Prevalence of human papillomavirus in cervical cancer: a multicenter study in China

A large-scale epidemiologic survey on the prevalence of different types of human papillomavirus (HPV) in cervical cancer in China is indicated because of the implications for the development of diagnostic probes and vaccines against cervical cancer. A total of 809 cervical cancer specimens were collected from 5 regions in China including Shanghai, Guangzhou, Sichuan, Beijing and Hong Kong. HPV DNA was detected in 83.7% of the specimens. HPV-16 was present in 79.6%, HPV-18 in 7.5%, HPV-52 in 2.6% and HPV-58 in 3.8% of all HPV-positive specimens. The prevalences of HPV-16 and HPV-18 in Hong Kong were 61.7 and 14.8%, respectively, representing a lower HPV-16 and a higher HPV-18 proportion compared with the other regions. HPV-16 remained the most common HPV infection in both squamous cell carcinoma (SCC) and adenocarcinoma (AC). The proportion of HPV-18 infection was significantly higher in AC than in SCC.

Effects of calcitonin gene-related peptide receptor antagonists on renal actions of adrenomedullin

1. Adrenomedullin is a novel vasoactive peptide which is produced in the lungs, ventricle, kidneys, heart and adrenal medulla. Adrenomedullin shows homology to calcitonin gene-related peptide (CGRP) and has similar pharmacological actions to CGRP. 2. This study examined the dose-response effects of adrenomedullin (rat, 11-50) on mean arterial pressure (MAP), heart rate (HR), renal blood flow (RBF), glomerular filtration rate (GFR) and renal tubular electrolyte excretion in Inactin-anaesthetized Sprague Dawley rats. The possible involvement of CGRP receptors in actions of adrenomedullin was also examined via renal arterial injection of a CGRP receptor antagonist, CGRP (8-37) (1 or 10 nmol kg-1) or [Tyr0]CGRP(28-37) (3 or 30 nmol kg-1), starting 15 min prior to the administration of adrenomedullin. 3. Renal arterial infusion (0.001 to 1 nmol kg-1) of adrenomedullin did not alter MAP, HR and renal K+ excretion but dose-dependently increased RBF and arterial conductance, GFR, urine flow and Na+ excretion. 4. The renal actions of adrenomedullin were not blocked by either the low or the high dose of CGRP(8-37) or [Tyr0]CGRP(28-37). 5. The results show that adrenomedullin causes renal vasodilatation, increments in GFR, diuresis and natriuresis. The renal actions of adrenomedullin are not mediated via the activation of CGRP1 receptors.

Effects of molecular crowding on the interaction between DNA and the Escherichia coli regulatory protein TyrR

Fluorescence quenching has been used to measure quantitatively the effects of sucrose and triethylene glycol on the interaction between the Escherichia coli regulatory protein TyrR and a 30-basepair oligonucleotide containing the strong TyrR box of the TyrR operon. It was observed that the apparent binding constant increased in the presence of co-solutes, the dependence of the logarithm of the apparent binding constant on molar concentration being indistinguishable and essentially linear for both co-solutes. This activation of the TyrR-oligonucleotide interaction is attributed to thermodynamic nonideality arising from molecular crowding, an interpretation which is supported by the reasonable agreement observed between the experimental extent of reaction enhancement and that predicted on the statistical-mechanical basis of excluded volume.

Vasodilator effects of organotransition-metal nitrosyl complexes, novel nitric oxide donors

Nitrovasodilators cause endothelium-independent relaxation of blood vessels by generating nitric oxide (NO). We examined the relaxation and depressor effects of two organotransition-metal nitrosyl complexes, CpCr(NO)2Cl and CpMo(NO)2Cl, relative to those of the prototypal nitrovasodilators, nitroglycerin, and sodium nitroprusside (SNP), in phenylephrine-preconstricted aortic rings and conscious, unrestrained rats. CpCr(NO)2Cl, CpMo(NO)2Cl, nitroglycerin and SNP caused dose-dependent relaxation of aortic rings at maximal responses (Emax) of -118+/-4, -113+/-4, -104+/-1, and -128+/-5% and EC50 of 0.14+/-0.04, 22+/-4, 1.23+/-0.65, and 0.063+/-0.013 microM, respectively. The dose-response curve of CpCr(NO)2Cl was displaced to the right by hemoglobin, as well as methylene blue, showing involvement of the NO/cGMP pathway. Unlike nitroglycerin, preexposure for 1 h to CpCr(NO)2Cl did not alter subsequent relaxation response to the compound. Intravenous bolus injections of CpCr(NO)2Cl, CpMo(NO)2Cl, nitroglycerin, and SNP caused dose-dependent decreases in MAP with Emax of -42+/-2, -51+/-8, -56+/-6, and -58+/-2 mm Hg and EC50 of 0.041+/-0.010, 13+/-4, 1.6+/-0.4, and 0.037+/-0.004 micromol/kg, respectively. These results show that CpCr(NO)2Cl and CpMo(NO)2Cl are efficacious nitrovasodilators in vitro and in vivo.

Clinical and prognostic significance of human papillomavirus in a Chinese population of cervical cancers

OBJECTIVE

To investigate the clinical and prognostic significance of human papillomavirus (HPV) in a Chinese population of cervical cancers.

METHODS

We studied 121 cervical cancer tissue samples from patients treated at our hospital. Identification and typing of HPV were done by polymerase chain reaction (PCR) using consensus primers MY11 and MY09 followed by direct DNA sequencing. The results were correlated with various clinical and prognostic parameters.

RESULTS

We found HPV DNA in 95 (78.5%) cases, including HPV-16 in 59 (48.8%) and HPV-18 in 14 (11.6%) cases. chi(2) analysis revealed no significant correlation between the presence of HPV DNA and age at diagnosis, clinical stage, histologic type, tumor grading, 2-year and 5-year survival rate. Of the factors evaluated, age at diagnosis and histologic type were found to have a statistically significant relationship with HPV type. The mean age of the HPV-18 group was 48.6 years compared to 57.1 years for the HPV-16 group (p = 0.045) and 58.2 years for the HPV-negative group (p = 0.04). HPV-18 was detected more often in adenocarcinomas (AC) than in squamous cell carcinomas (SCC). Conversely HPV-16 was detected significantly more often in SCC (p < 0.0001). The HPV-negative group also had a higher incidence of SCC (p = 0.007). HPV-18-positive patients seemed to have more nodal involvement than both HPV-16-positive patients (45.5 vs. 20.8%) and HPV-negative patients (45.5 vs. 18.2%); however, it did not reach statistical significance.

CONCLUSIONS

These observations suggest that the presence of HPV DNA does not bear any clinical or prognostic significance in a Chinese population of cervical cancers. HPV-18 is found more often in younger patients and is associated with AC.

Autonomic mechanisms in the acute cardiovascular effects of cocaine in conscious rats

We studied the differential involvement of central dopaminergic activation and autonomic nervous system regulatory mechanisms in the cardiovascular responses to cocaine in conscious rats. Sprague-Dawley rats, Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) were instrumented with catheters in the jugular vein and abdominal aorta at least 5 days before the experiment. Intravenous administration of cocaine (0.1-3.0 mg/kg) caused a dose-dependent increase in blood pressure that was biphasic, with a large and rapid increase peaking at 10 s, followed by a mild sustained pressor response. Pressor responses to cocaine were significantly greater in SHR when compared to WKY rats. However, pretreatment with dopamine D1 receptor antagonist SCH 23390 or the D2 receptor antagonist raclopride did not influence the effects of cocaine. Pretreatment with the alpha-adrenoceptor antagonist phentolamine or the ganglion blocker pentolinium blocked the peak response and reversed the more sustained response into a depressor effect. While pretreatment with propranolol alone did not alter the responses to cocaine, in rats pretreated with phentolamine and propranolol neither a pressor response nor a depressor response was observed. In conclusion, cocaine administration caused marked, but short lasting pressor responses that were mediated by sympathetic activation and alpha-adrenoceptor vasoconstriction with little involvement of central dopaminergic mechanisms. The rapid return of blood pressure towards baseline may be mediated by sympathoinhibition and beta-adrenoceptor-mediated vasodilatation, the latter of which being particularly prominent when alpha-adrenoceptor activation was prevented.

Validation of cardiac magnetic resonance tissue tracking in the rapid assessment of RV function: a comparative study to echocardiography

AIM

To investigate the accuracy of cardiac magnetic resonance (CMR) tissue tracking (CMR-TT) and speckle tracking echocardiography (STE) against CMR determined right ventricular (RV) ejection fraction (RVEF) and to identify an optimal cut-off value for STE and CMR-TT to determine RVEF <45% and compare this to other conventional methods for estimating RVEF in dilated cardiomyopathy (DCM) patients.

MATERIALS AND METHODS

Twenty-nine DCM patients were recruited prospectively. CMR and echocardiography were performed within 48 hours and four-chamber views were used for strain analysis. Contoured CMR short axis images provided RVEF. Intraclass correlation coefficient (ICC), bias, levels of agreement, and receiver operating characteristic (ROC) curve analyses were performed.

RESULTS

CMR-TT RV free-wall longitudinal strain (FLS) and STE RV global longitudinal strain (GLS) showed the best correlation with RVEF (r=-0.68, r=-0.82, p<0.001 respectively). There was moderate correlation between echocardiography RV GLS and CMR RV FLS (r=0.64, p<0.001). CMR-TT FLS showed excellent intra-observer and interobserver reliability (ICC=0.980; ICC=0.968 respectively). STE GLS correlated better with RVEF than with peak systolic annular velocity (S'; r=0.45), tricuspid annular plane systolic excursion (TAPSE; r=0.56), and fractional area change (FAC; r=0.78). CMR-TT RV FLS had better correlation with RVEF than CMR TAPSE (r=0.69 versus 0.40). ROC analysis demonstrated the optimal cut-off value for CMR-TT RV FLS and STE GLS in detection of RVEF <45% was ≥-24.4% (area under the curve=0.87, 100% sensitivity, 66.7% specificity) and ≥-20.9% (area under the curve=0.88, 100% sensitivity, 60% specificity) respectively.

CONCLUSION

CMR-TT FLS and STE GLS showed potential to provide rapid assessment of RV function and had superior correlation with RVEF compared to conventional parameters.

Clinical factors influencing return to work after ambulatory inguinal herniorrhaphy in Hong Kong

Ambulatory inguinal hernia repair is the commonest day case general surgery operation. The present study was conducted to evaluate factors influencing the contemporary pattern of convalescence following ambulatory inguinal hernia repair in Hong Kong. A total of 271 consecutive ambulatory inguinal hernia repairs were performed at a day surgery centre from December 1995 to December 1998. The convalescent period prior to resuming work was analysed by multi-variate analysis with respect to significant clinical variables. A sick leave of 3 weeks was adequate for most patients following uncomplicated ambulatory inguinal hernia repairs. Factors associated with early return to work included age </=50 years, indirect inguinal hernia and sedentary occupation. Occupation was the only independent factor affecting the duration of time off work on multi-variate analysis.

A scanning electron microscopic study of wear in the plastic components of prosthetic knee and hip joints

The polyethylene surfaces of four metal on plastic prosthetic knee joints were compared with those of four hip joint replacements, by the use of scanning electron microscopy. The acetabular components of the hip joints showed concentric machining marks, but were generally smooth, and in some areas plastic deformation of the articular surface was evident after 24 months' use. In contrast, the tibial components of knee joints removed after 12 to 22 months showed deep scoring and pitting near the centre of their articular surfaces. This appeared to be due to abrasion by a third material, possibly fragments of cement, which sometimes became embedded in the joint surface. These results indicate that wear in prosthetic knee joints may be much more rapid than in hip joint replacements made from similar materials.

Receptor subtypes mediating renal actions of calcitonin gene-related peptide

We previously reported that the renal arterial infusions of non-hypotensive doses of calcitonin gene-related peptide (CGRP) caused renal vasodilatation and increases in glomerular filtration rate at a low dose, but renal vasoconstriction, natriuresis and kaliuresis at a high dose. In the present study, we examined the effects of the specific CGRP1 receptor antagonist (CGRP-(8-37) (1 and 10 nmol/kg) and the putative CGRP receptor antagonist, [Tyr(0)]CGRP-(28-37)(3 and 30 nmol/kg), on the renal vascular and tubular effects of CGRP in inactin-anaesthetized Sprague-Dawley rats. Renal arterial infusion of single doses of CGRP (0.3-300 pmol/kg per min) did not significantly alter mean arterial pressure or heart rate. However, during the continuous renal arterial infusion of either CGRP-(8-37) or [Tyr(0)CGRP-(28-37) incompletely inhibited the vasoconstriction but did not inhibit diuresis, natriuresis and kaliuresis elicited by a high but non-hypotensive dose of CGRP. On the basis that CGRP-(8-37) is a competitive CGRP1 receptor antagonist, our results suggest: (1) the renal vascular effect of CGRP is completely mediated via the activation of CGRP1 receptors, (2) the renal tubular effects of CGRP are not mediated via CGRP1 receptors, and (3) [Tyr(0)]CGRP-(28-37) is a CGRP1 receptor antagonist with potency and efficacy less than those of CGRP-(8-37).

A168 IS ROUTINE SCREENING FOR HEREDITARY COLORECTAL CANCER FEASIBLE IN AN OUTPATIENT GASTROENTEROLOGY PRACTICE?

Background

Lynch syndrome (LS) is the most common cause of hereditary colorectal cancer (CRC), with a reported prevalence of 2–5% of all CRC cases. A study by Kastrinos et al. found that a simple 3 item survey identified 77% of individuals at high risk for hereditary CRC. Implementation of this questionnaire at a gastroenterology office may help identify patients at risk for LS and other hereditary CRC.

Aims

To assess whether implementation of a validated questionnaire to screen for hereditary CRC is feasible in an outpatient gastroenterology clinic.

Methods

Adult gastroenterology outpatients who consented to participate in the study completed the screening questionnaire. Those who had previously been assessed by the Hereditary Cancer Program were excluded. Each subject was asked the following three questions: (1) Do you have a first-degree relative with CRC or LS-related cancer diagnosed before age 50? (2) Have you had CRC or polyps diagnosed before age 50? (3) Do you have ≥3 relatives with CRC?. Answering yes to any question was considered a positive screen.

Results

A total of 288 patients were screened, with 12 (4.2%) screening positive for question 1, 28 (9.7%) screening positive for question 2, and 8 (2.8%) screening positive for question 3. In total, 14.2% of individuals surveyed screened positive.

Conclusions

Utilization of a simple 3-question survey as part of regular patient intake in a gastroenterology office resulted in 14.2% of individuals screening high-risk for hereditary CRC. This is similar to the 15% screen positive rate in the original study of individuals with CRC. Further research is needed to determine whether a physician’s knowledge of the questionnaire results will change management and whether a positive screen leads to a confirmed diagnosis of LS and other hereditary colorectal cancers.

Funding Agencies

None

The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort study

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is associated with an increased incidence of hepatic and extrahepatic cancers, in particular those linked to obesity. In people with chronic liver disease, aspirin may confer protection against hepatocellular carcinoma (HCC). We explore the potential chemoprotective effect of aspirin/other anti-platelet agents on obesity-related cancers, including HCC in people with NAFLD.

METHODS

We performed a retrospective cohort study of anonymised electronic medical records using the TriNetX network (Cambridge, MA, USA), a global federated database. We identified adults aged 18 or over with a diagnosis of NAFLD, prior to commencing antiplatelet agents. Two groups were created: antiplatelet (1) versus no antiplatelet use (2). We propensity score matched for nine variables. Antiplatelet use was defined as aspirin, ticagrelor, cangrelor, clopidogrel or prasugrel use for at least 1 year. The outcomes of interest were incidence of HCC and other obesity-related cancers. Follow-up was for 5 years. We performed subgroup analyses on aspirin users only and stratified findings for sex and age. Sensitivity analysis was conducted on individuals with 3- and 5-year aspirin exposure.

RESULTS

Post matching, there were 42,192 people per group. Antiplatelet use in people with NAFLD was associated with statistically significant reduction in all obesity-related cancers (HR 0.71, 95% CI 0.65-0.78, p < 0.001) and individually for HCC (HR 0.52, 95% CI 0.40-0.68, p < 0.001), breast carcinoma (HR 0.78, 95% CI 0.66-0.92, p = 0.003), pancreatic carcinoma (HR 0.61, 95% CI 0.47-0.78, p < 0.001) and colorectal carcinoma (HR 0.68, 95% CI 0.56-0.84, p < 0.001). For women, there was a significant reduction in risk of ovarian carcinoma (HR 0.75, 95% CI 0.57-0.98, p = 0.034). Aspirin monotherapy was similarly associated with reduced incidence of HCC (HR 0.46, 95% CI 0.32-0.64, p < 0.001) and all obesity-related cancers (HR 0.71, 95% CI, 0.56-0.90, p = 0.004), with benefits observed in males (HR 0.71, 95% CI 0.56-0.90, p = 0.004), females (HR 0.77, 95% CI 0.67-0.88, p < 0.001) and in older (HR 0.72, 95% CI 0.63-0.82, p < 0.001) but not younger people (HR 0.78, 95% CI 0.60-1.03, p = 0.589).

CONCLUSIONS

Aspirin/antiplatelet agents may have a role in primary cancer prevention in people living with NAFLD.

Robotic left lower sleeve lobectomy with bronchoplasty for the removal of a carcinoid tumour

Lung carcinoid tumours constitute approximately 1-2% of all pulmonary tumours. They are derived from enterochromaffin cells, which are also known as 'Kulchitsky cells' and generally have indolent growth and development patterns. Carcinoid tumours are categorized as typical or atypical, depending on the number of mitoses per high power field and the presence of necrosis. In terms of management, surgical resection has been recognized to be the standard treatment for pulmonary carcinoid tumours. To our knowledge, the da Vinci system and robotic surgery have not been applied in sleeve lobectomies and bronchoplasty for the removal of carcinoid tumours in the United Kingdom. Therefore, we present a case of a sleeve lobectomy with bronchoplasty procedure for the removal of a carcinoid tumour located in the left lower lobe of the patient. The bronchus was repaired using a V-lock suture & Prolene sutures with the surgery performed using the da Vinci robotic surgical system.

A review of heart valve disease research in Malaysia

INTRODUCTION

Heart valve disease comprises a cluster of conditions affecting the aortic, mitral, pulmonary and tricuspid valves. This paper reviews all the research on heart valve disease in Malaysia published between the years 2000- 2016.

METHODS

The methodology was based on the search process described in the paper, "Bibliography of clinical research in Malaysia: methods and brief results". The search databases included PubMed, Scopus and several Malaysian journals such as MyJurnal and UKM Journal Repository, by using the following keywords: (heart valve disease OR infective endocarditis OR rheumatic heart disease) and (Malaysia).

RESULTS

In all 94 papers were identified of which 39 papers were selected and reviewed on the basis of their relevance. The local studies contributed to the knowledge and understanding of the epidemiology, aetiology, pathophysiology, clinical presentations, investigations, treatment, and outcomes of heart valve disease in the country.

DISCUSSION

The clinical relevance of the studies performed in the country is discussed along with recommendations for future research.

Immunocytochemical characterization of quisqualic acid- and N-methyl-D-aspartate-induced excitotoxicity in the retina of chicks

A single, large dose of N-methyl-D-aspartate (NMDA) or quisqualic acid (QA) injected into the chick eye has been shown previously to destroy many retinal amacrine cells and to induce excessive ocular growth accompanied by myopia. The purpose of this study was to identify distinct populations of retinal cells, particularly those believed to be involved in regulating ocular growth, that are sensitive to NMDA or QA. Two pmol of NMDA or 0.2 micromol of QA were injected unilaterally into eyes of 7-day-old chicks, and retinas were prepared for observation 1, 3, or 7 days later. Retinal neurons were identified by using immunocytochemistry, and cells containing fragmented DNA were identified by 3'-nick-end labelling in frozen sections. NMDA and QA destroyed many amacrine cells, including those immunoreactive for vasoactive intestinal polypeptide, Met-enkephalin, and choline acetyltransferase, but they had little effect upon tyrosine hydroxylase-immunoreactive cells. Other cells affected by both QA and NMDA included those immunoreactive for glutamic acid decarboxylase, gamma-aminobutyric acid, parvalbumin, serotonin, and aminohydroxy methylisoxazole propionic acid (AMPA) receptor subunits GluR1 and GluR2/3. Cells largely unaffected by QA or NMDA included bipolar cells immunoreactive for protein kinase C (alpha and beta isoforms) and amacrine cells immunoreactive for glucagon. DNA fragmentation was detected maximally in many amacrine cells and in some bipolar cells 1 day after exposure to QA or NMDA. We propose that excitotoxicity caused by QA and NMDA induces apoptosis in specific populations of amacrine cells and that these actions are responsible for the ocular growth-specific effects of QA and NMDA reported elsewhere.