Artificial intelligence-enabled prediction of chemotherapy-induced cardiotoxicity from baseline electrocardiograms

Anthracyclines can cause cancer therapy-related cardiac dysfunction (CTRCD) that adversely affects prognosis. Despite guideline recommendations, only half of the patients undergo surveillance echocardiograms. An AI model detecting reduced left ventricular ejection fraction from 12-lead electrocardiograms (ECG) (AI-EF model) suggests ECG features reflect left ventricular pathophysiology. We hypothesized that AI could predict CTRCD from baseline ECG, leveraging the AI-EF model's insights, and developed the AI-CTRCD model using transfer learning on the AI-EF model. In 1011 anthracycline-treated patients, 8.7% experienced CTRCD. High AI-CTRCD scores indicated elevated CTRCD risk (hazard ratio (HR), 2.66; 95% CI 1.73-4.10; log-rank p < 0.001). This remained consistent after adjusting for risk factors (adjusted HR, 2.57; 95% CI 1.62-4.10; p < 0.001). AI-CTRCD score enhanced prediction beyond known factors (time-dependent AUC for 2 years: 0.78 with AI-CTRCD score vs. 0.74 without; p = 0.005). In conclusion, the AI model robustly stratified CTRCD risk from baseline ECG.

Ginkgo biloba extract EGb 761 attenuates hippocampal neuronal loss and cognitive dysfunction resulting from chronic restraint stress in ovariectomized rats

We have recently found that a combination of ovariectomy (OVX) and chronic restraint stress causes cognitive dysfunction and reduces hippocampal CA3 neurons in female rats and that estrogen replacement suppresses the OVX/stress-induced behavioral and morphological changes. In this study, we examined the effect of Ginkgo biloba extract (EGb 761), a popular herbal supplement, on the cognitive dysfunction and neuromorphological change in OVX/stress-subjected rats. Female Fisher 344 rats were randomly divided into three groups: vehicle-treated OVX, EGb 761 (50 mg/kg) -treated OVX and vehicle-treated sham-operated control groups. Two months after ovariectomy, all animals received restraint stress for 21 days (6 h/day), and were then subjected to a novel object recognition test followed by morphological examination by Nissl staining. EGb 761 was orally administered once daily until the behavioral analysis was done. Treatment with EGb 761 improved memory impairment and neuronal loss of hippocampus in the OVX/stress-subjected group in the same ways as 17beta-estradiol. On the other hand, EGb 761 did not affect the loss of bone mineral density and increase in body weight after OVX, although 17beta-estradiol attenuated them. These results have important implications for neuroprotective and cognition enhancing effects of EGb 761 in postmenopausal women and suggest that the effects are mediated by a different mechanism from estrogen.

17beta-estradiol attenuates hippocampal neuronal loss and cognitive dysfunction induced by chronic restraint stress in ovariectomized rats

Several lines of evidence suggest that hormonal changes after menopause may play an important role in the incidence of cognitive dysfunction, and also in the development of Alzheimer's disease. In this study, we investigated the effect of estrogen on cognitive function in rats under different stress environment. Female rats were divided into four groups: two groups were ovariectomized (OVX) and two were sham-operated. One group each of OVX and sham rats was kept in a normal environment, and the other groups were assigned to a daily restraint stress (6 h/day) for 21 days from 2 months after the operation. Following the stress period, subjects were tested for performance in novel object recognition test and then used for morphological and neurochemical analyses. The OVX plus stress (OVX/stress) group showed a significant impairment of recognition of novel objects, compared with the other groups. The OVX/stress group also showed a marked decrease in the number of pyramidal cells of the CA3 region and levels of brain-derived neurotrophic factor mRNA in the hippocampus. We further examined the effect of estrogen against cognitive dysfunction and hippocampal changes of OVX/stress rats. Vehicle or 17beta-estradiol (E2) at 20 microg/day was s.c. administered to OVX/stress rats from 2 days before the stress period to the end of behavioral analysis through an implantable osmotic pump. Chronic E2 treatment decreased stress response and improved the cognitive and morphological impairments relative to vehicle group. These data have important implications for cognition enhancing effect of estrogen treatment in postmenopausal women.

Polymorphisms of the insulin gene among Japanese subjects

We have sequenced the insulin gene in 72 unrelated Japanese subjects (52 with type 2 diabetes mellitus and 20 with normal glucose tolerance). We identified 6 mutations and all were found at a low frequency (1% to 4%). Three mutations were new. These included a C-to-G substitution in the promoter region, a G-to-A substitution in codon-2 resulting in an Ala-to-Thr replacement in amino acid -2 of the signal peptide, and a G-to-A substitution in intron 2. We have no evidence that any of the mutations that we found are the cause of diabetes. Thus, mutations in the insulin gene do not appear to be an important genetic factor contributing to the development of diabetes in this population.

Risk factors for distant recurrence of hepatocellular carcinoma in the liver after complete coagulation by microwave or radiofrequency ablation

BACKGROUND

In patients with hepatocellular carcinoma (HCC), recurrences in the distant liver often are observed after curative treatment. Microwave coagulation therapy (MCT) and radiofrequency ablation (RFA) have been developed as less invasive alternatives than surgical resection for small HCCs. In the current study, risk factors for distant recurrence of HCC were analyzed in patients in whom complete coagulation was achieved.

METHODS

Ninety-two patients with HCCs < 3 cm in greatest dimension were treated by MCT or RFA percutaneously or laparoscopically. Eighty-four patients in whom complete coagulation was achieved without recurrence in the same subsegment as the primary nodule were included in this study. Distant recurrences were observed in 22 patients. Fifteen possible risk factors for a distant recurrence were analyzed.

RESULTS

When comparing the patients with a recurrence of HCC nodules in the remnant liver to those without recurrence, the authors observed a statistically significant difference only in serum alpha-fetoprotein. The distant recurrence-free survival was analyzed by the Kaplan-Meier method. A statistically significant difference was observed in hepatitis C virus (HCV) infection as an etiopathic agent of underlying liver diseases (P < 0.005) and in the number of the primary HCC nodules (P < 0.05, log-rank test). A multivariate stepwise Cox hazard model revealed that HCV infection and the number of primary HCC nodules were statistically independent risk factors.

CONCLUSIONS

Patients who had more than two HCC nodules accompanied by HCV infection had a high incidence of recurrence of HCC in the remnant liver, even when coagulation by microwave or ablation by radiofrequency was complete.

Takayasu arteritis: diagnosis with breath-hold contrast-enhanced three-dimensional MR angiography

The purpose of the study was to determine the diagnostic accuracy of breath-hold contrast-enhanced three-dimensional (3D) magnetic resonance (MR) angiography in Takayasu arteritis. Thirty patients suspected of having Takayasu arteritis were examined with MR angiography and conventional angiography. Takayasu arteritis was diagnosed in 20 of these patients. MR angiography was performed using a 1.5-T system after bolus injection of 0.1 mmol/kg of gadodiamide. MR angiography clearly depicted various vascular lesions in the aorta and its major branches in all 20 patients with Takayasu arteritis. It also depicted pulmonary artery lesions in 10 (50%) of the 20 patients. MR angiography accurately depicted 323 (98%) of 330 arteries, but 7 (2%) stenotic arteries were overestimated as occluded. The sensitivity and specificity of MR angiography for the diagnosis of Takayasu arteritis were both 100%. Breath-hold contrast-enhanced 3D MR angiography clearly depicts various vascular lesions in both the systemic and pulmonary arteries in Takayasu arteritis, thus allowing a definitive diagnosis of Takayasu arteritis.

Renal artery lesions in patients with moyamoya disease: angiographic findings

BACKGROUND AND PURPOSE

Renal artery lesions in moyamoya disease have been described sporadically in several case reports. The purpose of this study is to evaluate the angiographic findings of renal artery lesions in moyamoya disease and to determine the prevalence of renal artery lesions in patients with moyamoya disease.

METHODS

Eighty-six consecutive patients with idiopathic moyamoya disease were prospectively examined with both cerebral angiography and abdominal aortography. The findings of abdominal aortography were reviewed for the presence and appearance of renal artery lesions and compared with the clinical data and cerebral angiographic findings.

RESULTS

Of 86 patients with idiopathic moyamoya disease, 7 patients (8%) were found to have renal artery lesions. Six patients (7%) had stenosis in the renal artery, and 1 patient (1%) had a small saccular aneurysm in the renal artery. Two patients (2%) with a marked renal artery stenosis presented with renovascular hypertension, which resulted in an intraventricular hemorrhage in 1 patient. Furthermore, the renal artery stenosis in the 2 patients with renovascular hypertension was successfully treated with percutaneous transluminal angioplasty. There was no significant correlation between the presence of renal artery lesions and cerebral angiographic findings.

CONCLUSIONS

Seven (8%) of 86 patients with moyamoya disease showed renal artery lesions, including 6 stenoses (7%) and 1 aneurysm (1%). Renal artery lesions are a clinically relevant systemic manifestation in patients with moyamoya disease.

Moyamoya disease: evaluation with diffusion-weighted and perfusion echo-planar MR imaging

PURPOSE

To determine the clinical efficacy of diffusion-weighted and perfusion echo-planar magnetic resonance (MR) imaging in the evaluation of moyamoya disease.

MATERIALS AND METHODS

Seventeen patients with moyamoya disease were examined prospectively with diffusion-weighted and perfusion echo-planar MR imaging and conventional angiography. The change in the effective transverse relaxation rate (delta R2*) peak value, delta R2* peak time, and delta R2* integral were calculated to assess regional cerebral perfusion. The MR images were compared with angiographic images.

RESULTS

Of the 34 posterior cerebral arteries (PCAs) of the 17 patients, 14 PCAs (41%) in 11 patients showed stenosis or occlusion. The delta R2* peak value ratio in the cerebral hemispheres decreased significantly, and the delta R2* peak time ratio increased significantly, with PCA stenosis and occlusion. However, no correlation was apparent between perfusion and extent of the stenotic or occlusive lesions of the internal carotid artery bifurcation. The frequency of cerebral infarctions was significantly increased in patients with stenotic or occlusive PCA lesions. For three acute infarctions, a decrease in the apparent diffusion coefficient was significantly correlated with a decrease in the delta R2* peak value, an increase in the delta R2* peak time, and a decrease in the delta R2* integral.

CONCLUSION

Regional cerebral perfusion in moyamoya disease is decreased and delayed with PCA stenosis, with greater decrease and delay with PCA occlusion. Diffusion-weighted and perfusion imaging are useful for evaluating cerebral ischemia in moyamoya disease.

Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging

PURPOSE

To determine the true diffusion coefficients of abdominal organs and hepatic lesions with intravoxel incoherent motion (IVIM) echo-planar magnetic resonance (MR) imaging.

MATERIALS AND METHODS

Seventy-eight patients suspected of having hepatic lesions were examined with IVIM echo-planar MR imaging at 1.5 T. There were 77 hepatic masses (27 hepatocellular carcinomas, 10 metastatic tumors, eight hemangiomas, and 32 cysts) in the 78 patients. The true diffusion coefficient D and the perfusion fraction f were calculated and compared with the apparent diffusion coefficient (ADC).

RESULTS

Specific values of D were found for abdominal organs (liver, 0.72 x 10(-3) mm2/sec; spleen, 0.80 x 10(-3) mm2/sec; kidney, 1.38 x 10(-3) mm2/sec; gallbladder, 2.82 x 10(-3) mm2/sec) and for hepatic lesions (hepatocellular carcinoma, 1.02 x 10(-3) mm2/sec; metastasis, 1.16 x 10(-3) mm2/sec; hemangioma, 1.31 x 10(-3) mm2/sec; cysts, 3.03 x 10(-3) mm2/sec). The ADCs of solid organs and solid lesions were significantly higher than their D values, indicating a high contribution of perfusion to the ADCs.

CONCLUSION

Perfusion contributes to the ADCs of abdominal organs and hepatic lesions. The D and f values are useful for the characterization of hepatic lesions.

Takayasu arteritis: evaluation of the thoracic aorta with CT angiography

PURPOSE

To determine the diagnostic accuracy of computed tomographic (CT) angiography in the evaluation of Takayasu arteritis.

MATERIALS AND METHODS

Twenty-five patients with clinical symptoms suggestive of Takayasu arteritis underwent CT angiography and conventional angiography. Takayasu arteritis was diagnosed in 20 patients on the basis of conventional angiography. CT angiography was performed with a helical CT scanner after injection of a bolus of contrast material, and images were generated for three-dimensional display, multiplanar reformation, and maximum intensity projection. For vascular assessment, all images from CT angiography were used, and the results were compared with those from conventional angiography.

RESULTS

CT angiography clearly depicted various luminal changes, including stenosis, occlusion, dilatation, and aneurysm, in the thoracic aorta and its major branches. CT angiography accurately depicted 190 (95%) of 200 arteries, although the extent of the steno-occlusive lesions was overestimated in five (2%) and underestimated in five (2%). Furthermore, CT angiography depicted mural changes, including wall thickening, calcification, and mural thrombi, not seen with conventional angiography. The sensitivity and specificity of CT angiography in the diagnosis of Takayasu arteritis were 95% and 100%, respectively.

CONCLUSION

CT angiography clearly depicts both luminal and mural changes in the thoracic aorta and its major branches and has a high accuracy in the diagnosis of Takayasu arteritis.

Aberrant left gastric vein demonstrated by helical CT

PURPOSE

Our goal was to describe the CT findings of aberrant left gastric vein (ALGV) and to evaluate the clinical significance of this vein.

METHOD

Four patients in whom ALGVs were demonstrated by helical CT were examined. Each patient had either intrahepatic cholangiocarcinoma, cirrhosis with gastric varices, chronic hepatitis, or nonspecific abdominal pain. All patients underwent two phase helical CT, and the patient with cholangiocarcinoma underwent CT during arterial portography, and 3D images of the abdominal veins were obtained.

RESULTS

In all patients, the ALGVs ran along the hepatogastric ligament and were directly connected with the left portal branch. In the patient with cholangiocarcinoma, the portal vein had severe stenosis by tumor invasion, and both the ALGV and the aberrant right gastric vein functioned as a collateral pathway of the portal flow into the liver. In the patient with cirrhosis, dilated ALGV with hepatofugal flow caused gastric varices.

CONCLUSION

The ALGV is directly connected with the left portal branch and may play an important role in the collateral pathway of the portal system.

Differential diagnosis of early homogeneously enhancing hepatocellular carcinoma and hemangioma by two-phase CT

PURPOSE

Our goal was to differentiate between early homogeneously enhancing hepatocellular carcinoma (HCC) and hemangioma by two-phase CT.

METHOD

Two phase images of 51 HCCs and 28 hemangiomas showing homogeneous high attenuation in the first series (arterial dominant phase) were reviewed. Enhancement patterns of the lesions in the second series (parenchymal phase) were classified as homogeneous high, peripheral high, iso-, and low attenuation. The attenuation values of all and the enhancement values of some (21 HCCs and 18 hemangiomas) in the first series were calculated.

RESULTS

Although low and peripheral high attenuation patterns were seen during the second series only in HCCs (n = 35), which could be used to correctly diagnose HCC, other nonspecific patterns were demonstrated in both HCCs (n = 16) and hemangiomas (n = 28). The attenuation values of 49 of the 51 HCCs and 5 of the 28 hemangiomas were below 130 HU on the first series. The enhancement values of all 21 HCCs and 3 of 18 hemangiomas were below 70 HU. Combining the enhancement patterns with a borderline attenuation value of 130 HU or borderline enhancement value of 70 HU yielded overall accuracies of 94 and 92%, respectively.

CONCLUSION

The combined criteria (enhancement pattern plus attenuation or enhancement value) were useful for differentiating between early homogeneously enhancing HCCs and hemangiomas.

Segmental anatomy of the liver under the right diaphragmatic dome: evaluation with axial CT

PURPOSE

To evaluate the segmental anatomy of the liver under the right side of the diaphragm with axial computed tomography (CT).

MATERIALS AND METHODS

Forty-six patients underwent CT arteriography with selective catheterization of the right hepatic artery in 25 cases, the left hepatic artery in 12, the anterior branch of the right hepatic artery in six, the posterior branch of the right hepatic artery in five, the superior anterior branch of the right hepatic artery in 10, and the superior posterior branch of the right hepatic artery in eight.

RESULTS

The boundary between the right and left lobes shifted by 16.2 degrees +/- 16.8 anteriorly, and the boundary between the anterior and posterior segments shifted by 43.9 degrees +/- 14.0 posteriorly to the line through the middle or right hepatic vein from the inferior vena cava. The top of the liver consisted of both lobes in 22 patients, only the right lobe in 17, and only the left lobe in two. Participation of segment 7 in the top was not demonstrated.

CONCLUSION

The line that extends beyond the middle or right hepatic vein from the inferior vena cava does not coincide with the main or right longitudinal scissura on axial images of the upper portion of the liver.

Angiographic findings in Buerger disease

To clarify the angiographic findings in patients with Buerger disease and to elucidate the relationship between the angiographic findings and the clinical prognosis, 144 angiographic images of the lower extremities of 119 patients with Buerger disease have been studied. The present study has included patient data in our previous report. Results of this study revealed that in lower extremities showing a femoropopliteal arterial occlusion (n = 57), the frequency of gangrene was significantly lower statistically in limbs in which the main arteries of the lower leg and foot were well visualized (2 (12%) of 17 limbs) than in limbs in which the main arteries did not visualize (25 (63%) of 40 limbs) (P < 0.001). Further, in lower extremities showing a crural arterial occlusion (n = 59), the incidence of pedal gangrene increased as the extent of pedal arterial occlusion increased, though this rise was not statistically significant. Also, the collateral vessels had a 'corkscrew' appearance in 39 (27%) of 144 limbs affected by Buerger disease, whereas this appearance was seen in only 2 (3%) of 63 limbs of patients with arteriosclerosis obliterans (P < 0.001). Another finding of this study is that corkscrew-shaped vessels that extend from the sites of the arterial occlusion to the periphery of the feet without opacification of the main pedal arteries indicate a poor prognosis. Based on the above findings, we thus believe that the appearance of corkscrew-shaped vessels is the most characteristic feature of Buerger disease and that each represents a dilated vasa vasorum of the occluded main arteries.

Preliminary results of concurrent methotrexate, cisplatin and radiation treatment for locally advanced urothelial cancers

Ten patients with invasive bladder cancer and one with locally advanced renal pelvic cancer were treated with concurrent methotrexate, cisplatin and radiotherapy. Methotrexate 30 mg/m2 was administered intravenously on the day of the initiation of radiotherapy and cisplatin 70 mg/m2 on the second day. The number of chemotherapy cycles delivered was 1 in 7 patients and 2 in 4. The median dose of radiation was 50 Gy. Of 11 patients, 7 (64%) achieved a partial response and 4 had no change in disease. The median duration of response was 16 months for patients with a partial response. Six patients with a partial response (55%) are alive for a median of 22.5 months and 2 of 4 with no change are alive for 4 and 15 months, respectively. Leukopenia less than 3000 cell/mm3 was observed in 4 (36%) and thrombocytopenia less than 100,000 cells/mm3 in 3 (27%). Local control could be achieved safely with concurrent methotrexate, cisplatin and radiation therapy in patients with locally advanced urothelial cancer who were unsuitable for surgery.

Evaluation of the argyrophilic nucleolar organizer region, nuclear DNA content and mean nuclear area in transitional cell carcinoma of bladder using a quantitative image analyzer

To search for reliable parameters that reflect the biological potential of bladder cancer, the argyrophilic nucleolar organizer region (AgNOR), nuclear DNA content and mean nuclear area (MNA) were studied in paraffin-embedded materials of 75 primary transitional cell carcinomas (TCCs) using a quantitative image analyzer, and were also compared with histological findings and prognosis. The AgNOR parameters studied were the mean AgNOR count (C-AgNOR) and the percentage of cells exhibiting more than 4 AgNOR dots within nuclei (P-AgNOR), whereas the DNA parameters were the 2c deviation index (2cDI) and 5c exceeding rate (5cER). These 5 parameters significantly correlated with the histological grade (p < 0.0001, respectively). Similarly, these 5 parameters correlated with the histological stage, but the correlation was higher in 2cDI and 5cER (p < 0.0001, respectively) in comparison with the AgNOR parameters and MNA. Using univariate analysis, the prognostic relevance was noted in all but P-AgNOR. The 5cER value could discriminate histological grade-II tumors in relation to prognosis, whereas the remaining parameters could not. In addition, the significant difference between noninvasive and invasive tumors was noted in 2cDI and 5cER (p < 0.05, respectively), but not in C-AgNOR, P-AgNOR and MNA. These results suggest that (i) 2cDI and 5cER exhibit superiority over the AgNOR parameters and MNA in predicting survival, and (ii) in histological grade-II tumors, evaluation of the 5cER value is most important when predicting survival as well as judging the necessity for further aggressive treatment in patients with TCCs of the bladder.

Posterior circulation in moyamoya disease: angiographic study

PURPOSE

To clarify the angiographic findings of the posterior circulation in patients with moyamoya disease.

MATERIALS AND METHODS

Seventy-six patients with idiopathic moyamoya disease were studied with conventional angiography. The angiographic findings were reviewed for steno-occlusive lesions, collateral vessels, and aneurysms and compared with the finding of parenchymal lesions on computed tomographic and magnetic resonance images.

RESULTS

Of 152 posterior cerebral arteries (PCAs), 66 (43%) had a stenotic or occluded lesion. The frequency of PCA lesions statistically significantly increased with the extent of the internal carotid artery (ICA) bifurcation steno-occlusive lesion. As the severity of ICA stenosis increased, basal cerebral moyamoya vessels and transdural collateral vessels similarly increased in number, but leptomeningeal collateral vessels decreased owing to the progressive development of more PCA lesions. Cerebral infarctions, ventricular dilatation, and cerebral atrophy were found to increase in frequency in patients with steno-occlusive PCA lesions.

CONCLUSION

Steno-occlusive lesions of the PCA increase in frequency proportionally with severity of ICA bifurcation steno-occlusive lesions, so that cerebral infarctions increase in frequency with the extent of the PCA lesions.

Hepatic hemangioma: findings with two-phase CT

PURPOSE

To characterize the appearance of hemagiomas at two-phase dynamic incremental computed tomography (CT) and to determine the cause of contrast material enhancement of adjacent parenchyma in the first series.

MATERIALS AND METHODS

Contrast-enhanced CT images of 51 hemangiomas in 20 patients were reviewed. Enhancement patterns of hemangiomas in the first series were classified as homogeneous high, peripheral high, and low attenuation; in the second series, as homogeneous high, peripheral high, iso-, and low attenuation. Correlations between arterioportal shunts and early parenchymal enhancement were evaluated in 45 hemangiomas in the 17 patients who underwent angiography.

RESULTS

Thirty-two hemangiomas progressively became enhanced. Four had low and eight had homogeneous high attenuation in both series. Seven changed from homogeneous high to isoattenuation. Early parenchymal enhancement was well correlated with presence of arterioportal shunt.

CONCLUSION

Low-attenuation hemangiomas and those that changed from homogeneous high to isoattenuation are atypical and difficult to differentiate from other neoplasms. Most early parenchymal enhancement is caused by associated arterioportal shunts.

Hepatic pseudolesion in the left lobe around the falciform ligament at helical CT

PURPOSE

To determine the prevalence and possible cause of pseudolesions in the left hepatic lobe around the falciform ligament at hepatic helical computed tomography (CT).

MATERIALS AND METHODS

Portal venous-dominant CT scans of 472 consecutive patients were reviewed. CT of the left hepatic lobe was performed after injection of contrast material into the portal vein in 73 patients, the hepatic artery in 32, and the internal thoracic artery in four. The scans were compared with those obtained at helical CT, and the findings were analyzed.

RESULTS

Pseudolesions were seen on 64 (14%) of 472 helical CT scans and correlated well (accuracy, 96%) with portal perfusion defects. They were not more enhanced than the surrounding liver parenchyma at CT arteriography with hepatic artery injection but were enhanced in two patients at CT arteriography with internal thoracic artery injection.

CONCLUSION

Pseudolesions are caused by portal perfusion defects and may receive an aberrant blood supply.

Neoadjuvant chemotherapy for locally advanced urothelial cancer of the upper urinary tract

Cisplatin-based multiple-drug chemotherapy is currently considered the most effective treatment for advanced and metastatic urothelial cancers. We treated 15 patients with locally advanced urothelial cancers of the upper urinary tract using the cisplatin-based multiple-drug regimen in a neoadjuvant setting. The regimens administered were: M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin); MEC (methotrexate, etoposide and cisplatin), or M-VEC (methotrexate, vinblastine, epirubicin and cisplatin). Total nephroureterectomy was performed in all patients and response was evaluated pathologically Of 15 patients 2 (13%) achieved a pathological complete response, 6 (40%) a pathological partial response, for an overall response rate of 53% (95% confidence limits 29-77%). The median durations of response were 54 months for patients with a pathological complete response and 15.5 months for patients with a pathological partial response. One of six patients with a pathological partial response and 4 of 7 with no remission died of cancer. While a positive relationship between the pathological response and prognosis was observed, adequate follow-up is needed to assess the ability of neoadjuvant chemotherapy to improve the prognosis of patients with locally advanced urothelial cancer of the upper urinary tract.

[Angiography in vasculitis]

The method of angiography in vasculitis has recently been changed due to the development of digital subtraction angiography (DSA). Intra-venous DSA is widely used in the diagnosis of vasculitis, although intra-arterial DSA is needed for depicting small vessel lesions. Low-osmolality contrast medium is another advancement in the angiography of vasculitis, which can make peripheral angiography painless. We discussed angiographic features in vasculitis diseases, including Takayasu arteritis, Buerger disease, moyamoya disease, and vasculo-Behçet disease. Angiography is the most important in order to diagnose vasculitis and evaluate the degree and extent of disease. Further, interventional radiology, which uses the technic of angiography for the purpose of therapy, is employed for the vascular treatment of vasculitis.

[Reproductive and developmental toxicity study of prednisolone farnesylate (PNF)--study by subcutaneous administration of PNF during the period of fetal organogenesis in rats]

A teratogenicity study of Prednisolone farnesylate (PNF), a newly synthesized corticosteroid, was conducted in Sprague-Dawley rats. This compound was administrated subcutaneously to female rats at dose levels of 0(control), 1, 5 and 25 mg/kg/day, once a day, for 11 days from day 7 to day 17 of pregnancy. In each dose group, 26 or 27 dams were killed on day 20 of pregnancy to examine their fetuses. The remaining 14 or 15 dams of each group were allowed to litter naturally, and observations were made on the postnatal growth and development of their offspring. 1. In the dams treated at doses of 1 mg/kg or more, decreased body weight gains and food consumption and retention of the substance at the injected site were noted. However, general signs, parturition, lactation and nursing behaviors were not affected by the administration of PNF. 2. In the F1 fetuses, no embryonic or fetal lethal effect, fetal retardation and teratogenic effect were noted. 3. In the F1 newborns, the postnatal growth, development, responses, behaviors, learning ability and reproductive ability were not influenced. Additionally, no embryonic or fetal abnormalities of their fetuses (F2) were detected. From these results, the no-effect dose levels of PNF on the parental general states, the parental reproductive ability and those of the F1 offspring are thought to be less than 1 mg/kg/day, 25 mg/kg/day and 25 mg/kg/day, respectively, under the experimental conditions of this study. Moreover, the F2 fetuses are not affected by doses up to 25 mg/kg/day of PNF.

[Reproductive and developmental toxicity study of prednisolone farnesylate (PNF)--study by subcutaneous administration of PNF prior to and in the early stages of pregnancy in rats]

A fertility study of Prednisolone farnesylate (PNF), a newly synthesized corticosteroid, was conducted in Sprague-Dawley rats. This compound was administered subcutaneously at dose levels of 0(control), 0.04, 0.2 and 1 mg/kg/day to males for 63 days before mating and during the mating period, and to females for 14 days before mating, through the mating period and until day 7 of pregnancy. Each 24 male and female rats were mated, and females were killed on day 20 of pregnancy to examine their fetuses. 1. In the parental animals, loss of fur or thin fur and incrustation of treated site occurred in male rats treated at doses of 0.2 mg/kg or more and female rats treated at dose of 1 mg/kg, and at the same dose groups, the thinning of skin, atrophy of the thymus and intention of the substance at the injected site were noted. Moreover, body weight gains and food consumption were suppressed in both sexes treated at the dose of 1 mg/kg. 2. Fertility and reproductive ability in both sexes, and estrus cycles in female rats were not affected by administration of PNF. 3. In the fetuses, no embryonic or fetal lethal effect and teratogenic effect were noted. From these results, the no-effect dose levels of PNF on the parental general states, the parental reproductive ability and those of the fetuses are thought to be 0.04 mg/kg/day, 1 mg/kg/day or more and 1 mg/kg/day or more, respectively, under the experimental conditions of this study.

Influence of calorie restriction on oncogene expression and DNA synthesis during liver regeneration

Controlling calorie intake (CCI) extends healthful life-span by a mechanism that may involve reduced rates of cell division without detriment to inducible cellular responses. To test whether inducible cellular proliferation is preserved by CCI and whether the mRNA expression levels of oncogenes activated by cell division can be reduced by CCI, we evaluated the effect of dietary energy on the hepatocellular proliferative burst and on oncogene and growth factor mRNA expression induced by partial hepatectomy. Eighty Fischer 344 rats were separated into two dietary groups and were fed semipurified diets for 10 weeks that differed only in calories by 40%. Mean hepatic levels of [3H]thymidine incorporation were greater among CCI animals at 18, 24, 28, and 36 hr after partial hepatectomy. The expression of c-fos and c-Ki-ras mRNAs, activated during hepatic regeneration, was reduced by CCI. Peak expression of c-fos among ad libitum fed controls to levels 4-6 times greater than prehepatectomy levels was not detected among CCI animals. Protracted elevated expression of c-Ki-ras among ad libitum fed animals was foreshortened by CCI. These findings demonstrate that inducible cellular proliferative responses are preserved by CCI and that the mRNA expression levels of c-fos and c-Ki-ras activated during cell division are reduced by controlling dietary energy. Preserved inducible cellular responses and lowered oncogene expression during cell division may be attributes of the healthful protective effect of CCI.

Organisms in the prostate and antibiotics in the treatment of postoperative infections

On 24 benign prostatic hyperplasia patients with preoperatively sterile urine, who also had no history of urinary tract infection, the organisms in the prostate obtained through transurethral resection as well as in the anterior urethra were isolated. In 17 patients out of 24, organisms obtained in the prostate were identical to those in the anterior urethra; therefore, it can be concluded that another 7 patients had organisms in the prostate itself before the operation. These results would suggest that sterile urine did not indicate sterile prostate and that organisms in the prostate did not always ascend from the urethra. In the patients who preoperatively received transurethral catheterizations, Streptococcus faecalis was the most predominantly isolated organism in the prostate, which was highly sensitive to ABPC and minocycline and lower to cephems. On the other hand, in the patients with no history of catheterizations, Staphylococcus epidermidis was the most commonly isolated one, which was highly sensitive to ABPC and minocycline as well as cephems. So, in the treatment of the cases with infectious symptoms after transurethral resection of the prostate, ABPC or minocycline should be selected as first-choice drugs rather than cephems.

Unstable chromosome aberrations in bladder and renal cell carcinoma

Structural chromosome aberrations were investigated in 18 bladder carcinoma and 14 renal cell carcinoma patients. Unstable chromosome aberrations, such as breaks, gaps, minutes, and fragments, appeared in varying proportion. Double minutes (dmin) were also observed. In bladder carcinoma, 10 kinds of aberration were observed in 38.8% of the metaphase analyzed, and, in renal cell carcinoma, 7 kinds of aberrations were observed in 15.0%. The frequency of chromosome aberrations observed, and the occurrence of dmin and of aneuploidy, were correlated positively with histopathological grade and stage. From the results obtained here, we conclude that study of chromosome aberrations should be added as one of investigations for evaluating the malignant potential of the tumors.

Analyses of T-cell differentiation from hemopoietic stem cells in the G0 phase by an in vitro method

Using differential radiation sensitivity of components of mouse embryonal thymus, an in vitro method for studying T-cell differentiation from hemopoietic stem cells (HSCs) in the G0 phase was established. Intrathymic T-cell precursors present in embryonal thymus were found to be quite radioresistant (up to 20 Gy), and consequently 25-Gy-irradiated embryonal thymic lobes were used. Thymic lobes (25-Gy irradiated) taken from mouse fetuses (gestation day 15) were placed in Millipore-HA culture plates supported on squares of gelatin foam sponge in 24-well culture plates in which neonatal thymus stromal cells were cultured. HSCs (10(5) cells per well) in the G0 phase were added to these thymic lobes and cocultured at 37 degrees C in a 5% CO2/95% air incubator. Half the culture medium was changed every week. After 3 weeks, a large number of colonies had formed. Immunohistochemical studies and fluorescence-activated cell sorter analyses revealed that the colonizing cells regularly develop and exhibit surface markers characteristic of T cells (Thy-1, IL-2R, L3T4, Lyt-2, etc.). In situ hybridization analyses revealed that mRNA expression for T-cell receptor (TCR) beta chains occurred within colonizing cells. Using a monoclonal antibody (F23.1), expression of TCR beta-chain variable domain (V beta 8) on the surface of these developing T cells was demonstrated. These cells responded to interleukin 2 and/or anti-CD3 monoclonal antibody, indicating functional T cells. This method will be useful in studying T-cell differentiation pathways from pluripotent HSCs and in clarifying the mechanisms involved in negative and positive selection of T cells within the thymus.

Mycoplasmas induce transcription and production of tumor necrosis factor in a monocytic cell line, THP-1, by a protein kinase C-independent pathway

We demonstrated that mycoplasmas (MP), previously shown to augment the antitumor activity of murine peritoneal macrophages, also induce cytotoxic activity in a human monocytic cell line, THP-1. THP-1 cells were induced to produce cytotoxic activity by MP in a time- and dose-dependent manner. By using neutralization by antibody against tumor necrosis factor (TNF), the cytotoxic activity was shown to be due to TNF released from the MP-stimulated cells. Studies with inhibitors of second-messenger pathways and Northern RNA blot analysis indicated that a Ca2(+)-dependent, but not protein kinase C-dependent, biochemical pathway is involved in MP-induced TNF production by THP-1 cells and that MP induce TNF production in the cells at the level of transcription. MP, unlike other bacteria, lack cell walls and lipopolysaccharide. The possible involvement of a TNF production mechanism distinct from that triggered by lipopolysaccharide is discussed.

Bilaterally dilated upper urinary tract and bladder induced by diabetes insipidus

A case of hypothalamic diabetes insipidus accompanied by nonobstructive dilatation of the bladder and upper urinary tract is reported. Treatment with dDAVP resulted in decrease of the urine volume and improvement of dilatation of the urinary tract.

Urological complications in gynaecological diseases. Review of 18 cases requiring diversion or reconstruction of the urinary tract

In 18 gynaecological patients requiring diversion or reconstruction of the urinary tract, the relationship between the urological treatments and their influences on the renal function based on DIP were studied. Double-J catheterization and percutaneous nephrostomy drainage with Fr 8 catheter are easily obstructed due to infection of the urinary tract, so a thicker catheter should be used to maintain drainage. Ureterocutaneostomy is considered to be a suitable method to divert urine in cases of poor general condition and poor prognosis in order to preserve renal function for a longer time.

Expression of oncogenes during rat chemical hepatotumorigenesis promoted by estrogen

To elucidate the role of oncogene expression in hepatocarcinogenesis, we examined the expression of 4 cellular oncogenes (c-myc, c-fos, Ha-ras and c-erbA) in liver tissues induced by chemical agents. Four groups of male Sprague-Dawley rats were examined in the present study. Rats of the first and second groups were given a single intraperitoneal injection of diethylnitrosamine (DEN), 200 mg/kg body weight. Two weeks later, these rats were divided into two groups; the DEN-C group received no further medication, whereas the DEN-DES group was given diethylstilbestrol (DES), 0.5 mg/day, for 12 months. The DEN group was given DEN, 100 ppm, in drinking water for five months as the hepatocellular carcinoma (HCC) group. The DES group was given DES, 0.5 mg/day, from the start for 8 months. Rats of the DEN-DES and DEN groups developed grossly visible hepatic tumors. Significantly higher levels of c-myc gene expression were observed in tissues of HCC of the DEN group and in neoplastic nodules of the DEN-DES groups than in the DES and DEN-C group. The increase of c-myc mRNA seemed to begin after 1 month of treatment and became significant at 4 months in the DEN-DES group. On the other hand, no significant differences in mRNA levels of c-fos, Ha-ras and c-erbA were observed among these four groups. Although the significance of increased c-myc gene expression in neoplastic liver is still not known, it is conceivable that the persistent elevation of c-myc gene expression in the DEN and DEN-DES groups might contribute to the development of rat chemical hepatotumorigenesis.

Expression of oncogenes in human liver disease

To elucidate the role of oncogene expression in hepatocarcinogenesis, we examined the expression of 8 cellular oncogenes by dot blot and/or northern blot analysis in neoplastic, cirrhotic and non-cirrhotic human liver tissues obtained at surgery. Significantly higher levels of c-myc gene expression were observed in tissues of hepatocellular carcinoma (HCC) and adjacent cirrhotic tissues than in apparently normal liver tissues or those of chronic hepatitis (normal-chronic hepatitis). There was a tendency to higher c-myc mRNA levels in HCC than in liver cirrhosis. However, when tumorous and adjacent cirrhotic tissues from the same patient were compared, c-myc mRNA levels were not consistently higher in HCC. No significant differences in mRNA levels of c-fos, N-myc, N-ras, Ha-ras, c-erbA, c-erbB and c-abl were observed among the HCC, cirrhosis and normal-chronic hepatitis groups. Although the significance of increased c-myc gene expression in liver cirrhosis and HCC is still not known, it is conceivable that the persistent elevation of c-myc gene expression in cirrhosis contributes to the development of HCC.

Immunochemical determination of the serum protein reacting with antibody against human urinary trypsin inhibitor by single radial immunodiffusion: use of polyethylene glycol

A single radial immunodiffusion method is described for determining the serum protein which reacts with antibody against the urinary trypsin inhibitor, but does not react with anti-inter-alpha-trypsin inhibitor antibody. Since the amount of this protein could not be determined with an agar plate containing antibody alone, we first prepared an agar plate containing 4% polyethylene glycol 6 000 and 1 mg of anti-urinary trypsin inhibitor gamma-globulin and confirmed that the amount of this protein could be measured accurately from the sizes of precipitin rings after 72 h incubation at room temperature. Levels of this serum protein, alpha 1-antitrypsin, alpha 2-macroglobulin and inter-alpha-trypsin inhibitor were measured in normal human serum by the single radial immunodiffusion method, and it was confirmed that the level of this serum protein did not correlate with the levels of these 3 other proteins.

Shoshin beriberi with severe metabolic acidosis

A case of Shoshin beriberi found in a patient with severe metabolic acidosis and shock was presented. We believe the metabolic acidosis in this case is ascribable to overproduction of pyruvate and lactate resulting from lack of thiamine due to preferential intake of sake, precooked food, and rice, and also to shock. The hemodynamic studies done after recovery from shock revealed that the cardiac output, which was initially high, decreased to a slightly low level and then increased to a normal level, concomitant with an increase in the peripheral vascular resistance after introductory administration of thiamine. After treatment with thiamine, all abnormalities disappeared.