Integration of untargeted and pseudotargeted metabolomics reveals specific markers for authentication and adulteration detection of Fritillariae Bulbus using tandem mass spectrometry and chemometrics

Authentication and adulteration detection of closely related herbal medicines is a thorny issue in the quality control and market standardization of traditional Chinese medicine. Taking Fritillariae Bulbus (FB) as a case study, we herein proposed a three-step strategy that integrates mass spectrometry-based metabolomics and multivariate statistical analysis to identify specific markers, thereby accurately identifying FBs and determining the adulteration level. First, an ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry-based untargeted metabolomics method was employed to profile steroid alkaloids in five sorts of FB and screen potential differential markers. Then, the reliability of the screened markers was further verified by the distribution in different FB groups acquired from ultra-high performance liquid chromatography triple quadrupole mass spectrometry-based pseudotargeted metabolomics analysis. As a result, a total of 16 compounds were screened out to be the specific markers, which were successfully applied to distinguish five FBs by using discriminant analysis model. Besides, partial least squares regression models based on specific markers allowed accurate prediction of three sets of adulterated FBs. All the models afforded good linearity and good predictive ability with regression coefficient of prediction (R2p) > 0.9 and root mean square error of prediction (RMSEP) < 0.1. The reliable results of discriminant and quantitative analysis revealed that this proposed strategy could be potentially used to identify specific markers, which contributes to rapid chemical discrimination and adulteration detection of herbal medicines with close genetic relationship.

Association between workplace health promotion service utilisation and depressive symptoms among workers: a nationwide survey

OBJECTIVES

Workplace-related factors are associated with the risk of depression. Despite implementation of workplace health promotion (WHP) programmes in China to promote the physical and mental well-being of workers, the relationship between WHP and depression has received limited attention. This study investigated the association between WHP service utilisation and depressive symptoms among workers.

STUDY DESIGN

This was a cross-sectional survey.

METHODS

A researcher-designed questionnaire was used to collect information on socio-demographic and occupational characteristics, WHP service utilisation, and mental health status. The Lasso method was used for variable selection to achieve dimension reduction, and logistic regression was used to assess the association between WHP service utilisation and depressive symptoms.

RESULTS

The analysis included 11,710 workers, of whom 17.0% had depressive symptoms. Lasso regression resulted in 6 of 18 WHP services showing significant negative associations with depressive symptoms, including occupational safety training, mental health services, health check-ups, sports activities, fitness rooms, and healthy canteens. The logistic regression results showed that, after adjusting for sociodemographic and occupational factors, utilisation of these six services was associated with a decreased likelihood of depressive symptoms. The adjusted odds ratio (aOR) was 0.84 (95% confidence interval [CI]: 0.73-0.96) for occupational safety training, aOR: 0.82 (95% CI: 0.68-0.99) for mental health services, aOR: 0.80 (95% CI: 0.71-0.90) for health check-ups, aOR: 0.68 (95% CI: 0.57-0.80) for sports activities, aOR: 0.59 (95% CI: 0.47-0.74) for fitness rooms and aOR: 0.72 (95% CI: 0.59-0.87) for healthy canteens.

CONCLUSIONS

Utilisation of WHP services was associated with a lower prevalence of depressive symptoms. Implementation of WHP services and the provision of a supportive workplace environment should be prioritised to benefit the mental health of workers.

An integrated strategy combining network toxicology and feature-based molecular networking for exploring hepatotoxic constituents and mechanism of Epimedii Folium-induced hepatotoxicity in vitro

Epimedii Folium (EF), a commonly used herbal medicine to treat osteoporosis, has caused serious concern due to potential hepatotoxicity. Until now, its intrinsic hepatotoxic mechanism and hepatotoxic ingredients remain unclear. Here, a novel high-throughput approach was designed to investigate the intrinsic hepatotoxic of EF. High-content screen imaging (HCS) and biochemical tests were first performed to obtain the cytotoxicity parameter matrix of 17 batch EF samples. EF-treated alpha mouse liver 12 (AML12) cells showed increased reactive oxygen species (ROS), reduced glutathione (GSH) and mitochondrial membrane potential (MMP), and apoptosis and cholestasis were further observed. Network toxicology predicted that EF-triggered hepatotoxiciy was involved in transcription factor (TF) activity. The FXR expression, screened by a TF PCR array, exhibited down-regulation following EF extract administration. Moreover, EF inhibited bile acid (BA) metabolism pathway in an FXR-dependent manner. Pearson correlation between the cytotoxicity parameter matrix and quantification feature table obtained from UHPLC-QTOF data of EF suggested 7 prenylated flavonoids possessed potent hepatotoxicities and their cytotoxicity order was further summarized. The transcriptional repression effects of them on FXR were also verified. Collectively, our findings indicate that FXR is probably responsible for EF-induced hepatotoxicity and prenylated flavonoids may be a major class of hepatotoxic constituents in EF.

Revealing active components and action mechanism of Fritillariae Bulbus against non-small cell lung cancer through spectrum-effect relationship and proteomics

BACKGROUND

Fritillariae Bulbus (FB) is widely used as a traditional medicine for the treatment of lung meridian diseases. It has been proved that FB has good anti-non-small cell lung cancer (NSCLC) activity. However, the active components and potential mechanism are still not clear.

PURPOSE

To reveal the bioactive components of FB against NSCLC and potential mechanism through spectrum-effect relationship and proteomics.

METHOD

First, the FB extract was chemically profiled by UHPLC-QTOF-MS and the inhibitory effect of FB extract on A549 cell viability was evaluated by Cell Counting Kit-8 assay. Second, orthogonal-partial least squares-regression analysis was applied to screen potential active compounds through correlating the chemical profile with corresponding inhibitory effect. Third, the anti-NSCLC activities of potential active components were further investigated in terms of cell proliferation, cell cycle and cell apoptosis in vitro and tumor growth in vivo. Finally, proteomics was utilized to reveal the underlying anti-NSCLC mechanism.

RESULTS

Six potential active components including verticine, verticinone, zhebeirine, ebeiedinone, yibeissine and peimisine were screened out by spectrum-effect relationship. Among them, zhebeirine showed higher inhibitory effect on A549 cell viability with IC₅₀ value of 36.93 μM and dosage-dependent inhibition of A549 xenograft tumor growth in nude mice. Proteomics and western blotting assays indicated that zhebeirine could arrest cell cycle by down-regulating the expressions of CDK1, CDK2, Cyclin A2, Cyclin B2 and inhibiting the phosphorylation of p53. Moreover, the proteins participating in p53 signaling pathway including PCNA, 14-3-3σ, CHEK1 were significantly decreased, which suggested that zhebeirine affected cell cycle progression through p53 signaling pathway.

CONCLUSION

This study not only provides scientific evidence to support the clinical application of FB against NSCLC, but also demonstrates that zhebeirine is a promising anti-NSCLC lead compound deserving further studies.

[Comparison of the therapeutic effects of optic nerve sheath fenestration and medication on papilledema due to cerebral venous thrombosis]

Objective: To compare the therapeutic effects of optic nerve sheath fenestration (ONSF) and medication on papilledema induced by cerebral venous thrombosis (CVT). Methods: Patients with papilledema induced by CVT in Beijing Tiantan Hospital and Xuanwu Hospital from January 2017 to July 2022 were retrospectively enrolled and were divided into two groups according to the treatment strategies they underwent, with 76 cases (107 eyes) in ONSF group and 35 cases (69 eyes) in medication group. The degree of papilledema was evaluated by the modified Frisén's grading (grade 0-1 was defined as mild, grade 2-3 was moderate, and grade 4-5 was severe edema). The mean defect (MD) of visual field, the degree of papilledema, and the mean retinal nerve fiber layer (RNFL) thickness in different subgroups were compared between baseline versus 1 month after ONSF or medication. Results: There were 76 cases in ONSF group (26 males and 50 females), and aged (35.3±11.4) years. Meanwhile, there were 35 cases in medication group (22 males and 13 females), and aged (35.2±11.0) years. Compared with baseline, MD were improved in both moderate [(-8.4±6.6) vs (-11.8±8.6) db, P=0.021] and severe [(-8.1±5.3) vs (-11.4±6.9) db, P<0.001] papilledema subgroups after ONSF, while there was an improvement in mild papilledema subgroup [(-1.5±5.3) vs (-3.4±5.1) db, P<0.001] after medication. The papilledema (Frisén's scores) in both ONSF group (P<0.001) and medication group (P=0.010) was improved. Compared with baseline, the mean RNFL decreased in mild [(78.5±13.5) vs (91.0±17.4) μm, P=0.002], moderate [(126.6±67.6) vs (154.8±77.9) μm, P=0.011] and severe [(179.0±70.9) vs (230.6±89.7) μm, P=0.001] papilledema subgroups after ONSF, while the mean RNFL decreased [(142.0±29.3) vs (158.8±22.7) μm, P=0.020] in moderate papilledema subgroup after medication. Conclusions: ONSF might attenuate CVT-mediated papilledema, and improve the visual function in patients with moderate and severe papilledema. Likewise, patients with mild papilledema could also get benefit from medication.

Chemometrics integrated with in silico pharmacology to reveal antioxidative and anti-inflammatory markers of dandelion for its quality control

Background

Dandelion is an herb with high nutritional and medicinal values, which has been listed in Chinese Pharmacopeia, European Pharmacopoeia and British Pharmacopoeia, gaining increasing acceptance around the world. However, the current quality control of dandelion is lagging behind. Only in Chinese Pharmacopeia, cichoric acid is used as a marker compound for its quality evaluation, whereas, it can not comprehensively reflect the bioactivity of dandelion.

Methods

This study developed a strategy by integrating chemometrics with in silico pharmacology to reveal the bioactive markers of dandelion for its quality control. Firstly, the major chemicals in dandelion were characterized using HPLC-DAD-MS/MS, and the corresponding antioxidant and anti-inflammatory activities were evaluated in vitro. Subsequently, the active components were screened by relating the chemicals and bioactivity of dandelion via grey relational assay and partial least squares regression analysis. The potential active components were then subjected to a validation for their activities. Moreover, in silico pharmacology was utilized to evaluate the contribution of active components to efficacy.

Results

A total of 22 phenolic compounds were characterized. Among them, cichoric acid, caffeic acid and luteolin were identified as quality markers owing to their good correlations with the bioactivities of dandelion. These three markers were quantified in frequently-used dandelion species, viz. Taraxacum mongolicum Hand.-Mazz. (TAM) and T. officinale F. H. Wigg. (TAO). TAM, with acceptably higher content of cichoric acid and caffeic acid, showed better antioxidant activity than TAO. While TAO included higher content of luteolin, presenting slightly more effective in anti-inflammation.

Conclusion

An useful strategy for the quality marker discovery was successfully designed. And the results provided more knowledge for the quality evaluation of dandelion.

RNA interference of vATPase subunits A and E affects survival of larvae and adults in Plagiodera versicolora (Coleoptera: Chrysomelidae)

Vacuolar-type H⁺-ATPases (vATPases) are ATP-driven proton pumps and play essential roles in many physiological functions. Plagiodera versicolora (Coleoptera: Chrysomelidae) is a leaf-eating forest pest found in salicaceous trees worldwide. RNA interference (RNAi) is a powerful tool for functional identify and pest control. In this study, we used RNAi as an approach to knock down subunits A and E of the vATPase gene. The phylogenetic analysis showed that vATPase-A and vATPase-E from the same order were clustered together to form Coleoptera subclades, respectively. The expression levels of vATPase-A and vATPase-E were higher in gut, Malpighian tubules and 1st instar larvae. Ingest the dsvATPase-A and dsvATPase-E significantly inhibited the development of 1st to 3th instar larvae, incapacitated of mating and oviposition in adults. In addition, knockdown of vATPase subunit genes caused higher mortality in larvae and adults. The results demonstrate that RNAi efficiencies both vATPase-A and vATPase-E genes at various larvae stages and adults. Moreover, this research suggested that silencing of two vATPase subunits A and E offers a potential strategy to control P. versicolora.

Long-term oral administration of Epimedii Folium induced cholestasis in mice by interfering with bile acid transport

ETHNOPHARMACOLOGICAL RELEVANCE

Epimedii Folium (EF) is a common traditional Chinese medicine that functions as a tonifying kidney yang to strengthen bones and muscles and dispel wind dampness (limb pain, lethargy, nausea, anorexia, and loose stools). Several studies have reported the potential risk of cholestatic liver damage from EF use; however, there have been few investigations of EF-induced cholestasis, particularly the underlying mechanisms.

AIMS OF THE STUDY

The purpose of this study was to evaluate the risk of EF-induced cholestasis in vivo and to explore the mechanisms of action.

MATERIALS AND METHODS

ICR mice were orally administered a water extract of EF (WEF) in doses of 6.5 and 19.5 g/kg/day for 14 weeks. Liver-to-body weight ratios, body weight, histopathological examination, and biochemical analyses were performed to assess WEF-induced cholestasis in the mice. Genes associated with bile acid (BA) metabolism and transport, including sodium taurocholate cotransporting polypeptide (NTCP), cytochrome P450 8B1 (CYP8B1), bile-salt export pump (BSEP), multidrug resistance P-glycoproteins 1 (MDR1), and farnesoid X receptor (FXR), were measured at the transcript and protein levels to investigate the potential mechanisms through which cholestasis is aroused by EF.

RESULTS

After administration of WEF for 14 weeks, mice in the high-dose WEF group showed poor health with an increased liver-to-body weight ratio as well as higher serum aminotransferase, alkaline phosphatase, direct bilirubin, and total BA levels. Compared with the control group, mRNA expression of NTCP and cholesterol 7a-hydroxylase (CYP7A1) increased, and levels of BSEP, MDR1, multidrug resistance-associated protein 2, and multidrug resistance-associated protein 3 decreased in the WEF-treated group. NTCP, BSEP, MDR1, and CYP8B1 showed similar mRNA and protein expression trends.

CONCLUSION

We demonstrated that the long-term oral administration of WEF causes cholestatic liver injury in mice, which is consistent with reported clinical cases. Furthermore, we found that the destruction of BA metabolism and transport is involved in WEF-induced cholestasis. The fine-scale molecular mechanisms of WEF-induced cholestasis and the active compounds of EF need further study.

Increased Vδ1γδT cells predominantly contributed to IL-17 production in the development of adult human post-infectious irritable bowel syndrome

Background

γδT cells play an important role in the mucosa inflammation and immunity-associated disorders. Our previous study reported that γδ T cells producing IL-17 were involved in the pathogenesis of post-infectious irritable bowel syndrome (PI-IBS). However, their subset characteristic profile in this kind of disease remains unclear. Thus the current study’s aim is to investigate the functionally predominant subset and its role in PI-IBS.

Methods

The total T cells were collected from the peripheral blood of patients with PI-IBS. The peripheral proportion of Vδ1 and Vδ2 subset was detected by FACS after stained with anti δ1-PE and anti δ2-APC. The local colonic proportion of this two subsets were measured under laser confocal fluorescence microscope. Vδ1 γδ T cells were enriched from the total peripheral T cells by minoantibody-immuno-microbeads (MACS) method and cultured, functionally evaluated by CCK-8 assay (proliferation), CD69/CD62L molecules expression assay (activation) and ELISA (IL-17 production) respectively.

Results

1. Vδ1 γδ T cells significantly increased while Vδ2 γδ T cells remained unchanged in both the peripheral blood and local colonic tissue from PI-IBS patients (p < 0.05). 2. When cultured in vitro, the Vδ1 γδ T cells remarkably proliferated, activated and produced IL-17 (p < 0.05).

Conclusions

Our results suggest that Vδ1 γδ T cells was the predominant γδ T cells subset in both peripheral and intestinal tissue, and was the major IL-17 producing γδ T cells in PI-IBS.

Molecular-networking-guided discovery of species-specific markers for discriminating five medicinal Paris herbs

BACKGROUND

Paridis Rhizoma (PR) is a famous traditional herbal medicine. Apart from two officially recorded species, viz. Paris polyphylla Smith var. yunnanensis (Franch.) Hand. - Mazz. (PPY) and P. polyphylla Smith var. chinensis (Franch.) Hara (PPC), there are still many other species used as folk medicine. It is necessary to understand the metabolic differences among Paris species.

PURPOSE

To establish a strategy that can discover species-specific steroidal saponin markers to distinguish closely-related Paris herbs for quality and safety control.

METHODS

A new strategy of molecular-networking-guided discovery of species-specific markers was proposed. Firstly, the ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-QTOF/MS) was applied to obtain the MS and MS/MS data of all samples. Then, molecular networking (MN) was created using MS/MS data to prescreen the steroidal saponins for subsequent analysis. Next, the principal component analysis (PCA) and orthogonal partial least square discriminant analysis (OPLS-DA) models were established to discover potential markers. Finally, the verification, identification and distribution of chemical markers were performed.

RESULTS

A total of 126 steroidal saponins were screened out from five species using MN. Five species were classified successfully by OPLS-DA model, and 18 species-specific markers were discovered combining the variable importance in the projection (VIP) value, P value (one-way ANOVA) and their relative abundance. These markers could predict the species of Paris herbs correctly.

CONCLUSION

These results revealed that this new strategy could be an efficient way for chemical discrimination of medicinal herbs with close genetic relationship.

[Reliability and validity of Stanford Presenteeism Scale (SPS-6) in Chinese occupational population]

Objective: To investigate the reliability and validity of Stanford attendance scale (sps-6) in the study of attendance among professional groups. Methods: In August, 2018, the 1455 employees from 81 workplaces in Beijing, Shanghai, Jiangsu and Guangdong were randomly investigated as the subjects. The reliability and validity of sps-6 were analyzed by using the internal consistency reliability (Cronbach's coefficient) , half split half coefficient, content validity, integration validity, discrimination validity, cluster analysis and structural validity analysis. Results: Cronbach's coefficients of sps-6 scale, working process and work results were 0.692, 0.918 and 0.907, respectively; Guttman of scales and dimensions The split half coefficients were 0.792, 0.803 and 0.794, respectively; Pearson correlation coefficients of the total score of each item and scale were 0.526-0.673 (P<0.01) ; the qualification rate of set validity and differentiation validity were 100%; the results of cluster analysis supported the theoretical basis for the formation of the scale. The general non-standard fitting index (TLI) =0.982, approximate error mean square root mean square (RMSEA) =0.071, comparative fit index (CFI) =0.990, fit goodness index (GFI) =0.987, modified fit goodness index (AGFI) =0.965, Norm fit index (NFI) =0.990. The results showed that the scale had higher structural validity, and the results of sps-6 in the occupational population were (21.36±4.04) , and the distribution was normal (deviation was 0.053, peak was 0.023) . The scores of sps-6 scale were statistically different in various charactoristics of gender, age, education level, marital status, annual income, position, position level and industry (P< 0.01) . Conclusion: Stanford attendance scale has high reliability and validity, and can be applied to the study of attendance in professional groups.

Diagnostic fragmentation-assisted mass spectral networking coupled with in silico dereplication for deep annotation of steroidal alkaloids in medicinal Fritillariae Bulbus

Fully understanding the chemicals in an herbal medicine remains a challenging task. Molecular networking (MN) allows to organize tandem mass spectrometry (MS/MS) data in complex samples by mass spectral similarity, which yet suffers from low coverage and accuracy of compound annotation due to the size limitation of available databases and differentiation obstacle of similar chemical scaffolds. In this work, an enhanced MN-based strategy named diagnostic fragmentation-assisted molecular networking coupled with in silico dereplication (DFMN-ISD) was introduced to overcome these obstacles: the rule-based fragmentation patterns provide insights into similar chemical scaffolds, the generated in silico candidates based on metabolic reactions expand the available natural product databases, and the in silico annotation method facilitates the further dereplication of candidates by computing their fragmentation trees. As a case, this approach was applied to globally profile the steroidal alkaloids in Fritillariae bulbus, a commonly used antitussive and expectorant herbal medicine. Consequently, a total of 325 steroidal alkaloids were discovered, including 106 cis-D/E-cevanines, 142 trans-D/E-cevanines, 29 jervines, 23 veratramines, and 25 verazines. And 10 of them were confirmed by available reference standards. Approximately 70% of the putative steroidal alkaloids have never been reported in previous publications, demonstrating the benefit of DFMN-ISD approach for the comprehensive characterization of chemicals in a complex plant organism.

A compressible anisotropic hyperelastic model with I5 and I7 strain invariants

It is obvious that the mechanical properties of arterial tissue include compressibility, anisotropy, and the fact that the out-of-plane shear modulus is smaller than the shear modulus in the plane of the fibers. However, the last point is rarely considered when it comes to compressible anisotropic hyperelastic models. In order to acquire different shear moduli, we propose a modified hyperelastic model including the influence of strain invariants I5 and I7. The convergence and correctness of this model are verified through the hydrostatic tension test, uniaxial tension test, and shear deformation test. It turns out that our model correctly predicts an anisotropic response and volume change to hydrostatic tensile test and the fact that the out-of-plane shear modulus is always smaller than the shear modulus in the plane of the fibers in shear deformation test. We conclude that the influence of strain invariants I5 and I7 is great, especially in the shear deformation, so that it is necessary to include I5 and I7 in the compressible anisotropic hyperelastic model.

[COVID-19 pandemic: global epidemiological trends and China's subsequent preparedness and responses]

The outbreak of COVID-19 has spread quickly across 114 countries/territories/areas in six continents worldwide and has been announced as a pandemic by WHO. This study analyzed global COVID-19 epidemiological trends, examined impact of the pandemic on global health security, diplomacy, and social environment in China, and provided short- and long-term strategic policy recommendations for China's subsequent preparedness and responses.

Metabolomic-transcriptomic landscape of 8-epidiosbulbin E acetate -a major diterpenoid lactone from Dioscorea bulbifera tuber induces hepatotoxicity

Studies have shown that 8-epidiosbulbin E acetate (EEA), a major diterpenoid lactone in the tuber of Dioscorea bulbifera, can induce hepatotoxicity in vivo. However, the underlying mechanisms remain unknown. Using the integrated transcriptomic and metabolomics method, in this study we investigated the global effect of EEA exposure on the transcriptomic and metabolomic profiles in mice. The abundance of 7131 genes and 42 metabolites in the liver, as well as 43 metabolites in the serum were altered. It should be noted that EEA mainly damaged hepatic cells through the aberrant regulation of multiple systems primarily including bile acid metabolism, and taurine and hypotaurine metabolism. In addition, an imbalance of bile acid metabolism was found to play a key pat in response to EEA-triggered hepatotoxicity. In summary, these findings contributed to understanding the underlying mechanisms of EEA hepatotoxicity.

Untargeted metabolomics coupled with chemometric analysis reveals species-specific steroidal alkaloids for the authentication of medicinal Fritillariae Bulbus and relevant products

Authentication of original species is embedded in the quality control system of herbal medicines. In this work, ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry-based untargeted metabolomics coupled with chemometric analysis was utilized for the precise authentication of the Fritillaria species for both raw materials and commercial products. First, a stepwise difference-enlarging chemometric analysis strategy was proposed to analyze eight medicinal Fritillaria species. Subsequently, 21 species-specific markers were discovered and the specificity was investigated under different sample preparation methods. Finally, the obtained species-specific markers were successfully utilized to identify the Fritillaria species in commercially relevant products. This work is the first to report robust and specific markers for authentication of Fritillaria products, showing promise for tracking the supply chain of herbal suppliers.

A pair of cyclopeptide epimers from the seeds of Celosia argentea

Two cyclopeptides, celogentin L (1) and its epimer lyciumin A (2) were firstly isolated from Celosia argentea L.. The planar structures of the two compounds were fully determined by spectroscopic data, including 1D-, 2D-NMR, and HR-ESI/MS. The absolute configurations of amino acid components were assigned via chiral-phase HPLC analyses after acid hydrolysis. Furthermore, the configuration of C-N linkage at the glycine Cα was elucidated by extensive analyses of 2D-NMR and comparison of the experimental and calculated electronic circular dichroism (ECD) spectra. Cytotoxicity of the two compounds against human alveolar epithelial A549, hepatocellular carcinoma HepG2, and cervical cancer Hela cell lines was assayed. Although both of them were inactive in these cells, the present findings add new facets for the chemistry of Celosia argentea.

[Clinical characteristics and pregnancy outcomes of pregnant women in different age groups in Beijing]

Objective: To investigate the influence of maternal age on the health status of pregnant women and the pregnant outcomes. Methods: Data obtained from "Beijing perinatal health management registration system" was analyzed, 263 157 pregnant women with age information were included from October 1st, 2015 to September 30th, 2016, in which 43 594 women delivered at the age of 35 or above (advanced age) . According to the age of maternal age, there were 5 groups. (1) Proper age: 219 563 (83.43%, 219 563/263 157) cases of the age of 18-34 years, including 122 735 cases (46.64%, 122 735/263 157) in the ≤29 years old group and 96 828 cases (36.79%, 96 828/263 157) in 30-34 years old group. (2) Advanced age: there were 43 594 cases (16.57%, 43 594/263 157) ≥35 years old, including 37 395 cases (14.21%, 37 395/263 157) in the 35-39 years old group, 5 790 cases (2.20%, 5 790/263 157) in the 40-44 years old group and 409 cases (0.16%, 409/263 157) in the ≥45 years old group. The trend-based chi-square test and logistic regression were used to analyze the effects of different age groups on maternal complications and pregnant outcomes. Results: (1) The total incidence of high risk pregnancy (HRP) : in advanced age women, the incidence of HRP was 67.83% (29 571/43 594) which was 56.73% (124 550/219 563) in proper age women, the difference was statistically significant (χ(2)=1 848.91, P<0.000) . In advanced age women, the incidence of severe HRP was 7.64% (3 329/43 594) which was 6.18% (13 571/219 563) in proper age women, the difference was statistically significant (χ(2)=128.211, P<0.000) . In advanced age women, the incidence of very severe HRP was 1.76% (769/43 594) which was 0.84% (1 838/219 563) in proper age women, the difference was statistically significant (χ(2)=318.58, P<0.000) . (2) Comparison of the incidence of HRP in 5 groups:the total incidence of HRP increased through the following age group ≤29 years, 30-34 years, 35-39 years, 40-44 years, ≥45 years (53.28%, 61.09%, 67.41%、70.09%, 74.57% respectively) , the difference was statistically significant (linear by linear χ(2)=3 165.72, P<0.000) . The incidence of very severe HPR increased (0.66%, 1.06%, 1.66%, 2.35%, 2.93% respectively) , the difference was statistically significant (linear by linear χ(2)=218.31, P<0.000) . The incidence of severe HPR increased (5.77%, 6.70%, 7.48%, 8.34%, 11.49% respectively) , the difference was statistically significant (linear by linear χ(2)=422.20, P<0.000) . The incidence of general HPR increased (46.84%, 53.34%, 58.26%, 59.40%, 60.15% respectively) , the difference was statistically significant (linear by linear χ(2)=1 947.51, P<0.000) . (3) As the maternal age group increased, the incidence of adverse pregnancy outcomes increased (5.54%, 6.85%, 8.77%, 9.90%, 18.09%, linear by linear χ(2)=674.57, P<0.000) . The incidence of perinatal death, premature birth and low birth weight also presented the above trends (perinatal death: linear by linear χ(2)=34.79, P<0.000; premature birth: linear by linear χ(2)=692.87, P<0.000; low birth weight: linear by linear χ(2)=379.20, P<0.000) . (4) Logistic regression analysis with the assisted reproductive technology and multiple pregnancy considered showed the same trend (P<0.000) . Conclusion: The maternal age has an impact on the maternal health status and pregnancy outcomes, and the risk of various types of pregnancy complications and adverse pregnancy outcomes increase with the maternal age group, antenatal care and management should be emphasized in women with advanced maternal age, especially for women ≥40 years old.

Laparoscopic extraperitoneal uterine suspension with suture line instead of mesh

OBJECTIVE

To compare the safety and effectiveness of two different materials (mesh and suture line) used in laparoscopic extraperitoneal uterine suspension.

DESIGN

A retrospective observational study.

SETTING

Gynaecology departments in two hospitals in China.

POPULATION

Women with symptomatic pelvic organ prolapse (POP) of stage II or higher.

METHODS

The women were divided into two groups according to the two different materials for laparoscopic extraperitoneal uterine suspension: mesh or suture line. The baseline characteristics, perioperative details, complications, objective and subjective indexes of the two groups were compared.

MAIN OUTCOME MEASURES

The primary outcome was subjective satisfaction rate based upon validated questionnaires. The secondary outcome was objective anatomic assessment with the POP-Q system.

RESULTS

No difference was found in baseline characteristics and perioperative details except that there were more cases of cardiovascular disease (CVD) and associated other surgeries in the Line than the Mesh group (36 versus 19, P < 0.05; 12 versus 2, P < 0.05). Statistically significant improvements were found in anatomical measures of points Aa, Ba, Ap, Bp, C and TVL (P < 0.01), as well as functional and quality-of-life measures (P < 0.01 for PFDI-20 and PFIQ-7) between both groups. The postoperative PFDI-20, PFIQ-7 and PGI-I scores were not different between two groups (P > 0.05). Two cases of deep wound infection were observed in Mesh group at 3-month follow up.

CONCLUSIONS

Laparoscopic extraperitoneal linear uterine suspension is easy to perform and is associated with fewer mesh-related complications. It is more secure, especially in elderly women and in those with physical complications.

TWEETABLE ABSTRACT

Laparoscopic extraperitoneal linear uterine suspension is safe, with fewer mesh-related complications.

Effects of lipopolysaccharide on the stearoyl-coenzyme A desaturase mRNA level in bovine primary hepatic cells

This study aimed to compare the effects of lipopolysaccharide (LPS) on stearoyl-coenzyme A desaturase (SCD) gene expression in mouse primary hepatic cells. To obtain sufficient total RNA, primary hepatic cells were plated on 6-cm diameter-type collagen 1-coated dishes (1 x 106 cells per dish). The test was divided into 6 groups with 6 replications per group. The 6 groups were treated with the following volumes of LPS (0.1 mg/mL): 0, 1, 1.5, 2, 4, and 8 μL. The cells were cultured for 24 h, and the total RNA was extracted from samples. Reverse transcription polymerase chain reaction was used to analyze SCD mRNA levels. With increasing LPS amounts, the SCD mRNA expression first decreased and then increased slightly; the expression was the lowest in the 2-μL LPS condition. The SCD mRNA levels from the 4- and 8-μL LPS conditions were slightly higher than that from the 2-μL LPS condition, but the difference was not significant (P > 0.05). The SCD mRNA level from the 2-μL LPS condition was obviously lower than that from the 0-, 1-, and 1.5-μL LPS condition, and the differences were significant (P < 0.05), and the SCD mRNA levels from the 0-, 1-, and 1.5-μL LPS conditions were not significantly different (P > 0.05). The SCD mRNA levels from the 4- and 8-μL LPS conditions were obviously lower than those from the 0- and 1-μL LPS conditions, and the differences were significant (P < 0.05).

The diagnostic accuracy of high-mobility group box 1 protein and twelve other markers in discriminating bacterial, viral and co-infected bronchial pneumonia in Han children

Pneumonia in children is common and can lead to grave consequences if not addressed in a proper and timely manner. In the management of pneumonia, early identification of the causative infective agent is of obvious importance for treatment, as it allows selection of the appropriate antibiotics. However, such identification requires laboratory test results, which may not be immediately available. The aim of this study was to evaluate the accuracy and usefulness of 13 markers in differentiating between viral and bacterial pneumonia in Han children (34 healthy controls and 78 patients). It was found that WBC counts were more accurate in diagnosis of the type of agent responsible for infection than was the degree of expression of HMGB1. Among the 13 markers investigated, HMGB1 was the best at discriminating between co-infected (bacterium and virus) and single-infected (bacterium or virus) children with bronchial pneumonia. HMGB1 expression of less than 1.0256, excluded most co-infections (the negative predictive value was greater than 89.7%). Diagnosed sole viral pneumonia clinically overlapped with bacterial pneumonia, but bacterial pneumonia was more often associated with higher white blood cell (WBC) counts (WBC ≥ 13,000 cells/mm(3)). When the two marker readouts--HMGB1 < 1.0256 and WBC ≥ 13,000 cells/mm(3)--were combined, the positive predictive value for bacterial pneumonia alone was 92.3%. These findings can help clinicians discriminate between bronchial pneumonia caused by virus, bacterium or both with a high specificity.

Phytohemagglutinin improves efficiency of electrofusing mammary gland epithelial cells into oocytes in goats

The objective was to investigate the effect of phytohemagglutinin (PHA) on the fusion of mammary gland epithelial (MGE) cells into enucleated oocytes in goats. The toxicity of PHA was evaluated by testing its effect on the development of parthenogenetic caprine oocytes. The effective dose and duration of PHA treatment (100 microg/mL, 20 min incubation) was selected and used to compare fusion efficiency and embryo development following nuclear transfer. Two electrofusion protocols, chamber fusion (CF) and pressurized microelectrode fusion (pMEF), were also compared, when couplets were treated with and without PHA (100 microg/mL, 20 min). Fusion rate of couplets increased from 52.8 to 74.0% for the CF protocol (P<0.05), but was not significantly different for the pMEF protocol (72.7% vs. 78.1%) after PHA treatment. There were no significant differences between treated group and control in rates of subsequent cleavage or blastocyst development. Following transfer of the cloned blastocysts derived from the PHA-treated group and the control group into synchronized recipients, pregnancy rates (Day 30) were not significantly different between treated group and control (28.6% vs. 25.0%). However, all recipients aborted within 120d, microsatellite DNA analyses confirmed that the aborted fetuses were genetically identical to the donor goat. In conclusion, the fusion rate of caprine MGE cell couplets was improved by pre-incubating couplets in medium containing 100 microg/mL PHA prior to electrical pulsing, and embryos derived from PHA treatment established early pregnancies.

A novel method to make regenerable core-shell calcium-based sorbents

A sorbent having a calcium oxide core and a clay shell was prepared and shown to be capable of reusable applications in absorption and desorption processes for carbon dioxide. The novelty of this sorbent is that only calcium carbonate and clay are used for its preparation with water as a binder. A two-step granulation procedure is used to get the core and then another step to coat the shell layer with the clay powder. A repeated wet-and-dry procedure probably makes the core porous yet strong enough to serve as a sorbent. The pellet is then calcined at 1200 degrees C for 2h to reach its final structure. The core-shell pellets have an overall diameter of 4.4mm with average shell thickness of 0.45 mm, crush load of 35 N and attrition index of 0.035 wt%/h. These results indicate that the pellets will probably be capable of withstanding the stress in future applications. Carbon dioxide absorption at or below 300 degrees C showed a maximum weight gain of 38% for our pellets. Finally, desorption in nitrogen at 800 degrees C can restore the pellet to its original state and hence it is ready for re-use as a sorbent.

Investigation of risk factors for development of human hydatidosis among households raising livestock in Tibetan areas of western Sichuan province

OBJECTIVE

To identify factors influencing the development of hydatidosis in Tibetan areas of western Sichuan.

METHODS

A questionnaire investigation was carried out to collect data on factors related to hydatidosis among households raising livestock.

RESULTS

Analyses of data revealed that dogs rather than foxes were the most important source of AE transmission. People below 19 years old tended to suffering from CE rather than AE and people 19-38 years old, especially the females, were under an increasing risk of suffering from AE (female vs. male, OR = 2.438, CI = 1.317-4.514, P < 0.05). Increased risks of both AE and CE prevalence associated with nomadic life, aging, playing with dogs, not protecting food from flies, and raising yaks or sheep.

CONCLUSION

In addition to age, sex, environmental conditions and hygienic behaviors, raising yaks or sheep and playing with dogs also increase the risk of suffering from hydatidosis as well in this area.

Echinococcosis on the Tibetan Plateau: prevalence and risk factors for cystic and alveolar echinococcosis in Tibetan populations in Qinghai Province, China

Infections by larval stages of tapeworms of the genus Echinococcus (echinococcosis or hydatid disease) are zoonotic infections of major public health importance throughout much of the world. Humans become infected through accidental ingestion of eggs passed in faeces of canid definitive hosts. Tibetan populations of China have some of the highest documented levels of infections by both Echinococcus granulosus and E. multilocularis, the causes of cystic and alveolar echinococcosis, respectively. In this study we measured the prevalence of cystic (CE) and alveolar (AE) echinococcosis disease in Tibetan communities in Qinghai, Province, China, and identified putative risk factors for both infections in these communities. 3703 volunteers in three predominately Tibetan counties of Qinghai were surveyed between June 1997 and June 1998. Parasitic lesions were diagnosed by imaging of characteristic space-occupying lesions in abdominal organs (ultrasound) or the lungs (radiographs). Specific serodiagnostic assays (Dot-ELISA and Em2-ELISA) were performed on sera of positively imaged subjects to further distinguish the disease agent. All participants completed a questionnaire documenting age, sex, education level, occupation, lifestyle (nomadic or settled), slaughter practices, drinking water source, hygienic practice and association with dogs. Data were analyzed using SAS version 8. 6.6% of the volunteers had image-confirmed infection with E. granulosus (CE) and 0.8% had E. multilocularis (AE) infection. The significant univariate factors for echinococcal infection (both CE and AE) included livestock ownership, Tibetan ethnicity, female gender, low income, herding occupation, limited education, water source, age greater than 25 years old, poor hygienic practices, offal disposal practices and dog care. Multivariate analysis revealed that livestock ownership was a significant risk factor for both forms of the disease, as well as age greater than 25 years, female gender, herding occupation, and being nomadic (vs semi-nomadic or settled). No additional significant risk factors were identified among the 344 nomadic participants. Being female and being older than 25 years of age were significant factors among the 1906 semi-nomadic participants. Among the 1445 settled participants, allowing dogs to sleep indoors was statistically significant. Issues such as inadequate assessment of animal ownership, selection bias, disease misclassification, and loss of information may have led to reduction in strength of some risk factor associations and need to be addressed in future epidemiologic analysis of echinococcosis in this population.

[The development of a simulated experimental system on humoral integrated parameter tests controlled by a microcomputer]

A simulated experimental system on humoral integrated parameter tests controlled by a microcomputer is developed for overcoming hard training in maintenance technical skill. This paper describes its structure, characteristics, functions and the prospects of its applications.

Lactate dehydrogenase isoenzyme 1 is the most important LD isoenzyme in patients with testicular germ cell tumor

We examined the clinical utility of serum lactate dehydrogenase (LD) isoenzyme catalytic concentrations in 58 patients with testicular germ cell tumors (TGCT) (13 with seminoma and 45 with non-seminomatous tumors). Twenty-one patients with no evidence of disease (NED) all had serum LD isoenzyme 1 catalytic concentrations (LD-1) and LD-1/LD fractions below the upper limit of the reference values (ULR). LD-1 and the LD-1/LD fraction discriminated significantly between evidence of disease (ED) and NED (p = 0.00009 and p = 0.028, respectively, Mann Whitney U-test). Twenty of the 37 patients with ED had raised values of LD-1. The 17 patients with an LD-1 < 1.0 x ULR had a better survival than the 10 patients with LD-1 between 1.0 and 2.9 x ULR, the 7 with LD-1 between 3.0 and 5.9 x ULR, and the 3 patients with LD-1 > 6.0 x ULR (p = 0.006, log-rank test, chi2 test for trend)). Twenty-three patients with an LD-1/LD fraction < or = 0.25 had a better survival than the 14 with an LD-1/LD fraction > 0.25 (p = 0.013). Nineteen patients with LD-5 < 105 U/L and the 15 with LD-5 > 105 U/L had a similar rate of survival (p = 0.85). Our findings add to the evidence showing LD-1 in preference to LD as a serum tumor marker of TGCT.

Acute injury to differentiating Clara cells in neonatal rabbits results in age-related failure of bronchiolar epithelial repair

Nonciliated bronchiolar (Clara) cells are progenitor cells during lung development. During differentiation, they have a heightened injury susceptibility to environmental toxicants bioactivated by cytochrome P450 monooxygenase. When neonatal rabbits are treated with the P450-mediated cytotoxicant 4-ipomeanol (IPO), abnormal bronchiolar epithelium results. This study establishes the impact of IPO cytotoxicity on 3 stages of rabbit Clara cell differentiation, early (2.5 and 5 days postnatal [DPN]), intermediate (7 and 9 DPN), and late (15 and 21 DPN), and relates the cytotoxicity to the extent of bronchiolar repair. Neonates received a single dose of IPO (5 mg/kg) and were assessed by qualitative pathology 48 hours later for injury or at 4 weeks for repair. IPO injured the 3 stages of Clara cell differentiation to the same degree; epithelium was swollen, exfoliated, and squamated. Epithelial repair differed among the 3 stages. Bronchioles of animals treated during early and intermediate stages had simple squamous and irregularly shaped cuboidal cells. Animals treated during late stages were similar to controls. Thus, differentiating Clara cells are susceptible to injury by the P450-mediated cytotoxicant IPO, but the extent of repair varies based on when the initial injury occurs.

Pycnogenol enhances immune and haemopoietic functions in senescence-accelerated mice

Pycnogenol (procyanidin extracted from Pinus maritima) has been shown to be a potent free radical scavenger and an antioxidant phytochemical. The effects of pycnogenol on immune and haemopoietic dysfunction in senescence-accelerated mice (SAM), as a murine model of accelerated ageing, were determined. SAMP8, a strain of senile-prone mice, exhibit learning and memory deficits, immunodeficiency and dysfunction of the haemopoietic system. Oral feeding with pycnogenol for 2 months significantly improved their T- and B-cell function. Pycnogenol also augmented the proliferative capacity of haemopoietic progenitors of bone marrow in SAMP8. These data suggest that pycnogenol may be useful for either retardation or restoration of parameters associated with ageing.

ERPs of characters of Chinese words compared with tone and picture stimuli in adolescents and aged persons

ERPs to target stimulation with tone, picture and characters of Chinese words ([symbol: see text] CCW were target stimulus) were studied in adolescents group and aged persons group. The age of the adolescent group ranged from 15-17 years, with 30 males and 30 females; the age of the elderly persons group ranged from 60-79 years with 29 males and 18 females. The latencies of N2 of aged persons in tone stimulus and in picture stimulus among males were longer than those of adolescents. The latencies of P3 and RT of aged persons were longer than those of adolescents in three stimulus models. The gender differences of latencies of N2 and RT were not obvious in two groups, but were apparent in P3 in adolescents. The latencies of N2, P3 and RT of CCW stimulus were longer compared to those of picture stimulus in the adolescent group, but not in the aged persons group.

[The study and manufacture of spinning counter for experimental animals]

The single-chip microcomputer technique is used in the present study of spinning counter, which has 4 observation tunnels, the spinning behave of four experiment animals can be recorded at same time. The function of this instrument has four selections according to different experiment, and the recording data can be compute processed.

Underestimation of monoclonal proteins by agarose serum protein electrophoresis

The effect of serum dilution on monoclonal protein quantitation by serum protein electrophoresis (SPE) on the agarose gel Paragon system was investigated in 388 serum samples from 106 patients with Ig G monoclonal gammopathy. It was found that the pre-electrophoretic 1:5 serum dilution recommended by the manufacturer was adequate for some but not all sera, especially those with the highest M-protein concentrations. As a result of the inadequate dilution, 232 (60 percent) of the 388 samples had M-protein concentrations that were significantly underestimated and the corresponding albumin concentrations overestimated. By Paragon SPE, the mean albumin concentration in these 232 sera was 41.8 (SD 6.7) g/L. After further dilution of these sera, the mean albumin concentration was 36.7 (SD 6.8) g/L and was, in each case, always less than that in the corresponding 1:5 diluted serum. By the bromcresol green (BCG) dye-binding method, the albumin concentration was 34.9 (SD 4.3) g/L. Similarly, the M-protein concentration for 1:5 diluted sera was 51.9 (SD 12.9) g/L vs. 59.1 (SD 16.1) g/L for the further diluted sera, with the M-protein concentration in each further diluted sample always exceeding that in the corresponding 1:5 diluted serum. Underestimation of the M-protein concentration limits its clinical utilization in evaluating the patient's response to therapy and for early detection of disease progression. A recommendation was made of a 1:10 dilution of sera that contain total protein from 91 g/L to 114 g/L and a 1:20 dilution of sera in which the protein content is in the range of 115 g/L to 152 g/L to insure accurate estimation of protein fractions by Paragon SPE.

Molecular study of hairy cell leukemia variant with biclonal paraproteinemia

We report an unusual case of hairy cell leukemia variant with IgA and IgG-lambda biclonal gammopathy exhibiting light chain and a surface immunoglobulin class different from that of the paraproteins. In addition, we documented by gene rearrangement study that the hairy cell leukemia variant clone appears independent from the paraprotein-producing cells. The kappa light chain was expressed on the surface of hairy cell leukemia variant cells. Southern blot analysis revealed rearrangement of the kappa-light-chain gene and germline configuration of lambda-light-chain gene. We observed significant clinical improvement and reduction in the leukemic infiltrate in the patient after treatment with 2-chlorodeoxyadenosine (2-CdA). The intensity of the rearranged kappa-light-chain gene band decreased with therapy and increased at relapse without significant change of the paraproteins. Previously reported cases of hairy cell leukemia variant with paraproteins are reviewed, and our patient's contribution to the understanding of this association is stressed.

Serum calcitonin in small cell carcinoma of the prostate

Small cell carcinoma (SCC) of the prostate is a rare and recently recognized subtype of prostate cancer. The neuroendocrine component of the prostate carcinoma is becoming more frequently detected in classic adenocarcinoma of the prostate. Clinically, these tumors represent a considerable portion of so called androgen independent prostatic carcinomas. It has been hypothesized that the neuroendocrine cells being admixed with adenocarcinoma is selected and emerges as a hormone refractory carcinoma after the androgen blockade. The SCC shows a spectrum from a mixed adenocarcinoma with SCC component to the extreme case of pure SCC. Characteristically, prostatic SCC shows low measurable serum level of traditional prostate tumor marker, prostatic specific antigen (PSA). Instead, SCC secretes several neural peptides and calcitonin (CT) is one of them. The usefulness of serum CT as a neuroendocrine marker was evaluated retrospectively in 16 patients with SCC of the prostate (5 pure SCCs and II combined adenocarcinoma and SCCs). The serum CT was measured by radioimmunoassay. In all the patients, serum CT level was measured after SCC was diagnosed histologically. All 16 patients presented with advanced tumor with extensive metastasis. Nine (56 percent) out of 16 cases showed elevated serum CT (range 42 approximately 2,654 pg/ml) and chemically supported the diagnosis of SCC. Owing to the retrospective nature of the study, the serum CT was measured only once in most of the cases, and the value of monitoring the disease progress or the responsiveness to the chemotherapy could not be evaluated. Survival analysis by logrank test did not show statistically significant prognostic value of serum CT in SCCs of the prostate. However, patients with extremely high serum CT level tend to have poor survival. Future studies are needed for further evaluation of serum CT as a disease monitor and prognostic marker in SCC of the prostate. Serum CT may have a role as a tumor marker in the early diagnosis of SCC of the prostate, which often is not diagnosed until the advanced stage.

Laparoscopic exploration of intra- and extrahepatic bile ducts and T-tube drainage

Laparoscopic cholecystectomy (LC) has rapidly become the procedure of choice for the management of patients with gall-bladder stones. This contrasts with patients who have common bile duct and intrahepatic duct stones who still usually need an open operation. On the basis of experience of a number of LC by one surgeon and animal experiments, we have completed laparoscopic exploration of both intra- and extrahepatic ducts and T-tube drainage of 57 patients with intra- and extrahepatic bile duct calculi over 13 months during 1992-1993 with satisfactory results. The average operating time was 150 min, with a range of 100 to 220 min. Most patients were mobile and on oral fluids within 24 h postoperative. Average hospital stay was 4 days. Retained stones were found via T-tube cholangiography in four patients (7%) and for each patient these were removed by fibre-optic choledochoscope 2 weeks postoperatively. Laparoscopic exploration of intra- and extrahepatic bile ducts is achievable by experienced surgeons and may be particularly helpful for patients who are not a good operative risk.

Serum and acute phase protein modulation of the effector phase of lymphokine-activated killer cells

An understanding of the role that immunomodulatory factors play in the effector phase of lymphokine-activated killer (LAK) activity is essential for the development of biologic response modifiers for use in the treatment of advanced carcinoma. Fifteen head and neck cancer patients were studied. Single-donor killer cells activated by recombinant interleukin-2 (10 U/mL) and induced in either a complete medium or complete medium plus a 10% autologous serum solution were used. Effector phase solutions of 25% autologous serum were used in chromium 51 release assays to determine sera immunomodulation of LAK cell cytotoxicity. Both K562 and squamous carcinoma (MDA686-Ln) tumor cell lines were tested. Significant effector phase inhibition (EPI) of cytotoxicity occurred in 40% of studied patients. Seventy percent of patients with stage III or IV or recurrent disease exhibited EPI, whereas only 20% of patients with stage I or II disease and 30% of controls did so. EPI of cancer patient serum correlated directly with alpha 1-antitrypsin, alpha 1-acid glycoprotein, and C-reactive protein (CRP) levels (MDA686-Ln targets) (r = 0.6, 0.7, and 0.6, respectively) (P < .02). Neither EPI against K562 targets nor EPI in control patients correlated with acute phase protein levels. These findings suggest that advances in in vivo immunomodulatory therapy will be dependent upon further elucidation of serologic inhibition of the effector phase of the LAK cell phenomenon. The relationship between LAK cell recognition and EPI requires further investigation.

Serologic determinants of survival in patients with head and neck cancer: validating a clinical prediction model

Quantitative measurements of serum C1q-binding macromolecules (C1qBM) and immunoglobulin A (IgA) were done on 162 patients using previously described methodology. The measurements were compared to a previously described head and neck cancer population. Using the Cox Proportional Hazards model, the prognostic implications regarding high C1qBM and subsequent death with disease (P = .02), and regional recurrence (P = .0094) were validated, but not our previous IgA-related prognostic implications. When both study populations were combined, C1qBM was predictive of survival in those patients treated with induction chemotherapy (P = .0001). C1qBM was not a significant predictor of survival in patients treated with surgery plus postoperative radiation therapy in either this second "test" population or in the original "training" population. The findings demonstrate the confounding influence of treatment modalities and the importance of model validation.

Epidemiology of measles immunity in a population of healthcare workers

OBJECTIVE

To evaluate epidemiologic factors that can be used to predict lack of measles immunity in healthcare workers.

DESIGN

During mandatory screening of employees for measles antibody, a questionnaire was used to collect demographic information.

SETTING

Inpatient hospital, acute care clinics, and skilled nursing facility of a health maintenance organization.

PARTICIPANTS

Employees of all ages and occupations.

RESULTS

Measles immunity could not be predicted from history of measles disease and vaccination, gender, or birthplace. Of nonimmune employees, 63.7% were in the 20- to 29-year-old age group and 26.5% were in the 30- to 39-year-old age group.

CONCLUSIONS

Age is the most clinically significant predictor of measles antibody, especially in persons born after 1950, who make up a large group susceptible to measles.

Acute-Phase Proteins in Patients With Head and Neck Cancer Treated With Interleukin 2/Interferon Alfa

Circulating acute-phase proteins may mediate adverse reactions in patients receiving biologic response modifiers, including inhibition of immune responsiveness and clinical toxic effects. Nine patients with unresectable head and neck squamous cell carcinoma were prospectively examined for levels of acute-phase proteins during interleukin 2/interferon alfa immunotherapy and for clinical toxic effects. Simultaneous determination of the in vitro immunomodulatory capacity of autologous serum on the induction of lymphokine-activated killer cells was assessed in 4-hour chromium release assays. Of the seven acute-phase proteins analyzed, haptoglobin and C-reactive protein levels were elevated before therapy was started. Toxic events leading to cessation of interleukin 2/interferon alfa therapy had a high correlation with elevated C-reactive protein and lowered C3 component of complement levels. No relationship was noted between serum levels of acute-phase proteins and induction inhibition of lymphokine-activated killer cell cytotoxicity. The role of C-reactive protein and complement degradation products in mediating interleukin 2/interferon alfa toxicity requires further investigation.

Serum lactate dehydrogenase-3 isoenzyme in chronic granulocytic leukemia

Abnormal levels of serum lactate dehydrogenase-3 (LD-3) activity were observed in 92% of patients (35 of 38) with active chronic granulocytic leukemia (CGL), in 40% of patients (4 of 10) in partial remission, and in 13% of patients (1 of 8) in complete remission. In evaluating the electrophoretic LD isoenzyme patterns of these patients, three criteria were used. In criterion-1 elevations, the LD-3/total LD ratio, expressed as a fraction of serum total LD, and LD-3 value, expressed in absolute units, were greater than the upper limit of the reference range. In criterion-2 elevations, only the LD-3/total LD ratio was greater than the upper limit of the reference range. In criterion-3 elevations, only the absolute LD-3 activity exceeded the upper limit of the reference range, and these specimens showed isomorphic elevation of all five LD isoenzymes. Use of the last of these criteria increased the clinical sensitivity of serum LD-3 elevations in active CGL from 82% to 92%. The mean serum LD-3 absolute value and serum total LD activity usually showed statistically significant differences (P less than 0.05) among patients with active CGL, those in partial remission, and those in complete remission, but did not distinguish between subgroups of individuals with active CGL. Elevation of the serum LD-5/total LD ratio in 16 of 58 patients was due to hepatic injury or methodologic imprecision, showing analytically insignificant, borderline abnormalities in all cases of active CGL. In 10 of 62 patients in complete remission or partial remission, however, such elevation was unexplained. Our results indicate that the evaluation of serum LD-3 values in both absolute and relative terms slightly increases the clinical sensitivity of LD-3, and, therefore, suggest that LD-3 might be a useful marker for CGL.

Immunomodulation of the induction phase of lymphokine-activated killer activity by acute phase proteins

Effective treatment of head and neck cancer with biologic response modifiers may be benefitted by an understanding of in vivo factors capable of modulating the lymphokine-activated killer (LAK) cell phenomenon. Eighteen patients with squamous cell carcinoma of the head and neck were studied. Killer cells from each patient, activated by recombinant interleukin-2 (10 U/ml), were induced in either complete medium alone or complete medium plus 10% autologous serum solution and analyzed. Cytotoxicity against both K562 and squamous cell carcinoma (MDA686-Ln) cell lines was determined by use of standard chromium-release assays. The immunomodulatory capacity of serum was correlated with levels of various acute phase proteins. Autologous serum significantly inhibited the induction phase of the LAK phenomenon in 61% of patients and stimulated it in 22%. No patients with early stage I or II disease had significant inhibition of induction. No direct correlation between inhibition and serum acute phase protein levels were seen. An inverse relationship was seen between the C3 component of complement and induction inhibition (r = -0.6). These findings suggest that advances of in vivo immunomodulatory therapy will require elucidation of mechanisms of serologic inhibition of the induction phase of the LAK phenomenon. Such studies may lead to serologic modification to enhance treatment efficacy of biologic response modifiers.

Serum biomarkers in metastatic renal cell carcinoma

To identify possible clinically valuable markers of metastatic renal cell carcinoma, we measured the serum concentrations of several commercially available biomarkers in 117 patients with this disease. The alpha-fetoprotein level was measured in 75 patients and was elevated in 8 (11%); elevation did not correlate with the presence of liver metastasis. Beta subunit of human chorionic gonadotropin levels increased in 8 of 83 patients tested (10%). C-terminal parathyroid hormone levels were measured in 79 patients and were elevated in 15 (19%); their serum creatinine level was normal. Thirteen of this group had normal serum calcium levels, whereas 7 patients with hypercalcemia and no clinically evident bone metastasis had normal parathyroid hormone levels. In only 2 of 72 patients, serum lactate dehydrogenase and its isoenzyme 1 were elevated. Only 1 of 85 patients had mildly elevated serum carcinoembryonic antigen, in contrast to 3 of 7 patients with metastatic transitional cell carcinoma of the renal pelvis who had moderately elevated carcinoembryonic antigen. Elevations in alpha-fetoprotein, human chorionic gonadotropin, and parathyroid hormone correlated with the course of the disease in 13 patients for whom follow-up measurements were available; measurement of these markers, however, is only useful in a small proportion of patients with metastatic renal cell carcinoma.

The in vivo biologic effect of interleukin 2 and interferon alfa on natural immunity in patients with head and neck cancer

Given the association of deficient natural immunity with the risk of metastatic disease, the ability to activate natural killer cell function may have a therapeutic significance. The effect of continuous infusion of interleukin 2 plus intramuscular interferon alfa on natural immune status was, therefore, analyzed in eight patients with head and neck cancer. Also evaluated was the effect of interleukin 2-interferon alfa therapy on lymphokine-activated killer cell activity as well as total lymphocyte count, percent of lymphocyte subsets, and levels of both circulating immune complexes and antibody classes. Both the percent and absolute number of natural killer cells (ie, CD56+ CD3- lymphocytes) within peripheral blood as well as natural killer cell activity against K562 targets increased significantly with treatment. The remaining immune parameters were not significantly altered. The demonstrated capacity to modulate natural immune function supports the potential use of interleukin 2-containing regimens as a preventive measure against metastatic disease in patients with head and neck cancer.

Serologic determinants of survival in patients with squamous cell carcinoma of the head and neck

Specific circulating serum proteins may reflect unique properties governing the growth and progression of head and neck cancers. One hundred three previously untreated patients with squamous cell carcinoma of the head and neck were prospectively evaluated for serum IgA, IgG, and IgM and C1q-binding macromolecules. Immunoglobulins were assessed by the immunoturbidimetric technique. C1q-binding macromolecules (C1qBM) were measured utilizing the iodine-125 assay of Zubler et al (J Immunol 1976; 116: 232-5). Neither the level of serum immunoglobulins nor C1qBM values were correlated with the primary site, AJC (American Joint Committee on Cancer) stage of disease, or size of primary lesion. Likewise, comparison of serum IgA with C1qBM values demonstrated that these laboratory parameters were independent variables (r = 0.15 by Pearson linear regression). Univariate statistical analysis, utilizing the Cox proportional hazard model, showed serum IgA and C1qBM values to each contribute significantly to the ability to predict survival in patients with advanced squamous cell carcinoma of the head and neck (p = 0.01 and 0.003, respectively). Furthermore, multivariate analysis reveals that both C1qBM and serum IgA levels contribute significantly to the hazards model beyond staging in predicting survival (p less than 0.001). Predictive results were most apparent in patients with stage IV disease and related to the probability of both regional and distant metastatic recurrences. Conversely, serologic analysis provided no information in patients who were staged early. These results support pretreatment multiparametric serologic analysis of patients with squamous cell carcinoma of the head and neck.

Significance of C1q-binding macromolecules within the head and neck cancer patient

Elevated levels of macromolecules, within the peripheral blood of head and neck cancer patients, capable of binding the first component of complement (C1qBM) in vitro have prognostic implication. Namely, elevated levels of C1qBM have been associated with nonresponse to induction chemotherapy. In this investigation, a series of in vitro studies regarding the biological properties of C1qBM were combined with a longitudinal analysis of 112 previously untreated head and neck cancer patients. Our purpose was to shed light on the biological significance of this circulating macromolecule, a substance composed, in part, of IgG and IgM. A potential confounding influence of C1qBM with induction chemotherapy, which could contribute to observed prognostic findings, was negated by two in vitro observations: the macromolecule failed both to bind the chemotherapeutic agents cisplatin, bleomycin, and 5-fluorouracil and to impede the cytotoxic effect of these same drugs on a cultured human head and neck cancer cell line. The clinical relevance of C1qBM was reinforced by the observation that elevated levels predicted a high probability of death with disease (P = 0.005 by Cox's proportional hazards model). The prognostic implication was independent of the use of induction chemotherapy, i.e., patients with high C1qBM levels treated with multimodality therapy not composed of anticancer drugs did equally poorly. Thus, the prognostic significance of C1qBM in patients undergoing induction chemotherapy appears independent of drug effect and appears reflective of tumors that are more rapidly progressive and potentially less responsive to therapeutic intervention, including combinations of surgery, radiation, and/or chemotherapy.