Contrast-enhanced transabdominal ultrasonography in the diagnosis of pancreatic mass lesions

PURPOSE

In this study, we evaluated the diagnostic usefulness of contrast-enhanced transabdominal ultrasonography (CE-US) in pancreatic mass lesions that could be detected by US.

MATERIAL AND METHODS

CE-US was performed in 37 patients with various pancreatic mass lesions to evaluate the characteristic vascular findings.

RESULTS

Pancreatic tubular adenocarcinoma showed negative enhancement pattern in 16 cases and a slight spotty enhancement pattern in 5 cases. Poorly differentiated adenocarcinoma showed slight homogeneous enhancement pattern in 1 case and acinar cell carcinoma was expressed as a heterogeneous enhancement pattern in 3 cases on CE-US. Endocrine cell tumor had a strong homogeneous enhancement pattern in 3 cases, a strong central enhancement in 1 case and a strong peripheral enhancement in 2 cases. Pseudotumorous pancreatitis showed an iso-enhancement pattern in 6 cases.

CONCLUSION

CE-US is useful in evaluating the vascularity of the lesions in various pancreatic mass lesions in real-time images, and may be useful for the differential diagnosis of pancreatic mass lesions.

[Relation between intraoperative salvaged blood transfusion and postoperative infection after cardiac surgery]

In cardiac surgery, several studies have shown bacterial contamination rates of intraoperative salvaged blood ranging from 12.7 to 96.8%. We evaluated the relation between intraoperative salvaged blood transfusion produced by the Cell Saver 5 device (Haemonetics Corp., Braintree, MA, USA) and postoperative infection determined by bacteriological study and the postoperative clinical course after cardiac surgery. Seven cases of cardiac surgery were investigated by bacteriological study. Although bacteria were cultured from all salvaged blood, no bacteria were cultured from the patients' blood 24 hours after salvaged blood infusion. Another 26 patients who underwent cardiac surgery, were divided into groups: group CS (n = 15) with salvaged blood transfusion after operation and group N (n = 11) without salvaged blood transfusion, and were evaluated in relation to the postoperative clinical course. There were no statistically significant differences between group CS and group N in the data of WBC, CRP and maximum body temperature. One case of deep sternal wound infection and 2 cases of local wound infection were observed in group CS, but none in group N (p = 0.18). These complications were treated by primary closure without muscle flaps. We conclude that salvaged blood autotransfusion was not related to postoperative infections in cardiac surgery.

Zero-point vibration of hydrogen adsorbed on Si and Pt surfaces

Hydrogen atoms adsorbed on Si(111) and Pt(111) were investigated by nuclear reaction analysis (NRA) using 1H(15N,alphagamma)12C. From measurements of the NRA spectrum at normal and tilted ion incidences the zero-point vibrational energies of H on Si(111) in the perpendicular and parallel directions were found to be 123.4+/-4.6 and 44.6+/-6.2 meV, respectively, which are consistent with harmonic potentials. The zero-point energies obtained for Pt(111)-H were 80.8+/-3.9 and 62.1+/-6.0 meV for perpendicular and parallel directions, respectively. These results indicate that the stretching mode is harmonic, while the bending mode is strongly anharmonic.

Clinical study of vestibular-evoked myogenic potentials and auditory brainstem responses in patients with brainstem lesions

A total of 13 patients, who were diagnosed with localized brainstem lesions using MRI, were investigated. The diagnoses were multiple sclerosis in five patients, brainstem hemorrhage in three patients, pontomedullary infarction in one patient and Wallenberg's syndrome in four patients. In addition, 42 ears of 21 normal adult volunteers were also examined. In a patient with upper brainstem lesions mainly affecting the midbrain, the auditory brainstem response (ABR) was abnormal but the vestibular-evoked myogenic potential (VEMP) was normal. In four patients with middle brainstem lesions which mainly affected the pons, both ABR and VEMP were abnormal. In five patients with lower brainstem lesions which mainly affected the medulla, the ABR was normal but the VEMP was abnormal. In those patients with middle-to-lower brainstem lesions, a disappearance of VEMP reactions, delay of the positive-negative (PN) wave, increase in PN interpeak latency and decrease in PN amplitude on the affected side were confirmed. In conclusion, the VEMP test comprises a useful new diagnostic method for identifying lower brainstem lesions.

Slit proteins are not dominant chemorepellents for olfactory tract and spinal motor axons

Members of the Slit family are large extracellular glycoproteins that may function as chemorepellents in axon guidance and neuronal cell migration. Their actions are mediated through members of the Robo family that act as their receptors. In vertebrates, Slit causes chemorepulsion of embryonic olfactory tract, spinal motor, hippocampal and retinal ganglion cell axons. Since Slits are expressed in the septum and floor plate during the period when these tissues cause chemorepulsion of olfactory tract and spinal motor axons respectively, it has been proposed that Slits function as guidance cues. We have tested this hypothesis in collagen gel co-cultures using soluble Robo/Fc chimeras, as competitive inhibitors, to disrupt Slit interactions. We find that the addition of soluble Robo/Fc has no effect on chemorepulsion of olfactory tract and spinal motor axons when co-cultured with septum or floor plate respectively. Thus, we conclude that although Slits are expressed in the septum and floor plate, their proteins do not contribute to the major chemorepulsive activities emanating from these tissues which cause repulsion of olfactory tract and spinal motor axons.

Comparison of the essential oils of Glehnia littoralis from Northern and Southern Japan

The essential oils from aerial and root parts of Glehnia littoralis were investigated by GC and GC-MS, and 125 compounds were identified. Plants were obtained from Northern and Southern Japan, and samples from the same locations were cultivated either exposed or unexposed to sunlight. The main constituents of the essential oils were found to be alpha-pinene (0.03-13.40%), limonene (0.15-10.71%), beta-phellandrene (0.03-22.93%), germacrene B (0.27-8.33%), spathulenol (0.24-6.50%), beta-oplopenone (0.06-6.47%), panaxynol (0.38-24.58%), propyl octanoate (3.44-27.85%), hexadecanoic acid (0.45-27.80%), and linoleic acid (0.16-17.56%). Terpenoid compounds were found in higher concentrations in the Northern type oils than in the Southern types, whereas the concentration of polyacetylenic compounds was higher in one of the Southern samples, except from the aerial parts of those cultivated exposed. Consequently, the constitution of the essential oils from G. littoralis could be separated into Northern and Southern types.

Glycosides of benzyl and salicyl alcohols from Alangium chinense

From the water-soluble fraction of the dried leaves of Alangium chinense, three new glycosides, benzyl alcohol beta-D-glucopyranosyl-(1 --> 2)-[beta-D-xylopyranosyl-(1 --> 6)]-beta-D-glucopyranoside, 2'-O-beta-D-glucopyranosylsalicin, and 2'-O-beta-D-glucopyranosyl-6'-O-beta-D-xylopyranosylsalicin were isolated along with seven known glycosides. The structures of the new compounds were determined by spectroscopic and chemical means.

Oxidative transformation of arylmethyl bromides and alcohols with a combination of mesoporous silica FSM-16 and alkali iodides under photoirradiation

[reaction: see text]. A mesoporous silica FSM-16 was found to be a selective and recyclable promoter for the oxidative dehalogenation of arylmethyl bromides to provide the corresponding alcohols and for the oxidation of arylmethyl alcohols to provide the corresponding aldehydes with a combination of alkali iodides and solvents under photoirradiation conditions.

Endoscopic diagnosis of pancreatic cancer using intraductal ultrasonography

BACKGROUND/AIMS

At present developed modalities are not sufficient for detecting early stage pancreatic cancer. We previously reported the clinical usefulness of intraductal ultrasonography in various pancreatobiliary diseases. In the present study we assessed the usefulness of intraductal ultrasonography in diagnosing pancreatic cancer.

METHODOLOGY

Thirty-one patients with pancreatic cancer were examined by intraductal ultrasonography. We approached the main pancreatic duct (pancreatic duct-intraductal ultrasonography) in 24 of 31 patients and the bile duct (bile duct-intraductal ultrasonography) in 20 patients with pancreatic cancer. We compared the diagnostic ability of pancreatic duct-intraductal ultrasonography with that of extracorporeal ultrasonography, computed tomography, endoscopic ultrasonography or endoscopic retrograde pancreatography. We examined the usefulness of bile duct-intraductal ultrasonography in diagnosing tumor invasion to the bile duct.

RESULTS

Pancreatic duct-intraductal ultrasonography was able to demonstrate a tumor in 22 of 24 patients. Extracorporeal ultrasonography, computed tomography, endoscopic ultrasonography or endoscopic retrograde pancreatography detected tumors in 26, 27, 29, 29 of 31 patients, respectively. In two patients, only intraductal ultrasonography could demonstrate a tumor, which was not detected by any other modalities. We examined bile duct invasion of the tumor according to our grading system. The overall accuracy rate was 90%. No complications were noted in any patients throughout the study period.

CONCLUSIONS

Intraductal ultrasonography is useful to diagnose pancreatic cancer, and it is suggested that it should be actively performed after endoscopic retrograde pancreatography.

Smoking and drinking habits as risk factors for hearing loss in the elderly: epidemiological study of subjects undergoing routine health checks in Aichi, Japan

In order to determine the risk factors for hearing loss in the elderly, a total of 496 subjects with bilateral hearing loss and 2807 age-matched persons without hearing disturbance were recruited from the participants in an automated multiphasic health screening examination, and their lifestyle and medical data were analysed. Current smokers showed a significantly increased risk of hearing loss compared with non-smokers (odds ratio after adjustment for sex, age, and potential confounders=2.10 (1.53-2.89)), while heavy drinkers did not show an increased risk compared to non-drinkers. Our findings might provide some clues for the primary prevention of age-related hearing loss.

Elevated levels of oxidized low density lipoprotein show a positive relationship with the severity of acute coronary syndromes

BACKGROUND

There is accumulating data that acute coronary syndromes relate to recent onset activation of inflammation affecting atherosclerotic plaques. Increased blood levels of oxidized low density lipoprotein (ox-LDL) could play a role in these circumstances.

METHODS AND RESULTS

Ox-LDL levels were measured in 135 patients with acute myocardial infarction (AMI; n=45), unstable angina pectoris (UAP; n=45), and stable angina pectoris (SAP; n=45) and in 46 control subjects using a sandwich ELISA method. In addition, 33 atherectomy specimens obtained from a different cohort of patients with SAP (n=10) and UAP (n=23) were studied immunohistochemically for ox-LDL. In AMI patients, ox-LDL levels were significantly higher than in patients with UAP (P<0.0005) or SAP (P<0.0001) or in controls (P<0.0001) (AMI, 1.95+/-1.42 ng/5 microgram LDL protein; UAP, 1.19+/-0.74 ng/5 microgram LDL protein; SAP, 0.89+/-0.48 ng/5 microgram LDL protein; control, 0.58+/-0.23 ng/5 microgram LDL protein). Serum levels of total, HDL, and LDL cholesterol did not differ among these patient groups. In the atherectomy specimens, the surface area containing ox-LDL-positive macrophages was significantly higher in patients with UAP than in those with SAP (P<0.0001).

CONCLUSIONS

This study demonstrates that ox-LDL levels show a significant positive correlation with the severity of acute coronary syndromes and that the more severe lesions also contain a significantly higher percentage of ox-LDL-positive macrophages. These observations suggest that increased levels of ox-LDL relate to plaque instability in human coronary atherosclerotic lesions.

Human homologues of Delta-1 and Delta-4 function as mitogenic regulators of primitive human hematopoietic cells

Delta-mediated Notch signaling controls cell fate decisions during invertebrate and murine development. However, in the human, functional roles for Delta have yet to be described. This study reports the characterization of Delta-1 and Delta-4 in the human. Human Delta-4 was found to be expressed in a wide range of adult and fetal tissues, including sites of hematopoiesis. Subsets of immature hematopoietic cells, along with stromal and endothelial cells that support hematopoiesis, were shown to express Notch and both Delta-1 and Delta-4. Soluble forms of human Delta-1 (h Delta-1) and h Delta-4 proteins were able to augment the proliferation of primitive human hematopoietic progenitors in vitro. Intravenous transplantation of treated cultures into immune-deficient mice revealed that h Delta-1 is capable of expanding pluripotent human hematopoietic repopulating cells detected in vivo. This study provides the first evidence for a role of Delta ligands as a mitogenic regulator of primitive hematopoietic cells in the human. (Blood. 2001;97:1960-1967)

Multielement determination and speciation of major-to-trace elements in black tea leaves by ICP-AES and ICP-MS with the aid of size exclusion chromatography

A multielement determination of major-to-trace elements in black tea leaves and their tea infusions was carried out by ICP-AES (inductively coupled plasma atomic emission spectrometry) and ICP-MS (inductively coupled plasma mass spectrometry). Tea infusions were prepared as usual tea beverage by brewing black tea leaves in boiling water for 5 min. About 40 elements in tea leaves and tea infusions could be determined over the wide concentration range in 8 orders of magnitude. The extraction efficiency of each element was estimated as the ratio of its concentration in tea infusions to that in tea leaves. From the experimental results for the extraction efficiencies, the elements in black tea leaves were classified into three characteristic groups: (i) highly-extractable elements (>55%): Na, K, Co, Ni, Rb, Cs and Tl, (ii) moderately-extractable elements (20-55%): Mg, Al, P, Mn and Zn, and (iii) poorly-extractable elements (<20%): Ca, Fe, Cu, Sr, Y, Zr, Mo, Sn, Ba and lanthanoid elements. Furthermore, speciation of major-to-trace elements in tea infusions was performed by using a combined system of size exclusion chromatography (SEC) and ICP-MS (or ICP-AES). As a result, many diverse elements were found to be present as complexes associated with large organic molecules in tea infusions.

The gene polymorphism of tumor necrosis factor-beta, but not that of tumor necrosis factor-alpha, is associated with the prognosis of sarcoidosis

OBJECTIVES

Few genetic markers for the prognosis of sarcoidosis have been found. Tumor necrosis factor (TNF)-alpha has been implicated in the pathogenesis of sarcoidosis. Induced TNF-alpha or TNF-beta levels have been shown to be associated with the polymorphisms of the TNF genes. We investigated the roles of such polymorphisms in the development and prolongation of sarcoidosis.

SUBJECTS AND MEASUREMENTS

One hundred ten Japanese patients with sarcoidosis and 161 control subjects were genotyped for three biallelic polymorphisms in the promoter region of TNF-alpha gene by direct sequencing of polymerase chain reaction (PCR) products. A polymorphism of the TNF-beta gene (TNFB*1/TNFB*2) was detected by NCO: I restriction fragment length polymorphism analysis of PCR products spanning intron 1 and exon 2 of the TNF-beta gene.

RESULTS

None of the polymorphisms conferred susceptibility to sarcoidosis. However, our study identified the allele TNFB*1, detected by the presence of a NCO: I restriction site, as a marker of prolonged clinical course, with the resolution of sarcoidosis being defined as the disappearance of all clinical symptoms, physical signs of active lesions, abnormal chest radiograph findings, and abnormal results of pulmonary function and biochemical tests. When the probability of remission in patients homozygous for TNFB*2 was defined as 1.00, it was 0.48 (95% confidence interval, 0.26 to 0.88; p < 0.05) in patients with TNFB*1 (genotypes TNFB*1/1 and TNFB*1/2).

CONCLUSIONS

The TNFB*1 allele is a marker for prolonged clinical course in patients with sarcoidosis. Our study is the first to link a cytokine gene polymorphism to the prognosis of sarcoidosis.

[Is open heart surgery clean: bacteriologic analysis of salvaged blood]

In this prospective study, we evaluated contamination of surgical fields in open heart operations by salvaged blood culture used in autologous transfusions device (Cell Saver 5, Heamonetics Corp., Braintree, MA, USA). And also, we prospectively investigated an efficacy of pre- and intra-operative prophylactic antibiotics administrations (cefazolin). Thirty patients undergone open heart surgeries with median sternotomy enrolled in this study. The patients were divided into two groups, group A (n = 15); without prophylactic antibiotics administration, group B (n = 15); with pre- and intra-operative prophylactic antibiotics administrations. Blood samples were drawn through the right atrium after the discontinuation of CPB and from salvaged blood bags. Bacterial growth was detected in 80.0% of salvaged blood samples in group A, 86.7% in group B (p = 0.62). Whereas no bacterial growth detection in blood samples though the right atrium. Quantitative estimates of contaminations showed 1.06 +/- 1.41, 0.90 +/- 1.24 cfu/ml, respectively (p = 0.22). Although bacterial growth rate were not statistically significant difference between groups, detective rate of Staphylococci was remarkably decreased (p = 0.005) in group B. Pre- and intra-operative prophylactic antibiotics administrations were effective for Staphylococci, but not whole microorganisms. In conclusion, salvaged blood used in autologous transfusions was highly contaminated and it suggests that surgical fields were not clear. Prophylactic antibiotics administrations were effective especially for Staphylococci.

Tetrahydroisoquinoline-monoterpene and iridoid glycosides from Alangium lamarckii

From the water soluble fraction of the dried fruits of Alangium lamrckii, four tetrahydroisoquinoline-monoterpene glycosides, 6-O-methyl-N-deacetylisoipecosidic acid, 7-O-methyl-N-deacetylisoipecosidic acid, 6,7-di-O-methyl-N-deacetylisoipecosidic acid and 6"-O-alpha-D-glucopyranosyl-6-O-methyl-N-deacetylisoipecosidic acid, and an iridoid glycoside, 6'-O-alpha-D-glucopyranosylloganic acid, were isolated, together with six known compounds. The structures of the previously unknown compounds were determined by spectroscopic and chemical means. The significance of these glucosides in the biogenesis of Alangium alkaloids is discussed; 6-O-methyl-N-deacetylisoipecosidic acid was also chemically converted into 10-O-demethylprotoemetine and dihydroisoalangine.

Multielement monitoring for dissolved and acid-soluble concentrations of trace metals in surface seawater along the ferry track between Osaka and Okinawa as investigated by ICP-MS

Multielement monitoring of the concentrations of trace metals dissolved in surface seawater collected at sampling stations along the ferry track between Osaka and Okinawa was performed by ICP-MS (inductively coupled plasma mass spectrometry). The surface seawater samples were collected by an automated sampling system for on-board sampling, which was installed on the bottom of a ferryboat. A part of each seawater sample was filtered with a membrane filter (pore size of 0.45 microm) immediately after sampling. Both filtered and non-filtered seawater samples were acidified to pH ca. 1 by adding conc. HNO3, and were subjected to chelating resin preconcentration for the determination of trace metals by ICP-MS, where the concentrations of analyte metals in the filtered and non-filtered seawater samples were referred to as the dissolved and total concentrations, respectively. According to the thus-obtained results, it was found that most trace metals, especially below the 0.01 microg l(-1) as the dissolved and total concentrations, sensitively reflected the environmental pollution in the Osaka Bay and Seto Inland Sea area, as well as near to the Bungo Canal and the outlet of Kagoshima Bay.

Molecular cloning of a divinyl ether synthase. Identification as a CYP74 cytochrome P-450

Lipoxygenase-derived fatty acid hydroperoxides are metabolized by CYP74 cytochrome P-450s to various oxylipins that play important roles in plant growth and development. Here, we report the characterization of a Lycopersicon esculentum (tomato) cDNA whose predicted amino acid sequence defines a previously unidentified P-450 subfamily (CYP74D). The recombinant protein, expressed in Escherichia coli, displayed spectral properties of a P-450. The enzyme efficiently metabolized 9-hydroperoxy linoleic acid and 9-hydroperoxy linolenic acid but was poorly active against the corresponding 13-hydroperoxides. Incubation of recombinant CYP74D with 9-hydroperoxy linoleic acid and 9-hydroperoxy linolenic acid yielded divinyl ether fatty acids (colneleic acid and colnelenic acid, respectively), which have been implicated as plant anti-fungal toxins. This represents the first identification of a cDNA encoding a divinyl ether synthase and establishment of the enzyme as a CYP74 P-450. Genomic DNA blot analysis revealed the existence of a single divinyl ether synthase gene located on chromosome one of tomato. In tomato seedlings, root tissue was the major site of both divinyl ether synthase mRNA accumulation and enzyme activity. These results indicate that developmental expression of the divinyl ether synthase gene is an important determinant of the tissue specific synthesis of divinyl ether oxylipins.

Tomato allene oxide synthase and fatty acid hydroperoxide lyase, two cytochrome P450s involved in oxylipin metabolism, are targeted to different membranes of chloroplast envelope

Allene oxide synthase (AOS) and hydroperoxide lyase (HPL) are related cytochrome P450s that metabolize a common fatty acid hydroperoxide substrate to different classes of bioactive oxylipins within chloroplasts. Here, we report the use of in vitro import assays to investigate the targeting of tomato (Lycopersicon esculentum) AOS (LeAOS) and HPL (LeHPL) to isolated chloroplasts. LeAOS, which contains a typical N-terminal transit peptide, was targeted to the inner envelope membrane by a route that requires both ATP and proteinase-sensitive components on the surface of chloroplasts. Imported LeAOS was peripherally associated with the inner envelope; the bulk of the protein facing the stroma. LeHPL, which lacks a typical chloroplast-targeting sequence, was targeted to the outer envelope by an ATP-independent and protease-insensitive pathway. Imported LeHPL was integrated into the outer envelope with most of the protein exposed to the inter-membrane space. We conclude that LeAOS and LeHPL are routed to different envelope membranes by distinct targeting pathways. Partitioning of AOS and HPL to different envelope membranes suggests differences in the spatial organization of these two branches of oxylipin metabolism.

Late Reperfusion (6-24 Hours After Onset) Improves Left Ventricular Function in Patients With Acute Myocardial Infarction

The TAMI-6 trial has demonstrated that coronary reperfusion >6h after onset (ie, late reperfusion) in patients with acute myocardial infarction (AMI) does not improve left ventricular (LV) function during the chronic phase of infarction. However, the low patency rate (only 60%) of the infarct-related artery (IRA) during the chronic phase in the TAMI-6 trial raises a new hypothesis that late reperfusion with a higher patency rate may improve LV function during the chronic phase. Forty-four patients with AMI, who were admitted to hospital 6-24h after the symptom onset and in whom emergency coronary angiography revealed a total occlusion of the IRA, were randomly assigned to either the late reperfusion group (n=22) or the non-reperfusion group (n=22). The initial success rate of reperfusion therapy in the late reperfusion group was 86% and the chronic patency rate of the IRA was 91%. The improvements in ejection fraction and chord shortening in the infarct region from the acute phase to the chronic phase were significantly greater in the late reperfusion group than in the non-reperfusion group. Late reperfusion with a high patency rate of the IRA significantly improves LV global and regional function in patients with AMI.