Descriptive study of COVID-19 vaccinations and infections within an NHS workforce

BACKGROUND

Healthcare workers were a priority group for coronavirus disease 2019 (COVID-19) vaccination during the pandemic. Occupational exposure may account for some of the increased risk faced.

AIMS

Describe COVID-19 vaccine uptake and infection rates in staff across a large NHS board in Scotland to better understand occupational risk during the pandemic.

METHODS

Descriptive cross-sectional study. Demographic data were extracted on 5 August 2021 from 26 058 members of staff. COVID-19 vaccination status and positive polymerase chain reaction (PCR) results were extracted on two separate dates to describe the timeline of staff infections between March 2020 and January 2022.

RESULTS

There was high uptake of all three vaccine doses across all demographic groups in hospital staff. PCR positivity decreased with increasing age and Scottish Index of Multiple Deprivation score. Staff and nosocomial COVID-19 infections followed peaks in community infection rates.

CONCLUSIONS

NHS Lothian is a typical NHS workforce with good vaccine uptake. Beyond very early cases, there seems to be minimal evidence of occupational acquisition of COVID-19. The large number of nosocomial infections at the start of the pandemic may, in fact, reflect lack of community testing at this time. Despite protection from high vaccine coverage, job type and good Infection Prevention and Control practices, it seems that staff remain at high risk of catching the highly transmissible omicron variant from the community rather than work.

GART Functions as a Novel Methyltransferase in the RUVBL1/β-Catenin Signaling Pathway to Promote Tumor Stemness in Colorectal Cancer

Tumor stemness is associated with the recurrence and incurability of colorectal cancer (CRC), which lacks effective therapeutic targets and drugs. Glycinamide ribonucleotide transformylase (GART) fulfills an important role in numerous types of malignancies. The present study aims to identify the underlying mechanism through which GART may promote CRC stemness, as to developing novel therapeutic methods. An elevated level of GART is associated with poor outcomes in CRC patients and promotes the proliferation and migration of CRC cells. CD133+ cells with increased GART expression possess higher tumorigenic and proliferative capabilities both in vitro and in vivo. GART is identified to have a novel methyltransferase function, whose enzymatic activity center is located at the E948 site. GART also enhances the stability of RuvB-like AAA ATPase 1 (RUVBL1) through methylating its K7 site, which consequently aberrantly activates the Wnt/β-catenin signaling pathway to induce tumor stemness. Pemetrexed (PEM), a compound targeting GART, combined with other chemotherapy drugs greatly suppresses tumor growth both in a PDX model and in CRC patients. The present study demonstrates a novel methyltransferase function of GART and the role of the GART/RUVBL1/β-catenin signaling axis in promoting CRC stemness. PEM may be a promising therapeutic agent for the treatment of CRC.

Inhibition of VCP modulates NF-κB signaling pathway to suppress multiple myeloma cell proliferation and osteoclast differentiation

Multiple myeloma (MM) is the second most common hematological malignancy, in which the dysfunction of the ubiquitin-proteasome pathway is associated with the pathogenesis. The valosin containing protein (VCP)/p97, a member of the AAA+ ATPase family, possesses multiple functions to regulate the protein quality control including ubiquitin-proteasome system and molecular chaperone. VCP is involved in the occurrence and development of various tumors while still elusive in MM. VCP inhibitors have gradually shown great potential for cancer treatment. This study aims to identify if VCP is a therapeutic target in MM and confirm the effect of a novel inhibitor of VCP (VCP20) on MM. We found that VCP was elevated in MM patients and correlated with shorter survival in clinical TT2 cohort. Silencing VCP using siRNA resulted in decreased MM cell proliferation via NF-κB signaling pathway. VCP20 evidently inhibited MM cell proliferation and osteoclast differentiation. Moreover, exosomes containing VCP derived from MM cells partially alleviated the inhibitory effect of VCP20 on cell proliferation and osteoclast differentiation. Mechanism study revealed that VCP20 inactivated the NF-κB signaling pathway by inhibiting ubiquitination degradation of IκBα. Furthermore, VCP20 suppressed MM cell proliferation, prolonged the survival of MM model mice and improved bone destruction in vivo. Collectively, our findings suggest that VCP is a novel target in MM progression. Targeting VCP with VCP20 suppresses malignancy progression of MM via inhibition of NF-κB signaling pathway.

Dietary Total Antioxidant Capacity and Cognitive Function in Older Adults in the United States: The NHANES 2011-2014

OBJECTIVES

Oxidative stress level takes part in the development of cognitive decline. However, the association between total antioxidant capacity (TAC) from diet and cognitive function is controversial. The aim of this study was to investigate the relationship between TAC and the cognitive function of older adults in the U.S.

DESIGN

A cross-sectional study.

SETTING

National Health and Nutrition Examination Surveys database.

PARTICIPANTS

2712 older adults aged over 60 years.

MEASUREMENTS

TAC was calculated from 8 antioxidative vitamins based on the reference values for vitamin C equivalent antioxidant capacity obtained from individuals' 24 h dietary recall. Four memory-related assessments were employed [Immediate Recall test (IRT), Delayed Recall test (DRT), Animal Fluency test (AFT), and Digit Symbol Substitution test (DSST)].

RESULTS

Among the 2712 participants, the median age was 68 years, and 50.4% were women. Participants in the group with higher TAC levels had relatively higher IRT, AFT and DSST scores (P=0.025, P=0.008, P<0.001, respectively). In adjusted weighted linear regression, log-transformed TAC was positively associated with AFT (β=1.10, 95%CI: 0.51, 1.70) and DSST (β=2.81, 95%CI: 1.16, 4.45). Compared with the first quartile, the participants in the second (Q2 vs. Q1, OR=0.66, 95%CI: 0.43,1.02) and fourth quartile (Q4 vs. Q1, OR=0.47, 95%CI:0.28, 0.78) of log-transformed TAC showed a decreased risk of impaired cognitive function (ICF) after adjusting for confounders. The dose-response analysis indicated a gradual descent in the risk of ICF as TAC increases. Diabetes mellitus (DM) mediated part of the effect of TAC on ICF. The relationship between TAC and ICF was more pronounced in subjects with DM (Q4 vs Q1, OR=0.36, 95%CI:0.17, 0.74).

CONCLUSION

Our findings support that higher dietary antioxidant potential was related to a decreased risk of cognitive dysfunction, particularly in the subjects with DM who may have oxidative injury. DM was one of the factors mediating the effect of TAC on ICF.

G6PD promotes cell proliferation and dexamethasone resistance in multiple myeloma via increasing anti-oxidant production and activating Wnt/β-catenin pathway

Background

Glucose-6-phosphate dehydrogenase (G6PD) as the rate-limiting enzyme in the pentose phosphate pathway (PPP) is well-established as an aberrantly expressed protein in numerous clinical diseases; however, its role in cancer, specifically in multiple myeloma (MM) remains elusive.

Methods

In this study, serum metabolites in 70 normal people and 70 newly diagnosed MM patients were analyzed using untargeted metabolomics and the results were verified using ELISA. The survival analysis of multiple clinical datasets was performed to identify a potential target gene in MM. The oncogenic role of G6PD was investigated using lentivirus-based overexpression or knockdown of G6PD using RNAi or an inhibitor in vitro, and in a xenograft mouse model in vivo. The mechanisms of induced Dexamethasone (Dexa)-resistance of G6PD were further explored using the above established MM cell lines in vitro.

Results

Based on the screening of potential genes, PPP was shown to be involved in the occurrence of MM, which was evidenced by the differential expression of serum metabolites of G6P and Dehydroepiandrosterone sulfate (DHEAS, the more stable sulfate ester form of an endogenously uncompetitive G6PD inhibitor known as DHEA). Elevated G6PD promoted MM cell proliferation. Mechanistically, high G6PD expression enhanced enzymatic generation of the antioxidant NADPH via the PPP and decreased the production of reactive oxygen species (ROS), thus inducing the proliferation and Dexa resistance in MM cells. Furthermore, canonical Wnt/β-catenin signaling also participated in regulating G6PD-induced drug resistance and cellular redox levels of ROS. Intriguingly, DHEA treatment could enhance the sensitivity of MM cells to Dexa primarily through augmenting cellular oxidative stress.

Conclusions

Our data demonstrate that G6PD enhances the generation of the enzymatic anti-oxidant NADPH and decreases ROS generation, thereby promoting resistance to Dexa-induced apoptosis via the enzymatic PPP and non-enzymatic Wnt/β-catenin signaling pathway in MM. Targeting G6PD to harness cellular redox may serve as a promising novel strategy for the management of MM.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40164-022-00326-6.

Untargeted serum metabolomics reveals specific metabolite abnormalities in patients with Crohn's disease

Crohn's disease (CD) is a subtype of inflammatory bowel disease (IBD) characterized by skip intestinal lesions that can occur in any part of the gastrointestinal tract. Currently, the diagnosis of CD is based on clinical history, physical examination and complementary diagnostic tests. It is challenging for physicians to make a definitive diagnosis. This study aimed to analyze the variation in metabolites in CD serum and identify potential predictive biomarkers of CD diagnosis. We collected serum samples from 316 subjects, including patients with CD and healthy controls (HCs). Serum metabolomics was conducted using liquid chromatography coupled to mass spectrometry. Potential biomarkers were screened and evaluated by univariate and multivariate analyses. A panel of two metabolites (deoxycholic acid and palmitic amide) was identified as a specific biomarker of CD. Receiver operating characteristic analysis (ROC) showed that the panel had a sensitivity of 80.25% with a specificity of 95.54% in discriminating CD patients from healthy controls. The biomarkers identified are increased in CD compared with healthy controls. Our approach successfully identified serum biomarkers associated with CD patients. The potential biomarkers indicated that CD metabolic disturbance might be associated with bile acid biosynthesis, fatty acids and energy metabolism.

Lipidomics Reveals Serum Specific Lipid Alterations in Diabetic Nephropathy

In diabetes mellitus (DM), disorders of glucose and lipid metabolism are significant causes of the onset and progression of diabetic nephropathy (DN). However, the exact roles of specific lipid molecules in the pathogenesis of DN remain unclear. This study recruited 577 participants, including healthy controls (HCs), type-2 DM (2-DM) patients, and DN patients, from the clinic. Serum samples were collected under fasting conditions. Liquid chromatography-mass spectrometry-based lipidomics methods were used to explore the lipid changes in the serum and identify potential lipid biomarkers for the diagnosis of DN. Lipidomics revealed that the combination of lysophosphatidylethanolamine (LPE) (16:0) and triacylglycerol (TAG) 54:2-FA18:1 was a biomarker panel for predicting DN. The receiver operating characteristic analysis showed that the panel had a sensitivity of 89.1% and 73.4% with a specificity of 88.1% and 76.7% for discriminating patients with DN from HCs and 2-DM patients. Then, we divided the DN patients in the validation cohort into microalbuminuria (diabetic nephropathy at an early stage, DNE) and macroalbuminuria (diabetic nephropathy at an advanced stage, DNA) groups and found that LPE(16:0), phosphatidylethanolamine (PE) (16:0/20:2), and TAG54:2-FA18:1 were tightly associated with the stages of DN. The sensitivity of the biomarker panel to distinguish between patients with DNE and 2-DM, DNA, and DNE patients was 65.6% and 85.9%, and the specificity was 76.7% and 75.0%, respectively. Our experiment showed that the combination of LPE(16:0), PE(16:0/20:2), and TAG54:2-FA18:1 exhibits excellent performance in the diagnosis of DN.

Serum metabolomic and lipidomic profiling identifies diagnostic biomarkers for seropositive and seronegative rheumatoid arthritis patients

BACKGROUND

Diagnosing seronegative rheumatoid arthritis (RA) can be challenging due to complex diagnostic criteria. We sought to discover diagnostic biomarkers for seronegative RA cases by studying metabolomic and lipidomic changes in RA patient serum.

METHODS

We performed comprehensive metabolomic and lipidomic profiling in serum of 225 RA patients and 100 normal controls. These samples were divided into a discovery set (n = 243) and a validation set (n = 82). A machine-learning-based multivariate classification model was constructed using distinctive metabolites and lipids signals.

RESULTS

Twenty-six metabolites and lipids were identified from the discovery cohort to construct a RA diagnosis model. The model was subsequently tested on a validation set and achieved accuracy of 90.2%, with sensitivity of 89.7% and specificity of 90.6%. Both seropositive and seronegative patients were identified using this model. A co-occurrence network using serum omics profiles was built and parsed into six modules, showing significant association between the inflammation and immune activity markers and aberrant metabolism of energy metabolism, lipids metabolism and amino acid metabolism. Acyl carnitines (20:3), aspartyl-phenylalanine, pipecolic acid, phosphatidylethanolamine PE (18:1) and lysophosphatidylethanolamine LPE (20:3) were positively correlated with the RA disease activity, while histidine and phosphatidic acid PA (28:0) were negatively correlated with the RA disease activity.

CONCLUSIONS

A panel of 26 serum markers were selected from omics profiles to build a machine-learning-based prediction model that could aid in diagnosing seronegative RA patients. Potential markers were also identified in stratifying RA cases based on disease activity.

Acupuncture Synergized With Bortezomib Improves Survival of Multiple Myeloma Mice via Decreasing Metabolic Ornithine

Multiple myeloma (MM) is a hematological malignancy worldwide in urgent need for novel therapeutic strategies. Since Velcade (bortezomib) was approved for the treatment of relapsed/refractory MM in 2003, we have seen considerable improvement in extending MM patient survival. However, most patients are fraught with high recurrence rate and incurability. Acupuncture is known for alleviating patient symptoms and improving the quality of life, but it is not well investigated in MM, especially in combination with bortezomib. In this study, we employed LC-MS and UHPLC-MS together with bioinformatics methods to test serum samples from 5TMM3VT MM murine model mice with four different treatments [control (C) group, bortezomib (V) treatment group, acupuncture (A) group, and combined (VA) group]. MM mice in group VA had longer survival time than mice in group A or group V. Joint pathway analysis indicated the underlying arginine and proline metabolism pathway among the 32 significantly decreased metabolites in group VA. CCK-8 assay and in vivo experiments validated that ornithine, the metabolite of arginine, promoted MM cell proliferation. In addition, gene expression omnibus (GEO) database analysis suggested that MM patients with higher ornithine decarboxylase 1 (ODC1) expression were evidently associated with poor overall survival. In summary, this study demonstrates the synergistic effects of acupuncture and bortezomib on extending the survival of MM model mice and provides potential therapeutic targets in the treatment of MM.

Untargeted serum metabolomics and potential biomarkers for Sjögren's syndrome

OBJECTIVES

At present, the pathogenesis of Sjögren's syndrome (SS) remains unclear. This research aimed to identify differential metabolites that contribute to SS diagnosis and discover the disturbed metabolic pathways.

METHODS

Recent advances in mass spectrometry have allowed the identification of hundreds of unique metabolic signatures and the exploration of altered metabolite profiles in disease. In this study, 505 candidates including healthy controls (HCs) and SS patients were recruited and the serum samples were collected. A non-targeted gas chromatography-mass spectrometry (GC-MS) serum metabolomics method was used to explore the changes in serum metabolites.

RESULTS

We found SS patients and HCs can be distinguished by 21 significant metabolites. The levels of alanine, tryptophan, glycolic acid, pelargonic acid, cis-1-2-dihydro-1-2-naphthalenediol, diglycerol, capric acid, turanose, behenic acid, dehydroabietic acid, stearic acid, linoleic acid, heptadecanoic acid, valine, and lactic acid were increased in serum samples from SS patients, whereas levels of catechol, anabasine, 3-6-anhydro-D-galactose, beta-gentiobiose, 2-ketoisocaproic acid and ethanolamine were decreased. The significantly changed pathways included the following: Linoleic acid metabolism; unsaturated fatty acid biosynthesis; aminoacyl-tRNA biosynthesis; valine, leucine, and isoleucine biosynthesis; glycerolipid metabolism; selenocompound metabolism; galactose metabolism; alanine, aspartate and glutamate metabolism; glyoxylate and dicarboxylate metabolism; glycerophospholipid metabolism; and valine, leucine and isoleucine degradation.

CONCLUSIONS

These findings enhance the informative capacity of biochemical analyses through the identification of serum biomarkers and the analysis of metabolic pathways and contribute to an improved understanding of the pathogenesis of SS.

BUB1B and circBUB1B_544aa aggravate multiple myeloma malignancy through evoking chromosomal instability

Multiple myeloma (MM) is an incurable plasma cell malignancy in the bone marrow characterized by chromosome instability (CIN), which contributes to the acquisition of heterogeneity, along with MM progression, drug resistance, and relapse. In this study, we elucidated that the expression of BUB1B increased strikingly in MM patients and was closely correlated with poor outcomes. Overexpression of BUB1B facilitated cellular proliferation and induced drug resistance in vitro and in vivo, while genetic targeting BUB1B abrogated this effect. Mechanistic studies unveiled that enforced expression of BUB1B evoked CIN resulting in MM poor outcomes mainly through phosphorylating CEP170. Interestingly, we discovered the existence of circBUB1B_544aa containing the kinase catalytic center of BUB1B, which was translated by a circular RNA of BUB1B. The circBUB1B_544aa elevated in MM peripheral blood samples was closely associated with MM poor outcomes and played a synergistic effect with BUB1B on evoking CIN. In addition, MM cells could secrete circBUB1B_544aa and interfere the MM microenvironmental cells in the same manner as BUB1B full-length protein. Intriguingly, BUB1B siRNA, targeting the kinase catalytic center of both BUB1B and circBUB1B_544aa, significantly inhibited MM malignancy in vitro and in vivo. Collectively, BUB1B and circBUB1B_544aa are promising prognostic and therapeutic targets of MM.

Serum lipidomics reveals distinct metabolic profiles for asymptomatic hyperuricemic and gout patients

OBJECTIVES

This study aimed to characterize the systemic lipid profile of patients with asymptomatic hyperuricemia (HUA) and gout using lipidomics, and find potential underlying pathological mechanisms therefrom.

METHODS

Sera were collected from Affiliated Hospital of Nanjing University of Chinese Medicine as center 1 (discovery and internal validation sets) and Suzhou Hospital of Traditional Chinese Medicine as center 2 (external validation set) including 88 normal subjects, 157 HUA and 183 gout patients. Lipidomics was performed by UHPLC-Q Exactive MS. Differential metabolites were identifed by both variable importance in the projection ≥ 1 in orthogonal partial least-squares discriminant analysis mode and false discovery rate adjusted p ≤ 0.05. Biomarkers were found by logistic regression and receiver operating characteristic (ROC) analysis.

RESULTS

In the discovery set, a total of 245 and 150 metabolites respectively were found for normal subjects vs HUA and normal subjects vs gout. The disturbed metabolites included DAG, TAG, PC, PE, PI, etc. We also found 116 differential metabolites for HUA vs gout. Among them, the biomarker panel of TAG 18:1-20:0-22:1 and TAG 14:0-16:0-16:1 could differentiate well between HUA and gout. The area under ROC curve was 0.8288, the sensitivity was 82%, the specificity was 78% at a 95% confidence interval from 0.747-0.9106. In internal validation set, the predictive accuracy of TAG 18:1-20:0-22:1 and TAG 14:0-16:0-16:1 panel for differentiation of HUA and gout reached 74.38%, while 84.03% in external validation set.

CONCLUSION

We identified serum biomarkers panel that have the potential to predict and diagnose HUA and gout patients.

CAR-T therapy alters synthesis of platelet-activating factor in multiple myeloma patients

The chimera antigen receptor (CAR) T cell therapy is a novel and potential targeted therapy and has achieved satisfactory efficacy in patients with relapsed or refractory multiple myeloma (MM) in recent years. However, cytokine release syndrome (CRS) and clinical efficacy have become the major obstacles which limit the application of CAR-T in clinics. To explore the potential biomarkers in plasma for evaluating CRS and clinical efficacy, we performed metabolomic and lipidomic profiling of plasma samples from 17 relapsed or refractory MM patients received CAR-T therapy. Our study showed that glycerophosphocholine (GPC), an intermediate of platelet-activating factor (PAF)-like molecule, was significantly decreased when the participants underwent CRS, and the remarkable elevation of lysophosphatidylcholines (lysoPCs), which were catalyzed by lysoPC acyltransferase (LPCAT) was a distinct metabolism signature of relapsed or refractory MM patients with prognostic value post-CAR-T therapy. Both GPC and lysoPC are involved in platelet-activating factor (PAF) remodeling pathway. Besides, these findings were validated by LPCAT1 expression, a key factor in the PAF pathway, associated with poor outcome in three MM GEP datasets of MM. In conclusion, CAR-T therapy alters PAF synthesis in MM patients, and targeting PAF remodeling may be a promising strategy to enhance MM CAR-T therapy.

HNRNPA2B1 promotes multiple myeloma progression by increasing AKT3 expression via m6A-dependent stabilization of ILF3 mRNA

N6-methyladenosine (m6A) modification is the most prevalent modification in eukaryotic RNAs while accumulating studies suggest that m6A aberrant expression plays an important role in cancer. HNRNPA2B1 is a m6A reader which binds to nascent RNA and thus affects a perplexing array of RNA metabolism exquisitely. Despite unveiled facets that HNRNPA2B1 is deregulated in several tumors and facilitates tumor growth, a clear role of HNRNPA2B1 in multiple myeloma (MM) remains elusive. Herein, we analyzed the function and the regulatory mechanism of HNRNPA2B1 in MM. We found that HNRNPA2B1 was elevated in MM patients and negatively correlated with favorable prognosis. The depletion of HNRNPA2B1 in MM cells inhibited cell proliferation and induced apoptosis. On the contrary, the overexpression of HNRNPA2B1 promoted cell proliferation in vitro and in vivo. Mechanistic studies revealed that HNRNPA2B1 recognized the m6A sites of ILF3 and enhanced the stability of ILF3 mRNA transcripts, while AKT3 downregulation by siRNA abrogated the cellular proliferation induced by HNRNPA2B1 overexpression. Additionally, the expression of HNRNPA2B1, ILF3 and AKT3 was positively associated with each other in MM tissues tested by immunohistochemistry. In summary, our study highlights that HNRNPA2B1 potentially acts as a therapeutic target of MM through regulating AKT3 expression mediated by ILF3-dependent pattern.

Untargeted lipidomics reveals specific lipid abnormalities in Sjögren's syndrome

OBJECTIVE

The relationship between serum lipid variations in SS and healthy controls was investigated to identify potential predictive lipid biomarkers.

METHODS

Serum samples from 230 SS patients and 240 healthy controls were collected. The samples were analysed by ultrahigh-performance liquid chromatography coupled with Q Exactive™ spectrometry. Potential lipid biomarkers were screened through orthogonal projection to latent structures discriminant analysis and further evaluated by receiver operating characteristic analysis.

RESULTS

A panel of three metabolites [phosphatidylcholine (18:0/22:5), triglyceride (16:0/18:0/18:1) and acylcarnitine (12:0)] was identified as a specific biomarker of SS. The receiver operating characteristic analysis showed that the panel had a sensitivity of 84.3% with a specificity of 74.8% in discriminating patients with SS from healthy controls.

CONCLUSION

Our approach successfully identified serum biomarkers associated with SS patients. The potential lipid biomarkers indicated that SS metabolic disturbance might be associated with oxidized lipids, fatty acid oxidation and energy metabolism.

Chinese Version of the Baylor Profound Mental Status Examination: A Brief Staging Measure for Patients with Severe Alzheimer's Disease

BACKGROUND

A specialized instrument for assessing the cognition of patients with severe Alzheimer's disease (AD) is needed in China.

OBJECTIVES

To validate the Chinese version of the Baylor Profound Mental Status Examination (BPMSE-Ch).

DESIGN

The BPMSE is a simplified scale which has proved to be a reliable and valid tool for evaluating patients with moderate to severe AD, it is worthwhile to extend the use of it to Chinese patients with AD.

SETTING

Patients were assessed from the Memory Clinic Outpatient.

PARTICIPANTS

All participants were diagnosed as having probable AD by assessment.

MEASUREMENTS

The BPMSE was translated into Chinese and back translated. The BPMSE-Ch was administered to 102 AD patients with a Mini-Mental State Examination (MMSE) score below 17. We assessed the internal consistency, reliability, and construct validity between the BPMSE-Ch and MMSE, Severe Impairment Battery (SIB), Global Deterioration Scale (GDS-1), Geriatric Depression Scale(GDS-2), Instrumental Activities of Daily Living (IADL), Physical Self-Maintenance Scale (PSMS), Neuropsychiatric Inventory (NPI) and Clinical Dementia Rating (CDR).

RESULTS

The BPMSE-Ch showed good internal consistency (α = 0.87); inter-rater and test-retest reliability were both excellent, ranging from 0.91 to 0.99. The construct validity of the measure was also supported by significant correlations with MMSE, SIB. Moreover, as expected, the BMPSE-Ch had a lower floor effect than the MMSE, but a ceiling effect existed for patients with MMSE scores above 11.

CONCLUSIONS

The BPMSE-Ch is a reliable and valid tool for evaluating cognitive function in Chinese patients with severe AD.

Fibrinogen-Like Protein 1 Is a Novel Biomarker for Predicting Disease Activity and Prognosis of Rheumatoid Arthritis

Rheumatoid arthritis (RA), afflicting over 1% of the population, is an inflammatory joint disease leading to cartilage damage and ultimately impaired joint function. Disease-modifying anti-rheumatic drugs are considered as the first-line treatment to inhibit the progression of RA, and the treatment depends on the disease status assessment. The disease activity score 28 as clinical gold standard is extensively used for RA assessment, but it has the limitations of delayed assessment and the need for specialized expertise. It is necessary to discover biomarkers that can precisely monitor disease activity, and provide optimized treatment for RA patients. A total of 1,244 participants from two independent centers were divided into five cohorts. Cohorts 1–4 constituted sera samples of moderate to high active RA, low active RA, RA in remission and healthy subjects. Cohort 5 consisted of sera of RA, osteoarthritis (OA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), primary Sjogren's syndrome (pSS) and healthy subjects. Biomarkers were found from cohorts 1–2 (screening sets), cohort 3 (discovery and external validation sets), cohort 4 (drug intervention set) and cohort 5 (biomarker-specific evaluation set). We found 68 upregulated and 74 downregulated proteins by TMT-labeled proteomics in cohort 1, and fibrinogen-like protein 1 (FGL1) had the highest area under the receiver operating characteristic curve (AUC) values in cohort 2. In cohort 3, in cross-comparison among moderate/high active RA, low active RA, RA in remission and healthy subjects, FGL1 had AUC values of approximately 0.9000 and predictive values of 90%. Additionally, FGL1 had a predictive value of 91.46% for moderate/high active RA vs. remission/low active RA and 80.77% for RA in remission vs. low active RA in cohort 4. Importantly, FGL1 levels had no significant difference in OA and AS compared with healthy persons. The concentrations in SLE and pSS were improved, but approximately 3-fold lower than that in active RA in cohort 5. In summary, FGL1 is a novel and specific biomarker that could be clinically useful for predicting progression of RA.

[Chorionic villus cell culture and karyotype analysis in 1 983 cases of spontaneous miscarriage]

Objective: To investigate the relationship between spontaneous miscarriage and embryonic chromosome abnormalities, and to evaluate the clinical application of karyotype analysis by chorionic villus cell culture. Methods: The chorionic villus karyotype of 1 983 cases of miscarriage from January 2010 to July 2016 in Guangzhou Women and Children's Mecical Center were analyzed retrospectively. The miscarried chorionic villi were obtained by curettage under sterilized condition. The chromosome specimens were prepared after chorionic villus cell culture. Karyotype analysis was performed by G-banding technique. Results: In the 1 983 samples, successful karyotype analysis was performed in 1 770 cases, with the successful rate of 89.98%. Chromosomal abnormalities were found in 1 038 cases (58.64%, 1 038/1 770). Chromosomal structural abnormalities were found in 37 cases. The numeral abnormalities were more common than structural abnormalities, and most of the numeral abnormalities were aneupoidies. In turn, they were trisomy 16, 45,X, trisomy 22, trisomy 2, trisomy 21, trisomy 15. The most common structural abnormality was balanced translocation, including Robersonian translocation. Female embryoes accounted for 61.02% (1 080/1 770) miscarriages and for 57.4%(596/1 770) of chromosomal abnormalities, while male embroyes acoounted for 61.02% (1 080/1 770) , 57.4% (596/1 770) respectively. The proportion of female embryoes was higher than male embryoes. The median age of the patients was 30 years old (16-46 years old) . As the maternal age increased, the proportion chromosomal abnormalities increased. The incidence of chromosomal abnormalities in the advanced age group (≥35 years) was 68.38% (240/351) , which was significantly higher than that in the younger group (56.24%, 798/1 419; χ(2)=17.10, P<0.01). Conclusions: Embryonic chromosomal abnormalities are the most common cause of early spontaneous miscarriage. The abnormalities centralize in some karyotypes. There is certain relationship between maternal age and the incidence of miscarriage, as well as the embryonic gender. Chorionic villus cell culture and karyotype analysis are helpful in finding the cause of miscarriage and counsel the patients.

[Corneal astigmatism among 2 085 age-related cataract patients before surgery]

Objective: To investigate the characteristics and distribution of corneal astigmatism before surgery among age-related cataract patients in the Hubei area. Methods: Retrospective study. From January 1, 2012 to July 31, 2016, IOL Master measurements of all qualified cataract surgery candidates were retrospectively collected. Descriptive statistical analysis was used to assess the degree, distribution and type of corneal astigmatism. Kolmogorov-Smirnov (K-S) test was used to evaluate the normal distribution of variables. One-way analysis of variance and Kruskal-Wallis test were applied for the comparison of variance for normally and non-normally distributed quantitative data among different age groups. Spearman's rank test was used to assess the relationship between age and corneal astigmatism. Results: The mean age of the 2 085 patients (3 586 eyes) involved was (73.1±9.43) years old, with more women (58.3%) than men. The mean value of corneal curvature was 44.33 D (95%CI: 44.28-44.39), and the mean corneal astigmatism was 1.06 D (range, 0.05 D to 6.74 D). K-S test indicated the distribution of corneal curvature was normal (P=0.18), while corneal astigmatism did not obey the normal distribution (P<0.01). Corneal astigmatism was between 0.25 D and 1.25 D in 67.7% of the eyes, >1.25 D in 29.7%, and<0.25 D in 4.2%. Corneal astigmatism degree increased with the age increase (P<0.01). There was no statistical difference in corneal astigmatism between women and men (P=0.075). However, women had steeper corneal curvatures than men with statistical difference (P<0.01). Corneal astigmatism with the rule was observed in 29.0% of the eyes, while astigmatism against the rule was found in 53.0%. And astigmatism against the rule increased with age. Conclusion: Corneal astigmatism mostly distributes between 0.25 D and 1.25 D in age-related cataract patients who lived in Hubei. Corneal astigmatism degree increased with age, and the dominant type was astigmatism against the rule. There was no difference in astigmatism between men and women patients aged 50 years and above, but in 70- to 79-year-old patients, women had a higher astigmatism degree than men. The corneal curvature of women was steeper than men in general and in each age group. (Chin J Ophthalmol, 2017, 53: 522-527).

Short-term and long-term effect of diaphragm biofeedback training in gastroesophageal reflux disease: an open-label, pilot, randomized trial

This study investigated the effectiveness of diaphragm biofeedback training (DBT) for patients with gastroesophageal reflux disease (GERD). A total of 40 patients with GERD treated at the Peking Union Medical College Hospital between September 2004 and July 2006 were randomized to receive DBT and rabeprazole proton pump inhibitor (PPI) or rabeprazole alone. The DBT + rabeprazole group received DBT during the 8-week initial treatment; the rabeprazole group did not. During the 6-month follow up, all patients took acid suppression according to their reflux symptoms, and the patients in the DBT + rabeprazole group were required to continue DBT. The primary outcome (used for power analysis) was the amount of acid suppression used at 6 months. Secondary outcomes were reflux symptoms, health-related quality of life (HRQL), and esophageal motility differences after the 8-week treatment compared with baseline. Acid suppression usage significantly decreased in the DBT + rabeprazole group compared with the rabeprazole group at 6 months (P < 0.05). At 8 weeks, reflux symptoms and GERD-HRQL were significantly improved in both groups (P < 0.05), without difference between them. Crural diaphragm tension (CDT) and gastroesophageal junction pressure (GEJP) significantly increased in the DBT + rabeprazole group (P < 0.05), but without change in lower esophageal sphincter (LES) pressure. There was no significant change in CDT, GEJP, and LES pressure compared with baseline in the rabeprazole group. In conclusion, long-term DBT could reduce acid suppression usage by enhancing the anti-reflux barrier, providing a non-pharmacological maintenance therapy and reducing medical costs for patients with GERD.

Mesenchymal stromal cells infusions improve refractory chronic graft versus host disease through an increase of CD5+ regulatory B cells producing interleukin 10

Refractory chronic graft-versus-host disease (cGVHD) is a significant complication resulting from allogeneic hematopoietic stem cell transplantation (HSCT). Mesenchymal stromal cells (MSCs) have shown promise for treating refractory cGVHD, but the favorable effects of MSCs therapy in cGVHD are complex and not fully understood. In this prospective clinical study, 20 of 23 cGVHD patients had a complete response or partial response in a 12-month follow-up study. The most marked improvements in cGVHD symptoms were observed in the skin, oral mucosa and liver. Clinical improvement was accompanied by a significantly increased number of interleukin (IL)-10-producing CD5+ B cells. Importantly, CD5+ B cells from cGVHD patients showed increased IL-10 expression after MSCs treatment, which was associated with reduced inflammatory cytokine production by T cells. Mechanistically, MSCs could promote the survival and proliferation of CD5+ regulatory B cells (Bregs), and indoleamine 2, 3-dioxygenase partially participates in the MSC-mediated effects on Breg cells. Thus, CD5+ Breg cells may have an important role in the process of MSC-induced amelioration of refractory cGVHD and may provide new clues to reveal novel mechanisms of action for MSCs.

Prucalopride in the treatment of chronic constipation in patients from the Asia-Pacific region: a randomized, double-blind, placebo-controlled study

BACKGROUND

The study evaluated efficacy and safety of the 2 mg dose of prucalopride compared to placebo in patients with chronic constipation (CC) from the Asia-Pacific region.

METHODS

Randomized, placebo-controlled, parallel-group, phase III study with 2-week run-in, 12-week treatment phase, and 1-week follow-up. Adult patients with CC (≤2 spontaneous bowel movements per week) received 2 mg prucalopride or placebo, once-daily, for 12 weeks. Primary efficacy measure was percentage of patients with average of ≥3 spontaneous complete bowel movements (SCBMs) per week (Responders) during the 12-week treatment. A key secondary endpoint was Responders during first 4 weeks of treatment. Other efficacy assessments were based on patient diaries, their assessments of symptoms and quality of life, and investigator's assessment on efficacy of treatment. Safety assessments included adverse events, laboratory values, and cardiovascular events.

KEY RESULTS

Efficacy and safety were evaluated for 501 patients who received study drug. On the primary endpoint, prucalopride was significantly more effective than placebo with 83 (33.3%) vs 26 (10.3%) patients having a weekly average of ≥3 SCBMs during the 12-week treatment (P < 0.001). Respective percentages were 34.5%vs 11.1% over first 4 weeks (P < 0.001). On other secondary endpoints, clinical improvement was generally larger and statistically superior (P < 0.001) in the prucalopride group. Most frequently reported adverse events were diarrhea, nausea, abdominal pain, and headache.

CONCLUSION & INFERENCES

Prucalopride 2 mg given once-daily significantly improved bowel function, associated symptoms, and satisfaction in CC over a 12-week treatment period, and was safe and well tolerated by patients in the Asia-Pacific region.

Genetic polymorphism of catechol O-methyltransferase and pharmacokinetics of levodopa in healthy Chinese subjects

We studied the distribution of catechol O-methyltransferase (COMT) genotypes in the Chinese Fujian Han population and explored the potential effect of COMT genetic polymorphism on the pharmacokinetics of levodopa. Polymerase chain reaction (PCR) was employed in the COMT genotype analysis of 166 volunteers. After a single oral dose of levodopa/benserazide, the plasma concentration of levodopa was determined by high-performance liquid chromatography (HPLC) with electrochemical detection (ECD). In the 166 subjects, the frequencies of G/G, G/A and A/A COMT genotypes were 58.4%, 36.7% and 4.9%, respectively. The frequency of the homozygous A/A genotype was much lower than in caucasians and Southwest Asians. COMT activity of erythrocytes in the G/A genotype group was significantly lower than in the G/G genotype group but significantly higher than in the A/A genotype group. There was no significant difference in pharmacokinetic parameters, including t(1/2alpha), t(1/2beta), AUC(0-infinity), CL/F, C(max), t(max) and V/F. The frequency of COMT genotypes in the Chinese Fujian Han population, which is related to COMT enzyme activity, is significantly different from that in caucasians and Southwest Asians. The pharmacokinetic characteristics of levodopa in healthy Chinese subjects may not be dependent on their COMT genotype status. From the 166 volunteers, 5 G/G, 5 G/A and 4 A/A genotype male subjects were recruited for the study of levodopa pharmacokinetics.

Transcutaneous electroacupuncture improves dyspeptic symptoms and increases high frequency heart rate variability in patients with functional dyspepsia

The aim of the study was to evaluate the therapeutic value and possible mechanisms of transcutaneous electroacupuncture (TEA) in a double-blind and cross-over study in patients with functional dyspepsia (FD). Twenty-seven patients with FD were enrolled and the study consisted of two parts: (i) acute effects of TEA at PC6 and ST36 on gastric slow waves and heart rate variability and (ii) chronic (2 weeks) effects of TEA at PC6 and ST36 on dyspepsia symptoms, gastric slow waves, heart rate variability and neuropeptide Y (NPY) and motilin. The results of this study are: (i) The dyspepsia symptom score was decreased by 55% at the end of chronic TEA and the improvement was significant (P < 0.01); (ii) the high frequency (HF) assessed from the spectral analysis of heart rate variability was markedly increased with both acute TEA (76% increase, P = 0.01) and chronic TEA (75% increase, P = 0.025); (iii) gastric slow waves were not altered by either acute or chronic TEA; and (iv) the plasma level of NPY but not motilin was increased after chronic TEA. Non-invasive and needleless transcutaenous electroacupuncture at ST36 and PC6 markedly improves dyspepsia symptoms and the improvement may be associated with the increase in HF heart rate variability and the modulation of NPY.

[Clinical characteristics and diagnosis of chronic intestinal pseudo-obstruction]

OBJECTIVE

To analyze and determine the clinical characteristics and diagnostic methods of chronic intestinal pseudo-obstruction(CIP).

METHODS

We reviewed the medical records of all 23 patients who diagnosed with CIP in Peking Union Medical College Hospital from 1978 to 2000.

RESULTS

Twenty three patients fulfilled the diagnostic criteria (9 male, 14 female, median age 50 years, range 4-75 years). The main symptoms at the presentation were abdominal distension(87%), pain(57%), diarrhea(65%), constipation(48%), vomiting(39%) and weight loss(83%). In this group of CIP patients, the abdominal distension was more common and serious than pain, presenting with diarrhea, weight loss and dismotility in esophagus and stomach. Bowel loops and visible peristaltic waves were seldom observed in the CIP patients. The plain film showed the multiple air-fluid levels (17/20, 85%) and generalized intestinal distention and air in colon. The abnormal findings on the barium contrast examination included intestinal dilation (19/23, 83%), weaken peristalses or/and prolongation of transit time (74%) without mechanical lesions. The pseudo-obstruction involved the small intestine (83%) and colon (39%) that determined according to the radiographic features, abnormal gastrointestinal motor functions, findings of endoscopic examination and laparotomy. Eighteen cases were chronic idiopathic intestinal pseudo-obstruction (1 familial myopathy), 5 were secondary to CTD.

CONCLUSIONS

Comparison with the typical mechanical obstruction, the presentations of CIP have some relatively characteristics. The clinical diagnosis of CIP can be confirmed on the basis of typical clinical symptoms and radiographic features, abnormal gastrointestinal motility.

[Gastric solid emptying in diabetic rats and its respond to Chinese traditional medicine]

OBJECTIVE

To investigate the change of gastric solid emptying at different stages in diabetic rats, and the effect of Chinese traditional medicine(CTM) on gastric emptying.

METHODS

40 Wistar rats were randomly divided into three groups: CTM treated diabetic(15 rats), untreated diabetic(15 rats) and control(10 rats). Diabetes was induced by i.p. of streptozotocin(STZ), 65 mg/kg. CTM, 3.75 g/kg daily (consisting of Dan shen, Fu Ling mainly which functioned as Huo xue hua yu and Bu shen) was administrated in treated diabetic rats. Blood glucose and body weights were measured weekly. 12 and 24 weeks after induction of diabetes, gastric emptying was examined with scintigraphy for 240 min (30 min interval). A test meal (42 kJ) labeled with 99mTc-SC(2.96 x 10(5) Bq) was provided.

RESULTS

(1) There were no significant differences in total gastric retention rate and T 1/2 among three groups at 12 weeks. (2) The lag phase of total stomach in DM-B was (41.56 +/- 8.39) min, shorter than in control's (67.50 +/- 9.09) min, (P < 0.05). (3) The proximal gastric retention rate of 12-week diabetes at 90 min were (38.2 +/- 6.2)% (vs control, P < 0.01), (16.0 +/- 7.9)% (vs control, P < 0.01), and (61.9 +/- 3.5)%; and of 24-week at 120 min were (21.3 +/- 6.8)% (vs control, NS), (48.5 +/- 8.2)% (vs control, P < 0.05, vs treated diabetes, P < 0.01), (28.3 +/- 6.4)% in treated, untreated and control group respectively. (4) There was negative correlation between blood glucose and gastric retention rate (r = -0.62, P < 0.05).

CONCLUSION

(1) The proximal gastric solid emptying was impaired in diabetic rats, there was significantly accelerated in 12-week and slowed down in 24-week compared with control. (2) CTM could modify these impairment. (3) Hyperglycemia had positive correlation to gastric emptying in animal model, which might explain the clinic presentations of patients with diabetes in early stage.

[Primary approach on midgastric-transverse band modifying the distribution of food between proximal and distal stomach]

OBJECTIVE

To explore the physiological function of the midgastric-transverse band (MTB) in the modification of intragastric food distribution in digestive period.

METHODS

18 healthy subjects(HS) and 18 patients with functional dyspepsia(FD) participated in this study. After fasting over 8 hours all subjects took 150 ml of milk (777 J) mixed with 150 g Magnesium Sulfate, and laid supinely on 30 degrees angle with horizontal line, X-ray films were taken at 0, 30, 60, and 90 minutes after the meal, respectively. Analyzed parameters included the width of MTB, the total, proximal and distal gastric area (TGA, PGA and DGA), the ratio of proximal and distal stomach during every 30 minutes period, the correlation between MTB and PGA, MTB and DGA.

RESULTS

(1) There was significant difference of MTB and DGA in every period postprandially (P < 0.05 or 0.01), by contrast, there were no significant differences of TGA or PGA between HS and FD except at TGA 90 min (P < 0.05). (2) There were close correlation between MTB and PGA at 0 (P < 0.01), 30 (P < 0.01), 60 min (P < 0.01) after the meal in HS, but only at 0 min (P < 0.01) in FD. Also close correlations between MTB and DGA at 60 (P < 0.01) and 90 min (P < 0.01) in HS, but in FD. (3) the ratios of PGA from 0-30 min and 60-90 min in FD significantly decreased respectively, however the other ratios were shown no significant difference between HS and FD during each period. (4) there were close correlations between PGA and MTB at 0, 30, 60 min after the meal in HS, however except 0 min there were no correlations in FD. By contrast, between DGA and MTB there were close correlations at 60, or 90 min in HS, no correlation in FD at any time point.

CONCLUSIONS

MTB may play an important role in modifying intragastric food distribution in HS, while the dysfunction of MTB may result in the distal gastric overloading in FD, the mechanism of MTB needs further studies.

[Correlation of Helicobacter pylori infection with symptoms and gastric electrical activity in functional dyspepsia]

OBJECTIVE

To investigate correlation of Helicobacter pylori (Hp) infection with symptoms and gastric electrical activity in patients with functional dyspepsia (FD).

METHODS

Sixty patients with FD confirmed by gastroscopy and pathology were enrolled in this study. Of them, 30 Hp positive (Hp+) and 30 Hp negative (Hp-). Ten dyspeptic symptoms were scored according to severity (0-3) and frequency (0-3), including abdominal bloating, abdominal pain, nausea, vomiting, early satiety, heartburn, and so on. Digitrapper EGG was used for recording 30 min during fasting and 60 min after a test meal (1890 kJ, C:F:P = 3.9:3.4:1).

RESULTS

(1) The total symptom score (TSS) was 26.57 +/- 9.16 and 24.37 +/- 6.86 in Hp+ and Hp- groups respectively (NS). There was no significance of each symptom score between both groups, except the score of heartburn in Hp+ were higher than in Hp- group (2.30 +/- 2.04 vs 1.13 +/- 1.78, P < 0.05). (2) The percentage of normal EGG rhythm (2.4-3.7 cpm) was (64.80 +/- 4.74)% in fasting and (55.84 +/- 4.71)% in postprandial stage in Hp+ group and (64.89 +/- 5.04)%, (62.72 +/- 4.57)% in Hp- group. There was no significance of the percentage of normal EGG rhythm, power ratio(PR), and dominant frequency(DF) between HP+ and HP- groups. (3) However, there was close negative correlation of TSS with normal rhythm in postprandial stage in Hp+ group (r = 0.41, P < 0.05).

CONCLUSION

There may be different pathophysiologic basis in FD with or without Hp infection. Hp infection may influence postprandial gastric electrical activity. Further study needs to be investigated.

[Gastro-pyloro-duodenal motor cooperation in patients with dyspepsia]

OBJECTIVE

To investigate the role of the midgastric transverse band(MTB) and gastro-pyloro-duodenal motility in functional dyspepsia (FD) and diabetic dyspepsia (DD).

METHODS

Healthy subjects, patients with FD and DD participated in the study. Of them, 65 subjects received radionuclide gastric emptying, 48 complex ultrasonograph, and 35 gastro-pyloro-duodenal manometry.

RESULTS

(1) MTB was (7.01 +/- 1.31), (3.39 +/- 0.21) cm in FD and DD, which was significantly wider than that in HS group [(2.42 +/- 0.16) cm, P < 0.01, P < 0.001]. (2) The half gastric emptying time (t 1/2) in FD and DD were prolonged, gastric remained rate at 120 min increased, the gastric emptying velocity reduced when compared with HS. (3) The gastric occlusive and non-occlusive peristaltic contractions could be clearly shown under ultrasonograph. The percentage of emptying circle > 10 seconds was reduced in FD and DD. (4) There was decreased number of migrating motor complex phase III in FD and DD, when compared with HS.

CONCLUSIONS

MTB is an area with physiological function, which affects intra-gastric food distribution. Patients with FD and DD showed delayed gastric emptying associated with decreased gastric motor activity and antro-pyloro-duodenal in-cooperative function. There may be different pathogenesis in FD and DD. Further study needs to be performed.

[Electrogastograph during interdigestive and digestive stages in patients with functional dyspepsia]

OBJECTIVE

To investigate the relationship between dynamic change of electrogastrogram (EGG) with motility index of antrum during migrating motor complex (MMC) cycle in healthy subjects and functional dyspepsia, and to verify whether a 100% coupling of electrical and mechanical events existed after meal.

METHODS

Eleven healthy subjects (HS) and 14 patients with functional dyspepsia (FD) were studied. An 8-channel Dent-sleeve catheter was positioned under fluoroscopic guidance across antropyloroduodenal region and bipolar electrodes were attached to the skin corresponding to the location of antrum. Antropyloroduodenal pressure waves and electrical signals were transferred simultaneously to PC Polygraph (CTD) and recorded for 3 hours preprandially and 2 hours after ingestion of 40 g solid meal (336 kJ). The power of EGG and motility index (MI) of antral contractions were calculated as the area under curve (AUC) by a build-in computer program.

RESULTS

The power increases of EGG increased significantly in phase II (P < 0.01), phase III (P < 0.01) and after meal (P < 0.01) compared with phase I in HS, however, this dynamic increase was not found in FD. The power of EGG was positively correlated with the motility index of antrum both in HS (r = 0.87, P < 0.01) and in FD (r = 0.79, P < 0.01) during the interdigestive period. A significant increase of EGG power after meal was found in HS, which corresponded to the degree of phase III and kept stable for the whole postprandial period. In contrast, power increase was not found in FD except during 30 min after test meal.

CONCLUSIONS

Prolonged cutaneous EGG recording can reflect the periodic variation of MMC cycle. EGG response in HS but not in FD after meal is characterized as persistent increase which is corresponded to phase III.

The cortical vibrissae representation is normal in transgenic mice lacking the 5-HT(1B) receptor

Recent studies have suggested that 5-HT may modulate thalamocortical development in somatosensory cortex (S-I) of rats and mice, and that the 5-HT(1B) receptor may play a critical role in this process. Analysis of CO-stained sections through lamina IV of S-I in perinatal and adult 5-HT(1B) knockout mice revealed a normal vibrissae-related pattern, indicating that activation of the 5-HT(1B) receptor is not necessary for the normal development of the vibrissae representation in S-I.

Morphometric evaluation of the human cervical motoneurons

Morphometric analysis of the human cervical large motoneurons in the anterior horn was performed in 7 male cadavers with the help of an image-analyzer and the use of a new tissue preparation method which minimizes shrinkage. This method makes it possible to precisely evaluate the size of cervical motoneurons at each level. Our study revealed a difference in number, average area and total area of the motoneurons between C1-C3 and C4-C7 levels. This results can be of importance in setting standard values for the understanding of morphological and functional correlations.

Gastro-oesophageal reflux disease in Asia

Gastro-oesophageal reflux disease (GORD) occurs more frequently in Europe and North America than in Asia but its prevalence is now increasing in many Asian countries. Many reasons have been given for the lower prevalence of GORD in Asia. Low dietary fat and genetically determined factors, such as body mass index and maximal acid output, may be important. Other dietary factors appear to be less relevant. Increased intake of carbonated drinks or aggravating medicines may influence the increasing rates of GORD in some Asian countries but no strong evidence links other factors, such as the age of the population, smoking or alcohol consumption, to GORD. The management of GORD in Asia is similar to that in Europe and North America but the lower incidence of severe oesophagitis in Asia may alter the approach slightly. Also, because Asians tend to develop stomach cancer at an earlier age, endoscopy is used routinely at an earlier stage of investigation. Gastro-oesophageal reflux disease is essentially a motility disorder, so short-term management of the disease can usually be achieved using prokinetic agents (or histamine (H2)-receptor antagonists). More severe and recurrent GORD may require proton pump inhibitors (PPI) or a combination of prokinetic agents and PPI. The choice of long-term treatment may be influenced by the relative costs of prokinetic agents and PPI.

[An epidemiologic study of irritable bowel syndrome in Beijing - a stratified randomized study by clustering sampling]

OBJECTIVE

To explore the prevalence of irritable bowel syndrome (IBS) and its risk factors in Beijing.

METHODS

Phase I: a screening program for IBS was carried out in Beijing area according to symptoms using both Manning (modified including constipation) and Rome criteria. Random clustered sampling involving 2 486 subjects of the inhabitants was carried out under stratification of city, suburban and rural areas. Sample size of each studied area was in proportion to the population of the area. The range of age was 18 - 70. All subjects studied were requested to fill in a questionnaire assisted by trained doctors or medical students during the visit to their families. Phase II: a small number of patients who fulfilled the Manning criteria were further selected to undergo detail clinical examination in the hospital including laboratory examination, abdominal ultrasonography, colonoscopy or/and barium enema to exclude organic disease of the colon. Prevalence of IBS of the population was then adjusted by the rate of correct diagnosis during phase II study. Minnesota Multi - Personality Indices was used in some cases. Potential risk factors were explored by comparing frequencies among IBS group and non - IBS group using chi(2) and logistic analysis of multifactors.

RESULTS

The adjusted point prevalence of IBS in Beijing according to Manning criteria was 7.26%, in contrast to Rome criteria - 0.82%. Higher prevalence rate of IBS in the city (10.50%) than in rural areas (6.14%) (P < 0.001) was noticed. Male to female ratio was 1:1.15 with majority of IBS fell in age 18 - 40 (51.6%), and among intellectuals. Our study indicated that history of dysentery (OR = 3.00), exposure to coldness (OR = 1.55), ingestion of cold food and raw materials (OR = 1.24) might serve as the most important risk factors (P < 0.001). Patients with IBS seemed to have a higher tendency of abnormal personalities.

CONCLUSION

IBS is a common disorder in Beijing which deserves greater care.

Epidemiologic study of the irritable bowel syndrome in Beijing: stratified randomized study by cluster sampling

OBJECTIVE

To explore the prevalence of irritable bowel syndrome (IBS) in Beijing and its risk factors.

METHODS

Phase I: a screening for IBS in Beijing area according to symptoms using both Manning (modified including constipation) and Rome criteria. 2486 subjects were studied by cluster sampling of the inhabitant groups according to a stratified design of urban, suburban and rural areas, and sample size of each area studied was in proportion to the population of the area. Selection of the inhabitant groups was made by simple random sampling. Age of subjects enrolled in the study was 18-70 years. All subjects fulfilling the selection criteria were requested to fill in a questionnaire assisted by trained doctors or medical students during the visit to their families. Phase II: an aliquot of patients who fulfilled at least the Manning criteria were further selected according to their scoring series to undergo detail clinical examination in the hospital including laboratory examination, abdominal ultrasonography, colonoscopy or/and barium enema to exclude organic disease of the colon. Prevalence of IBS of the population was then adjusted by the rate of correct diagnosis during Phase II study. Study using Minnesota Multi-Personality Indices (MMPI) was done in some cases. Probable risk factors were explored by comparing their frequencies among IBS group and non-IBS group using chi 2 and logistic analysis of multifactors.

RESULTS

The adjusted point prevalence of IBS in Beijing is 7.26% according to Manning criteria, and is 0.82% according to Rome criteria. There is a higher prevalence rate in city (10.50%) than in rural areas (6.14%) by stratified analysis (P < 0.001). Male to female ratio is 1:1.15. And IBS is more common in people aged between 18-40 years (51.6%), and among the intellectuals. Our study indicated that history of dysentery (OR 3.00), exposure to cool (OR 1.55) and ingestion of cold food and raw materials (OR 1.24) may be the most important risk factors (P < 0.001), and IBS patients may have a higher tendency of psychological abnormalities.

CONCLUSION

IBS is a common disorder in Beijing and should be taken into consideration in the human welfare strategy.

Increased serotonin in the developing superior colliculus affects receptive-field size of retinotectal afferents but not that of postsynaptic neurons

Administration of a single subcutaneous dose of 5,7-dihydroxytryptamine (5,7-DHT) to newborn hamsters results in a significant increase in the density of serotoninergic (5-HT) fibers in the superficial layers of the superior colliculus (SC) and marked abnormalities in the uncrossed retinotectal projection when these animals reach adulthood (Rhoades et al., 1993). The present study was undertaken to determine whether elevation of 5-HT in the developing SC altered the visual representation in SC. Multi-unit recordings from SC cells demonstrated that the overall organization of the visual map in the superficial SC laminae was normal and that the receptive-field sizes for unit clusters were unchanged in the 5,7-DHT-treated animals. However, when a combination of CNQX and MK-801 was directly applied to the SC to block postsynaptic activity, the receptive fields of unit clusters (presumably retinotectal axon terminals) in the 5,7-DHT treated animals were significantly larger than those in the normally reared hamsters. These results are consistent with the conclusions that elevation of 5-HT levels in the developing SC reduces the postnatal refinement of the crossed retinotectal axons, and that mechanisms operating within the SC may act to maintain normal sizes for the receptive fields of its constituent neurons.

[The relationship between obstructive sleep apnea and gastroesophageal reflux and the effect of antireflux therapy]

OBJECTIVE

To evaluate the relationship between gastroesophageal reflux (GER) and obstructive sleep apnea (OSA) and the effect of combined therapy with cisapride and omeprazole.

METHODS

24-hour esophageal pH and manometric monitoring and polysomnography (PSG) were performed in 18 patients with snoring, daytime sleepiness and acid reflux, heartburn and regurgitation. Cisapride 10 mg qid and omeprazole 20 mg q12h were given to patients with GER and OSA. these tests were repeated on the 7th day.

RESULTS

7 of the 18 patients with OSA had severe GER. All except one had daytime GER as well as nocturnal GER. Nocturnal recordings were analyzed and it was found that esophageal pH below 4.0 was frequently followed by swallow action (58.6%, control = 20.6%, P < 0.05), gross body movement (18.6%, control = 4.8%, P < 0.05) and arousal (26.8%, control = 16.8%, P < 0.05). The mean lowest esophageal pressure [(-15.2 +/- 9.6) mmHg] before and [(-18.6 +/- 10.1) mmHg] after the drops of pH were significantly lower than that during control periods [(-10.6 +/- 8.1) mmHg, P < 0.005]. After antireflux therapy, there was dramatically improvement in total apnea time [from (52.7 +/- 27.1) to (21.6 +/- 21.2) minutes, P < 0.002)] and apnea hypopnea index (AHI) [from (38.9 +/- 17.6) to (15.2 +/- 12.3) No./h, P < 0.002].

CONCLUSION

GER is a predisposing factor for OSA, they may coexist and aggravate each other. Combined therapy with cisapride and omeprazole is a new, simple and effective method for GER with OSA.

Temporal and spatial relationship of pylorus to antroduodenal motility in functional dyspepsia

OBJECTIVE

To investigate the temporal and spatial relationship of pylorus to antroduodenal motility in functional dyspepsia (FD).

METHODS

Eleven healthy subjects (HS) and 14 patients with FD were studied. Antral-pyloro-duodenal manometry was performed for 3 hours fasting and 2 hours after 80 Kcal of solid test meal.

RESULTS

(1) The incidence of phase III was 7/11 in HS and 3/14 in FD in antrum (P < 0.05), 8/11 and 4/14 in pylorus (P < 0.05), 10/11 and 6/14 in duodenum (P < 0.05), respectively. (2) The percentage of antropyloroduodenal coordinations during phase II of MMC was 58.5% in HS and 18.5% in FD (P < 0.001). (3) The pyloroduodenal coordination was 78.2% and 38.9% (P < 0.01) at 60 minutes after meal and 77.1% and 54.0% (P < 0.01) at 120 minutes postprandially in HS and in FD. (4) The percentage of isolated pyloric pressure waves (IPPWs) was 4.8%, 29.7% (P < 0.001) at 60 minutes, and 9.3%, 25.1% (P < 0.01) at 120 minutes in HS and FD.

CONCLUSIONS

There were abnormalities of gastro-pyloro-duodenal motility in both interdigestive and digestive stages; the higher incidence of IPPWs and disordered temporal and spatial relationship of pylorus to antroduodenal motility may result in a delayed gastric emptying in FD. The possible mechanism may be involved in abnormal neural control.

Augmentation of serotonin in the developing superior colliculus alters the normal development of the uncrossed retinotectal projection

A previous study from this laboratory showed that sprouting of serotoninergic axons in the hamster's superior colliculus (SC) induced by a single subcutaneous injection of 5,7-dihydroxytryptamine (5,7-DHT) at birth (postnatal day 0; P-0) resulted in an abnormal terminal distribution of the uncrossed retinotectal projection. The present study provided further evidence to support the role of increased 5-HT levels within the SC in this phenomenon. Slow-release polymer (ELVAX) chips impregnated with serotonin (5-HT) were placed over the SC on either P-1 or P-3, and retinotectal projections were assessed via anterograde transport of horseradish peroxidase when animals reached P > 18. Analysis of ELVAX chips indicated that they released 5-HT in amounts of > or = 1 pmole/hour for at least 12 days. Assessment of the SC of treated hamsters indicated significantly elevated 5-HT concentrations as late as P-12, but not on P-16. Implantation of 5-HT chips, but not control chips, resulted in abnormalities in the uncrossed retinotectal projection similar to those observed in the 5,7-DHT-treated animals. The patches that normally develop in the rostral part of the stratum opticum were not present, and uncrossed axons were distributed densely in this layer and in the lower portion of the stratum griseum superficiale throughout the rostrocaudal and mediolateral extents of the SC. Quantitative analysis of these changes indicated significant differences between the organization of the uncrossed retinotectal projections of 5-HT-treated animals vs. either blank-implant treated or completely untreated animals but not between 5-HT-treated hamsters and animals that received neonatal 5,7-DHT injections. All of these results support the conclusion that increased SC concentrations of 5-HT altered retinotectal development.

[Potential role of gut peptides in stress-induced colonic motor disorder]

OBJECTIVE

To explore the potential role of gut peptide in stress-induced colonic motor disorder.

METHODS

In 9 conscious Wistar rats pre-equipped with strain-gauge transducers on ascending and descending colon, colonic motility was recorded before, during and after stress. And colonic transit was evaluated by instilling Cr into the cecum through chronically implanted cannula in each group of 16 rats with or without stress, and then calculating the geometric center (GC) of radioactivity. The contents of VIP, SP, NT, SST, MOT and Leu-ENK in plasma, colonic mucosa and muscle layer were assessed in 16 stressed and 16 control rats. Exogenous peptides (VIP, SP, SST, NT) were intravenously administered in 9 rats to determine the colonic motor response. Also, the effects of peptides on colonic circular muscle strips were investigated.

RESULTS

Motor activity was increased after stress, whereas colonic transit was delayed. In the stressed rats, plasma levels of VIP and Leu-ENK were higher than those in controls. The content of Leu-ENK in muscle tissue decreased. Both in vivo and in vitro studies showed that SP and NT excited, whereas VIP and SST inhibited colonic motor activity.

CONCLUSION

Release of certain peptides is altered by stress. Increased release of ENK and VIP may be involved in stress-induced colonic motor disorder and in the regulation of "stress hormone" release.

Age-related reductions in number and size of anterior horn cells at C6 level of the human spinal cord

We examined numbers and sizes of anterior horn cells (AHCs) of the human spinal cord at C6 level with aging process. Spinal cords were obtained from twenty-four male cadavers, age ranged from 41 to 97 years without any accompanying pathological changes of the spinal cord. For quantitative investigation of the AHCs, spinal cord segments were embedded in celloidin after secondary fixation and dehydration; sections (20 microns thick) were stained with luxol fast blue-periodic acid-Schiff-hematoxylin and Klüver-Barrera methods; the neuronal number, the cell body area and the perimeter of AHCs in the gray matter (equivalent to the Rexed's lamina IX) were counted and measured using a combination of a microscope with a drawing tube, a digitizer and a computer at 400 times magnification. A marked reduction in number of AHCs was found in the aged subjects. Similarly, there were significantly age-related decreases in the cross-sectional area and perimeter of AHCs at C6 segment of the spinal cord. These findings indicate that the reduction in number and size of AHCs in the human spinal cord is associated with degenerative neuronal changes and loss of motoneurons during aging process.

Two auxin-responsive domains interact positively to induce expression of the early indoleacetic acid-inducible gene PS-IAA4/5

The plant growth hormone indole-3-acetic acid (IAA) transcriptionally activates expression of several genes in plants. We have previously identified a 164-bp promoter region (-318 to -154) in the PS-IAA4/5 gene that confers IAA inducibility. Linker-scanning mutagenesis across the region has identified two positive domains: domain A (48 bp; -203 to -156) and domain B (44 bp; -299 to -256), responsible for transcriptional activation of PS-IAA4/5 by IAA. Domain A contains the highly conserved sequence 5'-TGTCCCAT-3' found among various IAA-inducible genes and behaves as the major auxin-responsive element. Domain B functions as an enhancer element which may also contain a less efficient auxin-responsive element. The two domains act cooperatively to stimulate transcription; however, tetramerization of domain A or B compensates for the loss of A or B function. The two domains can also mediate IAA-induced transcription from the heterologous cauliflower mosaic virus 35S promoter (-73 to +1). In vivo competition experiments with icosamers of domain A or B show that the domains interact specifically and with different affinities to low abundance, positive transcription factor(s). A model for transcriptional activation of PS-IAA4/5 by IAA is discussed.

Abnormal cardiovascular reflexes in patients with achalasia

Using 3 non-invasive tests, abnormalities of cardiovascular reflex function were found in 7 of 15 patients with achalasia. Abnormalities of heart rate responses to the Valsalva maneuver, deep breathing, and standing were noted in patients with autonomic neuropathy defect. The findings are consistent with the hypothesis that an abnormality of vagal function may contribute to the pathogenesis of achalasia.

Impaired esophageal emptying in reflux disease

OBJECTIVES

The symptoms and mucosal damage that occur in gastroesophageal reflux disease (GERD) may be a consequence of either an increased frequency of reflux events or of a prolonged process of esophageal acid clearance. Acid clearance is dependent both upon effective esophageal emptying of luminal fluid and on normal salivary function to titrate residual acid to neutrality. This investigation examined the efficacy of esophageal emptying in a large group of GERD patients.

METHODS

Barium swallow examinations were done to categorize and quantify esophageal emptying dysfunction in 67 consecutive patients with reflux disease, compared with 85 patient asymptomatic controls. Quantitative fluoroscopic estimates of esophageal residua were compared with scintigraphic quantification in 14 controls and 20 GERD patients.

RESULTS

There was progressive impairment of esophageal emptying in the reflux patients without esophagitis compared with the controls, and it was even greater in patients with endoscopically evident esophagitis compared with reflux patients without esophagitis. Good correlation existed between the fluoroscopic and scintigraphic assessment of esophageal emptying.

CONCLUSIONS

These findings support the hypothesis that impaired esophageal emptying is an important determinant in the development of esophagitis among reflux patients. The dominant site of impaired emptying in the reflux patients was the phrenic ampulla as opposed to the tubular esophagus, suggesting a pathophysiological contribution of hiatus hernia.