A Phase I Trial of Focal Salvage Stereotactic Body Radiation Therapy for Radiorecurrent Prostate Cancer

PURPOSE/OBJECTIVE(S)

Locally recurrent prostate cancer after radiotherapy (RT) is an increasingly recognized entity with no standard management. NCT03253744 was a phase I trial with a primary objective of identifying the maximally tolerated dose (MTD) of a course of image-guided, focal, salvage stereotactic body radiotherapy (SBRT) for patients with local recurrence after prior definitive RT. Additional objectives included biochemical control and imaging response on mpMRI and 18F-DCFPyL (PSMA) PET/CT.

MATERIALS/METHODS

SBRT was prescribed to three dose levels (DLs): 40Gy (DL1), 42.5Gy (DL2), and 45Gy (DL3) in 5 fractions. The prescription dose was delivered to a PTV defined by mpMRI and PSMA imaging and biopsy confirmed tumor volume. Dose escalation followed a 3+3 design with a 3-patient expansion at the MTD. Toxicities above baseline were scored using CTCAE v5.0 criteria for two years after completion of SBRT. Escalation was halted if 2 dose limiting toxicities (DLTs) were observed. DLTs were defined as any persistent (>4 days) grade 3 toxicity occurring within the first 3 weeks after SBRT, and any grade 3 GU or grade 4 GI toxicity thereafter. Imaging response was compared between baseline and 6-months by the Wilcoxon signed rank test.

RESULTS

Between 08/2018 and 05/2022, 8 patients underwent salvage SBRT to 11 intraprostatic lesions with a median follow-up of 27 months. No DLTs were observed on DL1. Two patients were enrolled on DL2 and both experienced grade 3 GU toxicities, prompting de-escalation and expansion (n = 6) on DL1, the MTD. The most common toxicities were grade 2 GU toxicities: acute urinary urgency/frequency, acute weak urinary stream, and noninfective cystitis. One patient at DL1 had a self-limited episode of grade 2 GI toxicity (proctitis). No grade 3 GI toxicities were observed. All but two patients achieved an undetectable PSA nadir. Only one of these experienced biochemical failure (nadir + 2.0) at 33 months with suspicion of distant metastatic failure on restaging PET/CT. Imaging response was demonstrated by MRI in all lesions with heterogeneity in volumetric response (6% to 100%). A significant (p<0.01) response on PSMA PET/CT was observed for all measured parameters (SUVMax, SUVMean, GTVPSMA, Total Lesion PSMA [SUVMean × GTVPSMA]). Of the 11 lesions, 1 (9%) demonstrated a complete response (CR) by MRI and 9 (82%) by PSMA PET/CT. A single lesion increased in volume by 0.06 cc (16%) at 6-month PSMA PET/CT compared to baseline in the only patient who did not achieve an undetectable PSA nadir and did not have imaging suggestive of distant failure.

CONCLUSION

On this phase I dose escalation study of salvage SBRT for isolated intraprostatic local failure after definitive RT, the MTD was 40Gy in 5 fractions. producing a 100% 24-month bPFS, with one late failure at 33 months occurring after the 24-month study period. The most frequent clinically significant toxicity was late grade 2 GU toxicity. Imaging response was demonstrated in all lesions on MRI and PSMA PET/CT with exception of a single lesion.

Automated glioma grading on conventional MRI images using deep convolutional neural networks

PURPOSE

Gliomas are the most common primary tumor of the brain and are classified into grades I-IV of the World Health Organization (WHO), based on their invasively histological appearance. Gliomas grading plays an important role to determine the treatment plan and prognosis prediction. In this study we propose two novel methods for automatic, non-invasively distinguishing low-grade (Grades II and III) glioma (LGG) and high-grade (grade IV) glioma (HGG) on conventional MRI images by using deep convolutional neural networks (CNNs).

METHODS

All MRI images have been preprocessed first by rigid image registration and intensity inhomogeneity correction. Both proposed methods consist of two steps: (a) three-dimensional (3D) brain tumor segmentation based on a modification of the popular U-Net model; (b) tumor classification on segmented brain tumor. In the first method, the slice with largest area of tumor is determined and the state-of-the-art mask R-CNN model is employed for tumor grading. To improve the performance of the grading model, a two-dimensional (2D) data augmentation has been implemented to increase both the amount and the diversity of the training images. In the second method, denoted as 3DConvNet, a 3D volumetric CNNs is applied directly on bounding image regions of segmented tumor for classification, which can fully leverage the 3D spatial contextual information of volumetric image data.

RESULTS

The proposed schemes were evaluated on The Cancer Imaging Archive (TCIA) low grade glioma (LGG) data, and the Multimodal Brain Tumor Image Segmentation (BraTS) Benchmark 2018 training datasets with fivefold cross validation. All data are divided into training, validation, and test sets. Based on biopsy-proven ground truth, the performance metrics of sensitivity, specificity, and accuracy are measured on the test sets. The results are 0.935 (sensitivity), 0.972 (specificity), and 0.963 (accuracy) for the 2D Mask R-CNN based method, and 0.947 (sensitivity), 0.968 (specificity), and 0.971 (accuracy) for the 3DConvNet method, respectively. In regard to efficiency, for 3D brain tumor segmentation, the program takes around ten and a half hours for training with 300 epochs on BraTS 2018 dataset and takes only around 50 s for testing of a typical image with a size of 160 × 216 × 176. For 2D Mask R-CNN based tumor grading, the program takes around 4 h for training with around 60 000 iterations, and around 1 s for testing of a 2D slice image with size of 128 × 128. For 3DConvNet based tumor grading, the program takes around 2 h for training with 10 000 iterations, and 0.25 s for testing of a 3D cropped image with size of 64 × 64 × 64, using a DELL PRECISION Tower T7910, with two NVIDIA Titan Xp GPUs.

CONCLUSIONS

Two effective glioma grading methods on conventional MRI images using deep convolutional neural networks have been developed. Our methods are fully automated without manual specification of region-of-interests and selection of slices for model training, which are common in traditional machine learning based brain tumor grading methods. This methodology may play a crucial role in selecting effective treatment options and survival predictions without the need for surgical biopsy.

Three-dimensional alginate hydrogels for radiobiological and metabolic studies of cancer cells

The purpose of this study is to demonstrate calcium alginate hydrogels as a system for in vitro radiobiological and metabolic studies of cancer cells. Previous studies have established calcium alginate as a versatile three-dimensional (3D) culturing system capable of generating areas of oxygen heterogeneity and modeling metabolic changes in vitro. Here, through dosimetry, clonogenic and viability assays, and pimonidazole staining, we demonstrate that alginate can model radiobiological responses that monolayer cultures do not simulate. Notably, alginate hydrogels with radii greater than 500 μm demonstrate hypoxic cores, while smaller hydrogels do not. The size of this hypoxic region correlates with hydrogel size and improved cell survival following radiation therapy. Hydrogels can also be utilized in hyperpolarized magnetic resonance spectroscopy and extracellular flux analysis. Alginate therefore offers a reproducible, consistent, and low-cost means for 3D culture of cancer cells for radiobiological studies that simulates important in vivo parameters such as regional hypoxia and enables long-term culturing and in vitro metabolic studies.

Brain tumor segmentation using holistically nested neural networks in MRI images

PURPOSE

Gliomas are rapidly progressive, neurologically devastating, largely fatal brain tumors. Magnetic resonance imaging (MRI) is a widely used technique employed in the diagnosis and management of gliomas in clinical practice. MRI is also the standard imaging modality used to delineate the brain tumor target as part of treatment planning for the administration of radiation therapy. Despite more than 20 yr of research and development, computational brain tumor segmentation in MRI images remains a challenging task. We are presenting a novel method of automatic image segmentation based on holistically nested neural networks that could be employed for brain tumor segmentation of MRI images.

METHODS

Two preprocessing techniques were applied to MRI images. The N4ITK method was employed for correction of bias field distortion. A novel landmark-based intensity normalization method was developed so that tissue types have a similar intensity scale in images of different subjects for the same MRI protocol. The holistically nested neural networks (HNN), which extend from the convolutional neural networks (CNN) with a deep supervision through an additional weighted-fusion output layer, was trained to learn the multiscale and multilevel hierarchical appearance representation of the brain tumor in MRI images and was subsequently applied to produce a prediction map of the brain tumor on test images. Finally, the brain tumor was obtained through an optimum thresholding on the prediction map.

RESULTS

The proposed method was evaluated on both the Multimodal Brain Tumor Image Segmentation (BRATS) Benchmark 2013 training datasets, and clinical data from our institute. A dice similarity coefficient (DSC) and sensitivity of 0.78 and 0.81 were achieved on 20 BRATS 2013 training datasets with high-grade gliomas (HGG), based on a two-fold cross-validation. The HNN model built on the BRATS 2013 training data was applied to ten clinical datasets with HGG from a locally developed database. DSC and sensitivity of 0.83 and 0.85 were achieved. A quantitative comparison indicated that the proposed method outperforms the popular fully convolutional network (FCN) method. In terms of efficiency, the proposed method took around 10 h for training with 50,000 iterations, and approximately 30 s for testing of a typical MRI image in the BRATS 2013 dataset with a size of 160 × 216 × 176, using a DELL PRECISION workstation T7400, with an NVIDIA Tesla K20c GPU.

CONCLUSIONS

An effective brain tumor segmentation method for MRI images based on a HNN has been developed. The high level of accuracy and efficiency make this method practical in brain tumor segmentation. It may play a crucial role in both brain tumor diagnostic analysis and in the treatment planning of radiation therapy.

Output factor comparison of Monte Carlo and measurement for Varian TrueBeam 6 MV and 10 MV flattening filter-free stereotactic radiosurgery system

The dose measurements of the small field sizes, such as conical collimators used in stereotactic radiosurgery (SRS), are a significant challenge due to many factors including source occlusion, detector size limitation, and lack of lateral electronic equilibrium. One useful tool in dealing with the small field effect is Monte Carlo (MC) simulation. In this study, we report a comparison of Monte Carlo simulations and measurements of output factors for the Varian SRS system with conical collimators for energies of 6 MV flattening filter‐free (6 MV) and 10 MV flattening filter‐free (10 MV) on the TrueBeam accelerator. Monte Carlo simulations of Varian's SRS system for 6 MV and 10 MV photon energies with cones sizes of 17.5 mm, 15.0 mm, 12.5 mm, 10.0 mm, 7.5 mm, 5.0 mm, and 4.0 mm were performed using EGSnrc (release V4 2.4.0) codes. Varian's version‐2 phase‐space files for 6 MV and 10 MV of TrueBeam accelerator were utilized in the Monte Carlo simulations. Two small diode detectors Edge (Sun Nuclear) and Small Field Detector (SFD) (IBA Dosimetry) were applied to measure the output factors. Significant errors may result if detector correction factors are not applied to small field dosimetric measurements. Although it lacked the machine‐specific kQclin,Qmsrfclin,fmsr correction factors for diode detectors in this study, correction factors were applied utilizing published studies conducted under similar conditions. For cone diameters greater than or equal to 12.5 mm, the differences between output factors for the Edge detector, SFD detector, and MC simulations are within 3.0% for both energies. For cone diameters below 12.5 mm, output factors differences exhibit greater variations.

PACS number(s): 87.55.k, 87.55.Qr

Nodal ratio of positive to excised nodes, but not number of positive lymph nodes is better to predict group to avoid chemotherapy among postmenopausal ER-positive, lymph node-positive T1-T2 breast cancer patients

AIM OF STUDY

To identify whether nodal ratio (NR) of positive to excised nodes is superior to number of positive lymph nodes to predict group to avoid chemotherapy among postmenopausal ER-positive, lymph node-positive, T1-T2 breast cancer patients.

MATERIALS AND METHODS

Postmenopausal estrogen receptor (ER)-positive, lymph node-positive patients who received endocrine therapy (n = 173) with complete baseline data in our hospital between 2000 and 2006 were included. The disease-free survival (DFS) was compared. Survival analysis was performed using Kaplan-Meier method. Cox proportional hazard models were used to evaluate the prognostic value of chemotherapy with different NR for DFS. P--values less than 0.05 were regarded as significant.

RESULTS

The median follow-up was 72 months. Three of 13 variables analyzed remained significantly prognostic for survival in the Cox proportional hazards model. These included age (hazard ratio (HR) =1.642, 95% confidence interval (CI) =1.154-2.337, P = 0.006); histological grade (HR = 2.463,95% CI = 1.389-4.367, P = 0.002); and NR (HR = 2.280, 95% CI = 1.113-4.671, P = 0.024). Subgroup analysis by NR status showed that in patients with NR ≥ 0.20, chemotherapy significantly improves DFS (HR = 0.360, 95% CI = 0.195-0.663, P = 0.001); while in patients with NR < 0.20, chemotherapy did not significantly affect DFS (HR = 0.677, 95% CI = 0.227-2.107, P = 0.493). Radiotherapy is an important factor that improves DFS in lymph node-positive patients, so it is considered in all analysis.

CONCLUSION

This retrospective analysis demonstrates that NR of positive to excised nodes, but not number of positive lymph nodes is better to predict group to avoid chemotherapy among postmenopausal ER-positive, lymph node-positive T1-T2 breast cancer patients.

Insomnia symptoms in South Florida military veterans with epilepsy

BACKGROUND

Despite the high prevalence of insomnia in veterans with epilepsy, it remains understudied. Our aim was to identify the associations of insomnia with epilepsy, comorbidities, and treatment-related variables in South Florida veterans.

METHODS

We performed a cross-sectional analysis of veterans attending an epilepsy clinic over 18 months. Participants completed standardized assessments of seizure and sleep. Insomnia was defined as 1) difficulty with sleep onset, maintenance, or premature awakenings with daytime consequences or 2) sedative-hypnotic use on most nights of the previous month.

RESULTS

One hundred sixty-five veterans (87% male, age 56 ± 15 years) were included: 66 reporting insomnia (40%). In logistic regression analysis, insomnia was significantly associated with post-traumatic seizure etiology, lamotrigine prescription, and mood and psychotic disorders. Female gender and levetiracetam treatment were associated with lower odds for insomnia.

CONCLUSION

Insomnia was associated with post-traumatic epilepsy, mood/psychotic comorbidities, and antiepileptic regimen. Insomnia represents an under-recognized opportunity to improve comprehensive epilepsy care.

Patient-specific CT dosimetry calculation: a feasibility study

Current estimation of radiation dose from computed tomography (CT) scans on patients has relied on the measurement of Computed Tomography Dose Index (CTDI) in standard cylindrical phantoms, and calculations based on mathematical representations of “standard man”. Radiation dose to both adult and pediatric patients from a CT scan has been a concern, as noted in recent reports. The purpose of this study was to investigate the feasibility of adapting a radiation treatment planning system (RTPS) to provide patient‐specific CT dosimetry. A radiation treatment planning system was modified to calculate patient‐specific CT dose distributions, which can be represented by dose at specific points within an organ of interest, as well as organ dose‐volumes (after image segmentation) for a GE Light Speed Ultra Plus CT scanner. The RTPS calculation algorithm is based on a semi‐empirical, measured correction‐based algorithm, which has been well established in the radiotherapy community. Digital representations of the physical phantoms (virtual phantom) were acquired with the GE CT scanner in axial mode. Thermoluminescent dosimeter (TLDs) measurements in pediatric anthropomorphic phantoms were utilized to validate the dose at specific points within organs of interest relative to RTPS calculations and Monte Carlo simulations of the same virtual phantoms (digital representation). Congruence of the calculated and measured point doses for the same physical anthropomorphic phantom geometry was used to verify the feasibility of the method. The RTPS algorithm can be extended to calculate the organ dose by calculating a dose distribution point‐by‐point for a designated volume. Electron Gamma Shower (EGSnrc) codes for radiation transport calculations developed by National Research Council of Canada (NRCC) were utilized to perform the Monte Carlo (MC) simulation. In general, the RTPS and MC dose calculations are within 10% of the TLD measurements for the infant and child chest scans. With respect to the dose comparisons for the head, the RTPS dose calculations are slightly higher (10%–20%) than the TLD measurements, while the MC results were within 10% of the TLD measurements. The advantage of the algebraic dose calculation engine of the RTPS is a substantially reduced computation time (minutes vs. days) relative to Monte Carlo calculations, as well as providing patient‐specific dose estimation. It also provides the basis for a more elaborate reporting of dosimetric results, such as patient specific organ dose volumes after image segmentation.

PACS numbers: 87.55.D‐, 87.57.Q‐, 87.53.Bn, 87.55.K‐

Dynamic adsorption properties of n-alkyl glucopyranosides determine their ability to inhibit cytolysis mediated by acoustic cavitation

Suspensions of human leukemia (HL-60) cells readily undergo cytolysis when exposed to ultrasound above the acoustic cavitation threshold. However, n-alkyl glucopyranosides (hexyl, heptyl, and octyl) completely inhibit ultrasound-induced (1057 kHz) cytolysis (Sostaric, et al. Free Radical Biol. Med. 2005, 39, 1539-1548). The efficacy of protection from ultrasound-induced cytolysis was determined by the n-alkyl chain length of the glucopyranosides, indicating that protection efficacy depended on adsorption of n-alkyl glucopyranosides to the gas/solution interface of cavitation bubbles and/or the lipid membrane of cells. The current study tests the hypothesis that "sonoprotection" (i.e., protection of cells from ultrasound-induced cytolysis) in vitro depends on the adsorption of glucopyranosides at the gas/solution interface of cavitation bubbles. To test this hypothesis, the effect of ultrasound frequency (from 42 kHz to 1 MHz) on the ability of a homologous series of n-alkyl glucopyranosides to protect cells from ultrasound-induced cytolysis was investigated. It is expected that ultrasound frequency will affect sonoprotection ability since the nature of the cavitation bubble field will change. This will affect the relative importance of the possible mechanisms for ultrasound-induced cytolysis. Additionally, ultrasound frequency will affect the lifetime and rate of change of the surface area of cavitation bubbles, hence the dynamically controlled adsorption of glucopyranosides to their surface. The data support the hypothesis that sonoprotection efficiency depends on the ability of glucopyranosides to adsorb at the gas/solution interface of cavitation bubbles.

Mechanism of the protective effects of long chain n-alkyl glucopyranosides against ultrasound-induced cytolysis of HL-60 cells

Recently it has been shown that long chain (C5-C8) n-alkyl glucopyranosides completely inhibit ultrasound-induced cytolysis [J.Z. Sostaric, N. Miyoshi, P. Riesz, W.G. DeGraff, and J.B. Mitchell, Free Radical Biol. Med., 39 (2005) 1539]. This protective effect has possible applications in HIFU (high intensity focused ultrasound) for tumor treatment, and in ultrasound assisted drug delivery and gene therapy. n-Alkyl glucopyranosides with hexyl (5mM), heptyl (3mM), octyl (2mM) n-alkyl chains protected 100% of HL-60 cells in vitro from 1.057 MHz ultrasound-induced cytolysis under a range of conditions that resulted in 35-100% cytolysis in the absence of glucopyranosides. However the hydrophilic methyl-beta-d-glucopyranoside did not protect cells. The surface active n-alkyl glucopyranosides accumulate at the gas-liquid interface of cavitation bubbles. The OH radicals and H atoms formed in collapsing cavitation bubbles react by H-atom abstraction from either the n-alkyl chain or the glucose moiety of the n-alkyl glucopyranosides. Owing to the high concentration of the long chain surfactants at the gas-liquid interface of cavitation bubbles, the initially formed carbon radicals on the alkyl chains are transferred to the glucose moieties to yield radicals which react with oxygen leading to the formation of hydrogen peroxide. In this work, we find that the sonochemically produced hydrogen peroxide yields from oxygen-saturated solutions of long chain (hexyl, octyl) n-alkyl glucopyranosides at 614 kHz and 1.057 MHz ultrasound increase with increasing n-alkyl glucopyranoside concentration but are independent of concentration for methyl-beta-D-glucopyranoside. These results are consistent with the previously proposed mechanism of sonoprotection [J.Z. Sostaric, N. Miyoshi, P. Riesz, W.G. DeGraff, and J.B. Mitchell, Free Radical Biol. Med., 39 (2005) 1539]. This sequence of events prevents sonodynamic cell killing by initiation of lipid peroxidation chain reactions in cellular membranes by peroxyl and/or alkoxyl radicals [V. Misik, P. Riesz, Ann. N.Y. Acad. Sci., 899 (2000) 335].

Computational hydrodynamics of animal swimming: boundary element method and three-dimensional vortex wake structure

The slender body theory, lifting surface theories, and more recently panel methods and Navier-Stokes solvers have been used to study the hydrodynamics of fish swimming. This paper presents progress on swimming hydrodynamics using a boundary integral equation method (or boundary element method) based on potential flow model. The unsteady three-dimensional BEM code 3DynaFS that we developed and used is able to model realistic body geometries, arbitrary movements, and resulting wake evolution. Pressure distribution over the body surface, vorticity in the wake, and the velocity field around the body can be computed. The structure and dynamic behavior of the vortex wakes generated by the swimming body are responsible for the underlying fluid dynamic mechanisms to realize the high-efficiency propulsion and high-agility maneuvering. Three-dimensional vortex wake structures are not well known, although two-dimensional structures termed 'reverse Karman Vortex Street' have been observed and studied. In this paper, simulations about a swimming saithe (Pollachius virens) using our BEM code have demonstrated that undulatory swimming reduces three-dimensional effects due to substantially weakened tail tip vortex, resulting in a reverse Karman Vortex Street as the major flow pattern in the three-dimensional wake of an undulating swimming fish.

Adenovirus-Mediated MUC1 gene transduction into human blood-derived dendritic cells

MUC1 protein is widely expressed on various human cancer cells and has a specific highly glycosylated core structure with multiple tandem repeats, which may include an immunogenic peptide sequence. The potency of MUC1 protein to induce human histocompatibility leukocyte antigen-class I-restricted cytotoxic T-lymphocyte (CTL) induction remains to be fully clarified in human beings. In the current study, we made MUC1-expressing human dendritic cells (DCs) using recombinant adenovirus vector. Adenovirus vector plasmid containing human MUC1 cDNA, pAdHM4-MUC1 was constructed using in vitro ligation with a shuttle vector, pHMCMV5. Adenovirus vector expressing MUC1 was generated by the transfection of PacI-digested recombinant vector plasmid into 293 cells. Human blood DCs were obtained from 7-day culture of monocytes with recombinant human (rh) granulocyte-macrophage (GM) colony-stimulating factor (CSF) and (rh)interleukin (IL)-4. Then, 1 x 10(6) DCs were incubated with viral supernatant at a multiplicity of infection of 200 for 24 h in the presence of rhGM-CSF and rhIL-4. Flow cytometric analysis showed that 30% to 40% of the transduced DCs expressed MUC I protein; by contrast, nontransduced or transduced DCs with mock virus expressed only small amounts of MUC1 protein. Adenovirus-mediated MUC1 gene transduction into DCs had no significant effect on DC surface marker expressions or functions such as mixed leukocyte reaction. Furthermore, MUCI-specific CD8+ CTLs could be induced from healthy donor blood lymphocytes using MUC1-expressing DCs as stimulators. These results suggested that MUC1 gene-transduced DCs are a functional and potent tool for triggering a CTL response against MUC1 cancer cells.

Height and weight change across menarche of schoolgirls with early menarche

OBJECTIVE

To describe growth before and after menarche.

DESIGN

Nine hundred five fourth grade school girls were identified as a closed cohort from the first semester of 1993 for the observational study of the onset of menarche and its predictive factors.

SETTINGS

Eight elementary schools in Taipei City and Taipei County, Taiwan.

MAIN OUTCOME MEASURES

Data were collected from self-administered questionnaires and school records. Height and weight were measured in September, January, February, and June, or only in September and February of each year.

RESULTS

All subjects remained in the cohort until sixth grade, 410 of whom had their first menstruation before graduating from elementary school. Height, weight, and body mass index (calculated as weight in kilograms divided by the square of height in meters) at each time point were plotted against 2 time scales: chronological age and time from the onset of menarche. Growth velocity of height and weight across the onset of menarche was assessed with slope change using the mixed-effect model analysis.

CONCLUSIONS

The results support the hypothesis that height velocity reaches a peak 1 year before menarche but height velocity stopped increasing within 1 year after menarche. The change in weight velocity reveals no obvious growth spurt at age of menarcheal onset.

Molecular defects in variant forms of mannose-binding protein associated with immunodeficiency

Distinct molecular mechanisms underlying immunodeficiency caused by three different naturally occurring point mutations within the collagen-like domain of human mannose-binding protein (MBP; also known as mannose-binding lectin) have been revealed by introduction of analogous mutations into rat serum MBP. The change Arg23-->Cys results in a lower proportion of the large oligomers most efficient at activating the complement cascade. The presence of cysteine at position 23, which forms aberrant interchain disulfide bonds, causes disruption of the normal oligomeric state. The deficiency in MBPs containing Gly25-->Asp and Gly28-->Glu substitutions also results in part from reduced formation of higher oligomers. However, decreased ability to interact with downstream components of the complement cascade due to changes in both the N-terminal disulfide-bonding arrangement and the local structure of the collagenous domain make more important contributions to the loss of activity in these mutants.

Epstein-Barr virus LMP1 modulates the malignant potential of gastric carcinoma cells involving apoptosis

About 10% of gastric carcinomas including lymphoepithelioma-like carcinoma and adenocarcinoma are associated with Epstein-Barr virus (EBV) infection. In EBV-associated gastric carcinomas, the tumor cells express Epstein-Barr nuclear antigen 1 (EBNA-1) but not EBNA-2, -3A, -3B, or -3C, leader protein, or latent membrane proteins (LMPs) because of gene methylation. Only a few exceptional cases have LMP1 expression in tumor cells as demonstrated by immunohistochemical studies. To elucidate the biological effects of LMP1 and the significance of its restricted expression in EBV-associated gastric carcinomas, the LMP1 gene was transferred into EBV-negative gastric carcinoma cell lines (SCM1 and TMC1) and into EBV-negative nasopharyngeal carcinoma (NPC) cells (HONE-1) as a control. The biological effects of LMP1 in gastric carcinoma cells were monitored in vitro and in vivo. These results showed that the consequence of LMP1 expression is a growth enhancement in NPC cells, but it is a growth suppression in gastric carcinoma cells. The LMP1-expressing gastric carcinoma cells had a reduced growth rate, colony-forming efficiency, mean colony size, and tumorigenicity and a lower malignant cytological grade. The reduced growth rate, colony-forming efficiency, and mean colony size were partially reversible in vitro with treatment with LMP1 antisense oligonucleotide. In addition, enhanced apoptosis was found in the LMP1-expressing gastric carcinoma cells. This suggests that LMP1 may negatively modulate the malignant potential of gastric carcinoma cells via an enhancement of apoptosis. We concluded that the restriction of LMP1 expression in EBV-associated gastric carcinomas may lead to a growth advantage for tumor cells by avoiding LMP1 apoptotic effects and immunologically mediated elimination.

Expression of p53 protein in colorectal carcinoids

OBJECTIVE

To determine the frequency and prognostic significance of p53 protein expression in colorectal carcinoid tumors.

DESIGN

Thirty-one paraffin-embedded specimens of colorectal carcinoid tumor were studied by immunohistochemical staining to detect p53 protein expression. The association of p53 expression with tumor site, tumor size, invasion level, tumor stage, DNA pattern, and patient survival were analyzed.

RESULTS

p53 protein was detected in five (16%) of 31 colorectal carcinoid tumors. There was a correlation between p53 overexpression and tumor site, tumor size, tumor stage, and DNA ploidy (P < .05) but not for the depth of tumor invasion (P = .06). In addition to tumor size, invasion, stage, and DNA aneuploidy, p53 protein overexpression was also indicative of a poor prognosis (P < .001).

CONCLUSIONS

The overexpression of p53 protein is uncommon in colorectal carcinoid tumors. However, the expression of p53 protein has a correlation with clinicopathologic-predicting criteria in colorectal carcinoid tumors and may be used as an associated prognostic parameter to assess patient survival.

Detection of human papillomavirus DNA in colorectal carcinomas by polymerase chain reaction

Human papillomaviruses (HPVs) are associated with a number of benign and malignant neoplasms. To substantiate the relationship between HPV DNA and colorectal carcinomas, 70 carcinomas and 37 adenomas were analysed in this study. Specific types of HPV DNA in colorectal tumours were detected by polymerase chain reaction (PCR) and Southern blot hybridisation. HPV DNA was detected in 11 of 37 (29.7%) adenomas and in 52.9% 37 of 70 (52.9%) of carcinomas. The expression of HPV DNA in adenomas and carcinomas, especially that of HPV 16 in HPV positive cases (4 of 11 v 26 of 37), was significantly different (p < 0.05). There was no correlation, however, between HPV and the location, differentiation, stage, or survival of malignant neoplasms. These data suggest that HPV DNA, especially type 16, is associated with colorectal carcinogenesis.

Optimal dose of garlic to inhibit dimethylhydrazine-induced colon cancer

This study was designed to investigate the optimal dose of garlic during long-term feeding and its preventive and therapeutic effects on colon cancer in rats induced by 1,2-dimethylhydrazine (DMH). A total of 240 male Sprague-Dawley rats were grouped and fed with either a basal or a garlic diet of different concentration, and some groups were subcutaneously injected with DMH 20 mg/kg once a week for 20 weeks. The incidence of colon tumor was significantly decreased in the groups fed with 2.5%, 5%, and 10% garlic diets (p < 0.001). There was no distinct difference among these concentrations (p > 0.05). Therefore the minimal optimal dose of garlic to inhibit colon cancer was 2.5%. The equivalent dose of this concentration in humans is 4.76 g/m2 body surface/day. In a therapeutic study, the tumor-inducing interval in nude mice subcutaneously injected with colon cancer cells (CC-M2) was prolonged by a 2.5% garlic diet (p < 0.01). Thus smaller tumor volume and longer survival time were found in the garlic group than in the controls (p < 0.01). However, the growth rate of tumors was not markedly inhibited by garlic. All rats finally died within 18 weeks. This study suggested that a 2.5% garlic dose may be used mainly as an inhibitor to prevent colon cancers and improve survival time.

Detection of human papillomavirus DNA in colorectal adenomas

OBJECTIVE

To assess the presence of different types of human papillomavirus (HPV) DNA in colorectal adenomas.

DESIGN

The extracted DNA of 109 formalin-fixed, paraffin-embedded tissue sections of colorectal adenomas were analyzed by polymerase chain reaction and Southern blot hybridization. The correlations of HPV types 6, 11, 16, 18, and 33 DNA with the histological patterns of adenomas were also analyzed.

RESULTS

Human papillomavirus DNA was detected in 28% of the adenomas. There were eight (21%) of 38 in tubular adenomas, 13 (33%) of 40 in tubulovillous adenomas, and 10 (32%) of 31 in villous adenomas. All HPV-6/11-positive cases were tubular or tubulovillous adenomas. However, most HPV-16 infections (8/12) were seen in villous adenomas. Human papillomavirus-positive adenomas included three (8%) of 38 that showed mild dysplasia, 10 (25%) of 40 that showed moderate dysplasia, and 18 (58%) of 31 that showed severe dysplasia.

CONCLUSION

The association of the histological type with HPV-16 and the association of the grade of epithelial dysplasia with HPV DNA were highly significant. These associations support the adenoma-carcinoma hypothesis. In addition, the results suggest that HPV infection may be an important factor for the development of colorectal neoplasia.

Flow cytometric DNA analysis of colorectal carcinoid

We analyzed the patterns of DNA ploidy in 31 colorectal carcinoid tumors from paraffin-embedded tissues by DNA flow cytometry and the relationship of the patterns of DNA ploidy to prognosis. Diploid DNA was found in 78% (24 of 31) of carcinoids and tetraploid in 6% (2 of 31). Five (16%) carcinoids were DNA aneuploid, and four of the patients with aneuploidy showing a near-hypertriploid pattern died during the first 5 years of follow-up. The association of aneuploidy with stage, size, and invasion of tumor was significant. However, our data indicated that DNA aneuploidy of a near-hypertriploid pattern was the most precise and reliable parameter for predicting the prognosis of colorectal carcinoid tumors.

NOTE ON THE CALCULATION OF PROPELLER EFFICIENCY USING ELONGATED BODY THEORY

The elongated body theory has been widely used for calculations of the hydrodynamic propulsive performance of swimming fish. In the biological literature, terms containing the slope of the amplitude function at the tail end have been neglected in the calculations of thrust and efficiency, and a slope of zero has been assumed. However, some fishes, such as saithe and trout, have non-zero values of the slope near the tail end and, when this term is taken into account, the efficiency may be reduced by as much as 20 % and approaches the result given by the three-dimensional waving plate theory. The inclusion of the slope in the efficiency considerations results in an optimum ratio of the swimming speed to the wave speed that is clearly less than 1. It is suggested that the slope terms should be included in the estimation of propulsive performance for fish swimming with variable amplitude.

Human papillomavirus 16 DNA in NIH3T3 cells transformed by colonic cancer cellular DNA

Human papillomavirus (HPV) 16 DNA is closely associated with human cancers. It has been identified as an aetiological agent in cervical cancers and, recently, in colonic neoplasms. To further understand the role of HPV 16 DNA in colorectal carcinogenesis, NIH3T3 cells were transformed with high molecular weight DNA from colonic cancer cells and the expression of HPV 16 DNA detected. Both human Alu and HPV 16 DNA sequences were found in the type II foci of CC-M2T cells by Southern blot hybridisation. Additionally, 100% tumorigenicity in nude mice was seen. This study shows the transfection of HPV DNA from colonic cancers into NIH3T3 mouse cells and suggests that HPV type 16 might be associated with the malignant transformation of colonic cells.

Autumn southward 'return' migration of the mosquito Culex tritaeniorhynchus in China

Direct evidence for a southward 'return' migration in autumn of the mosquito Culex tritaeniorhynchus in China was obtained by aerial sampling with a net suspended from a balloon. In a preliminary study between 2 and 20 September 1990 at Jiangpu, near Nanjing, in Jiangsu Province, 11 females and 4 males of this species were taken at heights of 150-250 m. During 17-26 October 1991 at Dongxiang in northern Jiangxi Province, 44 mosquitoes (8 males, 36 females) were caught in the aerial net at heights of 80-380 m in northeasterly winds (E-NNW). Most of the specimens were flying within the subsiding air-mass behind a cold front. Cx tritaeniorhynchus was the only species identified (31 females) among the mosquitoes from Dongxiang. Of 24 females dissected, 17 had N stage ovaries--interpreted as diapause, five had stage I ovaries, one had stage II ovaries, and one was gravid (stage V), but none was freshly blood-fed. Cx tritaeniorhynchus is the main vector of Japanese viral encephalitis in China, and it is possible that the virus is reintroduced to northern temperate areas in spring by northward migration of infected Cx tritaeniorhynchus females.

[An animal model for colon cancer metastases to the lung and establishment of metastatic cancer cell line]

Death, in most colon cancer patients, is not caused by their primary tumors. Instead, metastasis is the major cause of morbidity and death. There are few appropriate animal models to investigate the complexity of the metastatic process. Therefore, the pathogenesis of the metastasis process is not clearly understood. We injected SW480 cells into the cecal wall of athymic nude mice to develop an animal model for colon cancer metastasis and to produce a metastasizing tumor. After metastatic foci formed in the murine lung, we established a metastatic cancer cell line, named CC-ML1, by in vitro primary culture. The characteristics of CC-ML1 were (1) a shorter doubling time; (2) a slightly higher metastatic rate and number of colonies; and (3) less morphological variation than those of SW480. Our research suggests that a higher metastatic potential may be found in CC-ML1 than in SW480 after the advanced cycles of the metastatic process. Thus, the primary animal model in this study may be useful in future studies of cells with a high metastatic potential in the pathogenesis of colon cancer metastases.

An animal model for colon cancer metastatic cell line with enhanced metastasizing ability. Establishment and characterization

We have developed an animal model for colon cancer metastasis and produced a metastasizing tumor after using a microinjection technique to inject SW480 cells into the cecal wall of athymic nude mice during "minilaparotomy." After the metastatic foci formed in murine lung, an in vitro primary culture was performed and a new metastatic cancer cell line, which was designated as CC-ML3, was established. The studies included: 1) the comparison between SW 480 and CC-ML3 in morphology, growth kinetics, seeding and plating efficiency, and karyotype; and 2) carcino-embryonic antigen determination, origination, and metastatic ability of CC-ML3. The results showed that CC-ML3 was significantly different from SW480 in vitro and possessed a high metastatic potential in vivo. This newly developed animal model may thus be useful for studying the biology and pathogenesis of metastasis of human colonic cancer.

Human papillomavirus type-related DNA and c-myc oncogene alterations in colon cancer cell lines

Although squamous-cell epithelium is the most frequent target site of human papillomavirus (HPV) infection, a similar infection is demonstrated in columnar epithelial cells in this paper. The papillomavirus expression in three cell lines was detected in colorectal adenocarcinoma of Chinese patients. The HPV-16 and HPV-18 DNA sequences were found in colorectal cancer cell lines, which might suggest the correlation of HPV to the etiology of colorectal cancers. In addition, c-myc oncogene was identified by amplification in all three colorectal cancer cell lines, but only normal germ-line fragments were found in control tissue. The correlation between HPV and c-myc, and the implications of these findings in colorectal cancers are also discussed.

[Production and characterization of monoclonal antibody against colon cancer associated antigen in Chinese]

Although many monoclonal antibodies have been made in human colon cancer, none of them are from the Chinese species. Recently, a colon cancer cell line CC-M2 established from a Chinese patient has been completely characterized and used as immunogen to produce monoclonal antibodies. Monoclonal antibodies were produced by standard hybridoma technique. The fusion rate was 95.8%. An isotype IgG1 of high proliferation named as Sam-2 was used in this study. The titers were measured around 10(4). Further studies on MoAb Sam-2 through indirect immunofluorescent and immunoperoxidase tests revealed its good specificity and sensitivity in colorectal cancer tissue. In CEA study, the result indicated that Sam-2 may react on a non-CEA related antigen. For further clinical application, the antigen was identified as a glycoprotein by chemical resistant test. In preliminary studies using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting techniques, Sam-2 could recognize two closed antigens or a dimer antigen with molecular weight 25.2 and 27 Kd respectively.

Characterization of four newly established human colorectal adenocarcinoma cell lines from Chinese patients

Four colon adenocarcinoma cell lines, CC-M2, CC-M3, CC-M4, and CC-M2NM, have been established from surgical specimens of 18 unselected patients without the use of "feeder" cells and additional growth factors (e.g., insulin, hydrocortisone, etc.) in the culture medium. The methods of primary cultivation of tissue explants are described. Studies of determination of morphology, growth curve, plating efficiency, chromosomal analysis, CEA and beta-HCG synthesis, and tumorigenicity, were done to characterize the cell lines. Significant variations have been found in one of the four cell lines, both in vitro and in vivo studies. There are distinct phenotypes in the established cell lines which may be useful in studying the cell differentiation and progression of colorectal cancer.

Synthesis of a cyclic hexapeptide with sequence corresponding to murine tumor necrosis factor-(127-132) as a novel potential antitumor agent

A cyclic hexapeptide cyclo(Lys-Gly-Asp-Gln-Leu-Ser-) 10 was synthesized stepwise in solution by acylation of peptide ester trifluoroacetates directly with preactivated Boc-amino acids using the DCC/HOBt method; the final cyclization reaction was performed using the pentafluorophenyl ester method in solution (1-4). This peptide is a cyclic derivative of murine tumor necrosis factor-(127-132) and is designed as a potential antitumor agent. The cyclic peptide 10 displayed weak cytotoxic activity on three of the four human tumor cell lines tested.

Preoperative use of 5-fluorouracil to reduce operative bleeding in transurethral resection of prostate

We report results of a preliminary study on the preoperative use of 5-fluorouracil (5-FU) to reduce bleeding in transurethral resection of prostate. The average amount of blood lost for each case in the 5-FU group (30 cases) was calculated to be 10.16 mL/g, while the average for the control group was 15.12 mL/g. A blood loss of about 5 mL/g in the 5-FU group was less than in the control group. In addition, the reduction of bleeding was apparent in cases where the removed prostate weighed more than 10 g, and was especially marked in those cases where the removed prostate weighed 20-29 g. A pathologic examination of the 5-FU-treated prostate revealed atrophy of the glandular tissue, hyperplasia of the connective tissue, marked dilatation of the lumen of some of the acini which indicated exhaustion of glandular secretion, a decrease in the number of blood vessels, and formation of lymphoid follicles. All of the test group, with the exception of one whose white blood cell count once dropped to 2,700/mm3, did not show any side effects.