Gait Disturbance Improvement and Cerebral Cortex Rearrangement by Acupuncture in Parkinson's Disease: A Pilot Assessor-Blinded, Randomized, Controlled, Parallel-Group Trial

BACKGROUND

Parkinson's disease (PD) leads to impaired mobility and limited independence.

OBJECTIVE

We investigated the effects of acupuncture on gait disturbance and analyzed hemodynamic changes caused by acupuncture in the cerebral cortex of patients with PD.

METHODS

Participants (n = 26) with gait disturbance due to PD were randomly assigned to the intervention (acupuncture twice a week for 4 weeks + conventional therapy) or control (conventional therapy) groups. We analyzed gait parameters using the GAITRite system and hemodynamic responses in the cerebral cortices using functional near-infrared spectroscopy, Unified Parkinson's Disease Rating Scale (UPDRS) scores, neurotransmitter levels, as well as the immediate effects of acupuncture in patients with PD.

RESULTS

The participants tended to walk with hypometric gait (high cadence, short steps) overground. After acupuncture treatment, those in the intervention group showed a significant reduction in cadence and the UPDRS scores involving "walking and balance" compared with those in the control group (P = .004 and P = .020, respectively); the stride, swing, and single support times were significantly increased (P = .006, P = .001, and P = .001, respectively). Oxyhemoglobin levels in the intervention group while walking on a treadmill were significantly increased in the prefrontal and supplementary motor areas. The oxyhemoglobin levels in the prefrontal cortex and swing time revealed significant positive correlations.

CONCLUSIONS

Our findings indicated that acupuncture tended to improve hypometric gait and rearranged activation of the cerebral cortex. Thus, acupuncture may be a useful complementary treatment for gait disturbance, including hypometric gait, in patients with PD. Trial Registration Number. Clinical Research Information Service (KCT0002603), https://cris.nih.go.kr/cris/index.jsp.

Effects of Cognitive Task Training on Dynamic Balance and Gait of Patients with Stroke: A Preliminary Randomized Controlled Study

Background

The decreased postural control ability of stroke patients affects their ability to balance in various postures such as sitting and standing. This study aimed to determine whether cognitive task training for stroke patients is effective in improving walking and balancing abilities.

Material/Methods

Seventeen stroke patients (10 males, 7 females) were randomized by ballot to be assigned to the cognitive task group (CBT) or the general task group (GBT). For the cognitive task training, a dual task of balance and cognition using traffic signals, a familiar form to the subjects, was applied as a program. In both groups the interventions were performed for 30 min a day, 3 times a week, for 4 weeks. The timed up and go test (TUG), the Berg balance scale (BBS), and gait ability evaluation were performed to compare the therapeutic effects.

Results

After the intervention, the BBS showed significant differences in both groups (p<0.05). The cognitive task training group had significant improvement in all outcome scores after the intervention (p<0.05). The TUG score of the CBT group significantly decreased to 6.17 s (p<0.05), but that of the GBT showed no statistically significant change.

Conclusions

Cognitive task training could be used in clinical rehabilitation as a more effective intervention method to improve balance and gait ability of stroke patients.

Comparison of underwater gait training and overground gait training for improving the walking and balancing ability of patients with severe hemiplegic stroke: A randomized controlled pilot trial

BACKGROUND

Walking training is an essential intervention to improve the function in stroke patients. However, only a limited number of gait training strategies are available for stroke patients with relatively severe disabilities.

RESEARCH QUESTION

Is underwater gait training or overground gait training more effective in severe stroke patients?

METHODS

A total of 21 patients with severe hemiplegic stroke were randomly assigned to the experimental and control groups. All participants (n = 21) received 60-minute sessions of general physical therapy, 5 times a week for a period of 12 weeks. Additionally, the experimental and control groups underwent underwater and overground walking training, respectively, for 30 min twice times a week for 12 weeks. Postural assessment for stroke score, center of pressure path length and velocity, step time and step length difference, and walking velocity were measured before and after the 12-week training.

RESULTS

Both groups showed a significant decrease in the center of pressure path length and velocity after the intervention compared to the values before the intervention (p < .05). However, there was no significant difference in the center of pressure path length and velocity changes after training between the two groups (p > .05). In the walking variables, the step length difference changes after training between the two groups showed a significant difference (p < .05). In the experimental group, the step length difference increased after the intervention compared to that before the intervention (+4.55 cm), whereas that of the control group decreased (-1.25 cm).

SIGNIFICANCE

In severe stroke patients, underwater gait training can be effective for improving balancing ability, but it may be less effective on the improvement of gait function than overground walking.

CLINICAL TRIAL REGISTRATION NUMBER

KCT0002587 (https://cris.nih.go.kr).

Three-percent sucrose acts as a thermostabilizer for cell-adapted foot-and-mouth disease virus without any negative effect on viral growth

AIMS

As cell-adapted foot-and-mouth disease virus (FMDV) with H56R mutation in VP3 has reduced thermostability, this study aimed to investigate the effect of thermostabilizers on cell-adapted FMDV for vaccine production.

METHODS AND RESULTS

We examined the effect of 3% sucrose, 10% (or 25%) glycerol or 10% FBS on cell-adapted FMDV O/SKR/JC/2014, containing H56R mutation in VP3, as vaccine seed virus at -80, 4, 25 or 37°C for 2, 4 or 7 days. The stabilizing effect of 3% sucrose on O/SKR/JC/2014 was observed at 25, 37°C, and after repeated freeze-thaw cycles. Additionally, we tested the effect of 3% sucrose on the growth of FMDV or cells and did not observe any decrease in either viral growth or cell viability.

CONCLUSIONS

Our study showed the protective effect of 3% sucrose on FMDV infectivity at various temperatures; this virus stock in 3% sucrose could be used for infecting cells without the removal of sucrose.

SIGNIFICANCE AND IMPACT OF THE STUDY

We suggest that 3% sucrose-containing medium could be beneficial for the stable storage and transport of cell-adapted FMDV.

Multidelay Arterial Spin-Labeling MRI in Neonates and Infants: Cerebral Perfusion Changes during Brain Maturation

BACKGROUND AND PURPOSE

Arterial spin-labeling with multiple postlabeling delays can correct transit times. We tried to evaluate CBF in neonates and infants using multidelay arterial spin-labeling.

MATERIALS AND METHODS

Multidelay arterial spin-labeling was applied to 13 preterm neonates (mean postmenstrual age, 34.9 weeks), 13 term-equivalent-age neonates (mean postmenstrual age, 39.2 weeks), and 6 infants (mean postmenstrual age, 57.8 weeks). Transit time-corrected CBF in the caudate, thalamus, frontal GM, occipital GM, frontal WM, and occipital WM was measured, and relative CBF compared with the whole-brain CBF was calculated. Inter- and intragroup comparisons were performed among the 3 age groups. A correlation and nonlinear regression analysis were performed between postmenstrual age and CBF.

RESULTS

Intergroup comparisons showed significantly higher whole-brain CBF in infants (38.3 mL/100 g/min) compared with preterm (15.5 mL/100 g/min) and term-equivalent-age (18.3 mL/100 g/min) neonates (P < .001). In the intragroup comparison, all 3 groups showed significantly higher relative CBF values in the occipital WM (63.6%-90.3%) compared with the frontal WM (46.3%-73.9%). In term-equivalent-age neonates, the occipital GM (120.8%) had significantly higher relative CBF values than the frontal GM (103.5%). There was a significant negative correlation between postmenstrual age and the relative CBF of the thalamus (r = - 0.449, P = .010). There were significant positive relationships between postmenstrual age and the relative CBF of the frontal WM (R ² = 0.298, P = .001) and occipital WM (R ² = 0.452, P < .001).

CONCLUSIONS

Multidelay arterial spin-labeling with transit time-corrected CBF showed developmental changes and regional differences of CBF in neonates and infants.

Patient-specific Virtual Simulation-A State of the Art Approach to Teach Renal Tumor Localization

OBJECTIVE

To test whether a novel visuospatial testing platform improves trainee ability to convert two-dimensional to three-dimensional (3D) space.

METHODS

Medical students were recruited from Baylor College of Medicine and McGovern Medical School (Houston, TX). We 3D reconstructed 3 partial nephrectomy cases using a novel, rapid, and highly accurate edge-detection algorithm. Patient-specific reconstructions were imported into the dV-Trainer (Mimics Technologies, Seattle, WA) as well as used to generate custom 3D printed physical models. Tumor location was altered digitally to generate 9 physical models for each case, 1 with the correct tumor location and 8 with sham locations. Subjects were randomized 1:1 into the dV-Trainer (intervention) and No-dV-Trainer (control) groups. Each subject completed the following steps: (1) visualization of computed-tomographic images, (2) visualization of the reconstructed kidney and tumor in the dV-Trainer (intervention group only), and (3) selection of the correct tumor location on the 3D printed models (primary outcome). Normalized distances from the correct tumor location were quantified and compared between groups.

RESULTS

A total of 100 subjects were randomized for this study. dV-Trainer use significantly improved subjects ability to localize tumor position (tumor localization score: 0.24 vs 0.38, P < .001). However, subjects in the No-dV-Trainer group more accurately assigned R.E.N.A.L. scores.

CONCLUSION

Even brief exposure to interactive patient-specific renal tumor models improves a novice's ability to localize tumor location. Virtual reality simulation prior to surgery could benefit trainees learning to localize renal masses for minimally invasive partial nephrectomy.

Eosinophil resistance to glucocorticoid-induced apoptosis is mediated by the transcription factor NFIL3

The mainstay of asthma therapy, glucocorticoids (GCs) exert their therapeutic effects through the inhibition of inflammatory signaling and induction of eosinophil apoptosis. However, laboratory and clinical observations of GC-resistant asthma suggest that GCs' effects on eosinophil viability may depend on the state of eosinophil activation. In the present study we demonstrate that eosinophils stimulated with IL-5 show impaired pro-apoptotic response to GCs. We sought to determine the contribution of GC-mediated transactivating (TA) and transrepressing (TR) pathways in modulation of activated eosinophils' response to GC by comparing their response to the selective GC receptor (GR) agonist Compound A (CpdA) devoid of TA activity to that upon treatment with Dexamethasone (Dex). IL-5-activated eosinophils showed contrasting responses to CpdA and Dex, as IL-5-treated eosinophils showed no increase in apoptosis compared to cells treated with Dex alone, while CpdA elicited an apoptotic response regardless of IL-5 stimulation. Proteomic analysis revealed that both Nuclear Factor IL-3 (NFIL3) and Map Kinase Phosphatase 1 (MKP1) were inducible by IL-5 and enhanced by Dex; however, CpdA had no effect on NFIL3 and MKP1 expression. We found that inhibiting NFIL3 with specific siRNA or by blocking the IL-5-inducible Pim-1 kinase abrogated the protective effect of IL-5 on Dex-induced apoptosis, indicating crosstalk between IL-5 anti-apoptotic pathways and GR-mediated TA signaling occurring via the NFIL3 molecule. Collectively, these results indicate that (1) GCs' TA pathway may support eosinophil viability in IL-5-stimulated cells through synergistic upregulation of NFIL3; and (2) functional inhibition of IL-5 signaling (anti-Pim1) or the use of selective GR agonists that don't upregulate NFIL3 may be effective strategies for the restoring pro-apoptotic effect of GCs on IL-5-activated eosinophils.

The structural connectivity of the recurrent transient global amnesia

BACKGROUND

One of recent interesting hypotheses of transient global amnesia (TGA) pathophysiology is the preexisting vulnerability of the memory network in patients with TGA.

AIM OF THE STUDY

To verify the hypothesis that patients with recurrent amnestic attacks may have more disrupted structural connectivity than patients of a single TGA event, we compared the brain imaging of patients with repeated episodes of TGA with those who experienced a single attack.

METHODS

Seven patients who were having recurrent TGA and 14 age- and sex-matched control subjects who had only a single episode of TGA participated in the study. Diffusion tensor images from both groups were assessed and analyzed using tract-based spatial statistics.

RESULTS

The fractional anisotropy and mean diffusivity values were not reduced in any lesion within the memory pathway of recurrent patient group when compared with those of single event group.

CONCLUSION

No disruptions in the structural connectivity of the memory pathway were observed in patients with recurrent TGA attacks, refuting the hypothesis that recurrent TGA patients present predisposing weakness of the memory network. The stability of structural connectivity suggests that repeated hippocampal lesions associated with TGA do not affect the microstructure of the brain.

Effects of auditory feedback during gait training on hemiplegic patients' weight bearing and dynamic balance ability

[Purpose] This study examined the effects of auditory feedback during gait on the weight bearing of patients with hemiplegia resulting from a stroke. [Subjects] Thirty hemiplegic patients participated in this experiment and they were randomly allocated to an experimental group and a control group. [Methods] Both groups received neuro-developmental treatment for four weeks and the experimental group additionally received auditory feedback during gait training. In order to examine auditory feedback effects on weight bearing during gait, a motion analysis system GAITRite was used to measure the duration of the stance phase and single limb stance phase of the subjects. [Results] The experimental group showed statistically significant improvements in the duration of the stance phase and single limb stance phase of the paretic side and the results of the Timed Up and Go Test after the training. [Conclusion] Auditory feedback during gait training significantly improved the duration of the stance phase and single limb stance phase of hemiplegic stroke patients.

Variability of peak shoulder force during wheelchair propulsion in manual wheelchair users with and without shoulder pain

BACKGROUND

Manual wheelchair users report a high prevalence of shoulder pain. Growing evidence shows that variability in forces applied to biological tissue is related to musculoskeletal pain. The purpose of this study was to examine the variability of forces acting on the shoulder during wheelchair propulsion as a function of shoulder pain.

METHODS

Twenty-four manual wheelchair users (13 with pain, 11 without pain) participated in the investigation. Kinetic and kinematic data of wheelchair propulsion were recorded for 3 min maintaining a constant speed at three distinct propulsion speeds (fast speed of 1.1 m/s, a self-selected speed, and a slow speed of 0.7 m/s). Peak resultant shoulder forces in the push phase were calculated using inverse dynamics. Within individual variability was quantified as the coefficient of variation of cycle to cycle peak resultant forces.

FINDINGS

There was no difference in mean peak shoulder resultant force between groups. The pain group had significantly smaller variability of peak resultant force than the no pain group (P<0.01, η²=0.18).

INTERPRETATION

The observations raise the possibility that propulsion variability could be a novel marker of upper limb pain in manual wheelchair users.

Enteropathogenic Escherichia coli-induced macrophage inhibitory cytokine 1 mediates cancer cell survival: an in vitro implication of infection-linked tumor dissemination

Mucosally adherent Escherichia coli is frequently observed in intestinal surface of patients with colorectal cancer, but rarely in healthy control. Particularly, enteropathogenic Escherichia coli (EPEC) is known to be closely associated with colorectal carcinogenesis in human. In this study, one consequence of EPEC infection in human intestinal cancer cells was induction of macrophage inhibitory cytokine 1 (MIC-1), which is a multifunctional cytokine with biological activities involved in cancer cell growth, differentiation and migration. The present investigation assessed the involvement of MIC-1 protein in EPEC infection-mediated cancer cell survival. The challenge with EPEC induced cancer cell detachment via cytoskeleton rearrangement, which was positively associated with induced MIC-1 expression. Moreover, MIC-1 also mediated RhoA GTPase-linked survival of the detached cancer cells. Blocking of MIC-1 or RhoA activity increased cellular apoptosis of the detached cancer cells. In terms of signaling pathway, MIC-1 triggered transforming growth factorβ-activated kinase 1 (TAK1), which enhanced expression of RhoA GTPase. We conclude that EPEC enhances MIC-1 gene expression in the human intestinal cancer cells, which can be associated with enhanced tumor cell resistance to anchorage-dependent tumor cell death via enhanced TAK1 and RhoA GTPase.

TGF-β suppresses the expression of genes related to mitochondrial function in lung A549 cells

TGF-β is a mediator of lung fibrosis and regulates the alveolar epithelial type II cell phenotype. TGF-β can induce epithelial mesenchymal transition of idiopathic pulmonary disease and cancer metastasis. Peroxisome proliferator-activated receptor gamma co-activator 1-alpha (PGC-1 α) is a key metabolic regulator that stimulates mitochondrial biogenesis and promotes remodeling of muscle tissue to oxidative fiber-type composition. Here, we report that the induction of TGF-β decreased mRNA expression of PGC-1α, and PGC-1 target genes, such as the transcription factors NRF-2, ERR-α, and PPAR-γ in lung epithelial A549 cells. In addition, TGF-β led to the reduction of super oxide dismutase 2 (anti-oxidant enzyme), cytochrome C (electron transport chain in mitochondria), and MCAD (a mitochondrial β-oxidant enzyme) in A549 cells. Together, our results suggest that TGF-β may suppress the transcriptional activity of the genes related to mitochondrial biogenesis or function. This mechanism may provide a novel insight into the understanding of fibrosis disease.

Radiosensitivity of human biliary tract cancer cell lines in vitro

The prognosis of biliary tract cancer is still poor. Although a number of clinical studies have suggested a role for radiation therapy in advanced biliary tract cancer, its value remains controversial. Moreover, the intrinsic radiosensitivity of bile duct cancer cell lines has not been described, and the molecular basis for the response of these tumors to ionizing radiation is poorly understood. The present study was designed to examine the intrinsic radiation sensitivity of human biliary tract cancer cells and its relationship to p53 status. Radiation response expressed by the parameters n, D-0, D-10, alpha, beta, (D) over bar (mean inactivation dose), and SF, of seven cell lines derived from gallbladder and bile duct cancers was determined. The results suggest that biliary tract cancer cell lines as a group are relatively radioresistant. The mean X-ray survival parameters for these seven cancer cell lines were D-0=2.13+/-0.29 Gy, D-10=5.73+/-0.59 Gy, (D) over bar=2.76+/-0.25 Gy, alpha=0.25+/-0.03, and SF2=0.54+/-0.05. One of the seven lines was more radiosensitive than the others (D-0=0.77+/-0.02 Gy, D-10=2.95+/-0.06 Gy, (D) over bar=1.57 Gy, alpha=0.35, SF2=0.35+/-0.03). Five of six lines examined expressed mutant p53 including the radiosensitive line; one radioresistant line expressed wild-type p53. Thus, although loss of wild-type p53 expression occurred frequently in these biliary cancer cell lines, radiosensitivity did not correlate with p53 status. In view of the intrinsic radioresistance of this type of tumor cell coupled with the poor tolerance of surrounding normal tissues, maximal surgical debulking and intraoperative radiation therapy may contribute to increased local control over resection and/or conventional fractionated radiotherapy.

Different expression patterns of Phactr family members in normal and injured mouse brain

Phosphatase and actin regulators (Phactrs) are a novel family of proteins expressed in the brain, and they exhibit both strong modulatory activity of protein phosphatase 1 and actin-binding activity. Phactrs are comprised of four family members (Phactr1-4), but their detailed expression patterns during embryonic and postnatal development are not well understood. We found that these family members exhibit different spatiotemporal mRNA expression patterns. Phactr4 mRNA was found in neural stem cells in the developing and adult brains, whereas Phactr1 and 3 appeared to be expressed in post-mitotic neurons. Following traumatic brain injury which promotes neurogenesis in the neurogenic region and gliogenesis in the injury penumbra, the mRNA expression of phactr2 and 4 was progressively increased in the injury penumbra, and phactr4 mRNA and protein induction was observed in reactive astrocytes. These differential expression patterns of phactrs imply specific functions for each protein during development, and the importance of Phactr4 in the reactive gliosis following brain injury.

Randomized phase II study of gefitinib alone or with simvastatin in previously treated advanced non-small cell lung cancer (NSCLC)

8057

Background: Statins reduce not only serum cholesterol levels but also mevalonate synthesis by inhibiting HMG-CoA reductase. Mevalonate is a precursor of several cellular major products including dolichol, geranylpyrophosphate (GPP) and farnesyl-pyrophosphate (FPP). Dolichol has a stimulatory effect on DNA synthesis and is linked to several tumor cell proteins. GPP and FPP cause isoprenylation of Ras and Rho those regulate signal transduction of several membrane receptors crucial for cell proliferation, differentiation, and apoptosis, which result in resistance to gefitinib. Thus depletion of mevalonate metabolites may enhance gefitinib activity in NSCLC. This study compared gefitinib alone with gefitinib plus simvastatin in patients with recurrent NSCLC after at least one chemotherapy. Methods: Between May 2006 and September 2008, 107 patients (51% male, 74% adenocarcinoma, 50% never-smoker, 54% more than two prior regimens) were randomly assigned to gefitinib alone (250 mg/d orally, n=53) or gefitinib plus simvastatin (250mg/d and 40 mg/d orally, respectively, n=54). A cycle was considered as 4 weeks of treatment. Therapy was continued until disease progression or intolerable toxicities. The primary end point was to assess response rate. Secondary end points included time to progression and survival. Median follow-up was 10.1 months. Results: Efficacy was similar for gefitinib and gefitinib plus simvastatin groups. Objective tumor response rates (RR) were 31.5% (95% CI, 19.1 to 43.9) and 32.1% (95% CI, 19.5 to 44.7); median PFS were 1.9 and 2.0 months; and median OS were 9.5 and 12.7 months, respectively. In subgroup analysis, gefitinib plus simvastatin showed a trend for higher RR than gefitinib alone in non-adenocarcinoma group (38.5% vs. 7.7%, p=0.08). Adverse events at both arms were generally mild (grade 1 or 2) and consisted mainly of skin reactions. Conclusions: Gefitinib combined with simvastatin did not improved efficacy compared to gefitinib alone in this unselected patient population, but showed a trend for higher efficacy in non-adenocarcinoma patients. Although it is preliminary, gefitinib combined with simvastatin showed slightly increased OS. Updated survival data will be presented.

No significant financial relationships to disclose.

Clinical outcome of sequential chemotherapy in metastatic and/or recurrent gastric cancer

e15521

Background: Little is known about data on subsequent chemotherapy (CTx) following 1st-line CTx in stage IV gastric cancer. The purpose of this study was to analyze the natural history of stage IV gastric cancer with sequential CTx Methods: A total of 532 patients (pts) with unresectable gastric adenocarcinoma were studied. They were managed with a strategy of maximal administration of CTx only if pts’ general conditions were allowed. Response evaluation was performed by RECIST every 2 cycles. Response of unmeasurable lesions was dichotomized only into stable disease or progressive disease. Results: When pts were divided into CTx group (460 of 532, 87%) and best supportive care group (BSC; 72 of 532, 13%) resulting from poor performance/pt's refusal/comorbidity (31/23/18), the former had younger age (p = 0.046), better performance (p < 0.001), and less advanced metastatic sites (p = 0.001) than the latter. Median overall survivals from diagnosis of unresectable cancer were 12.0/13.3/2.5 months for overall/CTx/BSC, respectively. 87%/47%/23% of the whole pts received 1st/2nd/3rd-line CTx, respectively. Median number of regimens delivered was 2. Maximally 5th-line CTx was given to 15 pts (3%). Response and disease control rates were 21.7%/12.5%/11.8% and 79.4%/56.3%/49.4% for 1st/2nd/3rd lines, respectively. Median progression-free and overall survivals from CTx were 5.5/3.4/2.5 months and 12.1/7.9/5.5 months for 1st/2nd/3rd lines, respectively. The most common cause of discontinuation of CTx was disease progression (68%/74%/70%) followed by pt's refusal (22%/13%/12%) for 1st/2nd/3rd lines, respectively. Prognosticators were performance status, histology, metastatic site, and CTx before 1st or 2nd line. Conclusions: When pts with unresectable gastric cancer were managed with a strategy of maximal administration of CTx, a considerable number of pts could receive 2nd or 3rd line CTx, showing modest activity. Performance status and metastatic site were consistent prognosticators even if lines changed. Our data on the natural history of stage IV gastric cancer with sequential CTx may suggest that clinical trials can be performed in a 2nd or 3rd line setting as well.

No significant financial relationships to disclose.

Characterization of cytochrome P450s mediating ipriflavone metabolism in human liver microsomes

Ipriflavone, a synthetic flavonoid for the prevention and treatment of osteoporosis, has been reported to be extensively metabolized in man to seven metabolites (M1-M7). This study was performed to characterize the human liver cytochrome P450s (CYP) responsible for the metabolism of ipriflavone. Hydroxylation at the beta-ring to M3, O-dealkylation to M1 and oxidation at isopropyl group to M4 and M5 are major pathways for ipriflavone metabolism in three different human liver microsome preparations. The specific CYPs responsible for ipriflavone oxidation to the active metabolites, M1, M3, M4 and M5 were identified using a combination of correlation analysis, immuno-inhibition, chemical inhibition in human liver microsomes and metabolism by expressed recombinant CYP enzymes. The inhibitory potencies of ipriflavone and its five metabolites, M1-M5 on seven clinically important CYPs were investigated in human liver microsomes. Our results demonstrate that CYP3A4 plays the major role in O-dealkylation of ipriflavone to M1 and CYP1A2 plays a dominant role in the formation of M3, M4 and M5. Ipriflavone and/or its five metabolites were found to inhibit potently the metabolism of CYPs 1A2, 2C8, 2C9 and 2C19 substrates.

Cellular and molecular mechanisms for immune modulation by deoxynivalenol and other trichothecenes: unraveling a paradox

Macrophages, T cells, and B cells of the immune system are central targets of deoxynivalenol (DON) and other trichothecenes-mycotoxins that can be immunostimulatory or immunosuppressive depending on dose, exposure frequency and timing of functional immune assay. Notably, low dose trichothecene exposure transcriptionally and post-transcriptionally upregulates expression of cytokines, chemokines and inflammatory genes with concurrent immune stimulation, whereas high dose exposure promotes leukocyte apoptosis with concomitant immune suppression. DON and other trichothecenes, via a mechanism known as the ribotoxic stress response, bind to ribosomes and rapidly activate mitogen-activated protein kinases (MAPKs). The latter are important transducers of downstream signaling events related to immune response and apoptosis. Using cloned macrophages, our laboratory has identified two critical upstream transducers of DON-induced MAPK activation. One transducer is double-stranded RNA-(dsRNA)-activated protein kinase (PKR), a widely-expressed serine/theonine protein kinase that can be activated by dsRNA, interferon, and other agents. The second transducer is hematopoetic cell kinase (Hck), a non-receptor associated Src family kinase. Inhibitors and gene silencing studies have revealed that Hck and PKR play roles in DON induced gene expression and apoptosis. Future studies should focus on the molecular linkages between these kinases and trichothecene toxicity.

Purulent pericarditis caused by group G streptococcus as an initial presentation of colon cancer

Bacterial pericarditis has been recognized as a rare disease since the development of antibiotics. Usually, the disease is associated with underlying conditions or a seeding of infection elsewhere to the pericardium. Here we describe a case of group G streptococcal pericarditis as an initial presentation of colon cancer. A 52-yr-old man was admitted because of dyspnea. An electrocardiogram showed a diffuse ST-segment elevation and a two-dimensional echocardiogram showed a large amount of pericardial effusion. A pericardiocentesis was done and purulent fluid was drained. Group G streptococci was cultured in pericardial fluid. The patient was treated with antibiotics and pericardiostomy with saline irrigation. A colonoscopy revealed a small mass with moderately differentiated adenocarcinoma in rectosigmoid colon. He underwent a mucosectomy and was recovered without any complication.

[Chemoradiotherapy and salvage surgery in a patient with advanced esophageal cancer]

We report a case of advanced esophageal cancer, which was treated by chemoradiotherapy combined with surgical treatment. Moreover, 14 advanced esophageal cancer patients treated by chemoradiotherapy are discussed. The chemoradiotherapy showed beneficial control of the tumor; however, it sometimes leads to esophageal stenosis and ulcer. We conclude that additional salvage surgery is needed for such complications.

Enhanced radiation killing by 5-fluorouracil of biliary tract cancer cell lines

Despite the frequent clinical use of 5-fluorouracil (5-FU) in combination with radiotherapy for patients with biliary tract cancers, data remain scarce concerning specifically the influence of 5-FU on the sensitivity of these cancer cells to radiation. The present study was carried out to evaluate the effects of concomitant treatment with 5-FU on radiation-induced cell killing in two established human biliary tract cancer cell lines (Mz-ChA-2 and SK-ChA-1 cells). These lines were chosen as we have previously shown that SK-ChA-1 cells are significantly more resistant to both radiation and 5-FU than Mz-ChA-2 cells. Clonogenic survival was employed as the end-point for cell killing. Administration of 5-FU at LD50 doses to each cell line significantly enhanced radiation-induced cell killing. The enhancement ratio (ER) was obtained by dividing the radiation dose required to decrease the cell survival fraction to 37% (D0) by the dose to decrease cell survival to the same level when the cells were also treated with 5-FU. The ER in each of the cell lines was greater when they were incubated with 5-FU after radiation rather than prior to radiation. Longer exposure times with 5-FU resulted in enhanced radiation killing. The ER was significantly higher in the radioresistant cell line than in the radiosensitive line. These findings suggest that therapy with radiation and 5-FU may be of value as components of multidisciplinary treatment for biliary tract cancer. Protracted low dose exposure to 5-FU may prove to be most efficacious in enhancing the effects of radiation therapy.

Regulation of the fatty acid synthase promoter by insulin

Expression of critical enzymes in fatty acid and fat biosynthesis is tightly controlled by nutritional and hormonal stimuli. The expression of fatty acid synthase, which catalyzes all reactions for synthesis of palmitate from acetyl-CoA and malonyl-CoA, and of mitochondrial glycerol-3-phosphate acyltransferase, which catalyzes the first acylation step in glycerophospholipid synthesis, is decreased to an undetectable level during fasting. Food intake, especially a high carbohydrate, fat-free diet after fasting, causes a dramatic increase in the transcription of these genes. Insulin secretion is increased during feeding and has a positive effect on expression. By using adipocytes in culture and transgenic mice that express the reporter gene driven by the fatty acid synthase promoter, the cis-acting sequence that mediates insulin regulation of the fatty acid synthase promoter was defined. Upstream stimulatory factors (USF) that bind to the -65 E-box are required for insulin-mediated transcriptional activation of the fatty acid symthase gene. Sterol regulatory element binding protein (SREBP)-1 may be also involved in induction of these genes during feeding. Using specific inhibitors and expressing various signaling molecules, we found that insulin regulation of the fatty acid synthase promoter is mediated by the phosphatidylinositol (PI)3-kinase signaling pathway and that protein kinase B/akt is a downstream effector.

Increase in signal intensities on T1-weighted magnetic resonance images in asymptomatic manganese-exposed workers

OBJECTIVES

To clarify the clinical significance of increased signal intensities on T1 weighted magnetic resonance imaging (MRI) we performed a large-scale epidemiological study on asymptomatic manganese (Mn)-exposed workers with its focus on MRI.

METHODS

We randomly selected 121 male workers out of a total of 750 workers including Mn-exposed, non-exposed manual, and non-exposed clerical workers in the factories. We studied environmental and biological monitoring, neurological examination, and MRI.

RESULTS

The proportion of workers with increased signal intensities among the exposed, the non-exposed manual workers, and the non-exposed clerical workers was 46.1%, 18.8%, and 0%, respectively. Especially, 73.5% of the welders showed increased signal intensities. In no subject, were clinical signs of manganism observed. The pallidal index correlated with blood Mn concentration.

CONCLUSION

Increase in signal intensities on the T1-weighted image reflect recent exposure to Mn, but not necessarily manganism. At which increase of signal intensity, the progression of manganism from Mn exposure occurs, remains to be solved.

Hematopoietic and reproductive toxicity of 2-bromopropane, a recently introduced substitute for chlorofluorocarbons

2-Bromopropane and hydrochlorofluorocarbons (HCFCs), whose toxicity has scarcely been known, have recently been introduced as main substitutes for chlorofluorocarbons (CFCs). A major corporation in Korea replaced CFCs with 2-bromopropane and this actually led 23 Korean workers to be the world's first 2-bromopropane intoxication victims. Out of 25 female workers in the tactile switch assembling section, 17 (68%) were diagnosed as having ovarian failure. Two affected female workers showed marked pancytopenia with markedly hypoplastic marrow. In the same section, two out of eight male workers showed azoospermia and four some degree of oligospermia. The above toxicity of 2-bromopropane was reproduced in experimental animal studies. Recently, health effects of HCFC 123, including toxic hepatitis, have been reported by several authors. The principle of replacement of toxic substances with non-toxic or less toxic chemicals is important in risk management, but substances still poorly known should not be confused with non-toxic or less toxic substances. Measures aimed at reducing exposure to chemicals with known toxicity rather than using new unknown alternatives may be a rational and effective approach to risk management.

Evaluation of exposure to ethylene glycol monoethyl ether acetates and their possible haematological effects on shipyard painters

OBJECTIVES

To evaluate exposure to mixed solvents containing ethylene glycol monoethyl ether acetate (EGEEA) in shipyard painters, to determine if EGEEA is toxic to the bone marrow.

METHODS

An industrial hygiene survey was performed to identify exposure to EGEEA of two groups of shipyard painters, a low exposure group (n = 30) and a high exposure group (n = 27). Urinary ethoxyacetic acid and methyl hippuric acid as well as haemoglobin, packed cell volume, red cell indices, total and differential white blood cell counts (WBCs), and platelet count for the shipyard painters and the control subjects were measured.

RESULTS

The mean (range) exposure concentration (ppm) to EGEEA in the high and low exposure groups were 3.03 (not detectable to 18.27), 1.76 (not detectable to 8.12), respectively. The concentrations of methyl hippuric acid and ethoxyacetic acid in the high exposure group were significantly higher than those in the control group. The mean WBCs in the high exposure group were significantly lower than in the control group, and a significant proportion, six (11%) of the 57 painters, were leucopenic; none of the controls were affected.

CONCLUSION

The high rate of possible haematological effects among shipyard painters and a hygienic evaluation of their working environment in the present study suggests that EGEEA might be toxic to bone marrow.

Idiopathic parkinsonism with superimposed manganese exposure: utility of positron emission tomography

It is difficult to distinguish manganism from idiopathic parkinsonism by clinical signs only. Case history and examination: A 48-year-old welder for over 10 years complained of masked face, right side (arm and leg) resting tremor, and bradykinesia for over one year. Magnetic resonance imaging (MRI) findings showed symmetrical high signal intensities in the globus pallidus on T1 weighted image. These intensities disappeared almost completely six months after cessation of exposure. 18F-6-fluorodopa (18F-dopa) positron emission tomography (PET) findings showed reduced 18F-dopa uptake in the left putamen, findings which appear in idiopathic parkinsonism. A PET study is necessary to distinguish manganism from idiopathic parkinsonism, especially in a working environment with elevated Mn concentrations, such as welding.

Killing effects of 5-fluorouracil on human biliary tract cancer cell lines

Data concerning the cellular sensitivity of human biliary tract cancer cell lines to 5-FU are scarce. The purpose of the present study was to evaluate the cellular sensitivity of Mz-ChA-2 (derived from gall bladder cancer) and SK-ChA-1 (derived from bile duct cancer) to 5-FU. The clonogenic capacity of these lines after pulse (1 h) or continuous (168 h) administration of various 5-FU concentrations (0.1-100 microg/ml) was evaluated in exponentially growing cells as well as in those that had reached the plateau phase. In both cell lines, exponentially growing cells were 1.8-times more susceptible to 5-FU than those in plateau phase. However, when cells in the same growth phase were compared, Mz-ChA-2 cells were 10 times more sensitive to the drug than SK-ChA-1 cells. Regardless of the growth phase or cell line, increasing the duration of exposure to 5-FU decreased the proportion of surviving cells. Even at a non-cytocidal dosage, exposing the cells for three doubling times markedly decreased the number of viable cells remaining after treatment.

Special medical examination program reform proposal in Korea

We are at a time when reform in the special medical examination program in keeping with the changing times is desperately needed because the common perception of workers, employers, and medical examination facilities is "special medical examination is merely ritualistic and unproductive." Therefore, we have tried to set forth the basic structure for reforming the special medical examination program by taking a close look at the management status of the current program and analyzing its problems. The specifics of the special medical examination program reform proposal consist of three parts such as the types, health evaluation based on occupational medicine, and the interval, subject selection, items and procedure. Pre-placement medical examination and non-periodic medical examinations-as-necessary are introduced newly. Health evaluation based on occupational medicine consists of classification of health status, evaluation of work suitability, and post-examination measure. Details regarding the medical examination interval, subject selection, items and procedure were changed.