The challenge of diagnosing seborrheic keratosis by reflectance confocal microscopy

BACKGROUND

Seborrheic keratosis (SK) is one of the most common skin tumors seen by dermatologists. It should be differentiated with many diseases, especially skin tumors. Reflectance confocal microscopy (RCM) has been applied for evaluation of SK. There are a few studies that describe the RCM of SK. The aim of the study was to find the challenge of diagnosing seborrheic keratosis by reflectance confocal microscopy.

METHODS

A total of 390 patients with a clinical suspicious diagnosis of seborrheic keratosis were enrolled in this study, and lesions from each patient were imaged with RCM. Thirty-seven of these patients performed a biopsy in order to be given a histological diagnosis. We retrospectively analyzed the outcomes of RCM diagnosis and histological diagnosis, and then found the RCM characteristics of biopsy-proven lesions.

RESULTS

According to RCM images, 258 of 390 (66.2%) patients were diagnosed with SK, 97 of 390 (24.9%) patients could not be diagnosed by the dermatologist according to RCM. Of all 37 biopsied lesions, 23 were SK, 6 were actinic keratosis, 2 were basal cell carcinoma, and 2 were squamous cell carcinoma.

CONCLUSION

It is challenge to diagnose seborrheic keratosis by reflectance confocal microscopy. It may due to the variable clinical and RCM appearances of SK, and limited depth of RCM.

Molecular-Scale Description of SPAN80 Desorption from a Squalane-Water Interface

Extensive all-atom molecular dynamics calculations on the water-squalane interface for nine different loadings with sorbitan monooleate (SPAN80), at T = 300 K, are analyzed for the surface tension equation of state, desorption free-energy profiles as they depend on loading, and to evaluate escape times for adsorbed SPAN80 into the bulk phases. These results suggest that loading only weakly affects accommodation of a SPAN80 molecule by this squalane-water interface. Specifically, the surface tension equation of state is simple through the range of high tension to high loading studied, and the desorption free-energy profiles are weakly dependent on loading here. The perpendicular motion of the centroid of the SPAN80 headgroup ring is well-described by a diffusional model near the minimum of the desorption free-energy profile. Lateral diffusional motion is weakly dependent on loading. Escape times evaluated on the basis of a diffusional model and the desorption free energies are 7 × 10^-2 s (into the squalane) and 3 × 10² h (into the water). The latter value is consistent with desorption times of related lab-scale experimental work.

Abstract P1-10-09: EPHA2-targeting enhances eicosapentaenoic acid cytotoxicity against triple-negative inflammatory breast cancer via ABCA1 inhibition–mediated membrane rigidity

Background: Effective treatment options for triple-negative inflammatory breast cancer (TN-IBC), the most aggressive form of breast cancer, are currently lacking. We previously reported that mediators of inflammation promote the growth of TN-IBC xenografts. Eicosapentaenoic acid (EPA), an omega-3 fatty acid (fish oil) with anti-inflammatory properties, is an emerging FDA-approved therapeutic with a favorable toxicology profile. Here we aimed to develop a novel approach to enhance EPA efficacy against TN-IBC by identifying a kinase inhibitor that synergizes with EPA's antitumor activity.

Methods and Results: Using a high-throughput siRNA screen in the TN-IBC cell line SUM149PT, we identified inhibition of ephrin type-A receptor 2 (EPHA2), an oncogenic receptor tyrosine kinase, as a target that sensitizes TN-IBC cells to EPA therapy. To determine the clinical relevance of EPHA2, we investigated a meta-analysis of breast cancer mRNA expression data sets and found that high EPHA2 tumor expression, compared with low expressing, correlated significantly with poor overall survival in TN-IBC patients (P = 0.01), while not with other subtypes. Similar findings were observed in vitro, were EPHA2 protein and mRNA overexpression occurred predominantly in the TN subtypes among 49 and 51 breast cancer cell lines (63% and 47%, respectively), highlighting EPHA2 translational potential. Functional expression studies using proliferation and apoptosis assays in vitro, and xenografts in vivo, were performed in two EPHA2-expressing TN-IBC cell lines, SUM149PT and BCX010, to validate EPHA2 as a synergistic combinational target with EPA. EPHA2 gene silencing in combination with EPA significantly reduced cell growth, and enhanced apoptosis, compared with untreated and monotherapy in vitro (P < 0.05), and in vivo (P < 0.001). To translate our findings to the clinic, we validated dasatinib, an FDA-approved small molecule inhibitor of EPHA2, in combination to EPA to significantly enhance apoptosis of TN-IBC cells in vitro (P < 0.05) and in vivo (P < 0.05), compared with untreated and monotherapies. Using membrane fluidity assessment and cholesterol quantification we determined that apoptosis induction after combination therapy was due to increased membrane rigidity and cholesterol concentrations in the plasma membrane of TN-IBC cells (P < 0.05, compared with monotherapies). Finally, we discovered by western blot and gain/loss-of-expression studies that combination therapy inhibited the cholesterol efflux protein ATP-binding cassette sub-family A member 1 (ABCA1), which plays a significant role mediating increased cellular cholesterol (P < 0.05), cell membrane rigidity (P < 0.05), and induction of apoptosis (P < 0.05) in TN-IBC after EPA and EPHA2-targeting combination therapy.

Conclusions: This is the first study demonstrating that EPA can enhance conventional targeted therapy against breast cancer. Our study provides molecular and preclinical evidence to support the development of an EPA/EPHA2-inhibition–based phase I clinical trial for patients with EPHA2-positive TN-IBC; our study further suggests the use of EPHA2 and ABCA1 protein expression as biomarkers for patient selection and therapeutic response.

Citation Format: Torres-Adorno AM, Vitrac H, Qi Y, Tan L, Levental KR, Fan Y-Y, Yang P, Chapkin RS, Eckhardt BL, Ueno NT. EPHA2-targeting enhances eicosapentaenoic acid cytotoxicity against triple-negative inflammatory breast cancer via ABCA1 inhibition–mediated membrane rigidity [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-10-09.

[Efficacy of nasal spray-type allergen blocker combined with oral antihistamines in patients with dust mite allergic AR]

Objective:To investigate the clinical effect of nasal spray type allergen blocker combined with oral antihistamine on dust mite allergic allergic rhinitis (AR). Method:Ninety cases of patients withmild-severe allergic to dust mite were randomly divided into experimental group and control group, 45 cases in each group. The experimental group used nasal spray allergen barrier agent combined with citrate tablets, and the control group used physiological seawater combined with citrate sheet. The symptoms of subjective rhinitis, objective signs, improvement of quality of life scores and adverse reactionsof 2 groups were evaluated before and 2 weeks after treatment. Result:The symptoms, signs and quality of life of the patients in the experimental group were better than those in the control group (P<0.05). No obvious adverse reactions were observed. Conclusion:The effect of nasal spray type allergen blocker combined with antihistamine on AR patients with allergic to dust mite is remarkable. They can significantly alleviate the symptoms and signs of rhinitis in patients, and is worthy to be popularized in clinical application.

[Gender differences of REM related obstructive sleep apnea-hypopnea syndrome]

Objective: To explore the gender differences of rapid-eye-movement (REM) related obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: Consecutive patients with primary complaint of snoring from Sleep Medicine Center of West China Hospital between January 2016 and November 2016 were included in the study. All participants underwent one night polysomnography (PSG) and Epworth sleep scale (ESS) was estimated. The patients diagnosed with OSAHS were classified as REM related OSAHS (REM-OSAHS group) and non-rapid-eye-movement (NREM) related OSAHS (NREM-OSAHS group) based on the PSG parameters. And the gender differences of demographic and polysomnograpic characteristics in both groups were compared. The associations between apnea-hypopnea index (AHI) and body mass index (BMI), neck circumference and waist circumference among patients with OSAHS were explored by multiple linear regression analysis. Results: A total of 1 258 patients were diagnosed with OSAHS. There were 997 (79.3%) male and 261 (20.7%) female among these patients, the mean age was (46.4±12.0) years old and mean BMI was (26.6±3.4) kg/m(2). There were 236 patients (18.8%) classified into REM-OSAHS group, and 1 022 patients (81.2%) classified into NREM-OSAHS group; the proportion of REM-OSAHS in female was significantly higher than that in male (34.1% vs 14.7%, P<0.001). After controlling for age, drinking, smoking, hypnotics, coffee, strong tea and sleep related parameters, in NREM-OSAHS group, AHI was positively correlated with BMI, neck circumference and waist circumference (P<0.001) both in male and female. In REM-OSAHS group, AHI was positively correlated with BMI, neck circumference and waist circumference in female (P<0.05), but only significantly correlated with BMI and waist circumference in male (P<0.05). Conclusions: REM-OSAHS is commonly seen in female OSAHS patients. Evaluation of the influences of anthropometric data on the severity of REM-OSAHS should consider the impact of gender.

The potential role of attitudes towards suicide between mental health status and suicidal ideation among Chinese children and adolescents

BACKGROUND

The objective of this study was to investigate the contributions of mental health status and attitudes towards suicide on suicidal ideation in a sample of 6568 Chinese children and adolescents in China. Attitudes towards suicide were investigated as a possible moderator and mediator of the influence of mental health status on suicidal ideation.

METHODS

Descriptive statistical analyses, Pearson correlation analyses and hierarchical regression analyses were adopted as methods of data analyses.

RESULTS

Approximately 35.38% of children and adolescents in our study reported having suicidal ideation. Mental health status and attitudes towards suicide both had an independent effect on the severity of suicidal ideation. Results indicated that mental health status was positively associated with suicidal ideation, while attitudes towards suicide were negatively associated with suicidal ideation. Moderation analysis showed that the impact of mental health status on suicidal ideation was significantly greater among children and adolescents who reported favourable attitudes towards suicide. Attitudes towards suicide partially mediated the link between mental health status and the severity of suicidal ideation. Specifically, students who experienced poorer mental health status might be more likely to report significantly more favourable attitudes towards suicide, which in turn promote greater suicidal ideation.

CONCLUSIONS

These results have implications for the prevention of youth suicide, suggesting that mental health status and attitudes towards suicide could be important targets for prevention and intervention for children and adolescents at risk of suicidal ideation.

Changes in the trend of anti-psychotics prescription in elderly patients in a general hospital in Singapore 2005–2013

Objectives

This was a descriptive study of the prescription trend of anti-psychotics for elderly patients in a general hospital in Singapore.

Methods

Elderly patients aged >65 who received at least 1 prescription of anti-psychotics during 2005, 2007, 2009, 2011 and 2013 in Tan Tock Seng Hospital, Singapore, were selected. Data was obtained from the hospital computerized prescription records.

Results

The total number of elderly patients who received anti-psychotics increased from 865 in 2005 to 1990 in 2013. Following the official warning issued by the health sciences authority in 2004 regarding the increased risks of cerebrovascular events in elderly patients taking olanzapine and risperidone, prescriptions for risperidone reduced between 2005 to 2013 (20.74% vs. 11.79%, 95% CI: 0.07–0.10, P < 0.0001). However, the percentage of prescriptions of other atypical anti-psychotics such as quetiapine increased from 27.47% to 58.48% (95% CI: 0.29–0.33, P < 0.0001), in 2005 and 2013 respectively, and prescriptions for olanzapine remained relatively stable at 6.65% in 2005 and 8.94% in 2013 (P > 0.05). With the black box warnings extended to typical anti-psychotics 3 years later, the percentage of prescriptions of typical anti-psychotics decreased between 2005 to 2013, e.g. haloperidol (33.19% vs. 13.39%, 95% CI: 0.17–0.22; P < 0.0001), sulpiride (6.58% vs. 2.83%, 95% CI: 0.03–0.05, P < 0.0001) and chlorpromazine (3.85% vs. 1.85%, 95% CI: 0.01–0.03, P < 0.0001).

Conclusions

After the first safety warning the percentage of prescriptions for risperidone dropped significantly, and there was a significant increase for quetiapine. The percentage of haloperidol, sulpiride and chlorpromazine prescriptions declined after both warnings. Anti-psychotics use in the elderly continues to be prevalent.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Association between subjective and objective sleepiness in obstructive sleep apnea hypopnea syndrome patients]

Objective: To examine the association between subjective sleepiness and objective sleepiness in Chinese obstructive sleep apnea hypopnea syndrome (OSAHS) patients. Methods: A total of 1 660 patients meeting the diagnostic criteria of OSAHS based on overnight polysomnography from West China Hospital, Sichuan University in the period from Jul 2010 to Jul 2014 were enrolled in the study. The Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT) were to evaluate subjective and objective sleepiness, respectively. The subjects were categorized into quartiles [A (0-4) (n=406), B (5-7) (n=325), C (8-12) (n=443), D(13-24) (n=486) groups] based on the ESS score distribution. Survival analysis was used to characterize the association between the ESS score and the mean sleep latency (MSL). Results: The apnea hypopnea index (AHI) in D group was higher than other three groups [(58.7±26.1) vs (36.8±24.2), (42.6±26.7), (45.7±26.6) events/h, all P<0.05]. The mean sleep latency in D group was shorter than other three groups [(8.0±4.6) vs (10.9±4.4), (10.3±4.8), (9.4±4.5) min, all P<0.05]. The Kaplan-Meier survivor functions across the ESS score quartiles were distinct and fourth quartiles were progressively associated with a greater tendency for falling asleep (χ(2)=77.76, P<0.001 by Log-rank test) in the daytime (The percentages of awaking patients in fourth quartiles were progressively lower at the same time). The adjusted hazard ratios for sleep onset during the MSLT for the group B, C and D were 1.05 (95%CI: 0.90-1.22), 1.22 (95%CI: 1.07-1.40), and 1.38 (95%CI: 1.20-1.60), respectively, comparing to group A. Conclusion: Subjective report of daytime sleepiness is consistent with the objective sleepiness in OSAHS patients.

Genetic association, mRNA and protein expression analysis identify ATG4C as a susceptibility gene for Kashin-Beck disease

OBJECTIVE

Recent study observed defective autophagy in chondrocytes with Kashin-Beck Disease (KBD). To clarify the potential role of autophagy-related ATG4C gene in the development of KBD, we conducted an integrative analysis of genetic association, messenger ribonucleic acid (mRNA) and protein expression of ATG4C in KBD patients.

METHODS

1026 subjects (559 KBD patients and 467 healthy cases) were enrolled in discovery association study. Four single nucleotide polymorphisms (SNPs) of ATG4C gene (rs11208030, rs4409690, rs12097658 and rs6587988) were genotyped by Sequenom MassARRAY platform. Association analysis was conducted by PLINK software. The significant SNPs of ATG4C were replicated using an independent sample of 899 subjects (including 90 KBD patients and 809 healthy controls). Ungenotyped SNPs in ATG4C gene were imputed by IMPUTE 2.0. Knee cartilage specimens were collected from five KBD patients and five healthy subjects. Quantitative real-time polymerase chain reaction (qRT-PCR) and western blot were performed to compare the mRNA and protein expression levels of ATG4C between KBD cartilage and control cartilage.

RESULTS

We observed significant association between KBD and rs11208030 (P value = 0.003), rs4409690 (P value = 0.004), rs12097658 (P value = 0.003) and rs6587988 (P value = 0.003) in both discovery and replication samples. The mRNA expression level of ATG4C (ratio = 0.168, P value = 0.007) in KBD chondrocytes was significantly lower than that in normal chondrocytes. Western blot (P value < 0.001) further confirmed the reduced expression of ATG4C protein in both KBD cartilage and chondrocytes.

CONCLUSION

Our results strongly suggest that ATG4C was a novel autophagy-related susceptibility gene of KBD.

Development and Evaluation of a Loop-Mediated Isothermal Amplification (Lamp) Assay for the Detection of Haemonchus contortus in Goat Fecal Samples

Haemonchus contortus is one of the most significant strongylid nematodes infecting small ruminants, and it causes great economic losses to the livestock industry worldwide. Accurate diagnosis of H. contortus is crucial to control strategies. Traditional microscopic examinations are the most common methods for the diagnosis of H. contortus , but they are time-consuming and inaccurate. Molecular methods based on PCR are more accurate, but need expensive machines usually only used in the laboratory. Loop-mediated isothermal amplification (LAMP) is a rapid, simple, specific, and sensitive method that has been widely used to detect viruses, bacteria, and parasites. In the present study, a LAMP method targeting ribosomal ITS-2 gene for detection of the H. contortus in goat fecal samples has been established. The established LAMP method was H. contortus specific, and the sensitivity of LAMP was the same as that of the H. contortus species-specific PCR, with the lowest DNA level detected as being 1 pg. Examination of the clinical samples indicated that the positive rate of LAMP was higher than that of PCR, but no statistical difference was observed between LAMP and PCR (χ² = 17.991, P = 0.053). In conclusion, a LAMP assay with a high specificity and a good sensitivity has been developed to detect H. contortus infection in goats. The established LAMP assay is useful for clinical diagnosis of H. contortus .

Evaluation of the relationship and genetic overlap between Kashin-Beck disease and body mass index

OBJECTIVES

Body mass index (BMI) is one of the major factors affecting the development of osteoarthritis (OA) but there is currently no information available regarding the relationship between BMI and Kashin-Beck disease (KBD). Our aim in this study was to investigate the relationship and genetic overlap between BMI and KBD.

METHOD

A total of 2050 Han Chinese subjects participated in this study. Using a cohort of 333 grade I KBD patients, logistic regression analysis was conducted to evaluate the correlation between BMI and KBD. Another independent sample of 1717 subjects was genotyped for a genome-wide association study (GWAS) using Affymetrix Human SNP 6.0 Arrays. Single nucleotide polymorphism (SNP) effect concordance analysis (SECA) was applied to the GWAS summaries of KBD and BMI for pleiotropy analysis. Genome-wide bivariate association analysis (GWBAA) of KBD and BMI was carried out to identify the genes with pleiotropic effects on KBD and BMI. The relevance of identified genes with KBD was validated by gene expression profiling and immunohistochemistry.

RESULTS

BMI correlated positively with knee movement disorder in KBD (coefficient β = 0.068, p = 0.045). SECA identified a significant pleiotropic effect (empirical p = 0.021) between KBD and BMI. In the GWBAA, the rs1893577 of the ADAMTS1 gene achieved the most significant association signal (p = 7.38 × 10^-9). ADAMTS1 was also up-regulated in KBD vs. normal (ratio = 2.64 ± 2.80) and KBD vs. OA (ratio = 2.31 ± 2.01). The rate of ADAMTS1-positive chondrocytes in KBD was significantly higher than that in OA (p < 0.05) and healthy controls (p < 0.05).

CONCLUSIONS

Our results suggest that ADAMTS1 is a novel susceptibility gene for KBD.

Treatment outcomes for eosinophilic esophagitis in children with esophageal atresia

Eosinophilic esophagitis (EoE) has been reported to be more prevalent in patients with esophageal atresia/tracheoesophageal fistula (EA-TEF). To date, there is limited data on the management of EoE in this group of patients. The aim of this study is to evaluate the treatment outcomes of EoE in children with EA-TEF. A retrospective chart review was performed on all EA-TEF children who were diagnosed with and treated for EoE between January 2000 and September 2013 at the Sydney Children's Hospital. Data collected included details of the patient's treatment, post-treatment endoscopy, symptoms and nutrition. Twenty patients were included in the study. Median age at diagnosis was 26 months (8-103 months), and median time from diagnosis to last follow-up was 23 months (2-132 months). Patients were treated with budesonide slurry, swallowed fluticasone, elimination diet alone or in combination. All patients were on proton pump inhibitors at time of diagnosis of EoE which was continued. Six out of seven patients who had furrowing/exudate in endoscopy at diagnosis had complete resolution at a median follow-up period of 26 months (P = 0.031). Median peak intraepithelial eosinophil count reduced significantly from 30/high-powered field (HPF) (19-80/HPF) to 8/HPF (0-85/HPF) (median time for improvement = 24 months) (P = 0.015). There was a significant reduction in symptoms of dysphagia and reflux post-treatment (P < 0.001). Prevalence of strictures significantly decreased (P = 0.016), as did need for dilatations (P = 0.004). In four out of six patients with gastrostomies at baseline, the feeding improved on treatment of EoE and the gastrostomy could be closed. There was also a nonsignificant trend towards improvement in weight and height 'z scores' of the patients. Treatment of EoE in children with EA-TEF was found to significantly reduce intraepithelial eosinophil count, symptoms, strictures and need for dilatations.

Oligomycins as inhibitors of K-Ras plasma membrane localisation

Frequently present in pancreatic, colorectal and non-small cell lung carcinomas, oncogenic mutant K-Ras must be localised to the plasma membrane (PM) to be functional. Inhibitors of K-Ras PM localisation are therefore putative cancer chemotherapeutics. By screening a microbial extract library in a high content cell-based assay we detected the rare oligomycin class of Streptomyces polyketides as inhibitors of K-Ras PM localisation. Cultivation and fractionation of three unique oligomycin producing Streptomyces strains yielded oligomycins A-E (1-5) and 21-hydroxy-oligomycin A (6), together with the new 21-hydroxy-oligomycin C (7) and 40-hydroxy-oligomycin B (8). Structures for 1-8 were assigned by detailed spectroscopic analysis. Cancer cell viability screening confirmed 1-8 were cytotoxic to human colorectal carcinoma cells (IC50 > 3 μM), and were inhibitors of the ABC transporter efflux pump P-glycoprotein (P-gp), with 5 being comparable in potency to the positive control verapamil. Significantly, oligomycins 1-8 proved to be exceptionally potent inhibitors of K-Ras PM localisation (Emax 0.67-0.75 with an IC50 ~ 1.5-14 nM).

A novel flow cytometric-based method to measure kinase inhibition in sputum from COPD subjects

Introduction

Janus kinases (JAKs) regulate inflammatory gene expression through phosphorylation of signal transducer and activator of transcription (STAT) proteins. Expression of STAT proteins is increased in chronic obstructive pulmonary disease (COPD), and may be involved in driving chronic inflammation. Oral JAK inhibitors are effective as anti-inflammatory therapy but exhibit dose-limiting adverse effects. Development of inhaled compounds would be enhanced by robust biomarkers that directly reflect the anti-inflammatory and pharmacological activity in the lung.

Methods

A novel flow cytometry assay was developed to measure STAT1 phosphorylation in sputum inflammatory cells. The standard sputum processing method was refined to improve sputum cell viability. The flow cytometric assay was used to assess the reproducibility of the measurement of STAT1 phosphorylation and the in vitro activity of a pan JAK-inhibitor on three separate visits in patients with COPD.

Results

Upregulation of STAT1 phosphorylation was measured following in vitro IFNγ stimulation of sputum macrophages (stimulated/unstimulated ratio 1.57; p<0.00001). Upregulation was inhibited following in vitro preincubation with a pan JAK-inhibitor (inhibited+stimulated/unstimulated ratio 0.97). STAT1 phosphorylation activity could only be measured in macrophages.

Conclusions

Sputum from patients with COPD can be used to reproducibly measure phospho-STAT expression in sputum macrophages. The flow cytometry-based method can be used to evaluate kinase inhibitors in vitro and subsequently in ex vivo studies. The assay is particularly useful for the assessment of inhaled compounds where whole blood assays may not be relevant.

Kinetic analysis of RNA editing of Newcastle disease virus P gene in the early period of infection

As a paramyxovirus, Newcastle disease virus (NDV) has the ability to edit its P (phosphoprotein) gene to synthesize three kinds of viral protein (P, V and W). It is technically very difficult to differentiate P, V and W mRNAs, and little was known about NDV regulation of RNA-editing frequency. To investigate the rules of NDV RNA editing, the ratio of the P gene-derived transcripts (P, V and W) was determined by sequencing at different time points post-infection. The results showed unstable ratio of V and W mRNA at different time points, and the frequency of NDV editing was significantly increased at the early period of infection (P 

KEYWORDS

Newcastle disease virus; phosphoprotein; RNA editing; G insertion.

Integrative analysis of genome-wide association studies and gene expression profiles identified candidate genes for osteoporosis in Kashin-Beck disease patients

SUMMARY

The molecular mechanism of osteoporosis (OP) in Kashin-Beck disease (KBD) patients was unclear. Our results suggest that KBD and OP shared some common causal genes, functionally involved in skeletal growth and development and chronic inflammation. Our results provide novel clues for clarifying the molecular mechanism of OP in KBD patients.

INTRODUCTION

KBD is a chronic skeletal disorder with osteopenia and OP. The pathogenesis of OP in KBD patients remains elusive.

METHODS

A total of 1717 subjects participated in this study. KBD was diagnosed according to the clinical diagnosis criteria of China (GB16395-1996). The bone mineral density (BMD) and bone areas of the ulna and radius, hip, and lumbar (L1-L4) were measured with a Hologic 4500 W dual-energy X-ray absorptiometry scanner. Genotyping was conducted using Affymetrix SNP Array 6.0. Gene expression profiling of peripheral blood mononuclear cells of KBD and OP patients were compared using Affymetrix HG-U133 plus 2.0 arrays and Agilent Human 1A arrays, respectively. Genome-wide association studies (GWAS) were conducted by PLINK. SCEA and DAVID were applied for pleiotropy and functional enrichment analysis, respectively.

RESULTS

SCEA analysis observed significant pleiotropic effects between KBD and the ulna and radius BMD (P value = 5.99 × 10(-3)). GWAS meta-analysis identified six candidate genes with pleiotropic effects, including PDGFD, SOX5, DPYD, CTR9, SPP1, and COL4A1. GO analysis identified 16 significant GO shared by KBD and the ulna and radius BMD, involved in cell morphogenesis and apoptosis. Pathway enrichment analysis detected two common pathways for KBD and the ulna and radius BMD, including calcium signaling pathway and vascular smooth muscle contraction pathway. Gene expression analysis detected three up-regulated inflammation-related genes for KBD and OP, including IL1B, IL8, and CCL1.

CONCLUSION

This study reported several candidate genes involved in the development of OP in KBD patients.

Correlation between sperm ultrastructure in infertile patients with abnormal sperm morphology and DNA damage

This study explored the correlation between sperm ultrastructure in infertile patients with abnormal sperm morphology and DNA damage. Three unusual sperm morphologies were selected for the experimental group namely case 1 (95% headless sperm), case 2 (98% headless sperm), and case 3 (100% headless sperm), and the control group consisted of 2 subjects (20 and 15% headless sperm). For case 1, the patient was negative for sexually transmitted diseases and had normal semen plasma biochemistry, reproductive hormones, peripheral blood chromosomes, and azoospermia factor (AZF). The aneuploid rate of sperm chromosomes was 0.6%, and DNA damage index of sperm nuclei was 84.4%. The partner of this patient did not get pregnant after artificial reproductive technology assistance. For case 2, the aneuploid rate of sperm chromosomes was 0.8% and DNA damage index of sperm nuclei was 95%. This patient and his spouse did not choose assisted reproduction. For case 3, reproductive hormones, peripheral blood chromosomes and AZF were normal and the aneuploid rate of sperm chromosomes was 0.2%. The wife of this patient gave birth to a healthy baby after ova removal, fertilization and transplantation. For the control group, the aneuploid rate of sperm chromosomes and DNA damage index of sperm nuclei were approximately 0.3 and 30%, respectively. To sum up, sperm ultrastructure of infertile patients suffering from unusual sperm morphology is associated with DNA damage to some extent and can cause infertility. However, pregnancy is still possible through intracytoplasmic sperm injection.

Inter- and intrasubject variability of the inflammatory response to segmental endotoxin challenge in healthy volunteers

Segmental endotoxin challenge with lipopolysaccharide (LPS) can be used as a pharmacodynamic model to safely induce a transient airway inflammation in the peripheral lung of healthy subjects and to test the anti-inflammatory efficacy of investigational new drugs. In contrast to whole lung LPS challenge only a fraction of the dose is required that can be precisely administered to a specific lung region and a vehicle challenged segment as an intra-subject control can be included. The aim of this study was to assess the intra- and inter-individual variability of the response to segmental LPS challenge for the appropriate design and power calculation of future clinical trials. Two cohorts with 10 subjects each underwent two segmental LPS challenges within five weeks. The inflammatory response was evaluated in bronchoalveolar lavage (BAL) fluid at 6 (cohort 1) and 24 h (cohort 2) both in the LPS and in a vehicle challenged segment, as well as in plasma for up to 26 h post LPS challenge. While the cytokine response was more pronounced at 6 h, the influx of neutrophils and monocytes dominated at 24 h; e.g. neutrophils increased from a median (inter-quartile range, IQR) of 0.14 (0.16) and 0.09 (0.08)x10(4) cells/mL BAL fluid at baseline to 10.2 (17.1) and 19.3 (15.9)x10(4) cells/mL 24 h after the two separate challenges. The within-subject variability was higher than the between-subject variability for most of the markers. However, sample size estimations based on the variability of outcome variables found lower or equal numbers with cross-over designs compared to parallel group designs for cellular markers at 24 h and cytokine variables at 6 h. The segmental LPS challenge model was safe. Future study designs have to balance between burden to the study subjects (4 versus 2 bronchoscopies), variability (within-versus between-subject), and the desired outcome variable (cells versus chemo/cytokine).

Performance of case definitions for influenza surveillance

Influenza-like illness (ILI) case definitions, such as those from the European Centre for Disease Control and Prevention, World Health Organization (WHO) and United States Centers for Disease Control and Prevention, are commonly used for influenza surveillance. We assessed how various case definitions performed during the initial wave of influenza A(H1N1) pdm09 infections in Singapore on a cohort of 727 patients with two to three blood samples and whose symptoms were reviewed fortnightly from June to October 2009. Using seroconversion (≥ 4-fold rise) to A/California/7/2009 (H1N1), we identified 36 presumptive influenza A(H1N1)pdm09 episodes and 664 episodes unrelated to influenza A(H1N1)pdm09. Cough, fever and headache occurred more commonly in presumptive influenza A(H1N1)pdm09. Although the sensitivity was low (36%), the recently revised WHO ILI case definition gave a higher positive predictive value (42%) and positive likelihood ratio (13.3) than the other case definitions. Results including only episodes with primary care consultations were similar. Individuals who worked or had episodes with fever, cough or sore throat were more likely to consult a physician, while episodes with Saturday onset were less likely, with some consultations skipped or postponed. Our analysis supports the use of the revised WHO ILI case definition, which includes only cough in the presence of fever defined as body temperature ≥ 38 °C for influenza surveillance.

QoL evaluation of olanzapine for chemotherapy-induced nausea and vomiting comparing with 5-HT3 receptor antagonist

This study evaluated the efficacy of olanzapine in preventing chemotherapy-induced nausea and vomiting (CINV) and improving the quality of life (QoL) of patients with cancer during chemotherapy. Two hundred twenty-nine patients with cancer who received chemotherapy from January 2008 to August 2008 were enrolled, and they were randomised to receive olanzapine or a 5-HT3 receptor antagonist. The patients completed a CINV questionnaire once daily on days 1-5 and a QoL questionnaire on days 0 and 6. The complete response (CR) rates for nausea (76.85% versus 46.2%) and vomiting (84.3% versus 67.6%) were significantly higher in the olanzapine group than in the 5-HT3 receptor antagonist group for delayed CINV but not for acute CINV. The CR rates for nausea (76.85% versus 44.44%) and vomiting (85.95% versus 67.59%) were also significantly higher in the olanzapine group for the 5 days post-chemotherapy. After chemotherapy, global health status, emotional functioning, and insomnia were improved in the olanzapine group but worsened in the 5-HT3 receptor antagonist group, whereas cognitive functioning and appetite loss were unchanged. Moreover, olanzapine significantly improved global health status, emotional functioning, social functioning, fatigue, nausea/vomiting, insomnia, and appetite loss. Olanzapine improved the QoL of patients with cancer during chemotherapy, in part by reducing the incidence of delayed CINV.