Association of the G-protein and α2-adrenergic receptor gene and plasma norepinephrine level with clonidine improvement of the effects of diuretics in patients with cirrhosis with refractory ascites: a randomised clinical trial

OBJECTIVE

Clonidine is an α(2)-adrenoceptor agonist which, by coupling with G-protein, has been proposed as an alternative treatment for refractory ascites of patients with cirrhosis for several years. Genetic polymorphisms of β-adrenoceptor and angiotensin II type 1 receptor blockers have been reported to affect drug response in patients with cirrhosis. This study evaluated the clonidine-diuretic response rate, favourable predictors and genetic components of the clonidine-diuretic response in patients with cirrhosis with refractory ascites.

METHODS

270 patients with cirrhosis with refractory ascites were randomised equally into two treatment groups to receive diuretics alone or the clonidine-diuretics association. The primary end point was clonidine-diuretic response rate. Secondary end points were mean daily dose of diuretics, times of paracentesis, ascites-related readmission and 1-year survival rate.

RESULTS

Good clonidine responders had better natriuresis and diuresis as well as a significant decrease in abdominal circumference, plasma renin, aldosterone and norepinephrine levels. The overall clonidine-diuretics response rate was 55-60%. In patients with cirrhosis, the prevalence of ARDA(2)C WD/DD and GNB3 CT/TT genotypes was 71% and 77%, respectively. Among the responders, 71% of patients with cirrhosis had the ARDA(2)C WD/DD genotype and 67% has the GNB3 CT/TT genotype. Besides higher baseline norepinephrine levels, the presence of both ARDA(2)C WD/DD and GNB3 CT/TT genotypes showed a positive predictive value of 82% and a negative predictive value of 79% for good clonidine response.

CONCLUSIONS

These results suggest that neurohormonal and genetic testing may be used as predictive factors for the additive effects of clonidine on the diuresis and natriuresis effects of diuretics in patients with cirrhosis with refractory ascites.

Electrophilic mercuration and thallation of benzene and substituted benzenes in trifluoroacetic acid solution

The mercuration and thallation of benzene and substituted benzenes was studied with mercuric and thallic trifluoroacetate, respectively, in trifluoroacetic acid. With the shortest reaction time (1 sec) at 0 degrees , the relative rate of mercuration of toluene compared to that of benzene was 17.5, with the isomer distribution in toluene of: ortho, 17.4%; meta, 5.9%; and para, 76.7%. The isomer distribution in toluene varied with the reaction time, significantly more at 25 degrees than at 0 degrees . The competitive thallation of benzene and toluene with thallic trifluoroacetate in trifluoroacetic acid at 15 degrees showed the relative rate, toluene/benzene, to be 33, with the isomer distribution in toluene of: ortho, 9.5%; meta, 5.5%; and para, 85.0%. With increasingly higher reaction temperatures in both mercuration and thallation reactions of aromatics, isomerization (both intramolecular and intermolecular) within the relevant ortho- and para-metallated intermediate ions and/or of the isomers becomes more important. Competitive rates and isomer distributions of mercuration and thallation of benzene and substituted benzenes were also determined. The predominant para substitution in both mercuration and thallation of methylbenzenes reflects, besides some steric factors, the strong stabilizing effect of para methyl groups on the arenium ion intermediates. Under predominantly kinetically controlled conditions, no anomalous increase in the amount of meta substitution was observed.

Electrophilic and free radical nitration of benzene and toluene with various nitrating agents

Electrophilic nitration of toluene and benzene was studied under various conditions with several nitrating systems. It was found that high orthopara regioselectivity is prevalent in all reactions and is independent of the reactivity of the nitrating agent. The methyl group of toluene is predominantly ortho-para directing under all reaction conditions. Steric factors are considered to be important but not the sole reason for the variation in the ortho/para ratio. The results reinforce our earlier views that, in electrophilic aromatic nitrations with reactive nitrating agents, substrate and positional selectivities are determined in two separate steps. The first step involves a pi-aromatic-NO(2) (+) ion complex or encounter pair, whereas the subsequent step is of arenium ion nature (separate for the ortho, meta, and para positions). The former determines substrate selectivity, whereas the latter determines regioselectivity. Thermal free radical nitration of benzene and toluene with tetranitromethane in sharp contrast gave nearly statistical product distributions.

Increased expression of MAIL, a cytokine-associated nuclear protein, in the prodromal stage of black walnut-induced laminitis

REASONS FOR PERFORMING STUDY

The mediators and signalling cascades important in the initiation of laminitis remain unclear. We therefore wanted to explore the genes and overall signalling mechanisms that play an important role in the developmental stage of laminitis.

OBJECTIVE

To use a broad genomic screening technique to identify novel genes that are differentially regulated in the equine lamellae during the developmental period of laminitis.

METHODS

Differential mRNA display (DRD) was performed to discover regulated genes, and real-time quantitative polymerase chain reaction (RT-qPCR) was then used to evaluate lamellar mRNA levels of a regulated gene (MAIL) and mediators related to that gene (IL-1beta and IL-6) in control horses (n = 5) and horses administered black walnut extract (BWE; n = 5).

RESULTS

Using DRD, MAIL was identified as a regulated gene. RT-qPCR indicated a 4-fold increase in expression of the MAIL mRNA in BWE lamellae compared to controls. A 30-fold increase in IL-1beta, and a 160-fold difference in IL-6 mRNA expression was present in BWE lamellae. Differences in MAIL, IL-1beta and IL-6 mRNA expression were statistically significant between groups (P < 0.05).

CONCLUSIONS AND POTENTIAL RELEVANCE

The data strongly support a role for inflammatory cytokines in the developmental stages of laminitis, possibly inducing the vascular and metabolic alterations reported to occur in the affected digit. These results potentially support the use of anti-inflammatory drugs in horses at risk of laminitis, and warrant further investigation of the link between systemic disease processes associated with laminitis and the reported digital inflammation.

Human plasminogen kringle 1-5 reduces atherosclerosis and neointima formation in mice by suppressing the inflammatory signaling pathway

BACKGROUND

Activation of vascular endothelial cells plays an important role in atherogenesis and plaque instability. Recent research has demonstrated that late-stage inhibition of plaque angiogenesis by angiostatin (kringle 1-4) reduces macrophage accumulation and slows the progression of advanced atherosclerosis. Kringle 1-5 (K(1-5)) is a variant of angiostatin that contains the first five kringle domains of plasminogen.

OBJECTIVE

To investigate whether K(1-5) has an inhibitory effect on early-stage atherosclerosis, using the apolipoprotein E (ApoE)-deficient mouse model and a carotid artery ligation model.

METHODS

ApoE-deficient mice received K(1-5) treatment for 4 weeks, and the severity of aortic atherosclerosis was measured. In the ligation model, the left common carotid arteries of C57BL/6 mice were ligated near the carotid bifurcation, and the mice received K(1-5) for 4 weeks. Human umbilical vein endothelial cells were pretreated with K(1-5) before tumor necrosis factor-alpha (TNF-alpha) treatment to explore the anti-inflammatory effect of K(1-5).

RESULTS

The areas of the lesion in the aortas of ApoE-deficient mice that received K(1-5) treatment were notably decreased, and the formation of carotid neointima in the C57BL/6 mice was decreased by treatment with K(1-5). Expression of TNF-alpha-induced intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 was inhibited by K(1-5) treatment, possibly via downregulation of translocation of nuclear factor-kappaB and expression of reactive oxygen species.

CONCLUSIONS

K(1-5) reduced atherosclerosis and neointima formation in mice, possibly through inhibition of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 expression in endothelial cells.

Transcriptome analysis during somatic embryogenesis of the tropical monocot Elaeis guineensis: evidence for conserved gene functions in early development

With the aim of understanding the molecular mechanisms underlying somatic embryogenesis (SE) in oil palm, we examined transcriptome changes that occur when embryogenic suspension cells are initiated to develop somatic embryos. Two reciprocal suppression subtractive hybridization (SSH) libraries were constructed from oil palm embryogenic cell suspensions: one in which embryo development was blocked by the presence of the synthetic auxin analogue 2,4-dichlorophenoxyacetic acid (2,4-D: ) in the medium (proliferation library); and another in which cells were stimulated to form embryos by the removal of 2,4-D: from the medium (initiation library). A total of 1867 Expressed Sequence Tags (ESTs) consisting of 1567 potential unigenes were assembled from the two libraries. Functional annotation indicated that 928 of the ESTs correspond to proteins that have either no similarity to sequences in public databases or are of unknown function. Gene Ontology (GO) terms assigned to the two EST populations give clues to the underlying molecular functions, biological processes and cellular components involved in the initiation of embryo development. Macroarrays were used for transcript profiling the ESTs during SE. Hierarchical cluster analysis of differential transcript accumulation revealed 4 distinct profiles containing a total of 192 statistically significant developmentally regulated transcripts. Similarities and differences between the global results obtained with in vitro systems from dicots, monocots and gymnosperms will be discussed.

Does multiple sclerosis increase risk of adverse pregnancy outcomes? A population-based study

Objective

To determine whether maternal multiple sclerosis (MS) is associated with increased risk of adverse pregnancy outcomes in an East Asian country by using a nationwide population-based dataset.

Method

This study linked two nationwide population-based datasets, the birth certificate registry and the Taiwan National Health Insurance Research Dataset. We identified a total of 174 women who gave birth from 2001 to 2003, who were diagnosed with MS within the 2 years preceding the index deliveries, together with 1,392 matched women without chronic disease as a comparison cohort. Multivariate logistic regression analyses were performed for estimation.

Results

We found that compared with healthy mothers, MS was independently associated with a 2.25-fold risk of preterm birth (95% CI = 1.37–3.70) and a 1.89-fold (95% CI = 1.30–2.76) higher risk of babies small for gestational age, after adjusting for family income and maternal, paternal, and infant characteristics. Mothers with MS were also more likely to have cesarean deliveries.

Conclusion

Our study documents increased the risk of adverse pregnancy outcomes for mothers with MS, highlighting a need for more intensive monitoring and obstetric care during pregnancy. Future studies should explore the distinct manifestations and mechanisms of MS in diverse ethnic groups, so more complete information can be provided to affected women concerning pregnancy.

Meconium aspiration syndrome: experiences in Taiwan

Meconium aspiration syndrome (MAS) is still one of the most challenged diseases for the neonatologists. We reviewed our earlier studies of MAS in an attempt to provide some idea for more understanding of MAS. This study is a retrospective review and summarization of our earlier studies in MAS at two tertiary neonatal centers in Taiwan. Incidence of MAS was decreased sharply in Taiwan. MAS infants who required resuscitation in the birth room being out-born, birth asphyxia and infants who developed persistent pulmonary hypertension (PPHN) and pneumothrax were associated with increasing mortality. In MAS infants who neither required mechanical ventilation nor had a history suggestive of perinatal infection, antibiotic treatments would not affect the outcome of MAS. Dexamethasone did reduce inflammation response and improve cardiopulmonary perfusion. However, steroids did not prevent the development of PPHN. Our review provided the risk factors of mortality for MAS. Antibiotic treatments should not be a routine for every infant with MAS. Although steroids reduce pulmonary inflammation, their role in the prevention of PPHN remains to be further studied.

The effects of maternal Cd on the metallothionein expression in tilapia (Oreochromis mossambicus) embryos and larvae

The purpose of this study was to identify the factor(s) which would enhance the Cd resistance as assessed by the metallothionein (MT) expression in tilapia larvae. Larvae were collected from parents that were pretreated respectively with Cd or saline. At the end of the 12-week experiment, the hepatic MT and Cd contents in the breeding female fish were recorded. Our results indicated that a significant relationship between Cd and MT contents can be found in the offspring from the parent fish treated with Cd. However, the higher Cd resistance, Cd contents, and MT expression were limited to those larvae from parent fish bred within 4 weeks of the injection. By week 12, the Cd-treated fish still contained high levels of MT in their hepatic tissues. However, the MT and Cd contents in the larvae from these adult fish were not significantly different from those from the controls. In summary, we suggest that the higher Cd resistance of larvae from the egg stage was a result of the Cd contamination of the parent female, as evidenced by an increase in MT expression induced in tilapia embryos and larvae.

Procedure volume of gastric cancer resections versus 5-year survival

AIM

We used nationwide, population-based data to examine associations between hospital and surgeon volumes of gastric cancer resections and their patients' short-term and long-term survival likelihood.

METHODS

The study uses 1997-1999 inpatient claims data from Taiwan's National Health Insurance linked to "cause of death" data for 1997-2004. The total cohort of 6909 gastric cancer resection patients were categorized by their surgeon's/hospital's procedure volume, and examined for differences in 6-month mortality and 5-year mortality (post 6 months), by procedure volume, using Cox proportional hazard regressions, adjusting for surgeon, hospital and patient characteristics. We hypothesized that surgeons' case volume and age but not hospital volume will predict short-term and long-term survival.

RESULTS

Adjusted estimates show that increasing surgeon volume predicts better 6-month survival (adjusted mortality hazard ratio = 1.3 for low-volume surgeons relative to very high-volume surgeons; p < 0.01) and 5-year survival (adjusted mortality hazard ratios = 1.3; p < 0.001 for low-volume; 1.2 with p < 0.01 for medium volume) and increasing surgeon's age (adjusted hazards ratio = 1.4 for age < 41 years relative to 41-50 years; p < or = 0.001; 0.8 for > or = 51 years relative to 41-50 years; p < 0.05). In hospital volume regressions, surgeon's age is a consistent and significant predictor, not hospital volume. Findings suggest a key role of experience in surgical skill and sensitivity for early stage diagnosis in gastric cancer survival.

CONCLUSIONS

Although a key study limitation is the lack of cancer stage data, the pattern of findings suggests that experienced surgeons have relatively better survival outcomes among gastric cancer patients.

Oral health care system in Chinese Mainland

The purpose of this review is to describe the training of dental professionals and to give an overview of the oral health care system in Mainland China. It may be of interest and importance for American readers to become aware that there are alternative practice structures and the world is getting smaller.

Craniofacial morphometric analysis of mandibular prognathism

The purpose of this study was to provide more information about the morphological characteristics of the craniofacial complex in mandibular prognathism. Forty young adult males having mandibular prognathism were compared with 40 having normal occlusion. This was conducted to carry out geometric morphometric assessments to localize alterations, using Procrustes analysis and thin-plate spline analysis, in addition to conventional cephalometric techniques. Procrustes analysis indicated that the mean craniofacial, midfacial and mandibular morphology was significantly different in prognathic subjects compared with normal controls. This finding was corroborated by the multivariate Hotelling T(2)-test of cephalometric variables. Mandibular prognathism demonstrated a shorter and slightly retropositioned maxilla, a greater total length and anterior positioning of the mandible. Thin-plate spline analysis revealed a developmental diminution of the palatomaxillary region anteroposteriorly and a developmental elongation of the mandible anteroposteriorly, leading to the appearance of a prognathic mandibular profile. In conclusion, thin-plate spline analysis seems to provide a valuable supplement for conventional cephalometric analysis because the complex patterns of craniofacial shape change are visualized suggestive by means of grid deformations.

Midfacial and mandibular morphometry of children with Class II and Class III malocclusions

There is insufficient evidence in conventional cephalometric analysis of the actual sites of putative maxillofacial change in Class II and Class III malocclusions. The purpose of this study was to provide more information about the morphological characteristics of the midfacial complex and mandible in children with Class II or III malocclusions. Seventy children with Class II, division 1 malocclusion and 70 children with Class III malocclusion were compared with 70 children with normal occlusion. This study was conducted to carry out geometric morphometric assessments to localize alterations using Procrustes analysis and thin-plate spline analysis. Procrustes analysis indicated the midfacial and mandibular morphologies differed between normal occlusion subjects and subjects with Class II or Class III malocclusion (P<0.0001). The deformations in subjects with Class II malocclusion may represent a developmental elongation of the palatomaxillary complex and a shortening of the mandible anteroposteriorly, which leads to the appearance of a protruding midface and retruding mandibular profile. In contrast, the deformations in subjects with Class III malocclusion may represent a developmental shortening of the palatomaxillary complex and elongation of the mandible anteroposteriorly, which leads to the appearance of a retrognathic midface and prognathic mandibular profile.

Geometric morphometric assessment of treatment effects of maxillary protraction combined with chin cup appliance on the maxillofacial complex

The aim of this study was to investigate the treatment effects on the maxillofacial complex by maxillary protraction combined with chin cup therapy among growing children. An effective geometric morphometric assessment of cephalometric radiographs, using Procrustes analysis and thin-plate spline analysis, was applied to evaluate shape change in the craniofacial and midfacial configurations of a treated sample of 20 children with skeletal Class III malocclusion. This was compared with matched untreated skeletal Class III controls. Marked treatment induced change involved the maxilla and the mandible. Major deformation consisted of forward advancement of the maxillary complex with negligible rotation of the palatal plane and a forward direction of growth of the mandibular condyle associated with a restriction in sagittal advancement of the chin. Considerable dentoalveolar components contributed to the correction of anterior crossbite. Further detailed study of skeletofacial remodelling in response to maxillary protraction in other skeletal components, including the cranial base and the mandibular complex that contribute to Class III skeletal discrepancies, is warranted.

A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing

BACKGROUND

An association between irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) has been found.

OBJECTIVE

To compare the prevalence and test results for bacterial overgrowth between IBS and fibromyalgia.

METHODS

Subjects with independent fibromyalgia and IBS were compared with controls in a double blind study. Participants completed a questionnaire, and a lactulose hydrogen breath test was used to determine the presence of SIBO. The prevalence of an abnormal breath test was compared between study participants. Hydrogen production on the breath test was compared between subjects with IBS and fibromyalgia. The somatic pain visual analogue score of subjects with fibromyalgia was compared with their degree of hydrogen production.

RESULTS

3/15 (20%) controls had an abnormal breath test compared with 93/111 (84%) subjects with IBS (p<0.01) and 42/42 (100%) with fibromyalgia (p<0.0001 v controls, p<0.05 v IBS). Subjects with fibromyalgia had higher hydrogen profiles (p<0.01), peak hydrogen (p<0.0001), and area under the curve (p<0.01) than subjects with IBS. This was not dependent on the higher prevalence of an abnormal breath test. The degree of somatic pain in fibromyalgia correlated significantly with the hydrogen level seen on the breath test (r = 0.42, p<0.01).

CONCLUSIONS

An abnormal lactulose breath test is more common in fibromyalgia than IBS. In contrast with IBS, the degree of abnormality on breath test is greater in subjects with fibromyalgia and correlates with somatic pain.

Slowing of intestinal transit by fat depends on an ondansetron - sensitive, efferent serotonergic pathway

The ileal brake is a neural reflex that slows proximal small bowel transit when fat enters the distal small bowel. In rats, ondansetron, a 5-hydroxytryptamine-3 (5-HT3)-receptor antagonist, abolishes the ileal brake. However, the location of this serotonergic pathway is unknown. Of the known enteric sites responsive to 5-hydroxytryptamine (5-HT), only the myenteric neurone is equipped with 5-HT3 receptors and is located on the efferent limb of reflex response. The aim of this study was to test the hypothesis that slowing of intestinal transit by fat may depend on an ondansetron-sensitive serotonergic pathway located on the efferent limb of this reflex response. In a fistulated dog model that compartmentalized the afferent from the efferent limb of the ileal brake response, ondansetron was delivered luminally into the distal (afferent) or proximal (efferent) half of the small bowel to localize the serotonergic pathway. It was found that activating the ileal brake slowed down the proximal intestinal transit to 30% of control values. The ileal brake was abolished when ondansetron was delivered into the proximal but not the distal small bowel. Our data supports the hypothesis that the 5-HT receptors participating in the ileal brake are on the efferent limb of this neural reflex, possibly on myenteric neurones.

Healthcare-associated outbreak due to pan-drug resistant Acinetobacter baumannii in a surgical intensive care unit

Acinetobacter baumannii is ubiquitous and has recently become one of the most important healthcare-associated (HA) pathogens in hospitals. Infection caused by this organism often leads to significant morbidity and mortality. Outbreaks of pan-drug resistant Acinetobacter baumannii (PDRAB) have rarely been reported. During a two-month period, an outbreak of PDRAB colonization and infection affecting 7 patients occurred in our surgical intensive care unit (SICU). The colonized sites were respiratory tract (N = 7) and central venous catheter (N = 2). One of the patients had a surgical wound infection. Extensive environmental contamination was identified, including sites such as bed rails, bedside tables, surface of ventilators and infusion pump, water for nasogastric feeding and ventilator rinsing and sinks. All of the isolates were analysed by pulsed-field gel electrophoresis (PFGE) and showed an identical pattern. After use of strict cohort nursing, hand hygiene environmental cleaning, and replacement of a dysfunctional high-efficiency particulate air filter (HEPA), the outbreak was controlled.

Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children

Untreated dental caries in Chinese pre-school children is common. This prospective controlled clinical trial investigated the effectiveness of topical fluoride applications in arresting dentin caries. Three hundred seventy-five children, aged 3-5 years, with carious upper anterior teeth were divided into five groups. Children in the first and second groups received annual applications of silver diamine fluoride solution (44,800 ppm F). Sodium fluoride varnish (22,600 ppm F) was applied every three months to the lesions of children in the third and fourth groups. For children in the first and third groups, soft carious tissues were removed prior to fluoride application. The fifth group was the control. Three hundred eight children were followed for 30 months. The respective mean numbers of arrested carious tooth surfaces in the five groups were 2.5, 2.8, 1.5, 1.5, and 1.3 (p < 0.001). Silver diamine fluoride was found to be effective in arresting dentin caries in primary anterior teeth in pre-school children.