[Research advances in nonalcoholic fatty liver disease and alcoholic liver disease in 2016]

Nonalcoholic fatty liver disease (NAFLD) has become the most important liver disease in the world and its prevalence rate still tends to increase. However, there are still no effective drugs so far. The complex and dynamic interactions between multiple effects/mediators in the pathophysiology of NAFLD provide new insights and help with stratification and redefinition of clinical phenotypes and evaluation of disease susceptibility and multiplicity of progression. They may also provide new targets for future treatment. Therefore, research on the pathophysiology of NAFLD is imperative. Alcoholic liver disease is a great harm to health and an important cause of end-stage liver disease. Some progress has been made in the research on alcoholic liver disease around the world in 2016. This article reviews the research advances in alcoholic liver disease in 2016 from the aspects of epidemiology, pathogenesis, diagnostic and therapeutic methods, and prognosis.

[Expression of serum interleukin-13 and significance of gene polymorphism on the patients with bronchiectasis in acute exacerbation period]

Objective: To explore the expression of serum interleukin-13 (IL-13) and significance of its gene polymorphism on the patients with acute exacerbation of bronchiectasis in acute exacerbation period. Methods: Forty-three patients with bronchiectasis in acute exacerbation period admitted into the respiratory ward of Fujian Provincial Hospital from December, 2014 to March, 2016 were included as bronchiectasis group. Thirty-three healthy controls from normal people of health examination were included as control group during the corresponding period. A total of 5 ml fasting peripheral blood sample was extracted from each individual. The IL-13 levels were determined by enzyme-linked immunosorbent assay (ELISA). IL-13 gene polymorphisms in+ 1923 C/T site and+ 2044 site were genotyped in these two groups by using polymerase chain reaction (PCR) combined with gene sequencing methods. About 7 days after admission, thirty patients with improved condition among the 43 patients were included as bronchiectasis improvement group, all had the extraction of 3 ml peripheral blood for IL-13 detection determined by ELISA. The expression of serum IL-13 and gene polymorphisms between bronchiectasis group and control group were analyzed statistically. The changes of serum IL-13 between bronchiectasis group and bronchiectasis improvement group were also analyzed statistically. Results: The serum IL-13 level was lower in the bronchiectasis group in acute exacerbation period than that of the healthy controls [(31.1±26.3) vs (70.6±53.6) μg/L, P<0.05]. There was no significant difference of the genotype distribution in + 1923C/T site of IL-13 gene between the two groups (χ(2)=0.915, P>0.05). In the bronchiectasis group, the C and T allele frequencies at+ 1923 site of IL-13 gene were 79.1% and 20.9%, respectively, and its single nucleotide polymorphism (SNP) was in strong linkage disequilibrium with the SNP IL-13+ 2044G/A site (R(2)=0.835, P<0.001). There was no significant difference of the serum IL-13 between allele T_ groups and allele CC group, and also no significant difference between allele A_ groups and allele GG group (P>0.05). Conclusion: The IL-13 levels decreased specifically in the bronchiectasis group in acute exacerbation period, but IL-13+ 1923C/T and+ 2044G/A polymorphisms are not significantly related to the susceptibility of bronchiectasis.

Human Sex Determination at the Edge of Ambiguity: INHERITED XY SEX REVERSAL DUE TO ENHANCED UBIQUITINATION AND PROTEASOMAL DEGRADATION OF A MASTER TRANSCRIPTION FACTOR

A general problem is posed by analysis of transcriptional thresholds governing cell fate decisions in metazoan development. A model is provided by testis determination in therian mammals. Its key step, Sertoli cell differentiation in the embryonic gonadal ridge, is initiated by SRY, a Y-encoded architectural transcription factor. Mutations in human SRY cause gonadal dysgenesis leading to XY female development (Swyer syndrome). Here, we have characterized an inherited mutation compatible with either male or female somatic phenotypes as observed in an XY father and XY daughter, respectively. The mutation (a crevice-forming substitution at a conserved back surface of the SRY high mobility group box) markedly destabilizes the domain but preserves specific DNA affinity and induced DNA bend angle. On transient transfection of diverse human and rodent cell lines, the variant SRY exhibited accelerated proteasomal degradation (relative to wild type) associated with increased ubiquitination; in vitro susceptibility to ubiquitin-independent ("default") cleavage by the 20S core proteasome was unchanged. The variant's gene regulatory activity (as assessed in a cellular model of the rat embryonic XY gonadal ridge) was reduced by 2-fold relative to wild-type SRY at similar levels of mRNA expression. Chemical proteasome inhibition restored native-like SRY expression and transcriptional activity in association with restored occupancy of a sex-specific enhancer element in principal downstream gene Sox9, demonstrating that the variant SRY exhibits essentially native activity on a per molecule basis. Our findings define a novel mechanism of impaired organogenesis, accelerated ubiquitin-directed proteasomal degradation of a master transcription factor leading to a developmental decision poised at the edge of ambiguity.

Metastasis-associated gene 1 expression in human medulloblastoma and its association with invasion and metastasis in medulloblastoma Daoy cell lines

This study aims to investigate the expression of metastasis-associated gene 1 (MTA1) in human medulloblastoma, and its significance in the invasion and metastasis in a medulloblastoma cell line. Positive expression rate of MTA1 protein in medulloblastoma and adjacent normal tissues collected from 29 medulloblastoma patients was detected by immunohistochemistry assay in vivo. In in vitro experiments, Daoy cells were transfected with MTA1-targeted small interfering RNA (siRNA, MTA1-siRNA group), niRNA (MTA1-niRNA group), and plasmid vectors (control group). Transfection efficiency was evaluated by PT-PCR and western blot; cell adhesion, migration, and invasion capacity was assessed by adhesion assays, scratch assays, and transwell chamber invasion assays, respectively. Results indicated that the positive expression rate of MTA1 protein in the medulloblastoma tissues was higher as compared with that of the adjacent normal tissues (P < 0.05). In addition, mRNA and protein expression of MTA1 in the MTA1-siRNA group was lower than that in the control and MTA1- niRNA groups (P < 0.05). Adhesion, migration, and invasion capacity of Daoy cells in the MTA1-siRNA group was inhibited as compared with the control and MTA1-niRNA groups (P < 0.05). In conclusion, MTA1 expression was increased in medulloblastoma cells, while MTA1 knockdown in medulloblastoma cells inhibited MTA1 expression. In addition, MTA1 knockdown inhibited the adhesion, migration, and invasive capabilities of medulloblastoma cells. It is possible that MTA1 can serve as a biomarker and a potential therapeutic target for medulloblastoma.

[Establishment and evaluation of a prognostic model for acute pulmonary embolism]

OBJECTIVE

To identify the factors influencing the prognosis of patients with acute pulmonary embolism(PE) and to establish a prognostic model.

METHODS

The clinical data of 331 patients (141 males and 190 females, aged 9 to 87 years ) with acute PE in Fujian Hospital from January 2007 to September 2013 were analyzed. Univariate analysis and logistic regression analysis were used for selecting the independent prognostic factors for acute PE. Based on logistic regression analysis, a prognostic model for PE was established.

RESULTS

Univariate analysis showed that statistically significant (all P<0.05) factors influencing the prognosis of PE were diabetes, tricuspid systolic murmur, body temperature, respiratory rate, heart rate, aspartate aminotransferase, triglycerides, abnormal ECG, mechanical ventilation, circulatory failure during hospitalization, risk stratification of PE, types of treatment, and use of low-molecular-weight heparin and Warfarin. Logistic regression analysis showed that recent (<1 month) operation or fracture, tricuspid systolic murmur, high triglyceride level, circulatory failure during hospitalization and mechanical ventilation were independent factors for poor prognosis of PE, while combined use of low-molecular-weight heparin and Warfarin was a protective factor for the prognosis of PE. The Fisher prognostic model equation was y=0.144+ 1.266x1+ 0.869x2+ 1.794x3-0.517x4+ 3.555x5+ 0.661x6. The accuracy of the Fisher discriminant function was 93.0%.

CONCLUSION

Recent (<1 month) operation or fracture, tricuspid systolic murmur, high triglyceride level, shock during hospitalization and mechanical ventilation were signs of poor prognosis for PE, while combined use of low-molecular-weight heparin and Warfarin were beneficial for the prognosis. The discriminant function based on these data can be helpful for predicting the prognosis of patients with PE.

Diffuse interstitial and multiple cavitary lung lesions due to Talaromyces marneffei infection in a non-HIV patient

A 57-year-old man presented with unproductive cough and dyspnea for 6 months in Fujian Province, China. His misuse of a large amount of steroids (accumulated dose equivalent to 3530 mg prednisolone) resulted in Talaromyces marneffei infection. Chest computed tomographic scan revealed diffuse interstitial and multiple cavitary lung lesions. Treatment with amphotericin B combined with itraconazole resulted in total recovery, with marked regression of lung lesions.

[Eisenmenger's syndrome in pregnancy: a case report and literature review]

OBJECTIVE

To investigate the clinical presentation, diagnosis and treatment of the Eisenmenger's syndrome in pregnancy.

METHODS

One case of Eisenmenger's syndrome in pregnancy in our hospital was retrospectively analyzed and the literature reviewed.

RESULTS

This patient who received antenatal care irregularly in other hospital was diagnosed with Eisenmenger's syndrome with the symptoms of chest distress. The other hospital suggested her to terminate pregnancy, but the patient refused. She was admitted to our hospital in her late pregnancy, received the treatment of rest, oxygen, blood gas and pulmonary artery pressure monitoring. Considering perioperative pulmonary hypertension crisis likely to occur, pulmonary artery catheter was placed preoperatively. In general anesthesia, the cesarean was performed. After operation, the patient was transferred to the intensive care unit, with the treatment of expanding blood vessels, reducing pulmonary artery pressure, administering anticoagulation and preventing infection. One week later, the patient was discharged from hospital with smooth condition.

CONCLUSION

Eisenmenger's syndrome in pregnancy is associated with extremely poor maternal and fetal outcome. Termination of pregnancy should be offered to such patients. When interruption of pregnancy is refused, the early hospital admission is needed. The patients should be managed in a high-risk pregnancy unit by a multidisciplinary team from obstetrics, cardiology, anesthesia and pediatrics for improving pregnancy outcomes.

Structure-function relationships in human testis-determining factor SRY: an aromatic buttress underlies the specific DNA-bending surface of a high mobility group (HMG) box

Human testis determination is initiated by SRY, a Y-encoded architectural transcription factor. Mutations in SRY cause 46 XY gonadal dysgenesis with female somatic phenotype (Swyer syndrome) and confer a high risk of malignancy (gonadoblastoma). Such mutations cluster in the SRY high mobility group (HMG) box, a conserved motif of specific DNA binding and bending. To explore structure-function relationships, we constructed all possible substitutions at a site of clinical mutation (W70L). Our studies thus focused on a core aromatic residue (position 15 of the consensus HMG box) that is invariant among SRY-related HMG box transcription factors (the SOX family) and conserved as aromatic (Phe or Tyr) among other sequence-specific boxes. In a yeast one-hybrid system sensitive to specific SRY-DNA binding, the variant domains exhibited reduced (Phe and Tyr) or absent activity (the remaining 17 substitutions). Representative nonpolar variants with partial or absent activity (Tyr, Phe, Leu, and Ala in order of decreasing side-chain volume) were chosen for study in vitro and in mammalian cell culture. The clinical mutation (Leu) was found to markedly impair multiple biochemical and cellular activities as respectively probed through the following: (i) in vitro assays of specific DNA binding and protein stability, and (ii) cell culture-based assays of proteosomal degradation, nuclear import, enhancer DNA occupancy, and SRY-dependent transcriptional activation. Surprisingly, however, DNA bending is robust to this or the related Ala substitution that profoundly impairs box stability. Together, our findings demonstrate that the folding, trafficking, and gene-regulatory function of SRY requires an invariant aromatic "buttress" beneath its specific DNA-bending surface.

Sesamin suppresses macrophage-derived chemokine expression in human monocytes via epigenetic regulation

BACKGROUND

Chemokines play important roles in the pathogenesis of asthmatic inflammation. Sesamin, a class of phytoestrogen isolated from sesame seed Sesamum indicum, is recently regarded as an anti-inflammatory agent. However, the effects of sesamin on asthma-related chemokines are unknown. To this end, we investigated the effects of sesamin on the expression interferon-γ-inducible protein-10 (IP-10/CXCL10), macrophage-derived chemokine (MDC/CCL22), growth-related oncogene-α (GRO-α/CXCL1) and tumor necrosis factor (TNF)-α in human monocytes.

METHODS

Cells were pretreated with sesamin before lipopolysaccharide (LPS) stimulation. IP-10, MDC, GRO-α and TNF-α were measured by ELISA. Involved receptors and intracellular signaling were investigated by receptor antagonists, pathway inhibitors, western blotting and chromatin immunoprecipitation.

RESULTS

Sesamin suppressed LPS-induced MDC in THP-1 and human primary monocytes. Sesamin suppressed LPS-induced IP-10 in THP-1 cells, but not human primary monocytes. Sesamin had no effects on LPS-induced GRO-α and TNF-α expression in THP-1 and human primary monocytes. The suppressive effect of sesamin on MDC was reversed by the estrogen receptor (ER) and peroxisomal proliferator-activated receptor (PPAR)-α antagonists. Sesamin suppressed LPS-induced phosphorylation of mitogen-activated protein kinase (MAPK)-p38 and nuclear factor kappa B (NFκB)-p65. Sesamin suppressed histone H3/H4 acetylation in the MDC promoter region.

CONCLUSION

Sesamin suppressed LPS-induced MDC expression via the ER, the PPAR-α, the MAPK-p38 pathway, the NFκB-p65 pathway and the epigenetic regulation. Sesamin may have therapeutic potential in preventing and treating asthma.

Physician Scientist Training in the United States: A Survey of the Current Literature

The declining number of physician scientists is an alarming issue. A systematic review of all existing programs described in the literature was performed, so as to highlight which programs may serve as the best models for the training of successful physician scientists. Multiple databases were searched, and 1,294 articles related to physician scientist training were identified. Preference was given to studies that looked at number of confirmed publications and/or research grants as primary outcomes. Thirteen programs were identified in nine studies. Eighty-three percent of Medical Scientist Training Program (MSTP) graduates, 77% of Clinician Investigator Training Program (CI) graduates, and only 16% of Medical Fellows Program graduates entered a career in academics. Seventy-eight percent of MSTP graduates succeeded in obtaining National Institute of Health (NIH) grants, while only 15% of Mayo Clinic National Research Service Award-T32 graduates obtained NIH grants. MSTP physician scientists who graduated in 1990 had 13.5 ± 12.5 publications, while MSTP physician scientists who graduated in 1975 had 51.2 ± 38.3 publications. Additionally, graduates from the Mayo Clinic's MD-PhD Program, the CI Program, and the NSRA Program had 18.2 ± 20.1, 26.5 ± 24.5, and 17.9 ± 26.3 publications, respectively. MSTP is a successful model for the training of physician scientists in the United States, but training at the postgraduate level also shows promising outcomes. An increase in the number of positions available for training at the postgraduate level should be considered.

Microsatellite-encoded domain in rodent Sry functions as a genetic capacitor to enable the rapid evolution of biological novelty

The male program of therian mammals is determined by Sry, a transcription factor encoded by the Y chromosome. Specific DNA binding is mediated by a high mobility group (HMG) box. Expression of Sry in the gonadal ridge activates a Sox9-dependent gene regulatory network leading to testis formation. A subset of Sry alleles in superfamily Muroidea (order Rodentia) is remarkable for insertion of an unstable DNA microsatellite, most commonly encoding (as in mice) a CAG repeat-associated glutamine-rich domain. We provide evidence, based on an embryonic pre-Sertoli cell line, that this domain functions at a threshold length as a genetic capacitor to facilitate accumulation of variation elsewhere in the protein, including the HMG box. The glutamine-rich domain compensates for otherwise deleterious substitutions in the box and absence of nonbox phosphorylation sites to ensure occupancy of DNA target sites. Such compensation enables activation of a male transcriptional program despite perturbations to the box. Whereas human SRY requires nucleocytoplasmic shuttling and coupled phosphorylation, mouse Sry contains a defective nuclear export signal analogous to a variant human SRY associated with inherited sex reversal. We propose that the rodent glutamine-rich domain has (i) fostered accumulation of cryptic intragenic variation and (ii) enabled unmasking of such variation due to DNA replicative slippage. This model highlights genomic contingency as a source of protein novelty at the edge of developmental ambiguity and may underlie emergence of non-Sry-dependent sex determination in the radiation of Muroidea.

Optimal treatment for asymptomatic neurosyphilis

In the pre-penicillin era, patients with asymptomatic neurosyphilis (ANS) were more likely to develop long-term neurological sequelae than those patients with normal cerebrospinal fluid (CSF). Although benzathine penicillin G cannot achieve treponemicidal levels in the CSF, decreased rates of neurological complications of syphilis and non-treponemal titre serological responses are usually observed after treatment with this antibiotic. We here a homosexual man with ANS successfully treated with benzathine penicillin G. This case suggests that reconsideration on the necessity of a lumbar puncture in HIV-infected patients with ANS is warranted.

Resurfacing arthroplasty for hip dysplasia: a prospective randomised study

In this prospective study a total of 80 consecutive Chinese patients with Crowe type I or II developmental dysplasia of the hip were randomly assigned for hip resurfacing arthroplasty (HRA) or total hip replacement (THR). Three patients assigned to HRA were converted to THR, and three HRA patients and two THR patients were lost to follow-up. This left a total of 34 patients (37 hips) who underwent HRA and 38 (39 hips) who underwent THR. The mean follow-up was 59.4 months (52 to 70) in the HRA group and 60.6 months (50 to 72) in the THR group. There was no failure of the prosthesis in either group. Flexion of the hip was significantly better after HRA, but there was no difference in the mean post-operative Harris hip scores between the groups. The mean size of the acetabular component in the HRA group was significantly larger than in the THR group (49.5 mm vs 46.1 mm, p = 0.001). There was no difference in the mean abduction angle of the acetabular component between the two groups. Although the patients in this series had risk factors for failure after HRA, such as low body weight, small femoral heads and dysplasia, the clinical results of resurfacing in those with Crowe type I or II hip dysplasia were satisfactory. Patients in the HRA group had a better range of movement, although neck-cup impingement was observed. However, more acetabular bone was sacrificed in HRA patients, and it is unclear whether this will have an adverse effect in the long term.

Heart retransplantation for pediatric primary allograft failure

PURPOSE

Heart transplantation is indicated for children with end-stage heart failure or complex inoperable congenital defects. When the transplanted heart fails, retransplantation is suggested and herein we have presented the prognosis of these pediatric cases.

MATERIALS AND METHODS

From March 1987 to March 2011, we performed 404 heart transplantations including 45 pediatric patients, 6 (13.3%) of whom experienced graft failure requiring retransplantation. Only four of the six patients (66.7%) had a chance for retransplantation.

RESULTS

Six of 45 pediatric heart transplant patients (13.3%) experienced graft failure requiring retransplantation. Four of them (66.7%) underwent retransplantation. Only one of the four died due to severe postoperative sepsis with acute respiratory distress. The other three patients recovered well and remain alive with no neurological sequelae; all are in New York Heart Association functional classification I at present.

CONCLUSION

Pediatric post-heart graft failure require expectations retransplantation, which shows a good prognosis.

Prevalence and risk factors for feeding and swallowing difficulties in spinal muscular atrophy types II and III

OBJECTIVE

To identify the prevalence and risk factors of feeding and swallowing problems in patients with type II and type III spinal muscular atrophy (SMA).

STUDY DESIGN

Cross-sectional data from 108 genetically confirmed patients with SMA (age range, 3-45 years; 60 with type II and 48 with type III) were analyzed. The questionnaire survey included demographic data, current motor function and respiratory status, feeding and swallowing difficulties, and consequences. The risk factors were analyzed via logistic regression.

RESULTS

The 3 most common feeding and swallowing difficulties in patients with type II and III SMA were choking (30.6%), difficulty conveying food to the mouth (20.4%), and difficulty chewing (20.4%). Current motor function status was an independent risk factor for feeding and swallowing difficulties (sitters vs walkers: OR, 7.59; 95% CI, 1.22-47.46). All 4 nonsitters (ie, patients with type II SMA who had lost their sitting ability) had feeding and swallowing difficulties. Patients with feeding and swallowing difficulties had significantly higher rates of underweight and aspiration pneumonia than those without these problems.

CONCLUSION

Patients with type II and III SMA have a high prevalence of risk factors for feeding and swallowing difficulties, suggesting that an individualized treatment plan should depend on current motor function status.

Medical education in Vietnam

BACKGROUND

Vietnam is one of the most populous countries in Southeast Asia, yet it displays an unsettling lack of doctors.

AIMS

Medical education is an important factor contributing to this issue, yet little is known about the system currently in place in Vietnam.

METHODS

Through an extensive literary search of medical schools' and Ministry of Health's data, we have examined the current medical education system in Vietnam.

RESULTS

At present, there are 12 medical universities, and the general curriculum at each university follows a national framework but tends to vary from university to university. Medical training lasts either 4 or 6 years, with competitive graduates attending residency programs following graduation. While examinations are required to graduate, the lack of a national licensing exam makes it difficult to ensure that a nation-wide standard of quality exists, both at the medical universities themselves as well as amongst the doctors graduating from them.

CONCLUSIONS

The development and institution of a national exam would introduce a standard of training throughout Vietnam's medical education system. Further, a substantial portion of a doctor's education is in subjects that are loosely related to medicine. When looking forward it will be important to evaluate whether or not these non-medical subjects detract from the quality of medical training.

Dynamic nuclear spin resonance in n-GaAs

The dynamics of optically detected nuclear magnetic resonance is studied in n-GaAs via time-resolved Kerr rotation using an on-chip microcoil for rf field generation. Both optically allowed and optically forbidden NMR are observed with a dynamics controlled by the interplay between dynamic nuclear polarization via hyperfine interaction with optically generated spin-polarized electrons and nuclear spin depolarization due to magnetic resonance absorption. Comparing the characteristic nuclear spin relaxation rate obtained in experiment with master equation simulations, the underlying nuclear spin depolarization mechanism for each resonance is extracted.

Mammalian testis-determining factor SRY and the enigma of inherited human sex reversal: frustrated induced fit in a bent protein-DNA complex

Mammalian testis-determining factor SRY contains a high mobility group box, a conserved eukaryotic motif of DNA bending. Mutations in SRY cause XY gonadal dysgenesis and somatic sex reversal. Although such mutations usually arise de novo in spermatogenesis, some are inherited and so specify male development in one genetic background (the father) but not another (the daughter). Here, we describe the biophysical properties of a representative inherited mutation, V60L, within the minor wing of the L-shaped domain (box position 5). Although the stability and DNA binding properties of the mutant domain are similar to those of wild type, studies of SRY-induced DNA bending by subnanosecond time-resolved fluorescence resonance energy transfer (FRET) revealed enhanced conformational fluctuations leading to long range variation in bend angle. (1)H NMR studies of the variant protein-DNA complex demonstrated only local perturbations near the mutation site. Because the minor wing of SRY folds on DNA binding, the inherited mutation presumably hinders induced fit. Stopped-flow FRET studies indicated that such frustrated packing leads to accelerated dissociation of the bent complex. Studies of SRY-directed transcriptional regulation in an embryonic gonadal cell line demonstrated partial activation of downstream target Sox9. Our results have demonstrated a nonlocal coupling between DNA-directed protein folding and protein-directed DNA bending. Perturbation of this coupling is associated with a genetic switch poised at the threshold of activity.

Autophagy inhibition contributes to radiation sensitization of esophageal squamous carcinoma cells

Radiotherapy is a useful component of treatment strategies for esophageal cancer. The role of autophagy in response to ionizing radiation was investigated in human esophageal squamous carcinoma cells. Cell viability and clonogenic survival assay were used to evaluate the radiosensitivity of autophagy inhibitor (3-MA) on esophageal squamous carcinoma cells. The percentage of apoptotic cells and cell cycle analysis were assessed by flow cytometry; DAPI staining was used to detect apoptotic cells. The expression of beclin-1 and LC3 was measured using a Western blot. The ultrastructural analysis was under the electron microscope. 6 Gy irradiation induced a massive accumulation of autophagosomes accompanied by strong upregulation of beclin-1 and LC3-II expression in TE-1 cells. Compared with radiation alone, 3-MA combined with radiation significantly decreased cell viability, as well as autophagic ratio, beclin-1, and LC3-II protein level. Inhibition of autophagy increased radiation-induced apoptosis and the percentage of G2/M-phase cells. Blockade of autophagy with 3-MA enhanced cytotoxicity of radiotherapy in human esophageal squamous carcinoma cells. It suggests that inhibition of autophagy could be used as adjuvant therapy to treat esophageal squamous cell carcinoma.

BioCARS: a synchrotron resource for time-resolved X-ray science

BioCARS, a NIH-supported national user facility for macromolecular time-resolved X-ray crystallography at the Advanced Photon Source (APS), has recently completed commissioning of an upgraded undulator-based beamline optimized for single-shot laser-pump X-ray-probe measurements with time resolution as short as 100 ps. The source consists of two in-line undulators with periods of 23 and 27 mm that together provide high-flux pink-beam capability at 12 keV as well as first-harmonic coverage from 6.8 to 19 keV. A high-heat-load chopper reduces the average power load on downstream components, thereby preserving the surface figure of a Kirkpatrick-Baez mirror system capable of focusing the X-ray beam to a spot size of 90 µm horizontal by 20 µm vertical. A high-speed chopper isolates single X-ray pulses at 1 kHz in both hybrid and 24-bunch modes of the APS storage ring. In hybrid mode each isolated X-ray pulse delivers up to ~4 × 10(10) photons to the sample, thereby achieving a time-averaged flux approaching that of fourth-generation X-FEL sources. A new high-power picosecond laser system delivers pulses tunable over the wavelength range 450-2000 nm. These pulses are synchronized to the storage-ring RF clock with long-term stability better than 10 ps RMS. Monochromatic experimental capability with Biosafety Level 3 certification has been retained.