Prognostic significance of apical lymph node metastasis in patients with node-positive rectal cancer

AIM

The aim of this study was to assess the effect of apical lymph node (APN) metastasis in predicting prognosis in curatively treated node-positive rectal cancer. We also investigated the relationship between APN metastasis and the total number of metastatic lymph nodes.

METHOD

A retrospective study was performed of 510 curatively treated patients with node-positive rectal cancer. Clinicopathological variables, including APN status, were assessed in univariate and multivariate analyses. The prognostic significance of APN status in predicting patient outcomes and the relationship between APN status and American Joint Committee on Cancer (AJCC) N stage were analysed.

RESULTS

At a median follow up of 47 months, the 5-year local recurrence (LR) rate, the disease-free survival (DFS) rate and the overall survival (OS) rate were 18.3%, 55.5% and 58.8%, respectively. The 5-year OS rate was 69.6% for patients with no metastasis in APNs (APN(-)) and 40.8% for patients with metastasis in APNs (APN(+)). DFS and OS for patients with undetermined APN status were between those for APN(-) and APN(+). Subgroup analysis gave a 5-year OS rate of 48.7% in Stage N1 patients with APN(+) and 58.8% for Stage N2 patients with APN(-) (P = 0.0004).

CONCLUSION

APN metastasis is an important prognostic factor in node-positive rectal cancer, which provides additional survival-related prognostic classification irrespective of N stage. As the APN is usually outside the radiation field, in the era of multidisciplinary treatment its assessment should be incorporated into prognostic evaluation of rectal cancer.

Isolation and characterisation of Chrysanthemum crassum SOS1, encoding a putative plasma membrane Na(+) /H(+) antiporter

A full-length cDNA homologue of SOS1 (salt overly sensitive 1) was isolated from the salinity-tolerant species Chrysanthemum crassum and found to encode a Na(+) /H(+) antiporter, using degenerate PCR and RACE-PCR. The 3752-bp sequence comprised a 3438 bp open reading frame, encoding a 127-kDa protein with 12 transmembrane domains within its N terminal portion, and a hydrophilic cytoplasmic tail in its C-terminal portion. CcSOS1 appears to be a plasma membrane protein, and shares ∼62% identity at the peptide level with its Arabidopsis thaliana homologue. Expression of CcSOS1 in the roots of C. crassum was sensitive to salinity stress, while in the leaves CcSOS1 was down-regulated in the presence of abscisic acid. CcSOS1 transcript abundance was reduced in both roots and leaves of plants exposed to low temperature, while it was increased in leaves (but not in roots) after drought stress. CcSOS1 expression was not regulated in the presence of CaCl2 . A heterologous complementation assay in yeast suggested that CcSOS1 directs Na(+) efflux, mimicking the function of the endogenous NHA1 protein. Thus CcSOS1 appears to encode a salinity-inducible plasma membrane Na(+) /H(+) antiporter. This gene may be useful in transgenic approaches to improving the salinity tolerance of related ornamental species.

Nucleosomes correlate with in vivo progression pattern of de novo methylation of p16 CpG islands in human gastric carcinogenesis

BACKGROUND

The exact relationship between nucleosome positioning and methylation of CpG islands in human pathogenesis is unknown.

METHODOLOGY/PRINCIPAL FINDINGS

In the present study, we characterized the nucleosome position within the p16 CpG island and established a seeding methylation-specific PCR (sMSP) assay based on bisulfite modification to enrich the p16 alleles containing methylated-CpG at the methylation "seeding" sites within its intron-1 in gastric carcinogenesis. The sMSP-positive rate in primary gastric carcinoma (GC) samples (36/40) was significantly higher than that observed in gastritis (19/45) or normal samples (7/13) (P<0.01). Extensive clone sequencing of these sMSP products showed that the density of methylated-CpGs in p16 CpG islands increased gradually along with the severity of pathological changes in gastric tissues. In gastritis lesions the methylation was frequently observed in the region corresponding to the exon-1 coding-nucleosome and the 5'UTR-nucleosome; the methylation was further extended to the region corresponding to the promoter-nucleosome in GC samples. Only few methylated-CpG sites were randomly detected within p16 CpG islands in normal tissues. The significantly inversed relationship between the p16 exon-1 methylation and its transcription was observed in GC samples. An exact p16 promoter-specific 83 bp-MSP assay confirms the result of sMSP (33/55 vs. 1/6, P<0.01). In addition, p16 methylation in chronic gastritis lesions significantly correlated with H. pylori infection; however, such correlation was not observed in GC specimens.

CONCLUSIONS/SIGNIFICANCE

It was determined that de novo methylation was initiated in the coding region of p16 exon-1 in gastritis, then progressed to its 5'UTR, and ultimately to the proximal promoter in GCs. Nucleosomes may function as the basic extension/progression unit of de novo methylation of p16 CpG islands in vivo.

Life with too much polyprenol: polyprenol reductase deficiency

Congenital disorders of glycosylation (CDG) are caused by a dysfunction of glycosylation, an essential step in the manufacturing process of glycoproteins. This paper focuses on a 6-year-old patient with a new type of CDG-I caused by a defect of the steroid 5α reductase type 3 gene (SRD5A3). The clinical features were psychomotor retardation, pathological nystagmus, slight muscular hypotonia and microcephaly. SRD5A3 was recently identified encoding the polyprenol reductase, an enzyme catalyzing the final step of the biosynthesis of dolichol, which is required for the assembly of the glycans needed for N-glycosylation. Although an early homozygous stop-codon (c.57G>A [W19X]) with no functional protein was found in the patient, about 70% of transferrin (Tf) was correctly glycosylated. Quantification of dolichol and unreduced polyprenol in the patient's fibroblasts demonstrated a high polyprenol/dolichol ratio with normal amounts of dolichol, indicating that high polyprenol levels might compete with dolichol for the initiation of N-glycan assembly but without supporting normal glycosylation and that there must be an alternative pathway for dolichol biosynthesis.

Antimuscarinics for treatment of storage lower urinary tract symptoms in men: a systematic review

Despite potential benefits, primary care clinicians may avoid using antimuscarinics in men with overactive bladder (OAB) symptoms because of safety concerns. To review the efficacy and safety of antimuscarinics, alone or in combination with an α-blocker, for the treatment of men with OAB symptoms, we conducted a systematic review of articles published before 22 July 2010, using PubMed. Data from 12-week, randomised, double-blind, placebo-controlled trials of tolterodine extended release (ER), oxybutynin and solifenacin show that combined antimuscarinic+α-blocker treatment is generally more effective than monotherapy or placebo in men with OAB symptoms. The efficacy and safety of tolterodine ER+α-blocker treatment was not affected by prostate size or prostate-specific antigen (PSA) level. In men meeting entry criteria for OAB and benign prostatic obstruction trials, tolterodine ER alone was effective selectively in men with prostate size or PSA level below study medians. Incidence of acute urinary retention (AUR) in men receiving antimuscarinics with or without an α-blocker was ≤3% in all of these trials; changes in postvoid residual volume and maximum flow rate did not appear clinically meaningful. Post hoc analyses from double-blind, placebo-controlled trials and prospective studies of fesoterodine, oxybutynin, propiverine, solifenacin and tolterodine also suggest that antimuscarinics are generally safe and efficacious in men. A retrospective database study found that risk of AUR in men was the highest in the first month of treatment and decreased considerably thereafter. Antimuscarinics, alone or with an α-blocker, appear to be efficacious and safe in many men with predominant OAB symptoms or persistent OAB symptoms despite α-blocker or 5-α-reductase inhibitor treatment. However, antimuscarinics are not approved for the treatment of benign prostatic hyperplasia. Monitoring men for AUR is recommended, especially those at increased risk, and particularly within 30 days after starting antimuscarinic treatment.

Macrophage migration inhibitory factor promotes central nervous system pathology through local microglial activation and macrophage trafficking (60.3)

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). It is reported that cerebrospinal fluid from MS patients during relapse contains higher levels of MIF than samples collected during remission. While the potent pro-inflammatory properties of MIF are well established, the precise contribution to neuroinflammation is not well defined. We have previously shown that despite their ability to generate pathogenic T cells, MIF-/- mice fail to develop experimental autoimmune encephalomyelitis (EAE), and have reduced CNS pathology. These findings suggest that MIF acts within the CNS to potentiate disease progression. We observed that MIF-treated microglia upregulate inflammatory mediators associated with MS and EAE including IL-1, IL-6, TNF-α, iNOS, and CCL2, and exhibit morphological changes consistent with activation. We extended these findings in vivo, performing stereotactic spinal microinjection of rMIF into naïve mice, which resulted in targeted microglial reactivity and cellular infiltration. To determine the role of MIF in the CNS during EAE, we examined the ability of rMIF spinal microinjection to restore CNS pathology in MIF-/- mice. Notably, rMIF microinjection was sufficient to restore CNS pathology in EAE-resistant MIF-/- mice following induction of EAE. Taken together, these studies implicate MIF as a CNS inflammatory mediator that may contribute to the development and maintenance of MS lesions.

Polycomb CBX7 directly controls trimethylation of histone H3 at lysine 9 at the p16 locus

BACKGROUND

H3K9 trimethylation (H3K9me3) and binding of PcG repressor complex-1 (PRC1) may play crucial roles in the epigenetic silencing of the p16 gene. However, the mechanism of the initiation of this trimethylation is unknown.

METHODOLOGY/PRINCIPAL FINDINGS

In the present study, we found that upregulating the expression of PRC1 component Cbx7 in gastric cancer cell lines MGC803 and BGC823 led to significantly suppress the expression of genes within the p16-Arf-p15 locus. H3K9me3 formation was observed at the p16 promoter and Regulatory Domain (RD). CBX7 and SUV39H2 binding to these regions were also detectable in the CBX7-stably upregulated cells. CBX7-SUV39H2 complexes were observed within nucleus in bimolecular fluorescence complementation assay (BiFC). Mutations of the chromodomain or deletion of Pc-box abolished the CBX7-binding and H3K9me3 formation, and thus partially repressed the function of CBX7. SiRNA-knockdown of Suv39h2 blocked the repressive effect of CBX7 on p16 transcription. Moreover, we found that expression of CBX7 in gastric carcinoma tissues with p16 methylation was significantly lower than that in their corresponding normal tissues, which showed a negative correlation with transcription of p16 in gastric mucosa.

CONCLUSION/SIGNIFICANCE

These results demonstrated for the first time, to our knowledge, that CBX7 could initiate H3K9me3 formation at the p16 promoter.

Investigation of Nanocrystalline Materials Using Radioactive Isotopes

The potential of detecting the hyperfine interaction at the nuclear site of radioactive isotopes for the investigation of nanocrystalline (nc) materials is discussed. The subject is illustrated with help of different examples for characterizing nc samples. Using the perturbed γ γ angular correlation technique (PAC) for detecting the hyperfine interaction at the site of the radioactive probe 111In/111Cd experiments regarding the doping of nc semiconductors ZnO and InP, the shift of the Néel temperature in nc antiferromagnetic NiO, the structure of grain boundaries in Ni, and the homogeneity of nc Ni-Cu alloys are presented. The resulting information is compared with that obtained by Mössbauer spectroscopy and by standard techniques used in materials science.

Effects of flexible-dose fesoterodine on overactive bladder symptoms and treatment satisfaction: an open-label study

AIMS

To evaluate the efficacy and tolerability of flexible-dose fesoterodine in subjects with overactive bladder (OAB) who were dissatisfied with previous tolterodine treatment.

METHODS

This was a 12-week, open-label, flexible-dose study of adults with OAB (> or = 8 micturitions and > or = 3 urgency episodes per 24 h) who had been treated with tolterodine (immediate- or extended-release) for OAB within 2 years of screening and reported dissatisfaction with tolterodine treatment. Subjects received fesoterodine 4 mg once daily for 4 weeks; thereafter, daily dosage was maintained at 4 mg or increased to 8 mg based on the subject's and physician's subjective assessment of efficacy and tolerability. Subjects completed 5-day diaries, the Patient Perception of Bladder Condition (PPBC) and the Overactive Bladder Questionnaire (OAB-q) at baseline and week 12 and rated treatment satisfaction at week 12 using the Treatment Satisfaction Question (TSQ). Safety and tolerability were assessed.

RESULTS

Among 516 subjects treated, approximately 50% opted for dose escalation to 8 mg at week 4. Significant improvements from baseline to week 12 were observed in micturitions, urgency urinary incontinence episodes, micturition-related urgency episodes and severe micturition-related urgency episodes per 24 h (all p < 0.0001). Approximately 80% of subjects who responded to the TSQ at week 12 reported satisfaction with treatment; 38% reported being very satisfied. Using the PPBC, 83% of subjects reported improvement at week 12 with 59% reporting improvement > or = 2 points. Significant improvements from baseline (p < 0.0001) exceeding the minimally important difference (10 points) were observed in OAB-q Symptom Bother and Health-Related Quality of Life (HRQL) scales and all four HRQL domains. Dry mouth (23%) and constipation (5%) were the most common adverse events; no safety issues were identified.

CONCLUSION

Flexible-dose fesoterodine significantly improved OAB symptoms, HRQL, and rates of treatment satisfaction and was well tolerated in subjects with OAB who were dissatisfied with prior tolterodine therapy.

Randomized, double-blinded trial evaluation of valsartan/hydrochlorothiazide combination therapy in mild to moderate essential hypertension in north-east China

In this randomized, double-blind study, 126 mild to moderate essential hypertensive patients from northern China were studied to determine the efficacy and safety of a combination therapy of valsartan and hydrochlorothiazide. Patients were randomized to the V80/H12.5 (80 mg valsartan/12.5 mg hydrochlorothiazide) group or the V80 (80 mg valsartan) group. Six weeks after treatment, the mean decrease from baseline in mean sitting systolic blood pressure (MSSBP) was significantly higher in the V80/H12.5 group than the V80 group, but there was no difference in the change of mean sitting diastolic blood pressure (MSDBP) in the two groups. Overall, 80.33% and 70.97% had a controlled response (normalized MSDBP), and 85.25% and 77.42% had a diastolic response (normalized MSDBP or > 10 mmHg reduction in MSDBP) in the V80/H12.5 and V80 groups, respectively (not significantly different). The incidence of adverse events was also similar between the two groups. The combination of 80 mg valsartan/12.5 mg hydrochlorothiazide was efficacious and well tolerated in mild and moderate essential hypertensive patients.

Effect of tolterodine on gastrointestinal transit and bowel habits in healthy subjects

Clinical trials and observations suggest that constipation is an uncommon side effect of treating overactive bladder with the muscarinic receptor antagonist tolterodine. Because muscarinic antagonism inhibits gastrointestinal motor activity, we evaluated the effects of tolterodine on bowel habits, gastrointestinal and colonic transit in healthy subjects. In this double-blind study, 36 healthy subjects were randomized to tolterodine extended release (ER, 4 mg daily) or placebo for 6 days. Gastric emptying (GE), small bowel and colonic transit were assessed on days 4-6 by scintigraphy. Bowel habits were recorded by diaries. Tolterodine did not significantly affect half-time for GE (GE t(half)) [116 +/- 6 min (mean +/- SEM) for placebo vs 126 +/- 7 min for tolterodine], small bowel transit measured by colonic filling at 6 h (45 +/- 6% for placebo vs 36 +/- 6% for tolterodine) or the geometric center of colonic transit at 24 h (2.9 +/- 0.2 for placebo vs 2.6 +/- 0.3 for tolterodine). Subjects who received tolterodine had slightly fewer bowel movements (i.e. 1.34 +/- 0.1 stools per day for placebo vs 1.0 +/- 0.1 for tolterodine; P = 0.02 for treatment effect). Tolterodine did not significantly affect stool consistency or ease of defecation. At the therapeutic dose used to treat overactive bladder, tolterodine did not significantly affect gastrointestinal or colonic transit and had minor effects on bowel habits in healthy subjects. Further studies are necessary to elucidate whether these observations are explained by tolterodine effects at muscarinic receptors which stimulate and inhibit gastrointestinal motility.

CDIO and the Liverpool Constructionarium

The Constructionarium initiative can be classified as the implement section of the conceive, design, implement, operate (CDIO) innovative educational framework for civil engineering students. CDIO is an international learning and teaching initiative which is based on the principle of embedding active learning into engineering education at all levels. The Constructionarium provides a practical construction experience for various civil engineering structures such as a gravity concrete oil rig, a cable-stayed steel bridge, a transmission tower, a subway entrance hall and a clay core dam, all at a reduced scale. Students are required to follow the same professional and health and safety procedures that a construction contractor follows on a real construction project. A collaborating construction contractor and a design consultant offer close supervision, support and guidance for all site activities, typically covering preparation of method statements, risk assessments, construction planning, costing, setting-out, use of construction tools, and so on. The Constructionarium is a concentrated learning week for students for which there is no other equivalent replacement activity. In this paper, the Liverpool Constructionarium is presented in detail, including pre-Constructionarium preparation, learning objectives, running projects, associated problems and learning outcomes. In addition the results from pre- and post-Constructionarium questionnaires are presented to show measurement of learning outcomes from student feedback.