Diagnostic value of serum ferritin, alpha-fetoprotein and alpha-fetoprotein-L3 alone or in combination for diagnosis of primary hepatic carcinoma / 中华检验医学杂志

Objective To investigate the diagnostic value of serum FER, AFP and AFP-L3 alone or in combination for diagnosis of primary hepatic carcinoma( PHC).Methods This was a case-control study. Serum FER, AFP and AFP-L3 were determined in 212 patients with PHC ( StageⅠ45 cases, StageⅡ78 cases, StageⅢ81 cases, StageⅣ8 cases) , 127 patients with cirrhosis, 101 patients with chronic hepatitis and 98 controls in the Beijing Youan Hospital affiliated to Capital Medical University from January 2014 to December 2014.Levels of FER, AFP and AFP-L3 were measured by chemiluminescence, while serum samples were pre-treatment with affinity adsorption before AFP-L3 detection.FER, AFP and AFP-L3 levels were analyzed using the nonparametric Wilcoxon test among all groups.Diagnostic performance were analyzed among the groups with the three biomarkers independently and combined.Logistic regression, plotted ROC curve and calculated the area under ROC curve ( AUC) were applied to assess the diagnostic value of each index.Results Serum concentration of FER in PHC, cirrhosis, chronic hepatitis groups and healthy controls were 308.45 ( 148.98 -662.80 ) , 151.70 ( 51.44 -507.40 ) , 298.20 ( 157.30 -701.80 ) , 113.50( 54.98-221.38) μg/L, respectively.The concentration of AFP were 48.50(5.25 -748.40), 3.91(1.80-17.53), 4.76 (2.29-30.56), 2.57 (0.93-3.68) μg/L in each group.The serum levels of AFP-L3 in each group were 4.75(0.61-127.95), 0.61 (0.61-2.50), 0.61 (0.61-2.85), 0.61 (0.61-0.61) μg/L.The concentration of FER, AFP and AFP-L3 differs statistically in PHC, cirrhosis, chronic hepatitis group and healthy controls (χ2 =67.66,146.31,119.02,P<0.001).The content of serum FER, AFP and AFP-L3 increased gradually as the stage level aggravating ( StageⅠ-Ⅳ) , there was significant differences among groups (χ2 =21.63,22.68,21.98, P<0.001) .When using one serum marker, FER had the highest sensitivity (75.00%) , while AFP-L3 had the highest specificity (82.52%). While using two serum markers, FER/AFP had the highest sensitivity (89.15%) , FER+AFP-L3 and AFP+AFP-L3 had a higher specificity (86.20%).The combined detection of FER/AFP/AFP-L3 improved the sensitivity of the test to 89.15%, while FER+AFP+AFP-L3 had a specificity of 86.50%.The AUC of combination of FER, AFP and AFP-L3 was 0.803 ±0.019 (95% CI:0.765-0.841), which was higher than the AUC of either FER(0.748 ±0.022,95% CI:0.705-0.790, Z=4.67,P<0.001) and AFP-L3 (0.726 ±0.024,95% CI: 0.679 -0.772, Z=3.64,P<0.001).However, there was no significant difference in AUC between AFP alone ( 0.776 ±0.021, 95% CI: 0.735 -0.818 ) and the combined detection ( Z=1.34, P=0.18 ) .Conclusions FER was a potential marker for PHC diagnosis.The combination of FER, AFP and AFP-L3 has higher value of clinical applications than one of them independently.

Estudo comparativo entre bupivacaína (S75-R25) e ropivacaína para avaliar a segurança cardiovascular em bloqueio do plexo braquial / Comparative study related to cardiovascular safety between bupivacaine (S75-R25) and ropivacaine in brachial plexus block / Estudio comparativo entre la bupivacaína (S75-R25) y la ropivacaína para evaluar la seguridad cardiovascular en el bloqueo del plexo braquial

JUSTIFICATIVA E OBJETIVOS: Bupivacaína é o fármaco de escolha para anestesia regional por causa da eficácia, longa duração e do bloqueio motor menos intenso. Bupivacaína (S75-R25) é uma mistura de isômeros ópticos que contém 75% de levobupivacaína (S-) e 25% de dextrobupivacaína (R+) e foi criada por uma companhia farmacêutica brasileira. Este estudo comparou a eficácia e segurança de bupivacaína S75-R25 com vasoconstritor e ropivacaína para o sistema cardiovascular em bloqueio do plexo braquial. MÉTODOS: Pacientes foram randomizados para receber bloqueio do plexo braquial com bupivacaína S75-R25 (Grupo B) com epinefrina 1:200.000 ou ropivacaína (Grupo R), ambos os fármacos a 0,50%, em 30 mL ECG contínuo (Holter) foi registrado durante todo o procedimento, bem como a escala de força de Lovett, além de monitoramento (frequência cardíaca, oximetria de pulso e pressão arterial não invasiva). A incidência de eventos adversos foi comparada com os testes do qui-quadrado ou exato de Fisher. RESULTADOS: Quarenta e quatro pacientes foram estudados. Não houve diferença significativa em relação à idade, peso, altura, gênero e tempo cirúrgico. Não houve diferença entre arritmias supraventriculares antes ou depois do bloqueio do plexo braquial, independentemente do anestésico local escolhido. A perda de sensibilidade foi mais rápida no Grupo B (23,1 ± 11,7 min) em comparação com o Grupo R (26,8 ± 11,5 min), embora não significativa (p = 0,205, teste t de Student). Houve uma redução da frequência cardíaca, observada durante a monitoração contínua de 24 horas (Holter). CONCLUSÃO: Este estudo demonstrou eficácia semelhante entre bupivacaína S75-R25 e ropivacaína para bloqueio do plexo braquial, com incidências semelhantes de arritmias supraventriculares.

BACKGROUND AND OBJECTIVES: Bupivacaine is a first choice for regional anesthesia considering its effectiveness, long duration and less motor blockade. Bupivacaine (S75-R25) is a mixture of optical isomers containing 75% levobupivacaine (S-) and 25% dextrobupivacaine (R+) created by a Brazilian pharmaceutical company. This investigation compared cardiac safety and efficacy of bupivacaine S75-R25 with vasoconstrictor and ropivacaine for brachial plexus blockade. METHODS: Patients were randomized to receive brachial plexus anesthesia with either bupivacaine S75-R25 with epinephrine 1:200,000 (bupi) or ropivacaine (ropi), both at 0.50%, in 30 mL solution. We registered a continuous Holter ECG throughout the procedure, as well as the Lovett scale of force in addition to monitoring (heart rate, pulse oximetry and non-invasive blood pressure). The incidence of adverse events was compared with the chi-square or Fisher test. RESULTS: We allocated forty-four patients into two groups. They did not show any difference related to age, weight or height, gender, as well as for surgical duration. Supraventricular arrhythmias were not different before or after the plexus blockade, independent of the local anesthetic chosen. Loss of sensitivity was faster for the bupivacaine group (23.1 ± 11.7 min) compared to the ropivacaine one (26.8 ± 11.5 min), though not significant (p = 0.205, Student t). There was a reduction in the cardiac rate, observed during the twenty-four-hour Holter monitoring. CONCLUSIONS: This study showed similar efficacy between bupivacaine S75-R25 for brachial plexus blockade and ropivacaine, with similar incidences of supraventricular arrhythmias.

JUSTIFICATIVA Y OBJETIVOS: La Bupivacaína es el fármaco por elección para la anestesia regional por poseer una eficacia, una larga duración y un bloqueo motor menos intenso. La Bupivacaína (S75-R25) consiste en una mezcla de isómeros ópticos que contienen un 75% de levobupivacaína (S-) y un 25% de dextrobupivacaína (R+), y fue creada por una compañía farmacéutica brasileña. Este estudio comparó la eficacia y la seguridad de la bupivacaína S75-R25 con el vasoconstrictor y la ropivacaína para el sistema cardiovascular en el bloqueo del plexo braquial. MÉTODOS: El equipo de investigación colocó de forma aleatoria a los pacientes que recibirían el bloqueo del plexo braquial con la bupivacaína S75-R25 (Grupo B) o la ropivacaína (Grupo R), ambos fármacos al 0,50%, y 30 mL de epinefrina 1:200.000. El ECG continuo (Holter) se registró durante todo el procedimiento, como también la escala de fuerza de Lovett, además de la monitorización (frecuencia cardíaca, oximetría de pulso y presión arterial no invasiva). La incidencia de eventos adversos fue comparada con los test del Xi-Cuadrado (Xi²) o exacto de Fisher. RESULTADOS: Fueron divididos en dos grupos 44 pacientes. No hubo diferencia significativa con relación a la edad, peso, altura, sexo y tiempo de operación. No hubo diferencia entre las arritmias supraventriculares antes o después del bloqueo del plexo braquial, independientemente del anestésico local elegido. La pérdida de sensibilidad fue más rápida en el Grupo B (23,1 ± 11,7 min) en comparación con el Grupo R (26,8 ± 11,5 min), aunque no fuere significativa (p = 0,205, test t de Student). Hubo una reducción de la frecuencia cardíaca, observada durante la monitorización continua de 24 horas (Holter). CONCLUSIONES: Este estudio demostró una eficacia parecida entre la bupivacaína S75-R25 y la ropivacaína para el bloqueo del plexo braquial, con incidencias parecidas de arritmias supraventriculares.

Análise do potencial citotóxico agudo da bupivacaína e bupivacaína em excesso enantiomerico de 50 por cento (S75-R25) incorporadas a microesferas sobre o nervo ciático de ratos / Analysis of the acute cytotoxic potential of bupivacaine and 50 percent enantiomeric excess bupivacaine (S75-R25) incorporated into microspheres in rat sciatic nerves / Análisis del potencial citotóxico agudo de la bupivacaína y bupivacaína en exceso enantiomérico de 50 por ciento (S75-R25) incorporadas a microesferas sobre el nervio ciático de ratones

JUSTIFICATIVA E OBJETIVOS: A duração do efeito dos anestésicos locais (AL) pode ser ampliada pela sua incorporação aos sistemas de liberação prolongada como microesferas. No entanto, a possibilidade de que os sistemas de liberação prolongada de AL sejam neurotóxicos não tem recebido a devida atenção na literatura. Este estudo teve o objetivo de investigar os efeitos de microesferas de ácido poliláctico-co-glicólico puras, preenchidas com bupivacaína em excesso enantiomérico de 50 por cento ou com bupivacaína (BP), assim como os efeitos da bupivacaína em excesso enantiomérico de 50 por cento em nervo ciático de ratos Wistar. MÉTODO: Os ratos foram alocados em quatro grupos de acordo com o tempo de avaliação (dois, quatro, seis e oito dias) e denominados conforme a solução injetada sobre o nervo ciático: microsferas com bupivacaína em excesso enantiomérico de 50 por cento (MBE), microesferas com bupivacaína (MB); microesferas puras (MP) e bupivacaína em excesso enantiomérico de 50 por cento (BE). RESULTADOS: Nos cortes histológicos semifinos observou-se distribuição regular homogênea nas fibras de colágeno no endoneuro e nenhuma alteração degenerativa dos axônios ou das bainhas de mielina foi constatada. Nos cortes ultrafinos foram observados axônios mielinizados e fibras de Remak de aspecto normal com axoplasma apresentando distribuição homogênea de neurofilamentos e microtúbulos. A análise histomorfométrica dos axônios não revelou diferença significativa entre os diâmetros dos axônios dos grupos estudados.

BACKGROUND AND OBJECTIVES: The duration of Local Anesthetic (LA) effects can be expanded by its incorporation into systems of sustained release microspheres. However, the possibility that LA sustained release systems are neurotoxic has not received due attention in literature. The objective of this study was to investigate the effects of pure microspheres of poly(lactic-co-glycolic acid), filled with 50 percent enantiomeric excess bupivacaine or bupivacaine (BP), as well as the effects of 50 percent enantiomeric excess bupivacaine in the sciatic nerve of Wistar rats. METHODS: The rats were allocated into four groups according to the evaluation time (two, four, six, and eight days) and nominated according to the injected solution on the sciatic nerve: Microspheres with 50 percent Enantiomeric excess Bupivacaine (MEB), Microspheres with Bupivacaine (MB), Pure Microspheres (PM), and 50 percent Enantiomeric excess Bupivacaine (EB). RESULTS: In semi-fine histologic sections, no regular homogeneous distribution of collagen fibers in the endoneurium or degenerative changes of axons and myelin sheaths were observed. In ultrathin sections, we found myelinated axons and normal Remak fibers with axoplasm showing homogeneous distribution of neurofilaments and microtubules. Histomorphometric analysis of axons revealed no significant difference between the axon diameters of the studied groups.

JUSTIFICATIVA Y OBJETIVOS: La duración del efecto de los anestésicos locales (AL), puede ser ampliada por su incorporación a los sistemas de liberación prolongada como microesferas. Sin embargo, la posibilidad de que los sistemas de liberación prolongada de AL sean neurotóxicos, no ha recibido la debida atención en la literatura. Este estudio tuvo el objetivo de investigar los efectos de microesferas de ácido poliláctico-co-glicólico puras, rellenados con bupivacaína en exceso enantiomérico de 50 por ciento o con bupivacaína (BP), como también los efectos de la bupivacaína en exceso enantiomérico de 50 por ciento en nervio ciático de ratones Wistar. MÉTODO: Los ratones se dividieron en cuatro grupos de acuerdo con el tiempo de evaluación (dos, cuatro, seis y ocho días), y fueron denominados conforme a la solución inyectada sobre el nervio ciático: microesferas con bupivacaína en exceso enantiomérico de 50 por ciento (MBE), microesferas con bupivacaína (MB); microesferas puras (MP) y bupivacaína en exceso enantiomérico de 50 por ciento (BE). RESULTADOS: En los cortes semifinos se observó la distribución regular homogénea en las fibras de colágeno en el endoneuro y no se comprobó ninguna alteración degenerativa de los axones o de las vainas de mielina. En los cortes ultrafinos fueron observados axones mielinizados y fibras de Remak de aspecto normal con axoplasma presentando una distribución homogénea de neurofilamentos y microtúbulos. El análisis histomorfométrico de los axones no reveló diferencias significativas entre los diámetros de los axones de los grupos estudiados.

Efectos de los isómeros en la práctica clínica / Isomers effects in clinical practice

Las isoformas estructurales de los medicamentos actúan de manera diferente en el organismo y se precisa un conocimiento básico para conocer sus efectos. El presente artículo tiene por objetivo presentar una revisión general sobre la estereoquímica de los agentes farmacológicos, cuya acción no siempre es la que desea el clínico, debido a que sus formas espaciales difieren a pesar de que estructuralmente sean idénticas. Para la realización del trabajo se realizó una revisión de la literatura mediante base de datos Embase y Medline. La farmacodinímica es la acción que ejercen los medicamentos en el organismo; sin embargo aún falta conocerse muchos efectos químicos producidos por sus propiedades espaciales, mientras que la farmacogénetica puede ser un gran aporte para aclarar el origen de muchas respuestas disímiles entre individuos, a pesar que los compuestos sean similares desde el punto de vista molecular.

The drugs structural isoforms work differently in the body and require a basic understanding for their effects. This articles aims to present a comprehensive review on the stereochemistry of pharmacological agents whose actions are not always desired by the clinician because, even though they are structurally identical, their spatial configuration differ. To carry out this work, a review of the literature by database Embase and medline has been made. Pharmacodynamics is the action exerted by drugs in the body, but we still need to know many chemical effects produced by their spatial properties, in the meanwhile pharmacogenetics may be an important contribution to clarify the origin many dissimilar response between individuals, although compounds are similar from the molecular standpoint of view.

Development of a real-time fluorescence quantitative PCR method for detection of FPGS mRNA expression in methotrexate enantiomer-resistant A549 cell lines and patients with leukemia / 中华检验医学杂志

Objective To establish a real-time fluorescence quantitative PCR method for detection of the different expression level of FPGS in methotrexate enantiomer-resistant A549 cell lines,and observe FPGS mRNA expression in patients with leukemia.Methods A real-time fluorescence quantitative PCR method for detection FPGS mRNA was established using SYBR Green Ⅰ as fluorescence and β-actin as reference.The method was evaluated by Ct,correlation coefficient,slope,repeatability curve,melting curve and amplification efficiency curve.The expression levels of FPGS gene in methotrexate enantiomer-resistant A549 cell lines and methotrexate resistant leukemia cells in bone marrow were detected by the method.Results The standard curves had a high linear relationship between cycle threshold and template concentration.The correlation coefficients of FPGS and β-actin were 0.996 8 and 0.998 7,and the slopes were -3.595 and -3.740,respectively.The inter-coefficient of variation was from 1.27% to 2.95%.The intra-coefficient of variation was 3.82%.The method was characterized with specific melting curve and similar amplification efficiency(slope was 0.021 7).The relative contents of FPGS mRNA were(3.51 ±0.66),(0.16 ±0.01) and(1.00 ±0.31) in L-(+)-MTX/A549 cells(L),D-(-)-MTX/A549 cells(D)and A549 parent cells,and there was statistically difference among the three groups(F = 64.45 ,P＜ 0.01)Statistical difference was observed between L and D(q =9.29,P＜0.01).After treated with MTX,the expression level of FPGS mRNA was(0.35 ± 0.04) in methotrexate resistant leukemia patients,compared with(1.00 ± 0.44) before treatment.Statistical difference was observed(t = 8.83 ,P＜ 0.01).Conclusions The real-time fluorescence quantitative PCR is suitable for the quantification of FPGS.The expression levels of FPGS in methotrexate resistant leukemia cells in bone marrow and drug resistant cells are different.Two enantiomer forms of methotrexate may play different roles in drug resistance mechanisms.

Determination of dynamic parameters of interaction between methotrexate enantiomer and dihydrofolate reductase by affinity capillary electrophoresis / 中华检验医学杂志

Objective To develop a method for the determination of the dynamic parameters of interaction between methotrexate(MTX)enantiomer and dihydrofolate reductase(DHFR).Methods An affinity capillary electrophoresis(ACE)method was adopted.Using bare fused-silica capillary,the electrophoresis buffer was 50 mmoL/L sodium tetraborate with 0.2%Brij-35,pH 9.50.The temperature of separation was controlled at 25℃ and a voltage of 25 kV was applied.The separation of the reaction mixture was performed at a wavelength of 254 nm.The difference of peak areas about the product was used to calculate the inhibitory rate and IC50 values.Results We establish the detection method for the dynamic parameters of interaction between MTX enantioner and DHFR.The separation of the reaction mixture could be achieved within 30 min.The IC50 value of D-(-)-MTX and L-(+)-MTX were 3.17×10-7 and 2.48×10-8mol/L,respective.The IC50 value of the D-(-)-MTX was 31.67×10-8mol/L,the L-(+)-MTX was2.48×10-8mol/L.The IC50 value of the D-(-)-MTX was about 13 times higher than that of the L-(+)-MTX.Conclusions ACE is a rapid.simple and accurate method that can be used to monitor DHFRdynamic reaction.The IC50 values of MTX enantiomer were quite different.The result first indicated that reaction between MTX enantiomer and DHFR had three-dimensional selection.

Structure and function of a truncated spliced isoform of interferon regulatory factor IRF-3c / 中华传染病杂志

Objective Interferon regulatory factors 3 (IRF-3) is a key transcription factor to regulate gene expression of interferon after virus infection. This study aims to look for new spliced isoforms of IRF-3 and to investigate their structures and functions. Methods RNA extracts from human embryonic kidney 293 cells were amplified by RACE and RT-PCR. New sequences were compared with published sequences of IRF-3 and murine EST database using bioinformatics method. A new sequence, IRF-3c, was subcloned into pcDNA3.1-flag. The IRF-3c/pcDNA3.1-flag plasmid was transfected in HEK 293 cells. Whole cell extract was analysed by Western blot and then probed with monoclonal Flag antibody. Luciferase assay was carried out by co-transfection with reporter plasmid, pGL2B with interferon ? promoter, and IRF-3c cDNA expression plasmid. At 16 hours posttransfection, cells were infected with Sendai virus for 8 hours. Cells were collected and assayed for luciferase activity. Results A novel spliced isoform of IRF-3, named IRF-3c was discovered. The new isoform is almost the same as IRF-3, except for the utilization of the 180 bp bases in intron 6 adjacent to exon 6. The first 2,3 and 4 bases are a stop codon, which may produce a protein with a truncated C-terminal stoped at amino acids 327. Western blot analysis confirmed an expected 44 kDa strong band. The new inserted bases can be found in murine EST database, suggesting a conservative function in evolution. The functional luciferase assay showed that IRF-3c inhibited the IFN? promoter activity to (around) 40%～50% as that of control after Sendai virus infection. Conclusions The discovery of a new isoform of IRF-3 provides a new insight into the functional regulation of IRF-3 family. It is a dominant-negative inhibitor for interferon ? promoter activity in the virus infection pathway, provides a mechanism for the fine-tuning of the virus-induced activation of the interferon response, and prevents interferon ? from its overexpression and its toxic effects. It is worthwhile to explore the role of IRF-3c in the pathogenesis of human diseases using IRF-3c’s specific sequence.