Imbalance of Th1 and Th2 Cytokines and Stem Cell Therapy in Pathological Pain

The pathophysiological importance of T helper 1 (Th1) and Th2 cell cytokines in pathological pain has been highly debated in recent decades. However, the analgesic strategy targeting individual cytokines still has a long way to go for clinical application. In this review, we focus on the contributions of Th1 cytokines (TNF-α, IFN-γ, and IL-2) and Th2 cytokines (IL-4, IL-5, IL-10, and IL-13) in rodent pain models and human pain-related diseases. A large number of studies have shown that Th1 and Th2 cytokines have opposing effects on pain modulation. The imbalance of Th1 and Th2 cytokines might determine the final effect of pain generation or inhibition. However, increasing evidence indicates that targeting the individual cytokine is not sufficient for the treatment of pathological pain. It is practical to suggest a promising therapeutic strategy against the combined effects of Th1 and Th2 cytokines. We summarize the current advances in stem cell therapy for pain-related diseases. Preclinical and clinical studies show that stem cells inhibit proinflammatory cytokines and release enormous Th2 cytokines that exhibit a strong analgesic effect. Therefore, a shift of the imbalance of Th1 and Th2 cytokines induced by stem cells will provide a novel therapeutic strategy against intractable pain. It is extremely important to reveal the cellular and molecular mechanisms of stem cell-mediated analgesia. The efficiency and safety of stem cell therapy should be carefully evaluated in animal models and patients with pathological pain.

Chemokine receptor CXCR2 in primary sensory neurons of trigeminal ganglion mediates orofacial itch

The CXCR2 chemokine receptor is known to have a significant impact on the initiation and control of inflammatory processes. However, its specific involvement in the sensation of itch is not yet fully understood. In this study, we aimed to elucidate the function of CXCR2 in the trigeminal ganglion (TG) by utilizing orofacial itch models induced by incision, chloroquine (CQ), and histamine. Our results revealed a significant up-regulation of CXCR2 mRNA and protein expressions in the primary sensory neurons of TG in response to itch stimuli. The CXCR2 inhibitor SB225002 resulted in notable decrease in CXCR2 protein expression and reduction in scratch behaviors. Distal infraorbital nerve (DION) microinjection of a specific shRNA virus inhibited CXCR2 expression in TG neurons and reversed itch behaviors. Additionally, the administration of the PI3K inhibitor LY294002 resulted in a decrease in the expressions of p-Akt, Akt, and CXCR2 in TG neurons, thereby mitigating pruritic behaviors. Collectively, we report that CXCR2 in the primary sensory neurons of trigeminal ganglion contributes to orofacial itch through the PI3K/Akt signaling pathway. These observations highlight the potential of molecules involved in the regulation of CXCR2 as viable therapeutic targets for the treatment of itch.

[The clinical value of radical resection of retroperitoneal lipo-lymphatic layer for pancreatic head cancer]

Objective: To investigate the clinical value of the novel approach,radical resection of the retroperitoneal lipo-lymphatic layer (RRRLLL),in the surgical treatment of resectable pancreatic head cancer. Methods: Between June 2020 and June 2022,a total of 221 patients with pancreatic head cancer underwent surgical treatment using the RRRLLL approach(RRRLLL group),while 107 patients received traditional surgical treatment(traditional group) in five high-volume pancreatic centers in China. Data from surgical technique and clinical perioperative outcomes,including lymph node harvested,surgical time,and complications,were analyzed. The RRRLLL group consisted of 144 males and 77 females with an age of (67.5±9.0) years(range:41.3 to 81.1 years). The traditional group included 71 males and 36 females,with an age of (66.3±8.1) years(range:45.1 to 79.2 years). Statistical analysis was performed using the K-S test,Z test,or χ2 test. Results: Pancreaticoduodenectomy was performed successfully in all patients,achieving R0 resection. RRRLLL group surgery required mobilization of retroperitoneal adipose and lymphatic tissues starting from the right edge of the inferior vena cava and extending to the left side,up to the superior mesenteric artery,down to the inferior mesenteric artery,and left to the left side of the aorta,including the perineural and lymphatic tissues around the superior mesenteric artery and the sheath of the mesenteric artery. However,the traditional group did not include the areas mentioned above in the scope of clearance. There were no statistically significant differences between the RRRLLL group and the traditional group in terms of age,sex,tumor size,T stage,and vascular invasion (all P>0.05). However,the number of lymph nodes harvested in the RRRLLL group was significantly higher at 28.7±9.0 (range: 18 to 39) compared to 18.2±8.0 (range: 12 to 21) in the traditional group (Z=-10.691,P<0.05). There were no statistically significant differences in the number of positive lymph nodes,N staging,and postoperative complications between the two groups. Conclusion: The RRRLLL approach improved lymph node dissection compared to the traditional approach,potentially leading to reduced recurrence rates.

[Application of membrane anatomy in hepatopancreatobiliary and splenic surgery]

Understanding of a variety of membranous structures throughout the body,such as the fascia,the serous membrane,is of great importance to surgeons. This is especially valuable in abdominal surgery. With the rise of membrane theory in recent years,membrane anatomy has been widely recognized in the treatment of abdominal tumors,especially of gastrointestinal tumors. In clinical practice. The appropriate choice of intramembranous or extramembranous anatomy is appropriate to achieve precision surgery. Based on the current research results,this article described the application of membrane anatomy in the field of hepatobiliary surgery,pancreatic surgery,and splenic surgery,with the aim of blazed the path from modest beginnings.

[Current situation and problems of the clinical application of completely digital workflow in fixed prosthodontics]

Compared with traditional prosthodontic methods, digital prosthodontic technology greatly simplifies the treatment process of patients and improves the accuracy of prosthesis. The fully digital workflow is becoming an important direction of the development of fixed prosthodontics. It can not only effectively improve the efficiency, accuracy and predictability of prosthodontics, but also help the cooperation between multiple disciplines to ensure the systematic treatment. This article systematically discusses the concept process, key technology, material progress and application of completely digital prosthodontic process, as well as the remaining problems, in order to provide reference for its clinical application.

[Considerations of the classification and treatment for fused teeth]

Fused teeth were a phenomena of teeth anomalies in shape, which can affect the dental teeth both in primary and permanent dentition. Fused teeth do not only cause problems on crowding of dentition, abnormal occlusion and aesthetic, but also increase risks of dental caries, endodontics diseases, periapical diseases and periodontal diseases. Fusion of deciduous teeth may lead to abnormality of subsequent permanent teeth. Treatment of fused teeth may require multidisciplinary approach in endodontics, periodontics, oral and maxillofacial surgery, prosthodontics and orthodontics. The aim of the present article is to review the etiology, classification, clinical manifestations and treatment of fused teeth in order to provide dental clinicians with a reference of clinical management for fused teeth.

A non-canonical retina-ipRGCs-SCN-PVT visual pathway for mediating contagious itch behavior

Contagious itch behavior informs conspecifics of adverse environment and is crucial for the survival of social animals. Gastrin-releasing peptide (GRP) and its receptor (GRPR) in the suprachiasmatic nucleus (SCN) of the hypothalamus mediates contagious itch behavior in mice. Here, we show that intrinsically photosensitive retina ganglion cells (ipRGCs) convey visual itch information, independently of melanopsin, from the retina to GRP neurons via PACAP-PAC1R signaling. Moreover, GRPR neurons relay itch information to the paraventricular nucleus of the thalamus (PVT). Surprisingly, neither the visual cortex nor superior colliculus is involved in contagious itch. In vivo calcium imaging and extracellular recordings reveal contagious itch-specific neural dynamics of GRPR neurons. Thus, we propose that the retina-ipRGC-SCN-PVT pathway constitutes a previously unknown visual pathway that probably evolved for motion vision that encodes salient environmental cues and enables animals to imitate behaviors of conspecifics as an anticipatory mechanism to cope with adverse conditions.

It has been shown that GRP-GRPR neuropeptide signaling in the SCN is important for contagious itch behavior in mice. Gao et al. find that SCN-projecting ipRGCs are sufficient to relay itch information from the retina to the SCN by releasing neuropeptide PACAP to activate the GRP-GRPR pathway.

Inhibitions and Down-Regulation of Motor Protein Eg5 Expression in Primary Sensory Neurons Reveal a Novel Therapeutic Target for Pathological Pain

The motor protein Eg5, known as kif11 or kinesin-5, interacts with adjacent microtubules in the mitotic spindle and plays essential roles in cell division, yet the function of Eg5 in mature postmitotic neurons remains largely unknown. In this study, we investigated the contribution and molecular mechanism of Eg5 in pathological pain. Pharmacological inhibition of Eg5 and a specific shRNA-expressing viral vector reversed complete Freund's adjuvant (CFA)-induced pain and abrogated vanilloid receptor subtype 1 (VR1) expression in dorsal root ganglion (DRG) neurons. In the dorsal root, Eg5 inhibition promoted VR1 axonal transport and decreased VR1 expression. In the spinal cord, Eg5 inhibition suppressed VR1 expression in axon terminals and impaired synapse formation in superficial laminae I/II. Finally, we showed that Eg5 is necessary for PI3K/Akt signalling-mediated VR1 membrane trafficking and pathological pain. The present study provides compelling evidence of a noncanonical function of Eg5 in primary sensory neurons. These results suggest that Eg5 may be a potential therapeutic target for intractable pain.

[A new classification of intrahepatic cholangiocarcinoma based on actual anatomy:a series of 135 cases]

Objective: To explore the feasibility and clinical value of a new classification for resectable intrahepatic cholangiocarcinoma (IHCC) according to the actual anatomy. Methods: The data of 135 patients with IHCC who were admitted to the Department of Hepatopancreatobiliary Surgery,Second Affiliated Hospital of Zhejiang University School of Medicine from November 2011 to November 2020 after discussion by a multidisciplinary team and planned to undergo radical resection were analyzed retrospectively. There were 77 males and 58 females,with a median age of 61 years (range:26 to 86 years),of which 38 cases had vascular invasion. This new classification was carried out independently by two hepatobiliary surgeons. First,a preliminary classification was made based on the location of the tumor,and then the final classification was based on vascular invasion. All patients were followed up by telephone,and the follow-up was as of November 2020. Survival time is defined as the time after surgery to follow-up or death. Log-rank test was used to compare patients' median recurrence-free survival and overall survival time. The Cox proportional hazard model was used to analyze the prognosis factors of the overall survival time of patients with IHCC. Results: Among the 135 patients,129 underwent R0 resection and 6 underwent R1 resection. According to the actual anatomy,28 cases (20.7%) belonged to segmental type, 43 cases (31.9%) belonged to branch type, 64 cases (47.4%). The median survival time of all patients was 35.2 months(95%CI:21.3 to 70.5 months),the 1-year cumulative survival rate was 75.1%,the 3-year cumulative survival rate was 45.8%,and the 5-year cumulative survival rate was 39.0%. After grouping according to the classification,the median survival time of segmental patients was 36.9 months (more than 50% of patients reached the median survival time),and the median survival time of branched patients was 33.8 months (95%CI:16.8 to 38.5);The median survival time of lobe patients was 25.0 months (95%CI:13.6 to 58.7). The result of Log-rank test between groups indicated that the median survival time of patients with segmental type was better than that of patients with branch and lobe type(HR=2.03,95%CI:1.24 to 3.64,P=0.006);There was no significant difference in survival time between patients with branch type and lobe type (P=0.685). The results of the multivariate analysis of the Cox risk ratio model suggested that the actual anatomical location classification (HR=2.32,95%CI:1.10 to 4.92,P=0.028) and the postoperative lymph node metastasis rate (HR=2.06,95%CI:1.24 to 3.45,P=0.005) were independent factors related to survival after radical resection of IHCC patients. Conclusion: It is simple and convenient to classify resectable IHCC by actual anatomy,which can be used to preliminarily judge the prognosis of patients and provide a feasible classification scheme for the clinic.

[Alteration on hepatocyte nuclear factor 1α expressions and significance in the process of occurrence and development of liver inflammation and fibrosis in patients with chronic hepatitis B]

Objective: To investigate the relationship between the expression of hepatocyte nuclear factor-1 α (HNF-1α) and the occurrence and development of liver inflammation and fibrosis in liver tissues of patients with chronic hepatitis B. Methods: Sixty-four patients with chronic hepatitis B who were diagnosed and treated in our hospital from 2011 to 2018 were selected. All patients underwent ultrasound-guided aspiration liver biopsy. The pathological results of liver biopsy were collected for inflammation grading and fibrosis staging. The liver puncture biopsies was collected by paraffin sectioning. The expression of HNF1α in the liver tissue was detected by immunohistochemical staining. Mantel-Haenszel χ(2) test was used for bidirectional ordered grouping data, and Spearman's rank-correlation test was used for rank correlation analysis. Results: There were varying degrees of inflammatory necrosis and fibrosis in the liver tissues of patients with chronic hepatitis B. There was a linear relationship between the expression of HNF1α and the level of inflammation in liver tissues (χ (2)(MH) = 40.70, P < 0.05). The expression of HNF1α in liver tissues of patients with chronic hepatitis B was decreased with the increase of liver inflammation. The expression intensity of HNF1α was negatively correlated with the inflammation grade (r(s) = -0.815, P < 0.05). There was a linear relationship between the expressions of HNF1α and the degree and stage of liver fibrosis (χ (2)(MH) = 31.95, P < 0.05). The expression level of HNF1α in liver tissue was gradually decreased with the aggravation of liver fibrosis. The expression intensity of HNF1α was negatively correlated with fibrosis stage (r(s) = -0.713, P < 0.05). Conclusion: HNF1α is closely related to the occurrence and development of liver tissue inflammation and fibrosis, and is expected to be a sensitive indicator for evaluating the level of liver tissue inflammation and fibrosis in patients with chronic hepatitis B. In addition, its down-regulation may be involved in the process of occurrence and development of liver inflammation and liver fibrosis, and may become a new target for the treatment of chronic hepatitis B.

[Exposure to famine in fetus and infant period and risk for hypertension in adulthood]

Objective: To investigate the relationship between exposure to famine in fetus and infant period and the risks for hypertension in adulthood. Methods: A total of 5 960 participants born between 1956 and 1965 were included in the study and were divided into unexposed group (1963-1965), fetal exposed group (1959-1961), early- childhood exposed group (1956-1958) and transitional group (1962). Logistic regression model was used to explore the association between famine exposure in early life and the risk for hypertension in adulthood. Results: Both the fetal exposure and the early-childhood exposure were the risk factors for hypertension in adulthood (OR=1.249, 95%CI: 1.049-1.486 and OR=1.360, 95%CI: 1.102-1.679). Meanwhile, in rural area, compared with unexposed group, the fetal exposure (OR=1.401, 95%CI: 1.091-1.798) and the early-childhood exposure (OR=1.460, 95%CI: 1.145-1.862) were also associated with a greater risk of hypertension in adulthood. In addition, fetal exposure and early-childhood exposure to famine in women were associated with 36.0% and 31.9% increased risks for hypertension (95%CI: 7.8%-71.7% and 95%CI: 4.8%-66.0%) according to the stratified analysis. Conclusion: Fetal exposure to famine might increase the risk for hypertension in adulthood.

[Factors related to antiretroviral therapy among HIV/AIDS positive students aged 15-30, in a hospital of Shenyang city]

Objective: To investigate the risk factors on antiretroviral therapy (ART) among HIV/AIDS positive students in Shenyang. Methods: A cross-sectional study was conducted among HIV/AIDS positive students aged between 15 and 30, in an HIV-treatment-designated hospital in Shenyang city, during 2007-2015. Data were analyzed by multivariate logistic regression mode to identify the risk factors related to ART. Results: A total of 2 379 HIV/AIDS patients attended the hospital and 6.1% (146/2 379) of them were students, during 2007-2015. All of the HIV/AIDS positive students were males, with homosexual transmission accounted for 93.2% (136/146). The overall rate on delayed diagnosis was 52.7% (77/146), when at diagnosis of CD(4)(+)T lymphocyte counts ≤350 cells/μl. The proportion of ART was 67.1% (98/146). Factors as: year that the HIV diagnosis was made (aOR=1.21, 95%CI: 1.02-1.44), age between 24-30 (compared with age below 18-year-old, aOR=8.15, 95%CI: 1.46-45.52), and delayed diagnosis (aOR=2.22, 95%CI: 1.05-4.71), appeared independently related to ART among HIV/AIDS positive students. Conclusions: Factors as the year that HIV diagnosis was made, age and delayed diagnosis of the patients seemed to be at higher risk for ART among HIV/AIDS positive students.

[The Correlation Analysis of Turnover Intention,Moral Distress and Stressor in Nurses]

Objective: To explore the turnover intention of nurses in Quzhou and its influential factors. Methods: From July to August in 2017 cross-sectional study and self-filled questionnaire are used to investigate 980 nurses from 7 hospitals in Quzhou, including two third-level hospitals and five second-level ones. T-test, F-test, Pearson and linear regression are used in data with the method of statistical analysis. Results: The total score of turnover intention of nurses was (14.95±3.17) points, and the index value was 62.27%, of which the turnover intention was above 78%. The analysis of Single factor showed that age (F=4.895) , Department (F=2.971) , title, nursing age (F=5.863) , self-assessment of physical conditions (F=4.092) were closely related to nurses' turnover intention(P<0.05). According to Person's correlation analysis, there are positive correlations between turnover intention and source of stressor, and moral distress (P<0.05) . Multiple linear regression showed that the nurses' turnover intention was age, Department, health selfevaluation, stressor and moral distress. Conclusion: The turnover intention of nurses is high, which is related to age, Department, self-evaluation of health, stressor and moral distress.

[Effects of Porphyromonas endodontalis lipopolysaccharides on the expression of matrix metalloproteinase-9 in mouse osteoblasts]

Objective: To evaluate the effects of lipopolysaccharides (LPS) extracted from Porphyromonas endodontalis (Pe) on the expression of matrix metalloproteinase-9 (MMP-9) mRNA and protein as well as enzyme activity in MC3T3-E1 cells and the role of nuclear factor-κB (NF-κB) in the process, so as to investigate the expression of MMP-9 dependent signaling pathways in mouse osteoblasts induced by Pe LPS. Methods: The experiment was conducted in 3 sessions: MC3T3-E1 cells were treated with various concentrations of Pe LPS (0-20 mg/L) and 10 mg/L Pe LPS for different time intervals (0-48 h). The expression of MMP-9 mRNA and protein were detected by real-time reverse transcription-PCR (RT-PCR) and enzyme-linked immunosorbent assay (ELISA), while the enzyme activity was detected by gelatin zymography method. The expression of MMP-9 mRNA was also detected in 10 mg/L Pe LPS treated MC3T3-El cells after pretreated with specific NF-κB inhibitor BAY 11-7082 for l h. Statistical analysis was performed using one-way ANOVA and Dunnett t test with SPSS 13.0 software package. Results: The levels of MMP-9 mRNA and protein increased significantly after the treatment with various concentrations of Pe LPS (0-20 mg/L), which indicated that Pe LPS induced osteoblasts to express MMP-9 in dose dependent manners. The expression of MMP-9 protein increased from (5 395±362) ng/L (blank control group) to (12 684±375) ng/L (20 mg/L group). Maximal induction of MMP-9 mRNA expression was found in the MC3T3-E1 cells treated with 10 mg/L Pe LPS for 24 h. The expression of MMP-9 mRNA in the 20 mg/L group was about 7 times than that in the blank control group. After 24 h, the expression of MMP-9 mRNA decreased. Maximal expression of MMP-9 protein was found in the MC3T3-E1 cells treated with 10 mg/L Pe LPS for 48 h ([35 055±2 346] ng/L) showing the highest enzyme activity. The mRNA of MMP-9 decreased significantly after pretreatment with 10 µmol/L BAY 11-7082 for 1 h. Conclusions: Pe LPS might induce the expression of MMP-9 in MC3T3-E1 cells through the signaling of NF-κB.

Invasiveness-triggered state transition in malignant melanoma cells

Cancer cells are considered to have high morphological heterogeneity in human melanoma tissue. Here, we report that epithelial cancer cells are dominant in different development stages of human melanoma tissues. The cellular and molecular mechanisms that maintain melanoma cells in the epithelial state are further investigated in the A2058 cell line. We find that micropore (8 µm) transwell invasion, but not superficial migration in the scratch assay, can induce remarkable morphological changes between epithelial and mesenchymal melanoma cells within 4 days. The morphological switch is associated with dynamic changes of epithelial-mesenchymal transition (EMT) hallmarks E-cadherin and vimentin. Further immunoflurencent staining and co-immunoprecipitation assay showed the uncoupling of the M3 muscarinic acetylcholine receptor (mAChR) and the p75 neurotrophin receptor (p75NTR) in epithelial melanoma cells. Specific knockdown of M3 mAChR by small interfering RNA (siRNA) significantly abrogates the transition of spindle-shaped mesenchymal cells to epithelial cells. Collectively, we report a cellular model of invasiveness-triggered state transition (ITST) in which melanoma cell invasion can induce morphological changes between epithelial and mesenchymal cells. ITST is one of the biological basis for maintaining metastatic melanoma cells in the epithelial state. Furthermore, M3 mAChR receptor-mediated ITST provides a novel therapeutic strategy to inhibit the development of malignant melanoma.

Validating Rat Model of Empathy for Pain: Effects of Pain Expressions in Social Partners

Pain can be socially transferred between familiar rats due to empathic responses. To validate rat model of empathy for pain, effects of pain expressions in a cagemate demonstrator (CD) in pain on empathic pain responses in a naïve cagemate observer (CO) after 30 min priming dyadic social interactions (PDSI) were evaluated. The CD rats were prepared with four pain models: bee venom (BV), formalin, complete Freund's adjuvant (CFA), and spared nerve injury (SNI). Both BV and formalin tests are characterized by displayable and eye-identifiable spontaneous pain-related behaviors (SPRB) immediately after treatment, while CFA and SNI models are characterized by delayed occurrence of evoked pain hypersensitivity but with less eye-identifiable SPRB. After 30 min PDSI with a CD immediately after BV and formalin, respectively, the empathic mechanical pain hypersensitivity (EMPH) could be identified at both hind paws in CO rats. The BV—or formalin-induced EMPH in CO rats lasted for 4–5 h until full recovery. However, EMPH failed to develop in CO after socially interacting with a CD immediately after CFA, or 2 h after BV when SPRB completely disappeared. The CO's EMPH was partially relieved when socially interacting with an analgecized CD whose SPRB had been significantly suppressed. Moreover, repeated exposures to a CD in pain could enhance EMPH in CO. Finally, social transfer of pain hypersensitivity was also identified in CO who was being co-housed in pairs with a conspecific treated with CFA or SNI. The results suggest that development of EMPH in CO rats would be determined not only by extent of familiarity but also by visually identifiable pain expressions in the social partners during short period of PDSI. However, the visually unidentifiable pain can also be transferred to naïve cagemate when being co-housed in pairs with a distressed conspecific. In summary, the vicariously social contagion of pain between familiar rats is dependent upon not only expressions of pain in social partners but also the time that dyads spent in social communications. The rat model of empathy for pain is a highly stable, reproducible and valid model for studying the neural mechanisms of empathy in lower animals.

Molecular and neural basis of contagious itch behavior in mice

Socially contagious itch is ubiquitous in human society, but whether it exists in rodents is unclear. Using a behavioral paradigm that does not entail prior training or reward, we found that mice scratched after observing a conspecific scratching. Molecular mapping showed increased neuronal activity in the suprachiasmatic nucleus (SCN) of the hypothalamus of mice that displayed contagious scratching. Ablation of gastrin-releasing peptide receptor (GRPR) or GRPR neurons in the SCN abolished contagious scratching behavior, which was recapitulated by chemogenetic inhibition of SCN GRP neurons. Activation of SCN GRP/GRPR neurons evoked scratching behavior. These data demonstrate that GRP-GRPR signaling is necessary and sufficient for transmitting contagious itch information in the SCN. The findings may have implications for our understanding of neural circuits that control socially contagious behaviors.

Response to Comment on "Molecular and neural basis of contagious itch behavior in mice"

Liljencrantz et al report the failure of observing contagious itch behavior using mice injected with histamine as the demonstrators. Analysis of their results shows that the histamine model is limited by inadequate frequency and duration of scratching bouts required for contagious itch test. To streamline the contagious itch test, the screen paradigm is highly recommended.

[Association of alcohol use and incidence of type 2 diabetes mellitus in the middle-aged and elderly male population: a prospective cohort study]

Objective: To investigate the association between alcohol use and incidence of type 2 diabetes mellitus (T2DM) in the middle-aged and elderly male population. Methods: All participants were from Dongfeng-Tongji cohort, 27 009 retired employees from Dongfeng Motor Corporation in Hubei Province were enrolled in the Dongfeng-Tongji cohort baseline survey in 2008. In baseline study, information of alcohol use and other covariates were collected by semi-structured questionnaire and all participants completed physical examination including the test of fasting glucose and blood lipid levels. A total of 6 784 male participants from Dongfeng-Tongji cohort who were without diagnosis of diabetes, coronary heart disease, stroke, or cancer in baseline study were enrolled in this study. We completed the first follow-up in 2013 and the outcome of disease or death was retrieved based on health-care medical records according to the unique medical insurance ID. Cox proportional hazard regression model was used to estimate the association between alcohol use and incidence of type 2 diabetes mellitus (T2DM), by drinking features and patterns. Results: Out of the 6 784 participants, 3 541 participant were defined as non-alcohol drinkers and there were 15 852.2 person-years of follow-up; among which 270 new cases of T2DM were diagnosed withthe crude incidence density of non-alcohol drinkers at 1 703.2/100 000 person-years. The other 3 243 subjects were classified as alcohol drinkers and there were 14 509.8 person-years of follow-up; and among which 258 new cases of T2DM were diagnosed, with the crude incidence density of T2DM at 1 778.1/100 000 person-years. Multivariate COX proportional hazard regression model indicated that there was no significantly increased risk of T2DM incidence between alcohol drinkers and non-alcohol drinkers(HR(95% CI): 1.09 (0.91- 1.30)). However, participants who averagely consumed >20 g/d or>7 times/week had a significantly increased risk of T2DM compared with non-alcohol drinkers, and the value of HR(95%CI) was 1.27 (1.02- 1.58) and 1.35 (1.00- 1.83), respectively. Among men who consumed alcoholic beverages more than 7 times/week, HR (95%CI) for T2DM incidence in the subjects who consumed 0.01 to 40 g and > 40 g once a time were 1.48 (1.05- 2.09) and 1.27 (0.80- 2.10), respectively. Conclusion: Although we found no relationship between alcohol use and T2DM incidence overall, alcohol use more than 20 g/d or more than 7 times/week would increase the risk of T2DM.

Temporal and spatial dynamics of peripheral afferent-evoked activity in the dorsal horn recorded in rat spinal cord slices

In the present study, multi-electrode array recording was used to examine dorsal horn activity following stimulation of primary afferents in a rat dorsal root attached-spinal cord slice preparation. The multi-electrode array probe was placed under the dorsal horn slice and local field potentials evoked by stimulation on the dorsal root were analyzed. Three kinds of dorsal root-evoked responses were identified. In lamina II_o, local field potentials exhibited P1 (peak latency 1.46±0.08ms), N1 (2.77±0.18ms, n=12), N2 (7.31±0.48ms), N3 (12.12±0.73ms) and P2(18.30±0.80ms) waves. In lamina II_i local field potentials exhibited P (1.99±0.10ms), N1 (3.35±0.17ms) and N2 (8.58±0.44ms) waves. In laminae III-VI, local field potentials exhibited P1 (3.01±0.07ms), P2 (7.02±0.21ms) and N waves (22.57±0.79ms). Sweep spread was calculated by two dimensional current source density (2D-CSD) analysis. Both α-amino-3-hydroxy-5-methylisoxazole-4-propionic a/kainate and N-methyl-d-aspartate-type glutamate receptors participated in this neuronal circuitry. Morphine diminished local field potentials. Gabapentin diminished the negative components in lamina II and P2 component in lamina II_o, but increased the positive components in lamina II_i and laminae III-VI. The present study revealed that functional dorsal horn activity was preserved in the spinal cord slice preparation. Glutamatergic synapses were crucially involved in information processing. Opioid interneurons and gabapentin may play a modulatory role in regulating signal flows in the dorsal horn. Taken together, these results identify a spatio-temporal profile of dorsal horn activity evoked by dorsal root stimulation, and implicate glutamatergic and opioidergic receptors and gabapentin in this activity.

[Association between 23 urinary metals and mean platelet volume among a community-dwelling population in Wuhan, China]

OBJECTIVE

To investigate the potential association between 23 urinary metals and mean platelet volume (MPV) among a community population in Wuhan.

METHODS

A total of 3 053 community residents who lived in the sampling buildings for more than 5 years, aged from 18 to 80 years, were recruited using a stratified, cluster sampling approach in Wuhan city, China. Blood and urine samples were obtained from participants in the morning under fasting conditions. Urinary metals, including aluminum, titanium, vanadium, chromium, manganese, iron, cobalt, nickel, copper, zinc, arsenic, selenium, rubidium, strontium, molybdenum, cadmium, tin, antimony, barium, tungsten, thallium, lead and uranium, were measured by inductively coupled plasma mass spectrometry. The MPV contents were determined using a fully automated clinical chemistry analyzer. Participants with missing data on covariates or cardiovascular disease were excluded. According to the reference intorvals of MPV for Chinese adults, the participants were classified into normal (7.0-11.0 fl) and high MPV (>11.0 fl) subgroups. Data from 2 203 participants were used to evaluate the associations between urinary metals and MPV levels using generalized linear regression models, and the risk of abnormal elevation of MPV using multivariable logistic regression models. The false discovery rate (FDR)-corrected P-value from 23 hypothesis tests was used to adjust for multiple testing.

RESULTS

After adjusting for potential confounders, urinary concentrations of arsenic (P50=2.431 μg/mmol creatinine) and molybdenum (P50=4.035 μg/mmol creatinine) were significantly associated with increased MPV levels and the risk of abnormal elevation of MPV. In contrast, urinary aluminum (P50=2.706 μg/mmol creatinine) and thallium (P50=0.046 μg/mmol creatinine) were associated with decreased MPV levels, but also the risk of abnormal elevation of MPV. The regression coefficients and 95% CIs were 0.119 (0.043-0.196) for arsenic (FDR-adjusted P=0.018), 0.119 (0.042-0.195) for molybdenum (FDR-adjusted P=0.018), -0.115 (-0.195--0.034) for aluminum (FDR-adjusted P=0.029), and -0.307 (-0.386- -0.228) for thallium (FDR-adjusted P<0.001), respectively. When comparing the extreme quartiles for arsenic, molybdenum, aluminum and thallium, adjusted OR and the 95%CIs were 1.830 (1.382-2.423), 1.496 (1.125-1.989), 0.566 (0.412-0.779) and 0.302 (0.219-0.416), respectively, and FDR-adjusted P-values were <0.001,<0.014,<0.008 and<0.001, respectively. Moreover, significant associations were found between an increased risk of abnormal MPV elevation with urinary iron (P50=6.716 μg/mmol creatinine) , antimony (P50=0.014 μg/mmol creatinine) and uranium (P50=0.003 μg/mmol creatinine) , and a decreased risk with urinary tungsten (P50=0.010 μg/mmol creatinine) and lead (P50=0.265 μg/mmol creatinine) . When comparing the extreme quartiles for iron, antimony and uranium, the respective adjusted OR (95%CI) were 1.866 (1.395-2.496), 1.507 (1.111-2.043) and 1.452 (1.063-1.984), and the respective FDR-adjusted P-values were <0.001,<0.022 and<0.012. The respective adjusted OR (95%CI) were 0.551 (0.417-0.726) and 0.534 (0.394-0.725), and the respective FDR-adjusted P-values were<0.001 and<0.001, when comparing the extreme quartiles for tungsten and lead. Based on multi-metal models, urinary chromium (P50=0.120 μg/mmol creatinine) and selenium (P50=0.646 μg/mmol creatinine) were associated with increased risk of abnormal MPV, while urinary nickel (P50=0.193 μg/mmol creatinine) was associated with decreased risk of abnormal MPV. When comparing the extreme quartiles for chromium, selenium and nickel, adjusted OR (95% CI) were 1.578 (1.054-2.363), 1.718 (1.159-2.549) and 0.535 (0.373-0.767), respectively, and the FDR-adjusted P-values were 0.017, 0.028 and 0.002, respectively.

CONCLUSION

In the general population of Wuhan city, exposure to aluminum, chromium, iron, nickel, arsenic, selenium, molybdenum, antimony, tungsten, thallium, lead and uranium were all associated with abnormal MPV elevation.

[Association between personal exposure to metals in fine particulate matter and urinary metals: baseline results from a panel study]

OBJECTIVE

To investigate the associations between 21 metals in fine particulate matter (PM2.5) and their corresponding concentrations in urine in the general population.

METHODS

Between April and May 2011, this panel study enrolled 120 residents using random sampling approach in Wuhan communities which contained 3 035 subjects. Participants were aged 18 to 80 years and had lived in the sampling buildings for at least 5 years. Data from basic questionnaires, physical examinations, and morning blood and urine samples under fasting conditions were collected. Participants with missing data were excluded. Finally, 83 particpants included. Participants were instructed to use personal air samplers to continuously monitor PM2.5 for 24 h. The following 21 metals were measured in PM2.5 and urine by inductively coupled plasma mass spectrometry: aluminum, titanium, vanadium, chromium, manganese, cobalt, nickel, copper, zinc, arsenic, selenium, rubidium, strontium, molybdenum, cadmium, tin, antimony, barium, tungsten, thallium and lead. The associations between PM2.5 metals and urinary metals were investigated using generalized linear regression models.

RESULTS

The age of the study population was (51.5±6.3)years. After adjusting for age, sex, smoking status, BMI, education and income, elevated urinary chromium was significantly associated with increased chromium concentrations in personal PM2.5. The least square means (standard deviation) of urinary chromium in participants classified as having low exposure (<12.491 ng/m(3)), intermediate exposure (12.491-32.388 ng/m(3)) and high exposure (>32.388 ng/m(3)) were (-1.334±0.756), (-1.114±0.813) and (-0.718±0.645) μg/mmol creatinine, respectively (P=0.009). However, the association between urinary and personal PM chromium was not observed after additionally adjusting for false discovery rate (P>0.05). Furthermore, the results demonstrated that other metals in PM2.5 were not related to their corresponding concentrations in urine of subjects.

CONCLUSION

Urinary concentrations of metals did not reflect human exposure to metals in air, and may not be appropriate as an index to assess personal exposure to metals in particulate matter.

Prevalence and patterns of multimorbidity in northeastern China: a cross-sectional study

OBJECTIVES

Information on multimorbidity in the general populations of developing countries is lacking. We examine the prevalence and patterns of multimorbidity in northeastern China.

STUDY DESIGN

A cross-sectional study was conducted on adult residents in Jilin Province, northeastern China from June 2012 to August 2012.

METHODS

Data were collected from a large cross-sectional study (n = 21,435) of adult community residents in Jilin Province in northeastern China. Multimorbidity, or co-morbidity, was defined as having two or more of 18 specified prevalent chronic diseases. A range of demographics, socio-economic factors, other risk factors and general mental health were used in describing the distribution of multimorbidity and in exploring the associations between them.

RESULTS

Almost a quarter (24.7%) of the adults were found to be multimorbid for chronic diseases. Multimorbidity was more common among older adults, women, rural residents and those with low income. Smoking, increasing BMI and psychological distress were independently associated with multimorbidity. Multimorbid patients were frequent users of primary care. Most dyads of chronic diseases co-occurred more frequently than would be expected on the basis of chance.

CONCLUSIONS

Researchers, clinicians and policy makers need to pay special attention to the health care challenges of multimorbidity and develop effective intervention strategies and programs to reduce the burden of multimorbidity.

Meta-analysis of differentially expressed genes in autism based on gene expression data

The purpose of this study was to identify differentially expressed (DE) genes and biological processes associated with changes in gene expression in autism. We performed a meta-analysis using new publicly available Gene Expression Omnibus (GEO) datasets of autism. We performed Gene Ontology (GO) enrichment analyses and pathway analysis using the Kyoto Encyclopedia of Genes and Genomes (KEGG). Ten GEO datasets, including 364 cases and 248 controls, were available for the meta-analysis. We identified 3105 genes that were consistently DE in autism (1425 upregulated and 1680 downregulated genes). We also found that 7 genes were associated with phospholipase A2 (PLA2), including LYPLA2P1, PLA2G4D, PNPLA2, LYPLA2, PLA2G6, PLA2G7, and PLA2G5. We found GO terms for molecular functions significantly enriched in structural constituent of ribosome (GO: 0003735, P = 1.87-E06) and transcription regulator activity (GO: 0030528, P = 8.86E-04), while for biological processes, the enriched GO terms were involved in translational elongation (GO: 0006414, P = 1.74E-12) and the response to cytokine stimuli (GO: 0034097, P = 2.76E-05). The most significant pathway in our KEGG analysis was the ribosome pathway (P = 7.90E-12). Our meta-analysis identified genes that were consistently DE and biological pathways associated with gene expression changes in autism.

Activation of tetrodotoxin-resistant sodium channel NaV1.9 in rat primary sensory neurons contributes to melittin-induced pain behavior

Tetrodotoxin-resistant (TTX-R) sodium channels NaV1.8 and NaV1.9 in dorsal root ganglion (DRG) neurons play important roles in pathological pain. We recently reported that melittin, the major toxin of whole bee venom, induced action potential firings in DRG neurons even in the presence of a high concentration (500 nM) of TTX, indicating the contribution of TTX-R sodium channels. This hypothesis is fully investigated in the present study. After subcutaneous injection of melittin, NaV1.8 and NaV1.9 significantly upregulate mRNA and protein expressions, and related sodium currents also increase. Double immunohistochemical results show that NaV1.8-positive neurons are mainly medium- and small-sized, whereas NaV1.9-positive ones are only small-sized. Antisense oligodeoxynucleotides (AS ODNs) targeting NaV1.8 and NaV1.9 are used to evaluate functional significance of the increased expressions of TTX-R sodium channels. Behavioral tests demonstrate that AS ODN targeting NaV1.9, but not NaV1.8, reverses melittin-induced heat hypersensitivity. Neither NaV1.8 AS ODN nor NaV1.9 AS ODN affects melittin-induced mechanical hypersensitivity. These results provide previously unknown evidence that upregulation of NaV1.9, but not NaV1.8, in small-sized DRG neurons contributes to melittin-induced heat hypersensitivity. Furthermore, melittin-induced biological effect indicates a potential strategy to study properties of TTX-R sodium channels.

Antisense-mediated knockdown of Na(V)1.8, but not Na(V)1.9, generates inhibitory effects on complete Freund's adjuvant-induced inflammatory pain in rat

Tetrodotoxin-resistant (TTX-R) sodium channels Na_V1.8 and Na_V1.9 in sensory neurons were known as key pain modulators. Comparing with the widely reported Na_V1.8, roles of Na_V1.9 on inflammatory pain are poorly studied by antisense-induced specific gene knockdown. Here, we used molecular, electrophysiological and behavioral methods to examine the effects of antisense oligodeoxynucleotide (AS ODN) targeting Na_V1.8 and Na_V1.9 on inflammatory pain. Following complete Freund's adjuvant (CFA) inflammation treatment, Na_V1.8 and Na_V1.9 in rat dorsal root ganglion (DRG) up-regulated mRNA and protein expressions and increased sodium current densities. Immunohistochemical data demonstrated that Na_V1.8 mainly localized in medium and small-sized DRG neurons, whereas Na_V1.9 only expressed in small-sized DRG neurons. Intrathecal (i.t.) delivery of AS ODN was used to down-regulate Na_V1.8 or Na_V1.9 expressions confirmed by immunohistochemistry and western blot. Unexpectedly, behavioral tests showed that only Na_V1.8 AS ODN, but not Na_V1.9 AS ODN could reverse CFA-induced heat and mechanical hypersensitivity. Our data indicated that TTX-R sodium channels Na_V1.8 and Na_V1.9 in primary sensory neurons played distinct roles in CFA-induced inflammatory pain and suggested that antisense oligodeoxynucleotide-mediated blocking of key pain modulator might point toward a potential treatment strategy against certain types of inflammatory pain.

Mediating roles of the vanilloid receptor TRPV1 in activation of rat primary afferent nociceptive neurons by formaldehyde

The formalin test is a commonly used animal model of acute and tonic pain. However, the molecular targets of formaldehyde (FA, the main ingredient of the formalin solution) on primary nociceptor cells remain controversial. In this report, the effects of FA on electrophysiologically-identified primary nociceptor cells were evaluated in vitro and the roles of the vanilloid receptor TRPV1 in FA-produced activation of primary nociceptors were also examined at both cellular and behavioral levels. Of 92 acutely dissociated dorsal root ganglion (DRG) cells recorded by current patch-clamp technique, 34% were discharged by FA application with the mean onset latencies of the first action potential (AP) being (367.34+/-32.96) s. All the FA-sensitive cells were identified as nociceptor cells by their distinguishable features of AP including longer duration, existence of a hump (a shoulder or inflection) on the repolarizing phase, and longer after-hyperpolarization of APs. Co-application of capsazepine (CPZ), a competitive antagonist of TRPV1 receptors, could block FA-evoked firing with partial inhibition on the membrane depolarization of all cells tested. Of another 160 cells examined by confocal calcium imaging, 32% were shown to respond to FA with an intracellular Ca(2+) rise. Of 51 FA-sensitive cells, 67% were suppressed by CPZ, suggesting partial involvement of TRPV1 in mediation of the FA-evoked intracellular Ca(2+) rise. Under voltage-clamp mode, 41% of DRG cells were evoked to give rise to inward current with the remaining 59% being unchanged. In separate experiments on the other 56 FA-sensitive cells, concentration-dependent increase in the FA-evoked current amplitude was demonstrated. In comparison with controls, the FA-evoked inward current could be significantly suppressed by CPZ that was further enhanced by HC-030031, a TRPA1 selective antagonist. Finally, local effects of CPZ were confirmed in the formalin test and it was shown that the formalin-induced paw flinches were strongly suppressed by CPZ in phase 1 but with phase 2 being significantly suppressed only during 25-55 min. It is therefore concluded that FA can directly activate a subpopulation of primary nociceptor cells and the FA-induced AP discharges are likely to contribute mainly to phase 1, but not phase 2 of the formalin-induced nociception. The activation of primary nociceptor cells by FA is likely to be mediated, at least in part, through TRPV1 and/or TRPA1 receptors.

Negative regulation of endogenous protein kinase Calpha on the dynamic change of carbachol-induced intracellular calcium response in different melanoma cells

Regulations of intracellular protein kinase C (PKC) on carbachol (CCh)-induced intracellular calcium ([Ca(2+)]i) responses were investigated in different stages of melanoma cells. We found that CCh (1 mM) significantly increased [Ca(2+)]i with 6-, 4-, 4-, and 25-folds intensities in WM793B, 451Lu, SK-MEL-5, and A2058 melanoma cells, respectively. Pretreatment of phorbol 12, 13-dibutyrate (PDBu, 2 microM), an activator of intracellular PKC, significantly suppressed CCh-induced peak reactions in WM793B, SK-MEL-5, and A2058 cells. RT-PCR data showed that mRNA levels of PKCalpha were 12-, 4-, 6-, and 0.9-folds higher in above four melanoma cells. Short interfering RNA (siRNA) targeting to PKCalpha in WM793B cells enhanced CCh-induced peak calcium reactions. Present data indicated that CCh-induced [Ca(2+)]i responses were dynamically changed in different stages of melanoma progression. Moreover, intracellular PKCalpha activated by exogenous agonist and expressed through endogenous gene transcription negatively regulated CCh-induced calcium responses. The functional analysis on the relationship between CCh-induced calcium response and endogenous PKCalpha expression might be helpful to predict the development of melanoma.

Activation of ERK1/2 in the primary injury site is required to maintain melittin-enhanced wind-up of rat spinal wide-dynamic-range neurons

Peripheral modulation of wind-up enhancement induced by peripheral tissue injury is investigated in rat spinal wide-dynamic-range (WDR) neurons. After subcutaneous (s.c.) injection of melittin, a pain-related peptidergic component separated from bee venom, the responsiveness of spinal cord WDR neuron to repeated suprathreshold (1.5T, the intensity threshold) electrical stimuli is enhanced. Comparing with the less effects on early response (0-100 ms), melittin significantly increases late response (100 ms to the next stimulus artifact) and after-discharge (starting from 2s after the last stimulus artifact) with 189% and 546%, respectively. Peripheral administration of a specific MEK inhibitor, 1,4-diamino-2,3-dicyano-1,4-bis-[o-aminophenylmercapto] butadiene (U0126, 1 microg) gradually suppresses, but not completely blocks melittin-enhanced wind-up to the similar level of baseline. The inhibitions of U0126 are mainly on late response and after-discharge with 49% and 65%, respectively. Peripheral administration of three doses of U0126 (0.1, 1, 10 microg) has no effects on melittin-induced local paw edema regardless of either pre- or post-treatment of the drug. We conclude that peripheral ERKs pathway in the primary injury site is required to maintain melittin-enhanced wind-up of rat spinal cord wide-dynamic-range neurons.

Extracellular signal-regulated kinases mediate melittin-induced hypersensitivity of spinal neurons to chemical and thermal but not mechanical stimuli

Subcutaneous melittin injection causes central plasticity at the spinal level in wide-dynamic-range (WDR) neurons, which are hypersensitive to various nociceptive stimuli. Previous behavioral studies demonstrated that the mitogen-activated protein kinases (MAPKs) extracellular signal-regulated kinase 1/2(ERK1/2), p38 MAPK, and c-Jun N-terminal kinase are involved in both peripheral and spinal processing of melittin-induced nociception and hypersensitivity. Yet the functional roles of the three MAPKs vary among different stimulus modalities, and must be further studied at the cellular level in vivo. In this report, extracellular single unit recordings were performed to investigate whether activation of ERK1/2 in the primary injury site of melittin is essential to the establishment of a spinally sensitized state. Localized peripheral administration of a single dose of the MEK inhibitor U0126 (1 μg/10 μl) significantly suppressed neuronal hyper-responsiveness to thermal stimulus and chemical (melittin)-induced tonic firing of WDR neurons after full establishment of a spinally sensitized state. However, U0126 failed to affect mechanical hypersensitivity to both noxious and non-noxious stimuli. Melittin-induced enhancement of thermal hypersensitivity was also greatly inhibited by a single dose of capsazepine, a thermal nociceptor (TRPV1) blocker. These results suggest that activation of the ERK signaling pathway in the periphery is likely necessary for maintenance of a spinally sensitized state; activation of ERK1/2 in the primary injury site may regulate TRPV1, leading to dorsal horn hypersensitivity to thermal and chemical stimuli. ERK signaling pathways are not likely to be associated with melittin-induced dorsal horn hypersensitivity to mechanical stimuli.

Ketamine inhibits polymorphonuclear leucocyte CD11b expression and respiratory burst activity in endotoxemic rats

OBJECTIVE AND DESIGN

To observe the effect of ketamine on polymorphonuclear leucocytes (PMN) adhesion and respiratory burst activity in endotoxemia rats.

MATERIALS

30 rats were randomly allocated to five groups: rats challenged with intraperitoneal injection of saline (saline group); challenged with intraperitoneal injection of LPS 10 mg/kg (LPS group); challenged with intraperitoneal injection of LPS 10 mg/kg and treated by intraperitoneal injection of ketamine 5, 25, 50 mg/kg at 0, 1, 2, 3, 4, 5 h after the injection of LPS, respectively (three ketamine treatment groups).

METHODS

PMN respiratory burst and CD11b expression were measured with flow cytometry at the end of 1 h, 4 h, and 6 h.

RESULTS

LPS challenge significantly increased PMN respiratory burst activity and CD11b expression when compared with the saline group (p < 0.01). There was a significant decrease in LPS-induced PMN respiratory burst activity and CD11b expression in three ketamine treatment groups when compared with LPS group (p < 0.01).

CONCLUSIONS

Ketamine significantly inhibits PMN CD11b expression and respiratory burst activity in endotoxemic rats.

Correlations between edema and the immediate and prolonged painful consequences of inflammation: therapeutic implications?

The precise relationship between the degree of pain and the degree of inflammation in the individual remains debated. A quantitative analysis simultaneously applied to the immediate and prolonged painful consequences of inflammation has not yet been done. Thus, the correlations between edema, nociception and hypersensitivity following an inflammatory insult were assessed in rodents. To better understand the therapeutic value of modifying specific aspects of inflammation, the effects of an anti-inflammatory drug were compared to the results. Inbred strains of mice and outbred rats received an intraplantar injection of honeybee venom and the between-group and within-group correlations were calculated for spontaneous nociceptive measures, thermal and mechanical hypersensitivity, and edema and temperature. The effect of indomethacin on the pain and inflammation measures was examined. Edema correlated with spontaneous flinching, licking and lifting of the injected paw (P< or =0.003), and not with thermal or mechanical hypersensitivity. Indomethacin affected edema and spontaneous nociception dose-dependently, and affected hypersensitivity only at the highest dose tested (P< 0.05). These results suggest that edema may contribute only to immediate spontaneous nociceptive responses to an inflammatory insult, and not to the more clinically relevant prolonged hypersensitivity. This analysis represents a method for determining which inflammatory processes are the most promising therapeutic targets against the multiple painful consequences of inflammation.

Activation of spinal extracellular signaling-regulated kinases by intraplantar melittin injection

Intraplantar injection of melittin, a major toxic peptide of whole bee venom, has been proved to cause alteration in both behavioral and spinal neuronal responses in rats. To see whether extracellular signaling-regulated kinases (ERK) in the spinal cord dorsal horn are activated and involved in induction and maintenance of persistent ongoing nociception, pain hypersensitivity and inflammation, three doses of U0126 (1,4-diamino-2,3-dicyano-1, 4-bis-[o-aminophenylmercapto]butadiene), a widely used specific MAP kinase kinase (MEK) inhibitor, were administered through chronic intrathecal catheterization prior to or after intraplantar injection of melittin. We found that: (1) the induction of melittin-induced persistent spontaneous nociception (PSN), mechanical and heat hypersensitivity could be suppressed by U0126 in a dose-related manner; (2) specific inhibition of ERK pathway suppressed the maintenance of melittin-induced PSN and heat hypersensitivity, while established mechanical hypersensitivity could not be reversed; and (3) intrathecal administration of U0126 had no effects on peripheral inflammation induced by melittin. This result suggests that spinal ERK pathway might be a common factor involved in inducing and maintaining pathophysiological processes of ongoing pain and heat hyperalgesia, while the role of ERK pathway in generation of the mechanical hypersensitivity is not consistent and remains to be further clarified.

Association study of neuregulin 1 gene with schizophrenia

A number of studies have indicated that 8p22-p12 is likely to harbor schizophrenia susceptibility loci. In this region, the candidate gene of interest, neuregulin 1 (NRG1), may play a role in the pathogenesis of schizophrenia. Then in the present study, we performed the linkage disequilibrium to determine the association between three genetic variants (SNPs: rs3924999, rs2954041, SNP8NRG221533) on NRG1 gene and schizophrenia in 246 Chinese Han schizophrenic family trios using PCR-based restriction fragment length polymorphism method and denaturing high-performance liquid chromatography. The transmission disequilibrium test analysis for each variant showed a significant difference between two transmitted alleles even after Bonferroni correction (rs3924999, P=0.007752; rs2954041, P=0.0009309; SNP8NRG221533, P=0.012606). The global chi(2) test for haplotype transmission also revealed a strong association (chi(2)=46.068, df=7, P&<0.000001). Our results suggest that the NRG1 gene may play a role in conferring susceptibility to the disease.

Naloxone increases vascular responsiveness in chronic morphine treated rats and facilitates intracellular signaling in cultured vascular cells

AIM

To probe the changes of vascular responsiveness and intracellular signaling during opiate withdrawal syndrome.

METHODS

Morphine withdrawal syndrome in rats was precipitated by iv naloxone following daily injection of increasing dose of morphine for 2 weeks, the changes in mean arterial blood pressure (MBP) caused by acetylcholine (ACh) were recorded. Isolated mesenteric vascular beds were perfused with Kreb's solution containing different concentration of drugs. The cytoplasmic Ca2+ ([Ca2+]i) in Fura 2-loaded cultured bovine aortic endothelial cells (aec) and smooth muscle cells (smc) were assayed. The positive immunoreaction to the phosphorylated cyclic AMP responsive element-binding protein (phospho-CREB) in cultured smc was calculated.

RESULTS

Naloxone 2 mg/kg iv following chronic morphine treatment precipitated severe opiate withdrawal signs in company with blunted hypotensive effect of Ach that was the same as chronic morphine treated rats before withdrawal. In the mesenteric vascular beds from chronic morphine treated rats, the EC50 of pressor effect of norepinephrine (NE) was decreased from (2.06 +/- 0.38) to (1.14 +/- 0.21) micromol/L (n = 8, P < 0.01) after the perfusion solution containing morphine 20 micromol/L was replaced by Kreb's containing naloxone 25 micromol/L. Furthermore, NE-induced perfusion pressure increases were completely prevented by Kreb's contained morphine 40 micromol/L. Morphine acutely applied to control smc produced some variable and naloxone-reversible [Ca2+]i changes, but naloxone did not. However, naloxone increased [Ca2+]i in two thirds of smc preincubated with morphine 0.1 or 0.5 mmol/L for 48 h from (97 +/- 20) to (167 +/- 29) nmol/L (n = 9, P < 0.01) and from (106 +/- 19) to (225 +/- 48) nmol/L (n = 10, P < 0.01), respectively, and it also increased the ratio of positive immunoreaction to phospho-CREB from (7.7 +/- 3.2) % to (19.6 +/- 4.7) % (n = 6, P < 0.01) in smc preincubated with morphine 0.5 mmol/L. In addition, naloxone decreased [Ca2+]i from (146 +/- 34) to (78 +/- 24) nmol/L in one third morphine-preincubated aec (n = 10, P < 0.01).

CONCLUSION

That naloxone enhances vascular responsiveness to NE in chronic morphine treatment rats may be relevant to [Ca2+]i transient facilitation in company with cAMP-dependent phosphorylation enhancement.

Complete resection of the caudate lobe of the liver with tumor: technique and experience

BACKGROUND/AIMS

To study the technique and curative effects of complete resection of the caudate lobe of the liver with tumors.

METHODOLOGY

There were 18 patients with tumors in the caudate lobe of the liver in this study. Among them, hepatocellular carcinoma was found in 12 patients, metastasis to the caudate lobe two years after resection of rectal carcinoma in one, cholangiocarcinoma in one, and huge benign tumor in four. Complete caudate lobectomy and combined with left lateral lobectomy or left hemihepatectomy or left trilobectomy were performed in this series.

RESULTS

The median operating time was 227 min and median blood loss was 1590 mL, and the median blood transfusion was 1520 mL. No operative or postoperative mortality, or any postoperative complications were found in any of the patients. The 1-, 3- and 5-year survival rates of the 12 patients with hepatocellular carcinoma were 58.3%, 55.5% and 37.8%, respectively. One patient with cholangiocarcinoma died in postoperative 4 months. One patient with metastatic rectal cancer has been alive for more than 5 years after the operation, and 4 patients with benign tumors are still alive and well.

CONCLUSIONS

Complete resection of the caudate lobe of the liver should be the first choice for removal of huge tumors originating from the caudate lobe, although this procedure is quite difficult and has a high risk factor.

[Pharmacokinetics and bioavailability of clinafloxacin in rats]

AIM

To study the pharmacokinetics and bioavailability of clinafloxacin in rats.

METHODS

The drug concentration was determined by HPLC. The main pharmacokinetic parameters were obtained by 3P87 program. An RP-C18 was used as the stationary phase. The mobile phase was a mixture of acetonitrile-0.05 mol.L-1 citric acid triethylamine (pH 2.5) (20:80). The flow rate was 1.0 mL.min-1. The UV absorbance detector was set at 300 nm.

RESULTS

A good linearity was obtained from 0.03-20 micrograms.mL-1 of clinafloxacin in rat plasma with gamma = 0.9998. The plasma concentration--time curve of clinafloxacin conformed to one compartment open model. After ig administration of 50 mg.kg-1 and 100 mg.kg-1 dose of clinafloxacin in six rats, mean Cmax and AUC values increased in proportion to dose. Mean T1/2 appeared to be independent of dose. Mean AUC was 65 +/- 6 and 27 +/- 4 micrograms.h.mL-1 respectively after i.v. and ig administration of 100 mg.kg-1 dose. The extent of bioavailability (F) of clinafloxacin was 42%.

CONCLUSION

The results of the pharmacokinetic study of clinafloxacin showed that it exhibited first order kinetic characteristics and the bioavailability is low.

Improved survival with resection after transcatheter arterial chemoembolization (TACE) for unresectable hepatocellular carcinoma

AIM

This retrospective study was undertaken to analyze the outcome of hepatic resection in hepatocellular carcinomas (HCCs) that shrunk after transcatheter hepatic arterial chemoembolization (TACE) in 65 patients with unresectable HCCs between June 1987 and September 1996.

MATERIALS AND METHODS

Among these 65 patients, the median diameter of the tumor was 9.9 cm (5.6-20.0) prior to the first TACE, after 1-6 times of TACE (median 3) the median tumor diameter reduced to 3.7 cm (1.9-12.5) prior to resection. The duration between the last TACE treatment and sequential resection varied from 1 to 9 months (median 2.5). Serum alpha-fetoprotein (AFP) levels were abnormal in 39 out of the 65 patients. In AFP producing HCCs, the AFP level returned to normal (</=20 microgram/l) in 14 out of 39 patients (35.9%). Hepatic segmentectomy, multiple hepatic segmentectomy or partial hepatic resection were performed in 61 patients, right hemihepatectomy in 1, left trisegmentectomy in 2, and left hemihepatectomy in 1.

RESULTS

Tumor necrosis ranged from 40 to 100% and pathologically and complete tumor necrosis occurred in 11 patients (16.9%). Of 14 patients with AFP levels decreased to normal, 10 still had microscopic living tumor foci. The 1-, 3- and 5-year survival rates of the 65 patients were 80.0, 65.0 and 56.0% respectively.

CONCLUSION

TACE treatment can provide a chance of tumor resection for those patients with initially judged unresectable HCCs, and liver resection should be performed when the tumor has shrunk to be resectable, even when the AFP level has returned to normal.

Plasticity of cadherin-catenin expression in the melanocyte lineage

Cadherins are calcium-dependent cell adhesion receptors with strong morphoregulatory functions. To mediate functional adhesion, cadherins must interact with actin cytoskeleton. Catenins are cytoplasmic proteins that mediate the interactions between cadherins and the cytoskeleton. In addition to their role in cell-cell adhesion, catenins also participate in signaling pathways that regulate cell growth and differentiation. Cadherins and catenins appear to be involved in melanocyte development and transformation. Here, we investigated the function of cadherin-catenin complexes in the normal development and transformation of melanocytes by studying the patterns of expression of the cell-cell adhesion molecules, E-, N- and P-cadherin, and the expression of their cytoplasmic partners, alpha-, beta- and gamma-catenin during murine development. Similar analyses were performed in vitro using murine melanoblast, melanocyte, and melanoma cell lines in the presence and absence of keratinocytes, the cells with which melanocytes interact in vivo. Overall, the results suggest that the expression of cadherins and catenins is very plastic and depends on their environment as well as the transformation status of the cells. This plasticity is important in fundamental cellular mechanisms associated with normal and pathological ontogenesis, as well as with tumorigenesis.

Radiation-induced arrest of cells in G2 phase elicits hypersensitivity to DNA double-strand break inducers and an altered pattern of DNA cleavage upon re-irradiation

PURPOSE

To determine how radiation-induced arrest in G2 affects the response of mammalian cells to a challenging dose of radiation or to antitumour drugs producing DNA double-strand breaks.

MATERIALS AND METHODS

V79 fibroblast survival to 5 Gy gamma-rays followed at intervals by 3 Gy irradiation or by contact with an equitoxic dose of neocarzinostatin or etoposide, was measured by clonogenic assays. The pattern of radiation-induced DNA double-strand breaks was determined by filter elution and CFGE (continuous field gel electrophoresis) or PFGE (pulsed-field gel electrophoresis) in G2-arrested cells as well as in nonpre-irradiated asynchronous or synchronized cells. The cell-cycle phase specificity of drug susceptibility was determined in synchronized HeLa cells.

RESULTS

Cell kill by radiation-drug combined treatment varied markedly with the time elapsed after priming irradiation. Pre-irradiated, G2-arrested V79 fibroblasts demonstrated excess double-stranded DNA cleavage upon re-irradiation and hypersensitivity to drugs and radiation, although maximum resistance to both neocarzinostatin and etoposide in synchronized HeLa cells was in G2. This effect occurred in the megabase range only, with a peak around 4 Mbp; no change in the electrophoretic migration profile of DNA was observed below 1 Mbp. Moreover, the DNA migration profile and the yield of DNA cleavage in G2-arrested cells were close to those expected from S-phase cells.

CONCLUSION

The available data suggest that mechanisms operating within the radiation-induced G2 block promote susceptibility to DNA double-strand break inducers at this stage. It is also proposed that the conformation of DNA in cells accumulated in G2 following irradiation bears resemblance to that for cells in S phase, due either to active repair mechanisms or to inhibition of chromosome disentanglement at the S-G2 transition.

Reactivity of Cl-P(+)-Cl toward cyclic organic ethers

The dichlorophosphenium ion (Cl-P(+)-Cl) undergoes a variety of reactions with cyclic organic ethers in the gas phase in a Fourier-transform ion cyclotron resonance mass spectrometer. Most of the reactions are initiated by Cl-P(+)-Cl-induced heterolytic C-O bond cleavage. However, the observed final products depend on the exact structure of the ether. For saturated ethers, e.g., tetrahydropyran, tetrahydrofuran, and 2-methyltetrahydrofuran, the most abundant ionic product corresponds to hydroxide abstraction by Cl-P(+)-Cl. This unexpected reaction is rationalized by a multistep mechanism that involves an initial heterolytic C-O bond cleavage accompanied by a 1,2-hydride shift, and that ultimately yields a resonance-stabilized allyl cation and HOPCl2. The process is estimated to be highly exothermic (AM1 calculations yield delta H = -(33-38) kcal mol(-1) for the ethers mentioned above). However, the adducts formed from most of the unsaturated ethers are unable to undergo hydride shifts and hence cannot react via this pathway. In some of these cases, e.g., for 2,5-dihydrofuran and 2,5-dihydro-3,4-benzofuran, the C-O bond heterolysis is followed by oxygen/chlorine exchange to yield the O=PCl radical and a resonance-stabilized carbocation (AM1 calculations yield delta H = -14 kcal mol(-1) for the reaction of 2,5-dihydro-3,4-benzofuran). Hydride abstraction by Cl-P(+)-Cl also yields an abundant product for these two ethers. On the other hand, the ethers with low ionization energies, such as 2,3-dihydrofuran and 2,3-dihydrobenzofuran, react with Cl-P(+)-Cl by electron transfer. Finally, a unique pathway, addition followed by elimination of HCl, dominates the reaction with furan. The observed reactions are rationalized by thermochemical data obtained from semiempirical molecular orbital calculations.

Progress and prospects in hepatocellular carcinoma surgery

Hepatocellular carcinoma (HCC), the second cause of cancer death in China, is responsible for 130,000 deaths every year. However, as a result of efforts in early detection and small HCC resection, re-resection for subclinical recurrence, cytoreduction and second-stage resection for unresectable HCC, and aggressive palliative surgery other than resection (hepatic artery ligation/cannulation, cryosurgery, etc.), and encouraging improvemental of long-term survival of inpatients has been observed in the authors' institution. In the entire series of 2672 HCC inpatients, the 5-year survival was 4.8% in 1958-70, 12.2% in 1971-83, and 46.7% in 1984-95. The 5-year survival rates were: 61.3% for small HCC resection (n = 645), 33.6% for large HCC resection (n = 950), 48.9% for re-resection (n = 147) calculated from the first resection, 67.9% for second-stage resection (n = 73), and 19.8% for palliative surgery (n = 574, including 73 with second-stage resection). By 1995, 239 HCC patients survived for more than 5 years. Recurrence and metastasis remained the major obstacles to more prolonged survival after HCC surgery. Molecular studies of HCC invasiveness, experimental intervention in the newly established highly metastatic model of human HCC in nude mice in the authors' institution have also been delineated. It is concluded that early detection and small HCC resection remain the major approach to improve survival. Aggressive surgical treatment, such as re-resection and second-stage resection, are also important, and invasiveness-related recurrence will be the next target to be studied.

Three decades' experience in surgery of hepatocellular carcinoma

In the author's institution, 2254 patients with hepatocellular carcinoma (HCC) have been treated during 1958-1994. The overall 5-year survival increased from 5.4% (1958-1970), to 11.9% (1971-1982), to 46.2% (1983-1984), which correlated well with the increasing proportion of small HCC in the series (2.6%, 12.1%, and 33.4%, respectively); with the increasing percentage of limited resection (3.1%, 32.2%, and 58.3%); with the increasing number of re-resections for recurrence (0, 27, and 114 patients); and with the increasing number of second stage resections (0, 5, and 67 patients). In our institution, surgical approaches that resulted in significantly prolonging survival included: small HCC resection, re-resection, and cytoreduction followed by sequential resection for initially unresectable HCC. Experience in these 3 aspects suggests: (a) Small HCCs are mainly found by screening using AFP and ultrasonography (US) in a high risk population, and limited resection is the best treatment in patients with compensated liver cirrhosis, the 5-year survival after resection being 62.9% (n = 549). (b) Postoperative monitoring using AFP/US every 2-3 months for 5-10 years after curative resection is needed to detect subclinical recurrence. Limited re-resection is indicated for liver recurrence less than 3 nodules, and lung lobectomy is of proven merit to prolong survival for solitary lung metastasis. Re-resection of subclinical recurrence has resulted in a 10-20% further increase in 5-year survival after curative resection. (c) Palliative surgery other than resection such as hepatic artery ligation (HAL) and cannulation with arterial infusion (HAI), cryosurgery, etc. are superior to palliative resection with residual cancer. (d) Cytoreduction and sequential resection have provided hope for localized unresectable HCC, particularly in the right cirrhotic liver. Multimodality combination treatments such as HAL+HAI+radioimmunotherapy/regional radiotherapy are acceptable cytoreductive therapies. Repeated transcatheter hepatic arterial chemoembolization (TACE) is an alternative nonsurgical approach. Sequential resection is important to eradicate residual cancer after cytoreduction. The 5-year survival of 72 patients with cytoreduction and sequential resection for initially unresectable HCC was 62.1% and resulted in improving 5-year survival in the entire series of unresectable HCC over the 3 periods from 0% to 7.4% to 25.7%, respectively. However, multicentric origin and tumor invasiveness are two major targets to be studied in the control of recurrence and metastasis.

Metastatic models of human liver cancer in nude mice orthotopically constructed by using histologically intact patient specimens

In this study of orthotopic implantation of histologically intact surgical specimens, the authors constructed metastatic models of human hepatocellular carcinoma (HCC) in nude mice. Histologically intact human liver cancer specimens, derived from patients, were implanted directly into the liver of nude mice, and their orthotopic growth and metastases were observed. The transplantability and metastatic rate of two specimen groups (primary and metastatic lesions) were analysed. alpha-Fetoprotein (AFP) was also determined in transplanted tumours by an immunohistochemical method. Orthotopic growth was observed in 14 of 30 transplanted specimens and formation of metastases in 7 cases, which exhibited the variety of clinical behaviours seen in patients with HCC. These behaviours included local growth, regional invasion, spontaneous intrahepatic, lymph node and lung metastasis and peritoneal seeding. In two groups the growth rate of metastatic lesions following implantation was clearly higher than that of primary tumours. Chromosome analysis from locally growing tumours confirmed their morphologically human origin. An immunohistochemical study showed that implanted tumours originating from AFP-positive specimens maintained AFP expression. These results indicated that the animal models should prove valuable for developing new treatment modalities and studying the mechanism of metastasis of human HCC.

Ablative approach for primary liver cancer: Shanghai experience

This article summarizes the results of 2018 patients receiving surgical treatment for pathologically proven primary liver cancer (PLC). Special references are made to the role of cryosurgery and cytoreduction for unresectable PLC.

Long-term results of surgery for small primary liver cancer in 514 adults

During 1958-1993, 2030 patients with pathologically proven primary liver cancer (PLC) were retrospectively reviewed. Comparison between small PLC (< or = 5 cm, n = 514) and large PLC (> 5 cm, n = 1516) revealed that small PLC had a higher resection rate (92.4% versus 49.1%), lower operative mortality (1.7% versus 5.2%), a higher percentage of single tumour nodules (78.0% versus 53.4%), a higher percentage of well encapsulated tumour (74.5% versus 35.8%) and higher survival rates after resection (5-year, 63.8% versus 36.6%; 10-year, 46.8% versus 28.5%). No significant difference was found between survival following limited resection (n = 440) and lobectomy (n = 34) in patients with small PLC. Re-resection of any subclinical recurrence or solitary pulmonary metastasis after small PLC resection was done in 70 cases. These results indicate that resection is still the modality of choice for treatment of small PLC; limited resection instead of lobectomy was the key to increasing resectability and decreasing operative mortality; re-resection of subclinical recurrence was important to prolong survival further.