Prognostic Molecular and Biological Characteristics of Phyllodes Tumors of the Breast

Prognosis for some histological variants of a rare breast disease, phyllodes tumors, is evaluated. The prognostic potential of some molecular biological factors significantly correlating with breast cancer prognosis is evaluated on a unique clinical material (244 cases with benign, intermediate, and malignant phyllodes tumors). The development of benign phyllodes tumor relapse directly correlated with the number of G0/1-phase cells and inversely correlated with the number of cells in the G2+M and S phases. The level of steroid hormone receptors in phyllodes tumors cannot serve as a prognostic marker predicting the disease course. The presence of somatic mutations of TP53 gene and loss of heterozygosity of specific intragenic loci in the tumor correlate with the development of disease relapse (p<0.05).

Magnetic field-induced pair density wave state in the cuprate vortex halo

High magnetic fields suppress cuprate superconductivity to reveal an unusual density wave (DW) state coexisting with unexplained quantum oscillations. Although routinely labeled a charge density wave (CDW), this DW state could actually be an electron-pair density wave (PDW). To search for evidence of a field-induced PDW, we visualized modulations in the density of electronic states N(r) within the halo surrounding Bi₂Sr₂CaCu₂O₈ vortex cores. We detected numerous phenomena predicted for a field-induced PDW, including two sets of particle-hole symmetric N(r) modulations with wave vectors Q_P and 2Q _P , with the latter decaying twice as rapidly from the core as the former. These data imply that the primary field-induced state in underdoped superconducting cuprates is a PDW, with approximately eight CuO₂ unit-cell periodicity and coexisting with its secondary CDWs.

Occupational exposure and idiopathic pulmonary fibrosis: a multicentre case-control study in Korea

SETTING

Multicentred hospital-based cases and control subjects in Korea.

OBJECTIVE

To evaluate the association between idiopathic pulmonary fibrosis (IPF) and hazardous materials to which people are occupationally exposed.

DESIGN

A multicentre, hospital-based, matched case-control study was performed. The ratio of IPF cases to controls was 1:1 (n = 78 in each group). IPF cases and controls were matched in terms of age group, sex and place of residence. Conditional logistic regression analysis was performed.

RESULTS

In simple logistic regression analysis, exposure to metal dust and any exposure for >1 year in an occupational setting were significantly associated with IPF (metal dust OR 4.00, 95%CI 1.34-11.97; any exposure OR 3.67, 95%CI 1.02-13.14). After adjustment for environmental and military exposures and smoking history, the OR for metal dust exposure was 4.97 (95%CI 1.36-18.17) in multiple logistic regression analysis.

CONCLUSIONS

Metal dust was associated with incident IPF in Seoul and Gyeonggi Provinces in Korea. This information will be used to support a tailored preventive strategy in specific industries or occupations.

Detection of a Cooper-pair density wave in Bi2Sr2CaCu2O8+x

The quantum condensate of Cooper pairs forming a superconductor was originally conceived as being translationally invariant. In theory, however, pairs can exist with finite momentum Q, thus generating a state with a spatially modulated Cooper-pair density. Such a state has been created in ultracold (6)Li gas but never observed directly in any superconductor. It is now widely hypothesized that the pseudogap phase of the copper oxide superconductors contains such a 'pair density wave' state. Here we report the use of nanometre-resolution scanned Josephson tunnelling microscopy to image Cooper pair tunnelling from a d-wave superconducting microscope tip to the condensate of the superconductor Bi2Sr2CaCu2O8+x. We demonstrate condensate visualization capabilities directly by using the Cooper-pair density variations surrounding zinc impurity atoms and at the Bi2Sr2CaCu2O8+x crystal supermodulation. Then, by using Fourier analysis of scanned Josephson tunnelling images, we discover the direct signature of a Cooper-pair density modulation at wavevectors QP ≈ (0.25, 0)2π/a0 and (0, 0.25)2π/a0 in Bi2Sr2CaCu2O8+x. The amplitude of these modulations is about five per cent of the background condensate density and their form factor exhibits primarily s or s' symmetry. This phenomenology is consistent with Ginzburg-Landau theory when a charge density wave with d-symmetry form factor and wavevector QC = QP coexists with a d-symmetry superconductor; it is also predicted by several contemporary microscopic theories for the pseudogap phase.

Antioxidative effects of ethyl 2-(3-(benzo[d]thiazol-2-yl)ureido)acetate against amyloid β-induced oxidative cell death via NF-κB, GSK-3β and β-catenin signaling pathways in cultured cortical neurons

We have previously shown that 2-(3-(benzo[d]thiazol-2-yl)ureido)acetate (KHG21834) attenuates amyloid beta(Aβ)25-35-induced apoptotic death and shows anti-inflammatory activity against Aβ25-35-induced microglial activation. However, antioxidative effects of KHG21834 against Aβ-induced oxidative stress have not yet been reported. In the present study, we investigated the antioxidative function of KHG21834 in primary cultured cortical neurons, to expand the potential therapeutic efficacy of KHG21834. Pretreatment with KHG21834 protected against Aβ-induced neuronal cell death and mitochondrial damage, and significantly restored GSH levels and the activities of catalase, superoxide dismutase, and glutathione peroxidase, and also suppressed the production of reactive oxygen species and protein oxidation. These results imply that KHG21834 may play a role in cellular defense mechanisms against Aβ-induced oxidative stress in cultured cortical neurons. Furthermore, KHG21834 significantly attenuated the effects of Aβ treatment on levels of NF-κB, β-catenin, and GSK-3β proteins in cortical neurons. Taken together, our results suggest that the antioxidant effects of KHG21834 may result at least in part from its ability to regulate the NF-κB, β-catenin, and GSK-3β signaling pathways. To our knowledge, this is the first report showing that KHG21834 significantly attenuates Aβ25-35-induced oxidative stress in primary cortical neurons, and provides novel insights into KHG21834 as a possible therapeutic agent for the treatment of Aβ-mediated neurotoxicity involving oxidative stress.

Simultaneous transitions in cuprate momentum-space topology and electronic symmetry breaking

The existence of electronic symmetry breaking in the underdoped cuprates and its disappearance with increased hole density p are now widely reported. However, the relation between this transition and the momentum-space (k-space) electronic structure underpinning the superconductivity has not yet been established. Here, we visualize the Q = 0 (intra-unit-cell) and Q ≠ 0 (density-wave) broken-symmetry states, simultaneously with the coherent k-space topology, for Bi₂Sr₂CaCu₂O(8+δ) samples spanning the phase diagram 0.06 ≤ p ≤ 0.23. We show that the electronic symmetry-breaking tendencies weaken with increasing p and disappear close to a critical doping p(c) = 0.19. Concomitantly, the coherent k-space topology undergoes an abrupt transition, from arcs to closed contours, at the same p(c). These data reveal that the k-space topology transformation in cuprates is linked intimately with the disappearance of the electronic symmetry breaking at a concealed critical point.

Brain MRI measurements at a term-equivalent age and their relationship to neurodevelopmental outcomes

BACKGROUND AND PURPOSE

An increased prevalence of disabilities is being observed as more preterm infants survive. This study was conducted to evaluate correlations between brain MR imaging measurements taken at a term-equivalent age and neurodevelopmental outcome at 2 years' corrected age among very low-birth-weight infants.

MATERIALS AND METHODS

Of the various brain MR imaging measurements obtained at term-equivalent ages, reproducible measurements of the transcerebellar diameter and anteroposterior length of the corpus callosum on sagittal images were compared with neurodevelopmental outcomes evaluated by the Bayley Scales of Infant Development (II) at 2 years' corrected age (mean ± standard deviation, 16.1 ± 6.4 months of age).

RESULTS

Ninety infants were enrolled. The mean gestational age at birth was 27 weeks and the mean birth weight was 805.5 g. A short corpus callosal length was associated with a Mental Developmental Index <70 (P = .047) and high-risk or diagnosed cerebral palsy (P = .049). A small transcerebellar diameter was associated with a Psychomotor Developmental Index <70 (P = .003), Mental Developmental Index <70 (P = .004), and major neurologic disability (P = .006).

CONCLUSIONS

A small transcerebellar diameter and short corpus callosal length on brain MR imaging at a term-equivalent age are related to adverse neurodevelopmental outcomes at a corrected age of 2 years and could be a useful adjunctive tool for counseling parents about future developmental outcomes.

[Minimally invasive methods for the treatment of the recurrent varicosis]

The experience of 193 cases of recurrent variceal disease (RVD) was summarized. Major reasons of recurrences after surgery were analyzed. Traditional and miniinvasive RVD treatment approaches are listed and its efficacy was thoroughly analyzed. Thus, endovasal laser coagulation and phleboscleroobliteration of insufficient communicant veins were effective in 85% and 65% of RVD, respectively. Possibilities of cryophleboextraction as well as apparate phlebectomy with transillumination were described.

Abstract P4-09-14: Invasive Lobular Carcinoma Is a Prototype of Luminal A Breast Cancer Subtype and Rare in Korea

Purpose Invasive lobular carcinoma (ILC) is known to be the second most frequent histologic subtype, occupying 10% of invasive breast cancer in the Western countries. The present study was designed to assess the clinical characteristics and outcomes of ILC compared to general invasive ductal carcinoma (IDC) and the luminal A subtype (LA-IDC).

Methods The study population included d 2916 patients with invasive breast cancer consecutively diagnosed at the National Cancer Center, Korea between 2001 and 2008. The clinicopathological characteristics and clinical outcomes were retrospectively reviewed.

Results There were 83 pts (2.8%) diagnosed with ILC and 1,088 pts (37.3%) with LA-IDC. Mean age was 48.2 years of all patients, 48.3 years of ILC group and 47.9 years of LA-IDC group. The ILC patients presented with a larger tumor size (≥T2, 59.8% vs. 38.8%, P=0.001), lower histologic grade (HG 1 or 2, 90.4% vs 64.4%, P&lt;0.001), more often estrogen receptor (ER) and progesterone receptor (PgR) positivity (ER+, 90.4% vs. 64.4%, P&lt;0.001; PgR+, 71.1% vs. 50.1%, P&lt;0.001), HER2 negativity (97.5% vs. 74.9%, P&lt;0.001), lower Ki-67 expression (10.3% ± 10.6% vs. 20.6% ± 19.8%, P&lt;0.001), and luminal A subtypes (91.4% vs. 51.2%, P&lt;0.001) compared to the IDC group. Six (7.2%) ILC patients and 359 (12.7%) IDC patients developed disease recurrence with a median follow-up of 56.4 months (range 4.9-136.6 months). Although ILC showed similar prognosis to IDC in general (5-year DFS rate, 91.7% in ILC vs. 87.4% in IDC, P=0.31; 5-year OS rate, 93.6% in ILC vs. 92.5% in IDC, P=0.38), its outcome was closer to LA-IDC, and better than non LA-IDC (LA-IDC (ref); ILC, HR 0.77 in recurrence, 95% CI 0.31-1.90, P=0.57; HR 0.75 in death, 95% CI 0.18-3.09, P=0.70; non LA-IDC, HR 1.69 in recurrence, 95% CI 1.23-2.33, P=0.001; HR 1.50 in death, 95% CI 0.97-2.33, P=0.07) in univariate and multivariate analysis.

Conclusions ILC is a very rare histologic subtype of breast cancer in Korea compared to the Western countries and has distinctive clinicopathological characteristics similar to those of LA-IDC. Acknowledgement: supported by NCC grant #0910320

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-09-14.

Abstract P2-09-01: Serial [18F] FDG-PET after the 2nd Cycle of Preoperative Chemotherapy Is Predictive for Pathological Complete Response in Stage II/III Breast Cancer

Purpose: One of substudies of the prospective trials aimed to evaluate the usefulness of serial [18F] 2-fluoro-2-deoxy-D-glucose-positron emission tomography ([18F] FDG-PET) for predicting pathological complete response (pCR) in stage II/III breast cancer with preoperative chemotherapy (PST).

Methods: Serial PET was undertaken in 57 breast cancer patients enrolled in three different neoadjuvant trials: 35 patients from a phase II study with paclitaxel/gemcitabine/trastuzumab with ClinicalTrial.gov NCT 00532857, 9 patients from a phase Ib study with paclitaxel/gemcitabine/lapatinib with ClinicalTrial.gov NCT 01133912, and 13 patients from a phase Ib with paclitaxel/gemcitabine/sunitinib with ClinicalTrial.gov NCT0 1070706. All patients received 6 cycles of PST followed by surgery and radiotherapy. We assessed the peak standardized uptake value (SUVp) in the primary tumor at the baseline and after the 2nd cycle (37 patients) or after completion (20 patients) of 6 cycles of PST, and calculated the reduction rate (RR) of the SUVp. Pathological response was classified into pCR and non-pCR. To compare the mean of SUVp and RR of SUVp between different response groups, two-way tables and chi-square tests were used

Results: Fifteen (40.6%) of 37 patients who took repeat PET after the 2nd PST and 15 (75%) of 20 patients after completion of PST achieved a pCR with overall pCR rate of 52.6% in the primary tumor. In patients with repeat PET after the 2nd PST, post-treatment SUVp and RR of the SUVp in primary tumors were significantly different by the pathological response (post-treatment SUVp, 1.54 ± 0.63 in pCR vs 2.54 ± 1.06 in non-pCR, P=0.002; RR of the SUVp, 79.2% ± 11.9% in pCR vs 68.9% ± 15.4% in non-pCR, P=0.03). However, in patients with repeat PET after completion of PST, there were no statistical differences of these values (post-treatment SUVp, 1.09 ± 0.63 in pCR vs 1.29 ± 0.36 in non-pCR, P=0.42; RR of the SUVp, 83.7% ± 14.0% in pCR vs 67.5% ± 21.1% in non-pCR, P=0.17)

Conclusions: This study demonstrated that repeat PET after the 2nd cycle of PST, not after completion of PST could predict pCR in stage II/III breast cancer with preoperative chemotherapy. Acknowledgement NCC Grant #0910320.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-01.

Fractional charges on an integer quantum Hall edge

We propose ways to create and detect fractionally charged excitations in integer quantum Hall edge states. The charge fractionalization occurs due to the Coulomb interaction between electrons propagating on different edge channels. The fractional charge of the solitonlike collective excitations can be observed in time-resolved or frequency-dependent shot noise measurements.

[Outcomes of surgical management of patients with thromboses of the superficial and deep venous system]

Presented herein are the outcomes of examination, surgical management and conservative treatment of 211patients presenting with phlebothromboses of the superficial and deep venous system of the lower limbs. Of these, 119 were treated conservatively and 92 underwent various types of surgical intervention, however those treated conservatively were not included into the final analysis. The diagnosis was verified using ultrasonographic duplex scanning (USDS) of the venous system of the inferior vena cava basin, allowing of assessing the condition of the superficial and deep venous system of the both lower extremities, followed by determining the length of the thrombotic lesion. Based on the findings of USDS, 68 (74%) patients were found to have thrombosis of the superficial veins and 24 (26%) subjects were diagnosed with deep-vein thrombosis. All the patients in order to prevent thromboembolic complications were subjected to active surgical policy. Also studied were methods of surgical management in patients with various-localization thromboses. Based on the obtained findings, it was determined that surgical treatment of patients with thromboses of the superficial and deep venous system of the lower limbs is a justified method to prevent the development of pulmonary thromboembolism.

[Minimally invasive interventions in surgical management of varicose diseases and its relapses]

Over the past several decades, many surgical methods of treatment for varicose disease have been implemented into clinical practice. Nonetheless, an intrinsically too traumatic nature thereof unsatisfactory cosmetic outcomes obtained, long-term postoperative rehabilitation required, and high recurrence rates reported send us in search of minimally invasive but at the same time highly efficient methods of treatment for varicose disease. The present article deals with the experience gained by Russian and foreign authors in and suggesting efficiency of novel minimally invasive technologies used for treatment of both newly diagnosed varicose disease and its relapsing forms. This is followed by analysing different variants of the procedural techniques involved.

[Combined therapy of lower limb variceal disease]

Complex surgical and medical therapy was used for 386 patients with lower limb variceal disease 2nd and 3rd form (segmental and disseminated varices with reflux through the superficial and perforant veins) and chronic venous insufficiency stage I (according to the Russian classification). Five main types of surgical interventions were fulfilled: combined phlebectomy, trunk scleroobliteration, short stripping with insufficient perforants ligation, short stripping with excision or damage of variceal influx, and short stripping with trunk scleroobliteration. Besides, vast majority of patients received venotonic drug Phlebodia 600 pre and postoperatively. Miniinvasive and atraumatic interventions were characterized by the decrease of postoperative subcutaneous hematomas, no incidence of n. saphenus damage and lymphorrhea, good cosmetic outcomes due to the absence of additional incisions. The duration of postoperative recovery correlated with intraoperative trauma and Phlebodia 600 administration. In conclusion, combination of complex surgical procedures and venotonic drugs can be widely used for the management of lower limb variceal disease, especially for its uncomplicated forms. While preserving the radicality, these interventions yield favorite esthetical results, reduce the time of postoperative recovery and disability, thus, appear to be cost effective.

[Influence of neoadjuvant therapy on VEGFR-2 levels in tumor and blood serum from breast cancer patients]

Degree and trends of changes taking place in the angiogenic factors VEGF and VEGFR-2 were studied in cytosols and blood serum sampled from breast cancer patients in the course of neoadjuvant therapy. Such evidence was evaluated vis-alpha-vis basic indices for clinic-morphological features of the disease. The study included 30 cases of locally-advanced tumors. Our results pointed to an influence produced by preoperative therapy on the levels of angiogenic factors both in tumor and serum. However, trends of development of such parameters are different and independent of therapeutic modality. Correlation was established between VEGF and VEGFR-2 levels in residual tumor, on the one hand, and degree of therapeutic pathomorphosis, on the other.

Complicated giant diverticulum of the transverse colon accompanied by right inguinal hernia of the greater omentum

Giant colonic diverticulum is a very rare entity in colonic diverticular disease and is characterized by a high rate of complications such as perforation, abscess formation and even carcinoma. We report a case of a complicated giant diverticulum of the transverse colon accompanied by a right inguinal hernia of the greater omentum in a 52-year-old man, as demonstrated on CT.

Dynamical layer decoupling in a stripe-ordered high-T(c) superconductor

In the stripe-ordered state of a strongly correlated two-dimensional electronic system, under a set of special circumstances, the superconducting condensate, like the magnetic order, can occur at a nonzero wave vector corresponding to a spatial period double that of the charge order. In this case, the Josephson coupling between near neighbor planes, especially in a crystal with the special structure of La(2-x)Ba(x)CuO(4), vanishes identically. We propose that this is the underlying cause of the dynamical decoupling of the layers recently observed in transport measurements at x = 1/8.

Sonographic windsock sign of a duodenal web

We report a neonate with a duodenal web demonstrating the windsock appearance on US. In neonates, duodenal web is rare and its windsock appearance is also rarely seen. The windsock sign of duodenal web has been a well-known finding on upper gastrointestinal series. The corresponding windsock appearance may be demonstrated on US. Duodenal web can, therefore, be accurately diagnosed by identifying the sonographic windsock sign even in neonates.

Quantification of ground-glass opacity on high-resolution CT of small peripheral adenocarcinoma of the lung: pathologic and prognostic implications

OBJECTIVE

The purpose of our study was to correlate the high-resolution CT findings of small peripheral adenocarcinoma of the lung with underlying histopathology and to evaluate the prognostic implications of the CT findings.

MATERIALS AND METHODS

The high-resolution CT findings of small peripheral adenocarcinoma of the lung in 224 patients were analyzed by two independent observers for location, size, marginal characteristics, and extent of ground-glass opacity and necrosis. The pathologic specimens were reviewed by an experienced lung pathologist.

RESULTS

One hundred and thirty-two patients had bronchioloalveolar carcinoma and 92 had adenocarcinoma. The extent of ground-glass opacity was greater in bronchioloalveolar carcinomas (mean +/- SD, 29% +/- 31.6%) than in other adenocarcinomas (8% +/- 13.3%) (p < 0.001). The extent of ground-glass opacity was significantly greater in patients without recurrence (p = 0.020) and those without nodal (p = 0.017) or distant (p = 0.007) metastases than in patients with nodal or distant metastases or in whom the carcinoma had recurred.

CONCLUSION

The extent of ground-glass opacity in a nodule is greater in bronchioloalveolar carcinomas than in other adenocarcinomas. Greater extent of ground-glass opacity also correlates with improved prognosis.

High-resolution CT of alveolar filling disorders

Airspace filling process is characterized on CT by the presence of one or more fairly homogeneous areas of consolidation with little or no volume loss. The consolidation may be segmental, subsegmental, lobular, or acinar (10 mm or less in diameter). Poorly defined centrilobular nodules may be associated. The margin of the consolidation usually is poorly defined except in the areas in which the consolidation abuts the pleura. Air-containing bronchi or bronchioles (CT air bronchograms or air bronchiolograms) are seen frequently. Many diseases can present with alveolar filling disorders. Because the HRCT findings overlap among various alveolar filling disorders, it may be impossible to make a definite diagnosis with HRCT findings alone. Integration of HRCT findings including disease pattern and distribution and time factors including evolution and resolution of the disease, however, may enable to narrow differential diagnosis of alveolar filling diseases. Furthermore, clinical and laboratory findings also may provide helpful clues to reach a reasonable diagnosis. The role of HRCT in alveolar filling disorders is not limited to diagnosis. HRCT also plays a useful role in determining the extent of disease and in identifying accompanying abnormalities, and complications of the primary disease.

Focal organizing pneumonia: CT and pathologic findings

The purpose of this study was to describe the CT findings of focal organizing pneumonia and to compare the findings with pathology. CT findings of histologically proven focal organizing pneumonias in 26 consecutive patients were analyzed. In 17 patients who had undergone surgical resections, the findings were correlated with pathology. Focal organizing pneumonias appeared as a nodule (n= 13) or a mass (n=13), ranging from 9 mm to 66 mm in diameter. Ground-glass opacity was seen in 6/13 (46%) nodules and 6.5/13 (50%) masses (k=.48) with an extent ranging from 5% to 75% (mean, 16%). In 4/26 (15%) patients, the extent was more than 50% of the lesion. They showed smooth (n=4), lobulated (n=8), spiculated (n=1), or lobulated and spiculated margin (n=13). On correlative analysis, nodule or mass on CT consisted histologically of intraalveolar exudate or microabscess, chronic inflammatory cell infiltration, fibrotic nodules, and polypoid granulation tissue in the alveolar or bronchiolar spaces. Ground-glass opacity consisted of interstitial fibrosis and chronic inflammatory cell infiltration and intraalveolar polypoid granulation tissue. Focal organizing pneumonia may simulate a lung cancer with variable appearances on CT and the findings reflect underlying histopathology of the disease.

Interstitial pneumonia in progressive systemic sclerosis: serial high-resolution CT findings with functional correlation

PURPOSE

The aim of our study was to assess the serial high-resolution CT findings and their correlation with the results of pulmonary function tests in patients with progressive systemic sclerosis (PSS) and interstitial pneumonia.

METHOD

The study included 40 patients with symptoms or signs of PSS and interstitial pneumonia, who underwent serial high-resolution CT scans (mean follow-up period 39 months). Seventeen patients simultaneously had serial pulmonary function tests (mean follow-up period 40 months). On high-resolution CT, the pattern and extent of parenchymal abnormalities were retrospectively analyzed. Serial changes on high-resolution CT were correlated with the changes of pulmonary function tests.

RESULTS

On initial CT, areas of ground-glass opacity (mean +/- SD extent 17.7 +/- 12.3% in all patients), irregular linear opacity (4.4 +/- 4.4% in 36 patients), small nodules (3.9 +/- 12.5% in 28), consolidation (1.9 +/- 4.2% in 13), and honeycombing (1.9 +/- 3.8% in 12) were seen. The total disease extent (p = 0.042) and extents of ground-glass opacity (18.9 +/- 15.5%; p = 0.04) and honeycombing (5.0 +/- 7.2%; p = 0.002) increased significantly on follow-up CT. Both forced vital capacity (from 2.4 +/- 0.4 to 2.0 +/- 0.4 L; p = 0.002) and forced expiratory volume in 1 s (from 2.0 +/- 0.4 to 1.6 +/- 0.3 L; p = 0.013) decreased significantly on follow-up examination. The increase in the extent of honeycombing on CT correlated significantly with the decrease in diffusing capacity for carbon monoxide (r = -0.411, p = 0.049).

CONCLUSION

In patients with PSS and interstitial pneumonia, the overall extent of disease and extents of honeycombing and ground-glass opacity increase significantly on follow-up CT. Increase of honeycombing correlates well with decrease of diffusing capacity for carbon monoxide.

Using edge enhancement to identify subtle findings on soft-copy neonatal chest radiographs

OBJECTIVE

The purpose of this study was to evaluate whether edge enhancement could improve the visibility of subtle findings on soft copies of neonatal chest radiographs.

MATERIALS AND METHODS

Two radiologists reviewed 82 soft-copy neonatal chest radiographs before and after the application of edge enhancement on our picture archiving and communication system (PACS). The visibility of a pneumothorax (n = 22), central venous catheter (n = 32), umbilical arterial catheter (n = 36), endotracheal tube (n = 40), and normal anatomic structures (the minor fissure, anterior segmental bronchus of the right upper lobe, and aortic arch, n = 57) was evaluated. Six of 22 soft-copy images depicting a pneumothorax were excluded from the evaluation of image quality either because of the large size of the pneumothorax itself (n = 7) or because of the lack of confirmatory evidence that would have been provided by an additional lateral decubitus (n = 6) or cross-table lateral radiograph (n = 3). Image quality was evaluated by visual grading analysis.

RESULTS

The visibility of a pneumothorax (p < 0.01), vascular catheters (p < 0.001), the minor fissure (p < 0.001), and the anterior segmental bronchus of the right upper lobe (p < 0.001) improved significantly after applying edge enhancement to soft copies of neonatal chest radiographs, whereas the visibility of the aortic arch did not improve. Evaluations of the improvements in the visibility of the endotracheal tube were inconsistent.

CONCLUSION

Application of edge enhancement to soft copies of neonatal chest radiographs helps radiologists to identify small pneumothoraces, vascular catheters, and delicate normal structures, thereby improving the detection of subtle chest findings in the neonatal intensive care unit.

Acid secretion from a heterotopic gastric mucosa in the upper esophagus demonstrated by dual probe 24-hour ambulatory pH monitoring

Heterotopic gastric mucosa in the upper esophagus is frequently found during endoscopic examination. Although most patients with heterotopic gastric mucosa of the upper esophagus, referred as inlet patch, are asymptomatic, symptomatic patients with complications resulting from this ectopic mucosa have also been reported. Acid secretion by the inlet patch has been suggested in some reports. We report a case of heterotopic gastric mucosa in the upper esophagus, with secretion of acid, demonstrated by continuous ambulatory pH monitoring, and the improvement of pharyngeal symptoms after the use of a proton pump inhibitor.

Malignant thymic epithelial tumors: CT-pathologic correlation

OBJECTIVE

The purpose of our study was to describe and compare the CT and pathologic findings of atypical thymoma and thymic carcinoma.

MATERIALS AND METHODS

Twenty-seven consecutive patients (14 men, 13 women ranging in age from 22 to 77 years [mean age, 52 years]) with pathologically proven atypical thymoma (n = 9) and thymic carcinoma (n = 18) constituted the study population. The chest CT findings in each of the 27 patients were reviewed retrospectively in consensus by two chest radiologists. These findings were correlated with pathologic findings.

RESULTS

The tumors were located in the anterior mediastinum, and most tumors had a lobulated margin (24/27, 89%). Atypical thymomas were significantly smaller (mean, 4.7 cm) than thymic carcinomas (mean, 7.2 cm) (p = 0.041) on CT. The findings of invasion of the great vessels, lymph node enlargement, extrathymic metastases, and phrenic nerve palsy were seen only in patients with thymic carcinoma. The frequencies of necrosis, intratumoral calcification, pleural effusion, pleural implants, pericardial effusion, and obliteration of the mediastinal fat plane were not significantly different between atypical thymomas and thymic carcinomas (p > 0.05). Various histologic subtypes were included in thymic carcinoma. The tumor necrosis and calcification seen on CT were confirmed at pathologic examination.

CONCLUSION

When a large thymic tumor appears with invasion of the great vessels, lymph node enlargement, phrenic nerve palsy, or extrathymic metastases on CT, thymic carcinoma rather than atypical thymoma should be considered.

Nitric oxide mediates platelet activating factor-induced microvascular leakage in rat airways

Platelet activating factor (PAF), a highly potent chemical mediator in inflammation and allergic reactions, induces microvascular leakage in several tissues. In rat airways, PAF-induced microvascular leakage is probably mediated by an endothelial cell receptor in the microvessels. Nitric oxide (NO), first identified as endothelium-derived relaxing factor, has been suggested to be a mediator of airway microvascular leakage. However, the role of NO in PAF-induced microvascular leakage in the airways has not yet been established. The aim of this study was to investigate the role of NO in PAF-induced microvascular leakage in rat nasal mucosa and trachea. We injected PAF (1 microg/kg) intravenously, and the amount of PAF-induced microvascular leakage was measured with extravasation of Evans blue dye (30 mg/kg, injected intravenously 5 minutes before the injection of PAF) by means of spectrophotometry and fluorescence microscopy. Five Sprague-Dawley rats were pretreated with NG-nitro-L-arginine methyl ester (L-NAME; 10 mg/kg, intravenously injected 1 hour before the injection of PAF) to inhibit NO synthase, and control rats (n = 4) were pretreated with normal saline solution. The average amount of extravasated Evans blue dye was significantly lower in the L-NAME-pretreated rats than in the control rats (t-test, p < .01). Tissue sections of the L-NAME-pretreated rats clearly showed a decreased extravasation of Evans blue dye on fluorescence microscopy. In conclusion, pretreatment with L-NAME clearly inhibited PAF-induced microvascular leakage in the nasal mucosa and trachea of rats. This finding implies that PAF may activate the constitutive endothelial NO synthase in the microvessels, and that activated endogenous NO may mediate PAF-induced microvascular leakage in rat airways.

Biological monitoring of occupational exposure to N,N-dimethylformamide--the effects of co-exposure to toluene or dermal exposure

OBJECTIVES

The objective of this study is to assess the exposure and intake dose of N,N-dimethylformamide (DMF) and the correlation between them, according to the type of exposure for the workers in the DMF industry.

METHODS

We monitored 345 workers occupationally exposed to DMF, from 15 workshops in the synthetic fiber, fiber coating, synthetic leather and paint manufacturing industries. Ambient monitoring was carried out with personal samplers to monitor the external exposure. Biological monitoring was done to determine the internal dose by analyzing N-methylformamide (NMF) in end-shift urine. Work procedure and exposure type of each DMF workshop was carefully surveyed, to classify workers by exposure type according to work details. Workers were classified into three groups (Group A: continuous and direct exposure through inhalation and skin; Group B: intermittent and short-term exposure through inhalation and skin; Group C: continuous and indirect exposure mostly through inhalation).

RESULTS

Geometric mean of DMF concentration in air was 2.62 (GSD 5.30) ppm and that of NMF in urine was 14.50 (GSD 3.89) mg/l. In the case of continuous absorption through inhalation and dermal exposure (Group A), the value of NMF in urine corresponding to 10 ppm of DMF was 45.3 mg/l (r = 0.524, n = 178), 39.1 mg/g creatinine (r = 0.424), while it was 37.7 mg/l (r = 0.788, n = 37), 24.2 mg/g creatinine (r = 0.743) in the case of absorption mostly through inhalation (Group C). Creatinine correction reduced the correlation between two parameters.

CONCLUSION

The NMF in urine corresponding to 10 ppm DMF, of the dermal and inhalation exposure group was 39.1 mg/g creatinine (r = 0.424, n = 178), while that of the inhalation exposure-only group was 24.2 mg/g creatinine (r = 0.743, n = 37). Co-exposure with toluene reduced the NMF excretion in urine.

Cytomegalovirus pneumonia: high-resolution CT findings in ten non-AIDS immunocompromised patients

OBJECTIVE

To describe the HRCT findings of cytomegalovirus (CMV) pneumonia in non-AIDS immunocompromised patients

MATERIALS AND METHODS

This retrospective study involved the ten all non-AIDS immunocompromised patients with biopsy-proven CMV pneumonia and without other pulmonary infection encountered at our Medical Center between January 1997 and May 1999. HRCT scans were retrospectively analysed by two chest radiologists and decisions regarding the findings were reached by consensus.

RESULTS

The most frequent CT pattern was ground-glass opacity, seen in all patients, with bilateral patchy (n = 8) and diffuse (n = 2) distribution. Other findings included poorly-defined small nodules (n = 9) and consolidation (n = 7). There was no zonal predominance. The small nodules, bilateral in eight cases and unilateral in one, were all located in the centrilobular region. Consolidation (n = 7), with patchy distribution, was bilateral in five of seven patients (71%). Pleural effusion and bilateral areas of thickened interlobular septa were seen in six patients (60%).

CONCLUSION

CMV pneumonia in non-AIDS immunocompromised patients appears on HRCT scans as bilateral mixed areas of ground-glass opacity, poorly defined centrilobular small nodules, and consolidation. Interlobular septal thickening and pleural effusion are frequently associated.

Fetus-in-fetu in the scrotal sac of a newborn infant: imaging, surgical and pathological findings

We report a case of fetus-in-fetu located in the scrotal sac of a newborn male infant. Plain radiography (including specimen radiography), ultrasonography and MRI clearly demonstrated vertebral column, ribs, skull, pelvic bones, femurs and a portion of tibiae and humeri. The diagnosis was confirmed by pathological examination.

Hypoxia-induced paracrine regulation of vascular endothelial growth factor receptor expression

Vascular endothelial growth factor (VEGF)/vascular permeability factor (VPF), an endothelial cell (EC)-specific mitogen, stimulates angiogenesis in vivo, particularly in ischemic regions. VEGF/VPF expression by cells of hypoxic tissues coincides with expression of its two receptors, KDR and flt-1, by ECs in the same tissues. We investigated whether hypoxia or hypoxia-dependent conditions operate in coordinating this phenomenon. Human umbilical vein and microvascular ECs were exposed to direct hypoxia or to medium conditioned (CM) by myoblasts maintained in hypoxia for 4 d. Control ECs were maintained in normoxia or normoxia-CM. Binding of 125I-VEGF to ECs was then evaluated. Hypoxic treatment of ECs had no effect on 125I-VEGF binding. However, treatment of ECs with hypoxia-CM produced a threefold increase in 125I-VEGF binding, with peak at 24 h (P < 0.001, ANOVA). Scatchard analysis disclosed that increased binding was due to a 13-fold increase in KDR receptors/cell, with no change in KDR affinity (Kd = 260 +/- 51 pM, normoxia-CM versus Kd = 281 +/- 94 pM, hypoxia-CM) and no change in EC number (35.6 +/- 5.9 x 10(3) ECs/cm2, normoxia-CM versus 33.5 +/- 5.5 x 10(3) ECs/cm2, hypoxia-CM). Similar results were obtained using CM from hypoxic smooth muscle cells. KDR upregulation was not prevented by addition to the hypoxia-CM of neutralizing antibodies against VEGF, tumor necrosis factor-alpha, transforming growth factor beta 1 or basic fibroblast growth factor. Similarly, addition of VEGF or lactic acid to the normoxia-CM had no effect on VEGF binding. We conclude that mechanism(s) initiated by hypoxia can induce KDR receptor upregulation in ECs. Hypoxic cells, normal or neoplastic, not only can produce VEGF/VPF, but can also modulate its effects via paracrine induction of VEGF/VPF receptors in ECs.

Hypoxia induces vascular endothelial growth factor in cultured human endothelial cells

Smooth muscle cells, macrophages, glial cells, keratinocytes, and transformed cells have been established as synthesis sites for vascular endothelial growth factor (VEGF). The modulating effects of VEGF are essentially limited to endothelial cells (ECs), the only cell type consistently shown to express VEGF receptors. VEGF has thus been considered to act exclusively via a paracrine pathway. We sought to determine whether the role of human ECs might, under selected conditions, extend beyond that of a target to involve contingency synthesis of VEGF. In both unstimulated human umbilical vein ECs (HUVECs) and human derma-derived microvascular ECs (HMECs), Northern analysis detected no VEGF transcripts. Phorbol-12-myristate 13-acetate (10(-7) M) treatment, however, induced VEGF mRNA expression in both HUVECs and HMECs, peaking at 3 and 6 h, respectively, and returning to undetectable levels by 12 h. In vitro exposure of HUVECs to a hypoxic environment (pO2 = 35 mm of mercury) for 12, 24, and 48 h and exposure of HMECs for 6, 12, 24, and 48 h induced VEGF mRNA in a time-dependent fashion. Re-exposure to normoxia (pO2 = 150 mm of mercury) for 24 h after 24 h of hypoxia returned VEGF mRNA transcripts to undetectable levels in HUVECs. Cobalt chloride and nickel chloride treatment each induced VEGF mRNA in ECs. Cycloheximide treatment further augmented expression of VEGF mRNA induced by cobalt chloride, nickel chloride, and hypoxia in HUVECs. VEGF protein production in hypoxia HUVECs was demonstrated immunohistochemically. Conditioned media from hypoxic HUVECs caused a 2-fold increase in the incorporation of tritiated thymidine. Finally, immune precipitates of anti-KDR probed with anti-Tyr(P) antibodies demonstrated evidence of receptor autophosphorylation in hypoxic but not normoxic HUVECs. These findings thus establish the potential for an autocrine pathway that may augment and/or amplify the paracrine effects of VEGF in stimulating angiogenesis.

Variable expression of the estrogen receptor in normal and atherosclerotic coronary arteries of premenopausal women

BACKGROUND

The relative absence of coronary atherosclerosis in premenopausal women has been established. Estrogen is presumed to play a role in the protection of coronary arteries from atherosclerosis, and part of this protective effect appears to be mediated by amelioration of serum lipid profiles. However, all of the atheroprotective effect of estrogen is not explained by alteration of serum lipids. In this study, we attempt to identify evidence of estrogen receptors in coronary artery specimens of female patients and in human vascular smooth muscle cells.

METHODS AND RESULTS

Postmortem coronary artery specimens were obtained from premenopausal (n = 18) and postmenopausal (n = 22) women who died with significant coronary artery disease (n = 19) and from noncardiac causes with normal coronary arteries (n = 21). Sections were examined for evidence of estrogen receptor expression using a monoclonal antibody stain. Radioligand binding assays for estrogen receptors were performed on human vascular smooth muscle cells in culture, and gel retardation assays were performed to confirm the presence of functional estrogen receptors. Estrogen receptor expression was identified by immunostaining in a total of 21 coronary arteries, with the majority of normal arteries (15 positive of 21 total, P = .0117) demonstrating evidence of estrogen receptor expression. Conversely, a minority (6 of 19, P = NS) of atherosclerotic arteries were positive for estrogen receptor expression. Furthermore, the relation between estrogen receptor expression and absence of coronary atherosclerosis was most evident in premenopausal subjects, with 10 of 12 normal arteries in this group demonstrating evidence of estrogen receptors, whereas only 1 of 6 atherosclerotic coronary arteries was positive (P = .0062). Radioligand binding assays confirmed the presence of estrogen receptors at significant concentrations in intact human vascular smooth muscle cells. Gel retardation assays also documented the presence of functional estrogen receptors in extracts from human vascular smooth muscle cells.

CONCLUSIONS

This investigation provides evidence of estrogen receptors in smooth muscle cells from human coronary arteries. The demonstrated relation between the presence of the receptors and the absence of atherosclerosis in premenopausal women suggests that these receptors may play a functional role in coronary atheroprotection.

[Na,K-ATPase activity in the myocardial sarcolemma in ischemia]

The total time-controlled ischemia (up to 45 min) was studied for its effect on the Na,K-ATPase activity, content of nonesterified fatty acids (NEFA) and intensity of lipid peroxidation (LP) in sarcolemmal (SL) preparations and soluble fractions (SF) from the rat and guinea-pig left ventricles. A strong correlation between Na, K-ATPase inhibition and NEFA accumulation was revealed in the SF. On the contrary, changes in the NEFA content and LP level both in SL and SF did not correlate with a decrease in the enzymic activity. Pretreatment with albumin (0.5 mg/ml) induced equally small increase both in the control and in the ischemic SL preparations. It is suggested that the Na,K-ATPase activity during a short period of myocardial ischemia (up to 45 min) may be due to the NEFA accumulation in the cytosolic and/or extracellular space, but not in SL.

[The mechanism of formation of spectrum of nonesterified fatty acids in biological fluids of rabbits with alimentary hypercholesterolemia]

Increase in activity of fatty tissue lipoprotein lipase and blood plasma post-heparin lipoprotein lipase, decrease in activity of myocardial lipoprotein lipase as well as in the rate of intracellular lipolysis of triacylglycerols in fatty tissue, unaltered activity of liver tissue endothelial lipase were observed in rabbits with moderate alimentary hypercholesterolemia (9.63 +/- 3.48 mumole of cholesterol per ml of blood plasma as compared with 1.51 +/- 0.16 mumole/ml under conditions of normal state). The ratio of stearate was increased in composition of unesterified fatty acids from blood plasma, mesenteric lymph and myocardial sarcolemma as well as in triacylglycerols of chylomicrons total fraction, in very low density lipoproteins and their remnants. Ratios free stearate/total content of other acids correlated in blood plasma and myocardial sarcolemma (r = 0.65). Any shifts in the spectra of fatty acid residues of phospholipids were not found in myocardial membranes. In rabbits with alimentary hypercholesterolemia importance of intestine-derived triacylglycerols for production of circulating unesterified fatty acids was increased, as a result of which the ratio of various acyls, metabolized in myocardium, was altered.

[Changes in the activity and regulatory properties of Na, K-ATPase from the myocardial sarcolemma in total graded ischemia]

Na, K-ATPase activity of the rat and guinea-pig myocardial sarcolemma and its sensitivity to digoxin (DG) and carbamylcholine (CCh) were investigated during experimental ischemia. Ischemia was induced by the incubation of hearts in the air at 37 degrees C. This 15-, 30- and 45-min treatment led to a decrease in enzymatic activity which was similar in both animal species. Dose-related dependence of DG effect (10(-8)-10(-2) M) on sarcolemmal Na, K-ATPase activity of guinea-pig ischemic hearts did not differ from the control, whereas the rat enzyme sensitivity to glycosides rose with the progress of ischemia. CCh (10(-7)-10(-3) M) produced an inhibition of Na, K-ATPase activity which had reached 40% both in the rat and guinea-pig myocardial preparations. This effect was blocked by atropine (10(-6) M). The magnitude of enzyme responses to CCh declined depending on the duration of ischemia, with it being greater in guinea-pig sarcolemma than in rat membrane. The increased sensitivity of the rat Na, K-ATPase to CCh was also observed.