An increased dose of insulin detemir improves glycaemic control and reduces body weight of Japanese patients with diabetes

AIMS

The aim of study was to evaluate the safety and efficacy of insulin detemir as a basal insulin switching from neutral protamine Hagedorn insulin (NPH) and insulin glargine in patients with diabetes on an intensive insulin therapy regimen.

METHODS

This 6-month multicentre, prospective, treat-to-target [glycosylated haemoglobin (HbA(1c) ) less than 6.5%] trial included 92 people with diabetes (61 type 1, 29 type 2 and two unknown diabetes types). Detemir was administered first with fixed dose and injection times and then adapted to optimal dose after 3 months.

RESULTS

Mean HbA(1c) (%) of all the subjects at months 4 to 6 of the study was improved compared with month 0 (7.34 ± 0.87, 7.28 ± 0.88, 7.25 ± 0.93 vs. 7.55 ± 1.18; p < 0.05 paired t-test). However, significant improvement was seen only among the patients who had previously used NPH as a basal insulin. Twice-daily injection of basal insulin increased among people in the type 1 previously injected insulin glargine. Total insulin dose increased in the type 1 glargine group. The mean body weight change in the highest quartile body mass index (BMI) group was from 70.7 to 69.3 kg over the 6 months. Quality of life (QoL) relating to the patients' glycaemic control tended to improve without a change in frequency of hypoglycaemia.

CONCLUSIONS

The results suggest that insulin detemir has a greater effect on glycaemic control in subjects with poor glycaemic control using NPH; can reduce or maintain body weight in obese patients; and obtains perceptive stability for patients with unstable glycaemic control.

Design and synthesis of KNT-127, a δ-opioid receptor agonist effective by systemic administration

We have reported previously the novel δ-opioid agonist, SN-28, which was more potent in in vitro assays than the prototype δ-agonists, TAN-67 and SNC-80. However, when administered by subcutaneous injection, this compound showed no analgesic effect at dosages greater than 30mg/kg in the acetic acid writhing test. We speculated that SN-28 was not effective in the test because the presence of the charged ammonium groups prevented its penetration through the blood-brain barrier. On the basis of our proposal, we designed the novel δ-agonist, KNT-127, which was effective with systemic administration.

Inverse correlation of HER2 with MHC class I expression on oesophageal squamous cell carcinoma

BACKGROUND

As HER2 is expressed in 30% of oesophageal squamous cell carcinomas (ESCCs), T-cell-based immunotherapy and monoclonal antibodies targeted against HER2 are attractive, novel approaches for ESCCs. However, it was shown that there is an inverse correlation between HER2 and MHC class I expression on tumours. Thus, the correlation between HER2 and MHC class I expressions on ESCC was evaluated.

METHODS

Expressions of MHC class I and HER2 in ESCC tissues (n=80) and cell lines were assessed by immunohistochemistry, fluorescence in situ hybridisation (FISH), and flow cytometry. We investigated whether HER2 downregulation with small interfering RNA (siRNA) in ESCC cell lines could upregulate the expression of MHC class I and the antigen presentation machinery components, and could increase their sensitivity for tumour antigen-specific CTLs.

RESULTS

There was an inverse correlation between HER2 and MHC class I expressions in both tumour tissues and cell lines. Downregulation of HER2 with siRNA resulted in the upregulation of MHC class I expression, leading to increased CTL recognition by tumour antigen-specific CTLs.

CONCLUSION

HER2-overexpressing ESCC tumour cells showed a reduced sensitivity for CTLs through the downregulation of MHC class I.

CCL17 and CCL22 chemokines within tumor microenvironment are related to infiltration of regulatory T cells in esophageal squamous cell carcinoma

It has been reported that an increased population of regulatory T cells (T-regs) is one of the reasons for impaired anti-tumor immunity. We investigated the frequency of Foxp3(+) T-regs in tumor-infiltrating lymphocytes (TILs) and peripheral blood lymphocytes (PBLs) of patients with esophageal squamous cell carcinoma (ESCC). Furthermore, in order to elucidate the mechanisms behind T-regs accumulation within tumors, we evaluated the relationship between CCL17 or CCL22 expression and the frequency of Foxp3(+) T-regs. CD4(+)CD25(+)Foxp3(+) T-regs as a percentage of CD4(+) cells were counted by flow cytometry. The frequency of CCL17(+) or CCL22(+) cells among CD14(+) cells in tumors was also evaluated by flow cytometry. Moreover, an in vitro migration assay using T-regs derived from ESCC was performed in the presence of CCL17 or CCL22. The frequency of Foxp3(+) T-regs in TILs was significantly higher than that in the normal esophageal mucosa (24.6 +/- 10.0 vs 7.1 +/- 5.9%, P < 0.01). The frequency of Foxp3(+) T-regs in PBLs of ESCC patients was significantly higher than that in normal healthy donors (7.0 +/- 4.2 vs 2.5 +/- 1.0%, P < 0.01). Furthermore, the frequency of CCL17(+) or CCL22(+) cells among CD14(+) cells within tumors was significantly higher than that of normal esophageal mucosa, and there was a significant correlation between the frequency of CCL17(+) or CCL22(+) cells and Foxp3(+) T-regs in TILs. In addition, the in vitro migration assay indicated that T-regs were significantly induced to migrate by CCL17 or CCL22. In conclusion, CCL17 and CCL22 within the tumor are related to the increased population of Foxp3(+) T-regs in ESCC.

[Chemotherapy for elderly colorectal cancer patients in a regional hospital--problems in regional cancer care]

At Nara Social Insurance Hospital, from January 2005 to September 2008, chemotherapy for older adult (>or=70) colorectal cancer patients was performed in 18 adjuvant cases and 10 advanced cases. In adjuvant cases, 18 out of 33 patients of >or= stage IIIa received chemotherapy, and 13 completed treatment safely. In advanced cases, all patients received FLOFOX or FOLFIRI, with or without bevacizumab as first-line treatment with a response rate of 50%. Although adverse events were relatively frequent in the older adult patients, there was no difference in the survival rate between elderly and younger patient groups. Cancer chemotherapy for older adults with a high comorbidity rate requires more skill and experience than for younger patients. It was possible even for a small-volume hospital, which plays an important role in regional medical service for elderly patients, to build up a system providing standard chemotherapy for colorectal cancer. However, considering the limited financial and human resources, it is essential to form a regional alliance of designated cancer care hospitals and other clinics in order to maintain the level of practice.

Mesothelin gene expression and promoter methylation/hypomethylation in gynecological tumors

PURPOSE

Mesothelin is a cell surface glycoprotein that is present on normal mesothelial cells and overexpressed in several cancers. In this study, we investigated the methylation/hypomethylation status in the promoter region of the mesothelin gene in gynecological tumors.

METHODS

Forty-four ovarian tumor specimens and 16 cases of uterine endometrial carcinoma, and normal tissue specimens were used. Monoclonal antibody (5B2) was employed for the immunohistochemical analysis. The methylation-sensitive single-nucleotide primer extension (Ms-SNuPE) technique was used to quantify the methylation/hypomethylation status at 20 CpG sites in the mesothelin promoter region.

RESULTS

Mesothelin was expressed in 100% of serous cystadenocarcinoma and 100% of serous borderline tumor of the ovary. None of the germ cell tumors and sexcord-stromal tumors was immunoreactive. Fifty percent of endometrial carcinoma was immunoreactive for mesothelin. The average methylation of CpG sites in ovarian tumors ranged from 6-56% (median: 31%) in mesothelin-positive and 13-79% (median: 43%) in mesothelin-negative samples. In endometrial tumors, the average methylation ranged from 5-52% (median: 28%) in mesothlin-positive and from 15-67% (median: 22%) in mesothlin-negative samples. A correlation was found between mesothelin expression and the average methylation/hypomethylation status as well as methylation/hypomethylation status at four of 20 CpG sites in ovarian samples. No correlation was found in endometrial samples.

CONCLUSION

We detected diverse levels of methylation/hypomethylation at CpG sites in the mesothelin promoter region in ovarian and endometrial tumors. We speculate that, although methylation/hypomethylation changes may affect its transcription, other mechanisms may synergically operate in tissue-specific expression and tumor-related mesothelin overexpression.

Drug design and synthesis of a novel kappa opioid receptor agonist with an oxabicyclo[2.2.2]octane skeleton and its pharmacology

A conformational analysis of kappa opioid receptor agonists, TRK-820 and U-50,488H indicated an active conformation of TRK-820 in which the C-ring was in the boat form with the 14-OH interacting with the amide nitrogen. Based on the obtained active conformation of TRK-820, we designed and synthesized a novel kappa agonist KNT-63 with oxabicyclo[2.2.2]octane skeleton. KNT-63 showed profound antinociceptive effects via the kappa receptor which were as potent as that of TRK-820.

Phase I trial of sorafenib in combination with interferon-alpha in Japanese patients with unresectable or metastatic renal cell carcinoma

e16107

Background: Sorafenib (SOR) is a multi-kinase inhibitor, targeting Raf kinase and the receptor tyrosine kinases VEGFR-2 and PDGFR-β. Interferon-α (IFN) is most commonly used for metastatic renal cell carcinoma (RCC) in Japan. In this phase I study, we investigated the safety profile, pharmacokinetics (PK), and tumor response of SOR/(recombinant)IFN combination in Japanese patients (pts) with RCC. Methods: After 2 weeks of IFN-alone treatment, a total of 18 pts (6 in each cohort) with unresectable/metastatic RCC received 28-day cycles of continuous SOR 200 (Cohort 1 [C1]) or (Cohorts 2 and 3 [C2 and C3]) 400 mg bid combined with intramuscular IFN 6 (C1 and C2) or 9 (C3) MIU three times a week (tiw). Objectives were safety/tolerability and recommended dose of SOR/IFN as primary, and tumor response and PK as secondary. Results: Pt characteristics were: median 64.5 y.o.; ECOG-PS 0:1, 14:4; prior anticancer therapy in 13 pts. All pts completed Cycle 1 and entered Cycle 2 or later cycles. At data cut-off (September 30, 2008), dose-limiting toxicities were reported in all cohorts, including G3 fatigue, G3 anorexia, and G3 skin disorders. Common drug-related grade 3/4 adverse events (AEs) included fatigue (50%), lipase increased (44%) and neutropenia (39%), all of which were reversible and manageable. AEs resulting in treatment discontinuation in Cycle 2 or later cycles were seen in 5 pts in Cohort 3. One death was reported in C1 at Cycle 18 due to gastrointestinal and intraabdominal hemorrhage. It seemed attributable to DIC accompanied by RCC. Five PR (1 in C1 and 4 in C3) and 11 SD (4 in C1, 5 in C2, and 2 in C3) were achieved as the best response. IFN had no relevant impact on PK of SOR. Conclusions: SOR/IFN combination has promise for clinical benefit in RCC, and its recommended dose was continuous SOR 400 mg bid and IFN 6 MIU tiw.

[Table: see text]

Extraction of acne lesion in acne patients from multispectral images

In acne treatment, it is important to accurately evaluate the severity of Acne. The acne should be classified into several skin lesions including comedo, reddish papule, pustule, and scar. However, in some cases, a visual detection from RGB image maybe difficult for the proper evaluation of acne skin lesions. This paper proposes an extraction method using the spectral information of the various type of acne skin lesions calculated from the multispectral images (MSI) of the lesions. In the experiment, we showed the possibility of classifying acne lesion types by applying a combination of several linear discriminant functions (LDF's).

Novel synthesis of a 1,3,5-trioxazatriquinane skeleton using a nitrogen clamp

An alpha-hydroxyaldehyde derived from naltrexone was converted to an oxazoline dimer with ammonium chloride and sodium acetate in MeOH under reflux. The resulting dimer was treated with dl-camphorsulfonic acid in CHCl(3) to give the trimer. The method for trimer synthesis was also applied to general alpha-hydroxyaldehydes to afford trimers in good yield.

Cardiac sympathetic activity in the asymmetrically hypertrophied septum in patients with hypertension or hypertrophic cardiomyopathy

BACKGROUND

In patients with essential hypertension (HT), proportional (symmetric) left ventricular hypertrophy (LVH) is common. In contrast, hypertrophic cardiomyopathy (HCM) is characterized by disproportional LVH and, in particular, asymmetric septal hypertrophy (ASH); however, some hypertensive patients also develop ASH. It has not been determined whether such cases represent a distinct type of hypertensive LVH or HCM combined with hypertension.

HYPOTHESIS

The study was undertaken to evaluate sympathetic activity in the interventricular septum in patients with HT and ASH or in patients with HCM.

METHODS

The patients were evaluated by I-123 meta-iodobenzylguanidine (MIBG) and thallium-201 (201Tl) single-photon emission computed tomography (SPECT), respectively. They were divided into three groups: patients with essential HT and symmetric septal hypertrophy (Group A), patients with HT and ASH (Group B), and patients with HCM and ASH (Group C).

RESULTS

Compared with the lateral wall, early uptake of MIBG in the septum was significantly higher in Group B than in Group A, but not significantly different between Groups A and C. Compared with the lateral wall, early uptake of 201Tl in the septum did not differ among the three groups. No significant difference in the MIBG clearance in the lateral wall was seen among the three groups. By contrast, MIBG clearances in the septum and apex were significantly greater in Group C than in Groups A and B. There was an inverse correlation between systolic thickening and MIBG clearance in the septum.

CONCLUSION

These findings suggest that sympathetic activity in the septum differs between patients with HT and ASH and patients with HCM.

Synthesis of a novel 6,14-epoxymorphinan derivative and its pharmacology

A novel 6,14-epoxymorphinan benzamide derivative (NS22) was synthesized, which showed opioid kappa receptor agonistic activity in the [(35)S]GTPgammaS binding assay. The antinociceptive effect of NS22 was evaluated in the tail-flick and the hot-plate test. This compound showed a potent antinociceptive activity in mice by s.c. administration, which was attenuated with nor-BNI (selective opioid kappa receptor antagonist).

Downregulation of HLA Class I molecules in the tumour is associated with a poor prognosis in patients with oesophageal squamous cell carcinoma

As antigenic peptides in the context of human leukocyte antigen (HLA) class I molecules are recognised by cytotoxic T lymphocytes (CTL), the downregulation of HLA class I molecules is one of the reasons why tumour cells can evade CTL-mediated anti-tumour immunity. In this study, we investigated HLA class I expression in oesophageal squamous cell carcinoma (ESCC) (n=70) and in their metastatic lesions (lymph nodes (n=40) and liver (n=3)), by immunohistochemistry with anti-HLA class I monoclonal antibody (EMR8-5). As a result, the downregulation of HLA class I expression in primary lesions of ESCC was observed in 43%, and that in metastatic lymph nodes was noted in 90%. Furthermore, patients with preserved HLA class I expression in primary tumours showed a better survival in comparison to those with downregulated HLA class I molecules (P<0.01). Furthermore, multivariate analysis using Cox's proportional hazards model revealed that the downregulated expression of HLA class I in primary lesions was an independent, unfavourable prognostic factor (P<0.01). In conclusion, the downregulation of HLA class I expression frequently occurred in primary tumour and, to a greater extent, in metastatic lesions of patients with ESCC and was associated with patient survival.

Synthesis of a stable iminium salt and propellane derivatives

The treatment of morphinan 1 with NaH and MsCl provided very stable iminium salt 7 possessing propellane skeleton. One of the synthesized iminium salts 7, isobutyl derivative 7b, was crystallized and its structure was determined by X-ray crystallography. The natural bond orbital analysis suggested that the stability of the iminium should result from the stereoelectronic effect (hyperconjugation) attributed to their own structures.

Low temperature specific heat of superconducting ternary intermetallics La(3)Pd(4)Ge(4), La(3)Ni(4)Si(4), and La(3)Ni(4)Ge(4) with U(3)Ni(4)Si(4)-type structure

A systematic investigation on the thermodynamic properties of La-based ternary intermetallic superconductors crystallizing in a U(3)Ni(4)Si(4)-type structure is presented. The U(3)Ni(4)Si(4)-type structure consists of a characteristic intergrowth of periodic BaAl(4) (ThCr(2)Si(2))- and AlB(2)-type segments. Pristine low temperature specific heat data for recently discovered members La(3)Ni(4)Si(4) and La(3)Ni(4)Ge(4) with T(c)s of 1.0 and 0.7 K, respectively, are presented as well as La(3)Pd(4)Ge(4) with the highest T(c) of 2.5 K in the U(3)Ni(4)Si(4)-type group. Owing to the higher T(c)s of U(3)Ni(4)Si(4)-type superconductors than the related ThCr(2)Si(2)-type compounds, comparisons are drawn in our investigations of the ternary intermetallics of LaPd(2)Ge(2), LaNi(2)Si(2), and LaNi(2)Ge(2) having a ThCr(2)Si(2)-type structure. Our investigations of the thermodynamic properties show that La(3)Ni(4)Si(4) and La(3)Ni(4)Ge(4) have higher values of γ(n), N(E(F)), and Θ(D) than La(3)Pd(4)Ge(4). The same trend was found in ThCr(2)Si(2)-type compounds of LaPd(2)Ge(2), LaNi(2)Si(2), and LaNi(2)Ge(2). It turns out that the difference in T(c) between La(3)Pd(4)Ge(4), La(3)Ni(4)Si(4), and La(3)Ni(4)Ge(4), as well as the relatively higher T(c) of the U(3)Ni(4)Si(4)-type superconductors than of the related ThCr(2)Si(2)-type compounds, are largely due to the strength of electron-phonon coupling.

Design, synthesis, and structure-activity relationship of novel opioid kappa-agonists

By focusing on 4,5-epoxymorphinan, a traditional opioid skeleton but a new structure in the opioid kappa-agonist research field, and by rationally applying the 'message-address concept' and 'accessory site hypothesis,' we discovered a new chemical class opioid kappa-agonist, TRK-820 (1). Its development as an antipruritus is now in the final stage. Here, the full scope of its design, synthesis, and structure-activity relationship are described.

Prospective randomized trial comparing the direct method using a 24 Fr bumper-button-type device with the pull method for percutaneous endoscopic gastrostomy

BACKGROUND AND STUDY AIMS

Percutaneous endoscopic gastrostomy (PEG) is the preferred route for long-term enteral feeding. The aim of this study was to compare a direct, modified introducer method using a bumper-button-type device with the standard pull method for PEG.

PATIENTS AND METHODS

Between October 2005 and January 2007 consecutive patients with dysphagia were randomly assigned to PEG using either the direct method or the pull method. The direct method directly placed a 24 Fr bumper-button-type device assisted by dual gastropexy. The primary outcome measure was the rate of peristomal infections. Secondary measures included success rates, procedure times, and other complications. The long-term outcome measure was the need for catheter change within 180 days of the PEG procedure.

RESULTS

Of the 140 patients enrolled, 68 were assigned to the direct method and 72 to the pull method. There were no significant differences between the two groups with respect to clinical baseline parameters. The occurrence of peristomal infection within 30 days was significantly lower following the direct method (0 vs. 6, P = 0.028). The success rates and duration of both methods were similar (100% vs. 100%; 10.5 vs. 9.6 minutes, P = 0.48). The catheters used in the direct method required replacement significantly less often than those placed using the pull method (no catheter change in 180 days: 75% vs. 45.2%, P = 0.0019).

CONCLUSIONS

The direct method using a 24 Fr bumper-button-type device was associated with reduced peristomal infections in the early phase and reduced catheter changes compared with a 20 Fr catheter placed using the standard pull method.

The role of silicon in preventing appressorial penetration by the rice blast fungus

To test the hypothesis that silicon (Si) confers resistance against appressorial penetration of the rice blast fungus, the proportion of appressorial penetration into the leaf epidermis to total appressoria formed was compared among rice plants amended with various rates of silica gel to those plants nonamended. The amounts of Si in the youngest leaves were consistent with the amounts of silica gel applied to the rice plants. Relative Si levels on the adaxial surface of leaves as detected by energy dispersive X-ray analysis also increased with the amounts of silica gel applied. Based on light microscopic observation of the adaxial surface of rice leaves, the proportion of appressorial penetration was reduced by increasing amounts of silica gel applied and increased with the length of period after spray inoculation. Consequently, these results strongly support the hypothesis and suggest that Si in the leaf epidermis may confer resistance against appressorial penetration. Meanwhile, the number of lesions per leaf also decreased with the amount of Si applied, while only a certain part of penetrated appressoria could become sporulating susceptible lesions. This suggests that Si also confers physiological resistance against blast infection after the penetration.

Anticipation and motor control on repetitive tooth tapping produced by open-close jaw movements

This study was designed to evaluate the relationship between the temporal anticipation effects and motor control on repetitive tooth tapping movements (tooth tapping produced by open-close jaw movements) commanded by six frequencies of acoustic signals. Ten dentulous young adults were asked to perform tooth tapping movements to acoustic command signals at constant frequencies of 0.3, 0.8, 1.3, 1.8, 2.3 and 2.8 Hz. Surface electromyograms of the Masseter muscles, vertical component of the Mandibular kinesiograph, and acoustic signals were simultaneously recorded. Some parameters were measured for tappings at the last signal (TL) and surplus tappings without signals after the last signal (TL(n)) in each frequency command signal. The results showed that changes in the strategy for tapping movement controls occurred between 0.3 and 0.8 Hz. Between 0.8 and 2.8 Hz, each tooth tapping was automatically initiated before the confirmation of the signal; initiation and control of repetitive tapping movements were apparently based on effector anticipation (predicting the duration of internal processes for a planned movement so that it can be made coincidental to some anticipated external event) and receptor anticipation (anticipation of the arrival of a stimulus due to sensory information about its time of arrival). However, at 0.3 Hz, the movement initiation was delayed, such that each tooth tapping was initiated after the confirmation of the signal. Therefore, tappings at 0.3 Hz showed less dependence on receptor anticipation. These changes in motor control strategy are considered to be a reasonable way to prevent incorrect movements and to minimize erroneous movements.

[Efficacy and toxicity of transcatheter arterial chemoembolization with Cisplatin suspended in lipiodol for unresectable hepatocellular carcinoma]

In this study we evaluated the efficacy and toxicity of transcatheter arterial chemoembolization (TACE) with Cisplatin (CDDP)-Lipiodol (LIP) suspension in 24 patients with advanced hepatocellular carcinoma (HCC). Eligibility criteria were as follows; unresectable HCC, age <75 years, performance status (PS) 0-2, Child-Pugh A or B and adequate heart and renal function. When TACE was performed, the catheter was placed selectively in feeding arteries of the tumors, and CDDP-LIP suspension (20 mg/mL) was injected followed by gelatin sponge particles. The direct and total effect on tumors were evaluated 3 and 6 months after TACE, respectively. As for a direct effect, complete and partial response rates were 54.2% and 25%, respectively. As for a total effect, complete and partial response rates were 41.7% and 4.1%, respectively. Grade 3/4 drug-related toxicities were as follows: thrombocytopenia (13%), appetite loss (8%) and nausea (4%). These severe side effects disappeared within 10 days after TACE. No renal and hepatic dysfunction was encountered, and no drug-related deaths occurred. TACE with CDDP suspended in LIP may provide some clinical benefits with relatively tolerable toxicities.

Clonal relationship between infiltrating immunoglobulin G4 (IgG4)-positive plasma cells in lacrimal glands and circulating IgG4-positive lymphocytes in Mikulicz's disease

Mikulicz's disease (MD) is gaining acceptance as an immunoglobulin G4 (IgG4)-related disease characterized by bilateral lacrimal and salivary gland swelling. The aetiology of MD and other IgG4-related diseases is still unclear. The present work was performed to study the clonality of infiltrating IgG4-positive plasma cells in lacrimal glands and circulating peripheral blood cells in patients with MD, and compare the clonal relationship between infiltrating and circulating IgG4 positive cells. Total cellular RNA was extracted from the lacrimal glands and peripheral blood in five MD patients. Reverse transcription polymerase chain reaction was performed with primers specific for activation-induced cytidine deaminase (AID) and for Ig VH and IgG4. Sequences of Ig VH were compared with the structure of Ig VH of the lacrimal glands and the peripheral blood cells. AID was expressed to varying degrees in lacrimal glands of all MD patients. Most IgG4-positive cells infiltrating lacrimal glands and in peripheral blood were polyclonal, although several clonally related pairs were detected. In one patient, two of the circulating IgG4 VH4-59 clones shared identical CDR3 sequences with the clones within the lacrimal glands. In conclusion, while most tissue-infiltrating and circulating IgG4-positive cells in MD are polyclonal, some clonally related IgG4 positive cells exist between lacrimal gland and peripheral blood, accounting for the clinical features of MD as an IgG4-related disease involving multiple organs.