Clinical Features and Outcomes of Myxedema Coma in Patients Hospitalized for Hypothyroidism: Analysis of the United States National Inpatient Sample

Background: Hypothyroidism is a common endocrine condition and chronic thyroid hormone deficiency is associated with adverse effects across multiple organ systems. In compensated hypothyroidism, however, patients remain clinically stable due to gradual physiological adaptation. In contrast, the clinical syndrome of decompensated hypothyroidism referred to as myxedema coma (MC) is an endocrine emergency with high risk of mortality. Because of its rarity, there are currently limited data regarding MC. This study analyzes the clinical features and hospital outcomes of MC compared with hypothyroid patients without MC (nonMChypo) in national United States hospital data. Methods: A retrospective analysis of the National Inpatient Sample, a public database of inpatient admissions to nonfederal hospitals in the United States, 2016-2018, including adult patients with primary diagnosis of MC (International Classification of Diseases 10th Revision [ICD-10]: E03.5) or nonMChypo (E03.0-E03.9, E89.0). Patient demographics, relevant clinical features, mortality, length of stay (LOS), and hospital costs were compared. Results: Of 18,635 patients hospitalized for hypothyroidism, 2495 (13.4%) had a diagnosis of MC. Sex distribution and race/ethnicity were similar between patients with MC and nonMChypo, whereas MC was associated with older patient age (p = 0.02), public insurance (p = 0.01), and unhoused status (p = 0.04). More admissions with MC occurred in winter compared with other seasons (p = 0.01). The overall mortality rate for MC was 6.8% versus 0.7% for nonMChypo (p < 0.001), and MC was independently associated with in-hospital mortality after adjusted regression analysis (adjusted odds ratio = 9.92 [CI 5.69-17.28], p < 0.001). Mean LOS ± standard error was 9.64 ± 0.73 days for MC versus 4.62 ± 0.12 days for nonMChypo (p < 0.001), and total hospital cost for MC was $21,768 ± $1759 versus $8941 ± $276 for nonMChypo (p = 0.07). In linear regression analyses, MC was an independent predictor of both increased LOS and total hospital cost. Conclusions: In summary, MC remains a clinically significant diagnosis in the modern era, independently associated with high mortality and health care costs. This continued burden demonstrates a need for further efforts to prevent, identify, and optimize treatment for patients with MC.

[Advances in molecular mechanism and treatment of chronic mucus hypersecretion]

Chronic obstructive pulmonary disease (COPD) is one of the chronic diseases with high morbidity and mortality in China, which imposes heavy economic burden on society. Research has shown that chronic mucus hypersecretion (CMH) is an independent risk factor for persistent clinical symptoms, poor quality of life, rapid decline in lung function, acute exacerbation and increased hospitalization rate in COPD patients. CMH is a clinical phenotype of COPD with specific pathological and physiological changes. At present, the formation mechanism of CMH is not clear. There is a lack of specific and effective targeted treatments. This article aimed to review the latest research findings on CMH at home and abroad from the overview, impact on COPD patients, molecular mechanisms of formation, current treatment status and progress, and discuss potential targets for CMH treatment, to provide new ideas and directions for improving CMH and treating COPD.

Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor-Induced Thyroiditis

Background/Objective

Immune checkpoint inhibitors (CPIs) activate antitumoral immune responses and are used to treat multiple types of primary and metastatic malignancies. Thyroid dysfunction is a known immune-related adverse event of CPI therapy. There are few data on the effect of CPI and CPI-induced thyroiditis on primary papillary thyroid carcinoma (PTC). We present a patient who developed CPI-induced thyroiditis during treatment for a nonthyroid malignancy and subsequent regression of a coexisting untreated primary PTC.

Case Report

A 49-year-old man with metastatic colon adenocarcinoma was found to have a large right thyroid nodule with biopsy confirmation of PTC. He did not have compressive symptoms or evidence of metastatic PTC. Resection was not performed because of colon cancer therapy. Treatment with CPI (ezabenlimab, an anti-programmed cell death protein 1 antibody) was initiated for the treatment of colon cancer. Four months after the initiation of CPI therapy, testing showed thyroid-stimulating hormone and free thyroxine levels of 174.9 (0.3-4.0 mIU/L) and 0.67 (0.93-1.70 ng/dL), respectively, consistent with CPI-induced hypothyroidism. Levothyroxine therapy was initiated. Repeat imaging 3 months later demonstrated a decrease in the tumor size to 4.1 × 4.9 × 4.2 cm (calculated volume change, -8.3% from baseline). At the last imaging, 1 year after the onset of CPI-induced thyroiditis, the PTC continued to decrease in size and measured 2.9 × 3.9 × 3.2 cm (volume change, -60.7% from baseline).

Discussion

CPI-induced thyroiditis suggests the development of an immune response against thyroid tissue and may reflect a similar increased immune response against PTC cells leading to tumor regression in this case.

Conclusion

Further research to assess the immunologic mechanism underlying this association is warranted to potentially develop improved immunotherapy for PTC.

[Treatment efficiency evaluation of left cardiac sympathetic denervation for patients with inherited arrhythmia by exercise-stress test]

Objective: To evaluate the efficiency of left cardiac sympathetic denervation (LCSD) in inherited arrhythmia patients with adrenergic activity-induced malignant ventricular arrhythmia, and observe exercise-stress test features before and after LCSD. Methods: This retrospective observational study included catecholaminergic polymorphic ventricular tachycardia(CPVT) and long QT syndromes(LQTS) patients who underwent video-assisted LCSD at Beijing Tsinghua Changgung Hospital and Peking University People's Hospital from September 2006 to May 2020. The indications for LCSD surgery were intolerant or refractory to beta-blocker medication. Clinical and exercise-stress tests data of included patients were collected before and 1 month after LCSD. Heart rate, exercise tolerance, atrial and ventricular arrhythmia, QTc interval and predictors for sudden cardiac death were analyzed. Patents were regularly followed up at 1, 3, 6, and 12 months after LCSD and then once every year thereafter. Cardiac events and medication adjustment records were collected. Results: Five patients (2 CPVT, 1 LQT1, and 2 LQT2)were included in the study. All patients experienced syncope as first symptom at the median age of 12(10, 16)years, and underwent LCSD at the median age of 21(16, 26)years, Baseline heart rate was similar before and after LCSD ((65.6±6.5) beats/min vs. (68.0±11.1) beats/min, P=0.57); while maximum workload tended to be lower after LCSD ((12.1±2.8) metabolic equivalents (METS) before surgery vs. (10.5±2.4) METS after surgery, P=0.07). Incidence of atrial and ventricular arrhythmia were significantly reduced post LCSD, and the ventricular arrhythmia score was decreased after LCSD in CPVT patients (4 points before LCSD vs. 3 points after LCSD in case 1;5 points before LCSD vs. 3 points after LCSD in case 2). QTc interval was shortened significantly in three LQTs patients (QTc interval at baseline heart rate: (546.6±72.3) ms before surgery vs. (493±61.1) ms after LCSD, P=0.047; QTc interval at maximal exercise heart rate: (516.3±73.7) ms before surgery vs. (486.7±64.2)ms after LCSD, P=0.035). Additionally, sudden cardiac death risk indicator ΔHRR1 (heart rate decreasing value within the first 1 min during recovery phase) decreased from (51.5±21.1) beats/min before surgery to (32.0±13.9) beats/min after surgery (P=0.035). During a median follow-up of 1(1, 4) year, all five patients were on low dosage of propranolol (37.0±21.7) mg/d. Cardiac events free survival was achieved in four out of 5 patients (80%) after sympathectomy, while 1 case suffered from sudden cardiac death after emotional stress. Conclusion: LCSD surgery can be safely and effectively performed in most hereditary arrhythmia patients with adrenergic activity-induced life-threatening cardiac events. Exercise stress test results show that LCSD could reduce malignant arrhythmias and improve sudden cardiac death risk indicators without decreasing heart rate.

[Perirectal fascial anatomy and pelvic autonomic nerve preservation during the transanal total mesorectal excision]

The difficulty of transanal total mesorectal excision (TME) is to find the correct dissection plane of perirectal space. As a complex new surgical procedure, the fascial anatomic landmarks of transanal approach operation are more likely to be ignored. It is often found that dissection plane is false after the secondary injury occurs during the operation, which results in the damage of pelvic autonomic nerves. Meanwhile, the mesorectum is easily damaged if the dissection plane is too close to the rectum. Thus, the safety of oncologic outcomes could be limited by difficulty achieving adequate TME quality. The promotion and development of the theory of perirectal fascial anatomy provides a new thought for researchers to design a precise approach for transanal endoscopic surgery. Transanal total mesorectal excision based on fascial anatomy offers a solution to identify the transanal anatomic landmarks precisely and achieves pelvic autonomic nerve preservation. In this paper, the authors focus on the surgical experience of transanal total mesorectal excision based on the theory of perirectal fascial anatomy, and discuss the feature of perirectal fascial anatomy dissection and technique of pelvic autonomic nerve preservation during transanal approach operation.

Racial disparities in receipt of standard chemoradiation in anal squamous cell carcinoma, an analysis of the National Cancer Database

Background

Standard treatment for locally advanced anal squamous cell carcinoma (SCC) consists of concurrent chemoradiation. We evaluated whether racial differences exist in the receipt of standard treatment and its association with survival.

Methods

From the National Cancer Database, we identified patients diagnosed with anal SCC (Stages 2–3) between 2004 and 2015. Using logistic regression, we evaluated racial differences in the probability of receiving standard chemoradiation. We used Cox proportional hazards models to evaluate associations between race, receipt of standard therapy and survival.

Results

Our analysis included 19,835 patients. Patients receiving standard chemoradiation had better survival than patients receiving nonstandard therapy (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.61–0.68; p < 0.001). Compared to White patients, Black patients were less likely to receive standard therapy (odds ratio [OR] 0.85; 95% CI 0.76–0.96; p < 0.008). We observed no statistical difference in mortality between Black and White patients overall (HR 1.05, 95% CI 0.97–1.15; p = 0.24). However, for the subgroup of patients receiving nonstandard therapy, Black patients had an increased mortality risk compared to White patients (HR 1.17, CI 1.01–1.35; p = 0.034). We observed no survival differences in the subgroup of patients receiving standard treatment (HR 1.00, CI 0.90–1.11, p = 0.99).

Conclusion

Standard treatment in anal SCC is associated with better survival, but Black patients are less likely to receive standard treatment than White patients. Although Black patients had higher mortality than White patients in the subgroup of patients receiving nonstandard therapy, this difference was ameliorated in the subset receiving standard therapy.

[Effect of high-titer plasma in pediatric patients with severe adenovirus pneumonia]

Objective: To explore the efficacy and safety of high-titer plasma in the treatment of pediatric patients with severe adenovirus pneumonia. Methods: The clinical data of 92 pediatric patients with severe adenovirus pneumonia admitted to pediatric intensive care unit (PICU) in Guangzhou Women and Children's Medical Center from January 2016 to October 2019 were retrospectively collected. According to the treatment with or without high-titer plasma, the patients were divided into plasma treatment group (n=41) and non-plasma treatment group (n=51). The 51 patients with chest radiograph showing more than half the lungs involved were divided into plasma treatment group (n=29) and non-plasma treatment group (n=22). According to fever duration before plasma treatment, patients were divided into early group (≤5 days, n=5), middle group (>5-10 days, n=14), and late group (>10 days, n=22). Baseline data, therapeutic effects, and prognosis of patients in each group were analyzed with t test, non-parametric rank sum test, one-way ANOVA and chi-square test. Results: Ninety-two patients were included. There were no significant differences in age, gender, body weight, fever duration, sequential organ failure assessment, and Murray lung injury score between plasma treatment group and non-plasma treatment group before admission (all P>0.05). The proportion of patients whose temperature drop to normal within 5 days was higher in plasma treatment group than that in non-plasma treatment group (88% (36/41) vs. 69% (35/51), χ(2)=4.745, P=0.029). However, there were no significant differences between the two groups in the proportions of invasive ventilator weaning within 14 days (63% (26/41) vs. 76% (39/51), χ(2)=1.868, P=0.172), transfer out from PICU within 14 days (49% (20/41) vs. 69% (35/51), χ(2)=3.724, P=0.054), discharge within 28 days (51% (21/41) vs. 61%(31/51), χ(2)=0.846, P=0.358) and survived patients (85% (35/41) vs. 76%(39/51), χ(2)=1.143, P=0.285). Among patients with severe chest radiograph, the proportions of patients whose temperature drop to normal within 5 days and survived patients were higher in plasma treatment group than those in non-plasma treatment group (86% (25/29) vs. 59% (13/22), χ(2)=4.843, P=0.028; 83% (24/29) vs. 55%(12/22), χ(2)=4.796, P=0.029, respectively). However, there were no significant differences between the two groups in the proportions of invasive ventilator weaning within 14 days (52% (15/29) vs. 59% (13/22), χ(2)=0.274, P=0.601), transfer out from PICU within 14 days (34% (10/29) vs. 45% (10/22), χ(2)=0.632, P=0.427), and discharge within 28 days (45% (13/29) vs. 45% (10/22), χ(2)=0.002, P=0.964). Among early, middle and late group, the proportions of invasive ventilator weaning within 14 days were 2/5, 13/14 and 50% (11/22), respectively, with statistically significant difference (χ(2)=8.119, P=0.017). There were no significant differences in the proportions of patients whose temperature drop to normal within 5 days (4/5, 14/14, 82% (18/22), χ(2)=2.965, P=0.227), transfer out from PICU within 14 days (2/5, 10/14, 36%(8/22), χ(2)=4.386, P=0.112), discharge within 28 days (2/5, 8/14, 50% (11/22), χ(2)=0.462, P=0.794) and survived patients (4/5, 13/14, 82% (18/22), χ(2)=0.966, P=0.617) in the three groups. Only one case with high-titer plasma therapy had rash in the course of infusing plasma and no other adverse reactions were observed. Conclusions: High-titer plasma can shorten the fever time and improve the proportion of survival patients in pediatric severe adenovirus pneumonia. The clinical effect of high-titer plasma is better in 5-10 days of fever course. High-titer plasma is an effective and safe treatment.

Gadoxetate-enhanced Abbreviated MRI for Hepatocellular Carcinoma Surveillance: Preliminary Experience

Purpose

To describe a single-center preliminary experience with gadoxetate disodium-enhanced abbreviated MRI for hepatocellular carcinoma (HCC) screening and surveillance in patients with cirrhosis or chronic hepatitis B virus (cHBV).

Materials and Methods

This was a retrospective study of consecutive patients aged 18 years and older with cirrhosis or cHBV who underwent at least one gadoxetate-enhanced abbreviated MRI examination for HCC surveillance from 2014 through 2016. Examinations were interpreted prospectively by one of six abdominal radiologists for clinical care. Clinical, imaging, and other data were extracted from electronic medical records. Diagnostic adequacy was assessed in all patients. Diagnostic accuracy was assessed in the subset of patients who could be classified as having HCC or not having HCC on the basis of a composite reference standard.

Results

In this study, 330 patients (93% with cirrhosis; 45% women; mean age, 59 years) underwent gadoxetate-enhanced abbreviated MRI. In the 330 patients, 311 (94.2%) baseline gadoxetate-enhanced abbreviated MRI examinations were diagnostically adequate. Of 141 (43%) of the 330 patients, 91.4% (129 of 141) could be classified as not having HCC and 8.6% (12 of 141) could be classified as having HCC. Baseline gadoxetate-enhanced abbreviated MRI had 0.92 sensitivity (95% confidence interval [CI]: 0.62, 1.00) and 0.91 specificity (95% CI: 0.84, 0.95) for detection of HCC. Of the 330 patients who underwent baseline gadoxetate-enhanced abbreviated MRI, 187 (57%) were lost to follow-up.

Conclusion

Gadoxetate-enhanced abbreviated MRI is feasible clinically, has a high diagnostic adequacy rate, and, on the basis of our preliminary experience, accurately depicts HCC in high-risk patients. Strategies to enhance follow-up compliance are needed.© RSNA, 2019Keywords: Abdomen/GI, Cirrhosis, Liver, MR-Imaging, Oncology, ScreeningSupplemental material is available for this article.

Functional characterization of AC5 gain-of-function variants: Impact on the molecular basis of ADCY5-related dyskinesia

Adenylyl cyclases are key points for the integration of stimulatory and inhibitory G protein-coupled receptor (GPCR) signals. Adenylyl cyclase type 5 (AC5) is highly expressed in striatal medium spiny neurons (MSNs), and is known to play an important role in mediating striatal dopaminergic signaling. Dopaminergic signaling from the D₁ expressing MSNs of the direct pathway, as well as the D₂ expressing MSNs of the indirect pathway both function through the regulation of AC5 activity, controlling the production of the 2nd messenger cAMP, and subsequently the downstream effectors. Here, we used a newly developed cell line that used Crispr-Cas9 to eliminate the predominant adenylyl cyclase isoforms to more accurately characterize a series of AC5 gain-of-function mutations which have been identified in ADCY5-related dyskinesias. Our results demonstrate that these AC5 mutants exhibit enhanced activity to Gα_s-mediated stimulation in both cell and membrane-based assays. We further show that the increased cAMP response at the membrane effectively translates into increased downstream gene transcription in a neuronal model. Subsequent analysis of inhibitory pathways show that the AC5 mutants exhibit significantly reduced inhibition following D₂ dopamine receptor activation. Finally, we demonstrate that an adenylyl cyclase "P-site" inhibitor, SQ22536 may represent an effective future therapeutic mechanism by preferentially inhibiting the overactive AC5 gain-of-function mutants.

[The role of NF-κB signaling pathway in laryngeal leukoplakia recurrent with laryngeal reflux]

Objective: To study the mechanism of vocal mucosal barrier damage mediated by NF-κB and NF-κB-regulated signaling pathway via probing the expression of inflammatory factors and essential proteins for node of NF-κB signaling pathway. Methods: The patients suffering from vocal leukoplakia accompanied with larygopharyngeal reflux(LPR) were treated with oral administration of proton pump inhibitor(PPI). Mucosal specimens of vocal cord were collected from all patients before PPI treatment. And the mucosal specimens of vocal cord were collected from the patients with suspected recurrence at 8 weeks after PPI treatment. HE staining was used to observe the histopathological changes of the mucosa. ELISA was utilized to detect the levels of inflammatory factors including tumor necrosis factor(TNF)-α, interleukin(IL)-1 and IL-6. Western blot was used to detect the expression of p-p65, p-IKK and p-IκB. Immunofluorescence method was adopted to detect the entrance of p65 to cell nucleus.Data was analyzed by SPSS 23.0 software. Results: In PPI untreated group, the expressions of IL-1β, TNF-α and IL-6 in the specimens of 8 weeks after operation were not different significantly from those obtained during operation.But in the PPI-treated group, the expressions were down-regulated.The expression of p-p65 in the middle and high grade heterogenous hyperplasia group was higher than that of low level heterogenous hyperplasia group.The difference of p65 and p-p65 expression between 8 weeks after surgery and surgery in PPI-untreated group was statistically insignificant (P>0.05). The difference of p65 expression between PPI-treated group and PPI pre-treatment group was statistically insignificant (P>0.05). The expression of p-p65 in the PPI-treated group was lower than that of the PPI pre-treatment group (P<0.05). The expressions of IL-1β, TNF-α and IL-6 were positively related with that of NF-κB-p65. Immun of luorescence method revealed the entrance of p65 to cell nucleus in PPI pre-treatment group, which meant that NF-κB was activated. In the PPI-treated group, few activated p65 could be observed in the cell nucleu. Conclusion: The possible mechanism of vocal mucosal barrier damage in vocal leukoplakia accompanied with LPR maybe the vocal mucosal inflammation mediated by NF-κB and NF-κB-regulated signaling pathway activated with refluxed materials.

[Coblation and silicon stent implantation for recurrent laryngeal papilloma with extensive lesions]

Objective:To evaluate the feasibility and long-term outcome of radiofrequency coblation combined with silicon stent implantation in the treatment of recurrent laryngeal papilloma with extensive lesions. Method:From March 2009 to April 2016, a total of 13 patients (8 males, 5 females; aged 28-67 years) who suffered recurrent laryngeal papilloma were enrolled in this retrospective study. All the cases had undergone at least one operation at other hospitals before this hospitalization. The recurrence interval (RI) of these cases ranged from 2 to 6 months. Video-laryngoscopy or stroboscopy were preformed preoperatively and postoperatively, as well as vocal function assessment. These cases underwent radiofrequency coblationin combination of different stent implantation (member, 7 cases; tube, 4 cases; T-shaped tube, 2 cases) under general anesthesia. The follow-up was 12 to 76 months. Result:Laryngoscopy revealed that the lesions mainly located in the vocal folds, anterior commissure, ventricular band, posterior commissure, epiglottis and even in subglottic area. Varying extent of mucosal adhesion of anterior or/and posterior commissure were observed in all cases, and two cases suffered mild subglottic tracheal stenosis. Two to six weeks after surgery, the silicon stent were removed and no mucosal adhesion were found except for 2 cases who suffered mucosal adhesion of anterior commissure again. Compared to preoperative scores, VHI-10 and G scores showed the significant improvement of voice quality postoperatively in all cases. The recurrence of papilloma was observed in 3 cases during 1-year follow-up, and 4 cases during 2-year follow-up, no recurrence in 6 cases. These recurrence lesions mainly located in ventricular band, subglottic area and trachea. However, no recurrence occurred in these cases who received ablation again. No serious complications were observed in these cases. Conclusion:Radiofrequency ablation may be an effective approach in the treatment of recurrent laryngeal papilloma with extensive lesions. One-stage application of suitable silicon stents can effectively prevent the adhesion of the wound and the onset oflaryngo-tracheal stenosis, and improve the quality of voice.

MRI proton density fat fraction is robust across the biologically plausible range of triglyceride spectra in adults with nonalcoholic steatohepatitis

BACKGROUND

Proton density fat fraction (PDFF) estimation requires spectral modeling of the hepatic triglyceride (TG) signal. Deviations in the TG spectrum may occur, leading to bias in PDFF quantification.

PURPOSE

To investigate the effects of varying six-peak TG spectral models on PDFF estimation bias.

STUDY TYPE

Retrospective secondary analysis of prospectively acquired clinical research data.

POPULATION

Forty-four adults with biopsy-confirmed nonalcoholic steatohepatitis.

FIELD STRENGTH/SEQUENCE

Confounder-corrected chemical-shift-encoded 3T MRI (using a 2D multiecho gradient-recalled echo technique with magnitude reconstruction) and MR spectroscopy.

ASSESSMENT

In each patient, 61 pairs of colocalized MRI-PDFF and MRS-PDFF values were estimated: one pair used the standard six-peak spectral model, the other 60 were six-peak variants calculated by adjusting spectral model parameters over their biologically plausible ranges. MRI-PDFF values calculated using each variant model and the standard model were compared, and the agreement between MRI-PDFF and MRS-PDFF was assessed.

STATISTICAL TESTS

MRS-PDFF and MRI-PDFF were summarized descriptively. Bland-Altman (BA) analyses were performed between PDFF values calculated using each variant model and the standard model. Linear regressions were performed between BA biases and mean PDFF values for each variant model, and between MRI-PDFF and MRS-PDFF.

RESULTS

Using the standard model, mean MRS-PDFF of the study population was 17.9 ± 8.0% (range: 4.1-34.3%). The difference between the highest and lowest mean variant MRI-PDFF values was 1.5%. Relative to the standard model, the model with the greatest absolute BA bias overestimated PDFF by 1.2%. Bias increased with increasing PDFF (P < 0.0001 for 59 of the 60 variant models). MRI-PDFF and MRS-PDFF agreed closely for all variant models (R²  = 0.980, P < 0.0001).

DATA CONCLUSION

Over a wide range of hepatic fat content, PDFF estimation is robust across the biologically plausible range of TG spectra. Although absolute estimation bias increased with higher PDFF, its magnitude was small and unlikely to be clinically meaningful.

LEVEL OF EVIDENCE

3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:995-1002.

[Pulmonary surfactant protein adenosine triphosphate-binding-cassette-A3 gene composite mutations in infant congenital interstitial lung disease: report of a case and review of literature]

Objective: To report a case of the pulmonary surfactant protein(SP) adenosine triphosphate-binding-cassette-A3 (ABCA3) gene mutations in infant congenital interstitial lung disease(ILD), and review the related literature, to investigate the relationships of ABCA3 gene mutation associated with ILD in infants. Method: A 6-months-old boy was hospitalized in the department of Pediatrics of the First Affiliated Hospital of Guangzhou Medical University. The clinical, radiological, histological information from transbronchial lung biopsy (TBLB) and genetic testing in this case was analyzed; 12 reports retrieved on literature search at Pubmed, OVID databases from 2004 to 2015 by using the ABCA3 as keyword were reviewed and analyzed. Result: (1)The patient, a 6-months-old boy, had progressive tachypnea and dyspnea since 4 months old. Physical examination on admission revealed respiratory rate of 78 times/min , heart rate of 187 times/min, SpO₂ 0.93(mask oxygen-inspiration with 6 L/min), scattered fine moist crackles could be heard over the both lungs, clubbing fingers were found. High-resolution computed tomography(HRCT) revealed diffuse ground-glass opacity, interlobular and intralobular septal thickening. Lung biopsies showed evidences of the alveolar cavity atelectatic changes and interstitial fibrosis. SP-A and SP-B were negative in immunohistochemical stainting. SP-related gene sequence analysis found that there was compound heterozygous missense mutation of ABCA3 gene in c. 1942A>G, c.2701-33G>C and c. 991-105C>A. (2)The review of related literature found that totally 12 cases were reported. The main manifestations were progressive tachypnea and dyspnea, age of onset was between birth and 4 years of age. The imaging characteristics of chest HRCT revealed diffuse infiltration or diffuse ground-glass pattern in the lung.

PROGNOSIS

6 cases died, and 6 cases survived, including 4 cases with pulmonary function disturbance to different degrees; 12 cases had ABCA3 gene mutations, 9 cases had composite ABCA3 gene mutations, in 11 cases the mutation occured in the exon of coding region, in 1 case in the intron, 9 cases had heterozygous mutations, 3 cases had homozygous mutations. Conclusion: The main phenotypes of ABCA3 mutation associated with ILD were full term neonatal respiratory distress syndrome or progressive tachypnea or dyspnea unexplained in infants. The chest HRCT showed two diffuse pulmonary interstitial changes. ABCA3 mutation mainly was multi-site composite mutations and heterozygous mutations in the exon of coding region.

[Comparing the free fasciocutaneous flap with free jejunium in reconstruction for hypopharyngeal and cervical esophageal defects]

Objective:To investigate the application of the reconstruction methods for hypopharyngeal and cervical esophageal defects due to the resection of hypopharyngeal cancer and advanced laryngeal cancer between free fasciocutaneous flaps and free jejunium transfer.We compared the superiorities and inferiorities of these two reconstruction methods. Method:Retrospective review of the archives of 56 patients from 2000 to 2010 who underwent pharyngoesophageal reconstruction with free flaps (n=32) or free jejunal transfer(n=24),comparison of indications,complications, hospitalization duration, swallowing function recovery and postoperative survival time. Result:The overall 3 year survival rate of free flap group and free jejunal transfer group was 59.3%,55.7% respectively; the overall 5 year survival rate was 38.5%,37.1% respectively. The overall rate of complication rate was 18.8%, 16.7% respectively. The patients with free flaps had higher incidence rate of fistula and scarring in the donor site and lower incidence rate of hues and stricture than the ones with free jejunal transfers. The mean hospitalization duration was (15.00±7.06) days and(13.00±6.75) days. The mean time of first oral food intake was(13.00±5.83)days and (11.00±6.67) days. The differences between two groups had no statistical significance(P>0.05). Conclusion:Free flaps and free jejunium transfer are the two most common reconstruction methods for the hypopharyngeal and cervical esophageal defects. Each has its own advantages and disadvantages respectively. We should choose reconstruction method according to the site and extent of the hypopharyngeal and cervical esophageal defects, preoperative and postoperative radiotherapy requirement.

Programmable shunt valves for the treatment of hydrocephalus: a systematic review

OBJECTIVE

To evaluate the clinical effectiveness of programmable valves compared with non-programmable valves of hydrocephalus.

METHODS

In this paper, the authors report a systematic review and meta-analysis of complications and revision rate for programmable valves and non-programmable implantation. Randomized or non-randomized controlled trials of hydrocephalus treated by programmable and non-programmable valves were considered for inclusion.

RESULTS

Seven published reports of eligible studies involving 1702 participants meet the inclusion criteria. Compared with non-programmable, programmable valves had no significant difference in catheter-related complications [RR = 0.88, 95%CI (0.66,1.19), p = 0.10] and infection rate [RR = 1.25, 95%CI (0.92,1.69), p = 1.00]. There were significant differences in overall complications [RR = 0.80, 95%CI (0.67,0.96), p < 0.01], over-drainage or under-drainage complications [RR = 0.44, 95%CI (0.31,0.63), p < 0.01] and revision rate [RR = 0.56, 95%CI (0.45,0.69), p < 0.01] in favor of programmable valves.

CONCLUSION

Although the studies seem to demonstrate a small advantage for the programmable shunts, the probable bias and the difficulties in patient selection are too important to make a general conclusion.

General behaviors and perching behaviors of laying hens in cages with different colored perches

Color is one of the perch properties. This study was conducted to investigate the general behaviors and perching behaviors in laying hens under different group size (stocking density), and to understand the perch color (black, white or brown) preference of hens during the night. A total of 390 Hyline Brown laying hens was used, and randomly allocated to three treatments: individual group (G1), group of four hens (G4), and group of eight hens (G8), respectively. There were 30 replicates in each group. The hens in G1, G4 and G8 groups were put into the test cages in which three colored perches were simultaneously provided and allowed for four days of habituation in the new cages. Hens behaviors were recorded using cameras with infrared light sources for the following periods: 8:00 to 10:00; 14:00 to 16:00; 19:00 to 21:00; 23:30 to 0:30 on the fifth day after transferring the birds into the test cages. The behaviors of hens in every time period were collected and analyzed, and hens positions on the test perches during mid-night were recorded. The results showed that, group size (stocking density) had significant effect on most of the general behaviors of laying hens except exploring behavior. There were great differences in most of the general behaviors during different time periods. In the preference test of perch color during night, the hens showed no clear preference for white, black or brown perches. For perching behaviors, perching time and frequency of transferring from one perch to another was higher on black perches than on white or brown perches in individual groups. In G4 groups, the hens spent more time on white perches during daytime and more frequent transferring during night compared with black or brown perches. The frequency of jumping upon and down from white perches was higher in G8 groups. It can be concluded that although the group sizes in the cage significantly affected most of the general behaviors, we found that no preference of perch color was shown by the caged laying hens in the different group sizes tested in this study.

Nanocrystallized SrHA/SrHA-SrTiO(3)/SrTiO(3)-TiO(2) multilayer coatings formed by micro-arc oxidation for photocatalytic application

Novel photocatalytic coatings containing strontium hydroxyapatite (SrHA), strontium titanate (SrTiO(3)), and TiO(2) were formed by micro-arc oxidation (MAO) in an aqueous electrolyte containing strontium acetate and β-glycerophosphate disodium at 530 V for 0.1-5 min. The structure evolution of the coatings was investigated as a function of processing time, and the photocatalytic activity of the coatings was evaluated by measuring the decomposition rate of methyl orange under ultraviolet irradiation. During the MAO processing of the coatings, it was observed that some granules appeared in the electrolyte adjacent to the anode and they increased in amount as the processing time was prolonged. The obtained results show that the granules are amorphous and poorly crystallized SrHA with negative charges. The coating prepared for 5 min presents a microporous structure of SrHA/SrHA-SrTiO(3)/SrTiO(3)-TiO(2) multilayers, in which the SrHA outermost layer and the SrHA-SrTiO(3) intermediate layer are nanocrystallized. It is suggested that formation of the granules, electro-migration of the granules onto the pre-formed layer, and crystallization of the adhered granules are possible mechanisms for the formation of a SrHA/SrHA-SrTiO(3)/SrTiO(3)-TiO(2) multilayer coating. This coating shows much higher photocatalytic decomposition efficiency relative to the MAO-formed TiO(2) coating, and is expected to have an important photocatalytic application.

The pattern of tegument-capsid interaction in the herpes simplex virus type 1 virion is not influenced by the small hexon-associated protein VP26

Examination of the three-dimensional structure of intact herpes simplex virus type 1 (HSV-1) virions had revealed that the icosahedrally symmetrical interaction between the tegument and capsid involves the pentons but not the hexons (Z. H. Zhou, D. H. Chen, J. Jakana, F. J. Rixon, and W. Chiu, J. Virol. 73:3210-3218, 1999). To account for this, we postulated that the presence of the small capsid protein, VP26, on top of the hexons was masking potential binding sites and preventing tegument attachment. We have now tested this hypothesis by determining the structure of virions lacking VP26. Apart from the obvious absence of VP26 from the capsids, the structures of the VP26 minus and wild-type virions were essentially identical. Notably, they showed the same tegument attachment patterns, thereby demonstrating that VP26 is not responsible for the divergent tegument binding properties of pentons and hexons.

Endostatin binds tropomyosin. A potential modulator of the antitumor activity of endostatin

The mechanism of action of Endostatin, an endogenous inhibitor of angiogenesis and tumor growth, remains unknown. We utilized phage-display technology to identify polypeptides that mimic the binding domains of proteins with which Endostatin interacts. A conformed peptide (E37) was identified that shares an epitope with human tropomyosin implicating tropomyosin as an Endostatin-binding protein. We show that recombinant human Endostatin binds tropomyosin in vitro and to tropomyosin-associated microfilaments in a variety of endothelial cell types. The most compelling evidence that tropomyosin modulates the activity of Endostatin was demonstrated when E37 blocked greater than 84% of the tumor-growth inhibitory activity of Endostatin in the B16-BL6 metastatic melanoma model. We conclude that the E37 peptide mimics the Endostatin-binding epitope of tropomyosin and blocks the antitumor activity of Endostatin by competing for Endostatin binding. We postulate that the Endostatin interaction with tropomyosin results in disruption of microfilament integrity leading to inhibition of cell motility, induction of apoptosis, and ultimately inhibition of tumor growth.

[Thermal decomposition kinetics of ribavirin and its stability]

AIM

To study Thermal stabilities and thermal decomposition process of ribavirin and establish thermal decomposition kinetics equation.

METHODS

Thermal weight loss curve was obtained by thermogravimetry balance. Thermal decomposition function mode was also determined by Achar differential method and Coats-Redfern integral method.

RESULTS

Thermal decomposition kinetics parameters and kinetics compensation parameters were calculated from thermogravimetry-differential thermogravimetry data. Activation energy deduced by extrapolation under heating rate of 0 degree C.min-1 was 188.04 kJ.mol-1. Thermal decomposition kinetics function expression was d alpha/dt = Ae [formula: see text] (1 - alpha)2 and the mathematic expression of the kinetic compensation effect is found to be InA = 0.2264 Ea - 5.4458.

CONCLUSION

Ribavirin has high thermal stability because of its high thermal decomposition activation energy. The thermal decomposition activation of capsule is little lower than that of material, which indicates no evident difference in thermal stability for capsules and material.

Both retinoic acid and 1,25(OH)2 vitamin D3 inhibit thyroid hormone-induced terminal differentiaton of growth plate chondrocytes

Thyroid hormone has been known for over 50 years to be a potent regulator of skeletal maturation at the growth plate. The receptor for thyroid hormone has been discovered to be a member of the nuclear hormone receptor superfamily. Retinoic acid and 1,25(OH)2 vitamin D3, whose receptors also belong to this nuclear hormone receptor family, have been implicated in the control of chondrocyte proliferation and differentiation at the growth plate. Recent studies demonstrate that the receptors for thyroid hormone, retinoic acid, and vitamin D bind to a similar DNA response element in the promoter region of target genes and may form heterodimers to regulate gene transcription in target cells. These observations led us to hypothesize that the retinoic acid and/or vitamin D signaling pathways may interact with thyroid hormone signaling at the molecular level to modulate growth plate chondrocyte differentiation. Using a chemically defined, serum-free model of growth plate chondrocyte maturation, both all-trans retinoic acid and 1,25(OH)2 vitamin D3 markedly inhibited thyroid hormone-induced terminal differentiation in a dose-dependent manner. In the absence of thyroid hormone, retinoic acid stimulated alkaline phosphatase activity modestly at the highest dose used, however neither retinoic acid nor 1,25(OH)2 vitamin D3 induced expression of type X collagen mRNA. We conclude that retinoic acid and vitamin D are likely to be antagonists of thyroid hormone signaling in the growth plate.

Chemical constituents of Typhonium giganteum Engl

A new cerebroside, named typhonoside (1), was isolated from the root tuber of Typhonium giganteum Engl. along with three known compounds dipalmitin (2), alpha-monopalmitin (3) and 2,6-diamino-9-beta-D-ribofuranosylpurine (4). The structure of 1 was determined to be 1-O-beta-D-glucopyranosyl-(2S,3S,4R,8Z)-2-[(2'-hydroxyl-docosanoyl)amino]-8-otadecene-1,3,4-triol on the basis of spectral data.

Expression of cyclin-dependent kinase inhibitors in epiphyseal chondrocytes induced to terminally differentiate with thyroid hormone

A growing body of evidence suggests that systemic hormones and peptide growth factors may exert their effects on cell growth and differentiation in part through regulation of the cell division cycle. We hypothesized that thyroid hormone regulates terminal differentiation of growth plate chondrocytes in part through controlling cell cycle progression at the G1/S restriction point. Our results support this hypothesis by demonstrating that treatment of epiphyseal chondrocytes with thyroid hormone under chemically defined conditions results in the arrest of DNA synthesis and the onset of terminal differentiation, indicating that thyroid hormone is one factor capable of regulating the transition between cell growth and differentiation in these cells. This terminal differentiation process is associated with induction of the cyclin/cyclin-dependent kinase inhibitors p21(cip-1 waf-1) and p27kip1, suggesting that thyroid hormone may regulate terminal differentiation in part by arresting cell cycle progression through induction of cyclin-dependent kinase inhibitors.

A self-learning segmentation framework--the Taguchi approach

The detection of object boundary is an interesting and challenging task in computer vision and medical image processing. The active contour model (snake model) has attracted much attention for object boundary detection in the past decade. However, due to the lack of understanding on the effect of different energy terms to the behavior of related objective functions for an image, the assignment of weights for different energy terms in this model is usually fulfilled empirically. Few discussions have been brought out specifically for assigning these weights automatically. In this paper, a novel self-learning segmentation framework, based on the snake model is proposed and applied to the detection of cardiac boundaries from ultrasonic images. The framework consists of a learning section and a detection section, and provides a training mechanism to obtain the weights from a desired object contour given manually. This mechanism first employs Taguchi's method to determine the weight ratios among distinct energy terms, followed by a weight refinement step with a genetic algorithm. The refined weights can be treated as the a priori knowledge embedded in the manually defined contour and be used for subsequent contour detection. Experiments with both synthetic and real echocardiac images were conducted with satisfactory outcomes. Results also show that the present method can be used to analyze successive images of the same object with only one training contour. Finally, the validity of the weight determining process was verified by the analysis of variance method (ANOVA).

Urinary tract infection in children

Two hundred and eighty-five children under 15 years old (169 boys and 116 girls) who had urinary tract infection (UTI) were admitted to our hospital during the period July 1995 to June 1998. Clinical presentation, laboratory data and image studies were recognized and analyzed. Most patients were younger than 2 years of age. Fever is the most common sign, especially in young children. With the urinary dipstick test a low positive rate of nitrite reaction (34.7%) was found. E. coli is the most common pathogen and exclusively resistant to ampicillin (90.2%). The E. coli is also relatively resistant to trimethoprim/sulfamethoxazole (57.1%). Voiding cystourethrogram was performed in 187 cases, in which 24.6% of those patients showed vesicoureteric reflux. Ninety-eight children received 99mTc-dimercaptosuccinic acid renal scans and 62 cases (63.3%) had abnormal findings compatible with pyelonephritis. The positive predictive values by renal ultrasonography for vesicoureteric reflux and pyelonephritis are 30.7% and 78.9%, respectively. In pyelonephritis patients, only 37% also had a vesicoureteric reflux. The fever duration and clinical inflammatory parameters were evaluated in all patients. Longer febrile periods are the risk of vesicoureteric reflux and pyelonephritis, and a high C-reactive protein concentration indicates the risk of pyelonephritis. In conclusion, fever was the most common sign in young UTI children who had a low positive nitrite reaction rate in the dipstick test. E. coli was the most common pathogen with a high ampicillin resistance in Taiwan. Only 37% pyelonephritis patients had refluxing nephropathy. It is indicated that pyelonephritis is not always attributed to reflux of infected urine. A longer febrile period and a high C-reactive protein level are good indicators for prediction of the risk of pyelonephritis in UTI patients.

Expression of thyroid hormone receptor isoforms in rat growth plate cartilage in vivo

Although thyroid hormone has been known for many years to be a potent regulator of skeletal maturation in vivo, it has not definitively been determined whether this effect is a result of a direct or indirect action of the hormone. Previous in vivo studies have suggested that thyroid hormone may stimulate longitudinal bone growth by increasing the secretion of growth hormone; however, growth hormone alone is unable to stimulate cartilage maturation. There are also indications that thyroid hormone is able to act directly on growth plate chondrocytes through growth hormone-independent mechanisms. In this study, we demonstrate that rat growth plate chondrocytes in vivo express genes encoding three of the four isoforms of the thyroid hormone receptors described to date, but the corresponding protein can only be detected for the TRalpha1 and TRbeta1 isoforms of the receptor. As has been noted in other tissues, there is generally poor correlation between the mRNA levels for each isoform and the relative amount of corresponding protein as measured by immunoblotting, suggesting the possibility that receptor expression may be regulated by post-transcriptional mechanisms.

Three-dimensional visualization of tegument/capsid interactions in the intact human cytomegalovirus

The three-dimensional structure of the intact human cytomegalovirus (HCMV) was determined to 18-A resolution by electron cryomicroscopy and computer reconstruction. Its capsid shell is composed of pentons, hexons, and triplexes arranged on a T = 16 icosahedral lattice and is identical to that of the B-capsid isolated from host cell nuclei. An icosahedrally ordered tegument layer formed by 960 copies of filamentous density is also visualized, which interacts with the pentons, hexons, and triplexes of the underlying capsid. The observed structural similarities and differences of HCMV with those of herpes simplex virus offer insights into the significance of the different tegument components for their infection processes while maintaining similar capsids.

Synthesis of Platinum Ultrafine Particles in AOT Reverse Micelles

The synthesis of platinum ultrafine particles by the reduction of H2PtCl6 with hydrazine in AOT/isooctane reverse micellar solutions has been studied. By high-resolution electron microscope, electron diffraction pattern, and XRD analyses, the resultant particles have been found to be pure platinum of fcc structure. Their sizes were observed to increase with the increases in the molar ratio of water to AOT (omegaO) and in the concentration of H2PtCl6, while they decreased with the increase of hydrazine concentration. At a constant omegaO value, the size of platinum ultrafine particles was not affected significantly when the concentration ratio of hydrazine to H2PtCl6 was above 10, the AOT concentration increased from 0.1 to 0.6 M, and the temperature varied from 15 to 35 degrees C. Furthermore, the kinetic study of particle formation indicated that the nucleation time needed several minutes. The time for the growth of platinum ultrafine particles to their final size after nucleation was about one to several hours. It was observed that the formation rates increased with the increase of omegaO value and the concentrations of AOT and H2PtCl6, but they were not affected by hydrazine concentration when the concentration ratio of hydrazine to H2PtCl6 was above 10. Copyright 1999 Academic Press.

Eliciting an immune response by plasmid DNA encoding a human sperm protein (HSD-1)

The cDNA encoding a human sperm membrane designated as HSD-1 was isolated from a human testis lambda gt11 cDNA expression library and assigned the accession number U12978 by GenBank. HSD-1 was conjugated to an eukaryotic expression plasmid (pRSV) to construct the recombinant plasmid pRSV-HSD-1. Female mice were inoculated intramuscularly with the plasmid DNA and the expression of HSD-1 was determined. HSD-1 mRNAs were detected in myocytes and endomysial connective tissue cells of the quadriceps muscle by in situ hybridization. Spleen of inoculated animals contained an increased number of cytotoxic T lymphocytes, phagocytes, and plasma cells. Fertility of the treated animals was not affected. Thus, intramuscular inoculation of female mice with the plasmid DNA (pRSV-HSD-1) results in the expression of HSD-1 and may elicit a tissue-mediated immune response.

Visualization of tegument-capsid interactions and DNA in intact herpes simplex virus type 1 virions

Herpes simplex virus type 1 virions were examined by electron cryomicroscopy, allowing the three-dimensional structure of the infectious particle to be visualized for the first time. The capsid shell is identical to that of B-capsids purified from the host cell nucleus, with the exception of the penton channel, which is closed. The double-stranded DNA genome is organized as regularly spaced ( approximately 26 A) concentric layers inside the capsid. This pattern suggests a spool model for DNA packaging, similar to that for some bacteriophages. The bulk of the tegument is not icosahedrally ordered. However, a small portion appears as filamentous structures around the pentons, interacting extensively with the capsid. Their locations and interactions suggest possible roles for the tegument proteins in regulating DNA transport through the penton channel and binding to cellular transport proteins during viral infection.

A novel deletion of the dystrophin S-promoter region cosegregating with mental retardation

A contiguous deletion of the S-promoter/first S exon and its downstream exon 56 of the dystrophin gene was identified in a Japanese dystrophinopathy family in which two brothers and their half brother were affected. Characteristically, severe mental retardation cosegregated with the deletion even though they grew up in different environments. Furthermore, mild cerebral atrophy was observed by CT scan and MRI in the eldest brother.

Preparation of Palladium Ultrafine Particles in Reverse Micelles

The preparation of palladium ultrafine particles by the reduction of Pd(NH3)4Cl2 with hydrazine in AOT/isooctane reverse micellar solutions has been studied. By the analyses of high-resolution electron microscope, electron diffraction pattern, and XRD, the resultant particles have been found to be pure fcc palladium. Their sizes were observed to increase first and then approach constant values with increases in the molar ratio of water to AOT (omega0) and in the concentration of Pd(NH3)4Cl2, but were not significantly affected when the concentration ratio of hydrazine to Pd(NH3)4Cl2 was above 10, the AOT concentration increased from 0.1 to 1.0 M, the temperature varied from 15 to 35 degreesC, and the pH of aqueous phase of Pd(NH3)4Cl2 was between 7 and 12. In addition, the kinetic study of particle formation indicated that the nucleation time needed several minutes. After nucleation, the particles grew to their final sizes within several to tens of minutes. The formation rates were found to be faster at larger omega0 values and higher AOT and Pd(NH3)4Cl2 concentrations. Copyright 1999 Academic Press.

Visualization of protein-RNA interactions in cytoplasmic polyhedrosis virus

Unlike the multiple-shelled organization of other Reoviridae members, cytoplasmic polyhedrosis virus (CPV) has a single-shelled capsid. The three-dimensional structures of full and empty CPV by electron cryomicroscopy show identical outer shells but differ inside. The outer surface reveals a T=1 icosahedral shell decorated with spikes at its icosahedral vertices. The internal space of the empty CPV is unoccupied except for 12 mushroom-shaped densities attributed to the transcriptional enzyme complexes. The ordered double-stranded RNA inside the full capsid forms spherical shells spaced 25 A apart. The RNA-protein interactions suggest a mechanism for RNA transcription and release.

Characterization of p96h2bk: immunoreaction with an anti-Erk(extracellular-signal-regulated kinase) peptide antibody and activity in Xenopus oocytes and eggs

We have shown previously that oncogenic Ras induces cell cycle arrest in activated Xenopus egg extracts [Pan, Chen and Lin (1994) J. Biol. Chem. 269, 5968-5975]. The cell cycle arrest correlates with the stimulation of a protein kinase activity that phosphorylates histone H2b in vitro (designated p96(h2bk)) [Chen and Pan (1994) J. Biol. Chem. 269, 28034-28043]. We report here that p96(h2bk) is likely to be p96(ram), a protein of approx. 96 kDa that immunoreacts with a monoclonal antibody (Mk-1) raised against a synthetic peptide derived from a sequence highly conserved in Erk1/Erk2 (where Erk is extracellular-signal-regulated kinase). This is supported by two lines of evidence. First, activation/inactivation of p96(h2bk) correlates with upward/downward bandshifts of p96(ram) in polyacrylamide gels. Secondly, both p96(h2bk) and p96(ram) can be immunoprecipitated by antibody Mk-1. We also studied the activity of p96(h2bk)/p96(ram) in Xenopus oocytes and eggs. p96(h2bk)/p96(ram) was inactive in stage 6 oocytes, was active in unfertilized eggs, and became inactive again in eggs after fertilization. Since stage 6 oocytes are at G2-phase of the cell cycle, unfertilized eggs arrest at M-phase and eggs exit M-phase arrest after fertilization, the results thus indicate that p96(h2bk)/p96(ram) activity is cell cycle dependent. Moreover, microinjection of oncogenic Ras into fertilized eggs at the one-cell stage arrests the embryos at the two-cell stage, and this induced arrest is correlated with an inappropriate activation of p96(h2bk)/p96(ram). The data are consistent with the concept that inappropriate activation of p96(h2bk)/p96(ram) plays a role in the cell cycle arrest induced by oncogenic Ras.

Ultrastructural changes in rat locus coeruleus induced by chronic opioids

The locus coeruleus (LC) is a major noradrenergic nucleus in the brain. The activity of the LC neurons is chronically regulated by opioids. So far, very little is known about the morphological changes induced by chronic treatment with opioids. In the present study, the effects of chronic treatment with morphine and dihydroetorphine, a new narcotic analgesic with lower physical dependence potential than morphine, were investigated on the ultrastructure of the rat LC. Rats received saline or increasing doses of morphine or dihydroetorphine for 5 days by twice daily subcutaneous injections. Withdrawal was precipitated in half of the opioid-treated rats by a single intraperitoneal injection of naloxone 4 h after the last injections of opioids. The ultrastructure of the LC was examined by electron microscopy. Results showed that chronic morphine treatment induced a marked injury to the LC neurons. The primary changes in the cell body were the indentation of nuclei, the fragmentation and degranulation of rough endoplasmic reticulum, as well as the disaggregation of polyribosomes. Myelinoid bodies were seen in the processes. An accumulation of presynaptic vesicles was observed in some of the terminals which formed synaptic junctions with the LC neurons as compared to the normal controls. Naloxone-precipitated withdrawal from morphine did not stop the morphine-induced injury on the LC neurons except that less accumulation of presynaptic vesicles occurred. Chronic dihydroetorphine treatment only induced a slight change in the ultrastructure of the LC neurons. These results indicate that the LC neurons are more vulnerable to chronic treatment with morphine than to that with dihydroetorphine.

The 96 kDa protein kinase activated by oncogenic Ras in Xenopus egg extracts is also activated by constitutively active Mek: activation requires serine/threonine phosphorylation

In the Xenopus egg and oocyte system, oncogenic Ras protein can induce cell cycle arrest. The effect of oncogenic Ras on the cell cycle seems to be mediated by the Raf-Mek-Erk pathway of Ras signal transduction since constitutively active Raf, Mek, or Erk can mimic the effect of oncogenic Ras protein and since specific inhibition of these kinases can block the effect of oncogenic Ras. Using activated Xenopus egg extracts, we previously reported that the cell cycle arrest induced by oncogenic Ras correlates with the activation of a 96 kDa protein that phosphorylates histone h2b in vitro. This result raised the possibility that the 96 kDa kinase (designated as p96h2bk) is a potential target of the Raf-Mek-Erk pathway that links the pathway to the control of the cell cycle. We report here that constitutively active Mek1 could activate p96h2bk in the absence of oncogenic Ras. Moreover, inhibition of endogenous Mek by a specific inhibitor, PD 098059, suppressed the activation of p96h2bk by oncogenic Ras. These results are consistent with the concept that p96h2bk is a component or target of the Raf-Mek-Erk pathway. Furthermore, we have shown that activation of p96h2bk requires serine/threonine phosphorylation of p96h2bk.

Identification of a potential physiological substrate for oncogenic Ras-activated protein kinases in activated Xenopus egg extracts: correlation with oncogenic Ras-induced cell cycle arrest

Activated Xenopus egg extracts are capable of undergoing cell-free cell cycling. Using these activated extracts, we previously showed that purified, bacterially expressed oncogenic human RasH protein arrests cell cycle progression. Because oncogenic Ras activates many serine/threonine protein kinases in Xenopus oocytes and egg extracts, it is possible that induction of cell cycle arrest involves the action of oncogenic Ras-activated kinases. Thus, the identification of the physiological substrates for oncogenic Ras-activated kinases is important for elucidating the molecular mechanism underlying oncogenic Ras-induced cell cycle arrest. We used 32P-orthophosphate as a label to identify the potential substrates. Our results demonstrated that the 32P-labeling of both a 32 and a 33 kDa protein were greatly enhanced by oncogenic Ras during the incubation of activated Xenopus egg extracts. The enhanced labeling correlated with the induced cell cycle arrest and was contributed by serine phosphorylation. Moreover, the 33 kDa protein was detected only in the presence of oncogenic Ras and was a serine-hyperphosphorylated form of the 32 kDa protein. Furthermore, new protein synthesis was not required for the enhanced labeling, consistent with the concept that the enhanced serine phosphorylation of the 32 kDa protein is by oncogenic Ras-activated protein kinases. In addition to serine phosphorylation, our results also suggested that an as yet unidentified modification of the 32 kDa protein might also be induced by oncogenic Ras. Our results suggest that the 32 kDa protein is a potential physiological substrate for oncogenic Ras-activated protein kinases.

Transport and hydrolysis of urea in a reactor-separator combining an anion-exchange membrane and immobilized urease

A membrane reactor-separator, in which an anion-exchange membrane and a urease-immobilized poly(vinyl alcohol) (PVA) membrane were clamped together to separate the feed solution and the stripping solution of a dialysis cell, was constructed. The urea in the feed solution passed through the anion-exchange membrane, water film, and then was hydrolyzed to ammonium carbamate in the urease-immobilized PVA membrane. The experimental results showed that no ammonium ion was found in the feed solution under either phosphate or citrate buffer systems at 0.05-0.2 mol dm-3 and pH 6-9, and various initial concentrations of urea in the feed solution (20-200 mmol dm-3). This indicates that the water film between two membranes allows the carbamate ions to decompose into ammonium and carbonate ions completely before entering the anion-exchange membrane. The device therefore can be used for the removal of urea from feed solution, while preventing the backflow of ammonium ions from the stripping solution or water film into feed solution. It has significant potential in the development of a wearable or portable artificial kidney. The properties of the urease-immobilized PVA membrane were examined. A kinetic model describing the transport-reaction behavior of urea in the membrane reactor-separator was developed, and the optimum values of the reactor parameters were obtained.

A nuclear tRNA gene cluster in the protozoan Leishmania tarentolae and differential distribution of nuclear-encoded tRNAs between the cytosol and mitochondria

All mitochondrial tRNAs in the protozoan Leishmania are believed to be encoded in the nuclear genome and imported selectively into the mitochondria by an as yet unknown mechanism. Previously, we reported that two tRNAs whose genes are tightly linked were imported by mitochondria. In contrast, a tRNA encoded by a lone tRNA gene was not detectable in mitochondria. The lone tRNA gene had flanking sequences that were different from the linked genes. These studies implied a possible correlation between tRNA gene organization and gene flanking sequence, and selective tRNA import into mitochondria. Here, we report the identification of a cluster of 10 tRNA genes and show the distribution of the corresponding tRNAs in cytosolic and mitochondrial fractions. tRNA(leu)(CAG) and tRNA2(arg)(TCG) are abundant in the cytosol, but relatively scarce in mitochondria. Conversely, tRNA(ile)(TAT) and tRNA1(lys)(TTT) are abundant in mitochondria, but relatively scarce in the cytosol. tRNA(val)(TAC) and tRNA2(thr)(TGT) are barely detectable in either cellular compartment, while tRNA(gln)(TTG), tRNA1(arg)(ACG), tRNA(gly)(TCC), and tRNA(trp)(CCA) are detected in approximately equal levels in both compartments. Sequencing of the 2600 bp that comprise the tRNA gene cluster also encoding the genes for 5S RNA and URNAB RNA indicates that nucleotide composition, length, and location of genes within the cluster do not clearly correlate with import characteristics. The unexpected presence of the tRNA(trp)(CCA)-gene transcript in mitochondria is also reported. Evidence suggests that this tRNA may have unidentified base modifications at the anticodon triplet.

In vivo expression and mitochondrial import of normal and mutated tRNA(thr) in Leishmania

Evidence suggests that mitochondria of protozoans and plants contain nuclear-encoded tRNAs. In trypanosomatids, the entire set of tRNAs in the mitochondria are presumably imported from the nucleus, but the mechanism of tRNA import is not presently understood. In this study, we have employed a plasmid-encoded nuclear tRNA gene as a means of investigating tRNA expression and mitochondrial import in vivo in Leishmania tarentolae. Using a Leishmania plasmid, we cloned a 1-kb or 250-bp restriction fragment carrying the nuclear tRNA(thr) gene and three in vitro mutagenized derivatives: Tac6 (an insertion of 6 nucleotides at the anticodon loop), Td4 (a 4-nt insert at the D-loop) and Tv4 (a 4-nt insert at the variable arm). Leishmania cells stably transfected with these plasmids were then examined for tRNA expression and import by Northern analysis. The results show that the plasmid-encoded wild type tRNA(thr) gene produced a significantly elevated level of expression in the cytosol. Similarly, the Tac6-transfected cells exhibited a large abundance of the mutant RNA relative to the normal tRNA (chromosome-encoded gene transcripts) in the cytosol. Furthermore, the mutant Tac6 RNA was found imported into mitochondria, although the proportion of the mutant vs. normal tRNA in mitochondria was greatly reduced as compared to that in the cytosol. We suggest that the mitochondrial import machinery is capable of discriminating against the mutant RNA in favor of the normal tRNA for import. In another example, we found that the Tv4 gene showed expression, albeit somewhat reduced, but its import into mitochondria was completely blocked. Unexpectedly, the 4-base addition mutation (Td4) at the D-loop showed neither expression nor import. While these results clearly signify the importance of various segments within the tRNA gene for in vivo expression, our data underscore the significance of the variable loop for mitochondrial import. It is our belief that this plasmid-encoded tRNA gene expression system in Leishmania may be useful in gaining further insights on tRNA import.

Selective import of nuclear-encoded tRNAs into mitochondria of the protozoan Leishmania tarentolae

The trypanosomatid mitochondrial genome does not encode tRNA genes at all and experimental evidence obtained with Leishmania tarentolae shows that tRNAs in mitochondria represent a selected set of imported nuclear-encoded tRNAs. In this paper we present the data showing that tRNAs derived from the clustered genomic tRNA genes are invariably imported into mitochondria, while tRNA from the solitary gene is not. By sequencing a cosmid DNA clone of L. tarentolae genomic DNA, we have identified a 1.5-kb subclone encoding a duplicate set of the closely linked tRNA(Tyr) (GTA) and tRNA(Thr) (AGT) genes. Northern analysis shows that these tRNAs are imported into mitochondria. In contrast, when the tRNA gene [tRNA(Gln) (CUG)] located alone in a 40-kb DNA fragment was examined, the corresponding tRNA was not detected in the mitochondrion. This "loner" tRNA gene is highly unusual since the 3'-flanking putative RNA polymerase III transcription termination signal sequence is characterized by a long string of 8 Ts followed by an A and a stretch of 7 Cs, while all other trypanosomatid tRNA genes whose tRNA transcripts are imported are terminated by a possible transcription termination signal of only 4-6 Ts. Whether the correlation found between the gene organization and tRNA-import characteristics is of general significance needs to be investigated further. A simple computer analysis presented in this paper rules out the possibility that tRNAs found in the trypanosomatid mitochondrion are the products of the U-addition type 'RNA editing' of maxicircle DNA.

Cigarette smoking among junior high school students in Beijing, China, 1988

Prevalence, behavioural patterns and risk factors of cigarette smoking were studied in a sample of 8437 junior high school students in Beijing in 1988. Smoking at least occasionally was reported by 34.4% of boys and 3.9% of girls, though the intensity tended to be low. Smoking prevalence increased with age among boys. Inhaling smoke into the lungs was practised by 68.2% of the boys who smoked and 37.3% of the girls. 'Believing that one looks elegant when smoking', 'trying to be fashionable' and 'seeking stimulation' were the most important reasons for smoking. Of the boys 83.5% and of the girls 86.5% usually smoked with friends or schoolmates. Many more boys (19.2%) than girls (1.7%) smoked at home. Examinations of risk factors for teenage smoking showed that it was associated with a combination of familial, psychological and socio-school factors, with peer group pressure being the most important one.

[Treatment of climacteric syndrome with new gengnian prescriptions]

It was found by the observations of clinical treatment that the three indexes of epinephrine(E), norepinephrine(NE) and dopamine(D) of urinary catecholamine(CA) increased (P less than 0.001, P less than 0.05 and P less than 0.001) for the climacteric patients who suffered from the deficiency of Yin leading to the hyperactivity of the internal heat of the heart, and the urinary 17-hydroxycorticosteroid (17-OHCS) increased (P less than 0.001) for the patients who suffered from the deficiency of Yin leading to the hyperactivity of the internal heat of the liver. Both the three indexes and urinary 17-OHCS increased for the two groups (P less than 0.01). However, for all the above groups who suffered from the deficiency of Yin leading to the hyperactivity of the internal heat, the NE/E ratio was larger than the normal ratio, which stands for the level of central catecholamine. After the treatment with new Gengnian prescriptions, the clinical symptoms of the patients were improved, and in the meantime urinary CA. 17-OHCS and NE/E were decreased. The total efficiency was 89.2%. The principle of treatment with this prescription may be due to the fact that the level of central catecholamine decreased so that the excessive excitation of sympathetics-adrenocortical system and sympathetics-adrenocortical system was restrained.

[Ultrastructural study of the lethal effect of lymphokine activated killer (LAK) cell on liver cancer cells]

Co-cultured subcloned LAK cell and human liver cancer cell (H7402) were fixed in situ for scanning electron microscopic and transmission electron microscopic examinations. The SEM and TEM findings gave a new evidence in answering how LAK cells kill the cancer cells. First, the activated killer cells recognized and made close contact with the target cell. Then some kind of lethal hit produced by intact killer cells was delivered, injuring the target cell, boring holes and pole-like tunnels on the cell surface or even penetrating into the cytoplasm of the cancer cells. Eventually, cell death in the manner of apoptosis and necrosis occurred as the end result of the damage to the cancer cell. These findings strongly support the idea that the death of the target cells is mediated by LAK cells.