Frequent DNA methylation of MiR‐129‐2 and its potential clinical implication in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a highly malignant tumor with poor prognosis and high mortality due to a lack of effective medical treatment and apparent early stage symptoms. Understanding molecular mechanism of cancer development is crucial for HCC diagnosis, prognosis, and treatment. Recently, microRNAs have been shown to play an important role in carcinogenesis, being regulated by DNA methylation in several cases. In this study, a whole genome approach was used to identify methylation‐regulated miRNAs in HCC, finally focusing on miR‐129‐2. MiR‐129‐2 methylation and reduced expression were observed in all examined HCC cell lines but not in normal liver cells and tissues. In 39 (93%) of 42 HCC, the methylation levels of miR‐129‐2 were significantly increased in tumor tissues compared with adjacent normal tissues. Furthermore, miR‐129‐2 methylation was detectable in plasma samples from HCC patients, but not in plasma samples from healthy individuals or patients with liver cirrhosis. At a cut‐off value of ?2.36 (log2 transformation of methylation level), it was possible to distinguish HCC from healthy and cirrhotic controls with sensitivity and specificity of 88% and 100%, respectively. This study indicates that miR‐129‐2 methylation is highly accurate in distinguishing HCC patients from cirrhosis patients and healthy individuals, implying its potential utility as an early diagnostic marker for HCC. © 2013 Wiley Periodicals, Inc.     

Simultaneous recording of blood pressure and ST-segment with combined,triggered ambulatory 24-h devices

Silent myocardial ischemia is defined as an ischemic episode without chest pain but with transient ST abnormalities during stress testing or Holter monitoring. With Holter monitoring the prevalence of silent myocardial ischemia in hypertensive patients without coronary artery disease is between 25% and 73%. Simultaneous recording of ambulatory 24-h ECG and 24-h ambulatory blood pressure measurements (ABPM) with the option of additional ST-triggered blood pressure measurement is useful to detect silent ischemia and triggers of silent ischaemia. It is surprising that only a few combined 24-h Holter/ABPM devices are on the market, and in turn only three devices allow additional triggered blood pressure measurements. The paper provides an overview of studies investigating hypertensive patients with Holter monitoring for the detection of ST segment depression indicating myocardial ischaemia. Furthermore, requirements for combined devices allowing simultaneous ambulatory 24-h ECG and ABPM are defined.     

Randomized comparison of conventional carbon dioxide insufflation and abdominal wall lifting for laparoscopic cholecystectomy

BACKGROUND: Gasless laparoscopy using abdominal wall lifting (AWL) has been developed in an attempt to avoid the adverse effects of carbon dioxide pneumoperitoneum that may occur in conventional laparoscopy. However, lifting has been criticized for its poor operative space and surgical invasiveness. This study compared the AWL method with conventional CO2 pneumoperitoneum for laparoscopic cholecystectomy with respect to operation performance, postoperative course, and stress response. PATIENTS AND METHODS: During a 6-month period, 95 patients with symptomatic gallstones were randomly assigned to receive laparoscopic cholecystectomy with conventional CO2 pneumoperitoneum (CO2 group; N = 47) or the AWL method (AWL group; N = 48). Operative results and operative time were recorded. Cardiopulmonary functions were assessed, and arterial blood gases were analyzed during surgery. Urinary cortisol, vanillylmandelic acid, metanephrines, and nitrogen loss; serum complement 3, C-reactive protein, and interleukin-6; postoperative pain; and the presence of nausea and vomiting were assessed for 48 hours after surgery. Postoperative time to recovery of flatus, tolerance of a full oral diet, and full activity were also determined. RESULTS: Only three significant differences were found. First, intraoperative ventilatory function deteriorated significantly less in the AWL group. Second, arterial blood gas determinations and capnography showed a greater decrease in intraoperative arterial pH and compliance with CO2 retention and an increase in peak airway pressure in the CO2 group (P < 0.05), reflecting poorer ventilatory performance. Third, preparation time and total operating time were significantly greater with the AWL method (P < 0.05). CONCLUSIONS: Although AWL required a longer operation time, our results suggest that the technique may still have value in high-risk patients with cardiorespiratory diseases.     

Development of an enzyme-linked immunosorbent assay (ELISA) for detecting IgA antibodies to the Epstein-Barr virus

A 3-step enzyme-linked immunosorbent assay (ELISA) was developed for detecting IgA antibodies to purified Epstein-Barr virus (EBV) polypeptides. The 3-step procedure included the use of a mouse anti-human IgA monoclonal antibody (MAb) to amplify the IgA reaction. The 2 major EBV proteins used in this assay were the 125-kDa component (gp125) associated with the viral capsid antigen (VCA) complex and a major glycoprotein (gp250/200) associated with the membrane antigen (MA) complex. Eighty-two sera were tested on ELISA plates containing either both of the glycoproteins or each one separately. These included 45 IgA antibody-positive sera from patients with nasopharyngeal carcinoma (NPC). With these sera, there was a good correlation, both qualitatively and quantitatively, between results with the immunofluorescence (IF) and ELISA procedures. Although most IgA antibody-positive sera contained antibodies reactive with both gp125 and gp250/200, a number of sera contained antibodies reactive with one of the glycoproteins but not with both. The data indicated that both of these glycoproteins should be used in assays for detecting IgA antibodies to EBV, to avoid false-negative results. This assay should be useful for screening large populations for IgA antibodies to EBV and also possibly for monitoring disease course in patients with NPC.     

Responsiveness and Minimal Clinically Important Differences after Cholecystectomy: GIQLI Versus SF-36

Introduction  To compare responsiveness and minimal clinically important differences (MCID) between the Gastrointestinal Quality of Life (GIQLI) and the Short Form 36 (SF-36), we prospectively analyze 159 patients undergoing cholecystectomy at two tertiary academic hospitals. Patients and Methods  All patients completed the disease-specific GIQLI and the generic SF-36 before and 3 months after surgery. Scores using these instruments were interpreted by generalized estimating equation before and after cholecystectomy. The bootstrap estimation was used to derive 95% confidence intervals for differences in the responsiveness estimates. Results and Discussion  Mean changes in all GIQLI and the SF-36 subscales were statistically significant (p < 0.05). Comparisons of effect size (ES), standardized response means (SRM), and relative efficiency (>1) indicated that the responsiveness of the GIQLI was superior to that of the SF-36. In the equivalence test, all lower or upper confidence limits presented no equivalence (>5), indicating good MCID. The ES and SRM for emotions and physical function in the GIQLI significantly differed from those of the SF-36 (p < 0.05). Conclusion  The data in this study indicate that clinicians and health researchers should weight disease-specific measures more heavily than generic measures when evaluating treatment outcomes.     

Surgical Anatomy of the Recurrent Laryngeal Nerves and its Clinical Applications in Chinese Adults

PURPOSE: When removing the thyroid gland, great care must be taken to avoid damaging the recurrent laryngeal nerves (RLNs). The present study aims to present a clear picture of certain anatomical features of the RLNs in relation to the inferior thyroid artery (ITA), the tracheoesophageal groove (TE), Berry's ligament, and the inferior cornu of the thyroid cartilage in Chinese adults. METHODS: We removed a collective 120 RLNs from 60 Chinese adult cadavers (52 men and 8 women), and examined their anatomic course and relationship on both sides. RESULTS: The right and left RLNs were found in the tracheoesophageal groove in 78.3% and 91.3% of cases, respectively. Both RLNs were found posterior to and to the right of the ITA in 80% of cases, and one was found on the left side of the ITA in 91.7%. Most of the RLNs were within 3 mm of Berry's ligament, with a laryngeal entry point about 0.8 cm below and just anterior to the inferior horn of the thyroid cartilage. CONCLUSIONS: The inferior cornu of the thyroid cartilage is a reliable landmark in identifying the RLNs. Racial variations between Caucasians and Chinese may explain some anatomic differences.     

Long-term outcomes of laparoscopic cholecystectomy: a prospective piecewise linear regression analysis

Background  

The objectives of this study were to examine longitudinal time trends, to predict thresholds of improvement in each dimension of health-related quality of life (HRQoL), and to identify long-term predictors of HRQoL.     

Using graphical representations to enhance the quality‐of‐care for colorectal cancer patients

The study was to enhance adherence to quality‐of‐care guidelines for colorectal cancer (CRC) patients through plotting graphical representations. Rasch analysis was performed to examine the unidimensional measurement of the 13 core indicators. An author‐made Excel module was applied to plot the so‐called Wright map and KIDMAP in education field to report physicians' adherence to the quality‐of‐life guidelines. We found that the scale of the quality‐of‐care guidelines for patients with colon cancer is unidimensional. A total of 15 (3.8%) and 14 (3.5%) persons' response patterns (i.e., Outfit MNSQs >2.0 and 4.0, respectively) are aberrantly dispersed from the majority of sample according to their estimated parameters of persons and indicators. It can be used for investigating the root cause of the 1ow measures and/or the most unexpected aberrant pattern of responses using Rasch analysis once any one indicator of unexpectedly aberrant treatment (p < .05) presents. The Rasch model can deal with these binary and/or missing data frequently seen in clinical settings. We confirm this computer module can contribute to ensuring that hospitals adhere to the treatment guidelines for patients with colon cancer.     

Single-dose time-resolved contrast enhanced hybrid MR angiography in diagnosis of peripheral arterial disease: compared with digital subtraction angiography

Purpose:

To validate cardiovascular magnetic resonance (CMR) arterial wall volume measurement using whole arterial specimens ex vivo.

Materials and Methods:

Twenty cadaveric carotid arteries (from 10 patients) were fixed in formaldehyde and imaged with a clinical T1‐weighted 2D CMR sequence and, for imaging validation, with a high‐resolution 3D sequence. Histological validation was performed by sectioning the arteries and microscopically determining area and volume.

Results:

Comparison between the clinical 2D CMR sequence and the 3D high‐resolution validation sequence showed equivalent luminal volumes (889 vs. 880 mm³; P = 0.54; R² = 0.99), and slightly higher 2D CMR arterial wall volumes (982 vs. 916 mm³; +7%; P < 0.01; R² = 0.96) and adventitial volumes (1901 vs. 1826 mm³; +4%; P < 0.01; R² = 0.99). Comparison between 2D CMR and microscopy, performed over a similar longitudinal extent of vessel, showed slightly higher 2D CMR volumes for the lumen (354 vs. 308 mm³; +14%; P < 0.01; R² = 0.97), arterial wall (388 vs. 351 mm³; +10%; P < 0.01; R² = 0.97) and total volumes (750 vs. 665 mm³; +12%; P < 0.01; R² = 0.95).

Conclusion:

The accuracy of the clinical 2D CMR vessel wall sequence for measuring carotid lumen, adventitial, and wall volumes is good against ex vivo measurements, with minor overestimation. This study validates carotid arterial wall quantification by CMR for atherosclerosis research. J. Magn. Reson. Imaging 2010;31:935–941. ©2010 Wiley‐Liss, Inc.