Antineutrophil cytoplasmic antibodies (ANCA) in Chinese patients with anti-GBM crescentic glomerulonephritis

OBJECTIVE

To study the prevalence of ANCA and their target antigen in Chinese patients with anti-GBM crescentic glomerulonephritis (CGN), and to evaluate the possible role of ANCA in Chinese anti-GBM CGN patients with coexisting serum ANCA by studying clinicopathologic features of this disease.

MATERIAL AND METHODS

Twenty-three sera were collected from 23 renal biopsy-proven anti-GBM CGN patients. According to the standardized procedures, all of the sera were determined by both, indirect immunofluorescence (IIF) ANCA, and enzyme-linked immunosorbent assay (ELISA) MPO-ANCA, PR3-ANCA and BPI-ANCA. The patients were divided into two groups according to serum ANCA positivity (Group A) or negativity (Group B). Thirty-three ANCA-associated pauci-immune CGN patients were regarded as control group (Group C). Their clinicopathologic features were compared to reveal whether ANCA correlated with disease activity.

RESULTS

There were 11 (47.8%) cases with positive serum ANCA in 23 anti-GBM glomerulonephritis patients. There were 4/11 MPO-ANCA (one with positive PR3-ANCA and C-ANCA, three with negative IIF-ANCA), 1/11 PR3-ANCA (with positive MPO-ANCA and C-ANCA), 3/11 P-ANCA (with negative ELISA-ANCA) and 5/11 C-ANCA (one with positive PR3-ANCA and MPO-ANCA, and the other four with negative ELISA-ANCA). No BPI-ANCA was detected. No different clinicopathologic features were found between Groups A and B. Both were different from Group C in age, sex ratio, frequence of anuria and ESRD, variety of crescents, glomerular sclerosis, vessel lesion and prognosis.

CONCLUSION

Our data demonstrate that ANCA in Chinese patients with anti-GBM CGN is not rare. The major target antigen of ANCA is MPO. ANCA seems not to be correlated with disease activity.

Sequence variation and gene duplication at MHC DQB loci of baiji (Lipotes vexillifer), a Chinese river dolphin

The major histocompatibility complex (MHC) is a fundamental part of the vertebrate immune system, and the high variability in many MHC genes is thought to play an important role in the recognition of parasites. Baiji (Lipotes vexillifer) is one of the most endangered species in the world. Its wild population has declined to fewer than 100 individuals and has a very high risk of becoming extinct in the near future. In this study we present a first step in the molecular characterization of a DQB-like locus of baiji by nucleotide sequence analysis of the polymorphic exon 2 segments. In the examined 172 bp sequences from a group of 18 incidentally captured or stranded individuals, 48 variable sites were determined and 43 alleles were identified, many of which were represented by only one clone. Three to seven alleles were found in each individual, suggesting gene duplications. No deletion, insertion, or exceptional stop codon was detected, suggesting these alleles function in vivo. Phylogenetic reconstruction using neighbor joining grouped the 43 alleles into two distinct lineages, differing by seven nucleotides and four amino acids. Substitutions of amino acids tend to be clustered around sites postulated to be responsible for selective peptide recognition. In the peptide-binding region (PBR) of the DQB locus, the average number of nonsynonymous substitutions per site is greater than that of synonymous substitutions per site (0.1962 versus 0.0256, respectively). Nucleotide and amino acid sequences both showed a relatively high level of similarity (nucleotides 90.6%; amino acids 80.6%) to those of beluga whale (Delphinapterus leucas) and narwhal (Monodon monoceros). The high level of baiji MHC polymorphism revealed in the present study has not been reported in other cetaceans and could be a consequence of the small baiji population adapting to freshwater with a relatively high level of pathogens.

Variation in nutrient intakes among women in Shanghai, China

BACKGROUND

In 1997, we launched a large population-based cohort study, the Shanghai Women Health Study (SWHS), to investigate diet in relation to cancer risk among 74 943 Chinese women. Simultaneously, a dietary calibration study was conducted among 200 SWHS participants with biweekly 24-h dietary recall (24HDR) over a 1-y period in order to evaluate the validity and reliability of the SWHS food frequency questionnaire (FFQ).

OBJECTIVE

The objectives of the current study were to evaluate the nature and magnitude of variances for intake of 26 nutrients among SWHS participants, and to estimate the number of 24HDR needed for estimate intake of the 26 nutrients examined in the study population.

DESIGN

In all, 1-y biweekly 24HDR collected from 200 healthy, free-living women aged between 40 and 70 y, who participated in the SWHS dietary calibration study, was analyzed by mixed effects model and ratios of within-individual and between-individual dietary intake variances (sigma(w)(2)/sigma(b)(2)) were estimated.

RESULTS

In agreement with reports from studies conducted in the US, we found that within-individual variances were larger than between-individual variances in dietary intake of most nutrients. The sum of all other variation (eg, weekday and weekend, seasonal, interviewer) accounted for less than 5% of total variation. Ratios of within- to between-individual variances (for log transformed data) ranged from 1.05 (carbohydrate) to 2.79 (fat) for macronutrient intake, 1.74 (niacin) to 8.48 (delta-tocopherol) for vitamin intake, and 1.35 (phosphorus) to 5.59 (sodium) for mineral intake.

CONCLUSIONS

The results of this study suggest that within- and between-individual differences in nutrient intake are the major sources of variation in this population of adult Chinese women. Cultural practices as well as seasonal supply and consumption patterns of vegetable intake are likely the major contributors to the variation. Implications of these results are discussed.

Clinical and cytogenetic features of 508 Chinese patients with myelodysplastic syndrome and comparison with those in Western countries

Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder characterized by ineffective hematopoiesis and leukemia progression. Racial differences may exist on clinical pictures and the molecular events leading to MDS, which are heterogeneous. To better define the clinical and cytogenetic features in Chinese patients, a retrospective multicentric study was performed in 508 MDS cases. Compared with Western countries, Chinese patients showed younger age (median: 49 vs 65-73 years), lower percentages of RARS (2.8 vs 6.6-15.3%), and CMML (5.2 vs 11.7-30.6%). Cytogenetically, among 367 cases with evaluable data, abnormal karyotypes were found in 136 cases, including 56 numerical and 80 structural changes. Incidences of single chromosome 5 and 7 abnormalities were lower than those in Western countries (2.2 vs 17.8-42.5%). However, complex cytogenetic aberrations and chromosome translocations were frequently observed and related to poor prognosis. Both multiple chromosome deletions and translocations were detected in advanced subtypes (RAEB and RAEB-T). Analysis of 200 cases revealed a higher incidence of hepatitis-B-virus infection than that in non-MDS population (21.00 vs 9.75%). This study further confirmed: (1) different genetic/environmental backgrounds between Asian and Western MDS populations; (2) a strong predictive value of cytogenetic abnormalities on disease outcome and involvement of genomic instability in leukemia clone development.

Potentiation and cellular phenotypes of the insecticidal Toxin complexes of Photorhabdus bacteria

The toxin complex (tc) genes of bacteria comprise a large and growing family whose mode of action remains obscure. In the insect pathogen Photorhabdus, tc genes encode high molecular weight insecticidal toxins with oral activity against caterpillar pests. One protein, TcdA, has recently been expressed in transgenic plants and shown to confer insect resistance. These toxins therefore represent alternatives to toxins from Bacillus thuringiensis (Bt) for deployment in transgenic crops. Levels of TcdA expression in transgenic plants were, however, low and the full toxicity associated with the native toxin was not reconstituted. Here we show that increased activity of the toxin TcdA1 requires potentiation by either of two pairs of gene products, TcdB1 and TccC1 or TcdB2 and TccC3. Moreover, these same pairs of proteins can also cross-potentiate a second toxin, TcaA1B1. To elucidate the likely functional domains present in these large proteins, we expressed fragments of each 'toxin' or 'potentiator' gene within mammalian cells. Several domains produced abnormal cellular morphologies leading to cell death, while others showed specific phenotypes such as nuclear translocation. Our results prove that the Tc toxins are complex proteins with multiple functional domains. They also show that both toxin genes and their potentiator pairs will need to be expressed to reconstitute full activity in insect-resistant transgenic plants. Moreover, they suggest that the same potentiator pair will be able to cross-potentiate more than one toxin in a single plant.

The role of B7-2 (CD86) in tumour immunity

Tumour cells engineered to express co-stimulatory molecules on their surface provide researchers with powerful new tools to manipulate antitumour responses. It has been demonstrated that B7-1+ and B7-2+ tumour cells can elicit effective responses against their wild-type counterparts. This response is primarily mediated by CD8+ cytolytic T-lymphocytes. The co-stimulatory ability of B7-2+ tumour cells is comparable to that of B7-1+ tumour cells, though with some exceptions. However, on host antigen-presenting cells (APC), B7-2 plays a dominant role in inducing T-cell-mediated immune responses. Up-regulation of B7-2 on host APC may, therefore, present an effective means of generating potent antitumour immunity.

Genomic organisation of the chicken ghrelin gene and its single nucleotide polymorphisms detected by denaturing high-performance liquid chromatography

(1) Ghrelin is a novel endogenous ligand for the growth hormone secretagogue receptor (GHS-R) and is expressed primarily in the stomach and hypothalamus with the probable function of stimulating GH secretion and food intake both in mammals and poultry. The complete sequences of ghrelin gene have been reported in humans and mice; however, that of chickens remains unclear. (2) Here, we report the complete sequence of chicken ghrelin gene (submitted to Genbank; accession number AY303688), which consists of 5 exons and 4 introns. As in mice, the first exon of chicken ghrelin gene does not encode any amino acid. (3) Scanning point mutations with denaturing high-performance liquid chromatography (DHPLC) using WAVE DNA Fragment Analysis Systems and confirmed with direct sequencing for polymerase chain reaction (PCR) products, we analysed the single nucleotide polymorphisms (SNPs) in the entire gene of chicken ghrelin. (4) Results showed that there were 19 SNPs in chicken ghrelin gene, and most of these SNPs were scattered in the 4 introns. In these SNPs, one mutation in exon 5 (A2355G) led to the change of amino acid from glutamine to arginine (Gln 113 Arg): as a result a different ghrelin precursor instead of a mature peptide was produced. In addition, one SNP in 5'UTR (C223G) determined the presence or absence of a potential binding site of transcription factor serum response factor (SRF), which might affect the expression of chicken ghrelin gene. Some of the SNPs detected in the present study could be used in quantitative trait loci (QTL) mapping for growth characters in chickens. (5) Because one SNP is located in a polymorphic site of restriction enzyme PagI of intron 4, it was possible to design a PCR-RFLP procedure and analyse the diversity of 10 chicken populations. Results showed the allelic frequencies of C2100T differ among these breeds, however, no significant difference was observed between imported breeds and Chinese native ones, nor between egg layers and meat type chickens. A chi-square test showed that 4 chicken populations of Beijing Fat, Xinghua, Recessive White and Silky followed the Hardy-Weinberg equilibrium.

Soyfood consumption and risk of glycosuria: a cross-sectional study within the Shanghai Women's Health Study

OBJECTIVE

To assess the association between soyfood intake and risk of glycosuria.

DESIGN AND METHODS

A cross-sectional study was conducted among participants of the Shanghai Women's Health Study, a population-based cohort study of women aged 40-70 y. Information on usual intake of soyfoods was obtained at baseline survey through an in-person interview using a validated food-frequency questionnaire. Included in this study were 39,385 cohort members screened for diabetes at the baseline survey and free of previously diagnosed diabetes, cardiovascular diseases, kidney diseases, and cancer. There were 323 women who tested positive for urine glucose. Odds ratios (ORs) and 95% confidence intervals (CIs) were employed to measure the association between soyfood intake and glycosuria using unconditional logistic regression.

SETTING

Urban communities of Shanghai, China.

RESULTS

Overall, soyfood intake was not related to the risk of glycosuria. Among postmenopausal women, however, intake of tofu and other soy products was inversely associated with risk of glycosuria after adjustment for potential confounders. The ORs across quintiles of intake were 1.0, 0.75 (95% CI=0.47-1.20), 0.79 (95% CI=0.51-1.25), 0.53 (95% CI=0.32-0.88), and 0.51 (95% CI=0.26-0.98; P for trend=0.05). Further analyses showed that the inverse association was primarily confined to postmenopausal women with a body mass index (BMI) of <25 kg/m2. The adjusted OR comparing the extreme quintiles was 0.36 (95% CI=0.13-0.97; P for trend=0.004).

CONCLUSIONS

Soyfoods may play a role in the development of glycosuria, an important indicator of diabetes, among postmenopausal women with a low BMI.

Validity and reproducibility of the food frequency questionnaire used in the Shanghai Women's Health Study

To evaluate the validity and reliability of the food frequency questionnaire (FFQ) used in the Shanghai Women's Health Study (SWHS), 200 SWHS participants were recruited for a dietary calibration study. Study participants completed an FFQ at baseline and 24-h dietary recalls (24-HDR) twice per month consecutively for 12 months. At the end of the study, a second FFQ was administered. Of the 200 study participants, 196 completed 24 or more days of 24-h dietary recalls, 191 completed two FFQs from whom the results of this report were based. The FFQ included the foods that accounted for 86% of the foods recorded in the 24-HDR surveys. Validity of the FFQ was evaluated by comparing intake levels of major nutrients and foods obtained from the second FFQ with those derived from the multiple 24-HDR. The median intake for major nutrients, rice, poultry and meat derived from the second FFQ and the 24-HDR was similar, with the differences ranging from 1.3 to 12.1%. The FFQ tended to overestimate the intake level of total vegetables and total fruits, and the differences were explained mainly by over-reporting seasonal vegetables and fruits consumption in the FFQ. Nutrient and food intake assessed by the FFQ and the multiple 24-HDR correlated very well, with the correlation coefficients being 0.59-0.66 for macronutrients, 0.41-0.59 for micronutrients, and 0.41-0.66 for major food groups. The reliability of the FFQ was assessed by comparing the correlation and median intake of nutrients and food groups obtained from the two FFQs that were administered approximately 2 y apart. The median intake levels for selected nutrients and food groups derived from the two FFQs were similar with differences below 10%. At the individual level, the intake levels of these dietary variables obtained from two FFQs also correlated well. When nutrient and food group intakes were categorized into quartiles, FFQ and 24-HDR produced exact agreement rates between 33 and 50%. Misclassification to adjacent quartile was common, ranging from 34-48%, while misclassification to an extreme quartile was rare (1-6%). These data indicate that the SWHS FFQ can reliably and accurately measure usual intake of major nutrients and food groups among women in Shanghai.

Should preoperative, post-chemoradiotherapy endoscopy be routine for esophageal cancer patients?

Chemoradiation therapy is used widely for locoregional esophageal cancer. Patients with persistent disease may benefit from surgery. Preoperative esophagoscopy can identify persistent tumor but its accuracy is uncertain. The primary objective of this study is to assess the extent of agreement between esophagoscopy and surgical pathology in patients treated with neoadjuvant chemoradiation. A retrospective chart review of patients who underwent chemoradiation, preoperative endoscopy and surgery from January 1996 to December 2002 was performed. Cohen's kappa statistic was used to measure the degree of agreement between findings at endoscopic biopsy and surgical pathology. Thirty cases were identified. All patients received chemoradiation followed by surgical resection. There was insufficient agreement between tumor size (kappa 0.25, standard error 0.17, P = 0.07) and appearance (kappa 0.19, standard error 0.18, P = 0.14). Preoperative endoscopy revealed atypia/inflammation in 15 cases and dysplasia in eight. Of these 23 cases, 11 were adenocarcinomas at surgery. Only nine patients had concurrence between surgical pathology and endoscopy. The positive and negative predictive values of esophagoscopy for identifying residual tumor were 100% and 11%, respectively. Our data suggests that after chemoradiation, esophagoscopy is unreliable for excluding residual disease. The roles of other modalities need to be explored.

Anthropometric predictors of coronary heart disease in Chinese women

OBJECTIVE

To evaluate the associations of body size and fat distribution with incidence of coronary heart disease (CHD) in Chinese women.

DESIGN

Population-based, prospective cohort study.

SUBJECTS

A total of 67 334 women aged 40-70 y, who had no prior history of CHD, stroke, and cancer at study recruitment.

MEASUREMENTS

Weight, standing and sitting heights, circumferences of waist and hip, and ratios of the anthropometric measurements.

OUTCOME

incidence of CHD (non-fatal myocardial infarction (MI) or fatal CHD).

RESULTS

After a mean follow-up of 2.5 y (168 164 person-years), there were 70 incident cases of CHD (49 non-fatal MIs and 21 CHD deaths). Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-standing height ratio (WHtR), waist-to-sitting height ratio (WsHtR), and conicity index were all positively associated with the risk of CHD. With the exception of WHR, all other anthropometric indexes only predicted the risk of CHD among women </=55 y of age at enrollment. The relative risks (RRs) between extreme tertiles of BMI were 9.0 (95% CI, 2.0-41.5; P for trend=0.002) for younger women vs 1.3 (0.6-3.0; P for trend=0.83) for older women. Similarly, the RRs for WC, WHtR, WsHtR, and conicity index were 6.1 (1.8-21.4) vs 1.9 (0.6-5.4), 9.4 (2.6-33.8) vs 1.2 (0.5-3.1), 15.2 (3.3-69.1) vs 1.0 (0.4-2.5), and 7.8 (2.2-28.0) vs 0.9 (0.4-2.3) for the young and elderly, respectively. In contrast, the RR for WHR was 3.2 (1.1-9.1) for the young and 2.9 (1.0-8.4) for the elderly.

CONCLUSIONS

WHR was positively associated with the risk of CHD in both younger and older women, while other anthropometrics, including BMI, were related to CHD risk primarily among younger women.

Body fat distribution and risk of diabetes among Chinese women

OBJECTIVE

To assess the relationship between measures of central and overall obesity and risk of diabetes.

DESIGN

Nested case-control study.

SETTING

Shanghai, China.

PARTICIPANTS

A total of 57 130 women were screened for diabetes at enrollment for the Shanghai Women's Health Study (SWHS), a population-based cohort study of Chinese women aged 40-70 y. In this study, 345 women diagnosed with diabetes and 2760 age-matched controls (eight controls per case), randomly selected from women who tested negative for urine glucose, were included.

RESULTS

Risk of diabetes increased significantly with increasing levels of obesity, particularly with measures of central obesity. Compared to those in the lowest quartile, women in the highest quartile of body mass index (BMI) (>/=26.57) and waist to hip ratio (WHR) (>/=0.855) had a 2.57-fold (95% CI 1.75-3.77) and a 6.05-fold (95% CI 4.05-9.04) increased risk of diabetes, respectively. The risk of diabetes was elevated with increasing WHR at all levels of BMI, while the positive association between BMI and diabetes was observed primarily among women with a low WHR. However, test for multiplicative interaction was not statistically significant.

CONCLUSIONS

Our data indicated that central obesity is a stronger risk factor for diabetes than overall obesity, suggesting that WHR may be a better indicator of risk of diabetes than BMI among Chinese women.

Sociodemographic, behavioral, and reproductive factors associated with weight gain in Chinese women

OBJECTIVE

To examine whether certain sociodemographic, behavioral, and reproductive factors are associated with an increased weight gain in Chinese women.

DESIGN

Baseline survey data, including recalled past weight and measured current weight, from an ongoing prospective cohort study conducted in Shanghai, China.

SUBJECTS

The analytical sample included 75 039 nonpregnant women aged 40-70 y.

MEASUREMENTS

Statistical associations between certain sociodemographic, behavioral, and reproductive factors and weight gain were evaluated using multiple linear and logistic regression models.

RESULTS

Weight gain and waist-to-hip ratio (WHR) increased with age among pre- and postmenopausal women before age 55 y. Weight gain declined but WHR continued rising as aging among postmenopausal women over age 55 y. Lower education levels, more parity and earlier age at the first birth, and earlier menarcheal age were associated with a higher long-term weight gain and current body weight.

CONCLUSION

Age, education levels, parity, age at the first live birth, and menarcheal age were associated with long-term weight gain in Chinese women. However, these results concerning weight gain are based on recalled past weight and should be interpreted with caution. Further studies are needed to clarify the association of weight gain with lifestyle factors suggested by this study.

Gene therapy for prostate cancer: toxicological profile of four HSV-tk transducing adenoviral vectors regulated by different promoters

Adenoviral vector delivery of the Herpes simplex virus thymidine kinase (HSV-tk) gene in combination with the prodrug ganciclovir (GCV) has been tested in phase I clinical trials for prostate cancer and found to exhibit a satisfactory toxicity profile. We have developed additional adenoviral vectors with differing promoters to optimize the expression profile and in the present study evaluate the potential systemic toxicity of these vectors. Four recombinant adenoviral vectors that express the HSV-tk gene were generated using three different promoters: CMV (leftward orientation); RSV (both rightward and leftward orientation); and the mouse caveolin-1 (cav-1) promoter (leftward orientation). Efficacy was determined in vitro by cytotoxicity assays in a mouse prostate cancer cell line, RM-9, and in vivo by treating orthotopic tumors. Potential toxicity was evaluated from liver histology and apoptotic cell counts and enzyme levels in the serum following intravenous adenoviral vector injection. Although there were differences in HSV-tk expression at the protein level among the four vectors there were no significant differences in in-vitro cytotoxicity studies with GCV or in vivo in tumor growth suppression of an orthotopic mouse prostate cancer model in GCV treated mice. Intravenous delivery of high doses of all adenoviral vectors lead to abnormalities in liver function as measured by specific serum markers and histological evaluation of liver tissue and increased levels of apoptosis in the liver. These abnormalities were most prevalent with the vector containing the CMV promoter and the rightward oriented RSV promoter. They were least prevalent in the vector regulated by the cav-1 promoter. Upregulation of specific chemokines, MIP-2 and MIP-1beta was correlated with apoptotic counts. Our results demonstrate that comprehensive toxicological analysis of adenoviral vectors provides internally consistent information that can differentiate vectors with comparable efficacy based on toxicity. In these studies vectors with the cav-1 promoter-driven and leftward RSV-driven HSV-tk gene demonstrated minimal toxicities with cytotoxic effectiveness comparable to more toxic vectors. Our studies further suggest that promoter selection can influence the toxic effects of an adenoviral gene therapy vector.

Median nerve somatosensory evoked potentials and upper limb motor function in hemiparesis

The purpose of this study is to describe the relationship between median nerve somatosensory evoked potential (SEP) parameters and clinical measures of motor impairment and physical disability in the affected upper limb of patients with hemiparesis. SEP assessments were carried out in 28 long-term survivors of stroke. Stroke survivors with preserved SEPs over the affected hemisphere exhibited significantly lower motor impairment and physical disability than those with absent waveforms. Among those with preserved waveforms, SEP amplitude exhibited a weak correlation with degree of upper limb motor impairment. The correlation between SEP amplitude and physical disability was not statistically significant. Contrary to prior reports, median nerve SEP appears to have a weak correlational relationship with clinical measures of upper limb function in hemiparesis.