Dynamic contrast-enhanced MRI to predict response to vinorelbine-cisplatin alone or with rh-endostatin in patients with non-small cell lung cancer and bone metastases: a randomised, double-blind, placebo-controlled trial

BACKGROUND

Metastatic bone disease is a frequent complication of advanced non-small-cell lung cancer and causes skeletal-related events which result in a poor prognosis. A standard method to assess the therapeutic response of bone metastases does not currently exist. We used dynamic contrast-enhanced MRI to obtain quantitative measures to assess the suitability of this technique to gauge therapeutic response to vinorelbine-cisplatin plus rh-endostatinfor previously untreated non-small cell lung cancer with bone metastases.

METHODS

We did a phase 4, randomised, prospective, double-blind, placebo-controlled clinical trial in Shanghai Sixth People's Hospital, Shanghai, China. Inclusion criteria were non-small-cell lung cancer patients with bone metastases confirmed by pathology or cytology; available imaging data of pelvic metastatic lesions; aged 18 to 75 years old; expected survival at least 3 months; not receiving taxane, bevacizumab, thalidomide, rh-endostatin, or bisphosphonate; not having radiation therapy within 3 months of enrollment into study; normal results of routine blood tests, liver and kidney function, and electrocardiogram; absence of cardiovascular disease, autoimmune disease, vasculitis, severe infection, diabetes, and other concomitant disease; and signed informed consent. Exclusion criteria were receiving granulocyte colony stimulating factor or granulocyte-macrophage colony stimulating factor during chemotherapy, intolerance to adverse reaction, and allergy to contrast agents. Patients were randomly assigned to treatment group and control group at a ratio of 2:1 by random code generation by an independent biostatistician in a double-blind fashion. Participants received either vinorelbine-cisplatin plus rh-endostatin or vinorelbine-cisplatin plus placebo. Vinorelbine (25 mg/m²) and cisplatin (75 mg/m²) were administered intravenously on the first day of a 21 day cycle. Patients received rh-endostatin (7·5 mg/m²) or placebo on days 1-14 of a cycle. The primary end points were objective response rate (complete remission+partial remission)/total × 100) and disease control rate (complete remission+partial remission+stable disease)/total × 100). Measurements including K_trans, K_ep, and V_e were evaluated by dynamic contrast-enhanced MRI before treatment and after completion of 2 treatment cycles. Blood concentrations of bone metabolites, tumour markers, and tumour vascular growth related factors were measured before and after treatment. Comparisons were made using paired t-test. Kaplan-Meier survival analysis was used to indicate the correlation between some measurements and progression-free survival or overall survival. The difference in K_trans between patients who had partial remission or stable disease group and those who had disease progression was tested using the Chi-square test. All statistical analyses were performed with SPSS version 21.0. This trial was approved by the State Food and Drug Administration (No: S20050088) and China State Food and Drug Administration. The trial is registered with China Clinical Trials Registry, number chictr-ctr-09000569. Written informed consent and ethical approval was obtained.

FINDINGS

We enrolled 33 patients (aged 52-70, 15 men and 18 women) of whom 28 were evaluable (20 in treatment group and 8 in control group). Five patients were excluded: 2 patients in treatment group and 1 patient in control group used granulocyte-macrophage colony stimulating factor, and 2 patients in the control group refused treatment. Objective response rate was higher (30% vs 0%; p<0·00001), mean overall survival was longer (21·44 [SD 17·28] vs 7·71 [4·68] months, p=0·008), and reduction in capillary permeability (measured by Ktrans) was greater (60·0% vs 4·4%; p=0·026) in the group given rh-endostatin than in the control group. Disease control rate was 80% in the treatment group and 75% in the control group (p=0·07). Overall survival was longer in patients with a greater than 50% reduction in Ktrans than in patients with a decrease of up to 50% (13·2 [1·8] vs 9·8 [0·2] months, p=0·026).

INTERPRETATION

Addition of rh-endostatin to treatment with vinorelbine-cisplatin increased the treatment response in patients with non-small cell lung cancer and bone metastases. Quantitative analysis using dynamic contrast-enhanced MRI can be used to evaluate therapeutic response and to predict survival of bone metastases after anti-angiogenesis therapy. Limitations of this study include the small number of patients and the single-centre design.

FUNDING

National Natural Science Foundation of China [grant number 81201628].

[Analysis of clinical and pathological characteristics of high- risk HPV-negative carcinoma of the uterine cervix]

Objective: To study the clinical and pathological characteristics of HPV-negative cervical cancer patients. Methods: Retrospective analysis of 785 cervical cancer patients in Guangdong Women and Children Hospital from Jan. 2005 to Oct. 2015. By detecting high- risk HPV infection by flow-through hybridization genechip technique. Results: (1)Among 785 cases of cervical cancer, 71 cases were negative for HPV infection tested by genechip technique, accounting for 9.0%(71/785), and the relative light units/cut off(RLU/CO)ratios of these 71 cases were less than 1 by hybird capture Ⅱ(HC-Ⅱ)methods. The results showed that the positive coincident rate of genechip technique detecting result with HC-Ⅱ method was 100.0%(71/71).(2)There was no difference between 43(60.6%)cases from 41-55 years old of 71 cases of HPV-negative patients and 392(54.9%)cases from 41- 55 years old of 714 cases of HPV infection patients(χ²=15.63, P=0.571). Among 71 cases of HPV-negative patients, 32 cases of patients with doing TCT, 6(18.8%)cases for normal, 10(31.2%)cases for atypical squamous cells of undetermined significance(ASCUS), 3(9.4%)cases for atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion(ASC-H), 3(9.4%)cases for low-grade squamous intraepithelial lesions(LSIL), 8(25.0%)cases for hight-grade squamous intraepithelial lesions(HSIL), 2(6.2%)cases for squamous cell carcinoma(SCC). And there were 391 cases of patients with doing thin-prep cytologic test(TCT)of 714 HPV infection patients, 60(15.3%)cases for normal, 61(15.6%)cases for ASCUS, 28(7.2%)cases for ASC-H, 29(7.4%)cases for LSIL, 164(41.9%)cases for HSIL, 49(12.5%)cases for SCC. There was no difference of TCT between HPV infection and HPV-negative patients(P>0.05). Among 70 cases from 71 patients with negative for HPV infection, there were 8(11.4%)cases in stage Ⅰ a, 26(37.1%)cases in stage Ⅰ b1, 12(17.1%)cases in stage Ⅰb2, 11(15.7%)cases in stage Ⅱa, 10(14.3%)cases in stage Ⅱb, 3(4.3%)cases in stage Ⅲ-Ⅳ. There were 118(16.6%)cases in stage Ⅰa, 261(36.8%)cases in stage Ⅰb1, 72(10.1%)cases in stage Ⅰb2, 152(21.4%)cases in stage Ⅱa, 87(12.3%)cases in stage Ⅱb, 20(2.8%)cases in stage Ⅲ-Ⅳ in 710 cases of HPV infection patients, in which there were no difference of clinical stage between HPV infection and HPV-negative patients(P>0.05). Among 69 cases from 71 patients HPV-negative infection, there were 51(73.9%)cases for squamous carcinoma, 13(18.8%)cases for adenocarcinoma, 5(7.2%)cases for adenosquamous carcinoma; and 593(87.2%)cases for squamous carcinoma, 38(5.6%)cases for adenocarcinoma, 39(5.7%)cases for adenosquamous carcinoma, 10(1.5%)case for others were in 680 patients of HPV infection, in which there was significant difference of adenocarcinoma between HPV infection and HPV-negative patients(χ²=11.96, P=0.001). Conclusions: Flow-through hybridization genechip technique is the method of high sensitivity to detect high-risk type HPV, as like HC-Ⅱ method. HPV-negative of cervical cancer occurs mainly in 41- 55 years old. Adenocarcinoma incidence is significantly higher in HPV-negative cases than those patients with infection of HPV positive.

Disaster nursing experiences of Chinese nurses responding to the Sichuan Ya'an earthquake

AIM

The aim of this study was to investigate the disaster experiences of nurses called to assist survivors one month after the 2013 Ya'an earthquake.

BACKGROUND

China has experienced an increasing number of earthquake disasters in the past four decades. Although a health and disaster management system was initiated after the 2008 Wenchuan earthquake, nurses' roles and experiences in a disaster have been overlooked.

METHODS

The researchers used qualitative descriptive design that included 16 participants. Data were collected using semi-structured interviews and observation notes, after which a qualitative content analysis was conducted.

FINDINGS

Three major themes emerged: the process of being dispatched from hospitals to the disaster zone, the effort involved in getting to and working in the affected site and reflecting on the challenges they encountered.

DISCUSSION

About half of the participants had received disaster nursing training before deploying to the disaster site, but they consistently expressed a lack of physical and psychological preparedness regarding the process of being dispatched from their hospitals to the disaster zone.

LIMITATIONS

This was a single-incident experience. Caution should be taken when trying to extend the findings to other parts of China.

CONCLUSION

These findings highlighted the need for disaster in-service training as well as for having disaster plans in place.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Hospital and nursing leaders should provide disaster training opportunities that included topics such as compiling resource inventories, formulating disaster drills and simulations, managing emergencies, and using emergency communication methods. Health policy-makers should be required to prioritize capacity-building training for front-line nurses as well as to develop and implement disaster management plans to better prepare nurses for future disasters.

Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

OBJECTIVES

To investigate the clinical predictors and the aetiologies for surgery in patients with Naja atra (Taiwan or Chinese cobra) envenomation.

METHODS

This case series was conducted in the only tertiary care centre in eastern Taiwan. Patients who presented to the emergency department with Naja atra bite between January 2008 and September 2014 were included. Clinical information was collected and compared between surgical and non-surgical patients.

RESULTS

A total of 28 patients with Naja atra envenomation presented to the emergency department during the study period. Of these, 60.7% (n=17) required surgery. Necrotising fasciitis (76.5%) was the main finding in surgery. Comparisons between surgical and non-surgical patients showed skin ecchymosis (odds ratio=34.36; 95% confidence interval, 2.20-536.08; P=0.012) and a high total dose of antivenin (≥6 vials; odds ratio=14.59; 95% confidence interval, 1.10-192.72; P=0.042) to be the most significant predictors of surgery. The rate of bacterial isolation from the surgical wound was 88.2%. Morganella morganii (76.5%), Enterococcus faecalis (58.8%), and Bacteroides fragilis (29.4%) were the most common pathogens involved. Bacterial susceptibility testing indicated that combined broad-spectrum antibiotics were needed to cover mixed aerobic and anaerobic bacterial infection.

CONCLUSIONS

Patients with Naja atra envenomation who present with skin ecchymosis or the need for a high dose of antivenin may require early surgical assessment. Combined broad-spectrum antibiotics are mandatory.

Diffusion kurtosis imaging study on temporal lobe after nasopharyngeal carcinoma radiotherapy

PURPOSE

Diffusion kurtosis imaging (DKI) is a MRI technique which can measure alterations in the diffusion of water molecules to reflect tissue changes in both white and grey matter. This study evaluated the potential of DKI for the early diagnosis of radiation-induced temporal lobe changes in the grey and white matter of the temporal lobe in patients with nasopharyngeal carcinoma (NPC).

MATERIALS AND METHODS

Sixty patients with NPC who had normal MRI brain scans were enrolled and underwent DKI at 1 week (n=20), 6 months (n=20) or 1 year (n=20) after radiotherapy; 20 normal control individuals were also evaluated. Nonlinear fitting routines and equations were used to calculate mean diffusion (MD) and mean kurtosis (MK) and fractional anisotropy (FA). Analysis of variance was used to compare the MK/MD/FA values of white and grey matter between groups.

RESULTS

Compared to the normal control group, grey and white matter MK values were significantly higher at 1 week after radiotherapy and significantly lower at 6 months and 1 year after radiotherapy in patients with NPC, whereas the grey and white matter MD values were significantly lower at 1 week after radiotherapy and returned to normal by 6 months and 1 year after radiotherapy.

CONCLUSION

DKI can be used to detect radiotherapy-induced changes in both the white and grey matter of temporal lobe in patients with NPC. MK and MD values may represent reliable indicators for the early diagnosis of radiation-induced temporal lobe changes in NPC.

[Application of benchmark dose on renal injury in people chronically exposed to lead]

Objective: To screen sensitive indicators of renal injury in lead workers using benchmark dose method. Methods: Of the 486 subjects,116 did not occupationally contact to lead as a control. The blood lead was considered as exposure biomarker, while Uβ₂-MG and UNAG as effect biomarkers for renal injury. The BMD and BMDL of blood lead were estimated at the 10% benchmark response using BMDS Version 2.6. Results: There was statistical rise in blood lead between the lead group and control group (P<0.05) ; and the blood lead level was divided into four groups by quarterback spacing method, among which UNAG was statistically different (P<0.05) . There was an increased prevalence of abnormal rates of Uβ₂-MG and UNAG with increasing blood lead concentration (P<0.05) , after trend chi-square test. BMD and BMDL of UNAG and Uβ₂-MG were 602.784/431.838 μg/L and 130.398/100.981 μg/L caculated by Log-Probit model, respectively. Conclusions: Occupational lead exposure may cause kidney damage, and UNAG could be as a more sensitive marker for monitoring early renal injury than Uβ₂-MG.

[Use of P-wave polarity during atrial tachycardia to predict site of origin in children]

OBJECTIVE

To perform a detailed analysis of the P-wave polarity in focal atrial tachycardia (FAT) on the basis of surface electrocardiograms (ECGs) and construct an algorithm for identification of the anatomic site of origin in children.

METHOD

P-wave polarities for 40 consecutive children(14 boys and 26 girls, mean age of(8±3)years) with FAT undergoing successful radiofrequency ablation of a single atrial focus at First Hospital of Tsinghua University (2009-2014) were analyzed retrospectively from 12-lead ECGs during tachycardia.P waves were classified as positive, negative, isoelectric, or biphasic.The relations between P-wave and anatomic site of origin were analyzed using a chi-square test.

RESULT

The P-wave polarities in leads V1(χ(2)=23.509, P=0.000) andⅠ(χ(2)=14.315, P=0.001) were significantly helpful in distinguishing left from right atrial origin of the tachycardia focus.The P-wave in lead V1 of a left atrial tachycardia was always positive or isoelectric in tachycardia.The P-wave in leadⅠof a right atrial tachycardia was always positive or isoelectric during tachycardia.The P-wave polarities in leads Ⅱ, Ⅲ, aVR and aVF(χ(2)=26.447, 23.974, 19.613, 17.415, all P=0.000)distinguished superior from inferior atrial foci significantly.Tachycardia arising from the superior foci (n=22) had positive P waves in leads Ⅱ, Ⅲ and aVF ( 95% (n=21), 86% (n=19), 95% (n=21), respectively) and negative P wave in lead aVR (73%, n=16). The P-wave was frequently negative in leads Ⅱ, Ⅲ and aVF(n=12) and positive in lead aVR (n=11) for a tachycardia arising from the inferior foci (n=18). The anatomic sites of FAT in children located mainly at right atrial appendage (23%, n=9), coronary sinus (18%, n=7), left atrial appendage (15%, n=6) and right superior pulmonary vein (10%, n=4).

CONCLUSION

The anatomic sites of FAT in children are located mainly at right and left atrial appendage, coronary sinus and right superior pulmonary vein.P-waves in leads V1 andⅠprove to be significantly useful in differentiating left from right atrial tachycardia foci.P-waves in leads Ⅱ, Ⅲ, aVR and aVF are helpful in distinguishing superior from inferior atrial foci.

[Technical guideline for human rabies prevention and control (2016)]

In order to promote the prevention and control programs on rabies in our country, to regulate the prevention and disposition of rabies and to reduce the deaths caused by rabies, the Chinese Center for Disease Control and Prevention has organized a panel of experts, in the reference with Guidelines issued by WHO, American Advisory Committee on Immunization Practices, and the latest research progress from home and abroad, and compiled this document-"Technical Guidelines for Human Rabies Prevention and Control (2016)". The Guidelines conducted a systematic review on the etiology, clinical characteristics, laboratory diagnosis, epidemiology of rabies and provided evidence on varieties, mechanisms, effects, side-effects and security of rabies vaccine, as well as on other preparations on passive immunity of its kind, on methods related to prevention and disposition of exposure etc, finally to have come up with the recommendation on the above mentioned various techniques. The guidelines will be used by staff working on prevention and control of rabies from the Center for Disease Control and Prevention at all levels, from the departments of outpatient and divisions of infection and emergency control in all the medical institutions. The guideline will be updated and revised, following the research progress from home and abroad.

Salusin-β Promotes Vascular Smooth Muscle Cell Migration and Intimal Hyperplasia After Vascular Injury via ROS/NFκB/MMP-9 Pathway

AIMS

Media-to-intima migration of vascular smooth muscle cells (VSMCs) is critical to intimal thickening in atherosclerosis and restenosis after coronary angioplasty. The aim of this study is to determine the effects of salusin-β on VSMC migration and intimal hyperplasia after vascular injury and the underlying mechanism.

RESULTS

In vitro, salusin-β promoted VSMC migration, which was attenuated by matrix metalloproteinase (MMP)-9 inhibition. Inhibition or knockdown of p65-nuclear factor kappa beta (NFκB) in VSMCs suppressed salusin-β-induced MMP-9 expression and VSMC migration. Salusin-β increased NADPH oxidase 2 (NOX2) expression and reactive oxygen species (ROS) production, which were prevented by NOX2-small interfering RNA (siRNA) transfection. Salusin-β-induced p65-NFκB translocation, MMP-9 expression, and VSMC migration were inhibited by ROS scavenger, NADPH oxidase inhibitor, or NOX2-siRNA. In vivo, carotid artery ligation-induced vascular injury resulted in intimal hyperplasia in injured artery in rats. Salusin-β was upregulated in the injured carotid arteries of rats, which was attributed to reduced miR-133a-3p expression. Knockdown of salusin-β with siRNA attenuated the vascular injury-induced intimal thickening, p65-NFκB nuclear translocation, and NOX2 and MMP-9 expressions in rats.

INNOVATION

Salusin-β is a critical modulator in VSMC migration and neointima formation in response to vascular injury.

CONCLUSIONS

Salusin-β promotes VSMC migration and vascular injury-induced intimal hyperplasia via MMP-9 accumulation due to NOX2 activation, followed by ROS production, IκBα phosphorylation and degradation, and p65-NFκB translocation. We propose that salusin-β may be important in the VSMC migration and neointima of some vascular diseases. Antioxid. Redox Signal. 24, 1045-1057.

[Association between grainyhead-like 2 gene polymorphisms and noise-induced hearing loss]

OBJECTIVE

To investigate association between genetic polymorphism in the grainyhead-like 2 gene (GRHL2) and noise-induced hearing loss (NIHL) in the Chinese population.

METHODS

A matched case-control association study was employed, In which, 3 790 workers exposed to continuous and steady-state occupational noise in a steel factory participated. The questionnaires were adopted to collect individual features and audiometry tests performed. In the sstudy, 286 subjects were diagnosed as cases, Which were each designated on the basis of the matched criterion, and 286 paired samples were selected finally. Noise intensity was measured according to the standards given in 'Measurement of Noise in the Workplace'(Occupational Health Standard of the People's Republic of China, GBZ/T189.8-2007). Cumulative noise exposure (CNE) was calculated, according to monitoring data on A-weighed sound pressure level and employment time. Genomic DNA was obtained from peripheral blood samples using 2 mL DNA extraction Kit following the manufacturer's protocol. Five single nucleotide polymorphisms (SNPs) of GRHL2 were genotyped by multiplex SNP genotyping kit. The continuous variables and categorical variables were analyzed by t-test and chi-square test respectively. Multivariate Logistic regression was used to test the association between genetic frequency and disease status, with adjustments for the possible confounding variables. The haplotypes were established and their frequencies in the two groups were assessed by haploview and phase softwares.

RESULTS

All the five SNPs (rs3735713, rs3824090, rs3735714, rs3735715 and rs611419) were in Hardy-Weinberg equilibrium (HWE) (P>0.05). The subjects carrying rs3735715 GG genotype had a higher NIHL risk than those carrying the GA genotype under the co-dominant model (OR=0.644, 95% CI: 0.442-0.939, P=0.022) after adjustment for height, blood pressure, drinking status and smoking status. After being stratified by CNE, in the CNE ≥ 98 dB (A) group, rs3735715 polymorphism was associated with the NIHL under the co-dominant model (OR=0.509, 95% CI: 0.281-0.923, P=0.026) after adjustment for height, blood pressure, drinking status and smoking status as well. However, no statistical significant difference was found in variant genotypes of the other SNPs between the case and control subjects. Four-locus (rs3735713, rs3824090, rs3735714 and rs3735715) haplotypes were constructed, and no risk or protective haplotypes was identified.

CONCLUSION

It is suggested that GRHL2 polymorphisms may be associated with development of NIHL.

Single-agent capecitabine as maintenance therapy after induction of XELOX (or FOLFOX) in first-line treatment of metastatic colorectal cancer: randomized clinical trial of efficacy and safety

BACKGROUND

The optimal strategy of maintenance therapy for patients with mCRC is controversial. This study was to evaluate the efficacy and safety of maintenance therapy with capecitabine versus observation following inductive chemotherapy in patients with metastatic colorectal cancer.

PATIENTS AND METHODS

In this randomized, open-label, multicenter, phase III trial, patients who received 18-24 weeks of induction chemotherapy with XELOX or FOLFOX and achieved disease control were randomly assigned centrally (1:1) to receive maintenance therapy of capecitabine or only observation until disease progression. The primary end point was progression-free survival (PFS) from randomization; the secondary end points included overall survival (OS), PFS from induction treatment (PFS2) and safety. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02027363.

RESULTS

Between 30 July 2010 and 15 September 2013, 274 patients were enrolled in the study from 11 sites in China and randomly assigned to maintenance group (n = 136) or observation group (n = 138). Clinicopathological characteristics were balanced in two groups. The median follow-up time from randomization was 29.0 months [interquartile range (IQR) 21-36 months]. The primary end point of PFS was statistically significantly longer in capecitabine maintenance group than in observation group {6.43 [95% confidence interval (CI) 5.26-7.71] versus 3.43 (2.83-4.16) months, HR 0.54 (0.42-0.70), P < 0.001}. The median OS of capecitabine maintenance group was longer than that of observation group, but not statistically significant [25.63 (22.46-27.80) versus 23.30 (19.68-26.92) months; HR 0.85 (0.64-1.11), P = 0.2247]. Similar safety profiles were observed in both arms. The most common grade 3 or 4 toxicities in capecitabine maintenance group versus observation group were neutropenia, hand-foot syndrome, and mucositis.

CONCLUSIONS

Maintenance therapy with a single agent of capecitabine can be considered an appropriate option following the induction of XELOX or FOLFOX in mCRC patients with acceptable toxicities.

CLINICAL TRIALS NUMBER

NCT02027363.

[Inhibitory effect of imrecoxib combined with lobaplatin on tumor growth and lymph node metastasis of human lung cancer xenografts in nude mice]

OBJECTIVE

To evaluate the inhibitory effect of imrecoxib combined with lobaplatin on tumor growth and lymph node metastasis of human lung adenocarcinoma xenografts in nude mice, and to explore its possible mechanisms.

METHODS

Human lung cancer A549 cells were injected into Bal B/c nude mice subcutaneously. Twenty-eight healthy male nude mice were randomly divided into 4 groups: the control group, imrecoxib group, lobaplatin group and imrecoxib combined with lobaplatin group. Each group was treated with appropriate drugs and the tumor size was measured every five days. The expression of ezrin and E-cadherin protein was detected by immunohistochemistry and flow cytometry. Ezrin and E-cadherin mRNA were detected by real-time PCR.

RESULTS

The tumor inhibition rates of imrecoxib group, lobaplatin group and combination group were 36.7%, 54.6% and 69.2%, respectively. The tumor volumes of imrecoxib group [(905.33±113.31) mm(3)] and combination group [(507.74±77.50) mm(3)] were significantly lower than that of the control group (1355.33±189.04) mm(3) (P<0.05), and the tumor weights were significantly reduced [(1.13±0.14) g, (0.63±0.10) g respectively] vs. (1.69±0.24) g (P<0.05). The expressions of ezrin protein and mRNA in the imrecoxib group and combined treatment group were significantly lower than that of the control group (136.53±35.52, 74.72±19.48 vs. 175.62±21.16 for protein expression level; 0.54±0.03, 0.36±0.03 vs. 1.02±0.02 for mRNA expression level, respectively, P<0.05 for both), while the expression of E-cadherin protein and mRNA in the imrecoxib group and combined treatment group was significantly higher than that of the control group (253.78±38.87, 308.94±24.67 vs. 213.66±30.31 for protein expression level; 2.19±0.02, 3.02±0.02 vs. 1.05±0.03 for mRNA expression level, respectively, P<0.05 for both). There was a significant negative correlation between ezrin protein and E-cadherin protein (r=-0.737, P<0.01), as well as between ezrin mRNA and E-cadherin mRNA (r=-0.977, P<0.01).

CONCLUSIONS

Administration of imrecoxib combined with lobaphatin has inhibitory effects on the growth of non-small cell lung cancer xenografts and lymph node metastasis via down-regulated ezrin and upregulated E-cadherin. Imrecoxib and lobaplatin have a synergistic antitumor effect.

Molecular cloning, functional verification, and evolution of TmPm3, the powdery mildew resistance gene of Triticum monococcum L

Powdery mildew (Pm) is one of the most harmful diseases in wheat. Three Pm-resistance genes, Pm3, Pm21, and Pm8, have been cloned but most Pm3/Pm8 alleles have lost their resistance to Pm in hexaploid wheat. In this study, a new Pm3 homolog gene (TmPm3) was isolated from Triticum monococcum L. using a homology-based cloning strategy, being the first report of a functional Pm3 homolog gene from a diploid wheat species. The transient expression of TmPm3 in leaf epidermal cells showed that over-expressed TmPm3 could significantly inhibit the penetration of Blumeria graminis f. sp tritici conidia spores and the formation of haustoria. Sequence analysis of Pm3 alleles shed new light on the evolution of Pm3 genes, providing a better understanding of the molecular basis of disease resistance. This study also suggested that homology-based cloning of resistance genes is a feasible method for the isolation of functional resistance genes from wheat germplasm.

Reduced dietary protein level influences the free amino acid and gene expression profiles of selected amino acid transceptors in skeletal muscle of growing pigs

This study was conducted to evaluate the effect of reduced dietary protein level on growth performance, muscle mass weight, free amino acids (FAA) and gene expression profile of selected amino acid transceptors in different fibre type of skeletal muscle tissues (longissimus dorsi, psoas major, biceps femoris) of growing pigs. A total of 18 cross-bred growing pigs (Large White × Landrace × Duroc) with initial body weight (9.57 ± 0.67 kg) were assigned into three dietary treatments: 20% crude protein (CP) diet (normal recommended, NP), 17% CP diet (low protein, LP) and 14% CP diet (very low protein, VLP). The results indicated improved feed-to-gain ratio was obtained for pigs fed LP and NP diets (p < 0.01), while the pigs fed VLP diet showed the worst growth performance (p < 0.01). There was no significant difference in the weights of longissimus dorsi and psoas major muscle between LP and NP groups (p > 0.05). Majority of the determined FAA concentration of LP group were greater than or equal to those of NP group in both longissimus dorsi and psoas major muscle (p < 0.01). Further, the mRNA expression levels of sodium-coupled neutral amino acid transceptor 2, L-type amino acid transceptor 1 and proton-assisted amino acid transceptors 2 were higher in skeletal muscle tissue in LP group compared to those of the pigs fed NP or VLP diet. These results suggested that reduced dietary protein level (3 points of percentage less than recommended level) would upregulate the mRNA expression of amino acid transceptors to enhance the absorption of FAA in skeletal muscle of growing pigs. There seems to be a relationship between response of AA transceptors to the dietary protein level in skeletal muscle tissue of different fibre type. To illustrate the underlying mechanisms will be beneficial to animal nutrition.

β-aminoisobutyric acid attenuates hepatic endoplasmic reticulum stress and glucose/lipid metabolic disturbance in mice with type 2 diabetes

β-aminoisobutyric acid (BAIBA) is a nature thymine catabolite, and contributes to exercise-induced protection from metabolic diseases. Here we show the therapeutical effects of BAIBA on hepatic endoplasmic reticulum (ER) stress and glucose/lipid metabolic disturbance in diabetes. Type 2 diabetes was induced by combined streptozotocin (STZ) and high-fat diet (HFD) in mice. Oral administration of BAIBA for 4 weeks reduced blood glucose and lipids levels, hepatic key enzymes of gluconeogenesis and lipogenesis expressions, attenuated hepatic insulin resistance and lipid accumulation, and improved insulin signaling in type 2 diabetic mice. BAIBA reduced hepatic ER stress and apoptosis in type 2 diabetic mice. Furthermore, BAIBA alleviated ER stress in human hepatocellular carcinoma (HepG2) cells with glucosamine-induced insulin resistance. Hepatic AMPK phosphorylation was reduced in STZ/HFD mice and glucosamine-treated HepG2 cells, which were restored by BAIBA treatment. The suppressive effects of BAIBA on glucosamine-induced ER stress were reversed by knockdown of AMPK with siRNA. In addition, BAIBA prevented thapsigargin- or tunicamycin-induced ER stress, and tunicamycin–induced apoptosis in HepG2 cells. These results indicate that BAIBA attenuates hepatic ER stress, apoptosis and glucose/lipid metabolic disturbance in mice with type 2 diabetes. AMPK signaling is involved to the role of BAIBA in attenuating ER stress.

[Factors influencing electrocardiogram results in workers exposed to noise in steel-making and steel-rolling workshops of an iron and steel plant]

OBJECTIVE

To investigate the factors influencing the electrocardiogram results in the workers exposed to noise in steel-making and steel rolling workshops of an iron and steel plant.

METHODS

From September to December, 2013, cluster sampling was used to select 3 150 workers exposed to noise in the steel-making and steel-rolling workshops of an iron and steel plant, and a questionnaire survey and physical examinations were performed. The number of valid workers was 2 915, consisting of 1 606 workers in the steel-rolling workshop and 1 309 in the steel-making workshop. The electrocardiogram results of the workers in steel-making and steel-rolling workshops were analyzed.

RESULTS

The overall abnormal rate of electrocardiogram was 26.35%, and the workers in the steel-making workshop had a significantly higher abnormal rate of electrocardiogram than those in the steel-rolling workshop(32.24% vs 21.54%, P<0.05). Male workers had a significantly higher abnormal rate of electrocardiogram than female workers(27.59% vs 18.61%, P<0.05). The workers with a drinking habit had a significantly higher abnormal rate of electrocardiogram than those who did not drink(28.17% vs 23.75%, P<0.05). The workers exposed to high temperature had a significantly higher abnormal rate of electrocardiogram than those who were not exposed to high temperature(29.43% vs 20.14%, P<0.05). The abnormal rates of electrocardiogram in the workers with cumulative noise exposure levels of <90, 90~94, 95~99, 100~104, and 105~113 dB(A)·year were 21.21%, 21.76%, 26.50%, 27.27%, and 32.16%, respectively, with significant differences between any two groups(P<0.05). The multivariate logistic regression analysis showed that a cumulative noise exposure of 105-113 dB(A)·year(OR=1.36, 95% CI: 1.03~1.80), a drinking habit(OR=1.20, 95% CI: 1.01~1.43), and high temperature(OR=1.60, 95% CI: 1.32~1.92) were the risk factors for abnormal electrocardiogram results.

CONCLUSION

High cumulative noise exposure, alcohol consumption, and high temperature may affect the abnormal rate of electrocardiogram in the workers exposed to noise in steel-making and steel-rolling workshops.

Short communication: Changes in fluorescence intensity induced by soybean soluble polysaccharide-milk protein interactions during acidification

Interactions between stabilizer and milk protein are believed to influence the stabilizing behavior of the milk system. We investigated changes in fluorescence intensity induced by interactions of soybean soluble polysaccharide (SSPS) and milk protein (Mp) during acidification. The fluorescence intensity (If) of Mp increased as pH decreased from 6.8 to 5.2. Compared with Mp alone, If of SSPS-Mp mixtures increased as the pH decreased from 6.8 to 5.2. We found that the If of the SSPS-Mp mixture decreased in a pH range from 5.2 to 3.6, which indicated a change in the polarity microenvironment around the Trp residues. We also found that the maximum emission wavelength (λmax) shifted from 337 to 330nm as pH decreased from 6.8 to 3.6, in further support of SSPS interacting with the polar portion of Mp during acidification. Furthermore, an excited monomeric molecule (pyrene exciplex) was found as a ground-state pyrene formed and a broad band was shown at about 450nm. The intensity ratio of the first peak to the third peak (I1:I3) of Mp increased slightly, and the ratio of intensity of pyrene exciplex to monomer (Ie:Im) decreased because pyrene molecules were located in a less hydrophobic microenvironment during acidification. However, the ratio of I1:I3 decreased clearly at pH below 5.6 and the ratio of Ie:Im showed the opposite trend in the SSPS-Mp mixture. Changes in intrinsic and exogenous fluorescence intensity confirmed that interactions of SSPS and Mp could change the polarity of the microenvironment and that SSPS probably interacted with the polar portion of Mp. These results could give insight into the behavior of stabilizers in acid milk products.

Villoglandular papillary adenocarcinoma of the uterine cervix: A report of 4 cases and a review of the literature

To investigate the clinicopathological features, management and prognosis of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix, the current study presents 4 cases of VGPA of the uterine cervix. The median age of the patients was 55 years (range, 47-70 years), with all 4 patients presenting with stage Ib disease. Human papillomavirus (HPV) infection was detected in 3 patients; this was mainly HPV-16. No history of oral contraceptive use was found in these cases. While 2 of the patients underwent a radical hysterectomy with bilateral salpingo-oophorectomy plus bilateral pelvic lymphadenectomy, 1 patient underwent a radical hysterectomy with bilateral pelvic lymphadenectomy and the remaining patient received a simple total hysterectomy plus post-operative radiotherapy. Of these patients, only 1 had been correctly diagnosed pre-operatively. In 2 patients, the biopsy results had been interpreted as cervical adenocarcinoma, and in the third, the biopsy result was of cervical intraepithelial neoplasia. All 4 patients presented with cervical wall invasion, including invasion of the inner two-thirds in 1 patient. No lymphovascular space invasion or lymph node metastasis was detected. The follow-up time ranged from 49 to 83 months (median, 64 months), and the patients are currently alive and well, with no evidence of recurrent disease. Taking these results as a whole, VGPA is an uncommon type of cervical adenocarcinoma, characterized by its excellent prognosis. HPV infection is associated with the molecular pathogenesis of VGPA, while oral contraceptive use can be excluded. As the disease has a low pre-operative diagnostic accuracy, frequent cervical wall invasion and concomitant lesions, conservative treatment strategies should be carefully considered.

Cloning and expression of the sucrose transporter gene PsSUT1 from tree peony leaf

This study reports the cloning of a sucrose transporter gene, PsSUT1, from the leaf of tree peony (Paeonia suffruticosa Lind. cv 'Huhong'). Expression patterns were examined in different organs and at different developmental stages. The full-length cDNA of PsSUT1 consisted of a 2001-bp sequence containing a 1557-bp open reading frame, encoding 519 amino acids with a conserved domain typical of the glycoside-pentoside-hexuronide superfamily. The amino acid sequence of PsSUT1 in tree peony shared high homology with that of other plants. At different developmental stages, PsSUT1 was expressed in roots, stems, leaves, and petals. Its expression level in stems was 10.9-fold higher than in petals at the flowering stage. Expression of PsSUT1 at the flowering stage was highest during flower development. The significant differences in PsSUT1 expression observed among developmental stages and organs were closely related to changes in sucrose content during flower opening. These results form the basis for further research on the molecular mechanisms of carbohydrate metabolism and transport during flower development in tree peony.

Advantage in Bright-blood and Black-blood Magnetic Resonance Imaging with High-resolution for Analysis of Carotid Atherosclerotic Plaques

BACKGROUND

About 50% of the cerebral ischemia events are induced by intracranial and extracranial atherosclerosis. This study aimed to evaluate the feasibility and accuracy for displaying atherosclerotic plaques in carotid arteries and analyzing their ingredients by using high-resolution new magnetic resonance imaging (MRI) techniques.

METHODS

Totally, 49 patients suspected of extracranial carotid artery stenosis were subjected to cranial MRI scan and magnetic resonance angiography (MRA) examination on carotid arteries, and high-resolution bright-blood and black-blood MRI analysis was carried out within 1 week. Digital subtraction angiography (DSA) examination was carried out for 16 patients within 1 month.

RESULTS

Totally, 103 plaques were detected in the 49 patients, which were characterized by localized or diffusive thickening of the vessel wall, with the intrusion of crescent-shaped abnormal signal into lumens. Fibrous cap was displayed as isointensity in T1-weighted image (T1WI) and hyperintensities in proton density weighted image (PDWI) and T2-weighted image (T2WI), lipid core was displayed as isointensity or slight hyperintensities in T1WI, isointensity, hyperintensities or hypointensity in PDWI, and hypointensity in T2WI. Calcification in plaques was detected in 11 patients. Eight patients were detected with irregular plaque surface or ulcerative plaques, which were characterized by irregular intravascular space surface in the black-blood sequences, black hypointensity band was not detected in three-dimensional time-of-flight, or the hypointensity band was not continuous, and intrusion of hyperintensities into plaques can be detected. Bright-blood and black-blood techniques were highly correlated with the diagnosis of contrast-enhanced MRA in angiostenosis degree, Rs = 0.97, P < 0.001. In comparison to DSA, the sensitivity, specificity, and accuracy of MRI diagnosis of stenosis for ≥50% were 88.9%, 100%, and 97.9%, respectively.

CONCLUSIONS

High-resolution bright-blood and black-blood sequential MRI analysis can accurately analyze ingredients in atherosclerotic plaques. Determined by DSA, MRI diagnosis of stenosis can correctly evaluate the serious degree of arteriostenosis.

Timing of recanalization and outcome in ischemic-stroke patients treated with recombinant tissue plasminogen activator

BACKGROUND

Intravenous administration of recombinant tissue plasminogen activator (rtPA) is approved treatment for acute ischemic stroke <3 h of symptom onset.

PURPOSE

To determine the impact of the timing and degree of recanalization on clinical outcome after rtPA infusion in patients.

MATERIAL AND METHODS

Seventy-five patients with ischemic stroke in the middle cerebral artery territory treated with intravenous rtPA within 3 h were studied consecutively. Magnetic resonance imaging (MRI), including magnetic resonance angiography (MRA), before, 6 h, and 24 h after thrombolytic therapy was undertaken. Depending on the MRA results acquired 6 h after rtPA infusion, recanalization was graded as: early recanalization (ER), delayed recanalization (DR), and no recanalization (NR). Clinical outcome was assessed using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).

RESULTS

Of patients in the ER, DR and NR groups, 71.4% (15/21), 13.3% (2/15), and 30.7% (12/39), respectively, showed dramatic improvement in NIHSS score 7 days after rtPA administration compared with those scores upon hospital admission. The 6-h and 24-h NIHSS scores and 3-month mRS scores of ER patients were significantly lower than those of the other two groups (P < 0.05). The 24-h, 7-d NHISS and mRS scores of DR patients were significantly higher than NR patients (P = 0.001, 0.002, 0.049, respectively). Three patients in the DR group died during follow-up.

CONCLUSION

These data suggest that DR is associated with clinical deterioration. Patients treated with rtPA thrombolysis should be under close observation for 6-24 h. Corresponding treatment should be considered once DR appears.

Examination of hippocampal differences between Alzheimer disease, amnestic mild cognitive impairment and normal aging: diffusion kurtosis

PURPOSE

To examine hippocampal differences between Alzheimer disease (AD), amnestic mild cognitive impairment (aMCI) and normal aging.

MATERIALS AND METHODS

This study was approved by the local ethics review board, and informed consent was obtained from volunteers/guardians. The study comprised 60 subjects: 20 aMCI patients, 20 AD patients and 20 normal controls (NC group). Magnetic resonance imaging and diffusion kurtosis imaging of the hippocampus were performed. Nonlinear fitting routines and equations were used to calculate mean diffusion (MD) and mean kurtosis (MK). Analysis of variance was used to compare the bilateral MK/MD values/volumes of the hippocampus for the three groups using the Fisher least significant difference test (a two-sample t-test comparison). Pearson correlation coefficients were calculated for the correlations between mini-mental state examination (MMSE) scores and MK/MD values/volumes.

RESULTS

There were significant differences between the AD and NC groups and between the AD and aMCI groups in terms of normalized bilateral hippocampal volume. There were significant differences between the NC, aMCI and AD groups in terms of both right and left hippocampus MK values. For the right hippocampus MD values, there was a significant difference between the NC and AD groups. For the left hippocampus MD values, there were significant differences between the AD and NC groups and between the AD and aMCI groups. Pearson correlation coefficients for all correlations between MMSE scores and hippocampus MK/MD values/volumes were significant.

CONCLUSION

The bilateral hippocampal MK/MD values may be more sensitive than volumes in the diagnosis of aMCI and AD patients.

GABA in Paraventricular Nucleus Regulates Adipose Afferent Reflex in Rats

BACKGROUND

Chemical stimulation of white adipose tissue (WAT) induces adipose afferent reflex (AAR), and thereby causes a general sympathetic activation. Paraventricular nucleus (PVN) is important in control of sympathetic outflow. This study was designed to investigate the role of γ-aminobutyric acid (GABA) in PVN in regulating the AAR.

METHODOLOGY/PRINCIPAL FINDINGS

Experiments were carried out in anesthetized rats. Renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) were continuously recorded. AAR was evaluated by the RSNA and MAP responses to electrical stimulation of the right epididymal WAT (eWAT) afferent nerve. Electrical stimulation of eWAT afferent nerve increase RSNA. Bilateral microinjection of the GABAA receptor agonist isoguvacine or the GABAB receptor agonist baclofen attenuated the AAR. The effect of isoguvacine on the AAR was greater than that of baclofen. The GABAA receptor antagonist gabazine enhanced the AAR, while the GABAB receptor antagonist CGP-35348 had no significant effect on the AAR. Bilateral PVN microinjection of vigabatrin, a selective GABA-transaminase inhibitor, to increase endogenous GABA levels in the PVN abolished the AAR. The inhibitory effect of vigabatrin on the AAR was attenuated by the pretreatment with gabazine or CGP-35348. Pretreatment with combined gabazine and CGP-35348 abolished the effects of vigabatrin.

CONCLUSIONS

Activation of GABAA or GABAB receptors in the PVN inhibits the AAR. Blockade of GABAA receptors in the PVN enhances the AAR. Endogenous GABA in the PVN plays an important role in regulating the AAR.

Acute pulmonary embolism caused by highly aggregated intravenous immunoglobulin

BACKGROUND AND OBJECTIVES

Six patients died and one patient survived following infusion of a specific lot of intravenous immunoglobulin (IVIG) within half an hour in May 2008. This study elucidated the underlying pathogenesis.

MATERIALS AND METHODS

A variety of protein fractionation and identification approaches were employed to determine the abnormal components in IVIG products obtained from the hospital where the patients were treated. Animal studies using mice and monkeys were conducted to elucidate the pathophysiological mechanisms. In animal experiments, the effect and distribution of immunoglobulin was investigated using HE staining and immunohistochemistry (IHC) separately, while platelets and fibrinogen depletion were utilized to determine a possible link between thromboembolism formation in animals and the lethal effect of the IVIG. The size and distribution of the protein aggregates were determined with Coulter Counter Multisizer-3 after the dilution of the IVIG with plasma, and the lethal effect of the protein aggregates was simulated with artificial microparticles.

RESULTS

The IVIG retrieved from the hospital was found to have striking similarities to the heat-treated IVIG in terms of protein aggregation profiles and lethal effects. Post-mortem examination indicated that immunoglobulin aggregates were mainly found in the lung of the animals, while depletion of platelets and fibrinogen from the IVIG preparations failed to prevent the death of the animals. Similar amount of artificial microparticles caused animal death in similar fashion.

CONCLUSIONS

Our findings indicate that the retrieved IVIG exerted its lethal effects by blocking the pulmonary circulation without markedly altering the coagulation cascade or immunological events.