[A case of nontuberculous mycobacterium presenting as a mass and atelectasis with mediastinal and hilar lymph node enlargement]

With the development of testing technology, the diagnosis of nontuberculous mycobacterium (NTM) lung disease has gradually increased in recent years. Because the clinical characteristics of NTM are not typical, and its imaging manifestations are diverse and nonspecific, missed diagnosis and misdiagnosis are common. Etiological investigation is necessary for diagnosis. Conventional etiological investigations are very limited for the diagnosis of NTM. We reported a case of NTM lung disease presenting with a mass and atelectasis with mediastinal and hilar lymph node enlargement that resembled malignant tumors. The literature on this condition was reviewed to improve the clinician's understanding and broaden clinical thinking.

[Endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma]

Objective: To describe a technique of endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma, based on anatomic studies and surgeries. Methods: Three dry human skulls and five fresh human cadaver heads were used for anatomic study of a endoscopic transoral approach to expose petroclival and jugular foramen. The anatomical landmarks and the extent of exposure were recorded. Six clinical cases who were treated in Eye & ENT Hospital, Fudan University from June 2020 to April 2022 were used to illustrate the technique and feasibility of this approach and to assess its indications and advantages, including 3 males and 3 females, aged 42 to 69 years old. Descriptive analysis was used in this research. Results: On the basis of the preservation of the internal pterygoid muscle and the external pterygoid muscle, this approach could fully expose the parapharyngeal, petrosal and paraclival segment internal carotid arteries, and safely deal with the lesions of jugular foramen and petroclival region. The 6 patients in our study tolerated the procedure well. Postoperative enhanced MRI showed complete resection of the tumor and no postoperative masticatory dysfunction. Conclusion: Endoscopic transoral approach is a safe, minimally invasive and effective surgical treatment for petroclival and jugular foramen recurrent nasopharyngeal carcinoma.

[Analysis of clinical prognosis of endoscopic salvage surgery in patients with rT2 recurrent nasopharyngeal carcinoma]

Objective: To investigate the feasibility of endoscopic salvage surgery for patients with rT2 recurrent nasopharyngeal carcinoma (rNPC) and to analyze their prognostic factors. Methods: The clinical data of 33 patients with rT2 rNPC who underwent endoscopic extended nasopharyngectomy in Eye & ENT Hospital Affiliated to Fudan University from January 2015 to July 2020 were analyzed, including 29 males (87.9%) and 4 females (12.1%), aging (51.7±10.6) years. The clinicopathological characteristics of these patients were recorded and analyzed, in terms of gender, sex, alcohol and cigarette use, interval between primary treatment to recurrence, adjuvant therapy, lymph node metastasis, internal carotid artery (ICA) invasion, necrosis, margin and reconstruction materials. Kaplan Meier analysis was used to plot the overall survival rate and progression free survival rate curve, Log-rank test was used to analyze the prognostic factors among patients, and multivariate Cox proportional hazards regression was used to determine the independent risk factors of tumor progression free survival. Results: Among 33 patients with rT2 rNPC, the recurrence interval of 24 patients with rNPC after primary radiotherapy was more than 2 years. A total of 25 patients received primary radiotherapy and adjuvant chemotherapy at the same time. There were 6 cases with cervical lymph node metastasis, 12 cases with ICA invasion, 8 cases with positive surgical margin, 7 cases underwent ICA embolization before operation. A total of 18 cases underwent pedicled tissue flap repairment after operation, including 12 pedicled nasal septal mucosa flaps and 6 temporalis muscle flaps. The median follow-up time was 15 months. Five patients died because of disease progression (in 2 cases), post surgical ICA hemorrhage (in 1 case), liver metastasis (in 1 case) and dysphagia (in 1 case). The 1-year, 2-year and 3-year overall survival rates of all patients were 93.9%, 81.8% and 81.8%, respectively. The 1-year, 2-year and 3-year progression free survival rates were 74.7%, 59.7% and 40.9%, respectively. Log-rank statistical analysis showed that the positive surgical margin (P=0.060) and recurrence interval (P=0.151) were possibly related to the prognosis of rT2 rNPC. Multivariate Cox regression analysis showed that the positive surgical margin was an independent risk factor for patients with rT2 rNPC (P=0.034). Nasopharynx hemorrhage occurred in 4 patients, skull base bone necrosis occurred in 2 patients, trismus occurred in 3 patients, and no obvious brain complications occurred in 7 patients with ICA embolization. Conclusion: Endoscopic salvage surgery for rT2 rNPC is a safe and effective surgical option, but the long-term effect still needs long-term follow-up in bulk cases.

[Internal carotid artery embolization in endoscopic salvage surgery for recurrent nasopharyngeal carcinoma: a single-center retrospective study]

Objective: To evaluate the efficiency of internal carotid artery (ICA) embolization technology in endoscopic salvage surgery for recurrent nasopharyngeal carcinoma (rNPC) invading the ICA. Methods: From January 2016 to March 2021, 83 patients with rNPC who invaded the ICA and underwent endoscopic extended nasopharyngectomy were retrospectively collected from the Eye & ENT Hospital in Fudan University, including 60 males and 23 females. The age of the patients ranged from 27 to 77 years. The standard of ICA invasion was that the distance from the lesion to the ICA on enhanced MRI was ≤ 1.8 mm. The clinical characteristics, ICA management strategy and survival prognosis of patients were analyzed, and the effectiveness of ICA embolization was evaluated. Kaplan-Meier method was used to calculate the survival rate and Log-rank test was used to compare the difference. Results: In 83 patients with rNPC, there were 13 patients with rT2, 38 patients with rT3, 32 patients with rT4, and 16 patients had lymph node metastasis. A total of 37 patients (44.6%) underwent ICA coil embolization before surgery, of which 2 cases underwent external carotid-middle cerebral artery artery bypass grafting and ICA embolization due to positive balloon occlusion test (BOT). Patients with positive surgical margin accounted for 24.1% (20/83). Among them, patients with rT4 and patients without ICA embolization had a higher positive rate of surgical margin (P value was 0.001, 0.043, respectively). The 3-year overall survival (OS) and progression free survival (PFS) rate of all patients was 46.5% and 26.7%, respectively. In addition, the 3-year OS and PFS of patients with ICA embolization was significantly higher than those without ICA embolization, respectively (69.1% vs 27.8%, P=0.003; 33.9% vs 18.9%, P=0.018). Only 2 patients (2/37, 5.4%) had cerebral infarction complications after coil embolization of the affected ICA due to negative BOT. Conclusion: Preoperative ICA embolization can be used to treat patients with rNPC invading the ICA, improve the total removal rate and survival rate of patients, which is an effective salvage treatment.

[The application of temporalis muscle flap in the salvage nasopharyngectomy for advanced recurrent nasopharyngeal carcinoma]

Objective: To summarize the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced recurrent nasopharyngeal carcinoma (rNPC), and to provide guidance for the repair of extensive skull base defects in salvage rNPC. Methods: A total of 54 patients with the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced rNPC were retrospectively analyzed, including 42 males and 12 females, aging from 29 to 71 years. There were 36 patients with rT3 and 18 patients with rT4. The surgical methods of temporalis muscle flap repair were summarized. The general situation, survival time and postoperative complications of patients were recorded, and the advantages and disadvantages of temporalis muscle flap were discussed. Results: The temporal muscle flap could completely cover the defect area of nasopharynx and skull base, without the need for other autologous repair materials. The follow-up period was 2 to 28 months. The survival rate of temporalis flap was 98.1% (53/54). The 1-year overall survival rate was 84.5% while 1-year progression-free survival rate was 49.0%. None of the patients had facial nerve injury. Three patients (5.6%) had necrosis of the cranial membrane required surgical intervention and four patients (7.4%) required a chonoplasty due to severe chonostril stenosis or chonostril atresia. Eleven cases (20.4%) had mouth opening restriction, chewing weakness, dysphagia and other eating difficulties. Conclusions: Temporalis muscle flap is an alternative flap for the salvage nasopharyngectomy for advanced rNPC. Temporal muscle flap shows high survival rate and wide coverage, but the surgeon should apprehend the possible complications and reduce the occurrence of them.

[Safety and efficacy of proximal gastrectomy with double tract anastomosis reconstruction for upper gastric cancer: a meta-ananlysis]

Objective: It is not yet to be clarified whether proximal gastrectomy with double tract anastomosis reconstruction (PG-DT) for gastric cancer increases postoperative complications. This meta-analysis aims to evaluate the safety and efficacy of PG-DT for upper gastric cancer. Methods: The Chinese and English literatures about PG-DT and total gastrectomy with Roun-en-Y digestive tract reconstruction (TG-RY) for upper gastric cancer were searched from PubMed, Embase, Cochrane Library, Wiley Online Library, Web of Science, CNKI net, Wanfang database and VIP database. Literature inclusion criteria: (1) prospective or retrospective cohort study of PG-DT and TG-RY for upper gastric cancer published publicly; (2) patients with upper gastric cancer; (3) the enrolled literatures included at least one of the following outcome indicators: operation time, intraoperative blood loss, postoperative exhaust time, postoperative feeding time, hospitalization time, number of harvested lymph nodes, postoperative complications, postoperative 1-year albumin, postoperative 1-year hemoglobin and 1-, 3-, 5-year survival after surgery. Literature exclusion criteria: (1) reviews, case reports, conference summaries and other non-control studies; (2) studies published repeatedly, studies with incomplete or unextractable information. The search time ended in February 2021. The basic information and evaluation indicators included in the article were extracted. The retrospective study was evaluated using Newcastle-Ottawa literature quality evaluation scale. The prospective randomized controlled study was evaluated using Jadad modified scale. Meta-analysis was performed using Review Manager 5.3. Publication bias was assessed using funnel map. Publication bias was tested using Egger tools. Results: A total of 385 literatures were searched, finally 2 randomized controlled trials and 16 retrospective cohort study were included. There were 1521 patients, including 692 in the PG-DT group and 829 in the TG-RY group. The meta-analysis of the enrolled indicators showed that as compared to TG-RYT group, PG-DT group had less intraoperative blood loss (OR=-54.58, 95%CI: -57.77 to -51.38, P<0.001), shorter postoperative exhaust time (OR=-0.21, 95%CI: -0.29 to -0.13, P<0.001), shorter hospitalization time (OR=-0.98, 95%CI: -1.31 to -0.64, P<0.001), less harvested lymph nodes (OR=-6.07, 95%CI: -7.14 to -4.99, P<0.001), lower morbidity of postoperative complication (OR=0.32, 95%CI: 0.24 to 0.43,P<0.001), higher level of postoperative 1-year albumin (OR=1.90, 95%CI: 1.08 to 2.77, P<0.001) and postoperative 1 year hemoglobin (OR=5.07, 95%CI: 2.83 to 7.31, P<0.001). While there were no significant differences in operation time (OR=0.08, 95%CI: -4.24 to 4.39, P=0.97), postoperative feeding time (OR=-0.05, 95%CI: -0.15 to 0.06, P=0.39), 1-year survival after surgery (OR=1.61, 95%CI: 0.69 to 3.75, P=0.27), 3-year survival after surgery (OR=1.31, 95%CI: 0.81 to 2.10, P=0.27) and 5-year survival after surgery (OR=1.50, 95%CI: 0.86 to 2.63, P=0.15) between two groups. Conclusions: PG-DT treatment for upper gastric cancer is safe and feasible. Compared with TG-RY, PG-DT has advantages in intraoperative bleeding, postoperative exhaust time, hospitalization time, morbidity of postoperative complication and postoperative nutritional indicators.

[Efficacy and safety of pylorus-preserving gastrectomy for early gastric cancer located in the middle third of the stomach: a meta-analysis]

Objective: It is yet to be clarified whether pylorus-preserving gastrectomy (PPG) for early gastric cancer will bring the risk of radical tumor resection, whether it will increase the incidence of postoperative complications, and how much is the benefit of the quality of life for patients after surgery, these issues are not clear. This meta-analysis aims to evaluate the efficacy and safety of pylorus-preserving gastrectomy (PPG) for early middle gastric cancer. Methods: The Chinese and English literatures about PPG and distal gastrectomy (DG) for early gastric cancer were searched from PubMed, Embase, The Cochrane Library, Web of Science, CNKI net and Wanfang database. Literature inclusion criteria: (1) Prospective or retrospective cohort study of PPG and DG for early middle-third gastric cancer published publicly; (2) Patients with early middle-third gastric cancer; (3) The enrolled literatures include at least one of the following outcome indicators: the efficacy indicators include gallstone, residual gastritis, bile reflux, delayed gastric emptying, dumping syndrome, reflux esophagitis and overall complication; the long-term prognostic indicators include 5-year survival rate and 5-year tumor recurrence. Literature exclusion criteria: (1) Reviews, case reports, conference summaries and other non-control studies; (2) Repeated published studies, incomplete studies and unextractable studies; (3) The depth of tumor invasion exceeding submucosa. The search time ended in July 2020. The basic information and evaluation indicators included in the article were extracted. The retrospective study was evaluated using Newcastle-Ottawa literature quality evaluation scale. The prospective randomized controlled study was evaluated using Jadad modified scale. Meta-analysis was performed using Review Manager 5.3. Publication bias was assessed using funnel map. Publication bias was tested using Egger tools. Results: A total of 717 literatures were retrieved, and 17 literatures were enrolled finally, including 2 randomized controlled trials and 15 retrospective studies. A total of 2427 patients were enrolled, including 948 in PPG group and 1479 in DG group. The meta-analysis of the efficacy indicators showed that there were significant differences in gallstones incidence (OR=0.42, 95% CI: 0.28-0.65, P<0.001), residual gastritis incidence (OR=0.50, 95% CI: 0.32-0.77,P=0.002), bile reflux incidence (OR=0.30, 95% CI: 0.20-0.45, P<0.001), delayed gastric emptying incidence (OR=2.40, 95% CI:1.67-3.45, P<0.001), and postoperative dumping syndrome incidence (OR=0.28, 95% CI: 0.15-0.51, P<0.001), while there were no significant differences in postoperative overall complications (OR=0.97, 95% CI: 0.69-1.35, P=0.840), reflux esophagitis incidence (OR=0.79, 95% CI: 0.39-1.61, P=0.520) between the two groups. The meta-analysis of the long-term prognostic indicators showed that no significant differences of 5-year survival (OR=1.02, 95% CI: 0.61-1.71, P=0.940) or 5-year tumor recurrence (OR=0.77, 95% CI: 0.36-1.68, P=0.520) were observed between the two groups. Conclusion: The incidences of gallstone, residual gastritis, dumping syndrome, bile reflux are lower after PPG in early gastric cancer, while the postoperative overall complications and long-term survival are comparable between PPG and DG, indicating that PPG is quite safe and feasible.

[The therapeutic effect of carnosine combined with dexamethasone in the lung injury of seawater-drowning]

Objective: To explore the therapeutic effect of carnosine and dexamethasone in lung injury caused by seawater drowning. Methods: The in vitro experiments with A549 cells were divided into 5 groups: blank control group (C), seawater injury group (S), seawater injury+dexamethasone treatment group (S+D), seawater injury+carnosine treatment group (S+C), seawater injury dexamethasone and carnosine combined therapy(S+D+C) group. The optimal therapeutic dose of drugs for the treatment of seawater drowning lung injury was tested in vitro. Based on the optimal dose, the levels of TNF-α and IL-6 in each group at different time points were detected at the cell level by ELISA. The level of apoptosis was detected by flow cytometry. The in vivo experiments with SD rats were randomly divided into 5 groups (n=8 each): blank control group (RC),seawater drowning injury group (RS),seawater drowning injury+dexamethasone treatment group (RSD),seawater drowning injury+carnosine treatment group (RSC),seawater drowning injury+dexamethasone+carnosine combined treatment group (RSDC). The animal model with seawater inhalation acute lung injury was made by intratracheal infusion (4 ml/kg). The pathological changes of the lungs were observed. The expression of superoxide dismutase (SOD) in each group was detected by Western blot. Results: The results of in vitro experiments showed significant increase of apoptosis after seawater injury. The normal cell rate in group C was 98.3% while the apoptosis rate was 1.7%. The normal cell in group S was 18.8%, and the apoptosis rate was 81% (P<0.01). TNF-α and IL-6 levels in group S increased to 180.25 ng/L and 61.56 ng/L, respectively, which were statistically significant compared with group C (P<0.01). After drug protection, apoptosis was reduced in S+D group, S+C group and S+D+C group, with apoptosis rates of 65.4%, 70.9% and 42.6%, respectively. The contents of TNF-α and IL-6 also decreased in the S+D+C group (P<0.01). The results of in vivo experiments showed obvious lung injury and disordered lung tissue structures in the RS group at 4 h after modeling. There was hemorrhage in the pulmonary interstitium and a large number of inflammatory cells. Results of western blot showed that the expression of SOD increased in the RS group. Compared with RS group, the treatment alleviated acute lung injury and decreased the expression level of SOD in RSD, RSC and RSDC groups (P<0.01). Conclusion: Dexamethasone and carnosine reduced the influence of seawater inhalation on the lung in the rat model. The positive effect of combination of these two drugs on lung injury caused by seawater inhalation was stronger than a single drug.

[Correlation between spatial navigation disorder and white matter hyperintensity in patients with mild cognitive impairment]

Objective: To investigate the relationship between white matter lesions and spatial navigation ability in patients with mild cognitive impairment (MCI). Methods: A total of 32 MCI patients [age (66±11) years, 16 males and 16 females] who were treated in the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2015 to February 2018 were selected, and matched with age, gender and education level of 28 healthy controls (NC) [age (70±11) years, 19 males and 9 females] underwent spatial navigation ability test and neuropsychology scale evaluation. In the cross-sectional study, all subjects simultaneously underwent 3.0T magnetic resonance three-dimensional liquid inversion recovery sequence and high-resolution T(1) weighted imaging scan. The Wisconsin White Matter Hyperintensities Segmentation Toolbox (W2MHS) was used to automatically mark and extract the volume of the white matter hyperintensity. Results: The average error distances of egocentric virtual (P=0.002) and allocentric virtual (P=0.039) of MCI patients are greater than that of the control group, but the average error distance of mixed (allocentric-egocentric virtual) navigation had no statistic difference between two groups (P=0.070). The volume of the whole white matter hyperintensity, periventricular white matter hyperintensity, and deep white matter hyperintensity showed no significant differences between two groups (all P>0.05). Partial correlation analysis showed that after controlling for age, gender, education level and whole brain volume, the average error distance of mixed (allocentric-egocentric virtual) navigation in MCI patients was positively correlated to the volume of the whole white matter hyperintensity, deep white matter intensity, and periventricular white matter hyperintensity (r=0.469, 0.434, 0.512, all P<0.05). The average error distance of allocentric virtual navigation is positively correlated with the volume of periventricular white matter hyperintensity (r=0.403, P=0.033). There is no correlation between the average error distance of egocentric virtual navigation and the hyperintensity of white matter. Conclusions: The spatial navigation ability of patients with MCI is related to white matter lesions, which is of great significance for further research on the potential biological mechanisms affecting human spatial navigation ability.

Ultrahigh-strength and ductile superlattice alloys with nanoscale disordered interfaces

Alloys that have high strengths at high temperatures are crucial for a variety of important industries including aerospace. Alloys with ordered superlattice structures are attractive for this purpose but generally suffer from poor ductility and rapid grain coarsening. We discovered that nanoscale disordered interfaces can effectively overcome these problems. Interfacial disordering is driven by multielement cosegregation that creates a distinctive nanolayer between adjacent micrometer-scale superlattice grains. This nanolayer acts as a sustainable ductilizing source, which prevents brittle intergranular fractures by enhancing dislocation mobilities. Our superlattice materials have ultrahigh strengths of 1.6 gigapascals with tensile ductilities of 25% at ambient temperature. Simultaneously, we achieved negligible grain coarsening with exceptional softening resistance at elevated temperatures. Designing similar nanolayers may open a pathway for further optimization of alloy properties.

Comparison of the efficacy and safety of the EC-T (epirubicin/cyclophosphamide followed by docetaxel) and TCb (docetaxel/carboplatin) neoadjuvant regimens in early TOP2A-normal stage II-III breast cancer

This study aimed to compare the efficacy and safety of the EC-T (4 cycles of epirubicin 90 mg/m2 + cyclophosphamide 600 mg/m2, followed by 4 cycles of docetaxel 75 mg/m2) and TCb (6 cycles of docetaxel 75 mg/m2, intravenous drip (ID), day 1 + carboplatin AUC 6, ID, day 1) neoadjuvant regimens in patients with TOP2A-normal stage II-III breast cancer. This study analyzed 280 patients enrolled from three studies registered with ClinicalTrials.gov (NCT03140553, NCT03154749, NCT03507465) with early TOP2A-normal stage II-III breast cancer who received neoadjuvant chemotherapy, including 100 patients who received the EC-T regimen and 180 patients who received the TCb regimen. The primary endpoint was the ratio of RCB 0/1 (residual cancer burden 0/1) after neoadjuvant chemotherapy. The secondary endpoint was the safety of the two groups. There was no significant difference in the ratio of RCB 0/1 between the two groups (23% vs. 23.9%, p=0.614). Among the triple-negative breast cancer patients, the efficacy did not differ between the two groups (40% vs. 32%, p=0.52). Among the lymph node metastasis patients, the efficacy of the EC-T group was significantly better than that of the TCb group (14% vs. 2.6%, p=0.03). Regarding the side effects, the incidence of grade 3/4 anemia was higher in the EC-T group than in the TCb group (21.0% vs. 8.33%, p=0.002), while the incidence of grade 3/4 neutropenia was higher in the EC-T group than in the TCb group (17% vs. 14.44%, p=0.570), and the incidence of grade 3/4 thrombocytopenia was low in each group (EC-T group: 6 % and TCb group: 7.22%, p=0.697). In the EC-T group, grade 3/4 nausea and vomiting occurred in 5 patients. The EC-T group showed a higher rate of grade 3/4 myalgia than the TCb group (7% and 4.44%, respectively, p=0.363). To conclude, the TCb regimen can be used as an alternative regimen for TOP2A-normal stage II-III breast cancer patients in neoadjuvant chemotherapy. However, in patients with node-positive tumors, EC-T is still recommended. Though no difference of grade 3/4 thrombocytopenia in two groups, grade 4 thrombocytopenia caused by the carboplatin-containing regimen should be taken seriously.

Dual heterogeneous structures lead to ultrahigh strength and uniform ductility in a Co-Cr-Ni medium-entropy alloy

Alloys with ultra-high strength and sufficient ductility are highly desired for modern engineering applications but difficult to develop. Here we report that, by a careful controlling alloy composition, thermomechanical process, and microstructural feature, a Co-Cr-Ni-based medium-entropy alloy (MEA) with a dual heterogeneous structure of both matrix and precipitates can be designed to provide an ultra-high tensile strength of 2.2 GPa and uniform elongation of 13% at ambient temperature, properties that are much improved over their counterparts without the heterogeneous structure. Electron microscopy characterizations reveal that the dual heterogeneous structures are composed of a heterogeneous matrix with both coarse grains (10∼30 μm) and ultra-fine grains (0.5∼2 μm), together with heterogeneous L1₂-structured nanoprecipitates ranging from several to hundreds of nanometers. The heterogeneous L1₂ nanoprecipitates are fully coherent with the matrix, minimizing the elastic misfit strain of interfaces, relieving the stress concentration during deformation, and playing an active role in enhanced ductility.

Improving both strength and ductility simultaneously in structural metals and alloys remains a challenge. Here, the authors design a heterogeneous structure in a Co-Cr-Ni alloy that results in ultrahigh strength and significant uniform elongation.

P3618Underweight predicts greater risk of cardiac mortality post acute myocardial infarction

Background

Increased body mass index (BMI) is a well-established risk factor for cardiovascular disease, however, patients with elevated BMI comparing to low BMI seem to have better survival, a phenomenon reported as “obesity paradox” which remains as a controversy. We investigated the effect of BMI, including underweight, normoweight, overweight and obese, on cardiac mortality post acute myocardial infarction (AMI).

Methods

This analysis included 3562 AMI patients with documented BMI. The baseline characteristics including clinical and laboratory parameters were collected at hospital admission for AMI. Patients were classified into 4 groups based on BMI values: underweight (BMI <18.5), normoweight (BMI 18.5 to 24.9), overweight (BMI 25 to 29.9) and obese (BMI ≥30). Patients were followed up for a median of 1.9 years. The rate of cardiac death (primary endpoint) was compared among the 4 BMI groups. Cox proportional hazard models were used to adjust for potential confounders.

Results

Of 3562, 110 (3%) were underweight, 1579 (44%) were normoweight, 1493 (42%) were overweight, and 380 (11%) were obese. Compared to the normoweight group, subjects in overweight and obese groups were younger, more men, more hypertension, more likely to receive percutaneous coronary intervention (PCI), and had higher levels of glucose and lipids, but, lower level of N-terminal pro-brain natriuretic peptide (NTproBNP). Subjects in underweight group were older, more women, fewer diabetes, less likely to receive PCI, lower levels of glucose and lipids, but, higher level of NTproBNP and higher rates of left ventricular ejection fraction (LVEF)<50%. Cardiac death over 1.9 years occurred significantly more in the underweight group (30.0%, 10.6%, 7.0% and 5.0% among the 4 groups from underweight to obese, p<0.001 for trend, Figure 1). The Cox proportional hazard model revealed that underweight was an independent predictor of subsequent cardiac death (OR=2.58, 95% CI: 1.52–4.39, p<0.001). Multivariate analysis identified that older age, higher levels of cardiac troponin I (cTnI) and LVEF<50% were independently associated with increased risk of cardiac death. PCI significantly and independently protected AMI patients against cardiac death (OR=0.34, 95% CI: 0.23–0.49, p<0.001).

Conclusions

Patients who were underweight were at greater risk of cardiac death post AMI. In addition, older age, higher levels of cTnI, LVEF<50%, and not receiving PCI also independently predicted cardiac mortality post AMI.

Acknowledgement/Funding

Beijing Natural Science Foundation (No. 7194253);Scientific Research Common Program of Beijing Municipal Commission of Education (KM201910025017)

[Diagnostic value of endobronchial ultrasonography with guide-sheath combined with virtual bronchoscopy navigation in peripheral lung cancer]

Objective: To explore the diagnostic value and safety of endobronchial ultrasonography with guide-sheath (EBUS-GS) combined with virtual bronchoscopy navigation (VBN) in peripheral lung cancer. Methods: Between Dec. 2015 to Dec. 2016, patients with pulmonary solitary nodule suspected of early lung cancer on computed tomography (CT) in Department of Respiratory, Tangdu Hospital, Fourth Military Medical University were enrolled for this study. The patients underwent EBUS-GS transbronchoscopic lung biopsy (TBLB) with or without VBN. The visibility rate, diagnostic yield, influencing factors, the operation time and complications were evaluated in the 2 groups. The data were compared using independent sample t test or chi-squared test. Results: A total of 134 patients were enrolled and completed this study. Among them 74 were males and 60 were females. There were 64 cases in the group of EBUS-GS with VBN (VBNA), and 70 in the group without VBN (NVBNA). The visibility rate and diagnosis rate of VBNA group were 87.5% (56/64) and 78.1% (50/64), respectively. The mean time of operation and confirming the target lesions were (25±5), (5.8±1.3) min, respectively. The visibility rate and diagnosis rate of NVBNA group were 81.4%(57/70) and 75.7%(53/70), respectively. The mean time of operation and confirming the target lesions were (27±6), (9.8±1.5)min .There was no significant difference in the visibility rate and diagnosis rate between the 2 groups (χ(2)=0.933, P=0.334; χ(2)=0.109, P=0.838). There was no significant difference in the mean operation time between the 2 groups(t=0.633, P=0.524). But the time of confirming the target lesions between the 2 groups was statistically different (t=17.41, P<0.01). EBUS-GS-TBLB was well tolerated. No severe complications such as pneumothorax or chest pain were observed. There were 3 patients in the VBNA group and 7 patients in the NVBNA group experiencing a small amount of biopsy site bleeding. The incidence of complications did not differ between the 2 groups(χ(2)=1.366, P=0.330). Conclusions: VBN could not improve the diagnostic yield of EBUS-GS. However, it could shorten the time needed to confirm the target lesions and did not increase the incidence of EBUS-GS complications, indicating that EBUS-GS with VBN was a safe and effective method.

SPHK2 protein expression, Ki-67 index and infiltration of tumor-associated macrophages (TAMs) in human glioma

INTRODUCTION

Sphingosine kinases (SPHKs), the Ki-67 index and tumor-associated macrophages (TAMs) are associated with diverse human malignancies, including glioma. SPHK2, a subtype of SPHKs, has not been assessed in glioma or correlated with the Ki-67 index or TAM infiltration. We tested the hypothesis that expression of SPHK2 correlates with the Ki-67 index and TAM infiltration in patients with glioma.

MATERIALS AND METHOD

Western blot analysis was performed on protein lysates prepared from human astrocyte (HA) and glioma cell lines. Immunofluorescence was used to determine the subcellular location of SPHK2 protein in glioma cells. Next, immunohistochemistry was employed to analyze the correlations among SPHK2, Ki-67, CD68, and CD206 in 11 non-neoplastic brain tissues and 60 glioma tissues. All slides were evaluated under ×400 magnification, and the ratio of positively stained cells to the total number of cells was calculated for analysis.

RESULTS

SPHK2, CD68 and CD206 were all increased in glioma tissues compared to non-neoplastic brain tissues, but there were no differences between WHO grades of glioma. Ki-67 was highest in WHO grade IV tumors and lowest in non-neoplastic brain tissues, and all between-group differences were statistically significant. Moreover, SPHK2 expression was positively correlated with the Ki-67, CD68 and CD206 indexes. Finally, the CD68 and CD206 indexes were both associated with the Ki-67 index.

CONCLUSION

SPHK2 protein expression, the Ki-67 index and TAM infiltration in human glioma tissue were reported in this study for the first time. SPHK2 was positively associated with TAM infiltration and glioma proliferation. Mechanistically, SPHK2 may promote glioma growth by stimulating TAMs to polarize M2-type macrophages.

[Effects of Na(+) /H(+) exchanger 1 inhibitor on intestinal injury of rats with burn sepsis and the mechanism]

Objective: To observe the effects of Na(+) /H(+) exchanger 1 (NHE1) inhibitor on intestinal injury of rats with burn sepsis, and to explore the possible mechanism preliminarily. Methods: Ninety SD rats were divided into control group, pure sepsis group, and NHE1 inhibitor group according to the random number table, with 30 rats in each group. Full-thickness scald (hereinafter referred to as burn) model with 20% total body surface area were reproduced on the back of rats in pure sepsis and NHE1 inhibitor groups, and then 50 μL liquid of Pseudomonas aeruginosa ATCC 27853 (2×10(5) colony forming unit/mL) were injected into the center of wounds on the back. Rats in NHE1 inhibitor group were intraperitoneally injected with 0.1 mmol/L NHE1 inhibitor cariporide (0.4 mg/kg) rapidly after the successful establishment of burn sepsis model, while rats in pure sepsis group were injected with the same volume of normal saline. Except for not being made burn wounds nor receiving bacterination, rats in control group were treated the same as those in pure sepsis group. Rats with burn sepsis in each group were laparotomized and injected with 200 mL fluorescein isothiocyanate (FITC)-dextran in the concentration of 0.1 mol/L in terminal ileum at 12 hours post injury, and their left ventricular blood and terminal ileum were collected 30 minutes later. The serum content of FITC-dextran was detected with fluorescence spectrophotometer (n=10); the morphology of intestinal tissue was observed with HE staining (n=10); the content of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in serum and intestinal tissue was determined with enzyme-linked immunosorbent assay (n=20); the activity of myeloperoxidase (MPO) in serum and intestinal tissue was detected with colorimetric method (n=20); the protein expression of nuclear factor-kappa B-p65 (NF-κB-p65) and phosphorylation levels of mitogen-activated protein kinase (MAPK) signal pathway related proteins p38MAPK, extracellular signal-regulated kinase 1/2 (ERK1/2), and c-Jun N-terminal kinase 1/2 (JNK1/2) were determined by Western blotting (n=4). The same samples of rats in control group were collected for related detection at the same time point as above. Data were processed with one-way analysis of variance and SNK test. Results: (1) The serum content of FITC-dextran of rats in pure sepsis group was significantly higher than that in control group (P<0.01), while the serum content of FITC-dextran of rats in NHE1 inhibitor group was significantly lower than that in pure sepsis group (P<0.01). Compared with that in control group, infiltration of a large number of inflammatory cells, ulcer and necrosis of intestinal mucosa of rats in pure sepsis group were observed. The injury condition of intestine of rats in NHE1 inhibitor group was better than that in pure sepsis group. (2) The serum content of IL-6, TNF-α, and MPO of rats in pure sepsis group was (387±42) and (164.7±10.1) ng/mL, and (7.5±1.5) U/mL, respectively, significantly higher than that in control group [(75±17) and (13.1±6.5) ng/mL, and (2.3±0.7) U/mL, respectively, with P values below 0.01]. The serum content of IL-6, TNF-α, and MPO of rats in NHE1 inhibitor group was (176±37) and (64.9±9.3) ng/mL, and (5.9±0.8) U/mL, respectively, which was significantly lower than that in pure sepsis group (with P values below 0.01). (3) The content of IL-6, TNF-α, and MPO in intestinal tissue of rats in pure sepsis group was (190±13) and (172.8±29.7) ng/mL, and (8.7±1.5) U/mL, respectively, significantly higher than that in control group [respectively (20±3) and (11.9±2.3) ng/mL, and (2.9±0.3) U/mL, with P values below 0.01]. The content of IL-6, TNF-α, and MPO of intestinal tissue of rats in NHE1 inhibitor group was (35±6) and (45.2±6.1) ng/mL, and (5.3±0.6) U/mL, respectively, significantly lower than that in pure sepsis group (with P values below 0.01). (4) The protein expression of NF-κB-p65 and phosphorylation levels of p38MAPK and ERK1/2 in intestinal tissue of rats in pure sepsis group were significantly higher than those in control group (with P values below 0.01); the protein expression of NF-κB-p65 and the phosphorylation level of p38MAPK in intestinal tissue of rats in NHE1 inhibitor group were significantly lower than those in pure sepsis group (with P values below 0.01); phosphorylation levels of JNK1/2 in intestinal tissue of rats in the three groups were similar (with P values above 0.05). Conclusions: The inhibition of NHE1 can significantly alleviate the intestinal injury, and the mechanisms may be attributed to the regulation of NF-κB and p38MAPK signal pathway, resulting in inhibition of the inflammatory response of intestinal tract.

[Study on age and white matter neuronal integrity in healthy volunteers based on automating fiber-tract quantification]

Objective: To analyze age-related change in cerebral matter tract, especially fractional anisotropy, based on automating fiber-tract quantification(AFQ). Methods: A total of 64 years old normal persons and 43 young volunteers were enrolled respectively from the Affiliated Drum Tower Hospital of Nanjing University Medical School and community from January 2015 to June 2016.All of them underwent MRI scan, which included DTI and 3D T(1)WI sequence .All cases were divided into 3 groups according to their ages, the young group 20-35 years old, the middle old group 60-75 years old, the old group 76-90 years old.AFQ was used to identify 20 major white matter tracts in brains of all subjects and make measurements at anatomically equivalent locations along their trajectories. Results: The FA change trend of each fiber was similar among three groups. The old and the middle old group had different FA value in both sides of inferior fronto-occipital fasciculus(left t=-2.73, right t=-6.12, P<0.05), thalamic radiation(left t=-4.79, right t=-19.61, P<0.05), arcuate(left t=10.53, right t=-2.72, P<0.05), callosum forceps(genu t=-2.66, splenium t=28.64, P<0.05), cingulum(left t=-4.53, right t=-2.22, P<0.05)and right corticospinal tract(t=3.10, P<0.05), among which each location of callosum forceps minor was different between the old group and the young group, and this area decreased in the middle group. The old group had different FA value in both sides of uncinate fasciculus(left t=-4.52, right t=-4.53, P<0.05), left corticospinal tract(t=-2.19, P<0.05)and right inferior longitudinal fasciculus(t=11.12, P<0.05). Compared to the young group, there was no statistical difference in the FA of both superior longitudinal fasciculus and left inferior longitudinal fasciculus in the old and the middle old group. Conclusion: AFQ has an impact on the further specific study of the age-related white matter tract.

[Change of white matter neuronal integrity associated with spatial navigation impairment in mild cognitive impairment]

Objective: To analyze the correlation between white matter integrity and spatial navigation impairment in patients with mild cognitive impairment (MCI). Methods: A total of 27 MCI subjects and 24 healthy controls were enrolled from the Affiliated Drum Tower Hospital of Nanjing University Medical School from May 2015 to February 2016, who underwent 3.0 T MRI scan and 2D-computer version spatial navigation test.DTI preprocessing and tract-based spatial statistics (TBSS) were performed by PANDA.Two sample t-test and partial correlation coefficients were performed to investigate the correlation of white matter impairments and spatial navigation decline. Results: Relative to controls, MCI showed worse egocentric navigation (t=-2.202, P<0.05). Decreased FA in superior longitudinal fasciculus (left t=2.95, right t=2.95, P<0.05), inferior longitudinal fasciculus and inferior fronto-occipital fasciculus (left t=2.66, right t=2.96, P<0.05), corpus callosum (t=2.09, P<0.05), cingulum (left t=2.76, right t=2.41, P<0.05), fornix (t=4.83, P<0.05), and corticospinal tract (left t=2.33, right t=2.26, P<0.05), were found in the MCI subjects.The decreased FA value of superior longitudinal fasciculus (left r=-0.354, right r=-0.347, P<0.05), inferior longitudinal fasciculus (left r=-0.338, right r=-0.336, P<0.05), cingulum (left r=-0.395, right r=-0.370, P<0.05), right corticospinal tract (r=-0.362, P<0.05) and fornix (r=-0.369, P<0.05) were correlated with increased ego average total error.Allo average total error were negative correlated with FA value of superior longitudinal fasciculus (left r=-0.329, right r=-0.350, P<0.05), inferior longitudinal fasciculus (left r=-0.349, right r=-0.378, P<0.05), splenium of corpus callosum (r=-0.364, P<0.05) and cingulum (left r=-0.340, right r=-0.406, P<0.05). Conclusion: This study implicated the potential white matter structural basis of spatial navigation impairment and will have an impact on the further study of the neurobiological mechanisms of human spatial navigation ability.

[Differentially expression p21 and p53 in laryngeal squamous cell carcinoma]

AbstractObjective:To investigate the role of the methylation of p21 and p53 gene in laryngeal cancer and laryngeal cancer cell line Hep-2.Method: Methylation of p21 and p53 gene were detected by methylation specific PCR(MSP) in 46 cases with paired cancer tissues and adjacent tissues. Hep-2 cell line was treated with 5-azacytidine at different time points, and Hep-2 cell growth was detected using the MTT assay. Hep-2 cell line was treated with 5-azacytidine at different time points, and then apoptosis was detected by the TUNEL assay. The expression difference of p21 mRNA was detected by RT-PCR method before and after intervention. p21 promoter CpG island methylation status was tested by MSP before and after intervention.Result: The incidence was 45.7% of p21 gene promoter CpG island methylation in 46 cases of laryngeal cancer, while methylation rate in adjacent tissues was 10.9%. There were significant differences between cancer tissues and adjacent tissues(P<0.05).The incidence was 6.5% of p53 gene promoter CpG island methylation in 46 cases of laryngeal cancer, while methylation rate was 4.3% in adjacent tissues,no significant difference of p53 gene methylation was found in laryngeal cancer and counterparts adjacent tissues(P>0.05). The effect of Hep-2 proliferation inhibition interfered by 5-azacytidine was gradually increased over time in a time-dependent manner. Meanwhile, interfered by 5-azacytidine increased the apoptosis in a time-dependent manner. After interference by 5-azacytidine, p21 gene is activated. The expression of p21 mRNA was significantly higher. The p21 gene methylation degree in laryngeal cancer cell line Hep-2 was 43.13%±0.79%. After 5-azacytidine intervention, the degree of methylation was obviously decreased and even showed unmethylation.Conclusion:There was p21 gene promoter CpG island hypermethylation in laryngeal cancer and laryngeal cancer cell line Hep-2, which was a molecular event distinguished laryngeal cancer from normal laryngeal tissue. There was p53 gene promoter CpG island hypomethylation in laryngeal cancer and laryngeal cancer cell line Hep-2.Inactivation of the gene may occur by gene mutation forms and others. Demethylation of drug 5-azacytidine can induce p21 gene promoter CpG island demethylation modification, change the regulation of tumor cell cycle genes in cells and promote tumor cell apoptosis.

Effects of short-term sitagliptin treatment on immune parameters in healthy individuals, a randomized placebo-controlled study

Sitagliptin, a dipeptidyl-peptidase 4 (DPP-4) inhibitor, improves blood glucose control in patients with type 2 diabetes by blocking cleavage of glucagon-like peptide 1 (GLP-1). In type 2 diabetes patients sitagliptin use is associated with an increase in minor infections, and in new-onset type 1 diabetes patients the ability of sitagliptin to dampen autoimmunity is currently being tested. DPP-4, also known as CD26, is expressed on leucocytes and can inactivate many chemokines important for leucocyte migration, as well as act as a co-stimulatory molecule on T cells. Therefore, this study was conducted to test whether sitagliptin is immunomodulatory. In this randomized, placebo-controlled trial, healthy volunteers were given sitagliptin or placebo daily for 28 days, and blood was drawn for immune assays. No significant differences were observed in the percentage of leucocyte subsets within peripheral blood mononuclear cells (PBMCs), plasma chemokine/cytokine levels or cytokines released by stimulation of PBMCs with either lipopolysaccharide (LPS) or anti-CD3. Individuals taking sitagliptin displayed increases in the percentage of cells expressing higher levels of CD26 at early time-points compared to placebo controls, but these differences resolved by day 28 of treatment. Therefore, in healthy volunteers, treatment with sitagliptin daily for 28 days does not overtly alter systemic immune function.

Expression and characterization of a recombinant Cry1Ac crystal protein fused with an insect-specific neurotoxin ω-ACTX-Hv1a in Bacillus thuringiensis

In order to assess possible enhancement of biopesticide activity, the fusion gene of crystal protein gene cry1Ac with the insect-specific neurotoxin ω-ACTX-Hv1a gene and egfp was expressed in Bacillus thuringiensis acrystalliferous strain Cry-B under the control of the native gene expression system. The fusion recombinant Cry-B(1Ac-ACTX-EGFP) generally produced two or three small crystal-like inclusion bodies in each cell and the GFP signal could be clearly observed. A 166 kDa full-length fusion protein was identified by immunoblot analysis. Virulence of the fusion inclusions was at least fivefold higher toward larvae of Spodoptera exigua. These results demonstrated that a foreign protein could be expressed and accumulate as parasporal inclusions in B. thuringiensis by C-terminal fusion with the native endotoxin while retaining partial insecticidal activity.

Clinical Significance of CDH13 Promoter Methylation in Serum Samples from Patients with Bladder Transitional Cell Carcinoma

H-cadherin (CDH13; also known as T-cadherin), which functions as a tumour suppressor, is frequently silenced by promoter methylation in human cancers including bladder transitional cell carcinoma (TCC). This study investigated the clinical significance of methylation of the CDH13 gene promoter in serum from patients with bladder TCC. Methylation status of CDH13 in serum samples from 127 patients with primary bladder TCC and 41 healthy volunteers (controls) was examined by methylation-specific polymerase chain reaction. CDH13 methylation was found in 39 patients with bladder TCC (30.7%) but in no controls. CDH13 methylation was significantly associated with advanced tumour stage, high-grade tumour, large tumour size, tumour recurrence and poor prognosis. The results suggested that CDH13 methylation in serum may be a potential predictive biomarker for malignancy in bladder TCC, and an independent pre-therapeutic predictor of outcome. Demonstration of CDH13 methylation in serum may facilitate in the prediction of which patients require more aggressive additional post-operative systemic therapy.

Relationship between psychosocial factors and onset of multiple sclerosis

OBJECTIVE

The aim of this study was to investigate the influence of psychosocial variables on patients with multiple sclerosis (MS) and the relationship between these variables and the onset of MS.

BACKGROUND

The current evidence indicates that many types of psychosocial factors are involved in the development and relapse of MS, and it has been suggested that they could serve as predictors as well. So far, little has been reported on the effect of psychosocial factors on MS and the relationship between psychosocial factors and the onset of MS.

METHODS

Forty-one patients, 15 males and 26 females, average age 37.44 +/- 12.24 years (mean +/- SD), were evaluated by the Life Event Scale, Eysenck Personality Questionnaire, Social Support Revaluate Scale and Symptom Check List 90 and compared with 41 equivalent healthy control subjects, 15 males and 26 females, average age 36.38 +/- 12.84 years (mean +/- SD). Disease, demographic, psychosocial and lifestyle factors were measured at baseline. Patients with MS were first diagnosed by 3 neurologists according to the Poser (1983) MS diagnostic criteria.

RESULTS

Significant differences were found between the MS and the control group in their negative emotions and symptoms such as depression, anxiety, obsession, phobia, tense interpersonal relationship and somatization disorder. Significant differences were found between the two groups in the total number of negative life events, their family problems and the utilization of social support. The scores for various negative emotions in the MS group correlated positively with those for neuroticisms in personality type, and negatively with those for introverted and extroverted personality. Many kinds of negative emotions in the MS group correlated positively with the total number of life events, negative life events and family problems. Many kinds of negative emotions in the MS group correlated negatively with the utilization of social support.

CONCLUSION

The psychosocial factors are closely associated with MS onset and may play important roles in the development of the disease.

A study of the purine derivative AIT-082 in G93A SOD1 transgenic mice

AIT-082 is a purine derivative with neuroprotective and neurotrophic activity that is desirable in a candidate therapy for Amyotrophic Lateral Sclerosis. Consequently, we investigated the effect of AIT-082 in a transgenic mouse model of ALS. AIT-082 (0, 1, 3, 10, 30, 60, 100 mg/kg) was given to TgN(SOD1-G93A)1Gur transgenic mice from age 30 days until death. The age at onset of clinical signs of disease and the age at death were recorded for each animal. Disease progression was measured by the weekly average distance run in a running wheel. Analysis was made by the Kaplan Meier method with log rank statistics, log rank for trend and Cox regression. Neuropathological study of the brain, spinal cord, muscles and other organs was undertaken at death. In a second experiment we studied the effect of AIT-082 (30 mg/kg) at the onset of disease and during survival of transgenic G93A SOD1 mice, beginning dosing at different ages (20, 30, 40, 60, 80 days). Disease onset was mildly earlier (i.e. worse) at 1 and 10 mg/kg AIT-082 and mildly delayed at 30 mg/kg. This improvement did not reach the usual statistical significance. There was no difference in the age at death for any treatment dose. There was no difference in the neuropathology of treated and untreated G93A mice. However, there was an early improvement in the running wheel function at all tested doses. Using Cox regression, after adjustment for sex, the mice in the running wheels had slightly delayed onset of disease without change in survival and, after adjustment for exercise, the female mice had slightly improved survival. Consequently, AIT-082 would not be an attractive candidate for ALS clinical trials as monotherapy and justification for its use in combination therapy would require additional laboratory support. There was dissociation between the endpoints of disease progression (as judged by running wheel performance) and disease onset and survival. AIT-082 improved early running wheel performance yet led to accelerated late decline and had no impact on survival. It is possible that the drug facilitates early sprouting that leads to accelerated late decline.

Imaging matrix metalloproteinase expression in tumors

metastatic Matrix metalloproteinases (MMPs) are zinc-dependent secreted or transmembrane enzymes constituting a family of over 21 proteolytic members that are capable of selectively digesting a wide spectrum of both extracellular matrix (ECM) and nonmatrix proteins. MMPs play a critical role in tumor growth, angiogenesis, and metastatic processes. MMP inhibitors (MMPIs) have been extensively investigated as anti-tumor drugs, although the clinical trials thus far have been disappointing. In order to better understand the role of MMPs in cancer growth and metastasis, as well as improve the therapeutic efficacy of MMPIs, there is a need to develop new procedures to assess and/or monitor MMP activity in vivo. In addition to determining whether MMPs are present in tumors, it would be desirable to have an imaging agent that better probes other processes associated with MMP overproduction, including angiogenesis and the establishment of the growth of metastatic lesions in distant organ sites. In this paper we review the studies relating to the recent development of in vivo imaging of MMP expression. One of the purposes of this review is to discuss the current status of imaging MMP expression, which includes the types of tracers being developed and the types of imaging modalities available. Although imaging MMP expression is a relatively new area of research, the progress thus far is highly promising.

[Study on the improvement of process technology of L(+)-tartaric acid fermentation]

This work proposes an improved process technology of L(+)-tartaric acid produced by using cis-epoxysuccinates as the substrate for fermentation. The key to the question is to apply dipotassium cis-epoxysuccinate as the substrate instead of disodium cis-epoxysuccinate. As compared with the original process technology, the improved one has prominent advantages: 1. High yield of acid, increased by 20%-30% over the old one; 2. High rate of recovery, from about 60% to 80%; 3. One of the raw materials is cheaper, the KOH is expensive than NaOH, but half of the K kions could be used cyclically, and the varied products could be obtained easily; 4. The tough working procedure of filtration of fermented liquor could be evaded, the total working procedures might increase to some extent, but the cost of production will be reduced obviously, it is advantageous to industrial production.

Cell-specific targeting of caveolin-1 to caveolae, secretory vesicles, cytoplasm or mitochondria

In commonly used tissue culture cells, caveolin-1 is embedded in caveolae membranes. It appears to reach this location after being cotranslationally inserted into ER membranes, processed in the Golgi and shipped to the cell surface. We now report that caveolae are not the preferred location for caveolin-1 in all cell types. Skeletal muscle cells and keratinocytes target caveolin-1 to the cytosol while in exocrine and endocrine cells it accumulates in the secretory pathway. We also found that airway epithelial cells accumulate caveolin-1 in modified mitochondria. The cytosolic and the secreted forms appear to be incorporated into a soluble, lipid complex. We conclude that caveolin-1 can be targeted to a variety of intracellular destinations, which suggests a novel mechanism for the intracellular traffic of this protein.

Development of an in vitro model for assessing the in vivo stability of lanthanide chelates

An in vitro model was developed to evaluate the in vivo stability of lanthanide polyaminocarboxylate complexes. The ligand-to-metal ratios for the chelates EDTA, CDTA, DTPA, MA-DTPA (monoamide-DTPA) and DOTA with the lanthanides lanthanum, samarium, and lutetium were optimized to achieve > or = 98% complexation yield for the resultant radiolanthanide complexes. The exchange of the radiolanthanides from their EDTA, CDTA, DTPA, MA-DTPA and DOTA complexes with Ca(2+) was determined by in vitro adsorption and in vitro column studies using hydroxyapatite (HA), an in vitro bone model. In vitro serum stability of these radiolanthanide complexes was used as an additional indicator of in vivo stability, although the mechanism of instability in serum will be different than with bone. The in vitro studies were consistent with the expected findings that the smallest lanthanide (Lu) formed the most stable complexes. In vivo studies were done to validate the in vitro model. Biodistribution studies in normal CF-1 mice showed that in vivo stability of the complex (i.e., the more lanthanide remaining in complex form) could be assessed by a combination of the urinary, bone and liver uptake. For example, biodistribution studies demonstrate that high urinary excretion correlated with complex stability, while high liver plus bone uptake correlated with complex instability. The urinary excretion of the EDTA complexes decreased from (177)Lu to (140)La indicating a loss in stability in the direction of (140)La, consistent with the in vitro studies. The more stable a lanthanide complex is, the lower its exchange with HA in vitro will be, and the lower its combined bone plus liver uptake and higher its urinary excretion will be in vivo. This investigation indicates that the in vivo stability can be determined by a screening method that measures the degree of exchange from the lanthanide chelate with hydroxyapatite (HA) and its serum stability.

Determination of the critical pressure drop for filtration of super-compactible cakes

In accord with Darcy's law, the flow rate through a porous bed depends upon the pressure drop deltap(c). In general, increasing deltap(c) leads to increased values of flow rate and average percentage solids in filtration operations. When cakes become super-compactible, their behavior undergoes an unexpected change in which both the flow rate and the percentage solids reach maximum values and thereafter are unaffected by increasing deltap(c). The critical pressure drop deltap(c)R is defined as that value at which the flow rate reaches 90% of its ultimate value. When deltap(c) is greater than deltap(c)R and is doubled or tripled, the cake resistance approximately doubles or triples leaving the rate virtually unchanged. The super-compactibility problem is analyzed theoretically, and is verified by stepped pressure filtration experiments on different materials from Houston and Korea.

Oxygen tension limits nitric oxide synthesis by activated macrophages

Previous studies have established that constitutive calcium-dependent ('low-output') nitric oxide synthase (NOS) is regulated by oxygen tension. We have investigated the role of oxygen tension in the synthesis of NO by the 'high-output' calcium-independent NOS in activated macrophages. Hypoxia increased macrophage NOS gene expression in the presence of one additional activator, such as lipopolysaccharide or interferon-gamma, but not in the presence of both. Hypoxia markedly reduced the synthesis of NO by activated macrophages (as measured by accumulation of nitrite and citrulline), such that, at 1% oxygen tension, NO accumulation was reduced by 80-90%. The apparent K(m) for oxygen calculated from cells exposed to a range of oxygen tensions was found to be 10.8%, or 137 microM, O(2) This value is considerably higher than the oxygen tension in tissues, and is virtually identical to that reported recently for purified recombinant macrophage NOS. The decrease in NO synthesis did not appear to be due to diminished arginine or cofactor availability, since arginine transport and NO synthesis during recovery in normoxia were normal. Analysis of NO synthesis during hypoxia as a function of extracellular arginine indicated that an altered V(max), but not K(m)(Arg), accounted for the observed decrease in NO synthesis. We conclude that oxygen tension regulates the synthesis of NO in macrophages by a mechanism similar to that described previously for the calcium-dependent low-output NOS. Our data suggest that oxygen tension may be an important physiological regulator of macrophage NO synthesis in vivo.

Transport-dependent proteolysis of SREBP: relocation of site-1 protease from Golgi to ER obviates the need for SREBP transport to Golgi

Cholesterol homeostasis in animal cells is achieved by regulated cleavage of membrane-bound transcription factors, designated SREBPs. Proteolytic release of the active domains of SREBPs from membranes requires a sterol-sensing protein, SCAP, which forms a complex with SREBPs. In sterol-depleted cells, SCAP escorts SREBPs from ER to Golgi, where SREBPs are cleaved by Site-1 protease (S1P). Sterols block this transport and abolish cleavage. Relocating active S1P from Golgi to ER by treating cells with brefeldin A or by fusing the ER retention signal KDEL to S1P obviates the SCAP requirement and renders cleavage insensitive to sterols. Transport-dependent proteolysis may be a common mechanism to regulate the processing of membrane proteins.

Experience of urgent reconstruction of electrical injuries

Although there have been great advances in the treatment of electrical injuries in the last 20 years, the extremity loss ratio in electrical injuries remains at an unacceptably high level. The primary reason for this is the progressive tissue necrosis and enlargement of the necrosis in the wound. The goal in this study is to examine possible ways to break the necrotic malignancy circle and save the form and function of damaged extremities. As a result of systematic experimental and clinical research, a comprehensive urgent reconstruction alternative for electrical injuries has been proposed. The alternative includes the following principles: debriding the wound as early as possible after injury; preserving as much as possible the vital tissue structures, such as nerve, vessels, joints, tendons, and bone, even when they have undergone devitalization or local necrosis; transplanting these vital tissues during the first surgery if the functional reconstruction requires; nourishing the wound bed by covering with tissue flaps that have rich blood supply; improving flap survival by continuous irrigations with a compound medicine beneath the flaps for a 24- to 72-hour period after surgery; providing general treatment with vasoactive agents and antibiotics. This paper summarizes our experience of using this method in the treatment of 105 electrical injury patients (a total of 309 wounds) in the time period from 1 January 1986 to 31 December 1996. Satisfying results were obtained, with the extremity loss ratio decreasing to 7% as compared to 41.5% during the 10 years preceding 1984 at the same hospital. Thus, the urgent comprehensive reconstruction alternative presented here is an effective and workable method to manage electrical injuries.

Identification of caveolin-1 in lipoprotein particles secreted by exocrine cells

Caveolin-1 is a protein component (of relative molecular mass 22, 000) of the striated coat that decorates the cytoplasmic surface of caveolae membranes. Previous biochemical and molecular tests have indicated that caveolin-1 is an integral membrane protein that is co-translationally inserted into endoplasmic-reticulum membranes of fibroblast and epithelial cells such that its carboxy- and amino-terminal ends are in the cytoplasm. Here we identify caveolin-1 in the secretory pathway of exocrine cells. Secretion of caveolin-1 from pancreatic acinar cells and a transfected exocrine cell line, but not from Chinese hamster ovary cells, is stimulated by the secretagogues secretin, cholecystokinin and dexamethasone. The secreted caveolin-1 co-fractionates with apolipoproteins, indicating that it may be secreted in a complex with lipids.

Deprivation of endogenous brain-derived neurotrophic factor results in impairment of spatial learning and memory in adult rats

Brain-derived neurotrophic factor (BDNF) is abundantly expressed in the hippocampus and cerebral cortex and is involved in synaptic plasticity and long-term potentiation (LTP). The present study was under taken to investigate whether endogenous BDNF was required for spatial learning and memory in a rat model. Antibodies to BDNF (anti-BDNF, n=7) or control immunoglobulin G (control, n=6) were delivered into the rat brain continuously for 7 days with an osmotic pump. The rats were then subjected to a battery of behavioral tests. The results show that the average escape latencies in the BDNF antibody treated group were dramatically longer than those of the control (F=13.3, p<0.001). The rats treated with control IgG swam for a significantly longer distance in the P quadrant (where the escape plane had been placed) compared with the other three quadrants (p<0.05). In contrast, anti-BDNF-treated rats swam an equivalent distance in all four quadrants. The average percentage of swimming distance in the P quadrant by anti-BDNF-treated rats was much less than that by control IgG treated rats (p<0.001). These results suggest that endogenous BDNF is required for spatial learning and memory in adult rats.

Nitric oxide synthase neurons in different areas of normal aged and Alzheimer's brains

This study investigated the distribution of nitric oxide synthase-containing neurons in the cerebral cortex of individuals with Alzheimer's disease, and compared them with age-matched controls. Paraffin-embedded sections of the frontal (area 10), occipital (area 17) and entorhinal cortices (area 28), and hippocampal formation obtained from 13 autopsy cases were used in the study. Neurons expressing nitric oxide synthase messenger RNA and protein were identified, respectively, by in situ hybridization and immunohistochemistry. Optical densities of nitric oxide synthase-positive neurons were assessed in 50 randomly selected fields of each of the above regions of the cortices, in each case by microscopic photometry. In the frontal cortex of the Alzheimer group, while a decrease in the number of nitric oxide synthase-positive neurons was evident, the nitric oxide synthase neurons, on the other hand, showed an increased optical density in layers II-IV when compared with those of normal ageing. In the occipital cortices, no significant differences in optical density were recorded between the normal ageing and Alzheimer specimens. In the entorhinal cortex, the optical densities of nitric oxide synthase neurons were again similar between the Alzheimer and age-matched control groups. In the hippocampar formation itself, there was an increase of nitric oxide synthase staining in the Alzheimer patients. These results show that (i) nitric oxide synthase neurons are abundant in the human cortex, (ii) the distribution of nitric oxide synthase neurons differs between different cortical regions, and (iii) there are differences between normal ageing and Alzheimer patients in the frontal cortex and the hippocampus.

Upregulation of brain-derived neurotrophic factor and neuropeptide Y in the dorsal ascending sensory pathway following sciatic nerve injury in rat

An immunohistochemical study was undertaken to examine the changes of brain-derived neurotrophic factor (BDNF) and neuropeptide Y (NPY) in the nucleus gracilis of rats following sciatic nerve transection. The results showed that BDNF-immunoreactivity (-ir) in the gracile nucleus was significantly increased after the nerve injury. The upregulation was apparent 24 h after nerve lesion, remaining robust up to 56 days postlesion. The increase in BDNF-ir was blocked by hemisection of the spinal cord, or by dorsal rhizotomy ipsilateral to the lesion. NPY-ir changes were similar to those of BDNF-ir, but the onset was delayed by 7 days. No NPY-ir was detected in dorsal root ganglion (DRG) from normal animals. Following sciatic nerve lesion, most of the NPY-immunoreactive neurones were found to be colocalized with BDNF-immunoreactive neurones. Neutralization of endogenous BDNF with its antiserum had no effects on NPY-ir in either the gracile nucleus or DRG. These results indicate that neurones contributing to the dorsal ascending sensory pathway upregulate the expression of both BDNF and NPY in response to sciatic nerve injury.

Neurotransmitters, peptides, and neural cell adhesion molecules in the cortices of normal elderly humans and Alzheimer patients: a comparison

Immunocytochemical techniques was used to compare the proportion of neurons expressing various neurotransmitters (tyrosine hydroxylase, choline acetyltransferase and gamma-aminobutyric acid), neuropeptides (Leu-enkephalin and substance P) and neural cell adhesion molecules (NCAM) in the hippocampus, frontal (area 10) and occipital (area 17) cortices of neurologically normal elderly humans to that of age-matched Alzheimer disease (AD) patients. There was no difference in the proportion of GABAergic and cholinergic cells between the normal and AD groups in all three brain regions studied. However, the catecholaminergic cells in the frontal cortex of the AD patients revealed a significant decrease. The catecholaminergic cells present in the cortex were both neurons and astrocytes, as revealed by a double immunostaining of tyrosine hydroxylase and glial fibrillary acid protein (GFAP). Furthermore, the difference in the proportion of cells expressing Substance P and Leu-enkephalin was minimal between the two groups studied. Although there was little difference in the levels of NCAM in the occipital cortex and hippocampus of the two groups, there were significantly fewer positive NCAM neurons in the frontal cortex of AD than normal aging individuals.

cDNA cloning of mouse and human cholesterol 25-hydroxylases, polytopic membrane proteins that synthesize a potent oxysterol regulator of lipid metabolism

Oxysterols regulate the expression of genes involved in cholesterol and lipid metabolism and serve as intermediates in cholesterol catabolism. Among the most potent of regulatory oxysterols is 25-hydroxycholesterol, whose biosynthetic enzyme has not yet been isolated. Here, we report the cloning of cholesterol 25-hydroxylase cDNAs from the mouse and human. The encoded enzymes are polytopic membrane proteins of 298 and 272 amino acids, respectively, which contain clusters of histidine residues that are essential for catalytic activity. Unlike most other sterol hydroxylases, cholesterol 25-hydroxylase is not a cytochrome P450, but rather it is a member of a small family of enzymes that utilize diiron cofactors to catalyze the hydroxylation of hydrophobic substrates. The cholesterol 25-hydroxylase gene lacks introns, and in the human it is located on chromosome 10q23. The murine gene is expressed at low levels in multiple tissues. Expression of cholesterol 25-hydroxylase in transfected cells reduces the biosynthesis of cholesterol from acetate and suppresses the cleavage of sterol regulatory element binding protein-1 and -2. The data suggest that cholesterol 25-hydroxylase has the capacity to play an important role in regulating lipid metabolism by synthesizing a co-repressor that blocks sterol regulatory element binding protein processing and ultimately leads to inhibition of gene transcription.

Prognostic value of beta1,6-branched oligosaccharides in human colorectal carcinoma

Increase of beta1,6-branched oligosaccharides is possibly associated with tumor progression and lymph node metastasis. The aim of this study was to determine the prognostic value of beta1,6 branches in human colorectal carcinoma. Expression of beta1,6 branches was histochemically evaluated using the leukoagglutinating Phaseolus vulgaris lectin, PHA-L, in 92 clinically documented colorectal carcinomas, of which 31 had formed lymph node metastases. The follow-up time ranged between 4 and 14 years (median, 10.3 years). A PHA-L staining index (SI), taking into account staining intensity and its percentage of tumor cut surface area, was established. The carcinoma SI was highly associated with the disease-free survival (P = 0.004) and overall survival (P = 0.005). Patients with a carcinoma SI of >1, as compared to those with a SI of < or =1, were at significantly higher risk for tumor recurrence, with a shorter disease-free survival (hazard ratio = 2.59, P = 0.005) and significant higher risk of death with shorter overall survival (hazard ratio = 2.51, P = 0.007). The carcinoma SI was also associated with the presence of lymph node metastases. We conclude that PHA-L staining in human colorectal carcinoma sections provides an independent prognostic indicator for tumor recurrence and patient survival and is associated with the presence of lymph node metastases.

PYY-preferring receptor in the dorsal vagal complex and its involvement in PYY stimulation of gastric acid secretion in rats

1. Microinjection of peptide YY (PYY, 7-46 pmol) into the dorsal vagal complex (DVC) stimulated gastric acid secretion in urethane-anaesthetized rats. Using a variety of neuropeptide Y (NPY) and PYY derivatives, we characterized the pharmacological profile of the receptor mediating the acid secretory response to PYY. 2. [Pro34]rat(r)/porcine(p)PYY and [Pro34]human(h)PYY (23-117 pmol), microinjected unilaterally into the DVC resulted in a similar maximal increase in net acid secretion reaching 68+/-11 and 89+/-31 micromol 90 min(-1) respectively. 3. Rat/hNPY and pNPY (47 pmol) microinjected into the DVC induced a similar net gastric acid secretion (27+/-8 and 23+/-8 micromol 90 min(-1) respectively) and a higher dose (116 pmol) tended to reduce the response. 4. Pancreatic polypeptide (PP, 4-46 pmol), [Leu31,Pro34]r/hNPY (47 and 117 pmol) and the Y2 selective agonists, hPYY3-36, pNPY5-36 and PNPY13-36 (25-168 pmol) microinjected into the DVC failed to influence basal gastric acid secretion. 5. The rank order of potency of PYY > or = [Pro34]r/pPYY = [Pro34]hPYY> r/hNPY = pNPY to stimulate gastric acid secretion upon injection into the DVC and the ineffectiveness of PP, [Leu31,Pro34]NPY and C-terminal NPY/PYY fragments suggest that a PYY-preferring receptor subtype may be involved in mediating the stimulating effect.

Lectin-Gold Histochemistry on Paraffin and Lowicryl K4M Sections Using Biotin and Digoxigenin-Conjugated Lectins

A variety of staining reactions for the visualization of cellular and extracellular glycoconjugates at the light microscopic level are available that are based on the detection of carboxyl and sulfate groups or periodic acid reactive configurations (1,2). Starting in the late 1960s lectins have replaced many of these chemical staining reactions because of their high specificity for defined monoand oligosaccharidic sequences in both N- and o-glycosidic-linked oligosaccharide side-chains of glycoproteins and glycolipids. In order to be useful as histochemical reagents, lectins must be tagged with appropriate markers and those employed in immunocytochemistry have been used successfully (3-9) Horisberger and coworkers were the first to prepare lectins labeled with particles of colloidal gold and used them in scanning electron mrcroscopy (10) Subsequently, gold-labeled lectins were applied in transmission electron microscopy to study various aspects of cell surface expression and internalization of lectin-binding sites (5,8,11,12), as well as in postembedding labeling of Lowicryl K4M thin sections (13). Later, it was shown that gold-labeled lectins can be used to stain sections of paraffin-embedded tissues (14-16), as well as semithin sections of Epon (17) and Lowicryl K4M-embedded tissues (18,19), However, in order to achieve a visible pink staining, which is the natural color of particles of colloidal gold in transmitted visible light (20), highly concentrated lectin-gold complexes had to be used, thereby allowing the possibility of nonspecific staining. A major improvement resulted through the application of a photochemrcal silver reaction for signal amphfication (21-24), whrch permitted the use of lectins for light microscopy in concentrations as applied for electron microscopy (25,26).

Expression of beta 1,6 branched asparagine-linked oligosaccharides in non-mitotic and non-migratory cells of normal human and rat tissues

Malignant transformation of cells leads to the synthesis of large asparagine-linked oligosaccharides that exhibit a higher degree of beta 1,6 branching. In rodent and human tumor cell lines and certain human tumors, increased beta 1,6 branching of oligosaccharides has been shown to be associated with metastasis. In addition, this structural change occurs in glycoproteins of stimulated normal human lymphocytes. The leukoagglutinating Phaseolus vulgaris lectin (L-PHA) has a high affinity for tri- and tetraantennary beta 1,6 branches carrying oligosaccharides and has been widely used for the detection of such structures by histochemistry and blotting. We have analyzed a spectrum of normal human and rat tissues using a sensitive silver-intensified lectin-gold technique. Staining by L-PHA was detected in undifferentiated cells of germinative layers of the gastrointestinal and respiratory tract as well as testis. However, differentiated and non-mitotic epithelia in most organs showed strong lectin staining as well. Notable exceptions were the epithelium of the colon and resting mammary gland, which were unreactive with L-PHA. The histochemical studies were supplemented by lectin blotting, which showed the presence of diverse L-PHA-reactive glycoproteins in rat tissues. Our data may be of importance for the use of L-PHA in studies on human malignant tumors.

Terminal dUTP nick end labeling (TUNEL) positive cells in the different regions of the brain in normal aging and Alzheimer patients

This study investigated terminal dUTP nick-end labeling (TUNEL)-positive cells in the frontal, occipital, and hippocampal cortices of seven normal aging and four Alzheimer's patients. Significant increase in TUNEL-positive cells was observed in the frontal and hippocampal cortices of Alzheimer's patients when compared with controls. In the hippocampal cortex, only area CA4 demonstrated a significant increase of TUNEL-positive cells. Double staining of TUNEL-positive cells for glial fibrillary acidic protein revealed that < 13% of the TUNEL-positive nuclei belonged to astrocytes. The results of this study illustrated a differential pattern of cortical degeneration between normal aging and Alzheimer patients.

Colon carcinoma glycoproteins carrying alpha 2,6-linked sialic acid reactive with Sambucus nigra agglutinin are not constitutively expressed in normal human colon mucosa and are distinct from sialyl-Tn antigen

In human colon carcinoma, increased amounts of sialic acids have been found and correlated with tumor progression. Further, the degree of O-acetylation of sialic acid residues in normal mucosa is higher than in colon carcinoma. Thus, tumor-associated sialylated antigens may be constitutively expressed in O-acetylated form in normal mucosa unreactive with the respective monoclonal antibodies. We have earlier demonstrated a colon carcinoma-associated expression of alpha 2,6-linked sialic acid residues with the Sambucus nigra agglutinin (SNA). We report now that de-acetylation of normal and transitional colonic mucosa, in contrast to sialyl-Tn antigen, does not result in SNA binding. Further, the alpha 2,6-linked sialic acid recognized by SNA is distinct from that of sialyl-Tn antigen. This is confirmed by Northern blotting detecting transcripts for alpha 2,6 sialyltransferase of N-glycoproteins and measurement of activity for this sialyltransferase. Blot analysis by SNA of colon carcinoma cells revealed few reactive glycoproteins. Quantitative differences in lectin labeling and sialyltransferase activity were found in HCT116 colon carcinoma cell sub-lines. Our data suggest that SNA binding in human colon carcinoma is due to de novo expression of a specific sialic acid present on selected glycoproteins.