Hyperthermic pressurized intraperitoneal aerosol drug delivery system in a large animal model: a feasibility and safety study

BACKGROUND

We developed a novel drug delivery system called hyperthermic pressurized intraperitoneal aerosol chemotherapy (HPIPAC) that hybridized Hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). The present study aims to assess the feasibility and safety of HPIPAC system in a large animal survival model.

METHODS

Eleven pigs (eight non-survival models and three survival models) were used in the experiment. The heat module in the HPIPAC controller circulates hyperthermic CO2 in a closed-loop circuit and creates gas-based dry intraperitoneal hyperthermia. Three 12 mm trocars were placed on the abdomen. The afferent CO2 tube wound with heat generating coil was inserted into a trocar, and the efferent tube was inserted into another trocar. Heated CO2 was insufflated and circulated in a closed circuit until the intra-abdominal and peritoneal surface temperature reached 42 °C. 100 ml of 5% dextrose in water was nebulized for 5 min and the closed-loop circulation was resumed for 60 min at 42 °C. Tissue biopsies were taken from several sites from the pigs in the survival model.

RESULTS

The average change in core temperature of the pigs was 2.5 ± 0.08 °C. All three pigs displayed no signs of distress, and their vital signs remained stable, with no changes in their diet. In autopsy, inflammatory and fibrotic responses at the biopsy sites were observed without serious pathologic findings.

CONCLUSIONS

We successfully proved the feasibility and safety of our novel HPIPAC system in an in-vivo swine survival model.

Single-port intragastric wedge resection using the tunnel method: a novel surgical approach for treating endophytic gastric subepithelial tumors

BACKGROUND

Intragastric wedge resection is an effective method for treating endophytic gastric subepithelial tumors (SETs). However, retracting the stomach wall to the umbilicus is difficult in certain patients. In response, we developed a novel surgical technique for single-port intragastric wedge resection, which we termed the "tunnel method."

METHODS

A transumbilical incision is made, and a wound retractor is applied. After diagnostic laparoscopy, a gastrostomy is made on the greater curvature, lower body. Another small wound retractor is inserted into the gastrostomy, and extracted through the transumbilical incision, creating a tunnel from the gastrostomy site to the umbilicus. Articulating laparoscopic instruments are inserted via the tunnel, and intragastric wedge resection is performed. We collected and analyzed the clinicopathologic and operative data of patients who underwent intragastric wedge resection via the tunnel method.

RESULTS

Twenty-seven patients who underwent single-port intragastric wedge resection via the tunnel method in a single tertiary referral hospital were included in this study. The mean age of the patients was 54.6 ± 11.4 years, body mass index was 26.5 ± 3.4 kg/m2. Twenty-four (88.9%) patients had tumors located in the upper third of the stomach. The average operative time was 65.0 ± 24.2 min. None of the patients experienced Clavien-Dindo grade IIIa or higher postoperative complications. The average postoperative hospital stay length was 2.5 ± 0.8 days. Thirteen gastrointestinal stromal tumors, nine leiomyomas, and one neuroendocrine carcinoma, schwannoma, lipoma, spindle cell proliferative lesion, and fibrotic lesion were pathologically diagnosed. The average tumor size was 2.6 ± 1.3 cm. All cases had negative resection margins.

CONCLUSIONS

Single-port intragastric wedge resection by the tunnel method is a feasible and safe approach for treating endophytic gastric SETs.

Automated deep learning model for estimating intraoperative blood loss using gauze images

The intraoperative estimated blood loss (EBL), an essential parameter for perioperative management, has been evaluated by manually weighing blood in gauze and suction bottles, a process both time-consuming and labor-intensive. As the novel EBL prediction platform, we developed an automated deep learning EBL prediction model, utilizing the patch-wise crumpled state (P-W CS) of gauze images with texture analysis. The proposed algorithm was developed using animal data obtained from a porcine experiment and validated on human intraoperative data prospectively collected from 102 laparoscopic gastric cancer surgeries. The EBL prediction model involves gauze area detection and subsequent EBL regression based on the detected areas, with each stage optimized through comparative model performance evaluations. The selected gauze detection model demonstrated a sensitivity of 96.5% and a specificity of 98.0%. Based on this detection model, the performance of EBL regression stage models was compared. Comparative evaluations revealed that our P-W CS-based model outperforms others, including one reliant on convolutional neural networks and another analyzing the gauze's overall crumpled state. The P-W CS-based model achieved a mean absolute error (MAE) of 0.25 g and a mean absolute percentage error (MAPE) of 7.26% in EBL regression. Additionally, per-patient assessment yielded an MAE of 0.58 g, indicating errors < 1 g/patient. In conclusion, our algorithm provides an objective standard and streamlined approach for EBL estimation during surgery without the need for perioperative approximation and additional tasks by humans. The robust performance of the model across varied surgical conditions emphasizes its clinical potential for real-world application.

Feasibility of articulating laparoscopic instruments in laparoscopic gastrectomy using propensity score matching

Advancements in minimally invasive surgery has led to the development of several surgical instruments, including the ArtiSential®. This new instrument provides a greater range of motion and improved dexterity to laparoscopic procedures, making it an alternative option to traditional straight instruments, and the Da Vinci robot system. The purpose of this study is to compare the postoperative outcomes of a prospective cohort of patients who underwent laparoscopic gastrectomy using articulating instruments with those of a historical cohort of patients who underwent the same procedure using straight instruments. The study was designed as a prospective observational cohort study matched to a retrospective historical cohort using propensity score matching. The primary outcome was the rate of early complications within 90 days of surgery. Other outcomes included the operation time, estimated blood loss, time to first flatus, time to first soft fluid diet, hospital stay, and mortality. After propensity score matching, 41 patients were enrolled in both groups. The mean age was 62.4 ± 12.3 years in the conventional group and 63.5 ± 9.6 years in the artisential group (p = 0.647). Mean operative time was significantly shorter in the artisential group compared to the conventional group (136.1 min vs. 163.9 min, p = 0.032). The time to first soft fluid diet was also significantly shorter in the artisential group (2.2 days vs. 2.8 days, p = 0.030), but there was no significant difference in the time to first flatus and overall hospital stay. The incidence of early complications was lower in the artisential group, but the difference was not significant (24.4% vs 7.3%, p = 0.070). There was no mortality in either group. The use of articulating instruments for laparoscopic gastrectomy did not increase postoperative morbidity compared to straight laparoscopic instruments. The use of articulating instruments may be associated with faster bowel recovery and less early complications.

The Shorr Versus Modified Ultrafast Papanicolaou Method for Intraoperative Diagnosis of Peritoneal Washing Cytology in Advanced Gastric Cancer: A Phase II Study

PURPOSE

According to the American Joint Committee on Cancer cancer staging system, positive peritoneal washing cytology (PWC) indicates stage IV gastric cancer. However, rapid intraoperative diagnosis of PWC has no established reliable method. This study evaluated and compared the diagnostic accuracy of the Shorr and the modified ultrafast Papanicolaou (MUFP) methods for intraoperative PWC.

MATERIALS AND METHODS

This study included patients with gastric cancer who were clinically diagnosed with stage cT3 or higher. The Shorr and MUFP methods were performed on all PWC specimens, and the results were compared with those of conventional Papanicolaou (PAP) staining with carcinoembryonic antigen immunohistochemistry. Sensitivity, specificity, and partial likelihood tests were used to compare the 2 methods.

RESULTS

Forty patients underwent intraoperative PWC between November 2019 and August 2021. The average time between specimen reception and slide preparation using Shorr and MUFP methods was 44.4±4.5 minutes, and the average time between specimen reception and pathologic diagnosis was 53.9±8.9 minutes. Eight patients (20.0%) had positive cytology in PAP staining. The Shorr method had a sensitivity of 75.0% and specificity of 93.8%; the MUFP method had 62.5% sensitivity and 100.0% specificity. The area under the curve was 0.844 for Shorr and 0.813 for MUFP. In comparing the C-indices of each method with overall survival, no difference was found among the Shorr, MUFP, and conventional PAP methods.

CONCLUSIONS

The Shorr and MUFP methods are acceptable for the intraoperative diagnosis of PWC in advanced gastric cancer.

Abstract 5322: High throughput chemotherapeutic drug screening system for gastric cancer: cure-GA

To discover clinically applicable anticancer drugs and predict therapeutic response for advanced gastric cancer, we developed a high-throughput drug (HTD) screening system that could rapidly evaluate drug reactivity using 3D cultured primary cells derived from gastric cancer (GC) patients. Primary cancer cells were isolated from fresh surgical specimens that resected from 143 GC patients using Gentle Max tissue dissociation system. Primary cells were mixed with Matrigel, and placed on a micropillar for three-dimensional (3D) culture. After the primary cells were stabilized in the complete culture medium (CCM) than added various chemotherapeutic drugs containing 5-FU, Oxaliplatin, and Paclitaxel in CCM and incubated for 7 days. Cell viability was determined through calcein staining and quantified scanned images. The IC50 for each drug was calculated by a sigmoidal dose-response curve, using the GraphPad Prism 9 program. The average weight of gastric cancer tissue used in the experiment was 300 mg (75 mg ~ 1930 mg), and the average number of dissociated viable cells for each tissue was 3.9 × 10^6 cells/case. About 2.4 × 10^5 live cell was required per drug, we were able to obtain an average of 6.4 (Min.2, Max 14) drug reactivity data per tissue using the HTD screening system. GC tissues obtained from the operating room were dissociated within 16 hours and then loaded into the HTS system within 3 hours. Cells were stabilized for 1 day in 3D culture plate and exposed to the drug for 7 days, and then data reports were made within 3 days. As a result, it was possible to obtain within 14 days from fresh surgical GC tissue to drug response data. Additionally, we confirmed that 3D cultured primary cells derived from GC tissues consistently preserved primary characters using IHC. Similar to their parental cancer tissue, GC 3D cultured primary cells derived from adenocarcinoma large glandular patterns and retain the expression of some marker proteins. In this study, we evaluated the drug response data for 101 cases (success rate 71%; 101/143) to 5-FU, Oxaliplatin, and Palitaxel, etc. using the HTD screening system and it was confirmed that individual patient had a difference response to each drug. Here we established the HTD screening system using 3D cultured GC patient derived primary cells. The advantages of this system were that it is the first model system that directly used patient-derived primary cells for drug screening, and it can rapidly evaluate drug reactivity to various anticancer drugs within 10 days. The HTD screening system based on patient-derived primary cells can provide that information to predict drug response and allow for finding more appropriate therapy for each patient.

Citation Format: Jieun Lee, Jung Eun Kim, Sanjun Lee, Tae-Kyeong Lee, In Hee Kim, So Hee Yoon, Mira Yoo, Eunju Lee, Doo-Young Hwang, So Hyun Kang, Bo Sung Ku, Dong Woo Lee, Young Suk Park, Ji-Won K, Jin Won Kim, Sang-Hoon Ahn, Keun-Wook Lee, Hyung-Ho Kim, Hyun Jung Oh, Yun-Suhk Suh. High throughput chemotherapeutic drug screening system for gastric cancer: cure-GA. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5322.

Postoperative pain and quality of life after single-incision distal gastrectomy versus multiport laparoscopic distal gastrectomy for early gastric cancer - a randomized controlled trial

BACKGROUND

Although it has been more than ten years since its first introduction, single-incision distal gastrectomy (SIDG) still lacks solid evidence and there are also no reports on patient quality of life (QOL). This study evaluates the postoperative outcomes and patient QOL of SIDG compared to multiport laparoscopic distal gastrectomy (MLDG).

METHODS

This study was designed as a prospective phase II randomized controlled study. Patients diagnosed with early gastric cancer in the distal 2/3rd of the stomach were randomized to either multiport or single-port group. Primary endpoint was pain using the visual analogue scale on postoperative day (POD) 1. Other outcomes include operative data, complications, and patient QOL using the EORTC C30 and STO22 modules.

RESULTS

A total of 43 patients in the SIDG group and 40 patients in the MLDG group were enrolled from September 2017 to February 2020. Mean operation time was 154.3 ± 53.3 min in the MLDG group and 148.9 ± 50.1 min in the SIDG group (p = 0.631). There was no difference in POD1 pain scores between the two groups (MLDG = 4.0 ± 1.3, SIDG = 4.3 ± 1.3, p = 0.372). Mean hospital stay was 5.5 (range 4-12) days in the MLDG group and 5 (range 4-17) days in the SIDG group (p = 0.993). There was no statistical significance in postoperative QOL scores.

CONCLUSION

Unlike previous reports, there was no difference in POD1 pain scores between SIDG and MLDG. Nevertheless, SIDG did not increase short-term morbidity compared to MLDG and had similar outcomes in QOL.

Postoperative major bleeding risk in patients using oral antiplatelets and/or anticoagulants after laparoscopic gastric cancer surgery

Purpose

The use of antiplatelet and/or anticoagulant therapies has become common. In rare cases, these therapies may increase the risk of dangerous postoperative bleeding. We investigated the association of antiplatelets and/or anticoagulants with postoperative major bleeding risk in laparoscopic gastric cancer surgery.

Methods

We retrospectively enrolled 3,663 gastric cancer patients (antiplatelet/anticoagulant group, 518; control group, 3,145) who had undergone laparoscopic surgery between January 2012 and December 2017. To minimize selection bias, 508 patients in each group were matched using propensity score matching (PSM) method. The primary outcome was postoperative major bleeding. Secondary outcomes were intraoperative, postoperative transfusion and early complications.

Results

After PSM, postoperative major bleeding occurred in 10 (2.0%) and 3 cases (0.6%) in the antiplatelets/anticoagulants and control groups, respectively (P = 0.090). Intraoperative and postoperative transfusions were not significantly different between 2 groups (2.4% vs. 1.4%, P = 0.355 and 5.5% vs. 4.3%, P = 0.469). Early complications developed in 58 (11.4%) and 43 patients (8.5%) in the antiplatelets/anticoagulants and control groups, respectively (P = 0.142). The mean amounts of intraoperative and postoperative transfusions were not significantly different between the groups (366.67 ± 238.68 mL vs. 371.43 ± 138.01 mL, P = 0.962; 728.57 ± 642.25 mL vs. 508.09 ± 468.95 mL, P = 0.185). In multivariable analysis, male (P = 0.008) and advanced stage (III, IV) (P = 0.024) were independent significant risk factors for postoperative major bleeding.

Conclusion

Preoperative antiplatelets and/or anticoagulants administration did not significantly increase the risk of postoperative major bleeding after laparoscopic gastric cancer surgery.

Falling short of a culture of health: Planning alcohol-permitted events at a U.S. university

The Healthy Campus movement in the United States aims to infuse health promotion into higher education operations. We examined the extent to which event planners employ a culture-of-health approach related to alcohol consumption when planning alcohol-permitted events in a large, public university in California. We interviewed 31 event planners to assess their strategies for ensuring health and safety at the events and accommodating people in recovery from substance use disorders. We focused on events that involved faculty, staff, and graduate students. Event planners were most concerned about avoiding legal liabilities at the events, were less concerned about promoting responsible drinking among drinkers, and often failed to consider the needs of non-drinkers at the events. Their actions were informed by problematic beliefs about alcohol (e.g., people need alcohol to relax), drinkers (e.g., only undergraduate students engage in risky consumption), and people in recovery (e.g., they lack self-control). Planners over-relied on informal control to shape attendees' behavior, failing to acknowledge how contextual factors can shape individual behavior. Planners need to be educated about how to shape the event context to promote healthy behaviors, avoid exclusively focusing on preventing unhealthy behaviors and informal control, and promote better inclusion of people who don't drink.

Key messages

There is fertile ground for infusing a culture of health into events in higher education. Event planners need expanded perspectives that consider context, inclusivity, and health promotion.

Regional assessment of trace element concentrations in arrow squids (Nototodarus gouldi, N. sloanii) from New Zealand waters: Bioaccessibility and impact on food web and human consumers

The New Zealand arrow squids, Nototodarus gouldi and N. sloanii, play an important role in the marine food web, and are both economically important fishery species. This study compares trace element concentrations (As, Cd, Co, Cr, Cu, Fe, Hg, Ni, Mn, Pb, U, and Zn) in these animals from different fishing locations within New Zealand's Exclusive Economic Zone (Auckland Islands, Chatham Rise, Dunedin, Golden Bay, Taranaki, and West Coast of the South Island). Muscular mantle (the tissue usually consumed by humans) and digestive gland tissue (the primary organ for trace element accumulation) concentrations were compared among regions, revealing size, species, and sampling location effects. Overall, N. gouldi had higher concentrations of As and Zn. The Taranaki region had the highest concentrations for Cd, Co, Cu, and Zn in both tissues analysed. To assess the bioaccessibility of these trace elements to humans, an in-vitro digestion simulation experiment was conducted, revealing bioavailable concentrations overall below the maximum levels presently considered tolerable for human consumption. However, the in-vitro digestion had no observable effect upon Cd concentrations in arrow squid mantle tissue (implying that the measured concentrations are bioaccessible to humans), and revealed that Cd had the highest potential impact on marine food webs and human health. Digestive gland concentrations in particular indicate that arrow squids can be considered important vectors for trace element transfer to top predators (mean concentration for Cd: 123 ± 148 μg g^-1 dw), with region-specific differences.

Moderate hearing loss is related with social frailty in a community-dwelling older adults: The Korean Frailty and Aging Cohort Study (KFACS)

OBJECTIVES

To determine whether hearing loss is associated with social frailty in older adults.

METHODS

Cross-sectional analysis of cohort study data. Hearing was measured using of Pure-tone audiometry. Hearing loss was determined based on the average of hearing thresholds at 0.5, 1, and 2 kHz in the ear that had better hearing. Social frailty was defined based on the summation of the following 5 social components (1. Neighborhood meeting attendance 2. Talking to friend(s) sometimes 3.Someone gives you love and affection 4. Living alone 5. Meeting someone every day). Participants who had no correspondence to the components were considered non-social frailty; those with 1-2 components were considered social prefrailty; and those having 3 or more components were considered social frailty.

RESULTS

The prevalence of non-social frailty, social prefrailty, social frailty was 27.6%, 60.7% and 11.7% respectively. Of the five questions, two components (Neighborhood meeting attendance and Presence of someone who shows love and affection to the participants) were associated with hearing loss (p < 0.001). Compared to non-social frailty, the odds ratio of social frailty for hearing loss was 2.24 (95% CI 1.48-3.38) after adjusting for age, residential area, economic status, smoking, depressive disorder and MMSE, and 2.17 (95% CI 1.43-3.30) after further adjustments with physical frailty.

CONCLUSION

Hearing loss was associated with social frailty even after controlling confounding factors even including physical frailty.

Recruiting Adolescents from Medicaid Enrollment Files into a Neighborhood Oral Health Study

INTRODUCTION

Strategies are needed to improve recruitment of low-income adolescents into oral health studies.

OBJECTIVES

In this study, we assessed the feasibility of recruiting Medicaid-enrolled adolescents into a neighborhood-level oral health study using Medicaid enrollment files and to evaluate the degree of bias in the final recruited study population.

METHODS

We obtained Medicaid enrollment files from the Oregon Health Authority for 15,440 Medicaid enrollees aged 12 to 17 y from Multnomah, Hood River, and Tillamook counties. We attempted to contact the primary caregiver of each adolescent by telephone, and we tracked contact, recruitment, enrollment, and study completion rates. We further assessed if these rates were different across county-level rurality, neighborhood-level income, and caregiver-level language preference (Spanish vs. English). The Pearson chi-square test was used to compare rates (α = 0.05). We contacted 6,202 caregivers (40.2%), recruited 738 adolescents (11.9%), enrolled 335 (45.4%), and had complete data for 284 (84.8%). The overall enrollment yield from contacted caregivers was 5.4%. Contact rates did not differ significantly by rurality (P = 0.897), but they were significantly lower in the lowest-income neighborhoods (P = 0.023). Recruitment rates were significantly higher for adolescents from rural counties (P = 0.001), but they did not differ by income or language preference. Enrollment rates were significantly higher among adolescents from rural counties (P < 0.001) and were significantly associated with income (P = 0.041), but they were not different by language preference (P = 0.083). Among participants with complete data, there were no differences by rurality or income, but a significantly larger proportion of adolescents with complete data had caregivers with a language preference for Spanish (P = 0.043).

RESULTS AND CONCLUSIONS

It is feasible to recruit Medicaid-enrolled adolescents into a neighborhood oral health study through the use of Medicaid files. County-, neighborhood-, and caregiver-level factors may influence characteristics of the final study population. Additional research is needed to improve recruitment of Medicaid enrollees into neighborhood oral health studies.

KNOWLEDGE TRANSFER STATEMENT

Researchers can use the results of this study to plan neighborhood-level oral health studies involving recruitment of low-income adolescents. Findings further underscore the importance of assessing factors related to recruitment to evaluate participant bias and the generalizability of study findings.

An Optimal Questionnaire Representing Slow Gait Speed(<1m/s) in Community-dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS)

OBJECTIVES

This study was conducted to find an optimal questionnaire to evaluate the slow gait speed seen in community dwelling elderly.

DESIGN

Four questions asking about difficulty in walking were compared against the measured usual gait speed. The questions were: 1) Is it difficult to walk 100 m without help? 2) Is it difficult to walk 300 m without help? 3) Is it difficult to walk around one lap of a 400-meter track without help? 4) Can you cross a crosswalk before the green on the crosswalk light turns red?

PARTICIPANTS

The subjects were 1479 older adults aged 70 to 84 years who had responded to the four questions and completed gait speed measuring in the first baseline year (2016) of the Korean Frailty and Aging Cohort Study.

RESULTS

Of the four questions, "Is it difficult to walk around one lap of track (400 m) without help?" showed the highest kappa coefficient (0.357), sensitivity (0.61), and negative predictive value (0.82).

CONCLUSION

Based on the results of this study, the authors suggest that "Difficulty in walking around one lap of a 400-m track without help" may be the best question to use when evaluating slow gait speed.

Abstract P3-12-03: Evaluation of women with BRCA mutations and breast cancer tested at an NCI designated comprehensive cancer center: A cost of illness estimation

Objectives: Little is known regarding the impact of mutation status on the costs of breast cancer care. This study sought to estimate health care charges (all-cause, BC related, other cancer related and non-cancer related) among women with breast cancer (BC) and BRCA mutations (BRCAm) in terms of BRCA status, HER2 expression status, ER/PR status, treatment patterns, serious adverse events related to the cancer or its treatment, and cancer treatment period.

Methods: Adult women with invasive BC diagnosed from 1995-2014 and tested for a BRCAm were identified from the Huntsman Cancer Institute tumor registry (Salt Lake City, Utah) and via chart review. Patients with available charge data were included in the study. Patients were categorized by mutation status, receptor status and initial treatment setting. Charges were categorized as inpatient, outpatient and pharmacy (both anticancer and other medication) related charges as well as by type of service (diagnosis, surgery, reconstruction, radiation, office visit, and medication). Descriptive statistics were used to describe mean (SD) charges. Wilcoxon Rank-Sum test was used to compare health care charges.

Results: There were 816 women with BC who underwent BRCA testing and had available charge data. There were 134 women with a BRCAm vs 682 with BRCA wild type (wt). Age at diagnosis was similar between the two groups, however, BRCAm patients had more triple negative BC and higher histologic grade. Total breast cancer related mean (SD) charges were similar between BRCAm vs BRCAwt ($86,689 (75,937) vs $85,843 (97,304), p=0.19). Of this a similar amount was due to facilities/ technical and pharmacy (41% each), while the remainder was physician/professional costs. Within pharmacy costs, similar amounts were due to chemotherapy (23%) and biologics (21%). However, while 58% received chemotherapy, only 8% received biologics. Patients seen initially in the neoadjuvant treatment setting (N=148) had higher breast cancer related mean charges than those in the adjuvant setting (N=553; $117,922 (102,108) vs $80,061 (90,010), p&lt;.0001), while those seen initially in metastatic setting had a mean charge of $103,525 (135,029).There were 142 HER2+ (ER+/PR+/HER2+ or ER-/PR-/HER2+) and 521 HER2- (TNBC or ER-/PR+/HER2-) breast cancer patients (receptor status unknown in 153 patients). HER2+ patients had higher breast cancer related mean charges than HER2- patients ($155,858 (122,227) vs $69,883 (67,642), p&lt;.0001). Further, anticancer treatment charges accounted for 53% ($82,890 (81,269)) of HER2+ costs and 11% ($7,929 (21,782)), p&lt;.0001 of HER2- costs. Biologics accounted for 87% of the former and chemotherapy accounted for 78% of the latter charge.

Conclusions: Mutation status was not associated with higher breast cancer charges. Patients initially seen in the neoadjuvant setting had higher breast cancer charges than those seen in the adjuvant setting. Receptor status (being HER2+) was associated with higher breast cancer charges and this was driven by expenditure on biologics.

Citation Format: Biskupiak JE, Telford C, Yoo M, Unni SK, Ye X, Deka R, Brixner DI, Stenehjem DD. Evaluation of women with BRCA mutations and breast cancer tested at an NCI designated comprehensive cancer center: A cost of illness estimation [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-12-03.

The extracellular matrix glycoprotein tenascin-C promotes locomotor recovery after spinal cord injury in adult zebrafish

Adult zebrafish, by virtue of exhibiting spontaneous recovery after spinal lesion, have evolved into a paradigmatic vertebrate model system to identify novel genes vital for successful regeneration after spinal cord injury. Due to a remarkable level of conservation between zebrafish and human genomes, such genes, once identified, could point to possibilities for addressing the multiple issues on how to deal with functional recovery after spinal cord injury in humans. In the current study, the extracellular matrix glycoprotein tenascin-C was studied in the zebrafish spinal cord injury model to assess the often disparate functions of this multidomain molecule under in vivo conditions. This in vivo study was deemed necessary since in vitro studies had shown discrepant functional effects on neurite outgrowth: tenascin-C inhibits neurite outgrowth when presented as a molecular barrier adjacent to a conducive substrate, but enhances neurite outgrowth when presented as a uniform substrate. Thus, our current study addresses the question as to which of these features prevails in vivo: whether tenascin-C reduces or enhances axonal regrowth after injury in a well accepted vertebrate model of spinal cord injury. We show upregulation of tenascin-C expression in regenerating neurons of the nucleus of median longitudinal fascicle (NMLF) in the brainstem and spinal motoneurons. Inhibition of tenascin-C expression by antisense oligonucleotide (morpholino) resulted in impaired locomotor recovery, reduced regrowth of axons from brainstem neurons and reduced synapse formation by the regrowing brainstem axons on spinal motoneurons, all vital indicators of regeneration. Our results thus point to an advantageous role of tenascin-C in promoting spinal cord regeneration, by promoting axonal regrowth and synapse formation in the spinal cord caudal to the lesion site after injury.

Interaction between udenafil and tamsulosin in rats: non-competitive inhibition of tamsulosin metabolism by udenafil via hepatic CYP3A1/2

BACKGROUND AND PURPOSE

Orthostatic hypotension has been observed when PDE 5 (cGMP-specific phosphodiesterase type 5) inhibitors are co-administered with alpha-adrenoceptor antagonists. Here we assessed the pharmacokinetic and haemodynamic interactions between udenafil and tamsulosin in rats, as both drugs are metabolized via rat hepatic cytochrome P450 3A1/2.

EXPERIMENTAL APPROACH

Interactions between the two drugs were evaluated in rats after simultaneous 1 or 15 min i.v. infusion or after p.o. administration of udenafil (30 mg x kg(-1)) and/or tamsulosin (1 mg x kg(-1)). In vitro metabolism of tamsulosin with udenafil was measured to obtain the inhibition constant (K(i)) and [I]/K(i) ratio of udenafil.

KEY RESULTS

The total area under the plasma concentration-time curve from time zero to time infinity (AUC)s (or AUC(0-4 h)) of tamsulosin were significantly greater after 15 min of i.v. infusion or after oral administration with udenafil, compared with tamsulosin alone. The hepatic first-pass metabolism of tamsulosin was inhibited by udenafil, and the inhibition in vitro was in a non-competitive mode. The arterial systolic blood pressure was significantly lower at 5, 10 and 60 min after oral co-administration of the drugs.

CONCLUSIONS AND IMPLICATIONS

The significantly greater AUC of tamsulosin after i.v. and p.o. administration of both drugs may be attributable to non-competitive inhibition of cytochrome P450 3A1/2-mediated hepatic tamsulosin metabolism by udenafil. The inhibition was also observed in human liver S9 fractions, suggesting that a reassessment of the oral dosage of tamsulosin is necessary when udenafil and tamsulosin are co-administered to patients with benign prostatic hyperplasia.

Scrub typhus as a possible aetiology of Guillain-Barré syndrome: two cases

Neurological complications of scrub typhus are reported to be rare. Peripheral nervous system involvement has been reported in only one case. We present two cases of Guillan-Barré syndrome (GBS) associated with scrub typhus. In both cases, the findings of an elevated indirect immunofluorescent antibody titer for Orientia tsutsugamushi and nerve conduction study showing sensory-motor polyneuropathy, have led us to believe that scrub typhus could be one of the antecedent illnesses associated with GBS.

Role of human cytochrome P450 3A4 in the metabolism of DA–8159, a new erectogenic

The purpose of this paper was to characterize cytochrome P450 (CYP) enzymes involved in N-dealkylation of a new oral erectogenic, DA-8159 to DA-8164, a major circulating active metabolite, in human liver microsomes and to investigate the inhibitory potential of DA-8159 on CYP enzymes. CYP3A4 was identified as the major enzyme responsible for DA-8159 N-dealkylation to DA-8164 based on correlation analysis and specific CYP inhibitor and antibody-mediated inhibition study in human liver microsomes, and DA-8159 metabolism in cDNA expressed CYP enzymes. There is the possibility of drug-drug interactions when prescribing DA-8159 concomitantly with known inhibitors or inducers of CYP3A4. DA-8159 was found to be only a very weak inhibitor of eight major CYPs (1A2, 2A6, 2C8, 2C9, 2C19, 2D6, 2E1 and 3A4), the largest inhibition occurring against CYP2D6 (IC5o 67.7 microM) in human liver microsomes. Drug-drug interactions would not be predicted on the basis of DA-8159 inhibiting the metabolism of coadministered drugs.

The effect of DA-8159, a novel PDE5 inhibitor, on erectile function in the rat model of hypercholesterolemic erectile dysfunction

This study examined the effects of a new phosphodiesterase type 5 inhibitor, DA-8159, on erectile function associated with hypercholesterolemia. First of all, in order to investigate whether chronic administration of DA-8159 prevents the development of erectile dysfunction associated with hypercholesterolemia, male SD rats were divided into four groups (normal control, hypercholesterolemic control, DA-8159 5 or 20 mg/kg/day). Over a 5-month period, the animals were fed a 2% cholesterol diet and administered DA-8159 orally once a day. After 5 months, the electrostimulation-induced penile erection and the vascular function using acetylcholine-induced vasodilation with endothelium-intact aortic rings were examined. Furthermore, the plasma lipid profiles, endothelin and N(G),N(G)-dimethylarginine (asymmetrical dimethylarginine, ADMA) concentrations were measured. In order to investigate the acute treatment effect of DA-8159 on the erectile function in an established hypercholesterolemic model, additional animals were given a 2% cholesterol diet for 5 months without DA-8159. At the end of 5 months, the rats were divided into three groups (hypercholesterolemic control, DA-8159 0.3 or 1 mg/kg). DA-8159 was administered intravenously 1 min prior to the intracavernous pressure (ICP) measurement. In a chronic treatment study, while the hypercholesterolemic control showed a significantly lower erectile function, vascular reactivity, and increased plasma cholesterol, endothelin and ADMA concentration, the chronic DA-8159 treatment clearly restored the erectile responses by electric stimulation, preserved the potential of thoracic aortic relaxation in a dose-dependent manner, and significantly decreased the plasma endothelin and ADMA concentrations. In an acute treatment study, DA-8159 induced a dose- and frequency-dependent increase in ICP. The ICP/BP ratio and the corresponding AUC values, and the detumescence time were also significantly increased compared to the hypercholesterolemic control. These results suggest that DA-8159 is beneficial for erectile dysfunction in a rat hypercholesterolemic model and provided a rationale for the potential use of DA-8159 for treating erectile dysfunction secondary to hypercholesterolemia.

DA-8159, a new PDE5 Iihibitor, induces penile erection in conscious and acute spinal cord injured rabbits

OBJECTIVES

DA-8159 is a pyrazolopyrimidinone derivative showing potent and selective phosphodiesterase 5 (PDE5) inhibition. In the previous study, DA-8159 induced a dose-dependent increase in the intracavernous pressure (ICP) in anaesthetized dogs. The aim of this study was to investigate the effects of DA-8159 on penile erection in conscious and acute spinal cord injured (ASCI) rabbits.

METHODS

DA-8159 was given orally (0.3 to 10mg/kg) to normal rabbits and ASCI rabbits with a surgical transection of the spinal cord at the L2-L4 lumbar vertebra or ischemic-reperfusion. The erection was evaluated in a time-course manner by measuring the length of the uncovered penile mucosa in the absence or presence of intravenous sodium nitroprusside (SNP), a nitric oxide (NO) donor.

RESULTS

DA-8159 induced a dose-dependent penile erection in both the conscious and ASCI rabbits. The efficacy of DA-8159 was potentiated and the effective doses were significantly decreased by an intravenous injection of SNP. Potentiation of the effect by a nitric oxide donor implies that DA-8159 can enhance the erectile activity during sexual arousal.

CONCLUSION

These results demonstrate that DA-8159 may be a useful treatment option for erectile dysfunction in patients with or without a spinal cord injury, but further evaluation of the effects of DA-8159 on humans must be performed.

Pharmacokinetics, stability, and blood partition of DA-8159, a new phosphodiesterase V inhibitor

The pharmacokinetics of DA-8159, a new phosphodiesterase V inhibitor, after 1 min intravenous, 30 mg/kg, and oral, 30 mg/kg, administration of the drug to rats, the stability of DA-8159 in various pH solutions ranging from 1 to 13, and human and rat plasma and urine, and the blood partition of DA-8159 between plasma and blood cells of rabbit were evaluated. After intravenous administration, DA-8159 was eliminated fast with the mean total body clearance of 126 ml/min/kg, and was almost completely metabolized in rats; 5.98% of intravenous dose of DA-8159 were excreted unchanged in 24-hr urine. The extent of absolute oral bioavailibility of DA-8159 was approximately 25%. The apparent volume of distribution at steady state was considerably large, 15048 ml/kg, suggesting that DA-8159 has a good affinity to rat tissues. DA-8159 was relatively stable in various pH solutions, and human and rat plasma and urine for up to 48 h incubation in a water-bath shaker kept at 37 degrees C and at a rate of 50 oscillations per min. DA-8159 reached equilibrium fast (within 30 sec mixing manually) between plasma and blood cells of rabbit blood and the plasma-to-blood cell concentration ratios were independent of initial blood concentrations of DA-8159, 1, 5, and 10 microg/ml, when the rabbit whole blood was incubated for up to 120 min; the ratios were in the range of 0.662-0.812. There was no in vitro 'blood storage effect' in the plasma concentration of DA-8159.

Thymic cyst: is a correct preoperative diagnosis possible? Report of a case and review of the literature

A case of a giant cervico-mediastinal cyst of thymic origin in an 8-year-old child is presented. The cyst was asymptomatic except for deformity due to its size. In spite of several diagnostic approaches like ultrasonography, computed tomography, cyst puncture with biochemical analysis of cyst content and direct contrast injection and radiography after emptying of the cyst, the ultimate diagnosis as to the origin of the cyst was not disclosed until after operation and histopathological examination of the operative specimen. On a more general basis the diagnostic possibilities and pitfalls are discussed.

CONCLUSION

a correct preoperative diagnosis of a thymus cyst is difficult and in many instances impossible even when all diagnostic measures at hand are utilized, including radiographic methods, computed tomography, magnetic resonance imaging, ultrasonography and biochemical examination of cyst aspirate and estimation of tumour markers in cyst fluid and serum.

Pregnancy-associated plasma protein-A accounts for the insulin-like growth factor (IGF)-binding protein-4 (IGFBP-4) proteolytic activity in human pregnancy serum and enhances the mitogenic activity of IGF by degrading IGFBP-4 in vitro

Pregnancy-associated plasma protein-A (PAPP-A) has been identified as the insulin-like growth factor (IGF)-dependent IGF-binding protein-4 (IGFBP-4) protease produced by human fibroblasts. Recently, we found that serum proteases induced during human pregnancy cleaved IGFBP-4 in both an IGF-II-dependent and an IGF-II-independent fashion. This study sought to determine whether PAPP-A is the predominant IGFBP-4 protease in human pregnancy serum (PS) and to assess the in vitro role of serum PAPP-A. Immunoprecipitation with PAPP-A antibody effectively depleted PAPP-A from the PS and completely abolished both IGF-II-dependent and IGF-II-independent IGFBP-4 proteolytic activity in PS. Direct addition of PAPP-A antibody to PS completely blocked IGFBP-4 proteolysis and partially blocked IGFBP-5 proteolysis, but had no effect on IGFBP-3 proteolysis. To evaluate the role of serum PAPP-A, we tested whether PAPP-A in PS modulated the inhibitory activity of IGFBP-4 on IGF-II-induced cell proliferation in human osteosarcoma MG63 cells. The wild-type IGFBP-4 (WTBP-4; 200 ng/mL) failed to inhibit proliferation of the cells treated with PS (0.1% or 0.3%) alone or in combination with IGF-II (40 ng/mL), whereas the inhibitory effect of WTBP-4 was observed in the cells treated with nonpregnancy serum alone or in combination with IGF-II (P < 0.05). In contrast to WTBP-4, a protease-resistant IGFBP-4 was able to inhibit proliferation of the cells treated with PS alone or in combination with IGF-II (P < 0.05). In the presence of PAPP-A neutralizing antibody, the inhibitory effect of WTBP-4 on proliferation of the cells treated with IGF-II and PS was restored. In summary, these data demonstrate 1) that PAPP-A represents the predominant IGFBP-4 protease in PS; 2) that PAPP-A may in part contribute to IGFBP-5, but not IGFBP-3, proteolytic activity in PS; and 3) that PAPP-A enhances the bioactivity of IGFs in vitro by degrading IGFBP-4.

The DNA replication-related element (DRE)-DRE-binding factor (DREF) system may be involved in the expression of the Drosophila melanogaster TBP gene

The TATA box binding protein (TBP) is a general transcription factor required for initiation by all three eukaryotic RNA polymerases. Previously, we found that the promoter region of the Drosophila melanogaster TBP gene contains three sequences similar to the DNA replication-related element (DRE) (5'-TATCGATA). In the present study, we found that the DRE-like sequences are also present in the promoter of the Drosophila virilis TBP gene, suggesting a role for these sequences in TBP expression. Band mobility shift assays revealed that oligonucleotides containing sequences similar to the DRE of D. melanogaster TBP gene promoter form specific complexes with a factor in a Kc cell nuclear extract and with recombinant DRE-binding factor (DREF). Furthermore, these complexes were either supershifted or diminished by monoclonal antibodies to DREF. Transient luciferase assays demonstrated that induction of mutations in two DRE-related sequences at positions -223 and -63 resulted in an extensive reduction of promoter activity. Thus, the DRE-DREF system appears to be involved in the expression of the D. melanogaster TBP gene.

Erectogenic effect of the selective phosphodiesterase type 5 inhibitor, DA-8159

DA-8159, a new phosphodiesterase 5 inhibitor, was assessed for its erectogenic potential by a penile erection test in rats, the relaxation of isolated rabbit corpus cavernosum (CC), and estimation of the intracavernous pressure (ICP) in the anesthetized dog. Oral administration of DA-8159 (0.3 to 1 mg/kg) increased the number of erections in rats with increasing dosage, with the highest penile erection index at 10 mg/kg. DA-8159 induced the relaxation of phenylephrine (PHE)-induced contractions in the rabbit CC and decreased the IC50 of the nitric oxide donor sodium nitroprusside (SNP) in a dose-dependent fashion. In pentobarbital-anesthetized dogs, the intravenous administration of DA-8159 (1 approximately 300 g/kg) potentiated the increase in ICP induced by the intracavernosal SNP in a dose-related manner. These findings suggest that DA-8159 has significant therapeutic potential in the treatment of erectile dysfunction.

Factors influencing the protein binding of a new phosphodiesterase V inhibitor, DA-8159, using an equilibrium dialysis technique

Various factors influencing the protein binding of DA-8159 to 4% human serum albumin (HSA) were evaluated using an equilibrium dialysis technique at an initial DA-8159 concentration of 5 microg/mL. It took approximately 8 h incubation to reach an equilibrium between 4% HSA and an isotonic phosphate buffer of pH 7.4 containing 3% of dextran ('the buffer') using a Spectra/Por 2 membrane (mol. wt. cut-off: 12,000--14,000) in a water bath shaker kept at 37 degrees C and at a rate of 50 oscillations per min. The extent of binding was dependent on DA-8159 concentrations, HSA concentrations, incubation temperature, buffer pH, and alpha-1-acid glycoprotein (AAG) concentrations. The binding of DA-8159 in heparinized human plasma (93.9%) was significantly higher than in rats (81.4%), rabbits (80.4%), and dogs (82.2%), and this could be due to differences in AAG concentrations in plasma.

A systemic administration of NMDA induces immediate early gene pip92 in the hippocampus

In the mammalian CNS, aspartate and glutamate are major excitatory amino acids, and their receptors are believed to mediate a wide range of physiological and pathological processes, including neurotransmission, plasticity, excitotoxicity, and various forms of neurodegeneration. The immediate early gene pip92 has been identified in serum-stimulated BALB/c 3T3 fibroblasts, activated T lymphocytes treated with cycloheximide, and fibroblast growth factor-stimulated hippocampal cells during neuronal differentiation. In this study we have demonstrated that pip92 is expressed in the mouse brain after a single intraperitoneal injection of NMDA. The distribution of pip92 mRNA levels in the NMDA-treated mouse brain was investigated using in situ RT-PCR. The region-specific activation of pip92 in the CNS was observed 3 h after NMDA injection, and high levels of pip92 mRNA were detected in the hippocampal dentate gyrus and piriform cortex regions. In addition, the activation of pip92 by NMDA was mediated by activation of mitogen-activated protein kinases (MAPKs), such as c-Jun N-terminal kinase (JNK) and p38 kinase, but not extracellular signal-regulated kinase (ERK) in the mouse hippocampus and immortalized rat hippocampal progenitor cells. This study suggests that pip92 is likely to play an important role in neuronal cell death induced by excitotoxic NMDA injury in the CNS.

Studies on human pregnancy-induced insulin-like growth factor (IGF)-binding protein-4 proteases in serum: determination of IGF-II dependency and localization of cleavage site

Insulin-like growth factor (IGF)-binding protein-4 (IGFBP-4), a consistent inhibitor of IGF action, is subject to proteolytic cleavage by the IGF-II-dependent IGFBP-4 protease. However, regulation of the IGF-II-dependent IGFBP-4 protease in vivo is not known. As IGFBP proteases are known to be triggered during pregnancy, we systematically evaluated the changes in IGFBP-4 proteolysis by serum collected throughout human pregnancy. Results from in vitro protease assays using recombinant IGFBP-4 revealed that IGFBP-4 proteolysis determined in both the presence and absence of exogenous IGF-II significantly increased during the first and second trimesters and reached a plateau by the third trimester. However, in the absence of IGF-II, IGFBP-4 proteolysis by pregnancy serum was only observed after prolonged incubation. IGF-II dose dependently increased IGFBP-4 proteolysis by pregnancy serum, with maximal stimulation observed at a concentration of 0.7 mol/L relative to IGFBP-4. In contrast, IGF-II at an equimolar dose had little effect on proteolysis of recombinant human IGFBP-3, whereas excess IGF-II reproducibly inhibited recombinant human IGFBP-3 proteolysis by pregnancy serum. Although IGF-II enhanced IGFBP-4 proteolysis, results from N-terminal sequence and mass spectrometric analyses of IGFBP-4 proteolytic fragments demonstrate that the cleavage site (Met135-Lys136) in human IGFBP-4 was not altered by IGF-II. Deletion of the residues 121-141 containing this cleavage site blocked IGFBP-4 proteolysis. These findings demonstrate that the increase in IGFBP-4 proteolysis during pregnancy was accounted for mainly by the IGF-II-dependent IGFBP-4 proteolysis. Because IGFBP-4 is a potent inhibitor of IGF actions, it can be speculated that the pregnancy-induced IGFBP-4 proteases may play an important role in regulating fetal growth.

Sequence analysis and tissue specific expression of human HOXA7

A 3071-bp fragment containing the human HOXA7 gene was sequenced. It contained two exons, one intron, and two polyadenylation signals (AATAAA) at positions 1844 and 2923. The exon encoded 230 aa residues, while the hexapeptide, homeodomain, and C-terminal acidic domains were detected. When the total sequences were compared with those of murine Hoxa-7, the 5' untranslated region (UTR), exon I, intron, exon II, and 3' UTR exhibited 99, 92, 65, 85, and 72% homology, respectively. Through Northern analysis, about a 1.9-kb transcript was detected in the fetal kidney. Minor transcripts of 1.5 and 1.1-kb were also detected in the fetal liver as well as in the kidney. In the case of adult tissues, most of the tissues tested (lung, liver, skeletal muscle, kidney, pancreas, and placenta), except brain tissue, expressed a 5.3 kb transcript with various intensities. Our results here suggested that not only Abd-B type Hox genes, but the ones in paralogous groups I-VIII could generate multiple transcripts. The characterization of these tissue-specific and stage-specific alternative transcripts would help to understand the regulatory function of the HOXA7 gene during development, and possibly the pathology of human disease caused by Hox genes.

Effect of DA-6034, a derivative of flavonoid, on experimental animal models of inflammatory bowel disease

Inflammatory bowel disease (IBD) is a multifactorial disorder with unknown etiology and pathogenesis. DA-6034, 7-carboxymethyloxy-3', 4', 5-trimethoxy flavone, is a synthetic flavonoid known to possess anti-inflammatory activity. This study was performed to evaluate the oral therapeutic effect of DA-6034 in three experimental animal models of IBD: two chemical-induced IBD models of rats and the human leukocyte antigen (HLA)-B27 transgenic rat model known to develop spontaneous colitis without the use of exogenous agents. Acute chemical colitis was induced by intracolonic instillation of 1.2 ml of 4% acetic acid solution. Prednisolone (1 mg/kg), sulfasalazine (100 mg/kg) and DA-6034 (0.3 to approximately 3 mg/kg) were orally administered twice daily for 6 days in these rats. In addition, chronic chemical colitis was induced by intracolonic administration of trinitrobenzene sulfonic acid (TNBS) 30 mg in 50% ethanol and agents were orally administered for 6 or 20 days. In chemical-induced IBD models, all of these agents reduced the severity of colitis and specially, DA-6034 (3 mg/kg) showed more potent effect than other drugs in macroscopic lesion score. In HLA-B27 transgenic rats, DA-6034 (3 mg/kg) and prednisolone (0.5 mg/kg) were treated orally twice daily for 6 weeks. The HLA-B27 transgenic rats showed only mild colitis, compared with the chemical-induced colitis models. DA-6034 ameliorated the loose stool and decreased microscopic damage, which is the important indicator of this model. In conclusion, oral therapy of DA-6034 attenuated the macroscopic and histologic damages of the colon in all three experimental models of IBD, which suggest that DA-6034 could be a promising drug in the treatment of IBD.

Two homologous cytochrome b5s are expressed in both neurons and glial cells of the rat brain

To avoid the possibility of blood contamination and of gene rearrangement during library construction we isolated total RNA directly from cultured rat embryonic neuronal cells and glioma C6 cells to be used as template for RT-PCR. By using specific primers for both membrane-bound b5 and soluble b5, DNA bands of appropriate size were clearly amplified indicating that both neurons and glial cells expressed b5s, although soluble b5 seemed to be less expressed in these cells. Nucleotide sequence of the internal exon for soluble b5 was reinvestigated and confirmed to be 58 bp containing genetic codons for His-Ser-Ala-Leu and stop.

Identification of two homologous cytochrome b5s in rat brain

Two kinds of PCR products were isolated from adult rat brain. The smaller product matched up to liver b5 mRNA completely. However, the larger one contained an additional 58 bp inserted between amino acids 96 and 97. This insertion was previously unknown and corresponded to in-frame codons for his-ser-ala-leu and the early stop. It is assumed that these two forms arise from a primary transcript by differential mRNA processing. This finding strongly suggests that there are two homologous b5s expressed in rat brain.

Identification of cytochrome P450 2E1 in rat brain

We have isolated cDNA fragments that were originated from P450 2E1 in rat brain by PCR analysis. Their size matched up to what we expected based on the reported sequence of rat liver P450 2E1 mRNA. Internal structure of the longest first-round PCR products were investigated by Southern blot analysis and "nested" PCR. Their results confirmed that PCR products actually originated from P450 2E1 mRNA in rat brain. RT-PCR was also carried out using P450 2E1 specific primers and the size of the product was exactly as we expected for P450 2E1. These experimental evidences should clarify the presence of P450 2E1 in rat brain.

A clinical and histopathological study of 22 patients with membranous lipodystrophy

Membranous lipodystrophy, an uncommon disorder, was described by Nasu et al. in 1973 as a form of regressive degeneration or localized destruction of the adipose tissue. Clinical features of the lesions with membranous fat necrosis are variable and the condition can only be diagnosed histopathologically. These peculiar changes in fat tissue have been associated with many local and systemic diseases including lupus erythematosus, diabetes mellitus, erythema nodosum, stasis dermatitis, morphoea and trauma, but occasionally no underlying disease is found. Even though various hypotheses concerning the pathogenesis of membranous lipodystrophy have been proposed, the exact causes are still in dispute. We reviewed 22 patients having membranous lipodystrophy confirmed by biopsy and discuss the pathogenetic mechanisms which have been suggested by many authors.

The isolation and characterization of the human cytochrome b5 gene

From a series of lambda and cosmid libraries, we isolated DNA sequences corresponding to the complete coding region for the human cytochrome b5 (CYB5) gene. The overall gene organization was the same as the bovine and rabbit CYB5 genes. One cosmid clone containing exon I plus the 5' flanking region was extensively characterized. From this clone we obtained 2000 bp of 5' flanking sequence, containing several distinctive GC rich regions, potential trans-acting factor binding sites and a 74 bp direct repeat. A series of deletion constructs were made in the pGL2 luciferase vector and then used to transfect HepG2 and K562 cells. The data obtained suggest the presence of two promotors and one silencer region in the analyzed 5' sequence.

The human cytochrome b5 gene and two of its pseudogenes are located on chromosomes 18q23, 14q31-32.1 and 20p11.2, respectively

Using very high stringency hybridization conditions for the Southern blot hybridization analysis of hamster-human cell hybrid DNA, we were able to map the human cytochrome b5 gene and two of its pseudogenes (psgb(5)1 and psgb(5)2) unambiguously to chromosomes 18, 14, and 20. These localizations were confirmed and extended to 18q23, 14q31-32.1, and 20p11.2 by using a combination of nonisotopic in situ hybridization of chromosomal spreads and the polymerase chain reaction analysis of DNA samples isolated from somatic cell hybrids retaining deletions or translocations of chromosome 18.