Chronic urticaria in Chinese population: a hospital-based multicenter epidemiological study

BACKGROUND

The epidemiologic profiles of chronic urticaria (CU) vary considerably among regions, and few such data are available from China.

METHODS

We performed a multicenter open questionnaire investigation about the clinical and laboratory features of CU, defined as recurrent wheals with/without angioedema lasting for ≥6 weeks, among 3027 patients.

RESULTS

Female preponderance was observed (female/male ratio, 1.46 : 1). The mean age at diagnosis was 34.7 ± 13.8 years, and the mean disease duration was 18.5 ± 46.1 months (range, 1.5-127 months). Patients were classified as having chronic spontaneous urticaria (CSU, 61.0% of patients), physical urticaria (PU, 26.2%), or other urticaria types (OU, 2.3%). Nocturnal attacks were reported by 60% of cases. The Urticaria Activity Score (UAS) in patients with CSU was 3.8 ± 1.4. The mean Dermatology Life Quality Index was 7.3 ± 3.4 (range 0-30). Induction or exacerbation of wheals with alcohol drinking was reported by 55.7% of patients. Chronic hepatitis B was less prevalent in our CU patients compared with the general Chinese population (2.7% vs 7%). Positive autologous serum skin tests (ASSTs) were observed in 66.9% of patients. Patients with positive ASST had higher UAS, greater angioedema frequencies, longer disease durations, and poorer QoL compared with patients with negative ASST (P < 0.05).

CONCLUSION

In this Chinese population, CU usually affected youth, and CSU was the most common subtype. Autoreactivity and alcohol consumption were the top two triggers for CU, whereas latent infectious and chronic inflammatory diseases were not as common as in previous reports.

Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil consumption and alleviates postoperative side-effects in patients undergoing sinusotomy: a prospective, randomized, placebo-controlled trial

BACKGROUND

Although opioids are widely used as analgesics in general anaesthesia, they have unpleasant side-effects and can delay postoperative recovery. Acupuncture and related techniques are effective for acute and chronic pain, and reduces some side-effects. We assessed the effect of transcutaneous electric acupoint stimulation (TEAS) on intra-operative remifentanil consumption and the incidences of anaesthesia-related side-effects.

METHODS

Sixty patients undergoing sinusotomy were randomly assigned to TEAS or control group. TEAS consisted of 30 min of stimulation (6-9 mA, 2/10 Hz) on the Hegu (LI4), Neiguan (PC6), and Zusanli (ST36) before anaesthesia. The patients in the control group had the electrodes applied, but received no stimulation. Bispectral index was used to monitor the depth of anaesthesia. Perioperative haemodynamics were recorded, and peripheral blood samples were collected to measure the levels of mediators of surgical stress. The primary end point was intraoperative remifentanil consumption and the secondary endpoints were recovery quality and anaesthesia-related side-effects.

RESULTS

Patients in the TEAS group required 39% less remifentanil during surgery than controls [0.0907 (SD 0.026) μg kg(-1) min(-1) vs 0.051 (0.018) μg kg(-1) min(-1)]. There were no differences in intra-operative haemodynamics or surgical stress between groups. However, the time to extubation and recall in the control group was 16.8 (6.8) min and 23.0 (5.0) min, respectively, significantly longer than that in the TEAS group (P<0.01). TEAS also decreased the incidence of dizziness and pruritus within the first 24 h after surgery (P<0.01).

CONCLUSION

The use of TEAS significantly reduced intra-operative remifentanil consumption and alleviated postoperative side-effects in patients undergoing sinusotomy.

CLINICAL TRIAL REGISTRATION

The trial was registered at clinicaltrials.gov (NCT01700855).

Subdiffractive microscopy: techniques, applications, and challenges

Cellular processes rely on the precise orchestration of signaling and effector molecules in space and time, yet it remains challenging to gain a comprehensive picture of the molecular organization underlying most basic biological functions. This organization often takes place at length scales below the resolving power of conventional microscopy. In recent years, several 'superresolution' fluorescence microscopic techniques have emerged that can surpass the diffraction limit of conventional microscopy by a factor of 2-20. These methods have been used to reveal previously unknown organization of macromolecular complexes and cytoskeletal structures. The resulting high-resolution view of molecular organization and dynamics is already changing our understanding of cellular processes at the systems level. However, current subdiffractive microscopic techniques are not without limitations; challenges remain to be overcome before these techniques achieve their full potential. Here, we introduce three primary types of subdiffractive microscopic techniques, consider their current limitations and challenges, and discuss recent biological applications.

Changes realized from extended bit-depth and metal artifact reduction in CT

PURPOSE

High-Z material in computed tomography (CT) yields metal artifacts that degrade image quality and may cause substantial errors in dose calculation. This study couples a metal artifact reduction (MAR) algorithm with enhanced 16-bit depth (vs standard 12-bit) to quantify potential gains in image quality and dosimetry.

METHODS

Extended CT to electron density (CT-ED) curves were derived from a tissue characterization phantom with titanium and stainless steel inserts scanned at 90-140 kVp for 12- and 16-bit reconstructions. MAR was applied to sinogram data (Brilliance BigBore CT scanner, Philips Healthcare, v.3.5). Monte Carlo simulation (MC-SIM) was performed on a simulated double hip prostheses case (Cerrobend rods embedded in a pelvic phantom) using BEAMnrc∕Dosxyz (400,000,0000 histories, 6X, 10 × 10 cm(2) beam traversing Cerrobend rod). A phantom study was also conducted using a stainless steel rod embedded in solid water, and dosimetric verification was performed with Gafchromic film analysis (absolute difference and gamma analysis, 2% dose and 2 mm distance to agreement) for plans calculated with Anisotropic Analytic Algorithm (AAA, Eclipse v11.0) to elucidate changes between 12- and 16-bit data. Three patients (bony metastases to the femur and humerus, and a prostate cancer case) with metal implants were reconstructed using both bit depths, with dose calculated using AAA and derived CT-ED curves. Planar dose distributions were assessed via matrix analyses and using gamma criteria of 2%∕2 mm.

RESULTS

For 12-bit images, CT numbers for titanium and stainless steel saturated at 3071 Hounsfield units (HU), whereas for 16-bit depth, mean CT numbers were much larger (e.g., titanium and stainless steel yielded HU of 8066.5 ± 56.6 and 13,588.5 ± 198.8 for 16-bit uncorrected scans at 120 kVp, respectively). MC-SIM was well-matched between 12- and 16-bit images except downstream of the Cerrobend rod, where 16-bit dose was ∼6.4% greater than 12-bit. Absolute film dosimetry in a region downstream of a stainless steel rod revealed that 16-bit calculated dose, with and without MAR, agreed more closely with film results (1%-2% less than film) as compared to 12-bit reconstructions (5.6%-6.5% less than film measurements). Gamma analysis revealed that 16-bit dose calculations were better matched to film results than 12-bit (∼10% higher pass rates for 16-bit). Similar results were observed in two patient cases; the largest discrepancy was observed for a femur case where 12-bit doses, both with and without MAR correction, were 6-7 Gy lower (∼17%-20% of the prescription dose) as compared to 16-bit dose calculations. However, when beams are not directly traversing metal, such as a prostate cancer case with bilateral hip prostheses; the impact of 16-bit reconstruction was diminished.

CONCLUSIONS

These results suggest that it may be desirable to implement 16-bit MAR-corrected images for treatment planning purposes, which can provide a more accurate dosimetric approach coupled with improved visualization by suppression of CT artifacts.

Performance of a modified rabbit model of abdominal aortic aneurysm induced by topical application of porcine elastase: 5-month follow-up study

OBJECTIVES

To modify the method for creating an abdominal aortic aneurysm in rabbits, and to study its performance.

MATERIALS AND METHODS

A total of 24 New Zealand white rabbits were induced topically with 10 μl of porcine elastase (0, 0.1, 5 and 10 units μl(-1)) to define the optimal concentration (groups A-D). Twelve aneurysms were induced with 10 units μl(-1) of 10 μl elastase to serve as a follow-up group (group E) to serve as a follow-up. A 1.5-cm aortic segment was isolated and induced with elastase solution for 30 min.

RESULTS

All animals in groups D and E developed AAA by day 5. Aneurysms in Group E were stable over 100 days. Partial destruction to disappearance of elastic lamellae and smooth muscle cells (SMCs) was seen in elastase-treated animals by day 5. Regenerated elastin and proliferated SMCs were present in group E. Matrix metalloproteinases 2 and 9 and RAM11 showed strong expression in group D, but expression decreased in group E after day 15.

CONCLUSIONS

The rabbit AAA model induced via topical application of porcine elastase at 10 units μl(-1) for 30 min appears easy and simple, with shorter induction and more rapid aortic dilation. The model is stable over 100 days and is useful to study the formation and progress of AAAs.

Cardiovascular drift during low intensity exercise with leg blood flow restriction

Previous studies reported that aerobic-type exercise such as walking or cycling with blood flow restriction (BFR) has been shown to elicit increases in leg muscle hypertrophy and strength, as well as improved aerobic capacity. Although previous studies investigated cardiovascular responses during a relatively short duration of exercise (∼5 min), the effects of prolonged leg muscular BFR have remained unknown. The purpose of this study was to examine the cardiovascular effects of longer duration low intensity exercise combined with BFR. Eight men performed 30 min of exercise at 40% of a predetermined maximal oxygen uptake under both BFR and normal flow (CON) conditions. Cardiovascular parameters were measured at rest and every 10 min during exercise. The main findings were that 1) the SV and HR did not change significantly between 10 to 30 min of exercise in BFR and CON conditions, although BFR-induced reduction of SV and increased HR were found at 10 min exercise compared with normal flow, 2) blood pressure was increased at 10 min of exercise in BFR compared to the CON, however the blood pressure decreased gradually with BFR from 10 to 30 min of exercise, and 3) blood lactate and RPE increased gradually during exercise with BFR. In conclusion, our results suggest that the BFR-induced reduction of SV and increased HR within the first 10 min of exercise are representative of changes in these parameters.

Botulinum toxin injections combined with or without sodium hyaluronate in the absence of electromyography for the treatment of infantile esotropia: a pilot study

OBJECTIVE

To evaluate the feasibility and safety of a revised technique of botulinum toxin type A (BTA) injections for the treatment of infantile esotropia.

METHODS

Forty-seven patients with infantile esotropia were randomly divided into two groups. In group A, 23 cases were treated with a bilateral injection of 2.5-3.75 U BTA combined with sodium hyaluronate (SH) to the medial rectus muscle. In group B, 24 cases were treated with a bilateral injection of 2.5-3.75 U BTA solution alone to the medial rectus muscle. Electromyography was not used in the study. All patients received one injection and were evaluated 2 weeks, 3 months, and 6 months following injection.

RESULTS

The measured changes between groups A and B included the frequencies of good alignment 6 months after injections (30.4% vs 37.5%), complicated ptosis (2.2% vs 20.8%), and vertical deviation (2.2% vs 2.1%).

CONCLUSION

BTA injections combined with or without SH in the absence of electromyography demonstrated effectiveness and feasibility in the treatment of infantile esotropia. A relative decrease in the frequency of complicated ptosis resulted from injections of BTA+SH.

Metagenomic sequencing of the human gut microbiome before and after bariatric surgery in obese patients with type 2 diabetes: correlation with inflammatory and metabolic parameters

Roux-en-Y gastric bypass (RYGB) has become a prominent therapeutic option for long-term treatment of morbid obesity and type 2 diabetes mellitus (T2D). Cross talk and pathogenetic consequences of RYGB-induced profound effects on metabolism and gut microbiome are poorly understood. The aim of the present study therefore was to characterize intra-individual changes of gut microbial composition before and 3 months after RYGB by metagenomic sequencing in morbidly obese patients (body mass index (BMI)>40 kg m(-)(2)) with T2D. Subsequently, metagenomic data were correlated with clinical indices. Based on gene relative abundance profile, 1061 species, 729 genera, 44 phyla and 5127 KO (KEGG Orthology) were identified. Despite high diversity, bacteria could mostly be assigned to seven bacterial divisions. The overall metagenomic RYGB-induced shift was characterized by a reduction of Firmicutes and Bacteroidetes and an increase of Proteobacteria. Twenty-two microbial species and 11 genera were significantly altered by RYGB. Using principal component analysis, highly correlated species were assembled into two common components. Component 1 consisted of species that were mainly associated with BMI and C-reactive protein. This component was characterized by increased numbers of Proteobacterium Enterobacter cancerogenus and decreased Firmicutes Faecalibacterium prausnitzii and Coprococcus comes. Functional analysis of carbohydrate metabolism by KO revealed significant effects in 13 KOs assigned to phosphotransferase system. Spearmen's Rank correlation indicated an association of 10 species with plasma total- or low-density lipoprotein cholesterol, and 5 species with triglycerides. F. prausnitzii was directly correlated to fasting blood glucose. This is the first clinical demonstration of a profound and specific intra-individual modification of gut microbial composition by full metagenomic sequencing. A clear correlation exists of microbiome composition and gene function with an improvement in metabolic and inflammatory parameters. This will allow to develop new diagnostic and therapeutic strategies based on metagenomic sequencing of the human gut microbiome.

Identifying crosstalk of mTOR signaling pathway of lobular breast carcinomas

BACKGROUND

Invasive lobular carcinoma (ILC) and its variants represent 5% to 15% of all invasive breast cancers diagnoses annually. AS a serine/threonine kinase, mammalian target of rapamycin (mTOR) is often a downstream effector of PI3K/Akt (phosphatidyl inositol 3-kinase/protein kinase B) signaling pathway in breasts and many types of cancer cells. Therefore, agents that target mTOR in direct or indirect manner are being developed in anti-cancer therapy.

AIM

In this study, our objective here was to explore more crosstalk pathway with mTOR signaling pathway.

MATERIALS AND METHODS

We collected pathways data from published database, then based on bioinformatics methods we analyzed the significant pathways in the database, additionally, the crosstalk pathways were also analyzed which were defined as those pathways which have the overlapping genes with each other.

RESULTS

As we expected, the results showed that Notch signaling pathway (hsa04330), Regulation of autophagy (hsa04140), and Adipocytokine signaling pathway (hsa04920) were linked to mTOR signaling pathway. All of them have been demonstrated participate in breast cancer progression.

CONCLUSIONS

We obtained some key pathways that crosstalked with mTOR signaling pathway, we hope our study could provide novel therapeutic approaches for breast cancer.

Inverse Correlation between Caveolin-1 Expression and Clinical Severity in Psoriasis Vulgaris

Objective:

This study investigated the clinical significance of expression of caveolin-1 - a plasma membrane protein involved in caveola formation, endocytosis, signal transduction and angiogenesis - inthe pathogenesis of psoriasis vulgaris.

Methods:

A total of 20 patients with psoriasis vulgaris and 20 healthy volunteers were recruited. The expressions of caveolin-1, Ki-67 (marker of cell proliferation) and CD34 (marker of angiogenesis) in skin biopsies were detected by immunohistochemistry, and the level of caveolin-1 protein was quantified by Western blotting. Clinical severity was assessed using the Psoriasis Area and Severity Index (PASI) score. Correlations between caveolin-1 expression and psoriasis severity, cell proliferation and angiogenesis were analysed using the Spearman rank correlation test.

Results:

Expression of caveolin-1 was significantly lower in psoriasis samples than in healthy skin samples. In psoriasis lesions, the level of caveolin-1 expression was inversely correlated with the severity of psoriasis, cell proliferation and angiogenesis.

Conclusions:

The level of caveolin-1 expression seems to be related to the clinical severity of psoriasis, and may play a role in the abnormal keratinocyte hyperplasia and angiogenesis seen in this condition.

Dual inhibitors of PI3K/mTOR or mTOR-selective inhibitors: which way shall we go?

The phosphatidylinositol-3-kinase (PI3K)/AKT/mTOR signaling pathway is a central regulator in cell proliferation, growth, and angiogenesis. Inhibition of this pathway therefore is a major strategy for cancer chemotherapy. In order to induce the maximal therapeutic outcome in cancer treatment, vertical inhibition of the PI3K/AKT/mTOR pathway or horizontal inhibition of PI3K/AKT/mTOR and other kinases has been reported. In this review, we discuss the drug design and clinical development of dual inhibitors of PI3K and mTOR as well as the mTOR-selective inhibitors, classified based on the mechanism of action and the chemical structures. Structural determinants for increasing selectivity toward PI3Kα or mTOR are revealed from the structure-activity relationship of the reported inhibitors. Current clinical development in combination therapy of inhibitors involving in the PI3K/AKT/mTOR pathway is also discussed.

MO-F-BRA-04: Voxel-Based Statistical Analysis of Deformable Image Registration Error via a Finite Element Method

Purpose Clinical implementation of adaptive treatment planning is limited by the lack of quantitative tools to assess deformable image registration errors (R-ERR). The purpose of this study was to develop a method, using finite element modeling (FEM), to estimate registration errors based on mechanical changes resulting from them. Methods An experimental platform to quantify the correlation between registration errors and their mechanical consequences was developed as follows: diaphragm deformation was simulated on the CT images in patients with lung cancer using a finite element method (FEM). The simulated displacement vector fields (F-DVF) were used to warp each CT image to generate a FEM image. B-Spline based (Elastix) registrations were performed from reference to FEM images to generate a registration DVF (R-DVF). The F- DVF was subtracted from R-DVF. The magnitude of the difference vector was defined as the registration error, which is a consequence of mechanically unbalanced energy (UE), computed using 'in-house-developed' FEM software. A nonlinear regression model was used based on imaging voxel data and the analysis considered clustered voxel data within images. Results A regression model analysis showed that UE was significantly correlated with registration error, DVF and the product of registration error and DVF respectively with R̂2=0.73 (R=0.854). The association was verified independently using 40 tracked landmarks. A linear function between the means of UE values and R- DVF*R-ERR has been established. The mean registration error (N=8) was 0.9 mm. 85.4% of voxels fit this model within one standard deviation. Conclusions An encouraging relationship between UE and registration error has been found. These experimental results suggest the feasibility of UE as a valuable tool for evaluating registration errors, thus supporting 4D and adaptive radiotherapy. The research was supported by NIH/NCI R01CA140341.