Disparities in Survival Outcomes Between Locally Advanced Cervical Squamous Cell Carcinoma and Adenocarcinoma Treated with Chemoradiotherapy

Purpose

To determine the disparities in survival outcomes between stage IIB-IVA cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) treated with chemoradiotherapy.

Methods

Patients diagnosed between 2004 and 2015 were retrospectively included from the Surveillance, Epidemiology, and End Results databases. Propensity score matching (PSM) was used in this study. The primary endpoints were cervical cancer-specific survival (CCSS) and overall survival (OS).

Results

A total of 2752 patients were identified, including 87.5% (n=2408) were SCC and 12.5% (n=344) were AC. Patients with AC had inferior 5-year CCSS (67.5% vs 54.8%, P<0.001) and OS (58.4% vs 47.2%, P<0.001) compared to those with the SCC subtype. The hazard curve of cervical cancer-related death in AC peaked at 2 years (19%) and still small peaks in the 7 and 11 years of follow-up. Regarding SCC, cervical cancer-related deaths peaked at 2 years (15%) and the hazard rate was 2.0% during the six years of follow-up. The multivariate Cox regression analyses indicated that histology was an independent prognostic factor associated with survival outcomes. Patients with AC had significantly poor CCSS (P<0.001) and OS (P<0.001). Similar results were found after PSM.

Conclusion

Our study demonstrates a significantly better prognosis for cervical SCC patients compared to those with cervical AC undergoing chemoradiotherapy. These results highlight the importance of histological subtyping in predicting treatment outcomes and tailoring therapeutic strategies.

Utilization and outcomes of the 21-gene recurrence score in de novo metastatic breast cancer

BACKGROUND

Limited data exist regarding the utility and validity of the 21-gene recurrence score (RS) in patients with de novo metastatic breast cancer (dnMBC). This study aimed to investigate the practice patterns as well as associated survival outcomes based on 21-gene RS in dnMBC.

RESEARCH DESIGN AND METHODS

The Surveillance, Epidemiology, and End Results Oncotype database was queried for women with hormone receptor-positive and Her2-negative dnMBC.

RESULTS

A total of 153 patients were identified, including 62.7% and 37.3% of patients who had RS < 26 and ≥ 26, respectively. Patients with RS ≥ 26 were more likely to receive chemotherapy compared to those with RS < 26 (61.4% vs. 28.1%, p < 0.001). Patients with RS ≥ 26 had an inferior breast cancer-specific survival (BCSS) (2-year BCSS: 84.3% vs. 89.5, p = 0.067) and overall survival (OS) compared to those with RS < 26 (2-year OS: 76.9% vs. 87.4%, p = 0.018). The multivariate Cox proportional hazard models showed that those with RS ≥ 26 had a significantly inferior BCSS (hazard ratio [HR] 2.251, 95% confidence interval [CI] 1.056-4.799, p = 0.036) and OS (HR 2.151, 95%CI 1.123-4.120, p = 0.021) compared to those with RS < 26.

CONCLUSIONS

The 21-gene RS assay is an important prognostic factor in patients with dnMBC.

[Development of an asthenopia survey questionnaire for general surveys]

Objective: To design a visual fatigue questionnaire that can be used for population surveys. Methods: This was a cross-sectional study that involved three stages of subjects' recruitment. In the first stage, by convenience sampling, 150 individuals who complained of visual fatigue were selected at public places in Wenzhou City in May 2016. The 19-Item Asthenopia Survey Questionnaire (ASQ-19) was used to conduct the survey, and the questionnaire was adjusted. In the second stage, 200 outpatient participants were recruited from Wenzhou Medical University Affiliated Eye and Optometry Hospital from June 2016 to May 2017 and were divided into a visual fatigue group and a control group based on clinical diagnosis. The adjusted visual fatigue questionnaire was used for validation. In the third stage, 64 outpatient participants who met the inclusion criteria were continuously recruited from the Wenzhou Medical University Affiliated Eye and Optometry Hospital in July 2022. They were tested using the adjusted visual fatigue questionnaire and retested one week later. During the questionnaire adjustment stage, factor analysis and feedback were used to adjust the scoring method and items of the ASQ-19 questionnaire. The adjusted questionnaire was then analyzed for reliability, validity, accuracy, and subject acceptance during the validation and retest stages. Results: A total of 403 participants were included, and 456 questionnaires were distributed. Eventually, 432 valid questionnaires were collected from 379 participants, resulting in a valid response rate of 94.7%. During the questionnaire adjustment phase, there were 140 valid questionnaires from 140 participants consisting of 56 males and 84 females with an average age of (35.2±12.4) years. In the questionnaire validation phase, there were 186 valid questionnaires from 186 participants. Sixty-two participants had visual fatigue and 124 were controls. During the questionnaire retesting phase, 53 participants yielded 106 valid questionnaires. The group consisted of 20 males and 33 females with an average age of (22.8±4.9) years. After factor analysis, the symptom severity graded as none, mild, moderate, severe, and very severe was scored as 0, 1, 2, 3, and 4 points, respectively. The total score was 44, and the final questionnaire consisted of 11 items (numbered 1, 2, 3, 5, 6, 8, 10, 15, 17, 18, and 19). The 11-Item Asthenopia Survey Questionnaire (ASQ-11) had a Cronbach's α coefficient of 0.89, a split-half reliability of 0.82, and a test-retest Pearson correlation coefficient of 0.90 (P<0.001). The structural validity was 51.26%, and the discriminative validity was a t-value of 9.19 (P<0.001). On average, it took (2.82±0.43) minutes for participants to complete the questionnaire. The receiver operating characteristic curve had a cutoff value of 8.5, with a sensitivity of 74.19% and a specificity of 80.65%. Conclusion: The ASQ-11, with fewer items and a shorter completion time, is easy for participants to use and is suitable for screening or self-assessment of visual fatigue in the general population. Additionally, it is convenient for clinical and epidemiological studies related to visual fatigue.

Prediction of Visual Impairment in Epiretinal Membrane and Feature Analysis: A Deep Learning Approach Using Optical Coherence Tomography

PURPOSE

The aim was to develop a deep learning model for predicting the extent of visual impairment in epiretinal membrane (ERM) using optical coherence tomography (OCT) images, and to analyze the associated features.

METHODS

Six hundred macular OCT images from eyes with ERM and no visually significant media opacity or other retinal diseases were obtained. Those with best-corrected visual acuity ≤20/50 were classified as "profound visual impairment," while those with best-corrected visual acuity >20/50 were classified as "less visual impairment." Ninety percent of images were used as the training data set and 10% were used for testing. Two convolutional neural network models (ResNet-50 and ResNet-18) were adopted for training. The t-distributed stochastic neighbor-embedding approach was used to compare their performances. The Grad-CAM technique was used in the heat map generative phase for feature analysis.

RESULTS

During the model development, the training accuracy was 100% in both convolutional neural network models, while the testing accuracy was 70% and 80% for ResNet-18 and ResNet-50, respectively. The t-distributed stochastic neighbor-embedding approach found that the deeper structure (ResNet-50) had better discrimination on OCT characteristics for visual impairment than the shallower structure (ResNet-18). The heat maps indicated that the key features for visual impairment were located mostly in the inner retinal layers of the fovea and parafoveal regions.

CONCLUSIONS

Deep learning algorithms could assess the extent of visual impairment from OCT images in patients with ERM. Changes in inner retinal layers were found to have a greater impact on visual acuity than the outer retinal changes.

Phonetic posteriorgram-based voice conversion system to improve speech intelligibility of dysarthric patients

BACKGROUND AND OBJECTIVE

Most dysarthric patients encounter communication problems due to unintelligible speech. Currently, there are many voice-driven systems aimed at improving their speech intelligibility; however, the intelligibility performance of these systems are affected by challenging application conditions (e.g., time variance of patient's speech and background noise). To alleviate these problems, we proposed a dysarthria voice conversion (DVC) system for dysarthric patients and investigated the benefits under challenging application conditions.

METHOD

A deep learning-based voice conversion system with phonetic posteriorgram (PPG) features, called the DVC-PPG system, was proposed in this study. An objective-evaluation metric of Google automatic speech recognition (Google ASR) system and a listening test were used to demonstrate the speech intelligibility benefits of DVC-PPG under quiet and noisy test conditions; besides, the well-known voice conversion system using mel-spectrogram, DVC-Mels, was used for comparison to verify the benefits of the proposed DVC-PPG system.

RESULTS

The objective-evaluation metric of Google ASR showed the average accuracy of two subjects in the duplicate and outside test conditions while the DVC-PPG system provided higher speech recognitions rate (83.2% and 67.5%) than dysarthric speech (36.5% and 26.9%) and DVC-Mels (52.9% and 33.8%) under quiet conditions. However, the DVC-PPG system provided more stable performance than the DVC-Mels under noisy test conditions. In addition, the results of the listening test showed that the speech-intelligibility performance of DVC-PPG was better than those obtained via the dysarthria speech and DVC-Mels under the duplicate and outside conditions, respectively.

CONCLUSIONS

The objective-evaluation metric and listening test results showed that the recognition rate of the proposed DVC-PPG system was significantly higher than those obtained via the original dysarthric speech and DVC-Mels system. Therefore, it can be inferred from our study that the DVC-PPG system can improve the ability of dysarthric patients to communicate with people under challenging application conditions.

The extracellular vesicular pseudogene LGMNP1 induces M2-like macrophage polarization by upregulating LGMN and serves as a novel promising predictive biomarker for ovarian endometriosis recurrence

STUDY QUESTION

How does ectopic endometrial stromal cell (Ecto-ESC)-derived extracellular vesicular Legumain pseudogene 1 (EV-LGMNP1), a newly identified pseudogene of Legumain (LGMN), contribute to M2-phenotype macrophage polarization, and does it predict recurrence in patients with ovarian endometriosis (EMs)?

SUMMARY ANSWER

EV-LGMNP1, which is abundant in Ecto-ESCs and serum from ovarian EMs, can direct macrophages towards an M2 phenotype by upregulating LGMN expression and is a promising biomarker for predicting ovarian EMs recurrence.

WHAT IS KNOWN ALREADY

Extracellular vesicles (EVs) can mediate cell-to-cell crosstalk to promote disease progression via cargo molecule transport. Recently, LGMNP1, a newly identified pseudogene of LGMN, has been reported to promote cancer progression by upregulating LGMN. LGMN is a well-studied protein that can induce M2-like polarization.

STUDY DESIGN, SIZE, DURATION

An in vitro study was conducted with Ecto-ESCs isolated from ectopic endometrial samples, collected from two patients with ovarian EMs (diagnosed by laparoscopy and histological analysis). A clinical retrospective cohort study of 52 ovarian EMs patients and 21 controls with available preoperative serum samples was carried out (2013-2017). The follow-up period ended either at the time of recurrence or on 31 December 2018.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Ecto-ESC-derived EVs (EV/Ecto-ESCs) were characterized by nanoparticle tracking analysis, transmission electron microscopy and western blotting. EV internalization by THP-1 cells, which are the most widely used primary human macrophages model, was detected by fluorescence labelling. After EV treatment, THP-1 cell polarization was detected by quantitative real-time PCR (qRT-PCR) and western blot analyses of CD86 (M1-related marker) and CD206 (M2-related marker). LGMNP1 mRNA expression level in EVs from both primary ectopic endometrioc stromal cells and serum was examined using qRT-PCR. Additionally, the expression of LGMN, the downstream target gene of LGMNP1, in THP-1 cells was evaluated using qRT-PCR and western blotting. Kaplan-Meier and multivariate Cox regression analyses were applied to evaluate the independent predictive factors of EMs recurrence-free survival. A novel nomogram model based on serum EV-LGMNP1 was then formulated to predict EMs recurrence.

MAIN RESULTS AND THE ROLE OF CHANCE

In vitro assays demonstrated that EV/Ecto-ESCs drove macrophages towards an M2-like phenotype. Moreover, LGMNP1 contributed to EV/Ecto-ESC-induced M2 macrophage polarization by upregulating LGMN mRNA expression levels. Clinically, serum EV-LGMNP1 was more highly expressed in recurrent EMs patients than in controls and EMs patients without recurrence. Survival analysis and our novel nomogram reconfirmed that serum EV-LGMNP1 was a novel promising and meaningful non-invasive biomarker for predicting EMs recurrence.

LARGE SCALE DATA

N/A.

LIMITATIONS, REASONS FOR CAUTION

In vitro experiments were only performed on samples from two patients with ovarian endometriosis, and a larger sample size is needed. ESCs isolated from the eutopic endometrium of EMs and non-EMs patients should be studied in the future. Additionally, in vitro experiments should be performed using endometrial epithelium cells and further in vivo experiments, such as using mice endometriotic models to investigate whether EV/Ecto could induce M2 macrophage polarization, should be conducted. Moreover, multicentre, large-sample data are needed to validate our predictive nomogram model.

WIDER IMPLICATIONS OF THE FINDINGS

Our study provides novel insights into the mechanism of M2 polarization involved in ovarian EMs progression mediated by an 'EV-shuttled pseudogene LGMNP1' mode. In addition, serum EV-LGMNP1 may serve as a novel non-invasive biomarker for predicting recurrence, providing a new therapeutic target for ovarian EMs.

STUDY FUNDING/COMPETING INTEREST(S)

This project was supported by funding from the National Natural Science Foundation of China (81971361), the Natural Science Foundation of Shanghai Science and Technology (19ZR1406900), the Shanghai 'Rising Stars of Medical Talent' Youth Development Program (AB83030002019004), the Clinical Research Plan of SHDC (SHDC2020CR4087), the Shanghai Municipal Health Commission (202040498), the Research and Innovation Project of the Shanghai Municipal Education Commission (2019-01-07-00-07-E00050) and the Clinical Research Plan of SHDC (SHDC2020CR1045B). There are no competing interests to declare.

Deep-learning-based human motion tracking for rehabilitation applications using 3D image features

Motion rehabilitation is increasingly required owing to an aging population and suffering of stroke, which means human motion analysis must be valued. Based on the concept mentioned above, a deep-learning-based system is proposed to track human motion based on three-dimensional (3D) images in this work; meanwhile, the features of traditional red green blue (RGB) images, known as two-dimensional (2D) images, were used as a comparison. The results indicate that 3D images have an advantage over 2D images due to the information of spatial relationships, which implies that the proposed system can be a potential technology for human motion analysis applications.

[Epidemiological characteristics of imported malaria cases in Fujian Province from 2014 to 2018]

OBJECTIVE

To analyze the epidemiological characteristics of imported malaria cases in Fujian Province from 2014 to 2018, so as to provide scientific basis for the development of the control strategy for imported malaria.

METHODS

The epidemiological data of malaria cases in Fujian Province from 2014 to 2018 were retrieved from the Notifiable Disease Reporting System and Parasitic Disease Information Reporting System of Chinese Center for Disease Control and Prevention, and the classification, origin of infections, temporal distribution, spatial distribution, population distribution, reporting institutions and diagnosis were analyzed.

RESULTS

A total of 540 overseas imported malaria cases were reported in Fujian Province from 2014 to 2018, and all cases were laboratory-confirmed, including 398 cases with falciparum malaria, 88 cases with vivax malaria, 38 cases with ovale malaria, 14 cases with malariae malaria and 2 cases with mixed infections. There were 90.56% (489/540) of the imported malaria cases with infections in 27 African countries, 5.92% (32/540) with infections in 5 Asian countries and 3.52% (19/540) with infections in one Oceania country. There was no significant seasonal distribution of the cases, and the imported malaria cases were predominantly detected in Fuzhou City (80.00%, 432/540) and at ages of 20 to 49 years (81.48%, 440/540). Initial diagnosis was predominantly at the city-level medical institutions, and 77.96% (421/540) were diagnosed as malaria at the initial diagnosis institutions. The median duration from onset to initial diagnosis was 2 days and 70.19% (379/540) were diagnosed within 3 days of onset. The interval between initial diagnosis and definitive diagnosis was 0 day, with 85.37% (461/540) definitively diagnosed within 3 days of initial diagnosis.

CONCLUSIONS

Overseas imported malaria is a continuous problem challenging the malaria elimination programme of Fujian Province. Improving the healthcare-seeking awareness and the diagnostic capability of healthcare workers, and intensifying the monitoring and management of malaria among overseas labors are strongly recommended.

[Clinical effect of X-N advancement flap in repairing pressure ulcer on the buttock or back]

Objective: To explore the clinical effect of X-N advancement flap in repairing pressure ulcer on the buttock or back. Methods: From June 2018 to June 2019, 20 patients with grade Ⅳ pressure ulcers on the buttock or back were hospitalized and treated in the Department of Traumatology, Burns and Plastic Surgery of Fourth Affiliated Hospital of Guangxi Medical University, including 15 males and 5 females, aged 48-89 years. The area of the patient's wound was 8 cm×5 cm-15 cm×12 cm after debridement, and all were repaired with the X-N advancement flap designed by the author. The flap was designed according to the direction of skin relaxation on both sides of the wound, and the skin was incised in X-shape and sutured in N-shape. The width and advancement distance of the flap were recorded, and the ratio of the advancement distance to the width of the flap was calculated. The flap survival, complication, and follow-up were observed and recorded. Results: The width of the flap was (5.9±1.2) cm, the advancement distance of the flap was (10.3±2.5) cm, and the ratio of the advancement distance to the width of the flap was 1.8±0.4. All the flaps survived, and none of the flaps had blood flow disorder. Local dehiscence occurred in the flap of one patient 1 week after surgery, which was healed after laying on the floating bed, strengthened care, and wound dressing change. The flap of one patient developed infection 5 days after surgery, which was healed after partial suture removal, smooth drainage, and replacement with sensitive antibiotics. The wounds of the remaining 18 patients were all cured. After 3 months of follow-up, the flaps survived well with good elasticity and texture. Conclusions: The X-N advancement flap can make the skin and soft tissue move forward effectively. It is simple and effective to repair pressure ulcers on the back or buttock of patients with this flap, which is worthy of clinical promotion and application.

[Application of laser speckle contrast imaging technology to researches on acupuncture and microcirculation]

The therapeutic effect of acupuncture is often closely related to the improvement of microcirculation. Acupuncture stimulation can adjust pathophysiological changes of microcirculation in the human body through multiple ways, multiple links and multiple levels, healing disorders at last. Laser speckle contrast imaging (LSCI), an emerging technology, can be used to study the effect of acupuncture on microcirculation. In this paper, retrieving the related literature published in recent years, we found that LSCI technology has already been applied to the following aspects 1) acupoint-viscera and microcirculation, 2) stimulation-induced transmission of sensations along the meridian and microcirculation, 3) non-meridians or non-acupoints and microcirculation, 4) specific acupoints and microcirculation, as well as 5) different acupuncture needle manipulations and microcirculation. However, most of the studies focused on animal experiments and healthy subjects, observing microcirculatory effects under normal physiological conditions, and the sample size of participants was smaller. In the future, we highly recommend that increasing the sample size and further studying the local microcirculation are necessary in the pathological state of diseases.

SAT-268 Thyrotropin Secreting Pituitary Adenoma Initially Misdiagnosed as Primary Hyperthyroidism in a Taiwanese Man

Background:TSH (Thyrotropin) secreting pituitary adenoma (TSHoma) account for less than 1% of all causes of hyperthyroidism and 1% of all functioning pituitary tumors. Definite diagnosis and treatment of TSHoma are clinical challenges in practice. Here we report laboratory data, imaging findings, endocrine dynamic test, and treatment outcomes in a 50-year-old Taiwanese man with pituitary plurihormonal adenoma secreting TSH and LH.

Clinical case:The patient was initially diagnosed as goiter with primary hyperthyroidism and DM while medical check-up by primary care physician in 2014. He had no significant hyperthyroidism symptoms and signs except goiter and mild palpitation. He received propylthiouracil and Metformin. Two years later, he visited to Endocrinologist’s clinic for poor glycemic control. Central hyperthyroidism was diagnosed due to measurable TSH level in the presence of increased serum thyroid hormone level. Moreover sella MRI revealed left sided pituitary lesion. He was referred to Taipei Veteran General Hospital for further management. There was no family history of thyroid disease. Physical examination was not remarkable except diffuse grade 3 goiter and tachycardia (HR 100~115 bpm). Follow up laboratory data showed TSH 4.89; range 0.4~4.0 uIU/ml, free T4: 3.05; range 0.9~1.8 ng/dl, T4: 16.02; range 4.50~12.50 μg/dl, T3: 249; range 58~159 ng/dl, free T3: 8.0; range 2.3~4.3 pg/ml. Two times of TRH stimulation test showed blunted TSH response. Normal limit of thyroid autoantibodies level were found. Thyroid sonography revealed heterogenous echogenicity with increased size and vascularity of both lobes. I-131 uptake was homogenous uptake (94%). Other pituitary hormones level were within normal limit except mild elevation of testosterone 12.69 ng/ml. Sella MRI with contrast showed macroadenoma (size 10x10x7.6 mm) at left pituitary gland. Taken together, he was diagnosed as central hyperthyroidism related to left sided pituitary macroadenoma. Surgery was performed after one year of definite diagnosis due to personal reason. TSH level returned to normal ranges (0.799 uIU/ml) in 1st post operative day. Histologically, the pituitary mass was compatible with plurihormonal adenoma and immunohistochemistry showed positivity for TSH (4+) and LH (3+). Post operative condition was well. Antithyroid agent was discontinued after operation. His blood glucose became well controlled after operation.

Clinical lessons:A biochemical hallmark of TSHoma is an escape of TSH from the feedback loop that is detectable TSH levels in the presence of increased serum thyroid hormone level. Diagnosis of TSHoma was frequently unrecognized and thus much delayed despite its relatively straightforward. Physician should keep in mind that the importance interpretation of simple laboratory tests to avoid delay diagnosis and unnecessary treatments.

MON-459 Bilateral Killian-Jamieson Diverticulum Mimicking Thyroid Nodules

Background

In recent years, incidence and prevalence of thyroid and extrathyroid lesion is increasing in the worldwide due to increase awareness of medical check-up, and widespread use of imaging techniques. A Killian Jamieson diverticulum (KJD), a rare type of hypopharyngeal pulsion diverticulum outpouching from the lateral wall of the proximal cervical esophagus, was incidentally detected and likely to be misinterpreted as a thyroid nodule while performing thyroid sonography. Clearly differentiate between those lesions is essential to avoid unnecessary invasive procedure. Here we report a typical case of bilateral Killian Jamieson diverticulum mimicking thyroid nodules.

Clinical case

A 57-year-old Taiwanese man was referred to our endocrine outpatient department for further evaluation of thyroid nodules. The lesions were discovered while sonographic examination performed in the clinic for routine medical check-up. He denied having dysphagia, epigastric pain, odynophagia, halitosis, chronic cough or acid regurgitation, body weight loss, fever and dyspnea. He had no previous systemic disease and no prior radiation therapy. He lives in Nangang District, Taipei city. His body weight was 70 kg and BMI was 25. An examination of head and neck was unremarkable. Laboratory data revealed normal thyroid function (TSH: 0.67 uIU/ml; range 0.4~4.0, free T4: 0.83 ng/dl; range 0.9~1.8 and aTPO <1.0 IU/ml; range <5). Thyroid ultrasonography demonstrated oval, hypoechoic nodule-like lesions containing bright foci with acoustic shadow in the posterior aspect of the both lobes of thyroid gland. The rest of thyroid glands were normal appearance. An esophagography was performed and showed two contrast-filling anterior outpouching lesions at both sides of the cervical esophagus, around C7 level and both lesions were showing anterior outpouching appearance, consider Killian-Jamieson diverticulum. Taken together, he was diagnosed as KJD and clinical follow-up alone is suggested.

Clinical lessons

KJD is usually incidentally detected and misdiagnosed as a thyroid nodule containing punctuate microcalcification foci as found in papillary thyroid carcinoma. To differentiate these nodules, real time sonographic examination is important. Although rare, non-thyroid lesions originating from the esophagus should be considered in the differential diagnosis of the thyroid nodules to avoid unnecessary invasive fine needle aspiration of thyroid gland.

[Survey on the quadrivalent influenza vaccine intention and related factors of health care workers in the Pearl River Delta region from 2015 to 2017]

Objective: To analyze the quadrivalent influenza vaccine intention of 718 health care workers (HCWs) in the Pearl River Delta region from 2015 to 2017. Method: In May 2018, 718 HCWs from the department related to the diagnosis and treatment of influenza in 17 hospitals (6 tertiary hospitals, 5 secondary hospitals and 6 primary hospitals) from Guangzhou, Jiangmen, Zhuhai and Dongguan were selected by using stratified sampling method. Questionnaire survey and face-to-face interview were used to collect the information of influenza vaccination, the intention of the quadrivalent influenza vaccine, the acceptance of free and required vaccination policies, and recommendations for increasing influenza vaccination intentions from 2015 to 2017. The multivariate logistic regression was used to analyze factors associated with the vaccination intention. Results: A total of 718 HCWs were surveyed and 147 of them were interviewed face to face. Among them, the vaccination rate of primary hospitals [17.39%(40/230)] was higher than that of other hospitals (χ(2)=15.80, P<0.05). If the vaccine could be free, 84.82% (609/718) of HCWs would like to be vaccinated. The multivariate logistic regression showed that the factors, HCWs who were aged ≥50 years (OR=3.44, 95%CI:1.43-8.28), worked in department of prevention and health care (OR=2.35, 95%CI:1.16-4.75), learned about the quadrivalent influenza vaccine (OR=2.94, 95%CI:2.08-4.18), knowed that HCWs are priority (OR=2.33, 95%CI:1.56-3.48), and had a history of trivalent influenza vaccination from 2015 to 2017 (OR=4.70, 95%CI:3.08-7.15), were associated with the vaccination intention. Conclusion: HCWs in the Pearl River Delta region had weak inclination of getting quadrivalent influenza vaccine. HCWs who were age (≥50 years old), worked in department of prevention and health care, learned about the quadrivalent influenza vaccine, knowed that HCWs are priority, and had a history of trivalent influenza vaccination from 2015 to 2017 were factors positively associated with the vaccination intention.

MON-545 Clinical Characteristics and Outcome of Clinically-Detected versus Imaging-Detected Incidental Thyroid Cancer

Introduction: Incidence and prevalence of thyroid cancer is increasing worldwide due to increased awareness of thyroid nodular diseases, advances in diagnostic tools and widespread use of imaging techniques. However, very few literatures reported the differences between clinically discovered and incidentally found thyroid cancer. Objective: The objective of this study was to evaluate clinical characteristics and outcome of clinically-detected and imaging-detected incidental thyroid cancer. Materials and Methods: This is a retrospective cohort study of 180 pathologically confirmed thyroid cancer patients who received thyroid surgery between January to December 2011 in Taipei Veterans General Hospital and had been long-term followed up with data on cancer outcome. Patients were categorized into two groups: group A (clinically-detected, n=127) and group B (imaging-detected incidental cancer, n=53). Results: In group A, the initial symptoms that prompted further investigation for thyroid disease included palpable mass (n=96), enlarged neck (n=11), change of voice (n=5), swallowing difficulty (n=7), breathing difficulty (n=6) and other non-specific discomfort (n=2). In group B, the initial image was ordered during health check-up in 30 patients and because of health issues other than thyroid disease in 23 patients. The imaging modalities included neck sonography (n=37), neck or chest computed tomography (n=5), whole body magnetic resonance imaging (n=9), whole body bone scan (n=1), positron emission tomography (n=1). Age, sex, tumor number, lobe involvement, AJCC staging, treatment modalities were not statistically different between the two groups. Mean tumor size was larger in group A (2.1±1.6 cm) compared to group B (1.2±0.9 cm, , P<0.001). Papillary thyroid microcarcinoma was more common in group B (26/53 = 49.0%) than group A (27/127 = 21.3%). No medullary or follicular thyroid carcinoma were detected in group B. Both groups contained mainly American Joint Committee on Cancer (AJCC) stage I disease (group A v.s. group B, 88/127 = 69.3% v.s. 40/53 = 75.5%). Recurrence free survival was not significantly different in the two groups (group A v.s. group B, 1177.7 v.s. 1247.5 days, P=0.14). In multivariate analysis, tumor size is still significantly different (group B v.s. group A, adjusted OR=0.56, P=0.001). Conclusion: Our result indicated that tumor size was significantly smaller in imaging-detected incidental thyroid cancer compared to clinical symptoms oriented ones. Although recurrence free survival was slightly longer in group B, the insignificant difference among the two groups does not encourage the wide-spread use of imaging techniques to detect smaller thyroid cancers.

SUN-397 A Rare Case of Ectopic Adrenocorticotropic Hormone (ACTH) Syndrome Due to Thymic Large Cell Neuroendocrine Carcinoma Presenting as Severe Hypokalemia in a Taiwanese Man

Background Ectopic ACTH syndrome (EAS) represented 5% of Cushing syndrome. EAS is rapid onset, severe, associated with hypercortisolism related life-threatening infections and hypokalemia. In 60% of cases, the tumor is located in intrathoracic organ (lung, bronchus and thymus). Large cell neuroendocrine tumor of thymus secreting ACTH is a high grade, aggressive, poor prognosis and only few case reports in literature. Here we report a case of thymic LCNEC related EAS, which presented as severe hypokalemia, metabolic alkalosis and muscle weakness. Clinical Case A 71-year-old man presented with 12-kg weight loss, progressive generalized weakness and bilateral legs edema for two months.He has medical histories of hypertension and diabetes mellitus. Physical examination revealed generalized weakness without Cushingoid appearance. Laboratory examination showed metabolic alkalosis and severe hypokalemia (1.7 mmol/L, range 3.4-4.7).Hypokalemia work-up showed high morning ACTH 497 pg/mL (normal <46.0), cortisol 87.8 μg/dL (range 3.7-19.4), and normal limits of other pituitary hormones. Cushing syndrome survey showed lack of ACTH/cortisol circadian rhythm, markedly increased 24h urinary free cortisol excretion on two consecutive days ( 21429, 17061 μg). Low-dose and high-dose dexamethasone suppression tests showed non-suppressible. Ovine corticotrophin-releasing hormone stimulation test and desmopressin (DDAVP) test showed ectopic ACTH source. Pituitary MRI revealed negative findings. Bilateral inferior petrosal sinus sampling showed no central-to-peripheral ACTH gradient. Ectopic ACTH syndrome was impressed. Etomidate continuous infusion was prescribed.Fournier gangrene of left scrotum occurred during hospitalization and antibiotic and surgical treatment were given. Chest CT scan revealed tiny lobulated nodule in left lower lung field and soft tissue nodule in prevascular of mediastium. In-111 Octreoscan revealed several nodular lesions with increased In-111 uptake in the paraortic and prevascular region considering neuroendocrine tumor. Anterior mediastinal tumor excision was performed and histopathological report showed large cell neuroendocrine carcinoma of thymus with mitotic count 13/10 HPF and positive immunohistochemical stain for synaptophysin, chromogranin, DD-56, SSTR2 and ACTH. Sandostain LAR injection was administered afterward. Unfortunately, tumor progression with hypercortisolemia occurred after 6 months . External radiation and systemic chemotherapy were performed later. Clinical Lessons Although rare, Cushing syndrome must be considered in differential diagnosis of hypokalemia like our case, a challenging case of EAS. Early diagnosis and treatment was important to avoid life-threatening infections and metabolic complications. Moreover recurrence free survival with Sandostain LAR alone was only 6 months for LCNEC.

SAT-616 Coexistence of Resistance to Thyroid Hormone Syndrome and Pituitary Granular Cell Tumor in a Taiwanese Young Lady Mimicking TSH Secreting Tumor

Background Resistance to thyroid hormone (RTH) syndrome is a rare disorder which presents as high free thyroid hormones with unsuppressed thyroid-stimulating hormone (TSH) secretion and diminished responsiveness to thyroid hormones by target organ. Appropriate diagnosis is crucial to avoid over-treatment with anti-thyroid drugs, radio-iodine ablation, and/or pituitary surgery. The aim of this report was to present the first case of RTH in Taiwan, who was misdiagnosed as TSH secreting tumor but later proved to have pituitary granular cell tumor instead. Clinical case A 33-year-old Taiwanese married woman was found to have elevated free T4: 3.92 ng/dL (normal: 0.8-1.9) and TSH: 5.82 μIU/mL (normal: 0.4-4.0) levels on pre-natal counseling for evaluation of palpitation and difficult conception in 2013. Besides mild tachycardia (heart rate: 98 beats per minute), she had no other symptoms and signs of hyperthyroidism. Propylthiouricil was prescribed by her gynecologist and discontinued one year later due to persistence of abnormal thyroid hormone levels under medication. Afterwards, she was referred to an endocrinologist and was told to have central hyperthyroidism based on negative thyroid autoantibodies, moderately enlarged homogenous thyroid glands on thyroid sonography, and a 1.2 cm right pituitary adenoma on sella magnetic resonance imaging (MRI). Endoscopic trans-phenoidal surgery for pituitary tumor removal was performed in May, 2017. Histopathology revealed granular cell tumors that were positive for S-100 protein and TTF-1 but negative for TSH, ACTH, GH and prolactin on immunohistochemical staining. In February 2018, she visited Taipei Veterans General Hospital due to persistence of abnormal thyroid hormone levels (free T4: 2.19 ng/dL; T3: 209 ng/dL, normal: 58-159; total T4 14.78 ug/dl, normal: 4.5-12.50; TSH 3.75 μIU/mL) after pituitary surgery. Post-operative sella MRI showed no residual pituitary tumor. After administration of 200 mcg of thyrotropin releasing hormone (TRH) intravenously, exaggerated TSH response was noted, with TSH levels showing 6.0, 24.7, 22.6, and 14.7 μIU/mL at 0, 20, 30, and 60 minutes, respectively, leading to the diagnosis of RTH. DNA sequencing of exons 4-10 of thyroid hormone receptor β gene revealed no mutation. As pregnancy was planned, Inderal 5mg thrice daily was used to lower T3 levels in case if a non-RTH fetus exists. Clinical lessons Although rare, RTH should be considered in the differential diagnosis of high thyroid hormone levels with unsuppressed TSH. The presence of a pituitary adenoma does not conclude a TSH secreting tumor, like our case. We suggest careful evaluation with functional and genetic testing prior to initiation of therapy in order to avoid unnecessary surgeries and medications. A favorable outcome generally follows a diagnosis of RTH. Special consideration needs to be taken in mothers with RTH harboring wild-type fetus.

Expression of Mucin 1 in salivary gland tumors and its correlation with clinicopathological factors

This study aimed to detect the expression of Mucin 1 (MUC1) in acinic cell carcinoma (AciCC) of salivary gland and to explore the relationship between MUC1 and clinicopathological factors of AciCC of salivary gland. Patients with salivary gland tumors who were treated at our hospital were enrolled in this study. The pathological sections collected from all subjects were classified by histological examinations. In addition, 40 cases of primary salivary gland AciCC tissues were selected and classified into experimental group, whereas 40 cases of normal salivary gland (NSG) tissues were selected and classified into control group. MUC1 positive cells in both experimental and control groups were detected by immunohistochemistry assays, while all clinical data were analyzed statistically. The results showed that MUC1 was only expressed in the ductal epithelium of NSG and distributed at the apical side of the cell membrane. In primary salivary gland AciCC tissues, scattered expressions of MUC1 were found both on the cell membrane and in the cytoplasm of tumor cells, and sometimes even in the cell nuclei, thus completely eliminating the polarized distribution of MUC1 expressions. The percentage of MUC1 positive cells in experimental group was significantly higher than that in control group (P < 0.05). In addition, the expression of MUC1 in salivary gland AciCC was correlated with gender, age, histological type, lesion location, cervical lymph node metastasis, local recurrence, and distant metastasis. In conclusion, MUC1 is related to the occurrence and development of salivary gland AciCC. Therefore, MUC1 may be used as a novel tumor marker in the clinical diagnosis and treatment of salivary gland AciCC.

Foetal bovine serum can reduce toxicity of indocyanine green, brilliant blue G and trypan blue in ARPE-19 cellular model that suggests new surgical staining protocols for internal limiting membrane peeling procedure

BACKGROUND

To investigate and compare the cytotoxicity of indocyanine green (ICG), brilliant blue G (BBG) and trypan blue (TB) using ARPE-19 cells that have been pre-treated/post-treated with balanced salt solution (BSS) or foetal bovine serum (FBS).

METHODS

The cultured human retina pigment epithelium ARPE-19 cells were pre-treated/post-treated with BSS or FBS (represent the autologous serum in clinic) in parallel with cells being soaked with various concentrations of ICG, BBG and TB. The cells were then assessed for viability, growth rate, reactive oxygen species (ROS) level, mitochondrial membrane potential (Δψ) and mitochondrial mass as cytotoxic indices. For the FBS pre-treated cells, only ROS was examined.

RESULTS

Using the MTT assay, cytotoxicity seemed to appear when the dye concentration was above 2.5 mg/mL for ICG but no cytotoxicity for BBG and TB at the concentrations used. Cell growth was arrested at a concentration 1 mg/mL when ICG or BBG were present but no arrest at any of the tested concentrations was found for TB with the cell-growth curve was slowest for ICG. Cellular ROS levels increased at all concentrations of all dyes, but the increasing slopes were decreased after FBS post-treatment washout.

CONCLUSIONS

As a rinse buffer FBS performs much better than BSS in terms of cell rescue, which agrees with a clinical report when autologous whole blood was applied to macular hole surgery. However, FBS pre-treatment seems to be much better than FBS use as washout buffer in post-treatment.

TNF-α was involved in calcium hydroxide-promoted osteogenic differentiation of human DPSCs through NF-κB/p38MAPK/Wnt pathway

It has been reported that calcium hydroxide can induce proliferation, migration, and mineralization in dental pulp stem cells (DPSCs), but the underlying molecular mechanisms are still unclear. In this study, we sought to explore the role of calcium hydroxide in the cell proliferation and directional differentiation of DPSCs and to study the regulatory effect of NF-κB, p38MAPK, and Wnt signaling on differentiation of DPSCs. CCK8 cell assay, Wound Healing Assay, and Alkaline Phosphatase Staining Assay were respectively used to determine the proliferation rate, migration and ALP expression of DPSCs. Alizarin Red Staining Assay was used to observe the mineralization of DPSCs. RT-PCR analysis and Western Blot Analysis displayed the expression of related fators at mRNA and protein level, respectively. In the present study, we found that NF-κB, p38MAPK, and Wnt signaling could abolish calcium hydroxide-induced proliferation of DPSCs. The inhibition of NF-κB, p38MAPK, and Wnt signaling suppressed the migration, ALP expression, and mineralization of DPSCs. NF-κB, p38MAPK, and Wnt signaling involved in directional differentiation of DPSCs. Moverover, calcium hydroxide could activate NF-κB, p38MAPK, and Wnt pathway by regulating TNF-α. Our study showed that NF-κB, p38MAPK, and Wnt signaling pathway were involved in calcium hydroxide-induced proliferation, migration, mineralization, and osteogenic differentiation in DPSCs. Calcium hydroxide affected NF-κB, p38MAPK, and Wnt pathway by regulating TNF-α.

Amelioration of amyloid-β-induced deficits by DcR3 in an Alzheimer's disease model

Background

Microglia mediate amyloid-beta peptide (Aβ)-induced neuroinflammation, which is one of the key events in the pathogenesis of Alzheimer’s disease (AD). Decoy receptor 3 (DcR3)/TNFRSF6B is a pleiotropic immunomodulator that promotes macrophage differentiation toward the M2 anti-inflammatory phenotype. Based on its role as an immunosupressor, we examined whether DcR3 could alleviate neuroinflammation and AD-like deficits in the central nervous system.

Method

We crossed human APP transgenic mice (line J20) with human DcR3 transgenic mice to generate wild-type, APP, DcR3, and APP/DcR3 mice for pathological analysis. The Morris water maze, fear conditioning test, open-field, and elevated-plus maze were used to access their cognitive behavioral changes. Furthermore, the pathological and immune profiles were examined by immunostaining, ELISA, Q-PCR, and IP. In vitro assays were designed to examine DcR3-mediated innate cytokine profile alteration and the potential protective mechanism.

Results

We reported that DcR3 ameliorates hippocampus-dependent memory deficits and reduces amyloid plaque deposition in APP transgenic mouse. The protective mechanism of DcR3 mediates through interacting with heparan sulfate proteoglycans and activating IL-4⁺YM1⁺ M2a-like microglia that reduces Aβ-induced proinflammatory cytokines and promotes phagocytosis ability of microglia.

Conclusion

The neuroprotective effect of DcR3 is mediated via modulating microglia activation into anti-inflammatory M2a phenotype, and upregulating DcR3 expression in the brain may be a potential therapeutic approach for AD.

Electronic supplementary material

The online version of this article (doi:10.1186/s13024-017-0173-0) contains supplementary material, which is available to authorized users.

Electro-optic spectral tuning in a fan-out double-prism domain periodically poled lithium niobate intracavity optical parametric oscillator

We report on the design and experimental demonstration of an electro-optically tunable, pulsed intracavity optical parametric oscillator (IOPO) based on a unique fan-out double-prism domain periodically poled lithium niobate (DPD PPLN) in a diode-pumped Nd:YVO₄ laser. The PPLN device combines the functionalities of fan-out and ramped duty-cycle domain structured nonlinear crystals, working simultaneously as a continuous grating-period quasi-phase-matched optical parametric downconverter and an electro-optic beam deflector/Q switch in the laser system. When driving the fan-out DPD PPLN with a voltage pulse train and varying the DC offset of the pulse train, a pulsed IOPO was realized with its signal and idler being electro-optically tunable over the 1880 and 2453 nm bands at spectral tuning rates of 13.5 (measured) and 25.8 (calculated) nm/(kV/mm), respectively.

Carrier transport in quantum dot quantum well microstructures of the self-assembled CdTe/CdS/ligand core-shell system

The study on the quantum dot quantum well (QDQW) microstructure modified by choosing different ligands containing a sulfhydryl group is of significance because it enables one to regulate photoexcited free charge carriers' (FCCs') transport behaviours in high-quality CdTe/ligand QDs via a self-assembled way. The photoelectron characteristics of ligand-capped CdTe nanoparticles were probed by a combination of surface photovoltaic (SPV) and photoacoustic technologies, supplemented by a computer simulation method of the CASTEP module. The experiment reveals that the D-value ΔEWi obtained by the associated two parameters of the SPV spectroscopy was closely related to the quantum confinement energy in the self-assembled CdTe/CdS/ligand core-shell system. In the paper the D-value was termed the depth of QWs, which were buried in the space charge regions located in the graded-band-gap and on either side of the shell-CdS. Obvious resonance quantum tunnelling may occur in the energy band structure with deep QWs on using certain ligands, resulting in an extended diffusion length of the FCCs on illumination of the photon energy hν ≥ Eg, core-CdTe, and in a strong SPV response at a specific wavelength region. In addition, the carrier-longitudinal optical phonon interaction is the reciprocal of the carriers' lifetime. The d-frontier orbital in the graded-band-gap plays an important role in both the microstructure and the resonance quantum tunnelling of the QDQW system according to the CASTEP calculations.

Efficacy of fexofenadine in isolated rat tracheas

OBJECTIVES

Histamine is an important chemical mediator in both nasal and bronchial inflammation in patients with allergic rhinitis and asthma. The effect of histamine receptor-1 antagonists on nasal mucosa in vivo is well known, however, the effect on tracheal smooth muscle has rarely been explored. The purpose of this study was to determine the effects of fexofenadine on isolated tracheal smooth muscle in vitro.

METHODS

Six tracheal strips were used for each experiment, and one untreated strip served as a control. We examined the effectiveness of fexofenadine on isolated rat tracheal smooth muscle by testing the effect on: 1) tracheal smooth muscle resting tension; 2) contraction caused by 10E-6 M methacholine as a parasympathetic mimetic; and 3) electrically induced tracheal smooth muscle contractions.

RESULTS

The results indicated that addition of methacholine caused the trachea to contract in a dose-dependent manner. The addition of fexofenadine at a dose of 10E-4 M elicited a significant relaxation response compared to 10E-6 M methacholine-induced contraction. There were no detectable changes in the peak tension of electrical field stimulation-induced contractions in the fexofenadine group.

CONCLUSION

High concentrations of fexofenadine had an anti-cholinergic effect. In addition to diminishing histamine-mediated allergic symptoms, fexofenadine may have a potentially therapeutic implication in alleviating asthma-related symptoms due to reducing methacholine-induced contractions of tracheal smooth muscle though these aspects were not studied.

First Report of Cowpea mild mottle virus in Cowpea and French Bean in Taiwan

In 2009, more than 50% of vine type French beans were found bearing severe viral symptoms in a vegetable garden in Nantou County, Taiwan. Infected plants were stunted and exhibited pronounced mottling symptoms on their leaves. The symptomatic plants were mechanically inoculated on Chenopodium quinoa and local lesions developed 7 to 10 days after inoculation. The virus source established by back isolation the single lesion from C. quinoa on French beans developed symptoms similar to those found in the field. Host range test showed that this isolate could only infect leguminous plants, including soybean, mung bean, pea, peanut, asparagus bean, cowpea, adzuki bean, and lima bean, but not cucurbitaceous and solanaceous plants. Since only Cucumber mosaic virus (CMV) has been reported in Taiwan to induce similar symptoms in French beans, we tested both the field collected and inoculated French beans by CMV antiserum in ELISA but obtained a negative result. Due to subsequent electron microscopy studies that found potyvirus and carlavirus like particles in the leaf dips of infected French beans, we conducted reverse transcription (RT)-PCR using generic degenerate primers for potyviruses (Hrp5/Pot1 (2) and PotZ/Pot1 (3)) and carlaviruses (Decarla-u2 (5'-TGCACTGARTCMGAYTATGARGCYTT-3' and Decarla-d1 (5'-GCACATRTCRTCVCCDGCAAA-3') previously designed in our lab. No amplification was found from the potyvirus primers, while the carlavirus one gave an expected amplicon of 285 bp, which was found sharing 81% nucleotide sequence identity with the replicase gene of Cowpea mild mottle virus (CpMMV) (GenBank Accession No. FJ560903). A primer pair (CpMMV-CPu: 5'-TTTACTCTTAggTWATggAgTC-3' and CpMMV-CPd: 5'-CCTATTAAAACACACAAHTCAAA-3') was thus designed to amplify the complete coat protein (CP) gene based on the reported CP sequences and obtained an expected 867-bp product from our French bean isolate. This 867-bp sequence (JX020701) was confirmed to have 97.6% amino acid sequence identities with the CP gene of a Puerto Rican CpMMV isolate (GU191840). In a separate survey, another isolate from asparagus bean (CpMMV-V) causing mild mottling symptom was obtained. Analyses of the CP gene of CpMMV-V (JX070669) confirmed that it shared 88.8% and 97.8% of nucleotide and amino acid sequence identities with the French bean isolate, respectively. Different from most carlaviruses with aphid transmissibility, CpMMV has been shown to be transmitted non-persistently by whiteflies (1). Both CpMMV isolates from Taiwan were confirmed to be transmitted by silver leaf whiteflies (Bemicia argentifolii Bellows and Perring). This is the first record of whitefly transmissible legume virus in Taiwan. Since whitefly has been a problem in agriculture worldwide, CpMMV can be a new emerging threat for Taiwan's legume crop production. References: (1) M. Iwaki et al. Plant Dis. 66:365, 1982. (2) S. S. Pappu et al. J. Virol. Methods 41:9, 1993. (3) F. M. Zerbini et al. Phytopathology 85:746.

Detection of gastroesophageal reflux esophagitis using 2-fluoro-2-deoxy-d-glucose positron emission tomography

Background. Gastroesophageal reflux disease (GERD) is a common disease and a major upper gastrointestinal problem. The purpose of the present study is to evaluate the use of noninvasive 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) to detect gastroesophageal reflux esophagitis. Materials and Methods. This is a retrospective study reviewing 408 healthy check-up subjects (169 females and 239 men), who underwent both FDG-PET and upper gastrointestinal endoscopy during September 2008 to December 2009. Quantitative analysis of FDG uptake in the distal part of the esophagus was performed by calculating the maximum standard uptake value (SUVmax). This indicated the degree of esophagitis. FDG-PET findings were compared with endoscopic (modified version of the Los Angeles classification) diagnoses as the gold standard. Results. The SUVmax ranged from 1.30 to 3.40 in normal subjects and from 1.30 to 4.00 in subjects with gastroesophageal reflux esophagitis. In the esophagitis group, the SUVmax was 2.13 ± 0.42 in subjects with modified LA grade M, 2.21 ± 0.45 in subjects with LA grade A, and 2.48 ± 0.44 in subjects with LA grade B and C gastroesophageal reflux esophagitis. One-way ANOVA and post-hoc comparison with Bonferroni correction (P value = 0.003) identified statistical differences between the three groups. Conclusion. Noninvasive FDG-PET may be useful in the detection and evaluation of various degrees of gastroesophageal reflux esophagitis.

Profiling lipid-protein interactions using nonquenched fluorescent liposomal nanovesicles and proteome microarrays

Fluorescent liposomal nanovesicles (liposomes) are commonly used for lipid research and/or signal enhancement. However, the problem of self-quenching with conventional fluorescent liposomes limits their applications because these liposomes must be lysed to detect the fluorescent signals. Here, we developed a nonquenched fluorescent (NQF)1 liposome by optimizing the proportion of sulforhodamine B (SRB) encapsulant and lissamine rhodamine B-dipalmitoyl phosphatidylethanol (LRB-DPPE) on a liposomal surface for signal amplification. Our study showed that 0.3% of LRB-DPPE with 200 μm of SRB provided the maximal fluorescent signal without the need to lyse the liposomes. We also observed that the NQF liposomes largely eliminated self-quenching effects and produced greatly enhanced signals than SRB-only liposomes by 5.3-fold. To show their application in proteomics research, we constructed NQF liposomes that contained phosphatidylinositol 3,5-bisphosphate (PI(3,5)P2) and profiled its protein interactome using a yeast proteome microarray. Our profiling led to the identification of 162 PI(3,5)P2-specific binding proteins (PI(3,5)P2-BPs). We not only recovered many proteins that possessed known PI(3,5)P2-binding domains, but we also found two unknown Pfam domains (Pfam-B_8509 and Pfam-B_10446) that were enriched in our dataset. The validation of many newly discovered PI(3,5)P2-BPs was performed using a bead-based affinity assay. Further bioinformatics analyses revealed that the functional roles of 22 PI(3,5)P2-BPs were similar to those associated with PI(3,5)P2, including vesicle-mediated transport, GTPase, cytoskeleton, and kinase. Among the 162 PI(3,5)P2-BPs, we found a novel motif, HRDIKP[ES]NJLL that showed statistical significance. A docking simulation showed that PI(3,5)P2 interacted primarily with lysine or arginine side chains of the newly identified PI(3,5)P2-binding kinases. Our study showed that this new tool would greatly benefit profiling lipid-protein interactions in high-throughput studies.

Shorter-time dual-phase FDG PET/CT in characterizing solid or ground-glass nodules based on surgical results

OBJECTIVES

We compared the accuracy of shorter-time dual-phase (18)F-FDG PET/CT in evaluating 94 different lung nodules classified as solid or ground-glass nodules (GGNs).

MATERIALS AND METHODS

Early and delayed maximum standardized uptake values (SUV(max)) as well as the retention index (RI) of each nodule were determined in 75 solid nodules and 19 GGNs.

RESULTS

In solid nodules, early SUV(max), delayed SUV(max), and RI were higher in malignant than in benign lesions. In GGNs, these values were not significantly lower in the malignant than in the benign lesions.

CONCLUSION

In the patient group with solid nodules, shorter-time dual-phase (18)F-FDG PET/CT could significantly differentiate the malignant from the benign ones.

Two-dimensional PPLN for simultaneous laser Q-switching and optical parametric oscillation in a Nd:YVO4 laser

We report on a tunable intracavity optical parametric oscillator (IOPO) achieved using a two-dimensional (2D) periodically poled lithium niobate (PPLN) as simultaneously an electro-optic (EO) Bragg Q-switch and an optical frequency mixer (OFM) in a diode-pumped Nd:YVO(4) laser. The 2D periodic domain inversion structure is designed to provide two orthogonal reciprocal vectors to respectively satisfy the phase-matching conditions required by the two quasi-phase-matching devices (i.e., the PPLN EO Bragg deflector and the PPLN OFM). At a ~140-V Q-switching voltage and a 1-kHz switching rate, we obtained a signal wave at 1550 nm with a pulse energy of 9.7 μJ (corresponding to a peak power of ~2.4 kW) from the IOPO at 9.1-W diode pump power. Simultaneously we also observed multi-wavelength generation from the system originating in the single-pass parametric conversions in the 2D nonlinear photonic crystal structure. Temperature tuning of the IOPO signal wavelength in the eye-safe region was also demonstrated.

Protein acetylation and aging

Our results suggest the possible benefit of manipulating an intrinsic aging pathway that is independent of nutrition availability, a potential therapeutic route that might be able to bypass shortcomings of calorie restriction.

Recent Chlamydia pneumoniae infection is highly associated with active ankylosing spondylitis in a Chinese cohort

OBJECTIVE

The aim of the present study was to investigate the presence of anti-Chlamydia pneumoniae (Cp) antibodies in patients with ankylosing spondylitis (AS) to determine whether there is an association with AS disease activity.

METHODS

Seventy-nine AS outpatients and 73 normal controls were enrolled in this case-control study. Serum anti-Cp immunoglobulins (CpIg) were detected by enzyme-linked immunosorbent assay (ELISA). Antibodies to Epstein-Barr virus (EBV), cytomegalovirus (CMV), and Chlamydia trachomatis (Ct) were also measured. Clinical and experimental data were collected, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was determined. Patients with positive Cp IgM or Cp IgA were considered to have had a recent Cp infection.

RESULTS

Cp IgG was detected in the majority of AS patients and also controls (88.8% vs. 91.8%, respectively). The seroprevalence of Cp IgA and Cp IgM was significantly higher in AS patients than in the controls (51.9% vs. 31.5%, p = 0.010 for Cp IgA; 79.7% vs. 20.5%, p < 0.0001 for Cp IgM). Seropositivity of Cp IgM was associated with elevation of the disease activity index, including erythrocyte sedimentation rate (ESR; p = 0.021), C-reactive protein (CRP; p = 0.007) and the BASDAI (p = 0.009). Persistent positive Cp IgM was associated with active disease, while seroreversion of Cp IgM was associated with a reduction in these disease activity indices. There was no correlation between Cp IgM or Cp IgA and symptomatic upper respiratory infections or other clinical manifestations.

CONCLUSIONS

Recent Cp infections occur frequently in AS patients and Cp IgM antibody is correlated with active disease. These findings indicate that Cp infections may be a triggering factor for active AS.

Effects of mechanical stimuli on the synthesis of superficial zone protein in chondrocytes

Superficial zone protein (SZP) has been demonstrated to contribute to the boundary lubrication in synovial joints. This study was designed to clarify the modulation of SZP expression by mechanical stress in articular chondrocytes. Cyclic tensile strains of 7 and 21% cell elongation were applied to cultured chondrocytes obtained from porcine mandibular condylar cartilage. The mRNA levels of SZP, IL-1 beta, and TGF-beta1 were examined by a quantitative real-time PCR analysis. Protein level of SZP was examined by Western blotting. The SZP mRNA level was significantly upregulated after 12, 24, and 48 h by 7% elongation. Although SZP mRNA level was upregulated by 21% elongation after 12 h, it decreased to a lower level than the control after 48 h. The TGF-beta1 mRNA level exhibited an almost similar change to SZP. The IL-1 beta mRNA level was not changed markedly by 7% elongation. However, the IL-1 beta mRNA level was significantly increased by a 12-h application of 21% elongation. Western blot analysis revealed that the SZP expression was increased by 7% elongation, but decreased remarkably by 21% elongation. It is suggested from these findings that the SZP expression level in the chondrocytes is enhanced by optimal mechanical stimuli, but inhibited by excessive loading partly affected by TGF-beta1 and IL-1 beta, leading to the deterioration of joint lubrication.

Fiber-laser-pumped CW OPO for red, green, blue laser generation

We report a CW, watt-level, red, green, and blue (RGB) laser pumped by an economical multimode (1-nm linewidth) Yb-fiber laser at 1.064 mum. A singly resonant optical parametric oscillator at 1.56 mum has two intracavity sum-frequency generators for red and blue laser generation. An extracavity second harmonic generator converts the residual pump power into green laser radiation. At 25-W pump power, the laser generated 3.9, 0.456, and 0.49 W at 633, 532, and 450 nm, respectively. The multimode pump laser offers a large temperature bandwidth for operating the RGB OPO without the need of a precision crystal temperature stabilizer.

Thermal waveguide OPO

We report a mid-infrared, CW singly resonant optical parametric oscillator (OPO) with a thermally induced waveguide in its gain crystal. We measured a numerical aperture of 0.0062 for the waveguide at 80-W intracavity power at 3.2 microm. This thermal-guiding effect benefits to the stable operation of an OPO and improves the parametric conversion efficiency by more than a factor of two when compared with that without thermal guiding.

Desmosine as a biomarker of elastin degradation in COPD: current status and future directions

Desmosine (DES) and isodesmosine (IDES) are two unusual, tetrafunctional, pyridinium ring-containing amino acids involved in elastin cross-linking. Being amino acids unique to mature, cross-linked elastin, they are useful for discriminating peptides derived from elastin breakdown from precursor elastin peptides. According to these features, DES and IDES have been extensively discussed as potentially attractive indicators of elevated lung elastic fibre turnover and markers of the effectiveness of agents with the potential to reduce elastin breakdown. In the present manuscript, immunology-based and separation methods for the evaluation of DES and IDES are discussed, along with studies reporting increased levels of urine excretion in chronic obstructive pulmonary disease (COPD) patients with and without alpha(1)-antitrypsin deficiency. The results of the application of DES and IDES as surrogate end-points in early clinical trials in COPD are also reported. Finally, recent advances in detection techniques, including liquid chromatography tandem mass spectrometry and high-performance capillary electrophoresis with laser-induced fluorescence, are discussed. These techniques allow detection of DES and IDES at very low concentration in body fluids other than urine, such as plasma or sputum, and will help the understanding of whether DES and IDES are potentially useful in monitoring therapeutic intervention in COPD.

The robotic radiosynthesis of 5-[(18)F]fluoro-2'-deoxyuridine and its biological characterization

5-[(18)F]fluoro-2'-deoxyuridine ([(18)F]FUdR) was synthesized using a robotic system as a proliferation probe for PET. [(18)F]FUdR was prepared via radiofluorodestannylation reaction from its organotin precursor. Biodistribution study and microPET imaging of [(18)F]FUdR in NG4TL4 sarcoma-bearing FVB/n mice were performed. The tumor-to-blood and tumor-to-muscle ratio increased steadily from 15 (1.81 and 3.42) to 120min (9.10 and 11.9) post injection. The dynamic microPET imaging demonstrates remarkable radioactivity retention in the tumor, which is consistent with the results of biodistribution study.

Observation of thermal-induced optical guiding and bistability in a mid-IR continuous-wave, singly resonant optical parametric oscillator

We report the observation of thermal-induced optical guiding and bistability in a mid-IR cw, singly resonant optical parametric oscillator (SRO) at approximately 3.2 microm. The SRO employs a MgO:PPLN crystal as the gain medium and a 1-nm-linewidth Yb-fiber laser at 1.064 microm as the pump source. As soon as the pump power reaches the thermal guiding threshold at 16.5 W, the SRO shows a step increase in the parametric efficiency by a factor of 2.5. At 25 W pump power, the SRO generated 5.3 and 1.2 W at 1.58 and 3.23 microm, respectively, with single-longitudinal-mode performance for the 3.23 microm radiation.

Low-threshold, narrow-line THz-wave parametric oscillator with an intra-cavity grazing-incidence grating

We report a low-threshold, narrow-line THz-wave parametric oscillator with an intra-cavity grazing-incidence grating and a 1-mm thick, 45-mm long lithium-niobate planar waveguide. When pumped by an actively Q-switched Nd:YAG laser, the threshold energy and intensity of the parametric oscillator were about 2.2 mJ and 70 MW/cm(2), respectively. The linewidths of the output THz wave were 12 and 134 GHz with and without the intra-cavity grating, respectively.

Forward and backward terahertz-wave difference-frequency generations from periodically poled lithium niobate

We report terahertz-wave generation in the wavelength range of 190 - 210 and 457 - 507 microm from forward and backward difference frequency generations, respectively, in a 3.2-cm long multi-grating periodically poled lithium niobate (PPLN) crystal. The grating period of the PPLN crystal varies form 63 to 70 microm in 1-microm increments. The extraordinary refractive index of lithium niobate in the THz-wave range was precisely deduced from the quasi-phase-matching condition of the difference frequency generations.

Monolithically integrated laser Bragg Q-switch and wavelength converter in a PPLN crystal

We report a periodically poled lithium niobate (PPLN) crystal for both temperature-insensitive laser Q-switching and temperature-tuned wavelength conversion. The PPLN crystal consists of two sections, a 20.3-mum period section functioning as an electro-optic Bragg grating for Qswitching a diode-pumped Nd:YVO4 laser at 1064 nm and a 31-mum-period section functioning as an optical parametric generator for down converting the generated 1064-nm laser. When driving the PPLN Bragg grating with 170-V voltage pulses, we measured 181 muJ pulse energy at 1064 nm from the Nd:YVO4 laser pumped by 20.4 W diode power. The 181-muJ pulsed laser was further converted into mid-infrared radiation in the monolithic PPLN crystal with 35% parametric efficiency. The wavelengths were broadly tunable in the range of 1.75-1.88 mum (signal) and 2.7-2.44 mum (idler) via temperature without affecting the performance of the PPLN Bragg Qswitch.

Functional dissection of a HECT ubiquitin E3 ligase

Ubiquitination is one of the most prevalent protein post-translational modifications in eukaryotes, and its malfunction is associated with a variety of human diseases. Despite the significance of this process, the molecular mechanisms that govern the regulation of ubiquitination remain largely unknown. Here we used a combination of yeast proteome chip assays, genetic screening, and in vitro/in vivo biochemical analyses to identify and characterize eight novel in vivo substrates of the ubiquitinating enzyme Rsp5, a homolog of the human ubiquitin-ligating enzyme Nedd4, in yeast. Our analysis of the effects of a deubiquitinating enzyme, Ubp2, demonstrated that an accumulation of Lys-63-linked polyubiquitin chains results in processed forms of two substrates, Sla1 and Ygr068c. Finally we showed that the localization of another newly identified substrate, Rnr2, is Rsp5-dependent. We believe that our approach constitutes a paradigm for the functional dissection of an enzyme with pleiotropic effects.