[A case of high-pressure injection injury of hand complicated with deep chemical burn caused by industrial cement]

This article reports a patient with extensive high-pressure injection injury of the hand combined with deep chemical burn caused by high-pressure injection of industrial cement materials was diagnosed and treated in the Department of Hand Surgery, Xiaolan Hospital Affiliated to Southern Medical University in 2022. The nerves, tendons and blood vessels of the left hand were involved, and the ulnar skin of the left thumb was extensively necrosis, and a large number of extensive cement foreign bodies remained under the skin. Part of the cement was inserted into the joint capsule of the interphalangeal joint. After emergency surgical treatment, the patient was saved successfully, and the wound healed well without chemical poisoning and other related complications, which created conditions for the second stage of flap repair.

Single-Cell Analysis of CX3CR1+ Cells Reveals a Pathogenic Role for BIRC5+ Myeloid Proliferating Cells Driven by Staphylococcus aureus Leukotoxins

Our previous studies identified a population of stem cell-like proliferating myeloid cells within inflamed tissues that could serve as a reservoir for tissue macrophages to adopt different activation states depending on the microenvironment. By lineage-tracing cells derived from CX3CR1+ precursors in mice during infection and profiling by single-cell RNA sequencing, in this study, we identify a cluster of BIRC5+ myeloid cells that expanded in the liver during chronic infection with either the parasite Schistosoma mansoni or the bacterial pathogen Staphylococcus aureus. In the absence of tissue-damaging toxins, S. aureus infection does not elicit these BIRC5+ cells. Moreover, deletion of BIRC5 from CX3CR1-expressing cells results in improved survival during S. aureus infection. Hence the combination of single-cell RNA sequencing and genetic fate-mapping CX3CR1+ cells revealed a toxin-dependent pathogenic role for BIRC5 in myeloid cells during S. aureus infection.

Tumor-derived interleukin-1 receptor antagonist exhibits immunosuppressive functions and promotes pancreatic cancer

BACKGROUND

Pancreatic ductal adenocarcinoma (PDA) is a pernicious disease characterized by an immunosuppressive milieu that is unresponsive to current immunotherapies. Interleukin-1 receptor antagonist (IL-1Ra) is a natural anti-inflammatory cytokine; however, its contribution to cancer pathogenesis and immunosuppression remains elusive. In this research, we investigated the role and mechanism of IL-1Ra in malignant progression of PDA.

RESULTS

Through analyzing clinical dataset and examining the pathological tumor tissues and serum samples, we have demonstrated that IL-1Ra expression is elevated in human PDA and positively associated with malignant progression of PDA. To study the biological function of IL-1Ra in tumors, we generated a set of mouse pancreatic cancer cell lines with a knockout (KO) of the Il1rn gene, encoding IL-1Ra, and compared the tumor growth rates in immune-competent and immune-deficient mice. We found that the Il1rn KO cells exhibited greater tumor inhibition in immune-competent mice, highlighting the crucial role of a functional immune system in Il1rn KO-mediated anti-tumor response. Consistently, we found an increase in CD8+ T cells and a decrease in CD11b+Ly6G- immunosuppressive mononuclear population in the tumor microenvironment of Il1rn KO-derived tumors. To monitor the inhibitory effects of IL-1Ra on immune cells, we utilized a luciferase-based reporter CD4+ T cell line and splenocytes, which were derived from transgenic mice expressing ovalbumin-specific T cell receptors in CD8+ T cells, and mice immunized with ovalbumin. We showed that IL-1Ra suppressed T cell receptor signaling and inhibited antigen-specific interferon-γ (IFN-γ) secretion and cytolytic activity in splenocytes.

CONCLUSIONS

Our findings illustrate the immunosuppressive properties of the natural anti-inflammatory cytokine IL-1Ra, and provide a rationale for considering IL-1Ra-targeted therapies in the treatment of PDA.

Rewilding of laboratory mice enhances granulopoiesis and immunity through intestinal fungal colonization

The paucity of blood granulocyte populations such as neutrophils in laboratory mice is a notable difference between this model organism and humans, but the cause of this species-specific difference is unclear. We previously demonstrated that laboratory mice released into a seminatural environment, referred to as rewilding, display an increase in blood granulocytes that is associated with expansion of fungi in the gut microbiota. Here, we find that tonic signals from fungal colonization induce sustained granulopoiesis through a mechanism distinct from emergency granulopoiesis, leading to a prolonged expansion of circulating neutrophils that promotes immunity. Fungal colonization after either rewilding or oral inoculation of laboratory mice with Candida albicans induced persistent expansion of myeloid progenitors in the bone marrow. This increase in granulopoiesis conferred greater long-term protection from bloodstream infection by gram-positive bacteria than by the trained immune response evoked by transient exposure to the fungal cell wall component β-glucan. Consequently, introducing fungi into laboratory mice may restore aspects of leukocyte development and provide a better model for humans and free-living mammals that are constantly exposed to environmental fungi.

Amelioration of Murine Colitis by Attenuated Salmonella choleraesuis Encoding Interleukin-19

The imbalance of mucosal immunity in the lower gastrointestinal tract can lead to chronic inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis. IBD is a chronic inflammatory disorder that causes small and/or large intestines ulceration. According to previous studies, recombinant interleukin (IL)-10 protein and genetically modified bacteria secreting IL-10 ameliorate dextran sulfate sodium (DSS)-induced colitis in mice. IL-19 is a transcriptional activator of IL-10 and can alter the balance of T helper 1 (Th)1/Th2 cells in favor of Th2. In this study, we aimed to investigate whether the expression of the murine IL-19 gene carried by Salmonella choleraesuis (S. choleraesuis) could ameliorate murine IBD. Our results showed that the attenuated S. choleraesuis could carry and express the IL-19 gene-containing plasmid for IBD gene therapy by reducing the mortality and clinical signs in DSS-induced acute colitis mice as compared to the untreated ones. We also found that IL-10 expression was induced in IL-19-treated colitis mice and prevented inflammatory infiltrates and proinflammatory cytokine expression in these mice. We suggest that S. choleraesuis encoding IL-19 provides a new strategy for treating IBD in the future.

Single-cell analysis of CX3CR1 + cells reveal a pathogenic role for BIRC5 + myeloid proliferating cells driven by Staphylococcus aureus leukotoxins

Our previous studies identified a population of stem cell-like proliferating myeloid cells within inflamed tissues that could serve as a reservoir for tissue macrophages to adopt different activation states depending on the microenvironment. By lineage tracing cells derived from CX3CR1 + precursors in mice during infection and profiling by scRNA-seq, here we identify a cluster of BIRC5 + myeloid cells that expanded in the liver during either chronic infection with the parasite Schistosoma mansoni or the bacterial pathogen Staphylococcus aureus . In the absence of tissue damaging toxins, S. aureus infection does not elicit these BIRC5 + cells. Moreover, deletion of BIRC5 from CX3CR1 expressing cells results in improved survival during S. aureus infection. Hence, the combination of scRNA-Seq and genetic fate mapping CX3CR1 + cells revealed a toxin dependent pathogenic role for BIRC5 in myeloid cells during S. aureus infection.

Single-cell multi-omic analysis identify heterogeneity and distinct features in fate-mapped tissue-resident alternatively activated macrophages

Peritoneal cavity cells play pivotal roles in inflammation, repair, and maintaining homeostasis in response to pathogenic infections and tissue injury. Two major tissue-resident macrophages (TRMs) are large peritoneal macrophages (LPMs) and small peritoneal macrophages (SPMs). These are the major macrophage subsets in the peritoneal cavity and originate from embryogenic (LPMs) or bone-marrow-derived myeloid precursors (SPMs). CITE-seq (Cellular Indexing of Transcriptomes and Epitopes by Sequencing) provides simultaneous information for single cells in both cell-surface protein and gene expression levels. Here, we used CITE-seq to profile peritoneal cells by an oligonucleotide-labeled antibody panel designed to react with 189 unique mouse cell surface antigens. We identify 14 markers exclusively expressed on TRMs but not other immune cell types. These markers can classify phenotype differences between LPMs and SPMs during IL-4 stimulation. We further profile fate-mapped TRMs by scRNA-seq and identified more heterogenous phenotypes of TRMs that originated from embryogenic rather than bone-marrow-derived myeloid precursors. Notably, serum amyloid A-3 (Saa3) and platelet factor 4 (Pf4), can distinguish TRM clusters from alternative activation to IL-4 stimulation and Heligmosomoides polygyrus infection. Hence, we identify distinct markers that can be used to distinguish the different origins and heterogenous TRM phenotypes under steady state and type 2 immune responses.

Redefining inflammatory macrophage phenotypes across stages and tissues by single-cell transcriptomics

Single-cell transcriptomic data identifies major activation paths of monocyte-derived macrophages as a framework for inflammatory tissue macrophages.

Helminth infections and cardiovascular diseases: A role for the microbiota and Mϕs?

Cardiovascular diseases are rising in developing countries with increasing urbanization and lifestyle changes and remains a major cause of death in the developed world. In this mini review, we discuss the possibility that the effect of helminth infections on the immune system and the microbiota may affect risk factors in cardiovascular diseases such as atherosclerosis, as part of the hygiene hypothesis. The effects of Type 2 immune responses induced by helminths and helminth derived molecules on regulating metabolism and Mϕ function could be a mechanistic link for further investigation. We emphasize the complexity and difficulties in determining indirect or direct and causal relationships between helminth infection status and cardiovascular diseases. New experimental models, such as rewilding laboratory mice, whereby different aspects of the environment and host genetics can be carefully dissected may provide further mechanistic insights and therapeutic strategies for treating cardiovascular diseases.

Critical role of interferons in gastrointestinal injury repair

The etiology of ulcerative colitis is poorly understood and is likely to involve perturbation of the complex interactions between the mucosal immune system and the commensal bacteria of the gut, with cytokines acting as important cross-regulators. Here we use IFN receptor-deficient mice in a dextran sulfate sodium (DSS) model of acute intestinal injury to study the contributions of type I and III interferons (IFN) to the initiation, progression and resolution of acute colitis. We find that mice lacking both types of IFN receptors exhibit enhanced barrier destruction, extensive loss of goblet cells and diminished proliferation of epithelial cells in the colon following DSS-induced damage. Impaired mucosal healing in double IFN receptor-deficient mice is driven by decreased amphiregulin expression, which IFN signaling can up-regulate in either the epithelial or hematopoietic compartment. Together, these data underscore the pleiotropic functions of IFNs and demonstrate that these critical antiviral cytokines also support epithelial regeneration following acute colonic injury.

Single-Cell Transcriptional Survey of Ileal-Anal Pouch Immune Cells From Ulcerative Colitis Patients

BACKGROUND & AIMS

Restorative proctocolectomy with ileal pouch-anal anastomosis is a surgical procedure in patients with ulcerative colitis refractory to medical therapies. Pouchitis, the most common complication, is inflammation of the pouch of unknown etiology. To define how the intestinal immune system is distinctly organized during pouchitis, we analyzed tissues from patients with and without pouchitis and from patients with ulcerative colitis using single-cell RNA sequencing (scRNA-seq).

METHODS

We examined pouch lamina propria CD45+ hematopoietic cells from intestinal tissues of ulcerative colitis patients with (n = 15) and without an ileal pouch-anal anastomosis (n = 11). Further in silico meta-analysis was performed to generate transcriptional interaction networks and identify biomarkers for patients with inflamed pouches.

RESULTS

In addition to tissue-specific signatures, we identified a population of IL1B/LYZ+ myeloid cells and FOXP3/BATF+ T cells that distinguish inflamed tissues, which we further validated in other scRNA-seq datasets from patients with inflammatory bowel disease (IBD). Cell-type-specific transcriptional markers obtained from scRNA-seq was used to infer representation from bulk RNA sequencing datasets, which further implicated myeloid cells expressing IL1B and S100A8/A9 calprotectin as interacting with stromal cells, and Bacteroidales and Clostridiales bacterial taxa. We found that nonresponsiveness to anti-integrin biologic therapies in patients with ulcerative colitis was associated with the signature of IL1B+/LYZ+ myeloid cells in a subset of patients.

CONCLUSIONS

Features of intestinal inflammation during pouchitis and ulcerative colitis are similar, which may have clinical implications for the management of pouchitis. scRNA-seq enables meta-analysis of multiple studies, which may facilitate the identification of biomarkers to personalize therapy for patients with IBD. The processed single cell count tables are provided in Gene Expression Omnibus; GSE162335. Raw sequence data are not public and are protected by controlled-access for patient privacy.

Housing laboratory mice deficient for Nod2 and Atg16l1 in a natural environment uncovers genetic and environmental contributions to immune variation

The relative contributions of genetic and environmental factors to variation in immune responses are still poorly understood. Here, we performed a deep phenotypic analysis of immunological parameters of laboratory mice released into an outdoor enclosure, carrying susceptibility genes (Nod2 and Atg16l1) implicated in the development of inflammatory bowel diseases. Variations of immune cell populations were largely driven by environment, whereas cytokine production in response to stimulation was affected more by genetic mutations. Multi-omic models identified transcriptional signatures associated with differences in T cell populations. Subnetworks associated with responses against Clostridium perfringens, Candida albicans and Bacteroides vulgatus were also coupled with rewilding. Hence, exposing laboratory mice carrying different genetic mutations to a natural environment uncovered important contributors to immune variation.

Altered Immunity of Laboratory Mice in the Natural Environment Is Associated with Fungal Colonization

Free-living mammals, such as humans and wild mice, display heightened immune activation compared with artificially maintained laboratory mice. These differences are partially attributed to microbial exposure as laboratory mice infected with pathogens exhibit immune profiles more closely resembling that of free-living animals. Here, we examine how colonization by microorganisms within the natural environment contributes to immune system maturation by releasing inbred laboratory mice into an outdoor enclosure. In addition to enhancing differentiation of T cell populations previously associated with pathogen exposure, outdoor release increased circulating granulocytes. However, these "rewilded" mice were not infected by pathogens previously implicated in immune activation. Rather, immune system changes were associated with altered microbiota composition with notable increases in intestinal fungi. Fungi isolated from rewilded mice were sufficient in increasing circulating granulocytes. These findings establish a model to investigate how the natural environment impacts immune development and show that sustained fungal exposure impacts granulocyte numbers.

Rewilding Nod2 and Atg16l1 Mutant Mice Uncovers Genetic and Environmental Contributions to Microbial Responses and Immune Cell Composition

The relative contributions of genetic and environmental factors to variation in immune responses are poorly understood. Here, we performed a phenotypic analysis of immunological parameters in laboratory mice carrying susceptibility genes implicated in inflammatory bowel disease (IBD) (Nod2 and Atg16l1) upon exposure to environmental microbes. Mice were released into an outdoor enclosure (rewilded) and then profiled for immune responses in the blood and lymph nodes. Variations of immune cell populations were largely driven by the environment, whereas cytokine production elicited by microbial antigens was more affected by the genetic mutations. We identified transcriptional signatures in the lymph nodes associated with differences in T cell populations. Subnetworks associated with responses against Clostridium perfringens, Candida albicans, and Bacteroides vulgatus were also coupled with rewilding. Therefore, exposing laboratory mice with genetic mutations to a natural environment uncovers different contributions to variations in microbial responses and immune cell composition.

Integration of multi-omics data from re-wilded laboratory mice to identify key parameters that determine immune heterogeneity and activation

Current research on immunology are largely based on clean laboratory mice kept in specific pathogen free (SPF) environments. They have the advantage of being inbred, genetically homogeneous and can be manipulated genetically in disease models. However, humans as with all free-living mammals face a more complex environment and are exposed to various food resources, microbial experiences, thermogenic changes, and must constantly respond to environmental challenges. We have established a unique experimental system in which laboratory mice are “re-wilded” through release into an outdoor enclosure facility. Here, we use multi-parameter assays including 16S/Metagenomic sequencing, intestinal RNA-sequencing, and 34 parameters of flow cytometry to explain heterogeneity of immune responses from exposure to the wild environment. Increased immune activation of re-wilded mice occur in the absence of viral, bacterial or parasitic pathogen exposure in this enclosure, including increase of CD4+ and CD8+ memory T cells, effector T cells, innate lymphoid cells (ILCs), circulating neutrophils, reduction in naïve T cells, and increased expression of costimulatory molecules on antigen presenting cells. When we examined cytokine production in response to ex vivo stimulation of mesenteric lymph node cells with 8 bacterial and fungal stimuli, the mesenteric lymph node cells from re-wilded mice are poised for different responses via robust induction of cytokines than laboratory mice. By using machine learning models, we are integrating these multi-omic datasets to better predict the association between environmental and host genetic factors on driving heterogeneity of immune responses in the re-wilded mice.

Single-cell analysis of fate-mapped macrophages reveals heterogeneity, including stem-like properties, during atherosclerosis progression and regression

Atherosclerosis is a leading cause of death worldwide in industrialized countries. Disease progression and regression are associated with different activation states of macrophages derived from inflammatory monocytes entering the plaques. The features of monocyte-to-macrophage transition and the full spectrum of macrophage activation states during either plaque progression or regression, however, are incompletely established. Here, we use a combination of single-cell RNA sequencing and genetic fate mapping to profile, for the first time to our knowledge, plaque cells derived from CX3CR1+ precursors in mice during both progression and regression of atherosclerosis. The analyses revealed a spectrum of macrophage activation states with greater complexity than the traditional M1 and M2 polarization states, with progression associated with differentiation of CXC3R1+ monocytes into more distinct states than during regression. We also identified an unexpected cluster of proliferating monocytes with a stem cell-like signature, suggesting that monocytes may persist in a proliferating self-renewal state in inflamed tissue, rather than differentiating immediately into macrophages after entering the tissue.

Heterogeneity of plaque macrophages derived from CX3CR1+ monocyte precursors in atherosclerosis progression and regression at a single-cell level

Atherosclerosis is a leading cause of death worldwide in industrialized countries. We have previously shown that disease progression and regression are strongly associated with the M1/M2 activation status of macrophages derived from inflammatory monocytes in the plaques with large differences in transcriptional profiles. However, the features of monocyte to macrophage transitions during either plaque progression or regression are poorly understood. Here, we use a combination of single-cell RNA sequencing and tamoxifen-inducible fate mapping approaches to profile 3157 and 2198 arterial cells derived from CX3CR1+ precursor in atherosclerotic mice during plaque progression and regression. There was surprising heterogeneity among the cell populations, despite derivation from a common precursor. We compared the distinct cell clusters with the IMMGEN database to define each population and then used pseudo-time analysis to model the differentiation process from monocyte precursors to activated macrophages under progression and regression conditions. Notably, distinct cell clusters with a type 1 interferon (IFN) signature was observed during progression, which was significantly rare in regression. Whereas a unique cluster in regression was marked by increased expression of various heat shock proteins (HSP). Overall, this study highlights previously unidentified genes and programs in macrophages associated with atherosclerosis progression and regression, uncovering the unexpected plasticity of CX3CR1+ monocyte derived cells.

An OLTAM system for analysis of brown/beige fat thermogenic activity

BACKGROUND/OBJECTIVES

Thermogenic fat is present in humans and emerging evidence indicates that increasing the content and activity of these adipocytes may lead to weight loss and improved metabolic health. Multiple reporter systems have been developed to assay thermogenic fat activity based on the transcriptional and translational activation of Ucp1, the key molecule that mediates nonshivering thermogenesis. Our study aims to develop a much-needed tool to monitor thermogenic fat activity through a mechanism independent of Ucp1 regulation, therefore effectively assaying not only canonical β-adrenergic activation but also various non-UCP1-mediated thermogenic pathways that have been increasingly appreciated.

METHODS

We detected increased luciferase activity upon thermogenic activation in interscapular brown and inguinal subcutaneous fat in ODD-Luc mice, a hypoxia reporter mouse model. We then developed an OLTAM (ODD-Luc based Thermogenic Activity Measurement) system to assay thermogenic fat cell activity.

RESULTS

In both primary murine and human adipocytes and an immortalized adipose cell line that were transduced with the OLTAM system, luciferase activity can be readily measured and visualized by bioluminescence imaging in response to a variety of stimuli, including UCP1-independent thermogenic signaling. This system can offer a convenient method to assay thermogenic activity for both basic and translational research.

CONCLUSIONS

The OLTAM system offers a convenient way to measure of the activation of thermogenic fat and presents opportunities to discover novel signaling pathways and unknown compounds targeting metabolically active adipocytes to counteract human obesity.

Vitamin A mediates conversion of monocyte-derived macrophages into tissue-resident macrophages during alternative activation

It remains unclear whether activated inflammatory macrophages can adopt features of tissue-resident macrophages, or what mechanisms might mediate such a phenotypic conversion. Here we show that vitamin A is required for the phenotypic conversion of interleukin 4 (IL-4)-activated monocyte-derived F4/80intCD206+PD-L2+MHCII+ macrophages into macrophages with a tissue-resident F4/80hiCD206-PD-L2-MHCII-UCP1+ phenotype in the peritoneal cavity of mice and during the formation of liver granulomas in mice infected with Schistosoma mansoni. The phenotypic conversion of F4/80intCD206+ macrophages into F4/80hiCD206- macrophages was associated with almost complete remodeling of the chromatin landscape, as well as alteration of the transcriptional profiles. Vitamin A-deficient mice infected with S. mansoni had disrupted liver granuloma architecture and increased mortality, which indicates that failure to convert macrophages from the F4/80intCD206+ phenotype to F4/80hiCD206- may lead to dysregulated inflammation during helminth infection.

Distinct Roles of Type I and Type III Interferons in Intestinal Immunity to Homologous and Heterologous Rotavirus Infections

Type I (IFN-α/β) and type III (IFN-λ) interferons (IFNs) exert shared antiviral activities through distinct receptors. However, their relative importance for antiviral protection of different organ systems against specific viruses remains to be fully explored. We used mouse strains deficient in type-specific IFN signaling, STAT1 and Rag2 to dissect distinct and overlapping contributions of type I and type III IFNs to protection against homologous murine (EW-RV strain) and heterologous (non-murine) simian (RRV strain) rotavirus infections in suckling mice. Experiments demonstrated that murine EW-RV is insensitive to the action of both types of IFNs, and that timely viral clearance depends upon adaptive immune responses. In contrast, both type I and type III IFNs can control replication of the heterologous simian RRV in the gastrointestinal (GI) tract, and they cooperate to limit extra-intestinal simian RRV replication. Surprisingly, intestinal epithelial cells were sensitive to both IFN types in neonatal mice, although their responsiveness to type I, but not type III IFNs, diminished in adult mice, revealing an unexpected age-dependent change in specific contribution of type I versus type III IFNs to antiviral defenses in the GI tract. Transcriptional analysis revealed that intestinal antiviral responses to RV are triggered through either type of IFN receptor, and are greatly diminished when receptors for both IFN types are lacking. These results also demonstrate a murine host-specific resistance to IFN-mediated antiviral effects by murine EW-RV, but the retention of host efficacy through the cooperative action by type I and type III IFNs in restricting heterologous simian RRV growth and systemic replication in suckling mice. Collectively, our findings revealed a well-orchestrated spatial and temporal tuning of innate antiviral responses in the intestinal tract where two types of IFNs through distinct patterns of their expression and distinct but overlapping sets of target cells coordinately regulate antiviral defenses against heterologous or homologous rotaviruses with substantially different effectiveness.

Two distinct families of interferons (IFNs), type I (IFN-α/β) and type III (IFN-λ) IFNs, are quickly produced in response to virus infection and engage distinct receptors to invoke shared rapid and broad-spectrum antiviral mechanisms against invading pathogens. However, the relative importance of type I and type III IFNs in protecting different organ systems against specific viruses or distinct strains of an individual virus remains to be fully explored. Here we demonstrated in suckling mice that neither type I nor type III IFNs are effective in blocking intestinal replication of murine rotavirus, rather, viral clearance is dependent upon adaptive immune responses. In contrast, both IFN types cooperate to control intestinal replication and extra-intestinal spread of simian rotavirus in neonatal mice. Unexpectedly, we found that although intestinal epithelial cells (IECs) respond to both types of IFNs in neonatal mice, responsiveness of IECs to type I IFNs, but not type III IFNs, is diminished in adult mice. Transcriptional analysis showed that both types of IFN receptors induced overlapping intestinal antiviral responses, which were abrogated only when both receptor types were deleted. Overall, these findings reveal a well-coordinated spatial and temporal regulation of antiviral defenses by type I and type III IFNs in the gastrointestinal tract that varies significantly depending on the viral strain examined.

In situ growth of carbon nanotubes on Ni/MgO: a facile preparation of efficient catalysts for the production of synthetic natural gas from syngas

Ni/MgO-CNTs catalysts are prepared by in situ chemical vapor deposition growth of CNTs on Ni/MgO. These catalysts exhibit an improved performance for the production of synthetic natural gas from syngas, which is attributed to the formation of highly catalytic active interfaces among Ni, CNTs and MgO.

Clinical presentations of thyroid cancer patients with multiple primary cancers

BACKGROUND

In thyroid cancer patients with multiple primary cancers, primary cancers tend to be more aggressive.

AIMS

We analyzed multiple primary cancers in thyroid cancer patients and determined the differences between the incidence and the characteristics of primary cancers.

MATERIALS AND METHODS

A total of 3070 patients with thyroid cancer underwent a thyroidectomy and follow-up examination at a single medical center. The times of diagnosis of the primary cancers were categorized as antecedent, synchronous, or subsequent to the diagnosis of thyroid cancer.

RESULTS

After a mean follow-up period of 8.8 ± 0.5 yr, the presence of multiple primary cancers was histopathologically confirmed in 163 patients (5.3%). Patients with multiple primary cancers had a lower female-to-male ratio, an older mean age, advanced tumor-node-metastasis (TNM) stage, higher total mortality, and higher therapeutic radioactive iodide (131I) doses than patients without multiple primary cancers. Hematological malignancy and renal cell carcinoma, neither of which are among the 10 most common cancers observed in the general population of Taiwan, were the most common multiple cancers among women and men with thyroid cancer. Patient age, thyroid cancer tumor size, and thyroid cancer mortality in the antecedent, synchronous, and subsequent groups were not significantly different.

CONCLUSIONS

Patients with multiple primary cancers in advanced stages had shorter disease-free survival period after treatment. Thyroid cancer patients with multiple primary cancers should be closely followed up for the occurrence of other secondary cancers in order to improve total mortality.

Research on burden of chronic diseases among rural-urban residents in Xuzhou

OBJECTIVES

To investigate the burden of chronic diseases among rural-urban residents in Xuzhou, China.

STUDY DESIGN

Retrospective study.

METHODS

The mortality rates and standardized mortality rates of neoplasms, diabetes mellitus, ischaemic heart disease and cerebrovascular diseases were calculated for the 10 years from 1997 to 2006 in Xuzhou. The potential years of life lost, rate of life lost and standardized rate of life lost were calculated for each disease. Direct treatment costs were also analysed.

RESULTS

The age-standardized mortality rates of the four diseases were 150, 9, 78 and 96 per 100,000, respectively. The standardized rates of life lost among urban residents were 11.7, 0.8, 4.9 and 4.1 per thousand, respectively, and among rural residents were 15.0, 0.3, 2.9 and 2.8 per thousand, respectively. The total direct medical expenses, including outpatient and inpatient costs, was 6.07 hundred million Yuan.

CONCLUSION

Chronic diseases place a heavy burden on rural and urban residents in Xuzhou. A multidimensional and multidisciplinary health promotion and disease management plan is urgently needed to control these diseases.

Study on cement mortar and concrete made with sewage sludge ash

This study investigated the feasibility of reusing wastewater sludge ash in construction materials to replace partial materials. Wastewater sludge sampled from thermal power plant was burned into sludge ash at 800°C in the laboratory. The sludge incineration ash has low heavy metal including Pb, Cd, Cr and Cu, so it belongs to general enterprise waste. The chemical composition of sludge incineration ash was summed up in SiO₂, CaO, Fe₂O₃ and MgO. Then the wastewater sludge ash is also found to be a porous material with irregular surface. When the sludge ash was used to replace mortar or concrete cement, its water-adsorption capability will result in the reduction of mortar workability and compressive strength. Cement is being substituted for sludge ash, and 10 percent of sludge ash is more appropriate. Sludge ash is reused to take the place of construction materials and satisfies the requests of standard specification except for higher water absorption.

Health, healthcare utilization and psychiatric disorder in people with intellectual disability in Taiwan

OBJECTIVES

The aims of the present study were to examine health characteristics and healthcare utilization in relation to people with intellectual disability (ID) having psychiatric disorders in Taiwan.

METHODS

A cross-sectional study was employed; study subjects were recruited from the National Disability Registration Database. Taiwan, stratified by administrative geographical area for the study. Statistical analysis of 1026 carers for people with ID was made to examine the health status and healthcare utilization of individuals with ID having psychiatric disorders.

RESULTS

Approximately 12.1% of people with ID had psychiatric disorders. These individuals were more likely to be poorer in health condition and consuming more medical services (in the outpatient, inpatient and emergency care areas), than those individuals without psychiatric disorders. These individuals with psychiatric disorders were also taking medicines regularly at a far greater percentage than did those without psychiatric disorders.

CONCLUSIONS

Given the high prevalence of psychiatric disorders among individuals with ID, the healthcare system should take further steps to develop an appropriate health status monitoring system and community-based and easily accessible mental health services for them.

Application of three-dimensional body scanner: observation of prevalence of metabolic syndrome

BACKGROUND AND AIMS

This retrospective cross-sectional study correlates blood pressure, blood glucose, lipid and uric acid levels with anthropometric measurements.

METHODS

A total of 3975 visitors to the Department of Health Management were randomly selected to participate in this cross-sectional study. Whole body three-dimensional (3-D) laser scans were used to obtain anthropometric measurements. A health index (HI) was also designed based on anthropometric parameters. Subjects were defined as having metabolic syndrome when three of the following criteria were met: obesity (BMI of at least 30 kg/m(2); or a WHR of over 0.9 for males and 0.85 for females); triglyceride of at least 150 mg/dl; high-density lipoprotein (HDL)-cholesterol below 35 mg/dl for males and 39 mg/dl for females; fasting sugar levels of at least 110 mg/dl and hypertension.

RESULTS

Of 3975 subjects, 341 (8.6%) met the criteria for diabetes mellitus (DM); of these, 32.8% were diagnosed with hypertension. This proportion exceeded 18% of the subjects had normal glucose levels. Of the 3975 subjects, 658 (16.6%) met the criteria for metabolic syndrome. Proportionally, more male subjects than female subjects were diagnosed with metabolic syndrome (18.5% vs 14.7%). Of these, central obesity, elevated triglyceride and low HDL-cholesterol were the main factors in men, while fasting glucose, hypertension and central obesity were the main factors in women. This investigation found that larger proportions of subjects with impaired glucose tolerance (41.1%) and DM (64.2%) than of subjects with normal glucose subjects, suffered from metabolic syndrome (9.5%).

CONCLUSIONS

3-D body scanning is useful in correlating pertinent factors with metabolic syndrome, these factors include central obesity, hyperglycemia, dyslipidemia, hyperuricemia and hypertension.

Utilization of inpatient care and its determinants among persons with intellectual disabilities in day care centres in Taiwan

BACKGROUND

In Taiwan, current understanding is limited concerning the manner in which health services are utilized by persons with intellectual disabilities (ID). The objective of this study is to describe the patterns of inpatient care sought by persons with ID, and factors affecting inpatient care utilization.

METHOD

The primary method used in this study was a cross-sectional survey of 1390 persons with ID in day care centres. Data were obtained from responses to a questionnaire, copies of which were mailed to 30 day care centres catering for persons with ID. The questionnaire assessed demographic and health characteristics, disability status, and inpatient care utilization for the 12 months leading up to the survey. Multivariate logistic regression analysis identified factors independently associated with inpatient care.

RESULTS

Findings indicated that the average age of the people with ID in the centres was 13.7 years. Fifty per cent of people were afflicted with multiple handicaps, with an average of 26 outpatient visits made per person during the 12 months, and 16% of persons having been hospitalized within the previous year. The average hospital stay was 6 days. Inpatient care was more likely to be used by those individuals with an ID who were younger, had multiple handicaps, required rehabilitation, and had other disabilities and existing illnesses.

CONCLUSIONS

The study concluded that the parameters describing age of persons with ID, as having an existing illness, and requiring rehabilitative care were statistically significant in the logistic regression model of the inpatient care.

An exploratory study into health care policy for persons with intellectual disabilities in Taiwan

BACKGROUND

Although Taiwan has already had a higher quality of health care compared with other countries, there still is a need to review the quality and effectiveness of services provided. The lack of health care policy for persons with disabilities is a reflection of health care provision in Taiwan. Health care provision problems will limit persons with disabilities in their access to the health care system. The purpose of the present study was to examine the general beliefs about the current health care policies for persons with intellectual disabilities (ID) in Taiwan.

METHODS

Data were obtained from two sources, namely government policies analysis and interviews with representatives for key stakeholders in the field of ID.

RESULTS

The results illustrate that health care service problems for persons with ID include: how to enforce the discovery system and early intervention service, disability evaluation system, National Health Insurance medical payment and medical care resource development are still confining their quality of care. Furthermore, the links between social welfare, education and health care have been lost because the different roles and perspectives of people in these fields are fundamentally at odds with one another. Health care professionals have become less reform-minded as a consequence of the conditions of their work. Consequently, a complete and coordinated health care policy for persons with ID has become unattainable in society. The present paper draws on evidence from research and policies to explore the problems and potential of service development for persons with ID, and to identify review and action points for managing its implementation.

Implementation of whole body scanner for determining somatotype index at Chang Gung Memorial Hospital

BACKGROUND

Body mass index (BMI) and waist-hip ratio (WHR) using 1-dimensional circumference data have been proven to be highly related to blood pressure and total cholesterol; these 2 indices have been widely used as health indicators in preventive diagnosis and health examination. Sophisticated software, which allows calculation of the triangular mesh related to the body surface in 3D space, is capable of computing the circumference, width, sectional surface, volume, and surface area of the body.

METHODS

Chang Gung Whole Body Scanner (CGWBS) was used to capture 3D whole body surface images. In this study, the human body was divided into 10 segments consisting of the head, breast, wrist, hip, upper arm, forearm, hand, thigh, calf, and foot. Five independent assessments were made on a total of 32 anthropometric sites, including 12 circumferences, 3 widths, 3 profile areas, 7 surface areas, and 7 volumes. In this study, the somatotype index (SI) was computed through anthropometric data after 1,323 subjects were investigated. Correlation analysis was used to describe the relationship between BMI, WHR, SI, and anthropometric data. One-way analysis of variance (ANOVA) and Duncan's multiple range tests were used to examine differences between examination variables across sex and SI groups.

RESULTS

This study found 4 somatotypes from anthropometric data. SI determined by CGWBS has better correlation with anthropometry than WHR or BMI. Of the 644 male subjects, 155 were in the ectomorph group, 232 in the semi-mesomorph group, 136 in the full-mesomorph group, and 121 in the endomorph group. Of the 679 female subjects, 160 were in the ectomorph group, 235 in the semi-mesomorph group, 168 in the full-mesomorph group, and 116 in the endomorph group.

CONCLUSION

The results show that SI has great potential to perform precise somatotype classification.

Extreme insulin resistance syndrome

Congenital extreme insulin resistance syndrome has rarely been reported in Taiwan. In 1982, a girl of a consanguineous marriage was noted to have increased body hair, an enlarged clitoris, and acanthosis nigricans at birth. Two months later, she received an operation for bilateral polycystic evaries. She was found to have diabetes at 8 years old and was treated with insulin. In March 1999, she was referred to our clinic with growth retardation and poor glycemic control. She had a characteristic face with a saddle nose, broad mouth, large low-set ears, absence of subcutaneous fat, and deformed nails. Although a very high dose of insulin (> 10 IU/kg/day) was used, her glycemic control was very poor (HbA1c 13.8%). Pediatricians should remain alert for the manifestations of extreme insulin resistance.

Evaluation of bone mineral density by quantitative ultrasound of bone in 16,862 subjects during routine health examination

Caucasians and Asians are among those with the highest risk for involutional osteoporosis. To obtain accurate data about the prevalence of osteoporosis or osteopenia in different age groups, a large epidemiological study is necessary. Quantitative ultrasound (QUS) of bone is a promising technique in assessing bone microarchitecture in addition to bone mass. This study had two aims. The first was to establish bone mineral density (BMD) using QUS in subjects with no obvious disease undergoing routine health examination. The second was to determine risk factors for osteoporosis in Taiwan in order that better prevention and treatment measures may be provided for these patients. A prospective study of the risk factors for fracture was conducted in the health examination division of Chang Gung Medical Center in Linkou, Taiwan, from January 1996 to December 1997. Broadband ultrasound attenuation of the right heel was measured with an achilles bone densitometer (Lunar, Nauheim, Germany). A total of 16,862 subjects were examined, including 9,314 women (mean age 51.5+/-11.7 years) and 7,548 men (mean age 51.1+/-12.1 years). The incidence of osteoporosis in all subjects increased from 1.13% in the 21--30-year-old age group to 54.55% in those over 80 years of age. 12.02% of the subjects had osteoporosis and 34.45% had osteopenia. From multivariate analysis, bone density evaluated by QUS showed a relationship with age, gender, body mass index, waist/hip ratio, smoking and frequency of exercise. In conclusion, BMD evaluated by QUS is not found to be higher in Taiwan than elsewhere. The role of QUS in predicting fractures in Taiwan requires further investigation.

The influence of long-term different diabetic therapies on plasma leptin in type 2 diabetic subjects

The aim of this study was to assess the effect of the long-term different diabetic therapies on the plasma leptin level in type 2 diabetic subjects. We measured plasma leptin, body fat and fasting plasma insulin in 96 type 2 diabetic male subjects. They had received the same treatment regimen for more than one year (3.5 +/- 2.3 years, mean +/- SD) and were weight-stable over the previous three months. The distribution was as follows: diet control group: 32, oral hypoglycemic agent (OHA) group: 32, and insulin group: 32. The results showed that the plasma leptin level of the different therapy groups was all positively correlated with body fat. The fasting insulin levels were significantly higher (p < 0.0001) in the insulin group than those in the other two groups. The fasting insulin of the OHA group was also greater than that of the diet group but was not statistically significant. The leptin concentrations were significantly higher in the insulin group (p < 0.001) and OHA group (p = 0.0082) than that in the diet group. The leptin concentrations of insulin group were also significantly higher (p = 0.0021) than that of the OHA group. Stepwise multiple regression analysis revealed that the significant differences in the leptin level of whole group was mainly affected by fasting insulin (p < 0.0001), followed by fat percentage (p = 0.001), fat distribution (p = 0.009) and fasting sugar (p = 0.02), whereas there was no association of leptin with age, height, glycosylated hemoglobin A1c, lipid, or blood pressure. We concluded that long-term different diabetic therapies may affect the plasma leptin level, which is mediated mainly by insulin changes. This insulin effect is independent of body fat and may be superior to the fat effect on plasma leptin in the type 2 diabetic patients.

Outcome after treatment for papillary thyroid cancer

BACKGROUND

To evaluate the results of treatment and the prognostic variables of papillary thyroid carcinoma patients after long-term follow-up.

PATIENTS AND METHODS

Retrospective review of 1,373 thyroid cancer patients. Of the 1,016 papillary thyroid cancer patients, 394 patients received follow-up for more than 5 years, including 305 women (mean age, 38.4 +/- 13.7 years) and 89 men (mean age, 44.0 +/- 13.4 years). Of these papillary thyroid carcinoma patients, 227, 76, 68, and 23 patients were categorized in clinical stages I, II, III, and IV, respectively, at the time of diagnosis.

RESULTS

After treatment, 36 (9.1%) patients died. Only 23 (5.8%) of them died of papillary thyroid carcinoma. The 1-, 5-, 10-, and 20-year survival rates were 0.980, 0.951, 0.901, and 0.731. Mortality factors of the papillary thyroid carcinoma patients related to age, gender, tumor size, and postoperative serum thyroglobulin (Tg) levels. Twenty-four patients progressed from clinical stages I, II, and III to stage IV during the follow-up period. Of these 24 patients, 12 died during the follow-up period. In this study, age, gender, 131I accumulated dose, postoperative serum Tg levels, and the survival rate were demonstrated to be statistically significant between the patients in early stage and advanced stage groups after treatment.

CONCLUSION

Twenty-four of the 47 papillary thyroid cancer patients with distant metastases were diagnosed during the follow-up period. This study suggests that distant metastasis may occur at a serum Tg level of 2.3 ng/mL with thyroxine replacement. Postoperative long-term close follow-up of these patients is recommended.

Hyperinsulinemia and insulin resistance related metabolic syndrome

BACKGROUND

A cross-sectional study in northern Taiwan was conducted to investigate the role of serum insulin level on the development of hyperglycemia, hypertension, obesity and hyperlipidemia.

METHODS

Demographic data (age, gender), body mass index, blood pressure, and laboratory blood tests (uric acid, total cholesterol, triglycerides, glucose and immunoreactive insulin when fasting and two hours after loading 75 gm glucose) were collected. A logistic model or polychotomous model, treating each chronic disease (hyperglycemia, hypertension, obesity and hyperlipidemia) as a dependent variable, were fitted to study the effect of serum insulin level.

RESULTS

Four hundred and twenty one volunteers (women:men = 237:184) were recruited from 1991 to 1993. Women were more obese and had more hyperglycemia, while the frequency of hyperuricemia was lower than of men. Women with a higher level of the sum of fasting and 2-hour post glucose load insulin (SIRI) levels had higher frequencies of glucose intolerance, hypertension, obesity and hyperlipidemia, whereas SIRI was related to only obesity and hyperlipidemia in men. The high plasma SIRI was a risk factor for both impaired glucose tolerance (IGT) and obesity in women. Men with a high plasma SIRI showed a more than three-fold risk of obesity.

CONCLUSIONS

We have observed that a higher serum insulin level was significantly associated with the development of metabolic manifestations (glycemic status and obesity) in a suburban community in northern Taiwan. Men and women with a higher serum insulin level probably had a greater chance of developing obesity, and women had a greater chance of developing IGT.

Identifying differentially expressed genes associated with metastasis of follicular thyroid cancer by cDNA expression array

Patients with follicular thyroid carcinoma have a higher incidence of metastasis than papillary thyroid carcinoma when thyroid cancer is diagnosed. The cDNA expression array technology is utilized herein to profile differentially expressed genes from metastatic human follicular thyroid carcinoma and reveal new tumor markers as well as target genes for therapeutic intervention. Tissue samples were obtained during surgical resection of the thyroid follicular carcinoma and metastatic tissue in the brain of the same patient. Two identical Atlas human cDNA expression arrays were hybridized with 32P-labeled cDNA probes derived from RNA of either primary thyroid cancer or metastatic tissue. Parallel analysis of the hybridized signals allowed us to identify the alteration of gene expression in the metastasis process. Eighteen genes significantly overexpressed and 40 genes significantly underexpressed were identified in the metastatic thyroid cancer. Genes that displayed an altered expression were associated with the processes of cell cycle regulation, apoptosis, DNA damage response, angiogenesis, cell adhesion and mobility, invasion, and immune response. An expression profile of genes that are associated with metastasis process of follicular thyroid cancer was also discussed. Further investigation is required to understand the precise relationship between the altered expression of these genes and the metastasis process of follicular thyroid cancer.

Expression of sodium iodide symporter in benign and malignant human thyroid tissues

The extent of human sodium iodide symporter (hNIS) expression in different kinds of human thyroid cancer tissues and cell lines remains controversial. In this study, polyclonal antibodies to hNIS were used to analyze the expression of symporter protein in benign and malignant human thyroid tissues. Formalin-fixed, paraffin wax-embedded tissue sections were used. Staining was performed using primary polyclonal antibody of rabbit anti-human hNIS diluted in PBS (1:500). Results showed that 2 of 3 normal tissue, 3 of 6 nodular hyperplasia, one follicular adenoma, 3 of 11 papillary thyroid carcinoma, 1 of 5 follicular carcinoma and none of 3 metastatic thyroid epithelial tissue specimens stained positively for hNIS. A higher percentage of positive staining for symporter protein was found in benign thyroid tissues including normal thyroid tissue, nodular hyperplasia, and adenoma (60%). In contrast, papillary and follicular thyroid carcinomas demonstrated lower symporter protein expression (20%). In conclusion, although the number of tissue samples examined in this study was small, hNIS staining found a higher ratio of symporter protein expression in normal and benign thyroid tissues compared with malignant tissues. Determination of the reason for discrepancies in the expression of hNIS in in vivo and in vitro studies will require further investigation.

Detection of mRNA of sodium iodide symporter in benign and malignant human thyroid tissues

Human sodium iodide symporter (hNIS) is an intrinsic membrane protein with 12 transmembrane regions, which shows homology to other sodium-dependent transporters. There is controversy as to the amount of hNIS expression in different kinds of human thyroid cancer tissues and cell lines. In this study, reverse transcription-polymerase chain reaction (RT-PCR) was used to detect mRNA of hNIS in various fresh normal, benign tissues and malignant human thyroid tissues. The forward primer was nested hNIS-5' primer containing the sequences: ACCTGGAAATGCGCTTCAGC. The reverse primer was nested hNIS-3' primer containing the sequences: AAGCATGACACCGCGTGCCA. The results revealed three of three normal tissues, six of eight nodular hyperplasia, two of two hyperthyroidism, one of three follicular adenomas, five of ten papillary thyroid carcinomas, one of one follicular carcinoma and zero of one metastatic follicular tissues demonstrated positive results for hNIS in thyroid epithelial cells. A higher percentage of positive results of the symporter mRNA were found in normal benign thyroid tissues and the thyroid tissues of hyperthyroidism, and nodular hyperplasia (84.6%); however follicular adenoma, papillary and follicular thyroid carcinomas demonstrated a lower percentage of expression in the RT-PCR studies (46.7%). Serum thyrotropin levels and the degree of differentiated components presented in cancer tissues have been mentioned as important factors for hNIS expression in the cancer tissues. The discrepancies of the expression of hNIS in in vivo and in vitro studies need further investigation. In conclusion, hNIS was found in higher ratios in normal and benign thyroid tissues than in the malignant tissues. In addition, the RT-PCR technique hNIS did not detect the transporter in most papillary thyroid cancer tissues.

Long-term effects of ketoconazole in the treatment of residual or recurrent Cushing's disease

Ketoconazole is an imidazole derivative used to treat systemic and superficial mycoses by inhibiting sterol synthesis in fungi. The drug impairs steroid hormone synthesis by blocking mitochondrial P450-dependent enzyme systems. Because of its potent inhibitory effects on adrenal steroidogenesis, ketoconazole is valuable in controlling hypercortisolism. We investigated the effects of long-term treatment of this drug on three patients who had residual or recurrent Cushing's disease after surgical treatment. Ketoconazole was administered orally and adjusted according to individual response and 24-hour urinary free cortisol excretion levels. All three patients had good clinical and biochemical responses to ketoconazole therapy without adverse effects. The 24-hour urinary free cortisol levels were kept around 114.8+/-52.4 microg/24 h, 143.0+/-59.9 microg/24 h, and 122.9+/-79.9 microg/24 h, respectively (reference range, 35 to 120 microg/24 h). All three patients had follow-up magnetic resonance imaging or computed tomography of the pituitary gland, which revealed no significant changes in the sellar region. Daily ketoconazole doses ranged from 200 to 1200 mg per day. Follow-up periods were 65, 86, and 83 months, respectively. In conclusion, ketoconazole is valuable in the long-term treatment of residual or recurrent Cushing's disease when surgical treatment is contraindicated or unsuccessful.

The effects of glurenorm on plasma glucose and lipids in patients with type 2 diabetes mellitus

BACKGROUND

The effects of sulfonylureas on plasma glucose, lipids, and macrovascular complications are of interest. This study was designed to investigate the effects of glurenorm on plasma glucose and lipids in patients with type 2 diabetes mellitus.

METHODS

Nineteen patients, 15 men and 4 women, with an age range of 38-69 years, and with type 2 diabetes mellitus, were studied. Plasma glucose, glycated hemoglobin, and lipids were compared before and 3 months after glurenorm treatment.

RESULTS

Fasting and postprandial plasma glucose, and HbA1c significantly improved after 3 months of glurenorm treatment. The mean (+/- SD) triglyceride level of 10 patients with mild to moderate hypertriglyceridemia decreased from 279 +/- 66 to 219 +/- 100 mg/dl (p = 0.054). The total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) of 14 hypercholesterolemic patients did not change significantly. Their mean body weight increased significantly from 65.7 +/- 9.6 to 67.2 +/- 9.9 kg (p = 0.002).

CONCLUSION

Glurenorm was effective for glycemic control but caused weight gain in type 2 diabetic patients. Triglycerides in hypertriglyceridemic patients, and total cholesterol, LDL-C, and HDL-C in hypercholesterolemic patients did not improve after glurenorm treatment.

Trends in the clinical characteristics of patients with papillary thyroid carcinoma in Taiwan

The incidence of thyroid cancer is influenced by many factors including socioeconomic status. As economic conditions have improved in Taiwan, the increased frequency of medical examinations in the general population has led to earlier diagnosis of this indolent malignancy. The purpose of this retrospective study was to compare the clinical characteristics of cases of papillary thyroid cancer diagnosed over a 6-year period from 1993 to 1998 with those patients diagnosed from 1977 to 1992 at a single medical center. Of the 1,485 pathologically verified cases of thyroid cancer from 1977 to 1998, 1, 093 had papillary thyroid carcinoma. The mean age of these patients was 40.4 +/- 14.6 years. In order to identify trends in the characteristics of patients with thyroid cancer, patients were divided into those diagnosed before and those diagnosed after 1993. Patients diagnosed in these two time periods were also categorized into disease-free or non-disease-free groups depending on their status at the end of 1998. Actuarial survival rates were calculated using the Kaplan-Meier method. Multivariate analysis was performed to assess the independent effect of these variables using the Cox model. By December 1998, 61 (5.6%) of the 1,093 patients with papillary thyroid carcinoma had died. Among them, only 35 (3.2%) patients had died of thyroid cancer. The 5-year Greenwood survival probabilities for the groups diagnosed before and after 1993 were 0. 9412 and 0.9817, respectively. The patients diagnosed after 1993 received more aggressive surgical procedures, had smaller tumor size, lower postoperative thyroglobulin levels, less advanced clinical stage at the time of diagnosis, showed more disease-free survival, and a lower mortality rate. In conclusion, the results of this study show that patients with a diagnosis of papillary thyroid cancer after 1993 had a smaller tumor size and a better prognosis than those diagnosed before 1993. This finding emphasizes the importance of early detection in thyroid cancer.

Overexpression of thyroid hormone receptor beta1 is associated with thyrotropin receptor gene expression and proliferation in a human thyroid carcinoma cell line

To correlate the differentiation phenotype of two human thyroid cancer cell lines with their expression of various molecular markers, we analyzed the mRNA levels of four thyroid-specific genes, including thyrotropin receptor (TSHR), thyroglobulin (Tg), thyroid transcription factor-1 (TTF-1), and paired-box containing transcription factor-8 (PAX-8) genes. The results showed a differentiation-status-related pattern in which a well-differentiated cell line (WRO) expressed all the four genes, in contrast to an anaplastic cell line (ARO) that expressed TTF-1 and reduced levels of TSHR, but no Tg or PAX-8 genes. Furthermore, to verify the finding of concomitant loss of beta subtype thyroid hormone receptor (TRbeta) and TSHR gene expression in neoplastic thyroid tumors (Bronnegard et al. 1994), we examined the expression levels of TRbeta1 gene in these cell lines. Whereas the WRO cells produced an abundant amount of TRbeta1 protein detectable by immunoprecipitation, the ARO cells produced none. This new observation prompted us to investigate whether overexpression of TRbeta1 protein in ARO cells might produce changes in the differentiation phenotypes. We found that the level of expression of the TSHR gene and the proliferative index of ARO cells were significantly upregulated in the cells stably transfected with wild-type TRbeta1. These findings suggest that TRbeta1 protein overexpression can affect the differentiation phenotypes and induce more efficient cell proliferation of the anaplastic ARO cells.

Expression of sodium iodide symporter in metastatic and follicular human thyroid tissues

Active iodide uptake across the basal membrane mediated by human sodium iodide symporter (hNIS) has been shown to be a process coupled with the flow of sodium. There is still controversy as to the amount of hNIS expression present in different kinds of human thyroid cancer tissues. In this study, we present a 58-year-old women with follicular thyroid carcinoma with vertebra and skull metastases. 201Tl and 5 mCi 131I scans clearly demonstrated the metastatic lesions in the brain of this patient. Thyroid and metastatic tissues were then obtained for this study, which is aimed at comparing the iodide trapping ability in vivo and in vitro of hNIS, and then comparing their expression in both thyroid tissue and metastatic tissues. Polyclonal antibodies to hNIS and competitive RT PCR were used to analyze the symporter protein and mRNA expressed in follicular human thyroid and metastatic tissues. Positive staining of the symporter protein was performed in the follicular thyroid carcinomas, otherwise, the metastatic tissues could not have demonstrated the protein in the staining. Follicular thyroid carcinoma tissues from thyroid were revealed around 5 pg hNIS expressed in follicular thyroid carcinoma tissues from the thyroid. Otherwise, there was almost an absence of hNIS expression in the metastatic tissue. These discrepancies of the expression in hNIS in vivo and in vitro studies need further investigation.

Characteristics of thyroid carcinomas in aging patients

BACKGROUND

To investigate the clinical features of thyroid cancer in aging patients and to present the results of treatment. From this we can provide bases for earlier diagnoses and better treatment of thyroid malignancies in older patients.

MATERIALS AND METHODS

In this study a retrospective analysis was performed with 204 thyroid cancer patients aged 60 years or older (132 women, with a mean age of 68.3 +/- 6.6 years; 72 men, with a mean age of 67.0 +/- 5.3 years).

RESULTS

Of the 204 patients, 142 had well-differentiated thyroid carcinomas (96 papillary thyroid carcinomas, 43 follicular carcinomas, three Hürthle cell carcinomas) and three medullary carcinomas. Sixty-nine (33.8%) of the 204 patients died after treatment. Of these, three patients died of causes not related to thyroid cancer. For well-differentiated thyroid carcinomas, male gender, follicular carcinoma, and a larger tumour size indicated a poor prognosis. Of the 59 non-well-differentiated thyroid carcinomas, 39 were anaplastic thyroid carcinomas, nine metastatic cancers of the thyroid, seven lymphomas, and four squamous cell carcinomas. After treatment, 40 (67.8%) of the 59 patients died. In multivariant analysis of the differences in clinical parameters between aging and younger thyroid cancer patients, the current status, tumour size, follow-up period, sex, and stage at diagnosis were independent factors. From this data the delayed diagnosis of aging patients with thyroid cancer was of note when compared with younger patients.

CONCLUSION

Thyroid cancer in older patients is not a benign clinical disorder. Early diagnosis and urgent aggressive treatment are recommended courses of action for this type of cancer, especially for non-well-differentiated thyroid cancers.

Octreotide treatment for a malignant islet cell tumor with variable hormone secretion: case report

It is well known that an islet cell tumor can secrete multiple hormones depending on its cell type. We report the case of a 70-year-old woman who initially presented with peptic ulcer symptoms, an elevated serum gastrin level, and multiple liver tumors. Liver biopsy and distal pancreatectomy were performed, and the pathological diagnosis was malignant islet cell tumor. Additionally, the immunohistochemical staining revealed scattered positivity for gastrin, and then also positivity for insulin 14 months later. A subsequent hypoglycemic episode and elevated serum gastrin and insulin levels suggested that the disease had developed into a condition of multiple hormone secretion. The plasma gastrin and insulin levels decreased from 584 pg/ml and 90.8 microIU/ml to 49.1 pg/ml and 20.9 microIU/ml, respectively, 5 days after treatment with subcutaneous octreotide 100 micrograms every 6 to 8 hours. In addition, follow-up computed tomography showed shrinkage of the metastatic liver tumors. In conclusion, we found a case of malignant islet cell tumor with variable hormone secretion which could be effectively controlled with octreotide.

Factors related to the survival of papillary and follicular thyroid carcinoma patients with distant metastases

There is limited clinical information comparing presentations and results of treatment of papillary and follicular thyroid carcinoma patients with distant metastases. We retrospectively analyzed data of 1,257 thyroid cancer patients who received their treatment and follow-up at Chang Gung Memorial Hospital. We found 992 patients with papillary carcinoma and 205 patients with follicular thyroid carcinoma. Of these, 68 patients with papillary thyroid carcinoma (6.9%) had distant metastases at the time of diagnosis or during the follow-up period. Of the follicular thyroid carcinoma patients, 69 (33.7%) had distant metastases. Of the 68 patients with papillary carcinoma, only 33 were categorized as stage IV at the time of diagnosis. Nine of the patients were categorized as clinical stage I carcinoma, 10 as stage II, and 16 as stage III. Sixteen patients (23.5%) died during the study period, all but 2 of thyroid cancer. Twelve of the 68 patients were disease-free after treatment. Of the 69 patients with follicular thyroid carcinoma, 58 were categorized as stage IV at the time of diagnosis. Six of the patients were categorized as clinical stage I carcinoma, 2 as stage II, and 3 as stage III at the time of diagnosis; all of these patients deteriorated to stage IV during the follow-up period. Of the 42 patients with follicular thyroid carcinoma involving bone, 24 presented with bone metastases during the initial diagnosis. After treatment, 25 of 69 patients with follicular carcinoma died of follicular carcinoma. Only 3 patients were disease-free after the treatment. In patients with follicular carcinoma, only tumor size was an important prognostic factor. In this study, 8 patients categorized as clinical stages I to III at the time of operation had thyroglobulin (Tg) levels less than 5 ng/mL and developed distant metastases during the follow-up period. In conclusion, at diagnosis a large group of Asian patients with metastatic well-differentiated thyroid cancer was more likely to have follicular than papillary histology, and that, as expected, metastases from follicular cancer were present earlier and more frequently, were more likely to involve bone, were more likely to be associated with mortality, and were linked to tumor size but not gender. Also unlike some other reports, treatment producing a low Tg did not always produce a good outcome. More aggressive surgical procedures may be able to improve outcomes.

Diagnosis of papillary and follicular thyroid cancers

In general, thyroid cancer patients are usually presented with asymptomatic neck nodules. A differential diagnosis between malignant and benign thyroid disorder is very important for these patients. In the preoperative diagnosis, thyroid ultrasonography has been proven to be quite useful in the detection of thyroid lesions. There are two major reasons to perform thyroid ultrasonography before fine needle aspiration cytology (FNAC): to detect deep-seated small nodules, and to realize the nature of the clinically palpable nodules. Despite the limitations of aspiration cytology in the diagnosis of primary neoplasms, using this method can increase diagnostic accuracy to 92.89% in thyroid malignancy cases. Most thyroid malignancies can be diagnosed with FNAC, except for cases involving follicular thyroid cancer and Hürthle cell carcinoma. Although the serum thyroglobulin level has been used as a post-operative, well-differentiated thyroid cancer tumor marker, the assay cannot be used for preoperative diagnosis of thyroid carcinoma. Two dimensional gels electrophoresis has also been used as a diagnostic tool to elucidate tumor-specific proteins in the detection of well-differentiated thyroid cancers. The results of this technique need further investigation. In conclusion, and at the present time, FNAC is considered a useful tool in the pre-operative diagnosis of most thyroid cancers. For patients with follicular or Hürthle cell carcinomas, we need to develop further specific tumor markers for differentiating them between benign and malignant nodules.

Identification of familial hypercholesterolemia in Taiwan: report of eleven cases

BACKGROUND

Familial hypercholesterolemia is associated with a very high risk of premature coronary heart disease. In order to identify cases of familial hypercholesterolemia in Taiwan, we screened the hyperlipidemic patients in our metabolic clinics.

METHODS

Hyperlipidemic patients were screened in the metabolic outpatient department and the cases which fulfilled the clinical criteria of definitive or possible familial hypercholesterolemia were further analyzed. Their clinical characteristics, including age, gender, physical findings, past history of coronary heart disease or cerebrovascular accident (CVA), family history, and lipid profiles before and after medical treatment, were reviewed.

RESULTS

Eight women and 3 men fulfilled the diagnostic criteria. The mean age at diagnosis was 51.1 +/- 11.9 years old. Tendon xanthomas were found in 5 patients with definitive familial hypercholesterolemia. Coronary heart disease was confirmed in one patient and old CVA was noted in another 2 patients. The mean total cholesterol level was 390.3 +/- 88.9 mg/dl and the mean low density lipoprotein-cholesterol (LDL-cholesterol) level was 309.6 +/- 89.9 mg/dl before treatment. After a mean treatment duration of 45.2 months, the mean total cholesterol level and LDL-cholesterol level were 326.8 +/- 87.8 mg/dl and 249.1 +/- 91.1 mg/dl, respectively.

CONCLUSION

Clinically diagnosed familial hypercholesterolemia indeed exists in Taiwan. As compared to other reports, the mean age at diagnosis in our series was older and the majority of patients were women. Most patients were not vigorously treated and the family members were not thoroughly screened. Adequate treatment of patients with familial hypercholesterolemia in clinical practice and screening their family members are crucial in preventing new or recurrent coronary heart disease.