A systematic review and meta-analysis of the diagnostic accuracy of metagenomic next-generation sequencing for diagnosing tuberculous meningitis

Objective

The utility of metagenomic next-generation sequencing (mNGS) in the diagnosis of tuberculous meningitis (TBM) remains uncertain. We performed a meta-analysis to comprehensively evaluate its diagnostic accuracy for the early diagnosis of TBM.

Methods

English (PubMed, Medline, Web of Science, Cochrane Library, and Embase) and Chinese (CNKI, Wanfang, and CBM) databases were searched for relevant studies assessing the diagnostic accuracy of mNGS for TBM. Review Manager was used to evaluate the quality of the included studies, and Stata was used to perform the statistical analysis.

Results

Of 495 relevant articles retrieved, eight studies involving 693 participants (348 with and 345 without TBM) met the inclusion criteria and were included in the meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver-operating characteristic curve of mNGS for diagnosing TBM were 62% (95% confidence interval [CI]: 0.46-0.76), 99% (95% CI: 0.94-1.00), 139.08 (95% CI: 8.54-2266), 0.38 (95% CI: 0.25-0.58), 364.89 (95% CI: 18.39-7239), and 0.97 (95% CI: 0.95-0.98), respectively.

Conclusions

mNGS showed good specificity but moderate sensitivity; therefore, a more sensitive test should be developed to assist in the diagnosis of TBM.

Recent advances in microbiological and molecular biological detection techniques of tuberculous meningitis

Tuberculous meningitis (TBM) is the most common type of central nervous system tuberculosis (TB) and has the highest mortality and disability rate. Early diagnosis is key to improving the prognosis and survival rate of patients. However, laboratory diagnosis of TBM is often difficult due to its paucibacillary nature and sub optimal sensitivity of conventional microbiology and molecular tools which often fails to detect the pathogen. The gold standard for TBM diagnosis is the presence of MTB in the CSF. The recognised methods for the identification of MTB are acid-fast bacilli (AFB) detected under CSF smear microscopy, MTB cultured in CSF, and MTB detected by polymerase chain reaction (PCR). Currently, many studies consider that all diagnostic techniques for TBM are not perfect, and no single technique is considered simple, fast, cheap, and efficient. A definite diagnosis of TBM is still difficult in current clinical practice. In this review, we summarise the current state of microbiological and molecular biological diagnostics for TBM, the latest advances in research, and discuss the advantages of these techniques, as well as the issues and challenges faced in terms of diagnostic effectiveness, laboratory infrastructure, testing costs, and clinical expertise, for clinicians to select appropriate testing methods.

Incidence and Risk Factors of Cranial Nerve Palsy in Patients with Tuberculous Meningitis: A Retrospective Evaluation

Objective

Tuberculous meningitis (TBM) is a common form of central nervous system (CNS) tuberculosis (TB). Cranial nerve palsy is a serious complication of TBM. Literature regarding this subject is still limited in China. This study evaluated the incidence of cranial nerve palsy in patients with TBM in South China, its association with the clinical forms of TB, and other patient characteristics.

Methods

A retrospective chart review of patients with a diagnosis of TBM between January 2004 and December 2019 was conducted, and the demographic characteristics, clinical characteristics, and laboratory results of 114 patients were collected and followed up for 3 months. A multivariate logistic regression analysis model was used to explore the risk factors of cranial nerve palsy in patients with TBM.

Results

A total of 114 patients were enrolled in this study. Cranial nerve palsy was observed in approximately 38 (33.3%) of TBM patients. Among them, 13 (28.3%) had optic nerve palsy, 24 (52.2%) had oculomotor nerve palsy, 5 (10.9%) had abducens nerve palsy, 2 (4.3%) had auditory nerve palsy, 1 (2.2%) had glossopharyngeal nerve palsy, and 1 (2.2%) had vagus nerve palsy. Using logistic regression analysis, focal neurological deficit, extracranial TB and cerebrospinal fluid (CSF) total white cell count (WCC) were shown to be risk factors for cranial nerve palsy.

Conclusion

The prevalence rate of cranial nerve palsy was 33.3% in patients with TBM. Focal neurological deficits, extracranial TB and CSF total WCC are important predictors of cranial nerve palsy in patients with TBM.

Exploration of the Risk Factors of Anemia in Patients with Tuberculous Meningitis in South China

OBJECTIVE

Central nervous system (CNS) infection has a high incidence and mortality worldwide. Tuberculous meningitis (TBM) accounts for approximately 5-6% of all extrapulmonary tuberculosis (TB), and is considered an extremely lethal form of CNS TB, which has become an important threat to human health. Anemia is a common symptom of TB, and its prevalence is generally higher in patients with TBM than in other meningitis patients and healthy individuals. Anemia can increase a person's susceptibility to common infectious diseases, including TB, by compromising the immune system. Information regarding anemia during the hospitalization of TBM is still scarce in China. This study aimed to describe in detail the prevalence of anemia in patients with TBM in Southern China and its association with the clinical forms of TB, as well as other characteristics of these patients.

METHODS

We conducted a retrospective analysis of patients diagnosed with TBM at two tertiary hospitals in southern China. The demographic characteristics, clinical characteristics, and laboratory results of 114 patients with TBM were collected. Multivariate logistic regression analysis was performed to explore the risk factors for anemia in patients with TBM.

RESULTS

Electronic medical record data of adult patients diagnosed with TBM from January 2004 to December 2019 were reviewed. Among 134 patients with TBM, 20 were excluded and 114 were analyzed, of whom 33 had anemic, the prevalence rate of anemia was 28.9%. Among patients with anemia, 51.5% had hypochromic microcytic anemia, 33.3% had normochromic normocytic anemia, and 15.2% had macrocytic anemia. Fever duration, TBM grade III and ESR were found to be independent predictors of anemia.

CONCLUSION

Anemia was highly prevalent in patients with TBM, mainly hypochromic microcytic anemia. Besides, Fever duration, TBM grade III and ESR are predictors of anemia in patients with TBM.

Diagnostic Accuracy of Interferon-Gamma Release Assays for Tuberculous Meningitis: A Systematic Review and Meta-Analysis

Background

In this study, we evaluated and compared the accuracy of blood and cerebrospinal fluid (CSF) interferon release tests [interferon-gamma release assays (IGRAs)] in the diagnosis of tuberculous meningitis (TBM) by a meta-analysis of the relevant literature.

Methods

We searched for studies published before 2021 in Medline, Embase, the Cochrane database, and Chinese databases. All studies used the QuantiFERON-TB Gold In-Tube and/or T-SPOT.TB method. Blood and/or CSF tests that met the guidelines for the quality assessment of studies with diagnostic accuracy were included. We used the revised diagnostic accuracy study quality assessment to assess the quality of the included studies. Begg’s funnel plots were used to assess publication bias in the meta-analysis of the diagnostic studies, and statistical analyses were performed by using Stata (Version 12) software.

Results

A total of 12 blood and/or CSF IGRA studies were included in this meta-analysis, with 376 patients and 493 controls. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve (SROC) of the blood IGRAs in the pooled data from 12 studies were 74% (95% CI: 0.65-0.82), 78% (95% CI: 0.68-0.86), 3.38 (95% CI 2.26-5.06), 0.33 (95% CI: 0.23-0.46), 10.25 (95% CI: 5.46-19.25), and 0.83 (95% CI: 0.79-0.86), respectively. For CSF IGRAs, these values for the pooled data from the 10 studies included were 79% (95% CI: 0.71-0.85), 95% (95% CI: 0.88-0.98), 16.30 (95% CI 6.5-40.83), 0.22 (95% CI: 0.16-0.31), 57.93 (95% CI: 22.56-148.78), and 0.91 (95% CI: 0.88-0.93), respectively.

Conclusion

CSF IGRAs exhibited a better diagnostic accuracy than blood IGRAs in diagnosing TBM.

A New Scoring System to Differentially Diagnose and Distinguish Tuberculous Meningitis and Bacterial Meningitis in South China

Background

Tuberculous meningitis (TBM) is the most serious form of extrapulmonary tuberculosis caused by Mycobacterium tuberculosis, and is characterized by high morbidity and mortality. Unfortunately, it is difficult to distinguish TBM from bacterial meningitis (BM) based on clinical features alone. The latest diagnostic tests and neuroimaging methods are still not available in many developing countries. This study aimed to develop a simple diagnostic algorithm based on clinical and laboratory test results as an early predictor of TBM in South China.

Methods

A retrospective study was conducted to compare the clinical and laboratory characteristics of 114 patients with TBM and 47 with BM. Multivariate logistic regression analysis was performed on the characteristics of independently predicted TBM to develop a new diagnostic rule.

Results

Five characteristics were predictive of a diagnosis of TBM: duration of symptoms before admission; tuberculous symptoms; white blood cell (WBC) count, total cerebrospinal fluid WBC count, and cerebrospinal fluid chloride concentration. The sensitivity and specificity of the new scoring system developed in this study were 81.6 and 93.6%, respectively.

Conclusion

The new scoring system proposed in this study can help physicians empirically diagnose TBM and can be used in countries and regions with limited microbial and radiological resources.

Bipolar disorder and the risk for stroke incidence and mortality: a meta-analysis

OBJECTIVE

Bipolar disorder (BD) may be associated with an increased risk of stroke, but to date, the results of the studies are still controversial. This study aimed to assess the association of BD with stroke incidence and mortality by a meta-analysis.

METHOD

PubMed, EMBASE, the Cochrane library databases, and Web of Science databases were searched from inception to July 2020. We regarded stroke as a composite endpoint. The pooled hazard ratio (HRs) of 95% confidence interval (Cls) was calculated. Subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity of the pooled estimation.

RESULTS

A total of 7 studies involving a total of 13,305,007 participants were included in this meta-analysis. Pooled analysis showed participants with BD experienced a significantly increased risk of both stroke incidence (combined HR, 1.43; 95% CI, 1.24-1.66; p = 0.000) and stroke mortality (combined HR, 1.54; 95% CI, 1.09-2.18; p = 0.013) compared to participants without BD. In addition, the pooled estimate of multivariate HRs of stroke incidence and mortality were 1.35 (95% CI: 1.26-1.45); 2.30 ( 95% CI: 1.37-3.85) among men and 1.43 (95% CI:1.27-1.60); 2.08 (95% CI:1.60-2.71) among women respectively.

CONCLUSIONS

This meta-analysis suggests that BD may modestly increase the risk of both stroke incidence and mortality. Extensive clinical observational studies should be conducted in the future to explore whether BD is a potentially modifiable risk factor for stroke.

[Long-term outcomes of 125I brachytherapy combined with maximal androgen blockade for metastatic prostate cancer]

OBJECTIVE

To investigate the long-term clinical value of prostate 125I brachytherapy (BT) combined with maximal androgen blockade (MAB) in the treatment of metastatic prostate cancer (mPCa).

METHODS

We retrospectively analyzed the clinical data on 173 cases of mPCa treated by MAB (n = 126) or BT+MAB (n = 47) from December 2011 to December 2016 and followed up for 6－76 (44.17 ± 19.73) months. We compared the PSA level, prostate volume, IPSS, progression-free survival, and the rates of 3- and 5-year overall survival between the two groups.

RESULTS

After treatment, the minimum PSA level was significantly lower in the BT+MAB than in the MAB group ［3.77 ± 4.14］ vs ［5.96 ± 7.01］ ng/ml, P = 0.046) and the time to reach the minimum level was shorter in the former than in the latter (［5.19 ± 2.83］ vs ［6.52 ± 3.34］ mo, P = 0.016). The prostate volume was markedly reduced in both of the groups at 1, 3 and 5 years after treatment as compared with the baseline, even more significantly in the BT+MAB than in the MAB group (P < 0.01), though with no statistically significant difference between the two groups before treatment (P = 0.307). The IPSS was remarkably decreased in both of the groups at 1 and 3 years (P < 0.01) but showed no significant difference at 5 years after treatment as compared with the baseline (P > 0.05) or between the two groups before and after treatment (P > 0.05). The progression-free survival was obviously longer in the BT+MAB than in the MAB group (［37.29 ± 15.73］ vs ［29.41 ± 14.37］ mo, P = 0.011), and the rates of 3- and 5-year overall survival were higher in the former than in the latter (74.60% and 60.70% vs 62.60% and 51.50%, P = 0.227 and P = 0.356). Kaplan-Meier survival curves showed no statistically significant difference in the overall survival between the two groups (P = 0.105).

CONCLUSIONS

Both MAB and BT+MAB are effective therapies for mPCa, but the latter can achieve a longer progression-free survival.

Effects of remote ischemic preconditioning on astrocyte proliferation and glial scars after cerebral infarction

The aim of this study was to investigate whether remote ischemic preconditioning (RIPC) can promote neurological function recovery after middle cerebral artery occlusion (MCAO) in rats and its possible mechanism. A total of 32 Sprague Dawley (SD) rats were randomly divided into RIPC group (n = 16) and MCAO group (n = 16). In the RIPC group, 1 h before induction of MCAO, the rats received bilateral femoral artery ischemic preconditioning (10 min/time), followed by 10 min of relaxation, and a total of three cycles were carried out. Then, the MCAO-2h model was established. In the MCAO group, the MCAO-2h model was established at 1 h after the separation of bilateral femoral arteries. The modified neurological severity score (mNSS) was assessed. At postmodeling day 7, triphenyltetrazolium chloride (TTC) staining and immunohistochemistry were conducted, and neurological function recovery, infarct size, and the expression levels of glial fibrillary acidic protein (GFAP), synaptophysin (SYN), and neurite outgrowth inhibitor A (Nogo-A) were observed. At postmodeling day 7, the difference in mNSS was statistically significant ( P < 0.05). Infarct size was significantly smaller in the RIPC group than in the MCAO group ( P < 0.05). The number of GFAP+ cells was significantly lesser in the RIPC group than in the MCAO group ( P < 0.05). The difference in thickness of the glial scar was not statistically significant ( P = 0.091). At postmodeling day 7, the expression level of SYN integrated optical density (IOD) was significantly higher in the RIPC group than in the MCAO group ( P < 0.05). The number of Nogo-A+ cells was significantly lesser in the RIPC group than in the MCAO group ( P < 0.05). At day 7 after MCAO, RIPC can promote neurological function recovery in rats and reduce infarct size. The mechanism may be that after 7 days, RIPC reduces GFAP expression, inhibits the trend of glial scar formation and Nogo-A expression, and increases SYN expression.

Effect of glycated hemoglobin index and mean arterial pressure on acute ischemic stroke prognosis after intravenous thrombolysis with recombinant tissue plasminogen activator

To determine whether glycated hemoglobin and mean arterial pressure (MAP) during thrombolysis are prognostic factors of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke (AIS).A total of 125 AIS patients, who received rt-PA intravenous thrombolysis in our hospital, were included into the present study, and divided into good prognosis group and poor prognosis group. Univariate and multivariate logistic regression analyses were used to determine the prognostic factors of AIS treated by rt-PA thrombolysis, Spearman correlation analysis was used to analyze the correlation of the accumulated cigarette consumption in the smoking subgroup and glycated hemoglobin in the diabetic subgroup with the prognosis after intravenous thrombolysis and the symptomatic intracranial hemorrhage (sICH).Univariate analysis revealed that the interval from onset to thrombolysis, baseline National Institutes of Health Stroke Scale (NIHSS) score, MAP during thrombolysis and DRAGON score were prognostic factors. Multivariate logistic regression analysis revealed that baseline NIHSS score and MAP during thrombolysis were independent prognostic factors for rt-PA thrombolysis. Furthermore, the glycated hemoglobin index was positively correlated with the incidence of sICH.The NIHSS score before thrombolysis and MAP during thrombolysis were independent factors for the prognosis of AIS treated by thrombolysis. The higher the glycated hemoglobin index of diabetic patients, the more likely they are to develop sICH, the glycated hemoglobin index was negatively correlated with the prognosis after intravenous thrombolysis. The accumulated cigarette consumption was negatively correlated with the prognosis after intravenous thrombolysis.

Relationship of atopic dermatitis with stroke and myocardial infarction: A meta-analysis

BACKGROUND

Lots of previous reports have suggested a potential association of atopic dermatitis (AD) with stroke and myocardial infarction (MI). However, the result is still controversial, Consequently, we conducted this meta-analysis to estimate the relationship of AD with Stroke and MI.

METHODS

PubMed, Embase, and Web of Science databases were searched from inception to June 2018. Stroke and MI were considered as a composite endpoint. We calculated pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup and sensitivity analysis were performed to assess the potential sources of heterogeneity of the pooled estimation.

RESULTS

A total of 12 articles with 15 studies involving 3,701,199 participants were included in this meta-analysis. Of these, 14 studies on stroke and 12 on MI. Pooled analysis showed participants with AD experienced a significant increased risk of stroke (combined HR, 1.15; 95% CI, 1.08-1.22; P = .000) and MI (combined HR, 1.13; 95% CI, 1.02-1.24; P = .014), compared with participants without AD. The risk of stroke and MI was significant both in male subjects (stroke: HR: 1.33, 95% CI: 1.14-1.56; MI: HR: 2.01, 95% CI: 1.31-3.08), but not in female subjects (HR: 1.02, 95% CI: 0.77-1.35; MI: HR: 0.98, 95% CI: 0.72-1.32). The results were more pronounced for ischemic stroke (HR: 1.16, 95% CI: 1.13-1.19) in the stratified with stroke type. Stratifying by AD type, the risk of stroke was significant in severe AD (HR: 1.29, 95% CI: 1.08-1.54) and moderate AD (HR: 1.11, 95% CI: 1.01-1.22) for MI.

CONCLUSIONS

AD is independently associated with an increased risk of stroke and MI, especially in male subjects and ischemic stroke and the risk is associated with the severity of AD.

A mathematical prediction model incorporating molecular subtype for risk of non-sentinel lymph node metastasis in sentinel lymph node-positive breast cancer patients: a retrospective analysis and nomogram development

BACKGROUND

Molecular subtype of breast cancer is associated with sentinel lymph node status. We sought to establish a mathematical prediction model that included breast cancer molecular subtype for risk of positive non-sentinel lymph nodes in breast cancer patients with sentinel lymph node metastasis and further validate the model in a separate validation cohort.

METHODS

We reviewed the clinicopathologic data of breast cancer patients with sentinel lymph node metastasis who underwent axillary lymph node dissection between June 16, 2014 and November 16, 2017 at our hospital. Sentinel lymph node biopsy was performed and patients with pathologically proven sentinel lymph node metastasis underwent axillary lymph node dissection. Independent risks for non-sentinel lymph node metastasis were assessed in a training cohort by multivariate analysis and incorporated into a mathematical prediction model. The model was further validated in a separate validation cohort, and a nomogram was developed and evaluated for diagnostic performance in predicting the risk of non-sentinel lymph node metastasis. Moreover, we assessed the performance of five different models in predicting non-sentinel lymph node metastasis in training cohort.

RESULTS

Totally, 495 cases were eligible for the study, including 291 patients in the training cohort and 204 in the validation cohort. Non-sentinel lymph node metastasis was observed in 33.3% (97/291) patients in the training cohort. The AUC of MSKCC, Tenon, MDA, Ljubljana, and Louisville models in training cohort were 0.7613, 0.7142, 0.7076, 0.7483, and 0.671, respectively. Multivariate regression analysis indicated that tumor size (OR = 1.439; 95% CI 1.025-2.021; P = 0.036), sentinel lymph node macro-metastasis versus micro-metastasis (OR = 5.063; 95% CI 1.111-23.074; P = 0.036), the number of positive sentinel lymph nodes (OR = 2.583, 95% CI 1.714-3.892; P < 0.001), and the number of negative sentinel lymph nodes (OR = 0.686, 95% CI 0.575-0.817; P < 0.001) were independent statistically significant predictors of non-sentinel lymph node metastasis. Furthermore, luminal B (OR = 3.311, 95% CI 1.593-6.884; P = 0.001) and HER2 overexpression (OR = 4.308, 95% CI 1.097-16.912; P = 0.036) were independent and statistically significant predictor of non-sentinel lymph node metastasis versus luminal A. A regression model based on the results of multivariate analysis was established to predict the risk of non-sentinel lymph node metastasis, which had an AUC of 0.8188. The model was validated in the validation cohort and showed excellent diagnostic performance.

CONCLUSIONS

The mathematical prediction model that incorporates five variables including breast cancer molecular subtype demonstrates excellent diagnostic performance in assessing the risk of non-sentinel lymph node metastasis in sentinel lymph node-positive patients. The prediction model could be of help surgeons in evaluating the risk of non-sentinel lymph node involvement for breast cancer patients; however, the model requires further validation in prospective studies.

[Laparoscopic excision of seminal vesicle cyst]

OBJECTIVE

To investigate the method and clinical efficacy of laparoscopic excision of seminal vesicle cyst.

METHODS

Laparoscopic excision of seminal vesicle cyst was performed under general anaesthesia in two patients with symptomatic seminal vesicle cyst confirmed by ultrasonography and CT scanning preoperatively. The sizes of the seminal vesicle cysts were 3.3 cm x 3.7 cm x 2.5 cm and 4.1 cm x 4.3 cm x 5.3 cm, respectively.

RESULTS

The operations were performed successfully in both the patients, with the operation time of 140 min and 100 min, blood loss of 50 ml and 20 ml, and postoperative stay of 6 days. The patients were followed up for 6 and 7 months, respectively. All the preoperative symptoms disappeared, and no complications and recurrence were found.

CONCLUSION

Laparoscopic excision of seminal vesicle cyst, with a good visual field, refined procedure, minimal invasiveness and rapid recovery, is a safe and effective surgical option for patients with seminal vesicle cyst.

Association of susceptibility to multiple sclerosis in Southern Han Chinese with HLA-DRB1, -DPB1 alleles and DRB1-DPB1 haplotypes: distinct from other populations

Association of HLA class II with multiple sclerosis (MS) has been widely studied in both Western and Oriental populations. However, such an association is not well documented in Chinese. The objective of this study was to examine the association between the susceptibility to conventional MS in Southern Chinese with HLA-DRB1,-DPB1 alleles and putative DRB1-DPB1 haplotypes. Genotyping of HLA-DRB1 and -DPB1 alleles was performed in 60 patients with conventional MS and 95 controls. Allele frequencies were compared between patients and controls to identify MSassociated alleles. Relative predisposing effect method was used to compare haplotype frequencies in patients and controls and to identify possible predisposing DRB1-DPB1 haplotypes, which were further examined for differences in haplotype carriage rates between the two groups. We found that the allele frequency of DRB1*1501 was not different between patients (18.3%) and controls (21.1%) ( p = 0.837). In contrast, frequency of the DPB1*0501 allele was significantly higher in patients (90%) than in controls (67.4%) (odds ratio = 4.36, p = 0.0013, pcorr = 0.025). DRB1-DPB1 linkage haplotype in patients (8.33%) was significantly higher than in controls (0%) ( p < 0.0001) and the carriage rate of this haplotype was significantly increased in patients (15%) as compared with controls (0%) ( p = 0.00013, pcorr = 0.003). Combined, these results suggest that HLA-DRB1*1501 is not associated with susceptibility to conventional MS in Southern Chinese. Instead, both the DPB1*0501 allele and the DRB1*1602- DPB1*0501 haplotype are strong predisposing factors for conventional MS in this population. Our results establish that the HLA profiles of MS in Southern Chinese are distinct from other populations.

[Relationship between the expression of matrix metalloproteinase-13 protein and other biomarkers, prognosis in invasive breast cancer]

OBJECTIVE

The study was designed to investigate the expression patterns of metalloproteinase (MMP)-13 protein in invasive breast carcinoma and to determine the clinicopathological and prognostic values of its various localization and relation to the tumor phenotypes.

METHODS

Immunohistochemistry was performed on paraffin-embedded tissue array from 263 invasive breast carcinomas to investigate the protein expressions of MMP-13, estrogen receptor, progesterone receptor, HER2, MMP-2, MMP-9 and tissue inhibitor of matrix metalloproteinases (TIMP)-1, TIMP-2.

RESULTS

MMP-13 protein was detected in the cytoplasm of carcinoma cells and peritumoral fibroblasts. High level expression of MMP-13 protein in tumor cells was associated with more lymph node involvement and higher tumor grade (both P < 0.01), and positively correlated with HER2 (P = 0.015) and TIMP-1 protein (P < 0.01) expression in carcinoma cells. Moreover, high expression of MMP-13 was associated with shortened overall survival for the entire patient population and the patient group with positive lymph node. Tumor cell derived MMP-13 had different impact on patients with different HER2 status. Peritumoral fibroblasts derived MMP-13 protein, although correlated with tumor cell derived MMP-13 and associated with lymph node stage and HER2 expression, was found having less prognostic impact. Univariate survival analysis showed that the tumor size, grade, lymph node status, PR status, HER2 expression, tumors TIMP-1 and MMP-13 expression were prognostic factors. However, multivariate survival analysis showed that only tumor size, lymph node status, HER2 expression, tumors TIMP-1 and MMP-13 were independent prognostic factors.

CONCLUSION

MMP-13 protein expressed by tumor cells correlates with the invasion and metastasis of breast carcinoma, and therefore, may serve as a poor prognostic marker for the patient.

Overexpression of Ets-like protein 1 in human esophageal squamous cell carcinoma

AIM: To study the expression pattern of Ets-like protein 1 (Elk-1) in human esophageal squamous cell carcinoma (ESCC) and to analyze its relationship with clinicopathologic parameters.

METHODS: The expression of Elk-1 in fresh esophageal cancer tissues and their corresponding normal mucosae was detected immunohistochemically (IHC) by means of tissue microarray (TMA). Its correlation with clinical characteristics was evaluated and analyzed by univariate analysis. All statistical analyses were performed by SPSS version 13.0.

RESULTS: Expression level of transcription factor Elk-1 increased in 78.5% (84/107) ESCC tissues compared with their matched normal esophageal epithelium. However, the expression of Elk-1 did not show any obvious correlation with degree of differentiation of esophageal carcinoma (in well-differentiated, moderately-differentiated and poorly-differentiated tumors, the increased expression was 7/8, 60/74, and 19/25, respectively, P > 0.05). Moreover, no obvious correlation was found with lymph node metastasis and depth of invasion.

CONCLUSION: Increased expression of transcription factor Elk-1 may play an important role in esophageal carcinogenesis.

Functional studies of a novel oncogene TGM3 in human esophageal squamous cell carcinoma

AIM: To investigate the role of transglutaminase 3 (TGM3) gene in human esophageal squamous cell carcinoma (ESCC), and analyze its relationship with clinicopathological parameters.

METHODS: Gene expression of TGM3 in fresh esophageal cancer tissues and their corresponding normal mucosas was detected immunohistochemically(IHC) by means of tissue microarray(TMA). Its correlation with clinical characteristics was evaluated and analyzed by univariate analysis. All statistical analyses were performed by SPSS version 10.0.

RESULTS: Expression rate of TGM3 was reduced to 81.8% in ESCC. Expression of TGM3 was significantly inversely correlated with histological grade of esophageal carcinoma (in grade I, II and III tumors, the reduced expression was 4/7, 57/71, and 20/21, respectively, P < 0.05), whereas it had no obvious correlations with lymph node metastasis and depth of invasion.

CONCLUSION: Reduced expression of TGM3 may play an important role in esophageal carcinogenesis.

[Changes in plasma levels of LPS, TNFalpha and IL-6 in burn patients with severe infection treated with Imipenem or Cefoperazone]

OBJECTIVE

To observe the changes in plasma levels of lipopolysaccharide (LPS), tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) in burn patients with severe infection treated with Imipenem or Cefoperazone.

METHODS

Thirteen severe burn patients infected with gram negative bacilli were enrolled in the study in which 7 were treated with IPM and 6 with CPZ. Venous blood samples were harvested before and 2, 12, 24, 48 and 72 hours after the use of antibiotic for the determination of the plasma levels of LPS, TNF-alpha and IL-6, and correlative analysis was carried out among all the factors in regard to their changes.

RESULTS

The plasma levels of LPS in both groups were elevated 2 hours after the injection of either antibiotic, but it was more obvious in patients with CPZ when compared with that before treatment (13.95 +/- 5.44 pg/ml), and the levels were much higher than that after IPM (P < 0.05). The plasma LPS level declined thereafter. The plasma TNF-alpha level in CPZ group was 0.86 +/- 0.16 ng/ml at 2 hours after the use of antibiotic, and it was much higher than that before the use of the drug, and it was higher compared with IPM group. (P < 0.01). But there was no change in the plasma IL-6 level in all the patients at all the time points before and after the use of either drug. The plasma TNF-alpha levels in the two groups were positively correlated with the plasma levels of LPS and IL-6.

CONCLUSION

The release of LPS and TNF-alpha from bacteria could be induced by the administration of different kinds of antibiotics in the management of burn patients infected by gram negative bacilli in different releasing amounts. And the TNF-alpha production was correlated with the release of LPS and IL-6.

Changes in adenine nucleotide, SOD and MDA contents and mitochondria ulteractructure during diaphragm fatigue in dogs induced by diaphragm pacing

OBJECTIVE: To explore the possible mechanisms for the occurrence of diaphragm fatigue induced by diaphragm pacing. METHODS: The phrenic nerve of 8 dogs were exposed and subjected to stimulation with electric pulses emitted by a diaphragm pacemaker to induce diaphragm fatigue models, and the contents of ATP, ADP, AMP and AXP in the diaphragm muscles before and after diaphragm pacing were determined by high-performance liquid chromatography (HPLC). The contents of SOD and MDA were also measured and the morphological alteration of the mitochondria observed with transmission electron microscope. RESULTS: The contents of ATP, ADP, AXP and SOD were found significantly lower but MDA was higher during fatigue than those in normal conditions, while AMP content manifested no obvious change. Some mitochondria in the diaphragm muscles swelled and in a few cases, vacuolar degeneration was observed. CONCLUSIONS: The exhaustion and synthesis disturbance of ATP may explain the generation of diaphragm fatigue, and the reduction of dynamophore and ultrastructural injuries of the cells induced by oxygen free radicals may also contribute to this result.

Effect of glutathione deficiency on the adipocyte sn-glycerol-3-phosphate acyltransferase

The present study investigates the effects of various glutathione (GSH) depleting agents on sn-glycerol-3-phosphate acyltransferase (GPAT) activity, the first committed step in adipose triacylglycerol formation. GPAT activity was measured in the presence of [14C]glycerol-3-phosphate and palmitoyl-CoA, using different subcellular fractions. Glutathione deficiency in animals was induced in the presence of diethylmaleate (DEM) or buthionine sulfoximine. In this respect, DEM (1.75 mmoles/kg) was more effective and caused over 75% decrease in GPAT activity within 4 h of DEM administration. Further studies indicated that this decrease in GPAT activity was mainly related to the microsomal form of GPAT, without any significant effect on mitochondrial GPAT activity. Adipocytes incubated with 2.5 mm DEM for 1 h at 37 degrees C also showed a reduction in the adipocyte glutathione content, which was accompanied by decreases in GPAT activity. The effect of DEM on adipocyte GPAT activity was partially reversible in the presence of cell permeable glutathione ethyl ester. Preincubation of adipose tissue homogenates with 2.5 mM DEM at 30 degrees C for 45 min also showed a significant loss of the GPAT activity. The presence of 5 mM dithiothreitol in the preincubation mixture offered a significant protection of the GPAT activity against DEM. However, glutathione was ineffective in this respect as it interfered with the utilization of palmitoyl-CoA in the GPAT assay. Therefore, on the basis of these three different approaches, the present studies suggest that the thiol environment offered by glutathione (in vivo and in vitro studies) or dithiothreitol (in a cell-free system) is critical for the maintenance of GPAT activity.

Effect of glutathione deficiency on the adipocyte Mg(2+)-dependent phosphatidate phosphohydrolase

Previous studies from this laboratory [Jamdar S. C. and Cao W. F. (1994) Biochem. J. 301, 793-799] show that the adipocyte Mg(2+)-dependent phosphatidate phosphohydrolase (MGPPH), a major regulatory enzyme in adipose triacylglycerol metabolism, requires an active thiol group for its activity and perturbation of this group results in the loss of enzyme activity. Since glutathione (GSH) is important in maintaining the intracellular thiol state, we have used GSH-deficient animals and adipocytes to test the possibility that intracellular GSH concentration is critical in controlling the MGPPH activity. The MGPPH was measured in the presence of aqueous dispersed phosphatidate, and the release of P1 was taken as a measure of enzyme activity. The GSH deficiency in animals and isolated adipocytes was produced in the presence of diethylmaleate (DEM) or buthionine sulfoximine (BSO). Intraperitoneal administration of BSO into animals (3 mmoles/kg) showed 10-25% reduction in the blood and adipose GSH and 25% decline in the adipose MGPPH activity. However, DEM (0.3 ml/kg) was more effective and caused over 70% reduction of the blood and adipose tissue GSH content and 75% decline in the adipose MGPPH activity within 4 hr of drug administration. After 24 hr, these values returned to normal. Adipocytes incubated with 2.5 mM DEM for 60 min at 37 degrees C also showed a significant reduction in the GSH content and the MGPPH activity present in the cytosol and membrane fractions. The loss of membrane MGPPH was associated with decreased rates of triacylglycerol formation from [14C]palmitate. Pre-incubation of adipocyte homogenates with 1 mM DEM also resulted in > 90% decline in the MGPPH activity, which was preventable in the presence of GSH and dithiothreitol. Therefore, these studies suggest that the sulfhydryl environment offered by glutathione is critical for the maintenance of adipocyte MGPPH activity.

Relationship between adipose polyamine concentrations and triacylglycerol synthetic enzymes in lean and obese Zucker rats

Previous studies from our laboratory demonstrate that polyamines, namely spermine and spermidine, stimulate adipose triacylglycerol formation from the sn-glycerol-3-phosphate pathway by activation of several enzymes from this pathway, including sn-glycerol-3-phosphate acyltransferase, Mg(2+)-dependent phosphatidate phosphohydrolase and diacylglycerol acyltransferase. Since obesity in Zucker rats was associated with increased accumulation of adipocyte triacylglycerols, we have examined the relationship between changes in the activities of various triacylglycerol synthetic enzymes and the endogenous concentrations of spermine and spermidine in the adipose tissues from lean and obese animals. As compared with lean rats, the adipocytes from obese rats showed a 4-fold rise in the concentration of spermine and spermidine which was accompanied by 4- to 14-fold increases in the activities of various triacylglycerol synthetic enzymes, including Mg(2+)-dependent phosphatidate phosphohydrolase. These studies suggest that obesity in Zucker rats is associated with the activation of various adipose triacylglycerol synthetic enzymes resulting from increased concentrations of endogenous spermine and spermidine.

Triacylglycerol biosynthetic enzymes in lean and obese Zucker rats

In the present investigation, we have compared the potential of triacylglycerol formation from sn-glycerol-3-phosphate (GP) and 2-monoacylglycerol (MG) in liver, adipose tissue and intestine from lean and obese Zucker rats. Microsomal fractions were used to measure the sn-glycerol-3-phosphate acyltransferase (GPAT), diacylglycerol acyltransferase (DGAT) and monoacylglycerol acyltransferase (MGAT) activities and homogenates were used to measure NEM-sensitive and NEM-insensitive phosphatidate phosphohydrolase (PPH) activities. In adipose tissue and liver, the GP pathway served as the major route of glycerolipid formation, with adipose tissue being 5-20-fold more active. The activities of the GP pathway enzymes increased further in response to obesity, with some degree of organ specificity. In adipose tissue of obese rats, the activities of all the pathway enzymes increased; whereas, in liver and intestine, this response was limited to PPH and GPAT, respectively. In contrast with the GP pathway enzymes, obesity in Zucker rats was not associated with alterations in the acylation of 2-monoacylglycerol. Comparison of the activities of MGAT in different intestinal segments indicated that the MG pathway was most active in the jejunum and least active in the ileum and that this pattern did not change in response to obesity. These measurements of the individual enzyme reactions provide evidence that the entire process of esterification via sn-glycerol-3-phosphate is accelerated in the various organs from obese rats and that this perturbation in lipid metabolism may contribute significantly to the increased deposition of body fat noted in this animal model.

Properties of phosphatidate phosphohydrolase in rat adipose tissue

Previously we have identified the presence of two different phosphatidate phosphohydrolase (PPH) activities in rat adipose tissue, based on Mg(2+)-dependency. In the present investigation, we have further characterized these isoenzymes, using both aqueous dispersed and membrane-bound phosphatidate as substrates and differentiated these activities on the basis of both Mg(2+)-dependency and N-ethylmaleimide (NEM)-sensitivity. These two distinguishing criteria gave identical estimates of PPH activities present in the different subcellular fractions. The microsomal and cytosol fractions contained mainly the Mg(2+)-dependent (NEM-sensitive) form, which was inhibited by various thiol reagents, was inactivated by heating at 55 degrees C for 20 min, and was decreased significantly within 2 h after intraperitoneal administration of cystamine (200 mg/kg). Such treatments had no effects on the Mg(2+)-independent (NEM-insensitive) form of PPH, which was mainly located in the plasma membranes, mitochondrial and microsomal fractions. Addition of Lipid A and guanosine 5'-[gamma-thio]triphosphate to the assay mixture had no effect on the PPH activities. The Mg(2+)-independent PPH form, which was thermostable in the intact subcellular fractions, became thermolabile when these fractions were disrupted in the presence of Triton X-100. The present studies demonstrate that: (1) the thermostability is not a satisfactory index to differentiate these isoenzymes; (2) the thiol/disulphide exchange may be involved in the regulation of Mg(2+)-dependent PPH activity; and (3) the PPH isoenzymes do not seem to be under G-protein control in adipose tissue, as reported previously in the mesangial cell line.

Adipose glycerolipid formation: effect of nutritional and hormonal states

The potential of glycerolipid formation from sn-glycerol-3-phosphate (GP) and 2-monoacylglycerol (MG) was studied in adipose microsomal fractions under various nutritional and hormonal states. Glycerolipid formation from GP was followed in the presence of [14C]glycerol-3-phosphate and palmitoyl-CoA and was assayed by measuring the formation of butanol-soluble product, consisting mainly of [14C]phosphatidate. Glycerolipid formation from MG was determined in the presence of 2-mono-oleyl glycerol and [14C]palmitoyl-CoA, and was estimated by the formation of both [14C]di- and triacylglycerol. Glycerolipid formation from GP was decreased significantly during food deprivation, in experimental diabetes, in the presence of lipolytic hormone, and during aging. Glycerolipid formation from MG did not change under these conditions and continued at the same rate as observed in control animals. The rate of glycerolipid formation from GP was 7-20 times greater than from MG in the various fat depots. Measurement of the adipose monoacylglycerol concentration did not show any correlation with the glycerolipid formation from MG. The studies suggest that glycerolipid formation from MG is active in various fat depots, and is substantial when glycerolipid formation via GP is impaired.

Properties of monoglycerol acyltransferase in rat adipocytes

Previous studies by Coleman and Haynes (1986, J. Biol. Chem. 261, 224-228) indicated the presence of two different tissue specific monoacylglycerol acyltransferases (MGAT) in intestinal mucosa and suckling rat liver. The evidence was based upon the differential responses of these two isoenzymes to various treatments including, the effects of temperature, proteolysis, protein modification reagents, detergents, and divalent cations. In the present investigation, we have used some of these criteria to determine the identity of adipose enzyme with the MGAT present in liver and intestinal microsomes. The properties of adipose and intestinal enzymes were similar in several respects, but differed from the liver enzyme. This suggests the possibility that MGAT activities from adipose and intestine may be mediated by the same enzyme protein, whereas the liver MGAT may be a separate isoenzyme as proposed earlier. The most distinguishing feature of the liver enzyme was its ability to sustain both high temperature (52 degrees C) and resist proteolysis. However, when disrupted microsomal preparations were used, the liver enzyme was both thermolabile and protease sensitive, as observed for the intestinal and adipose MGAT. Possibly, the location of liver MGAT within the membranes may be responsible for such unique properties of liver MGAT.