Dysregulation of Hypothalamo-Pituitary-Adrenocortical Axis in Overweight Female Diabetic Subjects is Associated with Downregulation of Corticosteroid Receptors and 11β-HSD1 in the Brain

The objective of this work was to assess hypothalamo-pituitary-adrenocortical (HPA) axis dysregulation in overweight diabetic women and investigate the possible mechanism using overweight diabetic rats. Twenty-two overweight diabetic women were recruited alongside 34 lean and 23 overweight healthy women serving as controls. Dexamethasone suppression test (0.25 mg DST) and low dose adrenocorticotropic hormone (ACTH) stimulation assay were used to evaluate the HPA axis activity. Then, high fat diet (HF) and STZ-induced diabetic rats were utilized to investigate the possible mechanism. After measurement of corticosterone circadian patterns and dexamethasone suppression levels, mRNA amounts of mineralocorticoid receptors (MR), glucocorticoid receptors (GR), and 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) were determined by real time PCR at hippocampus, hypothalamus, and pituitary levels. Overweight diabetic women showed impaired HPA axis with negative feedback efficacy (suppression ratio F-DEX%: 0.52±0.06% vs. 0.49±0.06% vs. 0.14±0.08%), as well as increased adrenal cortisol secretion response to low dose ACTH stimulation. Interestingly, F-DEX% was negatively correlated with BMI (r=- 0.323, p=0.003), waist circumference (r=- 0.319, p=0.004), and HbA1c (r=- 0.334, p=0.002). Stepwise linear regression analysis showed F-DEX% was significantly related to HbA1c level (β=- 0.328, p=0.007) after adjusting for other covariates (age, BMI, waist circumference, SBP, TC, TG, and HOMA-IR). Furthermore, 11β-HSD1, MR, and GR mRNA expression levels were reduced at pituitary level while GR expression was downregulated at hippocampus level in HF and HF+STZ rats. In conclusion, hyperactive HPA axis in overweight diabetic subjects may be associated with downregulation of 11β-HSD1, MR, and GR in the brain.

Examination of failed retrieved temporomandibular joint (TMJ) implants

In the management of end-stage temporomandibular joint disorders (TMD), surgeons must often resort to alloplastic temporomandibular joint (TMJ) total joint replacement (TJR) to increase mandibular function and form, as well as reduce pain. Understanding wear and failure mechanisms of TMJ TJR implants is important to their in vivo longevity. However, compared to orthopedic TJR devices, functional wear of failed TMJ TJR implants has not been examined. Not only do wear and corrosion influence TJR implant in vivo longevity, but so does reactivity of peri-implant tissue to these two events. The aim of this study was to examine and report on the wear of retrieved, failed metal-on-metal (MoM), metal-on-polymer (MoP), and titanium-nitride coated (TiN Coated) TMJ TJR implant components. A total cohort of 31 TMJ TJR devices were studied of which 28 were failed, retrieved TMJ TJRs, 3 were never implanted devices that served as controls. The mean time from implantation to removal was 7.24 years (range 3-15), SD 3.01. Optical microscopy, White Light Interferometry (WLI), Scanning Electron Microscopy (SEM), and Raman spectroscopy were utilized to characterize the surfaces of the devices. Data was acquired and evaluated by analyzing alloy microstructure. Substantial surface damage was observed between the articulating areas of the condylar head and the glenoid fossa components. Damage included pitting corrosion, evidence of deposited corrosion products, specific wear patterns, hard phases, surface depressions, and bi-directional scratches. Electrochemical analysis was performed on the MoM Control, retrieved, failed MoM, and TiN Coated devices. Electrochemical tests consisted of open circuit potential (OCP) and electrochemical impedance spectroscopy (EIS) tests conducted using the condylar head of the retrieved failed devices. EIS confirmed material properties as well as corrosion kinetics in vivo help to mitigate corrosion as reflected by the Raman spectroscopy results. In summary, this study demonstrated the role of wear and corrosion interactions on the early failure of TMJ TJR devices. Since the materials employed in most orthopedic TJR devices are similar to those used in TMJ TJR implants, studies such as this can provide data that will improve future embodiment paradigms for both. Further studies will include in vitro investigation of corrosion kinetics and the underlying tribocorrosion mechanism of TMJ TJR devices.

STATEMENT OF SIGNIFICANCE

An attempt is made in this study, to examine the retrieved TMJ implants and conduct surface and electrochemical analysis; further a translation research approach is employed to compare the observations from the total hip replacement (THR) retrievals. A total cohort of 31 TMJ TJR devices were studied of which 28 were failed, retrieved TMJ TJRs, 3 were never implanted devices that served as controls. Data was acquired and evaluated by analyzing alloy microstructure. Substantial surface damage was observed between the articulating areas of the condylar head and the glenoid fossa components. Electrochemical analysis was performed on the MoM Control, retrieved, failed MoM, and TiN Coated devices. This study demonstrated the role of wear and corrosion interactions on the early failure of TMJ TJR devices. Since the materials employed in most orthopedic TJR devices are similar to those used in TMJ TJR implants, a comparison study was conducted.

Expression and clinical significance of insulin-like growth factor 1 in lung cancer tissues and perioperative circulation from patients with non-small-cell lung cancer

OBJECTIVE

We explored the role of insulin-like growth factor 1 (igf-1) in the development of lung cancer.

METHODS

We used immunohistochemistry to measure the expression of igf-1 and igf-1 receptor (igf-1r) in specimens of tissue and perioperative circulation from 80 patients with primary non-small-cell lung cancer (nsclc) and from 45 patients with benign pulmonary lesions (bpls). Correlations of those measurements with clinicopathologic characteristics and clinical follow-up were analyzed. Circulating igf-1 was measured before and after surgery in all patients.

RESULTS

Compared with bpl specimens, nsclc specimens showed overexpression of igf-1and igf-1r (p < 0.001). The expression levels of igf-1 and igf-1r were significantly associated with advanced-stage disease (p = 0.034 and 0.029 respectively) and lymph node metastasis (p = 0.012 and 0.017 respectively), and expression of igf-1 correlated with tumour differentiation and tumour diameter (p = 0.011 and 0.021 respectively). Specimens positive for igf-1 or igf-1r were significantly correlated with shorter patient survival (p = 0.0012 and 0.0016 respectively). After surgery, circulating igf-1 was significantly elevated in patients with bpl (p = 0.0346) and significantly lower in patients with nsclc (p = 0.0030), especially in those with advanced-stage disease, a larger tumour size, regional lymphoid node metastasis, or lesser differentiation (p = 0.0092, 0.0051, 0.0131, and p < 0.001 respectively).

CONCLUSIONS

In nsclc, igf-1 and igf-1r are upregulated, and expression of those factors is correlated with tumour progression and prognosis in nsclc patients. Radical resection of nsclc can directly influence the serum concentration of igf-1. Autocrine/paracrine igf-1 might be playing an important role in the development of lung cancer.

Water-soluble metal nanoparticles stabilized by plant polyphenols for improving the catalytic properties in oxidation of alcohols

Plant polyphenols extracted from plants are one of the most abundant biomasses in nature, which are typical water soluble natural polymers. Herein, we reported a facile approach for the synthesis of platinum nanoparticle (PtNP) aqueous colloid by utilizing black wattle tannin (BWT, a typical plant polyphenol) as amphiphilic stabilizer. The phenolic hydroxyls of BWT provide the PtNPs with enough hydrophilicity, and their reduction ability could protect the PtNPs from deactivation caused by oxygen atmosphere. Additionally, the hydrophilic nature of BWT could efficiently promote the oxidation of alcohols in water, meanwhile, the hydrophobic and rigid backbones of plant polyphenols are able to suppress the PtNPs from aggregating, thus ensuring the high dispersion of the PtNPs during reactions. Under mild aerobic conditions, the as-prepared BWT-Pt colloid catalyst exhibited high activity in a series of biphasic oxidation of aromatic alcohols and aliphatic alcohols. As for the cycling stability, the BWT-Pt catalyst showed no obvious decrease during the 7 cycles, revealing superior cycling stability as compared with the counterparts using PVP or PEG as the stabilizer.

A role of pre-mir-10a coding region variant in host susceptibility to coxsackie virus-induced myocarditis

OBJECTIVE

Acute viral myocarditis (VM) is an important cause of sudden cardiac death and heart failure in healthy young person. Direct virus-mediated injury and secondary immune reactions, including inflammatory and autoimmune responses, have been reported both in animal models and in humans. Recently, genetic variation has been confirmed related to myocarditis process and susceptibility to VM. In this study, we scanned 339bp of pri-miR-10a coding region in CVB3 VM patients, want to found genetic relations between miR-10a and VM susceptibility.

PATIENTS AND METHODS

The secondary structure of two genotype 220 bp pri-miR-10a sequences was predicted using RNAfold web server. In vitro biological functional study concluded dual luciferase assay and Western blotting.

RESULTS

We found the rare allele T of rs3809783 was accumulated in VM patients and related to VM significantly. Subsequently, we confirmed that ITCH, a NK-κB signaling suppressor, is a direct target of miR-10a. In vitro biological functional study indicated that this site variation reduced mature miR-10a expression and induced a down-regulated cytokine secretion in the cell culture supernatant.

CONCLUSIONS

The results suggest that the rare allele T in pri-miR-10a coding region should be involved in the CVB3 caused VM pathogenesis through weakening host anti-virus immune response. This site may be used for clinical genetic evaluation for VM susceptibility.

Hydroxyapatite Growth Inhibition Effect of Pellicle Statherin Peptides

In our recent studies, we have shown that in vivo–acquired enamel pellicle is a sophisticated biological structure containing a significant portion of naturally occurring salivary peptides. From a functional aspect, the identification of peptides in the acquired enamel pellicle is of interest because many salivary proteins exhibit functional domains that maintain the activities of the native protein. Among the in vivo–acquired enamel pellicle peptides that have been newly identified, 5 peptides are derived from statherin. Here, we assessed the ability of these statherin pellicle peptides to inhibit hydroxyapatite crystal growth. In addition, atomistic molecular dynamics (MD) simulations were performed to better understand the underlying physical mechanisms of hydroxyapatite growth inhibition. A microplate colorimetric assay was used to quantify hydroxyapatite growth. Statherin protein, 5 statherin-derived peptides, and a peptide lacking phosphate at residues 2 and 3 were analyzed. Statherin peptide phosphorylated on residues 2 and 3 indicated a significant inhibitory effect when compared with the 5 other peptides ( P < 0.05). MD simulations showed a strong affinity and fast adsorption to hydroxyapatite for phosphopeptides, whereas unphosphorylated peptides interacted weakly with the hydroxyapatite. Our data suggest that the presence of a covalently linked phosphate group (at residues 2 and 3) in statherin peptides modulates the effect of hydroxyapatite growth inhibition. This study provides a mechanism to account for the composition and function of acquired enamel pellicle statherin peptides that will contribute as a base for the development of biologically stable and functional synthetic peptides for therapeutic use against dental caries and/or periodontal disease.

The effect of contact load on CoCrMo wear and the formation and retention of tribofilms

Tribochemical reactions in a protein lubricated metal-on-metal (MoM) sliding contact may play a significant role for its wear performance. Such reactions lead to the formation of a carbonaceous 'tribofilm', which can act as a protective layer against corrosion and wear. The purpose of this study was to determine the effect of contact load on wear and the formation and retention of tribofilms. Wear tests were performed in a custom-made ball-on-flat testing apparatus that incorporated an electrochemical cell. A ceramic ball was used to articulate against low-carbon wrought CoCrMo alloy pins in bovine serum. Using a range of contact loads at a single potentiostatic condition (close to free potential), weight loss and changes in surface properties were evaluated. We determined that wear was influenced by the loading condition. As expected, wear increased with load, but the association between applied load and measured weight loss was not linear. In the intermediate load region, in the range of 32-48 N (~58-80 MPa), there was more than an order of magnitude drop in the wear per unit load, and the wear versus load data suggested an inflexion point at 49 N. Regression analyses yielded a cubic model (R²=0.991; p=0.0002), where the cubic term, which represents the inflexion, was highly significant (p=0.0021). This model is supported by the observations that the minimum in the friction versus load curve is at 52 N and the highest relative increase in polarization resistance occurred at 49 N. Scanning electron microscopy and Raman spectroscopy indicated the absence of a tribofilm for the low and within the contact area of the high load cases. Synergistic interactions of wear and corrosion seem to play an important role.

Do stressed mothers have heavier children? A meta-analysis on the relationship between maternal stress and child body mass index

Child obesity continues to be a prevalent public health issue. This meta-analysis synthesized 17 studies investigating the association between levels of psychological stress experienced by mothers and the body mass index of their children. The overall standardized mean difference effect size was positive and significantly different from zero in cross-sectional d = 0.20 (k = 14, 95% confidence interval [CI]: 0.06, 0.34) and longitudinal studies d = 0.18 (k = 5, 95% CI: 0.00, 0.351) and had significant heterogeneity in both (cross-sectional, Q[13] = 193.00, P < 0.001; longitudinal, Q[4] = 29.46, P < 0.001). In longitudinal studies, effect sizes were larger when children also would have experienced the stressor, Q(6) = 4.68, P < 0.05, for toddlers than infants, Q(4) = 5.04, P < 0.05, and in higher quality studies, Q(4) = 14.58, P < 0.05. Results highlight the potential benefits of including a parent stress management component in childhood obesity prevention programmes.

The impact of Caspase-8 on non-small cell lung cancer brain metastasis in II/III stage patient

The aim of this study is to evaluate the role of Caspase-8 in predicting non-small cell lung cancer (NSCLC) metastasis to brain. The expression of Caspase-8 was analyzed by immunohistochemistry in 203 surgical resected NSCLC patients, who were followed up. Caspase-8 expression level was correlated with clinicopathological characteristics. Time to brain metastasis (TTBM) was estimated using Kaplan-Meier method. Caspase-8 staining was predominantly located in the cell cytoplasm of NSCLC. ROC curve achieved a Sensitivity=94.7%, Specificity=48.9% and Negative Predictive Value=98.9% in diagnosing high and low risk groups to develop brain metastasis (BM). BM was indentified in 16.1% (18/112) patients in high Caspase-8 expression group, in contrast, only 1.1% (1/91) patients in low level group developed BM. There was a certain relation between Caspase-8 level and lymph node metastasis (P=0.08); Caspase-8 expression level significantly elevated in high BM risk group (P=0.00). Multivariate logistic regression analysis revealed that there was ignificant correlation only between Caspase-8 and BM. Univariate and multivariable Cox regression analysis demonstrated that only Caspase-8 was the independent variable affecting lung cancer BM. Elevated Caspase-8 predicted early metastasis to brain (Log Rank test, P=0.00). Our results suggest that elevated Caspase-8 was associated with increased incidence of brain metastasis after surgery in NSCLC patients, further evaluation of Caspase-8 as a biomarker for identification of patients at high risk of brain metastasis is warranted.

Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status

OBJECTIVES

Administration of oral nutritional supplements (ONS) is an effective strategy to treat and avoid malnutrition, a persisting issue in nursing homes. However, little is known about compliance in the NH population. This study aimed to analyse the effects of compliance of NH residents with a low-volume, nutrient- and energy-dense ONS on nutritional status and to identify residents' characteristics associated with compliance.

DESIGN AND SETTING

Randomized, controlled trial in nursing homes.

PARTICIPANTS AND INTERVENTION

87 nursing home residents (87 ± 6y, 91% female) with malnutrition or at risk of malnutrition were randomly allocated to an intervention group (IG) receiving 2 x 125 ml ONS (2.4 kcal/ml)/d for 12 weeks, or the control group (CG) with usual care.

MEASUREMENTS

ONS intake was recorded daily and compliance calculated. Low and high compliance were defined as ≤ 30% and ≥ 80% of provided ONS actually consumed, respectively. Body weight (BW), BMI, upper-arm (UAC) and calf-circumference (CC) and MNA-SF were assessed at baseline and after 12 weeks. Associations between compliance and changes of nutritional parameters and residents' characteristics were analysed.

RESULTS

Compliance was high in 35.7% and low in 28.6% of the IG (n=42). BW change was significantly higher in subjects with high compliance (median +3.0 (interquartile range +2.1;+3.8) kg, n=15) than in those with low compliance (-0.2 (-2.2;+1.6) kg, n=12) and CG (-0.1 (-1.2; +0.6) kg, n=35; p<0.001), and significantly correlated with compliance in IG (r=0.691; p<0.001). Significant differences and correlations were also identified for BMI, UAC and MNA-SF. High compliance was more often observed in residents with malnutrition (66.7 vs. 27.3%) and chewing difficulties (77.8 vs. 24.2%) than in those without these conditions. Low compliance was more prevalent in residents who were immobile (45.0 vs. 13.6%), depressed (33.3 vs. 6.7%) or had gastrointestinal complaints (50.0 vs. 17.9%) (all p<0.05).

CONCLUSIONS

A high compliance of nursing home residents with a low volume, nutrient- and energy dense ONS was related to a significantly improved nutritional status in comparison to low compliance and therefore enhanced the effectiveness of ONS. A higher compliance may be achieved by consideration of different residents' characteristics.

Efficacy of transcatheter aortic valve implantation in patients with aortic stenosis and reduced LVEF. A systematic review

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is safe and effective for patients with aortic stenosis (AS) who have a high operative risk. However, there is still debate on the effect of TAVI in AS patients with reduced left ventricular ejection fraction (REF). The objective of the review is to clarify the efficacy of TAVI and the impact of REF on the 30-day and midterm mortality in these patients.

METHODS

Studies on TAVI were searched in PubMed, Embase, and the Cochrane Library databases and were included in this review following predefined criteria. Data were extracted and pooled risk ratios (RR) were synthesized to explore the relationship between REF and 30-day plus midterm mortality.

RESULTS

Twenty-eight studies comprising 14,099 patients were included in the analysis of the association of REF with the prognosis of patients after TAVI. An average increase in left ventricular ejection fraction of 8-10 % was observed among these patients after TAVI. REF was not related to the 30-day mortality [RR = 1.90, 95 % confidence interval (CI) = 0.80-4.47]; however, it was related to the midterm mortality (RR = 1.49, 95 %CI = 1.14-1.93) of patients undergoing TAVI. Patients with low-flow and low-gradient AS had a higher 30-day mortality (RR = 1.54, 95 %CI = 1.11-2.13) and midterm mortality rate (RR = 1.69, 95 %CI = 1.33-2.14) compared with AS patients without these characteristics. The mortality of TAVI patients was significantly lower than that of those undergoing conservative therapy, and was similar to that of patients undergoing surgical aortic valve replacement.

CONCLUSION

REF was not associated with 30-day mortality, but it was associated with the midterm mortality of TAVI patients. Patients with REF could benefit from TAVI compared with conservative therapy.

GOLPH3 is a novel marker of poor prognosis and a potential therapeutic target in human renal cell carcinoma

Background:

Golgi phosphoprotein 3 (GOLPH3) has been reported to be involved in the development of several human cancers. The present study was conducted to investigate the expression of GOLPH3 and its prognostic significance in renal cell carcinoma (RCC). Meanwhile, the function of GOLPH3 in human RCC was further investigated in cell culture models.

Methods:

Expression of GOLPH3 was examined in 43 fresh RCC tissues and paired adjacent normal renal tissues by real-time quantitative PCR and western blotting. Immunohistochemistry for GOLPH3 was performed on additional 218 RCC tissues. The clinical significance of GOLPH3 expression was analysed. Downregulation of GOLPH3 was performed using small-interfering RNA (siRNA) in Caki-1 and 786-O cells with high abundance of GOLPH3, and the effects of GOLPH3 silencing on cell proliferation, migration, invasion in vitro, and tumour growth in vivo were evaluated.

Results:

Expression of GOLPH3 was upregulated in the majority of the RCC clinical tissue specimens at both mRNA and protein levels. Clinicopathological analysis showed that GOLPH3 expression was significantly correlated with T stage (P<0.001), lymph-node status (P=0.003), distant metastasis (P<0.001), tumour-node-metastasis (TNM) stage (P<0.001), and Fuhman grade (P=0.001). Expression of GOLPH3 was inversely correlated with both overall and recurrence-free survival of RCC patients. Multivariate analysis showed that GOLPH3 expression was an independent prognostic indicator for patient's survival. Knockdown of the GOLPH3 expression reduced cell proliferation, anchorage-independent growth, migration, invasion, and tumour growth in xenograft model mice.

Conclusions:

These results suggest that GOLPH3 expression is likely to have important roles in RCC development and progression, and that GOLPH3 is a prognostic biomarker and a promising therapeutic target for RCC.

Reproductive risk factors and oestrogen/progesterone receptor-negative breast cancer in the Breast Cancer Family Registry

Background:

Oestrogen receptor (ER)- and progesterone receptor (PR)-negative (ER−PR−) breast cancer is associated with poorer prognosis compared with other breast cancer subtypes. High parity has been associated with an increased risk of ER−PR− cancer, but emerging evidence suggests that breastfeeding may reduce this risk. Whether this potential breastfeeding benefit extends to women at high risk of breast cancer remains critical to understand for prevention.

Methods:

Using population-based ascertained cases (n=4011) and controls (2997) from the Breast Cancer Family Registry, we examined reproductive risk factors in relation to ER and PR status.

Results:

High parity (⩾3 live births) without breastfeeding was positively associated only with ER−PR− tumours (odds ratio (OR)=1.57, 95% confidence interval (CI), 1.10–2.24); there was no association with parity in women who breastfed (OR=0.93, 95% CI 0.71–1.22). Across all race/ethnicities, associations for ER−PR− cancer were higher among women who did not breastfeed than among women who did. Oral contraceptive (OC) use before 1975 was associated with an increased risk of ER−PR− cancer only (OR=1.32, 95% CI 1.04–1.67). For women who began OC use in 1975 or later there was no increased risk.

Conclusions:

Our findings support that there are modifiable factors for ER−PR− breast cancer and that breastfeeding in particular may mitigate the increased risk of ER−PR− cancers seen from multiparity.

Comparison of metformin and repaglinide monotherapy in the treatment of new onset type 2 diabetes mellitus in China

OBJECTIVE

This study was designed to compare the effects of metformin and repaglinide on the fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) in newly diagnosed type 2 diabetes in China.

METHODS

A total of 107 newly diagnosed type 2 diabetic patients (46 women and 61 men) participated in the study. All patients received 3-month treatment of metformin or repaglinide. Fasting blood glucose and HbA1c were determined at baseline and at the end of the 3-month of treatment.

RESULTS

FPG and HbA1c decreased in both metformin and repaglinide groups after 3 months treatment (P < 0.01). The reduction of HbA1c was significantly greater in the repaglinide group (P < 0.01). Metformin decreases fasting insulin concentration and HOMA-IR (P < 0.01), and repaglinide improves HOMA-β(P < 0.01). Triglycerides (TG) were reduced in both groups (P < 0.01 in metformin group; P < 0.05 in repaglinide group), but total cholesterol (TC) and low-density lipoprotein (LDL) were decreased only after metformin treatment (P < 0.05).

CONCLUSIONS

Both repaglinide and metformin were effective in glycaemic control in new onset patients with type 2 diabetes in China. Repaglinide had no effect on insulin sensitivity, but it improved β-cell function.

Increased nucleobindin-2 (NUCB2) transcriptional activity links the regulation of insulin sensitivity in Type 2 diabetes mellitus

The protein nucleobindin-2 (NUCB2) has been recently identified as a novel satiety regulator. However, its pathophysiological role in humans remains unknown. The aims of the present study are to explore whether plasma NUCB2-1 and NUCB2 transcription activity are increased in newly diagnosed Type 2 diabetes mellitus (nT2DM) and, if so, whether changing NUCB2-1 level is a physiologic response or a compensatory mechanism for impaired insulin action. The nT2DM, impaired glucose tolerance (IGT), and healthy people (NGT, normal glucose tolerance) groups were enrolled in this study. The peripheral and hepatic insulin actions in rats with intracerebroventricular (ICV) NUCB2-1 administration were examined by euglycemic-hyperinsulinemic clamps. Plasma NUCB2-1 levels were elevated in subjects with both nT2DM and IGT compared with normal controls. NUCB2 mRNA and protein contents of muscle and adipose tissues in T2DM patients were also significantly increased compared to controls. ICV NUCB2-1 infusion in rats inhibited hepatic phosphoenolpyruvate carboxykinase (PEPCK) activity, and this was sufficient to induce insulin sensitivity in the liver and peripheral tissues during euglycemic-hyperinsulinemic clamps. In T2DM patients, there were increases in plasma NUCB2-1 levels and increases in NUCB2 mRNA and protein contents in muscle and adipose tissues. These increases are presumably a compensatory response to defective insulin action.

Retinoic acid alters the proliferation and survival of the epithelium and mesenchyme and suppresses Wnt/β-catenin signaling in developing cleft palate

Retinoic acid (RA) contributes to cleft palate; however, the cellular and molecular mechanisms responsible for the deleterious effects on the developing palate are unclear. Wnt signaling is a candidate pathway in the cleft palate and is associated with RA in organ development; thus, we aim to investigate whether RA-induced cleft palate also results from altered Wnt signaling. Administration of RA to mice altered cell proliferation and apoptosis in craniofacial tissues by regulating molecules controlling cell cycle and p38 MAPK signaling, respectively. This altered cell fate by RA is a crucial mechanism contributing to 100% incidence of cleft palate. Moreover, Wnt/β-catenin signaling was completely inhibited by RA in the early developing palate via its binding and activation with RA receptor (RAR) and is responsible for RA-induced cleft palate. Furthermore, PI3K/Akt signaling was also involved in actions of RA. Our findings help in elucidating the mechanisms of RA-induced cleft palate.

Effect of Intrafix® SafeSet infusion apparatus on phlebitis in a neurological intensive care unit: a case-control study

OBJECTIVE

To investigate the effect of the Intrafix(®) SafeSet infusion apparatus on the incidence of phlebitis in patients being intravenously infused in a neurological intensive care unit (ICU).

METHODS

Patients aged > 12 years, with no history of diabetes mellitus and no existing phlebitis, requiring a daily peripheral intravenous infusion of ≥ 8 h with the total period lasting ≥ 3 days, were enrolled. Infusions were performed using the Intrafix(®) SafeSet or normal infusion apparatus. Incidence of phlebitis (scored according to the Infusion Nursing Standards of Practice of the American Infusion Nurses Society) was analysed.

RESULTS

Patients (n = 1545) were allocated to Intrafix(®) SafeSet (n = 709) or normal infusion (n = 836) groups, matched for age, gender and preliminary diagnosis. Incidence of phlebitis was significantly higher using normal infusion apparatus compared with the Intrafix(®) SafeSet (23.4% versus 17.9%, respectively).

CONCLUSION

Intrafix(®) SafeSet infusion apparatus significantly reduced the incidence of phlebitis in patients in the neurological ICU, compared with normal infusion apparatus, and may be suitable for use in routine clinical practice.

Preparation and application of anti-HBx/anti-CD3 bispecific monoclonal antibody (BsAb) retargeting effector cells for lysis of human hepatoma xenografts in nude mice

Evidence indicated that the x gene of human HBV can cause cancer in transgenic mice, moreover, HBxAg was so far the most frequent and strong antigen among those HBV markers expressed in hepatocellular carcinoma (HCC) tissues. Aiming to enhance killing of HCC by effector cells, we established an anti-HBx/anti-CD3 hybrid-hybridomas by fusion of anti-HBx hybridoma cells with FITC-labeled anti-CD3 HAT sensitive cells, and followed by FACStar sterile cell sorting, HAT selection and eventually verified by ELISA and double bridging assay. Using two color cytometric analysis, we found that bispecific monoclonal antibody (BsAb) remarkably enhanced in vitro effector-target cell conjugates (48.3% vs. 8.5%). In in vivo study, BsAb retargeting effector cells were significantly more effective than that of effector cells alone in shrinkage of LTNM4 HCC xenografts (HBxAg positive) in nude mice, not only in fresh inoculated tumors but also in established tumors (p<0.01, p<0.01, respectively). Besides, pronounced apoptotic cell death and infiltration of lymphocytes in the peripheral of tumor nodules can also be witnessed in the tissues treated by BsAb plus effector cells, but not in the controls. The results demonstrated that antiHBx/anti-CD3 BsAb was able to redirect effector cells for lysis of HBxAg positive HCC cells both in vitro and in vivo and it also indicated that shrinkage of tumors in nude mice with therapy of BsAb retargeting effector cells was partially due to initiation of apoptotic cell death.

The antitumor natural compound falcarindiol promotes cancer cell death by inducing endoplasmic reticulum stress

Falcarindiol (FAD) is a natural polyyne with various beneficial biological activities. We show here that FAD preferentially kills colon cancer cells but not normal colon epithelial cells. Furthermore, FAD inhibits tumor growth in a xenograft tumor model and exhibits strong synergistic killing of cancer cells with 5-fluorouracil, an approved cancer chemotherapeutic drug. We demonstrate that FAD-induced cell death is mediated by induction of endoplasmic reticulum (ER) stress and activation of the unfolded protein response (UPR). Decreasing the level of ER stress, either by overexpressing the ER chaperone protein glucose-regulated protein 78 (GRP78) or by knockout of components of the UPR pathway, reduces FAD-induced apoptosis. In contrast, increasing the level of ER stress by knocking down GRP78 potentiates FAD-induced apoptosis. Finally, FAD-induced ER stress and apoptosis is correlated with the accumulation of ubiquitinated proteins, suggesting that FAD functions at least in part by interfering with proteasome function, leading to the accumulation of unfolded protein and induction of ER stress. Consistent with this, inhibition of protein synthesis by cycloheximide significantly decreases the accumulation of ubiquitinated proteins and blocks FAD-induced ER stress and cell death. Taken together, our study shows that FAD is a potential new anticancer agent that exerts its activity through inducing ER stress and apoptosis.

SU-E-T-426: Comparison of HDR Brachytherapy for Cervix Cancer Using an Adaptive Simulated Annealing Program and Oncentra- for Simultaneously Integrated Boost

PURPOSE

High dose rate (HDR) volumetric brachytherapy is an effective method of treating advanced cervix carcinoma. Local failure is associated with multiple factors including higher maximal standardized uptake value (SUV) values in fluorodeoxyglucose positron emission tomography (FDG- PET) scans. The purpose of this study is to evaluate the ability to simultaneously boost regions of high SUV values using an in-house adaptive simulated annealing (ASA) algorithm and the Oncentra® (Nucletron V.B., Veenendaal, The Netherlands) treatment planning system, thereby potentially improving local control.

METHODS

Five cervix cancers were evaluated for brachytherapy treatment (tandem/ring and/or interstitial needles). MRI and PET images were obtained post-implant and fused with treatment planning CTs to define a high-risk (HR) CTV (cervix and tumor on MRI) and GTV (volume with >50% of the maximum SUV on PET). The prescribed dose was 5-6 Gy to the HR CTV and 7-9 Gy to the GTV. Treatment plans were first generated in Oncentra® with IPSA followed by manual graphic optimization by the physician. Plans were also independently optimized using the ASA program. The two plans were compared side by side and one was chosen for treatment. Dose-volume parameters including D90, V100 of targets, D2cc to the critical organs, and generalized equivalent uniform dose (gEUD) of all structures were compared between the ASA and the Oncentra plans.

RESULTS

Both ASA and Oncentra plans were considered acceptable by the physician in four of five cases. Two ASA plans were chosen due to better critical organ sparing and tumor coverage. Two Oncentra plans were preferred because of lower doses to critical organs. One ASA plan was not accepted because of a higher bowel dose.

CONCLUSIONS

Both ASA and Oncentra® planning methods produce acceptable treatment plans for optimized brachytherapy of cervix carcinoma. Continued studies are warranted to further determine the relative strength of each method. This study was supported in part by a research grant from Varian Medical System Inc.

Assessment of the CKD-EPI equation to estimate glomerular filtration rate in adults from a Chinese CKD population

The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was introduced to estimate glomerular filtration rate (GFR) in chronic kidney disease (CKD) patients based on serum creatinine. The CKD-EPI equation shows better accuracy compared with the current gold standard equation, the Modification of Diet in Renal Disease (MDRD) equation, but it has not been externally validated in Chinese patients. This study compared the CKD-EPI equation with the original MDRD equation and two Chinese MDRD-based equations for estimating GFR in 200 Chinese CKD patients. The (99m)Tc-diethylenetriamine penta-acetate ((99m)Tc-DTPA) method was used to determine actual GFR. The CKD-EPI equation produced GFR estimates that were more consistent with the (99m)Tc-DTPA GFR than did the MDRD equations. The precision and accuracy of the CKD-EPI equation were significantly higher than those of the MDRD equations. In conclusion, the CKD-EPI equation was superior to the existing MDRD equations in terms of estimating GFR and we recommend its clinical use in Chinese CKD patients.