Patterns of co-morbidity with anxiety disorders in Chinese women with recurrent major depression

BACKGROUND

Studies conducted in Europe and the USA have shown that co-morbidity between major depressive disorder (MDD) and anxiety disorders is associated with various MDD-related features, including clinical symptoms, degree of familial aggregation and socio-economic status. However, few studies have investigated whether these patterns of association vary across different co-morbid anxiety disorders. Here, using a large cohort of Chinese women with recurrent MDD, we examine the prevalence and associated clinical features of co-morbid anxiety disorders.

METHOD

A total of 1970 female Chinese MDD patients with or without seven co-morbid anxiety disorders [including generalized anxiety disorder (GAD), panic disorder, and five phobia subtypes] were ascertained in the CONVERGE study. Generalized linear models were used to model association between co-morbid anxiety disorders and various MDD features.

RESULTS

The lifetime prevalence rate for any type of co-morbid anxiety disorder is 60.2%. Panic and social phobia significantly predict an increased family history of MDD. GAD and animal phobia predict an earlier onset of MDD and a higher number of MDD episodes, respectively. Panic and GAD predict a higher number of DSM-IV diagnostic criteria. GAD and blood-injury phobia are both significantly associated with suicidal attempt with opposite effects. All seven co-morbid anxiety disorders predict higher neuroticism.

CONCLUSIONS

Patterns of co-morbidity between MDD and anxiety are consistent with findings from the US and European studies; the seven co-morbid anxiety disorders are heterogeneous when tested for association with various MDD features.

Derivation of mesenchymal stem cells from human induced pluripotent stem cells cultured on synthetic substrates

Human-induced pluripotent stem cells (hiPSCs) may represent an ideal cell source for research and applications in regenerative medicine. However, standard culture conditions that depend on the use of undefined substrates and xenogeneic medium components represent a significant obstacle to clinical translation. Recently, we reported a defined culture system for human embryonic stem cells using a synthetic polymer coating, poly[2-(methacryloyloxy)ethyl dimethyl-(3-sulfopropyl)ammonium hydroxide] (PMEDSAH), in conjunction with xenogeneic-free culture medium. Here, we tested the hypothesis that iPSCs could be maintained in an undifferentiated state in this xeno-free culture system and subsequently be differentiated into mesenchymal stem cells (iPS-MSCs). hiPSCs were cultured on PMEDSAH and differentiated into functional MSCs, as confirmed by expression of characteristic MSC markers (CD166+, CD105+, CD90+,CD73+, CD31-, CD34-, and CD45-) and their ability to differentiate in vitro into adipogenic, chondrogenic, and osteoblastic lineages. To demonstrate the potential of iPS-MSCs to regenerate bone in vivo, the newly derived cells were induced to osteoblast differentiation for 4 days and transplanted into calvaria defects in immunocompromised mice for 8 weeks. MicroCT and histologic analyses demonstrated de novo bone formation in the calvaria defects for animals treated with iPS-MSCs but not for the control group. Moreover, positive staining for human nuclear antigen and human mitochondria monoclonal antibodies confirmed the participation of the transplanted hiPS-MSCs in the regenerated bone. These results demonstrate that hiPSCs cultured in a xeno-free system have the capability to differentiate into functional MSCs with the ability to form bone in vivo.

The efficacy of NMDA receptor antagonists for preventing remifentanil-induced increase in postoperative pain and analgesic requirement: a meta-analysis

BACKGROUND

Meta-analysis was performed to evaluate the preventive effects of N-methyl-D-aspartate (NMDA) receptor antagonists on remifentanil-induced increase in postoperative pain and analgesic requirement in patients.

METHODS

Pubmed, EMBase, Springer and the Cochrane Controlled Trials Register were searched to identify all randomized controlled trials (RCTs) published to November 2010 which investigated the preventive effects of NMDA receptor antagonists on remifentanil-induced postoperative hyperalgesia and/or tolerance. The studies listed at the end of these articles as reference were also searched. Two authors independently assessed the quality of each study met the inclusion criteria and extracted data. Then Meta-analysis was perfomed using RevMan 5.0 software. The outcomes analyzed were the postoperative analgesic consumption, pain intensity scores, time to first analgesic request, and the incidence of adverse effects.

RESULTS

A total of 623 patients (223 in the ketamine group, 87 in the magnesium group and 313 in the control group) from 14 prospective RCTs were included in the Meta-analysis. Administration of NMDA receptor antagonists reduced the pain scores at 4 hr after operation (P<0.05), and the standardized mean differences (SMD) was -0.21 (95% confidence interval was -0.41 to -0.01). There were no significant differences in postoperative analgesic consumption, pain scores at other time points, time to first analgesic request and the incidence of adverse effects (P>0.05). Further subgroup analyses based on the type of intervention showed that the results were almost the same.

CONCLUSION

These data do not support the use of NMDA receptor antagonists, ketamine and magnesium sulfate to prevent the development of remifentanil-induced postoperative hyperalgesia and tolerance.

SU-E-T-547: Rotating Shield Brachytherapy (RSBT) for Cervical Cancer

PURPOSE

To assess rotating shield brachytherapy (RSBT) delivered with the electronic brachytherapy (eBT) source comparing to intracavitary (IC) and intracavitary plus supplemental interstitial brachytherapy (IC+IS BT) delivered with conventional isotope radiation source.

METHOD AND MATERIALS

IC, IC+IS and RSBT plan was simulated for 5 patients with advanced cervical cancer (>40cc). One BT plan for each patient (fraction 1) guided by magnetic resonance imaging (MRI) was used in our treatment planning system (TPS). A bio- and MRI-compatible polycarbonate (Makrolon Rx3158) intrauterine applicator was simulated for IC and RSBT, and the vienna applicator was simulated for IC+IS BT. 192Ir was used as the radiation source of IC and IC+IS BT; Xoft AxxentTM eBT source was used for RSBT. A 0.5 mm thick tungsten shield was used for RS-BT with different azimuthal and zenith angles. The total dose for each plan was escalated as the external beam radiation therapy (EBRT) plus BT times fraction number (5 in our case).

RESULTS

RSBT and IC+IS BT had higher dose conformity in terms of D90 than IC BT for all the patients. The advantage of RSBT over IC+IS BT was dependent on the shield emission angle, tumor shape and tandem applicator location. The delivery time of RSBT was increased as finer emission angle was selected.

CONCLUSIONS

RSBT is a less-invasive potential alternative to conventional IC and IC+IS BT for treating bulky (>40cc) cervical cancer. RSBT can provide better treatment outcome with clinically acceptable increased delivery time if proper emission angle is selected based on the tumor shape and tandem applicator location. supported in part by NSF grants CCF-0830402 and CCF-0844765; and the NIH grant K25-CA123112, and American Cancer Society seed grant (IRG-77-004-31).

Pentamethylquercetin generates beneficial effects in monosodium glutamate-induced obese mice and C2C12 myotubes by activating AMP-activated protein kinase

AIMS/HYPOTHESIS

Pentamethylquercetin (PMQ) has recently been shown to have glucose-lowering properties. Here, we aimed to characterise the effectiveness and underlying mechanisms of PMQ for ameliorating metabolic disorders in vivo and vitro.

METHODS

We generated a mouse model of obesity by neonatal administration of monosodium glutamate (MSG) and used it to assess the properties of PMQ as a treatment for metabolic disorders. We also investigated the possible underlying mechanisms of PMQ in the prevention of metabolic disorders.

RESULTS

Compared with normal mice, MSG mice had metabolic disorders, including central obesity, hyperinsulinaemia, insulin resistance, hyperglycaemia, hyperlipidaemia, decreased phosphorylation of AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC), and downregulated levels of GLUT4 in gastrocnemius muscles. In MSG mice, PMQ treatment (5, 10, 20 mg/kg daily) reduced body weight gain, waist circumference, adipose tissue mass, serum glucose, triacylglycerol and total cholesterol, while improving insulin resistance, activating AMPK and increasing ACC phosphorylation and GLUT4 abundance. In C2C12 myotubes, PMQ (10 μmol/l) increased glucose consumption by ∼65%. PMQ treatment (1-10 μmol/l) also activated AMPK, increased ACC phosphorylation and GLUT4 abundance, and upregulated the expression of some key genes involved in fatty acid oxidation.

CONCLUSIONS/INTERPRETATION

These findings suggest that PMQ can ameliorate metabolic disorders at least in part via stimulation of AMPK activity.

Outcome of nerve transfers for traumatic complete brachial plexus avulsion: results of 28 patients by DASH and NRS questionnaires

The objective of this study was to evaluate outcomes of patients who suffered complete brachial plexus avulsion before and after nerve transfers by assessing upper extremity function and pain using the DASH and NRS questionnaires. Patients who underwent nerve transfers improved their DASH and NRS scores compared with before surgery. Although individually there was no correlation with improved scores, the triple combination of rehabilitation exercises, electrical stimulation therapy and neurotrophic drugs postoperatively correlated positively with improved functional outcomes. This study suggested a positive effect of the passage of time and nerve transfers in total brachial plexus avulsions from patients' self assessments.

SU-E-J-48: Real Time Image Guided Localization in SBRT Lung/Liver Patients Radiation Treatment

PURPOSE

Stereotactic body radiation therapy (SBRT) lung/liver patientradiation treatment requires high precision of patient position and target localization. For SBRT lung/liver patients positioning, cone beam CT imaging has been widely used, generally with zero couch rotation. The purpose of this study is to implement Stereotactic radiation surgery (SRS) patient positioning technology to SBRT by expanding patient positioning with couch rotation.

METHODS

A Varian® Novlis Tx for SRS treatment wasused to treat SBRT lung/liver patients implementing CBCT. BrainLAB® X-ray imaging system in conjunction with optical guidance is primarily used for SRS patients. CBCT and X-ray imaging system were independently calibrated with 1.0 mm accuracy. The X-ray imaging system was implemented through BrainLAB® ExacTrac system with CBCT localized position at the initial zero position for the X-ray imaging system. For the other couch positions, X-ray images were fused with patient DRRs for positioning.

RESULTS

Based on daily imaging QA records for a period oftwo years, the longitudinal, vertical and lateral coordination between CBCT and X-ray imaging average 0.3+/-0.5, 0.2+/-0.5 and 0.5+/-0.5 mm. The shiftfrom the CBCT imaging isocenter to the X-ray imaging isocenter is 0.5+/-0.5 mm accuracy for a 24-month period of tracking. Patient position accuracy: After initially localizing the patient with CBCT at the zero couch position, the patient was positioned with the X-ray imaging system. The computed translational and rotational shift accuracy are 0.5+/-0.5 mm and0.4+/-0.3 degree respectively, based on 66 SBRT lung/liver patients couchrotations.

CONCLUSIONS

Accurate coordination of CBCT and X-ray imaging in conjunction with optical imaging guidance can be expanded to patient positioning with couch rotation. The X-ray imaging capability at rotated-couch positions improved the physician confidence level during SBRT lung/liver patients treatment.

Randomized Prospective Study of Olecranon Fracture Fixation: Cable Pin System versus Tension Band Wiring

OBJECTIVE: This prospective, randomized study compared the effectiveness of the cable pin system (CPS) versus tension band wiring (TBW) for olecranon fracture fixation. METHODS: Patients with acute transverse or slight oblique olecranon fractures were randomly divided into two groups: one fixed by CPS and the other by TBW. Clinical outcome data were collected and analysed following a mean duration of 21 months. RESULTS: The mean ± SD fracture healing time was significantly shorter in the CPS group ( n = 30; 9.73 ± 2.02 weeks) compared with the TBW group ( n = 32; 11.13 ± 2.21 weeks). One patient in the CPS group and seven patients in the TBW group experienced postoperative complications; this difference was statistically significant. The mean ± SD Mayo Elbow Performance Score in the CPS group was significantly higher (88.67 ± 6.42) than that in the TBW group (80.78 ± 11.99). Logistic regression analysis showed an association between fixation method and fracture healing time, complications and elbow function. CONCLUSIONS: Internal fixation by CPS is an effective method for olecranon fracture and is associated with a shorter healing time, fewer complications and better function than TBW.

SU-E-T-606: Optimal Emission Angle Selection in Rotating Shield Brachytherapy

PURPOSE

In this work a general method is presented that enables clinicians to rapidly select Rotating shield brachytherapy (RSBT) emission angles based on the patient-specific tradeoff between delivery time and tumor dose conformity. Cervical cancer cases are used as examples.

METHODS

Anchor plans with high dose conformity but infeasible delivery times are generated with a fine emission angle, with simulated annealing. The RSBT emission angle selector determines the optimal emission angle for each case by efficiently solving a globally-optimal quadratic programming problem that closely reproduces the angular distribution of beam intensities from the anchor plan. Pareto plots of the dosimetric plan quality metrics, such as D90 versus the delivery time, are generated for clinicians. In this work two cervical cancer cases were considered for verification. The RSBT system was assumed to be a Xoft AxxentTM electronic BT(eBT) source with a 0.2mm tungsten shield. The intent for each treatment plans was to maximize tumor D90 while respective the GEC-ESTRO recommended constraints on the D2cc values to OARs.

RESULTS

Generating anchor plans with simulated annealing takes 10-20min while emission angle selection can finish within seconds. The shield sequencing algorithm also ensures the balance between D90 and delivery time. One case shows that the D90 can achieve 98.3Gy10 with emission angle 202.5 degree with 8.64min delivery, while the conventional intracavitary plan has D90 65Gy10 with 2.86min delivery. Another case shows RSBT with emission angle 67.5 degree can produce D90 108.7Gy10 with 44min, and the conventional plan uses 2.2min for D90 48.9Gy10.

CONCLUSIONS

The RSBT emission angle selection algorithm enables the users to rapidly determine the best emission angle for a given cervical cancer case by selecting the most appropriate D90 and delivery time. RSBT may be a less invasive alternative to intracavitary and supplementary interstitial BT for the treatment of cervical cancer tumors, supported in part by NSF grants CCF-0830402 and CCF-0844765, the NIH grant K25-CA123112.

The sensitivity of human mesenchymal stem cells to vibration and cold storage conditions representative of cold transportation

In the current study, the mechanical and hypothermic damage induced by vibration and cold storage on human mesenchymal stem cells (hMSCs) stored at 2-8°C was quantified by measuring the total cell number and cell viability after exposure to vibration at 50 Hz (peak acceleration 140 m s(-2) and peak displacement 1.4 mm), 25 Hz (peak acceleration 140 m s(-2), peak displacement 5.7 mm), 10 Hz (peak acceleration 20 m s(-2), peak displacement 5.1 mm) and cold storage for several durations. To quantify the viability of the cells, in addition to the trypan blue exclusion method, the combination of annexin V-FITC and propidium iodide was applied to understand the mode of cell death. Cell granularity and a panel of cell surface markers for stemness, including CD29, CD44, CD105 and CD166, were also evaluated for each condition. It was found that hMSCs were sensitive to vibration at 25 Hz, with moderate effects at 50 Hz and no effects at 10 Hz. Vibration at 25 Hz also increased CD29 and CD44 expression. The study further showed that cold storage alone caused a decrease in cell viability, especially after 48 h, and also increased CD29 and CD44 and attenuated CD105 expressions. Cell death would most likely be the consequence of membrane rupture, owing to necrosis induced by cold storage. The sensitivity of cells to different vibrations within the mechanical system is due to a combined effect of displacement and acceleration, and hMSCs with a longer cold storage duration were more susceptible to vibration damage, indicating a coupling between the effects of vibration and cold storage.

An efficacy analysis for nasopharyngeal carcinoma screening of different screening intervals

OBJECTIVE

To evaluate the impact of different screening intervals on screening for nasopharyngeal carcinoma (NPC).

METHODS

A Markov model was constructed, based on the natural history of NPC. The 5-year mortality rate of NPC was the major measurement to evaluate the efficacies of 16 screening strategies. Parameters for the model were derived from published literature.

RESULTS

Screening reduced the 5-year mortality rate for NPC by 20.4 - 43.3%, compared with the equivalent rate without screening. The 5 year mortality rate and the NPC pick-up rate with strategy A1 (annual screening) were 23.6% and 83.9%, respectively. Compared with strategy A1, strategy B1 (annual screening for seropositive subjects; biennial screening for seronegative subjects) had a similar 5-year mortality rate (24.0%) and a slightly smaller NPC pick-up rate (81.7%), but led to a 39.3% reduction in total screenings. Compared with all other strategies excluding strategy A1, strategy B1 achieved the lowest 5-year mortality rate and the largest NPC pick-up rate.

CONCLUSIONS

Strategy B1 had the highest efficacy for NPC screening.

Characteristics of infradian and circadian rhythms in the persistent vegetative state

This retrospective study investigated the circadian and infradian characteristics of blood pressure and heart rate in 26 patients with traumatic head injury in a persistent vegetative state (PVS). Systolic and diastolic blood pressures and heart rate were measured every hour for the first 240 h (10 days) following hospital admission. These data were analysed for the presence of circadian and infradian rhythms using the least-squares fit of the cosine function with the single cosinor method. Infradian rhythms were defined as biological rhythms with a period of approximately 7 days (circaseptan rhythms). All the patients studied had circadian and circaseptan rhythms of systolic and diastolic blood pressures and heart rate. The amplitudes of all the circaseptan rhythms were significantly greater than those of the corresponding circadian rhythms. It was concluded that there was an altered association between circadian and infradian blood pressure and heart rate rhythms in patients in a PVS. Circadian and infradian rhythms were present, but the infradian rhythm had a greater amplitude than the circadian rhythm.

Early-stage Pathogenic Sequence of Jaw Osteoradionecrosis in vivo

The mechanism underlying jaw osteoradionecrosis (ORN) is not fully understood, particularly in the early stages. To investigate bone and vessel pathogenesis in the early stages of jaw ORN, we generated a mandibular ORN model in miniature pigs (minipigs) by applying a combination of single-dose 25-Gy irradiation (IR) and tooth extraction. We studied 6 ORN model minipigs and 6 control, non-irradiated minipigs. We measured dynamic morphological changes, bone-remodeling-associated gene expression, sphingomyelinase activity, and local blood flow. Bone remodeling, including bone resorption and new bone formation, was observed within 15 days post-IR. Later, an ORN-related imbalance in bone metabolism gradually occurred, with loss of bone regeneration capacity, collagen collapse, and microvascular obliteration. Within 24 hrs post-IR, sphingomyelinase significantly increased in irradiated tissues. At 1 wk post-IR, local blood flow increased, but at 15 days post-IR, it significantly decreased to 50% below normal levels. This study provided details of the sequential occurrences in early-stage ORN in a large animal model. Our results suggested that reduced local blood flow and consequent hypovascularity may have caused an imbalance in bone remodeling. This suggested that microvessel damage may play a key role in the initiation of ORN.

Mobile stroke unit for diagnosis-based triage of persons with suspected stroke

BACKGROUND

In this feasibility study, we tested whether prehospital diagnostic stroke workup enables rational decision-making regarding treatment and the target hospital in persons with suspected stroke.

METHODS

A mobile stroke unit that delivers imaging (including multimodal brain imaging with CT angiography and CT perfusion), point-of-care-laboratory analysis, and neurologic expertise directly at the emergency site was analyzed for its use in prehospital diagnosis-based triage of suspected stroke patients.

RESULTS

We present 4 complementary cases with suspected stroke who underwent prehospital diagnostic workup that enabled direct diagnosis-based treatment decisions and reliable triage regarding the most appropriate medical facility for that individual, e.g., a primary hospital vs specialized centers of a tertiary hospital.

CONCLUSIONS

This preliminary report demonstrates the feasibility of prehospital diagnostic stroke workup for immediate etiology-specific decision-making regarding the necessary time-sensitive stroke treatment and the most appropriate target hospital.

Bending sensor based on intermodal interference properties of two-dimensional waveguide array fiber

We propose a highly sensitive bending sensor based on the intermodal interference properties of a strongly coupled two-dimentional waveguide array fiber (WAF). The interference resonance peaks formed by the SMF-WAF-SMF Mach-Zehnder interferometer are intrinsically the result of interference between the LP(01)-like supermode and other higher order supermodes, displaying supernormal sensitivity to bending in a wide curvature range. The bending sensitivity of the intermodal MZI is a quadratic function of curvature, and the resonance wavelength shift is up to 100 nm within a curvature range 0-10 m(-1). The fabrication reveals briefness, and temperature response shows little impact on the bend sensing precision. The high bending sensitivity and wide sensing range can make this device a candidate for bending discrimination and measurement in widespread areas.

Kidney transplantation from donation after cardiac death donors in China--a single-center experience

OBJECTIVE

To report clinical outcomes of kidney transplantation from cardiac death donors (DCD) in China, and to investigate its feasibility to expand the organ donor pool.

PATIENTS AND METHODS

We retrospectively studied clinical data of 46 DCD kidneys from 31 donors from February 2007 to August 2011. Recipients were followed for patient and graft survival.

RESULTS

We discarded the organs from 3 of 29 (10.3%) DCD donors and 7 of 42 (16.7%) kidneys that displayed renal thrombosis. Of the 39 recipients engrafted with DCD kidneys successfully, the mean follow-up was 16 months, (range = 50 days to 43 months). Delayed graft function (DGF) occurred in 15 (38.5%) recipients, who except one recovered within 3 months. Three biopsy-proven acute rejection episodes were observed in two recipients (5.1%). All patients survived through the follow-up. The graft survival rate was 97.4% at 12 months and 94.9% at 24 months. A 45-year-old male recipient who received a pair of grafts from a 6-year-old child survived with good renal function.

CONCLUSION

Although kidney transplantations from DCD donors showed a higher rate of DGF with a longer duration of graft recovery, we achieved favorable short-term clinical outcome in terms of graft survival and function. Donation after cardiac death can expand the organ donor pool in China.

Four SNPs of insulin-induced gene 1 associated with growth and carcass traits in Qinchuan cattle in China

The insulin-induced gene 1 (Insig-1) is a regulator of lipid metabolism and plays an important role in the sterol-mediated regulation of SREBP, SCAP and HMG-CoA reductase. We used PCR-RFLP and DNA sequencing to detect polymorphisms of the Insig-1 gene in 215 individuals of the Qinchuan cattle breed. Four SNPs [4366(A>G), 4534(T>C), 5001(T>C), and 5235(G>A)] were indentified. The association of the genetic viariation with growth and carcass traits (body length, withers height, hip width, slaughter weight, and carcass weight) was analyzed. The individuals with better performance had the GG genotype at locus A4366G, and CC genotypes at locus T4534C and locus T5001C. These could be used for beef cattle breeding improvement in China. Additionally, linkage disequilibrium analysis reflected that all mutations were in low linkage disequilibrium with each other. We concluded that polymorphisms in the Insig-1 gene are associated with growth and carcass traits and could be used for marker-assisted selection and management in beef cattle breeding programs.

Using PharmGKB to train text mining approaches for identifying potential gene targets for pharmacogenomic studies

The main objective of this study was to investigate the feasibility of using PharmGKB, a pharmacogenomic database, as a source of training data in combination with text of MEDLINE abstracts for a text mining approach to identification of potential gene targets for pathway-driven pharmacogenomics research. We used the manually curated relations between drugs and genes in PharmGKB database to train a support vector machine predictive model and applied this model prospectively to MEDLINE abstracts. The gene targets suggested by this approach were subsequently manually reviewed. Our quantitative analysis showed that a support vector machine classifiers trained on MEDLINE abstracts with single words (unigrams) used as features and PharmGKB relations used for supervision, achieve an overall sensitivity of 85% and specificity of 69%. The subsequent qualitative analysis showed that gene targets "suggested" by the automatic classifier were not anticipated by expert reviewers but were subsequently found to be relevant to the three drugs that were investigated: carbamazepine, lamivudine and zidovudine. Our results show that this approach is not only feasible but may also find new gene targets not identifiable by other methods thus making it a valuable tool for pathway-driven pharmacogenomics research.

First observation of B(s)(0) → J/ψη and B(s)(0) → J/ψη'

We report first observations of B(s)(0) → J/ψη and B(s)(0) → J/ψη'. The results are obtained from 121.4  fb(-1) of data collected at the Υ(5S) resonance with the Belle detector at the KEKB e+ e- collider. We obtain the branching fractions B(B(s)(0) → J/ψη)=[5.10±0.50(stat)±0.25(syst)(-0.79)(+1.14)(N(B(s)(*) B(s)(*))]×10(-4), and B(B(s)(0) → J/ψη')=[3.71±0.61(stat)±0.18(syst)(-0.57)(+0.83)(N(B(s)(*) B(s)(*))]×10(-4). The ratio of the two branching fractions is measured to be (B(B(s) → J/ψη'))/(B(B(s) → J/ψη))=0.73±0.14(stat)±0.02(syst).