Clinicopathologic and protein expression differences between cardia carcinoma and noncardia carcinoma of the stomach

BACKGROUND

Although the incidence of adenocarcinoma of the stomach has decreased over the past several decades, gastric cardia carcinoma has increased over the same period.

METHODS

The clinicopathologic characteristics and immunohistochemical staining results of 21 proteins were investigated in 165 patients with cardia carcinoma, including 74 patients with true cardia carcinoma and 91 patients with subcardia carcinoma, and the results were compared with the results from 564 patients with noncardia carcinoma.

RESULTS

In the clinicopathologic analysis, patients who had cardia carcinoma tended to have tumors with poorly differentiated histology according to the World Health Organization classification system (P = 0.012), diffuse type according to the Lauren classification system (P = 0.049), and advanced pathologic TNM stage (P < 0.001). On immunohistochemical staining, loss of the p16 (P = 0.038) and smad4 (P < 0.001) tumor suppressor genes was more frequent in cardia carcinoma than in noncardia carcinoma. Carcinoembryonic antigen and CD44 overexpression were more frequent in patients with cardia carcinoma (P < 0.05). Conversely, patients who had cardia carcinoma exhibited less frequent expression of MUC1 (P = 0.008) and MUC5AC (P = 0.006) compared with patients who had noncardia carcinoma. Epstein-Barr virus infection was more common in patients with cardia carcinoma (P < 0.001). In the survival analysis, the patients with cardia carcinoma had a poorer prognosis. In the multivariate analysis, tumor location in the cardia was confirmed as an independent, poor prognostic factor in patients with gastric carcinoma.

CONCLUSION

Cardia carcinoma and noncardia carcinoma differed in their clinicopathologic characteristics and in their alterations of gene expression, as evaluated by immunohistochemistry. The current results support the hypothesis that cardia carcinoma forms a specific category of gastric carcinoma that is distinct from noncardia carcinoma.

Expression of family A melanoma antigen in human gastric carcinoma

BACKGROUND

Since the members of the MAGE (melanoma antigen) gene family have been reported to be expressed in tumor cells but not in normal tissues, they have been considered as targets for tumor-specific immunotherapy.

MATERIALS AND METHODS

The expression pattern of MAGE-A genes and their expression mechanisms were investigated in 10 gastric cancer cell lines and 1,097 gastric carcinoma specimens by RT-PCR, IHC, Western blot and MSP.

RESULTS

MAGE-A1, -A2 and -A3 gene transcripts were detected in 1, 3 and 4 of 10 gastric cancer cell lines, respectively. In those cases in which the mRNA expression of MAGE-A2 or -A3 was detected, the promoters of the corresponding genes were hypomethylated. MAGE-A protein expression was detected in 30% (3/10) of the cell lines and 15.8% (173 out of 1,097) of the carcinoma specimens. Promoter hypomethylation of the MAGE-A2 or -A3 genes correlated with their expression in primary gastric cancer tissue and gastric cancer cell lines. MAGE-A protein expression was associated with tumor invasiveness (p=0.002), lymph node metastasis (p<0.001), advanced pathologic stage (p<0.001) and a worse prognosis (p<0.005).

CONCLUSION

MAGE-A protein expression occurred due to promoter hypomethylation in a minor subset of gastric cancers, and MAGE-A expression increased during the progression of the gastric cancer.

Prognostic significance of CD24 expression in gastric carcinoma

PURPOSE

The human CD24 antigen is a small heavily glycosylated cell surface protein, which is expressed in hematological malignancies, as well as in a large variety of solid tumors. Its expression is now known to be related to the prognosis of several kinds of tumors. This study is designed to examine the prognostic significance of CD24 in Korean gastric cancer patients.

MATERIALS AND METHODS

In the present study, we examined CD24 expression in 300 consecutive cases of gastric carcinoma by immunohistochemical staining using the tissue-array method. We also investigated the clinicopathological profiles related to CD24 expression.

RESULTS

One hundred and three cases out of 300 (34.3%) showed the positive expression of CD24. The altered expression of CD24 was significantly associated with differentiated cancer (p=0.003), the intestinal subtype according to the Lauren classification (p<0.001), the advanced stage cancer (p=0.027), with lymphatic invasion (p=0.038) and with vascular invasion (p=0.006). The survival analysis revealed that the patients with CD24 positive expression showed significantly poorer survival than those without CD24 expression. Moreover, a combined evaluation revealed that PTEN+/CD24- cases showed the best survival compared to other groups (p=0.01).

CONCLUSION

Positive CD24 expression occurs in a subset of gastric carcinomas and it correlates significantly with lymphatic invasion, blood vessel invasion and poor survival.

Right heart dysfunction in post-tuberculosis emphysema

SETTING

University-affiliated general hospital.

OBJECTIVE

To evaluate the pump performance of right heart before and after exercise in post-tuberculosis emphysema.

DESIGN

In patients with post-tuberculosis or primary emphysema (similar lung volumes), body plethysmography, arterial blood gas analysis and echocardiography were performed at rest and after exercise. Right heart pump performance was evaluated with the ejection fraction.

RESULTS

At rest, in post-tuberculosis emphysema, diffusing capacity (mean +/- SE 72.7 +/- 3.9 vs. 91.0 +/- 7.1% of reference) and right ventricular ejection fraction (57.5 + 1.4 vs. 61.3 +/- 1.2%) were lower and PaCO2 (42.7 +/- 1.1 vs. 38.6 +/- 0.7 mmHg) was higher, while lung compliance, airway resistance, PaO2, and alveolar-arterial oxygen difference were not different. After exercise, PaO2 (65.6 +/- 2.8 vs. 80.5 +/- 3.5 mmHg) and right ventricular ejection fraction (51.2 +/- 2.4 vs. 59.6 +/- 1.7%) were lower and PaCO2 (47.0 +/- 1.5 vs. 40.9 +/- 1.5 mmHg) was higher in post-tuberculosis emphysema, whereas alveolar-arterial oxygen difference was not different. PaCO2 and alveolar-arterial oxygen difference increased, and PaO2 and right ventricular ejection fraction decreased in post-tuberculosis emphysema, while they did not significantly change in primary emphysema.

CONCLUSION

In post-tuberculosis emphysema, the impairment of gas exchange was more serious. Global assessment should be focused on right heart dysfunction which might be more affected than in primary emphysema.

Cytokeratin expression profile in gastric carcinomas

Cytokeratin (CK) is observed mainly in epithelial cells, and the diverse expression pattern of CK subtypes may be helpful in discriminating between primary and metastatic carcinomas in various organs, including the stomach. To clarify the CK expression profiles in gastric carcinomas, 329 consecutive specimens were immunohistochemically evaluated in terms of their CK subtypes using the tissue array method. The overall positive rates were 84.7% for CK4, 3.2% for CK5, 28.7% for CK6, 71.1% for CK7, 96.6% for CK8, 0% for CK10, 81.6% for CK13, 0.3% for CK14, 4.1% for CK16, 0% for CK17, 99.4% for CK18, 89.7% for CK19, and 30.0% for CK20. Well-differentiated or moderately differentiated carcinomas were related to several CKs, and mucinous carcinoma was associated with CK20 expression. Interestingly, CK7 and CK20 expression was associated with the mucin phenotype of gastric carcinoma, but this association had no diagnostic value. Epstein-Barr virus (EBV)-associated gastric carcinomas showed a tendency toward negative expression of CK7. CK6 expression was related to microsatellite instability (MSI), early pTNM stage, and better clinical outcome. In conclusion, CK expression profiles in consecutive gastric carcinomas demonstrate heterogeneity, and no single CK has diagnostic value by itself. CK expression is associated with various clinicopathologic parameters, mucin phenotype, EBV positivity, MSI status, and patient survival.

Knowledge and performance of the universal precautions by nursing and medical students in Korea

BACKGROUND

Like the health care workers, nursing and medical students have to go through clinical practices; accordingly, they run a high risk of being exposed to bloodborne diseases. But there are few studies on the realities of preventive education or measures to be taken after exposure to such diseases. The purpose of this study was to identify a knowledge of universal precautions and their performance in practice among the nursing and medical students in Korea.

METHOD

This study was based on survey questionnaires with a total of 714 nursing and medical students for the period between November 2, 1998, and April 30, 2000.

RESULTS

The average knowledge level of the universal precautions was 267.8 +/- 21.3 (scores ranged from 150 to 300). The knowledge level of the universal precautions of the nursing students (270.4 +/- 19.4) was higher than that of the medical students (261.0 +/- 24.4; P =.000). The average performance level of the universal precautions was 52.7 +/- 6.2 (scores ranged from 14 to 70). The students of the nursing college showed a higher performance level of the universal precautions (53.2 +/- 5.9; P =.002). The correlation between knowledge and performance of the universal precautions showed a weak and positive correlation (r =.317; P=.000).

CONCLUSION

The study demonstrated that the knowledge level of the nursing students about universal precautions was relatively higher than that of medical students. The group that receives education about universal precautions has a higher level of knowledge and performance of the universal precautions than that group that receives no such education. The education about universal precautions is indispensable; it is desirable to raise the relative importance for the curriculum of both nursing and medical colleges.

The advantages of On-line transesophageal echocardiography guide during percutaneous balloon mitral valvuloplasty

The purpose of this study was to evaluate the potential advantages of on-line transesophageal echocardiography during percutaneous balloon mitral valvuloplasty (PBMV). One hundred thirty-four consecutive patients who underwent PBMV were included in this study. Group 1 included 64 patients who underwent PBMV under fluoroscopy guide only, and group 2 included 70 patients who underwent PBMV under on-line transesophageal echocardiography guide. Inoue balloons were used in all cases. The mitral valve area after valvuloplasty was comparable between the 2 groups. The procedure time was significantly shorter in group 2 (99 +/- 48 min vs 64 +/- 22 min, P <.0001 ), and the average fluoroscopy time was shorter in group 2 without statistical significance (30 +/- 17 min vs 19 +/- 15 min, P =.25 ). Five (7.8%) patients in group 1 and 2 (2.8%) patients in group 2 underwent surgery because of procedure-related complications. The limitation of this study was the learning curve of the operator, because the 2 groups were treated serially. In conclusion, transesophageal echocardiography can be used effectively during balloon mitral valvuloplasty, and it may help to reduce the rate of complications resulting from trans-septal catheterization and balloon valvuloplasty and to reduce procedure time and fluoroscopy time.

Metabotropic glutamate receptor mGluR2/3 immunoreactivity in the mouse superior colliculus: co-localization with calbindin D28K

We have studied the distribution of mGluR2/3 in the mouse superior colliculus (SC) with antibody immunocytochemistry and the effect of enucleation on this distribution. We also compared this labeling to that for calbindin D28K. Anti-mGluR2/3-immunoreactive (IR) cells formed distinctive laminar patterns within the lower optic and upper intermediate gray layers. By contrast, anti-calbindin D28K-IR cells formed obvious laminar patterns in three layers: one within the zonal and upper superficial gray layers, a second within the optic and intermediate gray layers, and the third within the deep gray layer. The distribution of mGluR2/3-IR cells thus matches the second layer of calbindin D28K cells. Two-color immunofluorescence revealed that more than half (52.5%) of mGluR2/3-IR cells were also labeled with antibody to calbindin D28K. The majority of mGluR2/3-IR cells were small to medium-sized round/oval or stellate cells. Immunoreactivity for mGluR2/3 was clearly reduced in the contralateral SC following unilateral enucleation. The present results show that mGluR2/3 has a unique cellular sublaminar organization in SC that includes some calbindin D28K-IR cells. The effects of enucleation suggest that the retinal projection may control the expression of mGluR2/3 in some cells in the mouse SC.

Equilibrium and non-equilibrium partition of tritium between organics and tissue water of different biological systems

The biological tritium fractionation factor, accompanying the equilibrium partition of tritium between the organic and the aqueous phases of the biosystem through isotope effects on the enzyme reactions of its metabolism, has been determined. The ratio (R) of the specific activities of organically bound tritium and tissue water tritium has been measured under special conditions to eliminate analytical as well as biological interfering effects that possibly alter the experimental R value. Two plant categories with distinct photosynthetic CO2-fixation pathways, adapted to their different water use efficiency, namely barley (C3 plant) and maize (C4 plant), have been compared in order to estimate the natural variation of the biological tritium fractionation factors among different biosystems.

Cardiac amyloidosis diagnosed by endomyocardial biopsy

A 56-year-old male patient who had a history of syncopal attack was diagnosed as having cardiac amyloidosis. His ECG finding showed a pattern of inferior and anteroseptal wall infarction with Wenckebach AV block.

Echocardiographic examination revealed that the LV posterior wall and interventricular septum were markedly thickened with granular sparkling.

We demonstrated the amyloid deposit in the myocardium by endomyocardial biopsy.

Pathology showed a green white birefringence by polarizing illumination and amyloid fibril in electron microscopic study.

Lymphocyte proliferation and nucleoid sedimentation in a case of premature aging distinct from Werner's syndrome

Lymphocyte proliferation and nucleoid sedimentation were studied in a patient with premature aging resembling the Werner's syndrome (WS). Onset of patchy brown hyperpigmentations at the age of 9 months permitted distinction from classical WS and suggested a WS-like premature aging disease. By photometric recording of density changes during cell culture, we examined the course of cell proliferation after PHA stimulation over 7 days and compared these results to those obtained in two normal controls. Cultured cells of the patient displayed an aberrant proliferation pattern characterized by continuous growth without an initial reduction phase. The markedly reduced proliferative capacity of purified cells from the patient could in part be corrected by fetal bovine serum. The cells of the patient displayed a characteristic nucleoid sedimentation profile after ultraviolet irradiation indicating retarded DNA replication, which may be a common feature of various premature aging diseases. The absence of thermolability of cell proliferation and the presence of a high number of chromatid aberrations disclosed differences from classical WS.

The reduction of allyl alcohols by Clostridium species is catalyzed by the combined action of alcohol dehydrogenase and enoate reductase

Cells, as well as crude extracts of Clostridium kluyveri or Clostridium spec. La 1, catalyze the hydrogenation of (E)- or (Z)-2-butenol to n-butanol. No single enzyme could be detected which directly accomplishes this reaction. It turned out that the reduction occurs as follows: 2-butenol leads to 2-butenal leads to n-butanal leads to n-butanol. The first step is catalyzed by the NAD-dependent alcohol dehydrogenase in C. kluyveri, the second by the recently detected enoate reductase which reduces not only nonactivated alpha, beta-unsaturated acylates but also alpha, beta-unsaturated aldehydes in a NADH-dependent reaction and the third step is again catalyzed by alcohol dehydrogenase. In Clostridium La 1 the alcohol dehydrogenase is NADP-dependent. The rate of the reduction of 2-butenol to n-butanol depends not only on the enzymes, but also on the ratio NAD(P)/NAD(P)H. In the presence of methylviologen cation radical which is formed by the reduction of methylviologen by the system H2/hydrogenase, the ratio NAD(P)/NAD(P)H is too small for the dehydrogenation of 2-butenol to 2-butenal. This explains the antagonistic effect of methylviologen in the hydrogenation of allyl alcohols and 2-enoates by both Clostridium species. Furthermore, the mechanism explains the finding that from a preparative point of view ethanol is a better electron donor than hydrogen for the stereospecific reduction of allyl alcohols.

[DNA repair in xeroderma pigmentosum]

DNA-repair of two patients affected with xeroderma pigmentosum was evaluated in lymphocytes after UV-exposure by mitotic index, sister chromatid exchange (SCE) and nucleoid sedimentation. The first patient showed no increase in SCE-rate and a sedimentation profile typical of repair deficient cells. In the second patient an increase in SCE-rate and a considerable, but delayed DNA-repair activity in nucleoid sedimentation was found indicating 2 genetically different defects of DNA-repair. In the second patient a defect of postreplication repair is assumed.

Demonstration of heterogeneity in xeroderma pigmentosum

Two cases of xeroderma pigmentosum were studied at the cytogenetic and molecular level. DNA repair impairment was revealed in case 1 by a nucleoid sedimentation technique whereas a half diminished rate of DNA repair could be demonstrated in case 2. This may be a further case of a xeroderma pigmentosum variant.

[The influence of highly purified hCG on the immunocompetence of human lymphocytes and DNA repair system]

PHA-stimulation of human T-lymphocytes, a parameter of cellular immunocompetence, can be suppressed by highly purified human chorionic gonadotropin (hCG) in a dose-dependent manner. This was shown spectrophotometrically and by the mitosis index. Our results are in agreement with H3-thymidine incorporation studies. We further investigated the DNA repair system in UV-light- and hCG-explsed lymphocytes. It could be shown that DNA repair-replication is disturbed by hCG. Such repair disturbances may cause reduced H3-thymidine incorporation in PHA-stimulated and hCG-treated lymphocytes. It is probably on this molecular level that hCG influences the immunocompetence of human lymphocytes.

[Reciprocal translocation t (5p--;19p+) in three generations (author's transl)]

A reciprocal translocation t (5p-;19p+) in 3 generations is reported. Three carriers with this translocation were healthy, the propositus with the same translocation showed cheilopalatochisis bilaterally, microphthalmus, coloboma of the retina and dysplasia of the hip joints. The cytogenetically unremarkable father of the propositus exhibited micropthalmus and coloboma of the disc and a bifid uvula. It was supposed that there is no correlation between caryotype and phenotype in the propositus. His abnormalities might be induced genetically by the father. The risk data for the descendants of carriers with balanced translocations are discussed.

Late replicating bands of human chromosomes demonstrated by fluorochrome and Giemsa staining

The addition of thymidine (TdR) to cells growing in a medium containing 5-bromodeoxyuridine (BUdR) at the end of the first replication cycle results in the incorporation of TdR into the late replicating DNA regions. These sites can be visualized by staining the metaphase chromosomes with the fluorescent dye "33258 Hoechst" or a "33258 Hoechst" Giemsa procedure. A sequence of late replication patterns has been established in metaphase chromosomes of cultured human peripheral lymphocytes. The patterns are in agreement with those obtained by the standard autoradiographic procedures, but are more accurate. As is known from autoradiography, late replicating bands are in the position of G or Q bands. The "33258 Hoechst" Giemsa staining procedure of chromosomes which have replicated in the presence of BUdR first and in TdR for the last 2 hrs of the S phase is preferable to the currently used Giemsa banding techniques: the method yields very well banded metaphases in all preparations examined, as the chromosome structure is not disrupted by the pretreatment. The bands are very distinct, even in the "difficult" chromosomes (e.g. No. 4, 5, 8 and X). In female cells the late replicating X chromosome can be identified by its size and staining pattern. In addition to the replication asynchrony, the sequence of replication within both X chromosomes in female cells is not absolutely identical. The phenomenon of a phase difference in replication between the homologues is not a peculiarity of the X chromosome, but can be found in all autosomes as well as in homologous positions on the chromatids of individual chromosomes.

Fluorometrical detection of thymine base differences in complementary strands of satellite DNA in human metaphase chromosomes

Using the fluorochrome "Hoechst 33258", intensity of fluorescence was found to differ distinctly between the sister chromatids in the paracentric regions of chromosomes 1, 16, and 19, after one round of replication in medium containing BUdR. Thus the effect of fluorescence asymmetry is not limited to the part of the Y chromosomes that fluoresces intensely with quinacrine; it can also be determined in the weakly Q-fluorescent pericentric regions of chromosomes, which are known to be the sites where highly reiterated sequences of satellite DNA are located. However, an exception is the paracentric region of chromosome 9 which does not show the effect of lateral asymmetry. The difference of fluorescence intensity in the heterochromatic regions of the sister chromatids of human chromosome 1 is measured by densitometric tracement along the long axes of chromosomes; this is obtained from two individuals with an "uncoiler" heterchomatic block (type III) having a relative intensity of 1:1.93 in an average of the total measured blocks. This corresponds to the uneven distribution of thymine base of 22.8 and 43.2 in the two strands of the DNA double hexlix. A chromatid exchange rate of 9 in 100 metaphases per cell cycle was found within the uncoiler region of chromosome 1.

Giemsa staining of the sites replicating DNA early in human lymphocyte chromosomes

A timetable for the initiation of DNA replication in human lymphocyte chromosomes has been established by a technique which allows detection of areas of chromosomes replicating at a given interval of the S-phase. The resolution of the method, using 33258 Hoechst-Giemsa staining, is more refined than that obtained with 3H-thymidine autoradiography. Early replicating regions coincide with R-bands. The timetable is rather coarse since replication may start asynchronously in the same region of homologous autosomes of the same metaphase and since even the sequence of bands appearing on individual chromosomes sometimes deviates from the rule.

Correlation of light and electron micrographs of human metaphase chromosomes after incorporation of BUdR and staining with "33258 Hoechst" and Giemsa

Stained (Giemsa, "33258 Hoechst"1) and "33258 Hoechst" + Giemsa) and unstained metaphase chromosomes from human peripheral lymphocytes, after two rounds of replication in the presence of 5-bromodeoxyuridine (BUdR), have been prepared for electron microscopy. There is a positive correlation between light and electron micrographs. The same differential contrast on electron micrographs has been obtained whether the preparations have been stained or not. We attribute this differential contrast primarily to the lesser condensation of the bifilarly substituted chromatid.