The viable circulating tumor cells with cancer stem cells feature, where is the way out?

With cancer stem cells (CSCs) became the research hotspot, emerging studies attempt to reveal the functions of these special subsets in tumorigenesis. Although various approaches have been used in CSCs researches, only a few could really reflect or simulate the microenvironment in vivo. At present, CSCs theories are still difficult to apply for clinical remedy because CSCs subpopulations are always hard to identify and trace. Thus an ideal approach for clinicians and researchers is urgently needed. Circulating tumor cells (CTCs), as the method of noninvasive-liquid biopsy, could be detected in the peripheral blood (PB) from many tumors and even could be treated as procurators for CSCs deeper researches from patient-derived sample. However, CTCs, as a diagnostic marker, also raise much controversy over theirs clinical value. Mechanisms causing CTCs to shed from the tumor have not been fully characterized, thus it is unclear whether CTCs represent the entire makeup of cancer cells in the tumor or only a subset. The heterogeneity of CTCs also caused different clinical outcomes. To overcome these unsolved problems, recently, CTC researches are not just depend on enumerations, whereas those CTC subsets that could expand in vitro may play a pivotal role in the metastatic cascade. Here, we retrospect the CTC developmental history and discourse upon the enrichment of viable CTCs in functional assays, probe the further avenue at the crossroad.

Radiation-Tolerance Assessment of a Redundant Wireless Device

This paper presents a method to evaluate radiation-tolerance without physical tests for a commercial off-the-shelf (COTS)-based monitoring device for high level radiation fields, such as those found in post-accident conditions in a nuclear power plant (NPP). This paper specifically describes the analysis of radiation environment in a severe accident, radiation damages in electronics, and the redundant solution used to prolong the life of the system, as well as the evaluation method for radiation protection and the analysis method of system reliability. As a case study, a wireless monitoring device with redundant and diversified channels is evaluated by using the developed method. The study results and system assessment data show that, under the given radiation condition, performance of the redundant device is more reliable and more robust than those non-redundant devices. The developed redundant wireless monitoring device is therefore able to apply in those conditions (up to 10 M Rad (Si)) during a severe accident in a NPP.

Peripheral Blood Leukocyte Telomere Length Is Associated with Age but Not Renal Function: A Cross-Sectional Follow-Up Study

OBJECTIVES

We aimed to evaluate the relationship between baseline renal function and changes in telomere length in Han Chinese.

METHODS

The telomere restriction fragment (TRF) length of leukocytes in the peripheral blood was measured in healthy volunteers recruited in 2014. The estimated glomerular filtration rate (eGFR) was calculated based on serum creatinine (Scr) and serum cystatin C (CysC)-eGFRcys and eGFRScr-cys through the Cockcroft-Gault formula (eGFRC-G) or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI / eGFRCKD-EPI) equation. The correlation between telomere length changes over time and renal function was analyzed.

RESULTS

Leukocyte TRF lengths were negatively correlated to age (r = -0.393, p < 0.001) and serum CysC (r = -0.180, p < 0.01), while positively associated with eGFRCKD-EPI, eGFRC-G, eGFRcys, and eGFRScr-cys (r = 0.182, 0.122, 0.290, and 0.254 respectively, p < 0.01). The 3-year change of telomere length was 46 bp/years. When adjusted for age, the associations between telomere length changes and baseline, subsequent TRF lengths, and serum CysC were no longer present. No association was observed between TRF length changes and renal function.

CONCLUSION

The rate of telomere length changes was affected by age and baseline telomere length. The telomere length changes might be important markers for aging.

The Hierarchy of Proinflammatory Cytokines in Ocular Inflammation

PURPOSE

The concept of tissue-dependent cytokine hierarchy has been demonstrated in a number of diseases, but it has not been investigated in ophthalmic diseases. Here, we evaluated the functional hierarchy of interleukin-1β (IL-1β), IL-6, IL-17A, and tumor necrosis factor (TNF) in the induction of ocular inflammation.

MATERIALS AND METHODS

We delivered adeno-associated virus (AAV) vectors expressing IL-1β, IL-6, IL-17A, or TNF intravitreally in naïve C57/BL6 mice and compared and contrasted the inflammatory effects in the eye 5 weeks after AAV-mediated gene transfer. We also used an in vitro human system to test the effect of cytokines on barrier function.

RESULTS

We found that IL-1β had the highest ability to initiate ocular inflammation. The continuous overexpression of IL-1β resulted in a significant upregulation of additional proinflammatory mediators in the eye. Using scanning laser ophthalmoscope and optical coherence tomography imaging techniques, we showed that a low dose of AAVIL-1β was sufficient and was as pathogenic as a high dose of TNF in inducing vascular leakage, retinal degeneration, and cellular infiltration. Furthermore, only a marginal increase in IL-1β was enough to cause cellular infiltration, thus confirming the highly pathogenic nature of IL-1β in the eye. Contrary to our expectation, IL-6 or IL-17A had minimal or no effect in the eye. To examine the clinical relevance of our findings, we used an impedance assay to show that IL-1β alone or TNF alone was able to cause primary human retinal endothelial cell barrier dysfunction in vitro. Again, IL-6 alone or IL-17A alone had no effect on barrier function; however, in the presence of IL-1β or TNF, IL-17A but not IL-6 may provide additive proinflammatory effects.

CONCLUSIONS

Our studies demonstrate the existence of a functional hierarchy of proinflammatory cytokines in the eye, and we show that IL-1β is the most pathogenic when it is continuously expressed in the eye.

[Experimental study of glioma stem cell-mediated immune tolerance in tumor microenvironment]

Objective: To investigate the tumor microenvironment of immune tolerance induced by glioma stem cells (GSC). Methods: Human GSC SU3 cells transfected with red fluorescent protein (SU3-RFP) gene were implanted into the brain, subcutis (armpit and foot), liver and abdominal cavity of transgenic green fluorescence protein (GFP) nude mice to establish RFP(+) /GFP(+) dual fluorescence solid tumor model. The re-cultured cells derived from implanted tumor tissues, SU3-RFP cells co-cultured with peritoneal fluid of transgenic GFP nude mice and malignant ascites of tumor-bearing mice were observed by fluorescence microscopy and real-time video image tracing to analyze the microenvironment of immune tolerance mediated by RFP(+) /GFP(+) implanted tumor. Results: Dual fluorescence labeled frozen section showed that all of cells in the tumor microenvironment were GFP(+) , while the pressed tissue-patch showed that the tumor blood vessels exhibited a RFP(+) /GFP(+) double-positioning yellow. In the GFP single fluorescence labeled tumor tissue, all of cells in the microenvironment were green, including tumor edge, necrotic foci and blood vessel. Among them, CD68(+) , F4/80(+) , CD11c(+) , CD11b(+) and CD80(+) cells were observed. In the dual fluorescence labeled co-cultured cells, the phagocytosis and fusion between green host cells and red tumor cells were also observed, and these fusion cells might transfer to the malignant dendritic cells and macrophages. Conclusions: The tumor microenvironment of immune tolerance induced by GSC is not affected by the tissue types of tumor-inoculated sites, and the immune tolerance mediated by inflammatory cells is associated with the inducible malignant transformation, which may be driven by cell fusion.

Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss and the inflammatory response following enhanced-recovery primary total hip arthroplasty: a randomised clinical trial

AIMS

The aim of this study was to examine the efficacy and safety of multiple boluses of intravenous (IV) tranexamic acid (TXA) on the hidden blood loss (HBL) and inflammatory response following primary total hip arthroplasty (THA).

PATIENTS AND METHODS

A total of 150 patients were allocated randomly to receive a single bolus of 20 mg/kg IV TXA before the incision (group A), a single bolus followed by a second bolus of 1 g IV-TXA three hours later (group B) or a single bolus followed by two boluses of 1 g IV-TXA three and six hours later (group C). All patients were treated using a standard peri-operative enhanced recovery protocol. Primary outcomes were HBL and the level of haemoglobin (Hb) as well as the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) as markers of inflammation. Secondary outcomes included the length of stay in hospital and the incidence of venous thromboembolism (VTE).

RESULTS

The mean HBL was significantly lower in group C (402.13 ml standard deviation (sd) 225.97) than group A (679.28 ml sd 277.16, p < 0.001) or B (560.62 ml sd 295.22, p = 0.010). The decrease in the level of Hb between the pre-operative baseline and the level on the third post-operative day was 30.82 g/L (sd 6.31 g/L) in group A, 27.16 g/L (sd 6.83) in group B and 21.98 g/L (sd 3.72) in group C. This decrease differed significantly among the three groups (p < 0.01). The mean level of CRP was significantly lower in group C than in the other two groups on the second (p ≤ 0.034) and third post-operative days (p ≤ 0.014). The levels of IL-6 were significantly lower in group C than group A on the first three post-operative days (p = 0.023). The mean length of stay was significantly lower in group C than group A (p = 0.023). No VTE or other adverse events occurred.

CONCLUSION

Multiple boluses of IV-TXA can effectively reduce HBL following primary THA. A regime of three boluses leads to a smaller decrease in the level of Hb, less post-operative inflammation and a shorter length of stay in hospital than a single bolus. Cite this article: Bone Joint J 2017;99-B:1442-9.

[Postoperative complications following dental rehabilitation under general anesthesia in children]

Objective: To assess the postoperative complications in systemically healthy children treated for dental caries under general anesthesia (GA) after discharge and analysis of the correlative factors. Methods: This prospective observational study included 124 children aged 2-8 years old who received extensive dental treatment under GA. General conditions and treatment information were obtained from questionnaires filled by the dentist and the anesthesiologist. Postoperative data were collected from a questionnaire filled by the parents in one week. Pain was assessed by using the dental discomfort questionnaire-8 (DDQ-8) pain assessment scale. Results: The mean anesthesia time for GA procedures was 102.6 min and the mean number of treated teeth was 13.5. Approximately 66.9% (83/124) of the children had one or more postoperative complaints on the first day after the treatments. The most common complaints reported were cough, hoarseness, and dental pain followed by throat discomfort, problems in eating, swelling, weakness, sleepiness, vomiting, fever and nausea. By the seventh day after the treatment, the main complications remained were dental pain and cough, while most of other symptoms disappeared. Preoperative DDQ-8 score and the number of extracted teeth were the factors that showed a significant association with postoperative dental pain on the first day. Conclusions: Dental pain and pharynx discomfort were most frequently noted postoperative symptoms. Postoperative dental discomfort on the first day might be predicted by dental pain before GA and tooth extraction under GA.

Hemodynamic Changes Caused by Multiple Stenting in Vertebral Artery Fusiform Aneurysms: A Patient-Specific Computational Fluid Dynamics Study

BACKGROUND AND PURPOSE

The multiple stent placement technique has largely improved the long-term outcomes of intracranial fusiform aneurysms, but the hemodynamic mechanisms remain unclear. In this study, we analyzed the hemodynamic changes caused by different stent-placement strategies in patient-specific models using the computational fluid dynamics technique, aiming to provide evidence for clinical decision-making.

MATERIALS AND METHODS

Ten vertebral artery fusiform aneurysms were included, and their patient-specific computational fluid dynamics models were reconstructed. A fast virtual stent placement technique was used to simulate sequential multiple stent placements (from a single stent to triple stents) in the vertebral artery fusiform aneurysm models. Hemodynamic parameters, including wall shear stress, pressure, oscillatory shear index, relative residence time, and flow pattern, were calculated and compared among groups with different numbers of stents.

RESULTS

Virtual stents were deployed in all 10 cases successfully, consistent with the real stent configuration. Wall shear stress decreased progressively by 7.2%, 20.6%, and 25.8% as the number of stents increased. Meanwhile, relative residence time and pressure increased on average by 11.3%, 15.4%, and 45.0% and by 15.7%, 21.5%, and 28.2%. The oscillatory shear index showed no stable variation trend. Flow patterns improved by weakening the intensity of the vortices and displacing the vortex center from the aneurysmal wall.

CONCLUSIONS

Stent placement modifies hemodynamic patterns in vertebral artery fusiform aneurysms, which might favor thrombosis formation in the aneurysmal sac. This effect is amplified with the number of stents deployed. However, a potential risk of rupture or recanalization exists and should be considered when planning to use the multiple stent placement technique in vertebral artery fusiform aneurysms.

Strategies to increase the efficacy of using gut microbiota for the modulation of obesity

Obesity is one of the most serious global public health challenges of the 21st century. The adjustment of gut microbiota is often recommended as an efficient strategy to treat obesity. This modulation of gut microbiota can be performed by many methods, including dietary intervention, antibiotic application, the use of prebiotics and probiotics, bariatric surgery and faecal microbiota transplantation. In most cases, positive effects have been observed in response to treatment, but invalid and even contrary effects have also been observed in some cases due to factors that are unrelated to intervention methods, such as genetic factors, patient age or gender, environmental microbiota, climate, geography and lifestyle. These factors can cause variation of gut microbial populations and thus should also be taken into consideration when selecting modulation strategies.

[Effects of retroperitoneal laparoscopic ureterolithotomy and flexible-ureteroscopic holmium laser lithotripsy for complex upper ureteral calculi]

Objective: To explore the clinical effects of retroperitoneal laparoscopic ureterolithotomy (RPLU) and flexible-ureteroscopic holmium laser lithotripsy (f-UHLL) for complicated upper ureteral calculi. Methods: A total of 45 cases of complicated upper ureteral calculi between March 2014 and January 2016 in Department of Urology, Affiliated Jiangyin Hospital of Southeast University Medical College were retrospectively analyzed, there were 32 males and 13 females, ranging from 27 to 45 years with an average age of (34.1±9.5) years. Of the 45 patients, 28 had ureteral distortion and 17 had concurrent ureteral stones in the lower or middle ipsilateral ureter. In those patients, 20 cases underwent f-UHLL, and 25 cases received RPLU. The stone size, operation time, hospital stay, stone clearance rates and postoperative fever rates between the two groups were compared with t test and χ(2)test. Results: The operation was successfully performed in all patients, no complications with leakage of urine or ureteral perforation occurred, and no significant difference in renal function between the two methods were founded in postoperative period. There was no significant difference in operation time((78.4±8.5) minuetes vs.(73.3±11.3) minuetes, t=0.61, P=0.67), time of double J tube removed ((33.8±3.4)days vs. (37.6±8.9) d, t=2.37, P=0.08) and ipsilateral renal glomerular filtration rates ((41.3±7.6)ml/minuetes vs.(40.5±7.1) ml/min, t=0.78, P=1.27) between the two groups. However, the hospitalization time ((5.9±1.7)days vs. (4.2±1.6) days, t=1.92, P=0.04), postoperative fever rates (4% vs.30%, χ(2)=5.72, P=0.03) and calculus clearance rates (100% vs. 75%, χ(2)=7.03, P=0.01) in RPLU were significantly higher than f-UHLL. Besides, 5 patients in the f-UHLL group had postoperative stone residue and were treated with extracorpore shock wave lithotripsy. Conclusions: Both RPLU and f-UHLL are safety and validity for complex upper ureteral calculi. RPLU can improve the rate of calculus removal and reduce the rate of postoperative fever.

Study on the expression and mechanism of plasma microRNA-21 in patients with ischemic cardiomyopathy

OBJECTIVE

To investigate the expression and mechanism of plasma microRNA-21 in patients with ischemic cardiomyopathy (ICM).

PATIENTS AND METHODS

56 cases of ICM patients were selected in our hospital from February 2010 to March 2016 as the observation group, and 60 cases of healthy patients were selected as control group. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression of microRNA-21 in two groups. Then, differences of the total cholesterol (TC), triglycerides (TG), left ventricular ejection fraction (LVEF), high and low density lipoprotein cholesterol (HDL-C, LDL-C), left ventricular end-diastolic volume (LVEDV), N terminal B type brain natriuretic peptide (NT-proBNP) and other clinical indicators of the two groups, were compared. The correlation between the plasma microRNA-21 level and the clinical indices was analyzed, and the value of microRNA-21 in the diagnosis and treatment of ICM was evaluated.

RESULTS

The levels of LDL-C, HDL-C and LVEF in the observation group were lower than those in the control group (p<0.05). Plasma microRNA-21, TG, NT-proBNP and LVEDV were higher than those in the control group; the difference was statistically significant (p<0.05). Logistic regression analysis showed that the plasma microRNA-21 level was positively correlated with NT-proBNP and LVEDV (p<0.05).

CONCLUSIONS

The expression of microRNA-21 in plasma of patients with ICM was significantly increased. And the expression of micro RNA-21 in plasma was positively correlated with NT-proBNP and LVEDV. Through the ventricular remodeling in ICM patients, it can be used as a new target for the diagnosis and treatment of ICM and a new biomarker for risk assessment.

The efficacy and safety of sublingual immunotherapy in children and adult patients with allergic rhinitis

BACKGROUND

Clinical research has shown that sublingual immunotherapy (SLIT) is effective and safe in moderate-severe allergic rhinitis (AR) induced by house dust mite (HDM). However, the sample size in many studies is small. Meanwhile, the controversy on the efficacy and safety in the very young children younger than four years old still existed.

OBJECTIVE

The aim of this retrospective study is to evaluate the efficacy and safety of SLIT with Dermatophagoides farinae (Der.f) extracts in children and adult patients with allergic rhinitis, particularly in the very young children.

METHOD

A total of 573 subjects aged 3-69 with AR received a three-year course of sublingual immunotherapy with Der.f extracts along with pharmacotherapy. The total nasal symptoms score (TNSS), total medication score (TMS), visual analogue score (VAS) and adverse events (AEs) were evaluated at each visit.

RESULT

TNSS, TMS, VAS were significantly improved during the three-year course of treatment in comparison to the baseline values (P<0.01). Besides, significant improvement in nasal symptoms and reduction of medication use were also observed in young children aged 3-6 years (P<0.01). No severe systemic adverse events (AEs) were reported.

CONCLUSION

SLIT with Der.f drops is clinically effective and safe in children and adult patients with HDM-induced AR, including the very young children less than four years old.

[Analysis of the effect of different surgical methods on the cavernous hemangioma of the deep orbit]

Objective: To explore the effect of the surgical removal of orbital deep cavernous hemangioma following the concept of minimal surgical invasion. Methods: Retrospective case series study. Sixty-three cases with surgical removal of deep orbital cavernous hemangioma were collected in the Affiliated Eye Hospital of Nanchang University from May 2012 to August 2015. There were 29 males and 34 females. The age was from 17 to 69 years with mean age (45±11) years.The surgical methods the conjunctival approach orbital surgery, lateral orbital surgery, medial skin orbital surgery, lateral orbital conjunctiva conjunctival pathway and endoscopic nasal approach were chosen for different cases. The visual acuity, visual field and electrophysiological examination were analyzed before and after operation. Result: Sixty-three patients underwent complete surgically removal of the tumor. Among them, 32 cases were conducted by conjunctival approach, 24 cases had improved visual acuity, 5 cases had no change of visual acuity, 3 cases had decreased visual acuity. Seventeen cases performed with lateral open orbital surgery had improved visual acuity in 11 cases, no change in visual acuity in 3 cases and decreased visual acuity in 3 cases postoperatively. Six cases with approach of the medial orbital surgery had improved visual acuity in 4 cases, no change of visual acuity in 1 case and decreased visual acuity in 1 case postoperatively. Six cases with approach of outside open orbital surgery combined with medial conjunctival pathway had improved visual acuity in 4 cases, no change of visual acuity in 1 case and decreased visual acuity in 1 case postoperatively. Two cases performed with endoscopic nasal approach. One of them had normal visual function and no change after surgery. Another had impaired visual function pre-operatively and it came back to normal postoperatively. Conclusions: With the concept of minimal surgical invasion, the choice of appropriate surgical approach can save patients with the greatest degree of visual function and even improve the visual function of the patients with orbital cavernous hemangioma. (Chin J Ophthalmol, 2017, 53: 288-293).

Meta-analysis of hypertension and osteoporotic fracture risk in women and men

The present meta-analysis synthesized evidence from 10 articles encompassing 28 independent studies to verify the association between hypertension and osteoporotic fracture risk in women and men. Our results indicate that the risk of osteoporotic fracture among individuals with hypertension was higher than that among individuals without hypertension.

INTRODUCTION

Epidemiological studies have suggested that hypertension is related to osteoporotic fracture. However, discrepancies exist in the reported findings. In this study, a systematic review of relevant published articles was conducted to verify the association between hypertension and osteoporotic fracture risk in women and men.

METHODS

PubMed (1953_October 5th, 2016) and Embase (1974_October 5th, 2016) were systematically searched for relevant articles. Odds ratios (ORs) and confidence intervals (CIs) were derived using random effect models. Categorical, subgroup, heterogeneity, publication bias, and meta-regression analyses were conducted.

RESULTS

We analyzed 10 articles encompassing 28 independent studies, 1,430,431 participants, and 148,048 osteoporotic fracture cases. The risk of osteoporotic fracture among individuals with hypertension was higher (pooled OR = 1.33, 95% CI 1.25-1.40; I ² = 72.3%, P < 0.001) than that among individuals without hypertension. The association between hypertension and fracture risk was slightly stronger in women (pooled OR = 1.52, 95% CI 1.30-1.79) than in men (pooled OR = 1.35, 95% CI 1.26-1.44). Studies conducted in Asia revealed results that were consistent with those of studies performed in Europe.

CONCLUSIONS

Hypertension is associated with osteoporotic fracture risk. However, the biological mechanisms underlying the effect of hypertension on osteoporotic fracture remain to be elucidated.

[Analysis of the effect of cochlear implant for the patients with acoustic neuroma in the only hearing ear]

OBJECTIVE

To discuss the method as well as effect of hearing restoration for patients with acoustic neuroma (AN) in the only hearing ear.

METHODS

A retrospective study was conducted in three patients with AN in the only hearing ear. Ipsilateral cochlear implantation (CI) was performed in case 1 and contralateral CI was performed in case 2 without tumor resection. In case 3, CI was performed 6 months after tumor removal by the retrosigmoid approach. Dynamic changes in the audiological tests was recorded regularly.

RESULTS

In case 1 and case 2, no matter which side CI was performed, pure tone average (PTA) was improved clearly, and speech discrimination score (SDS) was slightly increased. In case 3, hearing loss was observed after tumor removal. Simultaneous bilateral CI after 12 months was performed in this case. PTA on both sides was largely lower than that before CI, and SDS was slightly improved. With bilateral CI, SDS was improved, especially in noise, compared with unilateral CI on either side.

CONCLUSIONS

For patients with AN in the only hearing ear, CI can significantly improve PTA, and SDS can be slightly increased. Bilateral CI should improve the outcome of hearing restoration compared with unilateral CI.

[Relationship and influencing factors between the amplitude change of supramaximal facial nerve stimulation during acoustic neuroma removal and facial function outcome]

OBJECTIVE

To investigate the relationship between the amplitude change of supramaximal facial nerve stimulation during acoustic neuroma removal and facial function outcome, and discuss its influencing factors.

METHODS

Retrospective study of 34 acoustic neuroma patients. Intraoperative amplitude by supramaximal stimulation, facial function outcome, tumor size, surgical approach, facial nerve course pattern, and tumor cystic status, as well as tumor adhesion degree were collected and analyzed by SPSS 17.0.

RESULTS

Acoustic neurnomas were removed in all 34 patients without intra- and postoperative complications, the facial nerve were all anatomically preserved. Two weeks later, 5 cases showed facial function HB Grade Ⅰ, 13 HB Ⅱ, 11 HB Ⅲ and 5 HB Ⅳ. The amplitude changes under supramaximal stimulation after tumor removal were 12.9%-100%, average (63.9±25.7)%. The facial function outcomes were poor (HB Ⅳ) in the cases whose intraoperative amplitude decreases were more than 70%. Different postoperative facial function group showed significantly different intraoperative amplitude changes (F=7.585, P=0.001), except HB Ⅰ group and HB Ⅱ group. The existence of cystic degeneration showed strong correlation (r=-0.635) to the amplitude changes, the level of tumor adhesion showed moderately negative correlation (r=-0.455), and tumor size showed weak negative correlation (r=-0.292), surgical approach and the facial nerve course pattern were not statistically relevant.

CONCLUSIONS

The amplitude change of facial nerve supramaxial stimulation can predict the postoperative facial function. The amplitude change is valuable for early treatment of facial nerve damage.

Regulation of oncogenes and gap junction intercellular communication during the proliferative response of zearalenone in TM3 cells

Zearalenone (ZEA) is a nonsteroidal estrogenic mycotoxin produced by Fusarium species. The exposure risk to humans and animals is the consumption of contaminated food and animal feeds. The aim of this study was to investigate ZEA-induced effects and its tumorigenic mechanism in TM3 cells (mouse Leydig cells). Cell proliferation, apoptosis, and gap junction intercellular communication (GJIC) were assessed in this study. Results showed that low concentrations of ZEA could significantly promote the growth of TM3 cells. The percentage of cell distribution was decreased significantly in G1/G0 phase and was increased significantly in S phase with 10 and 20 μg/L of ZEA for 72 h ( p < 0.05, p < 0.01). The expressions of cyclin D1 and Cdk4 were significantly increased in the exposure groups compared with the control group ( p < 0.05, p < 0.01). Compared with the control group, the apoptosis was significantly decreased in 10 and 20 μg/L groups ( p < 0.01), and the ratio of Bax/Bcl-2 protein level was significantly decreased in a dose-dependent manner. The protein levels of proto-oncogene c-Myc, c-Jun, and c-Fos were significantly elevated and the protein levels of anti-oncogene p53 and phosphatase and tensin homolog (PTEN) were decreased obviously compared with the control group ( p < 0.05, p < 0.01). ZEA affected the expressions of connexins and inhibited the activity of GJIC. These results demonstrated that ZEA can disturb the dynamic balance between proliferation and apoptosis and causes abnormal regulation of oncogenes, GJIC, and connexins in TM3 cells, which may easily induce the translation of normal cells into tumor cells.

Clinical research of different analgesia methods on perianesthetic pain of patients with moderate and severe craniocerebral injury who have emergency operation

OBJECTIVE

To compare the effects of two different analgesia methods on postoperative pain of patients with moderate and severe craniocerebral injury who had an emergency operation.

PATIENTS AND METHODS

In this study, 64 patients who were treated in our hospital from January 2015 to January 2016 and diagnosed with acute craniocerebral injury, were consecutively selected. The patients were divided into the propofol total intravenous anesthesia group (the observation group) and the isoflurane intravenous-inhalation combined anesthesia group (the control group) randomly with 32 cases each. Mean arterial pressure (MAP), partial pressure of oxygen (SpO2), and heart rate (HR) were compared and analyzed before and after anesthesia. At the first, second, and third day after the operation, adopt visual analogue scale (VAS), and sedation-agitation scale (GCS) were used to evaluate sedative and analgesic effects of patients.

RESULTS

After anesthesia had succeeded, HR, SpO2, and MAP of patients in these two groups decreased, but the decrease in the observation group was less than that in the control group. The differences had statistical differences (p<0.05). At the first, second, and third day after the operation, scores of VAS and GCS in the observation group were obviously lower than those in the control group, and the differences had statistical differences (p<0.05). The total effective rate of anesthesia in the observation group was higher than that in the control group, and the differences had statistical differences (p<0.05).

CONCLUSIONS

For patients with moderate and severe craniocerebral injury who had an emergency operation, propofol total intravenous anesthesia is more stable and has a better postoperative pain comparing with isoflurane intravenous-inhalation combined anesthesia.

Comparison of the 7th and proposed 8th editions of the AJCC/UICC TNM staging system for esophageal squamous cell carcinoma underwent radical surgery

BACKGROUND

Recently, the 8th edition of the TNM classification of esophageal cancer has come up. The present study aims to compare the 7th and the proposed 8th edition of the AJCC/UICC TNM staging system for esophageal squamous cell carcinoma (ESCC).

METHODS

A total of 1872 ESCC patients who underwent radical surgery with curative intent were analyzed retrospectively. Survival was analyzed using the Kaplan-Meier method, and values were compared using the log-rank test. Multivariate analysis was performed using the Cox proportional hazard model. The Akaike information criterion (AIC) and the concordance index (c-index) were applied to compare the two prognostic systems.

RESULTS

On univariate analysis, the 7th staging system, the proposed 8th staging system, gender, age as well as adjuvant treatment were found to have significant association with overall survival (OS). In both the current staging system and the modified version, age and gender were independent prognostic factors in a multivariate analysis. The AIC value for the proposed 8th version was smaller than that for the 7th staging system; the c-index value for the proposed 8th version was larger than that for the 7th staging system. Subgroup analysis in patients with/without nodal metastasis obtained consistent results.

CONCLUSION

Based on the data from our single center, the proposed 8th AJCC staging system seems to be superior to the 7th AJCC staging system in terms of OS for patients with thoracic ESCC who underwent radical surgery.

[0.5 Gy X-ray radiation promotes osteoblast differentiation by Wnt/β-Catenin signaling]

Objective: To investigate the important roles of Wnt signaling in the processes of 0.5Gy X-ray promoting osteoblast differentiation, and make clear the molecular mechanisms involved. Methods: Flow cytometry was employed to detect the apoptosis after osteoblast exposure to 0.5 Gy X-ray radiation.The protein level of osteoblast differentiation markers, such as collagen Iα (Col1α), alkaline phosphatase (ALP), osteocalcin (OCN), were detected by Western-blot and ALP activity staining was performed. Real-time PCR and Western-blot were utilized to evaluate the variations of key factors in Wnt signaling pathways, while specific inhibitor of Wnt/β-Catenin, XAV939 was used to block the Wnt signaling. Results: Low-dose (0.5 Gy) X-ray induced significant decline in MC3T3-E1 osteoblast apoptosis at three days after radiation.The dynamic variations in the expression of osteoblast differentiation markers, including Col1α, ALP, OCN, were observed after 0.5 Gy X-ray irradiation by Western blot analysis.The protein levels of Col1α have a reduction temporarily at 4 days of radiation (34.5%±5.8%, t=9.912, P<0.001), then a significant increase is detected at 10 day after radiation (162.5%±6.5%, t=2.673, P<0.05). OCN levels dropped by 83% (t=3.968, P<0.01) at 4 day after 0.5 Gy X-ray radiation, and raised at 10 day (39.5%±4.1%, t=3.219, P<0.05) and 14 day (79.4%±7.5%, t=6.708, P<0.001), respectively. ALP levels increased at 7 day (79.7%±22.3%, t=6.257, P<0.001) and 10 day(128.3%±6.1%, t=4.340, P<0.01)after radiation. At the same time, 0.5 Gy X-ray radiation can activate Wnt/GSK-3/β-Catenin signaling.The mRNA levels of Wnt3a、LPR5 and TCF-4 increased by 1.7 fold (t=6.573, P<0.001), 1.1 fold (t=5.323, P<0.05) and 1.4 fold (t=3.054, P<0.05) at 7 day after radiation.In addition, p-GSK-3β level reduced by 42.1% (t=4.460, P<0.01), and active β-Catenin increased by 1.9 fold (t=3.528, P<0.05). However, the specific inhibitor of Wnt/β-Catenin, XAV939 completely abrogated Wnt/β-Catenin signaling and the increase in ALP expression and activity induced by 0.5 Gy X-ray radiation. Conclusion: These results demonstrated that low dose X-ray radiation promoted osteoblast survival at early differentiation, and promoted differentiation at middle and late stage, in which Wnt signaling participated the regulation processes.

Study on the expression and mechanism of inflammatory factors in the brain of rats with cerebral vasospasm

OBJECTIVE

We investigated the significance of IL-1 and ICAM-1 in rat's subarachnoid hemorrhage (SAH) cerebral vasospasm (CVS) model.

MATERIALS AND METHODS

A total of 30 Sprague-Dawley (SD) rats were randomly divided into the SAH group and the Sham group. Cisterna magna auto blood injection was used to prepare the CVS models. We studied and compared changes in the basilar arteries diameters before and after SAH. We measured the cerebrovascular inner diameter before and after SAH modeling using the ultrasound. ELISA method was used to measure the expression of IL-1 and ICAM-1 in peripheral blood. The expression of MAPK and P38 in the brain was tested using Western blot. Brain cells apoptosis was studied using TUNEL method.

RESULTS

Cerebrovascular inner diameter reduced significantly in the SAH group as compared to the control group. The expression of IL-1 and ICAM-1 increased significantly after 48 hours. Compared to the Sham group, p-38 and p-MAPK expression levels in the SAH group increased significantly after 48 hours. Results showed that 48 hours after the operation, the level of apoptosis was significantly higher in the SAH group. IL-1 and ICAM-1 expression levels were associated with a P38-MAPK signal pathway in the brain. p38 and MAPK activation were closely related to apoptosis in the cortex.

CONCLUSIONS

We suggest that the cerebral basilar vasospasm was occurred in rats 48 hours after ASH onset, with an increase in IL-1 and ICAM-1 expression and brain cells apoptosis.

miR-210 expression in PBMCs from patients with systemic lupus erythematosus and rheumatoid arthritis

BACKGROUND

In hypoxic conditions, miRNA-210 plays an important role in regulating the expression of hypoxia-inducing factor-1α (HIF-1α) and the differentiation of T helper 17 (Th17) cells, and this may be involved in the development and function of the immune system.

AIMS

This study was to investigate the miR-210 expression levels in peripheral blood mononuclear cells (PBMCs) from patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and its association with the clinical and laboratory features of both diseases.

METHODS

Real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to detect miR-210 expression levels in PBMCs from 35 patients with SLE, 38 patients with RA, and 35 healthy controls.

RESULTS

Compared with the healthy controls, the miR-210 expression levels were significantly increased in patients with SLE (P = 0.001) and there was increased significantly expression of miR-210 in SLE with pleuritis (Z = -2.345, P = 0.019) and anti-SSB/La-positive group (Z = -2.076, P = 0.038). However, we have not found the significant correlation between the miR-210 levels and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (r _s = 0.091, P = 0.602). Although, no significant difference between miR-210 levels in RA patients and those in healthy controls was found (Z = -1.226, P = 0. 220). There was a significant decreased expression of miR-210 in active RA patients than inactive RA patients (Z = -4.011, P < 0.001).

CONCLUSIONS

The dysregulation of miR-210 levels in SLE and RA patients suggests that miR-210 might play an important role in the pathogenesis of these diseases.

Small interfering RNA targeting receptor for advanced glycation end products protects the rats from multibacterial sepsis

BACKGROUND

Sepsis is a major challenge in clinical medicine, and treatment options are limited. Recently, the receptor for advanced glycation end products (RAGE) appears to be an excellent target for new therapeutic agents.

AIMS

The objective of this study is to investigate the effect of small interfering RNA (siRNA) targeting RAGE on the outcome of multibacterial sepsis induced by cecal ligation and puncture (CLP) in a rat model.

METHODS

A vector-based RAGE-targeted siRNA expression system (Psilencer-siRNA) was constructed and injected into rats via the jugular vein catheter after CLP injury. The RAGE expression in livers, survival rate, and plasma cytokine levels after CLP were compared between Psilencer-siRNA treated and control rats.

RESULTS

The expression of RAGE in livers which was upregulated after CLP injury was greatly curtailed by Psilencer-siRNA administration. Compared to control rats, the Psilencer-siRNA-treated rats had significantly higher survival rate (p < 0.05) and markedly decreased plasma cytokine levels (p < 0.001) after CLP.

CONCLUSIONS

Targeting RAGE by siRNA might attenuate hyperinflammation, improve survival rate, and offer new therapeutic options for sepsis.

[Minimally invasive plate osteosynthesis for treatment of proximal humeral fractures through anterolateral acromial approach]

OBJECTIVE

To investigate the feasibility, surgical technique and effect of osteosynthesis for proximal humerus fractures through the minimal incision anterolateral acromion.

METHODS

In this study, 32 patients of proximal humeral fractures were selected and treated through the minimal incision antero-lateral acromion between January 2012 and October 2014. Of these patients, there were 19 males and 13 females, with mean age 46 years old (range: 22-78 years). The mechanism of injury was a trauma of simple fall for 21 patients and motor vehicle accident for 11 patients. According to Neer classification, 18 cases had two-part fractures, 12 had three-part fractures, and 2 had four-part fractures. All patients were sustained operation of open reduction and internal fixation. The average delay between trauma and surgery was 4 d (0.5-10.0 d). The operations were performed in invariable operating room with general anesthesia. The fractures were reduced and immobilized with anatomical locking plate through the minimal incision anterolateral acromion during operation. Patients were received passive motion after operation.

RESULTS

All the 32 cases were followed up ranging from 3 to 34 months with an average of 11 months. All the fractures were healed. There was neither failure of internal fixation nor incision infection case. The functional results of the shoulder, according to Constant-Murley score was on an average 86 (range: 69-100).

CONCLUSION

The treatment for proximal humeral fractures through the minimal incision anterolateral acromion approach is a feasible and effective method, which shows good results for treating proximal humerus fractures with correct indication. There are several advantages compared with conventional deltopectoral approach. They are minimal soft tissue disruption, minimal blood loss and easily to manipulate technique. But it required selection of indication strictly and surgeon's experience.

Experimentally Induced Unilateral Tooth Loss: Histochemical Studies of the Temporomandibular Joint

Occlusal abnormality may contribute to osteoarthrosis of the temporomandibular joint (TMJ). Since mechanical force may induce changes in the extracellular matrix, we tested the hypothesis that unilateral removal of teeth and the resulting unilateral mastication change the content of glycosaminoglycans (GAGs) in the TMJ condyle and disc. Lower-right-side teeth were extracted from 12 adult male rabbits, which were killed 3 or 6 weeks later. Three normal rabbits served as controls. Sections were analyzed for morphological changes and levels of sulfated GAGs in the condyle and disc. Unilateral removal of teeth led to thickening of the condylar cartilage, alterations in the morphology of chondrocyte nuclei in the condylar cartilage and disc, and increases in levels of negatively charged ions in the hypertrophic layer of condylar cartilage. Small differences were observed, after unilateral removal of teeth, between the functional and non-functional sides of the TMJ. The results suggest that in response to mechanical stress, chondrocytes alter sulfated glycosaminoglycan (GAGs) synthesis and degradation rates, resulting in an elevated level of sulfated GAGs in the condylar cartilage.

A wireless system with stimulation and recording capabilities for interfacing peripheral nerves in rodents

Considerable progress has been made in the last decade in implantable bioelectronic neurosystems. Yet most neural implants are used in acute and tethered experimental conditions. Here, we present a preliminary prototype of a multichannel system for simultaneous peripheral nerve stimulation and neural recording. The system comprises miniaturized electronics with a total volume of less then 1.4cm3 including a 3.7V battery which is expected to last for 94 days of standby operation or 18 hours of continuous recording and stimulation. Data read-out and device configuration are wireless. Visceral nerves in rodents are interfaced with compliant extraneural electrodes. The 100×350μm2 electrodes display a low impedance (1.8kn at 1kHz) with a PEDOT:PSS coating. We validated the prototype in acute experiments by applying electrical stimulation to the aortic depressor nerve (ADN), resulting in effective and reproducible decrease in blood pressure and heart rate. The combination of miniaturized electronics and flexible electrodes makes the presented system a versatile platform for future implantable devices interfacing small peripheral nerves and potentially enables new applications in the field of neuroscience.

[Down-regulation of miR-146b-5p promotes malignant transformation of fusion cells after co-culture of macrophages with glioma stem cells in vitro]

Objective: To observe mutual interactions between macrophages(Mφ) and glioma stem cells (GSCs)in dual-color tracing model in vitro, to identify the biological characteristics of fusion cells in multiple levels, and to analysis the relevant molecular mechanisms. Methods: Red fluorescent protein(RFP) gene was stably transfected into human GSCs cell line SU4. Mφ cells were obtained from Balb/c nude mice with enhanced green fluorescent protein (EGFP) expression. Then two cells were co-cultured in dual-color tracing platform. RFP/EGFP double positive cells with high proliferation ability were mono-cloned. The fusion cells were verified by Western blot, fluorescence in situ hybridization, immunocytochemistry and chromosome karyotype analysis.The biological characteristics of fusion cells were further analyzed, together with relevant molecular changes. Results: RFP / EGFP double positive cells were obtained through in vitro co-culture. RFP and EGFP coexpression were proved at transcriptional and translational levels in the fusion cells. They also co-expressed GSCs marker Nestin and Mφ marker CD68, and karyotype analysis showed two types of characteristic chromosomes, which confirmed that the fusion cells originated from spontaneous fusion between SU4-RFP and Mφ.Fusion cell proliferation rate and invasion ability were higher than SU4-RFP, which were relevant with down-regulation of miR-146b-5p and activation of STAT3. Fusion cells transfected with miR-146b-5p showed a higher apoptosis rate(18.83%) and lower tumor formation(4/5). Conclusion: Mφ could fuse with GSCs spontaneously in local tumor micro-environment. The proliferation and invasion abilities of fusion cells were higher than their parent cells, which were relevant with down-regulation of miR-146b-5p and activation of STAT3. It revealed the possible mechanisms of malignant progression of gliomas.

[Cadmium burden and renal dysfunction among residents in cadmium-polluted areas: A 3-year follow-up study]

OBJECTIVE

To investigate dynamic change of cadmium body burden and renal dysfunction among residents living in cadmium-polluted areas.

METHODS

From April to July of 2011, the cadmium-polluted areas of northern Guangdong province in China was chosen as the study site. Based on the levels of cadmium pollution in soil and rice, the survey areas were divided into low exposed group (average concentration of cadmium was 0.15-0.40 mg/kg, 0.5-1.0 mg/kg in rice and soil, respectively) and high exposed group (average concentration of cadmium was >0.40 mg/kg, >1.0 mg/kg in rice and soil, respectively). Stratified random sampling and cluster sampling method of epidemiological investigations were carried out among 414 local residents who lived in cadmium exposure areas for more than 15 years, aged above 40, and without occupational cadmium exposure, including 168 and 246 residents in low and high exposed group, respectively. From March to June of 2014, 305 respondents of those who participated in 2011 were successfully traced, including 116 and 189 respondents in low and high exposed group, respectively. We used health questionnaires to acquire their health status. Home-harvested rice and vegetable samples were collected using quartering method for detection of cadmium level, including 190 rice samples, 161 vegetable samples in 2011 and 190 rice samples, 153 vegetable samples in 2014. Urine specimens of residents were collected for the detection of urinary cadmium and creatinine as well as renal dysfunction biomarkers, namely, N-acetyl-beta-D-glucosamidase (NAG) and β2-microglobulin (β2-MG), respectively. In 2011 and 2014, Chi-square test was used to investigate the differences of abnormality of cadmium concentration in rice, vegetables and urinary cadmium, β2-MG, and NAG that were expressed as odds ratio(OR) and 95% confidence intervals (95%CI).

RESULTS

In 2011 and 2014, cadmium concentration P50 (P25-P75) in rice was 0.43 (0.17-1.10) mg/kg, and 0.42 (0.20-1.14) mg/kg, respectively (Z=-0.77,P=0.440). In 2011 and 2014, cadmium concentrations P50 (P25-P75) in vegetables were 0.13 (0.07-0.34) mg/kg, and 0.25(0.12-0.59) mg/kg, respectively, with abnormal rates of 38.5%(62/161) and 60.8%(93/153), respectively. In 2014, both average concentration and abnormal rate of cadmium in vegetables were higher than those in 2011 (Z=-4.69, P<0.001 and χ(2)=15.58,P<0.001). Concentrations of urinary cadmium P50 (P25-P75) in high exposed group were 7.90 (3.96-14.91) μg/g creatinine, 8.64 (4.56-17.60) μg/g creatinine in 2011 and 2014, respectively. Contrary to that in 2011, urinary cadmium of high exposed group was significantly increased in 2014 (Z=-2.80, P=0.005). In 2011 and 2014, concentrations of β2-MG, NAG P50 (P25-P75) were 0.15(0.07-0.29) μg/g creatinine, 0.15 (0.07-0.45) μg/g creatinine, and 7.12 (5.05-10.65) U/g creatinine, 13.55(9.1-19.84) U/g creatinine, respectively, with abnormal rates of 7.5% (23/305), 15.1% (46/305), 8.2% (25/305) , and 33.8% (103/305), respectively. Compared with baseline in 2011, average concentrations of β2-MG, NAG significantly increased in 2014 (Z=-2.263, P=0.024 and Z=-12.52, P<0.001), and abnormal rates of β2-MG, NAG were also higher in 2014 (χ(2)=15.61 , P<0.001 and χ(2)=64.72, P<0.001), with odds ratio(OR) of 2.00 (95%CI:1.23-3.24) and 4.12 (95%CI:2.87-5.92).

CONCLUSION

Environmental cadmium pollution of crops such as rice and vegetables in survey areas continued to remain high. Body burden of cadmium might kept at sustainably high levels and renal dysfunction was worsened after continuous, long-term cadmium exposure. Our results suggested that NAG might be more sensitive than β2-MG to serve as an indicator for an individual's future tubular function.

[The effect of liraglutide in combination with human umbilical cord mesenchymal stem cells treatment on glucose metabolism and β cell function in type 2 diabetes mellitus]

OBJECTIVE

To observe the effect of liraglutide (LIRA) in combination of umbilical cord mesenchymal stem cells (hUC-MSCs) in treating type 2 diabetes mellitus.

METHODS

Eligibility criteria for subjects includes: type 2 diabetes mellitus with more than 10 years duration; having been treated with secretagogues, metformin and insulin in combination with LIRA for at least 6 months; poor glycemic control [glycosylated hemoglobin A1c(HbA1c) 7%-10%]. Totally, twelve patients were enrolled and randomly divided into two groups: the group A (LIRA group, n=6) and the group B (LIRA+ hUC-MSCs group, n=6). The hUC-MSCs were transplanted through infusing of 1×10(6) cells /kg via pancreatic artery directed by interventional radiology on the first day, and followed by infusing 1×10(6) cells /kg through peripheral vein on the eighth, the fifteenth and the twenty-second day sequentially. The control subjects were infused with saline. Both groups were treated with LIRA for 24 weeks at the same period. Fasting plasma glucose(FPG), 2h postprandial plasma glucose(2hPG) and HbA1c were measured. A 75 g oral glucose tolerance test(OGTT)was performed. The early phase of C peptide(CP) secretion function(ΔCP30/ΔG30), the total amount of C peptide secretion function(AUCCP180)and Homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.

RESULTS

(1) The baseline FPG, 2hPG, HbA1c, ΔCP30/ΔG30, AUCCP180 and HOMA-IR were comparable between the two groups(P>0.05). (2) Compared with subjects in group A, FPG, 2hPG and HbA1c levels were significantly decreased in subjects in group B [(8.33±0.99) mmol/L vs (6.64±0.79)mmol/L, (13.85±0.86) mmol/L vs (8.65±1.12) mmol/L, (7.82±0.31)% vs (6.82±0.53)%, P<0.05]. (3) Compared with group A, ΔCP30/ΔG30 and AUCCP180 were significantly increased, and HOMA-IR was significantly decreased in group B(0.22±0.13 vs 0.70±0.38, 12.52±5.30 vs 21.16±3.17, 9.46±4.88 vs 4.30±2.68, P<0.05).

CONCLUSION

LIRA treatment in combination with hUC-MSCs improves glucose metabolism and the β cell function in type 2 diabetic patients. (ClinicalTrials.gov NCT01954147).

A systemic lupus erythematosus patient presenting as type B insulin resistance complicated with cryoglobulinemia

Systemic lupus erythematosus (SLE) patients may present with various symptoms and multisystem damage. We reported a 63-year-old male patient with SLE presenting as type B insulin resistance (TBIR) complicated with cryoglobulinemia. TBIR is an extremely rare disease, which is a manifestation of anti-insulin receptor antibodies (AIRA). Clinical feature is a sudden onset of hyperglycemia with major weight loss; however, the ensuing refractory hypoglycemia is more fatal. The average dosage of exogenous insulin is 5100 U/d. SLE patients with AIRA had poor prognosis, most of whom died of SLE activity. Cryoglobulins are immunoglobulins that reversibly precipitate in the cold, which will induce clinical symptoms. Non-infectious mixed cryoglobulinemia is frequently secondary to autoimmune diseases, such as SLE. Our patient was prescribed methylprednisolone (MP) and cyclophosphamide (CTX). Finally he had remission during the short-term follow-up. To our knowledge, this is the first case report of an SLE patient presenting as TBIR complicated with cryoglobulinemia.

Dynamic dilution exponent in monodisperse entangled polymer solutions

We study and model the linear viscoelastic properties of several entangled semi-dilute and concentrated solutions of linear chains of different molar masses and at different concentrations dissolved in their oligomers. We discuss the dilution effect of the oligomers on the entangled long chains. In particular, we investigate the influence of both concentration and molar mass on the value of the effective dynamic dilution exponent determined from the level of the storage plateau at low and intermediate frequencies. We show that the experimental results can be quantitatively explained by considering the tension re-equilibration process along the chains, in agreement with van Ruymbeke et al. (Macromol., 2014), i.e. by considering that the real dilution exponent α is always equal to 1, while larger values of the dilution exponent (1 < α < 1.3) found experimentally are attributed to the enhanced relaxation of the long chain extremities. Then we discuss the influence of the polymer concentration on the terminal relaxation time of the solutions and how this can be modelled by the enhanced contour length fluctuation process (CR-CLF). We point out that this larger dilution effect is not only a function of concentration but also depends on the molar mass of the chains. While the proposed approach successfully explains the viscoelastic properties of a large number of semi-dilute solutions of polymers in their own oligomers, important discrepancies are found for semi-dilute entangled polymers in small-molecule theta or good solvents. Possible explanations for the differences between these sample sets are proposed, based on the comparison of their viscoelastic behavior.