Absence of 3a0 charge density wave order in the infinite-layer nickelate NdNiO2

A hallmark of many unconventional superconductors is the presence of many-body interactions that give rise to broken-symmetry states intertwined with superconductivity. Recent resonant soft X-ray scattering experiments report commensurate 3a0 charge density wave order in infinite-layer nickelates, which has important implications regarding the universal interplay between charge order and superconductivity in both cuprates and nickelates. Here we present X-ray scattering and spectroscopy measurements on a series of NdNiO2+x samples, which reveal that the signatures of charge density wave order are absent in fully reduced, single-phase NdNiO2. The 3a0 superlattice peak instead originates from a partially reduced impurity phase where excess apical oxygens form ordered rows with three-unit-cell periodicity. The absence of any observable charge density wave order in NdNiO2 highlights a crucial difference between the phase diagrams of cuprate and nickelate superconductors.

Myosin Va-dependent Transport of NMDA Receptors in Hippocampal Neurons

N-methyl-D-aspartate receptor (NMDAR) trafficking is a key process in the regulation of synaptic efficacy and brain function. However, the molecular mechanism underlying the surface transport of NMDARs is largely unknown. Here we identified myosin Va (MyoVa) as the specific motor protein that traffics NMDARs in hippocampal neurons. We found that MyoVa associates with NMDARs through its cargo binding domain. This association was increased during NMDAR surface transport. Knockdown of MyoVa suppressed NMDAR transport. We further demonstrated that Ca2+/calmodulin-dependent protein kinase II (CaMKII) regulates NMDAR transport through its direct interaction with MyoVa. Furthermore, MyoVa employed Rab11 family-interacting protein 3 (Rab11/FIP3) as the adaptor proteins to couple themselves with NMDARs during their transport. Accordingly, the knockdown of FIP3 impairs hippocampal memory. Together, we conclude that in hippocampal neurons, MyoVa conducts active transport of NMDARs in a CaMKII-dependent manner.

[Quantitative study of supraspinatus tendon injury grading based on synthetic magnetic resonance imaging]

Objective: To investigate the diagnostic value of quantitative parameters of synthetic magnetic resonance imaging (SyMRI) in the grade of supraspinatus tendon injury. Methods: Ninety-seven patients with clinical definite of supraspinatus tendon injury from July 2021 to July 2022 in General Hospital of Ningxia Medical University were prospectively collected (case group), including 54 males and 43 females, with an age of 29 to 56 (37.4±9.6) years. According to the results of shoulder arthroscopy, the case group were divided into three subgroups included tendinopathy group (37 cases, grade Ⅱ), partial tear group (34 cases, grade Ⅲ) and complete tear group (26 cases, grade Ⅳ). During the same period, 28 normal rotator cuff volunteers without supraspinatus tendon injury were recruited (control group), including 16 males and 12 females, aged 23 to 49 (36.1±7.2) years, and marked as grade Ⅰ. All the subjects underwent MRI scan of articulatio humeri included T₁-weighted imaging(T₁WI) fast spin echo(FSE) sequences in axial view, T₂-weighted imaging(T₂WI) fat suppression(FS) sequences in axial view, T₂WI FS sequences in oblique coronal view, proton density-weighted (PDW) imaging in oblique sagittal view and SyMRI in oblique coronal view. The supraspinatus tendon was divided into lateral, medial and middle subregions according to its shape in oblique coronal T₂WI view, two radiologists measured the T₁, T₂ and PD values of the supraspinatus tendon. The interclass correlation coefficient (ICC) were used to compare the consistency between and within observers. One-way analysis of variance or Kruskal-Wallis H test were used to compare the differences of quantitative parameters in different grades, the multivariate logistic regression model was used to analyze the risk factors of supraspinatus tendon injury grade, and the receiver operating characteristic (ROC) curves and area under curve (AUC) was drawn and calculated to evaluate the diagnostic efficacy. The Spearman correlation was used to analyze the correlation between the quantitative values and grades of supraspinatus tendon injury. Results: The ICC values of T₁, T₂ and PD values for the three subregions of the supraspinatus tendon were greater than 0. 700. The differences of T₁ values in the lateral subregion, T₂ values in the lateral and middle subregions were statistically significant in the overall comparison across different grades (all P<0. 001).The differences of T₁ values in the middle and medial subregions, T₂ values in the medial subregion and PD values in the lateral, middle and medial subregions were not statistically significant in the overall comparison of different grades (all P>0. 05). Multiple logistic regression model analysis showed that T₂ values in the lateral and middle subregions were related factors for the grade of supraspinatus tendon injury[ OR (95%CI):1.123 (1.037-1.216), 0.122 (1.151-1.197);all P<0.001 ]. The AUC of the T₂ values in lateral subregion diagnosing grade Ⅰ vs grade Ⅳ, grade Ⅱ vs grade Ⅳ and grade Ⅲ vs grade Ⅳ were 0.891(95%CI: 0.801-0.981), 0.797(95%CI: 0.680-0.914), 0.723(95%CI: 0.594-0.853) (all P<0.001), and the AUC of the T₂ values in middle subregion diagnosing grade Ⅰ vs Ⅳ, grade Ⅱ vs Ⅳ, grade Ⅱ vs Ⅲ, and grade Ⅰ vs Ⅲ were 0.946 (95%CI: 0.849-0.989), 0.886 (95%CI: 0.809-0.962), 0.746 (95%CI: 0.631-0.861), 0.843 (95%CI: 0.745-0.941)(all P<0.001). The T₂ values in the lateral and middle subregions were positively correlated with the grade of supraspinatus tendon injury (r=0.542, 0.615; both P<0.001), while T₁ values and T₂ values in the medial subregions were not significantly correlated with the grade of supraspinatus tendon injury (both P>0.05). Conclusion: SyMRI has high clinical application value in the grading of supraspinatus tendon injury, especially T₂ value can be used as an effective quantitative parameter for the grading of supraspinatus tendon injury.

A Novel MR Imaging Sequence of 3D-ZOOMit Real Inversion-Recovery Imaging Improves Endolymphatic Hydrops Detection in Patients with Ménière Disease

BACKGROUND AND PURPOSE

The detection rate of premortem MR imaging endolymphatic hydrops is lower than that of postmortem endolymphatic hydrops in Ménière disease, indicating that current MR imaging techniques may underestimate endolymphatic hydrops. Therefore, we prospectively investigated whether a novel high-resolution MR imaging technique, the 3D zoomed imaging technique with parallel transmission real inversion-recovery (3D-ZOOMit real IR), would improve the detection of endolymphatic hydrops compared with conventional 3D TSE inversion-recovery with real reconstruction.

MATERIALS AND METHODS

Fifty patients with definite unilateral Ménière disease were enrolled and underwent 3D-ZOOMit real IR and 3D TSE inversion-recovery with real reconstruction 6 hours after IV gadolinium injection. The endo- and perilymph spaces were scored separately. The contrast-to-noise ratio, SNR, and signal intensity ratio of the 2 sequences were respectively calculated and compared. The presence of endolymphatic hydrops was evaluated.

RESULTS

The endolymphatic space in the cochlea and vestibule was better visualized with 3D-ZOOMit real IR than with conventional 3D TSE inversion-recovery with real reconstruction (P < .001). There were differences between the 2 sequences in the evaluation of no cochlear hydrops and cochlear hydrops (both, P < .017). All contrast-to-noise ratio, SNR, and signal intensity ratio values of 3D-ZOOMit real IR images were statistically higher than those of conventional 3D TSE inversion-recovery with real reconstruction (all, P < .001).

CONCLUSIONS

The 3D-ZOOMit real IR sequences are superior to conventional 3D TSE inversion-recovery with real reconstruction sequences in visualizing the endolymphatic space, detecting endolymphatic hydrops, and discovering contrast permeability.

Effect of intracranial pressure on photoplethysmographic waveform in different cerebral perfusion territories: A computational study

Background: Intracranial photoplethysmography (PPG) signals can be measured from extracranial sites using wearable sensors and may enable long-term non-invasive monitoring of intracranial pressure (ICP). However, it is still unknown if ICP changes can lead to waveform changes in intracranial PPG signals.

Aim: To investigate the effect of ICP changes on the waveform of intracranial PPG signals of different cerebral perfusion territories.

Methods: Based on lump-parameter Windkessel models, we developed a computational model consisting three interactive parts: cardiocerebral artery network, ICP model, and PPG model. We simulated ICP and PPG signals of three perfusion territories [anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA), all left side] in three ages (20, 40, and 60 years) and four intracranial capacitance conditions (normal, 20% decrease, 50% decrease, and 75% decrease). We calculated following PPG waveform features: maximum, minimum, mean, amplitude, min-to-max time, pulsatility index (PI), resistive index (RI), and max-to-mean ratio (MMR).

Results: The simulated mean ICPs in normal condition were in the normal range (8.87–11.35 mm Hg), with larger PPG fluctuations in older subject and ACA/PCA territories. When intracranial capacitance decreased, the mean ICP increased above normal threshold (&gt;20 mm Hg), with significant decreases in maximum, minimum, and mean; a minor decrease in amplitude; and no consistent change in min-to-max time, PI, RI, or MMR (maximal relative difference less than 2%) for PPG signals of all perfusion territories. There were significant effects of age and territory on all waveform features except age on mean.

Conclusion: ICP values could significantly change the value-relevant (maximum, minimum, and amplitude) waveform features of PPG signals measured from different cerebral perfusion territories, with negligible effect on shape-relevant features (min-to-max time, PI, RI, and MMR). Age and measurement site could also significantly influence intracranial PPG waveform.

A81 TRANSITION PRACTICES FROM PEDIATRIC TO ADULT CARE OF CHILDREN LIVING WITH CROHN’S DISEASE IN QUEBEC

Background

Nearly 25% of Crohn’s disease cases are diagnosed during childhood. Among them, several adolescents may have extensive or complex disease implying specific needs during transition to adult care.

Aims

The primary aim was to describe current transition practices from pediatric to adult care in patients diagnosed with Crohn’s disease at CHU Sainte-Justine. The secondary aim was to determine factors that influenced the type of adult health centers (academic vs non-academic) to which patients were referred.

Methods

This single center study included patients diagnosed with Crohn’s disease at CHU Sainte-Justine between 2009 and 2019. Adult centers were separated into five categories: academic centers in Montreal (CHU-Mtl) and outside of Montreal (CHU), non-academic centers in Montreal (CHG-Mtl) and outside of Montreal (CHG), and other centers. The following factors influencing the transfer to an academic center were analyzed in a multivariate logistic regression model: age at diagnosis, gender, disease location, disease activity: relapses, hospitalizations, emergency room (ER) visits, and place of residence.

Results

A total of 366 patients were included: 44% female, median (IQR) age at transfer 18.0 (17.9–18.4). Among them, 169 (48%) were transferred to CHU-Mtl, 144 (39%) to CHG, 22(6%) to CHU, 4 (1%) to CHG-Mtl, 27 (7%) to other centers. There was a significant increase in the annual number of patients referred to CHG and CHU-Mtl across the decade, compared to other centers. Patients transferred to CHU-Mtl had more relapses per year (mean (SD) 0.8 (0.5) versus patients transferred to CHU, CHG and CHG-Mtl, p=0.0348), and 57% (N=97) of patients sent to CHU-Mtl had already visited the ER, as compared to 54%, 40% and 25% for CHU, CHG and CHG-Mtl respectively (p=0.0258). However, gender, age at diagnosis, maintenance treatment, number and duration of hospitalisations, extraintestinal manifestations, perianal inflammation or extensive disease location did not correlate with the type of adult center. Place of residence played a role in the choice of adult center: 56% (N= 95) of patients transferred to CHU-Mtl lived in Montreal (p<0.0001).

Conclusions

Clinical evolution and disease burden have an impact on the type of adult center. Efforts should be put to understand patient factors associated with the transfer to an academic vs non-academic center, for a better utilization of healthcare resources and adequate patient quality of life during transition.

Funding Agencies

NonePrincipal researcher funds

NMDAR-dependent somatic potentiation of synaptic inputs is correlated with β amyloid-mediated neuronal hyperactivity

BACKGROUND

β Amyloid (Aβ)-mediated neuronal hyperactivity, a key feature of the early stage of Alzheimer's disease (AD), is recently proposed to be initiated by the suppression of glutamate reuptake. Nevertheless, the underlying mechanism by which the impaired glutamate reuptake causes neuronal hyperactivity remains unclear. Chronic suppression of the glutamate reuptake causes accumulation of ambient glutamate that could diffuse from synaptic sites at the dendrites to the soma to elevate the tonic activation of somatic N-methyl-D-aspartate receptors (NMDARs). However, less attention has been paid to the potential role of tonic activity change in extrasynaptic glutamate receptors (GluRs) located at the neuronal soma on generation of neuronal hyperactivity.

METHODS

Whole-cell patch-clamp recordings were performed on CA1 pyramidal neurons in acute hippocampal slices exposed to TFB-threo-β-benzyloxyaspartic acid (TBOA) or human Aβ_1-42 peptide oligomer. A series of dendritic patch-clamp recordings were made at different distances from the soma to identify the location of the changes in synaptic inputs. Moreover, single-channel recording in the cell-attached mode was performed to investigate the activity changes of single NMDARs at the soma.

RESULTS

Blocking glutamate uptake with either TBOA or the human Aβ_1-42 peptide oligomer elicited potentiation of synaptic inputs in CA1 hippocampal neurons. Strikingly, this potentiation  specifically occurred at the soma, depending on the activation of somatic GluN2B-containing NMDARs (GluN2B-NMDARs) and accompanied by a substantial and persistent increment in the open probability of somatic NMDARs. Blocking the activity of GluN2B-NMDARs at the soma completely reversed both the TBOA-induced or the Aβ_1-42-induced somatic potentiation and neuronal hyperactivity.

CONCLUSIONS

The somatic potentiation of synaptic inputs may represent a novel amplification mechanism that elevates cell excitability and thus contributes to neuronal hyperactivity initiated by impaired glutamate reuptake in AD.

Long-Lasting Somatic Modifications of Convergent Dendritic Inputs in Hippocampal Neurons

Integrated neural inputs from different dendrites converge at the soma for action potential generation. However, it is unclear how the convergent dendritic inputs interact at the soma and whether they can be further modified there. We report here an entirely new plasticity rule in hippocampal neurons in which repetitive pairing of subthreshold excitatory inputs from proximal apical and basal dendrites at a precise interval induces persistent bidirectional modifications of the two dendritic inputs. Strikingly, the modification of the dendritic inputs specially occurs at soma in the absence of somatic action potential and requires activation of somatic N-methyl-D-aspartate receptors (NMDARs). Once induced, the somatic modification can also be observed in other unpaired dendritic inputs upon their arrival at the soma. We further reveal that the soma can employ an active mechanism to potentiate the dendritic inputs by promoting sustained activation of somatic NMDARs and subsequent down-regulating of the fast inactivating A-type potassium current (IA) at the soma. Thus, the input-timing-dependent somatic plasticity we uncovered here is in sharp contrast to conventional forms of synaptic plasticity that occur at the dendrites and is important to somatic action potential generation.

Serum miR-629 is a novel molecular marker for diagnosis and the prognosis of pancreatic cancer

OBJECTIVE

Increasing evidence indicates that dysregulation of miRNAs is involved in tumor progression and development. We aimed to determine potential values of miR-629 as a serum diagnostic and prognostic biomarker in pancreatic cancer (PC).

PATIENTS AND METHODS

MiR-629 expression levels in PC tissues and serum were measured by quantitative Real-time reverse transcription-polymerase chain reaction (qRT-PCR). Receiver operating characteristic analysis (ROC) was utilized to assess the predictive power of serum miR-629 for PC. Then, the associations of serum miR-629 expression levels with clinicopathological features and prognosis were evaluated.

RESULTS

We found that the expression levels of miR-629 were significantly upregulated in both PC tissues and serum in comparison with matched normal tissues and healthy controls, respectively. Importantly, serum miR-629 could efficiently screen PC patients from healthy controls (AUC=0.765). The diagnosis capability of serum miR-629 was significantly higher than that of CA19-9, and the combination of two molecules had higher diagnosis capacity. Higher expression of serum miR-629 in PC patients was associated with advanced TNM stage (p=0.000) and distant metastasis (p=0.003). Moreover, Kaplan-Meier analysis indicated that patients with high expression of serum miR-629 had significantly shorter overall survival (p=0.0022) and disease-free survival (p=0.0003) than the low expression group. Univariate and multivariate analysis showed that serum miR-629 was a significant and independent prognostic predictor for both overall survival and disease-free survival of PC patients.

CONCLUSIONS

This study suggested serum miR-629 may be a potential biomarker for the diagnosis and prognosis of PC.

Cyclin-dependent kinase 7 is a potential therapeutic target in papillary thyroid carcinoma

Given the pathological incidence of metastases or radioiodine-refractory papillary thyroid carcinoma (PTC) is increasing worldwide, patients have little alternatives when choosing effective drugs. Therefore, it is necessary to develop new therapeutic targets for PTC treatment. CDK7 is a member of the cyclindependent protein kinase (CDK) family, which plays an important role in various types of cancers. In this study, we found CDK7 were upregulated in PTC cell lines compared to normal thyroid cells using qRT-PCR and Western blot. Furthermore, using cell counting kit-8 (CCK-8) assay and 5-ethynyl-2-deoxyuridine (EdU) assay, we discovered cell growth ratio was positively correlated to the expression level of CDK7. Cell cycle analysis showed that the cells with higher CDK7 expression levels were prone to be in S phase. More importantly, we tested the inhibitory effects of BS-181 on CDK7 both in vitro and in vivo. Results obtained from this study indicated that BS-181 not only suppressed the cell proliferation in vitro, but also inhibited the tumor growth in nude mouse without changing mRNA and protein levels of CDK7. In conclusion, our study might provide a novel potential target for PTC therapy.

[Prevalence of hearing disorders in China: a population-based survey in four provinces of China]

Objective: To investigate the prevalence, severity of hearing disorders and demographics of people with hearing disorders based on the whole population in Jilin, Guangdong, Shannxi and Gansu provinces in China. Methods: According to " WHO Ear and Hearing Disorders Survey Protocol" , 144 clusters were chosen with probability proportional sampling(PPS) method from the four provinces covering 194, 688, 061 residents. Audiological test, otological examination and questionnaire surveying were conducted for all samples from August, 2014 to September, 2015. The hearing disorders were classified according to WHO criteria and classification. Results: Among 47 511 targeted residents, 45, 052 individuals (94.82% response rate) participated in the survey. The standardized prevalence rates of hearing disorders and disabling hearing disorders were 15.84 % and 5.17 % respectively. Almost 50% of people with hearing disorders had no awareness of it or its starting time. There was significant difference in the prevalence among people of different ages, genders, occupations, provinces, marital status and education levels. The prevalence of hearing disorders increased significantly as age grew. People above 60 years old occupied 55.31% of the total hearing disorders. The prevalence of hearing disorders among male, people of low education and those who lost husband or wife, as well as workers and farmers was relatively higher. Conclusions: The prevalence of hearing disorders is high, and hearing disorders are " invisible" . Demographics and socioeconomic factors significantly influence the prevalence of hearing disorders.

Amblyopic-related frontal changes in an orientation discrimination task: a research of P3a event-related potentials in anisometropic amblyopia

BACKGROUND

Amblyopic deficits in the primary and secondary visual cortex have been demonstrated broadly. However, the cognitive process at late stage originating in higher brain area in amblyopes hasn't been studied yet. The aim of this study was to investigate the late cognitive process at the frontal lobe in anisometropic amblyopes of a distinct degree, using visual event-related potential (ERP) techniques.

METHODS

Thirteen severe anisometropic amblyopes, 14 mild-to-moderate anisometropic amblyopes, and 13 control subjects participated in this study. Oddball paradigm (three stimuli: target, novel, and non-target stimuli) of low spatial frequency (1 cycle per degree, CPD) was used to elicit brain ERP waves. Reaction time, accuracy, latency, and amplitude of P3a waves evoked by novel stimuli at Fz electrode (the central electrode at frontal lobe), were analyzed statistically.

RESULTS

Neither accuracy nor reaction time showed significant difference among the three groups. The latency of N200 wave showed no significant difference. The latency of P3a wave was delayed in the amblyopes compared with healthy controls, but there was no significant difference between severe and mild-to-moderate amblyopes. P3a amplitude in mild-to-moderate amblyopes was significantly higher than in controls and severe amblyopes.

CONCLUSIONS

Our findings indicated that the cognitive process in anisometropic amblyopes was impaired, and the compensative effect of P3a amplitude was shown in mild-to-moderate amblyopes. P3a visual ERP could become a useful tool to investigate cognitive processing in amblyopes. Hippokratia 2016, 20(1): 60-66.

Common genes in coronary artery disease from Europe, Asia and North America regardless of race and lifestyle

OBJECTIVE

Coronary artery disease (CAD) remains one of the major causes of death worldwide. Despite considerable advances in the prevention and treatment of CAD, its complications, morbidity and mortality still remain very high, and vary widely across different ethnic groups.

MATERIALS AND METHODS

To detect genes involved in the development of CAD, we collected gene expression studies in the blood samples of CAD patients from different continents by searching the Gene Expression Omnibus database (GEO), performed a comparative analysis of gene expression between CAD patients and normal controls (NC) in each continent and identified the common set of differentially expressed genes (DEGs) between CAD patients and NC across different continents. PPI networks of the common set of DEGs were established by Cytoscape software to understand their biological role in CAD.

RESULTS

A total of 575, 868 and 476 genes were identified to be significantly differentially expressed between CAD patients and NC in Asia, Europe and North America. 24 genes were found common in three different continents, and 6 genes were previously linked to CAD or atherosclerosis. In the PPIs network the significant hub proteins contained IRF4 (Degree = 23), PLAUR (Degree = 17) and HIST1H2AE (Degree = 15).

CONCLUSIONS

Not only did we detect gene expression differences in the blood samples between CAD and NC in Asia, Europe and North America population, but analysis of the three population groups revealed a common set of 24 genes regardless of differences related to race, ethnicity, lifestyle, and environmental factor which may provide key factors to understand the pathogenesis of CAD and lead to development of diagnostic markers and/or effective therapeutic strategies.

PSTPIP2 dysregulation contributes to aberrant terminal differentiation in GATA-1-deficient megakaryocytes by activating LYN

GATA1 mutations are tightly associated with transient myeloproliferative disorder (TMD) and acute megakaryoblstic leukemia (AMKL) in children with Down syndrome. Numerous genes are altered in GATA-1-deficient megakaryocytes, which may contribute to the hyperproliferation and abnormal terminal differentiation of these malignant cells. In this study, we demonstrate that Pstpip2 is a GATA-1-repressed gene that controls megakaryopoiesis. Ectopic expression of PSTPIP2 impaired megakaryocytic differentiation as evidenced by a decrease of CD41 expression and reduced DNA content in K562 cells. PSTPIP2 overexpression also caused enhanced activation of Src family kinases and subsequently reduced ERK phosphorylation. Consistently, PSTPIP2 knockdown showed the opposite effect on differentiation and signaling. Moreover, the W232A mutant of PSTPIP2, defective in its interaction with PEST family phosphatases that recruit c-Src terminal kinase (CSK) to suppress Src family kinases, failed to inhibit differentiation and lost its ability to enhance Src family kinases or reduce ERK phosphorylation. In fact, the W232A mutant of PSTPIP2 promoted megakaryocyte differentiation. These observations suggest that PSTPIP2 recruiting PEST phosphatases somehow blocked CSK activity and led to enhanced activation of Src family kinases and reduced ERK phosphorylation, which ultimately repressed megakaryocyte differentiation. Supporting this idea, PSTPIP2 interacted with LYN and the expression of a dominant negative LYN (LYN DN) overwhelmed the inhibitory effect of PSTPIP2 on differentiation and ERK signaling. In addition, a constitutively active LYN (LYN CA) normalized the enhanced megakaryocyte differentiation and repressed ERK signaling in PSTPIP2 knockdown cells. Finally, we found that PSTPIP2 repressed ERK signaling, differentiation, and proliferation and verified that PSTPIP2 upregulation repressed megakaryocyte development in primary mouse bone marrow cells. Our study thus reveals a novel mechanism by which dysregulation of PSTPIP2 due to GATA-1 deficiency may contribute to abnormal megakaryocyte proliferation and differentiation in pathogenesis of related diseases.

Investigation of ultrasound screening efficiency for neural tube defects during pregnancy in rural areas of China

OBJECTIVES

To understand the uptake and efficacy of ultrasound screening for neural tube defects (NTDs) during pregnancy, and the outcomes when NTDs were detected in rural areas of China.

STUDY DESIGN

Prevalence study.

METHODS

Four hundred and twenty-four women who delivered or gestated babies/fetuses with NTDs were selected at random in 20 counties of two provinces of China from March 2008 to January 2009. The uptake of ultrasound screening, NTD detection rate and termination of pregnancy (TOP) rate were calculated and analyzed. Generalized estimating equations were employed to control for potential confounding factors.

RESULTS

The uptake of ultrasound screening was 98.8%. Among the study subjects, 361 (85.1%) NTDs were detected and 63 (14.9%) were not detected by prenatal ultrasound screening. The total detection rate was 43.3% (15.6%, 49.6% and 52.2% in the first, second and third trimesters, respectively; P < 0.05). Taking the possibility of NTD detection in the first trimester as 1.0, the possibilities in the second and third trimesters were 10.9 [95% confidence interval (CI) 6.5-18.3] and 25.2 (95% CI 13.3-47.6), respectively. The detection rate at the township health centres (THCs), family planning centres (FPCs), maternal and child care service centres (MCSCs) and hospitals was 24.5%, 29.1%, 53.6% and 78.1%, respectively (P < 0.05). Taking the possibility of NTD detection at THCs as 1.0, the possibilities at FPCs, MCSCs and hospitals were 0.9 (95% CI 0.5-1.6), 3.4 (95% CI 1.9-6.1) and 2.1 (95% CI 1.3-3.4), respectively. Three hundred and fifty-five (98.3%) of the 361 NTDs detected at prenatal ultrasound screening ended in TOP.

CONCLUSIONS

The uptake of ultrasound screening was satisfactory, but the NTD detection rate was low. Ultrasound screening did not play its full role in the secondary prevention of NTDs in the study areas. Medical institutions in rural areas in China need to improve their ultrasound screening skills in order to increase the efficacy of NTD control.

Estimating reaction rate coefficients within a travel-time modeling framework

A generalized, efficient, and practical approach based on the travel-time modeling framework is developed to estimate in situ reaction rate coefficients for groundwater remediation in heterogeneous aquifers. The required information for this approach can be obtained by conducting tracer tests with injection of a mixture of conservative and reactive tracers and measurements of both breakthrough curves (BTCs). The conservative BTC is used to infer the travel-time distribution from the injection point to the observation point. For advection-dominant reactive transport with well-mixed reactive species and a constant travel-time distribution, the reactive BTC is obtained by integrating the solutions to advective-reactive transport over the entire travel-time distribution, and then is used in optimization to determine the in situ reaction rate coefficients. By directly working on the conservative and reactive BTCs, this approach avoids costly aquifer characterization and improves the estimation for transport in heterogeneous aquifers which may not be sufficiently described by traditional mechanistic transport models with constant transport parameters. Simplified schemes are proposed for reactive transport with zero-, first-, nth-order, and Michaelis-Menten reactions. The proposed approach is validated by a reactive transport case in a two-dimensional synthetic heterogeneous aquifer and a field-scale bioremediation experiment conducted at Oak Ridge, Tennessee. The field application indicates that ethanol degradation for U(VI)-bioremediation is better approximated by zero-order reaction kinetics than first-order reaction kinetics.

Targeting of tumor radioiodine therapy by expression of the sodium iodide symporter under control of the survivin promoter

To test the feasibility of using the survivin promoter to induce specific expression of sodium/iodide symporter (NIS) in cancer cell lines and tumors for targeted use of radionuclide therapy, a recombinant adenovirus, Ad-SUR-NIS, that expressed the NIS gene under control of the survivin promoter was constructed. Ad-SUR-NIS mediating iodide uptake and cytotoxicity was performed in vitro. Scintigraphic, biodistribution and radioiodine therapy studies were performed in vivo. PC-3 (prostate); HepG2 (hepatoma) and A375 (melanoma) cancer cells all exhibited perchlorate-sensitive iodide uptake after infection with Ad-SUR-NIS, ∼50 times higher than that of negative control Ad-CMV-GFP-infected cells. No significant iodide uptake was observed in normal human dental pulp fibroblast (DPF) cells after infection with Ad-SUR-NIS. Clonogenic assays demonstrated that Ad-SUR-NIS-infected cancer cells were selectively killed by exposure to ¹³¹I. Ad-SUR-NIS-infected tumors show significant radioiodine accumulation (13.3±2.85% ID per g at 2 h post-injection), and the effective half-life was 3.1 h. Moreover, infection with Ad-SUR-NIS in combination with ¹³¹I suppressed tumor growth. These results indicate that expression of NIS under control of the survivin promoter can likely be used to achieve cancer-specific expression of NIS in many types of cancers. In combination with radioiodine therapy, this strategy is a possible method of cancer gene therapy.

Estimating kinetic mass transfer by resting-period measurements in flow-interruption tracer tests

Flow-interruption tracer test is an effective approach to identify kinetic mass transfer processes for solute transport in subsurface media. By switching well pumping and resting, one may alter the dominant transport mechanism and generate special concentration patterns for identifying kinetic mass transfer processes. In the present research, we conducted three-phase (i.e., pumping, resting, and pumping) field-scale flow-interruption tracer tests using a conservative tracer bromide in a multiple-well system installed at the US Department of Energy Site, Oak Ridge, TN. A novel modeling approach based on the resting-period measurements was developed to estimate the mass transfer parameters. This approach completely relied on the measured breakthrough curves without requiring detailed aquifer characterization and solving transport equations in nonuniform, transient flow fields. Additional measurements, including hydraulic heads and tracer concentrations in large pumping wells, were taken to justify the assumption that mass transfer processes dominated concentration change during resting periods. The developed approach can be conveniently applied to any linear mass transfer model. Both first-order and multirate mass transfer models were applied to analyze the breakthrough curves at various monitoring wells. The multirate mass transfer model was capable of jointly fitting breakthrough curve behavior, showing the effectiveness and flexibility for incorporating aquifer heterogeneity and scale effects in upscaling effective mass transfer models.

Glycogen synthase kinase 3beta: a novel marker and modulator of inflammatory injury in chronic renal allograft disease

One key cell-signaling event central to inflammation in kidney diseases, including chronic renal allograft dysfunction or disease (CRAD), is the activation of NF-kappaB, which controls transcription of numerous proinflammatory mediators. Glycogen synthase kinase (GSK) 3beta is an indispensable element of NF-kappaB activation, however, the exact role of GSK3beta in the pathogenesis of inflammatory kidney diseases like CRAD is uncertain and was examined. Immunohistochemistry staining of GSK3beta was weak in normal kidneys, but was markedly induced in inflamed allograft kidneys, with prominent cytoplasmic staining of tubular cells in areas of inflammation. Net GSK3beta activity is regulated by inhibitory phosphorylation of its serine 9 residue, and this occurred in CRAD. Thus, the magnitude of GSK3beta inactivation was inversely correlated with the degree of injury as assessed by Banff criteria. In vitro in cultured human tubular epithelial cells, GSK3beta overexpression augmented, while GSK3beta silencing diminished proinflammatory cellular responses to TNF-alpha stimulation, including NF-kappaB activation and expression of chemokines MCP-1 and RANTES. These inflammatory responses were obliterated by GSK3beta inhibitors. Collectively, GSK3beta plays an important role in mediating proinflammatory NF-kappaB activation and renal inflammation. Suppression of GSK3beta activity might represent a novel therapeutic strategy to treat CRAD.

Hepatocyte growth factor suppresses acute renal inflammation by inhibition of endothelial E-selectin

Vascular endothelial activation, marked by de novo expression of E-selectin, is an early and essential event in the process of leukocyte extravasation and inflammation. Evidence suggests that hepatocyte growth factor (HGF) ameliorates inflammation in animal models of renal disease, implying that HGF might inhibit specific components of the inflammatory response. This study examined the effect of HGF on endothelial E-selectin expression in acute inflammation induced by tumor necrosis factor (TNF)-α. In vitro, HGF suppressed TNF-α-induced cell surface expression of E-selectin in human umbilical vein endothelial cells (HUVEC) and inhibited E-selectin mediated monocytic adhesion to endothelial monolayers. HGF activated phosphatidylinositol 3-kinase (PI3K)–Akt that in turn inhibited its downstream transducer glycogen synthase kinase (GSK)3. Blockade of the PI3K–Akt pathway with specific inhibitors abrogated HGF induced inhibitory phosphorylation of GSK3 and suppression of E-selectin. In addition, selective inhibition of GSK3 activity by lithium suppressed TNF-α-induced E-selectin expression and monocytic adhesion, reminiscent of the action of HGF. Moreover, ectopic expression of an uninhibitable mutant GSK3β, in which the regulatory serine-9 is replaced by alanine, abolished HGF's suppressive effect on endothelial E-selectin. In vivo, administration of exogenous HGF reduced endothelial expression of E-selectin induced by bolus injection of TNF-α. This was associated with less sequestration of circulating fluorescence-labeled macrophages in the kidney. These findings suggest that HGF ameliorates acute renal inflammation in part by downregulating E-selectin mediated macrophage adhesion to the inflamed endothelium.

[Evaluation of endothelial cells differentiated from mesenchymal stem cells of human bone marrow with Tie-2 monoclonal antibody by immunohistochemistry in vitro]

AIM

To amplify mesenchymal stem cells (MSCs) from human bone marrow (HBM) and to induce MSCs differentiated into endothelial cells (ECs) in vitro, which possibility and conditions were to be discussed.

METHODS

MSCs were separated by gradient centrifugation on Percoll (density 1.073 g/ml) from HBM, and incubated for purification and amplification in DMEM (low glucose) with 10% fetal bovine serum (FBS). MSCs, which their phenotypic characteristics were analyzed by flow cytometry, were incubated for orientation differentiated into ECs in DMEM (high glucose) with 20% FBS and VEGF (10 ng/ml) for about 14 - 21 days. Afterwards, the cells differentiated were evaluated by immunohistochemistry with Tie-2 monoclonal antibody and by transmission electron microscopy (TEM) for observation Weible-palade corpuscle in the cytoplasm.

RESULTS

The quantity of MSCs was increased from 5.0 - 10(5) in the primary culture to 8.0 x 10(12), or to increase 1.6 x 10(7) times after 15 generations incubated. The purity of MSCs was above 95% and 98% homogeneous at passages 2 and 3, respectively. The typical "cobblestone" of these cells presented from MSCs differentiation culture after 14 - 21 days was observed by light microscopy. More than 90% of the cells were positive stain for Tie-2 related antigen by immunohistochemistry assay. The Weible-palade corpuscle, which form is typical morphology of ECs, was also observed by TEM in the cytoplasm.

CONCLUSION

MSCs from HBM has the capability in differentiation into ECs in vitro, which is possible to provide the seed cells for fabrication of tissue-engineering heart valve.

Gene polymorphism in IL-1 receptor antagonist affects its production by monocytes in IgA nephropathy and Henoch-Schonlein nephritis

OBJECTIVE

To define the functional significance of IL-1 receptor antagonist (IL-1ra) gene polymorphism and to investigate, the production of IL-1ra by monocytes from individuals with different genotypes of IL-1.

METHODS

The genotype of IL-1ra was detected by polymerase chain reaction (PCR). Peripheral monocytes obtained from patients with immunoglobin A nephropathy (IgAN), Henoch-Schonlein purpura nephritis (HSPN) and normal subjects were matched in sex and age between the IL1RN-2 allele carriers and non-carriers. The secretion of IL-1ra, IL-1 alpha and IL-1 beta in the supernatant of GM-CSF (10 ng/ml) treated and untreated monocytes were measured by ELISA.

RESULTS

The secretion of IL-1ra by monocytes stimulated with GM-CSF was significantly higher in the IL1RN-2 allele non-carriers than those of carriers both in IgAN (21.55 +/- 3.08 vs 13.85 +/- 2.24 ng/ml, P < 0.001) and HSPN (23.72 +/- 6.68 vs 12.67 +/- 2.24 ng/ml, P < 0.01) as well as in normal controls (20.29 +/- 1.45 vs 10.51 +/- 2.3 ng/ml, P < 0.001). All showed no significant differences in monocyte secretion of IL-1 alpha and IL-1 beta by GM-CSF stimulation between the IL1RN-2 allele carriers and non-carriers.

CONCLUSIONS

These results indicate that a functional correlation of the IL1RN-2 allele and IL-1ra production is present in patients with IgAN and HSPN. This gene polymorphism control of IL-1ra production may contribute to the variety of clinical responses to inflammatory stimulation in individuals with different genotype of IL-1ra.

Computerized tomography pleurography: a new method for detecting minor pleural lesion

OBJECTIVES

To evaluate the ability of CT pleurography (CTP) in detecting minor pleural lesions in patients with pleural effusion and to assess its value in distinguishing malignant from benign pleural lesions.

METHODS

A prospective study of 50 patients with pleural effusion was conducted using conventional CT and CTP. CT scan was run after injecting an appropriate amount of contrast medium into the pleural cavity.

RESULTS

In 24 patients, all lesions detected by conventional CT were demonstrated by CTP. In 13 of 24 patients, CT pleurography detected additional lesions. In 20 of 26 patients with negative findings on conventional CT, CTP was capable of demonstrating the presence of pleural lesions. The sensitivity, specificity and accuracy of detecting pleural lesions were 25%, 100% and 30% for conventional CT, 86%, 100% and 87% for CTP, respectively.

CONCLUSION

CTP is superior to conventional CT in detecting and for the differential diagnosis benign and malignant pleural lesions.

[Establishment and implication of an assay for high density lipoprotein phospholipids in human serum]

OBJECTIVE

To develop an assay for high density lipoprotein phospholipids in human serum based on ascorbutate reduction method.

METHODS

HDLs were separated from apolipoprotein B-containing lipoproteins by precipitation of phosphotungstic acid and magnesium chloride. Phospholipids of HDL were extracted by ethanol/ether, and dried. After the dried phospholipids were digested by sulphuric acid and perchloric acid, the color was developed by adding ammonium molybdate in ascorbutate. The levels of high density lipoprotein phospholipids (HDL-PL) were measured by spectrophotometry at 700 nm.

RESULTS

The coefficients of variation (CV) were 3.6% and 3.7% within two batches of assays. Recovery of isolated HDL-PL added to serum ranged from 98% to 107%, averagely 103%. The established assay for human serum HDL-PL was used to measure the serum levels of 30 hypercholesterolemic subjects, 30 hypertriglyceridemic subjects, 30 combined hyperlipidemic subjects, and 30 normolipidemic subjects. The hypertriglyceridemic subjects had lower HDL-PL level than normolipidemic subjects and hypercholesterolemic subjects (The P values are 0.005 and 0.007 respectively).

CONCLUSION

A simple and specific method for assay of HDL-phos-pholipids in human serum has been developed. The above data collected by the use of this method demonstrate the closer relationship between human HDL-PL metabolism and triglyceride metabolism, suggesting that lower HDL-PL level might serve as an index in the assay for type IV hyperlipidemia.

Cloning, expression patterns, and chromosome localization of three human and two mouse homologues of GABA(A) receptor-associated protein

Type A receptors of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, contain alpha, beta, delta, gamma, and rho subunits. The gamma subunit has four subtypes: gamma1, gamma2, gamma3, andgamma4. GABA(A) receptor-associated protein (GABARAP) was previously demonstrated to act as a linker protein between microtubules and the gamma2 subunit of GABA(A) receptors. However, no other linker proteins have been identified as mediating the linkage of microtubules and the remaining subunits of GABA(A) receptors. In this study we identified three human paralogues (GABARAPL1, GABARAPL2, and GABARAPL3) and two mouse orthologues (Gabarapl1 and Gabarapl2) of human GABARAP, all of which encoded 117 amino acids, as does Gabarapl. The expression patterns of GABARAPL1, GABARAPL2, and GABARAP in 16 adult tissues showed that they were expressed ubiquitously. The expression levels of GABARAPL1 as a 2.3-kb transcript were very high in brain, heart, peripheral blood leukocytes, liver, kidney, placenta, and skeletal muscle, very low in thymus and small intestine, and moderate in other tissues tested. The unique 1.35-kb transcript of GABARAPL2 was expressed at high levels in heart, brain, testis, prostate, ovary, spleen, and skeletal muscle, at very low levels in lung, thymus, and small intestine, and moderately in other tissues tested. For GABARAP, a 1.3-kb transcript was abundantly expressed in all tested tissues with small variation. The expression patterns of Gabarapl1 and Gabarapl2 were similar to those of their counterparts in human. In addition, GABARAPL1 was localized to human chromosome 12p12.3 and GABARAPL2 to 16q22.3-q24.1 by RH mapping, while GABARAP and GABARAPL3 were found to be localized at chromosomes 17p13.2 and 15q25.1, respectively, by searching the related databases. Sequence comparison of the cDNAs and their corresponding genomic sequences shows that GABARAP, GABARAPL1, and GABARAPL2 are composed of four exons each, while GABARAPL3 is distributed only at one exon.

Mannose-binding lectin gene polymorphism associated with the patterns of glomerular immune deposition in IgA nephropathy

OBJECTIVE

To elucidate the genetic background underlying the diversity of mesangial immune deposition in IgA nephropathy (IgAN), we investigated the distribution of mannose-binding lectin (MBL) gene codon 54 polymorphism and serum MBL levels in IgAN patients.

METHODS

Seventy-seven IgAN patients with glomerular IgA and C3 deposits (Group A) and 70 with glomerular IgA, IgG, IgM, C3 and Clq deposits (Group AGM) were included in the present study. Control group consisted of 140 normal adults. MBL genotypes were investigated by polymerase chain reaction and restriction fragment length polymorphism. Serum MBL levels with different genotypes were also assayed in some subjects.

RESULTS

The variant allele (GAC) was markedly associated with Group AGM (OR = 1.95, 95% C.I.: 1.06-3.58). In both Group A and Group AGM, more patients carrying the variant allele had episodes of upper respiratory or gastrointestinal infections prior to onset or exacerbation of IgAN than wild homozygotes (GGC/GGC). In addition, a significant difference in serum MBL level was also observed between wild homozygotes and heterozygotes (GGC/GAC) (GGC/GGC > GGC/GAC) (p<0.0001) in all groups, while there was no difference for subjects with the same genotypes among the three groups (p > 0.05). Serum MBL levels of the rare variant homozygotes approached zero.

CONCLUSIONS

Our findings provide evidence that the host defense molecule, MBL, may be involved in the formation of the diversity of glomerular immune deposition in IgAN. Genetic deficiency of MBL may partially account for abundant immune deposits in some IgAN patients.

[Mannose-binding protein gene polymorphism influences the patterns of glomerular immune deposition in IgA nephropathy]

OBJECTIVE

To investigate the relationship between mannose-binding protein(MBP) gene codon 54 (GGC/GAC) polymorphism and the patterns of glomerular immune deposition in IgA nephropathy (IgAN) and explore its functional significance.

METHODS

IgAN patients were divided into two groups according to the pattern of glomerular immune deposition. Group A included 77 patients with glomerular IgA and C3 deposits. Group AGM consisted of 70 patients with glomerular IgA, IgG, IgM, C3 and Clq deposits. One hundred and forty healthy adults were used as normal controls. MBP genotypes were investigated by PCR-RFLP. Serum MBP levels of some subjects with different genotypes were also assayed by ELISA simultaneously.

RESULTS

The genotype frequency of GAC heterozygotes was significantly higher in group AGM than in group A (41.4% vs. 19.5%, P<0.01) or normal subjects (41.4% vs. 26.4%, P<0.05), while no difference was found in the distribution of MBP genotypes between group A and normal subjects. The allele frequency of GAC mutation was also higher in group AGM than in group A (0.236 vs. 0.136, P<0.05) or normal subjects (0.236 vs. 0.146, P<0.05). The variant allele (GAC) was markedly associated with group AGM (OR=1.95, 95%CI: 1.06-3.58). In both group A and group AGM, more patients carrying the variant allele had episodes of upper respiratory or gastrointestinal infections prior to the onset or exacerbation of IgAN than wild homozygotes. In addition, a significant difference in serum MBP level was also observed among the three genotypes (GGC/GGC>GGC/GAC>GAC/GAC) (P<0.0001) for all groups, while there were no differences in serum MBP levels for subjects with the same genotypes among the three groups (P>0.05).

CONCLUSION

The above findings provide evidence that IgAN patients with abundant immune deposits in glomeruli show a higher frequency of MBP gene variation which is associated with a high frequency of infection and a low serum MBP level. This genetic deficiency may lead to an impaired first-line defense and a less effective clearance of immune complex than those without this mutation and thereafter accelerate glomerular immune deposition during the process of disease.

Cloning and tissue expressional characterization of a full-length cDNA encoding human neuronal protein P17.3

A full-length cDNA of 595 bp was isolated from a human fetal brain cDNA library. It contains an open reading frame encoding 153 amino acids, with an 18-bp 5'UTR and a 118-bp 3'UTR in which there is an atypical polyadenylation signal (ATTAAA). The calculated molecular weight of the deduced protein is 17.3 kU. The predicted isoelectric point is 4.89. On account of its high homology to mouse neuronal protein NP15.6 (81.2% identity), the deduced protein was named neuronal protein 17.3 (NP17.3). When its secondary structure was examined by the GGBSM program of PCGENE software, it was found that 32.6 and 15.0% of its amino acids are involved in forming alpha-helices and beta-sheets, respectively. Examined with the PESTFIND program, a typical PEST region found in rapidly degraded proteins was found between residue 48 and residue 68.

[Isolation of isoforms of apolipoprotein CIII from human serum by chromatofocusing]

This study aimed to isolate isoforms of apolipoprotein (apo) C III from human serum. 24-hour fasting serum from normal and hyperlipidemic subjects was pooled and subjected to ultracentrifugation at plasma density for 20 hours. Very low density lipoprotein (VLDL) was collected at density of d < 1.006 g/ml, and it was delipidated by ethanol and ether. The delipidated apo-VLDL was dissolved in a solution containing 7.2 mol/L urea and 20 mmol/L dithiothreitol. The insoluble apo B was removed by centrifugation. The soluble apo-VLDL was applied to PBE94 column, and eluted with elution buffer containing polybuffer 74 and 8 mol/L urea (1:8, pH4.0). After pooled, the eluted peaks of apolipoproteins were applied to column chromatography of hydroxylapatite to remove the polybuffer. The purified isoforms of apoC III and the purified apo C I, C II and E, were characterized by isoelectrofocusing and west blot. The results showed that the purified apoC III1, C III2, and C II were pure.

A new method for computerized tomography diagnosis of early transtentorial hernia

OBJECTIVE

To evaluate a new scanning method designed for the diagnosis of early transtentorial hernia as compared with the routine scanning method (parallel to orbitomeatal line).

METHODS

102 patients with unilateral high intracranial pressure and 100 volunteers without any cranial symptoms and signs were scanned on (1) the plane perpendicular to the plane of clivus and (2) the plane parallel to orbitomeatal line, a line joining the apex of the dorsum sellae and the lowest point of the clivus.

RESULTS

Vertical-to-clivus scanning method directly demonstrated the temporal transtentorial hernia in 48 of 102 patients with unilateral high intracranial pressure, but the orbitomeatal line scanning method was not able to show this direct finding. The projected tissue of the temporal lobe could be obviously shown and the degree of the hernia could be judged directly on the CT imaging with the vertical-to-clivus scanning method. Therefore, the CT diagnosis criterion of the hernia was suggested as follows: the hernia would be determined if the downward shift of the temporal lobe was more than 3 mm and suspected if less than 3 mm with ipsilateral high intracranial pressure.

CONCLUSION

This new method presented a superiority in showing the temporal transtentorial hernia for the patients with a cranial emergency.

Comparison of hypertonic saline solutions and dextran in dialysis-induced hypotension

The efficacy of three hypertonic saline solutions for treating dialysis-induced hypotension in a randomized, blinded, crossover clinical trial of 10 patients (a minimum of three cycles per solution) was compared. Dialysis-induced hypotension, defined as a decrease in systolic blood pressure of at least 10 mm Hg or systolic blood pressure less than 100 mm Hg, was treated with an iv bolus of either 10 mL of 23% saturated hypertonic saline, 30 mL of 7.5% hypertonic saline, or 30 mL of 7.5% saline with 6% dextran 70, each containing similar osmolar loads of 80, 80, and 100 mosM, respectively. All three solutions raised systolic blood pressure within 5 min (mean pretreatment systolic blood pressure, 87 mm Hg; mean posttreatment systolic blood pressure, 101 mm Hg; P < 0.05). The magnitude of the increase was greater with saturated hypertonic saline (15 mm Hg) and dextran 70 (17 mm Hg) compared with that with hypertonic saline (9 mm Hg; P < 0.05). At 10 min, dialysis-induced hypotension was less frequent with saturated hypertonic saline (incidence, 9%) compared with hypertonic saline (45%). Beyond 10 min, however, there was a trend toward a lower incidence of further dialysis-induced hypotension with dextran 70. There were no side effects. Given equal osmole loads, the more concentrated solution produced a greater increase in systolic blood pressure. The addition of an oncotic agent such as dextran may prolong the blood pressure response beyond 10 min. It was concluded that hypertonic saline solutions safely and effectively treat dialysis-induced hypotension.

Knotting and entanglement of multiple central venous catheters

A 53-yr-old black male was admitted with peripheral vascular disease and septic shock. Appropriate cardiopulmonary resuscitation and operative intervention required the placement of multiple central venous lines. These included two subclavicular central venous pressure (CVP) catheters and one Swan-Ganz catheter (SGC). During manipulation of the SGC, it formed a knot with the two CVP catheters entangled in it. After consideration of the variety of strategies that could be employed, the CVP catheters were manually disengaged from the knot and the knot was surgically removed. The increasing frequency and multiple central angioaccess catheters will result in a finite increase in the nature and complexity of the clinical challenges. The insistence on the use of multiple single-channel catheters for separate therapeutic functions and the duration of stay of pulmonary catheters should be reconsidered.