Quality of life after brain injury-overall scale, Japanese version: assessment of reliability and validity

This study analyzed the linguistic and psychometric validation of the Japanese version of the Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS) consisting of six items which cover several TBI-relevant domains. We hypothesized that the Japanese version has good reliability, convergent validity, and divergent validity, compared with its long version, the 37-item QOLIBRI. The QOLIBRI-OS Japanese version was forward and back-translated from the English version. In total, 129 individuals participated in this study after experiencing a traumatic brain injury and attending clinics, rehabilitation centers, and support centers in Japan. The structure of the QOLIBRI-OS was investigated by confirmatory factor analyses and compared with the QOLIBRI. Only one factor was extracted, and a model with one underlying factor had a good fit. The QOLIBRI-OS showed good-to-excellent internal consistency and test-retest reliability. The QOLIBRI-OS was positively correlated with the QOLIBRI, Short Form Health Survey-36 version 2, and Glasgow Outcome Scale Extended, and negatively correlated with the Hospital Anxiety and Depression Scale. The results suggest that the QOLIBRI-OS Japanese version is a reliable and valid tool for assessing disease-specific health-related QOL in individuals after traumatic brain injury in Japan.

EFFECTS OF REHABILITATION PROGRAM FOCUSED ON IMPROVING REAL-LIFE DAILY ACTIVITIES OF PATIENTS WITH MILD COGNITIVE IMPAIRMENTS OR DEMENTIA AND THEIR CAREGIVERS

Objective

To evaluate the effectiveness of a dyadic outpatient rehabilitation program focused on improving the real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers.

Design

Retrospective study.

Subjects

Eight patients with mild cognitive impairments or dementia and their caregivers.

Methods

The rehabilitation program comprised eight 1-hour sessions by occupational therapists with patients and his/her caregivers. Patients were assessed for motor function, cognitive function, and quality of life, and their caregivers were assessed for depression and caregiver burden. Participants were assessed at pre-program and post-program, and 3-month follow-up.

Results

The scores of caregiver-assessed Quality of life in Alzheimer's disease scale in patients significantly improved at post-program (median [interquartile range], 30.0 [7.0]) compared with pre-program (27.0 [2.8], effect size = 0.77, p = 0.029). In caregivers, the Zarit Caregiver Burden Interview scores decreased significantly at post-program (16.5 [13.0]) compared with pre-program (22.0 [17.5], effect size = 0.72, p = 0.042). There were no significant differences in other assessments.

Conclusions

The rehabilitation program focused on real daily activities and demonstrated to improve patients' quality of life and caregivers' depression and caring burden through patient-caregiver interaction. Future enhanced follow-up systems are warranted.

Stroke Patients with Nearly Independent Transfer Ability are at High Risk of Falling

OBJECTIVES

To examine the relationship between patients' transfer ability and fall risk in stroke patients during hospitalization.

MATERIALS AND METHODS

We retrospectively enrolled 237 stroke patients who were transferred to a convalescent rehabilitation ward from acute wards in the same hospital. Using incident reports, we investigated their fall rates and activity status at the falls according to their transfer abilities, which were assessed with Functional Independence Measure (FIM) transfer scores. The bi-weekly time trend of fall rates in all patients and in three subgroups based on FIM transfer scores of 1-3, 4-5, and 6-7, and activity status at the falls, were investigated. In addition, changes of patients' transfer ability on admission, at the first fall, and at discharge were investigated among falling patients.

RESULTS

The fall rate was the greatest in patients with a FIM transfer score of 4 (14.3 times/1000 person-days). The majority of falls for patients with a FIM transfer score of 1 occurred at the activity status of "on the bed" and "sitting", while three quarters of patients with a FIM score of 7 had falls during "standing" and "walking". No longitudinal trend in fall rates was found overall; however, the fall rate trends differed depending on the FIM transfer score. The majority of the patients who fell required full assistance for transfers upon admission but required no assistance at discharge.

CONCLUSIONS

Fall risk differed among patients with various transfer abilities; the greatest risk was in those who needed minimal assistance for transfers.

Abstract OT2-02-01: A confirmation study of omitting axillary dissection in patients with breast cancer and positive sentinel nodes

Background

The omission of axillary dissection for positive sentinel-node breast cancer is considered the standard treatment for patients who undergo breast conserving surgery and radiation therapy, according to the results of ACOSOG-Z0011 and AMAROS trials. On the other hand, some surgeons still think that the surgical stress of axillary dissection is minimal, and dissection is permitted. Furthermore, Z0011 contains several problems, such as insufficient number of entry cases and lack of radiation field unity. Thus, we planned a prospective trial to confirm the safety of omitting axillary dissection in patients with breast cancer and positive sentinel nodes.

Trial design

This is a single arm, confirmation study of three medical centers. Prior to surgery, informed consent is obtained, and patients are registered primarily. After surgery, patients with 1 to 2 positive sentinel nodes, for whom axillary dissection was omitted, are finally included in this trial at final registration.

Eligibility criteria

Patients with histologically-diagnosed breast cancer, Tis–2, N0 based on a core needle biopsy, will be included in this trial. Eligible patients must be between 20 and 80 years of age, with a performance status of 0–2 and adequate organ function. They must not have undergone any prior operation, radiation therapy, chemotherapy, endocrine therapy, or immunotherapy.

Specific aims

The primary endpoint is 5-year (y) axillary recurrence rate. Secondary endpoints are 5-y overall survival, 5-y recurrence-free survival, 5-y local recurrence-free survival, the rate of upper-limb lymphedema, quality of life, and comparison of axillary recurrence rates between patients with two or more dissected nodes and those with only one positive node.

Statistical methods

The expected rate of axillary recurrence is 2.0%, and non-inferiority is defined as an axillary recurrence lesser than or equal to 5% in the axillary radiotherapy group. The sample size was calculated with a study power of 80% and type I error of 10% (two-sided). The required number of patients is estimated to be 189.

Present and target accrual

Patient accrual from the three medical centers was initiated in July 2016. We plan to enroll a total of 189 patients at final registration in this trial.

Citation Format: Jibiki N, Hirano A, Ochi T, Sakamoto A, Horiuchi K, Noguchi E, Omi Y, Ogura K, Inoue H, Kamio T, Naritaka Y, Fujibayashi M, Hiroshima K, Nagashima Y, Sakai S, Karasawa K, Okamoto T. A confirmation study of omitting axillary dissection in patients with breast cancer and positive sentinel nodes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-02-01.

Abstract OT1-05-03: Efficacy and safety of scalp cooling device for prevention of alopecia in patients with breast cancer

Background

Chemotherapy for breast cancer causes alopecia as a side effect. Some patients refuse chemotherapy because of alopecia, resulting in the omission of a standard therapy. It is believed that a scalp cooling device can prevent alopecia by promoting vasoconstriction of the scalp and reducing exposure of the hair root cells to anticancer agents. There are phenotypic differences of the efficacy of a scalp cooling device for alopecia. In fact, a Dutch scalp cooling registry reported that the success rate of scalp cooling was 51% in European women and 33% in Asian women. Therefore, we aimed to investigate the efficacy of scalp cooling device for chemotherapy-induced alopecia among Asian women with breast cancer.

Trial design

This is a phase II trialto evaluate the efficacy and safety of scalp cooling device for risk reduction of alopecia in women with stage I/II/III breast cancer treated with adjuvant/neoadjuvant chemotherapy in a single institute.

Eligibility criteria

Women diagnosed with Stage I to III breast cancer who are scheduled to receive preoperative or postoperative adjuvant chemotherapy containing anthracycline and/or taxanes are enrolled. Patients who have blood malignancies (leukemia, non-Hodgkin lymphoma, other systemic lymphoma), and cold allergy, are excluded.

Specific aims

The primary endpoint is the proportion of patients with Common Terminology Criteria for Adverse Events (CTCAE) grade 0-1 alopecia after the completion of all cycles of chemotherapy (success rate). Secondary endpoints are safety, quality of life, use of wig or cap, and success rates after the completion of all cycles of chemotherapy distinguished by anthracycline(AC) and taxane.

The cooling device is the Paxman scalp cooling system. Scalp cooling was performed from 30 mins before initiation until 90 mins (25 min for taxane) after chemotherapy. Pictures of the scalp were taken at the time of the initiation of each course.

Statistical methods

Successful treatment was defined as the presence of less than 50% of hair-loss area. The sample size was calculated using the Simon method, with a type I error of 10% (two-sided) and a study power of 80%.The expected success rate is 30%, with a threshold success rate of 10%, and the required number of patients was estimated to be 19.

Present and target accrual

Patient accrual was started in April 2018 and present accrual is 3. We plan to enroll a total of 20 patients in the trial.

Citation Format: Kodera A, Ogura K, Hattori A, Yukawa H, Sakaguchi S, Matsuoka A, Tanaka N, Kamimura M, Jibiki N, Naritaka Y, Hirano A. Efficacy and safety of scalp cooling device for prevention of alopecia in patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-05-03.

The influence of CYP2C19 polymorphisms on exacerbating effect of rabeprazole in celecoxib-induced small bowel injury

BACKGROUND

Simultaneous use of proton pump inhibitors (PPIs) has been shown to increase the risk of nonsteroidal anti-inflammatory drug (NSAID)-induced small bowel injury.

AIM

To investigate whether polymorphisms of the cytochrome P450 2C19 gene (CYP2C19), encoding a key metabolising enzyme for PPIs, are associated with small bowel injury induced by celecoxib in combination with the PPI rabeprazole.

METHODS

Study participants included 55 healthy Japanese volunteers, who participated in the PPI-NSAID Kyushu University Study using video capsule endoscopy. For 2 weeks, 26 subjects were treated with celecoxib plus rabeprazole (rabeprazole group), and 29 subjects received celecoxib plus placebo (placebo group). All subjects were genotyped for CYP2C19 using real-time fluorescent polymerase chain reaction. Subjects were sub-classified as poor metabolizers or extensive metabolizers. The incidence and number of small bowel injuries were compared between poor metabolizers and extensive metabolizers in each group.

RESULTS

In the rabeprazole group, the incidence of small bowel injuries was significantly higher in poor metabolizers than in extensive metabolizers (85.7% vs 31.6%, P=.026). The number of mucosal injuries in the rabeprazole group was also significantly higher in poor metabolizers compared with extensive metabolizers (median [range] 3 [0-31] vs 0 [0-7], P=.01). In addition, we found a significant interaction between CYP2C19 genotype and concomitant use of rabeprazole in subjects at risk for celecoxib-induced small bowel injury.

CONCLUSIONS

The CYP2C19 genotype might be associated with the risk of small bowel injury when celecoxib is combined with rabeprazole.

Disulfide bond formation of thiols by using carbon nanotubes

Clarification of the interactions between carbon nanotubes (CNTs) and proteinogenic amino acids is a key approach to understanding CNT-protein interactions. Previous studies have addressed the mechanism of the physical adsorption of amino acids onto CNTs. However, little is known about their chemical reactions in aqueous solutions. Here, we established dispersant-free systems to clarify intrinsic CNT-thiol interactions. We demonstrated that the redox reaction of CNTs with cysteine, containing a thiol group, leads to disulfide bond formation between cysteine molecules, even under acidic conditions. The generality of the redox reaction is validated using other thiols such as dithiothreitol and glutathione. The present results suggest that structures of proteins and peptides containing free thiol groups are chemically modified and misfolded on CNT surfaces by this disulfide bond formation in biological systems.

Abstract OT1-01-03: A phase II trial of neoadjuvant epirubicin/cyclophosphamide followed by weekly nanoparticle albumin-bound paclitaxel with trastuzumab for HER2-positive breast cancer

Background

Paclitaxel (PTX) is a standard treatment for metastatic breast cancer (MBC) and it is often used as adjuvant and neoadjuvant chemotherapy for patients with early-stage disease. Nanoparticle albumin-bound (Nab)-PTX was also effective in patients with metastatic and early-stage. A comparison of weekly and triweekly nab-PTX regimens suggested that weekly nab-PTX resulted in superior progression-free survival. However, the optimal dose and schedule of weekly nab-PTX have not been determined. The efficacy and tolerability of epirubicin/cyclophosphamide (EC) followed by weekly nab-PTX (125 mg/m2) ± trastuzumab in node-positive breast cancer was determined in our previous trial. A high pathologic complete response (pCR) rate was obtained in HER2-positive patients. However, because nab-PTX administration was frequently postponed and discontinued, the optimal dose needs to be determined. In the previous trial, the median relative dose intensity of nab-PTX was 80% among patients with pCR. Therefore the dose of nab-PTX was reduced by 20% in this newly designed trial.

Trial design

This phase II trial aimed to evaluate the efficacy and toxicity of neoadjuvant EC followed by weekly nab-PTX with trastuzumab in patients with HER2-positive breast cancer. Patients will receive 4 cycles of epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks, followed by 4 cycles of nab-PTX (100 mg/m2) on days 1, 8, and 15, over a 28-day cycle. Fifteen cycles of trastuzumab (2 mg/kg, loading dose: 4 mg/kg) will be added to the nab-PTX regimen.

Eligibility criteria

Surgery and chemotherapy-naïve patients with pathologically confirmed T2-4 N0-3 invasive breast cancer, as diagnosed by core needle biopsy, are included. Eligibility criteria include age 20–70 years, a performance status of 0–2, and adequate organ function.

Specific aims

The primary endpoint is the pCR rate in the breast and axilla. Secondary endpoints include the breast conservation rate, toxicities, relative dose intensities, feasibility, and overall survival. A pCR is defined as the disappearance of invasive cancer cells, including in the axilla; residual intraductal cancer is acceptable.

Statistical methods

The sample size was calculated using the Simon method, with a type I error of 5% and a study power of 80%. The expected rate of pCR is 72% with a threshold pCR rate of 45%. The required number of patients was estimated to be 25.

Present and target accrual

Patient accrual within two medical centers began in May 2014. A final study population of 30 patients is expected (Trial registration: UMIN000013886).

Citation Format: Kodera A, Hirano A, Inoue H, Ogura K, Hattori A, Sakaguchi S, Yukawa H, Matsuoka A, Tanaka N, Kamimura M, Jibiki N, Fujibayasi M, Naritaka Y, Shimizu T. A phase II trial of neoadjuvant epirubicin/cyclophosphamide followed by weekly nanoparticle albumin-bound paclitaxel with trastuzumab for HER2-positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-01-03.

Abstract P3-13-13: Breast-conserving surgery plus hormone therapy without irradiation in elderly women with early breast cancer

Background

The meta-analysis of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) revealed that whole-breast irradiation after breast conserving surgery (BCS) decreased ipsilateral breast tumor recurrence (IBTR) and breast cancer-related death. However, elderly patients can find daily hospital attendance difficult, and their IBTR risk is low. A randomized control trial was performed in women aged ≥70 years with hormone-positive breast cancer to investigate the usefulness of breast-conserving therapy without irradiation (Hughes et al. N Engl J Med 2004). Since September 2001, we have offered BCS plus hormone therapy without irradiation in patients who satisfy the following criteria: age ≥60 years; pathologically node negative, hormone-positive breast cancer; a negative surgical margin; and no lymphovascular invasion. We assessed prognosis in patients who chose this option.

Patients and methods

Between September 2001 and December 2014, 219 patients met the inclusion criteria; 90 and 129 patients underwent BCS plus hormone therapy with or without irradiation, respectively. The cumulative IBTR incidence and overall survival (OS) for the groups was evaluated. A negative surgical margin was defined as a margin of ≥5 mm.

Results

The median ages at operation were 73 years (range, 60–88 years) and 65 years (range, 60–80 years) for the without and with irradiation groups, respectively (p <0.001). There were no significant differences in tumor size, lymph node metastasis, or adjuvant therapy between the groups. The median follow-up duration is presently 4.6 years. IBTR was observed in 5 (3.9%) and 1 (1.1%) patient(s) in the without and with irradiation groups, respectively (p = 0.192). The 5-year IBTR cumulative incidences were 0.9% and 2.2%, and the 10-year were 6.7% and 2.2%, for the without and with irradiation groups, respectively (p = 0.390). The 5-year OS rates were 93.8% and 98.5%, and the 10-year OS rates were 89.7% and 94.0 for the without and with irradiation groups, respectively (p = 0.205).

Conclusion

BCS plus hormone therapy without irradiation in elderly patients is an appropriate option.

Citation Format: Inoue H, Hirano A, Ogura K, Hattori A, Yukawa H, Sakaguchi S, Matsuoka A, Tanaka N, Kodera A, Kamimura M, Fujibayashi M, Naritaka Y, Shimizu T. Breast-conserving surgery plus hormone therapy without irradiation in elderly women with early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-13.

Nisin A extends the shelf life of high-fat chilled dairy dessert, a milk-based pudding

AIMS

The aims of this study were to evaluate the effectiveness of nisin A to control the growth of spore-forming bacteria, Bacillus and Paenibacillus, in chilled high-fat, milk pudding and to reduce heat treatment to improve aroma and flavour.

METHODS AND RESULTS

Nisin A was added to milk pudding containing 5·0 and 7·5% fat to final concentrations of 40, 80, 120 and 240 IU ml(-1). Spores from Bacillus thuringiensis, Bacillus cereus and Paenibacillus jamilae were inoculated into samples at 10 spores ml(-1) prior to pasteurization at 130°C for 2 s. Milk pudding without inoculation was pasteurized using less heat condition (100, 110 and 120°C for 2 s) to measure the effect of adjusting the ingredients to prevent naturally occurring bacteria. The viable cells during storage at 15, 20 and 30°C showed nisin A inhibited spiked bacteria to varying degrees depending on species, sensitivities to nisin A concentration and fat content, and inhibited natural populations at 80 IU g(-1) nisin A in 5·0% fat and at 120 IU g(-1) in 7·5% fat milk pudding. An aroma compound analysis and organoleptic assessment showed processing at 110 and 120°C decreased the temperature-dependent unpleasant odours, for example, reduced dimethyl sulfide and dimethyl disulfide by 1·2-1·5 times and increased rankings in taste tests compared with 130°C treated pudding.

CONCLUSIONS

Nisin A was found to be effective as a natural preservative to control spoilage bacteria in high-fat milk pudding and extend its shelf life, when using reduced heat treatments to improve the flavour and aroma without compromising food safety.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report showing nisin A is effective in reducing spoilage bacteria in high-fat, chilled dessert, milk pudding. Therefore, nisin A can be used to improve milk puddings to satisfy both industry and consumer demand for food quality and safety.

Abstract OT1-1-01: A phase II study of neoadjuvant epirubicin/cyclophosphamide (EC) followed by weekly nanoparticle albumin-bound paclitaxel with or without trastuzumab for node-positive breast cancer

Background: Paclitaxel is considered standard treatment for metastatic breast cancer (MBC) and is often used as adjuvant and neoadjuvant chemotherapy for patients with early-stage disease. Conventional paclitaxel requires solvents such as polyoxyethylated castor oil; however, such solvents are associated with toxicity including peripheral neuropathy and hypersensitivity reaction. Moreover, the use of the drug requires special tubing and in-line filters. Therefore, nanoparticle albumin-bound paclitaxel (nab-PTX) requiring no solvent has been developed. Nab-PTX was effective in patients with MBC and as a neoadjuvant therapy. A comparison between weekly and triweekly nab-PTX suggested that weekly nab-PTX was superior in progression-free survival.

Trial design: This is a phase II trial to evaluate the efficacy and toxicity of neoadjuvant epirubicin/cyclophosphamide (EC) (epirubicin/cyclophosphamide) followed by weekly nab-PTX with or without trastuzumab for node-positive breast cancer. Patients receive four cycles of epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks, followed by four cycles of nab-PTX (125 mg/m2) on days 1, 8 and 15 in a 28-day cycle. Fifteen cycles of trastuzumab (2 mg/kg, loading 4 mg/kg) are added to the nab-PTX regimen in HER2-positive patients every week.

Eligibility criteria: Patients with histologically diagnosed invasive breast cancer based on a core needle biopsy of the T1-4 N1-3 without previous operation or chemotherapy are included in this trial. Eligible patients are aged between 20 years and 70 years with a performance status of 0 to 2 and adequate organ functions.

Specific aims: The primary endpoint is the pathologic complete response (pCR) rate in the breast and axilla, and the secondary endpoints are the breast conserving rate, toxicities, feasibility and overall survival.

Statistical methods: The sample size was calculated using the Simon method, with a type I error of 10% and a study power of 80%. 1. HER2-negative patients

The expected rate of pCR was 25% and the required number of patients was estimated to be 33. 2. HER2-positive patients

The expected rate of pCR was 50%, and the required number of patients was estimated to be 21.

Present and target accrual: Patient accrual within two medical centers started in April 2011 with 20 patients being on study to date (2012, June 12). A total of 56 patients (22 are HER2-positive and 34 are HER2-negative) are planned to be enrolled in the trial.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr OT1-1-01.

Autologous adipose-derived regenerative cells are effective for chronic intractable radiation injuries

Effective therapy for chronic radiation injuries, such as ulcers, is prone to infection. Stiffness is expected since the therapeutic radiation often involves wider and deeper tissues and often requires extensive debridement and reconstruction, which are not sometimes appropriate for elderly and compromised hosts. Autologous adipose-derived regenerative cells (ADRCs) are highly yielding, forming relatively elderly aged consecutive 10 cases, 63.6±14.9 y (52-89 y), with mean radiation dose of 75.0±35.4 Gy (50-120 Gy) were included with at least 10-month follow-up. Minimal debridement and ADRC injection in the wound bed and margin along with the injection of mixture of fat and ADRCs in the periphery were tested for efficacy and regenerated tissue quality by clinically as well as imaging by computed tomography and magnetic resonance imaging. Uncultured ADRCs of 1.6±1.3×10(7) cells were obtained. All cases healed uneventfully after 6.6±3.2 weeks (2-10 weeks) post-operatively. The done site morbidity was negligible and without major complications, such as paralysis or massive haematoma. The regenerated tissue quality was significantly superior to the pre-operative one and the mixture of fat and ADRCs connected to the intact tissue was very soft and pliable. Mean follow-up at 1.9±0.8 y (0.9-2.9 y) revealed no recurrence or new ulceration after treatment. Thus, the ADRCs treatment for decades-long radiation injuries is effective, safe and improves the quality of wounds.

Advances in characterization of neuroprotective peptide, humanin

Humanin (HN), a short amino acid peptide, protects neurons as well as other cells from amyloid β-induced toxicities and other stresses. A number of HN binding proteins have been identified and their involvements in HN-mediated neuroprotection have been suggested in some cases. However, the way HN binds to the target molecules has never been clarified. Here we will review the structures of HN and HN analogs in solution as a function of solvent conditions and attempt to relate their structural characteristics to the functional properties.

Abstract P4-10-11: Nobel Approach for Breast Conserving Surgery after Primary Systemic Therapy: Real-Time Virtual Navigation

Background:

Breast-conserving surgery after primary systemic therapy (PST) has become a widely acceptable procedure for locally advanced breast cancers. Sometimes it is difficult to determine the appropriate resection-line at the time of surgical operation because of tumor size reduction or indistinct boundary of the tumor. Moreover we cannot detect tumors in cases with complete response. That was why we developed a new navigation technique using real-time image reconstruction.

Materials and methods: Multi-detector row computed tomography (MD-CT) has been performed for all breast cancer patients in our institute. DICOM images of MD-CT were analyzed by image processing software ‘OsiriX'. OsiriX is an open source software which anyone can download from website (http://www. osirix-viewer.com). OsiriX has been specifically designed for navigation and visualization of multimodality and multidimensional images. We used 3D volume rendering images. At the time of surgery, pre-PST volume rendering images ware superimposed directly on the patients’ skin from projector which was connected to a personal computer in the operating room.

Results: We could see ‘real-time’ rendering images (from skin to organ by layer to layer) on the patient's body. By using pre-PST imaging data, we could recognize precise tumor area and could perform breast conserving surgery safer and easier than before.

Conclusion: Using 3D reconstruction MD-CT images which were obtained before PST, ‘real-time’ virtual navigation was helpful to determine the resection-line for clear surgical margin in breast-conserving surgery after PST. This new technique does not need some expensive equipments and easily performed by surgeon. Ordinary personal computer and projector make it possible to demonstrate a new environment in surgical operation.

Potential application of arginine in interaction analysis

Aqueous solution of 0.1-2 M arginine at mildly acidic to neutral pH is widely used in biotechnology and protein research, including protein refolding, purification, and formulation. This is largely because of its ability to suppress non-specific protein-protein and protein-surface interactions. Here we propose potential applications of arginine in interaction analysis for proteins. One of the important goals of such analysis is discovery of small molecule antagonistic or agonistic ligands that bind to target proteins and thereby modulate their function. Such research is often hampered by the low solubility of the small molecules, the instability of target proteins and the non-specific protein-ligand interactions. Aqueous arginine solution increases the solubility of small molecules, which should give an alternative to conventional dissolution method of small molecules by organic solvents. Arginine may also directly impact on the analysis of protein-protein or protein-ligand interactions by suppressing weak non-specific interactions.

HtrA2/Omi-immunoreactive intraneuronal inclusions in the anterior horn of patients with sporadic and Cu/Zn superoxide dismutase (SOD1) mutant amyotrophic lateral sclerosis

AIMS

HtrA2/Omi is a mitochondrial serine protease that promotes the apoptotic processes, but the relationship between HtrA2/Omi and amyotrophic lateral sclerosis (ALS) is still unknown. The purpose of the present study was to determine whether abnormal expression of HtrA2/Omi occurs in patients with ALS.

METHODS

We prepared autopsied spinal cord tissues from 7 control subjects, 11 patients with sporadic ALS (SALS) and 4 patients with Cu/Zn superoxide dismutase (SOD1)-related familial ALS (FALS). We then performed immunohistochemical studies on HtrA2/Omi using formalin-fixed, paraffin-embedded sections from all of the cases.

RESULTS

In the control subjects, the anterior horn cells were mildly to moderately immunostained with HtrA2/Omi. In the patients with SALS, strong HtrA2/Omi immunoreactivity was found in some skein-like inclusions and round hyaline inclusions as well as many spheroids, but Bunina bodies were immunonegative for HtrA2/Omi. In the patients with SOD1-related FALS, Lewy body-like hyaline inclusions were observed in three cases and conglomerate inclusions were observed in the remaining case, and both types of inclusions were intensely immunopositive for HtrA2/Omi.

CONCLUSIONS

These results suggest that abnormal accumulations of HtrA2/Omi may occur in several types of motor neuronal inclusions in the anterior horn from SALS and SOD1-linked FALS cases, and that HtrA2/Omi may be associated with the pathogenesis of both types of ALS.

Epirubicin and cyclophosphamide (EC) followed by weekly paclitaxel with/without trastuzumab as primary systemic therapy in locally advanced breast cancer: Phase II study

e11590

Background: Primary systemic therapy (PST) has become a standard therapy for locally advanced breast cancer (LABC). The aim of this study was to evaluate the activity and toxicity of EC (epirubicin/cyclophosphamide) followed by weekly paclitaxel with/without trastuzumab as PST in LABC. Methods: Primary endpoint was pathologic complete response (pCR) rate in the breast and axilla, and secondary endpoints were breast conserving rate and toxicities. Patients with histologically diagnosed invasive breast cancer by core needle biopsy of the T2–4 (>3 cm) or N1–3 were included in this study. Eligible patients were age >20 years, had a performance status of 0 to 1, and had adequate organ functions. It was determined that the expected rate of pCR in the trial was 25%, and the sample size was calculated using the Simon method, with a type I error of 5% and a study power of 80%. The target enrollment was estimated to be 40 evaluable patients. Treatment: Patients received epirubicin (100 mg/m2) and cyclophosphamide (600mg/m2 ) every 3 weeks for four cycles followed by paclitaxel (80 mg/m2 ) every week for 12 cycles. Trastuzumab (2mg/kg) was added to paclitaxel in HER2-positive patients. Results: Forty-three patients were enrolled into this study and 3 patients withdrew. pCR were observed in 8 patients and pCR rate was 20.0% (95% confidence interval, 7.6- 32.4). Twenty-four patients (60.0%) underwent breast conserving surgery. In particular, patients with HER2 positive tumor had significantly higher rate of pCR than the others (62.5% vs. 8.6%; p=0.0014). Grade 4 neutropenia was recorded in 27.5% of the patients, and febrile neutropenia occurred in 4 patients (10.0%). No heart failure was seen. Conclusions: EC followed by weekly paclitaxel with/without trastuzumab was an active and well-tolerated treatment for LABC.

No significant financial relationships to disclose.

Dissecting aneurysms limited to the basilar artery: report of two cases and review of the literature

Spontaneous dissecting aneurysms limited to the basilar artery are rare. We describe two patients who presented to our institution with different clinical problems, one with brain stem infarction and the other with subarachnoid hemorrhage. We describe the clinical and imaging features in these patients, their treatment, and outcome. We also reviewed the literature concerning this entity, and we have identified 32 patients (including our two patients) with angiographically confirmed dissecting aneurysms limited to the basilar artery. Of these, 40.6% presented with brain stem infarction, 50.0% presented with subarachnoid hemorrhage, and 9.4% presented with both infarction and subarachnoid hemorrhage. Patients who presented with basilar artery dissecting aneurysms and brain stem infarction tended to be younger (mean age, 38 +/- 7 years) than those who presented with subarachnoid hemorrhage (48 +/- 12 years) and were more likely to be male. We discuss the natural history of this entity and suggest an approach to clinical management for these patients.

Clinicopathologic investigation of a family with expanded SCA8 CTA/CTG repeats

We investigated a family manifesting progressive ataxia, with expanded SCA8 CTA/CTG repeats. Neuropathologically, degeneration of Purkinje, inferior olivary, and nigral neurons and periaqueductal gliosis were evident. The sites of Purkinje cell loss were occupied by fibrillary accumulations. The remaining Purkinje cells showed somatic sprouts, and intracytoplasmic 1C2-positive granular structures were recognizable. This characteristic distribution of neurodegeneration and Purkinje cell cytopathology were distinct from those of other hereditary spinocerebellar ataxias previously reported.

S-carboxymethylcysteine normalises airway responsiveness in sensitised and challenged mice

S-carboxymethylcysteine (S-CMC) has been used as a mucoregulator in respiratory diseases. However, the mechanism of action of S-CMC on allergic airway inflammation has not yet been defined. In the present study, BALB/c mice were initially sensitised and challenged to ovalbumin (OVA) and, weeks later, re-challenged with OVA (secondary challenge). S-CMC (5-100 mg.kg-1) was administered from 2 days before the secondary challenge through to the day of assay. Mice developed airway hyperresponsiveness (AHR) 6 h after the secondary challenge and increased numbers of neutrophils were present in the bronchoalveolar lavage (BAL) fluid. At 72 h after secondary challenge, mice again developed AHR, but the BAL fluid contained large numbers of eosinophils. S-CMC treatment was found to reduce AHR and neutrophilia at 6 h, as well as eosinophilia and AHR at 72 h. These effects appeared to be dose dependent. Goblet cell hyperplasia, observed at 72 h, was reduced by S-CMC. In BAL fluid, increased levels of interferon-gamma, interleukin (IL)-12 and IL-10 and decreased levels of IL-5 and IL-13 were detected. In conclusion, the data indicate that S-carboxymethylcysteine is effective in reducing airway hyperresponsiveness and airway inflammation at two distinct phases of the response to the secondary allergen challenge in sensitised mice.

Expression of a CD44 variant and VEGF-C and the implications for lymphatic metastasis and long-term prognosis of human breast cancer

The aim of the present study was to determine whether expression of the CD44 variant v7-v8 (CD44v7-v8) or vascular endothelial growth factor-C (VEGF-C) is associated with long-term prognosis in breast cancer patients. A 10-year follow-up of 91 patients with primary breast cancer who were previously assessed for CD44 expression was undertaken. Immunohistochemical evaluation of VEGF-C expression was performed in 87 of these patients and their long-term prognosis was assessed. The disease-free and overall survival rates were significantly poorer for the CD44v7-v8-positive patients than for the patients negative for this marker. VEGF-C expression was detected in 38 out of the 87 patients (43.7%) with primary human breast cancer. There were no significant differences in tumor size, histological type, axillary lymph node status, presence of lymphatic or venous invasion, or presence of estrogen receptors and progesterone receptors between the VEGF-C-positive and -negative patients. There were also no significant differences in the disease-free or overall survival rates in these patient groups. In conclusion after the 10-year follow-up, expression of CD44v7-v8 was associated with poor prognosis for breast cancer patients. However, there was no association between VEGF-C expression and the clinicopathological factors or prognosis of breast cancer patients.

Frontotemporal and motor neurone degeneration with neurofilament inclusion bodies: additional evidence for overlap between FTD and ALS

We present the case of a patient who had clinical frontal lobe dementia without apparent motor neurone disease (MND), with pathologic findings not typical of any single currently classified frontotemporal degeneration (FTD). At autopsy, the brain had frontal and temporal atrophy with neuronal loss, gliosis, and superficial spongiosis, typical of all FTDs. There were at least three different morphologic types of intracytoplasmic neuronal inclusions in a variety of brain and brainstem regions, including the hippocampal dentate gyrus and pyramidal neurones, the neocortex (in particular, the motor cortex), basal ganglia, thalamus, subthalamic nucleus, basis pontis, and inferior olivary nuclei. Inclusions had the morphologies of Pick-like bodies, pleomorphic inclusions, and hyaline conglomerate (HC)-like inclusions. None of these were positive with tau immunostains. Pick-like bodies in the dentate gyrus were labelled with ubiquitin. The pleomorphic inclusions in the neocortex and dentate gyrus and the HC-like inclusions in the motor and parietal cortex were strongly positive with immunostains for neurofilament. We discuss the differential diagnosis and compare this case with those disorders to which it is most similar. In particular, we compare the unique neurofilament-positive inclusions to the inclusions of FTD-MND, to Pick bodies, and to the basophilic and HC inclusions that are occasionally seen in amytrophic lateral sclerosis (ALS). Although FTD-MND may be found in ALS, the findings in this case may have additional implications for a link between FTD and ALS.

Down-regulation in human cancers of DRHC, a novel helicase-like gene from 17q25.1 that inhibits cell growth

Frequent observations of allelic loss in chromosomal band 17q25.1 in a variety of human cancers have suggested that one or more tumor suppressor genes are normally present in this region. Moreover, a locus responsible for hereditary focal non-epidermolytic palmoplantar keratoderma (tylosis oesophageal cancer; TOC), a condition associated with esophageal cancer, has been mapped to the same band. During efforts to sequence, by shot-gun methods, a 1 Mb target region that we had defined as the DNA segment harboring the putative tumor suppressor gene(s) involved in these events, we identified a novel cDNA, DRHC (down-regulated in human cancers), that showed reduced expression in 28 of 95 (29%) cell lines derived from a variety of human cancers. The full-length cDNA, 6275 bp long, was expressed predominantly in thymus and brain. The predicted 1942-amino-acid product exhibited significant sequence homology to yeast enzymes belonging to the DEAD-helicase superfamily, and appeared to be a Uvr/Rep helicase with a DEXDc consensus domain. Transfection of a DRHC expression vector inhibited growth of cancer cells in liquid medium or soft agar. The results suggest that loss of expression of DRHC may play a role in human carcinogenesis.

High prevalence of Epstein-Barr virus in gastric remnant carcinoma after Billroth-II reconstruction

BACKGROUND

Epstein-Barr virus (EBV) has been detected in about 10% of gastric carcinoma cases worldwide, and a high prevalence of EBV involvement in gastric remnant carcinoma has been reported recently. Details of the background remnant stomach of EBV-positive lesions, however, have not been well clarified.

METHODS

We screened 17 consecutive gastric remnant carcinoma lesions resected surgically. To detect EBV, we used in situ hybridization (ISH) for EBV-encoded small RNA1 (EBER-1) and we compared the clinicopathologic feature between EBV-positive and -negative gastric remnant carcinoma cases.

RESULTS

EBV was detected in 41.8% (7 of 17) of the lesions by EBER-1 ISH. All 7 EBV-positive lesions developed in the anastomotic site had undergone Billroth-II reconstruction excess 20 years previously (mean 26.4 years). Histologically, all EBV-positive lesions were poorly differentiated adenocarcinomas with intense lymphocyte infiltration. In the adjacent mucosa of carcinomas, moderate or marked intestinal metaplasia was found in 85.7% (6 of 7) of EBV-positive lesions and in 40% (4 of 10) of EBV-negative lesions.

CONCLUSIONS

EBV infection is strongly associated with gastric remnant carcinoma. Atrophic change of remnant gastritis in Billroth-II anastomoses is considered to be the carcinogenic background for EBV-positive gastric remnant carcinoma.

High prevalence of Epstein-Barr virus in gastric remnant carcinoma after Billroth-II reconstruction

BACKGROUND

Epstein-Barr virus (EBV) has been detected in about 10% of gastric carcinoma cases worldwide, and a high prevalence of EBV involvement in gastric remnant carcinoma has been reported recently. Details of the background remnant stomach of EBV-positive lesions, however, have not been well clarified.

METHODS

We screened 17 consecutive gastric remnant carcinoma lesions resected surgically. To detect EBV, we used in situ hybridization (ISH) for EBV-encoded small RNA1 (EBER-1) and we compared the clinicopathologic feature between EBV-positive and -negative gastric remnant carcinoma cases.

RESULTS

EBV was detected in 41.8% (7 of 17) of the lesions by EBER-1 ISH. All 7 EBV-positive lesions developed in the anastomotic site had undergone Billroth-II reconstruction excess 20 years previously (mean 26.4 years). Histologically, all EBV-positive lesions were poorly differentiated adenocarcinomas with intense lymphocyte infiltration. In the adjacent mucosa of carcinomas, moderate or marked intestinal metaplasia was found in 85.7% (6 of 7) of EBV-positive lesions and in 40% (4 of 10) of EBV-negative lesions.

CONCLUSIONS

EBV infection is strongly associated with gastric remnant carcinoma. Atrophic change of remnant gastritis in Billroth-II anastomoses is considered to be the carcinogenic background for EBV-positive gastric remnant carcinoma.

Hepatic angiomyolipoma: radiologic and histopathologic correlation

We present two cases of hepatic angiomyolipoma. Histologic analysis showed that mature adipose tissue occupied 79.0% of the area on the largest cut surface in the first case and 40.2% in the second case. We suggest that the difference in the ratio of adipose tissue volume to its distribution is reflected on diagnostic images.

Meningeal Rosai-Dorfman disease: report of three cases and literature review

Rosai-Dorfman disease is a well-recognized clinicopathological entity, which in rare cases affects the central nervous system, where it mimics meningioma. We describe three cases and review the literature. Histological and immunohistochemical confirmation is essential for definitive diagnosis. In addition to emperipolesis (lymphophagocytosis), reactivity for S-100 and CD68 and nonreactivity for CD-la immunostaining are characteristic features of this histioproliferative disease. In contrast to meningioma, this tumor usually occurs in young males and infiltrates the brain parenchyma.

Embolization of the left portal vein to inferior vena cava shunts for chronic recurrent hepatic encephalopathy via the mesenteric vein

Diagnostic imaging and embolization therapy for very rare intrahepatic portal-systemic shunts with liver cirrhosis are reported. An 82-year-old woman was admitted to the hospital (Yachiyo Hospital) because of hepatic encephalopathy. Computed tomography with contrast enhancement demonstrated anomalous vessels between the portal vein and the inferior vena cava. Those shunts were suspected as the cause of her encephalopathy with hyperammonemia. Portography through McBurney's laparotomy demonstrated two portal-caval shunts; one was from the bifurcation of the portal vein and the other was from the left portal vein. They seemed to originate from the vascular system of the caudate lobe, and were obstructed with stainless coils. The patient is well with a normal serum ammonia level 40 months following the intervention.

Possible involvement of a single histidine residue in the P-type Na+-ATPase of a facultatively anaerobic alkaliphile, Exiguobacterium aurantiacum

Effect of various inhibitors on the P-type Na+-ATPase of a facultatively anaerobic alkaliphile, Exiguobacterium aurantiacum, was examined. The ATPase was extremely sensitive to p-chloromercuriphenylsulfonic acid, a modifier of SH-group. The enzyme was also sensitive to diethylpyrocarbonate, and analysis of the inhibition kinetics by the drug indicated that modification of a single histidine residue per ATPase molecule was sufficient to inactivate the enzyme.

Temporospatial relationship between the expressions of superoxide dismutase and nitric oxide synthase in the developing human brain: immunohistochemical and immunoblotting analyses

To clarify a significant relationship between superoxide dismutase (SOD) and nitric oxide synthase (NOS) in the developing human brain temporospatially, we demonstrate immunohistochemical expression of Cu/Zn-binding SOD1 (SOD1), Mn-containing SOD2 (SOD2), neuronal NOS (nNOS), inducible NOS (iNOS), and nitrotyrosine in human brains from 13 weeks of gestation to 2 years after birth. The immunoreactivities of both SOD1 and SOD2 were detected in fetal neuroblasts at 13 weeks' gestation, as well as mature neurons at the age of 2 years. By contrast, nNOS neurons could be recognized only at 28 and 33 weeks of gestation in the cerebrum, and only at 15, 18, and 23 weeks of gestation in the brain stem. No significant immunoreactivity for iNOS or nitrotyrosine was detected in any type of cell in any region during any stage examined. Immunoblotting analysis using frontal tissue homogenates at 15, 28, 40 weeks of gestation and 18 months of age revealed single band corresponding to SOD1 molecular weight, observed at all stages examined; a single band compatible with the nNOS molecular mass was detected only at the 28th week of gestation. Together with the fact that nitric oxide (NO) plays a potential role in neuronal differentiation, and that large amounts of NO have cytotoxicity from the reaction of NO with superoxide anions, our data suggested that the expressions of both SOD1 and SOD2, as scavengers of superoxide anions, were maintained from an early developmental stage to prepare stage-specific nNOS expression for a potential differentiation role and to elude NO cytotoxicity.