Stigmatization and shame: consequences of caring for HIV/AIDS patients in China

Using a representative sample of 478 doctors, nurses, and lab technicians working with people living with HIV/AIDS (PLWHA), a cross-sectional study was conducted to assess the impact of the AIDS epidemic on medical care systems and service providers in China. Correlation analyses showed significant association between internalized shame reported by service providers and their perception of being stigmatized due to working with PLWHA. Multivariate analyses revealed that the perceived level of institutional support for AIDS care was significantly related to the stigmatization and shame reported by the service providers. The study findings suggest that improved institutional support for AIDS care at the facility level and HIV-related stigma reduction intervention are crucial to maintain a high quality performance by the workforce in the health care system.

Identification of predictive markers to differentiate ixabepilone from paclitaxel activity in ER-negative breast cancer patients

2525

Background: Ixabepilone (BMS-247550) is a microtubule stabilizing agent with demonstrable therapeutic value in taxane- refractory breast cancer (BC) patients. Biomarkers to predict either ixabepilone or paclitaxel activity in BC patients have previously been reported. However, markers that differentiate response to the two agents have yet to be identified. This study sought to discover predictive markers that will enable patient selection to differentially enhance response to ixabepilone or paclitaxel in ER-negative (ER-) patients. Materials and Methodologies: Pre-treatment gene expression profiles were generated for 62 ER- patients treated with ixabepilone in clinical study CA163080, and 51 ER- patients treated with T/FAC (paclitaxel and fluorouracil-doxorubicin-cyclophosphamide) in clinical study MDA133. Biomarkers differentially predictive of complete pathological response in breast were identified through gene set enrichment analysis (GSEA) or classification by threshold gradient descent (TGD). Gene knockdown by siRNA was used to study some of these candidate markers. Results: Four candidate models that differentiate response to ixabepilone treatment and taxane-containing therapy were identified. Two of the models, found by GSEA, are based on expression levels for single microtubule-related genes: transforming, acidic coiled-coil containing protein 3 (TACC3) and chromosome condensation protein G (HCAP-G). The potential of HCAP-G as a differential marker was supported by siRNA studies. Two of the models, found by TGD, are based on expression levels for 26 and 20 genes. Areas under the ROC curves for the models applied to each study separately are given in the table . Conclusions: We have identified four predictive models that differentiate response in a clinical trial of ixabepilone from that in a trial of T/FAC. A clinical trial is under way to further evaluate their utility for differentiating response to ixabepilone- and taxane-containing regimens.

[Table: see text]

[Table: see text]

Identification of predictive and surrogate molecular markers for dasatinib in prostate cancer: Rationale for patient selection and efficacy monitoring

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Background: Dasatinib is a potent, multi-targeted kinase inhibitor that was recently approved for treatment of chronic myelogenous leukemia resistant to imatinib. To aid its clinical development in prostate cancer, we used a panel of prostate cancer cell lines to identify molecular markers that could be used to predict sensitivity to dasatinib and to monitor its activity. Methods: Baseline gene expression profiles of 16 cell lines were used to identify predictive biomarkers based on the correlation of gene expression with in vitro sensitivity of cells to dasatinib. Selected cell lines were treated with dasatinib to identify surrogate biomarkers based upon changes in gene expression following dasatinib treatment. Results: We identified 174 genes whose baseline expression levels were highly correlated with sensitivity or resistance to dasatinib. These include cell lineage markers cytokeratin 5 (CK5), androgen receptor (AR), and prostate specific antigen (PSA). Our results indicate that “basal type” cell lines (those with high expression of CK5 and low expression of AR and PSA) are sensitive to dasatinib. Dasatinib treatment studies further identified genes whose expression levels were significantly modulated by the drug. Ten genes, including urokinase-type plasminogen activator (uPA), were not only significantly correlated with sensitivity to dasatinib but also reduced in their expression upon drug treatment. In addition, the down-regulation of uPA was specific to dasatinib and the effect was not seen in taxol-treated cells. The extent of down-regulation was correlated with the sensitivity of cell lines to dasatinib. EphA2, a specific kinase target of dasatinib, was identified as a biomarker common to prostate and breast cancers. Finally, the expression of 5 genes including CK5, AR, PSA, uPA and EphA2 in prostate tumors was examined and the dasatinib sensitivity signature was validated using a published data set derived from a clinical population. Conclusions: Candidate markers correlated with dasatinib sensitivity were identified. A five-gene model consisting of predictive markers as well as potential surrogate markers has been formulated and will be evaluated in ongoing dasatinib prostate cancer trials.

No significant financial relationships to disclose.

Oxygen adsorption by carbon nanotubes and its application in radiotherapy

The ability to deliver large molecules, for example nucleic acids, to cells using carbon nanotubes has been reviewed. Potential applications of functionalised nanotubes to deliver oxygen to cancer cells to enhance the effects of radiotherapy are considered.

The telemedicine and teleconsultation system application in clinical medicine

Telemedicine and teleconsultation are the application and development of the telecommunication networks. Health experts can solve problems by using the electronic and communication technologies without distance limitation. In this study, we try to develop the telemedicine and teleconsultation system between local site and consulting expert site. Two applications of this system in clinical medicine are discussed. The system at each site has a workstation including a cable modem or ADSL connection, a monitor, a web camera, speakers, a microphone for communication, and NetMeeting application software. The first application in this study is to develop a school-based intervention program by using this system for high-risk school-age children in one of the earthquake-struck areas. The preliminary result of this study is that the telemedicine and teleconsultation system is more effective than traditional consultation and supervision. Moreover, we can apply this system in training local volunteers, educators, and welfare workers. Meanwhile, we can save lots of cost and time since we don't need to travel between the local site and the expert site. In the end of this study, the second application of this system in SARS case treatment was also discussed.

Congenital neuromuscular disease with uniform type 1 fiber and RYR1 mutation

BACKGROUND

Congenital neuromuscular disease with uniform type 1 fiber (CNMDU1) is a rare form of congenital myopathy, which is pathologically diagnosed by the presence of more than 99% of type 1 fiber, with no specific structural changes. Its pathogenic mechanism is still unknown. We recently reported that almost all patients with central core disease (CCD) with ryanodine receptor 1 gene (RYR1) mutations in the C-terminal domain had type 1 fibers, nearly exclusively, in addition to typical central cores.

OBJECTIVE

To investigate whether CNMDU1 is associated with RYR1 mutation.

METHODS

We studied 10 unrelated Japanese patients who were diagnosed to have CNMDU1 based on clinical features and muscle pathology showing more than 99% type 1 muscle fibers. We extracted genomic DNA from frozen muscles and directly sequenced all 106 exons and their flanking intron-exon boundaries of RYR1.

RESULTS

Four of 10 patients had a heterozygous mutation, three missense and one deletion, all in the C-terminal domain of RYR1. Two missense mutations were previously reported in CCD patients. Clinically, patients with mutations in RYR1 showed milder phenotype compared with those without mutations.

CONCLUSION

Congenital neuromuscular disease with uniform type 1 fiber (CNMDU1) in 40% of patients is associated with mutations in the C-terminal domain of RYR1, suggesting that CNMDU1 is allelic to central core disease at least in some patients.

The clinical anatomy of the triangle of Petit

INTRODUCTION

Hernias through the triangle of Petit (TP) are uncommon. The anatomy of the TP is known to be variable, yet quantitative data are scant.

MATERIALS AND METHODS

The triangle was observed in 80 adult cadavers and its dimensions and surface area were measured.

RESULTS

On the basis of surface area we classified the triangles into four types. Type I or small TP, with a surface area of <8 cm2, accounted for 43.7% of our specimens. Type II (26.2%) were intermediate in size, with a surface areas of 8-12 cm2. Type III (12.5%) were large triangles with surface areas >12 cm2. Finally, Type IV (17.5%) were not triangles. In these, the latissimus dorsi was covered by the external abdominal oblique muscle.

CONCLUSIONS

We hope these data will help prediction of which patients are at greater risk of herniation through the TP.

Gene and protein expression of protease-activated receptor 2 in structural and inflammatory cells in the nasal mucosa in seasonal allergic rhinitis

BACKGROUND

Protease-activated receptor 2 (PAR 2) has been shown to be responsible for trypsin and mast cell tryptase-induced airway inflammation. Here, the present study aimed to explore the expression of PAR 2 in the nasal mucosa of seasonal allergic rhinitis (SAR).

METHODS

Study subjects were recruited for the study by medical history, physical examination and laboratory screening tests. Using immunohistochemistry, laser-assisted cell picking and subsequently real-time PCR, nasal mucosa biopsies of SAR patients were investigated for PAR 2 gene and protein expression in complex tissues of the nasal mucosa.

RESULTS

Gene and protein expression of PAR 2 was firstly detected in nasal mucosa of SAR patients. The relative gene expression level of PAR 2 was significantly increased in complex tissues of the nasal mucosa of SAR (6.21+/-4.02 vs. controls: 1.38+/-0.86, P=0.004). Moreover, PAR 2 mRNA expression in epithelial cells (SAR: 4.78+/-4.64 vs. controls: 0.84+/-0.61, P=0.003) but not in mucus (SAR: 1.51+/-1.15 vs. controls: 1.35+/-1.02, P=0.78) and endothelial cells (SAR: 1.20+/-0.57 vs. controls: 1.73+/-1.30, P=0.5) was found to be significantly changed in the nasal mucosa in SAR. Using double immunohistochemistry the present study demonstrated that the total numbers of mast cells (P=0.0003) and eosinophils (P=0.03) and the numbers of eosinophils expressing PAR 2 (P=0.006) were significantly elevated in the nasal mucosa of SAR compared with the controls.

CONCLUSION

The abundant presence and distribution of gene and protein expression of PAR 2 in different cell types in the nasal mucosa under normal situation, the increased expression of PAR 2 in epithelial cells and the increased number of eosinophils with PAR 2 suggest that PAR 2 may contribute to the pathogenesis of allergic diseases such as SAR.

NK Cells Lyse T Regulatory Cells in Human Infection with An Intracellular Pathogen (B167)

Previously we found that regulatory T cells (CD4+CD25+Foxp3+ cells, Tregs) expand in response to M.tuberculosis (M. TB) through mechanism that depend on prostaglandin E2 production. In the current study, we determined the role of NK cells in regulating Tregs expansion in human M. TB infection. M. TB whole cell lysate (TB lysate) resulted in regulatory T cell expansion (15.33±1.02% vs 1.5±0.22%, P&lt;0.001). Addition of monokine-activated NK cells (IL-12, IL-15 and IL-18) markedly inhibited Treg expansion (6.2±1.2% vs 15±1.5%, P&lt;0.001) but freshly isolated NK cells had no effect. NK cells activated with TB lysate-stimulated monocytes also reduced Tregs expansion (13.2±0.3% to 3.4±1.4%, P&lt;0.001) confirming the physiological relevance of this effect. Reduced Tregs expansion was not due to inhibition of PGE2 production or because of IFN γ. Monokine activated NK cells lysed TB lysate-expanded Tregs, but not freashly isolated Tregs (% specific lysis of 21±3% vs 1±1% P&lt;0.001), nor T regs depleted T cells. Anti-NKG2D and anti-NKp46 reduced the % specific lysis of expanded Tregs from 22±3% to 7±3% and 8±3%, respectively (P&lt;0.001) but abs to CD16, DNAM-1, and 2B4 had no effect. NKG2D ligand, ULBP1 expression was markedly upregulated on expanded T regs, compared to T regs depleted cells ( 31±5% vs 2.1 ±0.4%, P=0.002) and freshly isolated Tregs (4.6±1.1%). Anti -ULBP1 significantly inhibited the NK mediated lysis of expanded Tregs (specific lysis of 27±4% vs 9±2%, P&lt;0.001) but abs to ULBP2, ULBP3 and MICA/B had no effect. These finding suggest that NK cells reduce the frequency of M.TB-expanded T regs by direct lysis.

Are Broadly Neutralizing Antibodies against HIV-1 Unusual? (47.32)

To date, AIDS vaccines cannot induce broadly(b)-neutralizing (Nt) antibodies (Abs) against HIV-1. It has been suggested that HIV’s Nt epitopes mimic “self” epitopes, and that bNt Abs are rare because they develop from autoreactive B cell clones that are normally deleted or made anergic by self antigens (Agns); such Abs are thought to have long CDR-H3 loops (H3s). Thus, self-tolerance must be broken to accumulate self-reactive naïve B cells whose Abs recognize Nt, HIV-1 epitopes. It has been reported that most of the bNt monoclonal (M)Abs have very long H3s, and that most react with self molecules (e.g., cardiolipin, CL). Alternatively, bNt Abs may arise out of “normal” Ab responses, with HIV Agns selecting bNt Abs with long H3s, and/or long H3s may develop via processes driven by persistent Agn.

We have begun to test these models by several approaches. Using autoAgn ELISAs and microarrays, bNt MAbs were shown not to be unusually self-reactive, compared to genuine autoreactive MAbs or autoimmune sera; also, bNt sera did not react significantly with CL. Finally, sequence analysis of ~700 human MAbs indicated that the bNt MAbs are no different than non-Nt MAbs against HIV-1 or other chronic viruses, or autoimmune anti-protein MAbs; but they are very different from autoimmune MAbs against non-protein autoAgns. Taken together, our results support the conclusion that HIV-bNt Abs are not unusual in their reactivity or structures.

Difference of NPY and its receptor gene expressions between obesity and obesity-resistant rats in response to high-fat diet

AIM

To investigate the effect of high-fat diet on expressions of hypothalamic neuropeptide Y (NPY) and Y1, Y2, Y5 receptors and the mechanism relative to the susceptibility of obesity.

METHODS

Thirty-six female SD rats were randomly divided into high-fat diet group (HF, n=27) and chow food group (CF, n=9), and given either HF or CF diet for 13 weeks. Then the HF diet group was subdivided into dietary induced obesi-ty (DIO) and dietary induced obesity resistant (DIO-R) rat according to the final body weight. Body weight, caloric intake, energy efficiency, visceral fat pads were measured and compared. The levels of plasma and hypothalamic NPY were determined by Radioimmunoassay. Real-time Polymerase Chain Reaction (PCR) was used to measure the gene expression of NPY and its receptors in hypothalamus.

RESULTS

Body weight, caloric intake, energy efficiency and visceral fat pads in DIO rats were higher significantly than those in CF or DIO-R rats (p<0.01). No difference in plasma NPY level was detected among the three groups (p>0.05); the hypothalamic NPY level was significantly higher in DIO group than in CF or DIO-R group (p<0.01). Gene expression levels of NPY and Y1, Y2, Y5 receptors were higher significantly in DIO group than in CF or DIO-R group (p<0.01), while no significant difference was found between DIO-R and CF rats (p>0.05), except that Y2 receptor was lower in DIO-R rats (p<0.01).

CONCLUSIONS

SD rat fed with a HF diet showed different susceptibility to obesity, and up-regulated hypothalamic NPY and Y1, Y2, Y5 receptor gene expressions were closely associated with being predisposed to obesity and overeating of DIO rats.

Left ventricular hypertrophy in patients with renal artery stenosis

Left ventricular hypertrophy (LVH) has been shown to be 3 times more prevalent in patients with renal artery stenosis (RAS) compared to essential hypertension, but factors that predict LVH in this population are not known. We identified 66 patients with unilateral renal artery stenosis and an interpretable electrocardiogram (ECG). LVH by either Cornell voltage-duration product or Sokolow-Lyon voltage criteria was present in 18 of the 66 patients (27%). The mean intra-aortic blood pressure was 100 +/- 14 mm Hg in patients with LVH, and 104 +/- 23 mm Hg in those without LVH (P = 0.37). The average stenosis by quantitative computerized angiography was 68 +/- 17% in patients with LVH, and 64 +/- 13% in those without LVH (P = 0.34). The mean translesional pressure gradient was 11 +/- 15 mm Hg in patients with LVH, and 13 +/- 20 mm Hg in those without LVH (P = 0.60). Using linear regression models, there was no correlation between intra-aortic blood pressure, percentage of stenosis, or translesional pressure gradient and either Cornell voltage-duration product or Sokolow-Lyon voltage criteria. In summary, LVH using ECG criteria was present in 27% of patients with unilateral RAS but was not associated with blood pressure at the time of the procedure or severity of renal artery stenosis.

Further evidence that the chromogranin B gene confers predisposition to schizophrenia: a family-based association study in Chinese

The Chromogranin B (CHGB) gene has been proposed as a candidate gene for predisposition to schizophrenia due to its location on the genome, the evidence of genetic studies, and its functional role in schizophrenia. To investigate its association with schizophrenia using case-control analysis, we genotyped eight single nucleotide polymorphisms (SNPs) and performed transmission disequilibrium tests (TDT) using 192 Han Chinese trios. The G allele of IVS4 + 808A > G showed a trend of over-transmission from heterozygous parents to affected offspring (P = 0.06), although no significant over-transmission was found for individual markers. Furthermore, a significant transmission was observed for the common haplotype G-G-A-G-C (P = 0.0018). Overall, our results suggest that at least one locus in or close to the CHGB gene confers risk of the disorder and strengthen the evidence that CHGB is a promising susceptibility gene for schizophrenia in Chinese population.

Anticancer Activity of 5-Benzylidene-2-Phenylimino-1, 3-Thiazolidin-4-one (BPT) Analogs

We recently identified two compounds of 5-benzylidene-2-phenylimino-1,3-thiazolidin-4-one (BPT) analog, 5-(4-methylbenzylidene)-2-phenylamino-1,3-thiazolidin-4-one (MMPT) and 5-(2,4-dihydroxybenzylidene)-2-phenylimino-1,3-thiazolidin-4-one (DBPT), that can effectively induce apoptosis in cancer cells but not in normal cells, independently of P-glycoprotein status. To further investigate the antitumor activity of BPT analogs, we obtained 18 commercially available analogs of BPT and synthesized 7 analogs in our lab, and analyzed their antitumor activity in various cancer cells, including paclitaxel- and vinorelbine-sensitive and -resistant human lung cancer cells. Two of the compounds were more potent than MMPT or DBPT in induction of apoptosis in certain cancer cell lines and remained tumor selective. Seven compounds did not induce any cytotoxic effects in any of the cell lines tested at the highest concentration tested (31 microM). The other compounds induced cytotoxic effects in some cancer cells but not in others or were less potent than MMPT and DBPT. Cell uptake studies showed that analogs that effectively induced cell killing in paclitaxel- and vinorelbine-resistant cells could be taken up easily by those cells despite their high levels of P-glycoprotein expression. These data further demonstrate that thiazolidinone analogs are not P-glycoprotein substrates and could be useful for treatment of P-glycoprotein overexpressing refractory cancers.

Coronary artery fistulae

Coronary artery fistulae are abnormal communications between a coronary artery and a cardiac chamber or major vessel (vena cava, pulmonary veins, pulmonary artery). They are usually diagnosed by coronary arteriography. Clinical presentations are variable depending on the type of fistula, shunt volume, site of the shunt, and presence of other cardiac conditions. In this article, we review the literature regarding etiology, incidence, clinical manifestation, image studies, and management.

Admixture and population stratification in African Caribbean populations

Throughout biomedical research, there is growing interest in the use of ancestry informative markers (AIMs) to deconstruct racial categories into useful variables. Studies on recently admixed populations have shown significant population substructure due to differences in individual ancestry; however, few studies have examined Caribbean populations. Here we used a panel of 28 AIMs to examine the genetic ancestry of 298 individuals of African descent from the Caribbean islands of Jamaica, St. Thomas and Barbados. Differences in global admixture were observed, with Barbados having the highest level of West African ancestry (89.6%+/- 2.0) and the lowest levels of European (10.2%+/- 2.2) and Native American ancestry (0.2%+/- 2.0), while Jamaica possessed the highest levels of European (12.4%+/- 3.5) and Native American ancestry (3.2%+/- 3.1). St. Thomas, USVI had ancestry levels quite similar to African Americans in continental U.S. (86.8%+/- 2.2 West African, 10.6%+/- 2.3 European, and 2.6%+/- 2.1 Native American). Significant substructure was observed in the islands of Jamaica and St. Thomas but not Barbados (K=1), indicating that differences in population substructure exist across these three Caribbean islands. These differences likely stem from diverse colonial and historical experiences, and subsequent evolutionary processes. Most importantly, these differences may have significant ramifications for case-control studies of complex disease in Caribbean populations.

Experimental study on in vitro tumor cell killing by focused bi-frequency ultrasound activated hematoporphyrin derivatives

OBJECTIVE

As ultrasound has become an important therapeutic technique on tumor, in order to find the cell-killing effect of focused bi-frequency ultrasound activated hematoporphyrin derivatives, experimental study was processed in vitro.

METHODS

Tumor cells K562 and SW-480 were killed by focused bi-frequency ultrasound activated hematoporphyrin (Hp) derivatives under optimized ultrasonic parameters and the cell-killing effect was tested by MTT (Thiazolyl blue: 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide) technique.

RESULTS

The lower frequency (0.6 MHz) was better than the higher (1.1 MHz) in activating hematoporphyrin derivatives; the bi-frequency was better than mono-frequency, and the cell-killing efficiency was 2-3 times of sum of the two kinds of ultrasounds which constitute bi-frequency. Incubation for the 16 h was better than 4 h after the cells exposed to the ultrasound.

CONCLUSION

The method of killing tumor cells by focused bi-frequency ultrasound activated hematoporphyrin derivatives is presented and evaluated in this paper.

Long-Term Results of Surgical Treatment of Tetralogy of Fallot in Adults

BACKGROUND

The long-term results of patients with tetralogy of Fallot surgically treated in adulthood were evaluated to define the real benefit of surgical correction.

METHODS

Between August 1990 and February 2004, 57 patients older than 18 years of age with tetralogy of Fallot received total correction. Forty-two patients (73.7 %) required transannular patch.

RESULTS

Hospital and late mortality were 7.0 % (n = 4) and 5.7 % (n = 3), respectively. One patient was reoperated on to close residual ventricular septal defect. Four patients were lost. Of the remaining 49 patients, the mean follow-up was 65 +/- 38 months (range 11 - 173 months). Actuarial survival was 97.4 +/- 2.5 %, 91 +/- 7 % and 72.8 +/- 17.1 % at 5, 10 and 14 years, respectively. At the latest follow-up, 35 (76.1 %) of the surviving patients presently have NYHA functional class I ( P < 0.01).

CONCLUSION

The overall survival of surgically treated adult patients with tetralogy of Fallot is acceptable. The greatest benefit of total correction at this age is the functional improvement.

Polymorphisms within the CTLA4 gene are associated with infant atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is one of the most common childhood disorders. It can have a significant impact on the physical and psychological well-being of affected individuals. Although environmental triggers are important, AD also has a strong genetic component. Identifying genes associated with AD may help to understand better the basis of this disorder and its relationship with other allergic disorders such as asthma.

OBJECTIVES

Polymorphisms in the gene encoding the inhibitory CTLA4 receptor, an important regulator of T cells, are associated with asthma as well as autoimmune disorders. We have now tested whether polymorphisms in the CTLA4 gene are also associated with early childhood AD.

METHODS

A family-based cohort of 112 children and their parents was recruited from Western Sydney, Australia. All children were seen by a paediatric dermatologist and presented with AD within the first 3 years of life. Using the transmission disequilibrium test, individual and haplotypic associations with the +49 and CT60 polymorphisms in exon 1 and the 3' nontranslated DNA of the CTLA4 gene were tested.

RESULTS

Single tests of association revealed significant association of the +49(A) [P = 0.037, odds ratio (OR) 1.59, 95% confidence interval (CI) 1-2.55] and borderline significance of the CT60(A) alleles (P = 0.055, OR 1.51, 95% CI 1-2.38). Significant association of the +49(A)/CT60(A) haplotype was detected (P = 0.002, OR 1.78, 95% CI 1.2-2.65).

CONCLUSIONS

Polymorphisms within the gene encoding CTLA4 were associated with early onset infant AD. This is in agreement with findings from asthmatic cohorts, suggesting that the +49(A)/CT60(A) haplotype is a genetic risk factor common to asthma and AD.

Rebound intracranial hypertension after treatment of spontaneous intracranial hypotension

Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache and the cause is usually cerebrospinal fluid leaks in spine level. Most patients with SIH have a benign course. Epidural blood patch (EBP) is the treatment of choice when initial conservative managements are ineffective. We reported a patient with SIH diagnosed by using magnetic resonance imaging and radionuclide cisternography. Acute rebound intracranial hypertension developed after EBP and was successfully treated with intravenous osmotic agent.