[Susceptibility study on the germline rare variants of bromodomain and extraterminal domain protein family-encoding genes and patients with cancer living in some regions of China]

Objective: To explore the relationship between germline rare variants of bromodomain and extraterminal domain (BET) protein family-encoding genes and susceptibility to cancer in some regions of China. Methods: Capturing probes were designed for bromodomain-containing protein 2 (BRD2), BRD3 and BRD4 genes, and Illumina high-throughput sequencing platform was used to conduct targeted sequencing of genomic DNA of peripheral blood leukocytes from 1 673 patients with cancer and 1 661 individuals without cancer recruited between October 2015 and July 2018 from Chinese PLA General Hospital, the Second Affiliated Hospital of Guangxi Medical University, People's Hospital of Macheng City, Hubei Province and Geneplus-Beijing Co. Ltd. Mutation detection and analysis were carried out according to the genome analysis toolkit (GATK) best practice guidelines, ANNOVAR and VEP software were used for annotation, and germline rare variants in BET family were screened. To determine potential pathogenic germline rare variants, clinical and experimental evidence was obtained from the ClinVar database and SIFT and Polyphen-2 softwares were used to predict pathogenicity. Fisher's exact test was used to compare the difference of the carrying rate of variants in the case group and the control group, and multivariate regression analysis was performed with the SKAT software with sex and age used as covariates. Results: Among the 1 673 cancer patients, 911 were males and 762 were females, with the mean age was (57.9±11.7) years. There were 1, 111 cases (66.4%) of lung cancer, 266 cases (15.9%) of colorectal cancer, 186 cases of breast cancer (11.1%), and 110 cases (6.6%) of esophagus or gastric cancer. In the same period 1, 661 non-tumor control individuals were recruited, including 821 males and 840 females, with the mean age was (44.5±13.9) years. It was observed that there were 4 potential pathogenic germline rare variants in BRD2 gene carried by 17 patients with cancer, 5 potential pathogenic germline rare variants in BRD3 gene and 8 potential pathogenic germline rare variants in BRD4 gene. The carrying rate of potential pathogenic germline rare variants in BRD2 gene in cancer patients was 1.02% (17/1 673), significantly higher than that in controls without cancer [0 (0/1 661); OR=+∞, 95%CI: 4.81-+∞, P<0.001]. The carrying rate of potential pathogenic germline rare variants in BRD3 gene in cancer patients was 0.24% (4/1 673), and the difference was not statistically significant compared with controls without cancer [0.12% (2/1 661); OR=1.99, 95%CI: 0.46-10.47, P=0.690]. The carrying rate of potential pathogenic germline rare variants in BRD4 gene in cancer patients was 0.18% (3/1 673), and the difference was not statistically significant compared with controls without cancer [0.36% (6/1 661); OR=0.50, 95%CI: 0.14-2.08, P=0.340]. Furthermore, the dataset of whole exome sequencing of Chinese individuals in "Huabiao Project" was used as an additional control, and the rate of carrying BRD2 rare variants in cancer patients was 17/3 346 (0.51%), significantly higher than that in controls without cancer [0.07% (3/4 154); OR=7.07, 95%CI: 2.32-22.83, P<0.001]. Among the 17 patients carrying 4 potentially pathogenic germline rare variants of BRD2 gene, 9 were patients with lung cancer, 6 were patients with colorectal cancer, 1 was patient with breast cancer, and 1 was patients with esophagus or gastric cancer. The carrying rate of potential pathogenic germline rare variants in BRD2 gene in lung cancer patients was 0.81 (9/1 111), significantly higher than that in controls without cancer [0(0/1 661); OR=+∞, 95%CI: 3.95-+∞,P<0.001]. The carrying rate of potential pathogenic germline rare variants in BRD2 gene in patients with colorectal cancer was 2.26% (6/266), significantly higher than that in controls without cancer [0(0/1 661); OR=+∞, 95%CI: 9.03-+∞, P<0.001]. Wilcoxon rank-sum test results showed that patients with colorectal cancer carrying BRD2 rare variants had an earlier age at diagnosis [(47.0±7.4) vs (57.2±12.1) years old, P=0.017]. Conclusions: BRD2 gene may be served as a candidate genetic susceptibility gene for lung cancer and colorectal cancer. Carrying BRD2 potential pathogenic germline rare variants is associated with higher risk of lung cancer and colorectal cancer, and with earlier age of colorectal cancer.

Better detection of Ig heavy chain and TCRγ gene rearrangement in plasma cell-free DNA from patients with non-Hodgkin Lymphoma

Plasma cell-free DNA is the soluble DNA and tumor-derived DNA in plasma which has the same mutation as the tumor cellular DNA. This study aimed at comparing the properties of plasma cell-free DNA with the biopsy's DNA in order to evaluate the clinical significance of IgH and TCRγ gene rearrangement in plasma cell-free DNA from patients with non-Hodgkin's Lymphoma. A total of 360 samples were studied. IgH (FR3A/VLJH) and TCRγ (TVG/TJX) were amplified by PCR. Results of plasma cell-free DNA were compared with biopsy's DNA and mononuclear cellular DNA respectively. Plasma cell-free DNA were successfully extracted from 288 cases of newly diagnosed, refractory and relapsed NHL in total 360 patients (80%).But nothing was found in the other 72 remittent patients. The positive percentage of IgH rearrangement in patients with B-NHL was 81% in plasma cell-free DNA and 77% in biopsy's DNA (P>0.05). As to the ratio of TCRγ rearrangement in patients with T-NHL, the former was 44%, and the latter was 39% (P>0.05). These results show tumor-derived DNA could be detected in tumor loaded plasma, even of underlying cancer patients. For NHL patients, detecting IgH and TCRγ gene rearrangement of plasma cell-free DNA has the same clinical significance as biopsy's DNA. Moreover, it's more simple, convenient and non-invasive.

KEYWORDS

Lymphoma non-Hodgkin, plasma, cell-free DNA, gene rearrangement, immunoglobulin, heavy-chain gene, T-cell receptor.γ

Potentially inappropriate prescribing for insomnia in elderly outpatients in Taiwan

OBJECTIVE

This study was based on Taiwan's National Health Insurance (NHI) claim records with the aim of identifying specific types of potentially inappropriate sedative-hypnotic prescribing in elderly outpatients with insomnia. The potentially inappropriate prescribing included duplicate treatment, excessive dosage and duration or treatment and prescribing of hypnotics that are too long-acting.

MATERIAL AND METHODS

This cross-sectional study was based on annual outpatient claim data for 2001 released by Taiwan's Bureau of National Health Insurance (BNHI). A subset was created for patients aged 65 years or older and coded as having insomnia. Physician consultation claim data were extracted and merged in 1 claim file consisting of ICD-9-CM codes, patient demographic data, specialty of physicians, medical institution code and pharmaceutical prescription content.

RESULTS

Elderly patients with insomnia constituted 216,994 of the 1,000,193 files surveyed on outpatient claims in 2001. The mean age was 74.33 years and gender distribution was nearly equal. Of the prescribed sleep medications, 41.26% were hypnotic benzodiazepines, 29.36% were hypnotic non-benzodiazepines and 29.38% were sedative-anxiolytics. Approximately 1 in 25 patients (4.12%) of all the patients prescribed hypnotics received duplicate treatment, 1 in 8 an inappropriately (12.27%) high dosage (daily dose > 1.5 DDD, Defined Daily Dose), 1 in 3 (32.25%) more than 28 DDD per prescription and 1 in 6 (17.52%) a drug with an effect which was too prolonged. Physicians tended to consider patient gender but not age when prescribing. Clear trends were found between the specialty of the physician and the type of inappropriate prescribing. The type of medical institution was significantly related only to the excessive quantity of medication prescribed.

CONCLUSIONS

Elderly people in Taiwan with insomnia receive potentially inappropriate prescriptions for sleep medications. Similar data could possibly be extracted from similar databases in other countries throughout the world. Some of these potentially inappropriate prescriptions are avoidable in terms of restricting the length of outpatient sedative-hypnotic treatment, introducing hypnotics in small dosage forms and continuously educating clinicians on the safety of geriatric medication.

Washing and cryoprotectant effects on frozen storage of spent hen surimi

Mince of 98-wk-old spent hens was washed two times with 0.1% NaCl. Portions of unwashed and washed mince were mixed with a cryoprotectant (CP) composed of 4% sucrose, 4% sorbitol, and 0.2% Na-tripolyphosphate and were immediately frozen and stored at -20 C. Mince without CP was run as control. Textural properties of the stored mince and surimi were measured at 1-mo intervals for 6 mo, after being thawed at 4 C overnight, ground with 3% NaCl, and heated at 90 C for 15 min. For freeze-thaw stability study, minces were subjected to six freeze-thaw cycles. Each freeze-thaw cycle was carried out at 1 mo of storage. Textural quality parameters (gel strength, breaking strength, deformation, protein solubility, expressible moisture, cooking yield, folding test, drip-loss, and sensory scores) were decreased in both unwashed and washed mince, mostly during the early stages of storage. Washed mince showed significantly better textural properties than unwashed mince. Washing protected the gel quality of the hen mince from degradation during frozen storage. Cryoprotectants could not protect the gel strength or breaking strength, but deformation was slightly improved. Water-retention properties were protected, and folding test and sensory scores were well preserved in the mince with added CP. Cryoprotectants had a beneficial effect on frozen, stored spent hen surimi to protect the elasticity and cohesiveness of the gel.

Differences in molar absorptivity of 4-NP with the reaction solution and apparatus affect ALP measurement

We examined the differences in molar absorptivity of 4-NP obtained using different kits for ALP measurement and different instruments. The apparent molar absorptivity of 4-NP in the same reaction solution determined by six different instruments was 15.98, 16.72, 16.06, 17.00, 16.27, 17.62 and that using four different reaction solution kits for ALP with the same instrument was 16.90, 17.38, 17.72, 16.11. We measured ALP in three serum samples with six instruments using the same kit and in twelve serum samples with the same instrument using four kits. ALP activities measured using the same molar absorptivity value differed with the instrument(p < 0.01). However, those measured using the apparent molar absorptivity value for each instrument revealed no significant differences(p > 0.05). In conclusion, we suggest that standard material should be contained in each kit for enzyme measurement and the apparent epsilon for each kit and instrument should be obtained to minimize the systematic error caused by using the same epsilon in different laboratories.

Adulteration by synthetic therapeutic substances of traditional Chinese medicines in Taiwan

The adulteration by synthetic therapeutic substances of traditional Chinese medicines has been reported on various occasions and has been a public health concern in Taiwan over the past several years. A large-scale effort was initiated in 1992 to screen traditional Chinese medicines that were suspected of adulteration with synthetic therapeutic substances. The term "adulteration" refers to traditional Chinese medicines that are tested and found to contain chemical substances not prescribed or labeled as part of the intended use. A total of 2,609 samples were collected by eight major general hospitals in Taiwan. Samples were collected through physicians' referrals during patients visits. The samples were analyzed by hospital pharmacists following the established standard procedures in comparison to references by thin-layer chromatography. An average of 23.7% (n = 618) of the samples collected from the eight hospitals were adulterated. Four samples with either a rheumatoid or an antiinflammatory indication contained six different kinds of adulterants. More than half (52.8%) of the adulterated traditional Chinese medicines contained two or more adulterants. The sources of adulterated samples and their claimed indications, as well as the most frequently detected synthetic therapeutic substances, are presented in this report. The controversies regarding the combination of synthetic therapeutic substances and traditional Chinese medicines without adequate labeling should be resolved through regulatory actions for better safety of drug use.

Case-control study of the effectiveness of different types of helmets for the prevention of head injuries among motorcycle riders in Taipei, Taiwan

A total of 1,351 victims of motorcycle accidents, brought to one of 15 hospitals responsible for emergency care in Taipei, Taiwan, between August 1 and October 15, 1990, were enrolled in a case-control study to investigate the effectiveness of different types of helmets for the prevention of head injuries. A total of 562 of those with head injuries were assigned to the case group, while the remaining 789 victims without head injuries were considered as emergency room controls. The case group was subdivided into daytime and evening cases, according to the time of accident. For each daytime case, we took four pictures of passing motorcycles at the same time and place during the week after each accident. Of the 254 daytime cases, we successfully took pictures for 224 (88%) and identified 1,094 motorcycle riders in the pictures as street controls. Logistic regression analyses were used to determine the roles of the following variables in predicting risk of head injury: age, sex, riding position, weather, place of accident, helmet type, and motorcycle type, and status of helmet wearing. The relative risk of head injury among motorcycle riders was significantly reduced by wearing a full-face helmet, but not by wearing a full- or a partial-coverage helmet.

[Chemotherapy of biliary tract infections (XXIV). Biliary excretion and gallbladder tissue levels of mezlocillin]

Mezlocillin (MZPC), a new broad spectrum penicillin, was studied for its biliary excretion and levels in gallbladder tissues. The mean serum concentration immediately after intravenous administration of 2 g of MZPC in 6 cholecystectomized patients was found to be 535.5 +/- 43.5 micrograms/ml, while its concentration in their gallbladder bile was 1,500-6,500 micrograms/ml at 30 minutes-1.5 hours and its concentration in their common duct bile was 6,500 and 4,000 micrograms/ml at 2 hours and 2.5 hours, respectively. Besides, its gallbladder tissue level around 2 hours was 37.5-500 micrograms/g, averaging as high as 215.6 +/- 79.5 micrograms/g. Crossover method was made to compare the biliary excretion of MZPC and PIPC in 4 patients inserted with a T-tube in their common bile duct. Each patient received 2 g each of 2 antibiotics intravenously. In case 1 with normal liver function, both drugs revealed the peak concentration of 3,500 micrograms/ml or more. In case 2, the peak concentration was 3,625 micrograms/ml for MZPC but 2,125 micrograms/ml for PIPC. In case 3 with slight hepatic dysfunction, the peak concentration for MZPC and PIPC was 906.4 micrograms/ml and 375.2 micrograms/ml, respectively. In case 4 with moderate hepatic dysfunction, the peak concentration for MZPC and PIPC was 27.6 micrograms/ml and 14.7 micrograms/ml, respectively. Simultaneous intravenous administration of MZPC and PIPC was made to compare the biliary excretion of these 2 antibiotics in 1 patient with T-tube drain in common bile duct. The bile concentration was measured by HPLC method which was developed by our laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)