[Analysis of changes in intrinsic neural timescales in male smoking addicts based on whole brain resting-state functional magnetic resonance imaging]

Objective: To investigate the abnormal changes of intrinsic neural time scale (INT) in male smoking addicts based on whole brain resting state functional magnetic resonance imaging (rs-fMRI). Methods: A case-control study. The clinical data and whole brain rs-fMRI data of 139 male subjects, aged (34.1±8.8) years, recruited through the online platform from January 2019 to December 2021 were retrospectively analyzed. According to the existence of smoking addiction, they were divided into smoking addiction group (n=83) and healthy control group (n=56).INT was calculated to reflect the brain neural activity dynamics. Single sample t test was used to obtain the whole brain spatial distribution maps of INT in smoking addiction group and the control group. Then two-sample t test was conducted to explore the difference of INT between the smoking addition group and the healthy control group, with age and years of education as covariates. Finally, Spearman correlation analysis was used to explore the relationship between INT and nicotine dependence scale score and smoking index. Results: Subjects with smoking addiction and healthy control group showed a similar pattern of hierarchical neural timescales, namely shorter INT in sensorimotor areas and longer INT in parietal lobe, posterior cingulate cortex. In addition, in the smoking addiction group, the left medial occipital gyrus (peak t=-3.18), left suproccipital gyrus (peak t=-3.66), bilateral pericalar cleft cortex (left: peak t=-3.02, right: peak t=-3.22), bilateral lingual gyrus (left: peak t=-3.10, right: t peak=-3.04), left cuneus (peak t=-2.97), default network associated brain region [left anterior cuneus(peak t=-3.23), left angular gyrus (peak t=-3.07), and left posterior cingulate cortex (peak t=-3.54) were significantly lower than those of healthy controls (gaussian random field correction, voxel level all P<0.005, mass level all P<0.05). However, there was no significant correlation between INT and nicotine dependence scale score and smoking index (both P>0.05 after Bonferroni correction). Conclusion: Compared with healthy controls, smoking addicts showed abnormal changes in the dynamics of neural activity in the visual cortex and the default network.

[Advances in the role of autoimmune mechanisms in chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease whose pathogenesis mainly involves airway remodelling and alveolar destruction caused by inflammation, protease-antiprotease imbalance, oxidative stress, and imbalance between apoptosis and compensatory repair of lung tissue structure cells. In recent years, the role of the autoimmune response in COPD has attracted widespread attention, but there is still some controversy. This article reviewed the role of autoimmunity in COPD from different perspectives, starting with the relationship between autoimmunity and the pathogenesis of COPD.

[Clinical outcomes of anterior tibial tendon transfer combined with supramalleolar osteotomy in stage 3b of varus ankle osteoarthritis]

To investigate the clinical and radiographic results of anterior tibial tendon (ATT) transfer combined with supramalleolar osteotomy in stage 3b of varus ankle osteoarthritis. Totally 13 patients with stage 3b of varus ankle osteoarthritis who received ATT transfer combined with supramalleolar osteotomy in Beijing Tongren Hospital from January 2018 to May 2021 were recruited. There were 6 males and 7 females with a mean age of (57.8±9.3) years. The overall evaluations included the preoperatively and postoperatively radiographic alignments, visual analog scale (VAS) score, and the American Orthopaedic Foot & Ankle Society (AOFAS) clinical ankle-hindfoot scale. The mean follow-up period was (33.5±13.4) months. The tibial articular surface (TAS), talar tilt (TT), and foot and ankle offset (FAO) changed from 83.3°±2.4° to 92.8°±1.7°, 12.3°±4.5° to 7.0°±4.7°, and -7.4%±2.8% to -0.7%±2.2% after the operation, respectively (all P<0.001). The AOFAS and VAS score improved significantly at the final follow-up when compared with those before the operation (both P<0.001). It indicated that ATT transfer after supramalleolar osteotomy can achieve good clinical and radiographic results in the treatment of varus ankle arthritis in Takakura stage 3b.

[Comparation of outcomes of iliac crest bone graft and accessory navicular bone graft in the Cotton osteotomy for pediatric and adolescent flexible flatfoot]

Objective: To compare the outcomes between iliac crest and accessory navicular as different bone grafts in the Cotton osteotomy in the treatment of pediatric flexible flatfoot deformity. Methods: A retrospective cohort study. The clinical data of pediatric flexible flatfoot patients with symptomatic accessory navicular received operations from July 2018 to March 2022 in Beijing Tongren Hospital were retrospectively analyzed. All the patients were treated with Cotton osteotomy. According to the different sources of bone grafting in Cotton osteotomy, the patients were divided into iliac crest group and accessory navicular group. There were 12 patients (19 feet) in iliac crest group, including 9 males and 3 females with a median age M(Q1, Q3) of 11(11, 12) years and were followed-up for 36(6, 48) months. There were 9 patients (16 feet) in accessory navicular group, including 6 males and 3 females, with a median age M(Q1, Q3) of 11(11, 11) years and were followed-up for 12(6, 17) months. Radiographic evaluations were reviewed and compared between the two groups before surgical treatment and at final follow-up, included talo-1st metatarsal angle (T1MT), talonavicular coverage angle (TNCA), talocalcaneal angle (TCA) in weight bearing anteroposterior view, and Meary angle, calcaneal Pitch angle, Kite angle, cuneiform articular angle (CAA) in weight bearing lateral view, and hindfoot alignment angle (HAA) in calcaneal long axial view. Functional scores included American Orthopedic Foot and Ankle Society (AOFAS), visual analog scale (VAS), and Maryland scores were recorded and compared before and after the operation. The complications were also recorded. Results: Total of 21 patients were successfully followed in this study. The radiographic measurements in the two groups, such as T1MT, TNCA, Meary angle, Pitch angle, Kite angle, CAA, HAA, were all significantly improved at the last follow-up when compared with those before the surgery (all P<0.05); and the AOFAS, VAS, Maryland scores in both groups were all improved after the surgery (all P<0.05). There was a significant difference in CAA alteration (∆CAA) after the operation between the two groups, the ∆CAA in iliac crest group and the accessory navicular group was 6.0°±2.6° and 4.3°±1.3°, respectively (P=0.017). There was no significant differences in the improvement of other radiographic measurements between the two groups (all P>0.05). All the patients had a successful bone union. Two patients had donor site pain in the iliac crest group and were treated conservatively. Conclusion: Compared with iliac crest bone graft, accessory navicular bone graft could achieve comparable outcomes in radiographic measurements and functional scores in the treatment of pediatric flexible flatfoot with accessory navicular pain.

[Interpretation of expert consensus for progressive collapsing foot deformity]

Adult flatfoot is a common foot deformity, mainly manifested as medial arch collapsing, hindfoot valgus and forefoot abduction. People have a more thorough understanding of the pathological changes and pathogenesis of flatfoot with further research. There is a new expert consensus for adult flatfoot published in Foot & Ankle Inter. in 2020. The expert panel reviewed the latest literature to develop consensus recommendations for flatfoot, including its nomenclature, diagnosis, classification and operative treatment. The consensus represents a new understanding of the disease and a new concept because of the authority of its authors and the comprehensiveness of its content, and it is also a phased summary of the theoretical and clinical progress of adult flatfoot. This article gives a detailed interpretation of the content in the consensus.

[Analysis of prognostic factors of extranodal NK/T-cell lymphoma treated with pegaspargase/L-asparaginase: a multicenter retrospective study]

Objective: To explore the prognostic factors of extracellular NK/T cell lymphoma (ENKTL) treated with pegaspargase/L-asparaginase. Methods: The clinical data of 656 ENKTL patients diagnosed at 11 medical centers in the Huaihai Lymphoma Working Group from March 2014 to April 2021 were retrospectively analyzed. The patients were randomly divided into two groups: a training set (460 cases) and a validation set (196 cases) at 7∶3, and the prognostic factors of the patients were analyzed. A prognostic scoring system was established, and the predictive performance of different models was compared. Results: Patients' median age was 46 (34, 57) years, with 456 males (69.5% ) and 561 nasal involvement (85.5% ). 203 patients (30.9% ) received a chemotherapy regimen based on L-asparaginase combined with anthracyclines, and the 5-year overall survival rate of patients treated with P-GEMOX regimen (pegaspargase+gemcitabine+oxaliplatin) was better than those treated with SMILE regimen (methotrexate+dexamethasone+cyclophosphamide+L-asparaginase+etoposide) (85.9% vs 63.8% ; P=0.004). The results of multivariate analysis showed that gender, CA stage, the Eastern Cooperative Oncology Group performance status (ECOG PS) score, HGB, and EB virus DNA were independent influencing factors for the prognosis of ENKTL patients (P<0.05). In this study, the predictive performance of the prognostic factors is superior to the international prognostic index, Korean prognostic index, and prognostic index of natural killer lymphoma. Conclusion: Gender, CA stage, ECOG PS score, HGB, and EB virus DNA are prognostic factors for ENKTL patients treated with pegaspargase/L-asparaginase.

[Retrospective analysis and a cross-sectional questionnaire survey of lung cancer concomitant with interstitial lung disease]

Objective: To describe the clinical characteristics and prognosis of lung cancer concomitant with interstitial lung disease (LC-ILD), and to understand the current status of knowledge of LC-ILD by physicians in the departments related to the treatment of the disease. Methods: We conducted a retrospective analysis of in-hospitalized pathology identified lung cancer (LC) patients who were admitted to our hospital between January 2014 and December 2018. After reviewing their chest CT imagings and pathological reports, 70 patients who were concomitant with interstitial lung disease (ILD) were enrolled in our study. On the other hand, a cross-sectional survey using an online questionnaire was conducted in LC-ILD management doctors who came from 29 provincial hospitals. The perceptions of demographic features, LC characteristics and management, ILD characteristics and management, and the prognosis of LC-ILD were investigated. Results: Among the 70 enrolled LC-ILD cases, there were 52 males, and the mean age was (64.3±7.63) years (ranged from 49 years to 84 years). There were 51 patients who were older than 59 years. The most common pathological pattern of LC was adenocarcinoma. Most of them were diagnosed with LC and ILD simultaneously, and they were usually treated with chemotherapy while unresectable. There were 11 patients (15.7%) with positive EGFR or ALK mutation. Forty-five patients (64.3%) died during the follow-up, and 33 were died from LC progression. There were no significant differences between the surgical group and non-surgical group on age, pathological patterns, EGFR or ALK mutation. However, LC-ILD patients in the surgical group were diagnosed with earlier TNM classification and with better prognosis. A total of 1 014 doctors answered the questionnaire completely. In the feedback, patients aged 60 years and older (785 doctors/77.4%), and male patients (720 doctors/71%) were the predominant LC-ILD patients. Adenocarcinoma (390 doctors/38.5%), adenocarcinoma or squamous-cell cancer (SCC) (182 doctors/17.9%), and SCC (151 doctors/14.9%) were considered as the common pathological patterns of LC-ILD patients. In most doctors' feedback, the EGFR or ALK mutation was not common for LC-ILD: low (646 doctors/63.7%) or hardly (306 doctors/30.5%) positive mutation. The diagnosis of ILD was earlier than LC (506 doctors/49.9%) or there was no identified precedence of LC and ILD diagnosis (208 doctors/20.5%). Most of the doctors (693 doctors/68.3%) agreed that the vital factor for surgery or not was the severity of ILD for LC-ILD patients. There were great divergences on the treatment protocol both for the advanced LC and ILD. The patients with LC-ILD were died mostly from LC progression and ILD exacerbation (542 doctors/53.5%), followed by ILD exacerbation (237 doctors/23.4%) or LC progression (226 doctors/22.3%). Conclusions: The elderly male patients were predisposed to LC-ILD, and adenocarcinoma was the common pathological pattern. The LC-ILD patients with non-advanced LC who were performed with surgery had better prognosis. However, it is recommended to consider whether to perform surgery in combination with the severity of the ILD.

[Analysis of effective connectivity in default mode network in male long-term smokers based on dynamic causal modeling]

Objective: To investigate the alterations in effective connection of default mode network (DMN) in long-term male smokers and its correlation with clinical characteristics of smoking. Methods: A total of 131 subjects through WeChat platform and underwent resting-state functional magnetic resonance (rs-fMRI) examinations were recruited, including 76 long-term smokers [long-term smoking group, male, aged 20 to 55 (32.1±6.3) years] and 55 non-smokers [healthy controls, male, aged 20 to 55(32.3±7.4) years] from January 2014 to December 2018. Long-term smokers were defined as those who smoked at least 10 cigarettes per day for more than 2 years, and met the Diagnostic and Statistical Manual of Mental Disorders-Four Edition (DSM-Ⅳ) criteria for substance dependence. Four major nodes of DMN, including left inferior parietal lobule (LIPL), right inferior parietal lobule (RIPL), posterior cingulate cortex (PCC), medial prefrontal cortex (mPFC) were chosen as for the region of interest. The effective connectivity (EC) alterations of DMN between smoking group and healthy controls were compared using dynamic causal modeling (DCM). The correlation between EC with significant difference among the two groups and Nicotine Dependence Scale (FTND) score, pack-year score and smoking duration were evaluated. Results: Compared to the healthy controls, the EC of LIPL to PCC and PCC to mPFC were decreased in the smoking group (EC = -0.091, -0.174, respectively, Bayesian-PP>0.95), and the EC of RIPL to PCC was increased (EC = 0.136, Bayesian-PP>0.95). Besides, EC of LIPL to PCC showed negative correlation with pack-year scores(r=-0.282,P=0.017). No significant linear correlations were observed between EC with significant group difference and FTND score or smoking duration (r=-0.103、-0.089,all P>0.05). Conclusion: Long-term smokers showed multiple abnormalities in IPL-PCC-mPFC circuits, and associated with the pack-year scores.

Zoledronic acid and fracture risk: a meta-analysis of 12 randomized controlled trials

OBJECTIVE

Zoledronic acid is widely used in patients with osteoporosis, and this meta-analysis aims to explore the influence of zoledronic acid on fracture risk and mortality in patients with osteoporosis or osteopenia.

MATERIALS AND METHODS

We searched PubMed, Google Scholar, and Cochrane Library for randomized clinical trials comparing zoledronic acid with control intervention (i.e., placebo or nothing) for osteoporosis or osteopenia. The fracture and mortality were estimated using the random-effect model.

RESULTS

12 randomized trials were included in this meta-analysis. Compared to control intervention, zoledronic acid was associated with significantly reduced incidence of fracture at the follow-up of 12 months, 24 months, 36 months and 72 months. In addition, zoledronic acid could remarkably reduce mortality at 12 months and 24 months than control intervention but revealed no influence on mortality at 36 months or 72 months. In terms of adverse events, zoledronic acid might result in the increase in serious atrial fibrillation and death from stroke than control intervention.

CONCLUSIONS

Zoledronic acid is beneficial to reduce the incidence of fracture, while its benefits to reduce the mortality are only observed at the follow-up time of 24 months.

[Analysis of liver cancer screening results and influencing factors of urban residents in Zhejiang Province from 2013 to 2018]

Objective: To analyze the results of liver cancer screening for urban residents in Zhejiang Province from 2013 to 2018 and explore the influencing factors of the detection rate. Methods: From September 2013 to August 2019, six urban communities in Hangzhou (Jianggan District and Gongshu District), Ningbo (Haishu District, Yinzhou District and Jiangbei District), and Quzhou (Kecheng District) were selected as study sites. All permanent residents aged 40-74 (with local household registration and living in the local area for more than 3 years) were selected as the research subjects by using cluster sampling method. Patients with confirmed cancers and other serious medical and surgical diseases were excluded. A total of 166 293 research subjects were included. Basic demographic characteristics and risk factors of subjects were obtained through questionnaire surveys. The cancer risk assessment system was used to evaluate the liver cancer risk of subjects. Clinical screening participation and screening results for subjects at high risk of liver cancer were obtained from participating hospitals. The high-risk rate of liver cancer, clinical screening rate, detection rate of positive lesions, and detection rate of suspected liver cancer were analyzed. Poisson regression was used to analyze the influencing factors of detection rate. Results: The age of 166 293 subjects was (56.01±8.40) years, of which 41.36% (68 777) were males. A total of 23 765 high-risk subjects for liver cancer were screened (the high-risk rate was 14.29%). Among them, a total of 12 375 subjects participated in clinical screening for liver cancer, with a screening rate of 52.07% (12 375/23 765). A total of 297 cases of positive lesions were detected and the detection rate was 2.40% (297/12 375). A total of 8 cases of suspected liver cancer were detected, with a detection rate of 0.06% (8/12 375). The results of multivariate Poisson regression model analysis showed that compared with men, people who never smoked, never ate pickled food, had low oil content, and had no history of hepatobiliary disease, female, people who were smoking or had smoked, sometimes ate pickled food, ate higher oil content, and had a history of hepatobiliary disease had a higher detection rate of positive lesions. The incidence rate ratio (IRR) (95%CI) values were 1.98 (1.45-2.70), 2.23 (1.61-3.09)/2.08 (1.31-3.28), 1.82 (1.22-2.70), 1.44 (1.08-1.91), and 1.45 (1.05-2.00), respectively. Compared with those aged from 40 to 49 years old and without HBsAg test, the IRR (95%CI) of suspected liver cancer in people aged 70 to 74 years old and HBsAg positive were 16.30 (1.32-200.74) and 6.43 (1.24-33.22), respectively. Conclusion: The urban cancer early diagnosis and early treatment project in Zhejiang Province has good compliance in clinical screening of liver cancer. Abdominal ultrasound examination and serum alpha-fetoprotein detection are helpful to detect liver cancer and its precancerous lesions in the high-risk population of liver cancer.

Effects of feeding corn bran and soybean hulls on nutrient digestibility, rumen microbial protein synthesis, and growth performance of finishing lambs

Some grain processing by-products rich in digestible fiber are good feed resources for ruminants. This experiment was conducted to investigate the effects of replacing a portion of corn and corn stover with the combinations of corn bran and soybean hulls in the diet of fattening lambs on nutrient digestion, rumen microbial protein synthesis, and growth performance. A total of 36 Dorper × Small Thin-Tailed crossbred ram lambs (BW = 22.2 ± 0.92 kg; mean ± SD) were randomly divided into three groups, and each group was fed 1 of 3 treatment diets: 1) 0% corn bran and soybean hulls (control); 2) 9% corn bran and 9% soybean hulls (18MIX); and 3) 17% corn bran and 17% soybean hulls (34MIX). The feeding experiment was conducted for 70 days, with the first 10 days for adaption. The DM intake was higher for 34MIX (1635.3 g/d) than for control diet (1434.7 g/d; P = 0.001). Lambs fed 18MIX and 34MIX diets (230.2 and 263.6 g/d, respectively) had higher average daily gain and feed efficiency than those fed control diet (194.8 g/d; P < 0.01). Dry matter and NDF digestibility for 34MIX group (60.9 and 49.5%) were higher than for control (55.2 and 41.3%; P < 0.01). No difference was observed in nitrogen digestibility among treatment diets (P = 0.778). The lambs fed 34MIX diet excreted more urinary purine derivatives, indicating that more microbial protein was yielded than those fed control diet (P < 0.01), while 18MIX was not different from the other two diets (P > 0.05). The metabolizable protein supplies were improved with increasing co-products inclusion rate. The results indicated that corn bran and soybean hulls in combination can effectively replace a portion of corn and corn stover in the ration of finishing lambs with positive effect on nutrient digestion and growth performance.

[Results and cost-effectiveness of colorectal cancer screening program among urban residents in Zhejiang province, 2013-2018]

Objective: To analyze the results and cost-effectiveness of colorectal cancer (CRC) screening program among Zhejiang urban residents so as to provide evidence for further optimization of CRC screening strategies. Methods: Based on the Cancer Screening Program in Urban China which was conducted in Zhejiang province from 2013-2018, data related to the rates on compliance and detection through the CRC screening program among the 40-74 year-old residents were analyzed. Chi-square tests were used to compare the differences among groups, and multivariate logistic regression models were applied to explore the potential risk factors. Cost-effectiveness ratio (CER) was calculated by using the cost per lesion detected as the indicator. Results: Among all the 166 285 participants who completed the risk assessment questionnaire, 21 975 (13.2%) were recognized as under the high risk of CRC and 4 389 (20.0%) of them received the colonoscopy. The detection rates of CRC, advanced adenoma, and non-advance adenoma were 0.3% (11 cases), 2.7% (119 cases), and 5.2% (229 cases), respectively. Results from the multivariate logistic regression analyses showed that factors as age, gender, education level, smoking, drinking alcohol, previous fecal occult blood test (FOBT), polyp history, and family history of CRC were significantly associated with the compliance rate of colonoscopy while age, smoking and polyp history were significantly associated with the detection rate of advanced neoplasms (CRC and advanced adenoma). The costs were ￥22 355.74 Yuan for every CER advanced neoplasm detection and ￥264 204.18 Yuan per CRC detection, respectively. The CER decreased along with ageing. Sensitivity analysis showed that CERs were expected to decrease when the compliance rate of colonoscopy was increasing. Conclusions: The current screening program seems effective in detecting the precancerous colorectal lesions, but the relatively low compliance rate of colonoscopy restricting both the diagnostic yields and economic benefits. It is necessary to improve the awareness and acceptance of colonoscopy among the high-risk CRC population.

Clinical features and survival impact of EBV-positive diffuse large B-Cell lymphoma with different age cutoffs

OBJECTIVE

In 2016 WHO classification, EBV +DLBCL of the elderly was replaced by EBV+ DLBCL NOS. This is due to the fact that many young patients of EBV+ DLBCL were found in recent years.

PATIENTS AND METHODS

In this study, we retrospectively analyzed clinical features and survival outcomes of EBV positive DLBCL patients in different age groups. All the patients treated at a single center.

RESULTS

When we use different ages (40, 50 and 60 years old) as cutoffs, the prevalence of EBV positive DLBCL was 12.0%, 12.3% and 13.0% in younger patients and 19.0%, 15.4% and 13.8% in elder patients respectively. Whatever the age cutoff was, EBV positive associated with unfavorable clinical prognosis in elder groups. When we use 40 and 50 years old as age cutoffs, poor impacts of EBV positive on overall survival and progression-free survival were observed only in elder patients, but not in younger patients. It should be noted that when we use 60 years old as age cutoff, the results were the opposite.

CONCLUSIONS

EBV+ DLBCL patients with age of 40 to 60 years old showed poorer prognostic features than EBV- DLBCL patients; however, patients in other age groups did not show evident differences in prognosis between EBV+ DLBCL patients and EBV- DLBCL patients. This finding was not reported before.

[Hepatic metastases after cervical cancer surgery: clinical analysis of 13 cases]

Objective: To investigate the clinical characteristics of patients with hepatic metastasis after cervical cancer operation, and analyze the risk factors and prognostic factors of hepatic metastasis. Methods: A total of 1 312 patients with stage Ⅰa2-Ⅱb2 cervical cancer received radical surgery from January 2013 to January 2016 in the First Affiliated Hospital of Zhengzhou University were collected, of which 13 cases (0.99%, 13/1 312) had hepatic metastasis after operation. A retrospective analysis was conducted on clinical features of patients with hepatic metastasis after cervical cancer operation. T-test, chi-square test, rank sum test and logistic regression were used to analyze the risk factors of hepatic metastasis after surgery of cervical cancer operation. Kaplan-Meier method was used for survival analysis. Log-rank test was used for screening of prognostic factors in patients with postoperative hepatic metastasis. Results: (1) Clinical features: there were 3 cases of simple hepatic metastasis without obvious clinical symptoms, 2 patients with perihepatic lymph node metastasis showed only low back pain, 8 patients with multiple extrahepatic metastases, and their clinical symptoms were related to the site of metastasis. Five cases out of 9 (5/9) with liver metastasis had abnormal tumor marker results. The abnormal kinds of tumor markers were mainly carcinoembryonic antigen (CEA), CA(125), CA(199), and CA(72-4). The interval time of hepatic metastasis after operation was 2-22 months. (2) Analysis of risk factors for hepatic metastasis: univariate analysis showed that lymph node metastasis, histological type, infiltration depth, and lymph-vascular space invasionwere associated with hepatic metastasis after cervical cancer surgery (P<0.05).Multivariate analysis showed that lymph node metastasis and small cell carcinoma were independent risk factors for postoperative hepatic metastasis (P<0.05). (3) Prognostic factors in patients with hepatic metastasis:among 13 patients with postoperative hepatic metastases from cervical cancer, 9 died during the follow-up period and 4 survived. The median total survival time after hepatic metastases was 7 months (range 3-32 months). Univariate analysis showed that multiple extrahepatic metastases and treatment after hepatic metastasis had significant effects on the prognosis of patients with hepatic metastasis after cervical cancer operation (P<0.05). Conclusions: The interval of hepatic metastasis after surgery for cervical cancer operation is within 2 years. Patients with lymph node metastasis and small cell carcinoma are more prone to postoperative hepatic metastasis. The prognosis of patients with extrahepatic multiple metastases is poor, and individualized treatment should be carried out after comprehensive analysis for patients with hepatic metastasis after cervical cancer operation.

[Clinical analyses of 24 patients with primary pulmonary NK/T-cell lymphoma]

Objective: To explore the clinical characteristics, the best treatment and prognostic factors of primary pulmonary NK/T-cell lymphoma. Methods: A total of 24 cases with primary pulmonary NK/T-cell lymphoma from April 2011 to May 2019 were analyzed retrospectively. Survival analysis was performed using the Kaplan-Meier method and groups were compared using the log-rank test. Multivariate analysis using Cox proportional hazard regression model was conducted to confirm independent prognostic factors for overall survival (OS) and progression-free survival (PFS) . Results: ①The cohort of 24 patients included 16 male and 8 female with a median age of 49 years (range, 4-76 years) old. ②Most patients initially presented with a fever (66.7%) , cough and dyspnea. Chest imaging manifestations were primarily unilateral (45.8%) or bilateral (54.2%) pulmonary consolidation, nodules or mass. ③20 patients received chemotherapy, radiotherapy or hematopoietic stem cell transplantation, the rest 4 cases palliative treatment. Median OS was 9.5 months (range, 0.1-26.0 months) . The estimated 1-year OS rate was 45.8%. Overall response rate of patients treated with asparaginase-based regimen was 88.2%. ④In univariate survival analysis, age≤60 was prognostic for longer OS and PFS, compared with age>60 (P=0.002 and 0.004, respectively) ; ECOG≤2 was prognostic for longer OS and PFS, compared with ECOG>2 (P=0.042 and 0.004, respectively) . In multivariate survival analysis, age>60 and ECOG>2 were significantly correlated with inferior OS and PFS (OS: P=0.024 and 0.024, respectively; PFS: P=0.035 and 0.024, respectively) . Conclusions: Primary pulmonary NK/T-cell lymphoma was a rare disease with poor prognosis. Asparaginase-based regimens appeared to be effective. Age and ECOG served as independent prognostic factors for primary pulmonary NK/T-cell lymphoma patients.

[National surveillance on Enterobius vermicularis infections among children at ages of 3 to 9 years in China from 2016 to 2018]

OBJECTIVE

To understand the epidemic status of Enterobius vermicularis infections among children aged 3 to 9 years in China, so as to provide scientific basis for the formulation of the prevention and control strategies for enterobiasis.

METHODS

The national surveillance of enterobiasis was performed in 736 national surveillance sites (counties) from 30 provinces (municipalities/autonomous regions) in China from 2016 to 2018. All surveillance sites were classified into parts according to the geographical directions, including the eastern, western, southern, northern and middle parts, and a township was randomly selected from each part. Then, an administrative village was randomly selected from the township, and 200 permanent residents at ages of over 3 years living in the administrative village were randomly selected using the cluster sampling method. A total of 1 000 residents were examined in each surveillance site. E. vermicularis infections were detected among children at ages of 3 to 9 years using the modified Kato-Katz technique and the adhesive cellophane-tape perianal swab method, and the prevalence of infections was calculated and compared.

RESULTS

The prevalence of E. vermicularis infections was 2.50%, 2.84% and 2.46% among children at ages of 3 to 9 years in the 736 surveillance sites from 30 provinces (municipalities/autonomous regions) in China from 2016 to 2018, and there was no gender-specific prevalence of E. vermicularis infections (P > 0.05). Enterobiasis was main prevalent in the southern and southwestern part of China (Jiangxi, Guangxi, Guangdong, Sichuan, Fujian, Chongqing and Hainan), with 5.00% prevalence and greater, and the highest prevalence was seen in Jiangxi and Guangxi for successive 3 years. In addition, the prevalence of E. vermicularis infections was higher in children with the Han ethnicity than in those with the minority ethnicity, and a high prevalence was found in children at ages of 4 to 7 years, and a low prevalence seen in children at ages of 3, 8 and 9 years.

CONCLUSIONS

The prevalences of E. vermicularis infections have not changed much among children at ages of 3 to 9 years in China from 2016 to 2018, and high prevalence is seen in southern and southwestern China, which should be given a high priority.

[14-3-3ζ protein mediates gemcitabine resistance in NK/T-cell lymphoma]

Objective: To explore the molecular mechanisms of 14-3-3ζ in gemcitabine resistance in extranodal NK/T-cell lymphoma, nasal type (ENKTL) . Methods: The effects of cell proliferation and invasion were detected by cell counting kit-8 (CCK-8) assay and transwell assay. YTS cells were exposed to gradually increased concentrations of gemcitabine to establish gemcitabine-resistant YTS cells (YTS-gem) in vitro. 14-3-3ζ specific siRNA lentiviral vector was transfected into YTS and YTS-gem cells to downregulate 14-3-3ζ expression, and stable transfected cell clones were screened. The protein expression was determined by Western blot. Results: ①14-3-3ζ expression was significantly up-regulated in gemcitabine resistant YTS-gem cells, comparing with that of YTS cells (P<0.05) . ②The results of CCK-8 and transwell assay showed that downregulation of 14-3-3ζ significantly reduced the cell proliferation and invasion abilities (P<0.05) . ③Downregulation of 14-3-3ζ could restore gemcitabine sensitivity in gemcitabine resistant YTS-gem cells (P<0.05) . ④Western blotting results showed that knockdown of 14-3-3ζ significantly upregulated pro-apoptotic Bax, and downregulated anti-apoptotic Bcl-2, Caspase-3, cleaved caspase-3, Cyclin D1 in gemcitabine-resistant YTS-gem cells (P<0.05) . There was no significant difference in p53 ang P-gp expression levels. Conclusions: 14-3-3ζ was upregulated in gemcitabine resistant YTS cells. Overexpression of 14-3-3ζ promoted cell proliferation and enhanced cell migration. 14-3-3ζ contributed to gemcitabine resistance to ENKTL through anti-apoptosis.

Effect of IL-1β on apoptosis of synovial cells in rheumatoid arthritis rats via the NF-κB pathway

OBJECTIVE

The aim of this study was to investigate the role of interleukin-1β (IL-1β) in the apoptosis of synovial cells in rheumatoid arthritis (RA) rats, and to explore the underlying mechanism.

MATERIALS AND METHODS

The apoptosis of the synovial cells in RA rats in the IL-1β group and the control group was analyzed by scoring under an electron microscope. The expressions of cleaved-poly (ADP-ribose) polymerase (PARP), PARP and anti-apoptosis gene products in synovial cells of IL-1β treated RA rats were explored as well. Meanwhile, the expressions of B-cell lymphoma 2 (Bcl-2), Bcl-xL, and Active-Caspase3 in the synovial cells of RA rats with IL-1β treatment were evaluated by the Western blotting. To further clarify the relationship between IL-1β and the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway in the synovial cells of RA rats, the expressions of NF-κB regulated the gene products of matrix metalloproteinase-3 (MMP-3), MMP-9, cyclooxygenase-2 (Cox-2), and vascular endothelial growth factor (VEGF) in synovial cells of RA rats after that we investigated the treatment with IL-1β (was investigated). In addition, the expression of NF-κB in the synovial cells of RA rats treated with IL-1β was determined.

RESULTS

The results showed that, compared with the control group, IL-1β treatment significantly increased the number of apoptotic cells. This meant that IL-1β treatment could promote the apoptosis of the synovial cells (p<0.05). IL-1β treatment significantly promoted the expression level of cleaved-PARP (p<0.05). However, it remarkably reduced the expressions of Bcl-2 and Bcl-xL (p<0.05). Meanwhile, the level of the active-Caspase3 in the synovial cells of RA rats treated with IL-1β was significantly enhanced (p<0.01). In comparison with the control group, the IL-1β group exhibited significantly elevated expressions of NF-κB-regulated gene products in the synovial cells of RA rats (p<0.01). Besides, the positive markers of the activated NF-κB were detected in the synovial cells of RA rats in the IL-1β group and the control group. The results demonstrated that they were mainly located in the nucleus of the IL-1β group.

CONCLUSIONS

IL-1β can promote the apoptosis of the synovial cells in RA rats via the NF-κB pathway.

Relationship between the Degeneration and Regeneration of Neuromuscular Junction and Wound Age during the Repair of Mouse Skeletal Muscle Contusion

Abstract

Objective To investigate the morphological changes in the degeneration and regeneration of neuromuscular junctions （NMJ） during the repair of mouse skeletal muscle contusion and discuss the correlation between the degeneration and regeneration of NMJ and wound age. Methods A total of 50 healthy adult male mice were randomly divided into 10 groups, including 9 experimental groups and 1 control group. Immunofluorescent staining was applied, and neurofilament was marked with neurofilament protein-H （NF-H）, presynaptic membrane was marked with synaptophysin （Syn）, presynaptic membrane was marked with acetylcholine receptor （AChR）. Morphological changes of NMJ regeneration at different time points after mouse skeletal muscle contusion were detected. Results The neurofilament and presynaptic membrane of NMJ at the junction of contusion zones began to degrade after contusion, and completed degradation at about 3 d post-injury. Then they gradually regenerated, roughly completing the regeneration at about 21 d and basically reaching the control group level. The ratio of presynaptic membrane quantity to presynaptic membrane quantity showed a trend of decreasing then rising and finally reaching the control level. Conclusion During the repair of mouse skeletal muscle contusion, the morphological changes and wound age of the NMJ at the junction of contusion zones have a close correlation, which is expected to be one of the biological indicators for forensic skeletal muscle wound age estimation.

Relationship between Changes of Pericyte Number and Wound Age during Repair of Skeletal Muscle Contusion in Mice

Abstract

Objective To observe the change pattern of pericyte number at different time periods after mice skeletal muscle contusion and discuss its role in wound age estimation. Methods A mice gastrocnemius muscle contusion model was established. The form and number changes of pericytes at 1, 3, 5, 7, 9, 14, and 28 d post-injury were detected by multiple immunofluorescence staining. Results Compared with the slender shape of pericytes in normal skeletal muscles, pericytes in the contusion area had increased volume, rounder form and a round nuclei. Part of pericytes were found to express satellite cell markers paired-box transcription factor （Pax7） or myoblast determination 1 （MyoD1）. The changes of pericyte number in skeletal muscles after contusion were time-dependant, and showed unimodal distribution with the extension of wound age. In the central contusion area, the number of pericytes peaked at 5 d post-injury while in the peripheral contusion area, the number of pericytes peaked at 5 d and 7 d post-injury. Conclusion The number of pericytes in contusion area varies time-dependently after skeletal muscle contusion in mice and might be a reference index for muscle wound age estimation, and is involved in the repair and regeneration of skeletal muscle injury.

Relationship between Expression Changes of CB2R and Wound Age of Brain Contusion in Mice

Abstract

Objective To investigate the expression of cannabinoid type 2 receptor （CB2R） at different time points after brain contusion and its relationship with wound age of mice. Methods A mouse brain contusion model was established with PCI3000 Precision Cortical Impactor. Expression changes of CB2R around the injured area were detected with immunohistochemical staining, immunofluorescent staining and Western blotting at different time points. Results Immunohistochemical staining results showed that only a few cells in the cerebral cortex of the sham operated group had CB2R positive expression. The ratio of CB2R positive cells gradually increased after injury and reached the peak twice at 12 h and 7 d post-injury, followed by a decrease to the normal level 28 d post-injury. The results of Western blotting were consistent with the immunohistochemical staining results. Immunofluorescent staining demonstrated that the changes of the ratio of CB2R positive cells in neurons, CB2R positive cells in monocytes and CB2R positive cells in astrocytes to the total cell number showed a single peak pattern, which peaked at 12 h, 1 d and 7 d post-injury, respectively. Conclusion The expression of CB2R after brain contusion in neurons, monocytes and astrocytes in mice suggests that it is likely to be involved in the regulation of the biological functions of those cells. The changes in CB2R are time-dependent, which suggests its potential applicability as a biological indicator for wound age estimation of brain contusion in forensic practice.

[PD-L1 expression is related with prognosis of small cell lung cancer]

Objective: To explore the correlation between programmed death ligand 1 (PD-L1) expression and clinicopathological features and prognosis of small cell lung cancer (SCLC). Methods: The clinicopathological data of 64 patients with small cell lung cancer from January 2013 to December 2016 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed in this study. The correlation between PD-L1 expression and the clinicopathological features and prognosis of SCLC was analyzed. Results: Immunohistochemical staining revealed that PD-L1 expression was observed in 60.9% (39/64) of patients with small cell lung cancer. PD-L1 expression was significantly related to stages (P<0.001). Univariate analysis showed that the median overall survival of PD-L1 negative group was longer than PD-L1 positive group (16 months vs 14 months, P<0.001). Median progression-free survival of PD-L1 negative group was longer than PD-L1 positive group(15 months vs 9 months, P<0.000 1). In multivariate analysis, PD-L1 positive was significantly correlated with inferior progression-free survival (P=0.006). Conclusions: PD-L1 expression rate was high in small cell lung cancer. PD-L1 expression was an independent predictor for poor prognosis of patients with small cell lung cancer.

The aberrant activation of Wnt pathway caused by β-catenin mutation and its prognostic significance in NK/T-cell lymphoma

The aberrant activation of the Wnt/β-catenin signal has an important role in the progression of cancers. Herein, we investigated β-catenin mutation and the activation of the Wnt pathway in association with the clinical-pathological characteristics, chemo-resistance and prognosis of NK/T-cell lymphoma (NKTCL). Real-time quantitative PCR, immunocytochemistry and immunohistochemistry SP methods detected the levels of β-catenin, c-myc and cyclin D1 in human NKTCL cell lines (SNK-6 and YTS) and NKTCL tissues. Mutation analysis was detected in exon 3 of β-catenin gene; and we analyzed cell viability after histone deacetylase inhibitor (HDACi) treatment. As a result, 19 (38%) of NK/T-cell lymphoma displayed nuclear β-catenin and 16 (32%) contained mutations in exon 3; while no mutations were detected in lymphomas negative for β-catenin nuclear staining (p<0.05). Most mutations affecting β-catenin were adjacent to regulatory phosphorylation sites. β-catenin, c-myc and cyclin D1 were significantly elevated in SNK-6 and YTS cell lines compared to normal NK/T cells (p<0.05). Furthermore, the high expression of β-catenin, c-myc and cyclin D1 significantly correlated with the III/IV Ann Arbor stage. Additionally, the expression of β-catenin in the SNK-6 cell line decreased significantly after treatment with HDACi, and Kaplan-Meier survival analysis revealed that the elevated expression of β-catenin correlated with poor prognosis in NKTCL patients (23.66±2.77 months vs 31.65±1.78 months, p=0.023). In conclusion: mutations in exon 3 of β-catenin and the activated Wnt pathway are common in NK/T-cell lymphoma that has nuclear β-catenin, and it is closely correlated with the Ann Arbor stage and prognosis in NKTCL patients.

[Time-dependent Protein Expressions of MMP-2 and MMP-9 in Liver Contusion Rats after Impact]

OBJECTIVES

To observe the protein expression patterns of matrix metalloproteinase （MMP）-2 and MMP-9 in the liver tissue of liver contusion rats at different time after impact.

METHODS

Fifty healthy adult male SD rats were randomly and evenly divided into control group and experimental groups （1 h, 3 h, 6 h, 12 h, 18 h, 24 h, 3 d, 5 d, 7 d after liver contusion）. A rat liver contusion model was established by a free-falling device. The rats were killed at corresponding time, and the contused hepatic lobes were extracted. The protein expressions of MMP-2 and MMP-9 in contused liver tissue of the rats in each group were observed by immunohistochemical staining （SP method） and Western blotting.

RESULTS

After the liver contusion, the expression of positive cell and the protein semiquantitative result showed that the protein expression of MMP-2 enhanced at 6 h and peaked at 24 h, then decreased gradually at 3-5 d, and returned to normal levels at 7 d. The difference of expression between group and its previous adjacent group after 6 h （except 18 h） had statistical significance （P<0.05）. The protein expression of MMP-9 rose obviously at 1 h after liver contusion and peaked at 18 h, then decreased gradually at 3-7 d which still higher than control group. The expression difference between group and its previous adjacent group （except 12 h and 24 h） had statistical significance （P<0.05）.

CONCLUSIONS

The protein expressions of MMP-2 and MMP-9 in contused liver tissue after impact show good time-dependent patterns, which may provide important reference indicators for the time estimation of liver contusion.

[Forensic Analysis of 6 Cases of Sudden Death due to Hyperthyroid Heart Disease]

OBJECTIVES

To analyse the cases of sudden death due to hyperthyroid heart disease, and explore the general information of deaths and the forensic pathological characteristics to provide reference evidence for forensic identification of such cases.

METHODS

Six cases of sudden death due to hyperthyroid heart disease between 2001 and 2016 were selected from School of Forensic Medicine, China Medical University. The general information （gender and age）, clinical manifestations, medical history, anatomical and histopathological findings, biochemical parameters and cause of death were analysed retrospectively.

RESULTS

Most of the 6 patients had definite history of hyperthyroidism, and they all showed certain degrees of symptoms of cardiovascular disease; had obvious incentive factors of death; histopathological examination of thyroid conformed to the performances of diffuse toxic goiter; with increase of cardiac weight, dilatation of cardiac chambers, myocardial hypertrophy and focal necrosis; postmortem biochemical analyses of pericardial fluid could be used as an additional method for diagnostic of sudden death due to hyperthyroid heart disease.

CONCLUSIONS

The identification of death due to hyperthyroid heart disease should be based on the clinical history and the results of autopsy, histopathological examination, postmortem toxicology tests. The postmortem biochemical detection of thyroid and cardiac function should be performed if necessary.

Migration and invasion enhancer 1 (MIEN1) is overexpressed in breast cancer and is a potential new therapeutic molecular target

Migration and invasion enhancer 1 (MIEN1) is a membrane-anchored protein that is highly expressed in various types of cancer, and is correlated with the PI3K/AKT pathway. The aim of this study was to investigate the expression of MIEN1 and its clinical pathological significance in breast cancer. We used immunohistochemical staining to examine the expression of MIEN1 in 40 samples of human breast cancer tissue and 10 samples taken from regions adjacent to normal breast tissue. The rate of detection of MIEN1 protein was 67.5%, which was significantly higher than that in adjacent non-cancerous breast tissue (0%, P < 0.05). The expression of MIEN1 correlated with age, World Health Organization grade, and lymph node metastasis, but not with tumor size or family history of cancer. Kaplan-Meier survival analysis showed that patients with positive MIEN1 protein expression had a lower overall survival rate than patients who did not express MIEN1. Downregulation of MIEN1 suppressed the expression of matrix metallopeptidase 9 by downregulating the expression of protein kinase B (also known as AKT) in breast cancer cells. Our results indicate that MIEN1 overexpression may facilitate migration and invasion in breast cancer, and MIEN1 is a potential molecular target for cancer chemotherapy.

Comparison of the expression of human equilibrative nucleotide transporter 1 (hENT1) and ribonucleotide reductase subunit M1 (RRM1) genes in seven non-Hodgkin lymphoma cell lines

We investigated the variability in the expression of human equilibrative nucleoside transporter 1 (hENT1) and ribonucleotide reductase subunit M1 (RRM1) in non-Hodgkin lymphoma cell lines. hENT1 and RRM1 mRNA expression levels in natural killer (NK) cells and seven non-Hodgkin lymphoma cell lines (YTS, SNK-6, Jeko-1, ly-1, Raji, Karpas, and Jurket) were studied using reverse-transcription quantitative real-time polymerase chain reaction (RT-qPCR) and the results were compared using the Student t-test. mRNA expression of hENT1 was detectable in YTS, SNK-6, Jeko-1, ly-1, Raji, Karpas, Jurket, and NK cells, which revealed variability in gene expression. There were significant differences in the mRNA expression values of hENT1 (P = 0.021) and RRM1 (P = 0.002) compared to those in NK cells. mRNA expression of both hENT1 and RRM1 was closely associated with non-Hodgkin lymphoma cell proliferation. Differential expression analysis of hENT1 and RRM1 in non-Hodgkin lymphoma cell lines may provide novel drug leads for precision medicine.

Highly specific detection of genetic modification events using an enzyme-linked probe hybridization chip

The enzyme-linked probe hybridization chip utilizes a method based on ligase-hybridizing probe chip technology, with the principle of using thio-primers for protection against enzyme digestion, and using lambda DNA exonuclease to cut multiple PCR products obtained from the sample being tested into single-strand chains for hybridization. The 5'-end amino-labeled probe was fixed onto the aldehyde chip, and hybridized with the single-stranded PCR product, followed by addition of a fluorescent-modified probe that was then enzymatically linked with the adjacent, substrate-bound probe in order to achieve highly specific, parallel, and high-throughput detection. Specificity and sensitivity testing demonstrated that enzyme-linked probe hybridization technology could be applied to the specific detection of eight genetic modification events at the same time, with a sensitivity reaching 0.1% and the achievement of accurate, efficient, and stable results.

Effects of temperature and fish oil supplementation on ovarian development and foxl2 mRNA expression in spotted scat Scatophagus argus

In this study, the complete foxl2 complementary (c)DNA sequence was isolated by simple modular-architecture research tool (SMART)er rapid amplification of cDNA ends (RACE). Two year-old female spotted scat, Scatophagus argus, were reared at different temperatures (23, 26 and 29° C) for 6 weeks, or fed with different concentrations of dietary fish oil (0, 2 or 6%) for 8 weeks. Ovarian development, serum oestradiol-17β (E2 ) levels, as well as ovarian foxl2 expression were measured. At the end of experiment, ovarian foxl2 messenger (m)RNA expression in fish reared at 23 and 26° C was significantly higher than that in fish reared at 29° C, and that in 2 and 6% fish oil groups was also significantly higher than that in control group (P < 0·05). Serum E2 levels exhibited the same trend with foxl2 mRNA expression in temperature treatment groups and fish oil fed groups. There was a significant positive correlation between stage of oocytes and foxl2 expressions. Results showed that from 23 to 29° C, the optimal temperature for ovarian development in S. argus was 23-26° C, and 6% fish oil supplementation could effectively promote ovarian development. Optimal temperature and fish oil supplement might increase ovarian foxl2 mRNA expressions to promote ovarian development in S. argus.

Effect of PTEN antisense oligonucleotide on oesophageal squamous cell carcinoma cell lines

OBJECTIVE

To investigate the effects of a phosphatase and tensin homologue (PTEN) antisense oligonucleotide on PTEN and mammalian target of rapamycin (mTOR) mRNA and protein, cell proliferation and apoptosis in oesophageal squamous cell carcinoma (OCSS) cell lines.

METHODS

EC9706 and EC1 cells were transfected with PTEN antisense oligonucleotide, sense oligonucleotide or nonsense oligonucleotide. Cell proliferation and apoptosis were quantified. Immuno cyto chemistry and in situ hybridization were used to determine PTEN and mTOR protein and mRNA levels, respectively.

RESULTS

Transfection with PTEN antisense oligonucleotide dose- and time-dependently enhanced cell proliferation and inhibited apoptosis in both EC9706 and EC1 cells. PTEN mRNA and protein were significantly downregulated, and mTOR protein and mRNA were significantly upregulated.

CONCLUSION

These data suggest that PTEN is an important tumour suppressor gene in the development of OSCC.

Mechanistic target of rapamycin small interfering RNA and rapamycin synergistically inhibit tumour growth in a mouse xenograft model of human oesophageal carcinoma

OBJECTIVES

To investigate the effect of mechanistic target of rapamycin (mTOR)-specific small interfering RNA (siRNA) and rapamycin on tumour size and levels of hypoxia inducible factor 1α(HIF-1α), vascular endothelial growth factor (VEGF) and mTOR proteins, and mTOR mRNA, in a mouse xenograft model of human oesophageal carcinoma.

METHODS

Tumours were induced in BALB/c nude mice using the human oesophageal squamous cell carcinoma cell line, EC1, injected subcutaneously. Animals were divided into four treatment groups (n = 5 per group) after 7 days: control (phosphate buffered saline, daily intraperitoneal [i.p.] injection); 50 μg/kg rapamycin, daily i.p. injection; 3 μg/kg mTOR siRNA, daily i.p. injection; combined mTOR siRNA and rapamycin, daily i.p. injections. Tumour volume was measured 21 days after xenograft. Levels of mTOR, VEGF and HIF-1α were assessed via immunohistochemistry and in situ hybridization.

RESULTS

mTOR siRNA and/or rapamycin significantly decreased tumour volume and levels of HIF-1α, VEGF and mTOR protein, and mTOR mRNA. Combination treatment was significantly more effective than either treatment alone.

CONCLUSIONS

mTOR siRNA and/or rapamycin inhibited the growth of oesophageal carcinoma in vivo. This may represent a novel and effective treatment strategy for oesophageal carcinoma.

The maternal cytoplasmic environment may be involved in the viability selection of gametes and zygotes

Segregation distortion is the phenomenon whereby the observed genotypic frequencies of a locus fall outside the expected Mendelian segregation ratio, and it is increasingly recognised as a potentially powerful evolutionary force. The main reason for segregation distortion is a difference in the viability of gametes and zygotes caused by viability loci in the segregating progeny. However, the maternal cytoplasm may also be involved in the viability selection of gametes and zygotes. The objectives of this study were to map the segregation distortion loci (SDL) in maize and to test the hypothesis that the viability of gametes and zygotes may also be associated with the maternal cytoplasmic environment. In the present study, a reciprocal mating design was conducted to generate an F2-segregating population. A linkage map was constructed with 126 microsatellite markers. A whole-genome scan was performed to detect the SDL in segregating populations with different maternal cytoplasm environments. Altogether, 14 SDL with strong LOD (logarithm (base 10) of odds) supports were identified in the specifically designed F2 populations. Interestingly, we found dramatic changes in the genotypic frequencies of the SDL in the two maternal cytoplasmic backgrounds, which indicated a change in the viability of gametes and zygotes in different cytoplasmic environments. Furthermore, in the JB cytoplasmic background, most of the detected SDL and complete distortion markers exhibited similar bias patterns favouring the Y53 alleles. These results suggested that selfish cytoplasmic elements may have an important role in shaping the patterns of segregation distortion in F2 populations through selective viability of gametes and zygotes.

Comparative analyses of genetic/epigenetic diversities and structures in a wild barley species (Hordeum brevisubulatum) using MSAP, SSAP and AFLP

We analyzed genetic diversity and population genetic structure of four artificial populations of wild barley (Hordeum brevisubulatum); 96 plants collected from the Songnen Prairie in northeastern China were analyzed using amplified fragment length polymorphism (AFLP), specific-sequence amplified polymorphism (SSAP) and methylation-sensitive amplified polymorphism (MSAP) markers. Indices of (epi-)genetic diversity, (epi-)genetic distance, gene flow, genotype frequency, cluster analysis, PCA analysis and AMOVA analysis generated from MSAP, AFLP and SSAP markers had the same trend. We found a high level of correlation in the artificial populations between MSAP, SSAP and AFLP markers by the Mantel test (r > 0.8). This is incongruent with previous findings showing that there is virtually no correlation between DNA methylation polymorphism and classical genetic variation; the high level of genetic polymorphism could be a result of epigenetic regulation. We compared our results with data from natural populations. The population diversity of the artificial populations was lower. However, different from what was found using AFLP and SSAP, based on MSAP results the methylation polymorphism of the artificial populations was not significantly reduced. This leads us to suggest that the DNA methylation pattern change in H. brevisubulatum populations is not only related to DNA sequence variation, but is also regulated by other controlling systems.

The diagnostic accuracy of high-mobility group box 1 protein and twelve other markers in discriminating bacterial, viral and co-infected bronchial pneumonia in Han children

Pneumonia in children is common and can lead to grave consequences if not addressed in a proper and timely manner. In the management of pneumonia, early identification of the causative infective agent is of obvious importance for treatment, as it allows selection of the appropriate antibiotics. However, such identification requires laboratory test results, which may not be immediately available. The aim of this study was to evaluate the accuracy and usefulness of 13 markers in differentiating between viral and bacterial pneumonia in Han children (34 healthy controls and 78 patients). It was found that WBC counts were more accurate in diagnosis of the type of agent responsible for infection than was the degree of expression of HMGB1. Among the 13 markers investigated, HMGB1 was the best at discriminating between co-infected (bacterium and virus) and single-infected (bacterium or virus) children with bronchial pneumonia. HMGB1 expression of less than 1.0256, excluded most co-infections (the negative predictive value was greater than 89.7%). Diagnosed sole viral pneumonia clinically overlapped with bacterial pneumonia, but bacterial pneumonia was more often associated with higher white blood cell (WBC) counts (WBC ≥ 13,000 cells/mm(3)). When the two marker readouts--HMGB1 < 1.0256 and WBC ≥ 13,000 cells/mm(3)--were combined, the positive predictive value for bacterial pneumonia alone was 92.3%. These findings can help clinicians discriminate between bronchial pneumonia caused by virus, bacterium or both with a high specificity.

Pharmacokinetics of dexmedetomidine in Chinese post-surgical intensive care unit patients

BACKGROUND

Dexmedetomidine is a rather new drug in China. We sought to describe the pharmacokinetics of dexmedetomidine in patients requiring post-operative sedation and ventilation in our surgical intensive care unit.

METHODS

Twenty-two patients received post-operative infusions of dexmedetomidine at 6 μg/kg/h for 10 min, followed by 0.4 μg/kg/h for 350 min. Venous blood samples were drawn and assayed for plasma concentration. The pharmacokinetics were analysed using a nonlinear mixed-effect model with an interindividual and intraindividual error model. An initial estimation was performed to determine which of the one-, two- or three-compartment models is best to describe the concentration-time data. The covariates age, gender, weight, height, lean body mass (LBM), body surface area (BSA) and body mass index (BMI) were tested for significant effects on parameters using a stepwise forward addition and backward elimination approach. Covariate effects were judged based on changes in the objective function value (OFV).

RESULTS

The pharmacokinetics of dexmedetomidine were best described by a three-compartment model. The model was further improved when height was a covariate of systemic clearance (Cl1), with a decrease in OFV by -13.56 (P<0.01). From the heights of 155-178 cm, Cl1 increased by approximately 143%. The final pharmacokinetic parameter values were as follows: V1 =63.4 l, V2=41.3 l, V3 =284.3 l, Cl1=0.47×(height/160 cm)(6.42) l/min, Cl2=2.43 l/min and Cl3=0.086 l/min.

CONCLUSIONS

This study identified (i) the effect of height on the pharmacokinetics of dexmedetomidine; (ii) that there is no influence of age, gender, weight, LBM, BSA and BMI on pharmacokinetic parameters; and (iii) it established a preliminary population pharmacokinetic model for Chinese patients.

A comparison of liver function after hepatectomy with inflow occlusion between sevoflurane and propofol anesthesia

BACKGROUND

In this study, we compared liver function tests after hepatectomy with inflow occlusion as a function of propofol versus sevoflurane anesthesia.

METHODS

One hundred patients undergoing elective liver resection with inflow occlusion were randomized into a sevoflurane group or a propofol group. General anesthesia was induced with 3 μg/kg fentanyl, 0.2 mg/kg cisatracurium, and target-controlled infusion of propofol, set at a plasma target concentration of 4 to 6 μg/mL, or sevoflurane initially started at 8%. Anesthesia was maintained with target-controlled infusion of propofol (2-4 μg/mL) or sevoflurane (1.5%-2.5%). The primary end point was postoperative liver injury assessed by peak values of liver transaminases.

RESULTS

Transaminase levels peaked between the first and the third postoperative day. Peak alanine aminotransferase was 504 and 571 U/L in the sevoflurane group and the propofol group, respectively. Peak aspartate aminotransferase was 435 U/L after sevoflurane and 581 U/L in the propofol group. There were no significant differences in peak alanine aminotransferase or peak aspartate aminotransferase between groups. Other liver function tests including bilirubin and alkaline phosphatase, and peak values of white blood cell counts and creatinine, were also not different between groups.

CONCLUSIONS

Sevoflurane and propofol anesthetics resulted in similar patterns of liver function tests after hepatectomy with inflow occlusion. These data suggest that the 2 anesthetics are equivalent in this clinical context.

The effects of obstructive jaundice on the pharmacodynamics of propofol: does the sensitivity of intravenous anesthetics change among icteric patients?

BACKGROUND

Some studies suggest that certain clinical symptoms of cholestasis, such as fatigue and pruritus, result from altered neurotransmission. Patients with obstructive jaundice also have labile blood pressure and heart rate. In the present study, the authors investigated whether obstructive jaundice affects a patient's sensitivity to hypnotics and the haemodynamic profile of propofol.

METHODS

Thirty-six ASA physical status I/II/III patients with serum total bilirubin (TBL) from 7.8 to 362.7 micromol/l scheduled for bile duct surgery were recruited. A computer-controlled propofol infusion programmed for effect site target was used to rapidly attain and maintain sequential increase of the compartment concentration (from 1 to 3 microg/ml). Each target-controlled concentration was maintained for about 12 min, and arterial blood samples were drawn for propofol concentration determination. The bispectral index (BIS) and mean arterial pressures (MAP) were used as indices of the propofol effect. The relation between the concentration and the effects was described by the Hill equation. The pharmacodynamic parameters were optimized using a nonlinear mixed-effect model.

RESULTS

TBL was not a significant covariate of EC(50) for the pharmacodynamic model. For BIS and MAP, the parameters of the pharmacodynamic model were E(max)=75.77%, EC(50)=2.34 microg/ml, and gamma=1.82, and E(max)=47.83%, EC(50)=1.49 microg/ml, and gamma=1.88, respectively.

CONCLUSIONS

We demonstrated that obstructive jaundice with serum TBL from 7.8 to 362.7 micromol/l had no effect on propofol pharmacodynamics observed by BIS and MAP.

Prevalence and molecular diversity of Archaea in subgingival pockets of periodontitis patients

INTRODUCTION

The aim of this study was to investigate the prevalence and molecular diversity of Archaea in the subgingival crevices of patients with chronic periodontitis.

METHODS

Subgingival plaque was collected from 41 patients with chronic periodontitis and 15 healthy subjects. The prevalence of Archaea in those plaque samples was tested by polymerase chain reaction with two broad-range archaeal primer sets. Amplicons from eight Archaea-positive plaque samples were cloned and sequenced for molecular diversity analysis using one of these two primer sets and a novel third primer set.

RESULTS

Archaea were detected in the subgingival plaque of patients with chronic periodontitis at a prevalence of 70.7-73.2%, but were not detected in healthy subjects. Using one primer set, all sequences of the archaeal amplicons were identified as Methanobrevibacter oralis-like species. With another primer set, the amplicons were also found to be identical to the uncultured M. oralis-like species except one phylotype was found to belong to the class Thermoplasmata.

CONCLUSION

Archaea might be correlated with periodontal diseases. The diversity of Archaea associated with periodontitis was limited. Almost all sequenced amplicons fell into the genus Methanobrevibacter of the Euryarcheota phylum. M. oralis-like species was the predominant but non-exclusive archaeon in the subgingival dental plaque of patients with periodontitis.

Predictors of atypical birefringence pattern in scanning laser polarimetry

AIM

To evaluate predictors of atypical birefringence patterns (ABP) observed in scanning laser polarimetry.

METHODS

A total of 179 eyes from 82 normal subjects and 97 glaucoma patients were included. The retinal nerve fibre layer in each eye was imaged sequentially with GDx variable corneal compensation (VCC) and GDx enhanced corneal compensation (ECC) (Carl Zeiss Meditec, Dublin, California). The associations between the typical scan score (TSS) and age, axial length, spherical error, parapapillary atrophy (PPA) and visual-field mean deviation (MD) were evaluated with univariate and multivariate regression analyses.

RESULTS

23.5% (42/179) and 5.0% (9/179) of subjects had ABP (TSS<80) with GDx VCC and GDx ECC, respectively. For both GDx VCC and ECC, the TSS was significantly correlated with age, axial length, spherical error and PPA, but not with visual-field MD. After adjusting the effect of covariates, the axial length/spherical error and PPA were significantly associated with GDx VCC TSS, whereas the axial length/spherical error was the only predictor for GDx ECC TSS. Myopic eyes were more likely to develop ABP in both GDx VCC and ECC.

CONCLUSIONS

Axial length or spherical error is a significant predictor for ABP with both GDx VCC and GDx ECC. Caution should be exercised in interpreting the results of scanning laser polarimetry in eyes with a long axial length or myopia.

Mismatch repair gene mutations in Chinese HNPCC patients

To explore the characteristics of DNA mismatch repair gene mutations in Chinese patients with hereditary non-polyposis colorectal cancer (HNPCC) or Lynch syndrome, the MLH1 and MSH2 genes from probands of 76 HNPCC families were sequenced. By doing so, two frame-shift mutations, three splice-site mutations and fourteen missense mutations (thirteen missense mutations and one nonsense mutation) were identified in the MLH1 gene. In addition, one splice-site mutation and six missense mutations were detected in the MSH2 gene. None of these mutations were detected in 100 matched healthy controls. The remaining mutation-negative cases were subjected to large fragment deletion analysis using multiplex ligation-dependent probe amplification (MLPA). By doing so, five large fragment deletions were detected in the MSH2 gene. No large fragment deletions were detected in the MLH1 gene. We conclude that the MLH1 and MSH2 genes in Chinese HNPCC families exhibit broad mutation spectra.

Differential roles of phosphatidylinositol 3-kinase/akt pathway in retinal ganglion cell survival in rats with or without acute ocular hypertension

Intraocular pressure (IOP) elevation has often been used as an experimental model to study mechanisms underlying retinal ganglion cell (RGC) death associated with ocular ischemic injury and glaucoma. The aim of the present study, using both in vitro and in vivo approaches, was to investigate the role of phosphatidylinositol 3-kinase (PI3K)/akt pathway in RGC viability in normal rats and rats following transient IOP elevation. For in vivo studies, pathway inhibitors were administered intravitreally on days 3, 9, and 15 post-2-h IOP elevation at 110 mm Hg. Toward the end of the 3-week examination period, the fluorescent dye Fluorogold was used to retrogradely label surviving RGCs. In order to examine the role of macrophages that were recruited into the eye following the pathway inhibition, clodronate liposomes were used to deplete phagocytic cells in the eye. PI3K/akt pathway activity and location in the retina were examined using Western blot and immunohistochemistry, respectively. Here we showed that PI3K/akt inhibitors 2-(4-morpholinyl)-8-phenyl-1(4H)-benzopyran-4-one hydrochloride (LY294002) and KY12420 at low concentrations (2 microM or 20 microM) did not influence RGC survival but caused RGC loss at high concentration (200 muM) in retinal explants derived from intact rats. In contrast, both LY294002 and KY12420 at 20 microM led to RGC loss in retinal explants derived from IOP-elevated eyes. A detrimental action of phagocytic cells on RGC survival was also seen in these retinas. In vivo results confirmed the detrimental actions of PI3K/akt inhibition and macrophages on RGC survival in IOP-elevated, but not intact eyes even with high concentration of LY294002. Low level of PI3K/akt activity was detected in the ganglion cell layer (GCL) in intact retina. Acute IOP elevation activated PI3K/akt pathway in the inner nuclear layer and GCL including RGCs. This study thus demonstrates that PI3K/akt pathway mediates RGC survival after IOP elevation but not under normal condition.

A comparison between bispectral index analysis and auditory-evoked potentials for monitoring the time to peak effect to calculate the plasma effect site equilibration rate constant of propofol

BACKGROUND AND OBJECTIVES

To the best of our knowledge, the value of the plasma effect site equilibration rate constant (k(e0)) of propofol has not been reported in Chinese patients. The aim of this prospective, randomized study was to examine the characteristics of the time to peak effect (T(PEAK)) of propofol, a pharmacokinetic-independent descriptor of blood-brain equilibration, and k(e0) derived from T(PEAK) with A-line auditory-evoked potential monitor and Aspect A-2000 bispectral index monitor in Chinese patients.

METHODS

Two-hundred ASA I patients received a submaximal bolus dose of propofol (1.5 mg kg(-1)). T(PEAK) was randomly measured by means of the A-line auditory-evoked potential monitor (Group AAI (auditory-evoked potential index), n = 100) or the Aspect A-2000 bispectral index monitor (Group BIS, n = 100). Using T(PEAK) and four previously validated pharmacokinetic parameter sets of propofol, the k(e0) was estimated according to a method proposed recently.

RESULTS

The mean T(PEAK) was 145 +/- 35 s (50-224 s) and 74+/-24 s (38-143 s) in Groups AAI and BIS, respectively (P < 0.01 between groups). There were no correlations between the patient's age and T(PEAK)s (r = 0.147 and 0.031 for Groups AAI and BIS). The median k(e0) in Group AAI was 0.64 min(-1) with the model of Marsh, 0.17 min(-1) with the Schnider model, 0.78 min(-1) with the Tackley model and 0.93 min(-1) with the Shafer model. The median k(e0) in Group BIS was 1.87 min(-1) with the model of Marsh, 0.83 min(-1) with the Schnider model, 2.14 min(-1) with the Tackley model and 2.48 min(-1) with the Shafer model (P < 0.01 between groups and models).

CONCLUSIONS

The T(PEAK) of propofol measured by the A-line auditory-evoked potential monitor is different from that measured by the Aspect A-2000 bispectral index monitor. The T(PEAK)s of propofol from auditory-evoked potential index and bispectral index, and the values of k(e0) calculated based on T(PEAK)s are different from previous reports and appear to be not affected by age. Further studies need to be taken to validate clinically the k(e0) values of propofol.

Cyclooxygenase-2 and the renal renin-angiotensin system

In the kidney, cyclooxygenase-2 (COX-2) is expressed in the macula densa/cTALH and medullary interstitial cells. The macula densa is involved in regulating afferent arteriolar tone and renin release by sensing alterations in luminal chloride via changes in the rate of Na(+)/K(+)/2Cl(-) cotransport, and administration of non-specific cyclooxygenase inhibitors will blunt increases in renin release mediated by macula densa sensing of decreases in luminal NaCl. High renin states [salt deficiency, angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers, diuretic administration or experimental renovascular hypertension] are associated with increased macula densa/cTALH COX-2 expression. Furthermore, there is evidence that angiotensin II and/or aldosterone may inhibit COX-2 expression. In AT1 receptor knockout mice, COX-2 expression is increased similar to increases with ACE inhibitors or AT1 receptor blockers. Direct administration of angiotensin II inhibits macula densa COX-2 expression. Previous studies demonstrated that alterations in intraluminal chloride concentration are the signal for macula densa regulation of tubuloglomerular feedback and renin secretion, with high chloride stimulating tubuloglomerular feedback and low chloride stimulating renin release. When cultured cTALH or macula densa cells were incubated in media with selective substitution of chloride ions, COX-2 expression and prostaglandin production were significantly increased. A variety of studies have indicated a role for COX-2 in the macula densa mediation of renin release. In isolated perfused glomerular preparations, renin release induced by macula densa perfusion with a low chloride solution was inhibited by a COX-2 inhibitor but not a COX-1 inhibitor. In vivo studies in rats indicated that increased renin release in response to low-salt diet, ACE inhibitor, loop diuretics or aortic coarctation could be inhibited by administration of COX-2-selective inhibitors. In mice with genetic deletion of COX-2, ACE inhibitors or low-salt diet failed to increase renal renin expression, although renin significantly increased in wild type mice. In contrast, in COX-1 null mice there were no significant differences in either the basal or ACE inhibitor-stimulated level of renal renin activity from plasma or renal tissue compared with wild type mice. In summary, there is increasing evidence that COX-2 expression in the macula densa and surrounding cortical thick ascending limb cells is regulated by angiotensin II and is a modulator of renal renin production. These interactions of COX-2 derived prostaglandins and the renin-angiotensin system may underlie physiological and pathophysiological regulation of renal function.

[Syndrome differentiation patterns for peri-operative coronary heart disease patients of coronary artery bypass graft]

OBJECTIVE

To explore the patterns of Syndrome Differentiation of coronary artery bypass graft (CABG) on the peri-operative coronary heart disease (CHD) patients.

METHODS

One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphenous vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, the pre- and post-operational ECG, color Doppler echocardiography as well as during and after operation. The hemodynamic parameters were monitored.

RESULTS

In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with Phlegm Syndrome and 62.2% with Stasis in blood, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenesis in patients after CABG. Moreover, the peri-operative Syndrome was correlated with the condition of coronary arterial lesions, heart and lung functions before operation, and the time for extracorporeal circulation during the operation.

CONCLUSION

TCM Syndrome Differentiation conducting in peri-operative stage might be useful to explore the patterns of Syndrome alteration which provided a basis for preventing peri-operational complication and elevating success rate of operation.

Near-work activity and myopia in rural and urban schoolchildren in China

PURPOSE

To examine the prevalence of myopia in rural and urban schoolchildren in Xiamen, China, and to assess the impact of environmental factors on rates of myopia.

METHODS

Second-grade children attending either a city (n=119) or rural (n=91) school in Xiamen, China, were examined using cycloplegic autorefraction and biometry. Detailed questions on socioeconomic status, near-work activity, reading and writing habits, and family histories of myopia were asked in a face-to-face interview using a standard questionnaire.

RESULTS

The prevalence of myopia was 19.3% (95% confidence interval [CI], 12.3, 29) in the city and 6.6% (95% CI, 2.4, 14.3) in the countryside. The average hours per day children spent reading and writing outside of school was 2.2 hours in the city compared with 1.6 hours in the countryside (P<.0001). In both schools, the odds ratio for total reading and writing, adjusted for parental history of myopia, was 2.2 (95% CI, 1.1, 4).

CONCLUSION

These data suggest the prevalence of myopia is higher in the city than in the countryside. One possible explanation for these different rates could be that schoolchildren in the city spend more time reading and writing outside of school compared with children in the countryside. Myopic children in both the city and the countryside spent more time reading and writing compared with nonmyopic children. This increased near-work activity may contribute to the prevalence of myopia.

Genetic deletion of COX-2 prevents increased renin expression in response to ACE inhibition

Cyclooxygenase-2 (COX-2) is expressed in macula densa (MD) and surrounding cortical thick ascending limb of the loop of Henle (cTALH) and is involved in regulation of renin production. We and others have previously found that selective COX-2 inhibitors can inhibit renal renin production (Cheng HF, Wang JL, Zhang MZ, Miyazaki Y, Ichikawa I, McKanna JA, and Harris RC. J Clin Invest 103: 953-961, 1999; Harding P, Sigmon DH, Alfie ME, Huang PL, Fishman MC, Beierwaltes WH, and Carretero OA. Hypertension 29: 297-302, 1997; Traynor TR, Smart A, Briggs JP, and Schnermann J. Am J Physiol Renal Physiol 277: F706-F710, 1999; Wang JL, Cheng HF, and Harris RC. Hypertension 34: 96-101, 1999). In the present studies, we utilized mice with genetic deletions of the COX-2 gene in order to investigate further the potential role of COX-2 in mediation of the renin-angiotensin system (RAS). Age-matched wild-type (+/+), heterozygotes (+/-), and homozygous null mice (-/-) were administered the angiotensin-converting enzyme inhibitor (ACEI), captopril, for 7 days. ACEI failed to significantly increase plasma renin activity, renal renin mRNA expression, and renal renin activity in (-/-) mice. ACEI increased the number of cells expressing immunoreactive renin in the (+/+) mice both by inducing more juxtaglomerular cells to express immunoreactive renin and by recruiting additional renin-expressing cells in the more proximal afferent arteriole. In contrast, there was minimal recruitment of renin-expressing cells in the more proximal afferent arteriole of the -/- mice. In summary, these results indicate that ACEI-mediated increases in renal renin production were defective in COX-2 knockout (K/O) mice and provide further indication that MD COX-2 is an important mediator of the renin-angiotensin system.

Boron neutron capture therapy of brain tumors: biodistribution, pharmacokinetics, and radiation dosimetry sodium borocaptate in patients with gliomas

OBJECTIVE

The purpose of this study was to obtain tumor and normal brain tissue biodistribution data and pharmacokinetic profiles for sodium borocaptate (Na2B12H11SH) (BSH), a drug that has been used clinically in Europe and Japan for boron neutron capture therapy of brain tumors. The study was performed with a group of 25 patients who had preoperative diagnoses of either glioblastoma multiforme (GBM) or anaplastic astrocytoma (AA) and were candidates for debulking surgery. Nineteen of these patients were subsequently shown to have histopathologically confirmed diagnoses of GBM or AA, and they constituted the study population.

METHODS

BSH (non-10B-enriched) was infused intravenously, in a 1-hour period, at doses of 15, 25, and 50 mg boron/kg body weight (corresponding to 26.5, 44.1, and 88.2 mg BSH/kg body weight, respectively) to groups of 3, 3, and 13 patients, respectively. Multiple samples of tumor tissue, brain tissue around the tumors, and normal brain tissue were obtained at either 3 to 7 or 13 to 15 hours after infusion. Blood samples for pharmacokinetic studies were obtained at times up to 120 hours after termination of the infusion. Sixteen of the patients underwent surgery at the Beijing Neurosurgical Institute and three at The Ohio State University, where all tissue samples were subsequently analyzed for boron content by direct current plasma-atomic emission spectroscopy.

RESULTS

Blood boron values peaked at the end of the infusion and then decreased triexponentially during the 120-hour sampling period. At 6 hours after termination of the infusion, these values had decreased to 20.8, 29.1, and 62.6 microg/ml for boron doses of 15, 25, and 50 mg/kg body weight, respectively. For a boron dose of 50 mg/kg body weight, the maximum (mean +/- standard deviation) solid tumor boron values at 3 to 7 hours after infusion were 17.1+/-5.8 and 17.3+/-10.1 microg/g for GBMs and AAs, respectively, and the mean tumor value averaged across all samples was 11.9 microg/g for both GBMs and AAs. In contrast, the mean normal brain tissue values, averaged across all samples, were 4.6+/-5.1 and 5.5+/-3.9 microg/g and the tumor/normal brain tissue ratios were3.8 and 3.2 for patients with GBMs and AAs, respectively. The large standard deviations indicated significant heterogeneity in uptake in both tumor and normal brain tissue. Regions histopathologically classified either as a mixture of tumor and normal brain tissue or as infiltrating tumor exhibited slightly lower boron concentrations than those designated as solid tumor. After a dose of 50 mg/kg body weight, boron concentrations in blood decreased from 104 microg/ml at 2 hours to 63 microg/ml at 6 hours and concentrations in skin and muscle were 43.1 and 39.2 microg/g, respectively, during the 3- to 7-hour sampling period.

CONCLUSION

When tumor, blood, and normal tissue boron concentrations were taken into account, the most favorable tumor uptake data were obtained with a boron dose of 25 mg/kg body weight, 3 to 7 hours after termination of the infusion. Although blood boron levels were high, normal brain tissue boron levels were almost always lower than tumor levels. However, tumor boron concentrations were less than those necessary for boron neutron capture therapy, and there was significant intratumoral and interpatient variability in the uptake of BSH, which would make estimation of the radiation dose delivered to the tumor very difficult. It is unlikely that intravenous administration of a single dose of BSH would result in therapeutically useful levels of boron. However, combining BSH with boronophenylalanine, the other compound that has been used clinically, and optimizing their delivery could increase tumor boron uptake and potentially improve the efficacy of boron neutron capture therapy.