Transcatheter aortic valve implantation: recommendations for practice based on a multidisciplinary review including cost-effectiveness and ethical and organizational issues

Transcatheter aortic valve implantation (TAVI) is a relatively new technology for the treatment of severe and symptomatic aortic valve stenosis. TAVI offers an alternative therapy for patients unable to be treated surgically because of contraindications or severe comorbidities. It is being rapidly dispersed in Canada, as it is worldwide. The objective of this article is to present our recommendations for the use of TAVI, based on a multidisciplinary evaluation of recently published evidence. We systematically searched and summarized published data (2008-2011) on benefits, risks, and cost-effectiveness of TAVI. We also examined ethical issues and organizational aspects of delivering the intervention. We discussed the soundness and applicability of our recommendations with clinical experts active in the field. The published TAVI results for high-risk and/or inoperable patients are promising in terms of survival, function, quality of life, and cost-effectiveness, although we noted large variability in the survival rates at 1 year and in the frequency of important adverse outcomes such as stroke. Until more data from randomized controlled trials and registries become available, prudence and discernment are necessary in the choice of patients most likely to benefit. Patients need to be well-informed about gaps in the evidence base. Our recommendations support the use of TAVI in the context of strict conditions with respect to patient eligibility, the patient selection process, organizational requirements, and the tracking of patient outcomes with a mandatory registry.

Icariin: a potential promoting compound for cartilage tissue engineering

OBJECTIVE

To investigate whether icariin, which is a widely used pharmacological constituent in traditional Chinese herbal medicine, can be a potential promoting compound for cartilage tissue engineering.

DESIGN

Icariin was added into cell-hydrogel constructs derived from neonatal rabbit chondrocytes and collagen type I. The chondrogenic gene expressions and the synthesis of cartilage matrix of the seeded cells were detected by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and Biochemical assay. The effects of icariin-added cell-hydrogel constructs on the restoration of supercritical-sized osteochondral defects of adult rabbit were investigated by histological observation. The cell-hydrogel constructs without Icariin were set for controls.

RESULTS

Icariin obviously up-regulate the expressions included aggrecan, sox9, and collagen type II of seeded chondrocytes from 99.7% to 248%. It increases the synthesis of glycosaminoglycan and collagen type II about fourfold to fivefolds from week 1 to week 4, and accelerates the formation of chondroid tissue in the cell-hydrogel constructs. Even, it improves the restoration efficiency of supercritical-sized osteochondral defects in adult rabbit model, and enhances the integration of new-formed cartilage with subchondral bone.

CONCLUSIONS

Icariin can be a potential promoting compound for cartilage tissue engineering, and it can be a substitute for the use of some growth factors. The long history and extensive cases of safe use in China, Japan and Korea make it more attractive.

Octanoylated Ghrelin Inhibits the Activation of the Palmitic Acid-Induced TLR4/NF-κB Signaling Pathway in THP-1 Macrophages

To investigate the effect of acylated ghrelin on the activation of TLR4/NF-κB signaling pathway induced by palmitic acid in human monocyte-derived (THP-1) macrophages, THP-1 macrophages were cultured for 12 h by palmitic acid with various concentrations. The THP-1 macrophages was pretreated by acylated ghrelin at different doses for 4 h before cultivated by palmitic acid (200 μmol/L) for 12 h. We observed the level of TLR4, NF-κB p65 phosphorylation in THP-1 macrophages and TNF-α, IL-1β in culture supernatant. TLR4 mRNA was measured by real-time PCR. TLR4 protein and NF-κB p65 phosphorylation was measured by western blotting. The expression of TNF-α and IL-1β was detected by ELISA. Compared to the THP-1 macrophages without palmitic acid, the level of TLR4 mRNA protein and NF-κB p65 phosphorylation and the expression of TNF-α and IL-1β increased after treatment by palmitic acid in a dose-dependent fashion (P < 0.05). Compared to the THP-1 macrophages with palmitic acid (200 μmol/L), the level of the pervious substances decreased after preadministration by acylated ghrelin in a dose-dependent fashion. So, we make a conclusion that acylated ghrelin can regulate the activation of TLR4/NF-κB signaling pathway and inhibit the release of inflammatory cytokines in THP-1 macrophages which are stimulated by palmitic acid in a dose-dependent fashion.

Extensive haplotype diversity in African American mothers and their cord blood units

HLA-A, -B, -C, -DRB1, -DQB1 assignments were obtained for 374 pairs of African American mothers and their umbilical cord blood units (CBU) by DNA sequencing. An algorithm developed by the National Marrow Donor Program was used to assign 1122 haplotypes by segregation. Seventy percent of the haplotypes carried assignments at all five loci. In the remainder, alleles at various loci, most often DQB1 in 48% of the haplotypes with a missing assignment, could not be assigned due to sharing of both alleles by mother and CBU. There were 652 haplotypes carrying a unique combination of alleles at the five loci; the majority (74%) were singletons. Novel B∼C and DRB1~DQB1 associations were observed. The results show the genetic diversity in this population and provide validation for a publically available tool for pedigree analysis. Our observations underscore the need for procurement of increased numbers of units in the national cord blood inventory in order to identify matching donors for all patients requiring hematopoietic stem cell transplantation.

X-ray emission spectroscopy of cerium across the γ-α volume collapse transition

High-pressure x-ray emission measurements are used to provide crucial evidence in the longstanding debate over the nature of the isostructural (α, γ) volume collapse in elemental cerium. Extended local atomic model calculations show that the satellite of the Lγ emission line offers direct access to the total angular momentum observable (J(2)). This satellite experiences a 30% steplike decrease across the volume collapse, validating the Kondo model in conjunction with previous measurements. Direct comparisons are made with previous predictions by dynamical mean field theory. A general experimental methodology is demonstrated for analogous work on a wide range of strongly correlated f-electron systems.

Developmental changes of <i>GHR</i> and <i>IGF-I</i> mRNA expression in lamb rumen

Abstract. Lambs from birth (0-day-old) to 56-day-old were selected in present study to investigate developmental changes of growth hormone receptor (GHR) and insulin-like growth factor I (IGF-I) mRNA expression in their rumen tissue. Forty-five lambs (5 lambs per group) were slaughtered at 0, 7, 14, 21, 28, 35, 42, 49, 56 days of age respectively for sampling the tissue of the rumen dorsal sac. The abundance of GHR and IGF-I mRNA were detected through real-time quantitative PCR method. The results indicated that the expression levels of GHR and IGF-I mRNA had similar change tendency in rumen tissue that the GHR and IGF-I mRNA abundance decreased with age from birth to 56-day-old. There was significant positive correlation between the two gene mRNA expression levels. The results suggested that GHR and IGF-I gene expression levels had the specific developmental pattern in rumen tissue.

[A study on the relationship between HPV infection and the oncogenesis of primary squamous carcinoma of the lung.]

BACKGROUND

To research the relationship between human papillomavirus (HPV) infection and the oncogenesis of primary squamous carcinoma of the lung.

METHODS

50 formalin-fixed paraffin-embedded tissues of squamous cell carcinoma of the lung , 30 samples of areas of squamous epithelium metaplasia near tumors , and 30 samples of normal bronchial mucosa were detected for the presence of HPV DNA by polymerase chain reaction (PCR) .

RESULTS

In these samples , the positive detection rate of HPV DNA was 26%, 36.7% and 10% respectively. Of the detected HPV DNA , HPV16 was of the highest ratio. The positive rate of HPV6/11 and HPV16 in squamous cell carcinoma and squamous epithelium metaplasia had no significant difference by Chi-Square test ( P > 0. 05) .

CONCLUSIONS

These results suggest that HPV infection might play an important role in the oncogenesis of squamous cell carcinomas of the lung , and squamous epithelium metaplasia of the bronchus could be regarded as a precancer lesion. Compared with biotinylated DNA probes and hybridization technique , PCR has a higher sensitivity.

Methanol from TES global observations: retrieval algorithm and seasonal and spatial variability

We present a detailed description of the TES methanol (CH3OH) retrieval algorithm, along with initial global results showing the seasonal and spatial distribution of methanol in the lower troposphere. The full development of the TES methanol retrieval is described, including microwindow selection, error analysis, and the utilization of a priori and initial guess information provided by the GEOS-Chem chemical transport model. Retrieval simulations and a sensitivity analysis using the developed retrieval strategy show that TES: (i) generally provides less than 1.0 piece of information, (ii) is sensitive in the lower troposphere with peak sensitivity typically occurring between ~900-700 hPa (~1-3 km) at a vertical resolution of ~5 km, (iii) has a limit of detectability between 0.5 and 1.0 ppbv Representative Volume Mixing Ratio (RVMR) depending on the atmospheric conditions, corresponding roughly to a profile with a maximum concentration of at least 1 to 2 ppbv, and (iv) in a simulation environment has a mean bias of 0.16 ppbv with a standard deviation of 0.34 ppbv. Applying the newly derived TES retrieval globally and comparing the results with corresponding GEOS-Chem output, we find generally consistent large-scale patterns between the two. However, TES often reveals higher methanol concentrations than simulated in the Northern Hemisphere spring, summer and fall. In the Southern Hemisphere, the TES methanol observations indicate a model overestimate over the bulk of South America from December through July, and a model underestimate during the biomass burning season.

Flagellin-PAc fusion protein is a high-efficacy anti-caries mucosal vaccine

We previously demonstrated that an anti-caries DNA vaccine intranasally administered with recombinant flagellin protein as a mucosal adjuvant enhanced salivary IgA response and conferred better protection against caries. However, the relatively weak immunogenicity of DNA vaccines and the necessity for a large quantity of antigens remain significant challenges. Here, we fused the flagellin derived from E. coli (KF) and target antigen PAc containing the A-P fragment of PAc from S. mutans (rPAc) to produce a single recombinant protein (KF-rPAc). The abilities of KF-rPAc to induce rPAc-specific mucosal and systemic responses and protective efficiency against caries following intranasal immunization were compared with those of rPAc alone or a mixture of rPAc and KF (KF + rPAc) in rats. Results showed that KF-rPAc promoted significantly higher rPAc-specific antibodies in serum as well as in saliva than did an equivalent dose of rPAc alone or a mixture of KF + rPAc. Intranasal immunization of 8.5 µg KF-rPAc could achieve 64.2% reduction of dental caries in rats. In conclusion, our study demonstrated that flagellin and PAc fusion strategy is promising for anti-caries vaccine development, and KF-rPAc could be used as an anti-caries mucosal vaccine.

Different approaches to expressing Edwardsiella tarda antigen GAPDH in attenuated Vibrio anguillarum for multivalent fish vaccines

With the development of gene technology, expressing heterologous antigens in attenuated bacteria has become an important strategy to design multivalent vaccines. In our previous work, an attenuated Vibrio anguillarum named MVAV6203 was developed and proven to be an efficient live vaccine candidate. In this research, we aimed to express protective antigen glyceraldehyde-3-phosphate dehydrogenase (GAPDH) of Edwardsiella tarda in attenuated Vibrio anguillarum to establish a multivalent V. anguillarum vector vaccine. Several strategies were compared between low- vs. high-copy plasmid-mediated antigen expression, in vivo-inducible vs. constitutive antigen expression and intracellular vs. surface-displaying antigen expression. Zebrafish, Danio rerio (Hamilton), was applied as the fish model to evaluate the immune protection of the V. anguillarum vector vaccine candidates. Our results demonstrated that V. anguillarum MVAV6203 (pUTatLNG40), which harbours a low-copy plasmid-loaded antigen surface display system under the control of a constitutive promoter, presented the best protective efficacy against the infection of Vibrio anguillarum (relative per cent survival, RPS = 85%) and Edwardsiella tarda (RPS = 70%).