Stent expansion evaluated by optical coherence tomography and subsequent outcomes

Background

Regarding stent expansion indexes, previous optical coherence tomography (OCT) studies have shown minimal stent area (MSA) to be most predictive of adverse events.

Purpose

We sought to evaluate the impact of various stent expansion indexes by post-stent OCT on long-term clinical outcomes, and hence to find OCT-defined optimal stent expansion criteria.

Methods

Of the patients registered in the Yonsei OCT registry, a total of 1071 patients with 1123 native coronary artery lesions treated with new-generation drug-eluting stents under the OCT guidance and analyzable final post-stent OCT were included. Stent expansion indexes and different suboptimal stent expansion criteria were evaluated for their association with device-oriented clinical endpoints (DoCE) including cardiac death, target vessel-related myocardial infarction (TVMI) or stent thrombosis, and target lesion revascularization. Major safety events (MSE) included cardiac death, TVMI or stent thrombosis.

Results

The median follow-up period was 40.6 (interquartile range 22.0–50.0) months. As a continuous variable, MSA, adaptive volumetric stent expansion (stent volume/adaptive reference lumen volume) and overall volumetric stent expansion (stent volume/post-stent lumen volume) were significantly predictive of DoCE. As a categorical criteria, MSA <5.0 mm2 (hazard ratio [HR] 3.80; 95% confidence interval [CI] 1.53–9.45), MSA/distal reference lumen area <90% (HR 2.13; 95% CI 1.10–4.14), and overall volumetric stent expansion ≥96.6% (HR 2.38; 95% CI 1.09–5.22) were independently associated with DoCE after adjusting for confounders, and a total malapposition volume ≥7.0 mm3 (HR 3.38; 95% CI 1.05–10.93) was linked to MSE.

Conclusions

This OCT study highlights that sufficient stent expansion to achieve adequate absolute MSA and relative MSA by distal reference lumen area and alleviate significant malapposition is important to improve clinical outcome, but overall stent overexpansion may have deleterious effect.

Funding Acknowledgement

Type of funding sources: None.

Effect of early hysterectomy on a risk of incident cardiovascular disease in women: a nationwide population-based cohort study

Aim

Women who inevitably underwent surgical hysterectomy before natural menopause may have an earlier increase in hematocrit and storage iron than women who continue menstruation, thereby increasing the risk of cardiovascular disease (CVD) early. We aimed to evaluate the association of women with hysterectomy vs. without hysterectomy before their 50s with the risk of incident CVD.

Methods

This was a retrospective-cohort study, 135,575 women aged 40 to 50 years in 2011–2014 were extracted from the Korean Health Insurance Review and Assessment Service data and after propensity score matching, 55,539 pairs were included in hysterectomy and non-hysterectomy group respectively. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiovascular death, myocardial infarction (MI), stroke, and coronary artery revascularization.

Results

After adjustment for confounding factors, hysterectomy group had an increased risk of MACCE compared with non-hysterectomy group (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.09–1.44). Regarding individual outcomes, cardiovascular death, MI, and coronary revascularization were comparable between the groups, whereas, the risk of stroke was significantly higher in hysterectomy group than non-hysterectomy group (HR, 1.31; 95% CI, 1.12–1.53). Even after excluding women who underwent oophorectomy, hysterectomy group had a higher risk of MACCE than non-hysterectomy group (HR, 1.24; 95% CI 1.06–1.44).

Conclusions

Early surgical menopause due to hysterectomy, not hormonal menopause, was associated with an increased risk for a composite of CVD, especially stroke. This suggest that the role of “uterus” as well as sex hormones may be important for the sharp increase in the risk of CVD in women after menopause.

Funding Acknowledgement

Type of funding sources: None.

Optimal strategy for antiplatelet therapy after endovascular revascularization in patients with lower extremity artery disease

Background

The duration of antiplatelet therapy after endovascular revascularization in patients with lower extremity artery disease (LEAD) has not been well established. This study aimed to evaluate the clinical outcome according to the duration of dual antiplatelet therapy (DAPT) in real practice.

Methods

From April 2009 to June 2019, 376 patients with LEAD underwent successful endovascular revascularization. After the procedure, the received single antiplatelet therapy (SAPT) or DAPT of various durations were classified into two groups (SAPT or DAPT <6 months vs. DAPT ≥6 months). The primary outcomes were major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). The safety outcome was moderate-to-severe bleeding according to the Global Use of Strategies to Open Occluded Arteries (GUSTO) criteria.

Results

Over the 40-month follow-up period, MACE occurred less frequently in the DAPT ≥6 months group than that in the SAPT or DAPT <6 months group (12.4% vs. 23.8%; hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.35–0.89; p=0.014) after inverse probability-weighted adjustment and propensity-score matching analysis (HR: 0.55, 95% CI; 0.30–0.99, p=0.048). The incidence of MALE did not show significant difference between the two groups (DAPT ≥6 months group: 17.1% vs. SAPT or DAPT <6 months group: 13.1%; HR: 1.05; 95% CI: 0.62–1.78; p=0.846). A significant difference between the DAPT ≥6 months group and the SAPT or DAPT <6 months group was not observed regarding the incidence of moderate-to-severe GUSTO bleeding.

Conclusions

In patients with LEAD, DAPT for ≥6 months after endovascular revascularization was associated with a lower incidence of MACE.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Research Foundation of Korea (NRF) grant funded by the government of Korea (MSIT) (No. 2019R1G1A1100442).

Response After Repeated Ketamine Injections in a Rat Model of Neuropathic Pain

Ketamine, an N-methyl-D-aspartate antagonist, reduces pain by decreasing central sensitization and pain windup. However, chronic ketamine use can cause tolerance, dependency, impaired consciousness, urinary symptoms, and abdominal pain. This study aimed to investigate the effects of repeated ketamine injections and ketamine readministration after discontinuation in a rat model of neuropathic pain. To induce neuropathic pain, partial sciatic nerve ligation (PSNL) was performed in 15 male Wistar rats, and these animals were divided into three groups: PSNL (control), PSNL + ketamine 5 mg/kg (K5), and PSNL + ketamine 10 mg/kg (K10; n=5 each). Ketamine was injected intraperitoneally daily for 4 weeks, discontinued for 2 weeks, and then readministered for 1 week. Following PSNL, the mechanical withdrawal threshold was determined weekly using the Von Frey. The K10 group showed a significant increase in the mechanical withdrawal threshold, presented here as the target force (in g), at 21 and 28 days compared to the time point before ketamine injection (mean±SE, 276.0±24.0 vs. 21.6±2.7 and 300.0±0.0 vs. 21.6±2.7, respectively; P<0.01) and at 14, 21, and 28 days compared to the control group (108.2±51.2 vs. 2.7±1.3, 276.0±24.0 vs. 2.5±1.5, and 300.0±0.0 vs. 4.0±0.0, respectively; P<0.05). However, in the K10 group, the ketamine effects decreased significantly at 7 days after readministration compared to those after 28 days of repeated injections (P<0.05). In the K10 group, repeated ketamine injections showed a significant increase in antinociceptive effect for >2 weeks, but this ketamine effect decreased after drug readministration.

Prospective randomized comparison of cerebrospinal fluid aspiration and conventional popping methods using 27-gauge spinal needles in patients undergoing spinal anaesthesia

Background

Performing spinal anaesthesia using the conventional popping method with a 27-gauge (27G) spinal needle is technically difficult. In this study, we compared the aspiration and conventional popping method for spinal anaesthesia using 27G Quincke-type needles.

Methods

This prospective, randomized study enrolled 90 patients, aged 19 to 65 years, with American Society of Anesthesiologists physical status I-III, who were undergoing spinal anaesthesia. Patients were randomly assigned to one of two groups using a computer-generated random number table: patients receiving spinal anaesthesia using the aspiration method, in which the needle is advanced with continuous aspiration, or the conventional popping method. The primary outcome measure was the success rate of the first attempt to perform dural puncture. Number of attempts and passages, withdrawal cases, successful attempt time, total procedure time, and actual depth of dural puncture were recorded.

Results

Eighty-eight patients were included in the study. In the aspiration group, the success rate of first attempt for dural puncture was 93.3%, compared with 72.1% in the popping group (P = 0.019). Success involving needle withdrawal was recorded in 4 (8.9%) patients in the aspiration group and 13 (30.2%) in the popping group (P = 0.024). In the popping group, the number of attempts was significantly higher (P = 0.044), and total procedure time was significantly longer (P = 0.023). Actual depths of dural puncture were deeper in the popping group than in the aspiration group (P = 0.019).

Conclusions

The aspiration method using a 27G Quincke-type needle offers clinical benefits for dural puncture compared with the conventional popping method for spinal anaesthesia.

Trial registration

Clinical research information service number: KCT0002815, registered 21/Apr/2018. Retrospectively registered.

Prevalence of measles IgG antibodies among immigrant workers in South Korea

Background

After the national vaccination for measles was introduced in 1985, the measles has been controlled in South Korea despite the epidemic in 2000-2001. Current cases in Korea were assumed to be transmitted from outside the country. Because the dynamics and social changes of the population has emerged as important factors in the measles epidemic, this study aimed to assess the prevalence of measles IgG antibodies among immigrant workers.

Methods

The cross sectional seroprevalence survey was conducted in Gyeongsangnamdo province, Korea. Because the representative sampling frame could not be possible, the voluntary foreign workers who have agreed informed consents with a translated format into the native language, participated in this study. IgG antibodies of measles was examined by ELISA using the automation equipment (BEP III- ELISA). This study obtained the approval of Dong-A University Clinical Research Ethics Review Committee.

Results

364 people of foreign workers participated in the study. Regional distribution for study participants was composed of 30 people in Vietnam (16.5%), Uzbekistan 71 people (19.5%), Thailand 70 people (19.2%), China 60 people (16.5%), Philippines 36 people (9.9%), and Indonesia 32 people (8.8%). The average age was 33.0 ± 6.9 years old and 86.5% of the total was men. High school or higher education accounted for 74%. 93.7% showed positivity (95% CI: 95.7-98.9%) for measles IgG antibody and 3.6% showed equivocal.

Conclusions

The measles seropositivity among immigrant workers in Korea was considered to be at the recommended level.

Key messages

The measles seropositivity among immigrant workers in Korea was considered to be at the recommended level. International cooperation is needed to prevent global measles epidemic.

Randomised clinical trial: the efficacy and safety of oltipraz, a liver X receptor alpha-inhibitory dithiolethione in patients with non-alcoholic fatty liver disease

BACKGROUND

Oltipraz is a synthetic dithiolethione with an antisteatotic effect by inhibiting the activity of liver X receptor alpha (LXR-α). Recent studies demonstrated the disruptive role of oltipraz on LXR-α-dependent lipogenesis in hepatocytes and a high-fat diet mouse model.

AIM

To evaluate the efficacy and safety of oltipraz for reducing liver fat in subjects with non-alcoholic fatty liver disease (NAFLD).

METHODS

We performed a multicentre, double-blind, placebo-controlled, phase II study. Subjects with a liver fat >20% and hypertransaminasemia were randomised to the three groups: placebo (n = 22), 30 mg of oltipraz (n = 22) or 60 mg of oltipraz (n = 24) twice daily for 24 weeks. Changes in the liver fat from baseline to 24 weeks quantified using magnetic resonance spectroscopy were the primary outcome.

RESULTS

Compared with the placebo group (-3.2 ± 11.1%), absolute changes in the liver fat content increased in a dose-dependent manner: -7.7 ± 7.0% and -13.9 ± 10.7% for the low-dose and high-dose groups (P = 0.13 and P < 0.01). Per cent reduction in the liver fat content was also significantly greater in the high-dose group than in the placebo group (-34.6 ± 29.4% vs. -0.6 ± 62.9%, P = 0.046). Body mass indices (-1.0 ± 0.9% vs. -0.5 ± 1.4%, P = 0.04) significantly decreased in the high-dose group compared to the placebo group. However, absolute changes in insulin resistance, liver enzymes, lipids and cytokines were not significantly different among groups. The incidence of adverse events was comparable among groups.

CONCLUSIONS

Twenty-four-week oltipraz treatment significantly reduced the liver fat content in patients with NAFLD. Clinicaltrials.gov (NCT01373554).

Characteristics of extracellular cyclic AMP-dependent protein kinase as a biomarker of cancer in dogs

OBJECTIVE

Early and proper diagnosis of cancer is the most critical factor for the survival and treatment of veterinary cancer patients. In this study, we evaluated extracellular cyclic AMP-dependent protein kinase A (ECPKA) level in serum as a useful cancer biomarker in dogs.

METHODS

ECPKA levels were detected in sera from dogs with cancers (n = 48), benign tumours (n = 18), and non-tumour diseases (n = 102) as well as healthy control dogs (n = 54) utilizing enzyme-linked immunosorbent assay (ELISA).

RESULTS

Sera from dogs bearing various types of cancer exhibited markedly increased levels of ECPKA by up to 7.1-, 8.8-, and 10.9-fold compared with those from dogs harbouring benign tumours, dogs with non-tumour diseases, and healthy control dogs, respectively (P < .0001). In addition, serum ECPKA level did not show statistically significant correlation with gender, breed, or age of dogs or their non-cancerous disease conditions.

CONCLUSION

Our data strongly propose that detection of serum ECPKA level is a potential and specific diagnostic tool for cancer in dogs.

Effects of ileal digesta collection time on standardized ileal digestibility of amino acids in corn, soybean meal, and distiller's dried grains with solubles fed to growing pigs

The objective of this experiment was to determine the minimum collection time needed to obtain representative samples of ileal digesta from pigs fed different types of diets. Eight barrows with an initial BW of 34.6 kg (SD 2.1) were individually fitted with a T-cannula in the distal ileum and randomly allotted to a replicated 4 × 4 Latin square design with 4 diets and 4 periods per square. Three diets contained corn, soybean meal (SBM), or distiller's dried grains with solubles (DDGS) as the sole source of CP. An N-free diet was also prepared. All diets contained 0.5% chromic oxide as an indigestible marker. Equal meals were provided at 0800 and 2000 h. Ileal digesta samples were collected in 2-h intervals from 0800 to 2000 h during the last 3 d of each 7-d period. When pigs were fed the corn diet, the standardized ileal digestibility (SID) of most indispensable AA and dispensable AA increased and then decreased (quadratic, < 0.05) during each of the six 2-h periods. The SID of most AA were less ( < 0.05) if the ileal digesta samples were collected from 1800 to 2000 h or from 1600 to 2000 h compared with the SID values from the ileal samples collected over the entire 12-h period. When pigs were fed the SBM diet, the SID of Ile, Leu, Thr, Trp, Val, Ala, and Cys increased and then decreased (quadratic, < 0.05) but the SID of all other AA linearly decreased ( < 0.05) during the six 2-h periods. The SID of almost all AA were greater ( < 0.05) if the ileal samples were collected from 0800 to 1000 h, from 0800 to 1200 h, from 1000 to 1400 h, or from 0800 to 1400 h but less ( < 0.05) if collected from 1600 to 1800 h, from 1800 to 2000 h, from 1600 to 2000 h, or from 1400 to 2000 h compared with the SID values from the ileal samples collected over the entire 12-h period. When pigs were fed the DDGS-based diet, the SID of Ile, Leu, Lys, Phe, Trp, Val, and Tyr increased and then decreased (quadratic, < 0.05) during the six 2-h periods. The SID of most AA were less ( < 0.05) if the ileal samples were collected from 1800 to 2000 h compared with the SID values from the ileal samples collected over the entire 12-h period. In conclusion, diurnal variations in SID of AA in pigs indicate that 6 h of ileal sample collection starting 4 or 6 h after feeding may provide representative samples of ileal digesta from pigs fed different types of diets.

Effects of collection time on flow of chromium and dry matter and on basal ileal endogenous losses of amino acids in growing pigs

The objectives of this experiment were to examine the diurnal patterns of chromium and DM flow at the distal ileum of pigs and to determine the effect of collection time on basal ileal endogenous losses (BEL) of CP and AA. Eight barrows with an initial BW of 34.6kg (SD = 2.1) were individually fitted with a T-cannula in the distal ileum and randomly allotted to a replicated 4× 4 Latin square design with 4 diets and 4 periods in each square. Three diets contained either corn, soybean meal, or distillers dried grains with solubles as the sole source of CP and AA. An N-free diet was also prepared. All diets contained 0.5% chromic oxide as an indigestible marker. Equal meals were provided at 0800 and 2000 h. Ileal digesta samples were collected in 2-h intervals from 0800 to 2000 h during the last 3 d of each 7-d period. The concentration of Cr in ileal digesta samples collected in each of the six 2-h periods exhibited a quadratic effect ( < 0.01) that increased and then decreased in pigs fed the CP containing diets. However, the concentration of Cr in ileal digesta collected in each of the six 2-h periods from pigs fed the N-free diet increased (linear, < 0.01). These differences were possibly related to differences in DM flow, because DM flow to the distal ileum had a pattern that was opposite of that observed for the concentration of Cr in the ileal digesta samples. The BEL of all indispensable AA and the sum of indispensable AA from pigs fed the N-free diet decreased (linear, < 0.05) in each of the six 2-h periods, with the exception that the BEL of Arg increased and then decreased (quadratic, < 0.05). The BEL of Asp, Cys, Glu, Ser, and Tyr also decreased (linear, < 0.05) during each of the six 2-h periods, whereas the BEL of Pro and the sum of dispensable AA increased and then decreased (quadratic, < 0.05) over the 12 h. Collection time did not affect BEL of CP. No differences were observed in the concentration of Cr, flow of DM, or basal endogenous loss of all AA if ileal digesta samples were collected over 6-, 8-, or 10-h periods, compared with collection over a 12-h period. In conclusion, diurnal variation of Cr concentration, DM flow, and the BEL of all AA were observed, but 4 to 6 h of ileal sample collection starting 4 or 6 h after feeding may provide representative samples that allow for calculation of accurate values for CP and AA digestibility.

Different Coefficients and Exponents for Metabolic Body Weight in a Model to Estimate Individual Feed Intake for Growing-finishing Pigs

Estimation of feed intake (FI) for individual animals within a pen is needed in situations where more than one animal share a feeder during feeding trials. A partitioning method (PM) was previously published as a model to estimate the individual FI (IFI). Briefly, the IFI of a pig within the pen was calculated by partitioning IFI into IFI for maintenance (IFI_m) and IFI for growth. In the PM, IFI_m is determined based on the metabolic body weight (BW), which is calculated using the coefficient of 106 and exponent of 0.75. Two simulation studies were conducted to test the hypothesis that the use of different coefficients and exponents for metabolic BW to calculate IFI_m improves the accuracy of the estimates of IFI for pigs, and that PM is applied to pigs fed in group-housing systems. The accuracy of prediction represented by difference between actual and estimated IFI was compared using PM, ratio (RM), or averaging method (AM). In simulation studies 1 and 2, the PM estimated IFI better than the AM and RM during most of the periods (p<0.05). The use of 0.60 as the exponent and the coefficient of 197 to calculate metabolic BW did not improve the accuracy of the IFI estimates in both simulation studies 1 and 2. The results imply that the use of 197 kcal×kg BW^0.60 as metabolizable energy for maintenance in PM does not improve the accuracy of IFI estimations compared with the use of 106 kcal×kg BW^0.75 and that the PM estimates the IFI of pigs with greater accuracy compared with the averaging or ratio methods in group-housing systems.

In vitro Solubility of Copper(II) Sulfate and Dicopper Chloride Trihydroxide for Pigs

This study was conducted to determine the solubility of copper (Cu) in two sources of copper(II) sulfate (CuSO₄) including monohydrate and pentahydrate and three sources of dicopper chloride trihydroxide (dCCTH) including α-form (dCCTH-α), β-form (dCCTH-β), and a mixture of α- and β-form (dCCTH-αβ) at different pH and a 3-step in vitro digestion assay for pigs. In Exp. 1, Cu sources were incubated in water-based buffers at pH 2.0, 3.0, 4.8, and 6.8 for 4 h using a shaking incubator at 39°C. The CuSO₄ sources were completely dissolved within 15 min except at pH 6.8. The solubility of Cu in dCCTH-α was greater (p<0.05) than dCCTH-β but was not different from dCCTH-αβ during 3-h incubation at pH 2.0 and during 2-h incubation at pH 3.0. At pH 4.8, there were no significant differences in solubility of Cu in dCCTH sources. Copper in dCCTH sources were non-soluble at pH 6.8. In Exp. 2, the solubility of Cu was determined during the 3-step in vitro digestion assay for pigs. All sources of Cu were completely dissolved in step 1 which simulated digestion in the stomach. In Exp. 3, the solubility of Cu in experimental diets including a control diet and diets containing 250 mg/kg of additional Cu from five Cu sources was determined during the in vitro digestion assay. The solubility of Cu in diets containing additional Cu sources were greater (p<0.05) than the control diet in step 1. In conclusion, the solubility of Cu was influenced by pH of digesta but was not different among sources based on the in vitro digestion assay.

Resistance to hypertension and high Cl- excretion in humans with SLC26A4 mutations

Pendrin is a membrane transporter encoded by solute carrier family26A4 (SLC26A4). Mutations in this gene are known to cause hearing loss, and recent data from animal studies indicate a link between pendrin expression and hypertension; although, this association in humans is unclear. To clarify this issue, we investigated the influence of pendrin on blood pressure by analyzing demographic and biochemical data - including blood pressure and urinary electrolyte excretion - in patients with bi-allelic SLC26A4 mutations. Systolic and diastolic blood pressure and the left ventricular hypertrophy index were lower in subjects with pendrin mutations than in controls. In addition, fractional excretion of Na⁺ and Cl^- was increased and serum renin, angiotensin I and II levels were higher in subjects with pendrin mutations as compared to controls. Thus, patients with impaired pendrin function are likely to be resistant to high blood pressure due to enhanced urinary Na⁺ /Cl^- excretion. These results suggest that pendrin may regulate blood pressure through increased urinary salt excretion.

Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial

BACKGROUND

Respiratory functions are usually impaired during pneumoperitoneum for laparoscopic surgery. This randomized, controlled and single-blinded study was performed to evaluate whether intraoperative protective lung ventilation influences postoperative pulmonary complications after laparoscopic hepatobiliary surgery.

METHODS

Sixty-two patients were randomized to receive either conventional ventilation with alveolar recruitment maneuver (tidal volume of 10 ml/kg with inspiratory pressure of 40 cmH2O for 30 s after the end of pneumoperitoneum, group R), or protective lung ventilation (low tidal volume of 6 ml/kg with positive end-expiratory pressure [PEEP] of 5 cmH2O, group P). Induction and maintenance of anesthesia were done with balanced anesthesia. Respiratory complications such as atelectasis, pneumonia or desaturation were observed postoperatively. The length of hospital stay, arterial blood gas analysis, peak inspiratory pressure and hemodynamic variables were also recorded. Results are presented as mean ± SD or number of patients (%).

RESULTS

Postoperative pulmonary complications (P = 0.023) and desaturation below 90 % (P = 0.016) occurred less frequently in group P than in group R. Eight patients of group R and 3 patients of group P showed atelectasis. Pneumonia was diagnosed in 1 patient of group R. No differences were observed in the length of hospital stay, arterial blood gas analysis (pH, PaO2, PaCO2 and PAO2) and hemodynamic variables except PAO2, AaDO2 and peak inspiratory pressure between the two groups.

CONCLUSION

Protective lung ventilation (low tidal volume with PEEP) during pneumoperitoneum was associated with less incidences of pulmonary complications than conventional ventilation with alveolar recruitment maneuver after laparoscopic hepatobiliary surgery.

Interaction between hypertension and cerebral hypoperfusion in the development of cognitive dysfunction and white matter pathology in rats

Hypertension is the most significant modifiable risk factor for vascular cognitive impairment. However, influence of hypertension on the development of ischemic white matter injury and cognitive dysfunction is not fully understood. We compared cognitive functions and neuropathological outcomes of chronic cerebral hypoperfusion induced by bilateral common carotid artery occlusion (BCCAO) between normotensive rats (NRs) and spontaneously hypertensive rats (SHRs). SHRs developed earlier and more severe deficits in spatial memory performance than NRs following BCCAO. Although no significant changes in the gross structure of myelinated white matter or oligodendrocyte number were noted, BCCAO resulted in subtle myelin degeneration and paranodal structural alterations at the nodes of Ranvier, regardless of hypertension. Disruption of the blood-brain barrier (BBB) was predominantly observed in the white matter of SHRs following BCCAO, implying a role of hypertension in BBB dysfunction in chronic cerebral hypoperfusion. In chronic cerebral ischemia, long-standing hypertension may aggravate impairment of BBB integrity, and the leaky BBB may in turn exacerbate dysfunction in the white matter leading to worsening of spatial cognitive performance.

Effects of Supplemental Beta-mannanase on Digestible Energy and Metabolizable Energy Contents of Copra Expellers and Palm Kernel Expellers Fed to Pigs

The purpose of this study was to determine the effect of β-mannanase supplementation on digestible energy (DE) and metabolizable energy (ME) contents of copra expellers (CE) and palm kernel expellers (PKE) fed to pigs. Six barrows with an initial body weight of 38.0 kg (standard deviation = 1.5) were randomly allotted to a 6×6 Latin square design with 6 dietary treatments and 6 periods. Six experimental diets were prepared in a 3×2 factorial treatment arrangement with 3 diets of a corn-soybean meal-based diet, a CE 30% diet, and a PKE 30% diet and with 2 concentrations of supplemental β-mannanase at 0 or 2,400 U/kg. All diets had the same proportion of corn:soybean meal ratio at 2.88:1. The marker-to-marker procedure was used for fecal and urine collection with 4-d adaptation and 5-d collection periods. No interactive effects were observed between diet and β-mannanase on energy digestibility and DE and ME contents of experimental diets. However, diets containing CE or PKE had less (p<0.05) DE and ME contents compared with the corn-soybean meal-based diet. The DE and ME contents in CE and PKE were not affected by supplemental β-mannanase. Taken together, we failed to find the effect of β-mannanase supplementation on energy utilization in CE and PKE fed to pigs.

Effects of Feeding Barley Naturally Contaminated with Fusarium Mycotoxins on Growth Performance, Nutrient Digestibility, and Blood Chemistry of Gilts and Growth Recoveries by Feeding a Non-contaminated Diet

The objectives of this study were to investigate the effects of feeding barley naturally contaminated with Fusarium mycotoxins on growth performance, vulva swelling, and digestibility of dry matter, organic matter, and crude protein of gilts and the recovery of gilts fed normal diets immediately after the exposure to contaminated diets by measuring growth performance and vulva swelling. In Exp. 1, four diets were prepared to contain 0%, 15%, 30%, or 45% contaminated barley containing 25.7 mg/kg deoxynivalenol and 26.0 μg/kg zearalenone. Sixteen gilts with an initial body weight (BW) of 33.3 kg (standard deviation = 3.0) were individually housed in a metabolism crate and assigned to 4 diets with 4 replicates in a randomized complete block design based on BW. During the 14-d feeding trial, individual BW and feed consumption were measured weekly and the vertical and horizontal lengths of vulva were measured every 3 d. From d 10, feces were collected by the maker-to-marker method for 4 d. Blood samples were collected on d 14. During the overall period, the average daily gain, average daily feed intake, and gain:feed of pigs linearly decreased (p<0.01) as the dietary concentration of contaminated barley increased. However, the digestibility of crude protein was linearly increased (p = 0.011) with the increasing amounts of contaminated barley. Increasing dietary Fusarium mycotoxin concentrations did not influence vulva size, blood characteristic as well as immunoglobulin level of pigs. In the Exp. 2, a corn-soybean meal-based diet was formulated as a recovery diet. Pigs were fed the recovery diet immediately after completion of the Exp. 1. During the 14-d of recovery period, the individual BW and feed consumption were measured weekly and the vertical and horizontal length of vulva were measured every 3 d from d 0. On d 7, the feed intake of pigs previously fed contaminated diets already reached that of pigs fed a diet with 0% contaminated barley and no significant difference in growth performance among treatments was observed during d 7 to 14 of the recovery period. In conclusion, increasing levels of mycotoxins in diets linearly decreased the growth performance of pigs, and these damages can be recovered in 7 d after the diet was replaced with a normal diet. The vulva size, blood characteristic, immune responses were not affected by increasing level of contaminated barley in the diets fed to pigs.

Adjuvant chemotherapy for elderly patients (aged 70 or older) with gastric cancer after a gastrectomy with D2 dissection: A single center experience in Korea

AIMS

Adjuvant chemotherapy is recommended for gastric cancer after a gastrectomy with D2 dissection. However, its survival benefit in elderly patients is unclear. Here we investigated the use of adjuvant chemotherapy in patients ≥70 years old with stage II or III gastric cancer.

METHODS

Patients ≥70 years old diagnosed with stage II or III gastric cancer at Ulsan University Hospital were identified. A retrospective analysis of electronic and paper patient records was performed.

RESULTS

From 2008 to 2012, 277 patients ≥70 years old underwent gastrectomy with D2 dissection. Of these patients, 94 were pathologically diagnosed with stage II or III; 55 of these patients (58.5%) received adjuvant chemotherapy and 39 received regular checkups without chemotherapy. Fluoropyrimidine-alone regimens, including TS-1 composed of tegafur, gimestat and otastat potassium (n = 26) and doxifluridine (n = 22), were more commonly used than fluoropyrimidine-platinum combination regimens (n = 7). With a median follow-up of 30.9 (range 0.8-65.5) months, the median relapse-free survival of patients with adjuvant chemotherapy or regular follow-up only was 35.5 and 20.4 months, respectively (P = 0.030). Multivariate analysis revealed that adjuvant chemotherapy is associated with longer relapse-free survival (hazard ratio 0.50; 95% confidence interval 0.27-0.96). There was a trend toward an improved overall survival in the adjuvant chemotherapy group compared with the follow-up only group (P = 0.242).

CONCLUSIONS

Although well-designed prospective studies are required, adjuvant chemotherapy may confer a potential survival benefit in elderly patients (aged 70 or older) with stage II or III gastric cancer after a gastrectomy with D2 dissection.

Effects of Palonosetron on Perioperative Cardiovascular Complications in Patients Undergoing Noncardiac Surgery With General Anesthesia: A Retrospective Cohort Study

We retrospectively investigated whether palonosetron administered during the induction of general anesthesia is associated with an increased risk of perioperative cardiovascular complications in a single tertiary center cohort consisting of 4,517 palonosetron-exposed patients and 4,517 propensity score-matched patients without palonosetron exposure. The primary endpoint was a composite of perioperative cardiovascular complications, including intraoperative cardiac arrhythmia, intraoperative cardiac death, and myocardial injury within the first postoperative week, and there was no significant difference between the groups (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 0.92-1.19). As secondary endpoints, intraoperative cardioversion, cardiac compression, use of cardiovascular drugs, postoperative hospital stay, and in-hospital mortality showed no differences between the groups. However, the palonosetron group showed decreased intraoperative hypotension (OR = 0.88; 95% CI = 0.79-0.97) and length of postoperative intensive care unit (ICU) stay (4.26 ± 9.86 vs. 6.14 ± 16.75; P = 0.026). Palonosetron did not increase the rate of perioperative cardiovascular complications, and can therefore be used safely during anesthetic induction.

Effects of dietary cellulose on the Basal endogenous loss of phosphorus in growing pigs

An experiment was conducted to determine the effect of cellulose concentration in diets containing no phosphorus (P) on the basal endogenous loss (BEL) of P in growing pigs. Twelve barrows (an initial mean body weight = 49.6±3.2 kg) were individually housed in metabolism crates. Pigs were allotted to 4 experimental diets according to a cross-over design with 12 animals and 2 periods. Four P-free diets were mainly based on corn starch, sucrose, and gelatin, and were formulated to contain 0%, 4%, 8%, or 12% cellulose. Each period consisted of a 5-d adaptation and a 5-d collection period. The marker-to-marker method was used for fecal collection. The feed intake (p<0.05, linear and quadratic) and dry feces output (p<0.01, linear and quadratic) were increased with increasing dietary cellulose concentration. However, P concentration in the feces was decreased (p<0.01, linear and quadratic) with increasing dietary cellulose concentration. There was no significant difference in total P output and the BEL of P as mg per kg DMI (ranging from 157 to 214 mg/kg of dry matter intake) among experimental diets. However, values for the apparent total tract digestibility of energy, dry matter, organic matter, crude protein, and calcium were linearly decreased (p<0.01) with increasing cellulose concentration in the diet. In conclusion, dietary cellulose affected the amount of feces and digestibility of energy and nutrients, but did not affect the endogenous loss of P.

Energy concentration and phosphorus digestibility in yeast products produced from the ethanol industry, and in brewers' yeast, fish meal, and soybean meal fed to growing pigs

Two experiments were conducted to determine the DE, ME, and standardized total tract digestibility (STTD) of P in 2 novel sources of yeast (C-yeast and S-yeast) and in brewers' yeast, fish meal, and soybean meal fed to growing pigs. The 2 new sources of yeast are coproducts from the dry-grind ethanol industry. The concentrations of DM, GE, and P were 94.8%, 5,103 kcal/kg, and 1.07% in C-yeast; 94.4%, 4,926 kcal/kg, and 2.01% in S-yeast; 93.6%, 4,524 kcal/kg, and 1.40% in brewers' yeast; 91.4%, 4,461 kcal/kg, and 3.26% in fish meal; and 87.7%, 4,136 kcal/kg, and 0.70% in soybean meal, respectively. The DE and ME in each of the ingredients were determined using 42 growing barrows (28.9±2.18 kg BW). A corn-based basal diet and 5 diets containing corn and 24% to 40% of each test ingredient were formulated. The total collection method was used to collect feces and urine, and the difference procedure was used to calculate values for DE and ME in each ingredient. The concentrations of DE in corn, C-yeast, S-yeast, brewers' yeast, fish meal, and soybean meal were 4,004, 4,344, 4,537, 4,290, 4,544, and 4,362 kcal/kg DM (SEM=57), respectively, and the ME values were 3,879, 3,952, 4,255, 3,771, 4,224, and 4,007 kcal/kg DM (SEM=76), respectively. The ME in S-yeast and fish meal were greater (P<0.05) than the ME in corn and brewers' yeast, whereas the ME in C-yeast and soybean meal were not different from those of any of the other ingredients. The STTD of P in the 5 ingredients was determined using 42 barrows (28.3±7.21 kg BW) that were placed in metabolism cages. Five diets were formulated to contain each test ingredient as the sole source of P, and a P-free diet was used to estimate the basal endogenous loss of P. Feces were collected for 5 d using the marker to marker method after a 5-d adaptation period. The STTD of P in brewers' yeast (85.2%) was greater (P<0.05) than the STTD of P in all the other ingredients except S-yeast (75.7%). The STTD of P in C-yeast (73.9%) was not different from the STTD of P in S-yeast and fish meal (67.3%) but was greater (P<0.05) than the STTD of P in soybean meal (56.7%). In conclusion, the 2 novel sources of yeast contain similar or greater concentrations of energy compared with brewers' yeast, corn, fish meal, and soybean meal, and the STTD of P in the 2 yeast products is not different from the STTD of P in fish meal.

Effects of dietary sulfur and distillers dried grains with solubles on carcass characteristics, loin quality, and tissue concentrations of sulfur, selenium, and copper in growing-finishing pigs

Inclusion of up to 0.38% S in diets that contain 30% distillers dried grains with solubles (DDGS) has no negative effect on growth performance of growing-finishing pigs, but there is no information about the effects of dietary S on accumulation of S in tissues in pigs. Therefore, the objective of this experiment was to determine if the concentration of S in diets containing DDGS affects carcass characteristics, loin quality, or tissue mineral concentrations in growing-finishing pigs. A total of 120 barrows (34.2 ± 2.3 kg BW) were allotted to 3 dietary treatments with 10 replicate pens and 4 pigs per pen in a randomized complete block design. Pigs were fed grower diets for 42 d and finisher diets for 42 d. At the conclusion of the experiment, the pig in each pen with the BW closest to the pen average was slaughtered. The control diet was based on corn and soybean meal and the finisher diet contained 0.14% S, 0.19 mg/kg Se, and 15.3 mg/kg Cu. The DDGS diet was formulated with corn, soybean meal, and 30% DDGS and the finisher diet with DDGS contained 0.16% S, 0.32 mg/kg Se, and 14.0 mg/kg Cu. The DDGS plus S (DDGS-S) diet was similar to the DDGS diet, except that 1.10% CaSO4 (16.2% S) was included in this diet, and the finisher diet with DDGS-S contained 0.37% S, 0.35 mg/kg Se, and 13.8 mg/kg Cu. Results indicated that organ weights and loin quality, 24-h pH, drip loss, loin subjective color, marbling, and firmness did not differ among treatments, but loin a* was greater (P < 0.05) for pigs fed the control diet than for pigs fed the DDGS-S diet. Concentrations of S in hair, liver, heart, loin, and all other tissues did not differ among treatments, but urinary S concentration was greater (P < 0.05) for pigs fed the DDGS-S diet than for pigs fed the other diets. Pigs fed the DDGS diet or the DDGS-S diet had greater (P < 0.01) concentrations of Se in hair, liver, heart, and loin than pigs fed the control diet, but liver concentrations of Cu did not differ among treatments. In conclusion, inclusion of 30% DDGS in diets fed to growing-finishing pigs did not influence carcass characteristics or tissue S concentrations regardless of S concentration in the diet, and excess dietary S was excreted in the urine. However, because of the greater concentration of Se in DDGS than in corn and soybean meal and, therefore, greater concentrations in DDGS-containing diets, tissue concentrations of Se were increased in pigs fed diets that contained DDGS. In contrast, dietary DDGS did not influence liver concentrations of Cu.

Ileal digestibility of amino acids in meat meal and soybean meal fed to growing pigs

The objective of this experiment was to determine the concentration and digestibility of crude protein (CP) and amino acid (AA) in meat meal (MM), and to compare these values with the respective values in soybean meal (SBM). Six barrows (initial body weight = 66.9±3.8 kg) surgically fitted with a T-cannula at the distal ileum were allotted to a replicated 3×3 balanced Latin square design with 3 diets and 3 periods. Two experimental diets containing test ingredients as the sole source of AA were prepared to estimate the apparent ileal digestibility (AID) for CP and AA by the direct method. An N-free diet was also prepared to estimate basal endogenous losses of CP and AA. All experimental diets contained 5% chromic oxide as an indigestible index. Each period consisted of a 5-d adaptation period and a 2-d of ileal digesta collection period. Ileal digesta samples were collected from 0900 to 1700 on d 6 and 7 of each period. The concentrations of CP, Lys, Met, and Trp in MM and SBM were analyzed to be 64.1, 3.5, 1.1 and 0.6, and 45.6, 2.8, 0.8, and 0.3%, respectively. The AID of all AA except Gly in MM was less (p<0.05) than in SBM. The AID of Lys, Met, and Trp in MM was estimated to be 56.0, 71.7, and 47.1%, respectively. The SID of all AA in MM was less (p<0.05) than in SBM. The SID of Lys, Met, and Trp was 65.1, 79.2, and 78.5%, respectively. In conclusion, the CP and AA contents in MM were greater than those in SBM whereas the ileal digestibility of all AA in MM was less than in SBM.

Feed energy evaluation for growing pigs

Pigs require energy for maintenance and productive purposes, and an accurate amount of available energy in feeds should be provided according to their energy requirement. Available energy in feeds for pigs has been characterized as DE, ME, or NE by considering sequential energy losses during digestion and metabolism from GE in feeds. Among these energy values, the NE system has been recognized as providing energy values of ingredients and diets that most closely describes the available energy to animals because it takes the heat increment from digestive utilization and metabolism of feeds into account. However, NE values for diets and individual ingredients are moving targets, and therefore, none of the NE systems are able to accurately predict truly available energy in feeds. The DE or ME values for feeds are important for predicting NE values, but depend on the growth stage of pigs (i.e., BW) due to the different abilities of nutrient digestion, especially for dietary fiber. The NE values are also influenced by both environment that affects NE requirement for maintenance (NE_m) and the growth stage of pigs that differs in nutrient utilization (i.e., protein vs. lipid synthesis) in the body. Therefore, the interaction among animals, environment, and feed characteristics should be taken into consideration for advancing feed energy evaluation. A more mechanistic approach has been adopted in Denmark as potential physiological energy (PPE) for feeds, which is based on the theoretical biochemical utilization of energy in feeds for pigs. The PPE values are, therefore, believed to be independent of animals and environment. This review provides an overview over current knowledge on energy utilization and energy evaluation systems in feeds for growing pigs.

Comparison of growth performance, carcass characteristics and meat quality of korean local chickens and silky fowl

This study was conducted to compare growth performance, carcass characteristics and meat quality of 4 breeds of local chicken. A total of 480 1-d-old chicks were distributed to 16 pens, with 4 treatments of breed, 4 replicates and 30 chicks per pen. Three Korean local breeds of white-mini broiler, Hanhyup-3-ho, and Woorimatdag, and a breed of silky fowl were raised under identical rearing and feeding conditions for 31-d, 37-d, 36-d, and 59-d, respectively. The BW and feed consumption on a pen basis were weekly measured for all pens, and ADFI, ADG and gain:feed were calculated for each pen. The ADFI and ADG of 3 breeds of Korean local chicken were greater than those of silky fowl (p<0.05). Within the Korean local breeds, ADFI of white-mini broiler was the highest (p<0.05), and ADG of Hanhyup-3-ho and white-mini broiler was the highest (p<0.05). Gain:feed of silky fowl was less than that of the 3 breeds of Korean local chicken. The carcass and breast yield of white-mini broiler were the greater than those of other breeds (p<0.05). The breast meat color (CIE L*, a*, and b*) of 3 breeds of Korean local chicken were higher than that of silky fowl (p<0.05). The breast meat of Hanhyup-3-ho had greater cooking loss (p<0.05), whereas water holding capacity and pH were less than those of other breeds (p<0.05). The color score of 3 breeds of Korean local chicken was higher than that of silky fowl (p<0.05). Woorimatdag had a higher score on tenderness (p<0.05), whereas flavor score was less than that of other breeds (p<0.05). In conclusion, 4 local breeds of chicken have some unique features and seem to have more advantages, and this information can help consumers who prefer healthy and premium chicken meat.

A simple novel endoscopic successive suture device: a validation study for closure strength and reproducibility

BACKGROUND AND STUDY AIMS

Endoscopic surgical technology has been developing rapidly. Although several successful endoscopic closure devices have already been introduced, only a few of them have demonstrated improvements in closure strength and reproducibility over conventional endoscopic clip closures or hand sutures. The objective of this study was to test the feasibility of a novel successive suturing device (SSD) by measuring closure strength and reproducibility.

MATERIAL AND METHODS

Porcine stomach models were used in this study. Endoclips, full-thickness hand sutures, and the novel SSD sutures were used to close a perforation in the stomach wall, with 10 stomachs being tested for each closure method. Endoclips and SSD sutures were performed using a two-channel endoscope, and the hand sutures were performed from outside of the stomach wall. Air leakage pressure was measured to determine the closure strength and reproducibility of each method.

RESULTS

The mean air leakage pressure of the SSD closure was 62.7 ± 8.2 mmHg. SSD-treated stomachs exhibited significantly greater air leakage pressure than Endoclip-treated stomachs. The standard deviation of bursting pressure in SSD stomachs was found to be significantly smaller than that of hand-sewn stomachs but was not different from that of Endoclip stomachs.

CONCLUSIONS

The consistent closure strength of SSD stomachs demonstrated the reliability and reproducibility of this new closure method. These promising results in closure strength and reproducibility suggest the feasibility of the proposed device for clinical applications.

Digestible and metabolizable energy concentrations in copra meal, palm kernel meal, and cassava root fed to growing pigs

An experiment was conducted to measure DE and ME in copra (Cocos nucifera) meal (CM), palm kernel meal (PKM), and cassava (Manihot esculenta) root (CR) in growing pigs. Eight boars with an initial BW of 67.3 ± 5.8 kg were individually housed in metabolism crates that were equipped with a feeder and a nipple drinker. A replicated 4 × 4 Latin square design was used with 4 dietary treatments, 4 periods, and 8 animals. A basal diet mainly contained corn (Zea mays) and soybean (Glycine max) meal. Three additional diets were formulated to contain 30% of CM, PKM, and CR. All diets contained the same proportion of corn:soybean meal ratio at 4.14:1. The apparent total tract digestibility of energy was 89.5, 84.1, 82.4, and 87.9% (P < 0.001) in the basal, CM, PKM, and CR diets, respectively. The DE in CM and PKM were greater (P < 0.05) than in CR (3440 and 3238 vs. 2966 kcal/kg as-fed). The ME in CM was greater (P < 0.05) than in CR (3340 vs. 2935 kcal/kg as-fed) but not different from the ME in PKM (3168 kcal/kg as-fed). In conclusion, CM and PKM have a higher DE value than CR, and CM has a higher ME value than CR.

Comparison of values for standardized total tract digestibility and relative bioavailability of phosphorus in dicalcium phosphate and distillers dried grains with solubles fed to growing pigs

Two experiments were conducted to compare values for the standardized total tract digestibility (STTD) and the relative bioavailability of P in dicalcium phosphate (DCP) and distillers dried grains with solubles (DDGS) when fed to growing pigs. In Exp. 1, the apparent total tract digestibility (ATTD), the basal endogenous P loss (EPL), and the STTD of P in DCP and DDGS were determined. Eighteen pigs (initial BW: 34.93±1.04 kg) were allotted to 3 cornstarch-based diets in a randomized complete block design and housed individually in metabolism cages. Two diets contained DCP and DDGS, respectively, as the sole source of P and the last diet was a P-free diet that was used to measure EPL from the pigs. Results indicated that the ATTD of P in DCP and DDGS were 86.1 and 58.8%, respectively, and the STTD of P in DCP and DDGS were 93.1 and 63.1%, respectively. The EPL was determined at 174 mg/kg DMI. In Exp. 2, 42 pigs (initial BW: 29.02±2.03 kg) were allotted to 7 dietary treatments in a randomized complete block design. Pigs were housed individually and allowed ad libitum access to feed and water. A basal diet (0.22% P) based on corn, casein, cornstarch, and potato protein concentrate was formulated. Three additional diets were formulated by adding 0.04, 0.08, or 0.12% P from DCP to the basal diet to create diets containing 0.26, 0.30, or 0.34% P. The last 3 diets were formulated by adding 0.04, 0.08, or 0.12% P from DDGS to the basal diet at the expense of cornstarch. Pigs were fed experimental diets for 28 d. They were then euthanized and the third and fourth metacarpals from the right front foot were collected. Metacarpal bone ash and bone P were regressed against P intake for each ingredient and via slope ratio methodology, it was determined that the bioavailability of P in DDGS was 87% relative to that in DCP. It was concluded from this work that the value for relative bioavailability of P in DDGS overestimates the digestibility of P in DDGS and values for the STTD of P, therefore, can not be accurately calculated from values for the relative bioavailability of P. As a consequence, it is necessary to determine the STTD of P in feed ingredients included in diets fed to pigs.

Prediction of response to entecavir therapy in patients with HBeAg-positive chronic hepatitis B based on on-treatment HBsAg, HBeAg and HBV DNA levels

Quantitative hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) assays are emerging as effective tools of on-treatment predictors of response to antiviral agents, in addition to monitoring serum HBV DNA levels. However, the dynamic relationship between quantitative HBsAg, as well as HBeAg and HBV DNA, and the predictability of subsequent clinical outcomes during entecavir (ETV) therapy remain unclear. Eighty-two patients with HBeAg-positive chronic hepatitis B (CHB) received ETV therapy for ≥3 years. Virologic response (VR) after 3 years of ETV therapy was achieved in 73 (89.0%) patients. Among baseline and on-treatment factors, on-treatment HBV DNA levels performed better with respect to the prediction of response than HBsAg and HBeAg levels. Especially, the performance of absolute values of HBV DNA with respect to response was superior to HBV DNA decline from the baseline. The best predictive value was an absolute HBV DNA level of 2.3 log(10) IU/mL at month 6 (areas under the curve [AUROC], 0.977; 95% CI, 0.940-1.000; P < 0.001). HBeAg seroconversion after 3 years of therapy was achieved in 26 (31.7%) patients. On-treatment HBeAg levels performed better with respect to the prediction of seroconversion than HBsAg and HBV DNA levels. The best cut-off value for the HBeAg level at month 12 for the prediction of seroconversion was 0.62 log(10) PEIU/mL. Although the HBsAg level at baseline is often used to predict the antiviral potency of entecavir, on-treatment HBV DNA and HBeAg levels are more helpful for prediction of subsequent clinical outcomes in HBeAg-positive CHB patients with entecavir treatment.

Prediction of response to entecavir therapy in patients with HBeAg-positive chronic hepatitis B based on on-treatment HBsAg, HBeAg and HBV DNA levels

Quantitative hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) assays are emerging as effective tools of on-treatment predictors of response to antiviral agents, in addition to monitoring serum HBV DNA levels. However, the dynamic relationship between quantitative HBsAg, as well as HBeAg and HBV DNA, and the predictability of subsequent clinical outcomes during entecavir (ETV) therapy remain unclear. Eighty-two patients with HBeAg-positive chronic hepatitis B (CHB) received ETV therapy for ≥3 years. Virologic response (VR) after 3 years of ETV therapy was achieved in 73 (89.0%) patients. Among baseline and on-treatment factors, on-treatment HBV DNA levels performed better with respect to the prediction of response than HBsAg and HBeAg levels. Especially, the performance of absolute values of HBV DNA with respect to response was superior to HBV DNA decline from the baseline. The best predictive value was an absolute HBV DNA level of 2.3 log(10) IU/mL at month 6 (areas under the curve [AUROC], 0.977; 95% CI, 0.940-1.000; P < 0.001). HBeAg seroconversion after 3 years of therapy was achieved in 26 (31.7%) patients. On-treatment HBeAg levels performed better with respect to the prediction of seroconversion than HBsAg and HBV DNA levels. The best cut-off value for the HBeAg level at month 12 for the prediction of seroconversion was 0.62 log(10) PEIU/mL. Although the HBsAg level at baseline is often used to predict the antiviral potency of entecavir, on-treatment HBV DNA and HBeAg levels are more helpful for prediction of subsequent clinical outcomes in HBeAg-positive CHB patients with entecavir treatment.

Spatial and temporal correlation in progressive degeneration of neurons and astrocytes in contusion-induced spinal cord injury

BACKGROUND

Traumatic spinal cord injury (SCI) causes acute neuronal death followed by delayed secondary neuronal damage. However, little is known about how microenvironment regulating cells such as microglia, astrocytes, and blood inflammatory cells behave in early SCI states and how they contribute to delayed neuronal death.

METHODS

We analyzed the behavior of neurons and microenvironment regulating cells using a contusion-induced SCI model, examining early (3-6 h) to late times (14 d) after the injury.

RESULTS

At the penumbra region close to the damaged core (P1) neurons and astrocytes underwent death in a similar spatial and temporal pattern: both neurons and astrocytes died in the medial and ventral regions of the gray matter between 12 to 24 h after SCI. Furthermore, mRNA and protein levels of transporters of glutamate (GLT-1) and potassium (Kir4.1), functional markers of astrocytes, decreased at about the times that delayed neuronal death occurred. However, at P1 region, ramified Iba-1+ resident microglia died earlier (3 to 6 h) than neurons (12 to 24 h), and at the penumbra region farther from the damaged core (P2), neurons were healthy where microglia were morphologically activated. In addition, round Iba-1/CD45-double positive monocyte-like cells appeared after neurons had died, and expressed phagocytic markers, including mannose receptors, but rarely expressed proinflammatory mediators.

CONCLUSION

Loss of astrocyte function may be more critical for delayed neuronal death than microglial activation and monocyte infiltration.

Concentrations of analyzed or reactive lysine, but not crude protein, may predict the concentration of digestible lysine in distillers dried grains with solubles fed to pigs

The objectives of this experiment were to evaluate procedures that may be used to predict the concentration of standardized ileal digestible (SID) Lys in distillers dried grains with solubles (DDGS) fed to pigs and to evaluate the accuracy of a published equation to predict SID Lys in DDGS. Twenty-one sources of DDGS were analyzed (as-fed basis) for CP (23.8% to 33.6%; CV = 8.3%), Lys (0.69% to 1.17%; CV = 12.4%), and furosine (0.02% to 0.22%; CV = 91.4%). The concentration of reactive Lys (%, as-fed basis) was calculated as analyzed Lys (%) - furosine (%) ÷ 0.32 × 0.40 and ranged from 0.47% to 1.15% (CV = 20.7%) in the 21 sources of DDGS. Twenty-one diets that each contained 60.0% of 1 source of DDGS as the sole source of CP and AA were formulated. An N-free diet was also formulated and was used to determine basal endogenous losses of CP and AA. Twenty-two barrows with an initial BW of 45.2 kg (SD = 3.1 kg) were fitted with a T-cannula in the distal ileum and allotted to a 22 × 10 Youden square design with the 22 diets and 10 periods. The SID of CP and AA were calculated for each source of DDGS. The SID of CP ranged from 69.8% to 79.6%, and the SID of Lys ranged from 45.3% to 74.1%. The concentration of SID Lys in the 21 samples of DDGS was highly related to the concentration of analyzed Lys (P < 0.001; r(2) = 0.849) and with the concentration of reactive Lys in the samples (P < 0.001; r(2) = 0.898). In contrast, the concentration of SID Lys in the 21 sources of DDGS was not related to the concentration of CP in the samples (P = 0.558; r(2) = 0.021). However, values for SID Lys were in good agreement with values predicted using a published prediction equation. In conclusion, analyzed Lys in DDGS, but not CP, may be used to predict the concentration of SID Lys in DDGS fed to pigs. However, analysis of furosine in addition to Lys and subsequent calculation of reactive Lys improve the prediction accuracy of digestible Lys concentration in DDGS.

PlexinA2 limits recovery from corticospinal axotomy by mediating oligodendrocyte-derived Sema6A growth inhibition

Axonal growth from both intact and severed fibers is limited after adult mammalian CNS injury. Myelin proteins contribute to inhibition of axonal growth. Semaphorin6A protein inhibits the extension of developing axons and is highly expressed in adult oligodendrocytes. This expression pattern suggests that a developmental axon guidance cue contributes to the restriction of adult CNS growth. Here, we assessed the role of a Sema6A receptor, PlexinA2, in recovery from adult trauma. Adult sensory neuron inhibition by Sema6A requires PlexinA2, with complete protection in PlexinA2-/- cultures. Mice lacking another myelin inhibitor receptor, NgR1, are known to exhibit greater axonal sprouting and functional recovery after lesions of the corticospinal tract at the medullary pyramid, so we investigated PlexinA2 in this lesion. Without injury, the corticofugal projection into the cervical spinal cord is normal in adult PlexinA2 null mice. After unilateral pyramidotomy, unlesioned PlexinA2-/- corticospinal fibers sprout across the midline to innervate the contralateral gray matter of the spinal cord to a significantly greater extent than do fibers in wild type mice. Sprouted fibers display frequent synaptophysin-positive synaptic puncta. The increased axonal growth in PlexinA2-/- mice after injury is accompanied by improved behavioral recovery in a pellet retrieval task using the impaired forelimb, and in a tape removal task. Thus, PlexinA2, as a receptor for oligodendrocyte-derived Sema6A and for secreted class 3 Semaphorins, plays a role in limiting adult axon growth and recovery after trauma.

Vimentin phosphorylation by Cdc2 in Schwann cell controls axon growth via β1-integrin activation

Although preconditioning injury on the peripheral nerve induces axonal regenerative capacity in neurons, it is not known whether similar lesion effects occur in glial cells. Here we demonstrate that Schwann cells are activated by peripheral nerve preinjury and primed to mediate axon regeneration. Cdc2, which was induced from Schwann cells after sciatic nerve injury, phosphorylated vimentin almost exclusively in the distal nerve area. Phospho-vimentin-positive Schwann cells showed increased migration activity and were in close contact with process outgrowth of co-cultured neurons. Vimentin phosphorylation by Cdc2 was involved in β1-integrin activation leading to FAK phoshorylation and associated with Erk1/2 activation in Schwann cells. Neurite outgrowth of dorsal root ganglion neurons was increased by co-culture with activated Schwann cells, in which phospho-vimentin signaling was transmitted into β1-integrin activation. Then neurite outgrowth was suppressed by genetic depletion of phospho-vimentin and β1 integrin as well as inhibition of vimentin phosphorylation by Cdc2 inhibitor purvalanol A. The sciatic nerve graft harboring activated Schwann cells into the spinal cord induced Schwann cell migration beyond the graft-host barrier and facilitated regeneration of spinal axons, which was inhibited by purvalanol A pretreatment of the graft. This is the first report to our knowledge demonstrating that activation of phospho-vimentin linked to β1-integrin pathway may mediate transcellular signaling to promote axon growth.

Sulfur concentration in diets containing corn, soybean meal, and distillers dried grains with solubles does not affect feed preference or growth performance of weanling or growing-finishing pigs

Four experiments were conducted to investigate the effects of distillers dried grains with solubles (DDGS) and dietary S on feed preference and performance of pigs. In a 10-d feed preference experiment (Exp. 1), 48 barrows (20.1 ± 2.2 kg of BW) were randomly allotted to 3 treatment groups, with 8 replicate pens per treatment and 2 pigs per pen. A control diet based on corn and soybean meal, a DDGS diet containing 20% DDGS, and a DDGS-sulfur (DDGS-S) diet were prepared. The DDGS-S diet was similar to the DDGS diet with the exception that 0.74% CaSO(4) was added to the diet. Two diets were provided in separate feeders in each pen: 1) the control diet and the DDGS diet, 2) the control diet and the DDGS-S diet, or 3) the DDGS diet and the DDGS-S diet. Preference for the DDGS diet and the DDGS-S diet vs. the control diet was 35.2 and 32.6%, respectively (P < 0.05), but there was no difference between the DDGS diet and the DDGS-S diet. In Exp. 2, a total of 90 barrows (10.3 ± 1.4 kg of BW) were allotted to 3 treatments, with 10 replicate pens and 3 pigs per pen, and were fed the diets used in Exp. 1 for 28 d, but only 1 diet was provided per pen. Pigs fed the control diet gained more BW (497 vs. 423 and 416 g/d; P < 0.05) and had greater G:F (0.540 vs. 0.471 and 0.455; P < 0.05) than pigs fed the DDGS or the DDGS-S diet, but no differences between the DDGS and the DDGS-S diets were observed. In a 10-d feed preference experiment (Exp. 3), 30 barrows (49.6 ± 2.3 kg of BW) were allotted to 3 treatment groups, with 10 replicates per group. The experimental procedures were the same as in Exp. 1, except that 30% DDGS was included in the DDGS and DDGS-S diets and 1.10% CaSO(4) was added to the DDGS-S diet. Feed preference for the DDGS and the DDGS-S diets, compared with the control diet, was 29.8 and 32.9%, respectively (P < 0.01), but there was no difference between the DDGS and the DDGS-S diets. In Exp. 4, a total of 120 barrows (34.2 ± 2.3 kg of BW) were fed grower diets for 42 d and finisher diets for 42 d. Diets were formulated as in Exp. 3. Pigs on the control diets gained more BW (1,021 vs. 912 and 907 g/d; P < 0.05) and had greater G:F (0.335 vs. 0.316 and 0.307; P < 0.05) than pigs fed the DDGS or DDGS-S diet, respectively, but no differences between pigs fed the DDGS and the DDGS-S diets were observed. In conclusion, dietary S concentration does not negatively affect feed preference, feed intake, or growth performance of weanling or growing-finishing pigs fed diets based on corn, soybean meal, and DDGS.

Energy concentration and phosphorus digestibility in whey powder, whey permeate, and low-ash whey permeate fed to weanling pigs

Two experiments were conducted to determine DE and ME, the apparent total tract digestibility (ATTD) of P, and the standardized total tract digestibility (STTD) of P in whey powder (3,646 kcal/kg), whey permeate (3,426 kcal/kg), and low-ash whey permeate (3,657 kcal/kg) fed to weanling pigs. The DE and ME in the 3 whey products were determined using 32 barrows (9.2 ± 0.4 kg of BW). A basal diet based on corn, soybean meal, and fish meal and 3 diets containing 70% of the basal diet and 30% of each whey product were prepared. Each diet was fed to 8 pigs that were housed individually in metabolism cages. The total collection method was used for fecal and urine collections with 5-d adaptation and 5-d collection periods, and the difference procedure was used to calculate DE and ME in the 3 whey products. The concentrations of DE in whey powder and low-ash whey permeate were greater (P < 0.001) than in whey permeate (3,646 and 3,683 vs. 3,253 kcal/kg of DM). The concentrations of ME in whey powder and low-ash whey permeate were also greater (P < 0.001) than in whey permeate (3,462 and 3,593 vs. 3,081 kcal/kg of DM). The ATTD and STTD of P in the 3 whey products were determined using 32 barrows (11.0 ± 0.81 kg of BW). Three cornstarch-sucrose-based diets containing 30% of each whey product as the sole source of P were prepared. A P-free diet that was used to estimate the basal endogenous losses of P was also formulated. The ATTD of P in whey powder and in whey permeate was greater (P < 0.001) than in low-ash whey permeate (84.3 and 86.1 vs. 55.9%), but the STTD values for P were not different among the 3 ingredients (91.2, 93.1, and 91.8% in whey powder, whey permeate, and low-ash whey permeate, respectively). In conclusion, whey permeate contains less GE, DE, and ME than whey powder and low-ash whey permeate, but all 3 ingredients have an excellent digestibility of P.

Amino acid digestibility in heated soybean meal fed to growing pigs

Heat treatment of soybean meal (SBM) is necessary to reduce the concentration of trypsin inhibitors, but excessive heat treatment may reduce AA concentration and digestibility because AA can be destroyed by the Maillard reaction. The objective of this experiment was to determine the effects of heat treatment of SBM on apparent ileal digestibility and standardized ileal digestibility (SID) of AA by growing pigs. A source of conventional dehulled SBM (48.5% CP) was divided into 4 batches. One batch was not additionally heated, 1 batch was autoclaved at 125°C for 15 min, 1 batch was autoclaved at 125°C for 30 min, and 1 batch was oven-dried at 125°C for 30 min. Four SBM-cornstarch diets were formulated, and each of the 4 batches of SBM was used as the sole source of dietary AA in 1 diet. A N-free diet was used to estimate basal endogenous losses of AA. Ten growing barrows with an initial BW of 25.3 ± 2.0 kg were individually fitted with a T-cannula in the distal ileum. Pigs were allotted to treatments in a replicated 5 × 5 balanced Latin square design with 5 diets and 5 periods. Each period lasted 7 d, and ileal digesta were collected on d 6 and 7 of each period. Results of the experiment indicated that the apparent ileal digestibility and SID of CP and all AA decreased linearly (P < 0.01) as the time of autoclaving increased from 0 to 30 min. The concentration of furosine and the color of samples of SBM indicated that autoclaving resulted in a Maillard reaction in the SBM. However, oven drying at 125°C for 30 min did not change (P > 0.10) the SID of CP and AA in the SBM or the furosine concentration, and the color in the oven-dried sample indicated that this sample was not heat damaged. In conclusion, the digestibility of all AA in autoclaved SBM is linearly reduced as the autoclaving time increases from 0 to 30 min. The reason for these changes is most likely that autoclaving at 125°C results in Maillard reactions in SBM.

Gene transfer mediated by stem cell grafts to treat CNS injury

INTRODUCTION

Stem cell transplantation holds promise for promoting anatomical repair and functional recovery after traumatic or ischemic injuries to the CNS. Harnessing stem cells with therapeutic genes of interest is regarded as an attractive approach to augment therapeutic benefits of stem cell grafts.

AREAS COVERED

The advantage of stem-cell-mediated gene transfer is the engraftibility of stem cells that can ensure a long-term and stable expression of therapeutic genes. In addition, stem-cell-gene interaction may synergistically amplify therapeutic benefits. Delivery of classical neurotrophic factor genes provided neuroprotective and pro-regenerative effects in various injury models. Some studies employed therapeutic genes targeting post-injury microenvironment to support endogenous repair. Recent trials of stem-cell-mediated transfer of nonclassical growth factors showed relatively novel biological effects. Combinatorial strategies seem to have the potential to improve therapeutic efficacy.

EXPERT OPINION

Future development of induced pluripotent stem cells and novel scaffolding biomaterials will greatly expedite the advances in ex vivo gene therapy to treat CNS injury. Before moving to a clinical stage, rigorous preclinical evaluations are needed to identify an optimal gene or gene combination in different injury settings. Improving the safety of viral vectors will be a critical prerequisite for the clinical translation.

Combination of Multifaceted Strategies to Maximize the Therapeutic Benefits of Neural Stem Cell Transplantation for Spinal Cord Repair

Neural stem cells (NSCs) possess therapeutic potentials to reverse complex pathological processes following spinal cord injury (SCI), but many obstacles remain that could not be fully overcome by NSC transplantation alone. Combining complementary strategies might be required to advance NSC-based treatments to the clinical stage. The present study was undertaken to examine whether combination of NSCs, polymer scaffolds, neurotrophin-3 (NT3), and chondroitinase, which cleaves chondroitin sulfate proteoglycans at the interface between spinal cord and implanted scaffold, could provide additive therapeutic benefits. In a rat hemisection model, poly(e-caprolactone) (PCL) was used as a bridging scaffold and as a vehicle for NSC delivery. The PCL scaffolds seeded with F3 NSCs or NT3 overexpressing F3 cells (F3.NT3) were implanted into hemisected cavities. F3.NT3 showed better survival and migration, and more frequently differentiated into neurons and oligodendrocytes than F3 cells. Animals with PCL scaffold containing F3.NT3 cells showed the best locomotor recovery, and motor evoked potentials (MEPs) following transcranial magnetic stimulation were recorded only in PCL-F3.NT3 group in contralateral, but not ipsilateral, hindlimbs. Implantation of PCL scaffold with F3.NT3 cells increased NT3 levels, promoted neuroplasticity, and enhanced remyelination of contralateral white matter. Combining chondroitinase treatment after PCL-F3.NT3 implantation further enhanced cell migration and promoted axonal remodeling, and this was accompanied by augmented locomotor recovery and restoration of MEPs in ipsilateral hindlimbs. We demonstrate that combining multifaceted strategies can maximize the therapeutic benefits of NSC transplantation for SCI. Our results may have important clinical implications for the design of future NSC-based strategies.

Differential and cooperative actions of Olig1 and Olig2 transcription factors on immature proliferating cells after contusive spinal cord injury

Spontaneous remyelination after spinal cord injury (SCI) is limited probably due to inadequate signaling to generate sufficient OLs from progenitor cells. The present study tested a hypothesis that introduction of olig genes, critical regulators of OL development, into immature proliferating cells could increase oligodendrogenesis after contusive SCI in adult rats. Recombinant retroviruses encoding Olig1 and Olig2 transcription factors, separately or in combination, with green fluorescent protein (GFP) were injected into the injured spinal cord. Unexpectedly, introduction of Olig2-GFP retroviruses led to a marked hyperplasia of GFP+ cells at 1 week, and soft agar colony forming assay of isolated GFP+ cells confirmed Olig2-induced tumorous transformation. In contrast, Olig1 did not alter the number of GFP+ cells. Simultaneous expression of Olig1 and Olig2 (Olig1/2) led to a marked increase in the number of GFP+ cells without tumor formation. The proportion of GFP+ cells with OL progenitor markers was increased by Olig1/2. Moreover, Olig1/2 robustly increased the proportion of mature OLs and expression of myelin related proteins, while Olig1 alone exhibited only modest effects. Olig1/2 upregulated Sox10, which drives terminal OL differentiation, implicating Sox 10 as a mediator of Olig1/2 effects on the maturation. Finally, injection of Olig1/2 retroviruses significantly improved a quality of hindpaws locomotion and increased the total number of OLs after SCI. Activation of both Olig1 and Olig2 may be beneficial by both increasing the progenitor cell proliferation and enhancing OL differentiation in the injured spinal cord.

A multi-domain fragment of Nogo-A protein is a potent inhibitor of cortical axon regeneration via Nogo receptor 1

Nogo-A limits axon regeneration and functional recovery after central nervous system injury in adult mammals. Three regions of Nogo-A (Nogo-A-24, Nogo-66, and Nogo-C39) interact with the neuronal Nogo-66 receptor 1 (NgR1). Nogo-66 also interacts with a structurally unrelated cell surface receptor, paired immunoglobulin-like receptor (PirB). We show here that the other two NgR1-interacting domains, Nogo-A-24 and Nogo-C39, also bind to PirB with high affinity. A purified 22-kDa protein containing all three NgR1- and PirB-interacting domains (Nogo-22) is a substantially more potent growth cone-collapsing molecule than Nogo-66 for chick dorsal root ganglion neurons and mature cortical neurons. Moreover, Nogo-22 inhibits axon regeneration of mature cortical neurons in vitro more potently than does Nogo-66. Although all three NgR1-interacting domains of Nogo-A also interact with PirB, expression of PirB in mature cortical cultures is nearly undetectable. Consistent with a relatively minor role for PirB in mature cortical neurons, Nogo-22 inhibition of axon regeneration is abolished by genetic deletion of NgR1. Thus, NgR1 is the predominant receptor for Nogo-22 in regenerating cortical neurons.

Endogenous expression of interleukin-4 regulates macrophage activation and confines cavity formation after traumatic spinal cord injury

Traumatic spinal cord injury (SCI) triggers inflammatory reactions in which various types of cells and cytokines are involved. Several proinflammatory cytokines are up-regulated after SCI and play crucial roles in determining the extent of secondary tissue damage. However, relatively little is known about antiinflammatory cytokines and their roles in spinal cord trauma. Recent studies have shown that an antiinflammatory cytokine, interleukin-4 (IL-4), is expressed and exerts various modulatory effects in CNS inflammation. We found in the present study that IL-4 was highly expressed at 24 hr after contusive SCI in rats and declined thereafter, with concurrent up-regulation of IL-4 receptor subunit IL-4alpha. The majority of IL-4-producing cells were myeloperoxidase-positive neutrophils. Injection of neutralizing antibody against IL-4 into the contused spinal cord did not significantly affect the expression levels of proinflammatory cytokines such as IL-1beta, IL-6, and tumor necrosis factor-alpha or other antiinflammatory cytokines such as IL-10 and transforming growth factor-beta. Instead, attenuation of IL-4 activity led to a marked increase in the extent of ED1-positive macrophage activation along the rostrocaudal extent at 7 days after injury. The enhanced macrophage activation was preceded by an increase in the level of monocyte chemoattractant protein-1 (MCP-1/CCL2). Finally, IL-4 neutralization resulted in more extensive cavitation at 4 weeks after injury. These results suggest that endogenous expression of antiinflammatory cytokine IL-4 regulates the extent of acute macrophage activation and confines the ensuing secondary cavity formation after spinal cord trauma.

Prognostic significance of MRI-detected bladder muscle and/or serosal invasion in patients with cervical cancer treated with radiotherapy

In cervical cancer, the prognostic significance of bladder wall invasion on MRI without pathological evidence of mucosal invasion is not known. From 454 consecutive patients with cervical cancer who were treated with radiation, we reviewed images and analysed the outcome of 92 patients with the Federation of International Gynecology and Obstetrics (FIGO) stage IIIB-IVA. We analysed the patients in three groups, normal, wall (muscle and/or serosal) invasion and mucosal invasion, according to the findings on the MRI. Kaplan-Meier life table analysis and the log-rank test were used to assess the survival rates and differences according to prognostic factors. MRI detected abnormalities in the bladder wall in 42 patients (45.6%): wall invasion in 24 and mucosal invasion in 18. 5 of 18 patients, suspected on MRI to have mucosal invasion, showed no pathological evidence of mucosal invasion. Median follow-up period was 34 months. 3-year cause-specific survival (CSS) in the normal group compared with the wall invasion group was 76.2% vs 71.4% (p = 0.48). 3-year CSS for the wall invasion group compared with the mucosal invasion group was 71.4% vs 54.3% (p = 0.04). Mucosal invasion on MRI (p = 0.03) and concurrent chemoradiotherapy (p = 0.01) was significant for CSS. The prognosis for patients with cervical cancer with evidence of muscle and/or serosal invasion of the bladder on MRI may not differ from that for patients without abnormality on MRI. In patients with the MRI finding of bladder mucosal invasion, further studies should be conducted regarding the role of cystoscopy to determine the need for pathological confirmation.

Clinical features of acute renal failure associated with hepatitis A virus infection

Acute hepatitis A (AHA) is one of the most common infectious diseases; it is usually a self-limiting disease affecting the liver. Although extrahepatic manifestations are not common, some cases have been reported associated with acute renal failure. We reviewed the clinical features of patients with AHA complicated by acute renal failure (ARF group) and compared them with patients with noncomplicated AHA (non-ARF group). The medical records of 208 consecutive patients with AHA who were diagnosed between January 2003 and October 2008 were reviewed. We identified 15 patients (7.2%) with ARF associated with AHA. There were no differences between the ARF and non-ARF group with regard to gender and age. The peak value of alanine aminotransferase (ALT) (median: 6060 IU/L vs 1792 IU/L, P < 0.001), prothrombin time (PT) (International normalized ratio, median 1.72 vs 1.10, P < 0.001), and total bilirubin level (median: 9.6 mg/dL vs 6.3 mg/dL, P = 0.04) were significantly higher in the ARF than in the non-ARF group. Twelve patients (80%) recovered completely with haemodialysis (seven patients, 46.7%) or only conservative management (five patients, 33.3%), while one patient underwent liver transplantation because of fulminant hepatic failure, and two patients died because of fulminant hepatic failure. There were no deaths among patients with noncomplicated AHA in the non-ARF group. Five patients underwent kidney biopsy; two patients were diagnosed with acute tubular necrosis, two patients with acute interstitial nephritis with IgA nephropathy and one patient with acute tubulointerstitial nephritis. All patients in the ARF group had microscopic haematuria and proteinuria (100%vs 31.1%, P < 0.001). Urine sodium levels were more than 10 mEq/L in 10 patients. The findings of high urinary sodium concentrations, microscopic haematuria and proteinuria did not support the diagnosis of hepatorenal syndrome (HRS). Patients with AHA with ARF had higher ALT levels, more prolonged PTs, and higher total bilirubin levels. The prognosis for these patients was poorer than for those without ARF. However, the patients with ARF and nonfulminant AHA had recovered with proper treatment and should not be confused with patients that have HRS.

High viremia, prolonged Lamivudine therapy and recurrent hepatocellular carcinoma predict posttransplant hepatitis B recurrence

Hepatitis B virus (HBV) recurrence following orthotopic liver transplantation (OLT) is generally preventable by prophylaxis with hepatitis B immunoglobulin (HBIG) and lamivudine (LAM). However, HBV recurrence sometimes develops despite prophylaxis. This study assessed posttransplant outcomes and identified predictors of HBV recurrence. We analyzed the outcomes of 209 consecutive patients positive for hepatitis B surface antigen who underwent OLT, who received either combination prophylaxis with HBIG and LAM (89.0%) or HBIG monoprophylaxis (11.0%). The median follow-up was 36.8 months (range, 1.0-84.4). Posttransplant HBV recurrence occurred in 22 patients (10.5%), including 13 patients with drug-resistant mutations. HBV recurrence was observed in six patients after hepatocellular carcinoma (HCC) recurrence. Independent predictors of HBV recurrence were recurrent HCC (p < 0.001), LAM therapy >1.5 years (p = 0.001) and high HBV DNA titers (> or =10(5) copies/mL) at OLT (p = 0.036). In conclusion, high viremia at OLT and prolonged exposure to LAM should be further stressed as main predictors of HBV recurrence.

A structured, segregated model for genetically modified Escherichia coli cells and its use for prediction of plasmid stability

A structured, segregated model is presented for an asynchronously growing population of genetically modified Escherichia coli cells. A finite representation method was modified so that 272 cells could be used to represent a microbial population. The concept of a "limbo" compartment was introduced to allow random plasmid distribution to daughter cells upon cell division while restricting the number of computer cells included in the calculation. This scheme enabled us to predict plasmid instability and distribution of plasmid-originated properties in a population without a priori determination of growth rates or probability of forming plasmid-free cells from plasmid-containing cells. Predictions of population behavior using a single-cell model requires no adjustable parameters. The results comparing different induction strategies suggest that in continuous culture, there exists an optimum efficiency of partial induction that maximizes the long-term productivity of the gene product due to plasmid stability. With the optimum efficiency of partial induction, constant induction appears to prove more stable than cycling induction.

Kinetic resolution of alpha-methylbenzylamine with omicron-transaminase screened from soil microorganisms: application of a biphasic system to overcome product inhibition

Two microorganisms showing high omicron-transaminase activity (Klebsiella pneumoniae JS2F and Bacillus thuringiensis JS64) were screened by the enrichment method using (S)-alpha-methylbenzylamine (alpha-MBA) as a sole nitrogen source. Optimal carbon and nitrogen sources for enzyme induction and the properties of omicron-transaminases were investigated. omicron-Transaminase from B. thuringiensis JS64 was highly enantioselective (E = 75.3) for (S)-enantiomer of alpha-MBA and showed remarkable stability. However, omicron-transaminase showed severe product inhibition by acetophenone. An aqueous/organic two-phase system was introduced to overcome this problem. Through solvent screening, cyclohexanone and ethyl acetate were selected as the best organic phases. The acetophenone-extracting capacity of the solvent and the biocompatibility of the solvent to the cell were important determinants in the reaction rate at high concentrations of alpha-MBA. The reaction rate of omicron-transamination was strongly influenced by the volume ratio of organic phase to aqueous phase as well as agitation speed in the biphasic mixture. Using the optimal volume ratio (Vorg:Vaq = 1:4) in the biphasic system with cyclohexanone, the reaction rate of omicron-transaminase under vigorous mixing conditions increased ninefold compared with that in the monophasic aqueous system. At the same optimal conditions, using whole cells, 500 mM alpha-MBA could be resolved successfully to above 95% enantiomeric excess of (R)-alpha-MBA with ca. 51% conversion. (c) 1997 John Wiley & Sons, Inc. Biotechnol Bioeng 55: 348-358, 1997.