Xwnt-11: a maternally expressed Xenopus wnt gene

We have isolated and characterized a novel Xenopus wnt gene, Xwnt-11, whose expression pattern and overexpression phenotype suggest that it may be important for dorsal-ventral axis formation. Xwnt-11 mRNA is present during oogenesis and embryonic development through swimming tadpole stages. Xwnt-11 mRNA is ubiquitous in early oocytes and is localized during mid-oogenesis. By late oocyte stages, Xwnt-11 mRNA is localized to the vegetal cortex, with some mRNA in the vegetal cytoplasm. After egg maturation, Xwnt-11 mRNA is released from the vegetal cortex and is found in the vegetal cytoplasm. This early pattern of Xwnt-11 mRNA localization is similar to another vegetally localized maternal mRNA, Vg1 (D. A. Melton (1987) Nature 328, 80–82). In the late blastula, Xwnt-11 mRNA is found at high levels in the dorsal marginal zone. As gastrulation proceeds, Xwnt-11 mRNA appears in the lateral and ventral marginal zone and, during tadpole stages, it is found in the somites and first branchial arch. Injection of Xwnt-11 mRNA into UV-ventralized embryos can substantially rescue the UV defect by inducing the formation of dorsal tissues. The rescued embryos develop somitic muscle and neural tube; however, they lack notochord and anterior head structures.

Xenopus axis formation: induction of goosecoid by injected Xwnt-8 and activin mRNAs

In this study, we compare the effects of three mRNAs-goosecoid, activin and Xwnt-8- that are able to induce partial or complete secondary axes when injected into Xenopus embryos. Xwnt-8 injection produces complete secondary axes including head structures whereas activin and goosecoid injection produce partial secondary axes at high frequency that lack head structures anterior to the auditory vesicle and often lack notochord. Xwnt-8 can activate goosecoid only in the deep marginal zone, i.e., in the region in which this organizer-specific homeobox gene is normally expressed on the dorsal side. Activin B mRNA, however, can turn on goosecoid in all regions of the embryo. We also tested the capacity of these gene products to restore axis formation in embryos in which the cortical rotation was blocked by UV irradiation. Whereas Xwnt-8 gives complete rescue of anterior structures, both goosecoid and activin give partial rescue. Rescued axes including hindbrain structures up to level of the auditory vesicle can be obtained at high frequency even in the absence of notochord structures. The possible functions of Wnt-like and activin-like signals and of the goosecoid homeobox gene, and their order of action in the formation of Spemann's organizer are discussed.

Metabolic stress induces a Wnt-dependent cancer stem cell-like state transition

Reciprocal interactions between cancer cells and the tumor microenvironment drive multiple clinically significant behaviors including dormancy, invasion, and metastasis as well as therapy resistance. These microenvironment-dependent phenotypes share typical characteristics with cancer stem cells (CSC). However, it is poorly understood how metabolic stress in the confined tumor microenvironment contributes to the emergence and maintenance of CSC-like phenotypes. Here, we demonstrate that chronic metabolic stress (CMS) in a long-term nutrient deprivation induces a Wnt-dependent phenoconversion of non-stem cancer cells toward stem-like state and this is reflected in the transcriptome analysis. Addition of Wnt3a as well as transfection of dominant-negative Tcf4 establishes an obligatory role for the Wnt pathway in the acquisition of CSC-like characteristics in response to metabolic stress. Furthermore, systematic characterization for multiple single cell-derived clones and negative enrichment of CD44+/ESA+ stem-like cancer cells, all of which recapitulate stem-like cancer characteristics, suggest stochastic adaptation rather than selection of pre-existing subclones. Finally, CMS in the tumor microenvironment can drive a CSC-like phenoconversion of non-stem cancer cells through stochastic state transition dependent on the Wnt pathway. These findings contribute to an understanding of the metabolic stress-driven dynamic transition of non-stem cancer cells to a stem-like state in the tumor metabolic microenvironment.

Sorafenib with Transarterial Chemoembolization Achieves Improved Survival vs. Sorafenib Alone in Advanced Hepatocellular Carcinoma: A Nationwide Population-Based Cohort Study

We hypothesized that sorafenib plus transarterial chemoembolization (TACE) would confer survival benefits over sorafenib alone for advanced hepatocellular carcinoma (aHCC). We investigated this while using the population-based All-Cancer Dataset to assemble a cohort (n = 3674; median age, 60; 83% men) of patients receiving sorafenib for aHCC (Child-Pugh A) with macro-vascular invasion or nodal/distant metastases. The patients were classified into the sorafenib-TACE group (n = 426) or the propensity score-matched sorafenib-alone group (n = 1686). All of the participants were followed up until death or the end of the study. Time-dependent Cox model and the Mantel-Byar test were used for survival analysis. During the median follow-ups of 221 and 133 days for the sorafenib-TACE and sorafenib-alone groups, 164 (39%) and 916 (54%) deaths occurred, respectively; the corresponding median overall survivals (OS) were 381 and 204 days, respectively (hazard ratio, HR: 0.74; 95% confidence interval, CI, 0.63-0.88; p = 0.021). The one-year and six-month OS were 53.5% and 80.3% in the sorafenib-TACE group and 32.4% and 54.4% in the sorafenib-alone group, respectively. The major complications were comparable between the two groups. The addition of TACE to sorafenib improves survival, with a 26% reduction in mortality. These findings provide strong real-world evidence that supports this combination strategy for eligible Child-Pugh A aHCC patients.

Developmentally regulated excision of a 28-base-pair sequence from the Paramecium genome requires flanking DNA

The micronuclear DNA of Paramecium tetraurelia is estimated to contain over 50,000 short DNA elements that are precisely removed during the formation of the transcriptionally active macronucleus. Each internal eliminated sequence (IES) is bounded by 5'-TA-3' dinucleotide repeats, a feature common to some classes of DNA transposons. We have developed an in vivo assay to analyze these highly efficient and precise DNA excision events. The microinjection of a cloned IES into mating cells results in accurately spliced products, and the transformed cells maintain the injected DNA as extrachromosomal molecules. A series of deletions flanking one side of a 28-bp IES were constructed and analyzed with the in vivo assay. Whereas 72 bp of DNA flanking the eliminated region is sufficient for excision, lengths of 31 and 18 bp result in reduced excision and removal of all wild-type sequences adjacent to the TA results in complete failure of excision. In contrast, nucleotide mutations within the middle of the 28-bp IES do not prevent excision. The results are consistent with a functional role for perfect inverted repeats flanking the IES.

The bovine pericardial xenograft: III. Effect of uniaxial and sequential biaxial stress during fixation on the tensile viscoelastic properties of bovine pericardium

Our previous two articles have shown that glutaraldehyde-fixed bovine pericardium is nearly isotropic, whether fixed without constraints, with tethering, or with pressure. In this study, we have used uniaxial stress during fixation to produce bovine pericardial material with marked tensile anisotropy. Rectangular and cruciate pericardial samples have been mechanically examined after one of four treatments: (i) fixation under 88-kPa uniaxial stress, (ii) fixation under 176-kPa uniaxial stress, (iii) 3 h of 176-kPa uniaxial stress in saline followed by 24-h fixation under the same stress, (iv) fixation under 176-kPa uniaxial stress followed by a second fixation under 176-kPa stress in a direction normal to the first. Strips of material were cut at 0 degree, 30 degrees, 60 degrees, and 90 degrees to direction of the initial stress, and tested for response to cyclic loading, stress relaxation, plastic deformation, and fracture properties. Fixation under uniaxial stress produced anistropy similar to that seen in porcine aortic valve leaflets; however, the overall extensibility of the material depended on the applied stress and the aspect ratio of the stressed sample. While loading in saline produced no change, the sequential biaxial stressing produced a reduction in anisotropy, suggesting exposure of additional crosslinking sites. Uniaxial stress during fixation may be a useful method for construction of anisotropic heart valve leaflets.

Diffuse large B-cell lymphoma: A consensus practice statement from the Australasian Lymphoma Alliance

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype, accounting for 30-40% of lymphoma diagnoses. Though aggressive, cure is achievable in approximately 60% of cases with primary chemo-immunotherapy, and in a further substantial minority by salvage therapy and autologous stem cell transplantation. Despite promising activity in early phase clinical trials, no intensified or novel treatment regimen has improved outcomes over R-CHOP21 in randomised studies. However, there remain several areas of controversy including the most appropriate prognostic markers, CNS prophylaxis and the optimal treatment for patients with high-risk disease. This position statement presents an evidence-based synthesis of the literature for application in Australasian practice. This article is protected by copyright. All rights reserved.

Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study

INTRODUCTION

Osteoporosis is becoming an impending epidemic in the Asia-Pacific region. The association between risk of osteoporotic fracture (OTPF) and chronic obstructive pulmonary disease (COPD) in East Asian patients is yet to be fully examined. We conducted a nationwide population-based retrospective cohort study of 98,700 patients aged ≥50 years with or without COPD using a national administrative claims dataset.

MATERIALS AND METHODS

The patients were divided into COPD and comparison groups comprising 19,740 and 78,960 patients, respectively. The groups were 1 to 4 matched for age, gender, index date, diabetes mellitus, pre-existing osteoporosis and chronic kidney disease. Information such as the geographic area where southern part represented more sunshine exposure, smoking-related diagnoses, alcohol use disorder, whether there was regular use of inhaled corticosteroids and oral corticosteroids, vitamin D prescriptions, Charlson-Deyo comorbidity index score, and other relevant medical comorbidities were extracted for analysis. They were followed up until OTPF or the end of the year 2013. The outcome measure was an osteoporotic vertebral fracture and other long-bone fractures. A multivariate Cox model was constructed to derive adjusted hazard ratios (aHR) for OTPF with corresponding 95% confidence intervals (CI) after controlling for age, sex, insurance premium category, vitamin D prescription, osteoporosis, and coronary heart disease (CHD). Kaplan-Meier curves of the probability of OTPF-free survival for each cohort were compared using the log-rank test. Patients with OTPF during the first follow-up year were excluded from the overall risk calculation. Contributing factors to the increased risk of OTPF in COPD patients were examined in a sensitivity analysis.

RESULTS

After a total follow-up of 68,743 patient-years for the COPD group and 278,051 patient-years for the matched comparison group, the HR for OTPF was 1.24 (95% CI [1.02-1.51]; P = 0.0322) in COPD patients. The aHR was increased by 30% for vertebral OTPF (aHR = 1.297, 95% CI [1.020-1.649]; P = 0.0339). Differential lag time sensitivity analysis revealed a progressively elevated risk up to 8-fold increase in women (aHR = 8.0 (95% CI [1.81-35.4]; P < 0.01)) during the fifth follow-up year. COPD patients with pre-existing osteoporosis or given vitamin D prescription harbor a sustained increased risk up to the 5th (aHR, 4.1; 95% CI [1.61-10.35]) and third (aHR, 2.97; 95% CI [1.48-5.97]) follow-up year, respectively.

CONCLUSIONS

Our nationwide population-based cohort study demonstrates that East Asian COPD patients aged 50 and beyond do harbor a modestly increased risk for osteoporotic vertebral fractures particularly for those who are female, have pre-existing osteoporosis or require vitamin D prescription.

Multiple gastrointestinal stromal tumors in a patient with type I neurofibromatosis presenting with tumor rupture and peritonitis

A young woman with type 1 neurofibromatosis (NF-1) complained of abdominal pain for 3 days. Computed tomography disclosed two jejunal tumors with rupture and peritonitis. Surgery revealed two tumors in the jejunum, one of which was ruptured. Specimen examination found four additional intramural nodules between these tumors. Histology proved these tumors were all gastrointestinal stromal tumors (GIST). The finding of multiple digestive tumors associated with peritonitis in an NF-1 patient should lead to the consideration of a ruptured GIST.

Clinical analysis of contributors to the delayed gallbladder opacification following the use of water-soluble contrast medium

OBJECTIVES

Gallbladder opacification (GBO) on computed tomography (CT) imaging may obscure certain pathological or emergent conditions in the gallbladder, such as neoplasms, stones, and hemorrhagic cholecystitis. This study aimed to investigate the clinical contributing factors that could predict the presence of delayed GBO determined by CT.

METHODS

This study retrospectively evaluated 243 consecutive patients who received enhanced CT or intravenous pyelography imaging and then underwent abdominal CT imaging within 5 days. According to the interval between imaging, the patients were divided into group A (1 day), group B (2 or 3 days), and group C (4 or 5 days). Three radiologists evaluated CT images to determine GBO. Fisher's exact test and multivariate backward stepwise elimination logistic regression were performed.

RESULTS

Positive GBO was significantly associated with the interval between imaging studies, contrast type, contrast volume, renal function, and hypertransaminasemia (P<0.05). Multivariate backward stepwise elimination logistic regression analysis of the three groups identified contrast type and hypertransaminasemia as independent predictors of GBO in group B patients (odds ratio [OR], 13.52, 95% confidence interval [CI], 1.72-106.38 and OR, 3.43, 95% CI, 1.31-8.98, respectively; P<0.05). Hypertransaminasemia was the only independent predictor of GBO in group C patients with an OR of 7.2 (95% CI, 1.62-31.73). Hypertransaminasemia was noted in three patients (100%) who initially underwent imaging 5 days prior to GBO.

CONCLUSION

Delayed GBO on CT imaging may be associated with laboratory hypertransaminasemia, particularly in patients receiving contrast medium over a period of ≥4 days. A detailed clinical history, physical examination, and further workup are of paramount importance for investigating the underlying cause behind the hypertransaminasemia.

Patient-controlled analgesia with morphine plus lysine acetyl salicylate

Using a patient-controlled analgesia (PCA) delivery system, we evaluated the clinical advantages and disadvantages of morphine PCA compared with morphine plus lysine acetyl salicylate (LAS), a soluble aspirin. After major orthopedic surgery, 50 adult patients were enrolled in a prospective, randomized, and double-blinded study. When a patient in the recovery room complained of pain, an initial dose of morphine or the morphine/LAS mixture was titrated to achieve analgesia of visual analog score < or = 3 in 30 min. An equivalent volume PCA dose of either morphine 1 mg/mL or morphine 0.5 mg + LAS 90 mg/mL was used with a lockout interval of 10 min. Pain score, patient satisfaction, vital signs, and adverse effects were observed for 48 h. Adequate analgesia (visual analog scale score < or = 3) was achieved with either drug. Morphine consumption in the morphine/LAS group was significantly less than in morphine group (13.9 vs 18.4 mg in 24 h and 24.3 vs 32.4 mg in 48 h). Significantly more sedation was evident with the morphine group (P < 0.05). We conclude that injectable LAS can be used as an effective and safe adjuvant to morphine for PCA. This combination reduces dose requirements of morphine and hence some of its adverse effects.

IMPLICATIONS

Injectable aspirin could be used as an effective and safe adjuvant to morphine for patient-controlled analgesia. This combination reduces the dose requirement of morphine and therefore some of the morphine-related untoward effects.

Treatment of femoral fracture with nonunion

Thirty-four patients with femoral nonunion were managed by autogenous and/or allogenous bone graft alone, or internal fixation (including DCP or intramedullary nail) combined with bone graft, or external fixation in Taichung Veterans General hospital. Adequate follow-up study was obtained in 32 patients; two patients were unable to be contacted for follow-up. All 32 patients had received one or more operations. All but four patients showed clinical and radiological union, with an overall union rate 87.5%. Twenty-five patients (89.3%) returned to work, but half of these patients changed jobs. All twenty-eight patients with solid unions could walk, but eleven patients (39.3%) had a slight limp. Twenty-two patients (78.6%) could squat, and all patients could straighten their knees. Fourteen patients (50%) complained of occasional soreness over the operated area. In our limited experience, most femoral nonunions result from (1) inappropriate selection and usage of internal fixator, (2) severe stripping of soft tissue around the fracture site, or inappropriate usage of cerclage wire, and (3) infection. Treatment must depend on the causes and types of nonunion. In this study, a high union rate and good functional recovery were achieved with interlocking nails with or without autogenous bone graft. Plating would extend the time for union to take place, and even resulted in refracture of the plate by contact with the medial cortex when there was no medial buttress. In general, detailed planning before operation, skilled surgical techniques and aseptic procedures are essential in the prevention and treatment of nonunion.

Diagnosis and management of primary central nervous system lymphoma: a Consensus Practice Statement from the Australasian Lymphoma Alliance

Primary central nervous system lymphoma is a clinicopathological disease entity that accounts for 1 % of all non-Hodgkin lymphoma (NHL). Advanced patient age, adverse disease biology and complexities of diagnosis and treatment render outcomes markedly inferior to systemic NHL. Despite this, an increasing evidence base including limited randomised controlled clinical trial data is informing optimal therapeutic strategies with methotrexate-based induction chemotherapy schedules and intensified consolidation in selected patients. This practice statement represents an evidence-based review of the literature and has been devised to assist healthcare professionals in the diagnosis and management of this disease. This article is protected by copyright. All rights reserved.

Pigmented villonodular synovitis

Seventy-three patients, 28 males and 45 females, diagnosed with pigmented villonodular synovitis (PVNS) between 1982 and 1990 were followed for an average of 42.2 months (range, 21 to 108 months). Fifty-five cases occurred in the tendon sheath and eighteen in synovial joint. Ages ranged from 5 to 77 years, with an average of 38.9 years. The clinical presentations included chronic tumescence, serosanguinous arthrocentesis and painful limitation of range of motion. Plain roentgenography usually demonstrated soft tissue swelling with varying density, bony erosion or joint space narrowing. Arthrography and magnetic resonance imaging both gave specific pictures, with good diagnostic rates. The therapeutic regimen consisted of marginal excision for tendon sheath lesions and total synovectomy for intraarticular lesions. Extensive synovectomy with prosthesis replacement yielded good functional results in elderly patients with PVNS and cartilage destruction. Recurrence rate averaged 26% and was higher among knee joint lesions (33%), possibly because of inaccessibility of the popliteal fossa and inadequate excision of the lesion. Differences in the mitotic index between recurrence and non-recurrence groups had no statistical significance. This phenomenon may well serve against "tumor origin" as the etiology of this disease.

[Second hip fracture]

During the period from 1982-1990, a total of 1644 patients were admitted to our hospital with proximal femoral fractures. Trochanteric fractures were encountered in 54 per cent of the cases (887/1644) with a mean age of 68 years. Cervical fractures were encountered in 46 per cent of the cases (757/1644) with a mean age of 62 years. We found 28 patients who had been readmitted with a second hip fracture in this retrospective study, including twenty three males and five females. Two of these second hip fractures occurred on the same side as the initial fracture and twenty six occurred on the opposite side. The time interval between the first and the second hip fracture was shorter in males than that in females (1.7 years V.S. 2.7 years) and the interval also was shorter in those with a previous trochanteric fracture as compared to those with a previous cervical fracture (1.5 years V.S. 2.6 years). It appeared that a hip fracture reduced the risk of a subsequent hip fracture on the same side, and almost all second hip fractures were located on the opposite side of the patient (93 per cent). A possible reason for this "protective mechanism" is increased strength of the bone due to callus formation. A significant symmetry (trochanteric-trochanteric or cervical-cervical) was found between the first and the second hip fractures (69 per cent). We believe the symmetrical fracture pattern is due to senile osteoporosis, a kind of ongoing systemic weakening of the skeletal system among the elderly.

[Tardy ulnar palsy treated by anterior subcutaneous transposition]

Twenty cases of tardy ulnar palsy were treated by anterior subcutaneous transposition in the past 6 years at the Veterans General Hospital-Taichung. These cases were followed up for at least 9 months after operation. Mean duration of follow up was 39.5 months. Age distribution was from 40y/o to 72y/o, mean age was 54.5y/o. Duration of symptoms was from 2 months to 72 months, mean was 20.3 months. Eight cases were attributed to the idiopathic type. 16 cases (80%) improved after operation. Four factors were analyzed to evaluate their status as a prognostic guide: age, duration of syndrome, severity before operation and precipitating factors. Only severity before operation correlated with prognosis, but good recovery can be achieved in severe cases. Anterior subcutaneous transposition is a good method for treating tardy ulnar palsy.

Insufficiency fracture of acetabulum: a case report

Most stress fractures of the hip joint occur on the femoral side. A review of the English literature showed that only eight cases of stress fracture of the acetabulum had been reported. Another insufficiency fracture of the acetabulum in an osteoporotic bone is reported.

[Treatment of proximal humeral tumor: a case report]

In management of malignancy of the proximal humerus, amputation or a complete flail limb both give poor functional results. The limb-salvage procedure with joint reconstruction preserves function in the elbow and hand, thereby improving the quality of remaining life for patient. Prosthetic humeral replacement may avert amputation and preserve a functional arm, but neither segmental modular proximal humeral prosthesis nor custom-made prosthesis is readily available here. Combining the Neer II shoulder prosthesis and Kuntscher's nail with acrylic cement can replace the proximal humerus with an adjustable length of stem within the humeral shaft. A piece of mesh is incorporated into the prosthesis, placed around the neck of the Neer II shoulder prosthesis, and sutured to the rotator cuff to prevent subluxation of the humeral head and preserve some function of the rotator cuff. The above prosthetic humeral replacement has been applied to one patient with a primary osteosarcoma. It preserved the function of the elbow and hand well. One year post-operatively, there was no dislocation or subluxation. Details of procedures used are given.

Two to five year follow-up of Harris-Galante cementless total hip arthroplasty

One hundred and forty-nine hips (125 patients) underwent cementless Harris-Galante primary total hip arthroplasty from September 1987 to June 1990 at the Taichung Veterans General Hospital. Seventy hips (61 patients) have been followed up for at least 2 years (range, 26-55 months, mean 36 months). The primary diagnoses included osteoarthritis (42.9%) and avascular necrosis (57.1%). All the hips were evaluated using Harris hip score and Mayo Clinic hip score. The average Harris hip score was 36.5 points (23-73) preoperatively, and 95 points (80-100) postoperatively. When evaluated by the Harris hip score, 94.3% were excellent, and 5.7% had good results; and 90% were excellent, 10% had good results when evaluated by Mayo Clinic hip score. No fair or poor results were noted by either evaluating system. Fifty-seven femoral components (81.4%) appeared to have stable bone ingrowth fixation, ten components (14.3%) had stable fibrous ingrowth, and three (4.3%) were unstable. Fifty-five hips (78.6%) showed radiolucent lines around the femoral component in follow-up roentgenogram; most were at the non-porous, fiber-mesh part. It seemed that there was no correlation between these radiolucent lines and clinical outcome, according to this short-term study.