CRISPR PERSIST-On enables heritable and fine-tunable human gene activation

Current technologies for upregulation of endogenous genes use targeted artificial transcriptional activators but stable gene activation requires persistent expression of these synthetic factors. Although general "hit-and-run" strategies exist for inducing long-term silencing of endogenous genes using targeted artificial transcriptional repressors, to our knowledge no equivalent approach for gene activation has been described to date. Here we show stable gene activation can be achieved by harnessing endogenous transcription factors ( EndoTF s) that are normally expressed in human cells. Specifically, EndoTFs can be recruited to activate endogenous human genes of interest by using CRISPR-based gene editing to introduce EndoTF DNA binding motifs into a target gene promoter. This Precision Editing of Regulatory Sequences to Induce Stable Transcription-On ( PERSIST-On ) approach results in stable long-term gene activation, which we show is durable for at least five months. Using a high-throughput CRISPR prime editing pooled screening method, we also show that the magnitude of gene activation can be finely tuned either by using binding sites for different EndoTF or by introducing specific mutations within such sites. Our results delineate a generalizable framework for using PERSIST-On to induce heritable and fine-tunable gene activation in a hit-and-run fashion, thereby enabling a wide range of research and therapeutic applications that require long-term upregulation of a target gene.

MOSAIC enables in situ saturation mutagenesis of genes and CRISPR prime editing guide RNA optimization in human cells

CRISPR prime editing offers unprecedented versatility and precision for the installation of genetic edits in situ . Here we describe the development and characterization of the Multiplexing Of Site-specific Alterations for In situ Characterization ( MOSAIC ) method, which leverages a non-viral PCR-based prime editing method to enable rapid installation of thousands of defined edits in pooled fashion. We show that MOSAIC can be applied to perform in situ saturation mutagenesis screens of: (1) the BCR-ABL1 fusion gene, successfully identifying known and potentially new imatinib drug-resistance variants; and (2) the IRF1 untranslated region (UTR), re-confirming non-coding regulatory elements involved in transcriptional initiation. Furthermore, we deployed MOSAIC to enable high-throughput, pooled screening of hundreds of systematically designed prime editing guide RNA ( pegRNA ) constructs for a large series of different genomic loci. This rapid screening of >18,000 pegRNA designs identified optimized pegRNAs for 89 different genomic target modifications and revealed the lack of simple predictive rules for pegRNA design, reinforcing the need for experimental optimization now greatly simplified and enabled by MOSAIC. We envision that MOSAIC will accelerate and facilitate the application of CRISPR prime editing for a wide range of high-throughput screens in human and other cell systems.

PrimeDesign software for rapid and simplified design of prime editing guide RNAs

Prime editing (PE) is a versatile genome editing technology, but design of the required guide RNAs is more complex than for standard CRISPR-based nucleases or base editors. Here we describe PrimeDesign, a user-friendly, end-to-end web application and command-line tool for the design of PE experiments. PrimeDesign can be used for single and combination editing applications, as well as genome-wide and saturation mutagenesis screens. Using PrimeDesign, we construct PrimeVar, a comprehensive and searchable database that includes candidate prime editing guide RNA (pegRNA) and nicking sgRNA (ngRNA) combinations for installing or correcting >68,500 pathogenic human genetic variants from the ClinVar database. Finally, we use PrimeDesign to design pegRNAs/ngRNAs to install a variety of human pathogenic variants in human cells.

Estimating sediment yield at Kaduna watershed, Nigeria using soil and water assessment tool (SWAT) model

Over the years, sedimentation has posed a great danger to the storage capacity of hydropower reservoirs. Good understanding of the transport system and hydrological processes in the dam is very crucial to its sustainability. Under optimal functionality, the Shiroro dam in Northern Nigeria can generate ∼600 MW, which is ideally sufficient to power about 404,000 household. Unfortunately, there have not been reliable monitoring measures to assess yield in the upstream, where sediments are sourced into the dam. In this study, we applied the Soil and Water Assessment Tool (SWAT) to predict the hydrological processes, the sediment transport mechanism and sediment yield between 1990 and 2018 in Kaduna watershed (32,124 km²) located upstream of the dam. The model was calibrated and validated using observed flow and suspended sediment concentration (SSC) data. Performance evaluation of the model was achieved statistically using Nash-Sutcliffe (NS), coefficient of determination (r²) and percentage of observed data (p-factor). SWAT model evaluation using NS (0.71), r² (0.80) and p-factors of 0.86 suggests that the model performed satisfactorily for streamflow and sediment yield predictions. The model identified the threshold depth of water (GWQMN.gw) and base flow (ALPHA_BF.gw) as the most sensitive parameters for streamflow and sediment yield estimation in the watershed. Our finding showed that an estimated suspended sediment yield of about 84.1 t/ha/yr was deposited within the period under study. Basins 67, 71 and 62 have erosion prone area with the highest sediment values of 79.4, 75.1 and 73.8 t/h respectively. Best management practice is highly recommended for the dam sustainability, because of the proximity of erosion-prone basins to the dam.

The NSL complex-mediated nucleosome landscape is required to maintain transcription fidelity and suppression of transcription noise

Nucleosomal organization at gene promoters is critical for transcription, with a nucleosome-depleted region (NDR) at transcription start sites (TSSs) being required for transcription initiation. How NDRs and the precise positioning of the +1 nucleosomes are maintained on active genes remains unclear. Here, we report that the Drosophila nonspecific lethal (NSL) complex is necessary to maintain this stereotypical nucleosomal organization at promoters. Upon NSL1 depletion, nucleosomes invade the NDRs at TSSs of NSL-bound genes. NSL complex member NSL3 binds to TATA-less promoters in a sequence-dependent manner. The NSL complex interacts with the NURF chromatin remodeling complex and is necessary and sufficient to recruit NURF to target promoters. Not only is the NSL complex essential for transcription, but it is required for accurate TSS selection for genes with multiple TSSs. Furthermore, loss of the NSL complex leads to an increase in transcriptional noise. Thus, the NSL complex establishes a canonical nucleosomal organization that enables transcription and determines TSS fidelity.

High-resolution TADs reveal DNA sequences underlying genome organization in flies

Despite an abundance of new studies about topologically associating domains (TADs), the role of genetic information in TAD formation is still not fully understood. Here we use our software, HiCExplorer (hicexplorer.readthedocs.io) to annotate >2800 high-resolution (570 bp) TAD boundaries in Drosophila melanogaster. We identify eight DNA motifs enriched at boundaries, including a motif bound by the M1BP protein, and two new boundary motifs. In contrast to mammals, the CTCF motif is only enriched on a small fraction of boundaries flanking inactive chromatin while most active boundaries contain the motifs bound by the M1BP or Beaf-32 proteins. We demonstrate that boundaries can be accurately predicted using only the motif sequences at open chromatin sites. We propose that DNA sequence guides the genome architecture by allocation of boundary proteins in the genome. Finally, we present an interactive online database to access and explore the spatial organization of fly, mouse and human genomes, available at http://chorogenome.ie-freiburg.mpg.de .

Adjuvant S-1 chemotherapy after curative resection of gastric cancer in Chinese patients: assessment of treatment tolerability and associated risk factors

INTRODUCTION

The use of adjuvant chemotherapy with S-1 (tegafur, gimeracil, and oteracil potassium) has been shown to improve the outcome of patients with gastric cancer. There are limited data on the tolerability of S-1 in Chinese patients. In this multicentre retrospective study, we assessed the toxicity profile in local patients.

METHODS

Patients with stage II-IIIC gastric adenocarcinoma who had undergone curative resection and who had received S-1 adjuvant chemotherapy were included in the study. Patient demographics, tumour characteristics, chemotherapy records, as well as biochemical, haematological, and other toxicity profiles were extracted from medical charts. Potential factors associated with grade 2-4 toxicities were identified.

RESULTS

Adjuvant S-1 was administered to 30 patients. Overall, 19 (63%) patients completed eight cycles. The most common grade 3-4 adverse events included neutropaenia (10%), anaemia (6.7%), septic episode (16.7%), diarrhoea (6.7%), hyperbilirubinaemia (6.7%), and syncope (6.7%). Dose reductions were made in 22 (73.3%) patients and 12 (40.0%) patients had dose delays. Univariate analyses showed that patients who underwent total gastrectomy were more likely to experience adverse haematological events (P=0.034). Patients with nodal involvement were more likely to report adverse non-haematological events (P=0.031). Patients with a history of regular alcohol intake were more likely to have earlier treatment withdrawal (P=0.044). Lower body weight (P=0.007) and lower body surface area (P=0.017) were associated with dose interruptions.

CONCLUSIONS

The tolerability of adjuvant S-1 in our patient population was similar to that in other Asian patient populations. The awareness of S-1-related toxicities and increasing knowledge of potential associated factors may enable optimisation of S-1 therapy.

High-Affinity Sites Form an Interaction Network to Facilitate Spreading of the MSL Complex across the X Chromosome in Drosophila

Dosage compensation mechanisms provide a paradigm to study the contribution of chromosomal conformation toward targeting and spreading of epigenetic regulators over a specific chromosome. By using Hi-C and 4C analyses, we show that high-affinity sites (HAS), landing platforms of the male-specific lethal (MSL) complex, are enriched around topologically associating domain (TAD) boundaries on the X chromosome and harbor more long-range contacts in a sex-independent manner. Ectopically expressed roX1 and roX2 RNAs target HAS on the X chromosome in trans and, via spatial proximity, induce spreading of the MSL complex in cis, leading to increased expression of neighboring autosomal genes. We show that the MSL complex regulates nucleosome positioning at HAS, therefore acting locally rather than influencing the overall chromosomal architecture. We propose that the sex-independent, three-dimensional conformation of the X chromosome poises it for exploitation by the MSL complex, thereby facilitating spreading in males.

A randomised comparison of InnoScope and Macintosh laryngoscope in simulated difficult tracheal intubation in manikins

We conducted a crossover randomised study to evaluate the performance of a novel optical stylet, the InnoScope, for tracheal intubation in simulated normal and difficult airways. Twenty-five anaesthetists attempted tracheal intubation on a SimMan 3G simulator using the InnoScope first followed by the Macintosh laryngoscope or vice versa. Three airway scenarios were tested: (1) normal airway; (2) difficult airway with swollen pharynx; and (3) limited neck movement. In each scenario, the laryngeal view, duration of and success rate for tracheal intubation were recorded. Compared with the Macintosh laryngoscope, the use of InnoScope increased the percentage of glottic opening seen by 17% in normal airway, 23% in the difficult airway and 32% with limited neck movement, p < 0.01. Despite this better laryngeal view, successful tracheal intubation achieved with the InnoScope (88.0%) was lower than that for the Macintosh laryngoscope (98.7%), p = 0.008. Using the InnoScope, tracheal intubation during the first attempt was only successful in 48% of cases with difficult airway. In this scenario, the median (interquartile range [range]) duration of tracheal intubation was significantly longer with [corrected] InnoScope compared with the Macintosh laryngoscope, (70 (19-120 [15-120)] s vs 30 [21-58 (15-120)] s, [corrected] p = 0.01. We conclude that an improved laryngeal view with the use of the InnoScope did not translate into better conditions for tracheal intubation.

The NSL complex regulates housekeeping genes in Drosophila

MOF is the major histone H4 lysine 16-specific (H4K16) acetyltransferase in mammals and Drosophila. In flies, it is involved in the regulation of X-chromosomal and autosomal genes as part of the MSL and the NSL complexes, respectively. While the function of the MSL complex as a dosage compensation regulator is fairly well understood, the role of the NSL complex in gene regulation is still poorly characterized. Here we report a comprehensive ChIP-seq analysis of four NSL complex members (NSL1, NSL3, MBD-R2, and MCRS2) throughout the Drosophila melanogaster genome. Strikingly, the majority (85.5%) of NSL-bound genes are constitutively expressed across different cell types. We find that an increased abundance of the histone modifications H4K16ac, H3K4me2, H3K4me3, and H3K9ac in gene promoter regions is characteristic of NSL-targeted genes. Furthermore, we show that these genes have a well-defined nucleosome free region and broad transcription initiation patterns. Finally, by performing ChIP-seq analyses of RNA polymerase II (Pol II) in NSL1- and NSL3-depleted cells, we demonstrate that both NSL proteins are required for efficient recruitment of Pol II to NSL target gene promoters. The observed Pol II reduction coincides with compromised binding of TBP and TFIIB to target promoters, indicating that the NSL complex is required for optimal recruitment of the pre-initiation complex on target genes. Moreover, genes that undergo the most dramatic loss of Pol II upon NSL knockdowns tend to be enriched in DNA Replication-related Element (DRE). Taken together, our findings show that the MOF-containing NSL complex acts as a major regulator of housekeeping genes in flies by modulating initiation of Pol II transcription.

Effectiveness of coordination exercise in improving cognitive function in older adults: a prospective study

Background:

Studies on the effect of a low intensity coordination exercise on the elderly with limited mobility are sparse. This prospective study attempted to compare the effectiveness of a customized coordination exercise and a strength exercise in improving the cognitive functioning and physical mobility on the elderly.

Methods:

Participants from two centers for the elderly were allocated to practice either an 8-week coordination training (CT) program or an 8-week towel exercise (TE) program. The Chinese Mini-Mental State Examination and Chinese Dementia Rating Scale (CDRS) were used to measure cognitive functioning of participants, and Timed Up-and-Go test for physical mobility. These assessments were administered before and after the program.

Results:

Paired t-tests showed that the CDRS scores of the CT group improved significantly from 114.8 at pre-test to 119.3 after training (P = 0.045). The CDRS scores of the TE group also improved from 114.9 at pre-test to 116.9 after training.

Conclusion:

Findings from this prospective study demonstrated that low-intensity level mind-body exercise could be beneficial to the cognitive functioning of older adults.

Guarding against natural disaster

Natural disasters have caused death and damage in many places, with the health sector particularly vulnerable to such havoc. Hospitals have collapsed, or been so severely damaged that they have had to be evacuated. It appears that many of them have suffered a distinct lack of disaster mitigation planning during the design and construction phases. To ensure that healthcare facilities can continue to operate after a disaster has struck, at the very moment when they are needed most, the design methodology discussed in this article should be adopted. A successful outcome also demands strong collaboration from all participating construction professionals.

A randomized study of aprepitant, ondansetron and dexamethasone for chemotherapy-induced nausea and vomiting in Chinese breast cancer patients receiving moderately emetogenic chemotherapy

OBJECTIVES

This is a single center, randomized, double-blind placebo-controlled study to evaluate the NK(1)-receptor antagonist, aprepitant, in Chinese breast cancer patients. The primary objective was to compare the efficacy of aprepitant-based antiemetic regimen and standard antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients who received moderately emetogenic chemotherapy. The secondary objective was to compare the patient-reported quality of life in these two groups of patients.

PATIENTS AND METHODS

Eligible breast cancer patients were chemotherapy-naive and treated with adjuvant AC chemotherapy (i.e. doxorubicin 60 mg/m(2) and cyclophosphamide 600 mg/m(2)). Patients were randomly assigned to either an aprepitant-based regimen (day 1, aprepitant 125 mg, ondansetron 8 mg, and dexamethasone 12 mg before chemotherapy and ondansetron 8 mg 8 h later; days 2 through 3, aprepitant 80 qd) or a control arm which consisted of standard regimen (day 1, ondansetron 8 mg and dexamethasone 20 mg before chemotherapy and ondansetron 8 mg 8 h later; days 2 through 3, ondansetron 8 mg bid). Data on nausea, vomiting, and use of rescue medication were collected with a self-report diary, patients quality of life were assessed by self-administered Functional Living Index-Emesis (FLIE).

RESULTS

Of 127 patients randomized, 124 were assessable. For CINV in Cycle 1 AC, there was no significant difference in the proportion of patients with reported complete response, complete protection, total control, 'no vomiting', 'no significant nausea' and 'no nausea'. The requirement of rescue medication appears to be lesser in patients treated with the aprepitant-based regimen compared to those with the standard regimen (11% vs. 20%; P = 0.06). Assessment of FLIE revealed that while there was no difference in the nausea domain and the total score between the two groups; however, patients receiving standard antiemetic regimen had significantly worse quality of life in the vomiting domain (mean score [SD] = 23.99 [30.79]) when compared with those who received the aprepitant-based regimen (mean score [SD] = 3.40 [13.18]) (P = 0.0002). Both treatments were generally well tolerated. Patients treated with the aprepitant-based regimen had a significantly lower incidence of neutropenia (53.2% vs. 35.5%, P = 0.0468), grade >or= 3 neutropenia (21.0% vs. 45.2, P = 0.0042) and delay in subsequent cycle of chemotherapy (8.1% vs. 27.4%, P = 0.0048).

CONCLUSION

The aprepitant regimen appears to reduce the requirement of rescue medication when compared with the control regimen for prevention of CINV in patients receiving both an anthracycline and cyclophosphamide, and is associated with a better quality of life during adjuvant AC chemotherapy.

Adopting better paths to major schemes

In recent decades, the construction industry has developed a range of procurement strategies to overcome perceived problems of inefficiency in the hospital building process.

Adjuvant Chemoradiation for Gastric Cancer: Experience in the Chinese Population

AIMS

The role of adjuvant chemoradiation for gastric cancer after curative R0 gastrectomy was first established by the US Intergroup 0116 study. Although confirmatory studies are in progress, few data are available regarding its application to the Chinese population. We describe our radiotherapy technique and report the treatment results in Hong Kong.

MATERIALS AND METHODS

This was a single centre retrospective study on 63 Chinese patients who underwent adjuvant chemoradiation for gastric adenocarcinoma between June 2000 and December 2004. The treatment protocol was based on that of the Intergroup study. Computed tomography planned anteroposterior opposing field arrangement and treatment under breath hold at deep inspiration position were adopted.

RESULTS

In total, 63 patients, mean age 50 years, with gastric cancer stage IB to limited metastatic IV disease were analysed. The median follow-up time was 27.2 months. The relapse-free survival and overall survival at 3 years were 50 and 54%, respectively. The recurrence pattern was dominated by distant failure and only one patient developed isolated locoregional recurrence. Of the 10 patients who had positive microscopic surgical margins after surgery, seven had recurred and died. On multivariate analysis, margin status was the only significant prognosticator for survival. Thirty per cent of patients experienced grade 3 or above acute toxicity (24% haematological, 14% gastrointestinal) and one patient died of neutropenic sepsis. There was one case of grade 3 late toxicity.

CONCLUSIONS

The outcome after adjuvant chemoradiation for gastric cancer seemed to be favourable, with manageable toxicities, in the Chinese population. Locoregional failure was uncommon. Patients with microscopic surgical margin involvement had a very high failure rate despite adjuvant chemoradiation.

Essential tasks must be programmed effectively

Few would argue that maintenance is not a problem. Practices do not eliminate problems, but only proper practice makes perfect maintenance. To master management of building services maintenance, there is no better teacher than experience. You must plan your maintenance system thoughtfully and try it out together with your professional knowledge. The system outlined in this article gives a systematic procedure in setting up a workable maintenance plan. The tedious management work and the inconvenience caused to a busy or new maintenance department will probably mean greater pressure of work for the maintenance engineer in the first year, but thereafter the pressure will be less than before and benefits of an organised system of maintenance will repay the effort of introducing it. It is essential that the paperwork be as simple as possible and very flexible in operation so that amendments can be made easily. Preparation of paperwork is by no means easy. It is highly likely that your schedules and programmes will have to be rewritten two or three times before arriving at the optimum plan. My management lecturer once told me: "Without a plan and a programme, you don't know whether you have done all the things that you need to do, and you will end up with many problems." Good planning gives you confidence, but take my advice--do not over plan. Too much paperwork can be just as bad if not worse than too little paper. Information will be of no use if it cannot be read, digested and used in practice.

A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity

BACKGROUND

Chinese herbal medicine (CHM) is a common complementary therapy used by patients with cancer for reduction of chemotherapy-induced toxic effects. This study applied the highest standard of clinical trial methodology to examine the role of CHM in reducing chemotherapy-induced toxicity, while maintaining a tailored approach to therapy.

PATIENTS AND METHODS

Patients with early-stage breast or colon cancer who required postoperative adjuvant chemotherapy were eligible for the study. Enrolled patients were randomly assigned to one of three Chinese herbalists who evaluated and prescribed a combination of single-item packaged herbal extract granules. Patients received either CHM or placebo packages with a corresponding serial number. The placebo package contained nontherapeutic herbs with an artificial smell and taste similar to a typical herbal tea. The primary end points were hematologic and non-hematologic toxicity according to the National Cancer Institute Common Toxicity Criteria Version 2.

RESULTS

One hundred and twenty patients were accrued at the time of premature study termination. Patient characteristics of the two groups were similar. The incidence of grade 3/4 anemia, leukopenia, neutropenia, and thrombocytopenia for the CHM and placebo groups were 5.4%, 47.3%, 52.7%, and 1.8% and 1.8%, 32.2%, 44.7%, and 3.6%, respectively (P = 0.27, 0.37, 0.63, and 0.13, respectively). Incidence of grade 2 nausea was the only non-hematologic toxicity that was significantly reduced in the CHM group (14.6% versus 35.7%, P = 0.04).

CONCLUSIONS

Traditional CHM does not reduce the hematologic toxicity associated with chemotherapy. CHM, however, does have a significant impact on control of nausea.

Fine-tuning critical services maintenance

Readers are recommended to make good use of the concepts of "Failure Model Effects and Criticality Analysis" as discussed above. These should provide a more comprehensive study of reliability and availability of building services. The assessment methodology presented in this article is to a certain extent subjective. It is considered that a more quantitative and comprehensive study based on reliability and availability data from similar hospitals over recent years will help the analysis. Building services maintenance involves risk. Risks must be assessed before a design is fully implemented. The risks associated with building services installation have to be assessed at all stages, from concept to dismantling and disposal. This will ensure that risks are acceptable and manageable within the parameters defined by the overall cost and engineering requirements, statutory obligations and good practice.

Irofulven as first line therapy in recurrent or metastatic gastric cancer: a phase II multicenter study by the Cancer Therapeutics Research Group (CTRG)

BACKGROUND

The purpose of this study was to evaluate the tolerability and efficacy of irofulven, a DNA interacting acylfulvene analog, as first line therapy for patients with recurrent or metastatic gastric cancer.

PATIENTS AND METHODS

Twenty-three patients with recurrent or metastatic gastric cancer received irofulven at a dose of 0.45 mg/kg administered intravenously over 30-min infusion (up to a maximum of 50 mg), on days 1 and 8, every 3 weeks.

RESULTS

The median number of cycles delivered per patient was 2 (range 1-6). Two patients (9%) had >or= 1-week delay in administration of subsequent cycle of chemotherapy. For the day 8 chemotherapy, dose reductions were required in seven patients (30%); dose omitting occurred in five patients (22%). Grade 3/4 anemia and neutropenia occurred in 22 and 17% of patients, respectively. There was no grade 4 thrombocytopenia and no neutropenic fever was observed. Of the 20 evaluable patients, there were no responses observed, 3 patients had stable disease after 2 cycles of treatment which was not confirmed by a further assessment. Median overall survival was 6.05 months (95% CI 4.55-9.39).

CONCLUSIONS

Irofulven was tolerated at the dose of 0.45 mg/kg on days 1 and 8, every 3 weeks but showed no evidence of antitumor activity in patients with advanced gastric cancer.

Restoration of marine coastal ecosystem health as a new goal for integrated catchment management in Tolo Harbor, Hong Kong, China

This article demonstrates why it is necessary to have the restoration of marine coastal ecosystem health as a new goal for integrated catchment management in the coastal area of Tolo Harbor. The present goal of integrated catchment management (ICM) in the Tolo Harbor is based on water quality objectives. The performance of the ICM plan, the Tolo Harbor Action Plan (THAP), was evaluated using marine coastal ecosystem health indicators including both stress and response indicators. Since the implementation of THAP in 1988, some significant reductions in pollution loading have been observed: reduction of 83% of biological oxygen demand load and 82% of total nitrogen between 1988 and 1999. There has also been an improvement in the health of Tolo Harbor's marine coastal ecosystem as evidenced by trends in physical, chemical, and biological indicators, although reverse fluctuations in some periods exist. However, such improvement can only be considered as the first sign of complete ecosystem health restoration, because ecosystem health covers not only physical, chemical, and biological aspects of an ecosystem, but also ecosystem service functions. The findings support the need to take the restoration and protection of marine coastal ecosystem health as a new goal rather than using water quality objectives. Steps necessary to further improve Tolo Harbor's marine coastal ecosystem health are also discussed.

Remission of hepatocellular carcinoma with arginine depletion induced by systemic release of endogenous hepatic arginase due to transhepatic arterial embolisation, augmented by high-dose insulin: arginase as a potential drug candidate for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is auxotrophic for the semi-essential amino acid arginine, depletion of which leads to tumor death. In humans, arginine is not an essential amino acid since many adult somatic cells can re-synthesize it from other sources, such as citrulline. Enzymes capable of depleting arginine in vitro include the urea cycle enzyme arginase, which is found in abundance in human liver. For over three decades, arginase has not been considered as a potential drug candidate because of its low substrate affinity, short circulatory half-life and sub-optimal enzymatic activity at physiological pH, though its in vitro anti-tumor activities in certain tumors have been amply reported. Arginine deiminase, a bacterial enzyme from Mycoplasma hominus has been shown to induce HCC remission through the mechanism of arginine depletion. We report here an innovative treatment approach for the treatment of locally advanced and metastatic HCC with transhepatic arterial embolisation (TAE) of the liver tumor with lipiodol and gel foam as a means of inducing a leakage of hepatic arginase from the liver into the circulation. Hepatic arginase released into the systemic circulation rapidly depleted plasma arginine. High-dose insulin was included to induce a state of hypoaminoacidaemia to augment arginine depletion. With this protocol, we have treated seven patients with locally advanced and/or metastatic HCC. Five patients achieved arginine depletion, ranging from 0 to 20 microM (normal plasma level 100-120 microM); all had varying degrees of tumor remission in their primary tumors and extra-hepatic sites in the lymph nodes, lungs and bones, suggesting systemic anti-cancer effect of arginine depletion. The two non-responders did not show significant reduction in plasma arginine. Based on our findings, we propose that the urea cycle enzyme, arginase, is a good drug candidate for the treatment of HCC.

Methods to much improve maintenance

The benefits to be gained from the application of both value engineering (VE) and quality systems--e.g. quality assurance (QA), and total quality management (TQM)--to the management of building services maintenance have yet to be realised by the building services industry. These concepts are particularly applicable to complex hospital engineering services.

Hepatitis B reactivation in patients with hepatocellular carcinoma undergoing systemic chemotherapy

BACKGROUND

Cancer patients who are hepatitis B virus (HBV) carriers and undergoing chemotherapy (CT) may be complicated by HBV reactivation. Over 80% of hepatocellular carcinoma (HCC) patients are HBV carriers; however, the incidence of HBV reactivation during CT has not been well-reported. A prospective study was conducted to determine the incidence of HBV reactivation, the associated morbidity and mortality, and possible risk factors.

PATIENTS AND METHODS

102 HBsAg-positive patients with inoperable HCC underwent systemic CT. Patients received either combination cisplatin, interferon, doxorubicin and fluorouracil (PIAF) or single-agent doxorubicin. They were followed up during and for 8 weeks after CT.

RESULTS

In 102 patients, 59 (58%) developed hepatitis amongst whom 37 (36%) were attributable to HBV reactivation. Twelve (30%) died of HBV reactivation. CT was interrupted in 32 patients (86%) with reactivation and 54 (83%) without reactivation (P>0.05). The median survivals were 6.00 and 5.62 months, respectively (P=0.694). Elevated baseline alanine aminotransferase (ALT) was found to be a risk factor.

CONCLUSION

HBV reactivation is a common cause of liver damage during CT in HBsAg-positive HCC patients. The only identifiable associated risk factor was elevated pre-treatment ALT. Further studies into the role of antiviral and novel anticancer therapies are required to improve the prognosis of these patients.

Full coordination is key to project success

The procurement of complex and highly serviced hospital buildings is always fraught with the expensive and complicated problem of inadequate coordination of building services. Obviously, this problem is detrimental to the success of any project. All project practitioners must respond positively to increasingly complex building design and construction and higher expectations of their clients. To give greater value improvement in construction, the present way of managing building services design and installation must be "re-engineered" whether we use traditional or nontraditional procurement methods. This will require a cultural shift in our industry as a whole, away from adversarial relationships to more cooperative and partnering relationships. The author's research based on case studies in Hong Kong indicates that there is no best procurement practice. Rather, there is appropriate management of building design and construction. The results also show that good building services coordination can only be achieved by a good building team having a fully integrated and coordinated design, an appropriate integrating mechanism, a fair contract, effective management of coordination, mutual trust and respect, highly integrated supply chain management, greater co-operation and involvement, efficient managerial control of the whole design and construction process and the use of re-engineering of construction. All these attributes can give significant improvement in time, cost and quality performance needed by each member of the building team.

Comprehensive analysis of risk factors associating with Hepatitis B virus (HBV) reactivation in cancer patients undergoing cytotoxic chemotherapy

For cancer patients with chronic hepatitis B virus (HBV) infection, who receive cytotoxic chemotherapy, HBV reactivation is a well-described complication, which may result in varying degrees of liver damage. Several clinical features and the pre-chemotherapy HBV viral load have been suggested to be associated with an increased risk of developing the condition: (1) to assess the clinical and virological factors in a comprehensive manner and thereby identify those that are associated with the development of HBV reactivation; (2) to develop a predictive model to quantify the risk of HBV reactivation. In all, 138 consecutive cancer patients who were HBV carriers and undergoing chemotherapy were studied, of which 128 patients had sera available for real-time PCR HBV DNA measurement. They were followed up throughout their course of chemotherapy and the HBV reactivation rate was determined. The clinical and virological features between those who did and did not develop viral reactivation were compared. These included age, sex, baseline liver function tests, HBeAg status and viral load (HBV DNA) prior to the chemotherapy, and the use of specific cytotoxic agents. In all, 36 (26%) developed HBV reactivation. Multivariate analysis revealed pre-chemotherapy HBV DNA level, the use of steroids and a diagnosis of lymphoma or breast cancer to be significant factors. Based on real-time HBV DNA PCR assay, detectable baseline HBV DNA prior to the administration of cytotoxic chemotherapy, the use of steroids and a diagnosis of lymphoma or breast cancer are predictive factors for the development of HBV reactivation. A predictive model was developed from the current data, based on a logistic regression method.

Long-term temporal-spatial dynamics of marine coastal water quality in the Tolo Harbor, Hong Kong, China

The long-term temporal and spatial dynamics of marine coastal water quality in Tolo Harbor, Hong Kong were explored. The Harbor is divided into three zones represented as Harbor, Buffer, and Channel Subzones. The time range for the study covers the period from the 1970s to the 1990s. The selected indicators for the comprehensive assessment of water quality consist of physical, chemical and biological aspects, including suspended solids(SS), Secchi disk depth(SD), 5-day biochemical oxygen demand(BOD5), total nitrogen (TN), total phosphorus(TP), faecal coliform, chlorophyll-a(Chl-a), and the number of red tide occurrences. The results indicated the presence of obvious temporal and spatial trends with regard to changes in water quality. Spatially, water quality in the Channel Subzone is the best, while that in the Harbor Subzone is the worst. On a temporal basis, the average trend from bad to good was 1980s > 1990s > 1970s as indicated by most of the selected water quality indicators. Water quality during the late 1980s reached its worst level with the lowest SD, the highest BOD5, TN, TP, Chl-a concentrations, and the number of red tide occurrences. These long-term temporal-spatial water quality trends were also found in other studies of the Tolo Harbor. The large quantity of pollutants produced as a result of increasing population, industrial and commercial actives, and urbanization and industrialization trends in both Shatin and Tai Po seem to be primarily responsible for the changes in marine coastal water quality.

The effect of pH, ion strength and reactant content on the complexation of Cu2+ by various natural organic ligands from water and soil in Hong Kong

The complexation constants for copper associated with different natural organic ligands, including dissolved organic carbon (DOC) extracted from water, water soluble organic carbon (WSOC), fulvic acid (FA) and humic acid (HA) from soil, were determined and then compared based on discrete single site model. Both ion-selective electrode (ISE) and anodic stripping voltammetry were used to determine the content of free copper ions, while the relative number of complexation sites was estimated using a fluorescence quenching (FQ) at the same time. ISE proved to be the most applicable technique when the concentration of copper was above 10(-7) moll(-1). The logk values for two WSOC sample sites (Song Ziyuan and Xin Niangtan) were 4.64 and 4.66; higher than both the DOC and HA values yet lower than the FA values, which were unusually high due to unavoidable pollution from the cation exchange resin used during the purification process. Binding affinities between the copper ions and the organic ligands obtained from streams in Yong Wei (DOC) and Song Ziyuan (WSOC) were influenced by pH, ion strength, and reactant concentration. Values for logk increased with increases in pH (ion strength of 0.1 N). At pH 4, the logk values decreased with increases in the supporting electrolyte concentration and total copper ion additions.

[Comparison of ISE, ASV and FQ for complexation characterization of river water DOC with copper]

Condition stabilization constants of complexation between naturally occurring organic ligand in river water and copper were measured lgk and compared by using ISE, ASV and FQ methods. The measured lgk results were 2.29-6.47 by ISE, 2.61-6.91 by ASV, and 3.52-4.71 by FQ, respectively. The constants went up with the raise of pH, the decrease of copper content, and the increase of ligand concentration.

Respiratory suspended particulate (RSP) concentration and its implications to roadside workers: a case study of Hong Kong

Respiratory Suspended Particulates (RSPs) have attracted increasing interest in recent years because of the potential risk of RSPs to human health. In Hong Kong, a large population of roadside workers is believed to be continuously exposed to high levels of RSPs. In this study, the roadside RSP concentrations at 72 locations in 6 urban districts of different land use types in Hong Kong are examined. Results show that the RSP pollution in Hong Kong's roadside environment is quite serious. The average RSP concentration at 61.11% of sampling sites is over 180 microg m(-3), the highest 24 h RSP mean concentration recommended by the Environmental Protection Department of Hong Kong. Analyses of RSP concentration data with reference to the local environmental conditions indicate that, among various environmental factors, land use, population density and traffic flow are important determinants of the RSP level. Because many roadside workers are exposed to high levels of RSP for prolonged periods, it is necessary to increase the public awareness of the health hazard of roadside workers.

Novel silver(I)-organic coordination polymers: conversion of extended structures in the solid state as driven by argentophilic interactions

Structurally distinct coordination polymers [Ag(bpp)]ClO4 1 and [Ag(bpp)]PF6 2 [bpp = 1,3-bis(4-pyridyl)propane] have been assembled; the conversion of 1 into 2 on treatment with NaPF6 is driven by argentophilic interactions and is the first such transformation reported for silver(I)-organic coordination polymers.

Examining maintenance responsibilities

This paper has examined the important responsibilities of the two organisations involved in the provision of maintenance service for the vital building services in many of our highly serviced buildings. The issues raised could be put to beneficial use in both clients and maintenance providers. All in all, the clients should work closely with their maintenance providers. Engineering services in buildings will not perform satisfactorily and efficiently if both parties do not work together and understand the maintenance tasks based on a business partnering mode. Put forward is the view that the management of the activities involved in the operation and maintenance process is a "shared commitment/involvement" between the client and the maintenance provider. It is obvious that many factors can influence the continued effectiveness of a quality maintenance scheme set up by client and provider. Some of these factors are: Change in key personnel Updates in technology Amendments to engineering practice Implementation of legislative requirements Changes in operation by client or provider Change of use of building Passage of time These factors must be fully reviewed by both parties from time to time, and necessary actions taken. A cooperative team working relationship and improved communication should be fostered by the client and his provider for the best management of services maintenance. This arrangement will contribute to better building services systems with continuous improvement; improved value for clients and higher return for the maintenance provider.

Synthetic models for the zinc sites in the methionine synthases

The syntheses and molecular structures of a series of tetrahedral zinc complexes designed to model the active sites in Escherichia coli methionine synthases are reported. [PhTttBu]ZnBr (PhTttBu = phenyltris((tert-butylthio)-methyl)borate) was prepared and characterized crystallographically to provide entry into [S3]ZnX complexes. Metathesis with KSPh yielded the phenylthiolato complex, [PhTttBu]Zn(SPh), which represents a structural mimic of the homocysteine ligated form of the enzyme. Alternatively, [S2N]ZnX (X = Br, CH3, SPh) species were prepared using the new mixed-donor ligands, [Ph(pz)BttBu] (phenyl(pyrazolyl)bis((tert-butylthio)methyl)borate) and [Ph(pztBu)BttBu] (phenyl(3-tert-butylpyrazolyl)bis((tert- butylthio)methyl)borate). Protonolysis of [Ph(pztBu)-BttBu]Zn(CH3) by PhSH in toluene yielded [Ph(pztBu)BttBu]Zn(SPh), a synthetic analogue of the homocysteine ligated form of cobalamin-independent methionine synthase (Met E). The average Zn-S bond distance in [Ph-(pztBu)BttBu]Zn(SPh) of 2.37 A compares well with the EXAFS-derived distance of 2.31 A found in the homocysteine-bound form of Met E.

Management of building services. Procurement for highly serviced healthcare facilities

The question of whether design and build is the best procurement system is hard to tell as other procurement alternatives (main-contractor and principal services contractor coupled with project management team, and construct management method plus good building team) can also give satisfactory results. Besides, it is also known that there is no standard solution or best buy amongst procurement systems. Indeed, there is no single method of procurement which can be suitable for every project for all time. It is also accepted that the choice and use of an inappropriate procurement system is not the only reason for inefficient project management, people and experience are far more important than strategy. Coordination of building services has a direct bearing on the success of a hospital project. Services must be fully integrated and coordinated. One thing is clear, as far as building services coordination is concerned, the traditional procurement system is not conducive to effect coordination process, however, the integrated nature of D&B has relieved all the burdens on the client's design team, and, from the face of this procurement path, all coordination problems that the client would normally encounter from the traditional method will no longer exist. Of course, the technical and managerial problems in relation to coordination still exist but they would all be passed to the contractor side. To protect the contractor's interest, all coordination problems would still have to be managed and controlled by D&B contractor and his specialist contractors expeditiously. Indeed, if design is not fully integrated, and construction and services are not completely coordinated, no matter how integrated is the team, D&B method will not work. To sum up, the author's discussions can be summarized as follows: Project success can be enhanced by engendering a team spirit and a high degree of cooperation between project participants. This can be achieved by the use of non-traditional procurement systems. Building services and hospital engineering systems must be properly coordinated at both design and installation stages. Coordination must be seen as both technical and managerial issues. A professional building team can manage the complex issues of services coordination. But it is known that an integrated building team can give better result. D&B is not a panacea, other procurement paths with adequate project management can provide a better alternative than either the traditional or the design and build system.

Formation of a tetranuclear copper (II) cluster assembled by metal-assisted hydrolysis and desulfurization of bis(3,5-dimethylpyrazolyl)methylphosphine sulfide, MeP(S)(3,5-Me2Pz)2

The reaction of methylphosphine sulfide, MeP(S)(3,5-Me2Pz)2, 1, with anhydrous CuCl2 affords a tetranuclear copper cluster[Cu2Cl2(3,5-Me2Pz)3(MePO3)]2, 2, and a dinuclear compound Cu2Cl4(3,5-Me2Pz)4, 3. This reaction involves a metal-assisted desulfurization along with concomitant hydrolysis of P-N bonds. The X-ray structures of 1-3 have been determined, and the crystal parameters for these are the following. 1: space group = C2/c, a = 15.2552(1) A, b = 8.7364(2) A, c = 21.4490(3) A, beta = 93.349(1) degrees, V = 2853.74(8) A3, and Z = 8. 2: space group = P2(1)/n, a = 12.5964(4) A, b = 15.7773(4) A, c = 13.9781(4) A, beta = 116.6280(10) degrees, V = 2483.32(12) A3, and Z = 2. 3: space group = P2(1)/c, a = 8.7137(8) A, b = 13.5493(14) A, c = 11.8847(12) A, beta = 106.179(2) degrees, V = 1347.6(2) A3, and Z = 2. The structure of 2 shows that it comprises two dinuclear copper cores bridged together by two tripodal methylphosphinate, MePO3, ligands. 2 is weakly antiferromagnetically coupled, as revealed by variable temperature magnetic susceptibility measurements.

Home sweet home? A case study of household dust contamination in Hong Kong

It is well recognized that many heavy metals have chronic effects on humans and as such, they are potential environmental health hazards, particularly to young children (see, for example, Body P, Inglis G, Dolan P, Mulcahy D. Environmental lead: a review. Crit Rev Environ Control 1991;20:299-310). Considerable attention has been paid to the study of metal pollution in city air, roadside dusts and soils. However, there is a lack of concern of the presence of trace metals in house dust in the populous city of Hong Kong, where it has traditionally been assumed that such pollutants are rapidly dispersed by ocean breezes. This research aims at quantifying the concentrations of heavy metals within the home environment in Hong Kong and their relationships with environmental factors. The results of this study seem to suggest that traffic and the age of the building and neighborhood are more important factors than the types of industry and socioeconomic status in affecting household dust contamination. The metal burdens in Kwung Tong, an old area with heavy traffic, are significantly higher than other districts. When a Kruskal-Wallis one-way analysis of variance was performed on the ranked metal concentrations in different housing districts, the Chi-square values are all significant at a probability level of < 0.001. This might be attributable to the fact that there is no highly contaminating industries (such as metal smelters, battery plants and petrochemicals) in Hong Kong. The dust metals may travel from the roads, through the windows and balconies, into the houses, as those homes that do not have their windows opened often had a lower level of contaminants in their house dust (median Cd= 3.6 microg/g; median Cu = 313.2 microg/g; median Pb = 144.6 microg/g; median Mn = 211.6 microg/g; and median Zn = 1,333.7 microg/g). Moreover, those occupants who sweep their floors or dust their furniture on daily bases, or use vacuum cleaners, had a lower level of metals inside their houses. Another finding of interest is that the color of the wall paint used in the house may be another factor influencing the contamination levels.

Fish uptake of inorganic and mucus complexes of lead

Carassius auratus were exposed to lead in synthetic water. Mucus secreted from the fish was measured and characterized for its lead binding capacity. The increase in mucus concentration in the water depended on secretion and degradation rates and the former was speeded up by lead. The complexation between mucus and lead can be described based on a single-site interaction model. Lead speciation in the system with or without mucus was calculated using chemical equilibrium modeling. The dominant species of lead was PbCO(3)(0). Other major species included Pb(OH)(+), Pb(OH)(2)(0), Pb(CO(3))(2)(2-), Pb-mucus, and Pb(2+), among which free lead and lead hydroxo complexes were available to fish uptake.

Titanium alkoxide complexes: condensed phase and gas phase comparisons

The complex [Ti(2,4-dimethyl-2,4-pentanediolate)2]2 (1) has been synthesized from [Ti(OiPr)4] by transesterification with a stoichiometric amount of 2,4-dimethyl-2,4-pentanediol. We have characterized complex 1 in the solid state by single-crystal X-ray diffraction and in the gas phase by desorption chemical ionization mass spectrometry (DCI-MS). The structural and mass spectrometric data show complex 1 to be stable as a dimer in both the solid and gas phases. The retention of dimeric nuclearity in the gas phase sets complex 1 apart from other simple titanium alkoxide complexes [Ti(OiPr)4] and [Ti(OMe)4]4 that give rise to respective families of molecular ions in the DCI-MS experiment. The highest mass molecular ions for Ti alkoxide complexes in the gas phase may reveal the highest nuclearity that these complexes achieve in condensed phases. According to this interpretation the complex [Ti(OiPr)4] is principally dimeric in the gas phase and probably also in the pure liquid phase and should be represented by the formula [Ti(OiPr)4]2.

[Uptake of particulate lead via gills of goldfish]

This paper studied the uptake of Pb absorbed on suspended gibbsite via gills of goldfish (Carassius auratus). Under conditions of the concentration of the particulate Pb varied while that of free Pb maintained at a constant level, the levels of both Pb and Al in the gills increased with increasing exposed Pb concentration. The increasing rate (slope 0.171) of Pb level in the blood with the Pb level in the gills was lower than that (slope 0.343) of soluble Pb exposure experiment. Partial Pb adhered on the gills did not transfer into blood. The ratio of Pb/Al in the gills was 1-2 orders of magnitude higher than that in the water, and on the microtome section of filament, the gibbsite particles adhered on gill mucus were observed, indicating the bioavailability of the particulate Pb uptake by the gills of goldfish. The major mechanism was: when the absorbed Pb on suspended particles was flowed into gill filaments, it was desorbed on the surface of gills, and then, passively diffused or transferred by carriers via gill cells into flood, and after the particles stayed on the surface of gill filaments for a short time, in company with sloughed mucus, they were released from the gills along with waterflow.

Lamivudine in the treatment of hepatitis B virus reactivation during cytotoxic chemotherapy

Hepatitis B virus (HBV) reactivation has been described in cancer patients who received cytotoxic/immunosuppressive therapy and may result in liver damage of varying degrees of severity. There is no known effective treatment. Lamivudine, a nucleoside analogue, has been found to suppress HBV replication and to improve histology in chronic carriers of hepatitis B virus. The outcome of lamivudine therapy (at doses of 100 or 150 mg/day) in eight patients who developed HBV reactivation while receiving cytotoxic chemotherapy is described. Each of the eight patients had >98% suppression of the pretreatment HBV DNA levels. Three of the five patients who were initially HBeAg positive underwent seroconversion. Five patients had normalization of liver function tests and improvement in clinical condition. However, one patient died of hepatic failure due to HBV-related submassive liver necrosis, and two died of widespread metastases (including liver) from the primary malignancies. It is concluded that early commencement, i.e., at the onset of HBV reactivation before severe hepatic decompensation, of lamivudine may be effective in the control of HBV reactivation during chemotherapy. In Hong Kong, where hepatitis B infection is endemic, we propose to screen all cancer patients for hepatitis B surface antigen before immunosuppressive/cytotoxic therapy, and to closely monitor liver function of those who are found to be HBsAg seropositive.

Lamivudine in the treatment of hepatitis B virus reactivation during cytotoxic chemotherapy

Hepatitis B virus (HBV) reactivation has been described in cancer patients who received cytotoxic/immunosuppressive therapy and may result in liver damage of varying degrees of severity. There is no known effective treatment. Lamivudine, a nucleoside analogue, has been found to suppress HBV replication and to improve histology in chronic carriers of hepatitis B virus. The outcome of lamivudine therapy (at doses of 100 or 150 mg/day) in eight patients who developed HBV reactivation while receiving cytotoxic chemotherapy is described. Each of the eight patients had >98% suppression of the pretreatment HBV DNA levels. Three of the five patients who were initially HBeAg positive underwent seroconversion. Five patients had normalization of liver function tests and improvement in clinical condition. However, one patient died of hepatic failure due to HBV-related submassive liver necrosis, and two died of widespread metastases (including liver) from the primary malignancies. It is concluded that early commencement, i.e., at the onset of HBV reactivation before severe hepatic decompensation, of lamivudine may be effective in the control of HBV reactivation during chemotherapy. In Hong Kong, where hepatitis B infection is endemic, we propose to screen all cancer patients for hepatitis B surface antigen before immunosuppressive/cytotoxic therapy, and to closely monitor liver function of those who are found to be HBsAg seropositive.