[Electroablation for the treatment of spontaneous pneumothorax using SOFT COAG electrosurgical output system]

We evaluated the validity of the SOFT COAG electrosurgical output system for the treatment of spontaneous pneumothorax. From April 2008 to May 2010, we compared 64 patients who had undergone bullae resection using endoscopic linear staplers, to 20 patients subjected to electroablation of the bullae using the SOFT COAG output system. There was no significant difference between the 2 groups in terms of operation time, bleeding, and mean duration of postoperative chest tube drainage. Postoperative recurrence was apparent in 3 cases for the linear stapler, and in 2 cases for SOFT COAG. Electroablation using the SOFT COAG output system was suggested to be valid for treatment of spontaneous pneumothorax.

Comparison of the Hafnium Diboride(0001) and Hafnium(0001) Surfaces

The surface properties of the (0001) surfaces of single crystals of hafnium and hafnium diboride are compared with a boride film deposited on the Hf(0001) surface. The surfaces were characterized with X-ray photoelectron spectroscopy (XPS) and low energy electron diffraction (LEED). Boron deposition was achieved through the thermal decomposition of diborane. The deposited boron reacts with the hafnium substrate to form HfB2 as determined by XPS and the HfB2 films were found to be epitaxial as determined by LEED. The epitaxial nature of the thin films was confirmed with X-ray diffraction. The epitaxial thin films of HfB2 on Hf(0001) display properties identical to those of the HfB2(0001) single crystal surface.

Phase I study of AMG 479, a fully human monoclonal antibody against the type 1 insulin-like growth factor receptor (IGF-1R), in Japanese patients (pts) with advanced solid tumors

318

Background: AMG 479 is a fully human monoclonal antibody against human IGF-1R that inhibits the survival and proliferative signals driven by IGF-1 and -2.

Methods: Patients (Pts) were enrolled into 1 of 3 dose cohorts (6, 12 or 20 mg/kg) of single-agent AMG 479 administered intravenously Q2W. Dose-limiting toxicity (DLT) was assessed for the first 28 days. The primary objectives were to assess the safety, tolerability, and pharmacokinetics (PK) of AMG 479 in Japanese pts with advanced solid tumors. An exploratory pharmacodynamic (PD) analysis was done to investigate the relationship between exposure and changes in the level of circulating factors in IGF-1R pathway (IGFBP-3 and total IGF-1).

Results: Nineteen pts with ECOG 0-1 (6 in cohort 1 and 3, 7 in cohort 2) received at least 1 dose of AMG 479. Median age was 58.0 years. Tumor types included: breast (4), gastric (3), rectal (2), NSCL (2), thymic (2), and other cancers (6). Enrollment has been completed; 5 pts remained on study as of 15 March 2010. No DLTs were observed. Three serious adverse events (SAE) were reported, only respiratory tract haemorrhage in a subject with thymic carcinoma was considered by the investigator to be related to AMG 479. The most common grade ≥3 AEs were neutropenia (21%), leukopenia (16%) and lymphopenia (11%). There was a trend of dose-dependency on severity of thrombocytopenia, but not on that of neutropenia. No neutralizing anti-AMG 479 antibodies were detected. PK was dose-linear and similar to PK in non-Japanese pts. Tumor response data were available for 17 pts. Stable disease (defined as a lack of progression at the first 8-week assessment) as best response was reported in 6 pts and progressive disease was reported in 11 pts. Exploratory PD marker analysis demonstrating exposure dependent changes will be presented.

Conclusions: AMG 479 up to 20 mg/kg was tolerable in Japanese pts with advanced solid tumors. The AE and PK profiles were similar to those previously observed in non-Japanese pts. An international phase 3 study in metastatic pancreatic cancer pts is planned based on the promising results from phase 1b/2 study (ASCO 2010, Abs 4035).

[Table: see text]

Mechanisms underlying ketamine-induced synaptic depression in rat hippocampus-medial prefrontal cortex pathway

The non-competitive N-methyl-D-aspartate NMDA receptor antagonist ketamine, a dissociative anesthetic capable of inducing analgesia, is known to have psychotomimetic actions, but the detailed mechanisms remain unclear because of its complex properties. The present study elucidated neural mechanisms of the effect of ketamine, at doses that exert psychotomimetic effects without anesthetic and analgesic effects, by evaluating cortical synaptic responses in vivo. Systemic administration (i.p.) of low (1 and 5 mg/kg), subanesthetic (25 mg/kg) and anesthetic (100 mg/kg) doses of ketamine dose-dependently decreased hippocampal stimulation-evoked potential in the medial prefrontal cortex (mPFC) in freely moving rats. The behavioral analysis assessed by prepulse inhibition (PPI) of acoustic startle response showed that ketamine (5 and 25 mg/kg, i.p.) produced PPI deficit. Thus, the psychotomimetic effects observed in ketamine-treated groups (5 and 25 mg/kg, i.p.) are associated with the induction of synaptic depression in the hippocampus-mPFC neural pathway. Based on these results, we further examined the underlying mechanisms of the ketamine-induced synaptic depression under anesthesia. Ketamine (5 and 25 mg/kg, i.p.) caused increases in dialysate dopamine in the mPFC in anesthetized rats. Moreover, the ketamine-induced decreases in the evoked potential, at the dose 5 mg/kg which has no anesthetic and analgesic effects, were indeed absent in dopamine-lesioned rats pretreated with 6-hydroxydopamine (6-OHDA; 150 μg/rat, i.c.v.). Ketamine (5 mg/kg, i.p.)-induced synaptic depression was blocked by pretreatment with dopamine D1 receptor antagonist SCH 23390 (10 μg/rat, i.c.v.) but not dopamine D2 receptor antagonist haloperidol (1.5 mg/kg, i.p.), suggesting that dopaminergic modulation mediated via D1 receptors are involved in the synaptic effects of ketamine. Furthermore, ketamine (5 mg/kg, i.p.)-induced synaptic depression was prevented also by GABAA receptor antagonist bicuculline (0.2 or 2 μg/rat, i.c.v.). These findings suggest that ketamine at the dose that exerts psychotomimetic symptoms depresses hippocampus-mPFC synaptic transmission through mechanisms involving dopaminergic modulation mediated via D1 receptors, which may lead to a net augmentation of synaptic inhibition mediated via GABAA receptors.

[Video-assisted thoracoscopic removal for mediastinal mature teratoma following extraction of cystic components]

Video-assisted thoracoscopic resection for mediastinal mature teratoma is sometimes converted to open thoracotomy. Because it has rich components including pancreatic tissue and dense adhesion, even when it is asymptomatic. Prior to thoracoscopic resection, extraction of the cystic components with the aid of a 20 Fr tube can provide a wide thoracoscopic view leading to easier complete removal. Between October 1998 and June 2008, 6 patients (1 man and 5 women) with benign mediastinal mature teratoma underwent the thoracoscopic operations. The average age was 36.3 (range, 24-54). The mean diameter was 9.0 cm (range, 5-11 cm). The mean operation time was 143 minutes and the mean blood loss was 103 ml. Neither complications nor tumor recurrences developed during the mean follow-up period of 3.4 years. The presented thoracoscopic surgery for benign mature teratoma is a feasible procedure.

[Atypical pulmonary carcinoid tumor with abnormal elevation of serum gastrin-releasing peptide precursor: report of a case]

We report a rare case of atypical pulmonary carcinoid tumor accompanied by elevation of serum gastrin-releasing peptide precursor (ProGRP). A 55-year-old male presented to our hospital with a history of bloody sputum. The level of serum ProGRP was elevated to 781 pg/ml (normal < 46 pg/ml). Chest computed tomography (CT) revealed a solitary pulmonary tumor in the left lower lobe with sub-carinal lymph node enlargement. Transbronchial lung biopsy showed a pulmonary carcinoid, therefore left lower lobectomy with mediastinal lymph node dissection was performed. ProGRP decreased to normal level 1 month after operation. Histopathological diagnosis showed an atypical pulmonary carcinoid tumor.

[Surgical outcome of tracheobronchial reconstruction for lung cancer]

We retrospectively evaluated the surgical outcome after sleeve lobectomy and pneumonectomy with tracheobronchial reconstruction for lung cancer. From 1993 to 2008, 46 patients with primary lung cancer underwent these surgical procedures. Seventeen patients (37%) received induction therapy, 15 received chemotherapy, while chemoradiotherapy or radiotherapy alone were received by one patient each. Sleeve lobectomy without carinal resection was performed in 41 patients. Carinal resection with 2 sleeve pneumonectomies was performed in 5 patients. There were no operative deaths. Bronchopleural fistula occurred in one patient, who required completion pneumonectomy. One patient presented local mucosal necrosis in the anastomotic site and was managed conservatively. Two patients had bronchial strictures as late complications and successfully dilated by a balloon using bronchoscopy. Overall 5-year and 10-year survival rates were 54% and 48%, respectively. No recurrence developed at any anastomotic site. The results showed that sleeve lobectomy and pneumonectomy with tracheobronchial reconstruction can be performed with low mortality and bronchial anastomotic complication rates. As well, local control of the tumor was satisfactory.

Surface phonon dispersion of [Formula: see text]

Surface phonon dispersion of [Formula: see text]-B was measured using high resolution electron energy loss spectroscopy. With adsorption of excess boron, an ordered structure of [Formula: see text] is found at the B coverage of about 0.8 ML. Another structure of 4 × 4 appears mixed with the [Formula: see text] phase at a higher coverage. Using the phonon dispersion relations, the [Formula: see text] structure is inferred to consist of a planar boron network, as in the bulk. In contrast to the NbB(2)(0001) case, no surface core level shift of B 1s is observed on this [Formula: see text] surface, suggesting that the planar boron is not outermost.

[Surgical treatment of an endobronchial inflammatory pseudotumor]

A 62-year old man with an abnormal chest radiograph was referred to our hospital for further evaluation. Chest computed tomography (CT) revealed a 3.0 cm tumor on the hilum of the right S3 segment. Bronchofiberscopic findings showed a polypoid tumor arising from right B3. Brushing cytology under bronchofiberscopy couldnot diagnose the tumor. The tentative preoperative diagnosis was primary lung cancer or a metastatic lung tumor. To confirm the histopathological diagnosis, a right upper lobectomy was performed. Intraoperative histopathological examination showed a pulmonary inflammatory pseudotumor.

Hypermethylation of multiple genes as clonal markers in multicentric hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is highly malignant and prone to multicentric occurrence. Differentiation between a true relapse of HCC and a second primary tumour appearing is of clinical importance. At this point, no convenient method is available to determine the origin of these HCCs. Tissue samples were obtained from 19 patients and analysed for the promoter hypermethylation status of multiple tumour suppressor genes (p16, DAP-Kinase, MGMT, GSTP1, APC, RIZ1, SFRP1, SFRP2, SFRP5, RUNX3, and SOCS1) using methylation-specific PCR (MSP). Methylation status was used to determine tumour clonality. In each of the 19 cases, at least one tumour was recognised as having an aberrantly methylated gene. The frequency of the methylation in tumour tissue was 57.1% in p16, 2.4% in DAP-kinase, 23.8% in GSTP1, 90.5% in APC, 45.2% in RIZ1, 64.3% in SFRP1, 59.5% in SFRP2, 28.6% in SFRP5, 47.6% in RUNX3, and 54.8% in SOCS1, while in MGMT, no aberrant methylation was detected. The methylation status of these genes was assessed using MSP as being either positive or negative, and was used to determine the tumour clonality. The clonality of every tumour could be decided even with lesions that could not be judged by clinical diagnosis or by another molecular method (mt DNA mutation). Determining the methylation status of multiple genes in multicentric HCC was useful as a clonal marker and provided useful information for characterising the tumour. From our findings, multicentric HCCs tend to occur more independently than metastatically from the original tumour. Expanded study should be pursued further for a better understanding of the molecular mechanism of hepatocarcinogenesis.

[Extrapleural pneumonectomy with wide resection of the chest wall, diaphragm, and pericardium for malignant pleural mesothelioma]

Malignant pleural mesothelioma is an aggressive neoplasm with poor prognosis. Extrapleural pneumonectomy is performed as surgical therapy. It is difficult to obtain enough range of view at costophrenic angle. We adopt extrapleural pneumonectomy with wide resection of the chest wall, diaphragm, and pericardium to remove the main lesion at the costophrenic angle and report 6 cases received this surgical procedure. With this procedure, a wide view of costophrenic angle and costal-pericardial angle can be obtained, and the resection margin can be placed outside the chest wall, costophrenic angle and costal-pericardial angle, which enables complete resection of masses at the costophrenic and costal-pericardial angles. Furthermore, extrapleural pneumonectomy with wide resection of the chest wall minimizes the resulting dead space, thereby minimizing the risk of postoperative hemorrhage and empyema. We consider that this procedure can be applied for malignant mesothelioma patients, especially those who have pleural masses at costophrenic angle.

Unusual evolution of the conduction-electron state in CexLa1-xB6 from non-Fermi liquid to Fermi liquid

We report unusual evolution of the conduction-electron state in the localized f electron system CexLa1-xB6 from normal electron state to heavy Fermi liquid (FL) state through local FL and non-FL states with increasing Ce concentration and/or with increasing magnetic field. The effective mass of quasiparticle or the coefficient A of T2 term of resistivity is found to increase divergently near the boundary between FL state and non-FL state. The features of the non-FL state are also different from those of the typical non-FL systems previously observed or theoretically predicted.

Frequent immune response to a melanocyte specific protein KU-MEL-1 in patients with Vogt-Koyanagi-Harada disease

AIM

To isolate autoantigens possibly involved in the pathogenesis of Vogt-Koyanagi-Harada (VKH) disease.

METHODS

Autoantigens recognised by immunoglobulin G antibodies (IgG Ab) in sera from VKH patients were isolated by screening the lambda phage cDNA libraries made from melanocytes and a highly pigmented melanoma cell line with the patients' sera. Presence of IgG specific for the autoantigens in sera from patients with various panuveitis and healthy individuals was evaluated. Relation between the specific IgG and various clinicopathological features was examined.

RESULTS

KU-MEL-1 was found to be one of the 81 isolated positive clones representing 35 distinct genes, which is a previously isolated melanoma antigen preferentially expressed in melanocytes. The IgG Ab specific for KU-MEL-1 was detected in sera from patients with VKH in significantly higher amounts than in sera from patients with Behçet's disease, sarcoidosis, and from healthy individuals. Positive serum KU-MEL-1 Ab was significantly associated with HLA-DRB1*0405 and male VKH patients.

CONCLUSION

KU-MEL-1 was identified as a new autoantigen for VKH. The highly frequent induction of IgG Ab for KU-MEL-1 in HLA-DRB1*0405 positive VKH patients may suggest the possible involvement of KU-MEL-1 specific CD4(+) T cells in the pathogenesis of VKH, suggesting the possible use in the development of diagnostic and therapeutic treatments for VKH patients.

[Prognosis of patients after resection for lung cancer with intrapulmonary metastasis in different lobes]

BACKGROUND

The prognosis of lung cancer patients with intrapulmonary metastasis in different lobes (pm2) is poor. However, some patients achieve long-term survival. We retrospectively investigated the prognosis of resected primary lung cancer patients with pm2.

METHOD

Among 845 patients with primary lung cancer who underwent complete resection from 1984 to 2003, 14 cases that had lung cancer with pm2 were evaluated about prognostic factors.

RESULTS

The overall 5-year survival rate was 9.5%. The analysis of survival curve based on clinicopathological factors (surgical procedure, histology, tumor size, lymph nodal metastasis, pleural invasion, pleural dissemination and number of pm2) revealed that bronchioloalveolar carcinoma (BAC), the absence of pleural invasion and the absence of pleural dissemination are better prognostic factors.

CONCLUSION

Lung cancer patients with pm2 whose lesions show BAC histology, the absence of pleural invasion or pleural dissemination may achieve long-term survival and could be candidates for surgical treatment.

Inhibition of IL-6 overproduction by steroid treatment before transsternal thymectomy for myasthenia gravis: does it help stabilize perioperative condition?

Overproduction of interleukin (IL)-6 plays an important role in the pathophysiology of myasthenia gravis (MG), and thymectomy can cause myasthenic crisis because of surgically induced overproduction of IL-6. Preoperative steroid therapy is beneficial in preventing MG crisis during the perioperative period. The purpose of this study was to clarify the effect of preoperative steroid therapy on proinflammatory mediators during the perioperative period of transsternal thymectomy for MG. The study group comprised 20 consecutive MG patients undergoing transsternal thymectomy during the period March 2002 through March 2004. Seventeen of these patients received dose-escalated steroid therapy before thymectomy (steroid treatment group) and three did not (non-steroid treatment group). Serum concentrations of C-reactive protein (CRP) and IL-6 were determined during the perioperative period; clinical outcomes were reviewed, and the results were compared between the two groups. Peak serum IL-6 and CRP concentrations were significantly lower in the steroid treatment group than in the non-steroid treatment group. Amongst perioperative variables subjected to multiple regression analysis, preoperative steroid treatment were found to be the most significant independent predictor of inhibited IL-6 production on postoperative day 1. No postoperative respiratory failure occurred in the steroid treatment group, but it did occur in the non-steroid treatment group. Preoperative steroid therapy can ameliorate IL-6 overproduction and may help stabilize the patient's postoperative condition.

A randomised, placebo controlled clinical trial of the aldose reductase inhibitor CT-112 as management of corneal epithelial disorders in diabetic patients

AIM

To evaluate the efficacy of topical aldose reductase inhibitor CT-112 (5-[3-ethoxy-4-pentyloxyphenyl]-2,4-thiazolidinedione) on corneal epithelial barrier function in diabetic patients.

METHODS

This was a prospective, randomised, double masked placebo controlled study. 34 eyes of 34 diabetic patients were randomly assigned treatment with 0.25% eye drops of CT-112 (n = 22) or a placebo (n = 12) four times a day for 8 weeks. Corneal fluorescein staining and corneal sensation were examined before treatment as well as 4 and 8 weeks after administration. Corneal epithelial permeability to fluorescence was measured with an anterior fluorophotometer.

RESULTS

Average scores of superficial punctate keratopathy and corneal sensitivity did not differ significantly between the two groups at any time. Whereas average fluorescein concentrations did not differ significantly for the CT-112 and placebo groups before treatment, they did differ significantly 4 and 8 weeks after treatment (4 weeks, p = 0.0327; 8 weeks, p = 0.0143).

CONCLUSION

The topical aldose reductase inhibitor, CT-112 improves the corneal epithelial barrier function in diabetic patients.

[Non-tuberculous mycobacterial infection along the staple-suture line after segmentectomy for small peripheral lung cancer; report of a case]

A 60-year-old non-immunocompromised man who had undergone right upper lobectomy and subsequent left superior segmentectomy for small peripheral lung cancers (stage I well-differentiated adenocarcinomas) 2 years earlier, was referred to us for further investigation of an asymptomatic abnormal shadow observed on a chest radiograph. Chest computed radiography showed air-space consolidation along the staple-suture line associated with the left superior segmentectomy, the abnormality was 4 x 5 x 5 cm. Completion lower lobectomy was performed because transbronchial biopsy did not provide for a definite diagnosis. Pathological examination revealed a large granuloma infected by Mycobacterium intercellulare. The lung parenchyma may be exposed along the staple-suture line and somewhat vulnerable to infection in cases of partial pulmonary resection. We should be aware of this possibility after lesser pulmonary resection for small peripheral lung cancer.

Phonon dispersion curves of a BC3 honeycomb epitaxial sheet

The entire phonon-dispersion curves along the Gamma-M direction of a BC3 honeycomb sheet have been determined both experimentally and theoretically for the first time. Most of the observed curves agreed with the theoretical ones calculated on the basis of ab initio theory. From the stretching force constants of the nearest-neighbor C-C and B-C bonds, together with that of the B-B bond, we clarified the characteristic feature of the C-C and B-C bonds. From the experimental and theoretical results, we discussed the possibility of high T(c).

[Chest wall epithelioid sarcoma]

Two relatively rare cases of epithelioid sarcoma located in the chest wall are reported herein. The first was a tumor, 3.8 x 5.5 x 2.4 cm in size, originating in the left erector spinae muscle of a man 64 years of age. He experienced local recurrence 3 times even after wide resections, and he died of systemic metastasis 22 months after the initial surgery. The second was a tumor, 2.2 x 2.0 x 1.5 cm in size, originating in the left seventh intercostal muscle of a woman 24 years of age. A metastatic tumor occurred in the same muscle, and wide resection including the seventh and eighth intercostal muscles was performed. There has been no recurrence for 1.5 years since surgery. Metastasis of chest wall epithelioid sarcoma in the muscle in which the primary lesion resides should be considered, even if the primary lesion is small.