Prevalence and correlates of obstructive sleep apnoea among patients with and without HIV infection

OBJECTIVES

In HIV-uninfected populations, obstructive sleep apnoea (OSA) is commonly associated with cardiovascular disease, metabolic syndrome, and cognitive impairment. These comorbidities are common in HIV-infected patients, but there are scarce data regarding OSA in HIV-infected patients. Therefore, we examined the prevalence and correlates of OSA in a cohort of HIV-infected and uninfected patients.

METHODS

An observational cohort study was carried out. Electronic medical record and self-report data were examined in patients enrolled in the Veterans Aging Cohort Study (VACS) between 2002 and 2008 and followed until 2010. The primary outcome was OSA diagnosis, determined using International Classification of Diseases, 9th edition (ICD-9) codes, in HIV-infected compared with uninfected individuals. We used regression analyses to determine the association between OSA diagnosis, symptoms and comorbidities in adjusted models.

RESULTS

Of 3683 HIV-infected and 3641 uninfected patients, 143 (3.9%) and 453 (12.4%) had a diagnosis of OSA (p<0.0001), respectively. HIV-infected patients were more likely to report symptoms associated with OSA such as tiredness and fatigue. Compared with uninfected patients with OSA, HIV-infected patients with OSA were younger, had lower body mass indexes (BMIs), and were less likely to have hypertension. In models adjusting for these traditional OSA risk factors, HIV infection was associated with markedly reduced odds of OSA diagnosis (odds ratio 0.48; 95% confidence interval 0.39-0.60).

CONCLUSIONS

HIV-infected patients are less likely to receive a diagnosis of OSA. Future studies are needed to determine whether the lower prevalence of OSA diagnoses in HIV-infected patients is attributable to decreased screening and detection or to a truly decreased likelihood of OSA in the setting of HIV infection.

Use of IgY antibody to recombinant avian reovirus σC protein in the virus diagnostics

Avian reovirus (ARV) is an important agent of several diseases causing considerable losses in poultry farming. An outer capsid protein (σC) of ARV, is known as a virus-cell attachment protein essential for virus infectivity. In this study, the σC gene of ARV was cloned and expressed in Escherichia coli. The expressed recombinant protein was used as immunogen for raising a specific IgY antibody in laying hens. At 14 weeks post immunization, the antibody titers in serum and egg yolk reached 302,000 and 355,000, respectively. The IgY antibody was capable to neutralize ARV in BHK-21 cells and it strongly reacted in ELISA with ARV but not with heterologous viruses. The IgY antibody detected ARV in field samples of infected animal tissues in dot blot assay. These results suggest that an efficient, economic and rapid diagnostics of ARV can be performed routinely using the IgY antibody against a recombinant ARV σC protein.

The effect of a Foley catheter balloon on cervical ripening

The Foley catheter balloon may affect cervical ripening through changes in biochemical mediators by immunoassay and immunohistochemistry, when it is used for pre-induction cervical ripening. The aim of the study was to evaluate the changes in the biochemical mediators from the extra-amniotic space and immunohistochemistry in ripened cervical tissue after the insertion of a Foley catheter balloon (FCB) for pre-induction cervical ripening. A total of 18 pregnant women with a Bishop's score < 6, who were undergoing labour induction, were evaluated in this prospective study. The FCB was irrigated with 10 ml of phosphate buffered saline and the irrigant was collected 0, 2, 4 and 8 h after placement of the FCB or until spontaneous expulsion of the FCB occurred. Irrigant specimens were also collected from 10 spontaneous labouring (SL) women in the active phase of labour. The levels of interleukin (IL)-6, IL-8, matrix metalloproteinase (MMP)-8 and NO were measured. Cervical specimens were obtained from 12 women, including four undergoing induction; four SL and four non-pregnant (NP) women. Immunohistochemical staining was performed to localise hyaluronic acid synthase (HAS)-1, IL-6, IL-8, MMP-8, endothelial nitric oxide synthase (eNOS) and inducible NOS (iNOS). Results showed that the levels of IL-6, IL-8, and MMP-8 significantly increased over time in FCB group (p < 0.01). In the immunohistochemical analysis of cervical tissues, immunoreactivity of HAS-1 in the after FCB group was stronger than any of the other groups. The protein expressions of IL-6, IL-8, MMP-8, eNOS and iNOS were more prominent in the after FCB and SL groups than in the NP and the before FCB groups. iNOS was only observed in the after FCB and SL groups. It was concluded that FCB may affect cervical ripening through changes in biochemical mediators by immunoassay and immunohistochemistry, when it is used for pre-induction cervical ripening.

Trends in gynecologic cancer mortality in East Asian regions

OBJECTIVE

To evaluate uterine and ovarian cancer mortality trends in East Asian countries.

METHODS

For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women ≥20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases.

RESULTS

Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has declined since 1993, at an annual percentage change (APC) of -4.8% (95% confidence interval [CI], -5.3 to -4.4). On the other hand, corrected uterine corpus cancer mortality has abruptly increased since 1995 (APC, 6.7; 95% CI, 5.4 to 8.0). Ovarian cancer mortality was stable, except in Korea, where mortality rates steadily increased at an APC of 6.2% (95% CI, 3.4 to 9.0) during 1995 to 2000, and subsequently stabilized.

CONCLUSION

Although uterine cancer mortality rates are declining in East Asia, additional effort is warranted to reduce the burden of gynecologic cancer in the future, through the implementation of early detection programs and the use of optimal therapeutic strategies.

Major clinical research advances in gynecologic cancer in 2013

In 2013, 10 topics were selected for major clinical research advances in gynecologic oncology; these included three topics regarding cervical cancer, three regarding ovarian cancer, two regarding endometrial cancer, and one each regarding breast cancer and radiation oncology. For cervical cancer, bevacizumab was first demonstrated to exhibit outstanding clinical efficacy in a recurrent, metastatic setting. Regarding cervical cancer screening, visual inspections with acetic acid in low-resource settings, p16/Ki-67 double staining, and the follow-up results of four randomized controlled trials of human papillomavirus-based screening methods were reviewed. Laparoscopic para-aortic lymphadenectomy before chemoradiation for locally advanced cervical cancer was the final topic for cervical cancer. Regarding front-line ovarian cancer therapies, dose-dense paclitaxel and carboplatin, intraperitoneal chemotherapy, and other targeted agents administered according to combination or maintenance schedules were discussed. Regarding recurrent ovarian cancer treatment, cediranib, olaparib, and farletuzumab were discussed for platinum-sensitive disease. The final overall survival data associated with a combination of bevacizumab and chemotherapy for platinum-resistant disease were briefly summarized. For endometrial cancer, the potential clinical efficacy of metformin, an antidiabetic drug, in obese patients was followed by integrated genomic analyses from the Cancer Genome Atlas Research Network. For breast cancer, three remarkable advances were reviewed: the long-term effects of continued adjuvant tamoxifen for 10 years, the effects of 2-year versus 1-year adjuvant trastuzumab for human epidermal growth factor receptor 2-positive disease, and the approval of pertuzumab in a neoadjuvant setting with a pathologic complete response as the surrogate endpoint. Finally, the recent large studies of intensity-modulated radiotherapy for gynecologic cancer were briefly summarized.

Pre- and intra-operative variables associated with surgical complications in elderly patients with gynecologic cancer: the clinical value of comprehensive geriatric assessment

OBJECTIVE

The aim of this study is to evaluate the associations of pre- and intra-operative variables including comprehensive geriatric assessment (CGA) with surgical complications in elderly patients who underwent primary surgery for gynecologic cancer.

METHODS

Sixty consecutive patients ≥70years of age who were scheduled to undergo elective surgery for the treatment of gynecologic cancer were preoperatively assessed by CGA. Every category of CGA, performance status (PS), and brief fatigue inventory (BFI) as well as surgical complexity were evaluated for 30-day surgical complications.

RESULTS

The overall postoperative complication rate was 30.0% (18/60) including 9 (15.0%) major and 8 (13.3%) multiple complications. Univariate analysis revealed that dependent instrumental activity of daily living (IADL) was associated with any (p=0.023) and multiple complications (p=0.019). Poor PS was associated with major (p=0.021) and multiple complications (p=0.014). Multivariate logistic regression analysis revealed that high surgical complexity was the most independent predictor of any, major, and multiple complications, whereas poor PS was the independent predictor only for multiple complications (odds ratio 10.7, 95% confidence interval 1.7 to 90.2, p=0.043). There was no CGA component which could independently predict postoperative complications.

CONCLUSION

Surgical complexity can predict any, major, and multiple postoperative complications, while PS seems to be useful in predicting multiple complications in elderly patients with gynecologic cancer. In this small study, a CGA was not useful in predicting postoperative complications.

Percentage of the population at high risk of osteoporotic fracture in South Korea: analysis of the 2010 Fifth Korean National Health and Nutrition Examination survey data

Osteoporosis and high-risk osteopenia (high-risk of osteoporotic fractures) are highly prevalent in South Korean postmenopausal women and men aged 50 years and over.

INTRODUCTION

This study determined the percentages of the population at high risk of osteoporotic fractures according to the World Health Organization (WHO) criteria and the Fracture Risk Assessment (FRAX) model.

METHODS

Data collected from the 2010 Fifth Korean National Health and Nutrition Examination Survey, a cross-sectional survey of the general South Korean general population, were analyzed. The percentages of the population with high-risk osteopenia according to the US National Osteoporosis Foundation (NOF) and Japanese treatment guidelines were subsequently determined and compared.

RESULTS

Based on the WHO criteria and FRAX model, 37.7% of the menopausal women and 12.7% of the men aged 50 years and older are at high risk of osteoporotic fracture. According to the Japanese and NOF guidelines, 10.9 (10.6% of men and 11.2% of women) and 10.7% (10.6% of men and 10.9% of women), respectively, of the study population with osteopenia are at high risk of fracture. By age group, 49.3% of Korean women aged 55 years and older, 67.7% of Korean women aged 65 years and older, and 33.5% of Korean men aged 75 years and older are at high risk.

CONCLUSION

As a very large percentage of the South Korean postmenopausal population has osteoporosis or high-risk osteopenia, greater effort at identifying and treating this population should be expended to prevent osteoporotic fracture.

Normal values for high-resolution anorectal manometry/topography in a healthy Korean population and the effects of gender and body mass index

BACKGROUND

High-resolution manometry (HRM) based on spatiotemporal plots is increasingly being used. The aim this study was to evaluate, for the first time, the influence of gender, with adjustment for age, body mass index (BMI), and vaginal delivery, on anorectal functions in asymptomatic adults.

METHODS

Fifty-four asymptomatic healthy subjects (M : F = 27 : 27; age = 20-67 years) who were matched by age and gender were enrolled prospectively. We evaluated anorectal pressures, rectal sensation using a HRM probe, and balloon expulsion time. Multivariate linear regression analysis was performed to identify the independent effects of each factor.

KEY RESULTS

Anal resting pressure (median [IQR]; 32 [18] vs 46 [17] mmHg, p < 0.001), anal squeeze pressure (75 [28] vs 178 [72] mmHg, p < 0.001), rectal pressure (33 [16] vs 53 [46] mmHg, p = 0.009) and anal pressure (16 [17] vs 30 [36] mmHg, p = 0.019) during simulated evacuation with rectal distention, and the threshold for the desire to defecate (60 [20] vs 80 [60] mL, p = 0.020) were significantly lower in women than in men. BMI was positively correlated with anal resting pressure (95% CI: 0.598-2.947) and negatively correlated with the threshold for first sensation (95% CI: -0.099 to -0.015). Vaginal delivery did not affect any of the anorectal HRM parameters.

CONCLUSIONS & INFERENCES

HRM parameters may be associated with gender and BMI. Therefore, gender and BMI should be taken into consideration when interpreting HRM results.

Transcriptional factor ATF6 is involved in odontoblastic differentiation

ATF6 is an endoplasmic reticulum (ER) membrane-bound transcription factor that regulates various cellular functions. The purpose of this study was to investigate the role of ATF6 in odontoblast differentiation. Rat tooth germs were isolated, changes in gene expression were evaluated over time, and localization of ATF6 was determined by immunohistochemistry. Human dental pulp cells (HDPCs) were cultured with 50 µg/mL ascorbic acid and 5 mmol/L β-glycerophosphate or 100 ng/mL bone morphogenetic protein 2 to induce differentiation. Translocation of ATF6 was observed by immunofluorescence and confocal microscopy. Overexpression of ATF6 was performed with an adenoviral vector. Matrix mineralization was evaluated by alizarin red staining. Immunoreactivity to anti-ATF6 was observed in the odontoblastic layer of the molar tooth germ, and expressions of ATF6, dentin sialophosphoprotein (DSPP) and dentin matrix protein 1 (DMP1) increased gradually during tooth germ development. When HDPCs were cultured in differentiation media, ATF6, DSPP, and DMP1 expression increased with the expression of unfolded protein response (UPR) markers, BiP and CHOP. Immunofluorescence results showed that ATF6 protein moved from cytoplasm to nucleus when cells were exposed to differentiation media. Notably, overexpression of ATF6 increased DSPP and DMP1 expression, alkaline phosphatase (ALP) activity, and matrix mineralization in HDPC cultures. Inhibition of ATF6 decreased ALP activity and mineralization. These results suggest that ER membrane-bound transcriptional factor ATF6 may be involved in odontoblastic differentiation.

Experimental observation of a theoretically predicted nonlinear sleep spindle harmonic in human EEG

OBJECTIVE

To investigate the properties of a sleep spindle harmonic oscillation previously predicted by a theoretical neural field model of the brain.

METHODS

Spindle oscillations were extracted from EEG data from nine subjects using an automated algorithm. The power and frequency of the spindle oscillation and the harmonic oscillation were compared across subjects. The bicoherence of the EEG was calculated to identify nonlinear coupling.

RESULTS

All subjects displayed a spindle harmonic at almost exactly twice the frequency of the spindle. The power of the harmonic scaled nonlinearly with that of the spindle peak, consistent with model predictions. Bicoherence was observed at the spindle frequency, confirming the nonlinear origin of the harmonic oscillation.

CONCLUSIONS

The properties of the sleep spindle harmonic were consistent with the theoretical modeling of the sleep spindle harmonic as a nonlinear phenomenon.

SIGNIFICANCE

Most models of sleep spindle generation are unable to produce a spindle harmonic oscillation, so the observation and theoretical explanation of the harmonic is a significant step in understanding the mechanisms of sleep spindle generation. Unlike seizures, sleep spindles produce nonlinear effects that can be observed in healthy controls, and unlike the alpha oscillation, there is no linearly generated harmonic that can obscure nonlinear effects. This makes the spindle harmonic a good candidate for future investigation of nonlinearity in the brain.

Oligodontia and curly hair occur with ectodysplasin-a mutations

Oligodontia is the developmental absence of more than 5 permanent teeth except for the third molar. Familial oligodontia can occur as an isolated form or as part of a genetic syndrome. Mutations in the MSX1, PAX9, AXIN2, EDA, and WNT10A genes have been identified in familial non-syndromic oligodontia. Ectodermal dysplasia is a group of syndromes involving abnormalities of the ectodermal structures and is comprised of more than 150 different forms. Mutations in the ectodysplasin-A (EDA) gene have been associated with X-linked hypohidrotic ectodermal dysplasia, and partial disruption of the EDA signaling pathway has been shown to cause an isolated form of oligodontia. We identified 2 X-linked oligodontia families and performed mutational analysis of the EDA gene. The mutational analysis revealed 2 novel EDA mutations: c.866G>T, p.Arg289Leu and c.1135T>G, p.Phe379Val (reference sequence NM_001399.4). These mutations were perfectly segregated with oligodontia and curly hair within each family and were not found in the 150 control X-chromosomes with the same ethnic background and in the exome variant server. This study broadens the mutational spectrum of the EDA gene and the understanding of X-linked oligodontia with curly hair.

Unusual maternal uniparental isodisomic x chromosome mosaicism with asymmetric y chromosomal rearrangement

Infertile men with azoospermia commonly have associated microdeletions in the azoospermia factor (AZF) region of the Y chromosome, sex chromosome mosaicism, or sex chromosome rearrangements. In this study, we describe an unusual 46,XX and 45,X mosaicism with a rare Y chromosome rearrangement in a phenotypically normal male patient. The patient's karyotype was 46,XX[50]/45,X[25]/46,X,der(Y)(pter→q11.222::p11.2→pter)[25]. The derivative Y chromosome had a deletion at Yq11.222 and was duplicated at Yp11.2. Two copies of the SRY gene were confirmed by fluorescence in situ hybridization analysis, and complete deletion of the AZFb and AZFc regions was shown by multiplex-PCR for microdeletion analysis. Both X chromosomes of the predominant mosaic cell line (46,XX) were isodisomic and derived from the maternal gamete, as determined by examination of short tandem repeat markers. We postulate that the derivative Y chromosome might have been generated during paternal meiosis or early embryogenesis. Also, we suggest that the very rare mosaicism of isodisomic X chromosomes might be formed during maternal meiosis II or during postzygotic division derived from the 46,X,der(Y)/ 45,X lineage because of the instability of the derivative Y chromosome. To our knowledge, this is the first confirmatory study to verify the origin of a sex chromosome mosaicism with a Y chromosome rearrangement.

Q-switched Nd:YAG optical vortex lasers

Q-switched operation of a high-quality Nd:YAG optical vortex laser with the first order Laguerre-Gaussian mode and well-determined helical wavefronts using a fiber-based pump beam conditioning scheme is reported. A simple two-mirror resonator incorporating an acousto-optic Q-switch was employed, along with an etalon and a Brewster plate to enforce the particular helicity of the output. The laser yielded Q-switched pulses with ~250 μJ pulse energy and ~33 ns pulse duration (FWHM) at a 0.1 kHz repetition rate for 5.1 W of absorbed pump power. The handedness of the helical wavefronts was preserved regardless of the repetition rates. The prospects of further power scaling and improved laser performance are discussed.

(18)F-FDG PET/CT surveillance at 3-6 and 12 months for detection of recurrence and second primary cancer in patients with head and neck squamous cell carcinoma

Background:

Early detection of recurrence of head and neck squamous cell carcinoma (HNSCC), which is often obscured by surgical or radiotherapy-induced tissue distortion, is essential for proper patient management.

Methods:

A total of 143 consecutive patients with previously untreated HNSCC were evaluated by whole-body fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and regular clinical follow-up after curative treatment. The ¹⁸F-FDG PET/CT was performed ∼3–6 and 12 months after treatment and findings suspicious for recurrence or SPC were confirmed using histopathology.

Results:

The sensitivities of 3–6- and 12-month PET/CT scans at patient level were 96% and 93%, respectively, and those of regular clinical follow-up were 11% and 19%, respectively (McNemar test, P<0.001). In patients with no clinical suspicion, PET/CT detected 95% and 91% of recurrent patients at 3–6 and 12 months, respectively. The sensitivity of PET/CT for the identification of SPC was 29% and 80% at 3–6 and 12 months, respectively. A positive interpretation of PET/CT was significantly associated with poor overall survival (log-rank test, P<0.001).

Conclusion:

The ¹⁸F-FDG PET/CT surveillance is beneficial for the detection of recurrence that may be missed by regular follow-up physical and endoscopic examinations of the head and neck area after curative treatment for HNSCC.

Improvements to the FIGO staging for ovarian cancer: reconsideration of lymphatic spread and intraoperative tumor rupture

Objective

To evaluate the improvement in prognosis prediction with reassignment of International Federation of Gynecology and Obstetrics (FIGO) stages for ovarian carcinoma.

Methods

This was a retrospective study of patients with epithelial ovarian, fallopian tube, and primary peritoneal cancers. Sub-staging criteria used in stage reassignment were defined as follows: surgical spillage (IC1), capsule rupture before surgery or tumor on the surface (IC2), and positive cytology results (IC3); microscopic (IIB1) and macroscopic (IIB2) pelvic spread; microscopic extrapelvic spread (IIIA1) and retroperitoneal lymph node (LN) metastasis without extrapelvic spread (IIIA2); and supraclavicular LN metastasis (IVA) and other distant metastasis (IVB). Survival outcomes associated with the current and reassigned stages were compared.

Results

Overall, 870 patients were eligible for analysis. The median follow-up period was 45 months (range, 0 to 263 months). The 5-year overall survival rates (5YSRs) according to the current staging were 93.5% (IA), 82.5% (IC), 75.0% (IIB), 74.5% (IIC), 57.5% (IIIA), 54.0% (IIIB), 38.5% (IIIC), and 33.0% (IV). The 5YSRs of patients with IC1, IC2, and IC3 after sub-staging were 92.0%, 85.0%, and 71.0%, respectively (p=0.004). Patients who were reassigned to stage IIIA2 had a better 5YSR than those with extrapelvic tumors >2 cm (66.3% vs. 35.8%; p=0.005). Additionally, patients with newly assigned stage IVA disease had a significantly better 5YSR than those with stage IVB disease (52.0% vs. 28.0%; p=0.015).

Conclusion

The modified FIGO staging for ovarian carcinoma appears superior to the current staging for discriminating survival outcomes of patients with surgical spillage, retroperitoneal LN metastasis without extrapelvic peritoneal involvement, or distant metastasis to supraclavicular LNs.

Incidence of cervical, endometrial, and ovarian cancer in Korea, 1999-2010

Objective

To investigate the recent incidence of and trends in cervical, endometrial, and ovarian cancer in Korean females.

Methods

Data from the Korea Central Cancer Registry between 1999 and 2010 were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) were calculated.

Results

The absolute incidence rates of the three major gynecologic cancers increased: 6,394 in 1999 to 7,454 in 2010. The ASR for gynecologic cancer was 23.7 per 100,000 in 1999 and decreased to 21.0 in 2010 (APC, -1.1%; 95% confidence interval [CI], -1.53 to -0.70) due to a definitive decrease in the incidence of cervical cancer (APC, -4.3%). Endometrial cancer has been definitively increasing (APC, 6.9% during 1999-2010), especially in females <30 years old (APC, 11.2%) and in females ≥80 years old (APC, 9.5%). The incidence of ovarian cancer is increasing gradually (APC, 1.5%).

Conclusion

ASRs and APC for gynecologic cancers overall are decreasing due to the decrease in the incidence of cervical cancer. However, the incidence of endometrial and ovarian cancer has been increasing.

The association between bone mineral density and periodontitis in Korean adults (KNHANES 2008-2010)

OBJECTIVES

This study investigated the association between bone mineral density (BMD) and periodontitis in a representative sample of Korean adults.

MATERIAL AND METHODS

Of 36 188 individuals who participated in the Korea National Health and Nutrition Examination Survey in 2008, 2009, and 2010, 9977 participants aged ≥40 years were included in this cross-sectional study. The associations of BMD of lumbar spine, total femur, and femoral neck with periodontitis were investigated using logistic regression analysis. Additionally, dose-response relationships with BMD divided into quintiles and the association between osteoporosis and periodontitis were investigated.

RESULTS

With the set of Community Periodontal Index (CPI) ≥ 3 as a dependent variable, logistic regression analysis revealed that a decrease of BMD was significantly associated with higher odds of periodontitis [range of adjusted odds ratios (AORs); 1.15-1.20, P < 0.001 for all BMD sites]. Similarly, these associations were also found in the CPI 4 model. With regard to dose-response relations, the lower the BMD quintile, the higher the AORs appeared with statistical significance in the CPI ≥ 3 model. (P for trend < 0.001) Participants with osteoporosis had 2.26 and 1.91 times higher odds for CPI ≥ 3 and CPI 4, respectively, than those with normal BMD, indicating a significant association between the two diseases.

CONCLUSIONS

Our results suggest that BMD is significantly associated with periodontitis.

Clinical significance of tumor volume in endometrial cancer: a Japan-Korea cooperative study

OBJECTIVE

The aim of this study was to elucidate the significance of tumor volume as a risk factor for predicting lymph node metastasis.

METHODS

We applied the tumor volume index to the data that were collected for 327 Korean patients with endometrial cancer who underwent preoperative assessment including magnetic resonance imaging (MRI) and subsequent surgery including systematic lymphadenectomy. The volume index, which we previously reported in the literature, was defined as the product of maximum longitudinal diameter along the uterine axis, maximum anteroposterior diameter in a sagittal section image, and maximum horizontal diameter in a horizontal section image according to MRI data, from 425 Japanese women with endometrial cancer. Relationships between lymph node metastasis and results of preoperative examinations including volume index were analyzed by logistic regression analysis.

RESULTS

The prevalence of affected lymph nodes was 14.2%. Multivariate analysis showed that high-grade histology assessed by endometrial biopsy [odds ratio (OR); 2.9, 95% confidence interval (CI): 1.4-6.4], volume index (OR; 2.4, 95% CI: 1.1-5.3), node enlargement assessed by MRI (OR; 4.2, 95% CI: 1.4-13.2), and high serum cancer antigen (CA)125 level (OR; 3.6, 95% CI: 1.6-8.1) were significantly and independently related to lymph node metastasis. When volume index was excluded from the analysis, myoinvasion assessed by MRI was an independent risk factor for lymph node metastasis as well as high-grade histology, node enlargement, and high serum CA125 level.

CONCLUSION

Volume index is compatible with myometrial invasion as a factor for predicting lymph node metastasis in endometrial cancer.

RAF kinase inhibitor-independent constitutive activation of Yes-associated protein 1 promotes tumor progression in thyroid cancer

The transcription coactivator Yes-associated protein 1 (YAP1) is regulated by the Hippo tumor suppressor pathway. However, the role of YAP1 in thyroid cancer, which is frequently associated with the BRAF^V600E mutation, remains unknown. This study aimed to investigate the role of YAP1 in thyroid cancer. YAP1 was overexpressed in papillary (PTC) and anaplastic thyroid cancer, and nuclear YAP1 was more frequently detected in BRAF^V600E (+) PTC. In the thyroid cancer cell lines TPC-1 and HTH7, which do not have the BRAF^V600E mutation, YAP1 was cytosolic and inactive at high cell densities. In contrast, YAP1 was retained in the nucleus and its target genes were expressed in the thyroid cancer cells 8505C and K1, which harbor the BRAF^V600E mutation, regardless of cell density. Furthermore, the nuclear activation of YAP1 in 8505C was not inhibited by RAF or MEK inhibitor. In vitro experiments, YAP1 silencing or overexpression affected migratory capacities of 8505C and TPC-1 cells. YAP1 knockdown resulted in marked decrease of tumor volume, invasion and distant metastasis in orthotopic tumor xenograft mouse models using the 8505C thyroid cancer cell line. Taken together, YAP1 is involved in the tumor progression of thyroid cancer and YAP1-mediated effects might not be affected by the currently used RAF kinase inhibitors.

Cost-utility analysis for platinum-sensitive recurrent ovarian cancer therapy in South Korea: results of the polyethylene glycolated liposomal doxorubicin/carboplatin sequencing model

Objective

We performed a cost–utility analysis to assess the cost-effectiveness of a chemotherapy sequence including a combination of polyethylene glycolated liposomal doxorubicin (PLD)/carboplatin versus paclitaxel/carboplatin as a second-line treatment in women with platinum-sensitive ovarian cancer.

Methods

A Markov model was constructed with a 10-year time horizon. The treatment sequence consisted of first- to sixth-line chemotherapies and best supportive care (BSC) before death. Cycle length, a time interval for efficacy evaluation of chemotherapy, was 9 weeks. The model consisted of four health states: responsive, progressive, clinical remission, and death. At any given time, a patient may have remained on a current therapy or made a transition to the next therapy or death. Median time to progressions and overall survivals data were obtained through a systematic literature review and were pooled using a meta-analytical approach. If unavailable, this was elicited from an expert panel (eg, BSC). These outcomes were converted to transition probabilities using an appropriate formula. Direct costs included drug-acquisition costs for chemotherapies, premedication, adverse-event treatment and monitoring, efficacy evaluation, BSC, drug administration, and follow-up tests during remission. Indirect costs were transportation expenses. Utilities were also derived from the literature. Costs and utilities were discounted at an annual rate of 5% per cycle.

Results

PLD/carboplatin combination as the second line in the sequence is more effective and costly than paclitaxel/carboplatin combination, showing an additional US$21,658 per quality-adjusted life years. This result was robust in a deterministic sensitivity analysis except when median time to progression of second-line therapies and administration cost of PLD/carboplatin per administration cycle were varied. The probability of cost-effectiveness for PLD/carboplatin combination was 49.4% at a willingness to pay $20,000.

Conclusion

A PLD/carboplatin combination is an economically valuable option as second-line chemotherapy for the treatment of platinum-sensitive ovarian cancer in South Korea.

Association of a single nucleotide polymorphism in the akirin 2 gene with economically important traits in Korean native cattle

The akirin 2 gene, located on chromosome 9 in cattle, was previously reported to be associated with nuclear factor-kappa B (NF-κB), involved in immune reactions and marbling of meat. To determine whether a single nucleotide polymorphism (SNP) in akirin 2 is associated with economically important traits of Korean native cattle, the c.*188G>A SNP DNA marker in the 3'-UTR region of akirin 2 was analyzed for its association with carcass weight, longissimus muscle area and marbling. The c.*188G>A SNP was genotyped by polymerase chain reaction restriction fragment length polymorphism, and the frequency of the AA, AG, and GG genotypes were 6.82%, 71.29% and 21.88% respectively. This SNP was significantly associated with longissimus muscle area (Bonferroni corrected P < 0.05), and marbling score (Bonferroni corrected P < 0.01). These results suggest that the c.*188G>A SNP of akirin 2 might be useful as a DNA marker for longissimus muscle area and marbling scores in Korean native cattle.

Clinical characteristics of patients with tuberculosis-destroyed lung

SETTING

Multicentre study.

OBJECTIVE

To define the clinical characteristics of patients with tuberculosis (TB) destroyed lung due to past TB.

DESIGN

We reviewed patients with TB-destroyed lung between May 2005 and June 2011.

RESULTS

A total of 595 patients from 21 hospitals were enrolled. The mean age was 65.63 ± 0.47 (mean ± standard error); 60.5% were male. The mean number of lobes involved was 2.59 ± 0.05. Pleural thickening was observed in 54.1% of the patients. Mean forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)), FEV(1)/FVC, bronchodilator response and number of exacerbations per year were respectively 2.06 ± 0.03 l (61.26% ± 0.79), 1.16 ± 0.02 l (49.05% ± 0.84), 58.03% ± 0.70, 5.70% ± 0.34, and 0.40 ± 0.04. The number of lobes involved was significantly correlated with FVC and FEV(1), and with the number of exacerbations per year. Use of long-acting muscarinic antagonists or long-acting beta-2 agonists plus inhaled corticosteroids resulted in bronchodilatory effects. Multivariable regression analysis showed that age, initial FEV(1) (%) and number of exacerbations during follow-up were independent factors affecting change in FEV(1).

CONCLUSION

Decreased lung function with exacerbation, and progressive decline of FEV(1) were observed in patients with TB-destroyed lung.

The effect of lipopolysaccharide on enhanced inflammatory process with age: Modulation of NF-κB

Oxidative stress is thought to be a causative factor for age-related damage in a wide variety of cellular constituents that can lead to dysfunction and various pathological conditions, including the inflammatory process. At the molecular level, the redox-sensitive transcription factor, NF-κB plays a key role in the regulation of the inflammatory process, along with cytokines, cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase (iNOS). We studied the mechanism underlying the modulation of the inflammatory reaction with age by investigating NF-κB activation and the expression of COX-2, iNOS, and cytokines genes in hepatic tissues isolated from young and old rats. We expanded our investigation of these factors in rats injected with the inflammatory activator, lipopolysaccharide (LPS). Data showed that NF-κB activity was up-regulated with age and was further enhanced by LPS injection, indicating an increased susceptibility and sensitivity to the inflammatory stimulus with age. To explore further the molecular events leading to NF-κB activation, we investigated the inhibitory component of NF-κB complex, IκB. Cytosolic IκBα, but not IκBβ, was significantly decreased in both old and LPS-treated rats, signifying the enhanced migration of cytosolic NF-κB complex into the nucleus following dissociation from the inhibitor. The appearance of the polypeptide, p65, as determined in the nucleus, corresponded with the change in IκBα, providing further supporting evidence for the molecular process involved in NF-κB activation. Our additional investigation of two proinflammatory-related enzymes, COX-2 and iNOS, and three cytokines, interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α, clearly showed aged-related increases, in corroboration with the NF-κB activation. Our results demonstrated that LPS injection caused the enhanced gene expression of inducible proinflammatory proteins, COX-2 and iNOS through NF-κB activation.

Practice guidelines for the early detection of cervical cancer in Korea: Korean Society of Gynecologic Oncology and the Korean Society for Cytopathology 2012 edition

The consensus guideline development committee of Korean Society of Gynecologic Oncology was reconvened in March 2012. The committee consisted of 36 experts representing 12 university hospitals and professional organizations. The objective of this committee was to develop standardized guidelines for cervical cancer screening tests for Korean women and to distribute these guidelines to every clinician, eventually improving the quality of medical care. Since the establishment of the consensus guideline development committee, evidence-based guidelines have either been developed de novo considering specific Korean situations or by adaptation of preexisting consensus guidelines from other countries. Recommendations for cervical cancer screening tests, management of atypical squamous and glandular cells, and management of low-grade and high-grade squamous intraepithelial lesions were developed. Additionally, recommendations for human papillomavirus DNA testing and recommendations for adolescent and pregnant women with abnormal cervical screening test results were also included.

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.

Firing patterns in a conductance-based neuron model: bifurcation, phase diagram, and chaos

Responding to various stimuli, some neurons either remain resting or can fire several distinct patterns of action potentials, such as spiking, bursting, subthreshold oscillations, and chaotic firing. In particular, Wilson's conductance-based neocortical neuron model, derived from the Hodgkin-Huxley model, is explored to understand underlying mechanisms of the firing patterns. Phase diagrams describing boundaries between the domains of different firing patterns are obtained via extensive numerical computations. The boundaries are further studied by standard instability analyses, which demonstrates that the chaotic neural firing could develop via period-doubling and/or period- adding cascades. Sequences of the firing patterns often observed in many neural experiments are also discussed in the phase diagram framework developed. Our results lay the groundwork for wider use of the model, especially for incorporating it into neural field modeling of the brain.

Graphene mode-locked femtosecond Cr:ZnSe laser at 2500 nm

We report, for the first time to our knowledge, femtosecond pulse generation from a graphene mode-locked Cr:ZnSe laser at 2500 nm. To minimize the insertion losses at the lasing wavelength, high-quality monolayer graphene transferred on a CaF(2) substrate was used in the experiments. Once mode-locking was initiated, the laser generated a stable train of 226 fs pulses with a time-bandwidth product of 0.39. The mode-locked laser operated at a pulse repetition rate of 77 MHz and produced 80 mW output power with an incident pump power of 1.6 W. To our knowledge, this is the longest laser wavelength at which graphene-based passive mode-locking has been demonstrated to date.

Association between urine cotinine levels, continuous performance test variables, and attention deficit hyperactivity disorder and learning disability symptoms in school-aged children

BACKGROUND

We examined the cross-sectional relationship between environmental tobacco smoke exposure, continuous performance test (CPT) measures, and attention deficit hyperactivity disorder (ADHD) or learning disability symptoms in school-aged children.

METHOD

In total, 989 children (526 boys, mean age 9.1 ± 0.7 years), recruited from five South Korean cities participated in this study. We used urine cotinine as a biomarker for environmental tobacco smoke exposure, and obtained the children's scores on a CPT. Parents completed the Korean versions of the ADHD rating scale-IV (ADHD-RS) and learning disability evaluation scale (LDES). Using generalized linear mixed model (GLMM), we assessed the associations between urine cotinine concentrations, neuropsychological variables, and symptoms of ADHD and learning disabilities. Additionally, we conducted structural equation models to explore the effects' pathways.

RESULTS

After adjusting for a range of relevant covariates, GLMM showed urinary cotinine levels were significantly and positively associated with CPT scores on omission errors, commission errors, response time, and response time variability, and with parent- and teacher-rated ADHD-RS scores. In addition, urine cotinine levels were negatively associated with LDES scores on spelling and mathematical calculations. The structural equation model revealed that CPT variables mediated the association between urine cotinine levels and parental reports of symptoms of ADHD and learning disabilities.

CONCLUSIONS

Our data indicate that environmental exposure to tobacco smoke is associated with ADHD and learning disabilities in children, and that impairments in attention and inhibitory control probably mediate the effect.

Major clinical research advances in gynecologic cancer in 2012

Ten topics were chosen among major clinical research achievements in gynecologic oncology in 2012. For ovarian cancer, comprehensive review of the history of bevacizumab studies was followed by poly adenosine diphosphate [ADP]-ribose polymerase (PARP) inhibitors and other molecular targeted agents such as epidermal growth factor receptor tyrosine kinase inhibitor and AMG 386. For the development of genomic study in gynecologic cancers, BRCA and DICER1 mutations were covered in epithelial and nonepithelial ovarian cancer, respectively. For endometrial cancer, targeted agents including mammalian target of rapamycin (mTOR) inhibitors and bevacizumab were discussed. Radiation therapy "sandwiched" between combination chemotherapy schedules for the treatment of uterine papillary serous carcinoma was also reviewed. Preoperative prediction of lymph node metastasis, definition of low-risk group, and recurrence and survival outcomes of laparoscopic approaches were addressed. For cervical cancer, we reviewed long-term benefit of human papillomavirus test and efficacy of paclitaxel/carboplatin versus paclitaxel/cisplatin in stage IVB, persistent or recurrent disease. In addition, the effect of three dimensional image-based high-dose rate brachytherapy was also reviewed. For vulvar cancer, the diagnostic value of sentinel lymph node biopsy was discussed. For breast cancer, positive results of three outstanding phase III randomized clinical trials, CLEOPATRA, EMILIA, and BOLERO-2 were introduced. Lastly, updates of major practice guidelines were summarized.

Abstract P5-16-06: A phase 2 randomized trial of docetaxel (DOC) alone or in combination with therapeutic cancer vaccine, CEA-, MUC-1-TRICOM (PANVAC)

Background: A previous phase 1/2 trial of PANVAC, a poxviral based cancer vaccine, suggested clinical efficacy in some patients (pts) with breast and ovarian cancer and evidence of immunologic activity. Preclinical data showed DOC can modify tumor phenotype, making tumor cells more amenable to T-cell mediated killing. The goal was to determine if DOC and PANVAC could synergize and improve clinical outcomes compared with DOC alone.

Methods: This is an open-label randomized phase 2 multi-center trial designed to enroll 48 pts with metastatic breast cancer to receive DOC in combination with PANVAC (A) or alone (B). Cross-over was allowed so that pts randomized to B could receive the vaccine upon progression. Eligibility included ECOG performance status &lt;1 and normal organ and immune function with no limits on previous lines of therapy, but pts may not have received DOC for metastatic disease. Her2+ pts on trastuzumab were allowed to continue trastuzumab on trial. All pts received DOC 35mg/m2 weekly × 3 doses during 28-day cycles. Pts on A were “primed” with recombinant vaccinia-PANVAC study day 1. Three weeks later, they began 28-day cycles of DOC with “boost” recombinant fowlpox-PANVAC given on day 1, given until progression. CT and bone scans were performed after 3 cycles and then every 2 cycles. 1° endpoint was PFS., with a phase 2.5 statistical design, with the intent of identifying a trend toward benefit to guide a larger trial design. A p value of 0.10 is considered a strong trend. 2° endpoints included overall survival and immunologic correlative studies. Immunologic assays included analysis of T cell and NK cell activation, presence and activity of regulatory T cells, and ELISPOT assays. Immune correlative analysis was done using multiparametric flow cytometry analysis of immune cell subpopulations from peripheral blood mononuclear cells (PBMCs) of pts and comparing those findings using Boolean logic with the immune assays and clinical outcomes.

Results: Enrollment of 48 pts completed in February 2012 (A, n=25; B, n=23). Five pts remain on treatment (2 on A, 3 on B). Pt and tumor characteristics were well matched. Analysis through August 2, 2012 (median follow-up of 5.1 months for pts on study), indicates PFS is 6.6 vs. 3.8 months in A vs. B (p = 0.12, HR=0.67, 95% CI: 0.34 to 1.31). Analysis of the adverse events on both arms demonstrated very little difference between the two groups. The only statistically significant differences were increases in the frequency of grade 1 and 2 edema (p = 0.018) and injection site reactions (p &lt;0.0001) in the combination arm. Immune analysis and correlation to pt clinical outcomes are ongoing and will be available for presentation at the time of the meeting. There are not yet enough events to perform a comparison of overall survival in the two groups.

Conclusion: This randomized study suggests the combination of PANVAC with DOC in metastatic breast cancer may provide a clinical benefit compared to DOC alone. The clear separation of the curves indicates potential benefit, which is not statistically significant, likely due to the small number of pts enrolled. This study was hypothesis generating and may provide both rationale and statistical assumptions for a larger definitive randomized study.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-16-06.

Interfacial ferromagnetism and exchange bias in CaRuO3/CaMnO3 superlattices

We have found ferromagnetism in epitaxially grown superlattices of CaRuO(3)/CaMnO(3) that arises in one unit cell at the interface. Scanning transmission electron microscopy and electron energy loss spectroscopy indicate that the difference in magnitude of the Mn valence states between the center of the CaMnO(3) layer and the interface region is consistent with double exchange interaction among the Mn ions at the interface. Polarized neutron reflectivity and the CaMnO(3) thickness dependence of the exchange bias field together indicate that the interfacial ferromagnetism is only limited to one unit cell of CaMnO(3) at each interface. The interfacial moment alternates between the 1 μ(B)/interface Mn ion for even CaMnO(3) layers and the 0.5 μ(B)/interface Mn ion for odd CaMnO(3) layers. This modulation, combined with the exchange bias, suggests the presence of a modulating interlayer coupling between neighboring ferromagnetic interfaces via the antiferromagnetic CaMnO(3) layers.

Dimensionality driven spin-flop transition in layered iridates

Using resonant x-ray diffraction, we observe an easy c-axis collinear antiferromagnetic structure for the bilayer Sr3Ir2O7, a significant contrast to the single layer Sr2IrO4 with in-plane canted moments. Based on a microscopic model Hamiltonian, we show that the observed spin-flop transition as a function of number of IrO2 layers is due to strong competition among intra- and interlayer bond-directional pseudodipolar interactions of the spin-orbit entangled J(eff)=1/2 moments. With this we unravel the origin of anisotropic exchange interactions in a Mott insulator in the strong spin-orbit coupling regime, which holds the key to the various types of unconventional magnetism proposed in 5d transition metal oxides.

Effects of Polycan, a β-glucan, on experimental periodontitis and alveolar bone loss in Sprague-Dawley rats

BACKGROUND AND OBJECTIVE

Polycan is a promising candidate for the treatment of periodontal disease. This study was undertaken to examine whether Polycan, a type of β-glucan, has a protective effect on ligature-induced experimental periodontitis and related alveolar bone loss in Sprague-Dawley rats.

MATERIAL AND METHODS

 Polycan was orally administered, daily, for 10 d, at 21.25, 42.5 or 85 mg/kg, beginning 1 d after ligation. Changes in body weight and alveolar bone loss were monitored, and the anti-inflammatory effects of Polycan were determined by measuring the levels of myeloperoxidase (MPO), interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) in gingival tissue. We also evaluated inducible nitric oxide synthase (iNOS) activity and malondialdehyde (MDA) concentrations as a measure of the antioxidant effect.

RESULTS

Ligature placement led to a marked decrease in body weight, increased alveolar bone loss and increased concentrations of MPO, IL-1β, TNF-α and MDA, as well as increased iNOS activity and inflammatory cell infiltration and decreased collagen-fiber content. Histological examination revealed increases in the number and activity of osteoclast cells, decreases in alveolar bone volume and elevated percentages of osteclasts on the alveolar bone surface. Daily oral treatment with 42.5 or 85 mg/kg of Polycan for 10 d led to significant, dose-dependent inhibition of the effect of ligature placement.

CONCLUSION

Taken together, these results suggest that 10 d of oral treatment with Polycan effectively inhibits ligature placement-induced periodontitis and related alveolar bone loss via an antioxidant effect.

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.

High-power Er:YAG laser with quasi-top-hat output beam

A simple method for simultaneously exciting the fundamental (TEM00) transverse mode and first order Laguerre-Gaussian (LG01) donut mode in an end-pumped solid-state laser to yield a quasi-top-hat output beam is reported. This approach has been applied to an Er:YAG laser, in-band pumped by an Er,Yb fiber laser, yielding 9.6 W of continuous-wave output at 1645 nm in a top-hat-like beam with beam propagation factor (M2)<2.1 for 24 W of incident pump power at 1532 nm. The corresponding slope efficiency with respect to incident pump power was 49%. The prospects of further scaling of output power and improved overall efficiency are considered.

Frequencies of 10 autosomal minor histocompatibility antigens in Korean population and estimated disparities in unrelated hematopoietic stem cell transplantation

Disparity of minor histocompatibility antigens (mHAs) is known to induce graft-versus-tumor and graft-versus-host disease reactions in stem cell transplantation. Not much information is available on genotypic and phenotypic distributions of the currently identified mHAs, especially in Korean population. Therefore, we report genotype and phenotype frequency analyses of 10 autosomal mHAs in 329 unrelated healthy Koreans using the Sequenom MassARRAY matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) system and polymerase chain reaction-sequence specific primers (PCR-SSP). Estimates of the probability of immunogenic mismatches between donor/recipient pairs were made from observed phenotypic frequencies. HA-1 was the most favorable mHA for clinical application with the highest disparity of 7.0%. Similar results were obtained in ACC-1. The Korean population can benefit the most in a setting of matched major histocompatibility complex (MHC)-restricted mHAs-mismatched unrelated hematopoietic stem cell transplantations with the disparity rate of 27.5% with eight hematopoietic mHAs. This is the first comprehensive report on the genotypic and phenotypic frequency distributions of human mHAs in the Korean population. It can contribute to not only donor selection before transplantation but also therapeutic approaches after transplantation. It is expected that mHA-based immunotherapy will lead to a new treatment modality tailored for patients at high risk of relapse following allogeneic hematopoietic cell transplantation.

Factors Affecting the Clearance of High-Risk Human Papillomavirus Infection and the Progression of Cervical Intraepithelial Neoplasia

OBJECTIVE: This study aimed to identify factors that predict clearance of high-risk human papillomavirus (HPV) infection and progression to cervical intraepithelial neoplasia (CIN) 2 or higher, in women with normal cervical histology or CIN 1. METHODS: A retrospective analysis was performed on 817 high-risk HPV-infected women with histologically verified CIN 1 or normal cervical histology. Patients were followed-up for a maximum of 24 months. Cervical HPV DNA tests were performed at every visit. RESULTS: At the end of follow-up, 648/817 (79.3%) patients were free from HPV infection and 66/817 patients (8.1%) progressed to CIN 2 or higher. Age, parity, cytology and viral load at diagnosis were significantly and inversely associated with HPV clearance. Cytology, viral load and presence of CIN 1 lesions were significantly associated with lesion progression. CONCLUSIONS: Cytology and high-risk HPV viral load may be useful markers for the likelihood of high-risk HPV clearance and lesion progression. Histological status, parity and marital status may also be useful factors to consider when predicting progression.

Genome-wide association analysis for quantitative trait loci influencing Warner-Bratzler shear force in five taurine cattle breeds

We performed a genome-wide association study for Warner–Bratzler shear force (WBSF), a measure of meat tenderness, by genotyping 3360 animals from five breeds with 54 790 BovineSNP50 and 96 putative single-nucleotide polymorphisms (SNPs) within μ-calpain [HUGO nomenclature calpain 1, (mu/I) large subunit; CAPN1] and calpastatin (CAST). Within- and across-breed analyses estimated SNP allele substitution effects (ASEs) by genomic best linear unbiased prediction (GBLUP) and variance components by restricted maximum likelihood under an animal model incorporating a genomic relationship matrix. GBLUP estimates of ASEs from the across-breed analysis were moderately correlated (0.31–0.66) with those from the individual within-breed analyses, indicating that prediction equations for molecular estimates of breeding value developed from across-breed analyses should be effective for genomic selection within breeds. We identified 79 genomic regions associated with WBSF in at least three breeds, but only eight were detected in all five breeds, suggesting that the within-breed analyses were underpowered, that different quantitative trait loci (QTL) underlie variation between breeds or that the BovineSNP50 SNP density is insufficient to detect common QTL among breeds. In the across-breed analysis, CAPN1 was followed by CAST as the most strongly associated WBSF QTL genome-wide, and associations with both were detected in all five breeds. We show that none of the four commercialized CAST and CAPN1SNP diagnostics are causal for associations with WBSF, and we putatively fine-map the CAPN1 causal mutation to a 4581-bp region. We estimate that variation in CAST and CAPN1 explains 1.02 and 1.85% of the phenotypic variation in WBSF respectively.

Spike, rate, field, and hybrid methods for treating neuronal dynamics and interactions

Spike-, rate-, and field-based approaches to neural dynamics are adapted and hybridized to provide new methods of analyzing dynamics of single neurons and large neuronal systems, to elucidate the relationships and intermediate forms between these limiting cases, and to enable faster simulations with reduced memory requirements. At the single-neuron level, the new approaches involve reformulation of dynamics in synapses, dendrites, cell bodies, and axons to enable new types of analysis, longer numerical timesteps, and demonstration that rate-based methods can predict spike times. In multineuron systems, hybrids and intermediates between spike-based and field-based coupling between neurons are used to provide stepping stones between descriptions based on pairwise spike-based interactions between neurons and ones based on neural field-based interactions within and between populations, including arbitrary spatial structure and temporal delays in the connections in general. In particular, a new neuron-in-cell approach is introduced that is a hybrid between neural field theory and spiking-neuron models in analogy to particle-in-cell methods in plasma physics. This approach enables large speedups in computations while preserving spike shapes and times. Various approaches are illustrated numerically for specific cases.

CT appearance of primary peritoneal serous borderline tumour: a rare epithelial tumour of the peritoneum

Primary peritoneal serous borderline tumour (PPSBT) is a rare epithelial neoplasm which is histologically identical to serous borderline tumour of the ovary. PPSBT is distinguishable from primary peritoneal serous carcinoma because the tumour cells do not invade the underlying tissue and affected patients have a good prognosis. We report the CT findings of surgically proven PPSBT in which multiple peritoneal cysts were seen. Although rare, PPSBT should be considered in the differential diagnosis of primary peritoneal tumours. Since the prognosis of the disease is good, conservation of the uterus and ovaries should be a consideration in young female patients during surgery.

Intravitreal bevacizumab and ranibizumab injections for patients with polypoidal choroidal vasculopathy

PURPOSE

To compare the effectiveness of intravitreal injection of bevacizumab and ranibizumab in patients with treatment-naïve polypoidal choroidal vasculopathy (PCV).

METHODS

A total of 66 and 60 eyes of 121 consecutive patients who received intravitreal bevacizumab (1.25 mg) or ranibizumab (0.5 mg) injection for treatment of PCV were retrospectively reviewed. After initial three loading injections by month, injection was performed as needed. Main outcome measures included best corrected visual acuity (BCVA), foveal center thickness (FCT) as assessed by spectral domain optical coherence tomography (SD-OCT), and change in polypoidal lesion on indocyanine green angiography (ICGA).

RESULTS

At 12 months, average number of injections was 4.72±1.84 in the bevacizumab group and 5.52±1.54 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline at 12 months after injection improved by 0.11 in the bevacizumab group (P=0.02) and by 0.14 in the ranibizumab group (P=0.01). Average FCT decreased from 368±62.48 to 298±40.77 μm in the bevacizumab group (P=0.01) and from 371±50.79 to 286±36.93 μm in the ranibizumab group (P=0.01). Polyp regression rate was 24.2% (16 eyes out of 66 eyes) in the bevacizumab group and 23.3% (14 eyes out of 60 eyes) in the ranibizumab group. There was no statistically significant difference in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups.

CONCLUSION

Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilization of visual acuity, macular edema, and regression of polypoidal complex with PCV eyes.

Unusual manifestation of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis of the uterus: emphasis on MRI and positron emission tomography CT findings

There are several reports of adenocarcinoma developing within adenomyosis of the uterus, but imaging features of MRI, including diffusion-weighted imaging (DWI) and positron emission tomography (PET)-CT, have not been published. Herein we report a rare case of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis to emphasise the unusual growth features, as well as the imaging findings of the tumour on MRI and PET-CT.

Silencing of the GnRH type 1 receptor blocks the antiproliferative effect of the GnRH agonist, leuprolide, on the androgen-independent prostate cancer cell line DU145

This study investigated the mechanism of action of a gonadotropin-releasing hormone (GnRH) agonist, leuprolide, on proliferation of the hormone-refractory prostate cancer cell line DU145, transfected with short hairpin RNA (shRNA), to reduce expression of the GNRHR1 gene (which encodes the GnRH type 1 receptor). DU145 cell proliferation in the presence of leuprolide (10(-9) and 10(-7) M) or control medium was measured before and after GnRHR1 knockdown. Reverse transcription-polymerase chain reaction and Western blot analysis were used to measure the degree of GNRHR1 silencing. DU145 cells treated with leuprolide (10(-9) and 10(-7) M) showed significant growth inhibition compared with control-treated DU145 cells. Transfection with GNRHR1 -shRNA significantly decreased GNRHR1 expression at 48 h. DU145 cells transfected with silencing GNRHR1 -shRNA showed normal growth patterns; however, there was no significant inhibition of proliferation of DU145 cells transfected with GNRHR1 -shRNA compared with cells transfected with control-shRNA in response to leuprolide. These data demonstrated that the antiproliferative effect of leuprolide was mediated by the GnRHR1.

Gene expression signatures associated with the in vitro resistance to two tyrosine kinase inhibitors, nilotinib and imatinib

The use of selective inhibitors targeting Bcr-Abl kinase is now established as a standard protocol in the treatment of chronic myelogenous leukemia; however, the acquisition of drug resistance is a major obstacle limiting the treatment efficacy. To elucidate the molecular mechanism of drug resistance, we established K562 cell line models resistant to nilotinib and imatinib. Microarray-based transcriptome profiling of resistant cells revealed that nilotinib- and imatinib-resistant cells showed the upregulation of kinase-encoding genes (AURKC, FYN, SYK, BTK and YES1). Among them, the upregulation of AURKC and FYN was observed both in nilotinib- and imatinib-resistant cells irrespective of exposure doses, while SYK, BTK and YES1 showed dose-dependent upregulation of expression. Upregulation of EGF and JAG1 oncogenes as well as genes encoding ATP-dependent drug efflux pump proteins such as ABCB1 was also observed in the resistant cells, which may confer alternative survival benefits. Functional gene set analysis revealed that molecular categories of ‘ATPase activity', ‘cell adhesion' or ‘tyrosine kinase activity' were commonly activated in the resistant clones. Taken together, the transcriptome analysis of tyrosine kinase inhibitors (TKI)-resistant clones provides the insights into the mechanism of drug resistance, which can facilitate the development of an effective screening method as well as therapeutic intervention to deal with TKI resistance.

A genome scan for quantitative trait loci influencing carcass, post-natal growth and reproductive traits in commercial Angus cattle

To gain insight into the number of loci of large effect that underlie variation in cattle, a quantitative trait locus (QTL) scan for 14 economically important traits was performed in two commercial Angus populations using 390 microsatellites, 11 single nucleotide polymorphisms (SNPs) and one duplication loci. The first population comprised 1769 registered Angus bulls born between 1955 and 2003, with Expected Progeny Differences computed by the American Angus Association. The second comprised 38 half-sib families containing 1622 steers with six post-natal growth and carcass phenotypes. Linkage analysis was performed by half-sib least squares regression with gridqtl or Bayesian Markov chain Monte Carlo analysis of complex pedigrees with loki. Of the 673 detected QTL, only 118 have previously been reported, reflecting both the conservative approach to QTL reporting in the literature, and the more liberal approach taken in this study. From 33 to 71% of the genetic variance and 35 to 56% of the phenotypic variance in each trait was explained by the detected QTL. To analyse the effects of 11 SNPs and one duplication locus within candidate genes on each trait, a single marker analysis was performed by fitting an additive allele substitution model in both mapping populations. There were 53 associations detected between the SNP/duplication loci and traits with -log(10) P(nominal) ≥ 4.0, where each association explained 0.92% to 4.4% of the genetic variance and 0.01% to 1.86% of the phenotypic variance. Of these associations, only six SNP/duplication loci were located within 8 cM of a QTL peak for the trait, with two being located at the QTL peak: SST_DG156121:c.362A>G for ribeye muscle area and TG_X05380:c.422C>T for calving ease. Strong associations between several SNP/duplication loci and trait variation were obtained in the absence of any detected linked QTL. However, we reject the causality of several commercialized DNA tests, including an association between TG_X05380:c.422C>T and marbling in Angus cattle.

Neuregulin 3 does not confer risk for schizophrenia and smooth pursuit eye movement abnormality in a Korean population

Located on chromosome 10q22-q23, the human neuregulin3 (NRG3) is considered to be a strong positional and functional candidate gene for schizophrenia pathogenesis. Several case-control studies examining the association of polymorphisms in NRG3 with schizophrenia and/or related traits such as delusion have been reported recently in cohorts of Han Chinese, Ashkenazi Jews, Australians and white Americans of Western European ancestry. Thus, this study aimed to comprehensively investigate the association of NRG3 genetic variations with the risk of schizophrenia and smooth pursuit eye movement (SPEM) abnormality in a Korean population. Using TaqMan assay, six single-nucleotide polymorphisms (SNPs) in the intronic region of NRG3 were genotyped and two major haplotypes were identified in 435 patients with schizophrenia as cases and 393 unrelated healthy individuals as controls. A total of 113 schizophrenia patients underwent an eye tracking task, and degree of SPEM abnormality was measured using the logarithmic values of the signal/noise (Ln S/N) ratio. Differences in frequency distributions were analyzed using logistic and regression models following various modes of genetic inheritance and controlling for age and sex as covariates. Subsequent analysis revealed that the frequency distributions of NRG3 polymorphisms and haplotypes were similar between schizophrenia patients and healthy controls of Korean ethnicity. Furthermore, no significant differences were observed between the genetic variants tested for SPEM abnormality. By elucidating a lack of association in a Korean population, findings from this study may contribute to the understanding of the genetic etiology focusing on the role of NRG3 in schizophrenia pathogenesis.