Sleep disordered breathing and neurobehavioral deficits in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Sleep disordered breathing (SDB) is broadly recognized to be associated with neurobehavioral deficits, which have significant impacts on developing-aged children and adolescents. Therefore, our study aimed to quantify the proportion of neurobehavioral impairments attributed to SDB in general children and adolescents by population attributable fraction (PAF).

METHODS

The study was registered at PROSPERO (ID: CRD42023388143). We collected two types of literature on the prevalence of SDB and the risk of SDB-related neurobehavioral deficits from ten electronic databases and registers, respectively. The pooled effect sizes (Pe, Pc, RR) by random-effects meta-analysis were separately substituted into Levin's formula and Miettinen's formula to calculate PAFs.

RESULTS

Three prevalence literature and 2 risk literature, all with moderate/high quality, were included in the quantitative analysis individually. The prevalence of SDB was 11% (95%CI 2%-20%) in children and adolescents (Pe), while the SDB prevalence was 25% (95%CI 7%-42%) in neurobehavioral patients (Pc). SDB diagnosis at baseline was probably associated with about threefold subsequent incidence of neurobehavioral deficits (pooled RR 3.24, 95%CI 1.25-8.41), after multi-adjustment for key confounders. Up to 19.8% or 17.3% of neurobehavioral consequences may be attributed to SDB from Levin's formula and Miettinen's formula, respectively.

CONCLUSIONS

A certain number of neurobehavioral consequences may be attributable to SDB. It is essential for clinicians to identify and treat SDB timely, as well as screen for SDB in patients with neurobehavioral impairments. More longitudinal studies of SDB and neurobehavioral deficits are needed in the future to further certify the association between them.

Induction Chemotherapy and Toripalimab for Larynx Preservation in Resectable Locally Advanced Laryngeal/Hypopharyngeal Carcinoma: Preliminary Results of INSIGHT Study

PURPOSE/OBJECTIVE(S)

Previous studies have demonstrated excellent pathological response of induction PD-1 inhibitor with chemotherapy for locally advanced head and neck cancer. To our knowledge, there is scarce evidence on induction chemotherapy (ICT) and PD-1 inhibitor in organ preservation for patients (pts) with laryngeal/hypopharyngeal carcinoma. Hence, the aim of this study is to evaluate the efficacy and toxicities of ICT and PD-1inhibitor (Toripalimab) followed by radiotherapy or surgery, for pts with resectable locally advanced laryngeal/hypopharyngeal carcinoma.

MATERIALS/METHODS

This isa single-arm phase II study. Pts with histopathologic confirmed, resectable locally advanced laryngeal/hypopharyngeal squamous cell carcinoma and ECOG PS 0-1 were eligible. Three cycles of ICT (paclitaxel 175 mg/m d1, cisplatin 25 mg/m d1-3) combined with PD-1 inhibitor (Toripalimab 240 mg d0) were given. Response assessment (RECIST 1.1) was performed post-ICT. Patients with complete response (CR)/partial response (PR) of primary tumor received concurrent chemoradiation, followed by maintenance therapy of Toripalimab for eight cycles. Otherwise, patients were referred to surgery, followed by adjuvant radiation (RT)/chemoradiation (CRT), and then maintenance therapy of Toripalimab. The primary endpoint is larynx-preservation (LP) rate at 3 months post-RT. Forty-two patients were planned. Based on a two-stage Fleming design (one-sided α:10%, power: 80%), if at least 22 patients attained LP of the first 27 patients in stage I or at least thirty-two pts attained LP of the 42 patients at the end of stage II, the null hypothesis would be rejected. The cohort would enroll 15 more pts in stage II if 19-21 pts in stage I observed LP, and the study would be terminated if the number of pts with LP were less than 18 in stage I.

RESULTS

A total of 27 pts were enrolled. By the cut-off date Feb 8, 2023, all reached at least 3 months of follow-up post-RT. Median age was 63 (53-74) years with 92.6% male. Hypopharyngeal cancer accounted for 66.7%. There were 74.1% who were T3 to T4, and 77.7% were N2 to N3. Six cases had primary invasion of esophagus and five pts underwent pretreatment tracheostomy. ORR of ICT was 85.2%. Afterward, 21 pts were treated with concurrent CRT, while 6 pts received surgery of primary tumor. At 3 months post-RT, 23 pts attained organ preservation and the LP rate was 85.2%. With a median follow-up of 13.5 months, 1-year OS rate, PFS rate and LP survival rate was 83.1%, 79.5% and 79.4%, respectively. During ICT, 22.2% of pts experienced grade 3-4 treatment-related AEs (TRAEs). The most common grade 3-4 TRAEs were nausea and neutrophil count decreased.

CONCLUSION

The primary endpoint LP rate was met. In this cohort of extensive locally advanced laryngeal/hypopharyngeal carcinoma, ICT and Toripalimab followed by radiotherapy or surgery resulted in satisfactory short-term LP rate and encouraging survival.

How is Obstructive Sleep Apnea Associated with High Blood Pressure and Diabetes Mellitus Type 2? Clues from a Two-Step Mendelian Randomized Study

Background

Obstructive sleep apnea (OSA), high blood pressure (HBP), and type 2 diabetes mellitus (T2DM) have a close clinical relationship, but whether and how OSA affects HBP and T2DM is unclear.

Study Design and Methods

Two-step, two-sample Mendelian randomization techniques were applied using single-nucleotide polymorphisms as genetic instruments for exposure and mediators, thus minimizing bias due to confounding factors and reverse causality. The total effect of OSA on HBP and T2DM was categorized into direct and mediating effects based on the mediating factors.

Results

Two-sample MR analysis showed that OSA increased the risk of HBP (odds ratio [OR] = 1.010, 95% confidence interval [CI], 1.002-1.018; P = 0.0121) and T2DM (OR = 1.140, 95% CI, 1.059-1.228; P = 0.0005). In the process of OSA caused by HBP, sex hormone-binding globulin (SHBG) (female, 4.47% mediation; male, 2.76% mediation), total testosterone (TT) (male, 3.72% mediation), bioavailable testosterone (BioT) (female, 7.74% mediation), high-density lipoprotein cholesterol (HDL-C) (3.25% mediation), and apolipoprotein A1 (ApoA1) (1.31% mediation) were individual contributors. SHBG (female, 4.10% mediation; male, 1.58% mediation), TT (male, 3.69% mediation), BioT (female, 2.58% mediation), HDL-C (3.32% mediation), ApoA1 (2.14% mediation), and omega-6 fatty acids (2.33% mediation) may have mediating roles to varying degrees in the process of OSA caused by T2DM.

Interpretation

This MR study showed that OSA is a risk factor for HBP and T2DM, and the evaluation of mediators may help further reveal the specific mechanism by which OSA causes HBP and T2DM.

DTI of Opioid-Exposed Fetuses Using ComBat Harmonization: A Bi-Institutional Study

BACKGROUND AND PURPOSE

The underlying mechanisms leading to altered cognitive, behavioral, and vision outcomes in children with prenatal opioid exposure are yet to be fully understood. Some studies suggest WM alterations in infants and children with prenatal opioid exposure; however, the time course of WM changes is unknown. We aimed to evaluate differences in diffusion tensor imaging MRI parameters in the brain between opioid exposed fetuses and normal controls.

MATERIALS AND METHODS

This is a pilot, prospective cohort study in which subjects in the third trimester of pregnancy underwent fetal DTI of the brain with 20 noncolinear diffusion directions and a b-value of 500 s/mm2 at 2.5-mm isotropic resolution.

RESULTS

The study included a total of 26 fetuses, 11 opioid-exposed (mean gestational age, 32.61 [SD, 2.35] weeks) and 15 unexposed controls (mean gestational age, 31.77 [SD, 1.68] weeks). After we adjusted for gestational age, fractional anisotropy values were significantly higher in opioid-exposed fetuses relative to controls in 8 WM tracts: the bilateral lemniscus (left: P = .017; right: P = .020), middle cerebellar peduncle (P = .027), left inferior cerebellar peduncle (P = .026), right sagittal stratum (P = .040), right fornix stria terminalis (P = .022), right inferior fronto-occipital fasciculus (P = .011), and the right uncinate fasciculus (P = .033). Significant alteration was also identified in other DTI indices involving a series of brain regions.

CONCLUSIONS

Our data demonstrate initial evidence of cerebral WM microstructural differences between opioid-exposed fetuses and unexposed controls. Further studies in larger patient populations will be needed to fully understand these findings.

Commemoration and Emotional Sustenance: A Text Analysis of Students' Motivations Behind Online Mourning of Dr Li Wenliang

As one of the first doctors issued a protective warning to the public, Dr. Li Wenliang was known as "whistleblower" of COVID-19 pandemic. After his death of COVID-19, students entered to his Sina Weibo to display their condolences and sorrow. We conduct text analysis and sentiment classification to investigate the motivation behind online mourning for Dr. Li among students on Sina Weibo. Our results indicate that, a) there always more than one motivation behind online mourning exists in each time period. b) continuing connection and semi-interaction with the deceased is the main motivation when students mourn online. c) there exists positive correlation between the influence of the deceased and the motivation--sharing information with the community of fans and creating social support in a time of loss and social support. d) the motivation--honoring the dead and expressing sadness and resentment can gradually lose over time.

Maternal Obesity during Pregnancy is Associated with Lower Cortical Thickness in the Neonate Brain

BACKGROUND AND PURPOSE

Recent studies have suggested that maternal obesity during pregnancy is associated with differences in neurodevelopmental outcomes in children. In this study, we aimed to investigate the relationships between maternal obesity during pregnancy and neonatal brain cortical development.

MATERIALS AND METHODS

Forty-four healthy women (28 normal-weight, 16 obese) were prospectively recruited at <10 weeks' gestation, and their healthy full-term neonates (23 boys, 21 girls) underwent brain MR imaging. All pregnant women had their body composition (fat mass percentage) measured at ∼12 weeks of pregnancy. All neonates were scanned at ∼2 weeks of age during natural sleep without sedation, and their 3D T1-weighted images were postprocessed by the new iBEAT2.0 software. Brain MR imaging segmentation and cortical surface reconstruction and parcellation were completed using age-appropriate templates. Mean cortical thickness for 34 regions in each brain hemisphere defined by the UNC Neonatal Cortical Surface Atlas was measured, compared between groups, and correlated with maternal body fat mass percentage, controlled for neonate sex and race, postmenstrual age at MR imaging, maternal age at pregnancy, and the maternal intelligence quotient and education.

RESULTS

Neonates born to obese mothers showed significantly lower (P ≤ .05, false discovery rate-corrected) cortical thickness in the left pars opercularis gyrus, left pars triangularis gyrus, and left rostral middle frontal gyrus. Mean cortical thickness in these frontal lobe regions negatively correlated (R = -0.34, P = .04; R = -0.50, P = .001; and R = -0.42, P = .01; respectively) with the maternal body fat mass percentage measured at early pregnancy.

CONCLUSIONS

Maternal obesity during pregnancy is associated with lower neonate brain cortical thickness in several frontal lobe regions important for language and executive functions.

Clinical epidemiology and outcome of HIV-associated talaromycosis in Guangdong, China, during 2011-2017

OBJECTIVES

Talaromycosis is an invasive mycosis endemic to Southeast Asia. This study aimed to investigate the epidemiology, clinical features and prognostic factors of HIV-associated talaromycosis in Guangdong, China.

METHODS

We retrospectively evaluated HIV patients hospitalized with histopathology- or culture-confirmed talaromycosis between 2011 and 2017. Factors associated with poor prognosis were identified using logistic regression.

RESULTS

Overall, 1079 patients with HIV-associated talaromycosis were evaluated. Both the number and prevalence of talaromycosis among HIV admissions increased from 125 and 15.7% in 2011 to 253 and 18.8% in 2017, respectively, reflecting the increase in HIV admissions. Annual admissions peaked during the rainy season between March and August. Common clinical manifestations included fever (85.6%), peripheral lymphadenopathy (72.3%), respiratory symptoms (60.8%), weight loss (49.8%), skin lesions (44.5%) and gastrointestinal symptoms (44.3%). Common laboratory abnormalities were hypoalbuminaemia (98.6%), anaemia (95.6%), elevated aspartate aminotransferase level (AST) (76.9%), elevated alkaline phosphatase level (55.8%) and thrombocytopenia (53.7%). The median CD4 count was 9 cells/μL. Talaromyces marneffei was isolated from blood and bone marrow cultures of 66.6% and 74.5% of patients, respectively. The rate increased to 86.6% when both cultures were performed concurrently. At discharge, 14% of patients showed worsening conditions or died. Leucocytosis, thrombocytopenia, elevated AST, total bilirubin, creatinine and azole monotherapy independently predicted poor prognosis.

CONCLUSIONS

The incidence of HIV-associated talaromycosis has increased in Guangdong with the high HIV burden in China. Skin lesions were seen in less than half of patients. Induction therapy with azole alone is associated with higher mortality. Findings from this study should help to improve treatment of the disease.

Maternal Anxiety and Depression during Late Pregnancy and Newborn Brain White Matter Development

BACKGROUND AND PURPOSE

Anxiety and depression during pregnancy have been associated with an increased risk of adverse neurodevelopmental outcomes in offspring. We aimed to study the in utero effects of maternal anxiety and depression on early brain development.

MATERIALS AND METHODS

Pregnant women were recruited at ∼36 weeks of gestation for this prospective study. They were assessed for anxiety symptoms by the State-Trait Anxiety Inventory and for depression symptoms by the Beck Depression Inventory, 2nd Edition. After delivery, infant underwent an MR imaging examination of the brain without sedation, including DTI, for evaluation of white matter (WM) development. Infant fractional anisotropy values, a putative marker of WM integrity, were correlated with the mothers' State-Trait Anxiety Inventory and Beck Depression Inventory scores by using both tract-based spatial statistics and ROI methods.

RESULTS

Thirty-four infants were included in this study. Both maternal State-Anxiety and Trait-Anxiety scores negatively correlated (P < .05, corrected) with fractional anisotropy values in widespread brain WM regions; Beck Depression Inventory scores also negatively correlated (P < .05) with fractional anisotropy values in one cluster in the brain. Further ROI analyses confirmed significant negative correlations between average fractional anisotropy values in ROIs including left and right prefrontal WM, left and right middle frontal gyrus WM, and the fornix, and State-Anxiety (R values, -0.47 to -0.67; P values, .008 to <.001), Trait-Anxiety (R, -0.37 to -0.59; P, .04 to <.001), and Beck Depression Inventory (R values, -0.36 to -0.55; P, .05 to .002) scores.

CONCLUSIONS

Higher maternal anxiety and depression symptom scores during late pregnancy were associated with lower estimated infant brain WM development, which indicated in utero influences of maternal mental health during pregnancy on the developing brain.

Brain Cortical Structure and Executive Function in Children May Be Influenced by Parental Choices of Infant Diets

BACKGROUND AND PURPOSE

While it is known that breastfeeding promotes healthy brain development in children, the potential effects of formulas substantially differing in composition (ie, milk-based versus soy-based) during infancy on brain development are unclear.

MATERIALS AND METHODS

Seventy-one 8-year-old children who were predominantly breastfed, milk formula fed, or soy formula fed during infancy were recruited for an MR imaging examination of the brain and a Behavior Rating Inventory of Executive Function assessment (completed via a questionnaire to the parents). Brain cortical features measured from MR imaging such as cortical thickness and surface area were extracted and compared among groups and correlated with Behavior Rating Inventory of Executive Function test scores.

RESULTS

Clusters in the frontal and occipital lobes showed significant differences (cluster-wise P  ≤  .05, corrected for multiple comparisons) in cortical thickness or surface area among the 3 diet groups. The effects were more prominent for boys, particularly for comparison of the milk formula fed versus soy formula fed boys. Assessments of executive function and behavior showed significantly lower Behavior Rating Inventory of Executive Function test scores in soy formula fed versus milk formula fed groups, which were mostly attributed to differences in boys. There were no differences between milk formula fed and breastfed groups for either sex. Mean cortical thickness for several of the clusters in the brain showing infant diet-associated effects significantly correlated with Behavior Rating Inventory of Executive Function scores.

CONCLUSIONS

Choices of infant diets (ie, breastfed, milk formula fed, soy formula fed) may have long-term and sex-specific effects on the cortical development and executive function and behavior of children's brains.

[Real-world efficacy and safety of lopinavir/ritonavir and arbidol in treating with COVID-19 : an observational cohort study]

Objective: To evaluate the efficacy and safety of lopinavir/ritonavir (LPV/r) and arbidol in the treatment of COVID-19 in the real world. Methods: The clinical data of 178 patients diagnosed with COVID-19 admitted to Guangzhou Eighth People's Hospital were retrospectively analyzed from January 21 to February 9, 2020. According to the patient's antiviral treatment regimen, 178 patients were divided into 4 groups including LPV/r group (59 patients), arbidol group (36 patients), combination therapy with LPV/r plus arbidol group (25 patients) and the conventional treatment group without any antiviral drugs (58 patients). The main observation end points of the study was the negative conversion time of nucleic acid of the novel coronavirus (2019-nCoV) in pharyngeal swab. Results: The baseline of 4 groups before treatment was consistent and comparable. The negative conversion time of nucleic acid of the 2019-nCoV in pharyngeal swab was (10.20 ± 3.49), (10.11 ± 4.68), (10.86 ± 4.74), (8.44 ± 3.51) days separately in the LPV/r group, the arbidol group, the combination therapy group, and the conventional treatment group without significant difference (F = 2.556, P = 0.058). There was also no significant difference in the rate of negative conversion rate of 2019-nCoV nucleic acid, the improvement ration in clinical symptoms, and the improvement ration of pulmonary infection in the lung CT imaging (P> 0.05). However, a statistically significant difference was found in the proportion of deterioration changing from mild/moderate to severe/critical type at day 7 (χ(2) = 9.311, P = 0.017) as follows: the combination therapy group (24.0%, 6/25), the arbidol group ( 16.7%, 6/36), LPV/r group (5.4%, 3/56) and conventional treatment group (5.2%, 3/58). Moreover, the frequency of adverse reactions in the three groups receiving antiviral drugs was significantly higher than that in the conventional treatment group (χ(2) = 14.875, P = 0.002). Conclusions: No evidences could prove that LPV/r and arbidol could shorten the negative conversion time of novel coronavirus nucleic acid in pharyngeal swab nor improve the symptoms of patients. Furthermore, the combination usage of LPV/r and arbidol may not benefit for improving the disease. Noteworthy, the adverse reactions of the antiviral drugs should be paid careful attention during the treatment.

A Protocol for Transverse Cardiac Slicing and Optical Mapping in Murine Heart

Thin living tissue slices have recently emerged as a new tissue model for cardiac electrophysiological research. Slices can be produced from human cardiac tissue, in addition to small and large mammalian hearts, representing a powerful in vitro model system for preclinical and translational heart research. In the present protocol, we describe a detailed mouse heart transverse slicing and optical imaging methodology. The use of this technology for high-throughput optical imaging allows study of electrophysiology of murine hearts in an organotypic pseudo two-dimensional model. The slices are cut at right angles to the long axis of the heart, permitting robust interrogation of transmembrane potential (Vm) and calcium transients (CaT) throughout the entire heart with exceptional regional precision. This approach enables the use of a series of slices prepared from the ventricles to measure Vm and CaT with high temporal and spatial resolution, allowing (i) comparison of successive slices which form a stack representing the original geometry of the heart; (ii) profiling of transmural and regional gradients in Vm and CaT in the ventricle; (iii) characterization of transmural and regional profiles of action potential and CaT alternans under stress (e.g., high frequency pacing or β-adrenergic stimulation) or pathological conditions (e.g., hypertrophy). Thus, the protocol described here provides a powerful platform for innovative research on electrical and calcium handling heterogeneity within the heart. It can be also combined with optogenetic technology to carry out optical stimulation; aiding studies of cellular Vm and CaT in a cell type specific manner.

Cesarean Delivery Impacts Infant Brain Development

BACKGROUND AND PURPOSE

The cesarean delivery rate has increased globally in the past few decades. Neurodevelopmental outcomes associated with cesarean delivery are still unclear. This study investigated whether cesarean delivery has any effect on the brain development of offspring.

MATERIALS AND METHODS

A total of 306 healthy children were studied retrospectively. We included 3 cohorts: 2-week-old neonates (cohort 1, n = 32/11 for vaginal delivery/cesarean delivery) and 8-year-old children (cohort 2, n = 37/23 for vaginal delivery/cesarean delivery) studied at Arkansas Children's Hospital, and a longitudinal cohort of 3-month to 5-year-old children (cohort 3, n = 164/39 for vaginal delivery/cesarean delivery) studied independently at Brown University. Diffusion tensor imaging, myelin water fraction imaging, voxel-based morphometry, and/or resting-state fMRI data were analyzed to evaluate white matter integrity, myelination, gray matter volume, and/or functional connectivity, respectively.

RESULTS

While not all MR imaging techniques were shared across the institutions/cohorts, post hoc analyses showed similar results of potential effects of cesarean delivery. The cesarean delivery group in cohort 1 showed significantly lower white matter development in widespread brain regions and significantly lower functional connectivity in the brain default mode network, controlled for a number of potential confounders. No group differences were found in cohort 2 in white matter integrity or gray matter volume. Cohort 3 had significantly different trajectories of white matter myelination between groups, with those born by cesarean delivery having reduced myelin in infancy but normalizing with age.

CONCLUSIONS

Cesarean delivery may influence infant brain development. The impact may be transient because similar effects were not observed in older children. Further prospective and longitudinal studies may be needed to confirm these novel findings.

Gestational Age at Birth and Brain White Matter Development in Term-Born Infants and Children

BACKGROUND AND PURPOSE

Studies on infants and children born preterm have shown that adequate gestational length is critical for brain white matter development. Less is known regarding how variations in gestational age at birth in term infants and children affect white matter development, which was evaluated in this study.

MATERIALS AND METHODS

Using DTI tract-based spatial statistics methods, we evaluated white matter microstructures in 2 groups of term-born (≥37 weeks of gestation) healthy subjects: 2-week-old infants (n = 44) and 8-year-old children (n = 63). DTI parameters including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were calculated by voxelwise and ROI methods and were correlated with gestational age at birth, with potential confounding factors such as postnatal age and sex controlled.

RESULTS

Fractional anisotropy values, which are markers for white matter microstructural integrity, positively correlated (P < .05, corrected) with gestational age at birth in most major white matter tracts/regions for the term infants. Mean diffusivity values, which are measures of water diffusivities in the brain, and axial and radial diffusivity values, which are markers for axonal growth and myelination, respectively, negatively correlated (P < .05, corrected) with gestational age at birth in all major white matter tracts/regions excluding the body and splenium of the corpus callosum for the term infants. No significant correlations with gestational age were observed for any tracts/regions for the term-born 8-year-old children.

CONCLUSIONS

Our results indicate that longer gestation during the normal term period is associated with significantly greater infant white matter development (as reflected by higher fractional anisotropy and lower mean diffusivity, axial diffusivity, and radial diffusivity values); however, similar associations were not observable in later childhood.

Effects of acute aerobic exercise on neural correlates of attention and inhibition in adolescents with bipolar disorder

Executive dysfunction is common during and between mood episodes in bipolar disorder (BD), causing social and functional impairment. This study investigated the effect of acute exercise on adolescents with BD and healthy control subjects (HC) to test for positive or negative consequences on neural response during an executive task. Fifty adolescents (mean age 16.54±1.47 years, 56% female, 30 with BD) completed an attention and response inhibition task before and after 20 min of recumbent cycling at ~70% of age-predicted maximum heart rate. 3 T functional magnetic resonance imaging data were analyzed in a whole brain voxel-wise analysis and as regions of interest (ROI), examining Go and NoGo response events. In the whole brain analysis of Go trials, exercise had larger effect in BD vs HC throughout ventral prefrontal cortex, amygdala and hippocampus; the profile of these effects was of greater disengagement after exercise. Pre-exercise ROI analysis confirmed this 'deficit in deactivation' for BDs in rostral ACC and found an activation deficit on NoGo errors in accumbens. Pre-exercise accumbens NoGo error activity correlated with depression symptoms and Go activity with mania symptoms; no correlations were present after exercise. Performance was matched to controls and results survived a series of covariate analyses. This study provides evidence that acute aerobic exercise transiently changes neural response during an executive task among adolescents with BD, and that pre-exercise relationships between symptoms and neural response are absent after exercise. Acute aerobic exercise constitutes a biological probe that may provide insights regarding pathophysiology and treatment of BD.

Skin image retrieval using Gabor wavelet texture feature

OBJECTIVE

Skin imaging plays a key role in many clinical studies. We have used many skin imaging techniques, including the recently developed capacitive contact skin imaging based on fingerprint sensors. The aim of this study was to develop an effective skin image retrieval technique using Gabor wavelet transform, which can be used on different types of skin images, but with a special focus on skin capacitive contact images.

METHODS

Content-based image retrieval (CBIR) is a useful technology to retrieve stored images from database by supplying query images. In a typical CBIR, images are retrieved based on colour, shape, texture, etc. In this study, texture feature is used for retrieving skin images, and Gabor wavelet transform is used for texture feature description and extraction.

RESULTS

The results show that the Gabor wavelet texture features can work efficiently on different types of skin images. Although Gabor wavelet transform is slower compared with other image retrieval techniques, such as principal component analysis (PCA) and grey-level co-occurrence matrix (GLCM), Gabor wavelet transform is the best for retrieving skin capacitive contact images and facial images with different orientations. Gabor wavelet transform can also work well on facial images with different expressions and skin cancer/disease images.

CONCLUSION

We have developed an effective skin image retrieval method based on Gabor wavelet transform, that it is useful for retrieving different types of images, namely digital colour face images, digital colour skin cancer and skin disease images, and particularly greyscale skin capacitive contact images. Gabor wavelet transform can also be potentially useful for face recognition (with different orientation and expressions) and skin cancer/disease diagnosis.

Voxel-Based Morphometry and fMRI Revealed Differences in Brain Gray Matter in Breastfed and Milk Formula-Fed Children

BACKGROUND AND PURPOSE

Infant diets may have significant impact on brain development in children. The aim of this study was to evaluate brain gray matter structure and function in 8-year-old children who were predominantly breastfed or fed cow's milk formula as infants.

MATERIALS AND METHODS

Forty-two healthy children (breastfed: n = 22, 10 boys and 12 girls; cow's milk formula: n = 20, 10 boys and 10 girls) were studied by using structural MR imaging (3D T1-weighted imaging) and blood oxygen level-dependent fMRI (while performing tasks involving visual perception and language functions). They were also administered standardized tests evaluating intelligence (Reynolds Intellectual Assessment Scales) and language skills (Clinical Evaluation of Language Fundamentals).

RESULTS

Total brain gray matter volume did not differ between the breastfed and cow's milk formula groups. However, breastfed children had significantly higher (P < .05, corrected) regional gray matter volume measured by voxel-based morphometry in the left inferior temporal lobe and left superior parietal lobe compared with cow's milk formula-fed children. Breastfed children showed significantly more brain activation in the right frontal and left/right temporal lobes on fMRI when processing the perception task and in the left temporal/occipital lobe when processing the visual language task than cow's milk formula-fed children. The imaging findings were associated with significantly better performance for breastfed than cow's milk formula-fed children on both tasks.

CONCLUSIONS

Our findings indicated greater regional gray matter development and better regional gray matter function in breastfed than cow's milk formula-fed children at 8 years of age and suggested that infant diets may have long-term influences on brain development in children.

Impaired white matter development in extremely low-birth-weight infants with previous brain hemorrhage

BACKGROUND AND PURPOSE

Brain hemorrhage is common in premature infants. The purpose of the study is to evaluate white matter development in extremely low-birth-weight infants with or without previous brain hemorrhage.

MATERIALS AND METHODS

Thirty-three extremely low-birth-weight infants were prospectively enrolled and included in this institutional review board-approved study. Another 10 healthy term infants were included as controls. The medical records of the extremely low-birth-weight infants were reviewed for sonography diagnosis of intraventricular hemorrhage. All infants had an MR imaging examination at term-equivalent age for detection of previous hemorrhage, and their white matter was scored and compared among different groups. DTI measured fractional anisotropy values were also compared voxelwise by tract-based spatial statistics.

RESULTS

Compared with controls, the white matter score was not significantly different in extremely low-birth-weight infants without blood deposition on MR imaging (P = .17), but was significantly worse in extremely low-birth-weight infants with blood deposition on MR imaging but no intraventricular hemorrhage diagnosis by sonography (P = .02), in extremely low-birth-weight infants with grade 1 or 2 intraventricular hemorrhage on sonography (P = .003), and in extremely low-birth-weight infants with grade 3 or 4 intraventricular hemorrhage on sonography (P = .0001). Extremely low-birth-weight infants without blood deposition on MR imaging did not show any white matter regions with significantly lower fractional anisotropy values than controls. Extremely low-birth-weight infants with blood deposition on MR imaging, but no intraventricular hemorrhage diagnosis, did show white matter regions with significantly lower fractional anisotropy values, and extremely low-birth-weight infants with intraventricular hemorrhage diagnosis had widespread white matter regions with lower fractional anisotropy values.

CONCLUSIONS

Previous brain hemorrhage is associated with abnormal white matter in extremely low-birth-weight infants at term-equivalent age, and sonography is not sensitive to minor hemorrhages that are sufficient to cause white matter injury.

Association of XRCC5 polymorphisms with COPD and COPD-related phenotypes in the Han Chinese population: a case-control cohort study

Genome-wide association studies (GWAS) and integrative genomic approaches have demonstrated significant associations between chronic obstructive pulmonary disease (COPD) and polymorphisms of the X-ray repair cross-complementing protein 5 gene (XRCC5) in non-Asian populations. We investigated whether XRCC5 polymorphisms might be associated with COPD susceptibility and COPD-related phenotypes in the Chinese Han population. Nine single nucleotide polymorphisms (SNPs) (rs3821104, rs12470053, rs207936, rs3770498, rs6704622, rs3770492, rs4674066, rs7573191, and rs207906) in the XRCC5 gene were genotyped in a case-control study including 680 COPD patients and 687 controls. To estimate the strength of association, odds ratios (ORs) were calculated and the effects of potentially confounding variables were tested by logistic regression analysis. The association between haplotypes and COPD outcome was also assessed. Our data identified that the SNP rs207936 was associated with COPD with an adjusted P value of 0.038, which was also found when analyzing only data of current smokers (P=0.046). No significant associations were found between any of the SNPs and pulmonary function. Eight SNPs (rs3821104, rs12470053, rs207936, rs3770498, rs6704622, rs3770492, rs4674066, and rs7573191) showed strong linkage disequilibrium (R2≥0.9). Two major haplotypes were observed and showed a significant difference between case and control groups (P=0.0054 and 0.0081, respectively). The present study showed that the XRCC5 locus might be a contributor to COPD susceptibility in the Chinese Han population.

Central and peripheral arterial stiffness in patients after surgical repair of tetralogy of Fallot: implications for aortic root dilatation

OBJECTIVES

To test the hypotheses that (1) the central conduit arteries stiffen preferentially over the peripheral conduit arteries in patients with repaired tetralogy of Fallot (ToF); and (2) central arterial stiffening is related to aortic root dilatation.

DESIGN AND PATIENTS

Heart-femoral pulse wave velocity (PWV), femoral-ankle PWV, carotid augmentation index and body surface area-adjusted aortic sinotubular dimension were determined in 31 children after ToF repair and compared with those in 31 age-matched controls after left-to-right shunt repair. In addition, the PWVs and augmentation index were related to the sinotubular junction dimension.

SETTINGS

Tertiary paediatric cardiac centre.

RESULTS

Compared with controls, patients had significantly greater heart-femoral PWV (mean 666 (SD 151) v 587 (81) cm/s, p = 0.021) and carotid augmentation index (-14.1 (17.0)% v -25.2 (14.6)%, p = 0.016), whereas the right (888 (202) v 845 (207) cm/s, p = 0.42) and left (918 (227) v 851 (215) cm/s, p = 0.25) femoral-ankle PWVs were similar between the two groups. The sinotubular junction z score of patients was significantly greater than that of controls (4.7 (1.5) v 1.1 (1.4), p < 0.001). Univariate analysis showed that the sinotubular junction z score correlated positively with heart-femoral PWV (r = 0.43, p = 0.001) and carotid augmentation index (r = 0.46, p = 0.001). Multiple linear regression similarly identified heart-femoral PWV (beta = 0.30, p = 0.04) and carotid augmentation index (beta = 0.31, p = 0.04) (model R(2) = 0.26) as significant determinants of sinotubular junction z score.

CONCLUSIONS

The aorta stiffens in patients with repaired ToF, which may contribute to progressive dilatation of the aortic root in the long term.

Hirudin ameliorates intestinal radiation toxicity in the rat: support for thrombin inhibition as strategy to minimize side-effects after radiation therapy and as countermeasure against radiation exposure

BACKGROUND

The small bowel is a dose-limiting normal tissue in radiation therapy of malignancies in the abdomen and pelvis, as well as an important determinant of survival after non-therapeutic radiation exposure. Irradiation of normal tissues, including intestine, causes loss of vascular thromboresistance and upregulation of thrombin receptors. Radiation-induced endothelial dysfunction is thought to be involved in both early and delayed radiation responses. Hence, thrombin may be a potential target for ameliorating normal tissue radiation toxicity.

OBJECTIVE

To assess direct thrombin inhibition as a protective strategy against small bowel radiation toxicity.

METHODS

Rat small intestine was exposed to localized orthovoltage X-radiation. Recombinant hirudin, a direct thrombin inhibitor, or vehicle was infused from 2 days before irradiation to 14 days after irradiation. Structural, cellular, and molecular aspects of intestinal radiation injury were assessed at 2 weeks (early toxicity) and 26 weeks (chronic toxicity) after irradiation.

RESULTS

Compared with unirradiated intestine, irradiated intestine showed increased expression of tissue factor, increased immunoreactivity for enzymatically active thrombin, and increased extravascular fibrin(ogen) deposition. Hirudin treatment significantly attenuated radiation-induced mucosal damage (P = 0.04), reactive intestinal wall thickening (P = 0.02), transforming growth factor-beta immunoreactivity levels (P = 0.0002), and collagen III deposition (P = 0.003). The differences between hirudin-treated and control rats were more pronounced at 2 weeks than at 26 weeks after irradiation. Hirudin treatment did not affect postradiation granulocyte infiltration.

CONCLUSIONS

Short-term thrombin inhibition attenuates important aspects of intestinal radiation toxicity. Thrombin is a promising target for minimizing normal tissue injury after radiation therapy of cancer, as well as for protecting normal tissues from the adverse effects of non-therapeutic radiation exposure.

[The binding characteristics of insulin-MTX to insulin receptor]

OBJECTIVE

It has been reported that several kinds of tumors express increased insulin receptor and the molecules of insulin can be internalized in cells and may thence enter into the nuclei mediated by insulin receptor. In this study, we investigated the receptor binding characteristics of insulin-MTX for the possibility of using insulin as a carrier for carcinoma targeted therapy by receptor mediation.

METHODS

MTX(methotrexate) was covalently linked to insulin directly. The insulin-MTX conjugate was purified by polyacrylamine agarose gel electrophoresis and analysed by high performance liquid chromatography and SDS- polyacrylamine agarose gel electrophoresis. Histologically confirmed human hepatocellular carcinoma specimens were obtained from patients at surgery and immediately frozen under -80 degrees C. Cell membrane fractions were isolated by sucrose density gradient centrifugation. Competitive displacement of 125I-insulin with insulin and insulin-MTX binding to insulin receptor were carried out and the values of IC50 and Ki were calculated so as to observe the characteristics of insulin-MTX binding to insulin receptor.

RESULTS

Insulin-MTX competed as effectively as insulin with 125I-insulin for insulin receptor. The values of IC50 and Ki for insulin-MTX were 93.82 +/- 19.32 nmol/L and 91.88 +/- 16.86 nmol/L respectively, while the values of IC50 and Ki for insulin were 5.01 +/- 1.24 nmol/L and 4.85 +/- 1.12 nmol/L respectively.

CONCLUSION

Insulin-MTX could bind with insulin receptor with high affinity. The result demonstrates us that there is a possibility of using insulin as a carrier for carcinoma targeted therapy by receptor mediation.

Cloning and characterization of the 5'-flanking region of the rat glutamate-cysteine ligase catalytic subunit

Glutamate-cysteine ligase (GCL), the rate-limiting enzyme in glutathione synthesis, is made up of two subunits, a catalytic (heavy) subunit (GCLC) and a modifier (light) subunit (GCLM), which are differentially regulated. Increased hepatic GCLC expression occurs during rapid growth, oxidative stress and after ethanol treatment. To facilitate studies of GCLC transcriptional regulation, we have cloned and characterized a 1.8 kb 5'-flanking region of the rat GCLC (GenBank accession number AF218362). A consensus TATA box and one transcriptional start site are located at 302 and 197 nucleotides upstream of the translational start site, respectively. The promoter contains consensus binding sites for many transcription factors including nuclear factor kappaB (NF-kappaB) and activator protein 1 (AP-1). The rat GCLC promoter was able to efficiently drive luciferase expression in H4IIE cells. Sequential deletion analysis revealed that three DNA regions, -595 to -111, -1108 to -705 and -705 to -595, are involved in positive (the first two regions) and negative (the latter region) gene regulation. Specific protein binding to these regions was confirmed by DNase I footprinting and electrophoretic mobility-shift assays (EMSAs). Ethanol-fed livers exhibit increased protein binding to region -416 to -336 on DNase I footprinting analysis, which was found to be NF-kappaB and AP-1 on EMSA and supershift analysis. Acetaldehyde treatment of H4IIE cells led to a time- and dose-dependent increase in GCLC mRNA levels, binding of NF-kappaB and AP-1 to the GCLC promoter, and luciferase activity driven by the GCLC promoter fragment containing these binding sites.

Cloning and analysis of the rat glutamate-cysteine ligase modifier subunit promoter

Glutamate-cysteine ligase (GCL), the rate-limiting enzyme in glutathione (GSH) synthesis, is made up of two subunits, a catalytic (GCLC) and a modifier (GCLM) subunit, which are differentially regulated. Increased GCLM expression occurs under certain oxidative stress conditions. To facilitate studies of GCLM transcriptional regulation, we have cloned and characterized a 1.86-kb 5'-flanking region of the rat GCLM (GenBank Accession No. AF311745). A TATA-like element and one transcriptional start sites are located at 364 and 93 nucleotides upstream of the translational start site, respectively. The promoter contains consensus binding sites for many transcription factors including activator protein 1 (AP-1), transcription factor 11 (TCF11), heat shock transcription factor (HSF), and nuclear factor kappa B (NFkappaB). The rat GCLM promoter was able to drive efficiently luciferase expression in H4IIE cells. Sequential deletion analysis revealed DNA regions, -649 to -154 and -1251 to -649, are involved in positive and negative gene regulation, respectively. Candidate transcription factors were identified by DNase I footprinting.

[Clinical study: the effects of inhaling nitrous oxide for analgesia labor on pregnant women and fetus]

OBJECTIVE

To investigate the effect of the inhalation of nitrous oxide premixed with oxygen (50%:50%) for analgesia labor on maternal and fetus.

METHODS

A total of 100 cases of pregnant women were provided with nitrous oxide premixed with oxygen (50%:50%) (control group); Another 100 cases were provided only with oxygen (comparison group). Recording duration of the Labor, way of delivery, bleeding volume, Apgars score, blood gas analysis to maternal radius artery and fetal umbilical blood among all patients.

RESULTS

The effect for analgesia labor of the premixed gas was much better than that of control group, but there were no significant differences in time of labor, bleeding volume, Apgars score between the two groups.

CONCLUSIONS

The inhalation of nitrous oxide premixed with oxygen (50%:50%) for analgesia labor benefits pregnant women because of keeping them being a good mental and physical condition. The inhalation of nitrous oxide for analgesia labor is a safe, effective and easy method.

Genetic analysis of vesicular stomatitis virus-New Jersey from the 1995 outbreak in the western United States

OBJECTIVE

To compare molecular associations between the vesicular stomatitis virus (VSV)-New Jersey isolates of the 1995 outbreak with those from previous outbreaks between 1982 and 1985 in the western United States.

SAMPLE POPULATION

23 virus isolates considered representative of the 1995 outbreak of vesicular stomatitis.

PROCEDURE

Viral gene coding for surface-envelope protein G was evaluated by use of nucleotide sequencing and phylogenetic analysis.

RESULTS

Changes in up to 0.77% of the nucleotide bases and 1.35% of the amino acids were detected among the 1995 viral isolates, whereas changes in up to 3.2 and 2.9% of the nucleotides and amino acids, respectively, were found, compared with the 1982 to 1985 viruses. Insertions or deletions were not found in the entire gene, which spanned 1,554 nucleotide bases.

CONCLUSIONS AND CLINICAL RELEVANCE

Phylogenetic analysis indicated that the 1995 VSV-New Jersey belongs to a lineage distinct from that of the 1982 to 1985 viruses that caused previous outbreaks in the western United States. Furthermore, it also is distinct from strains from Central America and from the Georgian Hazelhurst strain.

Regulation of the promoters for the human bone morphogenetic protein 2 and 4 genes

The bone morphogenetic proteins 2 and 4 are known to be important in bone formation and are expressed in both the developing and adult mammalian bone. Understanding the regulation of these genes in osteoblasts may yield methods by which we can control expression to induce bone formation. We have isolated and characterized the human BMP-2 and BMP-4 promoters and report substantially more upstream sequence information than that which has been published. Human osteoblasts were found to have a single transcript initiation site that is conserved across species, rather than multiple start sites, as has previously been reported (Feng, J.Q., Harris, M.A., Ghosh-Choudhury, N., Feng, M., Mundy, G.R., Harris, S.E., 1994. Structure and sequence of mouse morphogenetic protein-2 gene (BMP-2): comparison of the structures and promoter regions of BMP-2 and BMP-4 genes. Biochim. Biophys. Acta 1218, 221-224; Heller, L.C., Li, Y., Abrams, K.L., Rogers, M.B., 1999. Transcriptional regulation of the Bmp2 gene. J. Biol. Chem. 274, 1394-1400; Sugiura, T., 1999. Cloning and functional characterization of the 5'-flanking region of the human bone morphogenetic protein-2 gene. Biochem. J. 338, 433-440). A series of promoter deletions for both human BMP-2 and BMP-4 fused to the luciferase reporter gene were analyzed thoroughly in human and murine osteoblastic cell lines. Several compounds and growth factors that stimulate general or osteogenic pathways were used to treat cells transfected with the promoter constructs. Retinoic acid compounds and the phorbol ester, PMA were found to stimulate BMP-2 and, to a lesser degree, BMP-4. The combination of all trans-RA and PMA caused a synergistic increase in BMP-2 promoter activity and endogenous mRNA. The RA stimulation appears to be an indirect effect on the BMP-2 promoter, as the most highly conserved RRE in the BMP-2 promoter was unable to functionally bind or compete for protein binding. Potential binding sites in both promoters for the bone-specific transcription factor, Cbfa-1, were found to specifically bind Cbfa-1 protein in osteoblast nuclear extracts; however, deletion of these sites did not significantly affect transcriptional activity of the promoters in osteoblasts. These data thus present new sequence and regulatory information for the human BMP-2 and BMP-4 promoters and clarify the human BMP-2 gene transcriptional start site in osteoblasts.

[The use of insulin as carrier in targeted therapy]

Upon insulin binding to its receptor, the receptor-ligand complexes will be internalized into the target cell. The internalized insulin will leave the endosome and associate with the nuclear matrix. This process might be useful for targeted therapy. Some complex can link with the insulin be internalized into the target cell by insulin receptor-mediated endocytosis and enter the cell nuclei to cure some diseases.

[Determination of micro amounts of calcium and magnesium in saturated high purity sodium chloride solution by FAAS]

Micro amounts of calcium and magnesium in saturated high purity sodium chloride solution were determined by flame atomic absorption spectrometry after the preseparation of calcium and magnesium from matrix solution through ion-exchange resin column filled with model 401 chelate resin. The parameters and operating conditions of the preseparation of calcium and magnesium from matrix solution were studied by orthogonal optimization process. The relative standard deviations of this method were 6.5% and 5.5% for calcium and magnesium, respectively. The recoveries were 99% and 94% for calcium and magnesium, respectively.