Implications of Myocardial Infarction on Management and Outcome in Cardiogenic Shock

Background The randomized DOREMI (Dobutamine Compared to Milrinone) clinical trial evaluated the efficacy and safety of milrinone and dobutamine in patients with cardiogenic shock. Whether the results remain consistent when stratified by acute myocardial infarction remains unknown. In this substudy, we sought to evaluate differences in clinical management and outcomes of acute myocardial infarction complicated by cardiogenic shock (AMICS) versus non-AMICS. Methods and Results Patients in cardiogenic shock (n=192) were randomized 1:1 to dobutamine or milrinone. The primary composite end point in this subgroup analysis was all-cause in-hospital mortality, cardiac arrest, non-fatal myocardial infarction, cerebrovascular accident, the need for mechanical circulatory support, or initiation of renal replacement therapy (RRT) at 30-days. Outcomes were evaluated in patients with (n=65) and without (n=127) AMICS. The primary composite end point was significantly higher in AMICS versus non-AMICS (hazard ratio [HR], 2.21; 95% CI, 1.47-3.30; P=0.0001). The primary end point was driven by increased rates of all-cause mortality, mechanical circulatory support, and RRT. No differences in other secondary outcomes including cardiac arrest or cerebrovascular accident were observed. AMICS remained associated with the primary composite outcome, 30-day mortality, and RRT after adjustment for age, sex, procedural contrast use, multivessel disease, and inotrope type. Conclusions AMI was associated with increased rates of adverse clinical outcomes in cardiogenic shock along with increased rates of mortality and initiation of mechanical circulatory support and RRT. Contrast administration during revascularization likely contributes to increased rates of RRT. Heterogeneity of outcomes in AMICS versus non-AMICS highlights the need to study interventions in specific subgroups of cardiogenic shock. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03207165.

The association between mean arterial pressure and outcomes in patients with cardiogenic shock: insights from the DOREMI trial

AIMS

Cardiogenic shock (CS) is a state of low cardiac output resulting in end-organ hypoperfusion. Despite high in-hospital mortality rates, little evidence exists regarding the optimal mean arterial pressure (MAP) target in CS. We therefore evaluated the relationship between achieved MAP and clinical outcomes in patients with CS.

METHODS AND RESULTS

We performed a post hoc analysis of the CAPITAL DOREMI trial: a randomized, double-blind trial comparing dobutamine to milrinone in patients with CS. We divided patients into a high MAP group (average MAP ≥ 70 mmHg over the 36 h following randomization), and a low MAP group (average MAP < 70 mmHg). Our primary outcome included in-hospital all-cause mortality, resuscitated cardiac arrest, need for cardiac transplantation or mechanical circulatory support, non-fatal myocardial infarction, transient ischaemic attack or stroke, or initiation of renal replacement therapy. In total, 71 (37.0%) patients achieved an average MAP < 70 mmHg, and 121 (63.0%) achieved an average MAP ≥ 70 mmHg. The primary outcome occurred in 48 (67.6%) patients in the low MAP group and 51 (42.2%) patients in the high MAP group [adjusted relative risk (aRR) 0.70; 95% confidence interval (CI) 0.53-0.92; P = 0.01]. All-cause mortality occurred in 41 (57.8%) and 35 (28.9%) patients in the low and high MAP groups, respectively (aRR 0.56; 95% CI 0.40-0.79; P < 0.01). There were no significant differences in any secondary outcomes between each group.

CONCLUSIONS

In patients with CS treated with inotrope therapy, low MAP is associated with worse clinical outcomes. Randomized data evaluating optimal MAP targets in CS is needed to guide medical therapy.

Impact of baseline beta-blocker use on inotrope response and clinical outcomes in cardiogenic shock: a subgroup analysis of the DOREMI trial

Background

Cardiogenic shock (CS) is associated with significant morbidity and mortality. The impact of beta-blocker (BB) use on patients who develop CS remains unknown. We sought to evaluate the clinical outcomes and hemodynamic response profiles in patients treated with BB in the 24 h prior to the development of CS.

Methods

Patients with CS enrolled in the DObutamine compaREd to MIlrinone trial were analyzed. The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, need for cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite and hemodynamic response profiles derived from pulmonary artery catheters.

Results

Among 192 participants, 93 patients (48%) had received BB therapy. The primary outcome occurred in 47 patients (51%) in the BB group and in 52 (53%) in the no BB group (RR 0.96; 95% CI 0.73–1.27; P = 0.78) throughout the in-hospital period. There were fewer early deaths in the BB group (RR 0.41; 95% CI 0.18–0.95; P = 0.03). There were no differences in other individual components of the primary outcome or in hemodynamic response between the two groups throughout the remainder of the hospitalization.

Conclusions

BB therapy in the 24 h preceding the development of CS did not negatively influence clinical outcomes or hemodynamic parameters. On the contrary, BB use was associated with fewer deaths in the early resuscitation period, suggesting a paradoxically protective effect in patients with CS.

Trial registration ClinicalTrials.gov Identifier: NCT03207165

Simultaneous electrochemical detection of guanine and adenine using reduced graphene oxide decorated with AuPt nanoclusters

A rapid and sensitive electrochemical sensing platform is reported based on bimetallic gold-platinum nanoclusters (AuPtNCs) dispersed on reduced graphene oxide (rGO) for the simultaneous detection of guanine and adenine using square wave voltammetry (SWV). The synthesis of AuPtNCs-rGO nanocomposite was achieved by a simultaneous reduction of graphene oxide (GO) and metal ions (Au³⁺ and Pt⁴⁺) in an aqueous solution. The developed AuPtNCs-rGO electrochemical sensor with the optimized 50:50 bimetallic (Au:Pt) nanoclusters exhibited an outstanding electrocatalytic performance towards the simultaneous oxidation of guanine and adenine without the aid of any enzymes or mediators in physiological pH. The electrochemical sensor platform showed low detection limits of 60 nM and 100 nM (S/N = 3) for guanine and adenine, respectively, with high sensitivity and an extensive linear range from 1.0 μM to 0.2 mM for both guanine and adenine. The interference from the most common electrochemically active interferents, including ascorbic acid, uric acid, and dopamine, was almost negligible. The simultaneous sensing of guanine and adenine in denatured Salmon Sperm DNA sample was successfully achieved using the proposed platform, showing that the AuPtNCs-rGO nanocomposite could provide auspicious clinical diagnosis and biomedical applications.

[Impacts of incomplete revascularization following off-pump coronary artery bypass grafting on perioperative outcomes in octogenarians]

Objective: To assess the impacts of incomplete revascularization following off-pump coronary artery bypass grafting (OPCABG) on perioperative outcomes in octogenarians. Methods: A retrospective analysis of 242 octogenarian patients with coronary artery disease (CAD) hospitalized in Beijing Anzhen Hospital from June 2008 to July 2016 was performed. These patients were divided into the complete revascularization group (n=181) and the incomplete revascularization group (n=61) depending on whether they underwent complete revascularization. The impacts of incomplete revascularization following OPCABG on perioperative outcomes were summarized and compared between the two groups. Results: Among the 242 patients over 80 years who received OPCABG, there were 198 males (81.8%). Compared to the complete revascularization group, those in the incomplete revascularization group were older [(83.2±1.5) vs (81.5±1.1) years old, P=0.03], with more carotid stenosis (44.3% vs 25.4%, P=0.01), more involved in the diagonal and circumflex branch of coronary artery (49.2% vs 17.1%, P=0.01; 83.6% vs 70.2%, P=0.03), shorter operative time [(4.1±1.7) h vs (4.7±1.2) h, P=0.03), longer preoperative [(7.1±2.3) d vs (5.2±2.0) d, P=0.01] and total hospitalization time [(16.3±6.8) d vs (12.5±4.2) d, P=0.01], however, the differences of the in-hospital mortality and incidence of other perioperative complications were not statistically significant between the two groups (all P>0.05). Conclusion: Compared with complete revascularization, incomplete revascularization following OPCABG in CAD patients over 80 years old does not increase the perioperative mortality and the incidence of other complications, and it reduces the operative time. However, it increases the time of preoperative and total hospital stay.

Molecular genetic analysis in 21 Chinese families with congenital insensitivity to pain with or without anhidrosis

BACKGROUND AND PURPOSE

Hereditary sensory and autonomic neuropathies (HSANs) are a group of clinically and genetically heterogeneous neurological disorders characterized by sensory dysfunctions. Here, 21 affected Chinese families are reported, including 19 with congenital insensitivity to pain with anhidrosis (CIPA; namely HSAN IV) and two with congenital insensitivity to pain (CIP; namely HSAN IID) caused by biallelic variations in NTRK1 and SCN9A, respectively, aiming to identify causative variants in these families and compare how different variants in NTRK1 affect the function of tropomyosin receptor kinase A (TrkA).

METHODS

Recombinant plasmids harboring the wild-type and six mutant alleles (p.Gln216*, p.Glu584Lys, p.Leu595Arg, p.Pro684Leu, p.Val709Leu and p.Arg765Cys) of NTRK1 cDNA were constructed and transfected into HEK293 cells.

RESULTS

The results suggested that the five missense variants only presented a subtle influence on the expression level and glycosylation of TrkA but compromised the receptor phosphorylation. Our findings also suggested that a synonymous variant c.219C>T in NTRK1 may cause aberrant splicing, indicating a potential novel pathogenic mechanism of CIPA. Furthermore, gross deletion of SCN9A was first associated with CIP.

CONCLUSIONS

This study identified multiple forms of variants responsible for CIPA/CIP in the Chinese population and might provide new insights into the pathogenesis of CIPA.

[A comparative analysis of quality of life between surgical and interventional treatment in patients with complex coronary heart disease]

Objective: To compare the improvement of quality of life in the patients with left main coronary artery disease and multi-vessel disease between off-pump coronary artery bypass grafting (OPCABG) and percutaneous coronary intervention (PCI) within one year after revascularization. Methods: This study was a prospective study. Between January and July 2018, 840 patients with complex coronary heart disease accepted revascularization therapy, 420 of whom underwent OPCABG and 420 for PCI, with a mean age of 61 years and a male rate of 74% (622/840). European Quality of Life-5 Dimensions (EQ-5D) and Seattle Angina Questionnaire (SAQ) were employed to assess the quality of life and health status of patients. Inverse probability weighting (IPW) was used to adjust treatment selection bias. Results: All-cause mortality (3.6% vs 1.3%, P=0.045), major adverse cardiac and cerebrovascular events (MACCE) (11.3% vs 4.1%, P<0.001) and target lesion revascularization (8.3% vs 1.2%, P<0.001) were higher in PCI group than those in OPCABG group. EQ-5D scores in PCI group were significantly higher than those in OPCABG group at 1 month after operation (P<0.001), but there was no significant difference between the two groups at 12 months after operation (P=0.210). In SAQ scale, the frequency score of angina pectoris in OPCABG group was higher than that in PCI group in 1 month, 6 months and 12 months after operation (all P<0.05). The physical activity limitation score in PCI group was significantly higher than that in OPCABG group at one month after operation (P<0.01). There was no significant difference between OPCABG group and PCI group in terms of stable state of angina pectoris, satisfaction of treatment and the knowledge of disease. Conclusions: In the short term, the quality of life of patients with left main coronary artery disease and multi-vessel disease treated with OPCABG is better than PCI. However, the improvement of quality of life in the medium and long term still needs to be identified in future follow-up study.

Efficient dye removal and separation based on graphene oxide nanomaterials

Different graphene-based nanomaterials were synthesized and tested for dye removal, showing that graphene oxide demonstrates high capability for the separation of cationic and anionic dyes.

Comparing the efficacy of targeted next-generation sequencing in the identification of somatic mutations in circulating tumor DNA from different stages of lung cancer

This study aims to assess the potential clinical application of targeted next generation sequencing (NGS)-based deep sequencing for the detection of clinically relevant mutations in circulating tumor DNA (ctDNA) obtained from non-small cell lung cancer (NSCLC) patients. Targeted deep sequencing was performed to identify High Confidence Somatic Variants (HCSVs) in matched tumor tissue DNA (tDNA) and ctDNA in 50 NSCLC patients. Our results demonstrated that NSCLC patients with Stage IV (61.5%) exhibited a higher concordance rate at the mutation level between plasma ctDNA and tDNA samples than those with Stage I-III (14.5%). Moreover, it is noteworthy that the allele frequency of these detected HCSVs in ctDNA increased with the advance in tumor stage. Besides, using tDNA as a reference, the sensitivity of plasma ctDNA analyzed by deep NGS for actionable EGFR was much higher in patients with Stage IV (66.6%) than those with Stage I-III (7.7%). In conclusion, it appears that ctDNA NGS-based deep sequencing is a feasible approach to identify mutations in patients with Stage IV NSCLC. However, additional methods with higher sensitivity and specificity are needed to improve the successful application of this platform in the earlier stages of NSCLC.

Presence of pldA and exoU in mucoid Pseudomonas aeruginosa is associated with high risk of exacerbations in non-cystic fibrosis bronchiectasis patients

OBJECTIVES

To explore the association between the virulence genes exoU and pldA in isolated mucoid Pseudomonas aeruginosa and the clinical outcomes of patients with non-cystic fibrosis (CF) bronchiectasis.

METHODS

A prospective observational cohort study was performed in the Shanghai Pulmonary Hospital from October 2012 to January 2015. We consecutively enrolled all non-CF bronchiectasis patients with mucoid P. aeruginosa isolates obtained from bronchoalveolar lavage fluid or sputum. The exposure variable was the presence of virulence gene, exoU or pldA, in the strains. The primary outcome was exacerbation of bronchiectasis. Logistic regression analysis was performed to evaluate the association between virulence genes and exacerbation.

RESULTS

The final analysis included 147 patients (mean (SD) age, 57.86 (11.43) years, 101 female subjects) with median (interquartile range) follow-up of 18 (13-26) months. The following factors were relative to exacerbations: body mass index ≤18.5 kg/m² (odds ratio (OR) = 5.05; 95% confidence interval (CI), 1.37-18.57), length of stay ≥8 days (OR = 2.65; 95% CI, 1.14-6.19) and positive for either virulence gene (OR = 6.80; 95% CI, 1.47-31.37). The gene-positive group had more exacerbations per year (mean 2.37, SD 2.10, n = 33 vs. mean 0.79, SD 0.83, n = 114) and a higher proportion of patients with exacerbation (31/33, 93.94% vs. 74/114, 64.91%). The proportion of patients being exoU or pldA positive increased as the exacerbation frequency of bronchiectasis increased.

CONCLUSIONS

The virulence genes exoU and pldA in mucoid P. aeruginosa are significant risk factors for exacerbations in patients with non-CF bronchiectasis.

TNFα-YAP/p65-HK2 axis mediates breast cancer cell migration

Clinical and experimental evidence indicates that macrophages could promote solid-tumor progression and metastasis. However, the mechanisms underlying this process remain unclear. Here we show that yes-associated protein 1 (YAP1), a transcriptional regulator that controls tissue growth and regeneration, has an important role in tumor necrosis factor α (TNF α)-induced breast cancer migration. Mechanistically, macrophage conditioned medium (CM) or TNFα triggers IκB kinases (IKKs)-mediated YAP phosphorylation and activation in breast cancer cells. We further found that TNFα or macrophage CM treatment increases the interaction between p65 and YAP. Chromatin immunoprecipitation (ChIP) assay shows that YAP/TEAD (TEA domain family member) and p65 proteins synergistically regulate the transcription of hexokinase 2 (HK2), a speed-limiting enzyme in glycolysis, and promotes TNFα-induced or macrophage CM-induced cell migration. Together, our findings indicate an important role of TNFα-IKK-YAP/p65-HK2 signaling axis in the process of inflammation-driven migration in breast cancer cells, which reveals a new molecular link between inflammation and breast cancer metastasis.

Asthma-COPD overlap syndrome showed more exacerbations however lower mortality than COPD

BACKGROUND

Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is a new determinate syndrome whose exact characteristics remain unclear.

AIM

The objective of this study is to find more difference between ACOS and COPD.

DESIGN

A retrospective study of ACOS and COPD in Chinese.

METHODS

Data from 65 patients with ACOS and 65 patients with COPD were retrospectively collected and analyzed. The basis of this study was to compare the two groups while ruling out differences in age, sex and smoking history.

RESULTS

Patients with ACOS tended to have earlier ages of onset, longer durations of symptoms, better nutritional status, higher single-breath diffusing capacity of carbon monoxide (DLCO) %predicted and airway resistance %predicted, more exacerbations in the preceding 12 months and shorter lengths of hospitalization. DLCO %predicted, airway resistance %predicted, and length of hospitalization were the variables most significantly associated with the presence of ACOS in patients with COPD. ROC correlating airway resistance %predicted value and current ACOS showed an optimal cutoff of airway resistance %predicted of over 296.6. During follow-up (median: 45 months; interquartile range: 6-82 months), 16 patient deaths were recorded (3 patients with ACOS). The risk remained significantly higher in patients with COPD alone than in patients with ACOS (HR 3.932; 95% CI 1.083-19.755; P  = 0.046).

CONCLUSION

Patients with ACOS were more likely to have better prognoses and lower mortality than those with COPD alone, though with greater exacerbation frequency.

Novel cobalt quantum dot/graphene nanocomposites as highly efficient electrocatalysts for water splitting

A cost-effective, non-noble metal based high-performance electrocatalyst for the oxygen evolution reaction (OER) is critical to energy conversion and storage processes. Here, we report on a facile and effective in situ strategy for the synthesis of an advanced nanocomposite material that is comprised of cobalt quantum dots (Co QDs, ∼3.2 nm), uniformly dispersed on reduced graphene oxide (rGO) as a highly efficient OER electrocatalyst platform. This nanocomposite electrocatalyst afforded a mass activity of 1250 A g(-1) at a low overpotential (η) of 0.37 V, a small Tafel slope of ∼37 mV dec(-1) and a turnover frequency (TOF) of 0.188 s(-1) in 0.1 M KOH, comparing favorably with state-of-the-art RuO2, IrO2 and Pt/C catalysts. The synergy between abundant catalytically active sites through the fine dispersion of Co QDs, and enhanced electron transfer generated from the graphene resulted in first-rate electrocatalytic properties toward the OER. These merits coupled with the higher stability of the nanocomposite hold great promise for triggering breakthroughs in electrocatalysis for water splitting.

Novel β-carbolines against colorectal cancer cell growth via inhibition of Wnt/β-catenin signaling

Wnt signaling pathway is aberrantly activated in a variety of cancers, especially in colorectal cancer (CRC), because of mutations in the genes encoding adenomatous polyposis coli (APC), β-catenin and Axin. Small-molecule antagonists of Wnt/β-catenin signaling are attractive candidates for developing effective therapeutics for CRC. In this study, we have identified a novel Wnt signaling inhibitor, isopropyl 9-ethyl-1- (naphthalen-1-yl)-9H-pyrido[3,4-b]indole-3- carboxylate (Z86). Z86 inhibited Wnt reporter activities and the expression of endogenous Wnt signaling target genes in mammalian cells and antagonized the second axis formation of Xenopus embryos induced by Wnt8. We showed that Z86 treatment inhibits GSK3β (Ser9) phosphorylation, leading to its overactivation and promoting the phosphorylation and degradation of β-catenin. In vitro, Z86 selectively inhibited the growth of CRC cells with constitutive Wnt signaling and caused obvious G1-phase arrest of the cell cycle. Notably, in a nude mouse model, Z86 inhibited dramatically the xenografted tumor growth of CRC. Daily intraperitoneal injection of Z86 at 5 mg/kg resulted in >70% reduction in the tumor weight of HCT116 cell origin that was associated with decreased GSK3β (Ser9) phosphorylation and increased β-catenin phosphorylation. Taken together, our findings provide a novel promising chemotype for CRC therapeutics development targeting the canonical Wnt signaling.

Corticosteroids for the treatment of human infection with influenza virus: a systematic review and meta-analysis

Administration of corticosteroids to patients affected by influenza virus, especially pandemic avian influenza virus, although relatively common, remains controversial. A systematic review and meta-analysis was performed to assess the impact of corticosteroid treatment on outcomes of patients with influenza virus infection. The PubMed, EMBASE, Web of Science and Cochrane Library databases were searched up to February, 2015. Studies comparing corticosteroid treatment with no corticosteroid treatment in patients with influenza virus infection were included. The primary outcomes assessed were the association of mortality and nosocomial infection with corticosteroid treatment. Two authors independently extracted the data. ORs and weighted mean differences (WMDs) were used to describe dichotomous data and continuous data, respectively. Nineteen studies with 4916 patients were included in this meta-analysis. The results showed that corticosteroid treatment was significantly associated with mortality (OR 1.98, 95% CI 1.62-2.43, p < 0.00001) and nosocomial infection (OR 3.16, 95% CI 2.09-4.78, p < 0.00001). The durations of mechanical ventilation (WMD 3.82, 95% CI 1.49-6.15, p 0.001) and intensive-care unit stay (WMD 4.78, 95% CI 2.27-7.29, p 0.0002) were both markedly longer in the corticosteroid treatment group than in the control group. These findings suggest that routine steroid use may not be ideal for influenza virus infection. However, these results are derived from observational studies, with some important biases. They should be examined in future sufficiently powered randomized trials.

The combined effect of bacteria and Chlorella vulgaris on the treatment of municipal wastewaters

Impacts of Chlorella vulgaris with or without co-existing bacteria on the removal of nitrogen, phosphorus and organic matter from wastewaters were studied by comparing the wastewater treatment effects between an algae-bacteria consortium and a stand-alone algae system. In the algae-bacteria system, C.vulgaris played a dominant role in the removal of nitrogen and phosphorus, while bacteria removed most of the organic matter from the wastewater. When treating unsterilized wastewater, bacteria were found to inhibit the growth of algae at >231 mg/L dissolved organic carbon (DOC). Using the algae-bacteria consortium resulted in the removal of 97% NH4(+), 98% phosphorus and 26% DOC at a total nitrogen (TN) level of 29-174 mg/L. The reaction rate constant (k) values in sterilized and unsterilized wastewaters were 2.17 and 1.92 mg NH4(+)-N/(mg algal cell ·d), respectively.

Cultivation of Chlorella vulgaris on wastewater containing high levels of ammonia for biodiesel production

The feasibility of cultivating Chlorella vulgaris with wastewater containing high ammonia nitrogen concentrations was examined. The average specific growth rate of C. vulgaris was 0.92 d(-1) at 17 mg L(-1) NH4+-N, but declined to 0.33 d(-1) at NH4+-N concentrations of 39-143 mg L(-1). At 39 mg L(-1) NH4+-N, lipid productivity reached a maximum value (23.3 mg L(-1)d(-1)) and dropped sharply at higher NH4+-N levels, which demonstrated NH4+-N should be controlled for biodiesel production. C16 and C18 fatty acids accounted for 80% of total fatty acids. Increasing NH4+-N from 17 to 207 mg L(-1) yielded additional short-chain and saturated fatty acids. Protein content was in positive correlation with NH4+-N content from 17 mg L(-1) (12%) to 207 mg L(-1) (42%). Carbohydrate in the dried algae cell was in the range of 14-45%, with a peak value occurring at 143 mg L(-1) NH4+-N. The results demonstrate that product quality can be manipulated by NH4+-N concentrations of the initial feeds.

Molecular dynamics simulation by atomic mass weighting

A molecular dynamics-based simulation method in which atomic masses are weighted is described. Results from this method showed that the capability for conformation search in molecular dynamics simulation of a short peptide (FMRF-amide) is significantly increased by mass weighting.

Placement of covered stents for the treatment of direct carotid cavernous fistulas

BACKGROUND AND PURPOSE

Endovascular detachable balloon occlusion and coil occlusion are 2 well-established options for the treatment of direct carotid cavernous fistulas (DCCFs). In recent years, covered stents have been applied in the treatment of neurovascular pathologies such as aneurysms, pseudoaneurysms, arterial dissections, and DCCFs. The purpose of this study was to investigate the clinical efficacy of covered stents for the treatment of DCCFs.

MATERIALS AND METHODS

Ten consecutive patients underwent covered-stent placement after failure of detachable balloon occlusion for the treatment of their DCCFs. Clinical and angiographic follow-up ranged from 5 to 48 months (mean, 18.2 months) after stent placement.

RESULTS

Stent placement was technically successful in all except 1 patient. In this patient, stent placement failed after multiple attempts because of rigidity of the Jostent GraftMaster Coronary Stent Graft and the tortuous anatomy of the internal carotid artery (ICA). Complete exclusion of the fistula was achieved in 6 patients immediately after stent deployment. Endoleak was observed in 3 patients. Re-dilation of the stent avoided the endoleak in 2 patients; in 1 of these 2 patients, formerly improved symptoms recurred the next morning and the ipsilateral ICA was occluded with detachable balloons. Spasm of the ICA was observed in most of the patients after stent placement; however, angioplasty was not required. Symptoms improved in all patients after treatment, without thromboembolic events. Follow-up cerebral angiography showed complete exclusion of all DCCFs and stent patency without intrastent stenosis in the 8 patients who had successful deployment of the stent.

CONCLUSIONS

Although a larger sample and expanded follow-up are needed, our series shows that covered stents can be used in the treatment of DCCFs with symptomatic relief.

Superior mesenteric arterial embolism: a retrospective study of local thrombolytic treatment with urokinase in West China

Embolism of the superior mesenteric artery (SMA) is a rare disorder. To explore the selective criteria of local thrombolysis, evaluate its efficacy and discuss the therapeutic protocol of SMA embolism, a retrospective case control study was undertaken. Sixteen cases were divided into two groups: nine cases (group A) from May 1995 to April 1999 were given traditional treatment, while seven cases (group B) from November 1999 to June 2002 received comprehensive therapy including local thrombolysis. The local thrombolytic treatment was performed without procedure-related complications and the embolus was successfully lysed in four patients. The time between admission and diagnosis (or treatment) was shorter in group B than in group A (2.3 +/- 1.2 vs 12.3 +/- 9.2 hr, p = 0.013). Gangrenous bowel segments in group A were much longer than in group B (159.4 +/- 87.7 vs 45.7 +/- 61.6 cm, p = 0.009). However, mortality between the two groups was the same (p = 0.282, OR = 0.32, 95% CI = 0.039, 2.618) perhaps because of the small sample size. Angiography could shorten the duration from the onset of SMA embolism to therapy and certainly lowers the risk of mortality. Local fibrinolytic infusion may be an effective alternative to embolectomy in patients with SMA embolism but without intestinal infarction.

[The CPBC types used for clinical choice and observation on their microstructure]

According to the primary properties of calcium phosphate bone cement (CPBCs), we have chosen certain types of them for use in cranioplasty and have observed the microstructure of their set bodies by means of SEM. Five kinds of CPBCs powder have been prepared, including: octacalcium phosphate precipitated hydroxyapatite (OCP-PHA) type, octacalcium phosphate hydroxyapatite (OCP-HA) type, octacalcium phosphate (OCP) type, calcium deficient hydroxyapatite (CDHA) type and hydroxyapatite (HA) type. The mixing liquids were deionized water and 0.25 M Na2HPO4/NaH2PO4 buffer solution. The setting time was measured by Gillmore method. The compressive strengths were measured using the TS-14 automatically measured instrument-II of single granule's compressive strength. The CPBC types used for clinical cranioplasty were defined according to Ginebra's Criteria of the CPBCs, and the ultrastructure of the set-bodies of the defined CPBC type was observed by SEM before and after its immersion in Ringer's Solution.

RESULT

Two out of five CPBCs, OCP-PHA-CPBC and CDHA-CPBC were selected for clinical cranioplasty. Before and after they were immersed in Ringer's Sol., the SEM found their set-bodies to be structurally porous and to dissolve with the increase of immension time. These data indicate that OCP-PHA-CPBC and CDHA-CPBC are sufficient for the reconstruction of non-stress-bearing bone, and the porous structure of their set-bodies is advantageous to fibroplasty or fibrovasculization in their set bodies.

Clinical features of diffuse axonal injury

OBJECTIVE

To analyze the mechanism of diffuse axonal injury (DAI) and study the relationship between DAI and brain concussion, brain contusion, and primary brain stem injury.

METHODS

The clinical data and iconographic characteristics of 56 patients with DAI were analyzed retrospectively.

RESULTS

Traffic accidents were the main cause of DAI. Among t he 56 cases, 34 were injured for at least twice, and 71.43% of the patients were complicated with contusion.

CONCLUSIONS

It is considered that DAI is a common pattern of primary brain injury, which is often underestimated. And DAI includes cerebral concussion and primary brain injury, and is often complicated by cerebral cortex contusion. Therefore, it is very simple and practical to divide primary brain injuries into local and diffuse injuries.

Association of HIF-1alpha expression and cell apoptosis after traumatic brain injury in the rat

OBJECTIVE

To explore the expression of hypoxia inducible factor-1alpha (HIF-1alpha) and the correlation between HIF-1alpha and apoptosis after traumatic brain injury.

METHODS

Using experimental traumatic brain injury in the rats, the expression of HIF-1alpha was studied by immunohistochemistry in cerebral tissue, apoptotic cell death was evaluated with TUNEL (transferase-mediated X-dUTP nick end labeling), and double-labeled immunohistochemistry and TUNEL methods were used to investigate the relationship between HIF-1alpha and apoptosis.

RESULTS

There was remarkable difference in the expression of H IF-1alpha between the experimental groups and the control groups (P<0.01), in the experimental groups, the expression of HIF-1alpha at 48 hours was highest; the evidence of apoptotic cell death after experimental traumatic brain injury was found by TUNEL; the apoptotic percentage increased or decreased according to the changes of the positive expression of HIF-1alpha (r=0.99).

CONCLUSIONS

The results suggest that secondary brain ischemia plays a crucial role in apoptotic cell death after traumatic brain injury; HIF-1alpha can prompt apoptotic cell death after experimental traumatic brain injury.

[Inhibitory effects of phosphorothioate antisense oligonucleotides on gene expression controlled by HCV 5'NCR in nude mice xenograft]

OBJECTIVE

To evaluate the activity in vivo of 3 phosphorothioate antisense oligonucleotides, HCV363, HCV279 and HCV349 using nude mice xenograft models based on the establishment of HCV 5' NCR transgenic cellular model (HepG2.9706).

METHODS

Female BALB/C nude mice, aged 4 to 6 weeks and weighing around 20g, were implanted s.c. with 100mul (106 cells) of the HepG2.9706 cells suspension in the lower-back region. In approximate 1 weeks, the animals were randomly grouped and intraperitoneally administrated the antisense drugs at 10 mg/kg body weight.

RESULTS

HCV363, HCV279 and HCV349 had obvious sequence-specific inhibitory effects on luciferase expression controlled by HCV 5' NCR in xenograft cells with the inhibitory rates of 80.4%, 78.6% and 47.9%, respectively. The effects of three different concentrations (5, 10, 20 mg/kg body weight) of HCV363 indicated that HCV363 increased the inhibitory activities on luciferase expression following the concentration raise and its inhibitory rate was up to 82.7%.

CONCLUSIONS

This study suggests that antisense oligonucleotides may provide a novel therapeutic approach to the treatment of HCV infection.

Calcium imaging of epileptiform events with single-cell resolution

Epileptic discharges propagate through apparently normal circuits, although it is still unclear how this recruitment takes place. To understand the role of different classes of neurons in neocortical epilepsy, we have developed a novel imaging assay that detects which neurons participate in epileptiform discharges. Using calcium imaging of neuronal populations during bicuculline-induced spontaneous epileptiform events in slices from juvenile mouse somatosensory cortex, we find that fast calcium transients correlate with epileptiform field potentials and intracellular depolarizing shifts and can be used as an optical signature that a given neuron has participated in an epileptiform event. Our results demonstrate a novel method to characterize epileptiform events with single-cell resolution. In addition, our data are consistent with an important role for layer 5 in generating neocortical seizures and indicate that subgroups of neurons are particularly prone to epileptiform recruitment.

[Expression of KDR in medulloblastoma and its clinical implication]

OBJECTIVE

To gain an insight into the possible relationship between the expression of kinase insert domain-containning receptor (KDR) and the prognosis of medulloblastoma.

METHODS

Fifty cases of medulloblastoma of the posterior fossa and ten cases of normal cerebellar tissue were studied via a combination of immunnohistochemical staining in formalin fixed paraffin-embedded sections.

RESULTS

KDR was expressed weakly in 1 of 10 normal cerebellar tissues, while KDR was either moderately or strongly expressed in most of the medulloblastomas (49 of 50 cases). Moreover, KDR was expressed not only in the endothelial cells of tumor vasculature, but also in tumor cells. Correlation analysis indicated that expression of KDR was correlated significantly with survival time (r = -0.527, P < 0.01).

CONCLUSION

KDR was expressed in most of the medulloblastomas, not only in the endothelial cells of tumor vasculature, but also in tumor cells. The expression level of KDR had a negative correlation with the survival time, thus it might be used as one of the prognosticators of medulloblastoma.

[Expression and significance of urokinase-type plasminogen activator in medulloblastoma]

OBJECTIVE

To detect the expression and evaluate the clinical significance of urokinase-type plasminogen activator (uPA) in medulloblastoma.

METHODS

LSAB (labelled streptavidin biotin method) immunohistochemical technique was applied for detecting the expression of uPA in 50 patients with medulloblastoma, and a follow-up survey with Cox regression analysis was made.

RESULTS

The staining for uPA was localized on tumor cells and endothelial cells. Cox regression analysis showed that uPA was an independent prognostic factor affecting survival and it had a negative correlation with the prognosis.

CONCLUSION

uPA appears to be an independent marker for predicting the prognosis of medulloblastoma.

LDL-receptor-related protein 6 is a receptor for Dickkopf proteins

Wnt glycoproteins have been implicated in diverse processes during embryonic patterning in metazoa. They signal through frizzled-type seven-transmembrane-domain receptors to stabilize beta-catenin. Wnt signalling is antagonized by the extracellular Wnt inhibitor dickkopf1 (dkk1), which is a member of a multigene family. dkk1 was initially identified as a head inducer in Xenopus embryos but the mechanism by which it blocks Wnt signalling is unknown. LDL-receptor-related protein 6 (LRP6) is required during Wnt/beta-catenin signalling in Drosophila, Xenopus and mouse, possibly acting as a co-receptor for Wnt. Here we show that LRP6 (ref. 7) is a specific, high-affinity receptor for Dkk1 and Dkk2. Dkk1 blocks LRP6-mediated Wnt/beta-catenin signalling by interacting with domains that are distinct from those required for Wnt/Frizzled interaction. dkk1 and LRP6 interact antagonistically during embryonic head induction in Xenopus where LRP6 promotes the posteriorizing role of Wnt/beta-catenin signalling. Thus, DKKs inhibit Wnt co-receptor function, exemplifying the modulation of LRP signalling by antagonists.

[Expression of C-myc and N-myc protein in adulthood and childhood medulloblastomas and prognostic analysis]

OBJECTIVE

To detect the expression of C-myc and N-myc in medulloblastomas, the difference between adults and children, and the relation between expression and prognosis.

METHODS

ABC immunostaining was used to detect C-myc and N-myc protein expression in 21 cases of adulthood medulloblastomas and 14 childhood cases. Follow-up materials were obtained to perform survival curve analysis.

RESULTS

Of these 35 cases, 5 (4 children, 1 adult) showed C-myc positive expression. No N-myc expression was found. There was no relationship between expression and survival.

CONCLUSION

C-myc may play a role in the tumorgenesis of medulloblastoma, especially in children, but it is of no prognostic significance. N-myc antigen may be lost during the fixation of specimens.

[Effect of hypoxia and carbon monoxide on rat pulmonary arterial smooth muscle cell]

OBJECTIVE

To investigate the effect of carbon monoxide on rat pulmonary arterial smooth muscle cell (VSMC).

METHODS

Three groups were randomly divided, (1) Normoxia group(N), (2) Hypoxia group(H), (3) 3% CO + 1% O2 group (CO + H), then tested by immunocytochemical analysis 3H-TdR in incorporation.

RESULTS

(1) Hypoxia initiated the chang of VSMC from contractile phenotype to synthetic phenotype, the endoplasmic reticulum became dilated, the mitochondria became swollen and myelin figure appeared. alpha-actin and muscle fiber decreased. The form of VSMC in CO + H was similar to that in N. (2) Intracellular Ca2+ level of VSMC in H [4 h, 8 h, 12 h, 24 h, 36 h were (382.00 +/- 37.92) mmol/L, (456.00 +/- 53.76) mmol/L, (517.00 +/- 47.34) mmol/L, (608.00 +/- 35.92) mmol/L, (567.00 +/- 46.72) mmol/L, respectively] increased significantly(P < 0.01) than in N[4 h was(319.00 +/- 47.45) mmol/L], but that in CO + H increased slightly. (3) cAMP and cGMP level of VSMC in H increased significantly, cAMP of VSMC in CO + H increased significantly [2 h, 8 h, 12 h, 24 h were (1.87 +/- 0.36) pmol/mg protein, (2.16 +/- 0.36) pmol/mg protein, (2.36 +/- 0.41) pmol/mg protein, (2.12 +/- 0.39) pmol/mg protein, respectively] but cGMP of VSMC in CO + H increased slightly[2 h, 8 h, 12 h, 24 h were (0.52 +/- 0.21) pmol/mg protein, (0.58 +/- 0.21) pmol/mg protein, (0.60 +/- 0.24) pmol/mg protein, (0.68 +/- 0.29) pmol/mg protein, respectively].

CONCLUSION

Hypoxia may promote the proliferation of VSMC by second messenger system and CO in low desities can depress the action of hypoxia partly by Ca(2+)-cGMP system or by the expression of E2F-1 gene.