Integrating single-cell and bulk RNA sequencing reveals CK19 + cancer stem cells and their specific SPP1 + tumor-associated macrophage niche in HBV-related hepatocellular carcinoma

PURPOSE

Cytokeratin 19-positive cancer stem cells (CK19 + CSCs) and their tumor-associated macrophages (TAMs) have not been fully explored yet in the hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).

EXPERIMENTAL DESIGN

Single-cell RNA sequencing was performed on the viable cells obtained from 11 treatment-naïve HBV-associated HCC patients, including 8 CK19 + patients, to elucidate their transcriptomic landscape, CK19 + CSC heterogeneity, and immune microenvironment. Two in-house primary HCC cohorts (96 cases-related HBV and 89 cases with recurrence), TCGA external cohort, and in vitro and in vivo experiments were used to validate the results.

RESULTS

A total of 64,581 single cells derived from the human HCC and adjacent normal tissues were sequenced, and 11 cell types were identified. The result showed that CK19 + CSCs were phenotypically and transcriptionally heterogeneous, co-expressed multiple hepatics CSC markers, and were positively correlated with worse prognosis. Moreover, the SPP1 + TAMs (TAM_SPP1) with strong M2-like features and worse prognosis were specifically enriched in the CK19 + HCC and promoted tumor invasion and metastasis by activating angiogenesis. Importantly, matrix metalloproteinase 9 (MMP9) derived from TAM_SPP1, as the hub gene of CK19 + HCC, was activated by the VEGFA signal.

CONCLUSIONS

This study revealed the heterogeneity and stemness characteristics of CK19 + CSCs and specific immunosuppressive TAM_SPP1 in CK19 + HCC. The VEGFA signal can activate TAM_SPP1-derived MMP9 to promote the invasion and metastasis of CK19 + HCC tumors. This might provide novel insights into the clinical treatment of HCC patients.

[Construction of a risk prediction model for diabetes after kidney transplantation based on genome-wide association study]

Objective: To explore the clinical risk factors and susceptibility genes of diabetes after kidney transplantation (PTDM) and construct a risk prediction model for PTDM. Methods: The data of kidney transplant recipients who underwent follow-up in the Affiliated Lihuili Hospital, Ningbo University and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2001 to December 2022 were retrospectively analyzed. The recipients were divided into PTDM group and Non-PTDM group according to whether they were complicated with PTDM. The differences in clinical indicators between the two groups were compared, the risk factors affecting the incidence of PTDM were determined, and susceptibility genes of PTDM were screened by genome-wide association study (GWAS). PTDM risk prediction models based only on clinical indicators (Model 1) and clinical indicators combined with susceptibility genes (Model 2) were established respectively, and the predictive performance of the two prediction models was compared. Finally, the Nomogram of the optimal model was drawn, and the discrimination, calibration and clinical applicability of the model were evaluated. Results: A total of 113 kidney transplant recipients (70 males and 43 females) were included, with an average age of (46.2±10.8) years. There were 51 cases in PTDM group and 62 cases in Non-PTDM group. The related factors screened by GWAS and logistic regression analysis included family history of diabetes (OR=88.912, 95%CI: 5.827-1 356.601, P=0.001), preoperative triglyceride (TG) (OR=1.888, 95 %CI: 1.150-3.098, P=0.012), uric acid (UA) (OR=1.011, 95%CI: 1.000-1.022, P=0.045) and rs802707 (OR=10.046, 95%CI: 1.462-69.042, P=0.019). The area under the curve (AUC) of the receiver operating characteristics analysis (ROC) predicted by Model 1 for PTDM was 0.891 (95%CI: 0.811-0.972), with the sensitivity of 0.889 and the specificity of 0.742. The AUC of ROC curve predicted by Model 2 for PTDM was 0.930 (95%CI: 0.864-0.995), with the sensitivity of 0.885 and the specificity of 0.900. Conclusions: Family history of diabetes, preoperative TG and UA, and rs802707 are significantly associated with the occurrence of PTDM. In addition, the combination of susceptibility genes could improve the predictive ability of clinical indicators for the risk of PTDM.

Fe3O4nanoparticles anchored on carbon nanotubes as high-performance anodes for asymmetric supercapacitors

Fe3O4/CNT composites are synthesized with ethylene glycol as solvent by a one-step solvothermal method and used as anode materials for asymmetric supercapacitors (ASC). An appropriate amount of water in ethylene glycol can accelerate the formation of Fe3O4and reduce the average size of Fe3O4to around 20 nm. However, spherical Fe3O4particles larger than 100 nm will form in pure ethylene glycol for long reaction time. The Fe3O4/CNT composite with small Fe3O4nanoparticles exhibits a high specific surface area, promoted electron transfer ability, as well as a high utilization rate of active materials. The optimized electrode shows a high specific capacity of 689 C g-1at 1 A g-1, and remains 443 C g-1at 10 A g-1. The inferior long-term cycling stability is due to the phase transition of Fe3O4and a reductive effect to form metallic Fe. An ASC using Fe3O4/CNT and NiCoO2/C composites as anode and cathode, respectively, delivers a high energy density of 58.1 Wh kg-1at a power density of 1007 W kg-1in a voltage window of 1.67 V and has a capacity retention of 63% after 5000 cycles. The self-discharge behavior of the ASC is also investigated.

[Evaluation of the efficacy and safety of Nocardia rubra cell wall skeleton immunotherapy for cervical high-risk HPV persistent infection]

Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P>0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant (χ²=142.520, P<0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P<0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P>0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ²=0.073, P=0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.

Genome-wide identification and expression reveal the involvement of the FCS-like zinc finger (FLZ) gene family in Gossypium hirsutum at low temperature

FCS-like zinc finger (FLZ) is a plant-specific gene family that plays an important regulatory role in plant growth and development and its response to stress. However, studies on the characteristics and functions of cotton FLZ family genes are still lacking. This study systematically identified members of the cotton FLZ gene family based on cotton genome data. The cotton FLZ family genes were systematically analyzed by bioinformatics, and their expression patterns in different tissues and under low-temperature stress were analyzed by transcriptome and qRT-PCR. The G. hirsutum genome contains 56 FLZ genes distributed on 20 chromosomes, and most of them are located in the nucleus. According to the number and evolution analysis of FLZ family genes, FLZ family genes can be divided into five subgroups in cotton. The G. hirsutum FLZ gene has a wide range of tissue expression types, among which the expression is generally higher in roots, stems, leaves, receptacles and calyx. Through promoter analysis, it was found that it contained the most cis-acting elements related to methyl jasmonate (MeJA) and abscisic acid (ABA). Combined with the promoter and qRT-PCR results, it was speculated that GhFLZ11, GhFLZ25, GhFLZ44 and GhFLZ55 were involved in the response of cotton to low-temperature stress. Taken together, our findings suggest an important role for the FLZ gene family in the cotton response to cold stress. This study provides an important theoretical basis for further research on the function of the FLZ gene family and the molecular mechanism of the cotton response to low temperature.

[Research progress on the treatment of presbyopia]

Presbyopia is a physiological aging situation that the plasticity and elasticity of the lens and the function of the ciliary muscle become weaker, resulting in a decreased accommodation and inability to focus on near objects. Nowadays, there are many clinical strategies to correct presbyopia, each of which has its own advantages and disadvantages, however, there is no true sense of way to restore accommodation function. This article reviews both worldwide and domestic research on presbyopia, and analyzes and summaries the status quo as well as research progress of presbyopia correction modalities, surgical approaches, and drug therapies, hoping to provide a reference for clinical works.

[Clinical validation of the 2020 diagnostic approach for pediatric autoimmune encephalitis in a single center]

Objective: To evaluate the value of the 2020 diagnostic criteria (Cellucci criteria) for pediatric autoimmune encephalitis (AE) in children with suspected AE in a single center. Methods: The clinical data of 121 children hospitalized at the First Affiliated Hospital of Zhengzhou University from October 2019 to October 2021, with a diagnosis of suspected AE, were retrospectively collected and analyzed. The children were divided into definite antibody-positive AE (dAPAE), probable antibody-negative AE (prANAE), possible AE (pAE) and non-AE groups according to the Chinese expert consensus and the Graus criteria. A new diagnosis was made according to the Cellucci criteria which was compared with the clinical diagnosis to evaluate the diagnostic value of the Cellucci criteria. The Mann-Whitney U test, Kruskal-Wallis test, and χ² test were used to compare the differences among groups. The sensitivity and specificity were used to evaluate efficacy of the Cellucci criteria. Results: Among the 121 children, 72 were males and 49 were females, with an age of 10.3 (6.5, 14.0) years at disease onset. There were 99 cases diagnosed as AE according the clinical diagnosis (58 males and 41 females), of which 43 cases were diagnosed as dAPAE, 14 cases as prANAE and 42 cases as pAE, and the other 22 cases were not AE (14 males and 8 females). The top 2 initial symptoms in the 99 children with AE were seizures (53 cases, 53.5%) and abnormal mental behaviors (35 cases, 35.4%). And the most common symptoms during the course of the disease were abnormal mental behaviors (77 cases, 77.8%) and seizures (64 cases, 64.6%). There were statistically differences in the incidence of consciousness disorders, autonomic dysfunctions during the course of the disease and the length of hospitalization among the 4 groups (χ²=21.63, 13.74, H=22.60, all P<0.05). Ninety-six of the 121 children were tested for AE-related antibodies, of which 45 cases (46.9%) were antibody-positive. According to the Cellucci criteria, 42 cases were diagnosed as dAPAE, 34 cases as prANAE and 14 cases as pAE. Compared with the clinical diagnosis, the sensitivity of the Cellucci criteria for the diagnosis of the 3 types of AE were 93.02%, 92.86% and 87.88%, and the specificity were 96.23%, 74.39% and 86.36%, respectively. Conclusions: The Cellucci criteria has a high sensitivity and specificity for the diagnosis of pAE and dAPAE in the clinical management of children with suspected AE, while a high sensitivity but low specificity for the diagnosis of prANAE. Therefore, it is recommended to apply the Cellucci criteria selectively in clinical practice according to the actual situation, especially in the diagnosis of prANAE.

[FIGO 2018 staging of cervical cancer and related issues]

Globally, cervical cancer continues to be one of the most common cancers among females. Although screening for cervical cancer has been gradually carried out, the incidence and mortality of cervical cancer in China are still at a high level. So the prevention and treatment of cervical cancer in China still has lots of work to do. The International Federation of Obstetrics and Gynecology (FIGO) gynecological oncology committee revised the staging of cervical cancer in 2018. The new staging changed in terms of stage ⅠB and stage Ⅲ compared with previous FIGO staging. FIGO also provided prevention and treatment strategies and the treatment regimens of each stage, which had an important impact on the prevention and treatment of cervical cancer as well as an important enlightenment for China.

[The effect and mechanism of 2-methoxyestradiol on human laryngeal papilloma cell line]

Objective:To explore the signal pathway that mediates the effect of 2-methoxyestradiol（2ME2） on human laryngeal papilloma cell line, in terms of cell proliferation and neovascularization. Method:HIF-1α expression of human laryngeal papilloma cell line（Hs840. T） was interfered using siRNA, and the cells were then processed by 2ME2 in two concentrations. RT-PCR and ELISA were performed to detect the difference of HIF-1α in cells with normal or lower HIF-1α mRNA level, with ELISA test of excretory VEGF level and CCK8 test of cell viability. Result:The IC50of 2ME2 in Hs840. T was 0.309 μmol/L in terms of the inhibition effect of cell proliferation（P<0.01）. Baseline level of intracellular HIF-1α was detectable, and procession of Hs840. T cells by 2ME2 of 0.4 μmol/L inhibited the transcription and expression of HIF-1α by（76.8±2.0）% and（68.6±3.5）% [vs blank group（100.0±2.7）% and（100.0±6.9）%, P<0.01]. VEGF excretion decreased to（50.8±2.1） and（28.1±4.0）% [vs blank group（100.0±3.1）%, P<0.01]after procession by 2ME2 of 0.2 μmol/L and 0.4 μmol/L. After the successful interference of HIF-1α by siRNA, the inhibition effect on cell proliferation by 2ME2 of 0.4 μmol/L decreased to（51.5±3.8）% [vs control group（65.7±1.7）%, P<0.01]. siRNA interference of HIF-1α lead to a decrease of HIF-α mRNA and protein level to（16.3±0.9）% and（7.4±0.8）% [vs cells not interfered（76.8±2.0）% vs（68.6±3.5）%, P<0.01]. Secretory VEGF dropped to（41.0±2.9）% [vs cells not interfered（28.1±4.0）%, P<0.05]. Conclusion:2ME2 has a significant inhibitory effect on human laryngeal cell line. The inhibition of cell proliferation was mediated by a lower level of HIF-1α and therefore lower VEGF. 2ME2 might serve as a novel potential therapy for patients of recurrent respiratory papillomatosis.

[Analysis of chyle leakage after central lymph node dissection for thyroid carcinoma]

Objective: To analyze the clinical characteristics, treatment and prognosis of chyle leakage after central lymph node dissection for thyroid cancer. Methods: A retrospective analysis was made of 985 patients who underwent surgical for thyroid carcinoma plus central lymph node dissection from January 2017 to June 2018 in Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University. Patients were divided into those without (group A, n=973) and with (group B, n=12) chyle leakage. Patients with chyle leakage who underwent left central lymph node dissection were divided into group B1 (n=5) and right central lymph node dissection into group B2 (n=7). Patients with chyle leakage were treated with fat-free diet and negative pressure drainage. SPSS 20.0 software was used to analyze the general condition, surgical pathology, postoperative drainage, hospitalization days, treatment and prognosis of patients in B1 and B2 groups. Results: The incidence of chyle leakage after central lymph node dissection for thyroid cancer was 1.2% (12/985). There were no significant differences in age, sex, size of primary lesion, number of lymph node dissection in central area and number of lymph node metastasis in central area between group A and group B (all P>0.05). The drainage volume on the first day after operation [((51.7±26.7)) ml] and the average hospitalization days [(3.4±0.8) d] in group A were significantly lower than those in group B ([131.3±56.0)]ml, [10.4±2.6)]d). The differences were statistically significant (t value was -5.442, -11.238, respectively, both P<0.001). There were no significant differences in age, size of primary lesion, number of lymph node dissection, number of lymph node metastasis, drainage volume on the first day after operation and average hospitalization days between group B1 and group B2 (all P>0.05). All chyle leakages in group B stopped after conservative management without surgical intervention. Conclusion: The occurrence of chyle leakage after central lymph node dissection is a rare complication. It can be cured by conservative treatment such as diet control, pressure bandaging and negative pressure drainage, and generally does not require secondary surgery.

High performance and high power circularly polarized horn antenna for K-band microwave processing systems

A single-ridged K-band circularly polarized horn antenna offering excellent performance has been developed by improving the polarization conversion and manufacturing complexity. The numerical and experimental results are consistent showing the return loss of this antenna to be less than -20 dB and the axial ratio at the boresight direction to be less than 0.7 dB in the frequency range from 23.5 GHz to 24.5 GHz. In addition, the gain of this antenna is higher than 20 dB. The newly designed circularly polarized horn antenna has a simple structure and outperforms many existing circular polarization devices in high-power operations.

[History, current situation and bottleneck of the diagnosis and treatment system of hepatic hilar cholangiocarcinoma in Japan]

Hilar cholangiocarcinoma is one of the most difficult malignant tumors to treat in the biliary system. In Japan, 5-year survival rate of the disease has increased from 32.5% to 67.1% during the past 30 years. The impressive progress reflects the solid efforts in preoperative endoscopic diagnosis, innovation in surgery such as PTPE as well as hepato-pancreatoduodenectomy and perioperative treatment including replacement of the bile and synbiotic treatment, which have finally formed a set of standardized diagnosis and treatment systems. The present review intends to report the history, current status and remaining bottlenecks of the diagnosis and treatment system of hilar cholangiocarcinoma in Japan as follows.

[The expression and clinical progression of androgen, estrogen and prolactin receptor in laryngeal squamous cell carcinoma]

Objective:The aim of this study is to analyze the different expression and function of androgen receptors (AR) and estrogen receptor (ER-α) in laryngeal squamous cell carcinoma (LSCC). In combination with the expression of prolactin receptor (PRLR), we analyzed the prognostic impact of three receptors on the laryngeal carcinoma. Method:In this study, immunohistochemistry and reverse transcription polymerase chain reaction (RT-PC) analysis were performed on the tumor tissues and adjacent normal tissues in 112 LSCC patients (95 males and 17 females). We found that hormone receptor expression is closely related to the clinical tumor lesions and overall survival data. Result:The expression of AR, ER-α and PRLR in tumor tissues were much higher than those in adjacent normal tissues (P>0.05) at both protein and mRNA levels. The higher PRLR level indicate poor survival in LSCC patients (P=0.02), while higher ER-α expression could influence the survival with considerable trend toward significance (P=0.06). Furthermore, the higher expression of ER-α in tumours were corresponding with PRLR cytoplasmic higher level expression (r=0.802, P=0.04). This mutual promoted effect between ER-α and PRLR possibly suggests potential mechanisms among those sex related hormone receptors in laryngeal cancer. Conclusion:It has become increasingly credible that the sex related hormone receptors play an important role in the development of LSCC.

[Prevalence of high-risk HPV and its distribution in cervical precancerous lesions among 35-64 years old women who received cervical cancer screening in Beijing]

Objective: To study the prevalence of high-risk HPV (HR HPV) in women who accepted cervical cancer screening in Beijing and its distribution in cervical precancerous lesions. Methods: From January 2014 to March 2015, all women aged 35-64 years old and received free screening in institutions of cervical cancer in Beijing were recruited. Stratified cluster random sampling method was used in selecting 31 091 women for gynecological examination and genotyping of HR-HPV. Those positive for HR-HPV (except for HPV 16/18) were examined for cervical cell. For those atypical squamous cells of uncertain significance (ASCUS) and above, who were positive for HPV 16/18 and with uncertain results for cervical cell, were transferred for colposcopy examination. For those with suspicious or abnormal results for colposcopy, were transferred for histopathology. The prevalence of HR-HPV, cervical cancer and precancerous lesions among the participants were analyzed. Results: Totally 31 091 women aged from 35-year-old to 64-year-old, with 44.3% (13 780 women) in the 35-49 age group and 55.7% (17 311 women) in the 50-64 age group. 66.1% (20 536 women) were rural women. The infection rate of HR-HPV was 7.4%(2 305 cases) among the women. High-risk infection rates of HPV except HPV 16/18 were 5.7% (1 758 cases), and multi-infection rate was 1.5% (477 cases). The highest infection rate was 7.9% (1 044 cases) among the 45-49 year-old and 50-54 year-old age groups (χ(2)=14.07, P=0.015). The rate in rural women was significantly higher than that of the urban women (6.2%, 507 cases; 7.9%, 1 798 cases) (χ(2)=25.75, P<0.001). The proportion of HPV16, HPV18, HPV52, HPV51, HPV58 was 17.0% (391 cases), 6.9% (161 cases), 8.6% (20 cases), 5.2% (12 cases) and 7.7% (18 cases), respectively. The detection rate of cervical cancer and precancerous lesions in the population was 395.6/100 000 (123 cases). In high-grade squamous intraepithelial lesions (HSIL), HPV16 and 18 infections accounted for 60.5% (72 cases) of all. HPV16 infection rate and detection rate of HSIL were the highest in 50-54 year-old group which were 1.5% (107 cases) and 25.2% (30 cases) (χ(2)=11.54, P=0.042). Conclusion: Top five types of HR-HPV infection in women who accepted cervical cancer screening in Beijing were HPV16, 18, 52, 51 and 58. The infection rate of HPV16 and 18 increased significantly in HSIL women. HPV16 infection rate and detection rate of HSIL were the highest in 50-54 year-old age group.

[Effect of different surface treatments on the crystal structure and properties of zirconia]

OBJECTIVE

To investigate the effects of 3 surface different treatments on the crystal structure, shear bond strength,roughness value and flexural strength of zirconia.

METHODS

The zirconia specimens were prepared and randomly divided into 4 groups and received the following treatments: (1) blank control group,the specimens without treatments; (2)sandblasting with alumina group, sandblasting the specimens with 110 μm alumina particles for 21 s as working pressure 0.25 MPa and working distance 10 mm; (3)laser etching group, coating the surface of the specimens with graphite powder and using Er:Yttrium Aluminum Garnet (Er:YAG) laser to irradiate the surface 30 s; (4) hot-etching group, putting the specimens in a closed reactor within a 1:1 mixture of 40% (mass traction) nitric acid and 68%(mass traction) hydrofluoric acid liquid, the reaction of 30 min in a water bath at 100 degrees centigrade. The changes of crystal structure, shear bond strength(SBS) and flexural strength of zirconia after different surface treatments were tested.

RESULTS

The X-ray diffractometer (XRD) patterns showed that the volume percentage of monoclinic phase of the 4 groups was 0.91%, 12.50%, 6.64% and 17.81% respectively. The roughness value for the four groups were as follows: blank control group,(0.29±0.01) μm; sandblasting with alumina group, (1.05±0.11) μ m; laser etching group, (0.73±0.04) μm; hot-etching group, (1.31±0.06) μm, respectively(P<0.05). Mean SBS was (7.09±0.46) MPa in blank control group, (12.14±1.51) MPa in sandblasting with alumina group, (8.82±0.74) MPa in laser etching group and (11.97±0.99) MPa in hot-etching group. There was no statistically significant difference between sandblasting with alumina group and hot-etching group (P>0.05), but the difference between the other groups were statistically significant(P<0.05). Mean three-point bending was (933.70±44.13) MPa in blank control group, (850.95±60.66) MPa in sandblasting with alumina group, (771.53±68.08) MPa in laser etching group and (766.27±57.49) MPa in hot-etching group. There was no statistically significant difference between sandblasting with alumina group and hot-etching group (P>0.05), but the difference between the other groups were statistically significant (P<0.05).

CONCLUSION

After different surface treatments, the surface of zirconia has changed from tetrago-nal to monoclinic phases in varying degrees. In addition, surface treatments could improve the bond strength of zirconia to resin cement, and also lead to a decrease in the flexural strength of zirconia.

[Preliminary findings for metabolite profiles of papillary thyroid carcinoma and laryngeal squamous cell carcinoma]

Objective:To identify distinct metabolite profiles of papillary thyroid cancer (PTC) and laryngeal squamous cell carcinoma (LSCC).Method:Tumor and adjacent non-tumor specimens were collected from 57 PTC and 33 LSCC patients. Distinct metabolite profiles of tissues were examined using a combination of gas chromatography-time-of-flight mass spectrometry and ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry. The data were analyzed with multivariate statistical analysis to compare the distinct metabolite profiles and related pathways of these three tumors.Result:A panel of 46 and 41 differentially expressed metabolites were identified in tumor and adjacent non-tumor tissues of PTC and LSCC, respectively. Increased glycolysis, amino acids metabolism, one carbon metabolism and tryptophan metabolism were found in these two types of tumor tissues compared to adjacent non tumor tissues. Purine and pyrimidine metabolism was significantly elevated in PTC and LSCC tumor tissues, while taurine and hypotaurine were only higher in PTC tumor tissues. The fatty acid metabolism was detected at lower level in both PTC and LSCC tumor tissue.Conclusion:PTC and LSCC tumor tissues not only have common metabolic signatures characterized by increased glycolysis, amino acids metabolism, one carbon metabolism and tryptophan metabolism, but also have distinct metabolic signatures. It is helpful to understand the nature of these two tumors.

[Factors for lymph node metastasis and survival rate in papillary thyroid microcarcinoma: from a large cohort of 3 607 cases series]

Objective: To investigate high-risk factors for lymph node metastasis (LNM) and 10-year survival rate in patients with papillary thyroid microcarcinoma (PTMC). Methods: We retrospectively analyzed the clinical data of 3 607 patients with PTMC received surgery in our hospital from January 2005 to December 2015. Univariate and multivariate analyses were performed to identify the factors associated with metastasis and 10-year survival rate of the patients was calculated. Results: The patients accepted an average follow-up of 68 months, with follow-up from 18 to 138 months. Total LNM rate in the 3 607 patients with PTMC was 17.13%. Central lymph node metastasis rate was 16.86%, which was related to gender (males 21.89% vs females 15.26%, P<0.01), age (<45 years old 24.44% vs ≥45 years old 11.96%, P<0.01), tumor diameter (P<0.01) and multifocality (P<0.01). Lateral lymph node metastasis rate was 1.05%, which was related to age (<45 vs ≥45, P<0.01) and tumor diameter (P<0.01). The 10-year-survival rate was 93.0% and 10-year recurrence-free survival rate was 87.5%. Conclusion: PTMC may metastasize to cervical lymph node, especially in males, with age younger than 45, multifocal tumors and maximal tumor diameter larger than 0.7 cm. There was no significant correlation between these clinical features associated with LNM and the 10-year survival rate.

[Research for intraoperative localization of parathyroid gland usingnanocarbon imaging combined with 99m Tc-MIBI]

Objective:To explore the clinical application of nanocarbon(NC) suspension liquid combined with low dose of 99m Tc-MIBI for parathyroid localization in the hyperparathyroidism surgery.Method:Forty-four patients with secondary hyperparathyroidism(SHPT) in the department of head-neck surgery of Renji Hospital, affiliated to Shanghai Jiaotong University, School of Medicine, were enrolled and randomized into 3 groups including low-dose 99m Tc-MIBI+NC groupⅠ, high dose99m Tc-MIBI+NC group Ⅱ,and control group Ⅲ.We compared the level of PTH,serum calcium before and after operation,and the intraoperative amount of radioactive isotopes of parathyroid gland, etc.Use t-test and Anova for statistical processing. Result:After operation,the PTH levels in group Ⅰ,Ⅱ,Ⅲ were(23.8±32.4)ng/L,(15.8±18.2)ng/L,(90.1±139.4)ng/L,respectively(groupⅠvs Ⅲ,P<0.05;groupⅡvs Ⅲ,P<0.05,groupⅠvsⅡ,P>0.05).The intraoperative amount of radioactive isotopes of parathyroid gland had no significant difference among group Ⅰ,group Ⅱ and group Ⅲ. Conclusion:Nanocarbon combined with 99m Tc-MIBI for SHPT surgery has important localization value.And low dose of 99m Tc MIBI can reduce the cost and radiation, which can achieve the same outcome for patients..

[Comparison of the clinical efficacy of different treatments based on radical surgery in stage Ⅰ b2 and Ⅱa2 cervical cancer: a prospective randomized control study]

OBJECTIVE

To compare the clinical efficacy of different treatments based on radical surgery in stage Ⅰ b2 and Ⅱ a2 cervical cancer through prospective randomized controlled study.

METHODS

A total of 133 patients with stage Ⅰ b2 and Ⅱ a2 cervical cancer treated at Beijing Obstetrics and Gynecology Hospital of Capital Medical University during January 2009 to December 2012 were enrolled and randomly assigned to receive one of the following three treatments: preoperative intracavitary irradiation(PII)group, radical hysterectomy(RH)group, and neoadjuvant chemotherapy(NACT)group. Operation method included uterine extensive resection, pelvic lymph node excision, with or without para-aortic lymph node resection. The recent curative effect and side effect of preoperative treatment were observed. The operation time, intraoperative blood loss, surgical complications, postoperative pathological risk factors and postoperative adjuvant therapy and side effect, the survival situation were evaluated among the 3 groups.

RESULTS

(1)The response rates were 88%(37/42)and 82%(37/45)respectively of the PII group and NACT group. The difference was insignificant(P=0.528). Side effects were less in the PII group. Only 5 patients(12% , 5/42)had slight gastrointestinal reaction. Myelosuppression and gastrointestinal reaction in NACT group were 76%(34/45)and 67%(30/45)respectively, which were more serious than that in group PII group(P<0.05).(2)Intraoperative blood loss and operation time in PII group [(678± 239)ml and(181±39)minutes]and NACT group [(625±137)ml and(168±25)minutes]had a decreasing trend compared with that in RH group [(711 ± 319)ml and(202 ± 64)minutes], but the differences were no significant(P >0.05). NACT group could shorten operation time compared with the RH group(P <0.05). The lymph node metastases rate were 30%(14/46), 29%(12/42)and 29%(13/45)and the deep stromal invasion rate were 22%(10/46), 31%(13/42)and 31%(14/45)in RH group, PII group and NACT group respectively(all P>0.05). The lymph-vascular space involvement(LVSI)in NACT group was significantly lower than that in RH group [31%(14/45)vs 57%(26/46), P=0.015]. The number of patients with histological risk factors in NACT group was higher thanthat in RH group [27%(12/45)vs 9%(4/46), P= 0.024]. All surgery were successfully completed and no treatment-related deaths occurred in three groups. The incidence of 3-4 grade adverse reactions evaluated by the common terminology criteria for adverse event(CTCAE)was 13%(6/46), 14%(6/42), 18%(8/45)in RH group, PII group and NACT group respectively(P=0.855). Three-year disease free survival(PFS)were 74.0%, 78.5% and 80.0%, and 3-year overall survival(OS)were 80.4%, 83.3% and 84.4% in RH group, PII group and NACT group respectively(all P>0.05).

CONCLUSIONS

The recent curative effect of PII and NACT were similar. They couldn't improve 3-year of PFS and OS of the patients with Ⅰb2 and Ⅱa2 stage cervical cancer. But NACT can reduce the operation difficulty and can reduce the incidence of postoperative pathological risk factors, which could reduce postoperative adjuvant therapy.

Influence of passive potential on the electronic property of the passive film formed on Ti in 0.1 M HCl solution during ultrasonic cavitation

The influence of the applied passive potential on the electronic property of the passive film formed on Ti at different potentials in 0.1M HCl solution during ultrasonic cavitation, was investigated by electrochemical impedance spectra (EIS) and Mott-Schottky plot. The influence of the applied passive potential on the structure and composition of the passive film was studied by X-ray photoelectron spectroscopy (XPS) and Auger electron spectroscopy (AES). The results showed that the applied passive potential can obviously affect the electronic property of the passive film formed on Ti during ultrasonic cavitation. The resistance of the passive film increased, and the donor density of the passive film decreased with increasing the potential. The flat band potential moved to positive direction and the band gap of the passive film moved to negative direction with increasing potential. AES and XPS results indicated that the thickness of the passive film increased evidently with applying passive potential. The passive film was mainly composed of the mixture of TiO and TiO2. While the TiO2 content increased with increasing the applied passive potential, and the crystallization of the passive film increased with the increased potential.

The role of passive potential in ultrasonic cavitation erosion of titanium in 1 M HCl solution

The influence of the applied passive potential on the ultrasonic cavitation erosion of Ti specimen in 1 M HCl solution was investigated by mass loss experiment, scanning electron microscopy (SEM), electrochemical impedance spectra (EIS) and Mott-Schottky plot. The results showed that Ti was in the passive state within the potential region from -0.3 VSCE to 1.5 VSCE under ultrasonic cavitation erosion. The applied passive potential can obviously decrease the mass loss of Ti caused by ultrasonic cavitation erosion in 1 M HCl solution. The resistance of the passive film increased, the flat band potential moved to positive direction, and the donor density of the passive film decreased with increasing the passive potential. Finally, a physical model was provided to explain the experimental results based on energy band and semi-conductive theories.

Ultrasonic cavitation erosion of Ti in 0.35% NaCl solution with bubbling oxygen and nitrogen

The influences of oxygen and nitrogen on the ultrasonic cavitation erosion of Ti in 0.35%NaCl solution at room temperature, were investigated using a magnetostrictive-induced ultrasonic cavitation erosion (CE) facility and scanning electron microscopy (SEM). The roles of oxygen and nitrogen in the composition and the electronic property of the passive film on Ti, were studied by Mott-Schottky plot and X-ray photoelectron spectroscopy (XPS). The results showed that the mass loss of Ti in 0.35%NaCl solution increased with increasing cavitation time. Bubbling oxygen can evidently increase the resistance of ultrasonic cavitation erosion comparing with bubbling nitrogen. XPS results showed that the thickness of the passive film on Ti in 0.35%NaCl solution in the case of bubbling oxygen for 3 weeks, was about 7 nm, and the passive film was mainly composed of TiO2 with an anatase structure. While TiO2 with a rutile structure was found to be the major component of the passive film on Ti in 0.35%NaCl solution in the case of bubbling nitrogen for 3 weeks, and the film thickness was 5 nm. The results extracted from Mott-Schottky plot showed that the passive film on Ti in the case of bubbling oxygen had more donor density than the passive film on Ti in the case of bubbling nitrogen.

Association of thyroid carcinoma with pregnancy: A meta-analysis

A number of scholars reported that reproductive factors play a significant role in thyroid cancer and the correlation between the two may affect the diagnosis and treatment of thyroid carcinoma during pregnancy. To determine whether pregnancy reproductive factors affect thyroid carcinoma, we conducted a meta-analysis of studies that investigated the association between pregnancy factors and thyroid carcinoma. PubMed, OVID and the Cochrane Library were searched from their inception to April 1st, 2013. The searched publications mainly investigated reproductive factors and the morbidity or prognosis of female thyroid carcinoma. The studies were filtered by predetermined standards and the quality of the included studies was evaluated by the Newcastle-Ottawa scale inventory. Two researchers independently extracted information on first author, year of publication, study design (case-control or prospective cohort), compared populations, inclusion and exclusion criteria and total sample size. Other researchers assessed the studies for publication bias and performed statistical analyses. Discrepancies were resolved by consensus. A total of 21 studies were selected for the meta-analysis, including 406,329 cases in total. Compared to the control group, the risk of thyroid carcinoma in women with a history of pregnancy was not significantly discrepant, [odds ratio (OR)=1.00, 95% confidence interval (CI): 0.91-1.11]. However, the risk of thyroid carcinoma in women with a history of ≥ 3 pregnancies was significantly increased (OR=1.39, 95% CI: 1.21-1.59). Furthermore, an interval of ≤ 5 years since the last pregnancy was closely associated with thyroid carcinoma (OR=1.53, 95% CI: 1.29-1.81). The patients developed thyroid carcinoma during pregnancy did not exhibit an increased risk of lymphatic metastasis (OR=0.94, 95% CI: 0.53-1.67); the risk of distant metastasis also did not increase significantly (OR=1.03, 95% CI: 0.86-1.24). Therefore, multiple pregnancies and a ≤ 5-year interval between pregnancies were identified as high-risk factors for thyroid carcinoma, whereas thyroid carcinoma during pregnancy was not associated with a significant risk of lymphatic and distant metastasis.

Effect of micro/nano-particles in cavitation erosion

The tests in de-ionized water with micro/nano CeO2 particles are carried out to study the effect of the micro/nano particles in inception of cavitation erosion. The existence of micro/nano particles is found to be the requisite factor and the degree of cavitation erosion is related to the sizes of the particles. Particles in the micro/nano scale may act as the transporters of micro bubbles to keep or get close to the solid surface together and the pressure fluctuation induced by the surface roughness causes the collapse of bubbles and erosion of the surface. Discrete phase models are employed to simulation the moving tracks of the particles. The sizes of the particles affect their capabilities of keeping and getting close to the surface. The effect of the particles of a certain size in cavitation erosion is determined by the combinational action of the two.

[Surgical exploration of the sentinel lymph nodes in the papillary thyroid carcinoma]

OBJECTIVE

To study the technique of sentinel lymph node mapping in the papillary thyroid carcinoma and its evaluation in the search for cervical metastases.

METHOD

Exploration of the sentinel lymph nodes of the papillary thyroid carcinoma by injection of methylene blue around the tumour among 25 patients during surgery. The nodes which stained blue and the other nodes removed by functional neck dissection were examined histologically after staining with hematoxylin-eosin-saffron (HES). We have evaluated the predictive value of the technique in mapping the cervical metastases in the sentinel lymph node.

RESULTS

Among the 25 patients, 22 patients presented sentinel lymph nodes (blue-stained), that is to say a rate of identification of 88%. At histological examination, 19 of the 22 patients had positive sentinel lymph nodes, of which 13 had also positive nodes not coloured with blue. The histological examination of patients without sentinel lymph node was negative.

CONCLUSION

The technique of the sentinel lymph node has a strong positive predictive value in the search for cervical node metastases in the papillary thyroid carcinoma.

Menstrual-like changes in mice are provoked through the pharmacologic withdrawal of progesterone using mifepristone following induction of decidualization

BACKGROUND

Cyclic shedding of the endometrium is unique to menstruating species, and mouse menstruation models by physiologic progesterone withdrawal have been previously reported. Since progesterone action ablated pharmacologically may provide more insight into the mechanism of action, a mouse menstruation model using mifepristone was established.

METHODS

Mifepristone was administered following oil-induced decidualization in ovarectomized mice primed with hormones. Morphology, hormone levels, leukocytes and apoptosis were evaluated over a period of 48 h after treatment. Vaginal smears were used to monitor bleedings.

RESULTS

Mifepristone induced menstrual-like changes. Tissue breakdown was drastic by 16 h, and the decidual zone was shed by 24 h while the mice bled. The endometrium regenerated from 24 h onwards and became completely restored by 48 h. These results are consistent with previous reports. However, although progesterone levels remained constant, estradiol levels increased after the treatment. The CD45(+) cells showed two peaks of increase at 16 h (breakdown phase) and 32 h (regeneration phase) (Leukocyte levels also increased in the unstimulated horns, but no breakdown changes occurred there). Moreover, apoptosis drastically increased by 16 h concurrent with tissue destruction. These results differed from those of the physiologic withdrawal models.

CONCLUSIONS

The pharmacologic withdrawal of progesterone by mifepristone successfully provoked a menstrual-like process in mice after artificial decidualization.

Bacillus circulans WZ-12—a newly discovered aerobic dichloromethane-degrading methylotrophic bacterium

A novel dichloromethane (DCM)-degrading bacterial strain named WZ-12 (GenBank accession no. EF100968) was isolated and identified as Bacillus circulans based on standard morphological and physiological properties and nucleotide sequence analysis of enzymatically amplified 16S ribosomal deoxyribonucleic acid. DCM dehalogenase from B. circulans WZ-12 was purified to 8.27-fold with a yield of 34.83%. The electrophoretically homogeneous-purified enzyme exhibited a specific activity of 118.82 U/mg. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of purified DCM dehalogenase gave a distinct band with an estimated molecular mass of 20,000 +/- 1,000.

Life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy

BACKGROUND

Limited data are available on the life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy (HAART).

AIM

To provide such an estimate using a semi-parametric projection.

DESIGN

Statistical analysis.

METHODS

Follow-up data for patients newly diagnosed with HIV infection in Taiwan (HIV/AIDS Cohort) from 1 May 1997 to 30 April 2003 (n = 3351, only 1% are injecting drug users) were analysed using the Kaplan-Meier method. The survival function for an age- and gender-matched reference population was generated by the Monte Carlo method from the life-table of the general population. A constant excess hazard model was used to project long-term survival of HIV-infected patients, with linear extrapolation of a logit-transformed curve of survival ratio between HIV-infected patients and the reference population.

RESULTS

The 5-year survival rate was 58% in patients who had already developed AIDS at diagnosis (AIDS group), and 89% in those who had not (non-AIDS group). Extrapolation yielded an expected mean survival time of 10.6 years after diagnosis for the AIDS group, and 21.5 years after diagnosis for the non-AIDS group.

DISCUSSION

Our results support the expansion of HIV screening programs to minimize delay in diagnosis. With continuing advances in HAART, this estimate of survival in initially asymptomatic patients may be conservative. Their long life expectancy raises questions about what kind of preventive heath services should be offered. These should be addressed through further analysis of overall benefit and cost-effectiveness.

Assessment of soil lead exposure in children in Shenyang, China

Soil lead pollution is serious in Shenyang, China. The paper brings together the soil work, the bioaccessibility, and the blood lead data to assess the soil lead exposure in children in Shenyang, China. Approximately 15.25% of the samples were above China Environment Protection Agency guideline concentration for soil Pb to protect human from health risk (350 mgkg(-1)). Pb concentrations varied among use scenarios. The main lead contamination sources are industry emission and automobile exhaust. Bioaccessibility also varied among use scenarios. Children, who ingested soil from industrial area, public parks, kindergarten playground, and commercial area, are more susceptible to soil lead toxicity. The industrial area soil samples presented higher bioaccessibility compared to the other use scenario soil samples contaminated by automobile exhaust. The result also suggested a most significant linear relationship between the level of Pb contamination and the amount of Pb mobilized from soil into ingestion juice. Soil pH seemed to have insignificant influence on bioaccessibility in the present study. Bioaccessibility was mainly controlled by other factors that are not investigated in this study. A linear relationship between children blood lead and soil intestinal bioaccessibility was present in the study. Children who are 4-5 years old are more likely to demonstrate the significant relationship between soil lead bioaccessibility and blood lead as their behaviors place them at greatest risk of soil lead toxicity, and their blood lead levels are more likely to represent recent exposure.

Update on clarithromycin resistance in Helicobacter pylori in Hong Kong and its effect on clarithromycin-based triple therapy

AIM

To determine the antibiotic susceptibility of Helicobacter pylori and evaluate the efficacy of a clarithromycin-based triple therapy in relation to antibiotic resistance.

METHODS

Consecutive patients referred for upper endoscopy due to dyspeptic symptoms were recruited. Gastric biopsies were obtained for the CLO test, histology and culture. Antibiotic susceptibility was assessed by the E-test. Patients with H. pylori infection received rabeprazole 20 mg, clarithromycin 500 mg, and amoxicillin 1,000 mg, all twice daily for 7 days.

RESULTS

Of 234 patients recruited, 124 were H. pylori-positive and culture was successful in 102 patients. The updated prevalences of resistance to clarithromycin, amoxicillin and metronidazole were 7.8, 0 and 39.2%, respectively. A total of 86 patients received 1-week triple therapy with rabeprazole 20 mg, clarithromycin 500 mg, and amoxicillin 1,000 mg, all twice daily, and 81 patients attended the follow-up test. Eradication rates by per-protocol and intention-to-treat analysis were 92.6 and 87.2%, respectively. The eradication rate by per protocol was significantly higher in patients with clarithromycin-susceptible strains than in those with clarithromycin-resistant strains (98.6 vs. 28.6%, p < 0.001).

CONCLUSION

Clarithromycin resistance reduces the clinical efficacy of clarithromycin-based triple therapy. However, due to the low prevalence of clarithromycin resistance, clarithromycin-based therapy is still the first choice for clinical use.

Effect of cyclo-oxygenase inhibitors on Helicobacter pylori susceptibility to metronidazole and clarithromycin

BACKGROUND

We previously reported that aspirin inhibited Helicobacter pylori growth and suppressed the mutagenic effect of metronidazole.

AIM

To determine the effects of a cyclo-oxygenase (COX)-2-specific inhibitor, SC-236, and a non-selective COX inhibitor, indometacin, on the growth, urease activity and antimicrobial susceptibility of H. pylori.

METHODS

Three H. pylori reference strains, and 18 clinical isolates were treated with SC-236 or indometacin for 24 and 48 h. Growth, urease activity and susceptibility to clarithromycin and metronidazole of the bacteria were assessed by viable colony counting, spectrophotometry and E-test respectively.

RESULTS

SC-236 and indometacin inhibited H. pylori growth in a dose-dependent manner with the lowest inhibitory concentrations of 0.03 and 0.1 mm, and the lethal concentrations of 0.09 and 0.3 mm, respectively. The numbers of CFU/mL in Brucella broth containing 0.09 mm SC-236 were 2 log lower at 24 h, and even 3 log lower at 48 h than that at 0 h (P = 0.035, compared with the vehicle control). Treatment of 0.3 mm indometacin reduced the number of CFU/mL by 1 log at 24 h compared with that at 0 h (P = 0.037 compared with the vehicle control). Helicobacter pylori urease activity began to decrease with 0.06 mm SC-236 at 24 h (P = 0.016), and 0.3 mm indometacin at 48 h (P = 0.025). MICs of metronidazole and clarithromycin against H. pylori were decreased significantly in the presence of 0.03 mm SC-236 or 0.1 mm indometacin (all P < 0.001).

CONCLUSION

Both SC-236 and indometacin suppressed the growth and urease activity of H. pylori in a dose-dependent manner, and increased its susceptibility to the antibiotics.

Pharmacokinetics and Lipid-Lowering Effect of Fluvastatin in Hypercholesterolaemic Patients on Maintenance Haemodialysis

Patients undergoing haemodialysis are predisposed to serum lipid abnormalities that can accelerate the development of atherosclerosis. Serum lipid levels must therefore be controlled over a long period. For patients with reduced renal function (including dialysis patients), special attention must be paid to hyperlipidaemia therapy, particularly drug selection. In this study, 30 mg/day fluvastatin was administered orally to five patients receiving maintenance haemodialysis. Their serum lipid levels and blood biochemistry were monitored during the 6 months of fluvastatin administration, and the pharmacokinetic parameters calculated. The therapeutic efficacy and safety of fluvastatin were demonstrated in this patient group. Furthermore, fluvastatin is not influenced by the dialysis membrane and does not accumulate in haemodialysis patients with hyperlipidaemia.

Epithelial maturation and extracellular matrix in reduced enamel epithelium

OBJECTIVE

To evaluate epithelial-mesenchymal interactions in morphological homeostasis through histologically orientated observations on the reduced enamel in epithelium.

STUDY DESIGN

Specimens were taken from impacted molar sites in 20 patients using the surgery. These were processed using standard histological, pathological and biochemical techniques. Slides were observed with a Nikon Eclipse E-600, Plan Apo piece, Microscopy, and photography was done using a Nikon Coolpix 990 digital camera.

RESULTS

Radiolucent lesions displayed the supporting fibrous connective tissue wall with stratified squamous epithelium lining mostly. None of the specimens displayed prominent CAM 5.2, and anti-human K7 reacuvity, and PAS positive staining.

CONCLUSION

While the results of this study suggest that the reduced enamel epithelium showed a lower tendency in cell cycle, it does indicate that a histologically oriented study of reduced enamel epithelium is needed for the understanding of epithelial-mesenchymal interactions in morphogenesis.

Comparative evaluation of the BACTEC MGIT 960 system with solid medium for isolation of mycobacteria

SETTING

The utilisation of new, rapid methods of diagnosis of tuberculosis is currently of great interest for tuberculosis control. This study was carried out in a teaching hospital in the eastern region of Taiwan.

OBJECTIVE

The BACTEC MGIT 960 system was evaluated and compared with Lowenstein-Jensen (LJ) medium and Middlebrook 7H11 plate for recovery rate and time to detection of mycobacteria.

DESIGN

A total of 1396 sputum samples were tested for the presence of mycobacteria. Specimens were processed and inoculated separately in the BACTEC MGIT 960 system, on LJ medium and 7H11 for comparative study.

RESULTS

The BACTEC MGIT 960 detected 235 isolates (100%), followed by LJ with 205 isolates (87.2%) and 7H11 with 178 isolates (75.7%). The mean time to detection of Mycobacterium tuberculosis complex was 11.6 days with MGIT 960, 20.1 days with LJ, and 18.7 days with 7H11. The contamination rates were 15.1% with MGIT 960, 10.1% with LJ and 9.7% with 7H11.

CONCLUSION

The BACTEC MGIT 960 system is a sensitive, rapid mycobacterial culturing system. However, the high contamination rate is a concern that should be carefully evaluated in the clinical setting.

Validation of the World Health Organization quality of life instrument in patients with HIV infection

We studied the reliability and validity of the World Health Organization quality of life (WHOQOL) assessment instrument in patients with human immunodeficiency virus (HIV) infection. WHOQOL-BREF was used to assess 136 HIV-infected outpatients. The results were analyzed and compared with data from 213 healthy persons. The Cronbach's alpha for internal consistency ranged from 0.74 to 0.85 across domains in HIV-infected patients. The test-retest reliability ranged from 0.64 to 0.79 across domains at average 4-week retest interval. Factor analysis identified four major factors: social, psychological, environment, and physical, consistent with the four domains of the instrument. The scores of all four domains correlated positively with self-evaluated health status and happiness (r range: 0.52-0.60 and 0.55-0.73 across domains, respectively), and correlated negatively with the number and severity of symptoms (r range: -0.40 to -0.47 and -0.41 to -0.52, respectively). The scores of physical, psychological and social domains, but not the environment domain, discriminated between healthy persons and HIV-infected patients (all p < 0.01). We conclude that the WHOQOL-BREF can be a useful quality-of-life instrument in patients with HIV infection.

An alternative method to enhance vagal activities and suppress sympathetic activities in humans

Vagal withdrawal and/or sympathetic overactivity is always accompanied by various kinds of stress and is dangerous to the body. We proposed that mild acupuncture on the Sishencong points may effectively enhance vagal activities but suppress sympathetic regulations of the heart in humans. Experiments were carried out on nine healthy male volunteers, while they were lying in a quiet room during 2-4 P.M. Acupuncture was applied 2 mm deep into the skin using standard stainless acupuncture needles at the Sishencong points, which are located on the vertex of the head, each 1 cm away from Baihui (GV 20) in four directions. Four points around the temporal area were selected as control points. Forty minutes of precordial ECG signals before, during, and after acupuncture were recorded continuously. Frequency-domain analysis of the stationary RR intervals was performed to evaluate the total variance, high-frequency power (HF, 0.15-0.40 Hz) and low-frequency power (LF, 0.04-0.15 Hz) in normalized units (LF%). Acupuncture on the Sishencong points resulted in an increased HF but a decreased LF% compared with the before acupuncture stage. Such effects did not occur when manual acupuncture was applied to the control points. The differences in the heart rate dynamics between Sishencong and the control groups took place 10 min after initiation of acupuncture and persisted even after the removal of the needles. Based on these results, we concluded that manual acupuncture on the Sishencong points enhanced cardiac vagal and suppressed sympathetic activities in humans. The underlying mechanisms and potential applications warrant further investigations.

The differences between late graft loss group and long-term graft survival group in renal transplantation

In renal transplantation, the long-term graft survival rate has not been improved. Until now, the differences between late graft loss and long-term graft survival have still not been estimated thoroughly. We have attempted to define clinical risk factors and parameters for late graft loss by comparing the differences in these two groups. Data from the Osaka University Database were assessed on 156 renal allografts during a 7-yr period. Thirty-six patients comprised the late graft loss group (patients in this group had graft function without need for dialysis for more than 3 yr post-transplantation, afterwards lost the allograft: 'loss group'). One hundred and twenty patients comprised the long-term graft survival group (patients in this group had graft function without need for dialysis until 31 December 1999: 'survival group'). Various immunological and non-immunological parameters were included in an univariate regression analysis. This analysis showed that donor age (P < 0.01), HLA mismatch number (P < 0.01) and a repeat of acute rejection (P < 0.01) were significant factors. Serum creatinine levels at 3 months (P = 0.01), proteinuria at 1 yr (P < 0.01) and antihypertensive treatment at 2 yr (P = 0.03) after transplantation were predictive of the risk of late graft loss. CsA trough concentration at 3-6 months (P < 0.05) and body mass index increase at 1 yr (P = 0.046) were elevated in the loss group. These results from a single centre suggest that immunological as well as non-immunological factors are associated with the pathogenesis of late graft loss.

[Preparation and evaluation of alkyl ether-bonded phase for reversed-phase high performance liquid chromatography]

A new silane coupling agent, beta-(3,4-epoxycyclohexyl)ethyltrimethoxy silane, was for the firsty time used to react with octanol, then the intermediate product was coupled onto porous silica to obtain a novel bonded phase for reversed-phase high performance liquid chromatography (RP-HPLC). Characterization of prepared packing was carried out with elemental analysis, solid-state 13C nuclear magnetic resonance spectrometry (NMR), Fourier transform infrared(FT-IR) spectroscopy. Chromatographic evaluations were carried out by using a mixture of organic compounds and methanol-water as the binary mobile phase. The results showed that the stationary phase has excellent chromatographic properties and resist to hydrolysis at a pH value between 2.5 and 7.5. The silanophilic activity of the OEBP was weakened because of the existence of the cyclohexyl group in the packing. It can be efficiently used for the separation of basic compounds.

Changes in lipid metabolism and effect of simvastatin in renal transplant recipients induced by cyclosporine or tacrolimus

Hyperlipidemia is frequently developed following renal transplantation and results in worsening of the patient's prognosis. In study 1, the effects of immunosuppressants, cyclosporine (CsA) and tacrolimus on serum lipids were compared in-patients undergoing renal transplantation. The study included 32 cases of renal transplantation recipients who randomized to the CsA treatment group (15 patients) and the tacrolimus group (17 patients). Before and 1 month after the transplantation, we assessed the serum lipid levels, apolipoprotein levels, the concentrations of cholesterol in the respective lipoprotein fractions and the enzyme activities related to lipid-metabolism. The serum lipid levels in both groups were significantly increased at 1 month after renal transplantation. In the CsA group, there were significant increases in cholesterol contents in very-low-density lipoprotein (VLDL), LDL2 and HDL2 fractions, whereas, in the tacrolimus group, cholesterol content was increased in VLDL and HDL2 fractions. In study 2, 1 month after renal transplantation, 19 patients with hypercholesterolemia (total cholesterol (TC) >200 mg/dl) and hypertriglyceridemia (triglyceride (TG) >150 mg/dl) were treated with simvastatin 5-10 mg/day for 6 months. Simvastatin treatment significantly decreased serum TC (240+/-29-200+/-22 mg/dl, P<0.001), low-density lipoprotein cholesterol (LDL-C; 114+/-20-99+/-17 mg/dl, P<0.05) and TG levels (217+/-103-130+/-38 mg/dl, P<0.01). In addition, there were significant decreases in very-low-density lipoprotein cholesterol (VLDL-C; 53+/-20-34+/-15 mg/dl, P<0.001). The Cmax and AUC of simvastatin were increased about eight-fold, when simvastatin was given in combination with CsA. In contrast, no significant changes in simvastatin levels were observed when combination with tacrolimus. Although simvastatin levels were increased with CsA, there were no abnormal changes in renal and liver functions, creatinine phosphokinase (CPK) levels or in incidence of adverse effects.

[Using genetic algorithm for quantitative analysis of overlapped spectra in FTIR]

Technique for the quantitative analysis of FTIR spectra, which are serious overlapped in the spectral bands, is studied by genetic algorithm. The multicomponent in the mixture, which contains ten air toxic organic components, such as benzene, phenixin, chlorobenzene, nitrobenzene, phenol, toluene, methanol, o-cresol, m-cresol and p-cresol, is simultaneously determined. The effect of the probability of crossover and the establishment of objective function are discussed. The method of adaptive mutation is used. The results indicate that genetic algorithm has excellent non-linear ability of solution. Mean relative error of each results is really small, generally not bigger than 1%, when the conditions are properly controlled.

[Preparation and evaluation of amide-octyl-bonded phase for the separation of basic substances in reversed-phase liquid chromatography]

A new bonded-phase, amide-octyl-bonded phase (AOBP), with an internal polar functional group-amide was firstly prepared in domestic by two-step reaction process. The amino phase was formed in the first step and further modified in the second step by attaching an alkyl chain via reaction of an acid chloride with the amino ligand. Characterization of prepared packing was carried out with elemental analysis and Fourier transform infrared (FTIR) spectrometry. Hydrophobicity, selectivity and silanophilic activity of AOBP were evaluated by using organic components including acidic, bascic and neutral analytes and methanol-water as binary mobile phase. The applicable ranges of pH and stability of AOBP were also evaluated. The results showed that AOBP has excellent chromatographic properties and resistance to hydrolysis between pH = 2.5-7.5, It can be used for the separation of basic solutes efficiently.

Impact of age on the injury pattern and survival of people with cervical cord injuries

STUDY DESIGN

A retrospective, follow-up study.

OBJECTIVES

To differentiate the injury pattern and survival of people with cervical cord injuries with onset at different ages.

SETTING

Rehabilitation wards of a university hospital that is a tertiary referral center in Taipei, Taiwan.

METHODS

The records of acute and traumatic cervical cord injury patients hospitalized from 1989 to 1997 were reviewed. All subjects received comprehensive rehabilitation programs during hospitalization. Their survival status at the end of follow-up was studied.

RESULTS

Forty-seven of 109 (43.1%) people with cervical cord injuries were 50 years or older at onset. Older patients were more frequently injured by minor falls, resulting in more incomplete quadriplegia. They also showed fewer spinal fractures, and more demonstrated associated spondylosis and ossification of the posterior longitudinal ligament. Eleven (10.2%) subjects were deceased, found by a linkage to a death registration database at the end of follow-up. The significant predictor of survival status at follow-up was older age at injury using Cox proportional hazards model.

CONCLUSION

Spinal cord injured patients had different injury patterns, demanding different preventative strategies. Those injured at older ages were at higher risk of mortality according to our study.

SPONSORSHIP

This study was supported in part by grants from the National Taiwan University Hospital (89S2005), Taipei, Taiwan.

Clinicopathological evaluation in non-episode biopsies of renal transplant allograft

Histopathological findings in renal allograft with stable function remain unclear. We therefore performed non-episode biopsy in the long-surviving renal allograft to investigate the histopathological changes. Our data show that, although arteriolopathy is characteristic of drug-induced nephropathy, it is unrelated to dosage and concentration of cyclosporine or tacrolimus in non-episode biopsy. We evaluated therefore the clinicopathological findings of arteriolopathy in this study. Non-episode biopsy was defined as follows: as serum creatinine level lower than, 2.0 mg/dl and a urinary protein level lower than 500 mg/day. A total of 65 biopsy specimens were enrolled in this study as non-episode biopsy. Twenty-nine specimens revealed arteriolopathy. There were no statistically significant differences between arteriolopathy and dosage or concentration of cyclosporine or tacrolimus. Arteriolopathy in non-episode biopsy was related to time of biopsy, kidney age, hypertension, and hyperlipidemia, suggesting that it is important for graft survival to strictly control blood pressure and blood lipid level.

Factors influencing vertebral bone density after renal transplantation

To improve our understanding of the mechanisms underlying osteoporosis following renal transplantation, we compared bone mineral density (BMD) in 158 transplant recipients and in 293 patients undergoing maintenance hemodialysis with age- and sex-matched normal controls. Observations in graft recipients were made up to several years following transplantation. Dual-energy X-ray absorptiometry was used to measure BMD. Correlations with clinical variables including serum concentration of parathyroid hormone (PTH) and steroid therapy were evaluated. Lumbar BMD was lower in transplant patients than in dialysis patients at all ages, and continued to decrease with increasing interval posttransplant until the second year after transplantation. Persistent hyperparathyroidism and daily prednisolone dosage were both associated with decreased BMD. Age and creatinine clearance were independent long-term predictors of BMD by multiple regression analysis. Treatment of renal graft recipients with calcium and vitamin D supplements or calcitonin may be indicated in the early months after transplantation.

Arteriolopathy in non-episode biopsies of renal transplant allograft

PURPOSE

We have been performing protocol biopsies since 1995 to predict the outcome of renal allograft. However, histopathological findings in renal allograft with stable function remain unclear. For this reason, we performed non-episode biopsy on long-surviving renal allograft and investigated the histopathological changes. Among the several diseases seen in non-episode biopsies, arteriolopathy, such as drug-induced nephropathy, is one of the most frequent diseases. However, it is unrelated to the dosage and the concentration of cyclosporine or tacrolimus. Consequently, we evaluated the clinicopathological findings of arteriolopathy in this study in order to clarify whether cyclosporine (CsA) or tacrolimus (FK506) is responsible for these findings.

MATERIALS AND METHODS

We defined non-episode biopsy as a case with a serum creatinine level less than 2.0 mg/dL and containing less than 500 mg/dL of urinary protein. Final results showed that 71 cases were identified as non-episode biopsy. We then evaluated the histopathological findings and the clinical characteristics of these cases.

RESULTS

Thirty-two of the 71 non-episode biopsy specimens showed findings of arteriolopathy. The frequency and the severity of arteriolopathy are not concerned with dosage and concentration of CsA or FK506. The arteriolopathy seen in non-episode biopsy was related to the time of the biopsy and the kidney age. Arteriolopathy in nonepisode biopsy also had a relationship with hypertension, suggesting that it is important to strictly control blood pressure for graft survival.

[Purification of proteins in human plasma with new nylon affinity membranes]

A series of affinity membranes were prepared by using microporous nylon membrane as matrix and activation method with s-triazine and 1,4-butanediol diglycidyl ether, separately. Three proteins with clinic value, gamma-globulin, plasminogen and thrombin, were purified from human plasma by one step with affinity membrane chromatography. The purities of gamma-globulin purified were higher than 83%, and purification folds were higher than 5. The purity of gamma-globulin obtained was higher than that of standard human gamma-globulin. The efficiencies of gamma-globulin purification with affinity membranes prepared by two activation methods were equal. Plasminogen purified with affinity membranes prepared by s-triazine activation was higher than that by 1,4-butanediol diglycidyl ether activation. And SDS-PAGE analysis showed that the purities of gamma-globulin and plasminogen obtained were higher than that of the commercial product. In addition, the purification of thrombin from human plasma by one step with trypsin activation column and affinity membrane was studied. Thrombin with specific activity of 42 NIH unit/mg and 42.5 NIH unit/mg could be obtained from human plasma through affinity membranes prepared by s-triazine and 1,4-butanediol diglycidyl ether methods, respectively.