The Lymphatic Drainage Pattern of Internal Mammary Sentinel Lymph Node Identified by Small Particle Radiotracer (99mTc-Dextran 40) in Breast

PURPOSE

The purpose of this study was to detect the lymphatic drainage pattern of internal mammary area and verify the concept of internal mammary sentinel lymph node (IM-SLN) in breast.

Materials and Methods

A small particle radiotracer (99mTc-Dextran 40) was prepared and tested. 99mTc-Dextran 40 was injected into intraparenchyma at the sound breast by a modified radiotracer injection technique. Subsequently, dynamic single-photon emission computed tomography (SPECT), computed tomography (CT), and SPECT/CT combination images were performed to identify the radioactive lymph vessels and internal mammary lymph nodes (IMLNs). The direction of lymph drainage and the location of the IMLNs were identified in the SPECT/CT imaging.

RESULTS

The radiochemical purity of 99mTc-Dextran 40 was > 95%. 99mTc-Dextran 40 could drainage into first, second, and third lymph node and the radioactive lymph node could be detected by the γ detector in the animal experiment. After 99mTc-Dextran 40 injecting into intraparenchyma, 50.0% cases (15/30) were identified the drainage lymphatic vessels and radioactive IMLNs by SPECT. The drainage lymphatic vessel was found from injection point to the first IMLN (IM-SLN) after 10.5±0.35 minutes radiotracer injection, and then 99mTc-Dextran 40 was accumulated into the IM-SLN. The combination imaging of SPECT/CT showed the second IMLN received the lymph drainage from the IM-SLN. The lymphatic drainage was step by step in the internal mammary area.

CONCLUSION

The lymph was identified to drain from different regions of the breast to IM-SLN, and then outward from IM-SLN to other IMLN consecutively. It demonstrated the concept of the IM-SLN and provided more evidences for the application of internal mammary sentinel lymph node biopsy.

Internal Mammary Sentinel Lymph Node Biopsy With Modified Injection Technique: High Visualization Rate and Accurate Staging

Although the 2009 American Joint Committee on Cancer incorporated the internal mammary sentinel lymph node biopsy (IM-SLNB) concept, there has been little change in surgical practice patterns because of the low visualization rate of internal mammary sentinel lymph nodes (IMSLN) with the traditional radiotracer injection technique. In this study, various injection techniques were evaluated in term of the IMSLN visualization rate, and the impact of IM-SLNB on the diagnostic and prognostic value were analyzed.Clinically, axillary lymph nodes (ALN) negative patients (n = 407) were divided into group A (traditional peritumoral intraparenchymal injection) and group B (modified periareolar intraparenchymal injection). Group B was then separated into group B1 (low volume) and group B2 (high volume) according to the injection volume. Clinically, ALN-positive patients (n = 63) were managed as group B2. Internal mammary sentinel lymph node biopsy was performed for patients with IMSLN visualized.The IMSLN visualization rate was significantly higher in group B than that in group A (71.1% versus 15.5%, P < 0.001), whereas the axillary sentinel lymph nodes were reliably identified in both groups (98.9% versus 98.3%, P = 0.712). With high injection volume, group B2 was found to have higher IMSLN visualization rate than group B1 (75.1% versus 45.8%, P < 0.001). The IMSLN metastasis rate was only 8.1% (12/149) in clinically ALN-negative patients with successful IM-SLNB, and adjuvant treatment was altered in a small proportion. The IMSLN visualization rate was 69.8% (44/63) in clinically ALN-positive patients with the IMSLN metastasis rate up to 20.5% (9/44), and individual radiotherapy strategy could be guided with the IM-SLNB results.The modified injection technique (periareolar intraparenchymal, high volume, and ultrasound guidance) significantly improved the IMSLN visualization rate, making the routine IM-SLNB possible in daily practice. Internal mammary sentinel lymph node biopsy could provide individual minimally invasive staging, prognosis, and decision making of the internal mammary radiotherapy, especially for clinically ALN-positive patients.

Genetic diversity analysis of BMY cattle based on microsatellite DNA markers

BMY cattle (1/2 Brahman, 1/4 Murray Grey and 1/4 Yunnan Yellow cattle) has been inter se breeding since 1980s. Genetic diversity of BMY cattle was extensively investigated using 16 microsatellite markers. A total of 130 microsatellite alleles and high allele size variance were detected. All loci displayed high genetic diversity with overall mean of N(a) = 8.13, PIC = 0.7224 and H(e) = 0.7666, which were higher than those of many other beef breeds. The allele-sharing neighbour-joining tree clearly displayed the new genotypic combinations and the minglement from both BMY cattle and Brahman. The results provided the genetic information to match the standards of new beef breed in South China.

[Value of 18F-FETNIM PET-CT for detection of tumor hypoxia in non-small-cell lung cancer]

OBJECTIVE

To assess the feasibility of [(18)F]fluoroerythronitroimidazole ((18)F-FETNIM) with integrated positron emission tomography and computed tomography (PET-CT) imaging in detection of hypoxia in non-small-cell lung cancer (NSCLC) patients.

METHODS

Forty-two patients with newly diagnosed NSCLC underwent (18)F-FETNIM PET-CT before treatment. Nineteen patients rested for approximately 120 minutes before undergoing PET-CT, 23 patients underwent 2 sequential PET-CT scans at 60 minutes and 120 minutes after intravenous injection (18)F-FETNIM. (18)F-FETNIM uptake was quantified by calculating the maximum standardized uptake value in the tumor (SUVmax-T) and contralateral normal lung tissue (SUVmax-N). Regions of interest (ROIs) were drawn in the tumor and contralateral position and the radioactivity ratio of tumor to normal (T/N) was calculated.

RESULTS

SUVmax-T (2.43 +/- 1.34) was significantly higher than SUVmax-N (0.87 +/- 0.46, P < 0.001) at 120 min. SUVmax-T (2.80 +/- 1.09) and SUVmax-N (1.16 +/- 0.56) at 60 min were significantly higher than SUVmax-T (2.61 +/- 1.10) and SUVmax-N (P < 0.01) at 120 min. T/N (2.56 +/- 0.71) at 60 min was higher than that at 120 min (2.48 +/- 0.60), but the difference between them was not significant (P = 0.324).

CONCLUSION

Our results indicate that (18)F-FETNIM PET-CT may be a useful tool for evaluating hypoxia and may be a means to target specifically tumor cells resistant to conventional treatment before and during ongoing therapy in NSCLC.

[Correlation between PET-CT 18FDG uptake in primary lesions and clinicopathological parameters in esophageal carcinoma patients]

OBJECTIVE

To investigate the correlation between 18F-fluorodeoxyglucose (18FDG) uptake of primary lesions during PET-CT (positron emission tomography and computed tomography) examination and clinicopathological parameters such as the tumor length, depth of invasion, differentiation of the primary lesions and lymph node metastasis status in the patients with esophageal carcinoma.

METHODS

From June 2004 to November 2006, 68 operable esophageal carcinoma patients were enrolled into this study, and all had a whole body 18FDG PET-CT scan before operation. The maximum standardized uptake value (SUVmax) of the primary lesions was measured. The tumor length, depth of invasion, differentiation of the primary lesions and lymph node metastasis status were determined by postoperative pathological examination. The correlation between the standardized uptake value (SUV) of primary lesions and the above mentioned clinicopathological parameters was analyzed.

RESULTS

The overall length of primary lesion was positively correlated with SUVmax (r=0.512, P=0.01). Depth of invasion was also positively correlated with SUVmax (r=0.860, P=0.000). There was a statistically significant difference in SUVmax between poorly differentiated group and moderately or well differentiated group (r=0.781, P=0.000), and also between the groups with or without lymph node metastasis (r=0.852, P=0.000).

CONCLUSION

The tumor length, depth of invasion and differentiation of the primary lesions of the esophageal carcinoma are all positively correlated with maximum standardized uptake value of 18FDG. The more poorly differentiated lesions show a higher 18FDG maximum standardized uptake value. The lesions with lymph node metastasis have also a significantly higher 18FDG maximum standardized uptake value than those without lymph node metastases.

[(18)F-FDG PET-CT in detecting the primary tumor in patients with metastatic cancers of unknown primary origin]

OBJECTIVE

To evaluate the value of (18)F-FDG PET-CT in detecting the primary tumor in patients with metastatic cancers of unknown primary origin.

METHODS

Sixty-seven patients with metastatic cancers of unknown primary origin after extensive conventional diagnostic work-up were enrolled into this study. (18)F-FDG PET-CT scans were performed at approximately 60 minutes after the intravenous injection of 7.4 MBq (18)F-FDG/kg, then delayed imaging scans was done at approximately 180 minutes for detecting the primary focus. The standardized uptake value (SUV) >or= 2.5 on standard PET/CT imaging was considered as positive. Ten percent increase of retention index (RI) was also regarded as positive. The correlation between (18)F-FDG PET-CT results and histopathological and clinical findings were analyzed, and the SUV of detected primary focus and that of metastatic cancers were compared.

RESULTS

Of the 67 patients, the primary tumors were identified in 39 (53.7%) by (18)F-FDG PET-CT, and 36 of them were confirmed by pathology or follow-up. Thirteen distant metastases and seventeen lymphatic metastases were newly discovered by whole body (18)F-FDG PET-CT imaging. The SUV of metastatic tumors was significantly lower than that of primary tumors (t = 3.470,P = 0.001) and closely correlated with that of the primary tumors (r = 0.738, P = 0.000).

CONCLUSION

(18)F-FDG PET-CT is not only valuable in identifying the unknown primary tumor in patients with metastatic carcinoma, but can also be used to reveal the biological characteristics of the tumors by functional imaging.

[Molecular imaging of epidermal growth factor receptor in glioma-bearing rats]

OBJECTIVE

To investigate the value of 11C-PD153035 as an EGFR imaging agent in C6 tumor-bearing rat.

METHODS

The tumor-bearing rats were generated by subcutaneous injection of glioma C6 cells. Positron emission tomography/computer tomography (PET/CT) scans started as soon as intravenous injection of 11C-PD153035 (15-20 MBq/0.3 ml) was completed, images were collected continuously. The region of interest (ROI) was used to study the percentage of radioactivity in major organs and implanted tumors in the rats. The accumulation and blocking study in vitro was completed.

RESULTS

There were significant differences in 11C-PD153035 uptake among major organs. The maximum uptake in the organs ranked in the following order: liver > gastrointestinal tract > kidney > lung > brain > muscle. Radioactivity could be also observed in the tumors. The radioactivity ratio (T/NT, target/non-target) peaked (4.15) at 40 - 50 min post injection. The in vitro blocking study showed that 11C-PD153035 uptaken by C6 cells could be blocked by PD153035.

CONCLUSION

The results of this study show that 11C-PD153035 can be uptaken by EGFR-expressing tumors. 11C-PD153035 has a potential as a bioprobe to yield useful information for both diagnosis and therapy of tumors. However, the high concentration of 11C-PD153035 in the gastrointestinal tract is unfavorably affecting the tumor detection in these organs.

[Significance of dual-time-point 18F-FDG PET imaging in evaluation of hilar and mediastinal lymph node metastasis in non-small-cell lung cancer]

OBJECTIVE

To explore the diagnostic value of dual-time-point 18F-FDG PET-CT imaging in detecting hilar and mediastinal lymph node metastasis in non-small-cell lung cancer (NSCLC).

METHODS

Forty-six patients with NSCLC underwent standard whole body single-time 18F-FDG PET-CT scans and a delayed imaging for the thorax alone before surgery, meanwhile, the standard uptake value (SUV) and retention index (RI) were calculated.

RESULTS

A total number of 584 lymph nodes were excised in the 46 patients. Of these, 134 metastatic lymph nodes were pathologically confirmed in 31 patients. There were 189 lymph nodes detected and suspected to be metastatic by standard single-time 18 F-FDG PET-CT imaging, and 161 by dual-time-point imaging. Therefore, the sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value in the detection of hilar and mediastinal lymph node metastasis were 87.3%, 84.0%, 84.8%, 61.9% and 95.7% by standard single-time 18F-FDG PET-CT imaging, versus 94.8%, 92.2%, 92.8%, 78.9% and 98.1%, respectively, by dual-time-point imaging. There was a statistically significant difference in the detection of lymph node metastasis between the standard single-time imaging and dual-time-point 18F-FDG PET-CT imaging.

CONCLUSION

Dual-time-point 18F-FDG PET-CT imaging is more sensitive, specific and accurate than standard single-time 18F-FDG PET-CT imaging in the detection of hilar and mediastinal lymph node metastasis, and may provide more information for diagnosis, staging and treatment of non-small cell lung cancer.

[Preliminary study of 18F-FDG PET-CT in defining lymph node radiation target volume for non-small-cell lung cancer patients]

OBJECTIVE

To investigate the value of 18F-FDG PET-CT in detecting metastatic lymph node and radiation planning for patient with non-small-cell lung cancer (NSCLC).

METHODS

The data of 58 NSCLC patients were retrospectively analyzed. Preoperatively, Both 18F-FDG PET-CT and CT scan were performed for all patients. Blinded interpretation of these images was then carried out. The gross tumor volume defined by radiation oncologist based on imaging results of either PET-CT or CT alone was compared with pathological results eventually.

RESULTS

The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of detecting metastatic lymph node in the mediastinum was 56.0%, 54.2%, 54.8%, 38.9%, 70.3% by CT alone, and 88.0%, 85.4%, 86.3%, 75.9%, 93.2% by PET-CT, respectively. There was a statisticalty significant difference between two methods(P < 0.05). However, statisticalty no significant difference in detecting hilar lymph nodes was observed. The radiation target volume defined by CT was identical to that by PET-CT in 31(53.5%) cases, but changed in the other 27 (46.5%) cases when 18F-FDG PET data was added. The accuracy was 75.9% in detecting metastatic lymph nodes in the radiation target volume defined by PET-CT, while it was much lower by CT alone (48.3%) with a statistically significant difference between two methods (P < 0.05).

CONCLUSION

18F-FDG PET-CT is more accurate than CT alone in assessment of mediastinal lymph nodes for NSCLC patients. It may be recommended as a method in defining the radiation target volume.

[Prognostic value of 9mTc-HL91 SPECT hypoxia imaging in patients with advanced NSCLC]

OBJECTIVE

Tumor hypoxia can influence response to radiotherapy and other treatment modalities. Oxygenation status is proved to be an independent prognostic factor. 99mTc-HL91 (99mTc labeled 4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime) is a potential noninvasive marker of tumor hypoxia. It has been reported that 99mTc-HL91 has certain validity for hypoxia imaging. But its clinical study had not been reported widely. This study was carried out to evaluate the relationship between the T/N ratio of HL91 SPECT hypoxia imaging and the radiotherapeutic outcome.

METHODS

32 patients with pathologically proven non-small cell lung cancer received three-dimensional conformal radiotherapy were enrolled into the study. 99mTc-HL91 SPECT scanning was performed in all patients at one or two days before radiotherapy. It was also performed in 18 patients at one or two days after the onset of radiotherapy, when they received a dose of 30 - 40 Gy already. Anterior, posterior and lateral planar images were collected at 2, 4 and 6 hours, respectively, after intravenous injection of approximately 740 MBq 99mTc-HL91. Regions of interest (ROIs) were drawn in the tumor and the contralateral normal lung tissue, and the radioactivity ratio of tumor to normal tissue (T/N) was calculated. To assess whether the tumor uptake of 99mTc-HL91 is predictive of treatment response, the SPECT results were correlated with the results of clinical follow-up.

RESULTS

The relationship between T/N ratios at 4 h images after injection was shown to be the best of three acquired images before radiotherapy. The response and overall survival to radiotherapy were analyzed for all 32 patients. The results of 9mTc-HL91 correlated well with radiotherapy response (P = 0. 002) and also patients' survival (P = 0.043). The average T/N values of 18 patients who received serial scanning were 1.57 +/- 0.18, 1.44 +/- 0.19 and 1.30 +/- 0.14, respectively. There was a significant difference between those three groups (P = 0. 000). The T/N changes during radiotherapy were not associated with the treatment outcome.

CONCLUSION

HL91 SPECT imaging can identify the hypoxia status and changes during radiotherapy in lung cancer. Hypoxia SPECT imaging with HL91 before treatment may predict radiotherapy response and patients' survival. Longer follow up in more patients is planned to confirm this result.

Colon-specific delivery tablets of sodium 4-aminosalicylic acid

AIM

To prepare a new oral colon-specific delivery formulation and to investigate the release profile in vitro and the colon-specific delivery property in vivo in dogs.

METHODS

Sodium 4-aminosalicylic acid was selected as the model drug. The combination of Eudragit RL30D and RS30D were used as sustained-release film, and Eudragit FS30D used as enteric film, which was expected to release drug depending on pH and time. The release profile of tablets was studied in three phosphate buffers with the pH 6.5, 7.0 or 7.4 for 12 h after a simulated gastric presoak for 2 h in 0.1 mol x L(-1) HCl. The tablets were radiolabelled with 99mTc to make their release times and positions in the gastrointestinal tract be followed using a gamma camera.

RESULTS

For the in vitro study, there was no drug released in 0.1 mol x L(-1) HCl for 2 h, and release occurred slowly when pH was above 6.5. Drug was released faster while pH was higher. For the in vivo study, the coated tablets remained intact in the upper gastrointestinal tract, and drug release began after the colonic arrival. The uncoated tablets, however, disintegrated in the stomach of the dogs rapidly.

CONCLUSION

The coating could protect the drug until the tablets reached the ascending colon, where drug was released slowly for over 10 h.

Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS

AIMS

To investigate the relationships between a known history of diabetes and ambient fasting plasma glucose (FPG) levels with death and morbidity rates in patients with severe acute respiratory syndrome (SARS).

METHODS

In this retrospective analysis, the clinical and biochemical characteristics of 135 patients who had died from SARS, 385 survivors of SARS and 19 patients with non-SARS pneumonia were compared.

RESULTS

All patients were treated according to a predefined protocol. Before steroid treatment, the mean FPG level was significantly higher in the SARS group (deceased vs. survivors vs. non-SARS pneumonia group: 9.7 +/- 5.2 vs. 6.5 +/- 3.0 vs. 5.1 +/- 1.0 mmol/l, P < 0.01). In the SARS group, the percentage of patients with a known history of diabetes was significantly higher in the deceased patients than in the survivors (21.5% vs. 3.9%, P < 0.01). Among patients with no known history of diabetes and before commencement of steroid therapy, those who had hypoxaemia (SaO(2) < 93%) had higher FPG levels than those who did not have hypoxia in both the survivor (8.7 +/- 4.9 vs. 6.3 +/- 2.1 mmol/l, P < 0.001) and deceased (9.8 +/- 4.8 vs. 7.2 +/- 1.5 mmol/l, P < 0.001) groups. A known history of diabetes [odds ratio (OR) 3.0, 95% confidence interval (CI) 1.4, 6.3; P = 0.005] and FPG > or = 7.0 mmol/l before steroid treatment (OR 3.3, 95% CI 1.4, 7.7, P = 0.006) were independent predictors of death. During the course of the illness, FPG levels were negatively associated with SaO(2) (beta =-0.682 +/- 0.305, P = 0.025, general estimation equation model) in SARS patients. Survival analysis showed that FPG was independently associated with an increased hazard ratio (HR) of mortality (HR = 1.1, 95% CI 1.0, 1.1, P = 0.001) and hypoxia (HR = 1.1, 95% CI 1.0, 1.1, P = 0.002) after controlling for age and gender.

CONCLUSIONS

A known history of diabetes and ambient hyperglycaemia were independent predictors for death and morbidity in SARS patients. Metabolic control may improve the prognosis of SARS patients.

Effect of dl-praeruptorin A on ATP sensitive potassium channels in human cortical neurons

AIM

To investigate the effect of dl-praeruptorin A (Pd-Ia) on ATP sensitive potassium channels (KATP channel) in human cortical neurons.

METHODS

Using standard whole cell recording method. Cell membranes were held at -40 mV, commanding potential was -30 to +100 mV and duration was 600 ms.

RESULTS

Pd-Ia activated KATP channels in human cortical neurons in a concentration-dependent manner. After consecutive perfusion with external solution containing Pd-Ia 0.001, 0.01, 0.1, and 1 micromol/L, currents increased from control (0.9 +/- 0.4) nA to (1.0 +/- 0.4) nA, (1.1 +/- 0.4) nA, (1.2 +/- 0.4) nA, and (1.3 +/- 0.4) nA (P < 0.05 or P < 0.01, n = 5) respectively. Then the current decreased to (0.90 +/- 0.37) nA (P < 0.01, n = 5) after washout with glibenclamide (10 micromol/L). The increscent part of the currents could nearly be inhibited by specific KATP channel inhibitor.

CONCLUSION

Pd-Ia could open KATP channel and it is a kind of potassium channel opener

[Investigation on Schistosoma japonicum infection in rodents in Yunnan Province]

OBJECTIVE

To investigate the role of rodents in the transmission of schistosomiasis in endemic areas in Yunnan Province.

METHODS

Kato-Katz method was used to study the infection rate of rodents, humans and domestic animals.

RESULTS

The infection rate was 0.9% (32/3,411) for rodents, 15.6% (461/2,964) for humans, and 9.6% (239/2,482), for domestic animals. The EPG(mean) was 5.8 for rodents, 1.8 for humans, 0.1 for cattle, 0.1 for horses and 0.02 for pigs.

CONCLUSION

The rodents played a minor role in the transmission of schistosomiasis in the plateau area of Yunnan province.

Prevalence of Helicobacter pylori infection and gastritis among young adults in China

To investigate the prevalence of gastritis and H. pylori infection among young Chinese in Henan Province, a high incidence area for oesophageal cancer in China, the gastric mucosa was examined in 194 asymptomatic subjects, aged 15-26 years, in the course of an epidemiological study of precursor lesions of oesophageal cancer. Histopathological grading of gastritis and determination of H. pylori infection were performed on haematoxylineosin and Warthin-Starry stained section. An enzyme-linked immunosorbent assay was used to detect the presence of serum IgG antibodies to H. pylori. A very high prevalence of gastritis (93.8%) was found: 71 subjects (36.6%) presented with superficial gastritis (14 active), 94 (48.5%) with diffuse gastritis (92 active) and in 17 cases (8.8%) diffuse gastritis (16 active) was accompanied by focal atrophy. Silver staining detected H. pylori in 166 (85.6%) of the study participants. However, serological techniques identified H. pylori in only 109 (56.2%). H. pylori was seen in all the 119 cases showing histological signs of active gastritis, in 41 of the 63 cases (65%) without activity, and also in 50% (6/12) of histologically normal subjects. H. pylori infection was found to be associated with a 2.5-fold higher prevalence of chronic atrophic gastritis compared with non-atrophic gastritis. A family history of stomach cancer, consumption of pickled vegetables more than twice a month, and a high monthly salt consumption (> 500 g/month) also showed a positive association.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic Nd:YAG laser therapy in patients with early superficial carcinoma of the esophagus and the gastric cardia

A group of 33 patients, 27 with early superficial esophageal cancer and six with early superficial carcinoma of the gastric cardia, were treated with endoscopic neodymium:yttrium aluminum garnet (Nd:YAG) laser from April 1989 to March 1993. Of the 33 patients, in 32 (97%) the disappearance of the cancer cells was noted. They were treated 1-6 times (average 2.6) with laser irradiation. No serious complications, such as perforation, occurred in the series. Twenty-two patients were followed up for 24-55 months. A negative biopsy was recorded in 16 (72.7%) of the 22 patients; the other six (27.3%) cases were found to have recurrent early cancer during the follow-up period from the 36th to the 40th months, and were treated with supplementary endoscopic therapy or surgical resection. It is suggested that endoscopic Nd: YAG laser may be a safe and effective therapy for early carcinoma of the esophagus and the gastric cardia, when the risks of surgery are too high or the patient has refused surgical resection.

A randomized double-blind intervention study on the effect of calcium supplementation on esophageal precancerous lesions in a high-risk population in China

To determine whether dietary calcium supplementation affects esophageal precancerous lesions, 200 subjects with esophageal lesions in a high-risk area for esophageal cancer in China (Huixian, Henan) were randomly divided into 2 groups (100 subjects/group). Subjects in one group received an oral supplementation of calcium carbonate tablets (1200 mg of calcium daily), and subjects in the other group received placebo pills for 11 months. At the entry and the end of the trial, esophagoscopy was performed, and 2 or 3 biopsy specimens were taken from the middle and lower thirds of the esophagus and from macroscopic lesions, if any, of each subject for histopathology and cell proliferation analysis with deoxythymidine labeling. In comparison to normal epithelium, increased proliferative compartment size was observed in epithelia with hyperplasia or dysplasia. After the intervention, the percentage of individuals with "normal epithelium," "basal cell hyperplasia," "basal cell hyperplasia II," and "basal cell hyperplasia III and dysplasia" were 44, 31, 13, and 11% in the calcium group and 35, 39, 17, and 6% in the placebo group, respectively. The labeling index was 0.046 in the calcium group and 0.044 in the placebo group. After the intervention, the labeling index in basal cell layers 1 to 5, the major zone of cell proliferation, fell 38% in the calcium group and 44% in the placebo group from before the intervention. Therefore, in this study, calcium supplementation was not shown to have beneficial effects in alleviating precancerous lesions and abnormal cell proliferation patterns.

[Comparative study of brain tumors treated at China Medical University, China and Kyushu University, Japan]

We have re-examined histopathological specimens of brain tumors extirpated at China Medical University from May, 1990 to June, 1992. During the last 2 years, about 400 cases of brain tumors were operated and 349 cases were histopathologically diagnosed and classified by one of the authors (T. I). The most common tumor was meningioma, 97 cases, followed by gliomas, 87 case and neurinoma, 71 cases. The sex and age distributions of these three tumor types were compared to those of Kyushu University Hospital, Japan. The most striking difference was age of meningioma and neurinoma patients, and Chinese patients were 10 years younger than Japanese patients. The incidence of 30th age group of meningioma was 25% in China and 10% in Japan. Thirty percent of neurinoma patients were operated at 30th and 40th age in China and Japan, respectively. The sex and ages of astrocytoma patients were almost the same frequencies in China and Japan. Among 22 cases of congenital tumors, 11 cases of epidermoid tumor in cerebello-pontine cistern was included. Cerebral tuberculoma, although rarely encountered in Japan, was 2 cases in China.

Labeling index and labeling distribution of cells in esophageal epithelium of individuals at increased risk for esophageal cancer in Huixian, China

The pattern of proliferation of epithelial cells in esophageal epithelium was studied by means of [3H]deoxythymidine labeling of esophageal epithelium in subjects from Huixian, Henan Province, China, a high-risk geographical region for esophageal cancer. Comparisons were made among patterns of cell proliferation observed in normal esophagus, in hyperplasia, in mild dysplasia, and in moderate dysplasia in a total of 118 subjects. The amount of cell proliferation observed was lowest in normal esophageal epithelium and increased progressively in subjects having hyperplasia, mild dysplasia, and moderate dysplasia. The location of proliferating cells was limited mainly to the base of the esophageal epithelium in normal esophagus, but expanded toward the surface of the esophageal lining in individuals with hyperplasia and dysplasia. The larger total numbers of proliferating cells in the esophageal epithelium and the progressive expansion of the proliferative compartment toward the epithelial surface found in hyperplasia and in dysplasia could both facilitate the screening of subjects for esophageal cancer risk and serve as intermediate biomarkers in prophylactic dietary or pharmacological intervention studies.

Precursor lesions of esophageal cancer in high-risk populations in Henan Province, China

This report discusses precancerous changes in the esophageal mucosa from three points of view: the histopathologic features of the esophageal mucosa in persons known to be at high risk for esophageal carcinoma (EC); the histopathologic features of the esophageal mucosa of asymptomatic persons randomly selected from areas at high and low risk for EC; and a prospective follow-up of a randomly examined group to determine the impact of esophagitis and dysplasia upon subsequent development of EC. Esophagitis was commonly found at endoscopic examination, but there was no difference in frequency of esophagitis in the randomly selected subjects from high-risk and low-risk areas. Although one third of patients with dysplasia developed cancer over a follow-up period of 30 to 78 months, only 4% of those with esophagitis alone developed EC. The authors conclude that dysplasia, diagnosed by cytologic or histologic examination, is a precancerous state, and that esophagitis is a nonspecific pathologic condition of the esophagus, but moderate and severe types of chronic esophagitis might create an environment favorable for the development of esophageal carcinoma.

Precursor lesions of esophageal cancer in high-risk populations in Henan Province, China

This report discusses precancerous changes in the esophageal mucosa from three points of view: the histopathologic features of the esophageal mucosa in persons known to be at high risk for esophageal carcinoma (EC); the histopathologic features of the esophageal mucosa of asymptomatic persons randomly selected from areas at high and low risk for EC; and a prospective follow-up of a randomly examined group to determine the impact of esophagitis and dysplasia upon subsequent development of EC. Esophagitis was commonly found at endoscopic examination, but there was no difference in frequency of esophagitis in the randomly selected subjects from high-risk and low-risk areas. Although one third of patients with dysplasia developed cancer over a follow-up period of 30 to 78 months, only 4% of those with esophagitis alone developed EC. The authors conclude that dysplasia, diagnosed by cytologic or histologic examination, is a precancerous state, and that esophagitis is a nonspecific pathologic condition of the esophagus, but moderate and severe types of chronic esophagitis might create an environment favorable for the development of esophageal carcinoma.