Scutellaria baicalensis Induces Cell Apoptosis and Elicits Mesenchymal-Epithelial Transition to Alleviate Metastatic Hepatocellular Carcinoma via Modulating HSP90β

Hepatocellular carcinoma is one of the most common malignant tumors in the world and shows strong metastatic potential. Current medicine for hepatocellular carcinoma therapy is invalid, while Scutellaria baicalensis Georgi exhibits the pharmaceutical potential to treat liver diseases and liver cancer. Herein, we verified the inhibitory properties and the pivotal molecules regimented by Scutellaria baicalensis on advanced hepatocellular carcinoma. At first, the viability of SK-Hep-1 cells was significantly reduced under treatment of Scutellaria baicalensis extract in a dose-dependent manner without affecting the growth of normal hepatocyte. Scutellaria baicalensis extract application could remarkably cause apoptosis of SK-Hep-1 cells through p53/cytochrome C/poly-ADP ribose polymerase cascades and arrest the cell cycle at the G1/S phase by downregulating cyclin-dependent kinases. Meanwhile, administration of Scutellaria baicalensis extract remarkably attenuated the migration capability as well as suppressed matrix metalloproteinase activity of advanced hepatocellular carcinoma cells. The proteome profiles and network analysis particularly implied that exposure to Scutellaria baicalensis extract downregulated the expression of HSP90β, and the clinical stage of hepatocellular carcinoma is also positively correlated with the HSP90β level. Combined treatment of Scutellaria baicalensis extract and HSP90β siRNAs could markedly enhance the ubiquitination activity and the degradation of vimentin to subsequently inhibit the metastatic property of SK-Hep-1 cells. Moreover, application of Scutellaria baicalensis extract and HSP90β siRNAs depleted phosphorylation of AKT, which stimulated the expression of p53 and consecutively triggered cell apoptosis. These findings suggest that HSP90β may be a prospective target for the effective therapy of advanced hepatocellular carcinoma via accelerating apoptosis of hepatocellular carcinoma cells and eliciting mesenchymal-epithelial transition with the administration of Scutellaria baicalensis extract.

The impact of metformin on survival in diabetes patients with operable colorectal cancer: A nationwide retrospective cohort study

OBJECTIVE

To investigate the impact of metformin on survival of diabetic patients following surgery for colorectal cancer (CRC).

METHODS

This was a retrospective cohort study. From Taiwan's population-based National Health Insurance Research Database (NHIRD) we identified 12,512 patients with CRC and type II diabetes who underwent curative surgery between 2000 and 2012. Of these, 6222 patients were included in a matched cohort. Using Cox regression models with time-dependent covariates we examined the impact of metformin on survival.

RESULTS

Average duration of follow-up was 49 and 54 months for metformin users and non-users, respectively. Cox proportional hazard model showed that metformin was associated with 5-year overall survival benefit (Hazard ratio, 0.23 [95% CI, 0.20-0.26]) and inverse association with risk of liver metastasis (Hazard ratio, 0.79 [95% CI, 0.68-0.93]).

CONCLUSIONS

Metformin was associated with a survival benefit in diabetic patients with CRC following surgery, and an inverse association with risk of liver metastases suggesting a potential anti-tumorigenic effect.

Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Pulsatility index-adjusted doppler flow measurement of pedal arteries in peripheral artery disease patients

BACKGROUND

To examine the feasibility of using pulsatility index-adjusted (PI) flow equations to accurately characterize blood volume flow changes using Doppler technique in patients with peripheral artery disease (PAD) before and after percutaneous transluminal angioplasty (PTA).

METHODS

PTA was performed on 17 PAD patients (23 target vessels treated, 16 anterior tibial arteries, and 7 posterior tibial arteries). Arterial diameter, peak systolic velocity, PI, time-averaged mean velocity, and measured volume flow (MVF) of dorsalis pedis artery (DPA) and common plantar artery (CPA) were measured with duplex Doppler ultrasound before and after PTA. PI-adjusted volume flows (PIVF) were calculated as part of the MVF/PIVF relative percentage metric.

RESULTS

Significant changes (p < 0.001) of the MVF (mean: 33.0 mL/min, range: -20.9-102.2 mL/min) and MVF/PIVF relative percentages (mean: 51.8, range: 5.1-127.2%) in the DPA existed between before and after PTA, whereas no significant changes could be found in the CPA (mean:10.9 mL/min, p = 0.148 and mean: 21.3%, p = 0.146, respectively). Of the 7 treated posterior tibial arteries, the increments of the MVF/PIVF (mean: 60.4%, p = 0.033) was significant but not in the MVF (mean: 26.5 mL/min, p = 0.125). The ankle-brachial index also showed non-significant changes (p = 0.081). All PI-adjusted results matched clinical observations after blood flow restoration.

CONCLUSION

No conclusions can be drawn from the comparison of actual measured volume flow between before and after PTA. However, using the MVF/PIVF relative percentage allows for a more objective framework upon which to base clinical observations and provides clarity in situations where direct measurement provides a counter-intuitive or contradictory picture.

Performance of the EuroSCORE II Model in Predicting Short-Term Mortality of General Cardiac Surgery: A Single-Center Study in Taiwan

BACKGROUND

The latest European System for Cardiac Operative Risk Evaluation (EuroSCORE) II is a well-accepted risk evaluation system for mortality in cardiac surgery in Europe.

OBJECTIVES

To determine the performance of this new model in Taiwanese patients.

METHODS

Between January 2012 and December 2014, 657 patients underwent cardiac surgery at our institution. The EuroSCORE II scores of all patients were determined preoperatively. The short-term surgical outcomes of 30-day and in-hospital mortality were evaluated to assess the performance of the EuroSCORE II.

RESULTS

Of the 657 patients [192 women (29.22%); age 63.5 ± 12.68 years], the 30-day mortality rate was 5.48%, and the in-hospital mortality rate was 9.28%. The discrimination power of this new model was good in all populations, regardless of 30-day mortality or in-hospital mortality. Good accuracy was also noted in different procedures related to coronary artery bypass grafting, and good calibration was noted for cardiac procedures (p value > 0.05). When predicting surgical death within 30 days, the EuroSCORE II overestimated the risk (observed to expected: 0.79), but in-hospital mortality was underestimated (observed to expected: 1.33). The predictive ability [area under the curve (AUC) of the receiver operating characteristic (ROC) curve] and calibration of the EuroSCORE II for 30-day mortality (0.792) and in-hospital mortality (0.825) suggested that in-hospital mortality is a better endpoint for the EuroSCORE II.

CONCLUSIONS

The new EuroSCORE II model performed well in predicting short-term outcomes among patients undergoing general cardiac surgeries. For short-term outcomes, in-hospital mortality was better than 30-day mortality as an indicator of surgical results, suggesting that it may be a better endpoint for the EuroSCORE II.

Antioxidant properties of red raspberry extract alleviate hepatic fibrosis via inducing apoptosis and transdifferentiation of activated hepatic stellate cells

Hepatic fibrosis is a wound-healing process caused by prolonged liver damage and often occurs due to hepatic stellate cell activation in response to reactive oxygen species (ROS). Red raspberry has been found to attenuate oxidative stress, mainly because it is rich in bioactive components. In the current study, we investigated the inhibitory effects and associated molecular mechanisms of red raspberry extract (RBE) upon activated hepatic stellate cell (aHSC) in cellular and rat models. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased in the dimethylnitrosamine (DMN)-applied samples, whereas treatment of RBE significantly suppressed the activities of these enzymes. In addition, a histopathological analysis demonstrated that RBE could substantially diminish the hepatic collagen content and alpha-smooth muscle actin (α-SMA) expression induced by DMN. Administration of 250 μg/mL RBE could also arrest the growth and enhance the apoptosis of activated HSC-T6 cells, which was accompanied with elevated levels of activated caspases and poly (ADP-ribose) polymerase (PARP) cleavage. Particularly, RBE application remarkably abolished oxidative damage within the cells and reduced the carbonylation of proteins, which was attributed to the upregulation of catalase, nuclear factor erythroid 2-related factor 2 (Nrf2), and heme oxygenase-1 (HO-1). Moreover, the knockdown of Nrf2 together with the RBE treatment synergistically abrogated the expression of α-SMA and promoted the level of peroxisome proliferator-activated receptor gamma (PPAR-γ), suggesting that RBE could mitigate the transdifferentiation of HSC in a Nrf2-independent manner. These findings implied that the application of RBE could effectively remove oxidative stress and relieve the activation of HSC via modulating the caspase/PARP, Nrf2/HO-1 and PPAR-γ pathways, which may allow the development of novel therapeutic strategies against chemical-caused liver fibrogenesis.

Loading dose and efficacy of continuous or extended infusion of beta-lactams compared with intermittent administration in patients with critical illnesses: A subgroup meta-analysis and meta-regression analysis

WHAT IS KNOWN AND OBJECTIVE

The role of continuous/extended beta-lactam infusions (CEIs) in improving clinical outcomes among critically ill patients remains controversial. Therefore, we aimed to compare the clinical efficacy of CEI versus intermittent administration (IA) of beta-lactams by performing a systematic review and meta-analysis.

METHODS

PubMed, the Cochrane Library and Embase were searched from inception until December 2018 for studies comparing clinical outcomes of CEI versus IA in critically ill patients. The meta-analysis included 18 randomized controlled trials (RCTs) and 13 non-RCTs.

RESULTS AND DISCUSSION

For CEI versus IA, the summary relative risk (RR) for overall mortality and clinical cure was 0.82 (95% confidence interval [CI]: 0.72-0.94) and 1.31 (95% CI: 1.15-1.49), respectively. Subgroup and meta-regression analyses of the loading dose revealed a significantly increased clinical cure rate in the loading-dose group (RR: 1.44, 95% CI: 1.22-1.69), which remained significant after adjustments for beta-lactam type, and association between clinical cure and loading dose for clinical cure (RR: 1.47, 95% CI: 1.20-1.80; p = .001). Subgroup analysis of administration type indicated that both groups had low mortality and high clinical cure rates; however, the heterogeneity analysis did not support an association across continuous infusion and extended infusion groups. Subgroup analysis of the Acute Physiology and Chronic Health Evaluation (APACHE) score was conducted; according to APACHE scores ≥ 16, overall mortality and clinical cure significantly differed between CEI and IA.

WHAT IS NEW AND CONCLUSION

CEIs with loading-dose treatment may significantly improve the clinical outcomes in critically ill sepsis or septic shock patients.

The effect of androgen on wool follicles and keratin production in Hetian sheep

To investigate the optimal androgen concentration for culturing Hetian sheep wool follicle and to detect effects of androgen concentration on wool follicle cell proliferation and apoptosis using immunofluorescence labeling and real-time quantitative fluorescence determinations of wool keratin-associated protein gene expression levels. Wool follicles were isolated by microdissection and wool follicles and skin pieces were cultured in various concentrations of dihydrotestosterone (DHT) in culture medium. Next, daily lengthwise growth measurements of wool follicles were obtained using a microscopic micrometer. Cultured Hetian wool follicles were stained using the SACPIC method to reveal wool follicle structure, while sheep skin slices were used to observe cell proliferation by immunostaining and cell apoptosis using the TUNEL method. At the molecular biological level, keratin-associated protein (Kap) gene expression was studied using wool follicles cultured for various numbers of days in vitro. Effects of androgen concentrations on Hetian wool follicle growth and development were experimentally studied. EdU proliferation assays revealed that androgen promoted cell proliferation within wool follicle dermal papillae. TUNEL apoptosis detection demonstrated that androgen treatment could delay cell apoptosis. Quantitative reverse transcription polymerase chain reaction (qPCR) results demonstrated that gene expression level patterns of Hetian mountain sheep super-high sulfur protein. Kap1.1, KIF1.2, Kap2.12 and Kap4.2 gene expression level of the mountainous experimental group was significantly higher than plains Hetian sheep. An androgen concentration of 100 nM can promote the growth of Hetian wool follicle cells in vitro, resulting in overexpression of some genes of the Kap family.

Utilization of silicon nanowire field-effect transistors for the detection of a cardiac biomarker, cardiac troponin I and their applications involving animal models

This study develops an ultrasensitive electrical device, the silicon nanowire-field effect transistor (SiNW-FET) for detection of cardiac troponin I (cTnI) in obesity induced myocardial injury. The biosensor device utilizes metal-oxide-semiconductor (MOS) compatible top-down methodology for the fabrication process. After fabrication, the surface of the SiNW is modified with the cTnI monoclonal antibody (Mab-cTnI) upon covalent immobilization to capture cTnI antigen. The sensitivity of the device is also examined using cTnI at different concentrations with the lowest detection limit of 0.016 ng/mL. The electrocardiogram (ECG), magnetic resonance imaging (MRI), and superior vena cave (SVC) provide more information about cardiac responses in a mouse model of acute myocardial infarction (AMI). Further, magnetic resonance imaging helps to evaluate the cardiac output of an obesity induced myocardial injury mouse model. These methods play an essential role in monitoring the obesity based cardiac injury and hence, these studies were carried out. This is the first report to use the ECG, MRI, and SVC sampling methods to study the obesity based cardiac injury involving Syrian hamsters as animal models. The proposed SiNW-FET in this study shows greater sensitivity than the previously developed devices and demonstrates great potential for future applications in point-of-care (POC) diagnosis.

Endovascular management of aorto-iliac occlusive disease (Leriche syndrome)

BACKGROUND

Bypass grafting is the standard of care for chronic aorto-iliac occlusive disease (AIOD, aka Leriche Syndrome) but is associated with mortality rates of up to 25% if surgical re-intervention is necessary. Despite a recent shift towards an endovascular-first strategy for TransAtlantic InterSociety Consensus II ("TASC II") C and D lesions, reports from Leriche Syndrome are still limited.

PATIENTS AND METHODS

15 high-risk patients (11 male, 4 female), mean age of 60.6 years, with chronic aorto-iliac occlusive disease were retrospectively reviewed. Retrograde approaches via the bilateral femoral arteries for aortic occlusion less than 4 cm in length and/or antegrade fashion from the brachial artery for juxtarenal type lesions were made. For the latter, thrombolysis prior to angioplasty was also performed. Intraluminal or if necessary, subintimal angioplasty was performed with deployment of either bare metal stents or stentgrafts in a kissing-stent fashion.

RESULTS

A total of 28 iliac arteries and 14 occluded abdominal aorta were treated with 100% technical success, of which 25% success were achieved by using subintimal technique. Two minor complications occurred, including vascular rupture and distal emboli in one patient apiece, which were successfully managed via endovascular fashion. There were no complications of renal artery emboli. Primary and secondary patency rates at 1, 3 and 5 years were 92.3% and 100%; 83.9% and 100%; and 83.9% and 100%, respectively.

CONCLUSION

Endovascular therapy for chronic aorto-iliac occlusion has a high technical success rate, with good short- and mid-term primary and secondary patency rates and may provide a valid alternative to surgery for high-risk patients.

Humanized bispecific antibody (mPEG × HER2) rapidly confers PEGylated nanoparticles tumor specificity for multimodality imaging in breast cancer

Background

Developing a universal strategy to improve the specificity and sensitivity of PEGylated nanoaparticles (PEG-NPs) for assisting in the diagnosis of tumors is important in multimodality imaging. Here, we developed the anti-methoxypolyethylene glycol (mPEG) bispecific antibody (BsAb; mPEG × HER2), which has dual specificity for mPEG and human epidermal growth factor receptor 2 (HER2), with a diverse array of PEG-NPs to confer nanoparticles with HER2 specificity and stronger intensity.

Result

We used a one-step formulation to rapidly modify the nanoprobes with mPEG × HER2 and optimized the modified ratio of BsAbs on several PEG-NPs (Lipo-DiR, SPIO, Qdot and AuNP). The αHER2/PEG-NPs could specifically target MCF7/HER2 cells (HER2⁺⁺) but not MCF7/neo1 cells (HER2^+/−). The αHER2/Lipo-DiR and αHER2/SPIO could enhance the sensitivity of untargeted PEG-NPs on MCF7/HER2 (HER2⁺⁺). In in vivo imaging, αHER2/Lipo-DiR and αHER2/SPIO increased the specific targeting and enhanced PEG-NPs accumulation at 175% and 187% on 24 h, respectively, in HER2-overexpressing tumors.

Conclusion

mPEG × HER2, therefore, provided a simple one-step formulation to confer HER2-specific targeting and enhanced sensitivity and contrast intensity on HER2 positive tumors for multimodality imaging.

Label-Free Bimetallic In Situ-Grown 3D Nickel-Foam-Supported NH2-MIL-88B(Fe2Co)-MOF-based Impedimetric Immunosensor for the Detection of Cardiac Troponin I

In this study, a simple and competent metal-organic framework (MOF)-based nickel foam (NF)-supported three-dimensional (3D) immunosensor (Ab-NH₂-MIL-88B(Fe₂Co)-MOF/NF) was constructed and utilized for the specific recognition of the biomarker cardiac troponin (I) (cTnI). In the present work, biosensor fabrication was progressed through the modification of the NF substrate with the MOF material (NH₂-MIL-88B(Fe₂Co)-MOF) to enable an amine-functionalized electrode. This amine-functionalized NF electrodes (NH₂-MIL-88B(Fe₂Co)-MOF/NF) were then biointerfaced with anti-cTnI antibodies, which ended up as Ab-NH₂-MIL-88B(Fe₂Co)-MOF/NF electrodes. Analytical executions of the constructed bioelectrode were investigated for the quantitative analysis of cTnI in both buffered and serum solutions. Then, the electrochemical studies were carried out using the electrochemical impedance spectroscopy (EIS) method by monitoring changes concerning the charge transfer resistance (R_ct) characteristics. The limit of detection (LOD) of the Ab-NH₂-MIL-88B(Fe₂Co)-MOF/NF immunosensor was achieved to be 13 fg/mL with great specificity. This kind of immunosensor imparts a new platform for the construction and application of MOF-hybrid 3D electrode materials with enhanced electrochemical behavior in cTnI sensing for the first time.

Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure

Background

Severe blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence.

Methods

This observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. All patients received positive pressure mechanical ventilation within 24 h after trauma because of ARF. Some patients who received rib fixation with VATS were enrolled as group 1, and the others who received only VATS were designated as group 2. The length of ventilator use was the primary clinical outcome. Rates of pneumonia and length of hospital stay constituted secondary outcomes.

Results

A total of 61 patients were included in this study. The basic demographic characteristics between the two groups exhibited no statistical differences. All patients received operations within 6 days after trauma. The length of ventilator use was shorter in group 1 (3.19 ± 3.37 days vs. 8.05 ± 8.23, P = 0.002). The rate of pneumonia was higher in group 2 (38.1% vs. 75.0%, P = 0.005). The length of hospital stay was much shorter in group 1 (17.76 ± 8.38 days vs. 24.13 ± 9.80, P = 0.011).

Conclusion

Rib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Therefore, this operation could shorten the overall length of hospital stay.

Characterization of the Roles of Vimentin in Regulating the Proliferation and Migration of HSCs during Hepatic Fibrogenesis

The activation of hepatic stellate cells (HSCs) manifested as proliferation and migration is the pivotal event involved in liver fibrogenesis. The vimentin network, an intermediate filament (IF) system, is one of the critical cascades by which the cell morphology, growth, and motility are modulated. However, the vimentin-mediated cytoskeletal cross talk, as well as the signaling transduction, which further coordinates the cellular responses during hepatic fibrogenesis, is poorly understood. In the current study, both messenger RNA (mRNA) and the vimentin protein were significantly increased in a time-dependent manner in the dimethylnitrosamine (DMN)-exposed liver. In particular, vimentin was highly expressed in the activated HSCs. Again, the overexpressed vimentin was observed in the plasma samples derived from patients with hepatic fibrosis/cirrhosis, suggesting that vimentin may be a key factor in regulating the progression of liver fibrosis. Meanwhile, vimentin knockdown suppressed the migratory propensity, provoked morphological changes, and disturbed the focal adhesions in the HSCs due to the breakdown of associated cytoskeletal proteins. Western blotting showed that vimentin deletion inhibited proliferating cell nuclear antigen (PCNA) and arrested the Rho GTPase family, thereby impairing the HSCs’ growth as well as motility. The phosphorylated extracellular-signal regulated kinase (ERK) and AKT signals were also notably reduced in response to the silence of vimentin. Inhibitors of selected signaling pathways suppressed the migration and differentiation of activated HSCs by regulating specific serine phosphorylated sites on vimentin. Taken together, these findings revealed a novel mechanism of vimentin through which various signaling pathways controlled the proliferation, differentiation, and movement of the HSCs via the ERK/AKT and Rho cascades.

Activation of Angiogenesis and Wound Healing in Diabetic Mice Using NO-Delivery Dinitrosyl Iron Complexes

In diabetes, abnormal angiogenesis due to hyperglycemia and endothelial dysfunction impairs wound healing and results in high risks of diabetic foot ulcers and mortality. Alternative therapeutic methods were attempted to prevent diabetic complications through the activation of endothelial nitric oxide synthase. In this study, direct application of nitric oxide using dinitrosyl iron complexes (DNICs) to promote angiogenesis and wound healing under physiological conditions and in diabetic mice is investigated. Based on in vitro and in vivo studies, DNIC [Fe₂(μ-SCH₂CH₂OH)₂(NO)₄] (DNIC-1) with a sustainable NO-release reactivity (t_1/2 = 27.4 ± 0.5 h at 25 °C and 16.8 ± 1.8 h at 37 °C) activates the NO-sGC-cGMP pathway and displays the best pro-angiogenesis activity overwhelming other NO donors and the vascular endothelial growth factor. Moreover, this pro-angiogenesis effect of DNIC-1 restores the impaired angiogenesis in the ischemic hind limb and accelerates the recovery rate of wound closure in diabetic mice. This study translates synthetic DNIC-1 into a novel therapeutic agent for the treatment of diabetes and highlights its sustainable ^•NO-release reactivity on the activation of angiogenesis and wound healing.

The advantages of adding rib fixations during VATS for retained hemothorax in serious blunt chest trauma - A prospective cohort study

BACKGROUND

Serious blunt chest trauma usually induces hemothorax, pneumothorax, and rib fracture. Early video-assisted thoracoscopic surgery (VATS) to evacuate retained hemothorax is one commonly used treatment. In this study, a new strategy was implemented to combine VATS with fractured rib fixation simultaneously.

METHODS

This prospective observational study was performed from January 2013 to April 2018. All patients were aged 18 years or older and had blunt chest trauma with displaced fractures in more than three ribs. No patients had acute respiratory failure within 24 h after trauma. Patients with retained hemothorax who received VATS constituted the study cohort. Subsequently, patients who received rib fixation during VATS procedures were compared with those who did not. Clinical outcomes such as dose of analgesics, and length of hospital stay were recorded.

RESULTS

During the study period, 128 patients were enrolled. Available demographic characteristics of the 2 groups were compared, and no statistical differences were observed. The rates of shorter temporary ventilator dependence after operations were lower in the rib fixation group (0% vs. 24.7%, P = 0.017). Persistent air leakage more than 5 days after operations were also lower in the rib fixation group (0% vs. 10.4%, P = 0.001). The length of stay in overall hospital stay were longer for patients who received VATS without rib fixation (9.29 ± 2.51 days vs. 12.39 ± 4.65, P = 0.001). Furthermore, the rib fixation group were administered much lower doses of opiates during their hospital stays (52.45 ± 15.67 mg vs. 77.24 ± 50.42 mg, P = 0.001).

CONCLUSION

Adding rib fixation during VATS in the management of retained hemothorax can contribute to shorten whole treatment courses. Rib fixation can also reduce pain, thus reducing dependence on analgesics.

Integrated Proteome and Cytokine Profiles Reveal Ceruloplasmin Eliciting Liver Allograft Tolerance via Antioxidant Cascades

Acute rejection (AR) and spontaneous tolerance may occur after allograft orthotopic liver transplants (OLT) performed in certain combinations of donor and recipient rat strains, yet the underlying molecular cascades involved in these conditions remain poorly understood. Comprehensive analysis with proteomic tools revealed that ceruloplasmin was highly expressed during the tolerant period on day 63 post-OLT (POD 63) compared to the rejected samples on POD 14. Meanwhile, cytokine expression profiles implied that the inflammation was significantly stimulated in the AR subjects. Again, protein carbonylation was dramatically upregulated in the rejected subject within the tolerant group. Knockdown of ceruloplasmin would elicit more severe ROS damage, leading to cell death in the presence of H₂O₂, which induced Nrf2 cascade and the recovery of ceruloplasmin to mediate spontaneous tolerance. In summary, ceruloplasmin may contribute to amending the oxidative stress that eventually causes cell apoptosis and to maintaining the survival of hepatocytes in a drug-free tolerance OLT model.

Proteome-based identification of apolipoprotein A-IV as an early diagnostic biomarker in liver fibrosis

Hepatic fibrosis may ultimately result in organ failure and death, a reality compounded by the fact that most drugs for liver fibrosis appear to be effective only if given as a prophylactic or early treatment. In a dimethylnitrosamine-induced liver fibrotic model, aspartate aminotransferase/alanine aminotransferase levels could not precisely distinguish the differences between the initial stage of liver fibrosis and normal control, whereas histological examination indicated that dimethylnitrosamine treatment for two weeks has resulted in hepatic fibrogenesis. Comprehensive proteomics identified 12 proteins mainly associated with the interleukin 6-stimulated inflammatory pathway. Coordinately, cytokine profiles showed that dimethylnitrosamine administration would stimulate various signaling pathways leading to liver fibrosis. Of note, apolipoprotein A4 in serum samples obtained from patients in the early stage of liver fibrosis were significantly increased compared to the healthy controls (p<0.001) while the area under curve was 0.966. Moreover, increased apolipoprotein A4 significantly enhanced transforming growth factor beta 1-induced alpha smooth muscle actin expression. In this regard, overexpression of apolipoprotein A4 in early stage of liver fibrosis might magnify and imply the progression of hepatic fibrosis. These findings suggest that apolipoprotein A4 upregulation may correlate with hepatic fibrosis staging and that apolipoprotein A4 together with current biomarker can increase the sensitivity and specificity for the early detection of liver fibrosis in a high-throughput manner.

Evaluating the impact of hippocampal sparing during whole brain radiotherapy on neurocognitive functions: A preliminary report of a prospective phase II study

BACKGROUND

Whole brain radiotherapy (WBRT) is the treatment of choice for patients with brain metastases. However, neurocognitive functions (NCFs) decline due to impaired hippocampal neurogenesis might occur thereafter. It is hypothesized that conformal hippocampal avoidance during the course of WBRT (HA-WBRT) might provide meaningful NCF preservation. Our study aims to demonstrate the impact of delivering HA-WBRT on NCF changes in patients receiving WBRT.

METHODS

Twenty-five patients who were referred for prophylactic cranial irradiation (PCI) or treating oligometastatic brain disease were enrolled in the study. Before the HA-WBRT course, all participants should receive baseline neurocognitive assessment, including memory, executive functions, and psychomotor speed. The primary endpoint was delayed recall, as determined by the change/decline in verbal memory [Wechsler Memory Scale - 3rd edition (WMS III)- Word List score] from the baseline assessment to 4 months after the start of HA-WBRT.

RESULTS

Only three patients belonged to the clinical setting of PCI; the remaining 22 patients had oligometastatic brain disease. Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post-radiotherapy intervals, in immediate verbal memory and non-verbal memory, except for delayed recall memory on Word List (F = 5.727, p = 0.048).

CONCLUSIONS

Functional preservation by hippocampal sparing during WBRT could largely be achieved in this study, which also suggests that HA-WBRT should be a feasible technique preserving neurocognitive functions while maintaining intracranial control.

Hippocampal dosimetry correlates with the change in neurocognitive function after hippocampal sparing during whole brain radiotherapy: a prospective study

Background

Whole brain radiotherapy (WBRT) has been the treatment of choice for patients with brain metastases. However, change/decline of neurocognitive functions (NCFs) resulting from impaired hippocampal neurogenesis might occur after WBRT. It is reported that conformal hippocampal sparing would provide the preservation of NCFs. Our study aims to investigate the hippocampal dosimetry and to demonstrate the correlation between hippocampal dosimetry and neurocognitive outcomes in patients receiving hippocampal sparing during WBRT (HS-WBRT).

Methods

Forty prospectively recruited cancer patients underwent HS-WBRT for therapeutic or prophylactic purposes. Before receiving HS-WBRT, all participants received a battery of baseline neurocognitive assessment, including memory, executive functions and psychomotor speed. The follow-up neurocognitive assessment at 4 months after HS-WBRT was also performed. For the delivery of HS-WBRT, Volumetric Modulated Arc Therapy (VMAT) with two full arcs and two non-coplanar partial arcs was employed. For each treatment planning, dose volume histograms were generated for left hippocampus, right hippocampus, and the composite hippocampal structure respectively. Biologically equivalent doses in 2-Gy fractions (EQD₂) assuming an alpha/beta ratio of 2 Gy were computed. To perform analyses addressing the correlation between hippocampal dosimetry and the change in scores of NCFs, pre- and post-HS-WBRT neurocognitive assessments were available in 24 patients in this study.

Results

Scores of NCFs were quite stable before and after HS-WBRT in terms of hippocampus-dependent memory. Regarding verbal memory, the corresponding EQD₂ values of 0, 10, 50, 80 % irradiating the composite hippocampal structure with <12.60 Gy, <8.81, <7.45 Gy and <5.83 Gy respectively were significantly associated with neurocognitive preservation indicated by the immediate recall of Word List Test of Wechsler Memory Scale-III. According to logistic regression analyses, it was noted that dosimetric parameters specific to left sided hippocampus exerted an influence on immediate recall of verbal memory (adjusted odds ratio, 4.08; p-value, 0.042, predicting patients’ neurocognitive decline after receiving HS-WBRT).

Conclusions

Functional preservation by hippocampal sparing during WBRT is indeed achieved in our study. Providing that modern VMAT techniques can reduce the dose irradiating bilateral hippocampi below dosimetric threshold, patients should be recruited in prospective trials of hippocampal sparing during cranial irradiation to accomplish neurocognitive preservation while maintaining intracranial control.

Trial registration

Current Controlled Trials NCT02504788

Electronic supplementary material

The online version of this article (doi:10.1186/s13014-015-0562-x) contains supplementary material, which is available to authorized users.

Radiation doses of cerebral blood volume measurements using C-arm CT: A phantom study

BACKGROUND AND PURPOSE

Parenchymal blood volume measurement by C-arm CT facilitates in-room peritherapeutic perfusion evaluation. However, the radiation dose remains a major concern. This study aimed to compare the radiation dose of parenchymal blood volume measurement using C-arm CT with that of conventional CTP using multidetector CT.

MATERIALS AND METHODS

A biplane DSA equipped with C-arm CT and a Rando-Alderson phantom were used. Slab parenchymal blood volume (8-cm scanning range in a craniocaudal direction) and whole-brain parenchymal blood volume with identical scanning parameters, except for scanning ranges, were undertaken on DSA. Eighty thermoluminescent dosimeters were embedded into 22 organ sites of the phantom. We followed the guidelines of the International Commission on Radiation Protection number 103 to calculate the effective doses. For comparison, 8-cm CTP with the same phantom and thermoluminescent dosimeter distribution was performed on a multidetector CT. Two repeat dose experiments with the same scanning parameters and phantom and thermoluminescent dosimeter settings were conducted.

RESULTS

Brain-equivalent dose in slab parenchymal blood volume, whole-brain parenchymal blood volume, and CTP were 52.29 ± 35.31, 107.51 ± 31.20, and 163.55 ± 89.45 mSv, respectively. Variations in the measurement of an equivalent dose for the lens were highest in slab parenchymal blood volume (64.5%), followed by CTP (54.6%) and whole-brain parenchymal blood volume (29.0%). The effective doses of slab parenchymal blood volume, whole-brain parenchymal blood volume, and CTP were 0.87 ± 0.55, 3.91 ± 0.78, and 2.77 ± 1.59 mSv, respectively.

CONCLUSIONS

The dose measurement conducted in the current study was reliable and reproducible. The effective dose of slab parenchymal blood volume is about one-third that of CTP. With the advantages of on-site and immediate imaging availability and saving procedural time and patient transportation, slab parenchymal blood volume measurement using C-arm CT can be recommended for clinical application.

Clerodane diterpenes from Polyalthia longifolia var. pendula protect SK-N-MC human neuroblastoma cells from β-amyloid insult

The n-hexane layer of Polyalthia longifolia methanolic extract showed neuroprotective activity, resulting in the isolation of three new clerodane diterpenes.

Proteomics reveals plasma profiles for monitoring the toxicity caused by chromium compounds

BACKGROUND

Today, various heavy metals are widespread in the ecosystem and have become important environmental contaminants. Exposure to these hazardous metals such as chromium usually results in cytotoxicity and large-scale protein changes which reflect pathologic states.

METHODS

We used a comprehensive proteomic tool to survey changes in plasma proteins elicited by two chromium species (Cr(6+) and Cr(3+)). RT-PCR was applied to evaluate levels of cytokines associated with adverse responses. Lectin blotting was used to investigate the contents of fucosylated proteins.

RESULTS

Protein profiles revealed statistically significant changes in the intensity of 12 proteins. The network analysis implied that Cr(6+) application strongly induced the IL-6-stimulated inflammatory pathway. mRNA levels of specific cytokines were also correlated with inflammatory events. Increased IL-6 modulation of the fucosylation of haptoglobin was also identified in Cr(6+)-treated samples.

CONCLUSIONS

These results suggest that Cr(6+) may induce IL-6-mediated inflammatory responses which result in hepatic injury. This paper highlights the applications of functional proteomics of plasma profiles and fucosylated glycoproteins as a predictive tool to monitor human health in contact with chromium.

Can iterative reconstruction improve imaging quality for lower radiation CT perfusion? Initial experience

BACKGROUND AND PURPOSE

Initial results using IR for CT of the head showed satisfactory subjective and objective imaging quality with a 20-40% radiation dose reduction. The aim of our study was to compare the influence of IR and FBP algorithms on perfusion parameters at standard and lowered doses of CTP.

MATERIALS AND METHODS

Forty patients with unilateral carotid stenosis post-carotid stent placement referred for follow-up CTP were divided into 2 groups (tube currents were 100 mAs in group A and 80 mAs in group B). Datasets were reconstructed with IR and FBP algorithms; and SNRs of gray matter, white matter, and arterial and venous ROIs were compared. CBF, CBV, and MTT means and SNRs were evaluated by using linear regression, and qualitative imaging scores were compared across the 2 algorithms.

RESULTS

The mean effective radiation dose of group B (2.06 mSv) was approximately 20% lower than that of group A (2.56 mSv). SNRs for ROIs in the dynamic contrast-enhanced images were significantly higher than those for the FBP images. Correlations of the SNRs for CBF, CBV, and MTT across the 2 algorithms were moderate (R² = 0.46, 0.23, and 0.44, respectively). ROIs in gray matter rather than the IR algorithm predicted increasing SNRs in all CBF, CBV, and MTT maps. Two cases of significant restenosis were confirmed in both algorithms. CBV, CBF, and MTT imaging scores did not differ significantly across algorithms or groups.

CONCLUSIONS

Lower dose CTP (20% below normal dose) without IR can effectively identify oligemic tissue in poststenting follow-up. IR does not alter the absolute values or increase the SNRs of perfusion parameters. Other methods should be attempted to improve SNRs in settings with low tube currents.

Three dimensional microfluidics with embedded microball lenses for parallel and high throughput multicolor fluorescence detection

We report a 3D microfluidic device with 32 detection channels and 64 sheath flow channels and embedded microball lens array for high throughput multicolor fluorescence detection. A throughput of 358 400 cells/s has been accomplished. This device is realized by utilizing solid immersion micro ball lens arrays for high sensitivity and parallel fluorescence detection. High refractive index micro ball lenses (n = 2.1) are embedded underneath PDMS channels close to cell detection zones in channels. This design permits patterning high N.A. micro ball lenses in a compact fashion for parallel fluorescence detection on a small footprint device. This device also utilizes 3D microfluidic fabrication to address fluid routing issues in two-dimensional parallel sheath focusing and allows simultaneous pumping of 32 sample channels and 64 sheath flow channels with only two inlets.

Inhibitory effects of Scutellaria baicalensis extract on hepatic stellate cells through inducing G2/M cell cycle arrest and activating ERK-dependent apoptosis via Bax and caspase pathway

ETHNOPHARMACOLOGICAL RELEVANCE

The bioactive components extracted from Scutellaria baicalensis Georgi (SB) have been widely used for anti-cancer, anti-oxidation, anti-inflammation and modulating the immune response.

AIM OF THE STUDY

The purpose of this study is to verify the inhibitory effect and the underlying mechanisms of Scutellaria baicalensis ethanol extract (SBEE) on activated hepatic stellate cells which play a central role in liver fibrogenesis.

MATERIALS AND METHODS

Dimethylnitrosamine (DMN)-administrated rat model was applied to evaluate the anti-fibrotic effect of SBEE in vivo. Flow cytometric analysis and immunoblotting were then used to further investigate the molecular mechanisms by which Scutellaria baicalensis extract induces HSC-T6 cell death.

RESULTS

Hepatic collagen contents and alpha-smooth muscle actin levels were remarkably reduced by treating with SBEE. 100 μg/mL SBEE-induced apoptosis of HSC-T6 cell was characterized with elevated levels of activated caspase-3, poly-(ADP-ribose) polymerase (PARP) cleavage, and release of cytochrome c into the cytosol in a time-dependent manner. A 24h treatment of SBEE induced G(2)/M cell cycle arrest with increased expression of p21 and downregulation of cdc2 and cyclin B1 protein levels. Again, SBEE induced bax expression with concomitant decrease of bcl-2 and upregulated the p53 and MAPK signaling in HSC-T6 cells.

CONCLUSIONS

These findings demonstrated that SBEE could prevent hepatic fibrosis by promoting ERK-p53 pathways which may in turn cause G(2)/M cell cycle arrest and activate caspase system resulting in final apoptosis of HSC-T6 cells.

Ambient and personal dose assessment of a container inspection site using a mobile X-ray system

Ambient monitor and phantom studies of absorbed and effective doses by TLDs were carried out in a non-intrusive inspection station for containers, Terminal I, of Taichung harbor, Taiwan. The doses from the X-ray scan in the control room and driver waiting room, located outside of the radiation control area, were quite small and could not be distinguished from the natural background radiation. The doses in the driver cab and the inspector cab of the X-ray scan car were also within background radiation levels. The protection wall, a 40-cm thick concrete barrier, can effectively attenuate the intensity of the primary X-ray scan. The possible effective dose of a person in the container or trailer is about 3.15 ± 0.23 μSv/scan and 2.31 ± 0.38 μSv/scan. This dose is below the annual background dose. If someone was to be scanned by the X-ray, the effective dose would be at an acceptable level.

Performance of European system for cardiac operative risk evaluation in Veterans General Hospital Kaohsiung cardiac surgery

BACKGROUND

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) model is a widely-used risk prediction algorithm for in-hospital or 30-day mortality in adult cardiac surgery patients. Recent studies indicated that EuroSCORE tends to overpredict mortality. The aim of our study is to evaluate the validity of EuroSCORE in Veterans General Hospital Kaohsiung (VGHKS) cardiac surgery including a number of different surgical and risk subgroups.

METHODS

From January 2006 to December 2009, 1,240 adult patients who underwent cardiac surgery in VGHKS were included in this study. The study was followed the guidelines of the Ethics Committee of Kaohsiung Veterans General Hospital, Taiwan. Both additive and logistic score of all patients were calculated depending on the formula in the official EuroSCORE website. The entire cohort, different surgical type and risk stratification subgroups were analyzed. Model discrimination was tested by determining the area under receiver operating characteristic (ROC) curve. Model calibration was tested by the Hosmer-Lemeshow chi-square test. Clinical performance of model was assessed by comparing the observed and predicted mortality rates.

RESULTS

There were significant differences between the VGHKS and European cardiac surgical populations. The additive score and logistic score for the overall group were 7.16% and 12.88%, respectively. Observed mortality was 10.72% overall, 5.68% for isolated coronary artery bypass grafting (CABG), 4.67% for the mitral valve only and 4.25% for the aortic valve only group. The discriminative ability EuroSCORE was very good in all and various surgical subgroups, with area under the ROC curve from 0.75 to 0.87. The addictive and logistic models of EuroSCORE showed excellent accuracy, 0.839 and 0.845, respectively. Good calibration power was recognized by p value higher than 0.05 for the entire cohort and all subgroups of patients except for isolated CABG. The logistic EuroSCORE model overestimated mortality to different degrees in the various subgroups, indicating that the logistic EuroSCORE needs to be recalibrated by a factor about 0.55 for uncomplicated surgery and low-risk groups, and 0.85 for high-risk patients with original additive score more than six.

CONCLUSION

EuroSCORE is simple and easy to use. In the present study, the model demonstrated excellent accuracy in all and various surgical subgroups in VGHKS cardiovascular surgery populations. Good calibration ability in all and different risk categories was identified except for isolated CABG group. Recalibration factors of 0.55 and 0.85 were suggested for the various operative subgroups and risk categories.

Stabilizing oils from smoked pink salmon (Oncorhynchus gorbuscha)

Smoking of meats and fish is one of the earliest preservation technologies developed by humans. In this study, the smoking process was evaluated as a method for reducing oxidation of pink salmon (Oncorhynchus gorbuscha) oils and also maintaining the quality of oil in aged fish prior to oil extraction. Salmon heads that were subjected to high temperatures (95 degrees C) during smoking unexpectedly produced oils with fewer products of oxidation than their unprocessed counterparts, as measured by peroxide value (PV), thiobarbituric acid reactive substances (TBARS), and fatty acids (FA). Higher temperatures and longer smoking times resulted in correspondingly lower quantities of oxidative products in the oils. Fatty acid methyl ester (FAME) analysis of smoke-processed oils confirmed that polyunsaturated fatty acids (PUFA) were not being destroyed. Smoke-processing also imparted antioxidant potential to the extracted oils. Even when antioxidants, such as ethoxyquin or butylated hydroxytoluene, were added to raw oils, the smoke-processed oils still maintained lower levels of oxidation after 14 d of storage. However, decreased antioxidant capacity of smoke-processed oils was noted when they were heated above 75 degrees C. Vitamin studies supported the antioxidant results, with smoke-processed oils displaying higher levels of alpha-tocopherol than raw oils. Results suggest that smoking salmon prior to oil extraction can protect valuable PUFA-rich oils from oxidation. Improved preservation methods for marine oils may extend their usefulness when added as a supplement to enhance levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in foods.

A wearable mobihealth care system supporting real-time diagnosis and alarm

This paper describes a wearable mobihealth care system aiming at providing long-term continuous monitoring of vital signs for high-risk cardiovascular patients. We use a portable patient unit (PPU) and a wearable shirt (WS) to monitor electrocardiogram (ECG), respiration (acquired with respiratory inductive plethysmography, RIP), and activity. Owing to integrating fabric sensors and electrodes endowed with electro-physical properties into the WS, long-term continuous monitoring can be realized without making patients feel uncomfortable and restricting their mobility. The PPU analyzes physiological signals in real time and determines whether the patient is in danger or needs external help. The PPU will alert the patient and an emergency call will be automatically established with a medical service center (MSC) when life-threatening arrhythmias or falls are detected. With advanced gpsOne technology, the patient can be located and rescued immediately whether he/she is indoors or outdoors in case of emergency.

Effect of Regression of Enlarged Neck Lymph Nodes on Radiation Doses Received by Parotid Glands During Intensity-Modulated Radiotherapy for Head and Neck Cancer

OBJECTIVES

The regression of enlarged neck lymph nodes during intensity-modulated radiotherapy (IMRT) may increase actual radiation doses to the parotid glands of patients with head-and-neck cancer. We investigated the changes in the lymph nodes volume during IMRT and the effect of these changes to the parotid gland doses.

METHODS

Ten head and neck cancer patients with enlarged neck lymph nodes were enrolled in this study. Computed tomography (CT) imaging was repeated to evaluate the change in lymph nodes volume after initial 45 Gy, and the second part of IMRT (21 Gy) was then replanned to reflect the change of nodal tumor volume. The dosimetric benefit of parotid sparing with replanning was compared with that of no replanning.

RESULTS

The enlarged neck lymph nodes in all patients pushed the parotid glands outward in pretreatment CT images. After 45 Gy of IMRT, nodal regression caused the parotid glands to shift inward into the high-dose area. When compared with those without replanning, we found modification of IMRT plan after 45 Gy significantly reduced radiation dose to parotid glands (mean reduction of 2.95 +/- 1.10 Gy to the left and 3.23 +/- 1.37 Gy to the right, respectively; P < 0.001).

CONCLUSIONS

Excessive parotid gland doses secondary to the regression of enlarged neck nodes could be mitigated by replanning after 45 Gy. However, recontouring of large lymph nodes that regress during therapy has a risk of under-dosing extracapsular extension of lymph node metastases. Therefore, recontouring should be done with extreme caution.

Metallic stent placement in hemodialysis graft patients after insufficient balloon dilation

Objective

We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients.

Materials and Methods

Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation. The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patients (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients. Metallic stents 8-10mm in diameter and 40-80 mm in length were used. Of them, eight stents were deployed across the elbow crease. Access patency was determined by clinical follow-up and the overall rates were calculated by Kaplan-Meier survival analysis.

Results

No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure. The overall primary and secondary patency rates (±standard error) of all the vascular accesses in our 23 patients at 3, 6, 12 and 24 months were 69%±9 and 88%±6, 41%±10 and 88%±6, 30%±10 and 77%±10, and 12%±8 and 61%±13, respectively. For the forearm and upper-arm grafts, the primary and secondary patency rates were 51%±16 and 86%±13 vs 45%±15 and 73%±13 at 6 months, and 25%±15 and 71%±17 vs 23%±17 and 73%±13 at 12 months (p = .346 and .224), respectively.

Conclusion

Metallic stent placement is a safe and effective means for treating peripheral venous lesions in dialysis graft patients after insufficient balloon dilation. No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.

Development and characterization of a new tropical marine fish cell line from grouper, Epinephelus coioides susceptible to iridovirus and nodavirus

The development and characterization of a new tropical marine fish cell line (GS), derived from the spleen of orange spotted grouper, Epinephelus coioides is described. The GS cells grow well in Leibovitz's L-15 medium supplemented with 10% foetal bovine serum, and have been subcultured more than 200 times. The optimal growth temperature was 27 degrees C. The GS cell culture consisted of mostly fibroblastic cells. The modal diploid chromosome number was 48. GS cell cultures showed advanced cytopathic effects after infection with a pathogenic grouper iridovirus (Singapore grouper iridovirus, SGIV) or with a grouper nodavirus (Epinephelus tauvina nervous necrosis virus, ETNNV). Analysis by transmission electron microscopy showed a large number of SGIV and ETNNV particles in the cytoplasm of virus-infected cells, respectively, indicative of high sensitivity to these two viruses. Immunofluorescence microscopy showed that iridovirus-infected GS cells reacted strongly with monoclonal antibody against the grouper iridovirus. It is suggested that the GS cell line has good potential as a diagnostic tool for isolation and propagation of iridovirus and nodavirus. When the GS cells were transfected with pEGFP vector DNA, significant fluorescent signals were observed suggesting that the GS cell line can be used as a useful tool for transgenic and genetic manipulation studies.

Metallic Stent Placement for Treating Peripheral Outflow Lesions in Native Arteriovenous Fistula Hemodialysis Patients After Insufficient Balloon Dilatation

OBJECTIVE

The purpose of this study was to report our experience with metallic stent placement in the peripheral outflow veins in native arteriovenous fistula (A-V fistula) hemodialysis patients after insufficient balloon dilatation.

MATERIALS AND METHODS

During the past 4 years, 12 A-V fistula dialysis patients in our hospital underwent metallic stent placement in the peripheral outflow veins to restore vascular access. The indications for metallic stent placement in our study included (1) recoil stenosis of outflow vein in six patients; (2) outflow venous rupture in two patients and dissection in one patient; and (3) large residual adherent thrombus in outflow aneurysms in three patients with thrombosed (arteriovenous) access. Self-expandable Wallstent or Jostent (Jomed, Abbott Laboratories) of appropriate size (6-10 mm in diameter) was chosen for use in these patients. Kaplan-Meier survival analysis was used to calculate the access patency rates.

RESULTS

Twelve patients received stents. Eleven patients (92%) underwent successful dialysis after the procedure. One patient experienced complications due to incorrect positioning of the stent at the anastomotic site, causing flow compromise. The primary patency (+/- standard error) of the vascular access at 3, 6, 12, and 24 months was 92% +/- 8%, 81% +/- 12%, 31% +/- 17%, and 31% +/- 17%, respectively. The secondary patency of the vascular access at 3 months was 92% +/- 8%, and 82% +/- 12% at 6, 12, and 24 months each.

CONCLUSION

Metallic stent placement is safe and effective in treating peripheral venous lesions in native A-V fistula hemodialysis patients after unsatisfactory balloon dilatation.

Antioxidant supplementation may improve renal transplant function: A preliminary report

Dysfunction of the renal graft may not only be due to rejection but also other causes such as ischemia and reperfusion injury and calcineurin inhibitor nephrotoxicity. Antioxidant free radical scavengers may decrease oxidative stress and lipid peroxidation. Previous animal studies suggest that vitamins C (ascorbic acid) and E (alpha-tocopherol) are both strong antioxidants, that decrease oxidative stress caused by ischemia-reperfusion injury and calcineurin inhibitor nephrotoxicity. But there have been only limited reports about clinical efficacy. We report five cases supplemented with vitamin C (500 mg per day), vitamin E (500 mg per day), or both. After a 1- to 3-month prescription, the serum creatinine level decreased more than 20% from the original value. Interestingly, one patient had this experience: he ceased vitamin E for 1 month due to noncompliance. The serum creatinine level increased more than 50%. When he took vitamin E again, his serum creatinine level declined and returned to the previous level. From our limited experience, antioxidant supplementation with vitamin C or E may improve renal transplant function, especially in grafts donated from marginal donors.

Effect of 5-methoxypsoralen (5-MOP) on cell apoptosis and cell cycle in human hepatocellular carcinoma cell line

The chemopreventive role of 5-methoxypsoralen (5-MOP) in the human hepatocellular carcinoma (HCC) cell line was investigated by studying the regulation of proliferation and apoptosis in HCC (J5) cells. Morphological analysis, cell viability assay, DNA analysis and cell-cycle analysis suggest that there are at least three modes of the suppressive effects shown by 5-MOP: (a) kills J5 cells directly; (b) induces apoptosis by arresting J5 cells at the G2/M phase in the cell cycle; (c) induces apoptosis through an independent pathway with cell-cycle arrest at 24-72 h of exposure. Further immunoblot analysis demonstrated that inhibition of cyclin B1 by 5-MOP may play an important role in G2/M arrest of J5 cells and provides an additional way to prevent cells from entering the M phase and undergoing apoptosis. 5-MOP therefore appears to exert its anticarcinogenic properties by cytotoxic effect, inducing apoptosis and inhibiting proliferation in the human hepatocellular carcinoma cell line.

Evaluating geometric accuracy of multi-platform stereotactic neuroimaging in radiosurgery

We used a spherical phantom to evaluate geometric accuracy in multi-platform stereotactic neuroimaging for radiosurgery. The phantom consisted of two plastic 16-cm-diameter hemispheres in which an exchangeable 8-cm plastic functional cube was incorporated. The functional cube contained cylinder and point targets. The targets were filled with a mixed aqueous solution of 2-mM copper sulfate and 300-mg/ml iodinated contrast medium and were visible on both MR and X-ray images. Two MR scanners and a biplane X-ray angio-suite were used to scan the phantom stereotactically in two sessions of the experiment. The angio-suite was equipped with digital subtraction and distortion-correction software. The resulting stereotactic images were transferred to a dose-planning computer for length measurement and coordinate determination of the targets. The mean errors of the measured cylinder length on distortion non-corrected X-ray stereotactic images were 0.24 +/- 0.14 and 0.73 +/- 0.10 mm, respectively, in the experiments; on distortion-corrected images 0.22 +/- 0.10 and 0.35 +/- 0.39 mm. They were 0.50 +/- 0.24, 0.25 +/- 0.19 and 0.49 +/- 0.34, 0.23 +/- 0.25 mm, respectively, of the two MR scanners. The mean errors of coordinate determination of point targets between the stereotactic MR and the distortion-corrected X-ray images were 0.70 +/- 0.18, 0.52 +/- 0.22 and 0.76 +/- 0.25, 0.40 +/- 0.10 mm, respectively, in the experiments. We found that the overall geometric errors of target delineation between stereotactic MR and X-ray images were in the submillimeter range. The current study validates the multi-platform and multi-facility stereotactic neuroimaging practice and ensures imaging accuracy in radiosurgery.

Estimation of mean-glandular dose from monitoring breast entrance skin air kerma using a high sensitivity metal oxide semiconductor field effect transistor (MOSFET) dosimeter system in mammography

Estimation of mean-glandular dose (MGD) has been investigated in recent years due to the potential risks of radiation-induced carcinogenesis associated with the mammographic examination for diagnostic radiology. In this study, a new technique for immediate readout of breast entrance skin air kerma (BESAK) using high sensitivity MOSFET dosimeter after mammographic projection was introduced and a formula for the prediction of tube output with exposure records was developed. A series of appropriate conversion factors was applied to the MGD determination from the BESAK. The study results showed that signal response of the high sensitivity MOSFET exhibited excellent linearity within mammographic dose ranges, and that the energy dependence was less than 3% for each anode/filter combination at the tube potentials 25-30 kV. Good agreement was observed between the BESAK and the tube exposure output measurement for breasts thicker than 30 mm. In addition, the air kerma estimated from our prediction formula provided sufficient accuracy for thinner breasts. The average MGD from 120 Asian females was 1.5 mGy, comparable to other studies. Our results suggest that the high sensitivity MOSFET dosimeter system is a good candidate for immediately readout of BESAK after mammographic procedures.

Characterization of high-sensitivity metal oxide semiconductor field effect transistor dosimeters system and LiF:Mg,Cu,P thermoluminescence dosimeters for use in diagnostic radiology

Monitoring radiation exposure during diagnostic radiographic procedures has recently become an area of interest. In recent years, the LiF:Mg,Cu,P thermoluminescence dosimeter (TLD-100H) and the highly sensitive metal oxide semiconductor field effect transistor (MOSFET) dosimeter were introduced as good candidates for entrance skin dose measurements in diagnostic radiology. In the present study, the TLD-100H and the MOSFET dosimeters were evaluated for sensitivity, linearity, energy, angular dependence, and post-exposure response. Our results indicate that the TLD-100H dosimeter has excellent linearity within diagnostic energy ranges and its sensitivity variations were under 3% at tube potentials from 40Vp to 125kVp. Good linearity was also observed with the MOSFET dosimeter, but in low-dose regions the values are less reliable and were found to be a function of the tube potentials. Both dosimeters also presented predictable angular dependence in this study. Our findings suggest that the TLD-100H dosimeter is more appropriate for low-dose diagnostic procedures such as chest and skull projections. The MOSFET dosimeter system is valuable for entrance skin dose measurement with lumbar spine projections and certain fluoroscopic procedures.

Dynamic evaluation of absorbed dose to the bladder wall with a balloon-bladder phantom during a study using [(18)F]fluorodeoxyglucose positron emission imaging

An accurate evaluation of the absorbed dose to the bladder wall from 2-[(18)F]fluoro-2-deoxy-d-glucose (FDG) is clinically important because the bladder is considered as a critical organ in most positron emission tomography (PET) studies that cumulate about 20% of the total activity injection during image procedures. In the MIRD calculation, no allowance is made for the inclusion of all the dynamic parameters that affect the actual dose to the bladder wall to be taken in the dose assessment. The goal of the study is to propose a dose evaluation model by using a dynamic bladder phantom and time-activity curves from the bladder PET imaging. The proposed model takes all dynamic parameters into account and provides a much more accurate dose estimation to the bladder. In this study, the lowest dose to the bladder wall was obtained at the conditions of having a larger initial volume for the bladder contents and a higher production rate for urine. It is then advised patients to drink a bulk amount of water before the FDG injection or after urine voiding to facilitate urine production and to enlarge the bladder surface area, which are the most crucial steps in reducing the dose to the bladder wall. In our study, the voiding schedule in dose calculation plays certain roles although it is much more critical in the conventional MIRD calculation. The model estimated that the lowest dose to the bladder would occur at an initial void about 40 min after the FDG injection and the urine voiding was as complete as possible.