Adenosine deaminase modulates metabolic remodeling and orchestrates joint destruction in rheumatoid arthritis

Rheumatoid Arthritis (RA) is a chronic autoimmune disease associated with inflammation and joint remodeling. Adenosine deaminase (ADA), a risk factor in RA, degrades adenosine, an anti-inflammatory molecule, resulting in an inflammatory bias. We present an integrative analysis of clinical data, cytokines, serum metabolomics in RA patients and mechanistic studies on ADA-mediated effects on in vitro cell culture models. ADA activity differentiated patients into low and high ADA sets. The levels of the cytokines TNFα, IFNγ, IL-10, TGFβ and sRANKL were elevated in RA and more pronounced in high ADA sets. Serum metabolomic analysis shows altered metabolic pathways in RA which were distinct between low and high ADA sets. Comparative analysis with previous studies shows similar pathways are modulated by DMARDs and biologics. Random forest analysis distinguished RA from control by methyl-histidine and hydroxyisocaproic acid, while hexose-phosphate and fructose-6-phosphate distinguished high ADA from low ADA. The deregulated metabolic pathways of High ADA datasets significantly overlapped with high ADA expressing PBMCs GEO transcriptomics dataset. ADA induced the death of chondrocytes, synoviocyte proliferation, both inflammation in macrophages and their differentiation into osteoclasts and impaired differentiation of mesenchymal stem cells to osteoblasts and mineralization. PBMCs expressing elevated ADA had increased expression of cytokines and P2 receptors compared to synovial macrophages which has low expression of ADA. Our data demonstrates increased cytokine levels and distinct metabolic signatures of RA based on the ADA activity, suggests an important role for ADA in the pathophysiology of RA joints and as a potential marker and therapeutic target in RA patients.

Binary and Multiclass Classification of Histopathological Images Using Machine Learning Techniques

Background and Objective: Breast cancer is fairly common and widespread form of cancer among women. Digital mammogram, thermal images of breast and digital histopathological images serve as a major tool for the diagnosis and grading of cancer. In this paper, a novel attempt has been proposed using image analysis and machine learning algorithm to develop an automated system for the diagnosis and grading of cancer. Methods: BreaKHis dataset is employed for the present work where images are available with different magnification factor namely 40×, 100×, 200×, 400× and 200× magnification factor is utilized for the present work. Accurate preprocessing steps and precise segmentation of nuclei in histopathology image is a necessary prerequisite for building an automated system. In this work, 103 images from benign and 103 malignant images are used. Initially color image is reshaped to gray scale format by applying Otsu thresholding, followed by top hat, bottom hat transform in preprocessing stage. The threshold value selected based on Ridler and calvard algorithm, extended minima transform and median filtering is applied for doing further steps in preprocessing. For segmentation of nuclei distance transform and watershed are used. Finally, for feature extraction, two different methods are explored. Result: In binary classification benign and malignant classification is done with the highest accuracy rate of 89.7% using ensemble bagged tree classifier. In case of multiclass classification 5-class are taken which are adenosis, fibro adenoma, tubular adenoma, mucinous carcinoma and papillary carcinoma the combination of multiclass classification gives the accuracy of 88.1% using ensemble subspace discriminant classifier. To the best of author’s knowledge, it is the first made in a novel attempt made for binary and multiclass classification of histopathology images. Conclusion: By using ensemble bagged tree and ensemble subspace discriminant classifiers the proposed method is efficient and outperform the state of art method in the literature.

Automated Genomic Signal Processing for Diseased Gene Identification

Genomic signal processing (GSP) is the engineering discipline for the analysis, processing, and use of genomic signals to gain biological knowledge, and the translation of that knowledge into systems-based applications that can be used to diagnose and treat genetic diseases. Statistical Computations on DNA Sequences is one of key areas in which GSP can be applied. In this paper, we apply DSP tools on trinucleotide repeat disorders (too many copies of a certain nucleotide triplet in the DNA) to classify any gene sequence into diseased/non-diseased state. Intially, we collected the Gene sequences responsible for trinucleotide repeat disorders from NCBI. Then, we applied GSP techniques to convert the given gene sequence into an indicator sequence, and furthermore we apply Fast Fourier transforms (FFTs) and Discrete Wavelet Transforms (DWTs), followed by statistical feature extraction and the obtained statistical features, fed into an Artificial Neural Network to predict the state of the input genomic sequence.

The association with age, human tissue kallikreins 6 and 10 and hemostatic markers for survival outcome from epithelial ovarian cancer

PURPOSE

To assess known cancer biomarkers CA-125, human tissue kallikreins KLK6 and KLK10, hemostatic markers and age with 5-year survival outcome from epithelial ovarian cancer.

METHODS

Forty-one benign cyst cohorts and 83 patients diagnosed with ovarian cancer were recruited. The following assays were performed: fibrinogen, vWF antigen, D: -dimer, ATIII activity, tPA, PAI-1, uPAR, KLK6, KLK10 and CA-125. Follow-up visits of cancer patients of more than 60 months were noted. Data between those who survived past 60 months and mortality from cancer were analyzed.

RESULTS

Only 24 patients lived past 60 months, and 31 died (advanced stage n = 27). Those living past 60 months were significantly older and associated with similar pre-operative levels seen in benign cyst cohorts especially for KLK6, fibrinogen, vWF, AT levels despite upregulation of D: -dimer, CA-125 and KLK10. Ovarian cancer cohorts living past 60 months were younger than those who died within 12 months (n = 12). Mortality within 12 months was associated with older age, upregulation of KLK6, fibrinogen, D: -dimer, vWF, tPA antigen and reduced ATIII levels. Similarly, mortality within 36 months of disease showed older age with upregulation of CA-125, KLK6 D: -dimer vWF antigen and tPA antigen levels. Late stage cancer (III/IV) showed upregulated CA-125, KLK6, KLK10, D: -dimer and reduced AT compared to early stage cancer (I/II). The 5-year survival rate for early cancer was 80%, advanced 22.9% and overall 5-year survival rate was 43.6%.

CONCLUSION

Older age together with the novel biomarkers studied and their association with adverse outcome from epithelial ovarian cancer was seen especially within 12 and 36 months of disease. Those who lived past 60 months of disease showed similar pre-operative levels seen in benign cyst cohorts despite elevated D: -dimer, CA125 and KLK 10. An enlarged study is needed to confirm these findings.

Ceramic membrane ultrafiltration of natural surface water with ultrasound enhanced backwashing

Ultrafiltration membrane cleaning with ultrasound enhanced backwashing was investigated with two ceramic membrane systems in parallel. One of them was subjected to ultrasound during backwashing, the other acted as a reference system. The feed water was directly taken from a creek with a sedimentation process as only pre-treatment. The cleaning performance was improved with ultrasound but after 3 weeks of operation damages occurred on the membranes. These effects were studied with online measurements of flux, trans-membrane-pressure and temperature, but also with integrity tests, turbidity measurements and visual examination.

Inositol-1,4,5-trisphosphate receptor-mediated Ca mobilization is not required for cerebellar long-term depression in reduced preparations

Inositol-1,4,5-trisphosphate receptor-mediated Ca mobilization is not required for cerebellar long-term depression in reduced preparations. J. Neurophysiol. 80: 2963-2974, 1998. Cerebellar long-term depression (LTD) is a cellular model system of information storage in which coincident parallel fiber and climbing fiber activation of a Purkinje neuron (PN) gives rise to a sustained attenuation of parallel fiber-PN synaptic strength. Climbing fiber and parallel fiber inputs may be replaced by direct depolarization of the PN and exogenous glutamate pulses, respectively. The parallel fiber-PN synapse has a high-density of mGluR1 receptors that are coupled to phosphoinositide turnover. Several lines of evidence indicated that activation of mGluR1 by parallel fiber stimulation is necessary for the induction of cerebellar LTD. Because phosphoinositide hydrolysis has two initial products, 1, 2-diacylglycerol and inositol-1,4,5-trisphosphate (IP3), we wished to determine whether IP3 signaling via IP3 receptors and consequent Ca mobilization were necessary for the induction of cerebellar LTD. First, ratiometric imaging of free cytosolic Ca was performed on both acutely dissociated and cultured PNs. It was determined that the threshold for glutamate pulses to contribute to LTD induction was below the threshold for producing a Ca transient. Furthermore, the Ca transients produced by depolarization alone and glutamate plus depolarization were not significantly different. Second, the potent and selective IP3 receptor channel blocker xestospongin C was not found to affect the induction of LTD in either acutely dissociated or cultured PNs at a concentration that was sufficient to block mGluR1-evoked Ca mobilization. Third, replacement of mGluR activation by exogenous synthetic diacylglycerol in an LTD induction protocol was successful. Taken together, these results suggest that activation of an IP3 signaling cascade is not required for induction of cerebellar LTD in reduced preparations.

Defining a minimal computational unit for cerebellar long-term depression

In cerebellar long-term depression (LTD), conjunctive stimulation of parallel and climbing fiber inputs to a Purkinje neuron (PN) results in a selective depression of parallel fiber-PN synaptic strength. A similar phenomenon may be induced in the cultured PN when glutamate pulses and PN depolarization, which mimic the effects of parallel and climbing fibers, respectively, are coapplied. Here, we show that LTD can be induced in two very reduced preparations of the postsynaptic neuron; an acutely dissociated preparation and a perforated outside-out macropatch of dendritic membrane. LTD in these preparations retains properties of that seen in an intact cultured PN in that it is not induced by either glutamate pulses or depolarization alone and requires calcium influx, mGluR activation, and PKC activation for induction. As both of these preparations lack dendritic spine compartments, these findings suggest that the associative nature of LTD induction does not require this level of morphological organization.

ACEP chest pain policy: emergency physician awareness

STUDY OBJECTIVE

To assess emergency physician knowledge of and effect on clinical practice of the ACEP "Clinical Policy for Management of Adult Patients Presenting With a Chief Complaint of Chest Pain, With No History of Trauma."

METHODS

We conducted a written survey of attending physicians by mail and in person at emergency medicine meetings. Residents were surveyed at their academic departments. The survey recipients were emergency physicians and residents from university, community teaching, urban, and rural hospitals.

RESULTS

Of the 338 surveyed physicians, 163 (48%; 95% confidence interval [CI], 43% to 54%) said that they were aware of the policy. Fifty-four percent of ACEP members said they were aware of the policy, compared with 24% of nonmembers. Of the physicians who said they were aware of the policy, 63% did not know that the policy contains rules. Seventy-one percent of the physicians who were aware of the policy incorrectly believed the policy requires treatment with thrombolytic therapy in certain cases of myocardial infarction. Physicians said they learned about the policy by reading it (42%), by word of mouth (16%), or in department/quality assurance meetings (13%). Twelve percent of physicians believe the policy has changed their clinical practice.

CONCLUSION

Fewer than half the emergency physicians we surveyed were aware of the policy. Of the physicians who said they had been aware of the policy, most did not know important specifics of the policy.

Protoporphyrins modulate voltage-gated Ca current in AtT-20 pituitary cells

1. Zinc-protoporphyrin-IX (ZnPP-IX) is an inhibitor of the enzyme heme-oxygenase-2 (HO-2) and consequently has been used to examine the role of carbon monoxide production in neural tissues. We have measured voltage-gated Ca current in AtT-20 pituitary cells using the whole-cell patch-clamp technique and have assessed the effects of extracellularly applied ZnPP-IX and related compounds. 2. Ca currents evoked by depolarizing steps from a holding potential of -90 mV were of the high-threshold, slowly inactivating type. Fifty-six percent of this current was blocked by 10 microM nifedipine and 16% by 3 microM omega-conotoxin with the remainder resistant to both drugs in combination, suggesting that the total Ca current was a mixture of L, N, and possibly P-type conductances. 3. Bath application of ZnPP-IX resulted in an irreversible, dose-dependent attenuation of Ca current. Five micromolar ZnPP-IX produced a 62% reduction of peak current amplitude with no shift in the current-voltage relation, 0.5 microM produced a 19% reduction, and 0.05 microM produced a variable response, either a small transient attenuation or potentiation. 4. The attenuation of Ca current by 5 microM ZnPP-IX could be nearly completely blocked by co-application of superoxide dismutase in the bath (90 U/ml) but not by addition of an inhibitor of cGMP-dependent protein kinase to the internal saline (KT5823, 1 microM). 5. Other inhibitors of heme-oxygenase with similar potency such as tin-protoporphyrin-IX (Sn-PP-IX) and Zn-deuteroporphyrin-bis-glycol (ZnBG) did not attenuate Ca current when applied at 5microM.(ABSTRACT TRUNCATED AT 400 WORDS)

Emergency department discharges against medical advice

A retrospective chart review was performed on 52 consecutive discharges against medical advice (AMA) from an emergency department. The study's objective was to assess documentation of the medical record as well as the patients' perceptions of their experience. Sixty-seven percent of the charts reflected the competence of the patient. The physicians documented that the patients understood their diagnosis (36%), proposed treatment (44%), alternative therapy (2%), and the clinical consequences of refusal (57%). The discharge instructions included a referral to a physician 62% of the time. A post-visit survey contacting 46% of the group revealed that 82% of these respondents left because they didn't agree with the physician's management plan, although 70% of the patients were either "very satisfied" or "satisfied" with their interaction with the physician. These results suggest that more attention and better documentation needs to be directed to the patient who is leaving the emergency department against medical advice.

Jack o'lantern mushroom poisoning

The cases of seven adults who ingested jack o'lantern mushrooms are presented. All patients experienced nausea and vomiting associated with abdominal cramping, and three reported diarrhea. Four of the seven complained of weakness and dizziness. Two were diaphoretic on physical examination. All seven were given IV fluids and oral activated charcoal in a local emergency department and admitted overnight for observation. Laboratory studies showed three of the seven patients to have mildly elevated liver function tests. One patient had hypokalemia requiring potassium supplementation. All were discharged the following day with normal follow-up examinations and laboratory studies. We recommend that all patients presenting with jack o'lantern mushroom poisoning be observed and rehydrated and have baseline liver function tests and potassium levels obtained.

Tension pneumothorax associated with hyperbaric oxygen therapy

The authors present three patients who developed a tension pneumothorax while receiving emergent hyperbaric oxygen therapy for acute carbon monoxide poisoning. Each patient was intubated and received closed chest compressions for cardiac arrest prior to hyperbaric oxygenation. Despite the apparent absence of pneumothorax prior to hyperbaric therapy, tension pneumothorax was detected soon after decompression. These cases illustrate the need for vigilance in detecting and addressing pneumothorax prior to hyperbaric decompression in obtunded patients. Serial physical examinations, arterial blood gas determinations, properly positioned chest radiographs, and a high index of suspicion for pneumothorax in the setting of emergent hyperbaric therapy are recommended.

Immobilization of a primary amine-containing drug, adriamycin. Coupling to crosslinked polyvinyl alcohol and mechanistic comparison of hydrolytic stability

Literature reports have described the covalent coupling of the primary amine-containing anticancer drug, adriamycin, to polymeric supports through the amine group on the drug. These reports also have described drug mechanism studies with the immobilized adriamycin, where the release of the drug would undermine the validity of the conclusions. In the present paper, detailed experimental conditions are given for preparation of nonwater-soluble particles of polyvinyl alcohol by crosslinking water-soluble polyvinyl alcohol with 1,4-benzenedicarboxaldehyde, and for activation with cyanuric chloride and covalent attachment of adriamycin. The expected stability of this drug-support linkage against hydrolytic cleavage is compared mechanistically to that expected for less stable coupling through a carbamate linkage or for less stable coupling via an azomethine link.

Site-specific immobilization of flavin adenine dinucleotide on indium/tin oxide electrodes through flavin adenine amino group

A Mannich-type reaction was used to attach flavin adenine dinucleotide (FAD) covalently to aminosilane derivatized indium/tin oxide-coated glass plates. The aminosilane was activated with formaldehyde to give an intermediate that attached specifically to the adenine amino group of FAD. The presence of the intermediate also was demonstrated by coupling hydroquinone to the formaldehyde activated support. The immobilized FAD and hydroquinone were characterized by cyclic or differential pulse voltammetry. The immobilized FAD was shown to reduce the overpotential for NADH oxidation by 180 mV. In keeping with results for FAD on glassy carbon, FAD attached to indium/tin oxide at the adenine amino group did not lead to reconstitution of activity with apoglucose oxidase.