Mini review on chemotherapy of taeniasis and cysticercosis due to Taenia solium in Asia, and a case report with 20 tapeworms in China

A 43-year-old Tibetan woman living in northwest Sichuan, China, confirmed to be a taeniasis carrier of Taenia solium was treated with pumpkin seeds combined with Areca nut extract in October 2009. All 20 tapeworms except one without scolex were expelled under good conditions. She was free of secondary cysticercosis within one year follow up. Although the first choice for treatment of taeniasis is still praziquantel, it may often cause serious side effect on asymptomatic cysticercosis cases to suddenly become symptomatic within a half day of the treatment. Therefore, the problems in treatment of taeniasis and/or cysticercosis in Asia are briefly overviewed, since other platyhelminthic diseases including schistosomiasis, opisthorchiasis etc. are more common and praziquantel is strongly recommended for mass treatment of these trematodiases with no idea on the co-infection with eggs of T. solium which cause asymptomatic cysticercosis.

Effects of retrograde autologous priming on blood transfusion and clinical outcomes in adults: a meta-analysis

Objective:

Reducing the priming volume is an effective means of decreasing hemodilution and blood transfusion during cardiopulmonary bypass (CPB). The patient’s own blood was used to replace the crystalloid in the CPB circuit by retrograde autologous priming (RAP) in order to decrease the priming volume. Therefore, we performed a meta-analysis to investigate whether RAP could reduce blood transfusion and improve clinical outcomes.

Materials and Methods:

A comprehensive search was conducted for randomized, controlled trials (RCTs) exploring RAP in PubMed, Embase, The Cochrane Library, Google Scholar and Chinese literature databases (WanFang, WeiPu and CNKI). Clinical parameters and outcomes were focused on the lowest hematocrit (Hct) during CPB, the number of patients transfused blood intraoperatively, the number of patients transfused blood perioperatively, the number of blood units transfused, 24-hour chest tube drainage, hours to extubation, length of ICU stay, and length of hospital stay.

Results:

Ten trials, with a total of 1123 patients, were included. The number of patients transfused blood intraoperatively (RR = 0.39, 95% CI = [0.29, 0.53], p<0.00001, I2 = 40%) and perioperatively (RR = 0.53, 95% CI = [0.43, 0.66], p<0.00001, I2 = 0%) and the number of blood units transfused (SMD = -0.53, 95% CI = [-0.73, -0.33], p<0.00001, I2 = 14%) were all significantly reduced in the RAP group. No differences in the hours to extubation (SMD = -0.11, 95% CI = [-0.33, 0.12], p=0.37, I2 = 0%) and the length of ICU stay (SMD = -0.17, 95% CI = [-0.41, 0.08], p=0.18, I2 = 0%) were observed between the two groups.

Conclusion:

Compared to conventional priming, RAP could reduce transfusion in adults significantly, but had no effect on clinical outcomes, comparing to conventional priming. Further studies involving RAP are expected to investigate if this technique is beneficial to the patient.

Identification of nutritional risk by nursing staff in secure psychiatric settings: reliability and validity of St Andrew's Nutrition Screening Instrument

Nutrition screening is the first-line approach to addressing the nutritional needs of service users and has been recommended as best practice by several authoritative and regulatory bodies. A simple and comprehensive screening tool, the St Andrew's Nutrition Screening Instrument (SANSI), was developed for use in an inpatient secure psychiatric setting. The aim of this study was to test the screening tool for reliability and validity. This study identified SANSI as reliable and valid for use in secure psychiatric settings for adolescents and adults. This should give confidence to regulatory and commissioning organizations, that the nutritional risk for patients in an organization which serves a diverse mental health population is being correctly identified, raising staff awareness and allowing appropriate action to be planned.

Analysis of cardiopulmonary bypass status in China: eight-year development trends

Objective:

To study the development of cardiopulmonary bypass (CPB) in the past 8 years and to come up with predictions and recommendations for the future in China.

Methods:

Domestic hospitals performing cardiovascular operations were supplied with questionnaires, annually (between 2003 and 2008), upon the number of on-pump and off-pump cardiovascular operations, oxygenators of different types and the number of extracorporeal membrane oxygenation (ECMO). All the hospitals in this study were divided into 8 grades, according to the number of cardiovascular operations. The market share of hospitals in each grade was analyzed.

Results:

The total anumber of cardiovascular operations was 170,547 in 2010, of which 136,753 were performed under CPB. The ratio of imported membrane oxygenators increased from 43.22% in 2003 to 59.75% in 2010, while bubble oxygenator composition decreased from 43.78% in 2003 to 14.59% in 2010. Forty-four hospitals carried out 206 cases of ECMO in 2010. There were 32 hospitals that performed cardiovascular operations of over 1,000 cases and their market share was 43%. There were 255 hospitals that performed cardiovascular operations in less than 50 cases and their market share was only 3%.

Conclusions:

CPB in China has gone through a rapid development in the past eight years. Medical resources for CPB should be concentrated and systematic training regulations should be established in the future.

Antidote strategies to reverse anticoagulation with TB-402, a long-acting partial inhibitor of factor VIII

BACKGROUND

TB-402 is a partially inhibiting antibody of factor VIII that is under development as a long-acting anticoagulant.

PATIENTS AND METHODS

The reversibility of FVIII inhibition by TB-402 was evaluated in vitro after spiking with recombinant human FVIII (rhFVIII), human plasma-derived FVIII (hpdFVIII), recombinant activated human FVII (rhFVIIa), FVIII inhibitor bypassing activity (FEIBA), and prothrombin complex concentrate (PCC). Twelve subjects were randomized to placebo or 35 or 70 IU kg(-1) rhFVIII 48 h after a single dose of 620 μg kg(-1) TB-402. TB-402 concentrations, FVIII activity (FVIII:C), activated partial thromboplastin time (APTT) and thrombin generation were measured over a period of 8 weeks.

RESULTS

In spiked samples, TB-402 inhibited FVIII:C by 30%, prolonged APTT by 4.5 s, and reduced the peak height in the thrombin generation assay to 56% ± 13% of the control value. In the presence of 10 μg mL(-1) TB-402, rhFVIII restored FVIII:C and APTT to the values obtained in the absence of TB-402. The inhibitory effect of TB-402 on thrombin generation was entirely reversed by rhFVIII, hpdFVIII, rhFVIIa, FEIBA, and PCC. In men, the mean half-life (t(1/2) ) of TB-402 was 14.2 days. TB-402 lowered the endogenous thrombin potential by 23% for ~ 35 days. Infusion of 35 IU kg(-1) rhFVIII had a marginal effect, whereas 70 IU kg(-1) rhFVIII restored FVIII:C, reduced APTT back to baseline for 9 h, and restored thrombin generation for ~ 3 h.

CONCLUSIONS

TB-402 resulted in a stable long-term anticoagulant effect. rhFVIII and other procoagulants counteracted the effect of TB-402 temporarily, and may be effective antidotes for future clinical practice.

The effects of zero-balance ultrafiltration on postoperative recovery after cardiopulmonary bypass: a meta-analysis of randomized controlled trials

OBJECTIVE

Considered as a significant ultrafiltration technology during cardiopulmonary bypass (CPB), zero-balance ultrafiltration (Z-BUF) has always received controversial support regarding its effectiveness in reducing inflammatory mediators in plasma. Therefore, we conducted a meta-analysis to evaluate the clinical effect of Z-BUF through screening all relevant published randomized controlled trials (RCTs).

METHODS

A comprehensive search was conducted to screen all RCTs of Z-BUF. Three trained investigators searched databases, including PubMed, Embase, the Cochrane Library, Google scholar, and Chinese literature databases (CNKI, WanFang, WeiPu). RCTs that compared Z-BUF with non-ultrafiltration were included. We focused on clinical outcomes such as length of stay in ICU, duration of ventilation, hospital stay, total amount of chest tube drainage and mortality. Finally, a total of 7 studies containing appropriate criteria were divided into an adult group and a pediatric group. A random effects model was used to calculate weighted mean difference with 95% confidence intervals.

RESULTS

In the adult group, the benefits of Z-BUF in duration of ventilation (WMD=-2.77, 95% CI = [-6.26, 0.72], I(2)=71%, p=0.12) and the length of ICU stay (WMD=-4.13, 95% CI = [-10.09, 1.84], I(2)=77%, Z=1.36, p=0.17) were not apparent, with significant heterogeneity existing in the statistical results. The rest of the clinical parameters could not be evaluated due to insufficient data. In the pediatric group, combined analysis showed Z-BUF could reduce the duration of mechanical ventilation (WMD=3.07; 95%CI= [-7.56, -3.46], I(2)=17%, p=0.27). The advantage of Z-BUF was not observed in other clinical outcomes.

CONCLUSION

The benefits of Z-BUF were not apparent, according to the report. Further studies involving combined ultrafiltration are expected to provide improved ultrafiltration during CPB.

Early changes in cerebral oxidative stress and apoptotic neuronal injury after various flows for selective cerebral perfusion in piglets

BACKGROUND

The impact of various flows for selective cerebral perfusion (SCP) on cerebral oxidative stress in the immature brain is unknown. We examined early changes in cerebral markers of oxidative damage, apoptotic protein activation and histological outcome after different flows for SCP in a piglet model of deep hypothermic circulatory arrest (DHCA).

METHODS

Twenty piglets, randomly divided into four groups (each n = 5), were placed on cardiopulmonary bypass (CPB) at 20°C, then underwent DHCA for 60 minutes. SCP was conducted at flow rates of 0, 25, 50 and 80 ml·kg(-1)·min(-1) through the innominate artery in the DHCA, SCP 25, SCP 50, and SCP 80 groups, respectively. The animals were killed at 2 hours off CPB. Brain tissues were examined for the activity of SOD, MDA and caspase-3, and histological damage was quantitatively assayed by light microscopic examinations.

RESULTS

There were no significant differences in the activities of SOD, MDA and the SOD/MDA index between the groups. Caspase-3 activity significantly decreased in the SCP 25, SCP 50 and SCP 80 groups compared with the DHCA group. However, the caspase-3 level was higher in the SCP 80 group than in the SCP 25 and SCP 50 group. There were no significant correlations between MDA, SOD, SOD/MDA index and caspase-3.

CONCLUSIONS

In this acute model, under different flows for SCP, cerebral MDA and SOD activities show no change, whereas activated caspase-3 has a marked change. There was no relationship between oxidative stress, indicated by MDA and SOD, and apoptotic protein activation in the early phase after DHCA.

141 DEVELOPMENT OF rLENTIVIRAL VECTORS FOR MALE GERMLINE-SPECIFIC Cre RECOMBINASE EXPRESSION IN LIVESTOCK

Transgenic livestock have been used as biomedical models and have the potential to increase production characteristics. Unfortunately, some of the tools used to confirm genetic modification (transgenesis) are unacceptable in terms of public image. One key component is a fluorescent marker confirming foreign gene insert. The fluorescent protein benefits the researchers producing and selecting transgenic animals but is not required for the enhancement of the animal. Removal of the fluorescent marker can be accomplished by employing the Cre-lox recombination system. By using this system one can produce male genetically modified animals that express the enhanced trait in addition to the fluorescent marker, but their sperm only contain the portion of the transgene that represents the enhanced production trait. As a result, offspring derived from these animals exhibit the desired production trait but not the fluorescent marker. The goal of this research was to develop rlentiviral vectors that use the gamete-specific promoter stimulated by retinoic acid 8 (Stra8) to drive expression of Cre recombinase. The base rlentiviral vector we chose to use was pLB. It is ideal for this research because it has a U6 promoter to drive expression of a short hairpin RNA for an enhanced production trait, as well as Lox P sites flanking a cytomegalovirus-green fluorescent protein (CMV-GFP) expression cassette. Initially we identified and PCR amplified a 400-bp mouse Stra8 promoter and a 1.5-kb promoter region of the pig. The Stra8 promoters were integrated into the pLB vector directly upstream of the green fluorescent protein (GFP). These intermediate vectors should have germline-specific expression of GFP and are the first vectors using a pig Stra8 promoter. Next, we PCR amplified and inserted the coding sequence for Cre recombinase into these vectors for germline-specific Cre expression resulting in the first pig Stra8-Cre expression vector. The Lox P sites of this vector are flanking the GFP expression cassette as well as the Str8-Cre expression cassette. To confirm the functionality of the Cre-lox recombination system, the pLB vectors were transfected into human embryonic kindey 293T cells and fluorescence was measured. After Day 2, a Cre expression plasmid was transfected and 3 days post-Cre transfection, fluorescence was measured again. A decrease in fluorescence and GFP positive cell numbers was observed, thus confirming the functionality of the Cre-lox recombination event for these vectors. These vectors will be used to produce transgenic animals by lentiviral transgenesis. Our laboratory has been successful in using this method to produce transgenic livestock. The transgenic animals will be analysed to confirm male germ-cell-specific expression of Cre as well as removal of the GFP fluorescence. If successful, these will be the first transgenic animals using a pig Stra8 promoter for Cre expression for a novel single rlentiviral vector Cre-lox recombination system.

105 BOVINE EMBRYO TYPE, GRADE AND RECIPIENT SYNCHRONY, BUT NOT CORPUS LUTEUM QUALITY, INFLUENCED PREGNANCY RATES IN COMMERCIAL EMBRYO TRANSFER

Embryo transfer is a tool that enables progressive cattle producers to reach their reproductive, genetic and financial goals. The complexity of pregnancy establishment increases with any reproductive technology, especially with one with many variables. This clinical analysis employed a statistical model capable of explaining factors that affect pregnancy probability resulting from over 8000 embryo transfers. These data included corpus luteum (CL) quality score, embryo stage (morula to blastocyst) and grade (1–3), recipient synchrony (relative to the embryo age) and pregnancy rate (≥45 days). The CL score was an amalgamation of the palpable diameter of the CL, whether or not a crown was present and the overall quality of the reproductive tract (size of the uterine horns and perceived patency of the cervix). Embryos produced by IVF were transferred fresh and in vivo–produced embryos were transferred fresh (VIVO FRESH) or following cryopreservation (VIVO FROZ). Statistical methods were used to compare types of embryos transferred and pregnancy rates. All data were analysed using JMP 2009 software by logistic regression with the Logit link. Analysis for the odds of pregnancy occurring among groups using contrasts was conducted. Fisher's exact test showed significant differences (P < 0.05) among groups for pregnancy rate, with the VIVO FRESH embryos group having the highest rate (68.5 ± 1.5%) and the VIVO FROZ the lowest (54.7 ± 1.6%) and the IVF embryos were intermediate (62.1 ± 3.3%). Synchrony, stage, embryo grade and CL quality were analysed for their predictive ability of pregnancy rates in the IVF, VIVO FRESH and VIVO FROZ groups using effect tests with a P < 0.05. Interestingly, the CL quality had no predictive ability for any of the groups. Effectors that had an influence on the VIVO FROZ group included synchrony, stage and embryo grade. However, for the IVF and VIVO FRESH groups, pregnancy rates were affected by only embryo grade. Retrospective, observational analysis of commercial embryo transfer data represents a challenge to meaningful interpretation. Because of the nature of the business, experimental treatments cannot always be developed and implemented. Nonetheless, valuable information is gained by using appropriate statistical methods. As anticipated, these data suggested that the type of embryo transferred, grade and synchrony of the recipient are all important factors, particularly for cryopreserved embryos. Unexpectedly, the score of the CL did not influence pregnancy outcome regardless of embryo type. Evaluation of clinical data allows adjustment of embryo transfer protocols, facilitates genetic gain via enhanced reproductive success and provides a unique opportunity to analyse large, real-world data sets.

Does 6% hydroxyethyl starch 130/0.4 impact differently on blood glucose than 4% gelatin in patients receiving open heart surgery?

Objectives: To investigate whether starch-based colloid may impact differently on blood glucose than a gelatin-based colloid in adult patients receiving open heart surgery.

Methods: 70 adult patients scheduled for elective first-time cardiac surgery were enrolled and randomized into two groups. The circuits were primed with either 6% HES 130/0.4 or 4% gelatin. The peak glucose level, incidence of hyperglycemia, glucose variation and glucose level at different time points during operation were compared between the two groups. A p-value ≤ 0.05 was accepted as significant.

Results: The peak glucose (150±30mg/dl vs 142±27, p=0.236) and glucose variation demonstrated by standard deviation (26±12mg/dl vs 23±11mg/dl, p=0.202) were comparable between the two groups. Repeated measurement ANOVA revealed that the main effect for artificial colloid was not significant (p=0.349).

Conclusions: With the data available, we could not prove that starch-based colloid (HES130) had a different impact on intra-operative blood glucose than a gelatin-based colloid in adult patients receiving open heart surgery.

Estrogen prevents β-amyloid inhibition of sympathetic α7-nAChR-mediated nitrergic neurogenic dilation in porcine basilar arteries

AIM

β-amyloid peptides (Aβs) have been shown to block cerebral nitrergic neurogenic vasodilation by blocking sympathetic α7-nAChRs, and that oestrogen prevents Aβ-induced neurotoxicity. We examined whether Aβ-inhibition of α7-nAChR-mediated cerebral nitrergic vasodilation was prevented by oestrogen.

METHODS

Effects of Aβ and 17β-oestradiol on neurogenic nitrergic vasodilation in isolated porcine basilar arteries were examined using wire-myography. Drug effects on nicotine- and choline-induced calcium influx and inward currents in porcine cultured superior cervical ganglion (SCG) were investigated using confocal microscopy and patch-clamp techniques respectively.

RESULTS

Precontracted endothelium-denuded basilar arteries relaxed exclusively upon transmural nerve stimulation (TNS, 8 Hz), and applications of nicotine (100 μm) or choline (1 mm), which was sensitive to nitro-L-arginine (L-NNA, 30 μm) and tetrodotoxin (0.3 μm). The relaxation induced by nicotine and choline but not that by TNS was blocked reversibly by Aβ(1-40) in a concentration-dependent manner. Aβ(1-40) also reversibly blocked nicotine- and choline-induced increase of calcium influx and inward currents in the SCG neurons. Aβ inhibition of nicotine- and choline-induced α7-nAChR-mediated nitrergic vasodilation and inward currents was prevented by 17β-oestradiol (10 μm), but not by α-oestradiol (10 μm) or testosterone (10 μm).

CONCLUSION

These results provide further evidence supporting that Aβ is an antagonist for the α7-nAChR found on post-ganglionic sympathetic adrenergic nerve terminals originating in the SCG. Aβ can cause constriction of cerebral arteries with possible decreased regional cerebral blood flow by blocking sympathetic nerve-mediated release of nitric oxide from the perivascular nitrergic nerves. This effect of Aβ can be prevented by endogenous oestrogen but not testosterone.

Evaluation of supporting role of a foldable capsular vitreous body with magnetic resonance imaging in the treatment of severe retinal detachment in human eyes

PURPOSE

To determine the supporting role of a novel foldable capsular vitreous body (FCVB) with magnetic resonance imaging (MRI) in the treatment of severe retinal detachment in human eyes.

METHODS

The study examined nine eyes of nine patients. Among the nine eyes, five had suffered penetrating injuries while four had suffered contusions of the eyeball involving large defects of the retina or choroids. A standard three-port pars plana vitrectomy was performed, FCVB was triple-folded and sent into the vitreous cavity; balanced salt solution (BSS) was injected into the capsule to support the retina. Three cardinal axes of nine eyes were examined using MRI at baseline and at the 3-month follow up.

RESULTS

MRI revealed that the signal intensity of the FCVB was similar to the normal vitreous body, with low-signal intensity on T1-weighted image and high-signal intensity on T2-weighted image. In three pre-operative silicone oil- or heavy silicone oil-filled eyes, FCVBs were not fully inflated, and eyeball deformation was observed in one eye. Shifts of three cardinal axes of three eyes (horizontal, anteroposterior, and vertical) according to MRI, were -4.33, -4.67, and -2.67 mm. In the remaining six eyes, FCVBs were well distributed in the vitreous cavity and evenly supported the retina; the cardinal axes of the eyes were similar to pre-operation. Shifts of three cardinal axes of six eyes were -0.34, -0.34, and -0.34 mm. In a total of nine eyes, shifts of three cardinal axes were -1.67, -1.77, and -1.11 mm. Statistically significant difference showed only between the horizontal axis of nine eyes pre-operatively and post-operatively (P1=0.041, P2=0.058, P3=0.123).

CONCLUSION

This study demonstrated the effectiveness of MRI to monitor the supporting role of an FCVB in the treatment of severe retinal detachment in human eyes.