The prevalence of Parkinson's disease continues to rise after 80 years of age: a cross-sectional study of Chinese veterans

OBJECTIVE

The purpose of this study was to examine whether the prevalence of Parkinson's disease (PD) continues to rise after 80 years of age.

METHODS

This is a two-stage, multi-center, cross-sectional study using a stratified cluster sampling approach was employed. Subjects included veterans at ≥ 60 years of age living in veterans' communities for at least one month in 18 major cities across China. In the first step, possible PD was screened using a PD screening scale. Demographic and relevant information were collected. In the second step, PD diagnosis was established using the United Kingdom Parkinson's Disease Society Brain Bank (UKPDSBB) diagnostic criteria.

RESULTS

The study was conducted during the period from December 2009 to December 2012. The study included 277 veterans' communities. Among the approached 11,593 subjects, 9676 subjects, (9096 men, 580 women) responded. The response rate was 83.46%.The age was ≥ 80 years in 6722 (69.47%) subjects. A diagnosis of PD was established in 228 subjects (2.36%) in the entire sample. The rate of PD was 2.65% in those with an age of ≥ 80 years. The rate of PD increased with increasing age (0%, 1.84%, 2.60% and 3.68% in the subjects at < 70, 70-79, 80-89 and ≥ 90 years of age, respectively; χ2 = 10.891, p = 0.001 in chi-square test). The rate of PD was higher in men (2.44%) than in women (1.46%) on the surface. However, no significant difference was detected (p = 0.241).

CONCLUSIONS

The prevalence of PD continues to increase beyond the age of 80 years. The prevalence of PD in Chinese veterans is not lower than that in other countries and regions.

mTOR regulates DNA damage response through NF-κB-mediated FANCD2 pathway in hematopoietic cells

Hematopoietic stem/progenitor cells (HSPCs) function to give rise to mature blood cells. Effective DNA damage response (DDR) and maintenance of genomic stability are crucial for normal functioning of HSPCs. Mammalian target of rapamycin (mTOR) integrates signals from nutrients and growth factors to control protein synthesis, cell growth, survival and metabolism, and has been shown to regulate DDR in yeast and human cancer cells through the p53/p21 signaling cascade. Here, we show that gene targeting of mTOR in HSPCs causes a defective DDR due to a variety of DNA damage agents, mimicking that caused by deficient FANCD2, a key component of the Fanconi anemia (FA) DDR machinery. Mechanistically, mTOR(-/-) HSPCs express drastically reduced FANCD2. Consistent with these genetic findings, inactivation of mTOR in human lymphoblast cells by pp242 or Torin 1, mTOR kinase inhibitors, suppresses FANCD2 expression and causes a defective DDR that can be rescued by reconstitution of exogenous FANCD2. Further mechanistic studies show that mTOR deficiency or inactivation increases phosphorylation and nuclear translocation of nuclear factor (NF)-κB, which results in an enhanced NF-κB binding to FANCD2 promoter to suppress FANCD2 expression. Thus, mTOR regulates DDR and genomic stability in hematopoietic cells through a noncanonical pathway involving NF-κB-mediated FANCD2 expression.

Fanconi anemia pathway--the way of DNA interstrand cross-link repair

The study of rare genetic diseases usually inspires the research of cancer biology. Fanconi anemia (FA), is a rare cancer susceptibility syndrome with an incidence of only 1 per 350,000 births. FA is an autosomal recessive disease with three main features: chromosome instability, hypersensitivity to DNA cross-linking agents such as mitomycin C (MMC), cisplatin and so on, and susceptible to a number of cancer types, mainly leukemia and squamous cell carcinomas of the head and neck or gynecologic system. DNA crosslinking agents may led to DNA cross-linking lesion, and Fanconi anemia pathway plays a key role in repairing its cross-linking. However, FA pathway is closely linked with carcinogenesis and tumor drug resistance. This paper mainly focuses on the FA pathway and its progress in cancer research.

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.

ADAMTS9 is a functional tumor suppressor through inhibiting AKT/mTOR pathway and associated with poor survival in gastric cancer

Using genome-wide promoter methylation analysis, we identified a disintegrin-like and metalloprotease with thrombospondin type 1 motif 9 (ADAMTS9) is methylated in cancer. We aim to clarify its epigenetic inactivation, biological function and clinical implication in gastric cancer. ADAMTS9 was silenced in 6 out of 8 gastric cancer cell lines. The loss of ADAMTS9 expression was regulated by promoter hypermethylation and could be restored by demethylation agent. Ectopic expression of ADAMTS9 in gastric cancer cell lines (AGS, BGC823) inhibited cell growth curve in both the cell lines (P<0.0001), suppressed colony formation (P<0.01) and induced apoptosis (P<0.001 in AGS, P<0.01 in BGC823). Moreover, conditioned culture medium from ADAMTS9-transfected cell lines significantly disrupted the human umbilical vein endothelial cell tube formation capacity on Matrigel (P<0.01 in AGS, P<0.001 in BGC823). The in vivo growth of ADAMTS9 cells in nude mice was also markedly diminished after stable expression of ADAMTS9 (P<0.001). On the other hand, ADAMTS9 knockdown promoted cell proliferation (P<0.001). We further revealed that ADAMTS9 inhibited tumor growth by blocking activation of Akt and its downstream target the mammalian target of rapamycin (mTOR). ADAMTS9 also reduced phosphorylation of mTOR downstream targets p70 ribosomal S6 kinase, eIF4E-binding protein and downregulated hypoxia-inducible factor-1α. Therefore, this is the first demonstration that ADAMTS9 is a critical tumor suppressor of gastric cancer progression at least in part through suppression of oncogenic AKT/mTOR signaling. Moreover, promoter methylation of ADAMTS9 was detected in 29.2% (21/72) of primary gastric tumors. Multivariate analysis showed that patients with ADAMTS9 methylation had a poorer overall survival (relative risk (RR)=2.788; 95% confidence interval, 1.474-5.274; P=0.002). Kaplan-Meier survival curves showed that ADAMTS9 methylation was significantly associated with shortened survival in gastric cancer patients (P=0.001, log-rank test). In conclusion, ADAMTS9 acts as a functional tumor suppressor in gastric cancer through inhibiting oncogenic AKT/mTOR signaling pathway. Methylation of ADAMTS9 is an independent prognostic factor of gastric cancer.

Changes in Spontaneous Dorsal Horn Potentials after Dorsal Root Entry Zone Lesioning in Patients with Pain after Brachial Plexus Avulsion

OBJECTIVES: This study investigated spontaneous dorsal horn potentials in patients with pain after brachial plexus avulsion and determined the effect of dorsal root entry zone (DREZ) lesioning on these potentials and on pain levels. METHODS: Electrospinography (ESG) recordings were undertaken in seven patients using a noninvasive electrocorticography strip electrode. Measurements were taken from the DREZ on the intact side of the spinal cord before lesioning of the injured DREZ and from the injured DREZ before and after lesioning. RESULTS: DREZ lesioning had a significant positive effect on pain at 12 months postoperatively. At 15.0 Hz, the mean ESG power from the injured DREZ before lesioning was significantly higher than that from the intact DREZ. In addition, the mean ESG power from the injured DREZ after successful DREZ lesioning was significantly lower than that from the intact DREZ and that from the injured DREZ before lesioning. CONCLUSIONS: The ESG power from the injured DREZ increases in patients with pain after brachial plexus avulsion compared with that of the intact DREZ; this increase is reduced by successful DREZ lesioning.

SU-E-T-88: Evaluating Gantry Sag on Linear Accelerators and Introducing an MLC-Based Compensation Strategy

PURPOSE

Gantry sag is one of the well-known sources of mechanical imperfections that compromise the spatial accuracy of radiation dose delivery. This study aims to quantify the gantry sag on multiple linacs and to investigate a multiple leaf collimator (MLC)-base strategy to compensate for gantry sag.

METHODS

We used the Winston-Lutz method to measure the gantry sag on three Varian linacs. A ball-bearing phantom was imaged with a square radiation field during gantry rotation. The images were analyzed to derive the radiation isocenter and subsequently the gantry sag, that is, the superior-inferior wobble of the radiation field center from the radiation isocenter as a function of gantry angle. Compensation for gantry sag was attempted by offsetting the MLC leaves at 90-degree collimator angle. The amount of offset was the opposite of measured gantry sag, which was gantry angle-specific.

RESULTS

Gantry sag was reproducible within a six-month period. On the three linacs, the maximum gantry sag was found to vary from 0.7 mm to 1.0 mm, depending on the linac and the collimator angle. The radiation field center moved inferiorly, or away from the gantry, when the gantry was rotated from 0 to 180 degrees. Comparison of gantry sag at 0- and 90-degree collimator angles showed that the uncertainty in MLC leaf positions did not increase the gantry sag. Instead, gantry sag was caused primarily by nonideal gantry rotation. After the MLC compensation was applied, the maximum gantry sag was reduced to less than 0.2 mm.

CONCLUSIONS

The results indicated that gantry sag on a linac can be quantitatively measured with sub-millimeter precision, using a simple ball-bearing phantom and the electronic portal imaging device. Reduction of gantry sag is feasible by applying a gantry angle-specific correction to MLC leaf positions at 90 degree collimator angle.

SU-E-T-260: Radiation Exposure Estimation for 131Cs Prostate Implant Patient Release Determination

PURPOSE

Due to the short half-life and high energy of Cesium-131 (131Cs), the exposure rate outside the patient could potentially increase radiation exposure to hospital staff and exceed the maximum patient release exposure rate limit. A calculation technique has been developed to estimate the exposure rate at 1 meter from the patient, for prostate patients receiving 131Cs implants.

METHODS

In our calculation for each patient, all 131Cs sources were treated as one single source, and the point on the prostate with the shortest distance to skin surface was selected as the effective source position. Attenuation inside the patient was calculated based on the attenuation coefficient of 30 keV photons in water, assuming homogeneous patient density. This calculation technique was evaluated on our first 25 131Cs implant patients. For comparison, the exposure rate at approximately 1 meter inferior to patient perineum was measured prior to patient release using the Inovision 451P-RYR survey meter.

RESULTS

The distance from the edge of the prostate to skin surface along the inferior direction was the shortest in all 25 patients. The mean of the calculated exposure rates at 1 meter from skin surface was 0.53 mR/hr, 0.53 mR/hr, 0.04 mR/hr, 0.04 mR/hr and 1.5 mR/hr along the anterior, posterior, left, right and inferior directions, respectively. The mean of the measured exposure rate at 1 meter inferior to patient perineum was 1.1 mR/hr. The mean ratio of the measured versus calculated exposure rate was 0.74 (standard deviation = 0.23).

CONCLUSIONS

Our calculation technique is useful in determining in advance whether a patient may require hospitalization after his implant. The exposure rate at 1 meter inferior to patient perineum is a good indicator for determining whether the exposure rate along any direction might exceed the maximum allowed patient release exposure rate of 6 mR/hr.

Tumor-derived macrophage migration inhibitory factor promotes an autocrine loop that enhances renal cell carcinoma

The macrophage migration inhibitory factor (MIF) is a hypoxia regulated gene that has a variety of tumorigenic functions. In clear cell renal carcinoma (CCRC), hypoxic signaling is constitutively active because of the frequent loss of function of the von Hippel-Lindau tumor suppressor protein. We therefore sought to assess the expression of MIF in CCRC and its biological functions. We stained tumor tissue microarrays comprising sections of 128 CCRC tumors and found MIF to be moderately or highly expressed in >98%. MIF expression was further found to be dramatically elevated in blood plasma of individuals with CCRC compared with healthy controls, suggesting that measurement of MIF levels in the blood may have utility as a diagnostic marker in CCRC. At a functional level, MIF has been reported to engage the CD74 and CD44 receptors and induce signal transduction. In CCRC cell lines, depletion of MIF, CD74 or CD44 by small hairpin RNA led to a significant reduction in growth rate, and clonogenic survival, coinciding with the degree of knockdown. Interruption of the MIF pathway also decreased tumorigenic potential. Biochemically, we found that in CCRC cells MIF signaling leads to activation of the mitogen-activated protein kinase pathway and to Src phosphorylation, which is critical for regulation of p27. Together, our studies establish MIF as a protumorigenic signaling molecule that functions in an autocrine fashion to promote renal cell carcinoma and may be useful as a minimally invasive marker of disease status.

Socioeconomic status and children with intellectual disability in China

BACKGROUND

Intellectual disability (ID) accounts for 70% of all disabilities among children in China's Second National Sampling Survey on Disability. Although studies have shown a relationship between social class and ID in children, none have investigated the association of socioeconomic variables in Chinese children with mild or severe ID.

METHODS

Data for children aged 0-6 years with and without ID were abstracted from the Second National Sampling Survey on Disability in China, conducted in 2006. Crude odds ratios showed the effect of sociodemographic factors on mild and severe ID. Adjusted odds ratios (OR(a) ) (95% confidence intervals) estimated the independent effects of these factors.

RESULTS

For both mild and severe ID, risk of having ID increased with male sex, birth to a woman aged 35 years and older, lower maternal education, mother's older age at delivery, lower income and rural residence. After age, gender and parent disability were controlled, mothers aged 35 years and older were more likely to have a child with ID: mild ID, OR(a) 1.47 (1.15-1.88); severe ID, OR(a) 1.32 (1.00-1.73). There was an approximate increasing monotonic risk of severe ID with increasing socioeconomic disadvantage: lowest income, OR(a) 3.00 (2.19-4.12); low income, OR(a) 2.28 (1.63-3.19); lower middle income, OR(a) 1.72 (1.27-2.33); middle income, OR(a) 1.73 (1.28-2.36).

CONCLUSIONS

There is a significant relationship between sociodemographic factors and ID. Similar patterns were found for both mild and severe ID. Recommendations are given for preventing ID in Chinese children.

Nanoparticle delivery of mycophenolic acid upregulates PD-L1 on dendritic cells to prolong murine allograft survival

Conventional immunosuppressive drug delivery requires high systemic drug levels to provide therapeutic benefit, but frequently results in toxic side effects. Novel drug delivery methods, such as FDA-approved poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs), are promising drug delivery platforms to reduce drug doses and minimize toxicity. Using murine models of skin transplantation, we investigated whether PLGA NPs would effectively deliver mycophenolic acid (MPA), a common clinical immunosuppressant, and avoid the toxicity of conventional drug delivery. We found that intermittent treatment with NPs encapsulated with MPA (NP-MPA) resulted in a significant extension of allograft survival than intermittent conventional MPA treatment even though the concentration of MPA within NP-MPA was a 1000-fold lower than conventional drug. Importantly, recipients who were administered NP-MPA intermittently avoided drug toxicity, whereas those treated with daily conventional drug manifested cytopenias. Dendritic cells (DCs) endocytosed NP-MPA to upregulate programmed death ligand-1 (PD-L1) and displayed a decreased ability to prime alloreactive T cells. Importantly, the ability of NP-MPA to promote allograft survival was partly PD-L1 dependent. Collectively, this study indicates that NPs are potent drug delivery tools that extend allograft survival without drug toxicity.

Extended resections for colorectal cancer - indications for supraradical lymphadenectomy

The laparoscopic approach to standard resections in colorectal cancer has proven that it may provide equal rates of R0 resections and adequate retrieval of lymph nodes as open procedures if performed by experienced hands. There might be difficulties in more advanced tumors or those with lymphatic spread beyond typical drainage areas and more extensive operations might be required. An atypical pattern of lymphatic spread often is associated with other adverse factors such as multifocality of primary cancers and adverse tumorbiological factors such as grade. Such patient subgroups may be defined beforehand and include particularly patients with underlying ulcerative colitis. Repetitively, extended lymph node dissection approaches have been advocated, however neither in randomised trails nor in meta-analysis has a more favourable outcome of patients undergoing such extended lymphatic dissections been demonstrated. Sticking to the rules of classical dissection of lymphatic drainage basins with removal of adequate lymph node numbers is one corner stone for successful treatment of colorectal cancer. The other one refers to a detailed description of the procedure performed in order to make the surgical procedure trackable.

P2RX7 genotype association in severe sepsis identified by a novel Multi-Individual Array for rapid screening and replication of risk SNPs

BACKGROUND

Functional single nucleotide polymorphisms (SNPs) are relevant to individual therapeutic approaches and may play a role in disease susceptibility. Genome-wide scans, which are now widely applied to detect disease-associated SNPs, provide only limited evidence about SNP associations. Their usefulness as disease markers requires appropriate phenotype analysis and retesting of the gene providing SNP information. Larger data sets of thousands of samples are necessary to confirm the suggested SNPs.

METHODS

We applied a newly established microarray-based technology that significantly accelerates and simplifies such studies. A tailor-made microarray surface chemistry, sample/probe immobilization and a primer extension reaction are central to the multi-individual array (MIA) platform, which simultaneously identifies the same variable nucleotide in thousands of samples. The set of SNPs to be typed for is highly flexible and can be adapted to the demands of defined clinical questions.

RESULTS

A MIA-SNP analysis of functional SNPs in the P2RX7 calcium channel is presented. One risk genotype has been verified by functional analysis using patch clamping. Two clinically relevant genotypes composed of 5 functional SNPs in the P2RX7 gene have been identified in patients with severe sepsis and septic shock, whereas no significant association has been found in patient suffering from hemophagocytic syndromes.

CONCLUSIONS

These results support a functional SNP genotyping of the P2RX7 gene in patients at risk of severe sepsis following surgical trauma.

Intravenous administration of bone marrow mesenchymal stem cells benefits experimental autoimmune myasthenia gravis mice through an immunomodulatory action

Mesenchymal stem cells (MSC) are potent in immunomodulation. It has been proven that MSC functioned to correct immune disorder in several immune diseases. Here, we tested the hypothesis that MSC from human bone marrow (hMSC) can provide a potential therapy for experimental autoimmune myasthenia gravis (EAMG). EAMG mice model was established by subcutaneous injection of synthetic analogue of acetylcholine receptor (AchR), then, hMSC were intravenously delivered into these mice repeatedly. The results showed that hMSC could specifically home to spleen tissue and hMSC treatment significantly improved the functional deficits of EAMG mice. In addition, AchR antibody level was dramatically decreased in cell-treated group when compared with untreated control on 10 days after the second cell injection. Moreover, both in vivo and in vitro mixed lymphocyte proliferation assays revealed that hMSC could definitely inhibit the proliferation of AchR-specific lymphocyte. In conclusion, our study demonstrated that hMSC treatment was therapeutically useful in autoimmune myasthenia gravis mice, and the underlying mechanism may relate with their immunomodulatory potential.

Media framing of graduated licensing policy debates

BACKGROUND

The overrepresentation of young drivers in road trauma statistics produces significant media interest. Graduated licensing restrictions involving night-time curfews and restrictions on passenger numbers are prominent topics within media coverage. This was particularly apparent in Australia between January 2004 and July 2008, when various models of either restriction were introduced in four states.

METHODS

Australian newspaper and Sydney free-to-air television coverage during the peak period were analysed to identify the framing strategies used by news actors supporting or opposing these policies.

RESULTS

Fifteen frames were identified. These predominantly assessed the proposed restrictions in terms of their need, evidence base, practicality and the degree to which they were consonant with 'commonsense' perceptions and had community support. While expert road injury reduction news actors primarily emphasised their moral imperative and likely effectiveness, opponents stressed their impracticality and proposed alternative solutions.

CONCLUSIONS

Research evidence is only one component of information presented as policy-relevant in policy discourse conducted in news media. Policy reform advocates using the media to advocate for evidence-based policies in road injury prevention need to appreciate that evidence is not the only currency exchanged in such debates and should study opponents' rhetoric in order to anticipate and counteract the framing strategies being used.

The (-765 G→C) promoter variant of the COX-2/PTGS2 gene is associated with a lower risk for end-stage hip and knee osteoarthritis

BACKGROUND

Functional polymorphisms in genes of proinflammatory signalling cascades may contribute to the genetic risk of osteoarthritis (OA).

OBJECTIVE

To examine a possible association between end-stage OA of the hip and knee joint and a known single nucleotide polymorphism (SNP) of the COX-2 gene promoter.

METHODS

The SNP -765 G→C (rs20417) of the COX-2 gene promoter was genotyped by pyrosequencing in 531 (320 women/211 men) patients with OA from the Ulm Osteoarthritis Study and 400 (200 women/200 men) regional controls from the south-west of Germany.

RESULTS

In the whole study population the C allele was associated with a lower risk (per allele OR 0.57; 95% CI 0.43 to 0.75, p&lt;0.0001) and the G allele with a higher risk for end-stage OA. Analysis of subgroups confirmed this result for primary, bilateral, hip and knee OA.

CONCLUSION

The promoter polymorphism rs20417 of the COX-2 gene contributes to the genetic risk for end-stage hip and knee OA.

The rb pathway and cancer therapeutics

The retinoblastoma gene, Rb, was originally identified as the tumor suppressor gene mutated in a rare childhood cancer called retinoblastoma (reviewed in [1]). Subsequent studies showed that Rb functions in a pathway that is often functionally inactivated in a large majority of human cancers. Interestingly, recent studies showed that in certain types of cancers, Rb function is actually required for cancer development. The intimate link between the Rb pathway and cancer development suggests that the status of Rb activity can potentially be used to develop targeted therapy. However, a prerequisite will be to understand the role of Rb and its interaction with other signaling pathways in cancer development. In this review, we will discuss the roles of Rb in proliferation, apoptosis and differentiation by reviewing the recent findings in both mammalian systems and different model organisms. In addition, we will discuss strategies that can be employed that specifically target cancer cells based on the status of the Rb pathway.

Suppression of p53 activity by Siva1

The tumor suppressor p53 induces potent anti-proliferative responses in stressed cells; in unstressed cells this ability of p53 is restrained by Hdm2. Expression of Hdm2 is also induced by p53, thereby establishing feedback inhibition. Regulation of the p53-Hdm2 interaction and the feedback inhibition of p53 are not well understood. Here, we show that the p53-Hdm2 interaction in unstressed cells is promoted by Siva1, which, like Hdm2, is the product of a p53 target gene. Siva1 binds to both p53 and Hdm2 through distinct regions and enhances Hdm2-mediated p53 ubiquitination and degradation. Siva1 strongly inhibits p53-mediated gene expression and apoptosis. In xenograft mouse models, downregulation of Siva1 markedly inhibits tumor formation because of the activation of p53. On DNA damage, the interactions of Siva1 with both p53 and Hdm2 are diminished. The function of Siva1 seems to be related to its ability to form a homo-oligomer as the oligomerization defective splicing variant Siva2 fails to de-stabilize p53. These results identify Siva1 as an important adaptor promoting p53 degradation through Hdm2. Siva1 may be part of the negative feedback loop that inhibits p53 activity at the end of a non-lethal stress response.