ECMO support for right main bronchial disruption in multiple trauma patient with brain injury--a case report and literature review

Extracorporeal membrane oxygenation (ECMO) may offer life-saving treatment in severe pulmonary contusion or acute respiratory distress syndrome when conventional treatments have failed. However, because of the bleeding risk of systemic anticoagulation, ECMO should be performed only as a last resort in multiple trauma victims. Here, we report ECMO as a bridge for right main bronchus reconstruction and recovery of traumatic wet lung in a 31-year-old male multi-trauma patient with right main bronchial disruption, bilateral pulmonary contusion, cerebral contusion and long bone fracture. The patient was discharged without any obvious complication. ECMO support in a traumatic brain injured patient with severe hypoxemia caused by lung contusion and/or tracheal bronchus disruption is not an absolute contraindication.

Formononetin inhibits migration and invasion of MDA-MB-231 and 4T1 breast cancer cells by suppressing MMP-2 and MMP-9 through PI3K/AKT signaling pathways

Formononetin is a naturally existing isoflavone, which can be found in the roots of Astragalus membranaceus, Trifolium pratense, Glycyrrhiza glabra, and Pueraria lobata. It was found to be associated with inhibition of cell proliferation and cell cycle progression, as well as induction of apoptosis in various cancer cell lines. However, the effect of formononetin on breast cancer cell metastasis remains unclear. In this study, we examined the effect of formononetin on the migration and invasion of breast cancer cells MDA-MB-231 and 4T1 in vitro and in vivo. Our data demonstrated that formononetin did not effectively inhibit the cell viability of MDA-MB-231 and 4T1 in 24 h with the concentration lower than 160 μmol/l. When treated with nontoxic concentration of formononetin, the migration and invasion of MDA-MB-231 and 4T1 cells were markedly suppressed by wound healing assay, chamber invasion assay, and in vivo mouse metastasis model. In vitro, formononetin reduced the expression of matrix metalloproteinase-2 (MMP-2), MMP-9 and increased the expression of tissue inhibitor of metalloproteinase-1 (TIMP-1) and TIMP-2. Furthermore, the immunofluorescence and immunoblotting assays indicated that formononetin was very effective in suppressing the phosphorylation of Akt and PI3K. Collectively, these results suggest that formononetin inhibited breast cancer cell migration and invasion by reducing the expression of MMP-2 and MMP-9 through the PI3K/AKT signaling pathway. These findings demonstrate a potentially new therapeutic strategy of formononetin as anti-invasive agent for breast cancer.

Metabotropic glutamate receptor 5 modulates calcium oscillation and innate immune response induced by lipopolysaccharide in microglial cell

Microglia, the primary immune cells in the brain, have been implicated as the predominant cells governing inflammation-mediated neuronal damage. In response to immunological challenges such as lipopolysaccharide (LPS), microglia are activated and subsequently inflammatory process is initiated as evidenced by the release of pro-inflammatory chemokines and cytokines. Here we show that Group I metabotropic glutamate receptor 5 (mGluR5) is involved in LPS-induced microglia activation. LPS triggered a similar pattern of [Ca2+]i oscillation in N9, Toll-like receptor 4 (TLR4)-mutant EOC 20, TLR4-wild-type and TLR4-deficient primary mouse microglia, suggesting that LPS-induced [Ca2+]i oscillation is independent of TLR4. The characteristics of [Ca2+]i oscillation induced by LPS are consistent with those observed in mGluR5 activation. In addition, mGluR5 antagonist 3-[(2-methyl-1,3-thiazol-4-yl)ethynyl]pyridine (MTEP) abolished LPS-induced [Ca2+]i oscillation. Immunocytochemistry demonstrated that LPS colocalizes with mGluR5 in microglia and the direct binding of LPS and mGluR5 was further validated by antibody-based fluorescence resonance energy transfer (FRET) technology. Activation of mGluR5 using a selective agonist (RS)-2-chloro-5-hydroxyphenylglycine (CHPG) significantly expanded LPS-induced nuclear factor-kappa B (NF-κB) activity and CHPG alone increased NF-κB activity as well. But, mGluR5 antagonist MTEP attenuated the actions of LPS, CHPG and the additive effect of LPS and CHPG in microglia. LPS induced tumor necrosis factor-α (TNF-α) secretion in N9 microglia, but not in TLR4-mutant EOC 20 and TLR4-deficient primary mouse microglia. CHPG reduced LPS-caused TNF-α production, but MTEP increased LPS-induced TNF-α production and blocked the effect of CHPG in N9 microglia. These data demonstrate that mGluR5 and TLR4 are two critical receptors that mediate microglia activation in response to LPS, suggesting that mGluR5 may represent a novel target for modulating microglia-dependent neuroinflammation.

The effects of x-ray radiation on the eye development of zebrafish

The toxic effects of x-ray radiation on eye development was measured using zebrafish as a model organism. Zebrafish embryos at 8 h post-fertilization (hpf) were irradiated using X-rays at doses of 1, 2, 4, and 8 Gy. At 24 and 48 hpf, x-ray radiation induced a significant increase in reactive oxygen species (ROS) content and cell apoptotic signals. Both of these increases were dose dependent and there were significant positive relationships between them at 24 hpf. At 48 and 72 hpf, the increase of ROS concentration can be eliminated by increasing activities of superoxide dismutase and catalase. Although the ROS generated by x-ray radiation caused a significant increase in cell apoptosis at 24 and 48 hpf, the cellular layers of the retina and lens formation in the irradiated groups were not significantly disrupted at 144 hpf compared with the control group, with the exception of a heterogeneous distribution of the cells in inner nuclear cell layer and a significant decrease in the diameters of whole eyes after 8 Gy irradiation. X-Ray radiation at later stages of gastrulation may not cause distinct optic complications; however, there is still a risk of microophthalmia at high doses of irradiation.

Polymorphism and differentiation indices preferred for genetic analysis among cattle, goats, and sheep

Most studies of polymorphism and differentiation are based on a single gene; few have treated differences among numerous genes. We have analyzed the parameters of conservation, polymorphism, and genetic differentiation to find the preferred index of 40 genes, with 1,614 sequences from cattle, goats, and sheep. Clustering and principal component factor (PCF) analyses revealed three PCFs: PCF1, representing polymorphism and differentiation; PCF2, representing nucleotide usage; and PCF3, representing gene flow (G ST ) and gene differentiation (δ ST ). We found significantly higher correlations (p < 0.001) with other indices for sequence conservation (r of -0.66 to -0.98), θη (0.52-0.95), and γ ST (0.54-0.96). This shows that they are preferable for estimating conservation, polymorphism, and differentiation of genes, respectively. The codon bias index was significantly different between the autosome and sex chromosomes (p < 0.01).

The visual diagnosis of tuberculous pleuritis under medical thoracoscopy: a retrospective series of 91 cases

BACKGROUND

Despite progress of medical, the fast and accurate diagnosis of tuberculous pleuritis (TP) continues to be a challenge, mainly because of the lack of specific clinical features and the difficulty in isolating the Mycobacterium tuberculosis.

OBJECTIVES

To investigate the role of medical thoracoscopy in definite diagnosis of tuberculous pleuritis, especially the feature of visual diagnosis in tuberculous pleuritis via medical thoracoscopy. We performed a retrospective review of the utility of medical thoracoscopy in tuberculous pleuritis.

PATIENTS AND METHODS

A retrospective chart review was performed of 91 patients who had medical thoracoscopy for suspected TP at the Second Xiangya Hospital from October 1, 2006 to July 30, 2012.

RESULTS

In ninety one cases, 76 patients were diagnosed with TP by pathologic diagnosis. The visual findings via thoracoscopy of 76 TP patients included the following: (1) necrosis (76.32%, n=58), (2) diffuse miliary nodules (64.67%, n=49), (3) single or multiple pleural nodules (14.47%, n=11), (4) hyperemic, edematous and thickened pleura (56.58%, n=43), and (5) pleural adhesions or fibrotic septa (78.95%, n=60), and all of these samples had hydrothorax or loculated effusion. The diagnostic efficiency of visual diagnosis via medical thoracoscopy about tuberculous pleuritis was 93.41%. In the non-invasive test, ADA > 40 u/l with LDH > 200 u/l for TP showed relatively high sensitivity and specificity (73.68%, 80.00%, respectively).

CONCLUSIONS

TP presents a variety of scopic phenotypes under medical thoracoscopy. The experienced pulmonologists visually diagnose TP efficiently and directly via medical thoracoscopy. Medical thoracoscopy with combined biopsy is an accurate and safe method for diagnosing TP.

Abstract P1-17-02: Male breast carcinoma: A clinicopathological and immunohistochemical characterization study

AIM Male breast carcinoma is a relatively rare disease. This study retrospectively investigated the clinicopathological features of male breast carcinoma in Chinese population, and classified the molecular subtype based on surrogate immunohistochemical definitions. The expression of GCDFP15, MGB, AR and FOXP1 were also evaluated.

METHODS Clinical and pathological data on 73 cases of male breast carcinoma were collected and microscopic pathological features were examined. Immunostaining for ER, PR, HER2, Ki-67, CK5/6, EGFR, GCDFP15, MGB, AR and FOXP1 was performed and the molecular subtype was classified.

RESULTS Invasive carcinoma of no special type was the major histological type in our study group (71.2%, 52/73). Except for 4 cases of carcinoma in situ, forty-two male invasive carcinomas (42/69, 60.9%) were classified as luminal A subtype while 24 cases (24/69, 34.8%) were classified as luminal B subtype. Only 2 cases of basal-like subtype and 1 case of HER2 positive subtype were identified in this group. Nuclear immunostaining of AR and FOXP1 could be observed in 82.4% (48/57) and 71.9% (41/57) of the cases respectively. Cases of luminal A subtype expressed GCDFP15 (73.5%, 25/34) and MGB (58.8%, 20/34) more frequently than those of luminal B subtype (34.8%, 8/23 and 43.5%, 10/23, respectively).

CONCLUSIONS Invasive carcinoma of no special type was the most common histological type in male breast carcinoma. Our study revealed that luminal A and B subtypes were the major types of male breast carcinoma. AR and FOXP1 were highly expressed in male breast cancer. Luminal A subtype tends to express GCDFP15 and MGB more frequently than luminal B subtype.

KEYWORDS: breast carcinoma, male, molecular subtype, immunohistochemistry.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-17-02.

Baseline HbA1c predicts attainment of 7.0% HbA1c target with structured titration of insulin glargine in type 2 diabetes: a patient-level analysis of 12 studies

AIMS

To determine whether baseline characteristics, especially haemoglobin A1c (HbA1c), predict the likelihood of reaching HbA1c ≤ 7.0% or the risk of experiencing hypoglycaemia after the addition of insulin glargine to oral therapy in type 2 diabetes.

METHODS

Pooled patient-level data from 12 prospective, randomized, controlled studies that used insulin glargine in a treat-to-target titration regimen seeking fasting glucose levels ≤5.5 mmol/l (100 mg/dl) were analysed. Baseline characteristics were evaluated by logistic regression models as predictors of reaching a target HbA1c ≤ 7.0% or experiencing confirmed hypoglycaemia. The effect of prior glycaemic control was further explored by analysis of categorical ranges of baseline HbA1c.

RESULTS

Of 2312 participants, 95% completed 24 weeks of treatment. Lower HbA1c at baseline was independently associated with reaching HbA1c target [adjusted odds ratio (OR) for 1% difference: 0.538, p < 0.0001] and also with likelihood of experiencing confirmed hypoglycaemic events (adjusted OR: 0.835, p < 0.0001) at week 24. In an unadjusted analysis by baseline HbA1c range, the strong association between baseline control and attaining target HbA1c was confirmed (75% with baseline HbA1c < 8.0%, 60% with baseline HbA1c ≥ 8.0 and <9.0% and 38% with baseline HbA1c ≥ 9.0% attained HbA1c ≤ 7.0%). The incidence of hypoglycaemia confirmed <3.9 mmol/l (70 mg/dl) was higher in the lower baseline HbA1c ranges but severe hypoglycaemia was infrequent at all baseline HbA1c levels.

CONCLUSIONS

Systematically titrated insulin glargine, added to oral agents, was effective over a wide range of baseline HbA1c. Lower baseline HbA1c was the best clinical predictor of achieving HbA1c ≤ 7.0% and also associated with higher risk of glucose-confirmed hypoglycaemia. Severe hypoglycaemia was infrequent using this treatment approach.

The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population

BACKGROUND

Sexually transmitted infection with the human papillomavirus (hpv) is responsible for a significant burden of human cancers involving the cervix, anogenital tract, and oropharynx. Studies in the United States and Europe have demonstrated an alarming increase in the frequency of hpv-positive oropharyngeal cancer, but the same direct evidence does not exist in Canada.

METHODS

Using the London Health Sciences Centre pathology database, we identified tonsillar cancers diagnosed between 1993 and 2011. Real-time polymerase chain reaction was then used on pre-treatment primary-site biopsy samples to test for dna from the high-risk hpv types 16 and 18. The study cohort was divided into three time periods: 1993-1999, 2000-2005, and 2006-2011.

RESULTS

Of 160 tumour samples identified, 91 (57%) were positive for hpv 16. The total number of tonsillar cancers significantly increased from 1993-1999 to 2006-2011 (32 vs. 68), and the proportion of cases that were hpv-positive substantially increased (25% vs. 62%, p < 0.002). Those changes were associated with a marked improvement in 5-year overall survival (39% in 1993-1999 vs. 84% in 2006-2011, p < 0.001). When all factors were included in a multivariable model, only hpv status predicted treatment outcome.

INTERPRETATION

The present study is the first to provide direct evidence that hpv-related oropharyngeal cancer is increasing in incidence in a Canadian population. Given the long lag time between hpv infection and clinically apparent malignancy, oropharyngeal cancer will be a significant clinical problem for the foreseeable future despite vaccination efforts.

Clinical predictors of risk of hypoglycaemia during addition and titration of insulin glargine for type 2 diabetes mellitus

AIM

Addition and titration of basal insulin is usually effective in improving glycaemic control in type 2 diabetes, but fear of hypoglycaemia remains a barrier. Ability to predict which patients might be at greatest risk of hypoglycaemia might facilitate individualization of treatment and improve safety. The aim of this study was to obtain information about clinical characteristics which might predict risk of hypoglycaemia during initiation of basal insulin.

METHODS

Patient-level data from 2251 participants in 11 studies in which insulin glargine was started and titrated using similar treat-to-target methods was pooled and analysed with logistic regression models.

RESULTS

Participants had mean age 58 years, diabetes duration 8.9 years, body mass index 31.0 and baseline A1c 8.8%. They attained mean A1c 7.1% during 6 months of treatment with final mean glargine dosage 0.44 units/kg. Symptomatic hypoglycaemia occurred in 52%, glucose-confirmed hypoglycaemia (blood glucose <50 mg/dl) in 17%, repeated glucose-confirmed events in 7% and severe hypoglycaemia in 1.5%. Independent predictors of glucose-confirmed hypoglycaemia were younger age, lower body mass index, use of a sulphonylurea in addition to metformin, lower attained A1c and lower dosage of glargine.

CONCLUSIONS

These findings confirm low rates of clinically important hypoglycaemia using this method, and suggest that higher risk of hypoglycaemia may be suspected when patients needing insulin are younger, less obese and taking metformin and a sulphonylurea, and especially when A1c levels ≤7.0% are attained with glargine dosage ≤0.4 units/kg.

Prognostic value of the trichorhinophalangeal syndrome-1 (TRPS-1), a GATA family transcription factor, in early-stage breast cancer

BACKGROUND

TRPS-1 is a new GATA transcription factor that is differentially expressed in breast cancer (BC) where it been found recently to regulate epithelial-to-mesenchymal transition (EMT).

PATIENTS AND METHODS

We carried out a quantitative immunohistochemistry (qIHC) analysis of TRPS-1 expression in 341 primary-stage I-III BC samples in relation to patient clinical characteristics as well as its prognostic value, especially in an estrogen receptor-positive (ER+) subgroup.

RESULTS

Higher TRPS-1 expression was significantly associated with a number of clinical and pathological characteristics as well as with improved overall survival (OS) and disease-free survival (DFS). Among stage I/II ER+ BC patients who received endocrine therapy alone, those with high TRPS-1 expression had significantly longer OS and DFS. There was also a strong association between TRPS-1 levels and the EMT marker E-cadherin in the ER+ invasive ductal carcinoma cases. Analysis of gene expression data on a panel of BC lines found that TRPS-1 expression was low or absent in BC lines having enriched mesenchymal features.

CONCLUSIONS

Our data indicated that TRPS-1 is an independent prognostic marker in early-stage BC and a new EMT marker that can distinguish patients with ER+ BC who will respond longer to adjuvant endocrine therapy.

Leptonic-decay-constant ratio f(K+)/f(π+) from lattice QCD with physical light quarks

A calculation of the ratio of leptonic decay constants f(K+)/f(π+) makes possible a precise determination of the ratio of Cabibbo-Kobayashi-Maskawa (CKM) matrix elements |V(us)|/|V(ud)| in the standard model, and places a stringent constraint on the scale of new physics that would lead to deviations from unitarity in the first row of the CKM matrix. We compute f(K+)/f(π+) numerically in unquenched lattice QCD using gauge-field ensembles recently generated that include four flavors of dynamical quarks: up, down, strange, and charm. We analyze data at four lattice spacings a ≈ 0.06, 0.09, 0.12, and 0.15 fm with simulated pion masses down to the physical value 135 MeV. We obtain f(K+)/f(π+) = 1.1947(26)(37), where the errors are statistical and total systematic, respectively. This is our first physics result from our N(f) = 2+1+1 ensembles, and the first calculation of f(K+)/f(π+) from lattice-QCD simulations at the physical point. Our result is the most precise lattice-QCD determination of f(K+)/f(π+), with an error comparable to the current world average. When combined with experimental measurements of the leptonic branching fractions, it leads to a precise determination of |V(us)|/|V(ud)| = 0.2309(9)(4) where the errors are theoretical and experimental, respectively.

Fasting plasma glucose 6-12 weeks after starting insulin glargine predicts likelihood of treatment success: a pooled analysis

AIMS

To evaluate whether fasting plasma glucose values measured early during insulin therapy can identify patients with Type 2 diabetes who may not achieve adequate glycaemic control after 6 months and will require additional treatment.

METHODS

Patient-level data from seven prospective, randomized, controlled studies using treat-to-target methods were pooled to evaluate the efficacy of insulin glargine. Fasting plasma glucose was measured at baseline, week 6 or 8 (6/8) and week 12. HbA(1c) was measured at week 24 to assess glycaemic control.

RESULTS

One thousand and thirty-six patients (56% male, 81% white) were included in the analysis (mean age 56.3 years; duration of diabetes 8.4 years). Baseline mean fasting plasma glucose was 11.2 mmol/l and mean HbA(1c) was 73 mmol/mol (8.8%). After 24 weeks of treatment, mean HbA(1c) decreased to 53 mmol/mol (7.0%); 56% of patients reached a target HbA(1c) ≤ 53 mmol/mol (7.0%). Significant correlations with week 24 HbA(1c) were obtained for fasting plasma glucose measured at week 6/8 and week 12 (r = 0.32; P < 0.0001 for both). Patients with fasting plasma glucose > 10 mmol/l at week 6/8 or week 12 were significantly less likely to achieve the HbA(1c) target at the end of treatment than patients with fasting plasma glucose < 8.9 mmol/l (P < 0.0001 for both). If fasting plasma glucose was > 10 mmol/l at week 6/8 or week 12, patients had only a 27% chance of reaching the HbA(1c) goal.

CONCLUSIONS

Fasting plasma glucose remaining > 10 mmol/l after 6-12 weeks of glargine therapy indicates that reaching target HbA(1c) ≤ 53 mmol/mol (7.0%) is unlikely and calls for individualized attention to consider further therapeutic options.