[The role of DNA methylation in the screening of endometrial cancer in postmenopausal women]

Objective: To explore the application value of cervical exfoliated cell DNA methylation (CDO1^m and CELF4^m) combined with or without transvaginal sonography (TVS) for screening endometrial cancer in postmenopausal women. Methods: A total of 143 postmenopausal women who underwent hysteroscopy for suspected endometrial lesions in the Department of Obstetrics and Gynecology of Peking Union Medical College Hospital from May 2020 to October 2021 were enrolled in this study. The cervical exfoliated cells were collected for gene methylation before hysteroscopy. Clinical information, tumor biomarkers, and endometrial thickness of TVS were also collected. With endometrial histopathology as the gold standard, multivariate unconditional logistic regression was applied to analyze the risk factors of endometrial cancer. The role of gene methylation with or without TVS were specifically explored. Results: The 143 patients were divided into an endometrial cancer group (n=56) and a control group (n=87), aged (59.27±6.45) and (61.07±8.26) years, respectively (P=0.051). Multivariate logistic regression analysis showed that, CA125≥35 U/ml, postmenopausal bleeding, endometrial thickness≥5 mm, CDO1^m ΔCt≤8.4, and CELF4^m ΔCt≤8.8 were the risk factors for endometrial cancer, with OR (95%CI) of 33.23 (2.51-1 335.28), 8.41(1.81-39.05), 14.45 (2.35-88.84), 17.34 (3.34-89.98), and 44.01 (6.79-285.25), respectively (all P values<0.05). The sensitivity and specificity of dual-gene methylation (CDO1 or CELF4) in the screening of endometrial carcinoma were both higher than others factors, reaching 87.5% (95%CI: 75.9%-94.8%) and 90.8% (95%CI: 82.7%-95.9%), respectively. TVS combined with DNA methylation detection further improved the sensitivity to 100.0% (95%CI: 93.6%-100.0%), but could not improve the specificity (59.8%, 95%CI: 48.8%-70.1%). Conclusions: In postmenopausal women with suspected endometrial lesions, the accuracy of cervical cytology DNA methylation is better than other noninvasive clinical indicators for the screening of endometrial cancer. DNA methylation combined with TVS can further improve the sensitivity of screening.

Prognostic value of left ventricular myocardial work indices in patients undergoing transcatheter aortic valve replacement

Introduction

Left ventricular myocardial work (LVMW) is a novel echocardiographic-based method to assess LV function using pressure-strain loops taking LV afterload into account. In patients with aortic stenosis (AS), this approach was shown to improve assessment of LV performance as compared to conventional and advanced parameters of LV systolic function, but data on its prognostic value are lacking.

Purpose

To evaluate the prognostic value of LVMW indices in patients with severe AS undergoing transcatheter aortic valve replacement (TAVR).

Methods

LVMW indices, including LV global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were calculated in 281 patients with severe AS (age 82, IQR 78–85 years, 52% male) prior to the TAVR procedure. As previously validated, LV systolic pressure was derived non-invasively by adding the mean aortic gradient to the brachial systolic pressure. LV global longitudinal strain and LV systolic pressure were then incorporated to construct pressure-strain loops to determine the LVMW indices. The study endpoint was all-cause mortality.

Results

In the total population average GWI was 1872±753 mmHg%, GCW 2240±797 mmHg%, GWW 200 (IQR 127–306) mmHg% and GWE 89 (IQR 84–93)%. During a median follow-up of 52 (IQR 41–67) months, 64 patients died. These patients showed lower values of GWI (1644 vs 1940 mmHg%, p=0.006) and GCW (2010 vs 2307 mmHg%, p=0.009) as compared to patients who survived while GWW (197 vs 200 mmHg%, p=0.794) and GWE (88% vs 90%, p=0.102) were similar. While LV GCW, GWW and GWE did not show a significant association with the study endpoint, GWI was independently associated with all-cause mortality (HR per-tertile-increase 0.639; 95% CI 0.463–0.883; P=0.007), and the patients in the lowest GWI tertile showed the worst survival rates (Figure 1). Of interest, patients in the lowest GWI tertile were more likely to be male (63% vs 56% and 37% from the lowest to the highest tertile, P=0.001), had a higher prevalence of atrial fibrillation (26% vs 19% and 8% from the lowest to the highest tertile, P=0.006), worse renal function (53 mL/min/1.73 m2 vs 64 mL/min/1.73 m2 and 62 mL/min/1.73 m2 from the lowest to the highest tertile, P=0.038) and larger LV dimension (LVEDD 52 mm vs 47 mm and 46 mm from lowest through highest tertile, p&lt;0.001). Importantly, when added to a basal model, LVGWI yielded a higher increase in predictivity compared to both conventional and advanced parameters of LV systolic function (Figure 2). Also, in a model corrected for the hemodynamic class of AS (high-gradient, low-flow low-gradient), GWI also showed a significant independent association (P=0.003) with all-cause mortality.

Conclusions

LVGWI is independently associated with all-cause mortality in patients undergoing TAVR and has a higher prognostic value compared to both conventional and advanced parameters of LV systolic function.

Funding Acknowledgement

Type of funding sources: None.

In-kitchen aerosol exposure in twelve cities across the globe

Poor ventilation and polluting cooking fuels in low-income homes cause high exposure, yet relevant global studies are limited. We assessed exposure to in-kitchen particulate matter (PM_2.5 and PM₁₀) employing similar instrumentation in 60 low-income homes across 12 cities: Dhaka (Bangladesh); Chennai (India); Nanjing (China); Medellín (Colombia); São Paulo (Brazil); Cairo (Egypt); Sulaymaniyah (Iraq); Addis Ababa (Ethiopia); Akure (Nigeria); Blantyre (Malawi); Dar-es-Salaam (Tanzania) and Nairobi (Kenya). Exposure profiles of kitchen occupants showed that fuel, kitchen volume, cooking type and ventilation were the most prominent factors affecting in-kitchen exposure. Different cuisines resulted in varying cooking durations and disproportional exposures. Occupants in Dhaka, Nanjing, Dar-es-Salaam and Nairobi spent > 40% of their cooking time frying (the highest particle emitting cooking activity) compared with ∼ 68% of time spent boiling/stewing in Cairo, Sulaymaniyah and Akure. The highest average PM_2.5 (PM₁₀) concentrations were in Dhaka 185 ± 48 (220 ± 58) μg m^-3 owing to small kitchen volume, extensive frying and prolonged cooking compared with the lowest in Medellín 10 ± 3 (14 ± 2) μg m^-3. Dual ventilation (mechanical and natural) in Chennai, Cairo and Sulaymaniyah reduced average in-kitchen PM_2.5 and PM₁₀ by 2.3- and 1.8-times compared with natural ventilation (open doors) in Addis Ababa, Dar-es-Salam and Nairobi. Using charcoal during cooking (Addis Ababa, Blantyre and Nairobi) increased PM_2.5 levels by 1.3- and 3.1-times compared with using natural gas (Nanjing, Medellin and Cairo) and LPG (Chennai, Sao Paulo and Sulaymaniyah), respectively. Smaller-volume kitchens (<15 m³; Dhaka and Nanjing) increased cooking exposure compared with their larger-volume counterparts (Medellin, Cairo and Sulaymaniyah). Potential exposure doses were highest for Asian, followed by African, Middle-eastern and South American homes. We recommend increased cooking exhaust extraction, cleaner fuels, awareness on improved cooking practices and minimising passive occupancy in kitchens to mitigate harmful cooking emissions.

[The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020)]

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

[Analysis of microsatellite instability in endometroid carcinoma with deficient mismatch repair]

Objective: To analyze the microsatellite instability (MSI) status in endometrioid endometrial carcinoma (EEC) with deficient mismatch repair (dMMR) and to explore the concordance between MSI next generation sequencing (NGS)/PCR and MMR immunohistochemistry (IHC) results. Methods: Sixty dMMR EEC cases by IHC from November 2017 to February 2019 were selected in the Department of Pathology, Peking Union Medical College Hospital. Two pathologists reviewed the IHC results. The MSI status and the germline/somatic mutational status of MMR genes were analyzed by NGS. MLH1 promoter methylation status was determined by methylation-specific PCR (MSP) in cases with MLH1 protein deficiency. In cases with discrepant results between MMR IHC and MSI NGS, the MSI status was detected again by PCR, and the reasons for the discrepancy were discussed with gene mutation and MLH1 promoter methylation results. Results: Among 60 dMMR EEC specimens, 3 samples were re-assigned as proficient mismatch repair (pMMR) after pathological review, and identified as MSS by NGS. Another 3 dMMR cases showed MSI-uncertainty (MSI-U) by NGS due to insufficient tumor content. In the remaining 54 cases, the concordance between MMR IHC and MSI NGS was 87% (47/54). The seven discrepant cases was further analyzed: in 5 discrepant cases with MLH1/PMS2 protein loss, one case did not have enough samples for detection, one case was MSI-H, and the remaining three cases were MSS by PCR. All these 5 cases with MLH1/PMS2 protein loss showed the MLH1 promoter hypermethylation, two of which also had a somatic mutation in the MSH2 gene. The two discrepant cases with MSH6 protein loss were both MSS by PCR, one of which was considered to have Lynch syndrome with germline mutation in MSH6 gene. Conclusions: Although the overwhelming majority of dMMR EEC cases by IHC shows MSI-H by NGS/PCR, there are uncommon discrepant dMMR EEC cases with MSS. They are mostly found in cases with MLH1/PMS2 protein loss caused by MLH1 promoter hypermethylation and rarely related to Lynch syndrome. Both MMR IHC and MSI NGS/PCR tests have their advantages and disadvantages, complimentary to each other.

[Clinical analysis of 30 cases of traumatic aortic injury]

Objective: To examine the clinical treatment methods and short- and mid-term results of traumatic aortic injury (TAI). Methods: The clinical data of 30 patients suffering from TAI who were admitted to Department of Cardiothoracic Surgery, General Hospital of Eastern Theater Command from January 2010 to December 2018 were summarized and analyzed retrospectively. All patients were diagnosed as TAI by aortic CT angiography. There were 20 males and 10 females, aging (46.4±15.2) years (range: 17 to 76 years). One patient was diagnosed as extensive intramural hematoma (IMH). The other 29 cases had aortic intimal injury, and the primary intimal tear of all these patients was located in the isthmus of descending aorta. There were 2 cases of ulcer-like changes combined with IMH, and 27 cases of traumatic aortic dissection (TAD) including 23 cases of localized TAD and 4 cases of extensive TAD. Endovascular repair, artificial vascular replacement or conservative treatment were performed according to the patient's specific condition. The patients were followed up in outpatient or by telephone. The clinical data of all the patients of the in-hospital treatment and during follow-up period was analyzed retrospectively. Results: One patient with IMH was treated conservatively. Surgical intervention was performed in 29 cases with intimal injury, of which 14 cases underwent emergency surgery on the day of admission or the next day, and 15 cases underwent elective surgery. Twenty-seven cases underwent thoracic endovascular aortic repair (TEVAR), and 2 cases underwent artificial vascular replacement. Nine cases suffered combined operations in early or late stage. All patients were cured and discharged with in-hospital stay of (13.2±5.4) days (range: 7 to 30 days). There was no in-hospital death. Two patients underwent tracheotomy, and the rest had no serious complications. Up to the last follow-up in June 2019, 4 patients were lost to follow-up, and the remaining 26 patients were followed up for (50.6±34.1) months (range: 6 to 112 months) and survived healthily without new aortic events. Conclusions: Most of TAD cases are ascribed to Stanford type B aortic dissection, and a satisfactory short-term and mid-term result can be achieved by emergency TEVAR in most patients. Some patients can achieve good long-term results by open surgery with artificial vascular replacement.

[Clinicopathological features and prognosis of synchronous bilateral breast cancers]

Objective: To study the clinicopathologic characteristics and relevant factors affecting prognosis of patients with synchronous bilateral breast cancer. Methods: The clinical data, pathologic characteristics and immunohistochemical expression characteristics of 151 patients with synchronous bilateral breast cancers diagnosed in Peking Union Medical College Hospital from 2008 to 2018 were collected and analyzed. The factors affecting the prognosis were analyzed by Log rank test, Kaplan-Meier survival analysis, Cox regression and other methods. Results: Synchronous bilateral breast cancer cases accounted for 1.2% (151/12 239) of all breast cancer patients in the same period, and 14.6% (22/151) had a family history. The patients' age range was 22-88 years, mainly female, with a mean survival of 42.5 months. There were 106 patients with synchronous bilateral invasive breast cancers, 6 patients with synchronous bilateral breast cancer in situ, and 39 patients with unilateral invasive breast cancer and unilateral breast cancer in situ. In synchronous bilateral invasive breast cancers, the histological type was mainly non-specific type (84.9%, 180/212), the histological grade was mainly Grade 2 (60.8%,129/212), the TNM stage was mainly stage Ⅰ (50.5%, 107/212), the tumor size was mainly T1 (68.9%, 146/212), and the regional lymph node was mainly N0 (61.8%, 131/212). The molecular subtypes were mainly Luminal A-like (38.1%, 75/197) and Luminal B-like (43.7%, 86/197); ER (78.2%, 154/197) and PR (72.1%,142/197)were mainly positive, and HER2 was mainly negative (91.9%, 181/197). There were 85 (80.2%) patients and 75 (70.8%) patients with the same histological type and histological grade on both sides, respectively. The concordance of tumor size T stage and the regional lymph nodes N stage were 58.5% (62/106) and 55.7% (59/106), respectively. The concordance of molecular subtype was 54.9% (50/91), and the concordance of ER, PR, HER2 and Ki-67 were 83.5% (76/91), 76.9% (70/91), 89.0% (81/91) and 59.3% (54/91), respectively. The expression of ER and PR in synchronous bilateral invasive breast cancer was significantly correlated with prognosis (P<0.05). Conclusions: Among patients with synchronous bilateral breast cancers, bilateral invasive breast cancer is the most common, the prognosis is the worst, and the pathologic characteristics of bilateral breast cancer tend to be consistent. The expression of ER and PR in synchronous bilateral invasive breast cancer is significantly correlated with prognosis, that is, best for bilateral ER-positive patients, worst for bilateral ER-negative patients, and intermediate for unilateral ER-positive patients, thus suggesting the importance of ER and PR detection in synchronous bilateral invasive breast cancers.

[Correlation analysis between Dx-pH monitoring and proton pump inhibitor test in the diagnosis of laryngopharyngeal reflux disease]

Objective: The consistency of 24-hour oropharyngeal Dx-pH monitoring and proton pump inhibitor(PPI) test in the diagnosis of laryngopharyngeal reflux disease (LPRD) was investigated. Methods: Sixty patients with laryngopharyngeal reflux (LPR) related symptoms who had never received PPI treatment were assessed by reflux symptom index (RSI) and reflux finding score (RFS) between October 2017 and October 2018, including 28 males and 38 females, aged from 16 to 72 years, with a medium age of 38 years. Prior to treatment, all patients were evaluated with 24 hours oropharyngeal Dx-pH monitoring(Restech). After empiric therapy with PPI twice-daily for 8 weeks, the efficacy was evaluated according to posttreatment RSI score.The data was analysed with Kruskal-Wallis test, Student Newman Keuls test and consistency check. Results: (1)Among all 60 patients,13 patients (21.7%) had pathologic Ryan score and all resulted responsive to PPI;27 patients (45.0%) with a negative Ryan score were unresponsive to PPI; 20 patients (33.3%) despite a negative Ryan score resulted responsive to PPI therapy. Considering responsiveness to PPI therapy as the gold standard for the diagnosis of LPRD, the sensitivity, specificity, positive predictive value and negative predictive value of Ryan score were 39.4%, 100%, 100% and 57.4% respectively. The Kappa value was 0.369 (P<0.01). (2)Among 34 patients (56.7%) with positive Dx-pH results (24-hour oropharyngeal acid reflux events≥ 3 times), 29 patients were positive and 5 patients were negative in PPI test. Among 26 patients with negative Dx-pH results (24-hour oropharyngeal acid reflux events<3 times), 4 patients were positive and 22 patients were negative in PPI test. Considering responsiveness to PPI therapy as the gold standard for the diagnosis of LPRD, the sensitivity, specificity, positive predictive value and negative predictive value of 24-hour oropharyngeal acid reflux events were 87.9%, 81.5%, 85.3% and 84.6% respectively. The Kappa value was 0.696(P<0.01). Conclusions: There is a positive correlation between 24-hour oropharyngeal Dx-pH monitoring positive results (24-hour oropharyngeal acid reflux events≥3 times) and PPI test in the diagnosis of LPRD. The 24-hour oropharyngeal Dx-pH monitoring can be a promising tool for the diagnosis of suspected LPRD patients, and more sensitive and accurate Dx-pH diagnostic index will be required in the clinic.

[Clinicopathologic features of gastric adenocarcinoma based on the revised Lauren's classification]

Objective: To compare the clinicopathologic features and prognosis of the subtypes in a consecutive series of gastric cancers (GC) patients basing on the revised Lauren's classification so as to better understand the biological behavior of GC. Methods: The surgically resected GC from Peking Union Medical College Hospital during 2003-2005 were reviewed for patients' age, gender, tumor size, location, Borrman classification, depth of invasion, lymph node metastasis, vascular invasion, and tumor growth pattern (Ming classification). Results: One hundred and sixty-six GC cases were enrolled and classified into four groups: intestinal GC (30, 18.1%), diffuse GC (56, 33.7%), solid GC (9, 5.4%), and mixed GC (71, 42.8%). Intestinal GC patients were older[ (63.2±11.3) years], with a male predominance, and were more frequently found in the antrum. Intestinal GC was the most common subtype for early GC, and tend to develop liver metastases. Diffuse GC patients were youngest [(52.2±12.7) years], with no gender difference, and were usually found in the antrum. Microscopically, diffuse GC were more likely infiltrative (51/56, 91.1%), and tended to metastasize by lymphatic pathway. Solid GC were usually large[ (6.4±2.2) cm], with a male predominance, and the most frequent site was the body/fundus. Solid GC were more likely to show expansile growth pattern with greater depth of invasion (8 of 9 cases were T3/4), but lower rate of lymphatic metastasis. Mixed GC also showed a male predominance, usually found in the antrum, and showed an infiltrative growth pattern (49/71, 69.0%). Though there was fewer T3/4 than solid and diffuse GC, mixed GC were more likely to show lymph nodes, vascular metastases and liver metastases (13/71, 18.3%). TNM staging, lymph nodes metastasis, lymphovascular invasion and revised Lauren's classification were four independent prognostic factors on multivariate analysis(P<0.05). The survival of patients with mixed GC were significantly worse than patients with other histological types. Conclusion: Revised Lauren's classification for GC has four distinct subgroups and can be used as independent prognostic factors.

[Clinical and immunohistopathologic study of phosphaturic mesenchymal tumor]

Objective: To study the clinicopathological characteristics and immunohistochemical phenotype of phosphaturic mesenchymal tumor (PMT) . Methods: The clinicopathological data and immunohistochemical profiles were obtained retrospectively from 206 patients diagnosed with PMT at Peking Union Medical College Hospital (PUMCH) during July 2008 to September 2017, with a review of literature. Results: The mean age of PMT patients was 42 years (range 13 to 70 years), with a male to female ratio of 1.1∶1.0. All patients presented with different degree of bone pain, muscle weakness, shorten of stature, thoracic deformity and pathological fractures, with hypophosphatemia and high serum ALP. Phosphatemia returned to normal within 1 week after operation in all cases underwent complete tumor resection. The duration of osteomalacia before resection (documented in 197 cases) ranged from 20 days to 40 years (average 5.7 years). The average blood phosphorus concentration raised from 0.49 mmol/L to 0.92 mmol/L before and after tumor resection (P<0.01), with 147 cases (84.0%, 147/175) returned to normal range within 2 weeks. The rate or blood phosphorus concentration recovery in 15 days after operation was 79.6% in average, displayed significant differences between patients with complete resection and those with partial resection (85.4% vs. 21.1%, P<0.01). PMT lesions mainly involved lower extremities (55.8%), followed by head and neck (29.1%). In immunohistochemical study, all cases were positive for vimentin (100.0%), while most cases were positive for NSE (96.3%), CD56 (94.2%), FGF23(88.4%), CD68 (88.3%), D2-40 (70.9%), CD34 (23.1%), SMA (55.5%), bcl-2 (59.8%) and CD99 (47.1%). The Ki-67 positive index of tumor varied from less than 2% (51.4%), 3% to 10% (41.3%) to >10% (7.2%). Conclusions: PMT mainly occurs in lower limbs or head and neck, with unique clinical characteristics and blood biochemical indexes. The tumor expresses a variety of immunohistochemical markers, indicating the potential of multi-directional differentiation. Clinical profile, blood biochemistry testing and immunohistochemical phenotype is helpful for diagnosis of PMT.

[Primary carcinoid of ovary: a clinicopathologic analysis of 17 cases]

Objective: To study the clinicopathologic feature, diagnostic strategy and prognostic significance of primary carcinoid of the ovary (PCOTO). Methods: A series of 17 patients previously diagnosed as PCOTO at Department of Pathology, Peking Union Medical College Hospital during the period from 2002 to 2017 were evaluated with clinical data analysis, histopathology and immunohistochemistry, and the patients were followed up and the relevant literatures were reviewed. Results: The age of patients ranged from 24 to 64 years (mean, 42 years). Fourteen patients were found a pelvic mass for a health check-up, and only 3 patients presented with pain in the lower abdomen. The left ovary was involved initially in ten patients, and the right in seven. The major axis of the tumor ranged from 2 to 14 cm. The surface of these tumors was smooth. Seven of the tumors were solid-cystic, 6 were cystic and 4 were solid. Under light microscope, 6 cases were diagnosed as strumal carcinoid, 4 cases were insular carcinoid, 4 cases were trabecular carcinoid, 3 cases were insular and trabecular mixed type carcinoid and 1 case was mucinous carcinoid. The mitotic figures were no more than 1/10 HPF.There were 11 cases complicated with other ovarian tumors, including 10 cases with teratoma, and 1 case with mucinous cystic adenoma. The paraffin-embedded tissues of all cases showed immunoreactivity for NSE and Syn, and the positive propotion of CgA was 10/17. TTF1 was positive in thyroid follicles and negative in strumal carcinoid. The positive index of Ki-67 was no more than 2%. Follow-up of 13 to 188 months showed 16 patients without recurrence and 1 patients were loss to follow-up. Conclusions: PCOTO is very rare. Most of the patients are found with a mass during health check-up in unilateral ovary and without obvious clinical symptoms. Histologically, the tumor always exists with other ovarian tumors, including teratoma and mucinous cystic adenoma, with relatively good prognosis.

Haemolysis during sodium dimercaptosulphonate therapy for Wilson's disease in G6PD-deficient patients: First report of two cases

WHAT IS KNOWN AND OBJECTIVE

Wilson's disease (WD) is an inherited disorder in which defective biliary excretion of copper leads to its accumulation. Sodium dimercaptosulphonate (DMPS) is used as the primary therapy in China.

CASE DESCRIPTION

We report two cases, with WD and G6PD deficiency, who developed haemolysis on treatment with DMPS, without any other known risk. After withdrawal of DMPS and administration of dexamethasone and packed red blood cells, the patients recovered.

WHAT IS NEW AND CONCLUSION

Clinicians should keep in mind haemolysis as a potentially life-threatening side effect of DMPS in patients with G6PD.

[From traditional population-based approach to individualized precision medicine: the interpretation of update on The AJCC Colorectal Cancer Staging System, Eighth Edition]

The eighth edition of cancer staging system published by AJCC will be implemented all over the world in January 1, 2018. In addition to strengthening the traditional TNM staging system, the introduction of new molecular markers, is a major advance in the eighth edition, and is expected to play a more valuable role in the"individualized" clinical practice. The most important update in the eighth edition of AJCC colorectal cancer staging system is"non-anatomic" prognostic and predictive evaluation system based on the molecular detection. The system is useful for better understanding the pathogenesis of colorectal cancer, and guide clinicians to provide individualized treatment for the patients even in the same stage of colorectal cancer.

Cardiotoxicity evaluation of nine alkaloids from Rhizoma Coptis

PURPOSE

Alkaloids derived from Rhizoma Coptis (RC) has been widely applied to clinical treatments in China. However, the toxicity of RC and the alkaloids from RC remained controversial. The research is designed to clarify the cardiotoxic compounds found in RC.

METHODS

In this study, the real-time cellular analysis cardio system and the high-content analysis were applied to monitor the function of cardiomyocytes (CMs) in the treatment of nine alkaloids in RC. Luciferase-coupled adenosine triphosphate (ATP) assay was used to detect cell viability.

RESULTS

The results showed that berberine, palmatine, berbamine, and oxyberberine were cardiotoxic, which resulted in arrhythmia and cardiac arrest on CMs in a time- and dose-dependent manner. Meanwhile, berbamine and oxyberberine caused shrinkage and detachment on CMs at 10 μM. Cytotoxicity was induced by these two compounds with decline in cell index and ATP depletion. Cardiotoxicity or cytotoxicity was not observed in the other five alkaloids within 10 μM.

CONCLUSION

For the first time, the cardiotoxicity of the nine alkaloids was evaluated to clarify the cardiotoxic components in RC. Furthermore, the experimental evidences were provided to support the safety of drug application.

[Endovascular repair of primary retrograde Stanford type A aortic dissection]

Objective: To summarize the short- and mid-term results on endovascular repair of primary retrograde Stanford type A aortic dissection with an entry tear in distal aortic arch or descending aorta. Methods: Between December 2009 and December 2014, 21 male patients of primary retrograde Stanford type A aortic dissection with a mean age of (52±9) years received endovascular repair in Department of Cardiothoracic Surgery, Jinling Hospital. Among the 21 cases, 17 patients were presented as ascending aortic intramural hematoma, 4 patients as active blood flow in false lumen and partial thrombosis, 8 patients as ulcer on descending aorta combined intramural hematoma in descending aorta, and 13 patients as typical dissection changes. All patients received endovascular stent-graft repair successfully, with 15 cases in acute phase and 6 cases in chronic phase. Results: Cone stent was implanted in 13 cases, while straight stent in 8 cases, including 1 case of left common carotid-left subclavian artery bypass surgery and 1 case of restrictive bare-metal stent implantation. No perioperative stroke, paraplegia, stent fracture or displacement, limbs or abdominal organ ischemia or other severe complications occured, except for tracheotomy in 2 patients. Active blood flow in ascending aorta or aortic arch disappeared, and intramural hematoma started being absorbed on CT angiography images before discharge. All patients were alive during follow-up (6 to 72 months), and intramural hematoma in ascending aorta and aortic arch was absorbed thoroughly. Type Ⅰ endoleak and ulcer expansion were found in 1 patient, and type Ⅳ endoleak in distal stent was found in another one patient. Secondary ascending aortic dissection was found in 1 case two years later, which was cured by hybrid procedure with cardiopulmonary bypass. Conclusion: Endovascular repair of primary retrograde Stanford type A aortic dissection was safe and effective, which correlated with favorable short- and mid-term results.

[Clinical features of malignant tumor liver infiltration with liver failure as initial clinical manifestation: a single-center retrospective analysis of 9 cases]

Objective: To investigate the clinical features of patients with liver failure caused by tumor diffuse liver infiltration. Methods: A retrospective analysis was performed for the clinical data of 1008 patients with liver failure who were admitted to our hospital from July 2009 to December 2015. Among these patients, 9 had acute liver failure caused by liver metastasis of malignant tumor. Their clinical manifestations, laboratory markers, clinical progress, and outcome were observed, and the clinical features were summarized. Results: Such patients were manifested as liver enlargement and rapid clinical progression, and imaging examination showed stenosis due to external compression in the inferior vena cava. The patients might be easily misdiagnosed with Budd-Chiari syndrome and had a poor prognosis, with a mortality rate as high as 100%. Conclusion: As for the liver failure patients with unexplained liver enlargement, the possibility of liver metastasis of malignant tumors should be considered. Liver biopsy should be performed as early as possible before the deterioration of liver function, in order to facilitate the targeted therapy for the primary tumor.

A High-sugar High-fat Diet Induced Metabolic Syndrome Shows some Symptoms of Alzheimer's Disease in Rats

OBJECTIVES

Cases of sporadic Alzheimer's disease (SAD) are the predominant form of the age-related dementia. New evidence suggests that metabolic syndrome (MS), a metabolic disorder, is an initiating factor of some SAD cases. A high-sugar high-fat diet could cause MS, we aimed to investigate whether it could directly lead to SAD.

MEASUREMENTS

The characteristic molecules of AD (hippocampus Aβ and Tau) were tested by using ELISA and western blotting to confirm the happening hallmarks of AD in brain. MS and inflammation related biochemical indicators were measured using immunological method. Proteins associated with the insulin resistance signal pathway (JNK, PI-3K, AKT, GSK-3β, GLUT3) were evaluated using western blotting method. The levels of reactive oxygen species (ROS) were measured by immunofluorescence method.

RESULTS

Expressions of hippocampus Aβ, phosphorylation-Tau (p-Tau), inflammatory factors and p-JNK, Gsk-3βwere higher in the model rats than those in the control rats and expressions of p-PI3K, p-AKT and GLUT3 were reversed.

CONCLUSIONS

The MS model animals, which can induce the characteristics symptoms of AD, and therefore it may be preliminarily considered that the AD pertains to the MS-related diseases.

Cavity modes with optical orbital angular momentum in a metamaterial ring based on transformation optics

In this work, we theoretically study the cavity modes with transverse orbital angular momentum in metamaterial ring based on transformation optics. The metamaterial ring is designed to transform the straight trajectory of light into the circulating one by enlarging the azimuthal angle, effectively presenting the modes with transverse orbital angular momentum. The simulation results confirm the theoretical predictions, which state that the transverse orbital angular momentum of the mode not only depends on the frequency of the incident light, but also depends on the transformation scale of the azimuthal angle. Because energy dissipation inevitably reduces the field amplitude of the modes, the confined electromagnetic energy and the quality factor of the modes inside the ring are also studied in order to evaluate the stability of those cavity modes. The results show that the metamaterial ring can effectively confine light with a high quality factor and maintain steady modes with the orbital angular momentum, even if the dimension of the ring is much smaller than the wavelength of the incident light. This technique for exploiting the modes with optical transverse orbital angular momentum may provides a unique platform for applications related to micromanipulation.

Effects of 5-aza-2'deoxycytidine on RECK gene expression and tumor invasion in salivary adenoid cystic carcinoma

Reversion-inducing cysteine-rich protein with kazal motifs (RECK), a novel tumor suppressor gene that negatively regulates matrix metalloproteinases (MMPs), is expressed in various normal human tissues but downregulated in several types of human tumors. The molecular mechanism for this downregulation and its biological significance in salivary adenoid cystic carcinoma (SACC) are unclear. In the present study, we investigated the effects of a DNA methyltransferase (DNMT) inhibitor, 5-aza-2′deoxycytidine (5-aza-dC), on the methylation status of the RECK gene and tumor invasion in SACC cell lines. Methylation-specific PCR (MSP), Western blot analysis, and quantitative real-time PCR were used to investigate the methylation status of the RECK gene and expression of RECK mRNA and protein in SACC cell lines. The invasive ability of SACC cells was examined by the Transwell migration assay. Promoter methylation was only found in the ACC-M cell line. Treatment of ACC-M cells with 5-aza-dC partially reversed the hypermethylation status of the RECK gene and significantly enhanced the expression of mRNA and protein, and 5-aza-dC significantly suppressed ACC-M cell invasive ability. Our findings showed that 5-aza-dC inhibited cancer cell invasion through the reversal of RECK gene hypermethylation, which might be a promising chemotherapy approach in SACC treatment.

Th2 cytokines are associated with persistent hepatic fibrosis in human Schistosoma japonicum infection

We conducted a prospective cohort study in Leyte, the Philippines, among 611 Schistosoma japonicum-infected participants 7-30 years old, all of whom were treated with praziquantel at baseline. To detect hepatic fibrosis, abdominal ultrasound was performed at baseline and 12 months after treatment. Stool for assessment of S. japonicum infection was collected at baseline and at 3, 6, 9, and 12 months after treatment. Cytokines (interleukin [IL]-4, IL-5, IL-10, IL-13, tumor necrosis factor- alpha , and interferon- gamma ) produced by peripheral-blood mononuclear cells in response to soluble worm antigen preparation (SWAP), soluble egg antigen (SEA), and control medium were measured once 4 weeks after treatment. IL-4 to SWAP and IL-10 to both SWAP and SEA were associated with the presence of baseline fibrosis after adjustment for potential confounding variables (P<.03, for all). In participants with fibrosis at baseline, IL-4 to SWAP and IL-5 and IL-13 to both SWAP and SEA were associated with persistent fibrosis at 12 months after treatment (P<.05, for all). Males showed consistently stronger T helper 2 (Th2) cytokine responses to both SWAP and SEA than did females (P<.02, for all). These results suggest an independent role for Th2-biased cytokine responses to S. japonicum antigens in persistent hepatic fibrosis and indicate that Th2 cytokines may contribute to the male-biased prevalence of fibrosis.

Sustained activation of Src-family tyrosine kinases by ischemia: A potential mechanism mediating extracellular signal-regulated kinase cascades in hippocampal dentate gyrus

In the present report, we investigated the association between the sustained activation of Src family tyrosine kinases (primarily Src kinase) with the biphasic phosphorylation of extracellular signal-regulated kinase (ERK) induced by ischemia in the rat hippocampal CA3/dentate gyrus subfield. Post-ischemia reperfusion resulted in the phosphorylation of ERK in a Ras-dependent manner; down-regulation of NMDA receptors or Src family protein kinases by ketamine or 4-amino-5-(4-chlorophenyl)-7-(t-butyl) pyrazolo[3,4-d] pyrimidine (PP2) potently antagonized the activation of ERK, indicating that NMDA receptors and Src family tyrosine kinases are essential for the up-regulation of ERK activity following ischemic stimuli. Additionally, an ischemia-induced association between RKIP and Raf-1 resulted in the inhibition of the ERK signaling cascade through an inhibition of Src-mediated Raf-1 phosphorylation at Tyr340/341 residues. This ischemia-induced inhibition of ERK was not associated with other downstream pathways involving Raf-1 phosphorylation at Ser 259 elicited by protein kinase B (Akt). Dissociation of Raf-1 from RKIP by 24 h reperfusion or (4S)-3-[(E)-but-2-enoyl]-4-benzyl-2-oxazolidinone (locostatin) influenced the second phase of ERK activation elicited by the Src-Raf cassette. We propose that, following ischemia, the Src family tyrosine kinases are critical for modulation of the Ras/Raf/MEK/ERK cascade, in which RKIP is involved in biphasic phosphorylation of ERK via a blockade of Src-Raf cascades.

IFN-gamma is associated with risk of Schistosoma japonicum infection in China

Before the start of the schistosomiasis transmission season, 129 villagers resident on a Schistosoma japonicum-endemic island in Poyang Lake, Jiangxi Province, 64 of whom were stool-positive for S. japonicum eggs by the Kato method and 65 negative, were treated with praziquantel. Forty-five days later the 93 subjects who presented for follow-up were all stool-negative. Blood samples were collected from all 93 individuals. S. japonicum soluble worm antigen (SWAP) and soluble egg antigen (SEA) stimulated IL-4, IL-5 and IFN-gamma production in whole-blood cultures were measured by ELISA. All the subjects were interviewed nine times during the subsequent transmission season to estimate the intensity of their contact with potentially infective snail habitats, and the subjects were all re-screened for S. japonicum by the Kato method at the end of the transmission season. Fourteen subjects were found to be infected at that time. There was some indication that the risk of infection might be associated with gender (with females being at higher risk) and with the intensity of water contact, and there was evidence that levels of SEA-induced IFN-gamma production were associated with reduced risk of infection.

[Analysis of the mitochondria-related protein of Schistosoma japonicum and its antigen epitopes]

OBJECTIVE

To sequence the cloned gene Sj338 and to identify the encoded protein and its antigen epitopes.

METHODS

The Sj338 gene fragment obtained from adult S. japonicum cDNA library amplified by PCR method was subcloned into pGEM-T vector for sequencing. The sequence of nucleotides and the characteristics of the encoded protein were analyzed by DNASIS Program and Goldkey DNA and Protein Analytical Program, and then the homology of the amino acid sequence was searched on the BLAST net.

RESULTS

The cloned rSj338 gene was demonstrated to be 487 bp containing one 459 bp ORF, encoding a protein consisted of 153 amino acids with a molecular weight of 17.6 kDa. The amino acid sequence of the recombinant protein rSj338 shared 46% identity with that of the corresponding part of human mitochondrial import receptor and 44% identity with that of the Rattus sp. mitochondrial precursor receptor. The possible antigen epitopes were predicted within the peptide fragments of 26-32 aa, 37-46 aa and 147-151 aa.

CONCLUSION

The protein encoded by rSj338 gene fragment might be the mitochondria-related protein of Schistosoma japonicum.

[Human parasite antigen-specific IFN-gamma response in schistosomitsis japonica endemic area]

OBJECTIVE

To explore the characteristics of human schistosome antigen-specific IFN-gamma response in a population in an area endemic for schistosomiasis japonica.

METHODS

Three neighboring villages were chosen on Nanshan Island of Poyang Lake. 65 egg-negative persons and 64 egg-positive ones were selected randomly from the residents aged 14-41 years according to the egg counts by Kato-Katz thick smear method. IFN-gamma was measured in the whole blood culture supernatant after stimulated by the schistosome soluble egg antigen (SEA) and soluble worm antigen preparations (SWAP). Serum isotype-restricted antibody was detected by ELISA.

RESULTS

IFN-gamma levels induced by both SEA and SWAP were increased significantly after praziquantel treatment. The SEA-specific IFN-gamma level of the uninfected group was much higher than that of the reinfected group. A negative correlation between IFN-gamma level and IgG4 production was found, reflecting that IFN-gamma might be associated with the resistance to schistosome reinfection.

CONCLUSION

The changes in IFN-gamma level might play an important role in association with the resistance to schistosome reinfection.

[Studies on human cytokine responses before and after praziquantel chemotherapy in an endemic area of schistosomiasis japonica]

OBJECTIVE

To observe the cellular immune responses in a population of an endemic area of schistosomiasis japonica and the influence of praziquantel treatment.

METHODS

Blood was taken from 129 residents (64 cases were egg-positive, 65 cases were egg-negitive) of an endemic area of Poyang Lake before and 45 days after praziquantel treatment. Cytokines induced by the schistosome soluble egg antigen (SEA) and soluble worm antigen preparations (SWAP) in the peripheral blood cells including IL-5, IL-10 and IFN-gamma were measured.

RESULTS

Among 129 cases, the cytokine levels were found much higher in egg negative individuals than in egg-positive individuals. The cytokine levels induced by both antigens were increased significantly after praziqantel treatment especially IL-5 and IFN-gamma.

CONCLUSION

The cellular immune responses in the population in schistosomiasis japonica endemic area exhibited a general trend of down-regulation and were elevated significantly after praziquantel treatment.

[Gene cloning and characterization of mitochondria-related protein of Schistosoma japonicum]

OBJECTIVE

To subclone and characterize a cDNA clone coding for Schistosoma japonicum (S.j.) mitochondria-related protein.

METHODS

The open reading frame of the fragment(Sj338/24) obtained from an adult worm cDNA library of S.j. was analysed, at the upstream and downstream of the open reading frame(ORF) the primers A and B were designed, respectively, and the cDNA fragment was used as PCR template. The Sj338 gene fragment obtained was amplified by PCR method and then subcloned into pGEM-T vector for sequencing. The gene sequence was analyzed and the target fragment was restrictedly digested and subcloned into expression vector pGEX-6P-1. The expressed recombinant protein was purified and characterized.

RESULTS

The cloned Sj338 gene was demonstrated to be 487 bp long containing one 459 bp ORF, encoding a protein with a molecular weight of 17 kDa. The nucleotide sequence of the cloned gene Sj338 had higher homology with those genes coding for mitochondrial outer membrane protein of Homo sapiens and Rattus norvegicus. The recombinant construct of pGEX-6P-1/Sj338 could be expressed efficiently and the antigenicity of its product rSj338 has been demonstrated by Western blotting.

CONCLUSION

Sj338 may be the gene coding for S.j. mitochondria-related protein and the recombinant protein may be used as a new vaccine candidate.

Down-regulation of specific antigen-driven cytokine production in a population with endemic Schistosoma japonicum infection

Schistosome antigen-driven cytokine responses and antischistosome antibody levels of residents of a Schistosoma japonicum endemic island in Poyang Lake, Jiangxi Province were studied before and 45 days after treatment with praziquantel. IL-4, IL-5, IL-10 and INF-gamma were all detected in the supernatants of whole-blood cultures after stimulation with schistosome soluble egg antigen (SEA) and soluble worm antigen preparation (SWAP). The percentages of subjects producing detectable amounts of each cytokine assayed were higher in the group who were negative by stool examination at the start of the study than in those who were initially stool positive. After praziquantel treatment the percentages of subjects producing both type I and type II cytokines increased. This suggests that the production of both types of cytokine was down-regulated in the presence of live, egg-laying S. japonicum adult worms but that this was reversible by treatment. In contrast, the antibody studies showed higher levels of SWAP and SEA-specific antibodies (IgE, total IgG, IgG4, IgM) in subjects who were originally stool-positive than in those who were stool-negative. After treatment specific IgE responses were elevated, but total IgG and IgG4 anti-SEA and IgM anti-SWAP antibody levels all fell significantly.

[Histomorphometric analysis in ovariectomized rat with osteoporosis]

OBJECTIVE

To establish the pattern of bone loss of Sprague-Dawley rats after ovariectomy, to investigate and assess the pattern of bone remodeling in ovariectomized rats and the therapeutic action of nilestriol and levenorgestrel.

METHODS

Histomorphometric analysis for bone tissues was performed with the instrument of computerized image analysis.

RESULTS

The trabecular bone volume, mean trabecular thickness, and trabecular bone perimeter were all significantly decreased (P < 0.01) in ovariectomized rats in the 14th week postsurgery compared to the sham operated group. But the osteoblastic index, osteoclastic index, resorptive surface of trabecular, and trabecular surface covered by osteoblast were significantly increased (P < 0.01). There was no significant difference between the treatment group and the sham operated group.

CONCLUSIONS

The pattern of bone loss of rats after ovariectomy has been established successfully. The study provides evidence that the cause of bone loss in the ovariectomized rats is attributable to the increase of bone turnover and negative imbalance in bone remodeling process. The treatment of nilestriol and levenorgestrel may decrease the bone turnover and correct the imbalance to cure the osteoporosis.

Human NKT cells mediate antitumor cytotoxicity directly by recognizing target cell CD1d with bound ligand or indirectly by producing IL-2 to activate NK cells

alpha-Galactosylceramide (alphaGalCer) stimulates NKT cells and has antitumor activity in mice. Murine NKT cells may directly kill tumor cells and induce NK cell cytotoxicity, but the mechanisms are not well defined. Newly developed human CD1d/alphaGalCer tetrameric complexes were used to obtain highly purified human alphaGalCer-reactive NKT cell lines (>99%), and the mechanisms of NKT cell cytotoxicity and activation of NK cells were investigated. Human NKT cells were cytotoxic against CD1d(-) neuroblastoma cells only when they were rendered CD1d(+) by transfection and pulsed with alphaGalCer. Four other CD1d(-) tumor cell lines of diverse origin were resistant to NKT cells, whereas Jurkat and U937 leukemia cell lines, which are constitutively CD1d(+), were killed. Killing of the latter was greatly augmented in the presence of alphaGalCer. Upon human CD1d/alphaGalCer recognition, NKT cells induced potent cytotoxicity of NK cells against CD1d(-) neuroblastoma cell lines that were not killed directly by NKT cells. NK cell activation depended upon NKT cell production of IL-2, and was enhanced by secretion of IFN-gamma. These data demonstrate that cytotoxicity of human NKT cells can be CD1d and ligand dependent, and that TCR-stimulated NKT cells produce IL-2 that is required to induce NK cell cytotoxicity. Thus, NKT cells can mediate potent antitumor activity both directly by targeting CD1d and indirectly by activating NK cells.

[Comprehensive assessment of the ovariectomized rat model of postmenopausal osteoporosis]

Dual-energy X-ray absorptiometry(DEXA), scanning electron microscopy, and bone biomechanical test were used to assess comprehensively bone quantity and quality of ovariectomized rats. In OVX rats, not only bone mineral density (BMD) of lumbar vertebrae in vivo and vitro, but also BMD of femora (except for R3 region) and proximal metaphysis(R1 region) in vitro decreased obviously (P < 0.01), whose bone loss rates of L5 and L6 were the highest and achieved 13%; the trabeculae of OVX rats were few, fine, and discontinued and there were lacunae on the surface; in OVX rats, both compressive strength of vertebral bodies and the mechanical properties of femora decreased; the falling degree of the former was greater; the maximal compressive power of lumbar vertebrae decreased with 33.32%. We conclude that after 4-month post-ovariectomy, the bone quantity and quality of six-month-old rats decreased, especially in the area of abundant cancellous bone such as vertebral bodies, distal femora; the assessment of the efficiency of new drugs to prevent and treat postmenopausal osteoporosis using rat models should include these drugs' effects to the bone mass, the bone structure, and the bone strength.

Surface ozone trends in Hong Kong in 1985-1995

Ozone trends in Hong Kong were assessed from the ozone data recorded at three urban stations and one station in the new development area. Three parameters were selected as the robust trend indicators in the study: monthly mean, monthly averaged daily 1-h maximum, and number of annual hours > 120 microg m(-3). As the ozone data displayed obvious seasonal variation, using deseasonalized monthly average parameters to estimate the ozone trends could smooth out the influence of seasonal fluctuations. The detection of an increase of more than 10% per year in ozone concentration at one station was particularly alarming. Effects of meteorological factors, control programmes of ozone precursors, and long-range transport on the ambient ozone level were examined in the study.

Phase II study with gemcitabine, ifosfamide and cisplatin in advanced non-small cell lung cancer

The aim of the present study was to determine the clinical activity and toxicity of a novel chemotherapy combination regimen of gemcitabine, ifosfamide and cisplatin (GIP), administered every 3 weeks, in patients with inoperable non-small cell lung cancer (NSCLC). From October 1998 to July 1999, 18 previously untreated stages IIIb (4) and IV (14) patients were enrolled into the study. Gemcitabine and ifosfamide (with mesna as uroprotection) was administered on days 1 and 6, at a dose of 1000 and 1500 mg/m2, respectively; and cisplatin was given on day 1 at a dose of 60 mg/m2, every 3 weeks. All 18 patients were evaluable for response and toxicity profiles. One patient achieved a complete response, and II patients achieved a partial response, with an overall response rate of 66.7% (95%, CI, 45-89%). The main toxicity was hematological, a NCI grade 3-4 neutropenia in 16 patients (88.9%) during the treatment course. Febrile neutropenia occurred in three patients (16.6%). Grade 3 anemia occurred in eight patients (44.41%) and grade 3-4 thrombocytopenia occurred in 11 patients (61.1%). Non-hematological toxicity was mild and tolerable. No toxic death occurred. The median survival was 12.7 months and 1 year survival was 58.4%. The GIP combination chemotherapy produced a high response rate in advanced NSCLC; however, there was a relatively high percentage of hematological toxicity that still could be tolerated. A randomized trial comparing GIP to a two-drug combination of gemcitabine and cisplatin is planned.

Lower-dose (13)C-urea breath test to detect Helicobacter pylori infection-comparison between infrared spectrometer and mass spectrometry analysis

BACKGROUND

The expense of the (13)C-urea breath test (UBT) to detect Helicobacter pylori infection is mainly due to the cost of (13)C-urea and the analysis using isotope ratio mass spectrometry (IRMS).

AIM

To test whether a UBT, using a lower dose of urea and lower-priced isotope-selective nondispersive infrared spectrometry (INIS), can preserve diagnostic efficacy in clinical practice.

METHODS

A total of 177 dyspeptic patients received endoscopy for H. pylori culture and histology. All of them received a UBT in which the duplicate baseline, 10 min, and 15 min breath samples after ingestion of 50 mg (13)C-urea were collected to analyse the excess (13)CO(2)/(12)CO(2) ratio (ECR) by IRMS (ABCA, Europa Scientific, UK) and INIS (UBiT-IR200, Photal Otsuka Electronics, Japan), respectively.

RESULTS

Of the 177 patients, 84 were infected and 93 were uninfected with H. pylori. A close correlation of ECR was found between IRMS and INIS (r=0.9829 at 10 min; r=0.9918 at 15 min, P < 0.0001). Analysing the 15-min samples, UBT by both IRMS and INIS achieved the same sensitivity (96. 4%) and specificity (98.9%).

CONCLUSIONS

INIS is as effective as IRMS for UBT, and can use a lower dose of (13)C-urea. This can provide an economic UBT, using the lower-priced INIS and a low dose of (13)C-urea.

Nephrotoxicity of high- and low-osmolar contrast media. The protective role of amlodipine in a rat model

PURPOSE

To evaluate the nephrotoxicity of high- and low-osmolar contrast media (HOCM, LOCM) on kidneys in Sprague-Dawley rats. The protective role of amlodipine was studied.

MATERIAL AND METHODS

Forty rats of both sexes were randomly divided into 5 groups (n=8/group) and glycerine for inducing renal failure was given to all rats except controls.

RESULTS

In diatrizoate-injected rats, blood urea nitrogen (BUN) and serum creatinine (SCr) were increased; levels of phospholipase A2 (PLA2), lipid peroxide (LPO) and calcium were also increased in renal tissues. There was no significant difference between LOCM (iohexol) animals and glycerol controls either in the renal levels of PLA2, LPO and calcium or in the levels of BUN and SCr. The histologic changes were milder in the LOCM animals than in the HOCM animals. In the group pretreated with amlodipine, no increase in the levels of BUN or SCr was discovered and the renal content of PLA2, LPO and calcium were significantly lower than in the HOCM group; the renal injuries induced by diatrizoate were alleviated.

CONCLUSION

The HOCM, diatrizoate, was more toxic to rat kidneys than the LOCM iohexol; PLA2, LPO and calcium load played a role in producing renal function impairment induced by diatrizoate meglumine; amlodipine protected the renal tissue from nephrotoxicity induced by diatrizoate.

Phase II study of tamoxifen, ifosfamide, epirubicin and cisplatin combination chemotherapy in patients with non-small cell lung cancer failing previous chemotherapy

We conducted a phase II study of tamoxifen, ifosfamide, epirubicin, and cisplatin (TIEP) chemotherapy in patients with non-small cell lung cancer (NSCLC) who had failed previous chemotherapy, in order to assess the response and toxicity of TIEP. Between November 1997 and May 1999, 25 patients were treated. Twelve of the 25 patients (48%) had been previously treated with cisplatin-based combination chemotherapy. TIEP doses were tamoxifen 60 mg oral twice daily on days 1-3; ifosfamide 2.4 g/m(2) intravenous infusion (IV) 60 min with mesna on day 2; epirubicin 40 mg/m(2) IV bolus on day 2; and cisplatin 50 mg/m(2) IV 60 min on day 2 every 4 weeks for up to six cycles. Seventy one cycles were given to 25 patients, with a median of three cycles (range one to six cycles). All patients were evaluable for toxicity profile and response rate. As expected, the major toxicity was myelosuppression. Grade 3 or 4 neutropenia occurred in 15 patients (60%) during treatment, as well as in 31% of the total courses. Febrile neutropenia occurred in two patients. No toxic death occurred in this study. Grade 3 thrombocytopenia occurred in five patients with five cycles. Toxicities other than myelosuppression were few and mild in severity. After two cycles of treatment, five of 25 patients (20%) had a partial response (95% confidence interval 4.3-35.7%). Among 12 patients previously treated with cisplatin-based chemotherapy, three patients (25%) achieved a partial response. The median time to disease progression was 4.9 months and median survival was 7.7 months. The response rate and median survival were better than in our previous study of salvage chemotherapy with ifosfamide, 5-FU, and leucovorin; and with ifosfamide, epirubicin, 5-FU, and leucovorin. In conclusion, TIEP appears to be an active combination regimen with an acceptable toxicity profile in Chinese patients with NSCLC who have failed previous chemotherapy.

Combination chemotherapy with tamoxifen, ifosfamide, epirubicin and cisplatin in extensive-disease small-cell lung cancer

BACKGROUND

A study of tamoxifen, ifosfamide, epirubicin and cisplatin (TIEP) chemotherapy was conducted in patients with extensive-disease, small-cell lung cancer (SCLC) to assess response and toxicity.

METHODS

From November, 1997, to February, 1999, 11 patients were treated, including six chemo-naïve patients and five patients previously treated with cisplatin plus etoposide (EP). The treatment regimen included tamoxifen 60 mg twice daily orally on days 1 to 3, ifosfamide 3 g/m2 intravenous (i.v.) infusion for 60 minutes with mesna on day 2, epirubicin 50 mg/m2 i.v. bolus on day 2 and cisplatin 60 mg/m2 i.v. for 60 minutes on day 2, every 4 weeks for up to six cycles.

RESULTS

All patients were evaluated for toxicity and response rate. As expected, the major toxicity was myelosuppression. Grade 3 or 4 leukopenia or neutropenia occurred in all patients during treatment. Two patients (18.2%) experienced fever in association with the neutropenia, one of whom died of sepsis. Grade 3 anemia occurred in two patients (18.2%) during treatment. Toxicities other than neutropenia and anemia were limited. After two cycles of treatment, five of six chemo-naïve patients (83%), and one of five previously treated patients (20%) attained a partial response (overall 54.5%, 95% confidence interval 25%-83.9%). Median survival time was 8.5 and 6 months in chemo-naïve and previously EP-treated patients, respectively. The response rate and median survival time in chemo-naïve patients did not improve compared with a previous study of ifosfamide plus etoposide undertaken 4 years earlier.

CONCLUSIONS

Although TIEP is an active combination regimen with an acceptable toxicity profile in Chinese patients with extensive-disease SCLC, it showed no remarkable benefit compared with other regimens used in chemo-naïve patients. The 20% response rate and median survival of 6 months in EP-treated patients deserve further study.

Integration of computer-assembled digital images and text data as evidence for the oncological record

Digitally created visual images of pertinent patient data have been integrated with text information to formulate a visual evaluation and summary sheet (VESS) using computer processing. The VESS incorporates images of a patient's physical appearance, radiological images, pharmacokinetic graphs, and text information into a 1-page document of the patient's condition. Thus, computer processing of digital images and other information helps to refine patient data presentation, analysis, interpretation, and communication. This form of data management is especially valuable in oncological research, where clinical trials demand rapid, ongoing assessment of results and analysis of large amounts of data. The VESS is an effective mechanism for monitoring both the progress of individual patients and the endpoints of the overall clinical trial.

[Bone mineral density characteristics at the femoral neck and Ward's triangle for Chinese women]

The incidence of hip fracture is not as high in Chinese women compared to women from Western countries, though they usually have low bone mineral density(BMD) and get osteopenia easily. In this study, reference data(white women) supplied by the manufacturer of Hologic was compared with data obtained from healthy women in Changsha, Hunan, P.R.C. One thousand four hundred and eighty-eight Chinese women aged 15 to 95 years were randomly recruited. Measurements of BMD were taken at the hip by the dual energy x-ray absorptiometry(QDR 4,500A, Hologic Inc., USA). The BMD was somewhat lower than reference curves at all ages and all sites. But at the femoral neck and Ward's triangle, Chinese women reached their peak BMD 5 to 10 years later than the reference group, and had a lower BMD rate of decrease for about 35 years after peak BMD was reached. Whether the differences(i.e., longer time to peak BMD and a lower BMD decrease rate at the neck and Ward's triangle after the peak BMD reached) will result in a protection from hip fractures for Chinese women needs to be studied in the future.

Transforming growth factor-beta1 gene and protein expression associated with atherogenesis of cholesterol-fed rabbits

Transforming growth factor-beta1 (TGF-1beta) has been shown to modulate both cell proliferation and the synthesis of extracellular matrix by vascular cells. This study was aimed to establish the temporal correlation between TGF-beta1 expression, the expression of the extracellular matrix protein fibronectin, and plaque development during atherogenesis of hypercholesterolemic rabbits. New Zealand White rabbits were fed with 2% cholesterol-supplemented chow for 1 week, 2 weeks, 3 weeks or 6 weeks. TGF-beta1 mRNA and protein expression was examined in serial sections of aorta by in situ hybridization and immunohistochemistry. Fibronectin expression was examined by immunohistochemistry. In the control and 1-week feeding group, the expression of TGF-beta1 mRNA and protein was not apparent. In 2-week feeding group, intimal thickening was detected in which TGF-beta1 mRNA and protein were not clearly observed, either. The 3-week and 6-week feeding groups exhibited fatty streaks in which TGF-beta1 mRNA and protein expression markedly increased as feeding proceeded. Cell type-specific staining indicated that TGF-beta1 was expressed by macrophages as well as smooth muscle cells of the fatty streaks. Immunostaining of fibronectin detected low expression levels in control, 1-week and 2-week feeding groups with pronounced upregulation in the thickened intima and the proximal media in 3-week and 6-week feeding groups. These results implicate a role for TGF-beta1 in modulating fatty streak formation and the synthesis of extracellular protein fibronectin during plaque development.

Mouse peroxiredoxin V is a thioredoxin peroxidase that inhibits p53-induced apoptosis

We have identified human and mouse peroxiredoxin V (Prx-V) by virtue of the sequence homologies to yeast peroxisomal antioxidant enzyme PMP20. Prx-V represents the fifth of the six currently known subfamilies of mammalian peroxiredoxins. It is a novel organellar enzyme that has orthologs in bacteria. Biochemically, Prx-V is a thioredoxin peroxidase. One important aspect of p53 function in mammalian cells involves induction of apoptosis likely mediated by redox. We show that overexpression of Prx-V prevented the p53-dependent generation of reactive oxygen species. Likewise, Prx-V inhibited p53-induced apoptosis. Thus, Prx-V is critically involved in intracellular redox signaling.

A phase II trial of tamoxifen, ifosfamide, epirubicin, and cisplatin combination chemotherapy for inoperable non-small-cell lung cancer

A phase II trial of tamoxifen, ifosfamide, epirubicin, and cisplatin (TIEP) chemotherapy was conducted in patients with chemonaive inoperable non-small-cell lung cancer (NSCLC) to assess response and toxicity. From October 1997 to August 1998, 19 patients were treated. The treatment schema included tamoxifen 60 mg twice daily by mouth on days 1 to 3, ifosfamide 3 g/m2 intravenous infusion (IV) 60 minutes with mesna on day 2, epirubicin 50 mg/m2 IV bolus on day 2, and cisplatin 60 mg/m2 IV 60 minutes on day 2 every 4 weeks for up to six cycles. All patients were evaluable for response and toxicity. The major toxicity was myelosuppression; grade 3 or 4 leukopenia or neutropenia occurred in 14 of 19 (73.7%) patients during treatment, and 6 patients (31.6%) experienced fever in association with the neutropenia; no toxic deaths occurred. Grade 3 anemia occurred in six patients (31.6%) during the treatment. Grade 3 or 4 nausea/vomiting occurred in only one patient. Toxicities other than neutropenia and anemia were minimal. After two cycles of treatment, 9 of 19 patients attained a partial response (47.4%, 95% confidence interval 24.9%-69.9%) in this study. The median time to disease progression was 6 months and median survival time was 12 months. We conclude that TIEP is an active combination regimen with an acceptable toxicity profile in Chinese patients with inoperable NSCLC.

Assessment of renal function in the early stages of nephrotoxicity induced by iodinated contrast media

To determine whether there are early renal function parameters (RFP) which can be monitored to rapidly detect nephrotoxicity induced by contrast media (CM), we observed RFP in 16 patients with normal renal function before and after administration of CM. Forty-eight hours after diatrizoate meglumine administration, blood urea nitrogen (BUN) and serum creatinine (SCr) increased (p < 0.05). In all patients, acute tubular damage was revealed by early urinary RFP. Increases in levels of serum angiotensin-I-converting enzyme (ACE), beta(2)-microglobulin (beta(2)M) and urinary albumin (Alb) were associated with alterations in glomerular function. The changes in early RFP occurred earlier than those of BUN and SCr. The present study demonstrates that serum ACE, beta(2)M, urinary Alb, gamma-glutamyl-transpeptidase and N-acetyl-beta-D-glucosidase are sensitive parameters for the early assessment of subclinical nephrotoxicity induced by CM.

Optimum length of muscle contraction

OBJECTIVE

The purpose of this study was to develop a mathematical method to determine optimum muscle length and muscle stress based on the measurable physiological and biomechanical data.

DESIGN

The values of optimum muscle length and muscle stress are investigated.

BACKGROUND

Understanding the characteristics of muscle function in vivo is important for assisting the design of the tendon transfer and other rehabilitation procedures. In vivo determination of the physiological and anatomical parameters of muscle contraction is difficult but not impossible. Optimum muscle length and muscle stresses are important parameters for understanding muscle function.

METHODS

A Cybex dynamometer was used to measure isometric elbow flexion torque in eight different joint positions in seven subjects. Then the optimization method was used to determine optimum muscle length and muscle stress of three major elbow flexors, the biceps brachii, the brachialis, and the brachioradialis based on the model and joint torque data.

RESULTS

The calculated muscle stress for each subject was on average 109 N/cm(2), while the optimum muscle length for the biceps brachii, the brachialis, and the brachioradialis was on average 14.05, 6.53, 17.24 cm, respectively. The joint angles corresponding to these optimum muscle lengths are 110 degrees, 100 degrees and 50 degrees of elbow flexion, respectively.

CONCLUSIONS

Optimum muscle length and muscle stress can be properly predicted using an analytical mathematical model along with an experimentally measured joint torque.

RELEVANCE

The estimate of optimum muscle length is important for muscle modeling and tendon transfer surgery by taking advantage of length-tension relationship of individual muscles.

The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre

OBJECTIVE

To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients.

DESIGN

Retrospective descriptive study.

SETTING

A cancer clinical trials unit in a large teaching hospital.

PATIENTS

From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied.

MAIN MEASUREMENT

Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated.

RESULTS

DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge.

CONCLUSIONS

DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom.

Mechanical properties of L929 cells measured by atomic force microscopy: effects of anticytoskeletal drugs and membrane crosslinking

To shed light on the architecture of the cytoskeleton, we used the atomic force microscope (AFM) to measure the elasticity, viscoelasticity, and plasticity of L929 cells. The initial elastic response (Young's modulus approximately 4,000 Pa) of the cells to an applied force was followed by a slow compression of the cytoskeleton (tau 1/2 approximately equal to 10 s). When force application was terminated, the cytoskeleton underwent a sudden partial decompression and a subsequent slow, incomplete recovery. The role of the cytoskeletal elements in cell mechanics was accessed in AFM measurements carried out on cells treated with cytochalasin D, nocodazole, or colcemid. Cytochalasin D treatment reduced both elasticity (approximately 45%) and cytoplasmic viscosity (approximately 65%), whereas cells treated with nocodazole or colcemid exhibited a marked increase in elasticity (approximately 100%) and a slight increase in viscosity (approximately 15%). The AFM force measurements also provided evidence that the cell membrane and the cytoskeleton are mechanically coupled. Tightly adherent cells were stiffer than cells that were loosely attached. Moreover, cells crosslinked with either glutaraldehyde, 3, 3'-dithiobis [sulfosuccinimidylpropionate] (DTSSP), or Concanavalin A were more rigid than untreated cells. It is of interest that cells crosslinked with Concanavalin A, but not DTSSP, displayed plastic behaviors that may reflect the induction of cytoskeletal reorganization by Concanavalin A.

An instrumented wheel for kinetic analysis of wheelchair propulsion

An instrumented wheel system for three-dimensional kinetic analysis of upper extremity during wheelchair propulsion has been designed and validated. This system allows the direct measurements of three-dimensional dynamic forces and moments on the handrim during wheelchair propulsion in a laboratory setting as well as in the field. Static loading tests showed a high linearity and little drift (coefficient of determination, r2 > 0.999). Under dynamic loading, the instrumented wheel provided the well-matched measurement forces and moments with the predicted values from the inverse dynamic method using video-based kinematic data (correlation coefficient, p > 0.97). The three-dimensional handrim forces and moments during wheelchair propulsion by a non-disabled subject were demonstrated.

Ifosfamide-based chemotherapy for previously treated lung cancer patients

BACKGROUND

Ifosfamide-based chemotherapy has already been the basis of three separate clinical trials. In this study, ifosfamide was administered to lung cancer patients who had failed to respond to previous chemotherapy, to assess its response rate and toxicity.

METHODS

From January 1993 to December 1996, 21 patients were treated, including eight patients with small cell lung cancer (SCLC) and 13 with non-small cell lung cancer (NSCLC). Patients who had histocytologically confirmed lung cancer, were previously treated with chemotherapy, had a measurable lesion(s), were younger than 75 years of age, had an Eastern Cooperative Oncology Group performance status of 0-3 and adequate marrow, renal and liver function were eligible for inclusion in this study. For SCLC patients, ifosfamide 2.4 g/m2 intravenous (i.v.) infusion was given over 30 minutes on days 1-3 every four weeks. For NSCLC two regimens were used: IFL (ifosfamide 2 g/m2, 5-fluorouracil (FU) 600 mg/m2 and leucovorin 50 mg/m2 i.v. infusion on days 1-3 every four weeks) and LIFE (leucovorin 50 mg/m2, ifosfamide 1 g/m2, 5-FU 400 mg/m2 and epirubicin 12 mg/m2 i.v. infusion on days 1-3 every four weeks). For NSCLC patients, IFL was used for the first two years of treatment and LIFE was used in the last two treatment years. All patients were evaluated for treatment response and toxicity.

RESULTS

The major toxic effect, myelosuppression (grade 3 or 4 leukopenia), occurred in 62.5% of SCLC patients and 23.1% of NSCLC patients during treatment, and in 62.5% and 10% of SCLC and NSCLC patients, respectively, throughout the course. Only one SCLC and one NSCLC patient experienced febrile neutropenia. One toxic death, attributed to febrile neutropenia, was documented in a patient with SCLC. Alopecia was ubiquitous. Other toxicities were uncommon and mild. The overall response rate was 50% in SCLC and 7.7% in NSCLC. The median time to disease progression was 61 days in SCLC and 47 days in NSCLC. Median survival was 172 days in SCLC and 173 days in NSCLC.

CONCLUSIONS

The study results suggest that ifosfamide chemotherapy is active with an acceptable toxicity profile in previously treated SCLC patients. However, it lacks efficacy in NSCLC patients who have been previously treated.