A prospective longitudinal study evaluating the usefulness of a T-cell-based assay for latent tuberculosis infection in kidney transplant recipients

We evaluated whether ELISPOT assay can predict tuberculosis (TB) development in kidney-transplantation (KT) recipients with a negative tuberculin skin test (TST). All adult patients admitted to a KT institute between June 2008 and December 2009 were enrolled; TB development after KT was observed between June 2008 and December 2010. Isoniazid (INH) was given to those patients with positive TST or clinical risk factors for latent TB infection (LTBI). ELISPOT assay was performed on all patients, and TB development after KT was observed by a researcher blinded to the results of ELISPOT. A total of 312 KT recipients including 242 (78%) living-donor KT were enrolled. Of the 312 patients, 40 (13%) had positive TST or clinical risk factors for LTBI and received INH; none developed TB after KT. Of the remaining 272 patients, 4 (6%) of 71 with positive ELISPOT assay developed TB after KT, whereas none of the 201 patients with negative (n = 171) or indeterminate ELISPOTs (n = 30) developed TB after KT (rate difference between positive and negative/indeterminate ELISPOT, 3.3 per 100 person-years [95% CI 1.4-5.1, p<0.001]). Positive ELISPOT results predict subsequent development of TB in KT recipients in whom LTBI cannot be detected by TST or who lack clinical risk factors for LTBI.

Calpain cleaved-55kDa N-terminal huntingtin delocalizes from neurons to astrocytes after ischemic injury

The huntingtin (htt) mutation causes a polyglutamine expansion in the N-terminal region of protein. Mutant N-htt proteolytic fragments aggregate and cause cell death in Huntington's disease (HD). The normal huntingtin also can be cleaved by calpain and produce N-terminal htt fragments following ischemic injury, but the fate of cleaved fragment in dead neurons in the brain are unclear. To determine the localization of huntingtin following proteolysis, we examined htt expression after transient ischemic injury. Huntingtin immunoreactivity in mixed cultures of neuronal and astrocytes-derived clonal cells showed alteration of immunoreactivity from neurons into astrocytes. In the brain, both focal and global ischemia induced reactive astrocytes that were co-immunoreactive for huntingtin with elevated GFAP expression. The immunoreactive huntingtin was 55kDa calpain-cleaved N-terminal fragment, which appeared initially in the process, and extended into the cytoplasm of astrocytes. The results showed, after ischemic injury, huntingtin accumulated in astrocytes indicating that astrocytes may play a role in uptake of cleaved N-htt fragments.

Vitamin or antioxidant intake (or serum level) and risk of cervical neoplasm: a meta-analysis

BACKGROUND

Case-control studies have reported the preventive effect of vitamin or antioxidant intake on cervical neoplasms such as cervical intraepithelial neoplasia (CIN) and invasive cervical cancer. However, the findings are inconsistent.

OBJECTIVE

To investigate quantitative effects of vitamin or antioxidant intake on cervical neoplasm using meta-analysis.

SEARCH STRATEGY

We searched PubMed, EMBASE and the Cochrane Library in November 2008. All articles searched were independently reviewed and selected by two evaluators according to predetermined selection criteria.

SELECTION CRITERIA

We included case-control studies reporting an association between vitamin or antioxidant intake (or serum level) and cervical neoplasm risk and reporting the adjusted odds ratios (OR) and 95% confidence intervals (CI), whenever possible.

DATA COLLECTION AND ANALYSIS

After retrieval of data from selected articles, we performed a meta-analysis using both fixed-effects and random- effects models.

MAIN RESULTS

Of 274 articles meeting our initial criteria, we included 22 case-control studies involving a total of 10,073 participants. In meta-analyses by type of vitamin or antioxidant, a significant preventive effect on cervical neoplasm was found in intakes of vitamin B12 (OR 0.35, 95% CI 0.19-0.63; n=2), vitamin C (OR 0.67, 95% CI 0.55-0.82; n=8), vitamin E (OR 0.56, 95% CI 0.35-0.88; n=10), and beta-carotene (OR 0.68, 95% CI 0.55-0.84; n=9).

AUTHORS' CONCLUSIONS

The findings of this meta-analysis indicate that overall, there were preventive effects of vitamin or antioxidant intake on cervical neoplasms in case-control studies.

Dirac electrons of a split-gate Hall bar

In this work we study several unusual properties of Klein tunneling through the abrupt and flat barriers of a split-gate Hall bar system of graphene. We show that Klein tunneling of Dirac electrons can be rather strong in such a system, and that a significant electron density can be present under the barrier. It can be shown that the probability wavefunctions for large angular momenta are identical to the probability wavefunctions of the same angular momenta in the absence of the potential barrier, i.e., it is as if the barrier does not exist and the Klein tunneling is complete. This is a unique effect in a magnetic field. We propose that STM measurements may be used to detect the presence of such a density. We have also investigated drift velocity of electrons as the center of probability wavefunction varies from outside to inside of the flat potential barrier, and find a significant deviation from the semiclassical result.

Solid pseudopapillary tumor of the pancreas: can malignancy be predicted?

BACKGROUND

The objective of this study was to examine the clinicopathologic characteristics of solid pseudopapillary tumors (SPTs) of the pancreas, including the risk factors for disease recurrence and their effects on survival.

METHODS

The medical records of 114 patients who underwent surgery for a pathologically confirmed SPT between January 1995 and December 2007 were reviewed retrospectively.

RESULTS

Of the 114 patients, 98 (86.9%) were female, and the median age was 36 years (range, 11-75). All 114 patients underwent curative intent surgery and 13 (11.4%) underwent laparoscopic surgery. Of the 114 patients, 26 (22.8%) had solid pseudopapillary carcinoma (SPC). There were no differences in any clinical factors between the benign SPT and SPC groups; however, the only 4 recurrences identified were in the SPC group. After follow-up ranging from 11 to 177 months, all 114 patients were alive, with only 4 showing evidence of recurrence. Recurrence was observed in young patients with metastasis at first operation, invasion of an adjacent organ, and a large mass (≥13 cm).

CONCLUSION

Adequate operative resection including laparoscopic surgery is the mainstay of treatment for SPT. Although statistically significant risk factors for recurrence cannot be determined, tumor metastasis at the first operation, invasion of adjacent organ, large tumor size, young patient age, tumor rupture, and inadequate resection may increase the risk of recurrence. Our results demonstrate that long-term survival could be achieved by aggressive operative resection and interventional treatment of recurrent disease.

Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection

BACKGROUND

Laparoscopic distal pancreatectomy (LDP) is increasingly performed for lesions of the body and tail of the pancreas. We analyzed the clinical characteristics of the largest series of patients to date who underwent LDP at a single center, as well as their outcomes, to reassess the surgical paradigm for left pancreatic resection.

METHODS

We retrospectively reviewed the records of 359 patients who underwent LDP at Asan Medical Center, Seoul, Korea, for pancreatic neoplasms between March 2005 and December 2010.

RESULTS

Of the 359 patients, 323 (90%) had benign or low-grade malignant neoplasms and 36 (10%) had malignancies. The most common diagnosis was intraductal papillary mucinous neoplasm (IPMN) in 72 patients (21.2%). There were 24 patients (6.7%) with pancreatic ductal adenocarcinoma (PDAC). We found that 178 patients (49.6%) underwent spleen-preserving LDP (SP-LDP): 150 (84.3%) by main splenic vessel preservation, and 28 (15.7%) supported by short gastric and gastroepiploic vessels (Warshaw technique). Postoperative complications occurred in 43 (12%) patients, including 25 (7%) with pancreatic fistula (ISGPF grade B, C), but there was no death. Median operative time was 195 (range, 78-480) min, and median postoperative hospital stay was 8 (range, 4-37) days. The proportion of patients with pancreatic lesions who underwent LDP increased from 8.6% in 2005 to 66.9% in 2010. Kaplan-Meier analysis showed that the 1- and 2-year overall survival rates in the 24 patients with PDAC were 85.2% each.

CONCLUSIONS

LDP is feasible, safe, and effective for the treatment of benign and low-grade malignant lesions of the pancreas. The increased use of LDP for left-sided pancreatic lesions, including malignant lesions, represents a paradigm shift from open distal pancreatectomy.

Optimization of selective emitter fabrication method for solar cells using a laser grooving

In this paper, screen-printing laser grooved buried contact (LGBC) method was applied, which is compatible with the existing screen-printed solar cell equipment and facilities. Experiments were performed in order to optimize short circuit current (I(sc)), open circuit voltage (V(oc)) and fill factor of high efficiency solar cells. To enhance I(sc), V(oc) and efficiency, heavy doping was performed at low sheet resistance in the laser grooved region of the cell. In contrast, light doping was carried out at a high sheet resistance in the non-laser grooved region. To increase fill factor, porous silicon found on the wafer after dipping in an HF solution to remove SiN(x), was cleared. The fabricated screen-printing LGBC solar cell using a 125 mm x 125 mm single crystalline silicon wafer exhibited an efficiency of 17.2%. The results show that screen-printing LGBC method can be applied for high efficiency solar cells.

Effect of applying inoculants with heterolactic or homolactic and heterolactic bacteria on the fermentation and quality of corn silage

This study examined the effect of applying different bacterial inoculants on the fermentation and quality of corn silage. Corn plants were harvested at 35% DM, chopped, and ensiled in 20-L mini silos after application of (1) deionized water (CON) or inoculants containing (2) 1 × 10(5) cfu/g of Pediococcus pentosaceus 12455 and Propionibacteria freudenreichii (B2); (3) 4 × 10(5) cfu/g of Lactobacillus buchneri 40788 (BUC); or (4) 1 × 10(5) cfu/g of Pediococcus pentosaceus 12455 and 4 × 10(5) cfu/g of L. buchneri 40788 (B500). Four replicates of each treatment were weighed into polyethylene bags within 20-L mini silos. Silos were stored for 575 d at ambient temperature (25°C) in a covered barn. After silos were opened, aerobic stability, chemical composition, and yeast and mold counts were determined. The DNA in treated and untreated silages was extracted using lysozyme/sodium dodecyl sulfate lysis and phenol/chloroform and used as a template for a conventional PCR with primers designed on the 16S rRNA gene to detect the presence of L. buchneri in all silage samples. Acetic acid concentration was greater in B2 silages versus others (6.46 vs. 4.23% DM). Silages treated with BUC and B500 had lower pH and propionic acid concentration and greater lactic acid concentration than others. The B500 silage had the greatest lactic:acetic acid ratio (1.54 vs. 0.41), and only treatment with BUC reduced DM losses (5.0 vs. 14.3%). Yeast and mold counts were less than the threshold (10(5)) typically associated with silage spoilage and did not differ among treatments. Consequently, all silages were very stable (>250 h). Aerobic stability was not improved by any inoculant but was lower in B500 silages versus others (276 vs. 386 h). The conventional PCR confirmed the presence of similar populations of L. buchneri in all silages. This may have contributed to the prolonged aerobic stability of all silages.

Degradation of organic dye using zero-valent iron prepared from by-product of pickling line

In this study, zero-valent iron (ZVI) was produced using iron oxide that is a by-product of a pickling line at a steel works. The reaction activity of the produced ZVI was evaluated through a series of decomposition experiments of Orange II aqueous solution. The size of ZVI particles increased with reduction temperature due to coalescence. Correspondingly, the specific surface area of ZVI decreased with increasing reduction temperature. The decomposition efficiency of synthesized ZVI particles was higher at a lower pH. In particular, no significant decomposition reaction was observed at pH of 4 and higher. The rate of the ZVI-assisted decomposition of Orange II was increased by addition of H2O2 at pH of 3, whereas it was reduced by addition of H2O2 at a higher pH of 6. Nevertheless, simultaneous use of ZVI, UV and H2O2 led to a considerable increase in the decomposition rate even at a high pH condition (pH = 6).

Coupling of surface and lowest Landau level states in a rectangular graphene dot

A rectangular graphene dot with two zigzag edges and two armchair edges have electronic states in the presence of a magnetic field that are localized on the zigzag edges with non zero values of the wavefunction inside the dot. We have investigated the dependence of these wavefunctions on the size of the dot, and explain the physical origin of them in terms of surface and the lowest Landau level (LLL) states of infinitely long nanoribbons. We find that the armchair edges play a crucial role by coupling the surface and LLL states.

Adipose tissue derived stem cells for regeneration and differentiation into insulin-producing cells

Stem cells are considered an ideal tool for the supply of insulin-producing cells or repairing damaged pancreatic tissues to treat diabetes mellitus, with the possibility of unlimited sources. This cell population includes embryonic, adult bone marrow, pancreatic stem cells, extra pancreatic (such as hepatic cells) and adipose-derived stem cells. Multipotent adipose tissue-derived stem cells (ADSCs) are abundant in the human body, and thus are an ideal donor source for autologous transplantation to generate insulin-producing cells. Moreover these cells are better sources than bone marrow stem cells (BMSCs) for clinical applications, owing to minimal invasive procedures, high proliferation and multi-differentiation potential. Human adipose tissue-derived stem cells (hADSCs) may thus provide an alternative stem cell source, replacing BM-MSCs or embryonic stem cells (ESCs) for future clinical use in diabetes mellitus treatment.

Electronic properties of a graphene antidot in magnetic fields

We report on several unusual properties of a graphene antidot created by a piecewise constant potential in a magnetic field. We find that the total probability of finding the electron in the barrier can be nearly one while it is almost zero outside the barrier. In addition, for each electron state of a graphene antidot there is a dot state with exactly the same wavefunction but with a different energy. This symmetry is a consequence of Klein tunneling of Dirac electrons. Moreover, in zigzag nanoribbons we find strong coupling between some antidot states and zigzag edge states. Experimental tests of these effects are proposed.

Anti-inflammatory action of Cudrania tricuspidata on spleen cell and T lymphocyte proliferation

This study examined whether an extract of Cudrania tricuspidata shows anti-proliferative effects in anti-CD3/CD28-mediated spleen and CD4+CD25− T cells and decreases the production of the pro-inflammatory cytokines interleukin-2 (IL-2) and interferon-γ (IFN-γ) in anti-CD3/CD28-mediated CD4+CD25− T cells. The proliferation of anti-CD3/CD28-mediated spleen cells and CD4+CD25− T cells was effectively suppressed by C. tricuspidata. This extract, however, did not show cytotoxicity in spleen cells under conditions where the antigen was not stimulated using CCK-8 analysis. C. tricuspidata also decreased the production of the pro-inflammatory cytokines IL-2 and IFN-γ by selective inhibition of this extract on proliferating cells in anti-CD3/CD28-mediated CD4+CD25− T cells. These results suggest that C. tricuspidata may be useful in the treatment of autoimmune diseases and organ transplantation through the inhibitory action of T cells in inflammation.

Anti-inflammatory effects of Artemisia princeps in antigen-stimulated T cells and regulatory T cells

Objectives

The aim was to investigate the anti-inflammatory effects of Artemisia princeps extract on the activity of anti-CD3/CD28-stimulated CD4+CD25- T cells and antigen-expanded regulatory T cells.

Methods

CD4+CD25- T cells were activated with coated anti-CD3 and anti-CD28 and cultured in the presence or absence of various concentrations of A. princeps extract. The cultures were pulsed on Day 6 with [3H]thymidine and, after harvesting the cells, [3H] thymidine incorporation was measured. For analysis of interleukin-2 and interferon-γ secreted from CD4+CD25- T cells, culture supernatants were collected on Days 2 and 6. For the analysis of interleukin-10 secreted from the CD4+CD25- T cells and expanded regulatory T cells, supernatants were collected after 2 and 7 days, respectively. Cytokine levels were determined using an enzyme-linked immunosorbent assay. Potential medicinal components of the A. princeps extract were determined using gas chromatography–mass spectrometry.

Key findings

A. princeps (30 μg/ml) effectively suppressed proliferation of CD4+CD25- T cells that were stimulated with anti-CD3/CD28 without causing cytotoxicity in spleen cells incubated under conditions lacking antigen stimulation. A. princeps inhibited production of the pro-inflammatory cytokines interleukin-2 and interferon-γ in anti-CD3/CD28-stimulated CD4+CD25- T cells. Also, the extract slightly increased production of the anti-inflammatory cytokine interleukin-10 in these cells. In regulatory T cells expanded by anti-CD3/CD28, A. princeps increased production of interleukin-10 and Foxp3.

Conclusions

The results suggest that A. princeps may be useful in the treatment of autoimmune diseases and organ transplantation rejection by inhibiting proliferation of inflammatory T cells, suppressing inflammatory processes in antigen-stimulated CD4+CD25- T cells and increasing activity of expanded regulatory T cells.

A randomised phase II study of modified FOLFIRI.3 vs modified FOLFOX as second-line therapy in patients with gemcitabine-refractory advanced pancreatic cancer

Background:

Only a few clinical trials have been conducted in patients with advanced pancreatic cancer after failure of first-line gemcitabine-based chemotherapy. Therefore, there is no current consensus on the treatment of these patients. We conducted a randomised phase II study of the modified FOLFIRI.3 (mFOLFIRI.3; a regimen combining 5-fluorouracil (5-FU), folinic acid, and irinotecan) and modified FOLFOX (mFOLFOX; a regimen combining folinic acid, 5-FU, and oxaliplatin) regimens as second-line treatments in patients with gemcitabine-refractory pancreatic cancer.

Methods:

The primary end point was the 6-month overall survival rate. The mFOlFIRI.3 regimen consisted of irinotecan (70 mg m⁻²; days 1 and 3), leucovorin (400 mg m⁻²; day 1), and 5-FU (2000 mg m⁻²; days 1 and 2) every 2 weeks. The mFOLFOX regimen was composed of oxaliplatin (85 mg m⁻²; day 1), leucovorin (400 mg m⁻²; day 1), and 5-FU (2000 mg m⁻²; days 1 and 2) every 2 weeks.

Results:

Sixty-one patients were randomised to mFOLFIRI.3 (n=31) or mFOLFOX (n=30) regimen. The six-month survival rates were 27% (95% confidence interval (CI)=13–46%) and 30% (95% CI=15–49%), respectively. The median overall survival periods were 16.6 and 14.9 weeks, respectively. Disease control was achieved in 23% (95% CI=10–42%) and 17% patients (95% CI=6–35%), respectively. The number of patients with at least one grade 3/4 toxicity was identical (11 patients, 38%) in both groups: neutropenia (7 patients under mFOLFIRI.3 regimen vs 6 patients under mFOLFOX regimen), asthaenia (1 vs 4), vomiting (3 in both), diarrhoea (2 vs 0), and mucositis (1 vs 2).

Conclusion:

Both mFOLFIRI.3 and mFOLFOX regimens were tolerated with manageable toxicity, offering modest activities as second-line treatments for patients with advanced pancreatic cancer, previously treated with gemcitabine.

Anti-inflammatory effects of Artemisia princeps in antigen-stimulated T cells and regulatory T cells

OBJECTIVES

The aim was to investigate the anti-inflammatory effects of Artemisia princeps extract on the activity of anti-CD3/CD28-stimulated CD4(+)CD25(-) T cells and antigen-expanded regulatory T cells.

METHODS

CD4(+)CD25(-) T cells were activated with coated anti-CD3 and anti-CD28 and cultured in the presence or absence of various concentrations of A. princeps extract. The cultures were pulsed on Day 6 with [(3)H]thymidine and, after harvesting the cells, [(3)H]thymidine incorporation was measured. For analysis of interleukin-2 and interferon-gamma secreted from CD4(+)CD25(-) T cells, culture supernatants were collected on Days 2 and 6. For the analysis of interleukin-10 secreted from the CD4(+)CD25(-) T cells and expanded regulatory T cells, supernatants were collected after 2 and 7 days, respectively. Cytokine levels were determined using an enzyme-linked immunosorbent assay. Potential medicinal components of the A. princeps extract were determined using gas chromatography-mass spectrometry.

KEY FINDINGS

A. princeps (30 microg/ml) effectively suppressed proliferation of CD4(+)CD25(-) T cells that were stimulated with anti-CD3/CD28 without causing cytotoxicity in spleen cells incubated under conditions lacking antigen stimulation. A. princeps inhibited production of the pro-inflammatory cytokines interleukin-2 and interferon-gamma in anti-CD3/CD28-stimulated CD4(+)CD25(-) T cells. Also, the extract slightly increased production of the anti-inflammatory cytokine interleukin-10 in these cells. In regulatory T cells expanded by anti-CD3/CD28, A. princeps increased production of interleukin-10 and Foxp3.

CONCLUSIONS

The results suggest that A. princeps may be useful in the treatment of autoimmune diseases and organ transplantation rejection by inhibiting proliferation of inflammatory T cells, suppressing inflammatory processes in antigen-stimulated CD4(+)CD25(-) T cells and increasing activity of expanded regulatory T cells.

A multicenter phase II study of belotecan, new camptothecin analogue, in patients with previously untreated extensive stage disease small cell lung cancer

Belotecan (Camtobell, CKD602) is a new camptothecin derivative antitumor agent that belongs to the topoisomerase inhibitors. The aim of this phase II study was to evaluate the efficacy and safety of single agent belotecan in patients with small cell lung cancer (SCLC). Patients with previously untreated extensive stage disease (ED) SCLC were entered into the study. Belotecan was given by daily intravenous infusion at 0.5mg/m(2)/day for 5 consecutive days, every 3 weeks. 62 patients were enrolled in this study. The overall response rate to chemotherapy on an intention-to-treat basis was 53.2%. The median overall survival was 10.4 months, the median time to progression 4.6 months, and the 1-year survival rate 49.9%. The most common toxicity was hematologic. Grade 3/4 neutropenia occurred in 71.0% of patients and grade 3/4 thrombocytopenia 12.9%. Non-hematologic toxicity of grade 3 or 4 was low. The results suggest that belotecan is relatively active and well tolerable as single agent in patients with ED SCLC. Further investigations with platinum or other active agents are needed.

Septated cystic tumors of the pancreas: is it possible to treat them by endoscopic ultrasonography-guided intervention?

OBJECTIVES

Endoscopic ultrasonography (EUS)-guided intervention has recently been tried in the treatment of cystic tumors of the pancreas. Factors that can influence the treatment response include cyst wall thickness and the presence of septation and mural nodules. This study aimed to evaluate the effectiveness of EUS-guided ethanol lavage with paclitaxel injection (EUS-EP) in the treatment of septated cystic tumors of the pancreas.

METHODS

Ten patients with oligolocular septated cystic tumors underwent EUS-EP and the treatment response was analyzed by measuring cyst volume before and more than 6 months after treatment.

RESULTS

The 10 patients comprised 7 women and 3 men, of mean age 38.4 years (range 22-54 years). Median tumor diameter was 29.5 mm (range 20-68 mm), while median tumor volume was 5.07 ml (range 1.51-68.74 ml). Median carcinoembryonic antigen and amylase concentrations in the cyst fluid were 39.2 ng/ml (range 1-8,190 ng/ml) and 115.5 U/L (range 5-75,633 U/L), respectively. Three tumors were diagnosed as mucinous cystic neoplasms, four as serous cystadenomas, and three as indeterminate cysts. Median tumor volume had decreased to 0.54 ml (range 0.00-12.42 ml). Complete resolution was achieved in six patients and partial resolution in two, whereas two patients had persistent cysts. Two patients with persistent cysts underwent surgical resection, and focal remnant neoplastic epithelial lining was observed on the resected specimens.

CONCLUSIONS

EUS-EP resulted in complete resolution in 6 of 10 patients with septated cystic tumors. Careful patient selection and tailored intervention are required to maximize the therapeutic efficacy of this procedure.

Parainfluenza virus 3 pneumonia in a kidney transplant recipient

We report the first case of parainfluenza virus type 3 (PIV3) pneumonia in a kidney transplant recipient. A 39-year-old man developed pneumonia during hospitalization 6 years after kidney transplantation. He became hypoxic and underwent noninvasive ventilation. PIV3 was detected in the bronchoalveolar lavage fluid. He was treated successfully with aerosolized ribavirin and intravenous immunoglobulin. Although he recovered from pneumonia, his graft function deteriorated and he had to restart peritoneal dialysis.

Effect of applying molasses or inoculants containing homofermentative or heterofermentative bacteria at two rates on the fermentation and aerobic stability of corn silage

This study determined how the fermentation and aerobic stability of corn silage are affected by treatment with molasses or 2 dual-purpose inoculants applied at or above the recommended rate. Corn forage (DeKalb 69-70) was harvested at 39% dry matter (DM) and ensiled after treatment with no additives (control, CON), molasses (MOL), Buchneri 500 inoculant, or Pioneer 11C33 inoculant. Molasses was applied at 3% of forage DM. Buchneri 500 was applied at the recommended rate of 8 mg/kg fresh forage to supply 1 x 10(5) cfu/g of Pediococcus pentosaceus 12455 and 4 x 10(5) cfu/g of Lactobacillus buchneri 40788 (BB) or at twice the recommended rate (DBB). Pioneer 11C33 inoculant was applied at the recommended rate of 1.1 mg/kg fresh forage to supply 1 x 10(5) cfu/g of a mixture of Lactobacillus plantarum, L. buchneri, and Enteroccocus faecium (PN) or at twice the recommended rate (DPN). Each treatment was applied in quadruplicate and the treated forages were ensiled within 20-L mini silos for 135 d at 18 to 35 degrees C. Molasses-treated silages had greater ash and starch concentrations than CON silages and greater lactate and ethanol concentrations than other silages. Like CON silages, MOL silages had high yeast counts (>10(5) cfu/g); consequently, they deteriorated within 30 h as shown by temperature increase. Inoculant-treated silages had lower lactate to acetate ratios than CON or MOL silages largely because they had greater acetate concentrations. Consequently, all inoculant-treated silages had fewer yeasts (<10(5) cfu/g) and were more stable (>30 h) than CON and MOL silages. When applied at recommended rates, PN and BB had similar effects on silage chemical composition, fermentation, fungal counts, and aerobic stability, except for a lower lactate concentration in PN silages. Concentrations of VFA, and NH(3)-N, pH, and extent of aerobic stability were similar for PN, DPN, BB, and DBB silages. However, lactate concentration was greater in DPN than in PN. In conclusion, MOL application increased ethanol and lactate concentration and did not improve aerobic stability. Both dual-purpose inoculants made the fermentation more heterolactic and thereby improved the aerobic stability of corn silage. Doubling the rate of application of either inoculant did not further improve fermentation or aerobic stability.

[Clinical characteristics and malignant predictive factors of pancreatic neuroendocrine tumors]

BACKGROUND/AIMS

Neuroendocrine tumors (NET) of the pancreas are rare. Its prognosis is better than pancreas adenocarcinoma due to the slow growth, however, malignant NET of the pancreas are observed. The purposes of this study were to evaluate the clinical characteristics and to find the predictive factors of NET which are associated with malignancy and survival.

METHODS

We retrospectively evaluated the clinical outcomes of 122 patients with NET of the pancreas who were pathologically diagnosed at Asan Medical Center between 1990 and 2006.

RESULTS

Mean age of the patients was 48.9+/-14.0 years and there was no gender predilection. The major clinical manifestations were abdominal pain (44.0%) in non-functional tumor, neuroglycopenic symptoms (100%) in insulinoma and diarrhea (60%) in gastrinoma. Tumor size ranged from 4 to 140 mm (average 29.8+/-23.22). Ninety cases (73.8%) were classified as benign tumors and 32 cases (26.2%) as malignant. In multivariate analysis of clinical characteristics, large sized tumor (>20 mm, p=0.001) was confirmed as sole independent factor to predict malignant NET. Surgical resection was performed in 114 patients. All patients with benign NET are still alive without recurrence. Six out of 32 patients with malignant NET died at an average 40.3 months after diagnosis. The factors indicating favorable outcome were small size of tumors (p=0.046), resection of primary tumor (p=0.000), absence of lymph node invasion (p=0.0116) and distant metastasis (p=0.0005).

CONCLUSIONS

Large NET of the pancreas, regardless of their functioning status, were more likely to be associated with malignancy and predictor of worse survival.