Esophageal cancer: definitive chemoradiotherapy for elderly patients

To investigate the efficacy and toxicity of definitive chemoradiotherapy (CRT) for elderly patients with locally advanced esophageal cancer. Twenty-two patients aged over 75 that performed definitive CRT were retrospectively reviewed. The regimen included concurrent CRT consisting of two cycles of chemotherapy (CTx) of platinum and 5-fluorouracil, and radiation therapy (RT) of 50-50.4 Gy (actual range: 45.4-71.4 Gy), and additional CTx where possible. Both CTx and RT were reduced in dose and field where necessary. The disease-free survival rate and the overall survival rate at 3 years were 33.3% ± 11.4% and 25.9% ± 10.8%. Grade 4 leukocytopenia and thrombocytopenia occurred in three (14%) and four (18%) patients. Treatment-related death was suspected in up to four (18%) patients at the most. Univariate analyses for disease-free survival showed that neither total radiation dose nor number of total cycles of CTx was significant. The pattern of relapse was predominantly more frequent in the intra-RT field than outside the RT field. For elderly patients, adverse events are frequent, and decreased organ reserve may cause treatment-related death. Reduction in CTx dose or RT field, appropriate only for two cycles of CTx, and careful monitoring may help to minimize toxicity. Physicians should not be too afraid of adverse events or be negative about CRT for elderly patients, as long as comorbidities and complications are managed carefully.

Increase in tumour permeability following TGF-beta type I receptor-inhibitor treatment observed by dynamic contrast-enhanced MRI

Background:

To enhance the success rate of nanocarrier-mediated chemotherapy combined with an anti-angiogenic agent, it is crucial to identify parameters for tumour vasculature that can predict a response to the treatment of the anti-angiogenic agent.

Methods:

To apply transforming growth factor (TGF)-β type I receptor (TβR-I) inhibitor, A-83-01, to combined therapy, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was carried out in mice bearing colon 26 cells using gadolinium (Gd)-DTPA and for its liposomal formulation to evaluate changes in tumour microvasculature following A-83-01. Tumour vascular parameters from DCE-MRI were compared with histological assessment and apparent diffusion coefficient of water in tumour generated by diffusion-weighted MRI.

Results:

Contrary to evaluations reported for anti-angiogenic agents, A-83-01 treatment increased the initial area under the Gd concentration–time curve (IAUGC₆₀), volume transfer constant (K^trans) and fractional plasma volume (v_p) significantly within 24 h, that was positively related to α-smooth muscle actin-positive pericyte coverage and tumour cell proliferation, and was correlated inversely with the apparent diffusion coefficient. The vascular function of the tumour improved by A-83-01 treatment was well assessed on post-liposomal Gd-DTPA-enhanced MR images, which predicted delivery of a liposomal drug to the tumour.

Conclusion:

These findings suggest that DCE-MRI and, in particular, K^trans and v_p quantitation, provide important additional information about tumour vasculature by A-83-01 treatment.

[Six cases of spontaneous pneumomediastinum]

We report 6 cases of spontaneous pneumomediastinum. It is defined not to have clear etiology such as trauma, and is comparatively rare disease developing suddenly. Our patients complained of chest or neck pain, dyspnea and pain when swallowing. They were 3 men and 3 women, who were young and did not have causal disease. Chest X-ray films and computed tomography (CT) scans revealed pneumomediastinum. All of them were treated conservatively and recovered completely within 10 days hospitalization. Spontaneous pneumomediastinum is uncommon and usually benign. Most patients require only conservative treatment. However, since it possibly develops tension pneumothorax, pneumothorax, or mediastinitis, careful observation is recommended never to overlook life-threatening condition. In addition, it is important to distinguish from Boerhaave syndrome, tracheal trauma and so on.

Zoledronate facilitates large-scale ex vivo expansion of functional gammadelta T cells from cancer patients for use in adoptive immunotherapy

BACKGROUND

Human gammadelta T cells can be activated by phospho-antigens and aminobisphosphonates such as zoledronate. Because they can kill tumor cells in a major histocompatibility complex (MHC)-unrestricted manner, adoptive transfer of activated gammadelta T cells may represent a novel cancer immunotherapy. We tested whether gammadelta T cells from advanced cancer patients can be expanded by zoledronate.

METHODS

Peripheral blood mononuclear cells from healthy donors and patients with advanced non-small cell lung cancer, bone metastatic breast or prostate cancer, or lung metastatic colorectal cancer, were stimulated with zoledronate (5 microM) and interleukin (IL)-2 (1000 IU/mL) for 14 days. The phenotype and function of the expanded gammadelta T-cell populations from healthy donors and cancer patients were compared.

RESULTS

Gammadelta T cells from cancer patients and healthy donors responded to zoledronate equally well in terms of both phenotype and function. gammadelta T cells grew rapidly in vitro and expression of effector molecules, such as interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, perforin, granzyme B, FasL and TRAIL, increased over time. Cytotoxicity peaked on days 12-14, and proliferation continued up to 14 days, during which time>1x10(9) gammadelta T cells could be obtained from a starting sample of 45-70 mL peripheral blood.

DISCUSSION

Using the agent zoledronate, already widely used in the clinic, we have established that efficient large-scale ex vivo expansion of gammadelta T cells from cancer patients is possible. These cells exert potent cytotoxicity and may be used for autologous cellular immunotherapy of cancer.

INDICATION OF VARICOCELECTOMY IN THE ERA OF ASSISTED REPRODUCTIVE TECHNOLOGY: PREDICTION OF TREATMENT OUTCOME BY NONINVASIVE DIAGNOSTIC METHODS

Of 103 patients who underwent varicocelectomies, 87 underwent all the diagnostic methods: color Doppler ultrasonography (DOP), scrotal deep body temperature (DBT), and scrotal scintigraphy (SSG). Total motile sperm (TM) was calculated. The positivities of DOP, DBT, and SSG were 67, 51, and 90%, respectively. In the patients <30 years old, TM increased in the DBT-positive group. In older patients, positive for DBT indicated poor improvement of TM, whereas positive for DOP indicated better response in the group. Patients older than 30 years and positive for DBT, but not DOP, should be counseled directly to receive intrauterine insemination or in vitro fertilization/intracytoplasmic sperm injection.

YOUNG'S SYNDROME ASSOCIATED WITH SITUS INVERSUS TOTALIS

Primary ciliary dysfunction causes recurrent sino-pulmonary infections and shares the pathophysiology of the reproductive tract. A 34-year old man with bronchectasis and situs inversus totalis was investigated because of azoospermia. Endocrinological evaluations were all normal and scrotal exploration revealed the distended caput, but atrophic body to tail, of the epididymis. Light microscopy of testicular biopsy showed normal spermatogensis and motile sperms were easily obtained by testicular sperm extraction. Electron microscopy demonstrated normal sperm structure, whereas 65% of nasal cilias showed defect of central microtubules. This case, which bears a resemblance of Kartagener's syndrome (situs inversus totalis), is considered a unique variant of Young's syndrome.

Long-term results of breast-conservation therapy for Japanese women classified according to intrinsic subtype

e11578

Background: Microarray analysis has identified breast cancer subtypes with distinct gene expression profiles according to the estrogen receptor (ER) and the human epidermal growth factor 2 (HER2) expression. The luminal subtypes (ER-positive) appear to be associated with the better prognosis, whereas the basal and HER2 subgroups tend to have worse recurrence rates. The impact of intrinsic subtype for Japanese women with early-stage invasive breast cancer on prognosis is unknown. The purpose of this study is to address whether breast cancer subtype is associated with recurrence among Japanese women who receive breast-conservation therapy (BCT). Methods: The study cohort included 770 consecutive women with invasive breast cancer who received BCT at University of Tokyo Hospital from 1994 through 2007. Among them, 285 women had complete information on the ER and HER2 status of their primary tumors. The number of patients according to luminal A (ER+HER2- ), luminal B (ER+ HER2+), basal (ER-HER2-) and HER2 (ER-HER2+) subtype was 162, 66, 40 and 17, respectively. All patients received external-beam radiation therapy to the whole breast. The most common doses were 50 Gy in 25 fractions to the whole breast plus a tumor-bed boost to 60 Gy. Results: Median follow-up time was 55 months (range, 6 to 144 months). No significant difference was observed between 5-year disease control and four major subtypes. The 5-year relapse free survival rate of HER2-positive and -negative patients was 77% vs. 95%, which was of statistically significance (p = 0.001). Multivariate analysis showed that T stage, N stage, HER2 status and lymphatic vessel invasion correlated significantly with shorter relapse free survival. Multivariate analysis showed that only N stage was associated with decreased overall survival (p = 0.017). Conclusions: Overall, the 5-year relapse free survival rate after BCT was high, and no significant difference was found in four major subtypes as approximated using ER and HER2 status in Japanese women who receive BCT. Only HER2 status was a statistically significant risk factor after BCT. Although further follow-up is needed, BCT may still be optimal option in Japanese women with early-stage invasive breast cancer to whichever intrinsic subtype their tumors belong.

No significant financial relationships to disclose.

[Coronary artery bypass grafting for simultaneous subacute stent thrombosis after sirolimus-eluting stent implantation]

An 82-year-old man developed simultaneous stent thrombosis 11 days after the implantation of a sirolimus-eluting stent (SES) in the proximal left anterior descending artery (LAD) and the proximal right coronary artery (RCA). The patient immediately underwent percutaneous coronary intervention; however, his condition became critical due to the development of recurrent stent thrombosis, and emergent coronary artery bypass grafting with saphenous vein grafts was performed. Postoperative angiography showed good patency of both grafts; thrombus formation in the LAD and RCA was negative. Since the patient had a history of liver dysfunction due to ticlopidine administration, the thienopyridine derivative was not administered; this was believed to be the main cause of subacute stent thrombosis. He was administered aspirin, cilostazol, and sarpogrelate instead. A good postoperative course was achieved only using aspirin. This case demonstrates that simultaneous SES thrombosis in multivessel lesions poses a life-threatening situation.

Safety of ofloxacin (OFLX) and fosfomycin sodium (FOM) ear drops

OBJECTIVE

The objective of this study is to evaluate the safety of two ear drops, Ofloxacin (OFLX: Taribid Otic Solution, Daiichi Seiyaku) and Fosfomycin sodium (FOM: Fosmicin S, Meiji Seiyaku).

METHODS

Albino guinea pigs were used as experimental animals, and the ototoxicity was evaluated by means of threshold changes in the compound action potentials (CAP), when topically applied to the middle ear cavity of the guinea pig. The sound stimuli applied were; click sound, with tone bursts of 8 kHz, 4 kHz, and 2 kHz. In one group of animals, after one application of the ear drops in the right middle ear cavity, the change in CAP was compared with a contralateral saline control at 24h, one week, and four weeks. In other group of animals, the ear drops were applied into the middle ear cavity for seven consecutive days and the CAP was measured at 24h.

RESULTS

At 24h the CAP threshold for click, 8 and 4 kHz elevated significantly for both the saline and ear drop treatment, but the threshold returned to normal when measured at 7 days and 28 days. Seven consecutive days of ear drops administration resulted in no reduction in the CAP for either ear drops.

CONCLUSIONS

Based on the lack of changes in the CAP, these two ear drops studied did not show any significant ototoxicities.

p21 provides stage specific DNA damage control to preimplantation embryos

The early stage embryogenesis of higher eukaryotes lacks some of the damage response pathways such as G1/S checkpoint, G2/M checkpoint and apoptosis. We examined here the damage response of preimplantation stage embryos after fertilization with 6 Gy irradiated sperm. Sperm-irradiated embryos developed normally for the first 2.5 days, but started to exhibit a developmental delay at day 3.5. p21 was activated in the delayed embryos, which carried numerous micronuclei owing to delayed chromosome instability. Apoptosis was observed predominantly in the inner cell mass of the day 4.0 embryos. Sperm-irradiated p21-/- embryos lacked the delay, but chromosome instability and apoptosis were more pronounced than the corresponding p21 wild-type embryos. We conclude from the result that damage responses come in a stage-specific manner during preimplantation stage development; p53-dependent S checkpoint at the zygote stage, p21-mediated cell cycle arrest at the morula/blastocyst stages and apoptosis after the blastocyst stage in the inner cell mass.

[Emergent coronary artery bypass grafting in a survivor of out-of-hospital cardiac arrest]

We report a case of emergent coronary artery bypass grafting (CABG) in a survivor of an out-of-hospital cardiac arrest. A 64-year-old male driver lost consciousness and collapsed in a rice paddy field. A bystander placed him in a car and immediately started cardiopulmonary resuscitation after confirming the presence of pulselessness and apnea. Emergency medical service providers performed a defibrillation of ventricular fibrillation by using an automated external defibrillator (AED), and the patient was transferred to the critical care center in our hospital. Coronary angiography revealed a thrombus in the left main trunk (LMT), total occlusion of the left anterior descending artery (LAD) and the right coronary artery (RCA), and 90% stenosis of the left circumflex artery (Cx). Since the patient recovered consciousness 1 hour after admission and did not undergo any critical trauma, an on-pump CABG was performed for 3 vessels. He was discharged on the postoperative day 23, and he resumed a normal life.

Pre-B-cell leukemia transcription factor 1 is a major target of promyelocytic leukemia zinc-finger-mediated melanoma cell growth suppression

Promyelocytic leukemia zinc-finger (PLZF) is a transcriptional repressor and tumor suppressor. PLZF is expressed in melanocytes but not in melanoma cells, and recovery of PLZF expression markedly suppresses melanoma cell growth. Several target genes regulated by PLZF have been identified, but the precise function of PLZF remains uncertain. Here, we searched for candidate target genes of PLZF by DNA microarray analysis. Pre-B-cell leukemia transcription factor 1 (Pbx1) was one of the prominently suppressed genes. Pbx1 was highly expressed in melanoma cells, and its expression was reduced by transduction with the PLZF gene. Moreover, the growth suppression mediated by PLZF was reversed by enforced expression of Pbx1. Knockdown of Pbx1 by specific small interfering RNAs suppressed melanoma cell growth. We also found that Pbx1 binds HoxB7. Reverse transcription-polymerase chain reaction analysis demonstrated that repression of Pbx1 by PLZF reduces the expression of HoxB7 target genes, including tumor-associated neoangiogenesis factors such as basic fibroblast growth factor, angiopoietin-2 and matrix metalloprotease 9. These findings suggest that deregulation of Pbx1 expression owing to loss of PLZF expression contributes to the progression and/or pathogenesis of melanoma.

Dose effect for South Serbians due to 238U in natural drinking water

The use of depleted uranium ammunition in South Serbia during the 1999 Kosovo conflict raised a great deal of public concern in the Balkans. Radioactivity levels of 238U in 20 wells and lake water samples were checked from the viewpoint of internal radiation exposure for South Serbian subjects. We have measured 238U concentration using inductively coupled plasma mass spectrometry, whereas thermal ionisation mass spectrometry has been used for the measurement of isotope ratios, e.g. 234U/238U and 235U/238U. The concentration of uranium in water samples varies in the range 1.37-63.18 mBq/L. 234U belongs to the 238U natural radioactive decay series, and at secular equilibrium, the abundance ratio, 234U/238U, corresponds to the ratio of their half-lives. The 234U/238U activity ratio varies in the range 0.88-2.2 and 235U/238U isotope ratio varies from 0.00698 to 0.00745. These findings indicate that uranium in water was a mixture of natural and anthropogenic origin. The annual effective dose due to 238U was estimated to be in the range 9.2 x 10(-5)-2.1 x 10(-3) mSv.