Structure characterization and immunomodulatory activity of a polysaccharide from Saposhnikoviae Radix

A new polysaccharide, named SP800201 with Mw of 2.17 × 10⁵ g/mol, was isolated from Saposhnikoviae Radix. The monosaccharide composition of SP800201 mainly contained Gal, GalA, Ara, and Rha. SP800201 has a core structure containing GalA as the backbone and side chains consisting of GalA, Gal, Ara and Rha. Cell and zebrafish experiments were used to explore the immunomodulatory activity of SP800201. Results of vitro RAW264.7 cell experiments showed that SP800201 could significantly improve the proliferation and phagocytosis of macrophages, and promote the release of NO, TNF-α, IL-1β, and IL-6. Results of vivo experiments in immunocompromised zebrafish showed that SP800201 could also significantly increase the density of immune cells, the number of macrophages, and reduce NO, TNF-α, IL-1β, and IL-6. The above results showed that the Saposhnikoviae Radix polysaccharide has certain immunomodulatory activity.

Chemical Constituents of Gentiana Macrophylla Pall. From Shaanxi

A novel amide, qinjiaoamide and a novel iridoid, erythrocentaurin acid, together with seven known compounds [erythrocentaurin (3), roburic acid (4), oleanolic acid (5), gentiopicroside (6), swertiamarine (7), sweroside (8), and 6′-O-β-D-glucosylgentiopicroside (9)], were isolated from the root of Gentiana macrophylla Pall. from Shaanxi Province, China. The novel compounds were identified as N-pentacosyl-2-carboxy-benzoyl amide (1) and 5-carboxyl-3,4-dihydrogen-1H-2-benzopyran-1-one (2), on the basis of spectroscopic (UV, IR, 1D- and 2D-NMR) and mass spectrometric data. Among the known compounds, erythrocentaurin (3) was isolated from the genus Gentiana for the first time.

A systematic review of the relationship between the distributions of aggrecan gene VNTR polymorphism and degenerative disc disease/osteoarthritis

Objectives

Degenerative disc disease (DDD) and osteoarthritis (OA) are relatively frequent causes of disability amongst the elderly; they constitute serious socioeconomic costs and significantly impair quality of life. Previous studies to date have found that aggrecan variable number of tandem repeats (VNTR) contributes both to DDD and OA. However, current data are not consistent across studies. The purpose of this study was to evaluate systematically the relationship between aggrecan VNTR, and DDD and/or OA.

Methods

This study used a highly sensitive search strategy to identify all published studies related to the relationship between aggrecan VNTR and both DDD and OA in multiple databases from January 1996 to December 2016. All identified studies were systematically evaluated using specific inclusion and exclusion criteria. Cochrane methodology was also applied to the results of this study.

Results

The final selection of seven studies was comprehensively evaluated and includes results for 2928 alleles. The most frequent allele among all the studies was allele 27. After comparing the distributions of each allele with others, statistically significant differences have been found in the distribution of the alleles by the two groups, with an over-representation of allele (A)21 (disease: 3.22%, control: 0.44%). Thus, carrying A21 increased the risk of DDD. Such an association was not found to be statistically significant when considering the risk of OA.

Conclusions

The findings suggest that VNTR A21 seems to be associated with higher risk to DDD, however, such an association may not be statistically significant regarding the risk of OA.

Cite this article: L. Cong, G. Tu, D. Liang. A systematic review of the relationship between the distributions of aggrecan gene VNTR polymorphism and degenerative disc disease/osteoarthritis. Bone Joint Res 2018;7:308–317. DOI: 10.1302/2046-3758.74.BJR-2017-0207.R1

Structurally Diverse Cytotoxic Dimeric Chalcones from Oxytropis chiliophylla

Ten isomeric cyclobutane- and cyclohexene-containing chalcone dimers, oxyfadichalcones A-G, were isolated from the aerial parts of Oxytropis chiliophylla. These included six new compounds and three pairs of enantiomers that are being reported from natural sources for the first time. The relative configurations were elucidated by spectroscopic data analysis, while the absolute configurations were determined by comparing the experimental and calculated electronic circular dichroism spectra. Quantitative LC-MS analysis of the main dimers from different parts of the plant revealed their characteristic accumulation in the viscous secretion and provided supporting evidence for the hypothesized photochemical biosynthesis. In addition, the cytotoxic activities of all isolates against the PC-3 human prostate cancer cell line are reported.

Tempering-Drying Simulation and Experimental Analysis of Corn Kernel

In order to study the effect of corn kernel composition and physical structure on moisture distribution and transfer process and obtain the optimal tempering-drying parameters of corn kernel, a physical model was constructed with four different components as follows: seed coat, horny endosperm, farinaceous endosperm and embryo. The drying model was established based on the assumption of different diffusion coefficients and same thermal conductivity for the four components. The software of COMSOL Multiphysics was used to simulate the heat and mass transfer process inside the corn kernel during the thin-layer drying. The results showed that the least total drying time and the best drying quality were achieved under the multistage circulating drying of 10 min hot air drying and 60 min tempering, and the tempering degree was up to 0.9207.

A bioinformatic analysis of microRNAs role in osteoarthritis

OBJECTIVE

To evaluate the underlying function of microRNAs (miRNAs) in osteoarthritis (OA).

DESIGN

A bioinformatic analysis of miRNAs-OA studies was completed in multiple databases. All identified articles were assessed using specific inclusion and exclusion criteria (Eligible case-control studies for the present study included those which investigated miRNAs differential expression in cartilage tissues and cells of OA and controls. Abstracts, case reports, conference presentations, editorials, and expert opinions were excluded.). We performed bioinformatic analysis and assessed which miRNAs are commonly elevated or decreased in cartilage of OA, and assessed putative targets of these miRNAs using TargetScan, Database for Annotation, Visualization and Integrated Discovery (DAVID), FunRich and String.

RESULTS

Fifty seven studies were included in this study. Our current review has identified 46 differentially expressed miRNAs involved in autophagy, inflammation, chondrocyte apoptosis, chondrocyte differentiation & homeostasis, chondrocyte metabolism and degradation of the extracellular matrix (ECM). Additionally, our literature search identified a wide range of miRNAs that have been shown to be differentially expressed in OA. The function of up-regulated miRNAs primarily target nucleus, whereas the function of down-regulated miRNAs primarily target transcription.

CONCLUSIONS

Comprehensive analysis of all miRNAs studies reveals cooperation in miRNA signatures and suggests that there may be two biologically synergic classes of miRNAs that are associated with OA. This finding suggests that miRNAs may be useful as diagnostic biomarkers and/or may provide new therapeutic targets in OA. Furthermore, a better understanding of the targets of these miRNAs will accelerate biomedical discoveries and improve clinical care based on new knowledge of OA-related disease mechanisms.

Association of endothelin-1 gene polymorphisms with essential hypertension in a Chinese population

Endothelin-1 (ET-1) is the most potent endogenous vasoconstrictor and is involved in several vascular disorders such as hypertension. Its strong interaction with other vasoactive hormone systems suggests that the ET-1 gene (EDN1) is a potential candidate molecule that influences the risk of developing hypertension. Recently, two single nucleotide polymorphisms in EDN1 have been reported to be associated with hypertension: Lys198Asn and 3A/4A (-134delA) located in the 5'-untranslated region. To determine the association of these two polymorphisms with hypertension, we genotyped patients and controls (N = 537) and compared the allele and genotype frequencies between groups. There was no significant difference in the genotype frequencies of these two polymorphisms between healthy controls and hypertension patients. Although previous reports have revealed a significant interaction between the END1 Lys198Asn (G/T) polymorphism and body mass index in association with hypertension, no such relationship was observed in the present study. Further, we compared blood pressure among hypertensive subjects and observed that neither systolic nor diastolic blood pressure was significantly associated with variations in the genotypes of the two single nucleotide polymorphisms. In summary, these two END1 polymorphisms do not appear to affect the development of hypertension in the Chinese population.

High-flow Nasal Cannula Versus Noninvasive Ventilation for Treatment of Acute Hypoxemic Respiratory Failure in Renal Transplant Recipients

OBJECTIVE

This study aimed to evaluate the outcomes of high-flow nasal cannula (HFNC) oxygen therapy compared with noninvasive ventilation (NIV) for the treatment of acute hypoxemic respiratory failure in renal transplant recipients.

METHODS

Data were retrospectively collected from a tertiary intensive care unit (ICU) from July 1, 2011, to September 31, 2015. All renal recipients who had acute respiratory failure at that period of time were classified into the HFNC or NIV group depending on the initial form of respiratory support.

RESULTS

A total of 38 patients were enrolled in this study. Twenty patients received HFNC and the other 18 received NIV as the initial respiratory support. The ICU mortality in the HFNC group was 5% (1 patient), compared with 22.2% (4 patients) in the NIV group (P = .083). The median length of the ICU stay was 12 days in the HFNC group, compared with 14 days in the NIV group (P = .297). The number of ventilator-free days at day 28 was significantly higher in the HFNC group than in the NIV group (26 ± 3 vs 21 ± 3; P < .001). The incidences of both pneumothorax (0% vs 22.2%; P = .042) and skin breakdown (0% vs 22.2%; P = .042) were significantly lower in the HFNC group.

CONCLUSIONS

In renal transplant recipients with acute hypoxemic respiratory failure secondary to severe pneumonia, HFNC achieved outcomes similar to NIV. In addition, HFNC was associated with an increased number of ventilator-free days at day 28 and fewer complications.

Cytoplasmic GPER translocation in cancer-associated fibroblasts mediates cAMP/PKA/CREB/glycolytic axis to confer tumor cells with multidrug resistance

Multiple drug resistance is a challenging issue in the clinic. There is growing evidence that the G-protein-coupled estrogen receptor (GPER) is a novel mediator in the development of multidrug resistance in both estrogen receptor (ER)-positive and -negative breast cancers, and that cancer-associated fibroblasts (CAFs) in the tumor microenvironment may be a new agent that promotes drug resistance in tumor cells. However, the role of cytoplasmic GPER of CAFs on tumor therapy remains unclear. Here we first show that the breast tumor cell-activated PI3K/AKT (phosphoinositide 3-kinase/AKT) signaling pathway induces the cytoplasmic GPER translocation of CAFs in a CRM1-dependent pattern, and leads to the activation of a novel estrogen/GPER/cAMP/PKA/CREB signaling axis that triggers the aerobic glycolysis switch in CAFs. The glycolytic CAFs feed the extra pyruvate and lactate to tumor cells for augmentation of mitochondrial activity, and this energy metabolically coupled in a 'host-parasite relationship' between catabolic CAFs and anabolic cancer cells confers the tumor cells with multiple drug resistance to several conventional clinical treatments including endocrine therapy (tamoxifen), Her-2-targeted therapy (herceptin) and chemotherapy (epirubicin). Moreover, the clinical data from 18F-fluorodeoxyglucose positron emission tomography/computed tomography further present a strong association between the GPER/cAMP/PKA/CREB pathway of stromal fibroblasts with tumor metabolic activity and clinical treatment, suggesting that targeting cytoplasmic GPER in CAFs may rescue the drug sensitivity in patients with breast cancer. Thus, our data define novel insights into the stromal GPER-mediated multiple drug resistance from the point of reprogramming of tumor energy metabolism and provide the rationale for CAFs as a promising target for clinical therapy.

Genome-wide analysis of chitinase genes and their varied functions in larval moult, pupation and eclosion in the rice striped stem borer, Chilo suppressalis

Some insect chitinases are required to degrade chitin and ensure successful metamorphosis. Although chitinase genes have been well characterized in several model insects, no reports exist for the rice striped stem borer, Chilo suppressalis, a highly destructive pest that causes huge yield losses in rice production. Here, we conducted a genome-level analysis of chitinase genes in C. suppressalis. After amplification of full-length transcripts with rapid amplification of cDNA ends, we identified 12 chitinase genes in C. suppressalis. All these genes had the conserved domains and motifs of glycoside hydrolase family 18 and grouped phylogenetically into five subgroups. C. suppressalis chitinase 1 (CsCht1) was highly expressed in late pupae, whereas CsCht3 was abundant in early pupae. Both CsCht2 and CsCht4 were highly expressed in larvae. CsCht2 was abundant specifically in the third-instar larvae and CsCht4 showed periodic high expression in 2- to 5-day-old larvae in each instar. Tissue specific expression analysis indicated that CsCht1 and CsCht3 were highly expressed in epidermis whereas CsCht2 and CsCht4 were specifically abundant in the midgut. Knockdown of CsCht1 resulted in adults with curled wings, indicating that CsCht1 might have an important role in wing expansion. Silencing of CsCht2 or CsCht4 arrested moulting, suggesting essential roles in larval development. When the expression of CsCht3 was interfered, defects in pupation occurred. Overall, we provide here the first catalogue of chitinase genes in the rice striped stem borer and have elucidated the functions of four chitinases in metamorphosis.

Structure elucidation of a sodium salified anthraquinone from the seeds of Cassia obtusifolia by NMR technique assisted with acid-alkali titration

A new sodium salt of anthraquinone named sodium emodin-1-O-β-gentiobioside, together with nine known compounds, viz. rubrofusarin-6-O-β-D-gentiobioside, chrysophanol-1-O-β-D-glucopyranosyl-(1-3)-β-D-glucopyranosyl-(1-6)-β-D-glucopyranoside, obtusifolin-2-O-β-D-glucopyranoside, aurantio-obtusin-6-O-β-D-glucopyranoside, physcion-8-O-β-D-glucopyranoside, 1-hydroxyl-2-acetyl-3,8-dimethoxy-6-O-β-D-apiofuranosyl-(1-2)-β-D-glucosylnaphthalene, toralactone-9-O-β-D-gentiobioside, aurantio-obtusin, rubrofusarin-6-O-β-D-apiofuranosyl-(1-6)-O-β-D-glucopyranoside, was isolated from the seeds of Cassia obtusifolia and its structure was elucidated by (1)H and (13)C NMR technique assisted with acid-alkali titration. The change of chemical shifts of sodium emodin-1-O-β-gentiobioside before and after acid-alkali titration was also characterized.

Phenylpropanoyl esters from Horseweed (Conyza canadensis) and their inhibitory effects on catecholamine secretion

Three unique phenylpropanoyl 2,7-anhydro-3-deoxy-2-octulosonic acid derivatives were isolated from Conyza canadensis (horseweed). Their structures were defined as rel-(1S,2R,3R,5S,7R)-methyl 7-caffeoyloxymethyl-2-hydroxy-3-feruloyloxy-6,8-dioxabicyclo[3.2.1]octane-5-carboxylate (1), rel-(1S,2R,3R,5S,7R)-methyl 7-feruloyloxymethyl-2-hydroxy-3-feruloyloxy-6,8-dioxabicyclo[3.2.1]octane-5-carboxylate (2), and rel-(1R,2R,3R,5S,7R)-methyl 7-feruloyloxymethyl-2-feruloyloxy-3-hydroxy-6,8-dioxabicyclo[3.2.1]octane-5-carboxylate (3). Compound 1 and a 5:3 mixture of compounds 2 and 3 were demonstrated to inhibit the catecholamine secretion induced by acetylcholine with IC(50) values of 94.65 and 42.35 microM, respectively, and to inhibit the catecholamine secretion induced by veratridine and high [K(+)] at a dose of 100 microM in cultured bovine adrenal medullary cells.

The correlation between GPR30 and clinicopathologic variables in breast carcinomas

The G-protein-coupled-receptor 30 (GPR30) is a new membrane estrogen receptor. The aim of the present study was to determine the correlations among GPR30, ERalpha, PR, C-erbB-2, p53, TNM stage, and pathologic grade in breast carcinomas. Two hundred forty-one biopsy specimens were evaluated with immunohistochemical assays, and then correlations were analyzed. Low negative correlations of GPR30 with ERalpha (r = -0.144, P<0.05) and PR (r = -0.214, P<0.01) were observed. Associations of GPR30 with C-erbB-2, p53, TNM stage, and pathologic grade were not confirmed. These findings indicated that GPR30 might be an independent prognostic factor in breast carcinomas.

A new 5,11-epoxymegastigmane glucoside from Acanthus ilicifolius

From a China mangrove plant Acanthus ilicifolius Linn., a new compound, 5,11-epoxymegastigmane glucoside (1) was isolated along with one known compound of megastigmane glucosides, (6S, 9S)-roseoside (2). The structure of compound 1 was determined on the basis of 1D- and 2D-NMR techniques (DEPT, COSY, HMBC, HMQC, NOESY) and HR-FABMS. The structure of 1 was established as (1S, 3S, 5R, 6R, 7E)-5,11-epoxy-3-hydroxymegastigman-7-en-9-one-3-O-beta-D-glucopyranoside.

Three new phenolic glycosides from the caulis of Millettia speciosa

Three new phenolic glycosides, millettiaspecosides A--C (1-3), were isolated from the caulis of Millettia speciosa along with three known phenolic glycosides, khaephuoside B (4), seguinoside K (5), albibrissinoside B (6). Their structures were established by spectroscopic methods. The spectral analysis permitted correct assignments for (1)H and (13)C NMR data of compounds 4 and 5.

A Pair of Diastereoisomeric Steroidal Saponins from Cytotoxic Extracts of Tupistra chinensis Rhizomes

A pair of diastereoisomeric steroidal saponins were obtained from the saponin fraction (SF) of methanol extracts from Tupistra chinensis rhizomes, collected in Shennongjia Forest District, China. Based on the chemical and spectroscopic evidences, their structures were determined as shown in Fig. 1. The sample SF displayed marked inhibitory action in vitro towards HeLa and HL-60 cancer cell lines at 10 microg/ml by MTT method.

Microbial hydroxylation of bufalin by Cunninghamella blakesleana and Mucor spinosus

The microbial transformation of a cytotoxic bufadienolide, bufalin (1), was carried out using two strains of filamentous fungi. Cunninghamella blakesleana catalyzed the specific 12alpha-hydroxylation of bufalin and produced 12alpha-hydroxybufalin (2) and 7beta,12alpha-dihydroxybufalin (3) as the major metabolites, together with 7beta-hydroxybufalin (4) and 12beta-hydroxybufalin (5) in low yields. Two minor products were isolated from the culture broth of Mucor spinosus and were identified as 7beta,15alpha-dihydroxybufalin (6) and 5beta,7beta-dihydroxybufalin (7), respectively. Metabolites 2, 3, 6, and 7 are new compounds, and their structures were fully characterized by NMR and MS spectroscopy.

Structural determination of novel terpenes from Buddleia lindleyana

Three novel terpenes, named buddlindeterpene A, B and C, were isolated from Buddleia lindleyana Fort. The complete 1H and 13C NMR assignments of the three compounds were carried out by using DEPT, COSY, HMQC and HMBC techniques. The stereochemistry of 1 and 3 was confirmed by single-crystal x-ray diffraction analysis.

Cimidahuside 1 and 2, two new cyclolanostanol xylosides from the aerial parts of Cimicifuga dahurica

Cimidahuside 1 and 2, two new cyclolanostanol xylosides were isolated from the aerial parts of Cimicifuga dahurica (Turcz.) MAXIM, on the basis of spectral data and chemical evidences, their structures were determined to be (20R,24R)-24,25-epoxy-3-beta-(beta-D-xylopyranosyloxy)-9,19-cyclolanost-7-ene-16,23-dione (1), and (20R,24R)-24,25-epxy-15-alpha-hydroxy-3-beta-((bet-D-xylpyranosyoxy)-9,19-cyclanost-7-ene-16,23-dione (2), respectively.

A new steroidal saponin from Dioscorea zingiberensis Wright

Two compounds were obtained from the rhizome of Dioscorea zingiberensis Wright. One of them was elucidated as dioscin, the other one was a new compound and characterized as Spirost-5-en-3-yl beta-D-glucopyranosyl (1 --> 3)-beta-D-glucopyranosyl (1 --> 4)-[alpha-L-rhamnopyranosyl (1 --> 2)]-beta-D-glucopyranoside, structure was determined on the basis 2D NMR spectroscopic technique and the result of acid hydrolysis.

New triterpenoid saponins from Stelmatocrypton khasianum

Four new triterpenoid saponins, designated as stelmatotriterpenosides E-H (1-4), together with three known compounds, asterbatanoside B (5), 2alpha,3beta,19alpha,23-tetrahydroxy-olean-12-en-28-oic acid-3-O-beta-D-glucopyranosyl-28-O-beta-D-glucopyranosyl ester (6) and 2alpha,3beta,19alpha,23-tetrahydroxy-urs-12-en-28-oic acid-3-O-beta-D-glucopyranosyl-28-O-beta-D-glucopyranosyl ester (7), were isolated from the stems of Stelmatocrypton khasianum. On the basis of chemical and spectral evidence, the structures of 1-4 were established as 2alpha,3beta,23-trihydroxy-olean-12-en-28-oic acid-3-O-beta-D-glucopyranosyl-28-O-beta-D-glucopyranosyl-(1-->6)-beta-D-glucopyranosyl ester (1), 2alpha,3beta,23-trihydroxy-urs-12-en-28-oic acid-3-O-beta-D-glucopyranosyl-28-O-beta-D-glucopyranosyl-(1-->6)-beta-D-glucopyranosyl ester (2), 2alpha,3beta,19alpha-trihydroxy-urs-12-en-28-oic acid-3-O-beta-D-glucopyranosyl-28-O-beta-D-glucopyranosyl-(1-->2)-beta-D-glucopyranosyl ester (3), and 2beta,3beta,19alpha-trihydroxy-urs-12-en-24,28-dioic acid-24-O-beta-D-glucopyranosyl-28-O-beta-D-glucopyranosyl diester (4).

Two new cyclolanostanol xylosides from the aerial parts of Cimicifuga dahurica

From the aerial parts of Cimicifuga dahurica, two new cyclolanostanol xylosides, cimilactone A (1) and cimilactone B (2), and three known compounds were isolated. On the basis of spectral and chemical evidence, the structures of 1 and 2 were determined to be 12beta-acetoxy-3beta-O-D-xylopyranosyloxy-24,25,26,27-tetranor-9,19-cyclolanost-16,23-lactone (1) and 12beta-acetoxy-3beta-O-D-xylopyranosyloxy-24,25,26,27-tetranor-9,19-cyclolanost-7-ene-16,23-lactone (2). The known compounds were identified as cimigenol 3-O-beta-D-xylopyranoside, 23-O-acetylshengmanol-3-O-beta-D-xylopyranoside, and 25-O-acetylcimigenol-3-O-beta-D-xylopyranoside, respectively.

A new steroidal saponin from Tribulus terrestris Linn

A new steroidal saponin containing six monosaccharides was obtained from the total plant of Tribulus terrestris and elucidated based on chemical spectroscopic analysis, especially on 2D-NMR technology as 26-0-beta-D-glucopyranosyl-22-methoxy-furostane-3-O-[beta-D-xylopyranosyl(l --> 3)-[beta-D-xylopyranosyl(l --> 2)-beta-D-glucopyranosyl(1 --> 4)]]-[alpha-L-rhamnopyranosy(l --> 2)]-beta-D-galactopyranoside.

[A new saikosaponin from Bupleurum chinense DC]

Bupleurum chinense DC. is a well-known and very important traditional Chinese drug. It is often used to treat common cold with fever, alternating chill and fever, feeling of fullness and oppression in the chest. A new saikosaponin was isolated from Bupleurum chinense DC. and its structure was identified as 3-O-[beta-D-glucopyranosyl (1-->3)-beta-D-fucopyranosyl]-3 beta, 16 alpha, 23, 28-tetrahydroxy-olean-11, 13 (18)-dien-30-oic acid 30-O-[xylityl(1-->1)]-beta-D-glucopyranosyl-6-ester on the basis of chemical and spectral evidence. In addition, three known saikosaponins were isolated and characterized as saikosaponin 1, 2"-O-acetyl-saikosaponin b2 and 2"-O-acetyl-saikosaponin a. All the compounds were isolated from Bupleurum chinense DC. for the first time.

The value of a hospitalist service: efficient care for the aging population?

BACKGROUND

We studied patients of a hospitalist teaching service and patients receiving routine private care (control subjects). We sought to evaluate whether inpatients cared for by an academic hospitalist service had lower lengths of stay and resource utilization rates.

METHODS

Using monthly hospital census data, 477 hospitalist cases and 1,160 control cases were selected by explicit criteria from the Medicaid population of a large, university-affiliated, community medical center between July 1, 1996, and June 30, 1997. Outcomes in hospitalist faculty patients were compared to those of control patients under the care of private providers.

RESULTS

Median length of stay was 4 days for control subjects and 3 days for the hospitalist service (p < 0.0001). Median total cost per case was $4,853 for control subjects and $4,002 for hospitalist patients (p < 0.0001). Only patients > or = 65 years old showed statistically significant reductions in both length of stay (p < 0.0001) and total cost (p = 0.002). Subspecialty consultation rates were 37.6% for control subjects and 16.6% for hospitalist cases (p < 0.0001). We noted increasing consultations for patients > or = 65 years old, especially in the control group (p = 0.001). No significant differences in mortality, 30-day readmissions, or interfacility transfers were observed.

CONCLUSIONS

Patients cared for by an academic hospitalist service that includes actively participating medical residents appear to have lower lengths of stay, total costs, and consultation rates than patients receiving routine private care. The reductions are largely observed among patients > or = 65 years old.

[IR search through Internet]

In our laboratories, we have almost had the complete Sadtler IR database, about 133,000 spectra. Based on Sadtler IR Search Master software, off-line spectrum search through internet has been set up in this work. Customers e-mail their unknown spectra as attached files to ftir2000@sina.com or ftir@microchem.org.cn. After we download the unknown spectra and search them, we will send the search reports in Microsoft Word format back to the customers within 72 hours. Please visit our web site www.microchem.org.cn to know the policy about our IR search program.

[The status of protein P16 and P53 in the surgical margins of laryngeal carcinoma and the association with local recurrence]

OBJECTIVE

To assess the status of P53 and P16 of surgical margins in laryngeal carcinoma and the association with the local recurrence following surgical treatment

METHODS

The status of P53 and P16 of surgical margins in laryngeal carcinoma was studied using immunohistochemistry (IHC) staining method in 100 cases of laryngeal carcinoma. Fifty-two of them had recurrent tumors while 48 cases were free of local recurrence after 5-year follow up. The original tumor sites and T stages, which bear important influence over the risk of local recurrence, were strictly matched between the two groups, and the ages and preoperative doses of radiation were also considered.

RESULTS

The percentage of local recurrence was 85% in these patients who showed positive staining for P53 and simultaneous negative staining for P16 in both the cancer tissues and the surgical margins. No association was found between the expression of P53 and P16 and the clinical types or T stages.

CONCLUSION

The status of P53 and P16 in combination demonstrated by IHC technique in surgical margins of laryngeal carcinoma may predict the possibility of local recurrence.

Non-replicating Epstein-Barr virus-based plasmids extend gene expression and can improve gene therapy in vivo

To date, no gene transfer vector has produced prolonged gene expression following a single intravenous injection and then efficiently re-expressed the delivered gene following repeated systemic injection into immunocompetent hosts. To overcome these limitations, a gene therapy regimen using non-replicating Epstein-Barr virus (EBV)-based expression plasmids was developed. One plasmid contains the FR (EBV family of repeats) sequence and the expressed gene. The other encodes Epstein-Barr nuclear antigen 1 (EBNA-1), but lacks FR. Although unable to replicate in mice, intravenous co-injection of EBV-based plasmids in cationic liposome-DNA complexes (CLDCs) substantially prolonged luciferase gene expression. The use of a two-vector system limited host exposure to the EBNA-1 gene product. Furthermore, this EBV-based vector system could be intravenously re-injected multiple times into immunocompetent mice without loss of transfection efficiency. Use of this vector system significantly improved the therapeutic efficacy of the biologically important human granulocyte colony-stimulating factor gene. Delivery of the human granulocyte colony-stimulating factor gene in EBV-based plasmids increased circulating white blood counts for at least 2 months following a single CLDC-based intravenous co-injection. Conversely, white blood counts were never elevated following injection of CLDCs lacking EBV-derived elements. Thus, this EBV-based plasmid vector system both markedly prolongs gene expression at therapeutic levels and efficiently and repeatedly re-transfects immunocompetent hosts. These properties of EBV-based plasmid vectors appear to be due, at least in part, to the documented abilities of the EBNA-1 protein both to retain FR-containing DNA intracellularly and within the nucleus and to block anti-EBNA-1 cytotoxic T cell responses.

[Laryngeal function-sparing surgery for pyriform sinus cancer]

OBJECTIVE

To evaluate the oncologic effect of laryngeal function-sparing surgery for the patients with pyriform sinus carcinoma.

METHODS

A retrospective analysis was performed. Forty-four patients with pyriform sinus cancer who underwent operations were included. There were 10 patients in T1, 14 in T2, 18 in T3 and 2 in T4 categories. 42 patients received preoperative radiation and 2 cases, post-operative radiation. Surgery for the local lesions: 36 patients underwent pyriform sinusectomy and 8, partial laryngectomy and pyriform sinusectomy.

RESULTS

Five year survival rate is 50% for the whole series, 80% for stage I, 71.4% for stage II, 52.9% for stage III, 26.7% for stage IV and 45% for all T3 + T4 patients. Local control rate is 81.8% for all patients and 75% for T3, T4 patients.

CONCLUSION

For selected pyriform sinus cancer patient a conservative laryngeal surgery is warranted with the combination of preoperative radiative therapy.

[Lateral neck dissection of hypopharyngeal cancer with clinically regional metastasis]

OBJECTIVE

To assess whether lateral neck dissection can control the hypopharyngeal cancer with clinically regional metastasis.

METHODS

A retrospective review of medical chart from 1975 to 1992 was performed. Ninety-three hypopharyngeal squamous cell carcinoma patients who had performed RND were included. The distribution of metastatic neck lymph node was analyzed.

RESULTS

Submandibular triangle lymph node metastasis was occult in only 3 patients. Histological lymph node metastasis to the posterior triangle was found in 5.9% of patients with N0, 7.0% with N1, 37.5% with N2a and 36% with N2b-N3. Histological neck lymph node metastasis to the posterior triangle was found in 4.0% of patients without inferior jugular lymph node metastasis and 34.1% of patients with inferior jugular lymph node metastasis.

CONCLUSIONS

Lateral neck dissection was recommended to treat hypopharyngeal cancers of N0 and N1. N2 and N3 should be treated with neck dissection including II-V group lymph nodes. After lateral neck dissection, frozen section of the inferior jugular lymph node should be performed. If the result of the frozen section is positive, V group dissection should be performed.

Two diastereomeric saponins with cytotoxic activity from Albizia julibrissin

Two diastereomeric saponins, julibrosides J1 (1) and J9 (2), both of which show cytotoxic activity, were obtained from the stem bark of Albizia julibrissin Durazz. On the basis of chemical and spectral evidence [L.B. Ma et al., Carbohydr. Res., 281 (1996) 35-46], the structure of 1 was revised as 3-O-[beta-D-xylopyranosyl-(1-->2)-alpha-L-arabinopyranosyl-(1-->6) -beta-D-glucopyranosyl]-21-O-[(6S)-2-trans-2-hydroxymethyl-6-methyl-6-O- [4-O-((6R)-2-trans-2,6-dimethyl-6-O-(beta-D-quinovopyranosyl)-2,7- octadienoyl)-beta-D-quinovopyranosyl]-2,7-octadienoyl] acacic acid-28-O-beta-D-glucopyranosyl-(1-->3)-[alpha-L-arabinofuranosyl-(1-->4 )]-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranosyl ester. The diastereoisomer 2 of 1 was identified as 3-O-[beta-D-xylopyranosyl-(1-->2)-alpha-L-arabinopyranosyl-(1-->6) -beta-D-glucopyranosyl]-21-O-[(6S)-2-trans-2-hydroxymethyl-6-methyl-6-O- [4-O-((6S)-2-trans-2,6-dimethyl-6-O-(beta-D-quinovopyranosyl)-2,7- octadienoyl)-beta-D-quinovopyranosyl]-2,7-octadienoyl] acacic acid-28-O-beta-D-glucopyranosyl-(1-->3)-[alpha-L-arabinofuranosyl-(1-->4 )]-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranosyl ester. Saponin 2 is a new saponin named julibroside J9. Both julibrosides J1 and J9 show good inhibitory action against the KB cancer cell line in vitro.

[The treatment of tongue squamous cell with N0]

OBJECTIVE

To evaluate the validity of selective surgery for the N(0) neck in squamous cell carcinoma of the mobile tongue.

METHODS

116 patients with N(0) neck of the mobile tongue cancer who underwent comprehensive RND and 5 patients who had a selective RND were reviewed retrospectively.

RESULTS

According to the suggestion of division of neck level, 7 patients had metastasis at level I; 21, level II; 10, level III, 1 case for level IV or V each. There were 5 cases with level III involvement as a first echelon of metastasis which was peculiar for the neck metastasis of mobile tongue.

CONCLUSIONS

For N(0) neck of the mobile tongue cancer, a neck dissection of level I-III or level I-IV is more than enough.

Fetal gene transfer by transuterine injection of cationic liposome-DNA complexes

In utero injection of cationic liposome-DNA complexes (CLDCs) containing chloramphenicol acetyltransferase, beta-galactosidase (beta-gal), or human granulocyte colony-stimulating factor (hG-CSF) expression plasmids produced high-level gene expression in fetal rats. Tissues adjacent to the injection site exhibited the highest levels of gene expression. Chloramphenicol acetyltransferase expression persisted for at least 14 days and was reexpressed following postnatal reinjection of CLDCs. Intraperitoneal administration of the hG-CSF gene produced high serum hG-CSF levels. X-gal staining demonstrated widespread beta-gal expression in multiple fetal tissues and cell types. No toxic or inflammatory responses were observed, nor was there evidence of fetal-maternal or maternal-fetal gene transfer, suggesting that CLDCs may provide a useful alternative to viral vectors for in utero gene transfer.

Gene expression along the cerebral-spinal axis after regional gene delivery

We demonstrate here that intracerebroventricular or spinal cord (intrathecal) injection of either plasmid DNA alone or cationic liposome: DNA complexes (CLDCs) produces significant levels of expression of both reporter genes and biologically relevant genes in nonparenchymal cells lining both the brain and the spinal cord. Gene expression was identified both within the spinal cord and the brain after intracerebroventricular or intrathecal injection of either CLDCs or plasmid DNA alone. Intracerebroventricular or intrathecal injection of CLDCs containing the beta-galactosidase (beta-Gal) gene produced patchy, widely scattered areas of beta-Gal expression. The chloramphenicol acetyltransferase (CAT) reporter gene product reached peak levels between 24 hr and 1 week postinjection, and was still present at significant levels 3 weeks after a single intracerebroventricular or intrathecal injection. Intrathecal injection of the human granulocyte colony-stimulating factor (G-CSF) gene produced high levels of hG-CSF activity in both the spinal cord and the brain. Intracerebroventricular injection of CLDCs containing the murine nerve growth factor (NGF) gene increased mNGF levels in the hippocampus, a target region for cholinergic neurons in the medial septum, and increased cholinergic neurotransmitter synthetic enzyme choline acetyltransferase (ChAT) activity within the brain, a well-characterized effect of both purified and recombinant NGF protein. These findings indicate that intracerebroventricular or intrathecal injection of CLDCs can produce significant levels of expression of biologically and therapeutically relevant genes within the CNS. Efficient gene transfer into the CNS will facilitate the evaluation of gene function and regulation within the brain and spinal cord. We attempted to transfer and express genes within the brain and spinal cord by direct CNS injection of either DNA alone or CLDCs into the intraventricular and subarachnoid compartments. We show that intracerebroventricular or spinal cord (intrathecal) injection of either plasmid DNA alone or CLDCs produces significant levels of expression of both reporter genes and biologically relevant genes in nonparenchymal cells lining both the brain and the spinal cord. Intrathecal injection of the hG-CSF gene produced high levels of hG-CSF activity in both the spinal cord and the brain. Intracerebroventricular injection of CLDCs containing the murine NGF gene increased mNGF levels in the hippocampus, and increased cholinergic neurotransmitter synthetic enzyme ChAT activity within the brain. Locoregional diffusion of gene products expressed by transfected meningeal lining cells into brain and spinal cord parenchyma could potentially target secreted proteins within brain and spinal cord regions relevant to neuropathological states while limiting peripheral side effects.

Guidelines in pulmonary medicine: a 25-year profile

OBJECTIVE

We attempted to identify clinical practice guideline and pathway articles in the area of pulmonary medicine published in peer-reviewed journals since 1974.

DESIGN

Review.

DATA SOURCES

MEDLINE, the Cochrane Database, Best Evidence, and Abstracts of Clinical Care Guidelines from January 1974 to December 1998.

STUDY SELECTION

All articles contained relevant search terms for pulmonary topics and were included irrespective of setting (primary or specialty, inpatient or outpatient). Controlled and uncontrolled trials as well as observational studies and consensus opinion/statements were all identified. The articles were stratified by design as well as by pulmonary topic.

DATA EXTRACTION

Limited data on study type, study focus, year of publication, and results of study were abstracted.

RESULTS

Our criteria yielded 271 articles, including 115 consensus statements and expert opinion guidelines; 30 controlled studies, meta-analyses, or systematic reviews; and 126 uncontrolled trials and observational studies. Of these, 82 articles (30.3%) related to asthma, 46 articles (17.0%) related to COPD, and 36 articles (13.3%) related to pneumonia. In addition, we tracked the increasing publication of all guideline-related pulmonary articles; randomized, controlled trials (RCTs); systematic reviews; and consensus statements by year for the past 25 years.

CONCLUSION

Pulmonary guidelines are increasingly published in peer-reviewed journals, but few are tested clinically in RCTs. There is continued reliance on consensus statements and expert opinion. Pulmonary guideline publications have continued to dramatically increase in number and in importance since 1974, both on the local level and internationally.

Squamous cell carcinoma of temporal bone: reported on 33 patients

BACKGROUND

This study assessed the treatment results of a series of 33 patients with squamous cell carcinoma (SCC) of the temporal bone and evaluated the efficacy of mastoidectomy combined with perioperative radiation therapy protocol.

METHODS

Thirty-three patients with biopsy-proven SCC invaded to the temporal bone were reviewed retrospectively and staged into three subgroups according to the University of Pittsburgh TNM Staging System. There were 3 patients with Stage I and II disease(tumor confined to auditory canal), 17 patients with Stage III (tumor involving the middle ear or mastoid), and 13 patients with Stage IV(more extensive disease). Two patients were treated by surgery alone. Eleven patients received irradiation only, and the remaining 20 patients underwent combined surgery and perioperative radiotherapy. The surgical intervention included sleeve resection for patients with Stage I and II lesions and mastoidectomy for all patients with Stage III and IV lesions except 1 who had subtotal temporal bone resection. The radiation dose delivered was in the range of 3500 approximately 10 000 cGy, with an average dose of 6560 cGy.

RESULTS

The five-year survival rate for the whole series was 51.7% by the life-table analysis. After being staged into three subgroups (ie, Stage I + II, Stage III, and Stage IV), the estimated five-year survival rates were 100%, 68. 8%, and 19.6%, respectively (p = 0.04). Radiation alone yielded a 28. 7% five-year survival, while combined surgery and irradiation gave a result of 59.6% (p = 0.80). For patients treated with planned combined therapy, the actuarial five-year survival rates were 72.7% (8/11) for Stage III disease and 12.5% (1/8) for Stage IV disease (p = 0.02). Twelve patients who died of disease did so of local recurrence (10 cases), cervical metastases (1 case), and liver metastases (1 case), with 70% of succumbing to their diseases within two years. Complications include osteonecrosis (n = 1), osteitis (n = 3), radiation dermatitis (n = 2), facial nerve palsy (n = 2), and delayed healing (n = 2). Data on clinical presentation and treatment modality were also analyzed.

CONCLUSION

The results of mastoidectomy with removal of all gross tumor, combined with planned perioperative irradiation therapy, seems to be a useful approach for SCC of the temporal bone. This gives at least as good, and possibly better, five-year survival than temporal bone resection. The mastoidectomy procedure creates less operative morbidity and mortality. To facilitate the development of more effective means of treating advanced disease, an accepted staging system and cooperative group investigation is necessary.

[Cervical management in the N0 squamous cell carcinoma of the tongue]

OBJECTIVE

To assess whether the elective neck dissection would be beneficial as a routine management in the N0 squamous cell carcinoma of the tongue.

METHODS

Cox regression model was used for analysis of tongue cancer cases treated by our hospital in a period from 1958 to 1996.

RESULTS

Size of primary tumor and preoperative radiation showed significant difference in relation to cervical lymph node recurrence or metastasis. Neck dissection in the series was not a factor to influence the rate of cervical recurrence or survival. 5-years survival was 73.5% versus 69.3% in patients who underwent elective neck dissection and those without neck dissection (difference not statistically significant).

CONCLUSION

We suggest that elective neck dissection would be avoided in T1 or T2 patients who have no neck node metastases.

Systemic gene delivery expands the repertoire of effective antiangiogenic agents

Cationic liposome-DNA complex (CLDC)-based intravenous gene delivery targets gene expression to vascular endothelial cells, macrophages and tumor cells. We used systemic gene delivery to identify anti-angiogenic gene products effective against metastatic spread in tumor-bearing mice. Specifically, CLDC-based intravenous delivery of the p53 and GM-CSF genes were each as effective as the potent antiangiogenic gene, angiostatin, in reducing both tumor metastasis and tumor angiogenesis. Combined delivery of these genes did not increase anti-tumor activity, further suggesting that each gene appeared to produce its antimetastatic activity through a common antiangiogenic pathway. CLDC-based intravenous delivery of the human wild type p53 gene transfected up to 80% of tumor cells metastatic to lung. Furthermore, it specifically induced the expression of the potent antiangiogenic gene, thrombospondin-1, indicating that p53 gene delivery in vivo may inhibit angiogenesis by inducing endogenous thrombospondin-1 expression. CLDC-based delivery also identified a novel anti-tumor activity for the metastasis suppressor gene CC3. Thus, CLDC-based intravenous gene delivery can produce systemic antiangiogenic gene therapy using a variety of different genes and may be used to assess potential synergy of combined anti-tumor gene delivery and to identify novel activities for existing anti-tumor genes.