Predictors of intestinal pseudo-obstruction in systemic lupus erythematosus complicated by digestive manifestations: data from a Southern China lupus cohort

Objective

To determine factors that may predict intestinal pseudo-obstruction (IpsO) in systemic lupus erythematosus (SLE) patients complicated by digestive manifestations.

Methods

SLE patients with digestive manifestations ( n = 135) were followed at Southern Medical University affiliated Nanfang Hospital from 2000 until 2013. Demographic variables, clinical features, and laboratory data were compared between the two groups. Univariate and multivariate logistic regression models were used to establish factors that predispose to IpsO in these patients.

Results

At the end of the study period, 32 (23.7%) patients had developed IpsO. Mortality (9 patients) was infrequent and the cause of death was unrelated to IpsO. Independent predictors of IpsO in SLE were ureterectasia, anti-U1 RNP+, peritonitis, and low C3 levels.

Conclusions

Regular abdominal X-ray examinations are recommended in SLE patients with ureterectasia, anti-U1 RNP+, peritonitis, or low C3 levels, as early diagnosis and therapy may prevent unnecessary surgical intervention and improve the disease course.

Endogenous BDNF augments NMDA receptor phosphorylation in the spinal cord via PLCγ, PKC, and PI3K/Akt pathways during colitis

Background

Spinal central sensitization is an important process in the generation and maintenance of visceral hypersensitivity. The release of brain-derived neurotrophic factor (BDNF) from the primary afferent neurons to the spinal cord contributes to spinal neuronal plasticity and increases neuronal activity and synaptic efficacy. The N-Methyl-D-aspartic acid (NMDA) receptor possesses ion channel properties, and its activity is modulated by phosphorylation of its subunits including the NMDA receptor 1 (NR1).

Methods

Colonic inflammation was induced by a single dose of intracolonic instillation of tri-nitrobenzene sulfonic acid (TNBS). NR1 phosphorylation by BDNF in vivo and in culture was examined by western blot and immunohistochemistry. Signal transduction was studied by direct examination and use of specific inhibitors.

Results

During colitis, the level of NR1 phospho-Ser⁸⁹⁶ was increased in the dorsal horn region of the L1 and S1 spinal cord; this increase was attenuated by injection of BDNF neutralizing antibody to colitic animals (36 μg/kg, intravenous (i.v.)) and was also reduced in BDNF^+/− rat treated with TNBS. Signal transduction examination showed that the extracellular signal-regulated kinase (ERK) activation was not involved in BDNF-induced NR1 phosphorylation. In contrast, the phosphatidylinositol 3-kinase (PI3K)/Akt pathway mediated BDNF-induced NR1 phosphorylation in vivo and in culture; this is an additional pathway to the phospholipase C-gamma (PLCγ) and the protein kinase C (PKC) that was widely considered to phosphorylate NR1 at Ser⁸⁹⁶. In spinal cord culture, the inhibitors to PLC (U73122), PKC (bisindolylmaleimide I), and PI3K (LY294002), but not MEK (PD98059) blocked BDNF-induced NR1 phosphorylation. In animals with colitis, treatment with LY294002 (50 μg/kg, i.v.) blocked the Akt activity as well as NR1 phosphorylation at Ser⁸⁹⁶ in the spinal cord.

Conclusion

BDNF participates in colitis-induced spinal central sensitization by up-regulating NR1 phosphorylation at Ser⁸⁹⁶. The PI3K/Akt pathway, in addition to PLCγ and PKC, mediates BDNF action in the spinal cord during colitis.

Electronic supplementary material

The online version of this article (doi:10.1186/s12974-015-0371-z) contains supplementary material, which is available to authorized users.

EVALUATION OF ANTIVIRAL THERAPY TREATMENT FOR LIVER CIRRHOSIS CAUSED BY CHRONIC HEPATITIS C AND HEPATITIS C BY 31P-MRS, BASED ON METABOLITE DETECTION

This study discusses the application of magnetic resonance spectrum (MRS) to evaluate the efficacy of antiviral therapy in the treatment of liver cirrhosis caused by chronic hepatitis C and hepatitis C, based on metabolite detection. A total of 54 patients with liver cirrhosis caused by chronic hepatitis C and hepatitis C were selected and divided into treatment group and control group. 31P-MRS imaging was carried out on patients in the two groups both before receiving antiviral treatment and 6 months after treatment to compare the change of metabolite ratio (PE+PC)/(GPE+GPC). It was revealed that no statistically significant difference was found in the comparison of (PC+PE)/(GPC+GPE) ratio in the two groups before treatment, but the difference was found 6 months after treatment; ratio of (PC+PE)/ (GPC+GPE) in the treatment group distinctly decreased 6 months after treatment compared to before treatment, with a statistically significant difference, while the control group had no remarkable change or statistical significance. Moreover, 32 patients were found with sustained virus response to antiviral therapy. Of these, 25 patients possessed a decreased ratio of (PC+PE)/ (GPC+GPE), 4 remained without change and 3 had a slightly increased ratio after antiviral treatment. Of 12 patients with no response, 1 had a decreased ratio of (PC+PE)/ (GPC+GPE), 2 remained without change and 9 had a slightly increased ratio. The differences were all statistically significant in comparison of the two groups. 31P-MRS is thought to be effective for evaluating the efficacy of antiviral therapy through non-invasive detection of liver energy metabolism.

Unusual optic disc infarction in a case of arteritic anterior ischaemic optic neuropathy (AAION)

Herein, we report another case of arteritic anterior ischaemic optic neuropathy from Singapore, in which the initial optic disc swelling was extreme and the sequential disease resolved because the patient was already on maximum treatment. As the management of this biopsy-proven giant cell arteritis case was complicated by the presence of a number of other medical conditions, including end-stage renal failure, monitoring of the response to treatment proved problematic.

A multi-centre randomised trial comparing ultrasound vs mammography for screening breast cancer in high-risk Chinese women

Background:

Chinese women tend to have small and dense breasts and ultrasound is a common method for breast cancer screening in China. However, its efficacy and cost comparing with mammography has not been evaluated in randomised trials.

Methods:

At 14 breast centres across China during 2008–2010, 13 339 high-risk women aged 30–65 years were randomised to be screened by mammography alone, ultrasound alone, or by both methods at enrolment and 1-year follow-up.

Results:

A total of 12 519 and 8692 women underwent the initial and second screenings, respectively. Among the 30 cancers (of which 15 were stage 0/I) detected, 5 (0.72/1000) were in the mammography group, 11 (1.51/1000) in the ultrasound group, and 14 (2.02/1000) in the combined group (P=0.12). In the combined group, ultrasound detected all the 14 cancers, whereas mammography detected 8, making ultrasound more sensitive (100 vs 57.1%, P=0.04) with a better diagnostic accuracy (0.999 vs 0.766, P=0.01). There was no difference between mammography and ultrasound in specificity (100 vs 99.9%, P=0.51) and positive predictive value (72.7 vs 70.0% P=0.87). To detect one cancer, the costs of ultrasound, mammography, and combined modality were $7876, $45 253, and $21 599, respectively.

Conclusions:

Ultrasound is superior to mammography for breast cancer screening in high-risk Chinese women.

New erythromycin derivatives enhance β-lactam antibiotics against methicillin-resistant Staphylococcus aureus

Newly synthesized erythromycin derivatives were screened for synergy with oxacillin and other β-lactam antibiotics against methicillin-resistant Staphylococcus aureus (MRSA). MRSA ATCC43300 and some clinically isolated MRSA were used. Several erythromycin derivatives were found to possess high synergism with oxacillin against MRSA. The newly synthesized erythromycin derivatives were also tested for their inhibitory effects against MRSA, either separately or in combination with oxacillin, using serial broth dilution, disc diffusion, Etest strips, growth curves and time-kill curves. A representative derivative, SIPI-8294, could potentiate almost all β-lactam antibiotics tested against the model strain MRSA ATCC43300 from 4 to 128 times and had synergism with oxacillin against 12 of 16 clinical isolates of MRSA under one-fourth of the minimum inhibitory concentration (MIC) of the compounds. This is the first report on the synergistic activity of these new erythromycin derivatives. These findings provide a new choice for the treatment of infection caused by MRSA and lead us to further study the synergistic mechanism.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study is the first report on the synergy of anti-MRSA between new erythromycin derivatives and β-lactam antibiotics in vitro. The results show that although the erythromycin derivatives have poor anti-MRSA effects alone, they possess high synergism with oxacillin against MRSA ATCC43300 and clinically isolated MRSA. These novel compounds can significantly reduce the dosage of β-lactam antibiotics against MRSA, while this synergistic effect is different from the combination of β-lactams and β-lactamase inhibitors. The research may provide a new choice for the treatment of infection caused by MRSA and be useful to the research and development of new combination of medicines.

Virologic and Immunologic Impact and Durability of Enfuvirtide-Based Antiretroviral Therapy in HIV-Infected Treatment-Experienced Patients in a Clinical Setting

OBJECTIVE

To evaluate the effectiveness and safety of enfuvirtide-based therapy in treatment-experienced patients in a clinical setting.

METHOD

Retrospective study of treatment-experienced patients receiving enfuvirtide-based therapy for a minimum of 2 months. Endpoints included virologic suppression, virologic rebound, immunologic response, and adverse events.

RESULTS

Sixty-four patients were eligible for inclusion in the analysis. Median baseline viral load and CD4+ count were 4.7 log10 copies/mL (interquartile range [IQR], 4.0-5.2) and 150 cells/mm3 (IQR, 60-250), respectively. At month 12, viral load declined by a median of 2.53 log10 copies/mL (IQR, 0.97-3.12). The unadjusted median time to virologic suppression was 7.7 months (95% CI 4.1-10.4 months). Baseline viral load and number of protease inhibitors in the current regimen were significantly associated with virologic suppression following multivariate analysis (hazard ratio [HR] 0.45, 95% CI 0.31-0.63, p < .0001, and HR 0.51, 95% CI 0.27-0.94, p = .03, respectively). Among the 42 patients who attained sustained virologic suppression, 10 experienced virologic rebound during a median follow-up of 13.3 months (IQR, 7.0-19.1). Injection site reactions were reported in 33 (52%) patients, resulting in treatment discontinuation in nine patients.

CONCLUSION

Enfuvirtide-based therapy provides durable antiretroviral activity for treatment-experienced patients in a clinical setting.

Inhibition of NMDAR reduces bladder hypertrophy and improves bladder function in cyclophosphamide induced cystitis

PURPOSE

We examined the role of NMDAR in the regulation of bladder hypertrophy and function in a rat model of cyclophosphamide induced cystitis.

MATERIALS AND METHODS

Cystitis was induced by intraperitoneal injection of cyclophosphamide (150 mg/kg body weight). NMDAR phosphorylation (activity) and signal transduction pathways were examined by direct measurement and by specific inhibitors in vivo. Bladder hypertrophy was measured by bladder weight/body weight and type I collagen expression. Bladder function was examined by metabolic recording, conscious cystometry and detrusor muscle strip contractility in response to carbachol.

RESULTS

NMDAR activity measured by the phosphorylation level of the NMDAR1 (NR1) subunit was expressed in the spinal cord but not in the bladder at 48 hours of cystitis. NMDAR inhibition with dizocilpine (MK-801) reduced the cystitis induced increment of bladder weight and type I collagen up-regulation in the bladder. NMDAR regulated type I collagen up-regulation was mediated by the PI3K/Akt pathway. NMDAR inhibition also attenuated cystitis induced urinary frequency measured by metabolic cage and cystometry. Cystitis decreased the responsiveness of detrusor muscle strips to carbachol, which was reversed by MK-801 in vivo. Unlike MK-801 the NMDAR antagonist D-AP5, which could not block central NMDAR activity, had no effect on bladder hypertrophy, type I collagen up-regulation or Akt activation caused by cystitis in the bladder.

CONCLUSIONS

Findings suggest that NMDAR activity has a role in cystitis induced bladder hypertrophy and overactivity. NMDAR mediated Akt activation may underlie the mechanism of bladder dysfunction.

Emergence of Staphylococcal Cassette ChromosomemecType IV Methicillin-ResistantStaphylococcus aureusas a Cause of Ventilator-Associated Pneumonia

Staphylococcal cassette chromosomemec(SCCmec) type IV methicillin-resistantStaphylococcus aureus(MRSA) strains were identified in 8 (19.5%) of 41 consecutive patients with MRSA ventilator-associated pneumonia (VAP) in this retrospective, observational study. There were no significant differences in VAP severity and crude mortality rates between patients with SCCmectype II strains and patients with SCCmectype IV strains.

FBXO32, a new TGF-β/Smad signaling pathway target gene, is epigenetically inactivated in gastric cardia adenocarcinoma

FBXO32 has recently been identified as a TGF-β/Smad signaling pathway target gene, involved in regulating cell survival and may be transcriptionally silenced by epigenetic mechanisms in some kind of carcinomas. The present study was to investigate the role and promoter methylation status of FBXO32 in gastric cardia adenocarcinoma (GCA), and determine the prognostic significance of FBXO32 in GCA. Bisulfite Conversion-Specific and Methylation-Specific PCR, real-time RT-PCR and immunohistochemical staining methods were used to detect the methylation status and expression of FBXO32 in GCA samples. The frequency of FBXO32 methylation in GCA tumor tissues (44.6%) was significantly higher than that in corresponding normal tissues (3.6%) and was associated with TNM stage, pathological differentiation, distant metastasis or recurrence and upper gastrointestinal cancers (UGIC) family history. Decreased mRNA and protein expression of FBXO32 was observed in GCA tumor tissues and was associated with FBXO32 promoter methylation status. A positive correlation between FBXO32 and p-Smad2/3, Smad4 protein expression was also found in clinical specimens. GCA patients in stage III and IV, with positive UGIC family history, and hypermethylation and down-expression of FBXO32 were most likely to develop metastatic disease and also showed the worse survival. In all, aberrant hypermethylation of FBXO32 may be one of the mechanisms that lead to loss or down expression of the gene in GCA, FBXO32 may be a functional tumor suppressor and reactivation of FBXO32 gene may has therapeutic potential and may be used as a prognostic marker for GCA patients.

Suppression of the PI3K pathway in vivo reduces cystitis-induced bladder hypertrophy and restores bladder capacity examined by magnetic resonance imaging

This study utilized magnetic resonance imaging (MRI) to monitor the real-time status of the urinary bladder in normal and diseased states following cyclophosphamide (CYP)-induced cystitis, and also examined the role of the phosphoinositide 3-kinase (PI3K) pathway in the regulation of urinary bladder hypertrophy in vivo. Our results showed that under MRI visualization the urinary bladder wall was significantly thickened at 8 h and 48 h post CYP injection. The intravesical volume of the urinary bladder was also markedly reduced. Treatment of the cystitis animals with a specific PI3K inhibitor LY294002 reduced cystitis-induced bladder wall thickening and enlarged the intravesical volumes. To confirm the MRI results, we performed H&E stain postmortem and examined the levels of type I collagen by real-time PCR and western blot. Inhibition of the PI3K in vivo reduced the levels of type I collagen mRNA and protein in the urinary bladder ultimately attenuating cystitis-induced bladder hypertrophy. The bladder mass calculated according to MRI data was consistent to the bladder weight measured ex vivo under each drug treatment. MRI results also showed that the urinary bladder from animals with cystitis demonstrated high magnetic signal intensity indicating considerable inflammation of the urinary bladder when compared to normal animals. This was confirmed by examination of the pro-inflammatory factors showing that interleukin (IL)-1α, IL-6 and tumor necrosis factor (TNF)α levels in the urinary bladder were increased with cystitis. Our results suggest that MRI can be a useful technique in tracing bladder anatomy and examining bladder hypertrophy in vivo during disease development and the PI3K pathway has a critical role in regulating bladder hypertrophy during cystitis.

The urinary bladder of spontaneously hypertensive rat demonstrates bladder hypertrophy, inflammation, and fibrosis but not hyperplasia

AIMS

The present study aims to systemically characterize the factors that are associated with urinary bladder organ enlargement in spontaneously hypertensive rats (SHR).

MAIN METHODS

We compared the SHR to age-matched normotensive Wistar-Kyoto (WKY) control rats in the levels of bladder pro-inflammatory factors, collagen expression (type I), and detrusor smooth muscle growth.

KEY FINDINGS

Our results showed that enhanced inflammatory responses and fibrosis were key factors that were closely associated with bladder wall thickening in SHR. Specifically the mRNA levels of inflammatory factors interleukin (IL)-1α, IL-6 and TNFα were significantly higher in SHR than those in WKY rats. The SHR also had a higher number of mast cells in the suburothelium space. Type I collagen production was also significantly higher in SHR when compared to that in control rats. However, the smooth muscle content stayed the same in SHR and WKY rats. This was shown by the results that the ratio of α-smooth muscle actin (SMA) to the nuclear protein histone H3 had no difference between these two rat strains. The mRNA and protein levels of proliferating cell nuclear antigen (PCNA) also showed no change in the urinary bladder of SHR and WKY rats. Further study showed that the phosphorylation level of Akt in the urinary bladder was not changed in SHR when compared to WKY rats. In contrast, the phosphorylation level of ERK1/2 was significantly higher in SHR bladder when compared to that of WKY rats.

SIGNIFICANCE

These results suggest that inflammation and fibrosis are primary factors that may lead to urinary bladder hypertrophy in SHR.

The site of attachment of umbilical cord and branching pattern of umbilical arteries within the placenta

Placenta is the mirror of maternal and fetal status; it reflects the changes due to complication in pregnancy of mother. Numerous common and uncommon findings of the placenta, umbilical cord and membranes are associated with abnormal fetal development and perinatal morbidity. So, the examination of the placenta can yield information that may be important in the immediate and later management of mother and newborn. This information may also be essential for protecting the attending physician in the event of an adverse maternal or fetal outcome. This cross sectional descriptive study was carried out to determine the incidence of different types of placenta depending on attachment site and branching pattern of arteries of umbilical cord in Bangladeshi Women. To achieve this aim sixty placenta with umbilical cord were collected. Placenta was from 28 weeks to 42 weeks gestational age of normal pregnancy during normal labour at gynaecology and obstetric department of Mymensingh Medical College Hospital. After preservation in 10% formol saline, study was done in the Department of Anatomy of Mymensingh Medical College. In the present study, incidence of different types of placenta depending on attachment site of umbilical cord was 50% Central, 46% Paracentral and 18% Marginal in type. In this study it was also observed that 58% placenta were Disperse in type and 42% were Magistral in type depending on the distribution of umbilical arteries. Observed findings of this study were compared with those of Western and Bangladeshi researchers.