The Role of Postoperative Radiotherapy in T4 Rectal Cancer with Synchronous Distant Metastasis

PURPOSE/OBJECTIVE(S)

Studieson the role of surgery and local treatment in M1 rectal cancer have been actively studied recently. However, there is still controversy because no significant results have been reported for local control. The purpose of this study was to analyze the local control rates of postoperative radiotherapy for tumor stage T4 in M1 rectal cancer.

MATERIALS/METHODS

We investigated local recurrence after surgery for M1 rectal cancer that was operated at Seoul St. Mary's Hospital between 1995 and 2021. Locoregional recurrence rates were compared in patients who received postoperative pelvic radiotherapy and those who did not. In addition, an analytical comparison was performed only for patients with T4 rectal cancer. Statistical analysis was performed using the log rank test, and a p-value of less than 0.05 was considered significant.

RESULTS

During the investigation period, a total of 206 patients underwent surgery for M1 rectal cancer. There were 55 patients with T4 tumor stage. Of the 55 patients, 11 patients received radiotherapy after surgery, and 44 patients received systemic treatment such as chemotherapy after surgery without radiotherapy. During a median follow-up of 22 months, locoregional recurrence occurred in 1 (RT group) and 25 (no RT group) patients, respectively. Log-rank analysis of locoregional recurrence showed a significant difference between the two groups (p- value = 0.008). Death occurred in 10 (RT group) and 38 (no RT group) patients, respectively. The 2-year locoregional recurrence free-survival rates were 45.5% and 53.0%, respectively, and there was no significant difference between the two groups in the log-rank analysis.

CONCLUSION

Pelvic radiotherapy could be expected to improve locoregional recurrence in stage T4 of rectal cancer with synchronous distant metastasis. It would be warranted to prove this in a large-scale prospective study.

Evaluation of Usefulness of Yeast-Based Biological Phantom and Preliminary Study for Verification of Hypoxic Effect of Flash Radiotherapy

PURPOSE/OBJECTIVE(S)

As a basic hypothesis for the effectiveness of flash radiation therapy, the effect of preserving normal tissue during flash radiation is due to the instantaneous chemical depletion of oxygen. A yeast-based biological phantom was created to verify the hypoxic effect of flash radiation therapy. A study to upgrade the previously developed X-Band LINAC to a flash irradiation mode is in progress, and a preceding study is conducted to evaluate the usefulness of a yeast-based biological phantom manufactured by analyzing the change in oxygen by irradiating a high dose in a general radiation therapy device.

MATERIALS/METHODS

Freeze-dried yeast sample (Saccharomyces cerevisiae, S288C) is activated and sub-cultured. For mass production of yeast samples, yeast culture medium is prepared by adding yeast colonies to the ypd medium. This study was conducted to verify the hypoxic effect among the biological mechanisms that occur during flash radiation therapy at the basic stage, and the oxygen concentration change during general radiation irradiation was measured in real time using a DO (Dissolved oxygen) meter and fiber optic sensor designed to do that. To prevent scatter, which is a concern during flash irradiation, the fiber form was used, and precise experiments are possible as a non-invasive oxygen concentration measurement method. Based on 10MV of general radiation therapy device, high-dose radiation of 500-10,000 cGy is irradiated to measure real-time oxygen concentration change.

RESULTS

As a result of irradiation with high-dose (500-10,000 cGy) radiation of general LINAC, it was confirmed that the oxygen concentration of the yeast culture medium decreased by 5.7-63.2%, and the usefulness of the biological phantom fabricated based on the yeast culture medium was evaluated.

CONCLUSION

Prior to the analysis of oxygen concentration change in yeast cells during X-Band LINAC flash irradiation, a preliminary study was conducted at a high dose in a general LINAC to obtain a significant result of oxygen concentration change and confirm the usefulness of the yeast-based biological phantom. Prior research was conducted and verified as a general irradiation experiment using a yeast-based biological phantom manufactured based on a DO meter and a fiber optic oxygen sensor. After irradiation with high-dose radiation, the oxygen concentration of the yeast culture medium was measured 5 times, and it was confirmed that there was a change in oxygen concentration of 5.7-63.2%, verifying the usefulness and stability of the biological phantom. The usefulness of the yeast-based biological phantom for high doses was confirmed, and it is expected that the usefulness of the biological phantom for flash radiation can be verified by additionally measuring the change in oxygen concentration of the biological phantom according to the high dose rate in the future.

A passive upper-limb exoskeleton reduced muscular loading during augmented reality interactions

The aim of this study was to evaluate a passive upper-limb exoskeleton as an ergonomic control to reduce the musculoskeletal load in the shoulders associated with augmented reality (AR) interactions. In a repeated-measures laboratory study, each of the 20 participants performed a series of AR tasks with and without a commercially-available upper-limb exoskeleton. During the AR tasks, muscle activity (anterior, middle, posterior deltoid, and upper trapezius), shoulder joint postures/moment, and self-reported discomfort were collected. The results showed that the exoskeleton significantly reduced muscle activity in the upper trapezius and deltoid muscle groups and self-reported discomfort. However, the shoulder postures and task performance measures were not affected by the exoskeleton during the AR interactions. Given the significant decrease in muscle activity and discomfort without compromising task performance, a passive exoskeleton can be an effective ergonomic control measure to reduce the risks of developing musculoskeletal discomfort or injuries in the shoulder regions.

Efficacy of passive upper-limb exoskeletons in reducing musculoskeletal load associated with overhead tasks

Overhead work can pose substantial musculoskeletal stress in many industrial settings. This study aimed to evaluate the efficacy of passive upper-limb exoskeletons in reducing muscular activity and subjective discomfort ratings. In a repeated-measures laboratory experiment, 20 healthy male participants performed 10-min drilling tasks with and without two passive upper-limb exoskeletons (VEX and Airframe). During the tasks, muscle activity in eight muscles (upper limb - upper trapezius, middle deltoid, biceps brachii, triceps brachii; low back - erector spinae; lower limb - rectus femoris, biceps femoris, tibialis anterior) was collected using electromyography as a physical exertion measure. Subjective discomfort rating in six body parts was measured using the Borg's CR-10 scale. The results showed that muscle activity (especially in the upper-limb muscles) was significantly decreased by 29.3-58.1% with both exoskeletons compared to no exoskeleton condition. The subjective discomfort ratings showed limited differences between the conditions. These findings indicate that passive upper-limb exoskeletons may have potential as an effective intervention to reduce muscular loading and physical exertion during overhead work.

Nutritional Status and Frailty Improvement through Senior-Friendly Diet among Community-Dwelling Older Adults in South Korea

Considering that Korea’s aging population is rapidly increasing, health serves as an indicator of older adults’ quality of life, and dietary life directly affects their health. For health maintenance and improvement, preventive healthcare measures including safe food selection and nutritional supply are needed. This study aimed to evaluate the effect of senior-friendly diet on nutrition and health status improvement in older adults receiving community care. A total of 180 older adults were analyzed, with 154 and 26 in the senior-friendly diet intervention group and the general diet group, respectively. Surveys, blood tests, and frailty evaluations were conducted before and after the study. After 5 months of intervention, the blood status, nutrient intake, and frailty level were evaluated. The participants’ mean age was 82.7 years, and 89.4% of them were living alone. In both groups, energy, protein, vitamin A, vitamin D, vitamin C, calcium, and magnesium intake were insufficient initially but generally improved after the intervention. Especially in the intervention group, energy, protein, vitamin D, vitamin C, and folic acid intake significantly increased. The frailty level also slightly improved, and the malnutrition rate was reduced. Even after the passage of time, the improvement effect size significantly differed between the groups. Therefore, resolving and supporting meals corresponding to the physiological needs of the older adults has a great impact on improving their quality of life, and such special consideration is a reasonable way to respond to a super-aged society.

Comparison of the Physical Care Burden on Formal Caregivers between Manual Human Care Using a Paper Diaper and Robot-Aided Care in Excretion Care

Although the older population has been rapidly growing, the availability of formal caregivers remains limited. Assistance provided by care robots has helped lower this burden; however, whether using a care robot while providing excretion care (EC) is quantitatively increasing or decreasing caregivers' physical care burden has not been extensively studied. This study aimed to quantitatively compare the physical burden experienced by caregivers while providing manual excretion care (MC) using a paper diaper versus robot-aided care (RC). Ten formal caregivers voluntarily participated in the experiment. MC and RC tasks were structuralized according to phases and classified by characteristics. The experiment was conducted in a smart care space. The physical load of formal caregivers was estimated by muscular activity and subjective rating of perceived physical discomfort. The results demonstrated that although the physical load on the lower back and upper extremities during the preparation and post-care phases were greater in RC than MC, RC markedly alleviated caregivers' physical load when performing front tasks. In the preparation-care phases, the physical loads on the lower back and upper extremities were approximately 40.2 and 39.6% higher in the case of RC than MC, respectively. Similar to the preparation-care phases, the physical loads on the lower back and upper extremities during post-care phases were approximately 39.5 and 61.7% greater in the case of RC than MC, respectively. On the other hand, in the front-care phases, the physical loads on the lower back and upper extremities were approximately 25.6 and 34.9% lower in the case of RC than MC, respectively. These findings can quantitatively explain the effectiveness and features of a care robot to stakeholders and provide foundational research data for the development of EC robots. This study emphasizes the implementation and promotion of the dissemination, popularization, and development of care robots to fulfill formal caregiving needs.

Evaluation of the Efficacy of a Lift-Assist Device Regarding Caregiver Posture and Muscle Load for Transferring Tasks

The aim of this study was to confirm the effect of a lift-assist device when performing a patient-lifting task. Ten working caregivers participated in this experiment, and lifting patients from bed to wheelchair (B2C) and wheelchair to bed (C2B) was performed for manual care (MC) and lift-assist device (robot) care (RC). EMG sensors and IMU motion sensors were attached as indicators of the assistive device's effectiveness. EMG was attached to the right side of eight muscles (UT, MD, TB, BB, ES, RF, VA, and TA), and flexion/extension angles of the neck, shoulder, back, and knee were collected using motion sensors. As a result of the analysis, both B2C and C2B showed higher muscle activities in MC than RC. When using a lift-assist device to lift patients, the RC method showed reductions in muscle activities compared to MC. As a result of the work-posture analysis, both the task type and the task phase exhibited pronounced reductions in shoulder, back, and knee ROM (range of motion) compared to those of MC. Therefore, based on the findings of this study, a lift-assist device is recommended for reducing the physical workloads of caregivers while performing patient-lifting tasks.

Impact of obesity paradox between genders on in-hospital mortality in cardiogenic shock: a retrospective cohort study

Background

In a few studies, obesity was associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox”, reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in CS patients.

Methods and results

1,227 patients with CS from The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock (RESCUE) registry in Korea were analyzed. The study population was classified into obese and non-obese groups according to Asian-Pacific criteria (BMI >25.0 kg/m2 for obese). Clinical impact of obesity on in-hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. In-hospital mortality rate was significantly lower in obese men than non-obese men (34.2% vs. 24.1%, p=0.004) while the difference was not significant in women (37.3% vs. 35.8%, p=0.884). As a continuous variable, higher BMI showed a protective effect in men conversely, BMI was not associated with clinical outcomes in women. Comparing to normal-weight patients, obesity was associated with a decreased risk of in-hospital death in men (multivariable-adjusted OR 0.63, CI 0.43–0.92, p=0.016), not in women (multivariable-adjusted OR 0.94, 95% CI 0.55–1.61, p=0.828). Interaction P value for the association between BMI and sex was 0.023.

Conclusions

Obesity paradox exists and apparently occurs in men among CS patients. The differential effect of BMI on in-hospital mortality was observed according to sex.

Funding Acknowledgement

Type of funding sources: None.

Risk factors and clinical effects of late leaflet thrombosis after transcatheter aortic valve replacement

Background

As the indications for trans-catheter aortic valve replacement (TAVR) expand, it is expected that the number of TAVR patients would increase and the follow-up duration would be longer. It is known that the incidence of leaflet thrombosis is higher in TAVR than in surgical aortic valve replacement (SAVR), but not much is known about the risk factors of late leaflet thrombosis in TAVR.

Aim

Therefore, in this study, the incidence and risk factors of late leaflet thrombosis at late term after TAVR and the effect on clinical course of late leaflet thrombosis would be investigated.

Method

There were 176 patients undergone TAVR from January 2015 to October 2020 in one tertiary hospital of south korea. 94 patients had follow-up cardiovascular computed tomography (CT) between 3 months and 2 years after TAVR. Among 94 patients, late leaflet thrombosis was discovered at 20 patients, and risk factors were analyzed by comparing clinical factors, echocardiographic and cardiovascular CT information, and angiographic data between the group with and without late leaflet thrombosis. And the difference in aortic valve hemodynamics between the group with and without leaflet thrombosis was examined and clinical outcomes were compared. Clinical outcome was defined as the composite of all-cause death, stroke, heart failure (HF) admission, redo-aortic valve (AV) replacement and major bleeding after detection of late leaflet thrombosis.

Results

Indexed mean sinus of Valsalva diameter, AV calcium score and post procedure estimated orifice area (EOA) had predictability of late leaflet thrombosis with AUC value of 0.670 (95% CI [0.546–0.795], p value = 0.020), AUC value of 0.698 (95% CI [0.544–0.851], p value = 0.012) and AUC value of 0.665 (95 percent CI [0.548–0.782], p value = 0.031), respectively (Figure 1).

In echocardiography performed at the time of follow-up CT, AV max velocity and AV mean pressure gradient were higher in thrombosis group and EOA and Doppler velocity index were lower in thrombosis group than in no thrombosis group within normal range (Figure 2). Clinical outcome was not significant different between the two groups (log rank p value = 0.560).

Conclusion

Larger indexed sinus of Valsalva diameter, higher AV calcium score and smaller post procedure AV EOA were risk factors for late leaflet thrombosis after TAVR. Subclinical late leaflet thrombosis have a benign course when properly managed.

Funding Acknowledgement

Type of funding sources: None.

Quantification of physical stress experienced by obstetrics and gynecology sonographers: A comparative study of two ultrasound devices

This study aims to quantify the stresses of sonographers using two different ultrasound devices, one of conventional and one of ergonomic design. A total of 20 obstetricians and gynecologists participated in this study, and two types of tasks (scanning and positioning) were evaluated while using the two different devices. To quantify workload, four dependent variables (muscle activity, estimated grip force, subjective comfort rating, and task time) were measured. The muscular activity required while using the conventional device was 14.4% MVC (Maximum voluntary contraction) for the scanning task, which was significantly higher than that of the ergonomic device. The subjective comfort rating for the conventional design was lower than that of the ergonomic design. For the positioning task, the ergonomic device (33.2% MVC) resulted in significantly higher muscle activity in the extensor digitorum (ED) and flexor digitorum superficialis (FDS) than the conventional design (22.2% MVC), whereas the deltoid muscle showed significantly lower activity than in users of conventional design (4.5% MVC). Ergonomically-designed ultrasound devices improve ease of moving and the probe's supporters, reduce physical load and increase ease of use for sonographers. Our results may be used as guidelines for usability testing of ultrasound devices.

P–205 Epothilone D as an actin cytoskeleton stabilizer improved mitochondria bioenergenesis and blastocyst formation of mouse preimplantation embryo

Study question

What is primary factor of bioenergetics product activity between microtubule instability and the functional activity of mitochondria in embryo?

Summary answer

The actin cytoskeleton instability is presumably the primary cause for the bioenergenesis of mitochondrial function to the preimplantation embryo development.

What is known already

Mitochondria are cellular organelles dynamically moving and morphological changes. It provides for homeostatic energy to the cell. The dynamic property of the mitochondria is associated with the microtubule network in the cell. However, the stability of the microtubule was clearly identified for preimplantation embryo development.

Study design, size, duration

This study is designed to assess the ATP productivity of the mitochondria, and specifically to observe what its primary factor is in terms of providing microtubule stability in mammalian cells. Additionally, we investigated the relationship between blastocyst formation and actin cytoskeleton stabilization by EpD with 2-cell mice.

Participants/materials, setting, methods

We prepared the microtubule stability regulation model with the HEK293 cell line by using the microtubule stabilizer as an Epothilone D (EpD). Then we analyzed the metabolic activity of the cells through oxidative phosphorylation (OXP) ratios analysis. Also, we performed confocal live imaging to observe mitochondria morphology depending on the cells’ microtubule. Next, we treated EpD to 2-cell culture media for the analysis of blastocyst development ratios.

Main results and the role of chance

EpD significantly increased fusion form. Also, EpD enhance bioenergy ratios like OXP in the mitochondria and functional activity related marker, like mTOR compared with the control. These results suggest that microtubule stabilization enhances mitochondrial metabolism by increasing oxygen consumption. Also, EpD in 2-cell culture media led to a significant increase in the speed of development and 50% higher hatched out blastocyst formation ratios compared to the control group.

Limitations, reasons for caution

This study had limited animal experiments. For the next study, we are planning with an aim to improve the quality and development ratios of human embryos by EpD.

Wider implications of the findings: Microtubule stabilizer has a possibility to recover the mitochondria’s functional activity in the preimplantation embryo development. Mitochondrial functional activity along the actin cytoskeleton may play a pivotal role in determining the embryo quality and development ratios for archive pregnancy.

Trial registration number

non-clinical trials

P–657 Prostaglandin D2 is correlated with follicles development and a reliable marker of ovarian reserve of poor ovarian responder patients

Study question

Is the prostaglandin D2 (PGD2) associated with growing follicles and ovarian reserve of poor ovarian responders?

Summary answer

PGD2 is correlated with ovarian stimulation activity and follicle growth. Especially, poor ovarian responders show a significant decrease in the level of follicular fluid.

What is known already

Prostaglandins (PGs) are involved in the female reproductive process, mainly ovulation, fertilization, and implantation.

Study design, size, duration

We investigated the PGD2 level in the follicular fluid of poor ovarian responders. The collection of human follicular fluid was approved by the Institutional Research and Ethical Committees of CHA University (approval number: 1044308–201611-BR–027–04) from January to December 2019. Follicular fluid was collected from patients with normal ovarian response and patients with POR.

Participants/materials, setting, methods

We studied whether prostaglandin has related to POR in the clinical key factor by measuring human follicular fluid. Follicular fluid was collected from patients with normal ovarian response and patients with POR. The concentration of PGD2 in follicular fluid was determined with ELISA kits following the manufacturer’s protocol.

Main results and the role of chance

We analyzed the level of PGD2 in the follicular fluid of patients with normal ovarian response and patients with POR using an ELISA. The PGD2 concentration was significantly lower in the follicular fluid of patients with POR than in the follicular fluid of young and old patients with normal ovarian response.

Limitations, reasons for caution

This study has an identification of biomarker of the clinical samples as POR criteria patients. Therefore, further investigations aimed at specific recovery of low PGD2 metabolic activity in the CCs during control ovarian stimulation.

Wider implications of the findings: Until now there is no specific biomarker of POR. AMH is just an ovary reserve marker for an indication of ovary function. PGD2 is one of the metabolites in steroid metabolism in the ovary. Therefore, we can find some cure through further study for improved PGD2 production to POR patients.

Trial registration number

none

P–658 Lovastatin promotes the expression of LDL receptor and enhances E2 production in the cumulus cells

Study question

Lovastatin enhanced E2 productive ratios in the cumulus cells through promoted expression of Low-density lipoprotein receptor (LDLR).

Summary answer

Lovastatin up-regulated gene expression of LDLR in the CCs. And the high expression of LDLR promoted E2 productive ratios from CCs.

What is known already

We already reported that the up-regulation of LDLR correlated with clinical pregnancy. Therefore, we found lovastatin as an up-regulator of LDLR expression of clinical pregnancy.

Study design, size, duration

This is an expended study of LDLR to enhance steroidogenesis regarding the effect of lovastatin in the CCs. The collection of human cumulus cells was approved by the Institutional Research and Ethical Committees of CHA University (approval number: 1044308–201611-BR–027–04) from January to December 2019. The CCs were collected from 12 patients with normal ovarian response after oocyte denudation for ICSI.

Participants/materials, setting, methods

We studied whether lovastatin has up-regulated LDLR expression in human CCs. Cumulus cells were collected from patients with young (∼ 36) and old aged patients (37 ∼). After culturing human CCs, they were treated lovastatin for one day. The concentration of E2 in culture medium was measured using Chemiluminescence immunoassay. The mRNA isolated from CCs was analyzed gene expression level through real time-PCR.

Main results and the role of chance

The concentration of E2 was significantly increased in the culture medium treated with lovastatin. The CCs treated with lovastatin increased the expression of LDLR and StAR which are components of the steroidogenesis pathway.

Limitations, reasons for caution

We have found that the role of lovastatin promotes the E2 production by increasing the ldlr gene of CCs. Therefore, further investigations aimed at lovastatin effect on human oocytes embryo whether enhanced quality of oocytes or not.

Wider implications of the findings: Previous data show that high activation of LDLR and StAR was associated with embryo quality and clinical pregnancy in infertile women. Our data suggest that lovastatin is stimulated LDLR expression to enhanced pregnancy ratios of IVF patients.

Trial registration number

none

Guidelines for Working Heights of the Lower-Limb Exoskeleton (CEX) Based on Ergonomic Evaluations

The aim of this study was to evaluate the muscle activities and subjective discomfort according to the heights of tasks and the lower-limb exoskeleton CEX (Chairless EXoskeleton), which is a chair-type passive exoskeleton. Twenty healthy subjects (thirteen males and seven females) participated in this experiment. The independent variables were wearing of the exoskeleton (w/ CEX, w/o CEX), working height (6 levels: 40, 60, 80, 100, 120, and 140 cm), and muscle type (8 levels: upper trapezius (UT), erector spinae (ES), middle deltoid (MD), triceps brachii (TB), biceps brachii (BB), biceps femoris (BF), rectus femoris (RF), and tibialis anterior (TA)). The dependent variables were EMG activity (% MVC) and subjective discomfort rating. When wearing the CEX, the UT, ES, RF, and TA showed lower muscle activities at low working heights (40-80 cm) than not wearing the CEX, whereas those muscles showed higher muscle activities at high working heights (100-140 cm). Use of the CEX had a positive effect on subjective discomfort rating at lower working heights. Generally, lower discomfort was reported at working heights below 100 cm when using the CEX. At working heights of 100-140 cm, the muscle activity when wearing the CEX tended to be greater than when not wearing it. Thus, considering the results of this study, the use of the lower-limb exoskeleton (CEX) at a working height of 40-100 cm might reduce the muscle activity and discomfort of whole body and decrease the risk of related disorders.

Risk factors and renal outcomes of low bone mineral density in patients with non-dialysis chronic kidney disease

Bone disorder is a common complication of chronic kidney disease (CKD). The clinical usefulness of bone mineral density (BMD) in CKD is not well known. Our study shows that low BMD is associated with physical activity and dietary Na/K intake ratio and can predict poor renal outcome in non-dialysis CKD.

PURPOSE

Despite evidence of a link between bone mineral disorders and chronic kidney disease (CKD), the clinical implications of bone mineral density (BMD) in CKD are not well established. We investigated risk factors and renal outcomes of low BMD in CKD.

METHODS

We analyzed data from the KNOW-CKD. BMD measured by dual-energy x-ray absorptiometry was classified by T score: normal (T score ≥ - 1.0), osteopenia (- 1.0 > T score > - 2.5), and osteoporosis (T score ≤ - 2.5) of the lumbar spine, hip, or femoral neck. Logistic regression analysis to assess risk factors of low BMD (T score < - 1.0) and Cox proportional hazards models to estimate risk of incident end-stage renal disease (ESRD).

RESULTS

Low BMD was prevalent (osteopenia 33%; osteoporosis 8%) in 2128 adults with CKD (age 54 ± 12 years; male 61%). Over a median follow-up of 4.3 years, there were 521 cases of incident ESRD. Lower BMD was associated with female sex, older age, low eGFR, low BMI, and lifestyle factors of physical activity (odds ratio (OR) = 0.62, 95% confidence interval (0.49-0.77)) and spot urine Na/K ratio (1.07 (1.00-1.15)). In adjusted Cox models, low BMD was associated with increased incident ESRD (hazard ratio (HR) = 1.14 (0.92-1.41) for osteopenia; 1.43 (1.01-2.04) for osteoporosis, P for trend < 0.05) compared with the reference of normal BMD. The association between low BMD and ESRD was similar according to T score discordance classification.

CONCLUSIONS

Low BMD was associated with modifiable lifestyle factors including low physical activity and high dietary Na/K intake ratio. The presence of low BMD is associated with poor renal outcomes in non-dialysis CKD.

P5989Effect of neprilysin inhibitor for ischemic mitral regurgitation after myocardial injury

Background

After myocardial infarction (MI), mitral valve (MV) tethering and fibrosis stimulate functional mitral regurgitation (MR), resulting in high morbidity of heart failure and cardiac mortality. However, pharmacological treatment has not been proven effective in reducing ischemic MR. MV change post-MI is associated with an excessive endothelial-to-mesenchymal transition (EMT) by transforming growth factor (TGF)-β overexpression and also with left ventricular (LV) remodeling. In a recent clinical study using echocardiography, angiotensin receptor neprilysin inhibitor (ARNI) reduced functional MR to a greater extent than did valsartan, but the mechanism was not revealed.

Purpose

This study tested the hypothesis that treatment of neprilysin inhibitor attenuates functional MR after MI by facilitating LV reverse remodeling and suppressing EMT which mitigates inadequate leaflet adaptation.

Methods

In male Sprague-Dawley rats (n=31), functional MR was induced by occluding the left circumflex coronary artery. Two weeks after MI, MR and LV dilatation were confirmed by echocardiography and magnetic resonance imaging (MRI). Rats were randomly assigned to LCZ696 treatment (ARNI, 60 mg/kg/d, n=10), valsartan treatment (30mg/kg/d, n=10), or corn oil only (MR control group; n=11). After 6 weeks, LV volumes, functions and MR extent were quantified by using echocardiography, cardiac MRI and pressure-volume loop analysis. Also, excised mitral leaflets and LV were analyzed by histopathology and primary cultured valvular endothelial cells (VECs) were evaluated focusing on molecular changes.

Results

LCZ696 significantly attenuated post-MI LV dilatation after 6 weeks when compared with the control group (LV end-diastolic volume (EDV), 461.3±41.3 uL versus 525.1±78.2 uL; p<0.05), while valsartan did not (LV EDV, 471.2±26.8 uL; p>0.05 to control). There were no significant differences in the change of arterial pressure and ejection fraction between the treatment groups, however, dP/dt was greater in the LCZ696 group than in the MR control group (8203±286 mmHg/s for LCZ696 versus 6936±555 mmHg/s for MR control; p=0.01). MR extent and LA volume were significantly decreased in the LCZ696 group compared with the valsartan group. Pathological analysis showed that fibrosis was more prominent in the MR control than in the LCZ696 group. LCZ696 strongly reduced leaflet thickness, TGF-β, and downstream phosphorylated extracellular-signal-regulated kinase and EMT (25.4±11.8% vs. 53.4±12.6% α-smooth muscle actin-positive VECs; p<0.05). Leaflet area increased comparably (5%) in the LCZ696 group compared with the valsartan group.

Conclusions

Neprilysin inhibitor has positive effects on LV reverse remodeling and also directly modulates profibrotic changes of MV leaflets post-MI without eliminating adaptive growth. Understanding the mechanisms could provide new opportunities to ARNI reducing ischemic MR.

Acknowledgement/Funding

This work was supported by the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2014R1A6A3A04056205). It was also

P1711The association of multidisciplinary team approach with clinical outcomes in patients with acute myocardial infarction underwent veno-arterial extracorporeal membrane oxygenation

Background

Multidisciplinary team approach is necessary for the management of critically-ill patients. However, limited data are available on the impact of specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock.

Objectives

This study aimed to identify whether specialized ECMO team is associated with improved in-hospital mortality in AMI patients underwent venoarterial ECMO.

Methods

A total of 255 AMI patients underwent venoarterial ECMO from May 2004 to July 2018 were enrolled. In January 2014, multidisciplinary ECMO team was founded at our institution. Eligible patients were classified into pre-ECMO team group (n=131) and post-ECMO team group (n=124). The primary outcome was in-hospital mortality.

Results

In-hospital mortality (54.2% vs. 33.9%, p=0.002) and cardiac intensive care unit mortality (45.0% vs. 25.0%, p=0.001) were significantly lower after the implantation of multidisciplinary ECMO team (pre ECMO team vs. post-ECMO team). On binary logistic regression model, the multidisciplinary ECMO team approach was associated with lower risk of in-hospital mortality (odds ratio 0.36, 95% confidence interval 0.19–0.67, p=0.001). Incidence of all-cause mortality (58.3% vs. 35.2%, p<0.001) and rehospitalization due to heart failure (28.2% vs. 6.4%, p=0.001) at 6-months follow-up were also significantly lower in the post-ECMO team group than in the pre-ECMO team group.

Clinical outcomes Variables Total (N=255) Pre-ECMO team (N=131) Post-ECMO team (N=124) P value In-hospital mortality 113 (44.3) 71 (54.2) 42 (33.9) 0.002 Cardiovascular death 90 (35.3) 59 (45.0) 31 (25.0) 0.001 Noncardiovascular death 23 (9.0) 12 (9.2) 11 (8.9) >0.99 Cardiac intensive care unit mortality 106 (41.6) 68 (51.9) 38 (30.6) 0.001 Successful weaning of ECMO 169 (66.3) 75 (57.3) 94 (75.8) 0.002 Data are presented as n (%). Abbreviations: ECMO, extracorporeal membrane oxygenation.

Incidence of death, readmission for HF

Conclusions

The multidisciplinary ECMO team approach was associated with improved clinical outcomes in AMI patients complicated by cardiogenic shock. Our data support that specialized ECMO team is indispensable to improve outcomes in patients with AMI with refractory cardiogenic shock.

Accuracy of Plain Abdominal Radiography in the Differentiation between Small Bowel Obstruction and Small Bowel Ileus in Acute Abdomen Presenting to Emergency Department

Introduction

Our purpose was to evaluate whether plain abdominal radiography (PAR) could accurately differentiate between small bowel obstruction (SBO) and small bowel ileus (SBI) in an emergency setting. We also evaluated the value of known classic signs on the PAR for differentiating between SBO and SBI.

Methods

This retrospective study included 216 emergency room patients who had small bowel distension (maximal small bowel diameter ≥2.5 cm) on the PAR and who underwent successive abdominal computed tomography. One radiologist and one emergency physician retrospectively reviewed PAR in consensus, unaware of the patients' clinical data; they divided the patients into an SBO group and an SBI group according to the radiographic findings. Presence or numeric values of 10 radiographic signs were also recorded. Final diagnoses of SBO and SBI were established by a combined analysis of medical charts, surgical records, radiographic findings on abdominal computed tomography, and small bowel studies. The differential diagnoses based on PAR and the final diagnoses were compared, and the sensitivity and specificity of PAR were calculated. We also evaluated the differences among 10 radiographic signs between the final SBO and SBI groups.

Results

Sensitivity and specificity of PAR for SBO were 82.0% and 92.4%, respectively. Among the 10 radiographic signs, all except maximal colon diameter were statistically significant predictors on the final diagnosis.

Conclusions

PAR is an accurate and effective initial imaging modality for differentiating between SBO and SBI in an emergency setting, and most of the classic radiographic signs have a diagnostic value.

Evaluation of the controlled grip force exertion tasks associated with age, gender, handedness and target force level

INTRODUCTION

Force control of the hand is an essential factor for operating tools and moving objects. Therefore, a method for quantifying hand functionality more accurately and objectively is very important.

METHODS

The present study included 60 healthy participants (30 elderly and 30 young adults) to evaluate the effects of age, gender and target force levels on tracking performance. Tracking performance was quantified by measuring the difference between target force levels and exerted force.

RESULTS

Females exerted 59.6% of the maximum grip strength of males and the elderly group exerted 70.5% of maximum grip strength compared with the young group. The elderly group showed 3.1 times larger tracking error than the young group. There was a significant difference in females between the young and elderly groups, indicating age-related decline in hand function is more pronounced in females. The difference in grip force control ability between the elderly and young groups was significant at the low target force level (5% maximum voluntary contraction).

CONCLUSIONS

The results of this study could be used for hand function evaluation guidelines. In addition, this study could be used as a tool for physiotherapy to improve hand function and prevent its decline in elderly people.

Population genetic characterization of the Japanese oak silkmoth, Antheraea yamamai (Lepidoptera: Saturniidae), using novel microsatellite markers and mitochondrial DNA gene sequences

The Japanese oak silkmoth, Antheraea yamamai Guérin-Méneville, 1861 (Lepidoptera: Saturniidae), is an important natural resource of industrial value for silk fiber production. Owing to a lack of geographic and population genetic information, systematic domestication of An. yamamai has not been possible yet. In this study, 10 microsatellite markers developed using next-generation sequencing and two mitochondrial DNA (mtDNA) gene sequences (COI and ND4) were used to investigate the genetic variation and geographic structure of An. yamamai populations in South Korea. The two mtDNA gene sequences revealed very low total genetic variation and, consequently, low geographic variation, validating the use of more variable molecular markers. Genotyping of 76 An. yamamai individuals from nine localities in South Korea showed that the observed number of alleles at each locus ranged from 3 to 26, the polymorphism information content was 0.2990-0.9014, the observed and expected heterozygosities were 0.3252-0.9076 and 0.2500-0.9054, respectively, and F_IS was -0.654-0.520. The population-based F_IS, F_ST, R_ST, and global Mantel tests all suggested that the An. yamamai populations were overall well-interconnected, suggesting that any population can be used as a genetic source for domestication. Nevertheless, STRUCTURE analyses using microsatellite data and mtDNA sequences indicated the presence of two genetic pools in many populations, although a plausible explanation for this observation requires further studies.

Cognitive remediation for individuals with psychosis: efficacy and mechanisms of treatment effects

BACKGROUND

The popularity of cognitive remediation (CR) interventions for individuals with psychosis is in part based on the well-established link between cognition and functioning and the assumption that by targeting cognition, function can improve. While numerous trials have reported CR's efficacy, it is still not considered an evidence-based treatment. Importantly, little is known about the mechanisms through which it may affect functioning.

METHOD

In this study, we evaluated CR's proximal and distal effects, and examined potential mechanisms. A total of 75 individuals with psychotic disorders were randomized to a combination of strategy-based and drill-and-practice CR or wait-list control, with assessments of training task performance, neurocognition, functional capacity, symptoms and functioning conducted at baseline, end of the 2-month intervention, and 2-month follow-up.

RESULTS

Compared with treatment as usual, CR was associated with large post-training improvements on training tasks targeting attention, visuospatial memory, and verbal learning and memory, with persisting group differences at the 2-month follow-up. These generalized to mostly large improvements on neuropsychological measures targeting visuospatial memory, verbal learning and memory, delayed verbal memory and verbal working memory. While there were no CR-associated improvements on measures of functional capacity, symptoms, or a self-report measure of independent living skills, there was an effect on an interviewer-rated measure of functioning (Quality of Life Scale), which appeared primarily driven by the Intrapsychic Foundations subscale. Finally, for those randomized to CR, there were significant, medium-sized correlations between training task improvement, neuropsychological improvement and functioning measures.

CONCLUSIONS

This suggests a complex, multifactorial relationship between CR, and cognitive and functional change.

Late-onset bulky naevocytoma of the perineum masquerading as a malignant melanoma

Bulky naevocytoma of the perineum is a very rare variant of giant congenital melanocytic naevus (GCMN). It presents as a bulky naevocytic tumour in the perineal region with characteristic histological findings, such as extensive areas with a neural appearance called 'lames foliacees', formation of a pseudofollicular structure and extension of naevus cells between collagen bundles in a row called 'Indian-file' pattern. We report a case of late-onset bulky naevocytoma of the perineum in a 13-year-old girl. The patient presented with two bulky, pedunculated, heavily pigmented masses in the vulvar area that developed in a pre-existing GCMN lesion, which began around puberty and caused severe gait disturbance. Given the possibility of malignant transformation, we conducted staged reduction surgery of the tumour masses, which were found to be intradermal naevi without evidence of malignancy. The patient's gait disturbance improved markedly after surgery.

Clinical assessment of lipid profiles in live kidney donors

BACKGROUND

Abnormal serum lipid profiles are an issue in chronic kidney disease (CKD), but the clinical ramifications of dyslipidemia in live kidney donors are unclear. Thus, we explored the relationship between serum lipids and residual renal function in living donors post-nephrectomy.

METHODS

Charts of living donors who underwent nephrectomy between January 2010 and March 2013 were reviewed, targeting those with 6-month follow-up examinations at minimum. Altogether, 282 donors were studied, examining total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels assayed before donation by standard techniques. Median follow-up time was 14 months. The relationship between postoperative renal function and allograft biopsy results was assessed. Recursive partitioning was applied to identify optimal cut-off points for each parameter.

RESULTS

Median (interquartile range) serum TC, TG, LDL, and HDL levels were 183 (161-205) mg/dL, 86 (63-131) mg/dL, 108 (92-128) mg/dL, and 53 (44-62) mg/dL, respectively. The glomerular filtration rate at last follow-up was associated with TC (r = -0.187; P = .002) and LDL (r = -0.172; P = .005) levels, but showed no correlation with TG and HDL. Root nodes of TC and LDL determinations in recursive partitioning were 170.5 mg/dL and 80.5 mg/dL, respectively, serving as thresholds for further evaluation. On logistic regression analysis, the likelihood of CKD (glomerular filtration rate < 60 mL/min/1.73 m(2)) at last follow-up was greater in donors with elevated TC and LDL levels (odds ratio = 1.96 and 3.33; P = .021 and .029, respectively).

CONCLUSION

Kidney donors with serum TC and LDL elevations require close observation, given their demonstrable predisposition to CKD after donation.

Impact of metabolic syndrome on postdonation renal function in living kidney donors

INTRODUCTION

Optimization of kidney donor selection is critical to ensure recovery of the donor. The goal of this study was to determine the influence of metabolic syndrome on renal histology and perioperative renal function in living kidney donors.

PATIENTS AND METHODS

Between January 2010 and March 2013, a total of 363 living kidney donors who underwent donor nephrectomy at our institution were enrolled. Metabolic syndrome was diagnosed in patients according to the National Cholesterol Education Program's Adult Treatment Panel III, and renal histology of implantation biopsy specimens and perioperative renal function were compared in participants with or without metabolic syndrome. Using multivariate regression analysis, the goal was to identify which component of metabolic syndrome induces chronic histologic changes and delayed renal function recovery.

RESULTS

We identified 30 donors (8.45%) with metabolic syndrome. Donors with metabolic syndrome were older (48.4 ± 9.2 years vs 39.7 ± 11.4 years; P < .001) and more likely to have chronic histologic changes (36.8% vs 9.7%; P = .001) than subjects without metabolic syndrome. Results of the multivariate regression analysis indicated that obesity, hyperglycemia, and hypertriglyceridemia were independently associated with chronic histologic changes. Perioperative renal function was correlated with the presence of metabolic syndrome rather than with chronic histologic changes, and patients with metabolic syndrome were more likely to experience delayed renal function recovery. Linear regression models found that the sum of the metabolic components correlated with renal function 6 months postoperatively, but among all risk factors, only obesity was significantly associated with the occurrence of delayed renal function recovery (odds ratio, 2.67; P = .001).

CONCLUSIONS

Although metabolic syndrome in living kidney donors is characterized by chronic histologic changes, perioperative renal function is affected by the syndrome itself rather than by the histologic changes. Obesity is the most important metabolic factor for predicting delayed renal function recovery in living kidney donors, providing an important clinical indicator of postoperative renal function in these patients.

RNA-sequencing of the brain transcriptome implicates dysregulation of neuroplasticity, circadian rhythms and GTPase binding in bipolar disorder

RNA-sequencing (RNA-seq) is a powerful technique to investigate the complexity of gene expression in the human brain. We used RNA-seq to survey the brain transcriptome in high-quality postmortem dorsolateral prefrontal cortex from 11 individuals diagnosed with bipolar disorder (BD) and from 11 age- and gender-matched controls. Deep sequencing was performed, with over 350 million reads per specimen. At a false discovery rate of <5%, we detected five differentially expressed (DE) genes and 12 DE transcripts, most of which have not been previously implicated in BD. Among these, Prominin 1/CD133 and ATP-binding cassette-sub-family G-member2 (ABCG2) have important roles in neuroplasticity. We also show for the first time differential expression of long noncoding RNAs (lncRNAs) in BD. DE transcripts include those of serine/arginine-rich splicing factor 5 (SRSF5) and regulatory factor X4 (RFX4), which along with lncRNAs have a role in mammalian circadian rhythms. The DE genes were significantly enriched for several Gene Ontology categories. Of these, genes involved with GTPase binding were also enriched for BD-associated SNPs from previous genome-wide association studies, suggesting that differential expression of these genes is not simply a consequence of BD or its treatment. Many of these findings were replicated by microarray in an independent sample of 60 cases and controls. These results highlight common pathways for inherited and non-inherited influences on disease risk that may constitute good targets for novel therapies.

Methemoglobinemia associated with metaflumizone poisoning

CONTEXT

Metaflumizone is a voltage-dependent sodium channel blocker insecticide, which is chemically similar to indoxacarb. Although indoxacarb poisoning is known as a cause of methemoglobinemia, the effect of metaflumizone poisoning in humans is still unknown.

CASE DETAILS

A 57-year-old man presented with a decreased mentality following ingestion of 100 ml of metaflumizone, 150 ml of glyphosate and alcohol. Although initial methemoglobin (MetHb) level was slightly higher than the normal limit, it gradually rose to reach a maximum level of 27.8%, on the 19 h after ingestion. After hemodialysis, MetHb level was reduced to 15.8%, which decreased further to the level of 6%, following methylene blue administration.

DISCUSSION

Metaflumizone shares a similar chemical structure to indoxacarb, which is known to be a cause of methemoglobinemia. Physicians should be alert for the development of methemoglobinemia in symptomatic patients when facing potential pesticide poisoning such as metaflumizone poisoning.

Mosaic double aneuploidy (45,X/47,XX,+8) with aortic dissection

Chromosomal aneuploidy is considerably frequent and may involve either autosomes or sex chromosomes. While double aneuploidy involving both autosomal and sex chromosomes is rare, several reports described the cases of sex chromosomal aneuploidies in combination with trisomy 21, such as Down-Klinefelter and Down-Turner syndrome. However, trisomy 8-Turner syndrome has been rarely described to date. Here we report a case of a 28-year-old female with mosaic trisomy 8-Turner syndrome. The patient was referred to our hospital for aortic dissection. On physical evaluation, features of her phenotype, which included short stature, webbed neck and cubitus valgus, suggested congenital anomalies such as Turner syndrome. Chest CT revealed aortic dissection with bicuspid aortic valve and coarctation. G-banding cytogenetic analysis of peripheral blood showed mosaicism with two cell lines (45,X[17]/47,XX,+8[33]). FISH analysis indicated that 15% of the cells were of monosomy X karyotype and 85% of the cells were with XX karyotype and trisomy 8 was detected only in XX cells. Though the patient exhibited clinical features of Turner syndrome, somatic stigmas present were not clearly distinguishable from those of trisomy 8, such as short stature, skeletal and cardiac abnormalities. Observations from most of the double aneuploidy cases indicated that the patient's phenotype was not necessarily in correlation to the ratio of autosomal and sex chromosomal aberrations. Mosaicism in trisomy 8-Turner syndrome was rarely documented and we believe this is the first reported case of mosaicism in trisomy 8-Turner syndrome presenting with aortic dissection and surviving into adulthood.

Woman with hemorrhagic spots on her abdomen

Abstract Lipodissolve is a product that is composed of phosphatidylcholine and deoxycholate mixture, and other adjuvant. Lipodissolve injection seems to be performed in many countries for local fat reduction without any legal and scientific evidences of its safety and efficacy despite the US FDA warning.1 Herein, we report a case with agitation and metabolic acidosis following lipodissolve injection.

Cortical-striatal gene expression in neonatal hippocampal lesion (NVHL)-amplified cocaine sensitization

Cortical-striatal circuit dysfunction in mental illness may enhance addiction vulnerability. Neonatal ventral hippocampal lesions (NVHL) model this dual diagnosis causality by producing a schizophrenia syndrome with enhanced responsiveness to addictive drugs. Rat genome-wide microarrays containing >24 000 probesets were used to examine separate and co-occurring effects of NVHLs and cocaine sensitization (15 mg/kg/day × 5 days) on gene expression within medial prefrontal cortex (MPFC), nucleus accumbens (NAC), and caudate-putamen (CAPU). Two weeks after NVHLs robustly amplified cocaine behavioral sensitization, brains were harvested for genes of interest defined as those altered at P < 0.001 by NVHL or cocaine effects or interactions. Among 135 genes so impacted, NVHLs altered twofold more than cocaine, with half of all changes in the NAC. Although no genes were changed in the same direction by both NVHL and cocaine history, the anatomy and directionality of significant changes suggested synergy on the neural circuit level generative of compounded behavioral phenotypes: NVHL predominantly downregulated expression in MPFC and NAC while NVHL and cocaine history mostly upregulated CAPU expression. From 75 named genes altered by NVHL or cocaine, 27 had expression levels that correlated significantly with degree of behavioral sensitization, including 11 downregulated by NVHL in MPFC/NAC, and 10 upregulated by NVHL or cocaine in CAPU. These findings suggest that structural and functional impoverishment of prefrontal-cortical-accumbens circuits in mental illness is associated with abnormal striatal plasticity compounding with that in addictive disease. Polygenetic interactions impacting neuronal signaling and morphology within these networks likely contribute to addiction vulnerability in mental illness.

First Report of Stolbur Phytoplasma Infection in Commercial Freesia hybrida Cultivars

In January 2012, disease symptoms including chlorosis, leaf crinkle, leaf curving and stunting of whole plants, virescence, and curving and necrosis of flower stalks were observed in Freesia hybrida cvs. Evone, Honey Moon, Golden Gem, and Pallas in Icheon and Suwon (Gyeonggi Province in Korea). To determine a possible phytoplasma infection, the symptomatic freesia plants were examined for the presence of phytoplasma 16S rDNA fragment by PCR with the primer pair P1/P6 (2) and R16F1/R16R1 (in nested PCR), which amplifies phytoplasma 16S rDNA regions (4). An expected PCR product of ~1,096 bp was obtained from the symptomatic freesia plants, and they were designated as FreLN, Fre-phy-Ev4, Fre-phy-Ev6, Fre-phy-GG, Fre-phy-HM, and Fre-phy-Pal. The PCR products were sequenced and registered as GenkBank accessions AB695174 and AB709951-55. The sequence corresponding to symptomatic freesia had 98.8 to 99.4% identity with Stolbur phytoplasma strains in the 16S rDNA region, and it had only 95.7 to 96.3% identity with AY phytoplasma strains. In the ultra-thin sections of the leaf midribs, globous phytoplasmal bodies 54 to 214 nm in size were observed in sieve tube elements of phloem tissue. Fre-Phy-Ev6 and Fre-Phy-HM were doube-infected with Stolbur phytoplasma and Freesia mosaic virus (FreMV). Fre-Phy-Ev6 and Fre-Phy-HM revealed necrosis of flower stalks and flower color breaking besides curving of flower stalks. Therefore, flower color breaking and flower stalk necrosis were assumed to be caused by FreMV (1). Symptoms of chlorosis and stunting of whole plants shown in FreLN and virescence of Fre-phy-GG were typical symptoms of phytoplasmal diseases, while leaf crinkle, leaf curving, and curving of flower stalks appeared to be unique symptoms in F. hybrida. Stolbur phytoplasma was abundant in commercial freesia cultivation fields. Some of the cultivars, such as cv. Pallas, showed only curving of leaf and flower stalks without any typical symptom of phytoplasmal diseases. A phytoplasmal disease was reported in Poland in 2001 from F. hybrida exhibiting leaf chlorotic and necrotic spots, and classified as AY I-B based on RFLP analysis of PCR products (3). To our knowledge, this is the first report of Stolbur phytoplasma in F. hybrida. This result is significant because F. hybrida could be the infection source of Stolbur phytoplasma disease in floricultural crops. Interestingly, we found a prevalence of Stolbur phytoplasma in Petunia hybrida cultivars (GenBank Accession Nos. AB713757 to AB713758). High nucleotide sequence identity of 99.8% in the 16S rDNA region of Stolbur phytoplasma isolates from petunia and freesia support the inference that those Stolbur phytoplasma isolates could infect both floricultural crops. References: (1) A. A. Brunt. Freesia. Page 274 in: Virus and virus-like Diseases of Bulb and Flower Crops, John Wiley & Sons, Chichester, 1995. (2) S. Deng and C. Hiruki. J. Microbiol. Methods. 14:53, 1991. (3) M. Kamińska and H. Sliwa. Plant Dis. 85:336, 2001. (4) I. M. Lee et al. Phytopathology 84:559, 1994.

Synovial chondromatosis in the temporomandibular joint: a case with typical imaging features and pathological findings

Synovial chondromatosis of the temporomandibular joint is a rare benign joint disorder that has been reported in only a few studies. However, we recently encountered a pathologically proven case of this disorder. This case also showed the typical imaging findings on panoramic radiographs and on CT and MR images. Therefore, we report this case and the imaging and pathological findings.

Effect of β-phenylethyl isothiocyanate from cruciferous vegetables on growth inhibition and apoptosis of cervical cancer cells through the induction of death receptors 4 and 5

Cruciferous vegetables have been shown to have the possibility to protect against multistep carcinogenesis. β-Phenylethyl isothiocyanate (PEITC) is one component of these vegetables demonstrated to help fight many types of cancer. The present study examined the apoptotic effects of PEITC and its molecular mechanism in human cervical cancer cell lines (HEp-2 and KB). PEITC induced apoptosis to inhibit cell proliferation. According to the protein chip assay, PEITC increased the expression of the death receptors (DR4 and DR5) and cleaved caspase-3 compared to the DMSO treatment group. PEITC also induced caspase-8 and truncated BID. PEITC down-regulated the phosphorylation of extracellular-related kinase (ERK)1/2, whereas neither phospho-c-Jun NH(2)-terminal kinases (JNK) nor phospho-p38 MAPK was changed. The role of ERK in PEITC-induced apoptosis was also investigated using MEK inhibitor (PD98059). PD98059 increased the expression of DR4 and DR5, activated caspase-3, and cleaved PARP. In addition, PEITC decreased the phosphorylation of MEK. Therefore, the apoptotic mechanism of PEITC in cervical cancer cells involves the induction of DR4 and DR5 through the inactivation of ERK and MEK.

Apoptotic effect of tolfenamic acid in androgen receptor-independent prostate cancer cell and xenograft tumor through specificity protein 1

Tolfenamic acid (Tol) is a non-steroidal anti-inflammatory drug that was reported to exhibit anticancer activity in pancreatic and colorectal cancer models. This study examined the role of Tol in the death regulation of PC-3 and DU145 human androgen-independent prostate cancer cells. The results showed that Tol inhibited cell growth and induced apoptosis, as evidenced by nuclear fragmentation and cleaved caspase 3 and poly(ADP-ribose) polymerase. Tol suppressed the specificity protein 1 (Sp1) protein in both PC-3 and DU145 cells. Tol also attenuated Sp1 mRNA and its promoter activity in DU145 cells, but did not alter them in PC-3 cells, indicating that Tol degrades Sp1 protein in these cells. Tol also downregulated protein levels, mRNA levels and promoter activities of survivin and myeloid cell leukemia-1, which are downstream targets of Sp1. The expressions of survivin and Mcl-1 and cancer cell growth were lower in the PC-3 cells treated with Sp1 interfering RNA and mithramycin A. Moreover, an oral injection of Tol decreased tumor growth and downregulated the Sp1 protein in athymic nude mice bearing DU145 cell xenografts without hepatotoxicity. Overall, Tol downregulates the Sp1 protein to inhibit growth and induce apoptosis in androgen-refractory prostate cancers, both in vitro and in vivo, that show resistance against many chemotherapeutic agents.

Apoptotic Effect of Tolfenamic Acid in KB Human Oral Cancer Cells: Possible Involvement of the p38 MAPK Pathway

Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to inhibit cancer growth by inhibiting the activity of cyclooxygenase (COX). However, there is increasing evidence that the COX-independent pathway may be also involved in the inhibitory effect of NSAIDs against tumor progression. Tolfenamic acid is a NSAID that exhibits anticancer activity in pancreatic and colorectal cancer models. In the present study, the anti-tumor effect of tolfenamic acid in KB human oral cancer cells is investigated. The results showed that tolfenamic acid does not alter the expression of the COX proteins, but it inhibits cell growth and induces apoptosis as evidenced by the annexin V positivity, sub-G₁ population, nuclear fragmentation and the cleavage of poly ADP-ribose polymerase. In addition, tolfenamic acid also leads to a loss of the mitochondrial membrane potential in KB cells. These effects are related to the activation of p38 mitogen-activated protein kinase (MAPK) pathway. These results suggest that tolfenamic acid-induced apoptotic cell death inhibits cancer growth by activating the p38 MAPK pathway for cancer prevention.

Sulforaphane Increases Cyclin-Dependent Kinase Inhibitor, p21 Protein in Human Oral Carcinoma Cells and Nude Mouse Animal Model to Induce G(2)/M Cell Cycle Arrest

Previously, our group reported that sulforaphane (SFN), a naturally occurring chemopreventive agent from cruciferous vegetables, effectively inhibits the proliferation of KB and YD-10B human oral squamous carcinoma cells by causing apoptosis. In this study, treatment of 20 and 40 microM of SFN for 12 h caused a cell cycle arrest in the G(2)/M phase. Cell cycle arrest induced by SFN was associated with a significant increase in the p21 protein level and a decrease in cyclin B expression, but there was no change in the cyclin A protein level. In addition, SFN increased the p21 promoter activity significantly. Furthermore, SFN induced p21 protein expression in a nude mouse xenograft model suggesting that SFN is a potent inducer of the p21 protein in human oral squamous carcinoma cells. These findings show that SFN is a promising candidate for molecular-targeting chemotherapy against human oral squamous cell carcinoma.

An E3 ubiquitin ligase, Really Interesting New Gene (RING) Finger 41, is a candidate gene for anxiety-like behavior and beta-carboline-induced seizures

BACKGROUND

Identification of the genes underlying psychiatric illness remains a thorny problem. Previously, Quantitative Trait Loci (QTL) for anxiety-like behaviors and beta-carboline-induced seizure vulnerability have been mapped to the distal portion of mouse chromosome 10, with crosses of A/J and C57BL6 mice.

METHODS

An interval specific congenic strain for this chromosomal 10 region facilitated the genetic dissection of novelty-induced exploratory behaviors.

RESULTS

By microarray studies, an unsuspected E3 ubiquitin ligase, Really Interesting New Gene (RING) Finger 41 (Rnf41) was differentially expressed in the region of interest, being upregulated in the hippocampi of B6 compared with A/J as well as congenic A.B6(chr10) versus A/J. By quantitative real-time polymerase chain reaction (qRT-PCR), Rnf41 expression levels were significantly increased 1.5- and 1.3-fold in the hippocampi of C57BL6/J and A.B6(chr10) mice compared with A/J mice, respectively. Protein levels of Rnf41 were increased in hippocampi of B6 mice compared with A/J mice across postnatal development with a 5.5-fold difference at P56. Yeast two-hybrid studies searching for Rnf41 binding partners in fetal hippocampus identified several potential targets. An interaction between Rnf41 and NogoA was validated by glutathionine-S-transferase-Rnf41 pulldown experiments. Re-analysis of a microarray database of human postmortem prefrontal cortex (Brodmann's Area 46/10) found that RNF41 messenger RNA expression levels were reduced significantly in patients with major depression and bipolar disorder compared with unaffected control subjects and confirmed by qRT-PCR.

CONCLUSIONS

Overall, Rnf41 is nominated as a candidate gene for anxiety-like behaviors, depression, and vulnerability to seizures. The RNF41 and its binding partners suggest molecular pathways underlying behavior, highlighting a potential role for the ubiquitin proteasome system in psychiatric illness.

A novel method for estimating the safe margin and the adequate direction of endoscopic biliary sphincterotomy in choledocholithiasis with complications (with videos)

BACKGROUND

It is difficult to estimate the safe upper margin and the proper direction of endoscopic biliary sphincterotomy (EBS) in cases of choledocholithiasis complicated by periampullary diverticulum (PAD) or previous EBS.

OBJECTIVE

This study evaluated the clinical usefulness of an inflated-balloon-pulling (IBP) technique for assessing the safe margin and the proper direction of EBS in affected patients.

DESIGN

Prospective feasibility study.

SETTING

Academic tertiary center.

PATIENTS

From March 2003 to November 2003, the IBP technique was applied to patients with choledocholithiasis in whom EBS was difficult because of concomitant PAD or previous EBS.

INTERVENTIONS AND MAIN OUTCOME MEASUREMENTS

After the endoscopically visible papillary roof of the ampulla of Vater was fully dissected, an inflated 11.5- or 15-mm retrieval balloon was inserted in the bile duct and was pulled toward the duodenal lumen, creating an artificial bulge. This bulge was considered an endoscopic landmark to indicate the residual intramural portion and the direction of the bile duct.

RESULTS

A total of 19 patients (12 men, 7 women), with a mean age of 61.5 years, were consecutively enrolled. Of these patients, 7 had PAD, 7 had recurrent choledocholithiasis, and 5 had both conditions. The mean length of the IBP-induced residual intramural bile duct was 6.6 mm (range, 3-15 mm). The previous EBS was not oriented toward the bile duct in 4 of 12 patients with recurrent choledocholithiasis (33.3%). After EBS extended completely, choledocholithiases were successfully removed in all patients (1 by mechanical lithotripsy). Of the 19 patients, 2 had complications (11%; 1 mild hemorrhage, 1 mild pancreatitis), which were managed medically. There was no case of perforation.

CONCLUSIONS

The IBP technique is a feasible and a reliable method for safe and effective EBS in patients with choledocholithiasis in whom EBS is difficult because of PAD or/and previous EBS. The clinical significance of the direction of previous EBS needs to be defined.

Placenta hominis protects osteoporosis in ovariectomized rats

In China, Japan, and Korea, placenta hominis extracts (PHEs) are used clinically for the treatment of osteoporosis. The anti-osteoporotic effect of PHEs was studied. The trabecular bone area and thickness in OVX rats decreased by 50% from those in sham-operated rats; these decreases were completely inhibited by administration of PHEs for 7 weeks. Osteoclast numbers and the osteoblast surface were enhanced in OVX rats, but PHEs had no effect on these phenomena. Serum phosphorus and alkaline phosphatase in OVX rats increased compared to those in sham-operated rats, but the increases were not affected by the administration of PHEs. Thyroxine (T4) level was stimulated in OVX rats. The extracts inhibited the T4 level in the OVX rats. These results strongly suggest that PHEs be effective in preventing the development of bone loss induced by OVX in rats.

Degradation of parathion and the reduction of acute toxicity in TiO2 photocatalysis

Photocatalytic degradation of methyl parathion was done using a circulating TiO2/UV and TiO2/solar reactor. Indoor experimental results showed that, under the photocatalysis conditions, parathion was more effectively degraded than under the photolysis and TiO2 only conditions. Parathion (38 microM) was completely degraded under photocatalysis within 90 min, and more than 80% TOC decrease after 150 minutes. The main ionic byproducts during the photocatalysis were measured, and almost complete nitrogen recovery was achieved as mainly NO3- NO2-, and NH4+, and 80% of sulfur as recovered as SO4(2)-. Organic intermediates such as nitrophenol and methyl paraoxon were also identified during the photocatalysis of parathion, and these were further degraded after 90 minutes. Microtox bioassay using Vibrio fischeri was used in evaluating the toxicity of solutions treated by photocatalysis and photolysis of parathion. The results showed that the acute toxicity expressed as EC50 almost reduced after 90 min under the photocatalysis condition whereas only 40% reduction of toxicity as EC50 was achieved in photolysis condition. The outdoor results using a TiO2/solar system were similar to the TiO2 indoor system, indicating the possibility of applying TiO2/solar system for the treatment of parathion-contaminated water.

Risk of ovarian failure and pregnancy outcome in patients with lupus nephritis treated with intravenous cyclophosphamide pulse therapy

This study was designed to investigate the risk of ovarian failure and the pregnancy outcomes in women treated with intravenous cyclophosphamide (IVCYC) pulse therapy for lupus nephritis. Sixty-seven women with proliferative lupus nephritis were studied. The clinical and laboratory data, SLEDAI and damage indices at IVCYC initiation, doses and numbers of IVCYC pulses, pregnancy and fetal outcomes were evaluated. During a follow-up of 74.4+/-20.6 months, amenorrhea occurred in 25 (37.3%) and was sustained permanently in 10 patients (14.9%). Thirteen women became pregnant with a total of 19 pregnancies. Seventeen pregnancies ended without complications and all babies were born healthy without any congenital anomalies or perinatal illnesses. Two pregnancies were terminated by induced abortion but no congenital anomaly was noted in these cases. Logistic regression analysis showed that old age, high damage index at the initiation of IVCYC pulse therapy and high cumulative dosage of IVCYC were the independent risk factors of ovarian failure, and that the presence of amenorrhea, regardless of its duration, was the risk factor of pregnancy failure. Pregnancy was possible with a favorable outcome after the withdrawal of IVCYC pulse therapy, unless amenorrhea develops.

Application of a sponge media (BioCube) process for upgrading and expansion of existing caprolactam wastewater treatment plant for nitrogen removal

For the upgrade and expansion of an existing caprolactam wastewater treatment plant, a freely floating sponge media (BioCube) process was selected based on extensive pilot-plant tests, due to extreme space constraints. In order to protect nitrifier inhibition caused by high strength organics in caprolactam wastewater, the pilot plant consisted of an organics removal reactor, which functioned as a pretreatment for nitrification, and followed the nitrogen removal reactor. The suspended MLSS was 1,800-4,000 and the media attached MLSS was maintained at 22,000-26,000 mg/L. The final effluent COD was noticeably low, around 20.4-37 mg/L, even with fairly large fluctuations in the feed levels, between 1,400-6,770 mg/L. The removal of total nitrogen with the system, when denitrification was close to completion, was approximately 97.6%. For the entire run, complete nitrification of 99.6% was achieved, which might have been due to well-acclimatized nitrifiers attached in the BioCube media. Specifically, after adaptation, the nitrification continuously increased in the organics removal reactor, even under high residual organics conditions. From the numerous experimental results, the BioCube process seemed to be an effective method for the upgrading and expansion of the existing wastewater treatment plant, with minimum reactor enlargement.