Clinical significance of serum vascular cell adhesion molecule-1 levels in patients with hepatocellular carcinoma

Aim: To evaluate the correlation between serum vascular cellular adhesion molecule-1 (VCAM-1) levels and clinicopathological features in patients with hepatocellular carcinoma (HCC). Methods: Ninety-six patients who underwent HCC resection were recruited in the study. Preoperative serum levels of soluble VCAM-1 were measured by enzyme-linked immunosorbent assay. Results: Serum VCAM-1 level in HCC patients was inversely correlated with platelet count (r=-0.431, P<0.001) and serum albumin level (r=-0.279, P<0.001), and positively correlated with serum bilirubin level (r=-0.379, P<0.001). Serum VCAM-1 level was not associated with tumor characteristics such as tumor size, venous invasion, presence of microsatellite nodules, tumor grade and tumor stage. Serum VCAM-1 level was significantly higher in HCC patients with cirrhosis compared with those without cirrhosis (median 704 vs 546 ng/mL, P<0.001). Furthermore, a significantly better disease-free survival was observed in HCC patients with low VCAM-1 level (P=0.019). Conclusion: Serum VCAM-1 level appears to reflect the severity of underlying chronic liver disease rather than the tumor status in HCC patients, and low preoperative serum VCAM-1 level is predictive of better disease-free survival after surgery. Copyright © 2004 by The WJG Press.published_or_final_versio

Generalizations of Tucker-Fan-Shashkin lemmas

Tucker and Ky Fan's lemma are combinatorial analogs of the Borsuk-Ulam theorem (BUT). In 1996, Yu. A. Shashkin proved a version of Fan's lemma, which is a combinatorial analog of the odd mapping theorem (OMT). We consider generalizations of these lemmas for BUT-manifolds, i.e. for manifolds that satisfy BUT. Proofs rely on a generalization of the OMT and on a lemma about the doubling of manifolds with boundaries that are BUT-manifolds.Comment: 10 pages, 2 figure

Clinicopathological and prognostic implications of endoglin (CD105) expression in hepatocellular carcinoma and its adjacent non-tumorous liver

Aim: The expression pattern of endoglin (CD105) in hepatocellular carcinoma (HCC) has not been reported so far. We hypothesized that CD105 could differentially highlight a subset of microvessels in HCC, and intratumoral microvessel density (IMVD) by CD105 immunostaining (IMVD-CD105) could provide better prognostic information than IMVD by CD34 immunostaining (IMVD-CD34). Methods: Paraffin blocks of tumor and adjacent non-tumorous liver tissues from 86 patients who underwent curative resection of HCC were used for this study. Serial sections were stained for CD105 and CD34, respectively, to highlight the microvessels. IMVD was counted according to a standard protocol. Results: In the HCC tissues, CD105 was either negatively or positively stained only in a subset of microvessels. In contrast, CD34 showed positive and more extensive microvessel staining in all cases examined. However, in the adjacent non-tumorous liver sections, CD105 showed a diffuse pattern of microvessel staining in 20 of 86 cases, while CD34 showed negative or only focal staining of the sinusoids around portal area. Correlation with clinicopathological data demonstrated that lower scores of IMVD-CD105 were found in larger sized tumors [mean 41.4/0.74 mm 2 (>5 cm tumor) vs 65.9/0.74 mm 2 (≤5 cm tumor), P = 0.043] and more aggressive tumors, as indicated by venous infiltration [36.8/0.74 mm 2 (present) vs 64.2/0.74 mm 2 (absent), P = 0.020], microsatellite nodules [35.1/0.74 mm 2 (present) vs 65.9/0.74 mm 2 (absent), P = 0.012], and advanced TNM tumor stage [38.8/0.74 mm 2 (stage 3 or 4) vs 68.3/0.74 mm 2 (stage 1 or 2), P = 0.014]. No prognostic significance was observed when median values were used as cut-off points using either IMVD-CD105 or IMVD-CD34. However, the presence of the diffuse pattern of CD105 expression in the adjacent non-tumorous liver tissues predicted a poorer disease-free survival (median 8.6 vs 21.5 mo, P = 0.026). Conclusion: Our data demonstrate that a lower IMVD-CD105 is associated with larger and more aggressive tumors. In this study, IMVD-CD105 did not provide significant prognostic information. However, active angiogenesis as highlighted by diffuse CD105 staining of the microvessels in the adjacent non-tumorous liver tissues is predictive of early recurrence. © 2005 The WJG Press and Elsevier Inc. All rights reserved.published_or_final_versio

Treatment of insomnia in myasthenia gravis-A prospective study on non-benzodiazepine hypnotics in the treatment of myasthenia gravis patients with insomnia

Objectives: This study aimed to evaluate the efficacy and safety of non-benzodiazepine hypnotics in the treatment of myasthenia gravis (MG) patients with insomnia. Methods: This is a prospective longitudinal study. Outpatients who met the criteria for stable MG and insomnia diagnosis according to the International Classification of Sleep Disorders (third edition) were included in the study. They took a regular dose of non-benzodiazepine hypnotics (zolpidem 10 mg per night or zopiclone 7.5 mg per night) based on their own preferences. Patients received psychotherapy (including sleep health education) and were followed up for 4–5 weeks. Cases with lung diseases, respiratory disorders, or inappropriate use of hypnotic medications were excluded. The primary outcome is the difference in total Pittsburgh Sleep Quality Index (PSQI) score between baseline and the end of follow-up period. Secondary outcomes include the difference in Myasthenia Gravis Activities of Daily Living (MG-ADL) score, 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) between baseline and the end of follow-up period and the safety of medication. Results: A total of 75 MG patients with insomnia were included in this study. After 4–5 weeks of treatment, the total PSQI score and MG-ADL score were lower than baseline (p < 0.01). No patients had an increased MG-ADL score. The incidence rate of adverse events was 16.0% (12 cases), including dizziness (6 cases, 8.0%), drowsiness (3 cases, 4.0%), fatigue (2 cases, 2.7%), and nausea (1 case, 1.3%), all of which were mild. No patients had new onset breathing disorders. Conclusion: Non-benzodiazepine hypnotics are safe and effective for stable MG patients who need insomnia treatment

Suppression of liver tumor growth and metastasis by adiponectin in nude mice through inhibition of tumor angiogenesis and downregulation of rho kinase/IFN-inducible protein 10/matrix metalloproteinase 9 signaling

Purpose: We aimed to investigate the effects of adiponectin on liver cancer growth and metastasis and explore the underlying mechanisms. Experimental Design: An orthotopic liver tumor nude mice model with distant metastatic potential was applied. Either Ad-adiponectin (1 × 10 8; treatment group) or Ad-luciferase (control group) was injected via portal vein after tumor implantation. Tumor growth and metastasis were monitored by Xenogen In vivo Imaging System. Hepatic stellate cell activation by α-smooth muscle actin staining, microvessel density by CD34 staining, macrophage infiltration in tumor tissue, and cell signaling leading to invasion, migration [Rho kinase (ROCK), IFN-inducible protein 10 (IP10), and matrix metalloproteinase 9], and angiogenesis [vascular endothelial growth factor (VEGF) and angiopoietin 1] were also compared. Tumor-nontumor margin was examined under electron microscopy. Direct effects of adiponectin on liver cancer cells and endothelial cells were further investigated by a series of functional studies. Results: Tumor growth was significantly inhibited by adiponectin treatment, accompanied by a lower incidence of lung metastasis. Hepatic stellate cell activation and macrophage infiltration in the liver tumors were suppressed by adiponectin treatment, along with decreased microvessel density. The treatment group had less Ki-67-positive tumor cells and downregulated protein expression of ROCK1, proline-rich tyrosine kinase 2, and VEGF. Tumor vascular endothelial cell damage was found in the treatment group under electron microscopy. In vitro functional study showed that adiponectin not only downregulated the ROCK/IP10/VEGF signaling pathway but also inhibited the formation of lamellipodia, which contribute to cell migration. Conclusion: Adiponectin treatment significantly inhibited liver tumor growth and metastasis by suppression of tumor angiogenesis and downregulation of the ROCK/IP10/matrix metalloproteinase 9 pathway. ©2010 AACR.postprin

Impacts of climate change on hydropower generation in China

Analyzing the impact of climate change on China's hydropower system can make great contribution to understanding the feedback mechanism of the climate change on energy system. In this work, an econometric model for regional hydropower generation is constructed to explore the impact of climate factors on hydropower generation in different regions of China by using the monthly panel data of 28 provinces in China. Further, we also make a prediction for the changes of hydropower generation in China caused by the changes of climatic factors under the three climate change scenarios (RCP2.6, RCP4.5 and RCP8.5) proposed in the Intergovernmental Panel on Climate Change's (IPCC) fifth assessment report. The results show that: (1) At the national level, the influences of climatic factors on hydropower generation are significant, the elasticity coefficients of rainfall, heating degree day (HDD), cooling degree day (CDD) and sunshine duration are 0.081, -0.016, 0.089 and -0.043 respectively. (2) The impacts of climatic factors on the hydropower generation in the northern and southern regions of China are different. The effect of rainfall on the hydropower generation is significant in the southern regions, but not in the northern region. The CDD has a significant effect on both the northern and southern regions, and the latter is greater (0.136%). The impact of HDD on the northern area is significant, while its influence on the southern area is not significant. The influence of sunshine duration is not significant in any region in China. (3) Compared with the year of 2011, the total changes of hydropower output caused by climate factors by 2100 under the RCP8.5, RCP4.5 and RCP2.6 scenarios are 153.29 billion kWh, 67.49 billion kWh and 22.10 billion kWh, respectively. The results imply that the hydropower is sensitive and vulnerable to climate fluctuation, leading to many uncertainties for its development in the future. Finally, some policy implications are proposed for the planning of hydropower in China

The validity of using ICD-9 codes and pharmacy records to identify patients with chronic obstructive pulmonary disease

Background: Administrative data is often used to identify patients with chronic obstructive pulmonary disease (COPD), yet the validity of this approach is unclear. We sought to develop a predictive model utilizing administrative data to accurately identify patients with COPD. Methods: Sequential logistic regression models were constructed using 9573 patients with postbronchodilator spirometry at two Veterans Affairs medical centers (2003-2007). COPD was defined as: 1) FEV1/FVC <0.70, and 2) FEV1/FVC < lower limits of normal. Model inputs included age, outpatient or inpatient COPD-related ICD-9 codes, and the number of metered does inhalers (MDI) prescribed over the one year prior to and one year post spirometry. Model performance was assessed using standard criteria. Results: 4564 of 9573 patients (47.7%) had an FEV1/FVC < 0.70. The presence of ≥1 outpatient COPD visit had a sensitivity of 76% and specificity of 67%; the AUC was 0.75 (95% CI 0.74-0.76). Adding the use of albuterol MDI increased the AUC of this model to 0.76 (95% CI 0.75-0.77) while the addition of ipratropium bromide MDI increased the AUC to 0.77 (95% CI 0.76-0.78). The best performing model included: ≥6 albuterol MDI, ≥3 ipratropium MDI, ≥1 outpatient ICD-9 code, ≥1 inpatient ICD-9 code, and age, achieving an AUC of 0.79 (95% CI 0.78-0.80). Conclusion: Commonly used definitions of COPD in observational studies misclassify the majority of patients as having COPD. Using multiple diagnostic codes in combination with pharmacy data improves the ability to accurately identify patients with COPD.Department of Veterans Affairs, Health Services Research and Development (DHA), American Lung Association (CI- 51755-N) awarded to DHA, the American Thoracic Society Fellow Career Development AwardPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/84155/1/Cooke - ICD9 validity in COPD.pd

Shape memory characteristics of woven glass fibre fabric reinforced epoxy composite in flexure

Shape memory characteristics of a woven glass fibre (GF) fabric reinforced epoxy composite (reinforcement content: 38 vol.%) were assessed in three point bending mode in a dynamic-mechanical analysis device and compared to those of the parent epoxy resin (EP). From unconstrained tests the shape fixity and recovery ratios and the recovery rate, whereas from constrained tests the recovery stress were determined. The shape fixity and recovery rate decreased due to the GF reinforcement which had, however, no effect on the shape recovery. Major benefit of the woven GF fabric was that the recovery stress could be enhanced by two orders of magnitude in comparison to the neat EP. GF reinforcement was accompanied with a substantial decrease in the failure-free flexural deformability of the composite specimen