The role of serum CA-125 levels in early-stage epithelial ovarian cancer on preoperative CT and MRI

BACKGROUND

We sought to identify the role of serum CA-125 levels in early-stage epithelial ovarian cancer (EOC) on preoperative CT and MRI.

METHODS

Clinical data of 101 patients with early-stage EOC on preoperative CT and MRI were collected between January 2000 and December 2007. Clinical stage I (n=59) was defined as tumor limited to the ovaries with or without ascites, whereas clinical stage II (n=42) was defined as tumor within the pelvis with or without ascites. The primary endpoint was to investigate the efficacy of serum CA-125 levels for the prediction of advanced-stage disease, and secondary endpoints were to evaluate the accuracy of preoperative CT and MRI, and to examine the role of serum CA-125 levels as a prognostic factor for survival.

RESULTS

The results of preoperative CT and MRI were concordant with no peritoneal implants outside the pelvis in 50/101 (50%) and no lymph node metastasis in 71/101 (70%) patients. The receiver operating characteristic curves showed that best cut-off values of serum CA-125 levels were 320 U/ml (71% sensitivity, 84% specificity) and 510 U/ml (67% sensitivity, 80% specificity) for the prediction of peritoneal implants outside the pelvis and lymph node metastasis. The serum CA-125 level (> or =320 U/ml) was a significant factor for the prediction of advanced-stage disease (adjusted OR, 7.43; 95% CI, 2.39-23.04). However, it was not an independent prognostic factor for survival.

CONCLUSIONS

Serum CA-125 levels may be very useful for the prediction of advanced-stage disease in early-stage EOC on preoperative CT and MRI.

Polycyclic aromatic hydrocarbons in soils and crops after irrigation of wastewater discharged from domestic sewage treatment plants

The effects of domestic wastewater application on the translocation and accumulation of polycyclic aromatic hydrocarbons (PAHs) in soil and crops (rice, lettuce, and barley) were investigated by Wagner's pot experiment. In the soils and crops after domestic wastewater irrigation, high-molecular weight PAHs (5 to 6 ring) were not detected, but low-molecular weight PAHs (3 to 4 ring) were only detected at trace levels.

Degradation of naturally contaminated polycyclic aromatic hydrocarbons in municipal sewage sludge by electron beam irradiation

This study was to evaluate the degradation efficiency of naturally contaminated polycyclic aromatic hydrocarbons in sewage sludge by using electron beam irradiation as a function of the absorbed dose. Degradation efficiency of PAHs was near to 90% at the absorbed doses 5 kGy. The degradation of PAHs was "first order" reaction rates with respect to absorbed dose. The electron beam irradiation was found effective in means of removing PAHs in domestic wastewater.

Do cell surface trafficking impairments account for variable cell surface sodium iodide symporter levels in breast cancer?

The Na(+)/I(-) symporter (NIS) is a transmembrane glycoprotein that mediates iodide uptake into thyroid follicular cells and serves as the molecular basis of radioiodine imaging and therapy for thyroid cancer patients. The finding that NIS protein is present in 80-90% of breast tumors suggests that breast cancer patients may also benefit from NIS-mediated radionuclide imaging and targeted therapy. However, only 17-25% of NIS-positive breast tumors have detectable radionuclide uptake activity. The discrepancy between NIS expression and radionuclide uptake activity is most likely contributed by variable cell surface NIS protein levels. Apart from the prevalent view that NIS cell surface trafficking impairments account for the variability, our current study proposes that differential levels of NIS expression may also account for variable cell surface NIS levels among breast tumors. We address the need to confirm the identity of intracellular NIS staining to reveal the mechanisms underlying variable cell surface NIS levels. In addition, we warrant a quantitative correlation between cell surface NIS levels and radionuclide uptake activity in patients such that the cell surface NIS levels required for radionuclide imaging can be defined and the defects impairing NIS activity can be recognized.

Antipyretic, analgesic, and anti-inflammatory activities of the seaweed Sargassum fulvellum and Sargassum thunbergii in mice

Dichloromethane, ethanol, and boiling water extracts of the brown seaweeds Sargassum fulvellum and Sargassum thunbergii were examined for antipyretic, analgesic, and anti-inflammatory activities in mice. The activities were evaluated against yeast-induced pyrexia, tail-flick test, and phorbol myristate acetate-induced inflammation (edema, erythema, and blood flow). The dichloromethane extract (0.4 mg/ear) of Sargassum fulvellum inhibited an inflammatory symptom of mouse ear edema by 79.1%. The ethanol extract (0.4 mg/ear) of Sargassum thunbergii also inhibited edema by 72.1%. No acute toxicity was observed after p.o. administration of each extract (5 g/kg bw). These findings are consistent with various claims that these seaweeds can be used as remedies for inflammation-related symptoms.

Diameter of the normal fetal thymus on ultrasound

OBJECTIVE

To present the normative data of the transverse diameter of the developing fetal thymus.

METHODS

In this prospective study, the maximum transverse diameter of the thymus was measured by one sonologist in 376 normal fetuses between 19 and 38 weeks of gestation. We assessed the relationship of the transverse thymic diameter with gestational age (GA), biparietal diameter, femur length and abdominal circumference using general linear regression modeling. The predicted mean and 95% reference range of thymic diameter at each GA were calculated from the regression equation.

RESULTS

Measurements of the transverse diameter were possible in 352 of the 376 (94%) fetuses. The transverse diameter of the fetal thymus increased with increasing GA and fetal size parameters in a linear manner. The regression equation for transverse diameter of the thymus as a function of GA was: thymic diameter (cm) = 0.15 x GA (weeks) - 1.59 (r(2) = 0.86, P < 0.001).

CONCLUSION

The transverse diameter of the fetal thymus is easy to measure; this study presents normative data.

Prenatal diagnosis of horseshoe kidney by measurement of the renal pelvic angle

OBJECTIVE

The aim of this study was to evaluate the usefulness of measurement of the angle between bilateral renal pelves on axial views in the prenatal ultrasonographic diagnosis of horseshoe kidney.

METHODS

We retrospectively measured the renal pelvic angle in 19 fetuses with horseshoe and 20 fetuses with normal kidneys in the second and third trimesters. Renal pelvic angle was defined as the angle between the long axis of the renal pelves on the axial view of the abdomen. We compared the renal pelvic angles of horseshoe and normal kidneys with unpaired t-test. Taking 140 degrees as a cut-off value, we calculated the sensitivity, specificity and accuracy of pelvic angle measurement for the prenatal diagnosis of horseshoe kidney.

RESULTS

The mean pelvic angles in the fetuses with horseshoe kidney were 116 degrees and 110 degrees in the second and third trimester, respectively. In the normal fetuses, the equivalent angles were 172 degrees and 161 degrees. The difference between the two groups was statistically significant (P < 0.01). Using 140 degrees as the discriminating criterion, the sensitivity, specificity and accuracy of renal pelvic angle measurement for the prenatal diagnosis of horseshoe kidney were all 100%. Fifteen of 19 fetuses with horseshoe kidney had no other abnormality. Four (21%) fetuses had severe complex abnormalities which were associated with trisomy 18 in three cases.

CONCLUSION

Observation and measurement of the renal pelvic angle is a simple and useful method in the prenatal diagnosis of the horseshoe kidney.

Management of malignant stricture of the esophagogastric junction with a newly designed self-expanding metal stent with an antireflux mechanism

BACKGROUND AND STUDY AIMS

When stents are placed across the esophagogastric junction for palliative treatment of malignant strictures, they may lead to esophagogastric reflux. The aim of this study was to compare the effectiveness of a newly designed antireflux stent with that of a standard open stent and a currently available antireflux stent (Dostent) in preventing gastroesophageal reflux symptoms in patients with inoperable cancer at the esophagogastric junction.

PATIENTS AND METHODS

Thirty-six consecutive patients with cancer at the esophagogastric junction were randomly assigned to undergo placement of a newly designed antireflux stent (n = 12), a Dostent (n = 12), or a standard open stent (n = 12). Technical and clinical success, dysphagia score, reflux symptoms, complications and ambulatory 24-h esophageal pH monitoring were assessed.

RESULTS

The technical success rates were 100 %. After 1 week, dysphagia had improved in all patient groups ( P < 0.05), but the degree of improvement did not differ between the three groups. The DeMeester score was significantly lower in the group with the newly designed antireflux stent than in the other groups. The fraction of the total recording time during which esophageal pH was below 4 was 3.14 +/- 5.78 % using the newly designed antireflux stent, in comparison with 29.25 +/- 15.41 % in the Dostent group and 15.01 +/- 11.72 % in the standard open stent group ( P < 0.001). Fewer reflux episodes occurred with the newly designed antireflux stent than with the Dostent or standard open stent. There were no complications with any of the three stents.

CONCLUSIONS

The newly designed antireflux stent is effective in relieving dysphagia caused by malignant cancer at the esophagogastric junction. The newly designed antireflux stent is significantly more effective in preventing gastroesophageal reflux than currently available antireflux stents.

A phase II trial of capecitabine in previously untreated patients with advanced and/or metastatic gastric cancer

BACKGROUND

Capecitabine (Xeloda) is a novel, oral, selectively tumor-activated fluoropyrimidine with proven activity in the treatment of advanced colorectal cancer. This trial was conducted to evaluate the efficacy, safety and feasibility of capecitabine in previously untreated patients with advanced and/or metastatic gastric cancer, with a view to replacing 5-fluorouracil (5-FU) in such patients.

PATIENTS AND METHODS

Forty-four patients received capecitabine 1250 mg/m2 twice daily (2500 mg/m2/day) for 14 days followed by 7 days of rest, for up to six cycles.

RESULTS

Capecitabine produced an objective response rate of 34% (all partial responses) and stable disease in 14 patients (30%). The median time to disease progression (TTP) was 3.2 months [95% confidence interval (CI) 2.7-6.4 months] and median overall survival was 9.5 months (95% CI 6.9-13.2 months). Hand-foot syndrome (HFS), nausea, anorexia, diarrhea and vomiting were the most common adverse events. While HFS was the most frequent grade 3/4 toxicity (National Cancer Institute Common Toxicity Criteria), only 9% of patients experienced grade 3 HFS. Severe myelosuppression was not reported during the study.

CONCLUSIONS

Capecitabine monotherapy is active and well tolerated as first-line therapy in patients with advanced/metastatic gastric cancer. Larger comparative trials investigating capecitabine-based combination regimens in patients with advanced gastric cancer are warranted.

Measurement of nuchal skin fold thickness in the second trimester: influence of imaging angle and fetal presentation

OBJECTIVE

To assess the effect of imaging angle and fetal presentation on the measurement of nuchal skin fold thickness (NFT) in the second trimester.

METHODS

Fetal NFT was prospectively measured in 921 women at 18-21 weeks' gestation. The population was divided into two groups according to fetal presentation. Group A comprised 643 fetuses in cephalic or transverse presentation and Group B comprised 278 fetuses in breech presentation. To determine whether there was a difference in NFT depending on imaging angle, in Group A the NFT was measured on the standard axial horizontal images and then on images obtained after moving the transducer about 30 degrees toward the occiput. In Group B an assessment was made as to whether NFT changed with fetal presentation. Initial measurements were made with the fetuses in breech presentation. Repeat NFT measurements were made after 15 min in 64 fetuses that had converted to cephalic or transverse presentation. Statistical analysis was performed using a paired t-test.

RESULTS

The mean NFT on the standard horizontal image was 5.2 mm, while that on the 30 degrees occiput image was 4.0 mm. The difference was significant (P < 0.001). One hundred and twenty-three (19.1%) fetuses had a NFT greater than 6 mm on the standard image, but only two (0.3%) had an NFT of > 6 mm on the 30 degrees occiput image. There were no chromosomal or structural abnormalities in the 123 fetuses in which the NFT was > 6 mm. The mean NFT of 64 fetuses in the breech presentation was 4.4 mm, while it was 3.9 mm when they had converted to other presentations. The difference was statistically significant (P = 0.001). In breech presentation, 13/64 (20.3%) fetuses had a NFT greater than 6 mm compared to only one (1.6%) fetus in the other presentations. There were no structural or chromosomal abnormalities in any fetus with a NFT > 6 mm in either group.

CONCLUSIONS

In this study the NFT measurement varied with scan direction and fetal presentation. To avoid falsely thickened NFT measurements the scan should be directed to image the posterior surface of the occipital bone. This can be achieved by scanning from a 30 degrees occipital direction. Also, NFT is greater in fetuses in a breech presentation. Attention to these details can reduce false-positive NFT measurements.

Provocation of kainic acid receptor mRNA changes in the rat paraventricular nucleus by insulin-induced hypoglycaemia

Hypoglycaemia induced by insulin injection is a powerful stimulus to the hypothalamic-pituitary-adrenal (HPA) axis and drives the secretion of corticotropin-releasing hormone and vasopressin from the neurones in the paraventricular nucleus (PVN), as well as the downstream hormones, adrenocorticotropic hormone and corticosterone. In some brain regions, hypoglycaemia also provokes increases in extracellular fluid concentrations of glutamate. Regulation of glutamatergic mechanisms could be involved in the control of the HPA axis during hypoglycaemic stress and one potential site of regulation might be at the receptors for glutamate, which are expressed in the PVN. Insulin (2.0 IU/kg, i.p.) or saline was administered to adult male Sprague-Dawley rats and the animals were sacrificed 30 min, 180 min and 24 h after injection. The amount of several kainic acid-preferring glutamate receptor mRNAs (i.e. KA2, GluR5 and GluR6) were assessed in the PVN by in situ hybridisation histochemistry. Injection of insulin induced a rapid fall in plasma glucose concentrations, which was mirrored by an increase in plasma corticosterone concentrations. KA2 and GluR5 mRNAs are highly expressed within the rat PVN, and responded to hypoglycaemia with robust increases in expression that endured beyond the period of hypoglycaemia itself. However, GluR6 mRNA is expressed in the areas adjacent to the PVN and hypoglycaemic stress failed to alter expression of this mRNA. These experiments suggest that kainic acid-preferring glutamate receptors are responsive to changes in plasma glucose concentrations and may participate in the activation of the PVN neurones during hypoglycaemic stress.

Congenital curly toe of the fetus

OBJECTIVES

To assess the prevalence, prenatal detection rate, and associated anomalies of congenital curly toe in an unselected obstetric population.

METHODS

Between September 2001 and July 2002, 1167 singleton fetuses in the second and third trimesters underwent routine prenatal ultrasound at our hospital. Congenital curly toe was diagnosed when the fourth or fifth toe was not fully delineated on the axial image with medial and plantar flexion on the coronal image. All neonates underwent a physical examination within 3 days after delivery. Radiography was performed on those infants with curly toe. We assessed the prevalence, prenatal detection rate, and associated anomalies of the condition.

RESULTS

There were 38 congenital curly toes among the 1167 neonates, yielding a total prevalence of 32.6 per 1000. In 26 of the 38 the fourth toe was curly and in 12 the fifth toe was curly. Of those in which the fourth toe was curly, 26.9% involved the right toe, 65.4% the left, and 7.7% involved both toes. For a curly fifth toe, these values were 25.0%, 16.7% and 58.3%, respectively. There was no associated structural anomaly, chromosomal abnormality, or syndrome in any case. Sixteen of the 38 curly toes were detected on prenatal ultrasound, including 13 of 26 with the fourth toe being curly and three of 12 with the fifth being curly.

CONCLUSIONS

Congenital curly toe is not an uncommon condition, and can be detected on the prenatal ultrasound. Although it usually appears as an isolated finding without clinical significance, thorough ultrasound examination of the fetus should be recommended.

Management of malignant strictures of the cervical esophagus with a newly-designed self-expanding metal stent

Recently, the use of self-expanding metal stents has become a well-established method of palliative treatment for stenotic malignant diseases in the middle and distal esophagus. However, published results on the use of self-expanding metal stents in cervical esophageal cancer are somewhat limited by a paucity of clinical details and experience. A new self-expanding esophageal metal stent with a short upper flange 0.7 cm in length was studied prospectively in order to assess its efficacy for palliative treatment. This report presents experience in three patients in whom this new stent was used in the treatment of cervical esophageal cancers. Stent placement was successful in all three patients, with no serious complications such as esophageal perforation, hemorrhage, or foreign-body sensation. All of the patients experienced rapid improvement in dysphagia and clinical symptoms. The newly designed self-expanding stent can be of value in the treatment of stenotic cervical esophageal cancer.

Through-the-scope double colonic stenting in the management of inoperable proximal malignant colonic obstruction: a pilot study

BACKGROUND AND STUDY AIMS

Particularly in cases of proximal colonic obstruction, the long distance and tortuosity of the bowel make it difficult for gastroenterologists and radiologists to advance the stent to the point of the obstruction. The purpose of this study was to evaluate the clinical usefulness and efficacy in preventing stent migration and tumor ingrowth of a new self-expanding through-the-scope (TTS) double colonic stent in the palliative management of patients with inoperable proximal malignant colonic obstruction.

PATIENTS AND METHODS

A total of seven patients (four men, three women; mean age 62 years, range 57 - 68) underwent placement of a newly developed through-the-scope self-expanding double colonic stent. The etiologies of the obstructions at the time of stent insertion were colonic adenocarcinoma (no previous surgical resection) in five cases and metastatic adenocarcinoma from gastric carcinoma in two. The locations of the obstructions were the ascending colon in three cases, the hepatic flexure in two, and the transverse colon in two. To prevent tumor ingrowth and stent migration, an uncovered Niti-S stent (Taewoong Medical Co., Ltd., Seoul, South Korea) was inserted into the stenotic area; a partly membrane-covered Niti-S stent was then again inserted into the stenotic area inside the uncovered Niti-S stent.

RESULTS

The self-expanding TTS double colonic stents were placed in the colon in seven patients with acute malignant colonic obstruction. Double stenting was successful in traversing the lesion in six of the seven cases. In one patient, the stent was not successfully placed across the lesion due to a very acute angle at the hepatic flexure. There were no significant complications relating to the insertion, with no clinical or radiographic evidence of perforation or bleeding during or after the procedures, and there were no cases of stent migration or tumor ingrowth during the mean follow-up period of 13 months.

CONCLUSIONS

Placement of these new self-expanding through-the-scope double colonic stents for the management of inoperable proximal malignant colonic obstruction is a feasible, effective, and safe form of palliative treatment for the prevention of stent migration and tumor ingrowth.

Virtual histology of colorectal lesions using laser-scanning confocal microscopy

BACKGROUND AND STUDY AIMS

Histological examination of gastrointestinal lesions is currently based on light-microscopic examination of thin-slice specimens, with hematoxylin and eosin staining. A study of the use of laser-scanning confocal microscopy (LCM) to obtain immediate microscopic images of untreated specimens for examining colorectal lesions was carried out. A probe-type LCM prototype endomicroscope that can be passed through the working channel of an endoscope has also been developed.

MATERIALS AND METHODS

The study materials consisted of colorectal lesions resected either endoscopically or surgically at Showa University Northern Yokohama Hospital. One hundred untreated specimens were examined using LCM. The histopathological findings in the lesions were seven cases of normal colonic mucosa, five hyperplastic polyps, 68 adenomas with low-grade dysplasia, 10 adenomas with high-grade dysplasia, and 10 adenocarcinomas. An argon laser beam with a wavelength of 488 nm was used for the LCM study. Observation of the resected normal colonic mucosa (in vitro) and the rectal mucosa of a healthy volunteer (in vivo) was possible using the endomicroscope. The LCM images for each specimen were compared with the hematoxylin-eosin-stained histopathological cross-sections.

RESULTS

The LCM images corresponded well with the conventional hematoxylin-eosin light-microscopic images. The nuclei were not visualized in normal mucosa or hyperplastic polyps. In adenomas with high-grade dysplasia and carcinomas, nuclei were more often visible than in adenomas with low-grade dysplasia. The rate of visualization of nuclei was significantly different ( P < 0.01) between these two groups (60.0 % vs. 10.3 %). In LCM images using endomicroscope, it was possible to recognize the orifices of the colonic glands and goblet cells both in vitro and in vivo.

CONCLUSIONS

Laser-scanning confocal microscopy provides immediate images that correspond well with those of hematoxylin-eosin staining. An improved probe-type LCM endomicroscope is being developed which should provide better histological images of colorectal lesions in vivo.

Development of virtual histology and virtual biopsy using laser-scanning confocal microscopy

The aim of this project is to acquire a direct image of histology from in vivo gastrointestinal mucosa. In other words, the task of 'endo-microscope' is to observe the cellular architecture of tissue in vivo during routine endoscopic examination. As the first step to completing this study, resected fresh specimens from the oesophagus. stomach and colon were examined by laser-scanning confocal microscopy (LCM) (Fluoview, Olympus, Tokyo). Fresh untreated mucosal specimens obtained by endoscopic pinch biopsy, polypectomy or endoscopic mucosal resection were collected and placed in normal saline and examined by LCM, collecting the reflective light of a 488-nm wavelength argon laser beam. As the second step, a probe-type LCM 'endo-microscope' was designed and applied to observe the human oral-cavity mucosa. The probe has 4.5-mm outer diameter and 20-cm length, which enables easy access to oral cavity mucosa. The estimated special resolution of the probe is 1-5 microm. A real-time microscopic image directly from ex vivo fresh specimens was acquired. The acquired LCM images corresponded well with the conventional H-E light microscopic images. Cell wall, nucleus and cytoplasm were simultaneously visualized by LCM scanning. This novel method enables serial imaginary microscopic sections on fresh specimens. In addition, a probe-type LCM 'endo-microscope' was designed and was applied to observe human oral cavity mucosa. Virtual histological images from the living oral squamous cell were successfully obtained. LCM images from ex vivo fresh specimens demonstrated the features of the H-E staining histological image. In the next step to accomplish our project, we developed a LCM probe with 4.5-mm outer diameter to obtain a virtual image of human oral cavity mucosa.

Oxidation of N-hydroxyguanidines by copper(II): model systems for elucidating the physiological chemistry of the nitric oxide biosynthetic intermediate N-hydroxyl-L-arginine

The redox chemistry of models of N-hydroxy-L-arginine, the biosynthetic intermediate in the synthesis of NO by the family of nitric oxide synthase enzymes, has been explored experimentally and theoretically. The oxidation of N-hydroxyguanidine model compounds by Cu(II) was studied as a means of establishing possible metabolic fates and intermediates of this important functional group. These studies indicate than an iminoxyl intermediate is formed and may be an important biological species generated from N-hydroxyguanidines including N-hydroxy-L-arginine.

Col2-GFP reporter mouse--a new tool to study skeletal development

Transgenic mice were generated that harbor a Col2-GFP reporter that marks chondrocytes and their immediate precursors during skeletal development. Cells engaged in chondrogenesis were identified by conventional fluorescence microscopy and confocal optical sectioning within their native environments in live embryos and in thick tissue slices. The use of these mice offers a novel approach for studying the role of chondrocytes in skeletal development.

Immunostimulatory DNA sequences inhibit respiratory syncytial viral load, airway inflammation, and mucus secretion

BACKGROUND

Immunostimulatory DNA sequences (ISS) activate the innate immune system to generate antiviral cytokines, such as IFN-gamma.

OBJECTIVE

This study investigated whether ISS could reduce viral load, mucus secretion, airway inflammation, and airway hyperreactivity to methacholine in a mouse model of respiratory syncytial virus (RSV) infection.

METHODS

Mice were pretreated with ISS 6 days before RSV infection, and lung indices of RSV viral load (viral titer and PCR), bronchoalveolar lavage fluid cytokines (IFN-gamma), airway inflammation (peribronchial inflammation and periodic acid-Schiff-positive mucus cells), and airway hyperreactivity (methacholine responsiveness) were assessed 4 to 6 days after RSV infection.

RESULTS

ISS induced the expression of the antiviral cytokine IFN-gamma in the lung, and this was associated with significantly reduced RSV viral titers, mucus secretion, and peribronchial inflammation. ISS reduced, but did not significantly inhibit, RSV-induced airway hyperreactivity to methacholine.

CONCLUSION

Because ISS induced significant levels of lung IFN-gamma, an immunization strategy based solely on the administration of IFN-gamma may be insufficient to inhibit RSV-induced airway hyperreactivity to methacholine, an endpoint important in the subset of RSV-infected subjects with asthma.