[Research of gestrinone-related abnormal uterine bleeding and the intervention in the treatment: a multi-center, randomized, controlled clinical trial]

OBJECTIVE

To investigate the incidence, influencing factors and intervention of gestrinone-related abnormal uterine bleeding at different dosage of gestrinone in the clinical treatment.

METHODS

This was a multicenter, randomized, control study of 195 Chinese women with endometriosis or adenomyosis from June 2011 to November 2013. The subjects were randomized into three groups with oral administration of gestrinone, 2.5 mg dose at one time; twice a week group: 67 cases with oral administration twice a week last three months; double dose first month group: 67 cases with oral administration triple times a week at first month, then twice a week for two months; three times a week group: 61 cases with oral administration three times a week last three months. The improvement of the abnormal uterine bleeding, the changes in estrogen, liver function and blood coagulation were evaluated. At the same time, B-ultrasound examination evaluation were performed.

RESULTS

(1) Three months later, the incidence of abnormal uterine bleeding in twice a week group was 30% (20/67), in double dose first month group and three times a week group were 7%(5/67) and 16% (10/61) respectively, there were significant difference between three groups (P<0.05). The incidence in double dose first month group was the most lower. (2) Univariate analysis showed that the dosage and ovarian size were the significant factors for abnormal uterine bleeding (OR=0.461,P= 0.003;OR=0.303,P=0.016); logistic regression analysis demonstrated that the risk of abnormal uterine bleeding in double dose first month group was the lowest when compared with twice a week group and three times a week group, the risk in twice a week group was 5-fold higher than that in double dose first month group (OR=0.211,P=0.011). The incidence of abnormal uterine bleeding in participants with abnormal ovarian volume results from ovarian cyst or ovarian surgery was significantly lower than those with normal ovarian volume (OR=0.304,P=0.018). (3) After the treatment of three months, there were no significant difference in alanine transaminase level between the groups (P>0.05). The body mass index significantly increased in three group (P<0.05), but there were no significant differences between the groups (P>0.05). As for blood coagulation, there were also no significant differences between the groups (P>0.05).

CONCLUSIONS

Double dose of gestrinone in the first month could significantly decrease the incidence of gestrinone-related abnormal uterine bleeding. It is a more optimied dosage of gestrinone and without severe side effects.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry, registration number: ChiCTR-TRC-12002327.

Initial locomotor sensitivity to cocaine varies widely among inbred mouse strains

Initial sensitivity to psychostimulants can predict subsequent use and abuse in humans. Acute locomotor activation in response to psychostimulants is commonly used as an animal model of initial drug sensitivity and has been shown to have a substantial genetic component. Identifying the specific genetic differences that lead to phenotypic differences in initial drug sensitivity can advance our understanding of the processes that lead to addiction. Phenotyping inbred mouse strain panels are frequently used as a first step for studying the genetic architecture of complex traits. We assessed locomotor activation following a single, acute 20 mg/kg dose of cocaine (COC) in males from 45 inbred mouse strains and observed significant phenotypic variation across strains indicating a substantial genetic component. We also measured levels of COC, the active metabolite, norcocaine and the major inactive metabolite, benzoylecgonine, in plasma and brain in the same set of inbred strains. Pharmacokinetic (PK) and behavioral data were significantly correlated, but at a level that indicates that PK alone does not account for the behavioral differences observed across strains. Phenotypic data from this reference population of inbred strains can be utilized in studies aimed at examining the role of psychostimulant-induced locomotor activation on drug reward and reinforcement and to test theories about addiction processes. Moreover, these data serve as a starting point for identifying genes that alter sensitivity to the locomotor stimulatory effects of COC.

Chinese military medical teams in the Ebola outbreak of Sierra Leone

The 2014-2015 Ebola virus disease (EVD) epidemic in West Africa was the largest in history. The three most affected countries, Guinea, Liberia and Sierra Leone, have faced enormous challenges in controlling transmission and providing clinical care for patients with EVD. The Chinese government, in response to the requests of the WHO and the governments of the affected countries, responded rapidly by deploying Chinese military medical teams (CMMTs) to the areas struck by the deadly epidemic. A total of three CMMTs, comprising 115 military medical professionals, were rotationally deployed to Freetown, Sierra Leone to assist with infection prevention and control, clinical care and health promotion and training. Between 1 October 2014 and 22 March 2015, the CMMTs in Sierra Leone admitted and treated a total of 773 suspected and 285 confirmed EVD cases. Among the 285 confirmed cases, 146 (51.2%) patients survived after treatment. In addition, the CMMTs maintained the record of zero infections among healthcare workers and zero cross-infections between quarantined patients. In this manuscript, we aim to give an overview of the mission, and share our best practices experience on predeployment preparedness, EVD holding and treatment centre building and EVD case management.

[Selective internal radiotherapy (SIRT) of liver tumors]

METHODICAL INNOVATIONS

Selective internal radiotherapy (SIRT) is a safe and efficacious, minimally invasive procedure to treat primary and secondary unresectable liver tumors. For hepatocellular carcinoma (HCC), SIRT has proven to be a well-tolerated therapy option even in advanced stages of disease.

STANDARD RADIOLOGICAL METHODS

In cases of portal vein thrombosis SIRT is the alternative to transarterial chemoembolization (TACE).

PERFORMANCE

The role of SIRT regarding downstaging and bridging to transplantation is promising and SIRT has also been shown to be highly effective and well-tolerated in metastastic liver disease.

ACHIEVEMENTS

The results of prospective randomized trials are awaited to prove the efficiency and safety of SIRT described in numerous retrospective and prospective non-randomized studies.

PRACTICAL RECOMMENDATIONS

The indications are established within the framework of a tumor board.

Quality of life aspects in the management of thyroid cancer

While there is agreement that quality of life (QoL) is a central aim of medical treatment, the methods of its evaluation as well as its role in the patient's overall treatment experience are under continuous scrutiny. Different perspectives on patients' QoL have emerged; from the treating physician, from the psychologist, and naturally from the patient him/herself. This article provides insights into each of these views within the context of thyroid cancer where, as a consequence of increasing incidence and decreasing mortality rates, QoL aspects deserve close attention. Physicians often find themselves in situations where they perform a balancing act between what they know is best from a somatic point of view and learning about what is best for the individual patient. For psychologists in the field of oncology, a main area of interest is the incorporation of the patient's perspective into research by using patient-reported outcomes (PROs) which include QoL assessment. PROs can also be used in clinical practice as a way to start a conversation about symptoms and QoL aspects that perhaps patients might not volunteer, and this allows physicians to address QoL issues more directly. Patients usually appreciate being asked about all aspects of QoL, and need sound information about how their QoL might be affected by the disease and its treatment. By examining and understanding the different perspectives on QoL, and how QoL differs in patients with thyroid cancer compared with other cancers, it is hoped that the QoL can be enhanced in this particular patient group.

Regular aspirin use and stomach cancer risk in China

OBJECTIVE

Epidemiological studies on aspirin and stomach cancer have been inconclusive. The purpose of our study was to investigate the association between aspirin and stomach cancer in China.

METHOD

A 1:2 matched case-control study was conducted in four large medical centers. A self-designed questionnaire was used to collect information. Unconditional logistic regression was used to compute crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

RESULT

Our study indicated that risk of stomach cancer was greatly reduced for regular aspirin user (OR = 0.62; 95% CI 0.42-0.80). Specifically, dosage and tablet-years of use were associated with lower risk (OR = 0.54; 95% CI 0.29-0.84 for ≥7 tabs/week; OR = 0.47; 95% CI 0.32-0.81 for ≥10 tablet years, respectively). Furthermore, the finding was strengthened by stratified studies of gender, smoking status, body mass index (BMI) and helicobacter pylori.

CONCLUSION

Our study confirmed that regular aspirin use is a protective factor to stomach cancer.

Crossover of varicose and whipping instabilities in electrified microjets

In electrified liquid jets, varicose instability leads to jet breakup into droplets while whipping instability is responsible for jet stretching. We show that the coupling and relative importance of these two instabilities dictates the outcome for jet breakup. The codevelopment of transverse and radial perturbations lead to remarkable breakup modes linked to initial perturbation magnitude, perturbation wave numbers, and jet charge levels.

Multiplex RT-PCR detection and distribution of four apple viruses in China

Apple trees are natural hosts of four economically important virus species in China. We used a simple, sensitive multiplex RT-PCR protocol with an internal control to simultaneously detect and differentiate four apple viruses: apple chlorotic leaf spot virus (ACLSV), apple mosaic virus (ApMV), apple stem pitting virus (ASPV), and apple stem grooving virus (ASGV). This multiplex RT-PCR could be used as an alternative to other routinely used detection methods. We used this protocol to evaluate the occurrence and distribution of the four apple viruses in China. The four viruses were widely distributed throughout the main apple production region of China, including Heilongjiang, Liaoning, Hebei, Beijing, Henan, Shanxi, Shaanxi, Shandong, Gansu, Ningxia, Xinjiang, Sichuan, and Yunnan. The four viruses, ApMV, ASPV, ASGV, and ACLSV, were present in 80.1%, 65.1%, 73.7%, and 69.7% of the samples, respectively. Two or more of the viruses were detected in most of the infections. The most frequent virus combinations were ApMV + ASGV + ASPV + ACLSV with an incidence of 27.22%, followed by ApMV + ASGV + ACLSV (14.37%), ApMV + ASGV + ASPV (12.54%), and ASGV + ApMV (11.01%). The incidence of the ASPV + ACLSV combination was the lowest (0.61%). This is the first extensive survey conducted in China for monitoring the four apple viruses, which provides important information for apple virus distribution and management in China.

Peptide-binding motifs and characteristics for HLA -B*13:01 molecule

Trichloroethylene (TCE)-induced hypersensitivity dermatitis is one of the critical occupational diseases among workers in China. Our previous studies have identified a strong linkage between the disease and the HLA-B*13:01 allele. In this study, we searched for peptides bound to the HLA-B*13:01 molecule; 57 HLA-B*13:01-bound peptides in total were identified and 54 peptides were used to calculate frequency of amino acid residues to obtain binding motifs of HLA-B*13:01 molecule. The results showed P2, P3, and P9 were the primary binding anchor positions with the dominant anchor motifs of L, Q at P2, L at P9, D at P3. HLA-B*13:01-bound peptides were identified for the first time in our research, the results of which could contribute to the human leukocyte antigen (HLA)-binding peptides database.

Simultaneous HPLC determination of four active compounds in fengshiding capsules, a chinese medicine

A high performance liquid chromatography method was established for simultaneously determining four bioactive components, salicin, liquiritin, paeonolum, and imperatorin in Fengshiding capsule, a widely used traditional Chinese medicine for treating rheumatic disease. The chromatographic separation was performed on a Shimadzu Shim-pack Stable Bond C18 column using gradient elution with methanol and water. The analytical method was validated through precision, repeatability and stability, and the relative standard deviation values were less than 3%, respectively. The recoveries of the four investigated compounds ranged from 95.80 to 101.21% with relative standard deviation values less than 3.2%. Then this proposed method was successfully applied to determine six batches of Fengshiding commercial products of capsule dosage form from two pharmaceutical factories. This study might provide a basis for quality control for this traditional Chinese medicine preparation.

Preoperative level of serum amyloid A is superior to C-reactive protein in the prognosis of esophageal squamous cell carcinoma

Preoperative elevations in the levels of serum amyloid A (SAA) or C-reactive protein (CRP) have been reported to be prognostic indicators in several malignancies. The aim of this study is to evaluate the serum levels of SAA and CRP in the prognosis of esophageal squamous cell carcinoma (ESCC). In total, 252 patients with ESCC who had undergone surgery with curative-intent were retrospectively recruited. The specificity, sensitivity, and prognostic value of SAA or CRP levels were measured as the area under the receiver operating characteristic (ROC) curve (AUC). The clinical value of SAA and CRP levels as prognostic indicators was evaluated using Cox's proportional hazards model. The 1-, 3-, and 5-year overall survival (OS) rates for the entire cohort of patients with ESCC were 71.0%, 61.0%, and 43.0%, respectively. The correlation between the levels of SAA and CRP was significant (r(2) = 0. 685, P < 0.001). The ROC analysis showed that the levels of CRP were associated with a significantly lower overall accuracy than were the SAA levels (AUC, 0.615 vs. 0.880; P < 0.001). For the complete cohort, the median OS was 52.0 months longer in patients with low preoperative serum levels of SAA (72.0 months) compared with patients who had high SAA levels (20.0 months, P < 0.001). The median OS among patients with low CRP levels was also longer compared with the patients who had high CRP levels (72.0 vs. 51.0 months, respectively; P < 0.001). Subgroup analyses showed that the preoperative elevated levels of SAA could find significant differences in OS for stage I, stage II, and stage III (P < 0.001, P = 0.001, and P < 0.001, respectively), whereas the increased levels of CRP could only find a difference in OS for stage II cancers. After a multivariate analysis, preoperative elevated level of SAA was found to be an independently and significant prognostic factor (P < 0.001). Our study indicates that the preoperative levels of SAA and CRP can act as prognostic factors, and that elevated levels of these proteins are associated with negative effects on the survival of patients with ESCC. SAA showed a higher prognostic value than CRP in both cohort and subgroup analysis.

High-throughput measurement of ionic conductivity in composition-spread thin films

This paper demonstrates the feasibility of high-throughput investigation of ionic conductivity in oxygen-ion conductors. Yttria stabilized zirconia (YSZ) composition-spread thin films with nanometer-size grains were prepared by 90° off-axis reactive RF cosputtering. We compare results for two electrode configurations, namely, out-of-plane (parallel plate) and in-plane (planar interdigitated electrode) and find that the contribution from the intragrain conductivity in YSZ thin films (150 nm) is more explicit in the latter configuration because it greatly diminishes electrode effects. The intragrain oxygen ion conductivity of thin film YSZ was systematically measured as a function of yttria concentration over the range 2 mol % to 12 mol %. The results show that the measured conductivity of the YSZ thin films is close to that of corresponding bulk materials with a peak value around 3 × 10⁻⁴ S cm⁻¹ at 440 °C at the optimum Y₂O₃ concentration of 8 mol %. Validation of this technique means that it can be applied to novel chemical systems for which systematic bulk measurements have not been attempted.

Pharmacokinetics of a new immediate-release compound omeprazole capsule and its comparison with the enteric-coated formulation under fasting and fed conditions

The present study was conducted to describe the pharmacokinetic profile of immediate-release compound omeprazole capsule and compare it with the enteric-coated formulation under fasting and fed condition.This study was designed to phase I, open-label, randomized, 3-part clinical trial. 12 subjects in part one received single doses (20 mg and 40 mg) and repeated doses (20 mg). Different 30 subjects in part 2 (fasting condition) and part 3 (fed condition) received either compound omeprazole capsule (40 mg) or delayed-release omeprazole (40 mg) separated by 7 days.Compound omeprazole capsule showed dose non-proportionality in the range from 20 mg to 40 mg. The AUC0-t of 20 mg omeprazole is 78% higher after repeated doses. The C max was higher and T max was lower for compound omeprazole capsule than delayed-release omeprazole. 90% CIs for AUC0-t of the 2 periods (test/reference) under fasting and fed conditions were 106.3% (102.2%~109.2%) and 104.1% (93.4%~109.6%), respectively. Presence of food reduced the rate (C max) and extent (AUC0-t) of systemic exposure of the test and reference formulations from 1 462 to 777 ng · mL-1, 1 055 to 602 ng · mL-1, 2 597 to 1 852 ng · h · mL-1 and 2 454 to 1 873 ng · h · mL-1, respectively.Exposed dose of omeprazole in subjects with compound omeprazole capsule was time- and dose-dependent. Compared with delayed-release omeprazole, compound omeprazole capsule had rapid but similar degree of absorption of omeprazole.

Anti-cancer activities of tea epigallocatechin-3-gallate in breast cancer patients under radiotherapy

The purpose of this study was to test the hypothesis that administration of epigallocatechin-3-gallate (EGCG), a polyphenol present in abundance in widely consumed tea, inhibits cell proliferation, invasion, and angiogenesis in breast cancer patients. EGCG in 400 mg capsules was orally administered three times daily to breast cancer patients undergoing treatment with radiotherapy. Parameters related to cell proliferation, invasion, and angiogenesis were analyzed while blood samples were collected at different time points to determine efficacy of the EGCG treatment. Compared to patients who received radiotherapy alone, those given radiotherapy plus EGCG for an extended time period (two to eight weeks) showed significantly lower serum levels of vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), and reduced activation of metalloproteinase-9 and metalloproteinase-2 (MMP9/MMP2). Addition of sera obtained from patients treated with combination of radiotherapy and EGCG feeding for 2-8 weeks to in vitro cultures of highly-metastatic human MDA-MB-231 breast cancer cells resulted in the following significant changes: (1) suppression of cell proliferation and invasion; (2) arrest of cell cycles at the G0/G1 phase; (3) reduction of activation of MMP9/MMP2, expressions of Bcl-2/Bax, c-Met receptor, NF-κB, and the phosphorylation of Akt. MDA-MB-231 cells exposed to 5-10 µM EGCG also showed significant augmentation of the apoptosis inducing effects of γ-radiation, concomitant with reduced NF-κB protein level and AKT phosphorylation. These results provide hitherto unreported evidence that EGCG potentiated efficacy of radiotherapy in breast cancer patients, and raise the possibility that this tea polyphenol has potential to be a therapeutic adjuvant against human metastatic breast cancer.

Multivariate modelling of endophenotypes associated with the metabolic syndrome in Chinese twins

AIMS/HYPOTHESIS

The common genetic and environmental effects on endophenotypes related to the metabolic syndrome have been investigated using bivariate and multivariate twin models. This paper extends the pairwise analysis approach by introducing independent and common pathway models to Chinese twin data. The aim was to explore the common genetic architecture in the development of these phenotypes in the Chinese population.

METHODS

Three multivariate models including the full saturated Cholesky decomposition model, the common factor independent pathway model and the common factor common pathway model were fitted to 695 pairs of Chinese twins representing six phenotypes including BMI, total cholesterol, total triacylglycerol, fasting glucose, HDL and LDL. Performances of the nested models were compared with that of the full Cholesky model.

RESULTS

Cross-phenotype correlation coefficients gave clear indication of common genetic or environmental backgrounds in the phenotypes. Decomposition of phenotypic correlation by the Cholesky model revealed that the observed phenotypic correlation among lipid phenotypes had genetic and unique environmental backgrounds. Both pathway models suggest a common genetic architecture for lipid phenotypes, which is distinct from that of the non-lipid phenotypes. The declining performance with model restriction indicates biological heterogeneity in development among some of these phenotypes.

CONCLUSIONS/INTERPRETATION

Our multivariate analyses revealed common genetic and environmental backgrounds for the studied lipid phenotypes in Chinese twins. Model performance showed that physiologically distinct endophenotypes may follow different genetic regulations.

REP-PCR tracking of the origin and spread of airborne Staphylococcus aureus in and around chicken house

Staphylococcus aureus was used as an indicator to study the origin and spread of microbial aerosol in and around chicken houses. Air samples indoor, upwind (10 and 50 m), and downwind (10, 50, 100, 200, and 400 m) of four chicken houses were collected using Andersen-6 stages sampler. The concentrations of S. aureus were determined for every sample site. Isolation of S. aureus from chicken feces was performed according to the standard method. The genetic relationship among the isolates was determined by profiles of PCR-amplified repetitive extragenic palindromic (REP-PCR) elements. The results showed that the concentrations of S. aureus indoor of four chicken houses were higher than those upwind and downwind sites (P < 0.05 or P < 0.01), but there were no significant concentration differences among downwind sites (P > 0.05). The fingerprints and the phylogenetic tree indicated that a part of the S. aureus (55.6%, 10/18) isolates from indoor air had the same REP-PCR fingerprints as feces isolates. Consequently, most isolates (57.1%, 20/35) from downwind 10, 50, 100, 200, even 400 m had the same REP-PCR fingerprints as those from indoor or feces. These data indicated that some isolates from downwind and indoor originated from the chicken feces. However, those isolates from upwind had low similarity (similarity index 0.6-0.87) to those from indoor or feces. Therefore, the isolates upwind were not from the chicken feces or indoor. These results suggest that microbes in chicken feces can be aerosolized and spread indoor and outdoor, especially to downwind of the chicken houses. It should have an important epidemiological and public health significance.

PRACTICAL IMPLICATIONS

Thus, the use of S. aureus as an indicator to study the origin and spread of airborne pathogens from chicken houses is potentially useful for enhancing public health and understanding the airborne epidemiology of this pathogen. Meanwhile it can provide evidence for studying the spreading model of airborne pathogens.

Peroxynitrite mediates glomerular lesion of diabetic rat via JAK/STAT signaling pathway

BACKGROUND

Peroxynitrite, a highly reactive oxidant produced by the reaction of nitric oxide with free radicals superoxide, has been indicated to be involved in many diseases. However, the contributions of peroxynitrite to diabetic nephropathy and the underlying mechanism have not been fully explored.

AIM

The present study was designed to evaluate the role and the underlying mechanism of peroxynitrite in glomerular lesion of diabetic rat.

METHODS

Diabetes was induced in male Wistar rats by i.p. injection of streptozotocin, and urate was used as a specific scavenger of peroxynitrite; the pathological changes of rat glomerulus were evaluated by hematoxylin and eosin, periodic acid-Schiff staining and transmission electron microscopy observation; immunohistochemistry and Western blot were used to detect the content of nitrotyrosine (the marker of peroxynitrite) in renal cortex; the expression levels of tyrosine phosphorylation of JAK2, STAT1, and STAT3 were assessed by Western blot assay; RT-PCR and Western blot were used to assay expression levels of transforming growth factor (TGF)-beta1 and fibronectin; biochemical indicators of renal function were also detected.

RESULTS

The content of nitrotyrosine was increased, consistent with the pathological changes of glomerulus and renal dysfunction in the diabetes group. Urate prevented the formation of nitrotyrosine in rat glomerulus and attenuated the pathological alterations. Furthermore, urate inhibited the activation of JAK2, STAT1, and STAT3. Finally, homogenates from renal cortices demonstrated reduced expression of TGF- beta1 and fibronectin under urate treatment.

CONCLUSIONS

Our findings thus provides in vivo evidence that exaggerated peroxynitrite formation mediates the glomerular lesion in, at least, Type 1 diabetes, which may function through JAK/STAT signaling pathway.