Abdominal wall reconstruction (AWR) for post-trauma laparotomy ventral hernia and follow-up assessment of functional quality of life (QOL): experience of a level-1 trauma centre in India

PURPOSE

The aim of this study was to examine the postoperative outcomes and follow-up QOL of patients after AWR at a level-1 trauma centre in India.

METHODS

The study cohort included AWR patients treated between January 2011 and July 2022. The Activities Assessment Scale (AAS) was used to measure QOL, and the Ventral Hernia Recurrence Inventory (VHRI) was used to determine the occurrence of recurrence. In patients suspected of having recurrence, thorough clinical examination and relevant imaging were performed to confirm or rule out recurrence.

RESULTS

Out of 89 patients, 35 patients whose complete perioperative and follow-up data were available were enrolled. The mean age of the patients was 28 (SD, 9) years. The mean defect size was 14. 9 (SD, 7) cm. The mean time from laparotomy to AWR surgery was 21 months. During the postoperative course, 37% of patients developed complications, such as SSI and seroma. The mean follow-up time was 53 (SD, 43) months. Upon comparing procedures involving the mesh placed in the sublay position with procedures involving the mesh placed in other positions, no statistically significant difference in the recurrence rate (one in each group, p = 0.99), surgical complication rate (33% v/s 66%, p = 0.6), or mean AAS QOL score (94.7 v/s 98, p = 0.4) was observed. The specificity of the VHRI for diagnosing recurrence was 79%.

CONCLUSION

Overall, the recurrence rate was low in these patients despite the presence of large hernia defects. Long-term QOL was not affected by the specific procedure used. Timely planning and execution are more important than the specific repair approach for post-trauma laparotomy ventral hernia.

Inhibition of the glucocorticoid receptor attenuates proteinuric kidney diseases in multiple species

BACKGROUND AND HYPOTHESIS

Glucocorticoids are the treatment of choice for proteinuric patients with minimal-change disease (MCD) and primary focal and segmental glomerulosclerosis (FSGS). Immunosuppressive as well as direct effects on podocytes are believed to mediate their actions. In this study, we analyzed the anti-proteinuric effects of inhibition of the glucocorticoid receptor (GR) in glomerular epithelial cells, including podocytes.

METHODS

We employed genetic and pharmacological approaches to inhibit the GR. Genetically, we used Pax8-Cre/GRfl/fl mice to specifically inactivate the GR in kidney epithelial cells. Pharmacologically, we utilized a glucocorticoid antagonist called mifepristone.

RESULTS

Genetic inactivation of GR, specifically in kidney epithelial cells, using Pax8-Cre/GRfl/fl mice, ameliorated proteinuria following protein overload. We further tested the effects of pharmacological GR inhibition in three models and species: the puromycin-aminonucleoside-induced nephrosis model in rats, the protein overload model in mice and the inducible transgenic NTR/MTZ zebrafish larvae with specific and reversible podocyte injury. In all three models, both pharmacological GR activation and inhibition consistently and significantly ameliorated proteinuria. Additionally, we translated our findings to humans, where three nephrotic adult patients with MCD or primary FSGS with contraindications or insufficient responses to corticosteroids, were treated with mifepristone. This treatment resulted in a clinically relevant reduction of proteinuria.

CONCLUSIONS

Thus, across multiple species and proteinuria models, both genetic and pharmacological GR inhibition was at least as effective as pronounced GR activation. While, the mechanism remains perplexing, GR inhibition may be a novel and targeted therapeutic approach to treat glomerular proteinuria potentially bypassing adverse actions of steroids.

Combination Therapy for Alzheimer's Disease: Perspectives of the EU/US CTAD Task Force

Combination therapy is expected to play an important role for the treatment of Alzheimer's disease (AD). In October 2018, the European Union-North American Clinical Trials in Alzheimer's Disease Task Force (EU/US CTAD Task Force) met to discuss scientific, regulatory, and logistical challenges to the development of combination therapy for AD and current efforts to address these challenges. Task Force members unanimously agreed that successful treatment of AD will likely require combination therapy approaches that target multiple mechanisms and pathways. They further agreed on the need for global collaboration and sharing of data and resources to accelerate development of such approaches.

Physical Properties and Theoretical Study of NixCo3-xO₄ (0 ≤ x ≤ 1.5) Nanostructures as High-Performance Electrode Materials for Supercapacitors

Study evaluates the electrochemical performance of off-stoichiometric Ni_xCo_3-xO₄ compounds. The off-stoichiometric samples were prepared via hydrothermal technique by systematically varying Co/Ni molar ratio. Physical and electrochemical properties of Ni_xCo_3-xO₄ were observed to be stoichiometry dependent. The increase in Ni/Co ratio in Ni_xCo_3-xO₄ leads to the morphological transformation from fibrous bundles to urchin like nanospheres with a concomitant increase in the surface area reaching up to 132 m2/g. The optimal specific capacitance of 225 F/g at a current density of 1 A/g and 524 F/g at 10 mV/s scan rate was observed of x 1.0 sample, with an increased retention capacity ∼120% measured at 2 A/g current density. The hybrid density functional theory (DFT) calculations of the electronic density of states identified Ni_1.0Co₂O₄ with optimal band-gap of 2.38 eV with an expectation of displaying higher electrocapacitive performance. Experimentally, Ni_0.92Co_2.08O₄ displayed superior electrocapacitive performance among all Ni/Co ratio in Ni_xCo_3-xO₄. The DFT study also predicted Ni preference to the octahedral site, which is in-line with the observed increase in ferromagnetic nature, decreased lattice parameter, and increased structural disorder with increasing Ni/Co ratio. The improved electrochemical performance of Ni_xCo_3-xO₄ (x > 0) is attributed to the mesoporous hierarchical structure, with a high electroactive surface which can effectively improve structural stability, and reduce the ionic and electron diffusion length. Compared to the pure Co₃O₄, the reduction of Co content in Ni_xCo_3-xO₄ is desired due to the high cost and toxicity of Co element.

Macroanatomical Structure of the Lumbosacral Plexus and its Branches in the Indigenous Duck

The present study was carried out to determine the morphological structure and the branches of the lumbosacral plexus in the indigenous duck (Anas platyrhynchos domesticus). Six mature indigenous ducks were used in this study. After administering an anesthetic to the birds, the body cavities were opened. The nerves of the lumbosacral plexus were dissected separately and photographed. The lumbosacral plexus consisted of lumbar and sacral plexus innervated to the hind limb. The lumbar plexus was formed by the union of three roots of spinal nerves that included last two and first sacral spinal nerve. Among three roots, second (middle) root was the highest in diameter and the last root was least in diameter. We noticed five branches of the lumbar plexus which included obturator, cutaneous femoral, saphenus, cranial coxal, and the femoral nerve. The six roots of spinal nerves, which contributed to form three trunks, formed the sacral plexus of duck. The three trunks united medial to the acetabular foramen and formed a compact, cylindrical bundle, the ischiatic nerve. The principal branches of the sacral plexus were the tibial and fibular nerves that together made up the ischiatic nerve. Other branches were the caudal coxal nerve, the caudal femoral cutaneous nerve and the muscular branches. This study was the first work on the lumbosacral plexus of duck and its results may serve as a basis for further investigation on this subject.

Abstract P6-18-14: Patient-reported outcomes with ribociclib-based therapy in hormone receptor-positive, HER2-negative advanced breast cancer: results from the phase III MONALEESA-2, -3, and -7 trials

Background: In the Phase III MONALEESA (ML) trials, ribociclib (RIB; cyclin-dependent kinase 4/6 inhibitor) + endocrine therapy (ET) significantly improved progression-free survival (PFS) vs placebo (PBO) + ET in patients (pts) with hormone receptor-positive (HR+), HER2-negative (HER2–) advanced breast cancer (ABC). Here we report key patient-reported outcomes (PROs) for pts treated with RIB-based regimens of interest (i.e. with a non-steroidal aromatase inhibitor [NSAI] or fulvestrant [FUL]) in the ML-2, -3, and -7 trials.

Methods: Postmenopausal pts with HR+, HER2– ABC and no prior ET for advanced disease received RIB (600 mg/day; 3-weeks-on/1-week-off) + letrozole (2.5 mg/day; ML-2 [NCT01958021]), or FUL (500 mg every 28 days, with an additional dose on Day 15 of Cycle [C] 1; ML-3 [no prior ET for ABC subgroup only; NCT02422615]). Premenopausal pts with no prior ET and ≤1 line of chemotherapy for advanced disease received RIB + NSAI (anastrozole [1 mg/day]/letrozole [2.5 mg/day]) + goserelin (3.6 mg every 28 days; ML-7 [NCT02278120]). The primary endpoint for all trials was PFS. PROs were a secondary endpoint of all trials and were evaluated using EORTC QLQ-C30, QLQ-BR23 (ML-2 and ML-7), EQ-5D-5L, WPAI-GH (ML-7 only), and BPI-SF (ML-3 only) questionnaires. Changes from baseline and time to 10% deterioration (TTD) in health-related quality of life (HRQoL) were analyzed using linear mixed-effect and stratified Cox regression models, respectively.

Results: A total of 1530 pts were included in this analysis. Questionnaire compliance was high across trials (ML-2/ML-3: >90%; ML-7: >80%). On-treatment HRQoL (EORTC QLQ-C30 global health status/quality of life [QoL] score) was maintained from baseline up to C34, C28, and C17 in both treatment arms for ML-2, ML-3, and ML-7, respectively. In ML-7, mean overall HRQoL scores continued to improve in the RIB arm from C18 to C28, but scores decreased in the PBO arm. At end of treatment, mean overall HRQoL scores decreased in both arms across trials. Median TTD (RIB vs PBO) was similar between arms, favoring the RIB arms (ML-2: 27.7 vs 27.6 months; hazard ratio 0.944; 95% confidence interval [CI] 0.720–1.237; ML-3: not reached [NR] vs 22.4 months; hazard ratio 0.721; 95% CI 0.484–1.074; ML-7: 24.0 vs 19.4 months; hazard ratio 0.759; 95% CI 0.561–1.028). Clinically meaningful reductions in EORTC QLQ-C30 pain score (>5 points from baseline) were observed in the RIB arm of ML-2 from as early as C3 and were sustained vs only at C7 and C13 in the PBO arm. Clinically meaningful reductions in pain were observed from C22 to C28 in the RIB arm of ML-7 vs only at C28 in the PBO arm. In ML-3, clinically meaningful reductions in pain were observed from C3 to C5, C11–17, and at C22 and C28 in the RIB arm vs C17–C25 in the PBO arm. Furthermore, median TTD of the BPI-SF pain severity index score was NR in either arm of ML-3 (hazard ratio 0.858; 95% CI 0.554–1.330).

Conclusions: In addition to significantly prolonging PFS, RIB consistently maintains QoL regardless of ET combination partner. RIB + ET is also associated with clinically meaningful reductions in pain vs PBO + ET across a broad population of pts with HR+, HER2– ABC.

Citation Format: Beck JT, Neven P, Esteva FJ, Bardia A, Harbeck N, Hurvitz S, O'Shaughnessy J, Verma S, Lanoue B, Alam J, Kong O, Chandiwana D, Chia S. Patient-reported outcomes with ribociclib-based therapy in hormone receptor-positive, HER2-negative advanced breast cancer: results from the phase III MONALEESA-2, -3, and -7 trials [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-14.

Abstract P6-18-06: Ribociclib treatment benefit in patients with advanced breast cancer with ≥1 dose reduction: Data from the MONALEESA-2, -3, and -7 trials

Background: In the MONALEESA (ML) trials, addition of ribociclib (RIB; cyclin-dependent kinase 4/6 inhibitor) to endocrine therapy (ET) prolonged progression-free survival (PFS) in patients (pts) with hormone receptor-positive (HR+), HER2-negative (HER2–) advanced breast cancer (ABC). RIB was generally well tolerated, with adverse events (AEs) managed effectively by dose modifications. Here we present efficacy data for RIB-based regimens of interest for the proposed indication (i.e. with a non-steroidal aromatase inhibitor [NSAI] or fulvestrant [FUL]) from ML-2, -3, and -7 in pts who received no prior ET for ABC and who had ≥1 RIB dose reduction, to explore the efficacy of RIB in pts who need to dose reduce.

Methods: Pts included in this analysis were: postmenopausal women with HR+, HER2– ABC and no prior ET for ABC who received RIB (600 mg; 3-weeks-on/1-week-off) with letrozole (2.5 mg/day; ML-2 [NCT01958021]), or FUL (500 mg per label; ML-3 [NCT02422615]); and premenopausal women with no prior ET and ≤1 line of chemotherapy for ABC who received RIB with an NSAI (anastrozole: 1 mg/day; letrozole: 2.5 mg/day; ML-7 [NCT02278120]) plus goserelin (3.6 mg every 28 days). Dose reductions for RIB (600 to 400 to 200 mg) were permitted. Primary endpoint was PFS. Secondary endpoints included overall response rate (ORR), clinical benefit rate (CBR), and safety.

Results: In ML-2, -3, and -7, ≥1 RIB dose reduction occurred (n/N) in 169/334 (51%), 92/238 (39%), and 91/246 (37%) pts assigned to RIB, respectively. AEs were the main reason for dose reduction, with all-grade neutropenia the most common AE leading to dose reduction (ML-2 69%, ML-3 80%, ML-7 82%). Median PFS (months) was prolonged with RIB vs placebo in pts without a RIB dose reduction (ML-2: 27.7 vs 16.0; ML-3: not reached [NR] vs 18.3; ML-7: 23.8 vs 13.8); median PFS in pts with ≥1 RIB dose reduction was: ML-2 25.3, ML-3 NR, and ML-7 27.5 months. In pts with measurable disease and without a RIB dose reduction, ORR was 46% (ML-2), 43% (ML-3), and 48% (ML-7); CBR was 70%, 68%, and 79%, respectively. In pts with measurable disease and ≥1 RIB dose reduction, ORR was 62% (ML-2), 57% (ML-3), and 55% (ML-7); CBR was 88%, 85%, and 88%, respectively. The most common Grade 3/4 AEs in the RIB vs placebo groups (≥5% of pts in either ML trial, irrespective of causality or dose reduction) were neutropenia (ML-2: 62% vs 1%; ML-3: 55% vs 0; ML-7: 65% vs 4%), leukopenia (ML-2: 21% vs 1%; ML-3: 12% vs 0; ML-7: 16% vs 1%), hypertension (ML-2: 13% vs 13%; ML-3: 5% vs 5%; ML-7: 2% vs 3%), increased alanine aminotransferase (ML-2: 10% vs 1%; ML-3: 10% vs 0; ML-7: 5% vs 1%), and increased aspartate aminotransferase (ML-2: 6% vs 1%; ML-3: 6% vs 0; ML-7: 4% vs 1%).

Conclusions: Results from the ML-2, -3, and -7 trials suggest that pts who start on 600 mg of RIB and require dose reduction for the management of their AEs, or for other reasons, continue to derive clinical benefit.

Citation Format: Beck JT, Neven P, Sohn J, Chan A, Sonke GS, Bachelot T, Campos-Gomez S, Martin M, Bardia A, Alam J, Miller M, Diaz-Padilla I, Kong O, Hart L. Ribociclib treatment benefit in patients with advanced breast cancer with ≥1 dose reduction: Data from the MONALEESA-2, -3, and -7 trials [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-06.

Neflamapimod: Clinical Phase 2b-Ready Oral Small Molecule Inhibitor of p38α to Reverse Synaptic Dysfunction in Early Alzheimer's Disease

Neflamapimod (previously code named VX-745) is a clinical phase 2b-ready highly specific inhibitor of the intra-cellular enzyme p38 mitogen activated protein kinase alpha ("p38α") that is being developed as a disease-modifying drug for Alzheimer's disease (AD) that acts via targeting synaptic dysfunction. Neflamapimod was discovered through a proprietary structure-based drug discovery platform at Vertex Pharmaceuticals, and developed previously by Vertex through to phase 2a in rheumatoid arthritis. EIP Pharma licensed the compound in 2014 for development and commercialization as a treatment of central nervous system (CNS) disorders. Neflamapimod is the most advanced in the clinic drug that targets specific molecular mechanisms within neurons that leads to synaptic dysfunction, the pathogenic process that is now considered to be a major driver of the development of memory deficits and disease progression in the early stages of AD. Based on the scientific rationale of targeting synaptic dysfunction and the preclinical data, neflamapimod has the potential to both reverse memory deficits and slow disease progression. Phase 2a clinical data in patients with early-stage AD (MMSE 20-28, biomarker positive) provides evidence that the preclinical science may be translatable to human Alzheimer's, as 6- to 12-weeks of neflamapimod treatment led to significant improvement in episodic memory, the best clinical measure of synaptic dysfunction in AD. A phase 2b six-month placebo-controlled 150-patient clinical study is anticipated to start by end of 2017. This study is designed to definitively demonstrate that neflamapimod reverses memory deficits, and also to provide preliminary evidence that the drug slows disease progression.

Predicting Neonatal Hyperbilirubinemia Using First Day Serum Bilirubin Level in Late Preterm and Term Healthy Newborn

Hyperbilirubinemia is a common problem during the neonatal period and is the most common reason for readmission after early hospital discharge of the healthy near term and term infants. This early discharge policy along with limited follow-up facilities in developing countries and inadequate communication between physicians and parents necessitates a prognostic test to predict hyperbilirubinemia in these newborns; for early and effective management and prevention of potential complication before it occurred. This observational analytical study was done to determine the predictability of day1 total serum bilirubin (TSB) level as a screening test and identify the best cutoff value which would predict neonates likely to develop significant hyperbilirubinemia. The study was carried out in the Department of Neonatology and Department of Gynecology and Obstetrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 1st April 2013 to 31st March 2014. A TSB level of ≥17mg/dl after 72 hours was defined as significant hyperbilirubinemia. By purposive sampling method, 100 healthy late preterm and term neonates fulfilling the inclusion criteria were enrolled and 89 were finally analyzed. Among 89 neonates 14(15.74%) developed significant hyperbilirubinemia (Group II) and 75(84.26%) did not develop hyperbilirubinemia (Group I). Mean time of sample collection was similar in both groups. Mean TSB level on day1 was significantly higher in Group II (5.97±1.74mg/dl) than Group I (3.19±1.4mg/dl). By using ROC (Receiver Operating Characteristic) analysis, TSB level of 5.65mg/dl on day 1 has the best combination of sensitivity (86%) and specificity (91%) to predict neonates at risk of significant hyperbilirubinemia (AUC-0.880, p=0.001). At this cut-off PPV was 63% and NPV 97%. Total serum bilirubin level on first day of life predicts neonates at risk of subsequent significant hyperbilirubinemia and late preterm and term babies with TSB level of ≥5.65mg/dl on day 1 of life should be followed up strictly either in the hospital or in the outpatient department on day 5.

Functional Epitopes for Anti-Aquaporin 5 Antibodies in Sjögren Syndrome

We recently reported the presence of anti-aquaporin 5 (AQP5) immunoglobulin G (IgG) in patients with primary Sjögren syndrome (SS) with a sensitivity of 0.73 and a specificity of 0.68. The aim of this study was to identify functional epitopes for the anti-AQP5 autoantibodies detected in control subjects and patients with SS. Recognition of epitopes by anti-AQP5 autoantibodies in sera ( n = 13 for control and n = 24 for SS) or purified IgG ( n = 1 for control and n = 3 for SS) was evaluated by indirect immunofluorescence (IIF) assay performed in the presence or absence of peptides corresponding to the second transmembrane helix and extracellular loops A, C, and E of AQP5. Functional epitopes were determined by measuring the effects of purified IgG and neutralizing peptides on transepithelial osmotic permeability (P_f^T) of MDCK cells expressing AQP5. In the IIF assay, 89% of SS samples were inhibited by at least 1 peptide, while only half of control samples were inhibited by any peptide. Overall, SS samples were inhibited by peptides corresponding to extracellular loops A, C, and E by 40% to 50%, whereas control samples were inhibited only by peptides corresponding to loop E by <20%. A cyclized peptide (E1) mimicking loop E was most frequently recognized and best differentiated between the SS and control samples. Incubation of MDCK-AQP5 cells with SS but not with control IgG, significantly decreased P_f^T, which was reversed by neutralization of IgG binding to any of the extracellular loops. In conclusion, the anti-AQP5 autoantibodies detected in control and SS groups showed differences in fine specificity to the functional epitopes of AQP5. The prevalent recognition of functional epitopes by anti-AQP5 autoantibodies from SS patients suggests that anti-AQP5 autoantibodies act as mediators of glandular hypofunction and are a potential therapeutic target in SS.

Patients with prior vertebral or hip fractures treated with teriparatide in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study

SUMMARY

In patients in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study with and without a prior vertebral or hip fracture, the incidence of nonvertebral fractures was lower with >6 months of teriparatide treatment than during the first 6 months.

INTRODUCTION

Clinical evidence on the effect of teriparatide in patients with prior fracture is limited. In the DANCE observational study, the incidence of nonvertebral fragility fractures (NVFX) decreased significantly in patients receiving teriparatide for >6 months (6-24 months) versus >0 to ≤6 months (reference period).

METHODS

We performed a post hoc analysis to assess the effect of teriparatide 20 μg/day in patients who entered DANCE with prior vertebral or hip fractures. The incidence of patients experiencing a NVFX for four 6-month intervals during and after treatment was compared with the reference period.

RESULTS

Overall, 4085 patients received ≥1 dose of teriparatide. Of 3720 with sufficient data for efficacy analysis, 692 had prior vertebral fracture, including 179 with previous kyphoplasty/vertebroplasty; 290 had prior hip fracture. These patients were older, and those with prior vertebral fractures had more comorbid conditions at baseline than those without prior vertebral fractures. The incidence of patients experiencing NVFX declined over time in all patient groups. The fracture incidence rate declined 49 and 46%, respectively, in patients with and without prior vertebral fracture and was 63 and 46% lower in patients with previous kyphoplasty/vertebroplasty and without prior vertebral fracture. NVFX declined 43 and 48% in patients with and without prior hip fracture. The reduced incidence over time was consistent in the subgroups (all interaction p values >0.05). Patients with prior fracture were more likely to experience serious adverse events.

CONCLUSION

The incidence of NVFX decreased over time in patients receiving teriparatide in DANCE regardless of prior fracture status.

A case report of congenital high airway obstruction syndrome (CHAOS) caused by complete laryngeal obstruction

CHAOS or Congenital High Airway Obstruction Syndrome is a blockage of the fetus’s trachea or larynx due to a number of factors including narrowing of the airway, a web-like membrane or even tracheal atresia. In the uterus, the fetal lungs constantly produce fluid and as a result of this airway blockage in the trachea, the lung fluid cannot escape out of the fetal mouth. Because of this the fetus’s lungs become distended with fluid and over distended lungs can put pressure on the heart and affect the heart’s ability to function. If the heart cannot beat effectively hydrops or congestive heart failure can occur. We present a case of CHAOS with hydrops and associated anomalies, determined prenatally at about 21 weeks by MRI in our hospital.Pulse Vol.7 January-December 2014 p.38-41

A case of mr imaging detection of hemorrhages in cerebral amyloid angiopathy

A 70-year-old diabetic and hypertensive male patient with mild renal impairment presented with recurrent stroke. CT scan of brain demonstrated acute hemorrhagic / nonhemorrhagic infarcts in the brain. Gradient sequences in the follow-up MRI showed extensive blooming in the cortex of both cerebral hemispheres. There were multiple foci of blooming in basal ganglia and cerebellar hemispheres. Hemosiderin staining was present in posterior fossa. MR findings were consistent with extensive primary cerebral amyloid angiopathy (CAA).Pulse Vol.7 January-December 2014 p.53-55

Progressive Multifocal Leukoencephalopathy (PML) – a Case Report

Progressive Multifocal Leukoencephalopathy (PML) is a rare and usually fatal viral disease occurring almost exclusively in people with severe immune deficiency. This is a demyelinating disease of the central nervous system (CNS) that usually leads to death or severe disability. Patients usually present with focal CNS abnormalities like; hemiparesis, apathy, and confusion. Multifocal white matter lesions without mass effect lead to the diagnosis of PML. In this article we present a review of literature and report of a case of PML in which the patient’s clinical status and MR findings are typical. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20355 Pulse Vol.6 January-December 2013 p.57-59

Uterine Didelphys Associated With Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome: a Case Report

A 30 year old nulligravida female reported to the fertility centre of AHD with the complaints of primary infertility for three and half years and spasmodic dysmenorrhoea. There is also history of progressively increasing right lower abdominal pain as well as discomfort which was cyclically associated with the onset of menses. Transabdominal sonography showed-‘Endometrial splitting into two at the fundus–suggesting bicornuate uterus. Echogenic soft tissue in the cervical canal due to blood clots. Non visualized right kidney. Mildly enlarged left kidney’. HSG done outside AHD suggestive of unicornuate uterus with single fallopian tube. IVU showed non visualized right kidney. Normally excreting left kidney. TVS showed normal sized septated nulliparus uterus with homogeneous myometrium and thick endometrium with proliferative phase echo. Mildly enlarged right ovary with mildly distended right tube. Mild collection adjacent to the vagina. Then the patient came to the gynaecology dept of AHD from where she was sent to our Radiology department to undergo MRI of pelvis. The MRI showed uterine didelphys. Obstructed hemivagina (right) with hematocolpos extended upto pelvic brim along right and posterior aspect of uterus through anomalous dilated remnant of right lower ureter with ipsilateral renal agenesis. Patient was diagnosed as OHVIRA syndrome radiologically. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20358 Pulse Vol.6 January-December 2013 p.66-69

Environmentally persistant toxicant arsenic affects uterus grossly and histologically

The experiment was carried out to determine the gross and microscopic effects of arsenic on uterus of female Black Bengal Goats against control group in the Department of Anatomy and Histology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh-2202. A total of twelve mature female Black Bengal goats were studied, six from arsenic affected areas of Mymensingh district and theother six from Hill Tracts of Bangaldesh which are arsenic free. Gross parameters show slight variations in the morphology (color and shape) and biometry (size and weight) of uterus of arsenic affected Black Bengal goats, but this variation was statistically insignificant (p>0.05). For microscopic study, permanent slide was prepared by Mayer’s Hematoxylin and Eosin stain method. In microscopic level, there were significant variations in arsenic affected group of goats compared to the control group. Arsenic affected group of goats show thickening of uterine horn (p<0.01), uterine gland is lower in amount and diameter(p<0.01), cervical villi length was smaller (p<0.01), cervical wall thickness was higher (p<0.01). This work may be the tip of the iceberg representing the full extent of arsenic exposure to female genital tract. DOI: http://dx.doi.org/10.3329/bjvm.v11i1.13175 Bangl. J. Vet. Med. (2013). 11 (1): 61-68

The Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) study: 2-year nonvertebral fragility fracture results

This observational study evaluated the occurrence of nonvertebral fragility fractures (NVFX) in over 4,000 men and women with osteoporosis treated with teriparatide (TPTD). The incidence of new NVFX decreased for patients receiving TPTD treatment for greater than 6 months. No new significant safety findings were observed in this large trial.

INTRODUCTION

The Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) study evaluated the occurrence of NVFX in patients receiving TPTD for osteoporosis in a real-world setting.

METHODS

DANCE is a multicenter, prospective, observational trial that examined the long-term effectiveness of TPTD in men and women with osteoporosis whom study physicians judged to be suitable for TPTD therapy. Patients received 20 μg TPTD per day by subcutaneous injection for up to 24 months and were followed for 24 months after treatment cessation. The incidence of patients experiencing a new NVFX, defined as a fracture associated with low trauma, was evaluated during four 6-month periods in both the treatment and cessation phases with >0 to ≤6 months serving as the reference. We also observed the spectrum and occurrence of serious adverse events.

RESULTS

Of the 4,167 patients enrolled, 4,085 took one or more doses of TPTD (safety population); 3,720 were included in the efficacy analysis. The incidence of patients experiencing a NVFX was 1.42, 0.91, 0.70, and 0.81 % for the four treatment periods, respectively, and 0.80, 0.68, 0.33, and 0.33 % for the four periods after treatment cessation. Differences for each period were statistically significant compared with the reference period (first 6-month interval, each p < 0.05). No new significant safety findings were observed.

CONCLUSIONS

In this study, the incidence of NVFX decreased for patients receiving TPTD for all three treatment periods >6 months compared to 0 to ≤6 months, and this trend persisted throughout the cessation phase. TPTD was generally well tolerated.

The effect of teriparatide compared with risedronate on reduction of back pain in postmenopausal women with osteoporotic vertebral fractures

The effect of teriparatide and risedronate on back pain was tested, and there was no difference in the proportion of patients experiencing a reduction in back pain between groups after 6 or 18 months. Patients receiving teriparatide had greater increases in bone mineral density and had fewer vertebral fractures.

INTRODUCTION

This study aimed to understand the effect of teriparatide in reducing back pain in patients with prevalent back pain and vertebral fracture compared to risedronate.

METHODS

In an 18-month randomized, double-blind, double-dummy trial, we investigated the effects of teriparatide (20 μg/day) vs. risedronate (35 mg/week) in postmenopausal women with back pain likely due to vertebral fracture. The primary objective was to compare the proportion of subjects reporting ≥30% reduction in worst back pain severity from baseline to 6 months as assessed by a numeric rating scale in each treatment group. Pre-specified secondary and exploratory outcomes included assessments of average and worst back pain at additional time points, disability and quality of life, bone mineral density, incidence of fractures, and safety.

RESULTS

At 6 months, 59% of teriparatide and 57% of risedronate patients reported ≥30% reduction in worst back pain and there were no differences between groups in the proportion of patients experiencing reduction in worst or average back pain at any time point, disability, or quality of life. There was a greater increase from baseline in bone mineral density at the lumbar spine (p = 0.001) and femoral neck (p = 0.02) with teriparatide compared to risedronate and a lower incidence of vertebral fractures at 18 months (4% teriparatide and 9% risedronate; p = 0.01). Vertebral fractures were less severe (p = 0.04) in the teriparatide group. There was no difference in the overall incidence of adverse events.

CONCLUSIONS

Although there were no differences in back pain-related endpoints, patients receiving teriparatide had greater skeletal benefit than those receiving risedronate.

SMART phones and the acute respiratory patient

Definition of Respiratory Failure using PaO2 alone is confounded when patients are commenced on oxygen therapy prior to arterial blood gas (ABG) measurement. Furthermore, classification of Respiratory Failure as Type 1 or Type 2 using PaCO2 alone can give an inaccurate account of events as both types can co-exist. 100 consecutive presentations of acute respiratory distress were assessed initially using PaO2, and subsequently PaO2/FiO2 ratio, to diagnose Respiratory Failure. Respiratory Failure cases were classified as Type 1 or Type 2 initially using PaCO2, and subsequently alveolar-arterial (A-a) gradient. Any resultant change in management was documented. Of 100 presentations, an additional 16 cases were diagnosed as Respiratory Failure using PaO2/FiO2 ratio in place of PaO2 alone (p = 0.0338). Of 57 cases of Respiratory Failure, 22 cases classified as Type 2 using PaCO2 alone were reclassified as Type 1 using A-a gradient (p < 0.001). Of these 22 cases, management changed in 18.

Arzoxifene versus raloxifene: effect on bone and safety parameters in postmenopausal women with osteoporosis

Arzoxifene increased bone mineral density and decreased bone turnover to a significantly greater extent than raloxifene. The hot flush incidence was lower with arzoxifene than raloxifene.

INTRODUCTION

To assess the effect of arzoxifene versus raloxifene on change in lumbar spine (LS) bone mineral density (BMD) in postmenopausal women with osteoporosis.

METHODS

In this 12-month study (NEXT trial), participants were randomly assigned to arzoxifene 20 mg/day (N = 158) or raloxifene 60 mg/day (N = 162). All received daily calcium and vitamin D. Change in LS BMD was assessed by DXA. Secondary objectives included assessment of femoral neck (FN) and total hip BMD, serum bone turnover markers, and safety.

RESULTS

Treatment groups were similar at baseline (mean age 63 years, mean LS BMD T-score -2.9). At 12 months, the increase in LS BMD with arzoxifene was greater than with raloxifene (+2.75% vs. +1.66%), as was FN and total hip BMD (P < 0.05). For LS and FN, this effect was also evident at 6 months. Arzoxifene reduced bone turnover to a greater extent than raloxifene at 3, 6, and 12 months (P < 0.05). The proportion of women reporting ≥ 1 adverse event did not differ between treatment groups, nor did vaginal bleeding. No cases of endometrial polyps, hyperplasia, or cancer were reported. Nasopharyngitis and bronchitis were reported more frequently with arzoxifene versus raloxifene (10.1% vs. 2.5%, and 5.1% vs. 0%, respectively) and new/worsening hot flushes were reported less frequently with arzoxifene (7.0% vs. 16.7%) (P < 0.05).

CONCLUSIONS

Arzoxifene increased BMD and suppressed bone turnover to a greater extent than raloxifene and resulted in a lower incidence of new/worsening hot flushes. Based on subsequent findings from a fracture outcome study, this difference did not translate into improved fracture efficacy.

Cell-penetrating peptides corresponding to the angiotensin II Type 1 receptor reduce receptor accumulation and cell surface expression and signaling

BACKGROUND

Our previous published studies have established the γ-aminobutyric acid (GABA) receptor-associated protein (GABARAP) as a trafficking protein for the angiotensin II type 1A receptor (AT(1)R). GABARAP overexpression increases both AT(1)R protein accumulation and translocation to the plasma membrane. The present study examined the inhibitory effects of decoy peptides on receptor expression and plasma membrane accumulation. The decoy peptides correspond to the AT(1)R cytoplasmic domain located immediately proximal to the 7th transmembrane domain, a region implicated in GABARAP binding. This competitive binding study was designed as a first step toward evaluating the GABARAP:AT(1)R binding interface as a target for reducing AT(1)R trafficking to the plasma membrane.

METHODS

AT(1)R and GABARAP plasmids were transfected into mammalian cell lines simultaneously with cell-penetrating peptides (CPPs). CPP-1 and CPP-2 consist of the penetratin (pANT(43-58)) CPP with downstream fusions of GKKFKKYFLQL (AT(1)R) and GKKFEEAFLQL (AT(1)R-mutant) amino acids, respectively. CPP-3 consists of the HIV TAT(48-60) CPP with GKKFKKYFLQL (AT(1)R) fused downstream. Western blotting, signal transduction studies, and 3D deconvolution microscopy experiments were employed.

RESULTS

Immunoblot analyses and live cell deconvolution microscopy demonstrated that inhibitory (but not control) peptides completely blocked GABARAP-induced intracellular AT(1)R accumulation and cell surface accumulation. GABARAP also stimulated angiotensin II-mediated phospho-ERK1/2 induction by ~ fivefold. This activation was, similarly, quantitatively blocked by the inhibitory peptides.

CONCLUSIONS

Cell-penetrating decoy peptides which were designed to block the AT(1)R:GABARAP interaction, effectively reduced AT(1)R intracellular accumulation and cell-surface trafficking and signaling. The binding interaction site between AT(1)R and GABARAP represents a potential therapeutic target.

Pulmonary function status of Kolkata inhabitants of different economic class during rainy and winter seasons

The pulmonary function status of the Kolkata inhabitants was evaluated during rainy and winter seasons. The pulmonary function tests (PFT) of the 1st study was carried out in the months of July to August when the environment is pollution free and the 2nd study was carried out between November to January when the environment is polluted. In the 1st study a total of 162 (male-88, female-74) inhabitants were investigated and again they were repeated in same way in the 2nd study. To evaluate the respiratory function status, Slow Vital Capacity (SVC), Forced Vital Capacity (FVC) and Peak Expiratory Flow Rate (PEFR) were recorded. Forced expiratory volume in one second (FEV1), forced expiratory volume in 1 sec as the percentage of FVC (FEV1%), forced expiratory flow at 200mL-1200 mL, 25-75% and 75-85% were calculated from the same tracings. Males were having higher mean PFT values compared to females because of sex difference. In the 2nd study PFT values were significantly lower compared to 1st study. According to different durations of stay category the PFT values were significantly reduced in winter season. The regression lines showed decrement as the duration of stay on that area was increased and it was more in 2nd study compared to 1st study. In both studies the PFT values found higher in high economic class of people. Between the same economic class of people PFT values were significantly lower in winter season. Respiratory impairments were also found higher during winter and males were having more impairment compared to females. Respiratory impairments in both sexes were more in winter and low economic class of people had maximum respiratory impairments. In rainy season and winter season the respiratory impairments were less in non-smokers. Males had more respiratory function impairments compared to females.

Impact of population and latrines on fecal contamination of ponds in rural Bangladesh

A majority of households in Bangladesh rely on pond water for hygiene. Exposure to pond water fecal contamination could therefore still contribute to diarrheal disease despite the installation of numerous tubewells for drinking. The objectives of this study are to determine the predominant sources (human or livestock) of fecal pollution in ponds and examine the association between local population, latrine density, latrine quality and concentrations of fecal bacteria and pathogens in pond water. Forty-three ponds were analyzed for E. coli using culture-based methods and E. coli, Bacteroidales and adenovirus using quantitative PCR. Population and sanitation spatial data were collected and measured against pond fecal contamination. Humans were the dominant source of fecal contamination in 79% of the ponds according to Bacteroidales measurements. Ponds directly receiving latrine effluent had the highest concentrations of fecal indicator bacteria (up to 10⁶ Most Probable Number (MPN) of culturable E. coli per 100 mL). Concentrations of fecal indicator bacteria correlated with population surveyed within a distance of 30-70 m (p<0.05) and total latrines surveyed within 50-70 m (p<0.05). Unsanitary latrines (visible effluent or open pits) within the pond drainage basin were also significantly correlated to fecal indicator concentrations (p<0.05). Water in the vast majority of the surveyed ponds contained unsafe levels of fecal contamination attributable primarily to unsanitary latrines, and to lesser extent, to sanitary latrines and cattle. Since the majority of fecal pollution is derived from human waste, continued use of pond water could help explain the persistence of diarrheal disease in rural South Asia.

Monoparesis secondary to herpes zoster

We describe a 90-year-old woman with right upper limb monoparesis secondary to varicella zoster virus infection as a result of extensive inflammatory involvement of the entire brachial plexus at root level. To our knowledge, this is the first report of entire brachial plexus involvement in a living patient of such advanced age. Despite a delay in presentation and thus initiation of treatment, a favourable clinical response was observed.

Respiratory effect related to exposure of different concentrations of arsenic in drinking water in West Bengal, India

Arsenic toxicity due to drinking of arsenic contaminated water has been one of the worst environmental health hazards. High levels of arsenic have been reported in different natural water sources from West Bengal for more than two decades. Groundwater contamination by arsenic and its adverse effects on the health of a big population in nine districts of West Bengal have been reported. The problems found were mainly related to skin and respiratory, digestive, cardiovascular and nervous systems. The respiratory effects are largely confined to those who had the skin lesion. The present study was undertaken to evaluate the respiratory effects of exposure to different levels of arsenic in drinking water. The water samples were collected from different tube wells and wells in the study area. Analysis of arsenic was done by Atomic Absorption Spectrophotometer with hydride generation system. Based on the consumption of arsenic concentrations in drinking water the populations were divided into three categories, i.e., <=50 microg/L, >50 - <= 150 microg/L and >150 microg/L. Standard techniques of medical examination were applied to elicit signs and recorded in the pre-designed proforma. A written consent was taken from each subject for their voluntary participation in the study. 112 subjects were investigated. The respiratory effect was evaluated by measuring the pulmonary function test (PFT). Vital Capacity (VC) and Forced Vital Capacity (FVC) were measured by Spirovit-SP-10 (Schiller Health Care Pvt Ltd., Switzerland) and Peak Expiratory Flow Rate by Wrights Peak Flow Meter (Clement and Clarke, UK). The PFT values showed gradual decrement among the males following skin pigmentation, keratosis and arsenicosis. The respiratory function impairment among the male subjects found as restrictive type (26.41%), obstructive type (3.77%) and combined type (7.54%), whereas in females only the restrictive type of impairment (10.16%) was found. Restrictive type of impairments among the subjects increased as the concentration of arsenic in drinking water increased, in males 15.78%, 29.41% and 35.29% and in females 4.54%, 5.00% and 23.52% respectively. The pathophysiologic mechanism, by which ingested arsenic leads to impairments of lung function and increased respiratory symptoms, is yet to be understood and needs further investigation.

Effects of arzoxifene on bone mineral density and endometrium in postmenopausal women with normal or low bone mass

INTRODUCTION

Arzoxifene, a benzothiophene estrogen agonist/antagonist, is being developed for prevention and treatment of osteoporosis and for risk reduction of invasive breast cancer in postmenopausal women.

METHODS

The effects of arzoxifene 20 mg/d on bone mineral density (BMD), uterine safety, and overall safety were studied in the FOUNDATION study, a 2-yr randomized, placebo-controlled trial including 331 postmenopausal women with normal to low bone mass.

RESULTS

Compared to placebo, arzoxifene significantly increased lumbar spine (+2.9%) and total hip (+2.2%) BMD. Arzoxifene decreased biochemical markers of bone metabolism compared to placebo. Changes in breast density were neutral or slightly decreased in the arzoxifene vs. placebo group. There was no evidence of endometrial hyperplasia or carcinoma in the arzoxifene group as assessed by central review of baseline and follow-up endometrial biopsies. There was no significant change between the groups in endometrial thickness assessed by transvaginal ultrasound. The incidence of uterine polyps and vaginal bleeding was not significantly different between the groups. Vulvovaginal mycotic infection was the only adverse event significantly increased in the arzoxifene vs. placebo group. Hot flushes were not significantly different between the groups.

CONCLUSION

In postmenopausal women with normal to low bone mass, arzoxifene 20 mg/d increased BMD at the spine and hip and had a neutral effect on the uterus and endometrium.

Dibenzoylmethane activates Nrf2-dependent detoxification pathway and inhibits benzo(a)pyrene induced DNA adducts in lungs

Cigarette smoke derived carcinogens have been identified as the main agents implicated in lung carcinogenesis. Epidemiological as well as animal studies have indicated that certain phytochemicals can block the carcinogenic process by enhancing the detoxification of environmental and or dietary carcinogens. Dibenzoylmethane (DBM), a minor constituent of licorice, is a beta-ketone analog of curcumin, a promising chemopreventive agent for colon, breast and skin cancer. The present study was designed to examine the chemopreventive efficacy of DBM in lungs, its global molecular targets and the mechanism of its action. Feeding DBM to A/J mice significantly inhibited benzo[a]pyrene induced DNA adducts in lungs. Further analysis of its global molecular targets in lungs by oligonucleotide microarray revealed expression of several cytoprotective genes including phase II enzymes that are regulated by Nrf2, a basic leucine zipper transcription factor. To decipher if DBM mediates its function via Nrf2 activation, Nrf2 dependent reporter assays were performed. DBM elicited a dose-dependent increase in antioxidant response element (ARE)-driven luciferase reporter activity which correlated with an increase in mRNA expression of NQO1, GSTA2, and GCLC in mouse hepatoma cells, which are well established targets of Nrf2. Conversely, DBM stimulated ARE reporter activity was attenuated by a dominant-negative mutant of Nrf2. Electrophoretic mobility shift assay confirmed that DBM greatly increased the DNA binding activity of Nrf2. In conclusion, DBM mediates the induction of phase II enzymes by Nrf2 activation and inhibits benzo[a]pyrene induced DNA adducts by enhancing its detoxification in lungs.

Pulmonary function in aluminium smelter and surrounding community--a case study

The increase of industrial activities in the Angul-Talcher area, Orissa resulted in indiscriminate disposal of waste into the environment leading to the deterioration of the quality of the environment, which affects the health of the workers as well as the community people. Considering the magnitude of the problem, the pulmonary function study had been carried out in one of the largest aluminium producing plant of the country as well as surrounding community people. Aluminium is produced from oxides of alumina by Hall-Heroult smelting process. The electrolysis called as aluminium smelting is carried out in an electrolytic cell (pot) having anode, cathode and electrolyte. The aluminium is deposited in the cathode and the oxygen moves towards anode is released. The workers working at the captive power plant (CPP), which is necessary to meet the power demand of the smelter plant were also investigated. 180 smelter plants workers (non-smoker 129, smoker-51) of different sections and 37 captive power plant workers (non-smoker 29, smoker-8) had undergone pulmonary function tests. Besides these, 85 persons from the surrounding community (non-smoker-66, smoker-19) were also investigated. The workers were all male. Spirometric assessments of Vital Capacity (VC), Forced Vital Capacity (FVC), and Peak Expiratory Flow Rate (PEFR) were done by Spirovit-sp-10 (Schiller Health Care Ltd, Switzerland) and Wrights Peak flow meter (Clement and Clarke, UK). Different lung volumes like FEV1, FEV1%, and flow rates like FEF200-1200ml, FEF25-75% and FEF75-85% were calculated from the same tracings pulmonary function test (PFT) results of the workers according to different age groups, duration of exposures and smoking habits. The mean values of SVC, FVC and FEV1 of smelter plant workers were found higher compared to the community people but the values of captive power plant workers were very much close to the values of the community people. A gradual decrement of the PFT values was found as duration of exposure increased. Lung volumes and the flow rates were decreased as age increases but in some age groups that trend was not followed. It has been found that in each category of subjects, smokers have the higher mean pulmonary function values compared to the non-smokers. Except the community people in all other cases the different flow rates were found higher in nonsmokers compared to smokers. The restrictive, obstructive and combined restrictive and obstructive types of impairments among the subjects were noticed. The respiratory impairment among the workers as a whole was found higher in smelter plant workers (9.44%) followed by the captive power plant workers (5.40%) and the community people (2.35%). In smelter plant workers both the restrictive and obstructive impairments were found higher compared to captive power plant and the community people.

A study on blood eosinophil level and ventilatory pulmonary function of the workers exposed to storage grain dust

The workers engaged in storage grain handling are exposed to storage grain dust and suffer from different respiratory symptoms like, cough wheezing, chest tightness, eye and nasal irritations. It has been reported abroad and the present study results noted that the grain handlers have allergic symptoms like redness of eyes, itching, sneezing, skin rash, breathlessness and decrement of pulmonary function test values. According to their nature of job, the workers of storage grain godowns were divided into four categories i.e., load handling worker (LHW), ancillary, quality control and depot administration workers. The pulmonary function tests (PFT) and the differential count of leucocytes were carried out among the workers by standard technique. Decrement of pulmonary function test values was noted with the increment of blood eosinophil level.

The PFT results were presented according to the blood eosinophil level. The decrement of mean PFT values were noticed as the blood level of eosinophil gradually increased from, up to -4%, >4-10% and above 10%. The maximum numbers of workers in different job categories are belonged to >4 -10% of eosinophil level. The percentage figure of workers in different departments were LHW 48.38%, (n=45), ancillary 38.88%, (n=7), quality control 54.54% (n=6) and depot administration workers 47.05% (n=16) are belonged to that range. Among the total workers the higher figure was found >4-10% ranges 47.43% (n=74) workers. The allergic manifestations like redness, itchiness and watering of eyes, sneezing, cough, breathless etc. are reported. These workers have blood eosinophil level and low pulmonary function test values. The respiratory impairments among the workers are restrictive, obstructive and combined restrictive and obstructive type.

Doping induced surface chemistry dictating the characteristics of Schottky contacts to III-V nitride semiconductors

While lightly doped semiconductors are preferred for Schottky contacts, heavily doped semiconductors are preferred for Ohmic contacts. The upper limit of doping for Schottky contacts and the lower limit of doping for Ohmic contacts have not, however, been quantified. To address this problem, the influence of doping induced surface chemistry on the electrical characteristics of Schottky diodes has been studied. Hall measurement, current-voltage measurements, and transmission electron microscopy have been performed. The most remarkable observation of the study is a relationship between the surface dislocation density and the ideality factor of the Schottky diodes. The observation leads to a conclusion that the upper limit of the semiconductor doping for Schottky diodes should be such that it leads to negligible barrier height reduction without the creation of excessive surface dislocation density.

Phosphatidylinositol 3-kinase/Akt pathway mediates heme oxygenase-1 regulation by lipopolysaccharide

The stress-inducible protein heme oxygenase-1 exerts potent antiinflammatory, antiapoptotic and cytoprotective effects in vitro and in vivo. Another important mediator of cytoprotection, the phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway activates many proteins involved in the maintenance of cellular homeostasis. Since activation of heme oxygenase-1 and PI3K/Akt both protect the cellular environment, we postulated that PI3K/Akt can regulate the induction of heme oxygenase-1 by proinflammatory stress. The treatment of primary murine macrophage cells (RAW 264.7) with lipopolysaccharide induced heme oxygenase-1 protein and mRNA expression, and increased the phosphorylation of Akt and p38 mitogen activated protein kinase (p38 MAPK). These cellular effects of lipopolysaccharide were markedly diminished by pre-treatment with wortmannin, a specific inhibitor of PI3K. Furthermore, lipopolysaccharide-inducible heme oxygenase expression was blocked by SB203580, a specific inhibitor of p38 MAPK. Both wortmannin and SB203580 decreased lipopolysaccharide-inducible NF-E2-related factor (Nrf2) DNA binding activity. Transfection of macrophages with dominant negative mutants of PI3K, Akt and Nrf2, as well as wortmannin treatment, significantly reduced the transcriptional activity of a minimal heme oxygenase-1 promoter luciferase construct (D33HO-1luc). We demonstrate, to our knowledge for the first time, that upon proinflammatory stimulation heme oxygenase-1 gene expression in macrophages depends on PI3K/Akt and p38 MAPK acting upstream of Nrf2-dependent promoter activation.

Transcriptional regulation of the heme oxygenase-1 gene via the stress response element pathway

The heme oxygenase-1 (HO-1) enzyme catalyzes the rate-limiting reaction in the catabolism of heme yielding products with pleiotropic, but ultimately, cytoprotective activities. High levels of HO-1 are frequently detected in various pathological states and generally in states of cellular oxidative stress. Induction of HO-1, regulated at the level of gene transcription, is essential for manifestation of the enzyme's cytoprotective function. Extensive analysis of the mouse gene, and to a lesser extent of the human gene, has identified a common mechanism the stress response element (StRE)/Nrf2 transcription factor pathway for gene regulation in response to a diverse array of HO-1 inducers including the substrate heme, various environmental and industrial toxins, and plant-derived polyphenolic compounds. In addition to Nrf2 complexes, numerous dimeric transcription factors bind to the StRE, permitting induction, repression and overall fine-tuning of gene activity. In principle, the multiplicity of StRE binding proteins also provides for a range of pharmaceutical targets for controlled production of the potentially therapeutic HO-1 protein.

Pulmonary Function Abnormalities Associated with Exposure to Automobile Exhaust in a Diesel Bus Garage and Roads

In Kolkata city the road transports are maintained by private and Government organization. A major work force belonged to the State Transport Corporation (KSTC), Government of West-Bengal. The pollution caused by these vehicles affects the workers health and caused different types of respiratory problems. This study was undertaken to assess the pulmonary function status of these workers. City KSTC garage workers were investigated and categorically divided into two group: garage mechanics and the (2) those transporting the passengers (drivers and conductors). Vital capacity (VC), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) were recorded by Spirovit-SP-10 (Schiller Ltd, Switzerland) and Wright's Peak Flow Meter (UK) on 236 workers. The different flow volumes, FEV(1), FEV(1%), and flow rates, FEF(02-121), FEF(25-75%), etc. were calculated. The administrative people had higher PFT than the other categories. Drivers and conductors have almost equal mean PFT values but mechanical workers had slightly higher. PFT values according to different age ranges and duration of exposure showed gradual decrement as age and duration of exposure increased. Non-smokers had higher lung volumes compared to smokers and ex-smokers. Restrictive, obstructive and combined types of impairments were noticed in 28.4%, 1.7% and 2.9%, respectively, workers. The restrictive impairment was found to be 30.4% in conductors; 28.9% in drivers, 27.9% in mechanics and 21.7% in administration people. Obstructive type of impairment was found to be 2.9% in both drivers and conductors. The effect of pollution by dust and fumes may be responsible for these pulmonary function impairments, restrictive impairments being greater.

Cellular overexpression of heme oxygenase-1 up-regulates p21 and confers resistance to apoptosis

BACKGROUND

Induction of heme oxygenase-1 (HO-1) protects against diverse insults in the kidney and other tissues. We examined the effect of overexpression of HO-1 on cell growth, expression of p21, and susceptibility to apoptosis.

METHODS

LLC-PK1 cells were genetically engineered to exhibit stable overexpression of HO-1. The effects of such overexpression on cell growth, the cell cycle, and the cell cycle-inhibitory protein, p21, were assessed; additionally, the susceptibility of these HO-1 overexpressing cells to apoptosis induced by three different stimuli (TNF-alpha/cycloheximide, staurosporine, or serum deprivation) was evaluated by such methods as the quantitation of caspase-3 activity, phase contrast microscopy, and the TUNEL method.

RESULTS

HO-1 overexpressing LLC-PK1 cells demonstrated cellular hypertrophy, decreased hyperplastic growth, and growth arrest in the G0/G1 phase of the cell cycle. HO-1 overexpressing cells were markedly resistant to apoptosis induced by TNFalpha/cycloheximide or staurosporine as assessed by the caspase-3 activity assay. Such overexpression also conferred resistance to apoptosis induced by serum deprivation as evaluated by the TUNEL method; in these studies, inhibition of HO attenuated the resistance to apoptosis. Expression of the cyclin dependent kinase inhibitor, p21CIP1, WAF1, SDI1, as judged by Northern and Western analyses, was significantly increased in HO-1 overexpressing cells, and decreased as HO activity was inhibited. Moreover, this reduction in expression of p21 attendant upon the inhibition of HO activity in HO-1 overexpressing cells paralleled the loss of resistance of these cells to apoptosis when HO activity is inhibited. The pharmacologic inducer of HO-1, hemin, increased expression of p21 in wild-type cells and decreased apoptosis provoked by TNF-alpha/cycloheximide.

CONCLUSION

Cellular overexpression of HO-1 up-regulates p21, diminishes proliferative cell growth, and confers marked resistance to apoptosis. We speculate that such up-regulation of p21 contributes to the altered pattern of cell growth and resistance to apoptosis. Our studies uncover the capacity of HO-1 to markedly influence the cell cycle in renal epithelial cells. In light of the profound importance of the cell cycle as a determinant of cell fate, we speculate that the inductive effect of HO-1 on p21 and the attendant inhibitory effect on the cell cycle provide a hitherto unsuspected mechanism underlying the cytoprotective actions of HO-1.

Protective effect of heme oxygenase-1 gene transfer against oxyhemoglobin-induced endothelial dysfunction

The current study was designed to determine the effect of recombinant heme oxygenase-1 (HO-1) gene expression on endothelial function in cerebral arteries. Isolated canine basilar arteries were exposed ex vivo (30 minutes at 37 degrees C) to an adenoviral vector (10(10) PFU/mL, total volume 300 microL) encoding either the HO-1 gene (AdCMVHO-1) or the beta-galactosidase (beta-Gal) reporter gene (AdCMVbeta-Gal). Twenty-four hours after transduction, arterial rings were suspended in organ chamber for isometric force recording. Endothelium-dependent relaxations were obtained in response to bradykinin (10(-10) to 10(-6) mol/L) during contraction to uridine-5'-triphosphate (UTP; 3 x 10(-6) to 3 x 10(-5) mol/L). Certain rings were incubated with oxyhemoglobin (OxyHb; 10(-5) mol/L) overnight (16 to 18 hours of 24 hours). Expression and localization of recombinant protein were shown by Western blot analysis and immunohistochemistry. Endothelium-dependent relaxation to bradykinin and endothelium-independent relaxation to forskolin (10(-9) to 10(-5) mol/L) and DEA-NONOate (10(-10) to 10(-5) mol/L) were identical in beta-Gal- and HO-1-transduced arteries. Exposure to OxyHb caused impairment of endothelium-dependent relaxation to bradykinin (P < 0.01). In contrast, OxyHb did not affect endothelium-dependent relaxation in arteries expressing recombinant HO-1 ( P > 0.05). This protective effect of HO-1 was reversed by coincubation with tin protoporphyrin (SnPP9; 10(-5) mol/L), a selective inhibitor of HO-1 (P < 0.01). Basal levels of 3',5'-cyclic monophosphate (cGMP) in HO-1-transduced vessels were not significantly different from those in beta-Gal-transduced vessels. Pretreatment with OxyHb significantly reduced cGMP level in beta-Gal-transduced rings (P < 0.01), whereas it had no effect in HO-1-transduced rings. These results demonstrate that HO-1 gene transfer does not affect endothelial and smooth muscle function of normal arteries, and that expression of recombinant HO-1 in cerebral arteries protects vasomotor function against OxyHb-induced injury.

Gene microarray analysis reveals a novel hypoxia signal transduction pathway in human hepatocellular carcinoma cells

The molecular details of hypoxia-induced cellular responses have been difficult to identify since there is as yet no known oxygen receptor. We used cDNA microarray technology to extend our studies pertaining to these molecular details in human hepatocellular carcinoma (Hep3B) cells that produce erythropoietin (Epo) in response to hypoxia. Of approximately 1200 genes in the array, those associated with integrin-linked kinase (ILK), fibronectin precursor and glycogen synthase kinase-3beta (GSK-3beta) were markedly stimulated after exposure of Hep3B cells to low oxygen (1%) for 6 h. Epo, HIF-1, and von Hippel-Lindau cDNAs were measured in parallel as markers of low oxygen responses in Hep3B cells. ILK is a serine, threonine protein kinase that interacts with the cytoplasmic domains of integrin beta1 and beta3. This interaction localizes ILK to focal adhesion plaques. ILK is stimulated by cell-fibronectin interaction as well as insulin. It is regulated in a phosphatidylinositol 3-kinase dependent manner and can phosphorylate protein kinase B (PKB/AKT) and GSK-3beta. As a result of these and other activities ILK has been shown to affect anchorage-independent cell survival, cell cycle progression and tumorigenesis in nude mice. ILK has also been implicated in the Wnt pathway and as a critical target in PTEN-dependent tumor therapies. To our knowledge this is the first report implicating the ILK pathway in low oxygen responses. Other genes identified as a result of the microarray analysis not previously known to change as a result of low oxygen treatment were elongation factor-1alpha, glycyl-tRNA synthetase, and laminin receptor protein-1. These findings were all corroborated by RT-PCR assays and in some instances Western blot analysis.

Identification of activating transcription factor 4 (ATF4) as an Nrf2-interacting protein. Implication for heme oxygenase-1 gene regulation

Nrf2 regulates expression of genes encoding enzymes with antioxidant (e.g. heme oxygenase-1 (HO-1)) or xenobiotic detoxification (e.g. NAD(P)H:quinone oxidoreductase, glutathione S-transferase) functions via the stress- or antioxidant-response elements (StRE/ARE). Nrf2 heterodimerizes with small Maf proteins, but the role of such dimers in gene induction is controversial, and other partners may exist. By using the yeast two-hybrid assay, we identified activating transcription factor (ATF) 4 as a potential Nrf2-interacting protein. Association between Nrf2 and ATF4 in mammalian cells was confirmed by co-immunoprecipitation and mammalian two-hybrid assays. Furthermore, Nrf2.ATF4 dimers bound to an StRE sequence from the ho-1 gene. CdCl(2), a potent inducer of HO-1, increased expression of ATF4 in mouse hepatoma cells, and detectable induction of ATF4 protein preceded that of HO-1 (30 min versus 2 h). A dominant-negative mutant of ATF4 inhibited basal and CdCl(2)-stimulated expression of a StRE-dependent/luciferase fusion construct (pE1-luc) in hepatoma cells but only basal expression in mammary epithelial MCF-7 cells. A dominant mutant of Nrf2 was equally inhibitory in both cell types in the presence or absence of CdCl(2). These results indicate that ATF4 regulates basal and CdCl(2)-induced expression of the ho-1 gene in a cell-specific manner and possibly in a complex with Nrf2.