Transcription factors BmPOUM2 and BmβFTZ-F1 are involved in regulation of the expression of the wing cuticle protein gene BmWCP4 in the silkworm, Bombyx mori

In Bombyx mori, the wing cuticle protein gene BmWCP4 is expressed specifically in the epidermis at the onset and mid-stage of pupation and is responsible for the formation of the pupal cuticle during the larval-pupal metamorphosis. The gene consists of four exons and three introns and is present as a single copy in the genome. Its expression was up-regulated by 20-hydroxyecdysone (20E) and the 20E-induced expression was suppressed by juvenile hormone (JH) III. The upstream regulatory sequence region of the BmWCP4 gene was cloned and the regulatory elements responsible for 20E induction were identified. Two cis-regulatory elements (CREs) bound by the transcription factors BmPOUM2 and BmβFTZ-F1 were identified that mediated 20E-regulated expression of this gene. An electrophoretic mobility shift assay detected two nuclear proteins isolated from the epidermis and the BmN cell line that specifically bound to the POU and βFTZ-F1 CREs, respectively. BmPOUM2 recombinant protein explicitly bound to the POU CRE. Developmental and 20E-induced expression of the BmWCP4, BmPOUM2 and BmβFTZ-F1 genes showed that BmPOUM2 and BmβFTZ-F1 were initially expressed, followed by BmWCP4. These data suggest that the 20E-induced expression of BmWCP4 is mediated by the transcription factors BmPOUM2 and BmβFTZ-F1 binding to their CREs in the regulatory sequence region of the BmWCP4 gene.

EGFR, HER2 and HER3 expression in primary colorectal carcinomas and corresponding metastases: Implications for targeted radionuclide therapy

Members of the epidermal growth factor receptor, EGFR, family are interesting as targets for radionuclide therapy using targeting agents labeled with α- or β-emitting radionuclides, especially when EGFR-positive colorectal carcinomas, CRC, are resistant to EGFR inhibiting agents like cetuximab and various tyrosine kinase inhibitors. The expression of EGFR, HER2 and HER3 was therefore analyzed in CRC samples from primary tumors, corresponding lymph node metastases and, in a few cases, liver metastases. The expression of HER2 and EGFR was scored from immunohistochemical preparations using the HercepTest criteria 0, 1+, 2+ or 3+ for cellular membrane staining while HER3 expression was scored as no, weak or strong cytoplasm staining. Material from 60 patients was analyzed. The number of EGFR 2+ or 3+ positive primary tumors was 16 out of 56 (29%) and for lymph node metastases 8 out of 56 (14%) whereas only one out of nine (11%) liver metastases were positive. Thus, there was lower EGFR positivity in the metastases. Only one among 53 patients was strongly HER2 positive and this in both the primary tumor and the metastasis. Eight out of 49 primary tumors (16%) were strongly HER3 positive and the corresponding numbers for lymph node metastases were 9 out of 49 (18%) and for liver metastases 2 out of 9 (22%). The observed number of strongly EGFR positive cases was somewhat low but EGFR might be, for the cases with high EGFR expression in metastases, a target for radionuclide therapy. HER2 seems not to be of such interest due to rare expression, neither HER3 due to mainly expression in the cytoplasm. The requirements for successful EGFR targeted radionuclide therapy are discussed, as well as patient inclusion criteria related to radionuclide therapy.

Some results of our research on composite facial allograft transplantation in dogs

Composite facial allograft transplantation is a complicated surgical procedure, requiring evaluation of several questions. How should the facial allograft be preserved? What are the proper surgical skills to reduce surgery duration? Can composite facial allograft transplantation rebuild the motor functions of the facial muscles? In our research, University of Wisconsin (UW) solution was used to preserve canine facial tissue. We manipulated the surgical procedures of complete facial allograft transplantation on cadavers to improve surgery skills Canine facial allograft models with neuromuscular motor units were performed to evaluate nerve regeneration after allotransplantation. We observed that canine facial allografts could be preserved in UW solution for at least 18 hours. Superficial temporal artery and facial artery bipedicle flaps were safer and saved more time than single pedicle flaps from the external carotid artery. Facial neuromuscular activities were shown in the canine model by the blinking reflex.

Polymorphism in 3'-untranslated region of toll-like receptor 4 gene is associated with protection from hepatitis B virus recurrence after liver transplantation

BACKGROUND

Hepatitis B virus (HBV) recurrence is one of the more severe complications following liver transplantation. Toll-like receptors (TLRs) play a key role in human immunity by recognizing various bacteria, viruses, fungi, and parasites. Single nucleotide polymorphisms (SNPs) in the TLRs are thought to have an impact on the susceptibility to some pathogens. This study focused on the association between polymorphisms in the TLRs and HBV recurrence after liver transplantation in Han Chinese patients.

METHODS

A total of 41 tag SNPs in TLRs were detected by the snapshot technique in 125 patients with primary HBV-related diseases receiving liver transplantation in our center from 2004 to 2008.

RESULTS

By comparing the genetic variations and clinical data between the HBV recurrence patients and nonrecurrence patients, we found that the variant genotype of rs11536889 (TLR4) was significantly associated with HBV recurrence after liver transplantation (P = 0.040, odds ratio was 0.390, 95% confidence interval 0.159-0.957).

CONCLUSION

Our findings indicate that polymorphism in 3'-untranslated regions of the TLR4 gene may be related to protection from HBV recurrence after liver transplantation in Han Chinese patients.

A Comparison of Two Different Doses of Rectal Ketamine Added to 0.5 mg.kg-1 Midazolam and 0.02 mg.kg-1 Atropine in Infants and Young Children

In some circumstances, a high degree of sedation that results in a child being unconscious at the time of parental separation is desirable. We set out to investigate the efficacy and safety of a rectal premedication regimen designed to produce this increased level of sedation.

Sixty-seven children aged two to 24 months were randomised into two groups. Group MK received 4 mg.kg-1 ketamine, 0.5 mg.kg-1 midazolam and 0.02 mg.kg-1 atropine and group MKK received 8 mg.kg-1 ketamine, 0.5 mg.kg-1 midazolam and 0.02 mg.kg-1 atropine per rectum. The sedation score at the time of parental separation 30 minutes after drug administration and the response to intravenous cannulation were evaluated on a four-point scale. Respiratory rate, heart rate and arterial oxygen saturation were recorded immediately before parental separation.

More patients in group MKK were asleep during separation (62 vs 35%, P <0.05). Fewer patients in group MKK cried during intravenous cannulation (37 vs 68%, P <0.05). Sedation scores were significantly increased at both time points. There was no difference between groups in vital signs at the time of parental separation and no adverse respiratory events occurred during the study period.

In cases where a high degree of sedation following premedication in infants and toddlers is desired, the addition of 8 mg.kg-1 ketamine to 0.5 mg.kg-1 midazolam and 0.02 mg.kg-1 atropine administered rectally is more efficacious than 4 mg.kg-1 ketamine.

Activation of Akt and MAPK pathways enhances the tumorigenicity of CD133+ primary colon cancer cells

Cancer stem cells (CSCs) play an important role in carcinogenesis, resistance to treatment and may lead to cancer recurrence and metastasis. However, the molecular mechanism of CSC involved in these events needs to be further elucidated. In this study, CD133(+) colon cancer cells were cultured, which showed CSC properties both in vitro and in vivo from metastatic tissue. Upstream molecules in Akt and mitogen-activated protein kinase (MAPK) pathways were preferentially expressed in these CD133(+) cells, as revealed by a global gene chip. The kinase activities of Akt and extracellular signal-regulated kinase (Erk)1/2 were also significantly upregulated in CD133(+) cells. In addition, the clonogenic growth of CD133(+) cell was reduced greatly by inhibiting the activity of Akt and Erk1/2. The results revealed the Akt and MAPK pathways were involved in the tumorigenesis of CD133(+) colon cancer cells, suggesting that molecules in these two pathways might be potential targets in the future therapy.

Bone marrow-derived mesenchymal stem cells inhibit acute rejection of rat liver allografts in association with regulatory T-cell expansion

Bone marrow-derived mesenchymal stem cells (MSCs) exhibit immunosuppressive functions in vitro and in vivo. We investigated the immunoregulatory effects of rat MSCs in a model of allogeneic liver transplantation. Brown Norway rats received livers from inbred Lewis rats, and at designated intervals, infusions of MSCs derived from recipient, donor, or third-party rats. Allograft rejection and recipient survival rates were recorded. In particular, changes in circulating regulatory T cells (Tregs) were measured. After administration of MSCs derived from each of the 3 strains, allograft recipients demonstrated markedly longer survival compared with control animals. Histologic analysis revealed significant inhibition of allograft rejection. The MSCs induced generation of CD4+CD25+Foxp3+ Tregs. We concluded that MSCs inhibit acute rejection of allografts after liver transplantation, and propose that the immunoregulatory effects of MSCs are associated with expansion of Tregs.

Meta-analysis of dose-response characteristics of hydrochlorothiazide and chlorthalidone: effects on systolic blood pressure and potassium

BACKGROUND

Evidence supporting the benefit of low-dose thiazide-based regimens to reduce cardiovascular events is primarily derived from studies using chlorthalidone, yet low-dose hydrochlorothiazide (HCTZ) (12.5-25 mg) remains more widely prescribed. We sought to describe their comparative dose-response relationships for changes in systolic blood pressure (SBP) and potassium.

METHODS

PubMed from 1948 to July 2008 was systematically searched to identify clinical trials using either HCTZ or chlorthalidone monotherapies. A total of 108 clinical trials with HCTZ and 29 with chlorthalidone were analyzed. Data were pooled to evaluate the effects on SBP and potassium of both drugs throughout their respective dose-response curves. Equivalence analysis was performed for the clinically recommended low-dose range of 12.5-25 mg, grouped by study duration, using the two one-sided tests procedure described by Schuirmann.

RESULTS

When evaluated on a milligram-per-milligram basis using pooled data, chlorthalidone generally produces slightly greater reductions in SBP and potassium than HCTZ. In the low-dose range of 12.5-25 mg, equivalence analysis reveals that the reductions in SBP are not equivalent between the two drugs, using upper and lower equivalence bounds of 4 mm Hg. Within the same dosing range, the mean changes in potassium were determined to be equivalent when upper and lower equivalence bounds of 0.29 mEq/l are used.

CONCLUSIONS

Equivalence analysis using data from several studies suggests that the SBP reductions achieved with HCTZ and chlorthalidone cannot be considered equivalent within the low-dose range currently recommended. However, within this dosing range, reductions in potassium can be considered equivalent.

Screening of heterogeneous surfaces: charge renormalization of Janus particles

Nonlinear ionic screening theory for heterogeneously charged spheres is developed in terms of a mode decomposition of the surface charge. A far-field analysis of the resulting electrostatic potential leads to a natural generalization of charge renormalization from purely monopolar to dipolar, quadrupolar, etc, including 'mode couplings'. Our novel scheme is generally applicable to large classes of surface heterogeneities, and is explicitly applied here to Janus spheres with differently charged upper and lower hemispheres, revealing strong renormalization effects for all multipoles.

Diagnosis of C4d+ Renal Allograft Acute Humoral Rejection by Urine Protein Fingerprint Analysis

This study aimed to develop urine protein fingerprint models for the diagnosis of acute rejection (AR) and complement split product positive (C4d+) acute humoral rejection (AHR) following renal allograft transplantation. Urine samples from 101 renal transplant recipients were analysed by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry combined with bioinformatics. The patients comprised 36 with stable allograft function (stable group), 10 with acute tubular necrosis (ATN) and 55 with AR (20 with C4d- acute cellular rejection [ACR] and 15 with C4d+ AHR). The ATN group was differentiated from the stable group with a sensitivity and specificity of 100% (pattern 1). The stable group was differentiated from the AR group with a specificity of 86.4% and a sensitivity of 85.4% (pattern 2). The C4d- ACR subgroup was differentiated from the C4d+ AHR subgroup with a specificity and sensitivity of 95% and 80%, respectively (pattern 3). It is concluded that urine protein fingerprint analysis can provide a noninvasive tool to diagnose AR and C4d+ AHR.

Caspofungin for post solid organ transplant invasive fungal disease: results of a retrospective observational study

M. Winkler, J. Pratschke, U. Schulz, S. Zheng, M. Zhang, W. Li, M. Lu, D. Sgarabotto, G. Sganga, P. Kaskel, S. Chandwani, L. Ma, J. Petrovic, M. Shivaprakash. Caspofungin for post solid organ transplant invasive fungal disease: results of a retrospective observational study. Transpl Infect Dis 2010: 12: 230–237. All rights reserved

Brazilein inhibits survivin protein and mRNA expression and induces apoptosis in hepatocellular carcinoma HepG2 cells

Hepatocellular carcinomas represent the third leading cause of cancer-related deaths worldwide. Survivin, a structurally unique member of the inhibitor of apoptosis protein (IAP) family, is overexpressed in a wide range of malignancies, including hepatocellular carcinoma. Due to its involvement in cancer progression and treatment resistance, survivin is currently undergoing extensive investigation as a novel intervention target to induce apoptosis in cancer cells by phytochemicals or synthetic agents. Brazilein, a compound obtained in a large amount from the dried heartwood of Caesalpinia sappan Linn., which has long been used in traditional medicine in China, has some pharmacological activities. Human hepatocellular carcinoma HepG2 cells were treated with brazilein and analyzed for survivin protein and mRNA levels by Western blotting and real-time RT-PCR, respectively. Brazilein treatment of cells for 48 h at 5 and 10 microg/ml doses resulted in significantly decrease in survivin protein expression. We also observed that brazilein caused a strong decrease in survivin mRNA expression. In other studies, down-regulation of survivin by brazilein was associated with a strong and prominent caspases-9 and -3 activation as well as PARP cleavage. It was also shown that brazilein induced a strong apoptotic cell death, as shown by DNA ladder assay, and growth inhibition of HepG2 cells. Further studies are needed to investigate in vivo effect of brazilein on survivin expression and associated biological effects in hepatocellular carcinoma that could provide useful information for brazilein efficacy in the prevention/intervention of human hepatocellular carcinoma.

Toward the elimination of medical oncology admissions

e20740

Background: While medical oncology is growing in volume, it is increasingly becoming an outpatient enterprise. Issues leading to hospital admissions in the past are commonly either prevented or managed on an outpatient basis. We sought out trends within our practice on the frequency and reasons for hospital admissions. Methods: Computerized office visit and hospital admissions data were obtained on admissions by physician and year, for Pa. Oncology-Hematology Associates from 2000–2007. A retrospective chart review was also done for one physician from 6/08–12/08 to determine the reasons for admission. Results: While the total number of patients seen per year increased by 40% over the review period from 2000–2007, the relative number of admissions has steadily declined. Adjusting the number of admissions per patients in the practice (since the overall increase in volume partially masks the decline in admission frequency), the reduction in admissions is further evident. The frequency of admissions for the 4 senior oncologists showed a 50% reduction in admissions per patient over the past 8 years. Of 56 admissions reviewed from 6/08–12/08, 20 were related to infections (although only a minority were neutropenic), 13 for symptom management of disease progression, 6 for anemia/bleeding, 3 for bowel obstruction, 3 for non-infectious complications of treatment, and only 1 for chemotherapy administration. Conclusions: Trends in our practice indicate a continued decline in the frequency of admissions per patient. Elective admissions for diagnosis, work-up, and chemotherapy are rare. Improved medications for symptoms related to cancer, its complications and treatment-related toxicities and improvements in palliative care (psychosocial support, communication about prognosis and treatment goals, and end-of-life care) have contributed to decreased admissions. Increasingly, even patients with incurable disease are managed from diagnosis to death entirely as outpatients. Optimizing outpatient management and avoiding admissions in medical oncology has major implications for practice quality, patient quality of life, cost and allocation of health care resources.

No significant financial relationships to disclose.

Platelet adhesion to multimerin 1 in vitro: influences of platelet membrane receptors, von Willebrand factor and shear

BACKGROUND

Multimerin 1 (MMRN1) is a large, homopolymeric adhesive protein, stored in platelets and endothelium, that when released, binds to activated platelets, endothelial cells and the extracellular matrix.

OBJECTIVES

The goals of our study were to determine if (i) MMRN1 supports adhesion of resting and/or activated platelets under conditions of blood flow, and (ii) if MMRN1 enhances platelet adhesion to types I and III collagen.

PATIENTS/METHODS

Platelet adhesion was evaluated using protein-coated microcapillaries, with or without added adhesive proteins and receptor antibodies. Platelets from healthy controls, Glanzmann thrombasthenia (GT) and severe von Willebrand factor (VWF)-deficient donors were tested.

RESULTS

MMRN1 supported the adhesion of activated, but not resting, washed platelets over a wide range of shear rates. At low shear (150 s(-1)), this adhesion was supported by integrins alphavbeta3 and glycoprotein (GP) Ibalpha but it did not require integrins alphaIIbbeta3 or VWF. At high shear (1500 s(-1)), adhesion to MMRN1 was supported by beta3 integrin-independent mechanisms, involving GPIbalpha and VWF, that did not require platelet activation when VWF was perfused over MMRN1 prior to platelets. MMRN1 bound to types I and III collagen, independent of VWF, however, its enhancing effects on platelet adhesion to collagen at high shear were VWF dependent.

CONCLUSIONS

MMRN1 supports platelet adhesion by VWF-dependent and -independent mechanisms that vary by flow rate. Additionally, MMRN1 binds to, and enhances, platelet adhesion to collagen. These findings suggest that MMRN1 could function as an adhesive ligand that promotes platelet adhesion at sites of vascular injury.

The tolerance time limits of biliary tracts of liver grafts subjected to warm ischemia and cold preservation: an experimental study in swine

OBJECTIVE

The objective of this study was to investigate the tolerance time limits of liver grafts and biliary tracts with warm ischemia to cold preservation providing experimental data to the prevent primary graft nonfunction and biliary necrosis after orthotopic liver transplantation (OLT).

METHODS

OLTs were performed in Bama miniature swine. Morphological and functional changes in the liver graft and biliary tracts were investigated after 10 minutes of warm ischemia and various durations of cold preservation.

RESULTS

When grafts were subjected to 10 minutes of warm ischemia followed by less than 16 hours of cold preservation, all animals survived 1 week; no animal died of biliary necrosis. However, when the cold preservation time exceeded 16 hours, the incidence of biliary necrosis increased significantly (P < .05) with deaths due to bile leaks. As cold preservation persisted, primary graft nonfunction and intraoperative or early postoperative deaths occurred, and all surviving animals developed biliary necrosis. When compared with the group undergoing less than 16 hours of cold preservation, the morphological scores and apoptosis index of epithelial cells of graft bile ducts were significantly increased among the group subjected to more than 16 hours of cold preservation after reperfusion (P < .05), whereas the activity of Na+-K+-ATPase and Ca2+-ATPase of graft bile ducts were reduced significantly (P < .05). Liver function tests showed the concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase, and alkaline phosphatase (ALP) decreased more slowly among the group undergoing more than 16 hours of cold preservation after operation.

CONCLUSIONS

We concluded that given 10 minutes of warm ischemia, cold preservation should be less than 16 hours to avoid early biliary necrosis; the corresponding tolerance time limit of the liver to cold preservation was less than 20 hours.

Primary Hepatic Carcinoid Tumours: Clinical Features with an Emphasis on Carcinoid Syndrome and Recurrence

This study sought to determine the clinical profiles and optimal management of primary hepatic carcinoid tumours. The clinical features of nine Chinese patients and 64 patients reported in the English-language literature were characterized. Recurrence rate and survival analysis were performed with the Kaplan–Meier method. The impact of surgical resection and post-operative recurrence on survival was determined by means of the log-rank test. Carcinoid syndrome complicated 10 cases (14%). Sixty-two patients (85%) underwent surgical resection. Actuarial 5-and 10-year survival rates for resected patients were 80% and 75%, respectively. Twelve patients experienced recurrences: the recurrence rate at 5 years post-operatively was 26%. All patients with resectable recurrent disease achieved good long-term survival and no significant relationship was found between recurrence and survival. Owing to the high incidence of recurrence, long-term follow-up is necessary and it is recommended that recurrent cases should be managed with judicious surgical resection.