Superselective intra-arterial infusion chemotherapy for stage III/IV squamous cell carcinomas of the oral cavity: Midterm results

PURPOSE

We performed superselective intra-arterial infusion chemotherapy (SIC) according to a protocol in which drug distribution is evaluated by the use of interventional radiology (IVR)-computed tomography (CT) system, and the chemotherapy is combined with medium-dose conformal radiation therapy (CRT). We analyzed retrospectively the factors that affect the midterm survival ratio, including local response, for stage III and IV squamous cell carcinomas of the oral cavity.

MATERIALS AND METHODS

Forty consecutive patients with stage III and IV squamous cell carcinomas of the oral cavity and who had undergone both SIC and CRT were enrolled. A microcatheter was placed in the appropriate feeding artery of the tumor and cisplatin (50mg/body) was infused twice. CRT was administered with a dual-energy (4 and 10 MV) linear accelerator. The total and daily doses delivered were 30 and 2.0 Gy, respectively. Histopathologic effects were classified into five grades: grade 0 or 1 was defined as a poor response, and grade II or higher as a good response. Age, sex, stage, local response to treatment, mode of invasion and lymph node metastasis were analyzed, and differences in the midterm survival ratio were assessed.

RESULTS

The 3-year survival ratio of the 40 cases was 67%. A good local response (III or IV) was achieved in 75% of the cases. The survival ratio of the good local response group was significantly better than that of the poor response group (p=0.04). Mode of invasion (p=0.03) and lymph node metastasis (p=0.01) were also predictive of survival. In the multivariable analysis of survival, however, no variables including good local response (p=0.12), were predictive.

CONCLUSION

Our new protocol improved local response, but it did not contribute to the survival ratio.

Intraarterial infusion chemotherapy and conformal radiotherapy for cancer of the mouth: prediction of the histological response to therapy with magnetic resonance imaging

BACKGROUND

Although intraarterial chemotherapy has been used to treat head and neck cancers, some cases have shown poor response. If we can predict the response to this therapy on MRI, individual treatment plans may be altered to the most appropriate form of treatment.

PURPOSE

To evaluate whether MRI can predict the histological response to preoperative chemoirradiation in patients with cancer of the mouth.

MATERIAL AND METHODS

This study comprised of 29 consecutive patients with 30 oral cancers. All patients underwent tumor resection after intraarterial infusion chemotherapy and conformal radiotherapy. We compared the margin of the tumor, the presence of bone invasion, tumor area, and volume on pre- and post-treatment MRI with histological responses.

RESULTS

Eighteen lesions showed an excellent response, nine exhibited a good response, and three a poor response. Only the tumor area on pretreatment T1-weighted images and the tumor area and volume on pretreatment enhanced T1-weighted images were significantly correlated with the histological response (P = 0.039, 0.008, and 0.016, respectively); smaller cancers showed better responses. The other factors were not significantly correlated with the histological responses.

CONCLUSION

MRI parameters, excluding initial tumor area and volume, were not predictive of the histological response of oral tumors to preoperative treatment.

Molecular Distortion Effect on ff-Emission in a Pr(III) Complex with 4,7-Diphenyl-1,10-Phenanthroline

The electronic and structural behaviour of a Pr(III) complex with 4,7-diphenyl-1,10-phenanthroline, [Pr(bathophen)(2)(NO(3))(3)], is investigated with respect to the effect of configuration changes on the Pr(III) centre. [Pr(bathophen)(2)(NO(3))(3)] luminesces from the excited states of the ligand and the metal ion. The fluorescence, ff-emission ((1)D(2)-->(3)H(4)), and phosphorescence bands appear at 394, 608.2 and 482 nm, respectively, in the solid state. In acetonitrile, the complex also shows multiple emissions. From the time-resolved emission and the lifetime measurements, the excitation energy-transfer in [Pr(bathophen)(2)(NO(3))(3)] is clarified, that is, the upper excited triplet level of the ligand acts as an energy donor, while the (1)D(2) levels of Pr(III) is the acceptor. Additionally, the emission phenomena of the complex can be modified by molecular distortion, particularly by rotation of the phenyl groups in the ligand.

An atomic seesaw switch formed by tilted asymmetric Sn-Ge dimers on a Ge (001) surface

When tin (Sn) atoms are deposited on a clean germanium (Ge) (001) surface at room temperature, buckled dimers originating from the Sn atoms are formed at the Ge-dimer position. We identified the dimer as a heterogeneous Sn-Ge dimer by reversing its buckling orientation with a scanning tunneling microscope (STM) at 80 kelvin. An atomic seesaw switch was formed for one-dimensional electronic conduction in the Ge dimer-row direction by using the STM to reversibly flip the buckling orientation of the Sn-Ge dimer and to set up standing-wave states.

Novel emission properties of melem caused by the heavy metal effect of lanthanides(iii) in a LB film

A novel emissive molecular system is constructed by the intercalation of the fluorophore melem (triamino-tri-s-triazine) within a Langmuir-Blodgett (LB) film of stearic acid with the periodic arrangement of lanthanides (Ln(III)), mainly Pr(III) with supporting of Eu(III). From emission spectra, decay curves, quantum yields and XPS measurements, it is clarified that the external heavy metal effect of Pr(III) on melem is much stronger in the film than in the bulk solid state, resulting in producing an unusual triplet state of melem. The triplet state of melem in the LB film donates the excitation energy to Pr(III) in the LB film, which is completely different from the energy transfer pathway of Pr-melem complex in the solid state through the singlet state of melem.

Superselective arterial infusion chemotherapy for squamous cell carcinomas of the oral cavity: histopathologic effects on metastatic neck lymph nodes

We have performed superselective intra-arterial infusion chemotherapy (SIC) on carcinomas of the oral cavity according to a protocol in which the distribution of the drug was evaluated by the use of a combined CT and angiography system, and the chemotherapy was combined with medium-dose conformal radiation therapy (CRT). The purpose of this study was to evaluate the pathological effect of this treatment on the metastatic neck lymph nodes (LNs). Twenty consecutive patients who had metastatic neck LNs from squamous cell carcinomas of the mouth and who underwent both SIC and CRT were included in this study, in which a total of 22 LNs were evaluated. A microcatheter was placed in the appropriate feeding artery of the tumor, such as the internal maxillary artery, facial artery, lingual artery and external carotid artery (ECA), and cisplatin (50 mg/body) was infused twice through a microcatheter. The CRT was administered with a dual-energy (4 and 10 MV) linear accelerator. The total and daily doses delivered were 30 and 2.0 Gy, respectively. Intra-arterial infusion to the LNs was divided into two groups: superselective infusion (mainly to the submandibular LNs via the facial artery, n = 10) and nonsuperselective infusion via the ECA (n = 12). The distribution of cisplatin into the LNs was confirmed by slow-infusion CT. Histopathologic effects on the LNs were evaluated on the specimens obtained during the operation and classified into five grades (0: no or minimal response: I: disappearance of less than three quarters of the tumor cells: II: disappearance of more than three quarters of the tumor cells: III: disappearance of viable tumor cells with a small amount of residual nonviable tumor cells: IV: complete disappearance of all viable and nonviable tumor cells). Grade 0 or 1 was defined as poor response and Grade II or more as good response. Twenty-three LNs from nine patients without CRT and SIC were served as control. In the superselective infusion group, all 10 LNs showed good response (response rate, 100%: grade II = 4, grade III = 3, grade IV = 3). In the non-superselective group, however, 6 of 12 LNs showed poor response (response rate, 50%: grade 0 = 2, grade I = 4, grade II = 2, grade III = 2, grade IV = 2). All 23 control LNs with no treatment showed grade 0 response. Superselective infusion seems necessary to obtain good histopathologic effects on the metastatic LNs. SIC combined with CRT can be applied to the metastatic LNs.

Swine model of carotid artery atherosclerosis: experimental induction by surgical partial ligation and dietary hypercholesterolemia

INTRODUCTION

Limited availability of a large animal model of carotid atherosclerosis has limited preclinical evaluation of endovascular therapeutic devices. The present study is aimed at developing such animal models with a novel approach, emphasizing the role of hemodynamics.

METHODS

Using 18 carotid arteries from 9 miniswine, surgical partial ligation (approximately 80% stenosis) was carried out in untreated (group I; n = 6) and balloon-injured arteries (group II; n = 9). Three arteries were subjected to sham-operation for control (group III; n = 3). All animals were fed with a high-fat diet until sacrifice. Angiograms and histologic sections of the vessels were analyzed to evaluate both models.

RESULTS

Atherosclerotic changes were confirmed in 6 of 6 in group I and 6 of 9 arteries in group II, whereas all in group III remained intact. Three arteries in group II resulted in thrombotic occlusion. Advanced plaques with intraplaque hemorrhage and/or calcification were seen in 4 of 6 arteries in group I but none in group II. The cross-sectional area stenosis and atherosclerotic stage for plaques in group I were both significantly higher than that in groups II and III.

CONCLUSION

In this series, surgical partial ligation with concomitant dietary hyperlipidemia is an appropriate experimental technique to develop advanced atherosclerotic plaques with minimal technical complications. This model showed no evidence of such benefits when applied in balloon-injured arteries.

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

AIMS/HYPOTHESIS

Anaemia has been suggested to be an independent risk factor for subsequent progression of advanced diabetic nephropathy; however, the relationship between haemoglobin levels and progression of nephropathy in patients without clinical albuminuria is unknown.

METHODS

We conducted this prospective hospital-based cohort study of 464 type 2 diabetic patients (149 women and 315 men, 55+/-13 [mean+/-SD] years of age) with serum creatinine <177 micromol/l (2.00 mg/dl) and urinary albumin : creatinine ratio <300 mg/g creatinine. GFR was estimated using the equation formulated by the Modification of Diet in Renal Disease Study group, refitted for Japanese individuals. Most patients had haemoglobin concentrations in the normal range (144+/-15 g/l), only modest renal impairment (GFR: 74.8+/-14.5 ml min(-1) 1.73 m(-2)), and normal urinary albumin levels (81.5/18.5% with normo-/microalbuminuria). The primary outcome measurement was the rate of change in GFR determined by regression analysis with GFR as a function of time. Patients were followed up for a mean observation period of 5.0+/-0.9 (range: 2.5 to 6.2) years.

RESULTS

Univariate and multiple regression analyses yielded a significant association between the rate of change in GFR and baseline haemoglobin concentration. After adjusting for covariates, the rate of decline in GFR was significantly greater in patients in the lowest haemoglobin quartile (-3.27 ml min(-1) 1.73 m(-2) year(-1)) than in the third (-2.71 ml min(-1) 1.73 m(-2) year(-1), p = 0.024) and highest quartiles (-2.78 ml min(-1) 1.73 m(-2) year(-1), p = 0.046).

CONCLUSIONS/INTERPRETATION

Lower haemoglobin concentrations in type 2 diabetic patients without clinical albuminuria may be a significant predictor of subsequent decline in GFR.

Expression and cellular localization of calcitonin receptor: RT-PCR and in situ hybridization studies

Calcitonin receptor (CTR) has been identified in bone, kidney and brain, but precise tissue distribution and cellular localization remain to be established. In this study, we carried out in situ hybridization (ISH) analysis of CTR in rats and found intensive signals in exocrine glands, including salivary gland, exocrine pancreas and fundic glands of the glandular stomach, and epithelia of the seminal vesicle and prostatic glands. On the other hand, no signals were seen in the mesenchymal tissue including muscle, and connective and hematopoietic tissues. RT-PCR analysis showed that both CTR isoforms, C1a and C1b, were expressed in the central nervous system, only C1a isoform in the digestive, respiratory, urinary, reproductive and endocrine systems, and neither isoform in the mesenchymal tissue and hematopoietic tissues. These results showed that expression of CTR isoforms varies among various tissues, suggesting that CT functions through different mechanisms.

Cytosine-adenine repeat polymorphism at calcitonin gene locus associated with serum osteocalcin level in Japanese women

Bone mineral density and the serum concentration of osteocalcin are influenced by multiple genetic factors, including hormone and genes. Our aim was to evaluate the correlation between the dinucleotide (cytosine (C)-adenine (A)) repeat polymorphism at the calcitonin locus and bone mineral density and serum osteocalcin levels. Sixty-six healthy Japanese women over 50 years of age were included in this study. The bone mineral density of the second to fourth lumbar vertebrae was measured using dual-energy X-ray absorptiometry and serum osteocalcin was measured using an immunoradiometric assay. We isolated DNA from peripheral leukocytes and genotyped the cytosine-adenine repeats at the calcitonin locus using the polymerase chain reaction. We found that bone mineral density was not correlated with the number of cytosine-adenine repeats. However, the circulating osteocalcin level was significantly different among the different cytosine-adenine repeat groups. The osteocalcin level of the 10/17 (C-A) heterozygote group was significantly lower than those of the other groups (p<0.01). The 10/17 (C-A) and 17/17 (C-A) genotypes are common in the Japanese population, and the osteocalcin levels of the 10/17 heterozygotes were significantly lower than those of the 17/17 homozygote (p<0.05). Our findings suggest that the cytosine-adenine repeat at the calcitonin gene locus may be one of the genetic factors that regulate serum osteocalcin levels in Japanese women.

Conformation-Controlled Luminescent Properties of Lanthanide Clusters Containing p-tert-Butylsulfonylcalix[4]arene

Dinuclear and cubane-shaped lanthanide cluster complexes containing EuIII)and TbIII were synthesized by step-by-step construction using p-tert-butylsulfonylcalix[4]arene as a cluster-forming ligand. The sulfonylcalixarene adopts a pinched-cone conformation in the dinuclear complexes and a cone conformation in the cubane complexes. Because the calixarene has a large pi-conjugate system expanding over the entire molecule, it behaves as a good antenna chromophore for UV and near-UV light, and a slight conformational change of the calixarene (from cone to pinched-cone and vice versa) has an effect on the energy levels of excited S1 and T1 states. As a result, selectivity is observed in the luminescent properties of dinuclear and cubane-shaped systems of EuIII and TbIII.

Insulin Independence of Unstable Diabetic Patient After Single Living Donor Islet Transplantation

BACKGROUND

Current success in islet transplantation will lead to a donor shortage. Living donor islet transplantation could be an alternative approach to expand the potential donor pool. In this study we describe the first successful living donor islet transplantation for unstable diabetes, performed at Kyoto University Hospital on January 19, 2005.

METHODS

The donor was a healthy 56-year-old woman and mother of the recipient. The recipient was a 27-year-old woman with insulin-dependent diabetes since the age of 15 years. She experienced frequent hypoglycemic unawareness episodes. Her blood glucose concentration was difficult to control and C-peptide level was negative after glucagon stimulation. She needed an average 28 of units of insulin per day. The donor underwent a distal pancreatectomy and islets were isolated from the resected pancreas graft. The total islet yield was 408,114 islet equivalents and isolated islets were immediately transplanted into the recipient's liver.

RESULTS

After transplant, the blood glucose level of the recipient was tightly controlled without hypoglycemic episodes. She was discharged on day 37 with a normal oral glucose tolerance test (OGTT). The recipient remained insulin-independent for >3 months, since day 22 posttransplant. The donor's postoperative clinical course was uneventful. She was discharged on postoperative day 18 and returned to her job within 1 month.

CONCLUSIONS

We report the first successful living donor islet transplantation for the treatment of unstable diabetes. We believe that living donor islet transplantation may become an option in the treatment of insulin-dependent diabetes.

Simple Evaluation of Engraftment by Secretory Unit of Islet Transplant Objects for Living Donor and Cadaveric Donor Fresh or Cultured Islet Transplantation

BACKGROUND

Evaluation of engraftment is important to assess the success of islet transplantation. Recently we developed secretory unit of islet transplant objects (SUITO) index for simple evaluation of engraftment. Assuming that normal subjects aged <40 years have 100% pancreatic beta-cell function, SUITO index was calculated by the formula: 1500 x fasting C-peptide immunoreactivity [ng/dL]/(fasting blood glucose [mg/dL] - 63). In this study, we compared the efficacy of islet transplantation from cadaveric and living donors using the SUITO index.

METHODS

We performed eight islet transplantations with non-heart-beating donors (NHBDs) into five patients. Two patients received fresh islets once, one patient received fresh islets twice, one patient received cultured islets once, and one patient received cultured islets twice plus fresh islets once. In addition, one patient received fresh islets from a living donor. We calculated the SUITO index from postoperative days 3 to 30 for each case.

RESULTS

Mean SUITO index after one fresh islet transplant was 11.7 +/- 1.0, after two fresh islet transplants was 28.5 +/- 3.4, after one cultured islet transplant was 2.1 +/- 0.4, after two cultured islet transplant was 12.1 +/- 1.9, and after two cultured islet transplant plus one fresh islet transplant was 26.7 +/- 1.7. The mean SUITO index after single living donor islet transplant was 40.7 +/- 2.6, which was significantly higher compared with all other groups. Insulin independence was obtained when the SUITO index was >26, which might reflect that 26% beta-cell mass was required for insulin independence.

CONCLUSION

SUITO index is useful to evaluate islet engraftment and to predict the possibility of insulin independence.

The functional sites of chlorophylls in D1 and D2 subunits of photosystem II identified by pulsed EPR

The functional site of ChlZ, an auxiliary electron donor to P680+, was determined by pulsed ELDOR applied to a radical pair of YD * and Chlz+ in oriented PS II membranes from spinach. The radical-radical distance was determined to be 29.5 A and its direction was 50 degrees from the membrane normal, indicating that a chlorophyll on the D2 protein is responsible for the EPR Chlz+ signal. Spin polarized ESEEM (Electronin Spin Echo Envelop Modulation) of a 3Chl and QA - radical pair induced by a laser flash was observed in reaction center D1D2Cytb559 complex, in which QA was functionally reconstituted with DBMIB and reduced chemically. QA -ESEEM showed a characteristic oscillating time profile due to dipolar coupling with 3Chl. By fitting with the dipolar interaction parameters, the distance between 3Chl and QA - was determined to be 25.9 A, indicating that the accessory chlorophyll on the D1 protein is responsible for the 3Chl signal.

Differential modulation of human basophil functions through prostaglandin D2 receptors DP and chemoattractant receptor-homologous molecule expressed on Th2 cells/DP2

BACKGROUND

Both prostaglandin (PG) D receptor (DP) and CRTH2 (chemoattractant receptor-homologous molecule expressed on Th2 cells)/DP2 are high-affinity receptors for PGD2. Previous studies have demonstrated that PGD2 enhances releasability and induces CRTH2/DP2-mediated migration in human basophils, but the precise effects of PGD2 on basophils as well as receptor usage have not been fully clarified.

OBJECTIVE

We comprehensively explored the roles of DP and CRTH2/DP2 in basophil functions by using selective agonists and antagonists for each receptor.

METHODS

DP and CRTH2/DP2 transcripts were quantified by real-time PCR. We studied the effects of selective agonists (DP: BW245C; CRTH2/DP2: 13,14-dihydro-15-keto (DK)-PGD2) and/or antagonists (DP: BWA868C; CRTH2/DP2: ramatroban) on Ca2+ mobilization, migration, degranulation, CD11b expression and survival of human basophils.

RESULTS

Basophils expressed transcripts of both DP and CRTH2/DP2, but the levels of CRTH2/DP2 transcripts were ca. 100-fold higher compared with DP transcripts. Ca2+ influx was induced in basophils by either PGD2 or DK-PGD2/CRTH2 agonist but not by BW245C/DP agonist. Basophils treated with PGD2 were completely desensitized to subsequent stimulation with DK-PGD2, but not vice versa. DK-PGD2 as well as PGD2 up-regulated CD11b expression, induced migration and enhanced degranulation, and those effects were completely antagonized by ramatroban/CRTH2 antagonist. In contrast, BW245C/DP agonist exhibited an inhibitory effect on basophil migration and IgE-mediated degranulation, and the migration inhibitory effect was effectively antagonized by BWA868C/DP antagonist. On the other hand, while PGD2 significantly shortened the basophil life-span, neither DK-PGD2/CRTH2 agonist nor BW245C/DP agonist did.

CONCLUSION

CRTH2/DP2 is primarily responsible for the pro-inflammatory effects of PGD2 on human basophils, while DP introduces negative signals capable of antagonizing the effects of CRTH2/DP2 in these cells. The effects of PGD2 on longevity imply a mechanism(s) other than via DP or CRTH2/DP2. CRTH2/DP2 on basophils may afford opportunities for therapeutic targeting in allergic inflammation.

Acute flank pain, an unusual first symptom of a spinal arteriovenous malformation

This case report describes a 46-year-old man whose first symptom was an attack of acute flank pain, followed by the gradual onset neurological symptoms. We demonstrated a small nidus and serpentine signal-void area in the spinal cord by MRI and diagnosed a glomus type of spinal arteriovenous malformation (AVM). Flank pain is a rare initial finding in an adult with spinal AVM. In cases with acute flank pain, neurologists should consider spinal AVM as a differential diagnosis.

Industry forum: Progress in pursuit of therapeutic A2A antagonists: The adenosine A2A receptor selective antagonist KW6002: Research and development toward a novel nondopaminergic therapy for Parkinson's disease

Research and development of the adenosine A2A receptor selective antagonist KW6002 have focused on developing a novel nondopaminergic therapy for Parkinson's disease (PD). Salient pharmacologic features of KW6002 were investigated in several animal models of PD. In rodent and primate models, KW6002 provides symptomatic relief from parkinsonian motor deficits without provoking dyskinesia or exacerbating existing dyskinesias. The major target neurons of the A2A receptor antagonist were identified as GABAergic striatopallidal medium spiny neurons. A possible mechanism of A2A receptor antagonist action in PD has been proposed based on the involvement of striatal and pallidal presynaptic A2A receptors in the "dual" modulation of GABAergic synaptic transmission. Experiments with dopamine D2 receptor knockout mice showed that A2A receptors can function and anti-PD activities of A2A antagonists can occur independent of the dopaminergic system. Clinical studies of KW6002 in patients with advanced PD with L-dopa-related motor complications yielded promising results with regard to motor symptom relief without motor side effects. The development of KW6002 represents the first time that a concept gleaned from A2A biologic research has been applied successfully to "proof of concept" clinical studies. The selective A2A antagonist should provide a novel nondopaminergic approach to PD therapy.