'Something that helped the whole picture': Experiences of parents offered rapid prenatal exome sequencing in routine clinical care in the English National Health Service

OBJECTIVES

In October 2020, rapid prenatal exome sequencing (pES) was introduced into routine National Health Service (NHS) care in England. This study aimed to explore parent experiences and their information and support needs from the perspective of parents offered pES and of health professionals involved in its delivery.

METHODS

In this qualitative study, semi-structured interviews were conducted with 42 women and 6 male partners and 63 fetal medicine and genetic health professionals. Interviews were transcribed verbatim and analysed using thematic analysis.

RESULTS

Overall views about pES were positive and parents were grateful to be offered the test. Highlighted benefits of pES included the value of the additional information for pregnancy management and planning for future pregnancies. An anxious wait for results was common, often associated with the need to make decisions near to 24 weeks in pregnancy when there are legal restrictions for late termination. Descriptions of dealing with uncertainty were also common, even when results had been returned. Many parents described pES results as informing decision-making around whether or not to terminate pregnancy. Some professionals were concerned that a non-informative result could be overly reassuring and highlighted that careful counselling was needed to ensure parents have a good understanding of what the result means for their pregnancy. Emotional support from professionals was valued; however, some parents felt that post-test support was lacking.

CONCLUSION

Parents and professionals welcomed the introduction of pES. Results inform parents' decision-making around the termination of pregnancy. When there are no diagnostic findings or uncertain findings from pES, personalised counselling that considers scans and other tests are crucial. Directing parents to reliable online sources of information and providing emotional support throughout could improve their experiences of care.

[Feasibility study of using bridging temporary permanent pacemaker in patients with high-degree atrioventricular block after TAVR]

Objective: To determine the feasibility of using temporary permanent pacemaker (TPPM) in patients with high-degree atrioventricular block (AVB) after transcatheter aortic valve replacement (TAVR) as bridging strategy to reduce avoidable permanent pacemaker implantation. Methods: This is a prospective observational study. Consecutive patients undergoing TAVR at Beijing Anzhen Hospital and the First Affiliated Hospital of Zhengzhou University from August 2021 to February 2022 were screened. Patients with high-degree AVB and TPPM were included. Patients were followed up for 4 weeks with pacemaker interrogation at every week. The endpoint was the success rate of TPPM removal and free from permanent pacemaker at 1 month after TPPM. The criteria of removing TPPM was no indication of permanent pacing and no pacing signal in 12 lead electrocardiogram (EGG) and 24 hours dynamic EGG, meanwhile the last pacemaker interrogation indicated that ventricular pacing rate was 0. Routinely follow-up ECG was extended to 6 months after removal of TPPM. Results: Ten patients met the inclusion criteria for TPPM, aged (77.0±11.1) years, wirh 7 females. There were 7 patients with third-degree AVB, 1 patient with second-degree AVB, 2 patients with first degree AVB with PR interval>240 ms and LBBB with QRS duration>150 ms. TPPM were applied on the 10 patients for (35±7) days. Among 8 patients with high-degree AVB, 3 recovered to sinus rhythm, and 3 recovered to sinus rhythm with bundle branch block. The other 2 patients with persistent third-degree AVB received permanent pacemaker implantation. For the 2 patients with first-degree AVB and LBBB, PR interval shortened to within 200 ms. TPPM was successfully removed in 8 patients (8/10) at 1 month without permanent pacemaker implantation, of which 2 patients recovered within 24 hours after TAVR and 6 patients recovered 24 hours later after TAVR. No aggravation of conduction block or permanent pacemaker indication were observed in 8 patients during follow-up at 6 months. No procedure-related adverse events occurred in all patients. Conclusion: TPPM is reliable and safe to provide certain buffer time to distinguish whether a permanent pacemaker is necessary in patients with high-degree conduction block after TAVR.

Optimising Exome Prenatal Sequencing Services (EXPRESS): a study protocol to evaluate rapid prenatal exome sequencing in the NHS Genomic Medicine Service

Background

Prenatal exome sequencing (ES) for the diagnosis of fetal anomalies was implemented nationally in England in October 2020 by the NHS Genomic Medicine Service (GMS). is the GMS is based around seven regional Genomic Laboratory Hubs (GLHs). Prenatal ES has the potential to significantly improve NHS prenatal diagnostic services by increasing genetic diagnoses and informing prenatal decision-making. Prenatal ES has not previously been offered routinely in a national healthcare system and there are gaps in knowledge and guidance.

Methods

Our mixed-methods evaluation commenced in October 2020, aligning with the start date of the NHS prenatal ES service . Study design draws on a framework developed in previous studies of major system innovation. There are five interrelated workstreams. Workstream-1 will use interviews and surveys with professionals, non-participant observations and documentary analysis to produce in-depth case studies across all GLHs. Data collection at multiple time points will track changes over time. In Workstream-2 qualitative interviews with parents offered prenatal ES will explore experiences and establish information and support needs. Workstream-3 will analyse data from all prenatal ES tests for nine-months to establish service outcomes (e.g. diagnostic yield, referral rates, referral sources). Comparisons between GLHs will identify factors (individual or service-related) associated with any variation in outcomes. Workstream-4 will identify and analyse practical ethical problems. Requirements for an effective ethics framework for an optimal and equitable service will be determined. Workstream-5 will assess costs and cost-effectiveness of prenatal ES versus standard tests and evaluate costs of implementing an optimal prenatal ES care pathway. Integration of findings will determine key features of an optimal care pathway from a service delivery, parent and professional perspective.

Discussion

The proposed formative and summative evaluation will inform the evolving prenatal ES service to ensure equity of access, high standards of care and benefits for parents across England.

[Application of ultra-short echo time-T2* component analysis technology in monitoring morphological and biochemical changes of achilles tendon in amateur marathon athletes]

Objective: To explore the value of ultra-short echo time (UTE)-T₂* component analysis techniques in dynamic monitoring the morphological and biochemical changes in amateur marathon athletes' achilles tendon before and after the marathon. Methods: Twenty-nine amateur marathon runners were recruited between October 2020 and March 2021 in Zhuhai City, Guangdong Province, including 25 males and 4 females, aged from 24 to 50 (40±6) years old. All volunteers underwent bilateral achilles tendon MRI examination 1 week before the marathon, 48 hours after the race, and 1 month after the race. The shape and signal of the achilles tendon were evaluated by routine T1-weighted, proton density weighted with fat saturation sequence and different echo time (TE) UTE sequence, and the changes of achilles tendon after running was quantitatively analyzed by UTE-T2* sequence. The values of single-component analysis (T₂*_M), short T₂* components (T₂*_S), and long T₂* components (T₂*_L) and Fraction values were obtained using UTE-T₂* sequence. The value of the whole achilles tendon was measured on the sagittal images of achilles tendon, and the Achilles tendon was equally divided into three subregions [muscle-tendon junction (MTJ), middle (MID), and insertion (INS)]. The region of interest was delineated by two radiologists independently. The intra-group correlation coefficient (ICC) was used to evaluate the consistency of the data measured by two radiologists. Nonparametric Friedman M test was used to compare the differences of T₂*_M, T₂*_S, T₂*_L and Fraction values in different time points and different subregions. Wilcoxon rank-sum test was used to compare the difference between 48 h post-race and pre-race T₂*_S values (ΔT₂*_S) of different distance, different running posture, different pace and different amount of training, in which ΔT₂*_S equals the T₂*_S value of 48 h post-race minus the T₂*_S value of pre-race. Results: On the sequence of short TE (TE≤0.6 ms), achilles tendinopathy can manifest as scattered punctate hypointensity in areas of high signal intensity. The two radiologists showed a good consistency in measuring the T₂*_M, T₂*_S, T₂*_L and Fraction values of the achilles tendon, and the ICC values ​​were 0.96, 0.94, 0.83 and 0.94, respectively. The T₂*s values was significantly higher in the whole Achilles tendon, MTJ and MID segment at 48 h post-exercise compared to pre-exercise, and decreased after 1 month of exercise, [0.49 (0.45, 0.59) vs 0.54 (0.49, 0.59) vs 0.53 (0.49, 0.57), 0.48 (0.44, 0.54) vs 0.53 (0.47, 0.58) vs 0.50 (0.46, 0.57), 0.48 (0.43, 0.58) vs 0.54 (0.47, 0.59) vs 0.52 (0.46, 0.57); respectively, all P<0.05]. The changes in T₂*_M, T₂*_L and Fraction values are not statistically significant (all P>0.05). In different running gestures, the ΔT₂*_S of achilles tendon who using the postures of front-middle feet is higher than that using the postures of back feet (0.03(-0.05, 0.07) vs -0.03(-0.17, 0.11), P=0.001). Conclusion: The Bi-component analysis of UTE-T₂* technology is superior to single component analysis in monitoring the dynamic changes of achilles tendon before and after exercise, and T₂*_S is a more sensitive sequence to evaluate the subtle changes in the chemical composition of achilles tendon.

Marital Status and Gender Differences as Key Determinants of COVID-19 Impact on Wellbeing, Job Satisfaction and Resilience in Health Care Workers and Staff Working in Academia in the UK During the First Wave of the Pandemic

Background

The COVID-19 pandemic is an unprecedented global public health crisis that continues to exert immense pressure on healthcare and related professional staff and services. The impact on staff wellbeing is likely to be influenced by a combination of modifiable and non-modifiable factors.

Objectives

The aim of this study is to evaluate the effect of the COVID-19 pandemic on the self-reported wellbeing, resilience, and job satisfaction of National Health Service (NHS) and university staff working in the field of healthcare and medical research.

Methods

We conducted a cross sectional survey of NHS and UK university staff throughout the COVID-19 pandemic between May-November 2020. The anonymous and voluntary survey was disseminated through social media platforms, and via e-mail to members of professional and medical bodies. The data was analyzed using descriptive and regression (R) statistics.

Results

The enjoyment of work and satisfaction outside of work was significantly negatively impacted by the COVID-19 pandemic for all of staff groups independent of other variables. Furthermore, married women reporting significantly lower wellbeing than married men (P = 0.028). Additionally, the wellbeing of single females was significantly lower than both married women and men (P = 0.017 and P < 0.0001, respectively). Gender differences were also found in satisfaction outside of work, with women reporting higher satisfaction than men before the COVID-19 pandemic (P = 0.0002).

Conclusion

Our study confirms that the enjoyment of work and general satisfaction of staff members has been significantly affected by the first wave of the COVID-19 pandemic. Interestingly, being married appears to be a protective factor for wellbeing and resilience but the effect may be reversed for life satisfaction outside work. Our survey highlights the critical need for further research to examine gender differences using a wider range of methods.

New insights into the mechanisms of ultrasonic emulsification in the oil-water system and the role of gas bubbles

Ultrasonic emulsification (USE) assisted by cavitation is an effective method to produce emulsion droplets. However, the role of gas bubbles in the USE process still remains unclear. Hence, in the present paper, high-speed camera observations of bubble evolution and emulsion droplets formation in oil and water were used to capture in real-time the emulsification process, while experiments with different gas concentrations were carried out to investigate the effect of gas bubbles on droplet size. The results show that at the interface of oil and water, gas bubbles with a radius larger than the resonance radius collapse and sink into the water phase, inducing (oil-water) blended liquid jets across bubbles to generate oil-in-water-in-oil (O/W/O) and water-in-oil (W/O) droplets in the oil phase and oil-in-water (O/W) droplets in the water phase, respectively. Gas bubbles with a radius smaller than the resonance radius at the interface always move towards the oil phase, accompanied with the generation of water droplets in the oil phase. In the oil phase, gas bubbles, which can attract bubbles nearby the interface, migrate to the interface of oil and water due to acoustic streaming, and generate numerous droplets. As for the gas bubbles in the water phase, those can break neighboring droplets into numerous finer ones during bubble oscillation. With the increase in gas content, more bubbles undergo chaotic oscillation, leading to smaller and more stable emulsion droplets, which explains the beneficial role of gas bubbles in USE. Violently oscillating microbubbles are, therefore, found to be the governing cavitation regime for emulsification process. These results provide new insights to the mechanisms of gas bubbles in oil-water emulsions, which may be useful towards the optimization of USE process in industry.

P120 Self-reported disease activity was the main determinant of the perceived impact of COVID-19 pandemic on adolescent and young patients with juvenile dermatomyositis (JDM) and juvenile onset systemic lupus erythematosus (JSLE)

Background/Aims 

The impact of the COVID-19 pandemic on adolescent and young patients with chronic diseases is likely to be multi-factorial, and influenced by various aspects, such as age, sex, education, ethnicity, as well as disease control or personal coping strategies. Adolescents and young adults are at a time in their live when disruption in their education and social life, as well as uncertainty related to professional prospects and long-term disease outcomes are all associated with significant personal concerns. The aim of this survey was to assess the main determinants of COVID-19 associated concern in adolescent and young adults with JSLE and JDM as well as their well-being and resilience.

Methods 

Questionnaires comprising of questions related to patient and disease characteristics, wellbeing, resilience and concern about the COVID-19 pandemic were disseminated through hospital contacts and patient charities social media platforms. Participation was voluntary and implied consent. The preliminary results of this ongoing survey have been analysed using descriptive statistics and linear regression (R).

Results 

The main patient and disease characteristics, self-reported well-being, resilience and perceived concern about the COVID-19 pandemic are presented in comparison in male vs. female patients. Linear regression showed that the strongest determinant of COVID-19 concern was self-reported disease activity (p < 0.0003). The self-reported disease activity was associated with the COVID-19 concern level in both female (P = 0.003) and male patients (p = 0.004) and also with disease duration in males (P = 0.018). The COVID concern was not affected by any other factors such as, employment, education, well-being or resilience.

Conclusion 

The preliminary analysis of our survey showed that patient-reported COVID-19 concern during the pandemic was strongly determined by the self-reported disease activity irrespective of patients’ sex, despite significantly increased concern in the female compared to male patients, and association with disease duration in male patients only. We propose that further strategies for better patient support during the pandemic should focus on their optimal disease control as well as take into consideration the sex-biased patient concerns. P120 Table 1:

	Female	Male	p-value
Number	38	9
Current age mean (IQR)	22.21 (18.25- 25.75)	18.89 (14.00-26.00)
Age at diagnosis years mean (IQR)	13.01 (9.00-15.00)	9.333 (7.00-11.00)
Disease duration Mean (IQR)	9.197 (4.000-13.000)	9.556 (2.000-13.000)	0.4841
Ethnicity; White Non-white	25 (65.8%) 13 (34.2%)	7 (77.8%) 2 (22.2%)	0.4841
Location; England (%) Other (%)	35 (92.1%) 3 (7.9%)	9 (100%) 0 (0%)	0.2578091
Well-being (VAS -2 to + 2) mean (IQR)	-0.6765 (-2.0000 – 0.0000)	-0.4286 (-1.0000 – 0.0000)	0.5667
Resilience (VAS 1-7) mean (IQR)	4.906 (4.000 - 6.000)	5.0 (4.5 - 5.5)	0.8718
Self-reported disease activity (VAS 1-100) mean (IQR)	35.32 (15.00- 53.00)	18.67 (3.00-25.00)	0.06429
Self-reported COVID concern (VAS 1-100) mean (IQR)	62.92 (50.00-80.00)	32.33 (15.00- 40.00)	0.01052
Still in education No Yes Not recorded	16 (42.1%) 18 (47.4%) 4 (10.5%)	3 (33.3%) 4 (44.4%) 2 (22.2%)
Currently working No Yes Not recorded	24 (63.2%) 10 (26.3%) 4 (10.5%)	5 (55.6%) 2 (22.2%) 2 (22.2%)

Funding statement: This work was supported by Versus Arthritis (21593)

Disclosure 

A. Khatun: None. W. Wu: None. J. Peng: None. L. Hennelly: None. M. Sloan: None. M. Bosley: None. P. Howard: None. L. Jury: None. C. Ciurtin: None.

Specific PCR-based detection of Phomopsis heveicola the cause of leaf blight of Coffee (Coffea arabica L.) in China

Coffee (Coffea arabica L.) is currently grown in many tropical and subtropical areas countries and is a major traded commodity for the developing world. Coffee leaf blight, caused by Phomopsis heveicola, is one of the most important fungal diseases dangerous to coffee crops in China. This study aimed to develop a PCR-based diagnostic method for detecting P. heveicola in planta. Specific primers (CPHF/CPHR) were designed based on sequence data of region of internal transcribed spacer (ITS1 and ITS4) of P. heveicola. The efficiency and specificity of CPHF/CPHR were established by PCR analysis of DNA from P. heveicola strains isolated from China and fungal isolates of other genera. A single amplification product of 318 bp was detected from DNA P. heveicola isolates. No amplification product was observed with any of the other fungal isolates tested. The specific primers designed and employed in PCR detected P. heveicola up to 3 pg from DNA isolated. This is the first report on the development of a species-specific PCR assay for identification and detection of P. heveicola. Thus, the PCR-based assay developed was very specific, rapid and sensitive tool for the detection of pathogen P. heveicola.

[Long-term outcome of patients with hypertrophic obstructive cardiomyopathy post percutaneous transluminal septal ablation]

Objective: To evaluate the long-term outcome of patients with hypertrophic obstructive cardiomyopathy(HOCM) after percutaneous transluminal septal ablation(PTSMA). Methods: HOCM patients who underwent PTSMA and surgical myectomy at the Chest Hospital of Shanghai Jiao Tong University from April 2001 to February 2019 were included in this retrospective analysis. Patients were divided into PTSMA group and surgical myectomy group. In addition, patients undergoing PTSMA were further divided into HOCM-PTSMA non-survivor group and HOCM-PTSMA survivor group. The general clinical information, procedural/surgical information and complications during hospitalization were compared between groups. Multivariate Cox regression model was used to analyze the independent risk factors for all-cause death in HOCM patients after PTSMA. Results: A total of 104 patients with HOCM who underwent PTSMA were enrolled. Mean age of the patients was (54±15) years old, including 41 females (38.7%). The follow-up time was 37.5(14.3, 76.8) months. At the last follow-up, 12 patients died (HOCM-PTSMA non-survivor group) and 92 were alive(HOCM-PTSMA survivor group). The proportion of patients with NYHA function class Ⅲ/Ⅳ was higher(P=0.036), and the posterior wall of the left ventricle was thicker(P=0.006) in the HOCM-PTSMA non-survivor group than in the HOCM-PTSMA survivor group. The immediate success rate of PTSMA in this cohort was 66%(70/104). The amount of absolute alcohol during the operation in the HOCM-PTSMA non-survivor group was (2.9±0.8) ml, which tended to be higher as compared to that in the HOCM-PTSMA survivor group((2.4±1.0)ml, P=0.056). Kaplan-Meier survival curve analysis showed that patients with HOCM who underwent PTSMA had an all-cause mortality-free survival rate of 90.1%, 78.3%, and 56.9% at 5, 10 and 15 years, and a HOCM-free survival rate of 91.3%, 79.4% and 57.7% at 5, 10 and 15 years, respectively. Multivariate Cox regression analysis showed that age≥ 65 years was an independent risk factor for all-cause death after PTSMA in patients with HOCM (HR=2.697, 95%CI 1.292-18.977, P=0.020). There were 32 patients in the surgical myectomy group. The proportion of patients with NYHA function class Ⅲ/Ⅳ was higher than that in the PTSMA group(P<0.001), while age, gender, and major comorbidities(atrial fibrillation, coronary heart disease, hypertension, and diabetes) as well as the left atrium dimension were all similar between the two groups(all P>0.05). Patients in the surgical myectomy group were followed up for 38.0(17.6, 64.2)months, and no deaths occurred during the follow-up period. Kaplan-Meier survival curve analysis showed that there were no statistically significant differences in all-cause-free and HOCM-free survival rates between patients in PTSMA group and surgical myectomy group(P=0.089 and 0.110, respectively). Conclusion: PTSMA is safe and effective for the treatment of patients with HOCM, and the long-term survival rate of patients after PTSMA is similar as patients undergoing classical surgical myectomy surgery.

[Preliminary application value of ultrasound contrast agent with enteral nutritional suspension as mixed medium in locating indwelling nasointestinal tube in critically ill patients]

Objective: To evaluate the value of ultrasound contrast agent with enteral nutrition suspension as mixed medium in locating indwelling nasointestinal tube in critically ill patients. Methods: Total of 45 critically ill patients had nasointestinal tube indwelled were collected from June 1,2018 to April 1,2019 in the Intensive Care Unit of Zhejiang Provincial People's Hospital, including 30 males and 15 females, with an average age of (63±17) years.Enteral nutritional suspension Peptisorb Liquid was used as research medium,with the ultrasonic imaging performance of it confirmed by in vitro and in vivo experiments.The optimal mixing ratio of microbubble ultrasound contrast agent and Peptisorb Liquid was confirmed by in vitro experiment, then the mixture was quietly placed and its stability was dynamically observed. The nasointestinal tube was confirmed in the digestive tract by conventional ultrasound and then the ultrasound contrast mode turned on. Ultrasound contrast agent with Peptisorb Liquid as mixed medium was injected into the nasointestinal tube and the tube direction and end position were observed and recorded in real time. Abdominal X-ray examination or CT was used as the gold standard for verifying the location of the nasointestinal tube and the same result represented successful positioning. Results: The in vitro and in vivo experiments showed that Peptisorb Liquid had good ultrasound imaging uniformity and penetrating power, which could clearly show the range and boundary of the filling intestine cavity; the in vitro experiment showed that the ultrasound contrast agent prepared with the microbubble ultrasound contrast agent and Peptisorb Liquid by the ratio of 1∶1 000 and 1∶500 which had the best imaging effect and the best distribution uniformity, with the best stability within 10 minutes after quietly placed. Nasointestinal tubes were successfully located by using ultrasound contrast agent with enteral nutritional suspension as mixed medium in 95.6%(43/45) of the patients collected in this study,including success at one attempt in 39 cases, the operating time was (1.6±0.5) minutes and 4 cases were successfully located after multiple operations with (5.1±0.5) minutes, the tube bent in the stomach in one case and flexed back into the stomach from the descending duodenum in another. The operation failed in 2 cases (4.4%). No significant complications occurred during the examination. Conclusion: The ultrasound contrast agent with enteral nutritional suspension as mixed medium has the advantages of both, which can conveniently, safely and effectively locate the direction and end position of nasointestinal tube in critically ill patients.

Ultrasonic modulation of phase separation and corrosion resistance for ternary Cu-Sn-Bi immiscible alloy

The effect of power ultrasound on the liquid phase separation of ternary Cu-32%Sn-20%Bi immiscible alloy is experimentally investigated, which shows that as compared with the layered structure formed under static condition, the macrosegregation resulted from liquid phase separation is remarkably reduced with the increase of ultrasonic amplitude. A homogenous microstructure characterized by refined (Bi) particles dispersing uniformly on the (Cu₃Sn) matrix is obtained when the ultrasonic amplitude reaches the highest value of 24 μm. This is mainly ascribed to the ultrasonically induced cavitation and acoustic streaming, which promotes the nucleation, the fragmentation, and the dispersion of (Bi) droplets. The finally solidified immiscible alloy exhibits obvious improvements in electrochemical corrosion resistance, microhardness and wear-resisting if compared with those in static solidification. These results prove that applying power ultrasound is an effective way to modulate the liquid phase separation and enhance the applied performance for immiscible alloys.

[Effect of emergency thoracic endovascular aortic repair in patients with acute traumatic thoracic aortic injury]

Objective: To investigate the effect of emergency thoracic endovascular aortic repair (TEVAR) in patients with acute traumatic thoracic aortic injury. Method: From January 2014 to December 2016, a total of 35 patients with acute traumatic thoracic aortic injuries were treated with emergency TEVAR in our hospital, their clinical data were analyzed retrospectively in this study. Results: The patients were 42 (34, 55) years old,and there were 31 males.All cases were diagnosed by emergency aorta computed tomography angiography (CTA),and 5 cases were diagnosed as aortic transaction, 13 cases were diagnosed as aortic pseudoaneurysm, 7 cases were diagnosed as aortic dissection, and 10 cases were diagnosed as aortic intramural hematoma combined hemothorax.The concomitant injuries included cerebral contusion (3 cases, 8.6%), pulmonary contusion with rib fracture (31 cases, 88.5%), long bone fracture (7 cases, 22.5%), contusion of viscera or internal organs (3 cases, 8.6%).Emergency TEVAR were performed with vascular suture system preset under local anesthesia after diagnosis,and combined injury was treated in related departments.CTA was repeated after 1, 3 and 6 months and yearly thereafter. One patient died before transferring to catheter room,and 34 (97.1%) patients underwent TEVAR procedure successfully.Time from door to operating room was (88.6±26.6) minutes,and the procedure time was (52.0±9.4) minutes. A total of 69 Perclose Proglide vascular suture system were used,and 2 cases underwent surgical suture because of hematoma and pseudoaneurysm formation in femoral arteries.The involved length of thoracic aorta was (44.5±7.4)mm. A total of 46 stent-grafts were implanted, the length of stent-graft was (164.3±15.2)mm,and the proximal oversize rate was (22.3±8.6)%. The follow-up time was 24 (12,24) months, and there were no procedure related complication such as endoleak and paraplegia. Complete aortic remodeling was observed in 14 cases. Fully thrombolization at stent segments were observed in 7 cases. Fully thrombalization of pseudoaneurysms were observed in 13 cases. One patient complained mild left upper limb weakness due to left subclavian artery occlusion. Conclusion: Emergency TEVAR is safe and effective procedure for the treatment of patients with acute traumatic thoracic aortic injury.

[High resolution diffusion-weighted imaging for characterising nasopharyngeal carcinoma]

Objective: To evaluate the characteristics of high resolution diffusion-weighted imaging(DWI) using readout segmentation of long variable echo trains (RESOLVE ) for nasopharyngeal carcinoma (NPC). Methods: A total of 131 with newly diagnosed NPC patients from the 5th Affiliated Hospital of Sun Yat-sen University were included in this study from October 2013 to April 2016.DWI using RESOLVE technique was performed. The signal intensity (SI(lesion)), and mean(ADC(mean)), maximum(ADC(max)), minimum (ADC(min))ADCs of NPC were calculated. The signal intensity (SI(normal))and ADC (ADC(normal))of normal nasopharyngeal tissue were calculated. These quantitative parameters of NPC and normal nasopharyngeal tissue were compared.Statistical difference of ADC(mean), ADC(max) and ADC(min) between the clinical tumor stages were assessed. Results: On the DWI, all NPCs were clearly shown as high signal intensity relative to the surrounding normal nasopharyngeal structure(F=70.019, P=0.000). The ADC(mean)(F=20.442, P=0.000), ADC(max)(F=35.374, P=0.000), ADC(min)(F=61.534, P=0.000) in the carcinoma were significantly lower compared with that of normal nasopharyngeal structure. There was no statistically significant difference of ADC(mean), ADC(max) and ADC(min) (P>0.05)in different clinical stages of NPC. Conclusion: NPC can be clearly detected by RESOLVE-DWI, but the ADC(mean), ADC(max) and ADC(min) can not be used for differentiating the clinical stage of NPC.

[Feasibility and efficacy of transcatheter closure of anastomotic leakage after aortic surgery using Amplatzer Vascular Plug Ⅲ]

Objective: To investigate the feasibility and efficacy of transcatheter closure of anastomotic leakage after aortic surgery using Amplatzer Vascular Plug Ⅲ (AVP Ⅲ). Methods: A retrospective analysis was performed in 5 patients with anastomotic leakage after aortic surgery, who underwent transcatheter closure in our hospital from January to June 2017 using AVP Ⅲ. Surgeries were performed in 3 cases of Standford type A dissection, 1 case of ascending aortic aneurysm and 1 case of persistent truncus.There were 3 males,and age was (43.8±13.1) years old. Anastomotic leakages located at the ascending aorta in 4 patients, and the other one located between the aortic arch and the stent-graft.Three of them had aorta-right atrium fistula and patients suffered from progressive heart failure. False aneurysm between aorta and pulmonary artery was formed in 1 patient, and patent aortic false lumenwas found in the other patient. All the AVP Ⅲ were deployed based on a femoral arteriosus loop. Patients were followed up after transcatheter closure to observe the clinical results. Results: Six AVP Ⅲ were successfully implanted in the 5 patients. Trivial residual shunt was seen in 1 patient after closure. The patients were followed up 6 (1, 6) months. The cardiac function improved from NYHA class Ⅱ-Ⅳ to class Ⅰ-Ⅱ after the procedure in 3 congestive heart failure patients.The right atrium systolic pressure was significantly reduced after the procedure((8.7±1.8) mmHg (1 mmHg=0.133 kPa) vs. (24.3±2.3) mmHg, P=0.03). The diameter of the false aneurysm reduced in 1 patient after the procedure. Complete thrombosis formation of the thoracic false lumen was observed in 1 patient. Conclusion: Transcatheter closure of anastomotic leakage after aortic surgery using AVP Ⅲ is feasible and effective according to our primary experience.

[Clinical and imaging features of pulmonary veno-occlusive disease and pulmonary capillary hemangioma]

Objective: To improve the diagnosis and treatment of the pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangioma (PCH). Methods: The clinical features, radiological findings, laboratory testing and treatment in 8 cases of PVOD/PCH which was diagnosed from 2013 to 2017 were described. Results: PVOD/PCH was rare. The clinical symptoms were easily confused with IPAH, but the decrease of hypoxemia, clubbing, D(L)CO were more obvious, and the imaging features of HRCT were helpful for PVOD/PCH diagnosis. Combined with gene testing, it was helpful to diagnose PVOD/PCH and avoid the risk of surgical biopsy. Conclusion: PVOD and PCH are rare type of pulmonary vascular diseases. According to clinical manifestations, physical examination, pulmonary function test results, HRCT imaging, CPET and gene detection results, PVOD or PCH can be diagnosed.

[DeSUMOylation of protein kinase B1 inhibits cell proliferation and metastasis of hepatocellular carcinoma]

Objective: To investigate the effect of AKT1 deSUMOylation induced by Ubc9 silencing on the proliferation and metastasis of hepatocellular carcinoma (HCC) cells. Methods: The Ubc9 gene was silenced using RNA interference, and the expression levels of Ubc9, SUMO1 and AKT1 protein were detected by Western blot. Cell proliferation and cell cycle was analyzed by MTT and flow cytometry. Wound healing and transwell assays were used to detect the cell migration ability. Furthermore, the xenograft model was established, and tumor growth curves were drawn. The in situ apoptotic rates was measured using TUNEL Apoptosis Assay. The expression of proliferating cell nuclear antigen (PCNA), matrix metalloproteinase (MMP)-2 and MMP-9 were evaluated by immunohistochemical staining. Results: Knockdown of Ubc9 gene significantly decreased the protein expression levels of Ubc9, conjugated SUMO1, free SUMO1 and AKT1 in HCC cells (P<0.05 for all). In control, siR-neg and siR-Ubc9 groups, the cell proliferation indexes were 53.19%, 54.25% and 39.17%, respectively. Moreover, cell migration distance and migrating cells per low power field for all these three groups were (59.47±4.66) μm and 89.44±8.36, (56.56±5.37) μm and 93.84±8.79, as well as (34.57±6.61) μm and 41.67±5.39, respectively. In the xenograft model, the weights of subcutaneous tumors for these three groups were (3.78±0.69) g, (3.72±0.72) g and (2.09±0.61) g, respectively. The corresponding apoptotic cell rates were (7.79±2.21)%, (6.45±2.48)% and (33.59±5.44)%, respectively. The expression levels of PCNA, MMP-2 and MMP-9 protein were significantly decreased in siR-Ubc9 group (P<0.05). Conclusions: Ubc9 silencing in HCC cells induces AKT1 deSUMOylation, and then inhibits the proliferation and metastasis. These results provide a new therapeutic strategy for liver cancer in the future.

Identification of lipopeptides produced by Bacillus subtilis Czk1 isolated from the aerial roots of rubber trees

We obtained a strain of Bacillus subtilis, which we named Czk1, from the aerial roots of rubber trees. This bacterial isolate exhibits strong antagonistic activity against Ganoderma pseudoferreum, Phellinus noxius, Helicobasidium compactum, Rigidoporus lignosus, Sphaerostilbe repens, and Colletotrichum gloeosporioides. Our earlier research has shown that the antagonistic activity of a fermentation supernatant Czk1 isolate produces a complex mixture of lipopeptides. In this study, we used methanol to extract crude lipopeptides, purified them using a Sephadex G-25 column, cloned the lipopeptide genes, and analyzed purified fractions by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS) to identify the lipopeptides from B. subtilis strain Czk1. The cloned lipopeptide genes included those that encode the enzymes lpa, ituD, sfp, and fenB. The crude lipopeptides were purified and found in five fractions. Further analysis revealed that five fractions of the purified composition contained members of the surfactin, iturin, fengycin, and bacillomycin families of antibiotics. This suggests that these lipopeptides from strain Czk1 have potential as plant disease biocontrol agents.

Cloning and characterization of the dehydration-responsive element-binding protein 2A gene in Eruca vesicaria subsp sativa

Eruca vesicaria subsp sativa is one of the most tolerant Cruciferae species to drought, and dehydration-responsive element-binding protein 2A (DREB2A) is involved in responses to salinity, heat, and particularly drought. In this study, a gene encoding EvDREB2A was cloned and characterized in E. vesicaria subsp sativa. The full-length EvDREB2A cDNA sequence contained a 388-bp 5'-untranslated region (UTR), a 348-bp 3'-UTR, and a 1002-bp open reading frame that encoded 334 amino acid residues. The theoretical isoelectric point of the EvDREB2A protein was 4.80 and the molecular weight was 37.64 kDa. The genomic sequence of EvDREB2A contained no introns. Analysis using SMART indicated that EvDREB2A contains a conserved AP2 domain, similar to other plant DREBs. Phylogenetic analysis revealed that EvDREB2A and DREB2As from Brassica rapa, Eutrema salsugineum, Arabidopsis thaliana, Arabidopsis lyrata, and Arachis hypogaea formed a small subgroup, which clustered with DREB2Bs from A. lyrata, A. thaliana, Camelina sativa, and B. rapa to form a larger subgroup. EvDREB2A is most closely related to B. rapa DREB2A, followed by DREB2As from E. salsugineum, A. thaliana, A. hypogaea, and A. lyrata. A quantitative real-time polymerase chain reaction indicated that EvDREB2A expression was highest in the leaves, followed by the roots and hypocotyls, and was lowest in the flower buds. EvDREB2A could be used to improve drought tolerance in crops.

Large-scale production of megakaryocytes from human pluripotent stem cells by chemically defined forward programming

The production of megakaryocytes (MKs)--the precursors of blood platelets--from human pluripotent stem cells (hPSCs) offers exciting clinical opportunities for transfusion medicine. Here we describe an original approach for the large-scale generation of MKs in chemically defined conditions using a forward programming strategy relying on the concurrent exogenous expression of three transcription factors: GATA1, FLI1 and TAL1. The forward programmed MKs proliferate and differentiate in culture for several months with MK purity over 90% reaching up to 2 × 10(5) mature MKs per input hPSC. Functional platelets are generated throughout the culture allowing the prospective collection of several transfusion units from as few as 1 million starting hPSCs. The high cell purity and yield achieved by MK forward programming, combined with efficient cryopreservation and good manufacturing practice (GMP)-compatible culture, make this approach eminently suitable to both in vitro production of platelets for transfusion and basic research in MK and platelet biology.

Zhi-Long-Huo-Xue-Tong-Yu modulates mitochondrial fission through the ROCK1 pathway in mitochondrial dysfunction caused by streptozotocin-induced diabetic kidney injury

Zhi-Long-Huo-Xue-Tong-Yu (ZLHXTY) is a defined mixture of 5 herbs developed by Professor S.J. Yang according to the Buyang Huanwu decoction method, which has been recorded in the Yilingaicuo. This study investigated the renoprotective effects of ZLHXTY on mitochondrial dysfunction induced by diabetic kidney injury in a diabetic rat model. Diabetes was induced by a single intravenous injection of streptozotocin. Rats were daily fed either ZLHXTY or vehicle beginning in the 1st week after injection. Levels of mitofusin 2 (mfn2), dynamin-related protein 1 (Drp1), caspase-9, and rho-associated, coiled-coil-containing protein kinase 1 (ROCK1) were detected using Western blotting. Levels of intracellular calcium and adenosine triphosphate (ATP) were examined using an enzyme-linked immunosorbent assay. An electron microscopic examination of kidney tissue was performed. The levels of mfn2 and ATP in the diabetes and ZLHXTY groups decreased from the 4th week after modeling. The expression levels of Drp1, ROCK1, and caspase-9 increased in the diabetes group but decreased in the ZLHXTY group from the 4th week after modeling. Compared with the diabetes group, ZLHXTY treatment decreased the mesangial expansion index and proteinuria levels, and improved the pathological changes typical of diabetic kidney injury. Furthermore, ZLHXTY treatment inhibited the activation of ROCK1 and expression of Drp1 and caspase-9, but did not affect the expression of mfn2. This study indicates that ZLHXTY treatment could protect kidney tissue from diabetic injury through the ROCK1 pathway response to mitochondrial dysfunction induced by diabetes.

A vascular physician's view of venous thromboembolism and apixaban

Alexander Cohen speaks to Wing Han Wu, Commissioning Editor: Dr Cohen is a vascular physician and epidemiologist involved in clinical work, designing, managing and analyzing clinical trials from Phase I to IV. He is the Chairman and member of many international steering committees for multicenter trials, and epidemiological and pharmaco-economic studies. Dr Cohen graduated with honors in Medicine and Surgery from the University of Melbourne, Australia (MBBS). He achieved his fellow of the Royal Australasian College of Physicians (FRACP) in 1990, and received an MSc in Epidemiology in 1991 from the University of London. His MSc thesis in 1991 was on the Metabolic Syndrome in South Asia. In 1998, he achieved MD with a thesis on Epidemiology of VTE and Thromboprophylaxis. He has written or co-authored over 300 publications since 1990, including 40 publications in The Lancet and New England Journal of Medicine.

Assessment of sensitivity and virulence fitness costs of the AvrPik alleles from Magnaporthe oryzae to isoprothiolane

The in vitro sensitivity of AvrPik allele isolates of Magnaporthe oryzae to isoprothiolane was examined and the virulence fitness costs of AvrPik allele isolates to isoprothiolane were assessed. Isoprothiolane was found to suppress the radial growth of AvrPik allele isolates at all concentrations (1, 5, 10, 15, and 20 μg/mL). Generally, a higher isoprothiolane concentration has a stronger inhibitory effect on mycelial growth in AvrPik allele isolates at 6 and 10 days after inoculation. The inhibitory effect of isoprothiolane also increased with treatment time. To determine whether a correlation existed between the in vitro sensitivity of AvrPik allele isolates and virulence, the half-maximal inhibitor concentration and 75% of the maximum inhibitor concentration were calculated for each mutation isolate and wild-type isolate. Based on these values and virulence, no significant correlation between the susceptibility of AvrPik allele isolates and virulence was detected. In summary, no fitness costs were associated with sensitivity of blast isolates carrying specific AvrPik alleles to different virulence.

A new apparatus for study of pressure-dependent laminar premixed flames with vacuum ultraviolet photoionization mass spectrometry

We report a home-made combustion apparatus for study of pressure-dependent laminar premixed flames with tunable vacuum ultraviolet photoionization mass spectrometry. The instrument consists of a flame chamber, a photoionization chamber with a single-stage sampling system, an ion transfer/storage system, and an orthogonal-acceleration reflectron time-of-flight mass spectrometer. Preliminary results of fuel-rich C(2)H(4)/O(2)/Ar flames at pressures of 30, 150, and 760 Torr have been obtained with this instrument. Compared to previous instruments [T. A. Cool, A. McIlroy, F. Qi, P. R. Westmoreland, L. Poisson, D. S. Peterka, and M. Ahmed, Rev. Sci. Instrum. 76, 094102 (2005); F. Qi, R. Yang, B. Yang, C. Q. Huang, L. X. Wei, J. Wang, L. S. Sheng, and Y. W. Zhang, Rev. Sci. Instrum. 77, 084101 (2006)], performances of the new apparatus have higher mass resolution (~3500 at m/z = 40), better detection limit (<1 ppm), and broader dynamic range (better than 5 order of magnitude).

The effects of soygerm extracts on blood lipoproteins, antioxidative capacity and urinary estrogen metabolites in postmenopausal women on hormone therapy

OBJECTIVE

To evaluate the effects of soygerm isoflavones extracts on blood lipoproteins, antioxidative capacity and urinary estrogen metabolites in postmenopausal women who receive hormone therapy (HT).

METHOD

Thirty-nine volunteers receiving HT were recruited, and 33 completed the study. All subjects received 6 g of soygerm extracts per day for 4 weeks. Blood and urine samples were collected for study at the beginning and at the end of study.

RESULT

Plasma HDL-C levels increased markedly with significant decreases of plasma LDL-C/HDL-C ratio and LDL-TG levels. The lag time of conjugated dienes formation prolonged for 9.9% and thiobarbituric acid reactive substances production in copper-catalyzed oxidation of LDL decreased. The differences were statistically significant. Urinary ratio of 2-OHE(1) to 16alpha-OHE(1) increased without statistical significance.

CONCLUSION

Soygerm extracts may improve serum lipid profile in postmenopausal Taiwanese women who receive HT, and probably provide a favorable effect on estrogen metabolism.

Effects of docosahexaenoic acid supplementation on blood lipids, estrogen metabolism, and in vivo oxidative stress in postmenopausal vegetarian women

BACKGROUND

Vegetarians are generally deficient in long-chain n-3 fatty acids. Long-chain n-3 fatty acids have a beneficial effect on plasma lipid levels, and some studies showed that they had breast cancer suppression effect. One of the biomarkers of breast cancer risk is the ratio of urinary 2-hydroxyestrone (2-OHE(1)) to 16alpha-hydroxyestrone (16alpha-OHE(1)).

OBJECTIVE

To investigate the effect of docosahexaenoic acid (DHA, 22:6n-3) supplementation on blood lipids, estrogen metabolism and oxidative stress in vegetarians.

DESIGN

Single-blind, randomized, placebo-controlled trial.

INTERVENTIONS

Twenty-seven postmenopausal vegetarian women were recruited. After a 2-week run-in period with 6 g placebo corn oil, the subjects were subsequently randomized to receive either 6 g corn oil (n=13) or 6 g DHA-rich algae oil (2.14 g of DHA/day) (n=14) for 6 weeks. Two subjects in corn oil group withdrew before completion.

MAIN OUTCOME MEASURES

Plasma lipids, urinary 2-OHE(1) and 16alpha-OHE(1), urinary F(2)-isoprostanes and plasma alpha-tocopherol.

RESULTS

Plasma LDL-DHA and EPA level increased significantly by DHA supplementation. DHA decreased plasma cholesterol (C) levels (P=0.04), but did not influence the levels of plasma TG, LDL-C and HDL-C, alpha-tocopherol, urinary F(2)-isoprostanes, 2-OHE(1), 16alpha-OHE(1) and ratio of 2-OHE(1) to 16alpha-OHE(1) as compared to corn oil.

CONCLUSION

DHA supplementation at a dose of 2.14 g/day for 42 days decreases plasma cholesterol but neither does it show beneficial effects on estrogen metabolism, nor does it induce deleterious effects on the observed in vivo antioxidant or oxidative stress marker in postmenopausal vegetarian women.

SPONSORSHIP

A grant (# DOH89-TD-1062) from Department of Health, Executive Yuan, Taiwan.

Study on fluoride emission from soils at high temperature related to brick-making process

Characteristics of fluoride emission from 12 soils at temperatures of 400-1,100 degrees C related to the brick-making process were studied. The results obtained in this study indicate that fluoride emission as gaseous HF and SiF4 was related to the firing temperature, soil total fluoride content, soil composition and calcium compounds added to soils. Soils began to release fluoride at temperatures between 500 and 700 degrees C. Marked increases of the average fluoride mission rate from 57.2% to 85.4% of soil total fluoride were noticed as the heating temperature was increased from 700 to 1,100 degrees C. It was found that the major proportion (over 50%) of the soil total fluoride was emitted from soils at approximate 800 degrees C. The amount of fluoride released into the atmosphere when heated depended on the total fluoride contents in the soils. Correlation analysis showed that the soil composition, such as cation exchange capacity, exchangeable calcium and CaCO3, had some influence on fluoride emission below 900 degrees C, but had no influence at temperatures above 900 degrees C. Addition of four calcium compounds (CaO, CaCO3, Ca(OH)2, and CaSO4) at 1.5% by weight raised the temperature at which fluoride began to be released to 700 degrees C. The greatest decrease in fluoride emission among the four calcium compound treatments was found with CaCO3.

Association study of the 5-HT(6) receptor polymorphism (C267T) and symptomatology and antidepressant response in major depressive disorders

The serotonergic neurotransmitter system has been implicated in the pathogenesis of major depressive disorder (MDD). Of the 14 human serotonin (5-HT) receptors, the 5-HT(6) receptor may be a candidate for the study of MDD because of its relative abundance in certain limbic areas and its high affinity to several antidepressants. The present study tested the hypothesis that a 5-HT(6) genetic polymorphism (C267T) is associated with the clinical manifestations of, and/or antidepressant response in, MDD. The Hamilton Depression Rating Scale was used to assess 57 MDD patients before antidepressant treatment, with 34 patients completing the 4-week treatment and evaluation. The results of the association study provide that the 5-HT(6) C267T genetic variant does not play a major role in producing the clinical manifestations or antidepressant response for MDD patients. Further study with a functional 5-HT(6) polymorphism is needed to explore the role of 5-HT(6) in the pathogenesis of MDD.

Congenital prepubic sinus: a variant of dorsal urethral duplication suggested by immunohistochemical analysis

PURPOSE

Congenital prepubic sinus is a rare disorder of uncertain etiology. Immunohistochemical staining is used to elucidate the etiology of the sinus.

MATERIALS AND METHODS

We treated 5 patients with congenital prepubic sinus. A sinogram delineated the tract, which was then excised. In addition to routine hematoxylin and eosin stain of the 5 specimens, immunohistochemical analysis was also performed with smooth muscle and sarcomeric actin, high (34betaE12) and low molecular weight cytokeratin (35betaH11), and cytokeratin 7 antibodies.

RESULTS

The 2 females and 3 males were 1 month to 14 years old. All patients had presented with purulent discharge from the sinus opening. Hematoxylin and eosin stain demonstrated transitional and squamous epithelium lining the sinus. Immunohistochemical study showed that the stain with 3 cytokeratin antibodies was moderately to strongly positive in all patients at the proximal end, low molecular weight cytokeratin weakly to moderately positive and cytokeratin 7 weakly positive to negative in 4 at the distal end. The results suggested that the lining epithelium was transitional proximally and squamous distally. An exception was a female patient who had the shortest tract lined with squamous epithelium only. Furthermore, smooth muscle but not sarcomeric actin demonstrated smooth muscle bundles around the sinus tract in 4 patients.

CONCLUSIONS

The existence of transitional epithelium in the proximal part of the sinus and presence of smooth muscle bundles around it reinforce the theory that congenital prepubic sinus is a variant form of dorsal urethral duplication.

A 10-kDa structural protein of porcine reproductive and respiratory syndrome virus encoded by ORF2b

The major structural proteins of porcine reproductive and respiratory syndrome virus (PRRSV) are derived from ORFs 5, 6, and 7. Western blots of sucrose gradient-purified virions and PRRSV-infected MARC-145 cells, probed with immune pig serum, showed the presence of an additional 10-kDa protein. Nucleotide sequence analysis of North American PRRSV isolate SDSU-23983 revealed a small ORF within ORF2, named ORF2b, which, when translated, produced a 73-amino-acid nonglycosylated protein. Recombinant 2b protein expressed by a baculovirus clone, AcVR2, comigrated with the 10-kDa virus-associated protein. The loss of 10-kDa protein immunoreactivity after absorption of immune sera with lysates from AcVR2-infected insect cells demonstrated that the 2b and 10-kDa proteins are immunologically similar. Immunoblots were also used for the detection of anti-2b activity in serum samples from experimentally infected adult pigs. Antibodies against PRRSV were apparent by 14 days postinfection, followed by anti-2b activity and serum neutralizing activity. The putative ORF2b start codon is only 6 nucleotides downstream of the adenine of the ORF2a start codon. The expression of ORF2a and 2b as enhanced green fluorescent fusion proteins showed that both proteins were translated; however, the ORF2b was preferentially expressed. These results suggest that the 2b protein is virion associated and the principal product of ORF2.

In vitro Arabidopsis pollen germination and characterization of the inward potassium currents in Arabidopsis pollen grain protoplasts

The focus of this study is to investigate the regulatory role of K(+) influx in Arabidopsis pollen germination and pollen tube growth. Using agar-containing media, in vitro methods for Arabidopsis pollen germination have been successfully established for the first time. The pollen germination percentage was nearly 75% and the average pollen tube length reached 135 microm after a 6 h incubation. A decrease in external K(+) concentration from 1 mM to 35 microM resulted in 30% inhibition of pollen germination and 40% inhibition of pollen tube growth. An increase in external K(+) concentration from 1 mM to 30 mM stimulated pollen tube growth but inhibited pollen germination. To study how K(+) influx is associated with pollen germination and tube growth, regulation of the inward K(+) channels in the pollen plasma membrane was investigated by conducting patch-clamp whole-cell recording with pollen protoplasts. K(+) currents were first identified in Arabidopsis pollen protoplasts. The inward K(+) currents were insensitive to changes in cytoplasmic Ca(2+) but were inhibited by a high concentration of external Ca(2+). A decrease of external Ca(2+) concentration from 10 mM (control) to 1 mM had no significant effect on the inward K(+) currents, while an increase of external Ca(2+) concentration from 10 mM to 50 mM inhibited the inward K(+) currents by 46%. Changes in external pH significantly affected the magnitude, conductance, voltage-independent maximal conductance, and activation kinetics of the inward K(+) currents. The physiological importance of potassium influx mediated by the inward K(+)-channels during Arabidopsis pollen germination and tube growth is discussed.

Clinical and radiographic results of cementless AML total hip arthroplasty in young patients

A retrospective study was undertaken of the radiographic and clinical results and complications of 52 cementless (AML) total hip arthroplasties in 52 patients with a mean age of 48.3 years. The follow-up ranged from 9 to 12 years with a mean of 10.5 years. Of the patients, 88% had good or excellent results. Forty-two patients (81%) complained of anterior thigh pain at 3 months after surgery when weight bearing was allowed. The pain continued for a mean period of 4.3 months. In 4 patients (8%), this pain persisted after the first postoperative year. Calcar resorption was seen in 21 patients (40%), and 16 patients (31%) showed clinically insignificant heterotopic ossification. Four patients required revisions: 1 for acetabular loosening, 1 for persistent thigh pain, and 2 for massive osteolysis of the proximal femur. There were no dislocations, infections, thromboembolic events, or neurologic injuries.

LDL of Taiwanese vegetarians are less oxidizable than those of omnivores

The vegetarians in Taiwan consume diets high in polyunsaturated fatty acids. To investigate whether this dietary pattern results in high susceptibility of LDL to oxidation, 109 long-term (8 +/- 5 y) male and female vegans and lactovegetarians (ages 31-45 y) from Taipei and females from Hualien and matched omnivores were recruited to have 24-h-recall dietary assessments and blood lipid analysis. Body mass index and blood pressure were significantly lower in all vegetarian groups than in the matched omnivore groups (P < 0.05). Vegetarians consumed less energy except in the males and less protein, fat and cholesterol (P < 0.05). The mean polyunsaturated/saturated fatty acid (P/S) ratio of 2.4 in vegetarian diet was about two times that in omnivore diet (P < 0. 001). The concentrations of plasma total- and LDL-cholesterol (LDL-C) but not HDL-cholesterol (HDL-C) were significantly lower (P < 0.001) and resulting HDL-C/LDL-C ratio was 38, 46 and 30% higher (P < 0.01) in Taipei female, male and Hualien female vegetarians, respectively, than in the matched omnivores. Plasma triglyceride concentration was significantly lower only in the Hualien women vegetarians (31%, P < 0.001) than in the matched omnivores. The lag time of conjugated diene formation in LDL oxidized in vitro induced by copper was longer in Taipei female (62%, P < 0.001), male (29%, P < 0.05) and Hualien female (38%, P < 0.01), and the production of thiobarbituric acid reactive substances (TBARS) in LDL after 2-4 h of oxidation was 22-32% less (P < 0.005) in Taipei male and Hualien female vegetarians than the matched omnivores. Lag time of LDL oxidation was negatively related to LDL arachidonic (r = -0.55, P = 0.0003) and eicosapentaenoic (r = -0.47, P = 0.003) acid contents. LDL-TBARS production was negatively related to LDL linoleic acid content (r = -0.36, P = 0.023), but positively related to LDL arachidonic (r = 0.56, P = 0.0002) and eicosapentaenoic (r = 0.45, P = 0.004) acids. No significant differences were found in dietary vitamins C and E intakes and plasma LDL alpha-tocopherol concentrations between vegetarians and omnivores. Our results suggest that vegetarian diets decrease the susceptibility of LDL to oxidation despite their higher dietary P/S ratio.

Circadian variations in plasma neutral and basic amino acid concentrations in young men on an ordinary Taiwanese diet

BACKGROUND AND PURPOSE

Plasma levels of circulating free amino acids reflect the net status of protein breakdown and synthesis, and may be linked to various disease states. We studied circadian variations in plasma concentrations of neutral and basic amino acids during a 24-hour period in healthy young men who consumed ordinary Taiwanese test meals.

METHODS

Ten subjects ingested the test diet (protein intake, 1.5 g.kg-1.d-1) which was offered in three meals and two light snacks during the day. Thirteen heparinized blood samples were collected from each subject to analyze plasma amino acid concentrations during the experimental period, at 1- to 3-hour intervals.

RESULTS

The plasma concentrations of all neutral amino acids, including the large neutral amino acids (leucine, isoleucine, valine, tryptophan, tyrosine, and phenylalanine) and methionine, as well as the small neutral amino acids (glycine, serine, threonine, and proline) and the basic amino acids (histidine, arginine, lysine), varied significantly as a function of the time of day (p < 0.001). Except for glycine and proline, all of the neutral amino acids exhibited a marked evening elevation after dinner, with the highest plasma concentration at 23:00. Proline showed peak concentrations at 09:00, while glycine and the basic amino acids exhibited peak concentrations at 21:00. Most of the plasma amino acids exhibited the lowest concentrations at 12:00.

CONCLUSION

Plasma neutral and basic amino acid concentrations exhibited significant circadian variations. The present study also provided the mean fasting plasma levels of amino acids in healthy young men consuming an ordinary Taiwanese diet.

Mutational analysis of yeast TFIIB. A functional relationship between Ssu72 and Sub1/Tsp1 defined by allele-specific interactions with TFIIB

TFIIB is an essential component of the RNA polymerase II core transcriptional machinery. Previous studies have defined TFIIB domains required for interaction with other transcription factors and for basal transcription in vitro. In the study reported here we investigated the TFIIB structural requirements for transcription initiation in vivo. A library of sua7 mutations encoding altered forms of yeast TFIIB was generated by error-prone polymerase chain reaction and screened for conditional growth defects. Twenty-two single amino acid replacements in TFIIB were defined and characterized. These replacements are distributed throughout the protein and occur primarily at phylogenetically conserved positions. Most replacements have little or no effect on the steady-state protein levels, implying that each affects TFIIB function rather than synthesis or stability. In contrast to the initial sua7 mutants, all replacements, with one exception, have no effect on start site selection, indicating that specific TFIIB structural defects affect transcriptional accuracy. This collection of sua7 alleles, including the initial sua7 alleles, was used to investigate the allele specificity of interactions between ssu72 and sub1, both of which were initially identified as either suppressors (SUB1 2mu) or enhancers (sub1Delta, ssu72-1) of sua7 mutations. We show that the interactions of ssu72-1 and sub1Delta with sua7 are allele specific; that the allele specificities of ssu72 and sub1 overlap; and that each of the sua7 alleles that interacts with ssu72 and sub1 affects the accuracy of transcription start site selection. These results demonstrate functional interactions among TFIIB, Ssu72, and Sub1 and suggest that these interactions play a role in the mechanism of start site selection by RNA polymerase II.

Transcription: Common cofactors and cooperative recruitment

Mammalian counterparts of the yeast SRB/MED transcriptional 'mediator' complex have recently been identified. These complexes define a common cofactor requirement for diverse transcriptional activators and underscore the conserved nature of the transcriptional machinery among eukaryotic organisms.

Identification and characterization of the inward K+ channel in the plasma membrane of Brassica pollen protoplasts

Patch clamp techniques have been used to identify and characterize the whole-cell currents carried by inward K+ channels in isolated matured pollen protoplasts of Brassica chinensis var. chinensis. The whole-cell inward currents in the isolated pollen protoplasts were activated at hyperpolarized membrane potentials more negative than -100 mV. The magnitudes of the whole-cell inward currents were strongly dependent on the external K+ concentration, and were highly selective for K+ over other monovalent cations. The inward currents were not observed when external K+ was replaced with the same concentration of Cs+ or Na+. The addition of 1 mM or 10 mM Ba2+ in external solutions resulted in 30% or 80% inhibition of the inward currents at -180 mV, respectively. These results demonstrated that the inward K+ currents mainly account for the recorded whole-cell inward currents in Brassica pollen protoplasts. Increase of cytoplasmic Ca2+ concentrations from 10 nM to 30 microM or even 5 mM did not affect the inward K+ currents. Decrease of external Ca2+ concentrations from 10 mM to 1 mM inhibited the inward K+ currents by 25%, while the increase of external Ca2+ from 10 mM to 50 mM almost completely blocked the inward K+ currents. Physiological importance of K+ transport into pollen and its possible regulatory mechanisms are also discussed.

The chromatin-specific transcription elongation factor FACT comprises human SPT16 and SSRP1 proteins

The regulation of gene expression depends critically upon chromatin structure. Transcription of protein-coding genes can be reconstituted on naked DNA with only the general transcription factors and RNA polymerase II. This minimal system cannot transcribe DNA packaged into chromatin, indicating that accessory factors may facilitate access to DNA. Two classes of accessory factor, ATP-dependent chromatin-remodelling enzymes and histone acetyltransferases, facilitate transcription initiation from chromatin templates. FACT (for facilitates chromatin transcription) is a chromatin-specific elongation factor required for transcription of chromatin templates in vitro. Here we show that FACT comprises a new human homologue of the Saccharomyces cerevisiae Spt16/Cdc68 protein and the high-mobility group-1-like protein structure-specific recognition protein-1. Yeast SPT16/CDC68 is an essential gene that has been implicated in transcription and cell-cycle regulation. Consistent with our biochemical analysis of FACT, we provide evidence that Spt16/Cdc68 is involved in transcript elongation in vivo. Moreover, FACT specifically interacts with nucleosomes and histone H2A/H2B dimers, indicating that it may work by promoting nucleosome disassembly upon transcription. In support of this model, we show that FACT activity is abrogated by covalently crosslinking nucleosomal histones.

Inhibitory effect of ondansetron on glycine response of dissociated rat hippocampal neurons

We examined the effect of ondansetron, an antagonist of type 3 serotonin receptors, on the whole cell response of freshly isolated hippocampal CA1 pyramidal neurons of neonatal and "mature" rats to glycine using the gramicidin perforated patch technique. Ondansetron depressed the current induced by subsaturating concentrations of glycine (IGly) in a concentration-dependent manner. The ondansetron concentration needed to depress IGly induced by 30 microM glycine to half amplitude was 25 microM. Ondansetron (54 microM) shifted the glycine concentration-response curve to the right in a parallel manner, increasing the EC50 for glycine from 40 +/- 3 microM to 70 +/- 5 microM. Ondansetron increased the time constant of activation of IGly without affecting the time constant of deactivation. When examined under current clamp conditions, glycine induced depolarization and hyperpolarization in neonatal and mature neurons, respectively; ondansetron also suppressed these responses to glycine. The data suggest that ondansetron competitively inhibits the glycine receptor.

An activation-specific role for transcription factor TFIIB in vivo

A yeast mutant was isolated encoding a single amino acid substitution [serine-53 --> proline (S53P)] in transcription factor TFIIB that impairs activation of the PHO5 gene in response to phosphate starvation. This effect is activation-specific because S53P did not affect the uninduced level of PHO5 expression, yet is not specific to PHO5 because Adr1-mediated activation of the ADH2 gene also was impaired by S53P. Pho4, the principal activator of PHO5, directly interacted with TFIIB in vitro, and this interaction was impaired by the S53P replacement. Furthermore, Pho4 induced a conformational change in TFIIB, detected by enhanced sensitivity to V8 protease. The S53P replacement also impaired activation of a lexA(op)-lacZ reporter by a LexA fusion protein to the activation domain of Adr1, thereby indicating that the transcriptional effect on ADH2 expression is specific to the activation function of Adr1. These results define an activation-specific role for TFIIB in vivo and suggest that certain activators induce a conformational change in TFIIB as part of their mechanism of transcriptional stimulation.

Effects of qigong on late-stage complex regional pain syndrome

CONTEXT

Despite the growing popularity of qigong in the West, few well-controlled studies using a sham master to assess the clinical efficacy of qigong have been conducted.

OBJECTIVE

To study the effect of qigong on treatment-resistant patients with late-stage complex regional pain syndrome type I.

DESIGN

Block-random placebo-controlled clinical trial.

SETTING

Pain Management Center at New Jersey Medical School.

PATIENTS

26 adult patients (aged 18 to 65 years) with complex regional pain syndrome type I.

INTERVENTIONS

The experimental group received qi emission and qigong instruction (including home exercise) by a qigong master. The control group received a similar set of instructions by a sham master. The experimental protocol included 6 forty-minute qigong sessions over 3 weeks, with reevaluation at 6 and 10 weeks. Assessment included comprehensive medical history, physical exam, psychological evaluation, necessary diagnostic testing. Symptom Check List 90, and the Carleton University Responsiveness to Suggestion Scale.

MAIN OUTCOME MEASURES

Thermography, swelling, discoloration, muscle wasting, range of motion, pain intensity rating, medication usage, behavior assessment (activity level and domestic disability), frequency of pain awakening, mood assessment, and anxiety assessment.

RESULTS

22 subjects completed the protocol. Among the genuine qigong group, 82% reported less pain by the end of the first training session compared to 45% of control patients. By the last training session, 91% of qigong patients reported analgesia compared to 36% of control patients. Anxiety was reduced in both groups over time, but the reduction was significantly greater in the experimental group than in the control group.

CONCLUSIONS

Using a credible placebo to control for nonspecific treatment effects, qigong training was found to result in transient pain reduction and long-term anxiety reduction. The positive findings were not related to preexperimental differences between groups in hypnotizability. Future studies of qigong should control for possible confounding influences and perhaps use clinical disorders more responsive to psychological intervention.

Hypotension does not alter the antinociceptive effect of nifedipine

We explored the relationship between antinociceptive and hypotensive effects of nifedipine (NIF) injected intraperitoneally ( ip, 15 mg/kg) and epidurally (epi, 20 microM), as compared to verapamil (VER, 10 mg/kg ip) and nitroglycerin (NTG, 0.1 and 0.15 mg/kg ip). The systolic blood pressure (BP) and tail-flick (TF) latencies were measured simultaneously every 10 min for 2 hours and individual values of both measurements were correlated. The highest antinociceptive as well as hypotensive effects were both measured in the group receiving NIF epi., with the correlation coefficient r2=0.2878. Injected ip., NIF revealed similar antinociceptive effect, whereas the other studied drugs were not effective. As to the degree of hypotensive activity, NIF epi was followed by VER, NTG 0.1, NIF ip. and NTG 0.15. No significant correlation was found between BP and TF latencies in any group receiving the drugs. We concluded that the antinociceptive response, measured by the tail-flick technique, is independent of the hypotensive activity of the studied drugs, including NIF.

The effects of serotonin biosynthesis inhibition on nicotine and nifedipine-induced analgesia in rats

The calcium channel blocker nifedipine has analgesic properties that are enhanced by nicotine. Although it is not known how this analgesic state might affect the awareness of anginal pain and impending myocardial infraction, recent studies have shown an increased mortality associated with the use of large doses of nifedipine. Because both nifedipine- and nicotine-induced analgesia involve serotonergic mechanisms, we studied the effects of the serotonin biosynthesis inhibitor parachlorophenylalanine (pCPA) on nifedipine- and nicotine-induced analgesia. Nociception was assessed by tail-flick method. Rats pretreated with pCPA (300 mg/kg intraperitoneally [IP]) followed by either nifedipine (15 mg/kg IP) or nicotine (1 mg/kg subcutaneously) had a increase in tail-flick latency of 41% (P = 0.09) and 50% (P = 0.05), respectively, compared with animals that did not receive pCPA. Additionally, rats pretreated with pCPA followed by a combination of nicotine and nifedipine doubled their tail-flick latency (P = 0.0001) compared with animals that were not treated with pCPA. These data further support the involvement of the serotonergic system in both nifedipine- and nicotine-induced analgesia and suggest that drugs that affect serotonin levels, including tricyclic antidepressants and serotonin-specific reuptake inhibitors, may also affect the analgesia induced by nifedipine and nicotine.

IMPLICATIONS

This study examines the effect of serotonin depletion on nicotine- and nifedipine-induced analgesia. Nifidipine is a calcium channel blocker used to treat high blood pressure. It also has pain-relieving properties that are enhanced by nicotine. Because both nifedipine- and nicotine-induced analgesia involve the neurotransmitter serotonin, it is important to know how changes in serotonin concentration might affect both nicotine- and nifedipine-induced analgesia. This study not only supports the involvement of the serotonergic system in both nifidipine- and nicotine-induced analgesia, but also suggests that drugs that affect serotonin levels may also affect analgesia induced by nifidipine and nicotine.

Ondansetron exhibits the properties of a local anesthetic

The purpose of this study was to determine whether ondansetron (OND) has local anesthetic effects. Using a patch-clamp technique, we showed that OND concentration dependently blocked Na channel currents in freshly isolated neurons of rat brains with a 50% inhibition concentration of 12 microM. The blockade started immediately when OND was applied to the cell body using a fast perfusion system, reached a plateau within 15 s, and recovered to the control level within 30 s after washout of the OND-containing solution. Because this is a known property of local anesthetics, we used the tail-flick technique to verify this effect in vivo in Sprague-Dawley rats (n = 46). OND was injected subcutaneously into the tail at the doses of 0.08, 0.16, and 0.2 mg. The tail-flick latency increased 2 min after OND injection, reaching the plateau within 5 min. This effect was dose-related, lasting from 10 to 25 min. These preliminary data indicate that OND, a selective 5-HT3 receptor antagonist, might serve as a prototype molecule for development of a novel series of local anesthetics.

IMPLICATIONS

Ondansetron is a drug used to prevent vomiting, especially in cancer patients after chemotherapy. We found that it also causes numbness when injected under the skin. This new action may contribute to its role in "calming the stomach." We studied the effect of ondansetron on the isolated brain cells of live rats.

GABA(A) antagonist and nicotine-induced antinociception

Rats, pretreated with saline or GABA(A) antagonist bicuculline (BIC) at the doses of 2, 4, 6, 10 and 20 mg/kg, were injected with nicotine (NIC, 1 mg/kg) 30 min later. Tail-flick (TF) latencies were measured before (baseline) and three times at 10 min interval after pretreated compounds, continued every 10 min up to 1 hr after NIC injection. In all groups, median TF latencies did not change from the baseline for the first 30 min after the pretreatment. Following NIC alone (control) and in the group pretreated with 2 mg/kg BIC, 60% rats reached ceiling TF latencies (20 sec) lasting for 10 min. In groups with higher BIC doses (4 to 10 mg/kg), median TF latencies were in the range of 5-7 sec with 30% rats reaching the ceiling TF latencies. Following 20 mg/kg BIC, one out of five rats reached 20 sec; the median was in the range of 4-5 sec. Significantly lower responses were observed following 4 mg BIC and higher doses with no difference among the groups. In conclusion, our novel data show that BIC alone, injected systemically, does not possess any effect on the thermal nociceptive transmission as measured by the tail flick test. However, pretreatment with BIC partially prevents NIC-induced antinociception, in a non dose related manner. This suggests that GABA(A) receptors may, at least in part, contribute to the complex mechanisms involved in NIC-induced antinociception.