Time interval after various types of gastrectomy until metachronous multiple gastric cancer: Analysis of data from a nationwide Japanese survey

The factors influencing the time interval from the initial surgery for gastric cancer to the detection of metachronous multiple gastric cancer (MMGC) remain to be elucidated. The present study was performed to evaluate the association between the type of initial gastrectomy or reconstruction procedure and the time interval from initial gastrectomy to the detection of MMGC. A questionnaire survey on remnant stomach cancer was performed by the Japanese Society for Gastro-Surgical Pathophysiology in 2018. Participating facilities were requested to indicate the number of patients who underwent surgery for MMGC between 2003 and 2017, in association with the time interval from the initial gastrectomy until treatment for MMGC by type of initial gastrectomy or reconstruction procedure. Analyses were performed using data from 45 facilities. Gastrectomy for MMGC was performed on 1,234 patients during this period. Pylorus-preserving gastrectomy (PPG) accounted for only 3.6% (20/557) of the patients who underwent surgery for MMGC ≥10 years from initial gastrectomy, while PPG accounted for 10.1% (40/396) of patients who underwent surgery for MMGC within 5 years after initial gastrectomy. Billroth-II and Roux-en Y reconstruction accounted for 22.3% (103/462) and 1.3% (6/462), respectively, of patients who underwent surgery for MMGC ≥10 years from initial distal gastrectomy (DG), while such patients accounted for 8.0% (23/286) and 21.7% (65/286), respectively, of patients who underwent surgery for MMGC within 5 years after initial DG. Similarly, the proportion of each reconstruction procedure differed according to the time interval from initial proximal gastrectomy to treatment for MMGC. The types of gastrectomy or reconstruction procedure for initial gastrectomy differed significantly according to the time interval between the initial gastrectomy and treatment for MMGC, and the fact that PPG and R-Y reconstruction in DG is a relatively new method were assumed to be a major cause of these differences.

The incidences of metachronous multiple gastric cancer after various types of gastrectomy: analysis of data from a nationwide Japanese survey

BACKGROUND

The incidence of metachronous multiple gastric cancer (MMGC) after gastrectomy remains unclear. This study evaluated the incidences of MMGC according to specific gastrectomy types, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy (PG), and function-preserving gastrectomy (FPG), which was categorized as segmental gastrectomy and local resection.

METHODS

We conducted a questionnaire survey of the Japanese Society for Gastro-Surgical Pathophysiology members, who were asked to report their institutional numbers of radical gastrectomy cases for cancer between 2003 and 2012. The cases were categorized according to whether the remnant stomach's status was followed for > 5 years, confirmation of MMGC, time to diagnosis, and treatment for MMGC. We calculated the "precise incidence" of MMGC by dividing the number of MMGC cases by the number of cases in which the status of remnant stomach was followed up for > 5 years.

RESULTS

The responses identified 33,731 cases of gastrectomy. The precise incidences of MMGC were 2.35% after distal gastrectomy (DG), 3.01% after PPG, 6.28% after PG (p < 0.001), and 8.21% after FPG (p < 0.001). A substantial proportion of MMGCs (36.4%) was found at 5 years after the initial surgery. The rates of MMGC treatment using endoscopic submucosal dissection were 31% after DG, 28.6% after PPG, 50.8% after PG (p < 0.001), and 67.9% after FPG (p < 0.001).

CONCLUSIONS

The incidence of MMGC was 2.4% after DG, and higher incidences were observed for larger stomach remnants. However, the proportion of cases in which MMGC could be treated using endoscopic submucosal dissection was significantly higher after PG and FPG than after DG.

A single-institution retrospective analysis of gastric carcinoma with positive peritoneal lavage cytology and without serosal invasion: A case series

BACKGROUND AND OBJECTIVES

Peritoneal dissemination of gastric cancer is often associated with serosal infiltration. The aim of this study was to evaluate the clinical importance of peritoneal lavage cytology in patients with gastric carcinoma without serosal invasion. The incidence and impact on prognosis of positive cytology were analyzed.

METHODS

Of 2768 patients with gastric cancer, outcomes and pathological characteristics of 973 patients were reviewed retrospectively. All patients underwent peritoneal lavage at laparotomy for curative or palliative resection of gastric cancer between 1999 and 2017. Among these, 479 who underwent surgery from January 1999 to March 2012 were also reviewed to analyze 5-year survival.

RESULTS

Of 973 patients enrolled, 338 (35%) did not have serosal invasion, and peritoneal cytology was positive in 4/338 (1.2%). Of these four patients, one had submucosal invasion and three had muscularis propria invasion. Of 635 patients with serosal invasion, peritoneal cytology was positive in 74/635 (12%). Of 479 patients reviewed for survival, cytology was positive in 32/479, with 3/32 (9%) surviving for five years, and cytology was negative in 447 patients with 266/447 (60%) surviving for five years.

CONCLUSIONS

Cytologic evaluation should be routinely performed in patients with early-stage gastric cancer.

Identification of Eye-Specific Domains and Their Relation to Callosal Connections in Primary Visual Cortex of Long Evans Rats

Ocular dominance columns (ODCs) exist in many primates and carnivores, but it is believed that they do not exist in rodents. Using a combination of transneuronal tracing, in situ hybridization for Zif268 and electrophysiological recordings, we show that inputs from both eyes are largely segregated in the binocular region of V1 in Long Evans rats. We also show that, interposed between this binocular region and the lateral border of V1, there lies a strip of cortex that is strongly dominated by the contralateral eye. Finally, we show that callosal connections colocalize primarily with ipsilateral eye domains in the binocular region and with contralateral eye input in the lateral cortical strip, mirroring the relationship between patchy callosal connections and specific sets of ODCs described previously in the cat. Our results suggest that development of cortical modular architecture is more conserved among rodents, carnivores, and primates than previously thought.

Modic changes in the cervical spine

We conducted a prospective follow-up MRI study of originally asymptomatic healthy subjects to clarify the development of Modic changes in the cervical spine over a ten-year period and to identify related factors. Previously, 497 asymptomatic healthy volunteers with no history of cervical trauma or surgery underwent MRI. Of these, 223 underwent a second MRI at a mean follow-up of 11.6 years (10 to 12.7). These 223 subjects comprised 133 men and 100 women with a mean age at second MRI of 50.5 years (23 to 83). Modic changes were classified as not present and types 1 to 3. Changes in Modic types over time and relationships between Modic changes and progression of degeneration of the disc or clinical symptoms were evaluated. A total of 31 subjects (13.9%) showed Modic changes at follow-up: type 1 in nine, type 2 in 18, type 3 in two, and types 1 and 2 in two. Modic changes at follow-up were significantly associated with numbness or pain in the arm, but not with neck pain or shoulder stiffness. Age (≥ 40 years), gender (male), and pre-existing disc degeneration were significantly associated with newly developed Modic changes.

In the cervical spine over a ten-year period, type 2 Modic changes developed most frequently. Newly developed Modic changes were significantly associated with age, gender, and pre-existing disc degeneration.

Anterior screw fixation for odontoid fracture: clinical results in 45 cases

Clinical results of anterior screw fixation in 45 patients with odontoid fractures were reviewed retrospectively. The patients were 36 males and 9 females, with fractures classified as 35 type II and 10 type III. There were 34 fresh and 11 old fractures. Neurological complications were present in 16 patients and 18 had associated injuries. All patients underwent single screw fixation. Postoperative immobilization, external support, and surgical trauma were minimal. In one patient a screw extruded from the dens and immediate posterior fusion was necessary. The overall rate of fracture union was 93% (41 out of 44 fractures). Fracture resolution averaged 5.2 months. There were two delayed unions and three nonunions, the causes of which were preoperatively established nonunion, severe osteoporosis, and inaccurate screw placement. Out of 11 old cases, 8 went on to union. Ninety-six percent of the patients recovered neurologically. The overall complication rate, including a misplaced screw, a retropharyngeal wall injury, and three nonunions, was 11%. Head rotation was preserved in 90% of the patients with fracture union according to clinical measurements. Anterior screw fixation is an excellent treatment for fresh type II and cephalad type III odontoid fractures, carrying a high union rate, preservation of the C1-2 motion segment, and minimal surgical trauma; it can be applied even to some old cases. Precise patient selection in regard to patient age, bone density, and time elapsed since injury as well as preoperative anatomical reduction and meticulous surgical technique with fine fluoroscopy are essential to avoid complications and nonunions.

[A case of gastric cancer accompanied by disseminated carcinomatosis of bone marrow with DIC recovered by sequential therapy consisting of MTX and 5-FU]

A 78-year-old male was admitted to our hospital complaining of anorexia. Endoscopy revealed gastric cancer with pyloric stenosis and MRI showed multiple metastasis of thoracic vertebral body. Blood examinations showed DIC and CEA was 118.3 ng/mL. Sternum bone marrow biopsy revealed poorly-differentiated adenocarcinoma. Chemotherapy with sequential therapy consisting of MTX and 5-FU (MTX 150 mg/body, 5-FU 1,000 mg/body) was performed in addition to anti-DIC therapy. After 3 courses, DIC was resolved. Then, we changed the chemotherapy regimen to S-1/ paclitaxel (S-1 60 mg/body, PTX 60 mg/body). After 2 courses, the primary tumor was remarkably reduced and CEA decreased to within normal limits. After discharge, the patient has been undergoing chemotherapy on an outpatient basis.

Methylation pattern of the O6-methylguanine-DNA methyltransferase gene in colon during progressive colorectal tumorigenesis

O(6)-methylguanine-DNA methyltransferase (MGMT) is a DNA repair gene which is frequently methylated in colorectal cancer (CRC). However, it remains controversial whether methylation of specific CpG sequences within MGMT promoter leads to loss of its protein expression, and if MGMT methylation correlates with G to A transition mutations in KRAS. Two methylation sensitive regions (Mp and Eh region) of MGMT promoter were investigated in 593 specimens of colorectal tissue: 233 CRCs, 104 adenomatous polyps (AP), 220 normal colonic mucosa from CRC patients (N-C) and 36 normal colonic mucosa specimens obtained from subjects without colorectal neoplasia (N-N) by combined bisulfite restriction analysis (COBRA). The region-specific methylation data were compared to the MGMT protein expression, spectrum of KRAS mutations and other clinical features. Extensive (including both Mp and Eh) and partial (either Mp or Eh) MGMT methylation were found in 24.5% and 11.6% of CRCs, 3.8% and 27.9% of APs, 0.5% and 7.7% of C-Ns and 2.8% and 2.8% of N-Ns, respectively. Extensive methylation of MGMT promoter was primarily present in CRCs while partial methylation was common in APs. Extensive methylation of MGMT promoter was associated with loss/reduced protein expression (p < 0.0001), as well as with G to A mutations in KRAS (p = 0.0017). We herein provide first evidence that extensive methylation of MGMT promoter region is essential for methylation-induced silencing of this gene. Our data suggest that MGMT methylation may evolve and spread throughout the promoter in a stepwise manner as the colonic epithelial cells progress through the classical-adenoma-cancer multistep cascade.

Abnormality of growth hormone and insulin-like growth factor I axis in advanced cancer patients

19671

Background: Pituitary and thyroid hormones are known to be altered in anorexia nervosa, but few hormonal studies have been performed in cancer anorexia-cachexia syndrome. This study focused on growth hormone (GH) and Insulin-like Growth Factor (IGF)-I axis in cancer patients. Methods: To investigate the relationship among performance status (PS), nutritional and hormonal status, blood sampling was performed to measure GH, IGF-I, IGF-binding protein 3(IGFBP-3), T3, T4, complete blood counts and blood chemistry profiles for 15 cancer patients in each of PS0–1, PS2, PS3 and PS4 after the informed consent was obtained. Results: A total of 58 patients were evaluated including 15 patients in PS0–1, PS2 and PS3 and 13 in PS4. Hemoglobin and albumin levels went down along with progression of PS. GH level was high and T3 was low in poor PS. T4 and IGFBP-3 were lower in PS4 than those of other PS. There is a tendency of low IGF-I and thyroid hormones and high GH levels in poor PS as compared with those of good PS (p=0.0064 for IGF-I, p<0.001 for T3, and T4, not significant for GH analyzed by ANOVA). Conclusions: Abnormal GH - IGF-I axis was more pronounced in poor PS. It is conceivable that normalization of this abnormality can improve cancer anorexia-cachexia syndrome and new drug development for such normalizing agents is warranted.

No significant financial relationships to disclose.

Sudden death from metastatic esophageal cancer to the ventricular septum

A 67-year-old man was admitted to our hospital due to esophageal cancer. Cancer existed at the lower esophagus and subtotal esophagectomy and lymphadenectomy was performed. The postoperative course was uneventful. Pathological findings revealed moderately differentiated squamous cell carcinoma that metastasized to the abdominal lymph nodes which include the paraaortic lymph nodes. He complained of anorexia three months after the operation and was found to have multiple liver and mediastinal lymph node metastases. He was admitted for chemotherapy. Before starting chemotherapy, he suddenly died without any sign of hemorrhage or respiratory disorder. Autopsy showed metastatic lesions to the heart and mediastinal lymph nodes, liver, thoracic vertebrae, kidney, adrenal gland and heart. Metastatic nodules in the heart were on the ventricular septum where the conducting system exists. No direct invasion from the pericardium was observed. Blockade of the conducting system of the heart was considered to have caused the severe arrhythmia and sudden cardiac arrest.

ATP-dependent regulation of SK4/IK1-like currents in rat submandibular acinar cells: possible role of cAMP-dependent protein kinase

SK4/IK1 encodes an intermediate conductance, Ca2+ -activated K+ channel and fulfills a variety of physiological functions in excitable and nonexcitable cells. Although recent studies have provided evidence for the presence of SK4/IK1 channels in salivary acinar cells, the regulatory mechanisms and the physiological function of the channel remain unknown in these cells. Using molecular and electrophysiological techniques, we examined whether cytosolic ATP-dependent regulation of native SK4/IK1-like channel activity would involve endogenous cAMP-dependent protein kinase (PKA) in rat submandibular acinar (RSA) cells. Electrophysiological properties of tetraethylammonium (TEA) (10 mM)-insensitive, Ca2+ -dependent K+ currents in macropatches excised from RSA cells matched those of whole cell currents recorded from human embryonic kidney-293 cells heterologously expressing rat SK4/IK1 (rSK4/IK1) cloned from RSA cells. In outside-out macropatches, activity of native SK4/IK1-like channels, defined as a charybdotoxin (100 nM)-blockable current in the presence of TEA (10 mM) in the bathing solution, ran down unless both ATP and Mg2+ were present in the pipette solution. The nonhydrolyzable ATP analog AMP-PNP failed to support the channel activity as ATP did. The addition of Rp-cAMPS (10 microM), a PKA inhibitor, to the pipette solution containing ATP/Mg2+ induced a rundown of the Ca2+ -dependent K+ currents. Inclusion of cAMP (1 mM) into the pipette solution (1 microM free Ca2+) containing ATP/Mg2+ caused a gradual increase in the currents, the effect being pronounced for the currents induced by 0.1 microM free Ca2+. Forskolin (1 microM), an adenylyl cyclase activator, also increased the currents induced by 0.1 microM free Ca2+. In inside-out macropatches, cytosolic ATP/Mg2+ increased both the maximum current (proportional to the maximum channel activity) and Ca2+ sensitivity of current activation. Collectively, these results suggest that ATP-dependent regulation of native SK4/IK1-like channels, at least in part, is mediated by endogenous PKA in RSA cells.

SK4/IK1-like channels mediate TEA-insensitive, Ca2+-activated K+ currents in bovine parotid acinar cells

Although Ca(2+)-activated K(+) (K(Ca)) channels distinct from maxi-K(+) channels have been suggested to contribute to muscarinically stimulated K(+) currents in salivary acinar cells, the molecular nature of the channels is unclear. Using electrophysiological and RT-PCR techniques, we have now investigated the involvement of SK4/IK1-like channels in native K(Ca) currents in bovine parotid acinar (BPA) cells. Ca(2+)-dependent K(+) efflux from perfused bovine parotid tissues was not inhibited by a maxi-K(+) channel blocker, tetraethylammonium (TEA). Whole cell recordings from BPA cells showed a TEA-insensitive K(Ca) conductance, which was highly permeable to Rb(+). In inside-out macropatches, TEA-insensitive Rb(+) currents were activated by Ca(2+) with half-maximal values of 0.4 microM. 1-Ethyl-2-benzimidazolinone (1-EBIO) increased the Ca(2+) sensitivity of the currents. The calmodulin antagonists trifluoperazine, calmidazolium, and W-7 inhibited the Ca(2+)-activated Rb(+) currents. In outside-out macropatches, Ca(2+)-activated Rb(+) currents were inhibited by Ba(2+), quinine, clotrimazole, and charybdotoxin but not by d-tubocrarine or apamin. RT-PCR analysis showed transcripts of SK4/IK1 in BPA cells. These results collectively suggest that SK4/IK1-like channels mediate the native K(Ca) currents in BPA cells.

A first-passage-time analysis of the periodically forced noisy leaky integrate-and-fire model

We present a general method for the analysis of the discharge trains of periodically forced noisy leaky integrate-and-fire neuron models. This approach relies on the iterations of a stochastic phase transition operator that generalizes the phase transition function used for the study of periodically forced deterministic oscillators to noisy systems. The kernel of this operator is defined in terms of the the first passage time probability density function of the Ornstein Uhlenbeck process through a suitable threshold. Numerically, it is computed as the solution of a singular integral equation. It is shown that, for the noisy system, quantities such as the phase distribution (cycle histogram), the interspike interval distribution, the autocorrelation function of the intervals, the autocorrelogram and the power spectrum density of the spike train, as well as the input-output cross-correlation and cross-spectral density can all be computed using the stochastic phase transition operator. A detailed description of the numerical implementation of the method, together with examples, is provided.

Rapid and widespread microglial activation induced by traumatic brain injury in rat brain slices

In order to assess the role of circulating blood in early microglial activation after traumatic brain injury (TBI), controlled cortical impact injury was applied to adult rat brain slices (400 microm in thickness) and the microglial response was examined. The complement receptor (CR3) expression and morphological transformation of the microglia were evaluated by OX42 immunohistochemistry. At 5 min following injury, activated microglia with intense CR3 expression appeared throughout the hemisphere on the injured side. In contrast, the morphology and CR3 expression of the microglia on the contralateral side were indistinguishable from those of the resident ramified microglia seen in normal brains. At 30 min following injury, microglial activation was more pronounced on the injured side, while the microglia on the contralateral side still retained a ramified morphology. These results are consistent with our previous observations made in in vivo experiments, which indicate that, as the brain slice paradigm excludes variables arising from the circulating blood, the rapid and widespread microglial activation observed following TBI can not be attributed exclusively to the infiltration of blood-borne macrophages or molecules. Rather this activation is most likely caused by intrinsic mechanisms within the brain tissue, such as traumatic depolarization.

Establishment and characterization of a cisplatin-resistant human neuroblastoma cell line

BACKGROUND

To investigate the mechanisms of cisplatin (CDDP)-resistance in neuroblastoma(NB), we established a CDDP-resistant human NB cell line, BM1R2.

MATERIALS AND METHODS

We characterized BM1R2 in terms of the susceptibilities to other anticancer agents, MDR1 and MRP expression, MYCN amplification, intracellular gultathione-S-transferase(GST-pi), metallothionein(MT) and gultathione(GSH) levels, and immunocytochemical and cytogenetic features.

RESULTS

When compared to parent BM1 line, BM1R2 exhibited a 17.0-fold resistance to CDDP and cross-resistance to other agents. MRP expression was only observed in BM1R2, whereas MDR1 was expressed in both lines. Notably higher intracellular GST-pi and MT levels were observed in BM1R2 cells. MYCN amplifications were 50 and 6 copies in BM1 and BM1R2, respectively, and additional aberrations were observed in chromosome 1 and 2 in BM1R2.

CONCLUSION

It was suggested that GST-pi and MT could exert crucial roles on CDDP-resistance in our system. BM1R2 is of great interest for investigating the mechanisms of CDDP-resistance in NB.

A 1-hour enzyme-linked immunosorbent assay for quantitation of acrolein- and hydroxynonenal-modified proteins by epitope-bound casein matrix method

A simple and rapid enzyme-linked immunosorbent assay (ELISA) method for quantitation of acrolein and 4-hydroxy-2-nonenal (HNE)-modified proteins was developed. Microtiter plate wells were precoated and blocked simultaneously with epitope-bound bovine caseins as matrix proteins, and aldehyde-modified proteins were quantitated by a competition assay with a monoclonal antibody specific for acrolein-modified lysine or HNE-modified histidine epitopes. Minimal reaction times required for the coating/blocking; first monoclonal antibody and the peroxidase-conjugated second antibody binding steps were 3, 3, and 7 min, respectively, the former two steps being found to be or akin to diffusion-rate-limiting reactions. The convenient ELISA should find an application for analyses of the intricate processes involved in oxidative stress and carcinogenic insult. The epitope-attachment methodology may also be advantageous for the quantitation of various other biologically important haptenic molecules.

Decreased expression of the peroxisomal bifunctional enzyme and carbonyl reductase in human hepatocellular carcinomas

Human hepatocellular carcinomas (HCC) are known to frequently exhibit clear-cell or fatty change. The expression of three enzymes related to fatty acid metabolism, the peroxisomal bifunctional enzyme (enoyl-CoA hydratase/3-hydroxyacyl-CoA dehydrogenase, BE), cytosolic carbonyl reductase (CR) and the alpha-class glutathione S-transferase (GST) was investigated immunohistochemically in 45 HCC samples, to examine their relevance to this phenomenon and to antioxidant cellular defence. The tumour sizes ranged from 3 mm to 37 mm in diameter (mean 19 mm). Of 8 highly differentiated carcinomas (Edmondson's grade 1), 5 and 6 showed positive staining for BE and CR respectively, like the surrounding non-hepatoma tissues. Of 37 Edmondson's grade II-IV lesions, 31 exhibited negative or only weakly positive staining for both enzymes, as compared with the surrounding tissues. The combined rates for weakly positive and negative staining for BE or CR were proportional to the degree of dedifferentiation. However, 3 of 26 grade III tumours showed enhanced staining. Intensities of staining for CR were in accordance with those for BE in 40 of the total of 45 HCC. Immunoblot analysis also demonstrated concerted alteration of the two enzymes in carcinoma tissues. The staining of the alpha-class GST was hardly changed in Edmondson's grade I and II cases but was decreased in 24 of 31 grade III and IV lesions. The great majority of the BE-negative carcinomas did not demonstrate fatty or clear-cell change. These results suggested that BE and CR might be possible markers for the analysis of multistage hepatocarcinogenesis but that decrease or loss was not reflected in increased fat storage.

Quantitative differences in the active-site hydrophobicity of five human glutathione S-transferase isoenzymes: water-soluble carcinogen-selective properties of the neoplastic GSTP1-1 species

The active-site (the H-site) hydrophobicity of five human glutathione S-transferases (GSTs) was analyzed by application of linear free energy relationships (LFERs) with a series of S-alkylated glutathione inhibitors, GS(CH2)n - 1CH3 (n = 1-14). Distinct linear reltionships were observed in the plots of log Ki (inhibition constant) vs n for the five forms, whereby the Kis varied by three to four orders of magnitude. Mean free enthalpy changes per methylene group (-Delta DeltaG degreess), a measure of H-site hydrophobicity, were in the order M1-1 (4.6 kJ/mol) > A1-1 (3. 9 kJ/mol) > A1-2 (3.8 kJ/mol) > A2-2 (2.8 kJ/mol) > P1-1 (1.6 kJ/mol). The quantitative differences may in part account for the extraordinary broad and overlapping substrate specificities of the Alpha-, Mu-, and Pi-class isoenzymes. In contrast to the Alpha and Mu classes being selective for strongly electrophilic compounds, the neoplastic P1-1 species was indicated to be selective for weakly electrophilic and water-soluble carcinogens such as acrolein and hydroxyalkenals.

Treatment of chronic subdural hematoma by closed-system drainage without irrigation

BACKGROUND

Recurrence of chronic subdural hematoma after surgery has not been eliminated. We sought to determine whether irrigation influences recurrence rate.

METHODS

Patients who had undergone surgery for chronic subdural hematoma were reviewed retrospectively.

RESULTS

Between 1986 and 1993, 186 cases of chronic subdural hematoma were treated surgically at Mito National Hospital. Recurrence was limited to six cases (3.2%). A closed drainage system without irrigation has been used since 1988 in 119 patients. Before 1988, 67 cases were treated with single burr hole irrigation and drainage. The rate of recurrence with the closed drainage system was 3.4% (four cases), compared with 3.0% (two cases) for irrigation and drainage.

CONCLUSION

Compared with irrigation and drainage, the closed drainage system without irrigation was safe and effective, and recurrence of chronic subdural hematoma is not influenced by irrigation.

Identification of glutathione S-transferase p-1 as the class pi form dominantly expressed in mouse hepatic adenomas

To clarify which of the two genes for pi class glutathione S-transferases (GSTs) (p-1 and p-2) is dominantly expressed in mouse hepatic adenomas, the relative mRNA levels were examined by means of the reverse transcription-polymerase chain reaction (RT-PCR). Hepatic adenomas were induced in male and female B6C3F1 mice by diethylnitrosamine treatment. Northern blot analysis revealed that pi class mRNA levels were decreased in adenomas of male mice, but increased in those of females, with reference to the respective surrounding non-adenoma tissues. In contrast to the marked sex difference in surrounding tissues, pi class GST mRNA levels in adenomas were almost the same in both males and females. To evaluate p-1 and p-2 mRNA levels separately, the products of RT-PCR employing primers common for both cDNAs were digested with the endonuclease BanI (specific for p-2) and then resolved by electrophoresis. The p-1 mRNA was thus found to be dominant in adenomas of both female and male mice. The p-2 mRNA levels were increased in the lesions as compared with those in the surrounding non-adenoma tissues. Recombinant p-1 and p-2 proteins were expressed in Escherichia coli. Unlike p-1, the p-2 protein did not show any significant activity towards 1-chloro-2,4-dinitrobenzene and did not bind to S-hexylglutathione-Sepharose despite immunological cross-reactivity. The dominant pi class form in adenomas could also be identified as p-1 by its binding to S-hexylglutathione-Sepharose. Single radial immunodiffusion analyses confirmed that the p-1 protein levels were in line with the mRNA findings, i.e., 1.9+/-0.3 mg/g adenoma as compared to 6.5+/-1.2 mg/g non-adenoma tissue for males and 2.2+/-0.6 mg/g as compared to 0.7+/-0.2 mg/g for females. The results thus indicated that the change of pi class forms in adenomas is caused mainly by alteration in the p-1 level and the contribution of p-2 is minimal.

A filter immunobinding technique for the rapid detection and simultaneous identification of avian and bovine mycoplasmas

A filter immunobinding (FIB) method was developed for the detection and identification of mycoplasmas. Type strains of a total of 18 avian and bovine mycoplasma species propagated in broth media were diluted and immobilized on a nitrocellulose membrane as antigens for investigating the specificity with rabbit hyperimmune sera. Non-specific FIB reactions were easily eliminated by the procedure of absorbing rabbit hyperimmune sera in the broth. Absorbed rabbit hyperimmune sera exhibited clear species-specificity with mycoplasma antigens by the FIB. These specific reactions always agreed with the results of identification by tests of biochemical properties and growth inhibition for the isolates of M. bovirhinis, M. bovis, M. columbinum, M. columborale, M. gallisepticum and M. synoviae. Some bovine mycoplasma species, which were impossible to identify by growth inhibition test, because of their strong production of film and spots on the agar, specifically reacted with absorbed rabbit hyperimmune sera against M. bovis in the FIB. The detection limit of mycoplasmas by this method was about 10(4)-10(5) colony-forming units/ml, which is lower than that of colony determination on agar. The FIB seems to be a useful technique for rapid detection and simultaneous identification of mycoplasmas.

[The outcome of cerebrovascular disease in the elderly]

The outcome of cerebrovascular disease in the elderly, defined as persons 70 years of age and over, and in the non-elderly, those under 70 years, was compared. Fifty-one consecutive elderly and 156 non-elderly patients were studied. The patients in each group were classified according to type of cerebrovascular event: intracerebral hemorrhage, cerebral infarction, or subarachnoid hemorrhage. Patients were evaluated by using the Glasgow Outcome Scale both at the time discharge and 6 months later. The elderly patients were more severely disabled at the time of discharge than the non-elderly patients. The number of patients evaluated as "good recovery" or "moderate disability" had increased at the 6-month follow-up examination in the non-elderly patients, whereas the condition of many of the elderly patients had declined. The death rate of the elderly at the time of discharge and 6 months later was 17.6% and 52.0%, respectively, as opposed to 13.5% and 18.8% in the non-elderly group. The outcome of cerebrovascular disease was much worse in the elderly patients than in the non-elderly patients. Patient age and status at discharge were important predictors of the clinical course.

Epitope mapping of a monoclonal antibody to human glutathione transferase P1-1 the binding of which is inhibited by glutathione

Although the three-dimensional structure of human glutathione transferase (GST) P1-1 crystallized with a GSH analogue has been reported, its structure in the non-complexed form has not been determined. Four monoclonal antibodies to GST P1-1 were produced to facilitate structural analysis. Of these, one, clone d-1 of IgG2a isotype, dose-dependently inhibited the activity of GST P1-1 but did not affect the activities of either GST A1-1 or M1-1. On immunoblotting, the antibody reacted strongly with GST P1-1 and weakly with rat GST-P and mouse GST-II, indicating cross-reactivity with Pi-class forms but preferential reactivity with GST P1-1. When GST P1-1 and the antibody were incubated in the presence of 60 microM GSH, no inhibition of activity was found, whereas 1-chloro-2,4-dinitrobenzene had no effect at concentrations up to 10 microM. The binding of GST P1-1 to antibody adsorbed to Protein A-Sepharose was also prevented by both 0.1 mM GSH and N-ethylmaleimide treatment. Trypsin digests of GST P1-1 were resolved by HPLC and a peptide that reacted with the antibody was detected by absorption experiments. N-Terminal amino acid sequencing revealed the peptide to be in the C-terminal portion of the enzyme, stretching from amino acid residues 198 to 208. A synthetic peptide of this sequence also absorbed the antibody. These results suggest that both GSH bound to the active site and N-ethylmaleimide bound to the cysteine residue repress antibody binding to the C-terminal region. Thus this antibody may be useful for examining the steric configuration of the C-terminal and other regions of GST P1-1 in the absence of GSH.

[Usefulness of the preoperative MRI for diagnosis and operative method in a case of cor triatriatum]

A case was 6-year-old female diagnosed as the cor triatriatum. The magnetic resonance imaging synchronized at R wave on the electrocardiogram was performed in order to see the abnormal septum in the left atrium. In the horizontal view, the abnormal septum that divides the left atrium into the accessory left atrial chamber and the true left atrium, was well visualized. This septum lied on the vertical portion. Operation was carried out with the approach through the accessory chamber and the fibromuscular membrane were excised. Preoperative imaging of the MRI was useful and helpful for us to reach to a decision of the surgical approach in this patient.

Transplantation of polymer-encapsulated fetal hippocampal cells into ischemic lesions of adult rat hippocampus

In a previous study we demonstrated that fetal hippocampal cells, when transplanted into ischemic lesions of the adult rat hippocampus, can survive in large numbers in the host brain and show the innervation of the transplants by cholinergic fibers originated from the host brain. The present study was undertaken in an attempt to elucidate the hypothesis that the fiber connections forming synapses between the transplanted fetal neurons and the host brain play an important role in the survival of the transplanted cells. We transplanted the polymer-encapsulated fetal hippocampal cells prepared from E17-18 rat fetuses into the ischemic lesions in the adult rat hippocampus at which the CA1 pyramidal cells selectively died, and examined both histochemically or immunohistochemically for their survival and the expression of the synaptic vesicle protein, synaptophysin, and dendritic cytoskeltal protein, microtubule-associated protein 2 (MAP 2) within them. In addition, the cholinergic fibers originated from the host brain were examined by acetylcholine esterase (AChE) histochemistry. The results demonstrated that the polymer-encapsulated hippocampal cells could survive in the brain; however, the number of surviving cells markedly decreased following the transplantation, whereas no host-derived cholinergic fibers penetrated the polymer membrane of the capsules following the transplantation. In the cluster of surviving cells, only slight synaptophysin expression and no extensive growth of the dendrites were detected. The present results indicate that the direct contact between the host brain tissue and the transplant play an important role in the survival of such allografted neurons.

Antigenicity of cell wall mannans of Candida albicans NIH B-792 (serotype B) strain cells cultured at high temperature in yeast extract-containing sabouraud liquid medium

Cultivation of Candida albicans NIH B-792 (serotype B) at high temperature (37 degrees C) for 48 h in yeast extract-containing Sabouraud liquid medium (YSLM) provided the following findings in comparison with the findings obtained after incubation at 27 degrees C. Growth of the blastoconidia of this strain was decreased, with a dry weight of 9%, and the cells were deficient in cytokinesis. The cells did not undergo agglutination with serum factor 5 from a commercially available serum factor kit (Candida Check). Mannan (B-37-M) obtained from the cells cultured at 37 degrees C had partially lost its reactivity against serum factor 4 and lost most of its reactivity against serum factor 5 in an enzyme-linked immunosorbent assay (ELISA) in contrast to that (B-27-M) at 27 degrees C. Both cells and mannan prepared by cultivation first at 37 degrees C and then at 27 degrees C entirely recovered their reactivities with serum factors 4 and 5. 1H-nuclear magnetic resonance analysis also revealed that B-37-M had lost a beta-1,2-linked mannopyranose unit and retained a phosphate group. Similar changes were observed in the three other serotype B strains used in the study. The beta-1,2-linked mannooligosaccharides longer than mannotetraose were not included among the products released from B-37-M by mild acid treatment. The results of the inhibition ELISA with a series of beta-1,2-linked mannooligosaccharides from biose to octaose (M2 to M8, respectively) showed that the reactivity against serum factor 4 was inhibited most strongly by the oligosaccharides M4 to M8 and that the reactivity against serum factor 5 was inhibited completely by relatively longer oligosaccharides, M5 to M8, indicating their participation as the antigenic factor 5 epitopes.

[A case of bronchiolo-alveolar carcinoma with high production of carbohydrate antigen (CA19-9)]

A 75-year-old female had loss of appetite, left hypochondrial and back pain. An X-ray and a computed tomogram of both lungs showed multiple small granular shadows. By Tc-labelled bone scintigram, multiple uptakes were found. Since high serum CA19-9 was obtained, pancreatic or bile duct cancer with multiple lung and bone metastasis was suspected. The autopsy revealed, small nodules in both lungs were well-differentiated adenocarcinoma, bronchiolo-alveolar type, and immunohistologically, tumor cells were stained positively for CA19-9. Since CA19-9 exists in normal bronchial glands and bronchiole, high level of serum CA19-9 in our patient may be derived from the neoplastic bronchiolar epithelium.

Separation of B-3 monodesamidoinsulin from human insulin by high-performance liquid chromatography under alkaline conditions

The separation of human insulin (HI) and related compounds such as A-21 monodesamido HI (A-21DHI) and B-3 monodesamido HI (B-3DHI) was investigated using reversed-phase HPLC and capillary zone electrophoresis (CZE). In the case of HPLC under the usual acidic conditions, whereas A-21DHI was separately eluted, B-3DHI was included in the HI peak. Then it was found that by applying a novel ODS column resistant to alkaline conditions, a good separation of B-3DHI from HI could be achieved using an alkaline eluent, and two peaks corresponding to B-3DHI were eluted in front of the HI peak.

Ectopic pituitary adenoma occurring in the interpeduncular cistern. Case report

Intracranial ectopic pituitary adenoma occurs most frequently in the suprasellar cistern, usually in continuity with the pituitary stalk. Such tumors probably originate from cells of the pars tuberalis located above the diaphragma sellae or from aberrant anterior pituitary cells of the pituitary stalk. The authors report the case of a 37-year-old woman with Cushing's syndrome caused by an ectopic pituitary adenoma of unique location: the tumor was separate form the pituitary stalk and confined within the interpeduncular cistern. After surgical removal of the tumor, continued improvement in the patient's laboratory results and disappearance of her endocrine symptoms strongly indicated the absence of adenoma cells in the pituitary gland or stalk. The tumor in the present case appears to have arisen from aberrant pituitary cells that were present in the leptomeninges of the basal surface of the hypothalamus.

Neurological evaluation after radical resection of sacral neoplasms

Eight patients had a radical resection of sacral tumours, and bilateral severance of lumbosacral nerves was required. Their neurological deficits and disturbance of activities of daily living (ADL) were studied. The neurological deficits which occurred were motor dysfunction of the lower limbs, sensory disturbances, and urinary, faecal and sexual dysfunction. Bilateral preservation of the L5 nerve and above was necessary to permit the ability to walk, and bilateral preservation of the S2 nerve and above was necessary to spare urinary, faecal and sexual functions in order to establish ADL. To maintain normal ADL, bilateral preservation of the S2 nerve and above was necessary for walking, and bilateral preservation of the S3 nerve and above was necessary for urinary, faecal and sexual functions.

Temperature-dependent change of serological specificity of Candida albicans NIH A-207 cells cultured in yeast extract-added Sabouraud liquid medium: disappearance of surface antigenic factors 4, 5, and 6 at high temperature

The cells of Candida albicans NIH A-207 strain (A-strain) cultivated in YSLM at high temperatures (37 and 40 degrees C) did not undergo agglutination with the factor sera 4, 5, and 6 in a commercially available factor serum kit, 'Candida Check', and formed a grape-like shape. The mannans isolated from the cells had lost their reactivity against the factor sera in ELISA. It was also revealed by 1H NMR analysis that the mannans contained neither a phosphate group nor a beta-1,2-linked mannopyranose unit, although these mannans increased the non-reducing terminal alpha-1,3-linked mannopyranose unit. The cells and the mannans prepared by cultivation at such high temperatures followed by 27 degrees C in the same medium entirely recovered the reactivity with the factor sera.

Determination of the molecular-weight distribution of low-molecular-weight heparins using high-performance gel permeation chromatography

The molecular-weight distribution of commercially available low-molecular-weight heparins (LMWHs) was estimated by high-performance gel permeation chromatography (HPGPC) using a LMWH molecular-weight calibrant, supplied by the National Institute for Biological Standards and Control for the calibration of columns. This calibrant is a mixture of many polysaccharides with a disaccharide unit prepared by a random depolymerization of unfractionated heparin, and the ends of the fragments have a UV absorption. The ratio of the refractive index to the UV absorption is a relative measure of molecular weight. Various molecular-weight parameters such as weight-, number- or z-average molecular-weights, polydispersity and relative distributions of high, middle and low molecular-weight components were estimated, indicating that LMWHs have a wide variation in molecular-weight distribution. This variation was ascribed to the difference in preparation methods from unfractionated heparins.

Molecular mass determination of low-molecular-mass heparins. Application of wide collection angle measurements of light scattering using a high-performance gel permeation chromatographic system equipped with a low-angle laser light-scattering photometer

A high-performance gel permeation chromatographic system with on-line low-angle laser light-scattering detection (HPGPC-LALLS) was used to determine molecular masses of low-molecular-mass heparins (LMMHs). Measurements at wide and narrow collection angles were compared and the application of the HPGPC-LALLS method to small molecules, with molecular masses in the range 1000-10,000, was assessed. The molecular mass averages of fractionated heparins and commercially available LMMHs were also determined by ordinary HPGPC analysis using an LMMH molecular-mass calibrant, supplied by the National Institute for Biological Standards and Control for the calibration of columns. The LALLS intensity at the routinely used narrow collection angle (theta col = 1 degree) about doubled at the wide collection angle (theta col = 2 degrees) and the signal-to-noise ratio was improved. The present study thus indicates that wide collection angle measurement of light scattering allows the application of the HPGPC-LALLS method to very small biopolymers of molecular mass < 10,000.

[Factors for weight loss in patients with senile dementia]

The authors investigated causes for weight loss in inpatients with senile dementia, who could take diets. The 81 patients (80 +/- 8.3 years of mean age +/- S.D., 22 males and 59 females) included 48 cases of senile dementia of Alzheimer type (SDAT) and 25 cases of multi-infarct dementia (MID). Controls consisted of 77 non-demented patients (82 +/- 9.1 years, 29 males and 48 females) who were admitted because of cerebrovascular or cardiopulmonary diseases. Demented patients showed an average of -1.8 +/- 8.5% weight change per year, while that of non-demented patients was +4.4 +/- 6.3%, resulting in a significant difference between them (p < 0.0001). Between demented males and females, there was no significant difference. In male, SDAT cases showed more weight loss than MID cases (-5.0 +/- 5.1% vs +3.3 +/- 4.2%, P = 0.003), although in females there was no significant difference between SDAT and MID. Even when patients with a wandering tendency or complications were excluded, results essentially did not change. In demented patients, weight change did not correlated with age, amount of dietary intake, length of hospital stay or serum albumin level. However, it correlated with body weight (r = 0.26, P = 0.014), ADL index (GBS-A) (r = 0.22, P = 0.04), and with Mini-Mental State Examination score (r = 0.23, P = 0.048). In multiple regression analysis, the most powerful explanatory variable in demented males was the index for cerebral atrophy. These results confirmed previous studies reporting that reduced dietary intake, complications or hyperactivity do not fully explain weight loss in demented patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mild hypothermia in patients with senile dementia]

From the viewpoint of the high frequency of mild hypothermia in patients with senile dementia, we investigated causative factors in comparison with accidental hypothermia. We also investigated the relationship between hypothermia and the type or grade of dementia. A total of 127 demented cases including 30 males and 97 females, whose mean age was 80.6 +/- 8.9 years, were classified into 3 groups according to the axillary temperature measured in August 1989. Group A consisted of 33 cases whose body temperature was below 36 degrees C on more than 25 days. Group C consisted of 24 cases whose body temperature was above 36 degrees C on more than 25 days, and the remaining 70 cases were classified as group B. The frequency of group A classification in demented patients was higher than age-matched non-demented controls (26% vs 13%, p less than 0.05). In demented males, serum total cholesterol, serum albumin, and hemoglobin were significantly higher in group A than in group B or C. Body weight and serum triglyceride were also higher in group A, but not significantly. In demented females, serum albumin and hemoglobin were higher in groups A and B than group C. In addition, cases with diabetes mellitus or cases receiving with major tranquilizers were more frequent in group A, and the index of activities of daily living was higher in group A, in both sexes. Factors such as age, CRP or thyroid hormone (free T3, free T4) showed no significant difference among the 3 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Intradural extraosseous chordoma in the foramen magnum region. Case report

Chordomas that are entirely extraosseous and intradural are extremely rare. The tumors described in the literature were observed mostly in the prepontine region. This is the first case reported of an intradural extraosseous chordoma occurring in the foramen magnum region. The tumor was totally excised. The distinction between an intradural extraosseous chordoma and a classic chordoma is important from a clinical viewpoint because of the potential for complete surgical excision and a more benign growth pattern.

Detection of serum antibodies against Mycoplasma gallisepticum and Mycoplasma synoviae by a dot-immunobinding technique

Both Mycoplasma gallisepticum (MG) and M. synoviae (MS) antigens prepared for the routine haemagglutination inhibition (HI) test were diluted and absorbed to the separate pieces of durapore membrane for the measurement of dot-immunobinding (DIB) titers of test sera. Besides, durapore strips bearing both antigens were employed for a DIB test with chicken sera definitely diluted 100-fold. Shortening of reaction time of chicken sera with antigens as well as with the secondary serum markedly eliminated non-specific DIB reactions exhibited at low dilutions although the same condition was not so effective on the elimination of non-specific reactions among rabbit hyperimmune sera. Rapid and specific development of DIB antibody which continued at high titer up to 1:640 for 10 weeks postinoculation was proved in the sera of SPF chickens inoculated with MG or MS, while DIB titers of sera from uninoculated chickens remained 1:20 or lower. Non-specific reactions, which occurred in the routine serum plate agglutination test with a part of sera from the inoculated chickens, were not exhibited in the DIB as well as in the HI test with the same sera. Results of the DIB test with serum samples from 287 conventionally reared chickens definitely diluted 100-fold coincided with the results of HI test at a level of 90% with MG and 89% with MS antigen. This technique seems to be useful for a rapid, simple and specific diagnosis of avian mycoplasmosis.

[A biomechanical study of the lumbar intervertebral disc by the finite element method]

The biomechanical characteristics of the lumbar intervertebral disc were investigated by 3-dimensional finite element method. The results were: (1) Under compression load, the nucleus pulposus received the strongest vertical force and the annulus fibrosus restrained its expansion. The inner posterolateral annulus fibrosus was vulnerable. (2) Under flexion load, some posterior shifting of the nucleus pulposus occurred, along with the decrease of posterior bulging and the increase of anterior bulging. The outer anterior and inner posterior annulus fibrosus were vulnerable. (3) Under either compression or flexion load, the increase in the nucleus pressure ratio (PN/Pa) for the same disc attained almost the same value. (4) At the nucleus area ratio of 37.5%, the maximum compressive stiffness value occurred. (5) PN/Pa decreased with the increase of the nucleus area ratio but increased as disc narrowing advanced. (6) When the nucleus pulposus lost its hydrostatic property, the compressive stiffness value decreased to 43%, the potential damage could encompass the entire annulus fibrosus.

Effects of human menstrual cycle on thermoregulatory vasodilation during exercise

To investigate the effects of the menstrual cycle and of exercise intensity on the relationship between finger blood flow (FBF) and esophageal temperature (Tes), we studied four women, aged 20-32 years. Subjects exercised at 40% and 70% VO2max in the semi-supine posture at an ambient temperature of 20 degrees C. Resting Tes was higher during the luteal phase than the follicular phase (P less than 0.01). There were no significant differences between the two phases in FBF, oxygen consumption, carbon dioxide production, heart rate or minute ventilation at rest and during exercise, respectively. Each regression line of the FBF-Tes relationship consists of two distinct segments of FBF change to Tes (slope 1 and 2). FBF increased at a threshold Tes for vasodilation ([Tes 0]) and the rate of FBF rise became greater at ([Tes 0]) and the rate of FBF rise became greater at another Tes above this threshold ([Tes 0']). For both levels of exercise, [Tes 0] and [Tes 0'] were shifted upward during the luteal phase, but the slopes of the FBF-Tes relationship were almost the same in the two phases of the menstrual cycle. Increasing exercise intensity induced a significant decrease in slope 1 of the FBF-Tes relationship during the follicular (P less than 0.01) and the luteal phases (P less than 0.02), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)