A novel clinical pharmacy management system in improving the rational drug use in department of general surgery

Hospital information system is widely used to improve work efficiency of hospitals in China. However, it is lack of the function providing pharmaceutical information service for clinical pharmacists. A novel clinical pharmacy management system developed by our hospital was introduced to improve the work efficiency of clinical pharmacists in our hospital and to carry out large sample statistical analyzes by providing pharmacy information services and promoting rational drug use. Clinical pharmacy management system was developed according to the actual situation. Taking prescription review in the department of general surgery as the example, work efficiency of clinical pharmacists, quality and qualified rates of prescriptions before and after utilizing clinical pharmacy management system were compared. Statistics of 48,562 outpatient and 5776 inpatient prescriptions of the general surgical department were analyzed. Qualified rates of both the inpatient and outpatient prescriptions of the general surgery department increased, and the use of antibiotics decreased. This system apparently improved work efficiency, standardized the level and accuracy of drug use, which will improve the rational drug use and pharmacy information service in our hospital. Meanwhile, utilization of prophylactic antibiotics for the aseptic operations also reduced.

Multispecies coexistence of trees in tropical forests: spatial signals of topographic niche differentiation increase with environmental heterogeneity

Neutral and niche theories give contrasting explanations for the maintenance of tropical tree species diversity. Both have some empirical support, but methods to disentangle their effects have not yet been developed. We applied a statistical measure of spatial structure to data from 14 large tropical forest plots to test a prediction of niche theory that is incompatible with neutral theory: that species in heterogeneous environments should separate out in space according to their niche preferences. We chose plots across a range of topographic heterogeneity, and tested whether pairwise spatial associations among species were more variable in more heterogeneous sites. We found strong support for this prediction, based on a strong positive relationship between variance in the spatial structure of species pairs and topographic heterogeneity across sites. We interpret this pattern as evidence of pervasive niche differentiation, which increases in importance with increasing environmental heterogeneity.

Development of a high-volume air sampler for nanoparticles

As a tool to evaluate the characteristics of aerosol nano-particles, a high-volume air sampler for the collection of nano-particles was developed based on the inertial filter technology. Instead of the webbed fiber geometry of the existing inertial filter, wire mesh screens alternately layered using spacing sheets with circular holes aligned to provide multi-circular nozzles were newly devised and the separation performance of the filter was investigated experimentally. The separation performance was evaluated for a single-nozzle inertial filter at different filtration velocities. A webbed stainless steel fiber mat attached on the inlet surface of the developed inertial filter was discussed as a pre-separator suppressing the bouncing of particles on meshes. The separation performance of a triple-nozzle inertial filter was also discussed to investigate the influence of scale-up on the separation performance of a multi-nozzle inertial filter. The influence of particle loading on the pressure drop and separation performance was discussed. A supplemental inlet for the nano-particle collection applied to an existing portable high-volume air sampler was devised and the consistency with other types of existing samplers was discussed based on the sampling of ambient particles. The layered-mesh inertial filter with a webbed stainless steel fiber mat as a pre-separator showed good performance in the separation of particles with a d p50 ranging from 150 to 190 nm keeping the influence of loaded particles small. The developed layered-mesh inertial filter was successfully applied to the collection of particles at a d p50∼ 190 nm that was consistent with the results from existing samplers.

Abstract P2-06-01: Breast-to-breast metastasis can cause hormone-receptor positive/triple negative bilateral synchronous tumors

Background: Prior work suggests that synchronous bilateral breast cancers may be clonal, with one tumor a metastasis, although prior techniques lacked resolution to prove this relationship. We used deep whole exome and shallow whole genome sequencing to compare bilateral tumors in two cases. In both cases, tumors were invasive and node negative with one tumor ER+/PR+/HER2− (HR+) lobular and the other triple negative (TN) ductal. Case 1 is a 75-year-old African American woman and Case 2 a 70-year-old white woman. With 44 and 12 months of follow up, respectively, neither patient has recurred.

Methods: Agilent SureSelect All Exon 50Mb Target Enrichment Kits were used for exome capture. Paired-end sequencing was performed with 200 base pair reads on the Illumina HiSeq 2000. Sequencing depth was targeted to cover 80% of the genome at 100x for three tumors with 70% cellularity, 200x for one tumor with 40% cellularity and 30x for germline. Tumor and germline exome results were compared to identify high confidence somatic single nucleotide variants (HC SNV). HC SNV's were called using GATK and stringent custom filtering to avoid false positives resulting from unrecognized germline single nucleotide polymorphisms. For each tumor pair, we define a clonality likelihood score (CLS) as the ratio of the number of HC SNV called at the same site and with the same alternate base in both tumors, to the total number of sites with an HC SNV called in either tumor. For comparison we analyzed the called SNV data from The Cancer Genome Atlas (TCGA) for exome sequenced HR+ or TN breast cancers.

Results: In Case 1, of 102 HC SNVs called in either tumor, 82 were shared, for a CLS of 80.3%. Additionally, 11 shared SNVs were synonymous, consistent with clonality. Lastly the non-shared HC SNVs were asymmetrically found in the TN tumor, consistent with clonal evolution during metastasis. Copy number analysis (CNA) showed Case 1 to have a deletion in 6q, including the ESR1 gene, unique to the TN tumor.

To assess significance of the CLS, we found three primary/metastatic clonal pairs in the TCGA to serve as positive controls. To serve as negative controls, from 357 ER+ and 46 TN primary TCGA tumors, we formed a total of 16,422 independent ER+/TN pairs. For the 3 clonal TCGA pairs, the CLS values were 39.3%, 58.5% and 60.0%. Most of the independent TCGA pairs had a CLS of zero (98.5%), with a maximum CLS of 2.8%. As the CLS for Case 1 lies above maximum observed CLS among 16,422 independent tumor pairs, we reject the hypothesis that this tumor pair is independent, at p < 0.0001. For Case 2, of 222 HC SNV sites, 5 were shared for a CLS of 2.3%, consistent with independence.

Conclusion: Somatic single nucleotide mutations identified by exome sequencing found that the two tumors in Case 1 share >80% of SNVs, consistent with clonal evolution of metastasis. The two tumors from Case 2 have few shared SNVs, consistent with independent origin. CNA results were consistent. This is the first clonality analysis reported from deep sequencing of phenotypically discordant synchronous bilateral breast cancers, and demonstrates that next-generation sequencing can distinguish clonal from independent tumor pairs with high confidence.

Funding: The Breast Cancer Research Foundation

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-06-01.

Hypolipidemic effects of piperlonguminine in HepG2 cells and in Wistar rats

A novel thermostable form of piperlonguminine (GB-N) was extracted from medicinal plant Piper longum in efforts to explore the bioactive components underlying the mechanism of Piper longum in reducing plasma lipids. In vitro, HepG2 cells were employed to investigate the effects of GB-N on regulating cellular total cholesterol and low-density lipoprotein (LDL) receptor (LDLR) mRNA abundance, while high-fat and high-cholesterol diet-induced hyperlipidemic Wistar rats were used to investigate in vivo effects of GB-N. Cellular total cholesterol assay showed that GB-N dose-dependently reduced cellular total cholesterol in HepG2 cells in the presence and absence of elevated plasma cholesterol levels by 25% and 32%, respectively. Reverse transcription PCR assay showed that LDLR mRNA abundance was up-regulated dose-dependently by 142% via GB-N treatment in HepG2 cells. Animal experiment revealed that GB-N dose-dependently reduced serum total cholesterol by 26%, triglyceride by 47%, LDL cholesterol by 30%, while increased serum high-density lipoprotein (HDL) cholesterol by 524% in diet-induced hyperlipidemic Wistar rats. In conclusion, the results suggest the potential therapeutic uses of GB-N in the prevention and treatment of hyperlipidemia and related diseases.

Ventilation and dampness in dorms and their associations with allergy among college students in China: a case-control study

To study the associations between dorm environment and occupants' health, a nested case-control study on 348 college students was carried out in 2006-2007 at Tianjin University, China. Two hundred and twenty-three dorm rooms where the 'cases' and 'controls' resided were inspected. Measured variables were ventilation rate, air temperature, and relative humidity indoors. Allergic symptoms in the last 12 months were self-reported by occupants. Adjusted odds ratios (AORs) of a 'localized moldy smell/moisture indicator' in 'special places' (e.g., in a room corner or close to the radiator under the window) for wheezing was 3.56 [95% Confident Interval (CI): 1.56-8.14] and for rhinitis 2.81 (95% CI: 1.32-5.97). The AOR of a low air change rate (below the median value of 0.7/h) for wheezing was 2.28 (95% CI: 1.38-3.75) and for dry cough 2.26 (95% CI: 1.08-4.75). The prevalence of students with allergic symptoms in dorm rooms decreased with increasing ventilation rate. The combination of a 'localized moldy/moisture indicator' and a low air change rate significantly increased the AOR of case status to 13.35 (95% CI: 3.73-47.83), compared to the reference condition with no-dampness and high ventilation rate (above the median). This supports the hypothesis that ventilation rate is an effect modifier for moisture problems and indoor pollutants.

Improved immunogenicity of recombinant Mycobacterium bovis bacillus Calmette-Guérin strains expressing fusion protein Ag85A-ESAT-6 of Mycobacterium tuberculosis

Early secretory antigen target 6 (ESAT-6) is a dominant target for cell-mediated immunity in the early phase of tuberculosis (TB) in patients with TB, causing T-cell proliferation and gamma interferon (IFN-γ) production, which has been considered to be a protective antigen that can be used for future vaccine development. Ag85A is the most essential component for bacterial survival within macrophages and has been used in numerous vaccine preparations, which can induce strong cellular immune responses. In this study, we constructed a new recombinant bacilli Calmette-Guérin (BCG) strain (rBCG-AE) that could express fusion protein Ag85A-ESAT-6 of Mycobacterium tuberculosis and evaluated its immunogenicity in BALB/c mice. There was no evidence for increased virulence of this rBCG. Our experiments illustrated that the rBCG-AE was able to induce higher titer of antibody and elicit more long-lasting and stronger Th1 type cellular immune responses than the parental BCG strain, or rBCG-A (expressing Ag85A) strain, or rBCG-E (expressing ESAT-6) strain, which are characterized by the strong antibody response, the proliferation rate of splenocytes, the ratio of CD4(+) T and CD8(+) T cells stimulated by tuberculin-purified protein derivative and elevated levels of IFN-γ in antigen-stimulated splenocyte cultures. The results show that rBCG-AE is an improved TB vaccine for further study.

C3aR inhibition reduces neurodegeneration in experimental lupus

Complement activation is an important aspect of systemic lupus erythematosus. In this study we investigated the role of C3a/C3a receptor (R) signaling in brains of the lupus model, MRL/lpr mice, by treating the mice with C3aR antagonist (a) from 13 to 19 weeks of age. C3aR mRNA (0.2 +/- 0.027 versus 0.56 +/- 0.19) and protein (0.16 +/- 0.09 versus 0.63 +/- 0.19) expression was increased in MRL/lpr brains compared with MRL+/+ controls. Apoptosis, a key feature in lupus brain, was significantly reduced by C3aRa treatment, as assessed by DNA laddering, TUNEL staining and caspase3 activity (48% of MRL/lpr mice). mRNA expression of proinflammatory molecules that cause apoptosis, TNFalpha (0.33 +/- 0.07 versus 0.15 +/- 0.1), MIP2 (3.8 +/- 1.3 versus 1.7 +/- 0.6), and INFgamma (4.8 +/- 1.0 versus 2.07 +/- 1.28) are reduced in MRL/lpr brains with C3aRa treatment. In line with these results, Western blotting demonstrates the significant increase in phosphorylation of survival molecules Akt and Erk, decrease in PTEN and reduced iNOS expression. INFgamma receptor (R) and AMPA-GluR1 co-localized, and concomitant with reduced INFgammaR expression, AMPAGluR1 expression was also decreased by C3aR antagonist. All of these variables that modulate neuronal excitability and regulate synaptic plasticity are C3aR dependent in the MRL/lpr brains and suggest a potential therapeutic role for C3aR inhibition in CNS lupus.

Dampness in dorm rooms and its associations with allergy and airways infections among college students in China: a cross-sectional study

A cross-sectional study was carried out at Tianjin University campus, China, from February 21 to June 10, 2006, to survey the association between dampness in dorms, and allergy and airways infections among college students. The health and dampness conditions were self-reported by 3436 students living in 1511 dorm rooms located in 13 buildings on the campus. The buildings were selected according to their positions, construction periods and occupant densities. The symptoms involved wheezing, dry cough during night, rhinitis, eczema, cold/flu, ear inflammation, pneumonia and tuberculosis. The indoor moisture signs were mould/damp spots on walls, ceilings and floors; suspected or ever happened water damage; condensation on windowpane in winter and odours perceived by subjects themselves. There was a significant positive association between condensation and dry cough. Eczema was often reported in rooms with moisture problem. Dampness was a significant risk factor for common cold.

PRACTICAL IMPLICATIONS

Dampness problems in dorms of Chinese students are a risk factor for allergic symptoms, and hence there is a need for dorm environment improvement. Health problems related to ventilation and microbiology problems in dorms should be further studied.

High-titer lentiviral vectors stimulate fetal calf serum-specific human CD4 T-cell responses: implications in human gene therapy

Human immunodeficiency virus-1-derived lentiviral vectors have been increasingly used for gene delivery in both pre-clinical and clinical models. Numerous studies have shown that dendritic cells (DC) transduced with concentrated lentiviral vectors can induce primary T-cell responses to viral and tumor antigens. In this study, we attempted to generate influenza hemagglutinin-specific CD4 T cells using lentiviral vectors containing the signal sequence and human lysosome-associated membrane protein to target hemagglutinin to the major histocompatibility complex class II processing pathway. Autologous dendritic cells were generated in serum-free medium and transduced with concentrated, high-titer lentiviruses to stimulate autologous T cells. Unexpectedly, we failed to generate influenza hemagglutinin-specific CD4 T cells rather than T cells specific for fetal calf serum (FCS). By limiting dilution, we established several FCS-specific CD4 T-cell clones restricted by human leukocyte antigen-DR1 and human leukocyte antigen-DR4. Lentiviruses produced in human serum-adapted 293 cells or in serum-free medium were unable to sensitize dendritic cells for recognition by FCS-specific CD4 T-cell clones. Our results indicate that residual FCS in concentrated lentiviral pellets is, in part, responsible for its immunogenicity. These FCS-specific CD4 T cells may be useful in testing clinical grade lentiviral vectors for the presence of contaminating FCS.

Dampness at dorm and its associations with allergy and airways infection among college students in China: a cross-sectional study

A cross-sectional study was carried out at Tianjin University campus, China, from February 21 to June10, 2006, to survey the association between dampness in dorms and allergy and airways infection among college students. The health and dampness condition were self-reported by 3436 students living in 1511 dorm rooms located in 13 buildings on the campus. The buildings were selected according to their positions, construction periods and occupant densities. The allergy and airways infection symptoms involved wheezing, dry cough during night, rhinitis, eczema, cold/flu, ear inflammation, pneumonia and tuberculosis. The indoor moisture signs were mould/damp spots on walls, ceilings and floors; suspected or ever happened water damage; condensation on windowpane in winter and odours perceived by subjects themselves. This study showed there was significantly positive association between condensation and dry cough. Eczema was often reported in rooms with suspected moisture problem. Dampness was a significantly risk factor for common cold.

PRACTICAL IMPLICATIONS

This paper indicated that dampness problem at dorms of Chinese students was a risk factor in irritating allergic symptoms, and hence there is a need for dorm environment improvement. The ventilation and microbiology problems in dorm environment corresponding to dampness should be further studied, especially when it is associated to occupants' health.

The early and initiation processes of radiation-induced bystander effects involved in the induction of DNA double strand breaks in non-irradiated cultures

The initiation and the early process of bystander response induced by low dose alpha-particle irradiation are very important for understanding the mechanisms underlying the bystander response. Using a 1 cGy alpha-particle to irradiate 50% of the area of a rectangular mylar dish, time-dependent DNA double strand breaks (DSBs) were induced shortly after irradiation in AG1522 cells, located either in the irradiated area or in the non-irradiated bystander area, reaching a maximum 30 min post irradiation. Medium transfer experiments showed that the conditioned medium harvested from the irradiated culture induced excessive DNA DSBs in the medium recipient cells, and the DSB-inducing ability of the medium showed was time-dependent. The medium transfer results indicated that the soluble bystander signalling molecule(s) had been generated very soon (probably less than 2.5 min) after irradiation and exist continuously to 30 min although the production of signalling molecule(s) decreased after 10 min post irradiation. Pre-treatment with dimethyl sulphoxide (DMSO) eliminated the DNA DSB-inducing ability of the conditioned medium, as well as the formation of excessive DNA DSBs in both irradiated and non-irradiated bystander areas, indicating that reactive oxygen/nitrogen species etc. might be involved in these processes.

Constitutive nitric oxide acting as a possible intercellular signaling molecule in the initiation of radiation-induced DNA double strand breaks in non-irradiated bystander cells

The initiation and propagation of the early processes of bystander signaling induced by low-dose alpha-particle irradiation are very important for understanding the underlying mechanism of the bystander process. Our previous investigation showed that the medium collected from cell culture exposed to low-dose alpha-particle rapidly induced phosphorylated form of H2AX protein foci formation among the non-irradiated medium receptor cells in a time-dependent manner. Using N(G)-methyl-L-arginine, 4-amino-5-methylamino-2',7'-difluorofluorescein diacetate and N(omega)-nitro-L-arginine (L-NNA) treatment before exposure to 1 cGy alpha-particle, we showed in the present study that nitric oxide (NO(*)) produced in the irradiated cells was important and necessary for the DNA double strand break inducing activity (DIA) of conditioned medium and the generation of NO(*) in irradiated confluent AG1522 cells is in a time-dependent manner and that almost all NO(*) was generated within 15 min post-irradiation. Concurrently, the kinetics of NO(*) production in the medium of irradiated cells after irradiation was rapid and in a time-dependent manner as well, with a maximum yield observed at 10 min after irradiation with electron spin resonance analysis. Furthermore, our results that 7-Nitroindazole and L-NNA, but not aminoguanidine hemisulfate, treatment before exposure to 1 cGy alpha-particle significantly decrease the DIA of the conditioned medium suggested that constitutive NO(*) from the irradiated cells possibly acted as an intercellular signaling molecule to initiate and activate the early process (<or=30 min) of bystander response after low-dose irradiation.

Differential expression of synaptoporin and synaptophysin in primary sensory neurons and up-regulation of synaptoporin after peripheral nerve injury

Synaptoporin and synaptophysin are integral membrane components of synaptic vesicles. The distribution of synaptoporin and its relationship with synaptophysin in sensory afferent fibers remain unclear. In the present study, we showed that in the rat dorsal root ganglia synaptoporin was expressed in subsets of small neurons that contain either calcitonin gene-related peptide or isolectin B4, and was distributed in their afferent terminals in laminae I-II of the spinal cord. Synaptophysin was expressed in 57% of synaptoporin-containing small dorsal root ganglion neurons and in large dorsal root ganglion neurons. In the spinal dorsal horn, synaptophysin-immunolabeling was weak in the afferent fibers in lamina I, outer lamina II and the dorsal part of inner lamina II, but strong in the afferent fibers in laminae III-IV. However, a subpopulation of isolectin B4-positive small dorsal root ganglion neurons expressed both synaptoporin and synaptophysin, and their afferent fibers were mainly distributed in the ventral part of inner lamina II. After peripheral nerve injury, synaptoporin expression was up-regulated in small dorsal root ganglion neurons, and synaptoporin level was increased in their afferent terminals. Thus, synaptoporin and synaptophysin have topographically distinct distributions in afferent fibers. Synaptoporin is a major synaptic vesicle protein in Adelta- and C-fibers in both physiological and neuropathic pain states.