Augmentative compression plating versus exchanging reamed nailing for nonunion of femoral shaft fracture after intramedullary nailing : A retrospective cohort study

Aim of the present study was to compare the outcomes between exchanging reamed nailing (ERN) and augmentative compression plating (ACP) in treatment of femoral shaft nonunion after intra-medullary nailing (IMN) retrospectively. A retrospective, multicentre study was performed with 188 patients (190 cases)with femoral shaft nonunion after IMN, who received therapy with either ERN (n = 92) for 44/92 (47.8%) cases of nonisthmal nonunions and 48/92 (52.2%) cases of isthmal nonunions or ACP (n = 98) for 48/98 (49%) cases of nonisthmal nonunions and 50/98 (51%) cases of isthmal nonunions. Operation time, intraoperative blood loss, time to union, union rate, postoperative draining volume and complication rate were compared between ERN and ACP group. After a mean follow-up of 4.6 years (range 1-8.1 years), the bone union occurred in 98/98 (100%) cases in -total ACP group versus 80/92 (87%) cases in total ERN group [odds ratio (OR) = 3.34, 95% confidence interval (CI) 0.8-1.6]. Twelve cases with re-nonunion in the total ERN group included 10/12 (83.3%) cases of nonisthmal nonunions and 2/12 (16.7%) cases of isthmal nonunion with cortical bone defect > 3 cm. The average time to union, the intraoperative blood loss and the complication rate in total ERN group were also both significantly more than that in total ACP group (p = 0.031, p = 0.042, p = 0.028). No -significant difference was found in the average operation time between the two total groups (p = 0.213). However, for nonisthmal nonunions, the mean operation time for ERN group was 126.8 ± 19.6 min in -comparison to ACP group (88.6 ± 15.2 min), significant difference was found between ERN group and ACP group (p = 0.021). ACP could obtain the higher bone union rate and shorter time to union than ERN in the treatment of femoral shaft nonunion after failed IMN. Especially for nonisthmal femoral shaft nonunions or isthmal.

Low nanomolar concentrations of Cucurbitacin-I induces G2/M phase arrest and apoptosis by perturbing redox homeostasis in gastric cancer cells in vitro and in vivo

Cucurbitacin-I (Cu-I, also known as Elatericin B or JSI-124) is developed to inhibit constitutive and abnormal activation of STAT3 in many cancers, demonstrating a potent anticancer activity by targeting disruption of STAT3 function. Here, we for the first time systematically studied the underlying molecular mechanisms of Cu-I-induced gastric cancer cell death both in vitro and in vivo. In our study, we show that Cu-I markedly inhibits gastric cancer cell growth by inducing G2/M phase cell cycle arrest and apoptosis at low nanomolar concentrations via a STAT3-independent mechanism. Notably, Cu-I significantly decreases intracellular GSH/GSSG ratio by inhibiting NRF2 pathway to break cellular redox homeostasis, and subsequently induces the expression of GADD45α in a p53-independent manner, and activates JNK/p38 MAPK signaling. Interestingly, Cu-I-induced GADD45α and JNK/p38 MAPK signaling form a positive feedback loop and can be reciprocally regulated by each other. Therefore, the present study provides new insights into the mechanisms of antitumor effects of Cu-I, supporting Cu-I as an attractive therapeutic drug in gastric cancer by modulating the redox balance.

Epigenetic silencing of GDF1 disrupts SMAD signaling to reinforce gastric cancer development

Accumulating evidence reveals the effectiveness of epigenetic therapy in gastric cancer. However, the molecular mechanisms and targets underlying such therapeutic responses remain elusive. Herein, we report an aberrant yet therapeutically rectifiable epigenetic signaling in gastric carcinogenesis. Administration of DNA-demethylating drug 5-aza-2'-deoxycytidine (5-aza-dC) reduced gastric cancer incidence by ~74% (P < 0.05) in N-nitroso-N-methylurea-treated mice. Through genome-wide methylation scanning, novel promoter hypermethylation-silenced and drug-targeted genes were identified in the resected murine stomach tumors and tissues. We uncovered that growth/differentiation factor 1 (Gdf1), a member of the transforming growth factor-β superfamily, was silenced by promoter hypermethylation in control tumor-bearing mice, but became reactivated in 5-aza-dC-treated mice (P < 0.05). In parallel, the downregulated SMAD2/3 phosphorylation in gastric cancer was revived by 5-aza-dC in vivo. Such hypermethylation-dependent silencing and 5-aza-dC-mediated reactivation of GDF1-SMAD2/3 activity was conserved in human gastric cancer cells (P < 0.05). Subsequent functional characterization further revealed the antiproliferative activity of GDF1, which was exerted through activation of SMAD2/3/4-mediated signaling, transcriptional controls on p15, p21 and c-Myc cell-cycle regulators and phosphorylation of retinoblastoma protein. Clinically, hypermethylation and loss of GDF1 was significantly associated with reduced phosphorylated-SMAD2/3 and poor survival in stomach cancer patients (P < 0.05). Taken together, we demonstrated a causal relationship between DNA methylation and a tumor-suppressive pathway in gastric cancer. Epigenetic silencing of GDF1 abrogates the growth-inhibitory SMAD signaling and renders proliferation advantage to gastric epithelial cells during carcinogenesis. This study lends support to epigenetic therapy for gastric cancer chemoprevention and identifies a potential biomarker for prognosis.

Stillbirth: Genome-wide copy number variation profiling in archived placental umbilical cord samples with pathologic and clinical correlation

INTRODUCTION

Stillbirth remains a devastating health issue with 26,000 stillbirths occurring annually in the United States. Formalin-fixed, paraffin-embedded (FFPE) umbilical cord samples are available for many stillbirths. Our aim was to validate the use of these samples in identifying genetic variations in stillbirth through microarray analysis.

METHODS

This is a retrospective case-control study from a single institution of stillbirths ≥ 23 weeks gestational age and control liveborn infants. Fetal genomic DNA was extracted from FFPE umbilical cord samples of stillborn and control placentas, and genotyping was performed using the Illumina HumanOmniExpresss-12v1 Beadchip. Array results were verified with qPCR.

RESULTS

31 case-specific CNVs (17 deletions and 14 amplifications) with an average size of 294 kb for amplifications and 74 kb for deletions were identified among 94 FFPE samples (86 cases; 8 controls). In total 38 (44%) of the stillbirth samples had a CNV detected. Validation of a subset of microarray findings with qPCR confirmed deletions on 1p (2 cases), 11q (4 cases) and amplifications on 18 (1 case). Placental underperfusion changes were seen in stillborns with deletions on 1p, a region containing complement regulatory genes which have been shown to play a role in preeclampsia.

DISCUSSION

This study validated the use of archived FFPE umbilical cord samples for genome-wide copy number profiling in stillbirths, and demonstrates specific CNV deletions and amplifications. Microarray analysis in an expanded cohort of stillbirth FFPE samples has the potential to identify biomarkers involved in stillbirth pathogenesis.

Effect of nitric oxide inhalation combined with high-frequency oscillatory ventilation on the prognosis of neonatal severe hypoxemia

OBJECTIVE

The current study aimed to analyze the short-term and long-term curative effects of nitric oxide (NO) inhalation combined with high-frequency oscillatory ventilation (HFOV) on neonatal severe hypoxemia.

MATERIALS AND METHODS

A total of 98 neonates meeting the inclusion criteria were retrospectively analyzed. The control group comprised of 48 neonates and the NO inhalation group consisted of 50 neonates. In the control group, conventional mechanical ventilation was replaced by HFOV. In the experimental group, NO inhalation combined with HFOV was performed. The death rates within 28 days, mechanical ventilation and oxygen therapy time, and complications in both groups were observed. The survivors in both groups were followed up for 18 months for neural development evaluation.

RESULTS

The treatment group showed a significantly lower death rate and noticeably shorter mechanical ventilation and oxygen therapy time than the control group (8% vs. 22.9% with t = 4.20 andp < 0.05; 5.84 ± 3.36 days vs. 8.05 ± 5.48 days with t = 2.42 and p < 0.05; and 8.02 ± 4.31 days vs. 12.45 ± 5.14 days with t = 4.63 and p < 0.001). They did not show significant differences with regards to the complications and the incidences of cerebral palsy, hearing and visual impairments, and severe nervous damage (p > 0.05).

CONCLUSION

NO inhalation combined with HFOV significantly decreases the death rate of neonates with severe hypoxemia and reduces their mechanical ventilation and oxygen therapy time. It does not increase early adverse effects or affect long-term neurodevelopment.

Valley-polarized interlayer conduction of anisotropic Dirac fermions in SrMnBi2

We report the valley-selective interlayer conduction of SrMnBi(2) under in-plane magnetic fields. The c-axis resistivity of SrMnBi(2) shows clear angular magnetoresistance oscillations indicating coherent interlayer conduction. Strong fourfold variation of the coherent peak in the c-axis resistivity reveals that the contribution of each Dirac valley is significantly modulated by the in-plane field orientation. This originates from anisotropic Dirac Fermi surfaces with strong disparity in the momentum-dependent interlayer coupling. Furthermore, we found a signature of broken valley symmetry at high magnetic fields. These findings demonstrate that a quasi-two-dimensional anisotropic Dirac system can host a valley-polarized interlayer current through magnetic valley control.

An intrauterine catch-up growth regimen increases food intake and post-natal growth in rats

Nutritional conditions during the intrauterine stage are an important developmental programming factor that can affect the growth and metabolic status during foetal development and permanently alter the phenotypes of newborn offspring and adults. This study was performed to examine the effects of intrauterine catch-up growth (IUCG) on food intake, post-natal body growth and the metabolic status of offspring and growing rats. Control pregnant rats were fed ad libitum during the entire gestation period. For the IUCG regimen, pregnant rats were fed 50% of the food of the controls from pregnancy days 4 through 11 (8 days), followed by ad libitum feeding from pregnancy days 12 through parturition. The birth weight of offspring was not affected by the IUCG regimen. At weaning, offspring from each treatment group were assigned to two groups and given either a normal diet or high-fat diet (HFD) for 12 weeks until 103 days of age. In the normal diet group, the IUCG offspring showed a 9.0% increase (P < 0.05) in total food intake, were 11.2% heavier (p < 0.05) at 103 days of age and had an 11.0% greater (p < 0.05) daily weight gain compared with control offspring. The IUCG regimen did not affect body glucose and lipid metabolism. After exposure to the HFD, the IUCG regimen has not exacerbated metabolic disorders. In conclusion, our findings suggest that the IUCG nutritional regimen during pregnancy can increase the food intake and post-natal body growth of offspring without inducing metabolic disorders such as obesity and insulin resistance. The IUCG nutritional regimen might be used to improve the food intake and post-natal body growth of domestic animals.

Pharmacokinetic analysis of two different doses of duloxetine following oral administration in dogs

BACKGROUND

Duloxetine is a potent and balanced dual inhibitor of serotonin and norepinephrine reuptake that is being investigated for the treatment of depression and urinary incontinence. The purpose of this study was to investigate the pharmacokinetic properties of duloxetine in 20 beagle dogs following a single oral administration of a 30- or 60-mg enteric-coated pellet in a capsule (Cymbalta).

METHOD

Following the administration of 30 or 60 mg of Cymbalta to 20 beagle dogs, the plasma concentration of duloxetine was measured using LC-MS/MS. Pharmacokinetic parameters were analyzed using both noncompartmental and compartmental approaches.

RESULTS

The values of C max and AUC increased in proportion to the dose of duloxetine. The one compartment model with first-order absorption and a lag time was used successfully for pharmacokinetic analysis of duloxetine following a single oral administration of Cymbalta 30 mg or 60 mg.

CONCLUSIONS

The studies described here are the first to report the pharmacokinetics of oral duloxetine in dogs, and these findings provide important information for pharmaceutical formulation research of duloxetine using dogs.

An evidence-based approach for providing cautionary recommendations to sulfonamide-allergic patients and determining cross-reactivity among sulfonamide-containing medications

WHAT IS KNOWN AND OBJECTIVE

Prescribing sulfonamide-containing medications for patients with sulfonamide allergy continues to complicate medical decisions. We examined the cautionary recommendations in the approved drug monographs and primary literature, and formulated an evidence-based grading of cautionary recommendations for sulfonamide allergy and cross-reactivity among sulfonamide-containing medications.

METHODS

Drug monographs were collected from six countries and three drug compendia. Two reviewers independently extracted the data from the contraindication, warning and/or precaution sections of drug monographs. Evidence for cross-reactivity was examined in the primary literature and compared with drug monograph recommendations. Consequently, medications were categorized based on the strength of recommendation and level of evidence by consensus.

RESULTS AND DISCUSSION

We identified wide variability in cautionary recommendations ranging from no warning or precaution to contraindication among the sources reviewed. The recommendations were located mainly in the contraindication section of monographs for France (65·2%), United Kingdom (51·9%), Italy (50·0%), South Korea (43·5%), United States (38·2%) and Canada (37·0%), whereas in drug compendia, the recommendations were found in the precaution section for Martindale (51·4%) and Micromedex-Drugdex (33·3%), and contraindication and precaution section for the American Hospital Formulary Service Drug Information 2010 (30·8%). Evidence from the primary literature varied with recommendation included in drug monographs. Evidence-based categorization was carried out for 16 medications. Two sulfonamide-moiety-containing drugs were considered safe, six non-sulfonylarylamines required precaution, and eight medications from all three sulfonamide chemical classes were considered mostly unsafe.

WHAT IS NEW AND CONCLUSION

There are significant discrepancies in cautionary recommendations included in drug-labels and drug compendia. Statements concerning cross-reactive hypersensitivity with other sulfonamides generally suggest theoretical possibilities. The consensus evidence-based grading instrument developed may be useful for deriving cautionary recommendations for sulfonamide-allergic patients.

TGF-β1 and hypoxia-dependent expression of MKP-1 leads tumor resistance to death receptor-mediated cell death

Sporadic occurrence of transformed tumor cells is under the surveillance of the host immune system and such cells are effectively eliminated by immune-mediated cell death. During tumor progression, the antitumor effects of the tumor microenvironment are suppressed by diverse immunosuppressive mechanisms. In this research, we suggest novel immune evasion strategy of tumor cells through a transforming growth factor (TGF)-β1- and hypoxia-dependent mechanism. Experimental results showed that TGF-β1 and hypoxia induced mitogen-activated protein kinase phosphatase (MKP)-1 expression within 1 h, resulting in attenuation of c-Jun N-terminal kinase (JNK) phosphorylation and subsequent death receptor-mediated cell death. In addition, analysis of microarray data and immunostaining of MKP-1 in hepatocellular carcinoma (HCC) patient samples revealed that expression of MKP-1 is notably higher in tumors than in normal tissues, implying that MKP-1-dependent suppression of immune-mediated cell death takes place only in the tumor. To prove that MKP-1 can act as a mediator of immune escape by tumors, we determined whether chemo-resistance against several anticancer drugs could be overcome by knockdown of MKP-1. Cytotoxic assays showed that chemotherapy with siRNA targeting MKP-1 was significantly more effective than chemotherapy in the presence of MKP-1. Thus, we conclude that TGF-β1 and hypoxia ensure tumor cell survival and growth through expression of MKP-1.

Characterization and optimization of vascular endothelial growth factor(165) (rhVEGF(165)) expression in Escherichia coli

Vascular endothelial growth factors(165) (VEGF(165)) is the most potent and widely used pro-angiogenic factor. Here we determined optimal culture condition of recombinant human VEGF(165) (rhVEGF(165)) in Escherichia coli (E. coli). rhVEGF(165) expression was the highest in 0.25% of L-arabinose induction concentration, at 20 °C induction temperature, and for 5 h induction time under the control of araBAD promoter using pBADHisA vector. In biological activity test, rhVEGF(165) significantly increased the proliferative activity of CPAE cells (p<0.001) and upregulated the expressions of endothelial cell growth-related genes, such as platelet endothelial cell adhesion molecule (PECAM-1), endothelial-specific receptor tyrosine kinase (TEK), kinase insert domain protein receptor (KDR), and tyrosine kinase with immunoglobulin-like and EGF-like domains 1 (TIE1) in calf pulmonary artery endothelial (CPAE) cells.

Myocardial pharmacokinetics of ebastine, a substrate for cytochrome P450 2J, in rat isolated heart

BACKGROUND AND PURPOSE

It is well established that cytochrome P450 2J (CYP2J) enzymes are expressed preferentially in the heart, and that ebastine is a substrate for CYP2J, but it is not known whether ebastine is metabolized in myocardium. Therefore, we investigated its pharmacokinetics in the rat isolated perfused heart.

EXPERIMENTAL APPROACH

Rat isolated hearts were perfused in the recirculating mode with ebastine for 130 min. The concentrations of ebastine and its metabolites, hydroxyebastine and carebastine, were measured using liquid chromatography with a tandem mass spectrometry. The data were analysed by a compartmental model. The time course of negative inotropic response was linked to ebastine concentration to determine the concentration-effect relationship.

KEY RESULTS

Ebastine was metabolized to an intermediate compound, hydroxyebastine, which was subsequently further metabolized to carebastine. No desalkylebastine was found. The kinetics of the sequential metabolism of ebastine was well described by the compartmental model. The EC(50) of the negative inotropic effect of ebastine in rat isolated heart was much higher than free plasma concentrations in humans after clinical doses.

CONCLUSIONS AND IMPLICATIONS

The kinetics of ebastine conversion to carebastine via hydroxyebastine resembled that observed in human liver microsomes. The results may be of interest for functional characterization of CYP2J activity in rat heart.

Updated survival results of the randomized phase II study comparing cisplatin/capecitabine (CX) with epirubicin plus CX (ECX) in advanced gastric cancer (AGC)

46

Background: We previously reported results of a randomized study showing that CX is equally active to ECX in terms of progression-free survival (PFS) (Yun et al. Eur J Cancer. 2010). Here we report updated overall survival (OS) results with an additional 12 months' follow-up.

Methods: Ninety-one chemotherapy-naïve patients with histologically-confirmed, measurable AGC were randomized to receive CX (cisplatin 75 mg/m2 iv on day 1 and capecitabine 1,000 mg/m2 bid po on days 1-14, n=45) or ECX (epirubicin 50 mg/m2 plus CX, n=44) every 3 weeks. After CX or ECX had failed, second-line chemotherapy (SLC) was recommended for all patients if their performance status was preserved.

Results: Treatment duration was similar for both arms (4.4 for CX v 4.2 months for ECX). There was no relevant difference in the occurrence of overall grade 3 or 4 toxicities between the CX and ECX arms (80% v 78%, respectively; p=0.516). However, none in the CX and 12% in the ECX arm discontinued treatment because of toxicity. There were no significant differences in therapeutic efficacy between CX and ECX with respect to the response rate (38% v 37%, respectively), PFS (6.4 v 6.5 months), as well as OS (12.7 v 13.8 months; p=0.51). After failure, 60% of patients (26 CX and 28 ECX patients) received SLC. However, OS was not differed whether a patient was treated with SLC or not (13.1 v 11.2 months; p=0.94).

Conclusions: The present analysis confirms previous findings that both CX and ECX appear to be comparatively active as first-line chemotherapy for AGC. Furthermore, the role of SLC in AGC warrants further evaluation.

No significant financial relationships to disclose.

Clinicopathological correlation of beclin-1 expression in human colon cancer

464

Background: We investigated the expression of beclin-1 and bcl-2 in human colon cancer tissue by immunohistochemical analysis using a tissue microarray in relation to other prognostic factors.

Methods: Tissue samples from 78 cases of invasive colon cancer were used for the present study. A positive control for bcl-2 expression was small lymphocytes in the mantle zone. Immunohistochemical staining for beclin-1 and bcl-2 was evaluated according to intensity and proportion. The intensity score was determined as 0 (no staining), 1 (weak), 2 (moderate) and 3 (strong). The proportion score was determined as 1 (< 30% of tumor cells) and 2 (≥ 30% of tumor cells). The intensity score and proportion score were multiplied together for a total score. Total scores were as follows: 0-1 (negative) and 2-6 (positive).

Results: The normal colonic epithelium showed weak to no beclin-1 expression. Positive beclin-1 expression and positive bcl-2 expression of colon cancer cells was observed in 48 cases (61.5%) and 10 cases (12.8%), respectively. beclin-1 expression was significantly correlated with lymph node metastasis (p = 0.035) Bcl-2 expression in colon cancer cells showed no significant correlation with clinocopathologic factors studied. Beclin-1 expression was not correlated with bcl-2 expression in colon cancer cells (p = 0.348).

Conclusions: In conclusion, we have characterized the expression of beclin-1 in human colon cancer and the relationship with bcl-2 protein. Our results suggest that it seems reasonable to assume that beclin-1 might play a role in the development of colorectal cancer.

No significant financial relationships to disclose.

A retrospective study of first-line combination chemotherapy in advanced colorectal cancer: A Korean single-center experience

623

Background: Fluoropyrimidine-based combination chemotherapy, in combination with either oxaliplatin or irinotecan, have demonstrated efficacy and tolerability against advanced colorectal cancer (ACC).

Methods: Between Jan 2006 and Dec 2007, 478 ACC patients were treated with combination chemotherapy in first-line setting: 5-fluorouracil, folinic acid plus oxaliplatin (FOLFOX, n=172), 5-fluorouracil, folinic acid plus irinotecan (FOLFIRI, n=95), capecitabine plus oxaliplatin (XELOX, n=155), and capecitabine plus irinotecan (XELIRI, n=56). FOLFOX and FOLFIRI were repeated every 2 weeks, whereas XELOX and XELIRI were repeated every 3 weeks until disease progression or unacceptable toxicity occurred or until a patient chose to discontinue treatment.

Results: The median age was 58 years (range, 19-84 years) and the median chemotherapy duration for FOLFOX, FOLFIRI, XELOX and XELIRI were 4.9, 4.5, 5.7 and 5.4 months, respectively. Combination chemotherapy regimens were generally well tolerated. The estimated median PFS for all patients was 6.8 months (95% confidence interval, 6.3-7.3 months). No statistically significant difference in PFS was found each regimen used as first-line chemotherapy. Sixty-percent (n=290) of patients received second or further lines of therapy after failure.

Conclusions: Fluoropyrimidine-based combination chemotherapy regimens appear to be equally active and tolerable as first-line therapy for ACC.

No significant financial relationships to disclose.