Comparing the efficacy of different methods of faecal microbiota transplantation via oral capsule, oesophagogastroduodenoscopy, colonoscopy, or gastric tube

BACKGROUND

The increasing prevalence of multidrug-resistant organism (MDRO) carriage poses major challenges to medicine as healthcare costs increase. Recently, faecal microbiota transplantation (FMT) has been discussed as a novel and effective method for decolonizing MDRO.

AIM

To compare the efficacy of different FMT methods to optimize the success rate of decolonization in patients with MDRO carriage.

METHODS

This prospective cohort study enrolled patients with MDRO carriages from 2018 to 2021. Patients underwent FMT via one of the following methods: oral capsule, oesophagogastroduodenoscopy (EGD), colonoscopy, or gastric tube.

FINDINGS

A total of 57 patients underwent FMT for MDRO decolonization. The colonoscopy group required the shortest time for decolonization, whereas the EGD group required the longest (24.9 vs 190.4 days, P = 0.022). The decolonization rate in the oral capsule group was comparable to that in the EGD group (84.6% vs 85.7%, P = 0.730). An important clinical factor associated with decolonization failure was antibiotic use after FMT (odds ratio = 6.810, P = 0.008). All four groups showed reduced proportions of MDRO species in microbiome analysis after FMT.

CONCLUSION

Compared to other conventional methods, the oral capsule is an effective FMT method for patients who can tolerate an oral diet. The discontinuation of antibiotics after FMT is a key factor in the success of decolonization.

Effectiveness of antibacterial prophylaxis with non-absorbable polymyxin B compared to levofloxacin after allogeneic hematopoietic stem cell transplantation

BACKGROUND

Fluoroquinolones are widely used for antibacterial prophylaxis during neutropenia following hematopoietic stem cell transplantation (HSCT). Nevertheless, data are inadequate as to whether fluoroquinolones decrease mortality rate compared with other antibiotics.

METHODS

We retrospectively compared the efficacy of antibacterial prophylaxis using non-absorbable polymyxin B (PB) (n = 106) or systemic levofloxacin (LVFX) (n = 140) after allogeneic SCT at our institute between 2004 and 2013.

RESULTS

No significant difference was observed between the 2 groups in the cumulative incidences of failure of prophylaxis (P = 0.21), clinically documented infections (P = 0.70), or non-relapse mortality within the first 100 days after transplantation (P = 0.42). With bacteremia, the rate of resistance to LVFX was 82% in the PB group and 100% in the LVFX group (P = 0.41). Also, no significant difference was found in overall survival between the 2 groups (P = 0.78).

CONCLUSION

Our results indicate no difference in the effectiveness of antibacterial prophylaxis between systemic antibiotic LVFX and non-absorbable antibiotic PB.

Association between polymorphisms in period genes and bone density in postmenopausal Korean women

OBJECTIVE

In the present study, we aimed to investigate the association between genetic polymorphisms in period (PER) genes and bone mineral density (BMD) in postmenopausal Korean women.

METHODS

The PER1 c.2247C> T and c.2884C> G polymorphisms; the PER2 c.661G> A and c.3731G> A polymorphisms; the PER3 c.2592G> A, c.3029C> T, c.3035C> T, and c.3083T> C polymorphisms, and the 54 bp variable number tandem repeats polymorphism were analyzed in 551 postmenopausal Korean women. Serum leptin, soluble leptin receptor, osteoprotegerin, soluble receptor activator of the nuclear factor-κB ligand, and bone markers including bone alkaline phosphatase and carboxy-terminal telopeptide of type I collagen were measured, and the lumbar spine and femoral neck BMDs were also determined.

RESULTS

The PER2 c.661G> A, PER3 c.3029C> T and c.3035C> T polymorphisms were not observed. The PER2 and PER3 polymorphisms evaluated were not related to BMD, whereas associations of the c.2247C> T and c.2884C> G polymorphisms in PER1 with the lumbar spine BMD were observed both singly and in combination. The CC haplotype homozygotes showed significantly lower lumbar spine BMD than participants with other genotypes. Additionally, 2.01-fold higher odds for osteoporosis of the lumbar spine were found in the CC haplotype homozygotes compared to women not carrying the haplotype CC allele. No significant differences in bone markers were detected according to the PER1 haplotype genotype.

CONCLUSIONS

Our results suggest that both the PER1 c.2247C> T and c.2884C> G polymorphisms may be genetic factors affecting the lumbar spine BMD in postmenopausal Korean women.

Mitochondrial swelling and microtubule depolymerization are associated with energy depletion in axon degeneration

Although mitochondrial dysfunction is intimately related to axonal degeneration following nerve injury, the molecular mechanisms of mitochondrial swelling and its mechanistic relation to axonal degeneration are largely unknown. Previous studies have demonstrated that axonal degeneration in the injured peripheral nerves shows two morphologically distinct phases: (1) A latency period (∼24h), in which the morphology of axonal cytoskeletons seems unchanged, followed by (2) an execution period (36-48h), which shows a catastrophic granular degeneration of most axonal structures in rodent axons. In the present study, we found that, in the sciatic nerve axotomy model, energy failure and microtubule depolymerization occurred during the latency period whereas mitochondrial swelling and neurofilament degradation started in the execution period. The energy repletion with NAD or an NAD/pyruvate mixture inhibited microtubule depolymerization, mitochondrial swelling and axonal degeneration in transected sciatic nerve axons. In addition, microtubule perturbing agents enhanced axonal degeneration and mitochondrial swelling. Extracellular calcium chelation did not affect energy failure, microtubule depolymerization or mitochondrial swelling, but it did prevent neurofilament degradation. These findings suggest that an early disturbance in energy dynamics regardless of mitochondrial swelling might be a key trigger for the initiation of axonal degeneration and that extracellular calcium influx is a late effector for neurofilament degradation.

Risk factors affecting cardiac left-ventricular hypertrophy and systolic and diastolic function in the chronic phase of allogeneic hematopoietic cell transplantation

Chronic impairment of cardiac function can be an important health risk and impair the quality of life, and may even be life-threatening for long-term survivors of allogeneic hematopoietic cell transplantation (HCT). However, risk factors for and/or the underlying mechanism of cardiac dysfunction in the chronic phase of HCT are still not fully understood. We retrospectively investigated factors affecting cardiac function and left-ventricular hypertrophy (LVH) in the chronic phase of HCT. Sixty-three recipients who survived for >1 year after receiving HCT were evaluated using echocardiography. Based on simple linear regression models, high-dose TBI-based conditioning was significantly associated with a decrease in left-ventricular ejection fraction and the early peak flow velocity/atrial peak flow velocity ratio, following HCT (coefficient=-5.550, P=0.02 and coefficient=-0.268, P=0.02, respectively). These associations remained significant with the use of multiple linear regression models. Additionally, the serum ferritin (s-ferritin) level before HCT was found to be a significant risk factor for LVH on multivariable logistic analysis (P=0.03). In conclusion, our study demonstrated that a myeloablative regimen, especially one that involved high-dose TBI, impaired cardiac function, and that a high s-ferritin level might be associated with the development of LVH in the chronic phase of HCT.

Incarcerated diaphragmatic hernia as a cause of acute abdomen

Diaphragmatic hernias are usually congenital, and they usually occur in the neonatal group. They do occur in the adult population, albeit very rarely. We present a case of an adult male patient with complications as a result of a congenital diaphragmatic hernia. The patient presented with atypical abdominal pain and respiratory distress. Radiological investigations confirmed a left hydropneumothorax as well as large bowel obstruction secondary to herniation of the omentum and transverse colon through a congenital defect in the left hemi-diaphragm. He had a laparotomy, which confirmed the radiological findings and a perforated transverse colon. He went onto have an extended right hemicolectomy and end-ileostomy; his left hemithorax was lavaged and a thoracostomy tube was inserted. He recovered well, except that he developed an empyema postoperatively for which he required a thoracotomy and decortication. He made good recovery following this and was discharged home nine days following his initial laparotomy.

Fatal BK virus pneumonia following stem cell transplantation

We report the case of a 39-year-old male patient who died of severe BK virus (BKV) pneumonia 168 days after hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia. After suffering from BKV-associated late-onset hemorrhagic cystitis (HC) with long-term sustained BKV viremia, he died of rapidly progressive pneumonia. On autopsy, numerous viral intranuclear inclusions were seen in his lungs and bladder. An immunohistochemical examination of his lungs was positive for simian virus 40. Based on these pathological results and the high sustained BKV viral load in his blood, we reached a diagnosis of BKV pneumonia. Viral infection can occasionally become life threatening among HSCT recipients. It is widely known that BKV can cause late-onset HC, but BKV-associated pneumonia is rare. Because of its rapid progression and poor prognosis, it is difficult to make an antemortem diagnosis of BKV pneumonia. A treatment strategy for BKV pneumonia also needs to be formulated. Similar to other viral pathogens, BKV can cause pneumonia and the clinician should therefore be aware of it in immunocompromised patients.

Immunoglobulin prophylaxis against cytomegalovirus infection in patients at high risk of infection following allogeneic hematopoietic cell transplantation

Reports on the efficacy of intravenous immunoglobulin (IVIG) prophylaxis against cytomegalovirus (CMV) infection after allogeneic hematopoietic cell transplantation (HCT) have often sparked controversy. In addition, we are not aware of any study that has examined whether prophylaxis with IVIG affects the incidence of CMV infection in high-risk patients--those who are elderly or have received human leukocyte antigen (HLA) mismatched HCT. In the present open-label, phase II study, we addressed this question. We enrolled 106 patients in the study. The cumulative incidences of CMV infection at 100 days after HCT were similar in the intervention and the control groups (68% and 64%, P=.89; 89% and 87%, P=.79, respectively, for patients 55 years or older and those who received HLA-mismatched HCT). In those who received HLA-mismatched HCT, 1-year overall survival after HCT was 46% in the intervention group and 40% in the control group (P=.31); for age≥55 years, the corresponding values were 46% and 40% (P=.27). Our data showed that prophylaxis with regular polyvalent IVIG did not affect the incidence of CMV infections or survival among older patients or those who receive HLA-mismatched HCT.

Concurrent reactivation of latent EBV with hepatitis A can affect clinical feature of childhood hepatitis

AIMS

Some children with acute hepatitis A virus (HAV) infection have concurrent Epstein-Barr virus (EBV) reactivation serologically. We studied the frequency of EBV reactivation during HAV infection and determined whether simultaneous occurrence of EBV reactivation and HAV infection affected the clinical features of HAV infection.

METHODS

The medical records of patients under 19 years of age diagnosed with acute hepatitis A between January 1996 and June 2009 were reviewed.

RESULTS

Among 72 patients with acute hepatitis A, 22 patients (30.6%) had EBV reactivation. A markedly prolonged duration of full recovery from hepatitis was observed in reactivated group. The peak levels of AST and ALT in reactivated group were higher than non-reactivated group (p = 0.012 and p < 0.001, respectively). Higher peak levels of AST and ALT in reactivated subgroups over 10 years old were observed compared to non-reactivated subgroup (p = 0.027 and p = 0.001, respectively). Duration of recovery showed significant differences between two subgroups.

CONCLUSIONS

Concurrent reactivation of latent EBV and HAV infections is common. EBV reactivation with HAV infection adversely affects the clinical feature of hepatitis. Therefore, we should keep in mind that the concurrence especially in older children may cause worse injury to the liver.

Missing xy-band Fermi surface in 4d transition-metal oxide Sr2RhO4: effect of the octahedra rotation on the electronic structure

Electronic structures of the 4d transition-metal oxide compound Sr2RhO4 are investigated by angle-resolved photoemission spectroscopy and density-functional electronic structure calculations. In the measured Fermi surfaces (FS) of Sr2RhO4, the xy-band FS sheet expected from the well-established results of the FS of Sr2RuO4 is missing, the volume of which should be different only by one additional electron for Sr2RhO4. The apparent contradiction is resolved by a careful analysis of the band structure where the rotation of octahedra results in the hybridization of e(g) and t(2g) states and thus plays a key role in the determination of the electronic structure near EF. The modification of the FS structure due to the distorted lattice is related to the charge transfer among the orbital states and suggested to be relevant to the metal-insulator transition in Ca(2-x)Sr(x)RuO4.

Effect of the New York State cigarette fire safety standard on ignition propensity, smoke constituents, and the consumer market

OBJECTIVES

This study examines empirical evidence from the New York experience testing tobacco industry arguments made in opposition to fire safety standards for cigarettes.

DESIGN

Percentages of cigarettes exhibiting full length burns (FLBs), cigarette sales before and following the implementation of the New York standards, a sample of retail cigarette prices, brand availability, and selected smoke constituent yields were compared between cigarettes sold in New York and two other states. Cigarette paper analysis was conducted on cigarettes sold in New York.

RESULTS

New York cigarette brands averaged 10.0% FLBs as compared to 99.8% for California and Massachusetts brands. Reduced ignition propensity (RIP) appears to have been achieved by cigarette paper banding. Cigarette sales, prices, and brand availability do not appear to have been affected by the New York standards. Yields of the majority of smoke constituents tested did not differ substantially between RIP cigarettes sold in New York as compared to the same brands sold in Massachusetts. Average yields of tar, carbon monoxide, and two compounds were slightly higher, the yields of seven compounds were higher for one brand only, and nicotine was lower, among New York brands tested.

CONCLUSIONS

RIP cigarette brands have been designed to meet the New York fire safety standards. Their introduction has not affected cigarette sales or prices in New York. There is no evidence that the small increases in smoke constituent yields affect the already highly toxic nature of cigarette smoke. Data on smoking caused fires, deaths, and injuries dating from after the change in law are not yet available. Such data will be able to address the question of whether the demonstrated reduced ignition standards are associated with reduced fires and injuries. Based on the New York experience, prior industry objections to producing RIP cigarettes are unfounded. Other states and nations should adopt similar standards.

JNK pathway mediates apoptotic cell death induced by tumor suppressor LKB1 in Drosophila

Although recent progresses have unveiled the diverse in vivo functions of LKB1, detailed molecular mechanisms governing these processes still remain enigmatic. Here, we showed that Drosophila LKB1 negatively regulates organ growth by caspase-dependent apoptosis, without affecting cell size and cell cycle progression. Through genetic screening for LKB1 modifiers, we discovered the JNK pathway as a novel component of LKB1 signaling; the JNK pathway was activated by LKB1 and mediated the LKB1-dependent apoptosis. Consistently, LKB1-null mutant was defective in embryonic apoptosis and displayed a drastic hyperplasia in the central nervous system; these phenotypes were fully rescued by ectopic JNK activation as well as wild-type LKB1 expression. Furthermore, inhibition of LKB1 resulted in epithelial morphogenesis failure, which was associated with a decrease in JNK activity. Collectively, our studies unprecedentedly elucidate JNK as the downstream mediator of the LKB1-dependent apoptosis, and provide a new paradigm for understanding the diverse LKB1 functions in vivo.

Continuous tuning of electronic correlations by alkali adsorption on layered 1T-TaS2

Angle-resolved photoemission spectroscopy shows that a Mott-Hubbard type metal-insulator transition occurs at the Rb adsorbed surface of the layered charge-density-wave compound 1T-TaS2. The transition is driven by adsorption induced modifications of the charge-density wave and of the interlayer coupling, leading to an increase of the on-site Coulomb correlation energy and a narrowing of the Ta 5d band perpendicular to the layers, respectively. The continuous rearrangement of spectral weight is measured live during the deposition process.

Mechanism of gap opening in a triple-band Peierls system: in atomic wires on Si

One dimensional (1D) metals are unstable at low temperature undergoing a metal-insulator transition coupled with a periodic lattice distortion, a Peierls transition. Angle-resolved photoemission study for the 1D metallic chains of In on Si(111), featuring a metal-insulator transition and triple metallic bands, clarifies in detail how the multiple band gaps are formed at low temperature. In addition to the gap opening for a half-filled ideal 1D band with a proper Fermi surface nesting, two other quasi-1D metallic bands are found to merge into a single band, opening a unique but k-dependent energy gap through an interband charge transfer. This result introduces a novel gap-opening mechanism for a multiband Peierls system where the interband interaction is important.

Fermi surface and quasiparticle dynamics of Na0.7CoO2 investigated by angle-resolved photoemission spectroscopy

We present the first angle-resolved photoemission study of Na0.7CoO2, the host material of the superconducting NaxCoO2.nH(2)O series. Our results show a hole-type Fermi surface, a strongly renormalized quasiparticle band, a small Fermi velocity, and a large Hubbard U. The quasiparticle band crosses the Fermi level from M toward Gamma suggesting a negative sign of effective single-particle hopping t(eff) (about 10 meV) which is on the order of magnetic exchange coupling J in this system. Quasiparticles are well defined only in the T-linear resistivity (non-Fermi-liquid) regime. Unusually small single-particle hopping and unconventional quasiparticle dynamics may have implications for understanding the phase of matter realized in this new class of a strongly interacting quantum system.

Occlusal adjustment for treating and preventing temporomandibular joint disorders

To assess the effectiveness of occlusal adjustment (OA) for treating temporomandibular disorders (TMD) in adults and preventing TMD. The Cochrane Controlled Trials Register, MEDLINE and EMBASE were comprehensively searched using the Cochrane methods. Reports and review articles were retrieved. Unpublished reports or abstracts were considered from the SIGLE database. All randomized or quasi-randomized controlled trials comparing OA with placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement. Data collection and analysis followed the Cochrane Oral Health Group's statistical guidelines. Results showed no difference between OA and control group in symptom-based outcomes for treatment or incidence of symptoms for prevention. There is no evidence that OA treats or prevents TMD. OA cannot be recommended for the management or prevention of TMD. Future trials should use standardized diagnostic criteria and outcome measures when evaluating TMD.

Electronic quasiparticle renormalization on the spin wave energy scale

High-resolution photoemission data of the (110) iron surface reveal the existence of well-defined metallic surface resonances in good correspondence to band calculations. Close to the Fermi level, their dispersion and momentum broadening display anomalies characteristic of quasiparticle renormalization due to coupling to bosonic excitations. Its energy scale exceeds that of phonons by far, and is in striking coincidence with that of the spin wave spectrum in iron. The self-energy behavior thus gives spectroscopic evidence of a quasiparticle mass enhancement due to electron-magnon coupling.

Indium square root 7 x square root 3 on Si(111): a nearly free electron metal in two dimensions

We present measurements of the Fermi surface and underlying band structure of a single layer of indium on Si(111) with square root 7 x square root 3 periodicity. Electrons from both indium valence electrons and silicon dangling bonds contribute to a nearly free, two-dimensional metal on a pseudo-4-fold lattice, which is almost completely decoupled at the Fermi level from the underlying hexagonal silicon lattice. The mean free path inferred from our data is quite long, suggesting the system might be a suitable model for studying the ground state of two-dimensional metals.

Occlusal adjustment for treating and preventing temporomandibular joint disorders

BACKGROUND

There has been a long history of using occlusal adjustment in the management of temporomandibular disorders (TMD). It is not clear if occlusal adjustment is effective in treating TMD.

OBJECTIVES

To assess the effectiveness of occlusal adjustment for treating TMD in adults and preventing TMD.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register (April 2002); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2002); MEDLINE (1966 to 8th April 2002); EMBASE (1980 to 8th April 2002) and handsearched journals of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from review articles of treating TMD. There were no language restrictions. Unpublished reports or abstracts were considered from the SIGLE database.

SELECTION CRITERIA

All randomised or quasi-randomised controlled trials (RCTs) comparing occlusal adjustment to placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement.

DATA COLLECTION AND ANALYSIS

Data were independently extracted, in duplicate, by two reviewers, Holy Koh (HK) and Peter G Robinson (PR). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed and relative risk values calculated using random effects models where significant heterogeneity was detected (P<0.1).

MAIN RESULTS

Over 660 trials were identified by the initial search. Six of these trials, which reported results from a total of 392 patients, were suitable for inclusion in the review. From the data provided in the published reports, symptom-based outcomes were extracted from trials on treatment. Data on incidence of symptoms were extracted from trials on prevention. Neither showed any difference between occlusal adjustment and control group.

REVIEWER'S CONCLUSIONS

There is an absence of evidence, from RCTs, that occlusal adjustment treats or prevents TMD. Occlusal adjustment cannot be recommended for the management or prevention of TMD. Future trials should use standardised diagnostic criteria and outcome measures when evaluating TMD.

Stress relief as the driving force for self-assembled bi nanolines

Bi nanolines self-assemble on Si(001) and are remarkable for their straightness and length-they are often more than 400 nm long, and a kink in a nanoline has never been observed. Through electronic structure calculations, we have found an energetically favorable structure for these nanolines that agrees with our scanning tunneling microscopy and photoemission experiments; the structure has an extremely unusual subsurface structure, comprising a double core of seven-membered rings of silicon. Our proposed structure explains all the observed features of the nanolines, and shows that surface stress resulting from the mismatch between the Bi and the Si substrates is responsible for their self-assembly. This has wider implications for the controlled growth of nanostructures on semiconductor surfaces.

Smoking behaviours and attitudes among male restaurant workers in Boston's Chinatown: a pilot study

OBJECTIVE

Asian American immigrants experience high rates of cigarette smoking. A community based survey was conducted to understand the smoking behaviours, knowledge, and attitudes of restaurant workers in Boston's Chinatown.

DESIGN

Cross sectional survey in Chinese of a convenience sample of 54 restaurant workers recruited through extensive outreach activities.

RESULTS

All 54 of the workers were male immigrants. 45 (83.3%) reported smoking cigarettes regularly, and the remaining nine were former smokers. 36 of the smokers (80.0%) started smoking before entering the USA. The workers were aware that cigarettes are addictive (98.1%), cause lung cancer (79.6%), and lead to heart disease (64.8%). However, a substantial number reported that smoking was relaxing (75.9%) and enhanced concentration (66.7%). Nearly half believed low tar and low nicotine cigarettes to be safer than standard brands. The vast majority of workers believed that smoking was not socially acceptable for women. Smokers reported they received information on quitting most commonly from friends (60%), newspapers (53.5%), and television (44.4%). The restaurant workers most often saw advertising against smoking in Chinese newspapers (63%).

CONCLUSION

Despite high rates of smoking, Chinese American restaurant workers were generally aware of the health risks and were interested in quitting. Community based research can set the stage for targeted public health efforts to reduce smoking in immigrant communities.

Elevated circulating level of ghrelin in cachexia associated with chronic heart failure: relationships between ghrelin and anabolic/catabolic factors

BACKGROUND

Ghrelin is a novel growth hormone (GH)-releasing peptide, isolated from the stomach, that may also cause a positive energy balance by stimulating food intake and inducing adiposity. We sought to investigate the pathophysiology of ghrelin in the cachexia associated with chronic heart failure (CHF).

METHODS AND RESULTS

Plasma ghrelin was measured in 74 patients with CHF and 12 control subjects, together with potentially important anabolic and catabolic factors, such as GH and tumor necrosis factor (TNF-alpha). Patients with CHF were divided into two groups, those with cachexia (n=28) and those without cachexia (n=46). Plasma ghrelin did not significantly differ between all CHF patients and controls (181+/-10 versus 140+/-14 fmol/mL, P=NS). However, plasma ghrelin was significantly higher in CHF patients with cachexia than in those without cachexia (237+/-18 versus 147+/-10 fmol/mL, P<0.001). Circulating GH, TNF-alpha, norepinephrine, and angiotensin II were also significantly higher in CHF patients with cachexia than in those without cachexia. Interestingly, plasma ghrelin correlated positively with GH (r=0.28, P<0.05) and TNF-alpha (r=0.31, P<0.05) and negatively with body mass index (r=-0.35, P<0.01).

CONCLUSIONS

Plasma ghrelin was elevated in cachectic patients with CHF, associated with increases in GH and TNF-alpha and a decrease in body mass index. Considering ghrelin-induced positive energy effects, increased ghrelin may represent a compensatory mechanism under catabolic-anabolic imbalance in cachectic patients with CHF.

Akt/PKB promotes cancer cell invasion via increased motility and metalloproteinase production

The Akt/protein kinase B (PKB) serine/threonine kinase is well known as an important mediator of many cell survival signaling pathways. Here, we demonstrate for the first time a major role of Akt/PKB in the cell invasion properties of the highly metastatic cell line HT1080. Using confocal microscopic analyses of live samples, we found Akt/PKB to be localized in the leading edge membrane area of migrating HT1080 cells. This localization was dependent on phosphoinositide 3-kinase and required the lipid binding ability of the phosphoinositide binding pleckstrin homology domain of Akt/PKB. We examined the possible function of Akt/PKB in HT1080 invasion. Surprisingly, Akt/PKB potently promoted HT1080 invasion, by increasing cell motility and matrix metalloproteinase-9 (MMP-9) production, in a manner highly dependent on its kinase activity and membrane-translocating ability. The increase in MMP-9 production was mediated by activation of nuclear factor-kappaB transcriptional activity by Akt/PKB. However, Akt/PKB did not affect the cell-cell or cell-matrix adhesion properties of HT1080. Our findings thus establish Akt/PKB as a major factor in the invasive abilities of cancer cells.

Retroperitoneoscopic radical nephrectomy by the posterior lumber approach for renal-cell carcinoma associated with chronic renal failure

PURPOSE

To evaluate the efficacy and invasiveness of retroperitoneoscopic radical nephrectomy for renal-cell carcinoma (RCC) in patients with chronic renal failure (CRF), a group known to have relatively high surgical risk.

PATIENTS AND METHODS

Between May 1996 and September 1999, six CRF patients maintained on hemodialysis underwent retroperitoneoscopic radical nephrectomy for clinically localized RCC by the posterior lumber approach. The excised kidneys were evacuated via a posterior skin incision (5 cm) between two port sites; the muscle layers were not incised.

RESULTS

The procedure was completed in all patients with no major complications. The mean operative time was 162 (range 135-210) minutes, and the estimated blood loss was 58 (15-100) mL; none of the patients required a blood transfusion. Regular hemodialysis was restarted on postoperative day 2 or 3.

CONCLUSIONS

This procedure seems to be minimally invasive and suitable for the treatment of small RCC in atrophic kidneys, especially in patients with CRF.

[Giant cystic pheochromocytoma: a case report]

The patient, a 59-year-old woman, was referred to our University Hospital for evaluation of a left mass. Ultrasonography revealed a left adrenal cystic mass. On excretory urograms, the left kidney was pressed downward by a suprarenal mass, and computerized tomography (CT) and magnetic resonance imaging (MRI) confirmed an adrenal cyst. 131I-meta-iodo-benzylguanidine (MIBG) scintigraphy showed prominent accumulation in the left adrenal mass and the capsule. Considering the elevation of catecholamines in both blood and urine samples, we performed a left adrenalectomy with a presumptive diagnosis of pheochromocytoma (tumor size: 11.6 x 7.5 x 6.5 cm, tumor weight 720 g). The subsequent pathological examination confirmed a left giant cystic pheochromocytoma. 131I-MIBG scintigraphy was the most useful tool in the diagnosis of the cystic pheochromocytoma.