A case of alpha-fetoprotein-producing adenocarcinoma of the endometrium with a hepatoid component as a potential source for alpha-fetoprotein in a postmenopausal woman

Although case reports of alpha-fetoprotein (AFP)-producing adenocarcinoma other than hepatocellular carcinoma have gradually increased in number, AFP-producing adenocarcinoma of the endometrium is very rare. The patients universally complain of abnormal vaginal bleeding. The patient presented with complaints of epigastric discomfort. No vaginal bleeding was observed. Serum AFP concentration was 453 ng/mL, and lens culinaris agglutinin-reactive AFP percentage of total AFP was increased to 67%. Radiologic imaging and endoscopy did not provide evidence of any primary carcinoma in the liver and gastrointestinal tract. To investigate the unknown origin of high AFP, Pap smear of the endometrium followed by fractional curettage was performed and revealed adenocarcinoma of the endometrium. Radical hysterectomy with pelvic lymph node dissection and partial omentectomy was performed. Histologic study showed a mixture of major AFP-negative endometrioid adenocarcinoma and minor medullary proliferation of the AFP-positive hepatoid adenocarcinoma cells with eosinophilic cytoplasm and hyaline globules. After the surgery followed by four courses of weekly carboplatin and paclitaxel administration, serum levels of AFP dropped into normal range. The possible existence of AFP-producing adenocarcinoma of the endometrium should be considered in a postmenopausal woman even if there is no vaginal bleeding, when AFP-producing tumor is clinically suspected and the imaging studies fail to confirm the diagnosis.

Insignificant effects of plasma catecholamines on dynamic heart rate regulation by the cardiac sympathetic nerve

Although plasma catecholamines such as norepinephrine (NE) and epinephrine (Epi) increase during severe exercise, the effects of high levels of plasma catecholamines on dynamic heart rate (HR) regulation by the cardiac sympathetic nerve remains unknown. The aim of the present study was to examine the effects of plasma catecholamines on the transfer function from sympathetic nerve stimulation to HR. In anesthetized rabbits, we randomly stimulated the right cardiac sympathetic nerve according to a binary white noise signal while measuring HR. The effects of intravenous NE administration at 1 and 10 mugmiddotkg^-1middoth^-1 were examined in 6 rabbits. The effects of intravenous Epi administration at 1 and 10 mugmiddotkg^-1middoth^-1 were examined in different 6 rabbits. Although plasma NE increased 10 times as high as the baseline level during the NE administration at mugmiddotkg^-1middoth^-1 , dynamic gain of the transfer function was not changed significantly (7.1plusmn1.2, 6.9plusmn1.1, and 7.7plusmn1.1 beatsmiddotmin^-1middotHz^-1). Similarly, although plasma Epi increased 10 times as high as the baseline level during the Epi administration at 10 mugmiddotkg^-1middoth^-1, dynamic gain of the transfer function was not changed significantly (7.5plusmn0.8, 7.9plusmn0.8, and 7.6plusmn1.2 beatsmiddotmin^-1middotHz^-1). In conclusion, plasma catecholamines of physiologically-relevant high concentrations did not interfere with the dynamic HR regulation by the cardiac sympathetic nerve.

Transfer function analysis of carotid sinus baroreceptor transduction

The carotid sinus baroreflex is one of the most important negative feedback systems that regulate arterial pressure. The neural arc transfer function from carotid sinus pressure (CSP) input to efferent sympathetic nerve activity shows a gain increase of approximately 10 dB when input frequency increases from 0.01 to 0.5 Hz. The transfer gain of the neural arc decreases in the frequency range above 0.8 Hz. The aim of the present study was to elucidate the extent of contribution of the carotid sinus baroreceptor transduction to the determination of the neural arc dynamic characteristics. In 7 anesthetized rabbits, we isolated the right carotid sinus and controlled CSP while recording afferent nerve activity (ANA) from the carotid sinus nerve. CSP was randomly assigned to either 80 or 120 mmHg with a switching interval of 50 ms according to a binary white noise signal for 15 min. The transfer function from CSP to ANA was estimated in the frequency range from 0.01 to 3 Hz. The transfer function showed a gain increase of approximately 4.6 dB when input frequency increased from 0.01 to 0.3 Hz. The transfer gain remained relatively constant up to 3 Hz. These results suggest that the carotid sinus baroreceptor transduction partly contributes to the gain increase of the baroreflex neural arc in the frequency range from 0.01 to 0.5 Hz but not the gain decrease above 0.8 Hz.

Chronic vagal stimulation decreased vasopressin secretion and sodium ingestion in heart failure rats after myocardial infarction

Chronic vagal stimulation (VS) markedly improved long-term survival in the heart failure rats. We examined the effects of VS on arginine vasopressin (AVP) secretion and salt ingestion in heart failure rats after myocardial infarction (MI). Surviving rats after MI were randomly assigned to two groups. One group was treated with sham stimulation (SS), and the other group was treated with VS. All rats could access water and 1.8% NaCl solution ad libitum. Treatment started at 2 weeks after MI, and continued for 6 weeks. We monitored drinking behavior during treatment. At the end of treatment, we measured hemodynamics and plasma levels of AVP and brain natriuretic peptide (BNP). The plasma AVP and BNP levels were significantly lower in the VS group than the SS group. VS significantly inhibited the ingestion of 1.8% NaCl solution. The normalized biventricular weight of the VS group was significantly lower than that of the SS group. The VS group had significantly lower left ventricular end-diastolic pressure, and higher cardiac index than the SS group. In conclusion, these results suggest that chronic VS regulates the water balance by suppression of plasma AVP level and salt ingestion in the heart failure rats after MI.

A comprehensive physiological model of circulation enables automatic piloting of hemodynamics in patients with acute heart failure

A comprehensive physiological model of the whole circulation is mandatory to quantitatively diagnose pathophysiology and to guide an appropriate treatment. Such a model would enable automatic piloting of hemodynamics in patients with acute heart failure. By extending Guyton's model, so as to deal with heart failure predominantly affecting left heart and to quantify left atrial pressure, we constructed such a model consisting of a venous return (VR) surface and a cardiac output (CO) curve. VR surface, the integrated property of systemic and pulmonary vascular beds, relates VR and left and right atrial pressures (P(LA), P(RA)) linearly as VR = V/W - G(R)P(RA) - G(L)P(LA), given total blood volume (V). CO curve, the pumping ability of hearts, relates CO and either P(LA) or P(RA) approximately by logarithmic functions, respectively, as CO = S(L) [ln (P(LA)- B(L)) + C(L)] = S(R) [ln (P(RA) - B(R)) + C(R)]. The slopes (S(R) and S(L)) of CO curve mainly describes the pump performance. W, G(R), G(L), B(R), B(L), C(R) and C(L) are parameters. We validate the model with animal experiments. Parameters W, G's, B's and C's were relatively constant in 19 dogs. In other 8 dogs, with or without acute left heart failure, we determined V and S's from a single set of CO, P(RA), P(LA) and standard parameter values. We then predicted hemodynamics (CO, P(RA), P(LA)) for altered V from -8 to +8 ml/kg. We identified standard values of parameters as W (0.13 min), G(R) (19.6 ml/min/kg/mmHg), G(L) (3.5 ml/min/kg/mmHg). B(L) (2.1 mmHg), C(L) (1.9), B(R) (2.0 mmHg) and C(R) (0.80). Using these, we could accurately predict CO (y = 0.93x + 6.5, r2 = 0.96, Figure 2), P(RA) (y = 0.87x + 0.4, r2 = 0.91) and P(LA) (y = 0.90x + 0.48, r2 = 0.93). Our comprehensive physiological model of circulation is useful in accurately predicting hemodynamics from the measurement of a single set of CO, P(RA) and (P(LA) following blood volume changes. Therefore, this model enables continuous monitoring of blood volume and pump performance for automatic hemodynamic piloting.

High resolution optical mapping of cardiac action potentials in freely beating rabbit hearts

Optical mapping of action potentials (APs) has become important tools for the cardiac electrophysiology. However, cardiac contraction unavoidably produces motion artifacts (MA) in optical signal. We developed a method to suppress motion artifacts without arresting the hearts.

METHODS

Using a dual-wavelength optical mapping system, APs were recorded on the surface of an isolated rabbit heart. Transmembrane APs were simultaneously recorded using glass microelectrodes. We eliminated MA in a frontal plane by a motion tracking technique. Subsequently, a dual-wavelength ratiometric method was used to remove MA in a vertical direction to a frontal plane.

RESULTS

MA were effectively removed from optical signals. Action potential duration measured from optical signals corresponded with those measured from microelectrodes (r2=0.9677). Our method enables us to map action potentials in freely beating hearts.

New method for evaluation of lung lymph flow rate with intact lymphatics in anaesthetized sheep

AIM

Lung lymph has commonly been studied using a lymph fistula created by tube cannulation into the efferent duct of the caudal mediastinal node in sheep. In this method, the tail region of the caudal mediastinal node is resected and the diaphragm is cauterized to exclude systemic lymph contamination, and cannulation is performed into one of the multiple efferent ducts originating from the caudal mediastinal node. Moreover, the pumping activity of lymphatics might be diminished by cannulation. Therefore, the purpose of the study was to evaluate the flow rate of lung lymph with maintenance of intact lymphatic networks around the caudal mediastinal node to the thoracic duct in sheep.

METHODS

An ultrasound transit-time flow meter was used to measure lung lymph flow. The thoracic duct was clamped just above the diaphragm and the flow probe was attached to the thoracic duct just after the last junction with an efferent duct from the caudal mediastinal node. The lung lymph flow rate was measured at baseline and under conditions of lung-oedema formation.

RESULTS

The baseline lung lymph flow rate in our model was three- to sixfold greater than values obtained with the cannulation method. With oedema-formation, the lung lymph flow rate was the same as that measured using cannulation.

CONCLUSION

The lung lymph flow was unexpectedly large under the conditions of the study, and our data suggest that the drainage effect of lymphatics is significant as a safety factor against pulmonary oedema formation.

Cyclic performance of carbon-coated TiO2 for photocatalytic activity of methylene blue decomposition

Carbon-coated TiO2 powders were prepared from the mixtures of anatase (ST-01) and carbon precursor poly(vinyl alcohol) in different ratios by carbonization at 900 degrees C in a flow of either Ar or N2. Carbon-coated TiQ2 thus prepared was either fixed on an adhesive tape or formed into a film by using the organic binder poly(tetrafluoroethylene) and used for photodecomposition of methylene blue in water repeatedly. On the samples fixed on adhesive tapes, the rate constant was reproduced with about 10-20% scattering during repeated uses in a fresh methylene blue solution up to 7 times. On the samples formed into films by using the organic binder, the rate constant was reproduced after the 3rd or 4th cycle. The mutual relations in rate constant were almost the same among three different conditions for the determination, suspending the sample particles, fixed on an adhesive tape and formed into a film. The rate constant for the photodecomposition was found to give a maximum on the sample containing about 9 mass% carbon.

Levels of omega-3 fatty acid in serum phospholipids and depression in patients with lung cancer

Previous studies suggested that omega-3 fatty acids (FAs) have therapeutic effects against depression, but there is no evidence in the oncological setting. Our preliminary study reported the association between lower omega-3 FA intake and occurrence of depression in lung cancer patients. To explore the association further, the present study examined whether depression was associated with lower levels of omega-3 FAs in serum phospholipids. A total of 717 subjects in the Lung Cancer Database Project were divided into three groups by two cutoff points of the Hospital Anxiety and Depression Scale depression subscale (HADS-D). In all, 81 subjects of the nondepression and minor depression groups (HADS-D<5 and 5⩽HADS-D⩽10, respectively) were selected to match with 81 subjects of the major depression group (HADS-D>10) for age, gender, clinical stage, and performance status. Fatty acids were assayed by gas chromatography and compared among the three matched groups. There were no differences between the major depression group and nondepression group in any FAs. The minor depression group had higher mean levels of docosahexaenoic acid (mean±s.d. (%), nondepression: 7.40±1.54; minor depression: 7.90±1.40; major depression: 7.25±1.52, P=0.017). These results suggested that serum FAs are associated with minor, but not major, depression in lung cancer patients.

A case of alpha-fetoprotein–producing adenocarcinoma of the endometrium with a hepatoid component as a potential source for alpha-fetoprotein in a postmenopausal woman

Although case reports of alpha-fetoprotein (AFP)–producing adenocarcinoma other than hepatocellular carcinoma have gradually increased in number, AFP-producing adenocarcinoma of the endometrium is very rare. The patients universally complain of abnormal vaginal bleeding. The patient presented with complaints of epigastric discomfort. No vaginal bleeding was observed. Serum AFP concentration was 453 ng/mL, and lens culinaris agglutinin–reactive AFP percentage of total AFP was increased to 67%. Radiologic imaging and endoscopy did not provide evidence of any primary carcinoma in the liver and gastrointestinal tract. To investigate the unknown origin of high AFP, Pap smear of the endometrium followed by fractional curettage was performed and revealed adenocarcinoma of the endometrium. Radical hysterectomy with pelvic lymph node dissection and partial omentectomy was performed. Histologic study showed a mixture of major AFP-negative endometrioid adenocarcinoma and minor medullary proliferation of the AFP-positive hepatoid adenocarcinoma cells with eosinophilic cytoplasm and hyaline globules. After the surgery followed by four courses of weekly carboplatin and paclitaxel administration, serum levels of AFP dropped into normal range. The possible existence of AFP-producing adenocarcinoma of the endometrium should be considered in a postmenopausal woman even if there is no vaginal bleeding, when AFP-producing tumor is clinically suspected and the imaging studies fail to confirm the diagnosis.

Activation of Rac by cadherin through the c-Src–Rap1–phosphatidylinositol 3-kinase–Vav2 pathway

Cadherin first forms homo-cis-dimers on the cell surface of the same cells, followed by formation of homo-trans-dimers (trans-interactions) in a Ca2+-dependent manner, eventually causing adherens junctions. In addition, trans-interacting cadherin induces activation of Rac small G protein, which stabilizes non-trans-interacting cadherin on the plasma membrane by inhibiting its endocytosis through the reorganization of the actin cytoskeleton. However, it has not fully been understood how cadherin induces the activation of Rac. We examined here the molecular mechanism of the activation of Rac by trans-interacting cadherin in fibroblasts and epithelial cells. Trans-interacting cadherin induced activation of c-Src locally at the cadherin-based cell-cell adhesion sites. c-Src then tyrosine-phosphorylated Vav2, one of the Rac-GDP/GTP exchange factors (GEFs), and induced activation of C3G, one of the Rap1-GEFs, through Crk adaptor protein, resulting in the activation of Rap1 locally at the cadherin-based cell-cell adhesion sites. The c-Src-catalysed tyrosine phosphorylation was not sufficient for the activation of Vav2 and the c-Src-induced activation of Rap1 was additionally necessary for it, although activated Rap1 alone was not sufficient for the activation of non-tyrosine-phosphorylated Vav2. This effect of Rap1 on Vav2 was mediated by phosphatidylinositol 3-kinase. We describe here the signaling pathway from trans-interacting cadherin to the activation of Rac.

Modification of carbon-coated TiO2 by iron to increase adsorptivity and photoactivity for phenol

Carbon-coated TiO(2) modified by iron, were prepared from TiO(2) of anatase structure and PET modified by FeC(2)O(4). Catalysts were prepared by mixing powders of TiO(2) and modified PET and heating at different temperatures, from 400 to 800 degrees C under flow of Ar gas. High adsorption of phenol was observed on the catalyst heated at 400 degrees C, confirmed by FT-IR analysis. On this catalyst, fast rate of phenol decomposition was achieved by addition of small amount of H(2)O(2) to the reaction mixture. Phenol decomposition proceeded mainly through the direct oxidation of phenol species adsorbed on the catalyst surface due to the photo-Fenton reaction. Iron-modified carbon-coated TiO(2) catalysts heated at 500-800 degrees C showed almost no phenol adsorption or oxidation.

Intraportal donor bone marrow transplantation improves intestinal allograft survival in rats under FK506-based immunosuppression

Donor-specific immunosuppression is important in transplant surgery. We examined the effect of intraportal donor-specific bone marrow transplantation on heterotopic small bowel transplantation in the high responder rat combination, ACI to Lewis. The study comprised five treatment groups: untreated controls (group 1); FK506 alone (group 2); low-dose predonine + FK506 (group 3); high-dose predonine + FK506 (group 4); and intraportal donor-specific bone marrow transplantation + FK506 (group 5). Intraportal transplantation was performed pre-operatively and FK506 and predonine given post-operatively. Intestinal allograft survival and changes of intragraft cytokine expression were analysed using the reverse transcription polymerase chain reaction. Allograft survival (mean +/- SD) was lowest in group 1 and greatest in group 5. The group 5 treatment regimen also down-regulated interferon-gamma and interleukin-2 transcription in the transplanted intestine. Intraportal donor bone marrow transplant combined with FK506 immunosuppression was found therefore to be the most beneficial treatment regimen.

Activated T cells and soluble molecules in the portal venous blood of patients with cholestatic and hepatitis C virus-positive liver cirrhosis. Possible promotion of Fas/FasL-mediated apoptosis in the bile-duct cells and hepatocyte injury

We investigated the immune responses of patients with cholestatic and hepatitis C virus-positive (HCV-positive) liver cirrhosis by analysing T-cell subsets and cytokine levels in the portal and peripheral veins, using flow cytometry and enzyme-linked immunosorbent assay. In cholestatic liver cirrhosis, the proportion of natural-killer (NK) T cells and interleukin (IL) 6 and IL-18 levels in the portal venous blood were significantly higher than those in the peripheral venous blood. In HCV-positive liver cirrhosis, the proportions of NK T cells and Fas+ T cells and IL-6 and soluble Fas levels in the portal venous blood were significantly higher than those in the peripheral venous blood. These results suggest that in these diseases, activated T cells and soluble molecules in portal venous blood may promote Fas/FasL-mediated apoptosis of the bile-duct cells and hepatocytes, and contribute to the deterioration in liver function as an inevitable result of positive feedback.

The analysis of the usefulness of laparoscopic microwave coagulation therapy for hepatocellular carcinoma in patients with poor hepatic reserve by serial measurements of IL-6, cytokine antagonists, and C-reactive protein

BACKGROUND

Little is known about the effectiveness of laparoscopic microwave coagulation therapy (L-MCT) for hepatocellular carcinoma (HCC) in patients with liver cirrhosis and poor hepatic reserve. Here, we analyzed the usefulness of laparoscopic MCT by comparing the serum levels of IL-6, cytokine antagonists, and C-reactive protein (CRP) following L-MCT with those following MCT with the open method (O-MCT).

METHODS

Sixteen patients with hepatocellular carcinoma (HCC) were separated into L-MCT and O-MCT groups according to ICGR15 (ICGR15 30%<:L-MCT, 30%> :O-MCT). Nine patients with poorer hepatic reserve received L-MCT, while seven patients with relatively good hepatic reserve received O-MCT. Serum levels of cytokine antagonists (interleukin-6, IL-6; interleukin-1 receptor antagonist, IL-1ra; soluble tumor necrosis factor receptor type I, sTNF-R55) and C-reactive protein (CRP) were simultaneously measured on serial postoperative days (POD) by immunoassay.

RESULTS

Postoperative serum levels of IL-6, IL-1ra, and CRP were significantly elevated on POD-1 and returned to the preoperative levels on POD-7 in both L-MCT and O-MCT groups. In contrast, no significant elevation of sTNF-R55 was found during the period in both groups. In addition, no statistical differences were found in the levels of IL-6, IL-1ra, sTNF-R, and CRP between the groups, except that the level of IL-6 on POD-1 in L-MCT group was significantly lower than that in the O-MCT group.

CONCLUSION

These results suggested that the surgical stress by L-MCT in patients with poorer hepatic reserve were almost equal to that by O-MCT in patients with relatively good hepatic reserve, indicating the usefulness of L-MCT for HCC patients with poorer hepatic reserve. We recommend the laparoscopic approach for future patients with the criterion that ICGR15 is over 30%.