Nutritional State Predicts All-Cause Death Independent of Comorbidities in Geriatric Patients with Coronary Artery Disease

OBJECTIVE

To explore whether nutritional risk is associated with poor outcomes independent of complicated clinical status in older patients with coronary artery disease (CAD).

DESIGN

Cohort study.

SETTING

Patients referred for coronary angiography in West China Hospital, Sichuan University, China.

PARTICIPANTS

1772 patients with angiographic documented CAD whose age was above 65 years.

MEASUREMENTS

Nutritional state was appraised using geriatric nutritional risk index (GNRI). Nutritional risk was defined as the GNRI below 98. The event rate of all-cause death was observed among patients with nutritional risk and those without.

RESULTS

During a median follow-up period of 27 months, 224 patients died. Multivariate Cox regression analysis showed that nutritional risk was associated with all-cause death (adjusted hazard ratio 1.99; 95% confidence interval 1.35-2.95; P=0.001). Subgroup analysis verified the association between nutritional risk and death among patients with distinct clinical features, comorbidities, and medication. There was no interaction between nutritional risk and clinical characteristics with regard to all-cause death.

CONCLUSION

Nutritional state is independently associated with the risk of all-cause death in geriatric patients with CAD. Whether nutritional support in appropriate patients improves clinical outcomes deserves further investigation.

Increased interventricular septum wall thickness predicts all-cause death in patients with coronary artery disease

BACKGROUND

There is debate regarding the predictive value of interventricular septum (IVS) wall thickness for adverse events.

AIMS

The study investigated the association between the severity of thickened IVS and all-cause death in Chinese patients with coronary artery disease (CAD).

METHODS

A total of 2297 CAD patients verified by angiography was consecutively included. Patients were grouped according to the severity of thickened IVS. Cox regression analysis was conducted to determine the independent prognostic value of thickened IVS for all-cause death.

RESULTS

During a median follow up of 25 months, 149 patients died. A gradient increase in the risk of death was observed across thickened IVS groups. Compared to patients with normal IVS thickness, the adjusted hazard ratio (HR) was 1.49 (95% confidence interval (CI) 1.00-2.23, P = 0.05) and 2.13 (95% CI 1.29-3.54, P = 0.003) for all-cause death in those with mildly and moderately/severely thickened IVS respectively. For one unit increase in IVS thickness, the risk of all-cause death was elevated by 14% (adjusted HR 1.14, 95% CI 1.05-1.24, P = 0.003). In patients with normal indexed left ventricular mass, thickened IVS was also demonstrated as an independent risk factor for all-cause death.

CONCLUSION

Thickened IVS can be served as a reliable marker for predicting all-cause death in Chinese patients with CAD, even in those with normal left ventricular mass.

Deterioration of the coercivity due to the diffusion induced interface layer in hard/soft multilayers

Hard/soft permanent magnets have aroused many interests in the past two decades because of their potential in achieving giant energy products as well as their rich variety of magnetic behaviors. Nevertheless, the experimental energy products are much smaller than the theoretical ones due to the much smaller coercivity measured in the experiments. In this paper, the deterioration of the coercivity due to the interface atomic diffusion is demonstrated based on a three dimensional (3D) micromagnetic software (OOMMF) and a formula derived for the pinning field in a hard/soft multilayer, which can be applied to both permanent magnets and exchange-coupled-composite (ECC) media. It is found that the formation of the interface layer can decrease the coercivity by roughly 50%, which is responsible for the observed smaller coercivity in both composite and single-phased permanent magnets. A method to enhance the coercivity in these systems is proposed based on the discussions, consistent with recent experiments where excellent magnetic properties are achieved.

MicroRNA profiling in cutaneous wounds of diabetic rats

Despite years of effort, current therapies for diabetic wounds are still not fully efficacious. Emerging evidence has suggested that microRNAs (miRNAs) play key roles in multiple physiological and pathological processes in eukaryotes, and could potentially be powerful therapeutic tools. This study investigated the differential expression profiling of miRNAs in cutaneous wounds in streptozotocin-induced diabetic rats and normal rats, and its significance in diabetic wound healing. Using microarrays, 18 miRNAs were identified as being upregulated and 65 as being downregulated in the diabetic group. The miRNA profiling results were validated by quantitative reverse transcriptase polymerase chain reaction. Finally, functional annotation analysis using the DAVID and miR2Subpath databases revealed that the differentially expressed miRNAs were involved in MAPK signaling pathways, the Wnt signaling pathway, and other signaling pathways that may be closely linked to wound healing. This study provides an experimental foundation for further investigation of mechanisms that underlie poor diabetic wound healing, and of miRNA-based therapies that are associated with wound healing.

Lean mass index, body fat and survival in Chinese patients with coronary artery disease

BACKGROUND

'Obesity paradox' was not consistently observed in Asians with coronary artery disease (CAD).

AIM

The study investigated the association between body composition and outcomes in Chinese patients with CAD.

DESIGN

Cohort study.

METHOD

A total of 3280 patients with angiographically validated CAD were consecutively included. Body fat (BF) percentage and lean mass index (LMI) were evaluated using the Clínica Universidad de Navarra-Body Adiposity Estimator. The rate of mortality from any cause was compared across groups classified by the quartiles of LMI.

RESULTS

During a median period of 24 months, 288 (8.8%) participants died. There was a close association between increasing LMI and reducing mortality rate. However, univariate analyses did not find protective effect of BF on survival. After adjusting for age, sex, diabetes, current smoking, systolic blood pressure, creatinine, white blood cell count, haemoglobin and medication, Cox regression analyses showed that the significant relation between higher quartiles (Q) of LMI and survival benefit (Q4, hazard ratio 0.58 (95% confidence interval: 0.36-0.94) vs. Q3, 0.60 (0.39-0.91) vs. Q2, 0.60 (0.41-0.88) vs. Q1, reference) remained.

CONCLUSION

Low LMI but not BF predicts all-cause mortality in Chinese patients with CAD.

Viruses transfer the antiviral second messenger cGAMP between cells

Cyclic GMP-AMP synthase (cGAS) detects cytosolic DNA during virus infection and induces an antiviral state. cGAS signals by synthesis of a second messenger, cyclic GMP-AMP (cGAMP), which activates stimulator of interferon genes (STING). We show that cGAMP is incorporated into viral particles, including lentivirus and herpesvirus virions, when these are produced in cGAS-expressing cells. Virions transferred cGAMP to newly infected cells and triggered a STING-dependent antiviral program. These effects were independent of exosomes and viral nucleic acids. Our results reveal a way by which a signal for innate immunity is transferred between cells, potentially accelerating and broadening antiviral responses. Moreover, infection of dendritic cells with cGAMP-loaded lentiviruses enhanced their activation. Loading viral vectors with cGAMP therefore holds promise for vaccine development.

miRNAs in mtDNA-less cell mitochondria

The novel regulation mechanism in mtDNA-less cells was investigated. Very low mtDNA copy in mtDNA-less 206 ρ° cells was identified. But no 13 mitochondria-specific proteins were translated in 206 ρ° cells. Their mitochondrial respiration complexes V, III and II were 86.5, 29.4 and 49.6% of 143B cells, respectively. Complexes I and IV completely lack in 206 ρ° cells. Non-mitochondrial respiration to generate ATP in 206 ρ° cells was discovered. The expression levels of some mitochondrial RNAs including 12S rRNA, COX1, COX2, COX3, ND4 and ND5 were low. However, ND1, ND3 and Cyto b were not expressed in 206 ρ° cells. Unequal transcription of mitochondrial RNAs indicated the post-transcriptional cleavage and processing mechanisms in the regulation of mitochondrial gene expression in 206 ρ° cells. MicroRNAs (miRNAs) may modulate these mitochondrial RNA expression in these cells. RNA-induced silencing complex indeed within 206 ρ° cell mitochondria indicated miRNAs in 206 ρ° cell mitochondria. miRNA profile in mtDNA-less 206 ρ° cells was studied by next-generation sequencing of small RNAs. Several mitochondria-enriched miRNAs such as miR-181c-5p and miR-146a-5p were identified in 206 ρ° cell mitochondria. miR-181c-5p and miR-146a-5p had 23 and 19 potential targets on mitochondrial RNAs respectively, and these two miRNAs had multiple targets on mitochondria-associated messenger RNAs encoded by nuclear genes. These data provided the first direct evidence that miRNAs were imported into mitochondria and regulated mitochondrial RNA expressions.

Pathology of the lower nasolacrimal duct mucosa at multiple time points after lacrimal retrograde catheterization in rabbit

Lacrimal duct obstruction is a common eye disease, and obstruction of the nasolacrimal duct accounts for over 50% of these cases. Nasolacrimal duct obstruction is usually treated surgically. Lacrimal retrograde catheterization is a novel surgical approach with a high success rate and a relatively high recurrence rate. In this study, we examined the postoperative pathological changes in the lower nasolacrimal duct mucosa at multiple time points (2, 4, 6, 8, 10, 12, and 14 weeks) after retrograde lacrimal dilated drainage tube implantation in rabbits. One side of the nasolacrimal duct was obstructed in 14 rabbits. Compared to the control side, the 2-, 4-, 6-, and 8-week groups presented no obvious changes in hematoxylin and eosin (H&E)-stained tissue. The 10-week group presented isolated granulomas. The 12- and 14-week groups presented scattered granulomas. The granulomas were smaller and the density of fibroblasts was lower in the 12-week group compared with the 14-week group. Transforming growth factor-β1 immunohistochemistry resulted in strong immunoreactivity in the 14-week group and weak immunoreactivity in the 12-week group, and the difference was statistically significant (P < 0.05). Fibroblast apoptosis was observed in the 4- and 6-week groups, and disorganized fibers were observed in the 10-week group. Most fibroblasts in the 12- and 14-week groups were the active type with mechanocytes. Granulomas were induced after a long time by the implantation of silicone tubes in rabbits. Thus, recurrent obstructions of the nasolacrimal duct may be caused by granulomas, progressive fibrosis, and/or adhesion of the surrounding tissues.

Ipsilateral hippocampal proteomics reveals mitochondrial antioxidative stress impairment in cortical-lesioned chronic mild stressed rats

In this study, a two-dimensional gel-based proteomic approach was applied to profile the protein alterations underlying the significant adverse effects from post-stroke depression (PSD). In view of the close association between left prefrontal cortical dysfunction and PSD, a PSD rat model was constructed through a left anterior cortical lesion followed by chronic mild stress (CMS) for three weeks. Through sucrose preference testing, PSD rats displayed depression-like behavior during the entire CMS period. In contrast, stroke rats displayed depression-like behavior in the first week post-stroke and recovered in the second week post-stroke. To investigate the PSD-induced protein expression changes, ipsilateral hippocampal protein expression in stroke, PSD, and control rats were comparatively analyzed. 46 differential proteins were identified, 22 of which were regulated in opposing directions by stroke and post-stroke stress. The majority of these 22 proteins were involved in neurogenesis, cytoskeletal remodeling, and energy metabolism. Additional proteins were functionally related to mitochondrial antioxidative stress systems. The differential proteins expressed in opposing directions by stroke and post-stroke stress may play a role in self-repair after adult brain lesions, suggesting that stroke induces self-repair mechanisms, while post-stoke stress mitigates them, in the rat hippocampus. Among these differential proteins dysregulated in opposing directions, three mitochondrial proteins involved in mitochondrial antioxidative stress - heat shock 70 kDa protein 9, peroxiredoxin-6, and prohibitin - were validated and may play an important role in stroke-injury self-repair and PSD-induced injury of hippocampal neurons. These findings offer new insight into deciphering the molecular mechanisms underpinning PSD&#039;s adverse effects on stroke recovery.

Automation of ROI extraction in hyperspectral breast images

The extraction of regions-of-interest (ROIs) in hyperspectral images of breast cancer specimens is currently carried out manually or by visual inspection. In order to address the labor-intensive and time-consuming process of the manual extraction of ROIs in hyperspectral images, an algorithm is developed in this paper to automate the extraction process. This is achieved by using a contrast module and a homogeneity module to duplicate the same manual or visual steps that an expert goes through in order to extract ROIs. The success of the automated process is determined by comparing the classification rates of the automated approach with the manual approach in terms of the ability to separate cancer cases from normal cases.

An association analysis between psychophysical characteristics and genome-wide gene expression changes in human adaptation to the extreme climate at the Antarctic Dome Argus

Genome-wide gene expression measurements have enabled comprehensive studies that integrate the changes of gene expression and phenotypic information to uncover their novel associations. Here we reported the association analysis between psychophysical phenotypes and genome-wide gene expression changes in human adaptation to one of the most extreme climates on Earth, the Antarctic Dome Argus. Dome A is the highest ice feature in Antarctica, and may be the coldest, driest and windiest location on earth. It is considered unapproachable due to its hostile environment. In 2007, a Chinese team of 17 male explorers made the expedition to Dome A for scientific investigation. Overall, 133 psychophysical phenotypes were recorded, and genome-wide gene expression profiles from the blood samples of the explorers were measured before their departure and upon their arrival at Dome A. We found that mood disturbances, including tension (anxiety), depression, anger and fatigue, had a strong, positive, linear relationship with the level of a male sex hormone, testosterone, using the Pearson correlation coefficient (PCC) analysis. We also demonstrated that significantly lowest-level Gene Ontology groups in changes of gene expression in blood cells with erythrocyte removal were consistent with the adaptation of the psychophysical characteristics. Interestingly, we discovered a list of genes that were strongly related to significant phenotypes using phenotype and gene expression PCC analysis. Importantly, among the 70 genes that were identified, most were significantly related to mood disturbances, where 42 genes have been reported in the literature mining, suggesting that the other 28 genes were likely novel genes involved in the mood disturbance mechanism. Taken together, our association analysis provides a reliable method to uncover novel genes and mechanisms related to phenotypes, although further studies are needed.

Systematic analysis to identify a key role of CDK1 in mediating gene interaction networks in cervical cancer development

OBJECTIVE

This study aims to identify corresponding differentially expressed genes in cervical cancer by comparing gene expression profiles between normal and cervical cancer samples.

METHOD

To identify differentially expressed genes in cervical cancer, two groups of Affymetrix microarray data available online were analyzed. One group consisted of 43 carcinomatous cervical epithelial cell samples, and the other was composed of 17 healthy cervical epithelial cell samples, both from the Amerindian. R packages-GO.db, KEGG.db and KEGGREST were used to detect GO categories and KEGG pathways with significant overrepresentation in differentially expressed genes comparing with the whole genome. Cytoscape was utilized to construct biological networks.

RESULTS

By comparing gene expression profile of normal and cervical cancer samples, 122 differentially expressed genes were identified including 46 up-regulated genes and 76 down-regulated genes. Using the identified differentially expressed genes, a large and a small biological network was constructed. In addition, 402 GO biological processes and 9 KEGG pathways were over-represented. Top significant biological processes included cell cycle and cell proliferation. Moreover, top significant KEGG pathways were oocyte meiosis, cell cycle and progesterone-mediated oocyte maturation. Most importantly, CDK1 frequently appeared in these processes and pathways, which indicated its significant role in the progression of cervical cancer.

CONCLUSION

CDK1 plays a comprehensive role in mediating genetic networks implicated in the progression of cervical cancer. Novel therapeutics targeting CDK1 or its related pathways might help improve prognosis of advanced stage cervical cancer.

Efficacy of transcatheter aortic valve implantation in patients with aortic stenosis and reduced LVEF. A systematic review

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is safe and effective for patients with aortic stenosis (AS) who have a high operative risk. However, there is still debate on the effect of TAVI in AS patients with reduced left ventricular ejection fraction (REF). The objective of the review is to clarify the efficacy of TAVI and the impact of REF on the 30-day and midterm mortality in these patients.

METHODS

Studies on TAVI were searched in PubMed, Embase, and the Cochrane Library databases and were included in this review following predefined criteria. Data were extracted and pooled risk ratios (RR) were synthesized to explore the relationship between REF and 30-day plus midterm mortality.

RESULTS

Twenty-eight studies comprising 14,099 patients were included in the analysis of the association of REF with the prognosis of patients after TAVI. An average increase in left ventricular ejection fraction of 8-10 % was observed among these patients after TAVI. REF was not related to the 30-day mortality [RR = 1.90, 95 % confidence interval (CI) = 0.80-4.47]; however, it was related to the midterm mortality (RR = 1.49, 95 %CI = 1.14-1.93) of patients undergoing TAVI. Patients with low-flow and low-gradient AS had a higher 30-day mortality (RR = 1.54, 95 %CI = 1.11-2.13) and midterm mortality rate (RR = 1.69, 95 %CI = 1.33-2.14) compared with AS patients without these characteristics. The mortality of TAVI patients was significantly lower than that of those undergoing conservative therapy, and was similar to that of patients undergoing surgical aortic valve replacement.

CONCLUSION

REF was not associated with 30-day mortality, but it was associated with the midterm mortality of TAVI patients. Patients with REF could benefit from TAVI compared with conservative therapy.

First Report of Fusarium solani Causing Root Rot of Juglans sigllata Dode in China

Juglans sigllata Dode, known as the iron walnut, is widely planted in Liangshan prefecture of southwest China for its nuts and wood. Liangshan prefecture is a major traditional growing area of J. sigllata and has unique advantages for walnut industrial development because of its good soil, climate, and availability of water. Currently there are 2.7 million hectares of walnut, contributing important incomes for farmers. In April 2013, numerous J. sigllata were found infected with root rot in the Muli county of Liangshan prefecture. Symptoms included dried leaves, dead branchcs, and even death. Rotted roots were collected and surface-sterilized in 2% NaOCl and 70% ethanol. The junction (1 cm) between infected and healthy regions was removed, plated on rose bengal-glycerin-urea medium, and incubated at 20°C for 12 h. A fungus was found and purified successively by transferring hyphal tips from the margin of a thinly growing colony on 2% water agar (3). Morphological characteristics were identified both on potato dextrose agar (PDA) and carnation leaf-piece agar. Evaluation of pigmentation and colony growth rate were also measured using PDA. Ovoid microconidia (average dimensions 10.6 × 9.1 μm) were observed after 2 to 3 days, and most of them had no septa or only one septum. Macroconidia (average dimensions 47.4 × 5.3 μm), with one to three septate sickle shapes, were found after 3 to 6 days. Single or paired chlamydospores (average dimensions 10.3 × 9.2 μm), which were circular to ovate, smooth or not smooth, were observed after 7 days of incubation in clean water. According to the cultural characteristics, the fungus was primarily identified as Fusarium solani (1). To better determine the species, universal primers ITS1/ITS4 for the ribosomal internal transcribed spacer (ITS) coupled with translation elongation factor (EF-1α) primers EF1/EF2 were used for PCR-based molecular identification. Against GenBank and the FUSARIUM-ID databases, our sequences shared 99 and 98% identities with ITS (FJ459973.1) and EF-1α (JX677562.1) of F. solani, respectively. Both sequences produced in this study have been deposited in GenBank under accession numbers KJ528277 for ITS and KJ528278 for EF-1α. Pathogenicity tests were conducted by drop inoculating 20 ml of microconidia suspension (10⁶ spores/ml) on the roots of 1-year-old healthy potted J.sigllata, Mianyang walnut, and Xinjiang walnut. Controls were not treated with F. solani. Fifteen plants were in each group. All materials, including pots and soil, were disinfected. After 12 days, all J. sigllata inoculated with F. solani exhibited dried leaves, and after 17 days, Mianyang walnut and Xinjiang walnut infected with F. solani also developed the same symptoms. After 24 days, the inoculated J. sigllata died. However, control plants remained asymptomatic. The fungus re-isolated from infected roots showed the same characteristics as described above and was totally identical in appearance to the isolates used to inoculate the plants. No colonies of F. solani were isolated from untreated plants. At present, F. solani has been reported in stem cankers on English walnut in South Africa (2). To our knowledge, this is the first report of root rot caused by F. solani in J. sigllata in China. References: (1) C. Booth. Fusarium Laboratory Guide to the Identification of the Major Species. CMI, Kew, England, 1977. (2) W. Chen and W. J. Swart. Plant Dis. 84:592, 2000. (3) J. F. Leslie and B. A. Summerell. The Fusarium Laboratory Manual. Blackwell Publishing, Ames, IA, 2006.

Expression and significance of plasma 3-NT and ox-LDL in patients with Alzheimer's disease

To examine the expression and clinical significance of plasma 3-nitrotyrosine (3-NT) and oxidized low-density lipoprotein (ox-LDL) levels in patients with Alzheimer's disease (AD), we examined 48 AD patients and 37 healthy control subjects. The Mini-Mental State Examination, Activities of Daily Living Scale, and Hachinski Ischemic Scale were examined in all subjects. AD patients were classified using the Global Deterioration Scale. The concentrations of plasma 3-NT and ox-LDL were detected using an enzyme-linked immunosorbent assay. We found that the plasma 3-NT concentration in the AD group (119.46 ± 21.82 nM) was significantly higher than that in the control group (55.09 ± 9.63 nM) (P < 0.05). Spearman analysis showed that plasma 3-NT level was negatively associated with the Mini-Mental State Examination results of AD patients. Plasma ox-LDL level in the AD group (112.25 ± 17.81 mg/L) was significantly higher than that in the control group (47.46 ± 10.04 mg/L) (P < 0.05). Spearman analysis showed that plasma ox-LDL level was positively correlated with AD severity in AD patients. However, plasma 3-NT level in the AD group was not associated with plasma ox-LDL level. Therefore, plasma 3-NT and ox-LDL levels in AD patients were significantly increased, which may be related to the degree of AD severity in AD patients.

Deficiency of osteoblastic Arl6ip5 impaired osteoblast differentiation and enhanced osteoclastogenesis via disturbance of ER calcium homeostasis and induction of ER stress-mediated apoptosis

ADP-ribosylation-like factor 6 interacting protein 5 (Arl6ip5), which belongs to the prenylated rab-acceptor-family, has an important role in exocytic protein trafficking, glutathione metabolism and involves in cancer progression. However, its expression pattern and functional role in bone are unknown. Here we demonstrate that Arl6ip5 knock-out mice (Arl6ip5 (Δ2/Δ2)) show marked decrease of bone mineral density, trabecular bone volume and trabecular thickness. Histomorphometric studies reveal that bone formation parameters are decreased but bone resorption parameters and mRNA level of osteoclast-specific markers are increased in Arl6ip5(Δ2/Δ2) mice. In osteoblast, we demonstrate that Arl6ip5 abundantly expresses in osteoblastic cells and is regulated by bone metabolism-related hormones and growth factors. In vitro analysis reveals that osteoblast proliferation and differentiation are impaired in Arl6ip5 knocked-down and deficient primary osteoblast. Arl6ip5 is also found to function as an ER calcium regulator and control calmodulin signaling for osteoblast proliferation. Moreover, Arl6ip5 insufficiency in osteoblast induces ER stress and enhances ER stress-mediated apoptosis. CCAAT/enhancer-binding protein homologous protein (Chop) is involved in the regulation of apoptosis and differentiation in Arl6ip5 knocked-down osteoblasts. For osteoclastogenesis, Arl6ip5 insufficiency in osteoclast precursors has no effect on osteoclast formation. However, knocked-down osteoblastic Arl6ip5 induces receptor activator of nuclear factor-κB ligand (RANKL) expression and enhances osteoclastogenesis. In addition, ER stress and Chop are involved in the RANKL expression in Arl6ip5 knocked-down osteoblasts. In conclusion, we demonstrate that Arl6ip5 is a novel regulator of bone formation in osteoblasts.

Delivery of perioperative chemotherapy for bladder cancer in routine clinical practice

BACKGROUND

Few articles have documented regimens and timing of perioperative chemotherapy for bladder cancer in routine practice. Here, we describe practice patterns in the general population of Ontario, Canada.

METHODS

In this retrospective cohort study, treatment and physician billing records were linked to the Ontario Cancer Registry to describe use of neoadjuvant (NACT) and adjuvant (ACT) chemotherapy among all patients with muscle-invasive bladder cancer treated with cystectomy in Ontario 1994-2008. Time to initiation of ACT (TTAC) was measured from cystectomy. Multivariate Cox regression was used to identify factors associated with overall (OS) and cancer-specific survival (CSS).

RESULTS

Of 2944 patients undergoing cystectomy, 4% (129/2944) and 19% (571/2944) were treated with NACT and ACT, respectively. Five-year OS was 25% [95% confidence interval (CI) 17% to 34%] for NACT, 29% (95% CI 25% to 33%) for ACT cases. Among patients with identifiable drug regimens, cisplatin was used in 82% (253/308) and carboplatin in 14% (43/308). The most common regimens were gemcitabine-cisplatin (54%, 166/308) and methotrexate, vinblastine, doxorubicin, cisplatin (MVAC) (21%, 66/308). Mean TTAC was 10 weeks; 23% of patients had TTAC >12 weeks. TTAC >12 weeks was associated with inferior OS [hazard ratio (HR) 1.28, 95% CI 1.00-1.62] and CSS (HR 1.30, 95% CI 1.00-1.69). In adjusted analyses, OS and CSS were lower among patients treated with carboplatin compared with those treated with cisplatin; OS HR 2.14 (95% CI 1.40-3.29) and CSS HR 2.06 (95% CI 1.26-3.37).

CONCLUSIONS

Most patients in the general population receive cisplatin, and this may be associated with superior outcomes to carboplatin. Initiation of ACT beyond 12 weeks is associated with inferior survival. Patients should start ACT as soon as they are medically fit to do so.

Effects of low intensity vibration on bone and muscle in rats with spinal cord injury

Spinal cord injury (SCI) causes rapid and marked bone loss. The present study demonstrates that low-intensity vibration (LIV) improves selected biomarkers of bone turnover and gene expression and reduces osteoclastogenesis, suggesting that LIV may be expected to benefit to bone mass, resorption, and formation after SCI.

INTRODUCTION

Sublesional bone is rapidly and extensively lost following spinal cord injury (SCI). Low-intensity vibration (LIV) has been suggested to reduce loss of bone in children with disabilities and osteoporotic women, but its efficacy in SCI-related bone loss has not been tested. The purpose of this study was to characterize effects of LIV on bone and bone cells in an animal model of SCI.

METHODS

The effects of LIV initiated 28 days after SCI and provided for 15 min twice daily 5 days each week for 35 days were examined in female rats with moderate severity contusion injury of the mid-thoracic spinal cord.

RESULTS

Bone mineral density (BMD) of the distal femur and proximal tibia declined by 5 % and was not altered by LIV. Serum osteocalcin was reduced after SCI by 20 % and was increased by LIV to a level similar to that of control animals. The osteoclastogenic potential of bone marrow precursors was increased after SCI by twofold and associated with 30 % elevation in serum CTX. LIV reduced the osteoclastogenic potential of marrow precursors by 70 % but did not alter serum CTX. LIV completely reversed the twofold elevation in messenger RNA (mRNA) levels for SOST and the 40 % reduction in Runx2 mRNA in bone marrow stromal cells resulting from SCI.

CONCLUSION

The findings demonstrate an ability of LIV to improve selected biomarkers of bone turnover and gene expression and to reduce osteoclastogenesis. The study indicates a possibility that LIV initiated earlier after SCI and/or continued for a longer duration would increase bone mass.

Mesenchymal stromal cells infusions improve refractory chronic graft versus host disease through an increase of CD5+ regulatory B cells producing interleukin 10

Refractory chronic graft-versus-host disease (cGVHD) is a significant complication resulting from allogeneic hematopoietic stem cell transplantation (HSCT). Mesenchymal stromal cells (MSCs) have shown promise for treating refractory cGVHD, but the favorable effects of MSCs therapy in cGVHD are complex and not fully understood. In this prospective clinical study, 20 of 23 cGVHD patients had a complete response or partial response in a 12-month follow-up study. The most marked improvements in cGVHD symptoms were observed in the skin, oral mucosa and liver. Clinical improvement was accompanied by a significantly increased number of interleukin (IL)-10-producing CD5+ B cells. Importantly, CD5+ B cells from cGVHD patients showed increased IL-10 expression after MSCs treatment, which was associated with reduced inflammatory cytokine production by T cells. Mechanistically, MSCs could promote the survival and proliferation of CD5+ regulatory B cells (Bregs), and indoleamine 2, 3-dioxygenase partially participates in the MSC-mediated effects on Breg cells. Thus, CD5+ Breg cells may have an important role in the process of MSC-induced amelioration of refractory cGVHD and may provide new clues to reveal novel mechanisms of action for MSCs.

Curative therapy for bladder cancer in routine clinical practice: a population-based outcomes study

AIMS

Definitive therapy of bladder cancer involves cystectomy or radiotherapy; controversy exists regarding optimal management. Here we describe the management and outcomes of patients treated in routine practice.

MATERIALS AND METHODS

Treatment records were linked to the Ontario Cancer Registry to identify all cases of bladder cancer in Ontario treated with cystectomy or radiotherapy in 1994-2008. Practice patterns are described in three study periods: 1994-1998, 1999-2003, 2004-2008. Logistic regression, Cox model and propensity score analyses were used to evaluate factors associated with treatment choice and survival.

RESULTS

In total, 3879 cases (74%) underwent cystectomy and 1380 (26%) were treated with primary radiotherapy. Cystectomy use increased over time (66, 75, 78%), whereas radiotherapy decreased (34, 25, 22%), P < 0.001. There was substantial regional variation in the proportion of cases undergoing radiotherapy (range 16-51%). Five year cancer-specific survival (CSS) and overall survival were 40 and 36% for surgical cases and 35 and 26% for radiotherapy cases (P < 0.001). In multivariate Cox model and propensity score analyses, there was no significant difference in CSS between surgery and radiotherapy (hazard ratio 0.99, 95% confidence interval 0.91-1.08); radiotherapy was associated with slightly inferior overall survival (hazard ratio 1.08, 95% confidence interval 1.00-1.16).

CONCLUSION

Utilisation of cystectomy for bladder cancer in routine practice has increased over time with no evidence of a significant difference in CSS between radiotherapy and cystectomy.

Mixed Nipple Infections Caused by Variant of BPV3 and a Putative New Subtype of BPV in Cattle

Bovine papilloma is a chronic and proliferative skin and mucosal wart caused by Bovine papillomavirus (BPV). In June, 2013, a leaf-and flat-shaped wart disease was observed on the nipple skins in a cattle farm in Xinjiang. To diagnose the disease, we collected the diseased skins for pathological biopsy and DNA analysis by PCR amplification using a pair of degenerate primers FAP59 and FAP64. Sequencing and phylogenetic analysis showed that the infection was caused by a variant of BPV3 and putatively a new subtype of BPV (BPV/CHI-SW1, belonging to the Xi papillomavirus genus). This is the first report of mixed infection caused by variant of BPV3 and BPV (putatively new subtype) in China, and would be of importance for the molecular epidemiological study of the disease.

The expression of P2X7 receptors on peripheral blood mononuclear cells in patients with primary Sjögren's syndrome and its correlation with anxiety and depression

OBJECTIVES

To study surface expression of P2X7 receptors (P2X7R) on peripheral blood mononuclear cells (PBMC) in patients with primary Sjögren's syndrome (pSS), and its correlation with anxiety and/or depression.

METHODS

The Hamilton Anxiety Scale (HAMA) and Hamilton Rating Scale for Depression (HRSD) were used to assess 31 patients with pSS. P2X7R expression on the surface of CD14+ and CD14- PBMC, with or without ATP stimulation, was measured by flow cytometry. IL-1β and IL-6 levels in blood plasma and supernatant after ATP stimulation were measured by ELISA. Nineteen patients with rheumatoid arthritis (RA), 18 patients with anxiety and/or depression, and 20 healthy cases were used as controls.

RESULTS

P2X7R expression was detected in all subjects. Compared with no ATP stimulation, significant up-regulation of P2X7R expression on CD14+ PBMC was observed after ATP stimulation in the pSS group only (p=0.001), while on CD14- PBMC there was significant up-regulation in both the pSS (p<0.001) and anxiety/depression (p=0.003) groups. After ATP stimulation, P2X7R expression on CD14+ PBMC in the pSS group was significantly higher than the RA group (p=0.044), anxiety/depression group (p=0.004) and healthy controls (p=0.002). Moreover, in the pSS group, P2X7R expression on CD14+ PBMC was significantly positively correlated to IL-1β supernatant levels (r=0.447, p=0.025). Overall, there were 45.2% (14/31) patients with anxiety and 32.3% (10/31) with depression, in the pSS group. P2X7R expression on CD14- PBMC was significantly positively correlated to scores of anxiety (r=0.344, p=0.030) and depression (r=0.319, p=0.045).

CONCLUSIONS

Surface expression of P2X7R on PBMC in patients with pSS was significantly higher than controls, suggesting P2X7R may contribute to the complex pathogenesis of pSS and also anxiety and/or depression.

Organo-erbium systems for optical amplification at telecommunications wavelengths

Modern telecommunications rely on the transmission and manipulation of optical signals. Optical amplification plays a vital part in this technology, as all components in a real telecommunications system produce some loss. The two main issues with present amplifiers, which rely on erbium ions in a glass matrix, are the difficulty in integration onto a single substrate and the need of high pump power densities to produce gain. Here we show a potential organic optical amplifier material that demonstrates population inversion when pumped from above using low-power visible light. This system is integrated into an organic light-emitting diode demonstrating that electrical pumping can be achieved. This opens the possibility of direct electrically driven optical amplifiers and optical circuits. Our results provide an alternative approach to producing low-cost integrated optics that is compatible with existing silicon photonics and a different route to an effective integrated optics technology.

Relationship between the expression of CES2, UGT1A1, and GUSB in colorectal cancer tissues and aberrant methylation

Irinotecan (CPT-11) is considered an important drug in the treatment of colorectal cancer, but its continuous administration reduces its sensitivity and influences the curative effect. The metabolism of CPT-11 is mainly controlled by carboxy-lesterase (CES), UDP-glucuronosyltransferase 1A (UGT1A), and β-glucuronidase (GUSB). Studies to date have shown that methylation acts as an important mechanism for gene expression to suppress the metabolic enzymes of many chemotherapeutics. This study, which selected 99 colorectal cancer patients, 23 of whom had paracancerous tissues and eight of whom had large intestine adenomas, aimed to investigate the correlation between the protein expression of the CPT-11 metabolic enzyme genes CES2, UGT1A1, and GUSB and various clinical pathological parameters of colorectal cancer tissues, as well as the relationship between methylation regulation and the gene expression of CES2, UGT1A1, and GUSB. We used immunohistochemistry staining, methylation-specific PCR, and clinical status to reveal the possible regulatory targets of chemotherapeutic resistance in colorectal cancer and to provide new ideas and countermeasures to reverse anti-cancer drug resistance and chemosensitization. The results showed that the expression of CES2, UGTA1A1, and GUSB varies in colorectal pathology tissues and that the expression of CES2 is somewhat related to tumor staging. This relationship is likely caused by the gene regulation of UGT1A1 and GUSB, and other regulation mechanisms may also be involved. The methylation of the CES2 gene is irrelevant to the morbidity associated with colorectal cancer. The GUSB gene showed no significant differences in methylation, and the hemi-methylation was also positive, the regulating ability of which needs to be verified. The potential role of these genes in the colorectal cancer progression, which may be directly related to the methylation regulation of UGT1A1, requires further research. The promoter of the UGT1A1 gene in colorectal cancer cells is methylated, which is an important mechanism of UGT1A1 gene silencing and can be regarded as the target point of research for CPT-11 drug resistance and control mechanisms for the reversal of drug resistance.

A new respiratory monitoring and processing system based on Wii remote: proof of principle

PURPOSE

To create a patient respiratory management system and patient self-practice tool using the Wii remote, a widely available consumer hardware product.

METHODS

The Wii remote (Wiimote) (Nintendo, Redmond, WA) contains an infrared (IR) camera that can track up to four spots whose coordinates are reported to a host computer via Bluetooth. The Wiimote is capable of tracking a fiducial box currently used by a commercial monitoring system [Real-time Position Management(TM) (RPM) system, Varian Associates, Palo Alto, CA], if the correct IR source is used. The authors validated the Wiimote tracking by comparing the amplitude and frequency of signals among those reported by Wiimote with known movements from an inhouse servo-driven respiratory simulator, as well as with those measured using the RPM. The simulator comparison was done using standard sinusoid signals with amplitude of 2.0 cm as well as recorded patient respiratory traces. The RPM comparisons were done by simultaneously recording the RPM reflective box position with the Wiimote and the RPM. Timing was compared between these two systems by using the digital beam-on signal from the CT scanner, for the 4DCT to synchronize these acquisitions.

RESULTS

The data acquisition rate from the Wiimote was 100.0 ± 0.4 Hz with a version 2.1 Bluetooth adaptor. The standard deviation of the height of the motion extrema was 0.06 and 1.1 mm when comparing those measured by the Wiimote and the servomotor encoder for standard sinusoid signal and prerecorded patient respiratory signal, respectively. The standard deviation of the amplitude of motion extrema between the Wiimote and RPM was 0.9 mm and the timing difference was 253 ms.

CONCLUSION

The performance of Wiimote shows promise for respiratory monitoring for its faster sampling rate as well as the potential optical and GPU abilities. If used with care it can deliver reasonable spatial and temporal accuracy.

A novel technique for analyzing the similarity and dissimilarity of DNA sequences

l(i,j) denotes the distance between the point (xi, yi) and the point (xj, yi) in graphical representation. By classifying li,j, i, j = 1, 2,…, N according to the number of points between (xi, yi) and (xj, yi), N - 1 types are obtained. The average and variance of every type are assembled by the novel invariant v = (a1, d1, a2, d2,…, aN, d>N). Compared with the traditional invariants, the leading eigenvalue, the max-min (eigenvalue), the leading eigenvalue/N, the average matrix element, and the average row sum, this strategy complies with the rule of using the average, extracts more information about biological sequences, and reduces the amounts of computation. It is superior to the traditional invariants in predicting similarity and dissimilarity among different species.

Progesterone receptor-B enhances estrogen responsiveness of breast cancer cells via scaffolding PELP1- and estrogen receptor-containing transcription complexes

Progesterone and estrogen are important drivers of breast cancer proliferation. Herein, we probed ER-alpha and PR cross-talk in breast cancer models. Stable expression of PR-B in PR-low/ER+ MCF7 cells increased cellular sensitivity to estradiol and IGF1, as measured in growth assays performed in the absence of exogenous progestin; similar results were obtained in PR-null/ER+ T47D cells stably expressing PR-B. Genome-wide microarray analyses revealed that unliganded PR-B induced robust expression of a subset of estradiol-responsive ER-target genes, including CathepsinD (CTSD). Estradiol-treated MCF7 cells stably expressing PR-B exhibited enhanced ER Ser167 phosphorylation and recruitment of ER, PR, and the proline, glutamate and leucine rich protein 1 (PELP1) to an estrogen response element (ERE) in the CTSD distal promoter; this complex co-immunoprecipitated with IGF1R in whole cell lysates. Importantly, ER/PR/PELP1 complexes were also detected in human breast cancer samples. Inhibition of IGF1R or PI3K blocked PR-B-dependent CTSD mRNA upregulation in response to estradiol. Similarly, inhibition of IGF1R or PR significantly reduced ER recruitment to the CTSD promoter. Stable knockdown of endogenous PR or onapristone treatment of multiple unmodified breast cancer cell lines blocked estradiol-mediated CTSD induction, inhibited growth in soft agar, and partially restored tamoxifen-sensitivity of resistant cells. Further, combination treatment of breast cancer cells with both onapristone and IGF1R tyrosine kinase inhibitor AEW541 was more effective than either agent alone. In summary, unliganded PR-B enhanced proliferative responses to estradiol and IGF1 via scaffolding of ERalpha/PELP1/IGF1R-containing complexes. Our data provide a strong rationale for targeting PR in combination with ER and IGF1R in patients with luminal breast cancer.

Genetic association of IL-21 polymorphisms with dilated cardiomyopathy in a Han Chinese population

BACKGROUND

Autoimmune abnormalities appear to be major predisposing factors for dilated cardiomyopathy (DCM). Interleukin-21 (IL-21) gene polymorphisms have been previously found to be associated with autoimmune diseases. This study aimed to assess the role of IL-21 in DCM in a Han Chinese population.

PATIENTS AND METHODS

A total of 364 independent DCM patients and 384 unrelated healthy controls were recruited for this case-control association study. rs2055979 and rs12508721 were genotyped by PCR-RFLP. IL-21 plasma levels in samples from DCM and control individuals were evaluated by ELISA. The association between the SNPs and overall survival (OS) was evaluated by Kaplan-Meier analysis. Hazard ratios and 95 % confidence intervals (CIs) were assessed in a Cox regression analysis with adjustment for sex and age.

RESULTS

The T allele frequencies of both SNPs were higher in DCM patients than in controls (p < 0.001). The genotypic frequencies of rs2055979 G > T and rs12508721 C > T were associated with DCM in the codominant, dominant, and recessive models (p < 0.05). IL-21 plasma levels in patients were higher than those of the control subjects (p = 0.009). The TT genotypes of both SNPs were associated with significantly higher plasma levels (prs2055979 = 0.03, prs12508721 < 0.001). Kaplan-Meier analysis showed that the genotypic frequencies of both SNPs were associated with OS in the dominant and the recessive models (p < 0.001). The TT genotypes of both SNPs were associated with the worst OS (p < 0.001).

CONCLUSION

Our findings suggest that theIL-21 gene plays an important role in susceptibility to DCM as well as in the clinical outcome of this ailment in the Han Chinese population.

Predictive value of miR-9 as a potential biomarker for nasopharyngeal carcinoma metastasis

Background:

Nasopharyngeal carcinoma (NPC) has a distinctive geographic distribution and is characterised by its strong tendency of metastasis. We aimed to examine the microRNA (miRNA) expression profiles in plasma samples of NPC patients to explore their clinical significance in disease development and progression.

Methods:

This study was divided into four steps: (1) confirmation of differentially expressed miRNAs using microarray analysis and quantitative PCR validation; (2) comparison of plasma miR-9 levels during NPC progression; (3) evaluation of the predictive performance of plasma miR-9 as a biomarker for NPC metastasis; and (4) comparison of plasma miR-9 levels between pre- and post-treatment samples.

Results:

Plasma microarray profiling identified 33 differentially expressed miRNAs between NPC patients and healthy volunteers. The significantly declined level of miR-9 in NPC patients was confirmed through two-stage validation. The low level of plasma miR-9 was significantly correlated with worse lymphatic invasion and advanced TNM stage. The plasma miR-9 could distinguish locoregional from metastatic NPC cases with a high sensitivity and specificity. Furthermore, the plasma miR-9 level was significantly elevated in post-treatment plasma compared with those pre-treatment samples.

Conclusion:

Our study reports that plasma miR-9 may serve as a useful biomarker to predict NPC metastasis and to monitor tumour dynamics.

Homozygous loss-of-function mutation of the LEPREL1 gene causes severe non-syndromic high myopia with early-onset cataract

High myopia is a severe visual impairment which can increase the risk of retinal degeneration, subretinal hemorrhage, choroidal neovascularization, cataract and retinal detachment. We recruited an autosomal-recessive high myopia family, with affected subjects who also present early-onset cataract, retinal degeneration and other complications. Using targeted capturing and whole exome sequencing, we identified a homozygous non-sense mutation in the LEPREL1 gene which causes premature termination of the translation at the fifth amino acid (c.13C>T; p.Q5X), co-segregating with the phenotypes. LEPREL1 encodes a proline hydroxylase called prolyl 3-hydroxylase 2 (P3H2), a 2-oxoglutarate-dependent dioxygenase that hydroxylates collagens. The results show that LEPREL1 plays an important role in eye development and homozygous loss-of-function mutation of this gene can cause severely high myopia and early-onset cataract. Our study also strongly suggests that the disruption of collagen modification is one of the pathogenic mechanisms of high myopia and cataract.

Chinese urban-rural disparity in pandemic (H1N1) 2009 vaccination coverage rate and associated determinants: a cross-sectional telephone survey

OBJECTIVES

The present study aimed to examine the differences in pandemic (H1N1) 2009 vaccination coverage rate between urban and rural areas in China, and to explore factors associated with any urban-rural differences.

STUDY DESIGN

Cross-sectional study.

METHODS

Data were derived from a cross-sectional telephone survey performed in seven urban and two rural areas soon after the pandemic peak in China, concerning pandemic (H1N1) 2009 vaccination and associated knowledge, attitudes and practices among the general population in China. A total of 10 669 participants aged 18 years and above participated in the study.

RESULTS

Vaccination amongst rural residents was less than urban residents (8.9% vs 11.2%, P = 0.002). Among those who have not been immunized, 82.2% of rural respondents showed a willingness to get vaccinated against A/H1N1, significantly higher than that of urban respondents (55.3%). The major barrier to vaccination was reported as 'not being informed to get vaccination', of which there was a greater proportion in rural than urban population (71.9% vs 68.8%, P = 0.009). The analysis revealed a number of factors which contribute to this disparity: previous experience of vaccination against flu, degree of awareness of the free vaccination policy, and sociodemographic differences between urban and rural areas.

CONCLUSIONS

Significant discrepancies existed in the pandemic (H1N1) 2009 vaccination coverage rate and associated determinants, as well as the intention to get vaccinated between urban and rural residents. To improve the effectiveness of similar vaccination programmes in the future, campaigns for rural people need to be specifically tailored to address disparities in uptake.

Glucagon-like peptide-1 upregulates visfatin expression in 3T3-L1 adipocytes

The incretin hormone glucagon-like peptide-1 (GLP-1) exerts important functions in controlling glucose homeostasis. Many studies have revealed molecular targets of GLP-1, but its influence on adipokines has not been determined. Visfatin, a recently discovered adipokine, has been shown to attenuate insulin resistance by binding to insulin receptor. Our study shows that GLP-1 induced secretion of visfatin into the culture medium of 3T3-L1 adipocytes due to increased visfatin mRNA expression. Furthermore, the effect of GLP-1 on visfatin was dose- and time-dependent. H89, a protein kinase A inhibitor, prevented the induction of visfatin expression by GLP-1. Moreover, inhibition of NF-κB by PDTC reduced the basal visfatin release while having no effect on the transcription regulation by GLP-1. In addition, GLP-1 alleviated the decrease of visfatin mRNA expression under endoplasmic reticulum stress induced by thapsigargin. Taken together, our study suggests that GLP-1 promotes the novel insulin-mimetic adipocytokine visfatin expression via the PKA pathway and might influence glucose metabolism.