In vitro anti-severe acute respiratory syndrome coronavirus 2 effect of Ephedra przewalskii Stapf extract

ETHNOPHARMACOLOGICAL RELEVANCE

The terrestrial stems of Ephedra (Ephedra spp.; including Ephedra sinica Stapf and Ephedra przewalskii Stapf) extracts are used in traditional medicines in East Asia. In Japan, the Kampo formula containing E. sinica extract is prescribed for the treatment of the common cold, influenza virus infections, and mild symptoms of coronavirus disease 2019 (COVID-19). Although ephedrine alkaloids in E. sinica exert antitussive effects, they may have side effects associated with the sympathetic nervous system. E. przewalskii extract, a drug used in traditional Uyghur and Mongolian medicine, is considered to be free of ephedrine alkaloids and is a promising candidate for the treatment of infectious diseases. However, its use is currently limited because evidence of its antiviral efficacy remains inconclusive.

AIM OF THE STUDY

We compared the anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) effects of E. przewalskii and E. sinica extracts in vitro. Additionally, we examined the differences in their antiviral effects against different SARS-CoV-2 strains.

MATERIALS AND METHODS

VeroE6/TMPRSS2 cells were infected with SARS-CoV-2 (Conventional, Delta, and Omicron strains-BA.1, BA.2, BA.4, and BA.5), and lysates prepared from each herbal extract were added. The infectious titer was determined using the 50% tissue culture infectious dose (TCID50) method; in turn, the half-maximal inhibitory concentration (IC50) was calculated for each extract to compare the antiviral efficacy of E. sinica and E. przewalskii extracts. Further, the extracts were compared with remdesivir for their antiviral efficacy against the conventional viral strain. To verify the effect of the inactivation of virus particles, these extracts were added to each SARS-CoV-2 strain, and the infectious titers were determined using the TCID50 method.

RESULTS

The antiviral efficacy (i.e., IC50) of the E. przewalskii extract against each SARS-CoV-2 strain was 2.7-10.8-fold greater than that of the E. sinica extract. The antiviral efficacy of the E. przewalskii extract against conventional viral strains was compared with that of remdesivir, which was 1/27.6 of remdesivir's efficacy. The E. sinica extract showed minimal inactivation of virus particles of each strain, whereas the E. przewalskii extract resulted in substantial viral inactivation.

CONCLUSIONS

The E. przewalskii extract showed higher antiviral activity against SARS-CoV-2 than the E. sinica extract. Overall, our study suggests that E. przewalskii extract can be used for the treatment of viral infections, including COVID-19.

Viable SARS-CoV-2 detected in the air of hospital rooms of patients with COVID-19 with an early infection

OBJECTIVES

This study assessed the concentration of SARS-CoV-2 in the air of hospital rooms occupied by patients with COVID-19 who had viable SARS-CoV-2 in nasopharyngeal (NP) samples in early infection.

METHODS

Between July and October 2021, NP swabs were collected from 20 patients with early SARS-CoV-2 infection admitted to a tertiary hospital in Japan. Air samples were collected from their rooms, tested for SARS-CoV-2 RNA, and cultured to determine potential infectivity.

RESULTS

The NP swab samples of 18 patients were positive for viable SARS-CoV-2 (median concentration: 4.0 × 10⁵ tissue culture infectious dose 50/ml). In the air samples, viral RNA (median concentration: 1.1 × 10⁵ copies/m³) was detected in 12/18 (67%) patients, and viable virus (median concentration: 8.9 × 10² tissue culture infectious dose 50/m³) was detected in 5/18 (28%) patients. The median time between illness onset and sampling was 3 days. The RNA concentration was significantly higher in samples wherein viable SARS-CoV-2 was detected than in samples in which viable virus was not detected (P-value = 0.027).

CONCLUSION

Viable SARS-CoV-2 can be detected in the air surrounding patients with early SARS-CoV-2 infection. Health care workers should pay attention to infection control when caring for patients with early SARS-CoV-2 infection.

Duration of infectious viral shedding in patients with mild to moderate COVID-19 treated with REGN-CoV2

INTRODUCTION

New treatment methods, such as REGN-CoV2, have been approved for patients with coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the effect of the drug on the duration of infectious viral shedding and viral mutations is unknown. In this study, we investigated the clinical efficacy of REGN-CoV2 treatment in patients with mild to moderate disease and compared its antiviral effects against different strains of SARS-CoV-2.

METHODS

Viral culture and PCR testing were performed on the pharyngeal swabs collected from 28 patients with COVID-19 who were admitted and treated at Hiroshima University Hospital during the study period. Of these, 23 patients were treated with REGN-CoV2. The patients were classified into the REGN-CoV2(+) and REGN-CoV2(-) groups, and the clinical course was compared between the groups. The 50% inhibitory concentrations (IC₅₀) of REGN-CoV2 against the isolated virus strains were determined.

RESULTS

After treatment with REGN-CoV2, the virus culture positivity rate was greatly reduced. The time to negative viral culture was significantly shorter in the REGN-CoV2(+) group than in the REGN-CoV2(-) group. In vitro evaluation of REGN-CoV2 against isolated virus strains also showed efficacy.

CONCLUSIONS

REGN-CoV2 treatment was effective in patients with mild COVID-19 and could shorten the period of infectious viral shedding. This may be an important factor in preventing the spread of infection. It may be possible to revise the isolation period for patients with mild disease treated with REGN-CoV2.

In vitro Suppression of SARS-CoV-2 Infection by Existing Kampo Formulas and Crude Constituent Drugs Used for Treatment of Common Cold Respiratory Symptoms

Several traditional Japanese Kampo formulas are known to have inhibitory effects on infections with viruses that cause respiratory symptoms. Although some herbs and their components have been reported to suppress SARS-CoV-2 replication in vitro, it is difficult to compare effective Kampo formulas because of the different methods used in studies. Thus, we carried out in vitro experiments on the suppression of SARS-CoV-2 infection by Kampo formulas and crude drugs used for the common cold to compare their suppressive effects on virus infection. After infecting VeroE6/TMPRSS2 cells with SARS-CoV-2, lysates of the Kampo formulas and crude drugs were added, and after 24 h, the infectious titer in the medium was measured by the TCID₅₀ method. Maoto was the most effective among the Kampo formulas, and Ephedrae herba was the most effective among the constituent crude drugs. However, a comparison of the suppressive effects of Ephedrae herba and Kampo formulas containing Ephedrae herba showed that the suppressive effect on virus infection did not depend on the content of Ephedrae herba. Based on the results, we believe that the use of Maoto among Kampo formulas is suitable as a countermeasure against COVID-19.

Duration of infectious virus shedding in patients with severe coronavirus disease 2019 who required mechanical ventilation

Background

Approximately 5% of patients with coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 develop severe COVID-19. Severe COVID-19 requires respiratory management with mechanical ventilation and an extended period of treatment. Prolonged infectious virus shedding is a concern in severe COVID-19 cases, but few reports have examined the duration of infectious virus shedding. Therefore, we investigated the duration of infectious virus shedding in patients transferred to Hiroshima University Hospital with severe COVID-19 requiring mechanical ventilation.

Methods

Nasopharyngeal swab specimens were collected and analyzed using both viral culture and reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) tests between December 2020 and February 2021.

Results

Of the 23 patients tested, the proportions of those with positive test results at first specimen collection (the median number of days to first specimen collection after symptom onset was 10) on RT-qPCR and viral culture tests were 95·7% and 30·4%, respectively. All six patients with positive viral culture test results who were followed-up tested negative 24 days after symptom onset but remained positive on RT-qPCR. Viral loads based on PCR testing did not decrease over time, but those determined via culture tests decreased over time. The longest negative conversion time was observed in a dialysis patient on immunosuppressive drugs.

Conclusions

This study indicated that patients with severe COVID-19 remain culture positive for ≥ 10 days after symptom onset. Additionally, immunosuppressed patients with severe COVID-19 could consider isolation for ≥ 20 days.

Granulocyte Colony-stimulating Factor-induced Aortitis with Lung Injury, Splenomegaly, and a Rash During Treatment for Recurrent Extraosseous Mucinous Chondrosarcoma

We herein report a case of aortitis induced by granulocyte colony-stimulating factor (G-CSF) that coincided with lung injury, splenomegaly, and cutaneous manifestations during treatment for recurrent extraosseous mucinous chondrosarcoma. Computed tomography revealed large-vessel vasculitis, splenomegaly, and pulmonary interstitial changes. Treatment with prednisolone was successful. Because sarcoma is a rare disease, this case is valuable for showing clinicians that G-CSF preparations could cause aortitis regardless of the patient's underlying diseases or therapeutic pharmacological backgrounds.

[Selection of Operative Procedure for Breast Cancer in Carriers of BRCA VUS in Japan]

Risk classification and clinical management of the DNA variant of unknown significance(VUS)in BRCA 1/2 remains unestablished. The Japanese hereditary breast and ovarian cancer(HBOC)consortium and myriad genetics reported that the VUS rate of BRCA is 6.5% in Japanese patients, but is <2% in the USA. The types of mutation supposedly differ between Asian and European ethnicities. Breast-conserving therapy(BCT)is not recommended in HBOC breast cancer, according to the 2017 Japanese guidelines by the Ministry of Health, because of the risk of ipsilateral breast recurrence(IBR)and carcinogenesis by radiation. In our hospital, we recommend an initial mastectomy and breast reconstruction with an implant for patients with HBOC breast cancer, considering future surgery on the contralateral side and symmetry of the reconstructed breast. However, the risk of IBR after BCT is not significantly high in patients with HBOC breast cancer, and BCT is a reasonable option even for definite HBOC breast cancer under low risk conditions. Hence, BCT is feasible for treating breast cancer in carriers of VUS following decision-making and informed consent from the patients.

Two Patients with Paget-Schroetter Syndrome That Were Successfully Diagnosed by Doppler Ultrasonography: Case Studies with a Literature Review

We herein report on two male patients (age, 22 and 44 years) who were referred to our department with swelling of the upper right arm after attending other hospitals. Right subclavian vein thrombosis was demonstrated by ultrasonography and they were then further evaluated by contrast-enhanced computed tomography (CT). Successful treatment involved venous thrombectomy in one patient and anticoagulant therapy in the other. Paget-Schhroetter syndrome was confirmed using standard vascular ultrasonography. Despite the accuracy of this method for diagnosing Paget-Schroetter syndrome, some cases are difficult to confirm. We reviewed 29 previously published case reports of Paget-Schroetter syndrome and analyzed the patient baseline characteristics, time to diagnosis, and the diagnostic methods used.

Senescent hepatic stellate cells caused by deoxycholic acid modulates malignant behavior of hepatocellular carcinoma

PURPOSE

Deoxycholic acid (DCA), a secondary bile acid, is reportedly increased in the serum of patients with nonalcoholic steatohepatitis and animals with experimentally induced hepatocellular carcinoma (HCC), but its contribution to malignant behaviors of HCC has not been precisely clarified. This study aimed to examine the effect of DCA on hepatic stellate cells (HSCs), a major component of nonparenchymal cells in the liver, and its subsequent indirect effect on HCC cells.

METHODS

LX2 cells, a human HSC line, were treated with DCA in vitro. Then, HuH7 cells, a human hepatoma cell line, were incubated in conditioned media of DCA-treated LX2 to investigate the subsequent effect focusing on malignant behaviors.

RESULTS

DCA resulted in cellular senescence in LX2 with the decreased cell proliferation via cell cycle arrest at G0/1 phase, together with the induction of senescence-associated secretory phenotype (SASP) factors. To investigate the influence of SASP factors secreted by HSCs in response to DCA, HCC cells were treated with conditioned media that promoted cell migration and invasion via induction of epithelial mesenchymal transition. These changes were attenuated in the presence of neutralizing antibody against IL8 or TGFβ. Pathological analysis of surgical specimens from HCC patients revealed that senescent HSCs were detected in the stroma surrounding HCC.

CONCLUSION

Our data suggest an important role of HSC senescence caused by DCA for the malignant biological behaviors of HCC via induction of SASP factors, particularly IL8 and TGFβ.

Toxocariasis Suspected of Having Infiltrated Directly from the Liver to the Lung through the Diaphragm

A 37-year-old woman presented to our hospital with mild abdominal pain experienced for 2 months and hepatic nodules in segments 3 and 8. Peripheral blood eosinophilia was observed, and toxocariasis was serologically diagnosed. Seventeen days after the first imaging evaluation, a new lesion was found in segment 9 of the right lung, which was contiguous through the diaphragm to the hepatic nodule in segment 8. After treatment with albendazole, the liver and lung nodules disappeared. We suspect that larvae had directly invaded the lung from the liver, through the diaphragm.

Successful Treatment of Acute Chest Syndrome with Manual Exchange Transfusion in a Patient with Sickle Beta+-thalassemia

Acute chest syndrome (ACS), characterized by fever, respiratory symptoms, and new pulmonary infiltration, is a serious complication of sickle cell disease (SCD). Regardless of the etiology, the conventional treatment options for ACS include empirical antibiotic therapy, the administration of analgesics, and red cell transfusion. The indications and methods of red cell transfusion are critical. We herein report the case of a 26-year-old African-American man with SCD who developed ACS and who was successfully treated with manual exchange transfusion. Despite increasing globalization, SCD remains extremely rare in Japan. Manual exchange transfusion can be performed easily anywhere and should be considered for treating SCD patients presenting with ACS.

An Atypical Case of Non-asthmatic Eosinophilic Granulomatosis with Polyangiitis Finally Diagnosed by Tissue Biopsy

A 78-year-old woman with fever of unknown origin that had persisted for 3 months, systemic edema, and cervical lymphadenopathy was admitted to our hospital. Skin purpura and jaw claudication were subsequently observed. Histopathological examinations of the lymph nodes, skin, and temporal artery revealed findings characteristic of eosinophilic granulomatosis with polyangiitis (EGPA). However, she had no past medical history of asthma with modest eosinophilia. Although EGPA is a systemic vasculitis characterized by asthma and eosinophilia, various limited forms have been described. This was therefore considered to be an atypical form of non-asthmatic EGPA complicating with temporal arteritis (TA) diagnosed by tissue biopsy.

[A Case of Ileocecal Intussusception Due to Small Intestinal Adenocarcinoma]

A 67-year-old female with abdominal pain and vomiting was admitted to our hospital. Abdominal X-ray showed dilated small bowel in the left upper abdomen. She was diagnosed with ileocecal intussusception based on abdominal contrastenhanced computed tomography. Computed tomography showed a "pseudo kidney sign" in the right flank region. We also observed an enhanced mass lesion in the presenting portion ofthe intussusception. Laparotomy was performed to treat the invagination. We tried to reduce the invagination, without success. Ileocecal resection was performed. Pathological findings revealed that poorly differentiated adenocarcinoma in the ileum end portion had induced the invagination. Intussusception in adults should be treated with the knowledge that about 80% ofsuch cases have an organic lesion in the presenting portion.

[Two Cases of Obstructive Colorectal Cancer Effectively Treated with Colonic Stent Placement]

We report 2 cases of obstructive colorectal cancer that were successfully treated with a self-expanding metallic stent (SEMS). They were both diagnosed with obstructive colorectal cancer. Colonoscopy was performed to make a definitive and qualitative diagnosis and to relieve the stenosis using a SEMS. The SEMSs were inserted without complications. A few days later, the patients underwent laparoscope-assisted sigmoidectomy with lymph node resection. Despite the colon obstruction, a primary anastomosis was performed. They were both discharged without complications. Obstructive colorectal cancer is an oncological emergency commonly observed in our daily clinical practice. Conventional treatments such as stoma creation or insertion of a trans-analdrainage tube have been performed. However, these treatments significantly reduce the patient's QOL. On the other hand, colonic stent placement plays a satisfactory role in improvement of the patient's QOL by paying scrupulous attention to retaining the colonic stent.

[A Case of Long-Term Survival of Advanced Esophageal Basaloid Squamous Carcinoma Invading the Trachea]

A woman in her 50s complained of dysphagia and was diagnosed with locally advanced esophageal cancer in the middle and upper thoracic esophagus, invading the tracheal bronchus. The biopsy indicated esophageal basaloid squamous carcinoma. The pretreatment diagnosis was cT4N2M0, cStage Ⅳa. She was treated with systemic chemotherapy consisting of FAP (5-fluorouracil [5-FU], doxorubicin [DXR] and cisplatin[CDDP]), which resulted in significant tumor shrinkage. One year later, the tumor regrew, and nedaplatin (CDGP) plus docetaxel (DOC) was administered as second-line chemotherapy. The patient complained of dysphagia during the course of chemotherapy, and received radiation therapy for the residual tumor, which again significantly shrunk. Four years after the first round of chemotherapy, the patient can take oral nutrition, and is continuing to undergo chemotherapy. This is a case of long-term survival of locally advanced esophageal cancer of basaloid squamous carcinoma. Effective chemotherapy and radiation can improve the treatment outcome.

[A Case of Surgical Resection of Isolated Pulmonary Metastasis from Gastric Cancer]

We report a rare case of surgical resection for pulmonary metastasis from gastric cancer. A 71-year-old man underwent total gastrectomy for gastric cancer in October 2012. After the operation, he received S-1 chemotherapy for 1 year. In January 2014, computed tomography of the chest showed a nodule shadow with a cavity at S3 in the right lung. Because it showed a tendency to gradually enlarge, we performed an operation in September 2014. The nodule was diagnosed as metastatic adenocarcinoma from gastric cancer on pathology. The patient is being treated with S-1 chemotherapy during follow-up. The pulmonary metastases of gastric cancer often develop along with carcinomatous lymphangiosis or carcinomatous pleurisy, and isolated pulmonary metastasis is rare. A consensus has not been reached about the usefulness of surgical resection, and the accumulation of further cases is required.

[Subclavian Artery Hemorrhage Related to Everolimus in a Patient with Recurrent Breast Cancer--A Case Report]

A 53-year-old woman underwent breast-conserving surgery for right breast cancer (invasive ductal carcinoma, T1cN0M0, ly+, stage ⅠA, ER+, PR+, HER2-) 5 years previously. During treatment with tamoxifen, massive recurrence in the axillary lymph nodes was found. First- through fourth-line chemotherapy were tried, but they all failed. Everolimus and exemestane were administered, resulting in rapid shrinking of the tumor, but the patient developed sudden severe bleeding from the subclavian artery. Hemostasis was achieved with artery stenting. The patient also developed a thoracic duct-cutaneous fistula. The patient died from tumor regrowth 6.5 months after her first everolimus treatment. Treating tumors involving major vessels with everolimus can cause severe bleeding after rapid shrinking of the tumor.

[A case of locally recurrent breast cancer difficult to differentiate from nodular fasciitis]

Breast-conserving surgery was performed on a 78-year-old woman for left breast cancer 5 years previously (invasive ductal carcinoma, T1cN2M0, stage IIIA, ER[+], PR[-], HER2[-]). Chemotherapy, radiotherapy, and hormonal therapy were administered. A left subclavian tumor was detected, and an excisional biopsy was performed. Histological examination showed spindle cells, different from primary breast cancer histology, and nodular fasciitis was diagnosed negative cytokeratin and vimentin immunostaining results. After 12 months, a mass had developed in the same region, and reoperation was performed for resection. Similar spindle cells were observed, but they tested positive for cytokeratin. Carcinoma was diagnosed and thought to be locally recurrent breast cancer. Despite postoperative chemotherapy, the patient experienced bone and lung metastasis and a third local recurrence. She died 13 months following the last surgery. Recurrent breast cancer sometimes displays different histology from the initial cancer, and mimics stromal tumors in certain cases.

[Thyroid carcinoma diagnosed by pathology during surgery]

We describe the pathological diagnosis of 4 resected cases of thyroid carcinoma made during surgery in comparison to that for 6 benign thyroid tumors. Preoperative computed tomography scanning and ultrasonography revealed 1 case of simple nodules, 3 cases of multiple nodules, 3 cases of solid cystic nodules, and 3 cases of calcification. Cytological examination of fine needle aspirates revealed 1 case to be Class II and 3 cases to be Class III. The diagnosis, which was made during the operation procedure on the basis of the frozen section and final operative methods, was papillary adenocarcinoma in 2 cases (total thyroidectomy + D1 and subtotal thyroidectomy+D1) and suspected papillary adenocarcinoma in 2 cases (hemithyroidectomy+ D1 and lobectomy of the thyroid+D1). The final pathological diagnosis of the 4 cases was papillary adenocarcinoma (pStage I: 3 cases, pStage II: 1 case). In the 6 cases of benign thyroid tumor, preoperative examinations revealed variegated tumor findings, and cytological examination of fine needle aspirates revealed 1 case to be ClassII and 5 cases to be ClassIII. Pathological diagnosis of the frozen sections of the 6 benign samples indicated 1 case of suspected malignancy and 5 cases of benign tumor. In all 10 cases, the pathological diagnosis based on frozen sections (with a sensitivity of 4/4 and specificity of 5/6) was more accurate than that established with preoperative imaging and cytological examination, and is therefore effective for the decision-making process when selecting the operative method.

[A case of extragastric pedunculated gastrointestinal stromal tumor of the stomach with peritoneal dissemination]

Here, we present the case of a 73-year-old woman in whom abdominal computed tomography showed an abdominal tumor (13 cm in diameter) in the backspace of the posterior gastric wall. Its feeding artery was detected to be the left gastric artery by abdominal angiography. We diagnosed it as a gastrointestinal stromal tumor (GIST) of the stomach and performed an operation. Peritoneal dissemination was observed and the tumor was connected to the gastric wall by a stalk. Histologically, the tumor consisted of spindle-shaped cells. Immunohistochemical staining showed positive c-kit and CD34 expression and negative SMA and S100 protein expression. Therefore, we diagnosed this as a case of extragastric pedunculated GIST of the stomach with peritoneal dissemination. After surgery, internal use of imatinib was started. The patient is still followed up 15 months after the operation. Combination therapy of tumor resection and imatinib chemotherapy might improve the prognosis of patients with GIST of the stomach with pedunculated growth.

[A case of recurrent breast cancer in which gemcitabine-docetaxel therapy was successful for a long period]

This is a case of a 58-year-old woman who underwent mastectomy for advanced right breast cancer (T2N2M0, stage IIIA, ER+, PR+, and HER2 0) at another hospital 13 years ago. Tamoxifen was administered after the operation. Two years later, bone and lung metastases appeared and she was transferred to our hospital. Hormonal therapies, epirubicin- cyclophosphamide-5-FU, doxifluridine, paclitaxel, vinorelbine, and capecitabine were ineffective. We planned a sixth-line chemotherapy comprising gemcitabine combined with docetaxel, but not paclitaxel. Partial response was obtained by treatment with 3 courses of gemcitabine-docetaxel. The same treatment was continued and the patient is alive in a good condition without progression for 14 months.

Oxygen reduction activity of carbon nitride supported on carbon nanotubes

Fuel cells offer an alternative to burning fossil fuels, but use platinum as a catalyst which is expensive and scarce. Cheap, alternative catalysts could enable fuel cells to become serious contenders in the green energy sector. One promising class of catalyst for electrochemical oxygen reduction is iron-containing, nanostructured, nitrogen-doped carbon. The catalytic activity of such N-doped carbons has improved vastly over the years bringing industrial applications ever closer. Stoichiometric carbon nitride powder has only been observed in recent years. It has nitrogen content up to 57% and as such is an extremely interesting material to work with. The electrochemical activity of carbon nitride has already been explored, confirming that iron is not a necessary ingredient for 4-electron oxygen reduction. Here, we synthesize carbon nitride on a carbon nanotube support and subject it to high temperature treatment in an effort to increase the surface area and conductivity. The results lend insight into the mechanism of oxygen reduction and show the potential for carbon nanotube-supported carbon nitride to be used as a catalyst to replace platinum in fuel cells.

[Twenty-one-year survival case of rectal GIST treated with combined therapies]

A 55-year-old man underwent Miles' operation with a diagnosis of rectal leiomyosarcoma in 1990. From 1998 to 2004, he had liver and lung metastases and local site recurrent tumors which were removed surgically. Immunohistochemically the recurrent tumor was positive for c-kit and CD34, and the diagnosis of GIST was confirmed. He took an adjuvant imatinib mesylate for half a year in 2004. In July 2005, he had a recurrent tumor in upper mediastinum. We restarted an imatinib after radiation therapy, and got a clinical CR. After he had interstitial pneumonitis in 2009, he stopped taking inmatinb. Then he took sunitinb for two months after an operation for the sixth local recurrence in February 2010. But the upper mediastium recurrent tumor occurred again in November 2010. We restarted sunitinb and got a clinical PR. The patient is now alive and well for 21 years after the initial operation by combined therapies.

[A case with liver resection of metastasis from rectal cancer after bevacizumab treatment]

The advancement of systemic chemotherapy for colorectal carcinoma has improved a clinical response rate and expanded a possibility of resection, which we thought we could not have been operable at the initial visit. It also improved a prognosis of patients. We report here a case with liver resection of metastasis from rectal cancer followed by bevacizumab treatment.

[A case of synchronous double cancer of stomach and lung responding to neoadjuvant chemotherapy]

A 66-year-old male was admitted to our hospital because of dyspnea in 2007. Cancerous pleural effusion and gastric cancer was diagnosed, and the chemotherapy consisted of S-1 + DOC was started for Stage IV gastric cancer. In 2009, lung cancer was found. The chemotherapy was changed to CDDP + CPT-11. This chemotherapy was effective for both lung and gastric cancers. Operation was performed for both tumors in 2010, and the pathological diagnosis revealed that gastric cancer was pStage I, Cur A, and the lung cancer was pStage IA, R0. Pathologic histology inspection of both tumors was judged to be effective for the chemotherapy prior to resection.

[Resection of local recurrent gastric cancer following total gastrectomy]

We report a case of patient who underwent resection for local recurrent gastric cancer at the anastomotic site curatively. The patient was a 72 years old male with a history of undergoing total gastrectomy for gastric cancer located at the gastric cardia in February 2005. The histological findings of the resected tumor showed a Type 3 advanced gastric cancer invaded into subserosa in the cardia of the stomach with positive lymphatic and venous invasion and lymph node metastasis. The histological diagnosis was moderately differentiated tubular adenocarcinoma. Both the proximal and distal margins were negative for cancer. Endoscopy, 4 years after the first operation, showed a recurrent tumor at the site of esophago-jejunal anastomosis. A resection of the tumor was carried out curatively through the left thoraco-abdominal approach in June 2009. We recommend a resection of anastomotic recurrence especially if it occurs from the first operation in the long interval.

Effects of xenon on ischemic spinal cord injury in rabbits: a comparison with propofol

BACKGROUND

Xenon has been shown to reduce cellular injury after cerebral ischemia. However, the neuroprotective effects of xenon on ischemic spinal cord are unknown. The authors compared the effects of xenon and propofol on spinal cord injury following spinal cord ischemia in rabbits.

METHODS

Thirty-two male New Zealand white rabbits were randomly assigned to one of three groups. In the xenon and propofol group, 70% of xenon and 0.8 mg/kg/min of propofol were administered 30 min before an aortic occlusion and maintained until the end of the procedure. The aortic occlusion was performed for 15 min. In the sham group, the aorta was not occluded. After an assessment of the hind limb motor function using the Tarlov score (0=paraplegia, 4=normal) at 48 h after reperfusion, gray and white matter injuries were evaluated based on the number of normal neurons in the anterior spinal cord and the percentage areas of vacuolation in the white matter, respectively.

RESULTS

In the xenon and propofol groups, the Tarlov score and the number of normal neurons were significantly lower than those in the sham group, whereas the percentage areas of vacuolation were similar among the three groups. There were no significant differences in Tarlov scores and the number of normal neurons between the xenon and the propofol groups.

CONCLUSION

The results indicated that 70% of xenon has no additional neuroprotective effects on ischemic spinal cord injury in rabbits compared with propofol.

4-Hydroxy-2,5-dimethyl-3(2H)-furanone (HDMF) production in simple media by lactic acid bacterium, Lactococcus lactis subsp. cremoris IFO 3427

4-Hydroxy-2,5-dimethyl-3(2H)-furanone (HDMF) was detected in simple media prepared with heated sugar and amino acid solution as a result of the Maillard reaction. However, an increase in the amount of HDMF was observed in the media fermented by Lactococcus lactis subsp. cremoris IFO 3427. 4-Hydroxy-2(or 5)-ethyl-5(or 2)-methyl-3(2H)-furanone (HEMF) was not detected in all the simple media examined in this study.

Thymidylate synthase and dihydropyrimidine dehydrogenase gene expression in breast cancer predicts 5-FU sensitivity by a histocultural drug sensitivity test

Thymidylate synthase (TS), Dihydropyrimidine dehydrogenase (DPD) and Thymidine Phosphorylase (TP) gene expressions are reported to be predictive markers for 5-fluorouracil (5-FU) sensitivity in gastrointestinal cancer. However, in breast cancer, it is still controversial whether those molecular markers predict 5-FU sensitivity or not. One possible reason for the difficulty may be the histological heterogeneity in breast cancer specimens. In this study, TS, DPD and TP mRNA expression in 40 breast cancer tumors were semi-quantified separately in cancer cells (Ca), cancerous stroma (Str) and normal glands (Nor) using laser capture microdissection and real time RT-PCR (LCM+RT-PCR). The histoculture drug response assay (HDRA) for 5-FU sensitivity was performed for 22 tumors. TS and TP mRNA expressions were higher in Ca than Str, although DPD gene expression was lower in Ca than Str. The group of high TS and high DPD gene expression in Ca was resistant to 5-FU, and the group of low TS and low DPD gene expression in Ca was sensitive to 5-FU (P=0.048 chi-square test). TS and DPD mRNA expressions measured using LCM+RT-PCR might be useful predictive markers for 5-FU sensitivity in human breast cancer.

Magnetic resonance imaging of the metal clip in a breast: safety ana its availability as a negative marker

PURPOSE

This study assesses magnetic resonance (MR) safety of the stainless-steel clip inserted after stereotactic-guided directional vacuum-assisted biopsy (DVAB) of the breast, and evaluates its imaging value.

METHODS

We used a sausage as a substitute breast and inserted the clip into it. The MR images of the substitute were scanned using a breast coil, and it was then dissected. After the substitute experimentation, MR scanning of the breast was performed using a dynamic contrast enhanced technique, in which a clip was placed after DVAB for suspicion of ductal carcinoma was seen as grouped amorphous calcifications on mammography.

RESULTS

On every magnetic resonance image of the substitute, the clip was seen as a spotty signal void, with no surrounding artifact. There was no movement and no evidence of increased clip temperature on dissected of the substitute, confirming the safety of breast MR with a clip in place. There was no patient complaint of feeling heat or pain during the MRI examination and there were only biopsy scars on the surgically excised breast specimen material. On the breast MR images, a spreading region of the tumor adjoining the position of the signal void was identified as an early enhancing lesion.

CONCLUSIONS

The safety and reliability of breast MR examination using a mammotome clip was demonstrated by both the mock examination and the breast examination. It is possible to localize of tumor spread regions based on the marker position using the clip as a negative signal marker.

Increased expression of NAD(P)H oxidase subunits, NOX4 and p22phox, in the kidney of streptozotocin-induced diabetic rats and its reversibity by interventive insulin treatment

AIM/HYPOTHESIS

An increased production of reactive oxygen species (ROS) could contribute to the development of diabetic nephropathy. NAD(P)H oxidase might be an important source of ROS production in kidney as reported in blood vessels. In this study, we show the increased expression of essential subunits of NAD(P)H oxidase, NOX4 and p22phox, in the kidney of diabetic rats.

METHODS

The levels of mRNA of both NOX4 and p22phox were evaluated in kidney from streptozotocin-induced diabetic rats and age-matched control rats at 4 and 8 weeks after onset of diabetes by Northern blot analysis. The localization and expression levels of these components and 8-hydroxy-deoxyguanosine (8-OHdG), which is a marker of ROS-induced DNA damage, were also evaluated by immunostaining.

RESULTS

The levels of both NOX4 and p22phox mRNA were increased in the kidney of diabetic rats as compared with control rats. Immunostaining analysis showed that the expression levels of NOX4 and p22phox were clearly increased in both distal tubular cells and glomeruli from diabetic rats. Both the localization and the expression levels of these components were in parallel with those of 8-OHdG. Interventive insulin treatment for 2 weeks completely restored the increased levels of these components in the diabetic kidney to control levels in parallel with those of 8-OHdG.

CONCLUSIONS/INTERPRETATION

This study provides evidence that NAD(P)H oxidase subunits, NOX4 and p22phox, were increased in the kidney of diabetic rats. Thus, NAD(P)H-dependent overproduction of ROS could cause renal tissue damage in diabetes. This might contribute to the development of diabetic nephropathy.

A possible target of antioxidative therapy for diabetic vascular complications-vascular NAD(P)H oxidase

A growing body of evidence has shown that oxidative stress may be involved in the development of vascular complications associated with diabetes. However, the molecular mechanism for increased reactive oxygen species (ROS) production in diabetes remains uncertain. Among various possible mechanisms, attention have increasingly been paid to NAD(P)H oxidase as the most important source of ROS production in vascular cells. High glucose level stimulates ROS production through protein kinase C (PKC)-dependent activation of vascular NAD(P)H oxidase. Furthermore, the expression of NAD(P)H oxidase components is increased in micro- and macrovascular tissues of diabetic animals in association with various functional disorders and histochemical abnormalities. These results suggest that vascular NAD(P)H oxidase-driven ROS production may contribute to the onset or development of diabetic micro- or macrovascular complications. In this point of view, the possible new strategy of antioxidative therapy for diabetic vascular complications is discussed in this review.

Correlation among intratumoral blood flow in breast cancer, clinicopathological findings and Nottingham Prognostic Index

BACKGROUND

The purpose of this study was to evaluate the correlation among intratumoral blood flow as assessed by color Doppler ultrasonography, clinicopathological findings and the Nottingham Prognostic Index (NPI).

METHODS

Twenty-seven patients with breast cancer were examined. All patients received surgical treatment. Color Doppler ultrasonography was performed prior to surgery to detect arterial blood flow signals within the tumors. The lowest resistance index (RI) was recorded. Formalin-fixed, paraffin-embedded slides were reviewed by senior pathologists to evaluate the size of tumor, histological size, lymph node status and histological grade. Estrogen and progesterone receptor levels were measured by enzyme immunoassay. The Nottingham Prognostic Index was calculated using the equation NPI = 0.2 x tumor size (cm) + grade (I-III) + lymph node score (1-3).

RESULTS

The lowest RI correlated well with NPI and histological grade (grade II:III = RI 1.037:0.816, P = 0.0035). Regression analysis revealed a linear relationship between the lowest RI and NPI (correlation coefficient = 0.475; P = 0.0153).

CONCLUSIONS

Intratumoral blood flow analysis assessed by color Doppler ultrasonography correlates well with histological grade and NPI. Preoperative assessment using color Doppler ultrasonography provides useful information and may contribute to the determination of prognosis.

Effect of nitrous oxide on myogenic motor evoked potentials during hypothermia in rabbits anaesthetized with ketamine/fentanyl/propofol

BACKGROUND

A number of authors have reported that anaesthetics suppress myogenic motor evoked potentials (MEPs). However, the influence of hypothermia on these effects is unknown. Therefore we investigated the effects of hypothermia on nitrous oxide-induced suppression of myogenic MEPs.

METHODS

Twenty-two rabbits anaesthetized with ketamine, fentanyl and propofol were randomly allocated to one of three groups, with oesophageal temperatures of 40 degrees C (n = 8), 35 degrees C (n = 7) and 30 degrees C (n = 7). Myogenic MEPs in response to electrical stimulation of the motor cortex with a train of five pulses were recorded from the soleus muscle. Following the control recording, nitrous oxide was administered at concentrations of 30%, 50%, and 70% in random order, and MEPs were recorded. Control MEP amplitudes and percentage of control MEP amplitudes (%MEP amplitude) during the administration of nitrous oxide were compared between the three groups.

RESULTS

Control MEP amplitudes were similar between the three groups. Nitrous oxide suppressed MEPs in a dose-dependent manner in all groups. During the administration of nitrous oxide, % MEP amplitudes at 35 degrees C and 30 degrees C (hypothermia) were significantly lower than those at 40 degrees C (normothermia).

CONCLUSION

These results suggest that nitrous oxide-induced suppression of MEPs may be augmented during hypothermia.

[Intraoperative unilateral changes in myogenic motor evoked potentials in patients undergoing thoracic aortic surgery]

Motor evoked potentials (MEPs) can be employed for monitoring the functional integrity of the descending motor pathways during thoracic aortic surgery. Since MEPs can be affected by a variety of intraoperative factors, intraoperative MEP changes have to be carefully interpreted. In this report, we describe two patients undergoing thoracic aortic surgery, in whom MEPs from the unilateral lower limb disappeared after femoral artery cannulation, and MEPs' recovered by modifying the position or removing the cannula. MEPs in the contralateral side remained unchanged. Neither patients showed postoperative neurologic dysfunction in the lower limbs. These observations suggest that regional ischemia of the lower limbs caused by femoral artery cannulation can affect intraoperative MEP finding.

Altered gap junction activity in cardiovascular tissues of diabetes

Hyperglycemia appears to be an important etiologic factor in the development of micro- and macrovascular complications in diabetic patients. However, its detailed molecular mechanism remains unclear. Among various possible mechanisms, it is widely accepted that high glucose level and a diabetic state induce protein kinase C (PKC) activation in vascular cells in cultured and vascular tissues of diabetic animals. Gap junctions are clusters of membrane channels that permit the intercellular exchange of ions and second messengers between adjacent cells. Gap junctional intercellular communication (GJIC) plays an important role in cardiovascular tissue homeostasis. Here we report that GJIC in cultured vascular cells such as endothelial cells and smooth muscle cells is inhibited by high glucose level. Furthermore, we show that it is mediated by PKC-dependent excessive phosphorylation of connexin-43 which is the main functional component of gap junction in vascular cells. In addition, we also show that in diabetic rats, PKC-dependent excessive phosphorylation of connexin-43 induces the impairment of ventricular conduction in the heart. These results suggest that PKC-dependent impairment of GJIC may lead to various disorders of cardiovascular homeostasis and contribute to cardiovascular dysfunctions associated with diabetes.

Identification of human telomerase reverse transcriptase-derived peptides that induce HLA-A24-restricted antileukemia cytotoxic T lymphocytes

Human telomerase reverse transcriptase (hTERT) is considered a potential target for cancer immunotherapy because it is preferentially expressed in malignant cells. hTERT-derived peptides carrying motifs for HLA-A24 (HLA-A*2402), the most common allele among Japanese and also frequently present in persons of European descent, were examined for their capacity to elicit antileukemia cytotoxic T lymphocytes (CTLs). Two of the 5 peptides tested, VYAETKHFL and VYGFVRACL, appeared capable of generating hTERT peptide-specific and HLA-A24-restricted CTLs. The CD8(+) CTL clones specific for these hTERT peptides exerted cytotoxicity against leukemia cells in an HLA-A24-restricted manner. This cytotoxicity was inhibited by the addition of hTERT peptide-loaded autologous cells, suggesting that hTERT is naturally processed in leukemia cells and that hTERT-derived peptides are expressed on these cells and are recognized by CTLs in the context of HLA-A24. Taken together with the currently identified HLA-A2-restricted CTL epitopes derived from hTERT, identification of new CTL epitopes presented by HLA-A24 increases the feasibility of immunotherapy for leukemia using hTERT-derived peptides.

Saturated non-esterified fatty acids stimulate de novo diacylglycerol synthesis and protein kinase c activity in cultured aortic smooth muscle cells

AIMS/HYPOTHESIS

Insulin resistance is linked with a cluster of multiple risk factors and excessive acceleration of atherosclerosis. The underlying mechanism is not, however, fully understood.

METHODS

To determine the link between insulin resistance and altered vascular function, we focused on the effect of various non-esterified fatty acids on diacylglycerol-protein kinase C pathway and mitogen-activated protein kinase activity in cultured aortic smooth muscle cells.

RESULTS

Incubation of the cells with saturated non-esterified fatty acids (200 micromol/l) for 24 h, such as palmitate or stearate, induced a significant increase in diacylglycerol concentrations by about fivefold or eightfold, respectively, whereas oleate induced a slight increase in diacylglycerol concentrations by 1.8-fold and arachidonate induced none. In addition, the increased diacylglycerol concentrations induced by palmitate were completely restored to control concentrations by triacsin C, acyl-CoA synthetase inhibitor. These results suggest that saturated non-esterified fatty acids may increase diacylglycerol concentrations through de novo pathway by stepwise acylation. In parallel with the increased diacylglycerol, incubation of the cells with saturated non-esterified fatty acids significantly induced the activation of protein kinase C and mitogen-activated protein kinase. The palmitate-induced increase in mitogen-activated protein kinase activity was restored to control concentrations by GF109203X (5 x 10(-7) mol/l), a specific protein kinase C inhibitor, suggesting a protein kinase C-dependent activation of mitogen-activated protein kinase.

CONCLUSION/INTERPRETATION

Saturated non-esterified fatty acids induced an increase in de novo diacylglycerol synthesis and subsequent activation of protein kinase C and mitogen-activated protein kinase in cultured aortic smooth muscle cells. This could contribute to the altered vascular functions in the insulin resistant state.

CD20-positive adult T-cell leukemia

A 67-year-old woman was admitted to our hospital because of lymphadenopathy and lymphocytosis. Monoclonal integration of HTLV-I provirus DNA was detected, and a diagnosis of adult T-cell leukemia (ATL) was made. Flow cytometry revealed that the ATL cells expressed CD20 as well as T-cell-associated antigens, and expression of CD20 mRNA was also demonstrated. A novel T-cell subpopulation expressing CD20 molecules has recently been identified. This is the first report of CD20-positive ATL, suggesting that HTLV-I can infect and transform CD20-positive T cells.

Chronic sulfonylurea treatment and hyperglycemia aggravate disproportionately elevated plasma proinsulin levels in patients with type 2 diabetes

It is established that disproportionately elevated plasma proinsulin levels occur in patients with Type 2 diabetes. In the present study, multivariate analysis was performed to determine what factors contributed to the disproportionately elevated plasma proinsulin levels in Japanese patients with Type 2 diabetes (n=276). Results from univariate analysis showed that both fasting proinsulin/C-peptide ratio and proinsulin/IRI ratio were approximately 2-fold higher in patients with Type 2 diabetes than those in healthy nondiabetic subjects (n=45). In patients with Type 2 diabetes, both proinsulin/C-peptide ratio and proinsulin/IRI ratio were significantly positively correlated with fasting plasma glucose level (FPG) and HbA1c. Neither proinsulin/C-peptide ratio nor proinsulin/IRI ratio was significantly correlated with BMI. Sulfonylurea-treated subjects had a significant elevation in both proinsulin/C-peptide ratio and proinsulin/IRI ratio compared with diet-treated subjects, whereas nonsulfonylurea hypoglycemic agent-treated subjects did not. Multivariate analysis confirmed that sulfonylurea treatment and FPG were significant determinants of both fasting proinsulin/C-peptide ratio (P=0.006 and P=0.030, respectively) and proinsulin/IRI ratio (P=0.003 and P=0.016, respectively) in patients with Type 2 diabetes. These results imply that disproportionate hyperproinsulinemia may reflect an excessive overwork of beta cells under chronic sulfonylurea treatment as well as hyperglycemia.

[Two cases of ischemic changes indicated in the amplitude of motor evoked potentials during thoracoabdominal aortic aneurysm repair]

Monitoring of motor-evoked potentials (MEPs) is employed to examine functional integrity of descending motor pathway during thoracic aortic surgery. We experienced two cases of intraoperative changes in MEPs during thoracic aortic replacement. In one case, MEPs recovered after the intercostal artery reattachment, and in another case after the release of aortic clamping. No postoperative paraplegia was found in both cases. We conclude that monitoring of MEPs is useful not only because we can detect symptoms of the spinal cord injury from ischemia immediately but also because they give us a clue to decide operative procedures.

High glucose level and free fatty acid stimulate reactive oxygen species production through protein kinase C--dependent activation of NAD(P)H oxidase in cultured vascular cells

Recent studies have revealed that vascular cells can produce reactive oxygen species (ROS) through NAD(P)H oxidase, which may be involved in vascular injury. However, the pathological role of vascular NAD(P)H oxidase in diabetes or in the insulin-resistant state remains unknown. In this study, we examined the effect of high glucose level and free fatty acid (FFA) (palmitate) on ROS production in cultured aortic smooth muscle cells (SMCs) and endothelial cells (ECs) using electron spin resonance spectroscopy. Exposure of cultured SMCs or ECs to a high glucose level (400 mg/dl) for 72 h significantly increased the free radical production compared with low glucose level exposure (100 mg/dl). Treatment of the cells for 3 h with phorbol myristic acid (PMA), a protein kinase C (PKC) activator, also increased free radical production. This increase was restored to the control value by diphenylene iodonium, a NAD(P)H oxidase inhibitor, suggesting ROS production through PKC-dependent activation of NAD(P)H oxidase. The increase in free radical production by high glucose level exposure was completely restored by both diphenylene iodonium and GF109203X, a PKC-specific inhibitor. Exposure to palmitate (200 micromol/l) also increased free radical production, which was concomitant with increases in diacylglycerol level and PKC activity. Again, this increase was restored to the control value by both diphenylene iodonium and GF109203X. The present results suggest that both high glucose level and palmitate may stimulate ROS production through PKC-dependent activation of NAD(P)H oxidase in both vascular SMCs and ECs. This finding may be involved in the excessive acceleration of atherosclerosis in patients with diabetes and insulin resistance syndrome.