FSEM: Functional Structural Equation Models for Twin Functional Data

The aim of this paper is to develop a novel class of functional structural equation models (FSEMs) for dissecting functional genetic and environmental effects on twin functional data, while characterizing the varying association between functional data and covariates of interest. We propose a three-stage estimation procedure to estimate varying coefficient functions for various covariates (e.g., gender) as well as three covariance operators for the genetic and environmental effects. We develop an inference procedure based on weighted likelihood ratio statistics to test the genetic/environmental effect at either a fixed location or a compact region. We also systematically carry out the theoretical analysis of the estimated varying functions, the weighted likelihood ratio statistics, and the estimated covariance operators. We conduct extensive Monte Carlo simulations to examine the finite-sample performance of the estimation and inference procedures. We apply the proposed FSEM to quantify the degree of genetic and environmental effects on twin white-matter tracts obtained from the UNC early brain development study.

Detection of Babesia spp., Theileria spp. and Anaplasma ovis in Border Regions, northwestern China

Babesia spp., Theileria spp. and Anaplasma ovis are important intracellular agents that are transmitted by tick bites. However, Babesia spp., Theileria spp. and A. ovis in ticks have not been systematically reported along the border of northwestern China. In this study, a total of 1,084 adult ticks, including 134 Haemaphysalis punctata, 337 Hyalomma asiaticum, 233 Dermacentor nuttalli, 69 Rhipicephalus turanicus and 265 Dermacentor marginatus were collected from 11 counties or cities of Xinjiang Uygur Autonomous Region. The ticks were identified from morphological and molecular characteristics. Two fragments of 18S rRNA gene were used to determine the species level of Babesia and Theileria. Msp4 gene encoding major surface protein 4 was used to determine A. ovis. Of the 1,084 samples, five species of Babesia (B. occultans, B. caballi, B. motasi, B. major and Babesia sp. detected in this study), two kinds of Theileria (Theileria ovis and Theileria sp. detected in this study) and A. ovis with six phylogenic branches were detected in the border of northwestern China. Babesia occultans, first found in China, was first molecularly detected in D. nuttalli. Babesia caballi and Babesia sp. detected in this study were first molecularly detected in Hy. asiaticum. Genotype III of A. ovis was predominant in the border regions of northwestern China.

A reactive oxygen species activation mechanism contributes to Sophoridine-induced apoptosis in rat liver BRL-3A cells

ETHNOPHARMACOLOGICAL RELEVANCE

Sophora alopecuroides L., a traditional Chinese herb, has been widely used to treat numerous diseases throughout China. Quinolizidine alkaloids were identified as active components in Sophora alopecuroides L., and Sophoridine (SRI) is the major component in the Quinolizidine alkaloids.

AIM OF THE STUDY

To investigate the toxic effects of SRI in rat liver BRL-3A cells and to explore potential ROS-related mechanisms.

MATERIALS AND METHODS

Cell viability, cytotoxicity, apoptosis, intracellular generation of ROS, GSH/GSSG ratio and levels of proteins in mitochondria apoptosis pathway were analyzed.

RESULTS

Our data indicated that SRI could suppress BRL-3A cells viability in a concentration- and time-dependent manner and increase cytotoxicity, ROS accumulation and cell apoptosis in a concentration-dependent manner. Expressions and activities of apoptotic related proteins were upregulated, whereas expression of Bcl-2 was downregulated after treatment. Furthermore, level of H₂O₂ was increased, whereas level of Superoxide was not changed after treatment. Moreover, the antioxidant N-acetylcysteine reversed SRI-induced apoptosis and ROS accumulation.

CONCLUSION

Our data suggest that SRI promotes rat liver BRL-3A cells apoptosis by increasing intracellular ROS accumulation.

The differential impact of natural killer (NK) cell education via KIR2DL3 and KIR3DL1 on CCL4 secretion in the context of in-vitro HIV infection

Carriage of certain inhibitory natural killer (NK) cell receptor (iNKR)/HLA ligand pairs is associated with protection from infection and slow time to AIDS implicating NK cells in HIV control. NK cells acquire functional potential through education, which requires the engagement of iNKRs by their human leucocyte antigen (HLA) ligands. HIV infection down-regulates cell surface HLA-A/B, but not HLA-C/E. We investigated how NK cell populations expressing combinations of the iNKRs NKG2A, KIR2DL3 (2DL3) and KIR3DL1 (3DL1) responded to autologous HIV infected CD4 (iCD4) cells. Purified NK cells from HIV-uninfected individuals were stimulated with autologous HIV iCD4 or uninfected CD4 T cells. Using flow cytometry we gated on each of the 8 NKG2A^+/- 2DL3^+/- 3DL1^+/- populations and analysed all possible combinations of interferon (IFN)-γ, CCL4 and CD107a functional subsets responding to iCD4 cells. Infected CD4 cells induced differential frequencies of NKG2A^+/- 2DL3^+/- 3DL1^+/- populations with total IFN-γ⁺ , CCL4⁺ and CD107a⁺ functional profiles. 2DL3⁺ NKG2A⁺ NK cells had a higher frequency of responses to iCD4 than other populations studied. A higher frequency of 2DL3⁺ NK cells responded to iCD4 from individuals that were not HLA-C1 homozygotes. These results show that 2DL3⁺ NK cells are mediators of HIV-specific responses. Furthermore, responses of NK cell populations to iCD4 are influenced not only by NK cell education through specific KIR/HLA pairs, but also by differential HIV-mediated changes in HLA expression.

Anti-HIV Activities of Anionic Metalloporphyrins and Related Compounds

Various water-soluble polysulphonated and polycarboxylated porphyrins and some of their metallated derivatives have been prepared and their antiviral properties against human immunodeficiency virus (HIV-1, HIV-2), simian immunodeficiency virus and other viruses are reported. Besides these polyanionic compounds, two new series of porphyrins were included and studied from the perspective of bio-availability modulation: (i) acefylsulphonamido derivatives endowed with weak acidity properties (deprotonation gives the corresponding anionic derivatives in a pH range 4.5-8.5) and (ii) compounds with the anionic charge transiently masked by esterification (acetoxymethyl- and pivaloyloxymethylesters). Among the more active compounds in inhibiting HIV-induced cytopathic effects, the sulphonated and carboxylated porphyrin complexes were found to interact directly with the HIV protein gp 120 and not with the CD4 cellular receptor.

Identification and comparative proteomic study of quail and duck egg white protein using 2-dimensional gel electrophoresis and matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry analysis

A proteomic study of egg white proteins from 2 major poultry species, namely quail (Coturnix coturnix) and duck (Anas platyrhynchos), was performed with comparison to those of chicken (Gallus gallus) through 2-dimensional polyacrylamide gel electrophoresis (2-DE) analysis. By using matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry (MALDI-TOF MS/MS), 29 protein spots representing 10 different kinds of proteins as well as 17 protein spots designating 9 proteins were successfully identified in quail and duck egg white, respectively. This report suggested a closer relationship between quail and chicken egg white proteome patterns, whereas the duck egg white protein distribution on the 2-DE map was more distinct. In duck egg white, some well-known major proteins, such as ovomucoid, clusterin, extracellular fatty acid-binding protein precursor (ex-FABP), and prostaglandin D2 synthase (PG D2 synthase), were not detected, while two major protein spots identified as “deleted in malignant brain tumors 1” protein (DMBT1) and vitellogenin-2 were found specific to duck in the corresponding range on the 2-DE gel map. These interspecies diversities may be associated with the egg white protein functions in cell defense or regulating/supporting the embryonic development to adapt to the inhabiting environment or reproduction demand during long-term evolution. The findings of this work will give insight into the advantages involved in the application on egg white proteins from various egg sources, which may present novel beneficial properties in the food industry or related to human health.

Contribution of enhanced engagement of antigen presentation machinery to the clinical immunogenicity of a human interleukin (IL)-21 receptor-blocking therapeutic antibody

Reliable risk assessment for biotherapeutics requires accurate evaluation of risk factors associated with immunogenicity. Immunogenicity risk assessment tools were developed and applied to investigate the immunogenicity of a fully human therapeutic monoclonal antibody, ATR-107 [anti-interleukin (IL)-21 receptor] that elicited anti-drug antibodies (ADA) in 76% of healthy subjects in a Phase 1 study. Because the ATR-107 target is expressed on dendritic cells (DCs), the immunogenicity risk related to engagement with DC and antigen presentation pathways was studied. Despite the presence of IL-21R on DCs, ATR-107 did not bind to the DCs more extensively than the control therapeutic antibody (PF-1) that had elicited low clinical ADA incidence. However, ATR-107, but not the control therapeutic antibody, was translocated to the DC late endosomes, co-localized with intracellular antigen-D related (HLA-DR) molecules and presented a dominant T cell epitope overlapping the complementarity determining region 2 (CDR2) of the light chain. ATR-107 induced increased DC activation exemplified by up-regulation of DC surface expression of CD86, CD274 (PD-L1) and CD40, increased expansion of activated DC populations expressing CD86(hi), CD40(hi), CD83(hi), programmed death ligand 1 (PD-L1)(hi), HLA-DR(hi) or CCR7(hi), as well as elevated secretion of tumour necrosis factor (TNF)-α by DCs. DCs exposed to ATR-107 stimulated an autologous T cell proliferative response in human donor cells, in concert with the detection of immunoglobulin (Ig)G-type anti-ATR-107 antibody response in clinical samples. Collectively, the enhanced engagement of antigen presentation machinery by ATR-107 was suggested. The approaches and findings described in this study may be relevant to identifying lower immunogenicity risk targets and therapeutic molecules.

Treatment for LTBI in contacts of MDR-TB patients, Federated States of Micronesia, 2009-2012

SETTING

Few studies have shown the operational feasibility, safety, tolerability, or outcomes of multidrug-resistant latent tuberculous infection (MDR LTBI) treatment. After two simultaneous multidrug-resistant tuberculosis (MDR-TB) outbreaks in Chuuk, Federated States of Micronesia, infected contacts were offered a 12-month fluoroquinolone (FQ) based MDR LTBI treatment regimen.

DESIGN

Between January 2009 and February 2012, 119 contacts of MDR-TB patients were followed using a prospective observational study design. After MDR-TB disease was excluded, 12 months of daily FQ-based preventive treatment of MDR LTBI was provided by directly observed therapy.

RESULTS

Among the 119 infected contacts, 15 refused, while 104 began treatment for MDR LTBI. Of the 104 who initiated treatment, 93 (89%) completed treatment, while 4 contacts discontinued due to adverse effects. None of the 104 contacts who undertook MDR LTBI treatment of any duration developed MDR-TB disease; however, 3 of 15 contacts who refused and 15 unidentified contacts developed MDR-TB disease.

CONCLUSION

Providing treatment for MDR LTBI can be accomplished in a resource-limited setting, and contributed to preventing MDR-TB disease. The Chuuk TB program implemented treatment of MDR LTBI with an 89% completion rate. The MDR LTBI regimens were safe and well tolerated, and no TB cases occurred among persons treated for MDR LTBI.

Doubly Robust Learning for Estimating Individualized Treatment with Censored Data

Individualized treatment rules recommend treatments based on individual patient characteristics in order to maximize clinical benefit. When the clinical outcome of interest is survival time, estimation is often complicated by censoring. We develop nonparametric methods for estimating an optimal individualized treatment rule in the presence of censored data. To adjust for censoring, we propose a doubly robust estimator which requires correct specification of either the censoring model or survival model, but not both; the method is shown to be Fisher consistent when either model is correct. Furthermore, we establish the convergence rate of the expected survival under the estimated optimal individualized treatment rule to the expected survival under the optimal individualized treatment rule. We illustrate the proposed methods using simulation study and data from a Phase III clinical trial on non-small cell lung cancer.

Penalized Q-Learning for Dynamic Treatment Regimens

A dynamic treatment regimen incorporates both accrued information and long-term effects of treatment from specially designed clinical trials. As these trials become more and more popular in conjunction with longitudinal data from clinical studies, the development of statistical inference for optimal dynamic treatment regimens is a high priority. In this paper, we propose a new machine learning framework called penalized Q-learning, under which valid statistical inference is established. We also propose a new statistical procedure: individual selection and corresponding methods for incorporating individual selection within penalized Q-learning. Extensive numerical studies are presented which compare the proposed methods with existing methods, under a variety of scenarios, and demonstrate that the proposed approach is both inferentially and computationally superior. It is illustrated with a depression clinical trial study.

The use of electrical cardiometry for continuous cardiac output monitoring in preterm neonates: a validation study

BACKGROUND

Electrical cardiometry (EC) is a continuous noninvasive method for measuring cardiac output (CO), but there are limited data on premature infants. We evaluated the utility of EC monitoring by comparing the results obtained using EC to measurements of CO and systemic blood flow using echocardiography (ECHO).

METHODS

In this prospective observational study, 40 preterm neonates underwent 108-paired EC and ECHO measurements.

RESULTS

There were correlations between EC-CO and left ventricular output (LVO, p < 0.005) and right ventricular output (RVO, p < 0.005) but not with superior vena cava (r = 0.093, p = 0.177). Both RVO and LVO correlated with EC with and without a hemodynamically significant ductus arteriosus (p = 0.001 and 0.008, respectively). The level of agreement was decreased in infants ventilated by high-frequency oscillation ventilators (HFOV). The bias in HFOV was also positive compared with the negative biases found in other modes of ventilation.

CONCLUSION

Given the correlation of EC with LVO, RVO, and lack of confounding effects of the ductus, our results suggest that EC has promise for trending CO in the preterm infant. However, given the limitations with mode of ventilation and the lack of correlation at low LVO values, further study is needed before this technology can be for routine use.

Evaluation of SWI in children with sickle cell disease

BACKGROUND AND PURPOSE

SWI is a powerful tool for imaging of the cerebral venous system. The SWI venous contrast is affected by blood flow, which may be altered in sickle cell disease. In this study, we characterized SWI venous contrast in patients with sickle cell disease and healthy control participants and examined the relationships among SWI venous contrast, and hematologic variables in the group with sickle cell disease.

MATERIALS AND METHODS

A retrospective review of MR imaging and hematologic variables from 21 patients with sickle cell disease and age- and sex-matched healthy control participants was performed. A Frangi vesselness filter was used to quantify the attenuation of visible veins from the SWI. The normalized visible venous volume was calculated for quantitative analysis of venous vessel conspicuity.

RESULTS

The normalized visible venous volume was significantly lower in the group with sickle cell disease vs the control group (P < .001). Normalized visible venous volume was not associated with hemoglobin, percent hemoglobin F, percent hemoglobin S, absolute reticulocyte count, or white blood cell count. A hypointense arterial signal on SWI was observed in 18 of the 21 patients with sickle cell disease and none of the 21 healthy control participants.

CONCLUSIONS

This study demonstrates the variable and significantly lower normalized visible venous volume in patients with sickle cell disease compared with healthy control participants. Decreased venous contrast in sickle cell disease may reflect abnormal cerebral blood flow, volume, velocity, or oxygenation. Quantitative analysis of SWI contrast may be useful for investigation of cerebrovascular pathology in patients with sickle cell disease, and as a tool to monitor therapies. However, future studies are needed to elucidate physiologic mechanisms of decreased venous conspicuity in sickle cell disease.

Effects of feeding diets containing highly peroxidized distillers dried grains with solubles and increasing vitamin E levels to wean-finish pigs on growth performance, carcass characteristics, and pork fat composition

Lipid peroxidation in animal feed can negatively affect growth performance and meat quality. Weanling pigs (n = 432; BW = 6.6 ± 0.4 kg) were used to evaluate the effects of feeding peroxidized distillers dried grains with solubles (DDGS) with 3 levels of vitamin E (α-tocopheryl acetate) on growth performance, carcass composition, fatty acid composition of pork fat, and lipid peroxidation in LM. The DDGS source used in this study contained the highest thiobarbituric acid reactive substances (TBARS) value, peroxide value, and total S content (5.2 ng malondialdehyde/mg oil, 84.1 mEq/kg oil, and 0.95%, respectively) among 30 DDGS sources sampled. Pens within blocks were assigned randomly to 1 of 6 diets in a 2 × 3 factorial arrangement of treatments with 8 pens per treatment and 9 pigs per pen. Pigs were fed a corn-soybean meal (CON) or 30% peroxidized DDGS (Ox-DDGS) diets with 3 levels of vitamin E: none supplemented (No-E), NRC (1X-E), or 10X NRC (10X-E). Compared to CON, inclusion of 30% Ox-DDGS in diets reduced (P < 0.001) final BW (110 vs. 107 kg), overall ADG (0.76 vs. 0.74 kg/d), and G:F (0.39 vs. 0.37). Increasing dietary vitamin E concentrations improved G:F (P = 0.03) of pigs fed 10X-E and 1X-E vs. No-E diets (0.39 and 0.39 vs. 0.38, respectively). Hot carcass weight, dressing percentage, backfat depth, and LM area were reduced (P < 0.01) in pigs fed Ox-DDGS compared to CON, but percentage of fat-free carcass lean was not affected. Feeding Ox-DDGS increased (P < 0.001) PUFA concentration, particularly linoleic acid (P < 0.001), and iodine value (P < 0.001) in belly fat and backfat compared to pigs fed CON. Dietary vitamin E levels did not affect fatty acid profiles in belly or back fat. Loin muscle TBARS were measured to determine the lipid peroxidation level in pork loins. Although pigs were fed a Ox-DDGS source in this study, TBARS in LM were similar between Ox-DDGS and CON treatments. There was no interaction between Ox-DDGS and dietary vitamin E concentration in LM TBARS. Alpha-tocopherol concentration in LM was greater (P < 0.001) in 10X-E than No-E or 1X-E dietary treatments. Compared to CON, feeding Ox-DDGS increased α-tocopherol concentration in LM of pigs fed No-E (1.0 vs. 3.1 mg/kg; P = 0.005) but not in those fed 1X-E or 10X-E. These results indicate that feeding diets containing 30% Ox-DDGS to wean-finish pigs may negatively affect growth performance, but supplementation of additional vitamin E in the diet did not counteract these effects.

Evaluation of lipid peroxidation level in corn dried distillers grains with solubles

Lipid peroxidation in feed can negatively affect animal health, growth performance, and meat quality. The objective of this study was to determine the lipid peroxidation level in corn dried distillers grains with solubles (DDGS) samples from 31 U.S. ethanol plants and compare results with a corn sample obtained from a corn processing plant. Lipids from each sample were extracted with hexane and analyzed for peroxide value (PV) and thiobarbituric acid reactive substances (TBARS). Peroxide values of DDGS samples ranged from 4.2 to 84.1 milliequivalents (meq)/kg oil (CV = 97.5%). The greatest PV among DDGS samples was 27 times greater than that of the corn sample (3.1 meq/kg oil). The TBARS values for DDGS samples ranged from 1.0 to 5.2 ng malondialdehyde (MDA) equivalents/mg oil (CV = 43.6%). The DDGS sample with the greatest TBARS value was 25 times greater than that of the corn sample (0.2 ng MDA equivalents/mg oil). Color of DDGS samples was measured by Minolta L*, a*, and b*, corresponding to the degree of lightness, redness, and yellowness, respectively. Correlations between PV, TBARS, and color were determined. Values of PV and TBARS were correlated positively (r = 0.81; P < 0.001). Both TBARS and PV were correlated negatively with L* (r = -0.73; P < 0.001, and r = -0.63; P < 0.001, respectively) and b* (r = -0.67; P < 0.001, and r = -0.57; P < 0.001, respectively), which suggests that darker and less yellow-colored DDGS samples were more likely to have a greater lipid peroxidation level, as measured by TBARS and PV, compared with lighter or more yellow-colored DDGS samples. However, a* was not correlated with either PV (P = 0.97) or TBARS (P = 0.66). These results indicate that color can be a preliminary indicator of lipid peroxidation level in DDGS, but a more reliable assessment of peroxidation level is achieved by measuring PV and TBARS.

The expression of Sirtuins 1 and 4 in peripheral blood leukocytes from patients with type 2 diabetes

This study was designed to investigate the relationship between SIRTs 1 and 4 in peripheral blood leukocytes (PBLs) and human type 2 diabetes mellitus (T2DM). SIRTs 1 and 4 have been confirmed to be associated with homeostasis of glucose/lipid metabolism, but their roles in T2DM are still poorly understood. Peripheral blood and biochemical data were collected from 52 healthy individuals (normal control group, NC group) and 113 cases of T2DM patients. Immunocytochemical staining was used to detect SIRT1 and SIRT4 and reverse transcription polymerase chain reaction (RT-PCR) was used to detect SIRT1 or SIRT4 mRNA levels in PBLs. Immunocytochemical staining showed that SIRT1 is expressed in both nucleus and cytoplasm, and SIRT4 in the cytoplasm of granulocytes and monocytes. No SIRT1 or SIRT4 was found in lymphocytes. RT-PCR showed that SIRT1 and SIRT4 mRNA levels in T2DM group were lower than those in NC group (P&lt;0.01). Correlation analysis showed that there is a negative correlation between SIRTs 1 and 4 and fasting plasma glucose (FPG) (P&lt;0.05) (r= -0.161 and -0.156), a positive correlation between SIRT4 mRNA levels and triglyceride (TG)/lipoprotein a (LPa) levels (P&lt;0.05), and a negative correlation between SIRT4 mRNA levels and high density lipoprotein cholesterol (HDL) (P&lt;0.05). SIRTs 1 and 4 may have a role in the pathogenesis of T2DM and their expression in granulocytes and monocytes may indirectly reflect the homeostasis of glucose/lipid metabolism in T2DM.

Effects of feeding diets containing bacitracin methylene disalicylate to heat-stressed finishing pigs

The objective of this study was to evaluate the effects of heat stress and dietary bacitracin methylene disalicylate (BMD) on growth performance, carcass characteristics, and immunological responses in finishing pigs. Four groups of 32 finishing pigs (n = 128) with initial BW between 80 to 90 kg were used. Pigs were fed a corn-soybean meal-distillers grains-based control or BMD (31.5 mg/kg) diet for a 14-d adaptation period at the thermal neutral temperature (23°C), and continued to be fed their respective diets when exposed to a constant temperature (23°C) or a cyclical heat stress environment (37°C from 1000 to 1900 h and 27°C from 1900 to 1000 h) for a 28-d experimental period. Each group of pigs was housed in 4 rooms, with 2 pens/room and 4 pigs/pen. Saliva samples from each pig were collected on d -1 (initial baseline), 1, 13, and 27 for cortisol analysis. Concentrations of haptoglobin, IL-1β, and tumor necrosis factor-α were determined in serum samples on d -1, 1, 13, and 27. Pigs exposed to heat stress had 31% less ADG (P < 0.001), 23% less ADFI (P < 0.001), 9% less G:F (P < 0.001), and 34% greater average daily water intake (P = 0.03) than those in the non-heat-stress conditions. Dietary BMD tended to reduce ADG (P < 0.07) compared with the control (0.66 vs. 0.73 kg/d, respectively). Heat stress increased (P < 0.05) saliva cortisol on d 1, but no effects were observed on subsequent days. Serum haptoglobin concentrations were greater (P < 0.05) in heat-stressed pigs on d 1, and concentrations tended to remain greater (P < 0.1) on d 13. Pigs fed the BMD diet tended to have a longer villus height (P = 0.07) in the duodenum and greater crypt depths in the duodenum (P = 0.09) and jejunum (P = 0.07). Heat-stressed pigs tended to have a decreased proportion of propionate (P = 0.08), greater acetate:propionate (P = 0.08), and a reduced proportion of valerate (P = 0.02) in the cecum. These results indicate that BMD did not counteract the negative effects of heat stress on growth performance, but BMD appears to increase villus height and crypt depth in the duodenum. Furthermore, heat stress appears to alter VFA production in finishing pigs.

Multi-drug resistant tuberculosis in Chuuk State Federated States of Micronesia, 2008-2009

Multi-drug resistant tuberculosis (MDR TB) is a growing public health concern, particularly for the Pacific, where rates of tuberculosis infection are extremely high. In May 2008, a cluster of patients with MDR TB were identified in Chuuk State, Federated States of Micronesia. A multi-agency investigation led to the eventual discovery of 21 cases, and over 100 latent TB infections. Incomplete implementation of Directly Observed Therapy (DOT) and contact investigation were major contributors to the outbreak. The problem of MDR TB in Chuuk was controlled only after a concerted effort on the part of multiple agencies coupled with the highest level of political commitment.

Simvastatin Reduces OX40 and OX40 Ligand Expression in Human Peripheral Blood Mononuclear Cells and in Patients with Atherosclerotic Cerebral Infarction

This study investigated the effect of simvastatin on the expression of OX40 and OX40 ligand (OX40L) in vitro and in vivo. OX40 and OX40L mRNA and protein levels were measured in human peripheral blood mononuclear cells, using reverse transcription–polymerase chain reaction and Western blot, respectively, in response to simvastatin alone or given in combination with interferon-γ, mevalonate or GW9662, a peroxisome proliferator-activated receptor-γ (PPAR-γ) antagonist. Simvastatin induced down-regulation of OX40 and OX40L mRNA and protein in a concentration-dependent manner, and antagonized the interferon-γ-induced increase in OX40 and OX40L mRNA and protein levels. Mevalonate, but not GW9662, reversed the simvastatin-induced down-regulation of OX40 and OX40L expression, indicating that these effects were mediated through the mevalonate pathway. Serum levels of soluble OX40L and matrix metalloproteinase 9 levels were significantly reduced in patients with atherosclerotic cerebral infarction who were treated for 6 months with routine therapy plus simvastatin ( n = 46) compared with patients receiving routine therapy alone ( n = 30). These findings improve our understanding of the anti-inflammatory and immunomodulatory properties of simvastatin treatment for atherosclerotic disorders.

A profile of the belief system and attitudes to end-of-life decisions of senior clinicians working in a National Health Service Hospital in the United Kingdom

There is evidence from outside the United Kingdom to show that physicians' religious beliefs influence their decision making at the end of life. This UK study explores the belief system of consultants, nurse key workers and specialist registrars and their attitudes to decisions which commonly must be taken when caring for individuals who are dying. All consultants (N = 119), nurse key workers (N = 36) and specialist registrars (N = 44) working in an acute hospital in the north-east of England were asked to complete a postal questionnaire. In all, 65% of consultants, 67% of nurse key workers and 41% of specialist registrars responded. Results showed that consultants' religion and belief systems differed from those of nurses and the population they served. Consultants and nurses had statistically significant differences in their attitudes to common end of life decisions with consultants more likely to continue hydration and not withdraw treatment. Nurses were more sympathetic to the idea of physician-assisted suicide for unbearable suffering. This study shows the variability in belief system and attitudes to end of life decision making both within and between clinical groups. This may have practical implications for the clinical care given and the place of care. The personal belief system of consultants was not shown to affect their overall attitudes to withdrawing life-sustaining treatment or physician-assisted suicide.

Quantitative evaluation of motor functional recovery process in chronic stroke patients during robot-assisted wrist training

This study was to investigate the motor functional recovery process in chronic stroke during robot-assisted wrist training. Fifteen subjects with chronic upper extremity paresis after stroke attended a 20-session wrist tracking training using an interactive rehabilitation robot. Electromyographic (EMG) parameters, i.e., EMG activation levels of four muscles: biceps brachii (BIC), triceps brachii (TRI, lateral head), flexor carpiradialis (FCR), and extensor carpiradialis (ECR) and their co-contraction indexes (CI) were used to monitor the neuromuscular changes during the training course. The EMG activation levels of the FCR (11.1% of decrease from the initial), BIC (17.1% of decrease from the initial), and ECR (29.4% of decrease from the initial) muscles decreased significantly during the training (P<0.05). Such decrease was associated with decreased Modified Ashworth Scores for both the wrist and elbow joints (P<0.05). Significant decrease (P<0.05) was also found in CIs of muscle pairs, BIC&TRI (21% of decrease from the initial), FCR&BIC (11.3% of decrease from the initial), ECR&BIC (49.3% of decrease from the initial). The decreased CIs related to the BIC muscle were mainly caused by the reduction in the BIC EMG activation level, suggesting a better isolation of the wrist movements from the elbow motions. The decreased CI of ECR& FCR in the later training sessions (P<0.05) was due to the reduced co-contraction phase of the antagonist muscle pair in the tracking tasks. Significant improvements (P<0.05) were also found in motor outcomes related to the shoulder/elbow and wrist/hand scores assessed by the Fugl-Meyer assessment before and after the training. According to the evolution of the EMG parameters along the training course, further motor improvements could be obtained by providing more training sessions, since the decreases of the EMG parameters did not reach a steady state before the end of the training. The results in this study provided an objective and quantitative EMG measure to describe the motor recovery process during poststroke robot-assisted wrist for the further understanding on the neuromuscular mechanism associated with the recovery.

The therapeutic effects of myoelectrically controlled robotic system for persons after stroke--a pilot study

In this study, a myoelectrically controlled robotic system with one degree of freedom was developed to assist elbow training in the horizontal plane for patients after stroke. The system could provide assistive extension torque which was proportional to the amplitude of the subject's processed and normalized electromyograhpic (EMG) signal from triceps. The system also provided different resistive torques during movement, which were based on the maximum isometric voluntary extension (MIVE) and flexion (MIVF) torques. A study investigated its effect after 20-session of training for four weeks on the functional improvement of the affected arm in 3 subjects after stroke. Outcome measurements on the muscle strength at the elbow joint showed that there were increases in the MIVE and MIVF torques of the affected arms of all the subjects after the four-week rehabilitation training. The subjects could also reach a more extended position without the assistance of the robotic system than that before the four-week training.

Sorafenib inhibits activation of human peripheral blood T cells by targeting LCK phosphorylation

Sorafenib, a novel drug for metastatic renal cancer, has broad-spectrum activity against multiple tyrosine kinases, including Raf-1, vascular endothelial growth factor receptor and platelet-derived growth factor receptor. However, little is known about its effects on the immune system. In this report, we examine the effects of sorafenib on the proliferation and activation of human peripheral blood T cells, as well as its effects on T-cell-mediated immune response in mice. At concentrations similar to those used in patients, sorafenib inhibited the proliferation of primary human T cells in vitro. At more than 10 microM, sorafenib caused an irrecoverable inhibition of proliferation, even after drug withdrawal. In addition, sorafenib induced T-cell apoptosis at concentrations higher than 10 muM. sorafenib also caused G(0)/G(1) phase arrest, inhibition of CD25 and CD69 expression, interleukin-2 production and LCK phosphorylation in the T cells; all of these effects exhibited dose and time dependence. When tested against contact dermatitis in mice, sorafenib significantly reduced the ear swelling induced by picryl chloride. These findings suggest that sorafenib may cause the loss of T-cell immune response by inducing apoptosis and targeting LCK. This could potentially lead to immunosuppression in patients with cancer.

Coactivations of elbow and shoulder muscles in hemiplegic persons with chronic stroke during robot-assisted training

The motor recovery procedure of chronic stroke during robot-assisted training has not been well studied previously. In this work, we analyzed the variations in the coactivating patterns of elbow and shoulder muscles (biceps, triceps lateral, anterior deltoid, and posterior deltoid) in hemiplegic persons with chronic stroke (n=4) during a 20-session's interactive robot-assisted treatment. Significant decreases in muscle cocontractions (P<0.05) for all muscle pairs started from the 8th session of the training. Improvements were also observed in motor scores of Fugl-Meyer and modified Ashworth scale after the treatment. The results suggested an increased dexterity and selective control on individual muscles for both elbow and shoulder joints in a designed task after the robot-assisted training.

Using recurrent artificial neural network model to estimate voluntary elbow torque in dynamic situations

Muscle modelling is an important component of body segmental motion analysis. Although many studies had focused on static conditions, the relationship between electromyographic (EMG) signals and joint torque under voluntary dynamic situations has not been well investigated. The aim of this study was to investigate the performance of a recurrent artificial neural network (RANN) under voluntary dynamic situations for torque estimation of the elbow complex. EMG signals together with kinematic data, which included angle and angular velocity, were used as the inputs to estimate the expected torque during movement. Moreover, the roles of angle and angular velocity in the accuracy of prediction were investigated, and two models were compared. One model used EMG and joint kinematic inputs and the other model used only EMG inputs without kinematic data. Six healthy subjects were recruited, and two average angular velocities (60 degrees s(-1) and 90 degrees s(-1)) with three different loads (0 kg, 1 kg, 2 kg) in the hand position were selected to train and test the RANN between 90 degrees elbow flexion and full elbow extension (0 degrees). After training, the root mean squared error (RMSE) between expected torque and predicted torque of the model, with EMG and joint kinematic inputs in the training data set and the test data set, were 0.17 +/- 0.03 Nm and 0.35 +/- 0.06 Nm, respectively. The RMSE values between expected torque and predicted torque of the model, with only EMG inputs in the training data set and the test set, were 0.57 +/- 0.07 Nm and 0.73 +/- 0.11 Nm, respectively. The results showed that EMG signals together with kinematic data gave significantly better performance in the joint torque prediction; joint angle and angular velocity provided important information in the estimation of joint torque in voluntary dynamic movement.

Phosphatidylinositol 3-kinase/Akt pathway mediates heme oxygenase-1 regulation by lipopolysaccharide

The stress-inducible protein heme oxygenase-1 exerts potent antiinflammatory, antiapoptotic and cytoprotective effects in vitro and in vivo. Another important mediator of cytoprotection, the phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway activates many proteins involved in the maintenance of cellular homeostasis. Since activation of heme oxygenase-1 and PI3K/Akt both protect the cellular environment, we postulated that PI3K/Akt can regulate the induction of heme oxygenase-1 by proinflammatory stress. The treatment of primary murine macrophage cells (RAW 264.7) with lipopolysaccharide induced heme oxygenase-1 protein and mRNA expression, and increased the phosphorylation of Akt and p38 mitogen activated protein kinase (p38 MAPK). These cellular effects of lipopolysaccharide were markedly diminished by pre-treatment with wortmannin, a specific inhibitor of PI3K. Furthermore, lipopolysaccharide-inducible heme oxygenase expression was blocked by SB203580, a specific inhibitor of p38 MAPK. Both wortmannin and SB203580 decreased lipopolysaccharide-inducible NF-E2-related factor (Nrf2) DNA binding activity. Transfection of macrophages with dominant negative mutants of PI3K, Akt and Nrf2, as well as wortmannin treatment, significantly reduced the transcriptional activity of a minimal heme oxygenase-1 promoter luciferase construct (D33HO-1luc). We demonstrate, to our knowledge for the first time, that upon proinflammatory stimulation heme oxygenase-1 gene expression in macrophages depends on PI3K/Akt and p38 MAPK acting upstream of Nrf2-dependent promoter activation.