[Analysis of surgical treatment of primary lung cancer having M1 diseases]

The presence of distant metastasis is thought as systemic dissemination of disease. Patients with lung cancer in this category are not usually considered candidates for surgical resection of the primary and metastatic sites. The purpose of this study is to determine long-term survival and identify potential prognostic factors for surgical treatment to primary non-small cell lung cancer with distant metastasis. We conducted a retrospective analysis of the surgical outcome of 24 patients who were classified as having M1 disease. The 5-year survival rate was 34.6% in our facility. Among the 12 patients had N2 disease and a poor prognosis. Long-term survival can be achieved if the metastatic site is lung and there is no lymph node involvement, although differentiation of pulmonary metastasis and multiple primary lung cancer is commonly difficult.

[Primary lung cancer incidentally diagnosed in lung biopsy for diffuse pulmonary disease]

We here presented 2 cases of interstitial pneumonia with lung adenocarcinoma incidentally diagnosed by partially resected lung for diffuse pulmonary disease. CASE 1: A 78-year-old female was admitted to the hospital complaining of productive cough and general fatigue. The chest computed tomography (CT) revealed diffuse honey comb pattern in bilateral lung field especially in the right lower lung. Video-assisted thoracoscopic lung biopsy was performed and was diagnosed as diffuse spreading well differentiated adenocarcinoma. CASE 2: A 59-year-old male was admitted to the hospital complaining of dyspnea and general fatigue. The chest X-ray revealed right pneumothorax and chest CT revealed diffuse honey comb pattern and bullae in bilateral lung field and fibrous tumor-like lesion in the right middle lung. Video-assisted thoracoscopic lung biopsy was performed and was diagnosed as pulmonary fibrosis with papillary adenocarcinoma.

CONCLUSION

It is important to examine carefully the specimen obtained from thoracoscopic lung biopsy even if interstitial pneumonia is strongly suspected.

GABAergic activation of an inwardly rectifying K+ current in mouse cerebellar Purkinje cells

Cerebellar Purkinje cells integrate motor information conveyed by excitatory synaptic inputs from parallel and climbing fibres. Purkinje cells abundantly express B-type G-protein-coupled gamma-aminobutyric acid receptors (GABABR) that are assumed to mediate major responses, including postsynaptic modulation of the synaptic inputs. However, the identity and function of effectors operated by GABABR are not fully elucidated. Here we characterized an inwardly rectifying current activated by baclofen (Ibacl), a GABABR agonist, in cultured mouse Purkinje cells using a ruptured-patch whole-cell technique. Ibacl is operated by GABABR via Gi/o-proteins, as it is not inducible in pertussis-toxin-pretreated cells. Ibacl is carried by K+ because its reversal potential shifts with the equilibrium potential of K+. Ibacl is blocked by 10(-3) M Ba2+ or Cs+, and 10(-8) M tertiapin-Q. Upon the onset and offset of a hyperpolarizing step, Ibacl is activated and deactivated, respectively, with double-exponential time courses (time constants, <1 ms and 30-80 ms). Based on similarities in the above properties, G-protein-coupled inwardly rectifying K+ (GIRK) channels are thought to be responsible for Ibacl. Perforated-patch recordings from cultured Purkinje cells demonstrate that Ibacl hyperpolarizes the resting potential and the peak level achieved by glutamate-evoked potentials initiated in the dendrites. Moreover, cell-attached recordings from Purkinje cells in cerebellar slices demonstrate that Ibacl impedes spontaneous firing. Therefore, Ibacl may reduce the postsynaptic and intrinsic excitability of Purkinje cells under physiological conditions. These findings give a new insight into the role of GABABR signalling in cerebellar information processing.

Ca2+ activity at GABAB receptors constitutively promotes metabotropic glutamate signaling in the absence of GABA

Type B gamma-aminobutyric acid receptor (GABABR) is a G protein-coupled receptor that regulates neurotransmitter release and neuronal excitability throughout the brain. In various neurons, GABABRs are concentrated at excitatory synapses. Although these receptors are assumed to respond to GABA spillover from neighboring inhibitory synapses, their function is not fully understood. Here we show a previously undescribed function of GABABR exerted independent of GABA. In cerebellar Purkinje cells, interaction of GABABR with extracellular Ca2+ (Ca(2+)o) leads to a constitutive increase in the glutamate sensitivity of metabotropic glutamate receptor 1 (mGluR1). mGluR1 sensitization is clearly mediated by GABABR because it is absent in GABABR1 subunit-knockout cells. However, the mGluR1 sensitization does not require G(i/o) proteins that mediate the GABABR's classical functions. Moreover, coimmunoprecipitation reveals complex formation between GABABR and mGluR1 in the cerebellum. These findings demonstrate that GABABR can act as Ca(2+)o-dependent cofactors to enhance neuronal metabotropic glutamate signaling.

Calcium dependence of native metabotropic glutamate receptor signaling in central neurons

Metabotropic glutamate receptors (mGluRs) are G protein-coupled receptors that are distributed throughout the brain and play important roles in regulation of synaptic efficacy. Some studies report that mGluRs heterologously expressed in nonneuronal cells are sensitive not only to glutamate but also to extracellular Ca2+ (Ca2+o). We studied the Ca2+o-sensitivity of native mGluRs in mammalian central neurons. In cerebellar Purkinje cells that naturally express type-1 mGluR (mGluR1), physiological levels of Ca2+o (around 2 mM) activate mGluR1-mediated intracellular Ca2+ mobilization. The activation of the native mGluR1 response to Ca2+o appears to be slower than that to glutamate. Ca2+o (2 mM) also augments glutamate analog-evoked, native mGluR1-mediated inward cation current and intracellular Ca2+o mobilization. Detailed analysis of this effect suggests that Ca2+o modulates the glutamate responsiveness of native and heterologously expressed mGluR1s in different manners. These findings suggest that Ca2+o may enhance the basal level and glutamate responsiveness of neuronal mGluR signaling in vivo.

Altered agonist sensitivity and desensitization of neuronal mGluR1 responses in knock-in mice by a single amino acid substitution at the PKC phosphorylation site

mGluR1 and mGluR5 of the metabotropic glutamate receptor family are coupled to inositol trisphosphate-Ca2+ signal cascades and evoke distinct Ca2+ responses in neural cells and heterologously expressing cells. In heterologous cells, stimulation of recombinant mGluR1 evokes a single-peaked Ca2+ response whereas mGluR5 elicits an oscillatory Ca2+ response. The distinct Ca2+ responses are interchangeable by single amino substitution of aspartate for threonine at the corresponding position of the carboxy-terminal cytoplasmic regions of mGluR1 and mGluR5, respectively. In this investigation, we generated knock-in mice, termed mGluR1 D854T mice, in which aspartate of mGluR1 was replaced with threonine. We examined the effect of this D854T substitution on Ca2+ and current responses mediated by mGluR1 in cultured cerebellar Purkinje cells. Stimulation of mGluR1 D854T by a group 1 mGluR agonist, 3,5-dihydroxyphenylglycine (DHPG) evoked, as in wild-type mGluR1, only single-peaked Ca2+ responses as measured by Ca2+ fluorometric analysis. We then examined mGluR1-induced inward currents carried by nonselective cation channels during whole-cell recordings from cultured Purkinje cells. The mGluR1 D854T mutation abolished the responsiveness of mGluR1 to low concentrations of DHPG (0.5-500 nM) and reduced its desensitization during prolonged agonist application. mGluR1 D854T homozygous mutants showed no apparent behavioural abnormality as analysed by motor movement tests. These results indicate that, although additional modulatory mechanisms seem to be required to produce oscillatory Ca2+ responses of mGluR1, the single amino acid substitution at position 854 of mGluR1 is capable of influencing the kinetics of neuronal mGluR1 responses, most probably through PKC-mediated phosphorylation.

Expression of human coagulation factor VIII in adipocytes transduced with the simian immunodeficiency virus agmTYO1-based vector for hemophilia A gene therapy

We demonstrate that transduction of adipocytes with a simian immunodeficiency virus agm TYO1 (SIVagm)-based lentiviral vector carrying the human coagulation factor VIII gene (SIVhFVIII) resulted in expression of the human FVIII transgene in vitro and in db/db mice in vivo. Cultured human adipocytes were transduced with the SIVagm vector carrying the GFP gene in a dose-dependent manner and transduction of adipocytes with SIVhFVIII resulted in efficient expression of human coagulation factor VIII (hFVIII; 320 +/- 39.8 ng/10(6) adipocytes/24 h) in vitro. Based upon successful transduction of adipocytes by SIV vectors carrying the lacZ gene in vivo in mice, the adipose tissue of db/db mice was transduced with SIVhFVIII. There was a transient appearance of human FVIII in mouse plasma (maximum 1.8 ng/ml) on day 11 after the injection. Transcripts of human FVIII transgene and human FVIII antigen also were detected in the adipose tissue by RT-PCR and immunofluorescence, respectively, on day 14. Emergence of anti-human FVIII antibodies 14 days after the injection of SIVhFVIII may explain the disappearance of human FVIII from the circulation. These results suggest that transduction of the adipocytes with vectors carrying the human FVIII gene may be potentially applicable for gene therapy of hemophilia A.

Effects of antiplatelet agents on pulmonary haemodynamic response to fMLP in endotoxin primed rats

BACKGROUND

The interaction between neutrophils and platelets may be important in the modulation of pulmonary haemodynamics under systemic inflammatory conditions. A study was undertaken to examine whether antiplatelet agents inhibit platelet-neutrophil adherence and ameliorate the pulmonary haemodynamic response to fMLP by inhibiting thromboxane release in endotoxin primed lungs. fMLP stimulates neutrophils but not platelets; however, thromboxane synthesis in neutrophils is very low.

METHODS

Rats were pretreated with either cilostazol (300 mg/kg) or aspirin (50 mg/kg) before endotoxin priming (5 mg/kg). Platelets in the lung were identified by fluorescent immunohistochemistry. Platelet-neutrophil adherence was analysed by flow cytometry of the lung vascular flush. The effect of fMLP (10(-6) M) on thromboxane release, lung weight (an indicator of pulmonary vasoconstriction), and lung filtration coefficient was determined in an isolated lung system perfused at a constant pressure difference.

RESULTS

Endotoxin induced platelet accumulation and platelet-neutrophil adherence in the lung capillary were completely inhibited by cilostazol and aspirin while neutrophil recruitment was not affected. The fMLP challenge caused a significant increase in thromboxane B2 levels in endotoxin primed lungs. The fMLP induced decrease in lung weight was enhanced by endotoxin priming (from -4.9 to -63.9 mg, 95% CI of mean difference -99.5 to -10.5 mg, p<0.05). The fMLP induced increase in the lung filtration coefficient was also enhanced by endotoxin priming (from 0.63 to 2.40 mg/min/cm H2O/g, 95% CI of mean difference 1.17 to 2.37 mg/min/cm H2O/g, p<0.05). Treatment with cilostazol and aspirin completely inhibited the enhanced pulmonary haemodynamic response to fMLP.

CONCLUSION

The neutrophil-platelet interaction is of critical importance in the modulation of pulmonary haemodynamics via thromboxane.

Simian lentiviral vector-mediated retinal gene transfer of pigment epithelium-derived factor protects retinal degeneration and electrical defect in Royal College of Surgeons rats

Retinitis pigmentosa (RP) is a heterogenous group of inherited retinal diseases resulting in adult blindness caused by mutations of various genes. Although it is difficult to cure the blindness that results from these diseases, delaying the disease progression may be of great benefit, since the majority of RP diseases are seen in middle age or later. To test a gene therapy strategy for RP using a neurotrophic factor gene, we assessed the effect of simian lentivirus (SIV)-mediated subretinal gene transfer of pigment epithelium-derived factor (PEDF), a potent neurotrophic factor, during the disease progression in Royal College of Surgeons (RCS) rats, a well-accepted animal model of RP. Regional gene transfer via SIV into the peripheral subretinal space at the nasal hemisphere was performed in all animals to monitor site-specific transgene expression as well as the therapeutic effect in each retina. Gene transfer of lacZ and PEDF was observed in the regional pigment epithelium corresponding to the regional gene transfer. Histologically, PEDF gene transfer significantly protected the loss of photoreceptor cells (PCs) corresponding to the regions of the gene transfer, compared to those of control groups during the course of the experiment. The antiapoptotic effect of PEDF on PCs is likely to be a related mechanism, because a significant reduction of terminal dUTP-nicked end labeling-positive PC numbers was found in PEDF-treated eyes compared to those of the control group (P<0.05). PEDF-treated eyes also retained a significant sensitivity to light flash during the experimental course. These findings clearly show that neuroprotective gene therapy using PEDF can protect retinal degeneration and functional defects in individuals with RP.

Simian immunodeficiency virus-based lentivirus vector for retinal gene transfer: a preclinical safety study in adult rats

Although lentivirus vectors hold promise for ocular gene therapy, they also have potential safety issues, particularly in the case of the current human immunodeficiency virus-based vectors. We recently developed a novel lentivirus vector derived from the nonpathogenic simian immunodeficiency virus from African green monkeys (SIVagm) to minimize these potentials. In this preclinical study, we evaluated whether SIV vector could be efficiently and safely applicable to retinal gene transfer by assessing the transgene expression, retinal function and histology over a 1-year period following subretinal injection in adult rats. The functional assessment via electroretinogram after both titers of SIV-lacZ (2.5 x 10(7) or 2.5 x 10(8) transducing units/ml) injection revealed both the dark and light adaptations to soon be impaired, in a dose-dependent manner, after a buffer injection as well, and all of them recovered to the control range by day 30. In both titers tested, the retinas demonstrated a frequent transgene expression mainly in the retinal pigment epithelium; however, the other retinal cells rarely expressed the transgene. Retinas exposed to a low titer virus showed no significant inflammatory reaction throughout the observation period, and also maintained the transgene expression over a 1-year period. In the retinas exposed to a high titer virus, however, mononuclear cell infiltration persisted in the subretinal area, and the retina that corresponded to the injected area finally underwent degeneration by around day 90. No retinal neoplastic lesions could be found in any animals over the 1-year period. We thus propose that SIV-mediated stable gene transfer might be useful for ocular gene transfer; however, more attention should be paid to avoiding complications when administering high titer lentivirus to the retina.

Insulin-like growth factor-I as a promoting factor for cerebellar Purkinje cell development

In the mammalian CNS, the peptide hormone insulin-like growth factor-I (IGF-I) is synthesized in a certain subset of neurons and, it has been suggested, serves as a local neurotrophic factor. A postnatal increase in the expression of IGF-I and the type-1 IGF receptors (IGFR1) in the cerebellar cortex and its related brain regions indicates that developing cerebellar Purkinje cells (PC) may be an important target of IGF-I. However, little is known about how IGF-I influences PC development. Here we addressed this question, using a reduced environment of cerebellar neuron culture derived from perinatal mice. IGF-I exogenously applied at a physiological concentration (10 nm) greatly promoted the dendritic growth and survival of the PCs. By contrast, IGF-I only slightly promoted the somatic growth and little affected the maturation of the electrophysiological excitability of the PCs. The closely related hormone insulin had weaker promoting effects than did IGF-I. IGF-I appeared to at least bind to IGFR1 and to up-regulate the signalling pathways involving the phosphoinositide 3-kinase (PI3-K), mitogen-activated protein kinase (MAPK), p38 kinase (p38K), and an unknown signalling molecule(s). These signalling pathways may be coupled to the individual aspects of PC development in different manners and this may explain the difference in effects of IGF-I among these aspects. These findings suggest that IGF-I serves as a promoting factor for PC development, particularly postnatal survival and dendritic growth.

[Pleomorphic adenoma of the lung; report of a case]

A 67-year-old woman was admitted because of an abnormal shadow on the chest X-ray film. Chest computed tomography (CT) film revealed a peripheral mass in the middle lower lobe of the lung. We performed open lung biopsy and diagnosed as a benign epithelial adenoma but not ruled out adenocarcinoma completely by intraoperative examination of frozen sections. We operated right middle lobectomy and mediastinal lymph nodes dissections. Histological examination confirmed pleomorphic adenoma. We examined salivary glands, but didn't find the focus of that. The patient had been well for three years postoperatively.

Physiological properties of periodontal mechanosensitive neurones in the posteromedial ventral nucleus of rat thalamus

Unitary discharges of periodontal mechanosensitive (PM) neurones responding to mechanical tooth stimulation were recorded from the posteromedial ventral nucleus (VPM) of rat thalamus. PM neurones are distributed in the ventromedial area in the rostral two-thirds of the VPM nucleus. Maxillary and mandibular tooth-sensitive neurones are arranged in dorsoventral sequence. Of the PM neurones, 36% were slowly adapting to pressure applied to the tooth and 67% were rapidly adapting. The majority of PM units were sensitive to the contralateral incisor tooth. Response magnitudes of the slowly adapting neurones varied with stimulus direction and were directionally selective to mechanical tooth stimulation. The optimal stimulus direction was labiolingual or linguolabial. Rapidly adapting neurones were directionally non-selective to tooth stimulation. The threshold for mechanical stimulation was <0.05 N. Mean response latencies evoked by electrical stimulation of the peripheral receptive fields were 4.6 ms in the slowly adapting neurones and 5.8 ms in the rapidly adapting neurones.

Correlations between response properties of periodontal mechanosensitive neurones in the primary somatosensory cortex of the rabbit and cortically induced rhythmical jaw movements

The response properties of incisor- and molar-sensitive periodontal mechanosensitive (PM) neurones in the primary somatosensory (SI) cortex of rabbits were examined and rhythmical jaw movements induced by repetitive electrical stimulation of the recording sites of cortical PM neurones were observed. PM units were recorded from the rostromedial (RM) and rostrolateral (RL) areas of the SI cortex. In the RM area, most PMs (85%) were lower incisor-sensitive. Electrical stimulation of the RM area produced chopping-type rhythmical jaw movements. In the RL area, both incisor- and molar-sensitive PM units were recorded, and molar-sensitive units were located more rostromedially than incisor-sensitive units. More than half (66%) of the incisor-sensitive PM units were upper incisor-sensitive. The incidences of sustained-response type units were 8 and 10% for upper incisor- and lower incisor-sensitive units and 28 and 34% for upper molar- and lower molar-sensitive units, respectively. The optimal stimulus directions for the upper molar-sensitive units were predominantly labial or lingual, whereas those for most of the lower molar-sensitive units were lingual. Electrical stimulation of the PM unit-recording sites in the RL area induced grinding-type rhythmical jaw movements. Based on these findings, the lower incisor-sensitive neurones in the RM area of the SI cortex might mainly contribute to a neural network that controls jaw movements during ingestion. Furthermore, the response properties of molar-sensitive cortical neurones might be useful for discriminating the magnitude and direction of the biting force during grinding. Further studies are needed to clarify the role of upper incisor-sensitive neurones in the RL area in triggering grinding-type rhythmical jaw movements.

Extracellular calcium controls the dynamic range of neuronal metabotropic glutamate receptor responses

The metabotropicglutamate receptors (mGluRs) are neurotransmitter receptors important for synaptic plasticity in the brain. Here we report that native mGluR-mediated neuronal responses to glutamate are profoundly modulated by extracellular calcium (Ca2+(o)). In mouse cerebellar Purkinje cells (PCs), Ca2+(o) drastically broadened the effective dose range for glutamate analogs in which native mGluR1-mediated cation current and intracellular Ca2+ mobilization were evoked. This effect has not been observed for recombinant mGluRs expressed in the heterologous cell systems. Ca2+(o) also drastically augmented these native mGluR-mediated responses to the glutamate analog. These Ca2+(o) effects were observed in both the wild-type mice and the mutant mice expressing mGluR1 specifically in their PCs, suggesting that the native mGluR1 in the PCs but not those in other cell types are the key mediators of the effects. These findings demonstrate that Ca2+(o) plays an important role in regulating native mGluR-mediated neuronal responses.

Hepatic angiomyolipoma: radiologic and histopathologic correlation

We present two cases of hepatic angiomyolipoma. Histologic analysis showed that mature adipose tissue occupied 79.0% of the area on the largest cut surface in the first case and 40.2% in the second case. We suggest that the difference in the ratio of adipose tissue volume to its distribution is reflected on diagnostic images.

Heterogeneous intrinsic firing properties of vertebrate retinal ganglion cells

Retinal ganglion cells (RGCs) use their characteristic firing patterns to encode various aspects of visual information and carry them to the brain. It has been thought that the firing pattern of an RGC's light response is determined primarily by the time course and spatiotemporal interaction of the synaptic inputs. However, it is unclear whether there is a difference in intrinsic firing properties among RGCs that could contribute to the cell-to-cell distinction of the light response firing pattern. We investigated the intrinsic firing properties of isolated goldfish RGCs, minimizing cytoplasmic disturbance with a perforated-patch, whole-cell recording technique. In response to a 1-s depolarizing current step, the majority of the examined RGCs (n = 84) displayed sustained firing that lasted over 800 ms (n = 24; tonic RGCs) or transient firing accommodated within 200 ms of the step onset (n = 47; phasic RGCs). Tonic and phasic RGCs also differed in their firing frequency-current intensity dynamics. There was a significant difference in the soma sizes of phasic and tonic RGCs, indicating that some parts of these groups originate from distinct morphological subtypes. In the presence of extracellular Ba(2+) (1 mM), phasic RGCs displayed sustained firing and firing frequency-current intensity dynamics similar to those of tonic RGCs. Thus a Ba(2+)-sensitive ion current (I(Ba-s)) underlies the firing characteristics of phasic RGCs. Under voltage-clamp conditions, I(Ba-s) was identified as a low-threshold, noninactivating voltage-dependent K(+) current. Because of its slow kinetics (time constant of activation, approximately 100 ms), I(Ba-s) may confer a gradually increasing hyperpolarizing driving force during maintained excitatory stimulus, which eventually would result in firing accommodation. These findings suggest that RGCs have heterogeneous intrinsic firing properties that could aid synaptic inputs in shaping light responses.

Off-line leukapheresis using leukofiltration for active ulcerative colitis: a case report

The method of leukocytapheresis for ulcerative colitis (UC) by using extracorporeal circulation (on-line system) has been reported. To perform leukocytapheresis, we have applied leukocyte elimination filters for blood transfusion to leukocytapheresis without using extracorporeal circulation (off-line leukocytapheresis system). Four hundred milliliters of peripheral blood was collected and reinfused through a leukocyte elimination filter. This procedure was repeated 5 times, and up to 2,000 ml of peripheral blood was treated. This method has been applied once a week for 5 weeks. We applied the off-line leukapheresis system to a 31-year-old male ulcerative colitis patient. As a result, the frequency of defecation and the dose of medicine were effectively decreased, and endoscopic finding was also improved. Because of the absence of complications observed with the on-line system, the off-line leukocytapheresis system that we have applied to the clinical patient is simple, safe, and useful.