Predicting nedaplatin sensitivity of cervical cancer using the histoculture drug response assay

PURPOSE

There are currently no clinically available chemosensitivity assays for cervical cancer. In this study we evaluated whether the histoculture drug response assay (HDRA) could be used to predict chemosensitivity to nedaplatin (NDP) in cervical cancer.

METHODS

Fifty-four surgical specimens and biopsies from patients with squamous cell carcinoma of the cervix were tested with the HDRA. The results were used to calculate the concentration resulting in 50% inhibition of tumor growth (IC50). We then determined the cut-off concentration for NDP, and investigated the chemosensitivity of NDP for each patient. Moreover, the correlations between chemosensitivity and the clinical response of NDP-containing chemotherapy, and the clinical outcomes of the patients with Stage I and II disease were also investigated.

RESULTS

Fifty-one of 54 specimens (94.0%) were evaluable with this assay. The optimal cutoff concentration of NDP was determined to be 48 microg/ml. In 18 patients with measurable lesions, all nine patients in the high sensitive group by HDRA were judged as partial response (PR) to NDP containing chemotherapy. In contrast five of nine patients in the low sensitive group were classified as stable disease, and four were PR. The true positive rate was 100%, the true negative rate was 55.6%, and the accurate prediction rate was 77.8%. Furthermore, the disease-free survival of the high sensitive group tended to be better than that of the low sensitive group in the patients who received postoperative adjuvant chemotherapy with NDP.

CONCLUSIONS

In the current study, the sensitivity of cervical tumors to nedaplatin was predicted by the HDRA.

Ultrasound predictors of mortality in monochorionic twins with selective intrauterine growth restriction

OBJECTIVES

The aim of this study was to evaluate the use of ultrasound assessment to predict risk of mortality in expectantly managed monochorionic twin fetuses with selective intrauterine growth restriction (sIUGR).

METHODS

This was a retrospective study of 101 monochorionic twin pregnancies diagnosed with sIUGR before 26 weeks of gestation. All patients were under expectant management during the observation period. At the initial evaluation, the presence or absence of each of the following abnormalities was documented: oligohydramnios; stuck twin phenomenon; severe IUGR < 3(rd) centile of estimated fetal weight; abnormal Doppler in the umbilical artery; and polyhydramnios in the larger twin. The relationships between these ultrasound findings and mortality of sIUGR fetuses were evaluated using multiple logistic regression analysis.

RESULTS

Of 101 sIUGR twins, 22 (21.8%) fetuses suffered intrauterine demise and nine (8.9%) suffered neonatal death; 70 (69.3%) survived the neonatal period. Multiple logistic regression analysis revealed that the stuck twin phenomenon (odds ratio (OR): 14.5; 95% CI: 2.2-93.2; P = 0.006) and constantly absent diastolic flow in the umbilical artery (OR: 29.4; 95% CI: 3.3-264.0; P = 0.003) were significant risk factors for mortality.

CONCLUSIONS

Not only abnormal Doppler flow in the umbilical artery but also severe oligohydramnios should be recognized as important indicators for mortality in monochorionic twins with sIUGR.

Monochorionic monoamniotic twin pregnancies with two yolk sacs may not be a rare finding: a report of two cases

The exact determination of amnionicity is a major issue for the clinical management of monochorionic twin pregnancies, due to the high risk of perinatal mortality and morbidity in monochorionic monoamniotic (MCMA) twins. Counting the number of yolk sacs is believed to be a good indicator of amnionicity in the early first trimester, and it has previously been suggested that the number of yolk sacs is equal to amnionicity in both MCMA and monochorionic diamniotic twin pregnancies. However, the accuracy of the relationship between number of yolk sacs and amnionicity has recently been called into question. To the best of our knowledge, no previous reports have shown two yolk sacs in MCMA twin pregnancies. We report two cases of MCMA twins with two yolk sacs on first-trimester ultrasonography, and confirmed monoamnionicity in the second trimester showing umbilical cord entanglement. Postnatal examination showed an MCMA placenta in both cases, and entangled umbilical cords confirmed monoamnionicity. The possibility of monoamnionicity must still be suspected when two yolk sacs are detected early in the first trimester on ultrasound examination in monochorionic twin pregnancies.

Validation of Quintero stage III sub-classification for twin-twin transfusion syndrome based on visibility of donor bladder: characteristic differences in pathophysiology and prognosis

OBJECTIVE

To validate the Quintero stage III subclassification for twin-twin transfusion syndrome (TTTS) based on visibility of the bladder of the donor twin.

METHODS

Between July 2002 and August 2006, there were 131 pregnant Japanese women affected by severe TTTS before 26 weeks' gestation, treated with fetoscopic laser surgery at five centers in Japan, whose pregnancies continued beyond 22 weeks. Outcome data were available in all cases and surviving infants were followed up for at least 6 years. This study focused on the Stage III TTTS patients. These were subclassified into Stage III atypical (abnormal Doppler flow with visible donor bladder) and Stage III classical (abnormal Doppler flow with non-visible donor bladder) groups. Perioperative data and postnatal outcomes were compared between the groups.

RESULTS

Seven Stage I, 22 Stage II, 82 Stage III and 20 Stage IV pregnancies continued beyond 22 weeks. There was a significantly higher incidence of absent or reversed end-diastolic velocity in the umbilical artery (UA-AREDV) of the donor in Stage III atypical than in Stage III classical patients (83.8% vs. 53.3%, P = 0.004). Stage III atypical cases also had a significantly higher incidence of arterioarterial (AA) anastomoses (72.9% vs. 17.8%, P < 0.001) and intrauterine fetal demise (IUFD) of the donor (43.2% vs. 13.3%, P = 0.002). However, there were no differences in overall survival or in abnormal brain scans of surviving infants. Donors with both UA-AREDV and AA anastomoses had a significantly higher incidence of IUFD compared with the others (53.3%, P < 0.001).

CONCLUSIONS

Quintero stage III atypical was characterized by a high incidence of AA anastomoses and UA-AREDV of the donor, resulting in IUFD. Subclassification of Stage III based on visibility of the bladder of the donor twin was adequate for and compatible with differentiating prognosis and pathophysiology.

Sonography in total hip arthroplasty

PURPOSE

The distance between the anterior surface of the neck of the prosthetic stem and the anterior joint capsule, the "capsular distance", is increased in total hip arthroplasty (THA) with synovitis. We evaluated the potential of ultrasonography (US) in measuring the "capsular distance" in THA hips one year after insertion.

MATERIALS AND METHODS

We compared the measurements of the capsular distance using a ruler with those performed with US. A plastic pelvis and femur model with a prosthetic hip and paper tape to simulate the joint capsule were used. We also evaluated the intra- and interobserver agreements between 3 examiners of the US measurements of the anterior capsular distance in 22 patients with THA. The effect of experience in such type of examination was estimated.

RESULTS

There was a high correlation when measuring the anterior capsular distance in the prosthetic hip model with a ruler as compared with US. The interobserver agreement in the US measurements was good and became better after examiners gained experience in this procedure. The intraobserver agreement was always better than the interobserver agreement and also improved with increasing numbers of examinations.

CONCLUSION

Ultrasonography is a reliable method to measure the anterior capsular distance in THA, especially if performed by an experienced examiner.

Effect of 2-hydroxyethyl methacrylate pre-treatment on micro-tensile bond strength of resin composite to demineralized dentin

The purpose of this study was to evaluate the effect of 2-hydroxyethyl methacrylate (HEMA) application on the micro-tensile bond strength of resin composite to demineralized dentin. Artificially demineralized lesions were formed on bovine dentin surfaces and treated with 10, 30, 50, 70 and 100 wt% HEMA aqueous solution. The surfaces were then applied and covered with SE Bond and AP-X according to the manufacturer's instruction. After immersion in 37 degrees C water for 24 h, bond strength were measured using a universal testing machine. Bond strengths to both demineralized dentin and normal dentin, without HEMA application, were also measured. Scanning electron microscopic (SEM) observation and confocal laser scanning microscopy (CLSM) analysis at the resin-dentin interface were also performed. The bond strength data were statistically compared with anova and Scheffe's test (P < 0.05). Bond strength to demineralized dentin treated with over 30 wt% HEMA aqueous solution were significantly higher than that to demineralized dentin without HEMA application, but significantly lower than that to normal dentin. SEM observation revealed that the hybrid layer and resin-tags thickened and lengthened with HEMA application. In CLSM, the diffusion of adhesive primer into demineralized dentin increased with HEMA application. These results indicated that HEMA application might increase the bond strength to demineralized dentin by the enhancement of resin monomer penetration of HEMA.

Current clinical results of the Tsukuba BNCT trial

Nine high grade gliomas (5 glioblastomas and 4 anaplastic astrocytomas) were treated with BSH-based intaoperative boron neutron capture therapy (IOBNCT). BSH (100 mg/kg body weight) was intravenously injected, followed by single fraction irradiation using the mixed thermal/epithermal beam of Japan Research Reactor 4. The blood boron level at the time of irradiation averaged 29.9 (18.8-39.5)microg/g. The peak thermal neutron flux as determined by post-irradiation measurements varied from 1.99 to 2.77x10(9) n cm(-2)s(-1). No serious BSH-related toxicity was observed in this series. The interim survival data in this study showed median survival times of 23.2 months for glioblastoma and 25.9 months for anaplastic astrocytoma, results which are consistent with the current conventional radiotherapy with/without boost radiation. Of the 4 residual tumors, 2 showed complete response (CR) and 2 showed partial response (PR) within 6 months following BNCT. No linear correlation was proved between the dose and the occurrence of early neurological events. The maximum boron dose of 11.7-12.2 Gy in the brain related to the occurrence of radiation necrosis. The clinical application of a mixed thermal/epithermal beam and JRR-4 facilities on BSH-based IOBNCT proved to be safe and effective in this series.

Micro-tensile bond strength of self-etching primer adhesive systems to human coronal carious dentin

The aim of this study was to evaluate the micro-tensile bond strengths of three self-etching primer adhesive systems to normal dentin (ND), caries-affected dentin (CAD) and caries-infected dentin (CID). Human extracted molars with caries were used, and flat dentin surfaces ground by 600-grit SiC paper were prepared. The surfaces were dyed using Caries-Detector solution, treated with Clearfil SE Bond, Mac-Bond II and UniFil Bond, and then covered with resin composites according to manufacturer's instructions. After immersion in 37 degrees C water for 24 h, the teeth were serially sectioned into multiple slices. Each slice was distinguished into ND, CAD and CID groups by the degree of staining, and the bond strength was measured in a universal testing machine. Scanning electron microscopic (SEM) observation was also performed. For statistical analysis, anova and Scheffe's test were used (P < 0.05). The bond strengths of the three adhesive systems to CAD and CID were significantly lower than those to ND. There was significant difference in the bond strength to ND between Clearfil SE Bond and UniFil Bond, but no significant differences to CAD and CID among the three adhesive systems. On SEM, the hybrid layers in CAD and CID showed more porous structures compared with ND. The results indicated that the bond strengths to CAD and CID were not affected by a variety of self-etching primer adhesive systems because of the porous hybrid layer formation in carious dentin.

Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head

We reviewed the outcome of curved intertrochanteric varus osteotomy in the treatment of osteonecrosis of the femoral head in 20 hips. A mean varus angulation of 31 degrees was obtained by the osteotomy. The ratio of intact area on the weight-bearing portion increased from 19% to 61%. The mean elevation and lateral displacement of the greater trochanter were 1.2 cm and 0.5 cm, respectively. These changes in the position of the greater trochanter were very small when compared with those after conventional varus wedge osteotomy. Nonunion or delayed union was not observed. Quantitative analyses showed aggressive bone remodelling in the medial intertrochanteric region. Eighteen hips survived without collapse after a mean follow-up of 48 months. We conclude that curved varus osteotomy can be used to preserve the hip joint in patients with osteonecrosis of the femoral head.

Confocal laser scanning microscopic analysis of early plaque formed on resin composite and human enamel

The purpose of this study was to analyse quantitatively the early bacterial plaque formed on resin composite and human enamel in vivo, using a confocal laser scanning microscope. Test pieces of resin composite and human enamel were retained at the buccal surfaces of the upper first molars of three volunteers for 4, 8 and 24 h to allow plaque formation. Then, the specimens were immersed in propidium iodide in phosphate-buffered saline to stain adherent bacteria and observed with a confocal laser scanning microscope. The ratios of the area occupied by microorganisms to the whole area of the optical field were calculated using a photo-image analysis system. The thickness of the plaque was also measured. Quantitative analysis revealed that the resin composite showed significantly higher bacterial adherence than human enamel throughout the test period. A difference was noticed in the morphology of the bacteria between the two groups. Our findings suggest that resin composite shows higher bacteria adherence during early plaque formation compared with human enamel. In addition, the present findings may suggest a presence of the difference in bacterial composition of plaque in both specimens.

Effect of fluoride-releasing adhesive system on decalcified dentin

The aim of this study was to evaluate the effect of fluoride-releasing adhesive systems on human decalcified dentin in vitro. Two fluoride-releasing adhesive systems, Reactmer bond (RB, Shofu) and ABF (AF, Kuraray), an experimental system, and a commercial adhesive system without fluoride release, SE bond (SE, Kuraray), were used in this study. The amount of fluoride release from adhesive in deionized water was measured every week for 10 weeks. Class V cavities were prepared on extracted human pre-molars and decalcified dentin was promoted by using a bacterial caries induction system at the cavity floor. The cavities preserving decalcified dentin were restored with resin composite (AP-X, Kuraray) after treatment by each adhesive system. The specimens without treatment by adhesive system and restoration were used for control. The specimens with restoration were then incubated for 4 weeks at 37 degrees C, 100% humidity. Microradiographs of the specimens showed that the radiopacities of the decalcified dentin layers in RB and AF groups with fluoride release were significantly higher than those in SE or control groups without fluoride release. This result suggested that the fluoride-releasing adhesive systems enhanced mineralization of decalcified dentin.

Regulation of fluoride ion release from Na2SiF6 contained in resin based on hydrophobic siloxane layer coating

Regulation of fluoride release from restorative resin or sealant is beneficial to patients as it will prevent the occurrence of the secondary caries. In this study, we evaluated whether or not the formation of a hydrophobic polysiloxane layer on the surface of the fluoride compound could contribute to the regulation of fluoride release from resin. First, sodium hexafluorosilicate (Na2SiF6) powder was treated with gamma-methacryloxypropyltrimethoxysilane (gamma-MPTS) and analysed with scanning electronmicroscopy (SEM), Fourier-transform infrared spectroscopy (FT-IR) and electron spectroscopy for chemical analysis (ESCA). Analysis revealed that a hydrophobic polysiloxane layer was formed on the surface of Na2SiF6 powder. Heat treatment commonly used during gamma-MPTS treatment was not necessary for the polysiloxane layer formation on the surface of Na2SiF6 powder. Then Na2SiF6 powder treated with gamma-MPTS was loaded in bis-GMA/TEGDMA resin, immersed in distilled water and fluoride release was measured using a fluoride electrode. We found that the rate of fluoride release was significantly lower from the resin containing Na2SiF6 powder treated with c-MPTS. We concluded, therefore, that c-MPTS treatment and the resulting hydrophobic polysiloxane layer formation are very effective for the regulation of fluoride release from resin.

Inhibition of artificial secondary caries by fluoride-releasing adhesives on root dentin

Fluoride-releasing materials can be expected to inhibit the secondary caries. The aim;of this study was to evaluate the effect of fluoride-releasing adhesives on inhibition of secondary caries in outer and wall lesions. Two commercial fluoride-releasing adhesives, Reactmer bond (RB) and One-up bond F (OB), and a commercial adhesive without fluoride release, Mac-bond II (MB), were used prior to placement of restorative materials without fluoride release, Lite-fil II A (LF) and Estelite (EL), and a fluoride-releasing restorative material, Reactmer paste (RP). Class V cavities prepared on extracted human premolars were restored with various combinations of the materials: MB/EL, OB/EL, RB/LF and RB/RP. The restored teeth were incubated in bacterial medium containing sucrose with Streptoccus mutans for 14 days. Microradiographs of specimens showed no wall lesions in all groups and an acid-resistant layer adjacent to the restoration in the caries-like lesion. OB/EL, RB/LF and RB/RP groups showed thicker layers than the MB/EL group. The RB/RP group formed the shallowest outer lesion among all groups. These results indicate that fluoride-releasing adhesives are effective in the prevention of wall lesions but exhibit little outer lesion inhibition. Therefore, combined restoration using a fluoride-releasing adhesive and fluoride-releasing restorative material should be selected to inhibit secondary caries.

Enamel tensile bond strength and morphology of resin-enamel interface created by acid etching system with or without moisture and self-etching priming system

The purpose of this study was to estimate the effect of three types of different adhesive systems on enamel adhesion. Scotchbond Multi-Purpose (MP) as a traditional system, Single Bond (SB) as a wet-bonding system and Clearfil SE Bond (SE) and Unifil Bond (UB) as self-etching priming systems were used. Bovine enamel was treated with each system and tensile bond strength (TBS) of resin to the enamel was measured. The conditioned enamel surfaces and resin-enamel interfaces were also morphologically observed with scanning electron microscope (SEM). The mean TBS for MP, SB, SE and UB were 15.3, 13.7, 14.3 and 11.6 MPa, respectively. There was no significant difference in mean TBS among all products but the traditional system showed the most stable TBS. In SEM observations, self-etching primer created a weaker etched pattern on the enamel surface than phosphoric acid. At the resin-enamel interfaces, thick tag-like extensions penetrated into the enamel etched with phosphoric acid regardless of using the wet-bonding technique, while self-etching primer created thin lamina-like resin penetrations. These results indicate that the traditional system with phosphoric acid etching exhibits the most stable enamel adhesion although the enamel-bonding promoting abilities of these adhesive systems are equivalent to each other.

Island dynamics in the large-helical-device plasmas

In the Large Helical Device plasma discharges, the size of an externally imposed island with mode number ( n/m = 1/1) decreases substantially when the plasma is collisionless ( nu(*)< approximately 1) and the beta is finite ( > approximately 0.1%) at the island location. For the collisional plasmas with finite beta, on the other hand, the size of the island increases. However, there is a threshold in terms of the vacuum island size below which the island enlargement is not seen.

Anticarcinogenic antioxidants as inhibitors against intracellular oxidative stress

Oxidative stress has been implicated in the pathogenesis of numerous diseases, including cancer. In the present study, the protective effect of natural antioxidants, such as quercetin and tea polyphenols, on intracellular oxidative stress was studied. Here we report a novel function of quercetin and tea polyphenols, as potential inhibitors of 4-hydroxy-2-nonenal (HNE)-induced intracellular oxidative stress and cytotoxicity. In rat liver epithelial RL34 cells, a potent electrophile HNE dramatically induced the productions of reactive oxygen species (ROS), which correlated well with the reduction in cell viability. We found that quercetin and tea polyphenols, such as epigallocatechin gallate and theaflavins and their gallate esters, significantly inhibited the HNE-induced ROS production and cytotoxicity. In addition, HNE induced a transient decrease in the mitochondrial membrane potential (delta psi), which was also retarded by the antioxidants. These data suggest that the antioxidants, such as quercetin and tea polyphenols, are inhibitors against mitochondrial ROS production.

Observation of the "self-healing" of an error field island in the large helical device

It was observed that the vacuum magnetic island produced by an external error magnetic field in the large helical device shrank in the presence of plasma. This was evidenced by the disappearance of flat regions in the electron temperature profile obtained by Thomson scattering. This island behavior depended on the magnetic configuration in which the plasmas were produced.

Initial changes of non-traumatic osteonecrosis of femoral head in fat suppression images: bone marrow edema was not found before the appearance of band patterns

The present study examined initial changes in non-traumatic osteonecrosis of the femoral head (ONF) on T1- and T2-weighted MR images, and fat suppression images. The subjects were 57 renal transplant recipients (37 males and 20 females), whose median age at the time of transplantation was 31.5 years old (range, 10 to 58 years). Twelve patients developed band patterns (sign of established ONF) at an early postoperative period. Among them, 4 joints of 3 patients had a localized, faint signal abnormality in fat suppression images, where band pattern was confirmed later in T1- and T2-weighted images. In all the 57 patients, no bone marrow edema preceding to ONF was observed. Bone marrow edema would not be the cause of ONF in renal transplant patients. Early changes depicted in our fat suppression images would be useful information in the studies on pathogenesis of ONF.

Alteration of odontoblast osteonectin expression following dental cavity preparation

Cavity preparation can increase the active synthesis and secretion of non-collagenous proteins by odontoblasts, thus resulting in the deposition of tertiary dentine. In this study, the effect of cavity preparation on osteonectin expression was examined in odontoblasts of the rat tooth pulp. A class V cavity was prepared in rat first molars to stimulate odontoblastic secretory activity, and the animals were killed at various intervals. In the normal pulp, osteonectin immunoreactivity was detected in odontoblasts but not other cells. At 1 day after cavity preparation, immunoreactivity had diminished beneath the cavity. At 3 days, strong immunoreactivity could be detected in odontoblasts beneath the cavity. Numerous round cells underlying the odontoblastic layer also demonstrated immunoreactivity. Thereafter, the intensity of osteonectin immunoreactivity in odontoblasts beneath tertiary dentine decreased gradually, and at 30 and 60 days, it was weaker than in normal pulp. These findings suggest that osteonectin is actively synthesized by odontoblasts underlying a cavity in the initial stage of tertiary dentine formation.

Effect of adhesives on the inhibition of secondary caries around compomer restorations

This study evaluated the effect of adhesives on the inhibition of secondary caries around compomer restorations in vitro. Two adhesive systems with a Bis-GMA resin, Scotch bond Multi-purpose (MP) and Single Bond (SB), and one adhesive system with no Bis-GMA resin, F2000 compomer primer/adhesive (PA), were used prior to placement of the compomer (F2000), and non-fluoride releasing resin composite (Z100) was used as a control. Class V cavities prepared on extracted human premolars were restored with various combinations of materials: F2000/MP, F2000/SB, F2000/PA, Z100/MP, Z100/SB and Z100/PA. The restored teeth were incubated in bacterial medium containing sucrose with Streptococcus mutans for two weeks after storage for 14 days. On microradiographs, the radio-opaque layers adjacent to the F2000 restorations were thick and clear, while the layers in the Z100 restorations were unclear. In the F2000 restorations, the mean thickness of the radio-opaque layers in the PA group was significantly greater than that of the MP and SB groups. In fluoride-releasing measurement, F2000 coated with PA showed a significantly higher amount of fluoride release than MP and SB, and no significant difference in the amount of fluoride release from uncoated F2000. These results indicated that applying an adhesive without Bis-GMA resin to compomer restoration has no suppressive effect on the fluoride release from compomer and might be beneficial for inhibiting secondary caries in vitro.

Transcatheter arterial chemoembolization therapy combined with percutaneous ethanol injection for unresectable large hepatocellular carcinoma: an evaluation of the local therapeutic effect and survival rate

BACKGROUND/AIMS

This study was undertaken to evaluate the effectiveness of combination therapy with transcatheter arterial chemoembolization followed by percutaneous ethanol injection in patients with unresectable large hepatocellular carcinoma by comparing the use of this combined regimen with transcatheter arterial chemoembolization alone.

METHODOLOGY

Six hundred and thirty-one consecutive patients with hepatocellular carcinoma lesions observed from Jan 1989 to Dec 1999 (11 years) at the Internal Medicine Department, Saga Prefectural Hospital Koseikan were retrospectively enrolled in the study. The series included 120 patients with large unresectable hepatocellular carcinoma lesions, the largest of which were greater than 3 cm in largest dimension. Fifty-two patients underwent a single transcatheter arterial chemoembolization followed by percutaneous ethanol injection, which were compared with 68 patients treated by transcatheter arterial chemoembolization alone. Both groups of patients with hepatocellular carcinoma did not differ regarding the base-line characteristics. The overall survival rates and recurrence ratio of initially treated lesions were compared in both groups.

RESULTS

On overall survival rates by the Kaplan-Meier method, three- and five-year survival in the transcatheter arterial chemoembolization and percutaneous ethanol injection group (59.0%, 32.1%) proved to be significantly longer than those in the transcatheter arterial chemoembolization group (27.1%, 17.0%). In addition, during the follow-up local recurrence in the combination group (23.1%) was significantly lower than that in the transcatheter arterial chemoembolization group (50.0%).

CONCLUSIONS

The combined treatment with transcatheter arterial chemoembolization and percutaneous ethanol injection proved to be more effective and safer. Furthermore, a lower incidence of local recurrence was observed than transcatheter arterial chemoembolization alone which resulted in an increased survival of the patients associated with unresectable large hepatocellular carcinoma lesions.