.901 for spindle or chimeric cells, and 0.867 for the nests of whirlpool cells. Conclusions: The IVCM characteristics of OSSN are the dysplastic cells, hyper-reflective cytoplasm and increased nuclear plasma ratio in the corneal epithelium. Dysplastic cells appearing in the superficial stroma layer, nuclear mitotic figures and nests of vortex cells are the main IVCM parameters to support the malignant change of OSSN lesions. (Chin J Ophthalmol, 2018, 54: 652-660).

[Retinal image quality in northern rural Chinese adult population]

Objective: To assess the retinal image quality of the normal northern rural Chinese adult population. Methods: A normal population-based, cross-sectional study. From Oct, 2012 to Jan 2013, a clustered, random sampling procedure was used to select normal population who visual acuity≤ 0(LogMAR) and 30-69 years old from 2 villages. All eligible subjects were invited to undergo a comprehensive eye examination, and the retinal image quality related index were examined with pupil 4 mm using objective optical quality analysis systemⅡ(OQAS Ⅱ, Visiometrics, Spain), including MTFcutoff, VA20, VA9, PSF50, PSF10, OSI, SR. And describe the retinal image quality of different age group, including 30-39y, 40-49y, 50-59y, 60-69y. Results: Among 1 108 participants (61.9%) that completed examinations in our center, 681 participants (1 362 eyes) were recruited. There were 146, 586, 440 and 190 eyes in each group. The spherical equivalent refraction of each group was (-0.35±0.84), (-0.19±0.50), (-0.03±0.54) and (0.20±0.71) D. The best corrected vision acuity of each group was -0.02±0.04, -0.01±0.03, -0.01±0.02 and -0.00±0.01. The MTFcutoff of each group was (37.06±9.31), (36.69±8.93), (36.52±9.05) and (32.61±10.08) c/deg. Retinal imaging parameters were significantly different(MTFcutoff: MD=4.45, SR:MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, A9:MD=0.09, OSI:MD=-0.41, P<0.001)between aged 30-39 group and aged 60-69 group. Objective scattering index (OSI) were significantly different(MD=-0.13, P=0.004)between aged 30-39 group and aged 50-59 group. Retinal imaging parameters were significantly different(MTFcutoff:MD=4.45, SR:MD=0.03, PSF50:MD=-0.45, PSF10:MD=-2.87, VA20:MD=0.13, VA9: MD=0.09, OSI: MD=-0.41, P<0.001)between aged 40-49 group and aged 60-69 group. Retinal imageing parameters were significantly different(MTFcutoff: MD=4.45, SR: MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, VA9:MD=0.09, OSI:MD=-0.41,P<0.001)between aged 50-59 group and aged 60-69 group. Conclusion: Retinal image quality was gradually worse over time in the northern rural Chinese adult population. (Chin J Ophthalmol, 2018, 54:593-598).

Abstract P2-11-20: Tolerability and outcomes of radiation therapy for breast cancer in older women: A retrospective study in 817 patients

Background: Breast cancer (BC) management in older women requires an individual approach and is becoming increasingly topical given the aging population. Postoperative radiation therapy (RT) is a standard treatment of BC after breast-conserving-surgery in most patients but its relative benefit may be counteracted by potential side-effects, especially in elderly. The aim of this study was to assess acute and long-term radiation-induced toxicities and the impact of comorbidities on outcomes in the older women treated by RT for non-metastatic breast cancer.

Materials and Methods: Women aged ≥ 70 years at diagnosis, who received exclusive or postoperative RT for primary non-metastatic breast cancer, including carcinoma in situ, between 2003 and 2009 were retrieved from the Institut Curie registry. We calculated the Charlson Comorbidity Index (CCI) for each patient and collected the cardiovascular risk factors other than age (hypertension, dyslipidemia, smoking status). We analyzed overall survival (OS), progression free survival (PFS) and acute and late toxicities according to the CTCAE (Common Terminology Criteria for Adverse Events) v3.0.

Results: A total of 817 patients was included in this study. Median age at diagnosis was 76.6 years [70 – 93.3]. Most patients had HR+ (hormone-receptor positive) HER2- breast cancer (83.9 %). 517 patients (62.7%) had at least one cardiovascular risk factor. With a median follow-up of 6.7 years [0.5 - 13], OS at 5 years was 86.3% CI95%[83.8 - 88.8], and PFS was 84.5% CI95%[81.9 – 87.1]. OS at 5 years was statistically different according to the Charlson index: 90.2% CI95%[87.2 – 93.3] for a CCI of 0, 84.6 % CI95%[80.5 – 88.8] for a CCI of 1, and 78% CI95%[70.5 – 86.2] for a CCI ≥ 2 (p &lt; 0.001, log-rank test), respectively. Similar results were found for PFS (p &lt; 0.001, log-rank test). 22.6% of patients had no toxicity; of those who experienced toxicity, most was limited to grade I or II. Only five cases (0.6%) of radiation – induced pneumonitis were reported after a median time of 16.4 months (grade I, n = 1; grade II, n = 2). One case (0.1%) of myocardial ischemia was described 14.5 months after RT. Women older than 80 years were less likely to have acute dermatitis (OR = 0.62; CI95%[0.45 - 0.85]), long-term breast pain (OR = 0.31; CI95%[0.14 - 0.62]), and long-term breast deformation (OR = 0.63; CI95%[0.42 - 0.93]) compared to patients younger than 80 years. There was no significant association found between other cardiovascular risk factors and toxicities.

Conclusion: Radiation therapy for breast cancer in the older women is well-tolerated. An extended follow-up is planned in order to assess toxicities at a longer time horizon. Further studies could be envisaged to assess the quality-of-life during and after RT for breast cancer in the older patient population.

Citation Format: Cao KI, Salviat F, Fourquet A, Falcou M-C, Laki F, Beuzeboc P, Savignoni A, Bazire L, Poortmans P, Kirova YM. Tolerability and outcomes of radiation therapy for breast cancer in older women: A retrospective study in 817 patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-20.

[Application of decision curve on evaluation of MRI predictive model for early assessing pathological complete response to neoadjuvant therapy in breast cancer]

Objective: To construct a dynamic enhanced MR based predictive model for early assessing pathological complete response (pCR) to neoadjuvant therapy in breast cancer, and to evaluate the clinical benefit of the model by using decision curve. Methods: From December 2005 to December 2007, 170 patients with breast cancer treated with neoadjuvant therapy were identified and their MR images before neoadjuvant therapy and at the end of the first cycle of neoadjuvant therapy were collected. Logistic regression model was used to detect independent factors for predicting pCR and construct the predictive model accordingly, then receiver operating characteristic (ROC) curve and decision curve were used to evaluate the predictive model. Results: ΔArea(max) and Δslope(max) were independent predictive factors for pCR, OR=0.942 (95%CI: 0.918-0.967) and 0.961 (95%CI: 0.940-0.987), respectively. The area under ROC curve (AUC) for the constructed model was 0.886 (95%CI: 0.820-0.951). Decision curve showed that in the range of the threshold probability above 0.4, the predictive model presented increased net benefit as the threshold probability increased. Conclusions: The constructed predictive model for pCR is of potential clinical value, with an AUC>0.85. Meanwhile, decision curve analysis indicates the constructed predictive model has net benefit from 3 to 8 percent in the likely range of probability threshold from 80% to 90%.

High Expression of Nuclear Factor of Activated T Cells in Chinese Primary Non-Small Cell Lung Cancer Tissues

Purpose

Nuclear factor of activated T cells (NFAT) has been reported to be involved in the development of various types of cancer including adenocarcinoma of the breast. This research was the first to investigate NFAT protein expression in primary non-small cell lung cancer (NSCLC) tissues from Chinese patients.

Methods

NFAT protein expression was determined in 130 surgically resected primary NSCLC and matched normal tissues by immunohistochemical analysis. The association between NFAT expression and clinical categorical variables was further analyzed with the SPSS software.

Results

We found that NFAT expression was much higher in 85 tumor tissues (65.4%) and lower in 45 tumor tissues (34.6%) compared with the matched normal tissues. Further statistical analysis by the chi-square test showed that high expression of NFAT proteins was significantly associated with tumor differentiation (p=0.045), invasion (p=0.031), histology (p<0.0001), tumor size (p=0.038) and cigarette smoking history (p=0.024). However, there was no correlation between the expression of NFAT proteins and pTNM classification, and no difference in 5-year survival rate between patients with high or low expression of NFAT proteins. Multivariate logistic regression analysis for the correlation between NFAT protein expression levels and various characteristics showed a significant association with histology (p=0.008, OR=0.273).

Conclusion

Our results revealed that high NFAT expression was present in Chinese NSCLCs and that NFAT expression might be involved in the process of human lung cancer development.

[Malignant solitary fibrous tumor of the lung metastatic to the thyroid gland:a case report]

Solitary fibrous tumors(SFT) of the thyroid gland are rarely reported，especially metastases from a malignant solitary fibrous tumor(MSFT) of lung. We herein present a 35 year old man with history of SFT of lung and a 6 month history of rapidly enlarging thyroid masses. The CT showed masses in the left thyroid lobe. We performed thyroid lobectomy plus central compartment neck dissection. Immunohistochemically,Bcl2,Vim and CD99 were positive,while CK,CD34,EMA,TG,P53 and S100 were negative. Combined with patient medical history and pathological diagnosis,it confirmed that MSFT of the lung metastatic to the thyroid gland. within a period of 7 months of follow up,no reoccurrence was found so far.

Computational comparison of regional stress and deformation characteristics in tricuspid and bicuspid aortic valve leaflets

The bicuspid aortic valve (BAV) is the most common congenital valvular defect and a major risk factor for secondary calcific aortic valve disease. While hemodynamics is presumed to be a potential contributor to this complication, the validation of this theory has been hampered by the limited knowledge of the mechanical stress abnormalities experienced by BAV leaflets and their dependence on the heterogeneous BAV fusion patterns. The objective of this study was to compare computationally the regional and temporal fluid wall shear stress (WSS) and structural deformation characteristics in tricuspid aortic valve (TAV), type-0, and type-I BAV leaflets. Arbitrary Lagrangian-Eulerian fluid-structure interaction models were designed to simulate the flow and leaflet dynamics in idealized TAV, type-0, and type-I BAV geometries subjected to physiologic transvalvular pressure. The regional leaflet mechanics was quantified in terms of temporal shear magnitude (TSM), oscillatory shear index (OSI), temporal shear gradient (TSG), and stretch. The simulations identified regions of WSS overloads and increased WSS bidirectionality (174% increase in temporal shear magnitude, 0.10 increase in OSI on type-0 leaflets) in BAV leaflets relative to TAV leaflets. BAV leaflets also experienced larger radial deformations than TAV leaflets (4% increase in type-0 BAV leaflets). Type-I BAV leaflets exhibited contrasted WSS environments marked by WSS overloads on the non-coronary leaflet and sub-physiologic WSS levels on the fused leaflet. This study provides important insights into the mechanical characteristics of BAV leaflets, which may further our understanding of the role played by hemodynamic forces in BAV disease. Copyright © 2016 John Wiley & Sons, Ltd.

Influence of cognitive function on cerebrovascular disease among the elderly

OBJECTIVES

To determine the interrelationships between baseline Mini-Mental State Examination (MMSE) score and overall long-term risk of cerebrovascular disease (CBVD).

MATERIALS & METHODS

This was a prospective cohort study of subjects aged 55 years or more who were enrolled in the Beijing Longitudinal Study of Aging (BLSA) and had a baseline MMSE score available. Baseline MMSE score was divided into four categories: ≥28, 26-27, 23-25, and ≤22. Participants were followed for 23 years. Cox regression models were used to examine the association between MMSE score and CBVD.

RESULTS

A total of 2101 participants were included in this analysis, 335 (15.9%) with an MMSE score ≥28, 365 (17.4%) with a score of 26-27, 579 (27.6%) with a score of 23-25, and 822 (7.4%) with a score ≤22. There were 576 cases of CBVD. The overall risk of CBVD increased with decreasing MMSE score. The impact of MMSE score on the risk of CBVD was much stronger in women than in men. The hazard ratio for CBVD risk was 1.76 (95% confidence interval [CI], 1.29-2.39, P < 0.05) for subjects with an MMSE score ≤22, and 1.21 (95% CI, 0.91-1.61, P < 0.05) for those with an MMSE score of 23-25. Higher MMSE scores were less strongly associated with the risk of CBVD.

CONCLUSIONS

Elderly people with lower MMSE scores, especially women, are at higher long-term risk of CBVD.

[The questionnaire survey on glaucoma diagnosis and treatment in China (2016)]

Objective: To investigate the present situation of diagnosis and treatment for primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) and awareness of the relevant progress among Chinese ophthalmologists. Methods: This study was a cross-sectional, non-randomized sampling survey. Participants were ophthalmologists who attended the 11st Chinese Glaucoma Society Congress during November 11 to 12, 2016. They were invited to fill out a questionnaire. The questionnaire included participants' basic information and their knowledge about glaucoma diagnosis and treatment. The data collected through questionnaire were analyzed with SAS9.4. Results: A total of 450 questionnaires were distributed and 372 valid questionnaires were retrieved, with a response rate of 82. 7%(372/450). ISGEO classification system was adopted by 58.9% (219/372) of the participants as the diagnostic criteria for PACG. Of the respondents, 48.1% (179/372) of the participants believed that "anterior chamber angle closure mechanism-based PACG classification system" was more instructive for treatment, the percentage was higher than ISGEO classification system (42.2%, 157/372). Most (72.3%, 269/372) of the participants knew the 3-minute dark room prone test, but only 27.7%(103/372) of them applied it in clinical practice. A total of 83.4%(310/372) of the participants believed that low cerebrospinal fluid pressure is a risk factor for POAG. In all, 71.8% (267/372) of the participants reported that their institutes had applied compound trabeculectomy with adjustable suture, with 76.9%(286/372) of the participants agreeing that the adjustable suture reduced the rate of complications after trabeculectomy. Conclusions: Currently, both ISGEO classification system and anterior chamber angle closure mechanism-based PACG classification system were adopted in the diagnosis and treatment of glaucoma. Low cerebrospinal fluid pressure as new risk factors for POAG has been widely acknowledged and given attentions by Chinese ophthalmologists. The 3-minute darkroom prone test and compound trabeculectomy with adjustable suture still need to be promoted. (Chin J Ophthalmol, 2017, 53: 115-120).

Posttraumatic administration of a sub-anesthetic dose of ketamine exerts neuroprotection via attenuating inflammation and autophagy

As a complex disease, traumatic brain injury (TBI) can result in long-term psychiatric changes and sensorimotor and cognitive impairments. The TBI-induced loss of memory and long-term cognitive dysfunction are related to mechanistic factors including an increased inflammatory response, autophagy, edema, and ischemia. Many published studies have offered evidence for the neuroprotective effects and anti-inflammatory properties of ketamine for TBI patients. Nonetheless, there is a limited understanding of the accurate mechanism that underlies the potential neuroprotective effects of ketamine. Herein, it can be shown that posttraumatic administration of ketamine at a sub-anesthetic dose (10mg/kg ketamine, every 24h up to 7days) can prevent the TBI-induced production of IL-6 and TNF-α, attenuate deficits of dendrites and spines and exert beneficial effects on memory and behavior. Moreover, studies show that ketamine may activate the mTOR signaling pathway by p-mTOR induction to down-regulate the expression of crucial autophagic proteins such as LC3 and Beclin-1. According to these findings, ameliorating secondary brain injury and anti-inflammatory properties is closely related to the neuroprotection of ketamine, which supports the use of ketamine as a potential therapy for patients with TBI to alleviate functional deficits.

Aortic valve leaflet wall shear stress characterization revisited: impact of coronary flow

Computational characterizations of aortic valve hemodynamics have typically discarded the effects of coronary flow. The objective of this study was to complement our previous fluid-structure interaction aortic valve model with a physiologic coronary circulation model to quantify the impact of coronary flow on aortic sinus hemodynamics and leaflet wall shear stress (WSS). Coronary flow suppressed vortex development in the two coronary sinuses and altered WSS magnitude and directionality on the three leaflets, with the most substantial differences occurring in the belly and tip regions.

Three-dimensional macro-scale assessment of regional and temporal wall shear stress characteristics on aortic valve leaflets

The aortic valve (AV) achieves unidirectional blood flow between the left ventricle and the aorta. Although hemodynamic stresses have been shown to regulate valvular biology, the native wall shear stress (WSS) experienced by AV leaflets remains largely unknown. The objective of this study was to quantify computationally the macro-scale leaflet WSS environment using fluid-structure interaction modeling. An arbitrary Lagrangian-Eulerian approach was implemented to predict valvular flow and leaflet dynamics in a three-dimensional AV geometry subjected to physiologic transvalvular pressure. Local WSS characteristics were quantified in terms of temporal shear magnitude (TSM), oscillatory shear index (OSI) and temporal shear gradient (TSG). The dominant radial WSS predicted on the leaflets exhibited high amplitude and unidirectionality on the ventricularis (TSM>7.50 dyn/cm(2), OSI < 0.17, TSG>325.54 dyn/cm(2) s) but low amplitude and bidirectionality on the fibrosa (TSM < 2.73 dyn/cm(2), OSI>0.38, TSG < 191.17 dyn/cm(2) s). The radial WSS component computed in the leaflet base, belly and tip demonstrated strong regional variability (ventricularis TSM: 7.50-22.32 dyn/cm(2), fibrosa TSM: 1.26-2.73 dyn/cm(2)). While the circumferential WSS exhibited similar spatially dependent magnitude (ventricularis TSM: 1.41-3.40 dyn/cm(2), fibrosa TSM: 0.42-0.76 dyn/cm(2)) and side-specific amplitude (ventricularis TSG: 101.73-184.43 dyn/cm(2) s, fibrosa TSG: 41.92-54.10 dyn/cm(2) s), its temporal variations were consistently bidirectional (OSI>0.25). This study provides new insights into the role played by leaflet-blood flow interactions in valvular function and critical hemodynamic stress data for the assessment of the hemodynamic theory of AV disease.

Completion sequence and cloning of the infectious cDNA of a chb isolate of cucumber green mottle mosaic virus

Cucumber green mottle mosaic virus (CGMMV) is an important and widespread seed-borne virus that infects Cucurbitaceous plants. It is a member of the genus Tobamovirus in the family Virgaviridae with a monopartite (+) ssRNA genome. Here we report the complete genome sequence, construction and testing of the infectious clones of a chb isolate of CGMMV. Full-length CGMMV cDNA was cloned into the vector pUC19. The linearized vector containing full-length cDNA was used as template for in vitro transcription, and the synthesized capped transcript was highly infectious in Chenopodium amaranticolor and cucumber (Cucumis sativus). Inoculated plants showed symptoms typical of CGMMV infection. The infectivity was confirmed by mechanical transmission to new plants, RT-PCR and western blot. Progeny virus derived from infectious transcripts had the same biological and biochemical properties as wild-type virus. To our knowledge, this is the first detailed report of a biologically active transcript from CGMMV.

Evaluating local lymph node metastasis with magnetic resonance imaging, endoluminal ultrasound and computed tomography in rectal cancer: a meta-analysis

AIM

Magnetic resonance imaging (MRI), endorectal ultrasound (EUS) and computed tomography (CT) are commonly used to evaluate lymph node (LN) metastasis for rectal cancer, but there is no agreement on which form of imaging is most accurate. The study aimed to review systematically the diagnostic performance of the three imaging modalities.

METHOD

The PubMed, Cochrane Library and EMBASE databases were systematically searched for English and Chinese language studies evaluating the diagnostic accuracy of MRI, EUS and/or CT for evaluating LN metastasis. Papers published before 31 December 2013 were included in the search. Subject-level data were included. Diagnostic odds ratios were calculated for each modality and summary receiver operating characteristic curves were constructed using hierarchical regression models. The performance of the three modalities was compared.

RESULTS

The analysis included data from 123 studies evaluating LN metastasis. The sensitivity and specificity in patients having no chemoradiotherapy were 0.77 and 0.76 for MRI, 0.57 and 0.80 for EUS and 0.79 and 0.76 for CT. The three modalities showed similar accuracy (P = 0.39). MRI showed higher accuracy than EUS for patients who received neoadjuvant therapy (P = 0.04). MRI at a field strength > 1.5 T yielded better performance than EUS (P = 0.03) and similar performance to CT (P = 0.17). High resolution MRI showed similar diagnostic accuracy to EUS (P = 0.18) and CT (P = 0.16).

CONCLUSION

MRI, EUS and CT show similar accuracy but none could provide reliable evaluation for LN metastasis. MRI rather than EUS is recommended for LN evaluation after neoadjuvant therapy. MRI at a field strength of 3.0 T is the recommended method for MRI examination. But high resolution MRI does not improve the diagnostic performance in evaluating LN metastasis.