Foresight Infectious Diseases China Project--a novel approach to anticipating future trends in risk of infectious diseases in China: methodology and results from an initial application

The project devised a simple but novel methodology for identifying possible future trends in infectious diseases in animals and humans in China, of priority concern to the Chinese authorities. It used a model of disease drivers (social, economic, biological or environmental factors that affect disease outcomes, by changing the behaviour of diseases, sources or pathways) devised for the Foresight Programme in the United Kingdom. Nine families of drivers were adapted to Chinese circumstances and matrices were constructed to identify the likely relationship of single infectious diseases or families of diseases to the drivers. The likely future trends in those drivers in China were determined by interviews with 36 independent Chinese experts. These trends included not only potentially adverse animal and human movements but also opportunities for innovative surveillance methods, more use of hospitals, antimicrobials and vaccines. Some human behaviours and social trends were expected to increase the risk of infections (in particular sexually transmitted and healthcare-associated infections) while at the same time the experts thought the awareness of risk in the Chinese population would increase. The results suggested a number of areas where the Chinese authorities may experience difficulties in the future, such as rising numbers of healthcare-associated infections, zoonoses and other emerging diseases and sexually transmitted infections (including HIV). Not making firm predictions, this work identifies priority disease groups requiring surveillance and consideration of countermeasures as well as recommending strengthening basic surveillance and response mechanisms for unanticipatable zoonoses and other emerging disease threats.

Iron oxide nanoparticle platform for biomedical applications

Progress in nanosynthesis has succeeded in making nanoscale particles from iron oxide under precise quality control. Given the recent great advances in polymer manufacturing, antibody purification, DNA/RNA synthesis and magnetic resonance imaging (MRI), such iron oxide nanoparticles (IONPs) have been enriched with many variables and attracted great interest in studying their potential biomedical applications. After nearly two decades' effort, IONPs have become a powerful platform in many diverse aspects of biomedicine, including MRI, gene and drug delivery, and hyperthermia. While some studies are still at the proof-of-concept stage, others have now been widely used in clinics. With the on-going efforts to enhance their targeting ability and endow more functions, IONPs' future applications are highly expected.

A comparison of the role of two blue-green algae in THM and HAA formation

The contribution of two blue-green algae species, Anabaena flos-aquae and Microcystis aeruginosa, to the formation of trihalomethanes (THMs) and haloacetic acids (HAAs) was investigated. The experiments examined the formation potential of these disinfection by-products (DBPs) from both algae cells and extracellular organic matter (EOM) during four algal growth phases. Algal cells and EOM of Anabaena and Microcystis exhibited a high potential for DBP formation. Yields of total THMs (TTHM) and total HAAs (THAA) were closely related to the growth phase. Reactivity of EOM from Anabaena was slightly higher than corresponding cells, while the opposite result was found for Microcystis. Specific DBP yields (yield/unit C) of Anabaena were in the range of 2-11micromol/mmol C for TTHM and 2-17micromol/mmol C for THAA, while those of Microcystis were slightly higher. With regard to the distributions of individual THM and HAA compounds, differences were observed between the algae species and also between cells and EOM. The presence of bromide shifted the dominant compounds from HAAs to THMs.

Prognostic value of different B symptoms in upper aerodigestive tract NK/T-cell lymphoma

e19544

Background: Extranodal NK/T-cell lymphoma (ENKL) is a rare disease originated from NK or toxic T cells. ENKL arising from the upper aerodigestive tract (UNKTL) is a newly recognized subtype and commonly presents with B symptoms. This study is to investigate the prognostic value of different B symptoms in UNKTL. Methods: UNKTL cases with detailed clinical, pathological and prognostic data in our center since 2001 to 2007 were retrospectively analyzed with the major study endpoint of overall survival (OS). Central pathological review was performed. Survival curves were estimated by Kaplan-Meier method and tested by Log Rank method. Statistically significant factors in univariate analysis were then included in multivariate analysis. B symptoms were defined as fever, night sweat and weight loss according to the Ann Arbor Cotswolds meeting. The predictive values of survival for each type of B symptoms were studied independently. Results: 172 cases of UNKTL with a median follow-up duration of 27.4 months were included. 45 ladies and 127 gentlemen had a median age of 43 years. 98 cases were Ann Arbor stage I, 54 were stage II and the remaining 20 cases were stage III or IV. About half of the patients present B symptoms: 82 had fever, 5 had night sweat and 6 present weight loss. Totally 18 patients had ECOG PS larger than 1. The 5-year OS rate of the whole group is 41.8%. Patients with persistent fever before treatment indicated a poor outcome in the univariate analysis (p=.033) and its prognostic value was also confirmed by the Cox regression (p=.030) whereas those of night sweat and weight loss were not (p= .960 and .824 respectively). Conclusions: B symptoms were common in UNKTL patients. Our data suggested that only fever among the three types of B symptoms was independent prognostic factor for UNKTL but it still needs further confirmation.

No significant financial relationships to disclose.

Safety of bevacizumab in patients with metastases to the central nervous system

2007

Background:. The background rate of CNS hemorrhage (CH) in cancer patients with brain metastases not receiving bevacizumab (BV) treatment is 5%-29%, depending on tumor type. Patients with CNS metastases were routinely excluded from most BV late-stage clinical trials, following the occurrence of CH in one hepatocellular carcinoma patient with occult CNS metastasis in a BV phase I trial. In this particular tumour type, up to 87.5% has been reported as a background rate of CH without BV use. Available safety information in BV-treated patients with CNS metastases has been reviewed to determine whether the exclusion of these patients from trials is still justified. Methods: A retrospective exploratory analysis was conducted using safety data from three datasets: A.) 13 randomized controlled phase II or III trials (RCTs); B.) Two ongoing open-label trials MO19391 (ATHENA) and MO19390 (SAIL). While patients with known CNS metastases, based on imaging or clinical signs and symptoms, were excluded from trial in A and B datasets, patients who were found to have CNS lesions had either unrecognized CNS metastases at study entry or had developed these during the trial.; C.) 2 ongoing open-label studies AVF3752g and AVF3671g in patients with NSCLC, where inclusion of patients with treated CNS metastases was allowed. Incidence of CH in patients with brain metastases was quantified in each dataset. Results: A.) In 13 RCTs, with a total of 8443 patients with locally advanced, unresectable, or metastatic breast, renal, pancreatic, colorectal cancer, or NSCLC, brain metastases were identified in 187 patients (91 in BV-arms and 96 in control arm). Three of 91 (3.29%) BV-treated patients developed grade 4 CH, and one in 96 patients in the control arm (1.04%) developed grade 5 CH; B.) In open-label studies no CH was reported in 68 patients with CNS metastases, out of 3,252 patients enrolled. C.) In two studies in patients with treated CNS metastases, one subject in 83 (1.2%) BV treated patients developed a grade 2 CH. Conclusions: In this retrospective review, the rates of CH in BV-treated patients with CNS metastases is low, and appears consistent with historical rates of CH in these patient populations. Ongoing trials are expected to provide additional data regarding the risk of CH in patients with primary and metastatic CNS tumors.

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Association of chromosome 2q36.1-36.3 and autosomal dominant transmission in ankylosing spondylitis: results of genetic studies across generations of Han Chinese families

Background:

Ankylosing spondylitis (AS) is a chronic, potentially crippling, spondyloarthropathy with strong genetic components affecting approximately 0.3% of the population. Its exact genetic mechanism and mode of transmission, however, remains obscure.

Methods and results:

The authors conducted a genome wide scan on 75 individuals across multiple generations of three Han Chinese families affected with AS. Segregation analysis and pedigree investigation suggested an autosomal dominant inheritance. Pairwise logarithm of odds (LOD) scores were calculated using LINKAGE package for the obtained genotypes. High resolution mapping was then performed based on markers with significant LOD scores. To minimise the number of crossovers in each family, haplotype were constructed and assigned. Two of the pedigrees shared one candidate region for AS on 2q36.1–2q36.3 spanning 6-cM (maximum heterogeneity LOD score of 12.41 at marker D2S2228), while the other showed strong linkage to the HLA-B region.

Conclusions:

This is the first report which proposes one of the new genetic models of autosomal dominant transmission in AS. The breakthrough in the identification of linkage to chromosome 2q36.1–2q36.3 and the HLA-B region highlights the future potential of more comprehensive genetic studies of determinants of disease risk.

Clinics in diagnostic imaging (126). Right atrial myxoma

A 47-year-old woman presented with dyspnoea on exertion for several weeks. Echocardiogram and multidetector computed tomography of the heart showed a right atrial mass typical of an atrial myxoma. This was confirmed on histology. The imaging features of atrial myxoma and other conditions presenting as a right-sided cardiac mass are discussed.

Induction of myocarditis lesions in Lewis rats by formalin-killed cells of group A Streptococcus

The feasibility of inducing rheumatic myocarditis lesions in Lewis rats by immunization with formalin-killed group A Streptococcus was evaluated. The rats were divided into three groups. Group A was immunized by injecting formalin-killed group A Streptococcus suspended in complete Freund's adjuvant (CFA) into the hind-foot pads and repeat immunization was given 1 week later by subcutaneous injection into the belly. The rats were then sacrificed 3 weeks after the initial immunization. In group B, the rats received the same initial immunization as group A, but the repeat immunization was carried out at 1, 2 and 3 weeks after the initial immunization and the rats were sacrificed 6 weeks after the initial immunization. Group C was a control group with the rats injected with saline/CFA and sacrificed on the same schedule as group A. Heart pathology sections showed that myocarditis lesions, focal inflammatory cell infiltration in interstitial near small vessels and valvulitis were induced in Lewis rats following immunization with formalin-killed group A Streptococcus.

Magnetic Resonance Scanning of the Upper Airway following Difficult Intubation Reveals an Unexpected Lingual Tonsil

We present a case of a 40-year-old woman requiring elective surgery who had an unexpected Grade 4 Cormack and Lehane laryngoscopy view. Both curved and straight laryngoscope blades in the sniffing and hyperextended head and neck positions were used. Endotracheal intubation was accomplished with some difficulty using a No. 3 Macintosh blade and Frova intubating catheter in the sniffing position. The cause of the difficult laryngoscopy was a lingual tonsil as shown in postoperative magnetic resonance scans.

We feel that a comprehensive postoperative evaluation should be conducted after every difficult laryngoscopy (Cormack and Lehane Grade 3b and 4). The use of magnetic resonance imaging may provide important objective information for both the anaesthetist and the patient, allowing a better understanding of causes and possible solutions for future airway management.

The frequency of the TRPC4AP haplotype in Alzheimer's patients

A haplotype in the gene for transient receptor potential cation channel, subfamily C, member 4 associated protein (TRPC4AP), has been identified in two extended pedigrees with late-onset Alzheimer's disease. Nine of the SNPs in the haplotype were analyzed in our unrelated Alzheimer's patients and controls. The H1 haplotype was found in 36% of the patients (199 patients) and in 26% of the controls (85 controls) (P=0.0282; OR=1.56; 95%CI=1.05-2.32). The latent classification method of analysis showed that the H1 haplotype was characteristic of Alzheimer's patients, with ages-of-onset between 66 and 80 years. When clinical phenotypes were analyzed, there was a suggestion that the patients with this haplotype may have more behavioral changes and hallucinations. Moreover, both the latent classification analysis and logistic regression analysis indicated that there was no association of the haplotype with either APOE status or gender. The gene is part of a superfamily of cation channels that are involved with calcium entry into cells.

Correlation of coronary angiography with "tombstoning" electrocardiographic pattern in patients after acute myocardial infarction

BACKGROUND

It has been suggested that a specific pattern of electrocardiographic (ECG) changes following acute myocardial infarction (AMI), the so-called "tombstoning," predicts a poorer outcome, although the cause and associations of such changes are not known. To address the possible cause and implications, we correlated angiographic findings with tombstoning in patients following AMI.

METHODS

The study investigated 124 patients with AMI, whose ECGs were taken within 24 h of onset of symptoms and who subsequently underwent angiography. In this population, 24 (19%) patients had a definite tombstoning pattern on their admission ECG.

RESULTS

Compared with non-tombstoning ECGs, the significant differences in the tombstoning group are as follows: (1) All patients, including those with inferior infarction, had either total or partial occlusion of the left anterior descending (LAD) artery (100 vs. 44%, p < 0.0001); (2) LAD occlusions were significantly more severe and mostly proximal (100% occlusion: 50 vs. 20.5%, p = 0.02; <50% occlusion: 0 vs. 15.9% p = 0.039; proximal occlusion: 92 vs. 65%, p = 0.017); (3) patients with tombstoning ECGs had a significantly greater incidence of occlusion of all three coronary arteries (54.1 vs. 22%, p = 0.001); (4) tombstoning ECGs were more strongly associated with anterior than with inferior infarction (83.3 vs. 33%, p < 0.0001).

CONCLUSIONS

The patients with a tombstoning pattern on the admission ECG, who underwent angiography, were associated with occlusion of a high-grade stenosis of the proximal LAD artery (usually with involvement of more than one artery) and were predominantly seen in association with anterior infarction.

Tunability of mobility and conductivity over large ranges in poly(3,3'''-didodecylquaterthiophene)/insulating polymer composites

Semiconducting polymers are currently being considered as active layers in field-effect transistors, in which high charge carrier mobility and low off conductivity are important. For other applications, such as certain spintronic mechanisms, the opposite characteristics are desirable. Blending such polymers with insulating polymers would be expected to lower the mobility. In this paper, we report that the use of hydrocarbon polymers such as polystyrene as insulators generally raises the mobility when the semiconducting polymer is poly(bisdodecylquaterthiophene). A high mobility value of nearly 0.1 cm(2)/V.s was obtained for an optimal blend. While this is counterintuitive, it is consistent with a few other recent reports. In order to lower the mobility significantly, a much more polar and irregular blending agent is needed. The further addition of tetrafluorotetracyanoquinodimethane as a dopant gave a rare low mobility/high conductivity combination of properties, with a charge carrier density on the order of 10(19) cm(-3). Thus, mobility and conductivity were tuned somewhat independently over 3 and 4 orders of magnitude, respectively.

Hermodulins: bispecific ligand traps inhibit breast tumor growth and metastasis

Abstract #4127

Signalling by the human EGF (HER) receptor family can induce tumorigenicity and metastasis of cancer cells. Activation of these receptors has been associated with aggressive phenotypes and poor prognosis of breast cancer and other malignancies. Currently approved HER family targeted therapeutics are primarily directed against one member of the HER family.&#x2028; We have engineered a family of bispecific (HER1:HER3) heterodimers comprised of a human IgG1-Fc fragment fused with modified extracellular domains of HER1 and HER3. These compounds, termed Hermodulins, act as “ligand traps” and inhibit ligand-stimulated activity of all members of the HER family. In this study we have shown that Hermodulins can inhibit in vitro growth and motility in breast cancer cell lines, act synergistically with other HER-directed tyrosine kinase inhibitors and monoclonal antibody therapeutics in tumor cell antiproliferation assays, and decrease the formation of osteolytic bone metastases in animal models.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4127.

In vitro evaluation of nanosized carbonate-substituted hydroxyapatite and its polyhydroxyethylmethacrylate nanocomposite

Nanometer scale carbonate-substituted hydroxyapatite (nanoCHA) particles were prepared and examined using transmission electron microscopy, which revealed their polycrystalline nature with a rod-like morphology (20-30 nm in width and 50-80 nm in length). In vitro cytotoxicity study showed that there was some evidence of lactate dehydrogenase (LDH) release when macrophages were in contact with high concentrations of nanoCHA particles. The levels of LDH release decreased significantly with a reduction in nanoCHA concentration. A similar trend was observed for the inflammatory cytokine TNF-alpha. nanoCHA particles with high carbonate content induced a high level of TNF-alpha release. Biological testing using a human osteoblast (HOB) cell model found that HOB cells were able to grow and proliferate on a nanoCHA deposited surface. Well organized actin fibers were observed for HOB cells in contact with nanoCHA particles with low carbonate content and the cell proliferation rate was higher on these particles in comparison with those of high carbonate nanoCHA particles. Therefore, low carbonate nanoCHA particles were incorporated into poly-(2-hydroxyethylmethacrylate) matrix to make a nanocomposite. It was found that the nanoCHA composite was hydrophilic and became rubber-like after hydration. Both 20 wt % and 40 wt % composites were able to induce the formation of bone-like apatite after immersion in simulated body fluid. A high bioactivity of the composite was obtained with high loading of the nanoCHA filler. These results demonstrate the potential of formulating nanocomposites for biomedical applications.

Genome screen of late-onset Alzheimer's extended pedigrees identifies TRPC4AP by haplotype analysis

Alzheimer's disease is a complex progressive neurodegenerative disorder with profound cognitive decline. Multiple susceptibility genetic variants have been identified with equivocal replication. While rare, collections of extended pedigrees with multiple affected family members are invaluable for genome-wide screens. We have used two extended pedigrees, having 14-15 siblings with four to five affected late-onset Alzheimer's disease patients in each, to identify the gene, transient receptor potential cation channel, subfamily C, member 4 associated protein (TRPC4AP), on chromosome 20q11.22, as relevant for the disease. Multiple significant SNPs in this gene were found with the initial genome scan (after Bonferroni correction). Additional SNPs were assessed in the families and in the controls which were also significant by haplotype analysis. Moreover, 36% of the patients' haplotypes in our collection of late-onset patients had the same haplotype. These results suggest that TRPC4AP is involved with the disease in these late-onset Alzheimer's families. The results also confirm the use of the genome-wide association study for identifying new genetic variants of complex diseases.

An Outbreak of Head Rot of Cabbage Caused by Rhizoctonia solani AG2-1 in Central China

In July of 2007, an outbreak of head rot of cabbage (Brassica oleracea) occurred on more than 2,500 ha in Changyang County, Hubei Province, China. On average, yields were reduced by approximately 50%. Affected plants were first observed in 2006, and symptoms were considered physiological or nutritional disorders by growers. In 2007, the more extensive summer rains favored an increase in disease severity. Initial symptoms consisted of irregular, brown-to-black lesions on leaves and sometimes a wet decay of the base of outer leaves. Lesions expanded until entire heads were rotted. Rhizoctonia solani was recovered consistently from symptomatic plant tissues. Five isolates were used to evaluate cultural and morphological characteristics of the pathogen. On potato dextrose agar (PDA), all isolates yielded colonies that became brown after 5 days of incubation. The hyphae, 4.9 to 8.0 μm in diameter, branched at right or acute angles near the septa and each cell usually had six to eight nuclei. Dark brown sclerotia, 0.5 to 5 mm in diameter, appeared after 10 days of incubation. Genomic DNA of a representative isolate, CY-1, was extracted, and the rDNA-internal transcribed spacer sequence showed 99.5% identity to R. solani AG2-1 (Accession No. EU513147) in GenBank. Pathogenicity tests were completed in the laboratory by placing 6-mm-diameter mycelial plugs from 3-day-old PDA cultures of the five isolates onto 30 cabbage leaves detached from 5-week-old cabbage plants. The inoculated leaves were incubated at 28°C with 95% relative humidity in a controlled environment chamber. Two days after inoculation, black, wet lesions were observed on all inoculated leaves, while no symptoms were apparent on leaves inoculated with noncolonized PDA plugs. Koch's postulates were fulfilled by reisolating R. solani from diseased leaves. R. solani AG1 (1), AG2-1 (2), and AG4 (4) have been reported as causal agents of diseases of cabbage and related plants, and AG2-1 has been previously isolated from cabbage grown in southwest China (3), but to our knowledge, this is the most severe outbreak reported from China. References: (1) G. S. Abawi and S. B. Martin. Plant Dis. 69:158, 1985. (2) L. Corazza et al. Eur. J. Plant Pathol. 101:341, 1995. (3) H. R. Li and H. H. Zhu. J. Yunnan Agric. Univ. 3:247, 1993. (4) G. H. Yang et al. Plant Pathol. 56:351, 2007.