[Management of quadruple valves for severe infective endocarditis; report of a case]

A 74-year-old man had pustulant bilateral arthritis complicated with sepsis and disseminated intravascular coagulation (DIC). Microbiologic study of blood sample showed Streptococcus and methicillin resistant Staphylococcus aureus (MRSA). He was complicated with postulant diskitis since then. Medical treatment for DIC and administration of antibiotics were performed. Preoperative echocardiography revealed massive aortic regurgitation and vegetation of aortic valve, moderate pulmonary regurgitation and vegetation of pulmonary valve, massive mitral regurgitation, massive tricuspid regurgitation. He was diagnosed as infective quadruple valve endocarditis. He received aortic valve replacement, pulmonary valve replacement, mitral valve repair and tricuspid valve repair. Postoperative echocardiography showed satisfactory function of bioprosthesis. Postoperative course was uneventful.

Segmental copy-number variation observed in Japanese by array-CGH

Segmental copy-number variations (CNVs) may contribute to genetic variation in humans. In this study, we examined 80 unrelated Japanese individuals using a microarray (2,238 Bac-clones) based comparative genomic hybridization (array-CGH) assay. We found a total of 251 CNVs at 30 different regions in the genome; of these, 14 (termed 'rare' CNVs) were found individually located within distinct genomic regions of 14 individuals, while the remaining 16 CNV regions (termed 'polymorphic' CNVs) were observed in two or more individuals. The rare CNVs were confirmed by quantitative polymerase chain reactions, and characterized more precisely than in previous reports using array CGH. Distinctive features of these CNVs were observed: most prominent was that the majority of the rare CNVs presented on Bac-clones that did not overlap with regions of segmental duplication. About 90% of the polymorphic CNVs observed in this population had been previously identified, with the majority of those polymorphic CNVs located in regions of segmental duplication. It is likely, therefore, that rare and polymorphic CNVs arise through different genetic mechanisms. Since more than half of the rare CNVs are novel, it is also likely that different human populations bear different CNVs, as is the case for single-nucleotide-polymorphisms (SNPs) and insertion-deletion (indel) polymorphisms.

Complete removal of a bronchial granular cell tumor by bronchoplasty

A rare case of bronchial granular cell tumor (GCT) arising in the right upper bronchus is presented here, which was completely resected by sleeve lobectomy. The 46-year-old female patient had a three-month history of severe dry coughing, and multimodality imaging revealed a 20 mm-sized GCT of the right upper bronchial orifice. Since endoscopic treatment appeared to be impossible, she underwent right upper sleeve lobectomy and the lesion could be completely removed.

Phase II trial of gemcitabine and irinotecan in previously treated patients with small-cell lung cancer

7718

Background: Gemcitabine and irinotecan has been shown to have an antitumor activity as a single agent against previously treated SCLC. The objective of this study was to assess the efficacy and safety of gemcitabine combined with irinotecan in patients with refractory or relapsed SCLC. Methods: Patients with histologically or cytologically confirmed SCLC, 20 to 74 years in age, performance status 0–2, with a history of receiving one platinum-based chemotherapy were eligible for the study. Treatment consisted of gemcitabine (1,000 mg/m2) and irinotecan (150 mg/m2) on days 1 and 15 of a 28-day cycle.The primary endpoint was the response rate (RR), and planned sample size for this phase II study was 30 patients (Simon's two-stage minimax design). Results: Thirty-one patients were enrolled and 30 patients (24 males/6 females, 10 refractory/20 sensitive, median age, 65 years) receive protocol treatment in this phase II trial. The median treatment cycles were 3 (1–10). The overall response rates was obtained in 39.3% (95% CI: 18.1% to 60.5%) of the patients, including two patients with refractory disease and 9 patients with sensitive disease. The median overall survival time was 14.4 months, and the 1-year survival rate was 51%. The median survival time of the patients with refractory disease was 7.4 months, compared with 14.4 months for patients with sensitive disease. The chief grade 3/4 toxicities included neutropenia (42%), thrombocytopenia (3%), diarrhea (9%), and liver dysfunction (3%). The only grade 4 toxicities were one case of grade 4 neutropenia (3.3%) and one case of grade 4 thrombocytopenia (3.3%). Conclusion: Gemcitabine plus irinotecan is an active regimen that seems to be well- tolerated by patients with previously treated SCLC.

No significant financial relationships to disclose.

A feasibility study of adjuvant carboplatin (C) plus gemcitabine (G) in completely resected stage IB-III non-small-cell lung cancer (NSCLC)

18158

Background: In recent randomized phase III trials in early-stage NSCLC, cisplatin-based adjuvant chemotherapy resulted in a 4.1–15% 5-year survival benefit versus observation. However, only 56–74% of patients completed planned treatment, suggestive of poor compliance. C plus G (CG), one of the standard regimens for advanced NSCLC, is considered more tolerable than other platinum-based regimens because it is associated with less nausea/vomiting, sensory neuropathy, and alopecia. The objective of this study was to assess the feasibility and safety of adjuvant CG in patients with completely resected NSCLC. Methods: Eligibility criteria included histologically confirmed NSCLC, age 20–74 years, complete surgical resection, post-operative pathological stage IB-III, 4–8 weeks post-surgery, ECOG performance status (PS) 0–1, adequate organ function, and informed consent. Patients were treated with adjuvant CG (C, AUC=5 on day 1; G, 1,000 mg/m2 on days 1 and 8) every 3 weeks for 4 cycles. The primary endpoint was treatment compliance, and the planned sample size was 35 patients (Simon’s minimax design). Results: From October 2004 to July 2006, 35 patients (17 males, 18 females; median age, 64 years) were enrolled. All patients had PS=0. Histologic types included adenocarcinoma (n=27), squamous cell carcinoma (n=3), large cell neuroendocrine carcinoma (n=3), large cell carcinoma (n=1), and adenosquamous carcinoma (n=1). Pathological stages included stage IB (n=7), stage IIA (n=7), stage IIB (n=4), stage IIIA (n=13), and stage IIIB (n=4). Resection consisted of lobectomy (n=33) and pneumonectomy (n=2). All patients received =2 cycles of chemotherapy, with 29 patients (83%) completing 3 or 4 cycles. Primary G3/4 toxicities were leukopenia (51%), neutropenia (83%), thrombocytopenia (71%), and anemia (38%). Nonhematologic toxicities were very mild: 6% G3/4 febrile neutropenia, 3% infection, and 3% rash. No treatment-related deaths occurred. Conclusion: Adjuvant CG in patients with completely resected NSCLC is well tolerated, and treatment compliance is very good.

No significant financial relationships to disclose.

Molecular genetic cascades for external genitalia formation: an emerging organogenesis program

External genitalia are anatomical structures located at the posterior embryonic region as part of several urogenital/reproductive organs. The embryonic anlage of the external genitalia, the genital tubercle (GT) develops as a bud-shaped structure with an initial urethral plate and later urethra. Embryonic external genitalia are considered to be one of the appendages. Recent experiments suggest that essential regulatory genes possess similar functions for the outgrowth regulation of the GT and limb appendages. The transient embryonic epithelia located in the distal GT are called the distal urethral epithelium (DUE) regulating, at least in part, the (distal) GT development. This review covers the available data about early patterning of GT and discusses the molecular developmental similarities and points of divergence between the different appendages. Development of the male and female external genitalia is also reviewed.

Genetic and epigenetic alterations on the short arm of chromosome 11 are involved in a majority of sporadic Wilms' tumours

Wilms' tumour is one of the most common solid tumours of childhood. 11p13 (WT1 locus) and 11p15.5 (WT2 locus) are known to have genetic or epigenetic aberrations in these tumours. In Wilms' tumours, mutation of the Wilms tumour 1 (WT1) gene at the WT1 locus has been reported, and the WT2 locus, comprising the two independent imprinted domains IGF2/H19 and KIP2/LIT1, can undergo maternal deletion or alterations associated with imprinting. Although these alterations have been identified in many studies, it is still not clear how frequently combined genetic and epigenetic alterations of these loci are involved in Wilms' tumours or how these alterations occur. To answer both questions, we performed genetic and epigenetic analyses of these loci, together with an additional gene, CTNNB1, in 35 sporadic Wilms' tumours. Loss of heterozygosity of 11p15.5 and loss of imprinting of IGF2 were the most frequent genetic (29%) and epigenetic (40%) alterations in Wilms' tumours, respectively. In total, 83% of the tumours had at least one alteration at 11p15.5 and/or 11p13. One-third of the tumours had alterations at multiple loci. Our results suggest that chromosome 11p is not only genetically but also epigenetically critical for the majority of Wilms' tumours.

Genetic instability in lung cancer: concurrent analysis of chromosomal, mini- and microsatellite instability and loss of heterozygosity

To investigate what kind of genetic instability plays important roles in lung carcinogenesis, we analyzed micro- and minisatellite instability, loss of heterozygosity (LOH) and chromosome instability in 55 cases of lung cancer, including, 10 squamous cell, 5 large cell, and 3 small cell carcinomas, and 37 adenocarcinomas. Analysis of minisatellite instability, the mechanism of which is different from microsatellite instability, has not been reported previously. Minisatellite instability was detected in only one case (1/55, 1.8%), and the frequency of microsatellite instability was low, being found only in three cases (3/55, 5.5%). In contrast, LOH, for at least in one locus, was observed in 27 cases (49.1%). In adenocarcinomas, the frequency of LOH was higher in poorly differentiated compared to more differentiated carcinomas. For chromosome instability, a similar correlation between differentiation grade and instability was observed in adenocarcinomas. And instability was more common in large cell and small cell carcinomas than in adenocarcinomas. Our analysis showed that chromosome instability and LOH, rather than mini- and microsatellite instability, play significant roles in the development of lung cancer.

Detection of epidermal growth factor receptor mutation in transbronchial aspiration cytology of non-small cell lung cancer

7175

Background: Somatic mutations of epidermal growth factor receptor (EGFR) strongly associate with objective response to EGFR tyrosine kinase inhibitors. There are some problems to practically use it as prognostic markers. Since it is difficult to obtain sufficient tumor samples from non-small cell lung cancer (NSCLC) patients, they are often diagnosed by cytological procedure alone. Therefore, it is very useful if EGFR mutations are able to be detected in cytological samples. The aims of this study are to detect EGFR mutations in the samples of transbronchial aspiration cytology (TBAC) by using direct sequencing and Scorpion ARMS method, and to compare the sensitivities of these methods. Patients and Methods: 94 patients diagnosed as NSCLC in our institute were enrolled in this study, consisting of 63 males and 31 females with a median age of 66. In cytologic diagnosis, they were adenocarcinoma in 58, squamous carcinoma in 24, and the others in 12. DNA was extracted from the TBAC samples, and EGFR mutations were analyzed using direct sequencing (exon 19 and exon 21) and Scorpion ARMS method (E746-A750del and L858R). Results: The mutations were detected in 31patients (33%). 13 mutations (14%) (E746-A750del; 6 patients, L858R; 7 patients) were detected by direct sequencing. 27 mutations (29%) (E746-A750del; 16 patients, L858R; 11 patients) were detected by Scorpion ARMS method. Conclusion: EGFR mutations were able to be detected in TBAC samples by both methods. Scorpion ARMS method is more sensitive for the detection of EGFR mutations than direct sequencing.

No significant financial relationships to disclose.

Serum levels of administered gefitinib correlate with the time to treatment failure in non small cell lung cancer patients

17027

Background: Gefitinib, an inhibitor of the epidermal growth factor receptor tyrosine kinase, has been shown to have clinical activity against non-small cell lung cancer (NSCLC). The aim of the present study was to clarify the relationship between serum gefitinib levels and clinical efficacy in patients with advanced NSCLCs. Methods and Results: Sera from 89 cases (51 men and 38 women) were obtained after 2 weeks gefitinib (250 mg/day) monotherapy. The average gefitinib level was 429.4 ± 214.8 ng/ml (mean ± SD) with 17-fold variability observed. No significant variation was observed with reference to gender, smoking history or performance status. There was no direct link between gefitinib level and tumor response, but a significant positive correlation was evident with time to treatment failure in 44 patients receiving gefitinib for more than 3 months (R = 0.365, P = 0.0144). Conclusions: These results suggested that a dose response may exist for time treatment failure in the patients who benefit from gefitinib. Dose modification in accordance with the serum gefitinib level may thus improve the efficacy of gefitinib for NSCLCs.

[Table: see text]

Temperature rhythm reentrains faster than locomotor rhythm after a light phase shift

Mammalian endogenous circadian rhythms are entrained to the environmental light-dark (LD) cycle. Although the circadian rhythms of core body temperature (Tb) and spontaneous locomotor activity (LA) are well synchronized under stable LD conditions, it is thought that these two parameters are regulated by distinct mechanisms. The purpose of the present study was to examine the adaptability of these two rhythms to an abrupt change in the environmental light phase. Tb and LA were simultaneously recorded in individual mice kept under 12:12-h LD cycle conditions before and after an 8-h photic phase advance. The onset of LA required 8 days to reentrain to the new LD cycle, whereas 6 days were required for reentrainment of the acrophase of Tb. Resting Tb, i.e., the Tb level independent of LA, was extracted from the same data source. The resting Tb level exhibited a robust daily rhythm with a difference of 1.0 degrees C between LD phases. After the photic phase advance, the resting Tb rapidly reached a stable level within 4 days, whereas the uncorrected Tb required 6 days for reentrainment. Based on these findings, we revealed that, independent of LA, the adaptability of the Tb rhythm to a new light cycle is half as rapid as that of LA. These results therefore suggest that the circadian rhythms of Tb and LA are intrinsically regulated by different pacemaker or effector mechanisms.

Time-restricted feeding entrains daily rhythms of energy metabolism in mice

Energy metabolism, oxygen consumption rate (V̇o2), and respiratory quotient (RQ) in mice were monitored continuously throughout 12:12-h light-dark cycles before, during, and after time-restricted feeding (RF). Mice fed ad libitum showed robust daily rhythms in both parameters: high during the dark phase and low during the light phase. The daily profile of energy metabolism in mice under daytime-only feeding was reversed at the beginning of the first fasting night. A few days after daytime-only feeding began, RF also reversed the circadian core body temperature rhythm. Moreover, RF for 6 consecutive days shifted the phases of circadian expression patterns of clock genes in liver significantly by 8–10 h. When mice were fed a high-fat (HF) diet ad libitum, the daily rhythm of RQ dampened day by day and disappeared on the sixth day of RF, whereas V̇o2 showed a robust daily rhythm. Mice fed HF only in the daytime had reversed V̇o2 and RQ rhythms. Similarly, mice fed HF only in the daytime significantly phase shifted the clock gene expression in liver, whereas ad libitum feeding with HF had no significant effect on the expression phases of liver clock genes. These results suggested that V̇o2 is a sensitive indicator of entrainment in the mouse liver. Moreover, physiologically, it can be determined without any surgery or constraint. On the basis of these results, we hypothesize that a change in the daily V̇o2 rhythm, independent of the energy source, might drive phase shifts of circadian oscillators in peripheral tissues, at least in the liver.

Activation of c-Jun N-terminal kinase (JNK) signalling in experimentally induced gastric lesions in rats

The c-Jun N-terminal kinase (JNK) participates in intracellular signalling cascades that mediate inflammatory responses. Therefore, the JNK signalling may be involved in gastric injury and inhibition of this pathway may form the basis of a new strategy for the treatment of gastric injury. The aim of this study was to determine whether JNK participates in the formation of gastric lesions in an experimental model. Acute gastric injury was induced in Sprague-Dawley rats by intragastric administration of 100% ethanol. The amount of phospho-JNK in the rat stomach was determined using immunohistochemistry and Western analysis. Animals received subcutaneous injections of a specific JNK inhibitor SP600125 or vehicle and the extent of mucosal damage in the stomach was determined. Western analysis revealed early phosphorylation of JNK and, to a lesser extent, p38 as well as late phosphorylation of the p42/44 extracellular signal-related kinases during the development of gastric lesions. JNK was phosphorylated in epithelial cells and in occasional mononuclear cells present at lesion sites. These cells were rarely found in samples from control specimens. Treatment with SP600125 significantly reduced the extent of gastric lesions. These findings indicate that experimental gastric injury is associated with activation of the JNK signalling pathway, and also suggest that JNK inhibitors may play a role in the treatment of gastric injury in humans.

A novel ATP regeneration system using polyphosphate-AMP phosphotransferase and polyphosphate kinase

Polyphosphate-AMP phosphotransferase (PAP) and polyphosphate kinase (PPK) were used for designing a novel ATP regeneration system, named the PAP-PPK ATP regeneration system. PAP is an enzyme that catalyzes the phospho-conversion of AMP to ADP, and PPK catalyzes ATP formation from ADP. Both enzymes use inorganic polyphosphate [poly(P)] as a phosphate donor. In the PAP-PPK ATP regeneration system, ATP was continuously synthesized from AMP by the coupling reaction of PAP and PPK using poly(P). Poly(P) is a cheap material compared to acetyl phosphate, phosphoenol pyruvate and creatine phosphate, which are phosphate donors used for conventional ATP regeneration systems. To achieve efficient synthesis of ATP from AMP, an excessive amount of poly(P) should be added to the reaction solution because both PAP and PPK consume poly(P) as a phosphate donor. Using this ATP generation reaction, we constructed the PAP-PPK ATP regeneration system with acetyl-CoA synthase and succeeded in synthesizing acetyl-CoA from CoA, acetate and AMP. Since too much poly(P) may chelate MG2+ and inhibit enzyme activity, the Mg2+ concentration was optimized to 24 mM in the presence of 30 mM poly(P) in the reaction. In this reaction, ATP was regenerated 39.8 times from AMP, and 99.5% of CoA was converted to acetyl-CoA. In addition, since the PAP-PPK ATP regeneration system can regenerate GTP from GMP, it could also be used as a GTP regeneration system.

Gefitinib treatment affects androgen levels in non-small-cell lung cancer patients

Gefitinib, an inhibitor of the epidermal growth factor receptor (EGFR, HER1/ErbB1) tyrosine kinase, has been shown to have clinical activity against non-small-cell lung cancers (NSCLCs), especially in women nonsmokers with adenocarcinomas. The aim of the present study was to clarify the relationship between androgen levels and gefitinib treatment in patients with advanced NSCLCs. Sera from 67 cases (36 men and 31 women) were obtained pretreatment and during treatment with gefitinib monotherapy (days 14–18) for examination of testosterone, dehydroepiandrosterone sulphate (DHEA), and dehydroepiandrosterone sulphate (DHEAS) levels. Testosterone and DHEA during treatment were significantly lower than the pretreatment values in both women and men, and the DHEAS levels during treatment were also significantly lowered in women. Gefitinib treatment significantly suppressed androgen levels, especially in women who had no smoking history. In addition, hormone levels in women responding to gefitinib were significantly lower during the treatment than in women who did not respond. Gefitinib-associated decrease in serum androgen levels may play a role in its clinical efficacy.

Comparison of hemostatic effects by route of H2 receptor antagonist administration following endoscopic mucosal resection in patients with neoplastic gastric lesions

BACKGROUND

To date, there has not been an in-depth investigation to identify differences in the effects of bleeding prevention among different routes of administration of H2 receptor antagonists to treat gastric ulcers following endoscopic mucosal resection (EMR).

AIM

To prospectively compare the frequency of bleeding following EMR between patients treated with intravenous (IV) famotidine and those with oral famotidine.

METHODS

Fifty-three patients with neoplastic gastric lesions (33 carcinoma and 20 adenoma) treated by EMR were included. Subjects underwent EMR with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate (EMRSH), followed by IV or oral (PO) administration of famotidine at a dosage of 40 mg/day for 2 days. Patients with odd ID numbers were assigned to IV therapy (30 cases) while even numbers were given PO therapy (23 cases). Frequencies and endoscopic findings of bleeding during the first 2 days after EMR were examined.

RESULTS

Frequency of bleeding within 2 days after EMR was 3 and 4% in IV and PO patients, respectively, showing no significant difference. No significant difference was seen in the endoscopic findings of bleeding and therapy, either, with respective IV and PO findings at 23 and 26%.

CONCLUSIONS

No significant difference was observed in frequency of bleeding within 2 days after gastric EMR between IV and oral administrations of famotidine.