Calcification of the external carotid arteries and their branches

This patient had longstanding hypercalcaemia and hyperphosphataemia owing to chronic renal disease, then finally failure, inducing tertiary hyperparathyroidism. He also had long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. He then reported a painful expansile swelling of the anterior mandible which was diagnosed as a "brown tumour". Subsequent review of the CT data set by an oral and maxillofacial radiologist revealed two patterns of calcification of the carotid arteries. A pipestem pattern was observed bilaterally along almost the entire lengths of the external carotid artery, a muscular artery, and its branches whereas plaque-like calcification was observed in the common and internal carotid arteries (elastic arteries). The pipestem pattern, hitherto an unreported feature affecting the external carotid artery, may represent a metastatic calcified deposit owing to hypercalcaemia and hyperphosphataemia in the tunica media of muscular arteries, resulting in arteriosclerosis, which maintains a patent lumen. The plaque-like pattern is representative of lumen-occluding calcified atherosclerosis associated with the long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. As this patient did not have any symptoms and/or signs of myofacial pain, facial dysfunction or numbness, the calcification of his external carotid arteries and branches were considered as arteriosclerosis. The brown tumour responded to the parathyroidectomy and the renal transplant.

Introduction of electronic referral from community associated with more timely review by secondary services

BACKGROUND

Electronic referral (eReferral) from community into public secondary healthcare services was introduced to 30 referring general medical practices and 28 hospital based services in late 2007.

OBJECTIVES

To measure the extent of uptake of eReferral and its association with changes in referral processing.

METHODS

Analysis of transactional data from the eReferral message service and the patient information management system of the affected hospital; interview of clinical, operational and management stakeholders.

RESULTS

eReferral use rose steadily to 1000 transactions per month in 2008, thereafter showing moderate growth to 1200 per month in 2010. Rate of eReferral from the community in 2010 is estimated at 56% of total referrals to the hospital from general practice, and as 71% of referrals from those having done at least one referral electronically. Referral latency from letter date to hospital triage improves significantly from 2007 to 2009 (p<0.001), from a paper referral median of 8 days (inter-quartile range, IQR: 4-14) in 2007 to an eReferral median of 5 days (IQR: 2-9) and paper referral median of 6 days (IQR: 2-12) in 2009. Specialists upgrade the referrer-assigned eReferral priority in 19.2% of cases and downgrade it 18.6% of the time. Clinical users appreciate improvement of referral visibility (status and content access); however, both general practitioners and specialists point out system usability issues.

DISCUSSION

With eReferrals, a referral's status can be checked, and its content read, by any authorized user at any time. The period of eReferral uptake was associated with significant speed-up in referral processing without changes in staffing levels. The eReferral system provides a foundation for further innovation in the community-secondary interface, such as electronic decision support and shared care planning systems.

CONCLUSIONS

We observed substantial rapid voluntary uptake of eReferrals associated with faster, more reliable and more transparent referral processing.

Meta-analysis of an association of codon 72 polymorphisms of the p53 gene with increased endometrial cancer risk

Polymorphisms of the p53 gene have been associated with susceptibility to endometrial cancer. However, whether there is a specific association is still controversial. We investigated a possible association between p53 codon 72 polymorphism and endometrial cancer risk by conducting a meta-analysis. Publications addressing this association were selected from the Pubmed, Embase and CBM databases (up to January 2011). Data were extracted from the studies by two independent reviewers. The meta-analysis was performed using RevMan 5.0.25 and STATA 9.2 softwares. The odds ratio (OR) with 95% confidence intervals (CI) was calculated. Then, 10 case-control studies were retrieved, with a total of 917 endometrial cancer patients and 1680 healthy controls. Meta-analysis results showed that the Pro allele and Pro carrier (Arg/Pro + Pro/Pro) of p53 codon 72 polymorphism were significantly related with endometrial cancer risk (OR = 1.25, 95%CI = 1.10-1.41, P = 0.0005; OR = 1.34, 95%CI = 1.12-1.59, P = 0.001, respectively). In the subgroup analysis, based on ethnicity, studies were divided into Asian and Caucasian populations; the Pro allele and Pro carrier (Arg/Pro + Pro/Pro) of p53 codon 72 polymorphism were significantly related with endometrial cancer risk in Asian populations (OR = 1.41, 95%CI = 1.19-1.66, P < 0.0001; OR = 1.66, 95%CI = 1.30-2.13, P < 0.0001, respectively), but not in Caucasian populations (both P > 0.05). We concluded that the Pro allele (Arg/Pro + Pro/Pro) of p53 codon 72 polymorphism is a potential risk factor for endometrial cancer.

ADAM17 regulates TNFα production by placental trophoblasts

Increased trophoblast TNFα production is an important component of placental dysfunction in preeclampsia. However, the mechanism of increased TNFα production in the preeclamptic placenta is largely unknown. ADAM17 is a metallopeptidase that functions as a TNFα converting enzyme. In this study, we examined ADAM17 expression in placentas from normal and preeclamptic pregnancies and found increased ADAM17 expression in preeclamptic placentas compared to those from normal placentas, p < 0.05. Since hypoxia/oxidative stress is an underlying pathophysiology in the preeclamptic placenta, we further determined if hypoxia/oxidative stress could modulate ADAM17 expression and subsequently induce TNFα production in placental trophoblasts. Trophoblasts were isolated from normal term placentas and treated with cobalt (II) chloride (CoCl(2)), a hypoxia mimetic agent, at different concentrations. Our results showed that CoCl(2) induced a dose-dependent increase in TNFα production that is associated with enhanced ADAM17 expression. Trophoblast expressions of HO-1 (a sensor of cellular oxidative stress) and caspase-3 (an indicator of apoptosis) in response to CoCl(2) stimulation were also examined. We further found that metallopeptidase inhibitor GM6001 and ADAM17 siRNA could block CoCl(2) induced TNFα production, demonstrating the role of ADAM17 in TNFα production in placental trophoblasts. These results suggest that oxidative stress-induced increased ADAM17 expression could contribute to the increased TNFα production in preeclamptic placentas.

Assessment of haplotype variation in bovine &lt;i&gt;AMPD1&lt;/i&gt; gene for association with growth and carcass traits in Qinchuan beef cattle

Abstract. The AMPD1 gene plays an important role in the purine nucleotide cycle and energy metabolism in skeletal muscle. In the present study polymorphisms of the AMPD1 gene were detected by PCR-SSCP and DNA sequencing of 215 individuals of the Qinchuan beef cattle breed. DNA sequencing revealed two mutations by comparisons with the bovine genome sequence (acc. no.: NC_007301). Two single nucleotide polymorphisms (SNPs; g.19416T>C and g.19421A>G) were detected in intron 11 of the bovine AMPD1 gene. The sequencing of PCR products of animals providing different PCR-SSCP banding patterns showed that four kinds of haplotypes, named: A (T-A), B (T-G), C (C-A) and D (C-G); and the five diplotypes were segregating: AA (T-A/T-A), BC (T-G/C-A or C-G/T-A ), AC (T-A/C-A), CC (C-A/C-A) and CD (C-A/ C-G). A significant association of AMPD1 with carcass weight was shown. Animals with the new heterozygote diplotype BC (P<0.05, n=56) had greater carcass weight than those with the other diplotypes. The SNPs in AMPD1 may be used as a possible candidates for markerassisted selection in Qinchuan beef cattle breeding program.

Inducers and co-inducers of molecular chaperones

Molecular chaperones, which are mostly heat- or stress-induced proteins (HSPs), not only regulate various cellular functions such as protein folding, refolding of partially denatured proteins, protein transport across membranes, cytoskeletal organization, degradation of disabled proteins, and apoptosis, but also act as cytoprotective factors against deleterious environmental stresses. Recent studies indicated that moderate overexpression of molecular chaperones could confer cells and tissues stress tolerance and provide beneficial effects on various pathological states associated with protein misfolding and protein aggregation. Mild heat shock, transfection of HSP genes, and some chemical compounds are the major means of overexpression of molecular chaperones. In this review, we summarize recent studies of chemical compounds that could induce or enhance the expression of molecular chaperones or HSPs.

Differential cytokine responses in human and mouse lymphatic endothelial cells to cytokines in vitro

BACKGROUND

Inflammatory cytokines dysregulate microvascular function, yet how cytokines affect lymphatic endothelial cells (LEC) are unclear.

METHODS AND RESULTS

We examined effects of TNF-α, IL-1 beta, and IFN-gamma on LEC proliferation, endothelial cell adhesion molecule (ECAM) expression, capillary formation, and barrier changes in murine (SV-LEC) and human LECs (HMEC-1a).

RESULTS

All cytokines induced ICAM-1, VCAM-1, MAdCAM-1, and E-selectin in SV-LECs; TNF-α, IL-1 beta; and IFN-gamma induced ECAMs (but not MAdCAM-1) in HMEC-1a. IL-1 beta increased, while IFN-gamma and TNF-α reduced SV-LEC proliferation. While TNF-α induced, IFN-gamma decreased, and IL-1 beta did not show any effect on HMEC-1a proliferation. TNF-α, IL-1 beta, and IFN-gamma each reduced capillary formation in SV-LEC and in HMEC-1a. TNF-α and IL-1 beta reduced barrier in SV-LEC and HMEC-1a; IFN-gamma did not affect SV-LEC barrier, but enhanced HMEC-1a barrier. Inflammatory cytokines alter LEC growth, activation and barrier function in vitro and may disturb lymphatic clearance increasing tissue edema in vivo.

CONCLUSION

Therapies that maintain or restore lymphatic function (including cytokines blockade), may represent important strategies for limiting inflammation.

Study of a high-resolution, 3D positioning cadmium zinc telluride detector for PET

This paper investigates the performance of 1 mm resolution cadmium zinc telluride (CZT) detectors for positron emission tomography (PET) capable of positioning the 3D coordinates of individual 511 keV photon interactions. The detectors comprise 40 mm × 40 mm × 5 mm monolithic CZT crystals that employ a novel cross-strip readout with interspersed steering electrodes to obtain high spatial and energy resolution. The study found a single anode FWHM energy resolution of 3.06 ± 0.39% at 511 keV throughout most of the detector volume. Improved resolution is expected with properly shielded front-end electronics. Measurements made using a collimated beam established the efficacy of the steering electrodes in facilitating enhanced charge collection across anodes, as well as a spatial resolution of 0.44 ± 0.07 mm in the direction orthogonal to the electrode planes. Finally, measurements based on coincidence electronic collimation yielded a point spread function with 0.78 ± 0.10 mm FWHM, demonstrating 1 mm spatial resolution capability transverse to the anodes-as expected from the 1 mm anode pitch. These findings indicate that the CZT-based detector concept has excellent performance and shows great promise for a high-resolution PET system.

Clinical features of atopic dermatitis in a hospital-based setting in China

BACKGROUND

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. There have been few detailed reports of the clinical evaluation of Chinese patients with AD.

OBJECTIVES

To give a profile of the clinical features of Chinese AD patients in a university hospital setting.

METHODS

A total of 1008 cases met Hanifin and Rajka diagnostic criteria of AD were recruited at Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China.

RESULTS

In our survey, 22.7% patients were mild, 66.6% were moderate and 10.7% were severe according to the SCORAD index. Both the frequency and severity of the male patients were slightly higher. The frequency of asthma among the AD patients was 16.7% and it was increased with the age (χ2 = 205.20, P = 0.000). The frequencies of objective minor signs were demonstrated with age-related changes. Besides, three localized variants including eyelid eczema (49.8%), scalp dermatitis (49.7%), infra-auricular and retroauricular fissuring (44.8%) were commonly observed, especially in the infantile phase (P < 0.01). It was showed significant differences in serum total immunoglobulin E (IgE) and eosinophil cationic protein (ECP) levels of different age groups. The positive rate of Phadiatop was raised after 3 years old and that of the common food allergens were decreased after 6 years old.

CONCLUSIONS

More males than females had ongoing AD in our survey. Most AD debuted in the first year of the cases. High incidence of the three clinical signs: eyelid eczema, scalp dermatitis and infra-auricular and retroauricular fissuring among the patients suggests it can be a potential valuable diagnostic clue to AD.

Proteases and sFlt-1 release in the human placenta

Increased placental release of soluble VEGF receptor-1 (sFlt-1) is believed to play an important role in the pathogenesis of preeclampsia (PE). Although the reason for increased placental sFlt-1 release in PE is unknown, proteolytic effect has been proposed as one of the mechanisms that mediate sFlt-1 release in the placenta. In this study, using various protease inhibitors, we tested the possible role of proteases in sFlt-1 release by human placenta. Villous explants from normal term placentas were incubated with various protease inhibitors including serine protease inhibitors (PMSF, aprotini, and specific chymotrypsin inhibitor (CI)), cysteine protease inhibitor E-64, metalloendopeptidase inhibitor PAD, and universal metalloprotease (ADAM) inhibitor PTM. Culture medium was collected and measured for sFlt-1 by ELISA. Our results showed that villous tissue treated with CI and PTM produced significantly less sFlt-1 than those of controls. PMSF, aprotini, E-64, and PAD had no effect on sFlt-1 release. We further examined chymotrypsin-like protease/chymase and ADAM10 expressions in tissue sections from normal and PE placentas by immunohistochemistry. We found that immunostaining for chymase and ADAM10 was significantly increased in the layer of syncytiotrophoblasts in PE placentas compared to normal placentas. These results suggest chymotrypsin-like serine protease and ADAM10, but not cysteine protease and metalloendopeptidase, may play a role in inducing sFlt-1 release in PE placentas.