[Analysis of glucose changes in adults with type 1 diabetes mellitus within 1 year after using mobile APP decision support system]

Objective: To analyze the changes in glucose after using a decision support system (DSS) of a smartphone mobile application (APP) in adults with type 1 diabetes mellitus (T1DM). Methods: In the intervention study, the data (including general information at the time of registration) of adult T1DM patients enrolled in the Chinese T1DM Registration Management Project and registered with TangTangQuan® APP were collected. Within 1 year after registration, fasting blood glucose, pre-prandial and postprandial blood glucose at the three meals, blood glucose before bedtime and in nocturnal time were collected every 3 months. Frequencies of total recorded glucose values and proportion of different ranges of glycemia were also collected and analyzed, including the range between 3.9-7.8 mmol/L (Euglycemia), ranged below 3.9 mmol/L (Hypoglycemia) and range above 13.9 mmol/L (hyperglycemia). The patients were divided into 3 groups according to the daily use frequency of DSS (Low/Moderate/High frequency groups). The changes in point blood glucose, the proportion of hyperglycemia and hypoglycemia over time were compared among different groups, as well as the baseline characteristics and glucose characteristics of patients. Results: A total of 629 eligible T1DM patients were included, including 216 (34.3%) males and 413 (65.7%) females, aged (31.5±10.8) years, and disease duration [M(Q₁, Q₃)] of 1.2 (0.1, 7.4) years. There were 239, 189 and 201 patients in the low, moderate and high frequency groups, respectively. Significant differences were observed among the three groups in all timepoints of self-monitoring blood glucose except for the glucose before bedtime from 10 to 12 months after registration (all P values<0.05), and the glucose level at each point in the high frequency group was lower than that in the other two groups. In the first three months after registration, there was no difference in the proportion of hypoglycemia among the three groups (P>0.05). However, from 10 to 12 months after registration, the proportion [M(Q₁, Q₃)] of hypoglycemia [3.34% (0.85%, 7.40%), 3.00% (0.78%, 6.17%), 1.81% (0.37%, 4.69%)] (P=0.022) between groups (from low to high frequency groups) and hyperglycemia [4.04% (0, 12.16%), 1.88% (0, 7.80%), 0.81% (0, 3.87%)] (P=0.001) were significantly different. Conclusions: The DSS function of mobile APP is helpful to the glucose management of adult patients with T1DM within 1 year after registration. The average blood glucose in adults with T1DM decreased, and the proportions of hyperglycemia and hypoglycemia were also reduced.

[The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020)]

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

lncRNA SNHG3 accelerates the proliferation and invasion of non-small cell lung cancer by downregulating miR-340-5p

Small nucleolar RNA host genes (SNHGs) as a subset of long non-coding RNAs (lncRNAs) act critical roles in tumor progression. The present study aimed to elucidate the role and mechanisms of SNHG3 in non-small cell lung cancer (NSCLC). The correlation of SNHG3/miR-340-5p/HOXA10 with the clinicopathological features and outcomes in NSCLC was analyzed by TCGA cohort. In vitro and in vivo functional experiments were conducted to assess the role of SNHG3 in NSCLC cells. Bioinformatic analysis and luciferase gene reporter were used to estimate the interaction between miR-340-5p and SNHG3/HOXA10 3'UTR. The effects of SNHG3 and (or) miR-340-5p on HOXA10 expression were detected by qRT-PCR and Western blot analysis. As a consequence, the elevated expression of SNHG3 and HOXA10 or lowered expression of miR-340-5p was related to the lymph node infiltration, distant metastases and unfavorable prognosis in NSCLC. Ectopic expression of SNHG3 boosted the proliferation and invasion of NSCLC cells in vitro and in vivo, whereas downregulation of SNHG3 reversed these effects. Moreover, SNHG3 could bind with miR-340-5p and reduce its expression levels, and miR-340-5p attenuated SNHG3-induced tumor proliferation and HOXA10 expression in NSCLC cells. Our findings unveiled that SNHG3 might be an oncogenic factor in NSCLC by downregulating miR-340-5p.

Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy

BACKGROUND

Pancreatic fistula is one of the most serious complications after pancreatoduodenectomy for treating any lesions at the pancreatic head. For years, surgeons have tried various methods to reduce its incidence.

AIM

To investigate and emphasize the clinical outcomes of Blumgart anastomosis compared with traditional anastomosis in reducing postoperative pancreatic fistula.

METHODS

In this observational study, a retrospective analysis of 291 patients who underwent pancreatoduodenectomy, including Blumgart anastomosis (201 patients) and traditional embedded pancreaticojejunostomy (90 patients), was performed in our hospital. The preoperative and perioperative courses and long-term follow-up status were analyzed to compare the advantages and disadvantages of the two methods. Moreover, 291 patients were then separated by the severity of postoperative pancreatic fistula, and two methods of pancreaticojejunostomy were compared to detect the features of different anastomosis. Six experienced surgeons were involved and all of them were proficient in both surgical techniques.

RESULTS

The characteristics of the patients in the two groups showed no significant differences, nor the preoperative information and pathological diagnoses. The operative time was significantly shorter in the Blumgart group (343.5 ± 23.0 vs 450.0 ± 40.1 min, P = 0.028), as well as the duration of pancreaticojejunostomy drainage tube placement and postoperative hospital stay (12.7 ± 0.9 d vs 17.4 ± 1.8 d, P = 0.031; and 21.9 ± 1.3 d vs 28.9 ± 1.3 d, P = 0.020, respectively). The overall complications after surgery were much less in the Blumgart group than in the embedded group (11.9% vs 26.7%, P = 0.002). Patients who underwent Blumgart anastomosis would suffer less from severe pancreatic fistula (71.9% vs 50.0%, P = 0.006), and this pancreaticojejunostomy procedure did not have worse influences on long-term complications and life quality. Thus, Blumgart anastomosis is a feasible pancreaticojejunostomy procedure in pancreatoduodenectomy surgery. It is safe in causing less postoperative complications, especially pancreatic fistula, and thus shortens the hospitalization duration.

CONCLUSION

Surgical method should be a key factor in reducing pancreatic fistula, and Blumgart anastomosis needs further promotion.

[The effect of para-aortic lymph node metastasis on the resectability of pancreatic cancer]

Pancreatic cancer has poor prognosis and lymph node metastasis is a poor prognostic factor in patients with resectable pancreatic cancer. The metastatic prevalence of para-aortic lymph node (PALN) ranges from 9.1% to 26.5% and it is listed as the distant metastatic group in pancreatic cancer. Nevertheless, it is controversial whether PALN metastasis is the contraindication of surgery in resectable pancreatic cancer for the shortage of level Ⅰ evidence.This study concluded that PALN metastasis indicated poor prognosis in patients with pancreatic cancer, but some patients with PALN metastases could benefit from surgery and their survival could be much improved after the combination of surgery and adjuvant therapy. Therefore, it is not wise to refuse surgery for all pancreatic cancer patients with PALN metastasis and the clinicians can cautiously choose the patients to do surgery. Besides, there are mainly retrospective studies rather than prospective and multicenter studies to explore the prognosis of pancreatic cancer patients with PALN metastasis. Thus, more prospective and multicenter studies are needed to decide whether PALN metastasis is an independent prognostic factor in patients with resectable pancreatic cancer.

[Current diagnosis and treatment progress of small pancreatic neuroendocrine neoplasm]

Small(≤2 cm)pancreatic neuroendocrine neoplasm(pNEN) is a very special subgroup of pNEN featuring a small size, concealed pathogenesis, indolent course and remarkable heterogeneity.Differences in its diagnosis and interventional criteria have evolved from routine pNEN.During recent years, the incidence of small pNEN has increased sharply, while optimal management strategy of this subgroup still remains controversial.In this paper, the biological characteristics, pathological classification, diagnosis, intervention indication and therapeutic principles of small pNEN are reviewed based on recent researches, and current situations of diagnosis and treatment of small pNEN are summarized.

[Clinical observation on the treatment of periprosthetic infection of coagulase-negative staphylococci by two-stage revision]

OBJECTIVE

To investigate the risk factors for the failure in treating periprosthetic infection of coagulase-negative staphylococci by two-stage revision.

METHODS

From January 2005 to June 2015, 57 patients with periprosthetic hip and knee joint infection of coagulase-negative staphylococcus by two-stage revision were retrospectively reviewed with an average age of (61.3±11.9) years old. According to the drug resistance of methicillin, the patients were divided into methicillin sensitive group(MSCoN) and methicillin resistance(MRCoN) group, 25 cases in MSCoN group(9 knees and 16 hips) included 12 males and 13 females, 32 cases in MRCoN group(11 knees and 21 hips) included 14 males and 18 females. Follow-up for at least 2 years, the inflammatory markers, incidence rate of sinus and the duration of the symptoms, reinfection or persistent infection rate after two-stage revision were compared between two groups.

RESULTS

MSCoN group and MRCoN group were followed up(81.7±38.3) months and(65.9±33.8) months, respectively;23 cases and 27 cases were successfully treated;there was no significant difference between two groups(P=0.643). The patients who had surgery history were 4.04 times higher of failure than the patients without a history of surgery[OR=4.04, 95%CI(0.62, 26.5)]. Patients who had sinus were 4.26 times higher of failure than the patients without sinus[OR=4.26, 95%CI(0.7, 25.9)].

CONCLUSIONS

Two-stage revision is an effective procedure in treating patients infected by MSCoN and MRCoN. There is no significant difference of treatment failure rate between MSCoN and MRCoN group by two-stage revision. Surgery history and sinus maybe the risk factors of treatment failure, while methicillin-resistance is not.

[Effect of ceramic on ceramic total hip arthroplasty in Crowe IV developmental dysplasia of the hip]

OBJECTIVE

To observe the clinical effect of ceramic on ceramic total hip arthroplasty(THA)in Crowe IV developmental dysplasia of the hip(DDH).

METHODS

From April 2008 to December 2015, 137 hips of 111 Crowe IV DDH patients received THA using Forte or Delta ceramic on ceramic by one senior surgeon, which consists of 85 unilateral hips and 26 bilateral hips. The average age of the patients was(38.88±10.83) years old ranging from 18 to 68 years old. The mean follow-up was(41.16±21.50) months ranging from 12 to 96 months. All the patients were evaluated by Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up. Harris scores, the incidence of complications such as ceramic fracture, squeaking, dislocation were observed.

RESULTS

The mean preoperative Harris score was 56.54±15.67, the mean postoperative Harris score was 88.30±6.86(P=0.017). Periprosthetic osteolysis was not deteced around any cup. No ceramic fracture occurred. There were 3 cases of revision surgery due to infection, losening of the stem and limb length discrepancy, respectively; 3 cases of dislocation occurred. Seventy-seven patients were recorded the gait and the hip mobility, the hip flexion of 69 patients were above 120 degrees.

CONCLUSIONS

Ceramic on ceramic bearing showed an encouraging result in Crowe IV DDH total hip arthroplasty.

[Effects of trabecular metal augments for the reconstruction of Paprosky type Ⅲ acetabulum bone defects]

Objective: To investigate the methods and short-time clinical results of reconstruction of Paprosky type Ⅲ acetabulum bone defects by using tantalum augments. Methods: A total of 17 patients (17 hips) with Paprosky type Ⅲ acetabulum bone defects, treated with tantalum augments in revision of total hip arthroplasty at Department of Orthopedics Surgery in General Hospital of Chinese People's Liberation Army were retrospectively analyzed from March 2014 to May 2016.There were 6 males and 11 females aged from 23 to 74 years with an average of (50.2±16.3) years. Tantalum augments or TM-Cup augment (the cup-on-cup technique) were used to reconstruct the defects.The TM-Cup augment was the tantalum revision cup which was removed titanium ring. The cup-on-cup technique combined TM-Cup augment and biological acetabulum cup. Augments were served as the nonresorptive structural allograft in revision of total hip arthroplasty. Harris hip score was used to evaluate clinical effects. The vertical position of the rotation center was measured and analyzed. Radiographic assessments of the acetabular components were performed by DeLee-Charnley and the Anderson criteria and recorded postoperative complications. Results: All the patients were followed up from 3 to 29 months with an average of (16.2±5.4) months, tantalum augments and biological acetabulum cup were used in 13 patients, the TM-Cup augment and biological acetabulum cup were used in 4 patients. At the time of the latest follow-up, the mean Harris hip score increased compared to preoperatively (86.8±8.3 vs. 30.0±12.0) (t=12.78, P<0.01), the average vertical location of the center of rotation was decreased ((25.3±9.8) mm vs.(47.6±10.5)) mm (t=4.95, P<0.01). All the tantalum augments and biological acetabulum cups were stable, there were no infection, dislocation and other complications. Conclusions: The use of tantalum augments could be considered as an effective management of Paprosky type Ⅲ defects providing good clinical and radiographic outcomes in the short term.The cup-on-cup technique which was used in reconstruction of severe superior-invagination acetabular bone defects and restoration relatively normal center of rotation had special application value.

[Mechanical complications with self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement]

OBJECTIVE

To study the complications and efficacy of self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement.

METHODS

Between January 2006 and July 2016, 265 patients (266 hips) received a self-made, antibiotic-loaded cement articulating spacer as part of a two-stage protocol. Among those patients, there were 143 males(144 hips) and 122 females(122 hips). The cement articulating spacers with vancomycin and two Steinman pins were made by a self-made mold system. Meanwhile, another antibiotic was added to the spacers according to the drug sensitivity test. Record if the infected prosthesis was removed, related complication with spacer(breakage and dislocation), Harris score, and control rate of infection.

RESULTS

The mean age of two-stage revision operation was(57.4±14.2) years. Thirty-nine patients(14.7%) used extended trochanteric osteotomy(ETO) to remove the infected prosthesis. And 38 patients occurred mentioned complications(14.3%). Spacer breakage occurred in 28 cases(10.5%) and dislocation occurred in 10 cases(3.8%). The mean follow-up time was(83.4±14.6) months. The Harris hip score was from 47.56±14.23 preoperatively to 86.43±12.84 at final follow-up(P<0.05). The infection of 256 cases(96.6%) got control after revision operation. However, during postoperative follow-up, 4 cases occurred re-infection, and they were reoperated, and the infections obtained effective control after the operation. Thus total infection control rate was 95.1%(252/265).

CONCLUSIONS

Antibiotic-loaded cement articulating spacer made by a self-made mold system is effective in controling infection caused by hip replacement. Related complication is less with spacer by a mould enclosing two Steinman pins. Using metallic internal fixation or allograft bone combined with spacer does not affect infection control.

Neuroprotective Lignans from the Fruits of Schisandra bicolor var. tuberculata

Nine new lignans (1-9) and ten known analogues (10-19) were isolated from the fruits of Schisandra bicolor var. tuberculata. The structures of compounds 1-9 were established on the basis of spectroscopic data analysis. The absolute configuration of compound 1 was determined by single-crystal X-ray diffraction analysis with Cu Kα irradiation techniques, and the absolute configurations of compounds 2-9 were deduced by comparing their experimental ECD spectra and optical rotations with those of compound 1 or similar compounds. All isolates were evaluated for their neuroprotective activities against CoCl₂, H₂O₂, and Aβ_25-35-induced SH-SY5Y cell injury, and were found to exhibit different degrees of neuroprotective effects. At a low concentration of 3.2 nM, compounds 3, 8, 9, and 14-19 in CoCl₂-induced, compounds 7, 8, 13, 17, and 18 in H₂O₂-induced, and compounds 2, 6, 7, 9, 10, and 12-19 in Aβ_25-35-induced SH-SY5Y cell injury models, showed statistically significant neuroprotective activities, when compared with each negative control group.

[Clinical results in early and mid term of using the S-ROM femoral stem in revision]

OBJECTIVE

To investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty.

METHODS

From January 2008 to January 2016, 21 patients received revision hip arthroplasties using S-ROM stems. There were 5 males and 16 females with an average of 48.33 years old(range, 29 to 73 years old). There were 13 cases caused by aseptic loosening, 4 cases by infection, 2 cases by nonunion of sub-tuberosity osteotomy, 1 case for repeated dislocation, 1 case for traumatic great trochanter fracture. Primary THA reasons:12 cases for DDH(9 cases for Crowe IV), 5 cases for femoral neck fracture, 2 cases for necrosis of femoral head, 2 cases for proximal femoral deformity caused by early infection. The femur bone defects included Paprosky II in 11 cases, IIIa in 9, and IIIb in 1. Harris hip score , pain score and hip flexion were recorded before and after operation. The subjective satisfaction was recorded at the last follow-up.

RESULTS

The operation time and blood loss were 189 min(125 to 290 min) and 867 ml (200 to 2 000 ml). At the final followup, the pain score improved from (17.14±9.56) points preoperatively to (41.71±2.03) points (t=11.42, P=0.00). The function score improved from (24.01±11.02) points preoperatively to (49.95±5.38) points (t=9.73, P=0.00). Harris hip score improved from (41.15±14.81) points preoperatively to(91.67±5.83) points(t=15.33, P=0.00). The degree of hip flexion increased from (93.10±27.27) points preoperatively to (121.90±16.62) points at the last follow-up (t=4.59, P=0.00). The mean subjective satisfaction was 9.48(10 points system), 14 of which were completely satisfactory. The last follow-up hip X-ray showed 21 cases of bone ingrowth, and other femoral stem without loosening or sinking sign significantly. There were 5 cases with bone anchor syndrome around proximal femoral cuff. There were 5 cases of proximal femur fracture, 3 cases of lesser trochanter fracture, 2 cases of greater trochanter fracture intra-operatively. Due to femoral canal stenosis, there were 4 cases of pre-tied wire at lesser trochanter to prevent fractures. There was 1 case of traumatic femoral fracture around stems with a distal oblique fracture, open reduction and locking plate fixation was performed. Other patients had no nerve stretch injury, dislocation, infection and lower limb deep vein thrombosis and other complications at the final follow-up.

CONCLUSIONS

S-ROM prosthesis has satisfactory results in hip revision arthroplasty with Paprosky II and III femoral defects. Especially for patients with Crowe IV DDH and other proximal femoral deformities, it is possible to adapt to the medullary cavity morphology. Excellent initial stability, less complications and long-term biological fixation can be achieved with S-ROM in femur revision.

Prophylactic Dual Catheter Technique to Prevent Side Branch Snowplowing Complications during Angioplasty and Stenting

Objective

Angioplasty and Stenting of intracranial atherosclerotic lesions have a higher complication rate and a large proportion of this is attributable to side branch arterial occlusion from forceful displacement of the atheroma into the ostia or snowplowing effect. This can result in severe disabilities when it result in small infarcts involving eloquent areas in the posterior circulation or the motor tracts.

Materials and Methods

We present a series of 6 cases utilizing a new dual catheter technique for maintaining the patency of at-risk vessels during angioplasty and stenting. There are several methods previously described to help reduce the incidence of stroke but because they do not have a physical presence in the ostia to protect it, they are unable to guarantee the patency of the vessel.

Results

All 6 patients underwent angioplasty and stenting with the technique. The patients were assessed for complications with post-procedure magnetic resonance imaging and no complications were found.

Conclusion

In this preliminary series, the dual catheter technique appears to safe and effective in preventing occlusion of the adjacent branch arteries. This technique may facilitate the use of the Wingspan stent in the treatment of intracranial atherosclerotic stenotic segments by reducing the risk of peri-procedural stroke.

[A clinical study of serum protein markers in patients with 1-bromopropane poisoning]

Objective: To investigate the changes in protein expression in patients with 1-bromopropane (1-BP) poisoning using high-throughput proteomic technique and to screen out protein markers. Methods: Serum samples were collected from 3 patients with 1-BP poisoning and 15 controls. The label-free proteomic tech-nique was used for the quantitation and identification of proteins expressed in these samples, and the results were compared between the patients with 1-BP poisoning and the control population. The bioinformatics tools were used to analyze the function of differentially expressed proteins. Results: Compared with the control popula-tion, the patients with 1-BP poisoning had >2-fold upregulation of 38 proteins and >2-fold downregulation of 68 proteins. The differentially expressed proteins were mainly involved in immune response, signal transduction, and stress response. Conclusion: The proteins screened out may be potential protein markers for 1-BP poison-ing, which provides reliable and precise methods and thoughts for the diagnosis of 1-BP poisoning.

[The research of proteome profiling change of 1-bromopropane poisoning cases]

Objective: This study was mainly focused on styudy on he proteome profile change between exposure to 1-Bromopropane (1-BP) and 1-BP poisoning. Methods: The samples of serums from exposure to 1-BP and 1-BP poisoning were collected and analyzed through Label free proteome technology platform. The differently expressed proteins between the two groups were quantified and identified, followed by function analysis by bioinformatics. Results: 127 proteins over 2 fold-change were selected, in which 39 proteins were up-regulated and 88 proteins were down-regulated. These different-ly expressed proteins were mainly involved in the process of enzyme active regulation, inflammatory reaction, protein modification, stress response, coagulation, transport. Conclusion: The differently expressed proteins provided the potential protein biomarkers for the early diagnosis of 1-BP poisoning and was beneficial for clinical diagnosis of 1-BP and understanding of the mechanism of 1-BP poisoning.

Advances in understanding the molecular mechanism of pancreatic cancer metastasis

BACKGROUND

Pancreatic cancer (PC) is usually diagnosed at the late-stage and therefore, has widespread metastasis and a very high mortality rate. The mechanisms underlying PC metastasis are not well understood. Recent advances in genomic sequencing have identified groups of gene mutations that affect PC metastasis, but studies elucidating their roles are lacking. The present review was to investigate the molecular mechanisms of PC metastasis.

DATA SOURCES

Relevant articles on PC metastasis were searched in MEDLINE via PubMed prior to April 2015. The search was limited in English publications.

RESULTS

PC metastatic cascades are multi-factorial events including both intrinsic and extrinsic elements. This review highlights the most important genetic alterations and other mechanisms that account for PC invasion and metastasis, with particular regard to epithelial-mesenchymal transition, inflammation, stress response, and circulating tumor cells.

CONCLUSIONS

Analyses of relevant gene functions and signaling pathways are needed to establish the gene regulatory network and to define the pivotal modulators. Another promising area of study is the genotyping and phenotyping of circulating tumor cells, which could lead to a new era of personalized therapy by identifying specific markers and targets.

[Clinical features of patients with head and neck malignant tumor concurrent with multiple primary carcinoma]

OBJECTIVE

To analyze the clinical characteristics of multiple primary cancers (MPC) associated with head and neck.

METHODS

A total of 71 patients with MPC associated with head and neck treated from January 2008 to November 2015 were included in the retrospective study, of them 20 patients were synchronous MPC and 51 patients were metachronous MPC; 45 (63.4%) patients were field cancerization of head neck (FCHN) and 26 (36.6%) patients were non-field cancerization of head neck (NFCHN). For the synchronous MPC patients with an interval of 0 month, the lesion sites of FCHN were treated with combined chemotherapy and radiotherapy, the site of severe lesion of NFCHN received firstly a standard treatment. Other types of MPC were treated according to international guide lines or experts consensus.

RESULTS

With the mean follow-up of 63.4 months, the 3-year and 5-year overall survival (OS) were 84.6% and 75.7% respectively. The 3-year and 5-year OS were 56.4% and 37.6% respectively in patients with synchronous MPC, and were 92.2% and 84.2% respectively in patients with metachronous MPC. There was significant difference in the OS between patients with metachronous MPC and patients with synchronous MPC (P=0.0002). The 3-year and 5-year OS were 85.7% and 77.9% respectively in patients with FCHN, and were 82.9% and 72.8% respectively in patients with NFCHN, with no significant difference between the two groups (P=0.297).

CONCLUSION

With correct diagnosis and effective curative treatment, some of patients with MPC can get long-term survival, showing the better prognosis in metachronous MPC compared to synchronous MPC.

Two new alkaloids from the bulbs of Lycoris sprengeri

Two new alkaloids, lycosprenine (1) and 2α-methoxy-6-O-methyllycorenine (2), along with 22 known alkaloids (3-23b), were isolated from the bulb of Lycoris sprengeri. Their structures were elucidated on the basis of spectral analysis and by comparison of the spectroscopic data with those of known compounds. Selected compounds (1-3 and 6-9) were tested for their neuroprotective activities against H2O2-, CoCl2- and Aβ25-35-induced SH-SY5Y cell injury, most of which exhibited neuroprotective effects of different degrees.

Diagnostic accuracy of K-ras mutation for pancreatic carcinoma: a meta-analysis

BACKGROUND

The conventional tests for the diagnosis of early stage pancreatic carcinoma are not acceptable. This meta-analysis is to evaluate the accuracy of K-ras mutation for the diagnosis of pancreatic carcinoma.

DATA SOURCES

A systemic search of all relevant literature was performed in Web of Science, EMBASE, Cochrane Database, and MEDLINE (PubMed as the search engine) prior to June 1, 2011. Thirty-four studies fulfilled the inclusion criteria and data were pooled for analysis.

RESULTS

The pooled estimates for K-ras mutation in diagnosis of pancreatic carcinoma were as follows: sensitivity 0.68 (95% CI: 0.66-0.71), specificity 0.87 (95% CI: 0.85-0.88), positive likelihood ratio 4.54 (95% CI: 3.47-5.94), negative likelihood ratio 0.37 (95% CI: 0.30-0.44) and diagnostic odds ratio 14.90 (95% CI: 10.02-22.15). Summary receiver operating characteristic analysis demonstrated that the maximum joint sensitivity and specificity was 0.79, and the overall area under the curve was 0.86.

CONCLUSIONS

Diagnostic accuracy of K-ras mutation was not superior to that of conventional tests. Therefore, K-ras mutation analysis alone is not recommended for the diagnosis of pancreatic carcinoma.

Metabolic syndrome components and risk factors for pancreatic adenocarcinoma: a case-control study in China

BACKGROUND

Metabolic syndrome is a complex collection of interrelated conditions. Recent data have shown that metabolic syndrome may play a role in several cancers. Pancreatic adenocarcinoma is the fourth most common cause of death from cancer in the United States and the fifth in Europe. Despite the increasing numbers of published studies, the etiology of pancreatic adenocarcinoma is incompletely defined. Therefore, this paper aims to evaluate the risk factors for pancreatic adenocarcinoma.

METHODS

This was a case-control study of pancreatic adenocarcinoma patients who were referred to the Peking Union Medical College Hospital. Controls were randomly selected from an existing database of healthy individuals at the Health Screening Center. Data on metabolic syndrome, pancreatic diseases, liver diseases, and a history of diabetes and history of hypertension were collected either by conducting a retrospective review of the patients' records and health examination reports or by interview.

RESULTS

A history of smoking (OR = 2.981), diabetes (OR = 2.421), cholecystolithiasis (OR = 5.453), or chronic pancreatitis (OR = 28.264) as well as the levels of fasting blood glucose (OR = 4.241), total cholesterol (OR = 1.793), and apolipoprotein A (OR = 36.065) were significantly related to pancreatic adenocarcinoma.

CONCLUSIONS

Cholelithiasis, chronic pancreatitis, and certain metabolic syndrome components are potential risk factors for the development of pancreatic adenocarcinoma.

Robotic versus open pancreatectomy: a systematic review and meta-analysis

BACKGROUND

Robotic surgery is gaining momentum with advantages for minimally invasive management of pancreatic diseases. The objective of this meta-analysis is to compare the clinical and oncologic safety and efficacy of robotic versus open pancreatectomy.

METHODS

A systematic review of the literature was performed to identify studies comparing robotic pancreatectomy and open pancreatectomy. Postoperative outcomes, intraoperative outcomes, and oncologic safety were evaluated. Meta-analysis was performed using a random-effect model.

RESULTS

Seven studies matched the selection criteria, including 137 (40 %) cases of robotic pancreatectomy and 203 (60 %) cases of open pancreatectomy. None of the included studies were randomized. Overall complication rate was significantly lower in robotic group [risk difference (RD) = -0.12, 95 % confidence interval (CI) -0.22 to -0.01, P = 0.03], as well as reoperation rate (RD = -0.12; CI -0.2 to -0.03, P = 0.006) and margin positivity (RD = -0.18; 95 % CI -0.3 to -0.06, P = 0.003). There was no significant difference in postoperative pancreatic fistula (POPF) incidence and mortality. The median (range) conversion rate was 10 % (0-12 %).

CONCLUSIONS

The results of this meta-analysis suggest that robotic pancreatectomy is as safe and efficient as, if not superior to, open surgery for patients with benign or malignant pancreatic diseases. However, the evidence is limited and more randomized controlled trials are needed to further clearly define this role.

Increased COMT expression in pancreatic cancer and correlation with clinicopathologic parameters

Catechol-O-methyl transferase (COMT) is an enzyme involved in estrogen metabolism. Proteomic and immunoproteomic screens suggested COMT might be an immunogenic membrane antigen in human pancreatic cancer. The aim of this study was to investigate the dynamic expression of COMT in pancreatic ductal adenocarcinoma (PDAC) and noncancerous pancreatic tissue, and to determine the relationship between COMT expression and clinicopathologic parameters. COMT expression was analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and western blot in five pancreatic cell lines and five pairs of PDAC and noncancerous pancreatic tissue. Immunohistochemistry was used to evaluate COMT expression in tissue microarrays and 20 cases of paraffin-embedded clinical specimens. The results indicated that COMT expression was detected in AsPC-1, BxPC-3, MIA PaCa-2, Capan-1 and SW1990 pancreatic cell lines, and in five pairs of PDAC and noncancerous pancreatic tissue, at the mRNA and protein levels. Immunohistochemistry analysis revealed that COMT expression was significantly higher in PDAC than in nonmalignant pancreatic tissue. High expression of COMT significantly correlated to early T stages. Therefore, we conclude that COMT might serve as a potential biomarker for applied clinical pathology in PDAC.

The effects of delta1-cortienic acid on skin blanching, pharmacokinetics and stability of loteprednol etabonate

The effect of delta1-cortienic acid (delta1-CA) on human skin blanching activity of the soft corticosteroid, loteprednol etabonate (LE), has been studied. Ten volunteers had applied to their forearms a dose of LE ranging from 0.1 to 1 mM, or LE from 0.1 to 1 mM in combination with 2-times the concentration of delta1-CA (0.2 - 2mM). The results indicate that delta1-CA increased LE's effect on human vasoconstriction/skin blanching activity, both in the intensity and duration. This enhancing effect of delta1-CA was also observed in other blanching studies with other corticosteroids, such as hydrocortisone. The enhancement may occur through the displacement of LE bound to transcortin (also known as corticosteroid-binding globulin, or CBG) by delta1-CA as delta1-CA has a higher affinity for CBG than that for glucocorticoid receptor (GR), resulting in more free-LE to act on GR, and increased skin blanching. In rat studies, intravenous injection of delta1-CA (5-50 mg/kg) did not affect the pharmacokinetics of LE (5 mg/kg), indicating that delta1-CA is safe for combined use with LE. In stability studies, the presence of delta1-CA at the same concentrations as LE in aqueous suspension (0.1 and 0.2%) significantly increased the stability of LE. Thus, the combination of delta1-CA with LE serves an enhancing and stabilizing role while not impacting the pharmacokinetic properties of LE.

[Management of the perineal wounds after abdominoperineal resection: simple drainage only or with continuous irrigation?]

OBJECTIVE

To compare the effects of presacral irrigation and simple drainage on the perineal wound healing in patients after abdominoperineal resection (APR).

METHODS

From October 2004 to August 2009, patients with rectal cancer, ulcerative colitis or rectal gastrointestinal stromal tumor, who underwent APR or proctocolectomy, were randomized into two arms: simple drainage group (n = 37) and continuous irrigation (n = 37). Patients randomized to arm B received simple drainage only to presacral space; while those patients in arm A received continuous irrigation in addition to simple drainage. Perineal wound healing was taken as endpoint of this study. Major complication was defined as wound dehiscence or wound infection that the perineal wound should be reopened for drainage. Minor complication was defined as delayed healing wound with seroma or hematoma.

RESULTS

A total of 74 patients were enrolled in present study, with 37 patients in each arm, and there were 12 cases and 10 cases who received preoperative radiation therapy, respectively. In the arm A, 2 patients developed major complications, 3 patients incurred with minor complications and 32 patients got primary healing of the perineal wounds. In arm B, 8 patients suffered major complications, 3 patients incurred with minor complications and 26 patients got primary healing of the perineal wounds. The incidence of major complication was significantly lower in arm A (5.4% vs.21.6%, P = 0.042). Patients received preoperative radiation therapy had significantly higher rate of minor complications than patients underwent surgery only (18.2% vs. 3.9%, P = 0.039).

CONCLUSIONS

Simple drainage with continuous irrigation of the presacral space, in patients with abdominoperineal resection or proctocolectomy, could significantly lower the incidence of major complication and improve wound healing for perineal wound when compared with simple drainage only. Preoperative radiation therapy tends to increase the incidence of minor complications.

Anaerobic degradation of normal- and branched-chain Fatty acids with four or more carbons to methane by a syntrophic methanogenic triculture

Syntrophic degradation of normal- and branched-chain fatty acids with 4 to 9 carbons was investigated with a mesophilic syntrophic isobutyrate-butyrate-degrading triculture consisting of the non-spore-forming, syntrophic, fatty acid-degrading, gram-positive rod-shaped strain IB, Methanobacterium formicicum T1N, and Methanosarcina mazei T18. This triculture converted butyrate and isobutyrate to methane and converted valerate and 2-methylbutyrate to propionate and methane. This triculture also degraded caproate, 4-methylvalerate, heptanoate, 2-methylhexanoate, caprylate, and pelargoate. During the syntrophic conversion of isobutyrate and butyrate, a reversible isomerization between butyrate and isobutyrate occurred; isobutyrate and butyrate were isomerized to the other isomeric form to reach nearly equal concentrations and then their concentrations decreased at the same rates. Butyrate was an intermediate of syntrophic isobutyrate degradation. When butyrate was degraded in the presence of propionate, 2-methylbutyrate was synthesized from propionate and isobutyrate formed from butyrate. During the syntrophic degradation of valerate, isobutyrate, butyrate, and 2-methylbutyrate were formed and then degraded. During syntrophic degradation of 2-methylbutyrate, isobutyrate and butyrate were formed and then degraded.

Pharmacokinetics and delta1-cortienic acid excretion after intravenous administration of prednisolone and loteprednol etabonate in rats

Detailed pharmacokinetic (PK) studies in rats were performed (i)to compare the PK of prednisolone (PRN) and loteprednol etabonate (LE, a soft corticosteroid) as well as their common inactive metabolite delta1-cortienic acid (delta1-CA), (ii) to investigate the excretion of delta1-CA after PRN and LE administration, and (iii) to investigate the effect of delta1-unsaturation on the excretion of delta1-CA versus CA. Following a 10 mg x kg(-1) intravenous bolus dose, the total clearance (CL(tot)) of PRN (27.0 +/- 1.4 mL x min(-1) kg(-1)) was significantly lower than that of LE (67.4 +/- 11.6 mL x min(-1) kg(-1)) or delta1-CA (53.8 +/- 1.4 mL x min(-1) kg(-1)) indicating that the metabolism/elimination of PRN in the liver (primarily, conjugation) may be less efficient than that of LE (primarily, hydrolysis) or delta1-CA (unchanged). The volume of distribution (Vd(ss)) of PRN (823 +/- 78 mL x kg(-1)) was significantly lower than that of LE (3078 +/- 79 mL x kg(-1)) indicating that LE is more distributed to lipophilic tissues. Excretion studies have confirmed that delta1-CA is indeed a metabolite of PRN. After intravenous injection of 10 mg x kg(-1), less than 1% of the administered PRN was excreted as delta1-CA by 4 h (0.38 +/- 0.10% in bile and 0.18 +/- 0.04% in urine), significantly less than for LE (17.01 +/- 2.09% in bile and 2.53 +/- 1.17% in urine) indicating that extent of this metabolic transformation can indeed be affected by molecular design. At doses of 100 mg/kg, the proportion of delta1-CA excreted after PRN administration (0.12 +/- 0.03% in bile and 0.19 +/- 0.03% in urine) was similar to that of CA excreted after hydrocortisone administration (0.11 +/- 0.03% in bile and 0.22 +/- 0.04% in urine) indicating that the presence of the delta1 double bond (delta1-unsaturation) does not affect significantly this metabolic conversion.

From tortoise-shell-like molecular segments to C(4n)H(2n)N(2n) (n = 3-8) cages stabilized by alkenyl: a theoretical study

The C(4n)H(2n)N(2n) (n = 3-8) cage molecules with D(nh) symmetry and their nitrated products, C(4n)N(4n)O(4n) (n = 3, 4, 5) and C(4n)H(n)N(3n)O(2n) (n = 4, 6, 8) were studied by DFT at the B3LYP/cc-pVDZ level. Their geometrical structures, ground-state energies, and heats of formation have been investigated. They exhibit an obvious cage effect. Hirshfeld partitioning charges in momentum space give evidence of high strained energy in the title compounds. Their orbital energy and frontier orbital shape and electrostatic potential calculation are also studied. Investigation of heat of formation and NICS analysis reveal that C(24)H(12)N(12) is the most stable molecule among title compounds with D(nh) symmetry. Their half nitrated products are predicted as a promising candidate for high energy matter.

Reductive dechlorination of PCB-contaminated raisin river sediments by anaerobic microbial granules

A polychlorinated biphenyl (PCB)-dechlorinating anaerobic microbial consortium, developed in a granular form, demonstrated extensive dechlorination of PCBs present in Raisin River sediments at room (20 degrees to 22 degrees C) and at a relatively low (12 degrees C) temperature. Highly chlorinated PCB congeners were dechlorinated and less chlorinated compounds were produced. The homolog comparison showed that tri-, tetra-, penta-, hexa-, and heptachlorobiphenyl compounds decreased significantly, and mono- and dichlorobiphenyl compounds increased. After 32 weeks of incubation at 12 degrees C, the predominant less chlorinated products included 2-, 4-, 2-2/26-, 24-, 2-4-, 24-2-, 26-2-, and 26-4-CB. Among these, 24- and 24-2-CB did not accumulate at room temperature, suggesting a further dechlorination of these congeners. Predominantly meta dechlorination (i.e., pattern M) was catalyzed by the microbial consortium in the granules. Dechlorination in the control studies without granules was not extensive. This study is the first demonstration of enhanced reductive dechlorination of sediment PCBs by an exogenous anaerobic microbial consortium.

Research advances in plateau hypoxia and gut barrier injury

Gut barrier function is an important feature of the intestinal tract. It consists of mechanical barrier, immune barrier, chemical barrier and organism barrier. Each barrier has different structures, molecular regulatory mechanisms and biologic functions, which are connected organically via their own signal paths simultaneously to protect the host from intruding of foreign antigen. The injury to these barriers in the plateau environment is a complex and inter-related process with many changes of inflammatory mediators and pathologic procedure. In this review, we focus on the barrier injury mechanisms under this special environment.

Stereoisomers of N-substituted soft anticholinergics and their zwitterionic metabolite based on glycopyrrolate--syntheses and pharmacological evaluations

PURPOSE

In this study, isomers of two N-substituted soft anticholinergics based on glycopyrrolate, SGM (PcPOAGP_NA.Me) and SGE (PcPOAGP_NA.Et) [3'-(2-cyclopentyl-2-phenyl-2-hydroxyacetoxy)-1'-methyl-1'-alkoxycarbonylpyrrolidinium bromide] and their zwitterionic metabolite, SGa (PcPOAGP_NA.H) [3'-(2-cyclopentyl-2-phenyl-2-hydroxyacetoxy)-1'-methyl-1'-carboxymethylpyrrolidinium inner salt] were synthesized and their pharmacological activities were evaluated in vitro and in vivo.

METHODS

The isomers of SGM and SGE were synthesized with both optically pure methyl-cyclopentylmandelate and 3-hydroxy-N-methylpyrrolidine. Trans-esterification followed by quarternization with alkyl bromoacetate gave four isomers of SGM or SGE with the nitrogen chiral center unresolved (2R3'S-SGM, 2R3'R-SGM, 2S3'S-SGM, 2S3'R-SGM or 2R3'S-SGE, 2R3'R-SGE, 2S3'S-SGE, 2S3'R-SGE). The hydrolysis of these four isomers followed by HPLC separation resulted in eight fully resolved isomers of SGa (2R3'R1'R, 2R3'S1'R, 2R3'R1'S, 2R3'S1'S, 2S3'R1'R, 2S3'S1'R, 2S3'R1'S, and 2S3'S1'S). Pharmacological activities were assessed by using in vitro receptor-binding assay and guinea pig ileum pA2-assay, and by evaluating the in vivo rabbit mydriatic effects. Results were compared to those obtained with conventional anticholinergic agents, such as glycopyrrolate, N-meythylscopolamine, and tropicamide, as well as those obtained with previously prepared racemic mixtures and 2R isomers.

RESULTS

Receptor binding pKi values at cloned human muscarinic receptors (M1-M4 subtypes) were in the 6.0-9.5 range for the newly synthesized SGM and SGE isomers, and in the 5.0-8.6 range for the SGa isomers. In all cases, 2R isomers were significantly more active than 2S isomers (27 to 447 times for SGM isomers, and 6 to 4467 times for SGa isomers). Among the four SGM isomers with unresolved 1' (N) chiral center, the 3'R isomers were more active than the corresponding 3'S isomers (1.5-12.9 times), whereas, among the SGa isomers, the 3'S isomers were not always more active than the corresponding 3'R isomers indicating that activity determined based on configuration at chiral center 3' is significantly affected by the configuration of the other two chiral centers, 2 and 1'. Among the completely resolved eight SGa isomers (all three chiral centers resolved), 1'S isomers were always more active than the corresponding 1'R isomers (1.8-22.4 times). Results also indicate that some isomers showed good M3/M2 muscarinic-receptor subtype-selectivity (about 3-5 times), and 2R and 3'S were the determining configurations for this property. Guinea pig ileum assays and rabbit mydriasis tests on SGa isomers further confirmed the stereospecificity. In rabbit eyes, some 2R-SGa isomers showed mydriatic potencies similar to glycopyrrolate and exceeded tropicamide, but their mydriatic effects lasted considerably shorter, and they did not induce dilation of the pupil in the contralateral, water-treated eye. These results indicate that these compounds are locally active, but safe and have a low potential to cause systemic side effects. The pharmacological potency of the eight SGa isomers was estimated as 2R3'S1'S approximately equal to 2R3'R1'S approximately equal to 2R3'S1'R > 2R3'R1'R > 2S3'R1'S > 2S3'S1'S approximately equal to 2S3'R1'R > 2S3'S1'R (p < 0.05).

CONCLUSIONS

The stereospecificity and M3/M2 muscarinic-receptor subtype-selectivity of soft anticholinergics, SGM, SGE, and SGa have been demonstrated. In agreement with previous results, the potential for their effective and safe use has been confirmed.

Anti-inflammatory effects of isoflavone powder produced from soybean cake

Soybean cake, a byproduct obtained during the processing of soybean oil, has been shown to be a rich source of isoflavones. The objectives of this study were to use soybean cake as raw material for processing into powder and to evaluate the anti-inflammatory activity. Eleven treatments, including powders of malonylglucoside, glucoside, acetylglucoside, aglycone, ISO-1, and ISO-2, as well as genistein standard, gamma-PGA, control, normal, and PDTC, were used for evaluation. A total of 77 mice were each provided daily with tube feeding for 4 weeks at a dose of 0.3 mL of aqueous solution from each treatment, and inflammation was induced with intraperitoneal injection of 1 mg/kg of body weight lipopolysaccharide (LPS). Results showed that all of the isoflavone powders and genistein standard were effective in inhibiting LPS-induced inflammation, lowering leukocyte number in mice blood and reducing production of IL-1beta, IL-6, NO, and PGE2 in both peritoneal exudate cell supernatant and peritoneal exudate fluid. All of the isoflavone treatments failed to retard T cell proliferation; however, both ISO-1 and ISO-2 could inhibit B cell proliferation. The difference in anti-inflammatory activity was minor between any of the isoflavone treatments.

Pharmacological effects of some newly developed soft anticholinergics and a receptor-binding QSAR study

Receptor-binding studies using cloned human muscarinic receptors (M1-M4 subtypes) were performed on newly synthesized soft anticholinergics (F-828, F-838, SGM, SGE, SA-A) that are isosteric/ isoelectronic analogs of glycopyrrolate. The receptor binding pK(i) values of the new soft drugs were in the 5.5-9.5 range; with the majority being in the 7.0-8.5 range. As previously observed for similar structures, the pK(i) values tended to decrease with increasing molecular size, and with the introduction of three structural indicator variables, a QSAR equation accounting for close to 75% of the variability could be established. Confirming the known stereospecificity of these receptors, pure 2R isomers were found more active than the corresponding isomeric mixtures. In agreement with soft drug design principles, acid metabolites (SA-A) were found considerably less active than their parent esters. The more active, 2R isomer of SA-A showed some muscarinic subtype selectivity (M3/M2), which was not observed for the parent compounds of this zwitterionic metabolite. Guinea pig ileum assay pA2 values have also been determined, and they were found to be in good agreement with the pK(i), values obtained from the binding study (r2 = 0.72). SGM and SGE caused pupil-dilation in rabbit eyes, but their mydriatic effects lasted considerably shorter than that of glycopyrrolate, and they did not induce dilation of the pupil in the contralateral, water-treated eyes, indicating that they are locally active and safe, with a low potential to cause systemic side effects.

Estimating biomass of heterotrophic and autotrophic bacteria by our batch tests

A new method was developed, carrying out the batch tests of oxygen utilization rate with and without the addition of Allythiourea solution (inhibitor) at the same time, to separately and simultaneously estimate both the biomass of heterotrophic and autotrophic bacteria in a mixed culture activated sludge of a sequential batch reactor system. The results of the batch tests showed that the YH kinetic parameter was equal to 0.77 g cell COD per g oxidized COD and the maximum specific growth rate and biomass of heterotrophic bacteria were 2.13 d(-1) and 212 mg l(-1) as COD (about 66% of the activated sludge), respectively. On the other hand, the maximum specific growth rate and biomass of autotrophic bacteria were 1.62 d(-1) and 2.51 mg l(-1) as COD (about 0.8% of activated sludge), respectively. The proposed method is easier and cheaper than other developed methods.

Studies on a soft glycopyrrolate analog, SG-1

A short-acting soft drug analog (SG-1) of glycopyrrolate (G) was developed by retrometabolic design in order to minimize systemic side effects and optimize the therapeutic index. SG-1,3-(1'-hydroxycyclopentyl)phenylacetoxy-1-methyl-1- methoxycarbonylpyrrolidinium bromide, was synthesized by: (a) esterification of phenylacetic acid with N-methyl-3-pyrrolidinol by DCC to obtain N-methyl-3-pyrrolidinyl phenylacetate; (b) reaction of lithium salt of above phenylacetates with cyclopentanone to obtain N-methyl-3-pyrrolidinyl 3-(1'-hydroxycyclopentyl)phenylacetate; and (c) quarternization with methyl bromoacetate in acetonitrile to give the designed product. To evaluate the pharmacological effect of SG-1, its mydriatic activity in rabbit eyes was compared to that of glycopyrrolate. At the pharmacodynamically equivalent doses (the lowest dose that induces the maximum response) of SG-1 (1%) and glycopyrrolate (0.1%), the mydriatic activities lasted for 5 and 100 h, respectively. Compared to glycopyrrolate, the intrinsic pupil dilation potency of SG-1 was lower (approximately 1/10th) but the duration of action was much shorter (< 1/20th) as SG-1 is susceptible to facile enzymatic hydrolysis/deactivation in the rabbit eyes. In vitro metabolism and stability investigations further supported this finding. In vitro half lives of SG-1 in rat plasma, blood, and 20% liver and lung tissue homogenates were 15.62, 53.86, 263.43, and 318.35 min, respectively. In human plasma and blood, half-lives were 19.93 and 88.32 min, respectively. SG-1 was relatively stable under acidic conditions (pH 5 and lower). SG-1 is a promising, clinically useful short acting anticholinergic.

Design, pharmacokinetic, and pharmacodynamic evaluation of soft anticholinergics based on tropyl alpha-phenylcyclopentylacetate

Four new soft anticholinergic agents based on tropyl alpha-phenylcyclopentylacetate, 15a, 15b, 18a, and 18b, were designed and synthesized. Receptor binding studies on the cloned human muscarinic receptors indicated that the new soft anticholinergic agents possessed moderate potency as pKi ranged from 6.7 to 7.6. Mydriatic studies in rabbit eyes revealed that the duration of the action of the new soft anticholinergics (8.5-11.0 h) were shorter than that of atropine (about 24 h) under pharmacodynamic equivalent dose, and one of them, 18a, showed even shorter than that of tropicamide. In addition, after unilateral administration, significant dilation of pupil in the control eyes was observed with tropicamide and atropine but not with soft drugs, suggesting the systemic activity of soft drugs was minimal. With their soft nature, the new soft anticholinergics displayed much shorter protective effect against carbachol-induced bradycardia (about 30 min) than atropine (at least 60 min) in rats. In vitro and in vivo pharmacokinetic studies demonstrated that the soft anticholinergics were rapidly hydrolyzed into the corresponding inactive metabolites once they were introduced into the systemic circulation.

Soft cannabinoid analogues as potential anti-glaucoma agents

Cannabinoids are able to reduce elevated intraocular pressure; however, their use in glaucoma treatment is not approved due to severe systemic side effects. New cannabinoid derivatives have been designed based on a retrometabolic/soft drug approach; they were expected to have local effect, but not systemic side effects. Lead compounds and soft analogues were prepared using Pechmann condensation. In agreement with the SAR hypothesis used for the present soft drug design, all the compounds that were successfully synthesized had IOP lowering effect, but the common metabolite of soft analogues that was found to be inactive. Accordingly, when the soft analogue 8 was administered i.v., its biological effect lasted just for 15 minutes; nevertheless, when administered topically, its effect lasted significantly longer. Its metabolite, though, was inactive when applied either i.v. or topically. Thus, the designed soft analogues proved to be good candidates for topical control of glaucoma without producing systemic side effects. The preliminary i.v. experimental data could be successfully described by an indirect response PK/PD model.

Effect of 2-hydroxypropyl-beta-cyclodextrin on the solubility, stability, and pharmacological activity of the chemical delivery system of TRH analogs

To improve the aqueous solubility and stability of the chemical delivery system (CDS) of the thyrotropin-releasing hormone (TRH) analogs, 2-hydroxypropyl-beta-cyclodextrin (HPBCD) has been attempted. TRH analogs were [Leu2]-TRH, [Nva2]-TRH and [Nva2, Pip3]-TRH. Excess amount of CDS was added in various HPBCD in water solutions (0%-50%, pH 6.5). The mixture was saturated by ultra-sonication for 1 h at 15 degrees C and filtered. The concentration of CDS in the filtrate (solubility) was determined with UV detector, and subsequently the stability was investigated. By HPBCD complexation, the aqueous solubility and stability (half-life) of CDS were significantly improved from undetectable levels to about 15 mg/ml and 30 h, respectively. In pH 6.5 and 7.4 HPBCD solution, the degradation of CDS was mainly via acid catalyzed water addition reaction, thus, e.g. [Leu2]-TRH-CDS was more stable in pH 7.4 than in pH 6.5 aqueous solutions. After lyophilizing the saturated CDSs in 50% HPBCD complex solutions, the amount of CDS in the complex was determined as 26.22, 26.79, and 30.34 mg/g for [Leu2]-TRH, [Nva2]-TRH and [Nva2, Pip3]-TRH, respectively. The half-life of [Leu2]-TRH-CDS/HPBCD solid complex at 25 degrees C, 4 degrees C and -15 degrees C was about 100 days, 440 days and no detectable change in three months, respectively. Argon protected condition did not improve the stability of lyophilized [Leu2]-TRH-CDS/HPBCD complex. Dimethyl sulfoxide although increased the solubility of [Leu2]-TRH-CDS in the 50% HPBCD solution by 1.3 times, significantly decreased its stability by 6.6 times. After intravenous administration of CDS (in 30% HPBCD) at a dose of 10 mumole/kg in mice, compared to the vehicle control or the same dose of [Leu2]-TRH (in 30% HPBCD), a significant increase in pharmacological effect (decrease in barbiturate-induced sleeping time) was observed. These results demonstrate the usefulness of cyclodextrin in the formulation of the CDSs of TRH analogs.

Crystal structure of a soluble form of the intracellular chloride ion channel CLIC1 (NCC27) at 1.4-A resolution

CLIC1 (NCC27) is a member of the highly conserved class of chloride ion channels that exists in both soluble and integral membrane forms. Purified CLIC1 can integrate into synthetic lipid bilayers forming a chloride channel with similar properties to those observed in vivo. The structure of the soluble form of CLIC1 has been determined at 1.4-A resolution. The protein is monomeric and structurally homologous to the glutathione S-transferase superfamily, and it has a redox-active site resembling glutaredoxin. The structure of the complex of CLIC1 with glutathione shows that glutathione occupies the redox-active site, which is adjacent to an open, elongated slot lined by basic residues. Integration of CLIC1 into the membrane is likely to require a major structural rearrangement, probably of the N-domain (residues 1-90), with the putative transmembrane helix arising from residues in the vicinity of the redox-active site. The structure indicates that CLIC1 is likely to be controlled by redox-dependent processes.

A model of chronic lymphocytic leukemia with Ritcher's transformation in severe combined immunodeficiency mice

OBJECTIVE

The major aim of the study was to establish a murine model of chronic lymphocytic leukemia with B-1 cells derived from a New Zealand white mouse.

MATERIAL AND METHODS

Malignant B-1 cells (named CLL-RT cells) derived from a New Zealand white mouse were injected into the peritoneal cavity of severe combined immunodeficiency mice. Upon follow-up of recipient mice, the lymphomas showed characteristics similar to chronic lymphocytic leukemia (CLL) with Ritcher's transformation.

RESULTS

Blood samples from the recipient mice showed that CLL-RT cells increased rapidly in peripheral blood after 5 weeks. Serum interleukin-10 also increased significantly in recipient mice, as in human chronic lymphocytic leukemia patients. These CLL-RT cells showed a high nucleus-to-cytoplasm ratio. These cells could metastasize via circulation in the recipients and form diffuse lymphomas in various tissues. These aggressive and diffuse lymphomas were similar to Ritcher's transformation of human CLL. The cell surface antigens of the spleen and peritoneal resident cells were analyzed by flow cytometry. The CLL-RT cells constantly expressed surface immunoglobulins M and G, and CD5, CD19, B220, and CD40 molecules. They did not express any CD11b, CD3, MAC-3, CD23, NK1.1, or H-2K(d) molecules.

CONCLUSIONS

The characteristics of our animal model are very similar to human CLL. This animal system could be an ideal model for the human disease. We believe the animal model would be valuable in therapeutic studies and aid in the identification of the specific genetic alleles associated with the disease.

Characterization of self-T-cell response and antigenic determinants of U1A protein with bone marrow-derived dendritic cells in NZB x NZW F1 mice

Systemic lupus erythematosus (SLE) is characterized by the existence of a heterogeneous group of autoantibodies directed against nuclear intact structures, such as nucleosomes and small nuclear ribonucleoproteins (snRNPs). Autoantibodies against snRNPs are of special interest because they are detectable in the majority of SLE patients. Although the B-cell antigenic determinants have been well characterized, very limited data have been reported in regard to the T-cell epitopes of snRNPs. Furthermore, several studies have demonstrated that determination of the auto-T-cell epitopes recognized by freshly isolated T cells is difficult from unprimed lupus mice when self-antigen-pulsed B cells or macrophages are used as antigen-presenting cells (APCs) in vitro. In the present study, we showed a novel approach for determining the auto-T-cell epitopes, using bone marrow-derived dendritic cells (BMDCs) pulsed with the murine U1A protein - an immunodominant antigen of the U1 snRNPs - which is capable of activating freshly isolated T cells from unprimed (NZB x NZW) F1 (BWF1) mice in vitro. The T-cell epitope area was found to be located at the C-terminus of U1A, overlapping the T-cell epitope of human U1A that has been reported in human SLE. Identification of the autoreactive T-cell epitope(s) in snRNPs will help to elucidate how reciprocal T-B determinant spreading of snRNPs emerges in lupus. The results presented here also indicate that it is feasible to use this approach to further explore strategies to design immunotherapy for patients with lupus.

The effect of cytokines on the activation-induced apoptosis of B cells in autoimmune NZB x NZW F1 mice

Programmed cell death (apoptosis) is an essential process in the development of various tissues and its involvement has been proposed for the elimination of self-reactive immature T and B lymphocytes when self antigens are first encountered. In order to further investigate the role of apoptosis in the pathogenesis of autoimmune disease, the apoptosis of lipopolysaccharide (LPS)-activated B cells, peritoneal cells from NZB x NZW F1 (NZB/W F1) mice and nonautoimmune BALB/c mice were assayed using an in vitro culture system. Splenic B cells were isolated and then stimulated with LPS before further activated with crosslinking antimu antibody. In addition, the apoptosis of peritoneal cells induced by crosslinking antimu antibody was also analyzed. The data revealed that the specific apoptosis of both activated B cells and peritoneal cells induced by crosslinking antimu antibody was very similar comparing NZB/W F1 and nonautoimmune BALB/c mice. This activation-induced B-cells apoptosis could be rescued, however, with the addition of cytokines such as interleukin (IL)-5 or IL-10, to the culture. The results suggest that there is no endogenous defect in the apoptosis of activated B cells for autoimmune NZB/W F1 comparing nonautoimmune BALB/c mice. Notably, however, abnormally high levels of the type 2 T helper (Th2)-related cytokines such as IL-5 or IL-10 may play an important role in the abnormal expansion of activated B cells in autoimmune NZB/W F1 mice.

The propeptide of the transforming growth factor-beta superfamily member, macrophage inhibitory cytokine-1 (MIC-1), is a multifunctional domain that can facilitate protein folding and secretion

Macrophage inhibitory cytokine-1 (MIC-1) is a divergent member of the transforming growth factor-beta (TGF-beta) superfamily. While it is synthesized in a pre-pro form, it is unique among superfamily members because it does not require its propeptide for correct folding or secretion of the mature peptide. To investigate factors that enable these propeptide independent events to occur, we constructed MIC-1/TGF-beta1 chimeras, both with and without a propeptide. All chimeras without a propeptide secreted less efficiently compared with the corresponding constructs with propeptide. Folding and secretion were most affected after replacement of the predicted major alpha-helix in the mature protein, residues 56-68. Exchanging the human propeptide in this chimera with either the murine MIC-1 or TGF-beta1 propeptide resulted in secretion of the unprocessed, monomeric chimera, suggesting a specific interaction between the human MIC-1 propeptide and mature peptide. Propeptide deletion mutants enabled identification of a region between residues 56 and 78, which is important for the interaction between the propeptide and the mature peptide. Cotransfection experiments demonstrated that the propeptide must be in cis with the mature peptide for this phenomenon to occur. These results suggest a model for TGF-beta superfamily protein folding.