Single-cell analysis reveals a unique microenvironment in peri-implantitis

AIM

This study aimed to reveal the unique microenvironment of peri-implantitis through single-cell analysis.

MATERIALS AND METHODS

Herein, we performed single-cell RNA sequencing (scRNA-seq) of biopsies from patients with peri-implantitis (PI) and compared the results with healthy individuals (H) and patients with periodontitis (PD).

RESULTS

Decreased numbers of stromal cells and increased immune cells were found in the PI group, which implies a severe inflammatory infiltration. The fibroblasts were found to be heterogeneous and the specific pro-inflammatory CXCL13+ sub-cluster was more represented in the PI group, in contrast to the PD and H groups. Furthermore, more neutrophil infiltration was detected in the PI group than in the PD group, and cell-cell communication and ligand-receptor pairs revealed most neutrophils were recruited by CXCL13+ fibroblasts through CXCL8/CXCL6-CXCR2/CXCR1. Notably, our study demonstrated that the unique microenvironment of the PI group promoted the differentiation of monocyte/macrophage lineage cells into osteoclasts, which might explain the faster and more severe bone resorption in the progression of PI than PD.

CONCLUSIONS

Collectively, this study suggests a unique immune microenvironment of PI, which may explain the differences between PI and PD in the clinic. These outcomes will aid in finding new specific and effective treatments for PI.

Long-term outcomes of endoscopic resection for well-differentiated nonampullary duodenal neuroendocrine tumors

BACKGROUND & AIMS

Nonampullary duodenal neuroendocrine tumors (NAD-NETs) are rare with limited evidence regarding endoscopic treatment. The study aimed to investigate the efficacy and safety of endoscopic resection of well-differentiated NAD-NETs and evaluate long-term outcomes, including local recurrence and metastasis.

METHODS

A total of 78 patients with NAD-NETs who underwent endoscopic resection between January 2011 and August 2022 were included. The clinicopathologic characteristics and treatment outcomes were collected and analyzed.

RESULTS

En bloc resection was achieved for 74 of the tumors (94.9%) and R0 resection was obtained in 68 of the tumors (87.2%). Univariate analysis identified tumors in the second part of the duodenum, tumor size ≥ 10 mm and muscularis propria invasion as risk factors for non-curative resection. Two patients with R1 resection (vertical margin involvement) and two patients with lymphovascular invasion underwent additional surgery. Four patients experienced adverse events (5.1%), including two cases of delayed bleeding and two cases of perforation, all successfully managed conservatively. During a median follow-up period of 62.6 months, recurrence and lymph node metastasis were only detected in one patient with R1 resection 3 months after the original procedure.

CONCLUSION

Endoscopic resection is safe and effective and provides a favorable long-term outcome for patients with well-differentiated NAD-NETs without regional lymph node or distant metastasis.

[Investigate the role of neutrophil extracellular traps in immune checkpoint inhibitor-associated myocarditis with programmed death protein-1 inhibitors involvement]

Objective: To investigate the role of neutrophil extracellular traps (NETs) in immune checkpoint inhibitor-associated myocarditis (ICIAM) with programmed death protein-1 (PD-1) inhibitors involvement, and to explore the therapeutic potential of targeting NETs in the treatment of ICIAM. Methods: Thirty 6-week-old male BALB/c mice were randomly divided into control group (n=10), myocarditis group (n=10), and treatment group (n=10). Apart from the control group, each mouse was subcutaneously injected with 100 μl of complete Freund's adjuvant containing 250 μg of mouse cardiac troponin I peptide on the 1st and 7th day. Starting on the 8th day, PD-1 inhibitor (15 μg/per mouse) was intraperitoneally injected every other day for a total of 5 times. Since 1 day before the beginning of PD-1+TnI injection, the treatment group was injected with PF-1355 (50 mg·kg-1·d-1) for 16 consecutive days. The mice's general state was observed during the whole process. Real-time fluorescence quantitative PCR (RTFQ-PCR) was carried out to evaluate the transcriptional regulation of neutrophil related chemokines, NETs, pyronecrosis related factors and proinflammatory cytokines. Immunohistochemistry, immunofluorescence and western blot were applied to determine the changes of pyrosis related molecules. Echocardiography showed the differences of main cardiac indexes while cardiac pathology compared the degree of inflammatory infiltration in 3 gruops. Results: The immunofluorescence intensity of myocardial NETs in the myocarditis group was significantly increased compared to the control group mice (2.49±0.08 and 0.99±0.26, P<0.001). The protein expression levels of pyroptosis-related NLRP3, cleaved-Caspase 1, Caspase 1, cleaved-GSDMD, GSDMD, IL-1β and IL-18 in myocardial tissue of the model group were higher than those of the control group (all P<0.05). After treatment with PF-1355, compared to the myocarditis group, the left ventricular ejection fraction (LVEF) (73.58%±5.31% and 58.12%±3.19%, P<0.001) and left ventricular fraction shortening (LVFS) (39.78%±4.31% and 33.89%±2.19%, P<0.001) increased. H-E staining showed a reduction in inflammatory infiltration area in the treatment group compared to the myocarditis group (30.12%±3.57% and 14.92%±2.46%, P<0.001). The immunofluorescence intensity of NETs decreased in the treatment group compared to the myocarditis group (2.52±0.04 and 1.03±0.05, P<0.001). The levels of NLRP3 and other pyroptosis-related molecules were downregulated in the treatment group compared to the myocarditis group (all P<0.05). Conclusions: NETs lead to myocardial cell pyroptosis by activating the NLRP3 inflammasome in PD-1 inhibitor-associated myocarditis. The specific MPO inhibitor PF-1355 shows a therapeutic potential by regulating the formation of NETs, decreasing NLRP3 level and relieving myocardial pyroptosis, thus reducing myocardial damage.

[Analysis of the efficacy and influencing factors of sodium channel blockers in the treatment of focal epilepsy in infants under 6 months of age]

Objective: To analyze the efficacy and safety of the sodium channel blockers (SCB) antiseizure medication in the treatment of focal epilepsy in infants under 6 months of age. Methods: This was a case series study. Infants with focal epilepsy with onset within 6 months of age and treated with SCB attending the Department of Neurology of Beijing Children's Hospital from June 2016 to April 2022 were collected. The clinical data, auxiliary examinations, SCB application, efficacy, adverse reactions, and prognosis were analyzed retrospectively. Patients were grouped according to type of seizure and epileptic syndrome, age of onset and etiology. Chi square test and Fisher exact test were used to analyze the differences between groups statistically. Results: A total of 118 infants were enrolled, 65 males and 53 females, with an age of epilepsy onset of 56 (4, 114) days. Developmental and epileptic encephalopathy was diagnosed in 60 infants, 39 had self-limited neonatal and (or) infantile epilepsy, and 19 had non-syndromic focal epilepsy. Application of SCB: 106 used oxcarbazepine, 2 used lacosamide, 9 switched from oxcarbazepine to lacosamide or a combination of 2 SCB, and 1 used oxcarbazepine, lacosamide, and lamotrigine successively; oxcarbazepine was the first choice in 46 cases. The age at which SCB was applied was 103 (53, 144) days. The children were followed up for 6 months to 6 years. SCB was effective in 89 cases (75.4%), including 70 cases (59.3%) who achieved seizure freedom. The seizure-free rate was higher in the focal epilepsy only group than in the group with other seizure types (64.4% (65/101) vs. 4/17, χ²=9.99, P<0.05). The responder and seizure-free rates were all higher in the group with the onset age of >3-6 months than the group >1-3 months (84.4% (38/45) vs. 62.5% (20/32), 73.3% (33/45) vs. 46.9% (15/32), χ²=4.85 and 5.58, both P<0.05). With the exception of variants in the PRRT2 gene, those with variants in sodium or potassium channels had higher responder and seizure-free rates than those with variants in other genes(86.2% (25/29) vs. 45.5% (10/22), 62.1% (18/29) vs. 22.7% (5/22), χ²=9.65 and 7.82,both P<0.05). The most common adverse event was transient hyponatremia, which happened in 66 cases (55.9%). There were 9 cases of rash, which subsided in 6 cases after discontinuing oxcarbazepine and switching to lacosamide, and 7 cases of electrocardiogram abnormalities, which improved after withdrawing oxcarbazepine and changing to lacosamide in 1 case. Conclusion: SCB are effective and tolerable in the treatment of focal epilepsy in infants under 6 months of age, with better efficacy in patients with genetic variants of the sodium or potassium channel, focal seizures only, and seizure onset >3-6 months of age.

[Evaluation of left ventricular function with left atrio-ventricular longitudinal strain in patients with lymphoma underwent anthracycline therapy]

Objective: To analyze the value of 3-dimensional speckle tracking echocardiograghy (3D-STE) derived strain parameters on the detection of subclinical myocardial deformation alterations in patients with lymphoma treated with anthracycline agents. Methods: This study was a retrospective study. A total of 37 patients with newly diagnosed diffuse large B cell non-Hodgkin lymphoma between December 2012 and December 2014 in Cancer Center, Fudan university were included. 3D-STE strain measurements were performed at baseline (T0),after the completion of two therapy circles (T1) and at the end of anthracycline regimen chemotherapy (Te). Echocardiography images were analyzed on the TTA workstation, and the indexes included left atrial minimum volume (LAVmin), left atrial emptying index (LAEF), left atrial active emptying index (LAAEF), as well as the left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), left atrial global longitudinal strain (LAGLS). The overall left atrioventricular longitudinal strain (LAVGLS) was calculated, which was the sum of the absolute values of LVGLS and LAGLS. The changes of left ventricular strain indexes measured by 3D-STE at different time points of patients were evaluated. Results: Thirty-seven patients with DLBCL, aged (48.3±12.1)years, including 23 males (63.9%), were enrolled. Compared with baseline, LVGLS (T1: (-18.63±4.73)% vs. (-22.13±4.40)%, P=0.001; Te:(-18.26±4.64)% vs. (-22.13±4.40)%, P<0.001), LAGLS (T1: (20.41±5.56)% vs. (23.98±5.59)%, P=0.003; Te: (17.60±3.96)% vs. (23.98±5.59)%, P<0.001) and LAVGLS (T1: (39.05±7.60)% vs. (46.11±7.77)%, P<0.001; Te: (40.34±8.55)% vs. (46.11±7.77)%, P<0.001) were all deteriorated at the T1 and Te. While LVGCS ((-21.98±5.82)% vs. (-26.15±7.51)%, P=0.010), LAVmin ((23.93±7.29)ml vs. (20.33±7.03)ml, P=0.029), LAEF ((28.94±11.16)% vs. (35.79±11.12)%, P=0.002) and LAAEF ((11.93±10.00)% vs. (18.10±9.96)%, P=0.013) were decreased only until Te. Conclusions: 3D-STE strain measurements could detect early myocaridial function alteration in patients receiving anthracycline regimen chemotherapy, thus may provide a novel approach to monitor anthracycline caused myocardial toxicity.

[Application of liver venous deprivation in secondary hepatic resection of primary liver cancer]

Objective: To investigate the efficacy and safety of liver venous deprivation (LVD) before secondary resection of primary liver cancer. Methods: 56 patients with advanced primary liver cancer who were not suitable for primary resection in Liver Surgery Department of Xinxiang Central Hospital from January 2018 to January 2019 were analyzed retrospectively. They were divided into liver vein deprivation group (LVD group: LVD+ PVE, n=26) and portal vein embolization group (PVE group, n=30). The dynamic changes of liver reserve function and future liver remnant volume (FLR-V), R0 resection rate, surgical complications, postoperative recurrence rate and overall survival rate of two groups before and after LVD/PVE were compared. Results: The success rate of puncture and embolization in LVD group and PVE group was 100%. There were no grade Ⅳ complications, and there was no significant difference of grades Ⅰ, Ⅱ and Ⅲ complications between the groups (P=0.808). The FLR-V of LVD group before embolization, 7, 14 and 21 days after embolization was (493.1±25.8), (673.2±56.1), (779.5±81.6) and (853.3±85.2) cm(3), respectively. The FLR-V of PVE group before embolization, 7, 14 and 21 days after embolization were (502.4±20.1), (688.6±43.9), (656.8±73.7) and (563.5±69.1) cm(3), respectively. There was no significant difference in FLR-V between the two groups before and 7 days after embolization (P>0.05). The FLR-V of LVD group was higher than that of PVE group at 14 and 21 days after embolization (P<0.01). The preparation time of LVD group was (20.4±6.3) days, which was shorter than that of PVE group [(31.5±8.8) days, P=0.045]. The rate of secondary hepatectomy was 92.3% (24/26), which was higher than that of PVE group [70.0% (21/30), P=0.036]. The R0 resection rate was 87.5% (21/24), which was higher than that of the PVE group [57.1% (12/21), P=0.022]. However, there were no significant differences in surgical methods, operation time, intraoperative blood loss, Clavien-Dindo complication grade and length of hospital stay between the two groups (P>0.05). After hepatectomy, the median recurrence time and median survival time of LVD group were 12.6 months and 21.3 months, respectively, which were longer than those of PVE group (9.4 months and 13.5 months, respectively, P<0.01). Conclusions: For patients with advanced liver cancer who are not suitable for primary hepatectomy, preoperative LVD can significantly increase FLR-V, improve the resection rate of secondary surgery, shorten the preparation time of two operations, and do not increase surgical complications. Moreover, patients with LVD can improve the R0 resection rate of secondary surgery. The postoperative recurrence time and overall survival rate of patients with LVD are better than those of patients with PVE, and LVD has a good long-term effect.

Familial left cervical neurofibromatosis 1 with scoliosis: A case report

BACKGROUND

Neurofibromatosis type 1 (NF1) is an inherited autosomal dominant disorder affecting many parts of the body with café au lait spots, skeletal deformity, and scoliosis. A familial case of NF1 with scoliosis and a painless mass had not yet been reported.

CASE SUMMARY

We describe the case of a 15-year-old male patient with a painless lump on the left side of his neck for 10 years and scoliosis. His right shoulder was about 5 cm lower than the left, the left side of his face was deformed, and the left submandibular skin was relaxed. The folding and drooping were obvious and movement was poor. Computed tomography revealed the involvement of the neck, upper chest wall, and surrounding left shoulder, accompanied by bone changes and scoliosis. Histological evaluation showed subepidermal pale blue mucoid degeneration, fibrous fusiform cells in the dermis in a fascicular, woven arrangement. His mother had the same medical history. The diagnosis was neurofibromatosis of the left neck. Various parts of the tumor tissue were serially resected during several visits. Eight months after surgery, there was a slight tendency to regrow.

CONCLUSION

This case of slow-progressing NF1 highlights the importance of early diagnosis and treatment to reduce its impact on the patient’s growth and development.

[Accuracy and clinical outcome of a real-time surgical navigation system for the placement of quad zygomatic implants]

Objective: To evalute the accuracy and clinical outcome of a real-time navigation system for the placement of quad zygomatic implants. Methods: Twenty-four patients [9 males and 15 females, mean age was (50.8±14.7) years old], from January 2015 to December 2019, with 96 zygomatic implants placed under a real-time navigation system in Department of Second Dental Center and Department of Oral Implantology of Ninth People's Hospital, Shanghai Jiaotong University School of Medicine were included in the study. The preoperative and the postoperative multislice CT or cone-beam CT were fused to measure and record the entry, exit and angle deviation between the planned and placed implants. The implants were divided into groups according to implant insertion approach (real-time navigation and free-hand), implant length (<47.5 mm and ≥47.5 mm) and implant position (proximal and distal implant). And the differences of implant accuracy were analyzed. The intraoperative and postoperative complications were also recorded. The implant survival rate was evaluated after 6 months follow-up. A P value<0.05 indicates statistical significance. Results: The mean entry, exit and angle deviation of zygomatic implants were (1.49±0.64) mm, [2.03(1.58, 2.40)] mm and (2.49°±1.12°), respectively. The average entry, exit and angle deviation of the navigation guided implant insertion group were (1.45±0.60) mm, (1.96±0.44) mm and (2.66±1.13°) respectively, while those of the free-hand group were (1.50±0.64) mm, (2.04±0.79) mm and (2.50°±1.13°) respectively. There was no significant difference between the two groups (P>0.05). The average entry, exit and angle deviation of the group with length<47.5 mm were (1.42±0.60) mm, (2.13±0.60) mm and (2.61°±1.08°) respectively and those of the group with length ≥ 47.5 mm were (1.52±0.65) mm, (1.98±0.82) mm and (2.43°±1.14°) respectively. No significant difference was found between the two groups (P>0.05). In proximal implant group, the average entry, exit and angle deviation were (1.55±0.69) mm, (2.05±0.92) mm and (2.48°±1.16 °) respectively while those of distal implant group were (1.43±0.57) mm, (2.01±0.57) mm and (2.49°±1.10°), respectively. No significant difference was detected between the two groups (P>0.05). All zygomatic implants were placed uneventfully. There were no intra-operative complications, and post-operative reversible complications developed in 3 patients. Two zygomatic implants were lost and the overall zygomatic implant survival rate was 97.9% (94/96) within a follow-up of 6 months. Conclusions: Quad zygomatic implant placement can be achieved with high accuracy and predictable clinical outcome under guidance of a real-time navigation system.

[Predictive value of two-dimentional shear wave elastography in posthepatoectomy liver failure]

Objective: To investigate the value of two-dimensional shear wave elastography (2D SWE) combined with clinical biochemical data in predicting posthepatoectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). Methods: A total of 274 HCC patients who underwent hepatectomy in Zhongshan Hospital Fudan University from January 2015 to January 2016 were retrospectively collected, including 235 males and 39 females, age 19-80 (56±11) years. All patients were confirmed to be HCC by postoperative pathology. The preoperative 2D SWE examination, laboratory examination results and intraoperative indicators were analyzed. According to the occurrence of PHLF after surgery, single factor analysis and multiple logistic regression analysis were performed on the above indicators to obtain a binary logistic regression model, and evaluate the diagnostic effect of the model on PHLF. In addition, 103 HCC patients from October 2019 to January 2020 were retrospectively collected as an external validation set, including 89 males and 14 females, age 23-80 (55±11) years old. Results: The liver stiffness measurement (LSM) obtained from 2D SWE, INR and Laminin (LN) were independent predictors of PHLF. The formula of prediction model PM=-15.451+0.095×LSM+11.7×INR+0.012×LN was obtained by combining above three factors. The area under the curve (AUC) of PHLF was 0.82, which was higher than that of end-stage liver disease model (MELD) score and Child-Pugh grading diagnosis of PHLF. The AUC of PHLF predicted by PM in the external validation group was 0.81. Conclusion: 2D SWE is helpful for clinicians to evaluate liver reserve function preoperatively and to predict the occurrence of PHLF in patients with HCC.

[Development and progress of sixty years and stepping firmly to the future]

Since its establishment for 60 years, Department of Burns of the Second Affiliated Hospital of Zhejiang University School of Medicine has grown into a famous regional burn center in China under the leading of the pioneers and through the efforts of several generations. The department has distinctive disciplinary features in burn care, nutritional support, scar prevention and treatments, standard management of chronic wound, and skin tissue engineering research, making positive contribution to the development of burn medicine in China.

Effect of pH on uranium(VI) biosorption and biomineralization by Saccharomyces cerevisiae

Biosorption of radionuclides by microorganisms is a promising and effective method for the remediation of contaminated areas. pH is the most important factor during uranium biosorption by Saccharomyces cerevisiae because the pH value not only affects the biosorption rate but also affects the precipitation structure. This study investigated the effect of pH on uranium (VI) biosorption and biomineralization by S. cerevisiae. Cells have the ability to buffer the solution to neutral, allowing the biosorption system to reach an optimal level regardless of the initial pH value. This occurs because there is a release of phosphate and ammonium ions during the interaction between cells and uranium. The uranyl and phosphate ions formed nano-particles, which is chernikovite H₂(UO₂)₂(PO₄)₂·8H₂O (PDF #08-0296), on cell surface under the initial acidic conditions. However, under the initial alkaline conditions, the uranyl, phosphate and ammonium ions formed a large amount of scale-like precipitation, which is uramphite (NH₄)(UO₂)PO₄·3H₂O (PDF #42-0384), evenly over on cell surface.

[Efficacy and safety of linezolid among patients with methicillin-resistant Staphylococcus aureus bacteremia]

Objective: To study the efficacy and safety of linezolid for the treatment of patients with bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: Totally 52 cases of MRSA bacteremia patients, from January 2010 to April 2014 in the First Affiliated Hospital, School of Medicine, Zhejiang University, were retrospectively analyzed. They were classified into two groups based on linezolid therapeutic regimen: primary treatment with linezolid (19 cases) and alternated to linezolid (33 cases). The following data were collected and compared: clinical characteristics, lasting time of fever, bacterial clearance rate, clinical efficacy, fatality rate, and adverse events. Results: Forty three of the 52 patients (82.7%) suffered complicated MRSA bacteremia. The most common clinical feature was fever[86.5%(45/52)]. Linezolid was initiatively used mostly because of renal insufficiency[68.4%(13/19)]. In the other 33 patient, glycopeptides were initiatively used, then alternated to linezolid because of persistent fever[69.7%(23/33)]; damage of kidney function during treatment period of glycopeptides[12.1%(4/33)]; occurrence of new infectious site related to MRSA[18.2%(6/33)]. The clinical efficacy were 78.9%(15/19) in the group of primary treatment with linezolid and 81.8% (27/33) in the group of alternated to linezolid, persistent time of fever were 4(3, 15) d and 12(5, 24) d, mortality during 28 d period were 15.8% (3/19) and 9.1% (3/33), adverse rate were 15.8% (3/19) and 12.1% (4/33) in these two groups, respectively (all P>0.05). Conclusion: Linezolid is an option with high clinical efficacy and good safety for MRSA bacteremia patients.

Activation of the STING-IRF3 pathway promotes hepatocyte inflammation, apoptosis and induces metabolic disorders in nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a common result of obesity and metabolic syndrome. Hepatocyte injury and metabolic disorders are hallmarks of NAFLD. Stimulator of interferon genes (STING) and its downstream factor interferon regulatory factor 3 (IRF3) trigger inflammatory reaction in response to the presence of cytosolic DNA. STING has recently been shown to play an important role in early alcoholic liver disease. However, little is known about the role of STING-IRF3 pathway in hepatocyte injury. Here, we aimed to examine the effect of STING-IRF3 pathway on hepatocyte metabolism, inflammation and apoptosis.

METHODS

We examined the activation of the STING-IRF3 pathway, a high-fat diet (HFD)-induced obese mouse model, and determined the role of this pathway in a free fatty acid (FFA)-induced hepatocyte inflammatory response, injury, and dysfunction in L-O2 human liver cells.

RESULTS

STING and IRF3 were upregulated in livers of HFD-fed mice and in FFA-induced L-O2 cells. Knocking down either STING or IRF3 led to a significant reduction in FFA-induced hepatic inflammation and apoptosis, as evidenced by modulation of the nuclear factor κB (NF-κB) signaling pathway, inflammatory cytokines, and apoptotic signaling. Additionally, STING/IRF3 knockdown enhanced glycogen storage and alleviated lipid accumulation, which were found to be associated with increased expression of hepatic enzymes in glycolysis and lipid catabolism, and attenuated expression of hepatic enzymes in gluconeogenesis and lipid synthesis.

CONCLUSIONS

Our results suggest that the STING-IRF3 pathway promotes hepatocyte injury and dysfunction by inducing inflammation and apoptosis and by disturbing glucose and lipid metabolism. This pathway may be a novel therapeutic target for preventing NAFLD development and progression.

[Value of dual contrast-enhanced ultrasound in the preoperative T staging of rectal carcinoma]

Objective: To explore the value of dual contrast-enhanced ultrasound in preoperative T staging of rectal carcinoma. Methods: Dual contrast-enhanced ultrasound examinations were performed on 72 patients with rectal carcinoma via transrectal infusion and intravenous injection. The accordance of preoperative dual contrast-enhanced ultrasound results and postoperative pathologic results was evaluated retrospectively. Results: The overall accordance rate of preoperative T staging was 73.6% (53/72). And accordance rate was 100.0% (3/3), 100.0% (5/5), 68.4% (13/19), 71.4% (25/35)and 70.0% (7/10) for Tis , T1, T2, T3 and T4, respectively. The consistency was good (κ=0.607, χ(2) =8.363, P<0.01). The accordance rate of middle/lower vs high rectal carcinoma was 68.7% and 85.7%. Conclusion: Dual contrast-enhanced ultrasound can provide reference for preoperative T staging for patients with rectal carcinoma.

Induction of endoplasmic reticulum stress by deletion of Grp78 depletes Apc mutant intestinal epithelial stem cells

Intestinal epithelial stem cells are highly sensitive to differentiation induced by endoplasmic reticulum (ER) stress. Colorectal cancer develops from mutated intestinal epithelial stem cells. The most frequent initiating mutation occurs in Apc, which results in hyperactivated Wnt signalling. This causes hyperproliferation and reduced sensitivity to chemotherapy, but whether these mutated stem cells are sensitive to ER stress induced differentiation remains unknown. Here we examined this by generating mice in which both Apc and ER stress repressor chaperone Grp78 can be conditionally deleted from the intestinal epithelium. For molecular studies, we used intestinal organoids derived from these mice. Homozygous loss of Apc alone resulted in crypt elongation, activation of the Wnt signature and accumulation of intestinal epithelial stem cells, as expected. This phenotype was however completely rescued on activation of ER stress by additional deletion of Grp78. In these Apc-Grp78 double mutant animals, stem cells were rapidly lost and repopulation occurred by non-mutant cells that had escaped recombination, suggesting that Apc-Grp78 double mutant stem cells had lost self-renewal capacity. Although in Apc-Grp78 double mutant mice the Wnt signature was lost, these intestines exhibited ubiquitous epithelial presence of nuclear β-catenin. This suggests that ER stress interferes with Wnt signalling downstream of nuclear β-catenin. In conclusion, our findings indicate that ER stress signalling results in loss of Apc mutated intestinal epithelial stem cells by interference with the Wnt signature. In contrast to many known inhibitors of Wnt signalling, ER stress acts downstream of β-catenin. Therefore, ER stress poses a promising target in colorectal cancers, which develop as a result of Wnt activating mutations.

Esophageal submucosal gland duct adenoma: a clinicopathological and immunohistochemical study with a review of the literature

Esophageal submucosal gland duct adenoma (ESGDA) is a rare tumor. The clinicopathological features of the ESGDA and its precursor lesion have not been comprehensively evaluated. In this study, we aimed at delineating the clinicopathological features of the ESGDA and cyst formation of the esophageal submucosal gland duct (ESGD), as well as their correlations and clinical implications. We identified three cases of ESGDA and 16 cases of cyst formation of the ESGD among 786 endoscopic mucosal resection specimens over a 7-year period. The median patient age was 58 years with a male predominance. These lesions were small submucosal bulges locating at the lower esophagus with a size no more than 1 cm. The main microscopic changes of these lesions included content retention, multilayered epithelium or papillary folds of the ESGD and inflammatory cell infiltration, acidophilic degeneration, hyperplasia or atrophy of the acini. The included cases generally showed moderate to severe microscopic esophagitis. The ESGDA was mainly consisted by multiple glandular cysts covered by two layers of cells. Immunohistochemical results showed that the luminal duct lining cells and basal cells were positive for CK7 and p63, respectively. Both of the two layer cells were positive for HMWCK and negative for CK20, p53, CDX2, MUC5AC, MUC6, MUC2 and MUC1. The proliferation index was very low (1%). The diagnostic criteria of the ESGDA were proposed and, the differential diagnosis was discussed. Cyst formation of the ESGD is considered to be the precursor lesion of the ESGDA, because they have overlapping clinicopathological features with progressive relationship. In addition, the ESGDA have close connection with advance of the GERD and, probably, an increased risk of carcinoma.

Clinical analysis of gastroenteropancreatic neuroendocrine tumor with liver metastasis, compared with primary hepatic neuroendocrine tumor

OBJECTIVE

The objective was to study the clinicopathologic features, grading, treatment protocols, and prognostic of gastroenteropancreatic neuroendocrine tumor (NET) with liver metastasis and primary hepatic NET.

MATERIALS AND METHODS

The clinical data of 34 patients with hepatic NET were retrospectively reviewed. According to the primary tumor location and 2010 World Health Organization classification, the cases were categorized to analyze the clinicopathologic features, treatment condition, and prognostic factors.

RESULTS

There was a marked male predominance either in gastroenteropancreatic NET liver metastasis group or primary group. Primary hepatic NET is mostly single nodule located in the right lobe of liver, and the metastatic hepatic NET is mostly from pancreas with multiple nodules and metastasizes to both lobes of the liver, with a high degree of malignancy and poor prognosis. There are 17 cases (50%) of NET and 17 cases (50%) of neuroendocrine carcinoma (NEC) in all the 34 patients of this study. The mitotic figure and Ki-67 proliferation index are both higher in NEC group than in NET group, which indicated highly malignancy of the NEC. The 5-year disease-free survival (DFS) rates for primary group and metastatic group were 30% and 40%, respectively (P > 0.05), while the 5-year survival rates were 35% and 66%, respectively (P > 0.05). Different tumor grade was found closely associated with 5-year DFS (P < 0.05) and overall survival (OS) (P < 0.05) in both groups. Furthermore, we found 5-year DFS of patients with primary site of the tumor located in the gastrointestinal tract was much lower than that located in pancreas (P < 0.05), while the 5-year OS showed no significant differences between two groups (P > 0.05).

CONCLUSIONS

Surgery is an effective method for the treatment of hepatic NET; tumor grading is an important determinant factor of prognosis.

Construction of a gene-gene interaction network with a combined score across multiple approaches

Recent progress in computational methods for inves-tigating physical and functional gene interactions has provided new insights into the complexity of biological processes. An essential part of these methods is presented visually in the form of gene interaction networks that can be valuable in exploring the mechanisms of disease. Here, a combined network based on gene pairs with an extra layer of re-liability was constructed after converting and combining the gene pair scores using a novel algorithm across multiple approaches. Four groups of kidney cancer data sets from ArrayExpress were downloaded and analyzed to identify differentially expressed genes using a rank prod-ucts analysis tool. Gene co-expression network, protein-protein interac-tion, co-occurrence network and a combined network were constructed using empirical Bayesian meta-analysis approach, Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database, an odds ratio formula of the cBioPortal for Cancer Genomics and a novel rank algorithm with combined score, respectively. The topological features of these networks were then compared to evaluate their performances. The results indicated that the gene pairs and their relationship rank-ings were not uniform. The values of topological parameters, such as clustering coefficient and the fitting coefficient R(2) of interaction net-work constructed using our ranked based combination score, were much greater than the other networks. The combined network had a classic small world property which transferred information quickly and displayed great resilience to the dysfunction of low-degree hubs with high-clustering and short average path length. It also followed distinct-ly a scale-free network with a higher reliability.

Segmental testicular infarction: A case report

The incidence of segmental testicular infarction is extremely low. The condition usually presents with acute scrotal pain and may be confused clinically and radiologically with a testicular tumor or torsion. To the best of our knowledge, only a few cases have been reported in the English literature. In this study, we present a case of segmental testis infarction in a 23-year-old male with an acute onset of testicular pain. The diagnosis of testicular infarction was considered following sonography examination. Hemorrhagic infarction of the testis was confirmed by surgical exploration and pathological examination. Partial orchiectomy was performed. Although it is uncommon, segmental testicular infarction should be taken into consideration when acute scrotal pain is encountered, since the therapeutic strategy could be conservative.

Recurrent huge leiomyoma of the urethra in a female patient: A case report

Urethral leiomyoma is an extremely rare condition that arises from the smooth muscle of the urethra. To the best of our knowledge, there is only a single reported recurrence treated by a repeat excision in the literature to date. The present study reports an exceptionally rare case of a recurrent huge leiomyoma of the female urethra. The 47-year-old female was diagnosed with a huge mass located between the urethra and vagina during a gynecological examination. The patient had no symptoms and was successfully treated with transabdominal excision. Pathological examinations revealed a leiomyoma of the urethra. The patient was followed up for one year without any sign of recurrence.

Domain wall propagation through spin wave emission

We theoretically study field-induced domain wall motion in an electrically insulating ferromagnet with hard- and easy-axis anisotropies. Domain walls can propagate along a dissipationless wire through spin wave emission locked into the known soliton velocity at low fields. In the presence of damping, the usual Walker rigid-body propagation mode can become unstable for a magnetic field smaller than the Walker breakdown field.

[Probe into construction mode of wound care center]

Relevant data including diagnosis and treatment model, operation situation, etc. are analyzed in our wound care center and compared with abroad based-on literature retrieval, to find out a suitable way for setting up wound care centers in our country. Wound care center with mode of multidisciplinary cooperation that is "specialist-oriented" was established in our hospital, mirroring the experience of foreign wound care centers. The investigation showed the demands of patients could be met, their psychological and economic pressures as well as social burden might be greatly relieved in our center. For an example, we achieved our purpose readily by setting up a clinical pathway of diabetic foot according to the features of our hospital. The model of multidisciplinary cooperation, with minor adjustments, may be applicable for wound care centers at home and abroad. Our wound care center will establish better system of diagnosis and treatment to conform to the situation in our country.

Two new flavanes and bioactive compounds fromDaphne tanguticaMaxim

Two new flavanes, named daphneflavan B (1) and daphneflavan C (2), along with two known biflavonoids, daphnodorin D(1) (3) and daphnodorin D(2) (4), were isolated from the roots of Daphne tangutica Maxim. Their structures were established on the basis of chemical, physicochemical, and spectroscopic evidences. Two compounds 3 and 4 were noted to have the most marked antitumor activity in vivo assay.

Two new chemical constituents fromDaphne odoraThunb. var.marginata

Two new phenolic constituents, daphnenone (1) and daphneone (2), were isolated from the stem bark of Daphne odora Thunb. var. marginata. Their structures were established on the basis of spectroscopic analysis. Compounds 1 and 2 were tested for cytotoxic activity by MTT assays on five human tumour cell lines, K562, A549, MCF-7, LOVO and HepG2. Compound 1 showed obvious cytotoxic activity against all the five cell lines.

Two new diterpenoids from Coleus forskohlii

Two new diterpenoids, forskolins I and J, have been isolated in our further investigation on Coleus forskohlii (Willd.) Briq. collected in Yunnan Province. Their structures have been determined as 1alpha,6beta-diacetoxy-7beta,9alpha-dihydroxy-8,13-epoxylabd-14-en-11-one (1) and 1alpha,9alpha-dihydroxy-6beta,7beta-diacetoxy-8,13-epoxylabd-14-en-11-one (2) by spectral methods (including 1D and 2D NMR techniques).

Condylar resorption during active orthodontic treatment and subsequent therapy: report of a special case dealing with iatrogenic TMD possibly related to orthodontic treatment

A 28-year-old female underwent orthodontic treatment for approximately 22 months. During the later stages of this treatment, the patient reported right shoulder and neck-muscle pain. In addition, temporomandibular joint disorder (TMD) with a 'clicking' sound during mastication commenced 5 months prior to treatment completion. Specific medication to deal with these symptoms was suggested by medical specialists, as were some stress-relief methods, although the pain still progressed, and subsequent clinical and radiographical examinations were undertaken by another orthodontist. Right mandibular condylar resorption was observed from both the panorex and temporomandibular joint (TMJ) radiographs. No clinical signs of rheumatic disease were observed, although bruxism was noted. Following the termination of the orthodontic treatment by the second practitioner, the patient was treated with splint therapy 1 month subsequent to which, the previous symptoms of pain in the shoulder and neck, and the clicking sound during mastication had subsided. During the 14-month period of splint therapy and follow-up, new bone growth in the right condyle was observed from radiographs.

Patient Acceptance of Self-Sampling for Human Papillomavirus in Rural China

OBJECTIVE.: To test a new survey instrument and determine the acceptance and potential barriers of cervicovaginal self-sampling for high-risk human papillomavirus in rural Chinese women. MATERIALS AND METHODS.: Data from thirteen survey questions assessed acceptance of the self-sampling procedure. Pain, comprehension, and cultural beliefs were potential barriers evaluated by the survey. RESULTS.: A total of 1,560 women were surveyed. The average and mode number of steps of the self-sampling procedure recalled was 5 (out of 7). Ninety-one percent preferred performing the test at a clinic versus their home. The major barrier encountered was related to the educational level of the women. CONCLUSIONS.: The measure performed well in this population. The self-collection brush was well accepted by these women. Education is the largest hurdle to overcome in implementing a self-sampling screening program.

Removal of dissolved organic matter from water by adsorption-flocculation using organobentonite

Bentonite modified with short chain cationic surfactant might be the basis of a new approach to removing dissolved organic matter (DOM) from water. The treatment process involves dispersing bentonite to the DOM-containing water and then adding a small cationic surfactant to result in flocs which are agglomerates of organobentonite and bound DOM. The flocs are then removed from the solution by sedimentation. Experimental results indicate that Benzyltrimethylammonium bromide (BTMA)-bentonite displays a high affinity for DOM, most likely due to aromatic groups in the DOM molecule interacting with the benzene ring in the BTMA ion through increased pi-pi type interactions. Under appropriate operating conditions, 75% DOM removal and nearly 100% bentonite recovery could be achieved by the adsorption-flocculation process using BTMA-bentonite. Additionally, the rapid adsorption kinetics made adsorption-flocculation with BTMA-bentonite attractive for continuous treatment of large volumes of raw water. The bentonite may function as a recyclable surfactant medium for the adsorption and subsequent combustion of organic pollutants.

14-3-3 proteins; bringing new definitions to scaffolding

The 14-3-3 proteins are a part of an emerging family of proteins and protein domains that bind to serine/threonine-phosphorylated residues in a context specific manner, analogous to the Src homology 2 (SH2) and phospho-tyrosine binding (PTB) domains. 14-3-3 proteins bind and regulate key proteins involved in various physiological processes such as intracellular signaling (e.g. Raf, MLK, MEKK, PI-3 kinase, IRS-1), cell cycling (e.g. Cdc25, Wee1, CDK2, centrosome), apoptosis (e.g. BAD, ASK-1) and transcription regulation (e.g. FKHRL1, DAF-16, p53, TAZ, TLX-2, histone deacetylase). In contrast to SH2 and PTB domains, which serve mainly to mediate protein-protein interactions, 14-3-3 proteins in many cases alter the function of the target protein, thus allowing them to serve as direct regulators of their targets. This review focuses on the various mechanisms employed by the 14-3-3 proteins in the regulation of their diverse targets, the structural basis for 14-3-3-target protein interaction with emphasis on the role of 14-3-3 dimerization in target protein binding and regulation and provides an insight on 14-3-3 regulation itself.

Preparations of organobentonite using nonionic surfactants

Due to hydrophilic environment at its surface, natural bentonite is an ineffective sorbent for nonpolar nonionic organic compounds in water even though it has high surface area. The surface properties of natural bentonite can be greatly modified by simple ion-exchange reactions with large organic cations (cationic surfactants) and this organobentonite is highly effective in removing nonionic organic compounds from water. Cationic surfactant derived organobentonites have been investigated extensively for a wide variety of environmental applications. In this study, the preparation of organobentonite using nonionic surfactants has been investigated for the first time. Results indicate that nonionic surfactants intercalates into the interlamellar space of bentonite and may demonstrate higher sorption capacity than cationic surfactant. It is possible to create large interlayer spacing and high organic carbon content organobentonite by use of nonionic surfactants with suitable balance between the hydrocarbon and ethylene oxide chain lengths. In addition, nonionic surfactant derived organobentonites are more chemically stable than cationic surfactant derived organobentonites.

[Studies on retention behaviour of biopolymers on silica-based binding stationary phase in the mobile phase of acetic acid-water]

The reversed-phase chromatographic method consisting of acetic acid-water as a new mobile phase for separating biopolymers on ODS column is presented. The new mobile phase may overcome the weak points of irreversible adsorption in chromatographic separation to some degree and difficulty in concentrating proteins with lyophylization and reduce the three-component (organic solvent, ion-pairing agent and water) of typical mobile phase to two component system. Based on the retention and Z (the number of solvent molecules involving in the displacement from stationary-phase surface), log I (a constant relating to the affinity of 1 mol of solute to the bonded stationary phase), and j (a constant relating to the affinity of 1 mol of solvent to the bonded stationary phase), the elution strength of acetic acid-water mobile phase was found to be stronger than that of methanol-water-TFA. From a good linear relationship between log I and Z, it can be concluded that the interaction force between proteins and RPLC stationary phase with acetic acid-water as mobile phase is non-selective hydrophobic interaction forces. In addition, the molecular conformations of protein in acetic acid-water and methanol-trifluoroacetic acid-water were found to be different.

Sorption of non-ionic surfactants to soil: the role of soil mineral composition

In this study, the importance of individual soil mineral constituents on non-ionic surfactant sorption is evaluated by employing scanning electron microscopy (SEM) equipped with energy-dispersive X-ray analysis (EDAX) to observe microchemical surface composition of model soil colloids and relate surface microchemical composition to the sorption behavior of a non-ionic surfactant, Polyethylene Glyco Mono-p-nonylphenyl Ether (A9PE10), on selected model soil colloids. This information is critical to understanding the fate and transport of this class of contaminants in subsurface. Results obtained from this study indicate that a correlation between the atomic ratio of Si:(Al + Fe) on soil mineral surface and A9PE10 sorption capacity exist, where those soil with larger value of Si:(Al + Fe) ratio exhibit higher sorption capacity. This allows us to predict that the non-ionic surfactant sorption capacity for soil decrease with progressively increasing states of soil maturity.

The effects of 50 Hz magnetic field exposure on dimethylbenz(alpha)anthracene induced thymic lymphoma/leukemia in mice

Several epidemiological investigations have suggested an increased incidence of lymphoma, leukemia, and brain tumor in residents living near power transmission lines. However, some observers failed to confirm such a positive correlation. To evaluate the effects of extremely low frequency (ELF) magnetic fields on leukemogenesis, an experimental animal model was used, in which thymic lymphoma/leukemia was induced by dimethylbenz(alpha)anthracene (DMBA) injected subcutaneously into the interscapular region of newborn mice within 24 h after birth. Beginning at the second week of age, 165 mice were exposed to 50 Hz magnetic field at 1 mT, 3 h/day, 6 days/week for 16 weeks, and 155 animals exposed to sham conditions. All surviving animals were killed by cervical dislocation at the age of 32 weeks and were examined pathologically. The results showed that the incidences of advanced thymic lymphoma, complicated with lymphomatous leukemia, were 21.8 and 23.9% in the two groups, respectively, without statistically significant differences. But dense metastatic infiltration by lymphoma cells into liver in the field exposure group greater (50%) than that in the sham-exposure group (16.2%) was observed (chi 2 = 9.847, P < 0.01). To determine whether ELF acts as a tumor promoter, further experiments are required.

Osseous choristoma of oral cavity--report of two cases and review of the literature

Osseous choristoma of the oral cavity is an extremely rare lesion. Two cases of osseous choristomas of oral cavity, representing two different natures of such lesions are reported. One was situated on the dorsal surface of posterior tongue just anterior to the circumvallate papillae and the other on the right buccal mucosa just below the orifice of the Stensen's duct. To date, about 73 cases of oral osseous choristoma have been reported in the literature including the two present cases, of which, 61 and 8 cases occurred in the tongue and buccal mucosa, respectively. The clinical and microscopic characteristics, and their common sites of these peculiar lesions are presented. The origin and pathogenesis of the lesion are discussed and the literature on the subject is reviewed.

Nitric oxide induces and inhibits apoptosis through different pathways

Physiological levels of nitric oxide (NO) regulate vascular tone and protect the microvasculature from injury whereas excessive NO may be harmful. The present study explored the effects of NO on human endothelial cell apoptosis. We found that the NO donor S-nitroso-N-acetylpenicillamine (SNAP) inhibited TNFalpha-induced endothelial apoptosis and that this was mediated partly through the cGMP pathway. In contrast, high SNAP concentration induced endothelial apoptosis via cGMP-independent pathways and the cGMP pathway protected against NO-induced apoptosis. These findings demonstrate that low NO concentrations contribute to human endothelial cell survival, whereas higher NO concentrations are pathological and promote destruction of endothelial cells.

Low-frequency 'conditioning' provides long-term protection from noise-induced threshold shifts in chinchillas

Studies have shown that loss of auditory sensitivity caused by exposure to high-level acoustic stimuli can be significantly reduced by pre-exposing the subject to moderate-level acoustic stimuli. Although the protective effects of such 'conditioning' exposures have been well documented, very little is known about the persistence of conditioning-induced protection, or about the biological mechanisms underlying it. In the present study, the persistence of conditioning-induced protection was examined in chinchillas by imposing either a 30- or 60-day recovery period between conditioning (10 days of exposure to 0.5 kHz noise at 90 or 95 dB, 6 h/day) and high-level (0.5 kHz noise at 106 dB for 48 h) exposures. Comparisons of threshold shifts between conditioned animals and control animals exposed only to high-level noise indicated that conditioning provided significant protection from noise-induced threshold shifts for at least 2 months. Conditioned animals sustained outer hair cell losses similar to controls, ranging from 15 to 30% in the apical half of the cochlea. The results suggest that low-frequency conditioning can trigger long-lasting changes in cochlear homeostasis rather than temporary changes in physiology or reductions in susceptibility to hair cell loss in chinchillas.

Evaluation of topical viscous 2% lidocaine jelly as an adjunct during the management of alveolar osteitis

PURPOSE

This study evaluated the efficacy of topical viscous 2% lidocaine jelly for the alleviation of pain experienced during the instrumentation of mandibular third molar extraction sites diagnosed with alveolar osteitis and for pain relief during the postinstrumentation period.

PATIENTS AND METHODS

Thirty adult patients with a diagnosis of alveolar osteitis in a mandibular third molar extraction site were included in this prospective, double-blind study. Each patient had their sutures removed, the socket irrigated, and 2% lidocaine jelly placed on the tip and side of the tongue to blind the patient against the test substances. The subjects were then randomly distributed into two groups. Group 1 had a nonactive jelly base placed into the socket 2 minutes prior to the placement of a standard obtundant dressing. Group 2 had viscous 2% lidocaine jelly placed into the socket in the same manner. Patients subjectively quantified their pain intensity pretreatment, during instrumentation, immediately postmanipulation, at 5-minute intervals to 30 minutes, and at 45 and 60 minutes. They also subjectively quantified their pain relief at each of the time intervals following instrumentation.

RESULTS

There was no statistical difference between the pretreatment pain experienced by both groups. The use of 2% lidocaine jelly had a measurable (P = .056), but not statistically significant, effect on pain due to instrumentation. At every time interval thereafter, the use of 2% lidocaine jelly elicited a statistically significant (P < .05) decrease in pain perception, and a statistically significant increase in pain relief when compared with the inactive jelly.

CONCLUSION

Topical viscous 2% lidocaine jelly is a useful adjunct during the treatment of alveolar osteitis, especially in the early (< or = 60 minutes) postinstrumentation period.

[The application of Moiré topography in analysis of face among Taiwanese adults]

Moiré topography has been used in human body measurement for many years. However, the technique has rarely been applied in human facial measurement. The purpose of this study was to review the basic principles and techniques of Moiré topography, and to apply this technique in the three-dimension measurement of human faces. One hundred and thirty seven Taiwanese young adults aged from 18-22, including 70 males and 67 females, took part. Angle Class I occlusal relationship without anterior crowding was selected in this study. The data collected from Moiré topography were scanned and analyzed with the use of a computer. Eight x-values and 28 y-values were recorded, based on pre-set landmarks. The t-test was used to compare the male and female groups. The results of this study were also used to compare with the results reported in related studies. The conclusion are as follows: 1. Most of the data between male and female groups showed significant difference with the exception of the values of Y9, Y28 and Y29. The value of the female group was larger than that of the male group on Y23. However, compared with the male group, the females appeared to have smaller faces. 2. Compared with Kamura's data, this study showed that the Taiwanese young female group (TF) was larger than the Japanese young female group (JF) for the values of X2 X7 and X8. Most of the data for JF were larger than for TF in Y values. This proved that the Japanese young females had larger faces with smaller eyes. 3. The data between TF and the young female group of Taiwan aborigines (AF) showed significant difference at the values of X1, X2, X5 and X6, in which the AF was larger than TF. Contrarily, the TF values for X2, X4 and X8 were larger than those for the AF. It showed that the AF was larger in the facial width, the width between eyes, the nasal width, and the mouth width, but was smaller in the width of eyes. Furthermore, the AF was also larger than the TF in the values of Y2, Y11, Y12, Y13, Y14, Y15, Y16, Y17, Y18, Y23, Y24 and Y25. This showed that the AF had a long middle and lower face and high frontal protrusion. 4. The differences among TF, AF and JF: The narrowest facial breadth: TF The widest breadth of eyes: TF The widest breadth of nose: AF The widest breadth of mouth: AF The longest length of middle & inferior face: JF The highest height of frontal protrusion: AF The shortest length of nose: TF

[Experimental study of modified yu ping feng powder on antibacterial adhesion of tracheal mucosa in mice model of chronic bronchitis]

In order to observe the influence of modified Yu Ping Feng San (MYPFS) on bacterial adhesion of tracheal mucosa, four experiments of bacterial adhesion in pneumatic tract were conducted, in which mice of chronic bronchitis model (CBM) induced by SO2 stimulation and another health control group breathed in aerosol contained Pseudomonas aeruginosa under the same condition were observed. The results showed that, with scanning electron microscopy, ultrastructural lesions on tracheal mucosa surface and adhesive bacterial number in CBM administrated MYPFS were far less than that in CBM without MYPFS (P < 0.001), and quantitative culture of Pseudomonas aeruginosa with tracheal tissue homogenate was also markedly reduced. However, the tracheal mucosa of healthy control animals were intact, the adhesive bacteria were not found. It is suggested that bacterial adhesion was closely related to the injury of tracheal-mucosa, and MYPFS could play a role of anti-bacterial adhesion through the protection of tracheal mucosa epithelium or reduction of pneumatic tract injury. These were quite in accordance with the theories of traditional Chinese medicine in "strengthening body resistance to eliminate the pathogenic factor", so that they provided experimental evidence for TCM tonics to prevent and treat infection of respiratory tract.

Use of intravenous esmolol to predict efficacy of oral beta-adrenergic blocker therapy in patients with neurocardiogenic syncope

The usefulness of esmolol in predicting the efficacy of treatment with an oral beta-adrenergic blocking agent was evaluated in 27 consecutive patients with neurocardiogenic syncope. Seventeen patients had a positive head-up tilt test response at baseline and 10 patients required intravenous isoproterenol for provocation of hypotension. All patients were then given a continuous esmolol infusion (500 micrograms/kg per min loading dose for 3 min followed by 300 micrograms/kg per min maintenance dose) and rechallenged with a head-up tilt test at baseline or with isoproterenol. Of the 17 patients with a positive baseline tilt test response, 11 continued to have a positive response to esmolol challenge. Sixteen patients (including all 10 patients with a positive tilt test response with isoproterenol) exhibited a negative response to upright tilt during esmolol infusion. Irrespective of their response to esmolol infusion, all patients had a follow-up tilt test with oral metoprolol after an interval of greater than or equal to 5 half-lives of the drug. All 16 patients (100%) with a negative tilt test response during esmolol infusion had a negative tilt test response with oral metoprolol. Of the 11 patients with a positive tilt test response during esmolol infusion, 10 (90%) continued to have a positive response with oral metoprolol. It is concluded that in the electrophysiology laboratory, esmolol can accurately predict the outcome of a head-up tilt response to oral metoprolol. This information may be helpful in formulating a therapeutic strategy at the initial head-up tilt test in patients with neurocardiogenic syncope.

Detection of ABR thresholds with a statistical synchrony measure

Using the method of Fridman and his colleagues, a statistical test of auditory brainstem responses (ABR) for detecting auditory thresholds is presented. The synchrony measure (SM) which represents the degree of reproducibility for group averages was used to calculate the selected Fourier components of the group averages from phase variance. The sensitivity of the test was demonstrated on 35 normal ABRs with 60 and 45 dB SL stimulus intensity and in the absence of stimulus from the ipsilateral recordings. The SM of all cases of normal ABRs at 60 and 45 dB SL exceeded those in the absence of stimulation. The same procedure was applied to 16 ears with cochlear hearing loss with (4 ears) and without (10 ears) recruitment and 2 ears with relatively normal hearing threshold (less than 30 dB HL). Seven out of 10 ears without recruitment had the SM value at 60 dB SL stimulus intensity significantly lower than those of normal ABRs.