Construction and validation of a nomogram model for predicting early death in patients with metastatic pancreatic adenocarcinoma based on SEER database

BACKGROUND

Pancreatic adenocarcinoma is a highly aggressive malignancy that presents a considerable risk of early death (survival time ≤ 3 mo). As such, it is of great significance to develop an effective nomogram for predicting the likelihood of early death in patients with metastatic pancreatic adenocarcinoma.

AIM

To construct and validate a predictive nomogram model for early death in patients with metastatic pancreatic adenocar-cinoma.

METHODS

We extracted data from the SEER database of 18603 eligible patients with metastatic pancreatic adenocarcinoma from 2010 to 2015, and randomly divided them into training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed on the training cohort to identify the risk factors for early death, based on which a nomogram was constructed. The performance of the nomogram was verified by receiver operating characteristic (ROC) curve and calibration curve analyses in both the training and validation cohorts. The clinical practicability of the nomogram was evaluated by decision curve analysis (DCA).

RESULTS

Age, sex, primary site, grade, T stage, N stage, brain metastasis, bone metastasis, liver metastasis, lung metastasis, surgery, radiotherapy, and chemotherapy were identified as independent risk factors for early death in patients with metastatic pancreatic adenocarcinoma. Based on these variables, a nomogram was constructed. The areas under the ROC curves of the nomogram in the training and validation cohorts were 0.810 (95% confidence interval [CI]: 0.802-0.811) and 0.802 (95%CI: 0.790-0.813), respectively, indicating good discrimination. The calibration curves showed good calibration degrees in both cohorts, and the DCA results demonstrated that the nomogram had better clinical net benefit in predicting early mortality compared with TNM stage.

CONCLUSION

The constructed nomogram has good predictive ability for early death in patients with metastatic pancreatic adeno-carcinoma. This will help clinicians develop individualized treatment plans for these patients.

[Feasibility of single-stage stent implantation following rotational atherectomy combined with TAVR]

Objective: To explore the feasibility of the single-stage stent implantation following rotational atherectomy combined with transcatheter aortic valve replacement (TAVR) in treating patients with severe aortic stenosis(AS) and severe calcified coronary artery stenosis. Methods: Three patients who received single-stage stent implantation following rotational atherectomy combined with TAVR in Fuwai hospital from April to October 2019 were included in this retrospective analysis. Clinical and anatomical features (including echocardiography and aortic CT) of the patients were collected, efficacy and safety of this operation strategy were observed and 6 months follow up results were summarized. Results: Three patients (2 females, 66-80 years old) were included. The mean Society of Thoracic Surgeons (STS) risk score was 7.8%. The mean maximum velocity of aortic valve was 4.4 m/s, the mean transvalvular pressure gradient was 53.2 mmHg (1 mmHg=0.133 kPa), mean left ventricular ejection fraction (LVEF) was 48.6%. All three patients had severe calcified coronary artery stenosis: left anterior descending artery (LAD, n=2) and left main coronary artery (LM, n=1), requiring rotary grinding. The mean SYNTAX score was 20. All the procedures were performed through transfemoral access. After aortic valve crossing, all coronary lesions were successfully treated with stent implantation following rotational atherectomy, transfemoral TAVR was then immediately performed with a self-expandable Venus-A valve. One patient underwent"valve-in-valve"implantation due to the high-implantation position of the first valve. The procedures were completed without complications in all the three patients. The immediate effect was satisfactory. Echocardiography results showed that the mean maximum velocity of aortic valve was 2.1 m/s, mean gradient was 9.3 mmHg, and mean LVEF was 59% after the procedure. There was no death and revascularization during the 6 months follow-up. Conclusion: In patients with severe calcified coronary artery and severe AS with high risk of cardiac surgery, the single-stage stent implantation following rotational atherectomy combined with TAVR is feasible and results are satisfactory in this patient cohort.

[Consistency analysis and influencing factors of performing VOTE scores for drug-induced sleep endoscopy]

Objective: To investigate the consistency of Velum, Oropharygneal, Tongue base, Epiglottis (VOTE) scores between two surgeons with similar clinical experience in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with different degree of disease, and to analyze the influencing factors leading to the difference in score. Methods: This was a cross-sectional study. 64 preoperative drug-induced sleep endoscopy (DISE) videos of OSAHS patients during December 2014 to July 2018, from Nanfang Hospital, Southern Medical University were analyzed. The VOTE score was assessed single-blind by two similar experienced surgeons, and the Kappa value between the two scorers was calculated by the third researcher. According to the characteristics of the case, Fisher's exact test or chi-square test method was used to further explore the factors that influenced the consistency. Results: Sixty-four patients were divided into four groups according to the severity of the disease, including mild (7 cases), moderate (30 cases), severe(18 cases), and extremely severe (9 cases). The scores evaluated between two researchers were analysed for consistency. For mild patients, the two scorers were completely consistent in the configuration and degree of obstruction in the velum and epiglottis (Kappa=1). There was no agreement on whether obstruction or not, obstructed configuration, obstructed degree of the oropharynx and tongue base, and presence of velum and epiglottis obstruction. For moderate patients, the two scorers had a good consistency in the configuration and degree of the velum (0.61≤Kappa≤0.80), and there was no consistency in the evaluation of the degree of tongue base and epiglottis (P>0.05). The consistency of the remaining obstructed conditions in the four planes was generally or moderate (0.21≤Kappa≤0.60). For patients with severe OSAHS, the two raters were completely consistent in the evaluation of palatopharyngeal and epiglottic planes for the presence of obstruction, but there was no consistency in the degree of obstruction. Although the degree of obstruction in the oropharyngeal plane can be assessed with good consistency, the consistency of whether the plane was blocked or not was generally not high. In the assessment of other obstructive conditions in the four planes of severe patients, the agreement between the two scorers was moderate or generally. For extremely severe patients, the two scorers were completely consistent in the evaluation of the velum obstruction, but there was no consistency in the degree of obstruction of the oropharynx and tongue base, and the obstruction configuration and degree of the epiglottis. The evaluation of other obstructed conditions in the four planes is good or moderate. Among the patients with severe OSAHS, the difference in the assessment of obstruction of the oropharynx was associated with tonsil size (P<0.05). Conclusion: When physicians with similar clinical experience scored VOTE, the consistency of whether the velum and oropharyngeal planes are obstructed is related to the severity of the disease. Better consistency is observed among more severe OSAHS patients. The reason for the poor consistency of the oropharyngeal plane in severe OSAHS patients OSAHS is due to the difference of the tonsils size. For severe OSAHS patients with small tonsils, the assessment of whether the oropharynx is obstructed should be more cautious.

[A new antiviral isoquinoline alkaloid from Thalictrum glandulosissimum]

A new isoquinoline alkaloid(1) has been isolated from the whole plant of Thalictrum glandulosissimum by using various chromatographic techniques, including silica gel, sephadex, MCI-gel resin, and RP-HPLC, and its structure was determined as 1-(6-hydroxy-7-methylisoquinolin-1-yl) ethantone by physicochemical properties and spectroscopic data. This compound was evaluated for anti-tobacco mosaic virus(TMV) activity. The results showed that it had prominent anti-TMV activity with inhibition rates of 28.4%. This rate was closed to that of positive control.

Molecular mechanism for metformin to enhance pro-apoptotic effect of sorafenib in HepG2 cells

BACKGROUND

Prolonging the survival time of patients with advanced liver cancer is a major clinical challenge. Sorafenib (Sor) is the only targeted drug for the treatment of advanced liver cancer, but drug resistance has become a problem.

AIM

To explore the effect and molecular mechanism of metformin (Met) in enhancing pro-apoptotic effect of Sor in HepG2 cells.

METHODS

MTT assay was used to evaluate the anti-proliferation effects of Met and Sor, alone or in combination. Flow cytometry was employed to analyze cell cycle and cell apoptosis. The expression of Caspase-3, Bax, AMPK, P53, and mTORC1 was evaluated by Western blot.

RESULTS

MTT assay showed that both Met and Sor decreased HepG2 cells viability, and Met combined with Sor had a synergistic inhibitory effect. The relative cell viability rates of the control group, Met group, Sor group, and combination group were 100%, 79.96% ± 4.41%, 85.33% ± 1.00%, and 68.60% ± 4.02%, respectively. Flow cytometry showed that both Met and Sor induced HepG2 cell apoptosis, and Met combined with Sor had a synergistic effect. The apoptosis rates of the control group, Met group, Sor group, and combination group were 4.47% ± 1.93%, 13.73% ± 1.18%, 9.50% ± 0.20%, and 29.03% ± 0.35%, respectively. Western blot analysis showed that both Met and Sor increased the expression of Caspase-3, Bax, P53, and AMPK and decreased the expression of mTORC1.

CONCLUSION

Met can enhance the pro-apoptotic effect of Sor in HepG2 cells.

[A new antimicrobial isobenzoisofuran compound from Cassia pumila]

A new isobenzoisofuran(1) has been isolated from the whole plant of Cassia pumila using various chromatographic techniques, including silica gel, Sephadex, MCI-gel resin, and RP-HPLC, and its structure was determined as 9-(2-hydroxyethyl)-2,2-dimethyl-2H-furo[3,4-g]chromen-6(8H)-one. This compound was also evaluated for its antibacterial activity. The results showed that it had prominent antibacterial activity with MIC_(90) value of(45.2±4.2) μg·mL~(-1) for methicillin resistant Staphylococcus aureus(MRSA) strain. This value was closed to that of levofloxacin [with MIC_(90) value(48.5±4.3) μg·mL~(-1)].

[A new phenolic compound from endophytic fungus Aspergillus fumigatus of Euphorbia royleana]

This research was carried out to study the secondary metabolites of endophytic fungus Aspergillosis fumigatus from Euphorbia royleana. The endophytic fungus A. fumigatus was fermented by solid fermentation,and purified by various chromatographic methods after extraction. The structures of the compounds were identified by1 H-NMR,13 C-NMR and HSQC,HMBC spectra and physicchemical properties. Three compounds were isolated and their structures were identified as 3-( 3,4-dihydroxybenzoyl)-5-( 3,4-dihydroxyphenyl)-6-methyl-5,6-dihydro-2 H-pyran-2-one( 1),hydroxysydonic acid( 2) and 11-hydroxysydonic acid( 3). Compound 1 is a new compound.

Safety and long-term outcomes of endoscopic papillary balloon dilation for removal of common bile duct stones

BACKGROUND

Endoscopic papillary balloon dilation (EPBD) is an effective treatment for common bile duct stones (CBDSs), but there have been few evaluations on its safety and long-term outcomes.

AIM

To assess the safety and long-term outcomes of EPBD in the treatment of CBDSs.

METHODS

The clinical data of patients who underwent CBDSs removal by EPBD from January 2014 to December 2015 at our hospital were reviewed. The main outcomes were stone clearance, endoscopic retrograde cholangiopancreatography (ERCP)-related complications, and stone recurrence.

RESULTS

A total of 42 patients with CBDSs who underwent EPBD at our hospital were reviewed. The overall successful CBDSs clearance was 100%. ERCP-related complications occurred in four ERCP procedures, all of which were pancreatitis. There was no perforation, bleeding, or cholangitis. Ten (23.8%) of forty-two patients had CBDSs recurrence after a mean period of 51.8 mo (18-66 mo) from the end of EPBD. Female gender (odds ratio = 22.891, 95% confidence interval: 1.544-339.362, P = 0.023) was significantly related to stone recurrence.

CONCLUSION

EPBD is safe and effective in the removal of CBDSs. Female gender may be a risk factor for stone recurrence in a long term.

[A new cytotoxic flavone from Cassia nomame]

A new flavone( 1) has been isolated from the whole plant of Cassia nomame by using various chromatographic techniques,including silica gel,Sephadex,MCI-gel resin,and RP-HPLC,and its structure was determined as 8,4'-dimethoxy-7-( 2-oxopropyl)-flavone based on spectroscopic data. The biological activity test showed that this compound displayed potent cytotoxicity against NB4,SH-SY5 Y,PC3,A549 and MCF-7 cell lines with IC₅₀ values 2. 2,1. 8,3. 4,4. 5 and 1. 6 μmol·L^-1,respectively.

[A new isobenzofuranone derivative from Chaenomeles sinensis and its antibacterial activity]

A new isobenzofuranone derivative was isolated from Chaenomeles sinensis by using various chromatographic techniques,including silica gel,Sephadex LH-20,MCI-gel resin and RP-HPLC. This compound was determined as 2,2-dimethyl-5-( 2-oxopropyl)-2 H-furo[3,4-h]chromen-7( 9 H)-one( 1) by NMR,MS,IR and UV spectra,and was also evaluated for its antibacterial activity. The results showed that it showed prominent antibacterial activity with MIC90 value of( 53. 7±4. 5) mg·L-1 for methicillin resistant Staphylococcus aureus( MRSA) strain. This value is close to that of levofloxacin [with MIC90 value( 50. 2± 4. 2) mg·L-1].

Isolation and synthesis of a new benzylated alkamide from the roots of Lepidium meyenii

A new benzylated alkamide, N-(3,4-dimethoxybenzyl)-9Z-oleamide (1), along with two known ones (2 and 3) were isolated from the roots of Lepidium meyenii collected from Lijiang, Yunnan Province of China. Their structures were elucidated by extensive spectroscopic analyses and the new compound further confirmed by a one-step synthesis. All the isolated alkamides were evaluated for their cytotoxicity against five human cancer cell lines. However, no significant activities were detected at concentrations up to 40 μM.

[A new cytotoxic alkaloid from roots of Alangium chinense]

We have carried out the chemical investigation on the roots of Alangium chinense. The chemical constituents from the roots of A.chinense were isolated and purified by various chromatographic techniques, such as silica gel, MCI-Gel resin, Sephadex LH-20 and high performance liquid chromatography. As a result, three alkaloids (1-3) were isolated from 90% EtOH extracts of the roots of this plant. Their structures were elucidated by physical-chemical properties and spectral data. Among them, compound 1 is a new compound, determined as 8-hydroxy-3-hydroxymethyl-6,9-dimethyl-7H-benzo[de]isoquinolin-7-one. Cytotoxicity of the compounds was evaluated by the MTT method. Compound 1 displayed cytotoxicity against NB4, A-549, SHSY5Y, PC-3 and MCF-7 cell lines with IC₅₀ values of 4.2, 3.5, 5.7, 2.8 and 3.9 μmol•L⁻¹, respectively.

[Copy number aberrations of genes related to extrohepatic metastasis-free survival after operation for hepatocellular carcinoma]

Objective: To investigate the molecular markers of copy number aberrations (CNAs) of genes related to extrohepatic metastasis-free survival after the operation for hepatocellular carcinoma (HCC). Methods: The CNA status of 20 candidate genes in 66 HCC samples was detected by microarray comparative genomic hybridization. The associations between gene CNAs and extrohepatic metastasis-free survival were evaluated using the Cox regression model, Log-rank test, and Kaplan-Meier survival analysis. Results: Multivariate Cox analysis revealed that the independent risk factors for metastasis-free survival were MDM4 gain (hazard ratio [HR] = 2.74, 95% confidence interval [CI] = 1.18-6.37, P < 0.05), APC loss (HR = 8.43, 95% CI = 2.48-28.66, P < 0.01), and BCL2L1 gain (HR = 3.45, 95% CI = 1.13-10.52, P < 0.05) and the independent protective factor was FBXW7 loss (HR = 0.32, 95% CI = 0.12-0.89, P < 0.05). By stepwise Cox regression analysis, three CNAs related to metastasis-free survival were screened out: MDM4 gain (HR = 2.71, 95% CI = 1.11-6.64, P < 0.05), APC loss (HR = 7.19, 95% CI = 1.88-27.60, P < 0.005), and FBXW7 loss (HR = 0.16, 95% CI = 0.05-0.46, P < 0.01). There were significant differences in metastasis-free survival rate between the HCC patients with FBXW7 loss and without MDM4 gain or APC loss, those with MDM4 gain and/or APC loss and without FBXW7 loss, and those with other CNA combinations (log-rank test, P < 0.01). Conclusion: MDM4 gain, APC loss, and FBXW7 loss are the independent prognostic factors for extrohepatic metastasis-free survival after the operation for HCC and can be used to predict the risk of extrohepatic metastasis after the operation for HCC.

Role of VEGF in metformin induced apoptosis of HepG2 cells

AIM

To investigate the molecular mechanism of metformin induced apoptosis of HepG2 cells.

METHODS

HepG2 cells were treated with different concentrations (0-20 mmol/L) of metformin (MET) for 24 h or 10 mmol/L MET for different times (0-48 h), and the effect of MET on cell proliferation was measured by MTT assay. Annexin V-FITC/PI flow cytometry was used to determine the apoptosis rate. RT-PCR was used to analyze the expression of vascular endothelial growth factor (VEGF) in HepG2 cells treated with MET.

RESULTS

MET had an obvious inhibitory effect on HepG2 cell proliferation. After treatment with 0, 5, 10, 15, and 20 mmol/L MET for 24 h, the relative cell viability rates of HepG2 cells were 100%, 80.56% ± 0.72%, 71.06% ± 0.70%, 64.73% ± 0.35%, and 54.73% ± 0.40%, respectively, showing a dose-dependent manner. After treatment with 10 mmol/L MET for 0, 12, 24, 36, and 48 h, the relative cell viability rates of HepG2 cells were 100%, 83.40% ± 0.70%, 69.86% ± 0.45%, 60.40% ± 0.88%, and 50.70% ± 0.45%, respectively, showing a time-dependent manner. Annexin V-FITC/PI flow cytometry revealed that the apoptosis rates of HepG2 cell were increased after treatment with 0, 5, 10, 15, and 20 mmol/L MET for 24 h, and the apoptosis rates were 2.78% ± 0.68%, 9.33% ± 0.22%, 17.13% ± 0.10%, 21.61% ± 0.20%, and 25.26% ± 1.09%, respectively, showing a dose-dependent manner. The apoptosis rates of HepG2 cells were increased after treatment with 10 mmol/L for 0, 12, 24, 36, 48 h, and the apoptosis rates were 2.05% ± 0.04%, 8.10% ± 0.08%, 16.53% ± 0.93%, 20.95% ± 0.16%, and 25.65% ± 0.44%, showing a time-dependent manner. The expression of VEGF decreased after treatment with different concentrations of MET for 24 h or 10 mmol/L MET for different times, showing a dose- and time-dependent manner.

CONCLUSION

MET can inhibit HepG2 cell proliferation via inducing apoptosis, which may involve the expression of VEGF.

(+)-Meyeniins A-C, Novel Hexahydroimidazo[1,5-c]thiazole Derivatives from the Tubers of Lepidium meyenii: Complete Structural Elucidation by Biomimetic Synthesis and Racemic Crystallization

(+)-Meyeniins A-C (1-3), a novel class of sulfur-containing hexahydroimidazo[1,5-c]thiazole derivatives, were isolated from the tubers of Lepidium meyenii (maca) cultivated in Lijiang, Yunnan province, China. Guided by their biosynthetic hypothesis, a stereocontrolled biomimetic synthesis of meyeniins A-C and their individual enantiomers was efficiently accomplished by a combination of a condensation reaction and Edman degradation. The formation of high-quality crystals for X-ray crystallography occurred much more readily from a racemic mixture of (±)-meyeniin A than with the single enantiomer alone in this case. These extensive strategies, combined with circular dichroism (CD) spectra, allowed the complete structural assignments of (+)-meyeniins A-C. Among them, (+)-meyeniin A showed moderate selective cytotoxicities against the HL-60, A549 and MCF-7 human cell lines with IC₅₀ values of 14.41, 32.22, and 33.14 μM, respectively. To some extent, these findings support traditional applications of maca as healthy nutritional supplements or functional foods for cancer prevention.

[Outcome comparison of different therapy procedures in surgical high-risk elderly patients with severe aortic stenosis]

Objective: To compare the outcome of surgical high-risk elderly patients with severe aortic stenosis(SAS) treated by different therapy procedures, including transcatheter aortic valve implantation(TAVI), surgical aortic valve replacement(SAVR), and drug therapy. Methods: We retrospectively analyzed the clinical data of 242 surgical high-risk elderly (age ≥65 years old) SAS patients hospitalized in Fuwai Hospital between September 2012 and June 2015. According to the treatment method, patients were divided into TAVI group (81 cases), SAVR group (59 cases) and drug therapy group (102 cases). The primary end point was all-cause mortality at 1 year post procedure, and secondary end point included cardiac function class(NYHA), vascular complication, valvular function, non-fatal myocardial infarction, new atrial fibrillation, stroke, bleeding, pacemaker implantation, acute renal failure, and readmission. We used the Kaplan-Meier method to estimate survival function based on follow up data and survival was compared between groups with the use of the log-rank test. Results: (1) In the baseline data, there were statistically significant difference among 3 groups for the age, left ventricular ejection fraction, cardiac function class Ⅲ and Ⅳ, rates of combined diabetes, chronic renal failure, mild and moderate mitral regurgitation (P<0.01 or 0.05). The risk score of the Society of Thoracic Surgeons(STS) was 7.28±4.98 in the TAVI group, and 5.67±3.49 in the SAVR group(P=0.036). (2) The perioperative rates of pacemaker implantation(11.3%(9/81) vs. 0, P=0.025) and mild paravalvular regurgitation(29.6%(24/81) vs.1.7%(1/59), P<0.001) were significantly higher in TAVI group than in SAVR group.(3)The rate of rehospitalization was significantly lower in TAVI group than in SAVR group(3.0%(2/67) vs. 22.7%(10/44) P=0.005) and the rate of pacemaker implantation was significantly higher in TAVI group than in SAVR group(17.5 (12/67) vs. 0, P=0.008) after 1 year. The rates of death from any cause in the TAVI (5.8%(4/67)) and SAVR group (11.4%(5/44)) were significantly lower than that in the drug therapy group (54.9%(50/91), both P<0.05) after 1 year and was similar between TAVI group and SAVR group(P=0.622). (4) The rates of cardiac function classⅠandⅡ increased and Ⅲ and Ⅳ decreased in TAVI and SAVR group after 1 year when compared with base line(P<0.001). The rates of cardiac function class Ⅱ, and Ⅲ increased , class Ⅰ and Ⅳ decreased in drug therapy group after 1 year compared with base line (P=0.020). (5)The survival rates after 1 year were significantly higher in the TAVI group and SAVR group than in the drug therapy group(log-rank test, P<0.001), and the difference was similar between TAVI group and SAVR group (log-rank test, P=0.062). Conclusion: In surgical high-risk elderly patients with SAS, the prognosis of drug therapy was poor, and TAVI and SAVR were associated with similarly improved rates of survival after 1 year, although there were significant differences in periprocedural complications between TAVI and SAVR groups.

Anticoagulant rodenticide poisoning with strangulated intestinal obstruction as initial manifestation: A case report and literature review

The clinical manifestations of anticoagulant rodenticide poisoning include subcutaneous bleeding, alimentary tract bleeding, urinary tract bleeding, vaginal bleeding, and even visceral hemorrhage. Strangulated intestinal obstruction is a rare manifestation of rodenticide poisoning and may lead to misdiagnosis. Here, we report a case of anticoagulant rodenticide poisoning with strangulating intestinal obstruction as initial manifestation. We also performed a literature review to raise clinicians' awareness of atypical anticoagulant rodenticide poisoning.

Antiviral and Cytotoxic Isocoumarin Derivatives from an Endophytic Fungus Aspergillus oryzae

Oryzaeins A-D (1-4), four new isocoumarin derivatives, along with five known ones (5-9) were isolated from solid cultures of an endophytic fungus Aspergillus oryzae. Their structures were elucidated by detailed spectroscopic analysis and by comparison with reported data of related derivatives. Among them, compounds 1 and 2 represent the first examples of isocoumarins possessing an unusual 2-oxopropyl group and a rare 3-hydroxypropyl group. Compounds 1 and 2 displayed moderate anti-tobacco mosaic virus activities with inhibition rates of 28.4% and 30.6%, respectively, at the concentration of 20 µM. The new compounds showed moderate inhibitory activities against several human tumor cell lines with IC50 values in the range of 2.8-8.8 µM. Supporting information available online at http://www.thieme-connect.de/products.

Enhanced antitumor effects of adenoviral-mediated siRNA against GRP78 gene on adenosine-induced apoptosis in human hepatoma HepG2 cells

Our previous studies show that adenosine-induced apoptosis is involved in endoplasmic reticulum stress in HepG2 cells. In this study, we have investigated whether knockdown of GRP78 by short hairpin RNA (shRNA) increases the cytotoxic effects of adenosine in HepG2 cells. The adenovirus vector-delivered shRNA targeting GRP78 (Ad-shGRP78) was constructed and transfected into HepG2 cells. RT-PCR assay was used to determine RNA interference efficiency. Effects of knockdown of GRP78 on adenosine-induced cell viabilities, cell-cycle distribution and apoptosis, as well as relative protein expressions were determined by flow cytometry and/or Western blot analysis. The intracellular Ca2+ concentration was detected by laser scanning confocal microscope. Mitochondrial membrane potential (ΔΨm) was measured by a fluorospectrophotometer. The results revealed that GRP78 mRNA was significantly downregulated by Ad-shGRP78 transfection. Knockdown of GRP78 enhanced HepG2 cell sensitivity to adenosine by modulating G0/G1 arrest and stimulating Bax, Bak, m-calpain, caspase-4 and CHOP protein levels. Knockdown of GRP78 worsened cytosolic Ca2+ overload and ΔΨm loss. Knockdown of caspase-4 by shRNA decreased caspase-3 mRNA expression and cell apoptosis. These findings indicate that GRP 78 plays a protective role in ER stress-induced apoptosis and show that the combination of chemotherapy drug and RNA interference adenoviruses provides a new treatment strategy against malignant tumors.

Cytotoxic deoxybenzoins and diphenylethylenes from Arundina graminifolia

Eight new C-4-alkylated deoxybenzoins (1-8), three new diphenylethylenes (9-11), and five known diphenylethylenes were isolated from Arundina graminifolia. The structures of 1-11 were elucidated by spectroscopic methods including extensive 1D and 2D NMR techniques. Compounds 9-11 are the first naturally occurring diphenylethylenes possessing a hydroxyethyl unit. Compounds 1-11 were evaluated for cytotoxicity against five human tumor cell lines. Compounds 4, 5, and 9-11 showed significant cytotoxicity against five cancer cell lines, with IC50 values ranging from 1.8 to 8.7 μM.

Apoptosis induced by adenosine involves endoplasmic reticulum stress in EC109 cells

Apoptosis plays a critical role in the development and homeostasis of multicellular organisms, and endoplasmic reticulum stress (ERS) is one of the intrinsic apoptosis pathways. Previous studies have shown that adenosine induces apoptosis in several cancer cell lines. However, the molecular mechanism remains poorly understood. In this study, we explored whether adenosine triggers apoptosis of EC109 esophageal carcinoma (EC) cells by ERS. The MTT assay was used to determine cell proliferation; cell cycle detection (FCM) and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay were performed to determine cell apoptosis. The subcellular distribution and expression of the ERS-related proteins GRP78, cleaved caspase-3, cleaved caspase-4, CHOP and NF-κB p65 were detected by western blot techniques. NF-κB activation was measured by electrophoretic mobility shift assay (EMSA). The MTT assay demonstrated that adenosine inhibited EC109 cell proliferation in a dose- and time-dependent manner. FCM and TUNEL assay verified that adenosine caused an apoptotic peak in cell cycle arrest and a higher percentage of apoptotic cells. Western blot analysis confirmed that the expression of GRP78, cleaved caspase-4, CHOP, NF-κB p65 and cleaved caspase-3 were upregulated in a dose-dependent manner after adenosine treatment. EMSA revealed that adenosine activated NF-κB p65. This is the first demonstration that adenosine inhibits cell proliferation, increases GRP78 and NF-κB p65 expression and induces apoptosis by CHOP and caspase-4 pathways. The ERS pathway is involved in adenosine-induced apoptosis in EC109 cells.

[Determination of 11 kinds of inorganic elements in Cortex Spondiacis by microwave digestion/ICP-MS method]

The present research aimed to establish a kind of simple and rapid method to detect metal elements in Cortex Spondiacis were determined by microwave digestion and inductively coupled plasma mass spectrometry (ICP-MS). The sample was digested with HNO3-H2O2 acids system. The operation would be simplified and the blank value would be decreased with the above acids systems. Instead of using concent rated acid, this experiment not only can leave out the process of drying or dilution and save time, and extend the life of the instrument, but also eliminates the errors of the inconsistency between digestion solutions and standard solutions. The experimental results showed that Cortex Spondiacis is rich in beneficial elements such as potassium, calcium, magnesium, iron, sodium, and nickel. And the content of harmful elements of the drug, such as mercury, lead, cadmi um and arsenic, is under the national rule, which have some medicinal value. Under the optimum working conditions of the instrument, the detection limits were all smaller than 0.052 1 microg x L(-1), the recovery ratios by standard addition were in the range of 90.8%-113.8% and the RSD was smaller than 5.10% for all elements. Precision and accuracy of determining results are satisfactory. This results are reliable. These results are reliable. The method can meet the need for simultaneity determination of high content element and trace element in Cortex Spondiacis.

Involvement of endoplasmic reticulum stress in adenosine-induced human hepatoma HepG2 cell apoptosis

Endoplasmic reticulum stress (ERS)-mediated cell apoptosis has been implicated in the development of multiple diseases such as cancer, neurodegenerative diseases and ischemic reperfusion damage. Previous studies have demonstrated the adenosine-induced apoptosis in several tumor cell lines. However, the role of ERS in adenosine-induced human hepatoma HepG2 cell apoptosis remains unclear. The present study was designed to determine whether ERS is involved in adenosine-induced HepG2 cell apoptosis. The MTT assay was used to determine proliferation, and DAPI staining of cell nuclei was performed to determine cell apoptosis. The translocation of CHOP and caspase-3 was observed by immunofluorescence analysis, and the protein expression of CHOP, caspase-4 and caspase-3 was detected by Western blotting. The MTT assay demonstrated that adenosine inhibited HepG2 cell proliferation in a dose-dependent manner. DAPI staining of cell nuclei and cell cycle analysis verified cell apoptosis. The immunofluorescence assay demonstrated that adenosine induced the translocation of CHOP and of caspase-3 from the cytoplasm to the nucleus. Western blotting confirmed that CHOP, caspase-4 and caspase-3 were up-regulated in HepG2 cells after treatment with adenosine. However, JNK protein expression was not altered. These results show that ERS is involved in the adenosine-induced HepG2 cell apoptosis.

M. tuberculosis H37Rv infection of Chinese rhesus macaques

Mycobacterium tuberculosis is the most common communicable infectious disease worldwide and the top killer of human immunodeficiency virus (HIV)-infected people. Because of common dual HIV and M. tuberculosis infections, the emergence of multidrug-resistant M. tuberculosis strains, the lack of effective vaccination, the morbidity, and the mortality of M. tuberculosis infection are increasing sharply. Therefore, there is an urgent need for vaccine and drug development against M. tuberculosis infection. These require appropriate animal models that closely resemble human disease. To this end, we infected Chinese rhesus macaques with the M. tuberculosis H37Rv strain. Bronchoscopy was used to inoculate nine monkeys with different doses of M. tuberculosis H37Rv strain. Regardless of the M. tuberculosis dose, all monkeys were infected successfully. This was shown by clinical, laboratory, and histopathology assessments. Among nine infected monkeys, six developed acute rapid progressive tuberculosis and the remaining animals mirrored early-stage chronic disease. These data, taken together, demonstrate that Chinese rhesus macaques are highly susceptible to M. tuberculosis infection and develop similar manifestations of disease that are seen in humans. This model affords new opportunities for studies of M. tuberculosis disease pathology and therapeutics.

Involvement of NF-kappaB activation in the apoptosis induced by extracellular adenosine in human hepatocellular carcinoma HepG2 cells

Adenosine can exhibit cytotoxic activity in vivo and in vitro, though its mechanisms are still uncertain. In this study, we investigated the adenosine-mediated apoptotic signaling pathway and the role of NF-kappaB in human hepatocellular carcinoma HepG2 cells. HepG2 cells were treated with different concentrations of adenosine for 12-48 h, and the effect of adenosine on cell proliferation was evaluated by MTT assay. The cytotoxicity of adenosine alone or in combination with an NF-kappaB inhibitor, pyrrolidine dithiocarbamate (PDTC), was also evaluated by MTT assay and the mode of cell death was detected by Hoechst 33342 staining. Cell cycle progress was performed by flow cytometry with PI staining. The protein expressions of Bcl-2, p53, NF-kappaB subunit p65, and caspase-3 were assayed by Western blot. Caspase-3 activity was measured by spectrophotomteric assay. The results showed that adenosine significantly reduced the viability of HepG2 cells in a dose- and time-dependent manner, with IC 50 (24 and 48 h) of 2.52 and 1.89 mmol x L(-1), respectively. The apoptotic index (percentage of sub-G1 phase) of HepG2 cells in adenosine treatment alone for 12 and 24 h or in combination with PDTC were 8.30%, 22.32% and 20.18%, 30.89%, respectively. All of them were higher than that in the control group (0.81%, p < 0.01). The characteristic changes of cell apoptosis (chromatin condensation and sub-G1 peak) were observed under fluorescent microscopy and flow cytometry. We also found that the apoptotic process triggered by adenosine was involved in G0-G1 cell-cycle arrest, enhanced the activity of caspase-3, upregulated p53 and NF-kappaB p65 expression, and downregulated Bcl-2 expression. Inhibition of NF-kappaB by PDTC decreased NF-kappaB p65 expression, enhanced cell apoptosis ratio, and increased caspase-3 activity. NF-kappaB may play an anti-apoptosis role in adenosine-induced HepG2 cytotoxicity.

[Speciation analysis of eight metal elements in the leaves of Alstonia scholaris by flame atomic adsorption spectrometry]

The eight elements, Cu, Zn, Fe, Mg, Ca, Cr, Mn and Cd, in the leaves of Alstonia scholaris were extracted based on traditional analytical flowchart program and separated into water-soluble state and suspension state by micro porous filtering film. The water-soluble state was divided into organic state and inorganic state based on macro porous adsorption resin. The elements were detected by flame atomic adsorption spectrometry (FAAS). The results show that the extractive rates of the elements were in the range of 9.84%-89.07%, and the immersion-residue ratio in the range of 10.96%-903.4%. Adsorption ration of suspension state was in the range of 3.44%-23.37%. The recovery ratios by standard addition were in the range of 94.5%-111.6%, and the relative standard deviations (RSD) were in the range of 0.29%-2.47%. The precision and accuracy of determining results are satisfactory.

[Relative DNA content and cycle distribution of cells in pleural effusions studied by flow-cytometry]

Pleural effusions from 28 patients were studied by cytology, chromosome and flow-cytometry. Relative cellular DNA content was measured. An estimate of ploidy as well as cycle distribution has been given. Eighteen patients suffered from malignant effusions while the rest had TB effusions. 83.3% of malignant effusion had aneuploid. The relative cellular DNA content and the cell cycle distribution can provide valuable and decisive information. The study of chromosome also help the diagnosis in addition to cytological results.

[Changes in contents of aluminium, calcium and phosphorus contents of local bone after implantation of alumina endoprosthesis]

Thirty rabbits were divided equally into 5 groups randomly. A hole, 6mm in diameter and 2mm deep, was bored on both ilia of the thirty animals. Two cubes of alumina were implanted into the hole on one side of each animal, while the hole on the opposite side served as control. Six rabbits each were sacrificed on 10, 20, 40, 60 and 90 days after operation. Calcium, phosphorus and aluminium contents of bone tissues in and around both holes were determined by Inductively Coupled Plasma-Atomic Emission Spectrometry. The results show that the aluminium content of the bone tissues on the implanted side in each group was higher than that of the control with statistically significant difference in the 10-, 40- and 60-day groups (P < 0.05). This means that the implantation definitely releases aluminium into the bone tissues. On the contrary, calcium and phosphorus contents were significantly lower in the bone tissues on the implanted side than in the control side in the 10- and 20-day groups (P < 0.05-0.001). It implies that the aluminium released from the implant in the early stage can interfere with the metabolism of calcium and phosphorus and thus delay the mineralization of the bone tissues.

[Effects of different dosage of PGE1 in pulmonary arterial hypertension]

The effects of different dosage of PGE1 on hemodynamics, oxygen delivery (DO2), oxygen consumption (VO2) and hemorheology in patients with pulmonary arterial hypertension (PAH) were investigated. In group 1, 10 cases were treated with PGE1 at a dosage of 20ng/kg.min-1, It was found that pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) decreased by 23.3% and 38.7% respectively, CI and DO2 increased significantly; blood viscosity decreased significantly, but mean arterial pressure (MAP) and PaO2 were not affected. The side effects at such a dosage included flush of skin, headache and malaise. In group 2, 8 of the 10 cases were treated with PGE1 at a dosage of 40ng/kg.min-1. It was found that mPAP and PVR decreased by 22% and 40.4% respectively, CI increased significantly, MAP, systemic vascular resistance (SVR) and PaO2 decreased significantly while DO2 and VO2 changed slightly. The side effects at this dosage consisted of those occurring at the dosage of 20ng/kg.min-1 as well as hypotension and tachycardia. These results showed that PGE1 at a dosage of 20ng/kg.min-1 is effective, well-tolerated and yields less side effects.

Local changes in aluminium, calcium and phosphorus content of bone caused by alumina implant

Thirty rabbits were divided equally into 5 groups randomly. A hole, 6 mm in diameter and 2 mm deep, was bored on each iliac crest. Two pieces of alumina were implanted into the hole of one side, while the opposite side served as control. These rabbits were killed on 10, 20, 40, 60 and 90 days after operation. Calcium, phosphorus and aluminium contents of iliac bone on both sides were determined by Inductively Coupled Plasma--Atomic Emission Spectrometry. The results showed that the aluminium content of the implanted side in each group was higher than that of the control and difference was significant in 10, 40 and 60 day groups (P < 0.05). This shows that the implant releases aluminium into the bone. Moreover, the calcium and phosphorus contents were significantly lower on the implanted side than on the control side in 10 and 20 day groups (P < 0.05-0.001). Apparently, the aluminium released from the implant in the early stage can interfere with the local calcium and phosphorus metabolism and delay the mineralization of the bone.

[Effects of ipratropium bromide (IPB) and its combination with salbutamol sulfate (SAS) in acute asthmatic attack]

34 patients with acute asthmatic attack were studied in double-blind, randomized and crossover manner. Each of them was treated with following two protocols during two sequential days: 0.5 mg of ipratropium bromide (IPB), followed by 5 mg of salbutamol sulfate (SAS) 75 minutes later; or 5 mg of SAS, followed by another dose 35 minutes late. The drugs were delivered via a jet nebulizer. The effects and side-effects of the treatment were evaluated immediately before the first inhalation and at peak of bronchodilatation (60-75 minutes after IPB or 20-35 minutes after SAS). Compared with inhaled SAS, IPB produced considerable improvement in central airway parameters such as forced expiratory volume in one second (FEV1) peak expiratory flow (PEF) and respiratory resistance (Rrs) (P greater than 0.05), but less improvement in peripheral airway parameters such as forced vital capacity (FVC) and maximal mid-expiratory flow (MMEF) (P less than 0.01). The sequential inhaled SAS after IPB improved all five parameters (P less than 0.01), but the repeated dose of SAS increased only MMEF (P less than 0.01). Compared with double-dose SAS, the sequential treatment with IPB and SAS 1 ed to considerable improvement in FVC and MMEF (P greater than 0.05), but greater improvement in FEV1, PEF and Rrs (P less than 0.01). Heart (rate and tremor scores after two doses of SAS increased significantly (P less than 0.01). It is concluded that IPB alone is less effective than beta-adrenoceptor agonist, but its combination with SAS would be an effective and safe treatment in acute asthmatic attack.

Rapid detection of pneumococcal antigens in sputa in patients with community-acquired pneumonia by coagglutination

This paper introduces the clinical use of coagglutination as a method for the rapid detection of pneumococcal antigens in patients with community-acquired pneumonia and compares it with the sputum Gram stain and culture methods. Among 105 patients, 50 (48%) were diagnosed as having pneumococcal pneumonia by at least one of the three methods. Of 95 sputa tested, 44 (46%) were found to be positive by the coagulation test, 26 (27%) by Gram staining and only 16 (17%) by the bacterial culture method. The rate of detection of pneumococcal antigens was thus greater with coagulation than with either of the other two methods. The differences were very significant (both P less than 0.01). Our study indicates that the advantages of coagglutination over the traditional bacteriological methods are its speed, sensitivity, convenience and also its relative independence of antibiotic therapy. It thus provides a new dimension in the aetiological diagnosis of pneumococcal pneumonia.