Fluorine-18 prostate-specific membrane antigen-1007-avid indeterminate bone lesions in prostate cancer: clinical and PET/CT features to predict outcomes and prognosis

AIM

To determine clinical and fluorine-18 prostate-specific membrane antigen-1007 (18F-PSMA-1007) integrated positron-emission tomography (PET)/computed tomography (CT) features that could be used to interpret indeterminate bone lesions (IBLs) and assess the prognosis of prostate cancer (PCa) in patients with IBLs.

MATERIALS AND METHODS

Consecutive patients who underwent PSMA PET/CT were analysed retrospectively. IBLs were identified as benign or malignant based on follow-up imaging and clinical management. Lesion- and patient-based assessments were performed to define features predictive of bone lesion results and determine clinical risk. Patients' prognosis was analysed based on clinical characteristics, including prostate-specific antigen (PSA) and alkaline phosphatase (ALP), respectively.

RESULTS

A total of 105 patients (mean age ± SD, 72.1 ± 8 years) were evaluated and 158 IBLs were identified. Fifty-three (33.5%), 36 (22.8%), and 69 (43.7%) IBLs were benign, malignant, and equivocal, respectively. Variables including location, maximum standard uptake value (SUVmax), and lymph node metastases (LNM) were related to the benignancy or malignancy of IBLs (p=0.046, p<0.001 and p<0.001, respectively). Regression analysis indicated that LNM, SUVmax, and location of IBLs could be predictors of lesion interpretation (p<0.001, p=0.002 and p=0.035). Patients with benign IBLs experienced the most considerable decreases in PSA and ALP levels.

CONCLUSIONS

LNM, SUVmax, and location may contribute to IBL interpretation. A rapid decrease in PSA and ALP levels might suggest a better prognosis for patients with benign IBLs.

Resolvin E1 heals injured cardiomyocytes: Therapeutic implications and H-FABP as a readout for cardiovascular disease & systemic inflammation

The purpose of this study is to investigate heart-fatty acid binding protein (H-FABP) leakage from cardiomyocytes as a quantitative measure of cell membrane damage and to test healing by Resolvin E1 (RVE1) as a potential therapeutic for patients with inflammatory diseases (cardiovascular disease and comorbidities) with high morbidity and mortality. Our quantitative ELISA assays demonstrated H-FABP as a sensitive and reliable biomarker for measuring cardiomyocyte damage induced by lipopolysaccharide (LPS) and healing by RvE1, a specialized pro-resolving mediator (SPM) derived from the Omega-3 fatty acid, eicosapentaenoic acid (EPA), a dietary nutrient that balances inflammation to restore homeostasis. RvE1 reduced leakage of H-FABP by up to 86%, which supports our hypothesis that inflammation as a mechanism of injury can be targeted for therapy. H-FABP as a blood biomarker was tested in 40 patients admitted to Boston Medical Center for respiratory distress, (20 patients with and 20 patients without COVID infection). High levels of H-FABP correlated with clinically diagnosed CVD, diabetes, and end-stage renal disease (ESRD) in both patient groups. The level of H-FABP indicates not only CVD damage but is a valuable measure for patients with increased inflammation disease comorbidities.

Inline amplification of mid-infrared intrapulse difference frequency generation

We demonstrate an ultrafast mid-infrared source architecture that implements both intrapulse difference frequency generation (iDFG) and further optical parametric amplification (OPA), in an all-inline configuration. The source is driven by a nonlinearly compressed high-energy Yb-doped-fiber amplifier delivering 7.4 fs pulses at a central wavelength of 1030 nm, at a repetition rate of 250 kHz. It delivers 1 µJ, 73 fs pulses at a central wavelength of 8 µm, tunable over more than one octave. By enrolling all the pump photons in the iDFG process and recycling the long wavelength pump photons amplified in the iDFG in the subsequent OPA, we obtain an unprecedented overall optical efficiency of 2%. These performances, combining high energy and repetition rate in a very simple all-inline setup, make this technique ideally suited for a growing number of applications, such as high harmonic generation in solids or two-dimensional infrared spectroscopy experiments.

Down-regulation of betatrophin enhances insulin sensitivity in type 2 diabetes mellitus through activation of the GSK-3β/PGC-1α signaling pathway

OBJECTIVE

The incidence of type 2 diabetes mellitus (T2DM) among children and adolescents has been rising. Accumulating evidences have noted the significant role of betatrophin in the regulation of lipid metabolism and glucose homeostasis. In our study, we tried to figure out the underlying mechanism of betatrophin in insulin resistance (IR) in type 2 diabetes mellitus (T2DM).

METHODS

First, fasting serum betatrophin, fasting blood glucose (FBG), insulin, total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) were detected in T2DM children. The homeostasis model assessment of insulin resistance (HOMA-IR), Gutt insulin sensitivity index (ISI_G) and Matsuda insulin sensitivity index (ISI_M) were calculated. A T2DM-IR mouse model was induced by high-fat diet, with the expression of GSK-3β and PGC-1α detected. Besides, HepG2 cells were induced by a high concentration of insulin to establish an IR cell model (HepG2-IR). The cell viability, glucose consumption, liver glycogen content, inflammation, and fluorescence level of GSK-3β and PGC-1α were analyzed.

RESULTS

Betatrophin was highly expressed in serum of T2DM children and was positively correlated with FBG, insulin, TC, TG, LDL-C and HOMA-IR, while negatively correlated with ISI_G and ISI_M. Betatrophin and GSK-3β in the liver tissues of T2DM-IR mice were increased, while the PGC-1α expression was decreased. Betatrophin expression was negatively correlated with PGC-1α and positively correlated with GSK-3β. Silencing of betatrophin enhanced insulin sensitivity through the activation of GSK-3β/PGC-1α signaling pathway. In vitro experiments also found that silencing of betatrophin promoted glucose consumption and glycogen synthesis while inhibited inflammation.

CONCLUSION

Our findings concluded that silencing of betatrophin could enhance insulin sensitivity and improve histopathological morphology through the activation of GSK-3β/PGC-1α signaling pathway.

Characteristics and long-term outcomes of patients with reduced ejection fraction referred for adenosine stress perfusion cardiac magnetic resonance imaging

Funding Acknowledgements

Type of funding sources: None.

Background

Adenosine stress perfusion has been shown to be of minimal incremental benefit in distinguishing between ischaemic and non-ischaemic aetiology of severe left ventricular systolic dysfunction (LVSD) over and above that obtained from Cardiac Magnetic Resonance (CMR) with Late Gadolinium Enhancement (LGE). Stress CMR has, however, been shown to be effective in risk-stratifying LVSD patients, with ischaemia being an independent predictor of cardiovascular death or myocardial infarction (MI) and associated with higher rates of further intervention.

Purpose

Evaluate real world data from a single tertiary UK cardiac MRI centre to determine the characteristics and long-term clinical outcomes of patients with LVSD referred for stress CMR. 

Methods

As part of an ongoing registry, all consenting patients with Ejection Fraction (EF) ≤40% and a completed adenosine stress perfusion CMR between January 2015 and December 2019 were included with prospective baseline data collection. All-cause mortality and cardiac hospitalisation, coronary angiography/revascularisation was determined from electronic hospital records. Outcomes were compared between the inducible ischaemia vs. no ischaemia groups, and LGE present vs. no LGE groups using chi square. 

Results

The sample included 86 patients. The mean EF was 32 ± 6%. Median follow up was 3.8 years (range 41-2222 days). The indications for CMR were: 30 (35%) assess ischaemia, 35 (41%) assess LVSD aetiology and 21 (24%) LVSD assess viability. 

Inducible ischemia was present in 30 (35%) patients and absent in 56 (65%).  Patient characteristics and outcomes are shown in Table 1. Baseline characteristics were similar between the groups but there was a higher rate of hypertension and ischaemic heart disease in the ischaemia group. There was a non-significant difference in combined mortality and cardiac hospitalisation rates between the groups (40% vs. 27% p = 0.20). 

LGE was present in 69 (80%) patients (28 with ischaemia; 41 without) and absent in 17 (20%, 2 with ischaemia, 15 without). The event rate was 23 (33%) vs. 4 (24%) between LGE vs. No LGE groups (p = 0.44). Of the 15 patients (17%) with no LGE or ischaemia; 2 died and 1 was hospitalised, there were no MI"s and no Percutaneous Coronary Intervention (PCI).

The lack of statistical difference in event rates between ischaemia and no ischaemia groups may be due to our relatively small sample size or could reflect the effectiveness of contemporary disease modifying treatment for Heart Failure with reduced EF.

Conclusion

This real-world data supports published findings that in patients with LVSD and no LGE on CMR, ischaemia is very uncommon and stress CMR is unlikely to increase diagnostic yield. Conversely, if stress CMR is performed and ischaemia is absent, incidence of subsequent angiography and revascularisation is very low, which is reassuring in clinical practice.  In those patients without ischaemia and LGE, likelihood of MI is low.

The Function of Wnt Ligands on Osteocyte and Bone Remodeling

Bone homeostasis is continually maintained by the process of bone remodeling throughout life. Recent studies have demonstrated that Wnt signaling pathways play a fundamental role in the process of bone homeostasis and remodeling. Intracellular Wnt signaling cascades are initially triggered by a Wnt ligand-receptor complex formation. In previous studies, the blocking of Wnt ligands from different osteoblastic differentiation stages could cause defective bone development at an early stage. Osteocytes, the most abundant and long-lived type of bone cell, are a crucial orchestrator of bone remodeling. However, the role of Wnt ligands on osteocyte and bone remodeling remains unclear. In our present study, we found that, besides osteoblasts, osteocytes also express multiple Wnt ligands in the bone environment. Then, we used a Dmp1-Cre mouse line, in which there is expression in a subset of osteoblasts but mainly osteocytes, to study the function of Wnt ligands on osteocyte and bone remodeling in vivo. Furthermore, we explored the role of Wnt ligands on osteocytic mineralization ability, as well as the regulatory function of osteocytes on the process of osteoblastic differentiation and osteoclastic migration and maturity in vitro. We concluded that Wnt proteins play an important regulatory role in 1) the process of perilacunar/canalicular remodeling, as mediated by osteocytes, and 2) the balance of osteogenesis and bone resorption at the bone surface, as mediated by osteoblasts and osteoclasts, at least partly through the canonical Wnt/β-catenin signaling pathway and the OPG/RANKL signaling pathway.

PARE0009 COMMUNITY ADVISORY BOARD INPUT CAN MAKE LAY SUMMARIES OF CLINICAL TRIAL RESULTS MORE UNDERSTANDABLE

Background:

Under European Union (EU) Clinical Trial regulations,1clinical research sponsors (CRSs) must ensure all studies performed in the EU are accompanied by a trial summary for laypersons, published within 1 year of study completion. These lay summaries should disseminate clinical trial results in an easy-to-understand way for trial participants, patient and caregiver communities, and the general public. The European Patients Forum (EPF)2and European Patients’ Academy on Therapeutic Innovation (EUPATI)3encourage CRSs to engage with patient organisations (POs) in the development of lay summaries. This recognises the patients’ contribution to clinical research and supports the development of patient-focused material.

Objectives:

We share learnings from a collaboration between scleroderma POs and a CRS to create the SENSCIS® trial (NCT02597933) written and video lay summaries.

Methods:

A community advisory board (CAB), comprising representatives from 11 scleroderma POs covering a range of countries/regions, was formed based on the EURORDIS charter for collaboration in clinical research.4Through three structured meetings, over a seven-month period, the CAB provided advice on lay summary materials (written and video) drafted by the CRS’ Lay Summary Group (Fig. 1). At each review cycle, the CAB advice was addressed to make content more understandable and more relevant for patients and the general public.

Results:

The CAB advised that the existence of lay summaries is not well known in the patient community and also recommended the development of trial-specific lay summary videos to further improve understandability of the clinical trial results for the general public. Videos are a key channel of communication, enabling access to information for people with specific health needs and lower literacy levels. Following CAB advice, the CRS developed a stand-alone video entitled“What are lay summaries?”and a trial-specific lay summary video. Revisions to lay summary content (written and video) included colour schemes, iconography and language changes to make content more understandable. For videos, adjustments to animation speed, script and voiceover were implemented to improve clarity and flow of information (Fig. 2). Approved final versions of lay summary materials are publicly available on the CRS website. Translation into languages representing trial-site countries is in progress to widen access to non-English speakers and, where possible, local versions are being reviewed by the patient community.

Conclusion:

Structured collection and implementation of CAB advice can make lay summary materials more understandable for the patient community and wider general public.

References:

[1]EU. Summaries of clinical trial results for laypersons. 2018

[2]EPF. EPF position: clinical trial results – communication of the lay summary. 2015

[3]EUPATI. Guidance for patient involvement in ethical review of clinical trials. 2018

[4]EURORDIS. Charter for Collaboration in Clinical Research in Rare Diseases. 2009

Disclosure of Interests:

Joep Welling Speakers bureau: Four times as a patient advocate for employees of BII and BI MIDI with a fixed amount of € 150,00 per occasion., Annelise Roennow: None declared, Maureen Sauvé Grant/research support from: Educational grants from Boehringer Ingelheim and Janssen., EDITH BROWN: None declared, Ilaria Galetti: None declared, Alex Gonzalez Consultant of: Payment made to the patient organisation (Scleroderma Research Foundation) for participation in advisory boards, Alexandra Paula Portales Guiraud: None declared, Ann Kennedy Grant/research support from: AS FESCA aisbl, Catarina Leite: None declared, Robert J. Riggs: None declared, Alison Zheng Grant/research support from: We get grants from Lorem Vascular; BI China,; Jianke Pharmaceutical Co., Ltd.; Kangjing Biological Co., Ltd.; COFCO Coca-Cola to organize national scleroderma meetings, offer patients service, holding academic meetings and other public activities, there is also a small part of the grants used to pay the workers in our organization., Consultant of: I worked as a paid consultant for BI. Pay-per-job., Speakers bureau: I was invited once to be a speaker at BI China’s internal meeting and they paid me., Matea Perkovic Popovic: None declared, Annie Gilbert Consultant of: I have worked as a paid consultant with BI International for over 3 years, since Sept 2016., Lizette Moros Employee of: Lizette Moros is an employee of Boehringer Ingelheim, Kamila Sroka-Saidi Employee of: Paid employee of Boehringer Ingelheim., Thomas Schindler Employee of: Employee of Boehringer Ingelheim Pharma, Henrik Finnern Employee of: Paid employee of Boehringer Ingelheim.

Risk factors for cerebrospinal fluid shunt infections during an outbreak: a case-control study

BACKGROUND

There are few published reports of cerebrospinal fluid (CSF) shunt infection outbreaks. In 2017-2018, British Columbia Children's Hospital (BCCH) experienced an increase in CSF shunt infections co-incident with a move to new operating rooms and a change in shunt catheters used.

AIMS

To describe how an outbreak was detected, investigations were undertaken to determine the cause, risk factors associated with CSF shunt infection during the outbreak, and changes implemented to attempt to control the outbreak.

METHODS

Retrospective case-control study. Population included patients who underwent new shunt insertion or revision. Univariate logistic regression models were fitted for each of the variables. Associations with P-values <0.2 were considered of potential interest for further investigation.

FINDINGS

There were six cases of CSF shunt infection and 19 controls. The causative organism was different in each case. The only risk factors that met the criteria for further investigation were being a neonate at the time of surgery [odds ratio (OR) 9.0, 95% confidence interval (CI) 0.7-125.3, P=0.10] and the presence of gastrointestinal disease (OR 3.8, 95% CI 0.5-26.2, P=0.18). No association was found with the operating room used or the surgical staff. In response to the outbreak, human traffic through the operating rooms was limited, rigid adherence to the wearing of surgical masks was enforced, and return to the previous CSF shunt catheters used was implemented.

CONCLUSION

No modifiable risk factors were associated with CSF shunt infection. After implementation of surgical protocol changes, no further cases of CSF shunt infection linked to the outbreak were identified.

Bronchopleural fistula after lung ablation: Experience in two cases and literature review

BACKGROUND

Bronchopleural fistula (BPF) complicating lung tumor ablation is rare but severe. The purpose of this article was to study its characteristics and treatments.

MATERIALS AND METHODS

Two of 682 (0.3%) sessions of lung microwave ablation (MWA) were complicated with BPF and documented. Two electronic databases were searched for reported cases of BPF after lung tumor ablation. Case selection and data collection were done by 3 independent reviewers.

RESULTS

A 56-year-old man and a 61-year-old woman developed BPF after MWA and died. Thirteen cases (mean age 63.8, 61.5% male) of BPF with adequate information were identified from 8 articles. Of the 13 cases, 5 (38.5%) had pulmonary co-morbidity, 3 (23.1%) had a history of pulmonary surgery, 7 (53.8%) had a target tumor adjacent or abutting pulmonary pleura, and 6 (46.2%) developed severe infections. After chest tube placement, pleurodesis, endoscopic therapy, surgery, and other treatments, 12 were cured and 1 died of BPF and pneumonia.

CONCLUSION

BPF is a rare but severe complication of lung ablation, and the management needs a multidisciplinary and individualized treatment strategy.

Rebalance between 7S and 11S globulins in soybean seeds of differing protein content and 11SA4

Protein content and globulin subunit composition of soybean seeds affect the quality of soy foods. In this proteomic study, the protein profile of soybean seeds with high (∼45.5%) or low (∼38.6%) protein content and with or without the glycinin (11S) subunit 11SA4 was examined. 44 unique proteins and their homologues were identified and showed that both protein content and 11SA4 influenced the abundance of a number of proteins. The absence of 11SA4 exerted a greater impact than the protein content, and led to a decreased abundance of glycinin G2/A2B1 and G5/A5A4B3 subunits, which resulted in lower total 11S with a concomitant higher total β-conglycinin (7S). Low protein content was associated with higher glycinin G3/A1aB1b and lower glycinin G4/A5A4B3. Using the proteomic approach, it was demonstrated that 11SA4 deficiency induced compensatory accumulation of 7S globulins and led to a similar total abundance for 7S+11S irrespective of protein content or 11SA4.

Artificial pneumothorax for pain relief during microwave ablation of subpleural lung tumors

BACKGROUND

When microwave ablation (MWA) is used for subpleural lesions, severe pain was the common side effect under the local anesthesia conditions during the procedure and postprocedure. To study the pain relief effect of artificial pneumothorax in the treatment of subpleural lung tumors with MWA.

MATERIALS AND METHODS

From February 2012 to October 2014, 37 patients with 40 subpleural lung tumors underwent MWA, including 17 patients of 19 sessions given artificial pneumothorax prior to MWA (group-I), and 20 patients of 21 sessions without artificial pneumothorax (group-II). Patient's pain assessment scores (10-point visual analog scale [VAS]) at during-procedure, 6, 12, 24, and 48 h after the MWA procedure and mean 24 h morphine dose were compared between the two groups. Complications of the artificial pneumothorax were also summarized.

RESULTS

Pain VAS were 0.53, 0.65, 1.00, 0.24, and 0.18 at during-procedure, 6, 12, 24, and 48 h for group-I and 5.53, 2.32, 2.82, 1.21, and 0.21 for group-II, respectively. Pain VAS in group I was significantly decreased at during-procedure, 6, 12, and 24 h after the MWA (P < 0.001). No statistical pain VAS difference was observed at 48 h after the MWA between the two groups (P > 0.05). The mean 24 h morphine dose was 5.00 mg in group-I and 12.63 mg in group-II (P = 0.000). "Artificial pneumothorax" related complications occurred in two patients from group-I, including one pleural effusion and one minor hemoptysis. No patient in group-I and group-II died during the procedure or in 30 days after MWA.

CONCLUSION

Artificial pneumothorax is a safe and effective method for pain relief during MWA of subpleural lung tumors.

Styrene/Isoprene/Styrene Thermoplastic Elastomer Prepared by Anionic Bulk Polymerization in a Twin-Screw Extruder

In this study, a styrene/isoprene/styrene (SIS) triblock copolymer was synthesized in an intermeshing, co-rotating, twin-screw extruder. N-butyl lithium was used as the initiator. The styrene and isoprene monomer as well as 1,2-dibromoethane were sequentially added into the extruder. The weight content of isoprene in this copolymer was above 60%. Gel permeation chromatography (GPC) results showed that the polystyrene in the copolymer chains was mainly comprised of only one long block. Dynamic mechanical analysis (DMA) and transmission electron microscopy (TEM) showed that the polystyrene phase transferred from larger numbers of small microdomains to a continuous aggregation after the coupling reaction. As a result, the tensile stress and ultimate elongation was significantly improved, similar to the commercial product. Traditionally, SIS has only been synthesized by solution polymerization. The present work offers the capacity to synthesize it with very little or no solvent. This method fits the environmentally friendly trend.

The Second National Ballistics Imaging Comparison (NBIC-2)

In response to the guidelines issued by the American Society of Crime Laboratory Directors/Laboratory Accreditation Board (ASCLD/LAB-International) to establish traceability and quality assurance in U.S. crime laboratories, NIST and the ATF initiated a joint project, entitled the National Ballistics Imaging Comparison (NBIC). The NBIC project aims to establish a national traceability and quality system for ballistics identifications in crime laboratories utilizing ATF's National Integrated Ballistics Information Network (NIBIN). The original NBIC was completed in 2010. In the second NBIC, NIST Standard Reference Material (SRM) 2461 Cartridge Cases were used as reference standards, and 14 experts from 11 U.S. crime laboratories each performed 17 image acquisitions and correlations of the SRM cartridge cases over the course of about half a year. Resulting correlation scores were collected by NIST for statistical analyses, from which control charts and control limits were developed for the proposed quality system and for promoting future assessments and accreditations for firearm evidence in U.S. forensic laboratories in accordance with the ISO 17025 Standard.

Mitochondrial dysfunction-associated OPA1 cleavage contributes to muscle degeneration: preventative effect of hydroxytyrosol acetate

Mitochondrial dysfunction contributes to the development of muscle disorders, including muscle wasting, muscle atrophy and degeneration. Despite the knowledge that oxidative stress closely interacts with mitochondrial dysfunction, the detailed mechanisms remain obscure. In this study, tert-butylhydroperoxide (t-BHP) was used to induce oxidative stress on differentiated C2C12 myotubes. t-BHP induced significant mitochondrial dysfunction in a time-dependent manner, accompanied by decreased myosin heavy chain (MyHC) expression at both the mRNA and protein levels. Consistently, endogenous reactive oxygen species (ROS) overproduction triggered by carbonyl cyanide 4-(trifluoromethoxy) phenylhydrazone (FCCP), a mitochondrial oxidative phosphorylation inhibitor, was accompanied by decreased membrane potential and decreased MyHC protein content. However, the free radical scavenger N-acetyl-L-cysteine (NAC) efficiently reduced the ROS level and restored MyHC content, suggesting a close association between ROS and MyHC expression. Meanwhile, we found that both t-BHP and FCCP promoted the cleavage of optic atrophy 1 (OPA1) from the long form into short form during the early stages. In addition, the ATPase family gene 3-like 2, a mitochondrial inner membrane protease, was also markedly increased. Moreover, OPA1 knockdown in myotubes was accompanied by decreased MyHC content, whereas NAC failed to prevent FCCP-induced MyHC decrease with OPA1 knockdown, suggesting that ROS might affect MyHC content by modulating OPA1 cleavage. In addition, hydroxytyrosol acetate (HT-AC), an important compound in virgin olive oil, could significantly prevent t-BHP-induced mitochondrial membrane potential and cell viability loss in myotubes. Specifically, HT-AC inhibited t-BHP-induced OPA1 cleavage and mitochondrial morphology changes, accompanied by improvement on mitochondrial oxygen consumption capacity, ATP productive potential and activities of mitochondrial complex I, II and V. Moreover, both t-BHP- and FCCP-induced MyHC decrease was sufficiently inhibited by HT-AC. Taken together, our data provide evidence indicating that mitochondrial dysfunction-associated OPA1 cleavage may contribute to muscle degeneration, and olive oil compounds could be effective nutrients for preventing the development of muscle disorders.

Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy

OBJECTIVE

The aim of the study was to determine the efficacy of uterine artery embolisation (UAE) combined with local methotrexate (MTX) for the treatment of caesarean scar pregnancy, compared with other traditional modalities, and to investigate the complications associated with this treatment.

DESIGN

A retrospective cohort study.

SETTING

A large obstetrics and gynaecology unit within a university hospital in China.

SAMPLE

Women who were diagnosed with a caesarean scar pregnancy between January 2003 and December 2008, and who had informative case records, were included in the study.

METHODS

We reviewed the results for all women who received one of three treatments: dilation and curettage (D&C) (11 patients; group A), systemic MTX (17 patients; group B), and UAE and local MTX (38 patients; group C).

MAIN OUTCOME MEASURES

The main outcome measures were success rate, blood loss, time for beta human chorionic gonadotrophin (beta-hCG) to decline to normal values, and the duration of hospital stay. Success was defined as a complete recovery with no severe complications and with the preservation of fertility.

RESULTS

A total of 66 women diagnosed with caesarean scar pregnancy between January 2003 and December 2008 were identified, and their data were analysed. The success rate in group C was significantly higher than that in groups A and B after adjusting for beta-hCG level (89.5 versus 27.3 and 58.8%, respectively; P < 0.001). The mean blood loss in group C was lower than in the other two groups (240.5 versus 855.5 and 639.4 ml, respectively; P = 0.008 and 0.009, respectively). The average time for beta-hCG to decline to normal values was significantly shorter in group C than in group B (28.1 versus 44.3 days; P = 0.021). A significantly shorter duration of hospital stay was observed in group C compared with group B (12.5 versus 22.0 days; P = 0.024).

CONCLUSIONS

UAE combined with local MTX is of benefit to women wishing to preserve fertility, and is suitable for use as the primary treatment for caesarean scar pregnancy.

Effects of a low-frequency sound wave therapy programme on functional capacity, blood circulation and bone metabolism in frail old men and women

Objective: To evaluate the effects of a low-frequency sound wave therapy programme on functional capacity, blood circulation and bone metabolism of the frail elderly.

Design: Single-blind, randomized, controlled trial.

Setting: Two senior service centres.

Subjects: Forty-nine volunteers (14 males and 35 females) aged 62—93 years with up to 12 diagnosed diseases were allocated in either the intervention group (n = 30) or control group (n = 19).

Intervention: The intervention group underwent sound wave therapy, 3—5 times a week for 30 minutes per session over a period of 6 months. The control group received no intervention.

Main measurements: Blood pressure, functional capacity, mobility, bone density, biochemical markers, isometric muscle strength, balance, and skin surface temperature.

Results: Compared with the control group, the intervention group’s mobility and the amount of self-reported kilometres walked per week increased by 3 km (P<0.05), while levels of cholesterol (4.97 (0.72) to 4.52 (0.65) mmol/L, P =0.019), low-density lipoprotein (2.82 (0.72) to 2.45 (0.61) mmol/L, P =0.022), bone markers of total osteocalcin (11.0 (6.5) to 10.3 (5.9) ng/mL, P =0.048)) and tartrate-resistant acid phosphatase isoform 5b (2.50 (1.0) to 2.41 (1.1) IU/L, P =0.021)) decreased. The average skin surface temperature was significantly higher during active sessions at the end of the intervention than in the beginning (P = 0.004). No change was found during placebo sessions.

Conclusions: Low-frequency sound wave therapy may have the potential to promote well-being of frail elderly subjects via improved functional capacity, especially in subjects who are too frail to undertake exercise.

Evaluation of polydimethylsiloxane modification methods for cell response

Many methods exist in the literature to modify surfaces with extracellular matrix (ECM) proteins prior to cell seeding. However, there are few studies that systematically characterize and compare surface properties and cell response results among modification methods that use different bonding mechanisms. In this work, we compare cell response and physical characterization results from fibronectin or laminin attached to polydimethylsiloxane (PDMS) elastomer surfaces by physical adsorption, chemisorption, and covalent attachment to determine the best method to modify a deformable surface. We evaluate modification methods based on completeness and uniformity of coverage, surface roughness, and hydrophilicity of attached ECM protein. Smooth muscle cell adhesion, proliferation, morphology, and phenotype were also evaluated. We found that chemisorption methods resulted in higher amounts of protein attachment than physical adsorption and covalent bonding of the ECM proteins. Cell response to protein-modified surfaces was similar with respect to cell adhesion, area, aspect ratio, and phenotype. When all the data are considered, the chemisorption methods, most notably silane_70, provide the best surface properties and highest cell proliferation.

Role of mitochondria in tamoxifen-induced rapid death of MCF-7 breast cancer cells

Tamoxifen (Tam) is widely used in chemotherapy of estrogen receptor-positive breast cancer. It inhibits proliferation and induces apoptosis of breast cancer cells by estrogen receptor-dependent modulation of gene expression, but recent reports have shown that Tam (especially at pharmacological concentrations) has also rapid nongenomic effects. Here we studied the mechanisms by which Tam exerts rapid effects on breast cancer cell viability. In serum-free medium 5-7 microM Tam induced death of MCF-7 and MDA-MB-231 cells in a time-dependent manner in less than 60 min. This was associated with release of mitochondrial cytochrome c, a decrease of mitochondrial membrane potential and an increase in production of reactive oxygen species (ROS). This suggests that disruption of mitochondrial function has a primary role in the acute death response of the cells. Accordingly, bongkrekic acid, an inhibitor of mitochondrial permeability transition, was able to protect MCF-7 cells against Tam. Rapid cell death induction by Tam was not associated with immediate activation of caspase-9 or cleavage of poly (ADP-ribose) polymerase. It was not blocked by the caspase inhibitor z-Val-Ala-Asp-fluoromethylketone either. Diphenylene ionodium (DPI), an inhibitor of NADPH oxidase, was able to prevent Tam-induced cell death but not cytochrome c release, which suggests that ROS act distal to cytochrome c. The pure antiestrogen ICI 182780 (1 microM) could partly oppose the effect of Tam in estrogen receptor positive MCF-7 cells, but not in estrogen receptor negative MDA-MB-231 cells. Pre-culturing MCF-7 cells in the absence of 17beta-estradiol (E(2)) or in the presence of a low Tam concentration (1 microM) made the cells even more susceptible to rapid death induction by 5 or 7 microM Tam. This effect was associated with decreased levels of the anti-apoptotic proteins Bcl-X(L) and Bcl-2. In conclusion, our results demonstrate induction of a rapid mitochondrial cell death program in breast cancer cells at pharmacological concentrations of Tam, which are achievable in tumor tissue of Tam-treated breast cancer patients. These mechanisms may contribute to the ability of Tam therapy to induce death of breast cancer cells.

[A study of prognostic factors of stage IV epithelial ovarian cancer]

OBJECTIVE

To determine the effects of treatments for stage IV epidermal ovarian cancer and detect the prognostic factors.

METHODS

31 cases primarily treated in our hospital from 1990 to 1998 were analyzed retrospectively.

RESULTS

Univariate analysis showed that the number of courses of chemotherapy, the size of residual disease, the histologic cell type, and the metastatic site were the significant prognostic factors(P < 0.05). Cox proportional hazard model confirmed that two factors (the size of residual lesion < or = 2 cm and the cycles of chemotherapy > or = 8 decreased the death odds ratio by 0.28 and 0.72 respectively. Three factors (lack of operation, presence of supraclavicular lymph node involvement and liver involvement) increased the death odds ratio by 14.25 times, 11.44 times and 1.85 times respectively (P < 0.05).

CONCLUSION

Surgical debulking, aggressive and appropriate chemotherapy are important measures to improve survival rate for patients with stage IV epithelial ovarian cancer.

Optimal timing of coronary stenting in unstable angina patients

OBJECTIVE

To assess the efficacy and safety of intracoronary stenting in the acute phase of unstable angina pectoris (UAP).

METHODS

Fifty-five patients with UAP were randomized to early (Group I, n = 29) and delayed interventional treatment (Group II, n = 26). Coronary angiography and stenting were performed within 48 hours in Group I and 7-10 days later in Group II. Procedural success rate, time interval from admission to angina relief and duration of hospitalization were recorded. Cardiac events within 30 days were observed as well.

RESULTS

Clinical characteristics and angiographic features were similar between the two groups. There was no significant difference in the procedural success rate (93% versus 96%), but the cardiac event rate within 30 days was significantly lower in Group I than in Group II (0% versus 9.2%, P < 0.05). The time interval from admission to angina relief (4.4 +/- 3.1 days versus 5.7 +/- 2.9 days) and the duration of hospitalization (8.8 +/- 3.2 days versus 13.5 +/- 3.1 days) were significantly reduced in Group I (both P < 0.05).

CONCLUSIONS

Intracoronary stent implantation is effective and safe in the acute phase of UAP. Early percutaneous coronary intervention results in rapid improvement in symptomatology and a shorter hospitalization. Its long-term effect has to be confirmed in a future randomized study.

p53 pathway in apoptosis induced by all-trans-retinoic acid in acute myeloblastic leukaemia cells

The role of the p53 pathway in apoptosis induced by all-trans-retinoic acid (ATRA) was studied in 5 human acute myeloid leukaemia (AML) cell lines, OU-AML-3, -4, -5, -7 and -8, previously established and characterized by the authors. Although all the cell lines have a wild-type (wt) p53 gene, the protein is in a mutant conformation detectable by the anti-p53 antibody PAb 240. Exposure of the cell lines to 1.0 microM ATRA for 72 h caused induction of apoptosis detectable by morphology and the annexin V assay. The number of apoptotic cells according to the annexin V assay varied from 16 +/- 8% (OU-AML-7) to 61 +/- 4% (OU-AML-3) in ATRA-treated cells, while it was 7 +/- 6% in control cells. Western blotting and flow cytometry showed down-regulation of the p53 protein by ATRA. The conformation of p53 remained unchanged, being detectable in flow cytometry by PAb 240, but not by PAb 1620 (an antibody which only detects p53 in wt conformation). At the same time bcl-2 was down-regulated as shown by Western blotting and flow cytometry, while no induction of bax was observed by ATRA. On the basis of these results, ATRA-induced apoptosis in these AML cell lines is independent of the p53 pathway, although it is associated with the down-regulation of bcl-2.

[Relationship between vulvar dystrophy, malignant tumor and the estrogen progestin receptor]

In order to investigate the relationship between vulvar dystrophy, malignant tumor, and estrogen, progestin receptor, we made an analysis on estrogen and progestin receptor (ER, PR) contents in 31 cases of vulvar dystrophy and 19 cases of malignant tumor, using the dextran-coated charcoal method. The Results showed that ER content of the mixed type was higher than that of the atrophic type. PR content of the mixed type was higher than that of the hyperplastic type; and the PR content of the hyperplastic type was higher than that of the atrophic type. The relationship between ER and PR contents of the vulvar dystrophy and adjacent normal tissue was in positive correlation. The PR content of vulvar squamous cell carcinoma went down along with the drop of its dedifferentiation degree. The PR content of carcinoma was much lower than that of the adjacent normal tissue. The results of suggest that the study provided theoretic basis for endocrinotherapy of the vulvar dystrophy, PR in malignant tumor is regarded as one of the indexes to predict prognosis.

A facilitated cyclic ether formation and its potential application in solid-phase peptide and organic synthesis

A "trimethyl lock" system has been known to facilitate lactonization reactions through what has been termed a stereopopulation control mechanism. We have found that a similar trimethyl lock system can also facilitate cyclic ether formation with the concomitant release of a carboxylic acid in the presence of anhydrous tetrabutylammonium fluoride. To study this base-mediated trimethyl lock-facilitated cyclic ether formation, we synthesized fifteen model compounds. All model compounds underwent base-mediated cyclic ether formation in high yields at 0 degree C to room temperature (r.t.) with the concomitant release of the attached carboxylate. Such a system potentially could be used for the development of a two-dimensional linker for solid phase peptide and organic synthesis.

An association between mitochondrial function and all-trans retinoic acid-induced apoptosis in acute myeloblastic leukaemia cells

The present study investigated whether all-trans retinoic acid (ATRA)-induced apoptosis in acute myeloblastic leukaemia (AML) is related to changes in mitochondrial function. Two human AML cell lines, OU-AML-3 and OU-AML-7, known to be inducible to time-dependent apoptosis of varying degrees by ATRA, were used. Apoptosis induced by ATRA was shown to be a slow event. It was detected by the DNA electrophoretic method and cytofluorimetrical annexin V assay after 48 h exposure, and by morphology and polyADPribose polymerase (PARP) cleavage after 72 h exposure of AML cells to ATRA. The efflux of mitochondrial cytochrome c to cytosol was notable in Western blotting after 48 h exposure of the cells to ATRA and was observed before the drop in the mitochondrial membrane potential, which only took place after 72 h exposure, when measured by flow cytometry and a JC-1 probe. The apoptotic events in mitochondria were more evident in the OU-AML-3 than the OU-AML-7 cell line. This might relate to the different bcl-2 contents of the cell lines: the basic bcl-2 levels of the OU-AML-7 cell line were almost twofold compared to that of the OU-AML-3 cell line, as analysed by the ELISA method. However, both of the cell lines showed progressive down-regulation of bcl-2, which began after 12-24 h exposure of the cells to ATRA as determined by ELISA, Western blotting and flow cytometry. The present results show that mitochondria have a role in ATRA-induced apoptosis in AML cells and down-regulation of bcl-2 is related to it. In view of the previously published studies, the present results underline the fact that the timing of apoptotic events, such as fragmentation of DNA, externalization of phosphatidylserine, cytochrome c efflux, change in mitochondrial membrane potential and cleavage of PARP, are, to a notable extent, cell type and inducer-dependent.

p53 status of newly established acute myeloid leukaemia cell lines

We analysed the status of the p53 gene and protein in eight newly established acute myeloid leukaemia (AML) cell lines representing blast cells of either de novo leukaemia patients in first remission or patients with relapsed and chemotherapy-resistant disease causing their death. There were no mutations in the p53 gene in any of the cell lines as analysed by single-strand conformation polymorphism of amplified exons 5-8. However, the p53 protein was clearly and consistently expressed in all of these cell lines, as shown by immunohistochemistry, Western blotting and flow cytometry. The consistently expressed p53 protein was located in both the nucleus and the cytoplasm of all the cell lines and, as shown by flow cytometry, it was mostly in a conformation typical of the mutated protein. These AML cell lines offer a tool for studying the production and function of the p53 protein and its possible role in cell cycle regulation and chemoresistance as well as in the regulation of apoptosis in AML.

A comparative study on the effects of low dose of tPA and different regimens of intravenous urokinase in acute myocardial infarction

OBJECTIVE

To compare the effects of low dose of recombinant tissue-type plasminogen activator (tPA) with those of conventional dose of urokinase (UK) and assess the influence of different regimens of intravenous UK in patients with acute myocardial infarction (AMI).

METHODS

Eighty patients with AMI were randomized to 50 mg of tPA (Group I; n = 26) using an accelerating approach or 1.0-1.5 million U of UK (Group II; n = 54). UK was administered as a single bolus injection of whole dose (Group IIa; n = 26) or half dose bolus injection followed by half dose infusion (Group IIb; n = 28). All patients underwent coronary arteriography 90 min after the initiation of intravenous thrombolysis, and the infarct-related coronary artery (IRA) patency was evaluated. Cardiac events during hospitalization were recorded and predischarge left ventricular function was determined by two-dimensional echocardiography.

RESULTS

The IRA patency rate was significantly higher in Group I (88.4%) than in Group II (53.7%) (P < 0.01). Group I patients had less cardiac events during hospitalization (11.5% vs 33.3%) and greater improvement in left ventricular function than Group II patients. However, these angiographic, left ventricular functional and prognostic parameters did not significantly differ between Group IIa and Group IIb.

CONCLUSIONS

Thrombolysis after AMI with low dose of intravenous tPA exerts better angiographic and clinical effects than that with conventional dose of UK. The thrombolytic effects of UK were not affected by different regimens of intravenous administration of the agent.

Acute myeloblastic leukaemia cells produce soluble interleukin 6 receptor by a mechanism of alternative splicing

The aim of the present work was to investigate whether acute myeloblastic leukaemia (AML) blast cells express a soluble (s) form of interleukin 6 (IL-6) receptor (R), and if they do, what is the mechanism of production. Eight AML patient cell lines and 25 primary AML blast cell samples were investigated. The cell lines secreted high quantities of sIL-6R into their culture medium when examined by enzyme-linked immunosorbent assay (ELISA). To determine whether sIL-6R is synthesized by a mechanism of alternative splicing, RNA was analysed from all the AML blast cell samples by using reverse transcription polymerase chain reaction. In this method, primer sites flanking the transmembrane domain were utilized and the alternatively spliced IL-6R mRNA was distinguished from the non-spliced transcript form by size. All the cell lines and 64% of the primary blast cell samples expressed the alternatively spliced IL-6R mRNA. To confirm the phenomenon of alternative splicing at protein level, cytoplasmic protein fractions of the cell lines were investigated by using a sensitive adaptation of the Western blot method. All the cell lines expressed two IL-6R proteins sized 80 and 50 kDa and corresponding to the membraneous and soluble forms of IL-6R, respectively. In conclusion, the results obtained at both mRNA and protein levels strongly support alternative splicing as a mechanism of sIL-6R production in AML. Because sIL-6R modulates the effects of IL-6 on target cells, differences in sIL-6R expression levels may partially explain the previously observed diversity in IL-6-induced growth responses in AML

Signaling through interleukin-6 receptor supports blast cell proliferation in acute myeloblastic leukemia

The role of the interleukin-6/interleukin-6 receptor (IL-6/IL-6R) system in regulating blast cell growth in 8 acute myeloblastic leukemia (AML) patient-derived cell lines was investigated. As they all expressed IL-6R and as none of them responded to exogenous IL-6 under conventional serum-supplemented culture conditions, we investigated whether signaling through IL-6R plays any role in maintaining their spontaneous colony growth. This was done by treating the cells with monoclonal antibodies made against the ligand-specific IL-6R alpha-chain or the signal transducer gp130. In serum-supplemented cultures inhibition of gp130 function did not affect the cell line growth, whereas anti-IL-6R alpha-chain antibody reduced colony growth. While some of the cell lines also showed similar growth characteristics in a serum-free environment, some others changed their growth pattern and stopped responding to anti-IL-6R alpha-chain treatment. At the same time, these cell lines also began to respond to exogenously added IL-6 and, interestingly, were stimulated by anti-gp130 antibody. Hence, in some of the blast cells, clonogenic cell growth seemed to be also negatively controlled by an endogenously produced growth-depressing cytokine or cytokines that utilize gp130. All the cell lines, whether cultured in the presence or absence of serum expressed IL-6 both at mRNA and protein level. The current results indicate that AML cells can use IL-6 as a growth stimulating factor, supplied either paracrinely or autocrinely. This could implicate the use of anti-IL-6R alpha-chain antagonists in AML treatment, not IL-6.

Coumarin-based prodrugs. Part 3: Structural effects on the release kinetics of esterase-sensitive prodrugs of amines

To study the structural effects on the release kinetics of a coumarin-based esterase-sensitive prodrug system, two series of compounds with varying structural features of the ester 'trigger' part and the amine 'drug' part were synthesized. The half-lives of the nine model prodrugs in the presence of porcine liver esterase ranged from about 2 min to 190 min. The steric bulkiness of the acyl group seems to have only a very minor effect on the half-lives of the esterase-triggered release of amines from the model prodrugs. The rate of the lactonization depends on the steric and electronic properties of the amine moiety.

All-trans retinoic acid induces apoptosis in acute myeloblastic leukaemia cells

The effect of all-trans retinoic acid (ATRA) on leukaemia cell differentiation, proliferation and induction of apoptosis was studied by using autonomously growing blast cells isolated from eight patients with acute myeloblastic leukaemia (AML) either at diagnosis (n=4) or at relapse (n=4). No morphological or functional differentiation induced by ATRA was observed in any of the cases studied. In cell cultures, inhibition of leukaemia cell growth by ATRA was obvious, especially in the case of clonogenic cells, and it was both time- and concentration-dependent. Induction of apoptosis was more difficult to achieve. The cells retained over 90% viability in suspension when the ATRA exposure at any of the concentrations studied was 48 h or less. When the time of exposure to ATRA was longer than 48 h, the viability of the cells decreased in a concentration-dependent manner. Apoptosis was observed morphologically in each of the AML cases with 10(-5) to 10(-8) M ATRA, if the incubation time of cells in ATRA was 72 h. The percentage of apoptotic cells increased with increasing ATRA concentrations from 12+/- 9% of 10(-8) M ATRA to 78+/-12% of 10(-5) M ATRA. The DNA electrophoretic method was able to detect apoptosis in all the AML samples exposed to 10(-7) and 10(-6) ATRA for 48 h and occasionally in cases where lower concentrations and longer exposure time were used. In conclusion, the present study shows that it is possible to induce apoptotic leukaemia cell death in vitro with ATRA in AML, and this effect is dependent on both concentration and exposure time.

Effect of mast cell growth factor on clonogenic blast cell growth in acute myelogenous leukemia

The effect of the mast cell growth factor (MGF), also known as stem cell factor, steel factor, and kit ligand, alone or in combination with other GFs on clonogenic blast cell growth in 23 patients with acute myeloblastic leukemia (AML) was investigated. MGF alone enhanced colony formation by about 35%, being clearly stimulatory (> 20% increase in colony numbers) in nine patients. The additive effect of MGF on colony growth was observed in combination with interleukin-3 (IL-3). Preincubation of the cells with MGF in suspension did not sensitize them to the effect of IL-3, granulocyte-macrophage colony-stimulating factor (GM-CSF), G-CSF, or IL-4 in a clonogenic cell culture assay. Although almost all the blast cell samples expressed the c-kit the receptor for MGF, at the mRNA and/or the protein level, the cells did not necessarily respond to exogenous MGF. On the other hand, blast cells were able to respond to exogenous MGF even when the cells themselves expressed MGF. Neither the expression of MGF nor the response of blast cells to exogenous MGF was related to the capability of the cells to form colonies spontaneously. In conclusion, MGF alone, but especially combined with IL-3, was a potent growth factor for clonogenic blast cells in AML. Autocrine production of MGF by AML blast cells analyzed at the mRNA level was not related to autonomous growth of the cells.

Abnormal coronary flow reserve in patients with angina pectoris and hypertensive left ventricular hypertrophy

OBJECTIVE

To assess coronary flow reserve using a computer-assisted method with intracoronary papaverine in patients with angina pectoris.

PATIENTS AND METHODS

Coronary arterial diameter, cross-sectional area and blood flow velocity were measured during coronary arteriography before and after intracoronary papaverine in 26 control subjects, 45 patients with significant coronary artery disease (> 50% luminal narrowing), 16 patients with syndrome X and 14 patients with hypertension and left ventricular hypertrophy (LVH).

RESULTS

After intracoronary administration of papaverine, proximal diameter, cross-sectional area, blood velocity, flow volume and reserve capacity of both left anterior descending and right coronary arteries were lower in patients with significant coronary stenosis than in the controls. Despite similar changes in diameter and cross-sectional area, the blood velocity, flow volume and reserve capacity of the two vessels were also lower in patients with syndrome X than in the controls. In 14 patients with hypertension and LVH, although the blood velocity and flow volume were augmented for the two arteries and did not differ from those in the controls, the flow reserve was reduced because of higher baseline blood velocity and flow volume.

CONCLUSIONS

Coronary flow reserve is reduced in patients with coronary artery disease, syndrome X or hypertensive LVH, which may be related to abnormal changes at different levels of the coronary vasculature or resting flow states.