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The etiology of achalasia remains largely unknown. Considerable evidence reveals that the lower esophageal sphincter dysfunction is due to the lack of inhibitory neurotransmitter, secondary to esophageal neuronal inflammation or loss. Recent studies suggest hydrogen sulfide may act as an inhibitory transmitter in gastrointestinal tract, but study about hydrogen sulfide in human esophagus still lack. The aim of the study was to investigate if hydrogen sulfide synthesis enzymes could be detected in human esophagus and if the synthesis of the endogenous hydrogen sulfide could be affected in achalasia patients. Tissue samples in cardia, lower esophageal sphincter, 2 cm and 4 cm above lower esophageal sphincter were obtained from achalasia patients undergoing peroral endoscopic myotomy. Control tissues in lower esophageal sphincter were obtained from esophageal carcinoma patients. Expression of cystathionine-β-synthase and cystathionine-γ-lyase in lower esophageal sphincter of achalasia patients and control were detected by immunohistochemical staining. In addition, expression of cystathionine-β-synthase and cystathionine-γ-lyase were compared among different parts of esophagus in achalasia patients. Compared with control, the expression of cystathionine-β-synthase and cystathionine-γ-lyase in lower esophageal sphincter of achalasia patients was significantly reduced (χ2 = 11.429, P = 0.010). The expression of cystathionine-β-synthase and cystathionine-γ-lyase were lower in lower esophageal sphincter than that in 2 cm and 4 cm above lower esophageal sphincter, respectively (all P < 0.05). In conclusion, the expression of hydrogen sulfide synthesis enzymes, cystathionine-β-synthase and cystathionine-γ-lyase, can be detected in human esophagus and is reduced in patients with achalasia, which implicates the involvement of the two hydrogen sulfide synthesis enzymes in the pathophysiology of achalasia. [ABSTRACT FROM AUTHOR]

Moyamoya disease (MMD) is a progressive occlusive disease of the distal internal carotid artery that is primarily treated by superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Despite its effectiveness, several postoperative complications have been reported with STA-MCA bypass. Cerebral hyperperfusion syndrome (CHS) after STA-MCA has attracted considerable attention as a hemodynamics-related complication because more cases of CHS after STA-MCA bypass are reported in MMD than in non-MMD patients. The mechanisms underlying CHS after revascularization in MMD patients are poorly understood. This report presents a comprehensive review of the literature on CHS after revascularization in MMD patients, focusing on the pathogenesis, clinical features, imaging techniques, treatment, and prognosis of CHS. Impaired cerebrovascular autoregulation has been implicated in the pathogenesis of CHS, which is characterized by unilateral headache, face and eye pain, seizures, and focal neurological deficits secondary to cerebral edema, and intracranial hemorrhage. Imaging techniques, such as single photon emission computed tomography (SPECT), 3-T magnetic resonance imaging/angiography, and selective arterial spin-labeling magnetic resonance imaging, are valuable for identifying patients at risk for CHS. Treatment strategies include strict blood pressure control, intracranial hemorrhage prevention, and free oxygen radical scavenger administration. Most patients can achieve a satisfying prognosis after effective treatment. [ABSTRACT FROM AUTHOR]

Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder characterized by ineffective hematopoiesis and leukemia progression. Racial differences may exist on clinical pictures and the molecular events leading to MDS, which are heterogeneous. To better define the clinical and cytogenetic features in Chinese patients, a retrospective multicentric study was performed in 508 MDS cases. Compared with Western countries, Chinese patients showed younger age (median: 49 vs 65-73 years), lower percentages of RARS (2.8 vs 6.6-15.3%), and CMML (5.2 vs 11.7-30.6%). Cytogenetically, among 367 cases with evaluable data, abnormal karyotypes were found in 136 cases, including 56 numerical and 80 structural changes. Incidences of single chromosome 5 and 7 abnormalities were lower than those in Western countries (2.2 vs 17.8-42.5%). However, complex cytogenetic aberrations and chromosome translocations were frequently observed and related to poor prognosis. Both multiple chromosome deletions and translocations were detected in advanced subtypes (RAEB and RAEB-T). Analysis of 200 cases revealed a higher incidence of hepatitis-B-virus infection than that in non-MDS population (21.00 vs 9.75%). This study further confirmed: (1) different genetic/environmental backgrounds between Asian and Western MDS populations; (2) a strong predictive value of cytogenetic abnormalities on disease outcome and involvement of genomic instability in leukemia clone development.Leukemia (2005) 19, 767-775. doi:10.1038/sj.leu.2403688 Published online 10 March 2005 [ABSTRACT FROM AUTHOR]

Aims To investigate the risk prediction and the risk stratification performances of the Chronic Kidney Disease Epidemiology Collaboration ( CKD- EPI) equation and the Modification of Diet in Renal Disease ( MDRD) equation for estimated glomerular filtration rate ( eGFRCKD- EPI vs. eGFRMDRD) on heart failure in patients with Type 2 diabetes. Methods The study cohort included 12 258 White and 16 886 African American low-income patients with Type 2 diabetes who were 30-90 years old at baseline. Heart failure risk according to different eGFRCKD- EPI and eGFRMDRD categories was prospectively assessed. Results During a mean follow-up of 6.5 years, 5043 incident heart failure cases were identified. Multivariable-adjusted hazard ratios ( HRs) of heart failure associated with the eGFRCKD- EPI categories [≥ 90 (reference group), 75-89, 60-74, 30-59 and < 30 ml/min/1.73 m2] were 1.00, 1.11, 1.31, 1.75 and 2.93 ( Ptrend < 0.001) for African American patients, and 1.00, 1.11, 1.08, 1.59 and 2.92 ( Ptrend < 0.001) for White patients, respectively. The model with eGFRCKD- EPI and the other risk factors had significantly higher Harrell's C than the model with eGFRMDRD and other risk factors. Patients reclassified downward from eGFRMDRD 60-74 to eGFRCKD- EPI 30-59 and from eGFRMDRD 30-59 to eGFRCKD- EPI < 30 ml/min/1.73 m2 showed higher heart failure risk than those who were not reclassified. Conclusions Impaired kidney function (i.e. GFR < 60 ml/min/1.73 m2), and even mildly decreased GFR (60-74 ml/min/1.73 m2) estimated by both equations is associated with an increased risk of heart failure. Compared with GFR estimated using the MDRD equation, GFR estimated using the CKD- EPI equation added more predictive power to the model with the other risk factors. Also, eGFRCKD- EPI provided more accurate heart failure risk stratification than eGFRMDRD . [ABSTRACT FROM AUTHOR]

Aim To investigate the race-specific trend in attainment of the American Diabetes Association cardiovascular risk factor control goals (HbA1c <53 mmol/mol (7.0%), blood pressure <130/80 mmHg and LDL cholesterol <2.6mmol/l) by patients with Type 2 diabetes. Methods The study sample included 14 946 African-American and 12 758 white patients who were newly diagnosed with Type 2 diabetes between 2001 and 2009 in the Louisiana State University Hospital system. The race-specific percentages of patients' attainment of American Diabetes Association goals were calculated using the baseline and follow-up measurements of HbA1c, blood pressure, and LDL cholesterol levels. Logistic regression was used to test the difference between African-American and white patients. Results The percentage of patients who met all three American Diabetes Association goals increased from 8.2% in 2001 to 10.2% in 2009 (increased by 24.4%) in this cohort. Compared with African-American patients, white patients had better attainment of the following American Diabetes Association goals: HbA1c (61.4 vs. 55.1%), blood pressure (25.8 vs. 20.4%), LDL cholesterol (40.1 vs. 37.7%) and all three goals (7.3 vs. 5.1%). African-American and white patients generally had a better cardiovascular disease risk factor profile during follow-up when we assessed attainment of the American Diabetes Association goals by means of HbA1c, blood pressure and LDL cholesterol. Conclusions During 2001-2009, the present low-income cohort of people with Type 2 diabetes generally experienced improved control of cardiovascular disease risk factors. White patients had better attainment of the American Diabetes Association cardiovascular risk factor control goals than their African-American counterparts. [ABSTRACT FROM AUTHOR]

Brain metastasis (BM) is a major cause of mortality in small-cell lung cancer (SCLC) patients; however, the molecular pathway of SCLC BM remains largely unknown because of a lack of investigation. Here we screen the levels of some candidate-soluble factors in the serum of SCLC patients and find that SCLC patients with high levels of placental growth factor (PLGF) are prone to BM. Using in vitro blood-brain barrier model, we show that PLGF derived from SCLC cells triggers vascular endothelial growth factor receptor-1-Rho-extracellular regulated protein kinase 1/2 signaling axis activation, results in disassembly of tight junction in brain endothelial cells and promotes SCLC cell transendothelial migration. Furthermore, the downregulation of PLGF suppresses SCLC cell metastasis to the brain in an experimental BM model. These data suggest that PLGF is a potential signature of SCLC BM and a prospective therapeutic target for SCLC BM. [ABSTRACT FROM AUTHOR]