Risk factors for hypoactive delirium in patients with nontraumatic ARDS: a prospective observational study

To investigate the incidence, characteristics and risk factors for hypoactive delirium in patients with nontraumatic acute respiratory distress syndrome (ARDS) and to explore the independent risk factors associated with hypoactive delirium and provide new ideas for early prediction and treatment. Hypoactive delirium is a known serious complication in ARDS patients, and currently, there are no effective early detection models or clinical prediction tools, and there is a lack of clinical treatment. This study included nontraumatic ARDS patients who stayed in the intensive care unit (ICU) for more than 24 h and were older than 18 years. A total of 205 ARDS patients admitted to the ICU of Gansu Provincial People's Hospital between December 2021 and February 2023 were selected. Demographic data, clinical characteristics and laboratory test results were collected within 24 h after the patients entered the ICU. Multivariate logistic regression analysis was used to investigate risk factors, evaluate the clinical prediction effect of the model and construct a nomogram for visual display. The incidence of hypoactive delirium among the patients included in the study was 41%. Patients with hypoactive delirium had hypertension; diabetes mellitus; Acute Physiology and Chronic Health Evaluation II (APACHE II) scores ≥ 15; and increased procalcitonin, C-reactive protein (CRP), lactic dehydrogenase and interleukin-6 (IL-6) levels compared with those without hypoactive delirium. Logistic regression analysis revealed that diabetes mellitus (OR 3.305, 95% CI: 1.866-12.616; p = 0.047), CRP level (OR 1.002, 95% CI: 1.001-1.023; p = 0.044), and IL-6 level (OR 1.045, 95% CI: 1.017-1.063; p = 0.001) were independent risk factors for hypoactive delirium. After receiver operating characteristic (ROC) curve analysis, calibration plot and decision curve analysis (DCA) confirmed that the clinical prediction ability of this study model was satisfactory, and a nomogram was drawn for visual display. Hypoactive delirium is a common serious complication in nontraumatic ARDS patients. Our logistic regression model not only effectively predicts hypoactive delirium early but also reveals potential clinical therapeutic targets.

[Analysis of the therapeutic efficacy and factors influencing sequential combination of nucleos(t)ide analogues with pegylated interferon alpha for 48~96 weeks in the treatment of patients with chronic hepatitis B]

Objective: To explore the therapeutic efficacy and factors influencing the sequential combination of nucleos(t)ide analogues (NAs) with pegylated interferon alpha (Peg-IFN-α) in the treatment of patients with chronic hepatitis B (CHB). Methods: 144 CHB cases with NAs treatment for more than 1 year, HBV DNA < 20 IU/ml, hepatitis B surface antigen (HBsAg) quantification < 3 000 IU/ml, treated with a sequential combination of Peg-IFN-α treatment for 48 to 96 weeks, and followed up were selected from the Fifth Medical Center of the PLA General Hospital between May 2018 and May 2020. Intention-to-treat analysis was used to measure the HBsAg clearance rate at 96 weeks. The Kaplan-Meier method was used to compute the cumulative HBsAg clearance rate at 96 weeks. Univariate and multivariate logistic regression were used to analyze the factors influencing HBsAg clearance at 48 weeks of sequential combination therapy. Univariate and multifactorial COX proportional hazard models were used to analyze the factors influencing HBsAg clearance following 96 weeks of prolonged PEG-IFN-α treatment. The receiver operating characteristic curve was used to assess the predictive value of factors influencing HBsAg clearance. A Mann-Whitney U test was used to compare the measurement data between groups. The count data was compared using the χ(2) test between groups. Results: 41 (28.47%) cases achieved HBsAg clearance at 48 weeks of sequential combination therapy. The HBsAg clearance rate at 96 weeks was 40.28% (58/144) by intention-to-treat analysis. The Kaplan-Meier method computed that the cumulative HBsAg clearance rate at 96 weeks was 68.90%. Multivariate logistic regression analysis showed that HBsAg quantification at baseline (OR = 0.090, 95%CI: 0.034-0.240, P < 0.001) and a 24-week drop in HBsAg level (OR = 7.788, 95%CI: 3.408-17.798, P < 0.001) were independent predictors of HBsAg clearance in CHB patients treated sequentially in combination with NAs and Peg-IFN-α for 48 weeks. Receiver operating characteristic curve analysis showed that the baseline HBsAg quantification [area under the receiver operating characteristic curve (AUC), 0.911, 95% CI: 0.852-0.952)] and 24-week drop in HBsAg level (AUC = 0.881, 95%CI: 0.814-0.930) had equally good predictive value for 48-week HBsAg clearance, but there was no statistically significant difference between the two (Z = 0.638, P = 0.523). The value of the combination of baseline HBsAg quantification and 24-week drop in HBsAg level (AUC = 0.981, 95%CI: 0.941-0.997) was superior to that of single baseline HBsAg quantification (Z = 3.017, P = 0.003) and 24-week drop in HBsAg level (Z = 3.214, P = 0.001) in predicting HBsAg clearance rate at 48 weeks. Multivariate COX proportional hazards model analysis showed that HBsAg quantification at 48 weeks (HR = 0.364, 95%CI: 0.176-0.752, P = 0.006) was an independent predictor of HBsAg clearance with a prolonged course to 96 weeks of Peg-IFN-α treatment. Conclusion: The HBsAg clearance rate can be accurately predicted with baseline HBsAg quantification combined with a 24-week drop in HBsAg level in patients with CHB who are treated with a sequential combination of NAs and Peg-IFN-α therapy for 48 weeks. Prolonging the course of Peg-IFN-α treatment can enhance the HBsAg clearance rate's capability. An independent predictor of HBsAg clearance is HBsAg quantification at 48 weeks of sequential combination therapy with a prolonged course of 96 weeks of Peg-IFN-α treatment.

AB1311-HPR RHEUMATIC AND MUSCULOSKELETAL DISEASES MANAGEMENT TOOL HELPS TO IMPROVE TREAT-TO-TARGET THERAPY AND PATIENTS’ ADHERENCE TO TREATMENT

Background:

Many of the rheumatic and musculoskeletal diseases (RMD) are long term, painful, and function affecting, which takes both the doctors and patients a lot of time and effort. The number of Rheumatologists are not sufficient for the huge population of RMD patients in China. The doctor patient ratio is as low as 1:1000. Relatively inadequate medical resources, traffic inconvenience in rural area, and patients’ insufficient understandings of the RMD may cause delayed medical intervention and poor prognosis. Effective RMD patient management tools which provide disease monitoring and enough doctor-patient communication is essential to improve the patients’ adherence to treatment. We designed an RMD management app according to the social, cultural and economic situation of Chinese patients, which helps to facilitate shared decision making and relieve the pressure of insufficient medical resources.

Objectives:

We aim to investigate the effect of RMD patient management app on treat-to-target therapy and patients’ adherence and satisfaction to treatment.

Methods:

An observational survey was administrated using a RMD patient management app. The app was designed and improved by Rheumatologist, orthopedics, nurses, patients, and app technical experts. Patients were offered with a questionnaire in regard to satisfaction with the app and their attitudes about the disease. General therapeutic principles, rehabilitation exercise videos and follow-up information were distributed through the app. Warning signals were sent whenever there was a flag sign of exacerbation. The demographic and clinical data, social and economic status, and drug retention rates of the patients were documented. The survey was designed by clinical experts from relevant departments and developed by both doctors and patients.

Results:

All patients were supervised by the rheumatologist and orthopedist when using the app. In all the patients included, there were cases of rheumatoid arthritis (35.3%), osteoarthritis (32.4%), ankylosing spondylitis (26.5%), and other chronic arthritis (5.8%). The mean age 38.5±15.8 years old, with 52.9% male and 47.1% female. Most of the patients (85.3%) believed that the app was helpful. Young patients were more likely to respond to the survey than older patients. Some patients (79.4%) had increased compliance because the app offered more chances to communicate with the doctors, which increase their understanding and confidence about the disease. Three patients received flag signs of exacerbation much earlier than they could get to the hospital. From the feedback of the patients, we realized that the patient would like to have more information to keep them from stepping on the trap of false advertisement for therapy (which is very commonly seen in China).

Conclusion:

RMD patient need to manage disease activity, daily function and mental state. Insufficient medical resources and patients’ knowledge about the disease may lead to poor adherence and prognosis. RMD patient management tool on app was a feasible and cost-effective approach for data collection and patient education. The app increased treat-to-target therapy and patients’ adherence to treatment.

References:

None.

Disclosure of Interests:

None declared

[Efficacy and peripheral immunity analysis of allogeneic natural killer cells therapy in patients with hepatocellular carcinoma]

OBJECTIVE

To evaluate the safety and efficacy of allogeneic natural killer (NK) cells in the treatment of primary hepatocellular carcinoma (HCC), and to elucidate the mechanism of NK cells therapy.

METHODS

Twenty-one patients with primary HCC treated with allogeneic NK cells at the Fifth Medical Center of the PLA General Hospital were followed up for 1 year. Peripheral blood mononuclear cells (PBMCs) were isolated from patient-related donors and cultured in vitro for 15 days and infused to the patients in two consecutive days. Clinical data and laboratory data were collected and analyzed, including survival, clinical features, imaging changes, hematology, immunology, and biochemical indicators to evaluate the safety and efficacy of allogeneic NK cell therapy. The changes of peripheral blood lymphocyte subsets after treatment were also analyzed to explore the possible anti-tumor mechanisms.

RESULTS

(1) Of the 21 patients with primary HCC, 11 patients were treated once, 5 patients were treated twice, and 5 patients were treated 3 times. After allogeneic NK cells infusion, 10 patients had fever, 1 patient had slight hepatalgia and 1 patient had slight headache, no other adverse events occurred including acute and chronic graft-versus-host disease (GVHD). They resolved spontaneously within 8 hours without other treatment. (2) The total disease control rate was 76.2% during one-year follow-up. Among them, the patients with Barcelona clinic liver cancer (BCLC) stage A had a disease control rate of 100%, stable disease (SD) in 10 cases; BCLC stage B patients had a disease control rate of 60%, partial response (PR) in 1 case, and SD 2 in cases; BCLC stage C patients had a disease control rate of 50%, complete response (CR) in 1 case, and 2 cases of PR. (3) The frequencies of NK cells and CD8+ T cells in peripheral blood were significantly lower than that before at 24 hours after treatment, and the frequencies of CD4+ T cells and CD4/CD8 were significantly higher than the baseline.

CONCLUSION

Allogeneic NK cells have good safety and efficacy in the treatment of primary HCC. The anti-tumor effect of the allogeneic NK cells may play an important role in the activation of the patient's natural immune system and delay disease progression, suggesting that allogeneic NK cells combined with sorafenib may be a very effective treatment for advanced HCC, and further large-sample multicenter randomized controlled clinical trials are needed to validate this result.

[Neuropathologic study of massive subcortical heterotopia]

Objective: To investigate the clinicpathologic features and probable mechanisms of massive subcortical heterotopia. Methods: Clinical data, histologic features and neuropathologic data were analyzed in five cases of massive subcortical heterotopia collected from Xuanwu Hospital, Capital Medical University from January 2014 to October 2017. Results: All five patients (three males and two females) had a history of refractory epilepsy with a mean period of 15.4 years (range 7 to 21 years). The median age at surgery was 28.6 years(range 20 to 39 years). Magnetic resonance imaging showed that the lesions were located in the temporal lobe (two cases), parietal lobe (one case), both temporal and occipital lobes (one case) and both temporal and parietal lobes (one case). Pathologic examination disclosed that massive gray matter in subcortical and deep white matter with various shape and size. Moreover, one case also showed subpial and periventricular heterotopias and polymicrogyria. Polymicrogyria or hippocampal sclerosis were seen in the remaining three cases. None of the five patients experienced seizure attacks during the follow-up period. Conclusions: Heterotopia is malformations due to abnormal neuronal migration. Massive subcortical heterotopia due to widespread abnormal neuronal migration is relatively rare. The mechanism of heterotopia together with polymicrogyria needs further discussion.

Insulin and IGFs in renal cancer risk and progression

Insulin and IGFs play a significant role in cancer development and progression, including renal cell carcinoma (RCC). RCC is the most frequent type of kidney cancer in adults and the tenth most common malignancy worldwide. Insulin is normally associated with metabolism control, whereas IGFs are defined as proliferation regulators. Today, there is convincing evidence of an association between obesity and the risk of RCC. Indicated risk factors together with type 2 diabetes are irreversibly connected with circulating insulin and IGF levels. The interplay between these molecules, their receptors, and IGF-binding proteins might be crucial for RCC cell biology and RCC progression. Given the potent activity IGF/IGF receptor 1 (IGF1R) inhibitors demonstrate against RCC in basic research, some type of combination therapy may prove to be beneficial clinically in the management of RCC. This review addresses not only molecular but also clinical associations between insulin and IGF1 signaling pathways and both RCC biology and clinical course. Revealing these interactions may improve our understanding of basic molecular oncology processes in RCC and improve treatment strategies.

Enhanced uptake of heavy metals in municipal solid waste compost by turfgrass following the application of EDTA

Enhancement of multiple heavy metal uptake from municipal solid waste (MSW) compost by Lolium perenne L. in a field experiment was investigated with application of EDTA. EDTA was added in solution at six rates (0-30 mmol kg( - 1)) after 50 days of plant growth. Two weeks later, plants were harvested for the first crop and then all the turfgrasses were mowed. After another 30 days of growth, EDTA was added again at above six rates to the corresponding sites and the second crop was harvested 2 weeks later. The results showed that EDTA significantly increased heavy metal accumulation in both crops of L. perenne. For the first crop, the concentrations of Mn, Ni, Cd, and Pb in the shoots increased remarkably with increasing EDTA supply, peaked at 25 mmol kg( - 1) EDTA, and shoots of 0-5 cm height (shoots from medium surface to 5 cm height) had higher metal concentrations than 5-10 cm and >10 cm shoots. The highest concentration of Mn, Ni, Cd, and Pb was 2.3-, 2.3-, 2.6-, and 3.2-fold, respectively, in 0-5 cm shoots higher than control. For the second crop, the concentrations of Mn, Cu, and Pb in shoots were, in general, less than those in the first crop. However, the second crop was significantly higher (P < 0.05) than the first crop in dry biomass, so the total amount of metals removed by the second crop was more than the first crop. In addition, EDTA significantly increased the translocation ratios of most heavy metals from roots to shoots. For the first crop, 38% of the total Zn, 51% of Cd, 49% of Pb, 60% Mn, 55% Ni, and 45% Cu taken up by the plant was translocated in the shoots of 0-5 cm height. Turfgrass would have potential for use in remediation of heavy metals in MSW compost or contaminated soils.

The Long-term Effect of Autologous Endothelial Progenitor Cells from Peripheral Blood Implantation on Infarcted Myocardial Contractile Force

This study was designed to evaluate the long-term effect of endothelial progenitor cell (EPC) implantation in acute myocardial infarction in Sprague-Dawley rats after ligation of the left anterior descending coronary artery. Autologous EPCs from peripheral blood were purified and implanted into an acute myocardial infarct site. Specimens and muscle strip were harvested at 3 and 6 weeks, and at 6, 8 and 12 months for contractile force assessment and, by immunohistology, for expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and factor VIII. Expression of VEGF and bFGF, and microvessel counts and contractile force in the cell implantation group were significantly higher than in the control group up to 8 months after implantation. Beyond 8 months following implantation, however, no further improvement occurred. The EPCs showed an ability to improve contractile performance in infarcted myocardium by means of angiogenesis and vasculogenesis, and the results seemed to persist long-term.

Anti-malarial agent artesunate inhibits TNF-alpha-induced production of proinflammatory cytokines via inhibition of NF-kappaB and PI3 kinase/Akt signal pathway in human rheumatoid arthritis fibroblast-like synoviocytes

OBJECTIVES

Recent studies indicate that the anti-malarial agent artemisinin and its derivatives may exert an anti-inflammatory effect. In this study, we explored the effect of artesunate, an artemisinin derivative, on tumour necrosis factor (TNF)-alpha-induced production of interleukins, IL-1beta, IL-6 and IL-8, in human rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS), and further investigated the signal mechanism by which this compound modulates those cytokines' production.

METHODS

RA FLS obtained from patients with active RA were stimulated with TNF-alpha and incubated with artesunate, and IL-1beta, IL-6 and IL-8 production was measured by ELISA. DNA-binding activity and nuclear translocation of nuclear factor kappa B (NF-kappaB) were measured by a sensitive multi-well colourimetric assay and confocal fluorescence microscopy, respectively. Signal transduction proteins expression was measured by western blot.

RESULTS

Artesunate decreased the secretion of IL-1beta, IL-6 and IL-8 from TNF-alpha-stimulated RA FLS in a dose-dependent manner. Artesunate also prevented TNF-alpha-induced nuclear NF-kappaB translocation, DNA-binding activity and gene transcriptional activity, as well as phosphorylation and degradation of IkappaBalpha, but phosphorylation of p38 mitogen-activated protein kinase, extracellular signal-regulated kinase and c-Jun N-terminal kinase were unaffected. The production of IL-1beta, IL-6 and IL-8 induced by TNF-alpha was decreased by pyrrolidine dithiocarbamate (PDTC), a chemical inhibitor of NF-kappaB. These observations suggest that artesunate inhibits production of IL-1beta, IL-6 and IL-8 through inhibition of NF-kappaB signalling pathway. We also showed that artesunate prevented Akt phosphorylation. TNF-alpha-induced production of IL-1beta, IL-6 and IL-8 was hampered by treatment with the phosphatidylinositol 3 (PI3) kinase inhibitor LY294002, suggesting that inhibition of Akt activation might inhibit IL-1beta, IL-6 and IL-8 production induced by TNF-alpha.

CONCLUSIONS

Our results indicate that artesunate exerts an anti-inflammatory effect in RA FLS and provide the evidence that artesunate may have therapeutic potential for RA.

[Antisense RNA for urokinase receptor inhibits the invasiveness and metastasis of lung carcinoma]

OBJECTIVE

To inhibit invasion and metastasis of human lung carcinoma cell line 95D by antisense RNA for urokinase receptor (uPAR).

METHODS

Antisense RNA expression plasmid for uPAR was introduced into the highly metastatic human lung carcinoma cells 95D. Modified Boyden's chamber was used to detect the invasion ability, and nude mice were used to determine metastasis.

RESULTS

Two transfected clones were found to integrate the antisense expression plasmid into genomic DNA and to express antisense RNA for uPAR. Antisense RNA blocked the uPAR expression in the transfected clones. The evident reductions of the invasiveness of antisense clones were observed by comparison with control cells, 95D cells and cells transfected with pcDNA3 vector. The metastatic potential of these two antisense clones decreased significantly in comparison with the controls (P < 0.05).

CONCLUSIONS

The results suggest that antisense RNA for uPAR inhibits uPAR expression and leads to a decrease of metastatic potential of 95D cells. Antisense RNA technique may have a valuable application in anti-metastatic therapy of human lung carcinoma.

Anticoagulant activities of a monoclonal antibody that binds to exosite II of thrombin

A monoclonal IgG isolated from a patient with multiple myeloma has been shown to bind to exosite II of thrombin, prolong both the thrombin time and the activated partial thromboplastin time (aPTT) when added to normal plasma, and alter the kinetics of hydrolysis of synthetic peptide substrates. Although the IgG does not affect cleavage of fibrinogen by thrombin, it increases the rate of inhibition of thrombin by purified antithrombin approximately 3-fold. Experiments with plasma immunodepleted of antithrombin or heparin cofactor II confirm that prolongation of the thrombin time requires antithrombin. By contrast, prolongation of the aPTT requires neither antithrombin nor heparin cofactor II. The IgG delays clotting of plasma initiated by purified factor IXa but has much less of an effect on clotting initiated by factor Xa. In a purified system, the IgG decreases the rate of activation of factor VIII by thrombin. These studies indicate that binding of a monoclonal IgG to exosite II prolongs the thrombin time indirectly by accelerating the thrombin-antithrombin reaction and may prolong the aPTT by interfering with activation of factor VIII, thereby diminishing the catalytic activity of the factor IXa/VIIIa complex.

The effect of basic fibroblast growth factor slow-release microcapsules on angiogenesis in infarcted rabbit myocardium

OBJECTIVES

To observe the effect of basic fibroblast growth factor (bFGF) slow-release microcapsules on angiogenesis in infarcted myocardial regions.

METHODS

Myocardial infarction was induced in 24 New Zealand rabbits by ligating the root of left anterior descending coronary artery. Group I (n = 8) served as control, group II (n = 8) as a blank microcapsule group, group III (n = 8, each microcapsule contains 1 microg bFGF) as microcapsule group. In group II and III, 5 blank microcapsules or bFGF slow-release microcapsules were implanted into myocardium underneath the epicardium between the left anterior descending coronary artery and left circumflex artery. Infarct size was evaluated by infarcted weight/left ventricle weight ratio and angiogenesis was evaluated by immunohistochemical examinations 5 weeks later.

RESULTS

As compared with group I and II, rabbits treated with bFGF slow-release microcapsules showed higher microvessel counts (group I 37.75 +/- 4.50, group II 38.37 +/- 4.98, vs x group III 135.50 +/- 4.81, P < 0.001) and less infarcted weight/left ventricle weight (group I 16.8% +/- 0.4%, group II 16.7% +/- 0.5%, vs x group III 7.0% +/- 0.2%, P < 0.001).

CONCLUSIONS

Subepicardial administration of bFGF slow-release microcapsule in the infarcted rabbit model results in effective angiogenesis and reduction in infarct size.

p53-independent apoptosis induced by genistein in lung cancer cells

Lung cancer is the leading cause of cancer-related deaths in the world, with increasing incidence in many developed countries. Epidemiological data suggest that consumption of soy products may be associated with a decreased risk of cancer. Despite the association of nutrition and cancer, the molecular mechanisms by which the active metabolite in the soy diet, genistein, exerts its biological response have not been studied. We previously showed that genistein can inhibit the growth of H460 non-small-cell lung cancer (NSCLC) cells in vitro. To explore the molecular mechanisms by which genistein inhibits the growth of NSCLC cells, we investigated cell growth inhibition, modulation in gene expression, and induction of apoptosis by genistein in H460 cells, which harbor wild-type p53, and H322 cells, which possess mutated p53. Genistein was found to inhibit H460 and H322 cell growth in a dose-dependent manner. Staining with 4,6-diamidino-2-phenylindole, poly(ADP-ribose) polymerase cleavage, and flow cytometric apoptosis analysis were used to investigate apoptotic cell death, and the results show that 30 microM genistein causes cell death via a typical apoptotic pathway. Western blot analysis demonstrated upregulations of p21WAF1 and Bax by genistein in wild-type and mutant p53 cell lines. Furthermore, cells treated with genistein showed an increased expression of endogenous wild-type p53, while the level of the mutant p53 protein remained unchanged. From these results, we conclude that genistein induces apoptosis in NSCLC cells through a p53-independent pathway and, thus, may act as an anticancer agent.

[p53 mutations and protein overexpression in primary colorectal cancer and its liver metastasis]

OBJECTIVE

To compare p53 status between primary and hepatic metastatic colorectal cancer in 34 patients.

METHODS

p53 gene status (exon 5-9) was examined by PCR, denaturing gradient gel electrophoresis (DGGE) and automated sequencing. p53 protein was detected by immunohistochemistry using monoclonal antibody DO-7.

RESULTS

p53 mutations were found in exons 5 through 9 in 21 of 34 patients (61.8%). Among them, 5 patients had mutation in liver metastasis but not in their primary tumor while in the other 4 patients the same mutations were found in both primary and metastatic colorectal cancers. In no patients was p53 mutation exclusively found in the primary colorectal tumor. Moreover, additional mutation was detected in the metastatic lesions in two cases. Of the 37 mutations within the exons examined, 73% was missense mutation and 16% was nonsense mutation. There were 4 microinsertions. p53 protein was overexpressed in both primary and metastatic colorectal cancers with p53 gene mutations. The presence of p53 mutations significantly correlated with p53 protein accumulation (r = 0.96, P < 0.001). However, in 4 patients with p53 nonsense mutation, immunohistochemical staining was negative. In three patients who showed no p53 mutation of the primary tumor, p53 protein was consistently over-expressed.

CONCLUSION

In colorectal cancer, p53 gene mutation usually appears first in the primary tumor and maintains as such but more prominent when metastasized to the liver. However, p53 gene mutation may occur only after being metastasized. Although p53 gene mutation and p53 protein overexpression correlate with each other, either parameter examined alone may lead to false positive results.

Genistein-induced G2-M arrest, p21WAF1 upregulation, and apoptosis in a non-small-cell lung cancer cell line

Lung cancer is the leading cause of cancer-related death in the world, with increasing incidence in many developed countries. Epidemiological data suggest that consumption of soy products (the isoflavone genistein) may be associated with a decreased risk of breast and prostate cancer; however, such studies are not available for lung cancer. We investigated cell growth inhibition, modulation in gene expression, and induction of apoptosis by genistein in H460 non-small lung cancer cells. Genistein inhibited H460 cell growth in a dose-dependent manner. Flow-cytometric analysis showed that 30 microM genistein arrested cell cycle progression at the G2-M phase. 4,6-Diamidino-2-phenylindole staining, flow-cytometric analysis, and DNA laddering were used to investigate apoptotic cell death, and the results show that 30 microM genistein can cause typical DNA laddering, a hallmark for apoptosis. In addition, flow cytometry and 4,6-diamidino-2-phenylindole staining showed induction of apoptosis by genistein. Our investigation also demonstrated the modulation of p21WAF1 by Western blot analysis of cell lysates obtained from cultured cells treated with 30 and 50 microM genistein for 24, 48, and 72 hours. Simultaneously, immunocytochemical staining was conducted for the expression of p21WAF1 protein. Our results showed that genistein can upregulate p21WAF1 expression in genistein-treated cells. From these results, we conclude that genistein may act as an anticancer agent, and further studies may prove its efficacy in non-small lung cancer cells. Thus the biological effects of genistein may, indeed, be due to the modulation of cell growth, cell death, and cell cycle regulatory molecules.

[Clinical study of the treatment of fallopian tube obstruction with catheter recanalization and blood stasis removing drugs]

50 patients with fallopian tube obstruction were initially treated by catheter recanalization, and then randomly divided into two groups. Chinese medicine group (CMG) treated with Tongjingbao and Angelicae Complex Injection and Western medicine (Gentamycin, Dexamethasone, Chymotrypsin) group (WMG) as a control. The course of treatment was three months. Before and after treatment, the hemorheology change was analysed. After treatment, all patients except subsequent pregnancy were repeatedly performing hysterosalpingography. The results showed effective rate of recanalization was 94%; corrected pregnancy rate was 100% in CMG and 50% in WMG; the reocclusion rate of fallopian tube was 9% in CMG and 25% in WMG (P < 0.05). The difference of hemorheology change between two groups was significant (P < 0.01) and it was also different before and after treatment in CMG (P < 0.01). This study showed that catheter recanalization was effective in recanalizing the mechanical occluded fallopian tube. The Chinese medicine would inhibit the reocclusion and re-adhesion of tube.

TCM treatment of luteal phase defect--an analysis of 60 cases

Sixty cases of infertility due to luteal phase defect were treated with herbs to tonify the kidney and regulate the menstrual cycle. After the treatment, the hyperthermal phase score of basal body temperature (BBT) was markedly increased (P less than 0.05), the hyperthermal phase 7-8 days after ovulation improved (P less than 0.001), the transitional period of BBT remarkably shortened, and the pregnancy rate in 32 uncomplicated cases of luteal phase defect was 56%. The close relationship between luteal phase defect and the kidney deficiency syndrome in TCM was discussed. The key points of the treatment included coordination of yin and yang, regulation of qi and blood, and combination of tonification with reduction.

[Experimental and clinical study of tong jing bao and Angelicae complex injection in treating fallopian tube obstruction]

Twenty-two female rabbits with fallopian tube obstruction as the model, were made by 25% Phenol-Tragacanth Mucilage in the laboratory study. Eight rabbits were treated by taking Tong Jing Bao and giving transcervical intrauterine injecting of Angelicae complex injection. Seven were treated with the latter and other seven with 0.9% saline only as the control group. The study showed that in the opening fallopian tube, anti-inflammation, limiting the hyperplasia of fibro-connective tissue and improving the regeneration of epithelial tissue, the first group was more effective than the other two groups (P less than 0.05). Forty-eight infertile women, in whom the fallopian tube obstruction were proved by hysterosalpingography, were divided into two groups for the clinical study. Thirty patients were treated as same as the first group of rabbits. As the control group, other eighteen women were treated with transcervical intrauterine injecting of gentamycin and 0.9% saline in 3 to 6 months. The effective rates were 94.6% and 56.6% (P less than 0.01) and the subsequent pregnancy rates were 46.7% and 27.8% respectively in the different two groups.

HLA polymorphisms in a Shanghai Chinese population

The frequencies of the HLA-A, B, C, D, DR and MB antigens have been determined in a homogeneous Shanghai Chinese population. Comparisons with the HLA-A and -B frequencies in other subsets of the Chinese population revealed some marked differences. No comparisons were possible for the D, DR and MB antigens since there were no previous studies of the antigens in those loci. We suggest that studies of the Chinese population should be confined to clearly defined homogeneous subsets. In this manner, the confounding effect of population heterogeneity may be avoided, and it is this heterogeneity which calls for extensive surveys of the huge Chinese population.