Minimally invasive transanal surgery for localized rectal carcinoid tumors

Local excision is often fully justified for rectal carcinoid tumors. However insufficient surgical field and difficult access to proximal tumors have been drawbacks in performing pre-existing local excision procedures. A novel local excisional technique called minimally invasive transanal surgery (MITAS) has been experimented for local removal of carcinoid tumors in the rectum. A specially designed anal retractor connected to the Octopus retractor holder was used and an ENDO-stapler allowed the simultaneous excision and anastomosis to be performed. Eight patients with carcinoid tumors in the rectum (4 tumors in the upper rectum) underwent MITAS. Median distance from anal verge to proximal tumor was 6.5 cm (range, 5-12 cm). The median diameter of the tumor was 9 mm. Median operative time was 18.5 minutes and blood loss was minimal. No analgesics were needed postoperatively, and there was no morbidity or mortality. Full-thickness excision of the rectum was accomplished and the tumors confined in the submucosa were demonstrated histologically to be with free surgical margins. No recurrences have been observed with a median follow-up period of 39 months. The technique facilitates total excisional biopsy for rectal carcinoid tumors and reduces operative time, blood loss and complications.

Plasma equilibrium and confinement in a tokamak with nearly zero central current density in JT-60U

A high confinement equilibrium with nearly zero toroidal current in the central region (a "current hole") has been observed for the first time to persist stably for several seconds in the JT-60U tokamak. This observation indicates the possibility of stable tokamak operation without central toroidal current; the central current has previously been believed to be necessary in tokamaks. The radius of the current hole extended up to 40% of the plasma minor radius. It was observed that the current hole was formed by the increase of the off-axis noninductive current.

Immunization with plasmid DNA encoding MHC class II binding peptide/CLIP-replaced invariant chain (Ii) induces specific helper T cells in vivo: the assessment of Ii p31 and p41 isoforms as vehicles for immunization

A single helper T cell (Th) epitope-specific T cell subset was successfully induced in vivo by immunization with plasmid DNA encoding MHC class II binding peptide/class II-associated invariant chain peptide (CLIP)-replaced murine Ii molecules. Spleen cells from mice immunized by gene gun bombardment with plasmid DNA for Ii p31 and p41 molecules, whose CLIP regions were replaced with an I-A(d)-restricted Th epitope, ovalbumin (OVA) 323-336, showed the specific proliferation and interferon-gamma (IFN-gamma) production. A20-2J B cell lines having these plasmids were capable of stimulating spleen cells from the immunized mice and naïve DO10-transgenic mice bearing the epitope-specific T cell receptor (TCR) transgenes by examining the specific proliferative response and IFN-gamma production. Some mice immunized with the Ii p41-OVA323, but not with the Ii p31-OVA323 plasmid, produced the peptide-specific antibodies, suggesting the functional difference between Ii isoforms.

Structural requirements of sphingosine molecules for inhibition of DNA primase: biochemical and computational analyses

Using 28 chemically well-defined compounds containing D-erythro-sphingosine and its analogues, we analyzed structure-activity relationships for DNA primase inhibition. Biochemical studies demonstrated a positively charged amino group at C2 and a long aliphatic chain to be absolutely required for inhibition. Whereas C2-amino group is intact, sphingosine 1-phosphate was totally inactive. This result could be due to cancellation of positive charge of the amino group by the interaction with negatively charged C1-phosphate, since simulations with the software INSIGHT II showed these two groups to be close enough to interact. The hydroxyl group at C3 and trans-double bond at C4-C5 were also found to be important for the inhibition. Dehydroxylation of C3, as well as saturation or cis-conversion of the trans-double bond led to decrease of inhibitory activity. Despite saturation of the double bond, introduction of a hydroxyl group into C4 of dihydrosphingosine resulted in restoration of inhibition. Conversion of the double bond into a triple bond did not abolish but rather enhanced the inhibitory activity. Among sphingosine stereoisomers, the naturally occurring D-erythro-sphingosine proved to be the strongest inhibitor. To ascertain the contribution of the total conformation to the inhibition, especially of the long aliphatic chain, we constructed a 3D-quantitative structure-activity relationship model using the computer program Catalyst/HipHop on the basis of information described above. Analysis of the hypothesis model for active compounds revealed that the orientation of aliphatic chain, represented by the dihedral angle of C2-3-4-5, correlated well with the inhibition. Modifications such as deletion of the hydroxyl group at C3 or saturation of the C4-C5 double bond caused shifts in the dihedral angle of C2-3-4-5, with concomitant decrease in inhibitory activity.

Identification of immunostimulatory DNA-induced genes by suppression subtractive hybridization

Bacterial DNA and related synthetic immunostimulatory oligodeoxyribo-nucleotides (ISS-ODN) have stimulatory effects on mammalian immune cells through a Toll-like receptor, TLR9. Genes upregulated in ISS-ODN-stimulated immune cells are obviously significant to delineate the mechanism of the induced innate immunity. Employing suppression subtractive hybridization (SSH), we have generated a profile of genes induced by ISS-ODN in spleen cells. Sequencing of 87 clones isolated by the SSH showed 39 clones corresponding to known mouse genes in the public database. Eleven clones appeared to possess 80-90% homology with known mouse genes and the remaining 37 clones showed no significant homology with any known mouse genes. A series of known genes which have not previously been reported to be induced with ISS-ODN were confirmed to be induced in ISS-ODN-stimulated bone marrow-derived macrophages: NF-kappaB p105, IRF-1, PA28beta, IRG2, and MyD88. These genes were suggested to be involved in the molecular process of innate host defense mechanisms.

Quasisteady high-confinement reversed shear plasma with large bootstrap current fraction under full noninductive current drive condition in JT-60U

A quasisteady reversed shear plasma with a large bootstrap current fraction ( approximately 80%) has been obtained for the first time in the JT-60U tokamak. The shrinkage of reversed shear region was suppressed by the bootstrap current peaked at the internal transport barrier (ITB) layer and the ITBs at a large radius were sustained, which, by combination with an H-mode edge pedestal, resulted in a high confinement or 2.2 times the H-mode scaling for 6 times energy confinement time or 2.7 s. Furthermore, a full noninductive current drive was obtained by the bootstrap current and the beam driven current.

Protective CTL response is induced in the absence of CD4+ T cells and IFN-gamma by gene gun DNA vaccination with a minigene encoding a CTL epitope of Listeria monocytogenes

Our work was undertaken to learn the mechanism of induction of protective cytotoxic T lymphocytes (CTL) by gene gun DNA vaccination with p91m encoding an H-2Kd-restricted T cell epitope of listeriolysin O (LLO). Vaccination with p91m induced vigorous antigen-specific CD8+ CTL that produce IFN-gamma and was able to confer partial protection against listerial challenge. However, the p91m-induced protective immunity was revealed to be independent of the IFN-gamma and CD4+ T cell help. The CTL induction is also suggested to require neither adjuvant activity of the plasmid used nor IFN-gamma. The data may be feasible for the design of CTL inducing vaccines in various immunodeficiencies.

Electroporation-mediated transfer of cytokine genes into human esophageal tumors produces anti-tumor effects in mice

Electroporation facilitates transfer of chemicals or plasmid DNA from extracellular milieu into cells by increasing the permeability of the cell membrane. Delivery of electric pulses to established tumors thereby can improve the susceptibility of tumors to an anti-cancer agent administered. We examined whether electroporation-mediated transfer of cytokine genes into solid tumors could produce anti-tumor effects in the tumor-bearing mice. Plasmid DNA containing cytokine genes were injected into human esophageal T.Tn tumors developed in nude mice and electric pulses were then delivered. Administration of murine GM-CSF or human IL-2 gene followed by electroporation significantly suppressed the subsequent growth of T.Tn tumors and prolonged the survival of the inoculated mice. In contrast, electroporation-mediated introduction of a control gene, human GM-CSF gene, whose products do not bind to murine GM-CSF receptors, did not achieve any anti-tumor effects. In vivo transfection of cytokine genes with electroporation could be a possible therapeutic strategy for established solid tumors.

Protective cytotoxic T lymphocyte responses induced by DNA immunization against immunodominant and subdominant epitopes of Listeria monocytogenes are noncompetitive

Taking advantage of the fact that plasmid DNA encoding a single cytotoxic T lymphocyte (CTL) epitope can induce CTLs, we examined the influence of T-cell responses to dominant epitopes on those to a subdominant epitope derived from Listeria monocytogenes. Our data suggest that interaction between T cells against dominant and subdominant epitopes does not operate in the generation of the hierarchy. Furthermore, we found that a single dominant epitope is sufficient for the induction of protective immunity.

Combinatory anti-tumor effects of electroporation-mediated chemotherapy and wild-type p53 gene transfer to human esophageal cancer cells

Delivery of electric pulses to an established solid tumor augments the permeability of cell membrane and increases the susceptibility of tumors to an anti-cancer agent that is administered in the vicinity of tumors. Forced expression of the wild-type p53 gene in tumor cells that have non-functional p53 gene(s) can also enhance their sensitivity to a DNA-damaging agent. To investigate the feasibility of electroporation-mediated therapy for cancer, electric pulses were delivered to human esophageal tumors developed in nude mice after they received an anti-cancer agent and/or plasmid DNA containing the wild-type p53 gene. The growth of esophageal tumors was suppressed with electroporation-mediated chemotherapy compared with the treatment with an anti-cancer agent or electroporation alone. Intratumoral injection of the wild-type p53 gene into p53-mutated esophageal tumors followed by electroporation also inhibited tumor growth. When mice were administered with the wild-type p53 gene and an anti-cancer agent, subsequent electroporation produced a synergistic therapeutic effect. Combinatory transfer of plasmid DNA and a pharmacological agent by electroporation is thereby a possible therapeutic strategy for the treatment of solid tumors.

Myocardial damage and left ventricular dysfunction in patients with and without persistent negative T waves after Q-wave anterior myocardial infarction

Persistent T-wave inversions during the chronic stage of Q-wave myocardial infarction (MI) indicate the presence of a transmural infarction with a fibrotic layer pathologically. The aim of the present study was to examine the relation between left ventricular (LV) damage and changes in polarity of the T waves from the acute to chronic phase in patients with Q-wave anterior wall MI. We studied 140 patients with persistent T-wave inversions in leads with Q waves (negative T-wave group) and 158 patients with positive T waves (positive T-wave group) at 12 months after anterior MI. In the positive T-wave group, the precordial T waves reverted from a negative to a positive morphology < 3 months after MI in 21 patients (3 M-positive T-wave subgroup), 3 to 6 months in 52 patients (6 M-positive T-wave subgroup), and 6 to 12 months in 75 patients (12 M-positive T-wave subgroup). Ten patients had persistent positive T waves without initial T-wave inversion (persistent positive T-wave group). Wall motion index and LV dimension were higher and the wall thickness for the infarct area and LV ejection fraction were lower in the negative T-wave than in the positive T-wave groups, except the persistent positive T-wave group in the chronic stage (p < 0.0001). Wall motion in the infarcted area improved over the course of 1 year in the 3 M-, 6 M-, and 12 M-positive T-wave subgroups (p < 0.0001), but not in the persistent positive T-wave group. Among the patients with T-wave inversions after admission, those who had persistent negative T waves after 12 months had worse LV function. In patients with initial T-wave inversion, earlier normalization of the precordial T waves was associated with greater improvement in LV function. Patients with persistent positive T waves without initial negative T waves had poorer recovery of LV function than patients with persistent negative T waves. We conclude that the presence of inverted T waves in leads with abnormal Q waves 12 months after MI and the time required for T-wave normalization can be used to assess the degree of LV dysfunction.

Toxic shock syndrome toxin-1 accelerated collagen-induced arthritis in mice

The aim of this study was to explore the roles of toxic shock syndrome toxin-1 (TSST-1) in collagen-induced arthritis (CIA). DBA/1 mice were immunized with type II collagen (CII) and treated with TSST-1. Intraperitoneal and intravenous injections of TSST-1 aggravated CIA, enhancing its incidence and severity. CIA was accompanied by an increase in anti-CII IgG Ab levels. Intraperitoneal administration with TSST-1 enhanced IFN-gamma, TNF-alpha, and IL-4 production in DBA/1 mice. We discovered the mRNA expressions of IFN-gamma, IL-2, TNF-alpha, IL-1beta, and iNOS in spleen cells stimulated with TSST-1 in vitro. However, IL-12 and IL-4 mRNA expression were seen constitutively without stimulation. Only a little increase of IL-12 and IL-4 mRNA expression was seen at 2-3 h after treatment with TSST-1. Our experiments demonstrated that CIA was aggravated by the treatment with TSST-1, which may have induced various proinflammatory cytokines and the production of both Th1 and Th2 cytokines.

A new coronary artery disease index of treadmill exercise electrocardiograms based on the step-up diagnostic method

Treadmill exercise electrocardiography (ECG) is one of the most common noninvasive methods for detecting ischemic heart disease. However, this method has problems due to false-positive and false-negative results in a significant number of patients. The aim of this study was to determine whether the diagnostic accuracy of treadmill exercise ECG for detecting significant coronary stenosis can be improved by employing a step-up diagnostic method using multiple diagnostic indicators. We studied 273 consecutive patients (mean age, 56 +/- 9 years; 190 men and 83 women) without a history of myocardial infarction who underwent treadmill exercise ECG and coronary angiography for ischemic chest pain. Of these, 146 patients had no significant coronary stenosis, 61 had single-vessel disease, 56 had multivessel disease, and 10 patients had left main truncus disease. A multivariate logistic regression analysis was used to select 3 treadmill exercise electrocardiographic parameters that were independent predictors of the presence or absence of significant coronary stenosis: exercise-induced maximum ST-segment depression, QT dispersion immediately after exercise, and Athens QRS score. Significant coronary stenosis was diagnosed with a sensitivity of 84% and a specificity of 90% when a step-up diagnostic method using these 3 indicators was employed. These results were better than those obtained for each indicator alone (exercise-induced maximum ST-segment depression: sensitivity, 66%, and specificity, 73%; QT dispersion immediately after exercise [> or =60 ms positive]: sensitivity, 76%, and specificity, 86%; and Athens QRS score [< or =5 mm positive]: sensitivity, 72%, and specificity, 72%). We conclude that this step-up diagnostic method, using multiple diagnostic indicators, is a clinically useful predictor of the presence or absence of significant coronary stenosis.

Effects of glucose, vitamins, and DO concentrations on pyruvate fermentation using Torulopsis glabrata IFO 0005 with metabolic flux analysis

The effects of glucose, vitamins, and DO concentrations on efficient pyruvic acid fermentation were investigated using Torulopsis glabrata IFO 0005, and a novel biphasic culture method was developed on the basis of the metabolic flux analysis. T. glabrata requires the four vitamins nicotinic acid (NA), thiamine hydrochloride (B(1)), pyridoxine hydrochloride, and biotin for cell growth. The deficiency of these vitamins plays an essential role in pyruvate fermentation. In the present study, we considered the effects of the first two vitamins on the pyruvate fermentation. On the basis of several batch and fed-batch experiments, it was found that, as a result of glucose inhibition of cell growth, the initial glucose concentration should be around 30-40 g/L, and the glucose concentration during fermentation should be controlled at high level around 30 g/L. On the basis of an analysis of carbon flux distribution, a biphasic fermentation method was developed where the cultivation started with a high DO (at 40-50% of air saturation) for efficient cell growth and then was reduced to 5-10% for efficient pyruvate production. Since a fair amount of ethanol was formed when the DO concentration was decreased, the addition of NA turned out to be effective in reducing the ethanol formation. This may be due to a relaxing of the requirement for NADH oxidation by the alcohol dehydrogenase pathway. Since B(1) affects both the pyruvate dehydrogenase complex and pyruvate decarboxylase, its initial concentration must be carefully determined by considering both the cell growth and pyruvate production phases.

Identification of differentially expressed genes in rat hippocampus after transient global cerebral ischemia using subtractive cDNA cloning based on polymerase chain reaction

BACKGROUND AND PURPOSE

The purpose of this study is to identify new molecules that play important roles in the phenomena that occur in the hippocampus after transient global cerebral ischemia, as clues to better understanding of the mechanisms.

METHODS

A subtractive cDNA library was established by suppression subtractive hybridization of rat hippocampal tissues after transient global cerebral ischemia. With differential screening of the library, upregulated fragments were identified. The mRNA expression levels of selected genes were measured with semiquantitative reverse transcriptase polymerase chain reaction (PCR).

RESULTS

Among more than 100 isolated fragments, approximately half were determined to be identical to known sequences. The rest showed high homology to known sequences, and only 2 did not exhibit homology to any known sequences. The expression of 5 genes identified in this study increased in 24 hours after ischemia to a level twice as high as that in sham-operated controls. These included furin, prosaposin, synaptotagmin IV, heat shock protein 105, and the neutral and basic amino acid transporter (NBAT). The increases in the mRNA expression levels of the genes except NBAT, as revealed by semiquantitative reverse transcription PCR, were statistically significant at both 6 and 24 hours after ischemia.

CONCLUSIONS

Genes isolated are thought to be associated with production of proteins necessary for degeneration, neuroprotection, and reconstruction of neurons. How the expression of these genes relates to functional changes after ischemia remains to be determined. PCR-based subtractive cDNA cloning is demonstrated to be a useful tool for analyzing in vivo gene expression in animal ischemia models.

Usefulness of QT dispersion immediately after exercise as an indicator of coronary stenosis independent of gender or exercise-induced ST-segment depression

Several recent studies suggest that QT dispersion on a standard 12-lead electrocardiogram is a clinically useful indicator of significant coronary stenosis. In this study, we compared the diagnostic accuracy of QT dispersion immediately after exercise as an indicator of coronary stenosis in men and women, and in the presence or absence of exercise-induced significant ST-segment depression. The subjects were 273 consecutive patients (mean age 56 +/- 9 years; 190 men and 83 women) without a history of myocardial infarction who underwent treadmill exercise electrocardiography and coronary angiography for evaluation of angina. Of these, 146 patients had no significant coronary stenosis, 61 had single-vessel disease, 56 had multivessel disease, and 10 had left main coronary artery disease. QT dispersion immediately after exercise was significantly greater in patients with significant coronary stenosis than in those without (64 +/- 14 vs 39 +/- 14 ms, p <0.01). QT dispersion immediately after exercise was significantly more sensitive in men (sensitivity 75%; specificity 85%) and significantly more specific in women (sensitivity 77%, specificity 88%) than exercise-induced significant ST-segment depression (men: sensitivity 62%, specificity 74%; women: sensitivity 81%, specificity 68%) as an indicator of significant coronary stenosis. The addition of factors such as gender and the presence or absence of exercise-induced significant ST-segment depression did not significantly alter the sensitivity and specificity of QT dispersion immediately after exercise for detecting significant coronary stenosis (patients with significant ST-segment depression: sensitivity 77%, specificity 88%; patients without significant ST-segment depression: sensitivity 72%, specificity 86%). In conclusion, QT dispersion immediately after exercise is a clinically useful indicator of significant coronary stenosis independent of gender or the presence or absence of exercise-induced significant ST-segment depression.

DNA vaccines

DNA vaccination or genetic immunization is a rapidly developing technology that offers new approaches for the prevention and therapy of disease. Regarding the inoculation method of DNA vaccine, we recommend the gene gun delivery system, which is a highly reliable method compared to intramuscular inoculation. DNA vaccines could have potential advantages over other types of vaccines in that these vaccines can induce strong cellular immune responses, cytotoxic T lymphocytes and type 1 helper T cells, without resorting to live organisms or complicated protein formulation. The cellular immune responses are especially required for the protection against infections with intracellular pathogens such as viruses and Mycobacterium tuberculosis and protection against cancers, suggesting that they seem to be suitable targets of DNA vaccines. We describe here that their application to bacterial infections requires optimization of codon usage in the DNA vaccines to the host animal to improve translational efficiencies of the bacteria genes. DNA vaccines for a variety of pathogens and cancers have now entered phase I/II human clinical trials.

Retrovirus-mediated gene transfer of granulocyte colony-stimulating factor receptor (G-CSFR) cDNA into MDS cells and induction of their differentiation by G-CSF

Myelodysplastic syndromes (MDS) are clonal disorders in which the proper differentiation of hematopoietic stem cells is impaired. There is no effective treatment for this stem cell disorder at present. In an attempt to find a new strategy that promotes the differentiation of MDS blast cells, we tried retroviral transduction of granulocyte colony-stimulating factor receptor (G-CSFR) into an interleukin-3-dependent MDS cell line, MDS-L, since expression of G-CSFR is known to be essential for the differentiation of myeloid progenitor cells and this expression is impaired in most MDS cells. Ectopic expression of human G-CSFR cDNA in MDS-L cells gave rise to granulocytic differentiation by G-CSF stimulation. G-CSF caused the transformants expressing G-CSFR to display a morphological characteristic of mature granulocytes, upregulated CD11b on the cell surface, and improved NBT reduction activity. These results demonstrate that MDS-L cells ecopically expressing G-CSFR are induced to granulocytic differentiation upon exposure to G-CSF, and shed light on the molecular mechanisms of maturation arrest in MDS cells.

Scapholunate dissociation caused by gouty arthritis of the wrist. Case report

Gouty arthritis of the wrist is rare, and may be associated with scapholunate dissociation. To our knowledge, only two cases have been reported so far. In this report, we describe a 40-year-old patient with scapholunate dissociation caused by acute gouty arthritis of the wrist. His clinical findings and radiographs mimicked infectious arthritis or osteomyelitis of the carpal bones.

Expression of stanniocalcin in zona glomerulosa and medulla of normal human adrenal glands, and some adrenal tumors and cell lines

Stanniocalcin (STC) is a calcium (Ca)-regulating hormone that was originally discovered in the fish Stannius body, which is a unique endocrine organ. Hypercalcemia increases STC secretion, which inhibits Ca uptake by the gills and normalizes serum Ca level. In this study we investigated the STC expression in human normal and abnormal adrenal cells. Immunohistochemistry using monoclonal antibody against STC revealed specific staining in zona glomerulosa and medulla of normal human adrenal glands. STC was also detected in human adrenal tumors, such as pheochromocytoma, differentiated neuroblastoma, and aldosterone-producing adenoma, and cultured adrenal tumor cells (rat pheochromocytoma PC-12 cells and human neuroblastoma NB-1 cells). However, undifferentiated human adrenal neuroblastoma was negative for STC staining. Reverse transcription polymerase chain reaction demonstrated STC mRNA expression in cultured PC-12 cells and NB-1 cells. Following several studies indicating that zona glomerulosa cells of adrenal glands express neuroendocrine properties, STC expression in normal and abnormal adrenal cells provides additional evidence to support the neuroendocrine differentiation of these cells. In conclusion, STC may be useful as a new cell marker of adrenal glands under physiological and pathological conditions.

Value of QT dispersion in the interpretation of treadmill exercise electrocardiograms of patients without exercise-induced chest pain or ST-segment depression

It has recently been reported that increased QT dispersion seen on standard 12-lead electrocardiograms (ECGs) reflects transient myocardial ischemia. The present study investigates whether increased QT dispersion induced by exercise is a useful indicator for detecting significant coronary stenosis in patients who do not have chest pain or significant ST-segment depression in response to exercise. We studied 135 consecutive patients (mean age +/- SD, 55 +/- 9 years; 97 men and 38 women) who complained of anginal chest pain and who did not have exercise-induced chest pain or significant ST-segment depression during treadmill exercise electrocardiography. Coronary angiography was performed in all of patients. Of the 135 patients, 97 had no significant coronary stenosis, 25 had 1-vessel coronary artery disease (CAD), and 13 had multivessel CAD. QT dispersion immediately after exercise was significantly greater in the group with significant coronary stenosis than without significant coronary stenosis (62 +/- 13 vs 40 +/- 14 ms, p <0.0001). When QT dispersion >/=60 ms immediately after exercise was considered a positive result, this indicator had a sensitivity of 74%, a specificity of 85%, and an accuracy of 81% for the diagnosis of significant coronary stenosis. In conclusion, we have shown that QT dispersion immediately after exercise is useful for detecting significant CAD in patients who do not have exercise-induced chest pain or significant ST-segment depression.

Evaluation of isolated fractures of the greater trochanter with magnetic resonance imaging

The diagnosis of an isolated fracture of the greater trochanter can be done on routine radiographs, but this may not be the whole story. We evaluated fractures of the greater trochanter of the femur by magnetic resonance imaging (MRI). MR images were obtained within 5 days of the time of clinical presentation. Coronal images were performed on T1- and T2-weighted spin-echo images. Eight elderly patients who were diagnosed as having a greater trochanter fracture on standard radiographs underwent MRI. Three were men aged 62-76 (mean 63.4) years, and five were women aged 80-101 (mean 88.6) years. MRI showed that in seven of the eight cases, the fracture line was observed leading from the greater trochanter towards other trochanter regions. In only one case was the fracture limited to the greater trochanter and corresponded to the line observed on the standard radiographs. We suggest that in cases of greater trochanter fracture with somewhat severe symptoms, MRI should be performed in order to discover the appropriate diagnosis and treatment.

Measurement of natural plasma flow along the field lines in the scrape-Off layer on the JT-60U divertor tokamak

The plasma profile and parallel plasma flow in the scrape-off layer (SOL) were systematically measured using reciprocating Mach probes installed at the outer midplane and near the divertor magnetic null (x point) in the JT-60U tokamak with a single null divertor. For the ion vertical drift due to the toroidal magnetic field gradient (ion nablaB drift) directed towards the divertor, SOL plasma flow along the magnetic field lines away from the divertor ("flow reversal") was discovered at the midplane far from the divertor. A quantitative evaluation of the ion "Pfirsch-Schluter flow," wherein the parallel flow is naturally produced in a toroidal plasma, was consistent with the measurement.

Enhanced detection of ischemic but viable myocardium by QT interval dispersion on treadmill exercise electrocardiograms of patients with healed anterior wall myocardial infarcts

BACKGROUND

The presence of ischemic but viable myocardium in infarcted areas is an important indication for coronary revascularization, but is often difficult to detect with the use of treadmill exercise electrocardiography (ECG).

HYPOTHESIS

QT interval dispersion (QTd) is a sensitive method for detecting myocardial ischemia and may improve the accuracy of treadmill exercise ECG testing for detecting ischemic but viable myocardium in infarcted areas.

METHODS

Forty-five patients with Q-wave anterior wall myocardial infarctions who underwent treadmill exercise ECG, exercise reinjection thallium-201 (201Tl) scintigraphy, radionuclide angiocardiography, and coronary angiography 1 month after infarction were enrolled in this study. The presence of viable myocardium in the infarct area was determined by exercise reinjection 201Tl scintigraphy. Patients who had no redistribution in the infarct area after reinjection were included in Group 1, and those with redistribution were included in Group 2.

RESULTS

QTd immediately after exercise, and the difference between QTd before and immediately after exercise, were significantly greater in Group 2 than in Group 1. The sensitivity, specificity, and accuracy of conventional ST-segment depression criteria for detecting viable myocardium in the infarct area were 48, 64, and 56%, respectively. The measurement of QTd immediately after exercise (abnormal: > or = 70 ms; normal: < 70 ms) improved the sensitivity, specificity, and accuracy to 78, 82, and 80%, respectively.

CONCLUSIONS

This novel diagnostic method using QTd-based criteria significantly improves the clinical usefulness of treadmill exercise ECG testing for detecting ischemic but viable myocardium in infarct areas in patients with healed Q-wave anterior wall myocardial infarctions.

[Continuous monitoring of hemoglobin oxygen saturation of the hepatic vein in patients undergoing laparoscopic cholecystectomy]

We monitored of hemoglobin oxygen saturation of the hepatic vein (ShvO2) continuously in 6 patients undergoing laparoscopic cholecystectomy under inhalation anesthesia only, and in 6 patients under combined epidural and inhalation anesthesia. In inhalation anesthesia only group, arterial blood pressure increased and ShvO2 values decreased immediately after intraperitoneal insufflation with CO2, demonstrating the mean lowest ShvO2 value of 25 percent. In combined anesthesia group, arterial blood pressure and ShvO2 values were unchanged after the intraperitoneal insufflation compared with values obtained before the insufflation. The results indicate that hepatic blood flow may be better preserved with combined epidural and inhalation anesthesia than with inhalation anesthesia only, suggesting that sympathetic block by epidural anesthesia may contribute to this favorable effect on ShvO2.

Advantage of gene gun-mediated over intramuscular inoculation of plasmid DNA vaccine in reproducible induction of specific immune responses

Utilizing a plasmid DNA encoding a single cytotoxic T lymphocyte (CTL) epitope and that encoding ovalbumin (OVA), we compared the reproducibility in the induction of immune responses by gene gun and intramuscular immunization. As compared to intramuscular inoculation, gene gun DNA immunization appeared to bring about highly reproducible and reliable results in the induction of specific CTL and IFN-gamma production to the CTL epitope and production of anti-OVA IgG. The results obtained by intramuscular inoculation vary significantly. Our data shown here strongly suggest that gene gun immunization of skin is a much more reliable method for DNA vaccination to induce effective immune responses in an animal model.

Radiosensitivity of human breast cancer cells transduced with wild-type p53 gene is influenced by the p53 status of parental cells

Induction of apoptosis with chemotherapeutic agents or radiation in tumours is frequently related to the status of those p53 gene of the tumours. To examine whether forced expression of the wild-type p53 gene in tumour cells can modulate their susceptibility to radiation and anti-cancer agents, we retrovirally transduced two types of human breast cancer cell lines, which respectively harboured a mutated p53 gene (OCUB-M) or wild-type p53 gene (YMB-1), with the wild-type p53 gene. Transduced cells which consistently expressed the wild-type p53 gene (OCUB-M/p53, YMB-1/p53) proliferated at the same rate as control cells which were transduced with the beta-galactosidase gene (OCUB-M/lacz, YMB-1/lacz). However, sensitivity to radiation was increased in OCUB-M/p53 cells but not in YMB-1/p53 cells. In vitro chemosensitivity to DNA-damaging anticancer agents such as cyclophosphamide and 5-fluorouracil was not influenced by the transduction of the wild-type p53 gene in either cells. Expression of the wild-type p53 gene in p53-mutated human breast cancer cells can therefore increase their sensitivity to radiation but not their chemosensitivity. Therapeutic effects following by the transduction of the wild-type p53 gene were not observed in breast cancer cells already bearing the wild-type p53 gene.

[Minimally invasive transanal surgery]

A new anal retractor connected to an Octopus retractor holder and automatic suture clamp were used for local excision of rectal tumors to obtain easy access to proximal tumors with an adequate surgical field and to avoid complications. Shortening techniques and invagination techniques were adopted to pull down proximal tumors. This surgical procedure resulted in shorter operating time, less bleeding, earlier oral intake, shorter hospital stay, and fewer complications.

Physicochemical Properties of 2-Vinylpyridine Telomers Possessing Multihydrocarbon Chains in Aqueous Solution and at the Silica/Aqueous Solution Interface

Physicochemical properties of multialkylated surfactants of partially quaternized 2-vinylpyridine telomers having multihydrocarbon side chains (nRm-2VPQ: n, number of chains; m, alkyl chain length) in aqueous solutions were investigated. The critical micelle concentration (cmc) and surface tension at the cmc were 13 µmol dm(-3) and 52 mNm(-1) for 2.1R(8)-2VPQ, 7.1 µmol dm(-3) and 37 mNm(-1) for 2.5R(12)-2VPQ, and 4.7 µmol dm(-3) and 40.0 mNm(-1) for 3.4R(12)-2VPQ, respectively. The aggregation numbers at the cmc determined by the light scattering method were 4 +/- 1 for 2.1R(8)-2VPQ, 45 +/- 10 for 2.5R(12)-2VPQ, and 11 +/- 1 for 3.4R(12)-2VPQ. Thus, the number of chains and the alkyl chain length of the telomers affected the micellar properties in aqueous solutions. At the interface of the silica/aqueous solution, the adsorbed amounts of the telomers increased sharply at their low concentrations and reached a plateau by forming a monolayer and a subsequent bilayer. Silica suspensions also showed a dispersion-flocculation-redispersion sequence with the telomer concentration, where the maximum sedimentation rate was influenced by the number of chains and the alkyl chain length of the telomers. Copyright 1999 Academic Press.

Biased T cell receptor Vbeta gene expression in bronchoalveolar lavage fluid from Japanese patients with sarcoidosis

OBJECTIVE

Sarcoidosis is believed to be one of the T cell-mediated granulomatous diseases with unknown aetiology. We attempt to search for the causative T cell clones of sarcoidosis.

METHODS

We study T cell receptor beta-chain variable region (Vbeta) repertoire in peripheral blood (PB) and bronchoalveolar lavage fluid (BALF) from patients with sarcoidosis, using semi-quantitative reverse transcriptase-polymerase chain reaction method. The expression of 22 kinds of Vbeta genes is examined in 17 patients with sarcoidosis and nine normal subjects.

RESULTS

Compared with control subjects, the group with sarcoidosis exhibits significantly high expressions of the Vbeta2 (P < 0.005, Wilcoxon's test) and Vbeta6 (P = 0.005) genes in BALF. In each BALF sample, the Vbeta2 (P < 0.01, chi2 test) and Vbeta6 (P < 0.01) genes were overexpressed (> 2 SD above the mean value for each Vbeta observed in control subjects) in 11 and 10 of 17 patients with sarcoidosis, respectively. Furthermore, the amino acid sequences of Vbeta6+ complementarity determining region 3 were conserved in one of three patients. There is, however, no disposition of Vbeta gene usage in PB from patients with sarcoidosis compared with control subjects.

CONCLUSIONS

The T lymphocytes with Vbeta2 and/or Vbeta6 are associated with the pathogenesis of sarcoidosis. The possibility exists that these T lymphocytes might be capable of recognizing the restricted antigens, thereby inducing oligoclonal expansion.

The N-terminal propeptide and the C terminus of the precursor to 20-kilo-dalton potato tuber protein can function as different types of vacuolar sorting signals

Two types of vacuolar sorting signals (VSSs), an asparagine-proline-isoleucine-arginine-leucine (NPIRL)-related VSS in the N-terminal propeptides (NTPPs) and a C-terminal VSS in the C-terminal propeptides (CTPPs), function differently in plant cells. A precursor to a 20-kDa protein of potato tuber (PT20) contains two NPIRL-related sequences, NPINL in a short NTPP and NPLDV close to the C terminus of the precursor. We made mutant forms of sweet potato sporamin (SPO), nPT20-SPO, in which the N-terminal pre-pro part was exchanged with that of the precursor to PT20, and SPO-PT20c, in which the C-terminal 13 amino acids of the precursor to PT20 was attached to the C terminus of delta pro-SPO which lacked NTPP. Both nPT20-SPO and SPO-PT20c were efficiently transported to the vacuoles in tobacco cells. Unlike nPT20-SPO, the vacuolar transport of SPO-PT20c was inhibited by wortmannin and by the C-terminal addition of Gly or Gly-Gly suggesting its similarity to the vacuolar transport of sporamin mediated by CTPP of barley lectin. Further analysis of the C-terminal sequence of PT20 indicated that the most C-terminal SFKQVQ sequence functions as the C-terminal VSS. These results suggest that the precursor to PT20 contains both NPIRL-like VSS in its NTPP and C-terminal VSS at the C terminus.

Use of QT dispersion measured on treadmill exercise electrocardiograms for detecting restenosis after percutaneous transluminal coronary angioplasty

BACKGROUND

Treadmill exercise electrocardiography (ECG) has been used to detect restenosis in patients following percutaneous transluminal coronary angioplasty (PTCA). However, the level of sensitivity achieved using conventional criteria of ST-segment depression is too low to be clinically useful in this population.

HYPOTHESIS

QT dispersion is a sensitive method for detecting myocardial ischemia and may improve the accuracy of treadmill exercise ECG testing for detecting restenosis after PTCA.

METHODS

We evaluated 104 patients who underwent PTCA for the treatment of single-vessel coronary artery disease and who had no history of myocardial infarction. Treadmill exercise ECG and coronary angiograms were performed 3 months after PTCA to determine the accuracy of diagnosis restenosis based on standard ST-segment depression and QT dispersion criteria.

RESULTS

Restenosis was observed in 37 of the 104 patients (36%) 3 months after PTCA. QT dispersion immediately after exercise was significantly greater in patients with than in those without restenosis, as was the difference in QT dispersion before and immediately after exercise. The sensitivity, specificity, and accuracy of ST-segment depression criteria were 59, 64, and 63%, respectively. Measurements of QT dispersion immediately after exercise (> or = 50 ms: positive, < 50 ms: negative) improved the sensitivity, specificity, and accuracy of treadmill ECG for predicting restenosis to 81, 87, and 85%, respectively.

CONCLUSIONS

This novel diagnostic method using QT dispersion-based criteria significantly improves the clinical usefulness of treadmill exercise ECG for detecting the presence of restenosis after PTCA.

[Weekly hepatic arterial infusion of high dose 5-fluorouracil for liver metastasis from colorectal cancer]

A weekly infusion of high dose 5-fluorouracil by way of the hepatic artery has been performed in 23 cases with synchronous metastasis from colorectal cancer since 1993. The prognosis in these cases was compared with 94 cases treated without infusion chemotherapy in 94 cases before 1992. The overall one-year and three-year survival rate was 64.8% and 30.2%, respectively, in cases with infusion chemotherapy. The one-year and three-year survival rate was 42.8% and 18.6%, respectively, in cases without infusion chemotherapy. Overall survival rate was significantly different between cases with and without infusion chemotherapy (p < 0.05). In conclusion, weekly infusion chemotherapy resulted in a better survival rate than without infusion chemotherapy.

Pyogenic infection of the pubic symphysis in a diabetic patient

A 51-year-old woman with diabetes mellitus had swelling in the inguinal area leading to discharge. Insulin, irrigation of the wound and intravenous antibiotics had no effect. Fistulography and a fistula-CT showed a fistula connecting to the pubis symphysis. After curettage of the pubic symphysis, the wound was closed.

Differential efficacy of suicide gene therapy by herpes simplex virus-thymidine kinase gene reflects the status of p53 gene in human esophageal cancer cells

We examined the effect of herpes simplex virus-thymidine kinase gene (HSV-TK)-mediated suicide gene therapy on human esophageal cancer. Two human lines, T.Tn cells which bears truncated p53 and TE2 cells with wild-type p53, were transduced with the HSV-TK gene and tested for their sensitivities to a prodrug, ganciclovir (GCV). The transduced cells, T.Tn/TK and TE2/TK, increased in vitro sensitivity to GCV compared with that of respective wild-type cells. However, the growth suppression of T.Tn/TK tumors induced by GCV was marginal in nude mice and the tumors regrew thereafter. In contrast, the growth of TE2/TK tumors was significantly inhibited by GCV and all the tumors disappeared. The status of the p53 gene of tumor cells thereby may influence the efficacy of the HSV-TK/GCV system.

Codon optimization effect on translational efficiency of DNA vaccine in mammalian cells: analysis of plasmid DNA encoding a CTL epitope derived from microorganisms

Interspecific difference of codon usage is one of the major obstacles for effective induction of specific immune responses against bacteria and protozoa by DNA immunization. Using genes encoding major histocompatibility complex class I-restricted cytotoxic T-lymphocyte (CTL) epitopes, derived from an intracellular bacterium, Listeria monocytogenes and a mouse malaria parasite, Plasmodium yoelii, we report here that the codon optimization level of the genes is not precisely proportional to, but does correlate well with the translational efficiency in mammalian cells, which is concomitantly associated with the induction level of specific CTL response in the mouse. These results suggest that DNA immunization using the gene codon-optimized to mammals through the entire region is very effective.

Decreased expression of Th2 type cytokine mRNA contributes to the lack of allergic bronchial inflammation in aged rats

Sensitized Brown Norway rats are known to develop eosinophilic bronchial inflammation and airway hyperresponsiveness after Ag exposure. However, we have previously observed that sensitized aged rats of the same strain failed to develop such allergic inflammation. In the present study, we investigated age-associated changes of cytokine mRNA expression in bronchoalveolar lavage (BAL) cells. Both young (8- to 10-wk-old) and aged (100- to 120-wk-old) Brown Norway rats were sensitized with OVA, and BAL was performed 24 h after OVA inhalation challenge. Semiquantitative RT-PCR analysis of BAL cells showed that the cells from aged rats preferentially expressed Th1 type cytokine (IFN-gamma) mRNA, whereas cells from young animals expressed more Th2 type cytokine mRNAs including those for IL-4 and IL-5. Decreased expression of Th2 type cytokine transcripts in aged animals was further confirmed by quantitative analysis, competitive RT-PCR of BAL cells, and in situ hybridization. The age-associated changes of cytokine profile were not restricted to BAL cells but were a general feature of lymphocytes, as shown by examination of popliteal lymph nodes draining the site of sensitization. These findings suggest that decreased allergic inflammation in aged animals is attributable to age-dependent impairment of Th2 generation in response to Ag.

Case report: A case of lymphoepithelioma-like carcinoma of the oesophagus and review of the literature

A 78-year-old Japanese female was admitted to our hospital with dysphagia and weight loss. An oesophageal tumour was demonstrated radiologically and endoscopically, and was diagnosed as oesophageal cancer by biopsy. Histologically, the resected tumour showed poorly differentiated squamous cell carcinoma with prominent lymphoid stroma and was diagnosed as the so-called lymphoepithelioma-like carcinoma (LELC). Epstein-Barr virus in the tumour was negative by polymerase chain reaction and in situ hybridization. Oesophageal LELC is extremely rare. The cases in the literature, as well as the one reported here, presented with gross features of a submucosal tumour-like appearance. Although the differentiation of the tumour cells is often poor, prognosis seems to be better than for other types of oesophageal cancer. Oesophageal LELC has characteristic clinicopathological features and should be classified by criteria independent of other types of tumour.

The p53 gene mutation is of prognostic value in esophageal squamous cell carcinoma patients in unified stages of curability

BACKGROUND

The p53 gene alteration is identified in approximately half of all human tumors, and is now thought to be a key gene for regulating the cell cycle through the induction of p21(WAF1/CIP1) and inducing apoptosis through some genes such as BAX. In this study, we investigated the prognostic value of p53 mutation for postoperative esophageal squamous cell carcinoma patients.

METHODS

The subjects studied were 42 esophageal squamous cell carcinoma patients who underwent esophagectomy with complete curability in our department. The cases were limited to stage II and III. DNA was extracted from paraffin-embedded tissues. A p53 gene mutation was detected by polymerase chain reaction-single strand conformation polymorphism and subsequent direct sequencing method for exons 5 to 9. The 5-year survival rate was calculated and statistically compared between the p53 mutation(+) and (-) groups by the log rank test.

RESULTS

The p53 gene mutation was identified in 14 cases (33.3%). The 5-year survival rate of the p53 mutation(-) group (n = 28) was significantly higher than the (+) group (n = 14; 51.0% versus 35.7%, P <0.05 by the log rank test). Recurrence could be identified in 10 of 14 p53 mutation(+) cases (71.4%), whereas it was found in 12 of 28 (-) cases (42.8%).

CONCLUSION

The current study indicated that p53 mutation of tumor tissues might be a prognostic factor for esophageal squamous cell carcinoma cases and one of the risk factors for its recurrence.

Expression of wild-type p53 gene confers increased sensitivity to radiation and chemotherapeutic agents in human esophageal carcinoma cells

The status of the p53 gene of tumor cells can modify the sensitivity of the tumors to radiation and anti-cancer agents. Human esophageal cancer cells (T.Tn) bearing mutated p53 gene were retrovirally transduced with wild-type p53 gene. The transduced cells (T.Tn/p53) which stably expressed wild-type p53 proliferated at the same rate as parental cells. However, the sensitivity to radiation was significantly improved by the transduction and T.Tn/p53 cells became markedly susceptible to cisplatin and etoposide compared with parental cells. Administration of cisplatin noticeably suppressed the growth of T.Tn/p53 tumors but not T.Tn tumors inoculated in nude mice. Forced expression of wild-type p53 gene thereby can increase the sensitivity to DNA damage in esophageal cells.

Investigation on SCH00013, a novel cardiotonic agent with Ca++ sensitizing action. 2nd communication: in vivo cardiovascular effects and bioavailability in dogs

In vivo cardiovascular effects and bioavailability of 4,5-dihydro-6-[1-[2-hydroxy-2-(4-cyanophenyl)ethyl]-1,2,5,6- tetrahydropyrido-4-yl]pyridazin-3(2H)-one (SCH00013), a novel cardiotonic agent, were investigated. In anesthetized dogs, intravenous administration of SCH00013 (0.3-10 mg/kg) increased maximum rate of rise in left ventricular pressure (LVdP/dtmax) in a dose-dependent manner with no change in heart rate (HR) and, at the dose of 3 mg/kg or higher, at which the increase in LVdP/dtmax reached the maximum, it decreased blood pressure. In conscious dogs, oral administration of SCH00013 (1-10 mg/kg) also increased LVdP/dtmax dose-dependently with no change in HR. The increase in the plasma concentration of orally administered SCH00013 (3 mg/kg) was parallel to the increase in LVdP/dtmax. The areas under the plasma concentration versus time curve (AUC0-24 h) after oral and intravenous administration of SCH00013 (3 mg/kg) were essentially identical (15.3 +/- 2.0 micrograms.h/ml and 16.5 +/- 2.1 micrograms.h/ml, respectively). These results suggest that oral bioavailability of SCH00013 is notably high. In conclusion, the positive inotropic effect of SCH00013 with neither elevation of HR nor excessive hypotension, as well as the high oral bioavailability of this compound, may provide a beneficial pharmacological treatment of the patients with congestive heart failure.

Lymph node metastasis with adenocarcinoma of the gastric cardia: clinicopathological analysis and indication for D1 dissection

PURPOSE

To establish the indications for proximal resection with dissection of perigastric lymph nodes in order to treat adenocarcinoma of the gastric cardia.

METHODS

We analyzed the clinicopathological features of 110 resected adenocarcinomas of the gastric cardia with respect to the appropriate operative method and extent of lymphadenectomy for treatment.

RESULTS

Of the 110 patients, 93 underwent curative resection. The D2 group (total gastrectomy with dissection of extended regional lymph nodes) revealed higher morbidity and mortality rates compared to the D1 group (proximal resection with dissection of perigastric lymph nodes). The risk of lymph node metastasis was determined by depth of invasion, size of tumors, and gross findings of tumors.

CONCLUSION

The appropriate operative method for adenocarcinoma of the gastric cardia requires: (i) tumor size less than 4 cm; and (ii) gross findings indicating a superficial type of lesion, which are recommended for proximal resection with dissection of perigastric lymph nodes.

Simultaneous Adsorption of Poly(ethylene Oxide) and Cationic Surfactant at the Silica/Water Interface

The simultaneous adsorption of three poly(ethylene oxide) (PEO) with different molecular weights and two cationic surfactants on silica under a constant feed concentration of PEO has been investigated in aqueous solutions. Two cationic surfactants were used; dodecyltrimethylammonium bromide (DTAB) and 1,2-bis(dodecyltrimethyl ammonio) ethane dibromide (2RenQ). The amount of PEO adsorbed decreased with increasing surfactant concentration, while that of the surfactant increased with surfactant concentration but was lower in the presence of PEO than in the absence of PEO, indicating a competitive adsorption. The reduction in PEO adsorption was greater in the presence of 2RenQ than in the presence of DTAB accompanying an increase of the molecular weight of PEO. The dispersion stability of silica suspensions by the competitive adsorption showed a dispersion-flocculation-redispersion sequence with the surfactant concentration, suggesting the importance of electrostatic interactions as well as steric interactions. ESR measurements using spin-labeled PEO show that PEO molecules adsorbed take mainly loops or tails, inducing steric hindrance for the high dispersion stability of silica suspensions. Copyright 1998 Academic Press.

Preparation of a monoclonal antibody specific for human stanniocalcin

Stanniocalcin (STC) is a glycoprotein hormone that was first identified in fish, where it regulates the calcium level in the body fluid. The cDNA which encodes human STC has recently been reported but the function has not been completely elucidated. We have prepared a monoclonal antibody against human STC using an analogous peptide of the putative antigenic domain in human STC; it was conjugated with keyhole limpet hemocyanin (KLH). The monoclonal antibody specifically stained the distal convoluted tubules in human kidney which is a putative target organ of STC. The ELISA was established using the monoclonal antibody and recombinant human STC as a standard antigen. The monoclonal antibody prepared in this study provides a useful tool for clinical studies of STC in human.

Antitumor response of genetically engineered IL-2 expression to human esophageal carcinoma cells in mature T cell-defective condition

We examined whether antitumor effect could be produced by retrovirally expressed human interleukin-2 (hIL-2) gene in human esophageal cancer cells (T.Tn) using immunocompromised nude mice. Loss of tumorigenicity of hIL-2-producing T.Tn (T.Tn/hIL-2) cells inoculated subcutaneously was observed in contrast to continuous tumor growth of wild-type cells, although in vitro proliferation of T.Tn/hIL-2 cells remained the same as that of wild-type cells. The antitumor effect was also evidenced by the injection of T.Tn/hIL-2 cells into established tumors of wild-type cells. The injection significantly retarded the subsequent growth of wild-type tumors. Histological examination of regressing T.Tn/hIL-2 cells revealed necrotic areas and infiltration of several types of inflammatory cells. Treatment of nude mice with anti-asialoGM1 antibody did not influence the IL-2-mediated tumor rejection. Vaccination of nude mice with irradiated T.Tn/hIL-2 cells whose secretion of hIL-2 in amount was comparable to that of unirradiated cells did not develop protective immunity. Taken together, the antitumor effect achieved in nude mice by the inoculation of T.Tn/hIL-2 cells is mediated by non-T non-natural killer cells.

Optimization of codon usage of plasmid DNA vaccine is required for the effective MHC class I-restricted T cell responses against an intracellular bacterium

In an attempt to study codon usage effects of DNA vaccines on the induction of MHC class I-restricted T cell responses against an intracellular bacterium, Listeria monocytogenes, we designed two plasmid DNA vaccines encoding an H-2Kd-restricted epitope of listeriolysin O (LLO) of L. monocytogenes, LLO 91-99. One DNA vaccine, p91wt, carries the wild-type DNA sequence encoding LLO 91-99, and the other one, p91mam, possesses the altered DNA sequence in which the codon usage was optimized for murine system. Our read-through analyses with LLO 91-99/luciferase fusion genes confirmed that the optimized 91mam DNA sequence showed extremely higher translation efficiency than the wild-type sequence in murine cells. Consistent with this, i.m. injections of p91mam, but not of p91wt, into BALB/c mice were capable of inducing specific CTL- and IFN-gamma-producing CD8+ T cells able to confer partial protection against listerial challenge. Taken together, these observations suggest that optimization of codon should be taken into consideration in the construction of DNA vaccines against nonviral pathogens.

Intraoperative management for removal of tumor thrombus in the inferior vena cava or the right atrium with multiplane transesophageal echocardiography

BACKGROUND

To investigate the role and impact of multiplane transesophageal echocardiography during thrombectomy in the inferior vena cava or the right atrium.

EXPERIMENTAL DESIGN

Retrospective.

SETTING

A university hospital.

PARTICIPANTS

Four patients who underwent removal of tumor thrombus in the inferior vena cava (IVC) or the right atrium.

INTERVENTIONS

The medical records of 4 patients and videotapes of these intraoperative transesophageal echocardiography examinations were reviewed.

RESULTS

Before thrombectomy, multiplane transesophageal echocardiography (MTEE) provided excellent IVC long axis view, which offered precise recognition of the cephalic extent of tumor, extent of caval occlusion, characterization of the tumor head. During surgery, MTEE could provide continuous monitoring of cardiac function, cardiac volume, and pulmonary embolism. Moreover, MTEE could provide the useful images of a cannula or the caval occlusion balloon catheter, which facilitated removal of neoplasm extending into the IVC.

CONCLUSIONS

We presented four surgical cases, in which the removal of the tumor extended into the inferior vena cava or the right atrium using MTEE. MTEE could provide valuable information such as excellent images of the tumor, cardiac function, the position of a cannula or the caval occlusion balloon catheter. These findings could improve the anesthetic management of the patients, as well as the surgical approach and technical maneuvers, and facilitate removal of neoplasm into the IVC.