Changes in menopausal symptoms comparing oral estradiol versus transdermal estradiol

OBJECTIVE

This study aimed to compare the efficacy and safety of oral and transdermal estradiol in alleviating menopausal symptoms.

METHOD

A total of 257 recently menopausal women were randomized into two groups. The t-E2 group received transdermal estradiol (2.5 g per day) (n = 128) and the o-E2V group received oral estradiol valerate (2 mg per day) (n = 129) for 24 weeks; both groups received micronized progesterone (200 mg per day). The primary outcome measure is the change in the modified Kupperman Menopausal Index (KMI) after 24 weeks of treatment. Menopausal symptoms were recorded at screening and at 4, 12 and 24 weeks using both the KMI and the Menopause Rating Scale (MRS).

RESULTS

Significant amelioration was observed by KMI and MRS scores for both groups after treatment (p < 0.001). The mean KMI scores showed no difference between the two groups. The mean MRS scores were similar between the two groups at baseline and after 4 weeks of treatment. The results showed statistical differences after 12 weeks and 24 weeks of treatment (p = 0.005 and p = 0.011). Both the after-treatment scores minus the baseline scores of KMI and MRS and the incidence of adverse effects showed no difference between the two groups.

CONCLUSIONS

This study shows that both transdermal and oral estradiol are effective in relieving menopausal symptoms, with little difference in treatment efficacy and safety.

CLINICAL TRIAL NUMBER

ChiCTR2300073146.

[Clinicopathological and prognostic features of subungual melanoma in situ]

Objective: To investigate the clinicopathological characteristics, immunohistochemical profiles, molecular features, and prognosis of subungual melanoma in situ (SMIS). Methods: Thirty cases of SMIS were collected in Fudan University Shanghai Cancer Center, Shanghai, China from 2018 to 2022. The clinicopathological characteristics and follow-up data were retrospectively analyzed. Histopathologic evaluation and immunohistochemical studies were carried out. By using Vysis melanoma fluorescence in situ hybridization (FISH) probe kit, combined with 9p21(CDKN2A) and 8q24(MYC) assays were performed. Results: There were 8 males and 22 females. The patients' ages ranged from 22 to 65 years (median 48 years). All patients presented with longitudinal melanonychia involving a single digit. Thumb was the most commonly affected digit (16/30, 53.3%). 56.7% (17/30) of the cases presented with Hutchinson's sign. Microscopically, melanocytes proliferated along the dermo-epithelial junction. Hyperchromatism and nuclear pleomorphism were two of the most common histological features. The melanocyte count ranged from 30 to 185. Most cases showed small to medium nuclear enlargement (29/30, 96.7%). Pagetoid spread was seen in all cases. Intra-epithelial mitoses were identified in 56.7% (17/30) of the cases. Involvement of nailfold was found in 19 cases, 4 of which were accompanied by cutaneous adnexal extension. The positive rates of SOX10, PNL2, Melan A, HMB45, S-100, and PRAME were 100.0%, 100.0%, 96.0%, 95.0%, 76.9%, and 83.3%, respectively. FISH analysis was positive in 6/9 of the cases. Follow-up data were available in 28 patients, and all of them were alive without disease. Conclusions: SMIS mainly shows small to medium-sized cells. High melanocyte count, hyperchromatism, nuclear pleomorphism, Pagetoid spreading, intra-epithelial mitosis, nailfold involvement, and cutaneous adnexal extension are important diagnostic hallmarks. Immunohistochemistry including SOX10 and PRAME, combined with FISH analysis, is valuable for the diagnosis of SMIS.

Neobavaisoflavone improves medial collateral ligament-induced osteoarthritis through repressing the nuclear factor -κB/hypoxia-inducible factor-2α axis

Osteoarthritis (OA) is a chronic inflammatory joint disease. There have been some studies on the treatment of OA with traditional Chinese medicine (TCM). Neobavaisoflavone (NBIF) is an isoflavone isolated from TCM Psoralea corylifolia L (also called 'Buguzhi') and shows anti-inflammatory effects. This study aims to explore the potential role of NBIF in treating OA. The rat chondrocytes were dealt with interleukin-1beta (IL-1β) for inducing an in-vitro OA model and a rat OA model was established by medial collateral ligament resection. Followed by NBIF treatment, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and flow cytometry were performed to evaluate chondrocyte proliferation and apoptosis. The expression of inflammatory factors and oxidative stress factors in chondrocyte medium and rat serum was tested by enzyme-linked immunosorbent assay (ELISA). Hematoxylin-eosin (HE) staining and Safranin O-Fast Green staining were carried out to examine the histopathological changes in knee joints. Caspase-3, nuclear factor-kappaB (NF-κB), and hypoxia-inducible factor-2alpha (HIF-2α) expressions were monitored by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), Western blot, and/or immunohistochemistry. As indicated by the results, NBIF mitigated cartilage matrix degradation and chondrocyte apoptosis in the OA rat model. NBIF hampered IL-1β-mediated cell viability inhibition, apoptosis, inflammatory reactions, and oxidative stress of chondrocytes. Moreover, NBIF suppressed NF-κB phosphorylation and HIF-2α expression. HIF-2α overexpression induced inflammation, oxidative stress, and apoptosis in chondrocytes, while NBIF reversed HIF-2α overexpression-caused chondrocyte damage. Overall, NBIF had antiapoptotic, anti-inflammatory, and antioxidative stress effects in OA models by impeding NF-κB/HIF-2α axis, suggesting that NBIF has potential therapeutic effects in OA.

[Relationship between nutritional factors and clinical outcome in children with tuberculous meningitis]

Objective: To investigate the relationship between nutritional risk status and clinical outcome in children with tuberculous meningitis (TBM). Methods: The clinical data (basic information, clinical symptoms and laboratory test results) of 112 patients with TBM, who were admitted to Department of Pediatric Infectious Diseases of West China Second Hospital of Sichuan University,from January 2013 to December 2020 were retrospectively analyzed. The patients were divided into the nutritional risk group and the non-nutritional risk group according to the assessment of the nutritional risk by the STRONGkids Scale. The variables of basic information, clinical symptoms and laboratory test measurements etc. were compared between the two groups by using Student t test, Rank sum test or Chi-square test. Multivariate Logistic regression analysis were used to analyze nutritional risk factors. Results: Among 112 patient with TBM, 55 were males and 57 females. There were 62 cases in the nutritional risk group and 50 cases in the non-nutritional risk group. The proportion of cases with nutritional risk was 55.4% (62/112). Patients in the nutritional risk who lived in rural areas, had symptoms of brain nerve damage, convulsions, emaciation and anorexia, with a diagnosis time of ≥21 days, and the level of cerebrospinal fluid (CSF) protein were all higher than those in the non-nutritional risk group ((50 cases (80.6%) vs. 32 cases (64.0%), 20 cases (32.3%) vs.8 cases (16.0%), 33 cases (53.2%) vs. 15 cases (30.0%), 30 cases (48.4%) vs. 2 cases (4.0%), 59 cases (95.2%) vs. 1 case (2.0%),41 cases (66.1%) vs.18 cases (36.0%), 1 406 (1 079, 2 068) vs. 929 (683, 1 208) mg/L, χ²=3.91, 3.90, 6.10, 26.72, 98.58, 10.08, Z=4.35, all P<0.05). The levels of serum albumin,hemoglobin,lymphocyte count, white blood cell count, and CSF glucose were significantly lower in patients with nutritional risk ((36±5) vs. (41±4) g/L, (110±17) vs. (122±14) g/L, 1.4 (1.0, 2.0)vs. 2.3 (1.6, 3.8)×10⁹/L, 7.8 (6.3, 10.0)×10⁹ vs. 10.0 (8.3, 12.8)×10⁹/L, 1.0 (0.8, 1.6) vs. 2.1 (1.3, 2.5) mmol/L, t=-6.15, -4.22, Z=-4.86, -3.92, -4.16, all P<0.05).Increased levels of serum albumin (OR=0.812, 95%CI:0.705-0.935, P=0.004) and lymphocyte count (OR=0.609, 95%CI:0.383-0.970, P=0.037) may reduce the nutritional risk of children with TBM; while convulsions (OR=3.853, 95%CI:1.116-13.308, P=0.033) and increased level of CSF protein (OR=1.001,95%CI:1.000-1.002, P=0.015) may increase the nutritional risk of children with TBM. Similarly, the rate of complications and drug-induced liver injury was higher in the nutritional risk group (47 cases (75.8%) vs. 15 cases(30.0%), 31 cases (50.0%) vs.8 cases (16.0%), χ²=23.50, 14.10, all P<0.05). Moreover, the length of hospital stay was also longer in the nutritional risk group ((27±13) vs. (18±7) d, t=4.38, P<0.05). Conclusions: Children with TBM have a high incidence of nutritional risk. Convulsive, the level of serum albumin, the level of lymphocyte count and CSF protein may affect the nutritional risk of children with TBM. The nutritional risk group has a high incidence of complications and heavy economic burden.It is necessary to carry out nutritional screening and nutritional support for children with TBM as early as possible.

Ultra-low-dose estradiol and dydrogesterone: a phase III study for vasomotor symptoms in China

OBJECTIVE

This study aimed to evaluate the efficacy and safety of ultra-low-dose estradiol plus dydrogesterone for vasomotor symptoms in postmenopausal women in China (trial registration CTR20160689).

METHODS

A total of 332 patients were randomized to continuous combined estradiol 0.5 mg + dydrogesterone 2.5 mg or placebo for 12 weeks. The primary efficacy endpoint was change in the number of hot flushes per day from baseline to end of treatment. Secondary efficacy endpoints included change in the number of moderate-to-severe hot flushes per day, menopausal symptoms from baseline and quality of life.

RESULTS

Between baseline and end of treatment, change in the mean number of hot flushes per day was -5.9 (95% confidence interval [CI] - 6.6, -5.2) with estradiol + dydrogesterone and -4.5 (95% CI -5.1, -3.8) with placebo, with a mean difference of -1.4 hot flushes per day (95% CI -2.2, -0.7; p < 0.001). Significant differences in favor of estradiol + dydrogesterone were also observed in several secondary efficacy endpoints. The study treatment was well tolerated.

CONCLUSION

Continuous combined estradiol 0.5 mg + dydrogesterone 2.5 mg reduced hot flushes in postmenopausal women in China. This ultra-low-dose regimen provides an additional option for women experiencing the vasomotor symptoms of menopause. These data are consistent with previous results in other populations.

[Clinicopathological features and prognosis of nodal nevi]

Objective: To investigate the clinicopathological characteristics, differential diagnosis and prognosis of nodal nevi (NN). Methods: Eighteen cases of NN diagnosed at Fudan University Shanghai Cancer Center, Shanghai, China from 2009 to 2019 were collected. The clinicopathological characteristics and follow-up data were retrospectively analyzed. Histopathologic evaluation and immunohistochemical studies were carried out. The Vysis Melanoma FISH Probe Kit, combined with 9p21(CDKN2A) and 8q24(MYC) assays were performed in 2 cases. Results: There were 2 males and 16 females in the case series. The age of the patients ranged from 36 to 70 years (average 48.2 years). Fifteen cases located in axillary lymph nodes, 1 in inguinal lymph node, 1 in cervical lymph node, and 1 in external iliac lymph node. NN was found in only one lymph node in each case. Histologically, the nevus cell aggregates were found in capsule of lymph nodes in all cases. Nevus cells grew along the capsule into trabeculae in 8 cases, with 3 of them scattered in parenchyma. In one of these 8 cases, nevus cell aggregates massively occupied the parenchyma of the lymph node. The largest lesions in the 18 NN cases measured from 0.2 to 6.5 mm. All of the NN cases were classified as conventional nevi. The majority of the cases were composed of uniform nevus-like cells and identical to cutaneous pigmented nevi without atypia, necrosis, or mitosis. In the NN case that massively occupied parenchyma, some areas had abundant nevus cells and displayed atypical cytologic features, including increased nucleo-cytoplasmic ratio, small nucleoli, and occasional mitotic figures. Immunohistochemistry was performed in 13 cases. All of them were positive for S-100, SOX10, Melan A, and p16. HMB45 showed weak staining in rare cells of only one case out of 13 cases. Ki-67 labeling index <1% was found in all 13 cases. Additionally, the results of FISH assay were both negative. All patients were followed up for 13 to 129 months (median 31.5 months). Except that one patient died of the salivary gland carcinoma, the other patients all survived without tumor during the follow-up period. Conclusions: NN is a benign melanocytic lesion in lymph node. It is important to distinguish NN from metastatic melanoma when nevus cells occur in parenchyma and subcapsular sinus of lymph nodes, or show some atypical cytologic features. The morphology of bland nevus cells in capsule and trabeculae is a valuable clue. Besides, immunohistochemical profiling and FISH assay are helpful in the differential diagnosis.

[Application of immunohistochemical staining of bcl-2, Ber-EP4, CD10, CK20, and Ki-67 in differential diagnosis between trichoblastoma and basal cell carcinoma]

Objective: To study the utility of immunohistochemistry (IHC) in differential diagnosis between trichoblastoma (TB) and basal cell carcinoma (BCC). Methods: Fifty-eight cases of TB and 40 cases of BCC were collected at Fudan University Shanghai Cancer Center from January 2009 to December 2019 and retrospectively analyzed by IHC for bcl-2, Ber-EP4, CD10, CK20 and Ki-67. Fisher exact test was performed for statistical analysis. Results: Twenty-five (43.1%) TBs and 5 (12.5%) BCCs showed bcl-2 staining in the outermost layer of the epithelial nests, the difference was statistically significant (P<0.01). The proportion of cases with bcl-2 staining>75% of epithelial cells in BCC group was much higher than that in TB group (40% vs. 12.1%; P<0.01). BCC group showed larger proportions with Ber-EP4 staining>75%, 51%-75% of epithelial cells than TB group (12.5% vs. 1.7%, 37.5% vs. 8.6%;P<0.05). Fifty-five (94.8%) TBs demonstrated CD10 expression in the follicular stroma, while only 16 (40.0%) BCCs showed focal or scattered CD10 expression in reactive fibrous stroma (P<0.01). CK20 expression was present in 37 (63.8%) TBs with scattered pattern, but BCCs exhibited no CK20 staining except for only one case (2.5%) showing focal staining (P<0.01). Compared with TB group, the BCC group included more cases with Ki-67 labeling index ≥15% on average and ≥25% in hotspot areas (P<0.05). Conclusion: IHC is helpful in differential diagnosis between TB and BCC. Scattered CK20 staining pattern and stromal CD10 expression support the diagnosis of TB. Bcl-2 staining limited to the outermost layer of the proliferation is more likely to be found in TB. In contrast, Ber-EP4 positivity and higher Ki-67 labeling index tend to be present in BCC.

Validation of reference genes for the normalization of RT-qPCR expression studies on human laryngeal cancer and hypopharyngeal cancer

OBJECTIVE

Selecting stably expressed reference genes is crucial for evaluating real-time quantitative polymerase chain reaction (RT-qPCR) data via the relative quantification method. In the present-day study, our aim was to select optimal reference genes (RGs) for the investigation of target gene (TG) expression profiling in cancerous human laryngeal and hypopharyngeal tissues.

PATIENTS AND METHODS

12 cancerous laryngeal tissues and 10 cancerous hypopharyngeal tissues were investigated. The expression characteristics of 11 reference genes (18S rRNA, GAPDH, B2M, ACTB, TBP, ALAS1, RPL29, HMBS, HPRT1, GUSB, and PUM1), which were commonly used in RT-qPCR for the analysis of gene expression, were investigated using the geNorm, NormFinder, and BestKeeper algorithm programs.

RESULTS

HMBS, ALAS1, and B2M were suggested as optimal RGs for studying human laryngeal and hypopharyngeal cancerous tissues together, laryngeal cancerous tissue by itself, and hypopharyngeal cancerous tissue by itself, respectively. If 2 or more reference genes are needed to achieve better standardization, 3 reference genes can optimally be used in combination to improve the accuracy of relative quantitation normalization. The recommended combinations for studying human laryngeal and hypopharyngeal cancerous tissues together, laryngeal cancerous tissue by itself, and hypopharyngeal cancerous tissue by itself were HMBS + HPRT1 + GUSB, ALAS1 + GUSB + HMBS, and B2M + HPRT1 + TBP, respectively.

CONCLUSIONS

The recommended reference genes could be used to improve the accuracy of gene expression studies on the molecular mechanisms of cancerous human laryngeal and hypopharyngeal tissues. The selected combination of reference genes can effectively improve the accuracy of the relative quantitative diagnosis of gene expression levels, such as messenger RNA, circular RNA, and long-noncoding RNA.

Diagnostic performance of CT for differentiating peritoneal tuberculosis from peritoneal carcinomatosis: a systematic review and meta-analysis

AIM

To undertake a systematic review and meta-analysis of the diagnostic performance of CT for differentiating peritoneal tuberculosis (PTB) from peritoneal carcinomatosis (PC).

MATERIAL AND METHODS

PubMed, Embase, the Web of Science, and the Cochrane Library were searched for papers published before 23 July 2019. The methodological quality of the studies was analysed. Overlapping descriptors used in different studies to denote the same image finding were subsumed under a single CT feature. Sensitivity, specificity, and positive and negative likelihood ratios were pooled. A summary receiver operating characteristic curve (sROC) was constructed and the area under the curve (AUC) of the included studies was calculated when possible.

RESULTS

Six studies were included and 17 CT features were analysed. The pooled sensitivity and specificity of smooth peritoneal thickening were 59% (95% CI: 52-66%) and 84% (95% CI: 79-88%), respectively. The AUC of smooth peritoneal thickening was 0.83. Omentum line/rim, lymph node necrosis or calcification, and mesenteric macro nodules had a pooled specificity ranging from 95% to 100% and a pooled sensitivity ranging from 12% to 67%. The other 12 signs had a pooled sensitivity ranging from 21% to 79% and a pooled specificity ranging from 19% to 81%. Omentum involvement (cake-like pattern) showed a threshold-effect, so only the AUC (=0.70) was calculated.

CONCLUSIONS

Smooth peritoneal thickening shows fairly good diagnostic accuracy, while omentum rim/line, lymph nodes necrosis or calcification, mesenteric macro nodules have good specificity but limited sensitivity. The informative features summarised in this study may aid clinical practice and future studies.

Molecular Typing of Cryptosporidium Species Identified in Fecal Samples of Yaks ( Bos grunniens) of Qinghai Province, China

The frequency of Cryptosporidium infection in yaks from Qinghai province, People's Republic of China, was determined from examination of 1,027 fecal samples collected from 979 adult yaks and 48 yak calves during 4 seasons from 7 geographic areas within the province. PCR amplification of extracted DNA was used to characterize the different species of Cryptosporidium oocysts isolated by fecal examination. Twenty-six (2.53%) positive samples were identified and successfully sequenced: 17 Cryptosporidium ryanae (65.38%), 8 Cryptosporidium bovis (30.77%), and 1 Cryptosporidium baileyi (3.85%). The results of the study indicate that autumn is the primary season for transmission of Cryptosporidium to susceptible yak calves given the favorable temperatures and higher altitude of Qinghai province. To our knowledge, C. baileyi, a species predominately associated with birds (avian hosts), is described for the first time in yaks.

[Clinicopathological features and prognosis of ALK-positive Spitz tumors]

Objective: To investigate the clinicopathologic features and prognosis of ALK-positive Spitz tumors. Methods: Thirteen patients with ALK-positive Spitz tumors diagnosed at Shanghai Cancer Center, Fudan University from October 2016 to December 2017 were collected. All cases were routinely evaluated histopathological features in HE staining and detected ALK protein expression by immunohistochemistry. The ALK fusions of 7 cases were confirmed by fluorescence in situ hybridization (FISH).Follow-up data was collected. Results: The age of patients including 2 males and 11 females ranged from 4 to 47 years (mean 25 years). 12 patients were diagnosed with atypical Spitz tumors and 1 patient was diagnosed with Spitz nevus. Clinically, most lesions presented as papules or nodules, while a few lesions presented as plaques. Histologically, most tumors were exophytic (9/13). More than half of the tumors were amelanotic and the junctional component was mainly composed of melanocytic nests. Kamino bodies were not found. The bases of the tumors were mainly wedge-shaped (5/13) and flat (7/13). Eight tumors displayed mixed cell types, while 5 tumors were composed of only spindle cells. All the tumors showed a plexiform and/or intersecting fascicular growth pattern, and perineural extension was observed in 3 tumors. ALK immunohistochemistry showed diffuse and intense cytoplasmic staining in 13 cases, and 7 of them were detected by FISH to confirm the presence of ALK fusions. All patients were followed up for 7 to 21 months (median=12), with no recurrence or lymph node dissemination. Conclusions: Spitz tumors with ALK fusions have their special histopathologic features.ALK fusions mainly occur in Spitz nevi and atypical Spitz tumors. The follow-up data of the existing literatures and our research indicates that the prognosis of ALK-positive Spitz tumors may be good.

[Lentigo maligna and lentigo maligna melanoma: a clinicopathologic analysis of twenty-four cases]

Objective: To study the clinicopathologic features, differential diagnosis and prognosis of lentigo maligna (LM) and lentigo maligna melanoma (LMM). Methods: Histopathologic evaluation and immunohistochemical study by HRP multimer method were carried out in 24 cases of LM and LMM from 2012 to 2017 at Fudan University Shanghai Cancer Center. The clinical information and follow-up data were analyzed. Results: Of total 24 cases, there were 7 cases of LM and 17 cases of LMM; 10 males and 14 females. The age of patients ranged from 32 to 88 years (mean 67 years). The male-to-female ratio was 1.0∶1.4. Tumors were all located on head and face. Clinically, all patients presented with mottled light brown or sepia macule located on head and face for a long time, and some of them followed by nodules or ulceration within the lesion. The diameter of lesions ranged from 0.5 to 3.0 cm. Microscopically, LM and in-situ component of LMM were all characterized by a predominantly junctional proliferation of atypical melanocytes with marked pleomorphism, frequently extending down the walls of hair follicles and sweat ducts. Multinucleate cells were frequently present. The invasive components of LMM mainly consisted of atypical melanocytic spindle cells (13 cases, 76.5%), and the mean Breslow thickness was 1.2 mm (0.1-2.7 mm). The lesions of LM/LMM were generally associated with severe actinic damage, scattered infiltration of lymphocytes and melanophages. Statistically, the number of cases whose diameter of lesion ≥0.6 cm, mitotic rates ≥4/mm(2) and nests of melanocytes within epidermis in group of LMM were significantly more than those in group of LM. Immunohistochemically, atypical melanocytes in LM and LMM were generally positive for S-100, HMB45, PNL2, Melan A and SOX-10. Follow-up was available in all cases, ranging from 1 to 64 months. Only one out of 23 patients with wide surgical excision had local recurrence, and the remaining 22 patients were all alive with no evidence of disease. One LM patient who was merely treated with biopsy was alive with disease progression after 20 months follow-up. Conclusions: LM/LMM is a special subtype of melanoma predominantly located on the sun-exposed skin of elderly people. Recognition of its specific histologic features can help distinguish with sun-damaged diseases and other subtypes of melanoma. The prognosis of LM/LMM patients treated with surgical excision is considered relatively favorable. However, long term follow-up should be recommended in patients with LM/LMM because of high recurrence rates indicated by previous studies.

[Application of sentinel lymph node biopsy in patients with melanoma]

Objective: To investigate the difference between routine hematoxylin-eosin (HE) staining and immunohistochemistry in diagnosing metastatic melanoma in sentinel lymph node (SLN) metastases, and to evaluate the association of SLN tumor burden with the status of non-sentinel lymph nodes (NSLN). Methods: 126 melanoma patients were treated with SLN biopsy and further examined with immunohistochemistry at Fudan University Shanghai Cancer Center between 2010 and 2016, and the status of SLN was respectively estimated by HE stain and immunohistochemistry (S-100 protein, HMB45, Melan A and SOX10). In 39 patients who were treated with complete lymph node dissection, characteristics of SLN tumor burden (maximum diameter of the tumor deposit, tumor penetrative depth and the microanatomic location of the metastasis) and the associations of SLN tumor burden with the involvement of NSLN were all evaluated. Results: Of the total 126 cases, 33 (26.2%) were positive by HE staining and 49 (38.3%) were positive by immunohistochemistry. S-100 protein was positive in 48 out of 49 cases (98.0%). HMB45 was positive in 46 out of 49 cases (93.9%). Melan A was positive in 47 out of 49 cases (96.0%). SOX10 was positive in 8 out of 8 cases. The outcome indicated that the application of immunohistochemistry identified positive SLN missed by HE stain in about 12.1% of cases. Of the 39 patients who were treated with complete lymph node dissection, six showed metastases in NSLN. The frequency of metastases in NSLN was 15.4% (6/39) when SLN was positive. Additionally, the frequency of metastases in NSLN in cases with SLN metastatic deposits ≤2 mm was significantly lower than that in cases with SLN metastatic deposits >2 mm; eight cases with SLN metastatic deposits <0.2 mm had no additional positive NSLN. Conclusions: The findings suggest that immunohistochemistry could effectively improve the detection of positive SLN in melanoma. Cases with SLN metastatic deposits ≤2 mm are less likely to have further metastases in NSLN. There is a need for prospective large-population based studies to identify a subgroup of SLN positive patients who can safely be spared complete lymph node dissection.

[Rare primary proximal epithelioid sarcoma in skull base: clinical analysis of four cases]

Objective: To report the clinical and pathological features of primary proximal epithelioid sarcoma (PES) in skull base. Methods: The clinical and pathological features of four cases of PES in skull base from Sanbo Brain Institute of Capital Medical University and Kunming Sanbo Brain Institute were analysed retrospectively. Results: Three cases was female, and one male, the age ranged from 46 to 52 years.All cases occurred in skull base, and sellar region was the main site of involvement.Under the microscope, the tumor cells characterized by epithelioid cell changes, with or without rhabdoid tumor cells.Mitotic figure was active.Immunohistochemical staining showed that AE1/AE3, EMA and CD34 were variously expression in tumor cells.INI-1 protein was lost in all cases.Three cases were detected by FISH, and INI1 (22q11.2) gene locus was absent in them.Three patients died less than 3 months after surgery, and case 4 was under treatment after five months of surgery. Conclusions: Primary PES in skull base mostly occurs in sellar region and its clinical prognosis is poor.It features with epithelioid/rhabdoid tumor cells with lack granuloma structure as distal ES.It has epithelial and mesenchymal differentiation characteristics.CD34 is always positive.INI1 gene deletion and protein loss expression are characteristic molecular alteration of PES.

Nicotine inhibits osteogenic differentiation of human periodontal ligament cells under cyclic tensile stress through canonical Wnt pathway and α7 nicotinic acetylcholine receptor

BACKGROUND AND OBJECTIVES

Nicotine, the main psychoactive component of tobacco, affects cell metabolism, proliferation, adhesion and, importantly, the osteogenic differentiation of fibroblasts. Approximately 15% of all orthodontic patients are adults among who one-fifth are smokers. Hence, it is necessary to have insight into the effects of nicotine on the osteogenic differentiation of hPDLCs during orthodontic tooth movement. This study aimed to investigate the effects and mechanisms of nicotine on the osteogenic differentiation of human periodontal ligament cells (hPDLCs) under the application of cyclic tensile stress.

MATERIAL AND METHODS

hPDLCs were obtained from donor third molars. The hPDLCs were treated with nicotine and/or cyclic tensile stress that was applied with a cell stress plus unit. The effect of nicotine on cell viability was analyzed using the MTT assay. The osteogenic differentiation of hPDLCs was detected by alkaline phosphatase staining, Alizarin Red S staining, quantitative real-time polymerase chain reaction and western blotting.

RESULTS

In combination with cyclic tensile stress, nicotine prevented the tensile stress-induced increase in alkaline phosphatase activity, formation of mineralization nodules and the upregulation of mRNA and protein expression of Runt-related transcription factor 2, transcription factor Sp7 and collagen type I; however, canonical Wnt pathway was activated. Furthermore, the addition of Dickkopf-related protein 1 and α-bungarotoxin counteracted the negative effect of nicotine and rescued the osteogenic differentiation of hPDLCs, respectively.

CONCLUSION

These results indicate that nicotine prevents the increased osteogenic potential of hPDLCs induced by cyclic tensile stress by binding to an α7 nicotinic acetylcholine receptor and activating the canonical Wnt pathway.

Influence of exercise intervention on gestational diabetes mellitus: a systematic review and meta-analysis

AIMS

Exercise intervention might be a promising approach to prevent gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the effect of exercise intervention on gestational diabetes mellitus.

METHODS

PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of exercise intervention on gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was the incidence of gestational diabetes mellitus, preterm birth, and gestational age at birth. Meta-analysis was performed using random-effect model.

RESULTS

Five RCTs involving 1872 patients were included in the meta-analysis. Overall, compared with control intervention, exercise intervention was found to significantly reduce the risk of gestational diabetes mellitus (std. mean difference 0.62; 95% CI 0.43-0.89; P = 0.01), but demonstrated no influence on preterm birth (OR 0.93; 95% CI 0.44-1.99; P = 0.86), gestational age at birth (std. mean difference -0.03; 95% CI -0.12 to 0.07; P = 0.60), glucose 2-h post-OGTT (std. mean difference -1.02; 95% CI -2.75 to 0.71; P = 0.25), birth weight (std. mean difference -0.10; 95% CI -0.25 to 0.04; P = 0.16), Apgar score less than 7 (OR 0.78; 95% CI 0.21-2.91; P = 0.71), and preeclampsia (OR 1.05; 95% CI 0.53-2.07; P = 0.88).

CONCLUSIONS

Compared to control intervention, exercise intervention was found to significantly reduce the incidence of gestational diabetes mellitus, but had no significant influence on preterm birth, gestational age at birth, glucose 2-h post-OGTT, birth weight, Apgar score less than 7, and preeclampsia.

[Utility and evaluation of immunohistochemical detection of BRAF V600E mutation in melanoma]

Objective: To evaluate the sensitivity, specificity and clinical value of anti-BRAF V600E antibody (clone VE1) in detection of the BRAF V600E mutant in formalin-fixed and paraffin-embedded (FFPE) melanoma specimens by immunohistochemical (IHC) methods. Methods: A total of 50 melanoma samples collected between 2008 and 2016 from 40 patients were analyzed for BRAF mutation (exon 15) by DNA sequencing using FFPE. These tissues were immunostained with VE1 antibody, and the results were analyzed and compared with those by DNA sequencing. Results: By DNA sequencing, 36 cases showed BRAF mutation while others were BRAF wild type. Among the 36 cases with BRAF mutation, 32 harbored BRAF V600E, two harbored BRAF V600K, one had BRAF K601E and one had BRAF D594N, respectively. IHC staining showed 30 specimens were VE1 positive, while 19 were negative. The determination of IHC result for one case was obscured by heavy pigments. Of the BRAF-mutated specimens, four specimens with BRAF mutation other than V600E were all negative for VE1. The sensitivity and specificity of the VE1 immunostaining was 96.8% and 100.0% respectively.Concordance of BRAF V600E detection between immunostaining and DNA sequencing was 98.0%(48/49). Conclusions: High sensitivity and specificity for VE1 immunostaining in detecting BRAF V600E in melanomas are demonstrated. It is a rapid and cost-effective method for detecting BRAF V600E mutations in melanoma patients. Hence, VE1 immunostaining can be used as an important screening method for BRAF mutation in laboratories.

[Effects of overexpression of human tissue inhibitor of metalloproteinase-1 on the inflammatory response in rats with myocardial infarction and related mechanisms]

Objective: To observe the effects of recombinant adenovirus with human tissue inhibitor of metalloproteinase-1(Ad-hTIMP-1) on the inflammatory response in rats with myocardial infarction (MI) and explore the related mechanisms. Methods: The male Wistar rats were randomly divided into sham-operated group, saline group, Ad-Track group and Ad-hTIMP-1 group according to the random number table (n=8 each group). MI was induced by ligation of the left anterior descending coronary artery and MI rats were injected with saline, Ad-Track and Ad-hTIMP-1, respectively. Sham-operated rats received similar surgical procedure without ligation of the left anterior descending coronary artery. After 4 weeks, the cardiac function was measured by echocardiography, then rats were sacrificed and hearts were removed for morphological and biological analysis. The morphology of myocardial tissue in each group was detected by HE staining and Masson staining. The mRNA expressions of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10 and C-reactive protein(CRP) were detected by real-time PCR. Immune histochemical staining was performed to observe the protein expression levels of IL-6 and CRP. Results: (1) Left ventricular end systolic dimension derived from echocardiography was increased in saline group ((5.10±0.72) mm) and Ad-Track group ((4.88±0.64) mm) compared to sham-operated group ((4.25±0.46) mm), which was reduced in Ad-hTIMP-1 group ((4.13±0.35) mm, all P<0.05). The left ventricular ejection fraction was (72.46±5.74)%, (64.27±8.52)%, (64.65±3.90)%, and (71.55±6.95)%, the fractional shortening was (36.90±4.97)%, (29.03±3.40)%, (30.95±2.51)%, and (36.31±5.68)% in sham-operated group, saline group, Ad-Track group and Ad-hTIMP-1 group, respectively. The left ventricular ejection fraction and fractional shortening in saline group and Ad-Track group were lower than those in sham-operated group and Ad-hTIMP-1 group (all P<0.05). (2) Necrosis of myocardial cells was not found and a small amount of immune cell infiltration and interstitial fibrosis were observed on HE and Masson stained myocardial sections of Ad-hTIMP-1 group. (3) Real-time PCR showed that mRNA expressions of TNF-α, IL-6, IL-10 and CRP were lower in Ad-hTIMP-1 group than in saline group. mRNA expressions of TNF-α, IL-10 and CRP were lower in Ad-hTIMP-1 group than in Ad-Track group (all P<0.05). (4) Immune histochemical staining showed that protein expressions of IL-6 and CRP were higher in saline group and Ad-Track group than those in Ad-hTIMP-1 group (all P<0.05). Conclusion: Recombinant adenovirus Ad-hTIMP-1 can improve cardiac function in rats with myocardial infarction via inhibiting the inflammatory response and downregulating the expression of TNF-α, IL-6 and CRP.

Characterization and development of 56 EST-SSR markers derived from the transcriptome of Odontobutis potamophila

Expressed sequence tags (ETSs) are the sources of microsatellite development. In this study, we isolated and characterized microsatellite markers for Odontobutis potamophila by using Illumina RNA-sequencing. We sequenced a large number of ESTs and screened 200 potential microsatellites. Consequently, a total of 56 novel polymorphic microsatellite repeat markers were identified in thirty-two individuals from a wild population area (Jiande, Zhejiang Province, China). The number of alleles per locus varied from two to eight, the observed heterozygosity (H_O) ranged from 0.03571 to 0.9375, and the expected heterozygosity (H_E) ranged from 0.14326 to 0.81549. The average number of alleles, H_O, and H_E were 5.0, 0.4467, and 0.5518, respectively. By the calculation, the range of polymorphism information content (PIC) was 0.1177-0.8492. Most of the loci showed moderate or high polymorphism. These newly developed EST-simple sequence repeat (EST-SSR) markers would serve as an efficient tool for analyzing population connectivity and provide sufficient information for genetic diversity research, parentage, and molecular breeding of O. potamophila and other fishes with similar genetic relationship.

An autonomous lab on a chip for space flight calibration of gravity-induced transcellular calcium polarization in single-cell fern spores

This report describes the development of lab-on-a-chip device designed to measure changes in cellular ion gradients that are induced by changes in gravitational (g) forces. The bioCD presented here detects differential calcium ion concentrations outside of individual cells. The device includes sufficient replicates for statistical analysis of the gradients around multiple single cells and around control wells that are empty or include dead cells. In the data presented, the degree of the cellular response correlates with the magnitude of the g-force applied via rotation of the bioCD. The experiments recorded the longest continuous observation of a cellular response to hypergravity made to date, and they demonstrate the potential utility of this device for assaying the threshold of cells' g-force responses in spaceflight conditions.

Shock-transformation of whitlockite to merrillite and the implications for meteoritic phosphate

Meteorites represent the only samples available for study on Earth of a number of planetary bodies. The minerals within meteorites therefore hold the key to addressing numerous questions about our solar system. Of particular interest is the Ca-phosphate mineral merrillite, the anhydrous end-member of the merrillite–whitlockite solid solution series. For example, the anhydrous nature of merrillite in Martian meteorites has been interpreted as evidence of water-limited late-stage Martian melts. However, recent research on apatite in the same meteorites suggests higher water content in melts. One complication of using meteorites rather than direct samples is the shock compression all meteorites have experienced, which can alter meteorite mineralogy. Here we show whitlockite transformation into merrillite by shock-compression levels relevant to meteorites, including Martian meteorites. The results open the possibility that at least part of meteoritic merrillite may have originally been H⁺-bearing whitlockite with implications for interpreting meteorites and the need for future sample return.

Quantifying the amount of water in meteorites remains challenging, with minerals the key to understanding water contents. Here, Adcock et al. perform shock experiments on H⁺-bearing whitlockite demonstrating that it may transform into anhydrous merrillite, which is commonly found in Martian meteorites.

Ex vivo expansion of antigen-specific CD4+CD25+ regulatory T cells from autologous naïve CD4+ T cells of multiple sclerosis patients as a potential therapeutic approach

OBJECTIVE

CD4+CD25+ regulatory T cells (Tregs) have been found to have a decreased effector function in patients with multiple sclerosis (MS). In this study, we co-cultured naïve CD4+ T cells of MS patients with myelin basic protein (MBP)85-99 peptide as specific antigen and allogenic B cells as antigen-presenting cells, in an attempt to generate adequate antigen-specific CD4+CD25+ Tregs with normal or improved immune function.

PATIENTS AND METHODS

Naïve CD4+ T cells were isolated from peripheral blood mononuclear cells (PBMCs) from patients with MS (n=5) and healthy controls (HC, n=5). Furthermore, these purified naive CD4+ T cells were co-cultured with the CD40-activated B cells and MBP85-99 peptide to induce MBP-reactive CD4+CD25highCD127low Tregs. After harvesting these Tregs via a flow sorter, real-time PCR and mixed lymphocyte reaction (MLR) assay were performed to characterize cellular immune function. Supernatant interleukin (IL)-10 and transforming growth factor (TGF)-β1 protein levels were detected by an enzyme-linked immunosorbent assay (ELISA).

RESULTS

With this method, the frequency of CD4+CD25highCD127low Tregs in CD4+ T cells was 3.5%-6%. In both MS and HC groups, there were relatively lower proliferation indices (PI) of MLR assay but higher supernatant IL-10 and TGF-β1 levels in the presence of MBP than those in the presence of other control antigens, where no significant differences were found.

CONCLUSIONS

Via the ex vivo culture, adequate MBP-reactive CD4+CD25+ Tregsderived from autologous naïve CD4+ T cells of MS patients, were obtained and returned to normal without immune defects, and even upregulated their immunosuppressive function mostly through the elevated release of IL-10 and TGF-β1.

Branched-chain Amino Acids are Beneficial to Maintain Growth Performance and Intestinal Immune-related Function in Weaned Piglets Fed Protein Restricted Diet

As a novel approach for disease control and prevention, nutritional modulation of the intestinal health has been proved. However, It is still unknown whether branched-chain amino acid (BCAA) is needed to maintain intestinal immune-related function. The objective of this study was to determine whether BCAA supplementation in protein restricted diet affects growth performance, intestinal barrier function and modulates post-weaning gut disorders. One hundred and eight weaned piglets (7.96±0.26 kg) were randomly fed one of the three diets including a control diet (21% crude protein [CP], CON), a protein restricted diet (17% CP, PR) and a BCAA diet (BCAA supplementation in the PR diet) for 14 d. The growth performance, plasma amino acid concentrations, small intestinal morphology and intestinal immunoglobulins were tested. First, average daily gain (ADG) (p<0.05) and average daily feed intake (ADFI) (p<0.05) of weaned pigs in PR group were lower, while gain:feed ratio was lower than the CON group (p<0.05). Compared with PR group, BCAA group improved ADG (p<0.05), ADFI (p<0.05) and feed:gain ratio (p<0.05) of piglets. The growth performance data between CON and BCAA groups was not different (p>0.05). The PR and BCAA treatments had a higher (p<0.05) plasma concentration of methionine and threonine than the CON treatment. The level of some essential and functional amino acids (such as arginine, phenylalanine, histidine, glutamine etc.) in plasma of the PR group was lower (p<0.05) than that of the CON group. Compared with CON group, BCAA supplementation significantly increased BCAA concentrations (p<0.01) and decreased urea concentration (p<0.01) in pig plasma indicating that the efficiency of dietary nitrogen utilization was increased. Compared with CON group, the small intestine of piglets fed PR diet showed villous atrophy, increasing of intra-epithelial lymphocytes (IELs) number (p<0.05) and declining of the immunoglobulin concentration, including jejunal immunoglobulin A (IgA) (p = 0.04), secreted IgA (sIgA) (p = 0.03) and immunoglobulin M (p = 0.08), and ileal IgA (p = 0.01) and immunoglobulin G (p = 0.08). The BCAA supplementation increased villous height in the duodenum (p<0.01), reversed the trend of an increasing IELs number. Notably, BCAA supplementation increased levels of jejunal and ileal immunoglobulin mentioned above. In conclusion, BCAA supplementation to protein restricted diet improved intestinal immune defense function by protecting villous morphology and by increasing levels of intestinal immunoglobulins in weaned piglets. Our finding has the important implication that BCAA may be used to reduce the negative effects of a protein restricted diet on growth performance and intestinal immunity in weaned piglets.

Inflammatory dentigerous cyst of mandibular first premolar associated with endodontically treated primary first molar: a rare case report

AIM

Inflammatory dentigerous cysts usually occur in the mixed dentition. It has been reported that inflammatory lesions from the root area of a deciduous tooth bring about the development of dentigerous cysts around the unerupted permanent tooth bud. Endodontic treatment is a common and successful procedure for periapical inflammation in children. An inflammatory dentigerous cyst can occur in conjunction with endodontically treated primary tooth.

CASE REPORT

This article reports a case of 6 years and 6 months old boy, with a single, well-defined, unilocular, radiolucent area enclosing the first right unerupted mandibular premolar, accidentally discovered on the panoramic radiograph. The first right primary molar had received a root canal treatment 18 months prior. Clinical findings combined with radiographic and microscopic examinations confirmed the diagnosis of inflammatory dentigerous cyst. As treatment, enucleation of the cyst with removal of the involved permanent tooth was chosen and a removable partial denture was supplied to the patient after surgery. The 5-year follow-up revealed good healing of the bony lesion and displaced teeth.

CONCLUSION

This case presented a severe and rare complication of endodontically treated primary tooth, and the recommendation includes: (1) early diagnosis of dentigerous cysts, which is essential to prevent extensive treatment; (2) more information on the adverse side effects of an endodontic treatment should be given to patients and parents; (3) patients should be informed about the importance of follow-ups and radiographic follow-up should be routinised.

Effect of γ-Aminobutyric Acid-producing Lactobacillus Strain on Laying Performance, Egg Quality and Serum Enzyme Activity in Hy-Line Brown Hens under Heat Stress

Heat-stress remains a costly issue for animal production, especially for poultry as they lack sweat glands, and alleviating heat-stress is necessary for ensuring animal production in hot environment. A high γ-aminobutyric acid (GABA)-producer Lactobacillus strain was used to investigate the effect of dietary GABA-producer on laying performance and egg quality in heat-stressed Hy-line brown hens. Hy-Line brown hens (n = 1,164) at 280 days of age were randomly divided into 4 groups based on the amount of freeze-dried GABA-producer added to the basal diet as follows: i) 0 mg/kg, ii) 25 mg/kg, iii) 50 mg/kg, and iv) 100 mg/kg. All hens were subjected to heat-stress treatment through maintaining the temperature and the relative humidity at 28.83±3.85°C and 37% to 53.9%, respectively. During the experiment, laying rate, egg weight and feed intake of hens were recorded daily. At the 30th and 60th day after the start of the experiment, biochemical parameters, enzyme activity and immune activity in serum were measured. Egg production, average egg weight, average daily feed intake, feed conversion ratio and percentage of speckled egg, soft shell egg and misshaped egg were significantly improved (p<0.05) by the increasing supplementation of the dietary GABA-producer. Shape index, eggshell thickness, strength and weight were increased linearly with increasing GABA-producer supplementation. The level of calcium, phosphorus, glucose, total protein and albumin in serum of the hens fed GABA-producing strain supplemented diet was significantly higher (p<0.05) than that of the hens fed the basal diet, whereas cholesterol level was decreased. Compared with the basal diet, GABA-producer strain supplementation increased serum level of glutathione peroxidase (p = 0.009) and superoxide dismutase. In conclusion, GABA-producer played an important role in alleviating heat-stress, the isolated GABA-producer strain might be a potential natural and safe probiotic to use to improve laying performance and egg quality in heat-stressed hens.

PCDD/Fs in air and soil around an e-waste dismantling area with open burning of insulated wires in south China

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in ambient air and farmland soil sampled in 2006 around an e-waste dismantling area with open burning of insulated wires in Longtang in south China were investigated. The total toxic equivalent concentrations of PCDD/Fs were 3.2-31.7 pg/m(3) in air and 5.8 12.4 ng/kg in farmland soil at an e-waste site and 0.063-0.091 pg/m(3) in air at a background site. PCDD/Fs in the air at the e-waste site were characterized with dominant 1,2,3,4,6,7,8-HpCDF and OCDF and higher concentrations of furans than dioxins, suggesting open burning of insulated wires was likely to be the main source of PCDD/Fs. Compared with the results in this study, the level of PCDD/F tended to lessen with the average TEQ concentration decreasing by 41 % and the pattern changed to be dominated by OCDD in the air of Longtang in 2010 when insulated wires were openly burned in only a small scale. Our results indicate that the lower chlorinated congeners with higher vapor pressures have enhanced atmospheric transport tendencies.

Two-dimensional longitudinal strains and torsion analysis to assess the protective effects of ischemic postconditioning on myocardial function: a speckle tracking echocardiography study in rabbits

The reperfusion injury that occurs in the early reperfusion often results in myocardial dysfunction. This study evaluated global and regional left ventricular (LV) function using speckle tracking echocardiography (STE) in a rabbit ischemia-reperfusion (I/R) model with and without ischemic postconditioning (I-PostC). The aim is to investigate the potential benefit of I-PostC for myocardial function and validate whether regional longitudinal strain is an appropriate index to indicate myocardial dysfunction. Forty rabbits were divided into an ischemia-reperfusion group (group I) and an I-PostC group (group II). After the coronary arteries were ligated, LV systolic strain and twist parameters decreased, and absolute value of strain rate of isovolumetric relaxation period (SRivr) and post-systolic strain index (PSI) increased significantly in both groups (all p<0.05). After reperfusion, regional longitudinal systolic strain rate (SRsys), systolic strain (Ssys), LV twist and untwisting rate increased, and SRivr and PSI decreased in group II. These changes were not seen in group I. All STE parameters were correlated with area of necrosis (AN)/area at risk (AR) (all p<0.05). The correlations were morerelevant between SRsys and AN/AR (r=-0.673) and between Ssys and AN/AR (r=-0.777) (both p<0.001). The intra- and inter-observer repeatability of STE parameters were good with correlation coefficients (CCs) >0.8 or 0.6. The sensitivities of GSRsys, GSsys, SRsys, Ssys, and LV twist to detect the myocardial infarction were 81.3%, 62.5%, 87.5%, 93.8% and 81.3%, respectively. And the specificities of those parameters were 75.0%, 81.2%, 75.0%, 87.5% and 68.7%. These results indicate that STE is useful for quantitative detection on myocardial function improvement induced by I-PostC in a rabbit I/R model. The regional index-Ssys is an appropriate parameter to indicate myocardial dysfunction because of its sensitivity, specificity, and repeatability.

Dimethyl fumarate attenuates 6-OHDA-induced neurotoxicity in SH-SY5Y cells and in animal model of Parkinson's disease by enhancing Nrf2 activity

Oxidative stress is central to the pathology of several neurodegenerative diseases, including Parkinson's disease (PD), and therapeutics designed to enhance antioxidant potential could have clinical value. In this study, we investigated whether dimethyl fumarate (DMF) has therapeutic effects in cellular and animal model of PD, and explore the role of nuclear transcription factor related to NF-E2 (Nrf2) in this process. Treatment of animals and dopaminergic SH-SY5Y cells with DMF resulted in increased nuclear levels of active Nrf2, with subsequent upregulation of antioxidant target genes. The cytotoxicity of 6-hydroxydopamine (6-OHDA) was reduced by pre-treatment with DMF in SH-SY5Y cells. The increase in the reactive oxygen species caused by 6-OHDA treatment was also attenuated by DMF in SH-SY5Y cells. The neuroprotective effects of DMF against 6-OHDA neurotoxicity were dependent on Nrf2, since treatment with Nrf2 siRNA failed to block against 6-OHDA neurotoxicity and induce Nrf2-dependent cytoprotective genes in SH-SY5Y cells. In vivo, DMF oral administration was shown to upregulate mRNA and protein levels of Nrf2 and Nrf2-regulated cytoprotective genes, attenuate 6-OHDA induced striatal oxidative stress and inflammation in C57BL/6 mice. Moreover, DMF ameliorated dopaminergic neurotoxicity in 6-OHDA-induced PD animal models as evidenced by amelioration of locomotor dysfunction, loss in striatal dopamine, and reductions in dopaminergic neurons in the substantia nigra and striatum. Taken together, these data strongly suggest that DMF may be beneficial for the treatment of neurodegenerative diseases like PD.

The association of new inflammatory markers with type 2 diabetes mellitus and macrovascular complications: a preliminary study

AIM

Type 2 diabetes mellitus (T2DM) is not simply a disease of hyperglycemia, but also is an inflammatory disorder. This study aimed to observe the expression of inflammation-related factors in elderly T2DM patients with or without macrovascular disease (MVD).

PATIENTS AND METHODS

A total of 64 T2DM patients participated in this study, including 31 patients with MVD (group A) and 33 patients without MVD (group B); and 30 healthy volunteers were recruited as normal control (group C). The levels of serum irisin, retinol-binding protein 4 (RBP4) and adiponectin expression were all detected and compared between groups.

RESULTS

The demographic and clinical characteristics were comparable between T2DM patients and healthy volunteers. For patients in group A, the serum levels of irisin, RBP4 and adiponectin were 12.05 ± 2.12 pg/mL, 2.13 ± 0.83 µg/mL and 45.65±20.13 ng/mL, respectively. While the corresponding parameters were 26.11 ± 4.09 pg/ml, 1.54 ± 0.54 µg/ml and 57.93 ± 23.47 ng/mL for patients in group B; and were 40.25 ± 2.73 pg/mL, 0.98 ± 0.36 µg/mL and 60.03 ± 20.26 ng/mL for healthy volunteers in group C, respectively. As compared to healthy volunteers, the levels of irisin, RBP4 and adiponectin were all significantly changed in T2DM patients; and the difference in irisin, RBP4 and adiponectin between T2DM patients with and without MVD were all significant (p = 0.000, p = 0.001, and p = 0.029, respectively). Multivariate regression analysis showed that irisin and RBP4 are both independent predictors for MVD in T2DM patients.

CONCLUSIONS

Inflammatory disorder is significantly in T2DM patients with MVD, and serum irisin and RBP4 would be reasonable new markers of MVD.

Guanabenz delays the onset of disease symptoms, extends lifespan, improves motor performance and attenuates motor neuron loss in the SOD1 G93A mouse model of amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive neurodegenerative disease characterized by the loss of motor neurons in the motor cortex, brain stem and spinal cord. Currently, there is no cure for this lethal disease. Although the mechanism underlying neuronal cell death in ALS remains elusive, growing evidence supports a crucial role of endoplasmic reticulum (ER) stress in the pathogenesis of ALS. Recent reports show that guanabenz, a novel inhibitor of eukaryotic initiation factor 2α (eIF2α) dephosphorylation, possesses anti-prion properties, attenuates ER stress and reduces paralysis and neurodegeneration in mTDP-43 Caenorhabditis elegans and Danio rerio models of ALS. However, the therapeutic potential of guanabenz for the treatment of ALS has not yet been assessed in a mouse model of ALS. In the present study, guanabenz was administered to a widely used mouse model of ALS expressing copper zinc superoxide dismutase-1 (SOD1) with a glycine to alanine mutation at position 93 (G93A). The results showed that the administration of guanabenz significantly extended the lifespan, delayed the onset of disease symptoms, improved motor performance and attenuated motor neuron loss in female SOD1 G93A mice. Moreover, western blotting results revealed that guanabenz dramatically increased the levels of phosphorylated-eIF2α (P-eIF2α) protein, without affecting total eIF2α protein levels. The results also revealed a significant decrease in the levels of the ER chaperone glucose-regulated protein 78 (BiP/Grp78) and markers of another two ER stress pathways, activating transcription factor 6α (ATF6α) and inositol-requiring enzyme 1 (IRE1). In addition, guanabenz increased the protein levels of anti-apoptotic B cell lymphoma/lewkmia-2 (Bcl-2), and down-regulated the pro-apoptotic protein levels of C/EBP homologous protein (CHOP), Bcl-2-associated X protein (BAX) and cytochrome C in SOD1 G93A mice. Our findings indicate that guanabenz may represent a novel therapeutic candidate for the treatment of ALS, a lethal human disease with an underlying mechanism involving the attenuation of ER stress and mitochondrial stress via prolonging eIF2α phosphorylation.

Radix Astragali lowers kidney oxidative stress in diabetic rats treated with insulin

Fluctuations in glucose levels in diabetic patients can result in oxidative stress, resulting in an increased risk for diabetic complications. We investigated whether antioxidation would protect the kidney from oxidative stress in diabetic rats treated with insulin and provide evidence for the efficacy of antioxidant treatment in diabetes management. Diabetes was induced by injection of Streptozotocin intraperitoneally in male Wistar rats. Diabetic rats received either insulin, both insulin and Radix Astragali (RA), RA, or no treatment. The levels of malondialdehyde (MDA), interleukin 6 (IL-6), tumor necrosis factor α (TNF-α) and activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) in kidney were determined. The changes of blood glucose levels and body weight were monitored. The levels of serum creatinine (Scr) were determined. The expression of PKCα was determined by western blot. NF-κB activation in kidney was assessed using EMSA. Compared to diabetic rats treated with insulin alone, the diabetic rats treated with combination of insulin and RA showed: (1) significantly lower levels of MDA, IL-6, TNF-α, and Scr (p < 0.05); (2) significantly higher SOD and GSH-Px activities (p < 0.05); (3) significantly lower NF-κB activation and lower expression levels of PKCα (p < 0.05); (4) significantly smaller kidney-to-body weight ratio (p < 0.05). RA is an effective agent in lowering oxidative stress in diabetic rats treated with insulin. Antioxidation is beneficial in reducing the risk of kidney damage due to oxidative stress in diabetic patients.