The association of HMGB1 gene with the prognosis of HCC

High-mobility group box 1 protein (HMGB1) is an evolutionarily ancient and critical regulator of cell death and survival. HMGB1 is a chromatin-associated nuclear protein molecule that triggers extracellular damage. The expression of HMGB1 has been reported in many types of cancers, but the role of HMGB1 in hepato cellular carcinoma (HCC) is unknown.The aim of this study was to analyze the roles of HMGB1 in HCC progression using HCC clinical samples. We also investigated the clinical outcomes of HCC samples with a special focus on HMBG1 expression. In an immunohistochemical study conducted on 208 cases of HCC, HMGB1 had high expression in 134 cases(64.4%).The HMGB1 expression level did not correlate with any clinicopathological parameters, except alpha fetoprotein (AFP) (p = 0.041) and CLIP stage (p = 0.007). However, survival analysis showed that the group with HMBG1 overexpression had a significantly shorter overall survival time than the group with a down-regulatedexpression of HMBG1 (HR = 0.568, CI (0.398, 0.811), p = 0.002). Multivariate analysis showed that HMGB1 expression was a significant and independent prognostic parameter (HR = 0.562, CI (0.388, 0.815), p = 0.002) for HCC patients. The ability of proliferation, migration and invasion of HCC cells was suppressed with the disruption of endogenous HMGB1 using small interfering RNAs. On the other hand, the ability of proliferation, migration and invasion of HCC cells was strengthened when the expression endogenous HMGB1 was enhanced using HMGB1 DNA. HMGB1 expression may be a novel and independent predictor for the prognosis of HCC patients. The overexpression of HMGB1 in HCC could be a novel, effective, and supplementary biomarker for HCC, since it plays a vital role in the progression of HCC.

Investigation of clinical diagnosis and liver biopsy diagnosis in cases of patients with chronic HBV infection

The aim of this study was to investigate the pathomorphological changes of chronic hepatitis B virus (HBV) infection and the coincidence between clinical and pathological diagnosis. Hematoxylin and eosin staining and immunohistochemistry for HBsAg and HBcAg were performed on 97 liver biopsy specimens collected from 97 patients with chronic HBV infection, including 55 HBV carriers. The agreement between clinical diagnosis and pathological diagnosis in mild, moderate and severe chronic hepatitis was 71.4, 60 and 83.3%. The rate of clinical diagnosis matching the pathological diagnosis for fibrosis was higher than for inflammation (83.33 vs 54.76%), especially in moderate (83.33 vs 26.67%) and severe chronic hepatitis (66.67 vs 16.67%). The rate of serological/imaging examination results and immunohistochemistry confirmation was as high as 93.81% for HBsAg and 92.78% for HBcAg. In HBV carriers, the degree of inflammation and fibrosis in most cases was mild, and the younger the patients, the higher the ratios of G0 and S0. The clinical diagnosis was correct in most cases, especially for inflammation and in mild chronic hepatitis; the patients who were diagnosed as HBV carriers actually already had inflammation and fibrosis.

MiR-141 suppresses the migration and invasion of HCC cells by targeting Tiam1

Background

We have demonstrated that T lymphoma invasion and metastasis 1 (Tiam1) gene is associated with the poor prognosis of patients with hepatocellular carcinoma (HCC), and we used a computational approach to identify miR-141 as a Tiam1-targeting microRNA (miRNA). Here, we explored the function of miR-141 and the relationship between miR-141 and Tiam1 gene in HCC.

Methods

The miR-141 expression in HCC tissues and cell lines was detected and its roles in regulation of HCC cell proliferation, migration and invasion and target gene expression was investigated. Tiam1 was identified as a novel target of miR-141. Ethics statement: our study was approved by the Nanfang Hospital Medical Ethics Committee Ethics statement. Written informed consent was obtained before collection.

Results

Based on in situ hybridization (ISH) analysis, miR-141 was down-regulated in the same HCC samples. Kaplan-Meier analysis demonstrated that patients with low miR-141 expression had poorer overall survival rate than that of the patients with high miR-141 expression. Furthermore, multivariate Cox regression analysis indicated that miR-141 could serve as an independent prognostic factor in HCC. MiR-141 significantly inhibited in vitro cell proliferation, migration and invasion as proved by gain- and loss- of function studies, while the mRNA and protein levels of Tiam1 were reduced in cells over-expressing miR-141. Moreover, Tiam1 treatment antagonized this effect, while knockdown of Tiam1 by Tiam1 short hairpin RNA (shTiam1) induced inhibitory effects.

Conclusions

These findings indicated that miR-141 functions as a tumor suppressor and inhibits the migration and invasion of HCC cells by targeting Tiam1, which may provide novel prognostic and treatment strategies for HCC patients.

Retrograde Light-guided Laryngoscopy for Tracheal Intubation

Background:

Tracheal intubation with conventional laryngoscopy requires many trials until beginners are sufficiently skilled in intubating patients safely. To facilitate intubation, the authors used retrograde light-guided laryngoscopy (RLGL) and compared its feasibility with conventional direct laryngoscopy (DL).

Methods:

Twenty operators participated in a prospective, randomized, open-label, parallel-arm study. These operators intubated 205 patients randomly according to a computer-generated procedure by using either DL or RLGL (five intubations with each technique). The primary outcome was the success rate of tracheal intubation. The authors evaluated the success rate of tracheal intubation, the time to glottic exposure and tracheal intubation, and the Cormack and Lehane grades.

Results:

Compared with DL, the success rate was greater in the RLGL group for all five intubations (72% vs. 47%; rate difference, 25%; 95% CI [11.84–38.16%], P < 0.001). This was associated with a shorter time to glottic exposure (median [25th and 75th percentile]; 27 [15; 42] vs. 45 [30; 73] s, P < 0.001), shorter intubation time (66 [44; 120] vs. 120 [69; 120] s, P < 0.001), and decreased throat soreness (mean ± SD; visual analog scale, 2.1 ± 0.9 vs. 3.7 ± 1.0 cm, P = 0.001) in the RLGL group compared to the DL group.

Conclusion:

RLGL is an alternative intubation technique. In our study, it enables beginners to intubate patients more successfully and quickly than conventional DL.

Inhibition of activin receptor-like kinase 5 induces matrix metallopeptidase 9 expression and aggravates lipopolysaccharide-induced pulmonary injury in mice

BACKGROUND

TGF-β (Transforming Growth Factor-β) mediates its biological effects through members of activin receptor-like kinase (ALK) family and TGF-β/Smad3 signaling link inflammation to pulmonary fibrosis.

AIM

The aim of this study was to evaluate the role of SB431542 as a specific inhibitor of Activin receptor-Like Kinase 5 (ALK5) in pneumonic injury.

MATERIALS AND METHODS

Anesthetized and endo-tracheally intubated C57BL/6 mice were randomized to three groups: the control group with intra-tracheal instillation of 1.5 mg/kg normal saline (NS); LPS stimulation group with intra-tracheal instillation of 3 mg/kg LPS (lipopolysaccharide); and LPS+SB431542 group with intra-peritoneal (i.p.) injection of 4.2 mg/kg SB431542 1 h before intra-tracheal instillation of 3 mg/kg LPS. The lung tissue was obtained 6 h after injury, and the degree of pulmonary injury was evaluated by pathologic scoring. The lung wet/dry weight ratio was measured. TNF-α, IL-1β, and MMP-9 (matrix metallopeptidase-9) mRNA expression levels were assayed by real time PCR (polymerase chain reaction). The content of MMP-9 total protein was measured by Western blotting. The content of active MMP-9 was detected by gelatin zymography. Location of MMP-9 in mouse lung tissue was monitored by immunohistochemistry.

RESULTS

The results showed that (1) pathologic changes including interstitial pulmonary edema, neutrophil infiltration, alveolar edema and hemorrhage were observed 6 h after LPS instillation. The lung wet/dry weight rate and pathologic scores confirmed that SB431542 administration aggravated LPS injury to the mouse lung; (2) the amount of TNF-α and IL-1β mRNA expression in LPS groups was significantly higher than that in the control group, and the highest in LPS+SB431542 group; (3) the amount of MMP-9 mRNA and MMP-9 protein expression and active MMP-9 in the lung tissue of LPS groups was significantly higher than that in the control group 6 h after injury, and the highest in LPS+SB431542 group; and (4) MMP-9 expression was mainly observed in the airway epithelial cells, vascular smooth muscle cells and cytoplasm of inflammatory cells as shown by immunohistochemistry, and brownish yellow uniformed stained areas were also seen in the exudate from part of the alveoli.

CONCLUSIONS

These results indicate that blocking the activity of TGF-β/Smad pathway by specific inhibitor SB431542 of ALK5 promoted the releaser of large amounts of TNF-α, IL-1β and other pro-inflammatory cytokines from the lung tissue of mice sustaining acute lung injury (ALI). At the same time, the amount and activity of MMP-9 expression in the lung were increased, and MMP-9 expression was mainly located in the airway epithelial cells, vascular smooth muscle cells and inflammatory cells, causing increased permeability of the pulmonary blood vessels, degradation of the extracellular matrix and destruction of the normal lung tissue structures, which directly or indirectly promotes the progression of pulmonary inflammatory responses and aggravates ALI.

Clinical features of Chinese patients with Huntington's disease carrying CAG repeats beyond 60 within HTT gene

Patients with Huntington's disease (HD) carrying CAG repeats beyond 60 are less frequently seen and clinical features of them have been rarely reported. We identified four unrelated patients carrying CAG repeats beyond 60 (84.0 ± 13.76, ranging from 74 to 104) from 119 Chinese HD patients via direct sequencing. These four were all early onset with a mean age at presenting symptom of 9.8 ± 1.71 years. Paternal transmission was found in three of them and the fourth was apparently sporadic. In addition, they had atypical onset symptoms including epilepsy, intellectual decline, tics and walking instability, which might lead the clinicians to make the wrong diagnosis in the early stage of disease. Our work explores clinical features of Chinese HD patients with an expanded CAG repeat over 60 and may help the clinicians make a correct diagnosis in the early stage of disease.

Chinese patients with Huntington's disease initially presenting with spinocerebellar ataxia

Recent studies have described Huntington's disease (HD) patients with atypical onset of ataxia. Symptoms in these patients can overlap with those of spinocerebellar ataxia (SCA). We retrospectively examined clinical data for 82 HD probands and found 7 had initially been clinically diagnosed as SCA cases. Clinical features in these patients were further investigated and the number of CAG repeats in the huntingtin (HTT) gene was determined by direct sequencing. Genetic screenings for SCAs in the 7 patients were all negative. By contrast, HTT was heterozygous in each patient. The distribution of CAG number in the 7 patients was statistically the same as that in the other 75 patients. Each of 7 HD patients had presented with atypical onset of ataxia. The mean time from onset to HTT genetic testing was 5.6 ± 5.52 years. Three of the patients developed chorea, but the others did not. Our observations confirm the clinical heterogeneity of HD in Han Chinese. Based on these findings, testing for HTT expansions should be considered for clinically diagnosed SCA patients who test negatively in genetic screening of SCA genes.

Effects of propofol on P2X7 receptors and the secretion of tumor necrosis factor-α in cultured astrocytes

Upon CNS injury, adenosine-5'-triphosphate is released and acts on P2X7 receptors, which might influence many cytokines secretion from glial cells and, in turn, affects the survival of neurons. Propofol, an intravenous anesthetic, has been shown to provide neuroprotective effect. However, the effect of propofol on astrocyte-associated processes remains to be clarified. In this study, we investigated the effects of propofol on P2X7 activity in astrocytes and tumor necrosis factor-α (TNF-α) secretion from these cells and thereby to infer the possible role(s) of glial P2X7 receptors in propofol neural protective effects. Whole-cell patch clamp results showed that in clinically relevant concentrations (3.3, 10 or 33 μM), propofol increased the P2X7 current amplitudes significantly and propofol in 10 μM extended the inactivation times of P2X7 receptors. Enzyme-linked immunosorbent assay showed that propofol increased the secretion of TNF-α from astrocytes in high concentration (300 μM), while inhibited in clinically relevant concentration (10 μM). Both of these effects were not influenced by Brilliant blue G. These results suggest that in clinically relevant concentrations, propofol increases the activity of P2X7 receptors in activated astrocytes, but this does not contribute to the downregulation of the secretion of TNF-α.

[A new technique for esophagojejunostomy or esophagogastrostomy after laparoscopic gastrectomy]

OBJECTIVE

To report the newly developed reconstruction technique after laparoscopic total gastrectomy: intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil; Covidien), and evaluate its feasibility, safety, and clinical outcomes.

METHODS

After LTG (3 patients with gastric carcinoma in the body) or LPG (2 patients with gastric carcinoma in the cardiac and fundus, respectively, and 1 with cardiac stromal tumor), the anvil was then inserted transorally into the esophagus by using the OrVil system. Double-stapling esophagojejunostomy or esophagogastrostomy with a circular stapler was performed intracorporeally.

RESULTS

The operations were uneventful. The operative time was (183.3+/-25.8) min, and blood loss was (128.3+/-90.2) ml. Postoperative fluorography revealed no anastomotic leakage or stenosis. Patients resumed an oral liquid diet on postoperative day (4.0+/-1.1), and were discharged on day (9.0+/-2.6). Patients were followed at 28 days and no complications were reported.

CONCLUSIONS

LTG with Roux-en-Y reconstruction or LPG with esophagogastrostomy using the OrVil system appear to be safe and reliable with satisfactory short-term outcomes.

Inhibition of autophagy induced by overexpression of mda-7/interleukin-24 strongly augments the antileukemia activity in vitro and in vivo

Melanoma differentiation-associated gene-7/interleukin-24 (mda-7/IL-24) is a novel candidate of tumor suppressor that can selectively induce apoptosis experimentally in a spectrum of human cancer cells including leukemia cells. However, a recent study suggests that mda-7/IL-24 promotes the survival of chronic lymphocytic leukemia B-cells. In this study, we showed that mda-7/IL-24 was constitutively expressed in leukemia cell lines and primary acute myeloid leukemia samples. Using a conditionally replicating adenovirus expressing mda-7/IL-24 (ZD55-IL-24), we showed that enforced expression of mda-7/IL-24 in leukemia cells induced autophagy, which was triggered by the upregulation of Beclin-1. Immunofluorescence and coimmunoprecipitation studies suggested that mda-7/IL-24 protein interacts with Beclin-1. Class III PI3K/Beclin-1 complex was shown involved in the mda-7/IL-24-induced autophagy. Moreover, autophagy inhibition by phosphatidylinositol 3-kinase inhibitor, wortmannin, resulted in a reduced Beclin-1 expression and autophagosome formation associated with significantly enhanced cell death. Importantly, the combination of ZD55-IL-24 with wortmannin elicited a strongly enhanced antileukemia efficacy in established leukemia xenografts. These results suggest that mda-7/IL-24-induced autophagy in leukemia cells may provide survival advantage and mda-7/IL-24 combined with agents that disrupt autophagy is a promising new strategy for the treatment of leukemia.

The existence of a local 5-hydroxytryptaminergic system in peripheral arteries

BACKGROUND AND PURPOSE

5-HT is a vasoconstrictor exhibiting enhanced effects in systemic arteries from subjects with cardiovascular disease. The effect of endogenous 5-HT on arteries is controversial, because the concentration of free circulating 5-HT is low and a 5-hydroxytryptaminergic system has not been identified in peripheral arteries. We hypothesized that a local 5-hydroxytryptaminergic system (including 5-HT synthesis, metabolism, uptake and release) with physiological function exists in peripheral arteries.

EXPERIMENTAL APPROACH

The presence of key components of a 5-hydroxytryptaminergic system in rat aorta and superior mesenteric artery was examined using western blot analyses, immunohistochemistry and immunocytochemistry. The function of the rate-limiting enzyme in 5-HT biosynthesis, tryptophan hydroxylase (TPH), and 5-HT transporter was tested by measuring enzyme activity and 5-HT uptake, respectively. Isometric contraction of arterial strips was used to demonstrate the function of released endogenous 5-HT in arterial tissues.

KEY RESULTS

mRNA for TPH-1 was present in arteries, with low levels of TPH protein and TPH activity. Expression and function of MAO A (5-HT metabolizing enzyme) was supported by immunohistochemistry, western analyses and the elevation of concentrations of 5-hydroxyindoleacetic acid (5-HT metabolite) after exposure to exogenous 5-HT. The 5-HT transporter was localized to the plasma membrane of freshly isolated aortic smooth muscle cells. Peripheral arteries actively took up 5-HT in a time-dependent and 5-HT transporter-dependent manner. The 5-HT transporter substrate, (+)-fenfluramine, released endogenous 5-HT from peripheral arteries, which potentiated noradrenaline-induced arterial contraction.

CONCLUSIONS AND IMPLICATIONS

This study revealed the existence of a local 5-hydroxytryptaminergic system in peripheral arteries.

Steroidal saponins from Tacca plantaginea

Two new steroidal saponins, taccaoside C (1) and taccaoside D (3), along with one known saponin (2) have been isolated from the methanol extracts of Tacca plantaginea. Their structures have been elucidated by spectroscopic and chemical methods.

Improvement of phenylethanoid glycosides biosynthesis in Cistanche deserticola cell suspension cultures by chitosan elicitor

Effect of chitosan elicitor on growth and phenylethanoid glycosides (PeGs) accumulation in Cistanche deserticola cell suspension cultures was investigated. PeGs accumulation was dramatically improved by addition of selected chitosan at optimal elicitation conditions. Furthermore, a strategy of repeated addition of the chitosan elicitor for enhancing PeGs accumulation was developed. The chitosan elicitor of 10 mg l(-1)-medium repeatedly added on days 15 and 17 improved PeGs accumulation further, and the final PeGs production in the treated cell cultures of C. deserticola reached 364.6 mg l(-1), which was 3.4-fold higher than that of the control without elicitation. The increase of PeGs accumulation in C. deserticola cell suspension cultures was related to the increase of phenylalanine ammonium lyase activity stimulated by the chitosan elicitor.

Influence of Intravenous Drug Abuse on Vascular Access Placement and Survival in HIV-Seropositive Patients

BACKGROUND

The influence of intravenous drug abuse (IVDA) on hemodialysis access placement practices and access survival in HIV-infected patients is unknown.

METHODS

We conducted a retrospective study of 60, HIV seropositive, maintenance hemodialysis patients. Type of access and assisted access survival (measured from date of placement) were compared in those with (77%) and without (23%) a history of IVDA.

RESULTS

Mean age was 37.8 years, mean baseline serum albumin was 2.9 g/dl and median CD4 count was 222 cells/mm3. Fifteen patients, all IVDA, were dialyzed using only tunneled catheters (median number of catheters per person (range): 2.5 (1-11)). There were longer delays in creation of a permanent access (p = 0.08), but no difference in the type of permanent access placed in IVDA versus the non-IVDA group. Over 1,051 cumulative months of access follow-up, 134 tunneled catheters, 28 grafts and 19 fistulae were placed, with observed failure rates of 1 per 4.7 access-months, 1 per 19.7 access-months, 1 per 38.2 access-months, respectively. The adjusted relative hazard of access failure for grafts versus catheters was 0.41 (95% CI: 0.23, 0.72; p = 0.002) and for fistulae versus catheters was 0.21 (95% CI: 0.08, 0.52; p = 0.001). Thirty-two percent of accesses were removed due to infection, an infection removal rate for catheters of 1 per 7.8 access-months and for grafts of 1 per 62.5 access-months; all graft infections occurred in the IVDA group. No fistula was removed due to infection.

CONCLUSION

Fistulae are the first line of choice for hemodialysis access in HIV-seropositive patients regardless of IVDA history; if not feasible, graft placement in non-IVDA or abstinent IVDA patients is recommended. In those with active IVDA, the optimal method of renal replacement therapy and type of hemodialysis access remain uncertain.

The diagnosis value and its implication of impulse oscillometry in obstructive sleep apnea syndrome patients

The change of measurements of impulse oscillometry (IOS) in obstructive sleep apnea syndrome (OSAS) patients and its mechanism were observed. The respiratory impedance was measured by using IOS technique and polysomnography (PSG) was monitored synchronously in 36 OSAS patients, 14 patients with chronic obstructive pulmonary disease (COPD) and 12 normal controls. Results showed that R20 in OSAS group was significantly higher than in COPD group and control group (P < 0.01). R5-R20 in OSAS group was lower than that in COPD group, but significantly higher than that in control group (P < 0.01). The levels of R20 and R5-R20 were positively correlated with severity degree of the disease. In addition, apnea-hyponea index (AHI) was positively correlated with R5 and R20 with the correlation index (r)being 0.66 and 0.86 respectively. The lowest SO2 was negatively correlated with R5 and R5-R20, with r being -0.66 and -0.79 respectively. The mean SO2 was negatively correlated with R5 and R5-R20 with r being -0.81 and -0.69 respectively. IOS technique could be used as a valuable tool for assessing the degree of upper airway obstruction in the patients with OSAS, and could help to explore its pathological mechanism.

Effects of theophylline on plasma levels of interleukin-4, cyclic nucleotides and pulmonary functions in patients with chronic obstructive pulmonary disease

In order to measure the plasma levels of interleukin-4 (IL-4), cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) in patients with chronic obstructive pulmonary disease (COPD) and observe the effects of oral theophylline on them, we divided 28 COPD patients into COPD experimental group and COPD control group. Plasma levels of IL-4, cAMP and cGMP as well as parameters of pulmonary function tests were measured in these 2 groups before and after 2 weeks of treatment with oral theophylline (Protheo, 400 mg, qd) or placebo. Plasma levels of IL-4 and cGMP were significantly elevated in patients with COPD as compared with normal controls (P < 0.05), while cAMP and cAMP/cGMP were significantly lower than those in controls (P < 0.01). Plasma level of IL-4 was inversely correlated with forced expiratory volume at the first second (FEV1) and with maximum expiratory flow rate at 50% of forced vital capacity (V50) (both r = -0.46, P < 0.05) while it was directly correlated with the scores of the clinical manifestations (r = 0.57, P < 0.05) in COPD patients. Two weeks after treatment with theophylline, IL-4 and cGMP in COPD experimental group were decreased significantly while cAMP and cAMP/cGMP increased significantly (P < 0.05). The change of IL-4 was inversely correlated with the changes of FEV1 and V50 (r = -0.53 and -0.54, respectively, P < 0.05). Two weeks after placebo treatment, the COPD control group did not show such changes. We are led to conclude that IL-4 might play a role in the pathogenesis of the airway inflammation and air flow limitation in COPD patients and the mechanisms of theophylline's therapeutic effects of attenuating air-flow limitation may partially depend on its anti-inflammatory effects on the airways which, in turn, is dependent on its inhibitory effects on some inflammatory mediators such as IL-4.