Original sagittal split osteotomy revisited for mandibular distraction

INTRODUCTION

A malformed mandible and an abnormally positioned mandibular foramen make it difficult to plan an ideal osteotomy line for mandibular distraction. In addition, there have been reports of such complications as nonunion, damage and stretch injury of the inferior alveolar nerve and tooth germ damage when conventional osteotomy or corticotomy are used for mandibular distraction. The authors utilized the original sagittal split ramus osteotomy for mandibular distraction.

PATIENTS AND METHODS

Five patients (three unilateral hemifacial microsomia, one bilateral hemifacial microsomia, and one mandibular retrusion) were included in this study of distraction osteogenesis using the sagittal split ramus osteotomy. Extraoral distraction devices were applied to the first four patients. An intraoral device with mono-cortical screw fixation was used for the fifth patient.

RESULT

In all five cases, the results of the distraction were satisfactory. Complications (as listed) of conventional osteotomy when used for distraction were avoided. Satisfactory results were achieved and these were also well maintained postoperatively (mean follow up: 36 months).

CONCLUSION

The authors believe that sagittal osteotomy for mandibular distraction osteogenesis makes it possible, to avoid injury to the inferior alveolar nerve during operation and stretching injury during distraction and to prevent tooth germ injury. It is also possible to diversify the osteotomy line for various force vectors to enlarge the bony contact surface area. Therefore, we suggest that sagittal split ramus osteotomy should be used as a preferred modification of osteotomy for mandibular distraction.

Induction of diastereoselectivity in Fe(II) tris(amino acid-bipyridine) complexes

A group of iron(II) tris-bipyridine complexes bearing L-amino acids (L-Lys, L-Phe, L-Ser, L-Val) was prepared to investigate the predetermination of chirality of metal complexes by the chiral amino acid subunits. Noncovalent interactions and solvent polarity seemed to be important factors in inducing diastereoselectivity of the metal complexes. These phenomena were explained by (1)H NMR and CD spectroscopic studies and molecular mechanics calculations.

Brassinolide and [26, 28-2H6]brassinolide are differently demethylated by loss of C-26 and C-28, respectively, in Marchantia polymorpha

Metabolism of brassinolide in Marchantia polymorpha was investigated by use of in vivo suspension cultured cells. GC-MS analysis of metabolites derived from non-labelled brassinolide and [26, 28-2H6] brassinolide revealed that brassinolide was converted to 26-norbrassinolide while [26, 28-2H6]brassinolide to [26-2H3]28-norbrassinolide. It seems that Marchantia cells recognized [26, 28-2H6]brassinolide as a xenobiotic rather than brassinolide and deteriums attached to C-28 significantly affect demethylation reaction due to isotopic effect. Thus, demethylation of brassinolide in planta seems to proceed by loss of C-26 rather than C-28. The present finding is the first evidence for demethylation metabolism of brassinosteroids. The biological activity of 26-norbrassinolide was 10-fold reduced as shown by the rice lamina inclination test. However, because of its high biological activity, it remains difficult to conclude whether or not C-26 demethylation serves as an important deactivation process of brassinolide.

Prognostic significance of p53 gene mutations and protein overexpression in localized gastrointestinal stromal tumours

AIMS

Mutation of c-kit is a relatively early event in the tumorigenesis of gastrointestinal stromal tumours (GISTs). The aim was to determine the prognostic significance of p53 alterations as an additional genetic change in GISTs.

METHODS AND RESULTS

We reviewed 125 patients with localized GISTs subjected to complete resection between 1990 and 2002. Mutational analyses of c-kit exons 9, 11, 13 and 17, p53 exons 4-8 and immunohistochemistry for p53 protein were conducted using paraffin-embedded tissues. Alterations of p53 were observed in 50 patients (40.0%). Based on the National Institutes of Health's risk category, p53 alterations were noted more frequently in the higher risk categories (P = 0.041). With a median follow-up of 56.5 months (range: 2.3-126.8), 5-year relapse-free survival (RFS) rates were 61.7% without p53 alterations, compared with only 40.2% with p53 alterations (P = 0.009). Multivariate analysis indicated that p53 alterations comprised an independent, poor prognostic factor for RFS, in addition to c-kit mutations, large size, a high mitotic count and non-gastric primary sites.

CONCLUSIONS

Alterations in p53 were more commonly observed in localized GISTs at higher risk of relapse. This suggests that they are significant as an independent, poor prognostic factor.

Trapping-mediated dissociative chemisorption of cycloalkanes on Ru(001) and Ir(111): influence of ring strain and molecular geometry on the activation of C-C and C-H bonds

We have measured the initial probabilities of dissociative chemisorption of perhydrido and perdeutero cycloalkane isotopomers on the hexagonally close-packed Ru(001) and Ir(111) single-crystalline surfaces for surface temperatures between 250 and 1100 K. Kinetic parameters (activation barrier and preexponential factor) describing the initial, rate-limiting C-H or C-C bond cleavage reactions were quantified for each cycloalkane isotopomer on each surface. Determination of the dominant initial reaction mechanism as either initial C-C or C-H bond cleavage was judged by the presence or absence of a kinetic isotope effect between the activation barriers for each cycloalkane isotopomer pair, and also by comparison with other relevant alkane activation barriers. On the Ir(111) surface, the dissociative chemisorption of cyclobutane, cyclopentane, and cyclohexane occurs via two different reaction pathways: initial C-C bond cleavage dominates on Ir(111) at high temperature (T > approximately 600 K), while at low temperature (T < approximately 400 K), initial C-H bond cleavage dominates. On the Ru(001) surface, dissociative chemisorption of cyclopentane occurs via initial C-C bond cleavage over the entire temperature range studied, whereas dissociative chemisorption of both cyclohexane and cyclooctane occurs via initial C-H bond cleavage. Comparison of the cycloalkane C-C bond activation barriers measured here with those reported previously in the literature qualitatively suggests that the difference in ring-strain energies between the initial state and the transition state for ring-opening C-C bond cleavage effectively lowers or raises the activation barrier for dissociative chemisorption via C-C bond cleavage, depending on whether the transition state is less or more strained than the initial state. Moreover, steric arguments and metal-carbon bond strength arguments have been evoked to explain the observed trend of decreasing C-H bond activation barrier with decreasing cycloalkane ring size.

Synergistic effect between tannic acid and X-rays detected by the Tradescantia-micronucleus assay

Tannic acid (TA), a complex mixture of polyphenolics, exhibited synergism with 4-nitroquinoline 1-oxide (4-NQO), methyl methanesulfonate (MMS) and cis-platinum (cis-DDP) in a recent study on w/w+ somatic mutation in the eye pigment of Drosophila, although several studies indicated that tannic acid is an antimutagen in cultured mammalian cells. The goal of this study was to determine the genotoxicity of tannic acid alone and its possible synergistic effect with X-rays using the Tradescantia-micronucleus (Trad-MCN) bioassay. Plant cuttings were irradiated with 35 R of X-rays (80 kV, 5 mA) and followed by a series of increasing dosages (0.1, 0.5, 0.75, 1.0, 1.25, 1.50 mM) of TA treatment (24 h) and in some cases TA treatment was followed by X-irradiation. Inflorescences were fixed after a 24-h recovery period and slides were prepared for scoring MCN frequencies. Four series of experiments were conducted and the results of Trad-MCN tests on X-rays alone yielded an average of 47.5 MCN/100 tetrads (SE = 6.08), and 1.0 mM TA alone yielded an average of 8.95 MCN/100 tetrads (SE = 0.1), while the combined treatments (35 R X-rays plus 1.0 mM TA) yielded an average of 126.95 MCM/100 tetrads (SE = 13.69). The MCN frequency of the negative control was around 4.6 MCN/100 tetrads (SE = 0.75). This kind of synergism was exhibited through all the increasing dosages around 1.0 mM or higher. The synergistic effect of these two agents remained at the same level when TA was followed by X-irradiation. When a 12-h repairing period was allowed after X-irradiation in the combined treatment, the MCN frequency was similar to that of the X-ray treatment alone. The synergistic effect in the cases where the TA exposure was given immediately after X-irradiation could be attributed to the inhibitory action of TA on the DNA repair process.

A novel antagonist to the inhibitors of apoptosis (IAPs) potentiates cell death in EGFR-overexpressing non-small-cell lung cancer cells

In the effort to develop an efficient chemotherapy drug for the treatment of non-small-cell lung cancer (NSCLC), we analyzed the anti-tumorigenic effects of a novel small molecule targeting the inhibitor of apoptosis (IAPs), HM90822B, on NSCLC cells. HM90822B efficiently decreased IAP expression, especially that of XIAP and survivin, in several NSCLC cells. Interestingly, cells overexpressing epidermal growth factor receptor (EGFR) due to the mutations were more sensitive to HM90822B, undergoing cell cycle arrest and apoptosis when treated. In xenograft experiments, inoculated EGFR-overexpressing NSCLC cells showed tumor regression when treated with the inhibitor, demonstrating the chemotherapeutic potential of this agent. Mechanistically, decreased levels of EGFR, Akt and phospho-MAPKs were observed in inhibitor-treated PC-9 cells on phosphorylation array and western blotting analysis, indicating that the reagent inhibited cell growth by preventing critical cell survival signaling pathways. In addition, gene-specific knockdown studies against XIAP and/or EGFR further uncovered the involvement of Akt and MAPK pathways in HM90822B-mediated downregulation of NSCLC cell growth. Together, these results support that HM90822B is a promising candidate to be developed as lung tumor chemotherapeutics by targeting oncogenic activities of IAP together with inhibiting cell survival signaling pathways.

Evaluation of novel histone deacetylase inhibitors as therapeutic agents for colorectal adenocarcinomas compared to established regimens with the histoculture drug response assay

BACKGROUND AND AIMS

This study was to evaluate the efficacy of histone deacetylase (HDAC) inhibitors in colorectal cancer together with other established regimens.

MATERIALS AND METHODS

Chemosensitivities of 114 colorectal cancer patients to established regimens (fluorouracil (5-FU with leucovorin (FL), capecitabine, FL with irinotecan (FLIRI), and FL with oxaliplatin (FLOX)) as well as five hydroxamic acid derivatives (suberoylanilide hydroxamic acid, PXD101, and three novel candidates of CG-1, CG-2, and CG-3) were comparatively evaluated using the histoculture drug response assay.

RESULTS

The chemosensitivity with established regimens was between 34.2% and 52.6%, when the cutoff value of the inhibition ratio was set at 30%, and between 54.5% and 84.1% with HDAC inhibitors. All HDAC inhibitors displayed synergistic effects in combination with established regimens of FLOX and FLIRI (P < or = 0.0001-0.002). Advanced T- and N-category tumors and patients with synchronous adenoma displayed higher chemosensitivity to CG-3, CG-2, and CG-1, respectively, on a multivariate analysis (P = 0.023, 0.044, and 0.045, respectively). Tumors with mismatch repair defects were closely correlated with chemosensitivities to combined regimens of PDX101 with FLOX and FLIRI (P = 0.044 and 0.048, respectively).

CONCLUSIONS

Our findings firstly demonstrated the chemo-responsiveness of colorectal cancers to HDAC inhibitors with therapeutic efficacy comparable to the established regimens. Additionally, tumor growth and heredity were significantly associated with specific regimens, supporting their possible role as chemosensitive predictors.

Genome-wide identification of chemosensitive single nucleotide polymorphism markers in colorectal cancers

Improved methods for predicting chemoresponsiveness involving the identification of polymorphic markers is highly desirable, considering narrow therapeutic index and frequent resistance to anti-cancer regimens. The genome-wide screening of chemosensitive single nucleotide polymorphisms (SNPs) was undertaken in association with in vitro chemosensitivity assays in 104 colorectal cancer patients for the initial screening step. Allele frequency, linkage disequilibrium, potential function, and Hardy-Weinberg equilibrium of the candidate SNPs were then determined for the identifying step. Finally, clinical association analysis in the other 260 evaluable patients or cell viability assays of transfected RKO cells was used to verify candidate SNPs for the validation step. In total, 12 SNPs to six regimens were initially chosen during the screening and identifying steps. In patients receiving fluoropyrimidine-based adjuvant chemotherapy, the substitution alleles of GPC5 rs553717 (AA) correlated significantly with tumor recurrence and shorter disease-free survival (P = 0.019 and 0.023, respectively). Interestingly, RKO cells expressing mutant GPC5 showed enhanced cell death in response to 5-FU in cytotoxicity assays. Patients that were homozygous for the reference alleles SSTR4 rs2567608 (AA) and EPHA7 rs2278107 (TT) showed lower disease control rates in response to irinotecan and oxaliplatin regimens, respectively, than those with substitution alleles (P = 0.022 and 0.014, respectively). Thus, we identified chemosensitive SNP markers using a novel three step process of genome-wide analysis consisting of in vitro screening, identification, and validation. The candidate chemosensitive SNP markers identified in our study, including those identified in vitro, can now be further verified in a large cohort study.

Effects of phenethylisothiocyanate on the expression of glutathione S-transferases and hepatotoxicity induced by acetaminophen

1. The effect of PEITC on the expression of hepatic glutathione S-transferases (GST) and the glutathione (GSH) conjugation has been investigated in the Sprague-Dawley rat, and it has been determined whether hepatotoxicity of acetaminophen (AA) could be inhibited through the induction of GST expression in mouse. 2. The hepatic GST activity and protein levels of alpha class (Ya, Yc) and mu class (Yb1, Yb2) of GST were elevated in a dose-dependent manner after treatment with PEITC (0, 3.16, 10, 31.6, 100 and 200 mg/kg, p.o., 3 days). The mRNA levels of GST Ya and GST Yb1 were also markedly increased 1 day after treatment with PEITC at dosages ranging from 31.6 to 200 mg/kg. The hepatic GSH content was significantly increased to 200% of control at dose of 200 mg/kg PEITC. 3. Pretreatment with 100 mg/kg PEITC significantly enhanced the biliary excretion of glutathione conjugate of AA 2-fold, whereas treatment with 200 mg/kg did not affect it. 4. In mouse, PEITC (100 and 200 mg/kg, 3 days) decreased the lethality and hepatotoxicity caused by AA. 5. These results indicate that (1) the induction of GST by PEITC is presumably under transcriptional regulation, and (2) PEITC may have a protective function against AA-induced hepatotoxicity by induction effect on GST, in combination of enhancement of hepatic GSH.

Simultaneous estimation of zeta potential and slip coefficient in hydrophobic microchannels

Electroosmotic flows through hydrophobic microchannels experience velocity slip at the channel wall, which increases the volumetric flow rate at a given electric potential gradient. The conventional method of zeta potential estimation using the volumetric flow rate may yield quite inaccurate zeta potential unless the velocity slip is appropriately taken care of. In the present investigation we develop a method for simultaneous estimation of zeta potential and velocity slip coefficient in the electroosmotic flow through a hydrophobic microchannel using velocity measurements. The relevant inverse problem is solved through the minimization of a performance function utilizing a conjugate gradient method. The present method is found to estimate the zeta potential and slip coefficient accurately even with noisy velocity measurements.

Pediatric malignant hyperthermia: risk factors, morbidity, and mortality identified from the Nationwide Inpatient Sample and Kids' Inpatient Database

BACKGROUND

Malignant Hyperthermia (MH) is a potentially fatal metabolic disorder. Due to its rarity, limited evidence exists about risk factors, morbidity, and mortality especially in children.

METHODS

Using the Nationwide Inpatient Sample and the Kid's Inpatient Database (KID), admissions with the ICD-9 code for MH (995.86) were extracted for patients 0-17 years of age. Demographic characteristics were analyzed. Logistic regression was performed to identify patient and hospital characteristics associated with mortality. A subset of patients with a surgical ICD-9 code in the KID was studied to calculate the prevalence of MH in the dataset.

RESULTS

A total of 310 pediatric admissions were seen in 13 nonoverlapping years of data. Patients had a mortality of 2.9%. Male sex was predominant (64.8%), and 40.5% of the admissions were treated at centers not identified as children's hospitals. The most common associated diagnosis was rhabdomyolysis, which was present in 26 cases. Regression with the outcome of mortality did not yield significant differences between demographic factors, age, sex race, or hospital type, pediatric vs nonpediatric. Within a surgical subset of 530,449 admissions, MH was coded in 55, giving a rate of 1.04 cases per 10,000 cases.

CONCLUSIONS

This study is the first to combine two large databases to study MH in the pediatric population. The analysis provides an insight into the risk factors, comorbidities, mortality, and prevalence of MH in the United States population. Until more methodologically rigorous, large-scale studies are done, the use of databases will continue to be the optimal method to study rare diseases.

Clinical Utility of a Fully Automated Microsatellite Instability Test with Minimal Hands-on Time

Background

Microsatellite instability (MSI) analysis is becoming increasingly important in many types of tumor including colorectal cancer (CRC). The commonly used MSI tests are either time-consuming or labor-intensive. A fully automated MSI test, the Idylla MSI assay, has recently been introduced. However, its diagnostic performance has not been extensively validated in clinical CRC samples.

Methods

We evaluated 133 samples whose MSI status had been rigorously validated by standard polymerase chain reaction (PCR), clinical next-generation sequencing (NGS) cancer panel test, or both. We evaluated the diagnostic performance of the Idylla MSI assay in terms of sensitivity, specificity, and positive and negative predictive values, as well as various sample requirements, such as minimum tumor purity and the quality of paraffin blocks.

Results

Compared with the gold standard results confirmed through both PCR MSI test and NGS, the Idylla MSI assay showed 99.05% accuracy (104/105), 100% sensitivity (11/11), 98.94% specificity (93/94), 91.67% positive predictive value (11/12), and 100% negative predictive value (93/93). In addition, the Idylla MSI assay did not require macro-dissection in most samples and reliably detected MSI-high in samples with approximately 10% tumor purity. The total turnaround time was about 150 minutes and the hands-on time was less than 2 minutes.

Conclusions

The Idylla MSI assay shows good diagnostic performance that is sufficient for its implementation in the clinic to determine the MSI status of at least the CRC samples. In addition, the fully automated procedure requires only a few slices of formalin-fixed paraffin-embedded tissue and might greatly save time and labor.

The complete amino acid sequence of proapolipoprotein A-I of chicken high density lipoproteins

The complete amino acid sequence of proapolipoprotein (proapo) A-I of chicken high density lipoproteins was determined by sequencing overlapping peptides produced by trypsin, S. aureus V8 protease, and cyanogen bromide cleavage. There are 240 amino acid residues in mature chicken apoA-I. By direct sequence analysis of a cyanogen bromide peptide, we also determined the sequence of a 6-amino-acid prosegment which is present at approx. 10% the molar amount of the mature peptide in chicken plasma. Sequence comparison among apoA-I from chicken, human, rabbit, dog and rat, and secondary structure analysis indicate that while the degree of sequence homology is only moderate (less than 50% between chicken and man), there is good conservation of apoA-I secondary structure, especially in the N-terminal two-thirds of the protein in these widely separated species.

Antioxidative effects of cichorium intybus root extract on LDL (low density lipoprotein) oxidation

The water extract of Cichorium intybus (WECI) showed a remarkable antioxidative effect on LDL, and inhibitory effects on the production of thiobarbituric acid reactive substance and the Degradation of fatty acids in LDL. Vitamin E and unsaturated fatty acids in LDL were protected by adding WECI from the effects of metal catalyzed LDL oxidation. From the results obtained, we conclude that LDL oxidation is inhibited in vitro by the addition of WECI, and that LDL is protected by WECI from oxidative attack, as shown by agarose gel electrophoresis.

Increased prevalence of autoimmune thyroid disease in patients with type 1 diabetes

BACKGROUND

Type 1 diabetes mellitus is frequently associated with other autoimmune diseases. The occurrence of common features of autoimmune diseases and the coassociation of multiple autoimmune diseases in the same individual or family supports the notion that there may be common genetic factors.

METHODS

To investigate potential clustering of autoimmune thyroid disease (ATD) among type 1 diabetes patients and the contribution of common susceptibility genes to this, HLA DR/DQ alleles as well as antithyroid autoantibodies were measured in 115 Korean patients with type 1 diabetes and their 96 first-degree family members.

RESULTS

Twenty-five percent of the patients had ATD, whereas 3 of 36 (8%) age-matched normal controls had ATD (RR = 3.7, p < 0.05). Twenty-six of ninty-six (27%) type 1 diabetes family members had ATD. No differences in the distribution of HLA alleles/haplotypes and genotypes between the patients with and without ATD were found.

CONCLUSION

From this finding, we could assess that individuals with type 1 diabetes and their relatives frequently develop ATD, perhaps due to common susceptibility genes that are shared among first degree relatives.

Characterization of Mutator Phenotype in Familial Colorectal Cancer Patients Not Fulfilling Amsterdam Criteria

PURPOSE

Although the mutator phenotype, including genetic and epigenetic alterations of the mismatch repair (MMR) system, seems to be pronounced in familial colorectal cancer, there have been few integrative studies comprising the entire mutator pathway. This study was done to identify the entire mutator pathway determining risk factors in patients with familial colorectal cancer not fulfilling the Amsterdam criteria.

EXPERIMENTAL DESIGN

We consecutively recruited 134 colorectal cancer patients with a family history of accompanying cancers. Patients with hereditary nonpolyposis colorectal cancer meeting the Amsterdam criteria, familial adenomatous polyposis, or those receiving preoperative radiotherapy were excluded. Mutator phenotype was assessed by assaying microsatellite instability (MSI) at 24 markers, hMLH1-promoter methylation, mutations at MMR genes (hMLH1, hMSH2, hMSH6, and hPMS2), and immune staining of MMR proteins (hMLH1, hMSH2, hMSH6, hPMS1, and hPMS2).

RESULTS

Of the 208 cancers in first-degree and/or second-degree relatives of patients, colorectal and gastric cancers (81%) were most common. Of the 134 proband colorectal cancers, 23 (17%) were MSI in high level, and 32 (24%) were MSI in low level. MMR alterations, including known polymorphism and splicing substitution, were identified in eight patients (6%). Twenty-eight tumors with mutator phenotype were further identified by hMLH1-promoter methylation and/or loss of MMR protein expression. In 51 tumors (38%), mutator phenotype was associated with right-sided colon cancer (P < 0.001) and younger age at onset (P=0.032), but the number of patients with a mutator phenotype did not differ with respect to inheritance patterns of accompanying cancers, either successive or horizontal transmission (P=0.815). Familial impact value, which differentially associated the degree of relatives with all accompanying cancers, effectively discriminated MSI in high level from microsatellite stable/MSI in low level tumors.

CONCLUSION

Familial colorectal cancer may be associated with multiple occurrences of colorectal or accompanying cancers inherited by dominant or recessive transmission. MMR gene mutations, however, are less associated with mutator phenotype in familial colorectal cancer.