Efficacy of anti-interleukin-17A biological agents for palmoplantar psoriasis and palmoplantar pustulosis: A network meta-analysis

BACKGROUND

The comparative efficacy of anti-IL (interleukin)-17A biological agents in palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) are not well established.

OBJECTIVE

To investigate the efficacy of different dosage regimens of anti-IL-17A biological agents compared with placebo in PP and PPP.

METHODS

A literature search was conducted in PubMed, clinicaltrials.gov, and Embase. Meta-analysis was performed for all outcomes of randomized controlled trials, while network meta-analysis was only performed for the primary outcome.

RESULTS

In total, 21 articles exploring the efficacy of 5 treatment options were included, 4 cohort studies were also reviewed. Meta-analysis demonstrated a statistically significant difference favoring anti-IL-17A biological agents versus placebo (OR = 6.84, 95 %[CI] [5.34, 8.76]). On-label secukinumab was identified as the most effective treatment option for patients with PP (OR = 33.50, 95 %[CI] [4.37,256.86]). PPP treated with secukinumab 300 mg showed benefit in terms of PPPASI 75 responses over 52 weeks.

CONCLUSION

IL-17A biological agents had better PP disease clearance compared with placebo and on-label secukinumab was identified as the most effective treatment option for PP patients. Secukinumab 300 mg showed benefit for PPP patients.

Local injection of micro-dose anti-interleukin-17A antibody for palmoplantar pustulosis: A real-world study

Palmoplantar pustulosis (PPP), a chronic and stubborn skin disease, is mainly confined to the palms or/and soles, making it possible for localized use of therapeutic antibodies. In this real-world prospective cohort study, 8 patients with PPP received palms/soles injections of ixekizumab (0.8 mg in 0.1 ml) every 2 to 8 weeks due to the COVID-19 pandemic. The treatment endpoint was a 75% improvement from baseline in Palmoplantar Psoriasis Area and Severity Index (PPPASI 75). At week 8, 75%, 50% and 12.5% of 8 patients reached PPPASI 50, PPPASI 75 and PPPASI 90. At week 12, 100%, 67.5% and 25% of 8 patients reached PPPASI 50, PPPASI 75 and PPPASI 90. This is the first study to evaluate the efficacy and safety of local injection of micro-dose ixekizumab for PPP in real clinical practice. A high proportion of patients rapidly achieved PPPASI 75, and maintained long-term efficacy with satisfactory safety.

A Longitudinal Study of Journal Club to Enhance Physical Therapy Students' Research Appraisal Skill for Evidence-Based Practice: A Mixed-Methods Study

Evidence-based practice (EBP) requires that clinicians possess skills in appraisal of evidence. Journal club (JC) is demonstrated to increase EBP skills in medicine, nursing, and occupational therapy. Study in physical therapy remains elusive. The objective of this study was to examine the impact of JC on appraisal skills in student physical therapists (SPTs) and explore factors enhancing or hindering the utility of JC. One hundred fifteen SPTs from three cohorts participated in this mixed-methods study. In the first year, participants completed a survey assessing self-reported confidence level on EBP skills before and after attending multiple JCs. Cohorts I and II continued participation in the second year. Additionally, 36 participants attended focus-group interviews after completing 2 years of JC. All cohorts' confidence level increased. Wilcoxon signed-rank test revealed a significant increase (p < 0.001) for cohort III. Remaining cohorts' confidence continuously increased in the subsequent year. Thematic analysis revealed themes on benefits and barriers of JC, strategies for improvements, and connection of JC to clinical practice. The findings indicate that integration of JC promotes SPTs' confidence in EBP skills and connects with practice. Utilizing JC as a pedagogical strategy impacts curricular design and strengthens future health professionals' EBP skills pivotal for delivering quality healthcare.

Analysis of related factors of cervical intraepithelial neoplasia complicated with vaginal intraepithelial neoplasia

PURPOSE

To explore the underlying risk factors and to prevent misdiagnosis of cervical intraepithelial neoplasia (CIN) coexisted with vaginal intraepithelial neoplasia (VaIN).

METHODS

Clinical data of patients pathologically diagnosed with CIN were collected from January 2017 to December 2018. A total of 446 cases were analyzed, including 406 cases of single lesions ('CIN single' group) and 40 cases complicated with VAIN ('VAIN concurrent' group).

RESULTS

The median age of the VAIN concurrent group was 53 years (46.25-59 years), and the median age of the CIN single group was 44 years (36-50 years). Regarding menopausal status, there were 28 cases (70.0%) in the VAIN concurrent group and 89 cases (21.9%) in the CIN single group (P < 0.005). The median load of high-risk human papillomavirus (Hr-HPV) in the VAIN concurrent and CIN single group was 923.4 relative light units/cutoff (RLU/CO) (145-2172.2 RLU/CO) and 229.155 RLU/CO (18.615-638.1275 RLU/CO), respectively (P = 0.037). The results revealed that the menopausal status was an independent risk factor for VAIN occurrence in CIN patients. The risk of VAIN in menopausal patients was higher than that in non-menopausal CIN patients (OR = 8.311, 95% CI 4.062-17.005). Age and HPV load were also related to the concurrence of VAIN and CIN.

CONCLUSION

Examinations regarding vaginal screening are of great importance in the diagnosis of perimenopausal and postmenopausal CIN patients, especially patients with Hr-HPV load. Colposcopy and tissue biopsy should also be performed, when necessary, to avoid misdiagnosis and the appearance of vaginal lesions.

Successful treatment of synovitis, acne, pustulosis, hyperostosis and osteitis syndrome with ixekizumab

We report the use of ixekizumab in treating synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, the first such report to our knowledge. The patient presented with palmoplantar pustulosis and sternoclavicular joint pain, which was markedly improved with ixekizumab treatment.

Associations of Sarcopenic Parameters with Dysphagia in Older Nursing Home Residents: A Cross-Sectional Study

OBJECTIVES

To investigate the prevalence of sarcopenia and dysphagia in nursing homes and to analyze the associations between sarcopenic parameters and dysphagia.

DESIGN

A cross-sectional study.

SETTING

Nursing homes in Chengdu, Sichuan, China.

PARTICIPANTS

The study included 365 participants (122 men and 243 women) aged 60 years or older who could walk independently or with walking aids for at least 50 meters.

MEASUREMENTS

Dysphagia was defined by the water swallow test and sarcopenia and its components were evaluated by the criteria of the Asian Working Group for Sarcopenia, 2019. The values and percentages of sarcopenia associated parameters in relation to dysphagia were analyzed in both male and female residents. The Benjamini-Hochberg method was used to adjust for multiple comparisons. The relationship between sarcopenic components and dysphagia was analyzed using multivariate logistic regression analysis by sex.

RESULTS

A total of 365 residents (mean age: 84.28 years; 122 men and 243 women) were included in the study. Sarcopenia was diagnosed in 63.0% (n=230) and dysphagia in 75.3% (n = 275) of residents. For men, the percentage of sarcopenia was higher in residents with dysphagia. However, the sarcopenia percentage did not differ significantly between women with and without dysphagia. In both men and women, the handgrip strength (HGS) values were significantly lower in the dysphagic residents. The calf circumference (CC) value and appendicular skeletal muscle index (ASMI) were significantly lower in dysphagic men, while the SARC-CalF scores were higher. In women, the SPPB score was lower in residents with dysphagia. Furthermore, multivariate logistic regression analysis showed that low calf circumference (OR 4.415, 95% CI 1.561-12.490) and sarcopenia (OR 2.968, 95% CI 1.121-7.858) were significantly associated with dysphagia in men after adjusting for co-factors.

CONCLUSION

There is a high percentage of both dysphagia and sarcopenia in nursing home residents in West China. Low calf circumference and sarcopenia had strong associations with dysphagia among male nursing home residents.

Genome-wide analysis of mitochondrial DNA copy number reveals loci implicated in nucleotide metabolism, platelet activation, and megakaryocyte proliferation

Mitochondrial DNA copy number (mtDNA-CN) measured from blood specimens is a minimally invasive marker of mitochondrial function that exhibits both inter-individual and intercellular variation. To identify genes involved in regulating mitochondrial function, we performed a genome-wide association study (GWAS) in 465,809 White individuals from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium and the UK Biobank (UKB). We identified 133 SNPs with statistically significant, independent effects associated with mtDNA-CN across 100 loci. A combination of fine-mapping, variant annotation, and co-localization analyses was used to prioritize genes within each of the 133 independent sites. Putative causal genes were enriched for known mitochondrial DNA depletion syndromes (p = 3.09 × 10-15) and the gene ontology (GO) terms for mtDNA metabolism (p = 1.43 × 10-8) and mtDNA replication (p = 1.2 × 10-7). A clustering approach leveraged pleiotropy between mtDNA-CN associated SNPs and 41 mtDNA-CN associated phenotypes to identify functional domains, revealing three distinct groups, including platelet activation, megakaryocyte proliferation, and mtDNA metabolism. Finally, using mitochondrial SNPs, we establish causal relationships between mitochondrial function and a variety of blood cell-related traits, kidney function, liver function and overall (p = 0.044) and non-cancer mortality (p = 6.56 × 10-4).

Effectiveness of a novel fungicide pydiflumetofen against Fusarium head blight and mycotoxin accumulation in winter wheat

Fusarium head blight (FHB) causes yield loss, quality reduction, and grain mycotoxin accumulations. A novel pydiflumetofen-containing fungicide, Miravis Ace, was recently registered in North America. The main objective of this study was to assess the efficacies of Miravis Ace and the timing of application alongside industry standard triazole fungicides (Prosaro, Caramba, Proline and Folicur) on suppressing FHB, reducing mycotoxins and improving wheat agronomic performance. The assessment was conducted across six natural environments on commercial farm fields and in two artificially inoculated-misted environments. All environments included 5 fungicides (Miravis Ace and the four triazole fungicides) and 3 application timings (Zadoks GS 59, 65, 69-71). Additionally, for the ZGS 65 timing, the experiment in the natural environment included a quinone outside inhibitor (QoI) fungicide pyraclostrobin (Headline). In general, Miravis Ace tended to be more effective on FHB suppression than the triazole fungicides across all environments. However, any biological differences tended to be statistically non-significant, likely because of a lack of statistical power. Miravis Ace reduced total deoxynivalenol (DON) concentration by 52-73% compared to the non-treated control. If applied at ZGS 59-65, Miravis Ace was more effective in increasing yield and test weight than the triazoles tested. Across fungicides, applications made at ZGS 65 were most effective in FHB suppression compared to earlier or later application timings. There was no evidence that pyraclostrobin increased mycotoxin concentrations. Overall, compared to the triazole fungicides, the novel pydiflumetofen-containing fungicide tended to have lower FHB suppression and mycotoxins, higher grain yield and test weight, and higher harvest moisture, but differences were not always statistically significant. Because the main active ingredient in Miravis Ace has a different mode of action than the triazoles, we speculate that this fungicide will be competitive with industry standards, and benefit strategies for fungicide resistance management.

Inflammation, apoptosis and autophagy as critical players in vascular dementia

Vascular dementia is the second-most cause of dementia, characterized by cerebral infarcts, white matter lesions, myelin loss and often amyloid angiopathy. Hence, vascular damage is a critical cause of neuronal loss and synaptic disintegration. Abnormal neuroinflammation, autophagy and apoptosis are the prerequisite factors for endothelial and neuronal cell damage. This leads to the onset and progression of cerebrovascular disorders and cognitive dysfunction. The innate immune cells, pattern recognition receptors, Toll-like receptor-4 and related inflammatory mechanisms disrupt cerebrovascular integrity via glial activation and increased pro-inflammatory interleukins and TNFα. Inflammasome polymorphisms and multi-faceted neuro-immune interactions further integrate systemic and central inflammatory pathways, which induce vascular tissue injury and neurodegeneration. Specifically, chronic cerebral hypoperfusion disrupts the self-cannibalization mechanism of autophagy via altered expression of autophagy-specific proteins, Beclin-1, LC3 and P62. The deregulated autophagy pathway causes neuronal loss, hippocampal shrinkage, and ultimate loss in synaptic plasticity. The vascular dementia models typically exhibit downregulated anti-apoptotic Bcl-2 and upregulated pro-apoptotic Bax, cleaved caspase-3, and cleaved-PARP levels in the brain, for which modulated p38 MAPK and JNK phosphorylation pathways play a vital role. Endoplasmic stress-induced apoptosis, calcium overload and glutamate excitotoxicity in combination with ASK1-MAPK signaling mechanism also contribute to the cerebrovascular pathology. Vascular injury reduces neurological scores and increases the infarct volume, DNA damage and neuronal apoptosis in ischemia/reperfusion injury. Additionally, synergistic and additive interactions between inflammasome, autophagy and apoptotic signaling pathways augment symptoms of vascular neurodegeneration. Overall, the current review enlightens the key risk factors and underlying mechanism triggering vascular dementia. The review additionally informs the challenges associated while treating vascular dysfunction, and highlights the need for targeted drugs for reducing cerebrovascular damage.

Sevoflurane impedes the progression of glioma through modulating the circular RNA has_circ_0012129/miR-761/TGIF2 axis

OBJECTIVE

Glioma is a highly aggressive and lethal brain tumor. Anesthetics have been shown to have important effects on the biological characteristics of cancer cells. Nevertheless, the molecular mechanism of anesthetic-mediated glioma cells progression remains unclear.

MATERIALS AND METHODS

Sevoflurane (sev) was employed to treat glioma cells. The biological characteristics (viability, colony formation, apoptosis, cell cycle, migration, and invasion) of glioma cells were determined via Cell Counting Kit-8 (CCK-8), cell colony formation, flow cytometry, PI cytometry, or transwell assays. The protein levels of Cell Cycle Dependent Kinase (CDK) 2, CDK4, E-cadherin, N-cadherin, Vimentin, and Transforming Growth Factor Beta (TGFB) induced factor homeobox 2 (TGIF2) were assessed through Western blot analysis. Glucose consumption and lactate production were measured using special commercial kits. The expression of circular RNA has_circ_0012129 (circ_0012129) and miR-761 was detected via quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The relationship between circ_0012129 or TGIF2 and miR-761 was verified with Dual-Luciferase reporter assay. Sevoflurane-mediated molecular mechanisms have been confirmed via xenograft assay.

RESULTS

Sevoflurane suppressed viability, colony formation, cell cycle, migration, and invasion and promoted apoptosis of glioma cells in vitro, and impeded tumor growth in vivo. Circ_0012129 and TGIF2 were downregulated and miR-761 was upregulated in sevoflurane-treated glioma cells. Circ_0012129 elevation abolished sevoflurane-mediated biological characteristics of glioma cells. MiR-761 served as target for circ_0012129 and miR-761 targeted TGIF2. Moreover, both miR-761 overexpression and TGIF2 suppression restored circ_0012129 enhancement-mediated biological characteristics of sevoflurane-treated glioma cells.

CONCLUSIONS

Sevoflurane mediated the progression of glioma via regulating the circ_0012129/miR-761/TGIF2 axis.

Influence factors of dental anxiety in patients with impacted third molar extractions and its correlation with postoperative pain: a prospective study

Background

To explore the prevalence of dental anxiety (DA) in patients with third molar extractions and its influence factors and the correlation between DA levels and postoperative pain.

Material and Methods

A prospective and descriptive clinical study was performed. All patients who underwent the impacted third molar extraction from October 2017 to February 2019 were enrolled. DA levels were assessed by virtue of the modified dental anxiety scale (MDAS) and pain was assessed with a visual analog scale (VAS).

Results

A total of 150 patients were investigated and 136 valid questionnaires were retrieved, with an effective rate of 90.7%. The independent sample t-test and ANOVA results showed that the anxiety level of patients with the third molar extractions was statistically different in gender, teeth extraction experience and self-assessment oral health status. Multiple linear regression analysis with DA as a dependent variable showed that gender and teeth extraction experience were independent factors influencing DA in patients with third molar extractions. Pearson's test showed that there was a significant correlation between DA level in patients and the postoperative pain on the first day (r=0.542, p=0.000).

Conclusions

For patients (females, poor oral hygiene and no teeth extraction experience), surgeon should pay more attention to DA of such patients and take measures to reduce the anxiety when removing the third molars. Furthermore, surgeon can recommend oral administration ibuprofen sustained release capsules after surgery.

Key words:Dental anxiety, modified dental anxiety scale, visual analogue scale, postoperative pain.

“Duodenal Submucosal Glandular Lesion with Brunner and Paneth Cell Differentiation”: A Variant of Pyloric Gland Adenoma? Morphologic and Immunohistochemical Similarities and Differences

Introduction/Objective

Duodenal epithelial polyps are reported in up to 3% of patients referred for upper endoscopy. Most include non-neoplastic lesions such as Brunner gland nodule/polyp and pancreatic or gastric heterotopia.

Neoplastic lesions such as pyloric gland adenomas (PGA) are less frequently encountered and have the propensity to progress to adenocarcinoma. Herein we report a duodenal submucosal glandular lesion that has a morphologic resemblance to PGA, but very different in several aspects. We compare and contrast the characteristics of these two lesions.

Methods

This was a 63-year-old man referred for an upper GI endoscopy for complaints of indigestion, dyspepsia, and weight fluctuation. Endoscopy showed a 13 mm polypoid lesion in the second portion of the duodenum, opposite to and separate from the ampulla. An en-bloc hot snare was used to resect the polyp. Histopathologic examination showed features reminiscent of PGA, namely a complex submucosal proliferation of tightly packed variably dilated glands and villous fronds lined by a monolayer of columnar cells with basally located round nuclei and prominent nucleoli. In contrast, however, the columnar cells in most of the lesion contained abundant mucinous cytoplasm resembling Brunner’s glands as well as areas of prominent paneth cell differentiation. The characteristic amphophilic ground glass cytoplasm of PGAs was only noted in a minor component of the lesion. MUC6 and MUC5AC, immunostains that are typically expressed in PGA, were negative. Additionally, p53 showed a wild-type pattern, beta- catenin showed normal membranous staining, and the Ki-67 index was low.

Results

After review of the literature and expert consultation, we were not able to fully classify this lesion under any documented entity, however, we believe that it could be akin to PGA. Authors hypothesized that PGAs may originate from stem cells within Brunner glands as a response to chronic injury. These cells may then differentiate upwards, forming gastric foveolar metaplasia or downwards giving rise to Brunner gland hyperplasia.

Conclusion

Based on this hypothesis, the proliferating cells are prone to mutations resulting in a hyperplasia/metaplasia to dysplasia sequence that leads to the formation of PGAs or lesions such as the one demonstrated here.

Impact of the improvements in Fusarium head blight and agronomic management on economics of winter wheat

Fusarium head blight (FHB) is a devastating disease to cereal crops worldwide that decreases grain yield, grain quality, and causes mycotoxin contamination. FHB resulted in an estimated $2 billion USD loss in the US between 1993 and 2001, and 520 million Canadian dollars (CAD) in Canada in the 1990s. In the wheat producing areas in Canada and the United States, it is perceived that significant progress has been made to manage FHB, but the economic impact of various innovations has not been quantified. Therefore, the main objective of this study was to assess the economic impact of various practices deployed in the province of Ontario, Canada, on managing deoxynivalenol and improving agronomic performance in winter wheat since an epidemic in 1996. The impacts of four hypothetical FHB management scenarios on total deoxynivalenol (DON) concentration and grain yield were estimated in field experiments that compared old (mid-1990s) and modern era (mid-2010s) production practices. Management scenarios included old and new cultivars varying in susceptibility to FHB, fungicide application and nitrogen rates. These impacts were applied to farm survey data collected in 1996 to estimate farm revenue and profit. A similar economic estimate was conducted for the recent FHB epidemic in 2013. If a modern MR cultivar, a modern fungicide, and the combination were deployed in the epidemic of 1996, farm revenue would have increased by 26-32, 23-36 and 48-60%, and profit increased by 88-157, 42-59 and 165-207 CAD per ha, respectively, depending on the nitrogen rate. In the province of Ontario, up to 68 million CAD of revenue losses could have been avoided in 1996 with the use of modern agronomic and FHB management practices. Our study has quantified some of the major economic advances in managing FHB and DON since 1996, but further research is needed to develop better cultivars and management strategies.

Efficacy of plasma rich in growth factor used for dry socket management: a systematic review

Background

The main aim of this systematic review was to assess the dry socket management using plasma rich in growth factor (PRGF) in terms of pain relief, alveolar fossa healing, inflammation, the incidence of dry socket.

Material and Methods

PubMed, Cochrane Library, Elsevier Science Direct, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI) and VIP database were searched for the related articles without language limitation. Two reviewers independently searched and evaluated relevant studies. This review has been registered in the website PROSPERO (CRD42018087252).

Results

28 articles were retrieved on PubMed and 98 on other electronic databases in the initial search. In the end, 4 randomized controlled trials (RCTs) were included, with a total of 139 patients enrolled. The descriptive results indicated that the use of PRGF may help reduce pain and inflammation after tooth extraction. To some extent, it is beneficial to the management of dry socket after extraction.

Conclusions

Quality assessment indicated all the included studies were judged to be at high risk of bias with low quality. Hence, it was impossible to make a recommendation for clinical use of PRGF based on the current evidence. Clearly, a multicenter clinical randomized controlled trial is needed urgent to evaluate the safety and efficacy of PRGF for dry socket management.

Key words:plasma rich in growth factor, PRGF, dry socket, systematic review.

The significance of HBD-3 and fluorescent composite carriers in the processof bone formation in rats infected with Staphylococcus aureus

OBJECTIVE

The objective of the present study was to explore the significance of human β-defensin 3 (HBD-3) through establishment and evaluation of the model of implant-related biofilm infection of the femoral condyle of the outer knee using Sprague-Dawley (SD) rats.

MATERIALS AND METHODS

Age-matched SD rats were divided into three groups, the HBD-3 group, HBD-3 fluorescent liposome group, and the HBD-3 liposome-microbubble fluorescent composite carrier group. After biofilm infection for 24 h, the fluorescent composite vector was injected intraperitoneally 2 times/day. After the first injection, rats in each group were sacrificed on the 7th, 14th, and 28th day. The lower end of the femur bone was harvested after removing the surrounding soft tissue. H&E and immunohistochemical staining were applied and light microscopy was used for observation. Fluorescent markers including tetracycline and calcein were used to follow the formation of new bone in vivo. Undecalcified specimens were embedded in epoxy resin (thickness of roughly 150 m), and confocal microscopy was used for observation.

RESULTS

By assessing cell proliferation with cell counting kit-8, the proliferation ability of cells in the HBD-3 liposome-microbubble fluorescent composite carrier group was significantly increased compared with the other groups (p<0.05). qPCR was used to measure the levels of alkaline phosphatase (ALP), type I collagen, osteocalcin (OCN), osteopontin (OPN), and bone sialoprotein (BSP) in each group. The levels of these genes in the HBD-3 liposome-microbubble fluorescent composite carrier group were significantly higher than those in other groups (p<0.05).

CONCLUSIONS

The application of the HBD-3 liposome-microbubble fluorescent composite carrier can significantly promote osteogenesis in rats infected with Staphylococcus aureus, and increase the expression levels of ALP, type I collagen, OCN, OPN, and BSP.

Geographical and ethnic distribution of MTHFR gene polymorphisms and their associations with diseases among Chinese population

Numerous studies have investigated the distribution of methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms and their associations with diseases in China. In this study we conducted a systematic review and meta-analysis of these studies (715 eligible studies in total).Results revealed that the frequencies of the MTHFR C677T and A1298C polymorphisms varied markedly in different areas and ethnicities, and even showed geographical gradients. The MTHFR C677T polymorphism was significantly associated with 42 clinical disorders (p < 0.05), mostly relating to the diseases of circulatory system, birth defects and cancers. The association of the A1298C polymorphism with three diseases (coronary heart disease, breast cancer and neural tube defects fathers) was statistically significant (p < 0.05). However, according to the Venice criteria, only the associations of the C677T polymorphism with breast and ovarian cancers were assessed as having strong epidemiological credibility. This is the first study to provide a comprehensive assessment of the current status and gaps in genetic epidemiological study of the two polymorphisms in China, and its findings may be useful for medical and public health practices. Future studies are warranted to focus on the interactions of MTHFR genes with environmental exposure and with other genes, and to improve their methodological quality and reporting of findings.

Association of CYP1A1 MspI polymorphism with oral cancer risk in Asian populations: a meta-analysis

Numerous studies regarding the association between the CYP1A1 MspI polymorphism and oral cancer risk in Asian populations have shown controversial results. To get a more precise estimation of this relationship, we conducted a comprehensive meta-analysis. PubMed, the Cochrane Library, Elsevier Science Direct, Web of Knowledge, the Chinese National Knowledge Infrastructure, VIP, and Wan Fang Med Online were searched. Pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated using fixed-effects or random-effects models. Heterogeneity among studies was assessed using the Cochran Q test and I(2) statistics. Twelve articles including 1925 oral cancer patients and 2335 controls were ultimately included in the meta-analysis. Overall, the meta-analysis showed that the CYP1A1 MspI polymorphism was associated with oral cancer risk in Asians (m1/m1 vs m2/m2: OR = 0.46, 95%CI = 0.30-070, POR = 0.000; m1/m1 vs m1/m2+m2/m2: OR = 0.70, 95%CI = 0.51-0.98, POR = 0.037; m1/m1+m1/m2 vs m2/m2: OR = 0.48, 95%CI = 0.35-0.65, POR = 0.000). Subgroup analyses showed that the control source (hospital-based or population-based), the genotyping method [polymerase chain reaction (PCR) or PCR-restriction fragment length polymorphism], the country in which the study was conducted, and Hardy-Weinberg equilibrium (Yes or No) were positively related to the association. Sensitivity analysis suggested that the overall results showed no significant change in three genetic models when any one study was removed, and publication bias was undetected by the Egger test. The CYP1A1 MspI polymorphism may be associated with oral cancer risk in Asian populations.

SP1-induced upregulation of the long noncoding RNA TINCR regulates cell proliferation and apoptosis by affecting KLF2 mRNA stability in gastric cancer

The long noncoding RNA TINCR shows aberrant expression in human squamous carcinomas. However, its expression and function in gastric cancer remain unclear. We report that TINCR is strongly upregulated in human gastric carcinoma (GC), where it was found to contribute to oncogenesis and cancer progression. We also revealed that TINCR overexpression is induced by nuclear transcription factor SP1. Silencing TINCR expression inhibited cell proliferation, colony formation, tumorigenicity and apoptosis promotion, whereas TINCR overexpression promoted cell growth, as documented in the SGC7901 and BGC823 cell lines. Mechanistic analyses indicated that TINCR could bind to STAU1 (staufen1) protein, and influence KLF2 mRNA stability and expression, then KLF2 regulated cyclin-dependent kinase genes CDKN1A/P21 and CDKN2B/P15 transcription and expression, thereby affecting the proliferation and apoptosis of GC cells. Together, our findings suggest that TINCR contributes to the oncogenic potential of GC and may constitute a potential therapeutic target in this disease.

Comparison of full-mouth disinfection and quadrant-wise scaling in the treatment of adult chronic periodontitis: a systematic review and meta-analysis

Scaling and root planing are widely considered as effective methods for treating chronic periodontitis. A meta-analysis published in 2008 showed no statistically significant differences between full-mouth disinfection (FMD) or full-mouth scaling and root planing (FMS) and quadrant scaling and root planing (Q-SRP). The FMD approach only resulted in modest additional improvements in several indices. Whether differences exist between these two approaches requires further validation. Accordingly, a study was conducted to further validate whether FMD with antiseptics or FMS without the use of antiseptics within 24 h provides greater clinical improvement than Q-SRP in patients with chronic periodontitis. Medline (via OVID), EMBASE (via OVID), PubMed and CENTRAL databases were searched up to 27 January 2015. Randomized controlled trials comparing FMD or FMS with Q-SRP after at least 3 mo were included. Meta-analysis was performed to obtain the weighted mean difference (WMD), together with the corresponding 95% confidence intervals. Thirteen articles were included in the meta-analysis. The WMD of probing pocket depth reduction was 0.25 mm (p < 0.05) for FMD vs. Q-SRP in single-rooted teeth with moderate pockets, and clinical attachment level gain in single- and multirooted teeth with moderate pockets was 0.33 mm (p < 0.05) for FMD vs. Q-SRP. Except for those, no statistically significant differences were found in the other subanalyses of FMD vs. Q-SRP, FMS vs. Q-SRP and FMD vs. FMS. Therefore, the meta-analysis results showed that FMD was better than Q-SRP for achieving probing pocket depth reduction and clinical attachment level gain in moderate pockets. Additionally, regardless of the treatment, no serious complications were observed. FMD, FMS and Q-SRP are all effective for the treatment of adult chronic periodontitis, and they do not lead to any obvious discomfort among patients. Moreover, FMD had modest additional clinical benefits over Q-SRP, so we prefer to recommend FMD as the first choice for the treatment of adult chronic periodontitis.

A 39-gene signature is associated with early occurrence of distant metastasis in primary lymph-node negative breast cancers

Risk factors of the development of distant metastasis in primary node-negative breast cancer patients are heterogeneous. Identification of patients at high risk of early distant metastasis is of important clinical significance. In the current study, using the already published datasets, we develop a gene signature that can robustly predict early distant metastasis for patients with primary node-negative breast cancer. We identified a 39-gene signature, which were associated with distant metastasis and shorter distant metastasis free survival (DMFS) in node-negative breast cancers. Using the survival prediction analysis method in BRB-Array tools, this signature can stratify patients into early- and late- distant metastasis subgroups with different DMFS in VDX training dataset (AUC=0.734, P < 0.01). And we further validated the reliability of the prognostic value of this 39-gene signature in another two independent breast cancer cohorts (NKI dataset, AUC=0.642, P<0.0167; TRANSBIG dataset, AUC=0.711, P<0.0167). Furthermore, the early distant metastasis subgroups defined by the 39-gene signature exhibited a significant association with ER negative status and more aggressive molecular subtypes in all three datasets, and with poor differentiation status in two datasets. In summary, we developed a novel distant metastasis-related gene signature for predicting early occurrence of distant metastasis in node-negative breast cancers, what might be useful in making treatment decisions for these early metastasis patients.

LincHOTAIR epigenetically silences miR34a by binding to PRC2 to promote the epithelial-to-mesenchymal transition in human gastric cancer

lncRNAs play important roles in the epigenetic regulation of carcinogenesis and progression. Previous studies suggest that HOTAIR contributes to gastric cancer (GC) development, and the overexpression of HOTAIR predicts a poor prognosis. In this study, we found that HOTAIR was more highly expressed in diffuse-type GC than in intestinal type (P=0.048). In the diffuse type, there is significant relationship between HOTAIR expression and DFS (P<0.001). CDH1 was downregulated in diffuse-type GC tissues (P=0.0007) and showed a negative relationship with HOTAIR (r²=0.154, P=0.0354). In addition, HOTAIR knockdown significantly repressed migration, invasion and metastasis both in vitro and vivo and reversed the epithelial-to-mesenchymal transition in GC cells. We also showed that HOTAIR recruiting and binding to PRC2 epigenetically represses miR34a, which controls the targets C-Met (HGF/C-Met/Snail pathway) and Snail, thus contributing to GC cell-EMT process and accelerating tumor metastasis. Moreover, it is demonstrated that HOTAIR crosstalk with microRNAs during epigenetic regulation. Our results suggest that HOTAIR acts as an EMT regulator and may be a candidate prognostic biomarker and a target for new therapies in GC patients.

Effect of oral contraceptive use on the incidence of dry socket in females following impacted mandibular third molar extraction: a meta-analysis

The aim of this comprehensive meta-analysis was to provide evidence-based data to test whether oral contraceptive (OC) use can promote the incidence of dry socket (DS) in females following impacted mandibular third molar extraction. PubMed, the Cochrane Library, and Elsevier Science Direct databases were searched. The pooled risk ratio (RR) with 95% confidence interval (CI) was calculated using fixed-effects or random-effects model analysis. Heterogeneity among studies was evaluated with the Cochran test and I(2) statistic. Study quality was assessed with the Newcastle-Ottawa scale. Of 70 articles identified in the search, 12 reporting 16 clinical controlled trials were included in this study. The incidence of DS was significantly greater in the OC groups than in the control groups (RR 1.80, 95% CI 1.33-2.43). Subgroup analyses showed that the unit assessed (tooth or patient), the region in which the study was conducted, and the intervention were not related to the incidence of DS in females taking OC after impacted mandibular third molar extraction. The sensitivity analysis showed no significant change when any one study was excluded. Publication bias was also not detected. This study suggests that OC use may promote the incidence of DS in females following impacted mandibular third molar extraction.

EZH2-mediated epigenetic suppression of long noncoding RNA SPRY4-IT1 promotes NSCLC cell proliferation and metastasis by affecting the epithelial-mesenchymal transition

Recent evidence indicates that long noncoding RNAs (lncRNAs) have a critical role in the regulation of cellular processes such as differentiation, proliferation, and metastasis. These lncRNAs are dysregulated in a variety of cancers and many function as tumor suppressors; however, the regulatory factors involved in silencing lncRNA transcription are poorly understood. In this study, we showed that epigenetic silencing of lncRNA SPRY4 intronic transcript 1 (SPRY4-IT1) occurs in non-small-cell lung cancer (NSCLC) cells through direct transcriptional repression mediated by the Polycomb group protein enhancer of zeste homolog 2 (EZH2). SPRY4-IT1 is derived from an intron within SPRY4, and is upregulated in melanoma cells; knockdown of its expression leads to cell growth arrest, invasion inhibition, and elevated rates of apoptosis. Upon depletion of EZH2 by RNA interference, SPRY4-IT1 expression was restored, and transfection of SPRY4-IT1 into NSCLC cells resulted in a significant antitumoral effect, both in culture and in xenografted nude mice. Moreover, overexpression of SPRY4-IT1 was found to have a key role in the epithelial-mesenchymal transition through the regulation of E-cadherin and vimentin expression. In EZH2-knockdown cells, which characteristically showed impaired cell proliferation and metastasis, the induction of SPRY4-IT1 depletion partially rescued the oncogenic phenotype, suggesting that SPRY4-IT1 repression has an important role in EZH2 oncogenesis. Of most relevance, translation of these findings into human NSCLC tissue samples demonstrated that patients with low levels of SPRY4-IT1 expression had a shorter overall survival time, suggesting that SPRY4-IT1 could be a biomarker for poor prognosis of NSCLC.

Predictors of recovery of ovarian function during aromatase inhibitor therapy

BACKGROUND

Aromatase inhibitors (AIs) may cause a rise in estrogen levels due to ovarian function recovery in women with clinical chemotherapy-induced ovarian failure (CIOF). We carried out a prospective registry trial to identify predictors of ovarian function recovery during AI therapy.

PATIENTS AND METHODS

Women with hormone receptor (HR)-positive breast cancer who remained amenorrheic and had hormonal levels consistent with ovarian failure after adjuvant chemotherapy were enrolled in a multi-institutional clinical trial of anastrozole. Subjects underwent frequent assessment using an ultrasensitive estradiol assay. Multivariable analysis was used to evaluate clinical and biochemical predictors of ovarian function recovery within 48 weeks.

RESULTS

Recovery of ovarian function during AI therapy was observed in 13 of 45 (28.9%) assessable subjects after a median 2.1 months (range 0.6-11.9). Median age at chemotherapy initiation was statistically significantly different between those who regained ovarian function (43 years, range 40-51) and those who remained postmenopausal (49 years, range 44-52; P < 0.0001).

CONCLUSIONS

A significant proportion of women with CIOF recover ovarian function during AI therapy, including a woman over age 50 at initiation of chemotherapy. Tamoxifen remains the standard of care for women with CIOF. If an AI is used, patients should be monitored frequently with high-quality estradiol assays. CLINICALTRIALS.GOV: NCT00555477.

Quantitative proteomic study identified cathepsin B associated with doxorubicin-induced damage in H9c2 cardiomyocytes

The study was performed to analyze the proteomic profiling of doxorubicin-treated H9c2 cardiomyocytes in order to identify novel protein biomarkers associated with doxorubicin-induced cardiomyopathy. The protein profiling of H9c2 cells in response to doxorubicin at an apoptosis-induced concentration of 0.5 μM were compared using iTRAQ analysis. Western-blot analysis was used to confirm differentially expressed proteins identified in the proteomic study. A total of 22 differently expressed proteins were identified in doxorubicin-treated H9c2 cells including 15 up-regulated and 7 down-regulated proteins. Gene Ontology (GO) analysis revealed that 10 altered proteins were enriched in the process of apoptosis. We further validated the expression of cathepsin B and its possible regulator nuclear factor kappa B (NF-κB) in H9c2 cells were increased during doxorubicin treatment using Western-blots. Differentially expressed proteins might provide clues to clarify novel mechanisms underlying doxorubicin-induced cardiomyopathy. Our results also suggest that increased cathepsin B expression might be associated with NF-κB up-regulation, and the exact mechanisms need to be clarified.

Dual-frequency High Intensity Focused Ultrasound (HIFU) Accelerating Therapy

By cutting a spherical focused transducer into two coaxial and confocal transducer elements, a confocal complex transducer used in dual-frequency HIFU system was obtained. The lesion induced by dual-frequency HIFU in freshly excised porcine livers were obviously larger than that induced by conventional single-frequency HIFU at the same exposure conditions. The experiment results have also shown that injecting ultrasound contrast agents to the tissue or selecting appropriate difference frequency could further improve the lesioning effect. The dual-frequency HIFU would bring a new approach to accelerate ablating large tumor with HIFU and also provide a new method to miniaturize the conventional HIFU apparatus.

Expression of putative stem marker nestin and CD133 in advanced serous ovarian cancer

It is hypothesized that "cancer stem cells" are responsible for the resistance to chemotherapy of cancer cells in ovarian cancers. The objective of the studies was to explore if the stem cell biomarkers could be used to predict the tumor chemotherapy-resistance in serous ovarian cancer patients. Expression of two putative stem cell markers CD133 and nestin, and vascular epithelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) were detected in 123 cases of advanced serous ovarian cancer specimens by immunohistochemistry. To estimate intra-tumoral microvessel density (MVD), CD34 immunostaining was also performed. CD133 and nestin were defined to be positive in 35.0% and 32.5% of the serous ovarian carcinoma tissues, respectively. It was observed that overexpression of nestin but not CD133 was associated with the cisplatin-based chemotherapy resistance and shorter overall survival of the patients, and nestin was found to be an independent prognostic factor. Moreover, positive nestin expression also correlated to increased expression of EGFR and VEGF, and elevated MVD in tumors. The results of this study suggest that serous ovarian cancers with high expression level of nestin represent an aggressive malignant phenotype associated with poor prognosis, and treatment targeted the nestin positive cancer cells might be a promising therapeutic strategy for this subgroups.

Genetic diversity analyses of class 1 integrons and their associated antimicrobial resistance genes in Enterobacteriaceae strains recovered from aquatic habitats in China

AIMS

To characterize the molecular diversity of class 1 integrons and antibiotic resistance (AR) genes of Enterobacteriaceae strains recovered from aquatic habitats in Jinan, Shandong Province, China.

METHODS AND RESULTS

Six hundred and thirty-eight antimicrobial-resistant Enterobacteriaceae isolated from wastewater were examined for class 1 integron. Of these, 293 were positive for the class 1 integrase gene intI1; among these, 34 gene cassettes and 29 AR genes were detected. Twenty-nine distinct gene cassette arrays were identified by restriction fragment length polymorphism (RFLP). Seven strains harboring novel gene cassette arrays were subjected to further study, in which antimicrobial susceptibility profiles were determined, and the presence of other AR genes outside of the integrons was assayed. Several of the resistance determinants were found to be transferable by conjugation or transformation.

CONCLUSIONS

This study established the assessment of class 1 integron and antimicrobial resistance gene patterns among environmental Enterobacteriaceae. Also, a restriction enzyme EcoRII was employed to develop a rapid and simple method for characterizing gene cassette arrays by RFLP analysis, which facilitated further study of novel gene cassette arrays.

SIGNIFICANCE AND IMPACT OF STUDY

These data not only illustrated the diversity of class 1 integron gene cassettes but also provided direct evidence that integrons mobilized gene cassettes, generating new linkages of resistance genes, and they could be integrated in gene transfer units such as conjugative plasmids to contribute to the dissemination of AR genes by horizontal gene transfer (HGT) in aquatic environments.

Identification of a novel fosfomycin resistance gene (fosA2) in Enterobacter cloacae from the Salmon River, Canada

AIMS

To investigate the occurrence of fosfomycin-resistant (fos(R) ) bacteria in aquatic environments.

METHODS AND RESULTS

A fos(R) strain of Enterobacter cloacae was isolated from a water sample collected at a site (50°41'33·44″N, 119°19'49·50″W) near the mouth of the Salmon River at Salmon Arm, in south-central British Columbia, Canada. The strain was identified by PCR screening for plasmid-borne, fosA-family amplicons, followed by selective plating. Sequencing of the resistance gene cloned using PCR primers to conserved flanking DNA revealed a new allele (95% amino acid identity to fosA), and I-Ceu I PFGE showed that it was chromosomally located. In Escherichia coli, the cloned DNA conferred a greater resistance to fosfomycin than its fosA counterpart.

CONCLUSIONS

Gene fosA2 conferred fosfomycin resistance in an environmental isolate of Ent. cloacae.

SIGNIFICANCE AND IMPACT OF THE STUDY

The repurposing of older antibiotics should be considered in the light of existing reservoirs of resistance genes in the environment.

Cardiac toxicity in association with chemotherapy and radiation therapy in a large cohort of older patients with non-small-cell lung cancer

BACKGROUND

The study's objective was to investigate the risks of developing cardiac disorders following the administration of chemotherapy and radiation therapy in patients with non-small-cell lung cancer (NSCLC).

METHODS

The study consisted of 34 209 patients aged > or =65 years with American Joint Committee on Cancer stages I-IV NSCLC identified from the Surveillance, Epidemiology, and End Result-Medicare linked database (1991-2002) who were free of cardiac disorders at NSCLC diagnosis.

RESULTS

There were significant associations between the use of chemotherapy/radiation and the risks of developing ischemic heart disease, conduction disorders, cardiac dysfunction, and heart failure. The absolute risks for cardiac dysfunction increased with the administration of chemotherapy-only and radiation-only, and incrementally with chemoradiation. Men, blacks, older patients, those with higher comorbidity scores, and advanced disease were at higher risk. The risk for ischemic heart disease increased when radiation/chemoradiation were rendered to the left lung and both lungs and for cardiac dysfunction, radiation administered to the left lung.

CONCLUSIONS

There were significant associations especially for cardiac dysfunction with use of chemotherapy/radiation therapy and risks of developing cardiac toxicity in NSCLC patients. The risks of treatment-associated cardiac toxicity, specifically ischemic heart disease and cardiac dysfunction, were greatest among those with left-sided lung tumors.

Alteration of hormone and neurotransmitter production in cultured cells by high and low frequency electrical stimulation

HFS has become a widely used method in functional neurosurgery. However, its mechanism is not well understood, and its cellular and molecular effects have not yet been investigated. The aim of the study was to understand which cellular events, unrelated to the network organization of cells or neurons, participate in the mechanism of action of HFS. In vitro cellular effects of high (HFS) and low (LFS) frequency electrical stimulation on prolactin secretion in GH3 cell lines (prolactinoma), as well as the catecholaminergic secretion on PC12 cells (pheochromocytoma) were investigated. Cells were cultured in dishes with integrated electrodes to deliver stimulation at the same parameters as those used in clinical conditions to treat advanced forms of Parkinson's disease. Prolactin production was measured in GH3 using a Radio-Immuno-Assay. Dopamine, epinephrine and norepinephrine were measured in PC12 using Enzymo-immuno-assays. HFS for 24 hours reduced prolactin secretion by 40.3%, dopamine by 32.7%, epinephrine by 18.1% (non significant) and norepinephrine by 27.0%. LFS did not induce significant changes. These results suggest that HFS has an inhibitory impact on the cellular machinery responsible for hormone and neurotransmitter production. In this model of isolated cultured cells, network interactions and particularly presynaptic actions are discarded. HFS has inhibitory effects on cellular mechanisms responsible for the production and release of molecules participating in intercellular communication. This HFS-induced inhibition might participate in the lesion-like effect of therapeutic HFS in the basal ganglia during various movement disorders.

A comparison of the effects of imposed extension and flexion movements on Parkinsonian rigidity

OBJECTIVE

To test a hypothesis that Parkinsonian rigidity is more pronounced in imposed extension than flexion movement.

METHODS

Twelve Parkinsonian subjects (both "Off" and "On" medication states) and seven control subjects participated in the protocol, in which a servomotor imposed wrist flexion and extension. Rigidity was quantitatively evaluated by the rectified torque integral with time, i.e., temporal score, and by the torque integral with joint angle, i.e., work score, for extension and flexion, respectively.

RESULTS

In the "Off" state, the imposed extension induced a significantly higher resistance than did flexion. Dopaminergic medication significantly reduced the temporal score associated with imposed extension, and significantly decreased the work score of both movements. Compared with controls, the scores were higher for patients in the "On" state.

CONCLUSIONS

Rigidity is more readily elicited in extension movement. The distinction is not evident in clinical practice, whereas it can be clearly revealed with the application of biomechanical analyses.

SIGNIFICANCE

This distinction may prove to be a standard feature of rigidity. The procedures may be helpful in diagnosis and useful in evaluating new treatments and developing rehabilitation programs.

Surgical therapy for Parkinson's disease

High frequency stimulation (HFS) has become the main alternative to medical treatment, due to its reversibility, adaptability, and low morbidity. Initiated in the thalamus (Vim) for the control of tremor, HFS has been applied to the Pallidum (GPi), and then to the subthalamic nucleus (STN), suggested by experiments in MPTP monkeys. STN-HFS is highly efficient on tremor, rigidity and bradykinesia and is now widely applied. Criteria for success are correct patient selection and precise electrode placement. The best outcome predictor is the response to Levodopa. The mechanisms of action might associate inhibition of cell firing, jamming of neuronal message and exhaustion of synaptic neurotransmitter release. The inhibition of glutamate STN release could be neuroprotective on nigral cells. Animal experiments support this hypothesis, not contradicted by the long-term follow up of patients. Neuroprotection might have considerable impact on the management of PD patient and warrants clinical trials.

Reflex reciprocal facilitation of antagonist muscles in spinal cord injury

STUDY DESIGN

Electromyographic study in complete and incomplete spinal cord injury (SCI).

OBJECTIVE

To examine the changes in the pattern of reciprocal inhibition between agonist and antagonist muscles in SCI.

SETTINGS

Sensory Motor Performance Program, Rehabilitation Institute of Chicago, IL, USA.

METHODS

Tendon taps were delivered manually with an instrumented hammer to the tendons of the tibialis anterior and soleus muscle in positions of full-ankle dorsiflexion and plantarflexion in eight subjects with complete SCI and eight subjects with incomplete SCI. Electromyographic activity (EMG) was recorded from ankle dorsiflexor and plantarflexor muscles. Tapping force was also recorded by a force sensor mounted to the tendon hammer, indicating the stimulus onset. Measures of reflex EMG magnitude and reflex latency were obtained for both agonist and antagonist muscles. The ratio of antagonist to agonist EMG was computed based on normalized EMG.

RESULTS

Substantial reflex responses occurred in both the stretched muscle and in its antagonist. The reflex in antagonist, which we term 'reciprocal facilitation (RF)', was most evident in subjects with incomplete SCI. The magnitude of RF was consistently greater than reflex responses in agonist muscles under all test conditions. The latency of the RF was comparable to that of monosynaptic reflex response.

CONCLUSIONS

Following SCI, reciprocal organization of segmental reflexes at the ankle is often partially or completely suppressed, allowing reflex activation in antagonist muscles to be manifested. Possible mechanisms underlying these changes in neural organization are discussed.

SPONSORSHIP

This study was supported by Spinal Cord Research Foundation, the Paralyzed Veterans of America.

Skeletal muscle ryanodine receptor is a redox sensor with a well defined redox potential that is sensitive to channel modulators

Hyperreactive sulfhydryl groups associated with the Ca(2+) release protein from sarcoplasmic reticulum are shown to have a well defined reduction potential that is sensitive to the cellular environment. Ca(2+) channel activators lower the redox potential of the ryanodine receptor, which favors the oxidation of thiols and the opening of the Ca(2+) release protein. In contrast, channel inhibitors increase the redox potential, which favors the reduction of disulfides and the closure of the release protein. Modulation of redox potential of reactive thiols may be a general control mechanism by which sarcoplasmic/endoplasmic reticulum, ryanodine receptors/IP(3) receptors, control cytoplasmic Ca(2+) concentrations.

[Ultrastructure study on extraocular muscle of infiltrative exophthalmos]

OBJECTIVE

To investigate histopathologic and ultrastructural changes of extraocular muscles (EOMs) in infiltrative exophthalmos in order to collect some evidences of pathogenesis.

METHODS

Ten EOM samples in infiltrative exophthalmos were obtained after operation. Each of them was cut into two pieces. One of them was stained with HE and observed by light microscope. Another one was sectioned with ultrathin method and observed by transmission electron microscope.

RESULTS

Under the light microscope, the extraocular muscular cells had no significant abnormality at the early stage, while at the middle and late stage, sarcoplasm coagulation, granular degeneration, vacuolization and necrosis were found in the cells. Under the electron microscope, there were disturbance and disappearance of the Z line in part of muscular fibers in early cases; at the middle and late stage, various degrees of sarcoplasmic reticulum dilatation, myofilament lysis and destruction with formation of vacuoles, secondary lysosome and remnant bodies were seen. In severe cases, the muscular cells could be completely destroyed and phagocytosed by macrophages, fibrosis occurred and myofibroblasts were found in some cases.

CONCLUSIONS

The EOMs in infiltrative exophthalmos are destroyed in various degrees, and the muscular cells may be the target cells in Graves' ophthalmopathy.

[Effects of pyrethroids on the glutamate uptake system in synaptic vesicle of rats]

In order to study the effects of cypermethrin and permethrin insecticides on the glutamate uptake of rat brain, brain synaptic vesicles and cypermethrin or permethrin were incubated with 3H-glutamate (37 KBq, 1 mumol/L). The radio activity was detected by a liquid scintillation counter. The results showed that cypermethrin and permethrin in the concentration of 10(-9)-10(-4) mol/L could inhibit the high affinity uptake of glutamate in the synaptosomes of cerebral cortex, hippocampus and striatum in a dose-response manner. Cypermethrin was more powerful than permethrin at the same dose. It was concluded that glutamate uptake inhibition might play a vital role in the neurotoxicity induced by pyrethroid insecticides.

[A study on pathology and immunoglobulin of orbital tissues from cases with Grave's ophthalmopathy]

OBJECTIVE

To investigate pathological changes and the expression, localization of immunoglobulins (IgA & IgE) in orbital tissues from patients with Grave's ophthalmopathy.

METHODS

Orbital tissues were obtained at surgery from 19 patients with Grave's ophthalmopathy and 17 control subjects. Immunohistochemical studies were carried out by using anti-IgA, anti-IgE antibody and a streptavidin-biotin-peroxidase detection system. In addition, hematoxylin-eosin, alcian blue and Masson trichrome stains were employed to demonstrate the pathologic changes in the tissues.

RESULTS

12 of 17 samples from patients exhibited IgA positive staining for the connective tissue associated with the extraocular muscles and orbicularis oculi, however only 2 control muscles reacted minimally. IgE positive material was found in association with the majority of leukocytes and with muscle fibers in 13 patients, but only 4 control subjects displayed mild reactions. Significant expression of IgE was more often demonstrated in patients with eye disease of short course than in those of longer course.

CONCLUSION

These results support the notion that the eye muscle fiber and fibroblast are important targets of the orbital autoimmune reaction in Graves' ophthalmopathy in which IgA and IgE both play important roles.