Determining the association between the radiographic parameters and the SRS-22 scores in Chinese female patients with adolescent idiopathic scoliosis: does curve pattern matter?

Background: The Scoliosis Research Society (SRS)-22 outcomes have been shown to be correlated with radiographic parameter of adolescent idiopathic scoliosis (AIS). A recent study suggested that curve patterns might play a role in assessing the influence of deformity on patient's reported outcomes. The aim of this study was to examine the relationship between radiographic parameters and SRS-22 questionnaire outcomes in female patients with adolescent AIS among the Chinese population based on five curve patterns.Patients and Methods: The radiographic data and SRS-22 questionnaires of 259 female AIS patients were reviewed. Radiographic measurements included: Cobb angle of the major curve, T1 tilt angle, apical vertebral rotation, apical vertebral translation (AVT), thoracic kyphosis, and lumbar lordosis. Curve patterns included single thoracic (T), single thoracolumbar/lumbar (TL), double thoracic (DT), double major (DM), and triple major (TM). The correlation between radiographic measurements and each domain in SRS-22 was determined by Pearson's correlation coefficient.Results: The curve magnitude and AVT of the major curve were found to be significantly correlated with the self-image domain in all cases (Cobb angle: r = -0.426, p = 0.002; AVT: r = -0.281, p=0.006) and in all curve patterns except for TM. Compared to other groups, the TM group had a significantly larger major curve than the DT group and TL group (p ≤ 0.004). In TM group, the self-image scores were lower than TL group (p =0.018), and the function scores were lower than that in T, TL (p < 0.001) and DM groups (p =0.013). In the DT group, the T1 tilt was significantly correlated with the self-image domain (r = -0.376, p =0.004). In the T group, coronal curve magnitude was significantly correlated with function domain (r = -0.397, p < 0.001).Conclusion: Our findings suggested curve patterns should be considered in evaluating the correlations between radiographic parameters and SRS-22 outcomes in patients with AIS.

Advanced glycation end products promote intervertebral disc degeneration by transactivation of matrix metallopeptidase genes

OBJECTIVE

Examine the mechanism by which advanced glycation end products (AGEs) induce intervertebral disc degeneration (IDD) in C57BL/6J mice.

METHODS

Matrix metallopeptidase (MMP) gene mRNA levels were assessed using RT-qPCR. Immunoprecipitation and co-immunoprecipitation were performed to identify the transcriptional complex regulating MMP expression due to AGEs. The preventive effects of inhibitors targeting this complex were tested in mice on high AGE diets.

RESULTS

IDD and AGE accumulation were evident in mice on high-AGE diets (HAGEs), persisting across dietary shifts but absent in mice exclusively on low-AGE diets. Molecularly, HAGEs activated p21-activated kinase 1 (PAK1), prompting peroxisome proliferator-activated receptor gamma coactivator-related protein 1 (PPRC1) phosphorylation. Ubiquitin-specific protease 12 (USP12) interacted with the phosphorylated PPRC1 (pPPRC1), safeguarding it from proteasomal degradation. This pPPRC1, in collaboration with two histone acetyltransferases p300/CREB-binding protein (CBP) and a transcription factor activator protein 1(AP1), enhanced the expression of 12 MMP genes (MMP1a/1b/3/7/9/10/12/13/16/19/23/28). In vitro AGE exposure on nucleus pulposus and annulus fibrosus cells replicated this gene activation pattern, driven by the PAK1/pPPRC1-p300/CBP-AP1 pathway. The application of PAK1, p300, and AP1 inhibitors reduced pPPRC1-p300/CBP-AP1 binding to MMP promoters, diminishing their expression. These inhibitors effectively thwarted IDD in HAGE mice.

CONCLUSION

Our results revealed that HAGEs instigate IDD via the PAK1/pPPRC1-p300/CBP-AP1 signaling pathway. This insight can guide therapeutic strategies to slow IDD progression in prediabetic/diabetic patients.

Glucose-stimulated PGC-1α couples with CBP and Runx2 to mediate intervertebral disc degeneration through transactivation of ADAMTS4/5 in diet-induced obesity mice

Emerging evidence suggests that type 2 diabetes mellitus (T2DM) is associated with the pathogenesis of intervertebral disc degeneration (IDD). However, it is still unclear how T2DM contributes to IDD. Herein, we observed the accumulation of blood glucose and degenerative lumbar discs in mice fed a high-fat diet. Detection of differentially expressed genes in degenerative lumbar discs revealed that ADAMTS4 (A Disintegrin and Metalloproteinase with Thrombospondin motifs) and ADAMTS5 genes were significantly increased. In vitro analyses demonstrated that Runt-Related Transcription Factor 2 (Runx2) recruited both PPARgamma Coactivator 1alpha (PGC-1α) and CREB-Binding Protein (CBP) to transactivate the expression of ADAMTS4/5. Glucose stimulation could dose-dependently induce the accumulation of PGC-1α and promoted the binding of the CBP-PGC-1α-Runx2 complex to the promoters of ADAMTS4/5. Depletion of CBP-PGC-1α-Runx2 complex members and treatment with either PGC-1α inhibitor SR-18292 or CBP inhibitor EML425 in vitro could dramatically inhibit the glucose-induced expression of ADAMTS4/5. Administration of SR-18292 and EML425 in diabetic mice could prevent the degeneration of lumbar discs. Collectively, our results revealed a molecular mechanism by which the hyperglycemia-dependent CBP-PGC-1α-Runx2 complex was required for the transactivation of ADAMTS4/5. The blockage of this complex in diabetic mice may help prevent IDD.

The CRL4DCAF6 E3 ligase ubiquitinates CtBP1/2 to induce apoptotic signalling and promote intervertebral disc degeneration

Inflammation and apoptosis are two important pathological causes of intervertebral disc degeneration (IDD). The crosstalk between these two biological processes during IDD pathogenesis remains elusive. Herein, we discovered that chronic inflammation induced apoptosis through a cullin-RING E3 ligase (CRL)-dependent mechanism. Two cullin proteins, CUL4A and 4B, recruited DNA damage-binding protein 1 (DDB1), RING-box protein 1 (RBX1) and DDB1- and CUL4-associated factor 6 (DCAF6) to assemble a CRL4^DCAF6 E3 ligase in intervertebral discs (IVDs) derived from IDD patients. The CRL4^DCAF6 E3 ligase ubiquitinated and degraded C-terminal-binding protein 1 and 2 (CtBP1/2), two homologues of transcriptional corepressors. The degradation of CtBP1/2 disassociated from the p300-forkhead box O3a (FOXO3a) complex, inducing the expression of B-cell lymphoma 2 (Bcl2)-binding component 3 (BBC3) and causing BBC3-dependent apoptosis. TSC01131, a small molecule that specifically targets CUL4-DDB1 interaction, could inhibit the ubiquitination of CtBP1/2 in vitro and in vivo, thereby decreasing the BBC3 expression level and preventing apoptosis signalling. Using a mouse chronic inflammation model, we found that chronic inflammation could accelerate the IDD process through a conserved CRL4^DCAF6-mediated mechanism. The administration of TSC01131 to mice could significantly improve the outcome of IDD. Collectively, our results revealed that inflammation-dependent CRL4^DCAF6 E3 ligase triggered apoptosis through the removal of CtBP-mediated transrepression. The blockage of the CRL4^DCAF6 E3 ligase by TSC01131 may represent a new therapeutic strategy for IDD treatment. KEY MESSAGES: CUL4A and CUL4B recruited DDB1, RBX1 and DCAF6 to assemble a CRL4^DCAF6 E3 ligase in human IDD biopsies. The CRL4^DCAF6 E3 ligase ubiquitinated and degraded CtBP1/2, causing BBC3-dependent apoptosis. A small molecule TSC01131 that specifically targets CUL4-DDB1 interaction could inhibit the ubiquitination of CtBP1/2, improving the outcome of IDD in a mouse model.

[11C]PBR28 MR-PET imaging reveals lower regional brain expression of translocator protein (TSPO) in young adult males with autism spectrum disorder

Mechanisms of neuroimmune and mitochondrial dysfunction have been repeatedly implicated in autism spectrum disorder (ASD). To examine these mechanisms in ASD individuals, we measured the in vivo expression of the 18 kDa translocator protein (TSPO), an activated glial marker expressed on mitochondrial membranes. Participants underwent scanning on a simultaneous magnetic resonance-positron emission tomography (MR-PET) scanner with the second-generation TSPO radiotracer [11C]PBR28. By comparing TSPO in 15 young adult males with ASD with 18 age- and sex-matched controls, we showed that individuals with ASD exhibited lower regional TSPO expression in several brain regions, including the bilateral insular cortex, bilateral precuneus/posterior cingulate cortex, and bilateral temporal, angular, and supramarginal gyri, which have previously been implicated in autism in functional MR imaging studies. No brain region exhibited higher regional TSPO expression in the ASD group compared with the control group. A subset of participants underwent a second MR-PET scan after a median interscan interval of 3.6 months, and we determined that TSPO expression over this period of time was stable and replicable. Furthermore, voxelwise analysis confirmed lower regional TSPO expression in ASD at this later time point. Lower TSPO expression in ASD could reflect abnormalities in neuroimmune processes or mitochondrial dysfunction.

Prognostic gene expression signature for high-grade serous ovarian cancer

BACKGROUND

Median overall survival (OS) for women with high-grade serous ovarian cancer (HGSOC) is ∼4 years, yet survival varies widely between patients. There are no well-established, gene expression signatures associated with prognosis. The aim of this study was to develop a robust prognostic signature for OS in patients with HGSOC.

PATIENTS AND METHODS

Expression of 513 genes, selected from a meta-analysis of 1455 tumours and other candidates, was measured using NanoString technology from formalin-fixed paraffin-embedded tumour tissue collected from 3769 women with HGSOC from multiple studies. Elastic net regularization for survival analysis was applied to develop a prognostic model for 5-year OS, trained on 2702 tumours from 15 studies and evaluated on an independent set of 1067 tumours from six studies.

RESULTS

Expression levels of 276 genes were associated with OS (false discovery rate < 0.05) in covariate-adjusted single-gene analyses. The top five genes were TAP1, ZFHX4, CXCL9, FBN1 and PTGER3 (P < 0.001). The best performing prognostic signature included 101 genes enriched in pathways with treatment implications. Each gain of one standard deviation in the gene expression score conferred a greater than twofold increase in risk of death [hazard ratio (HR) 2.35, 95% confidence interval (CI) 2.02-2.71; P < 0.001]. Median survival [HR (95% CI)] by gene expression score quintile was 9.5 (8.3 to -), 5.4 (4.6-7.0), 3.8 (3.3-4.6), 3.2 (2.9-3.7) and 2.3 (2.1-2.6) years.

CONCLUSION

The OTTA-SPOT (Ovarian Tumor Tissue Analysis consortium - Stratified Prognosis of Ovarian Tumours) gene expression signature may improve risk stratification in clinical trials by identifying patients who are least likely to achieve 5-year survival. The identified novel genes associated with the outcome may also yield opportunities for the development of targeted therapeutic approaches.

Correction of Scoliosis with Large Thoracic Curves in Marfan Syndrome: Does the High-Density Pedicle Screw Construct Contribute to Better Surgical Outcomes

Background

The aim of this study was to determine whether higher density screw constructs resulted in better surgical outcomes in patients with scoliosis secondary to Marfan syndrome (MF-S) with large thoracic curves (≥70°).

Material/Methods

There were 34 MF-S patients who met the inclusion criteria and were evaluated radiographically before surgery, 2 weeks after operation, and at the final follow-up. The mean screw density was taken as the boundary, and patients were categorized as either in the high density (HD) group or the low density (LD) group. Parameters measured included coronal Cobb angle, T5–T12 kyphosis (TK), and T12–S1 lordosis (LL). Additionally, the operation duration, estimated blood loss, screw accuracy, complication rate, and clinical outcomes were compared between the 2 groups.

Results

The mean screw density of all patients was 1.40±0.15 (range 1.13 to 1.67). Correction rate of the thoracic curve was closely related to the screw density at the concave side (r=0.783, P=0.007). Intergroup comparison showed a significantly higher correction rate of the thoracic coronal curve in HD group (56.59±4.80% versus 44.54±9.61%, P=0.036). At last follow-up, coronal correction loss of >5° occurred in 8 cases (47.1%) in the LD group and 3 cases (17.6%) in the HD group. Both groups demonstrated improvement in each domain of the SRS-22 questionnaire after surgery and no significant intergroup difference was found.

Conclusions

The high-density pedicle screw construct contributed to the significantly improved correction rate of thoracic curves in MF-S patients with large thoracic curves (≥70°). Additionally, increasing of pedicle screw number could help to enhance the structural stability and reduce the correction loss during the follow-up period.

Abstract P1-12-17: Exercise and nutrition intervention on breast cancer survivors in Taiwan with BMI 25 or more to decrease BMI and maintain at an appropriate level -A preliminary report

It has been reported that lifestyle changes after completion of breast cancer treatment may decrease recurrence rate. Lifestyle was formed since childhood, and modified and sustained throughout lifetime. Usually, lifestyle changes are difficult without specific motivation.

Materials and Methods

Breast cancer survivors, aged from 20 to 80 years old with stage I, II, III, who have received surgery and completed courses of chemotherapy within 4 years, were candidates for the study.

According to the American Athletic Association sports guidelines, aerobic, muscular and extension exercises are taught by a sports instructor to the participants, and the participants were asked to exercise at home, 150 minutes a week, 30 minutes each time. Participants were instructed to calculate the calories they needed (25 calories/kg/day). Food selection and diet plan must meet the calories they have calculated, and a diet log was recorded.

The study of one-year diet and exercise intervention study was designed. Group meeting was started at the beginning and then held every 3 months. Measurements of body weight, height, body fat, BMI, waist circumference, muscle mass, and basal metabolic rate were performed; WHO quality of life and brief pain inventory (BPI) were also collected.

Results

A total of 32 breast cancer survivors were recruited, and 20 participants had completed one-year follow-up. Two of the participants withdrew from the study due to personal reasons, and the remaining 18 were included in the statistical analysis.

Body weight, BMI, and body fat decreased after interventions in diet and exercise and reached a significant lower level (p-value = 0.001, 0.002 and 0.01, respectively). In the linear regression model, it could be seen that body weight has a negative correlation with time; the body weight and BMI gradually decreased during the one-year period (β= -0.327, p-value=0.005; β= - 0.362, p-value=0 .002, respectively). There was no statistically significant change in waist circumference, muscle mass and basal metabolic rate.

BPI at baseline, 17 reported among 20 participants (80%) and decreased to 11% (2/18) at after one-year follow-up.

In the quality of life questionnaire, after the score calculation, the single factor repeated measurement analysis (calculated under the statistical power α=0.05) was used. There was no significant difference and change between the scores after the interventional measures. In the bivariate regression analysis, it was also seen that QOL had not changed due to weight loss, and there was no correlation between the two.

Discussion

This study results demonstrated that lifestyle adjustment can be motivated, and lifestyle can be changed by exercise and diet intervention; however, statistically, quality of life did not change with weight loss.

Citation Format: Hsieh C-M, Yang N-C, Yang A-K, Tseng C. Exercise and nutrition intervention on breast cancer survivors in Taiwan with BMI 25 or more to decrease BMI and maintain at an appropriate level -A preliminary report [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-17.

Radiographic and Clinical Outcomes of Surgical Correction of Poliomyelitis-Related Spinal Deformities: A Comparison Among Three Types of Pelvic Instrumentations

BACKGROUND

We compared the clinical and radiographic outcomes of corrective surgery in patients with poliomyelitis-related spinal deformity (PSD) using 3 types of pelvic fixation and investigated the incidence and risk factors for complications.

METHODS

We reviewed the data from 42 patients with PSD who had undergone spinopelvic reconstruction at a single institution from 2000 to 2016. Of the 42 patients, 15 had been treated with the Galveston technique, 13 with iliac screw fixation, and 14 with S2-alar-iliac (S2AI) screw fixation. Demographic data, radiographic parameters, and complications were analyzed. Health-related quality of life was determined using Scoliosis Research Society (SRS) 22-item questionnaires and the Oswestry Disability Index scores.

RESULTS

After surgery, the correction rate of the main curve was 51.7%, 57.8%, and 52.1% in the 3 groups, with significant improvement in regional kyphosis, coronal balance, and pelvic obliquity (PO) (P < 0.05). The correction of PO was similar among the 3 types of pelvic fixation; however, the patients treated with S2AI fixation required significantly less operative time (P < 0.05) and blood loss (P < 0.006). The overall complication rate was 40.5%, with a major complication rate of 23.8%. Age at surgery (P = 0.006) and grade >2 SRS-Schwab osteotomy (P = 0.036) were significant risk factors for complications. Significant improvement was found in the SRS-22 and Oswestry Disability Index scores at the final follow-up examination in the 3 groups.

CONCLUSIONS

The present study showed satisfactory correction of spinopelvic deformity for 42 patients with PSD. Compared with the Galveston technique and iliac screw fixation, the use of S2AI significantly decrease the operative time and estimated blood loss and obtained similar correction of PO. Patient age at surgery and grade >2 SRS-Schwab osteotomy were significant risk factors for complications.

The Use of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) for Pre-Oxygenation in Neurosurgical Patients: A Randomised Controlled Trial

This study explored the use of high-flow nasal oxygen (HFNO) in both pre-oxygenation and apnoeic oxygenation in adults who were intubated following a non–rapid sequence induction. Fifty patients were randomised to receive pre-oxygenation via a standard facemask or the Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) device. After five minutes of pre-oxygenation, induction and muscle relaxant agents were given. While waiting for complete paralysis, patients in the standard facemask group received bag–mask ventilation (BMV), whereas patients in the HFNO group received apnoeic oxygenation via the THRIVE device. Serial blood samples for arterial blood gas analysis were taken. Baseline patient and airway characteristics were similar. The median PaO2 after pre-oxygenation was 357 (interquartile range [IQR] 324–450 [range 183– 550]) mmHg in the facemask group, compared to 471 (IQR 429–516 [range 185–550]) mmHg in the HFNO group (P=0.01). The median arterial partial pressure of oxygen (PaO2) in the HFNO group decreased after a period of apnoeic oxygenation, and was significantly lower when compared to patients who received BMV in facemask group. The arterial carbon dioxide partial pressure (PaCO2) level after complete paralysis was significantly higher in the HFNO group when compared to the facemask group (median 52 [IQR 48–55 {range 40–65}] versus median 43 [IQR 40–48 {range 35–63}] mmHg, P=0.0005 and P=0.004 respectively). There were no differences in the time to muscle paralysis and time to intubation. Seven patients required use of airway adjuncts during BMV in the facemask group, compared to none in the HFNO group (P=0.004). No complications were observed in either group. HFNO produces a higher PaO2 after pre-oxygenation and safe PaO2 during intubation. However, the subsequent fall in PaO2 and rise in PaCO2 indicates that it is not as effective as BMV in maintaining oxygenation and ventilation following neuromuscular blockade.

Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery

PURPOSE

The purpose of this study was to analyze the occurrence of PE after intra-operative O-arm navigation-assisted surgery and determine whether the post-operative PE incidence could be decreased by using O-arm navigation as compared to conventional free-hand technique.

METHODS

A cohort of 27 patients with spinal deformity who were operated upon with an O-arm navigated system (group A) between 2013 and 2016 were enrolled in the study. A total of 27 curve-matched patients treated by conventional free-hand technique were included as the control group (group B). Whole spine posterior-anterior and lateral radiographs, and CT scans were taken pre and post-operation. Radiologic parameters and volume of PE were measured and compared between the two groups.

RESULTS

There were no significant differences in age, Cobb angle, and sagittal contour between the two groups pre-operatively. The mean total volume of post-operative PE was significantly larger in the free-hand group (p < 0.001). In the O-arm group, 59 malpositioned screws were identified in 22 patients. In the free-hand group, 88 malpositioned screws were found among 26 patients. The screw perforation rate was higher in the free-hand group than in the O-arm group (p = 0.007). In the O-arm group, the mean volume of PE was significantly larger among patients with malpositioned screws than those without malpositioned screws (p < 0.001), as well as in the free-hand group.

CONCLUSION

The volume of PE after correction surgery can be significantly decreased by application of O-arm navigation system as compared to conventional free-hand technique. We ascribed the improvement to the accuracy of screw implantation navigated by O-arm.

Depletion of white adipocyte progenitors induces beige adipocyte differentiation and suppresses obesity development

Overgrowth of white adipose tissue (WAT) in obesity occurs as a result of adipocyte hypertrophy and hyperplasia. Expansion and renewal of adipocytes relies on proliferation and differentiation of white adipocyte progenitors (WAP); however, the requirement of WAP for obesity development has not been proven. Here, we investigate whether depletion of WAP can be used to prevent WAT expansion. We test this approach by using a hunter-killer peptide designed to induce apoptosis selectively in WAP. We show that targeted WAP cytoablation results in a long-term WAT growth suppression despite increased caloric intake in a mouse diet-induced obesity model. Our data indicate that WAP depletion results in a compensatory population of adipose tissue with beige adipocytes. Consistent with reported thermogenic capacity of beige adipose tissue, WAP-depleted mice display increased energy expenditure. We conclude that targeting of white adipocyte progenitors could be developed as a strategy to sustained modulation of WAT metabolic activity.

Physicians' participatory decision-making and quality of diabetes care processes and outcomes: results from the triad study

OBJECTIVES

In participatory decision-making (PDM), physicians actively engage patients in treatment and other care decisions. Patients who report that their physicians engage in PDM have better disease self-management and health outcomes. We examined whether physicians' diabetes-specific treatment PDM preferences as well as their self-reported practices are associated with the quality of diabetes care their patients receive.

METHODS

2003 cross-sectional survey and medical record review of a random sample of diabetes patients (n=4198) in 10 US health plans across the country and their physicians (n=1217). We characterized physicians' diabetes care PDM preferences and practices as 'no patient involvement,' 'physician-dominant,' 'shared,' or 'patient-dominant' and conducted multivariate analyses examining their effects on the following: (1) three diabetes care processes (annual hemoglobin A1c test; lipid test; and dilated retinal exam); (2) patients'satisfaction with physician communication; and (3) whether patients' A1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL) were in control.

RESULTS

Most physicians preferred 'shared' PDM (58%) rather than 'no patient involvement' (9%), 'physician-dominant' (28%) or 'patient dominant' PDM (5%). However, most reported practicing 'physician-dominant' PDM (43%) with most of their patients, rather than 'no patient involvement' (13%), 'shared' (37%) or 'patient-dominant' PDM (7%). After adjusting for patient and physician-level characteristics and clustering by health plan, patients of physicians who preferred 'shared' PDM were more likely to receive A1c tests [90% vs. 82%, AOR: 2.05, 95% CI: 1.03-3.07] and patients of physicians who preferred 'patient-dominant' treatment decision-making were more likely to receive lipid tests [60% vs. 50%, AOR: 1.58, 95% CI: 1.04-2.39] than those of providers who preferred 'no patient involvement' in treatment decision-making. There were no differences in patients' satisfaction with their doctor's communication or control of A1c, SBP or LDL depending on their physicians' PDM preferences. Physicians' self-reported PDM practices were not associated with any of the examined aspects of diabetes care in multivariate analyses.

CONCLUSIONS

Patients whose physicians prefer more patient involvement in decision-making are more likely than patients whose physicians prefer more physician-directed styles to receive some recommended risk factor screening tests, an important first step toward improved diabetes outcomes. Involving patients in treatment decision-making alone, however, appears not to be sufficient to improve biomedical outcomes.

Cryptococcal meningitis in pediatric systemic lupus erythematosus

Cryptococcal meningitis is an uncommon but often fatal complication of systemic lupus erythematosus (SLE). We report on a 13-year-old girl with SLE using high-dose prednisolone for several months, presented to us with low grade fever, intermittent vomiting and headache. Physical examination, including papilloedema and meningeal irritation, was unremarkable. Serum and cerebrospinal fluid (CSF) cryptococcal antigen titer was 1: 128 by latex agglutination method. CSF culture yielded Cryptococcus neoformans. We used amphotericin B deoxycholate (a cumulative dose of 1.95 gm) and fluconazole (200 mg day-1) for 6 weeks. Clinical response was good. Then, we continued fluconazole 200 mg per qd as suppressive therapy for thirty-four months. There were no neurological sequelae or relapse after 20-month follow-up. Timely diagnosis and effective antifungal therapy could improve the prognosis of cryptococcal meningitis in SLE patients.

Uniform power method for sample size calculation in historical control studies with binary response

Makuch and Simon gave a sample size calculation formula for historical control (HC) studies that assumed that the observed response rate in the control group is the true response rate. We dropped this assumption and computed the expected power and expected sample size to evaluate the performance of the procedure under the omniscient model. When there is uncertainty in the HC response rate but this uncertainty is not considered, Makuch and Simon's method produces a sample size that gives a considerably lower power than that specified. Even the larger sample size obtained from the randomized design formula and applied to the HC setting does not guarantee the advertised power in the HC setting. We developed a new uniform power method to search for the sample size required for the experimental group to yield an exact power without relying on the estimated HC response rate being perfectly correct. The new method produces the correct uniform predictive power for all permissible response rates. The resulting sample size is closer to the sample size needed for the randomized design than Makuch and Simon's method, especially when there is a small difference in response rates or a limited sample size in the HC group. HC design may be a viable option in clinical trials when the patient selection bias and the outcome evaluation bias can be minimized. However, the common perception of the extra sample size savings is largely unjustified without the strong assumption that the observed HC response rate is equal to the true control response rate. Generally speaking, results from HC studies need to be confirmed by studies with concurrent controls and cannot be used for making definitive decisions.

Binding of the hepatitis C virus envelope protein E2 to CD81 provides a co-stimulatory signal for human T cells

Chronic hepatitis C virus (HCV) infection frequently develops into liver disease and is accompanied by extra-hepatic autoimmune manifestations. The tetraspanin CD81 is a putative HCV receptor as it binds the E2 envelope glycoprotein of HCV and bona fide HCV particles. Here we show that HCV E2 binding to CD81 on human cells in vitro lowers the threshold for IL-2 receptor alpha expression and IL-2 production, resulting in strongly increased T cell proliferation. HCV E2-induced co-stimulation also enhances the production of IFN-gamma and IL-4 and causes increased TCR down-regulation. This suggests that binding of HCV particles to CD81 on T cells in vivo may lead to activation by otherwise suboptimal stimuli. Therefore, co-stimulation of autoreactive T cells by HCV may contribute to liver damage and autoimmune phenomena observed in HCV infection.

Binding of the hepatitis C virus envelope protein E2 to CD81 provides a co-stimulatory signal for human T cells

Chronic hepatitis C virus (HCV) infection frequently develops into liver disease and is accompanied by extra-hepatic autoimmune manifestations. The tetraspanin CD81 is a putative HCV receptor as it binds the E2 envelope glycoprotein of HCV and bona fide HCV particles. Here we show that HCV E2 binding to CD81 on human cells in vitro lowers the threshold for IL-2 receptor alpha expression and IL-2 production, resulting in strongly increased T cell proliferation. HCV E2-induced co-stimulation also enhances the production of IFN-gamma and IL-4 and causes increased TCR down-regulation. This suggests that binding of HCV particles to CD81 on T cells in vivo may lead to activation by otherwise suboptimal stimuli. Therefore, co-stimulation of autoreactive T cells by HCV may contribute to liver damage and autoimmune phenomena observed in HCV infection.

Binding of the hepatitis C virus envelope protein E2 to CD81 provides a co-stimulatory signal for human T cells

Chronic hepatitis C virus (HCV) infection frequently develops into liver disease and is accompanied by extra-hepatic autoimmune manifestations. The tetraspanin CD81 is a putative HCV receptor as it binds the E2 envelope glycoprotein of HCV and bona fide HCV particles. Here we show that HCV E2 binding to CD81 on human cells in vitro lowers the threshold for IL-2 receptor alpha expression and IL-2 production, resulting in strongly increased T cell proliferation. HCV E2-induced co-stimulation also enhances the production of IFN-gamma and IL-4 and causes increased TCR down-regulation. This suggests that binding of HCV particles to CD81 on T cells in vivo may lead to activation by otherwise suboptimal stimuli. Therefore, co-stimulation of autoreactive T cells by HCV may contribute to liver damage and autoimmune phenomena observed in HCV infection.

Up-regulation of gut-enriched krüppel-like factor by interferon-gamma in human colon carcinoma cells

Interferon-gamma (IFN-gamma) induces growth arrest and apoptosis of tumor cells but the mechanisms for these functions are unknown. Recently, gut-enriched krüppel-like factor (GKLF) was found to possess similar biological properties. Treatment of HT-29 cells with IFN-gamma inhibited cell proliferation and induced apoptosis, the effect was found to associate with GKLF expression. IFN-gamma stimulates GKLF mRNA and protein levels in a dose- and time-dependent manner and this process is independent of p53, occurs rapidly and does not require de novo protein synthesis indicating that GKLF is an immediate-early IFN-gamma-responsive gene. Moreover, overexpression of GKLF results in similar effect as IFN-gamma suggesting that GKLF may function as a downstream target of IFN-gamma.

MCMC segregation and linkage analysis

Our objective was to infer the genetic model for the quantitative traits using a variety of methods developed in our group. Only a single data set was analyzed in any one analysis, although some comparison between data sets was made. In addition, the simulated model was not known during the course of the analysis. Basic modeling and segregation analyses for the five quantitative traits was followed by several simple genome scans to indicate areas of interest. A Markov chain Monte Carlo (MCMC) multipoint quantitative trait locus (QTL) mapping approach was then used to estimate the posterior probabilities of linkage of QTL to each chromosome simultaneously with trait model parameters, and to further localize the genes. Comparisons between the nuclear family and pedigree data sets indicated a greater power for QTL detection and mapping with the pedigree data sets. Even with the pedigree data, however, precise localization of the QTL did not appear to be possible using single replicate data sets. Two of the three genes with effects on trait Q1 were detected by the MCMC method.

Stochastic resonance and nonlinear response using NMR spectroscopy

We revisit the phenomenon of quantum stochastic resonance in the regime of validity of the Bloch equations. We find that a stochastic resonance behavior in the steady-state response of the system is present whenever the noise-induced relaxation dynamics can be characterized via a single relaxation time scale. The picture is validated by a simple nuclear magnetic resonance experiment on water.

Mechanisms underlying ketoconazole-induced Ca(2+) mobilization in Madin-Darby canine kidney cells

The effect of ketoconazole on Ca(2+) signaling in Madin-Darby canine kidney (MDCK) cells was investigated by using fura-2 as a Ca(2+) probe. Ketoconazole evoked increases in cytosolic free Ca(2+) concentration ([Ca(2+)](i)) concentration dependently. The response was decreased by external Ca(2+) removal. In Ca(2+)-free medium, pretreatment with ketoconazole abolished the [Ca(2+)](i) rise induced by thapsigargin, an inhibitor of the endoplasmic reticulum Ca(2+) pump. Addition of 3 mM Ca(2+) induced a significant [Ca(2+)](i) rise after preincubation with 150 microM ketoconazole in Ca(2+)-free medium. Pretreatment with aristolochic acid (40 microM) to inhibit phospholipase A(2) inhibited the 150-microM-ketoconazole-induced internal Ca(2+) release by 37%, but inhibition of phospholipase C with 1-(6-((17beta-3-methoxyestra-1,3, 5(10)-trien-17-yl)amino)hexyl)-1H-pyrrole-2,5-dione (U73122) (2 microM) had no effect. Collectively, we found that ketoconazole increases [Ca(2+)](i) in MDCK cells by releasing Ca(2+) from thapsigargin-sensitive pools in a manner independent of the production of inositol-1,4,5-trisphosphate, followed by Ca(2+) influx from the external space.

[The density and larval habitats of dengue vectors in Chungho city]

A survey was conducted to understand larval habitats and density of dengue vectors in Chungho city during the period of August 12 to September 13, 1996. Most villages (41 in the total of 93) were found to have the density figures of three for Aedes albopictus Skuse. The second common density figures were found at 2nd and 4th levels. The most common breeding containers found were less than 5 cm in water depth and less than 100 cm2 in water area. The number of breeding containers reduced when the water depth and size increased. The common breeding containers in villages were flower vases (30%) and water buckets (18%). In the mountains, water buckets (34%) and kitchen tools (11%) were common. In parks, water buckets (29%) and tires (15%) were commonly found. In cemeteries, the common breeding containers were flower vases (57%) and earthenware pots (17%). The average (2.05 containers per man-hour) of positive water containers in the mountains was significantly higher than that in parks (0.62). However, the average in cemeteries (1.29) was not significantly different from those collected in mountains and parks.

Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma

PURPOSE

To determine the patterns of recurrence and causes of regional nodal basin failure in stage I or II melanoma patients who had a histologically negative sentinel lymph node (SLN) and whose regional nodal basins were not dissected following lymphatic mapping and SLN biopsy.

PATIENTS AND METHODS

The records of 344 patients with primary cutaneous melanoma who underwent lymphatic mapping and SLN biopsy between 1991 and 1995 at The University of Texas M.D. Anderson Cancer Center were reviewed. Of 322 patients who underwent successful lymphatic mapping procedures, 270 had histologically negative SLNs; mapped nodal basins were observed without further surgical intervention in 243 of these 270 patients. Recurrence patterns were analyzed from this cohort and a histologic reevaluation of all previously identified SLNs on which a biopsy had been taken was performed in patients who developed recurrent disease.

RESULTS

Of 243 patients with a histologically negative SLN, 27 (11%) developed local, in-transit, regional nodal, and/or distant metastases after a median follow-up time of 35 months. Ten patients (4.1%) developed a nodal recurrence in the previously mapped basin, either solely or as a component of the first site of recurrence. Detailed analysis of the SLNs in these 10 patients demonstrated evidence of occult metastases in 80% by serial sectioning or immunohistochemical staining.

CONCLUSION

Regional nodal failures in melanoma patients following a negative SLN biopsy are infrequent and to date have most commonly occurred because conventional histologic evaluation was unable to identify occult metastatic disease. These data provide further evidence that lymphatic mapping and SLN biopsy accurately reflect the status of the regional nodal basin. Specialized pathologic techniques are necessary to reduce further the already low false-negative rates and to improve disease staging.