EEG complexity as a measure of depth of anesthesia for patients

A new approach for quantifying the relationship between brain activity patterns and depth of anesthesia (DOA) is presented by analyzing the spatio-temporal patterns in the electroencephalogram (EEG) using Lempel-Ziv complexity analysis. Twenty-seven patients undergoing vascular surgery were studied under general anesthesia with sevoflurane, isoflurane, propofol, or desflurane. The EEG was recorded continuously during the procedure and patients' anesthesia states were assessed according to the responsiveness component of the observer's assessment of alertness/sedation (OAA/S) score. An OAA/S score of zero or one was considered asleep and two or greater was considered awake. Complexity of the EEG was quantitatively estimated by the measure C(n), whose performance in discriminating awake and asleep states was analyzed by statistics for different anesthetic techniques and different patient populations. Compared with other measures, such as approximate entropy, spectral entropy, and median frequency, C(n) not only demonstrates better performance (93% accuracy) across all of the patients, but also is an easier algorithm to implement for real-time use. The study shows that C(n) is a very useful and promising EEG-derived parameter for characterizing the (DOA) under clinical situations.

Detecting ventricular tachycardia and fibrillation by complexity measure

Sinus rhythm (SR), ventricular tachycardia (VT) and ventricular fibrillation (VF) belong to different nonlinear physiological processes with different complexity. In this study, we present a novel, and computationally fast method to detect VT and VF, which utilizes a complexity measure suggested by Lempel and Ziv [1]. For a specific window length (i.e., the length of data segment to be analyzed), the method first generates a 0-1 string by comparing the raw electrocardiogram (ECG) data to a selected suitable threshold. The complexity measure can be obtained from the 0-1 string only using two simple operations, comparison and accumulation. When the window length is 7 s, the detection accuracy for each of SR, VT, and VF is 100% for a test set of 204 body surface records (34 SR, 85 monomorphic VT, and 85 VF). Compared with other conventional time- and frequency-domain methods, such as rate and irregularity, VF-filter leakage, and sequential hypothesis testing, the new algorithm is simple, computationally efficient, and well suited for real-time implementation in automatic external defibrillators (AED's).

Derived fuzzy knowledge model for estimating the depth of anesthesia

Reliable and noninvasive monitoring of the depth of anesthesia (DOA) is highly desirable. Based on adaptive network-based fuzzy inference system (ANFIS) modeling, a derived fuzzy knowledge model is proposed for quantitatively estimating the DOA and validate it by 30 experiments using 15 dogs undergoing anesthesia with three different anesthetic regimens (propofol, isoflurane, and halothane). By eliciting fuzzy if-then rules, the model provides a way to address the DOA estimation problem by using electroencephalogram-derived parameters. The parameters include two new measures (complexity and regularity) extracted by nonlinear quantitative analyses, as well as spectral entropy. The model demonstrates good performance in discriminating awake and asleep states for three common anesthetic regimens (accuracy 90.3 % for propofol, 92.7 % for isoflurane, and 89.1% for halothane), real-time feasibility, and generalization ability (accuracy 85.9% across the three regimens). The proposed fuzzy knowledge model is a promising candidate as an effective tool for continuous assessment of the DOA.

Long-term treadmill exercise improves spatial memory of male APPswe/PS1dE9 mice by regulation of BDNF expression and microglia activation

Increasing evidence suggests that physical activity could delay or attenuate the symptoms of Alzheimer's disease (AD). But the underlying mechanisms are still not fully understood. To investigate the effect of long-term treadmill exercise on the spatial memory of AD mice and the possible role of β-amyloid, brain-derived neurotrophic factor (BDNF) and microglia in the effect, male APPswe/PS1dE9 AD mice aged 4 months were subjected to treadmill exercise for 5 months with 6 sessions per week and gradually increased load. A Morris water maze was used to evaluate the spatial memory. Expression levels of β-amyloid, BDNF and Iba-1 (a microglia marker) in brain tissue were detected by immunohistochemistry. Sedentary AD mice and wildtype C57BL/6J mice served as controls. The results showed that 5-month treadmill exercise significantly decreased the escape latencies (P < 0.01 on the 4th day) and improved the spatial memory of the AD mice in the water maze test. Meanwhile, treadmill exercise significantly increased the number of BDNF-positive cells and decreased the ratios of activated microglia in both the cerebral cortex and the hippocampus. However, treadmill exercise did not significantly alleviate the accumulation of β-amyloid in either the cerebral cortex or the hippocampus of the AD mice (P > 0.05). The study suggested that long-term treadmill exercise could improve the spatial memory of the male APPswe/PS1dE9 AD mice. The increase in BDNF-positive cells and decrease in activated microglia might underpin the beneficial effect.

Molecular evolution of calmodulin-like domain protein kinases (CDPKs) in plants and protists

Many genes for calmodulin-like domain protein kinases (CDPKs) have been identified in plants and Alveolate protists. To study the molecular evolution of the CDPK gene family, we performed a phylogenetic analysis of CDPK genomic sequences. Analysis of introns supports the phylogenetic analysis; CDPK genes with similar intron/exon structure are grouped together on the phylogenetic tree. Conserved introns support a monophyletic origin for plant CDPKs, CDPK-related kinases, and phosphoenolpyruvate carboxylase kinases. Plant CDPKs divide into two major branches. Plant CDPK genes on one branch share common intron positions with protist CDPK genes. The introns shared between protist and plant CDPKs presumably originated before the divergence of plants from Alveolates. Additionally, the calmodulin-like domains of protist CDPKs have intron positions in common with animal and fungal calmodulin genes. These results, together with the presence of a highly conserved phase zero intron located precisely at the beginning of the calmodulin-like domain, suggest that the ancestral CDPK gene could have originated from the fusion of protein kinase and calmodulin genes facilitated by recombination of ancient introns.

Ovule development: identification of stage-specific and tissue-specific cDNAs

A differential screening approach was used to identify seven ovule-specific cDNAs representing genes that are expressed in a stage-specific manner during ovule development. The Phalaenopsis orchid takes 80 days to complete the sequence of ovule developmental events, making it a good system to isolate stage-specific ovule genes. We constructed cDNA libraries from orchid ovule tissue during archesporial cell differentiation, megasporocyte formation, and the transition to meiosis, as well as during the final mitotic divisions of female gametophyte development. RNA gel blot hybridization analysis revealed that four clones were stage specific and expressed solely in ovule tissue, whereas one clone was specific to pollen tubes. Two other clones were not ovule specific. Sequence analysis and in situ hybridization revealed the identities and domain of expression of several of the cDNAs. O39 encodes a putative homeobox transcription factor that is expressed early in the differentiation of the ovule primordium; O40 encodes a cytochrome P450 monooxygenase (CYP78A2) that is pollen tube specific. O108 encodes a protein of unknown function that is expressed exclusively in the outer layer of the outer integument and in the female gametophyte of mature ovules. O126 encodes a glycine-rich protein that is expressed in mature ovules, and O141 encodes a cysteine proteinase that is expressed in the outer integument of ovules during seed formation. Sequences homologous to these ovule clones can now be isolated from other organisms, and this should facilitate their functional characterization.

Predicting movement during anaesthesia by complexity analysis of electroencephalograms

A new approach to predicting movement during anaesthesia by using complexity analysis of electroencephalograms (EEG) signals is presented. The raw EEG signal is first decomposed into six consecutive different scaling components by wavelet transform on the basis of its self-similarity. The Lempel-Ziv complexity measures C(n) are extracted from the raw EEG and its corresponding components by complexity analysis. Prediction of movement during anaesthesia is then made by a four-layer artificial neural network (ANN) using the C(n)s. The combination of these three different approaches enables the system to address the non-analytical, non-stationary, non-linear and dynamical properties of the EEG. From 20 dog experiments, 109 distinct EEG recordings are collected under isoflurane anaesthesia. Testing the ANN using the 'drop one dog' method, the performance obtained for the system in detecting movement is: sensitivity 88%, specificity 97% and accuracy 92%. Comparisons with other methods, such as spectral edge frequency, median frequency and principal component analysis, show that the proposed system has a certain advantage. This new method is computationally fast and well suited for realtime clinical implementation.

Tanshinone IIA protects dopaminergic neurons against 6-hydroxydopamine-induced neurotoxicity through miR-153/NF-E2-related factor 2/antioxidant response element signaling pathway

Parkinson's disease (PD) is the second most common progressive neurodegenerative disorder with increased oxidative stress, the underlying vital process contributing to cell death. Tanshinone IIA (Tan IIA), a major bioactive diterpene quinone of Salva miltiorrhiza, had been proved effective in the MPTP model through its anti-inflammatory activity. Here in this research, we found that Tan IIA prevented the loss of nigrostriatal dopaminergic neurons by activating the NF-E2-related factor 2 (Nrf2)-antioxidant response element (ARE) pathway. The cytotoxicity of 6-hydroxydopamine (6-OHDA) was attenuated by the treatment of Tan IIA in SH-SY5Y cells, which significantly reduced 6-OHDA-induced lactic dehydrogenase release and reactive oxygen species production. Further study indicated that Tan IIA contributed to the nuclear accumulation of Nrf2, which bound to the ARE sequence, and activated ARE-regulated genes, including heme oxygenase-1, glutamate cysteine ligase catalytic subunit (GCLC) and glutamate cysteine ligase modifier subunit (GCLM). Tan IIA also protected against damage to mitochondrial membrane potential, reduced the translocation of cytochrome c from the mitochondria to the cytoplasm and the activation of Caspase-9 and Caspase-3. Moreover, we demonstrated the above effects were performed in Nrf2-dependent manner. Further studies revealed that Tan IIA reduced the enhancement of miR-153 by 6-OHDA, which targeted the 3'-UTR of Nrf2, and suppressed its expression and activation. Additionally, neurodegeneration caused by in vivo stereotaxic injection of 6-OHDA could also be ameliorated by the administration of Tan IIA. Taken together, our results strongly suggest that Tan IIA may be beneficial for the treatment of PD, and also confirm that targeting the Nrf2/ARE pathway is a promising strategy for therapeutic intervention in PD.

New approach to studies on ECG dynamics: extraction and analyses of QRS complex irregularity time series

How to extract information intensively from ECGs for the diagnosis of cardiovascular diseases and assessment of heart function is a topical subject. Using a method based on the wavelet transform to calculate the irregularity of the QRS complex, which may relate to inotropy, the QRS complex irregularity time series is successfully extracted from original ECG signals. This provides a new approach to studies of ECG dynamics. With the help of non-linear dynamics theory, the QRS complex irregularity time series of eight subjects from the MIT/BIH arrhythmia database are studied qualitatively and quantitatively, and the characteristics of ECG dynamics are analysed extensively. The power spectrum, phase portrait, correlation dimension, largest Lyapunov exponent, time-dependent divergence exponent and complexity measure all verify the fact that ECG dynamics are dominated by an underlying 5-6-dimensional non-linear chaotic system, whose complexity measure is about 0.7. The QRS complex irregularity time series contains abundant information about all parts of the heart and the regulation of the autonomic nervous system, and so further analyses are of great potential theoretical and clinical significance to patho-physiology studies and ambulatory monitoring.

Identifying sub-phenotypes of acute kidney injury using structured and unstructured electronic health record data with memory networks

Acute Kidney Injury (AKI) is a common clinical syndrome characterized by the rapid loss of kidney excretory function, which aggravates the clinical severity of other diseases in a large number of hospitalized patients. Accurate early prediction of AKI can enable in-time interventions and treatments. However, AKI is highly heterogeneous, thus identification of AKI sub-phenotypes can lead to an improved understanding of the disease pathophysiology and development of more targeted clinical interventions. This study used a memory network-based deep learning approach to discover AKI sub-phenotypes using structured and unstructured electronic health record (EHR) data of patients before AKI diagnosis. We leveraged a real world critical care EHR corpus including 37,486 ICU stays. Our approach identified three distinct sub-phenotypes: sub-phenotype I is with an average age of 63.03±17.25 years, and is characterized by mild loss of kidney excretory function (Serum Creatinine (SCr) 1.55±0.34 mg/dL, estimated Glomerular Filtration Rate Test (eGFR) 107.65±54.98 mL/min/1.73 m²). These patients are more likely to develop stage I AKI. Sub-phenotype II is with average age 66.81±10.43 years, and was characterized by severe loss of kidney excretory function (SCr 1.96±0.49 mg/dL, eGFR 82.19±55.92 mL/min/1.73 m²). These patients are more likely to develop stage III AKI. Sub-phenotype III is with average age 65.07±11.32 years, and was characterized moderate loss of kidney excretory function and thus more likely to develop stage II AKI (SCr 1.69±0.32 mg/dL, eGFR 93.97±56.53 mL/min/1.73 m²). Both SCr and eGFR are significantly different across the three sub-phenotypes with statistical testing plus postdoc analysis, and the conclusion still holds after age adjustment.

Temporal and spatial regulation of 1-aminocyclopropane-1-carboxylate oxidase in the pollination-induced senescence of orchid flowers

Pollination of many flowers initiates a sequence of precisely regulated developmental events that include senescence of the perianth and development of the ovary. The plant hormone ethylene is known to play a key role in regulating the biochemical and anatomical changes that constitute the postpollination syndrome. For this reason, we have studied the pollination syndrome in Phalaenopsis orchids by examining the spatial and temporal location of ethylene biosynthesis within the orchid flower, and how this biosynthesis is regulated by factors that influence expression of genes that encode key enzymes in the ethylene biosynthetic pathway. In particular, we examined the role in the postpollination syndrome of the expression of the gene for 1-aminocyclopropane-1-carboxylate (ACC) oxidase, which catalyzes the conversion of ACC to ethylene. In vivo incubation of tissues with the ethylene precursor ACC demonstrated that ACC oxidase activity increases after pollination in the stigma, contrary to the observation that activity is constitutive in petunia and carnation gynoecia. RNA blot hybridization of floral tissues indicates that the increase in ACC oxidase activity is due to de novo synthesis of mRNA and presumably protein, which is induced after pollination. Furthermore, the pattern of induction is consistent with a model of coordinate regulation of gene expression in which the pollination signal travels to other organs of the flower to induce their ethylene production. We have also used in situ hybridization to define further the temporal and spatial expression of ACC oxidase within the floral organs, showing that expression, and,by inference, the capability to oxidize ACC to ethylene, is induced in all living cells of the tissues examined after pollination. These findings contrast with work in petunia that suggests that ACC oxidase is localized to the stigmatic surface.

Glycoproteins in human parotid saliva assessed by lectin probes after resolution by sodium dodecyl sulphate-polyacrylamide gel electrophoresis

Human parotid salivary glycoproteins separated by gradient sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotted onto nitrocellulose have been investigated using a battery of biotinylated lectin probes of characterized sugar specificity. Lectin binding, detected on blots using avidin-biotin complex (ABC) and a chemiluminescence generating substrate, was recorded on photographic film and compared with the original fluorescein isothiocyanate (FITC) stained blots or with Coomassie Brilliant Blue R-250-stained gels run in parallel. A number of glycoprotein bands which were undetected by protein stains or the periodic acid Schiff reaction were revealed by lectins. Binding by lectins from Concanavalia ensiformis, Lens culinaris, Limax flavus, Phaseolus vulgaris, Ricinus communis, Triticum vulgaris, Lotus tetragonobulus and Ulex europaeus indicated that sialylated and fucosylated triantennary and bisected, N-linked complex sugar chains were present on many glycoproteins in addition to the major glycosylated proline-rich glycoprotein (GI). Binding with lectins from Arachis hypogaea and Dolichos biflorus indicated that the O-linked sugar chains were confined to the alpha-heavy chain of Ig A. Comparison of lectin binding in samples from five healthy individuals revealed differences in a number of glycoproteins in addition to the previously characterized G1 and CON 1/CON 2 polymorphisms and demonstrated that the H blood group antigen was expressed mainly on G1 in parotid saliva. This study will be used as a basis upon which to study salivary glycoproteins in diseases affecting parotid glands.

Mathematical models of cross protection in the epidemiology of plant-virus diseases

ABSTRACT Mathematical models of plant-virus disease epidemics were developed where cross protection occurs between viruses or virus strains. Such cross protection can occur both naturally and through artificial intervention. Examples of diseases with continuous and discontinuous crop-host availability were considered: citrus tristeza and barley yellow dwarf, respectively. Analyses showed that, in a single host population without artificial intervention, the two categories of host plants, infected with a protecting virus alone and infected with a challenging virus, could not coexist in the long term. For disease systems with continuous host availability, the virus (strain) with the higher basic reproductive number (R(0)) always excluded the other eventually; whereas, for discontinuous systems, R(0) is undefined and the virus (strain) with the larger natural transmission rate was the one that persisted in the model formulation. With a proportion of hosts artificially inoculated with a protecting mild virus, the disease caused by a virulent virus could be depressed or eliminated, depending on the proportion. Artificial inoculation may be constant or adjusted in response to changes in disease incidence. The importance of maintaining a constant level of managed cross protection even when the disease incidence dropped was illustrated. Investigations of both pathosystem types showed the same qualitative result: that managed cross protection need not be 100% to eliminate the virulent virus (strain). In the process of replacement of one virus (strain) by another over time, the strongest competition occurred when the incidence of both viruses or virus strains was similar. Discontinuous crop-host availability provided a greater opportunity for viruses or virus strains to replace each other than did the more stable continuous cropping system. The process by which one Barley yellow dwarf virus replaced another in New York State was illustrated.

MetaPred: Meta-Learning for Clinical Risk Prediction with Limited Patient Electronic Health Records

In recent years, large amounts of health data, such as patient Electronic Health Records (EHR), are becoming readily available. This provides an unprecedented opportunity for knowledge discovery and data mining algorithms to dig insights from them, which can, later on, be helpful to the improvement of the quality of care delivery. Predictive modeling of clinical risks, including in-hospital mortality, hospital readmission, chronic disease onset, condition exacerbation, etc., from patient EHR, is one of the health data analytic problems that attract lots of the interests. The reason is not only because the problem is important in clinical settings, but also is challenging when working with EHR such as sparsity, irregularity, temporality, etc. Different from applications in other domains such as computer vision and natural language processing, the data samples in medicine (patients) are relatively limited, which creates lots of troubles for building effective predictive models, especially for complicated ones such as deep learning. In this paper, we propose MetaPred, a meta-learning framework for clinical risk prediction from longitudinal patient EHR. In particular, in order to predict the target risk with limited data samples, we train a meta-learner from a set of related risk prediction tasks which learns how a good predictor is trained. The meta-learned can then be directly used in target risk prediction, and the limited available samples in the target domain can be used for further fine-tuning the model performance. The effectiveness of MetaPred is tested on a real patient EHR repository from Oregon Health & Science University. We are able to demonstrate that with Convolutional Neural Network (CNN) and Recurrent Neural Network (RNN) as base predictors, MetaPred can achieve much better performance for predicting target risk with low resources comparing with the predictor trained on the limited samples available for this risk alone.

Mathematical models of host plant infection by helper-dependent virus complexes: why are helper viruses always avirulent?

ABSTRACT Interactions between viruses in plants are common, and some viruses depend on such interactions for their survival. Frequently, a virus lacks some essential molecular function that another provides. In "helper-dependent" virus complexes, the helper virus is transmitted independently by a vector, whereas the dependent virus depends on molecular agents associated with the helper virus for transmission by a vector. A general mathematical model was developed of the dynamics of host plant infection by a helper-dependent virus complex. Four categories of host plants were considered: healthy, infected with helper virus alone, infected with dependent virus alone, and infected with both viruses. New planting of the host crop was constrained by a maximum abundance due to limitation of the cropping area. The ratio of infection rate to host loss rate due to infection is proposed as an important epidemiological quantity, A, that can be used as a measure of the mutual adaptation of the virus and host. A number of alternative equilibria of host infection could occur and were determined exclusively by parameter values; it was informative to display their distribution in the parameter plane: (1/A)(helper) versus (1/A)(dependent). A simple analysis of the distribution of the final equilibria illustrated that the dependent virus could affect the survival of the helper virus, so facilitation between the two can be reciprocal. The distribution of the final equilibria also indicated that a well-adapted helper virus increases the opportunity for a dependent virus to evolve and survive, and the model, therefore, explains why infection with a helper virus usually causes no or little damage to plants, whereas infection with a dependent virus or mixed infection with both often causes very severe damage.

Ovarian epidermoid cyst: report of eight cases

We report eight cases of ovarian epidermoid cyst in women 25-57 years of age. All of the cysts had a smooth inner lining composed of stratified squamous epithelium with no evidence of hair or a Rokitansky tubercle. Since these lesions accounted for 0.07% of gynecological specimens in our hospital over a 3-year period, epidermoid cysts of the ovary are not as rare as the literature suggests; some are probably misdiagnosed as dermoid cysts. We believe that ovarian epidermoid cysts represent monodermal and highly differentiated teratomas and should be classified as such.

RAPID COMMUNICATION: Generation of FGF5 knockout sheep via the CRISPR/Cas9 system

Sheep are an important source of fiber production. Fibroblast growth factor 5 (FGF5) is a dominant inhibitor of length of the anagen phase of the hair cycle. Knockout or silencing of the gene results in a wooly coat in mice, donkeys, dogs, and rabbits. In sheep breeding, wool length is one of the most important wool quality traits. However, traditional breeding cannot accurately and efficiently mediate an advanced genotype into the sheep genome. In this study, we generated 3 knockout sheep via the 1-step clustered regularly interspaced short palindromic repeat (CRISPR)/Cas9 system. Sequencing analysis confirmed that mutations in the gene existed in all germ lines of 3 founders: besides the intact sequence, 3 kinds of deletions in the gene (including 5, 13, and 33 bp) were detected. The changes in the primary and senior structure of the FGF5 protein due to the 3 deletions in founders suggested that the FGF5 protein was dysfunctional. In addition, the expression level of intact mRNA in heterozygous individuals decreased compared with the wild types ( < 0.01). Functionally, we discovered that wool length in founders was significantly longer than in wild types ( < 0.05). Collectively, the knockout sheep with the longer wool length phenotype will provide an efficient way for fast genetic improvement of sheep breeding and promote the development of wool industry.

In vivo biocompatibility and mechanical study of novel bone-bioactive materials for prosthetic implantation

Two epoxy materials with or without adhesively bonded hydroxyapatite (HA) coatings were studied for their biocompatibility and mechanical pushout strength using in vivo implantation in the rabbit lower femur for a duration of 10 days to 6 months. Both were two-part epoxies cured at room temperature for 24 h, with material 1 (Ampreg 26; SP Systems Limited, Cowes, UK) postcured at 110 degrees C (Tg approximately 80 degrees C) and Material 2 (CG5052; Ciba Geigy Limited, Cambridge, UK) at 125 degrees C (Tg approximately 120 degrees C). Implantation in dead rabbit bone was performed to provide mechanical baseline levels. Polymethylmethacrylate (PMMA) and conventionally HA-coated titanium alloy (Ti-6Al-4V) were used as control materials. In the biological study, different fluorescent dyes were used to label newly formed bone. After 6 weeks of implantation, results from mechanical pushout tests showed that the interfacial shear strength (ISS) values were significantly higher than for dead bones with each of the different implants (p < .01-.001). HA-coated material 2 showed a significantly higher ISS value than the uncoated material (p < .05) after 6 weeks' implantation. However, the ISS value for the uncoated material 2 was significantly higher than for PMMA controls (p < .05). No significant differences in the ISS values were shown between HA-coated materials 1 and 2 and Ti-6Al-4V on in vivo implantation for 6 weeks. Failure points of the pushout test from the three HA-coated materials were defined by scanning electron microscopy. Specimens implanted with both HA-coated epoxies were fractured within the HA-coatings or the bone, while with HA-coated Ti-6Al-4V cracked between the coating and metal implant. The percentage of bone in contact with the implant surface was obtained by image analysis which showed that there were no significant differences between different materials after short time implantation (up to 6 week). Long-term implantation of the HA-coated material 2 showed that the percentage of bone contact had increased from 52.8+/-1.1% (6 week) to 80.0+/-0.3% (3 months) (p < .01) and remained at 81.0+/-0.8% (6 months). Measurements of bone mineralization rate (BMR) showed that after 3 weeks of implantation, there were no significant differences between PMMA and uncoated materials 1 and 2. After 6 weeks, the BMRs in animals implanted with either HA-coated material 1 or 2 were significantly higher than with HA-coated Ti-6Al-4V (p < .05-.0001 in both cases), but with HA-coated material 2 was lower than with this material uncoated (p < .05-.001). No significant differences were found between the two HA-coated epoxy materials. In addition, there were always lower BMRs during the third week of implantation than other periods regardless of biomaterial implanted. The study indicated that the adhesively bonded HA-coated novel epoxy materials were superior to conventional plasma-sprayed Ti-6Al-4V implants with respect to both BMR and bone integration with the implant surfaces. Adhesively bonded HA-coated epoxy materials had similar ISS values to HA-coated Ti-6Al-4V, but the former failed within the bone and coating, while the latter showed splitting between coating and metal.

Primary Leiomyosarcoma of the Great Saphenous Vein: Case Report

OBJECTIVE

To describe a case of primary leiomyosarcoma of the great saphenous vein.

PATIENT RECORD

A 59-year-old Chinese lady presented with two painful lumps in the right thigh in the line of the great saphenous vein. At surgery, in September 2004, two tumors in the right great saphenous vein above the knee were excised with the intervening normal vein. Histopathological studies confirmed both masses as leiomyosarcoma. Radiotherapy was given postoperatively. The patient has been followed-up for 300 days after surgery with no evidence of local or distant metastasis.

CONCLUSION

Leiomyosarcoma of the great saphenous vein can exist at more than one site. Tumor resection and radiotherapy was associated with good patient prognosis.

In situ localization of apoptotic changes in the interface membrane of aseptically loosened orthopaedic implants

Twenty specimens of bone-implant interface membrane from THR/TKR were used for in situ localization of apoptotic changes. A panel of antibodies was used to label leukocyte antigens (CD68 and CD3) cytokines (IL-1alpha and IL-1beta) and apoptosis inhibiting and promoting proteins (bcl-2 and bax) by means of immunohistochemical techniques. A DNA fragment test on the tissue sections was also carried out to confirm actual cell death using the enzyme terminal deoxy nucleotidyl transferase (TdT) to incorporate biotinylated nucleotide with the 3'-OH DNA ends. Leukocyte antigen staining showed that there were large numbers of CD68 positive macrophages as well as multinucleate giant cells (MNGC) but that CD3 positive lymphocytes were also present in the interface membrane. The leukocyte surface antigen staining pattern corresponded to previous findings [1]. Immunostaining with bcl-2 and bax antibodies revealed that both of these proteins were expressed in the cytoplasm of the cells in the interface membrane but they showed different cellular patterns. Bcl-2 was localized in a small number of lymphocyte-like cells while bax was expressed by large numbers of cells, mainly macrophages. The number of cells which expressed bcl-2 was significantly lower than that of bax (P<0.01). DNA fragment localization occurred mostly in a layer of cells (1- 3 cells deep) next to the implant surface. Again the level of DNA fragment-containing cells was significantly lower than that of bax positive cells (P<0.01). The results, for the first time, indicate that there is an apoptotic activity occurring in cells in the interface membrane, but not all the cells which express apoptosis-promoting protein (i.e. bax) will enter into the phase of cell death.