Intracranial Hypotension as A Rare Complication of Vertebroplasty: A Case Report

BACKGROUND

Vertebral compression fracture is one of the frequent complications of osteoporosis. Percutaneous vertebroplasty (PVP) has been applied in the treatment of osteoporotic vertebral compression fractures, multiple myelomas and vertebral metastatic lesions. Complications of the procedure include bleeding at the puncture site, local infection, cement leakage in the vertebral canal and intervertebral foramen. Cerebrospinal fluid leakage after the procedure was rarely mentioned in the literature.

CASE REPORT

A 51-year-old healthy female patient has no neurologic or orthopedic illness before. She suffered from severe low back pain since 10 days ago after some exercise. She has back pain with radiating to bilateral subcostal areas. The pain aggravated by bending forward. X ray of spine showed T12 vertebral body compression fracture. MRI demonstrated compression fracture at T12 with bone marrow edema and increased bone marrow enhancement. Bone mineral density checked by Dualenergy X-ray absorptiometry revealed osteopenia. The symptoms were not relieved by conservative treatments and she received vertebroplasty for pain relief. The operation course was smooth, but she started to suffer from orthostatic headache after the procedure. Spinal MRI revealed fluid accumulation at posterior epidural space of T11-12-L1 and CSF leakage was impressed. Intracranial hypotension related to CSF leakage was diagnosed according to the Diagnostic criteria formulated by Schievink, et al (2008). After hydration and bed-rest, her symptoms improved gradually without epidural blood patch.

CONCLUSION

Our report highlights the possibility and importance of intracranial hypotension related to CSF leakage after vertebroplasty. Clinicians should be alert to this complication.

Monitoring changes in thioredoxin and over-oxidised peroxiredoxin in response to exercise in humans

INTRODUCTION

Peroxiredoxin (PRDX) and thioredoxin (TRX) are antioxidant proteins that control cellular signalling and redox balance, although their response to exercise is unknown. This study aimed to assess key aspects of the PRDX-TRX redox cycle in response to three different modes of exercise.

METHODS

Healthy males (n = 10, mean ± SD: 22 ± 3 yrs) undertook three exercise trials on separate days: two steady-state cycling trials at moderate (60% [Formula: see text]O2MAX; 27 min, MOD) and high (80% [Formula: see text]O2MAX; 20 min, HIGH) intensities, and a low-volume high-intensity interval training trial (10 × 1 min 90% [Formula: see text]O2MAX, LV-HIIT). Peripheral blood mononuclear cells were assessed for TRX-1 and over-oxidised PRDX (isoforms I-IV) protein expression before, during, and 30 min following exercise (post + 30). The activities of TRX reductase (TRX-R) and the nuclear factor kappa B (NF-κB) p65 subunit were also assessed.

RESULTS

TRX-1 increased during exercise in all trials (MOD, + 84.5%; HIGH, + 64.1%; LV-HIIT, + 205.7%; p < 05), whereas over-oxidised PRDX increased during HIGH only (MOD, - 28.7%; HIGH, + 202.9%; LV-HIIT, - 22.7%; p < .05). TRX-R and NF-κB p65 activity increased during exercise in all trials, with the greatest response in TRX-R activity seen in HIGH (p < 0.05).

DISCUSSION

All trials stimulated a transient increase in TRX-1 protein expression during exercise. Only HIGH induced a transient over-oxidation of PRDX, alongside the greatest change in TRX-R activity. Future studies are needed to clarify the significance of heightened peroxide exposure during continuous high-intensity exercise and the mechanisms of PRDX-regulatory control.

Significantly lower nerve growth factor levels in patients with major depressive disorder than in healthy subjects: a meta-analysis and systematic review

INTRODUCTION

Since its discovery several decades ago, nerve growth factor (NGF) has been found to play roles in different areas, such as neurology, endocrinology, and immunology. There is some evidence linking NGF and psychiatry, including the role of NGF in subjects' response to stress, the alteration of NGF in different emotional states, and the penetration of NGF across the blood-brain barrier under specific conditions. There are many inconsistent findings regarding the differences in NGF in patients with major depressive disorder (MDD) at the present time. The aim of our study was to clarify whether NGF levels are different in MDD compared with healthy controls (HCs).

METHODS

We conducted a thorough literature search and compared peripheral NGF levels between MDD and HC through meta-analysis, and investigated possible confounding variables through meta-regression.

RESULTS

Seven studies were brought into the current meta-analysis comparing peripheral NGF in MDD and HCs. The main result was that the NGF levels were significantly lower in MDD than in HCs and that this had an inverse correlation with mean age and disease severity. In addition, meta-analysis of four articles found that the peripheral NGF levels did not change significantly before and after treatment.

CONCLUSION

Our study highlights the significant differences in peripheral NGF levels in patients with MDD. However, further exploration of the dynamic changes in peripheral NGF along with the disease course, and specific studies investigating the correlation of NGF in the peripheral and CNS environments are still needed.

Zaleplon-induced Anemsic Somnambulism with Eating Behaviors Under Once Dose

PURPOSE

Zaleplon is a newly-developed rapid-acting non-benzodiazepine hypnotic. Few reports discuss zaleplon-induced somnambulism. This report describes a patient without history of somnambulism, who developed amnesic somnambulism after taking low-dose of zaleplon.

CASE REPORT

A 43-year-old schizophrenic male without history of physical illness, seizure, or somnambulism developed amnesic somnambulism after taking once low-dose of zaleplon from the outpatient-department. Somnambulism did not reoccur after discontinuing zaleplon. However, similar behaviors recurred after accidentally prescribing zaleplon on the first-day of hospitalization.

CONCLUSION

This patient is the first case without history of somnambulism, who developed zaleploninduced somnambulism after taking low-dose of zaleplon. This study underscores the importance of monitoring for zaleplon-induced somnambulism, even when administering low-dosage to those without risk factors or history of somnambulism.

Surgical management of biliary cystadenoma and cystadenocarcinoma of the liver

Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare biliary duct neoplasms. This study investigated reasonable management strategies of cystic neoplasms in the liver. Charts of 39 BCA/BCAC patients (9 males, 30 female; median age 53.74 ± 14.50 years) who underwent surgery from January 1999 to December 2009 were reviewed retrospectively. Cyst fluid samples of 32 BCA/BCAC patients and 40 simple hepatic cyst patients were examined for the tumor markers carbohydrate associated antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). The most frequent symptoms were abdominal pain (N = 10), abdominal mass (N = 7), abdominal distension (N = 4), jaundice (N = 2), and fever (N = 3); the remaining patients showed no clinical symptoms. Liver resection (N = 17) or enucleation (N = 22) was performed in the 39 patients. Ultimately, 35 patients were diagnosed with intrahepatic BCA and four patients were diagnosed with BCAC. The median CA19-9 level was significantly higher in BCA/BCAC patients than in simple hepatic cyst patients. The median CEA levels in BCA/BCAC patients and controls were 6.83 ± 2.43 and 4.21 ± 2.91 mg/L, respectively. All symptoms were resolved after surgery, and only one BCAC patient showed recurrence. The incidence of intrahepatic cystic lesions was 1.7%. Increased CA19-9 levels in the cyst fluid is a helpful marker for distinguishing BCA/BCAC from common simple cysts. The presence of coarse calcifications is suggestive of BCAC. Complete surgical removal of these lesions yielded satisfying long-term outcomes with a very low recurrence rate.

Hyperbaric oxygen therapy as an effective adjunctive treatment for chronic Lyme disease

Lyme disease is the most commonly reported vector-borne illness in the United States, but it is relatively rare in Taiwan. Lyme disease can be treated with antibiotic agents, but approximately 20% of these patients experience persistent or intermittent subjective symptoms, so-called chronic Lyme disease (CLD). The mechanisms of CLD remain unclear and the symptoms related to CLD are difficult to manage. Hyperbaric oxygen therapy (HBOT) was applied in CLD therapy in the 1990s. However, reported information regarding the effectiveness of HBOT for CLD is still limited. Here, we present a patient with CLD who was successfully treated with HBOT.

Sjogren's syndrome with acute cerebellar ataxia and massive lymphadenopathy : a case report

PURPOSE

Common etiologies of acute acquired cerebellar ataxia include cerebrovascular diseases, toxin or drugs, infections/para-infections, and autoimmune diseases. It is a rare manifestation of Sjögren's syndrome, which is a common autoimmune disease but is often missed as a differential diagnosis.

CASE REPORT

This is a report of a patient with acute onset cerebellar ataxia for one month. She also had massive neck lymphadenopathy. After a series of studies and the exclusion of other common causes of acute cerebellar ataxia, she was diagnosed as having Sjögren's syndrome. Patients with Sjögren's syndrome have higher risk for lymphoma, which leads to poorer prognosis. After lymph node biopsy, the patient was proven to have sinus histiocytosis, which is another rare finding in Sjögren's syndrome.

DISCUSSION

For patients with acute acquired cerebellar ataxia, immune-mediated cerebellar ataxia should be an important differential diagnosis aside from the more common causes like stroke or drugs.

Impact and predictors of prolonged chest tube duration in mechanically ventilated patients with acquired pneumothorax

BACKGROUND

Prolonged chest tube duration is less well studied in patients who are supported by mechanical ventilation and have acquired pneumothorax. We investigated the impact of prolonged chest tube duration on patient outcomes and the risk factors associated with prolonged chest tube duration.

METHODS

This retrospective observational study included 106 ventilated subjects who had been treated with thoracostomy for pneumothorax between May 2004 and December 2011. We analyzed 61 subjects and 63 events. The subjects were divided into a prolonged chest tube duration group (> 18 d) and a non-prolonged group (≤ 18 d).

RESULTS

Subjects with prolonged chest tube duration had significantly higher ICU mortality (P = .006), longer ICU stay (P = .001), longer hospitalization (P = .004), longer mechanical ventilation after development of pneumothorax (P = .003), higher maximum peak inspiratory pressure (P = .03), and a higher rate of surgical emphysema (P = .009). High peak inspiratory pressure and surgical emphysema remained independent predictors of prolonged chest tube duration after multivariate logistic regression analysis. The probability of chest tube removal within 28 days was significantly lower in subjects with both high peak inspiratory pressure and surgical emphysema, compared to subjects without any risk factors (log rank P = .001).

CONCLUSIONS

High peak inspiratory pressure and surgical emphysema are independent predictors of prolonged chest tube duration and negatively impact clinical outcomes in this patient group. These findings may provide information for better chest tube management.

Dosing patterns of three tumor necrosis factor blockers among patients with rheumatoid arthritis in a large United States managed care population

OBJECTIVE

To describe dosing patterns of etanercept, adalimumab, and infliximab in rheumatoid arthritis (RA) patients in US managed care.

METHODS

This retrospective analysis included adult (18-64 years) RA patients in the HealthCore Integrated Research Database with ≥ 1 claim for etanercept, adalimumab, or infliximab between 7/1/2007 and 1/31/2010. Patients had 6 months pre-index and 12 months post-index claim eligibility. Patients without any TNF blocker claim during the pre-index period were considered new patients and patients with a TNF blocker claim during the pre-index period were considered continuing patients. Persistence, discontinuation, switch, and dose escalation patterns were evaluated. Patients with 1-year persistence were evaluated for dose escalation using two methods: (1) average weekly dose and (2) increase from 50 mg to 75 mg or 100 mg weekly of etanercept or from 40 mg every other week to 40 mg weekly of adalimumab or increase in vial or decreased infusion interval for infliximab.

RESULTS

Data from 2426 patients were analyzed (1595 etanercept; 417 adalimumab; 414 infliximab). Persistence ≥ 1 year on index medication was reported in 62.2% and 89.2% of new and continuing patients on etanercept, respectively, 66.0% and 94.0% on adalimumab, and 68.9% and 96.4% on infliximab. Discontinuation occurred in 19.7% and 7.9% of new and continuing patients on etanercept, respectively, 20.6% and 4.5% on adalimumab, and 18.8% and 2.1% on infliximab. Switching occurred in 12.2% and 4.3% of new and continuing patients on etanercept, respectively, 9.1% and 1.8% on adalimumab, and 10.4% and 2.1% on infliximab. Dose escalation was lower with etanercept (0.4-2.6%) than adalimumab (12.6-24.3%) or infliximab (40.0-79.5%) (P < 0.0001).

CONCLUSIONS

Discontinuation and switching were common within 1 year of initiating etanercept, adalimumab, and infliximab in patients with RA in this analysis. Study limitations included the restricted patient age range; analysis of three TNF blockers; study period (prior to approval of additional agents); and missing reasons for treatment changes.

High NH(4)(+)-N concentration wastewater treatment by shortcut nitrification-denitrification using a system of A/O inner loop fluidized bed biofilm reactors

In this experiment, a rapid mass-transfer inner loop fluidized bed biofilm reactor (ILFBBR) was employed to treat synthetic high ammonia nitrogen-containing (NH(4)(+)-N) wastewater by shortcut nitrification-denitrification. The reactor operation was stable after a short start-up period. Ammonia oxidizing bacteria (AOB) were predominant and 65% nitrite (NO(2)(-)-N/NO(x)(-)-N) levels were achieved. During the nitrification-denitrification period, the removal rates of NH(4)(+)-N and total nitrogen (TN) reached 94 and 82%, respectively. From the material balance, it was indicated that 87% of NH(4)(+)-N was removed by shortcut nitrification. The features of ILFBBR and the benefits of shortcut nitrification were combined in this experiment, and showed an excellent removal of NH(4)(+)-N from high-concentration NH(4)(+)-N wastewater.

Multiparameter in vitro assessment of compound effects on cardiomyocyte physiology using iPSC cells

A large percentage of drugs fail in clinical studies due to cardiac toxicity; thus, development of sensitive in vitro assays that can evaluate potential adverse effects on cardiomyocytes is extremely important for drug development. Human cardiomyocytes derived from stem cell sources offer more clinically relevant cell-based models than those presently available. Human-induced pluripotent stem cell-derived cardiomyocytes are especially attractive because they express ion channels and demonstrate spontaneous mechanical and electrical activity similar to adult cardiomyocytes. Here we demonstrate techniques for measuring the impact of pharmacologic compounds on the beating rate of cardiomyocytes with ImageXpress Micro and FLIPR Tetra systems. The assays employ calcium-sensitive dyes to monitor changes in Ca(2+) fluxes synchronous with cell beating, which allows monitoring of the beat rate, amplitude, and other parameters. We demonstrate here that the system is able to detect concentration-dependent atypical patterns caused by hERG inhibitors and other ion channel blockers. We also show that both positive and negative chronotropic effects on cardiac rate can be observed and IC(50) values determined. This methodology is well suited for safety testing and can be used to estimate efficacy and dosing of drug candidates prior to clinical studies.

Synergistic impact of low serum albumin on intensive care unit admission and high blood urea nitrogen during intensive care unit stay on post-intensive care unit mortality in critically ill elderly patients requiring mechanical ventilation

AIMS

To identify intensive care unit (ICU) risk factors for post-ICU 6-month (PI6M) mortality in critically ill elderly patients requiring mechanical ventilation (MV).

METHODS

The present study was a retrospective observational study carried out in a respiratory ICU from December 2008 to December 2009. Medical records of patients aged ≥70 years and receiving MV were reviewed. Risk factors of PI6M mortality were assessed by multivariate Cox regression.

RESULTS

Of 120 patients enrolled, 46 (38%) died in the PI6M period. As compared with survivors, non-survivors had lower serum albumin levels on ICU admission, lower estimated glomerular filtration rate, higher peak blood urea nitrogen (BUN) levels during ICU stay (ICU-peak BUN), a higher ratio of prolonged steroid use and longer MV length in ICU. Independent risk factors of PI6M mortality were low albumin on admission (hazard ratio [HR] 3.53 per g/dL decrease, 95% CI [1.97-6.33], P<0.001) and high ICU-peak BUN (HR 1.11 per 10-mg/dL increase, [1.04-1.18], P=0.001). The HR for PI6M mortality was 7.88 [2.97-20.91] for patients with both risk factors (albumin ≤2.8 g/dL and ICU-peak BUN >72 mg/dL) as compared with those without. For patients with high ICU-peak BUN (>72 mg/dL), PI6M survival was better for those with a reduction in BUN level to ≤72 mg/dL at ICU discharge than those without.

CONCLUSIONS

Low serum albumin level on ICU admission and high BUN level during ICU stay are two independent risk factors, especially their combination, of PI6M mortality in critically ill elderly patients requiring MV. Furthermore, patients with a reduction in high BUN have a better PI6M survival.

Toxin ophthalmia caused by nuchal gland secretion of the Taiwan tiger keelback (Rhabdophis tigrinus formosanus)

Rhabdophis tigrinus is a common colubrid snake that can be found in an extensive geographical region in East Asia. It consists of two subspecies: R.t. tigrinus (yamakagashi) and R.t. formosanus (Taiwan tiger keelback). R. tigrinus possesses two different sets of poisonous glands: the Duvernoy's glands in the maxilla, and the nuchal glands in the dorsal skin of the neck. We report the first case in current English literature of toxin ophthalmia caused by the nuchal gland secretion of R.t. formosanus. The patient was a 40-year-old man whose right eye was sprayed by the nuchal gland fluid of R.t. formosanus. He presented with symptoms of foreign body sensation, progressive burning pain, and blurred vision. Ophthalmologic examination revealed diffuse superficial punctate keratitis, corneal stromal edema with Descemet folds, and conjunctival congestion. The patient responded well to topical treatment with a corticosteroid, antihistamine, and antibiotic, and had a favorable clinical course and outcome.

A cascade of anoxic and oxic fluidized bed biofilm reactors for treatment of synthetic municipal wastewater

In this study, a cascade of anoxic and oxic fluidized bed biofilm reactors system was carried out to treat synthetic municipal wastewater. The parameters of the influent flow rates and C/N ratios were discussed. System performance was acceptable for chemical oxygen demand (COD), ammonia, and total nitrogen removal. A decrease of ammonia and total nitrogen removal efficiencies, however, was observed when the influent flow rates increased to 5.04 and 6.12 1 h(-1). Total nitrogen removal decreased at the influent C/N ratio of 3:1. The measured ratios of COD reduction in the anoxic column to nitrogen removal through nitrification-denitrification were 3.7, 3.5, 3.3, and 3.1 g COD/g(-1) N on average when the influent C/N ratios changed from 6:1 to 3:1. The observed sludge yield (Yobs) was 0.169 g VSS g COD(-1) because of perfect denitrification in the anoxic column and the relatively long solids retention time.

Hyperbaric oxygen therapy as an adjunctive treatment for sternal infection and osteomyelitis after sternotomy and cardiothoracic surgery

Purpose

A retrospective study to evaluate the effect of hyperbaric oxygen (HBO2) therapy on sternal infection and osteomyelitis following median sternotomy.

Materials and methods

A retrospective analysis of patients who received sternotomy and cardiothoracic surgery which developed sternal infection and osteomyelitis between 2002 and 2009. Twelve patients who received debridement and antibiotic treatment were selected, and six of them received additional HBO2 therapy. Demographic, clinical characteristics and outcome were compared between patients with and without HBO2 therapy.

Results

HBO2 therapy did not cause any treatment-related complication in patients receiving this additional treatment. Comparisons of the data between two study groups revealed that the length of stay in ICU (8.7 ± 2.7 days vs. 48.8 ± 10.5 days, p < 0.05), duration of invasive (4 ± 1.5 days vs. 34.8 ± 8.3 days, p < 0.05) and non-invasive (4 ± 1.9 days vs. 22.3 ± 6.2 days, p < 0.05) positive pressure ventilation were all significantly lower in patients with additional HBO2 therapy, as compared to patients without HBO2 therapy. Hospital mortality was also significantly lower in patients who received HBO2 therapy (0 case vs. 3 cases, p < 0.05), as compared to patients without the HBO2 therapy.

Conclusions

In addition to primary treatment with debridement and antibiotic use, HBO2 therapy may be used as an adjunctive and safe treatment to improve clinical outcomes in patients with sternal infection and osteomyelitis after sternotomy and cardiothoracic surgery.

Mobile social network services for families with children with developmental disabilities

As Internet technologies evolve, their applications have changed various aspects of human life. Here, we attempt to examine their potential impact on services for families with developmentally delayed children. Our research is thus designed to utilize wireless mobile communication technologies, location services, and search technology in an effort to match families of specific needs with potential care providers. Based on the investigation conducted by our counselors, this paper describes a platform for smooth communication between professional communities and families with children with developmental disabilities (CDD). This research also looks into the impact of management of mobile social network services and training on the operation of these services. Interaction opportunities, care, and support to families with CDD are introduced.

Large-scale growth of Cu2ZnSnSe4 and Cu2ZnSnSe4/Cu2ZnSnS4 core/shell nanowires

We present a fast and simple protocol for large-scale preparation of quaternary Cu(2)ZnSnSe(4) (CZTSe), as well as CZTSe/Cu(2)ZnSnS(4) (CZTS) core/shell nanowires using CuSe nanowire bundles as self-sacrificial templates. CuSe nanowire bundles were synthesized by reacting Cu(2 - x)Se nanowire bundles with sodium citrate solution. CZTSe nanowires were prepared by reacting CuSe nanowire bundles with Zn(CH(3)COO)(2) and SnCl(2) in triethylene glycol. X-ray diffraction (XRD) and selected area electron diffraction studies show that stannite CZTSe is formed. The formed CZTSe nanowire bundles have diameters of 200-400 nm and lengths of up to hundreds of micrometers. CZTSe/CZTS nanocable bundles with similar morphologies were grown by the addition of some elemental sulfur to the reaction system for growth of CZTSe bundles. The stannite CZTSe/kesterite CZTS core/shell structure of the grown nanocables was confirmed by XRD and high-resolution transmission electron microscope investigation. The influence of S/Se molar ratio in the reaction system on the crystallographic structures and optical properties of CZTSe/CZTS nanocables was studied. The obtained CZTSe/CZTS core/shell nanocable bundles show broad and enhanced optical absorption over the visible and near-infrared region, which is promising for use in photovoltaic applications.

Acute kidney injury on ventilator initiation day independently predicts prolonged mechanical ventilation in intensive care unit patients

PURPOSE

The purpose of this study is to identify the predictors for prolonged mechanical ventilation (PMV) of more than 21 days among intensive care unit (ICU) patients.

MATERIAL AND METHODS

A retrospective observational study was conducted in a respiratory ICU from December 2008 to November 2009. The outcome measurement was the occurrence of PMV. Acute kidney injury (AKI) was identified and defined as an increase in the serum creatinine level of 50% or greater from baseline.

RESULTS

Of 154 patients enrolled, 41 patients (26.6%) had PMV. Patients with PMV showed higher Acute Physiology and Chronic Health Evaluation II scores, lower serum albumin levels, and more AKI on mechanical ventilation (MV) initiation day compared with the non-PMV patients. Patients with PMV were significantly associated with longer MV duration before the day of readiness for weaning (DRW) and a higher rapid shallow breathing index on DRW. In a multivariate regression analysis, the independent risk factors for PMV were AKI on MV initiation day (odds ratio [OR], 5.630; 95% confidence interval [CI], 1.378-22.994; P = .016), longer MV duration before DRW (OR, 1.289; 95% CI, 1.158-1.435; P < .001), and higher rapid shallow breathing index on DRW (OR, 1.012; 95% CI, 1.003-1.021; P = .010).

CONCLUSIONS

Acute kidney injury on MV initiation day is an independent risk factor for PMV of more than 21 days, which may be helpful for clinicians to refine their management of these ICU patients early.

Urinary CD14 as a potential biomarker for benign prostatic hyperplasia - discovery by combining MALDI-TOF-based biostatistics and ESI-MS/MS-based stable-isotope labeling

PURPOSE

Quest for specific urinary biomarkers for benign prostatic hyperplasia (BPH).

EXPERIMENTAL DESIGN

Proteomics studies were conducted with urines of the training set to discovering marker candidates that could differentiate BPH from normal subjects by matching results deduced from MALDI-TOF of individual samples and results deduced from nanoLC-ESI-MS/MS-based stable isotope dimethyl labeling of two pooled samples (BPH and normal). Samples were digested before analysis and such an approach takes into account the subject-to-subject variation and differential amount, as well as protein identification. Selected markers were validated by ELISA conducted on the training set and the test set as well as another set of urines collected from prostate cancer patients.

RESULTS

Nine marker candidates were identified from proteomics studies; CD14, prostate-specific antigen and pancreatic α-amylase precursor were further selected for ELISA validation. Urinary CD14 is among the best match with high specificity (>81%) for both training and test sets. In addition, from the study of prostate cancer patients, CD14 also allows the distinction of BPH from cancer with high specificity (84-100%) when combined with urinary prostate-specific antigen.

CONCLUSIONS AND CLINICAL RELEVANCE

Urinary CD14 is suggested to have a high specificity in the diagnosis of BPH in distinction from normal as well as cancer subjects.

Quantitative shot-gun proteomics and MS-based activity assay for revealing gender differences in enzyme contents for rat liver microsome

Liver microsomes are subcellular fractions that contain many metabolizing enzymes for drugs and endogeneous compounds. Some of these enzymes are regulated by sex hormonal control and exhibit sex-dependent expression pattern and metabolizing speed. Studying these enzymes, however, are complicated by the presence of isoforms such as cytochrome P450 (CYP450), which families share more than 50% amino acid identities. In this study, we applied quantitative shot-gun proteomics approach coupled with stable-isotope dimethyl labeling, two-dimensional reversed-phase peptide separation and tandem mass spectrometry (MS) to explore the gender-dependent expression of rat liver microsomal proteins. A total of 391 proteins were identified and quantified by this approach, and 56% of quantified proteins were enzymes. Although shot-gun approach is rarely used for identifying protein isoforms, we identified 53 isoforms by at least one unique peptide including 21 isoforms of CYP450s. Moreover, by quantitative and statistics assessment, we were able to classify them into 28 male dominant enzymes including CYP2C12 CYP2C11, CYP2C13, CYP2B3, CYP2C11, CYP2C70 and CYP3A2 which are known to be male specific, 21 female dominant enzymes including CYP2A1, CYP2C7, CYP2C12, CYP2D26, alcohol dehydrogenase 1, carboxylesterase 3, glutathione S-transferase, liver carboxylesterase 4, UDP-glucuronosyltransferase 2B1, and glyceraldehyde-3-phosphate dehydrogenase which are known to be female specific; and 125 sex-independent enzymes. However, most of the sex specificities revealed from this study, such as the male specificity of CYP2D1, were novel and not yet reported. We then conducted a mass spectrometry-multiple reaction mode (MS-MRM) based enzyme activity method to determine the catalyzing rate of CYP2D1 in male and female liver microsomes using carteolol as its specific substrate. The reaction rate catalyzed by CYP2D1 in female rats was determined to differ significantly with the rate in male rats. Moreover, the ratio (female/male) of reaction rate (0.68) was found to correlate with their relative protein abundance (0.72). This study revealed novel sex dependences of many rat liver enzymes and also demonstrated a unique MS-based analytical platform that could identify novel iso-enzymes and further quantify their abundance and enzyme activity.

Trends in parathyroidectomy rates in US hemodialysis patients from 1992 to 2007

BACKGROUND

Parathyroidectomy rates in hemodialysis patients increased from 1992 to 2002, when medication choices to manage secondary hyperparathyroidism expanded.

STUDY DESIGN

Retrospective follow-up registry study.

SETTING & PARTICIPANTS

We evaluated annual cohorts of point-prevalent US hemodialysis patients with Medicare as primary payer for 1992-2007 (n = 1,063,258 for 1992-1999; 757,207 for 2000-2003; 902,119 for 2004-2007).

PREDICTOR

Comorbid conditions, vitamin D use, previous kidney transplant, and parathyroid hormone testing were assessed in the previous year. Available bone and mineral disorder treatment patterns were evaluated.

OUTCOMES

We examined incidence rate trends and patient characteristics through 2007 to estimate the association between parathyroidectomy and patient factors. Follow-up was from January 1 of each study year to the earliest in the same year of parathyroidectomy, death, or December 31.

MEASUREMENTS

We used χ(2) analysis to compare patient characteristics in 3 time frames. Unadjusted and adjusted parathyroidectomy rates were calculated. Cox regression was used to test the association of parathyroidectomy and covariates.

RESULTS

Adjusted parathyroidectomy rates increased from 1998 (7.0/1,000 patient-years; 1,045 events), peaked in 2002 (12.8/1,000 patient-years; 2,229 events), decreased through 2005 (5.4/1,000 patient-years; 1,078 events), and increased in 2006 (8.6/1,000 patient-years; 1,743 events) and 2007 (8.8/1,000 patient-years; 1,832 events). Vitamin D use, virtually undetectable in 1991, subsequently steadily increased; >80% of patients received vitamin D in 2006.

LIMITATIONS

The study was not designed to provide causal explanations for observed changes; oral medication use trend data were limited to one large dialysis provider and may not reflect use patterns in all dialysis facilities; because Medicare is not the primary payer for all US hemodialysis patients, results do not describe the entire US hemodialysis population; parathyroid hormone values are lacking in the database.

CONCLUSIONS

Adjusted parathyroidectomy rates varied substantially from 1992 through 2007. Rates were highest in 1994 and 2002 and lowest in 1998 and 2005, likely influenced by changing medication use patterns and guideline publication.

Using mass spectrometry to detect buffalo salivary odorant-binding protein and its post-translational modifications

A large number of mammalian odorant-binding proteins, which are lipocalins, have been studied. These proteins participate in peri-receptor events by selecting and carrying odorant molecules. The present study aimed at identifying the buffalo salivary odorant-binding protein (sOBP), and to determine its post-translational modification using mass spectrometry. The buffalo salivary 21  kDa protein was initially separated adopting sodium dodecyl sulfate-polyacrylamide gel electrophoresis and it was identified as sOBP with high statistical reliability using liquid chromatography/tandem mass spectrometry (LC/MS/MS) and SEQUEST, for the first time. Further, the post-translationally modified peptides were screened adopting MS/MS. A total of four post-translational modifications, namely glycation at lysine-(59), hydroxylation at lysine-(134), ubiquitination at lysine-(121), and dihydroxylation in lysine-(108), were recorded. Moreover, these modifications have not been identified in buffalo salivary odorant-binding protein.

Heuristic optimization in penumbral image for high resolution reconstructed image

Penumbral imaging is a technique which uses the fact that spatial information can be recovered from the shadow or penumbra that an unknown source casts through a simple large circular aperture. The size of the penumbral image on the detector can be mathematically determined as its aperture size, object size, and magnification. Conventional reconstruction methods are very sensitive to noise. On the other hand, the heuristic reconstruction method is very tolerant of noise. However, the aperture size influences the accuracy and resolution of the reconstructed image. In this article, we propose the optimization of the aperture size for the neutron penumbral imaging.