Abstract OT3-07-02: Influence of exercise or educational programs on long-term physical activity by patients after surgery for primary breast cancer: A randomized trial

[Background]

Past studies revealed that a moderate to high level of physical activity after diagnosis of breast cancer reduces both the risk of breast cancer-related death and death from all causes. Furthermore, some randomized studies suggested that exercise programs improve the percentage of patients who complete the chemotherapy and quality of life, and decrease fatigue, and adverse events. The issues to be determined include defining an established uniform exercise program and the efficacy of a long-term exercise program after breast cancer surgery.

[Object] To elucidate the efficacy of a long-term exercise program and to verify the safety and feasibility of a uniform exercise program using an ‘existing social resource’ after primary therapy of breast cancer.

[Design] A multi-center, randomized trial.

[Method] Subjects: The subjects included patients who had completed treatment for primary breast cancer, including surgery and/or adjuvant chemotherapy. Patients with metastatic breast cancer were excluded.

Randomization & intervention: The patients were randomly assigned to three groups.

The first group followed an exercise program at Curves® that involved 30 minutes of exercise, including aerobics, weight training, and stretching 3 times a week for 4 months. The second group was given life-style guidance at least once that patients participate in a lecture program about recommended exercise at this point and the importance of weight control after diagnosis of breast cancer using a brochure. The third group served as controls that the patients receive a brochure used same one in the second group. The variables included age and weight.

Outcome: The primary endpoint is level of physical activity at 1 year after randomization, and the secondary endpoints are the percentage of those completing the exercise program, patient reported outcomes (QOL, cancer or treatment associated symptoms, fatigue, depression, and anxiety), body mass index, bone density, and level of lymphedema.

Period of research: The study will last 2 years beginning March 2016.

Sample size: We plan to enroll 400 patients to detect 20% difference with 90% power.

Additional study: Some biochemical markers in the blood will be evaluated to determine the mechanism of the effect of exercise on the human body.

Citation Format: Kawada K, Taira N, Hatono M, Takahashi Y, Miyoshi Y, Nogami T, Iwamoto T, Motoki T, Sien T, Matsuoka J, Doihara H, Ikeda M, Ogasawara Y, Takabatake D, Yoshitomi S, Kiyoto S, Yamamoto S, Mizota Y, Oka K. Influence of exercise or educational programs on long-term physical activity by patients after surgery for primary breast cancer: A randomized trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-07-02.

Abstract P5-08-14: Tumor Infiltrating lymphocytes (TIL) related genomic signature associated with chemotherapy response and prognosis in subtypes of breast cancer

Background: Tumor infiltrating lymphocytes (TIL) in subtypes of breast cancer may provide clinically important information on chemotherapy response and prognosis. However, the standardized methodology for immunohistochemical (IHC)-TIL has not yet been established, reproducible and objective method of evaluation of TIL such as gene expression profiles is warranted. We evaluated whether IHC-TIL level was associated with gene expression profiles and whether such profiles could be used to predict chemotherapy response and prognosis according to subtypes of breast cancers.

Methods: To select TIL associated genes, we used 40 samples with both IHC-TIL information and gene expression profiling data. The degree of TIL at the edges of the tumor mass, in the tumor mass, or in the stroma surrounding the expanding mammary ducts packed by carcinoma cells was evaluated as score 0, 1, and 2, when TIL was not unrecognizable (0%), sparse (0 << 50%) and dense (50% ≤), respectively. We selected 22 genes as the TIL-gene signature (GS), by comparing expression profiles between TIL score 2 and 0 tumors. We showed the associations between the TIL-GS levels and subtypes of breast cancers (Estrogen receptor: ER / Human Epidermal growth factor 2: HER2). The chemotherapy sensitivity analysis was performed on cohorts of 625 patients with stage I–III breast cancer who received neo adjuvant chemotherapy (NAC) based on Anthracycline and Taxane containing regimen. Data from 1,586 tumors were used to evaluate the association between distant metastasis free survival (DMFS) and the TIL-GS in a Kaplan-Meier analysis.

Results: The TIL-GS for ER negative (-)/HER2- and HER2 positive (+) cases were significantly higher expression level than luminal types (p-value <0.001). All breast cancer subtypes except luminal-low proliferation had significantly higher differential TIL-GS level in cases with pathological complete response (pCR) after NAC than residual disease (luminal-high: p-value = 0.013, HER2+: 0.005, and ER-/HER2-: 0.016). With no adjuvant chemo or only tamoxifen treated breast cancer data set, the TIL-GS had no prognostic power in luminal cases regardless of proliferative level. In HER2+ breast cancers, cases with the high TIL-GS had significantly better prognosis than low cases (p-value =0.001), but no significance in ER-/HER2- cases (p-value = 0.621).

Conclusions: Higher TIL-gene signature of 22 genes appeared to be associated with aggressive subtypes and pCR rate (except luminal-low) of breast cancers. This approach may improve the reproducibility of assessment on tumor TIL level and thus serve the clinical applications for breast cancers.

Citation Format: Kochi M, Niikura N, Iwamoto T, Bianchini G, Mizoo T, Nogami T, Shien T, Motoki T, Taira N, Masuda S, Doihara H, Fujiwara T, Tokuda Y, Matsuoka J. Tumor Infiltrating lymphocytes (TIL) related genomic signature associated with chemotherapy response and prognosis in subtypes of breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-08-14.

Abstract P2-01-07: Analysis of the relationship between breast cancer risk-related gene polymorphisms, ESR1/6q25.1-rs2046210 and mammographic breast density

Background: Based on the results of a case-control study performed in Japan (Okayama and Kagawa), it was revealed that gene polymorphisms of the estrogen receptor (single nucleotide polymorphisms, SNPs), ESR1/6q25.1-rs2046210 and rs3757318, were closely related to breast cancer risk in Japanese women, and that the odds ratios per allele of individual SNPs were 1.37 [95% CI: 1.1 - 1.7] and 1.33 [1.04 - 1.7], respectively (San Antonio Breast Cancer Symposium 2012, Mizoo et al.). To examine the effects of these SNPs on the pathogenic mechanism of breast cancer, we analyzed the relationship of SNPs with reproductive/physiological factors (age of menarche and number of births), physical factors (height and Body Mass Index [BMI]), family history and mammographic breast density.

Methods: Among the patients enrolled in the case-control study, the patients who could be evaluated regarding their lifestyle, SNPs and mammographic breast density were divided into the case group (N = 394) and the control group (N = 511) as the dataset for the study. SNPs were analyzed using the TaqMan genotyping assay® for blood samples. In the analysis of the relationship between SNPs and breast cancer risk, the odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression analysis. For the analysis of the relationship between SNPs and the factors, t-test and chi-square test were used.

Results: In our dataset, the age-adjusted OR [95% CI] of ESR1/6q25.1-rs2046210 and rs3757318 were 2.22 [1.41 - 3.55] (AA vs. GG) and 2.12 [1.2 - 3.8] (AA vs. GG), respectively, suggesting that they would be significant risk factors. As a result of analyzing the relationship between SNPs and other factors, a significantly lower BMI was observed for the risk allele AA/AG of rs2046210, compared to GG (p = 0.014, t-test). Regarding the mammographic breast density, a significantly higher proportion of mammary glands with high density was confirmed for the risk allele AA/AG of rs2046210, compared to GG (p = 0.0389, chi-square test). The tendency towards a high mammographic breast density in the rs2046210 risk allele AA/AG was also confirmed based upon a stratified analysis of the case and control groups before and after menopause, and a significant correlation was observed, especially before menopause (p = 0.026, chi-square test).

Conclusion: Mammographic high breast density is generally considered as one of the breast cancer risks, and it was suggested that gene polymorphisms of ESR1/6q25.1-rs2046210 might affect mammographic breast density.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-01-07.

Abstract P4-05-09: Estrogen receptor (ER) mRNA expression and molecular subtype distribution in breast cancers that are ER-negative but progesterone receptor-positive by immunohistochemistory

Purpose: We examined Estrogen receptor (ER) mRNA expression and molecular subtypes in breast cancers that are Progesterone receptor (PR) positive but ER negative by immunohistochemistry (IHC) to assess if these cancers molecularly resemble true ER positive cancers.

Patients and Methods: Patients were those with newly diagnosed ERBB2-negative breast cancer treated with neoadjuvant chemotherapy containing sequential taxane and antheracycline-based regimens (then endocrine therapy if ER-positive by IHC). ER and PR status was determined by IHC in 501 primary breast cancers in routine pathology laboratory. Gene expression profiling was done with the Affymetrix U133A gene chip (Gene Expression Omnibus number: GSE25066). We compared expressions of ESR1, MKI67 mRNA and molecular subtypes determined by the PAM 50 classifier between IHC-ER-positive/PR-positive (n = 223), ER-positive/PR-negative (n = 73), ER-negative/PR-positive (n = 20), and ER-negative/PR-negative (n = 185) cancers. We also plotted survival curves by ER and PR status based on IHC.

Results: ER or PR positivity by IHC was defined ≥ 1% staining. ER positivity by ESR1 mRNA expression was defined as > 10.18 previously published. Among the IHC-ER-negative/PR-positive, ER-positive/PR-negative, and both ER/PR-positive, and ER/PR-negative patients, 25%, 79%, 96% and 12% were positive by ESR1 mRNA expression, respectively. The average ESR1 expression was significantly higher in the ER/PR-positive and ER-positive/PR-negative cohorts compared with the ER-negative/PR-positive or ER/PR-negative cohorts. The average MKI67 mRNA expression was significantly higher in the ER-negative/PR-positive and ER/PR-negative cohorts. Among the ER-negative/PR-positive patients, 15% were luminal A, 5% were Luminal B, and 65% were basal like; among the ER-positive/PR-negative patients, 59% were luminal type. The relapse free survival rate of ER-negative/PR-positive patients was equivalent to ER/PR-positive or ER-positive/PR-negative, and significantly better than that of the ER-negative/PR-negative cohort.

Conclusion: Only 20-25% of the ER-negative/PR-positive tumors show molecular features of ER-positive cancers (i.e high ER mRNA expression and luminal molecular class). These cancers also have higher proliferation rate than ER-positive cancer. However, the survival of these cancers with only chemotherapy is similar to ER-positive cancers with chemotherapy and endocrine therapy, and is better than ER-negative cancers. The contribution of endocrine therapy to this good outcome is to be invested in the future.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-05-09.

Abstract P3-07-10: Breast cancer risk-related gene polymorphisms, ESR1/6q25.1-rs2046210 and rs3757318, and clinical characteristics of breast cancer patients

[Background] Based on the results of a case-control study performed in Japan (Okayama and Kagawa), it was revealed that gene polymorphisms of the estrogen receptor (single nucleotide polymorphisms, SNPs), ESR1/6q25.1-rs2046210 and SNPs of rs3757318 were closely related to breast cancer risk in Japanese women, and that the odds ratio per allele of individual SNPs were 1.37 [95% CI: 1.1 - 1.7] and 1.33 [1.04 - 1.7], respectively (San Antonio Breast Cancer Symposium 2012, Mizoo et al.). We analyzed the relationship of ESR1/6q25.1-rs2046210 and rs3757318 SNPs with the clinical characteristics of breast cancer patients.

[Methods] Among the patients enrolled in the case-control study, 508 breast cancer patients who underwent genotyping for ESR1/6q25.1-rs2046210 and rs3757318 were analyzed as the subjects. SNPs were analyzed using the TaqMan genotyping assay® for blood samples. To analyze the relationship of genotypes (AA/GG, GG) with age at diagnosis, height, weight, BMI, age of menarche, birth history, pathological degree of progression and estrogen receptor, t-test and chi-square test were used.

[Results] The genotypes of rs2046210 are AA (12%), AG (41%) and GG (46%), and the patients with the risk allele (AA/AG) had significantly higher height (p = 0.0015, t-test) and lower Body Mass Index (BMI) (p = 0.0022, t-test). The genotypes of rs3757318 are AA (8%), AG (39%) and GG (53%), and the patients with the risk allele (AA/AG) were characterized by significantly lower BMI (p = 0.041, t-test), no birth history (p = 0.0473, chi-square) and negative hormone receptor (p = 0.0128, chi-square). Overall, tendencies related to increased height, lower BMI and negative estrogen receptor were confirmed for the risk alleles of rs2046210 and rs3757318.

[Conclusion] It was suggested that SNPs of rs2046210 and rs3757318 might be related to the development of estrogen-receptor-negative breast cancer.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-07-10.

Abstract P3-07-10: Effect of lifestyle and single nucleotide polymorphisms on breast cancer risk: A case-control study in Japanese women

[Background] Lifestyle, including diet and physical activity, and birth/breastfeeding history are known to affect the risk for breast cancer. A correlation between single nucleotide polymorphisms (SNPs) and breast cancer risk has also been suggested in some reports, but the gene-environment interaction with breast cancer risk has not been examined widely.

[Methods] The subjects were 476 breast cancer patients and 528 controls who attended a health check and had no history of breast cancer. Lifestyle was examined using a questionnaire with 48 questions about diet, physical activity, smoking habits, alcohol intake, and birth/breastfeeding history, etc. Based on past reports, we analyzed 6 SNPs (TNRC9-rs3803662, LSP1/11q-rs3817198, MAP3K1-rs889312, 8q24-rs13281615, 5p12-rs981782, and TGFβ1-rs1800470) using blood samples, and calculated age-adjusted odds ratios in a multiple logistic regression analysis.

[Results] The study was performed from December 2010 to November 2011. Lifestyle factors (age-adjusted odds ratio, [95% confident interval]) found to have a significant correlation with development of breast cancer included BMI (1.041, [1.00–1.08]), smoking history (2.28, [1.45–3.65]), small number of births (1.18, [1.05–1.34]), no exercise during leisure time (1.36, [1.06–1.77]), low intake of green and yellow vegetables (1.69, [1.01–2.85]), and low intake of mushrooms (1.58, [1.05–2.39]). Stratified analysis based on menopause status showed that smoking history (1.85, [1.00–3.49]) and low intake of green and yellow vegetables (2.5, [1.03–5.88]) were significant risk factors before menopause, and that smoking history (2.28, [1.45–3.65]), low intake of green and yellow vegetables (2.24, [1.09–4.68]), no exercise during leisure time (1.67, [1.19–2.36]), small number of births (1.49, [1.25–1.78]), and no breastfeeding history (1.03, [1.01–1.06]) were significant risk factors after menopause. The results of SNP analysis suggested that TNRC9-rs3803662 was a significant risk factor in women before menopause (2.29, [1.25–4.25]). However, in multivariate analysis including lifestyle factors and SNPs, only smoking history emerged as a significant risk factor in women before menopause.

[Conclusion] A correlation between lifestyle and breast cancer risk was found in this study, consistent with previous findings. Lifestyle and environmental factors such as births and breastfeeding may be more important than SNPs as risk factors for breast cancer.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-07-10.

Abstract P5-14-20: Clinical Features of Surgical Resection for Solitary Pulmonary Metastasis and the Discrepancy in Immunopathological Features between Primary and Metastatic Breast Cancer Lesions

Background: The treatment for metastatic breast cancer (MBC) is usually systemic therapy decided by the hormone and HER2 status of primary breast cancer lesion. There are some reports about the discrepancy in hormone and HER2 status between primary and metastatic lesion in these days. We have reported previously that the expression of ALDH-1 which considered the pathological markers of breast cancer stem cell in axillary lymph node matastases is a significant predictor of poor outcome in primary breast cancer patients (Figure 1). We evaluated the role of surgery in the diagnosis and treatment of a solitary pulmonary nodule (SPN) in breast cancer patients and demonstrated the significance of analyzing the immunopathological features in metastatic breast cancer lesion.

Methods: Between 1990 and 2006, 17 patients (PM) with SPN which were diagnosed breast cancer metastases underwent complete pulmonary resection and 36 MBC patients (AP) underwent autopsy after breast cancer related death in our hospitals. We retrospectively analyzed clinicopathological features and the expression of ER, HER2, Ki-67 and ALDH-1 in both primary and metastatic breast cancer lesions.

Results: The median age of PM patients was 53 (range 30-80). All PM patients had not other metastases and had undergone curative breast cancer operation. The pulmonary operation were partial pulmonary resection in 15(88%) and lobectomy in 2 (12%) patients. The median disease free survival (DFS) was 63 months (range 9-175). Median overall survival (OS) was 181 months and the median OS after pulmonary operation was 48 months. The median DFS and OS of AP patients were 21 and 43 months. All AP patients had multiple visceral metastases. We compared the immunohistlogical status between primary and metastatic lesion and evaluated the colletation with these status in metastatic lesion and prognosis in all patients. Conclusion: Pulmonary resection was effective to diagnose and the OS after resection was relatively long in PM patients. We report the value of the expression of ER, HER2, Ki67 and ALDH-1 in distant metastatic lesions.

Abstract P4-01-01: Combination Treatment with Fulvestrant and Various Cytotoxic Agents Has a Synergistic Effect in ER-Positive Breast Cancer Cell Lines In Vitro and In Vivo

Background: Patients with estrogen receptor (ER)-positive breast cancers have a better prognosis than those with ER-negative breast cancers since they can be treated with anti-estrogen therapies. However, ER-positive breast cancers have low sensitivity to chemotherapy and the survival benefitof chemotherapy is limited. Microtubule associated protein-tau (MAPT) plays an important role in taxane sensitivity. In a previous study we showed that ER signaling influenced MAPT expression and that fulvestrant, an estrogen receptor antagonist, downregulated MAPT and reversed resistance to taxane in MAPT-and ER-positive breast cancer cells (SABCS 2009, Abstract 2118). In clinical treatment for breast cancer, the advantages and disadvantages of combination treatment with endocrine therapy and chemotherapy have long been discussed. Several studies have shown that endocrine therapy has an antagonistic effect on chemotherapy, which suggests that concurrent use of a hormone drug and a chemotherapeutic agent should be avoided clinically. However, most of these studies used tamoxifen (TAM) and anthracycline regimens. The effects of combination treatment using new hormone therapies, such as aromatase inhibitors or fulvestrant, and chemotherapeutic agents have not been examined thoroughly. In this study we evaluated the effects of combinations of hormone drugs and chemotherapeutic agents in vitro and in vivo.

Methods: In vitro, the effects of different combinations of five chemotherapeutic agents (doxorubicin, paclitaxel, docetaxel, vinorelbine, and 5-FU) and three hormone drugs (TAM, 4-hydroxytamoxifen (4OH-TAM), and fulvestrant) were examined in ER-positive breast cancer cell lines (MCF-7, ZR75-1) using CalcuSyn software. The cells were also exposed to hormone drugs and changes in chemoresistant factors such as Bcl2, multidrug resistance-associated protein 1 (MRP1), and MAPT were examined. In vivo, xenografts were created using MCF-7 cells transplanted into BALB/c nu/nu mice. Tumor sizes were evaluated after the mice were treated with tamoxifen alone, fulvestrant alone, docetaxel alone, and combinations of these drugs.

Results: Combination treatment with fulvestrant and all chemotherapeutic agents in vitro showed a synergistic effect regardless of the fulvestrant dose. In contrast, TAM showed an antagonistic effect with all the chemotherapeutic agents, with the strongest antagonism occurring at a low dose of TAM. 4OH-TAM showed an antagonistic effect with doxorubicin and 5-FU, and a synergistic effect with taxanes and vinorelbine. In the analysis of chemoresistant factors, Bcl2 and MAPT were downregulated by fulvestrant, but upregulated by TAM and 4OH-TAM. In vivo, the combination of fulvestrant and docetaxel showed the strongest inhibitory effect on tumor growth.

Conclusion: TAM and 4OH-TAM had different effects in combination with chemotherapeutic agents. Fulvestrant downregulated ER and chemoresistant factors such as Bcl2 and MAPT, which are regulated via ER. Fulvestrant showed good compatibility with all the evaluated chemotherapeutic agents in vitro and in vivo. These results suggest that combination therapy with fulvestrant and chemotherapeutic agents may be effective for ER-positive breast cancers.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-01-01.

The mandible advancement may alter the coordination between breathing and the non-nutritive swallowing reflex

The coordination between nasal breathing and non-nutritive swallowing serves as a protective reflex against potentially asphyxiating material, i.e. saliva and secretions, entering the respiratory tract. Although this protective reflex is influenced by positional changes in the head and body, the effect of mandible position on this reflex is not fully understood. We examined the effect of mandible advancement associated with mouth opening on the coordination between nasal breathing and non-nutritive swallowing induced by continuous infusion of distilled water into the pharyngeal cavity. The combination of mandible advancement and mouth opening increased the duration of swallowing apnoea and submental electromyographic burst duration. When the mandible was advanced with the mouth open, the duration of swallowing apnoea increased significantly compared with the centric position (0.79 +/- 0.23 vs. 0.64 +/- 0.12 s, P < 0.05, n = 12), and the duration of submental electromyographic activity increased significantly (2.11 +/- 0.63 vs. 1.46 +/- 0.25 s, P < 0.05, n = 12). Mandible advancement with mouth opening altered the respiratory phase resetting during swallowing and the timing of swallow in relation to respiratory cycle phase. We conclude that mandible re-positioning may strongly influence the coordination between nasal breathing and non-nutritive swallowing by altering respiratory parameters and by inhibiting movement of the tongue-jaw complex.

Microtubule Associated Protein-Tau (MAPT) Is Influenced by ER: ICI182,780, a Selective ER Inhibitor, Down-Regulates MAPT Expression and Reverses Resistance to Taxanes in MAPT- and ER-Positive Breast Cancer Cells

Background: Taxanes are important drugs in treatment of breast cancer. These drugs bind to tubulin and suppress spindle microtubule dynamics, which leads to cell cycle arrest in the G2/M phase followed by apoptosis. However, resistance to taxane therapy prevents some patients from benefiting from these drugs. Several mechanisms of taxane resistance have been described, including the involvement of microtubule-associated protein-tau (MAPT). MAPT binds to the same pocket as taxanes in microtubules and obstructs the function of the drug. Estrogen receptors (ER) are transcriptional factors that play an important role in the development and progression of breast cancer. However, the relationship between ER and MAPT in breast cancer is not entirely clear. In this study we examined the correlation between MAPT expression and the sensitivity of human breast cancer cells to taxanes, and the relationship between ER and MAPT at the protein level in these cells. We also examined combination therapy with hormone drugs and taxanes.Methods: The correlation between MAPT expression and sensitivity to taxanes was examined in 12 human breast cancer cell lines using real time PCR, western blotting analysis and an MTS assay. Following small interfering RNA (siRNA) knockdown of MAPT expression, the alteration of cellular sensitivity to taxanes was examined by MTS assay, flow cytometry and immunofluorescence. To examine the relationship between ER and MAPT, ER expression was knocked down with siRNA or stimulated with 17-β-estradiol in MAPT- and ER-positive cell lines (MCF-7 and ZR75.1, respectively). The cells were also treated with hormone drugs (tamoxifen and ICI182,780) and changes in MAPT protein expression were examined.Results: Six cell lines showed high MAPT mRNA expression and four showed high MAPT protein expression; that is, expression at the mRNA level did not always correlate with that at the protein level. MAPT mRNA expression did not correlate with taxane resistance, but expression of MAPT protein isoforms under 70 kDa correlated with taxane resistance. Downregulation of MAPT increased sensitivity to taxanes. MAPT protein expression was decreased by ER knockdown and increased by 17-β-estradiol stimulation. The MAPT protein level was also increased by tamoxifen, but decreased by ICI182,780. Combination treatment of taxanes with ICI182,780 showed a strong synergistic effect, but similar treatment with tamoxifen had an antagonistic effect in both cell lines.Conclusions: Expression of MAPT protein isoforms under 70 kDa correlates with taxane resistance in breast cancer cells. MAPT expression is influenced by ER in breast cancer and ICI182,780, a selective ER inhibitor, can reverse the resistance to taxanes in both MAPT- and ER-positive breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2118.

Converting an insulating silicon nanochain to a conducting carbon nanotube by electrical breakdown

Electrical breakdowns of individual silicon nanochains, in which silicon nanoparticles are covered with and connected by oxide alternatively forming nanowires, are studied by in situ transmission electron microscopy using a microprobe system. Individual silicon nanochains can endure a current typically as large as 10(0) nA, and we found that a silicon nanochain can be converted to a nanotube by applying a current as large as 10(1) nA. In the nanotubes, some silicon particles are left. Experimental results suggest that nanotubes are heavily distorted carbon nanotubes, which are formed through the aggregation of contaminating carbon on the nanochain surface and the evaporation of the oxide core due to Joule heating.

Effectiveness of two-liquid silane primers on bonding sintered feldspathic porcelain with a dual-cured composite luting agent

The purpose of the current study was to evaluate the effect of two-component ceramic primers on the bond strength of a composite material joined to a sintered porcelain material. Two sizes of porcelain discs (VMK 68; 10 and 8 mm in diameter by 2.5 mm thick) were ground (No. 1000 SiC), and surface-conditioned using one of the following systems: (i) unprimed, (ii) Liquid A of the Porcelain Liner M material (PLM-A), (iii) Liquid B of Porcelain Liner M (PLM-B), (iv) Liquids A and B of Porcelain Liner M (PLM-AB), (v) Liquid A of the Tokuso Ceramics Primer material (TCP-A), (vi) Liquid B of Tokuso Ceramics Primer (TCP-B) and (vii) Liquids A and B of Tokuso Ceramics Primer (TCP-AB). All specimens were bonded with the Bistite II dual-cured composite luting agent, and shear bond strengths were determined both after 24 h immersion in water and after subsequent thermocycling (4-60 degrees C, 1 min each, 20,000 cycles). Of the seven groups assessed, two groups (PLM-AB and TCP-AB) showed the greatest bond strength both before (30.7 MPa for PLM-AB and 29.7 MPa for TCP-AB) and after (19.7 MPa for PLM-AB and 22.4 MPa for TCP-AB) thermocycling (P < 0.05). No significant differences were found between the PLM-AB and TCP-AB groups regardless of the application of thermocycling (P > 0.05). It can be concluded that both of the acid-catalysed two-liquid ceramic primers showed superior bonding to the unhydrolysed single-liquid silane agents (PLM-B and TCP-A) when the feldspathic porcelain was bonded with the Bistite II luting composite.

Combination phase I study of nedaplatin and gemcitabine for advanced non-small-cell lung cancer

To establish the toxicities and maximum tolerated dose (MTD) of nedaplatin with gemcitabine, and to observe their antitumour activity, we conducted a combination phase I study in advanced non-small-cell lung cancer (NSCLC). Patients received nedaplatin (60–100 mg m⁻² given intravenously over 90 min) on day 1, and gemcitabine (800–1000 mg m⁻² given intravenously over 30 min) on days 1, 8, every 3 weeks. In total, 20 patients with locally advanced or metastatic NSCLC who received no prior chemotherapy or one previous chemotherapy regimen were enrolled. The most frequent toxicities were neutropenia and thrombocytopenia; nonhaematological toxicities were generally mild. Three out of six patients experienced dose-limiting toxicities (neutropenia, thrombocytopenia and delayed anaemia) at dose level 4, 100 mg m⁻² nedaplatin with 1000 mg m⁻² gemcitabine, which was regarded as the MTD. There were three partial responses, for an overall response rate of 16.7%. The median survival time and 1-year survival rate were 9.1 months and 34.1%, respectively. This combination is well tolerated and active for advanced NSCLC. The recommended dose is 80 mg m⁻² nedaplatin with 1000 mg m⁻² gemcitabine. This combination chemotherapy warrants a phase II study and further evaluation in prospective randomised trials with cisplatin- or carboplatin-based combinations as first-line chemotherapy for advanced NSCLC.

Laparoscopic intervention for intrathoracic stomach in infants

BACKGROUND

Intrathoracic stomach is an uncommon condition in infants. We report our experience managing such a condition successfully by laparoscopy in four patients.

METHODS

Patients' ages at the time of operation ranged from 30 days to 14 months. In all cases, the intrathoracic stomach was easily pulled down into the abdominal cavity. The phrenoesophageal ligament was completely resected, and the enlarged hiatus was narrowed by intraabdominal suturing technique. The esophagus was wrapped with the mobilized fundus in a floppy fundoplication. Anchoring sutures were placed between the wrapping cuff and crura.

RESULT

One patient had paraesophageal hernia (type 2), whereas the other had combined hiatal hernia (type 3). No adverse complications were observed in any of the cases. Symptomatic gastroesophageal reflux and radiographic recurrence of hernia were not seen in any case. The cosmesis was excellent in all cases.

CONCLUSIONS

We conclude that laparoscopic repair for intrathoracic stomach is a safe and feasible method when preoperative evaluation is conducted adequately.

Association between TNFA polymorphism and the development of asthma in the Japanese population

Tumor necrosis factor (TNF) is a proinflammatory cytokine that participates in the inflammatory reaction in patients with asthma. The TNFA and TNFB genes, which encode TNF-alpha and TNF-beta, respectively, are located within the region encoding the human major histocompatibility complex on chromosome 6p21.3, which showed linkage to atopic asthma in our genome-wide search. To determine whether polymorphisms in the 5' flanking region of the TNFA gene (-1031C/T, -863C/A, and -857C/T) and an NcoI polymorphism in the TNFB gene (LTA NcoI) are associated with the development of asthma, we performed transmission disequilibrium tests of families identified through children with atopic asthma. Genotypes of families were determined by polymerase chain reaction-based restriction fragment length polymorphism or SNaPshot analysis. Transmission disequilibrium tests of 144 asthmatic families revealed that transmission of the -857C allele and the -1031T-863C-857C haplotype in the TNFA gene to asthma-affected offspring occurred more frequently than expected (-857C allele, p = 0.0055; -1031T-863C-857C haplotype, p = 0.0002). Our results suggest that TNFA or nearby genes, including those in the major histocompatibility complex region, may contribute to the development of asthma in the Japanese population.

Benign transient non-organic ileus of neonates

There are a substantial number of neonates who present with Hirschsprung's disease-like symptoms, but respond very well to conservative therapy. However, once Hirschsprung's disease is ruled out, little attention is paid to these infants, because of the lack of necessity for surgical treatment and their excellent prognosis. The purpose of this study was to elucidate the clinical features of functional ileus of neonates, which we named benign transient non-organic ileus of neonates (BTNIN). Out of 61 neonates referred to our institution with suspected neonatal Hirschsprung's disease (NH), 10 were diagnosed as having NH and 51 as having BTNIN. All the cases of BTNIN showed marked abdominal distension, and 12 showed explosive defecation on digital examination at the first visit. Plain X-ray demonstrated marked whole intestinal dilatation in 12 cases including cases with niveau formation and segmental dilatation. These findings were indistinguishable from those of NH. However, all had a normal anorectal reflex, and rectal suction biopsy revealed normal acetylcholinesterase activity and submucosal ganglion cells. All the cases of BTNIN were treated with periodic glycerin enemas until daily spontaneous defecation was established, which took 2 to 14 months, with an average of 5.0 +/- 2.9 months. None of them showed residual symptoms during the follow-up period.

Ferromagnetic exchange coupling of vanadium(IV) dpi spins across pyrimidine rings: dinuclear complexes of oxovanadium(IV) bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionate) bridged by pyrimidine derivatives

Dinuclear oxovanadium(IV) complexes bridged by pyrimidine derivatives, L[VO(hfac)(2)](2) [L = pyrimidine (PM), 4-methylpyrimidine (MPM), 4,6-dimethylpyrimidine, 4-aminopyrimidine, and quinazoline; hfac = 1,1,1,5,5,5-hexafluoropentane-2,4-dionate], were synthesized and characterized. All of them showed intramolecular ferromagnetic interaction, and the magnetic susceptibilities were analyzed on the basis of the singlet-triplet model, giving 2J/k(B) = 2.2-5.5 K. PM[VO(hfac)(2)](2) crystallized in a monoclinic space group C2/c with a = 34.092(2), b = 6.9783(4), and c = 16.4940(9) A, beta = 109.104(1) degrees, V = 3707.8(4) A(3), and Z = 4 for C(24)H(8)F(24)N(2)O(10)V(2), and MPM[VO(hfac)(2)](2) gave isomorphous crystals. A semiempirical calculation study based on the determined structure suggests the presence of dpi-ppi interaction between vanadium and pyrimidine nitrogen atoms. Ferromagnetic coupling is explained in terms of a spin-polarization mechanism across the pyrimidine bridge. The intermolecular ferromagnetic interaction of PM[VO(hfac)(2)](2) can be interpreted by the contact between the spin-polarized pyrimidine moiety and the oxovanadium oxygen atom in an adjacent molecule.

Bis(hfac)-copper(II) complexes bridged by pyrimidines showing magnetic interactions

Crystals of bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)bispyrimidinecopper(II) (1), bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)bis(4-methylpyrimidine)copper(II) (2), bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)bis(quinazoline)copper(II) (3) showed ferromagnetic interactions at extremely low temperature. Crystal structure analyses revealed that these complexes were catena-bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)[mu-pyrimidine-N(1):N(3)]copper(II), [Cu(hfac)(2)(pm)(2)](n), catena-bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)[mu-4-methylpyrimidine-N(1):N(3)]copper(II), [Cu(hfac)(2)(4-Me-pm)](n), and catena-bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)[mu-pyrimidine-N(1):N(3)]copper(II), [Cu(hfac)(2)(qz)](n), for (1), (2) and (3), respectively. In (1) and (2) the pyrimidines bridge the Cu atoms with an axial-equatorial mode to form one-dimensional spiral chains. Complex (3) also forms a one-dimensional chain structure. The coordination mode of (3) is axial-axial at room temperature, while axial-equatorial at 120 K. On the other hand, the structure of the other modification of the 4-methylpyrimidine complex (4), showing paramagnetic properties, was revealed to be a trinuclei complex bridged by two 4-methylpyrimidines, tris[bis-(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)copper(II)][bis-mu-4-methyl-pyrimidine-N(1):N(3)]. The chain structures with an axial-equatorial coordination mode of the bridging organic moieties should play an important role in the appearance of the ferromagnetic interactions.

Radical-copper wheels: structure and magnetism of hexanuclear hybrid arrays

Complexation of copper(II) bromide and chloride with 4-pyrimidinyl nitronyl nitroxide (4PMNN) as a bridging ligand gave discrete hexanuclear complexes carrying 12 spins, [CuX(2).(4PMNN)](6) [X = Br (1), Cl (2)], which crystallize in a trigonal space group. The crystallographic parameters are C(11)H(15)Br(2)CuN(4)O(2).0.3H(2)O, a = 28.172(2), c = 12.590(2) A, V = 8653(2) A(3), and Z = 18 for 1, and C(11)H(15)Cl(2)CuN(4)O(2).0.3H(2)O, a = 28.261(2), c = 12.378(1) A, and Z = 18 for 2. The hexanuclear arrays construct a perfect column perpendicular to the molecular plane. The diameter of the resultant honeycomblike channel is ca. 11.5 A defined by the interatomic distance of two opposing copper ions. Their magnetic behavior is interpreted as the simultaneous presence of ferro and antiferromagnetic couplings. The ferromagnetic couplings are attributed to the interactions between a copper spin and the axially coordinated nitronyl nitroxide spin and between nitronyl nitroxide groups through van der Waals contacts. The antiferromagnetic coupling is due to the interaction between copper ions across the pyrimidine bridges.

Sleep-wake rhythm during stay in an intensive care unit: a week's long-term recording of skin potentials

To monitor the sleep-wake cycle of patients during their stay in the intensive care unit (ICU), we tried continuous and long-term recording of skin potential (SP) levels in patients after surgery. A graph of the week-long SP showed the sleep-wake pattern to be evident until the fourth day. It disappeared beginning on the fifth day, resulting finally in delirium with a relatively high mean SP level. In another record, the administration of sedative agents to calm the excitement lowered the mean SP level and suppressed SP responses evoked by frequent day and night treatment or nursing care. Continuous monitoring of arousal level by SP will be of help in prevention of ICU syndrome.

Dipyrimidine–copper(II) dinitrate complexes showing magnetic interactions

Crystals of CuII(NO3)2(pm)3 (1), and two crystalline forms of CuII(NO3)2(H2O)2(pm)2, (2) and (3), showed ferromagnetic, antiferromagnetic and paramagnetic interactions at extremely low temperatures, respectively. Crystal structure analyses revealed that the complexes were catena-dinitrato[μ-pyrimidine-κN 1:κN 3]-(pyrimidine-N 1)copper(II), [Cu(NO3)2(pm)2] n , catena-diaquadinitrato[μ-pyrimidine-κN 1:κN 3]copper(II), [Cu(NO3)2(H2O)2(pm)] n , and diaquadinitratodipyrimidinecopper(II), Cu(NO3)2(H2O)2(pm)2 for (1), (2) and (3), respectively. In (1) the Cu atom is coordinated by the two nitrates and N atoms of the non-bridging pyrimidine and bridging pyrimidine to form a one-dimensional coordination polymer. The complex is a five-coordinated square pyramid and can be regarded as a pseudo-seven-coordinated complex, since other short non-bonding Cu...O contacts are observed. In the crystals of (2) the pyrimidine bridges the Cu atoms to form a one-dimensional coordination chain. On the other hand, complex (3) is not a coordination polymer. It is important to form a coordination polymer for the appearance of the magnetic interactions. Types of coordination of the bridging organic moieties should also play an important role in magnetic properties. Magnetic measurements of (1) and (2) show that they are good examples of uniform S = 1/2 ferro- and antiferromagnetic Heisenberg chains with exchange parameters 2J/kB = +1.8 and −36 K, respectively.

Application of a drug delivery system in a novel rat model of chronic hyperendotoxemia

There has not been an ideal reproducible small-animal model of chronic hyperendotoxemia to date. Our drug delivery system (DDS) is a new technology that can deliver a drug conveniently to a target organ at an optional rate. 2-Hydroxyethyl methacrylate (HEMA) was used as a carrier of lipopolysaccharide (LPS), and diethylene glycol and polyethylene glycol dimethacrylates (2G, 4G, 9G) were used as cross-linking agents. A mixed solution of HEMA and di(poly)ethylene glycol dimethacrylate was charged into a glass tube with or without LPS and polymerized by ultraviolet irradiation. This polymer was cut into DDS tablets of the same size with or without LPS. A mixture with HEMA:4G = 1:3 was the most suitable composition to release a constant concentration of LPS. We also developed a novel rat model of chronic hyperendotoxemia. Four DDS tablets, each containing 15 mg LPS, were implanted into the abdominal cavity of rats in the LPS group. The control group was implanted with four DDS tablets without LPS. Plasma levels of LPS in the study group were maintained at more than 2,000 pg/ml for 72 h after implantation. Weight gain was lower and body temperature was higher in the LPS group than in the control group. Plasma levels of inter leukin (IL)-6 in the LPS group were higher than in the control group only during the initial 12 h after implantation of DDS tablets. The white blood cell count at 24 h and platelet counts at 24, 48, and 72 h in the LPS group were lower than those in the control group. These results indicate that chronic hyperendotoxemia was maintained for 72 h by continuous release of LPS from the DDS. Moreover, the intensity of endotoxemia could be varied by varying the number of DDS tablets. It is concluded that our new rat model using LPS-DDS will be applicable and useful as a model of chronic hyperendotoxemia.

Single-component organic semiconductors based on novel radicals that exhibit electrochemical amphotericity: preparation, crystal structures, and solid-state properties of N,N'-dicyanopyrazinonaphthoquinodiiminides substituted with an N-alkylpyridinium unit

N,N'-Dicyanonaphthoquinodiimines fused with a pyrazine ring 1 were prepared from the corresponding quinones 4. The new acceptors 1 have a planar pi-system and undergo reversible two-stage 1e-reduction. Quaternization of the pyridyl substituent in 1d-f gave pyridinium derivatives 2d+, 2e+, and R-3+, respectively, which are stronger acceptors that undergo three-stage 1e-reduction. Upon electrochemical reduction of these cations, novel radicals 2d., 2e., and R-3. were generated and isolated as stable solids. The molecular geometries determined by X-ray analysis indicated that these radicals adopt a zwitterionic structure, in which the unpaired electron is located on the quinodiimine unit but not on the pyridyl group. These novel radicals undergo facile and reversible 1e-oxidation as well as two-stage 1e-reduction. The observed amphotericity endows the radicals with electrical conductivities (10(-5) to 10(-9) S cm-1), and these thus represent a new motif for single-component organic semiconductors.

Phase I trial of oral 2'-deoxy-2'-methylidenecytidine: on a daily x 14-day schedule

2'-deoxy-2'-methylidenecytidine (DMDC) is a potent deoxycytidine analogue. Preclinical studies of DMDC demonstrated activity against a variety of murine and human tumors in cell cultures and murine models and indicate enhanced antitumor activity of DMDC when it was administered in a manner that provided prolonged systemic exposure. In view of this observation, this study was designed to determine the toxicities, maximum-tolerated dose, and pharmacokinetic profile of DMDC. DMDC was given p.o. under fasting conditions for 14 consecutive days every 4 weeks in patients with advanced solid tumors. The starting dose was 12 mg/m2/day. Pharmacokinetic studies were carried out on days 1 and 14 of the first cycle. Fourteen patients received 22 courses of DMDC. The dose-limiting toxicities were anorexia, leukopenia, thrombocytopenia, and anemia. General fatigue was the common nonhematological toxicity. The maximum-tolerated dose was 18 mg/m2/day, at which two of six patients developed grade 3 toxicities. This dose level could also be considered for Phase II testing with this schedule. At the 18-mg/m2/day dose level, the mean terminal half-life, maximum plasma concentration (Cmax), the area under the plasma drug concentration-time curve (AUC(0-infinity)) on day 1 were 1.7496 h, 112.9 ng/ml, and 399.8 ng x h/ml, respectively. Forty to 50% of the administered dose was recovered in the urine, indicating a good bioavailability and resulting significant systemic exposure to the drug, which may enable chronic oral treatment.

Estimation of bacterial contamination in ultrapure water: application of the anti-DNA antibody

We constructed and established a hybridoma cell line that produces immunoglobulin G-type anti-DNA antibody. By using this antibody, we could successfully detect a single bacterial cell in ultrapure water (UPW). The detection system is composed of a membrane-supported western blotting-type immunoassay and a two-dimensional photon analyzer with high resolution. It can detect and count every bacterial cell in a wide field of view on a trapping filter i.e., a circle with an 18-mm diameter. This means 10 fg (10(-14) g) of bacterial DNA can be detected in the field. This system could be a useful tool for evaluating the number of bacteria contained by UPW and water used for medical purposes.

Reconstruction for the brilliance-upgrading project of the Photon Factory storage ring

Reconstruction of the Photon Factory storage ring (PF ring; 2.5 GeV) is now in progress to provide very brilliant synchrotron radiation to users, i.e. the emittance is being reduced by a factor of five. Components, such as the quadrupole and sextupole magnets, vacuum chambers, beamlines and beam-position monitors, are being replaced by new ones in 16 normal-cell sections of the PF ring. The accelerating cavities, injection systems and control systems are also being replaced. Operation will commence when the improvements are completed on 1 October 1997.

[A case of complete remission of gastric endocrine cell carcinoma with multiple bone metastasis by combination chemotherapy and high-dose chemotherapy with autologous peripheral blood stem cell transplantation]

A 31-year-old man was admitted to our hospital complaining of epigastric discomfort and severe lumbago. An upper gastrointestinal endoscopy revealed several submucosallike tumors. Histologic examination of biopsy specimens confirmed the presence of endocrine cell carcinoma. Gallium scintigraphy and CT revealed multiple bone metastasis. He was treated with 6 cycles of combination chemotherapy consisting of CDDP, etoposide, CPA, EPI and VCR. Both gastric tumors and bone metastasis completely disappeared. After 7 cycles of the chemotherapy, he was treated with HDCT with PBSCT. There was no severe complication. This result suggested that the combination of conventional chemotherapy and HDCT with PBSCT was useful in cancer patients with poor prognoses, such as advanced gastric endocrine cell carcinoma.

Expression of Bcl-2 in human breast cancer: correlation between hormone receptor status, p53 protein accumulation and DNA strand breaks associated with apoptosis

The expression of Bcl-2, a suppressor of apoptotic cell death, was investigated in 52 invasive carcinomas of the breast using reverse transcription-polymerase chain reaction and immunohistochemical methods. After consideration of both sets of results, 42 tumors (80.8%) were confirmed to be positive (Bcl-2(+)) and 10 (19.2%) were judged negative (Bcl-2(-)) for Bcl-2 expression. Related factors (p53 protein accumulation, hormone receptor status and apoptotic cell index) were also examined using immunohistochemical and in situ end-labeling methods to elucidate their correlations with Bcl-2 expression. Bcl-2 expression correlated significantly with the hormone receptor status, whereas it showed significant inverse correlations with p53 accumulation and the apoptotic index. It was concluded that estrogen and mutant p53 are related to the regulation of Bcl-2 expression and that the ability to prevent tumor cell death due to Bcl-2 can be developed by breast cancers.

[Scimitar syndrome with diagnostic MRI findings]

A fifty-year-old woman was admitted to our hospital because of an abnormal shadow on a chest X-ray film. She was asymptomatic. Chest X-ray film showed a scimitar-like vessel in the right lung, dextroposition of the heart, and hypoplasia of the right pulmonary artery. MRI revealed that the scimitar vein was anomalous pulmonary venous return from the right lung. Normal venous return from the right lower lobe to the left atrium was confirmed by pulmonary artery angiography. MRI findings have been useful in the diagnosis of scimitar syndrome.