Deep Learning of Time-Signal Intensity Curves from Dynamic Susceptibility Contrast Imaging Enables Tissue Labeling and Prediction of Survival in Glioblastoma

BACKGROUND AND PURPOSE

An autoencoder can learn representative time-signal intensity patterns to provide tissue heterogeneity measures using dynamic susceptibility contrast MR imaging. The aim of this study was to investigate whether such an autoencoder-based pattern analysis could provide interpretable tissue labeling and prognostic value in isocitrate dehydrogenase (IDH) wild-type glioblastoma.

MATERIALS AND METHODS

Preoperative dynamic susceptibility contrast MR images were obtained from 272 patients with IDH wild-type glioblastoma (training and validation, 183 and 89 patients, respectively). The autoencoder was applied to the dynamic susceptibility contrast MR imaging time-signal intensity curves of tumor and peritumoral areas. Representative perfusion patterns were defined by voxelwise K-means clustering using autoencoder latent features. Perfusion patterns were labeled by comparing parameters with anatomic reference tissues for baseline, signal drop, and percentage recovery. In the validation set (n = 89), a survival model was created from representative patterns and clinical predictors using Cox proportional hazard regression analysis, and its performance was calculated using the Harrell C-index.

RESULTS

Eighty-nine patients were enrolled. Five representative perfusion patterns were used to characterize tissues as high angiogenic tumor, low angiogenic/cellular tumor, perinecrotic lesion, infiltrated edema, and vasogenic edema. Of these, the low angiogenic/cellular tumor (hazard ratio, 2.18; P = .047) and infiltrated edema patterns (hazard ratio, 1.88; P = .009) in peritumoral areas showed significant prognostic value. The combined perfusion patterns and clinical predictors (C-index, 0.72) improved prognostication when added to clinical predictors (C-index, 0.55).

CONCLUSIONS

The autoencoder perfusion pattern analysis enabled tissue characterization of peritumoral areas, providing heterogeneity and dynamic information that may provide useful prognostic information in IDH wild-type glioblastoma.

Development of Korean Version of PTSD Checklist for DSM-5 (K-PCL-5) and the Short Form (K-PCL-5-S)

OBJECTIVE

This study presents the reliability and validity of the Korean version of the post-traumatic stress disorder (PTSD) checklist for the Diagnostic and Statistical Manual for Mental Disorders-fifth edition (DSM-5) (K-PCL-5) and the short form (K-PCL-5-S).

METHODS

Seventy-one subjects with PTSD, 74 subjects with mood or anxiety disorders, and 99 healthy controls were enrolled. The Korean version of the Structured Clinical Interview for DSM-5-research version was used to confirm the presence of PTSD. The Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Impact of Event Scale-Revised (IES-R), and Spielberger State Trait Anxiety Inventory (STAI) were used to evaluate the concurrent validity of the K-PCL-5 and K-PCL-5-S.

RESULTS

It presented good internal consistency (Cronbach's α=0.93) and test-retest reliability (r=0.90). The K-PCL-5 and K-PCL-5-S were highly correlated with the BDI-II, BAI, IES-R, STAI-S, and STAI-T. The suggested cutoff score for PTSD was 33 for the K-PCL-5 with a sensitivity of 88.51 and specificity of 89.09, and 6 for the K-PCL-5-S with a sensitivity of 91.95 and specificity of 89.09. The data were best explained with a one-factor model.

CONCLUSION

These results demonstrated the good reliability and validity of the K-PCL-5 and K-PCL-5-S, and their suitability as simple tools for PTSD assessment.

A psychometric evaluation of the National Stressful Events Survey for PTSD-Short Scale (NSESSS-PTSD) among Korean psychiatric outpatients

The National Stressful Events Survey for PTSD-Short Scale (NSESSS-PTSD) is a brief screening measure for DSM-5 PTSD that has not been evaluated for its psychometric properties in clinical population. We developed a Korean version of the original English scale through translation-back translation process and examined its reliability and validity among treatment-seeking adults at a psychiatric outpatient unit of a university-affiliated hospital in South Korea. The sample comprised adults diagnosed with PTSD (n = 100) and other psychiatric disorders (n = 134). The NSESSS-PTSD, the PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI) were used to determine validity and reliability. The findings show modest test-retest reliability (r = .43), good internal consistency (Cronbach's α = .81), high convergent validity (r = .78) with PCL-5 and good concurrent validity with the BDI (r = .55) and BAI (r = .50), respectively. A cut-off score of 16 best predicted PTSD from other psychiatric disorders with specificity of .90 and sensitivity of .87. This study reveals sound psychometric properties of the Korean version of the NSESSS-PTSD and supports its use in the clinical population.

Vessel Type Determined by Vessel Architectural Imaging Improves Differentiation between Early Tumor Progression and Pseudoprogression in Glioblastoma

BACKGROUND AND PURPOSE

Currently available perfusion parameters are limited in differentiating early tumor progression and pseudoprogression with no insight about vessel size and type. We aimed to investigate differences in vessel size and type between early tumor progression and pseudoprogression in posttreatment glioblastoma and to demonstrate diagnostic performance using vessel architectural imaging.

MATERIALS AND METHODS

Fifty-eight patients with enlarging contrast-enhancing masses in posttreatment glioblastomas underwent simultaneous gradient recalled-echo and spin-echo dynamic susceptibility contrast imaging. Relative CBV and vessel architectural imaging parameters, including the relative vessel size index, peak shift between gradient recalled echo and spin-echo bolus signal peaks, and arterial dominance scores using spatial dominance of arterial/venous vessel type, were calculated and compared between the 2 conditions. The area under the curve and cross-validation were performed to compare the diagnostic performance of the relative CBV, vessel architectural imaging parameters, and their combinations.

RESULTS

There were 41 patients with early tumor progression and 17 patients with pseudoprogression. Relative to pseudoprogression, early tumor progression showed a lower peak shift (-0.02 versus 0.33, P = .02) and a lower arterial dominance score (1.46 versus 2.11, P = .001), indicating venous dominance. Patients with early tumor progression had higher relative CBV (1.88 versus 1.38, P = .02) and a tendency toward a larger relative vessel size index (99.67 versus 83.17, P = .15) than those with pseudoprogression. Combining arterial dominance scores and relative CBV showed significantly higher diagnostic performance (area under the curve = 0.82; 95% CI, 0.70-0.94; P = .02) than relative CBV alone (area under the curve = 0.64; 95% CI, 0.49-0.79) in distinguishing early tumor progression from pseudoprogression.

CONCLUSIONS

Vessel architectural imaging significantly improved the diagnostic performance of relative CBV by demonstrating venous dominance and a tendency toward larger vessel size in early tumor progression.

Development and Validation of a Deep Learning-Based Model to Distinguish Glioblastoma from Solitary Brain Metastasis Using Conventional MR Images

BACKGROUND AND PURPOSE

Differentiating glioblastoma from solitary brain metastasis preoperatively using conventional MR images is challenging. Deep learning models have shown promise in performing classification tasks. The diagnostic performance of a deep learning-based model in discriminating glioblastoma from solitary brain metastasis using preoperative conventional MR images was evaluated.

MATERIALS AND METHODS

Records of 598 patients with histologically confirmed glioblastoma or solitary brain metastasis at our institution between February 2006 and December 2017 were retrospectively reviewed. Preoperative contrast-enhanced T1WI and T2WI were preprocessed and roughly segmented with rectangular regions of interest. A deep neural network was trained and validated using MR images from 498 patients. The MR images of the remaining 100 were used as an internal test set. An additional 143 patients from another tertiary hospital were used as an external test set. The classifications of ResNet-50 and 2 neuroradiologists were compared for their accuracy, precision, recall, F1 score, and area under the curve.

RESULTS

The areas under the curve of ResNet-50 were 0.889 and 0.835 in the internal and external test sets, respectively. The area under the curve of neuroradiologists 1 and 2 were 0.889 and 0.768 in the internal test set and 0.857 and 0.708 in the external test set, respectively.

CONCLUSIONS

A deep learning-based model may be a supportive tool for preoperative discrimination between glioblastoma and solitary brain metastasis using conventional MR images.

Comparison of Dynamic Contrast-Enhancement Parameters between Gadobutrol and Gadoterate Meglumine in Posttreatment Glioma: A Prospective Intraindividual Study

BACKGROUND AND PURPOSE

Differences in molecular properties between one-molar and half-molar gadolinium-based contrast agents are thought to affect parameters obtained from dynamic contrast-enhanced imaging. The aim of our study was to investigate differences in dynamic contrast-enhanced parameters between one-molar nonionic gadobutrol and half-molar ionic gadoterate meglumine in patients with posttreatment glioma.

MATERIALS AND METHODS

This prospective study enrolled 32 patients who underwent 2 20-minute dynamic contrast-enhanced examinations, one with gadobutrol and one with gadoterate meglumine. The model-free parameter of area under the signal intensity curve from 30 to 1100 seconds and the Tofts model-based pharmacokinetic parameters were calculated and compared intraindividually using paired t tests. Patients were further divided into progression (n = 12) and stable (n = 20) groups, which were compared using Student t tests.

RESULTS

Gadobutrol and gadoterate meglumine did not show any significant differences in the area under the signal intensity curve or pharmacokinetic parameters of K ^trans, V_e, V_p, or K_ep (all P > .05). Gadobutrol showed a significantly higher mean wash-in rate (0.83 ± 0.64 versus 0.29 ± 0.63, P = .013) and a significantly lower mean washout rate (0.001 ± 0.0001 versus 0.002 ± 0.002, P = .02) than gadoterate meglumine. Trends toward higher area under the curve, K ^trans, V_e, V_p, wash-in, and washout rates and lower K_ep were observed in the progression group in comparison with the treatment-related-change group, regardless of the contrast agent used.

CONCLUSIONS

Model-free and pharmacokinetic parameters did not show any significant differences between the 2 gadolinium-based contrast agents, except for a higher wash-in rate with gadobutrol and a higher washout rate with gadoterate meglumine, supporting the interchangeable use of gadolinium-based contrast agents for dynamic contrast-enhanced imaging in patients with posttreatment glioma.

Determination of Medium Condition Effective to Cryopreservation of Primary Spermatogonial Stem Cells Derived from Porcine Neonatal Testes

BACKGROUND

The superior genetic resources of breeding pigs have been preserved for use through freezing the sperm or semen. However, because there is no way to collect their sperm or semen after depletion, the generation of sperm via the differentiation of porcine spermatogonial stem cells (SSCs) can be an alternative. To date, there have been no reports of techniques customized to in-vitro culture and differentiation into sperm in porcine SSCs. Accordingly, it is important to preserve porcine SSCs with outstanding genetic backgrounds until these technologies are developed. Unfortunately, a protocol for the long-term preservation of porcine SSCs has yet to be reported.

OBJECTIVE

We tried to develop a cryopreservation medium to preserve the characteristics of undifferentiated porcine SSCs for long-term cryopreservation.

MATERIALS AND METHODS

SSCs retrieved from porcine testes were freeze-cryopreserved in StemPro-34 medium supplemented with various concentrations of fetal bovine serum (FBS), dimethyl sulfoxide (DMSO), and trehalose; then, after 7 days, the viability and alkaline phosphatase (AP) activity was measured in thawed porcine SSCs. Additionally, we investigated the use of hypotaurine and/or glutathione as antioxidants in the optimized freezing medium for maintaining the viability and AP activity of porcine SSCs during the freezing-cryopreservation-thawing process.

RESULTS

Porcine SSCs frozen-cryopreserved-thawed in StemPro-34 medium supplemented with 10% (v/v) FBS, 10% (v/v) DMSO, 200 mM trehalose, 5 mM hypotaurine, and 5 mM glutathione showed the highest viability and AP activity.

CONCLUSION

We optimized a cryopreservation medium that inhibits the loss of viability and the increases differentiation post-thawing of the frozen porcine SSCs.

Reliability and Validity of the Korean Version of Clinician-Administered Posttraumatic Stress Disorder Scale for DSM-5

BACKGROUND

For diagnosis of post-traumatic stress disorder (PTSD), the Clinician-Administered PTSD Scale (CAPS) is one of the most widely used structured diagnostic interviews.

METHODS

In this study, we aimed to develop and validate the Korean version of CAPS for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition ([DSM-5] K-CAPS-5). Seventy-one subjects with PTSD, 74 with mood disorder or anxiety disorder, and 99 as healthy controls were enrolled. The Korean version of the structured clinical interview for DSM-5-research version was used to assess the convergent validity of K-CAPS-5. BDI-II, BAI, IES-R, and STAI was used to evaluate the concurrent validity.

RESULTS

All subjects completed various psychometric assessments including K-CAPS-5. K-CAPS-5 presented good internal consistency (Cronbach's α = 0.92) and test-retest reliability (r = 0.91). K-CAPS-5 showed strong correlations with the structured clinical interview for DSM-5 PTSD (k = 0.893). Among the three subject groups listed above there were significant differences in the K-CAPS-5 total score. The data were best explained by a six-factor model.

CONCLUSION

These results demonstrated the good reliability and validity of K-CAPS-5 and its suitability for use as a simple but structured instrument for PTSD assessment.

Differential effect of short-term popular diets on TMAO and other cardio-metabolic risk markers

BACKGROUND

Dietary nutrient intake and its metabolism by the gut microbiome have recently been implicated in cardiovascular disease (CVD) risk. In particular, trimethylamine N-oxide (TMAO), a metabolite of the gut microbiota, has been shown to be a predictor of incident CVD events. Elevated levels of branched-chain amino acids (BCAA) have also been associated with an increased propensity for insulin resistance.

METHODS

To study the association of dietary intake with systemic TMAO, its nutrient precursors, and BCAA levels on fasting plasma levels of TMAO and its nutrient precursors and BCAA, we conducted an exploratory post-hoc analysis of 3 popular diets - high fat (Atkins), Mediterranean (South Beach), and very low fat (Ornish) - using plasma samples from a prior randomized, crossover study, with each isocaloric dietary phase lasting 4 weeks. Metabolites were quantified using stable isotope dilution HPLC with on-line tandem mass spectrometry.

RESULTS

Compared to the low fat Ornish phase, the high fat Atkins dietary phase was characterized by increased levels of TMAO (3.3 vs. 1.8 μM, p = 0.01), and the BCAA valine (272.8 vs. 235.8 μM, p = 0.005) and leucine (105.9 vs. 96.4 μM, p = 0.01). The high fat Atkins dietary phase was also associated with higher levels of TMAO (3.3 vs 1.6 μM, p = 0.04), valine (272.8 vs. 240.7 μM, p = 0.004), and leucine (105.9 vs. 96.4 μM, p = 0.01) compared to baseline.

CONCLUSIONS

These data suggest that over a 4-week interval, a saturated fat diet that is predominantly animal-based, compared to an isocaloric, low fat, predominantly plant-based diet, is associated with heightened risk for cardiometabolic derangements, as monitored by a higher plasma levels of both TMAO and BCAA.

A Brief Screening Tool for PTSD: Validation of the Korean Version of the Primary Care PTSD Screen for DSM-5 (K-PC-PTSD-5)

The purpose of this study was to develop and evaluate psychometrically the Korean version of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual-fifth edition (K-PC-PTSD-5). In total, 252 participants were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual-fifth edition-research version (SCID-5-RV). The K-PC-PTSD-5 showed good internal consistency (α = 0.872), test-retest reliability (r = 0.89), and concurrent validity (r = 0.81). A score of 3 was identified as the threshold for clinically significant posttraumatic stress disorder (PTSD) symptoms. Overall, the results indicate that the K-PC-PTSD-5 is a useful, timesaving instrument for screening PTSD symptoms.

A Compressed-Sensing Based Blind Deconvolution Method for Image Deblurring in Dental Cone-Beam Computed Tomography

In cone-beam computed tomography (CBCT), reconstructed images are inherently degraded, restricting its image performance, due mainly to imperfections in the imaging process resulting from detector resolution, noise, X-ray tube's focal spot, and reconstruction procedure as well. Thus, the recovery of CBCT images from their degraded version is essential for improving image quality. In this study, we investigated a compressed-sensing (CS)-based blind deconvolution method to solve the blurring problem in CBCT where both the image to be recovered and the blur kernel (or point-spread function) of the imaging system are simultaneously recursively identified. We implemented the proposed algorithm and performed a systematic simulation and experiment to demonstrate the feasibility of using the algorithm for image deblurring in dental CBCT. In the experiment, we used a commercially available dental CBCT system that consisted of an X-ray tube, which was operated at 90 kV_p and 5 mA, and a CMOS flat-panel detector with a 200-μm pixel size. The image characteristics were quantitatively investigated in terms of the image intensity, the root-mean-square error, the contrast-to-noise ratio, and the noise power spectrum. The results indicate that our proposed method effectively reduced the image blur in dental CBCT, excluding repetitious measurement of the system's blur kernel.

Clinical Value of Vascular Permeability Estimates Using Dynamic Susceptibility Contrast MRI: Improved Diagnostic Performance in Distinguishing Hypervascular Primary CNS Lymphoma from Glioblastoma

BACKGROUND AND PURPOSE

A small subset of primary central nervous system lymphomas exhibits high cerebral blood volume, which is indistinguishable from that in glioblastoma on dynamic susceptibility contrast MR imaging. Our study aimed to test whether estimates of combined perfusion and vascular permeability metrics derived from DSC-MR imaging can improve the diagnostic performance in differentiating hypervascular primary central nervous system lymphoma from glioblastoma.

MATERIALS AND METHODS

A total of 119 patients (with 30 primary central nervous system lymphomas and 89 glioblastomas) exhibited hypervascular foci using the reference method of leakage-corrected CBV (reference-normalized CBV). An alternative postprocessing method used the tissue residue function to calculate vascular permeability (extraction fraction), leakage-corrected CBV, cerebral blood flow, and mean transit time. Parameters were compared using Mann-Whitney U tests, and the diagnostic performance to distinguish primary central nervous system lymphoma from glioblastoma was calculated using the area under the curve from the receiver operating characteristic curve and was cross-validated with bootstrapping.

RESULTS

Hypervascular primary central nervous system lymphoma showed similar leakage-corrected normalized CBV and leakage-corrected CBV compared with glioblastoma (P > .05); however, primary central nervous system lymphoma exhibited a significantly higher extraction fraction (P < .001) and CBF (P = .01) and shorter MTT (P < .001) than glioblastoma. The extraction fraction showed the highest diagnostic performance (the area under the receiver operating characteristic curve [AUC], 0.78; 95% confidence interval, 0.69-0.85) for distinguishing hypervascular primary central nervous system lymphoma from glioblastoma, with a significantly higher performance than both CBV (AUC, 0.53-0.59, largest P = .02) and CBF (AUC, 0.72) and MTT (AUC, 0.71).

CONCLUSIONS

Estimation of vascular permeability with DSC-MR imaging further characterizes hypervascular primary central nervous system lymphoma and improves diagnostic performance in glioblastoma differentiation.

Decision Making Regarding Key Elements of Korean Disaster Psychiatric Assistance Teams Using the Analytic Hierarchy Process

OBJECTIVE

The purpose of this study was to determine the key components of Korean disaster psychiatric assistant teams (K-DPATs), to set up new mental health service providing system for the disaster victims.

METHODS

We conducted an analytic hierarchy process (AHP) involving disaster mental health experts, using a pairwise comparison questionnaire to compare the relative importance of the key components of the Korean disaster mental health response system. In total, 41 experts completed the first online survey; of these, 36 completed the second survey. Ten experts participated in panel meetings and discussed the results of the survey and AHP process.

RESULTS

It was agreed that K-DPATs should be independent of the existing mental health system (70.1%), funding for K-DPATs should be provided by the Ministry of Public Safety, and the system should be managed by the Ministry of Health (65.8%). Experts shared the view that K-DPAT leaders would be suitable key decision makers for all types of disaster, with the exception of those involving infectious diseases.

CONCLUSION

K-DPAT, a new model for disaster mental health response systems could improve the insufficiency of the current system, address problems such as fragmentation, and fulfill disaster victims' unmet need for early professional intervention.

Heart rate variability of chronic posttraumatic stress disorder in the Korean veterans

Patients with post-traumatic stress disorder (PTSD) have lower heart rate variability (HRV) than the general population, but findings in this area have been inconsistent. This study was conducted to investigate the characteristics of HRV in patients with PTSD and to evaluate associations between PTSD symptoms and HRV indices. Sixty-eight patients with PTSD and 73 controls without PTSD were evaluated. HRV was measured in all subjects after they completed self-reported questionnaires. Patients with PTSD had significantly more depressed moods, anxiety, and poorer sleep quality than individuals in the non-PTSD group. Standard deviations of NN intervals (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD), and log high-frequency (LNHF) were significantly lower in the PTSD group than in the non-PTSD group. Comparisons of HRV indices among four sub-groups according to presence/absence of PTSD and experiences of combat-related or other trauma indicated that individuals in the PTSD group who had experienced combat-related trauma had the lowest HRV indices. These indices included SDNN, RMSSD, and LNHF. Further, SDNN, RMSSD, and HF power were significantly associated with symptoms of hyperarousal. HRV measures might be useful physiological parameters in assessing and monitoring sympathovagal function in patients with PTSD.

Improved Diagnostic Accuracy Using Arterial Phase CT for Lateral Cervical Lymph Node Metastasis from Papillary Thyroid Cancer

BACKGROUND AND PURPOSE

Contrast-enhanced CT protocols for papillary thyroid cancer are yet to be optimized. Our aim was to compare the diagnostic accuracy of arterial phase CT and delayed-phase CT protocols for lateral cervical lymph node metastasis from papillary thyroid carcinoma by using the lymph node tissue attenuation.

MATERIALS AND METHODS

This retrospective study included 327 lateral cervical lymph nodes (177 metastatic and 150 benign) from 131 patients with papillary thyroid carcinoma (107 initially diagnosed and 24 recurrences). Patients underwent CT by using 1 of 3 protocols: a 70-second (A) or a 35-second (B) delay with 100 mL of iodinated IV contrast or a 25-second delay with 75 mL of IV contrast (C). Two readers independently measured and compared lymph node tissue attenuation between metastatic and benign lymph nodes. An area under the receiver operating characteristic curve analysis was performed to differentiate metastatic and benign lymph nodes after multiple comparison correction for clustered data and was compared across the protocols.

RESULTS

The difference in mean lymph node tissue attenuation between metastatic and benign lymph nodes was maximum in protocol C (P < .001 for both readers). Protocol C showed the highest diagnostic performance (area under the receiver operating characteristic curve, 0.88-0.92) compared with protocol A (area under the receiver operating characteristic curve, 0.73-0.74, P < .001 for both readers) and B (area under the receiver operating characteristic curve, .63-0.65, P < .01 for both readers). The sensitivity, specificity, positive predictive value, and negative predictive value of lymph node tissue attenuation by using a 99-HU cutoff value were 83%-87%, 93.7%-97.9%, 95.1%-97.3%, and 81.2%-87%.

CONCLUSIONS

A combination of 25-second delay CT and 75 mL of iodinated IV contrast can improve the diagnostic accuracy for lateral lymph node metastasis from papillary thyroid carcinoma compared with a combination of a 35- or 70-second delay with 100-mL of iodinated IV contrast.

Comparison of 3 Different Types of Spinal Arteriovenous Shunts below the Conus in Clinical Presentation, Radiologic Findings, and Outcomes

BACKGROUND AND PURPOSE

Spinal arteriovenous shunts below the conus constitute 3 types of lesions, which have previously been mainly described in case reports, given their rarity, and are sometimes misdiagnosed. The purpose of this study was to describe the features of each type and compare these types as to epidemiologic features, clinical and radiologic presentations, treatment, and outcomes in a consecutive series of 48 cases.

MATERIALS AND METHODS

The prospectively collected data bases of 2 referral centers for spinal vascular lesions were retrospectively reviewed. Spinal arteriovenous shunts below the conus were defined as all dural and intradural shunts below the conus medullaris. Clinical features, radiologic findings, treatment results, and clinical outcomes were assessed.

RESULTS

There were filum terminale arteriovenous fistulas in 11 patients (22.9%), radicular arteriovenous shunts in 7 patients (14.6%), and spinal dural arteriovenous fistulas in 30 patients (62.5%). Radicular arteriovenous shunts presented at a younger age (P = .017) and with a higher incidence of back pain symptoms (P = .037). A tethered spinal cord was found in 54.5% of patients with filum terminale arteriovenous fistulas and 23.3% of patients with spinal dural arteriovenous fistulas. After treatment, the angiographic complete obliteration rate was 89.4% and spinal function was improved significantly (P < .001).

CONCLUSIONS

Three groups of spinal arteriovenous shunts below the conus can be differentiated according to clinical and radiologic features. Filum terminale arteriovenous fistulas are frequently associated with dysraphic malformations, which may suggest a particular embryologic origin.

Blonanserin Augmentation of Atypical Antipsychotics in Patients with Schizophrenia-Who Benefits from Blonanserin Augmentation?: An Open-Label, Prospective, Multicenter Study

OBJECTIVE

The purpose of this study was to investigate the efficacy and tolerability of atypical antipsychotics (AAPs) with augmentation by blonanserin in schizophrenic patients.

METHODS

aA total of 100 patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP were recruited in this 12-week, open-label, non-comparative, multicenter study. Blonanserin was added to their existing AAP regimen, which was maintained during the study period. Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at weeks 2, 4, 8, and 12. Predictors for PANSS response (≥20% reduction) were investigated.

RESULTS

The PANSS total score was significantly decreased at 12 weeks of blonanserin augmentation (-21.0±18.1, F=105.849, p<0.001). Moreover, 51.0% of participants experienced a response at week 12. Premature discontinuation of blonanserin occurred in 17 patients (17.0%); 4 of these patients dropped out due to adverse events. The patients who benefited the most from blonanserin were those with severe symptoms despite a treatment with a higher dose of AAP.

CONCLUSION

Blonanserin augmentation could be an effective strategy for patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP.

Reliability and Validity of the Korean Version of the Symptom Checklist-Post-Traumatic Stress Disorder Scale

The Symptom Checklist - Post-Traumatic Stress Disorder Scale (SCL-PTSD), also known as Crime-Related PTSD Scale has been validated in survivors of interpersonal trauma in the general population. However, the psychometric properties have not been investigated in a clinical setting for patients with PTSD from diverse traumatic events. This study investigates the reliability and validity of the Korean version of the SCL-PTSD among 104 psychiatric outpatients with PTSD, caused by interpersonal (n = 50) or non-interpersonal trauma (n = 54). Self-report data of the SCL-PTSD, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Impact of Events Scale-Revised (IES-R) were gathered. The Korean version of the SCL-PTSD showed excellent internal consistency and moderate-to-good four-week temporal stability in both the interpersonal and non-interpersonal trauma groups. In comparison with other diagnostic groups, the scores of the SCL-PTSD were significantly higher compared to those of adjustment disorder, depression, other anxiety disorders, and schizophrenia, demonstrating its criteria-related validity. Convergent validity was confirmed because the scores of the SCL-PTSD were significantly correlated with BDI, SAI and TAI scores. Concurrent validity was demonstrated by significant correlation with the IES-R score. This study demonstrated the favorable psychometric prosperities of the Korean version of the SCL-PTSD, supporting its use in clinical research and practice.

B7-H1 inhibits T cell proliferation through MHC class II in human mesenchymal stem cells

B7-H1 on mesenchymal stem cells (MSCs) is known to modulate immune response. However, its expression pattern and exact immunomodulatory mechanism are unclear. In this study, we examined the immunomodulatory mechanism through the expression pattern of B7-H1 and major histocompatibility complex class II in various MSCs. Human bone marrow, adipose tissue, and cord blood MSCs were isolated and cultured. B7-H1, HLA-ABC, and HLA-DR expression on MSCs by interferon-γ (IFN-γ) was detected time-dependently by flow cytometry. The inhibitory effect of MSCs on T lymphocytes was observed in phytohemagglutinin antigen-induced T cell proliferation assay. The expression of B7-H1 was rapidly induced, but the expression of HLA-DR was induced at 48 hours after IFN-γ treatment. The inhibitory effect of MSCs on T cell proliferation could be restored when the anti-B7-H1 monoclonal antibody was used to block the B7-H1, or when the HLA-DRα small interfering RNA was used to interfere with its expression. These results show that MSCs could inhibit the T cell proliferation and activation by B7-H1 depending on the presence of HLA-DR. Therefore, MSCs would have a strong effect on immune diseases such as graft-versus-host disease and autoimmune diseases when MSCs are primed with IFN-γ 48 hours before transplantation.

Cell cycle-dependent Cdc25C phosphatase determines cell survival by regulating apoptosis signal-regulating kinase 1

Cdc25C (cell division cycle 25C) phosphatase triggers entry into mitosis in the cell cycle by dephosphorylating cyclin B-Cdk1. Cdc25C exhibits basal phosphatase activity during interphase and then becomes activated at the G2/M transition after hyperphosphorylation on multiple sites and dissociation from 14-3-3. Although the role of Cdc25C in mitosis has been extensively studied, its function in interphase remains elusive. Here, we show that during interphase Cdc25C suppresses apoptosis signal-regulating kinase 1 (ASK1), a member of mitogen-activated protein (MAP) kinase kinase kinase family that mediates apoptosis. Cdc25C phosphatase dephosphorylates phospho-Thr-838 in the activation loop of ASK1 in vitro and in interphase cells. In addition, knockdown of Cdc25C increases the activity of ASK1 and ASK1 downstream targets in interphase cells, and overexpression of Cdc25C inhibits ASK1-mediated apoptosis, suggesting that Cdc25C binds to and negatively regulates ASK1. Furthermore, we showed that ASK1 kinase activity correlated with Cdc25C activation during mitotic arrest and enhanced ASK1 activity in the presence of activated Cdc25C resulted from the weak association between ASK1 and Cdc25C. In cells synchronized in mitosis following nocodazole treatment, phosphorylation of Thr-838 in the activation loop of ASK1 increased. Compared with hypophosphorylated Cdc25C, which exhibited basal phosphatase activity in interphase, hyperphosphorylated Cdc25C exhibited enhanced phosphatase activity during mitotic arrest, but had significantly reduced affinity to ASK1, suggesting that enhanced ASK1 activity in mitosis was due to reduced binding of hyperphosphorylated Cdc25C to ASK1. These findings suggest that Cdc25C negatively regulates proapoptotic ASK1 in a cell cycle-dependent manner and may play a role in G2/M checkpoint-mediated apoptosis.

The predictors for continuous renal replacement therapy in liver transplant recipients

BACKGROUND

Acute renal failure (ARF) after liver transplantation requiring continuous renal replacement therapy (CRRT) adversely affects patient survival. We suggested that postoperative renal failure can be predicted if a clinically simple nomogram can be developed, thus selecting potential risk factors for preventive strategy.

METHODS

We retrospectively reviewed the medical records of 153 liver transplant recipients from January 2008 to December 2011 at Severance Hospital, Yonsei University Health System, in Seoul, Korea. There were 42 patients treated with CRRT (20 and 22 patients received transplants from living and deceased donors, respectively) and 115 were not. Univariate and stepwise logistic multivariate analyses were performed. A clinical nomogram to predict postoperative CRRT application was constructed and validated internally.

RESULTS

Hepatic encephalopathy (HEP; odds ratio OR, 5.47), deceased donor liver donations (OR, 3.47), Model for End-Stage Liver Disease (MELD) score (OR, 1.09), intraoperative blood loss (L; OR, 1.16), and tumor (hepatocellular carcinoma) as the indication for liver transplantation (OR, 0.11) were identified as independent predictive factors for postoperative CRRT on multivariate analysis. A clinical prediction model constructed for calculating the probability of CRRT post-transplantation was 1.7000 × HEP + [-4.5427 + 1.2440 × (deceased donor) + 0.0830 × (MELD score) + 0.000149 × the amount of intraoperative bleeding (L) - 2.1785 × tumor]. The validation set discriminated well with an area under the curve (AUC) of 0.90 (95% confidence interval, 0.85-0.95). The predicted and the actual probabilities were calibrated with the clinical nomogram.

CONCLUSIONS

We developed a predictive model of postoperative CRRT in liver transplantation patients. Perioperative strategies to modify these factors are needed.

Comparison of serum neutralization and enzyme-linked immunosorbent assay on sera from porcine epidemic diarrhea virus vaccinated pigs

BACKGROUND

Porcine epidemic diarrhea virus (PEDV) is an economically important pathogen of swine.

OBJECTIVE

Serum neutralization (SN) and enzyme-linked immunosorbent assay (ELISA) test results as well as the utility of spike proteins S1, S2, and S3 and entire nucleocapsid protein were compared.

ANIMALS AND METHODS

Serum samples from 400 pigs vaccinated against PEDV strain SM98P were collected from 78 farms in Korea. SN test and ELISA were performed to confirm the presence of antibodies. For prokaryotic expression of partial fragments of spike protein the size and location of S1, S2, and S3, and full nucleocapsid protein, polymerase chain reaction was performed using specific primers.

RESULTS

Comparison of these results demonstrated that there was a correlation between the SN and ELISA results. Sera with higher neutralizing activity also had higher IgG titer. The antibody profiling data presented the correlation of neutralizing activity with the level of spike protein antibody. In particular, the S3 region may have an important role in neutralizing activity.

CONCLUSIONS

We confirmed that the carboxy-terminal region that includes the endodomain of the S protein induced stronger neutralizing activity than the region that includes the ectodomain.

CLINICAL RELEVANCE

The region of the S protein may have a stronger neutralizing KPEDV-9 epitope and could be useful for the evaluation of future PEDV vaccine efficacy.

Evaluation of antibody response of killed and live vaccines against porcine epidemic diarrhea virus in a field study

BACKGROUND

Porcine epidemic diarrhea virus (PEDV) is an infectious, highly contagious virus, and is an etiological agent of acute entero-pathogenic diarrhea in swine.

OBJECTIVES

Evaluation of the antibody response of two types of PEDV vaccines is to be carried out.

ANIMALS AND METHODS

Sows were vaccinated with either live or killed commercial PEDV SM98 (GenBank: GU937797.1) vaccines. Four different groups of sows with five sows in each group were used in this study: the unvaccinated negative control group, the killed virus vaccination group with killed virus boosting (K/K), the live virus vaccinated group with live virus boosting (L/L), and the combination group vaccinated with live virus and subsequently boosted with killed vaccine (L/K). Sows were vaccinated intramuscularly twice at four and two weeks prior to farrowing with 2ml/head vaccine dose. Antibody titers in sow and piglet serum one week after farrowing and that in colostrum were compared by enzyme-linked immunosorbent assay (ELISA) and serum neutralization test.

RESULTS

Vaccination with K/K vaccine induced the highest level of IgG and IgA in sow serum, colostrum, and especially in piglet serum, with the lowest levels found in the L/L group. The major neutralizing activity was also found in the K/K group, particularly in colostrum, with piglets bearing higher neutralizing activity compared to sow sera. Among recombinant spike S1, S2, S3, and nucleocapsid N protein of PEDV, S3 protein presented the highest antibody level in the K/K group.

CONCLUSION

Killed PEDV SM98 vaccine induced higher antibody levels.

CLINICAL IMPORTANCE

This study clearly confirms that killed vaccine has induced higher antibody levels and may contribute to the design of future research and vaccine programs.

Efficacy and safety of micafungin for the prophylaxis of invasive fungal infection during neutropenia in children and adolescents undergoing allogeneic hematopoietic SCT

The objective of this study was to evaluate the efficacy and safety of micafungin for the prevention of invasive fungal infection (IFI) during the neutropenic phase of allogeneic hematopoietic SCT (allo-HSCT) in children and adolescents. This was a prospective, multicenter, open-label, single-arm study. Micafungin was administered i.v. at a dose of 1 mg/kg/day (max 50 mg) from the beginning of conditioning until neutrophil engraftment. Treatment success was defined as the absence of proven, probable, possible or suspected IFI through to 4 weeks after therapy. From April 2010 to December 2011, 155 patients were enrolled from 11 institutions in Korea, and 147 patients were analyzed. Of the 147 patients, 121 (82.3%) completed the protocol without premature interruption. Of the 132 patients in whom micafungin efficacy could be evaluated, treatment success was achieved in 119 patients (90.2%). There was no proven fungal infection in any patient. The number of patients with probable, possible and suspected IFI was two, two and nine, respectively. Thirty-five patients (23.8%) experienced 109 adverse events (AEs) possibly related to micafungin. No patients experienced grade IV AEs. Two patients (1.4%) discontinued micafungin administration due to adverse effects. None of the deaths were related to the study drug.

Increased NFAT5 expression stimulates transcription of Hsp70 in preeclamptic placentas

OBJECTIVE

We investigated the expression of heat shock protein 70 (Hsp70), nuclear factor of activated T cells 5 (NFAT5), and hypoxia-induced factor-1α (HIF-1α) in the placentas of normal and preeclamptic pregnancies and in human placental hypoxia models in vitro to examine the regulatory mechanisms of placental Hsp70 expression.

METHODS

The expression levels of HIF-1α, NFAT5, and Hsp70 were examined in placental samples from 10 females with preeclampsia and 10 normotensive control patients and in human choriocarcinoma trophoblast cells treated with 1 mM CoCl2 by western blotting. Using models of placental hypoxia, pharmacological inhibition of HIF-1α with chetomin and shRNA knockdown and overexpression of NFAT5 were performed to investigate the roles of HIF-1α and NFAT5 in induction of Hsp70 by placental hypoxia.

RESULTS

The levels of HIF-1α, NFAT5, and Hsp70 expression were significantly higher in the preeclamptic compared to normal placentas. In the placental hypoxia models, the expression of HIF-1α, NFAT5, and Hsp70 were significantly higher after 3, 6, and 12 h of 1 mM CoCl2 treatment, respectively. Pharmacological inhibition of HIF-1α suppressed the induction of NFAT5 and Hsp70 at the protein level. shRNA knockdown of NFAT5 suppressed the induction of Hsp70 protein and overexpression of NFAT5 stimulated the induction of Hsp70 mRNA and protein in models of human placental hypoxia in vitro.

CONCLUSION

HIF-1α positively regulates the induction of NFAT5 and Hsp70 by placental hypoxia and NFAT5 stimulates transcription of Hsp70 in response to placental hypoxia in models of human placental hypoxia in vitro.

Cystatin SN neutralizes the inhibitory effect of cystatin C on cathepsin B activity

Cystatin SN (CST1) is one of the several salivary cystatins that form tight equimolar complexes with cysteine proteases, such as the cathepsins. High expression of CST1 is correlated with advanced pTNM stage in gastric cancer. However, the functional role of CST1 in tumorigenesis has not been elucidated. In this study, we showed that CST1 was highly expressed in colon tumor tissues, compared with nontumor regions. Increased cell proliferation and invasiveness were observed in HCT116 cell lines stably transfected with CST1 cDNA (HCT116-CST1) but not in CST3-transfected cells. We also demonstrated that CST1-overexpressing cell lines exhibited increased tumor growth as well as metastasis in a xenograft nude mouse model. Interestingly, CST1 interacted with cystatin C (CST3), a potent cathepsin B (CTSB) inhibitor, with a higher affinity than the interaction between CST3 and CTSB in the extracellular space of HCT116 cells. CTSB-mediated cellular invasiveness and proteolytic activities were strongly inhibited by CST3, but in the presence of CST1 CTSB activities recovered significantly. Furthermore, domain mapping of CST1 showed that the disulfide-bonded conformation, or conserved folding, of CST1 is important for its secretion and for the neutralization of CST3 activity. These results suggest that CST1 upregulation might be involved in colorectal tumorigenesis and acts by neutralizing the inhibition of CTSB proteolytic activity by CST3.

Genome-wide association study of body mass index in 23 000 individuals with and without asthma

BACKGROUND

Both asthma and obesity are complex disorders that are influenced by environmental and genetic factors. Shared genetic factors between asthma and obesity have been proposed to partly explain epidemiological findings of co-morbidity between these conditions.

OBJECTIVE

To identify genetic variants that are associated with body mass index (BMI) in asthmatic children and adults, and to evaluate if there are differences between the genetics of BMI in asthmatics and healthy individuals.

METHODS

In total, 19 studies contributed with genome-wide analysis study (GWAS) data from more than 23 000 individuals with predominantly European descent, of whom 8165 are asthmatics.

RESULTS

We report associations between several DENND1B variants (P = 2.2 × 10(-7) for rs4915551) on chromosome 1q31 and BMI from a meta-analysis of GWAS data using 2691 asthmatic children (screening data). The top DENND1B single nucleotide polymorphisms(SNPs) were next evaluated in seven independent replication data sets comprising 2014 asthmatics, and rs4915551 was nominally replicated (P < 0.05) in two of the seven studies and of borderline significance in one (P = 0.059). However, strong evidence of effect heterogeneity was observed and overall, the association between rs4915551 and BMI was not significant in the total replication data set, P = 0.71. Using a random effects model, BMI was overall estimated to increase by 0.30 kg/m(2) (P = 0.01 for combined screening and replication data sets, N = 4705) per additional G allele of this DENND1BSNP. FTO was confirmed as an important gene for adult and childhood BMI regardless of asthma status.

CONCLUSIONS AND CLINICAL RELEVANCE

DENND1B was recently identified as an asthma susceptibility gene in a GWAS on children, and here, we find evidence that DENND1B variants may also be associated with BMI in asthmatic children. However, the association was overall not replicated in the independent data sets and the heterogeneous effect of DENND1B points to complex associations with the studied diseases that deserve further study.

Species-specific challenges in dog cloning

Somatic cell nuclear transfer (SCNT) is now an established procedure used in cloning of several species. SCNT in dogs involves multiple steps including the removal of the nuclear material, injection of a donor cell, fusion, activation of the reconstructed oocytes and finally transfer to a synchronized female recipient. There are therefore many factors that contribute to cloning efficiency. By performing a retrospective analysis of 2005-2012 published papers regarding dog cloning, we define the optimum procedure and summarize the specific feature for dog cloning.

Influence of serum leptin levels on future overweight risk in Korean children

BACKGROUND AND AIMS

Leptin is an important regulator of energy metabolism. It is considered to be positively related to body adiposity and metabolic disorders in obese adults and children. The purpose of this study was to evaluate the relationship between baseline circulating leptin, insulin and adiponectin levels and future overweight and metabolic risks in a paediatric population-based cohort.

METHODS AND RESULTS

First-grade students, who entered elementary school at age 7 years in Gwacheon, a Korean city, were enrolled in this cohort study, and followed from 1st grade to 5th grade. Annual physical examinations from 2005 to 2009 were performed. In 2006, the levels of serum glucose, insulin, leptin and adiponectin and lipid profiles were examined. In 2008, the above parameters, except for adiponectin, were measured again in 381 children (202 boys and 179 girls) who participated. In 2006, 10.2% of the children were overweight (body mass index (BMI) ≥ 85th percentile), and after 2 years, an additional 3% became overweight. Compared with insulin and adiponectin, leptin was most highly associated with current and future BMI, and percent body fat. Boys in the highest tertile for initial leptin (T3) showed the highest prevalence of overweight and metabolic risk scores among three leptin tertile groups. Girls showed the same trends as boys. High initial leptin levels could be predictive of greater future BMI and metabolic risk score (p < 0.001).

CONCLUSION

These results suggest that elevated serum leptin concentrations among the childhood population could be a marker for future BMI and metabolic disorders.

Cystic fibrosis modifier genes related to Pseudomonas aeruginosa infection

Cystic fibrosis (CF) is one of the most common life-shortening genetic disorders, and the CF transmembrane conductance regulator (CFTR) is the major causal gene. However, a substantial clinical variability among patients with identical CFTR genotypes suggests the presence of modifier genes. We tested the effect of four genes involved in Pseudomonas aeruginosa infection. Analysis of a primary cohort detected eight candidate polymorphisms that were genotyped in the secondary cohort of 1579 patients; lung function and age at first infection with P. aeruginosa were considered as the phenotypes. Both additive and codominant models were considered, adjusting for confounding variables but not for multiple comparisons. In the secondary cohort, heme oxygenase-1 (HMOX1) rs2071749 had the most significant effect on lung function in the pediatric group (P=0.01; P(corrected)=0.03), and complement factor 3 (C3) rs11569393 and HMOX1 rs2071746 in the adult groups (P=0.03 for both variants; P(corrected)=0.16, 0.09). No polymorphism of complement factor B (CFB) or toll-like receptor 4 (TLR4) had a significant modifying effect on lung function in either group. We have identified two genes that showed nominal association with disease severity among CF patients. However, because of the multiple comparisons made, further studies are required to confirm the interaction between these modifying genes and CFTR.

Influence of oocyte donor and embryo recipient conditions on cloning efficiency in dogs

To determine factors that affect the efficiency of dog cloning by somatic cell nuclear transfer, the present study was performed to investigate 1) the effects of surgical history (non-operated/operated) and parity (nullipara/multipara) on the recovery of in vivo canine oocytes; 2) the effects of surgical history and parity of recipients on the pregnancy and delivery; and 3) the effects of synchronization state (AA, advanced asynchrony; SY, synchrony; RA, retarded asynchrony) between oocytes donor and recipient on the pregnancy and delivery. Oocyte recovery rate was significantly higher in non-operated dogs compared to operated dogs (93.8 vs. 89.6%, P < 0.05) and not different between nulliparous dogs and multiparous dogs. Delivery rate was also significantly higher in non-operated dogs compared to operated dogs (2.8 vs. 1.0%, P < 0.05) and in nulliparous dogs than multiparous dogs (3.0 vs. 1.7%, P < 0.05). Even though SY showed increased pregnancy and delivery rate (20.0% and 3.0%) compared to AA (15.0% and 2.0%) and RA (0.0% and 0.0%), there was no significant difference. In conclusion, we recommend non-operated dogs as experimental dogs and nulliparous dogs as recipient dogs to increase delivery rate after transfer of somatic cell nuclear transferred embryos, but further study is needed to find out appropriate synchrony status at the transfer.

Complete genome sequence of a newly isolated lytic bacteriophage, EFAP-1 of Enterococcus faecalis, and antibacterial activity of its endolysin EFAL-1

AIMS

In this work, we aimed to identify an effective treatment of infections caused by Enterococcus spp. strains resistant to conventional antibiotics.

METHODS AND RESULTS

We report the isolation and characterization of a new lytic bacteriophage, designated bacteriophage EFAP-1, that is capable of lysing Enterococcus faecalis bacteria that exhibit resistance to multiple antibiotics. EFAP-1 has low sequence similarity to all known bacteriophages. Transmission electron microscopy confirmed that EFAP-1 belongs to the Siphoviridae family. A putative lytic protein of EFAP-1, endolysin EFAL-1, is encoded in ORF 2 and was expressed in Escherichia coli. Recombinant EFAL-1 had broad-spectrum lytic activity against several Gram-positive pathogens, including Ent. faecalis and Enterococcus faecium.

CONCLUSIONS

The complete genome sequence of the newly isolated enterococcal lytic phage was analysed, and it was demonstrated that its recombinant endolysin had broad lytic activity against various Gram-positive pathogens.

SIGNIFICANCE AND IMPACT OF THE STUDY

Bacteriophage EFAP-1 and its lytic protein, EFAL-1, can be utilized as potent antimicrobial agents against Enterococcus spp. strains resistant to conventional antibiotics in hospital infections and also as environmental disinfectants to control disease-causing Enterococcus spp. in dairy farms.

Effects of activin A on the in vitro development and mRNA expression of bovine embryos cultured in chemically-defined two-step culture medium

The purpose of the present study was to evaluate the effects of activin A on the developmental competence of in vitro fertilized (IVF) bovine embryos derived from a two-step defined culture system (C1/C2 medium) during the early or later stages of embryo development. To evaluate the effects of activin A on transcriptional levels, we analysed genes related to blastocyst hatching and implantation and to activin signalling pathway in IVF embryos. Cumulus-oocyte complexes were matured for 22 h and fertilized in vitro. Presumptive zygotes were cultured in the presence or absence of activin A during early (0-120 h, C1) or later (120-192 h, C2) stages. Although the developmental competence of embryos cultured with activin A in C1 medium was not significantly different from their corresponding controls, development to blastocysts (22.4% vs 34.7%; p < 0.05) and the blastocyst hatching rate (9.3% vs 22.4%; p < 0.05) in C2 medium supplemented with 100 ng/ml activin A were significantly higher than in the control group. To evaluate the effect of activin A on transcription, the relative expression levels of genes related to blastocyst hatching and implantation (Na/K-ATPase, E-cad and Glut-1) as well as activin signalling pathway (ActRII, ActRIIB and Smad2) were analysed. Compared to control medium, gene expression of Na/K-ATPase, E-cad, Glut-1, ActRII and ActRIIB was increased in medium supplemented with activin A. In conclusion, this study suggests that activin A, during the later stage of in vitro bovine embryo development, can enhance in vitro development of embryos by increasing hatching rates and affecting expression levels of genes related to hatching and implantation in defined culture medium.

Improvement of canine somatic cell nuclear transfer procedure

The purpose of the present study on canine somatic cell nuclear transfer (SCNT) was to evaluate the effects of fusion strength, type of activation, culture media and site of transfer on developmental potential of SCNT embryos. We also examined the potential of enucleated bovine oocytes to serve as cytoplast recipients of canine somatic cells. Firstly, we evaluated the morphological characteristics of in vivo-matured canine oocytes collected by retrograde flushing of the oviducts 72 h after ovulation. Secondly, the effectiveness of three electrical strengths (1.8, 2.3 and 3.3 kV/cm), used twice for 20 micros, on fusion of canine cytoplasts with somatic cells were compared. Then, we compared: (1) chemical versus electrical activation (a) after parthenogenetic activation or (b) after reconstruction of canine oocytes with somatic cells; (2) culture of resulting intergeneric (IG) embryos in either (a) mSOF or (b) TCM-199. The exposure time to 6-DMAP was standardized by using bovine oocytes reconstructed with canine somatic cells. Bovine oocytes were used for SCNT after a 22 h in vitro maturation interval. The fusion rate was significantly higher in the 3.3 kV/cm group than in the 1.8 and 2.3 kV/cm treatment groups. After parthenogenesis or SCNT with chemical activation, 3.4 and 5.8%, respectively, of the embryos developed to the morula stage, as compared to none of the embryos produced using electrical activation. Later developmental stages (8-16 cells) were transferred to the uterine horn of eight recipients, but no pregnancy was detected. However, IG cloned embryos (bovine cytoplast/canine somatic cell) were capable of in vitro blastocyst development. In vitro developmental competence of IG cloned embryos was improved after exposure to 6-DMAP for 4 h as compared to 0, 2 or 6h exposure, although the increase was not significantly different among culture media. In summary, for production of canine SCNT embryos, we recommend fusion at 3.3 kV/cm, chemical activation, culture in mSOF medium and transfer of presumptive zygotes to the oviduct of recipient animals. The feasibility of IG production of cloned canine embryos using bovine cytoplasts as recipient of canine somatic cells was demonstrated.

G1 to S phase transition protein 1 induces apoptosis signal-regulating kinase 1 activation by dissociating 14-3-3 from ASK1

Apoptosis signal-regulating kinase 1 (ASK1), a member of the mitogen-activated protein kinase kinase kinase family, plays a critical role in mediating apoptosis signals initiated by a variety of death stimuli such as hydrogen peroxide and tumor necrosis factor-alpha. Owing to its critical role in inducing apoptosis, the activity of ASK1 is tightly regulated by various mechanisms such as post-translational modifications and protein-protein interactions. Here we describe the identification of G(1) to S phase transition protein 1 (GSPT1), which is associated with protein translation, as a regulator of ASK1. GSPT1 interacts with ASK1 and enhances ASK1-induced apoptotic activity through the activation of caspase-3. In vitro kinase assay data show that GSPT1 enhances ASK1 autophosphorylation and its kinase activity. Cell cycle-dependent GSPT1 induction and small interfering RNA analyses show that ASK1 autophosphorylation is dependent on the expression level of endogenous GSPT1 in cells. GSPT1 inhibits the binding of ASK1 to the 14-3-3 protein, an ASK1 inhibitor, while GSPT1 has no effect on the interaction between ASK1 and TRAF2, a C-terminal-binding activator of ASK1. Thus, our results reveal a novel role of GSPT1 in the regulation of ASK1-mediated apoptosis.

Efficacy and safety of abciximab in combination with cilostazol in patients undergoing stenting

OBJECTIVE

To evaluate the short- and long-term efficacy and safety of abciximab and cilostazol in patients with acute MI and unstable angina undergoing intracoronary stenting.

METHODS

Acute-phase (7 and 30 days), 6-month and long-term composite outcomes involving death, myocardial infarction or urgent target vessel revascularization (TVR) together with other outcomes (composite outcomes involving death, MI and elective TVR with restenosis and stroke) were evaluated retrospectively in a total of 175 patients. Safety outcomes were assessed using data on the incidence of bleeding and thrombocytopenia at Day 7 and Day 30.

RESULTS

Of 175 patients, 83 (47.4%) patients received abciximab. At 7 and 30 days, the composite outcome for the group treated with cilostazol alone and that treated with abciximab in combination with cilostazol did not differ significantly. The composite outcomes at 6 months and 1 year were significantly lower in the abciximab plus cilostazol group (relative risk 0.35, 95% Cl 0.13 - 0.90, relative risk 0.28, 95% CI 0.10 -0.78, respectively). The incidence of major bleeding at the access-site and in the gastrointestinal tract and minor bleeding were significantly higher in the group receiving abciximab plus cilostazol group at 7 days (relative risk 3.33, 95% CI 1.66 - 6.65, relative risk 9.98, 95% CI 1.29 - 77.07, relative risk 1.96, 95% CI 1.06 - 3.62, respectively) and at 30 days (relative risk 3.33, 95% CI 1.66 - 6.65, relative risk 5.54, 95% CI 1.25 - 24.56, relative risk 1.96, 95% CI 1.06 - 3.62, respectively).

CONCLUSION

The combination of abciximab and cilostazol showed an improvement in major cardiac incidents at 6 months and 1 year of the treatment when compared to the group receiving cilostazol alone. However, abciximab did not improve the incidence of death but increased the risk of bleeding complications.

A Caucasian male with very low blood cholesterol and low apoA-II without evidence of atherosclerosis

BACKGROUND

It is well known that a high level of apolipoprotein (apo) A-II can be associated with familial combined hyperlipidaemia, and that high apolipoprotein profiles can contribute to the development of atherosclerosis. The serum lipoprotein/apolipoprotein profile of a Caucasian patient who had unusually low serum total cholesterol (83 mg dL(-1)) and triglyceride (28 mg dL(-1)) levels despite a high body mass index (33.5 kg m(-2)), is the subject of this report.

MATERIALS AND METHODS

Each lipoprotein was isolated from serum by sequential ultracentrifugation, and serum and lipoprotein lipids and proteins were determined. The cholesteryl ester (CE) conversion ability of lecithin:cholesterol acyltransferase and CE transfer activity of CE transfer protein were assayed, and the composition of apolipoprotein and lipoprotein(-1) was analyzed by electrophoresis and Western blot analysis.

RESULTS

Electrophoresis and immunodetection analyses revealed a 60% decrease in the apoA-II band intensity compared to normal reference serum. The decreased apoA-II was associated with reduced very low density lipoprotein-cholesterol and protein content, as well as a greater high-density lipoprotein (HDL)(2) size with high cholesterol content. The CE conversion activity and CE transfer activity of HDL(3) were almost totally lacking in the hypolipidaemic serum, although the expression level of lecithin:cholesterol acyltransferase was normal. Electron microscopy revealed that the obese patient had larger HDL(2) and HDL(3) particle sizes than those of reference serum.

CONCLUSION

These results suggest that a decreased apoA-II protein in serum and increased HDL-cholesterol and particle size might protect against hyperlipidaemia and the atherosclerotic process, even in a patient with severe obesity.

Acetylcholine-induced proliferation of fibroblasts and myofibroblasts in vitro is inhibited by tiotropium bromide

Acetylcholine (ACh) has been suggested to exert various pathophysiological activities in the airways in addition to vagally-induced bronchoconstriction. This archetypal neurotransmitter and other components of the cholinergic system are expressed in a number of non-neuronal cells in the airways. Non-neuronal ACh released from these cells may affect fibroblasts (Fb) as well as inflammatory cells in lung tissue. Tiotropium bromide is a once-a-day antimuscarinic drug, marketed under the brand name Spiriva, for the treatment of chronic obstructive pulmonary disease (COPD). Besides its proven direct bronchodilatory activity, recent evidence suggests that tiotropium may be able to reduce the frequency of exacerbations and attenuate the decline in lung function, thus improving the course of obstructive airway diseases. The aim of the present study was to investigate the effects of tiotropium on the ACh-induced proliferation of primary human Fb isolated from biopsies of lung fibrosis patients and myofibroblasts (MyFb) derived from these cells. A human lung Fb cell line acted as control. Expression of muscarinic receptor subtypes M1, M2 and M3 was demonstrated by RT-PCR in both cell types. Acetylcholine stimulated proliferation in all cells investigated. Tiotropium concentration-dependently inhibited the ACh-induced proliferation in both the Fb and MyFb with a maximum effect at 30 nM. These results suggest that cholinergic stimuli mediated by muscarinic receptors could contribute to remodeling processes in chronic airway disease. Tiotropium bromide may have a beneficial influence on airway remodeling processes in chronic airway diseases through antiproliferative effects on fibroblasts and myofibroblasts.

Inhibition of PDGF, VEGF and FGF signalling attenuates fibrosis

BIBF 1000 is a small molecule inhibitor targeting the receptor kinases of platelet-derived growth factor (PDGF), basic fibroblast growth factor and vascular endothelial growth factor, which have known roles in the pathogenesis of pulmonary fibrosis. The anti-fibrotic potential of BIBF 1000 was determined in a rat model of bleomycin-induced lung fibrosis and in an ex vivo fibroblast differentiation assay. Rats exposed to a single intra-tracheal injection of bleomycin were treated with BIBF 1000 starting 10 days after bleomycin administration. To gauge for anti-fibrotic activity, collagen deposition and pro-fibrotic growth factor gene expression was analysed in isolated lungs. Furthermore, the activity of BIBF 1000 was compared with imatinib mesylate (combined PDGF receptor, c-kit and c-abl kinase inhibitor) and SB-431542 (transforming growth factor (TGF)-beta receptor I kinase inhibitor) in an ex vivo TGF-beta-driven fibroblast to myofibroblast differentiation assay, performed in primary human bronchial fibroblasts. Treatment of rats with BIBF 1000 resulted in the attenuation of fibrosis as assessed by the reduction of collagen deposition and the inhibition of pro-fibrotic gene expression. In the cellular assay both SB-431542 and BIBF 1000 showed dose-dependent inhibition of TGF-beta-induced differentiation, whereas imatinib mesylate was inactive. BIBF 1000, or related small molecules with a similar kinase inhibition profile, may represent a novel therapeutic approach for the treatment of idiopathic pulmonary fibrosis.

Birth of viable female dogs produced by somatic cell nuclear transfer

Since the only viable cloned offspring born in dogs was a male, the purpose of the present study was to produce female puppies by somatic cell nuclear transfer (SCNT). Adult ear fibroblasts from a 2-month-old female Afghan hound were isolated and used as donor cells. In vivo-matured canine oocytes surgically collected (approximately 72h after ovulation) from the oviducts of 23 donors were used for SCNT. After removal of the cumulus cells, oocytes were enucleated, microinjected, fused with a donor cell, and activated. A total of 167 reconstructed SCNT embryos were surgically transferred (Day 0) into the oviducts of 12 recipient bitches (average 13.9 embryos/recipient, range 6-22) with spontaneous, synchronous estrous cycles. Three pregnancies were detected by ultrasonography on Day 23, maintained to term, and three healthy female puppies (520, 460, and 520g), were delivered by Caesarean section on Day 60. These puppies were phenotypically and genotypically identical to the cell donor. In conclusion, we have provided the first demonstration that female dogs can be produced by nuclear transfer of ear fibroblasts into enucleated canine oocytes.