The value of quantitative contrast-enhanced ultrasonography analysis in evaluating central retinal artery microcirculation in patients with diabetes mellitus: comparison with colour Doppler imaging

AIM

To compare the efficacy of quantitative contrast-enhanced ultrasonography (CEUS) analysis and colour Doppler ultrasound (CDU) in evaluating central retinal artery (CRA) microcirculation in patients with diabetes mellitus (DM).

MATERIALS AND METHODS

In this prospective study, a total of 55 patients (98 eyes) with DM were enrolled as the study group. They were compared to 46 age-matched healthy volunteers (92 eyes) who were selected as the control group. Each patient underwent CDU and subsequent CEUS examination. CDU and quantitative CEUS parameters were evaluated. The diagnostic efficiency of the diagnostic performance of CEUS and CDU was evaluated and compared, and the scale thresholds of predictive indicators for the diagnosis of proliferative diabetic retinopathy (PDR) were evaluated using receiver operating characteristics (ROC) curve analyses.

RESULTS

Group pairwise comparisons showed that the end diastolic velocity (EDV) and arrival time (AT) of CRA were significant predictors for PDR by CDU and by quantitative CEUS analysis, respectively (all p<0.05). The ROC curve analysis showed that the area under the curve value of AT was significantly higher than that of EDV (0.875 versus 0.634, p=0.0002). Accordingly, an AT cut-off value of 1.07 seconds resulted a sensitivity of 90.62 % and a specificity of 79.31 %.

CONCLUSION

Quantitative CEUS analysis can improve the accuracy of clinical staging of diabetic retinopathy for the patients with DM, and the AT showed the best diagnostic efficiency.

[Clinical study on early predictors of concurrent bile duct injury following TACE in patients with liver cancer]

Objective: To explore the predictive factors of concurrent bile duct injury following transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods: A retrospective study was conducted on 483 HCC patients in relation to TACE postoperative complications. A total of 21 cases of bile duct injury were observed following the TACE procedure. Laboratory data, imaging data, and clinically relevant medical histories were recorded before and after one week following the TACE procedure and follow-up. The χ (2) test, or Fisher's exact probability method, was used for categorical variables. The mean of the two samples was compared using a paired t-test or Wilcoxon rank sum test. The comparison of multiple mean values was conducted using an analysis of variance. Results: Twenty-one cases with bile duct injury had intrahepatic bile duct dilatation, bile tumors, hilar biliary duct stenoses, and other manifestations. 14.3% (3/21) of patients showed linear high-density shadows along the bile duct on a plain CT scan, while 76.2% (16/21) of patients had ALP > 200 U/L one week following TACE procedure, and bile duct injury occurred in later follow-up. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transferase (GGT) were significantly increased in all patients following TACE procedure (t = -2.721, P = 0.014; t = -2.674, P = 0.015; t = -3.079, P = 0.006; t = -3.377, P = 0.003, respectively). Conclusion: The deposition of iodized oil around the bile duct on plain CT scan presentation or the continuous increase of ALP (> 200 U/L) one week following TACE procedure has a certain predictive value for the later bile duct injury.

[Efficacy of alcohol septal ablation in mildly symptomatic or severely symptomatic patients with hypertrophic obstructive cardiomyopathy]

Objective: To compare the prognosis of mildly or severely symptomatic patients with obstructive hypertrophic cardiomyopathy (OHCM) who underwent alcohol septal ablation (ASA). Methods: This retrospective study cohort consisted of patients with OHCM who received ASA treatment in Beijing Anzhen Hospital, Capital Medical University from March 2001 to August 2021. These patients were divided into mildly and severely symptomatic groups according to the severity of clinical symptoms. Long-term follow-up was conducted, and the following data were collected: duration of follow-up, postoperatire treatment, New York Heart Association (NYHA) classification, arrhythmia events and pacemaker implantation, echocardiographic parameters, and cause of death. Overall survival and survival free from OHCM-related death were observed, and the improvement of clinical symptoms and resting left ventricular outflow tract gradient (LVOTG) and the incidence of new-onset atrial fibrillation were evaluated. The Kaplan-Meier method and log-rank test were used to determine and compare the cumulative survival rates of the different groups. Cox regression analysis models were used to determine predictors of clinical events. Results: A total of 189 OHCM patients were included in this study, including 68 in the mildly symptomatic group and 121 in the severely symptomatic group. The median follow-up of the study was 6.0 (2.7, 10.6) years. There was no statistical difference in overall survival between the mildly symptomatic group (5-year and 10-year overall survival were 97.0% and 94.4%, respectively) and the severely symptomatic group (5-year and 10-year overall survival were 94.2% and 83.9%, respectively, P=0.405); there was also no statistical difference in survival free from OHCM-related death between the mildly symptomatic group (5-year and 10-year survival free from HCM-related death were 97.0% and 94.4%, respectively) and the severely symptomatic group (5-year and 10-year survival free from HCM-related death were 95.2% and 92.6%, respectively, P=0.846). In the mildly symptomatic group, NYHA classification was improved after ASA (P<0.001), among which 37 patients (54.4%) were in NYHA class Ⅰ, and the resting left ventricular outflow tract gradient (LVOTG) decreased from 67.6 (42.7, 90.1) mmHg (1 mmHg=0.133 kPa) to 24.4 (11.7, 35.6) mmHg (P<0.001). In severely symptomatic group, NYHA classification was also improved post ASA (P<0.001), among which 96 patients (79.3%) improved by at least one NYHA classification, and the resting LVOTG decreased from 69.6 (38.4, 96.1) mmHg to 19.0 (10.6, 39.8) mmHg (P<0.001). The incidence of new-onset atrial fibrillation was similar between the mildly and severely symptomatic groups (10.2% vs. 13.3%, P=0.565). Cox multivariate regression analysis showed that age was an independent predictor of all-cause mortality in OHCM patients post ASA (HR=1.068, 95%CI 1.002-1.139, P=0.042). Conclusions: Among patients with OHCM treated with ASA, overall survival and survival free from HCM-related death were similar between mildly symptomatic group and severely symptomatic group. ASA therapy can effectively relieve resting LVOTG and improve clinical symptoms in mildly or severely symptomatic patients with OHCM. Age was an independent predictor of all-cause mortality in OHCM patients post ASA.

[Two cases of airway dysfunction related to diacetyl exposure]

Occupational exposure to diacetyl can lead to bronchiolitis obliterans. In this paper, two patients with severe obstructive ventilation disorder who were exposed to diacetyl at a fragrance and flavours factory were analyzed. The clinical manifestations were cough and shortness of breath. One of them showed Mosaic shadows and uneven perfusion in both lungs on CT, while the other was normal. Field investigation found that 4 of the 8 workers in the factory were found to have obstructive ventilation disorder, and 2 had small airway dysfunction. This paper summarizes the diagnostic process of patients in order to improve the understanding of airway dysfunction caused by occupational exposure to diacetyl and promote the development of relevant standards.

[Survival analysis of patients with intrahepatic cholangiocarcinoma treated with adjuvant chemotherapy after radical resection based on CoxPH model and deep learning algorithm]

Objective: To establish a predictive model for survival benefit of patients with intrahepatic cholangiocarcinoma (ICC) who received adjuvant chemotherapy after radical resection. Methods: The clinical and pathological data of 249 patients with ICC who underwent radical resection and adjuvant chemotherapy at 8 hospitals in China from January 2010 to December 2018 were retrospectively collected. There were 121 males and 128 females,with 88 cases>60 years old and 161 cases≤60 years old. Feature selection was performed by univariate and multivariate Cox regression analysis. Overall survival time and survival status were used as outcome indicators,then target clinical features were selected. Patients were stratified into high-risk group and low-risk group,survival differences between the two groups were analyzed. Using the selected clinical features, the traditional CoxPH model and deep learning DeepSurv survival prediction model were constructed, and the performance of the models were evaluated according to concordance index(C-index). Results: Portal vein invasion, carcinoembryonic antigen>5 μg/L,abnormal lymphocyte count, low grade tumor pathological differentiation and positive lymph nodes>0 were independent adverse prognostic factors for overall survival in 249 patients with adjuvant chemotherapy after radical resection (all P<0.05). The survival benefit of adjuvant chemotherapy in the high-risk group was significantly lower than that in the low-risk group (P<0.05). Using the above five features, the traditional CoxPH model and the deep learning DeepSurv survival prediction model were constructed. The C-index values of the training set were 0.687 and 0.770, and the C-index values of the test set were 0.606 and 0.763,respectively. Conclusion: Compared with the traditional Cox model, the DeepSurv model can more accurately predict the survival probability of patients with ICC undergoing adjuvant chemotherapy at a certain time point, and more accurately judge the survival benefit of adjuvant chemotherapy.

[A nomogram for preoperative prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma based on inflammation-related markers]

Objectives: To construct a nomogram for prediction of intrahepatic cholangiocarcinoma (ICC) lymph node metastasis based on inflammation-related markers,and to conduct its clinical verification. Methods: Clinical and pathological data of 858 ICC patients who underwent radical resection were retrospectively collected at 10 domestic tertiary hospitals in China from January 2010 to December 2018. Among the 508 patients who underwent lymph node dissection,207 cases had complete variable clinical data for constructing the nomogram,including 84 males,123 females,109 patients≥60 years old,98 patients<60 years old and 69 patients were pathologically diagnosed with positive lymph nodes after surgery. Receiver operating characteristic curve was drawn to calculate the accuracy of preoperative imaging examinations to determine lymph node status,and the difference in overall survival time was compared by Log-rank test. Partial regression squares and statistically significant preoperative variables were screened by backward stepwise regression analysis. R software was applied to construct a nomogram,clinical decision curve and clinical influence curve,and Bootstrap method was used for internal verification. Moreover,retrospectively collecting clinical information of 107 ICC patients with intraoperative lymph node dissection admitted to 9 tertiary hospitals in China from January 2019 to June 2021 was for external verification to verify the accuracy of the nomogram. 80 patients with complete clinical data but without lymph node dissection were divided into lymph node metastasis high-risk group and low-risk group according to the score of the nomogram among the 858 patients. Log-rank test was used to compare the overall survival of patients with or without lymph node metastasis diagnosed by pathology. Results: The area under the curve of preoperative imaging examinations for lymph node status assessment of 440 patients was 0.615,with a false negative rate of 62.8% (113/180) and a false positive rate of 14.2% (37/260). The median survival time of 207 patients used to construct a nomogram with positive or negative postoperative pathological lymph node metastases was 18.5 months and 27.1 months,respectively (P<0.05). Five variables related to lymph node metastasis were screened out by backward stepwise regression analysis,which were combined calculi,neutrophil/lymphocyte ratio,albumin,liver capsule invasion and systemic immune inflammation index,according to which a nomogram was constructed with concordance index(C-index) of 0.737 (95%CI: 0.667 to 0.806). The C-index of external verification was 0.674 (95%CI:0.569 to 0.779). The calibration prediction curve was in good agreement with the reference curve. The results of the clinical decision curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.32,the maximum net benefit could be obtained by 0.11,and the cost/benefit ratio was 1∶2. The results of clinical influence curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.6,the probability of correctly predicting lymph node metastasis could reach more than 90%. There was no significant difference in overall survival time between patients with high/low risk of lymph node metastasis assessed by the nomogram and those with pathologically confirmed lymph node metastasis or without lymph node metastasis (Log-rank test:P=0.082 and 0.510,respectively). Conclusion: The prediction accuracy of preoperative nomogram for ICC lymph node metastasis based on inflammation-related markers is satisfactory,which can be used as a supplementary method for preoperative diagnosis of lymph node metastasis and is helpful for clinicians to make personalized decision of lymph node dissection for patients with ICC.

[Exploring the significance of chemotherapy in the perioperative application of biliary tract carcinomas]

Biliary tract cancer is extremely malignant with a poor prognosis. At the moment, the only curative method available is radical resection. Targeted and immunotherapy are currently advancing quickly, but chemotherapy still holds a key role in the perioperative management of biliary cancer. Perioperative chemotherapy aims to decrease tumor volume before surgery so that patients can have their tumors surgically removed or have a higher radical resection rate. It also aims to remove any tumor cells that remain after surgery and prevent the growth of new tumors. Chemotherapy-based combination treatment techniques have been increasingly investigated in recent years to improve perioperative care and patient survival. From the standpoint of chemotherapy regimens and clinical trial success in the perioperative phase of radical surgery, the value of chemotherapy in the perioperative period of biliary tract cancer were explored in this paper.

[Effect of deep dermal tissue dislocation injury on skin fibrosis in pig]

Objective: To explore the effect of deep dermal tissue dislocation injury on skin fibrosis in pig, in order to provide some theoretical basis for burn scar treatment. Methods: The experimental research method was applied. Six 2-month-old female Duroc pigs were taken. Fifteen operative areas on the right dorsum of pigs on which medium-thick skin grafts and deep dermal tissue slices were cut and re-implanted were included into dermal in situ reimplantation group, and fifteen operative areas on the left dorsum of pigs on which medium-thick skin grafts and deep dermal tissue slices were cut and the deep dermal tissue slice was placed under the fat layer were included into the dermal dislocation group. The hair growth in the operative areas on post-injury day (PID) 7, 14, and 21 and the cross-sectional structure on PID 14 were observed in the two groups. On PID 7, 14, and 21, the skin thickness (the distance from the epidermis to the upper edge of the fat), the dermal thickness (the distance from the lower edge of the epidermis to the upper edge of the fat, excluding the fibrotic tissue thickness between the dermis and the fat), and the fibrosis tissue thickness of the dermis-fat interface (from the lower edge of the deep dermis to the upper edge of the fat in dermal in situ reimplantation group and from the lower edge of the superficial dermis to the upper edge of the fat in dermal dislocation group) in the operative areas were measured and compared between the two groups; the fibrotic tissue thickness at the dermal cutting interface (from the lower edge of the superficial dermis to the upper edge of the deep dermis) in the operative areas in dermal in situ reimplantation group was measured and compared with the fibrotic tissue thickness at the dermal-fat interface. Sirius red staining was performed to observe and compare the type Ⅰ and Ⅲ collagen content in the dermal-fat interface in the operative areas between the 2 groups and between the dermal cutting interface and dermal-fat interface in the operative areas in dermal in situ reimplantation group. Immunohistochemical staining was performed to observe the positive expressions of proliferating cell nuclear antigen (PCNA), transforming growth factor β1 (TGF-β1), fibroblast growth factor 2 (FGF-2), and hepatocyte growth factor (HGF) in the operative areas in the two groups. The sample number was 6. Data were statistically analyzed with independent sample t test. Results: On PID 7, 14, and 21, the hairs in the operative areas in dermal in situ reimplantation group were denser than those in dermal dislocation group. On PID 14, the skin cross section in the operative areas in dermal dislocation group showed a "sandwich"-like structure, while the skin cross section in the operative areas in dermal in situ reimplantation group had normal structure. On PID 7, 14, and 21, the skin thickness in the operative areas in dermal dislocation group was (4 234±186), (4 688±360), and (4 548±360) μm, respectively, which was close to (4 425±156), (4 714±141), and (4 310±473) μm in dermal in situ reimplantation group (P>0.05); the dermal thickness in the operative areas in dermal dislocation group was significantly thinner than that in dermal in situ reimplantation group (with t values of -9.73, -15.85, and -15.41, respectively, P<0.01); the fibrotic tissue thickness at the dermal-fat interface in the operative areas in dermal dislocation group was significantly thicker than that in dermal in situ reimplantation group (with t values of 14.48, 20.58, and 15.67, respectively, P<0.01); there was no statistically significant difference between the fibrotic tissue thickness at the dermal-fat interface and the dermal cutting interface in the operative areas in dermal in situ reimplantation group (P>0.05). On PID 7, 14, 21, the type Ⅲ collagen content in the dermal-fat interface in the operative areas in dermal dislocation group was increased significantly compared with that in dermal in situ replantation group (with t values of 2.65, 0.61, and 7.39, respectively, P<0.05 or P<0.01), whereas there were no statistically significant differences in the type Ⅰ collagen content at the dermal-fat interface in the operative areas between the 2 groups (P>0.05) and the type Ⅰ and Ⅲ collagen content between the dermal-fat interface and the dermal cutting interface in the operative areas in dermal in situ reimplantation group (P>0.05). On PID 7, 14, and 21, PCNA, TGF-β1, FGF-2, and HGF were positively expressed in the superficial dermis and adipose tissue in the operative areas in dermal dislocation group, while PCNA, TGF-β1, FGF-2, and HGF were positively expressed in the superficial dermis, deep dermis, and adipose tissue in the operative areas in dermal in situ reimplantation group. Conclusions: Inadequate intrinsic thickness of dermal tissue is the key factor causing fibrosis, and the biological purpose of fibrosis is to "compensate" the intrinsic thickness of the skin. Besides, adipose tissue may also be an important component of fibrotic skin repair.

[Therapeutic effects of alcohol septal ablation in mildly symptomatic patients with hypertrophic obstructive cardiomyopathy]

Objective: To observe the therapeutic effects of alcohol septal ablation (ASA) in mildly symptomatic patients (NYHA class Ⅱ) with hypertrophic obstructive cardiomyopathy(HOCM). Methods: This retrospective study included 150 mildly symptomatic patients with HOCM hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University from March 2001 to December 2017, consisting of medical therapy group (n=102) and ASA group (n=48). Baseline clinical data were collected, patients were followed up to a mean of 6.0 (3.5, 8.1) years. Overall and HCM-related mortality events (including chronic heart failure, atrial fibrillation related stroke, sudden cardiac death) were observed in the two groups. Moreover, the improvement of NYHA function classification and left ventricular outflow tract gradient (LVOTG) were also evaluated. Survival analysis was performed by Kaplan-Meier method. Results: Age of this cohort was (52.9±14.5)years, 92 cases(61.3%) were male. In the follow-up, LVOTG was reduced from (85.8±35.4)mmHg (1 mmHg=0.133 kPa) to (27.7±19.8)mmHg (P<0.001) in the ASA group, and from (66.3±35.0)mmHg to (56.5±27.7)mmHg in medical therapy group(P<0.01). At the last clinical follow-up, there were 32 patients (66.7%) whose LVOTG were<30 mmHg, septal thickness decreased from (20.3±3.8)mm to (16.1±3.4)mm (P<0.001), NYHA classification was also remarkably improved (P<0.001). New-onset atrial fibrillation tended to be lower in the ASA group compared to medical therapy group (9.3%(4/43) vs. 20.8%(20/96),P=0.096). Eleven patients (10.8%) in the medical therapy group and 2 patients (4.2%) in the ASA group died during the follow-up. One patient received pacemaker during the peri-procedural period, 1 patient was implanted with two-chamber pacemaker due to Ⅲ° atrioventricular block at 10 years after operation in the ASA group. Survival free of all-cause mortality of ASA group at 5 and 10 years was 97.9% and 97.9%, respectively, which was comparable to the medical therapy group (P=0.231). Survival free of HCM-related mortality was similar between the two groups (P=0.397). Conclusions: Compared with medical therapy in mildly symptomatic patients with HOCM, long-term survival rate is similar after ASA. Meanwhile, ASA can remarkably reduce LVOTG and improve the clinical status of the patients. Therefore, ASA may be used as an alternative therapy for mildly symptomatic HOCM patients.

[Significance of combination of targeted therapy and immunotherapy in conversion therapy of biliary tract cancer]

Biliary tract cancer has insidious onset and high degree of malignancy, and radical resection is often impossible when it is diagnosed.Conversion therapy can achieve tumor downgrading, so that patients who were initially unresectable have a chance to achieve R0 resection.However, due to the high heterogeneity and complex immune microenvironment of biliary tract cancer, conversion therapy is still in the stage of active exploration.As a new type of conversion therapy, combination of targeted therapy and immunotherapy is of great significance to effectively improve the efficiency of conversion therapy.Further exploration of combination mechanism and improvement of immune microenvironment are expected to become the future direction of combination of targeted therapy and immunotherapy.

[Expression and significance of GLI1 and Shh in the malignant transformation of ovarian endometriosis]

Objective: To investigate the expression levels and clinical significance of glioma-associated oncogene homolog 1 (GLI1) and sonic hedgehog signaling molecule (Shh) in the malignant transformation of ovarian endometriosis (EM). Methods: The expressions of GLI1 and Shh were detected by real-time reverse transcription (RT)-polymerase chain reaction (PCR) and EnVision method in 50 cases of ovarian EM tissues, 35 cases of atypical endometriosis (aEM) and 50 cases of endometriosis-associated ovarian cancer (EAOC). The expression differences of two molecular markers in the malignant transformation of ovarian EM were compared, and the relationships between two molecular markers and the clinicopathological features and prognosis of EAOC were analyzed. Results: (1) RT-PCR showed that the expression levels of GLI1 mRNA in EM, aEM and EAOC group were 1.77±0.40, 3.54±0.44, and 7.80±0.24, respectively. The expression levels of Shh mRNA were 0.95±0.21, 3.14±0.35, and 5.41±0.31, respectively. GLI1 and Shh mRNA in EAOC group were significantly higher than those in EM and aEM group (all P<0.01), and there were statistically significant differences between EM and aEM group (all P<0.01). The percentages of GLI1 in ovarian EM, aEM and EAOC were 32% (16/50), 57% (20/35), and 66% (33/50), respectively, meanwhile, the positive expression rates of Shh were 20% (10/50), 49% (17/35), and 54% (27/50), respectively (all P<0.01). GLI1 mRNA expression was positively correlated with Shh mRNA expression in EAOC tissues (r=0.721, P<0.01). The expressions of GLI1 protein were proportionated to Shh protein in EAOC tissues (r=0.608,P=0.001). (2) The expression of GLI1 was significantly related to the International Federation of Gynecology and Obstetrics (FIGO) stage, cancer antigen 125 (CA₁₂₅) levels, lymph node metastasis, and Platinum resistance in EAOC patients (all P<0.05). The expression of Shh were related to FIGO stage and lymph node metastasis in EAOC patients (all P<0.05). Logistic regression analysis showed that GLI1 expression was an independent risk factor for poor prognosis in EAOC patients (P<0.05). Kaplan-meier survival analysis showed that the overall survival rate of EAOC patients with high GLI1 expression and low GLI1 expression was 12.1% and 35.3%, respectively, with statistical significance (χ²=10.73, P<0.01). The overall survival rate of EAOC patients with high and low expression of Shh protein was 11.1% and 30.4%, in which there was statistically significant difference (χ²=3.96, P=0.047). Conclusion: GLI1 and Shh are highly associated with the malignant transformation of ovarian EM, which may play a role in promoting malignant degeneration of ovarian EM, and the high expression of GLI1 and Shh indicates a poor prognosis in EAOC patients.

[The effect of chronic kidney disease on the long-term prognosis of patients with left main coronary artery disease after revascularization]

Objective: To analyze the effect of chronic kidney disease (CKD) on the long-term prognosis of patients with left main coronary artery disease after revascularization. Methods: A total of 1 040 patients with lesions in unprotected left main coronary artery who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) between January 2003 and July 2009 in Beijing An Zhen Hospital were enrolled (CKD group, n=240; non CKD group, n=800). The mean ages of CKD group and non CKD group were (68.9±6.5) and (61.1±9.7) years old, respectively. Patients were followed up through interviewing in clinic visit or calling by telephone. The primary endpoints of the study included death, myocardial infarction (MI) and stroke. Cox regression was used to analyze the associated factors on patients' long-term prognosis. Results: The median follow-up for included 1 040 patients was 6.1 years (first quartile Q₁, 5.1 years; Q₃, 8.0 years). The total occurrence of death, MI and stroke in the CKD group (48.9%, n=96) was significantly higher than that in the non CKD group (30.7%, n=136) (P<0.001). In the CKD group, the total occurrence of the death, MI and stroke was 51.2% in patients with PCI (n=46) compared to that of 47.2% in patients with CABG (n=50). In the non CKD group, the total occurrence of death, MI and stroke was 17.7% and 36.7% in patients with PCI (n=45) and CABG (n=91), respectively. Cox proportional hazards regression model analysis showed that after adjusted for confounding factors, the risk of all-cause death/MI/stroke [HR (95%CI): 1.97 (1.49-2.62)], all-cause death [2.67 (1.89-3.78)], cardiac death [3.46 (2.25-5.33)] and MI [2.31 (1.41-3.80)] increased in patients with CKD after revascularization. Conclusions: CKD significantly increases the occurrence of composite of death/MI/stroke, all-cause mortality, cardiac death and MI in patients with left main coronary artery disease after revascularization. There was no significant difference in the occurrence of the composite of death, MI and stroke between patients with PCI and those with CABG, regardless of in CKD group or non CKD group.

CircRNA_100395 protects breast carcinoma deterioration by targeting MAPK6

OBJECTIVE

This study aims to uncover the differential expression of circRNA_100395 in breast carcinoma specimens, and its regulatory effect on cancer cell phenotypes. The role of circRNA_100395 in affecting breast carcinoma progression and the molecular mechanism are explored as well.

PATIENTS AND METHODS

CircRNA_100395 expressions in breast carcinoma and paracancerous tissues were detected. The influence of circRNA_100395 level on clinical indicators of breast carcinoma patients was analyzed. In vitro regulations of circRNA_100395 on phenotypes of breast carcinoma cells were examined by CCK-8, colony formation, and transwell assay. The interaction between circRNA_100395 and MAPK6 was confirmed by Dual-Luciferase reporter assay and rescue assays.

RESULTS

CircRNA_100395 was downregulated in breast carcinoma tissues and cell lines. Its level was negatively correlated to tumor staging and tumor size of breast carcinoma. Overexpression of circRNA_100395 in SKBR3 and MDA-MB-231 cells weakened proliferative and migratory abilities. MAPK6 was the target gene of circRNA_100395. Overexpression of MAPK6 reversed the anti-cancer effect of circRNA_100395 on breast carcinoma.

CONCLUSIONS

CircRNA_100395 serves as an anti-cancer gene in breast carcinoma progression by targeting MAPK6, and its level is negatively correlated to tumor staging and tumor size of breast carcinoma. CircRNA_100395 can be utilized as a potential biomarker and therapeutic target of breast carcinoma.

[Opportunities and challenges of schistosomiasis control during the construction of the Chengdu-Chongqing economic circle]

Chengdu-Chongqing economic circle is centered on Chengdu City and Chongqing Municipality, with aims to build the "fourth growth pole" of China's economy. During this circle, elimination of schistosomiasis had been achieved in 82.5% of the endemic counties (districts) of Sichuan Province, and schistosomiasis is not historically endemic in Chongqing Municipality; however, there is still a risk of schistosmiasis transmission in Sichuan Province and Chongqing Municipality because the natural and social factors affecting schistosomiasis transmission have not been completely eliminated in these areas. Based on the endemic situation of schistosomiasis in Sichuan Province and Chongqing Municipality, we analyzed the opportunities and challenges of schistosomiasis control during the construction of Chengdu-Chongqing economic circle, and proposed the corresponding suggestions, so as to provide insights into the sustainable development of schistosomiasis control in the context of the Chengdu-Chongqing economic circle construction.

[Conversion therapy of biliary tract cancer from the perspective of tumor heterogeneity]

Biliary tract cancer is found in the middle and advanced stages mostly and patients will deprive surgical indications. Conversion therapy can make the stage of some patients down and thus make radical resection feasible. Biliary tract cancer is highly heterogeneous in clinical features, cell origin, histology, molecular biology and other aspects, resulting in a lack of specific and effective conversion therapy strategies. Currently, it is the important development direction to evaluate and classify different individual conditions and select individualized conversion therapy regimens. With the deepening of the research on the pathogenesis and the improvement of treatment protocols, the future conversion therapy will undoubtedly develop towards the direction of individualization and precision.

[Long-term outcomes and risk factors of ostial/shaft lesions in unprotected left main coronary artery after percutaneous coronary intervention]

Objective: To evaluate the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/shaft lesions in patients with unprotected left main coronary artery (ULMCA). Method: A total of 271 patients with isolated ostial/midshaft lesions in unprotected left main coronary artery who received drug-eluting stents (DES) implantation between January 2003 and July 2009 in Beijing An Zhen Hospital were consecutively enrolled . The endpoints of the study were all-cause death, repeat revascularization, myocardial infarction (MI) and stroke. Cox regression was carried out to analyze the all-cause mortality. Meanwhile, multivariate logistic regression analysis was performed to determine the independent risk factors of all-cause death. Results: The mean age of the patients was (62±10) years, and 201 of them (74.2%) were male. The median follow-up was 12.5 years (interquartile range: 10.1-14.5 years). During the follow-up, 46 patients (17.0%) died, of whom 20 (7.4%) died of a cardiovascular cause. A total of 38 (14.0%) cases suffered a MI, and 15 (5.5%) cases suffered a stroke. Repeat revascularization was performed in 63 (23.2%) cases. Multivariate logistic regression analysis showed that age (HR=1.041, 95%CI: 1.003-1.081, P=0.033), creatinine (HR=1.028, 95%CI:1.014-1.042, P<0.001) and diabetes mellitus (HR=1.924,95%CI: 1.053-3.514, P=0.033) were independent risk factors of all-cause death, whereas left ventricular ejection fraction (LVEF) (HR=0.972, 95%CI:0.953-0.992, P=0.007) was a protective factor. Conclusions: During a median follow-up of 12.5 years, the prognosis of PCI for left main ostium/shaft lesion was good. Age, creatinine and diabetes mellitus are independent risk factors of all-cause death.

Long noncoding RNA OR3A4 promotes the migration and invasion of melanoma through the PI3K/AKT signaling pathway

OBJECTIVE

Recent studies have revealed the crucial role of long non-coding RNAs (lncRNAs) in tumor progression. This study aims to identify the biological function of lncRNA OR3A4 in the progression of melanoma.

PATIENTS AND METHODS

OR3A4 expression in melanoma cells and tissue samples was detected by Real Time-quantitative Polymerase Chain Reaction (RT-qPCR). The regulatory effects of OR3A4 on melanoma cells were identified by performing transwell assay and wound healing assay in vitro. The underlying mechanism of OR3A4 in mediating the progression of melanoma was explored by RT-qPCR and Western blot.

RESULTS

OR3A4 expression was remarkably upregulated in melanoma tissues compared with normal tissues. Moreover, migration and invasion of melanoma cells were inhibited after knockdown of OR3A4 in vitro, which were promoted after overexpression of OR3A4. Furthermore, the targeted proteins in phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling pathway were downregulated after knockdown of OR3A4 in vitro, which were upregulated by overexpressed OR3A4.

CONCLUSIONS

OR3A4 could promote the invasion and migration of melanoma cells by inducing the PI3K/AKT signaling pathway, which may offer a new therapeutic intervention for melanoma patients.

Long noncoding RNA OR3A4 promotes the migration and invasion of melanoma through the PI3K/AKT signaling pathway

The article "Long noncoding RNA OR3A4 promotes the migration and invasion of melanoma through the PI3K/AKT signaling pathway, by J. Wu, M.-Y. Zhou, X.-P. Yu, Y. Wu, P.-L. Xie, published in Eur Rev Med Pharmacol Sci 2019; 23 (16): 6991-6996-DOI: 10.26355/eurrev_201908_18739-PMID: 31486499" has been withdrawn from the authors. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/18739.

[Long-term prognosis of drug eluting stents implantation in elderly patients with unprotected left main coronary artery disease]

Objective: To analyze the clinical characteristics and long-term prognosis of implantation of drug-eluting stents (DES) for elderly patients with unprotected left main artery (ULM) disease. Methods: A total of 414 patients (327 males and 87 females) who underwent DES implantation were enrolled in the Department of Cardiology, Beijing Anzhen Hospital from January 2005 to March 2010, with a mean age of (61.5±10.7) years old. The patients were divided into two groups according to age: 300 cases in the group of age <70 years old, and 114 cases in the group of age ≥70 years old. The clinical characteristics and long-term prognosis of two groups were compared. Results: In the group of age ≥ 70 years old, the proportion of female was higher (31.6% vs 17.0%, P=0.001) and the incidence of chronic total occlusion (CTO) (P=0.020), hypertension (P=0.018) and cerebrovascular disease (P=0.013) were higher than those in the group of <70 years old. All-cause mortality and cardiac mortality were also higher than those in the group of <70 years old (P=0.025, P=0.013). The follow-up period was (21.4±9.6) months. After adjusting for multiple clinical factors, there were no statistical differences of incidence of the total major adverse cardiac and cerebral events (MACCE), myocardial infarction, cerebrovascular events, and revascularization recurrence between the two groups. But all-cause mortality (HR=3.790, 95%CI: 1.271-11.298, P=0.017) and cardiac mortality (HR=17.424, 95%CI: 2.440-124.410, P=0.004) in the group of age ≥70 years old were still remarkably higher than those in the group of <70 years old. Conclusions: Age is an independent risk factor for increased mortality after DES stent implantation in ULM disease. DES stent implantation in age ≥70 years old patients with ULM disease is considered feasible, but it needs to be treated with caution.

[Long-term outcome comparison of ostial/shaft lesions in unprotected left main coronary artery treated by PCI or CABG]

Objective: To evaluate long-term clinical outcomes of consecutive patients treated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention(PCI) with drug-eluting stents(DES) for ostial/shaft lesions in unprotected left main coronary artery(ULMCA). Method: A total of 259 patients with isolated ostial/midshaft lesions in unprotected left main coronary artery were enrolled consecutively who received DES implantation or underwent CABG between January 2003 and July 2009 in Beijing Anzhen Hospital. The endpoints of the study were death, repeat revascularization, myocardial infarction (MI) and stroke. Time to the primary endpoint was evaluated according to the Kaplan-Meier method, and the log-rank test was applied to compare the incidence of the endpoint. Adjusted risks for adverse outcomes were compared by multivariate Cox proportional hazard regression analyses. Results: A total of 259 patients were included, including 149 in PCI group and 110 in CABG group. And 193(74.5%) cases were males.The age was (61.4±9.8) years old. The median follow-up was 10.1 years (interquartile range 8.3 to 11.2 years) in the overall patients. There were no significant difference for the incidence of death [37.0% vs. 43.1% ，P=0.143] , MI [34.0% vs. 19.4% ，P=0.866], stroke [6.4% vs. 11.7% ， P=0.732], repeart revascularization [33.6% vs. 39.9% ，P=0.522] between PCI group and CABG group before multivariate adjusting，according to the incidence calculated with Kaplan-Meier. After adjusting covariates such as age, left ventricular ejection fraction（LVEF） and serum creatine with multivariate Cox hazard regression model, there was still no significant difference between the two groups. Conclusions: PCI with DES is as effective and safe as CABG in patients with left main ostium/shaft lesion during a median follow-up of 10.1 years.

[Effects of pulse contour cardiac output monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage]

Objective: To analyze effects of pulse contour cardiac output (PiCCO) monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage. Methods: From November 2015 to November 2017, medical data of 52 patients with large area burn hospitalized in our unit, meeting the inclusion criteria, were analyzed retrospectively. Twenty-seven patients (18 males and 9 females) with age of (43±10)years in tradition group hospitalized from November 2015 to November 2016 were monitored by traditional monitoring methods for fluid resuscitation, and 25 patients (18 males and 7 females) with age of (44±10)years in PiCCO group hospitalized from December 2016 to November 2017 were monitored by traditional monitoring methods and PiCCO monitoring equipment for fluid resuscitation. Fluid infusion coefficients and total fluid replacement volume of patients in both groups at the first and second post burn hour (PBH) 24, as well as the levels of N terminal pro B type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and creatine kinase MB (CK-MB) immediately on admission and post burn day (PBD) 1, 2, 3, 4, 5, 6, and 7 were recorded. Data were processed with analysis of variance for repeated measurement, chi-square test, t test and Bonferroni correction, and Mann-Whitney U test and Bonferroni correction. Results: (1) The fluid infusion coefficients of patients in tradition group at the first and second PBH 24 were respectively (1.42±0.10) and (0.94±0.14)mL·kg(-1)·% total body surface area (TBSA)(-1), and those in PiCCO group were respectively (1.76±0.14) and (0.85±0.08) mL·kg(-1)·%TBSA(-1). Fluid infusion coefficient and total fluid replacement volume at the first PBH 24 of patients in PiCCO group were significantly higher than those in tradition group (t=-9.775, -4.769, P<0.01). Fluid infusion coefficient at the second PBH 24 of patients in PiCCO group was significantly lower than that in tradition group (t=2.682, P<0.05). There was no statistically significant difference in total fluid replacement volume at the second PBH 24 in patients between the two groups (t=1.167, P>0.05). (2) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of NT-proBNP of patients in tradition group were respectively 518 (320, 763), 236 (98, 250), 139 (62, 231), 172 (104, 185), 296 (225, 341), 727 (642, 921), 1 840 (1 357, 2 081), 1 005 (671, 1 297) pg/mL, and those in PiCCO group were respectively 444 (206, 601), 66 (29, 73), 54(28, 75), 139(101, 175), 199 (106, 279), 576 (333, 837), 833 (466, 1 080), 485 (225, 710) pg/mL. The levels of NT-proBNP of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (Z=-5.004, -3.967, -5.285, -4.626, P<0.01). The levels of NT-proBNP immediately on admission and PBD 3, 4, and 5 in patients between the two groups were close (Z=-0.834, -0.806, -2.665, -2.153, P>0.05). (3) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of cTnT of patients in tradition group were respectively (42±15), (21±12), (17±7), (11±4), (12±4), (94±32), (88±23), (42±23) pg/L, and those in PiCCO group were respectively (37±15), (9±3), (10±3), (13±3), (12±5), (85±30), (60±26), (22±14) pg/L. The levels of cTnT of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (t=5.227, 4.751, 4.239, 3.845, P<0.01). The levels of cTnT immediately on admission and PBD 3, 4, and 5 of patients between the two groups were close (t=1.098, -1.562, -0.117, 1.107, P>0.05). (4) The levels of CK-MB of patients in PiCCO group on PBD 3, 6, and 7 were significantly lower than those in tradition group (t=3.123, 4.103, 3.178, P<0.05 or P<0.01). The levels of CK-MB immediately on admission and PBD 1, 2, 4, and 5 in patients between the two groups were close (t=0.351, 1.868, 1.100, 0.798, 2.094, P>0.05). Conclusions: PiCCO monitoring technology can monitor and guide fluid resuscitation of patients with large area burn in the early stage more scientifically and reasonably, and the effect of reducing myocardial damage is better than traditional monitoring methods.

[Long-term outcomes of implanting drug-eluting stents for unprotected left main coronary artery disease patients with left ventricular systolic dysfunction]

Objective: To analyze the clinical characteristics and prognosis of implanting drug-eluting stents (DES) for unprotected left main (ULM) coronary artery disease patients with left ventricular systolic dysfunction (LVSD). Methods: A total of 511 ULM coronary artery disease patients who underwent DES implantation from January 2005 to January 2012 in Department of Cardiology, Beijing Anzhen Hospital were included in the study. Based on left ventricular ejection fraction (LVEF), the patients were divided into three groups: LVEF≤40% (n=104), 41%≤LVEF≤49% (n=137), and LVEF≥50% (n=270). The clinical characteristics of patients undergoing DES implantation were retrospectively compared, and the effects of LVSD on ULM coronary artery disease were analyzed. Results: After comparison of clinical baseline data among three different LVEF groups, the incidence of peripheral vascular diseases, old myocardial infarction (OMI), multi-vessel lesions, complete revascularization and chronic total occlusion (CTO) was statistically different (P=0.002, P<0.001, P<0.001, P=0.049, P=0.001, respectively). However, there was no significant difference in the incidence of other clinical characteristics (all P>0.05). In terms of survival analysis, total mortality and cardiac mortality were both remarkably higher in LVEF≤40% group than those in LVEF≥50% group (both P<0.001). There was no statistical difference of total mortality between 41%≤LVEF≤49% group and LVEF≥50% group (P>0.05), while cardiac mortality was higher in LVEF≥50% group (P=0.027) . Besides, there was no significant difference among three groups in major adverse cardiac and cerebral events (MACCE), myocardial infarction(MI), cerebral infarction and target vessel revascularization (TVR) (all P>0.05). After adjusting for multiple clinical factors, total mortality and cardiac mortality were both remarkably higher in LVEF≤40% group than those in LVEF≥50% group (P=0.002, P<0.001), while there were no statistical differences of total mortality and cardiac mortality between 41%≤LVEF≤49% group and LVEF≥50% group (both P>0.05). In terms of MACCE, MI, cerebral infarction and TVR, there were also no significant differences among three groups (all P>0.05). Conclusion: For ULM coronary artery disease patients with LVSD, implanting DES is safe and effective, but for those with severe LVSD (LVEF≤40%), DES implantation showed an increased risk of long-term death and therefore should be selected with great care.

[Predictive value of serial platelet function testing on outcome in patients undergoing complex percutaneous coronary intervention]

Objective: To observe the predictive value of serial platelet function testing (PFT) on outcome in patients undergoing complex percutaneous coronary intervention (PCI). Methods: Six hundred and two consecutive patients undergoing complex PCI in Anzhen hospital were enrolled during October 2011 to June 2012.Adenosine diphosphate(ADP)-induced platelet aggregation was measured by light transmission aggregometry on the first, sixth and twelfth month after PCI and the mean value was calculated.The cut-off value of high on-treatment platelet reactivity (HTPR) was defined as 40%.The primary endpoint was major adverse cardiovascular and cerebral event (MACCE). Clinical outcomes were analyzed by the Kaplan-Meier method and differences were compared using the log-rank test.Multivariate analyses by Cox proportion hazards regression were applied to identify variables independently associated with the adverse outcomes. Results: Five hundred and eighty-five patients (HTPR, n=285; non-HTPR, n=280) finished the follow-up ((28.47±7.45) months). A total of 33 cases of MACCE were observed during the follow-up, among which 29 cases(8.42%) were in HTPR group and 9 cases (3.21%) in the non-HTPR group.Kaplan-Meier analysis suggested that HTPR was associated with an increased incidence of MACCE (log-rank test, P=0.01). The Cox multivariate analysis indicated that HTPR was an independent risk factor of MACCE (HR=2.69, 95%CI 1.23-5.85, P=0.01) in patients undergoing complex PCI.Incidence of MACCE was similar between HTRP patients receiving standard dual antiplatelet therapy (DAPT) or prolonged DAPT (>12 months). Conclusion: Serial PFT could predict the long-term prognosis of patients underwent complex PCI.

[Analysis of clinical prognosis and the correlation between bile duct injury after transcatheter arterial chemoembolization and the level of hepatic arterial embolization in patients with hepatocellular carcinoma]

Objective: To evaluate the correlation between bile duct injury after transcatheter arterial chemoembolization and the level of hepatic arterial embolization, and to analyze the clinical prognosis of hepatocellular carcinoma patients. Methods: From January18, 2012 to December18, 2014, 21 patients underwent TACE for HCC were retrospectively reviewed, including patients' clinical and pathological data. The clinical outcome and relevant factors for bile duct injury were analyzed. Results: A total of 21 patients were identified with bile duct injury at our single institution. All patients received 48 TACE treatments, including proper hepatic artery (14), left hepatic artery (3), the right hepatic artery (10), left and right hepatic artery (9) and tumor artery branches (12). Thirty-five bile duct injury occurred in 21 patients: 7 cases was close to the tumor, 2 distant to the tumor, 7 at right liver, 2 left liver, 11 both lobes of liver and 6 hepatic hilar. After medical conservative treatment and biliary tract inside and outside drainage, liver function of 10 cases were improved. In four patients with hepatic bile duct stricture and biloma, the effect of drainage was not obvious, which subsequently caused biliary complications such as infection, gallbladder and common bile duct stones. Three patients with liver cirrhosis at decompensation stage developed complications, and one of them died of hepatic encephalopathy. Four patients experienced tumor recurrence during the follow-up period. Conclusions: The location of bile duct injury after transcatheter arterial chemoembolization is quite consistent with the level of hepatic arterial embolization. There may be some blood vessels mainly involved in blood supply of biliary duct. Complete embolism of these vessels may lead to bile duct injuries. Biliary drainage is ineffective in patients with hilar bile duct stricture, and can lead to complications of biliary tract later on.

[Comparison on the long-term outcomes post percutaneous coronary intervention or coronary artery bypass grafting for bifurcation lesions in unprotected left main coronary artery]

Objective: To compare the long-term clinical outcomes of consecutive patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention(PCI) with drug-eluting stents (DES) for bifurcation lesions in unprotected left main coronary artery (ULMCA). Methods: A total of 663 consecutively patients with unprotected left main bifurcation disease (defined as stenosis≥50%) who received either drug-eluting stents (DES) implantation (n=316) or underwent CABG (n=347) between January 2003 and July 2009 in Beijing Anzhen Hospital were enrolled retrospectively in this study.The endpoints of the study were death, repeat revascularization, myocardial infarction (MI), stroke, the composite of cardiac death, MI or stroke and MACCE (major adverse cardiac and cerebrovascular events, the composite of cardiac death, MI, stroke or repeat revascularization). To reduce the bias between two compared groups , our study applid propensity score matching by logistic regression.Cumulative survival rate was calculated by Kaplan-Meier method.Multiple regression analyses, hazard ratio(HR) and 95%CI were tested by Cox proportional hazard models with the CABG group as the reference category. Results: The median follow-up was 7.2 years (interquartile range 5.1 to 8.3 years) in the overall patients.Unadjusted analysis showed that MACCE rate (PCI 44.5% vs. CABG 45.7%, P=0.036), the rate of repeat revascularization (PCI 33.7% vs. CABG 19.5%, P<0.001), the composite rate of serious outcomes (cardiac death, MI or stroke) (PCI 20.4% vs. CABG 34.3%, P=0.032), stroke rate (PCI 3.7% vs. CABG 23.5%, P<0.001) were significantly different for patients undergoing PCI or CABG. Death rate (PCI 13.0% vs. CABG 18.9%, P=0.12) and MI rate (PCI 11.3% vs. CABG 6.1%, P=0.108) were similar between PCI and CABG group.After adjusting covariates with multivariate Cox hazard regression model, there was no significant difference in rates of death (P=0.286), MI(P=0.165) and the composite rate of serious outcomes (cardiac death, MI or stroke) (P=0.305) between the two groups. Patients in PCI group suffered significant higher rates of MACCE(P=0.011), mainly driven by the significant higher rates of repeat revascularization(HR=2.46, 95%CI 1.662-3.642, P<0.001). However, stroke rate was still significantly higher in CABG group than in PCI group(P=0.001)after multivariate adjusting. After propensity score matching (PSM), there was no more significant difference for all covariates in the matched cohorts (202 pairs). Further PSM analysis showed that overall findings were consistent with multivariate Cox hazard regression model except for MI (PCI 12.7% vs. CABG 3.8%, P=0.039). Conclusions: During a follow-up up to 8.3 years, the survival rate is similar between the PCI and the CABG group in patients with unprotected left main bifurcation disease.The rate of repeat revascularization is significantly higher whereas stroke rate is significantly lower in the PCI group compared to CABG group.After propensity score matching, PCI group not only had a significant higher rate of repeat revascularization, but also had significantly higher risk of MI in the matched cohorts; while they did not seem to translate into any disparity of mortality in ULMCA bifurcation disease patients.Accordingly, PCI for ULMCA disease can be used as a reasonable treatment option alternative to CABG.

[Security analysis of implanting drug-eluting stents for unprotected left main coronary artery disease patients with chronic kidney disease]

OBJECTIVE

To study the clinical characteristics and prognosis of unprotected left main (ULM) coronary artery disease patients with chronic kidney disease after drug-eluting stents (DES) implantation.

METHODS

267 ULM coronary artery disease patients who has implanted DES were included in the study from January 2005 to March 2010. Patients were divided into two groups according to their estimated glomerular filtration rate (eGFR): eGFR <60 ml·min(-1)·1.73 m(-2) (77 patients), and eGFR≥ 60 ml·min(-1)·1.73 m(-2) (190 patients) . The clinical parameters and prognosis of ULM patients treated with DES in different eGFR groups were retrospectively compared.

RESULTS

In higher eGFR group, left ventricular ejection fraction (LVEF) and morbidity of coronary ostial lesions were higher than the other group. Cerebrovascular diseases (13.0% vs 5.3%), chronic total occlusion (CTO, 28.6% vs 12.1%), hypertension (70.1% vs 53.2%) were more common in lower eGFR patients(all P<0.05). Total mortality and cardiac mortality were higher in eGFR<60 ml·min(-1)·1.73 m(-2) group (P=0.016, 0.006, respectively). Low eGFR level was an independent risk factor after adjusting multiple factors.

CONCLUSION

For the ULM disease patients with reduction in kidney function (eGFR<60 ml·min(-1)·1.73 m(-2)), DES should be selected with a careful study considering its increasing risk of death. Chronic renal insufficiency is a risk factor and may predict poor prognosis for patients with ULM after DES implantation.

Correlation between the 677C>T polymorphism in the methylene tetrahydrofolate reductase gene and serum homocysteine levels in coronary heart disease

The aim of the current study was to explore the correlation between serum homocysteine (HCY) levels and the methylene tetrahydrofolate reductase (MTHFR) gene 677C/T polymorphism and coronary heart disease (CHD). We consecutively enrolled 208 patients with CHD confirmed by CTA or coronary angiography from our hospital. An additional 200 healthy volunteers were enrolled as the control group. Serum HCY levels, MTHFR C677T genotype, and other related indicators were evaluated for the two groups. Compared to those in the control group, the serum HCY levels in the CHD patients were significantly higher (P < 0.05). The proportion of individuals with the heterozygous MTHFR CT genotype and homozygous mutant TT genotype among CHD patients was significantly higher than that in the control group (P < 0.05). In the acute coronary syndrome (ACS) subgroup, the proportion of those with the CT and TT genotypes was significantly higher than that of the stable CHD subgroup (P < 0.05). In summary, serum HCY levels were elevated in CHD patients, and the frequency of the CT and TT genotypes were also significantly increased, especially among the ACS subgroup. Taken together, this suggests that serum HCY levels and MTHFR C677T genotypes are correlated with CHD.

[Relationship between the mean platelet aggregation degree and the prognosis of patients underwent long-term dual antiplatelet therapy following drug eluting stent implantation]

OBJECTIVE

To evaluate the association between the mean platelet aggregation degree and the prognosis of patients underwent long-term dual antiplatelet therapy (DAPT more than 12 months) following drug eluting stent (DES) implantation.

METHODS

A total of 752 patients were retrospectively analyzed who were received DES between September 2006 and June 2009. Adenosine diphosphate-induced platelet aggregation (ADP) was monitored during the course of treatment with DAPT, and the mean platelet aggregation degree of each participant was calculated. Based on the mean platelet aggregation degree, patients were divided into the low ADP degree group (374 cases) and the high ADP degree group (378 cases). The median follow-up period was 32.2(25.1, 34.8) months. The comparison of the composite endpoints (all-cause death, nonfatal myocardial infarction, stent thrombosis, repeat revascularization and stroke) was performed between the two groups.

RESULTS

Compared with the high ADP degree group, there were more male, younger and smoker patients in the low ADP degree group (all P<0.05). COX regression analysis showed that the low ADP degree group was associated with a decreased incidence of primary endpoints (HR=0.463, 95%CI 0.23-0.92, P=0.028). After adjustment with multivariable COX regression analysis, the relationship was proven to be independent of other risk factors (HR=0.495, 95%CI 0.25-0.99, P=0.046). The Kaplan-Meier curve demonstrated the incidence of the composite endpoints was significantly higher in high ADP degree group compared to that of low ADP degree group (log-rank χ(2)=5.042, P=0.025).

CONCLUSION

The mean adenosine diphosphate-induced platelet aggregation degree is associated with the prognosis of patients underwent long term DAPT after DES implantation.

Rapid discrimination of pork in Halal and non-Halal Chinese ham sausages by Fourier transform infrared (FTIR) spectroscopy and chemometrics

Rapid discrimination of pork in Halal and non-Halal Chinese ham sausages was developed by Fourier transform infrared (FTIR) spectrometry combined with chemometrics. Transmittance spectra ranging from 400 to 4000 cm⁻¹ of 73 Halal and 78 non-Halal Chinese ham sausages were measured. Sample preparation involved finely grinding of samples and formation of KBr disks (under 10 MPa for 5 min). The influence of data preprocessing methods including smoothing, taking derivatives and standard normal variate (SNV) on partial least squares discriminant analysis (PLSDA) and least squares support vector machine (LS-SVM) was investigated. The results indicate removal of spectral background and baseline plays an important role in discrimination. Taking derivatives, SNV can improve classification accuracy and reduce the complexity of PLSDA. Possibly due to the loss of detailed high-frequency spectral information, smoothing degrades the model performance. For the best models, the sensitivity and specificity was 0.913 and 0.929 for PLSDA with SNV spectra, 0.957 and 0.929 for LS-SVM with second derivative spectra, respectively.

Regulation of chondrocyte differentiation by ADAMTS-12 metalloproteinase depends on its enzymatic activity

ADAMTS-12, a metalloproteinase that belongs to ADAMTS family, is strongly upregulated during chondrogenesis and demonstrates prominent expression in the growth plate chondrocytes. ADAMTS-12 potently inhibits chondrocyte differentiation, as revealed by altered expression of both early and later genes critical for chondrogenesis. In addition, ADAMTS-12-mediated inhibition of chondrogenesis depends on its enzymatic activity, since its point mutant lacking enzymatic activity completely loses this activity. Furthermore, the C-terminal four thrombospondin motifs known to bind COMP substrate is necessary for its full proteolytic activity and inhibition of chondrocyte differentiation. Mechanism studies demonstrate that ADAMTS-12 induces PTHrP, whereas it inhibits IHH during chondrogenesis. Furthermore, PTHrP induces ADAMTS-12 and ADAMTS-12 is hardly detectable in PTHrP-/-growth plate chondrocytes. Importantly, knocking down ADAMTS-12 mRNA levels or blocking ADAMTS-12 activity almost abolishes the PTHrP-mediated inhibition of type X collagen expression. Collectively, these findings demonstrate that ADAMTS-12, a downstream molecule of PTHrP signaling, is a novel regulator of chondrogenesis.

[Effects of activin and follistatin on FSH receptor mRNA expression of cultured Shao duck granulosa cells]

The aim of this study was to investigate the action of activin and follistatin either alone or in combination on FSH receptor mRNA expression. The results showed that activin alone increased FSH receptor mRNA level in the presence or absence of FSH in cultured granulosa cells, and the stimulating effect of activin on FSH receptor level was dose-dependent. This effect of activin was inhibited by FSP treatment which alone had no effect on FSH receptor expression. From the results, it can be concluded that activin and follistatin both exert autocrine actions on granulosa cells, and the two factors, possibly by regulating FSH receptor expression, may play important roles in follicular development.

[Expression pattern of mRNA for follistatin and inhibin/activin beta B-subunit during follicular and testicular development in duck]

Follistatin and inhibin/activin were closely related glycoprotein hormones. The quantitative competitive RT-PCR was used to investigate the expression of follistatin and inhibin/activin beta B-subunit mRNA in the developing ovarian follicles, immature and mature testes. The results revealed all samples showed the expression of mRNA for the two proteins, and the expression is more abundantly in the small follicles than in the large preovulatory follicles. Competitive RT-PCR revealed that the expression of follistatin is the highest in small yellow follicles (SYF), the mean relative content for the F1, F2, F3, F4, F5, F6-8, LWF (large white follicle), TI(immature testes), and TM(mature testes) was 0.011 +/- 0.004, 0.019 +/- 0.006, 0.021 +/- 0.009, 0.028 +/- 0.007, 0.075 +/- 0.023, 0.15 +/- 0.072, 0.29 +/- 0.068, 0.037 +/- 0.011, and 0.012 +/- 0.004, respectively, compared to a mean relative content of 1.00 for the SYF. The highest level of inhibin/activin beta B mRNA was also found in the SYF, the mean relative content for the F1, F2, F3, F4, F5, F6-8, LWF, TI, and TM was 0.009 +/- 0.003, 0.013 +/- 0.005, 0.019 +/- 0.007, 0.023 +/- 0.006, 0.29 +/- 0.084, 0.84 +/- 0.093, 0.031 +/- 0.008, 0.38 +/- 0.072, and 0.046 +/- 0.013, respectively, compared to a mean relative content of 1.00 for the SYF. Our data suggested that the expression pattern of mRNA for follistatin and inhibin/activin beta B-subunit was quite similar during follicular and testicular development. The great co-expression of mRNA for the two proteins in small follicles indicated that activin B(beta B-beta B) availability was tightly regulated by follistatin, and the two proteins might both play important roles in early follicular development.

[Studies of genetic diversity of Zhejiang native chicken breeds]

A total of 539 bases of mitochondrial DNA D-loop region of five native chicken breeds of Zhejiang province and the white leghorn chicken (as the control) were sequenced by DNA sequencing technique, and the phylogenetic trees of the chicken breeds were constructed. The results showed that 24 variation sites i.e. 4.45% sequence divergence were detected among the 30 DNA sequences, and the six breeds belonged to two different maternal lineage, one included Xianju chicken and White Leghorn chicken which had the same maternal origin, the other included Lingkun chicken, Baiyiner chicken, Wugu chicken and Xiaoshan chicken which had the same matriarchic ancestor. Among the latter lineage, Lingkun chicken, Baiyiner chicken and Wugu chicken had a closer relationship to each other than to Xiaoshan chicken.

[cDNA cloning and mRNA expression pattern in follicles of the mature inhibin alpha subunit from Xianju chicken]

The mature region of Xianju chicken inhibin alpha-subunit was amplified from the total RNA of follicle granulosa cells by RT-PCR using the primer pair designed according to the reported cDNA sequence of chicken inhibin alpha-subunit, and this fragment of alpha-subunit was cloned and sequenced subsequently. The results revealed that the mature alpha-subunit of Xianju chicken was a fragment of 113 amino acids containing one glycosylation site and seven cysteine residues. It was approximately 98% and 61.4%-68.7% identical in nucleotide sequence, 97.3% and 64.6%-69% similar in deduced amino acid sequence, respectively, in the mature region to the chicken and mammalian inhibin alpha-subunit cDNA clone. As for the mature chicken inhibin alpha-subunit, the number of potential glycosylation site and cysteine residues was the same, and their corresponding positions in the amino acid sequences were almost identical as compared to chicken and mammalian inhibin alpha-subunit, which indicated that the inhibin alpha-subunit was highly conserved among different species, implying an important role of inhibin alpha-subunit in various animals. The quantitative analysis of competitive RT-PCR for inhibin alpha-subunit revealed that the expression of alpha-subunit decreased with further follicle maturity from SYF to F1 follicle. The highest level of inhibin alpha-subunit mRNA was found in the SYF and F6-8 follicles, which indicated that inhibin alpha-subunit played an important role during the course of follicular recruitment, selection and dominance.

[Expression of inhibin alpha and inhibin/activin beta A subunits in the developing follicles of the duck]

The very sensitive quantitative competitive reverse transcription-polymerase chain reaction (RT-PCR) was used to investigate the expression of mRNA for the inhibin alpha and inhibin/activin beta A subunit in the developing ovarian follicles of the duck. The results indicated all follicles showed the expression of mRNA for the inhibin alpha and inhibin/activin beta A. The inhibin alpha subunit mRNA is expressed more abundantly than the beta A subunit in the large preovulatory follicles. Competitive RT-PCR revealed that the expression of inhibin alpha subunit is the highest in small yellow follicles (SYF), the mean relative content for the F1, F2, F3, F4/5 and LWF (large white follicle) was 0.26 +/- 0.05, 0.28 +/- 0.07, 0.57 +/- 0.12, 0.98 +/- 0.09 and 0.026 +/- 0.006, respectively, compared to a mean relative content of 1.00 for the SYF. The highest level of inhibin/activin beta A mRNA was found in the F1 follicle, the mean relative content for the F2, F3, F4/5, SYF and LWF was 0.218 +/- 0.09, 0.111 +/- 0.03, 0.058 +/- 0.011, 0.053 +/- 0.013 and 0.005 +/- 0.002, respectively, compared to a mean relative content of 1.00 for the F1 follicle. Our data suggest that the expression of the alpha subunit is reduced with follicular development whereas beta A subunit expression is dramatically enhanced, which indicates the expression of inhibin alpha and inhibin/activin beta A subunit is differentially regulated during follicular development. In addition, the highest level of beta A mRNA in F1 follicle indicates the production of dimeric inhibin and/or activin primarily occurred in the largest F1 follicle.

Activation of osteocalcin transcription involves interaction of protein kinase A- and protein kinase C-dependent pathways

Osteocalcin is a major noncollagenous protein component of bone extracellular matrix, synthesized and secreted exclusively by osteoblastic cells in the late stage of maturation, and is considered indicator of osteoblast differentiation. Osteocalcin expression is modulated by parathyroid hormone (PTH) and a variety of other factors. The cAMP-dependent protein kinase pathway has been shown previously to have an essential role in PTH signaling and regulation of osteocalcin expression. To determine the extent to which other pathways may also participate in osteocalcin expression, we used rat and human osteoblast-like cell lines to generate stably transfected clones in which the osteocalcin promoter was fused to a luciferase reporter gene. These clones were examined for their responsiveness to agents known to activate or interfere with protein kinase A (PKA)- and protein kinase C (PKC)-dependent pathways. We have found that forskolin, cAMP, and PTH, as well as insulin-like growth factor I (IGF-I) and basic fibroblast growth factor, all were effective in activating the osteocalcin promoter. Phorbol 12-myristate 13-acetate (PMA) was also a strong inducer of the promoter, indicating that PKC plays a role in expression of osteocalcin. In combination with PTH or forskolin, the effect of PMA was additive to synergistic. Calphostin C, a selective inhibitor of PKC, decreased the PMA-, PTH-, and IGF-I-induced luciferase activity in a dose-dependent manner; a PKA inhibitor, H-89, also blocked the induction by PTH and IGF-I but not by PMA. We conclude that regulation of osteocalcin transcription is mediated by both PKA-dependent and PKC-dependent mechanisms and that the respective kinases reside on a linear or convergent pathway.

[Regulation on growth and accumulation of total alkaloid in Leonurus artemisia (Lour.)S.Y. Hu by various microfertilizers]

OBJECTIVE

To trace the effects of various microfertilizers on the growth and accumulation of total alkaloid in Leonurus artemisia.

METHOD

The total alkaloid was determined by spectrophotometry.

RESULT

Microfertilizers of different concentrations could facilitate the growth of L. artemisia in various degrees and Mn-fertilizer of standard concentration and Cu-fertilizer of excessive concentration could help raise the output of the plant markedly by up to 43.6% and 55.2% respectively. Microfertilizers of different concentrations could improve the content of total alkaloid in L. artemisia: Mn-fertilizer of standard concentration and B-fertilizer of excessive concentration could enhance the contents of total alkaloid up to 2.15% and 2.09% respectively. Mn-fertilizer and Cu-fertilizer of standard concentration have been proved very useful in improving the resistibility and ability of the plant to survive summer safely, and Fe-fertilizer of standard concentration could bring the plant an obvious increase of output after surviving summer.

CONCLUSION

Application of Mn-fertilizer of standard concentration is very important for cultivating L. artemisia of excellent quality and high output.

Parathyroid hormone-(1-34) enhances aggrecan synthesis via an insulin-like growth factor-I pathway

During endochondral bone formation, the growth plate chondrocytes proliferate, become hypertrophic, lose the cartilage phenotype, undergo mineralization, and provide a scaffold upon which subsequent longitudinal bone growth occurs. Parathyroid hormone (PTH), a calcium-regulating hormone, and parathyroid hormone-related peptide (PTHrP), which shares several properties with PTH, have profound effects on skeletal growth and new bone formation. In order to define further the mechanism by which PTH/PTHrP promotes the cartilage phenotype, chondrocytes isolated from the rib cages of developing rat embryos were evaluated for the biosynthesis of aggrecan. Cells treated with PTH-(1-34) for a 4-h period followed by a 20-h recovery period showed a significant increase in cartilage proteoglycan (aggrecan) synthesis in a dose-dependent manner. Only N-terminally intact PTH and PTHrP were effective in stimulating aggrecan synthesis. Addition of a neutralizing antibody to insulin-like growth factor-I (IGF-I) during PTH treatment resulted in the inhibition of PTH-stimulated aggrecan synthesis, whereas the addition of a neutralizing antibody to insulin-like growth factor-binding protein-2 (IGFBP-2) resulted in an increase in synthesis in both the control and PTH-treated cells. In addition, PTH treatment resulted in an increase in the mRNA for aggrecan, a reduction in IGFBP-3 mRNA, and no discernible changes in IGF-I mRNA levels, which was complemented by quantitative changes in IGFBP-3 and free IGF-I levels. The reciprocal relationship in the expression of aggrecan and IGFBP was further confirmed in chondrocytes from various gestational stages during normal development. Collectively, our results indicate that the effect of PTH may be mediated at least in part through the regulation of the IGF/IGFBP axis, by a decrease in the level of IGFBP-3, and an increase in free IGF-I levels. It is likely that the local increase in IGF-I may lead to an increase in cartilage type proteoglycan synthesis and maintenance of the cartilage phenotype. The consequence of the prolonged maintenance may be to halt mineralization while a new scaffolding is created.

Parathyroid hormone (PTH 1-34) regulation of rat osteocalcin gene transcription

Osteocalcin (OC) is a bone-specific extracellular matrix protein expressed by mature osteoblasts during late stages of differentiation. Previous studies have shown that forskolin, an activator of adenylate cyclase, stimulated OC production. Because PTH has been shown to activate several intracellular signal transduction pathways including cAMP, inositol phosphate and intracellular calcium mobilization, we investigated whether PTH action on cAMP accumulation leads to OC promoter activation. The rat OC promoter (1095 bp) was cloned into the promoterless luciferase gene reporter vector. The transcriptional activity of the rat OC promoter was evaluated after transfection of SaOS-2, an osteosarcoma cell line, with the OC promoter followed by treatment with PTH. Maximal OC promoter activity was observed within 4-8 h after the addition of 10(-8) M PTH, whereas very little induction was seen after 24 and 48 h of treatment. The induction of OC promoter activity by PTH was concentration dependent. PTH analogs (PTH 1-84, PTH 1-34, and PTH 1-31) that stimulate intracellular cAMP accumulation, induced OC promoter activity, whereas other PTH analogs (PTH 3-34, PTH 7-34, PTH 13-34, and PTH 53-84) that do not stimulate cAMP production had no effect on OC promoter activation. Furthermore, PTH activation of the OC promoter was significantly enhanced in the presence of 3-isobutyl-1-methylxanthine (IBMX), a phosphodiesterase inhibitor. Inactivation of cAMP-dependent protein kinase A activity by either a selective protein kinase A inhibitor, H-89 (N-[2-(p-bromocinnamylamino)ethyl]-5 isoquinolinesulfonamide), or antisense oligonucleotide directed against the regulatory subunit of cAMP-dependent protein kinase A, led to a corresponding loss of OC promoter activation by PTH. 5' deletion analysis of the OC promoter demonstrated that the promoter (1095 bp) exhibited the greatest response to PTH, whereas the -198 bp construct of the OC promoter, containing only one cAMP response element and OC box, was no longer responsive. The constructs with further deletions (-120, -92, and -74) retained PTH responsiveness, but to a lesser extent. In summary, our results indicate that PTH activation of the OC promoter is a rapid event and mediated by the cAMP-dependent protein kinase A pathway. Although the novel cAMP response region overlapping the OC box is required for activation, full activation may require several cis-acting cAMP response elements or other response elements.

Down-regulation of NF-kappa B protein levels in activated human lymphocytes by 1,25-dihydroxyvitamin D3

The effect of 1,25-dihydroxyvitamin D3 [1,25(OH)2)D3], a steroid hormone with immunomodulating properties, on nuclear factor kappa B (NF-kappa B) proteins was examined in in vitro activated normal human lymphocytes by Western blot analysis. Over a 72-hr period of activation, the expression of the 50-kDa NF-kappa B, p50, and its precursor, p105, was increased progressively. When cells were activated in the presence of 1,25(OH)2D3, the levels of the mature protein as well as its precursor were decreased. The effect of the hormone on the levels of p50 was demonstrable in the cytosolic and nuclear compartments; it required between 4 and 8 hr and was specific, as 25-hydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 were ineffective. Besides p50, 1,25(OH)2D3 decreased the levels of another NF-kappa B protein, namely c-rel. In addition, 1,25(OH)2D3 decreased the abundance of a specific DNA-protein complex formed upon incubation of nuclear extracts from activated lymphocytes with a labeled NF-kappa B DNA binding motif. Further, 1,25(OH)2D3 inhibited the transcriptional activity of NF-kappa B in Jurkat cells transiently transfected with a construct containing four tandem repeats of the NF-kappa B binding sequence of the immunoglobulin kappa light chain gene linked to the chloramphenicol acetyltransferase reporter gene. These observations demonstrate directly that there is de novo synthesis of NF-kappa B during human lymphocyte activation and suggest that this process is hormonally regulated.

Vitamin D and the hematolymphopoietic tissue: a 1994 update

Monocytes/macrophages and activated (but not resting) lymphocytes as well as certain subsets of thymocytes express the VDR. This protein is indistinguishable from the classical 50-kDa VDR and is encoded by an mRNA with identical nucleotide sequence to that of the human intestinal VDR. Acting via the VDR, 1,25(OH)2D3 modulates the production of a plethora of monocyte, lymphocyte, and bone marrow stromal cell products, including several interleukins and other cytokines, as well as various oncogenes and transcription factors. However, these hormonal effects vary depending on the signals used to activate blood mononuclear cells; moreover, each of the effects of the hormone can be either attenuated, abolished, or even reversed from negative to positive in the presence of phorbol esters. Lymphocytes also express a previously unrecognized 80-kDa cytosolic protein that shares immunologic cross-reactivity with the VDR. This protein is induced on activation and is downregulated by 1,25(OH)2D3, whereas the VDR is upregulated by 1,25(OH)2D3. In contrast to the signal-dependent effects of the hormone on cytokine production and lymphocyte proliferation, the effects of 1,25(OH)2D3 on the 80-kDa protein and VDR are independent of the activation signals. This apparent mechanistic distinction raises the possibility that the signal-independent effects of 1,25(OH)2D3 on the 80-kDa protein and the VDR might be due to direct interactions of the 1,25(OH)2D3-VDR complex with specific response elements (negative and positive VDREs, respectively) on these two genes; as opposed to the signal-dependent effects that might be due to influences of the 1,25(OH)2D3-VDR complex on other transcription factors that are generated in response to the different activation stimuli. Consistent with the second part of this contention, we have recently found that 1,25(OH)2D3 regulates the 50-kDa DNA binding subunit of the pleiotropic transcription factor NF-kappa B and the 105-kDa precursor of this subunit; as well as other members of the rel-related family of proteins, including v-rel and its normal cellular homolog c-rel, in activated normal human lymphocytes. Besides its influence on immune cell products, 1,25(OH)2D3 is a potent agent for the differentiation of cells of the myeloid lineage. In addition, 1,25(OH)2D3 stimulates the fusion and differentiation of hematopoietic progenitors into osteoclasts, an effect which accounts for the potent role of the hormone in bone resorption.(ABSTRACT TRUNCATED AT 400 WORDS)

Vitamin D receptor quantitation in human blood mononuclear cells in health and disease

Vitamin D receptor (VDR) concentration was quantitated in human peripheral blood mononuclear cells (PBMC) from patients with absorptive hypercalciuria (AH) and patients with high 1,25(OH)2D3 due to acquired or transient disease states and the results compared to those in normal subjects. VDR concentration in resting cells was not different between the three groups and represented constitutive receptor expression of monocytes. Following activation with phytohemagglutinin, patients with hypercalcitriolemia demonstrated significantly greater VDR concentrations. Patients with AH demonstrated a normal value for the group, but 6 patients had significantly greater concentrations of VDR despite normal plasma 1,25(OH)2D3 in four of the patients. Proliferation, as assessed from [3H]thymidine incorporation was inversely correlated with serum 1,25(OH)2D3 and was significant (R = -0.299, p = 0.048). Taken together, the results suggest that PBMC provide a useful system for studying VDR status in transient or acquired states of hypercalcitriolemia. Furthermore, the studies in patients with absorptive hypercalciuria disclosed it to be a heterogeneous disorder, characterized by both vitamin D-dependent and D-independent forms of receptor up-regulation.

Demonstration of estrogen and vitamin D receptors in bone marrow-derived stromal cells: up-regulation of the estrogen receptor by 1,25-dihydroxyvitamin-D3

We have shown earlier that 17 beta-estradiol inhibits cytokine-induced interleukin-6 (IL-6) production by bone marrow-derived stromal cells as well as osteoblasts, two types of cells with a critical influence on osteoclast development, and that ovariectomy causes an IL-6-mediated up-regulation of osteoclastogenesis in mice. Prompted by this, we have searched here for the presence of estrogen receptors (ERs) in two murine bone marrow-derived stromal cell lines, +/+ LDA11 and MBA 13.2, and the osteoblast-like cell line MC3T3-E1. All three cell lines exhibited high affinity saturable binding for [125I]17 beta-estradiol with a dissociation constant of approximately 10(-10) M and concentration of binding sites of 260 +/- 30, 170 +/- 10, and 90 +/- 10 sites per cell, respectively. In addition, we amplified complementary DNA from the stromal cell lines by polymerase chain reaction using oligonucleotide primers flanking the DNA binding domain of the murine uterine ER. The amplified product showed an identical nucleotide sequence to the DNA binding domain of the murine uterine receptor. Consistent with the functionality of the ER in stromal cells, and specifically its role in the regulation of IL-6 by 17 beta-estradiol, we found that the pure estrogen antagonist ICI 164,384 completely prevented the effect of 17 beta-estradiol on IL-6. All three cell lines also expressed receptors for 1,25-dihydroxyvitamin-D3 [1,25(OH)2D3] (dissociation constant, approximately 10(-10) M), with a concentration of binding sites of 490 +/- 20, 920 +/- 20, and 1110 +/- 70 sites per cell, respectively. 1,25(OH)2D3 treatment of the stromal cells caused a 2-fold increase in the concentration of ERs and a decrease in cell proliferation. These data establish that bone marrow-derived stromal cells express functional estrogen as well as vitamin D receptors, which serve to mediate actions of their respective ligands on the biosynthetic activity of these cells and presumably the effects of these two steroid hormones on osteoclastogenesis.

Stimulation of interleukin-6 production by either calcitonin gene-related peptide or parathyroid hormone in two phenotypically distinct bone marrow-derived murine stromal cell lines

It was recently shown that interleukin-6 (IL-6) is produced by bone and bone marrow-derived stromal cells and that it plays an important role in osteoclast development. Here we examined whether parathyroid hormone (PTH), calcitonin (CT), or the calcitonin gene-related peptide (CGRP) influence IL-6 production by two murine bone marrow-derived stromal cell lines: the preadipocyte-like stromal cell line +/+ LDA11 and the fibroendothelial stromal cell line MBA 13.2. We found that CGRP (but not PTH or CT) exerted a dose-dependent increase in cAMP and IL-6 production in the +/+ LDA11 cells. In addition, CGRP had an inhibiting effect on the proliferation of this stromal cell line. CGRP, however, did not affect cAMP or IL-6 in the rat osteogenic sarcoma cell line UMR-106-06, which exhibits CT receptors, whereas CT stimulated both cAMP and IL-6 by the UMR-106-01 cells. In contrast to the specificity of the IL-6 response of the +/+ LDA11 cells to CGRP, IL-6 production by the MBA 13.2 stromal cells was stimulated by PTH whereas CGRP or CT had no effect. These data suggest that bone marrow-derived stromal cells express receptors for either CGRP or PTH in a phenotype-specific manner and that, acting via these receptors, CGRP and PTH stimulate IL-6 production by stromal cells. In addition, the evidence for specific receptors for the neuropeptide CGRP in bone marrow stromal cells and an effect of CGRP on IL-6 raises the possibility for a role of cytokines in a putative interplay between neuronal stimuli and bone.

Cytokine production and surface antigen expression by peripheral blood mononuclear cells in postmenopausal osteoporosis

It was reported earlier that IL-1 production by cultured monocytes and the ratio of helper (CD4) to suppressor (CD8) lymphocytes in peripheral blood are different in osteoporotic compared to nonosteoporotic subjects. We examined these and several other parameters related to the biosynthetic activity and differentiation status of peripheral blood mononuclear cells (PBMC) in untreated osteoporotic postmenopausal women (age 65 +/- 7, n = 46), nonosteoporotic postmenopausal women (age 55 +/- 3, n = 20), and nonosteoporotic premenopausal women (age 37 +/- 7, n = 8), as defined by spine density. We found that unstimulated monocytes from osteoporotics did not produce detectable IL-1 beta as determined by ELISA. In addition, there were no significant differences between osteoporotics and nonosteoporotics in IL-1 beta or IFN-gamma production by PBMC stimulated with OKT3, a monoclonal antibody to the T cell-receptor complex. The proliferative response of lymphocytes to OKT3 was significantly less (p < 0.02) in osteoporotics compared to nonosteoporotic post- and premenopausal women; multiple-regression analysis, however, indicated that this difference was not due to bone density but to age. Flow cytometric analysis of PBMC revealed no difference between osteoporotics and nonosteoporotics in the distribution of 18 phenotypic subsets determined, including CD4- or CD8-positive lymphocytes or the ratio of CD4 to CD8 cells. Further, there was no correlation of the surface markers with bone density, the exceptions being the subsets expressing the CD3/CD56 and CD8/CD56 markers, which were inversely related to spine density in the osteoporotic women.(ABSTRACT TRUNCATED AT 250 WORDS)

Demonstration of a 1,25-dihydroxyvitamin D3-responsive protein in human lymphocytes: immunologic crossreactivity and inverse regulation with the vitamin D receptor

Using Western blot analysis with a monoclonal antibody recognizing a 17-amino acid epitope of the 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]receptor, we have detected two crossreacting proteins in activated normal human lymphocytes. The smaller of the two proteins (50 kDa) was indistinguishable from the classical 1,25(OH)2D3 receptor and, similar to the classical 1,25(OH)2D3 receptor, was upregulated in a dose-dependent fashion by 1,25(OH)2D3. The larger crossreacting protein exhibited an electrophoretic mobility of 80 kDa, was localized in the cell cytosol, and appeared to be specific for activated lymphocytes since it was not detected in several other human cells including monocytes. More strikingly, the 80-kDa protein was downregulated in a dose-dependent fashion by 1,25(OH)2D3; this effect was independent of the mode of lymphocyte activation and specific for the 1,25(OH)2D3 metabolite of vitamin D3. However, two potent immunosuppressive agents, glucocorticoids and cyclosporin A, also inhibited the 80-kDa protein.

Vitamin D receptor expression in human lymphocytes. Signal requirements and characterization by western blots and DNA sequencing

The signals controlling the expression of the receptor protein for 1 alpha,25-dihydroxyvitamin D3 in normal human lymphocytes and the relationship of this protein to the classical vitamin D receptor were examined. Lymphocytes activated with the OKT3 antibody to the T-cell antigen receptor expressed fewer binding sites as compared to lymphocytes that were activated by the polyclonal activator phytohemagglutinin (PHA). However, combination of OKT3 and phorbol myristate acetate produced a concentration of binding sites similar to the PHA-activated cells. The receptor from OKT3 and OKT3 + phorbol myristate acetate-activated lymphocytes exhibited decreased binding to DNA-cellulose compared to PHA-activated lymphocytes. In lymphocytes activated either by PHA or OKT3 (but not in resting cells), a 50-kDa species cross-reacting with a monoclonal antibody against the intestinal vitamin D receptor was detected. Finally, RNA from activated lymphocytes was amplified by polymerase chain reaction using oligonucleotide primers flanking the 196 base pair long region encoding the DNA-binding domain of the human intestinal receptor. The amplified product showed an identical nucleotide sequence to the DNA-binding domain of the human intestinal receptor. These findings suggest that expression of the 1,25-(OH)2D3 receptor in lymphocytes is triggered by distinct and contingent signals, and that the protein and the mRNA encoding it are identical to the classical vitamin D receptor.

Characterization of human antibody-reactive epitopes encoded by human papillomavirus types 16 and 18

We have previously reported that the most common human serum immunoglobulin G antibody reactivities to human papillomavirus type 16 and type 18 (HPV16 and HPV18)-encoded proteins are directed against the minor capsid proteins (HPV16 L2 and HPV18 L2) and to the E7 protein of HPV16 (S. A. Jenison, X.-P. Yu, J. M. Valentine, L. A. Koutsky, A. E. Christiansen, A. M. Beckmann, and D. A. Galloway, J. Infect. Dis. 162:60-69, 1990). In this study, the antibody-reactive segments of the HPV16 E7, HPV16 L2, and HPV18 L2 polypeptides were mapped by using nested sets of deleted recombinant proteins. A single major immunoreactive region was identified in the HPV16 E7 polypeptide between amino acids (aa) 21 and 34 (DLYCYE-QLNDSSEE). In contrast, three distinct immunoreactive regions of the HPV16 L2 polypeptide were present in the segment between aa149 and aa204, and three distinct immunoreactive regions of the HPV18 L2 polypeptide were present in the segment between aa110 and aa211. With the exception of one serum sample, serum immunoglobulin G antibodies which reacted with HPV16 L2 polypeptides or with HPV18 L2 polypeptides were not cross-reactive.