Robot-assisted distal gastrectomy and local resection for gastric cancer and gastrointestinal stromal tumor

Gastrointestinal stromal tumors surrounding the esophagogastric junction are often challenging to resect, with no consensus regarding the optimal surgical technique. Here in, we present a case of concurrent gastric cancer in the antrum and gastrointestinal stromal tumors adjacent to the esophagogastric junction. The patient underwent simultaneous distal gastrectomy and local resection assisted by a surgical robot, avoiding the need for total gastrectomy. The utilization of robot-assisted surgery has become an increasingly popular technique, holding promise for simplifying complex surgical procedures across diverse medical settings.

Hyaline-vascular type unicentric Castleman disease with dysplastic follicular dendritic cell proliferative lesions: a case report

Castleman disease (CD) is a rare lymphoproliferative disease. Hyaline-vascular type unicentric CD has a good prognosis if completely resected during surgery. However, follicular dendritic cell proliferative lesions have the potential for recurrence and metastasis. A 22-year-old man was referred to our hospital with the chief complaint of nausea and vomiting. These symptoms were caused by a right mesocolonic tumor pushing the duodenum. The patient underwent laparoscopic tumorectomy and complete surgical excision. The postoperative course was uneventful, with no complications. Pathological examination confirmed that the tumor was an enlarged lymph node, typical of hyaline vascular-type CD; however, follicular dendritic cell proliferative lesions were noted. We report a rare case of hyaline-vascular-type CD with follicular dendritic cell proliferative lesions associated with malignancy, as limited case reports exist on this particular disease.

Prognostic factors to predict the survival in patients with advanced gastric cancer who receive later-line nivolumab monotherapy-The Asahikawa Gastric Cancer Cohort Study (AGCC)

BACKGROUND

Chemotherapy for advanced gastric cancer is recommended in the guidelines; however, later-line treatment remains controversial. Since immune checkpoint inhibitors have been used for the treatment of various malignancies, trials have been performed for gastric cancer. A phase 3 trial indicated the survival benefit of nivolumab monotherapy for gastric cancer patients treated with prior chemotherapy regimens.

PATIENTS AND METHODS

A regional cohort study was undertaken to determine the real-world data of nivolumab treatment for patients with advanced or recurrent gastric cancer. The patients were enrolled for 2 years from October 2017 to October 2019 and were prospectively followed for 1 year to examine the overall survival (OS). The patient characteristics were analyzed in a multivariate analysis and a nomogram to predict the probability of survival was generated.

RESULTS

In total, 70 patients who received nivolumab as ≥third-line chemotherapy were included in the Asahikawa Gastric Cancer Cohort. The median OS was 7.5 (95% CI, 4.8-10.2) months and the response rate was 18.6%. Diffuse type classification, bone metastasis, high neutrophil/lymphocyte ratio, and high CRP were associated with poor OS/prognosis in the multivariate analysis. A nomogram was developed based on these clinical parameters and the concordance index was 0.80 (95% CI, 0.68-0.91). The responders were aged and were frequently diagnosed with intestinal type gastric cancer, including patients with a HER2-positive status (27.3%) or microsatellite instability-high (27.3%) status.

CONCLUSIONS

The regional cohort study of nivolumab monotherapy for gastric cancer patients revealed prognostic factors and a nomogram was developed that could predict the probability of survival.

[A Case of Rectal Gastrointestinal Stromal Tumor(GIST)Treated with Imatinib Mesylate Neoadjuvant Therapy to Preserve the Anus]

A woman in her 40's who initially presented with anal pain was diagnosed with rectal GIST. A 9 cm tumor extended to near the anus, and curative abdominoperineal tumor resection was required. The patient initially received neoadjuvant therapy with imatinib mesylate. Neoadjuvant chemotherapy for 6 months reduced the tumor to approximately 47% of its original size and permitted anus-preserving surgery. The present case suggests that neoadjuvant therapy with imatinib mesylate is useful for large rectal GISTs, from the standpoint of anal function preservation.

Reduction of EDA (+) fibronectin and its clinical importance on cryofiltration

Cryofiltration (CRYO) removes cryogel, which is a combination of fibrinogen (Fbg) and fibronectin (FN), containing pathological substances. The purpose of this study was to measure cryogel EDA(+) FN and study the relationship between EDA(+) FN and clinical symptoms in patients with rheumatoid arthritis, SLE and polymyositis. Cryogel contains 51 times more EDA(+) FN than plasma. The patients with rheumatoid arthritis showed a high level of EDA(+) FN in their plasma, and the EDA(+) FN level in plasma corresponded with changes in joint pain. We calculated the clearance level at several points in cryofiltration, and the reduction enabled us to evaluate the CRYO device. The EDA(+) FN clearance was 23.3 ± 6.4 ml/min, the pFN clearance 16.5 ± 4.1 ml/min, and the Fbg clearance 22.9 ± 5.7 ml/min. As the plasma flow in cryofiltration was 30 ml/min, a clearance of EDA(+) FN and Fbg, approximately 23 ml/min, was obviously high. The study of the plasma level change of EDA(+) FN during cryofiltration revealed a temporary elevation. These results suggest that the EDA(+) FN was most efficiently reduced by cryofiltration, would become a good indicator on plasmapheresis, and might move from other tissues into the blood during cryofiltration.

[A Case of Advanced Colon Cancer with Long-Term and Re-Administration of Regorafenib]

A 54-year-old woman diagnosed with sigmoid colon cancer and multiple liver metastases underwent sigmoidectomy, partial hepatectomy, and RFA in September 2009. Because of postoperative liver and lung recurrence, 5 regimens with combinations of L-OHP/CPT-11 plus anti-VEGF antibody/anti-EGFR antibody was performed. Following these treatments, she underwent hepatic arterial infusion therapy with UFT/Krestin for progressive liver metastases. Starting in November 2014, regorafenib was administered, with an immediate decrease in tumor marker levels; tumor reduction demonstrated enhanced effect against liver metastases. After 8 months of administration, we stopped regorafenib and changed to TAS-102 due to diarrhea and eating disorders. However, TAS-102 was not effective; there were significant increases in tumor markers, liver function tests, and tumor size on computed tomography, and worsening of abdominal pain. After re-administration of regorafenib, a rapid decrease in tumor marker levels and improvement of liver dysfunction and abdominal pain were observed. Re-administration continued for 8 months until best supportive care was instituted. In cases with observed therapeutic effect of regorafenib, long-term or re-administration is possible, with extension of the prognosis depending on the adjustment, and without size reduction of metastatic tumors.

[A Case of Pseudomyxoma Peritonei Derived from Cecum Colon Cancer with Long-Term Recurrence-Free Survival]

A 29-year-old woman was diagnosed with advanced cecum colon cancer, and right hemicolectomy was performed. The pathological findings showed stage Ⅲa disease, including moderately differentiated tubular adenocarcinoma>mucinous adenocarcinoma, pT3, pN1, cM0, and Cur A resection. The patient was treated with 5-FU plus l-LV adjuvant chemotherapy. Fourteen months after surgery, bilateral ovarian metastasis and ascites were found, and another surgery was performed, revealing that the abdominal cavity was filled with a gelatinous ascites. Under the diagnosis of pseudomyxoma peritonei, resection of both ovaries, abdominal lavage, and intraperitoneal administration of CDDP were performed, followed by S-1 plus CDDP treatment. Two years after the recurrence, peritoneal re-recurrence on the vaginal fornix was detected. A total hysterectomy, partial vaginectomy, and resection of disseminated peritoneal nodules were performed. The patient received mFOLFOX6 treatment postoperatively. To date, 8 years and 9 months after her re-recurrence, the patient is alive and without signs of a third recurrence.

Total pancreatectomy for metachronous mixed acinar-ductal carcinoma in a remnant pancreas

In October 2009, a 71-year-old female was diagnosed with a cystic tumor in the tail of the pancreas with an irregular dilatation of the main pancreatic duct in the body and tail of the pancreas. A distal pancreatectomy with splenectomy, and partial resection of the duodenum, jejunum and transverse colon was performed. In March 2011, a follow-up computed tomography scan showed a low density mass at the head of the remnant pancreas. We diagnosed it as a recurrence of the tumor and performed a total pancreatectomy for the remnant pancreas. In the histological evaluation of the resected specimen of the distal pancreas, the neoplastic cells formed an acinar and papillary structure that extended into the main pancreatic duct. Mucin5AC, α1-antitrypsin (α-AT) and carcinoembryonic antigen (CEA) were detected in the tumor cells by immunohistochemistry. In the resected head of the pancreas, the tumor was composed of both acinar and ductal elements with a mottled pattern. The proportions of each element were approximately 40% and 60%, respectively. Strongly positive α-AT cells were detected in the acinar element. Some tumor cells were also CEA positive. However, the staining for synaptophysin and chromogranin A was negative in the tumor cells. Ultimately, we diagnosed the tumor as a recurrence of mixed acinar-ductal carcinoma in the remnant pancreas. In conclusion, we report here a rare case of repeated pancreatic resection for multicentric lesions of mixed acinar-ductal carcinoma of the pancreas.

Clear cell sarcoma of the esophagus: report of a case

We report a rare case of clear cell sarcoma of the esophagus and review the literature regarding clear cell sarcomas of the gastrointestinal tract. A 57-year-old male was admitted with dysphagia during swallowing. Preoperative imaging studies, including upper gastrointestinal endoscopy and endoscopic ultrasonography, showed that the tumor was located between the mucosa and the muscularis propria of the lower esophagus. We performed subtotal esophagectomy with gastric tube reconstruction. Pathological findings of the tumor showed mixed spindle cells and oval cells. Immunohistochemical staining showed that the tumor cells were positive for S-100, vimentin and neuron-specific enolase and negative for α-smooth muscle actin, myoglobin and c-kit. Fluorescence in situ hybridization using a Ewing sarcoma breakpoint region 1 probe showed split signals in a small percentage of cells. We finally diagnosed the patient with clear cell sarcoma of the esophagus.

[Prognostic factors affecting the surgical treatment of metastatic lung tumor from colorectal cancer]

For aging, people having malignant disease are increasing. And surgical resection is an important part in the treatment of pulmonary metastasis from colorectal cancer. We analyzed the treatment outcome and prognostic factors affecting survival in our subset of patients. We have experienced 64 operations of metastatic lung tumors from colorectal cancer for 23 years since January 1988. Various factors affecting prognosis are studied based on 5-year survival in this report. Overall 5-year survival rate was 38.7%. The disease-free intervals more than 2 years, a solitary metastatic pulmonary lesion and the serum level of prethoracotomy carcinoembryonic antigen (CEA) were significantly affecting factors on the prognosis. Furthermore, sequential study for 23 years couldn't demonstrate the prognostic improvement by the advance of the thoracoscopic technology or the development of the new anti-cancer drugs, though the treatment of patients with pulmonary metastases from colorectal cancer continues to evolve. The role of pulmonary metastasectomy is very important to reduce the volume of metastatic lesions for the better prognosis.

[Two cases of neuroendocrine carcinoma of the rectum]

We report two cases of neuroendocrine carcinoma of the rectum. CASE 1: A 50s woman was diagnosed as rectal cancer and underwent anterior resection of the rectum and lymphnode dissection. The histological diagnosis was neuroendocrine carcinoma with peritoneal dissemination. She was treated with chemotherapy as an outpatient. One year later from the operation, multiple liver metastases were revealed and she died eight months later. CASE 2: A 50s man underwent endoscopic mucosal resection (EMR) of the rectum as rectal tumor and histological diagnosis was an early well-moderate deferenciated carcinoma and its cut-tend was unclear. He received a careful follow-up. One year later, a follow-up colonoscopy revealed a submucosal tumor in the lower rectum. He was diagnosised with local reccurence of rectal cancer, and then underwent an abdominoperineal resection of the rectum and lymphnode dissection. The histological diagnosis was poorly differenciated neuroendocrine carcinoma with lymphnode metastasis. Two months later from the operation, a local reccurence was revealed and he was treated with octreotide and irradiation.

[A case of AFP-producing gastric cancer patient with liver relapse occurred three months after endoscopic mucosal resection (EMR) and gastrectomy]

A 60s male was admitted to our hospital for a diagnosis of gastric tumor sized 20 mm in diameter at the fornix of the stomach. Endoscopic mucosal resection (EMR) was performed, and the resected tumor was pap, m, ly0, v0, HMX, VM0, pathologically. One month after the EMR, the local recurrence was confirmed and a partial gastrectomy was performed. Pathological findings were tub1, sm2, ly1, v1, HM0, VM0. Total gastrectomy was added because of the possibility of the lymph node metastasis. Pathological findings revealed no residual cancers. The final pathological diagnosis was T1b(sm2) N0H0P0M0, Stage IA, based on the Japanese classification of gastric cancer. Three months thereafter, CT showed multiple liver metastases. Immunohistochemical study of the operated tumor revealed AFP-producing gastric cancer. Chemotherapy was performed, but he died of the gastric cancer. Endoscopic treatment is a minimally invasive therapeutic strategy, but it requires a considerable care in application.

[Two cases of gastric endocrine cell carcinoma]

Gastric endocrine cell carcinoma is rare and associated with a poor prognosis. The first case was a man in his sixties with gastric endocrine cell carcinoma, of which a clinical finding was T2N1M0H1 (Stage IV). S-1 + CDDP therapy was selected and failed. CDDP+CPT-11 therapy was started and CT showed a partial response in ten months. But the tumor was re-grown and the patient died twenty months after diagnosis. The second case was a man in his seventies with gastric endocrine cell carcinoma, of which a clinical finding was T3N1M0H0P0, Stage IIIa, underwent total gastrectomy. Abdominal contrast-enhanced CT scan performed a month after the operation disclosed hepatic metastasis. After two months of S-1 regimen, CDDP + CPT-11 therapy was started.

[A case of metastasis to the stomach from primary adenocarcinoma of the lung cancer]

We report a case of gastric metastasis of lung cancer performed gastrectomy for the primary foci. A 70s woman was diagnosed as having right lung cancer and underwent right lower lobectomy and lymph node dissection. The histological diagnosis was adenocarcinoma (pT4, N2, M0). Four years later, positron emission tomography (PET)-CT revealed a tumor in the stomach and para-aortic lymph nodes swelling. The submucosal tumor was showed in the cardia by endoscopic examination. Biopsy showed a papillary adenocarcinoma. With the diagnosis of gastric metastasis from lung cancer, she was operated on. A proximal gastrectomy was carried out. The histopathological examination demonstrated papillary adenocarcinoma similar to that of the lung cancer with lymph node metastasis. No postoperative complications occurred and she was discharged from the hospital. Since then, she was treated with adjuvant chemotherapy as an outpatient.

[A case of long-term survival of unresectable-advanced gastric cancer due to chemotherapy]

The case was a 50s male with chief complaints of body weight loss and nausea. A clinical finding was Stage IV gastric cancer of poorly differentiated adenocarcinoma. We diagnosed it unresectable and started 5-FU+CDDP as the first-line chemotherapy. Partial response (PR) was observed and progression free time was 7 months. After 9 courses of 5-FU+ CDDP, the tumor grew and an oral intake was getting impossible. Gastro-jejunostomy was performed and then started a weekly PTX as the second-line chemotherapy after operation. The response was progressive disease (PD) after 4 courses of weekly PTX. Then we started S-1+CPT-11 as the third-line chemotherapy. We could continue S-1+CPT-11 for 9 courses without a severe adverse effect. Overall survival was 26.2 months.

[A case report of metastatic liver tumor from rectosigmoid colon cancer demonstrating a pathological complete response with FOLFOX and FOLFIRI treatment]

We report a case of multiple liver metastases of rectsigmoid colon cancer treated with systemic chemotherapy and hepatectomy. A 40s woman had undergone anterior resection of rectum for rectsigmoid colon cancer with multiple liver metastases. Then FOLFOX4 regimen was performed fifteen times, and FOLFIRI regimen was performed eleven times. After chemotherapy was enforced, an abdominal CT revealed that liver metastases were reduced in size (effect judgment of partial response). Hepatic resection of the right lobe and partial of S2 segment were performed. Pathological findings of the resected liver revealed no residual cancer cells, indicating that the histological effect of chemotherapy was complete response (CR).

[Expandable metallic stent treatment for obstructive colorectal cancer patients]

The expandable metallic stent (EMS) have been used to treat obstructive colorectal cancer. We used EMS in 13 out of 14 cases of obstructive colorectal carcinoma patients (insertion rate 93%). Of these 13 cases, 6 cases were male patients, and 7 cases were female patients. The average age was 69.1-years-old (44-87). The placement of insertion part in rectum and sigmoid colon was 8 cases and 5 cases, respectively. We detained Ultraflex non-covered type for all patients. Seven patients were able to have an operation after stenting. After the stent treatment, 11 patients were able to eat, and 7 patients were discharged from hospital.

COMPLICATIONS

perforation and stent migration were occurred in one case. These results suggested that EMS might be an effective treatment for obstructive colorectal carcinoma.

[A case of local recurrence of rectal cancer in long-term responding to combined therapy of low-dose CPT-11 and 5'-DFUR]

A 68-year-old man underwent Miles'operation for advanced rectal cancer. Local recurrence occurred 9 months following the operation. We started the combined therapy of low-dose CPT-11 and doxifluridine (5'-DFUR). CPT-11 was administered at 80 mg/body biweekly and 5'-DFUR was orally administered at 800 mg/day/body on day 3-7. We then reduced the CPT-11 dose to 60 mg/body because of neutropenia. Four months later,we obtained a decrease in the tumor marker (carcinoembryonic antigen: CEA) to the normal serum level, and stopped the medication. However, 3 months later the serum CEA level was increased, and we restarted the same therapy. Six months after restarting this therapy, the serum CEA level decreased to the normal level,and the local recurrence was decreased in size. We finished this combined therapy and changed to 5'-DFUR only. No tumor progression or recurrences in this patient are seen 2 years after completing this combined therapy.

The Efficacy of Recombinant Fowlpox Vaccine Protection Against Marek's Disease: Its Dependence on Chicken Line and B Haplotype

Earlier studies have shown that the B haplotype has a significant influence on the protective efficacy of vaccines against Marek's disease (MD) and that the level of protection varies dependent on the serotype of MD virus (MDV) used in the vaccine. To determine if the protective glycoprotein gene gB is a basis for this association, we compared recombinant fowlpox virus (rFPV) containing a single gB gene from three serotypes of MDV. The rFPV were used to vaccinate 15.B congenic lines. Nonvaccinated chickens from all three haplotypes had 84%-97% MD after challenge. The rFPV containing gB1 provides better protection than rFPV containing gB2 or gB3 in all three B genotypes. Moreover, the gB proteins were critical, since the B*21/*21 chickens had better protection than chickens with B*13/*13 or B*5/*5 using rFPV with gB1, gB2, or gB3. A newly described combined rFPV/gB1gEgIUL32 + HVT vaccine was analyzed in chickens of lines 15 x 7 (B*2/*15) and N (B*21/*21) challenged with two vv+ strains of MDV. There were line differences in protection by the vaccines and line N had better protection with the rFPV/gB1gEgIUL32 + HVT vaccines (92%-100%) following either MDV challenge, but protection was significantly lower in 15 X 7 chickens (35%) when compared with the vaccine CVI988/Rispens (94%) and 301B1 + HVT (65%). Another experiment used four lines of chickens receiving the new rFPV + HVT vaccine or CVI988/Rispens and challenge with 648A MDV. The CVI 988/Rispens generally provided better protection in lines P and 15 X 7 and in one replicate with line TK. The combined rFPV/gB1gEgIUL32 + HVT vaccines protected line N chickens (90%) better than did CVI988/Rispens (73%). These data indicate that rFPV + HVT vaccines may provide protection against MD that is equivalent to or superior to CVI988/ Rispens in some chicken strains. It is not clear whether the rFPV/gB1gEgIUL32 + HVT vaccine will offer high levels of protection to commercial strains, but this vaccine, when used in line N chickens, may be a useful model to study interactions between vaccines and chicken genotypes and may thereby improve future MD vaccines.

Long-term acceptance of rat cardiac allografts on the basis of adenovirus mediated CD40Ig plus CTLA4Ig gene therapies

BACKGROUND

We have previously demonstrated that blockade of either CD80/86-CD28 or CD40-CD154 costimulatory pathways by using adenovirus vector coding CTLA4Ig (AdCTLA4Ig) or CD40Ig (AdCD40Ig) genes induced donor-specific tolerance in rat liver transplantation. In this study, we asked whether these gene-therapy-based costimulation blockade would induce tolerance in cardiac transplantation.

METHODS

Heterotopic heart transplantation was performed in a full major histocompatibility complex (MHC) barrier combination of ACI (RT1avl) to Lewis (LEW, RT1l) rats. Vector (1 x 10(9) plaque forming unit [PFU]), AdLacZ, AdCTLA4Ig, or AdCD40Ig, was administered intravenously to recipient animals immediately after grafting, and graft survival, serum CTLA4Ig/CD40Ig levels, and graft histology were assessed. Tolerance was determined by secondary skin-graft challenging.

RESULTS

Allografts of both untreated and AdLacZ controls were promptly rejected within 7 days, whereas a single treatment with AdCTLA4Ig or AdCD40Ig significantly prolonged median graft survival to 55.5 and 28.5 days, respectively. In contrast, the combined AdCTLA4Ig and AdCD40Ig gene therapy maintained high CTLA4Ig and CD40Ig levels through the posttransplant period and allowed long-term cardiac allograft survival for more than 270 days. However, both donor and third-party skin grafts were rejected in the animals who harbored cardiac grafts over 150 days. Also, typical features of chronic rejection were evident in the long-term surviving grafts.

CONCLUSION

Simultaneous blockade of CD28 and CD154 pathways by AdCTLA4Ig plus AdCD40Ig induces a strong immunosuppression that allows long-term acceptance of full MHC mismatched cardiac graft in rats. This strategy, however, was not enough to induce tolerance to skin grafts and to avoid chronic rejection, as shown in the liver-transplantation model.

Protection and Synergism by Recombinant Fowl Pox Vaccines Expressing Multiple Genes from Marek's Disease Virus

Recombinant fowl poxviruses (rFPVs) were constructed to express genes from serotype 1 Marek's disease virus (MDV) coding for glycoproteins B, E, I, H, and UL32 (gB1, gE, gI, gH, and UL32). An additional rFPV was constructed to contain four MDV genes (gB1, gE, gI, and UL32). These rFPVs were evaluated for their ability to protect maternal antibody-positive chickens against challenge with highly virulent MDV isolates. The protection induced by a single rFPV/gB1 (42%) confirmed our previous finding. The protection induced by rFPV/gI (43%), rFPV/gB1UL32 (46%), rFPV/gB1gEgI (72%), and rFPV/gB1gEgIUL32 (70%) contributed to additional knowledge on MDV genes involved in protective immunity. In contrast, the rFPV containing gE, gH, or UL32 did not induce significant protection compared with turkey herpesvirus (HVT). Levels of protection by rFPV/gB1 and rFPV/gl were comparable with that of HVT. Only gB1 and gI conferred synergism in rFPV containing these two genes. Protection by both rFPV/gB1gEgI (72%) and rFPV/gB1gEgIUL32(70%) against Marek's disease was significantly enhanced compared with a single gB1 or gI gene (40%). This protective synergism between gB1 and gI in rFPVs may be the basis for better protection when bivalent vaccines between serotypes 2 and 3 were used. When rFPV/gB1gIgEUL32 + HVT were used as vaccine against Md5 challenge, the protection was significantly enhanced (94%). This synergism between rFPV/gB1gIgEUL32 and HVT indicates additional genes yet to be discovered in HVT may be responsible for the enhancement.

Protection and synergism by recombinant fowl pox vaccines expressing genes from Marek's disease virus

Recombinant fowl poxviruses (rFPV) were constructed to express genes from serotype 1 Marek's disease virus (MDV) coding for glycoproteins B (gB1), C (gC), and D (gD) and tegument proteins UL47 and UL48, as well as genes from serotypes 2 and 3 MDV coding for glycoprotein B (gB2 and gB3). These rFPVs, alone and in various combinations, including combinations of fowl poxvirus (FPV)/gBs with turkey herpesvirus (HVT), were evaluated for ability to protect maternal antibody-positive (ab+) and -negative (ab-) chickens against challenge with highly virulent MDV isolates. The protective efficacy was also compared with that of prototype Marek's disease (MD) vaccines. No protection was induced in ab+ chickens by rFPV expressing gC, gD, UL47, or UL48. In contrast, the rFPV/gB1 construct protected about 23% of ab+ chickens against MDV challenge compared with 26% for cell-associated HVT. Levels of protection by rFPV/gBs of different MDV serotypes was highest for gB1, intermediate for gB2, and lowest for gB3. When rFPV/gB1 was combined with cell-associated HVT, protection was enhanced by an average of 138% compared with the best component monovalent vaccine, and the mean level of protection was 59% compared with 67% for the HVT+SB-1 bivalent vaccine. Relatively high protection (50%) and enhancement (200%) were also observed between rFPV/gB1 and cell-free HVT. These results suggest a specific synergistic interaction between rFPV/gB1 and HVT, possibly analogous to that previously described between serotypes 2 and 3 viruses. Levels of protection by rFPV/ gB1 alone or by bivalent rFPV/gB1+cell-associated HVT were similar to those of conventional cell-associated MD vaccines. However, the bivalent rFPV/gB1+cell-free HVT vaccine was clearly more protective than cell-free HVT alone and, thus, may be the most protective, entirely cell-free MD vaccine thus far described.

A recombinant fowlpox virus expressing the envelope antigen of subgroup A avian leukosis/sarcoma virus

A recombinant fowlpox virus (FPV) was constructed by inserting cloned sequences from Schmidt-Ruppin subgroup A avian sarcoma virus coding for the viral envelope (env) antigen into a nonessential region of FPV DNA downstream from a synthetic promoter. Sera from chickens hyperimmunized with the recombinant FPV neutralized the infectivity of the homologous subgroup A virus (RCASBP/AP) but only weakly neutralized the infectivity of Rous sarcoma virus, another subgroup A avian leukosis virus. Similarly, vaccination of 1-day-old chicks with this recombinant FPV protected against infection with RCASBP/AP virus but not against infection with another subgroup A Rous-associated virus (RAV-1). These results show that such a recombinant FPV can be used to protect chickens against avian leukosis virus and confirm previous observations that a type-specific antigenic variability existed within the subgroup A avian leukosis/sarcoma virus group.

Mutational analysis of the proteolytic cleavage site of glycoprotein B (gB) of Marek's disease virus

The Marek's disease virus (MDV) glycoprotein B (gB) precursor, gp100, is proteolytically cleaved into two disulfide-linked subunits, gp60 and gp49. In the gB homologs of most other herpesviruses, a tetrapeptide, Arg-Xaa-Arg-Arg, is immediately upstream from the predicted cleavage site. We have investigated the specificity of the proteolytic cleavage in gp100 by introducing mutations within its predicted cleavage site (Arg-Leu-Arg-Arg) and expressed these mutants in recombinant fowlpox virus (FPV). The results show that all three Arg residues at the predicted cleavage site play an important role in the specific proteolytic cleavage of gp100. Furthermore, we demonstrated that the cleavage of gp100 is not necessary for transport of gB to the cell surface.

Reduction of EDA(+) fibronectin and its clinical importance on cryofiltration

Cryofiltration (CRYO) removes cryogel, which is a combination of fibrinogen (Fbg) and fibronectin (FN), containing pathological substances. The purpose of this study was to measure cryogel EDA(+) FN and study the relationship between EDA(+) FN and clinical symptoms in patients with rheumatoid arthritis, SLE and polymyositis. Cryogel contains 51 times more EDA(+) FN than plasma. The patients with rheumatoid arthritis showed a high level of EDA(+) FN in their plasma, and the EDA(+) FN level in plasma corresponded with changes in joint pain. We calculated the clearance level at several points in cryofiltration, and the reduction enabled us to evaluate the CRYO device. The EDA(+) FN clearance was 23.3 +/- 6.4 ml/min, the pFN clearance 16.5 +/- 4.1 ml/min, and the Fbg clearance 22.9 +/- 5.7 ml/min. As the plasma flow in cryofiltration was 30 ml/min, a clearance of EDA(+) FN and Fbg, approximately 23 ml/min, was obviously high. The study of the plasma level change of EDA(+) FN during cryofiltration revealed a temporary elevation. These results suggest that the EDA(+) FN was most efficiently reduced by cryofiltration, would become a good indicator on plasmapheresis, and might move from other tissues into the blood during cryofiltration.

Identification and characterization of a Marek's disease virus gene homologous to glycoprotein L of herpes simplex virus

We have identified three Marek's disease virus (MDV) open reading frames (ORFs) within the BamHI D fragment of MDV genome. The predicted polypeptides are homologous to UL1 (glycoprotein L, gL), UL2 (uracil-DNA glycosylase), and UL3 (nuclear localizing phosphoprotein) of herpes simplex virus type 1 (HSV-1). Comparison of the deduced amino acid sequences of these three ORFs with HSV-1 counterparts revealed overall identities of 18, 43, and 49%, respectively. In spite of the low overall amino acid identity with HSV-1 gL, the first open reading frame was identified as a gL homolog of HSV-1 based not only on the gene arrangement but also on a limited amino acid conservation among gL homologs of alpha-herpesviruses. To characterize the expression of the MDV gL gene, an antiserum to a hydrophilic region of the gene expressed in a bacterial expression vector was produced. Immunoprecipitation with this antiserum revealed a 25,000-Da polypeptide in MDV-infected cells. Furthermore, the 25,000-Da polypeptide migrated as a 18,000-Da polypeptide following PNGase F treatment. This result is consistent with the predicted molecular weight of MDV gL, considering the two potential N-glycosylation sites and the predicted N-terminal signal sequence. A recombinant fowlpox virus expressing the MDV gL gene was generated to characterize this glycoprotein. Unlike gL in MDV-infected cells, gL expressed by recFPV-gL was highly sensitive to Endo H, indicating that it was probably retained in the endoplasmic reticulum and was not properly processed to a mature form. Therefore, similar to HSV-1 coexpression and complex formation of MDV gL and gH may be required for proper processing and transport of gL to the cell surface.

[Cerebellar hemangioblastoma associated with fatal intratumoral hemorrhage: report of an autopsied case]

Intracranial hemorrhage associated with brain tumors is rate, but when present, it is often seen in malignant tumors such as glioblastoma and metastasis, and in meningiomas. Hemangioblastomas, benign vascular tumors, rarely develop fatal intracerebral hemorrhage. We thus documented an uncommon case of cerebellar hemangioblastoma associated with massive hemorrhage, the cause of which was thoroughly examined during autopsy. A 69-year-old man was transferred to our Service because of swallowing disturbance and dysarthria. The patient was known to have a cerebellar hemangioblastoma and hydrocephalus, for which VP shunt had been placed. Two weeks after admission he suddenly became comatose and eventually died of progressive herniation. At autopsy it was shown that the brain was edematous and covered with subarachnoid blood clots. The tumor was found involving the cerebellar vermis and the right hemisphere, protruding upward from the superior surface of the cerebellum. Horizontal sections through the cerebellum disclosed a well circumscribed tumor with adjacent hematomas involving the vermis and brain stem. The pathological diagnosis was hemangioblastoma and varix-like abnormal vessels were observed within the tumor. The sites of hematoma and tumor adjacent to the tentorial incisura and the history of VP shunting may suggest that upward herniation played a significant role in rupture of the abnormal vessels, which then led to the devastating hemorrhage in this particular case.

The glycoprotein B genes of Marek's disease virus serotypes 2 and 3: identification and expression by recombinant fowlpox viruses

The nucleotide sequences of the glycoprotein B (gB) genes of Marek's disease virus (MDV) serotypes 2 and 3 were determined (gB-2 and gB-3, respectively). The genomic locations of these genes coincide with that of the gB gene of serotype 1 MDV (gB-1). Alignment with gB-1 (Ross et al., 1989, J. Gen. Virol. 70, 1789-1804) revealed predicted amino acid identities of 83 and 82% for gB-2 and gB-3, respectively. Excluding the predicted N-terminal signal sequences, 8 of 9 potential N-linked glycosylation sites and all 10 cysteine residues in gB-1 are conserved in both gB-2 and gB-3. In addition, the putative proteolytic cleavage sites for processing of precursors (gp100s) to gp60s and gp49s are conserved among the three gB homologs. Fowlpox virus (FPV) recombinants expressing either the gB-2 or the gB-3 gene were constructed. We detected expression of authentic gB-2 and gB-3 complexes in cells infected with these FPV recombinants. Digestion of immunoprecipitated gB-1 and gB-3 with endoglycosidases revealed that both gp60s are modified by the additions of O-glycans and complex carbohydrates after cleavage of gp100s, while gp100s and gp49s contain only high-mannose carbohydrates. We confirm that the size differences between gB-1 and gB-3 complexes are due to different carbohydrate modifications.

Nucleotide and predicted amino acid sequences of Marek's disease virus homologues of herpes simplex virus major tegument proteins

The DNA sequence of an 8.4 kbp BamHI-EcoRI fragment of Marek's disease virus (MDV) strain GA was determined. Three of the predicted polypeptides are homologous to UL47, UL48 and UL49 encoding the major tegument proteins of herpes simplex virus type 1 (HSV-1), and four are homologous to HSV-1 UL45, UL46, UL49.5 and UL50. These seven genes are found in the long unique region of the MDV genome and are collinear with homologues in HSV-1 and varicella-zoster virus (VZV). Northern blot analysis revealed different transcriptional patterns from those of HSV-1 and VZV. MDV homologues of UL49.5, UL49 and UL47 lack a poly(A) signal immediately downstream of their coding regions. Amino acid conservation between MDV and HSV-1, and between MDV and VZV is as high as that between HSV-1 and VZV. The MDV homologue of UL48 shows 60% similarity to its HSV-1 counterpart. Amino acid sequence comparison reveals that the MDV homologue of UL48 lacks an acidic carboxyl terminus. This homologue, like the VZV homologue of UL48, may be involved in the trans-activation of immediate early genes and may function as an important component of the structural proteins.

Fowlpox virus recombinants expressing the envelope glycoprotein of an avian reticuloendotheliosis retrovirus induce neutralizing antibodies and reduce viremia in chickens

Eight stable fowlpox virus (FPV) recombinants which express the envelope glycoprotein of the spleen necrosis virus (SNV) strain of reticuloendotheliosis virus (REV), an avian retrovirus, were constructed. These recombinants differ in the genomic location of the inserted genes, in the orientation of the insert relative to flanking viral sequences, and in the promoter used to drive expression of the env gene. Of these variables, promoter strength seems to be the most crucial. The P7.5 promoter of vaccinia virus, which is commonly used in the construction of both vaccinia virus and FPV recombinants, resulted in lower levels of expression of the envelope antigen in infected chicken cells compared with a strong synthetic promoter, as determined by immunofluorescence and enzyme-linked immunosorbent assay. Two peptides encoded by the env gene, the 21-kDa transmembrane peptide and a 62-kDa precursor, were detected by immunoprecipitation of labeled proteins from cells infected with recombinant FPVs, using monoclonal antibodies against REV. These peptides comigrated with those precipitated from REV-infected cells. One of the recombinants (f29R-SNenv) was used for vaccination of 1-day-old chickens. Vaccinated chicks developed neutralizing antibodies to SNV more rapidly than did unvaccinated controls following SNV challenge and were protected against both viremia and the SNV-induced runting syndrome.

Insertional inactivation of a fowlpox virus homologue of the vaccinia virus F12L gene inhibits the release of enveloped virions

Insertion of the Escherichia coli lacZ gene into a ClaI restriction enzyme site of a 5.7 kb HindIII fragment of the fowlpox virus (FPV) genome resulted in the generation of stable recombinants. These recombinants produced plaques that were significantly smaller than those produced by parental FPV or by FPV recombinants containing the lacZ gene at other non-essential sites. Insertion of foreign DNA into the ClaI site disrupts a previously unidentified open reading frame (ORF) which potentially encodes a 74K polypeptide. The predicted amino acid sequence of this FPV ORF has 24% identity with the F12L ORF of vaccinia virus, the function of which is not currently known. Production of intracellular FPV was similar in cells infected with recombinant or parental viruses, but the number of infectious extracellular virions released into the medium by the recombinant was about 20% of that released by the parental virus. Likewise, the release of FPV particles, which were labelled in vivo with [3H]thymidine, was significantly lower in recombinant FPV-infected cells. These results suggest that the FPV homologue of the vaccinia virus F12L ORF is involved in the envelopment or release of infectious extracellular virions.

Identification and functional analysis of the fowlpox virus homolog of the vaccinia virus p37K major envelope antigen gene

A fowlpox virus (FPV) gene with homology to the vaccinia virus p37K major envelope antigen gene was identified and sequenced. The predicted product has a molecular weight of 43,018 Da (p43K). The FPV p43K gene has 37.5% identity with its vaccinia counterpart and higher homology with a molluscum contagiosum virus gene (42.6% identity). Based on upstream sequences, p43K appears to be regulated as a late gene. Recombinant FPV were generated in which a large portion of p43K was replaced by the Escherichia coli lacZ gene. These recombinants failed to produce visible plaques under standard conditions. After prolonged incubation the microplaques developed into small macroscopic plaques. Plaques were purified on the basis of lacZ expression. Single-cycle growth curves comparing the p43K-deleted recombinant (designated fJd43Z) with parental FPV showed that the two viruses produce identical amounts of intracellular virions, but that fJd43Z released 20-fold fewer infectious particles into the medium. CsCl gradient centrifugation of [3H]thymidine-labeled virus was employed to examine differences in the production of physical particles. The two viruses produced equivalent levels of intracellular virions, but fJd43Z failed to produce detectable levels of released particles. FPV p43K is therefore involved in the release of virions from infected cells.

Recombinant fowlpox viruses expressing the glycoprotein B homolog and the pp38 gene of Marek's disease virus

Two Marek's disease virus (MDV) genes, one homologous to the glycoprotein B gene of herpes simplex virus and encoding the B antigen complex and the other encoding a 38-kDa phosphorylated protein (pp38), were inserted into the fowlpox virus (FPV) genome under the control of poxvirus promoters. Randomly selected nonessential regions of FPV were used for insertion, and the vaccinia virus 7.5 kDa polypeptide gene promoter or a poxvirus synthetic promoter was used for expression of MDV genes. Gene expression in cells infected with these recombinants was highly influenced by the promoter (the synthetic promoter being more effective) but was only slightly influenced by the insertion site and by the transcription direction of the insert relative to the direction of the flanking FPV sequences. Cells infected with an FPV recombinant expressing the MDV gB gene reacted positively with a monoclonal antibody specific to this glycoprotein in an immunofluorescence assay. Immunoprecipitation of infected cell lysates showed three glycoproteins identical to those associated with the B antigen complex of MDV (100, 60, and 49 kDa). Cells infected with a recombinant expressing the pp38 gene reacted positively with an anti-pp38 monoclonal antibody in an immunofluorescence assay. The generated protein was phosphorylated and had a molecular weight similar to that of the native pp38 protein. Sera from chickens immunized with an FPV recombinant expressing the MDV glycoprotein B gene reacted with MDV-infected cells.

Protection against Marek's disease by a fowlpox virus recombinant expressing the glycoprotein B of Marek's disease virus

Fowlpox virus (FPV) recombinants expressing the glycoprotein B and the phosphorylated protein (pp38) of the GA strain of Marek's disease virus (MDV) were assayed for their ability to protect chickens against challenge with virulent MDV. The recombinant FPV expressing the glycoprotein B gene elicited neutralizing antibodies against MDV, significantly reduced the level of cell-associated viremia, and, similar to the conventional herpesvirus of turkeys, protected chickens against challenge with the GA strain and the highly virulent RB1B and Md5 strains of MDV. The recombinant FPV expressing the pp38 gene failed to either elicit neutralizing antibodies against MDV or protect the vaccinated chickens against challenge with MDV.

Antibody response to Newcastle disease virus (NDV) of recombinant fowlpox virus (FPV) expressing a hemagglutinin-neuraminidase of NDV into chickens in the presence of antibody to NDV or FPV

Antibody response of recombinant fowlpox virus (FPV) was studied in chickens inoculated with the virus in the presence or absence of antibodies against Newcastle disease virus (NDV) or FPV. In the case of NDV, high hemagglutination-inhibition titers to NDV were obtained when the antibody was present. No immune response to NDV was observed in the chickens previously vaccinated with FPV.

Recombinant fowlpox viruses inducing protective immunity against Newcastle disease and fowlpox viruses

The haemagglutinin-neuraminidase gene of Newcastle disease virus was inserted into a non-essential region of the fowlpox virus genome and expressed under control of the vaccinia virus 7.5 kDa polypeptide gene promoter. Immunization with the recombinant fowlpox virus elicited protective immunity in chickens against both virulent Newcastle disease and fowlpox virus infection.

Characterization of the precursor of Serratia marcescens serine protease and COOH-terminal processing of the precursor during its excretion through the outer membrane of Escherichia coli

The Serratia marcescens serine protease, which is directed by the gene encoding a precursor composed of a typical NH2-terminal signal sequence, a mature enzyme domain, and a large COOH-terminal domain, was excreted through the outer membrane of Escherichia coli. The precursor, with the expected molecular size (110 kilodaltons), was detected in an insoluble form in the periplasmic space of E. coli cells after induction with isopropyl-beta-D-thiogalactopyranoside of the expression of the gene under the control of the tac promoter. Upon membrane fractionation of the disrupted cells by sucrose density gradient centrifugation, the precursor was recovered from a fraction slightly heavier than the outer membrane fraction but not from the inner membrane fraction. Conversion of the precursor into the mature form, which was accompanied by its excretion into the medium, was observed even in the absence of de novo protein synthesis caused by the addition of chloramphenicol. The mutated gene product lacking all of the COOH-terminal domain was localized in the periplasmic space only and was not excreted into the medium. Additional mutant genes were generated by site-directed mutagenesis to test the role of some amino acids in the excretion of this protease in E. coli. The mutant protein with no protease activity because of the change of the catalytic residue Ser-341 to Thr was still excreted into the medium but with abnormal processing. Both self-processing and host-dependent processing of the precursor seem to be involved in the excretion of the mature enzyme. Replacement of the four Cys residues, two in the mature enzyme and two in the COOH-terminal domain, with Ser in different combinations caused a distinct or complete loss of excretion, suggesting that a certain conformation possibly formed via disulfide bonding was important for the excretion of the S. marcescens protease.

Specific excretion of Serratia marcescens protease through the outer membrane of Escherichia coli

A DNA fragment of Serratia marcescens directing an extracellular serine protease (Mr, 41,000) was cloned in Escherichia coli. The cloned fragment caused specific excretion of the protease into the extracellular medium through the outer membrane of E. coli host cells in parallel with their growth. No excretion of the periplasmic enzymes of host cells occurred. The cloned fragment contained a single open reading frame of 3,135 base pairs coding a protein of 1,045 amino acids (Mr 112,000). Comparison of the 5' nucleotide sequence with the N-terminal amino acid sequence of the protease indicated the presence of a typical signal sequence. The C-terminal amino acid of the enzyme was found at position 408, as deduced from the nucleotide sequence. Artificial frameshift mutations introduced into the coding sequence for the assumed distal polypeptide after the C terminus of the protease caused complete loss of the enzyme production. It was concluded that the Serratia serine protease is produced as a 112-kilodalton proenzyme and that its N-terminal signal peptide and a large C-terminal part are processed to cause excretion of the mature protease through the outer membrane of E. coli cells.

[Cerebellopontine angle xanthogranuloma: report of a surgical case]

A Case of xanthogranuloma at the cerebellopontine angle is reported here in detail with a review of the literature. A 36-year-old male suffered from tinnitus and hearing disturbance for five months before admission. View of the internal auditory canal showed widening and destruction on the right side. Auditory brain stem response did not clarify any of wave. A slight high density area was revealed by CT with some degree of enhancement. A right paramedian suboccipital craniectomy revealed an encapsulated tumor at the right cerebellopontine angle extending into the internal auditory canal. The tumor was reddish-brown, creamy and 2 cm in diameter, which was totally extirpated. Twenty two days after the operation, the patient was discharged with a slight improvement of the right tinnitus. Seventeen surgical cases of intracranial xanthogranuloma were reviewed including the presented case. There were 10 males and seven females, and the age ranged from six to 57 years. Many of them were located in the choroid plexus or the dura mater. The presented case was the first reported one documenting a xanthogranuloma at the cerebellopontine angle. A solitary lesion was seen in 13 cases, and multiple lesions in four cases, among which Hand-Schüller-Christian disease was observed in two, and Weber-Christian disease in one. A high density area was revealed in eight out of nine cases, and some degree of enhancement was seen in nine. Surgical removal was performed totally in nine cases, subtotally in six, and partially in one. The outcome was excellent in eight cases, good in three, fair in one, poor in two, and dead in three.

Histochemical studies on the relationship between the morphology of the Golgi apparatus and G6PD activity in the locus coeruleus and dorsal vagal nucleus of the rat (application of karyometry)

Histochemical studies on the distribution of TPPase and G6PD in the neurons of locus coeruleus (LC) and dorsal vagal nucleus (DVN) of rats have been conducted by using the TPPase method, the G6PD method, karyometry, and statistics under normal conditions. 1. Neurons of the LC and DVN may undergo phasic changes of the GOLGI apparatus (GA) under normal condition. 2. No significant difference was found between neurons of the LC and DVN in regard to the GA morphology, but in general the latter revealed more complicated and developed GA than in the former. 3. Surprisingly, the G6PD activity of LC neurons was very weak. This is in agreement with the previous report by IIJIMA and IMAI (1975), and in disagreement with FRIEDE (1966). 4. An intimate parallel relationship was found between the GA morphology and G6PD activity in the DVN. The findings support the vigorous synthesizing activity found in the previous study of the rat supraoptic nucleus (IIJIMA 1979). In contrast to the DVN, such a parallel relationship between the Ga shape and G6PD activity was absent in the LC. Both findings strongly suggest that the role of the GA may be functionally different in the LC and DVN.