Realistic expectations for treatment success in Alzheimer's disease

Alzheimer's disease (AD) is a progressive degenerative disease that warrants active management to delay or slow progression of its symptoms. The symptoms of AD encompass behavior and daily function as well as cognition, so clinicians should take a global view in the assessment of treatment success. Because there is currently no cure for AD, one cannot expect an initial cognitive improvement observed in the first few months of therapy to be sustained indefinitely. However, one should expect that the patient who is treated early and persistently with medication for AD will show less evidence of behavioral, functional, and cognitive deterioration over a period of time than one would expect in the absence of pharmacotherapy. Thus, treatment success includes not only short-term improvement of symptoms but also less decline over the long term. Determination of treatment success therefore also requires awareness of the typical progression of untreated AD. In this article we review the natural history of AD and evidence for the effectiveness of the treatments indicated for AD: donepezil, galantamine, rivastigmine, and memantine.

[Subtype and sequence analysis of the ENV gene of HIV-1 drug users in Guangdong Pearl River delta.]

BACKGROUND

To determine the subtype of HIV-1 of drug users (DUS) in Guangdong Pearl River delta.

METHODS

HIV-1 pro-viral DNA from buffy coat of 43 DUS in Guangdong was amplified by nested PCR. The C2-V3 regions of HIV-1 ENV gene was sequenced directly from the PCR product and analyzed.

RESULTS

The 43 DUS were confirmed to be infected with four HIV-1 subtype or Circulating Recombinant Form (CRFs): 07-BC(n=29), AE(n=9), 08-BC(n=3) and B(n=2). Genetic distances showed that the AE group was the closest to CM240 strain isolated in Thailand which is mainly circulating in sexually transmitted infector. The 07-BC group was the closest to C54A strain isolated in Northeastern China. The 08-BC group was the closest to 97CNGX-9F strain isolated in Guangxi, China. The B strain was the closest to rl42 strain isolated in Thailand.

CONCLUSION

HIV-1 CRFs 07-BC predominates in DUS in Guangdong Pearl River delta.

Fusion of CpG-ODN-stimulating dendritic cells with Lewis lung cancer cells can enhance anti-tumor immune responses

Immunogenicity of tumor cells is generally weak. Therefore, dendritic cells (DCs) have been used to boost anti-tumor responses of DC-based vaccines. DC function is highly dependent on its subsets and the level of its maturation. Nowadays, DC/tumor cell fusion vaccines are already used in clinical trials, and there are numerous studies discussing the effects of cytidine-phosphate-guanosine-containing oligonucleotides (CpG-ODN) on various cell types including DC. CpG-ODN a powerful immuno-stimulant can drive DCs fully mature, thus improve the efficacy of vaccine therapy. There are two simple ways to help load tumor antigens onto DCs by direct contact with cells themselves: fusion or co-culture of DCs with whole tumor cells. In this study, we combined these two approaches to improve the efficacy of DC/tumor cell-based vaccine. Mature DCs are adept at presenting processed Ag to T cells with loss of its capacity to capture Ag, while immature DCs are on the contrary. Our results emphasize the necessity of considering the stage of DC maturation and corresponding choice of tumor antigen delivery when designing approaches for prophylaxis or therapy of tumors using DC-based immunization protocols. We used CpG-ODN-1826-stimulated mature DCs and non-CpG-ODN-stimulating DCs as sources of tumor antigen carriers to investigate the appropriate Ag-loading ways between fusion and co-culture. Our results displayed that DC/tumor vaccine using CpG-ODN-stimulating mature DCs fused, not co-cultured, with tumor cells can generate a consistent and highly effective anti-tumor immune responses in vivo.

Improved health-related quality of life for rheumatoid arthritis patients treated with abatacept who have inadequate response to anti-TNF therapy in a double-blind, placebo-controlled, multicentre randomized clinical trial

OBJECTIVE

Rheumatoid arthritis (RA) patients who have inadequate response to anti-tumour necrosis factor (TNF) therapy currently have treatment options that are limited and less than optimal in their risk-to-benefit ratio. Abatacept provides a new generation of RA medications that has previously been demonstrated to have positive clinical outcomes with this population. The current study sought to demonstrate the efficacy of abatacept on quality of life (QoL) for RA patients with inadequate response to anti-TNF therapy.

METHODS

Patients were entered into a double-blind, placebo-controlled, multicentre randomized clinical trial, with 258 patients randomized to abatacept + disease-modifying anti-rheumatic drugs (DMARDs) and 133 patients randomized to placebo + DMARDS. The QoL was measured with the Short Form Health Survey (SF-36), Health Assessment Questionnaire (HAQ) and fatigue visual analogue scale, and was analysed with basic (ANOVA, chi-square) and multigroup growth curve techniques to assess differential change over time.

RESULTS

Treatment group QoL improved significantly more than placebo on the HAQ and fatigue indices, as well as seven of the eight SF-36 scales and SF-36 physical and mental summary scores. Improvement rate was faster for abatacept than for placebo on the QoL measures, and the improvements from abatacept related to normal levels of QoL on many domains.

CONCLUSION

Clinically relevant benefits of abatacept over placebo are discussed regarding improving QoL. Importantly, the larger rate of change for abatacept over placebo provides clinicians with a medication that can lead to meaningful changes in a patient's life within a few weeks, even when the patient previously failed anti-TNF therapy.

Direct comparison of18F-fluorodeoxyglucose coincidence gamma camera tomography with gallium scanning for the staging of lymphoma

BACKGROUND

The present study compared the performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) using a coincidence dual-head gamma camera (FDG Co-PET) with 67gallium scinti graphy (GS) in pretreatment staging of lymphoma.

METHODS

A total of 46 patients underwent FDG Co-PET, computed tomography (CT) scanning and GS for pretreatment staging of lymphoma (40 newly diagnosed and recurrence) between November 1997 and December 1999.

RESULTS

Histological subgroups comprised low grade (8 patients), intermediate grade (25) high-grade (3) non-Hodgkin's lymphoma and Hodgkin's disease (10). Based on clinical assessment, CT scan findings and biopsy, 100 nodal sites and 15 extra-nodal sites were deemed positive. FDG Co-PET was superior to GS in nodal site positivity rate (97%vs 79%, P < 0.0001). Compared with GS, FDG Co-PET detected 39 more abnormal sites in 22 patients (48%), of which 28 sites were validated by biopsy, CT and/or progress FDG Co-PET scanning. There was only one proven false negative FDG site in the spleen. CT + FDG Co-PET led to upstaging in 2 patients (4%), compared to CT + GS.

CONCLUSION

FDG Co-PET shows potential for providing an accurate means for pretreatment staging of lymphoma and can detect extra sites of disease activity compared to GS.

Fourier transform infrared imaging spectroscopy analysis of collagenase-induced cartilage degradation

Collagenase treatment of cartilage serves as an in vitro model of the pathological collagen degradation that occurs in the disease osteoarthritis (OA). Fourier transform infrared imaging spectroscopic (FT-IRIS) analysis of collagenase-treated cartilage is performed to elucidate the molecular origin of the spectral changes previously found at the articular surface of human OA cartilage. Bovine cartilage explants are treated with 0.1% collagenase for 0, 15, or 30 min. In situ collagen cleavage is assessed using immunofluorescent staining with an antibody specific for broken type II collagen. The FT-IRIS analysis of the control and treated specimens mirrors the differences previously found between normal and OA cartilage using an infrared fiber optic probe (IFOP). With collagenase treatment, the amide II/1338 cm(-1) area ratio increases while the 1238 cm(-1)/1227 cm(-1) peak ratio decreases. In addition, polarized FT-IRIS demonstrates a more random orientation of the collagen fibrils that correlate spatially with the immunofluorescent-determined regions of broken type II collagen. We can therefore conclude that the spectral changes observed in the collagenase-treated cartilage, and similarly in OA cartilage, arise from changes in collagen structure. These findings support the use of mid-infrared spectral analysis, in particular the minimally invasive IFOP, as potential techniques for the diagnosis and management of degenerative joint diseases such as osteoarthritis.

The activation profile of tumour-associated reactive T-cells differs in the nodular and diffuse patterns of lymphocyte predominant Hodgkin's disease

AIMS

To compare the activation profile of T-cells in reactive lymphoid follicles with that of tumour-associated T-cells in lymphocyte predominant Hodgkin's disease (LPHD) with a nodular pattern (n = 21), LPHD with partial diffuse growth pattern (n = 11) and T-cell-rich large B-cell lymphoma (TCRLBCL, n = 8).

METHODS AND RESULTS

Reactive germinal centres showed sparse numbers of T-cells positive for CD134, a transient/early T-cell activation marker, and only scattered T-cells in the interfollicular areas positive for CD38, a marker of persistent activation. Lymphoid follicles showing progressive transformation of germinal centres (PTGC) had more numerous CD134+ T-cells which were negative for CD38. Tumour-associated T-cells in nodular LPHD were frequently positive for CD134 (15 of 16 cases, 94%), but negative or only focally positive for CD38 (three of 21 cases, 14%). LPHD with diffuse areas, however, showed increased CD38+ T-cells in the diffuse component in 10 of 11 (90%) cases, with CD134+ T-cells being more prominent in the nodular tumour component. TCRLBCL showed strong, uniform CD38 expression in T-cells and histiocytes in eight cases.

CONCLUSIONS

T-cells in nodular LPHD express markers of transient/early T-cell activation. By contrast, T-cells in the diffuse form of LPHD, similar to those in TCRLBCL, have an immunostaining profile consistent with persistent cellular activation. T-cell activation may precede or accompany histological progression in nodular LPHD and immunostaining for these markers, in small samples or in difficult cases, may be useful in highlighting those cases of LPHD undergoing histological progression.

Mode-specific photoelectron scattering effects on CO2+(C 2Σg+) vibrations

Using high-resolution photoelectron spectroscopy, we have determined the energy dependent vibrational branching ratios for the symmetric stretch [v+ = (100)], bend [v+ = (010)], and antisymmetric stretch [v+ = (001)], as well as several overtones and combination bands in the 4sigmag(-1) photoionization of CO2. Data were acquired over the range from 20-110 eV, and this wide spectral coverage highlighted that alternative vibrational modes exhibit contrasting behavior, even over a range usually considered to be dominated by atomic effects. Alternative vibrational modes exhibit qualitatively distinct energy dependences, and this contrasting mode-specific behavior underscores the point that vibrationally resolved measurements reflect the sensitivity of the electron scattering dynamics to well-defined changes in molecular geometry. In particular, such energy-dependent studies help to elucidate the mechanism(s) responsible for populating the symmetry forbidden vibrational levels [i.e., v+ =( 010), (001), (030), and (110)]. This is the first study in which vibrationally resolved data have been acquired as a function of energy for all of the vibrational modes of a polyatomic system. Theoretical Schwinger variational calculations are used to interpret the experimental data, and they indicate that a 4sigmag-->ksigmau shape resonance is responsible for most of the excursions observed for the vibrational branching ratios. Generally, the energy dependent trends are reproduced well by theory, but a notable exception is the symmetric stretch vibrational branching ratio. The calculated results display a strong peak in the vibrational branching ratio while the experimental data show a pronounced minimum. This suggests an interference mechanism that is not accounted for in the single-channel adiabatic-nuclei calculations. Electronic branching ratios were also measured and compared to the vibrational branching ratios to assess the relative contributions of interchannel (i.e., Herzberg-Teller) versus intrachannel (i.e., photoelectron-mediated) coupling.

Identification of Lps2 as a key transducer of MyD88-independent TIR signalling

In humans, ten Toll-like receptor (TLR) paralogues sense molecular components of microbes, initiating the production of cytokine mediators that create the inflammatory response. Using N-ethyl-N-nitrosourea, we induced a germline mutation called Lps2, which abolishes cytokine responses to double-stranded RNA and severely impairs responses to the endotoxin lipopolysaccharide (LPS), indicating that TLR3 and TLR4 might share a specific, proximal transducer. Here we identify the Lps2 mutation: a distal frameshift error in a Toll/interleukin-1 receptor/resistance (TIR) adaptor protein known as Trif or Ticam-1. Trif(Lps2) homozygotes are markedly resistant to the toxic effects of LPS, and are hypersusceptible to mouse cytomegalovirus, failing to produce type I interferons when infected. Compound homozygosity for mutations at Trif and MyD88 (a cytoplasmic TIR-domain-containing adaptor protein) loci ablates all responses to LPS, indicating that only two signalling pathways emanate from the LPS receptor. However, a Trif-independent cell population is detectable when Trif(Lps2) mutant macrophages are stimulated with LPS. This reveals that an alternative MyD88-dependent 'adaptor X' pathway is present in some, but not all, macrophages, and implies afferent immune specialization.

Fabrication and characterization of hydroxyapatite reinforced with 20 vol % Ti particles for use as hard tissue replacement

Hydroxyapatite(HA)-based composite reinforced with 20 vol % titanium (Ti) particles was fabricated by hot pressing based on the studies of the structural stability of HA phase in HA-Ti composite by means of FTIR spectrometry and X-ray diffractometry. The mechanical properties and biological behaviors of the composite were investigated by mechanical and in vivo studies. The existence of Ti metal phase can promote the dehydration and decomposition of HA ceramic phase into the more stable calcium phosphate phases, such as alpha-Ca(3)(PO(4))(2) (alpha-TCP) and Ca(4)O(PO(4))(2) at high temperatures. Comparing with pure HA ceramic manufactured under the same conditions, HA-20 vol % Ti composite with higher fracture toughness (0.987 MPa m(1/2)), bending strength (78.59 MPa), work of fracture (12.8J/m(2)), porosity (9.8%) and lower elastic modulus (75.91 GPa) is more suitable for use as hard tissue replacement. Crack deflection is the chief toughening mechanism in the composite. Histological evaluation by light microscope shows HA-20 vol % Ti composite implant could be partially integrated with newborn bone tissues after 3 weeks and fully osteointegrated at 12 weeks in vivo. The excellent biological properties of HA-20 vol % Ti composite may be contributed to the coexistence of high porosity and the decomposition products of HA phase in the composite.

Extraction and purification of decorin from corneal stroma retain structure and biological activity

We developed a method to purify decorin core protein from tissue with the goal of preserving its native structure and biological function. Currently, most procedures rely on the use of denaturing reagents potentially altering the biological activity. Decorin was purified from corneal stromas without the use of detergents or chaotropic reagents. Proteoglycans isolated using anion exchange chromatography on Q-Sepharose were treated with chondroitinase ABC. Decorin was isolated by a second Q-Sepharose chromatography with affinity chromatographies on heparin-Sepharose and concanavalin A-Sepharose. SDS-PAGE revealed a 98.4% pure 44kDa protein identified as decorin with a yield of 35mg per 100 bovine corneas. Identification was confirmed by NanoESI and MALDI qTOF. The novel inclusion of 20% propylene glycol in extraction and column buffers resulted in recoveries of proteoglycans comparable with those observed with detergents and urea. Purified decorin did alter the rate of fibrillogenesis of type I collagen and inhibited the lateral fusion of collagen fibrils. It also bound to [125I]TGF-beta1 with an apparent K(d) of 40nM. Circular dichroism spectroscopy of decorin displayed the spectra of alpha-helices and beta-pleated sheets consistent with those obtained from recombinant decorin. Urea-induced unfolding was cooperative and reversible while thermal denaturation caused irreversible unfolding. Native decorin can be purified from tissue in quantity and quality for biophysical, biochemical, and biological assays.

Colossal magnetoresistance is a Griffiths singularity

It is now widely accepted that the magnetic transition in doped manganites that show large magnetoresistance is a type of percolation effect. This paper demonstrates that the transition should be viewed in the context of the Griffiths phase that arises when disorder suppresses a magnetic transition. This approach explains unusual aspects of susceptibility and heat capacity data from a single crystal of La0.7Ca0.3MnO3.

Galpha i3 binding to calnuc on Golgi membranes in living cells monitored by fluorescence resonance energy transfer of green fluorescent protein fusion proteins

Galphai3 is found both on the plasma membrane and on Golgi membranes. Calnuc, an EF hand protein, binds both Galphai3 and Ca(2+) and is found both in the Golgi lumen and in the cytoplasm. To investigate whether Galphai3 binds calnuc in living cells and where this interaction takes place we performed fluorescence resonance energy transfer (FRET) analysis between Galphai3 and calnuc in COS-7 cells expressing Galphai3-yellow fluorescent protein (YFP) and calnuc-cyan fluorescent protein (CFP). The tagged proteins have the same localization as the endogenous, nontagged proteins. When Galphai3-YFP and calnuc-CFP are coexpressed, a FRET signal is detected in the Golgi region, but no FRET signal is detected on the plasma membrane. FRET is also seen within the Golgi region when Galphai3 is coexpressed with cytosolic calnuc(DeltaN2-25)-CFP lacking its signal sequence. No FRET signal is detected when Galphai3(DeltaC12)-YFP lacking the calnuc-binding region is coexpressed with calnuc-CFP or when Galphai3-YFP and calnuc(DeltaEF-1,2)-CFP, which is unable to bind Galphai3, are coexpressed. Galphai3(G2AC3A)-YFP lacking its lipid anchors is localized in the cytoplasm, and no FRET signal is detected when it is coexpressed with wild-type calnuc-CFP. These results indicate that cytosolic calnuc binds to Galphai3 on Golgi membranes in living cells and that Galphai3 must be anchored to the cytosolic surface of Golgi membranes via lipid anchors for the interaction to occur. Calnuc has the properties of a Ca(2+) sensor protein capable of binding to and potentially regulating interactions of Galphai3 on Golgi membranes.

[Clinical study of decompression of optic nerve through combined orbit, ethmoid and sphenoid approach]

OBJECTIVE

To improve the level of diagnosis and treatment of optic nerve trauma at the canalicular segment.

METHOD

Fifty-two patients with optic nerve trauma at the canalicular segment received decompression of optic canal through combined orbit, ethmoid and sphenoid approach.

RESULT

The visual improvement rate of all 52 patients was 42.3%, 73.9% in 23 patients with secondary optic trauma and 17.2% in 29 patients with primary optic trauma. Patients's vision covered from 0.05 to 0.6 after six months.

CONCLUSION

The advantages of decompression of optic nerve through combined orbit, ethmoid and sphenoid approach include easily operation and location, short approach, wide visual field and clear anatomy mark, so it is very safe and suited for those patients with dysplasia and osteosclerosis of ethmoidal or sphenoidal sinus. Orbital CT scan facilitates the diagnosis of optic canal fracture without false positive results. The curative effect is associated with the type of optic nerve trauma and the chance of surgery. Amaurosis shortly after trauma is a dangerous factor of poor prognosis, but it isn't impossible to improve vision if patients receive operation as early as possible.