Reduction of the total injection volume of contrast material with a short injection duration in 64-detector row CT coronary angiography

The ability of short injection duration of contrast material to reduce the total injection volume in 64-detector row CT coronary angiography was investigated. 45 patients were divided into three groups: (i) those receiving 0.8 ml kg(-1) of contrast material (350 mgI ml(-1)) injected with a fixed duration of 14 s (Group A; n = 16); (ii) those receiving 0.8 ml kg(-1) of contrast material injected with a fixed duration of 10 s (Group B; n = 15); and (iii) those receiving 0.7 ml kg(-1) of contrast material injected with a fixed duration of 10 s (Group C; n = 14). All patients then received 20 ml of saline. Contrast densities of the ascending aorta and proximal and distal coronary arteries were assessed where vessel diameters were >2.0 mm. The mean enhancement value in the ascending aorta for Group B was significantly higher than that for Groups A and C (p<0.05), whereas there was no significant difference between Groups A and C. All enhancement values in the coronary arteries were higher than 250 Hounsfield units. The mean enhancement value for each coronary artery in Group B was significantly higher than that for Group A (p<0.05), whereas there was no significant difference between Groups A and C. In conclusion, a short injection duration allows a reduction in the total volume of contrast material from 0.8 ml kg(-1) to 0.7 ml kg(-1) while a steady contrast enhancement is maintained in the ascending aorta and coronary arteries.

4f-derived Fermi surfaces of CeRu2(Si1-xGex)2 near the quantum critical point: resonant soft-X-ray ARPES study

Angle-resolved photoelectron spectroscopy in the Ce 3d-->4f excitation region was measured for the paramagnetic state of CeRu2Si2, CeRu2(Si0.82Ge0.18)2, and LaRu2Si2 to investigate the changes of the 4f electron Fermi surfaces around the quantum critical point. While the difference of the Fermi surfaces between CeRu2Si2 and LaRu2Si2 was experimentally confirmed, a strong 4f-electron character was observed in the band structures and the Fermi surfaces of CeRu2Si2 and CeRu2(Si0.82Ge0.18)2, consequently indicating a delocalized nature of the 4f electrons in both compounds. The absence of Fermi surface reconstruction across the critical composition suggests that SDW quantum criticality is more appropriate than local quantum criticality in CeRu2(Si1-xGex)2.

LKB1 mutations in mucinous bronchioloalveolar carcinoma occurring in Peutz-Jeghers syndrome patients

11047

Background: Mutations in the gene encoding Liver Kinase B1, LKB1, are common in patients with Peutz-Jeghers syndrome (PJS), which is characterized by mucocutaneous pigmentation, intestinal polyps and a high incidence of cancers at variable sites (colorectal, gynecological, breast, pancreas, and lung). Although tumors occurring in PJS patients are known to contain mucin-rich conmponents, mucinous bronchioloalveolar carcinomas (mBACs) arising from the PJS background have only rarely been reported. Here we report two mBAC patients with PJS. We further explored the LKB1 gene in these two patients and, in addition, eight sporadic mBAC patients. Methods: Frozen tissue specimens were collected from ten mBAC patients who underwent surgery in our department from 2002 to 2008, and high molecular weight genomic DNA was extracted from them and stocked in the bio-bank. Written informed consent was obtained from each patient, and ethical approval was obtained from the IRB. The nucleotide sequence of LKB1 (EX01–09) was determined by genomic PCR-direct sequencing. Loss of heterozygosity (LOH) was analyzed by high resolution fluorescent microsatellite analysis (HRFMA) using two microsatellite markers that encompass the LKB1 locus, D19S886 and D19S565. Results: Among 11 tumors derived from the 10 patients, 9 distinct LKB1 mutations were found in 7 tumors (4 G:C to A:T transitions; 3 G:C to C:G transversions; 2 single nucleotide insetion/deletion). All of three tumors obtained from the two PJS patients harbored a same sequence alteration. Although LOH was not observed in these tumors, independent sequence alterations were found in two of the three tumors, which may suggest biallelic inactivation of LKB1 in tumors occurred in the PJS patients. Conclusions: The relatively high frequency of LKB1 mutation in mBAC patients may suggest its implication in lung carcinogenesis, at least in mBAC, and its potential as a therapeutic target.

[Table: see text]

No significant financial relationships to disclose.

Activation of Wnt/beta-catenin signalling pathway induces chemoresistance to interferon-alpha/5-fluorouracil combination therapy for hepatocellular carcinoma

Type I IFN receptor type 2 (IFNAR2) expression correlates significantly with clinical response to interferon (IFN)-α/5-fluorouracil (5-FU) combination therapy for hepatocellular carcinoma (HCC). However, some IFNAR2-positive patients show no response to the therapy. This result suggests the possibility of other factors, which would be responsible for resistance to IFN-α/5-FU therapy. The aim of this study was to examine the mechanism of anti-proliferative effects of IFN-α/5-FU therapy and search for a biological marker of chemoresistance to such therapy. Gene expression profiling and molecular network analysis were used in the analysis of non-responders and responders with IFNAR2-positive HCC. The Wnt/β-catenin signalling pathway contributed to resistance to IFN-α/5-FU therapy. Immunohistochemical analysis showed positive epithelial cell adhesion molecule (Ep-CAM) expression, the target molecule of Wnt/β-catenin signalling, only in non-responders. In vitro studies showed that activation of Wnt/β-catenin signalling by glycogen synthesis kinase-3 inhibitor (6-bromoindirubin-3′-oxime (BIO)) induced chemoresistance to IFN-α/5-FU. BrdU-based cell proliferation ELISA and cell cycle analysis showed that concurrent addition of BIO and IFN-α/5-FU significantly to hepatoma cell cultures reduced the inhibitory effects of the latter two on DNA synthesis and accumulation of cells in the S-phase. The results indicate that activation of Wnt/β-catenin signalling pathway induces chemoresistance to IFN-α/5-FU therapy and suggest that Ep-CAM is a potentially useful marker for resistance to such therapy, especially in IFNAR2-positive cases.

Economic recession and health inequalities in Japan: analysis with a national sample, 1986-2001

OBJECTIVE

Little is known about whether economic crises widen health inequalities. Japan experienced more than 10 years of economic recession beginning in the 1990s. The question of whether socioeconomic-based inequality in self-rated health widened after the economic crisis was examined.

DESIGN, SETTING AND PARTICIPANTS

Repeated cross-sectional survey design. Two pooled datasets from 1986 and 1989 and from 1998 and 2001 were analysed separately, and temporal change was examined. The study took place in Japan among the working-age population (20-60 years old). The two surveys consisted of 168 801 and 150 016 people, respectively, with about an 80% response rate.

RESULTS

The absolute percentages of people reporting poor health declined across all socioeconomic statuses following the crisis. However, after controlling for confounding factors, the odds ratio (OR) for poor self-rated health (95% confidence intervals) among middle-class non-manual workers (clerical/sales/service workers) compared with the highest class workers (managers/administrators) was 1.02 (0.92 to 1.14) before the crisis but increased to 1.14 (1.02 to 1.29) after the crisis (p for temporal change = 0.02). The association was stronger among males. The adjusted ORs among professional workers and young female homemakers also marginally increased over time. Unemployed people were twice as likely to report poor health compared with the highest class workers throughout the period. Self-rated health of people with middle to higher incomes deteriorated in relative terms following the crisis compared with that of lower income people.

CONCLUSIONS

Self-rated health improved in absolute terms for all occupational groups even after the economic recession. However, the relative disparity increased between the top and middle occupational groups in men.

Exploratory study of clonality determined by expression of tumor markers in intrinsic subtypes of breast cancers

Abstract #5060

[Background] However expression profile-based intrinsic subtypes revealed heterogeneity of breast cancer, several biological issues are not clarified yet, especially in tumor development. [Objectives] In order to clarify the relationship between intrinsic subtypes and positivity of tumor markers (TMs), CEA, CA15-3, BCA225 and NCC-ST439 were measured from sera taken from patients at the relapse retrospectively. In addition to the analysis of positivity of TMs, migration of TMs were analyzed in each intrinsic subtype, especially focused on changes of CA15-3 (equivalent to soluble MUC1) to identify the heterogeneity and development to other subtypes in the meaning of TMs expression. [Methods] Sera were collected from seventy five patients of newly diagnosed metastatic breast cancer. Intrinsic subtypes were simply determined by immunohistochemical staining as Luminal A (LA) ,B (LB), HER2 and TN. The positivity of TM was defined if it elevated 20% higher than normal upper limit. [Results] The positive rate of any TMs were higher in order of LA, LB, HER2 and TN. There was significant difference between Luminal (LA+LB) and TN in positive rate of TMs(p&lt;0.05). If focused on mammary epithelium development marker MUC1 (CA15-3 as a soluble form), it was significantly elevated in Luminal (LA+LB) than HER2 and TN(p&lt;0.05). Interestingly, 18 of 23 (72.3%) TN tumors showed all TMs negative at the relapse, although 4 of 18 (22.2%) TN tumors developed to TMs positive after palliative chemotherapies. [Conclusion] Luminal type showed higher expression of TMs at the relapse. It might be explained by the fact that common TMs were selected as responsive serum proteins to the tumor volume of dominant population of breast cancer by chance. But if we integrate the idea that CA15-3 as a development marker, luminal cancer was developed from ER+ highly developed progenitor and HER2 and TN might be developed from ER- progenitor lineage. The migration of TMs of TN after palliative chemotherapies might be illustrated with clonal selection by chemosensitivity. These phenomenon will be understood by further biological experiments and prospective clinical trials to improve the outcome of metastatic breast cancer.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5060.

Nanogroove formation by ion irradiation on indentation-modified amorphous SiO(2)

Ion beams are widely used for micro/nanostructure fabrication with unique features of the energetic processes. In this work, we present a self-assembled nanostructure fabrication by ion irradiation with a patterned strain/stress field. The patterned strain/stress field is introduced by micro-Vickers indentation to amorphous SiO(2) (load = 100 mN). After irradiation of 60 keV Cu(-) ions, nanogrooves (width from 150 to 250 nm) were created at the indentation edge. Under the ion irradiation of a constant ion flux, the nanogroove size linearly increased with ion fluence from 2 × 10(16) to 1.2 × 10(17) ions cm(-2). Comparison of indented samples after irradiation and thermal annealing suggests that the nanogrooving originates from ion beam interactions with residual stress/strain by indentation and that a non-thermal effect results from the ion irradiation processes. Cross-sectional TEM analysis showed that the grooves extend over 200 nm below the surface, implying that the groove growth is not caused by surface diffusion. It is concluded from the results that the grooving is due to irradiation-induced mass transport accompanied by vacancy aggregation at the interface between the indented and non-indented areas.

Long-term effect of tacrolimus therapy in patients with refractory ulcerative colitis

BACKGROUND

Little is known about long-term outcome of tacrolimus therapy for ulcerative colitis. Aim To evaluate long-term efficacy and safety of tacrolimus in Japanese patients with refractory ulcerative colitis.

METHODS

Twenty-seven patients with UC refractory to conventional therapy were administered tacrolimus with trough whole-blood levels of 10-15 ng/mL to induce remission and 5-10 ng/mL to maintain remission. Median treatment duration was 11 months (1-39 months) and median follow-up duration was 17 months (2-65 months). Evaluation of the clinical response was based on a modified Truelove-Witts severity index (MTWSI).

RESULTS

Tacrolimus produced a clinical response in 21 patients (77.8%), and remission was achieved in 19 of these 21 (70.4%) within 30 days. Overall cumulative colectomy-free survival was estimated as 62.3% at 65 months. In 18 of 19 patients treated with corticosteroids at the initiation of tacrolimus therapy, corticosteroids were discontinued or tapered. Adverse events were tremor (25.9%), renal function impairment (18.5%), infectious disease (14.8%), hot flashes (11.1%), hyperkalaemia (7.4%), headache (7.4%), epigastralgia (7.4%) and nausea (3.7%). No mortality occurred.

CONCLUSION

Long-term administration of tacrolimus appears to be an effective and well-tolerated treatment for Japanese patients with refractory ulcerative colitis.

Nature of magnetic coupling between Mn ions in As-grown Ga1-xMnxAs studied by X-ray magnetic circular dichroism

The magnetic properties of as-grown Ga1-xMnxAs have been investigated by the systematic measurements of temperature and magnetic field dependent soft x-ray magnetic circular dichroism (XMCD). The intrinsic XMCD intensity at high temperatures obeys the Curie-Weiss law, but a residual spin magnetic moment appears already around 100 K, significantly above the Curie temperature (T_{C}), suggesting that short-range ferromagnetic correlations are developed above T_{C}. The present results also suggest that the antiferromagnetic interaction between the substitutional and interstitial Mn (Mn_{int}) ions exists and that the amount of the Mn_{int} affects T_{C}.

[Novel coronary transfer technique for transposition of the great arteries with Planché type II coronary anatomy]

The arterial switch operation has evolved to become the treatment of choice for most of transposition of the great arteries and some types of double outlet right ventricle. Technical improvement in the coronary transfer is the major contribution to the evolution of this procedure. We proposed a novel technique of coronary transfer for the patients with rare but difficult coronary anatomy of Planché type II. We believe it could become one of the options of coronary transfer technique and contribute to the completion of arterial switch operation with uncommon coronary artery patterns.

Amelogenin positive cells scattered in the interstitial component of odontogenic fibromas

BACKGROUND

Odontogenic tumours are often biphasic, consisting of epithelial and interstitial components, with an origin that is not well understood. Odontogenic fibromas are rich in mesenchymal component, but also have many epithelial nests.

AIMS

To investigate the origin of this tumour by immunohistochemistry.

METHODS

The expression of several odontogenic and epithelial markers, including amelogenin, was investigated by immunofluorescent studies.

RESULTS

Immunohistochemical analysis showed that epithelial nests exhibited E-cadherin expression, but not amelogenin. Amelogenin positive cells were scattered in the fibrous tissue, which did not exhibit epithelial marker expression except for epithelial membrane antigen. In one case that had received a test biopsy before whole resection of tumour, amelogenin positive cells were distributed in the regenerating mucosal epithelium or subepithelial tissue.

CONCLUSIONS

Results indicate that amelogenin positive cells of odontogenic fibromas have an epithelial origin and may have the potential for epithelial mesenchymal transition, which has not to date been investigated in benign tumours.

Nitric oxide synthase and NMDA receptor expressions in cavernoma tissues with epileptogenesis

OBJECTIVES

To investigate the contribution of nitric oxide (NO) and the glutamate systems to epileptogenicity of cavernoma (CA).

METHODS

Using immunohistochemistry we examined NO synthases (NOS; neuronal, inducible and endothelial) and N-methyl-D-aspartate (NMDA) receptor subunits 1(NR1) and 2A/B (NR2A/B) in tissues, with and without hemosiderin deposits, adjacent to CA resected from temporal (seven patients) and frontal (one patient) lobes.

RESULTS

All isoforms of NOS, especially iNOS expression, was significantly upregulated in company with NR2A/B expression, not only in declining neuronal cells but also in reactive astrocytes in the tissue, with hemosiderin deposits, adjacent to CA and moreover the degree of iNOS expression was significantly correlated with seizure frequency.

CONCLUSIONS

These preliminary results sustain a speculation that excessive NO may generate in the tissue surrounding CA with repeated microhaemorrhaging and seizures. The neuronal loss and reactive glial proliferation induced by iron or NO may play a role in epileptogenesis.

Muir-Torre syndrome caused by partial duplication of MSH2 gene by Alu-mediated nonhomologous recombination

We describe a 54-year-old man with a pedicled tumour on the neck. The surgical specimen revealed a sebaceous carcinoma. He belonged to a cancer-prone family susceptible to gastrointestinal cancer. Systemic evaluation for latent malignancies revealed early-stage colonic adenocarcinoma. These findings were compatible with Muir-Torre syndrome (MTS). Microsatellite instability was detected in the sebaceous carcinoma, suggesting a DNA mismatch repair gene mutation. Moreover, duplication of exon 7 generated a nonsense codon at codon 427 of the MSH2 gene causing truncation of MSH2 protein. Immunohistochemical analysis showed diminished MSH2 protein levels in the sebaceous carcinoma and colonic adenocarcinoma. To date, there have been no reports showing duplication of exon 7 of the MSH2 gene in MTS or hereditary nonpolyposis colorectal cancer kindreds. Furthermore, the present case indicates that the dermatologist plays an important role in the diagnosis of MTS and evaluation for latent malignancies.

Dual surface plasmon resonances in Zn nanoparticles in SiO(2): an experimental study based on optical absorption and thermal stability

Metallic zinc nanoparticles (NPs) of 5-15 nm in diameter, formed in silica glass (SiO(2)) by Zn ion implantation of 60 keV, showed a strong ultraviolet absorption peak at around 4.8 eV, which has been assigned as the surface plasmon resonance (SPR) of Zn NPs, and another small peak at 1.2 eV, which has never been reported before. To identify the origin of the 1.2 eV peak, the correlations of thermal stability between the two peaks and Zn NPs were evaluated under annealing both in a vacuum (pure thermal stability) and in oxygen gas (thermal oxidation stability). The well-correlated stability between the 1.2 eV peak, the 4.8 eV peak and Zn NPs indicates that the 1.2 eV peak is not ascribed to radiation-induced defects but to the Zn NPs. The 1.2 eV peak can be ascribed to an SPR of Zn NPs in SiO(2), because the peak satisfies the criterion of the SPR of metallic NPs. Since the 4.8 eV peak is also expected to satisfy the criterion, Zn NPs in SiO(2) have two SPRs at 1.2 and 4.8 eV.

A phase I/II, pharmacokinetic (PK) and pharmacogenomic (PG) study of weekly irinotecan (CPT-11) therapy for elderly patients with advanced non-small cell lung cancer

2539

Background: CPT-11 is commonly used to treat lung cancer, but there is little evidence about its efficacy in elderly patients. The aim of this study was to determine the recommended dose (RD) of CPT-11 for weekly administration to elderly patients, and to assess its efficacy and safety. In addition, a PK and PG study was performed to investigate the influence on the clinical outcome. Methods: CPT-11 was infused intravenously on Days 1 and 8 (every 21 days). In the phase I study, the dosage of CPT-11 was escalated from 60 (Level 1) to 80 (Level 2) and 100 mg/m2 (Level 3). PK of CPT-11 and SN-38, and UGT1A1 polymorphism were analyzed during the first treatment cycle in the phase II study. Results: In the phase I study, 12 patients were enrolled (level 1/2/3=6/3/3) and the RD was determined to be 100 mg/m2. The 37 patients in phase II had the following characteristics: male/female=25/12, median age=77 (71–88), IIIB/IV=10/27, PS 0/1=12/25. The overall response rate and the disease control rate (PR+SD) was 8% and 73%, respectively. The median survival time was 441 days and the 1-year survival rate was 54.0%. Grade 3/4 neutropenia and diarrhea occurred in 27% and 8%, respectively. The AUCs for both CPT-11 and SN-38 were significantly correlated with neutropenia (P=0.0095, P=0.0004). Both the UGT1A1*6 and UGT1A1*28 genotypes were significantly correlated with the AUC ratio, leukopenia, and neutropenia ( Table ). Conclusion: CPT-11 monotherapy is considered to be effective for non-small cell lung cancer in elderly patients because good survival with tolerable adverse events were achieved. The UGT1A1*6 and UGT1A1*28 genotypes might both influence the toxicity of irinotecan in Asians.

[Table: see text]

[Table: see text]

Impressive remission of locally advanced malignant peritoneal mesothelioma treated with combination of radiotherapy and intraperitoneal paclitaxel

BACKGROUND

The results of treatment of malignant peritoneal mesothelioma are quite unsatisfactory, especially in the later stages of the disease, regardless of the treatment modality employed.

CASE

We report a case of locally advanced malignant peritoneal mesothelioma, in which the combination of radiotherapy and intraperitoneal paclitaxel was beneficial for long-term disease stabilization. A 71-year-old woman presented with abdominal pain. Abdominal ultrasound and magnetic resonance imaging confirmed the presence of a mass with both cystic and solid components with moderate ascites. Serum CA-125 concentration was 727 IU/ml. At exploratory laparotomy, a large mass originating from the pouch of Douglas was found. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed with partial excision of the mass and involved the peritoneum of the pouch of Douglas. The histologic study showed malignant peritoneal mesothelioma. One year and five months after surgery, significant progression of the residual tumor with increasing ascites was noted. Radiotherapy to the whole pelvis with 45 Gy in 25 fractions was given over five weeks together with intraperitoneal paclitaxel (60 mg/m2) instillation, which was repeated every three weeks. The patient received eight cycles of paclitaxel instillation over seven months. The compliance of the patient was excellent under therapy and her general condition improved significantly one and half year with a marked regression of the tumor masses after this treatment.

CONCLUSION

The combination of radiotherapy and intraperitoneal paclitaxel seems suitable in palliative settings primarily aimed at improving the quality of life.

Budgets of major ionic species and nutrients on a dam reservoir in forested watershed

To evaluate the role of a dam reservoir in the runoff of pollutant loadings from a forested watershed, the input-output budgets in the Ikuno dam reservoir had been investigated for eight years since 1996. The T-N, T-P, TOC and major ionic species in the bulk precipitation, stream water, and outflow were measured. The residence time calculated by using the data of the inflow and outflow was 0.3 year. The average precipitation was 1,772 mm during the investigation period (1996-2004). The direct deposition to water surface was less than one percentage to total loadings of nutrients and major ionic species. The ratios of output to input of TOC, TN, and TP were 1.04 to 1.42, and those of major ionic species were from 0.83 to 0.99 except for NO3(-), which was 1.12. However, the ratios of output to input of major ionic species except for NO3(-) at the Ikuno dam reservoir will be larger, and those of NO3(-), TOC, TN, and TP will be smaller, if we also include rain events. These results suggested that the dam reservoir played a role as a sink for pollutants in forested watershed, and that the pollutant loadings to downstream may decrease.

[Coagulation and fibrinolysis system in pediatric cardiopulmonary bypass]

Coagulation and fibrinolysis system was evaluated during and after pediatric cardiopulmonary bypass (CPB. Twenty-two atrial septal defect (ASD) patients were surgically repaired under CPB and aortic cross-clamp through right thoracotomy. Drainage was established by gravity, CPB flow was kept 2.4 l/min/m2 and ACT was controlled over 400 seconds. HCT, PLT, fibrinogen, AT-III, D-dimer, thrombin-antithrombin complex (TAT), alpha2 plasmin inhibitor-plasmin complex (PIC), and plasminogen activator inhibitor (PAI-1) were measured at 6 points [after induction of anesthesia, 10 minutes after initiating CPB, end of CPB, on the entrance of intensive care unit (ICU), postoperative day (POD) 1, and at outpatient division]. Both fibrinogen and AT-III showed low values during CPB (121.9 +/- 22.0 mg/dl, 57.6 +/- 10.6%). D-dimer increased at 1 week postoperatively in all patients (5.57 +/- 3.45 microg/ml). There were significantly positive correlations between CPB duration and TAT value at the end of CPB (r = 0.88, p < 0.01), on the entrance of ICU (r = 0.71, p < 0.01). There was also a positive correlation between CPB duration and PIC value on the entrance of ICU (r = 0.53, p < 0.01). Five patients showed high PAI-1 value on the entrance of ICU, which remained high in 2 of them on POD 1. The outcomes from the current study suggest that there is a potential of coagulation-dominant disseminated intravascular coagulation (DIC) during pediatric CPB even in ASD patients who do not need long CPB. Longer CPB and severe hemodilution might become risk factors.

Alpha-fetoprotein mRNA Detection in Peripheral Blood for Prediction of Hepatocellular Carcinoma Recurrence After Liver Transplantation

The aim of this study was to assess the value of alphafeto protein (AFP) mRNA-expressing cells detected in peripheral blood for predicting tumor recurrence after living donor liver transplantation (LDLT) in patients with hepatocellular carcinoma (HCC). The test group consisted of 25 patients who underwent LDLT for end-stage liver disease with HCC while the control group consisted of 37 living donors. Quantitative real-time reverse-transcriptase polymerase chain reaction was used for detection of AFP mRNA-expressing cells in peripheral blood. Nine (36%) of 25 patients developed tumor recurrences (four lung; one liver; one peritoneum; two bone; one adrenal gland) during the follow-up period. Perioperatively, AFP mRNA was positive in peripheral blood of eight patients (32.0%) but only in 1 (2.7%) of the control. Preoperative AFP mRNA was positive in three cases. Univariate analyses revealed that preoperative and perioperative AFP mRNA and microscopical vascular invasion were the significant predictors for HCC recurrence (P = .007, .037, and .005, respectively). In the patients with HCC exceeding Milan criteria (n = 15), the presence of AFP mRNA-positive cells in the peripheral blood correlated significantly with HCC recurrence (P = .033). We concluded that the presence of AFP mRNA-expressing cells could be a useful predictor of HCC recurrence in liver transplant patients.

Expressional screening of interferon-stimulated genes for antiviral activity against hepatitis C virus replication

Type-I interferons (IFNs) and the interferon-stimulated genes (ISGs) play a major role in antivirus responses against hepatitis C virus (HCV) infection. In this study, we studied expression profiles of ISGs in cells supporting subgenomic HCV replication (Huh7/Rep), and screened their activities to suppress HCV replication. Real-time PCR analyses showed that the expression levels of 23 ISGs were significantly lower in Huh7/Rep than naive Huh7 cells due to transcriptional suppression of the interferon-stimulated response element (ISRE). Furthermore, the expression level of ISGs was also decreased in the cured Huh7 cells in which replicon had been eliminated (cHuh7), indicating adaptation of the cells to support HCV replication by downregulating ISGs. On the other hand, expression of HCV replicon was significantly suppressed by overexpression of several ISGs including PKR, MxA, IRF-9, GBP-1, IFI-6-16, IFI-27, 25OAS and IRF-1. Knock down of GBP-1, IFI-6-16 and IFI-27 by short hairpin RNA resulted in increase of HCV replication. Thus, we conclude that downregulation of ISG expression is required in the host cells supporting HCV replication and that several ISGs directly suppress HCV replication. The search for ISGs that regulate HCV replication may help to elucidate the cellular antiviral defence mechanisms against HCV infection.

The impact of multiple role occupancy on health-related behaviours in Japan: Differences by gender and age

OBJECTIVES

We examined gender and age differences in the impact of multiple role occupancy on health-related behaviours and health status among working age Japanese adults.

METHODS

We analysed the individually linked, nationally representative data of 5693 respondents aged 20-59, who completed the Comprehensive Survey of the Living Conditions of People on Health and Welfare and the National Nutrition Survey, conducted by the Japanese government in 1995.

RESULTS

Younger women benefited from multiple roles (less smoking), while younger men demonstrated more high-risk behaviours (more smoking, heavier drinking). By contrast, middle-aged men benefited from multiple roles (less smoking, fewer health problems), while middle-aged women reported lower health maintenance behaviours (less exercise, fewer health check-ups).

CONCLUSIONS

Japanese society appears to be undergoing a transition in gender roles, as reflected by age and gender differences in the impact of multiple roles on health and health-related behaviours. Middle-aged males benefit from multiple roles (being the primary bread-winner and being married), while middle-aged women do not. This pattern seems to break down for younger Japanese men and women.

Expression pattern of adhesion molecules in junctional epithelium differs from that in other gingival epithelia

BACKGROUND AND OBJECTIVE

The gingival epithelium is the physiologically important interface between the bacterially colonized gingival sulcus and periodontal soft and mineralized connective tissues, requiring protection from exposure to bacteria and their products. However, of the three epithelia comprising the gingival epithelium, the junctional epithelium has much wider intercellular spaces than the sulcular epithelium and oral gingival epithelium. Hence, the aim of the present study was to characterize the cell adhesion structure in the junctional epithelium compared with the other two epithelia.

MATERIAL AND METHODS

Gingival epithelia excised at therapeutic flap surgery from patients with periodontitis were examined for expression of adhesion molecules by immunofluorescence.

RESULTS

In the oral gingival epithelium and sulcular epithelium, but not in the junctional epithelium, desmoglein 1 and 2 in cell-cell contact sites were more abundant in the upper than the suprabasal layers. E-cadherin, the main transmembranous molecule of adherens junctions, was present in spinous layers of the oral gingival epithelium and sulcular epithelium, but was scarce in the junctional epithelium. In contrast, desmoglein 3 and P-cadherin were present in all layers of the junctional epithelium as well as the oral gingival epithelium and sulcular epithelium. Connexin 43 was clearly localized to spinous layers of the oral gingival epithelium, sulcular epithelium and parts of the junctional epithelium. Claudin-1 and occludin were expressed in the cell membranes of a few superficial layers of the oral gingival epithelium.

CONCLUSION

These findings indicated that the junctional epithelium contains only a few desmosomes, composed of only desmoglein 3; adherens junctions are probably absent because of defective E-cadherin. Thus, the anchoring junctions connecting junctional epithelium cells are lax, causing widened intercellular spaces. In contrast, the oral gingival epithelium, which has a few tight junctions, functions as a barrier.

Risk factors for graft dysfunction after adult-to-adult living donor liver transplantation

The aim of this study was to investigate the risk factors for graft dysfunction after adult-to-adult living donor liver transplantation (LDLT). Thirty-nine adults with chronic cirrhosis underwent LDLT between 1999 and 2004. Their postoperative courses were uneventful with no vascular or bile duct complications early after LDLT, except one mild hepatic artery stenosis. The preoperative MELD scores were significantly higher in the failed graft group (n=5) than the functioning graft group (n=34; P=.004), while the graft liver weight/standard liver volume ratio was similar between these groups. We concluded that a high preoperative MELD score was associated with postoperative graft failure and that graft size had little impact on graft outcome. Although large grafts would seem intuitively more suitable for sick recipients, we did not show a benefit among this cohort; the MELD score was the best predictor, a finding that is also most consistent with donor safety.

Difference of HBV Genotype Distribution Between Acute Hepatitis and Chronic Hepatitis in Japan

BACKGROUND

Recently genotype A which is rare in the patients in chronic hepatitis B (CHB) was frequently noted in patients with acute hepatitis B (AHB). To investigate their clinical and virological features, we studied the AHB patients in the past 5 years.

PATIENTS AND METHODS

98 patients with AHB and 80 patients with CHB admitted to our hospital between 1998 and 2003 were studied.

RESULTS

Genotype A was not found in CHB but was frequently noted in AHB (p < 0.001). Comparison of the clinical features of acute hepatitis between the two major genotypes, A and C, homosexual and heterosexual with multiple partners were frequently seen among genotype A patients (p < 0.001). On the other hand, infection from steady partner showed a tendency to be more frequent in genotype C (p = 0.065). In genotype A, the levels of HBVDNA on admission was higher (p = 0.007) and AHB has significantly more frequently progress to chronic infection than in genotype C (p = 0.028). Phylogenetic analysis of genotype A revealed that almost all strains from homosexual men belonged not to the African type A1 but to the Western type A2.

CONCLUSION

Genotype A has increased recently among AHB in Japan. This fact may correlate to promiscuous intercourse in high risk group. Prophylactic efforts should be considered to prevent the prevailing of genotype A.

Conceptual equivalence and health-related quality of life: an exploratory study in Japanese and Dutch cancer patients

Research into the equivalence of Western and Japanese conceptualizations of health-related quality of life (HR-QOL) is scarce. We used the Western (European Organization for Research and Treatment of Cancer, EORTC-QLQ-C30) and the Japanese (HRQoL-20) questionnaire in order to analyze the conceptual similarity of HR-QOL factors, and the associations between specific symptom items with overall HR-QOL in Japanese (n=265) and Dutch (n=174) patients with various types of cancer. Both populations completed both instruments. In both patient groups, the overall health scale of the EORTC-QLQ-C30 correlated highly (r=0.59; p<0.001) with the HRQOL-20 composite average score, indicating substantial conceptual comparability. Relationships between all EORTC-QLQ-C30 symptom items with HR-QOL were examined by ranking their correlations with the two overall measures of HR-QOL. Comparable patterns in the Japanese and Dutch samples were observed. The results suggest a considerable conceptual equivalence of HR-QOL in Japanese and Dutch cancer patients, and indicate a satisfactory structural and cross-cultural equivalence for the EORTC-QLQ-C30 with regard to items measuring functioning and specific symptoms. Longitudinal studies are needed to examine the impact of specific symptoms on general quality of life.

Prediction of gemcitabine resistance in patients with pancreatic cancer

4125

Background: Pancreatic cancer is the most lethal of all solid tumors partially because of its chemoresistance. Although a deoxycytidine analogue, gemcitabine, is widely used as a first selected and a single agent for the treatment of this disease despite low response rate, molecular mechanisms of gemcitabine resistance in pancreatic cancer still remain obscure. The purpose of this study is to identify the molecular marker for gemcitabine resistance in human pancreatic cancer. Methods: Gemcitabine resistant variants were established from human pancreatic cancer cell lines, MiaPaCa2. Gene expression changes between parental cells and resistant cells were assessed by an oligonucleotide microarray covering 30,000 human oligonucleotides, and candidate genes were validated by RT-PCR and Western blotting. The association to resistance was validated by RNAi assay. Clinical effects on 18 recurrent pancreatic cancer patients treated by gemcitabine were evaluated using mRNA of specimens resected at the primary operation. Results: The 81-fold gemcitabine resistant variant MiaPaCa2-RG was selected from pancreatic cancer cell line MiaPaCa2. By microarray analysis between parental and resistant MiaPaCa2 cells, 99.6% genes were altered expression of less than 2-fold. Among 43 genes with altered expression of more than 2-fold, the most up-regulated gene in MiaPaCa2-RG cells is ribonucleotide reductase M1 subunit (RRM1) with 4.5-fold up-regulation compared with MiaPaCa2 cells. Transfection with RRM1-specific RNAi suppressed more than 90% of RRM1 mRNA and protein expression both in MiaPaCa2 and MiaPaCa2-RG cells. After RRM1-specific RNAi transfection, gemcitabine chemoresistance of MiaPaCa2-RG was significantly reduced to the same level of MiaPaCa2. The 18 recurrent pancreatic cancer patients were divided into two groups by RRM1 mRNA expression levels. There was a significant association between gemcitabine response and RRM1 expression (p = 0.018). Furthermore, patients with high RRM1 levels had a poor survival times after gemcitabine treatment than those with low RRM1 levels (p = 0.016). Conclusions: RRM1 should be a key molecule in gemcitabine resistance in pancreatic cancer through both in vitro and clinical models. RRM1 should be considered as the predictor of gemcitabine resistance.

No significant financial relationships to disclose.

A phase I/II trial of irinotecan-cisplatin combined with an anti-late-diarrhoeal programme to evaluate the safety and antitumour response of this combination therapy in patients with advanced non-small-cell lung cancer

We conducted a phase I/II study in patients with advanced non-small-cell lung cancer (NSCLC) to increase the therapeutic index of the cisplatin–irinotecan combination by institution of an anti-late-diarrhoeal program (ADP). A total of 77 chemotherapy-naive patients with advanced NSCLC were enrolled. The cisplatin dose was fixed at 60 mg m⁻² (Day 1). Irinotecan was escalated in 5 mg m⁻² increments, starting from 60 mg m⁻² (Days 1 and 8). ADP consisted of oral sodium bicarbonate, magnesium oxide, basic water, and ursodeoxycholic acid, and was administered orally for 4 days with each dose of irinotecan. In the phase I portion, irinotecan pharmacokinetics was also examined. After the recommended dose of irinotecan with ADP was determined, a phase II study was conducted to evaluate the response. Maximum tolerated dose was reached at an irinotecan dose of 80 mg m⁻² (Grade 4 diarrhoea and neutropenia). Pharmacokinetic studies show that the maximum concentration and the area under the curve of both irinotecan and SN38 (active metabolite of irinotecan) tend to increase in the dose-dependent manner of irinotecan. The phase II portion of the study included 48 patients, who were treated with 75 mg m⁻² of irinotecan. Grade 3/4 toxicities included neutropenia in 65%, leucopenia in 33%, and late diarrhoea in 6% of the patients. During this treatment, PS did not change in 65% of patients. At the end of the chemotherapy, PS did not decline in 90% of patients. In the phase II portion, a response occurred in 63% (95% confidential interval (CI), 47–76%) of patients. Median time to progression was 19 weeks (95% CI, 15–22 weeks), and median survival was 52 weeks (95% CI, 39–64 weeks). This regimen of irinotecan and cisplatin with ADP resulted in promising efficacy with acceptable toxicity for patients with advanced NSCLC. This regimen is a candidate for the experimental arm towards future phase III studies.