e-Membranome: A Database for Genome-Wide Analysis of Escherichia coli Outer Membrane Proteins.

OBJECTIVE: Lectin-like adhesins of enteric bacterial pathogens such as Escherichia coli are an attractive target for vaccine or drug development. Here, we have developed e-Membranome as a database of genome-wide putative adhesins in Escherichia coli (E. coli). METHODS: The outer membrane adhesins were predicted from the annotated genes of Escherichia coli strains using the PSORTb program. Further analysis was performed using Interproscan and the String database. The candidate proteins can be investigated for homology modeling of the Three-Dimensional (3D) structure (I-TASSER version 5.1), epitope region (ABCpred), and the glycan array. RESULTS: e-Membranome is implemented using the Django (version 2.2.5) framework. The Web Application Server Apache Tomcat 6.0 is integrated into the platform on Ubuntu Linux (version 16.04). MySQL database (version 5.7) is used as a database engine. The information on homology model of the 3D structure, epitope region, and affinity information from the glycan array will be stored in the e- Membranome database. As a case study, we performed a genome-wide screening of outer membraneembedded proteins from the annotated genes of E. coli using the e-Membranome pipeline. CONCLUSION: This platform is expected to be a valuable resource for advancing research of outer membrane proteins for the construction of lectin-glycan interaction network of E. coli. In addition, the e- Membranome pipeline can be extended to other similar biological systems that need to address hostpathogen interactions.

Viral etiology of sporadic cases of parotitis among children in Korea during 2013-2014.

Recent years have seen a high incidence of mumps, which is generally diagnosed based on clinical features, especially parotitis, without laboratory confirmation in Korea. To better understand the epidemiology of mumps in Korean children, we investigated sporadic suspected mumps cases with parotitis. In total, 237 buccal swabs or throat swabs collected from children with parotitis who had been clinically diagnosed with mumps were tested using real-time PCR for the detection of six viruses (Epstein-Barr virus, Human herpesvirus 6, Mumps virus, Human parainfluenza virus-1, -2, -3, Human adenovirus, Human bocavirus). Among 237 parotitis cases, 87 (36.7%) were positive for at least one virus; a single infection was observed in 73 (83.9%) cases, and co-infections were detected in 14 (16.1%) cases. Epstein-Barr virus was most frequent (20.7%), followed by human herpesvirus 6 (8.0%), mumps virus (5.5%), human parainfluenza virus-3 (4.6%), human adenovirus (4.2%), and human bocavirus (0.4%). These data suggested that the sporadic suspected mumps in the children might be related to other respiratory viruses rather than to the mumps virus. Our findings also indicate the limitation of clinical diagnosis without laboratory confirmation for mumps and thus highlight the importance of laboratory testing in suspected mumps cases.

Increased incidence of open-angle glaucoma among hypertensive patients: an 11-year nationwide retrospective cohort study.

OBJECTIVE: To evaluate the risk of open-angle glaucoma (OAG) among patients with systemic hypertension (HTN). METHODS: This retrospective propensity-score-matched cohort study included patients with HTN and a matched comparison cohort from the Korean National Health Insurance Service National Sample Cohort database. The HTN group was defined as patients who were prescribed antihypertensive medication, or SBP at least 140 or DBP at least 90 mmHg. The OAG group was defined as patients satisfying OAG criteria during repeated visits to an ophthalmologist. The Charlson comorbidity index was used to control for systemic conditions. Cox proportional hazard regression analysis was performed. RESULTS: OAG occurred in 2.0% (n = 1961) in the HTN group, and 1.7% (n = 1692) in the comparison group (P < 0.001). The OAG incidence rates in patients with and without HTN were 19.0 and 16.4 per 10 000 person-years, respectively. HTN was associated with increased OAG incidence [adjusted hazard ratio (HR) = 1.16, 95% confidence interval: 1.09-1.24] from our multivariate Cox model. Participants with higher SBP (adjusted HR = 1.12 for 120-139 mmHg group; and adjusted HR = 1.20 for ≥140 mmHg group) was more likely to have subsequent OAG compared with participants with less than 120 mmHg blood pressure. Participants with higher DBP (adjusted HR = 1.11 for 80-89 mmHg group: and adjusted HR = 1.07 for ≥90 mmHg group) showed similar trends as participants with less than 80 mmHg blood pressure. CONCLUSION: Patients diagnosed with HTN are more likely to experience subsequent OAG than those without HTN.

SURGICAL OUTCOME OF SIMULTANEOUS INTRAOCULAR LENS RESCUE AND SUTURELESS INTRASCLERAL TUNNEL FIXATION OF DISLOCATED INTRAOCULAR LENSES.

PURPOSE: To report short-term surgical outcomes of single-stage simultaneous rescue and sutureless intrascleral fixation of dislocated intraocular lens (IOLs). METHODS: Sixteen eyes of 16 patients who underwent simultaneous rescue and intrascleral fixation of dislocated 3-piece IOLs were retrospectively evaluated. Partial thickness limbal-based scleral flaps (2.0 × 2.0 mm) were created, and a 22-gauge round needle was used to create a sclerotomy at 1.5 mm from the limbus under the previously created scleral flap, and a 23-gauge trans pars plana vitrectomy was performed. Bimanual maneuvers using two 23-gauge end-grasping forceps under chandelier illumination and a wide-angle viewing system enabled 1 step rescue of IOLs from the posterior vitreous cavity with 1 hand and simultaneous haptic externalization through sclerotomy with the other hand. An externalized haptic was placed into the 3-mm intrascleral tunnel created using a bent 26-gauge needle. Fibrin glue was used to fixate haptics and close the scleral flaps. RESULTS: Intraocular lenses were successfully rescued and sclera-fixated through intrascleral tunnels in all 16 eyes (mean age, 56.56 ± 19.89 years). The mean preoperative logarithm of the minimum angle of resolution best-corrected visual acuity was 0.92 ± 0.68, and this significantly improved at 6 months to 0.289 ± 0.36 (P = 0.003). During the follow-up period (10.1 ± 3.21 months), no significant change of endothelial cell count or central foveal thickness was noted postoperatively (P = 0.203 and P = 0.979, respectively). There were no significant postoperative complications such as IOL dislocation, IOL decentration, retinal detachment, endophthalmitis, or postoperative hypotony. CONCLUSION: Simultaneous rescue and sutureless intrascleral haptic fixation of dislocated 3-piece IOLs using bimanual maneuvers is an effective, safe, and minimally invasive surgical method to rescue and fixate the dislocated IOL without further explant.

Do CT scans overestimate the fusion rate after anterior cervical discectomy and fusion?

DESIGN: This study is a radiographic analysis. OBJECTIVE: To compare the fusion rates after anterior cervical discectomy and fusion (ACDF) using x-rays versus computerized tomography (CT). BACKGROUND: Although fusion status may be obvious when evaluating ACDFs performed in the remote past, determining the presence of a solid fusion at earlier time points after ACDF is often ambiguous but a necessary part of practice. Commonly used tools include radiographs and CT scans. Currently, there is no gold standard imaging modality to determine fusion status. METHODS: Twenty-two patients status post-ACDF (cortical allograft with anterior plates) at 34 levels with CT scans and dynamic x-rays obtained at 3, 6, and 12 months postoperatively were included. Four spine surgeons blinded to the time point independently determined fusion status according to the criteria. RESULTS: On the basis of the x-ray criteria, the fusion rates were 26%, 41%, and 65% at 3, 6, and 12 months, respectively, postoperatively. On the basis of CT criteria, the fusion rates were 79%, 79%, and 91% at 3, 6, and 12 months, respectively. There was a significant difference in the predicted fusion rate at each time point comparing x-ray versus CT criteria. In addition, at 3 months, 41% of the levels (11/27) thought to be fused by CT criteria demonstrated >1 mm motion on dynamic x-rays. At 6 months, 33% (9/27) of the levels thought to be fused by CT demonstrated persistent motion of ≥1 mm. At 12 months, 23% (7/31) of the levels considered fused by CT still had persistent motion. DISCUSSION: X-ray criteria for fusion, which incorporate both static and dynamic factors, predicted lower fusion rates at each time point when compared with CT scans, which evaluate only static factors. Depending on the time point, anywhere from 23% to 41% of levels thought to be fused by CT criteria demonstrated persistent motion on dynamic x-rays. Although <1 mm motion is not a sufficient criteria for fusion by itself, levels demonstrating >1 mm motion are less likely to be solidly fused. Thus, we conclude that CT scans may overestimate the fusion rate during the early stages of ACDF healing with cortical allograft, and that CT scans alone may not accurately determine fusion status. Reliable determination of fusion may thus require dynamic information obtained from flexion-extension x-ray in association with high-resolution static information from CT.

Use of recombinant human bone morphogenetic protein-2 with local bone graft instead of iliac crest bone graft in posterolateral lumbar spine arthrodesis.

STUDY DESIGN: Prospective clinical study. OBJECTIVE: Compare fusion rates between recombinant human bone morphogenetic protein-2 (rhBMP-2) and iliac crest bone graft (ICBG) with rhBMP-2 and local bone graft (LBG) (±bone graft extenders) in posterolateral fusion. SUMMARY OF BACKGROUND DATA: Previous reports have shown higher fusion rates when adding rhBMP-2 to ICBG in lumbar posterolateral fusion, compared with ICBG alone. We compared the fusion success rates between rhBMP-2 delivered with ICBG versus that with LBG. METHODS: Fusion rates were compared in patients with degenerative spondylolisthesis (1-2 levels) with accompanying lumbar stenosis. RhBMP-2 (INFUSE, Medtronic) was delivered on an absorbable collagen sponge (6 mg/side at 1.5 mg/mL) with ICBG alone or with LBG wrapped inside the sponge. Thin slice computed tomographic scans were assessed at 6, 12, and 24 months. RESULTS: In a consecutive series, 16 patients (30 levels) received ICBG with rhBMP-2 and 35 patients (49 levels) received LBG with rhBMP-2. For the ICBG cohort, 80.0%, 93.4%, 96.7% of levels were fused at 6, 12, and 24 months. In contrast, for the local bone with rhBMP-2 cohort, 87.7%, 98.0%, and 98.0% were fused at 6, 12, and 24 months. There was no statistically significant difference in fusion success rates between the 2 groups at any time point. As for fusion quality, the fusion mass showed superior quality in ICBG group than in the local bone group at each time point. CONCLUSION: This study validates the high fusion success rates previously reported by adding rhBMP-2 to ICBG and shows that local bone may be safely substituted for ICBG in 1- to 2-level posterolateral fusion. The fusion rates were comparable. The avoidance of ICBG harvest has implications for operative time, blood loss, and morbidity. Lastly, this is the first study that directly compares the fusion success rate and quality using local bone with rhBMP-2 versus ICBG with rhBMP-2 at various times. LEVEL OF EVIDENCE: 4.

Association of worse prognosis with an aberrant diurnal cortisol rhythm in patients with advanced lung cancer.

A flatter diurnal rhythm of cortisol has been reported to be associated with early mortality in patients with metastatic breast cancer. The clinical stage of disease at the time of diagnosis and the patient's performance status (PS) are known to be important prognostic factors for lung cancer (LC) survival. The authors examined the relationship between diurnal cortisol rhythms and these prognostic factors in patients with advanced LC. Cortisol concentrations were measured in saliva samples collected from 52 patients (37 males/15 females) with advanced LC and from 56 healthy subjects (32 males/24 females) to characterize the diurnal cortisol rhythm, specifically the cortisol awakening response (CAR) and diurnal cortisol decline (DCD). Variations of CAR and DCD in the patients were analyzed according to their clinical disease stage and PS score, and the differences in CAR and DCD between patients and healthy controls were compared. The patient group showed significantly reduced diurnal cortisol secretory activity and rhythmicity, compared with healthy controls. When the patients were subgrouped according to their clinical disease stage, patients with stage 4 disease showed significantly reduced CAR and flatter DCD compared with the healthy controls. However, the CAR and DCD in patients with stage 3a and 3b disease were comparable to those of healthy controls. Neither the CAR nor the DCD showed stepwise changes as the disease stage worsened. When patients were subgrouped according to their Eastern Cooperative Oncology Group (ECOG) PS score, there was stepwise reduction in the CAR and flattening of the DCD as the PS score increased. Both an abolished CAR and a flattened DCD were common in patients with ECOG PS scores of 3 and 4. These results indicate that alteration of the diurnal cortisol rhythm in patients with advanced LC is more closely associated with their PS score than with their clinical disease stage. Gradual alteration of the CAR and DCD, indicative of loss of 24-h cortisol rhythm, in concert with increase in PS score implies that endogenous circadian rhythms may also be disintegrating as the PS score worsens in these patients.

Cyclosporin A and sanglifehrin A enhance chemotherapeutic effect of cisplatin in C6 glioma cells.

Glioma is the most common type of brain tumors in adults, and treatment of high-grade gliomas is still palliative. Studies to date have revealed only modest effect in attenuating growth of these tumors with single agent therapy, but combination treatment appears to be more effective. Cyclophilin A (CypA), a target of immunosuppressive drugs cyclosporin A (CsA) and sanglifehrin A (SFA), is an intracellular protein that has peptidyl-prolyl cis-trans isomerase (PPIase) enzymatic activity. Previously, we showed that overexpressed CypA induced chemoresistance in cancer cells. Here we provide evidence that combination of cisplatin with either CsA or SFA synergistically enhances apoptotic cell death in C6 glioma cells, compared with single agent treatment. Enhanced apoptotic cell death is a result of an increase in ROS generation and a decrease in intracellular glutathione levels. Consistently, CypA knockdown by siRNA also enhances cisplatin-induced apoptosis. Immunohistochemical analysis showed increased expression of CypA in human glioblastoma multiforme, but not in normal human astrocytes. CypA was also shown to be up-regulated in C6 glioma cells during hypoxia. In conclusion, CsA or SFA in combination with cisplatin synergistically enhances cisplatin-induced apoptosis in C6 glioma cells via inhibition of PPIase activity of CypA, indicating that development of new drugs that selectively inhibit the CypA PPIase activity without immune suppression may facilitate alleviation of chemoresistance in treatment of high-grade glioma.

Somatic mutations and losses of expression of microRNA regulation-related genes AGO2 and TNRC6A in gastric and colorectal cancers.

Mounting evidence indicates that deregulation of microRNAs (miRNAs) are involved in development of many human diseases, including cancers. Regulation of miRNA is a complicated process and some components in the regulation are known to be altered in human cancers. Among the miRNA regulation-related genes, we found that AGO1, AGO2, TNRC6A, TNRC6C, TARBP2 and EXPORTIN5 genes have mononucleotide repeats in their coding sequences. To see whether these genes are mutated in cancers with microsatellite instability (MSI), we analysed the mononucleotide repeats in 27 gastric cancers (GCs) with high MSI (MSI-H), 18 GC with low MSI (MSI-L), 45 GC with stable MSI (MSS), 41 colorectal cancers (CRCs) with MSI-H, 14 CRCs with MSI-L and 45 CRCs with stable MSI (MSS) by single-strand conformation polymorphism (SSCP) analysis and DNA sequencing. We found AGO2, TNRC6A, TARBP2, TNRC6C and EXPORTIN5 mutations in 10, six, one, one and one cancer(s), respectively. They were detected in MSI-H but not in MSI-L or MSS cancers. The GCs and CRCs with MSI-H harboured one or more mutations of the genes in 22% and 27%, respectively. We also analysed Ago2 and TNRC6A protein expressions in GCs and CRCs with MSI-H. In cancers with MSI-H, loss of Ago2 expression was observed in 40% of GCs and 35% of CRCs, while loss of TNRC6A was observed in 52% of the GCs and 54% of the CRCs. Our data indicate that frameshift mutations in AGO2 and TNRC6A and their losses of expression are common in GCs and CRCs with MSI-H, and suggest that these alterations may contribute to the cancer development by deregulating miRNA regulation.

Expressional and mutational analysis of pro-apoptotic Bcl-2 member PUMA in hepatocellular carcinomas.

Deregulation of apoptosis is involved in mechanisms of cancer development. PUMA is a pro-apoptotic member of the Bcl-2 family and mediates p53-dependent and -independent apoptosis. The aim of this study was to investigate whether alterations of PUMA protein expression and somatic mutations of PUMA gene are characteristics of human hepatocellular carcinoma (HCC). We analyzed expression of PUMA protein in 20 HCCs using immunohistochemistry. Also, we analyzed mutation of the Bcl-2 homology 3 (BH3) domain of PUMA gene, which is an important domain in apoptosis function of PUMA by single-strand conformation polymorphism (SSCP) in 69 HCCs. PUMA protein expression was detected in both HCC cells and non-tumor hepatocytes in all of the 20 HCCs. In 10 of these HCCs, cancer cells showed higher PUMA expression than non-tumor (cirrhotic) hepatocytes of the same patients; whereas in the remaining 10, cancer cells and non-tumor hepatocytes showed similar levels. Mutational analysis revealed no PUMA BH3 domain mutation in the 69 HCCs, suggesting that PUMA BH3 domain mutation is not a direct target of inactivation in hepatocellular cancer development. The increased expression of PUMA in malignant hepatocellular cells relative to that in non-tumor hepatocytes suggests that PUMA expression may play a role in HCC development.

Altered expression of Skp2, c-Myc and p27 proteins but not mRNA after H. pylori eradication in chronic gastritis.

Helicobacter pylori infection is associated with increased gastric epithelial cell turnover and non-cardia gastric cancer. Cell cycle progression is dependent on the proteasomal degradation of p27, a cyclin-dependent kinase inhibitor and gastric tumor suppressor, following ubiquitination mediated by Skp2. c-Myc is a transcriptional repressor of p27 and also a target of Skp2. In vitro, H. pylori decreases p27 protein post-translationally. We aimed to determine how p27 is regulated by H. pylori in vivo. The effect of eradicating H. pylori on gastric epithelial p27, Skp2, and c-Myc proteins and mRNA was investigated in 22 patients with chronic gastritis, by immunohistochemistry and laser capture microdissection. The percentage of gastric antral epithelial cells expressing p27 protein was significantly higher after eradication of H. pylori (mean+/-s.e.m. 37+/-2.4% pre-eradication vs 55+/-2.8% post-eradication; P<0.001), while Skp2 and c-Myc protein-expressing cells were lower (Skp2: 35+/-3.8 vs 23+/-2.6%, P=0.009; c-Myc: 47+/-3.6 vs 30+/-3.8%, P<0.001). mRNA expressions of p27, Skp2, and c-Myc (normalized for 18SrRNA) were not changed by H. pylori eradication. H. pylori increases c-Myc and decreases gastric epithelial p27 protein expression in association with increased expression of Skp2, the regulator of p27's ubiquitin ligase complex. H. pylori may influence cell cycle progression and carcinogenesis through post-translational effects on specific gene expression.

Pathological dynamics of activated microglia following medial forebrain bundle transection.

To elucidate the role and pathological dynamics of activated microglia, this study assessed the phagocytic, immunophenotypic, morphological, and migratory properties of activated microglia in the medial forebrain bundle (MFB) axotomized rat brain. Activated microglia were identified using two different monoclonal antibodies: ED1 for phagocytic activity and OX6 for major histocompatibility complex (MHC) class II. Phagocytic microglia, characterized by ED1-immunoreactivity or ED1- and OX6-immunoreactivity, appeared in the MFB and substantia nigra (SN) as early as 1-3 days post-lesion (dpl), when there was no apparent loss of SN dopamine (DA) neurons. Thereafter, a great number of activated microglia selectively adhered to degenerating axons, dendrites and DA neuronal somas of the SN. This was followed by significant loss of these fibers and nigral DA neurons. Activation of microglia into phagocytic stage was most pronounced between 14 approximately 28 dpl and gradually subsided, but phagocytic microglia persisted until 70 dpl, the last time point examined. ED1 expression preceded MHC II expression in phagocytic microglia. All phagocytic microglia sticking to DA neurons showed activated but ramified form with enlarged somas and thickened processes. They were recruited to the SNc from cranial, dorsal and ventral aspects along various structures and finally stuck to DA neurons of the SNc. Characteristic rod-shaped microglia in the white matter were thought to migrate a long distance. The present study strongly suggests that neurons undergoing delayed neurodegeneration may be phagocytosed by numerous phagocytic, ramified microglia at various sites where specific surface signals are exposed or diffusible molecules are released.

Spermine oxidation induced by Helicobacter pylori results in apoptosis and DNA damage: implications for gastric carcinogenesis.

Oxidative stress is linked to carcinogenesis due to its ability to damage DNA. The human gastric pathogen Helicobacter pylori exerts much of its pathogenicity by inducing apoptosis and DNA damage in host gastric epithelial cells. Polyamines are abundant in epithelial cells, and when oxidized by the inducible spermine oxidase SMO(PAOh1) H(2)O(2) is generated. Here, we report that H. pylori up-regulates mRNA expression, promoter activity, and enzyme activity of SMO(PAOh1) in human gastric epithelial cells, resulting in DNA damage and apoptosis. H. pylori-induced H(2)O(2) generation and apoptosis in these cells was equally attenuated by an inhibitor of SMO(PAOh1), by catalase, and by transient transfection with small interfering RNA targeting SMO(PAOh1). Conversely, SMO(PAOh1) overexpression induced apoptosis to the same levels as caused by H. pylori. Importantly, in H. pylori-infected tissues, there was increased expression of SMO(PAOh1) in both human and mouse gastritis. Laser capture microdissection of human gastric epithelial cells demonstrated expression of SMO(PAOh1) that was significantly attenuated by H. pylori eradication. These results identify a pathway for oxidative stress-induced epithelial cell apoptosis and DNA damage due to SMO(PAOh1) activation by H. pylori that may contribute to the pathogenesis of the infection and development of gastric cancer.

Iris synechia after laser goniopuncture in a patient having deep sclerectomy with a collagen implant.

Neodymium:YAG (Nd:YAG) goniopuncture is an efficient and safe treatment for low filtration through the trabeculo-Descemet's membrane after deep sclerectomy with a collagen implant (DSCI). The only reported complication of this procedure is choroidal detachment. However, we found an iris synechia in a patient whose intraocular pressure (IOP) was elevated again 1 month after Nd:YAG goniopuncture. Synechiolysis and peripheral iridectomy with Nd:YAG and argon lasers effectively removed the iris synechia, and IOP immediately dropped to the normal range. We believe that iris synechia is a potential complication that may cause elevated IOP after laser goniopuncture in patients having DSCI.