Cabozantinib plus Nivolumab and Ipilimumab in Renal-Cell Carcinoma.

BACKGROUND: The efficacy and safety of treatment with cabozantinib in combination with nivolumab and ipilimumab in patients with previously untreated advanced renal-cell carcinoma are unknown. METHODS: In this phase 3, double-blind trial, we enrolled patients with advanced clear-cell renal-cell carcinoma who had not previously received treatment and had intermediate or poor prognostic risk according to the International Metastatic Renal-Cell Carcinoma Database Consortium categories. Patients were randomly assigned to receive 40 mg of cabozantinib daily in addition to nivolumab and ipilimumab (experimental group) or matched placebo in addition to nivolumab and ipilimumab (control group). Nivolumab (3 mg per kilogram of body weight) and ipilimumab (1 mg per kilogram) were administered once every 3 weeks for four cycles. Patients then received nivolumab maintenance therapy (480 mg once every 4 weeks) for up to 2 years. The primary end point was progression-free survival, as determined by blinded independent review according to Response Evaluation Criteria in Solid Tumors, version 1.1, and was assessed in the first 550 patients who had undergone randomization. The secondary end point was overall survival, assessed in all patients who had undergone randomization. RESULTS: Overall, 855 patients underwent randomization: 428 were assigned to the experimental group and 427 to the control group. Among the first 550 patients who had undergone randomization (276 in the experimental group and 274 in the control group), the probability of progression-free survival at 12 months was 0.57 in the experimental group and 0.49 in the control group (hazard ratio for disease progression or death, 0.73; 95% confidence interval, 0.57 to 0.94; P = 0.01); 43% of the patients in the experimental group and 36% in the control group had a response. Grade 3 or 4 adverse events occurred in 79% of the patients in the experimental group and in 56% in the control group. Follow-up for overall survival is ongoing. CONCLUSIONS: Among patients with previously untreated, advanced renal-cell carcinoma who had intermediate or poor prognostic risk, treatment with cabozantinib plus nivolumab and ipilimumab resulted in significantly longer progression-free survival than treatment with nivolumab and ipilimumab alone. Grade 3 or 4 adverse events were more common in the experimental group than in the control group. (Funded by Exelixis; COSMIC-313 ClinicalTrials.gov number, NCT03937219.).

A 128-channel receive array for cortical brain imaging at 7 T.

PURPOSE: A 128-channel receive-only array for brain imaging at 7 T was simulated, designed, constructed, and tested within a high-performance head gradient designed for high-resolution functional imaging. METHODS: The coil used a tight-fitting helmet geometry populated with 128 loop elements and preamplifiers to fit into a 39 cm diameter space inside a built-in gradient. The signal-to-noise ratio (SNR) and parallel imaging performance (1/g) were measured in vivo and simulated using electromagnetic modeling. The histogram of 1/g factors was analyzed to assess the range of performance. The array's performance was compared to the industry-standard 32-channel receive array and a 64-channel research array. RESULTS: It was possible to construct the 128-channel array with body noise-dominated loops producing an average noise correlation of 5.4%. Measurements showed increased sensitivity compared with the 32-channel and 64-channel array through a combination of higher intrinsic SNR and g-factor improvements. For unaccelerated imaging, the 128-channel array showed SNR gains of 17.6% and 9.3% compared to the 32-channel and 64-channel array, respectively, at the center of the brain and 42% and 18% higher SNR in the peripheral brain regions including the cortex. For R = 5 accelerated imaging, these gains were 44.2% and 24.3% at the brain center and 86.7% and 48.7% in the cortex. The 1/g-factor histograms show both an improved mean and a tighter distribution by increasing the channel count, with both effects becoming more pronounced at higher accelerations. CONCLUSION: The experimental results confirm that increasing the channel count to 128 channels is beneficial for 7T brain imaging, both for increasing SNR in peripheral brain regions and for accelerated imaging.

A patient-friendly 16-channel transmit/64-channel receive coil array for combined head-neck MRI at 7 Tesla.

PURPOSE: To extend the coverage of brain coil arrays to the neck and cervical-spine region to enable combined head and neck imaging at 7 Tesla (T) ultra-high field MRI. METHODS: The coil array structures of a 64-channel receive coil and a 16-channel transmit coil were merged into one anatomically shaped close-fitting housing. Transmit characteristics were evaluated in a B1+ -field mapping study and an electromagnetic model. Receive SNR and the encoding capability for accelerated imaging were evaluated and compared with a commercially available 7 T brain array coil. The performance of the head-neck array coil was demonstrated in human volunteers using high-resolution accelerated imaging. RESULTS: In the brain, the SNR matches the commercially available 32-channel brain array and showed improvements in accelerated imaging capabilities. More importantly, the constructed coil array improved the SNR in the face area, neck area, and cervical spine by a factor of 1.5, 3.4, and 5.2, respectively, in regions not covered by 32-channel brain arrays at 7 T. The interelement coupling of the 16-channel transmit coil ranged from -14 to -44 dB (mean = -19 dB, adjacent elements <-18 dB). The parallel 16-channel transmit coil greatly facilitates B1+ field shaping required for large FOV neuroimaging at 7 T. CONCLUSION: This new head-neck array coil is the first demonstration of a device of this nature used for combined full-brain, head-neck, and cervical-spine imaging at 7 T. The array coil is well suited to provide large FOV images, which potentially improves ultrahigh field neuroimaging applications for clinical settings.

In Vivo Absolute Metabolite Quantification Using a Multiplexed ERETIC-RX Array Coil for Whole-Brain MR Spectroscopic Imaging.

BACKGROUND: Absolute quantification of metabolites in MR spectroscopic imaging (MRSI) requires a stable reference signal of known concentration. The Electronic REference To access In vivo Concentrations (ERETIC) has shown great promise but has not been applied in patients and 3D MRSI. ERETIC hardware has not been integrated with receive arrays due to technical challenges, such as coil combination and unwanted coupling between multiple ERETIC and receive channels, for which we developed mitigation strategies. PURPOSE: To develop absolute quantification for whole-brain MRSI in glioma patients. STUDY TYPE: Prospective. POPULATION: Five healthy volunteers and three patients with isocitrate dehydrogenase mutant glioma (27% female). Calibration and coil loading phantoms. FIELD STRENGTH/SEQUENCE: A 3 T; Adiabatic spin-echo spiral 3D MRSI with real-time motion correction, Fluid Attenuated Inversion Recovery (FLAIR), Gradient Recalled Echo (GRE), Multi-echo Magnetization Prepared Rapid Acquisition of Gradient Echo (MEMPRAGE). ASSESSMENT: Absolute quantification was performed for five brain metabolites (total N-acetyl-aspartate [NAA]/creatine/choline, glutamine + glutamate, myo-inositol) and the oncometabolite 2-hydroxyglutarate using a custom-built 4x-ERETIC/8x-receive array coil. Metabolite quantification was performed with both EREIC and internal water reference methods. ERETIC signal was transmitted via optical link and used to correct coil loading. Inductive and radiative coupling between ERETIC and receive channels were measured. STATISTICAL TESTS: ERETIC and internal water methods for metabolite quantification were compared using Bland-Altman (BA) analysis and the nonparametric Mann-Whitney test. P < 0.05 was considered statistically significant. RESULTS: ERETIC could be integrated in receive arrays and inductive coupling dominated (5-886 times) radiative coupling. Phantoms show proportional scaling of the ERETIC signal with coil loading. The BA analysis demonstrated very good agreement (3.3% ± 1.6%) in healthy volunteers, while there was a large difference (36.1% ± 3.8%) in glioma tumors between metabolite concentrations by ERETIC and internal water quantification. CONCLUSION: Our results indicate that ERETIC integrated with receive arrays and whole-brain MRSI is feasible for brain metabolites quantification. Further validation is required to probe that ERETIC provides more accurate metabolite concentration in glioma patients. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 1.

Perioperative pectoral nerve block type II and postoperative recurrence in breast cancer: a randomized controlled trial.

BACKGROUND: A new technique for analgesia called pectoral nerve block is widely used in surgeries of breast cancer. Pectoral nerve block type II (Pecs II) block has less influence on immunity when compared with general anesthesia method. The purpose of this research is to demonstrate whether Pecs II block has influence on the recurrence of breast cancer after surgical operation. METHODS: 526 breast cancer patients were recruited in this research and randomized into general anesthesia group and general anesthesia with Pecs II block group. Recurrence-free survival (RFS), distant recurrence-free survival (DRFS), and overall survival (OS) were evaluated for the two groups. RESULTS: Based on the statistical data, only the consumption of remifentanil was dramatically reduced by the performance of Pecs II block when compared with general anesthesia method. The performance of Pecs II block had no significant influence on OS, RFS, and DRFS of breast cancer patients after surgery. ASA physical status III, TNM stage 2 + 3, and mastectomy were proved to have association with lower recurrence-free survival. CONCLUSION: In conclusion, the performance of Pecs II block declined the remifentanil consumption during surgery of breast cancer. Meanwhile, the performance of Pecs II block had no significant influence on the OS, RFS, and DRFS of breast cancer patients after surgical resection.

Characterization of the Survival Influential Genes in Carcinogenesis.

The genes influencing cancer patient mortality have been studied by survival analysis for many years. However, most studies utilized them only to support their findings associated with patient prognosis: their roles in carcinogenesis have not yet been revealed. Herein, we applied an in silico approach, integrating the Cox regression model with effect size estimated by the Monte Carlo algorithm, to screen survival-influential genes in more than 6000 tumor samples across 16 cancer types. We observed that the survival-influential genes had cancer-dependent properties. Moreover, the functional modules formed by the harmful genes were consistently associated with cell cycle in 12 out of the 16 cancer types and pan-cancer, showing that dysregulation of the cell cycle could harm patient prognosis in cancer. The functional modules formed by the protective genes are more diverse in cancers; the most prevalent functions are relevant for immune response, implying that patients with different cancer types might develop different mechanisms against carcinogenesis. We also identified a harmful set of 10 genes, with potential as prognostic biomarkers in pan-cancer. Briefly, our results demonstrated that the survival-influential genes could reveal underlying mechanisms in carcinogenesis and might provide clues for developing therapeutic targets for cancers.

Lipoxin A4 ameliorates renal ischaemia-reperfusion-induced acute lung injury in rats.

Lipoxin A4 (LA4), a bioactive product of arachidonic acid, has been shown to exert strong anti-inflammatory activity. By contrast, the anti-inflammatory action of LA4 in a renal ischaemia-reperfusion (RIR)-mediated acute lung inflammation (ALI) model and the potential pathogenesis of the condition is still unclear. The aim of the current research was to investigate the effect of LA4 on RIR-induced ALI. The rat ALI model was induced by RIR. LA4 was injected via the tail vein immediately after RIR. The results indicate that LA4 markedly inhibits inflammatory cells infiltration, attenuates myeloperoxidase activity, and reduces the concentration of inflammatory mediators and Toll-like receptor 4 (TLR4) in RIR-induced ALI. Furthermore, LA4 suppressed nuclear factor kappa B (NF-κB) p65 and mitogen-activated protein kinase (MAPK) activation. The protective effect of LA4 in RIR-stimulated ALI was reversed by BOC-2 (an antagonist of the LA4 receptor). These results indicate that LA4 exerts powerful anti-inflammatory functions in RIR-induced ALI by attenuating TLR4 expression via MAPK and NF-κB signalling. Accordingly, LA4 might be an underlying treatment drug for RIR-induced ALI.

High-speed whole-brain oximetry by golden-angle radial MRI.

PURPOSE: To determine whole-brain cerebral metabolic rate of oxygen (CMRO2 ), an improved imaging approach, based on radial encoding, termed radial OxFlow (rOxFlow), was developed to simultaneously quantify draining vein venous oxygen saturation (SvO2 ) and total cerebral blood flow (tCBF). METHODS: To evaluate the efficiency and precision of the rOxFlow sequence, 10 subjects were studied during a paradigm of repeated breath-holds with both rOxFlow and Cartesian OxFlow (cOxFlow) sequences. CMRO2 was calculated at baseline from OxFlow-measured data assuming an arterial O2 saturation of 97%, and the SvO2 and tCBF breath-hold responses were quantified. RESULTS: Average neurometabolic-vascular parameters across the 10 subjects for cOxFlow and rOxFlow were, respectively: SvO2 (%) baseline: 64.6 ± 8.0 versus 64.2 ± 6.6; SvO2 peak: 70.5 ± 8.5 versus 72.6 ± 5.4; tCBF (mL/min/100 g) baseline: 39.2 ± 3.8 versus 40.6 ± 8.0; tCBF peak: 53.2 ± 5.1 versus 56.1 ± 11.7; CMRO2 (µmol O2 /min/100 g) baseline: 111.5 ± 26.8 versus 120.1 ± 19.6. The above measures were not significantly different between sequences (P > 0.05). CONCLUSION: There was good agreement between the two methods in terms of the physiological responses measured. Comparing the two, rOxFlow provided higher temporal resolution and greater flexibility for reconstruction while maintaining high SNR. Magn Reson Med 79:217-223, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

[Plan for Improving the Initial Ambulation of Acute Stroke Patients].

BACKGROUND & PROBLEMS: Acute stroke patients should receive a rehabilitation assessment within 24-48 hours of hospitalization. Initial ambulation is known to reduce the occurrence of complications, improve the ability to perform activities of daily living, and reduce the risk of long-term disability. PURPOSE: To raise the initial ambulation willingness of acute stroke patients and to increase the willingness of these patients to receive rehabilitation treatment as soon as possible in order to reduce the long-term physical damage of the stroke incident. RESOLUTIONS: To develop and implement standard operating procedures for the initiation of ambulation (first time leaving the hospital bed) in acute stroke patients, to use health education brochures with texts and illustrations, and to have nurses physically assist patients to initiate ambulation. RESULTS: The rate of ambulation initiation in acute stroke patients rose from 32.0% pre-intervention to 85.4% post-intervention. CONCLUSIONS: Acute stroke patients who initiate ambulation soon after experiencing a stroke may reduce their risk of acute complications, increase their ability to perform activities of daily living, and reduce the risk of long-term disability. Thus, encouraging early ambulation is extremely important to improving the prognosis of this patient population.

3D-accelerated, stack-of-spirals acquisitions and reconstruction of arterial spin labeling MRI.

PURPOSE: The goal of this study was to develop a 3D acceleration and reconstruction method to improve image quality and resolution of background-suppressed arterial spin-labeled perfusion MRI. METHODS: Accelerated acquisition was implemented in all three k-space dimensions in a stack-of-spirals readout using variable density spirals and partition undersampling. A single 3D self-consistent parallel imaging (SPIRiT) kernel was calibrated and iteratively applied to reconstruct each imaging volume. Whole-brain (including cerebellum) perfusion imaging was obtained at 3-mm isotropic resolution (nominal) using single- and 2-shot acquisitions and at 2-mm isotropic resolution (nominal) using four-shot acquisitions, achieving effective acceleration factors between 5.5 and 6.6. The signal-to-noise (SNR) performance of 3D SPIRiT was evaluated. The temporal SNR (tSNR) of the cerebral blood flow (CBF) maps and the gray/white matter CBF ratios were quantified. RESULTS: The readout of the arterial spin labeling (ASL) sequence was significantly shortened with acceleration. The CBF values were consistent between accelerated and fully sampled ASL. With shorter spiral interleaves and shorter echo trains, the accelerated images demonstrated reduced blurring and signal dropout in regions with high susceptibility gradients, resulting in improved image quality and increased gray/white matter CBF ratios. The shortened readout was accompanied by a corresponding decrease in tSNR. CONCLUSION: The 3D acceleration and reconstruction allow a rapid whole-brain readout that improved the quality of ASL perfusion imaging. Magn Reson Med 78:1405-1419, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

In vivo lung morphometry with hyperpolarized (3) He diffusion MRI: reproducibility and the role of diffusion-sensitizing gradient direction.

PURPOSE: Lung morphometry with hyperpolarized gas diffusion MRI is a highly sensitive technique for the noninvasive measurement of acinar microstructural parameters traditionally only accessible by histology. The goal of this work is to establish the reproducibility of these measurements in healthy volunteers and their dependence on the direction of the applied diffusion-sensitizing gradient. METHODS: Hyperpolarized helium-3 ((3) He) lung morphometry MRI was performed on a total of five healthy subjects. Two subjects received duplicate imaging on the same day and three subjects received duplicate imaging after a 4-month or 27-month delay to assess reproducibility. Four subjects repeated the measurement during the same session with different diffusion-sensitizing gradient directions to determine the effect on the parameter estimates. RESULTS: The (3) He lung morphometry measurements were reproducible over the short term and long term (e.g., % coefficient of variation [CV] of mean chord length, Lm = 2.1% and 2.9%, respectively) and across different diffusion gradient directions (Lm % CV = 2.6%). Results also show independence of field inhomogeneity effects at 1.5T. CONCLUSION: (3) He lung morphometry is a reproducible technique for measuring acinar microstructure and is effectively independent of the choice of diffusion gradient direction. This provides confidence for the use of this technique to compare populations and treatment efficacy.

In vivo lung morphometry with accelerated hyperpolarized (3) He diffusion MRI: a preliminary study.

PURPOSE: Parallel imaging can be used to reduce imaging time and to increase the spatial coverage in hyperpolarized gas magnetic resonance imaging of the lung. In this proof-of-concept study, we investigate the effects of parallel imaging on the morphometric measurement of lung microstructure using diffusion magnetic resonance imaging with hyperpolarized (3) He. METHODS: Fully sampled and under-sampled multi-b diffusion data were acquired from human subjects using an 8-channel (3) He receive coil. A parallel imaging reconstruction technique (generalized autocalibrating partially parallel acquisitions [GRAPPA]) was used to reconstruct under-sampled k-space data. The morphometric results of the generalized autocalibrating partially parallel acquisitions-reconstructed data were compared with the results of fully sampled data for three types of subjects: healthy volunteers, mild, and moderate chronic obstructive pulmonary disease patients. RESULTS: Morphometric measurements varied only slightly at mild acceleration factors. The results were largely well preserved compared to fully sampled data for different lung conditions. CONCLUSION: Parallel imaging, given sufficient signal-to-noise ratio, provides a reliable means to accelerate hyperpolarized-gas magnetic resonance imaging with no significant difference in the measurement of lung morphometry from the fully sampled images. GRAPPA is a promising technique to significantly reduce imaging time and/or to improve the spatial coverage for the morphometric measurement with hyperpolarized gases.

Quantification of human lung structure and physiology using hyperpolarized 129Xe.

PURPOSE: To present in vivo, human validation of a previously proposed method to measure key pulmonary parameters related to lung microstructure and physiology. Some parameters, such as blood-air barrier thickness, cannot be measured readily by any other noninvasive modality. METHODS: Healthy volunteers (n = 12) were studied in 1.5T and 3T whole body human scanners using hyperpolarized xenon. Xenon uptake by lung parenchyma and blood was measured using a chemical shift saturation recovery sequence. Both dissolved-xenon peaks at 197 ppm and 217-218 ppm were fitted against a model of xenon exchange (MOXE) as functions of exchange time. Parameters related to lung function and structure can be obtained by fitting to this model. RESULTS: The following results were obtained from xenon uptake (averaged over all healthy volunteers): surface-area-to-volume ratio = 210 ± 50 cm(-1) ; total septal wall thickness = 9.2 ± 6.5 µm; blood-air barrier thickness = 1.0 ± 0.3 µm; hematocrit = 27 ± 4%; pulmonary capillary blood transit time = 1.3 ± 0.3 s, in good agreement with literature values from invasive experiments. More detailed fitting results are listed in the text. CONCLUSION: The initial in vivo human results demonstrate that our proposed methods can be used to noninvasively determine lung physiology by simultaneous quantification of a few important pulmonary parameters. This method is highly promising to become a versatile screening method for lung diseases.

Penehyclidine hydrochloride inhibits the release of high-mobility group box 1 in lipopolysaccharide-activated RAW264.7 cells and cecal ligation and puncture-induced septic mice.

BACKGROUND: High-mobility group box 1 (HMGB1) is a critical mediator in the pathogenesis of many inflammatory diseases. Penehyclidine hydrochloride (PHC) has been proven to reduce sepsis-related mortality and sepsis-induced pathological complications. These effects are because of the reduced expression and release of many inflammatory mediators, although it is not clear whether PHC affects the expression and release of HMGB1. In this study, we explored the effect of PHC on the release of HMGB1 in lipopolysaccharide (LPS)-activated RAW264.7 cells and cecal ligation and puncture (CLP)-induced septic mice. MATERIALS AND METHODS: RAW264.7 cells were incubated with LPS in the presence or absence of various concentrations of PHC. The expression levels of HMGB1 in the culture supernatant were detected by enzyme-linked immunosorbent assay and real-time polymerase chain reaction. Western blotting was used to observe changes in the translocation of HMGB1 from the nucleus to the cytoplasm, and the nuclear factor (NF)-κB activity in the nuclear extract was detected by the NF-κB p50/p65 Transcription Factor Assay Kit. In addition, 48 CLP-induced septic BALB/c were treated with different concentrations of PHC 1 h before performing the CLP, and the level of serum HMGB1 and the functional parameters of multiple organs were determined using several detection kits. RESULTS: We found that PHC inhibited the release of HMGB1 in LPS-activated RAW264.7 cells and CLP-induced septic mice. PHC inhibited the translocation of HMGB1 from the nucleus to the cytoplasm and also suppressed the expression of HMGB1 messenger RNA. Furthermore, PHC inhibited the translocation of NF-κB from the cytoplasm to the nucleus in LPS-activated RAW264.7 cells in a dose-dependent manner. Compared with the CLP alone group, the levels of alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, and creatine kinase were significantly decreased in mice treated with 0.45 mg/kg of PHC (P < 0.01). CONCLUSIONS: Our study demonstrates that PHC inhibits the translocation of HMGB1 from the nucleus to the cytoplasm and the expression of HMGB1 messenger RNA in a dose-dependent manner. The mechanism responsible for these effects involves the NF-κB signaling pathway. Moreover, PHC can significantly protect important organs, such as the liver, kidney, and heart in mice with sepsis.

Ga-doped TiZnO transparent conductive oxide used as an alternative anode in blue, green, and red phosphorescent OLEDs.

X-ray diffraction was used to study the optoelectronic characteristics of Ga-doped TiZnO (GTZO) thin film and revealed increased crystallinity with annealing temperatures ranging from as-grown to 450 °C. The low thin film resistivity of 6.1 × 10(-4) Ω cm and the average high optical transmittance of 93% in the wavelength range between 350 and 800 nm make GTZO an alternative candidate for application in organic light-emitting diodes (OLEDs). Both GTZO and indium-tin-oxide (ITO) anodes are employed for the successful fabrication of blue, green, and red phosphorescent OLEDs. The similar device electrical characteristics observed could be interpreted as evidence of the effectiveness of doping Ga in TiZnO. The simplified tri-layer blue, green, and red phosphorescent OLEDs demonstrated high performance with respective maximum efficiencies of 19.0%, 14.5%, and 9.1%, representing an improvement over ITO-based OLEDs. Furthermore, the OLEDs with the GTZO anode exhibited superior performance at higher current densities, demonstrating high potential for OLED display and lighting applications.

Spatial and temporal variations of cortical growth during gyrogenesis in the developing ferret brain.

Spatial and temporal variations in cortical growth were studied in the neonatal ferret to illuminate the mechanisms of folding of the cerebral cortex. Cortical surface representations were created from magnetic resonance images acquired between postnatal day 4 and 35. Global measures of shape (e.g., surface area, normalized curvature, and sulcal depth) were calculated. In 2 ferrets, relative cortical growth was calculated between surfaces created from in vivo images acquired at P14, P21, and P28. The isocortical surface area transitions from a slower (12.7 mm(2)/day per hemisphere) to a higher rate of growth (36.7 mm(2)/day per hemisphere) approximately 13 days after birth, which coincides with the time of transition from neuronal proliferation to cellular morphological differentiation. Relative cortical growth increases as a function of relative geodesic distance from the origin of the transverse neurogenetic gradient and is related to the change in fractional diffusion anisotropy over the same time period. The methods presented here can be applied to study cortical growth during development in other animal models or human infants. Our results provide a quantitative spatial and temporal description of folding in cerebral cortex of the developing ferret brain, which will be important to understand the underlying mechanisms that drive folding.

MOXE: a model of gas exchange for hyperpolarized 129Xe magnetic resonance of the lung.

We present a model of gas exchange for hyperpolarized (129)Xe in the lung, which we refer to as the Model of Xenon Exchange. The model consists of two expressions and characterizes uptake of dissolved xenon in the lung at two different resonance frequencies. The two expressions are governed by the following five critical pulmonary parameters that characterize both lung function and structure: the surface-area-to-volume ratio, barrier-to-septum ratio (ratio between air-blood barrier thickness and septal thickness), hematocrit, gas-exchange time constant, and pulmonary capillary transit time. The model is first validated by computer simulation. We show that Model of Xenon Exchange can be used to measure the pulmonary parameters mentioned above under various pathological or physiological conditions and is robust against moderate noise. Model of Xenon Exchange is further used to fit an existing data set of xenon uptake, thereby we demonstrate that the data can be well interpreted with Model of Xenon Exchange and reasonable parameters from the fitting routine. The good results obtained in both simulation and fitting to real data indicate that the model is sensitive to various functional and structural changes of the lung, and that it will allow for screening for a variety of pulmonary diseases by using hyperpolarized (129)Xe of the lung.

Dexmedetomidine inhibits the secretion of high mobility group box 1 from lipopolysaccharide-activated macrophages in vitro.

BACKGROUND: High mobility group box 1 (HMGB1) is a critical proinflammatory factor that is closely related to mortality in sepsis patients. Dexmedetomidine has been proven to reduce the mortality rate from endotoxin shock and attenuate endotoxin-induced acute lung injury. These effects result from reduced secretion of many proinflammatory mediators, although it is not clear whether dexmedetomidine affects the secretion of HMGB1. In this study, we explored the effect of dexmedetomidine on the expression and secretion of HMGB1 from lipopolysaccharide (LPS)-activated macrophages. METHODS: We incubated RAW264.7 cells with LPS in the presence or absence of various concentrations of dexmedetomidine. We used an enzyme-linked immunosorbent assay to detect the secretion levels of HMGB1 in the culture supernatant. We employed real-time polymerase chain reaction to assess the expression of HMGB1 mRNA, and used a nuclear/cytoplasm extraction kit to extract the nuclear and cytoplasmic proteins. We employed Western blotting to observe changes in the translocation of HMGB1 from the nucleus to the cytoplasm. In addition, we used a nuclear factor (NF)-κB p50/p65 transcription factor assay kit to analyze NF-κB activity in the nuclear extract. RESULTS: Dexmedetomidine inhibited the translocation of HMGB1 from the nucleus to the cytoplasm and its extracellular secretion in LPS-activated macrophages while suppressing the expression of HMGB1 mRNA. Dexmedetomidine inhibited the translocation of NF-κB from the cytoplasm to the nucleus in LPS-activated macrophages in a dose-dependent manner. Moreover, these effects were significantly reversed by the α2-adrenergic receptor antagonist yohimbine. CONCLUSIONS: Our study demonstrates that dexmedetomidine inhibits the translocation of HMGB1 from the nucleus to the cytoplasm and the expression of HMGB1 mRNA at clinically relevant dosages. The mechanism responsible for these effects may be through the NF-κB signaling pathway and the α2-adrenergic receptors.

Magnesium deficiency promotes secretion of high-mobility group box 1 protein from lipopolysaccharide-activated macrophages in vitro.

BACKGROUND: High-mobility group box 1 (HMGB1) is a critical mediator of sepsis that is closely related to sepsis lethality. Magnesium deficiency predisposes to worse outcomes from endotoxin challenge by promoting the production of cytokines. However, whether magnesium deficiency affects the expression and release of HMGB1 is not currently known. In the present study, we explored the effect of magnesium deficiency on the expression and secretion of HMGB1 in lipopolysaccharide (LPS)-activated RAW264.7 macrophages. METHODS: RAW264.7 cells were incubated with LPS in normal magnesium (1 mmol/L magnesium sulfate) or low magnesium (0.1 mmol/L magnesium sulfate) in Roswell Park Memorial Institute 1640 medium. An enzyme-linked immunosorbent assay was used to detect HMGB1 levels in the culture supernatant. Real-time polymerase chain reaction was used to assess the HMGB1 mRNA levels. A nuclear/cytoplasm extraction kit was used to extract the nuclear and cytoplasmic proteins. Western blotting was used to observe the changes in translocation of HMGB1 from the nucleus to the cytoplasm. A nuclear factor κ-light chain enhancer of activated B cells (NF-κB) p50/p65 transcription factor assay kit was used to analyze the NF-κB activity in nuclear extracts. RESULTS: Magnesium deficiency promoted translocation of HMGB1 from the nucleus to the cytoplasm and its extracellular secretion in LPS-activated macrophages, while enhancing the expression of HMGB1 mRNA. Furthermore, magnesium deficiency promoted the translocation of NF-κB from the cytoplasm to the nucleus in LPS-activated macrophages. CONCLUSIONS: Magnesium deficiency promotes the translocation of HMGB1 from the nucleus to the cytoplasm and the expression of HMGB1 mRNA. Magnesium deficiency also activates the NF-κB signaling pathway.

Pathogenesis of Comorbid ADHD and Chinese Developmental Dyslexia: Evidence From Eye-Movement Tracking and Rapid Automatized Naming.

BACKGROUND: ADHD and Chinese developmental dyslexia (DD) have a very high comorbidity rate; however, which cognitive deficits characterize the comorbidity and when they occur during cognitive processing are still under debate. METHODS: Rapid automatic naming (RAN) tasks with eye-movement tracking were conducted with 75 children who were typically developing, had comorbid ADHD and DD, had only ADHD, and had only DD. RESULTS: The clinical groups had longer first fixation durations than the control for RAN digits. Temporal eye-movement measures, such as gaze duration and total reading time, were found to vary between the comorbidity and ADHD groups. Spatial eye-movement measures, such as regression probability and incoming saccade amplitude, differed between the comorbidity and DD groups. CONCLUSIONS: These results indicate that investigation with eye-movement measures combined with RAN tasks can strengthen the understanding of the pathogenesis of comorbid ADHD and DD.