Prediction for relapse and prognosis of newly diagnosed epilepsy

OBJECTIVE

The objective of this study was to investigate the timing of therapy initiation and other clinical factors as potential predictors for relapse and prognosis of epilepsy, based on hospital-based prospective observational data in China.

METHODS

One hundred and seventy-one newly diagnosed patients with one or more seizures were recruited and followed for at least 2 years. Kaplan-Meier survival analysis was used for calculating recurrence and remission rates. Univariate and multivariate analyses for risk factors were performed using Cox proportional hazards model.

RESULTS

Among the 171 patients analyzed, more patients had partial (54.4%) than generalized seizures (45.6%). The range of patients' age was 6-70 years, but 70% were under 16 years of age. Multiple seizure types (HR = 2.01; 95% CI, 1.31-3.10), epileptiform electroencephalogram (EEG) abnormality (HR = 1.95; 95% CI, 1.09-3.49), and >1 seizure monthly before treatment (HR = 2.74; 95% CI, 1.69-4.51) were predictors of seizure recurrence. The best negative predictors of remission were as follows: relapse (HR = 0.13; 95% CI, 0.07-0.23) and epileptiform EEG within 1 year of treatment (HR = 0.61; 95% CI, 0.39-0.97). Delayed treatment after three or more seizures did not significantly increase the risk of recurrence (P = 0.70) or remission (P = 0.31) compared with early treatment after one or two seizures.

CONCLUSIONS

Multiple seizure types, epileptiform EEG abnormality, and >1 seizure monthly before treatment predict seizure recurrence. Relapse and epileptiform EEG within 1 year of treatment predict adverse seizure outcome. Early treatment does not affect relapse or prognosis.

Polymorphisms of the PNPLA3 gene and their associations with chicken growth and carcass traits

1. An F(2) resource population of Gushi chickens crossed with Anka broilers was used to investigate the genetic effects of the chicken PNPLA3 gene on growth and adipose accumulation. 2. Associations between three SNPs (g.40006G > T, g.42344T > C and g.42404A > T) and broiler traits were determined using linkage disequilibrium, haplotype construction and association analysis. 3. The g.40006G > T mutation was associated with body weights at 4, 6, 8, 10 and 12 weeks of age, carcass weight, evisceration weight and semi-evisceration weight (P < 0.05). 4. Haplotypes of the g.42344T > C and g.42404A > T mutations were associated with body weight at 12 weeks, carcass weight, evisceration weight, and semi-evisceration weight (P < 0·05) and were associated with significant dominance effects. 5. The results suggest that the PNPLA3 gene may be in linkage with the causative mutation or a QTL controlling growth traits in chickens. In contrast to human studies, the polymorphisms were not associated with fat related traits.

SS18-SSX2 and the mitochondrial apoptosis pathway in mouse and human synovial sarcomas

Synovial sarcoma is a deadly malignancy with limited sensitivity to traditional cytotoxic chemotherapy. SS18-SSX fusion oncogene expression characterizes human synovial sarcomas and drives oncogenesis in a mouse model. Elevated expression of BCL2 is considered a consistent feature of the synovial sarcoma expression profile. Our objective was to evaluate the expression of apoptotic pathway members in synovial sarcomas and interrogate the impact of modulating SS18-SSX expression on this pathway. We show in human and murine synovial sarcoma cells that SS18-SSX increases BCL2 expression, but represses other anti-apoptotic genes, including MCL1 and BCL2A1. This repression is achieved by directly suppressing expression via binding through activating transcription factor 2 (ATF2) to the cyclic adenosine monophosphate (AMP) response element (CRE) in the promoters of these genes and recruiting TLE1/Groucho. The suppression of these two anti-apoptotic pathways silences the typical routes by which other tumors evade BH3-domain peptidomimetic pharmacotherapy. We show that mouse and human synovial sarcoma cells are sensitive in vitro to ABT-263, a BH3-peptidomimetic, much more than the other tested cancer cell lines. ABT-263 also enhances the sensitivity of these cells to doxorubicin, a traditional cytotoxic chemotherapy used for synovial sarcoma. We also demonstrate the capacity of ABT-263 to stunt synovial sarcomagenesis in vivo in a genetic mouse model. These data recommend pursuit of BH3-peptidomimetic pharmacotherapy in human synovial sarcomas.

In ovo leptin administration inhibits chorioallantoic membrane angiogenesis in female chicken embryos through the STAT3-mediated vascular endothelial growth factor (VEGF) pathway

Previous studies indicate that leptin regulates placental angiogenesis and fetal growth in mammals and that in ovo leptin administration affects embryonic development and hatch weight in the chicken. To test the hypothesis that leptin affects embryonic growth through modifying chorioallantoic membrane (CAM) angiogenesis, we injected 0.5 μg of recombinant murine leptin into the albumen of fertilized eggs before incubation. On embryonic day 12 (E12), the number and the total area of blood vessels on CAM were measured, and expression of genes involved in angiogenesis was quantitated to show the possible mechanisms. Leptin in ovo administration decreased (P < 0.05) both the total area of blood vessels and the number of small-sized capillaries on CAM of E12 female chicken embryos, which coincided with significantly decreased (P < 0.05) embryo weight on E12 and BW at hatching. Vascular endothelial growth factor (VEGF) and inducible and endothelial nitric oxide synthases (iNOS and eNOS) were all downregulated (P < 0.05) in CAM both at the mRNA and protein/activity levels with reduced (P < 0.05) nitric oxide (NO) concentration in chorioallantoic fluid of female embryos. Furthermore, signal transducer and activator of transcription-3 (STAT3) was found to be diminished (P < 0.05) both at the mRNA and protein levels and associated with decreased (P < 0.05) binding of STAT3 to VEGF promotor in the CAM of leptin-treated E12 female embryos. These data suggest that in ovo leptin administration affects CAM angiogenesis and embryo growth in female chicken embryos, probably through STAT3-mediated VEGF/NO pathways.

Comparison of Tetrahymena pyriformis toxicity based on hydrophobicity, polarity, ionization and reactivity of class-based compounds

A toxicity data set containing the toxicities of 970 hydrophobic, polar and ionizable, nitro substituted and α,β-unsaturated compounds to Tetrahymena pyriformis was classified into different groups based on the structure and substituted functional groups. Polar, ionizable and reactive compounds exhibit greater toxicity as compared with the non-polar hydrophobic compounds. Step-by-step analysis was carried out between the toxicity and descriptors representing hydrophobicity, polarity/polarizability, ionization and reactivity of compounds. Significant relationships were developed between the toxicity and these descriptors for the compounds. The models developed are simple, interpretable and transparent, using a small number of descriptors that may reflect the interactions of chemicals with the biological macromolecules at the target sites. Hydrophobic parameter log P reflects bio-uptake process compounds. Polarity/polarizability descriptor S reflects the interaction of hydrophilic residues of polar chemicals with biological macromolecules. The fractions of ionized (F (i)) and neutral (F (0)) forms calculated from pK (a) reflect the interactions of ionizable compounds with the macromolecules and effect of ionization of ionizable compounds on the bio-uptake process, respectively. A successful single model was developed by using the descriptors log P, S, F (i) and log F (0) for non-polar, polar and ionizable compounds.

Use of a white light supercontinuum laser for confocal interference-reflection microscopy

Shortly after its development, the white light supercontinuum laser was applied to confocal scanning microscopy as a more versatile substitute for the multiple monochromatic lasers normally used for the excitation of fluorescence. This light source is now available coupled to commercial confocal fluorescence microscopes. We have evaluated a supercontinuum laser as a source for a different purpose: confocal interferometric imaging of living cells and artificial models by interference reflection. We used light in the range 460-700 nm where this source provides a reasonably flat spectrum, and obtained images free from fringe artefacts caused by the longer coherence length of conventional lasers. We have also obtained images of cytoskeletal detail that is difficult to see with a monochromatic laser.

A facile method for the synthesis of N-(α-aminoacyl) sulfonamides

N-Acylsulfonamide derivatives have important applications in organic synthesis and drug discovery. It was found that many problems occurred preparing amino acid derived N-acylsulfonamides with the commonly used coupling approach in our previous studies. In this paper, we report an efficient approach to synthesize various amino acids derived N-acylsulfonamides in high yields without any racemization.

Autoantibodies as biomarkers for the prediction of neuropsychiatric events in systemic lupus erythematosus

OBJECTIVE

Neuropsychiatric events occur unpredictably in systemic lupus erythematosus (SLE) and most biomarker associations remain to be prospectively validated. This study examined a disease inception cohort of 1047 SLE patients to determine which autoantibodies at enrolment predicted subsequent neuropsychiatric events.

METHODS

Patients with a recent SLE diagnosis were assessed prospectively for up to 10 years for neuropsychiatric events using the American College of Rheumatology case definitions. Decision rules of graded stringency determined whether neuropsychiatric events were attributable to SLE. Associations between the first neuropsychiatric event and baseline autoantibodies (lupus anticoagulant (LA), anticardiolipin, anti-β(2) glycoprotein-I, anti-ribosomal P and anti-NR2 glutamate receptor) were tested by Cox proportional hazards regression.

RESULTS

Disease duration at enrolment was 5.4 ± 4.2 months, follow-up was 3.6 ± 2.6 years. Patients were 89.1% female with mean (±SD) age 35.2 ± 13.7 years. 495/1047 (47.3%) developed one or more neuropsychiatric event (total 917 events). Neuropsychiatric events attributed to SLE were 15.4% (model A) and 28.2% (model B). At enrolment 21.9% of patients had LA, 13.4% anticardiolipin, 15.1% anti-β(2) glycoprotein-I, 9.2% anti-ribosomal P and 13.7% anti-NR2 antibodies. LA at baseline was associated with subsequent intracranial thrombosis (total n=22) attributed to SLE (model B) (HR 2.54, 95% CI 1.08 to 5.94). Anti-ribosomal P antibody was associated with subsequent psychosis (total n=14) attributed to SLE (model B) (HR 3.92, 95% CI 1.23 to 12.5, p=0.02). Other autoantibodies did not predict neuropsychiatric events.

CONCLUSION

In a prospective study of 1047 recently diagnosed SLE patients, LA and anti-ribosomal P antibodies are associated with an increased future risk of intracranial thrombosis and lupus psychosis, respectively.

Genetic variants associated with severe pneumonia in A/H1N1 influenza infection

The A/H1N1 influenza strain isolated in Mexico in 2009 caused severe pulmonary illness in a small number of exposed individuals. Our objective was to determine the influence of genetic factors on their susceptibility. We carried out a case-control association study genotyping 91 patients with confirmed severe pneumonia from A/H1N1 infection and 98 exposed but asymptomatic household contacts, using the HumanCVD BeadChip (Illumina, San Diego, CA, USA). Four risk single-nucleotide polymorphisms were significantly (p<0.0001) associated with severe pneumonia: rs1801274 (Fc fragment of immunoglobulin G, low-affinity IIA, receptor (FCGR2A) gene, chromosome 1; OR 2.68, 95% CI 1.69-4.25); rs9856661 (gene unknown, chromosome 3; OR 2.62, 95% CI 1.64-4.18); rs8070740 (RPA interacting protein (RPAIN) gene, chromosome 17; OR 2.67, 95% CI 1.63-4.39); and rs3786054 (complement component 1, q subcomponent binding protein (C1QBP) gene, chromosome 17; OR 3.13, 95% CI 1.89-5.17). All SNP associations remained significant after adjustment for sex and comorbidities. The SNPs on chromosome 17 were in linkage disequilibrium. These findings revealed that gene polymorphisms located in chromosomes 1 and 17 might influence susceptibility to development of severe pneumonia in A/H1N1 infection. Two of these SNPs are mapped within genes (FCGR2A, C1QBP) involved in the handling of immune complexes and complement activation, respectively, suggesting that these genes may confer risk due to increased activation of host immunity.

DAB389 EGF for the treatment of superficial urothelial cancer

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Background: Intravesical BCG has remained the standard treatment for superficial bladder cancer for decades, despite frequent recurrences after its use. Toxic fusion proteins are a novel class of agents containing both a targeting and a treatment component; correspondingly, DAB389EGF contains an EGF and a diphtheria element, thereby targeting any cell expressing EGFR. Notably, the normal urothelium has little or no luminal EGFR expression in contrast to urothelial cancers, which frequently overexpress EGFR.

Methods: DAB389EGF was tested in vitro to determine the effect of DAB389EGF on cell viability in culture. Tests of clonogenicity were performed by treating plated cells for 2 hours and following colony counts over 14 days. DAB389EGF was tested in an orthotopic murine model of bladder cancer with implanted HTB9 cells modified to express luciferase. DAB389EGF was administered intravesically via catheterization of the murine bladder and held in place for 2 hours with a temporary suture to close the urethra. Treatments were continued twice weekly for 2 weeks, with DT-GMCSF used as a control.

Results: Treatment with DAB389EGF yielded IC50's ranging from 0.5 to 15.7 ng/ml in 8 tested bladder cancer cell lines, but the IC50 was > 500ng/ml in the EGFR- negative H520 control cell line. A single 2-hour exposure to DAB389EGF (50ng/ml) decreased colony formation in all of the bladder cancer cell lines, with complete suppression in HT1376 and T24 cells. In the animal model, luciferase activity was lost in 5 of 6 mice treated with DAB389EGF, versus 1 of 6 mice treated with control. After the 2 week treatment period, histological assessment of the treated mice was undertaken and was consistent with the luciferase findings. FISH was used to detect human or murine-originated cells in order to confirm the presence or absence of xenograft tissue histologically.

Conclusions: Targeted-toxin fusion proteins represent a novel treatment approach for superficial bladder cancer. By capitalizing on the differential expression of EGFR between cancerous and normal urothelium, DAB389EGF selectively targets bladder cancer cells. Preliminary animal studies support the efficacy and tolerability of this approach with additionally animal work currently underway.

No significant financial relationships to disclose.

Stability and compatibility of doxofylline with phentolamine mesilate in 0.9% sodium chloride or 5% dextrose injection for intravenous infusion

WHAT IS KNOWN AND OBJECTIVE

The use of extemporaneously prepared admixtures of drugs must be supported by documentation of their chemical stability. The objective was to assess the physical compatibility and the chemical stability of doxofylline with phentolamine mesilate in 0.9% sodium chloride or 5% dextrose injection for intravenous infusion.

METHODS

Total volumes of 20 and 1 mL of doxofylline solution and phentolamine mesilate solution, respectively, were added to 250 mL polyolefin bags containing 5% dextrose injection or 0.9% sodium chloride injection. Bags were stored for 24 h at 20-25 °C. Chemical compatibility was measures with high-performance liquid chromatography, and physical compatibility was determined visually.

RESULTS

The samples were clear and colourless when viewed in normal fluorescent room light. The pH value and particulate content of the admixtures exhibited little change. The retentions of the initial concentration of doxofylline and phentolamine mesilate in the admixtures were within 97-105%. Doxofylline and phentolamine mesilate were stable in 5% dextrose injection or in 0.9% sodium chloride for up to 24 h at 20-25 °C.

WHAT IS NEW AND CONCLUSION

Doxofylline and phentolamine mesilate mixed in both 5% dextrose injection and 0.9% sodium chloride injection in 250 mL multilayer polyolefin bags at concentrations of 0.74 mg/mL and 36.9 μg/mL, respectively, were stable for up to 24 h at 20-25 °C.

Catheter ablation vs. amiodarone plus losartan for prevention of atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation

BACKGROUND

Although amiodarone plus angiotensin II receptor blockers (ARBs) and catheter ablation may improve sinus rhythm maintenance of paroxysmal atrial fibrillation (AF), their clinical efficacies have not been compared. This prospective cohort study was designed to compare clinical efficacy of catheter ablation and amiodarone plus losartan on sinus rhythm maintenance in patients with paroxysmal AF.

MATERIALS AND METHODS

A total of 240 patients with paroxysmal AF were assigned to four groups. CPVA group (n = 60) was treated with circumferential pulmonary vein ablation (CPVA), SPVI group (n = 60) with segmental pulmonary vein isolation, AMIO group (n = 60) with amiodarone and AMIO + LO group (n = 60) with amiodarone plus losartan. The endpoint was documented recurrence of AF > 30 s by Holter or conventional 12-lead ECG in the 1-year follow-up period.

RESULTS

During 12 months of follow-up, the primary end point was reached in 28 patients in CPVA group, 14 patients in SPVI group, 25 patients in AMIO group and 13 patients in AMIO + LO group, respectively. The sinus rhythm in SPVI and AMIO + LO group were significant higher than that in CPVA and AMIO group (P < 0.01 and 0.025), and no difference between CPVA and AMIO group. The maintenance rate of sinus rhythm in SPVI group was similar to that in AMIO + LO group.

CONCLUSIONS

This study demonstrates that segmental pulmonary vein isolation in preventing AF recurrence is similar to amiodarone plus losartan, but it is superior to CPVA and amiodarone alone in patients with paroxysmal AF. Larger multicentre studies are needed to confirm its long-term outcomes.