[Construction of a nomogram model for predicting 2-year survival rate of small cell lung cancer based on more comprehensive variables]

Objective: To construct a novel prognostic nomogram model based on more comprehensive variables for patients with small-cell lung cancer (SCLC). Methods: The data of 722 patients with SCLC confirmed by pathology in Affiliated Cancer Hospital of Shanxi Medical University from January 2015 to December 2018 were retrospectively analyzed [including 592 males and 130 females, aged from 23 to 82(61±9) years]. A random seed count of 133 was used to divide those patients into training set (n=422) and validation set (n=300). Kaplan-Meier was used for survival curves analysis and univariate Log-rank test was used for evaluating the influence of clinical variables on the prognosis of sclc, variables with P<0.05 in univariate analysis were included in a multivariate Cox regression model. The nomogram was constructed based on the variables which P<0.05 in multivariate analysis. Receiver operating characteristic (ROC) curve, calibration by Integrated Brier score (IBS) and clinical net benefit by decision curve analysis (DCA) were used to evaluate model discriminative power, prediction error value, and clinical net benefit, and compared with the American Joint Committee on Cancer 8th TNM. Results: Male, abnormal monocyte (MON) counts, abnormal neuron specific enolase (NSE), abnormal cytokeratin 19 fragment (Cyfra211), M1a stage, M1b stage, M1c stage, radiotherapy (RT), chemotherapy ≥4 cycles and prophylactic cranial irradiation (PCI) were prognostic factors for SCLC[HR(95%CI)=1.39(1.00-1.92), 1.29(1.02-1.63), 1.41(1.11-1.80), 2.02(1.48-2.76), 1.09(0.77-1.55), 1.44(0.94-2.22), 2.01(1.49-2.71), 0.75(0.57-0.98), 0.40(0.31-0.51)and 0.42(0.26-0.68), respectively, all P<0.05]. The area under ROC curve (AUC) of the nomogram in training set and validation set were 0.814(95%CI: 0.765-0.862)and 0.787 (95%CI: 0.725-0.849), which were higher than TNM [0.616(95%CI: 0.558-0.674) and 0.648(95%CI: 0.581-0.715)].The calibration curve showed a good correlation between the nomogram prediction and actual observation for the 2-year overall survival (OS). IBS indicted a lower prediction error rate (training set: 0.132 vs 0.169; validation set: 0.138 vs 0.169). DCA showed a wider threshold range than TNM (training set: 0.01-0.96 vs 0.01-0.85, validation set: 0.01-0.94 vs 0.01-0.86) and a greater improvement of the clinical net benefit (in training set the nomogram had a greater clinical benefit than TNM in the range of 0.19-0.96, and remained in validation set in the range of 0.19-0.94). Conclusion: The established nomogram model for predicting 2-year OS in patients with SCLC based on 8 variables, including gender, MON, NSE, Cyfra211, M stage, RT, CT cycles and PCI can be used for an more accurately prognosis prediction and reference for therapeutic regimen selection.

[Surveillance of soil-borne nematodiasis in Yancheng City from 2016 to 2020]

OBJECTIVE

To understand the prevalence of soil-transmitted nematode infections in Yancheng City from 2016 to 2020, so as to provide insights into the development of the scheme for further soil-transmitted nematodiasis surveillance.

METHODS

Soil-borne nematode infections were detected using the modified Kato-Katz method (two slides for one sample) among the permanent residents living in Yancheng City from 2016 to 2020, and Enterobius vermicularis infection was additionally detected among children at ages of 12 years and lower using the adhesive cellophane-tape perianal swab method. The prevalence and intensity of human soil-borne nematode and E. vermicularis infections were descriptively analyzed.

RESULTS

A total of 51 259 person-time residents were detected for soil-borne nematode infections in Yancheng City from 2016 to 2020, and 48 egg-positives were identified, with a 0.09% prevalence. The soil-borne nematodes infecting residents included Ascaris lumbricoides, hookworm and Trichuris trichiura, with 0.04%, 0.05% and 0.002% prevalence rates of infections, and all infections were mild. There was a region-specific prevalence of soil-borne nematode infections in Yancheng City (χ² = 18.21, P = 0.02), with the highest prevalence seen in Funing County (0.21%), while no infections were detected in Dafeng District for five successive years. The overall prevalence of E. vermicularis infections was 0.22% among children at ages of 12 years and lower in Yancheng City.

CONCLUSIONS

The prevalence of soil-borne nematode infections appears a gradual decline in residents living in Yancheng City from 2016 to 2020, and is at an extremely low level. Further surveillance of soil-transmitted nematodiasis requires to be intensified targeting key regions and populations to consolidate the control achievements.

CatLet score and Clinical CatLet score as predictors of long-term outcomes for patients with acute myocardial infarction undergoing delayed percutaneous coronary intervention

Background

We have recently developed a Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system based on the 17 myocardial segment model, law of competitive blood supply, and law of flow conservation. This novel angiographic scoring system can be utilized to account for the variable coronary anatomy, the severity and complexity of coronary artery lesions, and to standardize the collection of angiographic data. Our preliminary study demonstrated that the CatLet score better predicted clinical outcomes than the SYNTAX score for patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). The current study aimed at assessing whether the CatLet score (CS) and the Clinical CatLet score (CCS) predicted clinical outcomes for AMI patients undergoing delayed PCI.

Methods

The CS was calculated in 1018 consecutively prospectively enrolled AMI patients. Primary end point was major adverse cardiac events (MACEs), a composite of myocardial infarction, cardiac death, and ischemia-driven revascularization. CCS was calculated multiplying the CS by the ACEF score constructed using age, creatinine, and LVEF. Tertile partitioning of CS and CCS were as follows: CSlow ≤12, CSmid 13–18, and CStop ≥19; CCSlow ≤13, CCSmid 14–24, and CCStop ≥25, respectively. Cox regression analysis was employed to identify the associations between predictors and clinical outcomes.

Results

Four-year MACE rates were significantly higher with CStop compared with CSlow [4.82 (3.39–6.85), P&lt;0.001], which was also the case for all-cause death, cardiac death, myocardial infarction, and ischemia-driven revascularization; for all these endpoints, there were a significant trend (P&lt;0.001) for higher event rates with the increasing CS tertiles as shown in Figure 1. Stratifying outcomes across CCS tertiles resulted in similar results for the comparisons between CCStop and CCSlow. For MACEs, CCS had a significantly increased C-index [(C-index (95% CI), 0.725 (0.692–0.759) vs. 0.693 (0.659–0.727), P=0.001] compared with CS, which was also the case for all-cause death, cardiac death, and myocardial infarction. However, for ischemia-driven revascularization, CCS had a slightly decreased C-index [0.655 (0.609–0.701) vs. 0.670 (0.625–0.716), P=0.235] compared with CS, without a significant difference. In terms of calibration, CCS was comparable to CS for MACEs, all-cause death, cardiac death, and myocardial infarction. However, calibration for ischemia-driven revascularization worsened for CCS compared with CS (χ2=22.07, P=0.004 vs. χ2=7.79, P=0.454). Both scores remained to be independent predictors of clinical outcomes (in separate models) after adjustment for a broad spectrum of risk factors.

Conclusions

CS and to a greater extent CCS were able to risk-stratify long-term outcomes in AMI patients undergoing delayed PCI.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): 2020YFC2004705 & SYS2019040 Figure 1. Kaplan-Meier curves for endpoints

[Investigation on the risk of of Anisakis infection among high - risk populations along the coastal areas of Jiangsu Province]

OBJECTIVE

To investigate the risk of Anisakis infections among high-risk populations along the coastal areas of Jiangsu Province, so as to develop the strategy for the prevention and control of anisakiasis in the province.

METHODS

Three counties along the coastal areas of Jiangsu Province were selected as the study sites in 2018, including Rudong County in Nantong City, Haizhou District in Lianyungang City and Dongtai City in Yancheng City. The knowledge, attitude and practice (KAP) of anisakiasis prevention and control, and the prevalence of serum specific IgG antibody against Anisakis were investigated among high-risk populations among these three study sites, including fishermen, fish seller and people who liked eating fresh and live marine fish. Factors affecting the prevalence of the specific IgG antibody against Anisakis were identified using a multiple logistic regression model. In addition, Anisakis larvae infections were detected in fresh and live marine fish samples collected from local markets, and the prevalence and intensity of Anisakis infections were estimated.

RESULTS

A total of 625 high-risk populations were investigated, including 349 men (55.8%). Only 13.0% of the subjects heard about anisakiasis, and a low awareness rate of anisakiasis prevention and control knowledge was seen among these three types of high-risk populations. There were 21.6% of the subjects eating raw or half-cooked marine fish, 5.8% eating undercooked marine fish, 3.2% presenting vomiting, nausea and diarrhea after eating marine fish, 5.1% developing systemic allergic symptoms, and 65.6% using the same chopping board for raw and cooked food. The sero-prevalence of the anti-Anisakis IgG antibody was 7.0% among the study subjects. Multiple logistic regression analysis identified education level [OR = 0.687, 95% CI (0.478, 0.987)] and development of systemic allergic symptoms [OR = 4.641, 95% CI(1.411, 15.268)]as factors affecting the positive anti-Anisakis IgG antibody among the study subjects. Among 494 fresh and live marine fish detected, the prevalence and intensity of Anisakis larvae infection was 64.0% and 8.1 larvae per fish, with high prevalence seen in Trichiurus haumela and Pneumatophorus japonicas.

CONCLUSIONS

The awareness of anisakiasis prevention and control knowledge is low among the high-risk populations living along the coastal areas of Jiangsu Province, and there are high-risk behaviors, such as eating raw or half-cooked food, using the same chopping board for raw and cooked food. In addition, the prevalence of Anisakis infections is high in the marine fish in these areas. Therefore, the health education and health promotion for anisakiasis prevention and control should be intensified.

[Investigation of Anisakis infections in market-available marine fish in Dongtai City]

OBJECTIVE

To understand the situation of Anisakis infection of in market-available marine fish in Dongtai City, so as to provide the evidence for the assessment of the risk of human Anisakis infections.

METHODS

Raw and fresh marine fish caught in the sea of Dongtai City for sale were collected in 2018. The fish were weighted and dissected for the identification of Anisakis, and the prevalence and intensity of Anisakis infections were calculated. In addition, the correlation between the weight of Anisakis-infected marine fish and the infection intensity of Anisakis was examined.

RESULTS

There were four species of marine fish infected with Anisakis, including Trichiurus haumela, Scomberomorus niphonius, Pneumatophorus japonicus and Larimichthys polyactis. Among the 149 fish samples, there were 78 with Anisakis infections, with a prevalence rate of 52.35%. The prevalence of Anisakis infection was 100.00% (28/28), 30.00% (9/30), 0 (0/30), 53.33% (16/30) and 80.65% (25/31) in T. haumela, S. niphonius, cuttle fish, P. japonicus and L. polyactis, respectively. A total of 1 049 Anisakis worms were collected, and the overall intensity of infection was 13.45 worms per fish. Spearman correlation analysis showed a positive correlation between the weight of T. haumela and the intensity of Anisakis infection (rs = 0.38, P = 0.047), and no correlation was found in other fish species.

CONCLUSIONS

There is a high rate of Anisakis infection in marine fish along the offshore areas of Dongtai City. Intensification of health education is required and healthy and safe dietary habits are encouranged.

[Effect of CCR1 gene overexpression on the migration of bone marrow - derived mesenchymal stem cells towards hepatocellular carcinoma]

Objective: To evaluate the effect of human CCR1 (hCCR1) gene overexpression on the migration of human bone marrow-derived mesenchymal stem cells (hMSCs) towards hepatocellular carcinoma (HCC), and to examine the application prospects of MSCs as gene delivery vectors in the treatment of HCC. Methods: The hCCR1 gene was subcloned into a lentiviral vector to generate the recombinant plasmid pLV-hCCR1. The pLV-hCCR1 plasmid and two other packaging plasmids were co-transfected into 293T cells using calcium phosphate, and the virus-containing supernatant was collected. hMSCs were then infected with the recombinant lentivirus, and the expression of hCCR1 mRNA and protein was analyzed by RT-PCR and Western blot, respectively. The effect of CCR1 gene overexpression on the in vitro migration of hMSCs was examined using the Transwell migration assay. Orthotopic nude mice models of HCC were established using the MHCC-97H-GFP cell line, and the mice were divided into two groups (n = 8 per group). hMSCs were then intravenously injected via the tail vein into the tumor-bearing nude mice to examine the effect of hCCR1 overexpression on the in vivo migration of hMSCs towards HCC. Unpaired Student's t-test was used for two-group comparisons, and one-way ANOVA was used for multi-group comparisons. Results: Restriction enzyme digestion and DNA sequencing demonstrated that the recombinant plasmid pLV-hCCR1 was constructed successfully. The LV-hCCR1 lentivirus packaged by 293T cells has high infection efficiency in hMSCs, and hCCR1 was overexpressed in hMSCs after LV-hCCR1 infection. Transwell migration assay showed that hCCR1-transfected hMSCs had significantly enhanced migration towards HCC cell line-derived condition medium (CM) compared with the control RFP-hMSCs [(134.8±15.7)/LPF vs (83.5±10.9)/LPF, t = 10.40, P < 0.01]. In vivo migration experiment also demonstrated that there was significantly higher number of hCCR1-hMSCs localized within the MHCC-97H-GFP xenografts than hMSCs-RFP on day 14 following intravenous injection of hMSCs in mice [(86.7±14.1)/HPF vs (54.5±9.6)/HPF, t = -7.32, P < 0.01]. Conclusion: Overexpression of CCR1 gene can significantly enhance the migration capacity of hMSCs towards HCC cells in vitro and in vivo. This study provides evidence for potential clinical application of MSCs as more effective delivery vehicles in cancer gene therapy.

[Expressions and prognostic significance of PTEN and PD-1 protein in patients with classical Hodgkin's lymphoma]

目的

分析肿瘤免疫耐受信号通路的重要因子PD-1和PTEN在经典型霍奇金淋巴瘤（CHL）患者中的表达及其与患者临床特征和预后的相关性。

方法

回顾性分析2003年2月至2013年8月诊治的56例CHL患者的临床资料。采用免疫组织化学染色法检测CHL患者PD-1和PTEN蛋白的表达，采用原位杂交法检测EBV及EBV编码的小mRNA（EBER），并结合患者的临床特征与生存状态进行相关性分析。

结果

①56例患者中，男34例，女22例，中位年龄25（7~71）岁，PTEN阳性者11例（19.64%），PD-1阳性者14例（25.00%）。②PTEN和PD-1表达呈正相关（rs=0.320，P=0.016）；PTEN表达与Ann Arbor分期、IPS评分和有无大包块（≥5 cm）明显相关，PD-1仅与有无大包块相关（P值均<0.05）。③中位随访43（5~86）个月，多因素分析结果显示：年龄≥45岁（P<0.001）、IPS评分>2分（P=0.026）、EBER阳性（P=0.004）、PTEN蛋白高表达（P=0.035）是影响患者5年总生存的不良预后因素，也是影响5年无进展生存的不良预后因素（P值分别为0.007、0.014、0.002、0.024）。

结论

肿瘤免疫逃逸信号通路因子PTEN与CHL患者的预后相关，对CHL患者的预后判断有一定作用，同时也为CHL的免疫治疗提供了新思路和理论依据。

[Clinical application of LDLT after reconstruction of IVC using artificial blood vessel in the treatment of HCC beyond Milan Criteria]

Objective: To assess application of reconstruction of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation (LDLT) in the treatment of hepatocellular carcinoma (HCC) beyond Milan Criteria. Methods: The clinical data of 9 HCC patients who underwent right lobe liver transplantation after reconstruction of retrohepatic inferior vena cava using artificial blood vessel between June 2015 and Nov 2016 at Liver Transplantation Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The liver of the patients was removed with retrohepatic inferior vena cava, and then the right donor graft was implanted by conventional orthotopic liver transplantation. Results: All 9 liver transplantations were performed successfully. The time of reconstruction of hepatic venous outflow of the donor graft was (22.6±3.0) min, anhepatic time was (45.0±7.1) min, and total operation time was (321.9±52.5) min. All patients recovered uneventfully, ICU and hospital stay day were (1.2±0.4) days and (18.4±3.0) days. 2 patients suffered from thrombosis of artificial blood vessel, one recovered after conservative treatment and another was treated by placement of vein stent. No abdominal/pulmonary infection and non-artificial blood vascular complications were found, and none died in perioperative period. Postoperative pathological results showed that all patients were hepatocellular carcinomas and vascular tumor thrombosis was found in 5 cases. All patients were follow up, 1 patient died of pulmonary and brain metastasis 10 months after operation. One patient survived with local recurrence of tumor in liver. The other patients had no tumor recurrence and metastasis. Conclusion: Replacement of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation is safe and feasible in the treatment of HCC beyond Milan Criteria, and might improve the resection rate of diseased liver and the prognosis of HCC patients after living donor liver transplantation.

[Analysis of curative effect of transoral radiofrequency ablation microsurgery on glottic carcinoma with anterior commissure involvement at the early stage]

Objective: To explore the key technique and outcome of transoral radiofrequency ablation microsurgery for early stage of glottic carcinoma with anterior commissure involvement (ACI). Methods: A retrospective analysis was conducted on 31 patients, who were diagnosed as early stage glottic carcinoma during January 2010 to March 2016 in ENT Department. According to whether the anterior commissure was involved or not, two groups were divided. There were eleven cases with ACI (stages T1a, T1b, and T2). Twenty cases without ACI (stages Tis, T1a, and T2). All the patients received transoral radiofrequency ablation microsurgery and followed up closely.Only one case received radiotheraphy after surgery. SPSS19.0 software was used to analyze data. Results: The follow-up time was 12-67 months, and the median follow-up time was 30 months. Nine among 11 cases with ACI obtained good oncologic outcomes, initial local recurrence was identified in 2/11 cases, including 2 cases of T2. Two cases ultimately required salvage total laryngectomy. Meanwhile, initial local recurrence was identified in 2/20 cases without ACI, including 1 case of T1a and 1 case of T2. One case underwent elective neck dissection, and another one received salvage total laryngectomy.Compared to the patients without ACI, it seemed that the cases with ACI always accomponied with a little higher initial local recurrence and lower overall laryngealpreservation, but the difference had no significance (P>0.05). Conclusions: Transoral radiofrequency ablation microsurgery is an effective treatment for glottic carcinoma with ACI. Its advantages, such as more flexibility and deformability, make it more feasible to operate at the narrow space of anterior commissure assisted with laryngeal endoscopy.Good oncologic outcomes can be obtained by this technique with lower initial local recurrence as well as higher overall laryngeal preservation rate.

[Complications analysis of adenoidectomy and tonsillectomy assisted with ablation on children]

Objective:To analyze the complications of adenotonsilectomy assisted with coblation in children. Method:Complications of 2 089 cases of children with adenoid and tonsil surgery assisted with coblation, in our hospital nearly 10 years, were analyzed by epidemiological methods through the method of retrospective analysis. Result:①the sex ratio of male to female was 2.08：1, average age (5.87±3.12) years old, and most of 2 089 cases 76.35% (1 595/2 089) were 3-7 years old; ②all cases underwent adenoidectomy. Different surgery methods of tonsil consisted of three groups as partial resection associated with ablation was 69.17% (1 445/2 089), ablation (channeling) alone was 22.26% (465/2 089) and total resection was 8.57% (179/208). The amount of bleeding in operation was (8.52±3.18)ml, average operation time was (30.15±8.26) minutes, the postoperative pain score was (3.77±1.61); ③The incidence of postoperative complications: postoperative bleeding (all were secondary bleeding cases) rate was 0.24% (5/2 089), recurrence rate was 0.14% (3/2 089), prevertebral lymphadenitis was 0.96% (20/2 089), the other was 0.29% (torus hyperplasia in 2 cases, dyspnea in 2 cases, 1 cases of angle of mouth burned, nasopharyngeal adhesion in 1 cases). Postoperative fever rate was 9.81% (205/2 089). Conclusion:coblation technique is a good method for the treatment of children's adenoids and tonsil diseases with high efficiency and low complications. But improving the operation procedure proficiency level and skills of operation is an important link to reduce complications.

[Expression and prognostic significance of microenvironment related prognostic factors in patients with classical Hodgkin's lymphoma]

Objective: To observe the expression of three microenvironment related prognostic factors, i. e. programmed death 1 (PD-1), forkhead box protein 3(FOXP3) and colony-stimulating factor 1 receptor(CSF-1R) protein in classical Hodgkin's lymphoma (CHL) patients, and to explore the correlation between the protein expression and the prognosis of the patients. Methods: A total of 45 cases of CHL patients, who had been admitted to the Tianjin Medical University Cancer Institute and Hospital and Chinese PLA General Hospital from February 2005 to August 2010 were analyzed, including clinical features, prognostic factors, and treatment regimens. CHL patients' specimens were collected and the expression of PD-1, FOXP3, and CSF-1R proteins analyzed by immunohistochemical staining. Epstein-Barr virus encoded mRNA (EBER) was detected by in situ hybridization analysis. The relationship between the protein expression of PD-1, FOXP3 and CSF-1R and the patients' outcome was analyzed with clinical and follow-up data. Survival analysis was performed by Kaplan-Meier method, the Cox proportional hazard model was used to perform multivariate analysis. Results: In this cohort of 45 CHL patients, PD-1 positive was found in 7 cases (15.6%), FOXP3 high expression in 23 cases (51.1%), CSF-1R positive in 18 cases (40.0%). In the univariate analysis, the expression of FOXP3 and CSF-1R, International Prognostic Index (IPI) score, Ann Arbor stage and EBER were related with the patients' 5-year overall survival (OS); IPI score, the expression of FOXP3 and EBER were related with the patients' 5-year progress-free survival (PFS). Multivariate analysis indicated that CSF-1R protein expression was the independent prognostic factor affecting the patients' 5-year OS(HR: 8.918, P=0.020), and FOXP3 protein expression was the independent prognostic factor affecting the patients' 5-year PFS (HR: 0.122, P<0.001). And EBV was an independent prognostic factor of PFS and OS in the CHL patients. Conclusion: Microenvironment related prognostic factors FOXP3, CSF-1R and EBV may be independent prognostic factors of CHL and this study may provide novel strategies for targeted therapy of CHL.

[Photodynamic therapy by topical drup for the treatment of juvenile onset laryngeal papillomatosis]

Objective:To observe the therapeutic effect of photodynamic therapy(PDT) on the treatment of juvenile onset laryngeal papillomatosis. Method:Twenty-eight cases of children with laryngeal papilloma were treated,only 2 cases for the first time, and the rest were repeatedly treated outside our hospital, the average hospital surgery were more than 4 times. Under self retaining laryngoscope and microscope and endoscope assisted by semiconductor laser and plasma and cold instrument method，visible tumor resection and local affixed deposited 20% 5-aminolevulinic acid(photosensitizer) 3 hours later, with 635 nm semiconductor laser photodynamic,200-280 mW and can volume density of 80 to 120 J/cm², 20 min irradiation. PDT should be repeated after 25 days until no visible tumor.Then,2 times PDT must be done. Result:In 28 cases, 24 cases were followed up for more than 1 years(12 cases were followed up for 3 years),19 had no recurrence, the cure rate was 79.2%(19/24)；5 cases recurrence, and the recurrence rate was 20.8%(5/24)，among them,2 cases were abandoned because of the relapse，the other 3 cases were cure after 3 times of PDT.The main complications were adhesion of larynx. Conclusion:The preliminary effect of PDT by topical drug for the treatment of juvenile onset laryngeal papillomatosis is encouraging. The principle of PDT and the principle of the recurrence of laryngeal papilloma in children were also introduced in this paper.

[Clinical effect analysis of adenoidectomy and tonsillectomy assisted with ablation on children]

Objective:This study aims to explore the clinical effect of adenoidectomy and tonsillectomy assisted with ablation on children.Method:The investigation took the form of retrospective review of 2 089 cases of children applied with adenoidectomy and tonsillectomy assisted with ablation in our hospital in recent 10 years. We obtained data of these children with epidemiological methods based on analyzing the status of general information and operation selections, and then analyzing the scores of snoring and breath preoperation and postoperation.Result:①General information of 2 089 cases followed with: the ratio of male and female was 2.08∶1，the average onset age was（5.87±3.12）years old, mostly ranged from 3 to 7 years old, which consists of 76.35%（1595/2089）of the group.②Different surgery methods of tonsil consisted of three groups as: partial resection associate with ablation was 69.17%(1445/2089), ablation alone was 22.26%(465/2089) and partial resection alone was 8.57%(179/2089) of the group.③A high level scores of snoring and breath more frequently found in preoperative cases than in postoperative cases(P <0.01).There are no differentiation among the scores of above three groups(P >0.05).The postoperative effect evaluation were related to allergic rhinitis, recurrent of tonsillitis, obesity, circular occipital hyperplasia and nasopharyngeal adhesion.Conclusion:The results suggested that surgery assisted with ablation has its advantage in adenoidectomy and tonsillectomy. Individual therapy for different children will improve the curative effect and relieve the pain of operation, thus is worth a wide application.

[Evaluate the prevalence of trachoma in high risk area of China]

OBJECTIVE

To determine the prevalence of trachoma in urban and rural area in China. To provide the data evidence for the strategies of eliminating trachoma in China.

METHODS

Survey was conducted in 13 suspect trachoma high prevalence provinces according to the World Health Organization trachoma grading system and Trachoma Rapid Assessment(TRA).

RESULTS

From 2004 to 2007, a total number of examined children which were younger than 10 years old was 59 630. The prevalence of TF was 0.94%. To sum up the data of 2004 and 2005, the prevalence of active trachoma was 1.71% for children.TT and CO was not reported. The results for subjects older than 50 years old showed that the prevalence of TT was 0.34%. We examined 26 857 adults in both 2004 and 2005.The prevalence of TF, TI, TS and CO was 0.03%,0.08%,0.88% and 0.05% respectively.

CONCLUSIONS

The prevalence of active trachoma of younger children was under 5%. However,the prevalence of TT of the adults was not reached the target.

Genetic differentiation of Octopus minor (Mollusca, Cephalopoda) off the northern coast of China as revealed by amplified fragment length polymorphisms

Octopus minor (Sasaki, 1920) is an economically important cephalopod that is found in the northern coastal waters of China. In this study, we investigated genetic differentiation in fishery populations using amplified fragment length polymorphisms (AFLPs). A total of 150 individuals were collected from five locations: Dalian (DL), Yan-tai (YT), Qingdao (QD), Lianyungang (LY), and Zhoushan (ZS), and 243 reproducible bands were amplified using five AFLP primer combinations. The percentage of polymorphic bands ranged from 53.33 to 76.08%. Nei's genetic identity ranged from 0.9139 to 0.9713, and the genetic distance ranged from 0.0291 to 0.0900. A phylogenetic tree was constructed using the unweighted pair group method with arithmetic mean, based on the genetic distance. The DL and YT populations originated from one clade, while the QD, LY, and ZS populations originated from another. The results indicate that the O. minor stock consisted of two genetic populations with an overall significantly analogous FST value (0.1088, P < 0.05). Most of the variance was within populations. These findings will be important for more sustainable octopus fisheries, so that this marine resource can be conserved for its long-term utilization.

Comparison of high-intensity focused ultrasound therapy under nasal endoscopy guidance versus first-line drug treatment in patients with persistent allergic rhinitis

The aim of this study was to determine whether high-intensity focused ultrasound (HIFU) therapy under nasal endoscopy guidance could provide better efficacy and safety in patients with persistent allergic rhinitis (PAR) than the first-line drugs recommended by the World Health Organization. A total of 120 adult patients with PAR were randomly divided into 2 groups (N = 60 each). One group underwent HIFU therapy under nasal endoscopy guidance using an ultrasound rhinitis therapeutic machine. The other group served as the control group and was treated with corticosteroid nasal spray and oral cetirizine hydrochloride. All patients underwent follow-up treatment for 1 year, after which the efficacy and safety were evaluated. There was no significant difference between the two groups (P > 0.05) in the total effective rate. Moreover, no complications such as nasal adhesion, septal perforation, mucosal atrophy, and hyposmia were observed, indicating that HIFU was as effective as the first-line drug treatments recommended by the World Health Organization for symptom relief in PAR patients. The treatment efficacy, repeatability, safety, economical aspects, ease of performance, and few complications of HIFU therapy strongly suggest that HIFU should be routinely incorporated into clinical practice.

High-resolution cDNA microarray CGH mapping of genomic imbalances in osteosarcoma using formalin-fixed paraffin-embedded tissue

Formalin-fixed paraffin embedded (FFPE) tumor tissue provides an opportunity to perform retrospective genomic studies of tumors in which chromosomal imbalances are strongly associated with oncogenesis. The application of comparative genomic hybridization (CGH) has led to the rapid accumulation of cytogenetic information on osteosarcoma (OS); however, the limited resolving power of metaphase CGH does not permit precise mapping of imbalances. Array CGH allows quantitative detection and more precise delineation of copy number aberrations in tumors. Unfortunately the high cost and lower density of BACs on available commercial arrays has limited the ability to comprehensively profile copy number changes in tumors such as OS that are recurrently subject to genomic imbalance. In this study a cDNA/EST microarray including 18,980 human cDNAs (which represent all 22 pairs of autosomal chromosomes and chromosome X) was used for CGH analysis of eight OS FFPE. Chromosomes 1, 12, 17, and X harbored the most imbalances. Gain/amplification of X was observed in 4/8 OS, and in keeping with other recent genomic analyses of OS, gain/amplification of 17p11.2 was often accompanied by a distal deletion in the region of the p53 gene. Gain/amplification of the X chromosome was verified using interphase FISH carried out on a subset of OS FFPE sections and OS tissue arrays.

Validating a model of patient satisfaction with emergency care

STUDY OBJECTIVE

We sought to validate a previously developed model of emergency department patient satisfaction in a general population using a standard mailed format. The study aims to export the findings of a comprehensive ED quality-of-care study to an easily measured patient population.

METHODS

A double-sided, single-page survey was mailed to all patients discharged home from 4 teaching hospital EDs during a 1-month period. Determinants of patient satisfaction were analyzed with a previously developed multivariate, ordinal logistic-regression model.

RESULTS

The mail survey response rate was 22.9% (2,373/10,381). The survey validates the importance of previously identified determinants of patient satisfaction, including age, help not received when needed, poor explanation of problem, not told about wait time, not told when to resume normal activity, poor explanation of test results, and not told when to return to the ED (P <.01). Greater age predicted higher patient satisfaction, whereas all other variables correlated with lower patient satisfaction. In contrast with prior findings, black race was not a significant predictor of satisfaction in the mail survey population. Low ratings of overall care are strongly correlated with reduced willingness to return (P <.0001).

CONCLUSION

A patient satisfaction model was previously developed from a comprehensive research survey of ED care. We demonstrate the generalizability of this model to a mail survey population and replicate the finding that satisfaction strongly predicts willingness to return. The response rate of this study is typical of commercial patient-satisfaction surveys. The validated model suggests that ED patient satisfaction improvement efforts should focus on a limited number of modifiable and easily measured factors.

Treatment of collagen induced arthritis in DBA/1 mice with L-asparaginase

OBJECTIVE

To evaluate the safety and efficacy of L-asparaginase as an immunosuppressive agent in a mouse model of rheumatoid arthritis.

METHODS

Male DBA/1 mice with collagen-induced arthritis (CIA) were treated at different intervals with various doses of native and pegylated L-asparaginase from E. coli. The mice were observed for 4 weeks during which time arthritis was scored. Outcome parameters included effect on severity and progression of established arthritis as well as prevention of disease. In addition, X-rays from the affected joints were obtained for comparison.

RESULTS

Both native L-asparaginase at a dose of 50 IU/injection intraperitoneally three days a week and pegylated asparaginase (PEG-L-asparaginase) at a dose of 25 IU/injection twice a week, significantly reduced the mean arthritic score (MAS) in mice with established arthritis (p < 0.001 for PEG-L-asparaginase). When native L-asparaginase was administered before the onset of arthritis (days 14-post immunization) the number of mice developing arthritis as well as the number of arthritic paws and the severity of arthritis in the treatment group were significantly decreased (p < 0.0001). Significant differences were found in the X-ray evaluation between treated and control mice. None of the animals died due to drug related events or showed signs of asparaginase induced toxicity.

CONCLUSION

Our data provide the first direct evidence that L-asparaginase is a potent antiarthritic agent and may represent an effective second line agent for future treatment studies in juvenile and adult rheumatoid arthritis.

Modifications in surgical implantation of the Penn State electric total artificial heart

BACKGROUND

Two modifications of the surgical implantation protocol for the Penn State Total Artificial Heart (ETAH) were evaluated: Phrenic nerve ischemia was prevented by minimizing dissection and traction; and hemostasis was augmented and ETAH cuff anastomoses reinforced by using fibrin glue.

METHODS

Thirteen Holstein calves underwent orthotopic surgical implantation of the Penn State ETAH between February 1998 and August 2000. Mean hemodynamic and laboratory chemistry variables from the first postoperative week were compared between calves receiving the original (n = 7) and modified (n = 6) protocol.

RESULTS

Calves assigned to the modified protocol displayed an improvement in the Po2/FiO2 ratio compared to original (419.4 +/- 17.5 vs 336.3 +/- 35.4, respectively; p = 0.05). All additional parameters were equivalent between groups. The percent survival of animals receiving the modified protocol at 2, 4, and 12 weeks was higher than that of animals that underwent the original protocol. Original-protocol calf deaths consisting of hemothorax (n = 3), and respiratory failure (n = 1) were prevented in the modified protocol.

CONCLUSIONS

Our results suggest that manipulations in surgical protocol may promote increased survival in calves implanted with the Penn State ETAH.

Determinants of patient satisfaction and willingness to return with emergency care

STUDY OBJECTIVE

To identify emergency department process of care measures that are significantly associated with satisfaction and willingness to return.

METHODS

Patient satisfaction and willingness to return at 5 urban, teaching hospital EDs were assessed. Baseline questionnaire, chart review, and 10-day follow-up telephone interviews were performed, and 38 process of care measures and 30 patient characteristic were collected for each respondent. Overall satisfaction was modeled with ordinal logistic regression. Willingness to return was modeled with logistic regression.

RESULTS

During a 1-month study period, 2,899 (84% of eligible) on-site questionnaires were completed. Telephone interviews were completed by 2,333 patients (80% of patients who completed a questionnaire). Patient-reported problems that were highly correlated with satisfaction included help not received when needed (odds ratio [OR] 0.345; 95% confidence interval [CI] 0.261 to 0.456), poor explanation of causes of problem (OR 0.434; 95% CI 0.345 to 0.546), not told about potential wait time (OR 0.479; 95% CI 0.399 to 0.577), not told when to resume normal activities (OR 0.691; 95% CI 0.531 to 0.901), poor explanation of test results (OR 0.647; 95% CI 0.495 to 0.845), and not told when to return to the ED (OR 0.656; 95% CI 0. 494 to 0.871). Other process of care measures correlated with satisfaction include nonacute triage status (OR 0.701, 95% CI 0.578 to 0.851) and number of treatments in the ED (OR 1.164 per treatment; 95% CI 1.073 to 1.263). Patient characteristics that significantly predicted less satisfaction included younger age and black race. Determinants of willingness to return include poor explanation of causes of problem (OR 0.328; 95% CI 0.217 to 0.495), unable to leave a message for family (OR 0.391; 95% CI 0.226 to 0. 677), not told about potential wait time (OR 0.561; 95% CI 0.381 to 0.825), poor explanation of test results (OR 0.541; 95% CI 0.347 to 0.846), and help not received when needed (OR 0.537; 95% CI 0.340 to 0.846). Patients with a chief complaint of hand laceration were less willing to return compared with a reference population of patients with abdominal pain. Willingness to return is strongly predicted by overall satisfaction (OR 2.601; 95% CI 2.292 to 2.951).

CONCLUSION

These data identify specific process of care measures that are determinants of patient satisfaction and willingness to return. Efforts to increase patient satisfaction and willingness to return should focus on improving ED performance on these identified process measures.

100 long-term implantable left ventricular assist devices: the Columbia Presbyterian interim experience

BACKGROUND

The use of left ventricular assist devices (LVADs) as bridge to transplantation is now accepted as a standard of care for a subset of end-stage heart failure patients. Our interim experience with both pneumatically and electrically powered ThermoCardiosystems LVADs is presented to outline the benefits and limitations of device support as well as discuss its potential role as bridge to recovery and as destination therapy.

METHODS AND RESULTS

Detailed records were kept prospectively for all patients undergoing LVAD insertion. One hundred LVADs were inserted over 7 years into 95 patients, with an overall survival rate of 75% and a transplantation rate of 70%. Four patients underwent device explant for recovered myocardial function. Three patients received LVADs as destination therapy in the ongoing REMATCH (Randomized Evaluation of Mechanical Assist Treatment for Congestive Heart failure) trial. Overall mean patient age was 51 years, and mean duration of support was 108 days. There were 25 device-related infections including the drive line, device pocket, and blood-contacting surfaces. Cerebral vascular accidents and other embolic events occurred in 7 patients with six deaths. There were four device malfunctions and nine graft-related hemorrhages, resulting in six reoperations and three deaths.

CONCLUSIONS

The use of long-term implantable LVADs will likely not be limited to bridge to transplantation. The REMATCH trial has commenced to study the role LVADs may have as an alternative to medical management. Furthermore, as the issues of myocardial recovery are examined, the "bridge to recovery" may be an important additional role for these assist devices.

Bridge to transplantation: the Penn State experience

BACKGROUND

During the past decade, ventricular assist devices as a bridge to transplantation have moved from the experimental arena to accepted therapy. Our institution has been at the forefront of the development of this technology and consequently has had extensive experience with the devices that are currently approved by the Food and Drug Administration for use as a bridge to heart transplantation.

METHODS

The successful management of patients with assist devices hinges on patient and device selection as well as perioperative management strategies. The routine use of agents such as aprotinin, vasopressin, milrinone, and inhaled nitric oxide has contributed to successful management of these patients. We present our perspectives on the advantages and disadvantages of the Thermo-Cardiosystems HeartMate 1000 IP device and the Thoratec (Pierce-Donachy) system. We also discuss our protocols and methods for patient selection, preoperative preparation, intraoperative strategy, and postoperative management that have resulted in improved patient outcomes.

RESULTS

More than 60 device implantation procedures have been performed since the inception of our bridge to transplantation program. During this time, two thirds of our patients were successfully bridged to transplantation. Of these patients, 92% were alive at 1 month after transplantation, and 83% were alive at 1 year after transplantation.

CONCLUSIONS

Both support systems are effective in supporting patients to heart transplantation. We have developed a preference for the Thermo-Cardiosystems HeartMate 1000 IP device because of its portability and associated better quality of life. However, the Thoratec device is the more versatile device, and circumstances exist when its use is clearly advantageous. In our institutional experience, outcome for bridging to transplantation has not been device dependent.

Endometrial responsiveness to oxytocin during diestrus and early pregnancy in pigs is not controlled solely by changes in oxytocin receptor population density

These studies were performed to test the hypotheses that: 1) endometrial responsiveness to oxytocin (OT) in pig endometrium is associated with changes in OT receptor (OTr) population density resulting from corresponding regulation of OTr gene transcription, 2) endometrial responsiveness to OT is controlled solely through a mechanism involving changes in OTr population density, and 3) OTr population density and endometrial responsiveness to OT differ between diestrus and early pregnancy in pigs. In experiment 1, OTr population density and dissociation constant (Kd) in cyclic pigs were constant on Days 10-16 but increased (p < 0.05) between Days 10 and 12 of pregnancy before decreasing (p < 0.05) through Day 16. OT induced phosphoinositide (PI) hydrolysis and prostaglandin (PG) F2 alpha secretion in cyclic pigs only on Day 16 (p < 0.05), and during pregnancy only on Day 12 (p < 0.05). Activation of G protein by aluminum fluoride (AIF4-) treatment maximally stimulated (p < 0.05) PI hydrolysis and PGF2 alpha secretion in cyclic pigs on all days, indicating that downstream from the OTr, the PGF2 alpha secretory pathway was fully functional. During pregnancy, PI hydrolysis and PGF2 alpha secretion in response to AIF4- decreased (p < 0.01) on Days 14 compared to Days 10 and 12, and AIF4- did not stimulate PGF2 alpha release on Day 16. In experiment 2, abundance of OTr mRNA in cyclic pigs decreased between Days 0 and 5 before increasing between Days 5 and 12 (p < 0.05), but it was higher (p < 0.05) on Days 10-15 of pregnancy than on equivalent days in cyclic gilts. These results indicate that control of PGF2 alpha secretion in cyclic pigs appeared to occur primarily at the level of OTr coupling to G protein because changes in OTr number were not associated with increased sensitivity to OT or G-protein activation by AIF4-. During pregnancy, control was exerted at multiple levels, which included the OTr, G protein, phospholipase C, and subsequent aspects of the secretory pathway. The present study also indicated that endometrium was responsive to OT during luteolysis in cyclic pigs but not during corpus luteum maintenance in pregnant pigs.

The role of the active site cysteine in catalysis by type 1 iodothyronine deiodinase

Type 1 iodothyronine deiodinase (deiodinase 1) is a selenoenzyme that converts the prohormone T4 to the active thyroid hormone T3 by outer ring deiodination or to the inactive metabolite rT3 by inner ring deiodination. Although selenocysteine has been demonstrated to be essential for the biochemical profile of deiodinase 1, the role of a highly conserved, active site cysteine (C124 in rat deiodinase 1) has not been defined. The present studies examined the effects of a Cys124Ala mutation on rat deiodinase 1 enzymatic function and substrate affinity. At a constant 10-mM concentration of dithiothreitol (DTT), the C124A mutant demonstrated a 2-fold lower apparent maximal velocity (Vmax) and Km for rT3 (KmrT3) than the wild type for outer ring deiodination, whereas the Vmax/Km ratio was unchanged. Similarly, the apparent Vmax and KmT3 sulfate for inner ring deiodination were 2-fold lower in the C124A mutant relative to those in the wild type, with no change in the Vmax/Km ratio. The C124A mutant exhibited ping-pong kinetics in the presence of DTT, and substitution of the active site cysteine increased the KmDTT by 14-fold relative to that of the wild-type enzyme, with no significant effects on KmrT3 or Vmax. The C124A mutant was inhibited by propylthiouracil in an uncompetitive fashion and exhibited a 2-fold increase in K(i)propylthiouracil compared with that of the wild type. KmrT3 was also reduced for the C124A mutant when 5 mM reduced glutathione, a potential physiological monothiol cosubstrate, was used in outer ring deiodination assays. These results demonstrate that thiol cosubstrate interactions with C124 in type 1 deiodinase play an important role in enhancing catalytic efficiency for both outer and inner ring deiodination.

Implantable left ventricular assist devices provide an excellent outpatient bridge to transplantation and recovery

OBJECTIVES

Our recent experience with outpatient left ventricular assist device (LVAD) support is presented to demonstrate the possibilities and limitations of long-term outpatient mechanical circulatory assistance.

BACKGROUND

The experience with inpatient LVAD support as a bridge to transplantation has proved the efficacy of such therapy in improving circulatory hemodynamic status, restoring normal end-organ function and facilitating patient rehabilitation. With miniaturization of the power supplies and controllers, such mechanical circulatory support can now be accomplished in an outpatient setting.

METHODS

Between March 1993 and February 1997, 32 patients (26 male, 6 female, mean [+/-SEM] age 49 +/- 15 years) underwent implantation of the ThermoCardiosystems (TCI) Heartmate vented electric (VE) LVAD. The VE LVAD is powered by batteries worn on shoulder holsters and is operated by a belt-mounted system controller, allowing unrestricted patient ambulation and hospital discharge.

RESULTS

Mean duration of support was 122 +/- 26 days (range 3 to 605), with a survival rate to transplantation or explantation of 78%. Nineteen patients were discharged from the hospital on mean postoperative day 41 +/- 4 (range 17 to 68), for an outpatient support time of 108 +/- 30 days (range 2 to 466). Four patients underwent early transplantation and could not participate in the discharge program, and three patients currently await discharge. The complication rate was not statistically different from that encountered in our previous 52 patients with a pneumatic LVAD.

CONCLUSIONS

Outpatient LVAD support is safe and provides improved quality of life for patients awaiting transplantation. Wearable and totally implantable LVADs should be studied as permanent treatment options for patients who are not candidates for heart transplantation.

Vesicular transport regulates monoamine storage and release but is not essential for amphetamine action

To assess the role of exocytotic release in signaling by monoamines, we have disrupted the neuronal vesicular monoamine transporter 2 (VMAT2) gene. VMAT2-/- mice move little, feed poorly, and die within a few days after birth. Monoamine cell groups and their projections are indistinguishable from those of wild-type littermates, but the brains of mutant mice show a drastic reduction in monoamines. Using midbrain cultures from the mutant animals, amphetamine but not depolarization induces dopamine release. In vivo, amphetamine increases movement, promotes feeding, and prolongs the survival of VMAT2-/- animals, indicating that precise, temporally regulated exocytotic release of monoamine is not required for certain complex behaviors. In addition, the brains of VMAT2 heterozygotes contain substantially lower monoamine levels than those of wild-type littermates, and depolarization induces less dopamine release from heterozygous than from wild-type cultures, suggesting that VMAT2 expression regulates monoamine storage and release.

Improved results for postcardiotomy cardiogenic shock with the use of implantable left ventricular assist devices

BACKGROUND

Over the past decade, the use of mechanical circulatory support in patients with postcardiotomy cardiogenic shock has resulted in hospital discharge rates of 25% to 40%. In an attempt to improve patient survival, we initiated a program of early insertion of an implantable Thermocardiosystems Incorporated Heartmate left ventricular assist device in patients who have circulatory failure after having undergone high-risk cardiac operations.

METHODS

Between April 1993 and February 1997, 12 patients underwent insertion of an implantable left ventricular assist device for postcardiotomy cardiogenic shock after coronary artery bypass grafting. Indications for insertion included postoperative cardiogenic shock (7 patients), postoperative cardiac arrest (3 patients), and failure to wean from cardiopulmonary bypass (2 patients).

RESULTS

The median time to device insertion was 3.5 days. The mean duration of left ventricular assist device support was 103 +/- 19 days (range, 2 to 225 days). Nine of 11 patients (82%) survived to undergo either transplantation (8 patients) or explantation (1 patient), with successful hospital discharge of all 9 patients. The major complication was device-related infection (42%). A single thromboembolism occurred in a patient with an infection.

CONCLUSIONS

Long-term outcome after postcardiotomy cardiogenic shock is improved substantially with the use of an implantable left ventricular assist device early in the postoperative course. Access to such a device is an important consideration before undertaking a high-risk cardiac operation, and early implantation of the device is a critical factor in ensuring long-term survival.

Implantable left ventricular assist devices: an evolving long-term cardiac replacement therapy

OBJECTIVE

The authors' 8-year experience with both inpatient and outpatient left ventricular assist device (LVAD) support is presented to show the possibilities and limitations of long-term outpatient mechanical circulatory assistance.

SUMMARY BACKGROUND DATA

The limitation of suitable cardiac donors has led to the use of LVADs as a temporizing measure for patients awaiting cardiac transplantation. The success of such devices in the short and medium term as a bridge to transplantation has led to their evaluation as a long-term destination therapy for end-stage heart disease.

METHODS

Between August 1990 and February 1997, 85 patients with end-stage heart disease underwent insertion of implantable LVADs. Fifty-two patients underwent pneumatic device insertion and 32 patients received a vented electric device.

RESULTS

Patients were supported for a mean of 109+/-13 days for an overall survival to transplant (54) or explant (3) of 73%. Nineteen patients were discharged from the hospital on a mean of postoperative day 41+/-4 (range, 17-68) for an outpatient support time of 108+/-30 days (range, 2-466). Of 12 patients supported after postcardiotomy cardiogenic shock, 10 (82%) survived to hospital discharge. Perioperative right ventricular failure was treated in most patients with inotropic agents and inhaled nitric oxide with only six patients requiring right ventricular assist device support. Thromboembolic rate was low (0.016 events/patient-month) despite minimal or no anticoagulation in all cases.

CONCLUSIONS

Left ventricular assist device support has evolved to become an outpatient therapy with excellent survival rates and an acceptable morbidity. Accordingly, wearable LVADs should be studied as permanent treatment options for patients who are not transplant candidates.

Mechanical unloading with a miniature in-line axial flow pump as an alternative to cardiopulmonary bypass

Cardiopulmonary bypass (CPB) causes a well described systemic inflammatory response. To avoid these potential detrimental effects, coronary artery bypass grafting (CABG) has been attempted off CPB on the beating heart. With the use of a left ventricular (LV) assist device during CABG, the heart can be made flaccid with beta-blockade, and the systemic circulation can continue to be supported. The hemodynamic and hematologic consequences of left heart bypass with a miniature axial flow pump were studied in a sheep CABG model. The pump weighs 45 g and was connected to standard venous and arterial cannulas. Left sided inflow and brachiocephalic outflow were employed. A pump speed of 14,000 rpm resulted in a flow of 5.63 +/- 0.18 L/min and provided 75% of the LV output during a 2 hr pump run. This resulted in complete capture of the aortic pressure tracing (mean 56.3 mmHg) with a 15.5 mmHg augmentation in the esmolol depressed ventricle. Reductions in LV end diastolic pressure and LV end systolic pressure resulted in a 66% reduction in LV external work under baseline conditions and an 83% reduction in the beta-blocked ventricle. Myocardial oxygen demand was reduced 16% after axial flow unloading in the esmolol depressed condition. Right ventricular pressures, pulmonary artery flow, LV filling, and oxygenation were adequate in the esmolol depressed animal and remained unchanged throughout the experiment. No changes in hematocrit, total bilirubin, lactate dehydrogenase, or plasma free hemoglobin were detected after 2 hr of assist. Axial flow left heart bypass results in acceptable hemodynamics with no hemolysis and may provide an alternative to CPB during CABG.

Functional roles of dopamine D2 and D3 autoreceptors on nigrostriatal neurons analyzed by antisense knockdown in vivo

Two different 19-mer antisense oligodeoxynucleotides complementary to the initial coding regions of dopamine D2 or D3 receptor mRNA were infused unilaterally into the substantia nigra of rats for 3-6 d to suppress synthesis of D2 and/or D3 receptors on substantia nigra dopaminergic neurons, thereby producing specific reductions of D2 and/or D3 receptors. Autoradiographic receptor binding revealed that D2 and D3 antisense oligodeoxynucleotides specifically and significantly reduced D2 or D3 binding in the ipsilateral substantia nigra, respectively, without affecting dopamine receptor binding in the neostriatum. Either D2 or D3 antisense oligodeoxynucleotides greatly attenuated the ability of apomorphine to inhibit dopaminergic neurons in vivo, an effect that was potentiated by simultaneous administration of D2 and D3 antisenses. Despite these effects, neither the rate nor the pattern of spontaneous activity of antisense-treated nigrostriatal neurons differed from those in the control groups. The proportion of antidromic responses consisting of full spikes from antisense-treated rats was significantly greater, and the mean antidromic threshold was significantly lower than in controls, indicating that autoreceptor knockdown increased both somatodendritic and terminal excitability. These data demonstrate that selective reduction of specific dopamine receptor subtypes by antisense infusion can be effected in vivo, and that nigrostriatal neurons express both D2 and D3 autoreceptors at their somatodendritic and axon terminal regions. Although the somatodendritic and terminal autoreceptors modulate dendritic and terminal excitability, respectively, the interaction of endogenously released dopamine with somatodendritic autoreceptors does not appear to exert a significant effect on spontaneous activity in anesthetized rats.

D1 dopamine receptor stimulation inhibits firing activity of midbrain dopamine neurons in reserpine treated rats: an effect eliminated after hemitransection of diencephalon

It has been reported that systemic administration of the D1 dopamine (DA) receptor agonist SKF 38393 inhibits the firing rate of substantia nigra pars compacta (SNC, A9) DA neurons after repeated reserpine treatment in locally anesthetized rats, although SKF 38393 induces little effect on the firing of midbrain DA neurons in normal rats. The present study found that local pressure microejection of SKF 38393 (10(-2) M, 20-100 nl) to SNC or substantia nigra pars reticulata (SNR) failed to influence the firing of SNC DA neurons in reserpinized rats (reserpine 1 mg/kg x 6 days, s.c.); subsequent intravenous (i.v.) injection of SKF 38393 (4 mg/kg), however, inhibited their firing and the inhibition was reversed by the D1 receptor antagonist SCH 23390. Similarly, systemic administration of SKF 38393 (4 mg/kg, i.v.) inhibited the firing of ventral tegmental area (VTA, A10) DA cells in reserpinized rats, while local microejection of SKF 38393 (10(-2) M, 30-60 nl) did not affect their firing. Furthermore, the inhibitory effect of systemic SKF 38393 on firing rate of either SNC or VTA DA neurons in reserpinized rats was eliminated after hemitransection of diencephalon. These results suggest that repeated reserpine treatment renders midbrain DA neurons responsive to D1 receptor stimulation and that D1 receptor agonist-induced inhibition of midbrain DA cell firing in reserpinized rats may require the involvement of long-loop feedback pathways.

(-)-Stepholidine acts as a D1 partial agonist on firing activity of substantia nigra pars reticulata neurons in 6-hydroxydopamine-lesioned rats

(-)-Stepholidine (SPD), a novel dopamine (DA) D1 and/or D2 receptor antagonist in normosensitive animals, shows agonistic effects on D1 receptors in rotational behavior of 6-hydroxydopamine (6-OHDA)-lesioned rats. To further characterize the pharmacological properties of SPD, we investigated the effects of SPD on firing activity of substantia nigra pars reticulata (SNR) neurons in different sensitive models. In control rats, the selective D1 agonist SKF38393 (4 mg/kg, i.v.) induced inconsistent changes (i.e. increase, decrease or no change) in firing of SNR neurons. These effects were completely antagonized by SPD (i.v.), regardless of the changes induced by SKF38393. SPD (4 mg/kg), per se, increased firing by 30.9 +/- 14.4%. In reserpinized rats, SKF38393 also induced SPD-reversible inconsistent changes as in control rats. Nevertheless, SPD per se produced no alteration in firing of SNR neurons. In 6-OHDA-lesioned rats, 5/6 SNR neurons were inhibited by SKF38393. The inhibition was completely abolished by Sch23390, a selective D1 antagonist (0.5-2 mg/kg), but partially reversed by SPD (1-16 mg/kg). Moreover, SPD (4 mg/kg) itself caused SNR increased or decreased neuron firing, and these effects were completely reversed by Sch23390 (0.5-2 mg/kg) in 8/12 neurons recorded. These results suggest that SPD acts as a partial agonist to D1 receptors in 6-OHDA-lesioned rats, but as an antagonist to D1 receptors in normal and reserpinized rats.

Repeated reserpine treatment alters firing pattern and responses of substantia nigral dopamine neurons

Repeated reserpine treatment (1 mg/kg x 6 days) increased the number of spontaneously active substantia nigra pars compacta (SNC) dopamine (DA) cells and altered the firing pattern to a more irregular one in locally anesthetized rats. The selective DA D1 receptor agonist, SKF 38393, although having little effect on SNC DA cells in normal rats, profoundly inhibited the firing rate of SNC DA cells in reserpinized rats. On the contrary, the DA D2 receptor agonist, N-0437, significantly inhibited the firing rate of SNC DA cells in control rats, however, the inhibition was not significantly altered by reserpine. The inhibitory effect of the mixed DA receptor agonist, apomorphine, was significantly enhanced after reserpine treatment. In addition, the inhibition of SNC DA cell firing produced by D1 and D2 receptor agonists in reserpinized rats was reversed only by their own subtype antagonists. These results suggest that repeated reserpine treatment renders SNC DA cells responsive to D1 receptor stimulation, and that D1 receptors play a more important role than D2 receptors in the supersensitivity of SNC DA cells induced by repeated reserpine treatment. The results also indicate that D1 and D2 receptor agonists inhibit SNC DA cell firing separately and synergically in reserpinized rats.

Characteristics of (-)-stepholidine on the firing activity of substantia nigral dopamine neurons after repeated reserpine treatment

Although (-)-stepholidine [(-)-SPD] exhibits antagonistic effects to normosensitive dopamine (DA) receptors, it shows agonistic effect (probably D1) on rotational behavior in rats with unilateral 6-OHDA lesions of substantia nigra pars compacta (SNC). In this study, another supersensitive model, reserpinized rats (1 mg/kg x 6 days, s.c.), were used to investigate the properties of (-)-SPD. In reserpinized rats, (-)-SPD reversed and/or significantly attenuated the firing inhibition caused by the mixed DA receptor agonist apomorphine (APO). After reserpinization, the selective D1 and D2 receptor agonists separately inhibited the firing rate of SNC DA neurons, and (-)-SPD reversed both D2 receptor agonist N-0437- and D1 receptor agonist SKF 38393-induced inhibition of the SNC DA cell firing. These results suggest that (-)-SPD shows D1 and D2 receptor antagonistic action and does not possess the same DA receptor agonistic effect on SNC DA cell firing activity in reserpinized supersensitive rats as it does in unilateral 6-OHDA-lesioned rotational behavior. Also, large doses of (-)-SPD inhibited the firing rate of SNC DA cells in reserpinized rats, but the inhibition was not reversed by D1 receptor antagonist SCH 23390 but was reversed by N-0437 or APO. This inhibition, thus, could be interpreted as depolarization inactivation (DI) due to blockade of DA receptors. Interestingly, in control (nonreserpinized) rats, (-)-SPD did not produce DI of SNC DA cells as it did on ventral tegmental area DA cells. These results imply that reserpinization modulates the onset of DI of SNC DA cells and that (-)-SPD may serve as a leading compound for exploring new types of atypical neuroleptics.

Effects of (-)-stepholidine on firing activity of dopamine neurons in ventral tegmental area of rats

Extracellular single-unit recording techniques were used to evaluate the effects of (-)-stepholidine (SPD) on the firing activity of ventral tegmental area (VTA) dopamine (DA) neurons. SPD reversed the DA agonist apomorphine (Apo)-induced inhibition of VTA DA cell firing rate (ED50 = 4.9, 4.5-5.3 micrograms.kg-1), and the reversal was more rapid than that of a classic DA antagonist haloperidol (Hal) (ED50 = 11.2, 9.1-13.8 micrograms.kg-1). Pretreatment with SPD or Hal 0.5 mg.kg-1 attenuated Apo-induced inhibition, and SPD rendered the VTA DA cells less sensitive to larger doses of Apo (1024-4096 micrograms.kg-1) than Hal did. Pharmacological analysis indicated that the effects of SPD were mainly mediated through D2 subtype receptors. In addition, SPD increased the firing rate of VTA DA cells, while higher doses (1.4, 0.6-3.3 mg.kg-1) of SPD dramatically inactivated 4/6 of the VTA DA cells sampled. This inhibition was considered to be due to depolarization inactivation. These results suggest that SPD is a DA receptor antagonist and can effectively block the D2 autoreceptors located in the VTA DA cells.

Comparison of effects of tetrahydropalmatine enantiomers on firing activity of dopamine neurons in substantia nigra pars compacta

Extracellular single unit recording techniques were used to elucidate the effects of enantiomers of tetrahydropalmatine (THP) on the firing activity of dopamine (DA) neurons in substantia nigra pars compacta (SNC). (-)-THP rapidly reversed the apomorphine (Apo)-induced inhibition of the SNC DA cell firing activity (ED50 = 0.77, 0.52-1.14, mg.kg-1), while much larger doses of (+)-THP were required to reverse the Apo-induced inhibition (ED50 = 23, 15.2-34.7, mg.kg-1) and the maximal reversal caused by (+)-THP was 79 +/- 9% of the basal firing rate. In paralyzed rats, (-)-THP (0.5-16 mg.kg-1) significantly increased the spontaneous firing rate of SNC DA neurons dose-dependently, while (+)-THP did not until the dose reached 16 mg.kg-1. Pretreatment with (-)-THP 4 mg.kg-1 attenuated Apo-induced inhibition of SNC DA cell firing rate, while (+)-THP 32 mg.kg-1 revealed a similar potency to block the Apo-induced inhibition. In addition, (+)-THP did not potentiate the effect caused by d-amphetamine (Amp) as some behavioral experiments have shown, but large dose of (+)-THP (32 mg.kg-1) blocked the Amp-induced inhibition of SNC DA cell firing activity as (-)-THP (4 mg.kg-1) did. These results suggest that the interaction between D2 receptors and THP enantiomers has stereoselectivity and that (-)-THP is a D2 antagonist while (+)-THP seems to be not.

Dual actions of (−)-stepholidine on dopamine receptor subtypes after substantia nigra lesion

1. It was found that the contralateral rotation challenged by (-)-SPD (4 mg/kg, ip) in 6-OHDA-lesioned rats had a gradually progressive process with long latent period and a maximal response on 63 days after lesion. This steady contralateral rotation was preferably antagonized by D-1 antagonist SCH23390 than D-2 antagonists. During its latent period (-)-SPD exhibited the antagonistic effect to APO, while during its period of full response (-)-SPD could potentiate the APO-induced rotation. 2. In the rats lesioned with kainic acid plus 6-OHDA to destroy the SNC and SNR, (-)-SPD and SKF-38393 challenged neither contralateral nor ipsilateral rotation, while APO still induced the rotation but towards ipsilateral side, just opposite to that in 6-OHDA-lesioned rats. In this case, (-)-SPD antagonized the response to APO as did SCH 23390. 3. These evidences suggest that the agonistic action of (-)-SPD is resulted from D-1 receptor subtype at the SNR under supersensitive functional state. The fact that SNR lesion could completely eliminate the agonistic action of (-)-SPD further indicate that the D-1 receptors in the ipsilateral SNR may be the sites of action of (-)-SPD. The dual actions of (-)-SPD are dependent upon the supersensitivity of D-1 receptor subtypes which render the antagonistic action to convert into the agonistic.

[Effects of tetrahydroprotoberberines on dopamine release and 3,4-dihydroxyphenylacetic acid level in corpus striatum measured by in vivo voltammetry]

The extracellular (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC) in rat striatum were measured by in vivo voltammetry to elucidate the effects of 3 tetrahydroprotoberberines on DA neurotransmission. l-tetrahydropalmatine (l-THP, 2 mg.kg-1) or l-stepholidine (l-SPD, 0.5 mg.kg-1) iv increased the striatal DA release by 225% and 233%, respectively; and l-SPD increased the DOPAC level by 70%. Moreover, the enantiomer d-THP (2 mg.kg-1) increased the DA release by 97%, and a large dose of d-THP (20 mg.kg-1) dramatically increased the extracellular DA by 1456% while it slightly elevated the DOPAC level by 123%. These results support the previous ideas that l-SPD and l-THP can block DA receptors and d-THP can deplete neuronal DA.