Opposing effects of Sca-1(+) cell-based systemic FGF2 gene transfer strategy on lumbar versus caudal vertebrae in the mouse

Our previous work showed that a Sca-1⁺ cell-based FGF2 therapy was capable of promoting robust increases in trabecular bone formation and connectivity on the endosteum of long bones. Past work reported that administration of FGF2 protein promoted bone formation in red marrow but not in yellow marrow. The issue as to whether the Sca-1⁺ cell-based FGF2 therapy is effective in yellow marrow is highly relevant to its clinical potential for osteoporosis, as most red marrows in a person of an advanced age, are converted to yellow marrows. Accordingly, this study sought to compare the osteogenic effects of this stem cell-based FGF2 therapy on red marrow-filled lumbar vertebrae with those on yellow marrow-filled caudal vertebrae of young adult W⁴¹/W⁴¹ mice. The Sca-1⁺ cell-based FGF2 therapy drastically increased trabecular bone formation in lumbar vertebrae, but the therapy not only did not promote bone formation but instead caused substantial loss of trabecular bone in caudal vertebrae. The lack of an osteogenic response was not due to insufficient engraftment of FGF2-expressing Sca-1⁺ cells or inadequate FGF2 expression in caudal vertebrae. Previous studies have demonstrated that recipient mice of this stem cell-based FGF2 therapy developed secondary hyperparathyroidism and increased bone resorption. Thus, the loss of bone mass in caudal vertebrae might in part be due to an increase in resorption without a corresponding increase in bone formation. In conclusion, the Sca-1⁺ cell-based FGF2 therapy is osteogenic in red marrow but not in yellow marrow.

Abstract P2-12-16: Current trend and indications of endoscopy-assisted breast surgery for breast cancer: Experience from Taiwan endoscopic breast surgery cooperative group

Background: Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to conventional surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan.

Methods: The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. The Taiwan Endoscopic Breast Surgery Cooperative Group (T-EBSCG) was established to monitor the effectiveness of and clinical outcome associated with EABS in Taiwan. The T-EBSCG comprises members from three major endoscopic breast surgery centers, namely Changhua Christian Hospital, National Cheng-Kung University Hospital,and Taipei Medical University Hospital in Taiwan. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan.

Results: A total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The mean tumor size of these 315 EABS was 2.2 ± 1.8 cm, and 44(13.9%) of them were multifocal/multicentric breast cancer. Lymph node metastasis was found during 23.3% of the procedures. The stage distribution of them were stage II cancer (n=103, 34.4%), followed by stage I cancer (n=92, 30.7%), ductal carcinoma in situ (stage 0) (n=86, 28.7%), and stage III breast cancer (n=19, 6.3%). The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012-2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Of the 269 patients who underwent EATM, 198 (73.6%) received immediate breast reconstruction. The majority (72.2%) of them received implant-based (cohesive Gel implant or tissue expander) reconstruction and the remaining 27.8% received autologous pedicled TRAM flap for breast reconstruction. Endoscopic assisted nipple sparing mastectomy with Gel implant reconstruction was the most frequently performed EABS now. During the six-year study period, there was an increasing trend toward more frequently use of EABS in the management of breast cancer when total mastectomy was indicated (EATM) than breast conserving surgery (EPM). Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. There were no major or life threatening complications. The positive surgical margin rate was 1.9%. During a median follow-up of 26.8 months (range, 3.3-68.6 months), there were 3 (1%) cases of local recurrence (1 ipsilateral breast recurrence, 1 axillary local recurrence, and 1 core needle biopsy tract recurrences), 1 (0.3%) case of distant metastasis, and 1 death.

Conclusion: The EABS program in Taiwan showed that EABS is a safe procedure and results in acceptable cosmetic outcome, these findings could help to promote this under-used surgical technique in the field of breast cancer.

Citation Format: Lai H-W, Kuo Y-L, Hung C-S, Chen S-T, Chen D-R. Current trend and indications of endoscopy-assisted breast surgery for breast cancer: Experience from Taiwan endoscopic breast surgery cooperative group. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-16.

Abstract P4-02-03: The diagnostic accuracy of breast MRI in the prediction of malignant invasion of nipple areolar complex (NAC) of breast

Purpose: Nipple sparing mastectomy is increasingly used as a surgical treatment for breast cancer. To correctly predict the possibility of nipple invasion pre-operatively is critical important to prevent occult nipple invasion or early nipple recurrence. The objective of our study is to assess the diagnostic accuracy of breast MRI for the evaluation of malignant invasion of the nipple-areolar complex (NAC).

Material and Methods: From January 2011 to December 2013, patients with primary operable breast cancer diagnosed and treated at Changhua Christian Hospital (CCH), Taiwan were searched. The inclusion criteria were primary operable breast cancer patients, who received pre-operative breast MRI, and received breast cancer operation at CCH. The exclusion criteria were patients whose primary tumor was removed before definite cancer operation, those who received neoadjuvant chemotherapy, or patient's detailed data not available. Breast MRI examinations were retrospectively reviewed for nipple invasion or retraction, periareolar skin thickening, nipple areolar complex enhancement, relationship to the subareolar mass, malignant mass pattern, thickness of nipple-areolar complex enhancement, tumor-nipple distance and tumor size, and were correlated with pathologic findings. The accuracy of breast MRI to predict nipple invasion was compared with pre-operative image and post-operative pathologic reports.

Results: A total 704 primary operable breast cancers with pre-operative MRI and post operative pathologic reports were enrolled in our current study. In the total 704 patients, MRI showed signs of suspect NAC invasion in 160 (22.7%) patients. Total 41 (25.6%) patients were pathologic proven malignant invasion of NAC. In the final pathologic analysis, 57 pathologic confirmed NAC invasions were found in the 704 patients. The overall nipple invasion rate was 8.1% in this current study. The sensitivity of Breast MRI to predict NAC involvement was 71.9%. The Specificity of breast MRI to NAC invasion is 81.6%. The positive predictive value of breast MRI is 25.6%. The negative predictive value of breast MRI is 97.1%. The accuracy of breast MRI to predict NAC involvement is 80.8%. In univariate logistic regression analysis, tumor size, lymph node metastasis, central location of tumor, unilateral nipple enhancement, relationship to tumor, and HER-2 overexpression were prognostic factors for NAC invasion. In multivariate analysis, unilateral nipple enhancement (hazard ratio=4.944, CI: 1.938-12.616, P=0.001) was the most significant independently risk factor associated with the increased risk of NAC involvement.

Multivariate analysis of factors related to nipple invasion Multivariate analysisParametersOdds ratio95% CIpMRI tumor size0.8500.716-1.0090.063Distance to nipples (cm)1.1990.931-1.5440.160Location of tumor (Central)1.6830.724-3.9120.226Nipple enhancement (Unilateral)4.9441.938-12.6160.001Relationship (Yes)1.6160.625-4.1770.322MRI Lymph node metastasis (Yes)1.6740.870-3.2240.123

Conclusion: MRI is an useful diagnostic image method for the evaluation of malignant invasion of the nipple-areolar complex. Through preoperative breast MRI evaluation of NAC status, more personalized oncoplastic breast surgery could be performed.

Citation Format: Lai H-W, Chen S-T, Chen D-R, Wu H-K, Kuo S-J. The diagnostic accuracy of breast MRI in the prediction of malignant invasion of nipple areolar complex (NAC) of breast. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-03.

Abstract P4-02-02: Did adding breast MRI decrease the surgical margin involved rate than conventional breast image? - A case controlled comparison analysis

Purpose: Resection of primary tumor with clear margin is the goal of surgical management for primary operable breast cancer. Surgical margin involvement was associated with increased local recurrence, and usually mandated further surgery. The objective of current study is to assess whether combining breast MRI would decrease the rate of margin involvement compared with conventional breast image.

Material and Methods: A retrospective, case controlled comparison study was conducted. Patients with primary operable breast cancer who received surgical management were searched from Changhua Christian Hospital (CCH) breast cancer database. The rate of surgical margin involvement was compared between two groups of patients with conventional breast image (Group A: mammogram and sonogram) or combined with breast MRI (Group B: mammogram, sonogram and MRI). Surgical margin involvement was defined as cancer cells present at surgical margin, or < 1mm. To further evaluate the effect of breast MRI on surgeon's margin involved rates, the index surgeons, defined as with more than 100 breast cancer operations in both Group A and Group B, were selected and analyzed.

Results: Group A, conventional breast image group, consisted of 741 breast cancer patients. Among them, 381(51.4%) received partial mastectomy, and 360 (48.6%) received total mastectomy. Overall, 66 (8.9%) margin involved events were found in Group A. The margin involved rate in Group A patients received partial mastectomy or total mastectomy was 14.4% (55/381), and 3.1% (11/360), separately. The Group –B (combined with MRI) consisted of 736 breast cancer patients. Among them, 347 (47.1%) received partial mastectomy, and 389(52.9%) received total mastectomy. The margin involved rate in Group B was overall 4.8%(35/736). The margin involved rate in Group B patients who received partial mastectomy or total mastectomy was 6.1%(21/347), and 3.6% (14/ 389), respectively. The surgical margin involved rate was decreased after combination of MRI to conventional breast image as showed in table 1.

Margin involved rate with conventional breast image or combined with MRI Conventional Breast ImageCombined Breast MRI Patient741736P valuePartial mastectomy51.4%47.1%0.107Total mastectomy48.6%52.9% Rate of margin involvement  P valueOverall8.9%4.8%0.002Partial mastectomy14.4%6.1%0.001Total mastectomy3.1%3.6%0.834

Two index surgeons were selected for comparison of surgical margin involved rate before and after breast MRI. The "Surgeon A" 's margin involved rate in conventional breast image -> combined MRI were: overall: 7.6% -> 4.9%(0.202), partial mastectomy: 14.0% -> 8.1%(P=0.151), and total mastectomy: 1.3% -> 2.2%(P=0.8066). "Surgeon B" ‘s margin involved rate (from no MRI -> MRI ) was: overall: 9.0% -> 5.0%(P=0.121), partial mastectomy: 12.1% -> 3.9%(P=0.034), and total mastectomy: 6.2% -> 6.59%(P=0.722).

Conclusion: Adding breast MRI to conventional breast image decreased the surgical margin involved rate, with the cost of mild increase the mastectomy rate. This decreasing surgical margin involved rate was not mainly due to increase mastectomy rate, but due to the selection of patients who were not suitable for partial mastectomy to receive total mastectomy.

Citation Format: Lai H-W, Chen S-T, Chen D-R, Wu H-K, Ku S-J. Did adding breast MRI decrease the surgical margin involved rate than conventional breast image? - A case controlled comparison analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-02.

Cardiovascular risks associated with second-line oral antidiabetic agents added to metformin in patients with Type 2 diabetes: a nationwide cohort study

AIM

To compare the cardiovascular risks associated with second-line oral antidiabetic agents added to initial metformin therapy in a large nationwide observational study.

METHODS

We conducted a nationwide retrospective cohort study using the Taiwan National Health Insurance database. A total of 36 118 users of different add-on oral antidiabetic agents (sulphonylureas, glinides, pioglitazone, α-glucosidase inhibitors and dipeptidyl peptidase-4 inhibitors) after initial metformin therapy were included in the analysis. The reference group was sulphonylureas added to metformin, the most commonly used combination regimen. The main outcomes of interest were hospitalizations for any cardiovascular event including acute myocardial infarction, congestive heart failure and ischaemic stroke. In the main analysis, all patients were followed within their initiation groups until the study end, disregarding any changes in treatment status over time.

RESULTS

In intention-to-treat analyses, there was no difference in the risk of any cardiovascular event among the add-on combination treatment groups, but significantly lower risks of acute myocardial infarction were found for the glinides plus metformin treatment group (crude hazard ratio 0.52, adjusted hazard ratio 0.39; 95% CI 0.20-0.75) and for the α-glucosidase inhibitors plus metformin treatment group (crude hazard ratio 0.63, adjusted hazard ratio 0.54; 95% CI 0.31-0.95). No difference in risk of congestive heart failure or ischaemic stroke risk was found among the combination treatment groups. In secondary as-treated analyses, similar but less significant associations were found as compared with the primary intention-to-treat analyses for all treatment groups.

CONCLUSION

There were no differences in overall cardiovascular risks among several add-on second-line oral antidiabetic agents; however, glinide plus metformin and α-glucosidase inhibitors plus metformin combination therapies might be associated with lower risks of acute myocardial infarction.

Inhibition of adipogenic differentiation of bone marrow mesenchymal stem cells by erythropoietin via activating ERK and P38 MAPK

We examined whether erythropoietin (EPO) can inhibit adipogenic differentiation of mesenchymal stem cells (MSCs) in the mouse bone marrow and its underlying mechanism. We separated and extracted mouse bone marrow MSCs and induced adipogenic differen-tiation using 3-isobutyl-1-methylxanthine, insulin, and dexamethasone. Different concentrations of EPO were added to the cells and observed by Oil Red O staining on the 20th day to quantitatively analyze the degree of cell differentiation. mRNA expression levels of peroxysome proliferator-activated receptor γ (PPARγ), CCAAT enhancer binding protein α, and adiponectin were analyzed by real-time quantitative polymerase chain reaction, and the activity of PPARγ, extracellular sig-nal-regulated kinase (ERK), and p38 mitogen-activated protein kinase (p38 MAPK) were determined by western blotting. EPO significantly inhibited adipogenic differentiation of MSCs after 20 days and reduced absorbance values by Oil Red O staining without affecting proliferation activity. EPO downregulated the mRNA expression of PPARγ, CCAAT enhancer binding protein α, fatty acid binding protein 4, and adiponec-tin during adipogenesis and increased protein phosphorylation of ERK, p38 MAPK, and PPARγ during differentiation. EPO downregulated the mRNA expression of PPARγ, CCAAT enhancer binding protein α, fatty acid binding protein 4, and adiponectin by increasing protein phosphor-ylation of ERK, p38 MAPK, and PPARγ during differentiation, which inhibited adipogenic differentiation of MSCs.

Arecoline inhibits interleukin-2 secretion in Jurkat cells by decreasing the expression of alpha7-nicotinic acetylcholine receptors and prostaglandin E2

The purpose of the present study was to explore the effect of arecoline on phytohemagglutinin (PHA)-stimulated interleukin-2 (IL-2) secretion, the expression of alpha7-nicotinic acetylcholine receptors (α7-nAChRs), prostaglandin E2(PGE2) protein, and IL-2 mRNA in human lymphocyte cells (Jurkat cell line). The IL-2 and PGE2 were determined by enzyme-linked immunosorbent assay (ELISA). The expressions of phosphorylated extracellular signal-regulated kinase (ERK) and α7-nAChRs were determined by Western blotting. The level of IL-2 mRNA was determined by reverse-transcriptase polymerase chain reaction (RT-PCR). Arecoline, in a dose-dependent manner, significantly decreased IL-2 and PGE2 secretion by Jurkat cells incubated with 0 or 5 μg/ml 5 μg/ml PHA. PGE2 also significantly inhibited IL-2 secretion by Jurkat cells in a dose-dependent manner. In addition, reduced expression of PHA-induced ERK phosphorylation was observed in Jurkat cells treated with arecoline. PHA-enhanced IL-2 mRNA expression was also inhibited by arecoline. These results imply that arecoline inhibits the release of PGE2 and PHA-induced IL-2 secretion by Jurkat cells and that these effects seem to occur, at least in part, either through the attenuation of ERK in conjunction with a decrease of PHA-induced IL-2 mRNA expression. These results imply that arecoline inhibits the protein expression of α7-nAChRs , the release of PGE2 and PHA-induced IL-2 secretion by Jurkat cells.

Nutrition knowledge, attitude and practice of teachers in rehabilitation centres in northern Malaysia

INTRODUCTION

Persons with disabilities (PWD) are susceptible to malnutrition. Caregivers or teachers in rehabilitation centres may not be adequately trained in nutrition management of PWD. The aims of this study were (i) to assess the nutrition knowledge, attitude and practice among teachers in community-based rehabilitation centres for PWD; and (ii) to evaluate changes in the nutrition knowledge and attitude of the teachers before and after exposure to a training workshop on nutrition management for PWD.

METHODS

A cross-sectional survey was conducted using a guided self-administered Nutrition Knowledge, Attitude and Practice Questionnaire on Persons with Disabilities (KAP-nOKU), among a convenience sample of 210 teachers. Forty-five of them further participated in a nutrition training workshop and completed the post-test evaluation on knowledge and attitude of the same measures.

RESULTS

At baseline, the teachers' average knowledge, attitude and practice scores were 13.80 +/- 3.73 for knowledge (below 50th percentile); 51.49 +/- 4.08 for attitude (above 75th percentile); and 48.08 +/- 3.61 for practice (between 50th and 75th percentile). There was significant positive correlations between knowledge and attitude (r=0.343, p<0.05), as well as between attitude and practice (r=0.147, p<0.05). After exposure to a 3-day nutrition workshop, significant improvements in the teachers' knowledge and attitude were observed, whereby teachers' knowledge score increased from 14.20 +/- 3.80 to 25.38 +/- 2.36 and from 51.16 +/- 3.97 to 55.20 +/- 4.41 for attitude (p<0.001).

CONCLUSION

Nutrition intervention was associated with improvement in short term knowledge and attitude of the teachers. Sustainable interventional strategies are needed to enhance the nutrition knowledge and skills of teachers of PWD.

Capsaicin may induce breast cancer cell death through apoptosis-inducing factor involving mitochondrial dysfunction

The majority of breast cancer patients are resistant to chemotherapy or radiotherapy due to the down-regulation or lack of caspase-3 expression. Capsaicin was found to inhibit cancer cell growth in caspase-3-deficient human breast cancer cells. This study aimed to investigate the growth-inhibitive effect of capsaicin and its mechanisms in human breast cancer cell lines, MCF-7 and BT-20. The results showed that cell viability decreased in a dose-dependent manner in both the caspase-3-deficient and non-deficient cells through inducing cell apoptosis and arresting the cell cycle in the S phase. Capsaicin significantly decreased mitochondria membrane potential, induced the cleavage of PARP-1, and decreased procaspase-7 expression in both cells. Apoptosis-inducing factor (AIF) was distinctly released from mitochondria and translocated into the cytoplasm and nucleus in MCF-7 cells (52.9%), but not in BT-20 cells (2%) after treatment with 200 μM of capsaicin for 24 hours. Capsaicin inhibited breast cancer cell growth through inducing cell apoptosis and cell cycle arrest in the S phase. This apoptotic effect could be induced through the mitochondrial pathway, and PARP-1 subsequently cleaved by activation of caspase-7. The application of capsaicin in clinical therapy could be useful for breast cancer patients.

Abstract P4-07-10: Prognostic Significance of Triple Negative Breast Cancer at Tumor Size 1 Cm and Smaller

Triple negative breast cancer (TNBC) is an independent biomarker of poor prognosis, and associated with a higher predilection for visceral metastasis and early recurrence. However, the prognostic significance of TNBC with a tumor size ≥1 cm is unclear. Patients with primary operable breast cancer with a tumor size ≥1cm were retrospectively collected at Changhua Christian Hospital and National Cheng-Kung University Hospital in Taiwan. Tumors negative for ER, PR, and HER-2, determined by immunohistochemical stain, were classified as TNBCs and compared with tumors with any receptor positivity (non-TNBC) for disease-free survival (DFS) and cancer-specific survival (CSS). From 1995 to 2006, a total of 377 (13%) patients with tumor size ≥1 cm were enrolled from 2835 primary breast cancer patients. The mean age at diagnosis and follow-up time were 50.86 and 4.04 ± 2.83 years, separately. Compared with non-TNBC patients, TNBC with a tumor size ≥1 cm as a whole or in lymph node-positive subgroup was not associated with a poorer 5-year DFS and CSS. In lymph node-negative patients (pT1a-bN0M0), TNBC was associated with a poorer 5-year CSS but not DFS than the non-TNBC group. In multivariate Cox regression hazard analysis, lymph node invasion was the most important cause (hazard ratio: 19.89, 95% CI: 2.18-181.89, P=0.0081) of cancer-specific death.

Fig. (a) Disease-free survival (DFS) of TNBC patients versus non-TNBC patients with tumor ≥1 cm. (b) Cancer-specific survival (CSS) of TNBC patients versus non-TNBC patients with tumor ≥1 cm. (c) CSS in node-positive patients with a TNBC versus non-TNBC phenotype. (d) CSS in node-negative patients with TNBC versus non-TNBC. (e) DFS in patients with HR+/ERBB2-, ERBB2+, and TNBC. (f) CSS in patients of HR+/ERBB2- , ERBB2+, and TNBC. (g) CSS in node-positive patients with HR+/ERBB2-, ERBB2+, and TNBC. (h) CSS in node-negative patients with HR+/ERBB2- , ERBB2+, and TNBC.

TNBC is very likely an independent risk factor for CSS in small (≥1 cm) node-negative invasive breast cancer. With tumors 1 cm and smaller, lymph node invasion was the single most important prognostic factor.

Prognostic significance of triple negative breast cancer at tumor size 1 cm and smaller

AIMS

The purpose of this study was to clarify the prognostic significance of triple-negative breast cancer (TNBC) with a tumor size ≤ 1 cm.

MATERIALS AND METHODS

Patients with primary operable breast cancer with a tumor size ≤ 1 cm were enrolled at Changhua Christian Hospital and National Cheng-Kung University Hospital. Tumors negative for ER, PR, and HER-2 were classified as TNBCs and compared with tumors with any receptor positivity (non-TNBC) for disease-free survival (DFS) and cancer-specific survival (CSS).

RESULTS

From 1995 to 2006, a total of 377 patients with tumor size ≤ 1 cm were enrolled. Compared with non-TNBC patients, TNBC patients with a tumor size ≤ 1 cm as a whole or in a lymph node-positive subgroup were not associated with a poorer 5-year DFS and CSS. In lymph node-negative patients (pT1a-bN0M0), TNBC was associated with a poorer 5-year CSS but not DFS. Compared with the hormone receptor-positive, HER-2-negative subgroup, TNBC was associated with poorer DFS and CSS. In the multivariate Cox regression hazard analysis, lymph node invasion was the most important cause of disease recurrence and cancer-specific death.

CONCLUSION

TNBC is very likely an independent risk factor in small (≤1 cm) node-negative invasive breast cancer. With tumors 1 cm and smaller, lymph node invasion was the single most important prognostic factor.

Low viraemia at enrollment in children with chronic hepatitis C favours spontaneous viral clearance

The significance of hepatitis C viral (HCV)-RNA levels in long-term clinical outcomes of children with chronic HCV infection is not well understood. We conducted a long-term follow-up study of 42 children with chronic HCV infection that included clinical evaluation, biochemical tests, HCV genotyping and repeated quantitative HCV-RNA detection. Patients were divided into low and high viraemia groups according to RNA levels at enrollment (below/above 4.5 x 10(4) IU/mL), and clinical, biochemical and virological factors were evaluated. Overall, 14.3% (6/42) of patients developed spontaneous viral clearance during a median 10.1 years of follow-up. HCV-RNA levels at enrollment and mean RNA levels during follow-up for each patient were significantly correlated (R = 0.9018, 95% CI: 0.6637-0.9038, P < or = 0.001). HCV-RNA level fluctuation was within two log units in 76% of patients. Cumulative viraemia probability during follow-up could be predicted by viraemia levels at enrollment (P = 0.0092). Chronic HCV-infected children, with an RNA level below 4.5 x 10(4) IU/mL at enrollment, have a higher spontaneous viral clearance rate.

Hyperglycemia in vitro up-regulates growth-related cell cycle proteins of adult mouse pancreatic islets

To study effects of glucose on growth-related proteins of adult islets, we cultured mice islets in medium containing either 5.5 mmol/L (LG) or 20 mmol/L (HG) glucose. Total islet proteins were processed for sodium dodecyl sulfate polyacrylamide gel and Western blotting using antibodies against beta-actin (housekeeping), p27kip1 (G1/G0 checkpoint), cyclin D1 (G1/S), cyclin B1 (G2/M), and FoxM1. At day 1, protein levels p27, B1, D1, and FoxM1 of islets on LG and HG were 0.48- and 0.63-fold; 7.09- and 11.58-fold; 1.25- and 1.38-fold; and 1.75- and 1.75-folds, the value of day 0, determinations respectively. At day 3, the proteins of p27, B1, D1, and FoxM1 of islets in LG and HG were 0.84- and 0.84-fold; 3.08- and 17.17-fold; 1.41- and 1.54-fold; and 0.83- and 1.17-fold of those on day 0, respectively. On day 7 the values were 1.19- and 1.09-fold; 3.15- and 14.81-fold; 0.86- and 1.44-fold; and 2.75- and 3.42-fold that of day 0, respectively. At day 1, the ratios of protein in islets after HG verse LG were 1.25, 2.38, 0.94, and 1.00 for p27, B1, D1, and FoxM1, respectively. At days 3 and 7, the protein ratios of HG/LG were 0.81 and 0.82, 5.47 and 2.64, 0.81 and 1.51, and 1.11 and 1.24 for p27, B1, D1, and FoxM1, respectively. In conclusion, adult mouse islets rapidly respond to cultivation by reducing p27 and increasing B1; HG attenuates p27 elevation but enhances B1 and D1 elevations, which favor islet entry into the cell cycle.

T-box 3 negatively regulates osteoblast differentiation by inhibiting expression of osterix and runx2

T-box (Tbx)3, a known transcriptional repressor, is a member of a family of transcription factors, which contain a highly homologous DNA binding domain known as the Tbx domain. Based on the knowledge that mutation of the Tbx3 gene results in limb malformation, Tbx3 regulates osteoblast proliferation and its expression increases during osteoblast differentiation, we predicted that Tbx3 is an important regulator of osteoblast cell functions. In this study, we evaluated the consequence of transgenic overexpression of Tbx3 on osteoblast differentiation. Retroviral overexpression increased Tbx3 expression >100-fold at the mRNA and protein level. Overexpression of Tbx3 blocked mineralized nodule formation (28 +/- 8 vs. 7 +/- 1%) in MC3T3-E1 cells. In support of these data, alkaline phosphatase (ALP) activity was reduced 33-70% (P < 0.05) in both MC3T3-E1 cells and primary calvaria osteoblasts overexpressing Tbx3. In contrast, Tbx3 overexpression did not alter ALP activity in bone marrow stromal cells. Tbx3 overexpression blocked the increase in expression of key osteoblast marker genes, ALP, bone sialoprotein, and osteocalcin that occurs during normal osteoblast differentiation, but had little or no effect on expression of proliferation genes p53 and Myc. In addition, Tbx3 overexpression abolished increased osterix and runx2 expression observed during normal osteoblast differentiation, but the change in Msx1 and Msx2 expression over time was similar between control and Tbx3 overexpressing cells. Interestingly, osterix and runx2, but not Msx1 and Msx2, contain Tbx binding site in the regulatory region. Based on these data and our previous findings, we conclude that Tbx3 promotes proliferation and suppresses differentiation of osteoblasts and may be involved in regulating expression of key transcription factors involved in osteoblast differentiation.

Angiotensin-converting enzyme polymorphisms and risk of spontaneous deep intracranial hemorrhage in Taiwan

BACKGROUND AND PURPOSE

This study examines whether angiotensin-converting enzyme (ACE) gene polymorphisms are associated with the risk of spontaneous deep intracerebral hemorrhage (SDICH) in Taiwan using a case-control study.

METHODS

Totally, 217 SDICH patients and 283 controls were recruited. Associations of ACE A-240T and ACE I/D polymorphisms with SDICH were examined under the additive model and adjusted for gender, age, body mass index, total cholesterol level, smoking history, alcohol use, hypertension, and use of ACE inhibitors.

RESULTS

Hypertension, diabetes mellitus, family history of spontaneous intracerebral hemorrhage (SICH), and low cholesterol level increase risk of female SDICH, whereas hypertension, alcohol use, smoking history, family history of SICH, and low cholesterol level are an important risk factor for male SDICH. After adjusting for covariates, only haplotype ACE T-D (OR = 2.7, 95% CI, 1.1-6.5, P = 0.02) was associated with female SDICH.

CONCLUSIONS

This study demonstrates that environmental risk factors play a major role and ACE polymorphisms play a minor role in contributing risk of SDICH in Taiwan.

Ionophore-catalyzed cation transport between phospholipid inverted micelles manifest in DNMR

Studies of hyperfine shifts of lipid 31P resonances due to hydrated phospholipid inverted micelles in benzene are presented. Systems with distinct resonances from micelles containing no paramagnetic ions, and from micelles containing a single praseodymium(III) or a single europium(III) ion (and three nitrate counterions) have been generated. The addition of an ionophoric antibiotic from Streptomyces lasaliensis, lasalocid-A (X537A). causes both resonances to broaden and. with further additions, coalesce and eventually resharpen as a single line. Dilution of only the ionophore reverses these spectral changes. This is interpreted as a manifestation of dynamic NMR (DNMR. exchange broadening): i.e., that the ionophore catalyzes the equilibrium exchange of metal ions from micelle to micelle to the point where it becomes fast on the NMR time scale. This exchange is inhibited by protons or other competitive metal ions. We have simulated the spectra with a total lineshape analysis program and have thus extracted the average preexchange lifetimes for various concentrations of the antibiotic. We find a reasonably good first-order dependence on lasalocid-A concentration in each of several different experiments. This is in contrast to the higher order concentration dependences often observed by others using different techniques employing bilayer membranes. We favor a diffusional carrier mechanism involving surface aggregates of lasalocid-A for our process. This leads to the implication that a higher order concentration dependence found for a bilayer system arises from a different mechanism. The ionophore valinomycin does not catalyze rapid exchange in our system.

Hypokalemic thyrotoxic periodic paralysis: clinical characteristics and predictors of recurrent paralytic attacks

BACKGROUND AND PURPOSE

To study the clinical characteristics of hypokalemic thyrotoxic periodic paralysis (hoTPP) and identify the predictors of recurrent paralytic attacks before achieving the euthyroid status.

METHODS

We retrospectively analyzed 45 hoTPP patients who were admitted during the 7-year study period.

RESULTS

A tendency towards male predominance was observed among the 45 patients (91.1%, 41/45). The mean onset age was 32.9 +/- 10.0 years (range: 16-54 years). No significant differences were observed in the onset age between male and female patients. Precipitating factors included rest/sleep at night, hot weather, upper respiratory tract infections (URIs), and excessive physical activities. Atypical weakness was observed in nine (20%, 9/45) patients. One patient initially diagnosed with sporadic periodic paralysis eventually developed hoTPP.

DISCUSSION

In provocative tests, hypokalemia was not a consistent finding during paralytic attacks. Before achieving the euthyroid status, the rate of recurrent attacks was as high as 62.2%, and peaked in the first 3 months after hoTPP was diagnosed. Patients with URIs exhibited a higher incidence of recurrent paralytic attacks than those without (odds ratio = 13.00; 95% confidence interval = 1.08-156.08; P = 0.04).

Clinical features, vascular risk factors, and prognosis for transient global amnesia in Chinese patients

BACKGROUND

Transient global amnesia (TGA) is an intriguing clinical syndrome that has not been studied in a series of Chinese patients.

METHODS

From 1989 to 1995, we observed 28 consecutive patients with TGA. Their clinical characteristics, risk factors, and outcome were retrospectively reviewed and analyzed.

RESULTS

There were 13 men and 15 women with a mean age of 62 years (range, 39 to 76). The duration of amnesic attack ranged from 20 minutes to 24 hours (mean, 8 hours), with the majority (76%) of attacks lasting for 2 to 12 hours. In 9 (32%) of the 28 patients, the TGA was triggered by a potential precipitating factor including bathing, emotional stress, and headache. The most prominent symptom exhibited by patients during an attack was repetitive questioning, which occurred in 21 (75%) of the 28 patients. No focal neurological abnormality was noted during or after the attack. Electroencephalograms were obtained in 26 patients after experiencing TGA, which showed nonspecific findings in 6 patients and were normal in 20. In 21 patients who had cranial computed tomography scans, cortical atrophy was found in 5 (24%), focal infarction in 4 (19%), and the results were negative in 12 (57%). Hypertension was the predominant vascular risk factor (11 cases, 39%), then hyperlipidemia (7 cases, 25%), and smoking (3 cases, 11%). No vascular risk factor was found in 13 patients (46%). Recurrent TGA was found in 5 patients (18%), and stroke in 2 (7%).

CONCLUSION

Our study largely confirms the demographic pattern, clinical characteristics, and prognosis of TGA patients reported from the western countries. Although the cause is uncertain, TGA is a relatively benign entity.