Long-term outcomes after hepatectomy for recurrences after prior local ablation for hepatocellular carcinoma

AIMS

Intrahepatic recurrence is the most common manifestation of failure after local ablation therapy for hepatocellular carcinoma. The present study evaluates the safety and efficacy of partial hepatectomy for intrahepatic recurrence after prior local ablation.

METHODS

A retrospective analysis was conducted of 188 consecutive patients with hepatocellular carcinoma who underwent either partial hepatectomy for recurrence after prior local ablation (n=13) or partial hepatectomy as initial local treatment (n=175). The 13 patients with recurrence after prior local ablation were referred to our division after the resectable recurrences were considered to be resistant to non-surgical treatment modalities.

RESULTS

The incidences of postoperative morbidity and mortality were similar for patients with prior local ablation and patients without prior local ablation (p=0.75 and p=0.52, respectively). The overall survival rates after hepatectomy were comparable between patients with prior local ablation (median survival time of 86months; cumulative 5-year survival rate of 63%) and patients without prior local ablation (median survival time of 76months; cumulative 5-year survival rate of 54%; p=0.60). The disease-free survival rates after hepatectomy were significantly worse for patients with prior local ablation based on both univariate (p=0.01) and multivariate (relative risk, 2.73; p<0.01) analyses.

CONCLUSIONS

Hepatectomy can be performed safely and may be efficacious, in terms of overall survival, for selected patients with intrahepatic recurrence after prior local ablation for hepatocellular carcinoma. On the other hand, prior local ablation appears to increase the probability of failure after hepatectomy.

Preoperative predictors of vascular invasion in hepatocellular carcinoma

AIMS

Vascular invasion is an established adverse prognostic factor in hepatocellular carcinoma (HCC). The aim of the current study was to identify the preoperative predictors of vascular invasion in patients undergoing partial hepatectomy for HCC.

METHODS

A retrospective analysis of 227 consecutive patients who underwent partial hepatectomy for HCC was conducted. Vascular invasion was defined as gross or microscopic involvement of the vessels (portal vein or hepatic vein) within the peritumoral liver tissue.

RESULTS

Seventy-six (33%) patients had vascular invasion. Among the preoperative factors, only the tumour size (relative risk, 16.78; p<0.01) and the serum alpha-fetoprotein (AFP) level (relative risk, 3.57; p<0.01) independently predicted vascular invasion. As the tumour size increased, the incidence of vascular invasion increased: < or =2 cm, 3%; 2.1-3 cm, 20%; 3.1-5 cm, 38%; and > 5 cm, 65%. The incidence of vascular invasion was 32% in patients with serum AFP levels < or =1000 ng/mL, compared to 61% in patients with higher serum AFP levels (p<0.01). Patients with both tumours >5 cm and serum AFP levels >1000 ng/mL had an 82% incidence of vascular invasion.

CONCLUSIONS

The tumour size and serum AFP level, alone or in combination, are useful in predicting the presence or absence of vascular invasion before hepatectomy for HCC.

Hydrovenous Disorder in Vein of Galen Aneurysmal Dilatation: Special Focus on Tonsilar Prolapse

We analyzed five cases of vein of Galen aneurysmal dilatation (VGAD) and 12 cases of vein of Galen aneurysmal malformation (VGAM) using sagittal T1-weighted images. Tonsilar prolapse (TP) was confirmed in three cases, which were all VGAD. Two of these cases were treated by endovascular procedures. In one of these two cases, elevation of TP was observed after intervention. There were no signs of TP in the control group of 12 VGAMs. Venous hypertension interferes with cerebrospinal fluid (CSF) resorption resulting in increased brain fluid. TP frequently develops in high flow AVFs and is reversible if therapeutic intervention is performed by an experienced clinical team when appropriately indicated. We consider that TP in VGAD is mainly the result of cerebellar swelling due to chronic venous hypertension.

Nitroglycerin on contractile force in canine cardiac Purkinje fibers

The objective of this study was to investigate the effects of nitroglycerin (NG) on the contractile force in order to elucidate regulatory roles of cyclic guanosine monophosphate (cGMP) in the bundle of canine cardiac Purkinje fibers. NG suppressed the developed tension in canine Purkinje fibers immersed in normal Tyrode's solution. The contraction was also elicited in the depolarizing solution containing 30 mM K+ by adding isoproterenol (Iso) or tetraethylammonium (TEA). The suppression caused by NG was more marked in fibers in the depolarizing solution treated with TEA than in the depolarizing solution treated with Iso. 8-Bromo-cGMP and sodium nitroprusside had a slight inhibition on the contraction in the fibers. Methylene blue did not affect the decrease in contractile force induced by NG. The weaker inhibition caused by NG on the contraction in the presence of Iso might result from a possible increase in intracellular cAMP levels in the fibers.

Allergic inflammatory reaction is involved in necrosis of human pulmonary dirofilariasis

AIMS

To determine whether, in view of the massive inflammatory cell infiltration and the rounded rather than wedge-shaped character of pulmonary lesions in dirofilariasis, the inflammatory response against the worm contributes to the coagulative necrosis, in addition to an ischaemic process.

METHODS AND RESULTS

The histopathological features of 13 resected dirofilariasis cases with well-defined nodules ranged from 10 to 30 mm were analysed. On routine histology and using immunohistochemistry, the peripheral encapsulating wall showed mild to severe infiltration of eosinophils, lymphocytes and plasma cells and a histiocytic reaction in all cases, often with necrotic eosinophils seen within the necrosis (84.6%) and inflammatory changes in the adjacent lung (38.5%). The CD4+ lymphocyte count (80.8 +/- 33.4) was greater than that of CD8+ lymphocytes (24.5 +/- 16.9) in the central necrosis and vice versa in the wall. In the necrotic regions, disruption of the pulmonary artery (61.5%) and extravasation of the torn worm (23.1%) could be seen.

CONCLUSIONS

These findings indicate that an allergic inflammatory reaction, mediated by eosinophils and lymphocytes, is involved in the formation of the dirofilarial necrotizing granuloma rather than infarction caused simply by embolism.

Interleukin-1beta gene in esophageal, gastric and colorectal carcinomas

Interleukin (IL)-1 gene polymorphisms are associated with development of gastric atrophy and with increased risk of gastric carcinoma. A -31C to T base transition in the promoter region of this gene is involved in carcinogenic changes within the stomach, especially in Helicobacter pylori infected individuals. We examined association between IL-1 locus polymorphisms and risk of esophageal, gastric and colorectal carcinomas in Japanese patients with H. pylori infection. IL-1B and IL-1RN polymorphisms were analyzed in 136 controls, 75 patients with esophageal carcinoma, 186 patients with gastric carcinoma, 69 patients with colorectal carcinoma, and 18 patients with ulcerative colitis (UC). For IL-1B-511 and -31 polymorphisms were determined by fluorescence-based polymerase chain reaction single-strand conformation polymorphism analysis. For IL-1 receptor antagonist gene (IL-1RN), penta-allelic variable number of tandem repeats (VNTR) was determined by PCR-standard agarose gel electrophoresis. For gastric carcinoma, IL-1B-511 heterozygotes (OR, 0.48; 95% CI, 0.3-0.9; p=0.0115) and T carriers (OR, 0.52; 95% CI, 0.3-1.0; p=0.0185) had a significantly reduced risk of carcinoma. For colorectal carcinoma, IL-1B-511 heterozygotes (OR, 0.34; 95% CI, 0.2-0.7; p=0.0028) and T carriers (OR, 0.43; 95% CI, 0.2-0.9; p=0.0015) had a significantly low risk of carcinoma. No significant difference was observed in the frequencies of IL-1B-31C/T and IL-1RN genotypes between controls and the esophageal carcinoma patients. Our results shows that IL-1B-511C/T and T carrier state may indicate less risk for gastric and colorectal carcinoma in the Japanese population.

Coordination of the upper-limb segments in physiological tremor with various external loads

BACKGROUND

This study investigates coordination of the upper-limb segments with various external loads by frequency-domain analysis of physiological tremor during the maintenance of limb posture. Physiological tremor is an involuntary oscillation in every segment of a healthy human.

MATERIAL/METHODS

A subject raised his right upper limb forward while extending his hand and fingers. Physiological tremor was measured by acceleration sensors attached to four segments: the index finger, hand, forearm, and upper arm. A balloon filled with helium gas was attached to the forearm as a minus-load condition. A weight band was attached as a plus-load condition. The measured signals were evaluated by frequency-domain analysis: power spectrum and coherence spectrum.

RESULTS

The amplitude of upper-limb tremor measured from the four segments decreased with the minus-load and increased with the plus-load. However, the degree of the variation depended on the segment. The amplitude of upper-limb tremor measured from the forearm and the hand decreased remarkably with the minus-load, while the amplitude from the upper arm increased with the plus-load. Although adjacent segments were well coordinated, coordination between the segments varied depending on the external load. The minus-load at the forearm led to a lack of coordination between the upper arm and the forearm. To compensate for this, the movements of the forearm and the hand became coordinated.

CONCLUSIONS

The experimental protocol of this study allowed implementing a method to estimate the physiological modification of the neuromuscular system under a hypo-gravitational environment.

Interleukin-1beta gene in esophageal, gastric and colorectal carcinomas

Interleukin (IL)-1 gene polymorphisms are associated with development of gastric atrophy and with increased risk of gastric carcinoma. A -31C to T base transition in the promoter region of this gene is involved in carcinogenic changes within the stomach, especially in Helicobacter pylori infected individuals. We examined association between IL-1 locus polymorphisms and risk of esophageal, gastric and colorectal carcinomas in Japanese patients with H. pylori infection. IL-1B and IL-1RN polymorphisms were analyzed in 136 controls, 75 patients with esophageal carcinoma, 186 patients with gastric carcinoma, 69 patients with colorectal carcinoma, and 18 patients with ulcerative colitis (UC). For IL-1B-511 and -31 polymorphisms were determined by fluorescence-based polymerase chain reaction single-strand conformation polymorphism analysis. For IL-1 receptor antagonist gene (IL-1RN), penta-allelic variable number of tandem repeats (VNTR) was determined by PCR-standard agarose gel electrophoresis. For gastric carcinoma, IL-1B-511 heterozygotes (OR, 0.48; 95% CI, 0.3-0.9; p=0.0115) and T carriers (OR, 0.52; 95% CI, 0.3-1.0; p=0.0185) had a significantly reduced risk of carcinoma. For colorectal carcinoma, IL-1B-511 heterozygotes (OR, 0.34; 95% CI, 0.2-0.7; p=0.0028) and T carriers (OR, 0.43; 95% CI, 0.2-0.9; p=0.0015) had a significantly low risk of carcinoma. No significant difference was observed in the frequencies of IL-1B-31C/T and IL-1RN genotypes between controls and the esophageal carcinoma patients. Our results shows that IL-1B-511C/T and T carrier state may indicate less risk for gastric and colorectal carcinoma in the Japanese population.

A phase II study of chemoradiotherapy in patients with stage II, III esophageal squamous cell carcinoma (ESCC): (JCOG 9906)

15137

Background: The study objective was to evaluate the efficacy and toxicity of chemoradiotherapy (CRT) with cisplatin and 5- fluorouracil (5FU) in patients with stage II, III ESCC. Methods: Patients with clinical stage II or III (T1N1 or T2–3N0–1 and M0) thoracic ESCC, age of 70 or younger, preserved organ functions were eligible. Treatment consisted of two courses of cisplatin 40 mg/m2 (day 1, 8) and 5FU 400 mg/m2/day (days 1–5, 8–12), q5w combined with concurrent radiotherapy of 60 Gy in 30 fractions over 8 weeks with 2-week break. For responders, two courses of chemotherapy of cisplatin 80 mg/m2 (day 1) and 5FU 800 mg/m2/day (days 1–5) q4w were added. The primary endpoint was overall survival and the secondary endpoints were response, toxicity, and progression-free survival. Results: From April 2000 to March 2002, 76 patients were accrued from 12 institutions. Characteristics of all patients were as follows: median age of 61 (range 39–70), male/female; 68/8, PS 0/1; 59/17, stage IIA/IIB/III; 26/12/38. There were two ineligible cases with inadequate liver function and T4 disease. Grade 4 neutropenia, leukopenia, and anemia occurred in 1.3%, 1.3% and 2.6%. Grade 3/4 esophagitis, stomatitis and infection occurred in 17%, 8% and 17%. Grade 3/4 late toxicities occurred in the following incidences; esophagus (dysphagia, mucositis, stenosis, and fistula) in 13%, pericardial effusion in 17%, pleural effusion in 8%, and radiation pneumonitis in 4%. There were 4 treatment related deaths due to late toxicities such as esophageal fistula, radiation pneumonitis, and the other cardiopulmonary diseases. Of eligible 74 patients, there were 50 complete responses (CRs) with a CR rate of 68% (95% Confidence Interval (CI): 56–78%). Median survival time was 31 months and the 2, 3-year survival rates were 55% (95% CI: 43–67%), 47% (95% CI: 36–59%), respectively. Conclusion: CRT for stage II, III ESCC is effective with acceptable acute toxicities, however, careful follow up is necessary for late toxicities.

No significant financial relationships to disclose.

Effect of skin temperature on RMS amplitude of electromyogram and mechanomyogram during voluntary isometric contraction

The aim of this study is mainly to elucidate the relation between the modification of skin temperature and MMG signal properties depending on the contractile force. Ten healthy male volunteers, aged 22.8 +/- 0.7 (mean+/-SE) years, participated in this study. EMG and MMG signals were recorded during voluntary isometric contraction (20, 40, 60, and 80% MVC) of biceps brachii muscle under a skin temperature of 34 degrees C (control), 28 degrees C (cooling), and 40 degrees C (heating), respectively. A significant difference of MVC during elbow flexion was not recognized among the thermal conditions. Root mean square values of EMG and MMG (i.e., rms-EMG and rms-MMG) increased depending on the contractile level (P< 0.01). In the heating condition, the rms-MMG progressively increased in response to an increase of up to 60% MVC, however, it was nearly unchanged at a contractile force higher than 60% MVC The rms-EMG was not significantly influenced by the skin temperature. The rms-MMG significantly increased depending on the skin temperature at each contractile level (P< 0.01). There were significant interactions between contractile force and skin temperature for rms-MMG (P< 0.01). In conclusion, by modification of passive muscle temperature, rms-MMG was significantly altered in comparison with MVC and rms-EMG, which might be reflective of the changes of the mechanical contractile properties of muscle fibers.

Study of p53 gene alteration as a biomarker to evaluate the malignant risk of Lugol-unstained lesion with non-dysplasia in the oesophagus

Mutations of the p53 gene are detected frequently in oesophageal dysplasia and cancer. It is unclear whether Lugol-unstained lesions (LULs) with non-dysplastic epithelium (NDE) are precursors of oesophageal squamous cell carcinoma (ESCC). To study the genetic alterations of NDE in the multistep process of oesophageal carcinogenesis, we determined the relationship between p53 mutations and LULs-NDE. Videoendoscopy with Lugol staining was performed prospectively in 542 oesophageal cancer-free subjects. Lugol-unstained lesions were detected in 103 subjects (19%). A total of 255 samples, including 152 LULs (NDE, 137; dysplasia, 15) and 103 paired samples of normal staining epithelium, were obtained from 103 subjects. After extraction of DNA and polymerase chain reaction analysis, direct sequencing method was applied to detect mutations of the p53 gene. The p53 mutation was detected in five of 137 samples with LULs-NDE (4%) and in five of 15 samples with dysplasia (33%). A hotspot mutation was found in 20% of LULs-NDE with p53 mutation and in 40% of dysplasia with p53 mutation. In contrast, no p53 mutations were found in 103 paired NDE samples with normal Lugol staining. In biopsy samples from oesophageal cancer-free individuals, the p53 missense mutations containing a hotspot mutation were found in NDE, which was identified as an LUL. These findings suggest that some LULs-NDE may represent the earliest state of oesophageal squamous cell carcinoma in Japanese individuals.

Macrolide antibiotics promote the LPS-induced upregulation of prostaglandin E receptor EP2 and thus attenuate macrolide suppression of IL-6 production

We studied the influence of the inhibitory effect of clarithromycin (CAM) and erythromycin (EM) on the production of macrophage inflammatory protein (MIP)-2, interleukin-6 (IL-6), and prostaglandin E(2) (PGE(2)), as well as PGE(2) receptor (EP(2)) expression, by LPS-stimulated RAW264.7 cells. Production of IL-6 was significantly decreased by treatment with CAM or EM in a dose-dependent manner, but the inhibitory effect of CAM was significantly weaker than that of EM. In contrast, the production of MIP-2 and PGE(2) was inhibited to the same extent by CAM and EM. LPS induced the expression of EP(2) mRNA and its expression was promoted further by treatment with CAM or EM. In particular, CAM significantly upregulated EP(2) mRNA expression compared with that after stimulation by LPS alone. After treatment with a nonselective cyclooxygenase (COX) inhibitor (indomethacin), a selective COX-2 inhibitor (NS398), or an EP(2)/EP(4) receptor antagonist (AH6809), the inhibitory effect of CAM and EM on LPS-induced IL-6 production was equalized. These results indicate that macrolide antibiotics upregulate the expression of EP(2), which then attenuates the suppressive effect on IL-6 production of these antibiotics, suggesting that these drugs have a variable anti-inflammatory effect that could influence host defenses.

63 PARTHENOGENETIC DEVELOPMENT OF PORCINE OOCYTES RECONSTRUCTED BY CENTRIFUGATION AND ELECTROFUSION AFTER METAPHASE-II CHROMOSOME TRANSFER

Metaphase-II chromosome transfer (M-II transfer) is considered to be a useful technique for studying nucleus–cytoplasm relationships, or for generating oocytes with good developmental ability after transfer of the nucleus to the cytoplasm. The reconstructed oocytes carry the original genomic information within the metaphase chromosomes from the donor oocytes. The objective of the present study was to evaluate the parthenogenetic developmental ability of porcine M-II transferred oocytes. In vitro maturation was carried out as reported previously (Kikuchi et al. 2002 Biol. Reprod. 66, 1033–1041). After culture for 44 h, cumulus cells were removed by hyaluronidase treatment and gentle pipetting. Oocytes that had extruded the first polar body were selected and centrifuged at 13 000g for 9 min to stratify the cytoplasm. The zonae pellucidae were removed after exposure to pronase, and zona-free oocytes were layered on a 300 �L discontinuous gradient (100 �L each of 45%, 30%, and 7.5%) of Percoll in TCM-HEPES supplemented with 5 �g mL-1 cytochalasin B. After centrifugation of the oocytes on the gradient in microcentrifuge tubes at 6000g for 20 s, fragmented cytoplasm with an equal volume was obtained, stained with Hoechst 33342, and classified as cytoplasm with or without chromosomes by observation with a fluorescence microscope. One fragmented cytoplasm with chromosomes and 2 fragmented cytoplasms without chromosomes were fused by electric stimulation with a single DC pulse (1.5 kV cm-1, 20 �s) and cultured temporarily for 1 h. The reconstructed oocytes were then stimulated again to induce parthenogenetic activation (0.8 kV cm-1, 30 �s, 2 DC pulses) (treatment group). Zona-free mature oocytes that had not been subjected to reconstruction were activated as a control group. The oocytes in both groups were treated with 5 �g mL-1 cytochalasin B for 2 h, and then cultured for 6 days in media (Kikuchi et al. 2002) using the WOW system (Gabor et al. 2000 Mol. Reprod. Dev.). The blastocyst formation rate in the control group (22.9 � 5.5%) was significantly higher (P &lt; 0.05; ANOVA and PLSD-test) than that in the treatment group (7.6 � 1.8%). The total cell number per blastocyst in the control group (28.7 � 4.6) was significantly higher (P &lt; 0.05) than that in the treatment group (16.7 � 1.0). These results suggest that reconstructed porcine oocytes following M-II transfer by centrifugation and electrofusion can develop to the blastocyst stage in vitro. This technique enables transfer of the nucleus to cytoplasm with good developmental ability without the use of a micro-manipulation system.

O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) uptake in mouse thymoma cells, and its biodistribution in mice and human volunteers

PURPOSE

To evaluate O-(2-[18F]fluoroethyl)-l-tyrosine (18F-FET) uptake in mouse malignant thymoma (EL4), and its biodistribution in mice and humans.

MATERIAL AND METHODS

First, 18F-FET uptake in EL4 cells was examined in an in vitro study. Second, the kinetics of 18F-FET uptake and its biodistribution were examined in mice after subcutaneous injection of EL4 cells and complete Freund's adjuvant. Finally, the kinetics of 18F-FET uptake and its biodistribution in healthy human volunteers were examined.

RESULTS

In an in vitro study, 18F-FET was extensively incorporated in EL4 cells. In an animal study, 18F-FET accumulation in normal organs peaked within 30 min postinjection. The mean ratios of 18F-FET uptake in tumors and in inflammatory lesions to that in muscle tissue at 60 min postadministration were 2.18 (range 2.00-2.29) and 1.04 (range 0.95-1.14), respectively. In a human study, static images were taken 60 min after 18F-FET administration. Mean standardized uptake values (SUVs) of the liver (1.52, range 1.38-1.71) and kidneys (1.90, range 1.74-2.24) were nearly equal or slightly higher than that of muscle tissue (1.19, range 0.99-1.33).

CONCLUSION

This study demonstrates that 18F-FET accumulation in thymoma is significantly higher than in normal organs. 18F-FET could be a useful tracer for tumor imaging.

Independent risk factors for chronic cyclosporine induced nephropathy in children with nephrotic syndrome

BACKGROUND

Cyclosporine A (CsA) has been widely used in children with steroid dependent and steroid resistant nephrotic syndrome (NS) because of its efficacy in relieving these patients from systemic side effects of steroids. However, its long term use is controversial, since chronic CsA induced nephropathy (CsAN) may develop in a considerable number of patients.

AIMS AND METHODS

In order to clarify the risk factors for the development of CsAN, the clinical characteristics of children with steroid dependent or steroid resistant NS taking CsA (target blood trough levels 50-150 ng/ml) for more than six months, managed at a single centre, were retrospectively analysed.

RESULTS

Thirteen of 30 children (24 boys and 6 girls) taking CsA (mean duration 43 months, range 6-144) had CsAN defined as the presence of CsA associated arteriopathy with or without striped tubulointerstitial lesions. The multivariate analysis revealed that CsA treatment for more than 36 months and an age younger than 5 years at the start of CsA treatment were independent risk factors for the development of CsAN. The univariate analysis also showed that patients with CsAN had more frequent relapses during CsA treatment than those without CsAN.

CONCLUSION

An alternative treatment should be seriously considered after a 36 month administration of CsA in order to prevent CsAN. Data also suggest that CsA treatment in children younger than 5 years should be avoided if possible.

Probing the coulomb interaction of the unconventional superconductor by phonon spectroscopy

The phonon dispersion curves of the superconductor PuCoGa(5) were studied by inelastic x-ray scattering at room temperature. The experimental data agree well with ab initio lattice dynamics calculations. An accurate description of the phonon spectrum is obtained only when a local Coulomb repulsion U approximately equal 3 eV among 5f electrons is taken into account.

Iron overload and antioxidative role of perivascular astrocytes in aceruloplasminemia

Aceruloplasminemia (ACP) is an inherited disorder of iron metabolism caused by the lack of ceruloplasmin activity; the neuropathological hallmarks are excessive iron deposition, neuronal loss, bizarrely deformed astrocytes, and numerous 'grumose or foamy spheroid bodies (GFSBs)'. We histopathologically examined two autopsied ACP brains, and observed for the first time that GFSBs form in clusters at the ends of perivascular astrocytic foot processes. Both the deformed astrocytes and the GFSBs contained ferric iron and were intensely immunolabelled with antibodies against the antioxidant proteins ferritin and manganese superoxide dismutase (Mn SOD). Ceruloplasmin is largely produced by perivascular astrocytes in the central nervous system and exhibits a ferroxidase activity that inhibits iron-associated lipid peroxidation and hydroxyl radical formation; therefore, the lack of ceruloplasmin causes direct oxidative stress on astrocytes. The intense immunolabelling of ferritin and Mn SOD most likely reflects a defensive response to iron-mediated oxidative stress. This study suggests that astrocytes play key roles in iron trafficking and the detoxification of iron-mediated free radicals at the blood-brain barrier and in the parenchyma in ACP brain. The antioxidative ability of astrocytes is one of their essential neuroprotective effects, and the decompensation of this ability may lead to secondary neuronal cell death in ACP.