Influence of Intramuscular Injection Sites on Pharmacokinetics of Amoxicillin in Olive Flounder (Paralichthys olivaceus) and Its Implication for Antibacterial Efficacy

This study aimed to investigate the effects of different injection sites, including dorsal, cheek, and pectoral fin muscles, on the pharmacological properties of amoxicillin (AMOX) in olive flounder (Paralichthys olivaceus) after a single intramuscular (IM) injection of 40 mg/kg. The AMOX concentration was measured using high-performance liquid chromatography-tandem mass spectrometry, followed by a non-compartmental model analysis. The peak serum concentrations (C_max) achieved 3 h after dorsal, cheek, and pectoral fin IM injections were 202.79, 203.96, and 229.59 μg/mL, respectively. The area under the concentration-time curve (AUC) was 1697.23, 2006.71, and 1846.61 µg/mL·h, respectively. The terminal half-life (t_1/2λ_Z) was prolonged for cheek and pectoral fin IM injections (10.12 and 10.33 h, respectively) compared to dorsal IM injection (8.89 h). In the pharmacokinetic-pharmacodynamic analysis, a higher T > minimum inhibitory concentration (MIC) and AUC/MIC values were observed after AMOX was injected into the cheek and pectoral fin muscles compared to the dorsal muscle. Muscle residue depletion was below the maximum residue level from day 7 after IM injection at all three sites. These findings suggest that the cheek and pectoral fin sites provide advantages regarding systemic drug exposure and prolonged action compared with the dorsal site.

First Report of Enterocytozoon hepatopenaei Infection in Giant Freshwater Prawn (Macrobrachium rosenbergii de Man) Cultured in the Republic of Korea

In the Republic of Korea, Enterocytozoon hepatopenaei (EHP) was first isolated from Pacific whiteleg shrimp in April 2020; however, there are no existing reports of EHP infection in other shrimp or prawns. Here, we aimed to investigate EHP infection and its prevalence in giant freshwater prawn farms in the Republic of Korea. We tested prawns from 22 farms for EHP infection, and samples from eight farms showed positive EHP infection results in 2021. In EHP-infected prawn farms, the prevalence ranged from 4.9% to 18.2%. The prevalence of EHP infection in the Republic of Korea, derived from the prevalence in prawn farms, was estimated to be 0.8% in 2021. The proliferation of EHP was observed within the hepatopancreatic epithelial cells of prawns using H&E and Giemsa staining. Mature EHP was observed in the sinus between epithelial cells of the digestive tubules. Phylogenetic analysis revealed a clade distinct from the previously reported EHP in Pacific whiteleg shrimps. This is the first report of EHP infection in a giant freshwater prawn in the Republic of Korea, where the prevalence of EHP infection is not high, but it is recognized as an emerging disease that requires periodic monitoring and quarantine management in giant freshwater prawns.

Association of tumor-infiltrating lymphocytes with survival depends on primary tumor sidedness in stage III colon cancers (NCCTG N0147) [Alliance]

BACKGROUND

Tumor-infiltrating lymphocytes (TILs) are a robust and independent prognostic variable in localized colon cancer. Given reported differences in molecular features and prognosis of right- versus left-sided tumors, we examined the association of TIL densities with patient survival by primary tumor sidedness in stage III cancers, including clinical low- (T1-3, N1) and high-risk (T4 and/or N2) groups.

PATIENTS AND METHODS

In a phase III trial of FOLFOX-based adjuvant chemotherapy, TIL densities were analyzed and dichotomized in colon carcinomas (N = 1532) based on a previously determined cut point optimized for disease-free survival (DFS). Right-sided tumors were defined as proximal to the splenic flexure. Associations of TILs and sidedness with 5-year DFS were examined using Kaplan-Meier methodology along with multivariable modeling and relative contribution analysis by Cox regression.

RESULTS

Lower TIL densities were found in left- versus right-sided tumors (P < 0.0001). The association of TIL densities with DFS differed significantly by tumor sidedness (Pinteraction = 0.045). Overall, patient tumors with low (versus high) TILs had significantly poorer DFS in right-sided (hazard ratio 2.02, 95% confidence interval 1.45-2.82; Padj < 0.0001), but not left-sided tumors (Padj = 0.1731). Among clinical low-risk patients, low (versus high) TILs were adversely prognostic only in right-sided tumors (Padj = 0.0058). Among high-risk patients, low TILs were prognostic independent of sidedness (Padj < 0.025). The relative contribution of TILs to DFS was substantially greater in right- versus left-sided tumors (24% versus 1.5%). In high-risk tumors, TILs had the highest relative contribution to DFS (42%) of all variables. In low-risk tumors, the contribution of TILs (16%) to DFS was second to KRAS.

CONCLUSIONS

The association of TIL densities with patient survival differed by primary tumor sidedness and clinical risk group, suggesting that TILs should be interpreted in this context among stage III colon cancers.

CLINICALTRIALS

GOV IDENTIFIER

NCT00079274; https://clinicaltrials.gov/ct2/show/NCT00079274.

Optimization of a Cryopreservation Method for the Endangered Korean Species Pogostemon yatabeanus Using a Systematic Approach: The Key Role of Ammonium and Growth Regulators

Cryopreservation provides a secure long-term conservation option for rare and endangered plant species with non-orthodox or limitedly available seeds. Wide application of cryopreservation to biobank wild flora is hampered by the need to re-optimize nearly all protocol steps for every new species. We applied a systematic approach to simplify optimization of a multi-stage droplet-vitrification method for the endangered wetland Korean species, Pogostemon yatabeanus. This approach consisted of a standard procedure pre-selected based on material type and size, which was complemented with 11 additional treatments to reveal the most impactful conditions. Effect of ammonium nitrate at various protocol steps was also tested. The highest shoot tip survival (92%) and plant regeneration (90%) after cryopreservation were achieved using preculture with 10% sucrose followed by 40 min osmoprotection and 60 min treatment with vitrification solution A3-80% (33.3% glycerol + 13.3% dimethyl sulfoxide + 13.3% ethylene glycol + 20.1% sucrose) on ice. A three-step regrowth procedure starting with ammonium-free medium with 1 mg/L GA3 and 1 mg/L BA followed by ammonium-containing medium with and without growth regulators was essential for the development of healthy plants from cryopreserved shoot tips. This approach enables fast optimization of the cryopreservation procedure for new osmotic stress-sensitive plant species.

Antioxidant effects of Geranium nepalense ethanol extract on H2O2-induced cytotoxicity in H9c2, SH-SY5Y, BEAS-2B, and HEK293

Oxidative damage leads to many diseases. In this study, we evaluated the antioxidant effects of 70% ethanol extract of Geranium nepalense (GNE) on hydrogen peroxide-induced cytotoxicity in cell lines: H9c2, SH-SY5Y, HEK293, and BEAS-2B. We determined the free radical scavenging activity of GNE using 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS), and superoxide dismutase-like activities, as well as the polyphenol and flavonoid contents of GNE. The results showed that GNE scavenged DPPH and ABTS radicals in a dose-dependent manner. In addition, it contained abundant contents of total polyphenol and flavonoid contents and strongly suppressed cellular reactive oxygen species, thereby protecting H₂O₂-induced cytotoxicity in H9c2, SH-SY5Y, HEK293, and BEAS-2B cell lines. The powerful antioxidant activity exhibited by GNE, both in vitro and in cell systems, was attributed to its free radical scavenging activity. Therefore, GNE may be useful in preventing oxidative stress-induced diseases including Alzheimer's disease, respiratory inflammatory disease, and chronic kidney diseases.

Peptide fragment of thymosin β4 increases hippocampal neurogenesis and facilitates spatial memory

Although several studies have suggested the neuroprotective effect of thymosin β4 (TB4), a major actin-sequestering protein, on the central nervous system, little is understood regarding the action of N-acetyl-serylaspartyl-lysyl-proline (Ac-SDKP), a peptide fragment of TB4 on brain function. Here, we examined neurogenesis-stimulative effect of Ac-SDKP. Intrahippocampal infusion of Ac-SDKP facilitated the generation of new neurons in the hippocampus. Ac-SDKP-treated mouse hippocampus showed an increase in β-catenin stability with reduction of glycogen synthase kinase-3β (GSK-3β) activity. Moreover, inhibition of vascular endothelial growth factor (VEGF) signaling blocked Ac-SDKP-facilitated neural proliferation. Subchronic intrahippocampal infusion of Ac-SDKP also increased spatial memory. Taken together, these data demonstrate that Ac-SDKP functions as a regulator of neural proliferation and indicate that Ac-SDKP may be a therapeutic candidate for diseases characterized by neuronal loss.

Dose-related effect of urinary cotinine levels on pulmonary function among Korean women

SETTING

Country-wide general population in South Korea.

BACKGROUND

The dose-response relationship between smoking and pulmonary function in women may have been significantly over-estimated by studies that employed a self-reporting questionnaire.

OBJECTIVE

To evaluate whether this relationship was still observed among Korean women when smoking levels were determined by urinary cotinine measurements.

DESIGN

A total of 4584 Korean women from the spirometry data set of the Korean National Health and Nutrition Examination Surveys IV and V (2008-2010) were included. Analysis of covariance was performed to estimate the dose-related effect of urinary cotinine levels on pulmonary function after adjusting for covariates in this country-wide cross-sectional study.

RESULTS

Compared to urinary cotinine levels (cut-off 50 ng/ml), the false-positive rate of self-reported smoking was 53.2%. After the smokers were divided into deciles, the regression coefficients for percentage forced expiratory volume in 1 second (FEV₁%) and percentage forced expiratory volume/forced volume capacity (FEV₁/FVC) ratio (FEV1/FVC%) were -0.2903 and -0.2680 (%/decile), respectively (both P < 0.001).

CONCLUSION

It is necessary to use objective methods when determining the smoking status of Korean women. Even after reducing information bias, smoking affected pulmonary function in a dose-dependent manner.

Effect of antihistamine as an adjuvant treatment of isotretinoin in acne: a randomized, controlled comparative study

BACKGROUND

Isotretinoin has been frequently used for acne therapy. However, it has limitation in acceptance because of its adverse effects. Although antihistamine recently revealed to decrease the lipogenesis, evidence is lacking regarding the clinical relevance of antihistamine in the treatment of acne.

OBJECTIVES

To evaluate the clinical efficacy and tolerability of antihistamine as an adjuvant treatment of isotretinoin.

METHODS

Forty patients with moderate acne were included in this randomized, controlled comparative study. Twenty patients were treated with isotretinoin and 20 patients were treated with additional antihistamine, desloratadine. Assessment was made at baseline, after 2, 4, 8 and 12 weeks of treatment.

RESULTS

At week 12, compared with isotretinoin only group, isotretinoin with additional antihistamine group showed more statistically significant decrease in acne lesion counts (non-inflammatory lesions: 44.8% vs. 17.8%; inflammatory lesions: 55.8% vs. 22.9%; total lesions: 45.6% vs. 18.7%; all P < 0.05). Significant decrease was also observed in the score of global acne grading system and the measured value of sebum and erythema. Moreover, acne flare during the treatment occurred less frequently and adverse events of isotretinoin were more tolerable in additional antihistamine group.

CONCLUSIONS

This results provide early evidence that antihistamine has a synergic effect with minimizing the side-effect of isotretinoin, and may be used as an adjuvant treatment of moderate acne.

Abstract P1-08-39: Tumor-infiltrating CD8+ lymphocytes as an independent predictive factor for pathologic complete response to primary systemic therapy in breast cancer

Background: Tumor infiltrating lymphocytes (TILs), stem cell phenotype and epithelial-mesenchymal transition (EMT) are known to be associated with response to primary systemic therapy (PST) in breast cancer. However, these markers are strongly correlated with triple negative breast cancer, which shows high pathologic complete response (pCR) to PST. This study was conducted to evaluate clinical implication of these markers as predictive factor for pCR after PST in breast cancer and to find independent predictive factors, irrespective of breast cancer subtype.

Methods: The pre-chemotherapeutic biopsy specimens of 153 breast cancer patients who underwent surgical resection after anthracycline-or anthracycline/taxane-based PST were enrolled. TILs (CD4, CD8, and FOXP3), breast cancer stem cell phenotype (CD44+/CD24-, and ALDH1), expression of EMT markers [vimentin, smooth muscle actin (SMA), osteonectin, E-cadherin, and N-cadherin] were evaluated by immunohistochemistry and were correlated with pCR after PST.

Results: High infiltration of TILs (CD4+, CD8+, and FOXP3+), expression of stem cell markers (CD44+/CD24-, ALDH1+) and expression of EMT markers (expression of vimentin, SMA and osteonectin; loss of E-cadherin) were significantly associated with high histologic grade and triple negative breast cancer. Of them, high TILs (CD4+, CD8+, and FOXP3+) and expression of ALDH1, vimentin and osteonectin were associated with pCR. In multivariate analysis, CD8+ TILs and a conventional predictive marker, Ki67 were found to be independent predictors for pCR. In subgroup analyses, high CD8+ TILs was remained as a predictive factor for pCR, irrespective of PST regimen and tumor subtype.

Conclusion: CD8+ TILs could therefore be used as a reliable predictor of response to PST in breast cancer.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-39.

Tumour-infiltrating CD8+ lymphocytes as an independent predictive factor for pathological complete response to primary systemic therapy in breast cancer

Background:

Tumour-infiltrating lymphocytes (TILs) are known to be associated with response to primary systemic therapy (PST) in breast cancer. This study was conducted to assess the association of TIL subsets with pathological complete response (pCR) after PST in breast cancer in relation to breast cancer subtype, breast cancer stem cell (BCSC) phenotype and epithelial–mesenchymal transition (EMT).

Methods:

The pre-chemotherapeutic biopsy specimens of 153 breast cancer patients who underwent surgical resection after anthracycline- or anthracycline/taxane-based PST were analysed. TIL subsets (CD4+, CD8+, and FOXP3+ TILs), BCSC phenotype, and the expression of EMT markers were evaluated by immunohistochemistry and were correlated with pCR after PST.

Results:

Infiltration of CD4+ and CD8+ T lymphocytes was closely correlated with BCSC phenotype and EMT. High levels of CD4+, CD8+, and FOXP3+ TILs were associated with pCR, and CD8+ TILs were found to be an independent predictive factor for pCR. In addition, CD8+ TILs were associated with pCR irrespective of breast cancer subtype, CD44+/CD24− phenotype, EMT, and chemotherapeutic regimen in subgroup analyses.

Conclusion:

These findings indicate that CD8+ cytotoxic T lymphocytes are a key component of TILs associated with chemo-response and can be used as a reliable predictor of response to anthracycline- or anthracycline/taxane-based PST in breast cancer.

Abstract P5-04-03: Epithelial-mesenchymal transition is associated with in situ to invasive transition of basal-like breast cancer

BACKGROUND: Epithelial-mesenchymal transition (EMT) is known to play an important role in breast cancer invasion and metastatic progression and to be associated with cancer stem cells and basal-like subtype. However, its role in the progression of in situ to invasive breast carcinoma is uncertain. To investigate this question, we evaluated the difference in the expression of EMT-related markers between pure ductal carcinoma in situ (DCIS) and invasive carcinomas according to molecular subtype.

METHODS: We performed immunohistochemical analyses of EMT-related markers [expression of vimentin, smooth muscle actin (SMA), osteonectin and N-cadherin, translocation of β-catenin and loss of E-cadherin] and breast cancer stem cell markers (CD44+/CD24−, ALDH1) in 320 invasive carcinomas and 179 pure DCIS of breast using tissue microarrays. We also analyzed 39 basal-like invasive cancers with adjacent DCIS component to determine the difference in the expression of EMT-related markers in the invasive and DICS component within individual cases.

RESULTS: In invasive carcinomas, vimentin, SMA and osteonectin were highly expressed in basal-like subtype. In addition, loss of E-cadherin and translocation of β-catenin were most frequently found in basal-like subtype. Furthermore, there were positive correlations between the expression of EMT-related markers and stem cell markers (CD44+/CD24- and ALDH1). However, there was no significant difference in the expression of EMT-related markers according to molecular subtype in pure DCIS. When comparing invasive carcinoma with pure DCIS, expression of EMT-related markers was significantly higher in invasive carcinoma than in pure DCIS. Subgroup analysis revealed higher expression of EMT-related markers in invasive carcinoma than in DCIS in basal-like subtype, but not in non-basal-like subtypes. Moreover, in 39 basal-like invasive cancers with adjacent DCIS, expression of mesenchymal markers was increased in invasive component compared to DCIS component.

CONCLUSIONS: Our study confirmed that EMT is an intrinsic characteristic of basal-like subtype and is associated with breast cancer with stem cell phenotype. However, increased expression of EMT-related markers in invasive carcinoma compared to pure DCIS, especially in basal-like subtype, and in the invasive component of basal-like invasive carcinoma with DCIS component also suggests a role of EMT in the transition of in situ- to invasive carcinoma in basal-like breast cancer.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-04-03.

MET in gastric carcinomas: comparison between protein expression and gene copy number and impact on clinical outcome

Background:

The aim of this study was to compare gene copy number (GCN) and protein expression of MET and to evaluate their prognostic roles in gastric carcinomas.

Methods:

MET protein expression and gene amplification (GA) status were determined by immunohistochemistry (IHC) and silver in-situ hybridisation (SISH), respectively, in a large series of gastric carcinoma.

Results:

Protein overexpression was observed in 104 of 438 cases, with IHC 2+ in 94 and IHC 3+ in 10, and high polysomy of chromosome 7 and GA were found in 61 and 13 of 381, respectively. Direct comparison revealed a significant correlation between high level of protein expression and increased GCN. All cases with GA showed protein overexpression. Furthermore, all with IHC 3+ showed GA except 1, even which could be categorised as GA according to the ASCO/CAP guideline for human epidermal growth factor receptor 2 assessment. IHC 3+ and GA were significantly associated with poor prognosis.

Conclusion:

MET IHC reflects well on GA, and therefore, it could be a primary screening test for patient selection for anti-MET therapy if GA is a major determinant of drug responsiveness. Also, the prognostic role of MET indicates that anti-MET therapy is a very promising modality in adjuvant treatment for gastric cancer.

P1-05-04: Distinct Patterns of Promoter CpG Island Methylation of Breast Cancer Subtype Are Associated with Different Stem Cell Phenotype

Background: Although DNA methylation profiles in breast cancer have been connected to breast cancer molecular subtype, there have been no studies of the association of DNA methylation with stem cell phenotype. This study was designed to evaluate promoter CpG islands methylation of 15 genes with regard to breast cancer subtype and to investigate whether the patterns of CpG island methylation in each subtype are associated with cancer stem cell phenotype represented by CD44+/CD24- or ALDH1 expression.

Methods: We performed MethyLight analysis for the methylation status of 15 promoter CpG island loci involved in breast cancer progression (APC, DLEC1, GRIN2B, GSTP1, HOXA1, HOXA10, IGF2, MT1G, RARB, RASSF1A, RUNX3, SCGB3A1, SFRP1, SFRP4, and TMEFF2) and determined cancer stem cell phenotype by CD44/CD24 and ALDH1 immunohistochmeistry in 36 luminal A, 33 luminal B, 30 luminal-HER2, 40 HER2 enriched, and 40 basal-like subtypes of breast cancer.

Results: The number of CpG island loci methylated was significantly different among subtypes and it was highest in luminal-HER2 subtype and lowest in basal-like subtype. Methylation frequencies and levels in 12 out of the 15 genes were significantly different among all subtypes and basal-like subtype showed significantly lower methylation frequencies and levels in nine genes, compared to luminal A, luminal B, HER2 enriched, and luminal-HER2 subtypes. CD44+/CD24- or ALDH1+ putative stem cell populations were most enriched in basal-like subtype. The methylation of promoter CpG islands was significantly lower in CD44+/CD24-cell (+) tumors, compared to CD44+/CD24-cell (−) tumors, even within the basal-like subtype. ALDH1 (+) tumors also had significantly lower methylation, compared to ALDH1 (−) tumors.

Conclusions: Our findings showed that promoter CpG island methylation was significantly different according to breast cancer subtype and stem cell phenotype of tumor, suggesting that breast cancers have different methylation patterns according to molecular subtypes and it is associated with stem cell phenotypes of the tumor.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-05-04.

High FOXP3+ regulatory T-cell density in the sentinel lymph node is associated with downstream non-sentinel lymph-node metastasis in gastric cancer

Background:

We aimed to evaluate the immunologic nature of sentinel lymph nodes (SLNs) in gastric cancer patients and to determine whether it can predict non-SLN metastasis.

Methods:

Sentinel lymph node samples were collected from 64 gastric carcinoma patients who had undergone gastrectomy with SLN biopsy. One representative SLN sample was selected from each patient and was subjected to immunostaining for CD8, CD57, FOXP3, and DC-LAMP. The numbers of marker-positive cells in each sample were counted. The relationships between various immune cell densities and clinicopathologic parameters or metastasis status of SLNs and non-SLNs were sought.

Results:

High FOXP3+ Treg density of the SLN was found to be significantly associated with the presence of metastasis in either SLNs or non-SLNs. DC-LAMP+ cell density of the SLN was the highest at the isolated tumours cell level, and this decreased along with an increase in tumour metastasis in either SLNs or non-SLNs. Univariate and multivariate logistic regression models revealed that high FOXP3+ Treg density of the SLN was an independently significant predictor of non-SLN metastasis.

Conclusions:

This study is the first to indicate an important role of SLNs in metastatic dissemination of gastric cancer. Our findings suggest that Tregs could be a new therapeutic target for regulating the metastasis of gastric cancer.

Prognostic implications of type and density of tumour-infiltrating lymphocytes in gastric cancer

The study aims to determine whether type and density of tumour-infiltrating lymphocytes (TILs) can predict the clinical course in gastric cancer. Gastric carcinomas (n=220) were immunostained for CD3, CD8, CD20, and CD45RO and evaluated for clinicopathologic characteristics. Number of TILs that immunostained positively for each marker were counted using NIH ImageJ software. Tumours were grouped into low- and high-density groups for each marker (CD3, CD8, CD45RO). The densities of CD3(+), CD8(+), and CD45RO(+) TILs were found to be independent predictors of lymph node metastasis by multivariate analysis with odds ratios (95% CI) of 0.425 (0.204-0.885), 0.325 (0.150-0.707), and 0.402 (0.190-0.850), respectively. Kaplan-Meier survival analysis revealed that patients in the high-density groups for CD3, CD8, and C45RO had a significantly longer survival time than the patients in the corresponding low-density groups, respectively. In multivariate survival analysis, the densities of CD3(+), CD8(+), and CD45RO(+) TILs remained independent prognostic factors with hazard ratios (95% CI) of 0.549 (0.317-0.951), 0.574 (0.347-0.949), and 0.507 (0.298-0.862), respectively. In conclusion, density of TILs was found to be independently predictive of regional lymph node metastasis and patient survival in gastric cancer.

EGFR in gastric carcinomas: prognostic significance of protein overexpression and high gene copy number

AIMS

Epidermal growth factor receptor (EGFR) expression has been observed in a variety of solid tumours with the potential of new targeted therapeutic agents. The aim was to evaluate the EGFR status of gastric carcinoma (GC) using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH).

METHODS AND RESULTS

The EGFR status was evaluated in GC tissues from 511 patients using IHC and FISH. In addition, the clinicopathological characteristics were examined and the results were compared with the EGFR status. One hundred and forty cases (27.4%) showed EGFR overexpression by IHC. EGFR overexpression was associated with older age (P = 0.001), moderately or poorly differentiated histology (P = 0.001) and higher stage disease (P = 0.046). Sixteen cases (3.1%) showed high polysomy and 12 cases (2.3%) had gene amplification by FISH. The correlation between IHC and FISH results was statistically significant (P < 0.001). The patients with GC who had EGFR overexpression had an unfavourable prognosis and multivariate analysis showed that EGFR overexpression was a possible independent unfavourable prognostic factor.

CONCLUSIONS

EGFR overexpression was observed in a subset of cases with GC and was associated with an unfavourable prognosis. It will be important to evaluate EGFR status to interpret future clinical trials properly using EGFR targeted agents.

Characteristics of KIT-negative gastrointestinal stromal tumours and diagnostic utility of protein kinase C theta immunostaining

AIMS

To characterise KIT-negative gastrointestinal stromal tumours (GISTs) clinically, pathologically, immunohistochemically and genetically, and to establish the usefulness of protein kinase C theta (PKC) as a diagnostic marker in KIT-negative GIST.

METHODS

252 consecutive cases of GIST were evaluated for clinicopathological characteristics and immunostained for various antibodies. Mutational analyses of KIT and platelet-derived growth factor receptor alpha (PDGFRA) were also performed in 62 cases.

RESULTS

20 (7.9%) GISTs showed negative immunostaining for KIT. KIT-negative GISTs were more likely to originate from omentum or peritoneum, have an epithelioid histology, and be classified as high risk. The overall survival rate of patients with KIT-negative GISTs (5-year survival rate 68.7% (SD 10.7%)) was lower than that of patients with KIT-positive GISTs (5-year survival rate, 79.9% (3.0%)) (p = 0.042, log-rank test). Negative KIT expression was an independent prognostic factor in multivariate Cox regression analysis when the risk of aggressive behaviour and the status of imatinib treatment were adopted as covariates. KIT-negative GISTs also showed lower expression rates of CD34, Bcl-2, and PKC than KIT-positive GISTs; mutational analysis revealed that 30% of KIT-negative GISTs harboured a PDGFRA exon 18 mutation. Immunostaining on PKC showed that 93.9% of all GISTs expressed PKC protein. However, 21.9% of 64 mesenchymal tumours other than GIST also showed positivity on PKC.

CONCLUSIONS

KIT-negative GISTs had characteristics that differ from those of KIT-positive GISTs, and negative KIT expression was an independent prognostic indicator for overall survival of patients. Although PKC is a sensitive diagnostic marker for GIST, its usefulness is limited because of low sensitivity and low specificity in KIT-negative GISTs.

The effect of chromosome 17 polysomy on HER-2/neu status in breast cancer

AIM

To investigate the effect of polysomy 17 on HER-2 status as evaluated by immunohistochemistry (IHC), dual-colour fluorescence in situ hybridisation (FISH) and chromogenic in situ hybridisation (CISH).

METHODS

Dual-probe FISH and single-probe CISH were performed to detect HER-2 gene amplification, and IHC to detect HER-2 expression, on 309 invasive breast cancers.

RESULTS

Polysomy 17 was detected in 32.0% of the total number of breast cancers; it was detected in 12.3% of the IHC 0 or 1+ cases, 42.8% of the IHC 2+ cases and 66.0% of the IHC 3+ cases (p<0.001). In addition, there was a substantially higher rate of polysomy 17 in the IHC 2+ or 3+/FISH-negative cases than in the IHC 0 or 1+ cases (40.8% vs 12.3%; p<0.001). The FISH and CISH results were concordant in 299 cases (96.8%). Of the 10 discordant cases, FISH suggested amplification in five with disomy 17 and one with monosomy 17, whereas CISH pointed to borderline copy numbers in each of these six cases. The remaining four cases had high polysomy 17; CISH, but not FISH, indicated amplification.

CONCLUSIONS

Results suggest that an increase of HER-2 gene copy number secondary to polysomy 17 leads to HER-2 overexpression in some IHC 2+/3+ breast cancers, without gene amplification. The high level of concordance between FISH and CISH suggests that CISH is a valid alternative to FISH for assessing HER-2 gene amplification. However, cases in which CISH indicates the presence of borderline copy numbers or low levels of amplification may need FISH to rule out polysomy 17 and to determine HER-2 gene amplification status accurately.

Acute paronychia heralding the exacerbation of pemphigus vulgaris

Acute paronychia, the suppurative inflammation involving the paronychium of the nails, is usually caused by bacterial or fungal infection and has been rarely reported as a presentation of pemphigus vulgaris (PV). We report a woman with PV who presented with suppurative paronychia of multiple fingernails and toenails, which preceded the exacerbation of other mucocutaneous lesions. A biopsy specimen of the paronychium revealed suprabasal vesicles due to acantholysis. Systemic corticosteroids and adjuvant immunosuppressants were effective in treating mucocutaneous lesions as well as nail disease. We conclude that in patients with PV, acute paronychia could be a manifestation of the disease per se, rather than an infectious process. Only the precise diagnosis with adequate immunosuppressive treatment can lead to good control of disease activity.

Life-threatening thrombotic thrombocytopenic purpura (TTP) in a patient with sickle cell-hemoglobin C disease

We report a patient with hemoglobin sickle cell-hemoglobin C disease who developed the clinical syndrome of thrombotic thrombocytopenic purpura (TTP) during admission for typical acute pain crisis. The potential for multiorgan involvement secondary to vaso-occlusive crisis complicated the diagnosis and overlapped with the patient's clinical presentation of chronic bone pain and hemolytic anemia. Clinical improvement and normalization of laboratory parameters followed rapidly in response to plasma exchange therapy.

Stresses at the cervical lesion of maxillary premolar--a finite element investigation

OBJECTIVES

The objective of this study was to use a three-dimensional (3-D) finite element model to investigate normal stress distribution to substantiate the tooth flexure mechanism. The study also compared the changes in the stresses by different occlusal loading sites and directions.

METHODS

The 3-D finite element analysis was used. A maxillary premolar was selected to construct the simulation model. The model was constructed step-by-step for convergence and validity. Seven load conditions for various load sites and different directions were simulated to the model.

RESULTS

The maximal principal stress and minimal principal stress distributions developed within the structures of seven load conditions were output and their stress distributions on z-plane at the vertical midline were shown. The peak tensile stress of the cervical area for various load conditions were compared and listed.

CONCLUSIONS

This study has shown that the presence of tensile stresses in the cervical region of a maxillary premolar by various loading sites and different directions. The results coincided with the stress-induced theory, hence sustaining it. The relationship of the affected factors of leverage to the development of cervical abfraction lesions, was explored.

Numerical investigation of the factors affecting interfacial stresses in an MOD restored tooth by auto-meshed finite element method

Many researches have addressed the high correlation between the fracture of restored teeth and the prepared cavity geometry. In addition, concerns about bonding versus debonding dental materials from cavity walls and different occlusal force conditions could also alter the mechanical responses in a restored tooth. This study employed an automatic mesh procedure to investigate the mechanical interactions between different interfacial conditions and cavity parameters such as pulpal wall depth under different chewing functions. The results indicated that when occlusal force was applied directly on the tooth, it could increase unfavourable stress dramatically. When interfacial fixation was simulated as the contact condition between the tooth tissue and restorative material, it might increase the fracture potential exponentially compared with the bonded interface. For pulpal wall depth analyses, greater risks of fracture for the remaining tooth were observed in deeper cavity of mesio-occlusal-distal (MOD) restorations and the existence of a pulpal wall is essential even it is only 1 mm above the gingival wall.

Highly phosphorescent bis-cyclometalated iridium complexes: synthesis, photophysical characterization, and use in organic light emitting diodes

The synthesis and photophysical study of a family of cyclometalated iridium(III) complexes are reported. The iridium complexes have two cyclometalated (C(**)N) ligands and a single monoanionic, bidentate ancillary ligand (LX), i.e., C(**)N2Ir(LX). The C(**)N ligands can be any of a wide variety of organometallic ligands. The LX ligands used for this study were all beta-diketonates, with the major emphasis placed on acetylacetonate (acac) complexes. The majority of the C(**)N2Ir(acac) complexes phosphoresce with high quantum efficiencies (solution quantum yields, 0.1-0.6), and microsecond lifetimes (e.g., 1-14 micros). The strongly allowed phosphorescence in these complexes is the result of significant spin-orbit coupling of the Ir center. The lowest energy (emissive) excited state in these C(**)N2Ir(acac) complexes is a mixture of (3)MLCT and (3)(pi-pi) states. By choosing the appropriate C(**)N ligand, C(**)N2Ir(acac) complexes can be prepared which emit in any color from green to red. Simple, systematic changes in the C(**)N ligands, which lead to bathochromic shifts of the free ligands, lead to similar bathochromic shifts in the Ir complexes of the same ligands, consistent with "C(**)N2Ir"-centered emission. Three of the C(**)N2Ir(acac) complexes were used as dopants for organic light emitting diodes (OLEDs). The three Ir complexes, i.e., bis(2-phenylpyridinato-N,C2')iridium(acetylacetonate) [ppy2Ir(acac)], bis(2-phenyl benzothiozolato-N,C2')iridium(acetylacetonate) [bt2Ir(acac)], and bis(2-(2'-benzothienyl)pyridinato-N,C3')iridium(acetylacetonate) [btp2Ir(acac)], were doped into the emissive region of multilayer, vapor-deposited OLEDs. The ppy2Ir(acac)-, bt2Ir(acac)-, and btp2Ir(acac)-based OLEDs give green, yellow, and red electroluminescence, respectively, with very similar current-voltage characteristics. The OLEDs give high external quantum efficiencies, ranging from 6 to 12.3%, with the ppy2Ir(acac) giving the highest efficiency (12.3%, 38 lm/W, >50 Cd/A). The btp2Ir(acac)-based device gives saturated red emission with a quantum efficiency of 6.5% and a luminance efficiency of 2.2 lm/W. These C(**)N2Ir(acac)-doped OLEDs show some of the highest efficiencies reported for organic light emitting diodes. The high efficiencies result from efficient trapping and radiative relaxation of the singlet and triplet excitons formed in the electroluminescent process.

Automatic finite element mesh generation for maxillary second premolar

Developing three dimensional finite element mesh models for irregular geometric objects requires a large amount of manual efforts, hence limiting the three dimensional approach for dental structure analyses. An automatic procedure which can be used to generate a three dimensional finite element mesh for the maxillary second premolar was developed in this study. Firstly, a embedded second premolar was sliced and scanned parallel to the occlusal surface. A self-developed image processing system was employed to detect the boundaries of different materials within each section. An automatic mesh generation program was used on these boundaries to create tetrahedral elements based on moving nodes of uniform cube approach. Six mesh models of the second premolar with different element sizes using linear and quadratic elements were analyzed. Strain energy and von Mises stresses were reviewed for convergence in the crown regions.

Methods to improve a periodontally involved terminal abutment of a cantilever fixed partial denture--a finite element stress analysis

The two-dimensional plane stress finite element stress analysis was used to evaluate the stress of mandibular posterior cantilevers for compromised periodontal involved distal terminal abutments. Some commonly practiced methods to alleviate the stress from mastication of the cantilever FPDs were also evaluated. From the analysis the following was concluded: (1) The most distal terminal abutment of a cantilever FPD generally experienced a high stress concentration. (2) The cantilever FPDs require at least two abutments. Optimum stress reduction occurred with a splinting of three abutments. To increase the number of abutments to more than three, would not result in a proportional and meaningful reduction of stress in the periodontium. (3) To alter the bridge material with more rigid material or to have a longer marginal preparation of the terminal abutment are ineffective for better stress distribution.

Stress analysis of four-unit fixed bridges on abutment teeth with reduced periodontal support

The variable properties of photoelastic models and the difficulty of fabrication of the model limit experimental designs. The 'material fringe value' is introduced into the definition of the 'stress concentration index' by multiplying the fringe orders. Three levels of periodontal support in three photoelastic models (nine cases) were compared quantitatively by determining the stress concentration induced in periodontium by point loading vertically on a span of the fixed partial denture of four units length. The results indicate that comparison among photoelastic models is possible and useful. The stress concentration effects produced by the second molar were more prominent and determinant than that by the first premolar in the periodontium of the abutments.

[The stress distribution of prefabricated screw posts. Part III: Techniques]

Some commonly used endodontic screw posts were analysed for various techniques of post insertion by photoelastic stress distribution. These endodontic dowels were installed in assumed clinical conditions. These conditions included: (1) no backing off during post installation, (2) the channelling of the post without cleaning, (3) a smaller drill was used prepare the post channel, and (4) an axis deviated contrangle was used to prepare the post channel. According to this photoelastic analysis, the techniques of post insertion may affect the stress distribution. Suggestions for post insertion are as follows: 1. The stress can be reduced by counterrotating the dowel one-fourth turn after resistance to installation has been detected. 2. The channel should be cleaned thoroughly before post insertion. 3. Because accurate post fit is important to maximize both retention and support, the screw post should be used with the matched post/reamer system; and accurate contrangle drilling should be maintained.

[Stress distribution of prefabricated screw posts. Part II: Different designs and materials]

This study compared stress distribution during installation and the functions of prefabricated posts of different designs and materials. When endodontic dowels were installed in standardized models as well as simulated loads were applied, direct comparisons of stress distributing properties were analyzed by photoelastic stress analysis. Based on our findings, we concluded that: 1. During installation and under simulated functional loads, the tapered-end posts produced wedging stresses near the apex. More uniform stress distributions were observed with parallel-sided posts. 2. When the coronal flanges of flange type posts engaged the model around the occlusal portion of the channel preparation, stress concentrations occurred at the flange-dowel-dentin area. Stress levels were reduced toward the apical portion of the dowels. 3. The split shaft of Flexi-Post posts appeared to compress inward, stress concentrations occurred at the cervical and middle third and the other portion of the dowels were reduced. 4. Cementation type posts displayed a low and even distribution of dentinal stress during installation and functional loads.

[Stress distribution of prefabricated screw posts. Part I: Post size]

A commonly used prefabricated screw post was analysed for its various lengths and diameters. When endodontic dowels were installed in standardized models, direct comparisons of stress distributing properties were analysed through photoelastic stress analysis. According to the analysis, installation of the post produced severe lateral stress. At shorter lengths, these stress concentrations were much more severe. However, increasing the diameter of the dowel may reduce the stress slightly. Under load conditions, the stress-producing characteristics of the dowel increased with shorter lengths and smaller diameters. It seems that increasing the surface area of insertion with the dentin improves the distribution of the load caused by the insertion of the post.

[Use of silicone template to prepare guide planes for removable partial denture]

Guide planes are used not only for one path of insertion and removal but also to increase both the stability of the denture and resistance to lateral movement; they also protect the abutments from displacement during insertion and removal of the denture. Therefore, it is necessary to give attention to this part of the mouth preparation in the construction of removable partial dentures. Some methods have developed to form exact guide planes. They are the free-hand method, the modeling plastic index, the acrylic index, the laboratory milling technique, and the intraoral parallelism device. However, most of these instruments are either too expensive or too sophisticated to be considered practical for removable partial denture preparations. This article describes a simple and effective method to assure the development of guide planes intraorally as they are planned on the diagnostic cast. The occlusal or incisal surface of the abutment on the prepared stone cast was completely covered with a newly mixed putty type silicone rubber base. The plastic silicone was put against the prepared guide plane on the stone cast and was compressed with a blockout trimmer held on the surveyor before the silicone setting. All of the prepared guide plane was contoured to disclose the marker and to form a ledge. After the silicone setting, the template was removed and trimmed so that soft tissue will not interfere with the intraoral reorientation. As the templates are placed on the abutments intraorally, the abutments bulging out of the template area are obviously discernible and prepared guide planes on the diagnostic cast can be easily and definitely duplicated on the abutments.

cis-beta-acetylacrylate is a substrate for maleylacetoacetate cis-trans isomerase. Mechanistic implications

Maleylacetoacetate cis-trans isomerase together with coenzyme glutathione catalyzes cis-trans isomerization of cis-beta-acetylacrylate strongly suggesting that the isomerase directly catalyzes isomerization of the diketo forms in addition to the ketoenol forms of maleylacetone and maleylacetoacetate. The isomerase exhibits wider substrate acceptance than previously thought.

Premixed intravenous admixtures: a positive development for hospital pharmacy

The development of premixed intravenous admixtures is reviewed in a historical context, and its effects on hospital pharmacy practice are discussed. As pharmaceutical manufacturers introduce more i.v. medications in ready-to-use containers, the same complaints that were voiced by pharmacists about unit dose packaging and ready-to-dispense tablets and capsules are being aired. But premixed i.v. admixtures are a logical extension of the basic unit dose principle of providing a readily identifiable and ready-to-administer dose. The time and cost savings these products offer are needed in hospital pharmacies. Some of the disadvantages of these products--including storage and freezer space and multiplicity of administration systems--are overcome by proper planning and education of personnel. If fewer personnel are now needed to prepare i.v. admixtures, then those personnel should be used to improve patient care in other ways. The use of premixed i.v. admixtures is a positive technological advance in drug packaging. Its advantages outweight its disadvantages, and it will soon be become the universally accepted form of i.v. drug packaging.

[The effect of eugenol cement, CC, FC on the bonding strength of the adhesive resin to the tooth surface (author's transl)]

Bovine tooth surface pretreated with dental medicaments-Eugenol cement (ZOE), CC, FC was used to adhere to acrylic rod by adhesive resins-Clearfil F II and 4 META-MMA-TBB-O. The effects of the dental medicaments on the bonding strength of the adhesive resin were measured. The results were showed as follows: (1) Any pretreatment of the three medicaments reduced the bonding strength of Clearfil to both enamel and dentin surface. With 4-META-MMA-TBB-O resin system the bonding strength was reduced by ZOE and CC while it was increased by FC pretreatment. (2) On the enamel tooth surface premedicated with ZOE, FC or CC, the alcohol rinsing or mechanic grinding reduced the decrease of the bonding strength of Clearfil. With 4-META-MMA-TBB-O resin, the mechanic grinding of the premedicated enamel tooth surface increased the bonding strength. (3) On the premedicated dentin tooth surface, the mechanic grinding reduced the decrease of the bonding strength of 4-META-MMA-TBB-O. Alcohol rinsing, on the contrary, decreased the bonding strength. (4) On both fresh and premedicated dentin surface the bonding strength of Clearfil was lower than 3 MPa.

Effects of primary nursing on pharmaceutical services

The effects of primary care nursing on the provision of pharmaceutical services are discussed. Primary care nursing poses advantages and disadvantages for pharmacy. It makes communications and distribution more complex, except when pharmaceutical services are decentralized. Introduction of innovative patient care pharmaceutical services has been made more difficult. Solutions to these problems include assigning pharmacist/technician teams to specific patient-care areas, orienting nursing staff to the pharmacy department, and establishing committees to handle potential problems.