Wavelength-agile high-power sources via four-wave mixing in higher-order fiber modes

Frequency doubling of conventional fiber lasers in the near-infrared remains the most promising method for generating integrated high-peak-power lasers in the visible, while maintaining the benefits of a fiber geometry; but since the shortest wavelength power-scalable fiber laser sources are currently restricted to either the 10XX nm or 15XX nm wavelength ranges, accessing colors other than green or red remains a challenge with this schematic. Four-wave mixing using higher-order fiber modes allows for control of dispersion while maintaining large effective areas, thus enabling a power-scalable method to extend the bandwidth of near-infrared fiber lasers, and in turn, the bandwidth of potential high-power sources in the visible. Here, two parametric sources using the LP_0,7 and LP_0,6 modes of two step-index multi-mode fibers are presented. The output wavelengths for the sources are 880, 974, 1173, and 1347 nm with peak powers of 10.0, 16.2, 14.7, and 6.4 kW respectively, and ~300-ps pulse durations. The efficiencies of the sources are analyzed, along with a discussion of wavelength tuning and further power scaling, representing an advance in increasing the bandwidth of near-infrared lasers as a step towards high-peak-power sources at wavelengths across the visible spectrum.

Abstract P5-11-12: MOCHA: An institution-based care coordination app for post-hospitalization breast cancer patients

Purpose: Hospitals face many challenges in effective care coordination for post-surgery breast cancer patients, especially with scarce resources and limited availability of nurse navigators for care transition and post-hospitalization follow up. Mobile health provides an inexpensive and convenient means of real time care monitoring and communication between patients and care providers. Nevertheless, most current health apps focus on individual consumers and gather information from their daily lives, but do not integrate with clinical workflow or capture physiological and activity data into electronic medical record for real-time monitoring, patient surveillance, and professional care. To fill this gap, we have developed and implemented MOCHA (MethOdist Hospital Cancer Health Application), a coordinated care mobile app for post-hospitalization breast cancer patients from the perspective of a primary care institution. Methods: MOCHA supports both iOS and Android platforms and contains two main modules: health care monitoring and data communication, designed together with the physicians and nurses of the Houston Methodist Cancer Center. The Health care monitoring module aims to support real-time monitoring of the post-discharge medical state of breast cancer patients. Physicians can monitor the daily food intake and activities for patients and provide advice to patients in real-time. The data communication module was developed to safely exchange the care coordination data with the hospital electronic medical record or data warehouse. Communication between the patient and the physician can be via an in-house protocol or an open data exchange standard Fast Healthcare Interoperability Resources (FHIR), that describes data format and elements for exchanging electronic health records. Our communication module uses https-based protocol to exchange the structured data with the FHIR resource server. Implementation: To validate the MOCHA app, we collaborated with the oncologists and dietitians at the Houston Methodist Cancer Center, who provided breast cancer patients for post-surgery care coordination. Our app exchanges health care data in real time with our hospital's clinical data warehouse. MOCHA searches Nutritionix food database for nutritional information and uses personal trackers such as Fitbit for patients' daily activities with their authorization. The app sends patients' daily burned calories into our clinical data warehouse. During the evaluation period, the physician communicates with cancer patients daily. In addition, every patient has a bi-weekly physical examination, and all examination results are shown in the app. After the experimental evaluation, the physician will access the data warehouse and analyze the test data in order to improve the quality of care coordination. The experimental clinical evaluation is ongoing, and we will report the results once the study is completed. Conclusion: MOCHA app provides health care monitoring and secure communication functions with interface with clinical data warehouse. The technical evaluation shows that the proposed methods are robust and efficient in support of care coordination for post-surgery cancer patients.

Citation Format: He T, Ogunti R, Yu X, Puppala M, Chen S, Mancuso J, Stephen W. MOCHA: An institution-based care coordination app for post-hospitalization breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-12.

Twist1 promotes breast cancer invasion and metastasis by silencing Foxa1 expression

The heterogeneous breast cancers can be classified into different subtypes according to their histopathological characteristics and molecular signatures. Foxa1 expression is linked with luminal breast cancer (LBC) with good prognosis, whereas Twist1 expression is associated with basal-like breast cancer (BLBC) with poor prognosis owing to its role in promoting epithelial-to-mesenchymal transition (EMT), invasiveness and metastasis. However, the regulatory and functional relationships between Twist1 and Foxa1 in breast cancer progression are unknown. In this study, we demonstrate that in the estrogen receptor (ERα)-positive LBC cells Twist1 silences Foxa1 expression, which has an essential role in relieving Foxa1-arrested migration, invasion and metastasis of breast cancer cells. Mechanistically, Twist1 binds to Foxa1 proximal promoter and recruits the NuRD transcriptional repressor complex to de-acetylate H3K9 and repress RNA polymerase II recruitment. Twist1 also silences Foxa1 promoter by inhibiting AP-1 recruitment. Twist1 expression in MCF7 cells silenced Foxa1 expression, which was concurrent with the induction of EMT, migration, invasion and metastasis of these cells. Importantly, restored Foxa1 expression in these cells largely inhibited Twist1-promoted migration, invasion and metastasis. Restored Foxa1 expression did not change the Twist1-induced mesenchymal cellular morphology and the expression of Twist1-regulated E-cadherin, β-catenin, vimentin and Slug, but it partially rescued Twist1-silenced ERα and cytokeratin 8 expression and reduced Twist1-induced integrin α5, integrin β1 and MMP9 expression. In a xenografted mouse model, restored Foxa1 also increased Twist1-repressed LBC markers and decreased Twist1-induced BLBC markers. Furthermore, Twist1 expression is negatively correlated with Foxa1 in the human breast tumors. The tumors with high Twist1 and low Foxa1 expressions are associated with poor distant metastasis-free survival. These results demonstrate that Twist1's silencing effect on Foxa1 expression is largely responsible for Twist1-induced migration, invasion and metastasis, but less responsible for Twist1-induced mesenchymal morphogenesis and expression of certain EMT markers.

High-dose calcium channel blocker (CCB) monotherapy vs combination therapy of standard-dose CCBs and angiotensin receptor blockers for hypertension: a meta-analysis

In this study, we evaluated the efficacy and safety of high-dose calcium channel blocker (CCB) monotherapy and standard-dose CCBs combined with angiotensin receptor blockers (ARBs) for patients with hypertension. A comprehensive search of PubMed, Embase and the Cochrane Central Register of Controlled Trials was performed in December 2015. Randomized controlled trials designed to identify the above goal were included. Thirteen trials including 2371 patients were identified. The standard-dose CCB/ARB combination resulted in a greater reduction of systolic blood pressure (WMD -2.52, 95% confidence interval (CI): -3.76 to -1.28) and diastolic blood pressure (weighted mean difference (WMD) -2.07, 95% CI: -3.73 to -0.42) compared to high-dose CCB monotherapy. The overall hypertension control rate for the CCB/ARB combination was higher than that for CCB monotherapy (relative risk (RR): 1.17, 95% CI: 1.08-1.26). Furthermore, the CCB/ARB combination treatment yielded significantly fewer overall adverse events (RR: 0.84, 95% CI: 0.74-0.95), oedema (RR: 0.31; 95% CI: 0.18-0.52) and rash (RR: 0.27, 95% CI: 0.08-0.96, P=0.04) than did CCB monotherapy. The standard-dose CCB/ARB combination is superior to high-dose CCB monotherapy for lowering blood pressure and reducing adverse events in hypertensive patients. Future research should focus on the cost-effectiveness and long-term effects of these two treatment strategies for patients with hypertension.

Erosion protection benefits of stabilized SnF2 dentifrice versus an arginine-sodium monofluorophosphate dentifrice: results from in vitro and in situ clinical studies

Objectives

The aim of these investigations was to assess the ability of two fluoride dentifrices to protect against the initiation and progression of dental erosion using a predictive in vitro erosion cycling model and a human in situ erosion prevention clinical trial for verification of effectiveness.

Materials and methods

A stabilized stannous fluoride (SnF₂) dentifrice (0.454 % SnF₂ + 0.077 % sodium fluoride [NaF]; total F = 1450 ppm F) [dentifrice A] and a sodium monofluorophosphate [SMFP]/arginine dentifrice (1.1 % SMFP + 1.5 % arginine; total F = 1450 ppm F) [dentifrice B] were tested in a 5-day in vitro erosion cycling model and a 10-day randomized, controlled, double-blind, two-treatment, four-period crossover in situ clinical trial. In each study, human enamel specimens were exposed to repetitive product treatments using a standardized dilution of test products followed by erosive acid challenges in a systematic fashion.

Results

Both studies demonstrated statistically significant differences between the two products, with dentifrice A providing significantly better enamel protection in each study. In vitro, dentifrice A provided a 75.8 % benefit over dentifrice B (p < 0.05, ANOVA), while after 10 days in the in situ model, dentifrice A provided 93.9 % greater protection versus dentifrice B (p < 0.0001, general linear mixed model).

Conclusion

These results support the superiority of stabilized SnF₂ dentifrices for protecting human teeth against the initiation and progression of dental erosion.

Clinical relevance

Stabilized SnF₂ dentifrices may provide more significant benefits to consumers than conventional fluoride dentifrices.

Molecular basis of retinol anti-ageing properties in naturally aged human skin in vivo

OBJECTIVE

Retinoic acid has been shown to improve the aged-appearing skin. However, less is known about the anti-ageing effects of retinol (ROL, vitamin A), a precursor of retinoic acid, in aged human skin in vivo. This study aimed to investigate the molecular basis of ROL anti-ageing properties in naturally aged human skin in vivo.

METHODS

Sun-protected buttock skin (76 ± 6 years old, n = 12) was topically treated with 0.4% ROL and its vehicle for 7 days. The effects of topical ROL on skin epidermis and dermis were evaluated by immunohistochemistry, in situ hybridization, Northern analysis, real-time RT-PCR and Western analysis. Collagen fibrils nanoscale structure and surface topology were analysed by atomic force microscopy.

RESULTS

Topical ROL shows remarkable anti-ageing effects through three major types of skin cells: epidermal keratinocytes, dermal endothelial cells and fibroblasts. Topical ROL significantly increased epidermal thickness by stimulating keratinocytes proliferation and upregulation of c-Jun transcription factor. In addition to epidermal changes, topical ROL significantly improved dermal extracellular matrix (ECM) microenvironment; increasing dermal vascularity by stimulating endothelial cells proliferation and ECM production (type I collagen, fibronectin and elastin) by activating dermal fibroblasts. Topical ROL also stimulates TGF-β/CTGF pathway, the major regulator of ECM homeostasis, and thus enriched the deposition of ECM in aged human skin in vivo. 0.4% topical ROL achieved similar results as seen with topical retinoic acid, the biologically active form of ROL, without causing noticeable signs of retinoid side effects.

CONCLUSION

0.4% topical ROL shows remarkable anti-ageing effects through improvement of the homeostasis of epidermis and dermis by stimulating the proliferation of keratinocytes and endothelial cells, and activating dermal fibroblasts. These data provide evidence that 0.4% topical ROL is a promising and safe treatment to improve the naturally aged human skin.

The Burden of Hypertension and Associated Risk for Cardiovascular Mortality in China

IMPORTANCE

Hypertension is a leading cause of premature death in China, but limited evidence is available on the prevalence and management of hypertension and its effect on mortality from cardiovascular disease (CVD).

OBJECTIVES

To examine the prevalence, diagnosis, treatment, and control of hypertension and to assess the CVD mortality attributable to hypertension in China.

DESIGN, SETTING AND PARTICIPANTS

This prospective cohort study (China Kadoorie Biobank Study) recruited 500 223 adults, aged 35 to 74 years, from the general population in China. Blood pressure (BP) measurements were recorded as part of the baseline survey from June 25, 2004, to August 5, 2009, and 7028 deaths due to CVD were recorded before January 1, 2014 (mean duration of follow-up: 7.2 years). Data were analyzed from June 9, 2014, to July 17, 2015.

EXPOSURES

Prevalence and diagnosis of hypertension (systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, or receiving treatment for hypertension) and treatment and control rates overall and in various population subgroups.

MAIN OUTCOMES AND MEASURES

Cox regression analysis yielded age- and sex-specific rate ratios for deaths due to CVD comparing participants with and without uncontrolled hypertension, which were used to estimate the number of CVD deaths attributable to hypertension.

RESULTS

The cohort included 205 167 men (41.0%) and 295 056 women (59.0%) with a mean (SD) age of 52 (10) years for both sexes. Overall, 32.5% of participants had hypertension; the prevalence increased with age (from 12.6% at 35-39 years of age to 58.4% at 70-74 years of age) and varied substantially by region (range, 22.7%-40.7%). Of those with hypertension, 30.5% had received a diagnosis from a physician; of those with a diagnosis of hypertension, 46.4% were being treated; and of those treated, 29.6% had their hypertension controlled (ie, systolic BP <140 mm Hg; diastolic BP <90 mm Hg), resulting in an overall control rate of 4.2%. Even among patients with hypertension and prior CVD, only 13.0% had their hypertension controlled. Uncontrolled hypertension was associated with relative risks for CVD mortality of 4.1 (95% CI, 3.7-4.6), 2.6 (95% CI, 2.4-2.9) and 1.9 (95% CI, 1.8-2.0) at ages 35 to 59, 60 to 69, and 70 to 79 years, respectively, and accounted for about one-third of deaths due to CVD (approximately 750 000) at 35 to 79 years of age in 2010.

CONCLUSIONS AND RELEVANCE

About one-third of Chinese adults in this national cohort population had hypertension. The levels of diagnosis, treatment, and control were much lower than in Western populations, and were associated with significant excess mortality.

Abstract P1-05-02: The N-terminus of Twist1 is responsible for interacting with transcriptional repressors to promote EMT and metastasis of breast cancer cells

Twist1, a basic helix-loop-helix transcription factor, plays a key role to mediate epithelial-mesenchymal transition (EMT) and promote breast cancer metastasis. However, knowledge about Twist1 structure-function relationships to cancer-related phenotypes is limited. Therefore, we studied the requirement of Twist1 N-terminus in Twist1-dependent breast cancer metastasis. We showed that the amino-terminus of Twist1 was the dominant negative mutant of Twist1. Overexpression of Twist1 N-terminus exhibited different cell morphology and motility in vitro. Inoculation of Twist1 N-terminus overexpression cells into SCID mice showed delayed tumor formation and reduced lung metastasis. Furthermore, Twist1 N-terminus overexpression induced expression change of EMT markers, including E-cadherin, β-catenin, vimentin and Twist1 both in vivo and in vitro. Co-immunoprecipitation and mass spectrometry revealed that Twist1 N-terminus interacted with several members of the Mi2/nucleosome remodeling and deacetylase (Mi2/NuRD) complex, HDAC2, 3 and 7, MTA1 and 2, RbAp46/48, and many corepressors including NCoR1 and 2, which released them from the proximal region of E-cadherin promoter for transcriptional activation. These data suggest that Twist1 N-terminus is required for Twist1-mediated transcriptional programs and breast cancer metastasis.

Citation Format: Yu X, He T, Xu J. The N-terminus of Twist1 is responsible for interacting with transcriptional repressors to promote EMT and metastasis of breast cancer cells. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-05-02.

A randomized clinical study to assess ingestion of dentifrice by children

This study investigated whether there was a difference in amounts of dentifrice ingested by children based on age using pea-sized instructions. The study had a randomized, single-blinded, 3-period, crossover design modelled after Barnhart et al. (1974) with one regular-flavored and two specially-flavored dentifrices used ad libitum. Subjects were enrolled in three groups: 2-4, 5-7, and 8-12 years. They were instructed to brush at home as they would normally with each dentifrice for 3 weeks (9 weeks total). On weekly study-site visits, subjects brushed with the assigned dentifrice containing a lithium marker to measure the amount of dentifrice ingested and used. Averaging across dentifrices, amounts ingested were: 0.205 g (2-4 yr), 0.125 g (5-7 yr) and 0.135 g (8-12 yr), demonstrating 2-4 year-olds ingested significantly more than older children (p ≤ 0.002). Averaging across dentifrices, amounts used were: 0.524 g (2-4 yr), 0.741 g (5-7 yr) and 0.978 g (8-12 yr) suggesting an age-related effect (p < 0.01). Findings also showed that ingestion amount for specially-flavored dentifrices may increase relative to regular-flavored dentifrice for children 2-7 years-old. This research demonstrated that dentifrice ingestion amount decreased significantly with age while usage amount increased with age. Importantly, ingestion and usage levels in younger children reflect "pea-sized" direction and were numerically lower than historical levels reported prior to this direction.

Hypoxia-inducible factor-1α expression in the different stages of rat thromboangiitis obliterans

We investigated the expression and effects of hypoxia-inducible factor-1α (HIF-1α) in rat thromboangiitis obliterans (TO). Rats were divided into sham and model groups. The model group was further divided into groups based on observation duration. Lauric acid was injected below an artery clamp to simulate TO in the model group; saline was used in the sham group. Clamps were removed 15 min after injection in both groups, and physiological changes were observed at different times (gross observation and hematoxylin and eosin staining). The animals were killed at various times following the operation and serum and muscle tissues were sampled. For the sham group: the endometrium was relatively intact; medial membrane and epineurium lesions were absent; and blood vessels and surrounding tissues had no inflammatory cell infiltration. For the model group: all subgroups displayed inflammation; large numbers of inflammatory cells were gathered; muscle tissue lost its normal texture and structure; and the internal elastic membrane was integrated. Compared with the preoperative status, HIF-1α expression increased significantly in all subgroups (P < 0.05); there was no change in the sham group. HIF-1α expression in each subgroup was different (F = 14.267, P < 0.05). Femoral artery injection of lauric acid can be used as a rat TO model owing to its simple application and success rate. HIF-1α expression increased in the early stage of TO and gradually decreased with the extension of ischemia time; it may play a leading role in TO development and can be used for diagnosis and cure evaluation.

Experimental gingivitis, bacteremia and systemic biomarkers: a randomized clinical trial

BACKGROUND AND OBJECTIVE

Bacteremia and systemic inflammatory markers are associated with periodontal and systemic diseases and may be linking mechanisms between these conditions. We hypothesized that in the development of gingival inflammation, systemic markers of inflammation and bacteremia would increase.

MATERIAL AND METHODS

To study the effect of bacteremia on systemic inflammatory markers, we recruited 80 subjects to participate in an experimental gingivitis study. Subjects were stratified based on gender, smoking and the number of bleeding sites and then randomized to one of two groups: control group (n = 40) or experimental gingivitis group (n = 40). Subjects in the control group conducted an oral hygiene regimen: brushing twice daily with a regular sodium fluoride cavity protection dentifrice and a standard manual toothbrush, flossing twice daily, and mouth rinsing with an anti-cavity fluoride rinse once daily. The experimental group stopped brushing and flossing, and used only the fluoride anti-cavity mouth rinse for 21 d.

RESULTS

Seventy-nine of 80 subjects were evaluable. One subject in the control group was excluded from the results due to antibiotic use during the study. Our data showed the experimental gingivitis group exhibited a significant (p < 0.05) increase in dental plaque level and gingival inflammatory indices relative to baseline and the control group but a decrease in bacteremia and soluble intercellular adhesion molecule-1 levels vs. baseline. Bacteremia was negatively correlated with gingival inflammatory indices and soluble intercellular adhesion molecule-1 levels in the experimental gingivitis group, thus negating our hypothesis.

CONCLUSION

We conclude that there are marked differences in systemic cytokine levels over the course of short-term experimentally induced gingivitis and further conclude that a long-term periodontitis study must be considered to address mechanisms whereby oral diseases may affect systemic diseases.

[Professor HE Tianyou's clinical experience of acupuncture and medicine on intractable facial paralysis]

Professor HE Tianyou's unique understanding and treatment characteristics for intractahle facial paralysis are introduced. In clinical practice professor HE highly values acupoint selection and manipulation application, and integrates Chinese and western medicine to flexibly choose acupoints and formulate prescriptions according to syndrome differentiation and location differentiation, besides, he creates several specialized manipulation methods including "tug-of war opposite acupuncture method" and "tractive flash cupping". Based on strengthening body and dredging collaterals. more attention is given on stimulation to local paralyzed facial nerves; meanwhile acupuncture and medication are combined to improve clinical efficacy. During the treatment, the important role of psychological counseling on patient's anxiety is emphasized, and comprehensive treatment is given physically and psychologically in order to achieve the purpose of total rehabilitation.

Regional variations in the prevalence and misdiagnosis of air flow obstruction in China: baseline results from a prospective cohort of the China Kadoorie Biobank (CKB)

Background

Despite the great burden of chronic respiratory diseases in China, few large multicentre, spirometry-based studies have examined its prevalence, rate of underdiagnosis regionally or the relevance of socioeconomic and lifestyle factors.

Methods

We analysed data from 512 891 adults in the China Kadoorie Biobank, recruited from 10 diverse regions of China during 2004–2008. Air flow obstruction (AFO) was defined by the lower limit of normal criteria based on spirometry-measured lung function. The prevalence of AFO was analysed by region, age, socioeconomic status, body mass index (BMI) and smoking history and compared with the prevalence of self-reported physician-diagnosed chronic bronchitis or emphysema (CB/E) and its symptoms.

Findings

The prevalence of AFO was 7.3% in men (range 2.5–18.2%) and 6.4% in women (1.5–18.5%). Higher prevalence of AFO was associated with older age (p<0.0001), lower income (p<0.0001), poor education (p<0.001), living in rural regions (p<0.001), those who started smoking before the age of 20 years (p<0.001) and low BMI (p<0.001). Compared with self-reported diagnosis of CB/E, 88.8% of AFO was underdiagnosed; underdiagnosis proportion was highest in 30–39-year olds (96.7%) compared with the 70+ age group (81.1%), in women (90.7%), in urban areas (89.4%), in people earning 5K–10 K ¥ monthly (90.3%) and in those with middle or high school education (92.6%).

Interpretation

In China, the burden of AFO based on spirometry was high and significantly greater than that estimated based on self-reported physician-diagnosed CB/E, especially in rural areas, reflecting major issues with diagnosis of AFO that will impact disease treatment and management.

High-resolution chromatin immunoprecipitation (ChIP) sequencing reveals novel binding targets and prognostic role for SOX11 in mantle cell lymphoma

Sex determining region Y-box 11 (SOX11) expression is specific for mantle cell lymphoma (MCL) as compared with other non-Hodgkin's lymphomas. However, the function and direct-binding targets of SOX11 in MCL are largely unknown. We used high-resolution chromatin immunoprecipitation sequencing to identify the direct target genes of SOX11 in a genome-wide, unbiased manner and elucidate its functional significance. Pathway analysis identified WNT, PKA and TGF-beta signaling pathways as significantly enriched by SOX11-target genes. Quantitative chromatin immunoprecipitation sequencing and promoter reporter assays confirmed that SOX11 directly binds to individual genes and modulates their transcription activities in these pathways in MCL. Functional studies using RNA interference demonstrate that SOX11 directly regulates WNT in MCL. We analyzed SOX11 expression in three independent well-annotated tissue microarrays from the University of Wisconsin (UW), Karolinska Institute and British Columbia Cancer Agency. Our findings suggest that high SOX11 expression is associated with improved survival in a subset of MCL patients, particularly those treated with intensive chemotherapy. Transcriptional regulation of WNT and other biological pathways affected by SOX11-target genes may help explain the impact of SOX11 expression on patient outcomes.

Temporal trends of main reproductive characteristics in ten urban and rural regions of China: the China Kadoorie biobank study of 300 000 women

BACKGROUND

Chinese women's reproductive patterns have changed significantly over the past several decades. However, relatively little is known about the pace and characteristics of these changes either overall or by region and socioeconomic status.

METHODS

We examined the cross-sectional data from the China Kadoorie Biobank cohort study that recruited 300 000 women born between 1930 and 1974 (mean age: 51 years) from 10 socially diverse urban and rural regions of China. Temporal trends in several self-reported reproductive characteristics, and effect modification of these trends by area and education (as a surrogate for socioeconomic status), were examined.

RESULTS

The overall mean age at menarche was 15.4 (standard deviation 1.9) years, but decreased steadily over the 45 birth cohorts from 16.1 to 14.3 years, except for an anomalous increase of ∼1 year for women exposed to the 1958-61 famine in early adolescence. Similarly large changes were seen for other characteristics: mean parity fell (urban: 4.9 to 1.1; rural: 5.9 to 1.4); mean age at first birth increased (urban: 19.0 to 25.9 years; rural: 18.3 to 23.8 years); and birth spacing increased after 1980 to over 5 years. Breastfeeding declined after 1950 in urban and, after 1980, in rural women; and 68% of urban and 48% of rural women experienced a terminated pregnancy. Mean age at menopause increased from 47.9 to 49.3 years.

CONCLUSIONS

There have been striking changes in reproductive factors over time and between areas among these Chinese women. Their effects on major chronic diseases should be investigated.

Plasminogen activator urokinase expression reveals TRAIL responsiveness and supports fractional survival of cancer cells

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL/TNFSF10/Apo2L) holds promise for cancer therapy as it induces apoptosis in a large variety of cancer cells while exerting negligible toxicity in normal ones. However, TRAIL can also induce proliferative and migratory signaling in cancer cells resistant to apoptosis induced by this cytokine. In that regard, the molecular mechanisms underlying the tumor selectivity of TRAIL and those balancing apoptosis versus survival remain largely elusive. We show here that high mRNA levels of PLAU, which encodes urokinase plasminogen activator (uPA), are characteristic of cancer cells with functional TRAIL signaling. Notably, decreasing uPA levels sensitized cancer cells to TRAIL, leading to markedly increased apoptosis. Mechanistic analyses revealed three molecular events taking place in uPA-depleted cells: reduced basal ERK1/2 prosurvival signaling, decreased preligand decoy receptor 2 (DcR2)-death receptor 5 (DR5) interaction and attenuated recruitment of DcR2 to the death-inducing signaling complex upon TRAIL challenge. These phenomena were accompanied by increased FADD and procaspase-8 recruitment and processing, thus guiding cells toward a caspase-dependent cell death that is largely independent of the intrinsic apoptosis pathway. Collectively, our results unveil PLAU mRNA levels as marker for the identification of TRAIL-responsive tumor cells and highlight a key role of uPA signaling in ‘apoptosis versus survival' decision-making processes upon TRAIL challenge.