Video-assisted superior mediastinal lymphadenectomy for papillary thyroid cancer: a case report

Superior mediastinal lymph node metastases in papillary thyroid cancer are uncommon. The clinical characteristics and surgical strategy of superior mediastinal lymph node metastases remain unclear. Superior mediastinal lymphadenectomy can be accomplished either by a transcervical or transsternal approach. Transsternal approach for superior mediastinal lymphadenectomy can cause great damage; transcervical approach sometimes results in inadequate exposure. Here we report our experience of a papillary thyroid cancer patient with superior mediastinal lymph node metastases who underwent video-assisted superior mediastinal lymphadenectomy. A 49-year-old woman diagnosed with papillary thyroid cancer in left thyroid underwent unilateral lobectomy and ipsilateral central and lateral node dissection in the local hospital 4 years ago. Currently lymph node metastases were found in mediastinum and the right neck, some of which were adjacent to the right innominate vein. Unilateral lobectomy, ipsilateral central and lateral node dissection, and video-assisted superior mediastinal lymphadenectomy were successfully performed by transcervical approach. Subsequently, the patient received thyroxine suppression therapy and adjuvant radioiodine treatment. Video-assisted superior mediastinal lymphadenectomy, providing adequate exposure for a complete superior mediastinal lymphadenectomy, is proved to be safe and feasible.

Efficacy and safety of endothelin receptor antagonists in type 2 diabetic kidney disease: A systematic review and meta-analysis of randomized controlled trials

AIM

To analyse the efficacy and safety of endothelin receptor antagonists for people with diabetic kidney disease.

METHODS

Randomized controlled trials comparing endothelin receptor antagonists with placebo in people with diabetic kidney disease were identified through PubMed, Embase and the Cochrane Library. We used a random-effect model to calculate the mean difference or risk ratio with the 95% CI.

RESULTS

Seven studies with a total of 4730 participants were included. Overall, endothelin receptor antagonists significantly reduced albuminuria compared with placebo (standardized mean difference -0.48, 95% CI -0.64 to -0.33). Atrasentan, in particular, effectively reduced albuminuria (standardized mean difference -0.58, 95% CI -1.00 to -0.17) and the risk of composite renal endpoints (risk ratio 0.65; 95% CI 0.49 to 0.88), with insignificant change in the rate of congestive heart failure (risk ratio 1.40, 95% CI 0.76 to 2.56) and mortality (risk ratio 1.11, 95% CI 0.77 to 1.61). In contrast, although avosentan reduced albuminuria (standardized mean difference -0.47, 95% CI -0.57 to -0.36) and the risk of composite renal endpoints (risk ratio 0.63, 95% CI 0.42 to 0.94), it was associated with a significant increase in congestive heart failure risk (risk ratio 2.61, 95% CI 1.36 to 5.00) and an insignificant increase in mortality risk (risk ratio 1.50, 95% CI 0.81, 2.78). No significant change in efficacy or safety outcomes with bosentan was detected. Dose-response analysis indicated that 0.75 mg/day atrasentan is expected to be optimal for renoprotection, with maximal albuminuria reduction and minimal fluid retention events.

CONCLUSIONS

Among the endothelin receptor antagonists, atrasentan and avosentan, but not bosentan, are effective for renoprotection in people with diabetic kidney disease. Compared with other types and doses, atrasentan 0.75 mg/day is the most promising, with maximal albuminuria reduction and minimal fluid retention. Vigilant monitoring of congestive heart failure risk is needed in future clinical practice. (PROSPERO registration no. CRD42020169840).

Low-dose CT of paediatric paranasal sinus using an ultra-low tube voltage (70 kVp) combined with the flash technique

AIM

To evaluate the radiation dose and diagnostic image quality of low-dose computed tomography (CT) of the paranasal sinus in children, with acquisition at an ultra-low tube voltage (70 kVp) combined with the Flash technique.

MATERIALS AND METHODS

Eighty paediatric patients underwent CT of the paranasal sinus and were divided into two groups according to different protocols (group A: 80 kVp protocol with conventional spiral mode [n=40] and group B: 70 kVp protocol with Flash scan mode [n=40]). For each examination, the CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED) were estimated. The image noise, signal-to-noise ratio (SNR), and overall subjective diagnostic image quality were also evaluated.

RESULTS

For radiation dose, the CTDIvol (mGy), DLP (mGy·cm), and ED (mSv) values of the 70 kVp protocol were significantly lower than those of the 80 kVp protocol (CTDIvol: 1.57±0.009 versus 0.39±0.004 mGy, p<0.001; DLP: 19.88±2.01 versus 6.31±0.52 mGy·cm, p<0.001; ED: 0.079±0.016 versus 0.024±0.005 mSv, p<0.001). Compared with those of the 80-kVp protocol, the image noise increased by 40.7% (p=0.113), the SNR_soft-tissue decreased by 48.9%, and the SNR_bone increased by 10.1% with the 70-kVp protocol (p=0.176 and 0.227, respectively). There was no significant difference in the overall subjective image quality grades between these two groups (p=0.15).

CONCLUSION

When imaging the paranasal sinus in children, an ultra-low tube voltage (70 kVp) combined with the Flash CT technique can reduce the radiation dose significantly while maintaining diagnostic image quality with clinically acceptable image noise.

Clinical outcomes of ultrasound-guided radiofrequency ablation for the treatment of primary papillary thyroid microcarcinoma

AIM

To evaluate the safety, efficacy, and long-term outcomes of ultrasound-guided radiofrequency ablation (RFA) for the treatment of primary papillary thyroid microcarcinoma (PTMC).

MATERIALS AND METHODS

A total of 37 patients with 38 PTMC nodules underwent RFA at a power of 20 W between September 2014 and December 2017. The clinical data of these patients were reviewed retrospectively and analysed. Imaging studies of the nodules were conducted, and the patients' thyroid function was assessed before RFA; 1, 3, 6, and 12 months after RFA; and every 6 months thereafter. The volumes and volume reduction rate (VRR) of the nodules were also calculated.

RESULTS

RFA with a low power of 20 W was used in the treatment of 37 patients with 38 PTMC nodules. All nodules achieved complete ablation, no complications occurred, and thyroid function was not affected. During follow-up, the volume of the nodules gradually decreased. Twelve months after ablation, the mean volumes of the nodules significantly decreased to 0.01±0.03 ml with a VRR of 99.34±3.49%. At a median follow-up of 6 (range: 1-18) months, 37 of the 38 nodules were completely absorbed, and no recurrence was observed in all 37 patients.

CONCLUSIONS

Low-power RFA showed good safety and promising efficacy outcomes for the treatment of PTMC. In addition to surgery and active surveillance, RFA may be an alternative treatment option for patients with PTMC.

Cortistatin inhibits arterial calcification in rats via GSK3β/β-catenin and protein kinase C signalling but not c-Jun N-terminal kinase signalling

AIM

Cortistatin (CST) is a newly discovered endogenous active peptide that exerts protective effects on the cardiovascular system. However, the relationship between CST and aortic calcification and the underlying mechanism remain obscure. Therefore, we investigated effects of CST on aortic calcification and its signalling pathways.

METHODS

Calcium content and alkaline phosphatase (ALP) activity were measured using the o-cresolphthalein colorimetric method and ALP assay kit respectively. Protein expression of smooth muscle (SM)-ɑ-actin, osteocalcin (OCN), β-catenin, glycogen synthase kinase 3β (GSK3β), p-GSK3β, protein kinase C (PKC), p-PKC, c-Jun N-terminal kinase (JNK) and p-JNK was determined using Western blotting.

RESULTS

In aorta from a rat vitamin D3 calcification model, CST abrogated calcium deposition and pathological damage, decreased the protein expression of OCN and β-catenin and increased SM-ɑ-actin expression. In a rat cultured vascular smooth muscular cell (VSMC) calcification model induced by β-glycerophosphate (β-GP), CST inhibited the increase in ALP activity, calcium content and OCN protein and the decrease in SM-α-actin expression. CST also inhibited the β-GP-induced increase in p-GSK3β and β-catenin protein (both P < .05). The inhibitory effects of CST on ALP activity, calcium deposition and β-catenin protein were abolished by pretreatment with lithium chloride, a GSK3β inhibitor. CST promoted the protein expression of p-PKC by 68.5% (P < .01), but not p-JNK. The ability of CST to attenuate β-GP-induced increase in ALP activity, calcium content and OCN expression in the VSMC model was abolished by pretreatment with the PKC inhibitor Go6976.

CONCLUSION

These results indicate that CST inhibits aortic calcification and osteogenic differentiation of VSMCs likely via the GSK3β/β-catenin and PKC signalling pathways, but not JNK signalling pathway.

Eye on the B-ALL: B-cell receptor repertoires reveal persistence of numerous B-lymphoblastic leukemia subclones from diagnosis to relapse

The strongest predictor of relapse in B-cell acute lymphoblastic leukemia (B-ALL) is the level of persistence of tumor cells after initial therapy. The high mutation rate of the B-cell receptor (BCR) locus allows high-resolution tracking of the architecture, evolution and clonal dynamics of B-ALL. Using longitudinal BCR repertoire sequencing, we find that the BCR undergoes an unexpectedly high level of clonal diversification in B-ALL cells through both somatic hypermutation and secondary rearrangements, which can be used for tracking the subclonal composition of the disease and detect minimal residual disease with unprecedented sensitivity. We go on to investigate clonal dynamics of B-ALL using BCR phylogenetic analyses of paired diagnosis-relapse samples and find that large numbers of small leukemic subclones present at diagnosis re-emerge at relapse alongside a dominant clone. Our findings suggest that in all informative relapsed patients, the survival of large numbers of clonogenic cells beyond initial chemotherapy is a surrogate for inherent partial chemoresistance or inadequate therapy, providing an increased opportunity for subsequent emergence of fully resistant clones. These results frame early cytoreduction as an important determinant of long-term outcome.

GPU accelerated FDTD solver and its application in MRI

The finite difference time domain (FDTD) method is a popular technique for computational electromagnetics (CEM). The large computational power often required, however, has been a limiting factor for its applications. In this paper, we will present a graphics processing unit (GPU)-based parallel FDTD solver and its successful application to the investigation of a novel B1 shimming scheme for high-field magnetic resonance imaging (MRI). The optimized shimming scheme exhibits considerably improved transmit B(1) profiles. The GPU implementation dramatically shortened the runtime of FDTD simulation of electromagnetic field compared with its CPU counterpart. The acceleration in runtime has made such investigation possible, and will pave the way for other studies of large-scale computational electromagnetic problems in modern MRI which were previously impractical.

Comparative genomic and protein signatures and intratumoral treatment responses in patients with metastatic breast cancer (MBC) treated with paclitaxel (PTX) and 2-methoxyestradiol (2ME2)

e22049

Background: Tumors respond to both chemotherapy and radiation through a number of poorly understood survival mechanisms. These potential mechanisms include upregulation of anti-apoptotic and pro-angiogenic pathways, including those regulated by HIF-1α. Sequential MBC biopsies were used to examine 1) the effects of PTX on intratumoral HIF-1α mediated pathways; and 2) the ability of a HIF-1α inhibitor (2ME2) to modulate the tumor's HIF- 1α response to PTX. Methods: Key eligibility included pts with MBC, ECOG 0–2, unlimited prior therapies, and biopsiable tumors. Pts were treated on a 28-day schedule with weekly PTX (90 mg/m2 D1, D8, D15) and daily oral 2ME2 (1000, 1250,1500 or 2000 mg qid starting D8) and had 3 tumor biopsies: baseline (A); D8 post-PTX/pre-2ME2 (B); D22 post-PTX/post- 2ME2 (C). Serial biopsies were compared for genomic and single protein changes. Results: 20 pts (median age 52 yrs [31- 75]) were treated. 60% had ≥2 prior regimens for MBC, 35% had ≥3. No unexpected grade 3/4 toxicities were seen: neutropenia (n=6), anemia (2), hypophosphatemia (2), PE (1). The clinical benefit rate was 25% (4 PR, 1 SD). There were 13 pairs of tumor biopsies to compare points A/B and 10 to compare B/C. There were no consistent gene expression changes between A and B. Significant differences at C vs. B included changes in hypoxia-responsive genes (including CA9, HIF-2α) and upregulation of pro- angiogenic factors and hemoglobin transcripts. For the B/C comparison, 2 distinct groups emerged: the first (biopsy site liver) showed downregulation of gene expression programs driven by ER and the second (lymph node, breast) showed upregulation of endothelial cell- related genes. Conclusions: Combination therapy with PTX and 2ME2 is a well-tolerated and viable option for delaying disease progression for patients with heavily pretreated MBC. Significant gene expression changes before and after exposure to 2ME2 may reflect changes in tumor microcirculation consistent with the idea of vascular normalization. The potential significance of the differences in gene expression observed in the 2 distinct groups remains to be investigated. Supported by Komen Grant BCTR0504044 (MWD).

[Table: see text]

The effects of paclitaxel (PTX) and 2-methoxyestradiol (2-ME2) on tumor oxygenation and HIF-1α in breast cancer

3517

Background: Radiation activates HIF-1a via a free radical mediated mechanism associated with reoxygenation. This response could be inhibited, resulting in reduced tumor vascularity and proliferation. Preclinical breast cancer models and a Phase Ib clinical trial (CT) were employed to look at the effects of chemo with or without an oral HIF-1a inhibitor, 2-ME2 (EntreMed) on tumor oxygenation and HIF-1a. Methods: Preclinical models of chemo effects on HIF-1a/oxygenation used 4T1 tumors and either doxorubicin (DOX) or cyclophosphamide (CTX). In addition, MDA-MB-231 tumors were treated with 2-ME2 (5days), and HIF-1a/MVD was assessed. In the CT, up to 15 pts with metastatic breast cancer, and biopsiable (>2 cm) non-bone sites were eligible. Tx was: D 1: PTX, 90 mg/m2; D 8: PTX, 90 mg/m2 with 2-ME2 (cohorts of 1,000/1,250/1,500 mg, qid). PTX was given 3 out of 4 wks. Bxs were done at enrollment, D8 (post-PTX), and D22 (post-PTX/2-ME2). Tumors were examined for changes in HIF-1a and CA9 levels, MVD, and genomic signatures of hypoxia. Plasma was obtained for osteoponin, PAI-1, and VEGF. Results: DOX and CTX both led to increases in HIF-1a, oxygenation, vascularity, and proliferation 4–10 days post treatment in the 4T1 model, while 2-ME2 reduced HIF-1a and MVD post treatment (5 d) in the MDA-MB-231 model. The CT opened in 6–2006, 9 pts have consented and 8 pts have undergone sequential biopsies and accrual continues. No DLT have been seen. Biopsy sites include chest wall, liver, and LN. Sufficient tissue/RNA/plasma has been obtained and the planned analyses will be presented. Conclusions: HIF-1a and tumor oxygenation appear to be modulated as a response to chemotherapy. The combination of PTX and 2-ME2 is clinically active, well-tolerated, and could serve as one of the first approaches to target HIF-1a in order to optimize therapy. Supported by Komen Grant BCTR0504044.

[Table: see text]

Characterization of nelfinavir binding to plasma proteins and the lack of drug displacement interactions

OBJECTIVES

To determine the characteristics of the binding of nelfinavir and active M8 to alpha1-acid glycoprotein (AAG) and human serum albumin (HSA), and to examine the displacement effects of drugs binding extensively to AAG (ritonavir and saquinavir) or to HSA (salicylic acid and valproic acid).

METHODS

Free drugs were separated by equilibrium dialysis after incubation with human plasma or purified plasma proteins and after co-incubation with potential displacers. Association constants were estimated from double-reciprocal plots of the data.

RESULTS

Nelfinavir and M8 free fractions [fractions of unbound drug (fus)] were 0.42+/-0.08% (mean+/-standard deviation) and 0.64+/-0.07%, respectively. For the two analytes, respectively, association constants were 7.25 x 10(7)/m and 3.33 x 10(7)/m for AAG and 1.11 x 10(6)/m and 7.92 x 10(5)/m for HSA. Nelfinavir fu in an AAG solution was significantly (P < 0.01) increased by the addition of ritonavir or saquinavir, whereas it was unaltered by addition of these drugs to whole plasma. Similarly, fu in an HSA solution was significantly increased (P < 0.01) by the addition of salicylic acid or valproic acid, whereas there was no difference in the free fraction in plasma.

CONCLUSIONS

The affinity of nelfinavir for human plasma proteins was higher than that of M8, and both nelfinavir and M8 showed higher affinity to AAG than to HSA. The free fraction of nelfinavir was not affected by drugs that bind extensively to AAG or albumin when these drugs were added to whole plasma in combination, suggesting a compensatory effect of alternate binding proteins.

New insights into the karyotypic relationships of Chinese muntjac (Muntiacus reevesi), forest musk deer (Moschus berezovskii) and gayal (Bos frontalis)

To investigate the karyotypic relationships between Chinese muntjac (Muntiacus reevesi), forest musk deer (Moschus berezovskii) and gayal (Bos frontalis), a complete set of Chinese muntjac chromosome-specific painting probes has been assigned to G-banded chromosomes of these three species. Sixteen autosomal probes (i.e. 6-10, 12-22) of the Chinese muntjac each delineated one pair of conserved segments in the forest musk deer and gayal, respectively. The remaining six autosomal probes (1-5, and 11) each delineated two to five pairs of conserved segments. In total, the 22 autosomal painting probes of Chinese muntjac delineated 33 and 34 conserved chromosomal segments in the genomes of forest musk deer and gayal, respectively. The combined analysis of comparative chromosome painting and G-band comparison reveals that most interspecific homologous segments show a high degree of conservation in G-banding patterns. Eleven chromosome fissions and five chromosome fusions differentiate the karyotypes of Chinese muntjac and forest musk deer; twelve chromosome fissions and six fusions are required to convert the Chinese muntjac karyotype to that of gayal; one chromosome fission and one fusion separate the forest musk deer and gayal. The musk deer has retained a highly conserved karyotype that closely resembles the proposed ancestral pecoran karyotype but shares none of the rearrangements characteristic for the Cervidae and Bovidae. Our results substantiate that chromosomes 1-5 and 11 of Chinese muntjac originated through exclusive centromere-to-telomere fusions of ancestral acrocentric chromosomes.

Effect of Anti-Cancer Drugs on the Binding of 125I-Fibrinogen to Two Leukaemia Cell Lines In Vitro

Anti-cancer drugs may be able to inhibit tumour growth and metastasis by blocking fibrinogen- and/or fibrin-related pathways. To test this hypothesis, the effect of various anti-neoplastic drugs on the binding of 125I-Fibrinogen to two leukaemia cell lines, HL60 and P388, was investigated. All the drugs tested inhibited the binding of fibrinogen to leukaemia cells. This effect was particularly marked for drugs that act as inhibitors of protein synthesis. Since these anti-neoplastic drugs do not have anti-coagulant actions, these results provide evidence for the potential of targeting tumour fibrinogen as a new form of cancer chemotherapy.

A direct determination of thymidine triphosphate concentrations without dephosphorylation in peripheral blood mononuclear cells by LC/MS/MS

A rapid, sensitive and specific analytical method with minimal sample preparation for the measurement of thymidine triphosphate (TTP) in peripheral blood mononuclear cells (PBMC) by LC/MS/MS has been developed. PBMC were separated from whole blood or buffy coat. The analyte and internal standard were extracted from PBMC with 70% methanol (pH 7.2). These extracts after centrifugation were directly injected onto LC/MS/MS without need for any further sample preparation. The calibration curve was linear over the range 0.8-800 ng/ml. Mean inter- and intra-assay coefficients of variation (CVs) over the range of the standard curve were less than 10%. The overall recovery of TTP was 103.5%.

Age changes in orthodontic treatment need: a longitudinal study of 10- and 13-year-old children, using the Dental Aesthetic Index

The Dental Aesthetic Index (DAI) was used to assess the prevalence of unmet orthodontic treatment need in 150 13-year-old schoolchildren in Dunedin, New Zealand, and to compare the findings with those obtained in the same children at 10 years of age. Fewer 13-year-olds (27%) had a "mandatory" need of orthodontic treatment than when they were 10 years old (33%), 20% had "no/little" need for orthodontic treatment, 33% had an "elective" need for treatment and 20% had a "desirable" need for treatment. The fall in DAI scores is attributed to over-sensitivity of the Index to mixed dentition traits. When the individual scores were analysed, only 7% of the 10-year-olds were given the same scores as when they were 13 years old, 52% were given higher scores and 41% were given lower scores. This disagreement between scores was masked to a limited extent by the DAI categories: 49% of the 10-year-olds were assigned to the same DAI category at 13 years of age, 20% to a greater treatment-need category and approximately 30% to a lower treatment-need category. The DAI, in common with other malocclusion indices, is unreliable over time because it is affected by developmental changes in the occlusal traits measured.

Incidence of presbycusis of Korean populations in Seoul, Kyunggi and Kangwon provinces

Presbycusis, a bilateral sensorineural hearing loss caused by changes in the inner ear, is related to multiple factors such as noise exposure and otologic disease. In institute-based studies, we tried to determine the incidence of presbycusis in Korean populations living in Seoul, Kyunggi and Kangwon provinces by gender and age groups. The subjects were people who had visited health promotion centers. Pure tone audiometry was done over 20 years on 6,028 subjects. In a community-based study, the subjects were elderly residents of Kanghwa-do area. There were no obvious factors that could cause hearing impairment in the subjects. For the pure tone audiometry, hearing threshold was obtained by using the six-dimension method. The incidence of presbycusis for subjects aged 65 years and older was 37.8% and 8.3% for > or = 27 dB HL criterion and > or = 41 dB HL criterion, respectively. The incidence increased with age. A statistically significant difference in the hearing threshold was found between men and women aged 65 years or older. No differences were found between the community-based study and the institute- based studies. There was a high incidence (about 40%) of presbycusis among Koreans aged 65 years or older (for > or = 27 dB HL criterion). With an aging population, we anticipate that this report could be used to provide a basic data for the study of presbycusis.

A longitudinal study of orthodontic treatment need in Dunedin schoolchildren

The Index of Orthodontic Treatment Need (IOTN) was used to assess unmet orthodontic treatment need in 152 13-year-old Dunedin schoolchildren, and to compare the findings with those obtained in the same children 3 years previously. The children were randomly selected from Dunedin schools as 10-year-olds, and had not received orthodontic treatment. Approximately 86 percent of the 13-year-old children had "No-little" need for orthodontic treatment when assessed by the child-assessed Aesthetic Component (AC) and the examiner-assessed AC. Slightly less than half the children had "No-little" need for orthodontic treatment when assessed with the Dental Health Component (DHC). More 10- and 13-year-old children "Needed" orthodontic treatment with the DHC than with the AC. Both the examiner-assessed AC and the DHC assessed significantly fewer 13-year-olds as needing orthodontic treatment than the same children as 10-year-olds. Complete agreement between the grades assigned at 10 and 13 years occurred in 30-43 percent of the children and, in the treatment-need categories, between 53 percent (DHC) and 84 percent (child-assessed AC) of the children. The fall in treatment need over the 3-year period may be due to selection bias, over-sensitivity of the IOTN to mixed dentition traits, or both. Although a number of 10-year-old children were assigned different grades as 13-year-olds, many remained within the same treatment category. The apparent stability of the IOTN to assess treatment need in 10- and 13-year-old children is attributed to the grouping of different occlusal traits in the same treatment-need category, and to the small number of treatment-need categories in each component.

Induction of gastritis and gastric ulcer in Mongolian gerbils infected with Helicobacter pylori

OBJECTIVE

To induce the model of Mongolian gerbil infected by Helicobacter pylori (HP) and to observe the changes of the infiltration and the proliferation of inflammatory cells before and after the bactericidal treatment.

METHODS

The animal model of HP infection was induced by inoculating the HP strain (American Type Culture Collection) to male Mongolian gerbil MGS/Sea (SPF). Half a month, 1 month and 3 months after inoculation, kill the animals and make HE staining and immunohistochemistry staining of the stomach to observe the pathological changes.

RESULTS

The infiltration of a great number of inflammatory cells was observed with the center of the mucosa of pylorus at the second week of HP infection. At the 3rd month of infection, ulcer appeared near the lesser curvature side of the pylorus. On the early stage of infection, the lesion was acute inflammation characterized by the neutrophilic infiltration, and then transformed into the chronic inflammation characterized by the lymphatic infiltration and the wide formation of lymphatic follicles.

CONCLUSION

Mongolian gerbil is an ideal and standard animal model of HP infection.

Neuroendocrine evidence for dopaminergic actions of hypericum extract (LI 160) in healthy volunteers

BACKGROUND

We studied the effect of a single dose of a formulation of a methanolic extract of Hypericum perforatum (HP), also known as St. John's wort, on plasma concentrations of growth hormone (GH), prolactin (PRL), and cortisol (CORT) in 12 healthy male volunteers.

METHODS

Subjects received 9 tablets of the finished product Jarsin 300 and placebo in a double-blind, balanced-order, cross-over design.

RESULTS

Following HP relative to placebo, there was a significant increase in plasma GH and a significant decrease in plasma PRL. Plasma CORT levels were unchanged.

CONCLUSIONS

Taken together with data from animal experimental studies, the findings suggest that this dose of HP may increase some aspects of brain dopamine function in humans.

Globular domains of agrin are functional units that collaborate to induce acetylcholine receptor clustering

Agrin, an extracellular matrix protein involved in neuromuscular junction formation, directs clustering of postsynaptic molecules, including acetylcholine receptors (AChRs). This activity resides entirely in the C-terminal portion of the protein, which consists of three laminin-like globular domains (G-domains: G1, G2 and G3) and four EGF-like repeats. Additionally, alternate mRNA splicing yields G-domain variants G2(0,4) with 0- or 4-amino-acid inserts, and G3(0, 8,11,19) with 0-, 8-, 11- or 19-amino-acid inserts. In order to better understand the contributions of individual domains and alternate splicing to agrin activity, single G-domains and covalently linked pairs of G-domains were expressed as soluble proteins and their AChR clustering activity measured on cultured C2 myotubes. These analyses reveal the following: (1) While only G3(8) exhibits detectable activity by itself, all G-domains studied (G1, G2(0), G2(4), G3(0) and G3(8)) enhance G3(8) activity when physically linked to G3(8). This effect is most pronounced when G2(4) is linked to G3(8) and is independent of the order of the G-domains. (2) The deletion of EGF-like repeats enhances activity. (3) Increasing the physical separation between linked G1 and G3(8) domains produces a significant increase in activity; similar alterations to linked G2 and G3(8) domains are without effect. (4) Clusters induced by two concatenated G3(8) domains are significantly smaller than all other agrin forms studied. These data suggest that agrin G-domains are the functional units which interact independently of their specific organization to yield AChR clustering. G-domain synergism resulting in biological output could be due to physical interactions between G-domains or, alternatively, independent interactions of G-domains with cell surface receptors which require spatially localized coactivation for optimal signal transduction.

Elongated stylohyoid process: a report of three cases

The stylohyoid process is part of the stylohyoid chain--the styloid process, the stylohyoid ligament, and the lesser cornu of the hyoid bone. The stylohyoid chain is derived from the second branchial arch. Mineralisation of the stylohyoid ligament and ossification at the tip may increase the length of the styloid process. An elongated stylohyoid or styloid process is considered to be the source of craniofacial and cervical pain commonly known as Eagle's syndrome. In some instances the stylohyoid process may be considerably elongated, yet remain asymptomatic. This paper reports three patients with elongated stylohyoid processes discovered incidentally on routine radiographic examination.

[A flavonoid compound in Ginkgo biloba L. leaves]

One compound was isolated for the first time from ethyl acetate extract of Ginkgo biloba leaves and identified as kaempferol-3-O-rhamnoside by spectroscopic methods.

[Chemical constituents of flavonoids in the leaf of Ginkgo biloba L]

A compounds were isolated from the ethyl acetate extract of Ginkgo biloba leaves for the first time and was identified as 5,7,4'-trihydroxy-flavone by spectroscopic methods.

Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes

Chromium is an essential nutrient involved in normal carbohydrate and lipid metabolism. The chromium requirement is postulated to increase with increased glucose intolerance and diabetes. The objective of this study was to test the hypothesis that the elevated intake of supplemental chromium is involved in the control of type 2 diabetes. Individuals being treated for type 2 diabetes (180 men and women) were divided randomly into three groups and supplemented with: 1) placebo, 2) 1.92 micromol (100 microg) Cr as chromium picolinate two times per day, or 3) 9.6 micromol (500 microg) Cr two times per day. Subjects continued to take their normal medications and were instructed not to change their normal eating and living habits. HbA1c values improved significantly after 2 months in the group receiving 19.2 pmol (1,000 microg) Cr per day and was lower in both chromium groups after 4 months (placebo, 8.5 +/- 0.2%; 3.85 micromol Cr, 7.5 +/- 0.2%; 19.2 micromol Cr, 6.6 +/- 0.1%). Fasting glucose was lower in the 19.2-micromol group after 2 and 4 months (4-month values: placebo, 8.8 +/- 0.3 mmol/l; 19.2 micromol Cr, 7.1 +/- 0.2 mmol/l). Two-hour glucose values were also significantly lower for the subjects consuming 19.2 micromol supplemental Cr after both 2 and 4 months (4-month values: placebo, 12.3 +/- 0.4 mmo/l; 19.2 micromol Cr, 10.5 +/- 0.2 mmol/l). Fasting and 2-h insulin values decreased significantly in both groups receiving supplemental chromium after 2 and 4 months. Plasma total cholesterol also decreased after 4 months in the subjects receiving 19.2 micromol/day Cr. These data demonstrate that supplemental chromium had significant beneficial effects on HbA1c, glucose, insulin, and cholesterol variables in subjects with type 2 diabetes. The beneficial effects of chromium in individuals with diabetes were observed at levels higher than the upper limit of the Estimated Safe and Adequate Daily Dietary Intake.

Nimodipine ameliorates impaired eyeblink classical conditioning in older rabbits in the long-delay paradigm

Research using the hippocampally dependent short-conditioned stimulus trace conditioning paradigm demonstrated that nimodipine ameliorated learning deficits in older rabbits. Evidence from in vitro and in vivo measures indicated that the site of drug action was hippocampal pyramidal cells. Acquisition occurs in the long (750 ms) delay conditioning paradigm in the absence of the hippocampus. This experiment with 40 older rabbits was undertaken to determine if nimodipine ameliorates impaired acquisition in a conditioning paradigm not dependent on the hippocampus. Fifteen 90-trial sessions of paired conditioning stimuli were presented to 3 groups receiving daily injections of 0, 1, or 5 mg/kg nimodipine. Explicitly unpaired control groups received 0 or 5 mg/kg nimodipine. Acquisition with the 5 mg/kg dose was significantly faster. Existing evidence suggested that nimodipine acted in the hippocampus, but we could not rule out the possibility that the drug also affected conditioning via the cerebellum.

5-CT or DOI augments TRH analog-induced gastric acid secretion at the dorsal vagal complex

Serotonin (5-HT) interacts with thyrotropin-releasing hormone (TRH) at the dorsal vagal complex (DVC) to augment TRH-induced stimulation of gastric acid secretion. To investigate the 5-HT receptor family involved in the augmentation response, prototypical 5-HT receptor-selective agonists (146 pmol) were coinjected with the TRH analog RX-77368 (RX; 12 pmol) into the rat DVC in a 30-nl volume. The DVC coordinates were 0.2 mm anterior, 0.2 mm right, 0.6 mm ventral with respect to the calamus scriptorius. Coinjection of RX with the 5-HT agonists 5-carboxyamidotryptamine (5-CT) or (+/-)-1-(4-iodo-2,5-dimethoxyphenyl)-2-aminopropane hydrochloride (DOI; 5-HT2 agonist) produced a 183 or 103% increase in gastric acid output compared with the RX injection alone. In contrast, coinjection of 2-methyl-5-HT (5-HT3 agonist) with RX produced no effect on RX-induced increase in gastric acid secretion. Moreover, coinjection of SC-53116 (5-HT4 agonist) decreased the gastric acid output by 45% compared with the RX response itself. Examination of the RX/5-HT agonist coinjection response in more rostral regions of the DVC using the same doses (5-CT/RX or DOI/RX) revealed that only 5-CT was effective in producing the augmented response to TRH analog. The results suggest that activation of 5-CT- or DOI-sensitive receptors augments, and of 5-HT4 receptors inhibits, the gastric acid response to TRH analog injected into the DVC. Thus the integrated response to several serotonin receptor subtypes may mediate changes to the TRH response induced by 5-HT at the DVC.

Predictive factors for early menarche in Taiwan

The rapid increase of breast cancer in Taiwan has prompted the authors to evaluate the predictive factors of early menarche among contemporary Taiwanese girls. A total of 895 four-grade girls from eight elementary schools in Taipei City and County were identified as a closed cohort from the first semester of 1993. Data were collected from self-administered questionnaires and school records. A total of 799 girls who had not menstruated in the first year remained in the group through 1994. The effects of potential predictive factors were assessed by logistic regression. Among the 799 girls followed, 69 (8.6%) had first menstruation between the fourth and fifth grades. Height, weight, body mass index and maternal early onset of menarche were positively related to the onset of menarche within the preceding year. Energy consumption during exercise showed only moderate association after being adjusted for age and weight. Calorie intake from junk food was not associated with early menarche within the preceding year. Poor interpersonal family relationships and stressful life events also showed a moderate association with early menarche. The data obtained supported the hypothesis that height, weight, body mass index and maternal early menarche are positive predictive factors of early menarche. The effects of exercise and childhood stress are less prominent.

[Chemical constituents of the leaves of Ginkgo biloba]

Four compounds were isolated from ethyl acetate extract of the leaves of Ginkgo biloba. Compounds II, III, IV were identified as ginkgolides A, B and C respectively, Compound I, which was obtained from the leaves of G. biloba for the first time, was identified as 3,3'-dimethoxy-4,4'-dihydroxy-stilbene by spectroscopic methods.

Gastric antisecretory effect of serotonin: quantitation of release and site of action

Despite many reports that serotonin (5-HT) inhibits gastric acid output, the role and mechanism of action of endogenous 5-HT to modulate gastric secretion remain unclear. Vagal stimulation enhanced the basal rate of 5-HT release into both the gastric lumen (600%) and the portal circulation (265%) of the rat. The peak rate of 5-HT release into the portal circulation was 1,000-fold higher that luminal release (12 micrograms/min and 1.2 ng/min, respectively). To elucidate site(s) of action of 5-HT to inhibit acid secretion, several approaches were taken. Intraluminal perfusion of exogenous 5-HT to encompass enhanced levels seen after vagal stimulation did not reduce gastric acid output. In contrast, administration of systemic 5-HT, which raised portal venous 5-HT to similar levels as vagal stimulation, had a marked antisecretory effect. Chemical or surgical ablation of enteric or sympathetic nerves innervating the stomach did not attenuate the inhibitory effect of exogenous 5-HT on gastric acid output. The antisecretory effect of systemic 5-HT was insensitive to pretreatment with piroxicam, doxantrazole, close gastric intra-arterial sodium nitroprusside, somatostatin monoclonal antibody, or bilateral adrenalectomy. The results suggest that 5-HT is released from endogenous stores into the portal circulation in sufficient quantities after vagal stimulation to alter gastric physiology and that its action is independent of the autonomic nervous system, gastric mucosal prostaglandins or somatostatin, mucosal mast cell or adrenal constituents, or changes in gastric mucosal blood flow.

5-HT in DVC: disparate effects on TRH analogue-stimulated gastric acid secretion, motility, and cytoprotection

Convergent evidence suggests that thyrotropin-releasing hormone (TRH) is a principal regulator of several vagally mediated gastric responses. Serotonin (5-HT) interacts with TRH in the dorsal vagal complex (DVC) to augment gastric acid secretory responses. This study investigated the ability of 5-HT to alter other gastric responses mediated by TRH administration into the DVC. Co-injection of 5-HT (7.9 pmol) and the TRH analogue RX-77368 (0.66 pmol) produced a 117% enhancement in 1-h gastric acid output compared with rats treated with RX-77368 (0.66 pmol) alone into the DVC. In contrast, coadministration of RX-77368 (4 pmol) with various doses of 5-HT (0.0048-480 pmol) was ineffective in significantly altering stimulation of gastric antral motility produced by RX-77368 (4 pmol) alone. The effect of a lower dose of DVC RX-77368 (0.66 pmol) on gastric motility was also not changed by 5-HT coadministration. Moreover, the cytoprotective effect of DVC RX-77368 (1.5 pmol) on oral ethanol-induced gastric mucosal lesions was reversed by 5-HT coadministration (54 or 18 pmol). The results suggest that activation of 5-HT receptors in the DVC can augment, not affect, and attenuate DVC TRH analogue-stimulated gastric acid secretion, antral motility, and cytoprotection, respectively.

[Lipoprotein (a) and non-insulin dependent diabetes mellitus]

To study the relationship of the concentration of serum lipoprotein (a) [Lp(a)] with diabetic complications in non-insulin dependent diabetes mellitus (NIDDM), 100 non-diabetics with 150 patients with NIDDM were compared. There was no difference in Lp(a) concentration (P > 0.5) between the two groups. Lp(a) concentration was not significantly correlated with the levels of total cholesterol, low-density lipoprotein cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), HDL2-C, HDL3-C, apolipoprotein A-I, apolipoprotein B in both groups. In NIDDM group, patients with hypertension, macro- and microangiopathy had higher levels of Lp(a) than those without these complications (P < 0.001 and P = 0.002 respectively). Lp(a) level was positively related to presence of macroangiopathy (r = 0.185, P = 0.024) and proteinuria (r = 0.316, P < 0.001) in NIDDM.

Stimulation of the nucleus raphe obscurus produces marked serotonin release into the dorsal medulla of fed but not fasted rats--glutamatergic dependence

Serotonin interacts with TRH at the dorsal vagal complex (DVC) to augment gastric functional parameters. To ascertain physiologic relevance, patterns of stimulated release at the terminal field were characterized. Stimulation of the nucleus raphe obscurus (nRO) by kainic acid (423 pmol/10 nol) produced marked release of serotonin into dorsal medullary dialysates containing the DVC in freely fed, but no 24-h fasted rats. Probe infusion of kynurenic acid (1 mM), but not acute bilateral cervical vagotomy attenuated nRO-stimulated serotonin release in fed animals. The results suggest that the fed state facilitates serotonin release into the dorsal medulla by a mechanism mediated by activation of excitatory amino acid receptors in the dorsal medulla. Enhanced serotonergic neurotransmission at the DVC may comprise a heretofore unrecognized component of the integrated vago-vagal response to a meal.

Eosinophilic colitis associated with larvae of the pinworm Enterobius vermicularis

Various helmintic parasites, most of which are uncommon in economically developed countries, can cause abdominal pain and eosinophilic inflammation of the bowel. A homosexual man presented with severe abdominal pain and haemorrhagic colitis, eosinophilic inflammation of the ileum and colon, and numerous unidentifiable larval nematodes in diarrhoeal stool. His symptoms resolved with anthelmintic treatment alone. Using comparative morphology and molecular cloning of nematode ribosomal RNA genes, we identified the parasites as larvae of the pinworm Enterobius vermicularis, which are rarely observed or associated with disease. Occult enterobiasis is widely prevalent and may be a cause of unexplained eosinophilic enterocolitis.

Insulin action and metabolism in patients with head and neck cancer

Cachexia is a phenomenon commonly observed in patients with cancer, but its etiology is poorly understood. Abnormalities of insulin action and metabolism that have been hypothesized to promote cancer cachexia were investigated in this study using a computerized euglycemic clamp and modified frequently sampled intravenous glucose tolerance test (FSIGT) in a group of malnourished patients with localized head and neck cancer, and in healthy, well-nourished, age- and, sex-matched controls. Glucose disposal rates, determined by the euglycemic clamp at three different rates of insulin infusion did not differ significantly between the two groups. However, mean plasma insulin concentrations at each level of insulin infused were significantly lower in the patients with cancer than in the control subjects resulting in unexpectedly higher calculated insulin metabolic clearance rate in the patients with cancer. Peripheral insulin sensitivity calculated from the slope of glucose disposal versus plasma insulin concentration did not differ between the two groups. Results from the FSIGT demonstrated no difference in insulin sensitivity or insulin-independent glucose disappearance between the two groups. However, whole body glucose appearance was significantly elevated in the patients with cancer. Thus, increased whole body glucose utilization in the absence of insulin resistance or increased insulin-dependent glucose disposal was observed. These data are consistent with the concept of a localized tumor acting as a glucose drain in which case increased glucose appearance and increased insulin clearance would defend against hypoglycemia.

Hydrazine sulfate in cancer patients with weight loss. A placebo-controlled clinical experience

Hydrazine sulfate was evaluated using 24-hour dietary recalls and body weight determinations before and after 30 days of either placebo or hydrazine (60 mg, 3 times/d) oral administration in 101 heavily pretreated cancer patients with weight loss. After 1 month, 83% of hydrazine and only 53% of placebo patients completing repeat evaluation maintained or increased their weight (P less than 0.05). In addition, appetite improvement was more frequent in the hydrazine group (63% versus 25%, P less than 0.05). Although caloric intake was only slightly greater in hydrazine-treated patients, an increased caloric intake was more commonly associated with weight gain in patients receiving hydrazine compared with those receiving placebo (81% versus 53%, respectively). Hydrazine toxicity was mild, with 71% of patients reporting no toxic effects. Hydrazine sulfate circulatory levels were obtained from a subset of 14 patients who completed 30 days of treatment, with a single sample obtained in the morning at least 9 hours after the last dose. Mean maintenance hydrazine sulfate levels, determined using a spectrofluorometric assay, ranged from 0 to 89 ng/ml (mean 45 +/- 16 ng/ml). These data, which demonstrate an association between 1 month of hydrazine sulfate administration and body weight maintenance in patients with cancer, suggest future clinical trials of hydrazine sulfate are indicated to definitively assess its long-term impact on important clinical outcome parameters in defined cancer populations.