DDIT3-amplified or low-polysomic pleomorphic sarcomas without MDM2 amplification: Clinicopathological review and immunohistochemical profile of nine cases

Several high-grade pleomorphic sarcoma cases that cannot be classified into any existing established categories have been reported. These cases were provisionally classified into undifferentiated pleomorphic sarcoma (UPS). Some dedifferentiated liposarcoma (DDLS) cases may also have been classified into the UPS category due to the absence of MDM2 amplification or an atypical lipomatous tumor/well-differentiated liposarcoma component. We retrieved and reviewed 77 high-grade pleomorphic sarcoma cases, initially diagnosed as UPS in 66 cases and DDLS in 11 cases. Fluorescence in situ hybridization (FISH) analyses of DDIT3 and MDM2 were performed for available cases. Of the cases successfully subjected to DDIT3 FISH (n = 56), nine (7 UPS and 2 DDLS) showed DDIT3 amplification but no MDM2 amplification. Two UPS cases showed both telomeric (5') and centromeric (3') amplification of DDIT3 or low polysomy of chromosome 12, whereas 5 UPS and 2 DDLS cases showed 5'-predominant DDIT3 amplification. Histopathologically, all cases showed UPS-like proliferation of atypical pleomorphic tumor cells. Immunohistochemically, only one case showed focal nuclear positivity for DDIT3, supporting the previous finding that DDIT3 expression was not correlated with DDIT3 amplification. All three cases with focal MDM2 expression involved 5'-predominant amplification, two of which showed DDLS-like histological features. The majority of cases (7/9) showed decreased expression in p53 staining, suggesting that DDIT3 amplification regulates the expression of TP53 like MDM2. From a clinicopathological perspective, we hypothesize that DDIT3-amplified sarcoma, especially with 5'-predominant amplification, can be reclassified out of the UPS category.

Utility of computed tomography and 18 F-fluorodeoxyglucose with positron emission tomography/computed tomography for distinguishing appendiceal mucocele caused by mucinous adenocarcinoma from other pathologies

AIM

Differentiating appendiceal mucocele with mucinous adenocarcinoma from other pathologies before surgery is difficult. The objective of this study was to evaluate the utility of CT and ¹⁸ F-fluorodeoxyglucose (FDG) with positron emission tomography (PET)/CT for differentiating mucinous adenocarcinoma of appendiceal mucocele from other pathologies.

METHOD

The study included 25 patients who underwent surgery for clinically diagnosed appendiceal mucoceles detected on CT at the University of Tokyo Hospital. Among these patients, 19 underwent FDG-PET/CT preoperatively. We compared features of the CT imaging findings and maximum standard uptake values (SUV_max ) detected by FDG-PET/CT between mucocele with mucinous adenocarcinoma and other pathologies.

RESULTS

A total of 13 men (52%) and 12 women (48%) were included in this study, with a median age of 65 years (range 34-83). There were six patients (24%) with pathologically confirmed mucinous adenocarcinoma, 15 patients (60%) with appendiceal mucinous neoplasm and four patients (16%) with simple mucocele caused by chronic inflammation. On the CT findings, wall irregularity was the only significant feature for the two groups in this study (83.3% vs 0.0%, P < 0.01). There was a significant difference in the SUV_max levels on PET/CT between the two groups (100.0% vs 20.0%, P < 0.01).

CONCLUSION

Distinguishing between mucocele with mucinous adenocarcinoma and other pathologies using imaging modalities is challenging. Our results suggest that wall irregularity on CT and elevated SUV_max on PET/CT are useful factors that can be employed for such discrimination.

Effects of preceding endoscopic treatment on laparoscopic surgery for early rectal cancer

AIM

Endoscopic treatment for rectal cancer, such as endoscopic mucosal resection and endoscopic submucosal dissection, causes inflammation, oedema and fibrosis in the surrounding tissue. However, little is known about the effect of these endoscopic therapies on salvage laparoscopic rectal surgery. The objective of this retrospective cohort study was to analyse the effect of preceding endoscopic treatment on the outcomes of laparoscopic surgery for rectal cancer.

METHOD

We analysed 53 patients who underwent laparoscopic surgery for rectal cancer with clinical Tis or T1 at our department between May 2011 and June 2019. Data from 30 patients who underwent laparoscopic surgery after preceding endoscopic treatment (Group E + S) were compared with those of 23 patients who underwent laparoscopic surgery alone (Group S).

RESULTS

There was no significant difference between the groups with respect to preoperative details. The mean operative time tended to be longer in Group E + S, and the volume of intra-operative blood loss was greater in Group E + S than in Group S (median 63 ml vs 10 ml, P = 0.049). There were no significant differences between the groups in other surgical parameters or oncological outcomes.

CONCLUSION

Laparoscopic surgery after endoscopic treatment for rectal cancer may be difficult due to an increased risk of intra-operative bleeding. Long-term prognosis after surgery was not affected by preceding endoscopic treatment in rectal cancer.

Vascular anatomy of the splenic flexure, focusing on the accessory middle colic artery and vein

AIM

Recently, the accessory middle colic artery (AMCA) has been recognized as the vessel that supplies blood to the splenic flexure. However, the positional relationship between the AMCA and inferior mesenteric vein (IMV) has not been evaluated. Herein, we aimed to evaluate the anatomy of the AMCA and the splenic flexure vein (SFV).

METHOD

Two hundred and five patients with colorectal cancer who underwent enhanced CT preoperatively were enrolled in the present study. The locations of the AMCA and IMV were evaluated, focusing on the positional relationship between the vessels and pancreas - below the pancreas or to the dorsal side of the pancreas.

RESULTS

The AMCA was observed in 74 (36.1%) patients whereas the SFV was found in 177 (86.3%) patients. The left colic artery (LCA) was the major artery accompanying the SFV in 87 (42.4%) of patients. The AMCA accompanied the SFV in 65 (32.7%) patients. In 15 (7.8%) patients, no artery accompanied the SFV. The origin of the AMCA was located on the dorsal side of the pancreas in 15 (20.3%) of these 74 patients. Similarly, the destination of the IMV was located on the dorsal side of the pancreas in 65 (31.7%) of patients.

CONCLUSION

The SFV was observed in most patients, and the LCA or AMCA was the common accompanying artery. In some patients these vessels were located on the dorsal side of the pancreas and not below it. Preoperative evaluation of this anatomy may be beneficial for lymph node dissection during left-sided hemicolectomy.

Incidence of and risk factors for lymphocele formation after lateral pelvic lymph node dissection for rectal cancer: a retrospective study

AIM

Pelvic lymphocele is a common complication that develops after pelvic lymph node dissection. The incidence of pelvic lymphocele formation has been reported to be 10.5-51% after gynaecological or urological procedures. However, no evidence has been reported thus far with regard to the development of pelvic lymphocele following lateral pelvic lymph node dissection (LPND) for low rectal cancer. The aim of this study was to investigate the incidence of and risk factors for lymphocele formation after LPND for low rectal cancer and to examine its clinical management.

METHOD

We retrospectively analysed the incidence of and risk factors for pelvic lymphocele formation after LPND for rectal cancer in our hospital between January 2012 and December 2017. We also compared the size of the lymphocele between asymptomatic and symptomatic patients by using CT volumetry and examined its clinical management.

RESULTS

A total of 30 out of 98 patients (30.8%) developed pelvic lymphocele after rectal LPND. The number of resected nodes was significantly higher in patients with a pelvic lymphocele (P < 0.01). The median volume was significantly higher in patients with symptomatic pelvic lymphocele (P = 0.011). Among the nine symptomatic patients, two underwent CT-guided drainage, one underwent transurethral ureteral stent placement and one underwent laparoscopic marsupialization.

CONCLUSION

It is essential to keep in mind the possibility of pelvic lymphocele formation during follow-up of patients who undergo LPND, and to consider an appropriate treatment when these patients are symptomatic.

Obstruction is associated with perineural invasion in T3/T4 colon cancer

AIM

Perineural invasion (PNI) is a risk factor for recurrence and metastasis and consequently leads to decreased survival in patients with various malignancies. Recent studies showed that stent placement in obstructive colon cancer increases the frequency of PNI. We hypothesized that mechanical stress including obstruction itself may be associated with PNI.

METHOD

We retrospectively reviewed 496 patients with pathological T3 or T4 colon cancer who did not receive preoperative treatment. Data were collected from medical charts and pathological findings. The relationships between PNI and other clinicopathological factors were analysed using univariate and multivariate analyses.

RESULTS

PNI was observed in 239 (48%) patients. Obstruction was markedly more frequent in PNI-positive cancer (39%) than in PNI-negative cancer (24%, P = 0.0003). Multivariate analyses identified obstruction as one of the significant factors associated with PNI (OR 1.68, P = 0.028). Moreover, in 414 patients without distant metastasis who underwent complete resection, PNI was an independent factor associated with poor recurrence-free survival (hazard ratio 2.35, P = 0.003). The coexistence of PNI and obstruction resulted in greater decreases in recurrence-free survival than PNI-negative and/or non-obstructive cases.

CONCLUSION

Our results suggest that obstruction is associated with PNI and consequently contributes to an increased postoperative recurrence in colon cancer.

Hyperthermic intraperitoneal chemotherapy using a combination of mitomycin C,5-fluorouracil, and oxaliplatin in patients at high risk of colorectal peritoneal metastasis: A Phase I clinical study

INTRODUCTION

The drugs and protocols used for hyperthermic intraperitoneal chemotherapy (HIPEC) vary among institutions. Here we show the efficacy of the 3-drug combination of mitomycin C (MMC), 5-fluorouracil (5FU), and oxaliplatin (OHP) in an in vitro simulation of HIPEC and the safety of HIPEC with these drugs during a Phase I study of patients at high risk of developing colorectal peritoneal metastasis.

METHODS

To simulate HIPEC, we used HCT116 and WiDr cells to assess the growth inhibitory efficacy of MMC 2 μg/mL, 5FU 200 μg/mL, and OHP 40 μg/mL as single drugs or their combination after an exposure time of 30 min at 37 or 42 °C. In addition, nine patients underwent surgical resection of tumors and HIPEC with MMC, 5FU, and an escalating dose of OHP (90/110/130 mg/m²). Dose-limiting toxicity was monitored.

RESULTS

In the simulation, the 3-drug combination showed marked tumor-suppressive effects compared with those from ten times higher dose of OHP 400 μg/mL, with significant augmentation under hyperthermic conditions. No dose-limiting toxicity occurred in the clinical study. Dose escalation was completed at the final level of OHP.

CONCLUSIONS

The MMC-5FU-OHP combination showed marked growth inhibition against colorectal cancer cells under hyperthermic conditions in vitro. In the phase I study, the recommended dose of OHP was determined as 130 mg/m² when used with MMC and 5FU; HIPEC using MMC-5FU-OHP appears to be safe and feasible for patients at high risk of colorectal peritoneal metastasis.

Epithelial expression of interleukin-37b in inflammatory bowel disease

Interleukin (IL)-37 is a member of the IL-1 cytokine family. We investigated IL-37b expression in the inflamed mucosa of inflammatory bowel disease (IBD) patients. Furthermore, we analysed IL-37b expression in human colonic epithelial cells. The human colonic epithelial cell line T84 and human colonic subepithelial myofibroblasts (SEMFs) were used. IL-37b expression in the IBD mucosa was evaluated by immunohistochemistry. IL-37b mRNA and protein expression were determined by real time-polymerase chain reaction (PCR) and Western blotting, respectively. IL-37b was not detected in the normal colonic mucosa. In the inflamed mucosa of IBD patients, epithelial IL-37b expression was increased markedly. In ulcerative colitis (UC) and Crohn's disease (CD) patients, IL-37b expression was enhanced in the affected mucosa. In the intestinal epithelial cell line T84, the expression of IL-37b mRNA and protein was enhanced by tumour necrosis factor (TNF)-α. This IL-37b induction by TNF-α was mediated by nuclear factor (NF)-κB and activator protein (AP)-1 activation. Furthermore, IL-37b inhibited TNF-α-induced interferon-γ-inducible protein (IP)-10 expression significantly in human colonic SEMFs. Epithelial IL-37b expression was increased in IBD patients, especially UC patients. IL-37b may be involved in the pathophysiology of IBD as an anti-inflammatory cytokine and an inhibitor of both innate and acquired immune responses.

Brachial-ankle pulse wave velocity predicts increase in blood pressure and onset of hypertension

BACKGROUND

The present study was designed to test the hypothesis that brachial-ankle pulse wave velocity (baPWV) predicts longitudinal increases in blood pressure (BP) and new onset of hypertension in individuals with normal BP.

METHODS

baPWV was measured using a semiautomated device in 2,496 participants (27-84 years) without hypertension who visited our hospital for a yearly health check-up. They were followed up for 4 years with the endpoint being development of hypertension.

RESULTS

During the follow-up period (median, 733 days; actual follow-up, 5,215 person-years), hypertension developed in 698 participants (133.8/1,000 person-years). Kaplan-Meier analysis revealed that risk for hypertension was increased across the tertiles of baseline baPWV. The hazard ratio (first tertile as reference) was 2.02 (95% confidence interval (CI) 1.55-2.64) and 3.49 (95% CI 2.66-4.57) in the second and third tertiles, respectively, after adjustment for possible risk factors. Multivariate Cox proportional hazard regression analysis adjusted for known risk factors, where baPWV was used as a continuous variable, also indicated that the baseline value of baPWV independently predicted new onset of hypertension (P < 0.001). Furthermore, baseline baPWV was significantly associated with a longitudinal increase in BP after adjustment for known risk factors in multiple regression analysis (P < 0.001).

CONCLUSION

This study provides the first evidence that baPWV is an independent predictor of longitudinal increases in BP as well as of new onset of hypertension.

Large-scale gene expression profiles, differentially represented in osteoarthritic synovium of the knee joint using cDNA microarray technology

Osteoarthritis (OA) is one of the most common age-related chronic disorders of articular cartilage, joints and bone tissue. Diagnosis of OA commonly depends on clinical and radiographic findings. However, changes in cartilage associated with the early stage of OA cannot be detected using radiographs, because significant cartilage degeneration must occur before radiographic findings show alterations of the appearance of cartilage. To identify new biomarkers of OA, we analysed gene expression profiles of synovium from 43 patients with OA, ten patients with rheumatoid arthritis (RA), and eight non-OA/non-RA patients using a novel cDNA microarray chip. We identified 21 genes with simultaneous significant differences in expression between OA and non-OA/non-RA groups and between OA and RA groups. Linear discriminant analysis showed that the three groups could be well separated using those 21 genes. Statistical analysis also revealed that several of the 21 genes were associated with disease progression and clinical presentation. The graphical modelling method indicated that some of the 21 genes are significantly associated with a particular clinical presentation, suggesting biological relationships among those genes. This is the first report of the use of cDNA microarray technology to create large-scale gene expression profiles differentially expressed in situ in OA synovium of the knee joint.

An in vitro investigation of microtensile bond strengths of two dentine adhesives to caries-affected dentine

OBJECTIVES

To compare the micro-tensile bond strengths of two different adhesive systems (ABF (Clearfil Protect Bond), Kuraray Medical Inc., Tokyo, Japan) and Prime & Bond NT (PBNT, Dentsply, Konstanz, Germany) bonded to caries-affected dentine retained after chemo-mechanical caries removal using Carisolv gel, with that retained after excavation using conventional hand instrumentation.

METHOD

Twenty, adult, human extracted carious teeth were used in this split tooth study with bur-cut cavities in sound dentine acting as controls. After clinical caries excavation, the occlusal cavities in each experimental group were restored with either bonding system plus composite. Matchstick-shaped samples through the bond interfaces were sectioned and microtensile bond strengths recorded. Scanning electron microscopy (SEM) was used to ascertain the mode of failure at the restoration-dentine interface.

RESULTS

Statistical analysis of the bond strength data showed that for the ABF group, there was no difference in bond strengths between the controls and Carisolv group but these values were significantly higher than those for the hand-excavated samples. PBNT samples showed no significant differences in any of the three test groups, with wider ranging data sets. SEM analysis indicated a variety of failures at the interface including cohesive failures within the caries-affected dentine itself.

CONCLUSIONS

From the data generated by this study it could be concluded that microtensile bond strengths of PBNT/composite restorations to caries-affected dentine in clinical cavities were statistically comparable to those to sound dentine. In the ABF/composite restored group (self-etched), the use of conventional hand excavation appeared to weaken the bond strength to the remaining caries-affected dentine. However, the use of Carisolv gel excavation did not compromise bond strengths to caries-affected dentine in either group tested.

The effects of tibial component inclination on bone stress after unicompartmental knee arthroplasty

Unlike the case with total knee arthroplasty, the femorotibial angle (FTA) after unicompartmental knee arthroplasty (UKA) does not directly depend on the inclination of the tibial component when the height of the joint line is maintained. This study analyzed the effects of the inclination of the tibial component in the coronal plane on the contact pressure of the implant-bone surface and the stresses on the proximal tibia. A two-dimensional, coronal plane model of the proximal tibia was subjected to finite-element analysis. Sixteen patterns of finite-element models of equal FTA were developed in which the inclination of tibial components ranged from 5 degrees valgus to 10 degrees varus in increments of 1 degrees. Stress concentration at the proximal medial diaphyseal cortex gradually increased as the inclination changed from valgus to varus. Maximum contact pressure on the metal-bone interface similarly changed and shifted from the lateral edge to the medial edge of the implant as the inclination changed to varus. It was found that even without changing FTA, the inclination of the tibial component might affect stress concentration and contact pressure in the proximal tibia after UKA. The results suggested that slight valgus inclination of the tibial component might be preferable to varus and even to 0 degrees (square) inclination so far as the stress distribution is concerned.

[Dental treatment in the north area of Ishigaki Island in Okinawa]

Dental treatment and oral health care were performed on inhabitants in the north area of Ishigaki Island in Okinawa. There are no dentists in the area at present. One hundred sixty-six patients received treatment taking 528 man-days, during the period from November 9 to December 8, 2000. The area has 2 primary schools and 1 junior high school. The average DMFT of the children in the primary schools was 1.31, and in the junior high school it was 4.98. Compared with Japanese national survey data, the children in the area had a higher DMFT. Among the treatment procedures, the rate of conservative treatment was 62%, most of which was composite resin filling. Preventive measures for dental disease were offered to the inhabitants by means of topical fluoride application or oral health education. The period of this promotion was too short to perform complete dental treatment and to prevent caries and periodontal disease. It seems that primary prevention and higher dental hygiene education are needed for inhabitants in no-dentist areas, because the inhabitants do not have access to dental service easily.

Small-diameter compliant arterial graft prosthesis: Design concept of coaxial double tubular graft and its fabrication

To minimize compliance mismatch between native artery and arterial graft prosthesis over the entire pressure regions, we proposed a coaxial double tubular artificial graft which consists of an enhanced compliant inner tube and a less compliant outer tube, both of which were fabricated using well-controlled multiply micropored segmented polyurethane (SPU) films. Double tubular grafts were coaxially assembled by inserting the inner tube into the outer tube. First, the pressure-diameter (P-D) relationship of canine common carotid arteries, which exhibited a "J" curve, was determined as a targeted artery. Two determinant variables, the pressure-induced distensibility of each tube and the intertubular space distance, were defined and formulated in several models of coaxial double tubular SPU grafts, which had various intertubular space distances, micropore densities, and wall thicknesses. The distensibility of the inner tube determined the distensibility in the low-pressure regions, which was adjusted using wall thickness and microporosity. Thinner films with higher porosities resulted in a high pressure-induced distensibility. On the other hand, a low pressure-induced distensibility in the high-pressure regions was realized using an outer tube with a thicker wall and lower microporosity. The transition point from low- to high-pressure regions was determined by the intertubular distance using the theoretical values. On the basis of these results, we presented a prototype model of a coaxial double tubular graft that exhibited well-matched compliance with canine carotid artery.

Analgesic mechanisms of ketamine in the presence and absence of peripheral inflammation

BACKGROUND

The studies on the mechanisms of ketamine antinociception have led to conflicting results. In this study, the authors investigated the contribution of supraspinal monoaminergic descending inhibitory system to ketamine analgesia for acute nociception and inflammation-induced hyperalgesia.

METHODS

Male Sprague-Dawley rats were used. The paw withdrawal latencies to radiant heat stimuli were measured to assess the thermal nociceptive threshold. The analgesic effects of intrathecal or intraperitoneal ketamine were examined in the rats that received unilateral intraplantar carrageenan and in those that were untreated. In addition, it was examined whether pretreatment with intrathecal yohimbine or methysergide inhibited the analgesic effects of ketamine. Using an intrathecal microdialysis method, noradrenaline and 5-hydroxytryptamine concentrations in lumbar cerebrospinal fluid were measured after intraperitoneal ketamine in both saline- and carrageenan-treated rats.

RESULTS

In the untreated rats, intraperitoneal but not intrathecal ketamine produced antinociceptive effects in a dose-dependent manner. Pretreatment with intrathecal yohimbine or methysergide inhibited these antinociceptive effects. Intraplantar carrageenan significantly reduced paw withdrawal latencies on the injected paw but not on the contralateral paw. Both intraperitoneal and intrathecal ketamine reversed the shortened paw withdrawal latencies on the injected side in a dose-dependent manner without any effects on the contralateral side. Neither yohimbine nor methysergide inhibited these antihyperalgesic effects. In analyses of monoamines, the magnitude of increase in monoamines after intraperitoneal ketamine was significantly smaller in the carrageenan-treated rats than in the saline-treated rats.

CONCLUSION

These results demonstrated that ketamine produced antinociceptive effects through an activation of the monoaminergic descending inhibitory system, whereas, in a unilateral peripheral inflammation-induced hyperalgesic state, the monoaminergic system did not contribute to the antihyperalgesic effects of ketamine. The mechanisms of the antinociceptive and antihyperalgesic properties of ketamine are different.

Monkey pulpal response and microtensile bond strength beneath a one-application resin bonding system in vivo

OBJECTIVES

The aim of this in vivo study was to investigate the biocompatibility and microtensile bond strength of a one-application resin bonding system.

METHODS

Class V cavities were prepared on the facial surfaces of 36 intact monkey teeth, and the cavities were restored with an experimental one-application resin bonding system (TOF-1; Tokuyama Corp., Tokuyama, Japan) and a hybrid resin composite (PALFIQUE ESTELITE; Tokuyama Corp., Tokuyama, Japan). Histopathological changes of the restored teeth were evaluated at 3, 30 and 90 days after operation (N = 10). Microtensile bond tests were performed at 3 and 90 days after operation (N = 10).

RESULTS

Only two of 30 pulps showed a slight inflammatory cell infiltration. There were no statistically significant differences in the incidence of slight inflammatory cell infiltration among time periods. Bacterial penetration along the cavity walls could not be detected in any specimen. The mean microtensile bond strength at 3 days after operation was 20.6 MPa, and that at 90 days was 14.9 MPa. Differences in bond strengths between the 3 day specimen and the 90 day specimen were statistically significant (p < 0.05).

CONCLUSIONS

The one-application resin bonding system exhibited acceptable biologic compatibility to the monkey pulp. Although there were statistically significant differences in bond strengths between the 3 day specimen and the 90 day specimen, this material provided a hermetic seal, eliminating bacterial microleakage.

HRad17 colocalizes with NHP2L1 in the nucleolus and redistributes after UV irradiation

The rad17 gene of Schizosaccharomyces pombe plays an important role as a checkpoint protein following DNA damage and during DNA replication. The human homologue of S. pombe rad17, Hrad17, was recently identified, but its function has not yet been established. Using the yeast two-hybrid system, we determined that HRad17 can interact with a nucleolar protein, NHP2L1. This interaction was also demonstrated biochemically, in human cells. Immunofluorescence studies revealed that HRad17 and NHP2L1 colocalize to the nucleolus, and immunogold labeling further resolved the location of NHP2L1 to the dense fibrillar component of the nucleolus. Interestingly, the localization of HRad17 in the nucleolus was altered in response to UV irradiation. These results provide some insight into the DNA damage and replication checkpoint mechanisms of HRad17.

Light and scanning electron microscopy of the inner surfaces of resins used in direct pulp capping

PURPOSE

To investigate with the scanning electron microscopy (SEM) the inner surface of the resin restorative used as a direct pulp capping.

MATERIALS AND METHODS

Class V cavities were prepared on the facial surfaces of 90 intact monkey teeth, and the pulps were intentionally exposed with a carbide bur through the cavity floor. Each exposed pulp was capped with one of three commercially available adhesive resin systems (BondWell LC, GC; Imperva Bond, Shofu; Clearfil Liner Bond II, Kuraray). The cavities were restored with an adhesive resin and a hybrid resin-based composite. Histopathological changes of the mechanically exposed pulp were evaluated at 3, 30 and 60 days postoperatively. The interface between the resin and pulp tissues on the inner surface of the resin restorative was observed by SEM.

RESULTS

Bacterial penetration along the cavity walls and pulp tissue could not be detected in any specimen. Slight inflammatory cell infiltration was the main initial reaction, while dentin bridge formation was the major long-term reaction in all groups. The resin surface adjacent to the etched cavity floor contained numerous resin tags corresponding to the dentin tubules. Remnants of pulpo-dentin complex, such as fragments of blood clots, pulpal cell, and dentin were also seen scattered along the inner resin surface.

Cloning and characterization of psu1(+), a new essential fission yeast gene involved in cell wall synthesis

We have isolated a new gene, psu1(+), from the fission yeast Schizosaccharomyces pombe. The predicted amino acid sequences shows that this protein has striking homology to the SUN family of the budding yeast, hence designated Psu1 (S. pombe homologue of the SUN family). Disruption of the psu1(+) gene revealed that it is essential for growth, and the null phenotype showed the swelling of cells followed by eventual lysis. We introduced psu1(+) gene in the disruptant strain and repressed it giving resistance to 1, 3-beta-glucanase digestion. Our results suggest that Psu1 plays an essential role in cell wall synthesis in S. pombe.

Suppression of oncogenic transformation by hypothemycin associated with accelerated cyclin D1 degradation through ubiquitin-proteasome pathway

Hypothemycin was originally isolated as an antifungal metabolite of Hypomyces trichothecoides. Here we report that treatment on v-K-ras-transformed NIH3T3 cells (DT cells) with hypothemycin caused drastic decrease in amount of cyclin D1 protein with concomitant prolongation of G1 phase in their cell cycle. Analysis using hypothemycin-resistant mutant of Schizosaccharomyces pombe (S. pombe) was carried out to show that S. pombe rhp6+ (homologue of Saccharomyces cerevisiae RAD6) and mammalian ubiquitin-conjugating enzyme 2 (ubc2) are the targets of hypothemycin or its downstream molecules in ubiquitin-conjugation process. Furthermore, in the presence of lactacystin, a specific inhibitor for proteasome, hypothemycin greatly enhanced the accumulation of multi-ubiquitinated form of cyclin D1 in DT cells. Therefore, it is indicated that hypothemycin facilitates ubiquitinating process of cyclin D1. In terms of malignant phenotype, hypothemycin inhibited anchorage-independent growth and reverted the morphology of DT cells. On the contrary, their morphology still remained transformed in the additional presence of lactacystin. Our results suggest that cyclin D1 is a key molecule working downstream in ras-signaling and that the transformation can be inhibited by the compound which can activate ubiquitin-proteasome pathway including degradation of cyclin D1.

[Descending aorta perfusion through median sternotomy in primary repair of aortic interruption complex]

Circulatory arrest is frequently used in aortic arch reconstruction in pediatric cardiac surgery. However, risks of postoperative acute renal failure and neurological deficit can not be ignored. We performed primary repair of aortic interruption in one-month old girl. After commencing extracorporeal circulation with bicaval venous cannulae and with arterial cannulae into the pulmonary trunk and the innominate artery, the descending aorta was cannulated just superior to the diaphragm. The cannula in the pulmonary trunk was then removed. Arch reconstruction and closure of the ventricular septal defect were performed with continuous perfusion to the brain and the lower body. The extracorporeal circulation time and the aortic cross-clamp time were 117 min and 21 min, respectively. Postoperative renal function was excellent, and there was no finding of neurological deficit. Cannulation of the descending aorta is a simple and useful technique with safety, in arch reconstruction in infants.

Use of bronchopulmonary lavage for eliminating inhaled fume particles from a patient with arc welder's lung

A 42-year-old man, who had worked as a welder for 20 years, was admitted to our hospital complaining of a dry cough. A chest radiograph showed diffuse small nodular shadows and chest computed tomography revealed small patchy opacities. A transbronchial lung biopsy specimen showed welding fume particles mainly located in alveolar space with mild fibrosis of alveolar septa. In order to prevent further fibrosis, bronchopulmonary lavage (BPL) was performed to eliminate the fume particles. The amount of iron particles derived from the total lavage fluid was 911.7 mg.

[Propofol anesthesia for a patient with Arnold-Chiari deformity]

We gave anesthesia for the suboccipital decompression in a 25-yr-old female patient with Arnold-Chiari deformity. The induction and maintenance of anesthesia were performed with fentanyl, continuous infusion of propofol 10-3 mg.kg-1.h-1 and inhalation of nitrous oxide and oxygen, and the operation was performed without any complication. Postoperative course of the patient was also uneventful except a short-term pneumonia. Propofol is more advantageous compared with volatile anesthetics for decreasing intracranial pressure. This suggests that propofol is a suitable anesthetic agent for a patient with Arnold-Chiari deformity.

[Positive end-expiratory pressure facilitates washout of nitrous oxide in patients with obstructive pulmonary disease]

This study was designed to investigate the relationship between nitrous oxide elimination and each value of pulmonary function tests: percent vital capacity, air way resistance and percent of forced expiratory pressure (FEV1.0%) in patients undergoing general anesthesia. Furthermore, the effect of positive end-expiratory pressure (PEEP) on nitrous oxide elimination was studied. Thirty nine patients, anesthetized by oxygen, nitrous oxide and sevoflurane, were allocated randomly to one of two groups; one, with PEEP 10 cmH2O during nitrous oxide elimination and the other, without. After discontinuation of nitrous oxide, the concentration of nitrous oxide was measured at 15 sec intervals under controlled ventilation with 100% oxygen-sevoflurane. There was a significant correlation between nitrous oxide washout time and FEV1.0% (P < 0.05). Patients were further divided into two subgroups: FEV1.0% of over 70% (normal FEV) and that of less than 70% (low FEV). In the normal FEV group, the washout time was unaffected by PEEP. In the low FEV group, the washout times, with and without PEEP, were 7.07 +/- 0.93 min and 9.13 +/- 2.32 min, respectively. The difference was significant (P < 0.05). These results suggest that patients with chronic obstructive lung disease are at risk of delay in nitrous oxide elimination. This delay was found to be preventable with PEEP.

[Suppressive effects of ketamine on neuropathic pain]

We previously reported that ketamine analgesia in acute pain was produced by the activation of the monoaminergic descending inhibitory system. Recent studies have confirmed that the NMDA receptor antagonists attenuate the hyperalgesia in neuropathic pain. In this study, we investigated the suppressive effects of a clinically available NMDA antagonist, ketamine, and the mechanisms of its effects on neuropathic pain in rats with peripheral mononeuropathy. A unilateral chronic constriction injury (CCI) model was introduced by loose ligation of the sciatic nerve of the rats. The CCI rats showed hyperalgesia to thermal and mechanical pressure stimuli on the injured side of their hind paws. Intraperitoneal (IP) ketamine (25 or 50 mg.kg-1) and intrathecal (IT) ketamine (25-500 micrograms) reversed, dose-dependently, both thermal and mechanical hyperalgesia. Pretreatment with IT yohimbine (alpha-2 adrenergic antagonist) or IT methysergide (serotonergic antagonist) did not show the suppressive effects of IP ketamine (50 mg.kg-1) on hyperalgesia. Concentrations of norepinephrine (NE) and serotonin (5HT) in the spinal dorsal horn were measured using high performance liquid chromatography. The CCI rats showed increased NE and 5HT concentrations on both ligated and unligated sides of spinal dorsal horn, compared with shamoperated rats. IP ketamine (50 mg.kg-1) in the CCI rats did not boost the spinal NE or 5HT levels. These results indicate that the anti-hyperalgesic effect of ketamine is derived from a direct action on the spinal cord, but not from the activation of monoaminergic descending inhibitory systems.

Monkey pulpal responses to conventional and adhesive luting cements

Monkey pulpal responses to metal inlays luted with a combination of an adhesive resin and luting composite and conventional dental cements were histopathologically evaluated. Initial pulpal responses caused by re-exposure of the cut dentin surfaces and luting procedure under hydraulic pressure subsided at 90 days after final cementation. There was no significant difference among pulpal reactions to conventional dental cements and a combination of an adhesive resin and luting composite. The adhesive resin coating of freshly cut dentinal walls/floors immediately after cavity preparation seems to provide protection for the dentin and pulp in indirect restorations requiring temporary sealing.

[Preoperative flurbiprofen provides pain relief after laparoscopic cholecystectomy]

In a single-blind randomized prospective study, postoperative pain was assessed in 60 patients undergoing elective laparoscopic cholecystectomy with three types of anesthesia: standardized general anesthesia (control group), preoperative 50 mg flurbiprofen as an addition to the same method of general anesthesia (flurbiprofen group), and conventional combined epidural and general anesthesia with epidural administration of 0.25% bupivacaine 5-8 ml and 0.1-0.2 mg buprenorphine after surgery (epidural group). After the operation we found that the average time from the end of surgery to the first request for an analgesic was 3.9 h, 22.7 h and 43.7 h in the control, flurbiprofen and epidural group, respectively. Substantially it was longer in the flurbiprofen and epidural group than in the control group (P < 0.01 and < 0.001, respectively). Patients in the control group requested analgesics for a longer period of time after the initial request compared with patients in the other groups. Our results indicate that postoperative pain can be reduced when flurbiprofen is added to general anesthesia before surgery, although use of flurbiprofen was not as effective as the conventional combined epidural and general anesthesia used for treating pain after laparoscopic cholecystectomy.

Comparison of the Jackson-Rees circuit, the pediatric circle, and the MERA F breathing system for pediatric anesthesia

The purpose of this study was to compare the Jackson-Rees circuit with the pediatric circle and MERA F breathing system (MERA F system) for pediatric anesthesia from the viewpoint of work of breathing (WOB). Twenty-three children (2-10 yr old) were studied during spontaneous breathing under endotracheal anesthesia with 4 L/min nitrous oxide, 2 L/min oxygen, and 1% end-tidal concentration of sevoflurane. WOB, inspiratory and expiratory airway resistance, dynamic compliance (CDYN), pressure time product (PTP), and arterial blood gasses were measured in the three circuits. The inspiratory WOB was estimated directly by measuring the esophageal pressure-volume loop using the Campbell technique. In a laboratory study, we measured the compliances of the Jackson-Rees circuit, the pediatric circle, the MERA F system, and the adult circuit. WOB differed among the three circuits (MERA F system > pediatric circle > Jackson-Rees circuit). Inspiratory and expiratory resistances, and arterial carbon dioxide tension in the Jackson-Rees circuit were significantly lower than those of both the pediatric circle and MERA F system. The CDYN and PTP in the MERA F system were significantly higher than those in both the Jackson-Rees circuit and the pediatric circle. The MERA F system had significantly higher compliance than the Jackson-Rees circuit and pediatric circle. It is concluded that the Jackson-Rees circuit is most efficient, the pediatric circle is intermediate, and the MERA F system is the least efficient from the viewpoint of WOB during spontaneous breathing for pediatric anesthesia.

[Estimation of SIDS with measurement of cardio-respiratory contribution ratio through multivariate autoregressive modelling approach]

We obtained the cardio-respiratory impulse response and noise contribution ratio to study the central respiratory control system in one case of Ondine's curse, one case of sleep apnea syndrome and 34 cases of preterm infants, using multivariate autoregressive analysis. In Ondine's curse, the noise contribution ratio decreased during sleep. In the sleep apnea syndrome, the noise contribution ratio before apnea and after apnea decreased. In the preterm infants, the noise contribution ratio increased with the conceptional age. From these results, we concluded that the central cardio-respiratory control system was disturbed in Ondine's curse, sleep apnea syndrome and preterm infants. The cardio-respiratory impulse response using a multiple autoregressive analysis was useful for prediction of sudden infant death syndrome.

Oxamflatin: a novel compound which reverses malignant phenotype to normal one via induction of JunD

In the course of screening for inhibitors of tumorigenic phenotype of K-ras-transformed NIH3T3 cells (DT cells), we found a novel compound, oxamflatin, an aromatic sulfonamide hydroxamate derivative, which induces flat phenotype in these cells and suppresses their anchorage-independent growth. In contrast to DT cells, in v-raf-transformed NIH3T3 cells, no change in their morphology and no specific inhibition of their anchorage-independent growth was observed. Interestingly, oxamflatin was effective to NIH3T3 cells transformed by constitutively activated mutant of MEK, indicating the possibility that oncogene-induced morphological change is not necessarily induced by common signaling pathway such as MAP kinase cascade. In oxamflatin-treated DT cells, the expression of transcription factor junD was highly augmented, resulting in trans-activation of fibronectin gene by junD via cyclic AMP responsive element in its promoter. This behavior of junD was confirmed to correlate well with partial blocking of malignant phenotype in DT cells. Thus, oxamflatin can be categorized as the first reagent which induces genes whose products can interfere with oncogene-dependent transformation.

[Analgesic mechanism of ketamine]

The present study was conducted to investigate the mechanism of antinociceptive action of ketamine in rats. Intraperitoneally administered ketamine showed antinociception in the tail flick (TF) and mechanical paw pressure (MPP) tests in a time- and dose-dependent manner. However, intrathecal ketamine, 50-1,000 micrograms, did not exert any antinociceptive effect in TF and MPP tests. In contrast to the antinociceptive actions of intraperitoneal ketamine in TF test in intact rats, ketamine did not produce any effect in spinally transected rats. Further, pretreatment with an intrathecal serotonin antagonist, methysergide, and an intrathecal alpha 2 adrenergic antagonist, yohimbine, abolished the antinociceptive effects of intraperitoneal ketamine in the TF and the MPP tests. The monoamine levels (noradrenaline, MHPG, 5-HT, 5-HIAA) in the spinal cord, which were measured by high performance liquid chromatography, increased after the intraperitoneal administration of ketamine. We conclude that the antinociceptive effects of ketamine involve an activation of the monoaminergic (noradrenergic and serotonergic) descending inhibitory system, and that spinal ketamine does not affect the responses to the acute noxious stimuli.

Developmental characteristics of topographic EEG in school-age children using an autoregressive model

Developmental characteristics of the resting EEG were investigated in 47 school-age children using statistical analysis. Total and component EEG power were statistically analyzed between the subject groups from 7 to 14 year-old using our autoregressive pattern discrimination system. In early school-age children, significant topographic differences were seen in theta waves, while in late school-age children, the differences were found in alpha waves in the frontal and occipital regions, and in beta waves in the frontal region.

[Evaluation of postoperative hypoxemia with a pulse oximeter]

We investigated postoperative hypoxemia by monitoring of SPO2 with a pulse oximeter for the first 5 hours in the ward. Forty-eight adults were divided into the general anesthesia along (G) group and the combination of epidural and general anesthesia (E) group. The patients were randomly administered either 3 l. min(-1) oxygen with face mask for the initial 3 hours or room air. Postoperative Spo2 values in the patients who breathed room air in both groups were less than 94% in 33% of G group and 50% of E group. 3 l. min(-1) oxygen inhalation through the face mask was enough to avoid postoperative hypoxemia in both groups; the mean values of Spo2 were 99% in G group and 97.9% in E group. Spo2 rapidly and significantly decreased after stopping the oxygen inhalation to under 94% in 25% of G group and 58% of E group. Significant correlations were found between Spo2 levels and both age (R = 0.75) and preanesthetic Spo2 (R = 0.66) in G group. Spo2 was significantly lower in the patients whose anesthesia was stopped after 5 p.m. than in those who were weaned before 5 p.m. In conclusion, there is a high incidence of postoperative hypoxemia for several hours in the ward, which can be relieved by 3 l. min(-1) oxygen inhalation with face mask.

Development of relative power contribution ratio of the EEG in normal children: a multivariate autoregressive modeling approach

The relative power contribution ratio using a multivariate autoregressive model was applied to determine the spread of delta, theta, alpha and beta activity over the scalp in childhood. EEGs of 264 normal healthy subjects from 3 to 26 years were recorded from Fp1, Fp2, C3, C4, O1 and O2 with linked ears during the resting relaxed state with eyes closed. After selecting the epoch to remove artifacts, the relative power contribution ratio at each frequency band was calculated from the digitized EEG. The most noticeable developmental change was seen in the alpha frequency, where the relative power contribution ratio from its own area decreased significantly with age, and ratios from the other areas increased significantly. The change was larger at the frontal and smaller at the occipital region. Consequently, the occipital alpha wave was stable after 3 years of age. Developmental change at beta frequency was similar to alpha activity, but the number of components with significant change was smaller at delta and theta frequencies. Thus the relative power contribution of the EEG enabled us to observe how relationships among each location of EEG matured.

Developmental change in carotid artery blood flow waveform by component analysis in children

The carotid artery blood flow waveform (CABFW) is regarded as a summation of cardiac impulse responses. These impulse responses are divided into several components through a two-dimensional autoregressive modelling approach. Using this approach, we determined the developmental change in CABFW in 94 normal subjects from the neonatal period to adolescence. Our analysis demonstrated that: (i) the total power of impulse response increased significantly with increasing age. The component of impulse response was divided into six groups according to the damping frequency: group I (0 Hz), group II (1-5 Hz), group III (5-8 Hz), group IV (8-13 Hz), group V (13-17 Hz) and group VI (> 17 Hz); (ii) the power-density and the damping time of group I and II impulse response increased significantly with increasing age; (iii) the power-density and percent power of group III impulse response and power-density of group IV impulse response increased significantly with increasing age. Our results indicated that CABFW contained some regular impulses and that group I, II, III and IV, which were influenced by several factors, including cardiac contraction and the compliance and frictional forces of the carotid artery, appeared to be important to the developmental change of CABFW in children.

Temporal activation of nontransmembrane protein-tyrosine kinases following mast cell Fc epsilon RI engagement

One of the primary responses observed following antigen-induced cross-linking in mast cells is an increase in the phosphorylation of certain cellular proteins on tyrosine residues. Stimulation of protein-tyrosine kinase activity appears to be necessary for induction of downstream responses such as degranulation. The role of nonreceptor protein-tyrosine kinases in the signal transduction pathway initiated by Fc epsilon RI engagement in an interleukin-3-dependent mast cell line has been examined. The results presented here show that the enzymatic activity of Lyn is increased within seconds of receptor engagement. Syk activity also undergoes a rapid and transient increase, reaching a peak at approximately 30 s. Similarly, the activity of Fer, representing a third class of nontransmembrane protein-tyrosine kinase increases as well, with its activity peak reached at 1 min poststimulation. The enzymatic activities of Syk and Fer were found to correspond to anti-phosphotyrosine antibody reactivity. Phosphorylation of tyrosine residues of the beta and gamma chains of Fc epsilon RI increased concomitant with increased protein-tyrosine kinase activity. These results indicate that at least three classes of nontransmembrane protein-tyrosine kinases are involved in mast cell FceRI signaling and that the activation of these classes of enzymes is temporally regulated.

[Evaluation of 26G pencil point spinal needle in combined epidural-spinal anesthesia]

Twenty six gauge pencil point spinal needles and an adaptor for the fixation of the spinal needle were developed for combined epidural/spinal anesthesia on an experimental basis and applied on 110 patients. The length of the spinal needles was either 11.7 cm or 13 cm. Fifty out of 110 patients were punctured with the 11.7 cm needle and then were divided into 2 groups. The difference in length of the spinal and epidural needles was 8 mm in group 1 and 15 mm in group 2. In 80% of the patients in group 1 and in 95% of the patients in group 2, the subarachnoidal space was reached on the first puncture. These results indicate that the subarachnoidal space can be more easily punctured when a spinal needle 15 mm longer than the epidural needle is used. On the other hand, when a 13 cm spinal needle was employed, it often did not remain in place during drug injection. This problem could be solved, however, by using an adaptor with which the spinal needle was fixed firmly on the epidural needle at the point of dural puncture. The incidence of the post dural puncture headache was 1.7% (1 out of 60 patients).

Multivariate autoregressive analysis of carotid artery blood flow waveform in an infant of a diabetic mother with cardiomyopathy

We analyzed the carotid artery blood flow waveform (CABFW) of an infant of a non-insulin dependent diabetic mother with hypertrophic cardiomyopathy (IDM cardiomyopathy) through multivariate autoregressive analysis and compared the developmental change of his CABFW with that of normal newborns. The total power was lower than normal newborns on the second and third day of life when his heart dysfunction was severe, and elevated on the fifth day of life when normal-heart function was recovered. The power of component 3 (C3), of which the damping frequency was 7-11 Hz, was slightly high on the second and third day of life and it decreased to the normal range on the fifth day of life by component analysis. In contrast, the power of C3 increased with decreasing resistance index of anterior cerebral artery (RI of ACA) which shows the cerebral vascular resistance of normal newborns. These results suggest that the carotid artery blood flow volume decreased by low cardiac output and the cerebral vascular resistance decreased to maintain the cerebral circulation, when the heart dysfunction was severe.

[Effect of preoperative treatment with recombinant human erythropoietin in patients undergoing hemodilutional autologous transfusion]

This study evaluated whether a combination of recombinant human erythropoietin (rHuEPO) and hemodilutional autologous transfusion could reduce homologous blood transfusion in 37 patients who underwent elective urological surgery. A single dose of 6000 IU rHuEPO was administered 2 weeks before operation to patients whose preoperative hemoglobin was less than 12.0 g.dl-1 (8.5-12.0 g.dl-1) (EPO group, n = 15) and compared these with control subjects whose preoperative hemoglobin was more than 12.0 g.dl-1 (non-EPO group, n = 22). Both hemoglobin and hematocrit levels after administration of rHuEPO in the EPO group increased significantly to the same levels as in those in the non-EPO group and remained at these levels. The mean volume of donated autologous blood was 980 g in the EPO group and 110 g in the non-EPO group. The mean surgical blood loss was 1330 g in the EPO group and 1120 g in the non-EPO group. No homologous blood transfusion was required in 80 percent of the cases in both groups: however, homologous transfusions were added to 3 cases in the EPO group and 4 cases in the non-EPO group whose surgical blood loss was over 2500 g. We conclude that the combination of preoperative rHuEPO treatment and hemodilutional autologous transfusion can reduce homologous transfusion during surgery in anemic patients.

[Effects of preoperatively administered flurbiprofen axetil on the action of inhaled anesthesia and postoperative pain]

Flurbiprofen axetil (FP) was evaluated in a randomized study relative to placebo in 26 patients undergoing endonasal ethmoidectomy. The FP group (n = 13) was administrated 1 mg.kg-1 FP 15 minutes before operation during a half hour. Likewise, the control group (n = 13) received intravenous NaCl 0.9%. Concentration and the quantity consumed of sevoflurane, perioperative body temperature, postoperative pain and on-demand dicrofenac sodium consumption were measured. No significant differences were observed concerning concentration and the quantity consumed of sevoflurane. Body temperature of the FP group fell significantly before infusion. The FP group showed lower pain scores and required less dicrofenac sodium than the control group (P < 0.05). This study suggests that preoperative FP infusion relieves postoperative pain, but does not affect the action of the inhalation anesthetic.