Outcomes of antiretroviral treatment for 0-14-year-old children living with HIV in Ganzhou, China, 2006-2023

BACKGROUND

Studies on antiretroviral therapy (ART) in children living with HIV (CLHIV) are limited due to the small population and low accession rate of ART.

METHODS

All 0-14-year-old CLHIV admitted to the Ganzhou Center for Disease Control and Prevention from January 2006 to June 2023 were included retrospectively. The information of treatment regimens, disease progression, and laboratory tests of the patients under ART were used to explore the outcomes and impacts of long-term ART. The normality of all the data was tested by the Shapiro-Wilk test.

RESULTS

From 2006 to 2023, 18 CLHIV were reported in Ganzhou. Among them, 11 received ART and were followed up for 60.0 ± 48.4 months. After receiving ART, the median viral load of them decreased from 89,600 copies/ml to 22 copies/ml (P = 0.007), the median CD4+ T cell count increased from 380.7 cells/µL to 661.9 cells/µL (P = 0.028), and the median CD8+ T cell count decreased from 1065.8 cells/µL to 983.3 cells/µL (P = 0.584). The laboratory test results regarding liver function, renal function, blood cell count, and glucolipid metabolism tended to be within normal reference ranges, and the mean height-for-age z-score and weight-for-age z-score increased. However, all the three CLHIV who received cotrimoxazole developed pneumocystis carinii pneumonia, upper respiratory infection, skin lesions, bacterial pneumonia and/or thrush; the mean body-mass-index-for-age z-score decreased from 0.52 to -0.63.

CONCLUSION

For CLHIV, ART could effectively inhibit the replication of HIV and improve the immune function of patients. More studies that focus on ART in CLHIV are urgently needed.

[Construction and preliminary validation of a risk prediction model for the recurrence of diabetic foot ulcer in diabetic patients]

Objective: To develop a risk prediction model for the recurrence of diabetic foot ulcer (DFU) in diabetic patients and primarily validate its predictive value. Methods: Meta-analysis combined with retrospective cohort study was conducted. The Chinese and English papers on risk factors related to DFU recurrence publicly published in China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and PubMed, Embase, Cochrane Library, and Web of Science, and the search time was from the establishment date of each database until March 31st, 2022. The papers were screened and evaluated, the data were extracted, a meta-analysis was performed using RevMan 5.4.1 statistical software to screen risk factors for DFU recurrence, and Egger's linear regression was used to assess the publication bias of the study results. Risk factors for DFU recurrence mentioned in ≥3 studies and with statistically significant differences in the meta-analysis were selected as the independent variables to develop a logistic regression model for risk prediction of DFU recurrence. The medical records of 101 patients with DFU who met the inclusion criteria and were admitted to Affiliated Hospital of Guizhou Medical University from January 2019 to June 2022 were collected. There were 69 males and 32 females, aged (63±14) years. The receiver operating characteristic (ROC) curve of the predictive performance of the above constructed predictive model for DFU recurrence was drawn, and the area under the ROC curve, maximum Youden index, and sensitivity and specificity at the point were calculated. Dataset including data of 8 risk factors for DFU recurrence and the DFU recurrence rates of 10 000 cases was simulated using RStudio software and a scatter plot was drawn to determine two probabilities for risk division of DFU recurrence. Using the β coefficients corresponding to 8 DFU recurrence risk factors ×10 and taking the integer as the score of coefficient weight of each risk factor, the total score was obtained by summing up, and the cutoff scores for risk level division were calculated based on the total score × two probabilities for risk division of DFU recurrence. Results: Finally, 20 papers were included, including 3 case-control studies and 17 cohort studies, with a total of 4 238 cases and DFU recurrence rate of 22.7% to 71.2%. Meta-analysis showed that glycosylated hemoglobin >7.5% and with plantar ulcer, diabetic peripheral neuropathy, diabetic peripheral vascular disease, smoking, osteomyelitis, history of amputation/toe amputation, and multidrug-resistant bacterial infection were risk factors for the recurrence of DFU (with odds ratios of 3.27, 3.66, 4.05, 3.94, 1.98, 7.17, 11.96, 3.61, 95% confidence intervals of 2.79-3.84, 2.06-6.50, 2.50-6.58, 2.65-5.84, 1.65-2.38, 2.29-22.47, 4.60-31.14, 3.13-4.17, respectively, P<0.05). There were no statistically significant differences in publication biases of diabetic peripheral neuropathy, diabetic peripheral vascular disease, glycosylated hemoglobin >7.5%, plantar ulcer, smoking, multidrug-resistant bacterial infection, or osteomyelitis (P>0.05), but there was a statistically significant difference in the publication bias of amputation/toe amputation (t=-30.39, P<0.05). The area under the ROC curve of the predictive model was 0.81 (with 95% confidence interval of 0.71-0.91) and the maximum Youden index was 0.59, at which the sensitivity was 72% and the specificity was 86%. Ultimately, 29.0% and 44.8% were identified respectively as the cutoff for dividing the probability of low risk and medium risk, and medium risk and high risk for DFU recurrence, while the corresponding total scores of low, medium, and high risks of DFU recurrence were <37, 37-57, and 58-118, respectively. Conclusions: Eight risk factors for DFU recurrence are screened through meta-analysis and the risk prediction model for DFU recurrence is developed, which has moderate predictive accuracy and can provide guidance for healthcare workers to take interventions for patient with DFU recurrence risk.

[Management of menopausal syndrome in women with dyslipidemia]

The prevalence of dyslipidemia is increased in postmenopausal women due to dysregulation of lipid metabolism and deficiency of estrogen levels. At the same time, some postmenopausal women also have menopausal syndromes such as vasomotor symptoms, physical physiology, mental psychology, and urogenital tract atrophy. Menopausal hormone therapy is the most effective measure to alleviate menopausal syndrome. And initiating MHT in early menopause can reduce cardiovascular damage. However, menopausal hormone therapy can also bring the risk of thromboembolic diseases such as venous embolism, myocardial infarction and stroke. Different drug regimens have different effects on lipid metabolism. Women with menopausal syndrome should take individualized treatment plans for different types of dyslipidemia. Therefore, this article reviews the management and treatment of menopausal syndrome in women with dyslipidemia, so as to provide a reference for personalized management of dyslipidemia in postmenopausal women.

[Prevalence and influencing factors of abnormal spinal curvature in primary and secondary school students in Shandong Province in 2020]

In 2020, the prevalence of abnormal spinal curvature among 54 079 students in Shandong Province was 1.54%. The multivariate logistic regression model analysis showed that, compared with those in primary school, economically underdeveloped areas, and non-residential schools, students in middle and high schools, economically average areas, and residential schools had a higher risk of abnormal spinal curvature, with OR (95%CI) values of 2.029 (1.662-2.476), 2.746 (2.208-3.416), 2.237 (1.740-2.875) and 2.057 (1.705-2.483), respectively. Compared with those in economically underdeveloped areas, who were underweight, who had seat adjustments≤1 time per academic year, and who had physical education classes≤1 per week, students in economically developed areas, who were normal weight, overweight, and obese, who had seat adjustments≥2 times per academic year, and who had physical education classes 2-3 or≥4 per week, had a lower risk of abnormal spinal curvature, with OR (95%CI) values of 0.690 (0.521-0.915), 0.722 (0.546-0.955), 0.535 (0.389-0.735), 0.383 (0.274-0.535), 0.835 (0.711-0.980), 0.561 (0.474-0.663) and 0.491 (0.315-0.766), respectively.

[Bioinformatics analysis and key gene verification of sepsis myocardial macrophage microarray data based on GEO database]

Objective: Bioinformatics analysis was used to screen differentially expressed genes (DEGs) in macrophages of sepsis myocardial injury and to verify key genes. Methods: Experiment 1 (gene chip and bioinformatics analysis): The gene chip data GSE104342 of cardiac macrophages in septic mice was downloaded from Gene Expression Omnibus database. DEGs were obtained by R language analysis. DAVID online database was used to obtain gene ontology and kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis of DEGs. STRING online database was used for protein-protein interaction network analysis of DEGs, and then key genes were screened by using Cytoscape software and molecular complex detection (MCODE) plug-ins. Experiment 2 (sepsis model construction and related protein verification): Ten male C57BL/6 mice, aged 8-14 weeks. Five mice were randomly selected as control group, and 5 mice were selected as the sepsis group by building a mice sepsis model in vivo. Echocardiography was used to detect the cardiac function. Hematoxylin-eosin staining was used to assess the cardiac morphology. TUNEL staining was used to evaluate cardiomyocyte apoptosis. Immunofluorescence staining was used to detect the expression of differentiation antigen cluster 206 (CD206),inducible nitric oxide synthases (iNOS),F4/80,suppressor of cytokine signaling 3 (Socs3) ,interleukin 1 receptor antagonist (Il1rn) and chemokine C-C motif ligand 7 (Ccl7) protein. RAW264.7 macrophages were cultured in vitro and divided into 2 groups: LPS groupstimulated by lipopolysaccharide (LPS, 1 mg/L) and blank control group treated with equal-volume phosphate buffer solution. Reverse transcription-polymerase chain reaction (RT-PCR) was used to evaluate the expression of Socs3, Il1rn and Ccl7 in vitro. Results: Experiment 1: 24 647 genes were screened in GSE104342 dataset and 177 genes (0.72%) were differential expression, including 120 up-regulated genes and 57 down-regulated genes. Gene ontology enrichment analysis showed that DEGs were mainly involved in inflammatory response, immune response, apoptosis regulation and antigen processing and presentation. KEGG signaling pathway analysis showed that DEGs in cardiac macrophages of septic mice were mainly enriched in cytokine-cytokine receptor interaction, tumor necrosis factor signaling pathway, NOD like receptor signaling pathway. Three hub genes were obtained by STRING and Cytoscape analysis, including Socs3, Il1rn and Ccl7. Experiment 2: In vivo, it was found that compared with the control group, the cardiac function of the sepsis mice decreased significantly, the myocardial cells were significantly edema, inflammatory cell infiltration, myocardial fiber rupture, some myocardial nuclei dissolved and disappeared, and the cardiomyocyte apoptosis increased, suggesting that the sepsis myocardial injury model of mice was successfully constructed. Compared with the control group, the expression of CD206 in the myocardium of septic mice was down-regulated, the expression of iNOS, F4/80, Socs3, Il1rn and Ccl7 were up-regulated. In addition, there was co-localization between Socs3, Il1rn, Ccl7 and F4/80 protein. Compared with the blank control group, the expression of Socs3, Il1rn and Ccl7 significantly upregulated after LPS intervention in vitro by RT-PCR. Conclusions: The selected key genes Socs3, Il1rn and Ccl7 were up-regulated in myocardial macrophages of septic mice. Socs3, Il1rn and Ccl7 are expected to become new targets for the diagnosis and treatment of sepsis cardiac injury.

[Summary of the best evidence on exercise for the prevention and treatment of diabetic foot]

Objective: To summarize the best evidence on exercise for the prevention and treatment of diabetic foot. Methods: A bibliometric approach was used. Systematic searches were carried out to retrieve all the publicly published evidences till July 2022 on exercise for the prevention and treatment of diabetic foot, including guidelines, evidence summary, recommended practices, expert consensus, systematic review, and original research, from foreign language databases including BMJ Best Practice, UpToDate, Joanna Briggs Institute Evidence-Based Practice Database, Cochrane Library, Embase, PubMed, Guideline International Network, National Guideline Clearinghouse, Chinese databases including China National Knowledge Infrastructure, Wanfang Database, VIP Database, China Biology Medicine disc, China Clinical Guidelines Library, and the official websites of relevant academic organizations including National Institute for Health and Care Excellence of the United Kingdom, Registered Nurses' Association of Ontario of Canada, the International Working Group on the Diabetic Foot, International Diabetes Federation, American College of Sports Medicine, American Diabetes Association, and Chinese Diabetes Society. The literature was screened and evaluated for the quality, from which the evidences were extracted and evaluated to summarize the best evidences. Results: Nine guidelines, three expert consensuses, one evidence summary (with two systematic reviews being traced), two systematic reviews, 6 randomized controlled trials were retrieved and included, with good quality of literature. Totally 33 pieces of best evidences on exercise for the prevention and treatment of diabetic foot were summarized from the aspects of appropriate exercise prevention of diabetic foot, exercise therapy of diabetic foot, precautions for exercise, health education, and establishment of a multidisciplinary limb salvage team. Conclusions: Totally 33 pieces of best evidences on exercise for the prevention and treatment of diabetic foot were summarized from 5 aspects, providing decision-making basis for clinical guidance on exercise practice for patients with diabetic foot.

[Progress in research of deaths and disease burden of major chronic diseases caused by indoor and outdoor air pollution in China]

Health damage including chronic disease caused by air pollution have attracted increasing attention. With the acceleration of industrialization and urbanization, the emission of air pollutants has increased, and its association with chronic diseases has become a research trending topic. Cardiovascular disease, cancer, diabetes, and chronic respiratory disease are the major chronic diseases, causing about 86.6% of the total deaths in China. The prevention and control of chronic diseases, especially the etiologic prevention, is a major public health issue related to national health. This article summarizes the recent progress in research of association of indoor and outdoor air pollution with all-cause mortality, the deaths and disease burden of four major chronic diseases, i.e. cardiovascular disease, cancer, diabetes, and chronic respiratory disease, and puts forward suggestions for the reduction of the burden caused by chronic diseases due to air pollution to provide a theoretical foundation to revise air quality standards in China.

[Research progress in the methodology used in phenome-wide association studies]

Phenome-wide association study (PheWAS) is a reverse genetic analysis method to identify the potential phenotypes associated with genetic variations. With the increasing availability of biomedical databases and electronic medical records (EMR), PheWAS has gradually become an effective tool to unveil the relationships between exposure and a broad range of health phenotypes. The unique advantage of this method is that it can simultaneously explore the associations of a specific exposure with a variety of disease outcomes, thus helping to reveal multiple causal relationships and the shared pathogenic mechanisms among diseases. However, PheWAS has limitations, including selecting instrumental variables and the heavy burden of various corrections. In addition, how to interpret the biological mechanisms underlying significant findings is another crucial issue of PheWAS. This review will focus on the methodology and application of PheWAS to provide meaningful suggestions and insights for future studies.

[Endemic situation of schistosomiasis in national surveillance sites of Zhejiang Province from 2015 to 2019]

OBJECTIVE

To analyze the endemic situation of schistosomiasis in national surveillance sites of Zhejiang Province, so as to provide the scientific evidence for formulating the new schistosomiasis surveillance program and consolidating schistosomiasis elimination achievements.

METHODS

A total of 54 to 55 national surveillance sites and 6 risk monitoring sites were assigned in historical endemic regions of Zhejiang Province from 2015 to 2019, where the Schistosoma japonicum infections in humans, livestock, snails and wild feces were monitored. All data pertaining to the surveillance results were descriptively analyzed.

RESULTS

There were 34 530 person-time local residents receiving serological screening for S. japonicum infections in national surveillance sites of Zhejiang Province from 2015 to 2019, and the seroprevalance of S. japonicum infections were 0.29% to 0.68%; however, no egg-positives were detected. During the period from 2015 to 2019, there were 62 086 person-time mobile populations receiving serological screening for S. japonicum infections in national surveillance sites of Zhejiang Province, and the seroprevalance of S. japonicum infections were 0.32% to 0.56%; additionally, there were 27 egg-positives identified, including 3 imported cases with schistosomiasis haematobia and one case with acute schistosomiasis japonica, indicating that the adjusted prevalence of Schistosoma infections were 0.01% to 0.07% among mobile populations. A total of 829 livestock were examined for S. japonicum infections, with no positives detected. There were 10.55 hm² and 2.89 hm² snail habitats found in national surveillance sites and risk monitoring sites of Zhejiang Province during the 5-year period, respectively; however, no S. japonicum infections were identified in snails. Moreover, a total of 305 wild feces were tested for S. japonicum infections, and no egg-positives were identified.

CONCLUSIONS

The schistosomiasis elimination achievement have been consolidated in Zhejiang Province; however, the risk factors of re-emerging schistosomiasis have not been completely eliminated, such as residual snails and imported schistosomiasis cases. Further surveillance and control activities of snails and the source of S. japonicum infections should be reinforced.

[Establishment of nutrition literacy core items for Chinese lactating women]

Objective: To establish the nutrition literacy core items for Chinese lactating women. Methods: The framework system and preliminary items of nutrition literacy were established through literature review and experts consultation. E-Delphi method was used to determine the nutrition literacy items. 11 experts in the field of maternal and child nutrition, obstetrics and gynecology, health education and nutrition and diseases were invited to score the importance of each nutrition literacy item via Email. The judgment basis and familiarity of experts towards the items, active coefficient, authority coefficient and harmony coefficient were evaluated and analyzed to generate the final list of nutrition literacy items. Results: The active coefficients of consultation in two rounds were 81.8% (9/11) and 87.5% (8/9). The authority coefficients were (0.86±0.11) and (0.85±0.06). The average scores of importance were (4.03±1.24) and (4.64±0.50)and the harmony coefficients were 0.556 (χ²=163.42, P<0.001) and 0.40 (χ²=64.41, P<0.001). After the second round of consultation, all selected items met the inclusion criteria. We identified the final list of nutrition literacy items consisting of 3 scales (basic knowledge and concept, lifestyles and dietary behaviors, and basic skills), 10 subscales (basic nutrition concept, food and nutrition knowledge, feeding knowledge, lifestyles, dietary behaviors, feeding behaviors, weight management, complementary food production, acquisition, understanding and application of nutrition information, judgement of nutrition information, and nutrition decision making) with 24 items in total. Conclusions: The framework system and core items of nutrition literacy were established for Chinese lactating women based on E-Delphi method. The experts involved in the consultation process presented a performance with good representativeness, enthusiasm and authority. All experts' opinions are coordinated and unified, which could satisfy the demand of developing nutrition literacy core items for target population.

Knockdown of lncRNA HCP5 protects against cerebral ischemia/reperfusion injury by regulating miR-652-3p

Previous studies have shown that lncRNAs play crucial roles in cerebral ischemia/reperfusion injury. In this study, the function and possible mechanism of lncRNA HCP5 in cerebral ischemia/reperfusion injury was investigated. An oxygen glucose deprivation (OGD) model in N2a cells was used to simulate cerebral ischemia/reperfusion injury in vitro. The functional mechanism of lncRNA HCP5 was detected using Trypan blue staining, JC-1, MTT and dual luciferase reporter assays. The expression of apoptosis-related proteins (Bcl-2 and Bax) was measured by Western blot analysis. We found that lncRNA HCP5 was upregulated in N2a cells treated with OGD/R, and knockdown of lncRNA HCP5 enhanced cell viability and reduced cell death. In addition, miR-652-3p was found to act as a sponge for lncRNA HCP5. The overexpression of miR- 652-3p can prevent cerebral ischemic reperfusion injury, however, lncRNA HCP5 attenuated the protective effect of miR-652-3p in cerebral ischemic reperfusion injury. In conclusion, upregulation of lncRNA HCP5 may exacerbate cerebral ischemic reperfusion injury by sponging miR-652-3p.

[Exploration and application of occupational disease risk assessment model based on information diffusion theory]

Objective: To research build a kind of occupational disease risk assessment model which provides scientific basis for prevention and control of occupational diseases. Methods: Based on the principle of information diffusion, this paper uses spread function to extend the incomplete gathered information, establishes the mapping relationship between observation samples and risk probability distributions, and constructs the occupational disease risk assessment model, to analyzes the risk data of occupational disease reported cases in Guangdong Province in the past five years. Results: Through evaluation analysis, every year, 200-300 cases of pneumoconiosis probability is 67.77%, 100-200 cases of occupational poisoning probability is 68.52%, 20-40 cases of occupational cancers probability is 71.62%, each year, the incidence of occupation otorhinolaryngology and oral diseases in 200 cases was 62.23%. Conclusion: A model of occupational disease risk assessment based on information diffusion theory is constructed, the evaluation result is basically consistent with the actual situation of occupational disease, which can provide reference for occupational disease prevention and control.

[Predictive study on recurrence of chronic sinusitis with nasal polyps by tissue eosinophils and sinus CT]

Objective: To investigate the correlation between postoperative recurrence and clinical parameters in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and to study predicitve value of total scores of eosinophils (EOS) and sinus CT for postoperative recurrence. Methods: A retrospective analysis of 264 patients with CRSwNP who were admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2015 was performed. The patient was subjected to a visual analogue scale (VAS) score, a skin prick test, a peripheral blood cell count, a sinus CT score, and a nasal polyp EOS count. All patients underwent endoscopic surgery and were followed up for at least 2 years. The demographic characteristics of the nasal polyps recurrence group and the non-recurrence group were compared with other clinical indicators. Quantitative data were compared by t test or Mann-Whitney U test, qualitative data were compared by chi-square test, and Logistic regression analysis was used for Logistic regression analysis. The risk factors for recurrence were assessed. The best cut-off value was determined by using the receiver operating characteristic (ROC) curve. The predictive value of the parameters was determined by area under curve (AUC). The difference was statistically significant at P<0.05. Results: The recurrence rate of the study patients was 43.56% (115/264). Sex, olfactory VAS score, total sinus CT score, peripheral blood neutrophil ratio, peripheral blood EOS absolute value and proportion, and tissue EOS absolute value and proportion were associated with postoperative recurrence of nasal polyps (χ(2)=5.241, t=-3.146, t=-7.441, χ(2)=180.617, t=-5.313, χ(2)=100.067, t=-7.471, χ(2)=258.916, all P<0.05), and the tissue EOS ratio and total sinus CT scores have higher predictive value for recurrence of nasal polyps (AUC values were 0.793, 0.767, respectively, all P<0.001). With the EOS ratio of nasal polyps >0.032, the sensitivity of predicting recurrence was 83.48%, the specificity was 56.38%. With the total score of sinus CT>15, the sensitivity of predicting recurrence was 51.30% and the specificity was 87.25%. The combined sensitivity of predictive recurrence was 92.00% and the specificity was 49.20%. Conclusion: The percentage of EOS in nasal polyps and the total score of sinus CT in patients with CRSwNP have better predictive diagnostic value for recurrence of nasal polyps.

Circular RNA hsa_circ_0000523 regulates the proliferation and apoptosis of colorectal cancer cells as miRNA sponge

Among the novel class of endogenous long non-coding RNAs, circular RNA (circRNA) is known as a key regulator in the development and progression of different cancers. Its function and mechanism in the tumorigenesis of colorectal cancer, however, has not been well studied. This study thus aimed to investigate potential regulation of colorectal cancer by circRNAs and the corresponding regulatory mechanism. We demonstrated that the expression of circRNA hsa_circ_0000523 (also known as circ_006229) was down-regulated in different colorectal cancer cell lines. It was also found that interference of hsa_circ_0000523 induced proliferation and suppressed apoptosis of colorectal cancer cells, the proliferation rate of which was reduced by the overexpression of hsa_circ_0000523. In addition, we found that miR-31 could recognize hsa_circ_0000523 sequence and that it acted as a "sponge" of miR-31, indirectly regulating Wnt/β-catenin signaling pathway, which was involved in the progression of colorectal cancer. The results suggested that the expression of hsa_circ_0000523 correlated to the tumorigenesis of colorectal cancer cells. In addition, as a sponge of miR-31, the low level of hsa_circ_0000523 led to activation of Wnt/β-catenin signaling pathway, inducing the subsequent progress of colorectal cancer.

[An analysis of the new "three tubes" method in the treatment of spontaneous esophageal rupture]

To investigate the clinical efficacy, feasibility and safety of new "three tubes" method in the treatment of spontaneous esophageal rupture. A total of 22 patients with spontaneous esophageal rupture were retrospectively analyzed. Through the new "three tubes" method of treatment, patients achieved leak cured with reduced hospital stay, less medical expenses and early resumption of oral diet. The new "three tubes" method for spontaneous esophageal rupture has the advantages of easy handling, minimal invasion, few complication and exact curative effect.

In ovo feeding of L-arginine alters energy metabolism in post-hatch broilers

This study aimed to investigate the effects of in ovo feeding (IOF) of L-arginine (Arg) on energy metabolism in post-hatch broilers. A total of 720 eggs was randomly assigned to 3 treatments: 1) non-injected control group, 2) 0.75% NaCl diluent-injected control group, and 3) 1.0% Arg solution-injected group. At 17.5 d of incubation, 0.6 mL of each solution was injected into the amniotic fluid of each egg of injected groups. After hatching, 80 male chicks were randomly assigned to each treatment group with 8 replicates per group. The results showed that IOF of Arg increased glycogen and glucose concentrations in the liver and pectoral muscle of broilers at hatch (P < 0.05). The plasma glucose and insulin levels were higher in the Arg group than in the non-injected and diluent-injected control groups (P < 0.05). Meanwhile, IOF of Arg enhanced the hepatic glucose-6-phosphatase (G6P) activity at hatch (P < 0.05). There was no difference in hexokinase (HK) or phosphofructokinase (PFK) enzyme activities in the pectoral muscle in all groups. Further, IOF of Arg increased the phosphoenolpyruvate carboxykinase (PEPCK) and fructose-1,6-bisphosphatase (FBP) mRNA expressions at hatch (P < 0.05). In addition, broilers in the Arg group had a higher mRNA expression of glycogen synthase and a lower expression of glycogen phosphorylase in the liver and pectoral muscles than in the non-injected controls at hatch (P < 0.05). In conclusion, IOF of Arg solution enhanced liver and pectoral muscle energy reserves at hatch, which might be considered as an effective strategy for regulating early energy metabolism in broilers.

Dietary butylated hydroxytoluene improves lipid metabolism, antioxidant and anti-apoptotic response of largemouth bass (Micropterus salmoides)

A 10-week growth trail was conducted to investigate the efficacy and tolerance of dietary butylated hydroxytoluene (BHT) by evaluating inflammation, apoptosis and hepatic disease related to oxidative stress in largemouth bass (Micropterus salmoides). Four experimental diets were prepared with BHT supplement levels of 0 (B0), 150 (B150), 300 (B300) and 1500 (B1500) mg/kg, in which B150 was at the maximum recommended level established by European Union Regulation, and the B300 and B1500 levels were 2 and 10-fold of B150, respectively. Each diet was fed to 6 replicates with 30 largemouth bass (initial body weight, IBW = 6.20 ± 0.01 g) in each tank. The BHT inclusion level did not affect the specific growth rate, but fish in the B150 group showed the lowest feed conversion rate (P < 0.05). BHT inclusion significantly decreased the levels of plasma TC, TG, LDL, ALT and AKP, and increased the (HDL-C)/TC ratio (P < 0.05). Plasma MDA was significantly decreased in the B150 group and GSH-Px was extremely enhanced in each BHT inclusion group (P < 0.05). Hepatic T-AOC was significantly enhanced and O₂^- was significantly decreased in each BHT inclusion group compared to the B0 group (P < 0.05), as well as hepatic MDA was significantly decreased in B1500 group (P < 0.05). Dietary BHT inclusion down-regulated the hepatic mRNA levels of inflammation, apoptosis and fibrosis related genes, including TNFα, TGF-β1, α-SMA, IL8, IL11β and caspase-9. Moreover, BHT could improve hepatic lipid metabolism via up-regulating the mRNA levels of APOA1, CYP7A1, CYP8B1, and down-regulating the mRNA levels of PPAR-γ and APOB. Histological examination of the liver morphology with H&E and Sirius Red staining showed that BHT inclusion decreased necrotic degenerative changes and collagen deposition in largemouth bass. An immunofluorescence examination revealed significantly decreased cleaved caspase-3 signals in the BHT groups. In conclusion, the results demonstrated that ROS induces hepatic cell apoptosis and fibrosis via the intrinsic pathway of apoptosis by activating caspase-9 in the mitochondria and then initiates apoptosis by activating caspase-3. Consuming 2.32-23.80 mg/kg·bw/d (150-1500 mg/kg in diet) of BHT effectively improved the plasma and hepatic lipid metabolism, antioxidant response as well as reduced ROS production, protecting hepatic cells from injury. It is implied that even a 10-fold increase of the maximum level of BHT (150 mg/kg) is safe for the largemouth bass.

Lichenoid keratosis is frequently misdiagnosed as basal cell carcinoma

Lichenoid keratosis (LK), also known as benign lichenoid keratosis or lichen planus-like keratosis, is a solitary, pink to red-brown scaly plaque representing a host immunological response to a variety of precursor lesions. LK is often misdiagnosed as a dermatological malignancy owing to its clinical resemblance to basal cell carcinoma (BCC) or Bowen disease. We performed a retrospective analysis of the pathology records of a series of LK lesions with reference to the demographic features and accuracy of clinical diagnosis. The pathology records from 2008 to 2009 of 263 consecutive patients with a histological diagnosis of LK from a specialized skin laboratory were retrieved. Data relating to clinical diagnosis, age, sex, anatomical location, time of year of presentation and any coexistent pathological lesions adjacent to the LK were recorded. Mean age at presentation was 64 years (range 34-96), and 58% of patients were female. The most common anatomical site was the chest/anterior torso, followed by the back and legs. The most common coexisting lesion was solar keratosis at 14%, followed by seborrhoeic keratosis (SK) at 7.8%. The correct clinical diagnosis of LK was made in 29.5% of cases. The most common clinical diagnosis was BCC (47%), while SK was the preferred diagnosis in 18%. A clinical diagnosis was not given in 5.5% of cases. In conclusion, it appears that LK is frequently misdiagnosed, with misdiagnosis occurring in > 70% of cases in this study.

[Clinical value of a domestic portable monitoring system for the diagnosis of obstructive sleep apnea syndrome]

Objective:The aim of this study is to evaluate the clinical value of a portable monitoring system(YH600B) in OSAHS by comparing the consistency of overnight sleeping data recorded by polysomnography and YH600B. Method:One hundred and nineteen snoring patients underwent one-night polysomnography(PSG)and YH600B simultaneously.The measured data by the two methods were compared to analysis their correlation,including AHI and LSaO₂.The Bland Altman plots was used to assess the consistency between PSG and STD.Sensitivity and specificity comparisons were plotted graphically using receiver operating characteristic(ROC) curve analysis.Result:All cases were well tolerated the procedure.①AHI and LSaO₂ measured by the two techniques have strong correlation(r=0.981, r=0.882,P<0.05,respectively).②Bland Altman analyses showed strong agreement between AHI values from the YH600B and PSG recordings.③the ROC-curve showed that AHI cut off value was 7.25,area under the curve was 0.992 3,sensitivity was 98.1%,and specificity was 92.2%.Conclusion:These data suggest that YH600B have highly consistency with PSG,and YH600B is accurate in the application of the diagnosis of OSAHS.

Prevalence of Mycoplasma pneumoniae: a cause for community-acquired infection among pediatric populaztion

BACKGROUND

Atypical pneumonia caused by Mycoplasma pneumoniae is a leading cause of mortality among the pediatric age group.

OBJECTIVES

Our study was designed to know the prevalence of M. pneumoniae in children with community-acquired pneumonia and the involvement in the cytoadherence to the respiratory epithelium by M. pneumoniae using electron microscopy and immuno-gold labeling technique.

MATERIALS AND METHODS

A total of 152 children of 1 month to 12 years of age of both sexes attending Hebei Provincial People's Hospital, Shijiazhuang, Hebei with diagnosed pneumonia were included in the study.

RESULTS

Out of 152 children 84 (55.3%) were males, and 68 (44.7%) were females. The mean age of the patients in the control group (50 patients) was 18.5 ± 3 months with 31 (62%) males and 19 (38%) females. IgM antibodies against M. pneumoniae were positive in 84 (55.3%) males and 68 (44.7%) females. Out of 50 patients 9 (18%) were found to positive for IgM M. pneumoniae antibodies of which four (44.4%) males and 5 (55.5%) females were positive. Our study observed that the gold particles were clustered on the filamentous extension of the tip of the cells. Out of 152 serum samples subjected to particle agglutination assay 138 (90.7%) were positive 1:320 titer, 9 were >1:80 and 3 showed titer was >1:40.

CONCLUSION

We suggest that clinicians should consider empirical therapy of broad spectrum antibiotics therapy to cover these atypical pathogens to reduce the severity before obtaining the serological results. From our study, we also suggest electron microscopic and biochemical studies for better diagnosis of these pathogens.

Multichromatic narrow-energy-spread electron bunches from laser-wakefield acceleration with dual-color lasers

A method based on laser wakefield acceleration with controlled ionization injection triggered by another frequency-tripled laser is proposed, which can produce electron bunches with low energy spread. As two color pulses copropagate in the background plasma, the peak amplitude of the combined laser field is modulated in time and space during the laser propagation due to the plasma dispersion. Ionization injection occurs when the peak amplitude exceeds a certain threshold. The threshold is exceeded for limited duration periodically at different propagation distances, leading to multiple ionization injections and separated electron bunches. The method is demonstrated through multidimensional particle-in-cell simulations. Such electron bunches may be used to generate multichromatic x-ray sources for a variety of applications.

Radially polarized, half-cycle, attosecond pulses from laser wakefields through coherent synchrotronlike radiation

Attosecond bursts of coherent synchrotronlike radiation are found when driving ultrathin relativistic electron disks in a quasi-one-dimensional regime of wakefield acceleration, in which the laser waist is larger than the wake wavelength. The disks of overcritical density shrink radially due to focusing wakefields, thus providing the transverse currents for the emission of an intense, radially polarized, half-cycle pulse of about 100 attoseconds in duration. The electromagnetic pulse first focuses to a peak intensity (7×10(20)W/cm(2)) 10 times larger than the driving pulse and then emerges as a conical beam. Basic dynamics of the radiative process are derived analytically and in agreement with particle-in-cell simulations. By making use of gas targets instead of solids to form the ultrathin disks, this method allows for high repetition rates required for applications.

Characterization of surface accumulation and release of nanosilica during irradiation of polymer nanocomposites by ultraviolet light

Polymer nanocomposites are increasingly used in applications that are subjected to harsh environments. Owing to polymer's susceptibility to photodegradation, nanofillers in a polymer nanocomposite may be released into the environments during the composite's life cycle. Such release potentially poses an environmental health and safety problem and may hinder commercialization of these advanced materials. This study investigated the fate and release of nanosilica from epoxy/nanosilica composites. Specially-designed holders containing nanocomposite specimens were irradiated with UV light in a well-controlled environmental chamber. UV irradiated samples were removed for measurements of polymer chemical degradation, mass loss, surface morphology, nanosilica accumulation on the composite surface, and nanosilica release. Epoxy matrix underwent rapid photodegradation, resulting in substantial accumulation of silica nanofillers on the composite surface and also release from the composite. A conceptual model for surface accumulation and release of nanosilica during UV irradiation of epoxy nanocomposites is presented.

Development of a rapid dipstick with latex immunochromatographic assay (DLIA) for diagnosis of schistosomiasis japonica

BACKGROUND

Schistosomiasis japonica (schistosomiasis) is a zoonosis that can seriously affect human health. At present, the immunodiagnostic assays for schistosomiasis detection are time-consuming and require well-trained personnel and special instruments, which can limit their use in the field. Thus, there is a pressing need for a simple and rapid immunoassay to screen patients on a large scale. In this study, we developed a novel rapid dipstick with latex immunochromatographic assay (DLIA) to detect anti-Schisaosoma japonicum antibodies in human serum.

RESULTS

Using latex microspheres as a color probe, DLIA was established to test standard positive and negative sera, in comparison with the classical enzyme-linked immunosorbent assay (ELISA). The sensitivity and specificity of DLIA were 95.10% (97/102) and 94.91% (261/275), respectively. The cross-reaction rates with clonorchiosis, intestinal nematodes, Angiostrongylus cantonensis and paragonimiasis were 0, 0, 0 and 42.11% respectively. All the results showed no significant difference to the ELISA. In field tests, 333 human serum samples from an endemic area were tested with DLIA, and compared with ELISA and Kato-Katz method. There was no significant difference between DLIA and ELISA on positive and negative rates of detection; however, significant differences existed between DLIA and Kato-Katz method, and between ELISA and Kato-Katz method. The kappa value between DLIA and ELISA was 0.90.

CONCLUSIONS

This is the first study in which DLIA was used to detect anti-Schistosoma japonicum antibody. The results show that DLIA is a simple, rapid, convenient, sensitive and specific assay for the diagnosis of schistosomiasis and is therefore very suitable for large-scale field applications and clinical detection.

[Recent investigation and treatment of 1 060 advanced schistosomiasis cases in Zhejiang Province]

OBJECTIVE

To understand the current status of advanced schistosomiasis patients, deliver medical treatment, and improve the case management in Zhejiang Province.

METHODS

The cases previously diagnosed or suspected as advanced schistosomiasis in the province were the subjects of the investigation. Questionnairing (demographical information, disease history, etc.), clinical examination (ascites syndrome, abdominal palpation), laboratory examination (blood biochemistry, anti-Schistosoma japonicum antibody, eggs), and ultrasonography of the abdomen were used confirming the diagnosis. Treatment was given to the patients.

RESULTS

There were 1 060 advanced schistosomiasis patients in 32 counties of 7 prefectures in the province. Majority of them distributed in water network regions, and lived with poor economic conditions. The average age of the patients was (66.3 +/- 9.3), with 89.3% ranged from 50 to 80 years old. Clinically 71.3% of the cases were with splenomegaly, 27.6% with ascites, 0.9% cases of multiple granuloma in the colon and 0.2% cases with dwarfism. 1 023 patients (96.5%) had received medical treatments. 69.4% of the cases had serious complications with advanced schistosomiasis and 52.5% had concurrently disorders in other systems. 71.1% of the patients had subjective symptoms and 65.2% had hepatosplenomegaly with hepatic fibrosis and dysfunction. The serum positive rate of anti-S. japonicum antibody was 15.7%. Stool hatching test and microscopy revealed no eggs in fecal samples, but 24 out of 38 cases were found metamorphic eggs by rectal biopsy. Three years' medical treatment improved the clinical conditions in 74.3% of the cases.

CONCLUSION

Situation of the advanced schistosomiasis patients is quite critical. Treatment and care are urgently needed especially for those aged 50 to 80 years old. [

Potential of a novel polysaccharide preparation (GLPP) from Anhui-grown Ganoderma lucidum in tumor treatment and immunostimulation

Growing evidence indicates the potential of developing novel polysaccharide-based adjuvant for tumor therapy from edible mushrooms, including Ganoderma lucidum. In the present study, a novel polysaccharide preparation (GLPP) was isolated from the fruiting body of G. lucidum grown in Anhui, China, and characterized for its physicochemical properties. GLPP had an average molecular weight of 6600 and a specific optical rotation of +25.6 degrees , contained 10.6% protein, and had a molar ratio of 0.9:15:1 for mannose, glucose, and galactose, respectively. GLPP was also investigated and compared with PSP (polysaccharopeptide preparation), a commercial antitumor and immunostimulating agent, for its antitumor and immunostimulation capacity, and potential in reducing the toxic effects induced by cyclophosphamide (Cy) treatment and Cobalt-60 ((60)Co) radiation in mice. GLPP at levels of 100 and 300 mg/kg body weight (BW)/d significantly inhibited the growth of inoculated S(180), Heps, and EAC tumor cells in mice. GLPP at a dose of 300 mg/kg BW/d showed stronger growth inhibition against all 3 tested tumor cells than PSP at 1 g/kg BW/d. GLPP also dose-dependently increased phagocytic index, phagocytic coefficient, and 50% hemolysin value in the EAC tumor-bearing mice, indicating its potential immunostimulating property. In addition, GLPP at 300 mg/kg BW/d was comparable to PSP at 1000 mg/kg BW/d in preventing the decrease of thymus index, spleen index, white blood cells, and bone marrow karyote numbers induced by Cy treatment and (60)Co radiation. These data demonstrated the potential utilization of GLPP as an adjuvant to conventional treatments of cancers and its use for cancer prevention.

[Observation on the change of anti-S. japonicum antibody level in population migrated from outside embankment to new town]

OBJECTIVE

To detect the change of the anti-S. japonicum antibody level after people migrated from outside embankment to newly established town.

METHODS

Three pilot spots were established for the investigation: one spot that both inhabitancy and cultivation disuse (A), one spot that only inhabitancy disuse but farming continued (B) and the third one served as control (C). DIGFA and ELISA were used to detect the antibody level in the populations from 2002 to 2005.

RESULTS

The positive rate of anti-S. japonicum antibody declined significantly from 6.63% to 3.52% by DIGFA and from 7.26% to 3.71% by ELISA at spot A (chi2=5.2625, P<0.05; chi2=6.3296, P<0.05, respectively). There was no significant difference on the positive rate of antibody in spots B and C. The average A450 value of ELISA in the three spots was statistically analyzed by One-Way ANOVA. It was only in spot B that the average A450 value declined from 0.182 in 2003 to 0.147 in 2005 (P<0.01).

CONCLUSION

The anti-S. japonicum antibody level in human population has decreased at certain degree after they migrated from outside embankment to new town.

Development and certification of the new SRM 695 trace elements in multi-nutrient fertilizer

During the past seven years, several states within the US have enacted regulations that limit the amounts of selected non-nutritive elements in fertilizers. Internationally, several countries, including Japan, China, and Australia, and the European Union also limit the amount of selected elements in fertilizers. The elements of interest include As, Cd, Co, Cr, Cu, Hg, Mo, Ni, Pb, Se, and Zn. Fertilizer manufacturers and state regulatory authorities, faced with meeting and verifying these limits, need to develop analytical methods for determination of the elements of concern and to validate results obtained using these methods. Until now, there were no certified reference materials available with certified mass fraction values for all elements of interest in a blended, multi-nutrient fertilizer matrix. A new standard reference material (SRM) 695 trace elements in multi-nutrient fertilizer, has been developed to help meet these needs. SRM 695 has recently been issued with certified mass fraction values for seventeen elements, reference values for an additional five elements, and information values for two elements. The certificate of analysis includes an addendum listing percentage recovery for eight of these elements, determined using an acid-extraction inductively-coupled plasma optical-emission spectrometry (ICP-OES) method recently developed and tested by members of the Association of American Plant Food Control Officials.

Evaluation on the applied value of the dot immunogold filtration assay (DIGFA) for rapid detection of anti-Schistosoma japonicum antibody

The dot immunogold filtration assay (DIGFA) is a rapid technique for the detection of anti-Schistosoma japonicum antibody. Its sensitivity with regard to sera obtained from patients with acute or chronic schistosomiasis was shown to be 100 and 96.9%, respectively. The specificity when using sera of people living in an area non-endemic for schistosomiasis japonica was 100%. Cross-reaction rates for paragonimiasis and clonorchiasis patients were 14.3% and 0%, respectively. Parallel serum tests of 1091 residents from an area endemic for S. japonicum by means of DIGFA, enzyme-linked immunosorbent assay and indirect haemagglutination test resulted in positive rates of 9.3%, 11.5% and 11.0%, respectively. Thus, there was a high level of agreement between the sets of results (P>0.05). In conclusion, DIGFA holds considerable promise for rapid and accurate diagnosis of S. japonicum, as it does not require any specific instruments and can be applied with ease. DIGFA has therefore several advantages over conventional diagnostic approaches and is useful not only for screening and sero-epidemiological surveys in the field, but also in clinical settings.

Determination of As, Cd, Cr, and Hg in SRM 2584 (trace elements in indoor dust) by high-resolution inductively coupled plasma mass spectrometry

Standard reference material (SRM) 2584 (Trace Elements in Indoor Dust) was developed as a reference standard for evaluating field methods and for validating laboratory and reference methods for the assessment of lead contamination and exposure. In addition to lead, the toxic trace elements As, Cd, Cr, and Hg, at approximately 17, 10, 140, and 5 microg g(-1), respectively, have been certified in the SRM. These four analytes were successfully determined by use of high-resolution inductively coupled plasma mass spectrometry (HR-ICP-MS). Isobaric interferences at masses of As and Cr were resolved by using the high resolution mode (nominal 8000) and the medium resolution mode (nominal 3000), respectively, of the instrument. The effects of a significant drift in analyte sensitivity in the course of measurement were rectified by use of internal standardization, single spike standard addition, and an optimized analysis sequence. The results were compared with those obtained by instrumental neutron activation analysis (INAA) and isotope dilution inductively coupled plasma mass spectrometry (ID-ICP-MS). The results for the quality control, SRM 2704 (Buffalo River Sediment), were in good agreement with the certified values, indicated by the uncertainty intervals of the measured values overlapping the certified intervals at 95% confidence level.

Using inductively coupled plasma-mass spectrometry for calibration transfer between environmental CRMs

Multielement analyses of environmental reference materials have been performed using existing certified reference materials (CRMs) as calibration standards for inductively coupled plasma-mass spectrometry. The analyses have been performed using a high-performance methodology that results in comparison measurement uncertainties that are significantly less than the uncertainties of the certified values of the calibration CRM. Consequently, the determined values have uncertainties that are very nearly equivalent to the uncertainties of the calibration CRM. Several uses of this calibration transfer are proposed, including, re-certification measurements of replacement CRMs, establishing traceability of one CRM to another, and demonstrating the equivalence of two CRMs. RM 8704, a river sediment, was analyzed using SRM 2704, Buffalo River Sediment, as the calibration standard. SRM 1632c, Trace Elements in Bituminous Coal, which is a replacement for SRM 1632b, was analyzed using SRM 1632b as the standard. SRM 1635, Trace Elements in Subbituminous Coal, was also analyzed using SRM 1632b as the standard.

Anti-diarrheal effect of water extract of Evodiae fructus in mice

Our previous study showed that Evodiae fructus (the dried, unripe fruit of Evodia rutaecarpa) has an inhibitory effect on the intestinal transit (anti-transit effect) in mice. In the present study, a water extract of Evodiae fructus was used to examine its effect on castor oil-induced diarrhea and to compare with its anti-transit effect in mice. The results indicated that Evodiae fructus had both anti-transit and anti-diarrheal effects with comparable ID(50) (the dose for 50% inhibition) values of 54+/-7 and 76+/-17 mg/kg. The time-courses of Evodiae fructus pretreatment for both anti-transit and anti-diarrheal effects were very similar. Because no significant influences of both nitric oxide (NO) precursor L-arginine (600 mg/kg, i.p.) and NO synthase inhibitor N(G)-nitro-L-arginine methyl ester (25 mg/kg, i.p.) pretreatment, the NO system was not involved in both the anti-transit and anti-diarrheal effects of Evodiae fructus. Like Evodiae fructus, a muscarinic acetylcholine receptor antagonist atropine inhibited castor oil-induced increase in fecal weight and loss of body weight. However, the potencies or time-courses of atropine pretreatment for both anti-transit and anti-diarrheal effects were different. Furthermore, the anti-diarrheal effect of atropine was independent of its anti-transit effect at the lower dose (0.5 mg/kg, i.p.). Therefore, the action of Evodiae fructus appeared to be something different from atropine, suggesting that an action other than the anti-muscarinic action, as previously proposed for Evodiae fructus, may be involved.

Sjögren's syndrome and granulomatous panniculitis

An 83-year-old Cambodian woman presented with multiple painful erythematous nodules on the lower legs, forearms and wrists. Subsequent history and investigations revealed a granulomatous lobular panniculitis associated with Sjögren's syndrome. This is a rare cutaneous association of Sjögrens syndrome with only three similar case reports in the literature.

Bioequivalence study of tramadol by intramuscular administration in healthy volunteers

Tramadol hydrochloride (CAS 36282-47-0) is a centrally acting analgesic agent binding to mu opiate receptors. The bioavailability of a new tramadol hydrochloride injection (Limadol) was compared with a commercially available reference product by intramuscular administration in twelve healthy Chinese male volunteers by a standard two-way cross-over trial. Each volunteer received a single 100 mg injection of tramadol HCl in each phase. The bioavailability was compared using the area under the plasma concentration-time curve from time 0 to 30 h (AUC0-30), the area under the plasma concentration-time curve from time 0 to infinity (AUC0-infinity), peak plasma concentration (Cmax), and time to reach peak plasma concentration (Tmax). No statistically significant difference was observed between the Tmax, Cmax, AUC0-30 and AUC0-infinity of the two preparations. It is concluded that test and reference formulations of tramadol hydrochloride are bioequivalent for both the extent and rate of absorption after a single intramuscular injection.

Detection of microscopic melanoma metastases in sentinel lymph nodes

BACKGROUND

Sentinel lymph node biopsy following radioisotope labeling is a recently developed, minimally invasive surgical staging procedure used in the management of primary cutaneous malignant melanoma. If histologic analysis reveals melanoma metastasis in the sentinel lymph node, completion lymphadenectomy is performed and adjuvant therapy considered. The routine pathologic assessment of the sentinel lymph node consists of bisecting the lymph node along its long axis and histologic examination of one hematoxylin and eosin-stained section of each cut surface.

METHODS

In this study, the authors reexamined 235 sentinel lymph nodes reported as negative for melanoma metastasis following routine histologic examination, from 94 patients with American Joint Committee on Cancer (AJCC) Stage I and II cutaneous melanoma.

RESULTS

Deeper sections into the lymph node and immunohistochemical stains with antibodies to S-100, HMB-45, NK1C3, and MART-1 led to the identification of microscopic metastases in 11 sentinel lymph nodes from 11 patients and capsular nevi in 9 sentinel lymph nodes from 8 patients.

CONCLUSIONS

Deeper serial sections and immunohistochemical stains detected microscopic metastases in approximately 12% of cases that would be reported as negative for metastasis by routine pathologic analysis. These techniques also allowed for the identification of capsular melanocytic nevi in the sentinel lymph nodes of 9% of patients. [See editorial on pages 551-2, this issue.]

The morphological features of locally recurrent melanoma and cutaneous metastases of melanoma

Local recurrence of melanoma at the primary excision site usually implies that the primary excision was incomplete or "inadequate" and that the recurrence was attributable to retained primary melanoma cells or occult melanoma metastases in the adjacent tissue. Pathologists frequently report these tumors in the scar as recurrent or residual melanoma, apparently without considering the possibility that they may be local metastases and manifestations of systemic disease. In this study of 72 cases, we have shown that the morphological features of locally recurrent melanoma, excluding persistent incompletely excised primary melanoma, and cutaneous metastases of melanoma were identical. Because the prevention of local recurrence is the main reason for wide excision of melanoma beyond complete excision of the primary tumor itself, it is essential that pathologists should classify these neoplasms precisely as either persistent incompletely excised primary melanoma or metastatic melanoma.

Determination of clindamycin in human plasma by liquid chromatography-electrospray tandem mass spectrometry: application to the bioequivalence study of clindamycin

A simple, sensitive and specific liquid chromatography-electrospray tandem mass spectrometry (LC-MS-MS) method for the determination of clindamycin (I) was developed. Both I and verapamil (II, internal standard) were analyzed using a C18 column with a mobile phase of 80% acetonitrile-0.01% trifluoroacetic acid. Column eluents were monitored by electrospray tandem mass spectrometry. Multiple reaction monitoring (MRM) using the parent to daughter combinations of m/z 425-->126 and 455-->165 was used to quantitate I. A limit of quantitation of 0.0500 microgram/ml was found. The assay exhibited a linear dynamic range of 0.0500-20.0 micrograms/ml and gave a correlation coefficient (r2) of 0.998 or better. The chromatographic run time was approximately 2 min. The intra-batch precision and accuracy of the quality controls (QCs, 0.0500, 0.150, 1.50, 15.0 and 20.0 micrograms/ml) were characterized by coefficients of variation (CVs) of 5.13 to 13.7% and relative errors (REs) of -4.34 to 4.58%, respectively. The inter-batch precision and accuracy of the QCs were characterized by CVs of 4.35 to 8.32% and REs of -10.8 to -4.17%, respectively. The method has successfully been applied to the analysis of samples taken up to 12 h after oral administration of 300 mg of I in healthy volunteers.

Intralesional cytokine therapy in cancer: a pilot study of GM-CSF infusion in mesothelioma

Systemic cytokine therapy in cancer has major side effects, and we reasoned that the local infusion of cytokines into tumors could induce local immunologic responses with minimal toxicity and potentially strong systemic anticancer effects. This study investigated the toxicity and effectiveness of intralesional granulocyte/macrophage-colony-stimulating factor (GM-CSF) infusion in solid-tumor masses. We studied 14 patients (12 men, two women) with malignant mesothelioma (MM), aged 60 years (range, 46-70 years), with stage 2 disease, in whom the tumor was of sufficient size and accessibility for an intralesional catheter to be inserted. Recombinant human GM-CSF (Molgramostim; Schering Plough) was infused intralesionally for 8 weeks, by using a portable pump, at a dose of 2.5-10 micrograms/kg/day. One patient using GM-CSF developed histologically confirmed necrosis of tumor surrounding the distal catheter, one developed a marked lymphocytic infiltrate in the tumor and had a partial response measured by chest computed tomography (CT) scan, 10 progressed, and three had no response. Neutrophilia with morphologic evidence of neutrophil activation and clinical features suggestive of neutrophil plugging of blood vessels occurred at doses > 5 micrograms/kg/day. In vitro, GM-CSF doubled human neutrophil/CD11b/CD18 expression, suggesting that neutrophil clumping as seen in vivo might be due to integrin upregulation. Intralesional infusion of cytokines is feasible but can be associated with systemic toxicity and has considerable technical problems. It produces a localized immune reaction with tumor regression in a minority of patients.

Central inhibitory effects of water extract of Acori graminei rhizoma in mice

The present study evaluated in mice the central inhibitory effects of a water extract of shichangpu (Acori graminei rhizoma (AGR), the dry rhizome of Acorus gramineus Soland. (Araceae)). AGR (0.5-5.0 g/kg) dose-dependently decreased the locomotor activity and increased the pentobarbital-induced sleeping time, but had no significant effect on the treadmill performance. AGR also dose-dependently inhibited the intensity of apomorphine-induced stereotypic behavior. At the highest dose (5.0 g/kg), AGR had a weak anticonvulsant effect on the pentylenetetrazol-induced seizures. Receptor binding assays showed that AGR competed with [3H]SCH-23390 and [3H]YM-09151-2 for specific binding to striatal dopamine D1 and D2 receptors with Ki values of 5.6 and 4.2 mg/ml, respectively. AGR also competed with [3H]muscimol for specific binding to the gamma-aminobutyric acid (GABA) binding site of cortex GABA(A) receptors with a Ki value of 0.31 mg/ml. It also increased the specific binding of [3H]flunitrazepam to the benzodiazepine binding site of the GABA(A) receptors, suggesting a GABA agonist-like action. These results suggested that the central inhibitory effects of AGR were probably effected through an action on the central dopamine receptors and GABA(A) receptors. The principle of AGR acting at these ligand binding sites was not alpha-asarone, one of the important principles of AGR, since that alpha-asarone (10(-6)-10(-4) M) had no significant interactions with these binding sites.

6-Methoxy-N-methyl-1,2,3,4-tetrahydro-beta-carboline from Evodiae Fructus

A receptor binding assay directed separation has led to the identification of a minor alkaloid 6-methoxy- N-methyl-1,2, 3,4-tetrahydro-beta-carboline (1) from the Chinese herbal drug Evodiae Fructus [EF, the dried, unripe fruit of Evodia rutaecarpa Look. f. et Thomas (Rutaceae)]. The structure of compound 1 was elucidated by means of spectroscopic methods and a comparison with synthetic materials. Compound 1 interacted with 5-HT (1A) and 5-HT (2) receptors with a moderate K (i) value of 78 and 1.2 microM, respectively. Compound 1 is found in EF and the genus Evodiae for the first time.