Prednisolone inhibits hyperosmolarity-induced expression of MCP-1 via NF-κB in peritoneal mesothelial cells

The mechanism of peritoneal fibrosis in patients on continuous ambulatory peritoneal dialysis (CAPD) is poorly elucidated. We investigated the cellular mechanism of high-glucose-induced expression of monocyte chemoattractant protein-1 (MCP-1), which is important in recruiting monocytes into the peritoneum and progression of peritoneal fibrosis, and examined the inhibitory mechanism of glucocorticoids. Rat peritoneal mesothelial cells were cultured in high-glucose-containing medium and then analyzed for phosphorylation levels of p42/44 and p38 mitogen-activated protein (MAP) kinases (MAPK), MAPK or extracellular signal-regulated kinase kinase (MEK)1/2, c-Jun N-terminal kinase (JNK)1/2, and protein kinase C (PKC) by Western blotting. Expression of MCP-1 was examined by reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. DNA-binding activity of nuclear factor (NF)-kappaB was measured by electrophoretic mobility shift assay. High glucose increased MCP-1 mRNA and MCP-1 protein expression. Although glucose increased phosphorylation of MEK1/2, p42/44 MAPK, p38 MAPK, JNK1/2, and PKC, and DNA-binding activity of NF-kappaB, its effect on MCP-1 expression was suppressed only by PKC and NF-kappaB inhibitors. Mannitol caused a similar increase in PKC and NF-kappaB activation and MCP-1 synthesis. Prednisolone increased I-kappaB-alpha expression and inhibited glucose/mannitol-induced NF-kappaB DNA binding and MCP-1 expression without affecting PKC phosphorylation. The inhibitory effects of prednisolone on MCP-1 expression were reversed by mifepristone, a glucocorticoid receptor antagonist. Our results indicate that glucose induces MCP-1 mainly through hyperosmolarity by activating PKC and its downstream NF-kappaB, and that such effect was inhibited by prednisolone, suggesting the efficacy of prednisolone in preventing peritoneal fibrosis in patients on CAPD.

Acid sphingomyelinase deficiency: cardiac dysfunction and characteristic findings of the coronary arteries

Two sisters with type B Niemann-Pick disease (genotype: S436R/S436R) showed cardiac dysfunctions, not secondary to pulmonary disease, at the beginning of the third decade. In the younger sister, myocardial dysfunction was refractory to treatment, resulting in death. At autopsy, the distal branches of the coronary arteries showed narrowing of the arterial lumina due to swelling of the medial and intimal smooth-muscle cells. This is the first report describing characteristic findings of coronary arteries in type B Niemann-Pick disease.

Effects of acute preload reduction on myocardial velocity during isovolumic contraction and myocardial acceleration in pediatric patients

We evaluated the effects of acute preload reduction with inferior vena cava (IVC) occlusion on myocardial velocities during systole (Sa), early (Ea) and late (Aa) diastole, isovolumic contraction (IVV), and myocardial acceleration (IVA) measured by tissue Doppler imaging (TDI) in pediatric patients. A total of 22 patients (5 +/- 3 years) were studied: 9 patients (4 +/- 3 years) with Kawasaki disease, 8 patients (6 +/- 3 years) with atrial septal defect and right ventricular (RV) volume overload, and 5 patients (5 +/- 4 years) with pulmonary stenosis and RV pressure overload. Using TDI, Sa, Ea, Aa, IVV were recorded at the base of the RV free wall from a four-chamber view. IVA was calculated by dividing IVV by the time interval from onset of IVV to the time at peak velocity of this wave. In each group, IVC occlusion caused significant decreases in peak Sa, peak Ea, and peak Aa (p < 0.05). However, IVV and IVA did not change during acute preload reduction. This study demonstrated the effects of acute preload reduction on TDI velocities. In contrast to peak Sa, peak Ea, and peak Aa, IVV and IVA were unaffected by preload within a physiological range.

Effects of zinc and copper on adhesion and hemagglutination of Prevotella intermedia and Prevotella nigrescens

This study investigated the mechanism of protein attachment to the surface of the putative periodontal pathogens Prevotella intermedia and Prevotella nigrescens in artificial gingival crevicular fluid, and ways to increase protein attachment to the bacterial cells. The effects of cations on protein attachment, bacterial adhesion, and hemagglutination were examined, and cation-binding components on both bacterial species were identified. The presence of cations, especially zinc, copper and cerium, increased attachment of human serum proteins to both bacterial species. In contrast, the presence of hydrophobic inhibitors or sugars had little effect. Protein attachment was reduced by heat treatment of the bacterial cells. Pretreatment of bacteria with human serum proteins inhibited adhesion of both species to buccal epithelial cells and hemagglutination. These effects were enhanced by the presence of zinc and copper during pretreatment. Using a chelating column, specific zinc- and copper-binding proteins were identified on the surfaces of both bacterial species.

Collapse of coherent quasiparticle states in theta-(BEDT-TTF)2I3 observed by optical spectroscopy

Optical conductivity measurements on the organic metal theta-(BEDT-TTF)2I3 revealed that the system crosses over rapidly from a coherent quasiparticle state to an incoherent state with temperature. Despite the metallic temperature dependence of resistivity, a well-defined Drude peak at low temperatures turns into a far-infrared peak with temperature. The peak energy shifts to higher frequencies and, simultaneously, the spectral weight is transferred to high frequencies beyond the electron band width. These characteristics imply that theta-(BEDT-TTF)2I3, so far believed to be a typical metal, is in fact a strongly correlated electron system with "bad-metal" character.

[Surgical results of non-small cell lung cancer invading parietal pleura and chest wall]

This retrospective analysis was undertaken to review our results of treatment of lung cancers with invasion of non-apical and non-vertebral chest wall structures. In summary of our experience, although relatively good prognosis can be expected in N0M0 patients with the histological type of adenocarcinoma by initial operation, distant relapse remains a major problem of the disease. Furthermore, our results are in agreement with the idea that postoperative adjuvant therapy is of little value in patients with complete resection. To ameliorate surgical outcomes, induction treatment should be considered and preoperative staging assessment needs to be strictly done for proper selection of patients with this locally advanced disease. The indication of initial operation needs to be cautiously determined for patients with this disease.

[Completion pneumonectomy after 4 times of resections for metastatic lung tumors from rectal carcinoma]

We report a case of completion pneumonectomy after 4 times of metastasectomy for metastatic lung tumors from rectal carcinoma. A 63-year-old man underwent Miles' operation for advanced rectal carcinoma. Forty-seven months after the operation, bilateral metastasis was appeared, and bilateral metastasectomy was performed. After the resection, 3 times of metastasectomy were performed during 40 months. Follow-up X-ray and computed tomography (CT) showed abnormal shadow in his left hilum of lung. Completion pneumonectomy with mediastinal lymph node sampling was performed. He is still alive without recurrence 4 years after first thoracotomy. Repeated pulmonary resection can lead to good outcome for selective patients with metastatic colorectal carcinoma, and repeated surgery can be useful for pulmonary recurrences after thoracotomy.

[Perioperative targeting brachytherapy for lung cancer invading the chest wall]

We evaluated the efficacy of perioperative targeting brachytherapy for lung cancer invading the chest wall. Between 1998 and 2003, 7 patients underwent perioperative targeting brachytherapy for lung cancer invading the chest wall. There were 5 male and 2 female patients. The mean age was 63.3 years, with a range of 45 to 77 years. All patients underwent complete resection including the chest wall combined resection. During the operation, plastic afterloading catheters fixed on the Vicryl mesh at interval of 1 cm were placed on the site of chest wall resection. From the third to sixth day after the operation, 15 to 32 Gy of radiation was delivered over 3 or 4 days using a high dose rate remote afterloading system. The area targeted for brachytherapy was determined by a computed tomography (CT) scanner translator with a computer program for radiation planning. The median postoperative hospital stay was 35 days. Local recurrences were observed in 2 patients, but there was no evidence of recurrence in the margin of the resected chest wall. We believe that this short period of treatment and the low side effects enhances the quality of the patients. Prevention of local recurrence was achieved in short term follow-up.

Posterior descending coronary artery flow reserve assessment by Doppler echocardiography in children with and without congenital heart defect: comparison with invasive technique

To evaluate whether transthoracic Doppler echocardiography can reliably measure coronary flow velocity and coronary flow velocity reserve (CFVR) in the posterior descending coronary artery (PD) in children, we examined 32 patients who had congenital heart disease (ventricular septal defect in 10, tetralogy of Fallot in 6, tricuspid atresia in 3, double-outlet right ventricle in 2, patent ductus arteriosus in 2, and aortic valve stenosis in 2) and 7 patients who had a history of Kawasaki disease without stenosis or aneurysm formation of the coronary artery. Average peak flow velocity (APV) in the PD was measured by transthoracic Doppler echocardiography at the time of intracoronary Doppler study. CFVR was defined as the ratio of hyperemic to basal APV. Clear envelopes of basal and hyperemic APV in the PD were obtained in 23 of 32 patients by transthoracic Doppler echocardiography. APV obtained from transthoracic Doppler echocardiography correlated highly with that from the Doppler guidewire method (r=0.91). The mean difference between transthoracic Doppler echocardiography and the Doppler guidewire method was 0.1+/-2.9. There was an excellent correlation between transthoracic Doppler echocardiography and the Doppler guidewire method for the measurements of CFVR (r=0.84). The mean difference between transthoracic Doppler echocardiography and Doppler guidewire was -0.016+/-0.198. Noninvasive measurement of coronary flow velocity and CFVR in the PD using transthoracic Doppler echocardiography accurately reflects invasive measurement of coronary flow velocity and CFVR by the Doppler guidewire method in pediatric patients with various heart diseases.

The results of therapy for bilateral multiple primary lung cancers: 30 years experience in a single centre

AIMS

This study reviews our 30 years experience in the clinical assessment and surgical management of bilateral multiple primary lung cancer (BMPLC).

METHODS

Between January 1973 and December 2001, 1906 patients with primary lung cancer underwent surgical resection in Kanazawa University Hospital. Thirty-seven patients (1.9%) who had developed a BMPLC using the criteria of Martini and Antakli.

RESULTS

Eighteen patients had synchronous lesions, and 18 patients had metachronous lesions. One patient had synchronous and metachronous lesions. Overall 10-year survival was 56%. The actuarial 5-year survival for bilateral synchronous cancers was 69%, median survival (MST) 90 months (range 8-153 months), and 10-year survival was 47%. The actuarial 5-year survival for second metachronous cancers was 51%, with an MST of 114 months (range 6-192 months).

CONCLUSION

Aggressive surgical therapy is effective in patients with a bilateral MPLC if they satisfy the usual criteria of operability. The surgical methods that preserve healthy lung tissue such as sleeve resection and limited resection must be selected in compliance with cancer characters.

[Changing radiological results, pitfalls and criteria of failure]

RATIONALE

To evaluate the morphological changes occurring during the Years following radiosurgery in order to better define the cure-failure parameters.

MATERIAL AND METHODS

Between July 1992 and January 2002 the otoneurosurgical group of the Timone Hospital in Marseille have operated 1000 vestibular schwannomas. The MR imaging performed before (at diagnosis) during and after radiosurgery (6 months, 1 year, 2 years, 3 years, 5 years, 7 years and 10 years) was carefully studied. Systematically six lenghts measurements were obtained for each lesion.

RESULTS

Preoperatively 129 patients were had progressive tumors. At time of radiosurgery, median tumor Volume was 732mm3 (mean: 1346, range: 20-14405). According to the Koos topographical classification, lesions were stage I in 80 patients, stage II in 538 patients, stage III in 322 patients and stage IV in 56 patients. A clear loss of the central enhancement was visible on the postoperative MR control at 6 months and/or 1 Year in 45.5% of patients. In 64% of these patients, this loss of the central contrast enhancement have disappeared. A significant increase of the tumor size was recorded in 15% of the patients. The median increase was 62% (mean: 78%, range: 30-350%). Progression led to salvage surgery (either resection or radiosurgery), in only 3% of the patients.

CONCLUSION

The specificity of the morphological changes after radiosurgery, when ignored, can lead to misinterpretation and eventually to inappropriate decisions, dangerous for the patient. The analysis of our results had led us to consider continuous progression after 3 Years as mandatory to retain the diagnosis of failure.

[Radiology of radiosurgery]

Proper understanding of the fundamentals of radiosurgery and the main principles of radiobiology is a key point for the development and adaptation of therapeutic strategies and for the definition of indications. The prediction of local effects of radiosurgery requires taking into account both the target Volume and the marginal dose (energy,...) and not only the marginal dose which alone is poorly predictive of the outcome. Other additional factors such as topography, age, previous irradiations,... are likely to influence this risk relationship. The comparison of different dose regimens leads to proposing theoretical models for calculating radiobiological equivalences: the Biological Equivalent Dose (BED) Using these models one can think in terms of the practical consequences of dose fractionation. This allows, depending on the medical context, identifying the potential advantages of the radiosurgery or of a fractionated regimen. For small mid-sized vestibular schwannomas this approach indicates a clear advantage for a single-dose regimen. Retrospectively it has been possible to identify the dose-Volume relationship to the risk of neuropathy for facial motor function, facial sensitivity, and hearing.

[Preserving hearing function after Gamma Knife radiosurgery for unilateral vestibular schwannoma]

OBJECTIVE

The majority of the patients still lose hearing function in spite of the technical advances in microsurgery. We wanted to evaluate preservation of hearing function potential after Gamma Knife Surgery.

MATERIAL AND METHOD

In Marseille, we performed 1000 Gamma-Knife procedures for vestibular schwannomas between July 1992 and January 2002. This population included 175 patients undergoing first intention surgery for a unilateral schwannoma with functional preoperative hearing (Gardner and Robertson 1 or 2) who were studied with a follow-up longer than 3 Years. Univariate and multivariate analysis was performed.

RESULTS

Numerous parameters significantly influenced the probability of functional hearing preservation at 3 years. The overall rate of preservation was 60%. The main parameters of predictability were limited hearing loss (Gardner and Robertson stage 1 versus 2) before radiosurgery, presence of tinnitus as the initial symptom, young age and the small tumor size. Preservation of functional hearing at 3 years was 77.8% when the patient was initially in stage I, 80% when the patient's first symptom was tinnitus, and 95% when the patient had both. In these patients, the probability of functional preservation at 5 years was 84%.

CONCLUSION

We report a large population of patients treated by radiosurgery with initial functional hearing. These results demonstrate that a large percentage of selected patients can preserve functional hearing after Gamma Knife Surgery, their chances of functional preservation being greater than after microsurgery or simple surveillance.

[Gamma Knife surgery for VII nerve schwannomas]

RATIONALE

Radical resection of VII nerve schwannomas classically implies a high risk of severe facial palsy. Due to the rarity of facial palsy after Gamma Knife surgery (GKS) of vestibular schwannomas the evaluation of GKS in this specific difficult group of patient appears rational. We have found no similar evaluation in the literature.

METHOD

Among 1.000 schwannomas of the cerebello-pontine angle operated in Marseilles, France between July 1992 and March 2003, 9 have been diagnosed as originating from the VII. Criterias for this diagnosis are the involvement of the second or third portion of the VII nerve canal (7 patients) and/or peroperative observation during a previous microsurgery (2 patients). The rare facial palsy after vestibular schwannomas radiosurgery occurring usually before 18 Months have been considerated only the patients with more than 2 Years of follow-up (8 patients).

RESULTS

Four of these patients had the experience of a previous spontaneous facial palsy one (3 patients) or several times (1 patient). A normal motor facial function was observed only in 2 cases before GKS (House 2 in 6 patients, House 3 in one). The follow-up was 2-7 Years for the evaluable patients. None of these have developed or worsened facial palsy, two have improved their preoperative facial palsy. To date, all tumors have been evaluated. The specificity and heterogeneity of this group of patients led us to develop an original classification in 4 anatomical types presenting different clinical and surgical difficulties.

CONCLUSION

This first study demonstrates that radiosurgery allows treating these patients while preserving a normal motor facial function. Because of this advantage, GKS must be considered as a first option for all small to middle sized facial nerve schwannomas.

Injury of the lacrimal component of the nervus intermedius function after radiosurgery versus microsurgery

RATIONALE

Due to the synergetic role of the facial nerve and the nervus intermedius in the mechanical protection of the eye, vestibular schwannomas (VS) and/or their treatment are dangerous for the visual function. Our goal was to evaluate and compare the impact of the tumor itself, and the microsurgery (MS) or radiosurgery (RS).

MATERIAL AND METHOD

A functional questionnaire evaluating among other items the patient's complaints related to the eye was addressed to a series of 100 patients, 3 years after GKS of a previously unresected unilateral VS. Answers were compared with those of a group of 100 patients operated microsurgically. A Shirmer test was additionally performed before radiosurgery, and more than 2 years after radiosurgery in 46 patients.

RESULTS

The risk of dry eye and burning eye was much higher in patients operated by MS compared to patients operated by GKS due to the high incidence of facial palsy in the former (57/99) and the its absence in the later (0/80). In the population operated microsurgically, the presence of a permanent facial palsy (57 patients among 99 responding to the questionnaire) was, of course, associated with a high rate of complaints about burning eye (n=18) and crying eye (n=23). Among patients from the two arms with no facial palsy, a dry eye was reported by 8/64 after GKS and 7/42 after MS (NS) and a burning eye by 9/64 after GKS and 9/42 after MS (NS). Thus patients with no clinical signs of impairement of the VII motor nerve accounted for 14% of the cases signs indicating injury of the intermedius nerve with the same probability whatever the kind of surgery. When no permanent facial palsy was observed a crocodile tear syndrome was more frequently observed after MS (4/42 versus 1/64, p=0.07). This suggests an early lesion of the VII motor and intermedius, and a subsequent abnormal regrowth. The only patient reporting a crocodile tear syndrome after GKS turned out to have presented transiently a discret deficit of orbicular muscle signaling transient partial facial nerve injury. In absence of facial palsy, a "crying eye" was reported more frequently after MS (16/42 versus 9/64, p=0.01), leading us to suspect frequent infraclinical VII nerve injury in patients with no obvious facial palsy operated by MS. Patients tested with Shirmer test, before and more than 2 Years after, were improved in 28.3%, stable in 56.5%, and worse in 15.2%.

CONCLUSIONS

This study is the first demonstrating that radiosurgery can induce nervus intermedius injury in a small percentage of cases (14%). These patients had been treated 11 years ago with what we can consider as "archeoGKS technology" compared to today's refinements. The impact of modern GKS on the nervus intermedius is currently under evaluation in our group. However, symptoms related to the eye either due to the injury of the nervus intermedius or of the VII motor or both are much more frequent after MS than after RS.

Tei index determined by tissue Doppler imaging in patients with pulmonary regurgitation after repair of tetralogy of Fallot

The myocardial performance index (Tei index) determined by the pulsed Doppler method is a simple and noninvasive measurement for assessing global right ventricular (RV) function. This index can also be obtained by tissue Doppler imaging (TDI). The effects of significant pulmonary regurgitation (PR) on the determination of the Tei index by these two methods have not been investigated. We examined 15 patients (6.3 +/- 2.2 years) with significant PR after repair of tetralogy of Fallot (TOF) and 24 age-matched healthy children. Myocardial wall motion velocities at the tricuspid annulus were assessed during systole (Sa), early diastole (Ea), and late diastole (Aa) from a four-chamber view. Pulsed Doppler-Tei index and TDI-Tei index were measured as reported previously. The Tei index obtained by the pulsed Doppler method in TOF patients did not differ from that in normal children (0.30 +/- 0. 12 vs 0.32 +/- 0.07, p = not significant). TDI showed that TOF patients had significantly decreased Ea, Aa, and Sa velocities compared to those of normal children. Both isovolumic contraction time and isovolumic relaxation time in TOF patients were significantly longer than those in normal children (88 +/- 18 vs 62 +/- 23 msec and 46 +/- 11 vs 21 +/- 12 msec, respectively; p < 0.0001), although the duration of Sa did not differ between the two groups. Consequently, the Tei index as measured by TDI was significantly greater in TOF patients than in normal children (0.48 +/- 0.07 vs 0.30 +/- 0.07, p < 0.0001). The Tei index measured by the pulsed Doppler method is limited in its ability to assess RV function in patients with significant PR. However, the Tei index determined by TDI is a sensitive indicator of RV function in these patients, and it appears to be a promising new means of assessing global RV function in patients with significant PR.

Carrier dependent cell differentiation of bone morphogenetic protein-2 induced osteogenesis and chondrogenesis during the early implantation stage in rats

To evaluate the osteoinductive effects of recombinant human bone morphogenetic protein (rhBMP)-2 during the early stages of rat ectopic bone formation, we prepared two distinct carriers. Two carriers, insoluble bone matrix (IBM) and fibrous glass membrane (FGM) were combined with rhBMP-2 and implanted into the backs of rats to evaluate the osteoinductive effects of the two rhBMP-2 carrier systems. Insoluble bone matrix particle size was 320 to 620 microm. Fibrous glass membrane was constructed from unwoven glass fibers 1 microm in diameter. Alkaline phosphatase (ALP) activity and type II collagen were detected in IBM/rhBMP-2 at 5 days postimplantation. Calcium (Ca) was also detected in IBM/rhBMP-2 at 7 and 9 days postimplantation. In contrast, ALP and type II collagen were detected in FGM/rhBMP-2 at 7 days. Calcium was undetected, indicating that the bone formation in IBM/rhBMP-2 proceeded faster than in FGM/rhBMP-2 during the early stage of BMP-induced osteogenesis. In addition, mRNA expression level of KDR, a receptor for vascular endothelial growth factor, was also increased in IBM/rhBMP-2. To investigate the in vivo release profile of rhBMP-2, iodine 125 ((125)I)-labeled BMP-2-incorporating IBM and FGM implants were inserted into the back subcutis of mice. More than 60% of the rhBMP-2 was released from the IBM/rhBMP-2 carrier within 1 day after implantation, whereas 50% of the rhBMP-2 was released from the FGM/rhBMP-2 10 days postimplantation. These results indicated that osteo- and chondrogenesis depends highly upon the geometry of the carrier and the in situ retention of rhBMP-2 during the early stage of rhBMP-2 induced bone formation.

Inhibition of attachment of virions of Norwalk virus to mammalian cells by soluble histone molecules

Viral infection is usually initiated by the binding of virus particles to specific receptor molecule(s) on the host cell surface. Blocking of this step prevents the following step, penetration into the cell. In the present study, we investigated the virus-cell interactions of virions of Norwalk virus (NV), a major etiological agent for viral diarrhea. We found that histone was an extremely strong NV-binding protein. Histone H1, a heterologous histone molecule, appeared to be able to interact not only with NV particles, but also with the cell surface. Histone H1 appeared capable of effectively preventing the attachment of NV to intestinal cells, but not of other viruses. No cytotoxic effects of histone were observed under the assay conditions. These results indicate that nonsecretory histone molecules may inhibit the attachment of viruses to cells like lactoferrins. Our results suggest that by searching virus-binding molecules, we might find antiviral agents, even for new viruses.

Angle-resolved mapping of the fermi velocity in a quasi-two-dimensional organic conductor

We demonstrate a new method for determining the Fermi velocity in quasi-two-dimensional (Q2D) conductors. Application of a magnetic field parallel to the conducting layers results in periodic open orbit quasiparticle trajectories along the Q2D Fermi surface. Averaging of this motion over the Fermi surface leads to a resonance in the interlayer microwave conductivity. The resonance frequency is simply related to the extremal value of the Fermi velocity perpendicular to the applied field. Thus, angle dependent microwave studies enable a complete mapping of the in-plane Fermi velocity. We illustrate the applicability of this method for the highly 2D organic conductor kappa-(BEDT-TTF)2I3.