Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view

The risk of locoregional recurrence in resected gastric adenocarcinoma is high, but the benefit of adjuvant treatment remains controversial. In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed.

A new selection method for pepper transformation: callus-mediated shoot formation

We used two genes, TMV-CP and PPI1 (pepper-PMMV interaction 1 transcription factor), to transform commercially important chili pepper (Capsicum annuum) inbred lines (P915, P409) by means of Agrobacterium co-culture. Eighteen independently transformed T0 plants were obtained. The most critical point in the pepper transformation protocol was the selection of shoots growing on calli--referred to as callus-mediated shoot formation (indirect shooting)--because shoots not grown from the callus (direct shooting from the wounded surface) developed into non-transformants. Selection of the correct right callus type also proved to be an important requirement for obtaining transformed peppers. Six different types of callus developed during the selection process. Shoots regenerated from two of these types, while one type regenerated significantly more shoots than the other types, suggesting that the capacity for shoot formation is callus type-specific. Although the transformation rate was low, transformation via callus-mediated shoot formation proved to be reproducible and was confirmed by Southern and Northern blot analyses. Based on the experimental data, we have succeeded in developing a new protocol for the selection and transformation of pepper and expect that it will be used in the future for pepper transformation.

Overexpression of Id-1 is significantly associated with tumour angiogenesis in human pancreas cancers

It has been suggested that Id-1 has a critical role in the tumour progression and aggressiveness of several human cancers. However, the clinicopathological and biological significance of Id-1 overexpression remains unclear in human primary cancer. To investigate the association between Id-1 expression and cell proliferation or tumour angiogenesis, we examined the cell cycle kinetic indices (the proliferation and apoptotic indices, PI and AI) and intratumoral microvessel density (MVD) in 65 human pancreatic cancers. We also investigated the relationship between its expression and various clinicopathological factors to determine the clinical significance of Id-1 overexpression. Out of a total 65 cases, 32 (49.3%) showed overexpression of Id-1 vs normal tissues. Id-1 expression was found to be significantly associated with MVD (P=0.002). In further analysis of subgroups with higher and lower Id-1 expression, tumours with higher Id-1 expression (scores 4 and 5) showed significantly higher MVD than tumours with lower expression of Id-1 (scores 2 and 3) (111.18+/-57.14 vs 64.13+/-28.19, P<0.001). However, no significant association was found between Id-1 overexpression and patient survival rate. No significant association was also found between Id-1 expression and cell cycle kinetic indices (PI or AI) in pancreatic cancer. Moreover, the overexpression of Id-1 protein was not correlated with any significant clinicopathologic factors. These findings indicate that Id-1 overexpression is closely related with tumour angiogenesis and a higher density of intratumoral vessel, but that it is not associated with a poorer prognosis of survival or a higher cell proliferative potential in human pancreatic cancer.

The influence of lithium fluoride on in vitro biocompatibility and bioactivity of calcium aluminate-pMMA composite cement

The objective of this study is to assess the influence of lithium fluoride on in vitro biocompatibility and bioactivity of calcium aluminate (CA)-polymethylmethacrylate (PMMA) composite cement exhibiting quick setting time ( < 15 min), low exothermic temperature (< 47 degrees C), and high compressive strength (> 100 MPa). The biocompatibility was measured by examining cytotoxicity tests such as the agar diffusion test with L929 cell line and the hemolysis test with fresh rabbit blood. To estimate the bioactivity of CA-PMMA composite cement, we determined hydroxyapatite (HAp) formation on the surface of composite cement in the simulated body (SBF) solution by using thin-film XRD, XPS, SEM, EPMA and ICP-AES. The results of biocompatibility tests indicated that all experimental compositions of this study had no cytotoxicity and no hemolysis so that there was no cytotoxicity with regard to non-reacted monomers (MMA and TEGDMA) and lithium fluoride. The results of bioactivity tests revealed that CA-PMMA composite cement without lithium fluoride did not form HAp on its surface after 60 days of soaking in the SBF. On the other hand, LiAl2(OH)7 . 2H2O and HAp were formed on the surface of CA-PMMA composite cement including 1.0% by weight of lithium fluoride after 7 and 15 days of soaking in the SBF, respectively. The 5 microm of LiAl2(OH)7 . 2H2O and HAp mixed layers were formed on the surface of specimen after 60 days of soaking in the SBF.

Liposome-complexed adenoviral gene transfer in cancer cells expressing various levels of coxsackievirus and adenovirus receptor

PURPOSE

Loss of coxsackievirus and adenovirus receptor (CAR) is frequently observed in malignant cancer, hampering adenoviral gene therapy approaches. Complexing adenovirus with cationic liposomes can increase adenoviral transgene expression, particularly in cells with CAR-deficiency. We investigated whether other factors such as lipid composition might be involved in determining the efficiency of liposome-complexed adenoviral gene transfer in cancer cells.

MATERIAL AND METHODS

Human cancer cell lines with different expression levels of CAR were infected with a GFP transgene. The efficiency of transgene expression was assessed by determining GFP expression using FACS analysis.

RESULTS

The efficiency of liposome-complexed adenoviral gene transfer was dependent on the lipid composition constituting liposomes. Polyethylene glycol (PEG)-containing liposomes were most effective in increasing liposome-complexed adenoviral gene transfer. In CAR-deficient cells, use of PEG-containing liposomes enhanced adenoviral gene transfer, whereas in CAR-expressing cells enhancement varied depending on cell type. In some CAR-expressing cells, the effect of liposome complexing was even comparable to that in CAR-deficient cells. Increased adenoviral transgene expression following complexing with PEG-containing liposomes correlated with liposome uptake in cancer cells.

CONCLUSIONS

Liposome-complexed adenoviral gene transfer appears to depend on lipid composition and the level of liposome uptake by cancer cells, in addition to CAR levels. Our study suggest that these multiple factors should be considered in designing liposome-complexed adenoviral vectors to improve outcomes of current adenoviral cancer gene therapies.

Characterization of the 3'-terminal nucleotide sequence of two Korean isolates of Daphne virus S support its placement as a distinct species of the genus Carlavirus

This study determined the 3'-terminal nucleotide sequences of two Korean isolates of Daphne virus S (DVS), a tentative member of the genus Carlavirus, causing leaf distortion and chlorotic spot disease symptoms in daphne plants. The 3'-terminal 1,465 nucleotide sequences of the two isolates contained two open reading frames coding for proteins of 36 kDa viral coat protein (CP) and 12 kDa from the 5'-3' end, which is a typical genome structure of the 3'-terminal region of carlaviruses. Both DVS isolates were 98.1% and 93.6% amino acid identical in the CP and 12 kDa, respectively. The CP gene of DVS shares 25.2-55.2% and 42.9-56.1% similarities with that of 19 other carlaviruses at the amino acid and nucleotide levels, respectively. The 3'-proximal 12 kDa gene of DVS shares 20.2-57.8% amino acid identities with that of 18 other members of the genus. The 3' noncoding region of DVS consists of 73 nucleotides with long excluding poly A tract, and shares 69.1-77.1% identities to the known carlaviruses. In the phylogenetic analyses of the two proteins, DVS was closely related to Helenium virus S and Chrysanthemum virus B. This is the first sequence information for the DVS, and further confirms the classification of DVS as a distinct member of the genus Carlavirus.

Postoperative chemoradiotherapy for gastric cancer

BACKGROUND

We report the results of postoperative chemoradiotherapy after curative resection in gastric cancer patients.

PATIENTS AND METHODS

Patients with gastric cancer staged IB to IV(M0) were treated with chemoradiotherapy after curative resection with extensive (D2) lymph node dissection. Nodal metastases were observed in 261 (90%) patients. The chemotherapy consisted of fluorouracil 400 mg/m(2) plus leucovorin 20 mg/m(2) for 5 days, followed by 4500 cGy of radiotherapy for 5 weeks with fluorouracil and leucovorin on the first 4 days and the last 3 days of radiotherapy. Two 5-day cycles of chemotherapy were given 4 weeks after the completion of radiotherapy.

RESULTS

Of 290 patients accrued, 229 (79%) patients completed chemoradiotherapy as planned. With a median follow-up of 49 months, 114 (34%) patients have relapsed: 33 (29%) locoregional relapses, 76 (67%) peritoneal relapses and 41 (36%) distant metastases. The 5-year overall and relapse-free survivals were 60% and 57%, respectively. Tolerance was acceptable, the main toxicity being neutropenia.

CONCLUSIONS

This postoperative chemoradiotherapy after curative resection of gastric cancer was feasible, with acceptable toxicities. Whether this adjuvant therapy in gastric cancer patients that have undergone a D2 lymph node dissection impacts on survival or reduces the incidence of relapses remains to be studied.

Dynamic and quantitative evaluation of eyelid motion using image analysis

Evaluation of facial movement, especially eyelid movement, has depended on the subjective judgment of trained clinicians. Recently, a few objective methods have been reported, but they required uncomfortable markers to be attached to the eyelids and a special-purpose, high-speed video camera. This study had two aims: one was to develop a new device for measuring eyelid motion dynamically and quantitatively, without eyelid markers or a high-speed camera; the other was to devise feasible parameters for eyelid motion. The system consisted of a personal computer with a general-purpose multimedia board and a software program that the authors named blepharokymography. A sequence of blinking eyes was recorded with a video camera. After the capturing process of the video, kymograms were produced from the movie file. Kymograms were converted to binary images by threshold filtering. The lower margin of the upper eyelid was traced, and displacement and velocity curves were obtained. Some parameters were devised and verified in preliminary clinical data. The analysis revealed that the displacement (8 mm in normal compared with 5.2 mm in paralysis), average closing velocity (74 mm s(-1) in normal compared with 30.6 mm s(-1) in paralysis) and peak closing velocity (154 mm s(-1) in normal against 63.4 mm s(-1) in paralysis) were useful parameters for differentiating the normal and facial-paralysis states.

Tumor removal enhances immunity induced by B7.1

Costimulation of tumor T cells by B7.1 has been shown to be important for eliciting cell-mediated anti-tumor immunity. We constructed a stable B7.1 gene transfectant of a poorly immunogenic murine sarcoma, Moloney murine sarcoma virus-induced tumor cell line (MMSV). This transfectant, MMSV-B7.1, failed to produce any tumor development in syngeneic mouse models. When MMSV-B7.1 was simultaneously injected with wild-type MMSV, about half of the coinjected mice remained tumor free and displayed an increase in T cell population, upregulation of the mRNA level of various cytokines such as IL-4, IL-5, IL-10, IL-13, IL-15 and IFN-gamma, and complete rejection of reinjected MMSV. To investigate whether MMSV-B7.1 demonstrates any vaccinal effect, the transfectant was injected following the surgical removal of the primary tumor mass. Following a re-challenge with wild-type MMSV, all vaccinated mice maintained their tumor free status and displayed a rapid recovery of down-regulated cytokine levels. The results suggest that B7.1 vaccination after tumor removal might be useful for the prevention of tumor recurrence.

Changes in the E-cadherin-catenin complex expression in early and advanced gastric cancers

BACKGROUND/AIM

In various human cancers, dysfunction of the E-cadherin-catenin complex is associated with a decrease in cellular and tissue differentiation and with higher invasive and metastatic potentials. Since advanced gastric cancers are thought to evolve from early gastric cancers, we investigated whether differences of the E-cadherin-catenin complex expression can be observed between early and advanced gastric cancers.

METHODS

We have used an immunohistochemical technique to localize E-cadherin and alpha-, beta-, and gamma-catenins in 114 formalin-fixed, paraffin-embedded tissue blocks: 57 from patients with early gastric cancer and 57 from patients with advanced gastric cancer.

RESULTS

The immunoreactivity of E-cadherin and alpha-, beta-, and gamma-catenins was expressed by normal gastric epithelial cells with strong membranous staining at the intercellular border. Reduced expression of E-cadherin and alpha-, beta-, and gamma-catenins occurred in a considerable proportion of both cancer groups. However, no significant difference was seen between early and advanced cancer groups. In the early cancer group, reduced expression of E-cadherin and alpha-, beta-, and gamma-catenins correlated with diffuse type of cancer and poor differentiation. However, in the advanced cancer group, reduced expression of the three adhesion molecules, but not beta-catenin, correlated with diffuse type of cancer and poor differentiation. The expression of E-cadherin and alpha-, beta-, and gamma-catenins did not correlate with depth of invasion or lymph node metastases in both cancer groups.

CONCLUSION

These results suggest that alterations of the E-cadherin-catenin complex may be induced at an early stage of gastric tumorigenesis and may be associated with poorly differentiated and diffuse-type pathways in gastric tumorigenesis.

Completion of nucleotide sequence and generation of highly infectious transcripts to cucurbits from full-length cDNA clone of Kyuri green mottle mosaic virus

The nucleotide sequence of the genome of the type strain of Kyuri green mottle mosaic virus (KGMMV-C1) has been completely determined. The genome structure and sequence of the virus were compared to those of Yodo strain of KGMMV (KGMMV-Y). The genome of KGMMV-C1 is 6,514 nucleotides long consisting of 5' and 3' nontranslated regions (NTRs) and four open reading frames coding for 131 kDa and 189 kDa viral replicases, 28 kDa movement protein and 17 kDa coat protein. The nucleotide and amino acid sequences identities of the four encoded proteins and two NTRs between KGMMV-C1 and KGMMV-Y were 85.6% to 93.9% and 87.6% to 95.5%, respectively. Full-length cDNA of KGMMV-C1 was directly amplified by reverse-transcription polymerase chain reaction (RT-PCR) with a set of S'-end primer anchoring T7 RNA promoter sequence and 3'-end primer. This full-length RT-PCR product allowed RNA to be transcribed in vitro. The T7 promoter-anchored RT-PCR product was cloned and used as templates for transcription for plant inoculation test. Capped transcript RNAs transcribed from the full-length cDNA clone as well as capped transcript RNAs from the uncloned RT-PCR products were infectious and caused symptoms characteristic of KGMMV when mechanically inoculated to systemic host plants such as zucchini squash, cucumber and Nicotiana benthamiana. Transcript-derived progeny virus was indistinguishable from the wild-type virus with the same biological and biochemical properties. To our knowledge, this is the first report of the generation of a biologically active KGMMV clone, driven by the T7 promoter, that is highly infectious to cucurbitaceous plants.

Nonviral vector for efficient gene transfer to human ovarian adenocarcinoma cells

OBJECTIVE

Various strategies have been attempted to design efficient protocols for ovarian cancer gene therapy but there has been little progress in their clinical application. In this study, we formulated and evaluated a new cationic liposome prepared with dioleoyltrimethylaminopropane (DOTAP), 1,2-dioleoyl-3-phosphophatidylethanolamine (DOPE), and cholesterol (Chol) (DDC) for plasmid DNA transfer into ovarian cancer cells.

METHOD

The DDC liposome was prepared by mixing the DOTAP:DOPE:Cholin a 1:0.7:0.3 molar ratio using the extrusion method. Plasmid DNA (pEGFP-C1) and DDC were complexed at various weight ratios to find the optimum condition and the percentage of transfected cells was determined by selecting a green fluorescence protein (GFP) expressing cells in flow cytometry. The transfection efficiency of the DDC liposome was compared with 3[N-(N,N-dimethylaminoethylene) carbamoyl] cholesterol (DC-Chol)/DOPE liposome and commercially available lifopectin.

RESULTS

The optimal transfection of plasmid DNA was achieved at a 1:4 (w/w) ratio of DDC to DNA. The DDC/DNA complex exhibited higher transfection efficiency in human ovarian cancer cells (OVCAR-3 and SK-OV-3 cells) compared to that in other types of cell lines (NCI-NIH:522 and HepG2 cells). Flow cytometric analysis revealed that the DDC/DNA complex exhibited an over fourfold increase in GFP expression levels compared with DC-Chol/DOPE or lipofectin in OVCAR-3 cells. This result was further confirmed by confocal microscopy and RT-PCR analysis.

CONCLUSION

These results suggest that our newly formulated cationic liposome (DDC) appears to be a promising nonviral vector for treating ovarian adenocarcinoma because of its selective high gene transfer ability in ovarian cancer cells.

A planar amperometric creatinine biosensor employing an insoluble oxidizing agent for removing redox-active interferences

A planar microchip-based creatinine biosensor employing an oxidizing layer (e.g., a PbO2 film), where interfering redox-active substances are broken (i.e., oxidized) to redox-inactive products, was developed to facilitate the microfabrication of the sensor and to provide improved, reliable determination of creatinine in physiological samples. The feasibility of using hydrophilic polyurethanes in permselective barrier membranes for creatinine biosensors and the effect of adding a silanizing agent (adhesion promoter) on the sensor performance (e.g., sensitivity, stability, and lifetime) are described. The proposed creatinine microsensor with a three-layer configuration, i.e., enzyme, protecting, and oxidizing layers, exhibits good electrochemical performance in terms of response time (t95% = 98 s at 100-->200 microM creatinine change), linearity (1-1000 microM, r = 0.9997), detection limit (0.8 microM), and lifetime (approximately 35 days). The creatinine biosensor devised in a differential sensing arrangement that compensates the erroneous results from creatine is considered to be suitable for assay of serum specimens.

The role of fetal surgery in life threatening anomalies

The development and evolution of fetal surgery and the recognition of the fetus as a patient came from two sources. First, were those obstetricians and perinatologists who detected life threatening anomalies before birth, and re-described a hidden mortality arising from death in utero. Ultrasonography, color Doppler ultrasound and ultrafast fetal magnetic resonance imaging have since enhanced the accuracy of prenatal evaluation. Second, were those pediatricians responsible for treating newborn infants with extremely serious problems, and that appeared untreatable, although, it was believed that they could have been treated at an earlier stage of development. After the natural history of several correctable lesions had been determined and the selection criteria for intervention developed, fetal surgery emerged as a means of improving the overall morbidity and mortality rates.

Contralesional directional hypermetria associated with line bisection-specific ipsilesional neglect

Patients with contralesional neglect from right hemisphere injuries often fail to be aware of or respond to visual stimuli in the left hemispace. In contrast, other patients with right hemisphere damage rarely demonstrate behavior consistent with task-specific ipsilesional neglect (IN). We performed a series of experiments in a patient with IN on a line bisection task after a right frontal infarct. When asked to perform horizontal limb movements without visual feedback, the patient showed a leftward directional hypermetria. Similar performance was also observed during a representational production of a given distance without sensory input. These results suggest that IN is induced by a directional hypermetria resulting from disruption of the motor-intentional system.

The prognosis of stage IV gastric carcinoma patients after curative resection

BACKGROUND/AIMS

In the UICC staging system, stage IV contains not only those patients with distant metastasis but also patients with far-advanced T and N status but without distant metastasis. We investigated the prognostic factors of stage IV gastric carcinoma patients, without distant metastasis after curative resection and the role of surgery.

METHODOLOGY

One hundred and ninety stage IV gastric carcinoma patients, without distant metastasis were reviewed after curative resection in our hospital from January 1987 to December 1996.

RESULTS

Male sex, distal third location, diffuse or infiltrative type and histologically undifferentiated type were common. Of the 190 patients, 52 (27.4%) patients lived more than 3 years. The lymph node ratio (positive lymph node/retrieved lymph node) and combined resection independently affected survival (P = 0.0013, 0.0061, respectively). The perigastric lymph node ratio was well correlated with overall lymph node ratio (r = 0.794, P < 0.001).

CONCLUSIONS

With the involvement of an adjacent organ and knowing the perigastric lymph node ratio, the surgeon can decide upon the extent of dissection and postoperative treatment. However, a prospective study is warranted.

DNA ploidy patterns in advanced gastric carcinoma; is it a clinically applicable prognosticator?

BACKGROUND/AIMS

The purpose of this study was to evaluate the prognostic significance of ploidy patterns as determined by flow cytometry in terms of clinical usefulness.

METHODOLOGY

270 patients with a diagnosis of advanced gastric carcinoma were studied with fresh specimens obtained from multiple site avoiding nonviable or nonneoplastic tissues by DNA flow cytometry. DNA ploidy and clinicopathologic factors were compared and survival was analyzed.

RESULTS

The mean age of the patients was 56.1 +/- 11.6 years (25-80 years). There were 195 males and 75 females. Aneuploidy was shown in 93 (35.9%) patients. Male sex and differentiated tumor were more frequent in aneuploidy than diploidy (P = 0.011, < 0.001, respectively). By univariate analysis, tumor location, size, extent of resection, curative resection, serosa invasion, lymph node involvement, and distant metastasis significantly affected survival but not aneuploidy. Significant independent prognostic factors by multivariate analysis were curative resection, serosa invasion and lymph node involvement (P = 0.0001, 0.0114, 0.0262, respectively).

CONCLUSIONS

DNA ploidy patterns of advanced gastric carcinoma are of limited clinical significance, therefore not a clinically applicable prognosticator.