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.

Glutamine induces heat-shock protein-70 and glutathione expression and attenuates ischemic damage in rat islets

BACKGROUND

The transplantation of isolated islets is believed to be an attractive approach for cure of diabetes mellitus. Heat-shock protein (HSP70), which plays a vital role in cellular protection, has been detected in various tissues subjected to stress. Glutamine (GLN) is an important cellular fuel and an essential precursor for the antioxidant glutathione (GSH). It is believed to enhance cellular survival against a variety of stressful stimuli through HSP70. Thus, we performed this study to examine the hypothesis that preoperative GLN administration induces HSP70 and GSH expression before islet transplantation attenuating ischemic damage to rat islets.

METHODS

Adult male Sprague-Dawley (SD) rats were randomly divided into two groups according to the administration of GLN after islet isolation. Group A served as the controls, receiving no GLN. Group B islet cells were cultured with L-GLN (10 mmol/L) supplementation for 24 hours. The GSH levels were measured in islet cells. Both HSP70 and proteins related to apoptosis were analyzed in islet cells by Western blots. Isolated rat islets were cultured with interleukin (IL)-1beta. Nitrite production was measured using the Griess reagent.

RESULTS

The GSH levels were significantly elevated in the glutamine-treated group. HSP70 expression in islets treated with GLN was markedly stronger compared with the control group. The basal Bcl-2 expression was markedly increased by GLN treatment. The GLN-treated group showed attenuated IL-1beta-induced injury in association with NO production.

CONCLUSION

These results suggested that preoperative GLN administration induced HSP70 and GSH expressions before islet transplantation, thus attenuating IL-1beta-induced injury in association with NO production and apoptosis, which might be potential tool to mitigate the ischemic damage to islet cells and the early inflammation at the site of implantation through a self-protective mechanism.

Improved islet yields after purification following the novel endogenous trypsin inhibitor and histidine-tryptophan-ketoglutarate treatment in pigs

BACKGROUND

Adult porcine islet xenotransplantation into humans is greatly diminished by the difficulty to isolate islets because of their fragility. The goal of this study was to improve the efficacy of islet yields using endogenous trypsin inhibitor and histidine-tryptophan-ketoglutarate (HTK) perfusate.

METHOD

We compared two porcine islet isolation protocols: Eurocollins solution for in situ pancreas perfusion without use of an endogenous trypsin inhibitor versus HTK solution including endogenous trypsin inhibitor for pancreas perfusion.

RESULTS

Endogenous trypsin inhibitor and HTK strategies significantly improved total islet yield, recovery, and islet index after purification (P < .05), whereas unpurified islet yield did not increase. An average of 228,000 +/- 95,000 islet equivalents (IEQ) (n = 20) purified islets were obtained in the first group compared with 115,000 +/- 56,000 IEQ (n = 18) in the second group. The average islet index was significantly increased in the first group compared with the second group before and after purification: before: 0.28 versus 0.49 versus after: 0.25 versus 0.4 (P < .05). At this time, islet purity, viability, and stimulation index did not show a significant difference between groups.

CONCLUSION

Our study showed that endogenous trypsin inhibitor and HTK strategies significantly improved purified islet isolation efficacy because of reduction of islet fragility.

Experimental microencapsulation of porcine and rat pancreatic islet cells with air-driven droplet generator and alginate

Transplantation of microencapsulated islets is proposed as an ideal therapy for the treatment of type 1 diabetes mellitus without immunosuppression. This strategy is based on the principle that foreign cells are protected from the host immune system by an artificial membrane. The aim of this study was to establish an ideal condition of microencapsulation using an air-driven droplet generator and alginate in vitro. The optimal conditions for islet encapsulation were an alginate inflow rate of 10 mL/h, CO2 flow rate of 2.0 L/min in a concentration of 2% alginate. For 2.5% alginate, the alginate inflow rate of 20 mL/h, CO2 flow rate 3.0 L/min was ideal; alginate inflow rate of 40 mL/h, CO2 flow rate of 4.0 L/min showed good microcapsules at 3% alginate. Viability of encapsulated islets was greater than 90%. In terms of insulin secretion, encapsulated islets secreted insulin in response to glucose in static culture medium. However, there was no normal response to low or high glucose challenge with a stimulation index less than 2.0. Microencapsulation of pig islets was successfully performed with air-driven droplet generator and alginate in vitro. Further studies about biocompatibility and glucose control in vivo may provide a useful tool for treatment of patients with diabetes mellitus.

Calf-contouring surgery of gastrocnemius hypertrophy: selective neurectomy of the sural nerve

Generally, Asians tend to have obese calves that are shorter and thicker than those of Caucasians. The cause of the enlarged calves is either an excess of subcutaneous fat or calf muscular hypertrophy, but some patients have both conditions. These features are accentuated by the contraction of the calf muscles when patients stand in tiptoe position or wear high heels. In the case of calf muscular hypertrophy without excessive subcutaneous fat, manipulation of the calf muscle is an effective method for reducing calf circumference. From January 2005 to December 2006, the authors performed selective sural neurectomy for 20 patients who complained of obese calves. Using a popliteal incision, the sural nerve branches to the medial and/or lateral gastrocnemius muscles were dissected from the posterior tibial nerve. Using a nerve stimulator, the branches with the most contractile portions were resected in 1 cm lengths at the distal ends. One medial branch was resected in 15 patients, and two branches were resected in 5 patients. In the case of a lateral neurectomy, only one branch was resected. Ultrasound-assisted liposuction was combined for five patients who also showed excessive subcutaneous fat. The patients ranged in age from 19 to 29 years (mean, 23 years). The follow-up period varied from 6 to 18 months. The circumferential change was checked 6 months postoperatively 15 cm below the medial condyle and 15 cm above the medial malleolus. These average circumferences were reduced, respectively, from 36.6 and 32.5 cm to 35.5 and 32.2 cm. In gait analysis performed at 6 months postoperatively, the calf muscle power was slightly reduced to 95% of the preoperative state, but still remained above the normal range. Subjectively, no patient complained of muscle weakness or gait disturbance. One patient showed lower leg edema after mountain climbing that subsided after 1 day of rest. The authors believe a selective neurectomy technique can be an effective method for treating obese calves.

Complete oxidation of volatile organic compounds over Ce/Cu/gamma-AL2O3 catalyst

The effect of cerium (Ce) addition into Cu (5, 10 or 15 wt%)/gamma-Al2O3 catalysts on the catalyst properties and catalytic activity was investigated for the complete oxidation of volatile organic compounds (VOCs). X-ray diffraction (XRD), the Brunauer Emmett Teller method (BET), temperature programmed reduction (TPR) by H2, and N2O pulse titration were used to characterize a series of supported copper catalysts modified with cerium. Cerium was observed to be an inhibitor for 5 wt% and promoter for 10 or 15 wt% Cu/gamma-Al2O3 catalyst. The results of TPR, average crystallite size and dispersion indicated that even though Ce loadings on 10 and 15 wt% Cu/gamma-Al2O3 caused a reduction in BET surface area of the catalysts, the loaded amounts of Ce enhanced the catalytic activity through the formation of highly dispersed copper clusters. Kinetic parameters were developed for individual benzene, toluene and o-xylene (BTX) for 5 wt% Ce/10 wt% Cu/gamma-Al2O3 catalyst at temperatures ranging from 210 to 240 degrees C. The Mars and Van Krevelen model was found to be an adequate description of the catalytic oxidation of BTX for this study. The activity sequence with respect to the BTX molecules was found to be benzene > toluene > o-xylene under the surface-reaction-controlled region.

Anti-inflammatory action of alpha-melanocyte stimulating hormone (alpha-MSH) in anti-CD3/CD28-mediated spleen and CD4(+)CD25(-) T cells and a partial participation of IL-10

alpha-Melanocyte stimulating hormone (alpha-MSH) has been shown to inhibit the production and the effects of pro-inflammatory cytokine by inflammatory cells in innate immunity. We have determined whether alpha-MSH inhibits anti-CD3/CD28-mediated spleen cells and CD4(+)CD25(-) T cells proliferation and its mechanism of action. The proliferation of anti-CD3/CD28-mediated spleen cells and CD4(+)CD25(-) T cells markedly were suppressed by 50-100 nM and 5-100 nM alpha-MSH, respectively. alpha-MSH (100 nM) increased the production of the anti-inflammatory cytokine IL-10 and decreased the production of the pro-inflammatory cytokine IL-2 and IFN-gamma from CD4(+)CD25(-) T cells. Moreover, anti-IL-10 blocking Ab decreased the inhibitory effects of anti-CD3/CD28-mediated spleen cells and CD4(+)CD25(-) T cells proliferation by alpha-MSH, indicating a partial participation of IL-10 in its mechanism of inhibitory action. These results suggest that alpha-MSH may be useful for treatment of autoimmune diseases and transplantation involving innate and adaptive immunity.

The prognostic factors of pancreatic cancer can be different according to clinical stages

BACKGROUND/AIMS

The prognosis of patients with pancreatic cancer remains very poor. Although many studies have evaluated the prognostic factors of pancreatic cancer, their results are inconclusive because of different inclusion criteria, tumor stages, and treatment modalities. This large scale retrospective analysis was performed to assess whether active treatment of pancreatic cancer, even in its advanced stage, could improve patients' survival. In addition, we sought to identify factors associated with favorable prognosis of pancreatic cancer.

METHODS

Between 1994 and 2004, a total of 971 patients with pancreatic cancer were treated at Asan Medical Center. The patients were classified into three groups according to clinical stages: resectable (RE, n=226), locally advanced (LA, n=409), and far advanced (FA, n=336). Treatment response and prognostic factors for survival were analyzed in each group.

RESULTS

Compared to supportive care, active treatment significantly increased the median survival time in all groups (RE: 18.0 vs. 9.0 months; LA: 10.0 vs. 7.0 months; FA: 5.0 vs. 3.0 months). Multivariate analysis showed that prognostic factors for survival differed according to clinical stages. In the RE group, unfavorable prognostic factors were high CA 19-9, poor histologic differentiation, large tumor size, and regional lymph node involvement. In the FA group, however, poor outcomes were associated with old age, poor performance status, and hypoalbuminemia.

CONCLUSIONS

More active treatment of pancreatic cancer, even in advanced stage, can make a significant difference in terms of patient's survival. The prognosis of resectable pancreatic cancer is dependent on tumor-related factors, while the prognosis of patients with far advanced pancreatic cancer is dependent on patient-related factors.

[Surgical management of pancreatic cancer]

Pancreatic cancer is a major problematic concern among all forms of gastrointestinal malignancies because of its poor prognosis. Although significant progress has been made in the surgical treatment in terms of increased resection rate and decreased treatment-related morbidity and mortality, the true survival rate still remains below 5% today. Surgical options for pancreatic cancer are based on the its unique anatomy and physiology, catastrophic tumor biology, experience of surgeon, and status of patients. Four main options exist for the surgical treatment of pancreatic cancer. These include standard "Whipple" pancreaticoduodenectomy (PD), pylorus preserving PD (PPPD), distal pancreatectomy (left-side pancreatectomy), and total pancreatectomy according to the location of tumor. Portal vein involvement by tumor is regarded as an anatomical extension of disease, and en bloc resection of portal vein with tumor is recommended if technically feasible, which is stated in 2002 AJCC tumor staging for pancreatic cancer. In comparison of the survival rates between standard and extended resection of pancreatic head cancer, no significant survival benefit was demonstrated from the prospective reports. PPPD may be superior to standard PD in respect to nutrition and quality of life without any deleterious effect upon long term survival or tumor recurrence. New surgical treatment modalities including modified extended pancreatectomy, neoadjuvant chemotherapy, and radical antegrade modular distal pancreatectomy have been tried to improve the patients' survival. However, early diagnosis and treatment remain as key factors for the cure of pancreatic cancer irrespective of various surgical trials.

Discordant MRI/FDG-PET imaging for the diagnosis of borderline ovarian tumors

The objective of this study was to assess the role of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) for the characterization of ovarian masses that were diagnosed as ovarian malignancies by magnetic resonance imaging (MRI). We performed a retrospective review of eight patients with pathologically confirmed borderline ovarian tumors (BOT) who underwent MRI and FDG-PET before surgical staging from August 2005 to March 2007. We assessed the PET imaging of the BOT, measured the FDG uptake and quantified the findings as a standardized uptake value (SUV). The FDG-PET scans, of all eight patients, showed uptake of FDG with a mean SUV of less than 2.0 in the solid portion of the masses evaluated. We conclude that the MRI-PET differences may help differentiate borderline from malignant ovarian tumors.

Optimizing nitrogen utilization in growing steers fed forage diets supplemented with dried citrus pulp

Our objectives were to compare the effects of sources of supplemental N on ruminal fermentation of dried citrus pulp (DCP) and performance of growing steers fed DCP and bahiagrass (Paspalum notatum) hay. In Exp. 1, fermentation of DCP alone was compared with that of isonitrogenous mixtures of DCP and solvent soybean meal (SBM), expeller soybean meal (SoyPLUS; SP), or urea (UR). Ground (1 mm) substrates were incubated in buffered rumen fluid for 24 h, and IVDMD and fermentation gas production kinetics and products were measured. Nitrogen supplementation increased (P < 0.10) ruminally fermentable fractions, IVDMD, pH, and concentrations of NH3 and total VFA, but reduced the rate of gas production (P < 0.10) and the lag phase (P < 0.01). Supplementation with UR vs. the soy-based supplements increased ruminally fermentable fractions (P < 0.05) and concentrations of total VFA (P < 0.10) and NH3 (P < 0.01), but these measures were similar (P > 0.10) between SBM and SP. In Exp. 2, 4 steers (254 kg) were fed bahiagrass hay plus DCP, or hay plus DCP supplemented with CP predominantly from UR, SBM, or SP in a 4 x 4 Latin square design, with four 21-d periods, each with 7 d for DMI and fecal output measurement. Nitrogen-supplemented diets were formulated to be isonitrogenous (11.9% CP), and all diets were formulated to be isocaloric (66% TDN). Intake and digestibility of DM, N, and ADF were improved (P < 0.05) by N supplementation. Compared with UR, the soy-based supplements led to greater (P < 0.05) DM and N intakes and apparent N and ADF digestibilities. Plasma glucose and urea concentrations increased (P < 0.10) with N supplementation and were greater (P < 0.01) for the soy-based supplements than for UR. Intake, digestibility, and plasma metabolite concentrations were similar (P > 0.1) for SBM and SP. In Exp. 3, 24 steers (261 kg) were individually fed bahiagrass hay plus DCP (control), or hay plus DCP supplemented with CP predominantly from UR or SBM. Over 56 d, DMI and ADG were greatest (P < 0.05) in steers fed SBM. Nitrogen supplementation increased (P < 0.05) DMI, ADG, and G:F. However, SBM supplementation produced greater (P < 0.05) DMI and ADG and similar (P > 0.05) G:F compared with UR supplementation. We conclude that supplemental N is important to optimize ruminal function and performance of growing steers fed forage diets supplemented with DCP. Diets with supplemental N mainly from SBM improved diet digestibility and animal performance beyond that achieved by UR.