[OCT analysis of in-stent neointima over 5 years post-DES implantation]

Objective: To investigate the characteristics of neointimal hyperplasia (NIH) in patients with in-stent restenosis (ISR) over 5 years post-drug-eluting stent (DES) implantation based on optical coherence tomography (OCT). Methods: In this cross-sectional study, patients with DES-ISR who underwent OCT examination at PLA General Hospital between March 2010 and March 2022 were retrospectively included. All patients were divided into≤5 years DES-ISR group and>5 years DES-ISR group according to the time interval after DES implantation. Quantitative and qualitative analyses were conducted on OCT images to compare the clinical data and lesion characteristics of two patient groups. Furthermore, the independent clinical predictive factors of in-stent neoatherosclerosis (ISNA) were analyzed by multivariable logistic regression. Results: A total of 230 DES-ISR patients with 249 lesions were included, with an age of (63.1±10.4) years and 188 males (81.7%). The median interval after DES implantation was 6 (2, 9) years. There were 117 patients (122 ISR lesions) in the≤5 years DES-ISR group, and 113 patients (127 ISR lesions) in the>5 years DES-ISR group. Compared with≤5 years DES-ISR,>5 years DES-ISR showed more heterogeneous patterns (65.4% (83/127) vs. 48.4% (59/122), P=0.007), diffuse patterns (46.5% (59/127) vs. 31.2% (38/122), P=0.013), macrophage accumulations (44.1% (56/127) vs. 31.2% (38/122), P=0.035) in NIH and higher prevalence of ISNA (83.5% (106/127) vs. 72.1% (88/122), P=0.031). According to multivariable logistic regression, the independent predictive factor for ISNA was female (OR=0.44, 95%CI 0.21-0.90, P=0.026). Female (OR=0.48, 95%CI 0.23-0.99, P=0.046) and low-density lipoprotein cholesterol level (OR=1.62, 95%CI 1.01-2.59, P=0.046) were independent predictive factors, respectively, for lipid ISNA. Calcified ISNA was independently associated with time interval of post-DES implantation (OR=1.18, 95%CI 1.07-1.29, P=0.001). Conclusion: DES-ISR patients with a time interval of>5 years after stent implantation have a higher prevalence of ISNA and more complex lesions. Gender, the level of low-density lipoprotein cholesterol, and the time interval post-DES implantation are independently correlated with ISNA, lipid ISNA, and calcified ISNA.

[Association between digestive tract cancer and severity of coronary artery disease]

Objective: To evaluate the association between digestive tract cancer and anatomical severity of coronary artery disease. Methods: This study enrolled 142 patients with digestive tract cancer who underwent coronary angiography in the Department of Cardiology of the First Medical Center of Chinese PLA General Hospital from 2009 to 2020 as the cancer group. The patients in cancer group were matched with 426 non-cancer patients who underwent coronary angiography at our hospital during the same period in a 1∶3 ratio based on gender and age. All enrolled patients had no previous history of percutaneous coronary intervention or coronary artery bypass grafting surgery. The severity of coronary artery disease was documented and assessed using the SYNTAX score based on angiogram. High SYNTAX score (SXhigh) was defined as SYNTAX score≥22 (upper quartile), while low SYNTAX score (SXlow) was SYNTAX score<22. High NLR (NLRhigh) was NLR≥2.287 (median), while low NLR (NLRlow) was NLR<2.287. The association between digestive tract cancer and severity of coronary artery disease was analyzed using logistic regression analysis. Results: This study included a total of 568 patients, with a mean age of (66.6±8.7) years. Among them, 430 patients (75.7%) were male. The cancer group consisted of 142 patients with digestive tract cancers, with a mean age of (66.5±8.4) years. The non-cancer group consisted of 426 patients, with a mean age of (66.7±8.8) years. The proportion of SXhigh in patients with digestive tract cancers (33.1%, 47 patients) was higher than that in non-cancer patients (23.9%, 102 patients) (P=0.032). Compared to non-cancer patients, SXhigh in patients with digestive tract cancers was higher (OR: 1.614, 95%CI: 1.051-2.481, P=0.029). Subgroup analysis stratified by NLR levels revealed that in the NLRhigh group, patients with digestive tract cancers exhibited a higher severity of coronary artery disease compared to non-cancer patients, with an OR of 1.948 (95%CI: 1.005-3.779, P=0.048). In the NLRlow group, there was no significant relationship between digestive tract cancers and the severity of coronary artery disease, with an OR of 1.277 (95%CI: 0.586-2.781, P=0.538). Conclusions: Digestive tract cancer is associated with the severity of coronary artery disease, and patients with digestive tract cancers have a higher risk of severe coronary artery disease than non-cancer patients. Additionally, there is an association between digestive tract cancers and the severity of coronary artery disease under conditions of high levels of inflammation.

[Protection of side-branch ostium by the jailed balloon technique validated by three-dimensional optical coherence tomography]

Objective: To evaluate the protective effect of jailed balloon technique on side branch (SB) ostium using three-dimensional optical coherence tomography(OCT). Methods: This is a retrospective study. Consecutive coronary disease patients with coronary artery bifurcation lesions who underwent percutaneous coronary intervention (PCI) and completed pre-and post-procedural OCT examinations at the Chinese People's Liberation Army General Hospital from September 2019 to March 2022 were enrolled. Patients were divided into the jailed balloon technique group and the unprotected group according to the options applied for the SB. The SB ostium area difference was calculated from OCT images (SB ostium area difference=post-PCI SB ostium area-pre-PCI SB ostium area). The SB ostium area differences were compared between the two groups and compared further in the subgroup of true bifurcation lesions and non-true bifurcation lesions. In the jailed balloon group, the SB ostium area difference was compared between the active jailed balloon technique and the conventional jailed balloon technique, between the jailed balloon>2.0 mm diameter and the jailed balloon≤2.0 mm diameter, and between the higher balloon pressure (>4 atm, 1 atm=101.325 kPa) and the lower balloon pressure (≤4 atm). Multivariate linear regression analysis was used to explore the correlation between the technical parameters of the jailed balloon technique and the SB protection effect. Results: A total of 176 patients with 236 bifurcation lesions were enrolled, aged (60.7±9.3) years, and there were 128 male patients (72.7%). There were 67 patients in the jailed balloon technique group with 71 bifurcation lesions and 123 patients in the unprotected group with 165 bifurcation lesions. Fourteen patients had 2 to 3 lesions, which were treated in different ways, so they appeared in the unprotected group and the jailed balloon technique group at the same time. The area difference in SB ostium was greater in the jailed balloon group than in the unprotected group (0.07 (-0.43, 1.05)mm² vs.-0.33 (-0.83, 0.26)mm², P<0.001), and the results were consistent in the true bifurcation lesion subgroup (0.29 (-0.35, 0.96)mm² vs.-0.26 (-0.64, 0.29)mm², P=0.004), while the difference between the two groups in the non-true bifurcation lesion subgroup was not statistically significant (P=0.136). In the jailed balloon technique group, the SB ostium area difference was greater in patients treated with the active jailed balloon technique than in those treated with the conventional jailed balloon technique ((0.43±1.36)mm² vs. (-0.22±0.52)mm², P=0.013). The difference in SB ostium area was greater in those using>2.0 mm diameter jailed balloons than in those using≤2.0 mm diameter jailed balloons (0.25 (-0.51, 1.31) mm² vs.-0.01 (-0.45, 0.63) mm², P=0.020), while SB ostium area difference was similar between those endowed with higher balloon pressure (>4 atm) compared to those with lower balloon pressure (≤4 atm) (P=0.731). Multivariate linear regression analysis showed that there was a positive correlation between jailed balloon diameter and SB ostium area difference (r=0.344, P=0.019). Conclusions: The jailed balloon technique significantly protects SB ostium, especially in patients with true bifurcation lesions. The active jailed balloon technique and larger diameter balloons may provide more protection to the SB.

[Analysis of the international application of healthy life expectancy]

Healthy life expectancy is based on life expectancy to further identify the healthy component, moving the assessment threshold from the mortality to the whole life cycle, receiving more and more attention worldwide. Nowadays, it has become one of the core indicators of national major strategy and plan. As a comprehensive indicator of health measurement, healthy life expectancy is complicated and multi-dimensional. Different social and cultural backgrounds have different understandings of health and choose different measurement dimensions. Overall, although high-income countries have different choices in their national health plan, healthy life expectancy without activity restriction is by far the most widely used indicator. This paper reviewed the concept and application of healthy life expectancy systematically, drawing on international practical experience to provide reference for the establishment of a healthy life expectancy indicator system in line with the Chinese national conditions.

[Coronary CT angiography derived fractional flow reserve: opportunity for a win-win cooperation between cardiologists and radiologists]

The advent of coronary CT angiography derived fractional flow reserve (CT-FFR) calculation technology has brought great improvements to the clinical diagnostic process and treatment decision-making towards coronary artery disease. In recent years, CT-FFR technology has gradually begun to be taken into clinical practice in China, however, currently, the popularization is not widespread, and it is imperative to further standardize the clinical application of CT-FFR technology. This paper focused on the opportunities, significance and challenges of CT-FFR application in China from the advantages and disadvantages perspectives of this new technology based on three international studies. Combined with specific national conditions and the latest evidence-based clinical medical results, this paper proposes a win-win cooperation initiative between cardiologists and radiologists for the reference and caution of both clinical practitioners and medical affairs bureaus.

Explainable deep neural network for echocardiography view classification

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Taiwan

Background

Deep neural network may assist echocardiography interpretation in several tasks; however, the lack of expandability hindered its broader application since physicians couldn’t realize the rationale of interpretation clearly and comfortably.

Method

Retrospectively, we manually annotated 26,465 transthoracic echocardiography images into 29 classes for model development in 4:1 ratio as training and validation datasets. We added an autoencoder component into our model, adapted from capsule net, for view-classifying to deconvolute the feature maps of last layer as decoder for human interpretation. The performance of view classification was measured in accuracy and confusion matrix, and the interpretability of model were assessed by cardiologist.

Result

After appropriate model training, the accuracy of our model achieved averaged 98.2% for echocardiography view classification, ranged from lowest 80.0% in suprasternal view to 100% of several more common view in validation dataset. The successful deconvolution of feature map to reconstruct images showed essential independent components of echocardiography view and could be interpretated by cardiologist and clinical physicians.

Conclusion

With the use of autoencoder in model for echocardiography view classification showed maintainable good performance in accuracy and facilitated clinical interpretation to enhance its reliability. Abstract Figure. Model architecture and performance  Abstract Figure. Example of explaniable deconvolution

[A pretest model of obstructive coronary artery disease based on machine learning: from the C-Strat study]

Objective: To develop a pretest probability model of obstructive coronary artery disease with machine learning based on multi-site Chinese population data. Methods: Chinese regiStry in early deTection and Risk strAtificaTion of coronary plaques (C-Strat) study is a prospective multi-center cohort study, in which consecutive patients with suspected obstructive coronary artery disease and ≥64 detector row coronary computed tomography angioplasty (CCTA) evaluation were included. Data from the patients were randomly split into a training set (70%) and a test set (30%). More than 50% of coronary artery stenosis by CCTA was defined as positive outcome. A boosted ensemble algorithm (XGBoost), 10-fold cross-validation and Bayesian optimization were used to establish a new prediction model-CARDIACS(pretest probability model from Chinese registry in eARly Detection and rIsk stratificAtion of Coronary plaques Study), and a logistic regression was used to establish a model-LOGISTIC in training set. The test set was used for validation and comparison among CARDIACS, LOGISTIC, UDFM (updated Diamond-Forrester Model) and DFCASS(Diamond-Forrester and CASS). Results: The study population included 29 455 patients with age of (57.0±9.7) years and 44.8% women, of whom 19.1% (5 622/29 455) had obstructive coronary artery disease. For CARDIACS, the age, the reason for visit and the body mass index (BMI) were the most important predictive variables. In the independent test set, the area under the curve (AUC) of CARDIACS was 0.72 (95%CI 0.70-0.73), which was significantly superior to that of LOGISTIC (AUC 0.69, 95%CI 0.68-0.71, P=0.015), UDFM (AUC 0.64, 95%CI 0.62-0.65, P<0.001) and DFCASS (AUC 0.66, 95%CI 0.64-0.67, P<0.001), respectively. Conclusion: Based on Chinese population, the study developed a new pretest probability model--CARDIACS, which was superior to the traditional models. CARDIACS is expected to assist in the clinical decision-making for patients with stable chest pain.

[Current status and challenges for taeniasis and cysticercosis control in China]

In the WHO new road map for neglected tropical diseases 2021-2030, the disease-specific targets are classified into control, elimination as a public health problem, elimination and eradication, and taeniasis and cysticercosis are targeted for control. The overall prevalence of taeniasis and cysticercosis is low in China, and varies remarkably in regions and populations; however, there are many challenges for elimination of taeniasis and cysticercosis in China. Based on previous taeniasis and cysticercosis control programs, developing a sensitive taeniasis and cysticercosis surveillance-response system, updating criteria for diagnosis of taeniasis and cysticercosis, proposing a national guideline for treatment of taeniasis and cysticercosis, and strengthening interdisciplinary and intersectoral communications and collaborations are urgently needed under the One Health concept.

Synthesis and characterization of an anti-caries and remineralizing fluorine-containing cationic polymer PHMB-F

Dental caries have become a major global public health problem. Plaque control and remineralization of initial enamel lesions are paramount for the prevention and control of caries. Polyhexamethylene biguanide (PHMB) is a type of cationic amphipathic antibacterial agent with broad-spectrum antibacterial properties and good biological safety. Fluoride delays demineralization and promotes the remineralization of hard dental tissues. However, a high concentration is needed for it to function as an antibacterial agent. In order to create a PHMB with the benefits associated with fluoride, we synthesized a fluorine-containing cationic polymer, PHMB-F. Fourier transform-infrared spectroscopy and solid state nuclear magnetic resonance characterization confirmed the successful synthesis of PHMB-F. Antibacterial tests showed that PHMB-F had better antiseptic efficacy for Streptococcus mutans compared with just PHMB. Moreover, positively-charged PHMB-F allows fluoride ions to exist closer to the enamel surface with negative potential, which markedly lowers the ion concentrations in the microenvironment adjacent to hard dental tissues needed to maintain equilibrium. Thus, only low concentrations of PHMB-F are required for enamel remineralization.

[Some considerations on professional education and teaching reform for public health and preventive medicine]

Following a brief overview of the historical development of undergraduate education of public health and preventive medicine in China's medical universities and colleges, this editorial points out existing issues and dominant challenges, and puts forward compelling demands for undergraduate education in preventive medicine, including in-depth integration with society and population, combined with practice, focusing on problem identificantion and problem solving based on population health, as well as developing undergraduate education programs, education syllabus and courses, construction of teaching materials and off-campus practice teaching bases.

[Prevalence of soil - borne nematode infections among residents living in urban/town areas of China in 2015]

OBJECTIVE

To understand the prevalence of soil-borne nematode infections among residents living in urban/town areas of China, so as to provide insights into the control and elimination of soil-borne nematodiasis.

METHODS

A total of 5 epidemic areas were classified in China according to the prevalence of human Clonorchis sinensis infections captured from the 2014-2015 national survey on major human parasitic diseases in China, and the total sample size was estimated according to the binomial distribution and Poisson's distribution. Then, the total sample size was allocated proportionally to each province (autonomous region, municipality) of China based on the percentage of residents living in urban and town areas, and the number of survey sites in each province (autonomous region, municipality) was proportionally assigned according to the percentages of residents living in urban and town areas. Then, stratified sampling was performed at county, township and community levels according to the number of sampling sites in each province (autonomous region, municipality), and the survey site (community) was defined as the smallest sampling unit. All permanent residents in the survey sites were selected as the study subjects, and their stool samples were collected for identification and counting of parasite egg using a Kato-Katz technique. The prevalence and intensity of each parasite species were calculated.

RESULTS

From 2014 to 2015, among the 133 231 residents detected in 31 provinces (autonomous regions, municipalities) of China, the overall prevalence of soil-borne nematode infections was 1.23% (1 636/133 231), and the prevalence rates of hookworm, Ascaris lumbricoides and Trichuris trichiura infections were 0.77% (1 032/133 231), 0.32% (426/133 231) and 0.17% (224/133 231), respectively. The highest prevalence of soil-borne nematode infections was seen in Jiangxi (4.03%, 82/2 034) and Chongqing (4.03%, 524/13 012), followed by in Hainan (3.47%, 72/2 075). The prevalence of soilborne nematode infections was 1.07% (662/62 139) in men and 1.37% (974/71 092) in women, and the greatest prevalence was found in residents at ages of 65 to 70 years (2.56%, 219/8 569). With regard to occupations and education levels, herdsmen (2.47%, 2/81) and illiterate residents (3.33%, 226/6 795) were found to have the highest prevalence of soil-borne nematode infections, respectively. In addition, mild infections were predominantly identified in hookworm-, A. lumbricoides- and T. trichiura-infected individuals (all > 90%).

CONCLUSIONS

The overall prevalence of soil-borne nematodiasis remains low in urban and town areas of China; however, human infections are widespread. According to the epidemiological features, health education combined with deworming are recommended to reduce the prevalence of soil-borne nematode infections among residents living in urban and town areas of China.

[Epidemiological characteristics of amoebic dysentery in China, 2015-2018]

Objective: To understand the characteristics and changes of the incidence of amoebic dysentery in China during 2015-2018, explore the causes of high incidence in some areas and provide a data base for the development of national prevention and control strategies and measures. Methods: Data were collected from the infectious disease reporting management information system from Chinese Disease Control and Prevention. To understand the seasonal, population and area distributions of amoebic dysentery, descriptive epidemiological method and software SPSS 16.0 were used to analyze the amoebic dysentery data. Results: A total of 4 366 amoebic dysentery cases were reported without death in China during 2015-2018. The reported average annual incidence was 0.08/100 000, and the overall proportion of laboratory confirmed cases was 68.23%(2 979/4 366). Amoeba dysentery mainly occurred during May to October. One seasonal peak was observed in 2015 and 2017 (July and June, respectively), and two seasonal peaks were observed in 2016 and 2018 (June and October). The patients were mainly children aged under 5 years (42.28%, 1 846/4 366), and the incidence rate decreased with age in children aged under 10 years. Of these, children under 1 years of age had the highest incidence rate (1.28/100 000). The number of cumulative reported cases in Guangxi, Henan, Guangdong, Heilongjiang and Jiangxi provinces ranked top five from 2015-2018, accounting for 64.50% (2 816/4 366) of the total. The cumulative cases in Dongxing county, Guangxi, in Suixian county, Henan and in Ranghulu district, Heilongjiang, respectively accounted for more than 50.00% of the total number of cases in their provinces. Conclusions: The incidence rate of amoebic dysentery reported in China during 2015-2018 showed a decreasing trend, with a higher incidence in children under 5 years old and a higher number of cases in some areas. It is suggested to further investigate and analyze the diagnosis and reporting of amoeba dysentery in key areas and promote the update of the diagnostic standards for amoeba dysentery.

[National surveillance on Enterobius vermicularis infections among children at ages of 3 to 9 years in China from 2016 to 2018]

OBJECTIVE

To understand the epidemic status of Enterobius vermicularis infections among children aged 3 to 9 years in China, so as to provide scientific basis for the formulation of the prevention and control strategies for enterobiasis.

METHODS

The national surveillance of enterobiasis was performed in 736 national surveillance sites (counties) from 30 provinces (municipalities/autonomous regions) in China from 2016 to 2018. All surveillance sites were classified into parts according to the geographical directions, including the eastern, western, southern, northern and middle parts, and a township was randomly selected from each part. Then, an administrative village was randomly selected from the township, and 200 permanent residents at ages of over 3 years living in the administrative village were randomly selected using the cluster sampling method. A total of 1 000 residents were examined in each surveillance site. E. vermicularis infections were detected among children at ages of 3 to 9 years using the modified Kato-Katz technique and the adhesive cellophane-tape perianal swab method, and the prevalence of infections was calculated and compared.

RESULTS

The prevalence of E. vermicularis infections was 2.50%, 2.84% and 2.46% among children at ages of 3 to 9 years in the 736 surveillance sites from 30 provinces (municipalities/autonomous regions) in China from 2016 to 2018, and there was no gender-specific prevalence of E. vermicularis infections (P > 0.05). Enterobiasis was main prevalent in the southern and southwestern part of China (Jiangxi, Guangxi, Guangdong, Sichuan, Fujian, Chongqing and Hainan), with 5.00% prevalence and greater, and the highest prevalence was seen in Jiangxi and Guangxi for successive 3 years. In addition, the prevalence of E. vermicularis infections was higher in children with the Han ethnicity than in those with the minority ethnicity, and a high prevalence was found in children at ages of 4 to 7 years, and a low prevalence seen in children at ages of 3, 8 and 9 years.

CONCLUSIONS

The prevalences of E. vermicularis infections have not changed much among children at ages of 3 to 9 years in China from 2016 to 2018, and high prevalence is seen in southern and southwestern China, which should be given a high priority.

[Establishment of an evaluation system for the field assessment of the Kato-Katz technique in detection of soil-transmitted nematodiasis]

OBJECTIVE

To establish an evaluation system for the field assessment of the Kato-Katz technique in detecting soiltransmitted nematodes, so as to provide insights into the field application of the Kato-Katz technique.

METHODS

The initial evaluation indicators were determined through literature search, brainstorming and expert consultation. The evaluation indicatorswere improved and the weight of each indicator was decided through three rounds of expert consultation by using the Delphimethod. In addition, the expert authority coefficient and the coordination coefficient of each indicator were calculated at eachround of expert consultations.

RESULTS

The recovery rates of the questionnaire were 100.00%, 100.00% and 89.29% at the firstto the third round of the expert consultations, respectively, and the expert authority coefficients were all more than 0.85 at eachround. The final evaluation system included 4 first-level indicators and 15 second-level indicators. In the first-level indicators, "detecting effect" and "funds investment" had the mean weighted value of 4.53 and 4.49, which were relatively higher than that of"person-time investment" and "operability" (both 4.34). Among the second-level indicators under each first-level indicator, thefour most significant indicators included "ability of personnel in egg discrimination", "cooperation of village cadres and doctors","Person-time on testing" and "organizational start-up cost", with the mean weighted values of 4.74, 4.43, 4.39 and 4.17, respectively. The coordination coefficients were 0.39 to 0.65, 0.28 to 0.58 and 0.45 to 0.65 at the first to the third round of the expertconsultations, respectively, and there were significant differences in the coordination coefficients at all three rounds of the consultations (all P < 0.05).

CONCLUSIONS

An evaluation system for the field assessment of the Kato-Katz technique in detecting soiltransmitted nematodes is successfully established, among which "ability of personnel in egg discrimination" and "cooperation ofvillage cadres and doctors" have the greatest mean weighted values of the significance.

[Declaration of Astana and preventive medicine in China]

At the time of the 40th anniversary of the Alma-Ata Declaration, the World Health Organization member states signed the Declaration of Astana. From Health For All to Universal Health Coverage, primary health care is consistantly identified as the key to achieving human health, and preventive services are critical and central component of primary health care. China has provided valuable experience for primary health care to countries around the world. However, with significant socioeconomic changes and rapid population aging, the contexts of primary health care and prevention services in China has undergone tremendous changes. Chronic diseases have become major burden of disease. System development and institution building, health service delivery system development, and the entire society of the country with large population are encountering new and serious challenges. On the basis of reviewing the development of preventive medical services in China for 40 years, Authors analyzes strengths and weaknesses of preventive services in China and looks forward to the challenges and opportunities in the coming decades, from perspective of primary, secondary and tertiary prevention strategies, and proposes suggestions for future development.

[Establishment and role of national clonorchiasis surveillance system in China]

Clonorchiasis is one key food-borne parasitic disease in China. Owing to several years'efforts and preparation, the national clonorchiasis surveillance system in China has been established preliminarily since 2016. In this article, the necessity to establish the national clonorchiasis surveillance system is explained. Then, the structure, content and corresponding methods of the surveillance system are briefly introduced. Key points in the surveillance are summarized and the development of surveillance in future is discussed. Furthermore, the contribution of clonorchiasis surveillance in China to the world is also analyzed.

[Value of fragmented QRS wave in evaluating the prognosis of patients with coronary artery disease]

Objective: The aim of the current study was to investigate the predictive value of fragmented QRS wave ( fQRS) for the prognosis of patients with coronary heart disease (CHD). Methods: A total of 714 consecutive patients with confirmed CHD were included from Department of Cardiology, General Hospital of PLA between January 2013 and January 2014, and were divided into fQRS group and non-fQRS group based on the presence of fQRS wave or not according to Electrocardiograph (ECG). The baseline, ECG characteristic value, the echocardiography results of the patients were compared between the two groups. Cardiac events were recorded in all patients during 12 months' follow-up. Subgroup analysis was also conducted among patients with abnormal Q wave to investigate the association between fQRS and cardiovascular events. Results: A total of 673 patients completed the follow-up, with 533 in fQRS group and 140 in non-fQRS group. The P wave duration in the fQRS group was longer than non-fQRS group [(92±21) vs (82±23)ms, P<0.01]. The left ventricular ejection fraction (LVEF) value in the fQRS group was lower than non-fQRS group (42%±22% vs 49%±15%, P<0.01) according to echocardiography results. The subgroup analysis with abnormal Q wave showed that compared with non-fQRS group, the left ventricular ejection fraction (LVEF) value in the group of fQRS was lower (38%±21% vs 50%±7%, P<0.01). There was statistically significant in the mortality of patients within follow-up period between the two groups (P<0.05), and the survival time in fQRS group was shorter than the non-fQRS group [(28.3±3.4) vs (30.5±1.5)months, P<0.01]. Conclusion: FQRS presence in body surface ECG of CHD patients with abnormal Q wave is a sign for increased risk of cardiovascular events, which can serve as an indicator to identify CHD patients at high risk of death.

[Prediction value of deceleration capacity of rate and GRACE risk score on major adverse cardiac events in patients with acute myocardial infarction]

OBJECTIVE

To investigate the prediction value of deceleration capacity of rate (DC) and GRACE risk score for cardiovascular events in AMI patients.

METHODS

Consecutive AMI patients with sinus rhythm hospitalized in our department during August 2012 to August 2013 were included in this prospective study. 24-hour ECG Holter monitoring was performed within 1 week, and the DC value was analyzed, GRACE risk score was acquired with the application of GRACE risk score calculator. Patients were followed up for more than 1 year and major adverse cardiac events (MACE) were obtained. Analysised the Kaplan Meier survival according to DC and GRACE score risk stratification respectively.

RESULTS

A total of 157 patients were enrolled in the study (average age: (58.9±12.7)years old). The average follow-up was (20.54±2.85) months. Mortality during follow-up was significantly higher in patients with DC>2.5 compared to patients with DC≤2.5 (P<0.01). In terms of early warning cardiac death, the area under ROC curve of DC risk stratification was 0.898 (95%CI 0.840-0.940, P<0.01), the sensitivity was 84.6%, and the specificity was 84.0%. The area under ROC curve of GRACE risk stratification was 0.786 (95%CI 0.714-0.847, P<0.01), the sensitivity was 84.6%, and the specificity was 74.3%. In terms of early warning cardiac adverse events, the ROC curve of DC was 0.747(95%CI 0.672-0.813, P<0.01), with the 90.0% sensitivity and 67.7% specificity. The GRACE risk stratification was 0.708 (95%CI 0.652-0.769, P<0.01), with the 63.3% sensitivity and 75.6% specificity. Subgroup analysis showed that mortality during follow-up was significantly higher in high risk patients than those with intermediate and low risk patients according to DC risk stratification in intermediate and low risk patients by GRACE risk stratification (P<0.01).

CONCLUSION

DC could predict cardiac death and MACE in patients with AMI. DC risk stratification is superior to GRACE risk score on outcome assessment in this AMI patient cohort.

[Cross-sectional study of differential effects with age on non-invasive central hemodynamics and peripheral arterial stiffness of healthy people in Beijing communities]

OBJECTIVE

To observe the variation of central hemodynamics and peripheral arterial stiffness in different ages and to investigate the parameters of differential effects in younger individuals (≤60y) and older individuals (>60y).

METHODS

We conducted a population-based cross-sectional study in eight regions by random cluster sampling, from April to July 2014 in Beijing, China.Central hemodynamics and peripheral arterial stiffness parameters were determined in 861 healthy (372 male), normotensive individuals, aged 20 to 91(56±14) years.The main observed indexes were central systolic blood pressure (cSBP), arterial augmentation index (AI), augmentation pressure (AP), heart-ankle pulse wave velocity (haPWV) and brachial-ankle PWV (baPWV). Subjects were divided into six groups by 10 aged segment.Differences between groups and age tendency were observed.

RESULTS

The mean values of cSBP, AI, AP, haPWV and baPWV were (113±12) mmHg, (90±18)%, (-5±9) mmHg, (987±144) cm/s and (1 382±254) cm/s, respectively.cSBP, AI, AP, haPWV and baPWV increased with age (P<0.001). In average, cSBP, baPWV and haPWV increased 3 mmHg, 97 cm/s and 62 cm/s by additional 10 years, respectively.cSBP, AI and AP increased slowly after 60 years old, while haPWV and baPWV increased significantly with age (P<0.001). Stepwise regression analysis showed: cSBP was mainly relevant with mean arterial pressure(b=0.990, P<0.001), while baPWV and haPWV were relevant with age(b=8.858, 5.971; P<0.001). AI and AP were associated with height and rest heart rate (b=-0.676, -0.660 and b=-0.361, -0.341, P<0.001). Individuals were divided into two groups by age 60.The age-related changes in AI were significant in under 60-year-old; while the changes in baPWV were more prominent in over 60-year-old.However there was no significant difference in cSBP between two groups.

CONCLUSIONS

In healthy people, there are obvious differences of age tendency in central hemodynamics and peripheral arterial stiffness parameters.AI might be a good predictor of cardiovascular disease for early stage, especially for early coronary artery disease.

[A large-scale, multicenter, retrospective study on efficacy of bivalirudin use during peri-percutaneous coronary intervention period for Chinese patients with coronary heart disease]

OBJECTIVE

To observe the efficacy and safety of bivalirudin use in Chinese patients with coronary heart disease (CHD) during the peri-percutaneous coronary intervention(PCI) period.

METHODS

A total of 3 271 patients who underwent PCI and received periprocedural bivalirudin treatment between July 2013 and October 2015 from 88 centers of China were involved in this study. The primary outcome was 30-day net adverse clinical events (NACE a composite of major adverse cardiac or cerebral events (MACE, all-cause death, reinfarction, urgent target vessel revascularization, or stroke) or bleeding), the secondary outcome was stent thrombosis at 30 days.

RESULTS

The mean age of enrolled patients was (65.12±12.44) years old, 27.4%(889/3 244) of them were female. Percent of stable coronary disease (SCD), non-ST segment elevation acute coronary syndrome (NSTE-ACS) and ST elevation myocardial infarction (STEMI) was 5.0%(162/3 248), 44.6%(1 450/3 248) and 50.4%(1 636/3 248) respectively. Radial access was performed in 89.5% (2 879/3 271) patients, and 9.7% (316/3 271) and 34.1% (1 115/3 271) patients also received ticagrelor and tirofiban medication. 69.3% (2 266/3 271) patients received post-procedural bivalirudin infusion, in which 46.3% (1 050/2 266) was treated at PCI-does, with a median duration of 2.5(1.0, 4.0) h. During the 30-day follow-up, NACE occurred in 3.45% (103/2 988) patients, the incidence of MACE, death was 2.17% (65/2 994) and 1.03% (31/3 017), respectively and bleeding events were recorded in 1.37% (41/2 996) patients. Four cases (0.13%) of stent thrombosis (3 acute stent thrombosis) were recorded.

CONCLUSION

Peri-PCI Bivalirudin use is safe and related with low bleeding risk in Chinese CHD patients.

QSAR studies on imidazopyrazine derivatives as Aurora A kinase inhibitors

Aurora kinases have emerged as attractive targets for the development of novel anti-cancer agents. A combined study of molecular docking, pharmacophore modelling and 3D-QSAR was performed on a series of imidazo [1, 2-a] pyrazines as novel Aurora kinase inhibitors to gain insights into the structural determinants and their structure-activity relationship. An ensemble of conformations based on molecular docking was used for PHASE pharmacophore studies. The developed best-fitted pharmacophore model was validated by diverse chemotypes of Aurora A kinase inhibitors and was consistent with the structural requirements for the docked binding mechanism. Subsequently, the pharmacophore-based alignment was used to develop PHASE and comparative molecular similarity indices analysis (CoMSIA) 3D-QSAR models. The best CoMSIA model showed good statistics (q (2 )= 0.567, r (2 )= 0.992), and the predictive ability of the model was validated using an external test set of 13 compounds giving a satisfactory prediction ([Formula: see text]). The 3D contour maps provided insight into the binding mechanism and highlighted key structural features that are essential to the inhibitory activity. Based on the PHASE and CoMSIA 3D-QSAR results, a set of novel Aurora A inhibitors were designed that showed excellent potencies.

The usefulness of phosphorylated-signal transduction and activators of transcription 3 in detecting prostate cancer from negative biopsies

AIMS

To avoid the misdiagnosis of prostate cancer (PCA), many patients receive repeated biopsies, despite receiving prior negative biopsies for PCA. Signal transduction and activators of transcription 3 (STAT3), a component of the JAK-STAT signaling pathway, can be activated by tyrosine phosphorylation as P-STAT3 and involved in the regulation of cellular growth, survival and oncogenesis. We aimed to assess the reliability of detecting PCA from the expression of P-STAT3 in prostate tissue previously designated as a negative biopsy.

METHODS

Prostate tissues were obtained from the biopsies of 52 patients with localized PCA as well as from the biopsies of 80 patients free of PCA. Expression of P-STAT3 in these specimens was examined by immunohistochemical staining (IHC) and used to distinguish tissue with PCA from tissue designated as benign during a biopsy procedure.

RESULTS

P-STAT3 staining intensities in all samples (initial negative biopsies, cancer positive cores and other negative cores from the same-batch biopsies) of PCA patients was significantly higher than that of benign patients (F = 23.664, P < 0.001). Analysis of the receiver operating characteristics (ROC) curve showed that the area under curve (AUC) for P-STAT3 staining was 0.785. When positive immuno-labeling of P-STAT3 in samples from initial biopsies was used as a marker for PCA, it showed relatively high sensitivity (80.8%) and specificity (76.3%).

CONCLUSIONS

IHC of P-STAT3 could be utilized to detect PCA patients with initial negative biopsies. As a result, it can be a potential adjunctive tool for current PCA diagnostic programs. P-STAT3 can predict the onset of PCA up to 40 months earlier than currently used diagnostic approaches.

Free energy of nascent-chain folding in the translocon

During their synthesis, many water-soluble proteins and nearly all membrane proteins transit through a protein-conducting channel in the membrane, the Sec translocon, from where they are inserted into the lipid bilayer. Increasing evidence indicates that folding of the nascent protein begins already within the ribosomal exit tunnel in a sequence- and environment-dependent fashion. To examine the effects of the translocon on the nascent-chain folding, we have calculated the potential of mean force for α-helix formation of a 10-alanine oligopeptide as a function of its position within the translocon channel. We find that the predominant conformational states, α-helical and extended, reflect those found for the peptide in water. However, the translocon, via its surface properties and its variable diameter, shifts the equilibrium in favor of the α-helical state. Thus, we suggest that the translocon facilitates not only the insertion of membrane proteins into the bilayer but also their folding.

Recent progress in the identification and development of InhA direct inhibitors of Mycobacterium tuberculosis

The InhA-related enoyl-ACP reductase, an enzyme involved in fatty acid synthesis, is one of the best validated targets for the development of anti-tubercular agents. However, the majority of isoniazid (INH)-resistant clinical strains are observed mainly due to the emergence of KatG mutants that do not form an INH-NAD adduct. Thus compounds that directly inhibit InhA avoiding activation by KatG would be promising candidates for combating MDR-TB. Herein, some predominant examples of InhA direct inhibitors recently developed are reviewed and special attention is paid to 3D-structures of InhA in drug design process.

Anomalous properties of a simple small-volume membrane transport system at steady state

We investigate the transport of a single ligand L, between two macroscopic baths with different concentrations of L, by a simple membrane system. The center of this system is a very small volume V that might contain N = 0, 1, 2,... molecules of L. Access to V from either bath is by means of a single binding site for L. The steady-state properties of this simple system are studied exactly by a discrete-N master-equation approach. It is found that the mean concentration of L in V, c = N/V, is not a significant quantity either kinetically or thermodynamically. Further, the chemical potential of L in V is not defined and hence the overall thermodynamic force on L between the two baths cannot be subdivided at V. In fact, because V is small, the transport system must be treated as an indivisible system with interdependent parts. In the limit when V and N are very large, V becomes in effect a third macroscopic bath and two well-defined transport subsystems emerge (between V and either bath).

Three-state, steady-state Ising systems: Monte Carlo and Bragg-Williams treatments

In two earlier papers, the steady-state critical and phase-transition properties of a lattice of three-state enzyme molecules were studied by using the "closed" Bragg-Williams (BW), or mean field, approximation. The "open" BW and Monte Carlo methods are applied to the same problem in this paper by using finite lattices. The open BW treatment provides a way of locating the cut across a van der Waals type of loop encountered in a phase transition in the closed BW system. Thermodynamic-like methods cannot be used for this purpose as they can with two-state, steady-state systems.

Study comparing the double kissing (DK) crush with classical crush for the treatment of coronary bifurcation lesions: the DKCRUSH-1 Bifurcation Study with drug-eluting stents

BACKGROUND

Classical crush has a lower rate of final kissing balloon inflation (FKBI) immediately after percutaneous coronary intervention (PCI). The double kissing (DK) crush technique has the potential to increase the FKBI rate, and no prospective studies on the comparison of classical with DK crush techniques have been reported.

MATERIALS AND METHODS

Three hundred and eleven patients with true bifurcation lesions were randomly divided into classical (n = 156) and DK crush (n = 155) groups. Clinical and angiographic details at follow-up at 8 months were indexed. The primary end point was major adverse cardiac events (MACE) including myocardial infarction, cardiac death and target lesion revascularization (TLR) at 8 months.

RESULTS

FKBI was 76% in the classical crush group and 100% in the DK group (P < 0.001). The incidence of stent thrombosis was 3.2% in the classical crush group (5.1% in without- and 1.7% in with-FKBI) and 1.3% in the DK crush group. Cumulative 8 month MACE was 24.4% in the classical crush group and 11.4% in the DK crush group (P = 0.02). The TLR-free survival rate was 75.4% in the classical crush group and 89.5% in the DK crush group (P = 0.002).

CONCLUSIONS

DK crush technique has the potential of increasing FKBI rate and reducing stent thrombosis, with a further reduction of TLR and cumulative MACE rate at 8 months.

Diffusion pollution from livestock and poultry rearing in the Yangtze Delta, China

BACKGROUND

The Yangtze Delta is one of the most developed regions in China and includes Shanghai, eight cities in Jiangsu province and eight cities in Zhejiang province. Meat consumption in this region has increased with economic growth, and most of the consumed meat is produced locally. The water quality of surface waters has deteriorated in recent years. An example was the huge blue-green algae bloom in Tai Lake in late May 2007, which affected millions of people's daily drinking water. However, animal husbandry is considered to be one of the main pollution sources.

METHODS

Pollutants (NH3-N, total phosphorus (TP), and total nitrogen (TN)) excreted by livestock and poultry, and the resultant COD (chemical oxygen demand) and BOD (biochemical oxygen demand), were estimated using two different methods based on different data sets.

RESULTS

The number of livestock and poultry has remained stable in the Yangtze Delta over the four years from 1999 to 2002, with the average number of pigs, cattle, sheep and poultry being 21.1 M, 0.4 M, 7.7 M and 597.6 M, respectively. Pollutants in livestock and poultry excreta estimated by Method I were: 0.12 Mt NH3-N, 0.11 Mt TP and 0.29 Mt TN, resulting in COD and BOD of 1.34 Mt and 1.30 Mt, respectively, while the estimations based on Method II were: 0.18 Mt NH3-N, 0.15 Mt TP and 0.40 Mt TN, resulting in COD and BOD of 1.95 Mt and 1.80 Mt, respectively.

DISCUSSION

Pollutants excreted annually by livestock and poultry in the Yangtze Delta are estimated to be: 0.17 Mt NH3-N, 0.16 Mt TP and 0.42 Mt TN, giving rise to a COD of 1.86 Mt and a BOD of 1.72 Mt. Approximately 25% of this pollution was estimated to enter water bodies, which means that the annual pollutant load is 43,700 t NH3-N, 39,400 tTP, 104,600t TN with a COD of 465,000 tand a BOD of 430,100 t. Pollutants from animal husbandry were similar in magnitude to those from industrial wastewater. Pigs produced the most pollution, followed by poultry, cattle and sheep. The pollution load from animal husbandry in the Yangtze Delta is about twice the average level of the whole of China.

CONCLUSIONS

Domestic wastewater was the main pollution source in the Yangtze Delta, followed by pollution from raising livestock and poultry and from industrial wastewater. The pollution load in Shanghai and Jiaxing were the greatest, followed by 7 cities of Jiangsu province (except Suzhou) and other cities of Zhejiang province and Suzhou. Pigs and poultry produced about 90% of the total pollutants from animal husbandry.

RECOMMENDATIONS AND PERSPECTIVES

The local governments, especially in Shanghai and Jiaxing, should focus their attention on the pollution produced by livestock and poulrry. Controlling pollution from pigs and poultry will have the greatest impact in this region. Control of pollution will be facilitated by the development of large-scale livestock and poultry farming units and a shift away from small scale husbandry.

Inverted papilloma of urinary bladder: Is long-term cystoscopic surveillance needed? A single center’s experience

OBJECTIVES

To review all cases of urinary bladder inverted papilloma (IP) in our institution and determine the need for cystoscopic surveillance. IP is an uncommon benign tumor of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) suggest possible malignant potential, leading to conflicting clinical conclusions regarding the need for surveillance.

METHODS

All consecutive patients from January 1991 to December 2004 with IP were included in this study. A single pathologist performed the histologic review. The patients had undergone cystoscopy and ultrasound evaluation of the kidneys every 6 months.

RESULTS

Of the 52 patients, 45 were men and 7 were women. The average age at presentation was 58.9 +/- 11.8 years (range 30 to 79). No patient had a synchronous or previous bladder tumor. The most common complaint was macroscopic hematuria. Ten cases were incidental findings during bladder ultrasonography or cystoscopy. All were solitary tumors, most commonly found at the bladder neck. The average follow-up period was 62 +/- 23 months, with no recurrence. One case of subsequent noninvasive papillary TCC developed 15 months later. The initial histologic findings had revealed cytologic atypia, with suspicious urine cytology findings. On review, it was more compatible with TCC with an inverted pattern.

CONCLUSIONS

Although our cases exhibited benign biologic behavior, the presence of cytologic atypia and suspicious urine cytology require exclusion of TCC with an inverted pattern. Thus, in histologically proven solitary bladder IP with no associated TCC, cystoscopic surveillance may not be necessary.

Estimation and projection of the national profile of cancer mortality in China: 1991-2005

There are no national-level data on cancer mortality in China since two surveys in 1973–1975 and 1990–1992 (a 10% sample), but ongoing surveillance systems, based on nonrandom selected populations, give an indication as to the trends for major cancers. Based on a log-linear regression model with Poisson errors, the annual rates of change for 10 cancers and all other cancers combined, by age, sex and urban/rural residence were estimated from the data of the surveillance system of the Center for Health Information and Statistics, covering about 10% of the national population. These rates of change were applied to the survey data of 1990–1992 to estimate national mortality in the year 2000, and to make projections for 2005. Mortality rates for all cancers combined, adjusted for age, are predicted to change little between 1991 and 2005 (−0.8% in men and +2.5% in women), but population growth and ageing will result in an increasing number of deaths, from 1.2 to 1.8 million. The largest predicted increases are for the numbers of female breast (+155.4%) and lung cancers (+112.1% in men, +153.5% in women). For these two sites, mortality rates will almost double. Cancer will make an increasing contribution to the burden of diseases in China in the 21st century. The marked increases in risk of cancers of the lung, female breast and large bowel indicate priorities for prevention and control. The increasing trends in young age groups for cancers of the cervix, lung and female breast suggest that their predicted increases may be underestimated, and that more attention should be paid to strategies for their prevention and control.

Estimation and projection of the national profile of cancer mortality in China: 1991-2005

There are no national-level data on cancer mortality in China since two surveys in 1973-1975 and 1990-1992 (a 10% sample), but ongoing surveillance systems, based on nonrandom selected populations, give an indication as to the trends for major cancers. Based on a log-linear regression model with Poisson errors, the annual rates of change for 10 cancers and all other cancers combined, by age, sex and urban/rural residence were estimated from the data of the surveillance system of the Center for Health Information and Statistics, covering about 10% of the national population. These rates of change were applied to the survey data of 1990-1992 to estimate national mortality in the year 2000, and to make projections for 2005. Mortality rates for all cancers combined, adjusted for age, are predicted to change little between 1991 and 2005 (-0.8% in men and +2.5% in women), but population growth and ageing will result in an increasing number of deaths, from 1.2 to 1.8 million. The largest predicted increases are for the numbers of female breast (+155.4%) and lung cancers (+112.1% in men, +153.5% in women). For these two sites, mortality rates will almost double. Cancer will make an increasing contribution to the burden of diseases in China in the 21st century. The marked increases in risk of cancers of the lung, female breast and large bowel indicate priorities for prevention and control. The increasing trends in young age groups for cancers of the cervix, lung and female breast suggest that their predicted increases may be underestimated, and that more attention should be paid to strategies for their prevention and control.

Long-term temporal-spatial dynamics of marine coastal water quality in the Tolo Harbor, Hong Kong, China

The long-term temporal and spatial dynamics of marine coastal water quality in Tolo Harbor, Hong Kong were explored. The Harbor is divided into three zones represented as Harbor, Buffer, and Channel Subzones. The time range for the study covers the period from the 1970s to the 1990s. The selected indicators for the comprehensive assessment of water quality consist of physical, chemical and biological aspects, including suspended solids(SS), Secchi disk depth(SD), 5-day biochemical oxygen demand(BOD5), total nitrogen (TN), total phosphorus(TP), faecal coliform, chlorophyll-a(Chl-a), and the number of red tide occurrences. The results indicated the presence of obvious temporal and spatial trends with regard to changes in water quality. Spatially, water quality in the Channel Subzone is the best, while that in the Harbor Subzone is the worst. On a temporal basis, the average trend from bad to good was 1980s > 1990s > 1970s as indicated by most of the selected water quality indicators. Water quality during the late 1980s reached its worst level with the lowest SD, the highest BOD5, TN, TP, Chl-a concentrations, and the number of red tide occurrences. These long-term temporal-spatial water quality trends were also found in other studies of the Tolo Harbor. The large quantity of pollutants produced as a result of increasing population, industrial and commercial actives, and urbanization and industrialization trends in both Shatin and Tai Po seem to be primarily responsible for the changes in marine coastal water quality.

[Analysis on karyotypes of ANKA strain of Plasmodium berghei]

OBJECTIVE

To analyze the molecular karyotypes of ANKA strain of Plasmodium berghei and demonstrate the size and number of chromosomes.

METHODS

To isolate the genome DNA of P. berghei ANKA strain and analyze molecular karyotypes through CHEF-III pulsed field gel electrophoresis (PFGE).

RESULTS

The number of chromosomes was found to be 14, and their size ranged from 0.6 Mb to 3 Mb. Chromosomes number 5 to 7 and 9 to 12 appeared co-migrated in the gel.

CONCLUSION

PFGE technique is useful for analyzing the molecular karyotypes and may be also useful for further study to locate the special gene on chromosomes and carry out the genetic characters and mechanism of drug resistance.

The glycine allele of a glycine/arginine polymorphism in the beta2-adrenergic receptor gene is associated with essential hypertension in a population of Chinese origin

BACKGROUND

Several studies implicate polymorphisms in the human beta-adrenergic receptor gene (ADRB2) in the susceptibility to hypertension. We sought to replicate these results in a population of Chinese origin primarily from Taiwan and the San Francisco Bay area.

METHODS

We genotyped >800 hypertensive subjects and individuals with low-normal blood pressure that were derived largely from the same families as the hypertensive patients for three polymorphisms in the ADRB2 gene: a C/T transition at position 47 (C-47T) in the 5' leader cistron; another C/T transition that results in a glycine/ arginine substitution at codon 16 (Gly16Arg), and a G/C transversion that causes a glutamate/glutamine substitution at codon 27 (Glu27Gln).

RESULTS

The Gly16Arg was significantly associated with hypertension (P < .03). Under a dominant model, for hypertension the relative risk for the Gly/Gly and Gly/Arg genotypes versus the Arg/Arg genotype was 1.35 (95% confidence limits [CL] 1.08, 1.70); for low-normal blood pressure the relative risk was 0.79 (95% CL 0.66, 0.94). This polymorphism explained approximately 1% of the variance in systolic and diastolic blood pressures in our study population. There was no evidence of association between the C-47T and Glu27Gln polymorphisms and hypertension in this population.

CONCLUSIONS

The Glyl6 allele in the beta2-adrenergic receptor gene is a susceptibility allele for essential hypertension in a population of Chinese origin.

Genetic variation in aldosterone synthase predicts plasma glucose levels

The mineralocorticoid hormone, aldosterone, is known to play a role in sodium homeostasis. We serendipitously found, however, highly significant association between single-nucleotide polymorphisms in the aldosterone synthase gene and plasma glucose levels in a large population of Chinese and Japanese origin. Two polymorphisms--one in the putative promoter (T-344C) and another resulting in a lysine/arginine substitution at amino acid 173, which are in complete linkage disequilibrium in this population--were associated with fasting plasma glucose levels (P = 0.000017) and those 60 (P = 0.017) and 120 (P = 0.0019) min after an oral glucose challenge. A C/T variant in intron 1, between these polymorphisms, was not associated with glucose levels. Arg-173 and -344C homozygotes were most likely to be diabetic [odds ratio 2.51; 95% confidence interval (C.I.) 1.39-3.92; P = 0.0015] and have impaired fasting glucose levels (odds ratio 3.53; 95% C.I. 2.02-5.5; P = 0.0000036). These results suggest a new role for aldosterone in glucose homeostasis.

Sibling-based association study of the PPARgamma2 Pro12Ala polymorphism and metabolic variables in Chinese and Japanese hypertension families: a SAPPHIRe study. Stanford Asian-Pacific Program in Hypertension and Insulin Resistance

The peroxisome proliferator activated receptor (PPAR) gamma2 is a transcription factor that has been shown to be involved in adipocyte differentiation, adipogenesis, and insulin sensitivity. To address the role of PPARgamma2 in glucose homeostasis and insulin sensitivity, among many other objectives, we conducted a sibling-controlled association study in a multicenter program - the Stanford Asian-Pacific Program in Hypertension and Insulin Resistance (SAPPHIRe). Approximately 2525 subjects in 734 Chinese and Japanese families have been recruited from six field centers for SAPPHIRe. In total, 1702 subjects including parents and siblings from 449 families have been genotyped for PPARgamma2, of which 328 families were Chinese and 121 Japanese. Only 88 subjects of the 1525 siblings screened for the P12A polymorphism were found to be carriers of the A variant, the most common variant of the PPARgamma2 gene. A variant frequencies of the siblings were 4.27% in Chinese and 2.72% in Japanese. A sibling-controlled association study was performed through genetically discordant sibships (i.e., P/P genotype vs. P/A + A/A genotypes). Specifically, we examined whether there were differences in metabolic variables between the discordant siblings within families. In total, 88 subjects carrying either 1 or 2 A alleles had at least one sibling who was discordant for the P12A polymorphism, yielding a total of 180 individuals from 47 families for analyses, among which 92 siblings were homozygous for wild-type P allele. Siblings with the A variant tended to have lower levels of fasting plasma glucose (OG-10), and lower glucose levels at 60 min following oral glucose loading after adjusting for age, gender, and body mass index. Using a mixed model treating family as a random effect, we found that P12A polymorphism of the PPARgamma2 gene contributes significantly to the variance in fasting plasma glucose, glucose level at 60 min, and insulin-resistance homeostasis model assessment. Our results suggest that within families siblings with the A variant in the PPARgamma2 gene may be more likely to have better glucose tolerance and insulin sensitivity independent of obesity in Chinese and Japanese populations.

Stiff-Baby--an unusual manifestation of cytoplasmic body myopathy: report of one case

A 2-month-old male baby was admitted to our hospital with episodic cyanosis and respiratory failure which required mechanical ventilation. He was found to have upper limb flexion rigidity and poor weight gain since one month old. Progressive muscle stiffness over the abdomen, chest wall, back and four limbs were also noted. He could not be weaned from the ventilator smoothly due to recurrent CO2 retention. Laboratory tests revealed a high serum creatine kinase level. Cytoplasmic body myopathy was confirmed by muscle biopsy. The unusual initial presentations of generalized stiffness and early onset of respiratory failure were quite different from those of patients reported in the literature, who had floppiness, muscular atrophy and weakness. Prednisolone and Vigabatrin were given and the patient showed slight improvement in muscle stiffness and spontaneous movement.

Genetic variation in the human urea transporter-2 is associated with variation in blood pressure

The kidney, by regulating the volume of fluid in the body, plays a key role in regulating blood pressure (BP). The kidney uses primarily sodium and, to a lesser extent, urea to maintain the appropriate volume of fluid. Genetic variation in proteins that determine sodium reabsorption and excretion is known to significantly influence BP. However, the influence of genetic variation in urea transporters on BP has not been examined. We determined therefore whether nucleotide variation in the kidney-specific human urea transporter, HUT2, is associated with variation in BP. After determining the genomic structure of the coding sequence, seven single nucleotide polymorphisms (SNPs) were identified. Two of the SNPs result in Val/Ile and Ala/Thr amino acid substitutions at positions 227 and 357 in the HUT2 open reading frame, respectively. Another SNP is silent and four others are in introns or the 3' untranslated region. Over 1000 hypertensive and low-normotensive individuals of Chinese origin were typed for five of these SNPs using a high-throughput genotyping method. The Ile227 and Ala357 alleles were associated with low diastolic BP in men but not women, with odds ratios 2.1 [95% confidence interval (CI) 1.5-2.7, P < 0.001] and 1.5 (95% CI 1.2-1.8, P < 0.001), respectively. There was a similar trend for systolic BP, and odds ratios for the Ile227 and Ala357 alleles were 1.7 (95% CI 1.2-2.3, P = 0.002) and 1.3 (95% CI 1.1-1.6, P = 0.007), respectively, in men.

Growth response and final height in growth hormone-deficient patients treated with biosynthetic growth hormone

Twenty-three patients with growth hormone deficiency (GHD) followed until their final heights (FH) were reported by retrospective review. Seven patients had spontaneous puberty (group 1) and sixteen required induction of puberty (group 2). Their heights prior to growth hormone (GH) therapy were -3.7 +/- 1.4 and -2.8 +/- 1.4 SDS in men and women respectively. The mean ages at initiation of GH therapy were 17.2 +/- 3.3 in men and 13.0 +/- 1.7 years in women, with a growth velocity < 4 cm/year and a mean bone age (BA) of 12.6 +/- 0.7 years (men) and 9.8 +/- 1.2 years (women). The dose of GH was 0.27-0.83 IU/kg/week, with a total duration of 2.5 +/- 1.0 years. Their consecutive annual mean growth velocities on GH therapy were: 10.6 cm/year, 8.0 cm/year, 6.1 cm/year, 5.1 cm/year and 4.6 cm/year respectively. They reached a mean final height of 167.1 +/- 5.3 cm (-0.4 +/- 1.0 SDS) in men and 157.9 +/- 3.5 cm (-0.1 +/- 0.7 SDS) in women, which is slightly taller than their target height. Demographic factors related to growth response and final heights were analyzed. We conclude that GH therapy is very effective in linear growth promotion. Their final height was correlated with initial height SDS, target height SDS, predicted adult height SDS according to the bone age at the start of GH therapy and height SDS at the onset of puberty.

High-throughput genotyping with single nucleotide polymorphisms

To make large-scale association studies a reality, automated high-throughput methods for genotyping with single-nucleotide polymorphisms (SNPs) are needed. We describe PCR conditions that permit the use of the TaqMan or 5' nuclease allelic discrimination assay for typing large numbers of individuals with any SNP and computational methods that allow genotypes to be assigned automatically. To demonstrate the utility of these methods, we typed >1600 individuals for a G-to-T transversion that results in a glutamate-to-aspartate substitution at position 298 in the endothelial nitric oxide synthase gene, and a G/C polymorphism (newly identified in our laboratory) in intron 8 of the 11-beta hydroxylase gene. The genotyping method is accurate-we estimate an error rate of fewer than 1 in 2000 genotypes, rapid-with five 96-well PCR machines, one fluorescent reader, and no automated pipetting, over one thousand genotypes can be generated by one person in one day, and flexible-a new SNP can be tested for association in less than one week. Indeed, large-scale genotyping has been accomplished for 23 other SNPs in 13 different genes using this method. In addition, we identified three "pseudo-SNPs" (WIAF1161, WIAF2566, and WIAF335) that are probably a result of duplication.

Precocious puberty associated with growth hormone deficiency in a patient with craniopharyngioma: report of one case

Isosexual precocious puberty in girls is not uncommon, but its association with craniopharyngioma and growth hormone deficiency is rarely reported. We present a patient with this combination. An 8-year-old girl developed breasts and then had menarche at 7 9/12 years old. Growth hormone deficiency was suspected due to inappropriate height and growth velocity in association with idiopathic precocity and a poor predicted adult height of 138.8 cm. Growth hormone deficiency was confirmed by clonidine and insulin stimulation tests. Intracranial lesion was suspected due to precocity associated with GH deficiency. MRI of the sella's region revealed a 1 cm mass in the hypothalamus. After surgical resection, pathology of the tumor disclosed a craniopharyngioma which has rarely been reported to cause precocious puberty. The precocious puberty regressed after surgery. Growth hormone deficiency persisted and GH therapy was given to improve growth. The growth rate of patients with both growth hormone deficiency and precocious puberty may be maintained within the normal prepubertal range by the effect of sex steroid. We suggest that in patients with central type precocity in association with an inappropriate growth status, physicians should investigate the underlying intracranial lesion, and the possibility of growth hormone deficiency.

Theoretical formalism for bead movement powered by single two-headed motors in a motility assay

Kinesins and dyneins are protein motors that can use the free energy of ATP hydrolysis to carry a cargo and move uni-directionally along a microtubule filament. The purpose of this paper is to derive the formalism connecting the ATP-driven translocation reactions of these motors on microtubule filaments and the movement of the bead carried by the motor in a motility assay in which the bead is clamped at an arbitrary constant force. The formalism is thus useful in elucidating the load-dependent kinetic mechanism of the free-energy transduction of the motor using the mechanical data obtained from the motility assay. The formalism is also useful in assessing the effect on the measured motility data of various physical and hydrodynamic parameters of the assay, such as the size of the bead, the viscosity of the medium, the stiffness of the elastic element connecting the motor and the bead, etc. In a previous paper [Biophys. J. 67 (2000) 313] (hereafter referred to as paper I), we have derived the formalism for the case that the motor in the assay has only one head. In this paper we extend the derivation to the case that the motor is two-headed. The formalism is derived based on a simple two-state hand-over-hand model for the movement of the motor on microtubule, but can be easily extended to more complicated kinetic models. Effects of various hydrodynamic parameters on the velocity of the bead are studied with numerical calculations of the model. The difference between the formalism presented in this paper and the widely used "chemical" formalism, in which the movement of the kinesin and the bead is described by pure chemical reactions, is discussed.

Caldesmon reduces the apparent rate of binding of myosin S1 to actin-tropomyosin

Equilibrium measurements of the rate of binding of caldesmon and myosin S1 to actin-tropomyosin from different laboratories have yielded different results and have led to different models of caldesmon function. An alternate approach to answering these questions is to study the kinetics of binding of both caldesmon and S1 to actin. We observed that caldesmon decreased the rate of binding of S1 to actin in a concentration-dependent manner. The inhibition of the rate of S1 binding was enhanced by tropomyosin, but the effect of tropomyosin on the binding was small. Premixing actin with S1 reduced the amplitude (extent) of caldesmon binding in proportion to the fraction of actin that contained bound S1, but the rate of binding of caldesmon to free sites was not greatly altered. No evidence for a stable caldesmon-actin-tropomyosin-S1 complex was observed, although S1 did apparently bind to gaps between caldesmon molecules. These results indicate that experiments involving caldesmon, actin, tropomyosin, and myosin are inherently complex. When the concentration of either S1 or caldesmon is varied, the amount of the other component bound to actin-tropomyosin cannot be assumed to remain fixed. The results are not readily explained by a mechanism in which caldesmon acts only by stabilizing an inactive state of actin-tropomyosin. The results support regulatory mechanisms that involve changes in the actin-S1 interaction.

Direction Reversal of Fluctuation-induced Biased Brownian Motion on Distorted Ratchets

The biased movement of Brownian particles on a fluctuating two-state periodic potential made of identical distorted ratchets is studied. The purpose is to investigate how the direction of the particle movement is related to the asymmetry of the potential. In general, distorting one of the two linear arms of a regular symmetric ratchet (with equal arm lengths) can create a driving force for the Brownian particle to execute biased movement. The direction of the induced biased movement depends on the type of the distortion. It has been found that if one linear arm is kinked into two linear sub-arms, the direction of the movement can be either positive or negative depending on the frequency of the fluctuation and the location and the degree of the kink. In contrast, if one arm of the symmetric ratchet is replaced by a continuous nonlinear sinusoidal function, the movement is always unidirectional. Thus, for the latter case to generate the direction reversal phenomenon, the ratchets have to have an additional asymmetry. We also have found that two potentials with different distorted ratchets can generate identical fluxes if the distortions are polar symmetric about the mid-point of the arm(s) of the basic linear two-arm ratchet. The results are useful for designing experimental apparatuses for the separation of protein particles based on their sizes and charges and the viscosity of the medium.

Metabolic abnormalities characteristic of dysmetabolic syndrome predict the development of transplant coronary artery disease: a prospective study

BACKGROUND

This study examines the hypothesis that metabolic abnormalities of dysmetabolic syndrome are risk factors for transplant coronary artery disease (TxCAD).

METHODS AND RESULTS

Sixty-six patients without overt diabetes, 2 to 4 years after surgery, underwent intracoronary ultrasound (ICUS), measurement of plasma glucose and insulin after oral glucose (75 g), and fasting lipid and lipoproteins. TxCAD incidence by angiography or autopsy was prospectively determined during subsequent follow-up (8 years). Coronary artery intimal thickness (IT) and subsequent outcomes were compared in patients stratified as having "high" versus "low" plasma glucose (>8.9 mmol/L) and insulin (>760 pmol/L) 2 hours after glucose challenge; and "abnormal" versus "normal" fasting lipid and lipoprotein concentrations as defined by the National Cholesterol Education

PROGRAM

Patients with high glucose or insulin concentrations had greater IT: 0.38+/-0.05 versus 0.22+/-0.02 mm, P</=0.05, and 0.39+/-0.05 versus 0.20+/-0.02 mm, P</=0.01, respectively. Freedom from TxCAD was 56+/-11% versus 81+/-6% (P<0.01) in patients with high versus low glucose and 57+/-10% versus 82+/-7% (P<0.05) in patients with high versus low insulin. Actuarial survival was 60+/-12% versus 92+/-5% (P<0.005) in patients with high versus low glucose and 72+/-9% versus 88+/-6% (P<0.05) in patients with high versus low insulin. Triglycerides and VLDL were higher and HDL was lower in patients with IT >0.3 mm than with IT </=0.3 mm. TxCAD incidence was higher in patients with high plasma TG and VLDL and low HDL.

CONCLUSIONS

These data suggest that insulin resistance plays a role in TXCAD:

Reversal of aberrant splicing of beta-thalassaemia allele (IVS-2-654 C-->T) by antisense RNA expression vector in cultured human erythroid cells

The antisense fragment targeting the aberrant splice sites of the beta-thalassaemia allele, IVS-2-654 C-->T (beta654), pretranscript was cloned into the mammalian expression vector, pcDNA3. The recombinant construct, pCMVA, was then used to repair the defective splicing of the beta654 mutant pretranscript in cultured beta654 erythroid cells by the lipofectin-mediated DNA transfection method. The total RNA was extracted at given time points after transfection and the effect of antisense RNA was studied by reverse transcription polymerase chain reaction (RT-PCR)-mediated mRNA quantitative assay, as well as globin chain microbiosynthesis. The antisense fragment transcribed from pCMVA effectively improved the beta654 splicing pattern in cultured erythroid cells. The level of correctly spliced transcript increased from 0.19 (day 0 after transfection) to 0.58 (day 8) in beta654/beta654 homozygous erythroid cells, and from 0.45 (day 0) to 0.83 (day 8) in beta654/betaA heterozygous erythroid cells, as determined by the ratio of normally spliced beta-globin transcript over total beta-globin transcript. Correspondingly, the ratios of globin chain biosynthesis (beta/alpha) increased from 0.16 (day 0) to 0.52 (day 8) in beta654/beta654 erythroid cells, and from 0.39 (day 0) to 0.84 (day 8) in beta654/betaA erythroid cells. Antisense RNA had no significant effect on the splicing pattern in betaA/betaA erythroid cells. The splicing pattern in transfected cells with pCMVA showed significant changes compared with that in untransfected cells and that in transfected cells with the control antisense fragment (human SRY gene sequence). In addition, we did not observe side-effects on cytological features after the introduction of pCMVA. All these results indicated that the antisense RNA transcribed from the mammalian expression vector pCMVA could efficiently and specifically suppress the aberrant splicing pattern of beta654 mutant pretranscript and restore the correct splicing pathway in vivo, leading to the improvement of globin chain biosynthesis in thalassaemic cells.

Asymmetry and direction reversal in fluctuation-induced biased Brownian motion

The biased movement of a Brownian particle in a periodic potential fluctuating between a flat and a kinked ratchet state, as first studied by Chauwin, Ajdari, and Prost, is examined. The purpose is to study the physical origin of the frequency-dependent direction reversal of the biased Brownian motion in this system. We show that the existence of the directional reversal depends not only on the lengths of the projections of the two ratchet arms on the potential axis (the arm-projection asymmetry), but also the overall spatial geometry of the potential in a period. In particular, we show that the direction reversal can be obtained in this kinked ratchet model even when the two arm projections are equal. Since this two-state model is the simplest to generate direction reversal and particles can be separated more efficiently in a fluctuating potential if direction reversal exists, the results obtained in this study should be useful for future application in particle separation.