Ultrasound-guided foam sclerotherapy of the great saphenous vein with sapheno-femoral ligation compared to standard stripping: a prospective clinical study

AIM

This study is a prospective randomized controlled trial comparing ultrasound-guided foam sclerotherapy of the great saphenous vein (GSV) combined with sapheno-femoral junction (SFJ) ligation to standard stripping surgery. Primary endpoints were patient recovery period, postoperative pain, quality of life and recurrence rate and secondary end points were frequency of complications on the two arms of the trial.

METHODS

Sixty consecutive patients with incompetence of the GSV resulting in varicose veins were prospectively randomized into 2 groups of 30, treated by SFJ ligation and either ultrasound-guided foam sclerotherapy or standard stripping of the GSV. The study protocol included history, physical examination, assignment of CEAP class, assessment of the Aberdeen varicose vein questionnaire (AVVQ) and colour Duplex ultrasound.

RESULTS

All treatments were completed as intended. The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group as compared to standard stripping: 43 min vs. 65 min (P<0.01, Mann-Whitney). Less analgesic use postoperatively was recorded in the foam sclerotherapy group. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group (3 days) compared to the surgical group (6 days) (P<0.01, Mann-Whitney). The median overall cost of the procedure in the sclerotherapy group was 3143RMB, and was 3638RMB in the conventional surgery (P=0.235, Mann-Whitney). At 3 months, median CEAP class dropped from four preoperatively to one following treatment in both groups (p<0.01, Wilcoxon test). After 6 months, in the foam sclerotherapy group five patients (20%) needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 80%. And the short-term obliteration rate was 89.5% in the conventional surgery group.

CONCLUSION

Ultrasound guided sclerotherapy combined with sapheno-femoral ligation involved a shorter treatment time, less postoperative discomfort and resulted in more rapid recovery compared to conventional GSV stripping.

Effect of a high-fat meal on the pharmacokinetics of dapagliflozin, a selective SGLT2 inhibitor, in healthy subjects

Dapagliflozin is a potent and selective inhibitor of sodium-glucose co-transporter type 2 that is being developed for the treatment of type 2 diabetes mellitus. This open-label, randomized, two-period, two-treatment (single doses of 10-mg dapagliflozin fasted or fed), crossover study was conducted to evaluate the effect of a high-fat meal on the pharmacokinetics of dapagliflozin in 14 healthy subjects. Compared to the fasted state, a high-fat meal decreased mean dapagliflozin maximum plasma concentrations (C(max) ) by 31%, increased the time to C(max) (T(max) ) by 1 h, but did not affect overall dapagliflozin systemic exposure [area under the plasma concentration-time curve (AUC)]. As the cumulative (daily) amount of glucose excreted in the urine induced by dapagliflozin is dependent upon dapagliflozin AUC, the effect of food on dapagliflozin C(max) is unlikely to have a clinically meaningful effect on dapagliflozin's efficacy. On the basis of these findings, dapagliflozin can be administered without regard to meals.

Quercetin protects oligodendrocyte precursor cells from oxygen/glucose deprivation injury in vitro via the activation of the PI3K/Akt signaling pathway

The aim of this study was to investigate the protection of quercetin (QUE) on oligodendrocyte precursor cells (OPCs) from oxygen/glucose deprivation (OGD)-induced injury in vitro and explore whether the PI3K/Akt signaling pathway contributed to the protection provided by quercetin. The OGD condition was induced by including 2mM sodium dithionite (Na(2)S(2)O(4)) in glucose-free DMEM medium. The concentration of QUE in this study ranged from 3μM to 81μM. OPCs were identified by immunocytochemical staining. Cell viability was analyzed using the water soluble tetrazolium salt-8 (WST-8) and lactate dehydrogenase assay (LDH). The morphological changes of the nucleus were measured using Hoechst 33258 nuclear staining, and the ratio of apoptotic cells was determined by FITC annexin V- and propidium iodide (PI) flow cytometry assay kit. In addition, the levels of pro-apoptotic proteins such as cleaved-caspase-3 and Bax and the anti-apoptotic proteins p-Akt and Bcl-2 were quantified using western blotting. The results showed that the OPC cell survival rate was significantly increased by incubation in conditioned medium supplemented with QUE as measured by the WST-8 assay, while the LDH release rate was significantly decreased as analyzed by the LDH assay. Furthermore, apoptosis assay showed that the apoptosis ratio of OPCs was also dramatically reduced by QUE. Western blotting showed that the expression levels of Bax and cleaved-caspase-3 proteins were down-regulated, while Bcl-2 and p-Akt were up-regulated. Further study showed that the increase in p-Akt by QUE was reduced by the PI3K inhibitor LY294002. These results indicated that QUE effectively protected OPCs from OGD-induced injury and that the mechanism might be related to the activation of the PI3K/Akt signaling pathway.

Autism severity is associated with child and maternal MAOA genotypes

Autism severity is associated with child and maternal MAOA genotypes. We replicated and extended a previously reported association between autism severity and a functional polymorphism in the monoamine oxidase A (MAOA) promoter region, MAOA-uVNTR, in a sample of 119 males, aged 2-13 years, with autism spectrum disorder from simplex families. We demonstrated that (i) boys with the low activity 3-repeat MAOA allele had more severe sensory behaviors, arousal regulation problems, and aggression, and worse social communication skills than males with the high activity allele; and (ii) problems with aggression, as well as with fears and rituals, were modified by the mothers' genotype. Boys with the 4-repeat high activity allele who had homozygous 4-repeat mothers showed increased severity of these behaviors relative to those born to heterozygous mothers. These findings indicate the importance of considering maternal genotype in examining associations of MAOA and other genes with behavior in male offspring.

Unconventional magnetism in a nitrogen-containing analog of cupric oxide

We have investigated the magnetic properties of CuNCN, the first nitrogen-based analog of cupric oxide CuO. Our muon-spin relaxation, nuclear magnetic resonance, and electron-spin resonance studies reveal that classical magnetic ordering is absent down to the lowest temperatures. However, a large enhancement of spin correlations and an unexpected inhomogeneous magnetism have been observed below 80 K. We attribute this to a peculiar fragility of the electronic state against weak perturbations due to geometrical frustration, which selects between competing spin-liquid and more conventional frozen states.

A genome-wide association study for quantitative traits in schizophrenia in China

Few genome-wide association studies (GWAS) of schizophrenia have included Chinese populations, and verification of positive genetic findings from other ethnic groups is rare in Chinese groups. We used fluid intelligence as the quantitative trait reflecting schizophrenia dysfunction in Chinese populations, and determined the impact of genetic variation on fluid intelligence phenotypic patterns to identify genetic influences in schizophrenia. The study sample comprised 98 patients with schizophrenia and 60 healthy controls. The general fluid intelligence of participants was assessed with Cattell's Culture-Free Intelligence Test (CCFIT). Subjects were genotyped using the Illumina HumanHap 660 beadchip. We identified the methionine sulfoxide reductase A (MSRA) gene on chromosome 8 as having an association with fluid intelligence. However, only CCFIT subtest 1 (series score) demonstrated a significant result for the interaction term using the criteria of the quantitative trait (QT) analysis of 10(-5) for at least three SNPs. There were 15 haplotype blocks of MSRA gene SNPs identified using Haploview 4.2 with solid spine D' > 0.80. The strongest QT interaction was noted in Block 3, with the most common haplotypes being AAACAGCAG and CGCAGAAGA. In conclusion, we report data from a GWAS with quantitative traits design from Chinese first-episode schizophrenia patients and matched controls. Although the gene identified requires confirmation in an independent sample, the MSRA gene located on chromosome 8 was found to be associated with the phenotype of schizophrenia.

Immunogenicity and protective efficacy of a fusion protein vaccine consisting of antigen Ag85B and HspX against Mycobacterium tuberculosis infection in mice

Subunit vaccines have the potential advantage to boost Mycobacterium bovis Bacillus Calmette-Guérin (BCG)-primed immunity in adults. However, most candidates are antigens highly expressed in replicating bacilli but not in dormant or persisting bacilli, which exist during Mycobacterium tuberculosis infection. We constructed M. tuberculosis fusion protein Ag85B-Mpt64(190-198) -HspX (AMH) and Ag85B-Mpt64(190-198) -Mtb8.4 (AMM), which consist of Ag85B, the 190-198 peptide of Mpt64, HspX (Rv2031c) and Mtb8.4 (Rv1174c), respectively. AMH and/or AMM were mixed with adjuvants composed of dimethyl-dioctyldecyl ammonium bromide and BCG polysaccharide nucleic acid (DDA-BCG PSN) to construct subunit vaccines. Mice were immunized thrice with Ag85B, AMH and AMM vaccines and the immunogenicity of the fusion protein vaccines was determined. Then, mice were primed with BCG and boosted twice with Ag85B, AMH, AMM and AMM + AMH vaccines, respectively, followed by challenging with M. tuberculosis virulent strain H37Rv, and the immune responses and protective effects were measured. It was found that mice immunized with AMH vaccine generated high levels of antigen-specific cell-mediated responses. Compared with the group injected only with BCG, the mice boosted with AMM, AMH and AMM + AMH produced higher levels of Ag85B-specific IgG1 and IgG2a and IFN-γ-secreting T cells upon Ag85B and Mycobacterium tuberculosis purified protein derivative (PPD) stimulation. It is interesting that only mice boosted with AMM + AMH had significantly lower bacterial count in the lungs than those receiving BCG, whereas mice boosted with AMH or AMM did not. The results suggest that AMH consisting of HspX, the antigen highly expressed in dormant bacilli, could be combined with antigens from replicating bacilli to enhance BCG primed immunity so as to provide better protection against both growing and non-growing bacteria that occur during the infection process.

Introducing traditional Chinese nursing: a review of concepts, theories and practices

AIM

This paper discussed the basic concepts, theories and practices of traditional Chinese nursing (TCN) to enrich our understanding of relevant concepts and ways to contribute to human health.

BACKGROUND

Advantages of TCN include health education based on theories and techniques of traditional Chinese medicine. It focuses mainly on mobilizing humans' capacity for self-adjustment and self-rehabilitation to make a dynamic balance between yin and yang, qi and blood and zang and fu. It has played a significant role in the fields of primary nursing, geriatric nursing, hospice, family nursing, etc., in China.

METHOD

PubMed, CINAHL, Ovid Medline (English) and the Wang Fang (Chinese) databases were searched for literature on a range of keywords relating to traditional Chinese medicine and nursing. Forty references (13 English and 27 Chinese) were finally selected for review.

CONCLUSION

Practices of nursing care in traditional Chinese medicine are based mainly on the theories of yin-yang and the five elements. There are two prime characteristics in the theoretical system of TCN: holism and nursing determination based on syndrome differentiation. The distinctive content include prevention, daily care of patients, dietary nursing, etc. TCN, with its characteristics of little damage, little pain, ease of operation and low cost, is appropriately used in primary health care in China. By combining Western and Eastern philosophies and approaches to nursing, life phenomena can be better understood, and more ways to promote health can be exploited. Scientists are beginning to use Western research methods to establish effectiveness. Many common interventions would not, however, be considered safe in Western nursing practice without more evidence and consideration of health and safety issues.

Feasibility and safety of stenting for symptomatic carotid arterial dissection

OBJECTIVE

To determine the procedural feasibility and safety of carotid angioplasty and stent placement of carotid artery dissection (CAD) patients who had failed antithrombotic therapy in acute dissection.

METHODS

A series of 33 consecutive patients (mean age, 40.21 years; 29 men and 4 women) who underwent angioplasty and stent placement for symptomatic carotid artery dissection (sCAD) from May 2005 to December 2010 in the Nanjing Stroke Registry Program (NSRP) was retrospectively reviewed. All the included patients had been diagnosed definitively based on catheter angiography, and had failed to respond to medical therapy during the course of initial hospital admission. The baseline and followed up data of these patients were collected and analyzed.

RESULTS

Of all the 33 included patients, 32 patients had achieved technical success without any intraoperative complications. Two patients manifested ipsilateral Horner sign on the next day after stenting, and one of them suffered from recurrence of transient ischaemic attack (TIA) during the course of follow up, but completely remission via antithrombotic therapy.

CONCLUSION

Endovascular stenting is a feasible and safe therapeutic strategy of CAD patients who have failed medical therapy.

QSAR studies on the depuration rates of polycyclic aromatic hydrocarbons, polybrominated diphenyl ethers and polychlorinated biphenyls in mussels (Elliptio complanata)

Based on the mechanism of action, a quantitative structure-activity relationship (QSAR) model for the depuration rate constants (k(d)) of 28 PAHs, 8 PBDEs and 28 PCBs in mussels (Elliptio complanata) was constructed by partial least squares (PLS) regression, following the guidelines for development and validation of QSAR models. For the training set of the QSAR model, r² = 0.953, the cross-validated regression coefficient (Q²(CUM)) was 0.947. The predicted log k(d) values for the validation set were consistent with the observed values, with a standard error (SE) of 0.160 log units and a squared correlation coefficient (Q²(EXT)) of 0.892. Comparatively, the developed QSAR model had good robustness, predictive ability and extended applicability domain. The electrophilicity index (ω), molecular polarizability (α), the averages of the negative potentials on the molecular surface (V(s⁻)) and the balance parameter of surface potential (τ) were the key parameters governing the log k(d) values in the QSAR model, which indicated that the log k(d) value was mainly related to the partition ability, electrostatic interactions, and van der Waals interactions of compounds.

Use of the asymmetric planar hall resistance of an Fe film for possible multi-value memory device applications

Systematic planar Hall measurements have been performed on a ferromagnetic Fe film grown on a standard (001) GaAs substrate at room temperature. The angular dependence of the planar Hall effect revealed the presence of both four-fold (cubic) and two-fold (uniaxial) anisotropies in the 7 nm thick Fe film. The dominance of the four-fold symmetric anisotropy, however, provided four magnetic easy axes near the (100) direction, which results in a two step switching phenomenon in the magnetization reversal process. An interesting asymmetric hysteresis loop was observed in the planar Hall resistance (PHR) when the turning point of the field scan is set at the value in the region of the second transition. The intermediate resistance states appearing in the asymmetric PHR loop were understood in terms of mutli-domain structures formed during the second switching of magnetization. Such multi-domain structure of the Fe film showing robust time stability provided additional Hall resistance states, which can be used for multi-valued memory device applications.

Efficacy, tolerability, and biomarker analyses from a phase III, randomized, placebo-controlled, parallel group study of gefitinib as maintenance therapy in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC; INFORM; C-TONG 0804)

LBA7511

Background: INFORM (a phase III, randomized, multicenter, parallel group study; NCT00770588 ) investigated the efficacy, safety and tolerability of gefitinib (G) vs. placebo (P) as maintenance therapy in pts with locally advanced/metastatic NSCLC following standard first-line platinum based chemotherapy. Methods: Pts (≥18 years, with stage IIIB/IV NSCLC and WHO performance status 0-2) had completed 4 cycles of first-line platinum based doublet chemotherapy without progression/unacceptable toxicity. Pts were randomized 1:1 to G 250mg/day or P on discontinuation of first-line therapy. Progression-free survival (PFS; primary endpoint) was assessed in the intent to treat population (Cox proportional hazards adjusted for histology [adenocarcinoma vs. non-adenocarcinoma], smoking status [never-smoker vs. smoker], EGFR mutation status [positive vs. negative vs. unknown] and best response to first-line chemotherapy [complete response/partial response vs. stable disease]). PFS was considered superior with gefitinib if the G:P hazard ratio (HR) upper confidence interval (CI) was <1.00. Secondary endpoints included overall survival (OS), objective response rate, disease control rate, symptom improvement and tolerability. Results: 296 pts (n=148 G, n=148 P) were randomized (27 centers in china; 26 September 2008-10 August 2009). PFS data cutoff on 24 January 2011. Median duration of follow-up was 16.8 months: 91% pts progressed; 59% deaths. Demography was balanced between treatments; overall, 54.1% pts were never-smokers, 70.6% had adenocarcinoma, and 40.9% were female. For G vs. P, PFS HR=0.42; 95% CI 0.32-0.54; p<0.0001; median PFS 4.8 vs. 2.6 months. Most common AEs (any grade) with G were rash (49.7%), diarrhea (25.2%), and ALT increase (21.1%) which were generally mild/moderate. Overall incidence of serious AEs: G (6.8%); P (3.4%). Other secondary endpoint data (including OS and biomarkers) will be presented. Conclusions: PFS was significantly longer with G compared with P as maintenance therapy in Chinese patients with locally advanced NSCLC.

Cell apoptosis of taste buds in circumvallate papillae in diabetic rats

Diabetes mellitus may result in taste disturbance. The present study has revealed that cell apoptosis of taste buds in circumvallate papillae may contribute to the taste disturbance in a rat model of type2 diabetes. Type2 diabetes was induced in Wistar rats by feeding them with a high-fat diet (30% fat), and a single intraperitoneal injection of streptozotocin (30 mg/kg). The increased cell apoptosis of taste buds in circumvallate papilla sections was detected by TUNEL staining in diabetic rats, and the ultrastructure was further examined by transmission electronic microscopy. Immunohistochemical and Western blot analyses revealed the downregulation of Bcl-2, upregulation of Bax, and increased activation of caspase-9 and -3, in diabetic rats, indicating that the apoptosis of taste bud cells may be mediated via the intrinsic mitochondrial pathway in diabetics.