Engaging carers in neuropsychological rehabilitation for brain cancer survivors: The "I'm aware: Patients And Carers Together" (ImPACT) program

BACKGROUND

Cognitive impairment is a common late effect in child and adult brain cancer survivors (BCS). Still, there is a dearth of research aimed at therapeutic interventions and no standard treatment options for most BCS.

OBJECTIVE

To describe 1) a novel neuropsychological rehabilitation program for BCS - the "I'm aware: Patients And Carers Together" (ImPACT) program, and 2) two studies that aim to assess the feasibility of the ImPACT program in child and adult BCS, respectively. The program adapts the holistic neuropsychological approach pioneered by Leonard Diller and Yehuda Ben-Yishay to an outpatient setting.

METHODS

Two feasibility studies are described: 1) A single-armed study with 15 child BCS (10-17 years) (ImPACT Child); and 2) a randomized waitlist-controlled trial with 26 adult BCS (>17 years) (ImPACT Adult). In both studies, patients will undergo an 8-week program together with a cohabiting carer. Primary outcomes (i.e., cognitive and neurobehavioral symptoms), and secondary outcomes (i.e., behavioral and psychological symptoms, e.g., quality of life, fatigue) will be assessed at four time points: pre-, mid-, and post intervention, and 8 weeks follow-up. Adult waitlist controls will be assessed at equivalent time points and will be included in the intervention group after all study assessments. Semi-structured interviews will be conducted at follow-up.

EXPECTED OUTCOMES

Results will provide feasibility data in support of future larger scale trials.

DISCUSSION

The findings could potentially improve the management of cognitive impairment in BCS and transform available services. The program can be delivered in-person or remotely and harnesses existing resources in patients' lives.

P09.02.B Engaging Parents in Neuropsychological Rehabilitation for Childhood Cancer Survivors: The I’M aware: Patients And Carers Together (ImPACT) Program

Background

Cognitive impairment is the most common late effect in childhood cancer survivors (CCS). A third are likely to experience impairments in skills such as attention, processing speed, memory, and executive function. Neurobehavioral impairments are also observed in CCS (e.g., apathy) and may underlie cognitive impairment. Although these problems can impair quality of life, scholastic achievement and long-term socioeconomic outcomes, there is a dearth of research on interventions to treat cognitive impairment in CCS. Cognitive rehabilitation studies in CCS have focused primarily on computerized cognitive training and meta-cognitive strategy training, but with limited effects and poor study designs. They have lacked four key elements: 1) transfer of learning to real-world functional outcomes; 2) awareness training to enhance compensatory strategy use, particularly since CCS may experience neurological unawareness preventing the optimal application of strategies; 3) inclusion of parents that could enhance transfer of learning to the home; and 4) recognition of the inter-related nature of cognitive, neurobehavioral, and psychological functions. A novel, context-sensitive neuropsychological rehabilitation program has been developed for CSS to address these missing elements - the “I’M aware: Patients and Carers Together (ImPACT)” program - based on an evidenced-based approach pioneered at NYU Hospital in the US. In this protocol, the feasibility, acceptability, and preliminary efficacy of the ImPACT program (8 x 1 hour sessions) will be evaluated.

Material and Methods

Phase One will consist of semi-structured interviews with 5 to 10 CCS and their parents in order to review and refine procedures for the ImPACT program. In Phase Two, twenty participants will be randomized to a wait-list control (WLC) or intervention group. WLCs will not receive the intervention immediately, but will serve as the control comparison group. Measures of self- and parent-reported cognition, neurobehavioral function, and global function will be administered pre- and post- intervention, and 9 weeks later (or equivalent time points for WLCs).

Results

Results of this project will provide vital data in support of a future large-scale trial.

Conclusion

Findings could have implications for the management of cognitive and neurobehavioral impairment in CCS that could transform the nature of services provided to CCS. The program can be delivered remotely or in-person and harnesses existing supports in the child’s life to promote real-world functioning.

Associations between patient-reported outcomes and radiation dose in patients treated with radiation therapy for primary brain tumours

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Higher radiation doses to the brain may negatively affect quality of life.

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Higher radiation doses to the brain may negatively affect patient-reported cognition.

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Patients with fatigue had received higher dose to certain areas in the brain.

Aim

This study aimed to explore associations between radiation dose and patient-reported outcomes in patients with a primary non-glioblastoma brain tumour treated with radiation therapy (RT), with a focus on health-related quality-of-life (HRQoL) and self-reported cognitive function.

Methods

In this cross-sectional study, 78 patients who had received RT for a non-glioblastoma primary brain tumour, underwent neuropsychological testing and completed questionnaires on HRQoL, cognitive function, fatigue, depression, anxiety and perceived stress. The study explores the association between HRQoL scores, self-reported cognitive function and radiation doses to total brain, brainstem, hippocampus, thalamus, temporal lobes and frontal lobes. In addition, we examined correlations between neuropsychological test scores and self-reported cognitive function.

Results

The median time between RT and testing was 4.6 years (range 1–9 years). Patients who had received high mean radiation doses to the total brain had low HRQoL scores (Cohen’s d = 0.50, p = 0.04), brainstem (d = 0.65, p = 0.01) and hippocampus (d = 0.66, p = 0.01). High mean doses to the total brain were also associated with low scores on self-reported cognitive functioning (Cohen’s d = 0.64, p = 0.02), brainstem (d = 0.55, p = 0.03), hippocampus (d = 0.76, p < 0.01), temporal lobes (d = 0.70, p < 0.01) and thalamus (d = 0.64, p = 0.01). Self-reported cognitive function correlated well with neuropsychological test scores (correlation range 0.27–0.54.)

Conclusions

High radiation doses to specific brain structures may be associated with impaired HRQoL and self-reported cognitive function with potentially negative implications to patients’ daily lives. Patient-reported outcomes of treatment-related side-effects and their associations with radiation doses to the brain and its sub-structures may provide important information on radiation tolerance to the brain and sub-structures.

[Radiofrequency catheter ablation of ventricular tachycardia in patients post surgical repair of tetralogy of Fallot]

Objective: To investigate the clinical and electrophysiological features of ventricular tachycardia (VT) in tetralogy of Fallot (TOF) patients post surgical repair (rTOF) and to analyze the therapeutic effect and prognosis of radiofrequency ablation of rTOF-VT. Methods: This is a retrospective study. Consecutive patients with rTOF-VT, who were treated in Fuwai Hospital from January 2015 to March 2020, were enrolled. All the patients underwent right ventricular voltage mapping following routine cardiac electrophysiological examination, followed by linear or homogenizing radiofrequency ablation based on the low-voltage substrate. The clinical features, 3-dimentional electrophysiological substrate mapping, radiofrequency ablation and long-term prognosis of the enrolled patients were analyzed. Acute ablation success was defined as completion of linear or homogenizing ablation or intraoperative evoked VT as destination of the procedure. Patients were followed up at 3 and 6 months post operation and every year thereafter. The endpoints were sudden cardiac death (SCD) and recurrence of ventricular tachycardia. Results: A total of 20 patients with rTOF-VT were enrolled including 14 males with an age of (35.8±11.8) years. The electrocardiogram identified 23 types of ventricular tachycardia, 19 of which were originated from right ventricular inflow tract outlet. The most common clinical manifestations were heart murmur (19 cases, 95%) and syncope (4 cases, 25%). Electroanatomical substrate mapping was performed in 20 patients and evidenced localized or diffuse scar or low-voltage area of right ventricle. Intraoperative electrophysiological tests provoked ventricular tachycardia in 6 patients (30%), including 5 patients with hemodynamics disturbance. The acute success rate of radiofrequency ablation was 95% (19/20). The follow-up time was (31.1±17.7) months and the recurrence rate of ventricular tachycardia was 30% during follow-up period and 5 cases received repeat radiofrequency ablation and there was no recurrent ventricular tachycardia during follow-up post repeat radiofrequency ablation. Conclusions: The voltage substrate mapping under sinus rhythm is a feasible mapping method for rTOF-VT. Linear or flaky radiofrequency ablation of the slow conduction zone is safe and effective treatment strategy, the recurrence rate after the first radiofrequency ablation is still high, and the effectiveness of repeat radiofrequency ablation is satisfactory in this patient cohort.

Wilson disease: copper deficiency and iatrogenic neurological complications with zinc therapy

A 17-year-old female was diagnosed with Wilson disease and commenced on oral zinc therapy. She re-presented 6 months later with a fall and had classical signs of subacute combined degeneration of the spinal cord confirmed on nerve conduction studies, as a result of zinc-induced copper deficiency. After 6 months of copper therapy, she made a complete recovery with no residual neurological deficits. Early detection of zinc-induced copper deficiency and stringent follow-up mechanisms are crucial. Early initiation of copper replacement may both limit and completely reverse neurological deficits.

[Effects of percutaneous coronary intervention on cardiac function in ischemic cardiomyopathy patients with different left ventricular ejection fraction and SYNTAX score≤22]

Objective: To evaluate the clinical impact of percutaneous coronary intervention (PCI) on left ventricular myocardial remodeling and main adverse cardiovascular and cerebrovascular events (MACE) in ischemic cardiomyopathy patients with different left ventricular ejection fraction and SYNTAX score≤22. Methods: A total of 191 ischemic cardiomyopathy patients who underwent PCI in Department of Cardiology from May 2017 to October 2018 were enrolled in this study, and they were divided into three groups according to preoperative left ventricular ejection fraction (≥50% group, 36%~49% group and ≤35% group). The main outcomes and left ventricular ejection fraction, left ventricular end-diastolic volume were analyzed at 12 months follow-up. The main outcomes were the recurrence of acute left ventricular failure, recurrent angina, restenosis, revascularization, non-fatal myocardial infarction, cardiovascular death and non-cardiovascular death. Results: The incidence of MACE was 32.6% (15 cases) in ≥50% group, 32.0% (31 cases) in 36%-49% group, 45.8% (22 cases) in ≤35% group, respectively, which was lower in the first two groups than in ≤35% group, but there was no statistically significant difference among the 3 groups (P=0.231). The incidence of acute left ventricular failure in the three groups was 2.2%, 12.4% and 22.9%, respectively, and there was statistically significant difference among the 3 groups (P= 0.01). Multivariate analysis indicated that preoperative left ventricular ejection fraction ≤35% was an independent predictor of acute left ventricular failure (OR=2.696, 95%CI: 1.099-6.612, P=0.030). Compared with baseline data, left ventricular end-diastolic volume ((62±4) mm vs (56±5) mm, P<0.001), left atrium ((42±6) mm vs (40±6) mm, P<0.001) decreased significantly 1 year after PCI. However, left ventricular ejection fraction ((43±10)% vs (51±13)%, P<0.001) increased significantly. At 1 year, left ventricular remodeling related parameters were detected in 3 groups, and there was statistically significant difference in left ventricular end-diastolic volume ((53.1±0.6) mm vs (55.1±0.5) mm vs (59.1±0.7) mm, P<0.001), left ventricular ejection fraction ((62.1±1.1)% vs (51.4±1.0)% vs (37.0±1.5)%, P<0.001) among the 3 groups. Conclusions: Coronary vascular reopening with PCI in patients with ischaemic cardiomyopathy and SYNTAX score≤22, can improve prognosis of patients with preoperative left ventricular ejection fraction>35% significantly, but not in those with preoperative left ventricular ejection fraction≤35%. Preoperative left ventricular ejection fraction may be an independent predictor of acute left ventricular failure in patients with ischemic cardiomyopathy and SYNTAX score≤22, postoperative left ventricular remodeling and left ventricular systolic function correlate with preoperative left ventricular ejection fraction.

[Epidemiology of syphilis in Zhejiang province, 2010-2019]

Objective: To investigate the epidemiological characteristics of syphilis in Zhejiang province and to provide scientific basis for the development of syphilis prevention and control strategies. Methods: A descriptive epidemiological analysis was conducted on the incidence data of syphilis in Zhejiang from 2010 to 2019. Results: During the period, the incidence rate of syphilis decreased from 94.90/100 000 in 2010 to 53.53/100 000 in 2019 with an average decreasing rate of 6.16%. The annual decreases of the incidences of congenital syphilis, primary syphilis and secondary syphilis were all obvious, which were 43.47%, 21.38% and 14.19% respectively. The proportion of latent syphilis cases increased with year. Except for Lishui, the incidences of syphilis in the remaining 10 prefectures showed declining trends. The incidence rates in both men and women showed declining trends with the average rates of 4.80% and 6.45% respectively. The incidence peaks occurred in old men aged ≥60 years and in sexually active women aged 20-34 years, and the syphilis cases in age group ≥60 years increased significantly. The cases were mainly farmers, accounting for 43.00%. Conclusion: The incidence of syphilis in Zhejiang showed a decreasing trend, but the situation remains serious, indicating that the intensity and quality of the comprehensive prevention and control needs to be further strengthened.

[Clinical characteristics of cardiomyopathies complicated with ventricular thrombosis]

Objective: To summarize the clinical characteristics of cardiomyopathy complicated with ventricular thrombosis. Methods: The clinical data of inpatients suffered from cardiomyopathy complicated with ventricular thrombosis in Fuwai Hospital between January 2015 and May 2019 were analyzed retrospectively. Results: A total of 125 cases were reviewed, and 24.8% were female. Dilated cardiomyopathy was the most common disease (62.4%), followed by arrhythmogenic right ventricular cardiomyopathy (ARVC) (13.6%) and hypertrophic cardiomyopathy (11.2%). There were 74.4% thrombosis in left ventricle, 12.8% in right ventricle and 12.8% in biventricle. The proportions of right ventricle thrombosis were higher in ARVC than in other cardiomyopathies (52.9% vs 6.5%, P<0.01). The majority suffered from cardiac function New York Heart Association (NYHA) Class Ⅲ (45.6%) and class Ⅳ (39.2%). The ratio of NYHA Class Ⅳ was higher in female patients than in male ones (25.8% vs 10.6%, P<0.05). In lab detection, positive results of D-Dimer and N terminal-pro B type natriuretic peptide (NT-proBNP) accounted for 72.8% and 97.6%, respectively. There were 2.5% patients died in the hospital or discharged because of the worsening of illness, the chances were higher in female than male patients (9.7% vs 0, P<0.01). Among these patients, one succumbed to massive ischemic stroke caused by ventricular thrombus detachment under standard anticoagulation therapy. Conclusions: Dilated cardiomyopathy is the most common cardiomyopathy complicated with ventricular thrombosis. The most common location of thrombosis is left ventricle. Right ventricle thrombosis is more common in ARVC. The majority suffer from moderate or severe cardiac dysfunction. Higer proportion of female patients suffer from anemia, severe condition and poor prognosis.

[Initial experience of catheter ablation of ventricular tachycardia originate from endocardium via direct ventricle puncture access in patients underwent mechanical valve implantation]

Objective: To evaluate the results of catheter ablation of ventricular tachycardia (VT) via direct ventricle puncture access in patients without traditional approach. Methods: Two idiopathic left fasicular VT patients with mechanical aortic and mitrial valve repalcement and 1 patient with right ventricular originated VT post mechanical tricuspid valve repalcement from March 2010 to July 2012 in Fuwai hospital were enrolled in this study. For left fasicular VT patients, catheter ablation was performed using transapical left ventricular access via minithoracotomy. For the patient with right ventricular originated VT, catheter ablation was performed via percutaneous right ventricle puncture at xiphoid. Abaltion was guided under EnSite NavX mapping system. The feasibility of VT ablation via direct ventricle puncture access and long-term VT recurrence were investigated. Results: Catheter ablation was successful in all patients, and all clinical VTs were eliminated. The procedure time was 53, 62 and 74 minutes respectively with radiation time 11, 16 and 20 minutes. The ablation time was 130, 170 and 240 seconds individually. No procedure related complication occurred. After a follow-up time of 76, 55 and 82 months respectively, no VT recurrence was found in patients with left fasicular VT. New-onset VT with different morphology with previous VT was recorded in the patient with right ventricular originated VT, subcutaneous implantable defibrillator was implanted finally in this patient. Conclusions: For patients with endocardial origined ventricular arrhythmias which could not be ablated via traditional approaches, direct ventricle puncture access with hybrid techniques provides a new approach foreliminating VTs in these patients.

[Systematic review on orofacial myofunctional therapy to treat obstructive sleep apnea-hypopnea syndrome]

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an important risk factor for cardiovascular and cerebrovascular diseases. The widespread collapse of the airway, which can't maintain its normal position and structure, is an important cause of OSAHS. Noninvasive ventilator-assisted ventilation is the preferred treatment for OSAHS, but there are shortcomings of poor compliance. Orofacial myofunctional therapy (OMT) is a noninvasive, simple, low-cost, low-risk therapy that is expected to replace noninvasive ventilator-assisted ventilation to a certain extent. So far, there is little Chinese literature on OMT, especially no training methods in Chinese version. Therefore, this paper systematically reviewed anatomical abnormalities and pathology of OSAHS, possible treatment mechanism of OMT and related research progress. And we translated two kinds of training method of OMT (Guimarase's and Hemmat Baz's) into Chinese for researchers and clinicians' reference, which is widely cited in foreign literature.

Ectopic fat accumulation in the pancreas and its clinical relevance: A systematic review, meta-analysis, and meta-regression

OBJECTIVE

Growing evidence suggests that individuals with excessive fat in the pancreas are at an increased risk of chronic metabolic disorders. The aim was to systematically review studies on non-alcoholic fatty pancreas disease (NAFPD) with a view to determine its prevalence, associations with metabolic co-morbidities, and to suggest normal pancreatic fat percentage threshold.

METHODS

Three electronic databases (MEDLINE, Scopus, and Embase) were queried. Studies in humans were eligible for inclusion if they provided data on NAFPD and/or pancreatic fat percentage. Where possible, data were pooled using random-effects meta-analysis and the effect of covariates analysed using meta-regression.

RESULTS

Pooling data on pancreatic fat percentage from nine studies (1209 healthy individuals who underwent magnetic resonance imaging), yielded the weighted mean and weighted standard deviation of 4.48% and 0.87%, respectively. Pooling data on NAFPD from eleven studies (12,675 individuals), yielded the pooled prevalence of 33% (95% confidence interval, 24% - 41%). Meta-regression analysis showed that the prevalence of NAFPD was independent of age and sex. The presence of NAFPD was associated with a significantly increased risk of arterial hypertension (risk ratio 1.67; 95% confidence interval, 1.32-2.10; p<0.0001), diabetes mellitus (risk ratio 2.08; 95% confidence interval, 1.44-3.00; p=0.0001), and metabolic syndrome (risk ratio 2.37; 95% confidence interval, 2.07-2.71; p<0.0001).

CONCLUSION

The findings indicate that NAFPD is a frequent clinical entity, associated with significantly increased risk of metabolic syndrome and its components. The normal pancreatic fat cut-off point of 6.2% may be recommended for use in future prospective studies.

Comparative analysis of shell color variety and genetic structure among five high-quality freshwater pearl mussel populations

Four Hyriopsis cumingii populations, a breeding population (BP), a cultured population (FP), two wild populations from Poyang Lake (PY) and Dongting Lake (DT), and an H. schlegelii population were collected (JX), and the first filial generations (F1) were bred synchronously. The shell nacre polymorphisms, population genetic diversity, and genetic structures of the F1 of each population were analyzed and compared using CIELAB colorimetric measurements and microsatellite markers. The color parameters of the shell nacre (L*, a*, dE*) in the BP were significantly different from those in the FP, PY, and JX populations (P < 0.05), whereas the shell nacre color did not differ significantly between the left and right sides of the shells within the same population (P > 0.05). The BP had relatively darker nacre at the posterior end of the shell, and the color parameters (L*, a*, b*, and dE*) differed significantly from those at the front end (P < 0.05). The five populations showed relatively high levels of genetic diversity (H_O = 0.733-0.829). The genetic distance between the H. cumingii populations and H. schlegelii was the greatest, whereas that within the H. cumingii populations and between the FP and the PY population was the smallest. All the individuals tested in this study were optimally grouped into four theoretical populations. In conclusion, the BP was significantly different from the base populations of PY and DT in terms of genetic background and phenotypic parameters of shell nacre color, with potential for further genetic improvement.

Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies

BACKGROUND

There is a lack of robust estimates of the worldwide incidence and mortality of acute pancreatitis, chronic pancreatitis, pancreatic cysts, and pancreatic cancer in the general population. Our aim was to quantitate and compare the incidence and mortality of major pancreatic diseases in high-quality population-based cohort studies.

METHODS

Three databases (PubMed, Embase, and Scopus) were searched independently by two reviewers. Data from eligible studies were subject to meta-analysis to obtain global estimates. A number of prespecified subgroup analyses and meta-regression analyses were also done.

FINDINGS

48 population-based cohort studies (35 on pancreatic cancer, ten on acute pancreatitis, three on chronic pancreatitis, and none on pancreatic cysts) were identified, with a total study population of 296 million individuals and 119 000 patients with pancreatic diseases. Global estimates of incidence and mortality were 8·14 cases (95% CI 6·63-9·98) per 100 000 person-years and 6·92 deaths (95% CI 3·72-12·89) per 100 000 person-years for pancreatic cancer, 33·74 cases (95% CI 23·33-48·81) per 100 000 person-years and 1·60 deaths (95% CI 0·85-1·58) per 100 000 person-years for acute pancreatitis, and 9·62 cases (95% CI 7·86-11·78) per 100 000 person-years and 0·09 deaths (95% CI 0·02-0·47) per 100 000 person-years for chronic pancreatitis. Subgroup analysis based on the WHO regions showed that the incidences of both pancreatic cancer and acute pancreatitis, and mortality from pancreatic cancer, were significantly higher in the American region than in the European and Western Pacific regions, while the incidence of chronic pancreatitis was significantly higher in the European region than in the American region. Mortality from pancreatic cancer was lowest in the Southeast Asian region. The incidence of chronic pancreatitis was twice as high in men as in women, although there was no difference between sexes for pancreatic cancer or acute pancreatitis.

INTERPRETATION

Globally, acute pancreatitis is the most common pancreatic disease whilst pancreatic cancer is the most lethal. However, their burden is not equal across the globe. The epidemiological estimates reported in this study could inform future high-quality studies.

FUNDING

None.

Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis

BACKGROUND & AIM

Acute pancreatitis (AP) and chronic pancreatitis (CP) traditionally have been thought to be distinct diseases, but there is evidence that AP can progress to CP. Little is known about the mechanisms of pancreatitis progression. We performed a meta-analysis to quantify the frequency of transition of AP to CP and identify risk factors for progression.

METHODS

We searched PubMed, Scopus, and Embase for studies of patients with AP who developed CP, published from 1966 through November 2014. Pooled prevalence and 95% confidence intervals (CIs) were calculated for these outcomes, and sensitivity, subgroup, and meta-regression analyses were conducted.

RESULTS

We analyzed 14 studies, which included a total of 8492 patients. The pooled prevalence of recurrent AP was 22% (95% CI, 18%-26%), and the pooled prevalence of CP was 10% (95% CI, 6%-15%). Sensitivity analyses yielded a pooled prevalence of CP of 10% (95% CI, 4%-19%) and 36% (95% CI, 20%-53%) in patients after the first occurrence and recurrent AP, respectively. Subgroup analyses found alcohol use and smoking to be the largest risk factors for the development of CP, with pooled prevalence values of 65% (95% CI, 48%-56%) and 61% (95% CI, 47%-73%), respectively. Meta-regression analysis found that men were more likely than women to transition from AP to CP.

CONCLUSIONS

Ten percent of patients with a first episode of AP and 36% of patients with recurrent AP develop CP; the risk is higher among smokers, alcoholics, and men. Prospective clinical studies are needed to study pancreatitis progression.

Comparative study of clinical efficacy of laparoscopy-assisted radical gastrectomy versus open radical gastrectomy for advanced gastric cancer

The purpose of this study is to compare the efficacy of laparoscopy-assisted radical gastrectomy (LARG) versus that of open radical gastrectomy (ORG). Clinical data of 355 patients who underwent radical gastrectomy (160 in the LARG group and 195 in the ORG group) were analyzed retrospectively. Efficacy indices were compared and analyzed between the two groups. The operating time of LARG was longer than that of ORG (228.43 ± 34.77 versus 207.59 ± 28.39 min). However, patients in the LARG group lost less blood than did those in the ORG group (169.46 ± 82.92 versus 193.86 ± 82.09 mL), and more lymph nodes were removed in the LARG group (19.84 ± 4.7 versus 18.04 ± 4.14 per case). The recovery of intestinal function was faster (3.72 ± 1.03 versus 4.41 ± 1.30 days) in the LARG group. Patients in the LARG group were administered a semi-fluid diet earlier (5.66 ± 2.27 versus 7.09 ± 2.33 days) and had a shorter hospital stay (9.44 ± 3.06 versus 11.07 ± 7.91 days) than did those in the ORG group, and these differences were statistically significant (P < 0.05). No significant differences were found in the length of proximal and distal resection margin and the incidence of complications (P > 0.05) between the two groups. Thus, LARG is safe, feasible, and effective for treating advanced gastric cancer.

Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis

BACKGROUND

The gut is implicated in the pathogenesis of acute pancreatitis but there is discrepancy between individual studies regarding the prevalence of gut barrier dysfunction in patients with acute pancreatitis. The aim of this study was to determine the prevalence of gut barrier dysfunction in acute pancreatitis, the effect of different co-variables, and changes in gut barrier function associated with the use of various therapeutic modalities.

METHODS

A literature search was performed using PRISMA and MOOSE guidelines. Summary estimates were presented as pooled prevalence of gut barrier dysfunction and the associated 95 per cent c.i.

RESULTS

A total of 44 prospective clinical studies were included in the systematic review, of which 18 studies were subjected to meta-analysis. The pooled prevalence of gut barrier dysfunction was 59 (95 per cent c.i. 48 to 70) per cent; the prevalence was not significantly affected by disease severity, timing of assessment after hospital admission or type of test used, but showed a statistically significant association with age. Overall, nine of 13 randomized clinical trials reported a significant improvement in gut barrier function following intervention compared with the control group, but only three of six studies that used standard enteral nutrition reported a statistically significant improvement in gut barrier function after intervention.

CONCLUSION

Gut barrier dysfunction is present in three of five patients with acute pancreatitis, and the prevalence is affected by patient age but not by disease severity. Clinical studies are needed to evaluate the effect of enteral nutrition on gut function in acute pancreatitis.

Role of magnetic resonance imaging in the detection of local prostate cancer recurrence after external beam radiotherapy and radical prostatectomy

AIMS

To carry out a meta-analysis to assess the effectiveness of magnetic resonance imaging (MRI) during the follow-up of patients with prostate cancer after undergoing external beam radiotherapy (EBRT) or radical prostatectomy.

MATERIALS AND METHODS

MEDLINE, EMBASE and other databases were searched for relevant original articles published from January 1995 to October 2011. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Pooled estimation and subgroup analysis data were obtained by statistical analysis.

RESULTS

Fourteen of 768 initially identified studies were included in the meta-analysis. Seven studies examining patient after radical prostatectomy had a pooled sensitivity and specificity on the patient level of 82% (95% confidence interval 78-86%) and 87% (95% confidence interval 81-92%), respectively. In the subgroup analysis, compared with T2-weighted imaging (T2WI), dynamic contrast-enhanced (DCE) MRI showed higher pooled sensitivity (85%, 95% confidence interval 78-90%) and specificity (95%, 95% confidence interval 88-99%). DCE MRI combined with magnetic resonance spectroscopic imaging (1H-MRSI) had the highest pooled sensitivity (92%, 95% confidence interval 83-97%). Nine studies examining men after EBRT had a pooled sensitivity and specificity on the patient level of 82% (95% confidence interval 75-88%) and 74% (95% confidence interval 64-82%), respectively. Compared with T2WI, DCE MRI showed higher pooled sensitivity (90%, 95% confidence interval 77-97%) and specificity (81%, 95% confidence interval 64-93%). DCE combined with 1H-MRSI had the highest pooled specificity (90%, 95% confidence interval 56-100%). The pooled sensitivity and specificity on sextant analysis was 58% (95% confidence interval 53-64%) and 85% (95% confidence interval 82-88%), respectively. DCE MRI showed the highest pooled sensitivity: 71% (95% confidence interval 60-80%).

CONCLUSION

A limited number of small studies suggest that MRI can accurately detect local recurrences after EBRT and radical prostatectomy. DCE MRI is particularly accurate. The addition of MRSI to DCE MRI can significantly improve the diagnostic accuracy of local prostate cancer recurrence. The eventual role of 1H-MRSI alone remains controversial and needs to be defined further.

MMP2 promoter polymorphism (C-1306T) and risk of recurrence in patients with hepatocellular carcinoma after transplantation

Genetic variants in matrix metalloproteinase (MMP) gene may influence the biological function of these enzymes and change their role in carcinogenesis and progression. The effect of MMP2 C-1306T and MMP9 C-1562T polymorphisms on genetic susceptibility has been investigated in various kinds of cancer. However, the relationship between these polymorphisms and risk of recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) has not been reported. The present study was designed to investigate the association of these two loci with the risk of HCC recurrence in 93 HCC patients treated with LT. Genotyping was performed using direct DNA sequencing. For MMP2 C-1306T variant, patients with CT heterozygous conferred a 58% reduction in recurrence risk (risk ratio: 0.419; 95% confidence interval: 0.177-0.994). The mean recurrence-free survival for CT genotype was significantly longer than that for homozygous CC patients (30.4 vs 19.3 months, p = 0.019). However, no association was found between MMP9 C-1562T polymorphisms and recurrence of HCC (p = 0.259). These findings suggest that MMP2 promoter polymorphisms may provide some predictive value for HCC recurrence after LT.

A minimally invasive model of myocardial infarction made by video-assisted thoracoscopic surgery

The general myocardial infarction model was made by ligating the left anterior descending coronary artery through traditional large opening thoracotomy, although there were many drawbacks such as severe injuries and pain in this method. The present study tried to find a new method to establish a minimally invasive canine model of myocardial infarction that was less injurious and more accurate. Twelve mongrel dogs were used in this study. After three 10-mm-long incisions were made on the left thoracic wall, pericardium was cut, left anterior descending coronary artery was found and titanium nips were clamped through video-assisted thoracoscopy. Two or three titanium nips were used until ECG showed a definite ST-segment elevation more than 0.1 mV, then the thoracic wall was sutured. The survival time of the dogs was 4 weeks. During this period, a series of thoracoscopy were performed. White blood count, biochemical analysis of oxidatively modified proteins, creatine kinase and cardiac Troponin I were examined at the baseline and in the 1st and 6th hour, and 1st, 4th, 7th, 14th and 28th day after surgery. The dogs were then killed and the ratio of fibrosis area to whole left ventricular area was measured and calculated to assess the extent of fibrosis. The sections from different parts of the heart were stained with Masson trichrome stain to assess degree of fibrosis. In the model group we observed that ST-segment of ECG elevated more than 0.1 mV instantly when titanium nips were clamped and the elevation could last for 28 days after surgery. Significant difference between the model and control group was discerned in white blood count, the levels of oxidatively modified proteins, creatine kinase, cardiac Troponin I and the ratio of fibrosis area to whole left ventricular area. Masson trichrome staining showed a large amount of collagen deposition in the fibrosis area. All these results demonstrated that a new canine model of myocardial infarction could be established with a minimally invasive procedure through video-assisted thoracoscopy. This minimally invasive pharmacological animal model was perhaps a more promising animal model for some newly rising science fields such as the study of Metabonomics.

Cloning and characterization of leaf cDNAs that are differentially expressed between wheat hybrids and their parents

Previous studies have shown that heterosis is associated with differential gene expression between hybrids and their parents. In this study, we performed a screen for genes that are differentially expressed between wheat hybrids and their parents in jointing-stage leaves and flag leaves using the differential display technique. Twenty-four differentially expressed cDNA were cloned and sequenced, and their expression patterns were confirmed by reverse-Northern blotting. Sequence analysis and database searches revealed that among the genes that showed differential expression between hybrid and parents were transcription factor genes and genes involved in metabolism, signal transduction, disease resistance, and retrotransposons. These results indicate that hybridization between two parental lines can cause changes in the expression of a variety of genes, and it is concluded that the altered pattern of gene expression in the hybrid may be responsible for the observed heterosis.

Efficiency and structure-activity relationship of the antioxidant action of resveratrol and its analogs

Resveratrol and its analogs, six other polyhydroxystilbenes, were synthesized and their antioxidative activities were evaluated in vitro by determination of the levels of malondialdehyde and hydrogen peroxide. Results clearly exhibited that resveratrol and its analogs had various potencies in inhibiting lipid peroxidation in rat brain, kidney, and liver homogenates and rat erythrocyte hemolysis. Several polyhydroxystilbenes were found to be more active than resveratrol in these models, and structure-activity relationship studies on polyhydroxystilbenes are described in this paper.

[Experimental studies of antitumor effect of artesunate on liver cancer]

OBJECTIVE

To observe the inhibiting effect of Artesunate on liver cancer in vitro and in vivo.

METHOD

The mice bearing H22 solid and ascitic liver tumor were applied in vivo experiments. Microculture tetrazolium assay and colony-forming unit assay were applied to test the cytotoxicity to human hepatocarcinoma SMMC-7721 cell line in vitro.

RESULT

The growth of solid tumor were obviously inhibited by Artesunate at the dose of 300 mg.kg-1.d-1 ig for 7 days. The tumor inhibiting rates of Artesunate were 49.1%, 48.7%, 46.6% in 3 experiments respectively. After administration of Artesunate, the survival rate of the mice bearing H22 ascitic liver tumor were increased to 45%. Compared with the control groups, the difference was statistically significant (P < 0.01). In additional, Artesunate can synergize the antitumor activity of 5-fluorouracil. Artesunate showed evident cytotoxicity to human hepatocarcinoma SMMC-7721 cells, the IC50 of Artesunate being 2.07 micrograms.ml-1 in MTT experiment and 2.48 micrograms.ml-1 in colony-forming unit experiment.

CONCLUSION

Artesunate has marked antitumor activity in vitro and in vivo.

Interpenetration in [Cd(isonicotinate)2(1,2-bis(4-pyridyl)-ethane)0.5(H2O)]n, a novel octahedral polymer containing an unusual two-dimensional bilayer motif generated by self-assembly of rectangle building blocks

A hydrothermally synthesized mixed-ligand molecular solid composed of pillared bilayers has been formulated; it presents a new remarkable three-dimensional architecture sustained by the catenation of two-fold decked layers, and exhibits intense photoluminescence upon photoexcitation at 314 nm.

[Relationship between differential expression patterns of multigene families and heterosis in a wheat diallel crosses]

In order to understand molecular basis of heterosis, the patterns of differential gene expression of multigene families between wheat hybrids and their parents in seedling leaves were analyzed by using mRNA differential display. Relationships between differential gene expression patterns, heterosis and F1 hybrid performance were determined. Four patterns of differential gene expression were observed, which include: (1) bands observed in both parents but not in the F1; (2) bands occurring in only one parent but not in the F1 or the other parent; (3) bands detected in only the F1 but neither of the parents; (4) bands present in one parent and F1 but absent in the other parent. The analysis showed that patterns of differential gene expression were not correlated with the F1 hybrid performance for all the eight agronomic traits. However, differentially expressed fragments that occurred only in the F1 but neither of the parents were found to be positively correlated with heterosis. On the contrary, fragments observed in both parents but not in the F1 were negatively correlated with heterosis. It is concluded that the differential expression of regulatory genes plays an important role in heterosis.

Oxidative reactivity of S-nitrosoglutathione with Hantzsch 1,4-dihydropyridine

[formula: see text] S-Nitrosoglutathione oxidized 4-substituted Hantzsch 1,4-dihydropyridines in CH3CN/H2O or CH3CN/phosphate aqueous buffer solution to give aromatic products in various yields.

Remarkable enhancement of antioxidant activity of vitamin C in an artificial bilayer by making it lipo-soluble

The reaction kinetics between 4-palmitoyloxy-2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO-16) and vitamin C (VC) and its lipophilic derivative ascorbyl-6-palmitate (VC-16) was studied by stopped-flow ESR spectroscopy in a synthetic surfactant vesicle sodium 1-pentadecyl hexadecyl sulfate (SPHS). TEMPO-16 reacted with VC very slowly and showed a biphasic first-order kinetics with rate constants of 9.6 x 10(-4) and 2.5 x 10(-4) s-1, corresponding to diffusion of TEMPO-16 from the external monolayer of SPHS to the bulk water and flip-flop of TEMPO-16 from the internal to external monolayer of the vesicle, respectively. On the other hand, the reaction of TEMPO-16 with VC-16 was second-order and over three orders of magnitude faster than that with VC, presumably due to VC-16 induced fusion of the vesicle.

Insulin stimulates thyroid hormone receptor alpha gene expression in cultured bovine aortic endothelial cells

Thyroid hormones and insulin regulate numerous cell processes and potentially interact through the transcriptional regulation of key genes. For instance, thyroid hormones stimulate the transcription of the fatty acid synthase and malic enzyme genes in chick embryonic hepatocytes, while insulin amplifies these effects. It is possible that insulin augments these actions of thyroid hormone by stimulating production of the thyroid hormone nuclear receptor (TR). In these studies, we examined the regulation of TR production/gene expression by insulin in bovine aortic endothelial cells (BAEC). We demonstrate that insulin significantly stimulates the gene expression of the TR alpha receptor, from BAEC. Insulin causes a maximal threefold induction above control TR alpha steady state mRNA levels in time and dose-related fashion in these cells. The increased mRNA mainly resulted from a twofold increase in transcription, as determined by nuclear run on. Insulin also increases thyroid receptor number and thyroid hormone binding, determined by Scatchard analysis of competitive inhibition binding studies. An established observation is that insulin can synergistically augment thyroid hormone-induced transcriptional activation of several important genes. It has also been previously determined that thyroid hormone action correlates closely to TR nuclear receptor number. Therefore, our studies, which show that insulin stimulates TR alpha production, suggests a potential mechanism whereby insulin can augment thyroid hormone transcriptional action.

Studies on bio-antioxidants--micellar effects on the reduction of nitroxides by vitamin C

The kinetics of reduction of nitroxides including 4-hydroxy-TEMPO, 4-methoxy-TEMPO and 4-hexanoyloxy-TEMPO, which are of different lipophilicities, by vitamin C in cationic, non-ionic and anionic micelles, i.e. CTAB, Triton X-100 and SDS, respectively, have been studied by FSR spectroscopy by a stopped-flow technique. A mechanism for the reaction conducted in micelles is proposed and the rate constants for the elementary reactions are evaluated. It is found that the rates of single electron transfer reactions involving the nitroxides are dependent on the nature of the micelle and the lipophilicity of the nitroxide. The rates are increased in CTAB, decreased in SDS, whereas unaffected in Triton X-100. And the greater the lipophilicity of the nitroxide, the more pronounced the rate variation. As high as a 3600-fold increase in the rate was observed for 4-hexanoyloxy-TEMPO in CTAB over that in SDS. The micellar effects are rationalized on the basis of analysis of parameters and line shape of the ESR spectra for the nitroxides in the micelles.