Metformin reduces decline in the estimated glomerular filtration rate during progression of autosomal dominant polycystic kidney disease: a systematic review and meta-analysis

OBJECTIVE

A meta-analysis (MA) was carried out to examine the influence of metformin on autosomal dominant polycystic kidney disease (ADPKD) patient prognosis.

MATERIALS AND METHODS

We reviewed and examined scientific articles from PubMed, Clinicalkey, Google Scholar, Medline, Embase, and Cochrane from the initiation date till June 2023 to identify investigations that examined metformin performance in managing ADPKD. Among the employed search terminology, we searched for terms such as "metformin" and "ADPKD". MA was conducted using the Cochrane Collaboration's RevMan version 5.3.0 (The Cochrane Collaboration, Oxford, UK).

RESULTS

We identified 4 investigations, with 164 total subjects who fulfilled our inclusion criteria. The experimental cohort displayed a marked reduction in the decline of estimated glomerular filtration rate (eGFR) relative to controls [mean difference (MD) = 2.31, 95% confidence interval (CI) = 0.82-3.79, p = 0.002]. We observed no obvious difference in the height-adjusted total kidney volume alteration, gastrointestinal side effects, and hypoglycemia between the two cohorts.

CONCLUSIONS

Metformin was easily tolerable and safe and substantially reduced the eGFR decline among ADPKD patients. Moreover, although metformin-treated patients were more likely to suffer gastrointestinal adverse events, we observed no discernible difference between the two cohorts.

[Clinical diagnosis and treatment of multiple pulmonary nodules]

CT screening has markedly reduced the lung cancer mortality in high-risk population and increased the detection of early-stage pulmonary neoplasms, including multiple pulmonary nodules, especially those with a ground-glass appearance on CT. Multiple primary lung cancer (MPLC) constitutes a specific subtype of lung cancer with indolent biological behaviors, which is predominantly early-stage adenocarcinoma. Although MPLC progresses slowly with rare lymphatic metastasis, existence of synchronous lesions and distributed location of these nodules still pose difficulty for the management of such patients. One single operation is usually insufficient to eradicate all neoplastic lesions, whereas repeated surgical procedures bring about another dilemma: whether clinical benefits of surgical treatment outweigh loss of pulmonary function following multiple operations. Therefore, despite the anxiety for treatment among MPLC patients, whether and how to treat the patient should be assessed meticulously. Currently there is a heated discussion upon the timing of clinical intervention, operation mode and the application of local therapy in MPLC. Based on clinical experience of our multiple disciplinary team, we have summarized and commented on the evaluation, surgical treatment, non-surgical local treatment, targeted therapy and immunotherapy of MPLC in this article to provide further insight into this field.

Increased Percentage of CD8+CD28- Regulatory T Cells With Fingolimod Therapy in Multiple Sclerosis

BACKGROUND AND OBJECTIVES

Fingolimod, an oral therapy for MS, decreases expression of membrane S1P1 receptors on CD4⁺ memory cells, causing their retention and deactivation in lymph nodes. We determined fingolimod effects on the number and proportion of potentially CNS-damaging CD8⁺CD28⁺ cytolytic T lymphocyte cells (CTLs) and on MS-depleted and dysfunctional CD8⁺CD28^- anti-inflammatory suppressor/regulatory T cells (Treg) and on CD8⁺ T-cell expression of the CD69 activation/lymph node retention protein in MS.

METHODS

CD8, CD28, CD4, and CD69 expression on peripheral blood mononuclear cells was measured with flow cytometry. In vitro concanavalin A (ConA) activation of T cells, including CD8⁺CD28^- cells, was used to mimic inflammation.

RESULTS

Fifty-nine patients with MS, 35 therapy-naive (16 clinically stable; 19 exacerbating) and 24 fingolimod-treated (19 clinically stable; 5 exacerbating), and 26 matched healthy controls (HCs) were compared. In therapy-naive patients, the CD8⁺ Treg percent of total lymphocytes was only 1/4 of HC levels. In fingolimod-treated patients, however, CD8⁺ Treg percentages rose to 2.5-fold higher than in HC and 10-fold higher than in therapy-naive MS. With fingolimod therapy, in contrast, CD8⁺ CTL levels were less than half of levels in HCs and therapy-naive patients. In HCs and all MS, activation with ConA strongly induced CD69 expression on CD4⁺ cells and induced 3-fold higher CD69 levels on CD8⁺ CTL than on CD8⁺ Treg. Fingolimod and analogs in vitro did not modify lymphocyte CD69 expression. Lower levels of CD69 on CD8⁺ Treg than on CTL may allow easier Treg egress from lymph nodes and enhance control of peripheral inflammation. In vitro activation reduced the already low CD8⁺ Treg population in therapy-naive MS, but only slightly altered Treg levels in fingolimod-treated MS.

DISCUSSION

Fingolimod therapy markedly increases the percentage of CD8⁺ Treg in MS, reversing the low CD8⁺ Treg:CTL ratio seen in untreated MS. The increase in immune regulatory cells has potential therapeutic benefit in MS. Activation in vitro depletes CD8⁺CD28⁺CTL in patients with MS; the loss is more pronounced in older patients with MS. This suggests that inflammation can disrupt the tenuous immune regulation in MS, especially in older patients.

POS0962 CAN RADIOMICS REPLACE SPARCC SCORING SYSTEM IN EVALUATING BONE MARROW OEDEMA OF THE SACROILIAC JOINTS IN AXIAL SPONDYLOARTHRITIS?

Background

Bone marrow oedema (BMO) of the sacroiliac joints (SIJs) is evaluated to diagnose, classify and monitor disease activity in patients with axial spondyloarthritis (axSpA). Available quantitative methodologies rely on human visual assessment, and errors can’t be completely avoided. Radiomics can extract and select discriminative and quantified features from regions of interest (ROIs), making a more accurate and objective description of BMO.

Objectives

To develop a more objective and efficient method based on radiomics to evaluate BMO of the SIJs by magnetic resonance imaging (MRI) in patients with axSpA in comparison with Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system.

Methods

From September 2013 to July 2021, 523 patients with axSpA underwent 3.0T SIJ-MRI were included, who were randomly classified as training cohort(n=367) and validation cohort(n=156). The optimal radiomics features, selected from the 3.0T SIJ-MRI in the training cohort, were included to build the radiomics model. Four clinical risk predictors were adopted to build the clinical model. The performance of the clinical and radiomics models was evaluated by ROC analysis and decision curve analysis (DCA). Rad-scores were calculated by the radiomics model and SPARCC scores were performed to quantify the BMO of SIJs. We also assessed the correlation between Rad-score and SPARCC score.

Results

The radiomics model, built by 15 optimal features, showed favorable discrimination about SPARCC score <2 or ≥2 both in the training (AUC, 0.91; 95% CI: 0.88-0.94) and the validation cohort (AUC, 0.89; 95% CI, 0.84-0.94). DCA confirmed that the radiomics model was clinically useful. Furthermore, Rad-score has significant correlation with SPARCC score for scoring the status of BMO (rs=0.78, P< 0.001), and moderation correlation for scoring the change (r=0.40, P=0.005).

Conclusion

The radiomics can accurately assess the BMO of the SIJs in axSpA, providing an alternative to SPARCC scoring system. There was a positive correlation between Rad-score and SPARCC score.

References

[1]van der Heijde D, Sieper J, Maksymowych WP, Lambert RG, Chen S, Hojnik M, et al. Clinical and MRI remission in patients with nonradiographic axial spondyloarthritis who received long-term open-label adalimumab treatment: 3-year results of the ABILITY-1 trial. Arthritis Res Ther. 2018;20(1):61.

[2]Landewé RB, Hermann KG, van der Heijde DM, Baraliakos X, Jurik AG, Lambert RG, et al. Scoring sacroiliac joints by magnetic resonance imaging. A multiple-reader reliability experiment. The Journal of rheumatology. 2005;32(10):2050-5.

[3]Cereser L, Zabotti A, Zancan G, Quartuccio L, Cicciò C, Giovannini I, et al. Magnetic resonance imaging assessment of ASAS-defined active sacroiliitis in patients with inflammatory back pain and suspected axial spondyloarthritis: a study of reliability. Clinical and experimental rheumatology. 2021.

[4]Maksymowych WP, Inman RD, Salonen D, Dhillon SS, Williams M, Stone M, et al. Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum. 2005;53(5):703-9.

[5]Gillies RJ, Kinahan PE, Hricak H. Radiomics: Images Are More than Pictures, They Are Data. Radiology. 2016;278(2):563-77.

Table 1.

Rad-scores corresponding to different SPARCC score intervals about the status of SIJ-BMO.

SPARCC scorenRad-scoreMean(sd)Median (iqr)Range0-1170-1.31(1.64)-1.39(2.16)-6.46, 2.352-61250.73(1.86)0.62(2.12)-3.08, 8.487-11552.25(1.80)2.36(1.79)-1.17, 8.3612-16432.65(2.14)2.66(3.21)-0.76, 7.3917-21383.31(2.05)3.25(2.88)-0.88, 7.5522-26263.08(1.55)3.38(2.12)-1.00, 5.3827-31253.77(1.36)3.77(1.59)0.40, 6.27>31414.10(1.51)4.32(2.28)1.00, 6.96

Disclosure of Interests

None declared

Age and Sex Differences in the Association of Sleep Duration and Overweight/Obesity among Chinese Participants Age above 45 Years: A Cohort Study

OBJECTIVES

We aimed to evaluate the association between sleep duration and obesity and estimate the attributable risk of sleep in the China Health and Retirement Longitudinal Study surveys (CHARLS).

METHODS

A total of 9061 adults aged 45 years above from CHARLS (2011-2015) were included. The main outcome of this study was incident overweight/obesity specific to general and abdominal obesity. Overweight/obesity was defined as BMI ≥ 23.0 (kg/m2) and BMI≥27.5 (kg/m2), respectively. Abdominal obesity was defined as waist circumference ≥90 cm for men and ≥80 cm for women. Self-reported sleep durations were obtained using a structured questionnaire. We assessed hazard ratios (HRs) and 95% confidence intervals (CIs) as well as the population attributable fraction (PAF) for associations between sleep duration and obesity.

RESULTS

986 and 606 participants were identified as overweight and general obesity respectively, 1253 experienced abdominal obesity events. In multivariable-adjusted models, participants with daytime sleep of 0-30 minutes and more than 30 minutes associated with 30% (HR: 0.70, 95% CI: 0.56-0.87) and 35% (HR: 0.65, 95% CI: 0.55-0.78) decreased incident overweight risk respectively compared to those having no daytime sleep, this association also found among females and middle-aged, not males or elderly. Similarly, 0-30 minutes (HR: 0.68, 95% CI: 0.48-0.96) and more than 30 minutes of daytime sleep (HR: 0.73, 95% CI: 0.59-0.91) were associated with a reduced risk of abdominal obesity, similar results also found among females and middle-aged. Compared with 7-9 hours of nocturnal sleep, people who slept 5-7 hours had a reduced risk of overweight (HR: 0.59, 95% CI=0.47-0.74),but not found in subgroups. The hazard role of long nocturnal sleep for abdominal obesity was only found among elderly (HR: 2.33, 95% CI=1.35-4.04) and males (HR: 2.24, 95% CI=1.17-4.29). Compared with moderate total sleepers (7-9hours/day), participants with short total sleep duration exhibited an elevated risk of overweight (HR: 1.13, 95% CI=1.00-1.28), this also found among middle-aged. The PAF for inadequate total sleep duration (<7 hours/day) was 10.77% for overweight individuals.

CONCLUSIONS

Insufficient sleep duration was associated with an elevated risk of overweight only detected among middle-aged not elderly and other subgroups specific by age. The risks for abdominal obesity were increased for males and middle-aged with long nocturnal sleep. Daytime sleep may significantly reduce the risk of overweight and abdominal obesity in female and middle-aged individuals. The link between sleep duration and obesity requires further study.

FABP4 inhibitor attenuates inflammation and endoplasmic reticulum stress of islet in leptin receptor knockout rats

OBJECTIVE

Metabolic syndrome is characterized by abdominal obesity, hypertriglyceridemia and hyperglycemia. Fatty acid binding protein 4 (FABP4), as a member of intracellular lipid chaperones, is not only engaged in lipid transport but involved in inflammation and insulin resistance. The present study was to investigate the effects of BMS309403, a specific FABP4 inhibitor, on metabolic syndrome and its possible molecular mechanisms in islets.

MATERIALS AND METHODS

Leptin receptor knockout (Lepr-/-) rat, a novel and representative animal model of metabolic syndrome, was adopted in this study. Lepr-/- male rats and their wild littermates were grouped and intragastrically administered with BMS309403. Glucose Tolerance Test (GTT) and Insulin Tolerance Test (ITT) were performed on all rats. Serum insulin was detected by ELISA. The metabolic characters, as well as liver and kidney functions, were evaluated by serum biochemical assay. Immunohistochemistry and Western blot were adopted to detect the expression levels of FABP4, CD68, GRP78, ATF6, p-IRE1a, and Cleaved caspase-3.

RESULTS

Lepr-/- rats showed prominent characteristics of metabolic syndrome with increased FABP4, inflammatory infiltration, ER stress and apoptosis in islets. BMS309403 administration attenuated inflammation, ER stress and apoptosis in Lepr-/- rat islets while stimulating insulin secretion as well as improving manifestation of metabolic syndrome without hepatic and renal toxicity.

CONCLUSIONS

FABP4 increased in Lepr-/- rat islets and might be involved in the regulation of islet inflammation and apoptosis via ER stress. FABP4 inhibitor BMS309403 could ameliorate islet inflammation and apoptosis in metabolic syndrome through suppressing ER stress.

Abstract P6-17-16: Efficacy and safety of shorter duration of adjuvant trastuzumab for patients with HER2 positive early breast cancer: A meta-analysis of randomized controlled trials

Background: Trastuzumab has been shown to be able to improve disease free survival(DFS) and overall survival(OS) in HER2-positive breast cancer patients. Adjuvant trastuzumab is empirically recommended for 1 year as a standard regimen. However, several studies claimed that shorter duration of adjuvant trastuzumab is non-inferior to 12 months treatment with reduced cardiac toxicities and costs.

Methods: PubMed, EMBASE, Cochrane Library, Google scholar Web, ISI Web of Science, BIOSIS and CNKI, and major conference abstracts were searched systematically in June 2018 to identify eligible non-inferiority studies comparing the intervention outcomes of adjuvant trastuzumab in chemotherapy for women with HER-2 positive breast cancer between short-term and 1-year treatments. Hazard-Ratios(HR) and corresponding 95% Confidence Intervals(CI) were calculated to compare OS and DFS of trastuzumab between short-term and long-term treatments. Pooled data of Odds-Ratio was analyzed for cardiac toxicities.

Results: 5 articles were finally eligible in the study. Totally, there were 11,376 women with HER-2 positive early breast cancer, with 5,684 in short-term group and 5,692 in the 1-year group. We found a distinct difference of DFS (HR=1.19, 95% CI=1.08-1.30) and OS (HR=1.22, 95% CI=1.07-1.39) between short-term and 12 months trastuzumab in the total analysis, which demonstrated short-term treatment exhibited a worsening trend on DFS and OS. Subgroup analysis was performed based on estrogen receptor (ER) and lymph node status, and no statistical interaction could be found(p=0.12, 0.52, respectively). The two groups with different duration of trastuzumab treatment displayed statistically significant difference for cardiotoxicities, which favored shorter duration(OR=0.54, 95% CI=0.38-0.77).

Conclusions: 1-year adjuvant trastuzumab remains the standard strategy for HER2 positive early breast cancer, however, a concomitant higher risk of associated cardiac adverse effects should not be ignored.

Citation Format: Li J, Wang G, Wu Q, Chen C, Tu Y, Yao F, Wei W, Sun S, Santa-Maria CA, Geng P. Efficacy and safety of shorter duration of adjuvant trastuzumab for patients with HER2 positive early breast cancer: A meta-analysis of randomized controlled trials [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-16.

[Economic burden of stomach cancer in China during 1996-2015: a systematic review]

Objective: To clarify the research status of economic burden of stomach cancer in China from 1996 to 2015. Methods: Based on three electronic literature databases (China Knowledge Resource Integrated Database, Wanfang Database and PubMed), a total of 2 873, 1 244 and 84 articles published during 1996 to 2015 were found, respectively, using keywords of"cancer","neoplasms","malignant tumor","tumor","economic burden","health expenditure","cost","cost of illness", and"China". According to the inclusion and exclusion criteria, 30 literatures were included in the final analysis. Then the basic information and study subjects, indicators and main results of economic burden were abstracted and analyzed. All the expenditure data were discounted to the values in 2013 by using China's percapita consumer price index. Results: Totally, 30 articles were included, covering 14 provinces and of which 16 were published during 2011-2015. One article was based on population-level and the remaining studies were all based on individual-level. The number of individual-level articles that reported direct medical, non-medical and indirectly economic burden was 29, 1 and 2, respectively. The main indicators of direct medical expenditure were expenditure per patient (22), per clinical visit (9) and per diem (11), respectively. The median expenditure per patient was 7 387-28 743 RMB (CNY), with average annual growth rate (AAGR) of 1.7% (1996-2013). The median expenditure per clinical visit was 18 504-41 871 RMB (2003-2013), with AAGR of 5.5%. The median expenditure per diem was 313-1 445 RMB (1996-2012), with AAGR of 3.7%. Difference was found among provinces. Conclusions: The evidence for economic burden of stomach cancer was still limited over the past two decades and mainly focused on individual and regional levels. An increase and differences in provinces were observed in direct medical expenditure. Evaluation on direct non-medical and indirect medical expenditure needs to be addressed.

[Exogenous CRX gene induces Müller cell-derived progenitors to differentiate into photoreceptors]

Objective: To investigate whether exogenous CRX gene would be able to induce Müller cells-derived progenitors to differentiate into photoreceptors. Methods: Experimental study. Müller cells-derived progenitors resulted from primary Müller cells isolated from KunMing mice(5-7 days old) and cultured in free-serum media. Markers of Müller cells(glutamine synthetase, GS and Vimentin) and stem cells (Nestin and Sox2) were analysed by immnocytochemical assays. The secondary passage progenitors were divided into three groups: (1)the control group; (2)the empty vector group was transfected with lentivirus GFP; (3)the treated group was transfected with lentivirus GFP-CRX. After differentiation for 7 days, 7 days after differentiation, the expression of markers of photoreceptors were analyzed by q-PCR and Western blot assay. Results: There were 96.03%±1.21% of Müllerz cells cultured in vitro were immunoreactive to both GS and Vimentin. The dedifferentiation cells expressed Nestin and Sox2. After 7 days of induction, Exogenous CRX induced Müller cell-derived progenitors to differentiate into rod-like cells showed appearance like neuron morphology. q-PCR demonstrated that mRNAs of CRX and Rhodopsin were upregulated greatly. CRX mRNA were 9 times (P<0.05) and Rhodopsin mRNA were 20 times (P<0.05). The difference between the control group and the empty vector group was not statistically significant. Western blot showed that the expression of CRX was upregulated significantly, and was 2.7 times(P<0.05). But expression of Rhodopsin was weak and was nearly not detected in the control group and empty vector group. The expression of S-opsin was not detected. Conclusion: CRX gene could induce the differentiation of Müller cell-derived progenitor into rod photoreceptors, indicating a new avenue to study müller cells as endogenous seed cells for retinal photoreceptor. (Chin J Ophthalmol, 2018, 54: 923-928).

A modified method for plasmid extraction from Lactobacillus plantarum contained lysozyme removal step

Plasmids of Lactobacillus plantarum PC518 cannot be effectively extracted by existing methods. It was studied that the effect of lysozyme treatment and removal on plasmid extraction by 7 protocols. The modified method was compared with a commercial kit using L. plantarum PC518, 410, 9L15, and JS193 and Weissella cibaria M2 as the tested strains. The results suggested that the step of lysozyme removal is the key to improve the efficiency of plasmid extraction. The concentrations of plasmid DNA isolated from the 5 tested strains were increased by 10.6, 9.5, 6, 5.6 and 1.5 times respectively compared with the commercial kit.

Antiviral effect of baicalin phospholipid complex against duck hepatitis A virus type 1

Duck hepatitis A virus type 1 (DHAV-1) is one of the main pathogens of ducklings and causes a high mortality rate. Baicalin (BA) has potent antiviral effect, but the solubility is very poor. In order to increase the absorption, solubility, and pharmacological activity, the phospholipid complex was used to modify BA in present study. Therefore, BA phospholipid complex (BAPC) was prepared. The anti-DHAV-1 abilities of BA and BAPC in vitro was evaluated by cell counting kit-8 and reverse transcription quantitative PCR. The curative effects of BA and BAPC on ducklings which were infected by DHAV-1 in addition to the ALT and AST levels were also detected. The results indicated the anti-DHAV-1 ability of BAPC was stronger than that of BA both in vitro and in vivo. To explore the anti-DHAV-1 mechanism, the influence of BAPC on DHAV-1 adsorption, replication, and release was studied. Furthermore, the anti-oxidative and immuno-enhancing abilities of BAPC in the treatment of infected ducklings were also determined. The results showed BAPC inhibited DHAV-1 adsorption, replication and release. Furthermore, it played anti-oxidative and immno-enhancing roles in the treatment, and the immno-enhancing role was crucial to the treatment.

[The colonoscopic characteristics of colorectal endometriosis: a single-centered retrospective study]

Objective: To reinforce the awareness of colorectal endometriosis (EM) in colonoscopy examination. Methods: Patients diagnosed as colorectal EM at Peking Union Medical College Hospital between February 2002 and February 2017 were enrolled in this study. The clinical characteristics and endoscopic features of EM lesions were summarized and compared between pathologically positive group and negative group. Results: A total of 34 cases were included with average age of (38.3±8.9) years old. All EM lesions located within rectum and sigmoid colon. The endoscopic lesions manifested as protrusion in 21 cases (61.8%) and protrusion-depression in 13 cases (38.2%), local stenosis in 8 cases (23.5%); erosive surface in 33 cases (97.1%) with local spontaneous hemorrhage in 4 cases (11.8%); nodal surface in 23 cases (67.6%), and lymphangiectasis base in 9 cases (26.4%). Endoscopic biopsy specimens were obtained in all cases with average 3 (2, 4) pieces. Positive results were found only in 4 patients (11.8%) with 3 endometriosis and one (endometrial) adenosarcoma. Compared with negative group, spontaneous hemorrhage was more frequent in positive group (2/4 vs. 2/30, P=0.013). Mean biopsy sample number was significantly larger in positive group (5 vs. 3, P=0.004). Conclusions: Colorectal endometriosis is mostly located within rectosigmoid region. Endoscopic features mainly include protrusion or protrusion-depression lesions with erosive and nodular surface, or local stenosis. Spontaneous hemorrhage under colonoscopy yields higher positive rate for biopsy, thus increasing biopsy sample numbers may improve pathology results.

[Development of CalliSpheres® embolic microspheres]

CalliSpheres® embolic microspheres for embolization of the vasculature of liver cancer are designed, manufactured, and verified, in order to improve the effect of transcatheter arterial chemoembolization in the treatment of primary liver cancer.

Diversity of killer cell immunoglobulin-like receptor genes in Drung Chinese

Killer cell immunoglobulin-like receptor (KIR) genes are variably distributed among populations from distinct geographic areas and ethnic origins. We describe, for the first time, KIR gene diversity in 152 unrelated and healthy Drung individuals, as measured by sequence-specific polymerase chain reaction. All 16 known KIR genes were detected. Of these, the framework genes KIR2DL4, 3DL2, 3DL3, and 3DP1 were present in all individuals as expected, along with the non-framework genes KIR2DL1, 2DL3, and 2DP1. In contrast, KIR2DL2, 2DS2, and 2DS5 were unusually rare, suggesting that KIR gene distribution was relatively concentrated. Ten different KIR genotypes were found, of which the most common consisted of nine genes (KIR2DL1, 2DL3, 2DL4, 2DS4, 3DL1, 3DL2, 3DL3, 2DP1, and 3DP1) and accounted for 66.4% of participants. There were eight different haplotypes present, of which the A haplotype was the most common (81.9%). Principal components and dendrogram analysis confirmed that the Drung Chinese are most closely related to the Japanese, the Zhejiang Han, and the Yunnan Han. In conclusion, distinctive frequencies of KIR genes, haplotypes, and genotypes are observed in Chinese Drung.

Recognition of Y Fragment Deletion by Genotyping Graphs after Amplified by PowerPlex® 21 Detection Kit

OBJECTIVES

To recognize the possibility of Y fragment deletion of Amelogenin gene intuitively and simply according to the genotyping graphs.

METHODS

By calculating the ratio of total peak height of genotyping graphs, the statistics of equilibrium distribution between Amelogenin and D3S1358 loci, Amelogenin X-gene and Amelogenin Y-gene, and different alleles of D3S1358 loci from 1 968 individuals was analyzed after amplified by PowerPlex^® 21 detection kit.

RESULTS

Sum of peak height of Amelogenin X allele was not less than 60% that of D3S1358 loci alleles in 90.8% female samples, and sum of peak height of Amelogenin X allele was not higher than 70% that of D3S1358 loci alleles in 94.9% male samples.

CONCLUSIONS

The result of genotyping after amplified by PowerPlex^® 21 detection kit shows that the possibility of Y fragment deletion should be considered when only Amelogenin X-gene of Amelogenin is detected and the peak height of Amelogenin X-gene is not higher than 70% of the total peak height of D3S1358 loci.

Improved survival associated with a balanced structure between adenomatous and squamous components in patients with adenosquamous carcinoma of the lung

BACKGROUND

Primary adenosquamous carcinoma (ASC) of the lung is rare and its biological behavior has not yet been thoroughly described. The aim of this study was to analyze the clinicopathological characteristics and prognostic factors associated with ASC.

MATERIALS

Clinical records of patients with ASC of the lung who underwent surgery between October 2008 and December 2014 in a single institution were retrospectively reviewed.

RESULTS

A total of 205 patients were identified. Patients with balanced structural components had significantly better prognosis than those with squamous (p = 0.014) or adenomatous (p < 0.001) predominance, and those with N0, N1, and N2 ASC (N0 vs. N1 [ p = 0.031] and N1 vs. N2 [p = 0.037], respectively), or stage I, II and IIIA ASC (stage I vs. II [p = 0.021] and stage II vs. IIIA [p = 0.007], respectively) had significant differences with respect to overall survival (OS). Multivariate analysis identified structural components (p = 0.011), tumor, node and metastasis (TNM) status (p < 0.001), and adjuvant chemotherapy (p = 0.008) as significantly prognostic factors for OS, and structural components (p = 0.030), TNM stage (p < 0.001) and adjuvant chemotherapy (p = 0.005) as the corresponding variables for disease-free survival.

CONCLUSIONS

A balanced structure between adenomatous and squamous components in patients with primary ASC of the lung was associated with better prognosis.

Development of an E-learning System for the Endoscopic Diagnosis of Early Gastric Cancer: An International Multicenter Randomized Controlled Trial

Background

In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness.

Methods

The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results.

Findings

515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P < 0·001).

Interpretation

This global study clearly demonstrated the efficacy of an e-learning system to expand knowledge and provide invaluable experience regarding the endoscopic detection of early gastric cancer (R000012039).

•

This report establishes that an e-learning system on the Internet can improve the diagnostic ability of endoscopists.

•

Countless endoscopists worldwide can access the system to learn how to make an endoscopic diagnosis of early gastric cancer.

•

The e-learning system could be modified to provide education regarding endoscopic diagnosis in other organs.

This is the first report to demonstrate how an e-learning system based on the Internet can improve the diagnostic ability of gastrointestinal endoscopists worldwide. There is no limit to the number of endoscopists who can access the system and benefit from this opportunity to learn how to make an endoscopic diagnosis of early gastric cancer. This e-learning system could be modified to provide education regarding endoscopic diagnosis in other organs such as the large intestine and the esophagus, as well as the stomach. It may contribute to human welfare and health by reducing the mortality from gastrointestinal cancer.

Effective dimension reduction for sparse functional data

We propose a method of effective dimension reduction for functional data, emphasizing the sparse design where one observes only a few noisy and irregular measurements for some or all of the subjects. The proposed method borrows strength across the entire sample and provides a way to characterize the effective dimension reduction space, via functional cumulative slicing. Our theoretical study reveals a bias-variance trade-off associated with the regularizing truncation and decaying structures of the predictor process and the effective dimension reduction space. A simulation study and an application illustrate the superior finite-sample performance of the method.

The efficacy of pemetrexed and bevacizumab intrapleural injection for malignant pleural mesothelioma-mediated malignant pleural effusion

OBJECTIVE

The aim of the present study was to evaluate the efficacy and safety of pemetrexed chemotherapy combined with intrapleural injection of pemetrexed and bevacizumab in the treatment of malignant pleural mesothelioma (MPM)-mediated malignant pleural effusion, and analyze the objective response rate (ORR), the median progression-free survival (PFS) and the median overall survival (OS).

METHODS

We analyzed the clinical data of 23 MPM patients with pleural effusion who were treated with a combination chemotherapy of pemetrexed at 500 mg/m 2 , on day 1 plus cisplatin (DDP) at 20 mg/m 2 on day 1-5 of each 21 days cycle, and concurrently, intrapleural injection of pemetrexed 0.5 g and bevacizumab 300 mg was administered on day 3 or day 4 after complete effusion drainage. ELISA test was applied to detect the vascular endothelial growth factor (VEGF) level in the pleural effusion and serum, and assess the ORR and survival.

RESULTS

In the 23 evaluable patients, the VEGF level in the pleural effusion and serum was significantly decreased, P < 0.01, pleural effusion of 20 patients (86.96%) was controlled effectively. There were 8 complete responses, 7 partial responses, 5 stable disease and 3 progressive disease, the ORR was 65.21%, the disease control rate was 86.96%, the median PFS was 6 months, the median OS was 14.5 months, and the 1-year survival rate was 41.22%. Toxicities were generally mild and manageable; the major toxicities included myelosuppression, fatigue, and anemia, mainly were grade 1-2 which could be managed by symptomatic treatments.

CONCLUSION

The combination of pemetrexed chemotherapy with intrapleural injection of pemetrexed and bevacizumab is efficacious and safe for MPM pleural effusion, and results of the present study demonstrate some improvement in the PFS and OS. The expression of VEGF in the pleural effusion and serum plays a guiding role in monitoring the efficacy of bevacizumab in the treatment of malignant pleural effusion.

Low-grade Albuminuria Associated with Subclinical Left Ventricular Diastolic Dysfunction and Left Ventricular Remodeling

AIMS

Low-grade albuminuria (LGA) has been shown to be associated with increased risk for cardiovascular disease. Our study investigated the relationship between normal urinary albumin-to-creatinine ratios (UACRs) and subclinical left ventricular (LV) diastolic dysfunction and remodeling in diabetics and non-diabetics.

METHODS

A total of 888 diabetic and 208 non-diabetic patients with normal UACRs (< 30 mg/g) from Fuzhou, Fujian Province, China were examined. The subjects were stratified into quartiles based on their respective UACR levels. LV diastolic function was defined by early diastolic transmitral velocities (E)/average early diastolic annular velocities (average e), accompanied by average e. LV remodeling was defined by LV mass indexed to body surface area and relative wall thickness based on 2-dimensional and Doppler echocardiography.

RESULTS

UACR was independently associated with cardiac diastolic function as defined by E/e and average e (OR=1.042, P=0.001) and LV remodeling (OR=1.037, P=0.001) in all participants. Diabetic patients in the highest quartile of UACR demonstrated a greater risk of developing LV diastolic dysfunction by a magnitude of 1.625 (OR=1.625, P=0.037) than patients in the lowest quartile; those in the third and highest quartiles demonstrated a greater risk of LV remodeling by a magnitude of 1.729-1.994 compared to the lowest quartile (OR=1.729, P=0.027 and OR=1.994, P=0.005, respectively). The association between UACR and subclinical diastolic dysfunction was most prevalent in younger, non-obese, non-hypertensive females or patients who had experienced diabetes for fewer than 10 years. The association between UACR and LV remodeling was most prevalent in non-obese, older males, in patients with normal low-density lipoprotein levels, in patients who had experienced diabetes for fewer than 10 years, and in patients without hypertension.

CONCLUSION

UACR was associated with subclinical LV diastolic dysfunction and remodeling in both patients with and without Type 2 diabetes. We conclude that LGA may also be a marker for subclinical cardiovascular damage in Type 2 diabetics.

A genetic coding variant rs72474224 in GJB2 is associated with clinical features of psoriasis vulgaris in a Chinese Han population

Our recent targeted sequencing study identified a missense single-nucleotide polymorphism rs72474224 (c.324C>T) in GJB2. To investigate the correlation between rs72474224 (c.324C>T) and subphenotypes of psoriasis, genotype data for rs72474224 (c.324C>T, p.Val37Ile) was analyzed in 9946 cases and 9906 controls. The additive model provided the best fit for rs72474224 (P = 7.34 × 10(-9)). The genotypic and allelic frequency distributions were associated with plaque psoriasis in case-only (Pgenotype = 2.67 × 10(-3), Pallele = 6.22 × 10(-4)) and subphenotype-control (Pgenotype = 1.58 × 10(-11), Pallele = 8.16 × 10(-12)) analyses. No other significant difference was found in case-only analyses. Rs72474224 in GJB2 is preferentially associated with plaque psoriasis in Chinese population and might contribute to the complexity of psoriasis clinical features.

Astragalus membranaceus as a cause of increased CA19-9 and liver and kidney cysts: a case report

WHAT IS KNOWN AND OBJECTIVE

Astragalus membranaceus, one of the most common Chinese herbs, is widely used to prevent and treat a variety of diseases. Very few adverse reactions, caused by A. membranaceus, have been reported in the literature. The purpose of this article was to report a case of marked increase in carbohydrate antigen 19-9 (CA19-9) and the formation of liver and kidney cysts following oral administration of A. membranaceus.

CASE SUMMARY

A 38-year-old woman was found to have a high serum CA19-9 level (156 U/mL) at her routine annual examination. On follow-up, several small cysts were found in her left kidney and liver by CT scan. Her medical history showed that she had taken Astragalus tea every day for 1 month. One month after she stopped taking it, the CA19-9 level decreased to 40·19 U/mL. Ten months later, PET-CT showed that there were no liver and kidney cysts. However, she took Astragalus powder again in the second year and 1 month later her CA19-9 level increased again to more than 1000 U/mL. Several small cysts were again seen in her left kidney and liver by enhanced CT. Her CA19-9 level gradually became normal after she stopped taking the Astragalus powder.

WHAT IS NEW AND CONCLUSION

This case strongly suggests that oral administration of A. membranaceus may lead to increase in CA19-9 and the formation of liver and kidney cysts.

A study on dysbaric osteonecrosis in caisson workers

PURPOSE

To study the effects of exposure to compressed air on tunnel workers' health and to investigate the prevalence of dysbaric osteonecrosis (DON) in caisson workers.

METHODS

128 tunnel workers were divided into the exposed group (n = 58) and the control group (n = 70), and their shoulders, hips and knees were examined with X-ray, computed tomography (CT) and magnetic resonance imaging (MRI).

RESULTS

1) 34.5% of the exposed group were diagnosed with DON based on the national diagnostic criteria of decompression sickness. 2) The incidental difference of skeletal cystic changes between the exposed group and the control group was highly statistically significant (p < 0.01). 3) CT and MRI examination could detect early onset of DON lesions, and the cystic changes shown in CT and abnormal signals in MRI were diagnostic indicators in cases.

CONCLUSION

Cystic changes in CT and abnormal signals in MRI are key imaging findings of early DON.

Use of extracorporeal membrane oxygenation in tracheal surgery: a case series

OBJECTIVES

To review our experience of extracorporeal membrane oxygenation in airway management during tracheal surgery.

METHODS

A retrospective, observational study was conducted to evaluate the effectiveness of extracorporeal membrane oxygenation in tracheal surgery in Shanghai Chest Hospital between 2008 and 2012.

RESULTS

In all 91 tracheal surgeries, 7 high-risk cases used extracorporeal membrane oxygenation. The duration of extracorporeal membrane oxygenation support ranged from 10 min to 31 min. All extracorporeal membrane oxygenation patients underwent surgical procedures safely and there was no hospital mortality.

CONCLUSIONS

Although various advanced anesthesia techniques can ensure a safe airway in tracheal surgery in most cases, extracorporeal circulation plays an important role in high-risk cases.

First-time donors responding to a national disaster may be an untapped resource for the blood centre

BACKGROUND

On 12 May 2008, a severe earthquake struck Sichuan in China. Many people donated blood for the first time, leading us to question whether these donors might become repeat donors in the future. The return pattern of post-earthquake first-time donors (PEFTD) was compared with that of first-time donors (FTD) in a comparable period.

METHODS

Demographic characteristics, transfusion-transmissible infection rates and 1-year return rates were compared between 5147 PEFTD (5/13-5/19, 2008) and 3176 FTD (5/13-5/19, 2009) from five Chinese blood centres using chi-squared tests. Adjusted logistic regression was used to detect earthquake effect on donor return.

RESULTS

Post-earthquake first-time donors were more frequently between 26 and 45 years, men, and better educated compared with the control group. Slightly higher but not statistically significant increased rates of hepatitis B virus surface antigen (HBsAg) (0·87% vs. 0·50%, P=0·054), hepatitis C virus (HCV) (0·70% vs. 0·63%, P=0·414), syphilis (0·9% vs. 0·7%, P=0·489) and lower rates of human immunodeficiency virus (HIV) (0·31% vs. 0·60%, P=0·078) reactivity were detected for PEFTD. The 1-year return rate for PEFTD was significantly lower than that of the controls (8·0% vs. 13·0%, P<0·001). After adjusting for demographic factors, donation volume and sites, the PEFTD were less likely to return in 1 year than the controls (OR: 0·520; 95% CI: 0·442, 0·611).

CONCLUSION

Post-earthquake first-time donors may be less likely to donate again without continuing motivation strategies. Further studies on PEFTD's lack of motivation to return for donation are needed to design recruitment strategies to convert PEFTD to become repeat donors to continuously replenish the blood supply.

Subclinical endothelial dysfunction and low-grade inflammation play roles in the development of erectile dysfunction in young men with low risk of coronary heart disease

The purpose of this study is to investigate the possible underlying pathogenesis of erectile dysfunction(ED) in young men with low risk of coronary heart disease and no well-known aetiology. To conduct this study, 122 patients with ED under the age of 40 were enrolled, along with 33 age-matched normal control subjects. The patients with ED had significantly higher levels of systolic blood pressure (SBP), total cholesterol and triglyceride, high sensitivity C-reactive protein (hs-CRP), greater carotid intima-media thickness (CIMT) and Framingham risk score (FRS) than the control group, though all of these values were within the respective normal range. Further, the brachial artery flow- mediated vasodilation (FMD) values were significantly lower in ED patients and correlated positively with the severity of ED (r = 0.714, p < 0.001). When these significant factors were studied in the multivariate logistic regression model, FMD, SBP, hs-CRP and FRS remained the statistical significance. The receiver-operating characteristic (ROC) analysis demonstrated that FMD had a high ability to predict ED in young male with low FRS [area under the curve (AUC) 0.921, p < 0.001]. The cutoff value of FMD <10.25% had sensitivity of 82.8% and specificity of 100% for diagnosis of ED. FRS and hs- CRP were also proven to be predictors of ED (AUC 0.812, p < 0.001; AUC 0.645, p = 0.011, respectively). The results of this study validated that subclinical endothelial dysfunction and low-grade inflammation may be the underlying pathogenesis of ED with no well-known aetiology. Young patients complaining of ED should be screened for cardiovascular risk factors and possible subclinical atherosclerosis. Measurement of FMD, hs-CRP and FRS can improve our ability to predict and treat ED, as well as subclinical cardiovascular disease early for young male.

Analysis of altered proteins related to blast crisis in chronic myeloid leukemia by proteomic study

INTRODUCTION

Chromic myeloid leukemia (CML) blast crisis (BC) and imatinib (IM) resistance is a significant barrier to the effective treatment of the disease.

METHODS

Expression profiles of differential proteins were identified, and new biomarkers or pathways related to BC in CML were screened through proteomic analysis. Total proteins from primary bone marrow cells of CML patients in chronic phase (CP) and BC were separated via two-dimensional (2D) polyacrylamide gel electrophoresis and then analyzed by imagemaster 5.0 software to detect differential protein spots which were already identified by mass spectrometry. Based on the variation of the whole expression profile, some key proteins were picked out for Western blot to confirm the accuracy of proteomics data. Moreover, related signal pathways involving those proteins were investigated.

RESULTS

The result indicated that thirteen protein points between CML-CP and CML-BC were successfully determined. Results from Western blot of RhoA, hnRNPK, ANXA1, PSMB4, and LTA4H were similar to those from 2D polyacrylamide gel electrophoresis. Most of those proteins were involved in the proteosome pathway and the small G-protein pathway.

CONCLUSION

A group of proteins associated with BC can be obtained and the result of this study might provide clues for further research.

Smart nanofibers from combined living radical polymerization, "click chemistry", and electrospinning

A simple method for preparing solvent-resistant nanofibers with a thermal-sensitive surface has been developed by the combined technology of reversible addition-fragmentation chain-transfer (RAFT) polymerization, atom transfer radical polymerization (ATRP), electrospinning, and "click chemistry". Initially, well-defined block copolymers of 4-vinylbenzyl chloride (VBC) and glycidyl methacrylate (GMA) (PVBC-b-PGMA) were prepared via RAFT polymerization. Electrospinning of PVBC-b-PGMA from a solution in tetrahydrofuran gave rise to fibers with diameters in the range of 0.4-1.5 microm. Exposure to a solution of sodium azide (NaN(3)) not only affords nanofibers with azido groups on the surface but also leads to a cross-linking structure in the nanofibers. One more step of "click chemistry" between the PVBC-b-PGMA nanofibers with azido groups on the surface (PVBC-b-PGMA(-N3)) and alkyne-terminated polymers of N-isopropylacrylamide (NIPAM) (PNIPAM(AT)), which were prepared by ATRP, allows the preparation of a PVBC-b-PGMA nanofiber with thermal-sensitive PNIPAM brushes on the surface (PVBC-b-PGMA-g-PNIPAM). PVBC-b-PGMA-g-PNIPAM nanofibers exhibit a good resistance to solvents and thermal-responsive character to the environment, having a hydrophobic surface at 45 degrees C (water contact angle approximately 140 degrees) and having a hydrophilic surface at 20 degrees C (water contact angle approximately 30 degrees).

Effect of high-dose isoflavones on cognition, quality of life, androgens, and lipoprotein in post-menopausal women

CONTEXT

Recent interventional studies indicate that post-menopausal hormone replacement therapy is associated with an increased risk of cardiovascular mortality and breast cancer. Isoflavones, a class of plant estrogens, have structural similarities to estradiol. Hence, isoflavones may exert beneficial estrogenic health effects in postmenopausal women with fewer adverse effects.

OBJECTIVE

To evaluate the effect of high-dose isoflavones on self-reported quality of life (QOL), cognition, lipoproteins and androgen status in post-menopausal women.

DESIGN AND SUBJECTS

Double-blind, randomized, placebo-controlled, 12-week trial of 93 healthy, ambulatory, post-menopausal women (mean age 56 yr). The study was conducted at a tertiary care center in the United States.

INTERVENTION

Participants were randomly assigned to receive 20 g of soy protein containing 160 mg of total isoflavones vs taste-matched placebo (20 g whole milk protein). Both soy and the placebo were provided in the form of a powder to be mixed with beverages.

MAIN OUTCOME MEASURES

QOL was judged by the Menopause-specific Quality of Life (MENQOL) questionnaire while cognitive function was assessed with standard instruments. Total, free, and bioavailable testosterone, gonadotropins, SHBG, and fasting lipids were measured.

RESULTS

Eighty-four women (90%) completed the study (active=38, placebo=46). There was a significant improvement in all 4 QOL subscales (vasomotor, psychosexual, physical, and sexual) among the women taking isoflavones, while no changes were seen in the placebo group. No significant changes in cognition, serum androgens or plasma lipids were seen within any of the groups. However, at the end of the study, a group-by-time interaction was observed such that total testosterone and HDL levels were significantly lower in the isoflavones compared to placebo groups.

CONCLUSION

High-dose isoflavones is associated with improved QOL among women who have become menopausal recently. Hence, the timing of isoflavone supplementation with regards to the onset of menopause appears to be important. The use of isoflavones, as an alternative to estrogen therapy, may be potentially useful and seemingly safe in this group of women who are looking for relief from menopausal symptoms.

Surgical treatment of esophageal leiomyoma located near or at the esophagogastric junction via a thoracoscopic approach

Esophageal leiomyoma can be enucleated safely and effectively by minimally invasive surgery. The laparoscopic approach has been a conventional option for this kind of tumor located near or at the esophagogastric (EG) junction. The aims of this study were to evaluate the surgical outcome of thoracoscopic resection of leiomyoma at the EG junction, and discuss factors affecting the incidence of postoperative gastroesophageal reflux. Fourteen patients who underwent thoracoscopic resection of esophageal leiomyoma located near or at the EG junction (<4 cm above the esophageal hiatus) from January 2002 to August 2007 were reviewed retrospectively. Tumor characteristics, surgical methods, and postoperative outcomes were evaluated. A left approach of video-assisted thoracoscopy was used in 13 patients; a right approach was used for the other patient, whose multiple tumors were located in the EG junction and mid-esophagus. Postoperative recovery was uneventful in all patients, with no mucosa leakage or other significant complications. Mean tumor size was 3.2 cm (1.2-6.0 cm). Of the 14 patients, two had serpiginous leiomyoma, two had multiple tumors, and the others had solitary tumors. Mean postoperative stay in hospital was 7 days (4-11 days). Postoperative dysphagia was not reported, although gastroesophageal reflux was noted in one patient. Thoracoscopic resection of esophageal leiomyomas near or at the EG junction is feasible, with a low prevalence of postoperative gastroesophageal reflux.

The risk of HIV, HBV, HCV and HTLV infection among musculoskeletal tissue donors in Australia

In Australia, there are no current national estimates of the risks of transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) or human T-lymphotrophic virus (HTLV) by musculoskeletal tissue transplantation. We determined the prevalence rates of antibodies against HIV (anti-HIV), HCV (anti-HCV) and HTLV (anti-HTLV) and Hepatitis B surface antigen (HBsAg) for 12,415 musculoskeletal tissue donors from three major bone tissue banks across Australia for the period 1993-2004. The prevalence (per 100,000 persons) was 64.44 for anti-HIV, 407.13 for HBsAg, 534.63 for anti-HCV and 121.88 for anti-HTLV. The estimated probability of viremia at the time of donation was 1 in 128,000, 1 in 189,000, 1 in 55,000 and 1 in 118,000, respectively. With the addition of nucleic acid amplification testing (NAT), the probability of donor viremia would be reduced to 1 in 315,000 for HIV, 1 in 385,000 for HBV and 1 in 500,000 for HCV. The prevalence of HIV, HBV, HCV and HTLV although low, are higher among musculoskeletal tissue donors than among first-time blood donors. The risks associated with musculoskeletal donation will be reduced with NAT, though further cost analysis is required prior to its implementation.

Recurrent spontaneous abortions patients have more −14 bp/+14 bp heterozygotes in the 3′UT region of the HLA-G gene in a Chinese Han population

Although human leukocyte antigen (HLA)-G gene polymorphism is low, it may influence levels of protein expression and, in some cases, has been associated with pregnancy diseases. Apart from the 23 HLA-G alleles, including a null allele known as HLA-G*0105N, a 14-bp deletion or insertion in the 3'UT region also contributes to the HLA-G gene polymorphism. In order to discover any correlation between the 14-bp deletion polymorphism and pregnancy diseases, we isolated the genomic DNA from 24 recurrent spontaneous abortions (RSA) patients and 88 normal fertile control individuals using the salted out method. Exon-8 of HLA-G gene of the two groups was amplified by polymerase chain reaction, respectively, and analyzed by electrophoresis on 9% nondenaturing polyacrylamide gel and stained with ethidium bromide. Differences between the two groups were compared using the chi(2) test. The results were there was no significant difference in allelic frequencies of 14-bp deletion polymorphism between normal control and RSA patients; frequency of -14 bp/+14 bp heterozygotes was significantly increased in RSA patients as compared with normal fertile controls. Our results are similar to a study of Indian women but contradictory to a study of Danish women. This discrepancy may be due to ethnic differences.

A comparison of three methods of wound closure following arthroplasty

We carried out a blinded prospective randomised controlled trial comparing 2-octylcyanoacrylate (OCA), subcuticular suture (monocryl) and skin staples for skin closure following total hip and total knee arthroplasty. We included 102 hip replacements and 85 of the knee.

OCA was associated with less wound discharge in the first 24 hours for both the hip and the knee. However, with total knee replacement there was a trend for a more prolonged wound discharge with OCA. With total hip replacement there was no significant difference between the groups for either early or late complications. Closure of the wound with skin staples was significantly faster than with OCA or suture. There was no significant difference in the length of stay in hospital, Hollander wound evaluation score (cosmesis) or patient satisfaction between the groups at six weeks for either hips or knees.

We consider that skin staples are the skin closure of choice for both hip and knee replacements.