Identification of small molecular compounds and fabrication of its aqueous solution by laser-ablation, expanding primordial cartilage

OBJECTIVE

The discovery of small molecular compounds that expand cartilage is needed. We searched for small molecular compounds that expand cartilage or enhance the actions of bone morphogenetic proteins (BMPs) on cartilage.

DESIGN

Metatarsal primordial cartilage explants prepared from 14.5 days postcoitum (d.p.c.) mouse embryos were organ-cultured in the presence or absence of BMPs and/or 4-(5-Benzol[1,3]dioxol-5-yl-4-pyrldin-2-yl-1H-imidazol-2-yl)-benzamide hydrate (BPIB) and its related molecules. The perichondrium was removed from some of the cartilage explants by partial digestion with collagenase. BPIB aqueous solution was prepared by fragmenting BPIB crystals in water with laser irradiation and then added to cartilage explants in organ culture.

RESULTS

We found that small molecular compounds, BPIB, available as SB431542 from Sigma and its related molecules, expand primordial cartilage explants in organ culture. These molecules are transforming growth factor-β (TGF-β) inhibitors, and the addition of excess TGF-β reduced cartilage expansion induced by these molecules. The co-administration of BPIB and BMPs synergistically expanded cartilage explants. Removal of the perichondrium abolished BIPB-induced cartilage expansion but not BMP-induced cartilage-expansion, suggesting that BPIB, but not BMPs, expands cartilage through the perichondrium. Furthermore, we used the laser-ablation technique to generate BPIB aqueous solution in the presence of 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) without the use of hazardous dimethyl sulfoxide (DMSO). The laser-ablation-generated BPIB aqueous solution was more stable, expanded cartilage explants more effectively than BPIB colloidal solution prepared with DMSO, and synergistically enhanced BMP-induced cartilage expansion.

CONCLUSIONS

A small molecular compound, BPIB, expands primordial cartilage explants. A BPIB aqueous solution was created by laser-ablation without using DMSO and proved to be biologically active.

Periodontal bacteremia and various vascular diseases

BACKGROUND AND OBJECTIVE

Weak oral bacteria, such as periodontal bacteria, have been found in various vascular lesions, including atheroma, the thrombus of the occluded artery of Buerger's disease, the abdominal aortic aneurismal wall and varicose veins. Serum titer levels of each bacterium are now available and have shown a significant relationship between severity and individual differences.

MATERIAL AND METHODS

The Medline and Tokyo Medical and Dental University databases were searched to identify the literature currently available on oral bacteria and vascular diseases.

RESULTS

It is estimated that lymph vessel openings trap bacteria en route from the mouth to the bloodstream and then carry them to the vein of the venous angle near the supraclavicular area. In the case of periodontal bacteria, a typical bacterium, such as Porphyromonas gingivalis, strongly activates platelets and makes them mass, including the bacteria without phagocytosis. Simultaneously, cytokines and serotonin are discharged. Platelet engulfment was clearly demonstrated by electron microscopy analysis. An animal study using rats showed the formation of a small arterial thrombus after continuous intravenous infusion of P. gingivalis for 2-4 wk.

CONCLUSION

Weak oral bacteria, such as periodontal bacteria, may play an important role in the development of various vascular diseases, such as Buerger's disease, atherosclerosis and varicose veins, through bacteremia.

Solubility of Pu and rare-earths in LiCl-Li2O melt

The solubility of Pu and rare-earths (REs) were measured in LiClLi2O melt where individually the oxides precipitated. The solubility of Pu(III) was measured at 923 K as a function of Li2O concentration. After every addition of Li2O to increase the Li2O concentration in the melt, the Pu concentration increased and showed a saturation in several hours. The stepwise variation means that the Pu concentrations at the saturation are regarded as the Pu solubility at the respective Li2O concentrations. The solubility of Nd(III), Gd(III), Pu(IV), and Ce(IV) were also measured as a fanction of Li2O concentration, and all of them increased with increased Li2O concentration. Especially, the solubility of the trivalent Pu and REs were related almost proportionally with the Li2O concentration. The solubility of La(III) and Pr(III) were measured in molten LiCl saturated with Li2O between 883 and 973 K. The logarithmic solubility was related linearly with the reciprocal temperature. The systematic measurement indicated that the solubility was higher for the element with a larger ionic radius as to the trivalent Pu and REs.

Enhanced adhesion of early endothelial progenitor cells to radiation-induced senescence-like vascular endothelial cells in vitro

The effects of ionizing radiation (IR) on tumor neovascularization are still unclear. We previously reported that vascular endothelial cells (ECs) expressing the IR-induced senescence-like (IRSL) phenotype exhibit a significant decrease in angiogenic activity in vitro. In this study, we examined the effects of the IRSL phenotype on adhesion to early endothelial progenitor cells (early EPCs). Adhesion of human peripheral blood-derived early EPCs to human umbilical vein endothelial cells (HUVECs) expressing the IRSL phenotype was evaluated by an adhesion assay under static conditions. It was revealed that the IRSL HUVECs supported significantly more adhesion of early EPCs than normal HUVECs. Expressions of ICAM-1, VCAM-1 and E-selectin were up-regulated in IRSL HUVECs. Pre-treatment of IRSL HUVECs with adhesion-blocking monoclonal antibodies against E-selectin and VCAM-1 significantly reduced early EPC adhesion to IRSL HUVECs, suggesting a potential role for the E-selectin and VCAM-1 in the adhesion between IRSL ECs and early EPCs. Therefore, the IRSL phenotype expressed in ECs may enhance neovascularization via increased homing of early EPCs. Our findings are first to implicate the complex effects of this phenotype on tumor neovascularization following irradiation.

Association between periodontitis and anti-cardiolipin antibodies in Buerger disease

AIM

Anti-cardiolipin (CL) antibodies can be induced in Buerger disease (BD), an inflammatory occlusive disorder affecting peripheral blood vessels, in response to bacteria bearing homology to the TLRVYK peptide of a phospholipid-binding plasma protein beta-2-glycoprotein I. TLRVYK homologies are present in Porphyromonas gingivalis (TLRIYT) and Treponema denticola (TLALYK). This study investigated the association between periodontal infection and anti-CL antibodies in BD patients.

MATERIAL AND METHODS

Periodontal conditions were examined in 19 BD patients and 25 systemically healthy control subjects. All subjects were heavy smokers. Serum anti-CL, anti-TLRVYK, anti-TLRIYT, and anti-TLALYK antibodies were assessed using the enzyme-linked immunosorbent assay.

RESULTS

BD patients had a significantly higher prevalence of periodontitis, more severe periodontal destruction and increased titres of serum anti-CL, anti-TLRVYK, anti-TLRIYT, and anti-TLALYK antibodies compared with healthy subjects. The levels of anti-CL antibodies positively correlated with those of the three anti-peptide antibodies. Anti-CL antibody titres were significantly associated with the percentage of sites with clinical attachment level >or=4 mm in BD patients.

CONCLUSION

Elevated anti-CL antibody levels were associated with periodontal destruction in BD patients. Periodontopathic bacteria may serve as exogenous antigens that stimulate the anti-CL antibody production through molecular mimicry between the bacterial peptides and a host plasma protein.

Efficacy of the transfer function index using the pulse volume recording as a parameter to assess intermittent claudication

PURPOSE

The aim of this study was to elucidate whether the ankle brachial pressure index (ABPI) or transfer function index (TFI) was useful as an alternative parameter to the treadmill-walking test using near-infrared spectroscopy (NIRS) in evaluating muscle ischemia for patients with intermittent claudication (IC).

METHODS

In 155 claudicants, the treadmill-walking test using NIRS was performed to calculate the recovery ability index (=recovery time/walking time). The ABPI and TFI were measured at the calf (TFI(calf)) and ankle (TFI(ankle)) using pulse volume recording. The area under the curve (AUC) was calculated from the receiver operating characteristic (ROC) curve and cutoff value was determined using crossing point of the ROC curve with a diagonal line.

RESULTS

In the nondiabetics, AUCs were 77.3%, 80.0%, and 76.0% in the ABPI, TFI(calf), and TFI(ankle), respectively, which were not different significantly. In the diabetics, the AUC of TFI(calf) was 77.9%, which was different significantly from those of the other indices such as the ABPI or TFI(ankle) showing 66.2% or 68.1%. The cutoff value of ABPI indicating moderate or severe IC was 0.75 in the nondiabetics whereas that of TFI(calf) was 0.85 in the diabetics.

CONCLUSION

TFI(calf) was useful to distinguish moderate or severe IC from mild IC in diabetic patients even if the ABPI was sufficient in nondiabetic patients.

Daily concurrent chemoradiotherapy with docetaxel (DOC) and cisplatin (CDDP) using superselective intra-arterial infusion via superficial temporal artery for T3 and T4 head and neck cancer: Possibility of organ preservation in advanced head and neck cancer

e17020

Background: Superselective intra-arterial chemotherapy via a superficial temporal artery (HFT method) has become feasible for daily concurrent radiotherapy and chemotherapy for head and neck cancer. We used this novel method for head and neck cancer, and evaluated its efficacy. Treatment consisted of superselective intra-arterial infusions (docetaxel total 60 mg/m2, cisplatin total 100 mg/m2) and concurrent radiotherapy (total 40 Gy) for 4 weeks as preoperative therapy. Thirty-five patients with stage III and IV oral cancer underwent surgery after this treatment, of whom pathological complete response (CR) was obtained in 31 (88.6%). In this study, the possibility of organ preservation in cases of advanced head and neck cancer was evaluated based on this result. Methods: Eligibility included T3 or T4 squamous cell carcinoma of head and neck. Treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m2, cisplatin, total 150 mg/m2) and concurrent radiotherapy (total 60 Gy) for 6 weeks. Organ preservation was demonstrated in cases when the biopsy specimen of the primary lesion showed grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) after the completion of all treatments. Results: Thirty two patients (21 male and 11 female) were eligible for evaluation. A relapse was detected in 11 cases (34.4%): primary sites, 7 cases (21.9%); cervical lymph node and distant metastasis, 2 cases (6.3%); primary site and distant metastasis, 1 case (3.1%); cervical lymph node, 1 case (3.1%). Seven patients (21.9%) died. The Kaplan-Meier method was used to estimate the 3-year and 5-year survival rates, which were 81.3% and 78.1%, respectively, and the 3-year and 5-year locoregional control rates, which were 68.8% and 64.5%, respectively. No major complications such as cerebral infarctions or other neurological complications developed in any patient. Conclusions: These results of the present study demonstrate that this is a promising new treatment strategy for advanced head and neck cancer, thus contributing to patients’ QOL.

No significant financial relationships to disclose.

[Thoracic aortic aneurysm due to giant cell arteritis without any specific symptom]

A 76-year-old female was admitted to our hospital for investigation and treatment of aortic regurgitation. She was found to have an ascending aortic aneurysm extending to the proximal arch. She had not suffered from any symptoms except chest discomfort. Total arch replacement and aortic valvoplasty were performed under cardiopulmonary bypass. Pathological examination of the aneurismal wall revealed giant cell arteritis. Aortic aneurysm due to giant cell aortitis without such symptom as temporal pain or polymyalgia was considered to be very rare.

[Gigantic coronary aneurysm arisen from coronary fistula between the left circumflex artery and the left ventricle]

A 71-year-old male was referred to our hospital due to abnormality detected by a chest roentgenogram. He had no symptoms except for slight chest oppression. He was found to have a giant coronary aneurysm. It was originated from a coronary artery (left circum flex branch) left ventricular fistula. The orifice of this fistula to the left ventricle was also dilated and formed diverticulum. Ligation of the feeding coronary branch, closure of the aneurysmal fistula in the left ventricular wall and aneurysmectomy were performed under cardiopulmonary bypass. Postoperative course was uneventful. A giant aneurysm originated from a coronary-left ventricular fistula was considered to be very rare.

Buerger disease, smoking, and periodontitis

Weak oral bacteria such as periodontal bacteria or Chlamydia pneumoniae have been observed in various arterial and venous lesions with epidemiological data reported prior to the discovery of bacterial invasion into vessels. Rich lymph vessels easily bring the bacteria from the mouth to the neck and the venous angle, which is directly open to the blood vessels. Periodontal bacteria travel within platelets and Chlamydia pneumoniae can be carried by monocytes. The transportation system of other weak oral bacteria have not been determined. Periodontal bacteria, especially P. gingivalis aggregate platelets and form thrombi. At the same time, secretions such as serotonin, various cytokines, and adhesion factors also appear in the blood. The characteristics of arterial lesions are dependent on the age of the patient and the condition of the endothelial cells. In young patients, infectious incidents occur due to embolic mechanisms in Buerger disease or adhesion to the superficial veins valves in varicose veins. In older patients, incidents result in adhesion in the proximal aorta, coronary arteries, or large arteries. The hypothesis here unifies the evidence on vessel lesion development and explains the possible discrepancy between vascular diseases.

Effects of cilostazol and k-134 on reconstructive surgery using prosthetic grafts in the abdominal aorta of beagle dogs

Problems associated with prosthetic graft replacement are stenosis at the anastomosis site and thrombus formation on the inner surface. Cilostazol is known to have antiplatelet activity and inhibit vascular smooth muscle cell proliferation and neointima thickening. A cilostazol derivative, (-)-6-[3-[3-cyclopropyl-3-[(1R,2R)-2-hydroxycyclohexyl]ureido]-propoxy]-2-(1H)-quinolinone (K-134), has more potent anti-platelet activity and anti-neointimal thickening activity than cilostazol in the in-vitro platelet aggregation and in-vivo anti-hyperplastic activity assay. The aim of this study was to investigate effects of cilostazol and K-134 on thrombus formation and neointimal thickening at the site of prosthetic graft replacement. Beagle dogs underwent infrarenal abdominal aortic resection with straight Dacron graft replacement, which were allocated to the control, cilostazol, and K-134 groups. Two dogs were dead without confirming the cause of death. After 6 months, all dogs were necropsied. All prosthetic grafts were patent in each group. Ratios of red thrombus to prosthetic graft area were 0.3+/-6.4%, and 3.3+/-4.5% in the cilostazol and K-134 groups, respectively, which were significant different from that in the control group (24.4+/-16.8%). However, no clear difference was seen among the 3 groups with respect to neointimal thickness (control group, 0.70+/-0.13 mm; cilostazol group, 0.59+/-0.14 mm; K-134 group, 0.67+/-0.14 mm). Cilostazol and K-134 significantly inhibited thrombus formation on the inner surface of the prosthetic graft at 6 months after graft replacement. Neointimal thickening on the inner surface was slight even in control-group animals, and the effects of cilostazol and K-134 on such thickening were unclear.

Endovascular Treatment of Vertebral Artery Dissecting Aneurysms using Stents

SUMMARY

We report on five patients who were treated by stent-assisted coil embolization to preserve the patency of the parent artery. Three patients presented with subarachnoid haemorrhage and two with ischemic symptoms. Four patients were treated with stenting and then followed by coil embolization of the aneurysmal dilatation, and the remaining patient with stenting alone because the aneurysmal dilatation was too small to insert coils. Complete obliteration of the aneurysm was achieved in three patients, but in one patient an aneurysmal rupture occurred during the insertion of the first coil and a parent artery occlusion was therefore performed. In the one patient treated with stenting alone, a small aneurysmal dilatation remained patent, but complete obliteration was confirmed by the follow-up angiography. Subsequent subarachnoid haemorrhage was not observed in any of the patients. Four of them achieved a good recovery, but one patient suffered severe disability due to the aneurysmal rupture during the procedure. Parent artery occlusion remains the treatment of choice. Stentassisted coil embolization has a higher risk of rupture than does the parent artery occlusion during the procedure. Furthermore, recanalization or subsequent subarachnoid haemorrhage is more likely to occur in a stent-assisted coil embolization after the procedure. However, this procedure, which can maintain the patency of the parent artery, will become an alternative for patients who are at a high risk of developing ischemic symptoms in parent artery occlusions.

An ultrastructural study of Porphyromonas gingivalis-induced platelet aggregation

One of the major pathogens of periodontitis, Porphyromonas gingivalis (P. gingivalis), has the ability to aggregate human platelets. To investigate the interaction between P. gingivalis and human platelets in platelet rich plasma (PRP), platelet aggregation was measured by an aggregometer based on laser light scattering (LS) methods, and an ultrastructural study was performed using electron microscopy. A sharp and rapid increase of small-sized platelet aggregates was observed immediately after the addition of P. gingivalis to PRP, followed by the formation of medium- and large-sized aggregates in 2-3 min. In contrast, when Staphylococcus aureus (S. aureus) was used in the control experiment, only a slight increase in small-sized aggregates was detected. By electron microscopy, discoid-shaped platelets were observed prior to adding P. gingivalis. By 5 min after the addition of the bacteria, enormous platelet aggregates were observable. Most of the P. gingivalis were present between the adherent platelets, while some were internalized in platelet engulfment vacuoles. In contrast, when washed platelets were incubated with the bacteria under a non-stirring condition to prevent platelet aggregation, and stained with ruthenium red (RR) as an electron dense tracer of the cell surface including the open canalicular system (OCS), both RR-positive and -negative vacuoles containing P. gingivalis were identified in the activated platelets. Thus, this observation suggests that P. gingivalis residing in the RR-negative vacuoles is incorporated into the platelet cytoplasm by phagocytosis.

Microbiological evaluation after gastrectomy and reconstruction for gastric cancer

The purpose of this study was to evaluate microbial flora in the mucosa of reconstructed organs after gastrectomy for gastric cancer and improve postoperative quality of life by treating the flora. The number of aerobes was significantly higher in the gastric remnant in the proximal gastrectomy-jejunal pouch interposition group (n=8) than the distal gastrectomy-Billroth II reconstruction (G-BII) group (n=2) or the pylorus-preserving gastrectomy (PPG) group (n=8). The mean number and positive rate of anaerobes tended to be higher in jejunal pouch reconstruction groups. No Helicobacter pylori were detected in any specimens after the G-BII and jejunal pouch reconstruction. However, the gastric remnant and duodenum in the distal gastrectomy-Billroth I reconstruction group (n=5; positive rate of 80% and 20%, respectively) and the PPG group (positive rate of 63% and 25%, respectively) showed H. pylori. We concluded that more anaerobes tended to grow in the mucosa of reconstructed organs after jejunal pouch reconstruction than other procedures. Some patients after jejunal pouch reconstruction worried about their halitosis. Therefore, elimination of anaerobes may relieve it and improve postoperative quality of life.

Detection of venous emboli using Doppler ultrasound

OBJECTIVES

To detect emboli in the venous system using a Doppler ultrasound device with embolism detecting software.

METHODS

Pulmonary embolism (PE) was induced by injecting thrombus through the iliac vein of castrated swine under general anaesthesia. Data recorded from the Doppler system were analysed for high intensity transient signals (HITS) using receiver operating characteristic curves. Four different thrombi (5 or 10mm long and 3 or 5mm in diameter) were then injected to assess the quantitative analysis.

RESULTS

Thrombus could be detected in the venous system by the Doppler ultrasound device with an embolism detecting function. Appropriate confidence level was 60%. If thrombus were assumed to travel at the maximum flow rate (30 cm/s) in the inferior vena cava, the estimated embolism size was 10.4 S.D. 2.8mm for 3mm and 10.8 S.D. 4.9 mm for 5mm, both of which were close to 10mm.

CONCLUSION

Thrombi could be detected as high intensity transient signals in the venous system. The appropriate confidence level was 60%. The size of emboli can be estimated if they are more than 3mm in diameter when the venous flow rate is 30 cm/s or less. Our results suggest that it may be possible to detect emboli in the subclavian vein, axillary vein or inferior vena cava in clinical cases.

Periodontitis may increase the risk of peripheral arterial disease

OBJECTIVES

The aim of this case control study was to evaluate whether periodontitis was associated with peripheral arterial disease (PAD).

SUBJECTS AND METHODS

Twenty-five patients diagnosed with aorto-iliac and/or femoro-popliteal occlusive disease and thirty-two generally healthy control subjects were enrolled in this study. Polymerase chain reaction (PCR) was used to identify Porphyromonas gingivalis, Treponema denticola, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Cytomegalovirus (CMV), Chlamydia pneumoniae, and Helicobacter pylori in tissue specimens taken from the anastomotic site of distal bypasses. Periodontal status was evaluated; serum IgG titres against the four listed bacteria were measured.

RESULTS

Periodontopathic bacteria were detected in 13/25 (52%) atherosclerotic specimens. CMV or C. pneumoniae was detected in 1/25 (4%) specimens; H. pylori was not detected from any of these specimens. Fontaine grade III or IV patients showed higher detection frequency of P. gingivalis than Fontaine grade II patients (57.1% vs 22.2%, P=0.09). After adjusting for age, gender, diabetes and smoking, periodontitis increased 5-fold the risk of having PAD (OR 5.45). There were preliminary indications that periodontitis was associated with increased serum IL-6 and TNF-alpha concentrations.

CONCLUSIONS

This study suggests that periodontitis may be associated with an increased risk of PAD. This association could result from the increased concentration of serum inflammatory cytokines in those with periodontitis.

Elevated IgG titers to periodontal pathogens related to Buerger disease

BACKGROUND

Periodontal pathogens were frequently detected in the occluded arteries of Buerger disease patients, hence we hypothesized that the infection from periodontal pathogens may be associated with Buerger disease.

METHODS

We investigated periodontal status using various clinical parameters and serum IgG antibody levels against T. denticola, P. gingivalis, A. actinomycetemcomitans and P. intermedia in nineteen Buerger disease patients and fifteen control subjects. The results were statistically analyzed.

RESULTS

The prevalence of periodontitis and the percentages of probing sites with PD> or =4 mm and CAL> or =4 mm were significantly higher in the patient group (P<0.001, P=0.016, and P<0.001, respectively). Patients had significantly higher serum IgG titers against T. denticola, P. gingivalis and A. actinomycetemcomitans (P=0.002, P=0.039, and P=0.011, respectively).

CONCLUSIONS

This study provides evidence for possible implications of periodontitis in Buerger disease.

Synergistic contribution of CD14 and HLA loci in the susceptibility to Buerger disease

Buerger disease (BD) is an occulusive vascular disease of unknown etiology. Although cigarette smoking is a well-known risk factor of BD, genetic factors may also play a role in the etiology. Because chronic bacterial infection such as oral periodontitis is suggested to be involved in the pathogenesis of BD, gene polymorphisms involved in the infectious immunity might be associated with BD as the genetic factor(s). We have previously reported that HLA-DRB1*1501 and B54 was associated with BD in Japanese. In this study, polymorphisms in HLA-DPB1, DRB1 and B were analyzed in 131 Japanese BD patients and 227 healthy controls. In addition, we investigated a functional promoter polymorphism, -260 C > T, of CD14 that is a main receptor of bacterial lipopolysaccharide. It was found that the frequencies of CD14 TT genotype [37.4 vs. 24.2%, P = 0.008 OR = 1.87, 95% confidence interval (CI); 1.18, 2.97], DRB1*1501 (34.4 vs. 13.2%, P (c) = 4.4 x 10(-5), OR = 3.44, 95%CI; 2.06, 5.73) and DPB1*0501 (79.4 vs. 55.1%, P (c) = 4.7 x 10(-5), OR = 3.14, 95%CI; 1.93, 5.11) were significantly higher in the patients than in the controls, demonstrating that at least three genetic markers were associated with BD. Stratification analyses of these associated markers suggested synergistic roles of the genetic factors. Odds ratios ranged from 4.72 to 12.57 in individuals carrying any two of these three markers. These findings suggested that the susceptibility to BD was in part controlled by genes involved in the innate and adaptive immunity.

Oral Bacteria are a Possible Risk Factor for Valvular Incompetence in Primary Varicose Veins

OBJECTIVES

To investigate a possible link between valvular incompetence in primary varicose veins and chronic infection of periodontal disease by assessing the presence of oral bacteria in the great saphenous vein from patients with varicose veins and control subjects.

MATERIAL AND METHODS

Forty-four primary varicose vein patients were enrolled in the study. 12 control saphenous veins were obtained from patients undergoing peripheral arterial bypass without clinical evidence of venous reflux. In total, 56 saphenous vein specimen (44 varicose veins and 12 control veins) were examined for 7 periodontal bacteria using a polymerase chain reaction (PCR) method.

RESULTS

Of the 44 primary varicose vein patients, 31 patients were women and mean age was 59 years (range, 39-79 years). PCR examination of the diseased vein specimens showed that 48% were positive for at least one of 7 periodontal bacterial DNA. No bacteria were detected in the control specimens.

CONCLUSION

Bacterial colonisation or infection of varicose veins is a frequent event although we were not able to establish whether this is a cause or consequence of the development of varices but this could be considered a risk factor for the development of varices.

[Pathophysiology, diagnosis, and laboratoy examination in critical limb ischemia]

The term critical limb ischemia (CLI) is defined as chronic ischemic pain at rest, ulcers, or gangrene lasting more than 2 weeks attributable to objectively confirmed occlusive arterial disease. Patients with ischemic pain at rest generally have ankle pressure (AP) of less than 50 mmHg or toe pressure (TP) of less than 30 mmHg, while patients with ulcers or gangrene usually have AP of less than 70 mmHg or TP of less than 50 mmHg. Healing requires an inflammatory response and additional perfusion above that required for supporting intact skin and underlying tissues. The AP and TP levels needed for healing are, therefore, higher than the pressures found in ischemic pain at rest. A combination of blood-flow reduction due to multisegmental lesions of the proximal artery and blood-flow imbalance in the local tissue lead to CLI. It is important to evaluate not only the macroscopic blood flow but also the microcirculation to understand the pathophysiology of CLI. Transcutaneous oxygen tension measurement (critical level <30 mmHg) and skin perfusion pressure measurement (critical level < 30 mmHg) are useful methods to evaluate the microcirculation.

Chromosome elimination in the interspecific hybrid medaka between Oryzias latipes and O. hubbsi

An interspecific hybrid medaka (rice fish) between Oryzias latipes and O. hubbsi is embryonically lethal. To gain an insight into the cellular and molecular mechanisms that cause the abnormalities occurring in the hybrid medaka, we investigated the behavior of chromosomes and the expression patterns of proteins responsible for the chromosome behavior. The number of chromosomes in the hybrid embryos gradually decreased to nearly half, since abnormal cell division with lagging chromosomes at anaphase eliminated the chromosomes from the cells. The chromosome lagging occurred at the first cleavage and continued throughout embryogenesis even after the midblastula transition. Fluorescent in-situ hybridization analyses revealed that the chromosomes derived from O. hubbsi are preferentially eliminated in both O. latipes-hubbsi and O. hubbsi-latipes embryos. Whole-mount immunocytochemical analyses using antibodies against alpha-tubulin, gamma-tubulin, inner centromere protein, Cdc20, Mad2, phospho-histone H3 and cohesin subunits (SMC1alpha, SMC3 and Rad21) showed that the expression patterns of these proteins in the hybrid embryos are similar to those in the wild-type embryos, except for phospho-histone H3. Phospho-histone H3 present on chromosomes at metaphase was lost from normally separated chromosomes at anaphase, whereas it still existed on lagging chromosomes at anaphase, indicating that the lagging chromosomes remain in the metaphase state even when the cell has proceeded to the anaphase state. On the basis of these findings, we discuss the cellular and molecular mechanisms of chromosome elimination in the hybrid medaka.

Frequent methylation-associated silencing of a candidate tumor-suppressor, CRABP1, in esophageal squamous-cell carcinoma

Epigenetic alterations and the resulting inactivation of tumor suppressor genes often contribute to the development of various cancers. To identify novel candidates that may be silenced by aberrant methylation in esophageal squamous-cell carcinoma (ESCC), we analysed ESCC cell lines by a recently developed method known as bacterial artificial chromosome array-based methylated CpG island amplification (BAMCA), and selected candidates through BAMCA-assisted strategy. In the course of this program, we identified frequent CpG methylation-dependent silencing of the gene encoding cellular retinoic acid binding protein 1 (CRABP1) in our panel of ESCC cell lines. Expression of CRABP1 mRNA was restored in gene-silenced ESCC cells after treatment with 5-aza 2'-deoxycytidine. The DNA methylation status of the CRABP1 CpG island with clear promoter activity correlated inversely with expression of this gene. CpG methylation of CRABP1 was frequently observed in primary ESCC tissues as well. Restoration of CRABP1 expression in ESCC cells lacking the protein reduced cell growth by inducing arrest at G(0)-G(1), whereas knockdown of the gene in cells expressing CRABP1 promoted cell growth. Among 113 primary ESCC tumors, the absence of immunoreactive CRABP1 was significantly associated with de-differentiation of cancer cells and with distant lymph-node metastases in the patients. These results indicate that CRABP1 appears to have a tumor-suppressor function in esophageal epithelium, and its epigenetic silencing may play a pivotal role during esophageal carcinogenesis. Its expression status in biopsies or resected tumors might serve as an index for identifying ESCC patients for whom combined therapeutic modalities would be recommended.

Hand-assisted Laparoscopic Esophagojejunostomy Using Newly Developed Purse-string Suture Instrument “Endo-PSI”

Although there are several reports on the esophagojejunostomy during laparoscopy-assisted total gastrectomy, the procedures still remain to be established. We report hand-assisted laparoscopic esophagojejunostomy using circular stapler and newly developed instrument "Endo-PSI." Between April 2005 and April 2006, 13 patients received these products during laparoscopy-assisted total gastrectomy. The Endo-PSI was attached to the abdominal esophagus using hand-assisted laparoscopic surgery. The insertion of the straight needle with 2-0 polypropylene into the device and the cutting of the esophagus were also performed using hand-assisted laparoscopic surgery. The insertion of the anvil head into the esophagus and the ligation of the purse-string suture were performed laparoscopically. After the jejuno-jejunal anastomosis was performed extracorporeally, the combination of the circular stapler for esophagojejunostomy and the closure of the stump of the jejunum were performed laparoscopically. There were no complications attributable to this procedure and there were no cases that required conversion to conventional open procedure or required extension of median incision. This newly developed Endo-PSI was useful for laparoscopic purse-string suture.

Extended exposure of lipopolysaccharide fraction from Porphyromonas gingivalis facilitates mononuclear cell adhesion to vascular endothelium via Toll-like receptor-2 dependent mechanism

Certain infectious pathogens contribute to atherogenesis. Indeed, the strong relationship between periodontal pathogens, such as Porphyromonas gingivalis (P.g.) and coronary heart disease has been demonstrated. We investigated the potential role of P.g. in monocyte-endothelial interaction. Lipopolysaccharide (LPS) fraction was extracted from P.g. cultured under anaerobic conditions and compared to that obtained from an Escherichia coli (E. coli) strain (JM109). Human umbilical vein endothelial cells (HUVECs) were incubated in the presence of P.g.-LPS fraction or E. coli-LPS fraction for various periods and mononuclear cell adhesion assays were conducted under flow. The adhesion of mononuclear cells to HUVECs treated with P.g.-LPS fraction peaked after 24h of incubation, whereas those treated with E. coli-LPS fraction maximized after 4h of incubation. A fluorescent immunobinding assay revealed that P.g.-LPS fraction significantly upregulated ICAM-1 and VCAM-1 in HUVECs. Antibodies against ICAM-1 and Toll-like receptor (TLR)-2, but not TLR-4, attenuated P.g.-LPS fraction-facilitated mononuclear cell adhesion to HUVECs. In conclusion, these results suggest that chronic P.g. infection may facilitate monocyte recruitment to vascular endothelium through sustained upregulation of ICAM-1 and VCAM-1. Our findings provide new evidence that the TLR-2 pathway may contribute to atherogenesis by mediating P.g.-LPS signal transduction.

Enhancement of immunologic tumor regression by intratumoral administration of dendritic cells in combination with cryoablative tumor pretreatment and Bacillus Calmette-Guerin cell wall skeleton stimulation

PURPOSE

We developed an effective immunotherapy, which could induce antitumor immune responses against shared and unique tumor antigens expressed in autologous tumors.

EXPERIMENTAL DESIGN

Intratumoral administration of dendritic cells is one of the individualized immunotherapies; however, the antitumor activity is relatively weak. In this study, we attempted to enhance the antitumor efficacy of the i.t. dendritic cell administration by combining dendritic cells stimulated with Bacillus Calmette-Guerin cell wall skeleton (BCG-CWS) additionally with cryoablative pretreatment of tumors and analyzed the therapeutic mechanisms.

RESULTS

These two modifications (cryoablation of tumors and BCG-CWS stimulation of dendritic cells) significantly increases the antitumor effect on both the treated tumor and the untreated tumor, which was distant at the opposite side, in a bilateral s.c. murine CT26 colon cancer model. Further analysis of the augmented antitumor effects revealed that the cryoablative pretreatment enhances the uptake of tumor antigens by the introduced dendritic cells, resulting in the induction of tumor-specific CD8(+) T cells responsible for the in vivo tumor regression of both treated and remote untreated tumors. This novel combination i.t. dendritic cell immunotherapy was effective against well-established large tumors. The antitumor efficacy was further enhanced by depletion of CD4(+)CD25(+)FoxP3(+) regulatory T cells.

CONCLUSIONS

This novel dendritic cell immunotherapy with i.t. administration of BCG-CWS-treated dendritic cells following tumor cryoablation could be used for the therapy of cancer patients with multiple metastases.

Enhancement of immunologic tumor regression by intratumoral administration of dendritic cells in combination with cryoablative tumor pretreatment and Bacillus Calmette-Guerin cell wall skeleton stimulation

PURPOSE

We developed an effective immunotherapy, which could induce antitumor immune responses against shared and unique tumor antigens expressed in autologous tumors.

EXPERIMENTAL DESIGN

Intratumoral administration of dendritic cells is one of the individualized immunotherapies; however, the antitumor activity is relatively weak. In this study, we attempted to enhance the antitumor efficacy of the i.t. dendritic cell administration by combining dendritic cells stimulated with Bacillus Calmette-Guerin cell wall skeleton (BCG-CWS) additionally with cryoablative pretreatment of tumors and analyzed the therapeutic mechanisms.

RESULTS

These two modifications (cryoablation of tumors and BCG-CWS stimulation of dendritic cells) significantly increases the antitumor effect on both the treated tumor and the untreated tumor, which was distant at the opposite side, in a bilateral s.c. murine CT26 colon cancer model. Further analysis of the augmented antitumor effects revealed that the cryoablative pretreatment enhances the uptake of tumor antigens by the introduced dendritic cells, resulting in the induction of tumor-specific CD8(+) T cells responsible for the in vivo tumor regression of both treated and remote untreated tumors. This novel combination i.t. dendritic cell immunotherapy was effective against well-established large tumors. The antitumor efficacy was further enhanced by depletion of CD4(+)CD25(+)FoxP3(+) regulatory T cells.

CONCLUSIONS

This novel dendritic cell immunotherapy with i.t. administration of BCG-CWS-treated dendritic cells following tumor cryoablation could be used for the therapy of cancer patients with multiple metastases.

Functional pathway characterized by gene expression analysis of supraclavicular lymph node metastasis-positive breast cancer

The outcome of breast cancer patients with supraclavicular lymph node metastasis is generally poor, but some patients do survive for a long time. Consequently, the ability to predict the outcome is important in terms of choosing the appropriate therapy for breast cancer patients with supraclavicular lymph node metastasis. In this study, we attempted to identify functional pathways that determine the outcome of breast cancer patients with supraclavicular lymph node metastasis by profiling cDNA microarrays. Thirty-one breast cancer patients with supraclavicular lymph node metastasis without distant metastasis comprised the study cohort; these were divided into three groups based on prognosis - poor, intermediate, and good. Two functional pathways, the Wnt signaling pathway and the mitochondrial apoptosis pathway, were constructed using six genes (DVL1, VDAC2, BIRC5, Stathmin1, PARP1, and RAD21) that were differently expressed between the good and poor outcome groups. Our results indicate that these two functional pathways may play an important role in determining the outcome of breast cancer patients with supraclavicular lymph node metastasis. We also determined that immunohistostaining for the Stathmin1 gene product is a potential tool for predicting the outcome of breast cancer patients with supraclavicular lymph node metastasis.

Tumor thrombectomy without bypass for low-grade malignant tumors extending into the inferior vena cava: report of two cases

Endometrial stromal sarcoma (ESS) rarely extends into the inferior vena cava (IVC). Two cases of ESS extending into the IVC were encountered. In the first case a low-grade sarcoma and cavography revealed the tumor thrombus to extend to just below the left renal vein from the right internal iliac vein, and the IVC was patent. A tumor thrombectomy was accomplished to prevent pulmonary embolism (PE) and to achieve a good prognosis. The second case was also a low-grade sarcoma. Abdominal computed tomography scanning revealed a large thrombus extending into the IVC just below the hepatic vein. A tumor thrombectomy with an IVC resection was performed. The postoperative course was uneventful for both cases. Aggressive surgical treatment is thus recommended to excise a tumor thrombus with or without an IVC resection in patients with ESS of low-grade malignancy extending into the IVC to prevent sudden death due to PE.

Effects of acupressure on lower limb blood flow for the treatment of peripheral arterial occlusive diseases

PURPOSE

To investigate the effects of acupressure on lower limb blood flow for the treatment of peripheral arterial occlusive diseases (PAOD).

METHODS

From February 2004 to February 2005, 30 patients with stage II PAOD underwent measurements of the lower limb blood flow. Six patients (group A) were assigned as controls without any acupoint stimulation, while 24 (group B) underwent stimulation at acupoints by acupressure. The acupoints Yanglingquan (GB34), Zusanli (ST36), Yinlingquan (SP9), and Sanyinjiao (SP6) of the symptomatic lower limbs were stimulated for 3 min. Transcutaneous oximetry (tcPO2) was used to determine the blood flow of the chest wall, bilateral distal crura, and bilateral dorsa of the foot before and during the stimulations at the acupoints.

RESULTS

Group A showed no significant change in the lower limb blood flow. In group B, the tcPO2 values of chest wall, bilateral distal crura, and the dorsum of foot of the stimulated lower limb increased significantly during acupressure (P < 0.01), whereas no significant change was shown in the dorsum of the foot of the non-stimulated lower limb. Moreover, the blood flow of the lower limbs that had undergone an ipsilateral sympathectomy increased significantly (P < 0.01).

CONCLUSIONS

Acupressure was found to cause significant increases in the lower limb blood flow of stage II PAOD patients. This treatment modality may therefore be effective for improving the symptoms of such patients.

Application of chimerism-based drug-induced tolerance to rat into mouse xenotransplantation

The current critical shortage of human donor organs has stimulated the feasibility of the xenogenic transplantation, such as swine to primate. We have previously reported the induction of donor-specific tolerance in MHC-disparated recipient mice by using our cyclophosphamide (CP)-induced tolerance conditioning. In this study, we examined the efficacy of our CP-induced tolerance conditioning in xenogenic transplantation model. F344 rats and B10 mice were used as donors and recipients. Recipient mice were treated with donor spleen cells, CP, Busulfan and bone marrow cells, with or without prior NK-cell depletion. Donor mixed chimerism, and the presence of donor reactive T-cell population were analysed by flow cytometry. The survival of the donor skin grafts were observed after the conditioning. Donor mixed chimerism was temporary induced but terminated at 10 weeks after treatments. Donor-specific prolongation of the skin graft survival was observed after the treatments, however, grafts were rejected in the long term. NK-cell depletion, prior to the treatments, did not affect the levels of the mixed chimerism or graft prolongation. The donor-reactive recipient T-cell population was remained the same level as the untreated mice, suggesting the failure of the induction of the central T-cell tolerance. Thus, partial efficacy of our CP-induced tolerance treatments in the rat to mice xenotransplantation was observed. Our results suggested that the additional treatments were required to establish the stable xenogenic tolerance.

Effect of low-density lipoprotein apheresis on patients with peripheral arterial disease. Peripheral Arterial Disease LDL Apheresis Multicenter Study (P-LAS)

AIM

The effectiveness of low-density lipoprotein (LDL) apheresis for patients with peripheral arterial disease (PAD) was investigated to confirm a hypothesis based on subjective evidence that the amelioration of blood rheology would be the most contributing factor for improvement in clinical symptoms. Evaluation of the severity of intermittent claudication is difficult because of the lack of an accurate parameter to assess muscle ischemia during exercise, thus we objectively evaluated by non-invasive near-infrared spectroscopy (NIRS) on a treadmill in this study.

METHODS

Thirty-one patients with PAD were evaluated for hemostatic function and physiological parameters such as ankle-brachial pressure index (ABI), maximum tolerated walking distance (MTWD) and recovery time (RT) or recovery ability index (RAI) on NIRS. Laboratory tests included plasma assays of total cholesterol, LDL-cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, and fibrinogen. The change in red-cell filtration rate was evaluated for the improvement of microcirculation. Statistical analysis was performed using the paired Student's t-test with Bonferroni's correction.

RESULTS

A significant improvement in ABI and MTWD was observed after average 9.6+/-0.8 sessions of LDL apheresis treatment and the amelioration of microcirculation in ischemic muscle was objectively evaluated as significant improvement in RAI on NIRS. Rest pain was improved in all 5 patients with Fontaine's classification III or IV. A severe ulcer refractory to usual medications was dramatically diminished in the area by 10 sessions of LDL apheresis and fully healed 5 months after the final LDL apheresis treatment followed by medication. No angiographical change was observed in the arterial occlusive lesions in any patients.

CONCLUSIONS

The effectiveness of LDL apheresis on the improvement in physiological parameters such as ABI, MTWD and clinical symptoms in patients with PAD was confirmed. The severity of intermittent claudication was objectively evaluated using non-invasive NIRS. The RT or RAI was useful parameter to evaluate the improvement in the ischemic symptoms of the extremities.

Accelerated growth of intestinal tumours after radiation exposure in Mlh1-knockout mice: evaluation of the late effect of radiation on a mouse model of HNPCC

Mlh1-knockout mice have been developed as a useful model of hereditary non-polyposis colorectal cancer (HNPCC). In this study, we analyzed the pathology of gastrointestinal tumours (GIT) in these mice in detail and examined the possible effects of ionizing radiation on the induction of intestinal tumours to evaluate the late response to radiotherapy in HNPCC. Mlh1-/- mice spontaneously developed GIT and thymic lymphomas by 48 weeks. GIT included not only well differentiated adenocarcinomas but also poorly differentiated and mucinous adenocarcinomas, suggesting that this mouse is a good model for HNPCC. In contrast to colon cancers from HNPCC patients, however, carcinomas of Mlh1-/- mice expressed p53 and showed a lack of transforming growth factor (TGF)-betaRII mutation, which resulted in the expression of TGF-betaRII protein. Irradiation of 10-week-old Mlh1-/- mice accelerated GIT development but had little effect at 2 weeks. Mlh1+/- and Mlh1+/+ mice were not susceptible to spontaneous or radiation-induced thymic lymphomas and GIT until 72 weeks after birth. The development and pathology of GIT in Mlh1-/- mice suggest that this mouse is a good model for HNPCC, although tumour-related responsible genes might be different from HNPCC. As X-ray exposure promoted carcinogenesis of GIT in adult Mlh1-/- mice, an increased risk of secondary cancers after radiotherapy for HNPCC patients should be taken into consideration.

Urinary protein analysis in pre- and postoperative cancer patients

Urinary proteins from six patients with esophageal cancer and two with stomach cancer were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Analyses were performed on days-1 to 3, 5, 7, 10, 14, and 21 (or 22) after surgery. The protein patterns were scanned by densitometry and divided into nine fractions. The main proteins in the fractions (Fr.) were identified as follows: immunoglobulin G in Fr. A, Tamm-Horsfall glycoprotein (THP) in Fr. B, transferrin in Fr. C, albumin in Fr. D, alpha(1)-acid glycoprotein in Fr. E, alpha(1)-microglobulin in Fr. F, retinol binding protein in Fr. G, and beta(2)-microglobulin in Fr. I. The protein in Fr. H was not identified. The percentage of each fraction was calculated from the densitometry pattern of each lane. The percentage values were averaged among all the patients, and pre- and postoperative data were compared. The percentage of Frs. E, F, and G increased on days 1-7, and the changes in these three proteins were similar to changes in serum C-reactive protein (CRP). In particular, the percentage of Fr. G peaked within 1 day of operation, which was faster than for CRP. Conversely, other fractions decreased. These results suggest that urinary protein analysis is useful for monitoring the response to surgical stress.

Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy

Laparoscopy-assisted distal gastrectomy has been applied to the treatment of early gastric cancer in Japan. So far, several studies about comparison between laparoscopy-assisted distal gastrectomy and conventional open distal gastrectomy were reported. However, there are few reports on the laparoscopy-assisted total gastrectomy, mainly because this procedure is performed relatively infrequently, and the procedure is more difficult than laparoscopy-assisted distal gastrectomy. This was a case-control study comparing between laparoscopy-assisted total gastrectomy group and open total gastrectomy group. From June 2001 to August 2004, laparoscopy-assisted total gastrectomy was performed in 20 patients. Reconstruction was performed by Roux-en-Y method or Roux-en-Y with jejunal pouch method through the mini-laparotomy. These cases were compared with 19 cases of open total gastrectomy, regarding operating time, blood loss, leukocyte count, C-reactive protein, time to the first passage of gas, time to initiate oral intake, and postoperative hospital stay.Laparoscopy-assisted total gastrectomy was successful in 20 patients. The mean operating time was 280 minutes and blood loss was 227.5 mL. Leukocyte counts on days 1, 3, and 7 were significantly lower in laparoscopic surgery group than in open surgery group. The time to first flatus, time to initiate oral intake, and postoperative hospital stay was significantly shorter (P < 0.05) in the laparoscopic surgery group than in the open surgery group. This study demonstrated that laparoscopy-assisted total gastrectomy is suitable and feasible for early gastric cancer and has the advantage of a shorter recovery time compared with open total gastrectomy.