[Effect of gender on the prognosis of patients with non-small cell lung cancer]

Objective: To analyze the effect of gender on the prognosis of patients with non-small cell lung cancer (NSCLC). Methods: Data of 1 195 patients with NSCLC were analyzed by Chi-square, Kaplan-Meier, log-rank tests and Cox regression models. Results: Women had a longer survival than men (median overall survival 31.64 versus 22.71 months, P<0.01) in the participants of this study. Differences seen in overall survival remained the similar, after stratified by age, pathologic types, clinical stage, sizes, pleural effusion and surgery of the patients, respectively. Data from the multivariate analysis revealed that factors as smoking, clinical stage, metastatic when diagnosis was made and surgery, but not gender, were independent prognostic factors for patients with NSCLC. After adjustment for potential confounders, we found that smoking was a major confounding factor, affecting the relationship between gender and prognosis of NSCLC. Conclusion: Gender did not seem an independent prognostic factor for NSCLC patients while the survival advantages of females might be attributed to the lower prevalence of smoking in this population.

Tea consumption and its interactions with tobacco smoking and alcohol drinking on oral cancer in southeast China

BACKGROUND/OBJECTIVES

Epidemiological results on the association between tea consumption and oral cancer remain controversial. We aimed to evaluate the exact relationship between tea consumption and oral cancer in Chinese population.

SUBJECTS/METHODS

A large-scale case-control study was conducted on 586 oral cancer patients and 1024 controls frequency-matched by age and gender. Epidemiological data were collected through face-to-face interviews with a structure questionnaire. Unconditional logistic regression model was used to assess the effect of tea consumption on oral cancer stratified by smoking, alcohol drinking and demographics. Quantity of tea consumed (ml/day) was categorized into five subgroups based on quartiles and then its interactions was evaluated with tobacco smoking and alcohol drinking at each subgroup.

RESULTS

Tea consumption showed an inverse association with oral cancer for non-smokers or non-alcohol drinkers (the odds ratios (ORs) were 0.610 (95% confidence interval (CI): 0.425-0.876) and 0.686 (95% CI: 0.503-0.934), respectively). For smokers or alcohol drinkers, decreased risk was only observed in those who consumed >800 ml/day. Furthermore, oolong tea consumption was associated with decreased risk of oral cancer in smokers or alcohol drinkers but not in non-smokers or non-alcohol drinkers. Tea consumption combined with smoking or/and alcohol drinking had a greater risk than tea consumption alone, but the risk was roughly reduced from zero to Q4 (>800 ml/day). Additionally, when stratified by demographics, the protective effect of tea was especially evident in females, urban residents, normal body mass index population (18.5-23.9), farmers, office workers and those aged <60 years.

CONCLUSIONS

Tea consumption protects against oral cancer in non-smokers or non-alcohol drinkers, but this effect may be obscured in smokers or alcohol drinkers. Additionally, demographics may modify the association between tea consumption and oral cancer.

Comparison of Insulin Resistance and β-Cell Dysfunction Between the Young and the Elderly in Normal Glucose Tolerance and Prediabetes Population: A Prospective Study

Insulin resistance and β-cell function are different between the young and elderly diabetes individuals, which are not well elaborated in the nondiabetic persons. The aims of this study were to compare insulin resistance and β-cell function between young and old adults from normal glucose tolerance (NGT) to prediabetes [which was subdivided into isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), and a combination of both (IFG/IGT)], and compare the prevalence of diabetes mellitus (DM) in the above prediabetes subgroups between different age groups after 3 years. A total of 1 374 subjects aged below 40 or above 60 years old with NGT or prediabetes were finally included in this study. Insulin resistance and β-cell function from homeostasis model assessment (HOMA) and interactive, 24-variable homeostatic model of assessment (iHOMA2) were compared between different age groups. The rate of transition to diabetes between different age groups in all pre-diabetes subgroups was also compared. Compared with the old groups, young i-IFG and IFG/IGT groups exhibit higher log HOMA-IR and log HOMA2-S, whereas the young i-IGT groups experienced comparable log HOMA-IR and log HOMA2-S when compared with old i-IFG and IFG/IGT groups. Three prediabetes subgroups all had similar log HOMA-B and log HOMA2-B between different age groups. In addition, the prevalence of diabetes in young i-IFG was statistically higher than that in old i-IFG after 3 years. Age is negatively related to log HOMA2-B in both age groups. Considering an age-related deterioration of β-cell function, young i-IFG, young i-IGT, and young IFG/IGT all suffered a greater impairment in insulin secretion than the old groups. Young i-IFG and IFG/IGT have more severe insulin resistance than the old groups. In addition, young i-IFG characterized with a higher incidence of DM than the old i-IFG. These disparities highlight that the prevention to slow progression from prediabetes to type 2 diabetes should be additionally focused in young prediabetes individuals, especially young i-IFG.

Hybrid Pixel-Waveform (HPWF) Enabled CdTe Detectors for Small Animal Gamma-Ray Imaging Applications

This paper presents the design and preliminary evaluation of small-pixel CdTe gamma ray detectors equipped with a hybrid pixel-waveform (HPWF) readout system for gamma ray imaging applications with additional discussion on CZT due to its similarity. The HPWF readout system utilizes a pixelated anode readout circuitry which is designed to only provide the pixel address. This readout circuitry works in coincidence with a high-speed digitizer to sample the cathode waveform which provides the energy, timing, and depth-of-interaction (DOI) information. This work focuses on the developed and experimentally evaluated prototype HPWF-CdTe detectors with a custom CMOS pixel-ASIC to readout small anode pixels of 350 μm in size, and a discrete waveform sampling circuitry to digitize the signal waveform induced on the large cathode. The intrinsic timing, energy, and spatial resolution were experimentally evaluated in this paper in conjunction with methods for depth of interaction (DOI) partitioning of the CdTe crystal. While the experimental studies discussed in this paper are primarily for evaluating HPWF detectors for small animal PET imaging, these detectors could find their applications for ultrahigh-resolution SPECT and other imaging modalities.

87 EFFECTS OF HUMAN RECOMBINATION GRANULOCYTE–COLONY STIMULATING FACTOR (hrG-CSF) ON IN VITRO CULTURE OF PORCINE CLONED EMBRYOS DERIVED FROM THIN CUMULUS CELL LAYER OF OOCYTES MATURED IN VITRO

Although several cloned pigs have been successfully produced, the developmental competence of cloned embryos in vitro is still very low. Granulocyte colony-stimulating factor receptor (G-CSFR) was founded in the human trophoblastic cell line that is implicated in regulation and proliferation of trophoblast. In the present study, the somatic cell NT embryos derived from oocytes that have more than 3 cumulus cells layer were cultured and supplemented with various concentrations of hrG-CSF (0, 10, 50, and 100 ng mL−1, respectively). Although there were no significant effects on the various concentration of hrG-CSF treatment groups compared with control, the somatic cell NT blastocysts formation tended to increase after 10 ng mL−1 hrG-CSF treatment (24.19 ± 2.90%) compared with control (21.37 ± 2.98%). Moreover, we investigated the effects of 10 ng mL−1 hrG-CSF on in vitro culture of porcine cloned embryos derived from oocytes that were categorized into grade A (cumulus cell layer >10), grade B (10 > cumulus cell layer ≥ 3), and grade C (cumulus cell layer <3). After supplementation of 10 ng mL−1 hrG-CSF on in vitro-culture of different groups, the developmental competence, blastocyst quality, and gene transcript levels were observed. The results showed that 10 ng mL−1 hrG-CSF has no beneficial effects on cloned embryos derived from grade A oocytes (10 ng mL−1 hrG-CSF 25.35 ± 2.53% v. control 25.00 ± 2.66%), but it significantly increased blastocyst formation of embryos derived from grade B oocytes (22.09 ± 2.10%) compared with grade B control (12.09 ± 2.31%, P < 0.05). There were obvious increases in blastocyst formation derived from grade C oocytes after 10 ng mL−1 hrG-SCF treatment (25.74 ± 1.65%) compared with grade C control (16.82 ± 2.30%, P < 0.05). However, there were no significantly differences in cleavage rate and total cell number of blastocysts among each group. Otherwise, the PCNA, POU5F1, Dnmt1, Bcl2, and Bax transcript levels were significantly increased in blastocysts that were derived from grade C oocytes after 10 ng mL−1 hrG-SCF treatment compared with grade C control. In conclusion, supplementation of 10 ng mL−1 hrG-CSF in in vitro-cultured porcine embryos increased blastocyst formation of embryos derived from thin cumulus layer of oocytes by reducing apoptosis while increasing cell proliferation and nuclear reprogramming. These results provide an experimental basis for the use of poor quality oocytes for agricultural production. This work was supported by a grant from Research Program (No. 307–02) Gyeonggi-province project and the Next-Generation BioGreen21 Program [no. PJ01107702], Rural Developmental Administration (RDA), Republic of Korea.

[Preoperative prognostic factors and preoperative risk stratification of upper tract urothelial carcinoma]

OBJECTIVE

To identify the preoperative prognostic factors of upper tract urothelial carcinoma (UTUC) and construct preoperative risk stratification system.

METHODS

A retrospective study including 686 patients who were diagnosed with UTUC and received radical nephroureterectomy or partial ureterectomy in Peking University First Hospital during 2003 and 2013.

RESULTS

Of the 686 UTUC patients, 303 (44.2%) were male and 383 (55.8%) female. The postoperative pathological examination showed that 203 (29.6%) had high tumor stages (T3, T4), 300 (43.7%) had high tumor grades (G3) and 54 (7.9%) had lymph nodes metastasis (N1). After multivariate analysis, renal pelvic tumor, large tumor, estimated glomerular filtration rate (eGFR)≥30 mL/min, and male were associated with high tumor stage. Ureteral tumor, large tumor, and non-smoking history were associated with high tumor grade. Renal pelvis tumor, large tumor, and preoperative anemia were associated with positive N status. During the follow-up, 208 (30.3%) died for cancer and 210 (30.6%) developed intravesical recurrence. Multivariate analysis showed: large tumor (P=0.001), concomitant ipsilateral hydronephrosis (P=0.041), and preoperative anemia (P=0.001) were independently associated cancer-specific mortality after surgery, while ureteral tumor (P=0.04), multiple tumor (P=0.005), and high preoperative creatinine (P=0.036) were independent risk factors for intravesical recurrence.

CONCLUSION

Of the preoperative clinical parameters of UTUC patients, the large tumor, concomitant ipsilateral hydronephrosis, and preoperative anemia were independently associated with cancer-specific mortality after surgery. Ureteral tumor, multiple tumor, and high preoperative creatinine were independently associated with intravesical recurrence after surgery.

[Association between human papillomavirus infection and lung cancer]

Objective: To investigate the association between human papillomavirus (HPV) and lung cancer. Methods: We examined a series of 83 lung cancer patients with HPV DNA in both lung tumor specimens and adjacent normal specimens from Fujian province. Twenty-one of the most clinically relevant HPV types from the highly conserved L1 region of the viral genome were analyzed, using the PCR amplification and were followed by reverse hybridization with specific probes. Chi-square test of paired design was used to test the difference of HPV positive rates between lung cancer specimens and adjacent normal specimens. Chi-square test and Fisher's exact test were used to analyze the differences of HPV positive rate of tumor specimens on factors as gender, age, histological subtype, clinical stage, smoking status and alcohol consumption. Results: HPV was detected in 7 of the 83 tumor specimens and in 6 of the paired normal lung tissues. There was no significant correlation between HPV and lung cancer (P>0.999). Neither demographic characteristics nor clinical features were found with significant differences on HPV in lung cancer tissues (P>0.05). Conclusion: Our data showed that HPV was not significantly associated with the risk of lung cancer in Fujian province.

Influence of oral hygiene and its interaction with standard of education on the risk of oral cancer in women who neither smoked nor drank alcohol: a hospital-based, case-control study

We know of only limited data about the role of oral hygiene and the risk of oral cancer with different standards of education. The aim of this study was to assess the association between oral hygiene and risk of oral cancer, with stratification by standard of education, in Chinese women. We organised a case-control study with 250 women with oral cancer and 996 age-matched controls in Fujian, China. Data were collected by personal interview using a structured questionnaire. We used unconditional logistic regression with stratification by educational standard to estimate the odds ratios (OR) and 95% CI. Tooth-brushing twice a day or more was inversely related to the risk of oral cancer in women with high school education or above (OR 0.50; 95% CI 0.25 to 0.98), but not in those who were illiterate or had primary-middle school education. Wearing dentures showed an increased risk only in less well-educated women: the OR were 2.23 (95% CI 1.14 to 4.34) for the illiterate and 1.68 (95% CI 1.08 to 2.62) for the primary-middle school group. The loss of more than five teeth and oral ulceration were associated with increased risks of oral cancer in all three groups. There was also a multiplicative interaction between oral hygiene and standard of education for risk of oral cancer (p=0.001). Our results suggest that oral hygiene seems to have a critical role in the risk of oral cancer in Chinese women, but this effect may be modified by their educational standard.

[Application evaluation of multi-parametric MRI in the diagnosis and differential diagnosis of early prostate cancer and prostatitis]

Objective: To evaluate the value of multi-parametric MRI (Mp-MRI) in the diagnosis and differential diagnosis of early prostate cancer(PCa) in the peripheral zone(PZ) and low T₂WI signal intensity of prostatitis. Methods: A total of 40 patients with PZ early PCa and 37 with prostatitis of hypointense T₂WI signal in PZ were retrospectively analyzed, which were collected from the General Hospital of Ningxia Medical University from Janurary 2009 to June 2015, who underwent T₂WI, DWI, and DCE-MRI examination and all patients were confirmed by pathology. All the data was transferred to GE Advanced Workstation AW4.3, the indexes divided into cancerous and prostatitis regions were calculated by Functool2 of signal intensity-time(SI-T) curve and ADC value, to calcuate the time to minimum(T_max), the whole enhancment degree (SI_max). ROC cure was used to determine the cutoff value for PCa detection with the ADC value. Result: On T₂WI, 57.5% of PCa (23/40) showed focal nodular homogeneous low signal intensity, 70.3% of prostatitis(26/37) showed diffuse inhomogeneous low signal intensity. DCE-MRI, the distribution of curve types for malignant tumors was type Ⅰ 2.5%(1/40), typeⅡ32.5%(13/40) and type Ⅲ 65.0% (26/40). While the numbers for prostatitis was type Ⅰ 16.2%(6/37) , type Ⅱ 56.8% (21/37) and type Ⅲ 27.0% (10/37)respectively.The patterns of curve types in malignant lesions were different from benign lesions significantly(χ² =12.32, P<0.01). The mean values of T_max, SI_max in cancerous and prostatitis regions were (17.96±2.91)s, 1.76%±0.23% and (21.19±3.59)s, 1.53%±0.18%, respectively (t=5.37, 6.10; P<0.01). On DWI, The mean ADC values in cancerous and prostatitis regions were (0.95±0.13)×10^-3 mm²/s and (1.12±0.13)×10^-3 mm²/s, respectively (t=7.10, P<0.01). According to the ROC analysis, when the cutoff value was 1.01×10^-3 mm²/s, the early PCa of diagnostic sensitivity, specificity and accuracy was 79.1%, 72.7% and 76.1% respectively. Conclusion: Combined with morphology and signal characteristics of conventional T₂WI, DWI and DCE-MRI improve the power of MR imaging in discriminating prostatitis from early PCa.

The added value of SPECT/spiral CT in patients with equivocal bony metastasis from hepatocellular carcinoma

The aim of this study was to evaluate the incremental value provided by single-photon emission computed tomography (SPECT)/spiral computed tomography (CT) over SPECT alone for the evaluation of equivocal bone lesions in patients with hepatocellular carcinoma (HCC).

PATIENTS, METHODS

This was a retrospective study of 65 patients (61 men and 4 women; mean age, 53.1 ± 10.1 years; age range, 31-78 years) with HCC confirmed by pathology who underwent planar whole body scintigraphy and SPECT/CT. Each lesion was scored visually using a 5-point scale (0, negative; 1, benign; 2, likely benign; 3, likely bone metastasis; 4, bone metastasis). Lesions in which diagnostic confidence was scored as 3 or 4 were categorized into metastases.The final diagnosis of each lesion was based on pathological confirmation or follow-up by whole body scintigraphy and SPECT/spiral CT conducted two or more times. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SPECT alone and SPECT/CT were computed.

RESULTS

The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of SPECT alone were 78.4, 70.9%, 94.9%, 96.8% and 59.7%, respectively. Moreover, for agreement of SPECT alone and the final results, the kappa value was 0.567 (p < 0.001), which was considered to be moderate agreement. The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of SPECT/CT were 99.2%, 100%, 97.4%, 98.9% and 100 %, respectively. Furthermore, for agreement of SPECT/CT and the final results, the kappa value was 0.981 (p < 0.001), which was considered to be nearly perfect agreement.

CONCLUSIONS

SPECT/spiral CT is more accurate and valuable than SPECT alone in the differential diagnosis of equivocal bone lesions in patients with HCC.

Development of a New Meat Analog Through Twin-Screw Extrusion of Defatted Soy Flour-lean Pork Blend

A pilot scale co-rotating, self-wiping twin-screw extruder was used to produce high-moisture texturised meat analogue products from defatted soy protein and lean pork blend with different combinations of operational variables and feed compositions. The effects of operational variables and feed compositions that include temperature setting in five heating zones of the extruder, screw speed, throughput, moisture content, oil content, and pork percentage upon sensory textual quality were determined. The optimal sensory texture and energy consumption of extrusion cooking of the feed blend were obtained with a die of rectangular slit configuration, barrel temperature setting at 60-100-120-150-110°C, screw speed at 80rpm, 50% moisture content, lean pork content ranging from 30-50%, and the oil content ranging from 12-16% (depending upon the fat content of the pork) for optimal extrudate texture formation and stable operation.

[Primary penoscrotal extra-mammary Paget's disease: analysis of 22 cases]

OBJECTIVE

To investigate the clinical characteristics, treatment and prognosis of primary penoscrotal extra-mammary Paget's disease (PSPD).

METHODS

The clinical and pathological data of 22 cases of primary PSPD were retrospectively reviewed. Survival rate of the overall patients, the invasive patients, and the patients with positive surgical margin or negative surgical margin were analyzed with Kaplan-Meier survival curve method.

RESULTS

Among all the patients with primary PSPD, the median age of onset was 64.5 (39-84) years, the median time of disease duration was 40 (2-300) months, and the median long diameter of lesion was 4.75 (1-10) cm. In the study, 12 patients (54.5%) were in pathological stage A1, 6 patients (27.3%) were in pathological stage A2, and 4 patients (18.2%) were in pathological stage B. Scrotum and penile of most patients (n=12, 54.5%) were involved, 5 patients (22.7%) were scrotum only, and 5 patients (22.7%) were penile only. Erythema (n=18, 81.8%), itchiness (n=16, 72.7%), ulcerate (n=12, 54.5%), exudation (n=11, 50.0%), and pain (n=4, 18.2%) were the major manifestations. All the patients with primary PSPD were treated with wide surgical excision. The rate of invasive patients was 77.3% (n=17). Of them, 6 patients had positive surgical margin. The surgical margins of non-invasive patients were all negative. Twelve patients exhibited local recurrence or/and metastases, and the status of surgical margins (P=0.015) and the depth of invasion (P=0.010) were important risk factors. Inguinal lymph nodes were generally involved. The difference of the delay of diagnosis between metastasis and non-metastasis was significant (P=0.040). The 5-year survival rates of the overall and invasive patients were 33.7% and 27.9%, respectively. The patients with positive surgical margin had poor prognosis.

CONCLUSION

Primary PSPD, with the characteristics of long duration, high invasive tendency and high incidence of local recurrence or metastases, generally occurs in the elderly. Surgery should be performed at first. The delay of diagnosis, positive surgical margins and the involvement of inguinal lymph node are important risk factors. Biopsy, frozen section and inguinal lymph node biopsy (ILNB) can standardize diagnosis and treatment.

Efficacy and safety of adalimumab in Chinese patients with moderate-to-severe plaque psoriasis: results from a phase 3, randomized, placebo-controlled, double-blind study

Background

This phase 3 trial is the first to evaluate the efficacy and safety of treatment with the systemic TNF‐α inhibitor, adalimumab, for Chinese patients with moderate‐to‐severe plaque psoriasis.

Methods

In the 12‐week, double‐blind, placebo‐controlled Period A, patients were randomized 4 : 1 to receive adalimumab 40 mg every‐other‐week (following a single 80 mg dose), or placebo every‐other‐week. In the subsequent 12‐week, open‐label, Period B, all patients received adalimumab 40 mg every‐other‐week starting at week 13, following a single, blinded dose at week 12 of adalimumab 80 mg or matching placebo (for patients receiving placebo or adalimumab in Period A respectively). In Period A, efficacy was analysed for all randomized patients and safety for all patients receiving ≥1 dose of the study drug.

Results

For the 425 patients in this study (87 placebo; 338 adalimumab), a higher percentage randomized to adalimumab achieved the primary endpoint of ≥75% improvement from baseline in PASI score (PASI 75) at week 12: placebo 11.5% (10/87); adalimumab 77.8% (263/338; P < 0.001). Physician's Global Assessment of clear to minimal was achieved at week 12 by 14.9% placebo (13/87) and 80.5% adalimumab (272/338; P < 0.001). For patients who received adalimumab at any time during the study (All‐adalimumab Population), treatment‐emergent adverse events (AEs) were reported by 63.4%; the most common was upper respiratory infection (16.1%). Serious AEs were reported by 3.5% of the All‐adalimumab Population, and serious infectious AEs by 1.2%, which include lung infection, pneumonia and tuberculosis [2 (0.5%) patients each]. There was one death (chronic heart failure).

Conclusion

In these Chinese patients with moderate‐to‐severe psoriasis, a significantly greater percentage treated with adalimumab compared with placebo achieved efficacy endpoints at week 12 and efficacy was sustained to week 24. Safety results were consistent with the known adalimumab safety profile; no new safety signals were identified in the 24 weeks of treatment.

[Primary penoscrotal extra-mammary Paget's disease: analysis of 22 cases]

OBJECTIVE

To investigate the clinical characteristics, treatment and prognosis of primary penoscrotal extra-mammary Paget's disease (PSPD).

METHODS

The clinical and pathological data of 22 cases of primary PSPD were retrospectively reviewed. Survival rate of the overall patients, the invasive patients, and the patients with positive surgical margin or negative surgical margin were analyzed with Kaplan-Meier survival curve method.

RESULTS

Among all the patients with primary PSPD, the median age of onset was 64.5 (39-84) years, the median time of disease duration was 40 (2-300) months, and the median long diameter of lesion was 4.75 (1-10) cm. In the study, 12 patients (54.5%) were in pathological stage A1, 6 patients (27.3%) were in pathological stage A2, and 4 patients (18.2%) were in pathological stage B. Scrotum and penile of most patients (n=12, 54.5%) were involved, 5 patients (22.7%) were scrotum only, and 5 patients (22.7%) were penile only. Erythema (n=18, 81.8%), itchiness (n=16, 72.7%), ulcerate (n=12, 54.5%), exudation (n=11, 50.0%), and pain (n=4, 18.2%) were the major manifestations. All the patients with primary PSPD were treated with wide surgical excision. The rate of invasive patients was 77.3% (n=17). Of them, 6 patients had positive surgical margin. The surgical margins of non-invasive patients were all negative. Twelve patients exhibited local recurrence or/and metastases, and the status of surgical margins (P=0.015) and the depth of invasion (P=0.010) were important risk factors. Inguinal lymph nodes were generally involved. The difference of the delay of diagnosis between metastasis and non-metastasis was significant (P=0.040). The 5-year survival rates of the overall and invasive patients were 33.7% and 27.9%, respectively. The patients with positive surgical margin had poor prognosis.

CONCLUSION

Primary PSPD, with the characteristics of long duration, high invasive tendency and high incidence of local recurrence or metastases, generally occurs in the elderly. Surgery should be performed at first. The delay of diagnosis, positive surgical margins and the involvement of inguinal lymph node are important risk factors. Biopsy, frozen section and inguinal lymph node biopsy (ILNB) can standardize diagnosis and treatment.

Adjuvant therapies using normobaric oxygen with hypothermia or ethanol for reducing hyperglycolysis in thromboembolic cerebral ischemia

BACKGROUND AND PURPOSE

Normobaric oxygen (NBO), ethanol (EtOH), and therapeutic hypothermia (TH) delivered alone or in combination have neuroprotective properties after acute stroke. We used an autologous thromboembolic rat stroke model to assess the additive effects of these treatments for reducing the deleterious effects of hyperglycolysis post-stroke in which reperfusion is induced with recombinant tissue plasminogen activator (rt-PA).

METHODS

Sprague-Dawley rats were subjected to middle cerebral artery (MCA) occlusion with an autologous embolus. One hour after occlusion, rt-PA was administered alone or with NBO (60%), EtOH (1.0 g/kg), TH (33 °C), either singly or in combination. Infarct volume and neurological deficit were assessed at 24h after rt-PA-induced reperfusion with or without other treatments. The extent of hyperglycolysis, as determined by cerebral glucose and lactate levels was evaluated at 3 and 24h after rt-PA administration. At the same time points, expressions of glucose transporter 1 (Glut1), glucose transporter 3 (Glut3), phosphofructokinase1 (PFK-1), and lactate dehydrogenase were (LDH) measured by Western blotting.

RESULTS

Following rt-PA in rats with thromboembolic stroke, NBO combined with TH or EtOH most effectively decreased infarct volume and neurological deficit. As compared to rt-PA alone, EtOH or TH but not NBO monotherapies significantly reduced post-stroke hyperglycolysis. The increased utilization of glucose and production of lactate post-stroke was prevented most effectively when NBO was combined with either EtOH or TH after reperfusion with rt-PA, as shown by the significantly decreased Glut1, Glut3, PFK-1, and LDH levels.

CONCLUSIONS

In a rat thromboembolic stroke model, both EtOH and TH used individually offer neuroprotection after the administration of rt-PA. While NBO monotherapy does not appear to be effective, it significantly potentiates the efficacy of EtOH and TH. The similar neuroprotection and underlying mechanisms pertaining to the attenuation of hyperglycolysis provided by EtOH or TH in combination with NBO suggest a possibility of substituting EtOH for TH. Thus a combination of NBO and EtOH, which are widely available and easily used, could become a novel and effective neuroprotective strategy in the clinical setting.

Unravelling Colletotrichum species associated with Camellia: employing ApMat and GS loci to resolve species in the C. gloeosporioides complex

We investigated the phylogenetic diversity of 144 Colletotrichum isolates associated with symptomatic and asymptomatic tissues of Camellia sinensis and other Camellia spp. from seven provinces in China (Fujian, Guizhou, Henan, Jiangxi, Sichuan, Yunnan, Zhejiang), and seven isolates obtained from other countries, including Indonesia, UK, and the USA. Based on multi-locus (ACT, ApMat, CAL, GAPDH, GS, ITS, TUB2) phylogenetic analyses and phenotypic characters, 11 species were distinguished, including nine well-characterised species (C. alienum, C. boninense, C. camelliae, C. cliviae, C. fioriniae, C. fructicola, C. gloeosporioides, C. karstii, C. sia-mense), and two novel species (C. henanense and C. jiangxiense). Of these, C. camelliae proved to be the most dominant and probably host specific taxon occurring on Camellia. An epitype is also designated for the latter species in this study. Colletotrichum jiangxiense is shown to be phylogenetically closely related to the coffee berry pathogen C. kahawae subsp. kahawae. Pathogenicity tests and the pairwise homoplasy index test suggest that C. jiangxiense and C. kahawae subsp. kahawae are two independent species. This study represents the first report of C. alienum and C. cliviae occurring on Camellia sinensis. In addition, our study demonstrated that the combined use of the loci ApMat and GS in a phylogenetic analysis is able to resolve all currently accepted species in the C. gloeosporioides species complex.

The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly patients

PURPOSE OF THE STUDY

Treatment of distal radius fractures in elderly patients is controversial. This study explored the relationship between radiographic parameters and clinical outcomes of patients with distal radius fractures following conservative treatment. The study was done using radiographic measurements of distal radius fractures in elderly patients.

PATIENTS AND METHODS

Ninety-two active, healthy patients with conservatively managed distal radius fractures were included in the study. Functional and radiographic assessments were made 1 year after injury. Fifty patients who underwent corrective osteotomy comprised the control group. Radiographic parameters and clinical outcomes were compared between the two groups. The correlation coefficients of the radiographic parameters were analysed using multiple regression.

RESULT

Radius height (RH), volar tilt (VT) and Mayo wrist and Disabilities of the Arm, Shoulder and Hand (DASH) scores in the experimental group were significantly superior to those of the control group. There was no significant group difference in radial inclination. Multiple regression analysis revealed that the most important factor affecting functional outcome was RH, followed by VT.

DISCUSSION

RH and VT were significantly correlated with the clinical outcomes of conservative treatment of distal radius fractures. RH should be given foremost consideration in elderly patients. Preoperatively, surgeons should evaluate this parameter carefully and be prepared to treat injuries accordingly.

LEVEL OF EVIDENCE

Level IV retrospective study.

Characteristics of Small Intestinal Diseases on Single-Balloon Enteroscopy: A Single-Center Study Conducted Over 6 Years in China

The small intestine has been considered inaccessible for a long term. The development of single-balloon endoscopy has greatly improved the diagnosis and treatment possibilities for small intestinal diseases.In this study, we aimed to explore the demographic characteristics and small intestinal diseases of patients who underwent single-balloon enteroscopy between 2009 and 2014 at our endoscopy center. We determined the enteroscopic findings for each small intestinal disease and the most susceptible age groups.In total, 186 patients were included in the study. Their mean age was 45.87 ± 15.77 years. Patients who underwent single-balloon enteroscopy were found to have neoplasms (most common age group: 14-45 years, most common lesion location: jejunum), lymphoma (46-59 and 60-74 years, ileum), protuberant lesions (45-59 years, jejunum), inflammation (14-45 and 46-59 years, ileum), benign ulcers (14-45 years, jejunum), diverticulum (14-45 years, ileum), vascular malformations (60-74 years, jejunum), polyps (14-45 years, jejunum), Crohn's disease (14-45 years, jejunum), hookworm infection (14-45 years, jejunum), lipid pigmentation (14-45 and 46-59 years, jejunum), undetermined bleeding (46-59 years, ileum), or undetermined stenosis (31 years, duodenum). Each small intestinal disease had distinct enteroscopic findings.

Resolving the Phoma enigma

The Didymellaceae was established in 2009 to accommodate Ascochyta, Didymella and Phoma, as well as several related phoma-like genera. The family contains numerous plant pathogenic, saprobic and endophytic species associated with a wide range of hosts. Ascochyta and Phoma are morphologically difficult to distinguish, and species from both genera have in the past been linked to Didymella sexual morphs. The aim of the present study was to clarify the generic delimitation in Didymellaceae by combing multi-locus phylogenetic analyses based on ITS, LSU, rpb2 and tub2, and morphological observations. The resulting phylogenetic tree revealed 17 well-supported monophyletic clades in Didymellaceae, leading to the introduction of nine genera, three species, two nomina nova and 84 combinations. Furthermore, 11 epitypes and seven neotypes were designated to help stabilise the taxonomy and use of names. As a result of these data, Ascochyta, Didymella and Phoma were delineated as three distinct genera, and the generic circumscriptions of Ascochyta, Didymella, Epicoccum and Phoma emended. Furthermore, the genus Microsphaeropsis, which is morphologically distinct from the members of Didymellaceae, grouped basal to the Didymellaceae, for which a new family Microsphaeropsidaceae was introduced.

Effects of a multi-strain Bacillus species-based direct-fed microbial on growth performance, nutrient digestibility, blood profile, and gut health in nursery pigs fed corn-soybean meal-based diets

This experiment was conducted to investigate the effect of a spp.-based direct-fed microbial (DFM) on growth performance, apparent total tract digestibility (ATTD), blood profile, intestinal histomorphology, and fecal gas emission in piglets fed corn and soybean meal-based diets. The DFM product was based on 1 strain of and 2 strains of and formulated to supply 1.5 × 10 cfu/g of feed. A total of 128 piglets ([Yorkshire × Landrace] × Duroc; 6.8 ± 0.6 kg BW; weaning age: 24 d) were housed in groups (4 pigs/pen, 2 barrows and 2 gilts) and fed diets ( = 16) without or with DFM in a 2-phase feeding program: d 0 to 14 (phase I) and 15 to 42 (phase II). Feed intake and BW were measured weekly. At the end of each phase, samples for blood urea nitrogen (BUN), blood creatinine, ATTD, and fecal noxious gas emission were taken. At termination, 12 piglets per treatment were killed to access intestinal tissues for histomorphology. Overall, pigs fed DFM had a greater ( < 0.05) G:F than pigs fed the control diet. In phase I, pigs fed DFM showed a greater ( < 0.05) ADG and lower ( < 0.05) concentration of BUN and fecal ammonia emission than the control group. In phase II, a greater ( < 0.05) ATTD of nitrogen and longer ( < 0.05) duodenum and jejunum villi were observed in pigs fed the DFM diet compared with the control group. In conclusion, inclusion of DFM improved growth performance and villi length of the duodenum and jejunum in nursery pigs. Furthermore, DFM enhanced protein utilization as demonstrated by increased nitrogen digestibility, lower BUN, and lower fecal ammonia release.

What childhood obesity prevention programmes work? A systematic review and meta-analysis

Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high-income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi-experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2-18 in high-income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta-analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity-related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity-only interventions delivered in schools with home involvement or combined diet-physical activity interventions delivered in schools with both home and community components. SOE was moderate for school-based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school-based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics-oriented interventions.

Psychrophilic fungi from the world's roof

During a survey of cold-adapted fungi in alpine glaciers on the Qinghai-Tibet Plateau, 1 428 fungal isolates were obtained of which 150 species were preliminary identified. Phoma sclerotioides and Pseudogymnoascus pannorum were the most dominant species. Psychrotolerant species in Helotiales (Leotiomycetes, Ascomycota) were studied in more detail as they represented the most commonly encountered group during this investigation. Two phylogenetic trees were constructed based on the partial large subunit nrDNA (LSU) to infer the taxonomic placements of these strains. Our strains nested in two well-supported major clades, which represented Tetracladium and a previously unknown lineage. The unknown lineage is distant to any other currently known genera in Helotiales. Psychrophila gen. nov. was therefore established to accommodate these strains which are characterised by globose or subglobose conidia formed from phialides on short or reduced conidiophores. Our analysis also showed that an LSU-based phylogeny is insufficient in differentiating strains at species level. Additional analyses using combined sequences of ITS+TEF1+TUB regions were employed to further investigate the phylogenetic relationships of these strains. Together with the recognisable morphological distinctions, six new species (i.e. P. antarctica, P. lutea, P. olivacea, T. ellipsoideum, T. globosum and T. psychrophilum) were described. Our preliminary investigation indicates a high diversity of cold-adapted species in nature, and many of them may represent unknown species.

A single-centre, open-label, prospective study of an initially short-term intensified dosing regimen of enteric-coated mycophenolate sodium with reduced cyclosporine A exposure in Chinese live-donor kidney transplant recipients

AIMS

The nephrotoxicity of cyclosporine A (CsA) accounts for dysfunction of kidney allografts in the clinic. Short-term intensified dosing using enteric-coated mycophenolate sodium (EC-MPS) may facilitate CsA sparing after kidney transplantation without compromising safety.

METHODS

In a 12-month, single-centre open-label prospective trial, 180 de novo live-donor kidney transplant recipients at low-immunological risk were randomised to a low-dose cyclosporine group which received a low dose of cyclosporine, short-term intensified EC-MPS dosing (2160 mg/day to week 6, 1440 mg/day thereafter) and corticosteroids or a standard-dose cyclosporine group which received a standard dose of cyclosporine, standard EC-MPS dosing (1440 mg/day) and corticosteroids. The primary end-point [treatment failure including biopsy-proven acute rejection (BPAR), graft loss, death], secondary end-point and adverse events were monitored.

RESULTS

The primary end-point (treatment failure) occurred in 13.3% (12/90) of the low-dose cyclosporine group and 16.7% (15/90) of the standard-dose cyclosporine group (p = 0.53) (difference -3.4%, 95% confidence interval -11.7% to 7.5%, based on a noninferiority margin of 20%). BPAR occurred in 11.1% and 13.3% of patients in the low-dose cyclosporine group and standard-dose cyclosporine group, respectively (p = 0.65). The estimated glomerular filtration rate, as calculated by the Cockcroft-Gault formula, was similar at 12 months after transplantation (low-dose cyclosporine group 63 ± 19 ml/min/1.73 m(2) and standard-dose cyclosporine group 59 ± 15 ml/min/1.73 m(2) ; p = 0.43). The levels of serum creatinine and occurrence of adverse events between the two groups were not statistically different.

CONCLUSIONS

A regimen of early intensified EC-MPS dosing permits low-dose cyclosporine in live-donor kidney transplant patients at low-immunological risk without compromising efficacy at 12 months' follow-up.

SIRT1/PGC-1α signaling protects hepatocytes against mitochondrial oxidative stress induced by bile acids

Oxidative stress and mitochondrial dysfunction are hypothesized to contribute to the pathogenesis of chronic cholestatic liver diseases. Silent information regulator 1 (SIRT1) attenuates oxidative stress and improves mitochondrial biogenesis in numerous mitochondrial-related diseases; however, a functional role for SIRT1 in chronic liver cholestasis, characterized by increased levels of toxic bile acids, remains unknown. We show decrease in SIRT1 levels and its activity and impairment of mitochondrial biogenesis in the liver of patients with extrahepatic cholestasis. Moreover, we found that glycochenodeoxycholic acid (GCDCA) stimulated cytotoxicity, disrupted the mitochondrial membrane potential, increased reactive oxygen species production, and decreased mitochondrial mass and mitochondrial DNA content in L02 cells. Consistent with this finding, GCDCA was found to decrease SIRT1 protein expression and activity, thus promoting the deacetylation of peroxisome proliferator-activated receptor gamma, coactivator 1 alpha (PGC-1α), a key enzyme involved in mitochondrial biogenesis and function. Conversely, GCDCA-induced mitochondrial injury was efficiently attenuated by SIRT1 overexpression. In summary, these findings indicate that the loss of SIRT1 may play a crucial role in the pathogenesis of liver damage observed in patients with extrahepatic cholestasis. The findings also indicate that genetic supplementation of SIRT1 can ameliorate GCDCA-induced hepatotoxicity through the activation of PGC-1α-dependent mitochondrial biogenesis.

Parameter estimation in a Holzapfel-Ogden law for healthy myocardium

A central problem in biomechanical studies of personalized human left ventricular (LV) modelling is to estimate material properties from in vivo clinical measurements. In this work we evaluate the passive myocardial mechanical properties inversely from the in vivo LV chamber pressure-volume and strain data. The LV myocardium is described using a structure-based orthotropic Holzapfel-Ogden constitutive law with eight parameters. In the first part of the paper we demonstrate how to use a multi-step non-linear least-squares optimization procedure to inversely estimate the parameters from the pressure-volume and strain data obtained from a synthetic LV model in diastole. In the second part, we show that to apply this procedure to clinical situations with limited in vivo data, additional constraints are required in the optimization procedure. Our study, based on three different healthy volunteers, demonstrates that the parameters of the Holzapfel-Ogden law could be extracted from pressure-volume and strain data with a suitable multi-step optimization procedure. Although the uniqueness of the solution cannot be addressed using our approaches, the material response is shown to be robustly determined.

Generation and characterization of polyclonal antibodies against mouse T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory domain by DNA-based immunization

Mouse T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory domain (TIGIT) is a newly identified surface protein expressed in regulatory, memory, natural killer (NK), and activated T cells. Several studies indicate that mouse TIGIT is a vital immunomodulator that can control the activities of both NK and T cells and plays an important role in transplantation tolerance. In this study, we designed a vector, TIGIT-pcDNA3.1 (+), that encodes the complete coding sequence of mouse TIGIT. The vector was intramuscularly injected into rats, and then the specific antisera were harvested and purified using a protein A/G PLUS-agarose affinity column. Western blot and immunohistochemistry analyses revealed that the antibodies generated by DNA immunization can bind with the mouse TIGIT. Using these antibodies in immunoblots, TIGIT was detected in lysates of mouse organs, T cells from mouse lymph nodes, and recombinant mouse fusion protein of TIGIT and Fc fragment. Immunohistochemistry analysis of normal mouse kidney showed that immunoreactivity was located on endothelial cells of glomerular capillary loops and peritubular capillaries. Our results demonstrated that the DNA immunization of rats through intramuscular injection was a simple and easily available method of producing polyclonal antibodies that can be used to detect and analyze mouse TIGIT expression in mouse systems.

303 HUMAN RECOMBINATION GRANULOCYTE-COLONY STIMULATING FACTOR (HRG-CSF) HAVE BENEFICIAL EFFECTS ON PORCINE OOCYTES QUALITY DURING IN VITRO MATURATION AND SUBSEQUENT VIABILITY OF EMBRYONIC DEVELOPMENT

Granulocyte colony-stimulating factor (G-CSF), also known as colony-stimulating factor 3 (CSF3), is required for the proliferation, differentiation, and survival of cells. In humans, G-CSF is a biomarker of human oocyte developmental competence for embryo implantation. Furthermore, G-CSF concentration increases during the menstrual cycle and levels were significantly higher during ovulatory phase than the other phases. In this study, we examined G-CSF and its receptor gene expression in the porcine granulosa cells, corpus luteum, cumulus cells, and oocytes. The cumulus-oocyte complexes (COC) were aspirated from antral follicles 1 to 3 mm (small follicle) and 3 to 6 mm (medium follicle). The COC from 2 kinds of follicles were matured in protein-free maturation medium supplemented with various concentrations of hrG-CSF (0, 10, and 100 ng mL–1, respectively). Statistical analyses were done by one-way analysis of variance (ANOVA) followed by Duncan's multiple range tests. After real time-PCR was performed, the CSF3 and its receptor (CSF3R) were observed all of granulosa cells, corpus luteum, cumulus cells, and oocytes. Interestingly, the CSF3 transcript levels were significantly lower in oocytes compared with other cell types, but the CSF3R transcript levels in oocytes were almost similar with granulosa cells. After 44 h of IVM, the rates of nuclear maturation had no difference, and the intracellular ROS levels of oocytes from both kind of follicle groups matured with 10 ng mL–1 were significantly decreased compared to other groups (P < 0.05). After PA, the cleavage and blastocyst formation rates were significantly (P < 0.05) increased for the 100 ng mL–1 of small follicle (SF; 63.29 and 31.18%) group compared to control and 10 ng mL–1 of SF (38.64, 10.4, and 49.0, 15.6%, respectively) group, and significantly (P < 0.05) increased in the 10 ng mL–1 of medium follicle (MF; 76.32 and 45.61%) group compared with control and 100 ng mL–1 of MF (52.1, 32.8 and 61.3, 33.9%, respectively). The total cell numbers of blastocyst from SF and MF groups were significantly increased in the 10 ng mL–1 (73.67 and 106.52) groups. At IVF, the blastocysts formation rates were significantly increased in the 10 ng mL–1 of MF group compared to control, 100 ng mL–1 of SF, and control of MF (21.1, 22.8, and 27.8%, respectively). We also examined the Bcl2 and ERK2 transcript levels, which were significantly increased at 100 ng mL–1 of SF and 10 ng mL–1 of MF. These results suggest that hrG-CSF improved the quality of porcine oocyte and embryonic viability.This was supported, in part, by a grant from the National Research Foundation of Korea Grant Government (NRF-2012R1A1A4A01004885, NRF-2013R1A2A2A04008751), Republic of Korea.

Association study of UGT1A9 promoter polymorphisms with DILI based on systematically regional variation screen in Chinese population

Drug-induced liver injury (DILI) is caused by unpredictable adverse drug reaction due mainly to the accumulation of hepatotoxic compounds in the liver resulting in significant damage. Drug-metabolizing enzymes have been prime targets for molecular studies relevant to DILI. The gene UGT1A9 mainly expresses in the liver and has an important role in drug metabolism. The Han Chinese has a very long and complex demographic history, and the population stratification arising from the interplay of different geographic areas may influence the polymorphism pattern. We selected 260 healthy subjects in three different geographic areas (including Xian, Shanghai and Liuzhou) for systemic screening and analysis of single-nucleotide polymorphisms (SNPs) in the promoter region of UGT1A9. Eight SNPs were identified and no regional disparity exists among the three populations. Based on these results, 213 DILI patients from all over the Chinese mainland were further recruited to investigate possible association between UGT1A9 and DILI. We observed statistically significant associations between SNP rs2741045 and DILI at both allele and genotype levels (allele: P=0.032; genotype: P=0.029; after Bonferroni correction). Also, multivariate interaction analysis discovered the interaction between rs2741045 and age associated with DILI significantly. This is the first such screening study to investigate the association between UGT1A9 promoter polymorphisms and DILI in the Chinese population and it could provide the basis for further study of DILI mechanisms.

Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta-analysis

We aimed to assess the effects of childhood obesity prevention programmes on blood lipids in high-income countries. We searched MEDLINE®, Embase, PsychInfo, CINAHL®, clinicaltrials.gov, and the Cochrane Library up to 22 April 2013 for relevant randomized controlled trials, quasi-experimental studies and natural experiments published in English. Studies were included if they implemented diet and/or physical activity intervention(s) with ≥1 year follow-up (or ≥6 months for school-based intervention studies) in 2-18-year-olds, and were excluded if they targeted only overweight/obese children, or those with a pre-existing medical condition. Seventeen studies were finally included. For total cholesterol, the pooled intervention effect was -0.97 mg dL(-1) [95% confidence interval (CI): -3.26, 1.32; P = 0.408]; for low-density lipoprotein cholesterol (LDL-C), -6.06 mg dL(-1) (95% CI: -11.09, -1.02; P = 0.018); for high-density lipoprotein cholesterol (HDL-C), 1.87 mg dL(-1) (95% CI: 0.39, 3.34; P = 0.013); and for triglycerides, -1.95 mg dL(-1) (95% CI: -4.94, 1.04; P = 0.202). Most interventions (70%) showed similar significant or no effects on adiposity- and lipids outcomes: 15% interventions improved both adiposity- and lipids outcomes; 55% had no significant effects on either. Childhood obesity prevention programmes had a significant desirable effect on LDL-C and HDL-C. Two-thirds of interventions showed similar significant or no effects in adiposity- and lipids outcomes. Assessing lipids outcomes provide additional useful information on obesity prevention programme benefits.