Designing Patient-Centered Health Education Materials for Radiation Dermatitis in Breast Cancer Patients: A Pilot Study and Single-Center Clinical Trial

PURPOSE/OBJECTIVE(S)

For breast cancer patients receiving radiotherapy (RT), radiation dermatitis is the most commonly experienced discomfort. However, patients usually do not participate in the design of health education materials regarding radiation dermatitis. We designed a pilot study to investigate the unmet need of breast cancer patients who would be receiving RT at our department and created a patient-centered educational video. We initiated a single-arm clinical trial to evaluate the effectiveness of the video in improving patient and their family's knowledge of radiation dermatitis, alleviating their anxiety, and helping patients improve self-care skills during RT course.

MATERIALS/METHODS

The pilot study was executed in a radiation oncology department of a tertiary medical center in Taiwan. We designed a questionnaire to explore new breast cancer patients' idea of a comprehensive pre-RT health education. Enrolled patients would fill out an electronic questionnaire during their first visit at our outpatient clinic. They were asked to select at most two of the following items they considered most important for pre-RT health education: (1) The mechanism behind RT; (2) Self-care skills for irradiated skin; (3) Activities to be avoided during RT course; (4) The toxicity grading of radiation dermatitis. Given the above information, we created a 4-minute video set in a clinical scenario of a patient receiving pre-RT health education from a nurse. A single-arm clinical trial (IRB approval number: CMUH111-REC2-121) is currently recruiting. The video was launched on YouTube (Link: https://youtu.be/O1uTXpS_ed0) to give patients easy access to the video. Enrolled patients would complete Skindex-16 survey (translated into Chinese) at 3 timepoints: during their first visit at our clinic, in the middle of RT course, and at the first post-RT follow-up visit. Cronbach's alpha test was applied to determine the internal consistency of the questionnaires.

RESULTS

The pilot study included 19 patients with an average age of 46.6 (range: 34 to 69) years old. All patients' primary language was Chinese Mandarin. Most patients (84%) received at least secondary education. We found by surprise that RTOG skin toxicity grading was considered very important for most patients (79%), while less than half (42%) found the mechanism behind RT important. The internal validity of the Chinese version of Skindex-16 was good (Cronbach's alpha score = 0.87). For the recruiting trial, we have enrolled 10 patients and planned to close the trial upon enrolling 50 participants. The study result should be available before August 2023.

CONCLUSION

We suggest to actively involve patients in designing health education materials for patient-centered care. Toxicity grading of radiation dermatitis should be included in pre-RT health education for breast cancer patients. Whether the educational video helps reduce patients' anxiety and the incidence of severe radiation dermatitis will soon be answered by our ongoing clinical trial.

Increased Interleukin-17 and Glucocorticoid Receptor-β Expression in Interstitial Lung Diseases and Corticosteroid Insensitivity

Background

Treatment responsiveness to corticosteroids is excellent for cryptogenic organizing pneumonia (COP) and sarcoidosis, but suboptimal for idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP). We hypothesise that the differential expression of IL-17 contributes to variable corticosteroid sensitivity in different interstitial lung diseases.

Objective

To determine the associations among expression of IL-17, glucocorticoid receptor-β and responsiveness to corticosteroid treatment in interstitial lung diseases.

Methods

Immunohistochemical (IHC) staining was performed on formalin-fixed paraffin-embedded (FFPE) lung tissues obtained by bronchoscopic, CT-guided or surgical biopsies, and quantified by both cell counting (% positive cells) by individuals and by software IHC Profiler plugin of ImageJ (opacity density score). We studied the effect of IL-17 on corticosteroid sensitivity in human fibroblast MRC5 cell line.

Results

Compared with specimens from patients with COP (n =13) and sarcoidosis (n =13), those from IPF patients (n = 21) had greater GR-β and IL-17 expression and neutrophil infiltration. Radiographic progression after oral corticosteroid treatment was positively correlated with the expression in IL-17 and GR-β/GR-α ratio in all patients (COP, sarcoidosis and IPF) and also within the IPF subgroup only. IL-17 expression level was positively associated with GR-β and GR-β/GR-α ratio. In MRC5 cells, exogenous IL-17 increased the production of collagen I and up-regulated GR-β expression and dexamethasone’s suppressive effect on collagen I production was impaired by IL-17, and silencing IL-17 receptor A gene attenuated the effect of IL-17.

Conclusion

Up-regulation of GR-β/GR-α ratio by IL-17 could be associated with the relative corticosteroid-insensitivity of IPF.

Oxygen Desaturation Is Associated With Fibrocyte Activation via Epidermal Growth Factor Receptor/Hypoxia-Inducible Factor-1α Axis in Chronic Obstructive Pulmonary Disease

Fibrocytes are bloodborne mesenchymal progenitors which accumulate and differentiate at the disease site. We investigated whether hypoxemia activates fibrocytes, accelerating airflow limitation and exercise intolerance in chronic obstructive pulmonary disease (COPD) patients. Flow cytometry was used to determine collagen I+/CD45+ fibrocytes and α-smooth muscle actin+ differentiating fibrocytes within peripheral blood and cultured cells, as well as the expression of CXC chemokine receptor 4 (CXCR4), epidermal growth factor receptor (EGFR), connective tissue growth factor (CTGF) and hypoxia-inducible factor (HIF)-1α. Fibrocytes in lung specimens were identified by confocal microscopy. Compared to non-desaturators, COPD desaturators (peripheral blood oxygen saturation ≤88% during exercise) had greater number of fibrocytes in peripheral blood and lung specimens, paralleled with faster yearly lung function decline and a 6-minute walk distance. Fibrocytes from desaturators expressed more EGFR, CXCR4, CTGF, and HIF-1α, with a higher capacity of proliferation and myofibroblastic differentiation. Hypoxia (5% oxygen) increased the expression of EGFR, CXCR4, CTGF, and HIF-1α, the number and differentiation in fibrocytes. These effects were attenuated by EGFR inhibitor gefitinib, HIF-1α gene silencing, and anti-CTGF antibody. These data elucidate that hypoxemia triggers fibrocyte activation through the EGFR/HIF-1α axis, aggravating airflow obstruction in COPD.

Host Genetic Associations with Salivary Microbiome in Oral Cancer

Despite the growing recognition of a host genetic effect on shaping gut microbiota composition, the genetic determinants of oral microbiota remain largely unexplored, especially in the context of oral diseases. Here, we performed a microbiome genome-wide association study in 2 independent cohorts of patients with oral squamous cell carcinoma (OSCC, n = 144 and 67) and an additional group of noncancer individuals (n = 104). Besides oral bacterial dysbiosis and signatures observed in OSCC, associations of 3 loci with the abundance of genus-level taxa and 4 loci with β diversity measures were detected (q < 0.05) at the discovery stage. The most significant hit (rs10906082 with the genus Lachnoanaerobaculum, P = 3.55 × 10^-9 at discovery stage) was replicated in a second OSCC cohort. Moreover, the other 2 taxonomical associations, rs10973953 with the genus Kingella (P = 1.38 × 10^-9) and rs4721629 with the genus Parvimonas (P = 3.53 × 10^-8), were suggestive in the meta-analysis combining 2 OSCC cohorts. Further pathway analysis revealed that these loci were enriched for genes in regulation of oncogenic and angiogenic responses, implicating a genetic anchor to the oral microbiome in estimation of casual relationships with OSCC. Our findings delineate the role of host genotypes in influencing the structure of oral microbial communities.

[Controversy and prospect of transanal total mesorectal excision]

As a novel surgical technique, taTME has developed rapidly in recent years. TaTME inevitably attracts some skepticism on safety, efficacy, and indication. First, the controversies over taTME are mainly reflected on the safety and effectiveness of taTME. On one hand, the increase of surgical complications, such as urethral injury, CO2 embolism, anastomotic leakage and pelvic infection, has raised concerns about the safety of taTME. Second, the poor quality of taTME specimens, the increased local recurrence rate and the impaired anal function after taTME, also make people question the effectiveness of taTME. Third, there are more or less controversies in the selection of taTME cases, surgical procedures and cost-effectiveness. However, it can not be denied that taTME has a promising future in view of both surgical theory and clinical practice. Furthermore, taTME is a relatively safe and effective supplementary surgical procedure, especially for patients with low rectal cancer. We should attach more importance to structured training for beginners and conduct high-quality clinical studies in the future development of taTME in China, so as to ensure the safe implementation of taTME and obtain high-level evidence-based medicine evidence, and then standardize the clinical practice of taTME.

Short-Chained Platinum Complex Catalyzed Hydrosilylation under Thermomorphic Conditions: Heterogeneous Phase Separation at Ice Temperature

Homogeneous catalysts PtCl₂[5,5'-bis-(n-ClCF₂(CF₂)₃CH₂OCH₂)-2,2'-bpy] (2A) and PtCl₂[5,5'-bis-(n-HCF₂(CF₂)₃CH₂OCH₂)-2,2'-bpy] (2B), which contained short fluorous chains, were synthesized and used in catalysis of hydrosilylation of alkynes. In these reactions the thermomorphic mode was effectively used to recover these catalysts from the reaction mixture up to eight cycles by taking advantage of heterogeneous phase separation at ice temperature. This kind of catalysis had previously been observed in fluorous catalysts of platinum containing about 50% F-content, but in this work the percentage of F-content is decreased to only about 30%, by which we termed them as "very light fluorous". Our new type of catalyst with limited number of F-content is considered as the important discovery in the fluorous technology field as the reduced number of fluorine atoms will help to be able to comply the EPA 8-carbon rule. The metal leaching after the reaction has been examined by ICP-MS, and the testing results show the leaching of residual metal to be minimal. Additionally, comparing these results to our previous work, fluorous chain assisted selectivity has been observed when different fluorous chain lengths of the catalysts are used. It has been found that there exists fluorous chain assisted better selectivity towards β-(E) form in the Pt-catalyzed hydrosilylation of non-symmetric terminal alkyne when the Pt catalyst contains short fluorous chain (i.e., 4 Cs). Phenyl acetylenes showed the opposite regioselectivity due to pi-pi interaction while using the same catalyst via Markovnikov's addition to form terminal vinyl silane, which is then a major product for Pt-catalyzed hydrosilylation of terminal aryl acetylene with triethylsilane. Finally, the kinetic studies indicate that the insertion of alkyne into the Pt-H bond is the rate-determining step.

Etiology and characteristics of patients with bronchiectasis in Taiwan: a cohort study from 2002 to 2016

Background

Bronchiectasis is a chronic infectious respiratory disease with diverse causes and ethnic or geographic differences. However, few large-scale studies of its etiology have been conducted in Asia. This study aimed to determine the etiology and clinical features of bronchiectasis in Taiwan.

Methods

This longitudinal cohort study investigated the etiology and clinical features of newly diagnosed non-cystic fibrosis bronchiectasis patients from January 2002 to December 2016. The clinical, functional and microbiological data of patients were retrieved from the Chang Gung Research Database, which includes seven medical facilities throughout Taiwan. The index date was the date of the first bronchiectasis diagnosis. Known diseases that were diagnosed before the index date were regarded as etiologies of bronchiectasis.

Results

The cohort comprised 15,729 adult patients with bronchiectasis. Idiopathic (32%) was the most common cause, followed by post-pneumonia (24%). Other causes included post-tuberculosis (12%), chronic obstructive pulmonary disease (14%), asthma (10%), gastroesophageal reflux disease (2%) and rheumatic diseases (2%). At diagnosis, 8487 patients had sputum culture. Pseudomonas aeruginosa (5.3%) was the most common bacteria, followed by non-tuberculosis mycobacteria (3.6%), Haemophilus influenzae (3.4%) and Klebsiella pneumoniae (3.1%), but 6155 (72.1%) had negative sputum cultures. Patients with post-tuberculosis had a higher sputum isolation rate of non-tuberculosis mycobacteria than P. aeruginosa. Patients with post-tuberculosis and post-pneumonia bronchiectasis had a higher frequency of chronic lung infection than other groups (p < 0.05). Clinical characteristics, such as gender, lung function, comorbidities and microbiology, were significantly different between idiopathic and known etiologies.

Conclusions

Idiopathic, post-infection and tuberculosis constitute major bronchiectasis etiologies in Taiwan. Clinical characteristics and sputum microbiology were distinct among separate etiology phenotypes.

Structure-Dependent Photoluminescence in Low-Dimensional Ethylammonium, Propylammonium, and Butylammonium Lead Iodide Perovskites

Hybrid organic-inorganic perovskites have attracted great attention as the next generation materials for photovoltaic and light-emitting devices. However, their environment instability issue remains as the largest challenge for practical applications. Recently emerging two-dimensional (2D) perovskites with Ruddlesden-Popper structures are found to greatly improve the stability and aging problems. Furthermore, strong confinement of excitons in these natural quantum-well structures results in the distinct and narrow light emission in the visible spectral range, enabling the development of spectrally tunable light sources. Besides the strong quasi-monochromatic emission, some 2D perovskites composed of the specific organic cations and inorganic layer structures emit a pronounced broadband emission. Herein, we report the light-emitting properties and the degradation of low-dimensional perovskites consisting of the three shortest alkylammonium spacers, mono-ethylammonium (EA), n-propylammonium (PA), and n-butylammonium (BA). While (BA)₂PbI₄ is known to form well-oriented 2D thin films consisting of layers of corner-sharing PbI₆ octahedra separated by a bilayer of BA cations, EA with shorter alkyl chains tends to form other types of lower-dimensional structures. Nevertheless, optical absorption edges of as-prepared fresh EAPbI₃, (PA)₂PbI₄, and (BA)₂PbI₄ are obviously blue-shifted to 2.4-2.5 eV compared to their 3D counterpart, methylammonium lead iodide (MAPbI₃) perovskite, and they all emit narrow excitonic photoluminescence. Furthermore, by carefully optimizing deposition conditions, we have achieved a predominantly 2D structure for (PA)₂PbI₄. However, unlike (BA)₂PbI₄, upon exposure to ambient environment, (PA)₂PbI₄ readily transforms to a different crystal structure, exhibiting a prominently broadband light from ∼500 to 800 nm and a gradual increase in intensity as structural transformation proceeds.

Maintenance Negative Pressure Ventilation Improves Survival in COPD Patients with Exercise Desaturation

Negative pressure ventilation (NPV), when used as an adjuvant to pulmonary rehabilitation, improves lung function, increases exercise capacity, and reduces exacerbations. The aim of this study was to determine whether maintenance NPV improves long-term clinical outcomes and reduces mortality in patients with chronic obstructive pulmonary disease (COPD). Between 2003 and 2009, 341 patients were treated for COPD either with or without hospital-based NPV. We measured forced expiratory volume in one second (FEV₁), 6-min walking distance (6MWD), and oxygen saturation by pulse oximetry (SpO₂) during a 6-min walk test (6MWT) every 3–6 months. Desaturation (D) during the 6MWT was defined as a reduction in SpO₂ of ≥10% from baseline. The NPV group had a better survival outcome than the Non-NPV group. The 8-year survival probabilities for the NPV and Non-NPV groups were 60% and 20%, respectively (p < 0.01). Baseline desaturation was a significant risk factor for death, and the risk of death increased with desaturation severity (SpO₂ 80~89: hazard ratios (HR) 2.7, 95% confidence interval (CI) 1.4–5.3; SpO₂ < 80: HR 3.1, 95% CI 1.3–7.4). The NPV group had a slower decline in lung function and 6MWD. The NPV + D and Non-NPV+D had a threefold and fourfold increase in the risks of all-cause mortality compared with the NPV-ND, respectively. Maintenance non-invasive NPV reduced long-term mortality in COPD patients. The desaturating COPD patients had an increased mortality risk compared with non-desaturating COPD patients.

Mesalazine-related lung disease in a patient with ulcerative colitis: A case report

RATIONALE

Mesalazine is widely used to treat inflammatory bowel disease (IBD). However, discriminating between pulmonary manifestations of IBD and drug-related lung disease remains a challenge. There were few case reports of mesalazine-related organizing pneumonia so far.

PATIENT CONCERNS

A 75-year-old female was diagnosed with ulcerative colitis and took mesalazine over a period of 2 years and 8 months. She presented with progressive shortness of breath for 3 days and visited our emergency department. Chest radiography showed increased bilateral infiltrates. During hospitalization her clinical condition deteriorated, and she was transferred to our intensive care unit under noninvasive ventilator support.

DIAGNOSIS

Computed tomography (CT) scan showed diffuse peribronchial and subpleural consolidations in bilateral lungs. Possible etiologies of interstitial lung disease were surveyed, including various infectious diseases and connective tissue diseases. Transbronchial lung biopsy showed characteristic features of organizing pneumonia.

INTERVENTIONS

Under the consideration of mesalazine-related lung disease, mesalazine was discontinued early in disease course and steroid therapy was given.

OUTCOMES

The patient was discharged from hospital with improved clinical symptoms and radiographic images.

LESSONS

Although this patient suffered a life-threatening adverse event, prompt diagnosis with proper management can result in a favorable outcome.

Efficient Defect Healing of Transition Metal Dichalcogenides by Metallophthalocyanine

Two-dimensional (2D) transition metal dichalcogenides (TMDCs) have attracted great attention as alternatives to graphene with semiconducting band gaps. Mono- or few-layer TMDCs can be prepared by various methods, but regardless of the fabrication methods [such as mechanical exfoliation and chemical vapor deposition (CVD)], TMDCs contain many structural defects, which significantly affect their physical properties and limit their performance in applications. Metallophthalocyanines (MPcs) are organic semiconductors, and as dopants, they are capable of modulating the optical and electrical properties of other semiconducting materials. Here, we report that besides the ability to modulate the optoelectronic properties of 2D TMDCs, MPc molecules can be used to heal defects and improve the physicochemical properties of TMDCs. Doping of planar MPc molecules to TMDCs is achieved by a simple solution dip-coating method and results in a significant improvement in the optical properties and thermal responses of CVD-grown TMDCs, even comparable to those of mechanically exfoliated counterparts. Study of carrier dynamics shows that the adsorption of MPc on the TMDC surface leads to the complete suppression of the mid-gap defect-induced absorption in TMDCs. Furthermore, MPc molecules with a large lateral size are found to effectively reduce the point defects in mechanically exfoliated TMDCs introduced during the preparation process. Our results not only clarify the optoelectronic modulation mechanism of chemical doping but also offer a simple method to control the nanosized defects in 2D TMDCs.

[Effect of paraquat on the expression of a disintegrin and metalloproteinase-17 in A549 cells]

Objective: Construct a paraquat (PQ) cell fibrosis model in vitro, observe the effect of PQ on the expression of a disintegrin and metalloproteinase-17 (ADAM17) in A549 cells, and explore the role of ADAM17 in the pulmonary fibrosis induced by PQ poisoning. Methods: A549 cells are divided into normal control group, different concentration of PQ groups, CCK-8 is used to detect cell viability, screening concentration and time of PQ, cell morphology is observed under microscope; Enzyme-linked immunosorbent assay (ELISA) detectes fibrosis markers of collagen type I (Col I) and fibronectin (FN) expression. Establishment of cell model of fibrosis; distribution by immunocytochemical detection of ADAM17 in A549 cells, Reverse transcription-polymerase chain reaction and Western blot are used to detect the expression of ADAM17 mRNA and protein. Results: 1. With the increase of PQ concentration and the prolongation of the action time, the activity of A549 cells decreased (P< 0.05) , which is dose-dependent and time dependent. 2.The normal A549 cells fusion is paving stone growth and arranged more closely. After PQ induction, the cell arrangement was loose, the intercellular connection became loose, and some cells dissolved and died. 3.ELISA showed that with the increase of PQ concentration, the expression of Col I and FN increased (P<0.05) , and Col I and FN expression gradually increased with the prolongation of PQ time (P<0.05) , and the fibroblast model is successfully established. 4. Immunocytochemistry showes that ADAM17 is expressed in the cytoplasm of A549 cells. 5. RT-PCR and Western blot showed that the expression of ADAM17 mRNA and protein increased significantly with the increase of PQ concentration (P<0.05) , which is most obvious at PQ 200 μmol/L. With the prolonged action of PQ, the expression level of ADAM17 mRNA and protein also increased significantly (P<0.05) , and reached the peak in 24 h. Conclusion: PQ can induce morphological changes of alveolar epithelial cells, cause cell damage, and successfully establish a cell fibrosis model, which has a dose and time dependence on the toxicity of A549 cells. ADAM17 is overexpressed in the A549 cells induced by PQ and may be involved in the process of pulmonary fibrosis induced by paraquat.

Nintedanib reduces ventilation-augmented bleomycin-induced epithelial-mesenchymal transition and lung fibrosis through suppression of the Src pathway

Mechanical ventilation (MV) used in patients with acute respiratory distress syndrome (ARDS) can increase lung inflammation and pulmonary fibrogenesis. Src is crucial in mediating the transforming growth factor (TGF)‐β1‐induced epithelial–mesenchymal transition (EMT) during the fibroproliferative phase of ARDS. Nintedanib, a multitargeted tyrosine kinase inhibitor that directly blocks Src, has been approved for the treatment of idiopathic pulmonary fibrosis. The mechanisms regulating interactions among MV, EMT and Src remain unclear. In this study, we suggested hypothesized that nintedanib can suppress MV‐augmented bleomycin‐induced EMT and pulmonary fibrosis by inhibiting the Src pathway. Five days after administrating bleomycin to mimic acute lung injury (ALI), C57BL/6 mice, either wild‐type or Src‐deficient were exposed to low tidal volume (V_T) (6 ml/kg) or high V_T (30 ml/kg) MV with room air for 5 hrs. Oral nintedanib was administered once daily in doses of 30, 60 and 100 mg/kg for 5 days before MV. Non‐ventilated mice were used as control groups. Following bleomycin exposure in wild‐type mice, high V_T MV induced substantial increases in microvascular permeability, TGF‐β1, malondialdehyde, Masson's trichrome staining, collagen 1a1 gene expression, EMT (identified by colocalization of increased staining of α‐smooth muscle actin and decreased staining of E‐cadherin) and alveolar epithelial apoptosis (P < 0.05). Oral nintedanib, which simulated genetic downregulation of Src signalling using Src‐deficient mice, dampened the MV‐augmented profibrotic mediators, EMT profile, epithelial apoptotic cell death and pathologic fibrotic scores (P < 0.05). Our data indicate that nintedanib reduces high V_T MV‐augmented EMT and pulmonary fibrosis after bleomycin‐induced ALI, partly by inhibiting the Src pathway.

Trichostatin A attenuates ventilation-augmented epithelial-mesenchymal transition in mice with bleomycin-induced acute lung injury by suppressing the Akt pathway

Background

Mechanical ventilation (MV) used in patients with acute respiratory distress syndrome (ARDS) can cause diffuse lung inflammation, an effect termed ventilator-induced lung injury, which may produce profound pulmonary fibrogenesis. Histone deacetylases (HDACs) and serine/threonine kinase/protein kinase B (Akt) are crucial in modulating the epithelial–mesenchymal transition (EMT) during the reparative phase of ARDS; however, the mechanisms regulating the interactions among MV, EMT, HDACs, and Akt remain unclear. We hypothesized that trichostatin A (TSA), a HDAC inhibitor, can reduce MV-augmented bleomycin-induced EMT by inhibiting the HDAC4 and Akt pathways.

Methods

Five days after bleomycin treatment to mimic acute lung injury (ALI), wild-type or Akt-deficient C57BL/6 mice were exposed to low-tidal-volume (low-V_T, 6 mL/kg) or high-V_T (30 mL/kg) MV with room air for 5 h after receiving 2 mg/kg TSA. Nonventilated mice were examined as controls.

Results

Following bleomycin exposure in wild-type mice, high-V_T MV induced substantial increases in microvascular leaks; matrix metalloproteinase-9 (MMP-9) and plasminogen activator inhibitor-1 proteins; free radical production; Masson’s trichrome staining; fibronectin, MMP-9, and collagen 1a1 gene expression; EMT (identified by increased localized staining of α-smooth muscle actin and decreased staining of E-cadherin); total HDAC activity; and HDAC4 and Akt activation (P < 0.05). In Akt-deficient mice, the MV-augmented lung inflammation, profibrotic mediators, EMT profiles, Akt activation, and pathological fibrotic scores were reduced and pharmacologic inhibition of HDAC4 expression was triggered by TSA (P < 0.05).

Conclusions

Our data indicate that TSA treatment attenuates high-V_T MV-augmented EMT after bleomycin-induced ALI, in part by inhibiting the HDAC4 and Akt pathways.

Surgical treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a very common foregut disease prevalent worldwide. The prevalence of GERD has risen strikingly over the past decades, causing substantial health and economic burdens. Due to high rates of recurrent reflux symptoms, reoperations and complications, surgical therapy of GERD did not attach enough attention in its early stage. However, surgical therapy for GERD was subsequently revolutionized by the development of anti-reflux surgical techniques and the introduction and popularization of minimally invasive surgeries. Anti-reflux surgery has gradually proved to be a well-documented, effective, therapeutic option for GERD by long-term follow-up studies. In order to improve results and to reduce unwanted effects, surgeons should master the indications of surgery and techniques of anti-reflux surgery. Besides, choosing appropriate candidates and surgical approach is also crucial for outcomes. However, limited by the regional economy and surgeon's skill, the use of anti-reflux surgery is still very limited. The aim of this review is to analyze and discuss the current spectrum of surgical therapy of GERD, and to provide orientation for surgeons in the challenging therapy of GERD.

Activation of Src-dependent Smad3 signaling mediates the neutrophilic inflammation and oxidative stress in hyperoxia-augmented ventilator-induced lung injury

Background

Mechanical ventilation and concomitant administration of hyperoxia in patients with acute respiratory distress syndrome can damage the alveolar epithelial and capillary endothelial barrier by producing inflammatory cytokines and reactive oxygen species. The Src tyrosine kinase and Smad3 are crucial inflammatory regulators used for ventilator-induced lung injury (VILI). The mechanisms regulating interactions between high-tidal-volume mechanical ventilation, hyperoxia, and acute lung injury (ALI) are unclear. We hypothesized that high-tidal-volume mechanical stretches and hyperoxia augment lung inflammation through upregulation of the Src and Smad3 pathways.

Methods

Wild-type or Src-deficient C57BL/6 mice, aged between 6 and 8 weeks, were exposed to high-tidal-volume (30 mL/kg) ventilation with room air or hyperoxia for 1–4 h after 2-mg/kg Smad3 inhibitor (SIS3) administration. Nonventilated mice were used as control subjects.

Results

We observed that the addition of hyperoxia to high-tidal-volume mechanical ventilation further induced microvascular permeability, neutrophil infiltration, macrophage inflammatory protein-2 and matrix metalloproteinase-9 (MMP-9) production, malondialdehyde, nicotinamide adenine dinucleotide phosphate oxidase activity, MMP-9 mRNA expression, hypoxemia, and Src and Smad3 activation (P < 0.05). Hyperoxia-induced augmentation of VILI was attenuated in Src-deficient mice and mice with pharmacological inhibition of Smad3 activity by SIS3 (P < 0.05). Mechanical ventilation of Src-deficient mice with hyperoxia further reduced the activation of Smad3.

Conclusions

Our data suggest that hyperoxia-increased high-tidal-volume ventilation-induced ALI partially depends on the Src and Smad3 pathways.

Effects of low amplitude pulsed radiofrequency stimulation with different waveform in rats for neuropathic pain

Pulsed-radiofrequency (PRF) electrical stimulation has been widely used for chronic pain treatment. It has been demonstrated with advantages of low temperature over traditional continuous radiofrequency (CRF) lesions with higher amplitude and mono polar electrode to treat pain in clinics (frequency 500 KHz, Pulse duration 20 msec, Amplitude 45 V, Treatment 2 min). We compare the effects of different pulse waveforms and PRF parameters (Pulse duration 25 ms, Treatment duration 5 min, low amplitude of 2.5/1.25 V) with a miniature bi-polar electrode on Dorsal root ganglion (DRG). The pain relief effect due to PRF is evaluated by using Von Frey method for the pain threshold index based on behavior response to mechanical stimulus of various strengths. Experimental results of Von Frey Score show that the sinusoidal group has higher responses than the square wave one. Both fast and secondary expressed proteins of c-fos and pp38 are measured from spinal cord tissue sectioning slides to characterize the pain associated inflammatory responses and their responses due to PRF stimulation.

Effect of JJYMD-C, a novel synthetic derivative of gallic acid, on proliferation and phenotype maintenance in rabbit articular chondrocytes in vitro

Tissue engineering encapsulated cells such as chondrocytes in the carrier matrix have been widely used to repair cartilage defects. However, chondrocyte phenotype is easily lost when chondrocytes are expanded in vitro by a process defined as “dedifferentiation”. To ensure successful therapy, an effective pro-chondrogenic agent is necessary to overcome the obstacle of limited cell numbers in the restoration process, and dedifferentiation is a prerequisite. Gallic acid (GA) has been used in the treatment of arthritis, but its biocompatibility is inferior to that of other compounds. In this study, we modified GA by incorporating sulfamonomethoxine sodium and synthesized a sulfonamido-based gallate, JJYMD-C, and evaluated its effect on chondrocyte metabolism. Our results showed that JJYMD-C could effectively increase the levels of the collagen II, Sox9, and aggrecan genes, promote chondrocyte growth, and enhance secretion and synthesis of cartilage extracellular matrix. On the other hand, expression of the collagen I gene was effectively down-regulated, demonstrating inhibition of chondrocyte dedifferentiation by JJYMD-C. Hypertrophy, as a characteristic of chondrocyte ossification, was undetectable in the JJYMD-C groups. We used JJYMD-C at doses of 0.125, 0.25, and 0.5 µg/mL, and the strongest response was observed with 0.25 µg/mL. This study provides a basis for further studies on a novel agent in the treatment of articular cartilage defects.

TAp63 suppress metastasis via miR-133b in colon cancer cells

BACKGROUND

TAp63 is a tumour-suppressor protein that is often underexpressed in various types of cancer. It has been shown to activate gene transcription depending on the transcription domain and to be closely related with metastasis. In this study, we demonstrate that TAp63 suppresses metastasis in colon cancer cells through microRNA-133b.

METHODS

We evaluated the correlation of TAp63 and miR-133b with HT-29 and SW-620 cells and investigated the roles of TAp63 in the expression of RhoA, E-cadherin and vimentin. We further investigated the roles of TAp63-mediated invasion and migration of colon cancer cells.

RESULTS

TAp63 expression is downregulated in colon cancer, and microRNA-133b is a transcriptional target of TAp63. Furthermore, microRNA-133b is essential for the inhibitory effects of TAp63 on RhoA, E-cadherin and vimentin. Moreover, TAp63 inhibits cell migration and invasion through microRNA-133b. Correspondingly, the inhibitory effect of TAp63 on RhoA, E-cadherin, vimentin, migration and invasion can be blocked by the microRNA-133b inhibitor.

CONCLUSIONS

TAp63 and microRNA-133b were able to suppress the metastasis of colon cancer. Both TAp63 and microRNA-133b may be potential biomarkers for diagnosis in colon cancer metastasis and may provide unique therapeutic targets for this common malignancy.

Limits on spin-independent couplings of WIMP dark matter with a p-type point-contact germanium detector

We report new limits on a spin-independent weakly interacting massive particle (WIMP)-nucleon interaction cross section using 39.5 kg days of data taken with a p-type point-contact germanium detector of 840 g fiducial mass at the Kuo-Sheng Reactor Neutrino Laboratory. Crucial to this study is the understanding of the selection procedures and, in particular, the bulk-surface events differentiation at the sub-keV range. The signal-retaining and background-rejecting efficiencies were measured with calibration gamma sources and a novel n-type point-contact germanium detector. Part of the parameter space in the cross section versus WIMP-mass implied by various experiments is probed and excluded.

Effect of mild hypothermia on breast cancer cells adhesion and migration

To explore the effect of mild hypothermia (35ºC) on breast cancer cells adhesion to vascular endothelial cells, a parallel plant flow chamber was used to observe the adhesion of human breast cancer cells MDA-MB-231 to endothelial cells Eahy926 under physiological flow at 35ºC and 37ºC, as well as the role of intercellular adhesion molecule 1 (ICAM-1) in this process. Further, the effect of mild hypothermia (35ºC) on migration of MDA-MB-231 was also studied. Our results show that mild hypothermia can inhibit the adhesion of tumor cells to endothelial cells and ICAM-1 plays an important role in this process. However, mild hypothermia inhibits breast cancer cell adhesion in a way independent on the change of ICAM-1 expression under our experimental conditions. Mild hypothermia can weaken the chemotaxis of breast cancer cells while it has no obvious effect on unidirectonal migration capacity. These results suggest that mild hypothermia could be used as a potentially adjunct treatment combined with surgery to decrease tumor cell adhesion and migration.

Potential location of a bladder tumor suppressor gene on chromosome 9q at 9q13 to 9q22.1

Allelic losses involving chromosome 9q occur in a significant percentage of bladder tumors. Experimental evidence suggests that a putative tumor suppressor gene located on this chromosome may play a role in the development of bladder cancer. The precise location of this potential tumor suppressor gene is not clear. Previous studies have targeted a large region between 9p12-13 and 9q22 or 9p12 and 9q34.1 as the likely site. To further delineate the location of this gene, we examined 49 tumors by loss of heterozygosity (LOH) analysis, using seven microsatellite polymorhpic loci spanning from 9p21 to 9q34 of the chromosome. LOH was found in at least one of the loci in 20 (41%) of the tumors examined, and the majority (12 of 17; 71%) of the losses on 9q involved large segments or the entire chromosome arm. Although many of the tumors with large losses on 9q also involved 9p21, several tumors with small losses did not involve the 9p marker. Conversely, there were tumors with 9p21 losses that did not involve the q-arm. These data agree with recent findings that distinct tumor suppressor genes associated with bladder cancer are located on separate arms of chromosome 9. Among tumors with single locus LOHs, the most common deletion was located in 9q 13-21.2, which was detected by probe D9S15. This also is the smallest area of critical loss when LOH patterns of tumors with partial or interstitial losses were examined. Results of the study therefore suggest that a potential tumor suppressor gene may reside within or near the region of 9q13-22.1.

Role of lipocalin 2 and its complex with matrix metalloproteinase-9 in oral cancer

OBJECTIVES

Recent evidence demonstrated that lipocalin (LCN)2 is induced in many types of human cancer, while the detection of its complex with matrix metalloproteinase (MMP)-9 is correlated with the cancer disease status. We attempted to evaluate plasma expressions of LCN2, MMP-9, and their complex (LCN2/MMP-9) during the diagnostic work-up of patients with oral squamous cell carcinoma (OSCC) and investigated their correlations with disease progression.

METHODS

In total, 195 patients with OSCC and 81 healthy controls were recruited. Expression levels of LCN2, MMP-9, and LCN2/MMP-9 were determined with immunoenzymatic assays.

RESULTS

Patients with OSCC exhibited significantly higher levels of LCN2, MMP-9, and LCN2/MMP-9 compared with healthy controls (LCN2: P < 0.001; MMP-9: P < 0.001; LCN2/MMP-9: P < 0.01). Plasma levels of LCN2, MMP-9, and LCN2/MMP-9 in patients with OSCC were significantly correlated with each other and were associated with more-advanced clinical stages (P < 0.05) and/or a larger tumor size (P < 0.05), but were not associated with positive lymph-node metastasis or distal metastasis.

CONCLUSION

Our results suggest that plasma levels of LCN2 and the LCN2/MMP-9 complex may be useful in non-invasively monitoring OSCC progression, while supporting their potential role as biomarkers of oral cancer disease status.

Survivin SNP-carcinogen interactions in oral cancer

In Taiwan, oral cancer is causally associated with environmental carcinogens. Survivin is an anti-apoptotic protein and is generally considered a marker of malignancy. The current study explored the combined effect of survivin gene polymorphisms and environmental carcinogens on the risk and clinico-pathological development of oral cancer. Five single-nucleotide polymorphisms (SNPs) of survivin genes from 439 male patients with oral cancer and 424 male control participants (who did not have cancer) were analyzed. The survivin -31GG, +9194 GG, and +9809 TT homozygotes exhibited higher risk for oral cancer compared with the corresponding ancestral genotype, after adjustment for related confounders. The survivin -31, +9194, and +9809 SNPs combined with betel quid chewing and/or tobacco consumption could robustly elevate susceptibility to oral cancer. The distribution frequency of the -31 G: +9194 A: +9809 T haplotype was significantly higher in oral cancer patients than in control participants. These results suggest that survivin gene polymorphisms and their interactions with environmental carcinogens may increase susceptibility to oral cancer in Taiwanese men.

ABBREVIATIONS

AOR, adjusted odds ratio; CI, confidence intervals; PCR, polymerase chain-reaction; SNP, single-nucleotide polymorphisms.

Ileocolorectal intussusception due to caecal hamartoma

Although 75% of intussusceptions occur within the first two years of life, they can also develop in teenage years. This is a case report of a 13-year old boy with an ileocolorectal intussusception from a large caecal hamartoma (10 x 6 x 2 cm3) adjacent to the ileocaecal valve. Partial resection of the ascending colon and terminal ileum was performed, and the pathology of the resected mass revealed a hamartoma. Ileocolorectal intussusception secondary to hamartoma represents a particularly rare event in the paediatric population. With early surgical intervention, this patient's outcome was uneventful.

A Bayesian population analysis of the development of type 2 diabetes in the offspring of diabetic parents

Disease progression of type 2 diabetes (T2D) has received considerable attention, but little is known about the disease development of T2D. The purposes of this study were to identify disease development variables (DDV) for development of T2D and to compare corresponding models for disease development. All subjects included in this study were the offspring of diabetic parents and were followed up to 25 years. Repeated fasting blood samples were collected during the follow-up. Longitudinal data of four DDVs, namely fasting blood glucose (FBG), fasting serum insulin (FSI), homeostatic model assessment of insulin resistance (HOMA-IR) and body mass index (BMI) were recorded and compared. According to the diabetes status at the end of the follow-up, the data analysis involved a progressor group of 25 subjects, and a non-progressor group of 127 subjects. The temporal changes in the four DDVs over the time course of the disease development were evaluated by a single-slope and a dual-slope population-based Bayesian model. A dual-slope model based on FBG was found to be the best disease development model. For non-progressors, the FBG baseline stayed at 69.2 [66.5, 72.1] mg/dl (Bayes estimate [95% Bayesian credible set]) and increased with age by a rate of 0.227 mg/dl [0.149, 0.3] per year. For the progressors, the FBG increase with age the same rate as non-progressors and started to have an additional increase of 2.27 [0.505, 4.52] mg/dl per year, starting 8.73 [-10.8, -6.93] years before the diagnosis of T2D. No significant longitudinal increasing or decreasing temporal pattern was found for FSI, HOMA-IR and BMI by the population-based Bayesian approach. The proposed model, which enables a quantitative, time-based evaluation of the development of T2D in this higher risk population, may be used to quantify the effect of interventions/prevention strategies such as drug treatment and lifestyle changes.

Genetic polymorphisms of the DNA repair gene MPG may be associated with susceptibility to rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease and can lead to deformities and severe disabilities, due to irreversible damage of tendons, joints, and bones. A previous study indicated that a DNA repair system was involved in the development of RA. In this study, we investigated the association of four N-methylpurine-DNA glycosylase (MPG) gene polymorphisms (rs3176364, rs710079, rs2858056, and rs2541632) with susceptibility to RA in 384 Taiwanese individuals (192 RA patients and 192 control subjects). Our data show a statistically significant difference in genotype frequency distributions at rs710079 and rs2858056 SNPs between RA patients and control groups (P = 0.040 and 0.029, respectively). Our data also indicated that individuals with the GG genotype at rs2858056 SNP may have a higher risk of developing RA. In addition, compared with the haplotype frequencies between case and control groups, individuals with the GCGC haplotype appeared to be at a greater risk of RA progression (P = 0.003, OR = 1.75; 95&percnt; CI = 1.20-1.55). Our results suggest that rs710079 and rs2858056 polymorphisms and the GCGC haplotype in the MPG gene are associated with the risk of RA progression, and thus may be used as molecular markers of RA if they are confirmed by further research.

Atorvastatin or transgenic expression of TFPI inhibits coagulation initiated by anti-nonGal IgG binding to porcine aortic endothelial cells

BACKGROUND

Intravascular thrombosis remains a barrier to successful xenotransplantation. Tissue factor (TF) expression on porcine aortic endothelial cells (PAECs), which results from their activation by xenoreactive antibodies (Abs) to Galα1,3Gal (Gal) and subsequent complement activation, plays an important role.

OBJECTIVES

The present study aimed to clarify the role of Abs directed against nonGal antigens in the activation of PAECs to express functional TF and to investigate selected methods of inhibiting TF activity.

METHODS

PAECs from wild-type (WT), α1,3-galactosyltransferase gene-knockout (GT-KO) pigs, or pigs transgenic for CD46 or tissue factor pathway inhibitor (TFPI), were incubated with naïve baboon serum (BS) or sensitized BS (with high anti-nonGal Ab levels). TF activity of PAECs was assessed.

RESULTS

Only fresh, but not heat-inactivated (HI), naïve BS activated WT PAECs to express functional TF. Similarly, PAECs from CD46 pigs were resistant to activation by naïve BS, but not to activation by fresh or HI sensitized BS. HI sensitized BS also activated GT-KO PAECs to induce TF activity. TF expression on PAECs induced by anti-nonGal Abs was inhibited if serum was pretreated with (i) an anti-IgG Fab Ab or (ii) atorvastatin, or (iii) when PAECs were transgenic for TFPI.

CONCLUSIONS

Anti-nonGal IgG Abs activated PAECs to induce TF activity through a complement-independent pathway. This implies that GT-KO pigs expressing a complement-regulatory protein may be insufficient to prevent the activation of PAECs. Genetic modification with an 'anticoagulant' gene (e.g. TFPI) or a therapeutic approach (e.g. atorvastatin) will be required to prevent coagulation dysregulation after pig-to-primate organ transplantation.

Metallothionein-1 genotypes in the risk of oral squamous cell carcinoma

BACKGROUND

We conducted an independent analysis of metallothionein 1 (MT-1) rs8052394, rs11076161, rs8052334, rs964372, rs7191779, and rs708274 in 587 individuals who were either healthy controls or subjects with oral squamous cell carcinoma (OSCC).

METHODS

All participants provided a nucleic acid sample (blood) as well as epidemiologic information on covariates or "risk factors" for OSCC, including tobacco, alcohol, and areca quid use. The genotyping result was used in a logistic regression model that examined main effects as well as statistical interactions while controlling for confounders.

RESULTS

MT-1 is involved in regulation of zinc and copper homeostasis. It also is a potent antioxidant and its polymorphisms correlate with the risk for OSCC. Rs11076161 A, rs964372 C, and rs7191779 C alleles were protective against OSCC (adjusted OR = 0.53, 0.49, 0.36, respectively; p < 0.05), whereas rs8052394 A alleles were associated with increased risk. Areca quid chewing and tobacco use were strong risk factors for developing the disease and were associated with 20- and 8-fold increases in adjusted risk (p < 0.05), respectively.

CONCLUSIONS

Controlling for the effects of age, gender, areca quid, tobacco, and alcohol use, individuals with inherited the MT-1 rs11076161 AA, rs964372 CC, and rs7191779 GC genotypes may experience significant protection against OSCC, whereas individuals carrying the MT-1 rs8052394 A allele seem exposed to higher risk.

Atorvastatin or transgenic expression of TFPI inhibits coagulation initiated by anti-nonGal IgG binding to porcine aortic endothelial cells

BACKGROUND

Intravascular thrombosis remains a barrier to successful xenotransplantation. Tissue factor (TF) expression on porcine aortic endothelial cells (PAECs), which results from their activation by xenoreactive antibodies (Abs) to Galα1,3Gal (Gal) and subsequent complement activation, plays an important role.

OBJECTIVES

The present study aimed to clarify the role of Abs directed against nonGal antigens in the activation of PAECs to express functional TF and to investigate selected methods of inhibiting TF activity.

METHODS

PAECs from wild-type (WT), α1,3-galactosyltransferase gene-knockout (GT-KO) pigs, or pigs transgenic for CD46 or tissue factor pathway inhibitor (TFPI), were incubated with naïve baboon serum (BS) or sensitized BS (with high anti-nonGal Ab levels). TF activity of PAECs was assessed.

RESULTS

Only fresh, but not heat-inactivated (HI), naïve BS activated WT PAECs to express functional TF. Similarly, PAECs from CD46 pigs were resistant to activation by naïve BS, but not to activation by fresh or HI sensitized BS. HI sensitized BS also activated GT-KO PAECs to induce TF activity. TF expression on PAECs induced by anti-nonGal Abs was inhibited if serum was pretreated with (i) an anti-IgG Fab Ab or (ii) atorvastatin, or (iii) when PAECs were transgenic for TFPI.

CONCLUSIONS

Anti-nonGal IgG Abs activated PAECs to induce TF activity through a complement-independent pathway. This implies that GT-KO pigs expressing a complement-regulatory protein may be insufficient to prevent the activation of PAECs. Genetic modification with an 'anticoagulant' gene (e.g. TFPI) or a therapeutic approach (e.g. atorvastatin) will be required to prevent coagulation dysregulation after pig-to-primate organ transplantation.

Effect of cranberry extracts on lipid profiles in subjects with Type 2 diabetes

AIM

To examine the effect of cranberry ingestion on lipid profiles in Type 2 diabetic patients taking oral glucose-lowering drugs.

METHODS

Thirty Type 2 diabetic subjects (16 males and 14 females; mean age 65 +/- 1 years) who were taking oral glucose-lowering medication regularly were enrolled in this randomized, placebo-controlled, double-blind study. Changes in lipid profiles, oxidized low-density lipoprotein (ox-LDL), glycaemic control, components of the metabolic syndrome, C-reactive protein (CRP) and urinary albumin excretion (UAE) were assessed after cranberry or placebo treatment for 12 weeks.

RESULTS

Low-density lipoprotein (LDL) cholesterol decreased significantly in the cranberry group (from 3.3 +/- 0.2 to 2.9 +/- 0.2 mmol/l, P = 0.005) and the decrease was significantly greater than that in the placebo group (-0.4 +/- 0.1 vs. 0.2 +/- 0.1 mmol/l, P < 0.001). Total cholesterol and total : high-density lipoprotein (HDL) cholesterol ratio also decreased significantly (P = 0.020 and 0.044, respectively) in the cranberry group and the reductions were significantly different from those in the placebo group (P < 0.001 and P = 0.032, respectively). However, ox-LDL levels did not change significantly in response to cranberry consumption. Neither fasting glucose nor glycated haemoglobin improved in either group. Changes in components of the metabolic syndrome, UAE and CRP were not significantly different between groups.

CONCLUSIONS

Cranberry supplements are effective in reducing atherosclerotic cholesterol profiles, including LDL cholesterol and total cholesterol levels, as well as total : HDL cholesterol ratio, and have a neutral effect on glycaemic control in Type 2 diabetic subjects taking oral glucose-lowering agents.

Effect of bradykinin metabolism inhibitors on evoked hypotension in rats: rank efficacy of enzymes associated with bradykinin-mediated angioedema

BACKGROUND AND PURPOSE

Inhibition of bradykinin metabolizing enzymes (BMEs) can cause acute angioedema, as demonstrated in a recent clinical trial in patients administered the antihypertensive, omapatrilat. However, the relative contribution of specific BMEs to this effect is unclear and confounded by the lack of a predictive pre-clinical model of angioedema.

EXPERIMENTAL APPROACH

Rats were instrumented to record blood pressure and heart rate; inhibitors were infused for 35 min and bradykinin was infused during the last 5 min to elicit hypotension, as a functional marker of circulating bradykinin and relative angioedema risk.

KEY RESULTS

In the presence of omapatrilat bradykinin produced dose-dependent hypotension, an effect abolished by B(2) blockade. In the presence of lisinopril (ACE inhibitor), but not candoxatril (NEP inhibitor) or apstatin (APP inhibitor), bradykinin also elicited hypotension. Lisinopril-mediated hypotension was unchanged with concomitant blockade of NEP or NEP/DPPIV (candoxatril+A-899301). However, hypotension was enhanced upon concomitant blockade of APP and further intensified in the presence of NEP inhibition to values not different from omapatrilat alone.

CONCLUSIONS AND IMPLICATIONS

We demonstrated that bradykinin is degraded in vivo with an enzyme rank-efficacy of ACE>APP>>NEP or DPPIV. These results suggest the effects of omapatrilat are mediated by inhibition of three BMEs, ACE/APP/NEP. However, dual inhibition of ACE/NEP or ACE/NEP/DPPIV elicits no increased risk of angioedema compared to ACE inhibition alone. Thus, novel BME inhibitors must display no activity against APP to avoid angioedema risk due to high prevalence of ACE inhibitor therapy in patients with diabetes and cardiovascular disease.

Influence of solution acidity and CaCl2 concentration on the removal of heavy metals from metal-contaminated rice soils

Soil washing is considered a useful technique for remediating metal-contaminated soils. This study examined the release edges of Cd, Zn, Ni, Cr, Cu or Pb in two contaminated rice soils from central Taiwan. The concentrations exceeding the trigger levels established by the regulatory agency of Taiwan were Cu, Zn, Ni and Cr for the Ho-Mei soil and Pb for the Nan-Tou soil. Successive extractions with HCl ranging from 0 to 0.2 M showed increased release of the heavy metals with declining pH, and the threshold pH value below which a sharp increase in the releases of the heavy metals was highest for Cd, Zn, and Ni (pH 4.6 to 4.9), intermediate for Pb and Cu (3.1 to 3.8) and lowest for Fe (2.1), Al (2.2) and Cr (1.7) for the soils. The low response slope of Ni and Cr particularly for the rice soils make soil washing with the acid up to the highest concentration used ineffective to reduce their concentrations to below trigger levels. Although soil washing with 0.1 M HCl was moderately effective in reducing Cu, Pb, Zn and Cd, which brought pH of the soils to 1.1+/-0.1 (S.D.), the concurrent release of large quantities of Fe and Al make this remediation technique undesirable for the rice soils containing high clay. Successive washings with 0.01 M HCl could be considered an alternative as the dissolution of Fe and Al was minimal, and between 46 to 64% of Cd, Zn, and Cu for the Ho-Mei soil and 45% of Pb in the Na-Tou soil were extracted after four successive extractions with this dilute acid solution. The efficacy of Cd extraction improved if CaCl2 was added to the acid solution. The correlation analysis revealed that Cr extracted was highly correlated (P < 0.001) with Fe extracted, whereas the Cu, Ni, Zn, Cd or Pb extracted was better correlated (P < 0.001) with Al than with Fe extracted. It is possible that the past seasonal soil flooding and drainage in the soils for rice production was conducive to incorporating Cr within the structure of Fe oxide, thereby making them extremely insoluble even in 0.2 M HCl solution. The formation of solid solution of Ni with Al oxide was also possible, making it far less extractable than Cd, Zn, Cu, or Pb with the acid concentrations used.

Lipopolysaccharide plus 12-o-tetradecanoylphorbol 13-acetate induction of migration and invasion of glioma cells in vitro and in vivo: Differential inhibitory effects of flavonoids

In an earlier study, we reported that nitric oxide is involved in lipopolysaccharide plus 12-o-tetradecanoylphorbol 13-acetate-induced malignant transformation via increases in metalloproteinase 9 enzyme activity and inducible nitric oxide synthase gene expression in rat glioma C6 cells, however the mechanism has remained undefined. Lipopolysaccharide plus 12-o-tetradecanoylphorbol 13-acetate, but not lipopolysaccharide or 12-o-tetradecanoylphorbol 13-acetate alone, induced transformation in glioma C6 cells (but not in human glioblastoma cells GBM-8401 cells) without affecting their viability. An increase in inducible nitric oxide synthase protein expression, nitric oxide production, and metalloproteinase 9 enzyme activity is identified lipopolysaccharide/12-o-tetradecanoylphorbol 13-acetate-treated C6 cells, however lipopolysaccharide/12-o-tetradecanoylphorbol 13-acetate and 12-o-tetradecanoylphorbol 13-acetate (but not lipopolysaccharide) addition shows the similar inductive pattern on metalloproteinase 9 enzyme activity without affecting inducible nitric oxide synthase protein expression and nitric oxide production in GBM-8401 cells. Treatment of C6 cells with lipopolysaccharide/12-o-tetradecanoylphorbol 13-acetate increases the expression of phosphorylated extracellular regulated protein kinases and Jun N-terminal kinases, but not p38, proteins, and an addition of the extracellular regulated protein kinases inhibitor PD98059 or Jun N-terminal kinases inhibitors SP600125, but not the p38 inhibitor SB203580, significantly blocked lipopolysaccharide/12-o-tetradecanoylphorbol 13-acetate-induced inducible nitric oxide synthase protein expression and metalloproteinase 9 enzyme activity accompanied by blocking morphological transformation in C6 cells. Among 19 structurally related flavonoids, kaempferol and wogonin exhibit significant inhibitory effects on lipopolysaccharide/12-o-tetradecanoylphorbol 13-acetate-induced morphological transformation and colony formation, and attenuation of inducible nitric oxide synthase, phosphorylated extracellular regulated protein kinases protein expression, and metalloproteinase 9 enzyme activity was observed. 2'-OH flavone at a dose of 100 microM inhibition of lipopolysaccharide/12-o-tetradecanoylphorbol 13-acetate-induced events via apoptosis induction is identified. Furthermore, lipopolysaccharide/12-o-tetradecanoylphorbol 13-acetate, but not lipopolysaccharide or 12-o-tetradecanoylphorbol 13-acetate, induces tumoral invasion and migration in vitro and in vivo, and those are blocked by kaempferol and wogonin addition. These data suggest that combination of lipopolysaccharide and 12-o-tetradecanoylphorbol 13-acetate promotes tumoral progression via activating metalloproteinase 9 enzyme activity and inducible nitric oxide synthase gene expression, which is located downstream of mitogen-activated protein kinases activation, in rat glioma cells C6. Kaempferol and wogonin exhibit effective inhibitory effects on lipopolysaccharide/12-o-tetradecanoylphorbol 13-acetate-induced events, and thus possess the potential for further development.

Performance of elbow tracking under constant torque disturbance in normotonic stroke patients and normal subjects

OBJECTIVE

In this study, the influences of externally imposed constant torque on the voluntary elbow movements of stroke and normal subjects were investigated quantitatively.

BACKGROUND

Muscle weakness, spasticity and incoordination are the major factors that interfere with stroke patient's limb functions. Imposing external torque disturbance may worsen the motor performance. This experiment was designed to investigate the effects of small constant external torque on the performance of voluntary elbow movements.

METHODS

Tracking of a ramp-and-hold angle trajectory in the direction of extension was used as the main task for performance assessment. Each subject repeated the same tracking movement six times in each of three loading conditions: no, assistive or resistive loading. Five normal and six stroke subjects were recruited for this study. We used parameters extracted from movement trajectory and processed electromyograms as the performance indicators.

RESULTS

For normal subjects, there was no difference in the tracking performance in the three loading conditions. For stroke patients, the affected side had inferior performance to the healthy side in the free loading condition and the difference diminished in assistive and resistive loading conditions as the performance of the affected side improved. Integrated electromyograms of biceps or triceps did not show significant changes in different loading conditions.

CONCLUSIONS

Small externally imposed constant torque, either resistive or assistive, may improve motor performance of affected elbows in stroke patients.

RELEVANCE

Most of the currently available prostheses are passive devices, aiming at providing better support and improving stability. The results of the current study imply that an active prosthetic device that applies a small constant torque to the hemiparetic elbow can improve its motor performance in stroke patients. The direction of external torque is to assist the weaker side of the antagonistic muscle pair.

Surface characterization and platelet compatibility evaluation of surface-sulfonated chitosan membrane

The effect of various sulfonated derivatives of chitosan on platelet activation and blood coagulation was examined. The surface properties of artificial biomaterials have been thought as the key factors which mediate the interactions between the biological environment and biomaterial itself. In this study, the sulfonation was directly performed on the chitosan membrane surface. The chitosan membrane was surface-sulfonated by reactions with sulfur-pyridine trioxide complex (SO3/pyridine) in H2O solution and N,N-sulfur-dimethylformamide trioxide complex (SO3/DMF) in DMF. Blood compatibility was evaluated by an in vitro platelet adhesion assay. The surface reaction of SO3/pyridine in aqueous acid medium yields N,O-sulfated chitosan with cationic NH3+ groups. After neutralization, this surface has been shown to induce a low degree of platelet adhesion and activation. When the surface-sulfonation is performed in an aqueous alkaline medium, although the degree of sulfonation is lower than the samples above, the N-sulfated chitosan significantly reduced the adhesion and activation of platelets. For the acidic SO3/DMF reaction system, N,O-sulfated chitosan was obtained with a high extent of sulfonation and cationic NH3+ groups. On this surface fully spread platelets and some platelet aggregates were found instead. This may be attributed to the ionic interactions between the platelets membrane surface and the cationic groups on the modified chitosan membrane.

Nonsteroidal selective glucocorticoid modulators: the effect of C-5 alkyl substitution on the transcriptional activation/repression profile of 2,5-dihydro-10-methoxy-2,2,4-trimethyl-1H-[1]benzopyrano[3,4-f]quinolines

The preparation and characterization of a series of selective glucocorticoid receptor modulators are described. The preliminary structure-activity relationship of nonaromatic C-5 substitution on the tetracyclic quinoline core showed a preference for small lipophilic side chains. Proper substitution at this position maintained the transcriptional repression of proinflammatory transcription factors while diminishing the transcriptional activation activity of the ligand/glucocorticoid receptor complex. The optimal compounds described in this study were the allyl analogue 18 and cyclopentyl analogue 32. These candidates showed slightly less potent, highly efficacious E-selectin repression with significantly reduced levels of glucocorticoid response element activation in reporter gene assays vs prednisolone. Allyl analogue 18 was evaluated in vivo. An oral dose of 18 showed an ED(50) = 1.7 mg/kg as compared to 1.2 mg/kg for prednisolone in the Sephadex-induced pulmonary eosinophilia model and an ED(50) = 15 mg/kg vs 4 mg/kg for prednisolone in the carrageenan-induced paw edema model.

Diffusion characteristics of collagen film

Collagen films prepared by treating collagen gel solutions with different concentrations of glutaraldehyde were evaluated as a biodegradable and biocompatible drug carrier for cosmetically effective agents in this study. The influences of concentration of glutaraldehyde (0, 0.05, 0.075, 0.1, 0.2, 0.25, and 0.3%, v/w) with a fixed concentration (1%, w/w) of collagen on the crosslinking rate of collagen gel solutions and on the crosslinking extent of the collagen contained within were examined by monitoring changes in viscosity. In addition, the influences of the addition of different model drugs (retinoic acid, retinol palmitate, ascorbic acid 6-palmitate, and tocopherol acetate) on viscosity changes of collagen gel solutions were compared. The results demonstrate that the maximal viscosity of collagen gel solutions increases with increasing concentrations of glutaraldehyde. When the concentration of glutaraldehyde exceeds 0.2%, the maximal viscosity of collagen gel solutions reaches a plateau. However, model drugs showed insignificant effects on viscosity changes of collagen gel solutions. The diffusion characteristics of collagen films prepared from those gel solutions crosslinked with different concentrations of glutaraldehyde were assessed using two different matrix forms of solution or gel for the model drugs in a flow-through diffusion system. The matrix effect on the flux of model drugs from both solution and gel matrix through collagen films was inconclusive. However, both fluxes show the same tendency to decrease when the concentration of glutaraldehyde used for crosslinking is increased. However, when the concentration of glutaraldehyde exceeds 0.2%, these model drugs, except retinoic acid, show similar diffusion characteristics across the collagen films.

Restricted killer cell immunoglobulin-like receptor repertoire without T-cell receptor gamma rearrangement supports a true natural killer-cell lineage in a subset of sinonasal lymphomas

The cellular lineage of sinonasal T/NK (natural killer) cell lymphoma remains controversial. Lineage assignment is difficult because T cells and NK cells have a similar morphology and surface markers. Consequently, the assignment must depend heavily on the status of T-cell receptor (TCR) rearrangement. A monoclonal TCR rearrangement supports a T lineage; however, a corresponding monoclonality test for NK cells has not yet been established. Each NK cell bears a distinct set of killer cell immunoglobulin (Ig)-like receptors (KIRs) that are randomly distributed over three groups. In principle, restriction of the KIR repertoire signifies a monoclonal or possibly oligoclonal NK-cell proliferation, just as Ig light-chain restriction usually indicates a monoclonal B-cell neoplasm. Using a novel group-specific reverse transcriptase-polymerase chain reaction, we found a restricted KIR repertoire in most sinonasal lymphomas (9 of 10), but only rarely in T-cell lymphomas (2 of 10) or reactive conditions involving T/NK cells (1 of 10). KIR+ sinonasal lymphomas usually lacked a monoclonal TCR-gamma rearrangement pattern, expressed another NK cell receptor, NKG2a, and were usually CD56-positve, cyclin-dependent kinase-6 (CDK6)-positive, CD44-negative, a phenotype already reported to indicate a true NK cell lineage. We conclude that, although sinonasal lymphomas have heterogeneous genotypes and phenotypes, a restricted KIR repertoire without TCR-gamma rearrangement provides preliminary support for the monoclonality hypothesis and can be used for defining a true NK-cell lineage in a subset of sinonasal lymphomas.

A new mode of percutaneous upper thoracic phenol sympathicolysis: report of 50 cases

OBJECTIVE

Our previous study demonstrated that a high concentration of phenol (75-90%) with minimal volume (0.02 ml) can elicit serious degeneration of ganglion cells of the stellate ganglia in cats. Another previous study in our clinical patients demonstrated that approximately 84 to 90% of the upper thoracic (T2-T3) sympathetic trunks can be found under an endoscope on the ventral side of the T2-T3 rib heads. In this report, we present a new mode of dorsal percutaneous thoracic phenol sympathicolysis (PTPS) for the treatment of palmar hyperhidrosis or axillary bromidrosis.

METHODS

Fifty patients with palmar hyperhidrosis or axillary bromidrosis were injected with 75% phenol into a total of 98 sides of the T2-T3 or T3-T4 sympathetic trunks and ganglia. The injected volume was 0.6 to 1.2 ml (average, 0.8 ml) for each side. The technique of dorsal percutaneous injection was performed under local anesthesia or local with intravenous general anesthesia and under the guidance of a C-arm fluoroscope.

RESULTS

Forty patients (80%) showed satisfactory results, including cessation of sweating. The success rates of PTPS were 83.7% (41 of 49 patients) on the left side and 91.8% (45 of 49 patients) on the right side. The skin temperature of the thumb increased by 5.3 to 5.4 degrees C approximately 1 hour after the phenol injection in patients with satisfactory results, whereas it increased by only 1.3 to 2.7 degrees C in patients who had unsatisfactory results.

CONCLUSION

PTPS may be a good alternative to endoscopic sympathectomy to treat palmar hyperhidrosis and axillary bromidrosis. The skin temperature of the thumb is still a useful index to evaluate preliminarily whether PTPS has been successful.

Synthesis and characterization of non-steroidal ligands for the glucocorticoid receptor: selective quinoline derivatives with prednisolone-equivalent functional activity

A novel class of functional ligands for the human glucocorticoid receptor is described. Substituents in the C-10 position of the tetracyclic core are essential for glucocorticoid receptor (GR) selectivity versus other steroid receptors. The C-5 position is derivatized with meta-substituted aromatic groups, resulting in analogues with a high affinity for GR (K(i) = 2.4-9.3 nM) and functional activity comparable to prednisolone in reporter gene assays of glucocorticoid-mediated gene transcription. The biological activity of these novel quinolines was also prednisolone-equivalent in whole cell assays of glucocorticoid function, and compound 13 was similar to prednisolone (po ED(50) = 2.8 mpk for 13 vs ED(50) = 1.2 mpk for prednisolone) in a rodent model of asthma (sephadex-induced eosinophil influx).

Diagnostic pitfalls of fine-needle aspiration cytology and prognostic impact of chemotherapy in thyroid lymphoma

BACKGROUND AND PURPOSE

Fine-needle aspiration cytology (FNAC) is an important method in the evaluation of goiter. However, difficulties are encountered when using this technique to distinguish Hashimoto's thyroiditis from thyroid lymphoma. This study sought to determine the diagnostic sensitivity of FNAC and to determine the effectiveness of chemotherapy in the treatment of thyroid lymphoma.

METHODS

We retrospectively reviewed the clinical manifestations, diagnostic methods, treatment, and prognosis in 14 consecutive patients with histopathology-verified thyroid lymphoma treated in National Taiwan University Hospital from 1981 to 2000.

RESULTS

Eleven of the 14 patients underwent FNAC, which identified six lymphomas, one anaplastic carcinoma, three cases of Hashimoto's thyroiditis, and one case of Riedel's struma. Because all cases were promptly biopsied, the mean survival times for patients with or without the correct initial diagnosis (15 mo vs 43 mo) did not differ significantly (p = 0.098 by Student's t-test). Thyroid lymphoma was diagnosed before 1990 in four patients, three of whom were treated with local radiotherapy and one with surgical resection. The mean survival time of these four patients was 60 days. Thyroid lymphoma was diagnosed after 1990 in 10 patients, nine of whom underwent systemic chemotherapy, with additional adjunctive radiotherapy in three patients. The mean survival time in the nine of these 10 patients with follow-up was 60 months. A significant difference was found in the mean disease-free survival times between patients treated before and after 1990 (60 d vs 60 mo, p = 0.005).

CONCLUSIONS

In this study, FNAC had a sensitivity of only 55%, its major limitation being misdiagnosis of lymphoma as Hashimoto's thyroiditis in three patients. However, such initial misdiagnosis does not affect the prognosis if promptly corrected by histopathology. As evidenced by the improved survival of patients receiving chemotherapy after 1990, we conclude that chemotherapy is effective in the treatment of thyroid lymphoma.

Colonoscopic manifestations of primary colorectal lymphoma

BACKGROUND AND STUDY AIMS

Little is known about the colonoscopic manifestation of colorectal lymphoma. This article describes the use of colonoscopy for diagnosis of primary colorectal lymphoma.

PATIENTS AND METHODS

We analyzed colonoscopic findings in 13 retrospectively collected cases of primary colorectal lymphoma diagnosed between 1990 and 1999 at our hospital.

RESULTS

The primary colorectal tymphomas were distinguished into three colonoscopic types: a) the mucosal type, which included six lymphomas (46%), which were classified into two subtypes, erosive (two lymphomas) and ulcerative (four tymphomas); b) the polypoid type, which included three tymphomas (23%); and c) the massive type, which included four (31%). The proportion of patients with T-cell lineage lymphoma (5 of 12, 42%) was higher than in previous studies. Three cases were diagnosed as enteropathy-associated T-cell (EAT)-like lymphoma: one presenting with multicentric ulcerations, one as a massive type and another as a polypoid type. Of those with B-cell lineage lymphoma (7 of 12, 58%), three presented as massive type, two as polypoid type and two as erosive subtype.

CONCLUSIONS

Based on the analysis of colonoscopic records, we have proposed three main types of primary colorectal lymphoma. An unusually high proportion of T-cell lineage lymphomas was noted, but as the number of cases was low, further study is still needed for confirmation.

Neutralizing peptide ligands selected from phage-displayed libraries mimic the conformational epitope on domain III of the Japanese encephalitis virus envelope protein

The envelope (E) protein of Japanese encephalitis virus (JEV) contains 500 amino acids with six "conserved" disulfide bonds to maintain its conformational structure. Neutralizing epitopes located on the E protein are mostly conformational dependent. In this study, we used phage-displayed 12-residue combinatorial peptide libraries to select high-affinity peptide ligands bound to monoclonal antibody E3.3. The specific peptide ligands presented on ten high-affinity phage clones displayed six different amino acid sequences, all showing a novel cis-proline turn structure. After being superimposed onto the best fit of the three-dimensional structure of JEV E protein, these peptide structures were mapped to a conformational region constituted by three continuous polypeptide segments (E307-E309, E327-E333, E386-E390) in domain III. Synthetic peptide ligands based on one peptide sequence (E18) were further investigated using alanine scanning within the cis-proline turn structure to demonstrate its unique molecular characteristics. Our results showed that three residues forming the novel cis-proline turn structure were all important in eliciting JEV-specific neutralizing antibodies in mice.

Preparation of EVAL membranes with smooth and particulate morphologies for neuronal culture

In this work, the in vitro interaction of cerebellar granule neurons prepared from 7-day-old Wistar rats and poly ethylene-co-vinyl alcohol (EVAL) membranes was investigated. Cells were cultured in smooth and particulate EVAL membranes for up to 7 days. Particulate membranes were prepared by using 1-octanol to precipitate EVAL solutions in DMSO. Such a membrane was microporous characterized by a packed bed of particles. Voids left between the aggregated particles formed a continuous and interconnected porous network. Crystallization of the EVAL polymer induced by 1-octanol is responsible for the formation of particulate morphology. The membrane structure and its relationship with cells were examined by scanning electron microscopy and the MTT assay. It was observed that the particulate membrane was more favorable for the neuron culture than the smooth membrane. Neurons seeded on the particulate membrane were able to regenerate with formation of an extensive neuritic network. Therefore, the particulate structure may spatially mediate cellular response that can promote neuronal cell attachment, differentiation and neuritic growth, indicating that the particulate structure should be useful as a new polymer scaffold for nerve repair.

Polarization gating in ultrafast-optics imaging of skeletal muscle tissues

By comparing the results of polarization-dependent, time-resolved intensity profiles of photons transmitted through diluted milk, chicken breast tissue, and chopped chicken breast tissue, we found that the inherent anisotropic optical property of skeletal muscle tissue resulted in coherent coupling between two mutually perpendicular polarization directions. This coupling process led to difficulty in using the conventional polarization gating method for imaging unless the anisotropy characteristics were well understood. However, imaging based on polarization gating in diluted milk and chopped chicken breast tissue, which had an isotropic random-scattering nature, was quite effective.

In vitro and in vivo studies for modified ethyl cyanoacrylate regimens for sclerotherapy

Cyanoacrylates have known for their ability to polymerize rapidly in the presence of traces of weakly basic moieties such as water. The tissue adhesive, Histoacryl(R) (N-butyl 2-cyanoacrylate), has been reported to control bleeding through endoscopic sclerotherapy. But the commercially available Histoacryl(R) is expensive, and it has the problem like other cyanoacrylates that the glue tends to flow/run away from the point of application, which is inherent to the low viscosity, making precise application difficult. In this study, ethyl cyanoacrylate (ECA), the main constituent of "super glue," was employed instead of Histoacryl(R) due to its lower cost. The aim of the research is to modify the compositions of ECA regimen and evaluate its feasibility for sclerosant application through both in vitro flow circuit model and in vivo animal tests. It was noted that the difference in the relative hardening rate between the in vitro Hepes-Tyrodes buffer flowing model and the in vivo rat model for the ECA and Histoacryl(R) was related to the existence of the blood protein, such as albumin, in the physiological milieu. It was also noticed that the ECA setting rate was greatly increased either in Hepes-Tyrodes buffer or in blood (to a comparable rate as Histoacryl(R) in vivo) by adding a few doses of caffeine, which acts as a polymerization initiator. This would lead to far better injection precision during sclerotherapy. Furthermore, in vivo histological examination for the occluded lumen of the rat's inferior vena cava and a clinical piglet portal vein occlusion experiment have suggested this new sclerosant regimen, caffeine/ECA, is of great promise in endoscopic sclerotherapy.

An adaptive 3-D discrete cosine transform coder for medical image compression

In this communication, a new three-dimensional (3-D) discrete cosine transform (DCT) coder for medical images is presented. In the proposed method, a segmentation technique based on the local energy magnitude is used to segment subblocks of the image into different energy levels. Then, those subblocks with the same energy level are gathered to form a 3-D cuboid. Finally, 3-D DCT is employed to compress the 3-D cuboid individually. Simulation results show that the reconstructed images achieve a bit rate lower than 0.25 bit per pixel even when the compression ratios are higher than 35. As compared with the results by JPEG and other strategies, it is found that the proposed method achieves better qualities of decoded images than by JPEG and the other strategies.