Effects of a priming dose of fentanyl during anaesthesia on the incidence and severity of fentanyl-induced cough in current, former and non-smokers

Fentanyl is commonly used during anaesthesia and can cause fentanyl-induced cough (FIC). This study investigated whether a priming dose of fentanyl reduced FIC, and determined the factors associated with increased risk of FIC. Subjects undergoing elective surgery under general anaesthesia (n = 800) were randomized into four groups: group 1 received 2 μg/kg fentanyl bolus; groups 2, 3 and 4 received a priming dose of fentanyl 0.5 μg/kg followed by 1.5 μg/kg after 1, 2 or 3 min, respectively. The incidence of FIC was 17.0%, 10.0%, 12.5% and 11.5% for groups 1, 2, 3 and 4, respectively, with no significant between-group differences in FIC incidence or severity. The mean FIC onset time was 22 s. Former smokers were 2.91 times more likely than current smokers to experience cough. A fentanyl priming dose did not reduce the incidence and severity of FIC. Former smokers were hyper-reactive to fentanyl compared with current smokers.

Therapeutic effect of high-intensity focused ultrasound combined with transarterial chemoembolisation for hepatocellular carcinoma <5 cm: comparison with transarterial chemoembolisation monotherapy--preliminary observations

OBJECTIVE

To retrospectively compare the therapeutic effects of combined high-intensity focused ultrasound (HIFU) and transarterial chemoembolisation (TACE) with TACE alone for the treatment of non-advanced hepatocellular carcinomas (HCCs) <5 cm.

METHODS

We retrospectively reviewed the tumour responses of 32 HCCs of 25 patients who underwent combined HIFU and TACE, and 46 HCCs of 32 patients who underwent TACE only. The mean follow-up observation of the TACE+HIFU group was on average 31 months and that of the TACE group was 33 months. Those patients who had undergone any other treatment modality (including systemic chemotherapy) during the follow-up observation period were excluded. The therapeutic effects were classified according to the modified Response Evaluation Criteria In Solid Tumors (mRECIST): complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Additionally, we defined CR', PR', SD' and PD' as the therapeutic effects "per tumour".

RESULTS

The disease control rate calculated using the RECIST criteria (CR+PR+SD/All) was 48% in the HIFU+TACE group and 47% in the TACE group (p=0.78, Fisher's exact test). The disease control rate "per tumour" (CR'+PR'+SD'/All) was 78% in the HIFU+TACE group and 54% in the TACE group (p=0.035, Fisher's exact test). In the HIFU+TACE group, no HIFU-related complications requiring treatment were observed. The median survival time was 57 months in TACE+HIFU group and 36 months in the TACE group (p=0.048).

CONCLUSION

This preliminary study shows that the combination therapy of HIFU and TACE is more effective than TACE monotherapy for treating HCCs <5 cm.

Metformin ameliorates IL-6-induced hepatic insulin resistance via induction of orphan nuclear receptor small heterodimer partner (SHP) in mouse models

AIMS/HYPOTHESIS

IL-6 is a proinflammatory cytokine associated with the pathogenesis of hepatic diseases. Metformin is an anti-diabetic drug used for the treatment of type 2 diabetes, and orphan nuclear receptor small heterodimer partner (SHP, also known as NR0B2), a transcriptional co-repressor, plays an important role in maintaining metabolic homeostasis. Here, we demonstrate that metformin-mediated activation of AMP-activated protein kinase (AMPK) increases SHP protein production and regulates IL-6-induced hepatic insulin resistance.

METHODS

We investigated metformin-mediated SHP production improved insulin resistance through the regulation of an IL-6-dependent pathway (involving signal transducer and activator of transcription 3 [STAT3] and suppressor of cytokine signalling 3 [SOCS3]) in both Shp knockdown and Shp null mice.

RESULTS

IL-6-induced STAT3 transactivation and SOCS3 production were significantly repressed by metformin, adenoviral constitutively active AMPK (Ad-CA-AMPK), and adenoviral SHP (Ad-SHP), but not in Shp knockdown, or with the adenoviral dominant negative form of AMPK (Ad-DN-AMPK). Chromatin immunoprecipitation (ChIP), co-immunoprecipitation (Co-IP) and protein localisation studies showed that SHP inhibits DNA binding of STAT3 on the Socs3 gene promoter via interaction and colocalisation within the nucleus. Upregulation of inflammatory genes and downregulation of hepatic insulin signalling by acute IL-6 treatment were observed in wild-type mice but not in Shp null mice. Finally, chronic IL-6 exposure caused hepatic insulin resistance, leading to impaired insulin tolerance and elevated gluconeogenesis, and these phenomena were aggravated in Shp null mice.

CONCLUSIONS/INTERPRETATION

Our results demonstrate that SHP upregulation by metformin may prevent hepatic disorders by regulating the IL-6-dependent pathway, and that this pathway can help to ameliorate the pathogenesis of cytokine-mediated metabolic dysfunction.

Multiple-electrode radiofrequency ablations using Octopus® electrodes in an in vivo porcine liver model

OBJECTIVES

The objective of this study was to determine the in vivo efficacy of radiofrequency ablation (RFA) in porcine liver using Octopus® electrodes for creating a large coagulation compared with RFA using clustered electrodes.

METHODS

A total of 39 coagulations were created using a 200-W generator and clustered electrodes or Octopus electrodes during laparotomy in 19 pigs. Radiofrequency was applied to the livers using four protocols: (1) Group A-1, monopolar mode using a clustered electrode (n=11); (2) Group A-2, monopolar mode using an Octopus electrode (n=11); (3) Group B-1, consecutive monopolar mode using three, clustered electrodes (n=8); and (4) Group B-2, switching monopolar mode using two Octopus electrodes (n=9). The energy efficiency, shape, diameters (D) and volume (V) of the coagulation volume were compared in each of the two groups.

RESULTS

The mean maximum D and V of the coagulations in Group A-2 (4.7 cm and 33.1 cm(3), respectively) were significantly larger than those in Group A-1 (4.1 cm and 20.3 cm(3), respectively) (p<0.05). Furthermore, the mean minimum D, maximum D and V of the coagulations in Group B-2 were significantly larger than those in Group B-1, i.e. 5.3 vs 4.0 cm, 6.6 vs 4.9 cm and 66.9 vs 30.2 cm(3), respectively (p<0.05). The energy efficiencies were also significantly higher in Groups A-2 and B-2 than in Groups A-1 and B-1 (p<0.05).

CONCLUSION

The Octopus electrodes were more efficient for creating a large ablation zone than clustered electrodes, and the efficacy of RFA with Octopus electrodes can be amplified in the switching monopolar mode.

Intercomparison of methods for coincidence summing corrections in gamma-ray spectrometry--part II (volume sources)

The second part of an intercomparison of the coincidence summing correction methods is presented. This exercise concerned three volume sources, filled with liquid radioactive solution. The same experimental spectra, decay scheme and photon emission intensities were used by all the participants. The results were expressed as coincidence summing corrective factors for several energies of (152)Eu and (134)Cs, and different source-to-detector distances. They are presented and discussed.

Molecular characterization of heterochromatin proteins 1a and 1b from the silkworm, Bombyx mori

Heterochromatin protein 1s (HP1s) are nonhistone chromosomal proteins that play a direct role in the formation and maintenance of heterochromatin structure. Similarly to Caenorhabditis elegans, silkworms possess holocentric chromosomes, in which diffused kinetochores extend along the length of each chromosome. We have isolated two silkworm HP1 homologues, BmHP1a and BmHP1b. Cytological analysis showed a unique localization of BmHP1s during cell division, in which these proteins first appear to dissociate from the chromosomes, but then return to enclose the chromosomes during metaphase. BmHP1s formed homo- and hetero-dimers and interacted with BmSu(var)3-9, which is a methyltransferase for histone H3 lysine 9 (H3K9). We further showed, using a silkworm cell-based reporter system, that BmHP1b had higher transcriptional repression activity than BmHP1a, whereas BmHP1a interacted more strongly with BmSu(var)3-9 than did BmHP1b. These results suggest that silkworm HP1a and HP1b may play different roles in heterochromatin formation in holocentric silkworm chromosomes.

Perioperative Assessment of Terlipressin Infusion during Living Donor Liver Transplantation

OBJECTIVE: To investigate the safety and efficacy of infusion of terlipressin during living donor liver transplantation (LDLT). METHODS: Patients undergoing LDLT with low systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) ( n = 41) were randomly allocated into control ( n = 20) and terlipressin groups ( n = 21). Terlipressin was infused at 1.0 – 4.0 μg/kg per h in the terlipressin group during surgery. Controls received generally accepted inotropic and vasopressor agents. RESULTS: Terlipressin infusion induced significantly higher SVRI and PVRI at 60 min after drug infusion, produced significantly greater hourly urine output during the anhepatic phase, and was related to significantly shorter stays in the postoperative intensive care unit (ICU) compared with control treatment (mean ± SD ICU stay 5.7 ± 1.5 versus 6.9 ± 1.5 days, respectively). Patients given a terlipressin infusion > 2.0 μg/kg per h during the preanhepatic phase had a median ICU stay of < 6 days (sensitivity 90.0%; specificity 89.0%). CONCLUSIONS: Terlipressin infusion improved low SVRI and PVRI during LDLT and may have contributed to better renal function and shorter ICU stays.

PD02-02: A Decision Analysis of Contralateral Prophylactic Mastectomy in Women Undergoing Treatment for Sporadic Unilateral Breast Cancer

Background:

The intent of contralateral prophylactic mastectomy (CPM) is to improve survival after a diagnosis of unilateral breast cancer by reducing the risk of contralateral breast cancer (CBC). CPM rates are rising among women with sporadic breast cancer, despite limited evidence that its benefits outweigh its harms. Although CPM is highly effective in reducing a woman's risk of CBC, the competing mortality risk from a patient's index breast cancer may offset its benefits. Furthermore, any examination of CPM needs to consider quality of life effects.

Methods:

We developed a Markov decision analytic model to estimate the effect of CPM in women with newly diagnosed unilateral breast cancer. The primary outcomes examined were gains in life expectancy (LE) and quality-adjusted life expectancy (QALE) for CPM compared with no CPM in 18 hypothetical cohorts of 45-year old women. Data from the British Columbia Cancer Agency (BCCA) was used to generate AJCC stage and molecular subtype-specific estimates of the risk of developing distant metastases from an index breast cancer. A correction factor was applied to account for the omission of relevant systemic therapy (including trastuzamab) in some women in the BCCA cohort. Additional model parameters, including utilities (quality of life weights) for breast cancer and CPM health states, were identified from the published medical literature. LE and QALE estimates were not discounted in the base case. Univariate sensitivity analysis was used to examine the impact of plausible variation in the key model parameters on model results.

Results:

CPM improved LE in all cohorts (range: 0.06 - 0.54 years, Table 1). AJCC stage had more effect on LE than molecular subtype (stage I mean, 0.43 years, stage III mean, 0.11 years). However, after adjusting for quality of life, a strategy of no CPM was favored in all cohorts. Univariate sensitivity analysis demonstrated that the only model parameter that influenced the outcome of QALE was the utility for health after CPM. In the base case the utility after CPM was 0.81 (compared to 0.85 for No CPM). The preferred strategy did not change from No CPM to CPM unless the utility after CPM exceeded 0.83. Model results were otherwise stable across the ranges of the key parameters examined, including the risk of distant metastases resulting from a patient's index breast cancer by stage and subtype, duration of survival with metastatic breast cancer, and the risk of CBC.

Conclusions:

The primary drivers of survival after unilateral breast cancer are stage at diagnosis and molecular subtype. Our model demonstrates that CPM confers modest additional LE gains, even in women with early-stage, favorable-subtype breast cancer. Furthermore, this modest benefit is negated if one assumes a small reduction in quality of life due to CPM. The decision to pursue CPM as part of treatment of unilateral breast cancer should include consideration of both patient specific breast cancer characteristics and individual preferences.

Identification of specific sites in the third intracellular loop and carboxyl terminus of the Bombyx mori pheromone biosynthesis activating neuropeptide receptor crucial for ligand-induced internalization

Sex pheromone production in most moths is mediated by the pheromone biosynthesis activating neuropeptide receptor (PBANR). Using fluorescent Bombyx mori PBANR (BmPBANR) chimeras to study PBANR regulation, we previously showed that BmPBANR undergoes rapid ligand-induced internalization, that the endocytotic motif resides between residues 358-367 of the BmPBANR C terminus, and that the internalization pathway is clathrin-dependent. Here, we sought to expand our understanding of the molecular mechanisms underlying BmPBANR function and regulation by transiently expressing a series of fluorescent BmPBANR chimeric constructs in cultured Spodoptera frugiperda (Sf9) cells and assaying for internalization of a fluorescently labelled ligand. Pharmacological inhibition of phospholipase C significantly reduced internalization, suggesting that BmPBANR regulation proceeds via a conventional G-protein-dependent pathway. This was further supported by impaired internalization following site-directed mutagenesis of R263 and R264, two basic residues at the transmembrane 6 intracellular junction that are thought to stabilize G-protein coupling via electrostatic interactions. Ala substitution of S333 and S366, two consensus protein kinase C sites in the C terminus, likewise impaired internalization, as did RNA interference-mediated knockdown of Sf9 protein kinase C. N-terminal truncations of BmPBANR indicate that the first 27 residues are not necessary for cell surface trafficking or receptor functionality.

Intraoperative calcium-related risk factors for biochemical acute pancreatitis after living-donor liver transplantation

Laboratory-based biochemical acute pancreatitis (BAP) is considered to be a benign but common complication after liver transplantation (LT), which to compensate for transfusion-related hypocalcemia, usually demands a large quantity of exogenous calcium which may be associated with pancreatic injury. We sought to investigate the relationship between intraoperative calcium-related factors and BAP occurrence after living-donor LT. Perioperative data, including intraoperative calcium chloride administration and serum calcium levels, were reviewed from 217 patients who underwent living-donor LT. Hyperamylasemia (≥ 458 U/L) was used to define posttransplantation BAP according to previous reports. Posttransplantation BAP was identified among 37 patients (17.3%), who showed a greater death rate than those in the non-BAP group (21.6% vs 8.6%; P = .013). Compared to with calcium-related parameters, the 2 groups showed differences in the amount of calcium chloride administered during the preanhepatic phase, the serum calcium surge during the initial 2 h after the liver graft reperfusion, the last serum calcium level, and the amount of transfused pack red blood cells (P < .05). However, after multivariate adjustment, only the amount of administered calcium chloride during the preanhepatic phase (odds ratios, 2.11-5.87, depending an amount) and the serum calcium surge during the initial 2 hours after liver graft reperfusion (odds ratio, 2.34) were selected as risk factors for posttransplantation BAP. The risk ratio of posttransplantation BAP increased in proportion to the administered amount of calcium chloride. In conclusion, limiting excessive calcium administration during the preanhepatic phase and close monitoring of the serum calcium surge after reperfusion may be required to prevent posttransplantation BAP in living-donor LT.

The humoral immune response to the inactivated influenza A (H1N1) 2009 monovalent vaccine in patients with Type 2 diabetes mellitus in Korea

AIMS

We evaluated the antibody response to a single-dose adjuvanted, inactivated, pandemic H1N1 influenza vaccination in patients with diabetes and assessed factors associated with the failure to induce antibody responses.

METHODS

Eighty-two patients with Type 2 diabetes were vaccinated and antibody responses were determined with haemagglutination inhibition assay and anti-haemagglutinin antibody ELISA.

RESULTS

Among 70 antibody-negative patients at baseline, 34 (48.6%) achieved seroconversion; 28 (60.9%) in the young adults group and six (25%) in the elderly group acquired H1N1-specific antibodies. Patients in the older age range or with longer duration of diabetes had a lower seroconversion rate.

CONCLUSIONS

Our data show low cross-reactive antibody carrying rate and low seroconversion rate in patients with diabetes. Until larger-scale, case-controlled trials become available, older patients and patients with a longer duration of diabetes should be considered for the two-dose vaccination or have antibody titres measured after the first vaccination.

Gqalpha-linked phospholipase Cbeta1 and phospholipase Cgamma are essential components of the pheromone biosynthesis activating neuropeptide (PBAN) signal transduction cascade

Sex pheromone production for most moths is regulated by pheromone biosynthesis activating neuropeptide (PBAN). In Bombyx mori, PBAN binding triggers the opening of store-operated Ca(2+) channels, suggesting the involvement of a receptor-activated phospholipase C (PLC). In this study, we found that PLC inhibitors U73122 and compound 48/80 reduced sex pheromone production and that intracellular levels of (3)H-inositol phosphate species increased following PBAN stimulation. In addition, we amplified cDNAs from pheromone glands corresponding to PLCbeta1, PLCbeta4, PLCgamma and two G protein alpha subunits, Go and Gq. In vivo RNA interference-mediated knockdown analyses revealed that BmPLCbeta1, BmGq1, and unexpectedly, BmPLCgamma, are part of the PBAN signal transduction cascade.

Effect of cigarette taxes on the consumption of cigarettes, alcohol, tea and coffee in Taiwan

OBJECTIVES

To analyse whether a health tax of 10 New Taiwan Dollars (NT$) (US$0.3) imposed on cigarettes in 2009 will help to reduce cigarette consumption, and whether or not the cigarette tax will affect consumption of alcohol, coffee and tea.

STUDY DESIGN

Time series data for consumption and retail prices of tobacco, alcohol, tea and coffee were collected and analysed for the period 1973-2007.

METHODS

To establish the Central Bureau of Statistics demand function to estimate the overall demand price elasticities of cigarettes, alcohol, tea and coffee, a seemingly unrelated regression analysis was used. The independent variables were annual consumption of cigarettes, alcohol, tea and coffee. The dependent variables were prices of and expenditures on cigarettes, alcohol, tea and coffee.

RESULTS

The estimated own-price elasticities for cigarettes and alcohol are close to -0.726. The own-price elasticities for tea and coffee are less than those for cigarettes and alcohol. Hence, it is predicted that the NT$10 health tax on cigarettes will reduce cigarette consumption by a significant 13.19%. Analysis of cross-price elasticity reveals that alcohol is complementary to cigarettes.

CONCLUSIONS

Taxation is an effective smoking control policy tool that not only helps to reduce consumption of cigarettes, but also reduces consumption of alcoholic beverages.

Significant structure theory applied to electrolyte solution

The significant structure theory has been successfully applied to an aqueous NaCl solution. Liquid water is assumed to have a domain structure and the ions are hydrated by water molecules. The partition function is composed of the partition function for the water and that for the salt, and the excess free energy term from the Debye-Hückel theory is also added. The thermodynamic properties, such as molar volume, vapor pressure, entropy of vaporization, and heat capacity, as well as the dielectric constant are calculated over the whole concentration ranges and wide temperature ranges. The agreement between theory and experiment is satisfactory.

Oligodendrocyte degeneration and recovery after focal cerebral ischemia

The vulnerability of oligodendrocytes to ischemic injury may contribute to functional loss in diseases of central white matter. Immunocytochemical methods to identify oligodendrocyte injury in experimental models rely on epitope availability, and fail to discriminate structural changes in oligodendrocyte morphology. We previously described the use of a lentiviral vector (LV) carrying enhanced green fluorescent protein (eGFP) under the myelin basic protein (MBP) promoter for selective visualization of oligodendrocyte cell bodies and processes. In this study, we used LV-MBP-eGFP to label oligodendrocytes in rat cerebral white matter prior to transient focal cerebral ischemia, and examined oligodendrocyte injury 24 h, 48 h and 1 week post-reperfusion by quantifying cell survival and assaying the integrity of myelin processes. There was progressive loss of GFP+ oligodendrocytes in ischemic white matter at 24 and 48 h. Surviving GFP+ cells had non-pyknotic nuclear morphology and were terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-negative, but there was marked fragmentation of myelin processes as early as 24 h after stroke. One week after stroke, we observed a restoration of GFP+ oligodendrocytes in ischemic white matter, reflected both by cell counts and by structural integrity of myelin processes. Proliferating cells were not the main source of GFP+ oligodendrocytes, as revealed by bromodeoxyuridine (BrdU) incorporation. These observations identify novel transient structural changes in oligodendrocyte cell bodies and myelinating processes, which may have consequences for white matter function after stroke.

A randomized controlled trial of rivastigmine in patients with cognitive impairment no dementia because of cerebrovascular disease

OBJECTIVES

The safety and efficacy of early acetylcholinesterase inhibitors therapy in patients with cognitive impairment no dementia (CIND) after a cerebrovascular accident have not been examined. In this study, we investigated the safety and efficacy of rivastigmine in cognition, particularly executive function in patients with CIND because of cerebrovascular disease.

METHODS

This study was a 24-week, double-blind, randomized, placebo-controlled trial of ischemic stroke patients seen at a tertiary hospital who had cognitive impairment no dementia because of cerebrovascular disease. The intervention was either rivastigmine or placebo up to 9 mg/day. The primary outcome of interest was mean change from baseline in the Ten-Point Clock Drawing and Color Trails 1 and 2.

RESULTS

Fifty patients were randomized into rivastigmine (n = 25) and placebo (n = 25) arms. Patients in the rivastigmine group showed statistically significant improvement (1.70 vs 0.13, P = 0.02) on the animal subtask of the verbal fluency measure compared with placebo. There was also a trend (non-significant) towards improvement in Color Trails II.

CONCLUSIONS

In this pilot study, we demonstrated that rivastigmine was well tolerated in patients with CIND because of cerebrovascular disease and may potentially improve executive functioning.

The relationship between adipokines, metabolic parameters and insulin resistance in patients with metabolic syndrome and type 2 diabetes

This study was designed to investigate the relationship between adipokines in metabolic syndrome and insulin resistance. Sixty male and female subjects with or without metabolic syndrome and type 2 diabetes were included. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Compared with lean control subjects, patients with metabolic syndrome and type 2 diabetes had lower circulating levels of total adiponectin and high molecular weight (HMW) adiponectin, and higher levels of leptin and interleukin-6 (IL-6). Total and HMW adiponectin and the adiponectin/leptin (A/L) ratio were negatively correlated with HOMA-IR. After adjusting for age and sex, leptin, IL-6 and tumour necrosis factor-alpha (TNF-alpha) were positively correlated with HOMA-IR. After also adjusting for body mass index, HOMA-IR was found to be independently associated with leptin, A/L ratio and TNF-alpha levels. In conclusion, decreased total adiponectin and HMW adiponectin and increased leptin and IL-6 levels are characteristic of patients with metabolic syndrome and type 2 diabetes.

Bioconversion of waste cellulose by using an attrition bioreactor

A new type of reactor, an attrition bioreactor, was tested to achieve a higher rate and extent of enzymatic saccharification of cellulose than is possible with conventional methods. The reactor consisted of a jacketted stainless-steel vessel with shaft, stirrer, and milling media, which combined the effect of the mechanical action of wet milling with cellulose hydrolysis. The substrates tested were newsprint and white-pine heartwood. The performance of the reactor was excellent. The extent and rate of enzymatic hydrolysis could be markedly improved over other methods. The power consumption of the attrition bioreactor was also measured. The cellulase enzyme deactivation during attrition milling was not significant.

Getting heavier, younger: trajectories of obesity over the life course

Context

Although recent trends in obesity have been well documented, generational patterns of obesity from early childhood through adulthood across birth cohorts, which account for the recent epidemic of childhood obesity, have not been well described. Such trends may have implications for the prevalence of obesity-associated conditions among population subgroups, including type 2 diabetes.

Objective

Our objective was to evaluate trajectories of obesity over the life course for the US population, overall and by gender and race.

Design, Setting, and Participants

We conducted an age, period, and birth cohort analysis of obesity for US individuals who participated in the National Health and Nutrition Examination Surveys (1971-2006).

Main Outcome Measures

Obesity was defined as a body mass index ≥ 95th percentile for individuals aged 2-16 years or ≥ 30 kg/m2 among individuals older than 16 years. Age was represented by the age of the individual at each NHANES survey, period was defined by the year midpoint of each survey, and cohort was calculated by subtracting age from period.

Results

Recent birth cohorts are becoming obese in greater proportions for a given age, and are experiencing a greater duration of obesity over their lifetime. For example, whereas the 1966-75 and 1976-85 birth cohorts had reached an estimated obesity prevalence of at least 20% by 20-29 years of age, this level was only reached by 30-39 years for the 1946-55 and 1956-65 birth cohorts, by 40-49 years for the 1936-45 birth cohort, and by 50-59 years of age for the 1926-35 birth cohort. Trends are particularly pronounced for female compared with male, and black compared with white cohorts.

Conclusions

The increasing cumulative exposure to excess weight over the lifetime of recent birth cohorts will likely have profound implications for future rates of type 2 diabetes, and mortality within the US population.

Pattern formation in prey-taxis systems

In this paper, we consider spatial predator-prey models with diffusion and prey-taxis. We investigate necessary conditions for pattern formation using a variety of non-linear functional responses, linear and non-linear predator death terms, linear and non-linear prey-taxis sensitivities, and logistic growth or growth with an Allee effect for the prey. We identify combinations of the above non-linearities that lead to spatial pattern formation and we give numerical examples. It turns out that prey-taxis stabilizes the system and for large prey-taxis sensitivity we do not observe pattern formation. We also study and find necessary conditions for global stability for a type I functional response, logistic growth for the prey, non-linear predator death terms, and non-linear prey-taxis sensitivity.

Salivary diagnostics

The ability to monitor health status, disease onset and progression, and treatment outcome through non-invasive means is a most desirable goal in the health care promotion and delivery. There are three prerequisites to materialize this goal: specific biomarkers associated with a health or disease state; a non-invasive approach to detect and monitor the biomarkers; and the technologies to discriminate the biomarkers. A national initiative catalyzed by the National Institute of Dental & Craniofacial Research (NIDCR) has created a roadmap to achieve these goals through the use of oral fluids as the diagnostic medium to scrutinize the health and/or disease status of individuals. Progress has shown this is an ideal opportunity to bridge state of the art saliva-based biosensors, optimized to disease discriminatory salivary biomarkers, for diagnostic applications. Oral fluid being the 'mirror of body' is a perfect medium to be explored for health and disease surveillance. The translational applications and opportunities are enormous.

Duct-to-duct biliary reconstructions and complications in 100 living donor liver transplantations

OBJECTIVE

We evaluated the risk factors for biliary complications and surgical procedures for duct-to-duct reconstructions in adult living donor liver transplantation (LDLT).

PATIENTS AND METHODS

From February 2005 to March 2008, we performed 100 cases of adult LDLT with duct-to-duct biliary reconstruction, using 64 right lobe grafts, 33 left lobe grafts, and 3 right lateral grafts. We employed 4 types of duct-to-duct procedures: all interrupted 6-0 Prolene suture (group 1, n = 9); continuous posterior and interrupted anterior wall 6-0 Prolene suture (group 2, n = 49); all continuous 7-0 Prolene suture (group 3, n = 26); and all continuous 7-0 Prolene suture with external stent (group 4, n = 16). Biliary complications were defined as an anastomosis stricture or a leakage.

RESULTS

Thirty-four patients experienced biliary complications during the follow-up period (median, 27 months). The incidence of stricture was 27% and that of leakage, 8%. There were no perioperative, intraoperative, or anatomic risk factors for biliary complications, except the type of duct-to-duct procedure. Group 1 and 2 patients showed higher incidences of biliary strictures than groups 3 and 4 (43.1% vs 4.7%; P = .00). Group 3 patients experienced a higher incidence of bile leakage than the other groups (23.1% vs 2.7%; P = .004).

CONCLUSIONS

The type of biliary reconstruction is a factor affecting biliary complications following duct-to-duct anastomosis in LDLT. Duct-to-duct biliary anastomosis with 7-0 monofilament suture and a small external stent is a feasible procedure in LDLT that significantly reduces the incidence of biliary complications.

Insulin resistance in divergent strains of Holstein-Friesian dairy cows offered fresh pasture and increasing amounts of concentrate in early lactation

The objective of this study was to determine whether the physiological response to an intravenous glucose challenge would be affected by genetic strain or concentrate supplementation in grazing Holstein-Friesian cows in early lactation. North American (NA; n = 30) or New Zealand (NZ; n = 30) cows were randomly allocated to 1 of 3 feeding treatments. All cows were offered a generous pasture allowance, and 4 of the 6 groups received either 3 or 6 kg of dry matter (DM)/cow per day of concentrates. During wk 5 of lactation, all cows underwent an intravenous glucose challenge. Cows of NA origin produced more milk than NZ cows, but there was no significant strain effect on milk fat or protein yield. Milk yield and the yield of individual components increased with increasing level of concentrate eaten, but there were no significant strain x diet interactions. During wk 1 to 6, mean body weight and body condition score decreased in all treatments. Average body weight was greater in NA cows, but body condition score was greater for NZ cows. There was no strain or diet effect on the length of the postpartum anovulatory interval, with cows ovulating before 40 d postpartum on average. Glucose fractional turnover rate was greater in NZ cows compared with those of NA origin and in all cows receiving 6 kg of DM concentrates, indicating a less severe insulin resistance in those treatments. Consistent with this, the time taken to dispose of half the peak glucose concentration was less when 6 kg of DM concentrate was fed, and tended to be less in NZ than in NA cows. There was no effect of genetic strain on glucose area under the curve (AUC) at 60 or 120 min, but AUC at both time points was less in cows receiving 6 kg of DM concentrates per day. Neither genetic strain nor nutrition affected basal or peak insulin concentrations, insulin increment, or insulin AUC, and there were no strain x diet interactions for any of the glucose challenge response variables measured. In conclusion, differences in milk production between NA and NZ cows in early lactation can, at least in part, be explained by the greater degree of insulin resistance in the NA cows, and this insulin resistance can be overcome by supplementing grazing cows with 6 kg of DM concentrates.

Positive predictive value of breast MRI in cancer detection

Abstract #4007

Purpose: &#x2028; Positive predictive values (PPVs) are among the performance benchmarks which have been reported when examining clinical outcomes related to mammography. Breast MRI is increasingly being used as a tool for screening and diagnostic purposes and current performance benchmarks for breast MRI have yet to be established. The purpose of this study is to assess breast MRI performance in our academic clinical practice via comparison of breast MRI PPVs with reported PPV values for mammography. Specifically, we sought to determine the abnormal interpretation rate of breast MRI examinations, and then to calculate the PPVs related to recommendations for further diagnostic evaluation and to recommendations for biopsy of breast lesions visualized on MRI.&#x2028; Materials and Methods: &#x2028; This study was approved by our institutional review board and its methodology is in compliance with federal HIPAA regulations. A retrospective search of our institutional breast imaging database identified all breast MRI examinations performed 4/1/07 - 3/31/08. Data abstracted included: patient age, clinical indication for breast MRI, Breast Imaging Reporting and Data System (BI-RADS) assessments for all breast imaging examinations, clinical follow-up, and pathology results. Positive exams were defined as those with an initial BI-RADS 0, 4, or 5. Exams with suspicious findings were defined as those with a final BI-RADS 4 or 5 after additional workup. PPVs were calculated based on American College of Radiology recommendations and using the following definitions: PPV1 = exams with cancer/positive exams, PPV 2 = exams with cancer/exams with suspicious findings, and PPV 3 = cancers/biopsied lesions.&#x2028; Results:&#x2028; 2,600 breast MRI examinations were performed during the study period. After exclusion criteria were applied, 285 positive exams (BI-RADS 0, 4 or 5) were identified for further analysis. The abnormal interpretation rate was 10.96% (285/2600, 95% CI: 9.7% - 12.2%). After non-invasive workup, including mammographic and sonographic correlation, 186 lesions on 177 exams had biopsy recommendations (final BI-RADS 4 or 5). Following biopsy, 55 malignancies were diagnosed (35 invasive carcinomas, 18 DCIS, 2 phyllodes/sarcoma). The overall PPV for a positive breast MRI exam (PPV1) was 17.2% (49/285). The PPV for suspicious findings after non-invasive workup (PPV2) was 27.7% (49/177). The PPV for biopsied lesions (PPV3) was 29.6% (55/186). When stratified by MRI indication, the cancer yield was lower in the screening setting (PPV1 = 9.7%, PPV2 = 19.7%, PPV3 = 19.4%) than in the diagnostic setting (PPV1 = 23.0%, PPV2 = 31.9%, PPV3 = 34.7%).&#x2028; Conclusions:&#x2028; Diagnostic breast MRI PPVs are comparable to published benchmarks for diagnostic mammography. Screening breast MRI PPVs are lower than published values for screening mammography, and lower when compared with reports from high-risk screening breast MRI trials. This may reflect characteristics of the population undergoing screening breast MRI in our academic clinical practice. Factors such as cancer detection rate and the population risk for breast cancer should be considered when examining PPVs for breast MRI.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4007.

Weather, herbage quality and milk production in pastoral systems. 3. Inter-relationships and associations between weather variables and herbage growth rate, quality and mineral concentration

Prevailing weather conditions influence herbage growth and quality, and therefore may have a substantial impact on animal production. Before investigating relationships between weather factors, herbage quality and animal production, it is beneficial to first quantify interactions between herbage quality characteristics and mineral concentrations. The objective of the present study was to investigate the association between weather and herbage growth rate, quality and mineral concentration under rotational grazing systems. Daily weather data and weekly records of herbage quality and mineral concentration from a research dairy farm were available across the years 1995 to 2001, inclusive. Herbage growth rates were also recorded on a monthly basis. Results imply moderate correlations between some weather variables and herbage quality and mineral concentration. Generally, the strength of the absolute correlations between weather and herbage-related variables decreased following adjustment of the herbage-related variables for month of year and research farmlet. Negative correlations existed between rainfall and herbage water-soluble carbohydrate (r = –0.19) and organic matter digestibility concentration (r = –0.13) and metabolisable energy content (r = –0.14), independent of time of year and farmlet. Weather explained up to 14% of the variation in herbage nutrient content over and above that explained by time of year and farmlet. Significantly different correlations existed across time between some weather and herbage-related variables, indicating that the relationships may differ across seasons. Results from the present study, in conjunction with information on the effect of herbage quality and/or mineral concentration on animal production, will be valuable in improving our understanding of weather influences on herbage growth, quality and mineral concentration.

Weather, herbage quality and milk production in pastoral systems. 4. Effects on dairy cattle production

Prevailing weather conditions are one factor that influences herbage growth and quality, and therefore may have a substantial impact on animal production. The objective of the present study was to quantify the associations between weather, herbage quality and mineral concentration, and animal production. Daily weather data and weekly records of herbage quality and mineral concentration, as well as dairy cattle production, were available from a research farm and nearby weather station across the years 1995 to 2001, inclusive. Animal production variables of interest included individual cow milk production and composition, body condition score, and liveweight, as well as group herbage dry matter intake. Results indicate moderate relationships between some weather- and herbage-related variables and dairy cattle production variables, although most relationships appeared to be an artefact of temporal variation, as evidenced by weakening of correlations following adjustment for animal parity, stage of lactation, and week of the year at calving. Prior to adjustment for the confounding factors, the negative associations between milk yield and all temperature-related variables (r = –0.46 to –0.34) were most notable. Following adjustment for time of year, milk yield became positively associated with sunlight hours (r = 0.14). Negative relationships were demonstrated between temperature-related variables and milk protein concentration (r = –0.08), regardless of time of year. Milk protein concentration was positively associated with herbage metabolisable energy content (r = 0.06), water-soluble carbohydrate (r = 0.11), and organic matter digestibility (r = 0.06) concentrations, and negatively associated with ether extract (r = –0.07), acid detergent fibre (r = –0.06), and neutral detergent fibre (r = –0.05) concentrations. Weather, herbage quality and mineral concentration explained up to 22% more variation in dairy cattle production variables over and above farmlet and time of year, with a greater effect on dry matter intake than the other production parameters.

Weather, herbage quality and milk production in pastoral systems. 1. Temporal patterns and intra-relationships in weather variables

Prevailing weather conditions are one factor that influences herbage growth and quality, and therefore may have a substantial impact on animal production. Before investigating relationships between weather factors, herbage growth and quality, and animal production, it is beneficial to first quantify temporal trends in weather variables. The objective of the present study was to investigate the existence of temporal weather trends in a predominantly dairy production region of New Zealand, and to quantify the level of intra-dependency among the weather variables measured. Daily weather data across the years 1995 to 2001 were merged. Fitted sinusoidal functions demonstrated cyclic temporal trends in weather throughout the year. Air and soil temperatures, radiation, and potential evapotranspiration were highly repeatable within fortnight. Repeatability of all other weather variables was low; for example repeatability of rainfall was ≤7%. Linear relationships were also observed among all weather variables. All air and soil temperature measurements were highly positively correlated with each other (r = 0.53–0.99), and with evaporation (r = 0.40–0.68) and potential evapotranspiration (r = 0.43–0.79), while maximum air temperature was positively correlated with radiation (r = 0.61). Further investigation is required to quantify the effect of temporal weather trends on herbage growth and quality, and subsequent animal production.

Weather, herbage quality and milk production in pastoral systems. 2. Temporal patterns and intra-relationships in herbage quality and mineral concentration parameters

Prevailing weather conditions influence herbage growth and quality, and therefore may have a substantial impact on animal production. Before investigating relationships between weather factors, herbage quality, and animal production, it is beneficial to first quantify temporal trends in herbage quality characteristics and mineral concentrations. The objective of the present study was to investigate the existence of temporal trends in herbage quality characteristics and mineral concentrations, and to quantify the intra-dependency among these variables. Weekly herbage quality and mineral concentration data from a research farm were collected from 1995 to 2001, inclusive. Fitted sinusoidal functions demonstrated cyclic temporal trends across herbage quality variables, but there was little cyclic temporal variation in the majority of herbage mineral concentration variables. The repeatability of herbage quality measurements was low to moderate (22% for ether extract to 54% for metabolisable energy). Linear relationships were observed within all herbage quality variables and herbage mineral concentration variables. Neutral detergent fibre and acid detergent fibre concentrations were strongly positively correlated with each other (r = 0.87), and negatively correlated with herbage digestibility (r = –0.64 and –0.74, respectively), water-soluble carbohydrate concentration (r = –0.52 and –0.68, respectively) and metabolisable energy content (r = –0.60 and –0.75, respectively). The absolute correlations among most herbage minerals were poor (r <0.30). However, magnesium concentration was positively correlated with calcium (r = 0.54), copper (r = 0.56), and manganese (r = 0.37) concentrations, and negatively correlated with zinc (r = –0.56) concentration. Further investigation is required into the relationships between temporal weather and herbage quality trends, and their impact on animal production.

Adoptive immunotherapy using human peripheral blood lymphocytes transferred with RNA encoding Her-2/neu-specific chimeric immune receptor in ovarian cancer xenograft model

The current gene transfer technology for single chain (scFv)-based chimeric immune receptor (CIR) has relied on retrovirus and lentivirus vectors which require a long time to obtain sufficient number of transduced cells and stably incorporate into genome. To ameliorate these limitations, we applied RNA electroporation to human peripheral blood lymphocytes (PBLs) activated with anti-CD3 antibody and interleukin-2 (IL-2) for 3 days and assessed that PBL transiently expressing anti-Her-2/neu CIR (CIR-PBL) containing signaling portion of CD28 and CD3zeta could elicit strong cytotoxicity in vitro and antitumor responses in vivo. The CIR-PBL expressed high level of CIR in CD4+, CD8+ and CD56+ cells. Her-2/neu-specific stimulation induced secretion of type-I cytokines including interferon-gamma (IFN-gamma), IL-8 and granulocyte-macrophage colony-stimulating factor, and IFN-gamma secretion was mainly mediated by CD8+ T cells. CIR-PBL specifically killed SKOV3 cell line expressing Her-2/neu. Adoptive transfer of CIR-PBL in SKOV3 xenograft model led to significant inhibition of tumor growth compared with transfer of mock-transduced PBL and showed higher inhibition than those with Herceptin, humanized monoclonal antibody specific for Her-2/neu. These results provided evidence that electroporation of CIR RNA to human PBLs could be used for rapid generation and high number of therapeutic antigen-specific T cells for adoptive immunotherapy.

Expression of pituitary tumor-transforming gene in endometrial cancer as a prognostic marker

The pituitary tumor-transforming gene (PTTG) is a novel oncogene expressed abundantly in most tumors, regulates basic fibroblast growth factor secretion, and induces angiogenesis. The objective of this study is to compare the expression rate of PTTG in endometrial cells, to correlate the level of expression of PTTG with the clinicopathologic parameters and overall survival, and to evaluate the possible use of PTTG as a prognostic marker of endometrial cancer. Forty patients diagnosed with endometrial cancer, 20 patients with endometrial hyperplasia, and 20 patients with normal endometrial tissues were included in the study. Immunohistochemical analyses on paraffin-embedded blocks were performed using a polyclonal anti-PTTG antibody. The decrease in expression of cytoplasmic and nuclear PTTG seen for endometrial cancer cells was statistically significant (P< 0.05). Cytoplasmic PTTG expression correlated with expression of progesterone receptor (P= 0.009) and FGF-2 (P= 0.007) but not with other parameters such as the expression of estrogen receptor, tumor grade, and surgical stage. Nuclear PTTG expression did not correlate with any parameters. The mean survival of patients with positive and negative cytoplasmic PTTG expression was 40.8 and 48.6 months (P= 0.78). In nuclear PTTG expression, the survival was 20.0 and 51.8 months, respectively (P= 0.04). Cytoplasmic PTTG expression was not associated with survival. Patients with nuclear PTTG overexpression showed a significant decrease in survival. The use of PTTG as a prognostic marker for endometrial cancer needs further investigation.

Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery

BACKGROUND

Rapidly acting narcotics enhance the degree of bradycardia due to the oculocardiac reflex (OCR) elicited by extraocular muscle (EOM) tension during strabismus surgery. We evaluated and compared the effects of remifentanil and sevoflurane on OCR during paediatric strabismus surgery.

METHODS

One hundred and twenty children, 1-9 years old, undergoing elective strabismus surgery, were randomly assigned to receive sevoflurane or remifentanil. No anticholinergic prophylaxis was administered. Anaesthesia was induced using ketamine 1.0 mg/kg or midazolam 0.15 mg/kg with 66% N(2)O in O(2). Laryngeal mask airways were placed with rocuronium 0.5 mg/kg. Anaesthesia was maintained with sevoflurane 2.0-3.0 vol% with 66% N(2)O in O(2) or remifentanil 0.75 mug/kg over 1 min and followed by the continuous infusion of remifentanil 0.5 mug/kg/min with 66% N(2)O in O(2). Heart rate (HR) and blood pressure (BP) were measured and compared. OCR was defined as a reduction in HR of >20% induced by traction of an EOM.

RESULTS

During anaesthesia, HR and BP were maintained at a lower level in the remifentanil group than in the sevoflurane group (each, P<0.05). The mean percent change in HR (-23.3+/-17.0% vs. -11.2+/-13.0%; P<0.05) and the incidence of OCR (58.3% vs. 28.3%; P<0.05) following traction of an EOM were higher in the remifentanil group than in the sevoflurane group.

CONCLUSIONS

Remifentanil enhanced the degree of bradycardia due to OCR as compared with sevoflurane during paediatric strabismus surgery.

Luminal hydrochloric acid stimulates rapid transepithelial ion fluxes in rodent esophageal stratified squamous epithelium

It remains unclear whether enhanced ion fluxes occur in the esophageal stratified squamous epithelium upon acid exposure. Rat esophageal tissues devoid of submucosal glands displayed basal short-circuit current (Isc) of 5.03 +/- 1.93 microA/cm(2) and lumen-negative potential difference (PD) in association with net absorption of Na+ and Cl-, and secretion of HCO3(-). Luminal hydrochloric acid (HCl) challenge (pH = 1.6) triggered an acute rise of the Isc and increment of negative PD to seven-fold of baseline, which was diminished in HCO3(-)-free, but not Na+- free buffer. The rise of Isc was inhibited by pretreatment with di-isothiocyanatostilbene-2, 2'-disulphonic acid (DIDS) and 5-(N-ethyl-N-isopropyl)-amiloride (EIPA). Topical carbachol, capsaicin, forskolin or CFTR(inh)-172 had no effect on basal Isc.CFTR(inh)-172 did not reduce the acid-increased Isc. Functional ablation of capsaicin-sensitive nerves had no effect on the acid-induced Isc. The phenomenon of enhanced ion fluxes upon acid stimulation was confirmed in human esophageal specimens. Our results demonstrated that the mechanism of acid-induced rapid transepithelial ion fluxes is dependent on the presence of bicarbonate ions as well as functional anion transporters and Na+/H+ exchanger, but independent of cystic fibrosis transmembrane conductance regulator (CFTR). The capsaicin-sensitive and muscarinic-dependent nerve pathways did not play roles in the mechanism.

Subclinical Cushing's syndrome associated with an adrenocortical oncocytoma

Oncocytoma is a neoplasm that can arise in several organs, and it has been more commonly described in the kidney, salivary gland and thyroid. Oncocytoma arising in the adrenal gland is a rare finding. Moreover, functioning adrenocortical oncocytoma is exceptionally rare. A 47-yr-old man was incidentally discovered to have a right adrenal mass. The patient had no clinical features suggestive of increased adrenal function. However, hormonal evaluation showed a disturbed cortisol circadian rhythm, supranormal urinary cortisol excretion, a low level of ACTH, and a lack of suppressibility of cortisol secretion after dexamethasone. Right adrenalectomy was performed, and this revealed a well-circumscribed dark-brown tumor that measured 2.4x2.2 cm. The tumor consisted almost exclusively of large eosinophilic and epitheloid cells whose cytoplasm was packed with eosinophilic granulations, which corresponded to the numerous mitochondria confirmed on electron microscopy. This is a rare case of subclinical Cushing's syndrome that was caused by adrenocortical oncocytoma.

Osteoprotegerin Lys3Asn polymorphism and the risk of fracture in older women

CONTEXT

Osteoprotegerin (OPG) is a soluble decoy receptor for receptor activator nuclear factor kappa-beta that blocks osteoclastic bone resorption.

OBJECTIVE

We investigated the association between a Lys3Asn polymorphism in the OPG gene and bone mineral density (BMD), and the risk of fracture in 6695 women aged 65 yr and older participating in the Study of Osteoporotic Fractures.

DESIGN

BMD was measured using either single-photon absorptiometry (Osteon Osteoanalyzer; Dove Medical Group, Los Angeles, CA) or dual-energy x-ray absorptiometry (Hologic QDR 1000; Hologic, Inc., Bedford, MA). Incident fractures were confirmed by physician adjudication of radiology reports. Genotyping was performed using an immobilized probe-based assay.

RESULTS

Women who were homozygous for the minor G (Lys) allele had significantly lower BMD at the intertrochanter, distal radius, lumbar spine, and calcaneus than those with the C (Asn) allele. There were 701 incident hip fractures during 13.6-yr follow-up (91,249 person-years), including 362 femoral neck and 333 intertrochanteric hip fractures. Women with the C/C (Asn-Asn) genotype had a 51% higher risk of femoral neck fracture (95% confidence interval, 1.13-2.02) and 26% higher risk of hip fracture (95% confidence interval, 1.02-1.54) than those with the G/G (Lys-Lys) genotype. These associations were independent of BMD. Intertrochanteric fractures were not associated with the Lys3Asn polymorphism.

CONCLUSION

These results require confirmation but suggest a role for the OPG Lys3Asn polymorphism in the genetic susceptibility to hip fractures among older white women.