Enhanced recovery after surgery for gastric cancer and an assessment of preoperative carbohydrate loading

BACKGROUND

We previously reported on the feasibility of enhanced recovery after surgery (ERAS) protocol for gastric cancer with a prospective phase II study, but the superiority of this approach over non-ERAS perioperative management remains unclear. Preoperative carbohydrate loading, an important element of the ERAS protocol, has been shown to reduce insulin resistance, but its effects on clinical endpoints in gastric cancer surgery remain controversial. The aim of this study was to clarify the efficacy of the ERAS protocol for gastric cancer surgery, with particular focus on preoperative carbohydrate loading.

METHODS

In this ERAS case-control study, we enrolled 121 patients as a case group and 259 patients undergoing gastrectomy for gastric cancer with our conventional perioperative management as a control group. Matched-pair analysis was performed to balance the patients' characteristics for comparison analysis.

RESULTS

After matching, 108 patients were included in each group. Postoperative hospital stay was significantly shorter in the ERAS group than in the control group (8 days vs. 9 days, p < 0.001), while the incidence of Clavien-Dindo classification grade II or more postoperative complication was similar between the groups (11.1% vs. 15.7%, p = 0.325). No significant differences were found in serum albumin level, body weight, or grip strength between the groups before surgery and at 1 week and 1 month after surgery.

CONCLUSION

Use of the ERAS protocol for gastric cancer shortened the length of postoperative hospital stay without increasing complications. Preoperative carbohydrate loading didn't improve the postoperative nutritional status or maintain the muscle strength postoperatively.

Trace metal levels in serum and urine of a population in southern Brazil

This study aimed to evaluate serum and urine concentrations of several trace metals of a non-directly exposed population in southern Brazil and establish reference values. Serum and urine samples were obtained from 240 volunteers (175 males and 65 females, age ranging from 18 to 74 years old). Levels of arsenic, chromium, cobalt, copper, lead, nickel, manganese and zinc were determined by means of dynamic reaction cell inductively coupled plasma mass spectrometry (DRC-ICP-MS). Comparison between genders resulted in no significant difference for all metals but serum copper, as concentrations are higher in females than males. For most metals assessed, a negative correlation between serum concentrations and age was found, but no significant correlation was found between urine concentrations and age.

Efficacy of adjuvant chemotherapy with S-1 in patients with positive peritoneal cytology (CY1) who underwent R1 surgery

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Background: In recent TNM classification, positive peritoneal cytology (CY1) is regarded as M1 disease and classified into stage IV. However, the prognosis of the CY1 patients underwent R1 surgery (microscopic residual tumor) is considered to be relatively better than those underwent R2 surgery (macroscopic residual tumor). Adjuvant chemotherapy with S-1 had demonstrated significant survival benefit in stage II and III gastric cancer in Japan. However, the efficacy of adjuvant S-1 in patients with relatively more advanced stage had not been investigated. Therefore, we investigated the efficacy of adjuvant chemotherapy with S-1 in CY1 patients underwent R1 surgery.

Methods: Among the 2,202 patients with gastric cancer treated at our department between September 2002 and July 2009, a total of 105 patients with CY1 and underwent R1 surgery were included in this study. Clinocopathological features and survival were retrospectively analyzed using prospectively registered data base system.

Results: There were 64 male and 41 female patients. The median age was 61 years old. Eighty-five patients had T4a or T4b tumor and 96 patients had lymph node metastasis. Seventy-eight patients had undifferentiated type of tumor. In 83 patients, adjuvant chemotherapy with S-1 had been performed. In the uni-variate analysis, only the extent of lymph node dissection (D2) and the adjuvant chemotherapy with S-1 demonstrated significant survival benefit. In multi-variable analysis using Cox proportional hazarded model, N-factor, extent of lymph node dissection (D2 vs D1), and adjuvant chemotherapy with S-1 were selected as independent prognostic factors. The median survival time and 5-year survival rate in patients underwent R1 resection with D2 lymphadenectomy and adjuvant S-1 treatment were 42 months and 46%, respectively.

Conclusions: In patients with CY1 and underwent R1 surgery, adjuvant chemotherapy with S-1 demonstrated significant survival benefit. In patients with positive peritoneal cytology without other non-curative factors, D2 lymph node dissection and adjuvant chemotherapy using S-1 is recommended.

No significant financial relationships to disclose.

Prognostic value of duodenal invasion length in patients with gastric cancer

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Background: Duodenal invasion (DI) has been considered as a poor prognostic factor of gastric cancer patients. Not all the patients would be able to undergo curative operation. Neoadjuvant chemotherapy (NAC) may improve the rate of curative operation of these patients. In this study, we investigated whether the length of duodenal invasion preoperative diagnosis can be one of factor to decide indication of NAC.

Methods: A total of 118 gastric cancer patients with clinically evident DI, who underwent laparotomy at our center, were enrolled in this study. 42 patients with DI length 20 mm or longer were categorized into long invasion group (LI), 76 patients with DI length shorter than 20 mm were categorized into short invasion group (SI). Clinicopathologic features, rate of direct invasion and lymph nodes involvement, R0 resection, and survival rate were compared between two groups.

Results: Resection rate was significantly different between two groups: SI group (85.5%; 65/76), LI group (69.0%; 29/42). Direct invasion to adjacent organs was significantly more frequently observed in LI group (21%; 6/29) than SI group (4 %; 3/65, p = 0.02). In LI group, pancreas invasion was observed in all patients except for one patient. Multivariate analysis to predict the adjacent organ invasion revealed that CT diagnosis (p = 0.005) and invasion length (p = 0.01) were selected as risk factors of direct invasion to adjacent organs. There was no significant difference of nodal involvement between LI group (83%; 24/29) and SI group (83%; 54/65 p = 0.99). The 5-year survival rate was 19% in LI group and 43% in SI group (p = 0.23). The number of patients who underwent R0 resection was more frequently in SI group (75.4%; 49/65) than SI group (69.1%; 16/29). The factors of R1 or R2 resection were metastasis of peritoneum or direct invasion to adjacent organs.

Conclusions: In patients with long duodenal invasion, direct invasion to the pancreas was more frequently observed, and resulted in low curative resection rate and poor survival. Preoperative chemotherapy may improve the curative resection rate and survival in these patients. Prospective study is warranted to evaluate the efficacy of NAC for these patients.

No significant financial relationships to disclose.

Occurrence and antibiotic resistance of coliform bacteria and antimicrobial residues in pasteurized cow's milk from Brazil

In this study we examined the hygienic and sanitary quality of pasteurized cow's milk in the state of Paraná, Brazil, by determining the presence of coliforms and occurrence of antimicrobial residues. A total of 260 milk samples were collected from commercial establishments in different regions of the state. Coliform populations were estimated by the multiple-tube test, and antimicrobial residues were detected by enzyme-linked immunosorbent assay. Overall, 105 samples (40.4%) were unsuitable for consumption according to Brazilian legal standards. Among the coliforms, Escherichia coli and Klebsiella pneumoniae were respectively identified in 77.05 and 36.07% of the samples. The highest rates of resistance to antimicrobial agents were observed for ampicillin (19.2%), cephalothin (18.9%), and tetracycline (17.1%). Antimicrobial residues were detected in 80 samples (30.8%). Forty-eight samples (18.5%) were positive for tetracycline, 29 (17.4%) for neomycin, 9 (3.5%) for beta-lactams, 6 (2.3%) for gentamicin, 4 (1.5%) for chloramphenicol, and 1 (0.4%) for streptomycin-dihydrostreptomycin. The results demonstrate a high prevalence of coliforms and also a high occurrence of antimicrobial residues in pasteurized cow's milk from Paraná, Brazil.

Occurrence of antimicrobial residues in pasteurized milk commercialized in the state of Paraná, Brazil

Milk containing antimicrobial residues presents a health risk to the human population. The objective of this study was to use an enzyme-immunoassay technique to determine the occurrence of antimicrobial residues in 151 samples of pasteurized milk sold in cities of the State of Paraná, Brazil, from March 2005 to April 2006. Fifty-nine (41.3%) of the 151 samples contained antimicrobial residues. Residues of neomycin, streptomycin, and/or dihydrostreptomycin and chloramphenicol were found in three, two, and four, respectively. None of the samples with neomycin residues had levels above the maximum residue limit (MRL) permitted in this country, which is 500 microg/kg. Only one sample had a higher level of streptomycin-dihydrostreptomycin (260 microg/kg) than the MRL (200 microg/kg). The four samples positive for chloramphenicol had levels above the zero tolerance level. In the qualitative analysis, 41 of 151 samples contained tetracyclines (tetracycline, chlortetracycline, and/or oxytetracycline), 4 of 82 samples contained gentamicin, and 5 of 151 samples contained beta-lactams (amoxicillin, ampicillin, ceftiofur, cephapirin, and/or penicillin G). It was not possible to determine whether the levels of the antimicrobials found in the qualitative analyses (tetracyclines, gentamicin, and beta-lactams) were above the MRLs because the detection limits were below the MRLs in Brazil. In nine samples, two or more antimicrobial residues were found. The results demonstrate the need for monitoring various antimicrobial residues in pasteurized milk to ensure safety, quality, and integrity and to protect the health of the Brazilian population.

Relationship between occlusal tooth contact patterns and tightness of proximal tooth contact

The aim of this study was to investigate the relationship between occlusal tooth contact patterns and the tightness of proximal tooth contact (TPTC) during clenching. Twenty young adult volunteers with healthy dentition participated in the study. TPTC between the left second premolar (P2) and the first molar (M1) was measured during clenching at the 50% maximum voluntary contraction level in the intercuspal position (ICP). A silicone impression material was used to make an interocclusal record at the ICP in each subject, and interocclusal records were analysed using an image-processing system. Subjects were classified according to the presence or absence of each type (A, B or C) of occlusal contact. Statistical analysis was performed using the Mann-Whitney U-test. The results of this study exhibited a relationship between B-type contact and the TPTC of maxillary teeth. The experimental group with a lack of B-type contact on maxillary P2 and/or M1 showed a statistically greater TPTC than the group with B-type contact on both of these teeth (P < 0.01). These results suggest that occlusal tooth contact patterns have an influence on TPTC during clenching.

Prognostic value of age and sex in early gastric cancer

BACKGROUND

The need for lymph node dissection in early gastric cancer (EGC) is controversial. The present study investigated the possibility of planning treatment for EGC according to age and sex rather than node status.

METHODS

Overall survival rate and cause of death were analysed according to age (5-year increments) and sex in 4231 patients with EGC. Cox proportional hazard regression analyses were used to identify the most valuable predictor.

RESULTS

In patients with EGC 5- and 10-year cancer-specific survival rates were 98.4 and 96.3 per cent respectively, whereas corresponding overall survival rates were 90.2 and 80.9 per cent. The critical age for determining prognosis was 70 years for men (chi2 = 131.34, P < 0.001) and 75 years for women (chi2 = 64.35, P < 0.001). For both sexes, the 10-year overall survival rate was less than 30 per cent in patients over 80 years old. Multivariate Cox stepwise regression analysis identified age as the most powerful prognostic indicator in EGC. The rate of death from causes unrelated to the tumour increased significantly with age, whereas that from recurrence was not affected by age.

CONCLUSION

Age is a better prognostic indicator than node status in both men and women with EGC. Age and sex should be taken into account as well as conventional clinicopathological variables related to lymph node metastases when determining appropriate therapy for EGC.

Evaluation of proximal tooth contact tightness at rest and during clenching

The aims of this study were to develop a device for measuring the tightness of proximal tooth contact and to evaluate the proximal contact tightness using this device at rest and during clenching. Twenty young adult volunteers with healthy dentition participated in this experiment. The tightness of proximal tooth contact between the second premolar and the first molar of both the maxilla and the mandible was measured by pulling a stainless steel strip between them at rest, and at 20 and 50% clenching levels of maximum voluntary contraction of masseter muscles at intercuspal position. Proximal contact tightness increased as the clenching levels of both the maxilla and the mandible increased. At rest, proximal contact tightness was less in the maxilla than in the mandible, whereas during clenching it was less in the mandible. These results indicate that during clenching, the teeth are displaced and they contact appropriately with adjacent teeth, making it possible to exert sufficient occlusal force while maintaining the integrity of dental arches.

Lymphangiogenesis and the vascular endothelial growth factor receptor (VEGFR)-3 in gastric cancer

Vascular endothelial growth factor C (VEGF-C) is the only factor known to cause lymphangiogenesis. We studied the correlation between VEGF-C and vascular endothelial growth factor receptor-3 (VEGFR-3) expression of 85 primary gastric cancers by reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemistry, and the results were correlated with the number of lymphatic vessels, stained with anti-VEGFR-3 antibody. RT-PCR and immunohistology demonstrated that VEGF-C was mainly produced from cancer cells, but not from stromal elements. Morphologically, VEGFR-3 expression was detected in the endothelial cells of the stromal lymphatic vessels. There was a statistically positive correlation between the incidence of VEGF-C and VEGFR-3 mRNA expression in the primary tumours (P=0.0002). The number of VEGFR-3-positive lymphatic vessels in VEGF-C mRNA positive tumours was significantly larger than that in VEGF-C-negative tumours. The number of VEGFR-3-positive vessels in the tumour stroma was closely related to the grade of lymphatic invasion of gastric cancer. These results strongly indicate that VEGF-C may induce the proliferation of lymphatic vessels in the stroma of primary gastric cancer via activation of VEGFR-3, expressed on the endothelial cells of lymphatic vessels. In these circumstances, cancer cells can easily invade the lymphatic vessel, because of the increase of the contact points of cancer cells with the lymphatic vessels.

Quantitative study of bite force during sleep associated bruxism

Nocturnal bite force during sleep associated bruxism was measured in 10 subjects. Hard acrylic dental appliances were fabricated for the upper and lower dentitions of each subject. Miniature strain-gauge transducers were mounted to the upper dental appliance at the right and left first molar regions. In addition, thin metal plates that contact the strain-gauge transducers were attached to the lower dental appliance. After a 1-week familiarization with the appliances, nocturnal bite force was measured for three nights at the home of each subject. From the 30 recordings, 499 bruxism events that met the definition criteria were selected. The above described system was also used to measure the maximum voluntary bite forces during the daytime. The mean amplitude of detected bruxism events was 22.5 kgf (s.d. 13.0 kgf) and the mean duration was 7.1 s (s.d. 5.3 s). The highest amplitude of nocturnal bite force in individual subjects was 42.3 kgf (15.6-81.2 kgf). Maximum voluntary bite force during the daytime was 79.0 kgf (51.8-99.7 kgf) and the mean ratio of nocturnal/daytime maximum bite force was 53.1% (17.3-111.6%). These data indicate that nocturnal bite force during bruxism can exceed the amplitude of maximum voluntary bite force during the daytime.

[A case of stage IVb (H2P0N4T4) gastric cancer successfully treated with neoadjuvant chemotherapy (PMFE therapy)]

A 69-year-old man was examined at our hospital because of a sense of upper abdominal fullness. He was diagnosed as having stage IVb (H2P0N4T4) gastric cancer and treated with neoadjuvant chemotherapy. One course of the regimen consisted of 10 mg CDDP (day 1-5), 10 mg MMC (day 1), 250 mg 5-FU (day 1-20) and 50 mg ETP (day 6, 7). The patient underwent the regimen three times in succession. After the chemotherapy, his hepatic metastases showed necrotic changes and the swelling of the para-aortic lymph nodes disappeared on a CT scan. A histological examination revealed that the cancer cells had completely vanished both at the site of the hepatic tumor and the para-aortic lymph nodes. This combination chemotherapy, named PMFE therapy, is considered effective without serious side effects for gastric cancer in patients with non-curative factors.

Dye- and gamma probe-guided sentinel lymph node biopsy in breast cancer patients: using patent blue dye and technetium-99m-labeled human serum albumin

BACKGROUND

Sentinel lymph node (SLN) biopsy is a promising method for the diagnosis of the axillary nodal status. We examined the availability of the SLN biopsy using two mapping procedures: the dye- and gamma probe-guided method, and preoperative lymphoscintigraphy by gamma camera imaging.

METHODS

We enrolled 48 patients with breast cancer. Technetium-99m-labeled human serum albumin was injected into the subdermal tissue above the primary tumor or biopsy cavity, and preoperative gamma camera imaging was performed. After induction of general anesthesia, patent blue dye was injected into the peritumoral area prior to the surgical procedure. A handheld gamma-detection probe was used to assist in SLN detection. Careful dissection was performed to identify blue-stained afferent lymphatic vessels and nodes. An SLN was defined as any blue and/or radioactive node, and was excised. After SLN biopsy, axillary lymph node dissection of level I, II, and III was completed, in order to confirm the diagnostic ability of the SLN biopsy.

RESULTS

Intraoperative SLN identification of axillary lesions was successful in 43 of 48 patients (90%). The dye- and gamma probe-guided method was successful in 25 patients (52%), the dye-guided method alone succeeded in 11 patients (23%), and the gamma probe-guided method alone succeeded in 7 patients (15%). Preoperative lymphoscintigraphy revealed axillary focal accumulations in 29 of 48 patients (60%). All patients who underwent successful preoperative SLN identification by lymphoscintigraphy had successful intraoperative SLN identification. A diagnostic accuracy of 95%, a sensitivity of 89%, and a specificity of 100% were achieved in the diagnosis of axillary metastasis. Internal mammary SLNs were identified in four patients intraoperatively, but we could not detect cancer metastasis in the internal mammary SLNs.

CONCLUSIONS

The dye-guided and gamma probe-guided methods were complementary. Preoperative lymphoscintigraphy was useful to predict intraoperative SLN identification. Further study is necessary to assess the role of SLN biopsy of the internal mammary lymph nodes.

Antibacterial activity of Ocimum gratissimum L. essential oil

The essential oil (EO) of Ocimum gratissimum inhibited Staphylococcus aureus at a concentration of 0.75 mg/ml. The minimal inhibitory concentrations (MICs) for Shigella flexineri, Salmonella enteritidis, Escherichia coli, Klebsiella sp., and Proteus mirabilis were at concentrations ranging from 3 to 12 microg/ml. The endpoint was not reached for Pseudomonas aeruginosa (>=24 mg/ml). The MICs of the reference drugs used in this study were similar to those presented in other reports. The minimum bactericidal concentration of EO was within a twofold dilution of the MIC for this organism. The compound that showed antibacterial activity in the EO of O. gratissimum was identified as eugenol and structural findings were further supported by gas chromatography/mass spectra retention time data. The structure was supported by spectroscopic methods.

Intraoperative lavage for cytological examination in 1,297 patients with gastric carcinoma

BACKGROUND

This study examined the clinical value of intraoperative peritoneal lavage for cytological examination in patients with gastric cancer. Peritoneal dissemination is the most frequent mode of recurrence for this tumor.

METHODS

A retrospective of lavage findings, other factors, and outcome was performed in 1,297 patients with gastric cancer who underwent intraoperative peritoneal lavage.

RESULTS

The 5-year survival rate of patients with positive lavage cytology was only 2%. Patients who underwent curative resection and had negative cytology had a significantly better 5-year survival rate (P < 0.001). Even among patients with macroscopic peritoneal dissemination, the survival rate was significantly better with negative cytology, which reflected fewer free cancer cells in the peritoneal cavity. Serum concentrations of carcinoembryonic antigen and carbohydrate antigen 19-9 were significantly higher in patients with positive cytology. Multivariate analyses indicated that intraoperative cytological findings was an independent prognostic factor for survival, and was the most important factor for predicting peritoneal recurrence.

CONCLUSIONS

Intraoperative peritoneal lavage cytology is important in predicting survival and peritoneal recurrence in gastric cancer.

Staging efficacy of breast cancer with sentinel lymphadenectomy

Seventy-two patients underwent dye-guided or dye- and gamma probe-guided sentinel lymphadenectomy (SLND) followed by complete axillary lymph node dissection (ALND). The results of imprint cytology, frozen sections, and permanent sections of the sentinel lymph node (SLN) were compared to each other and to the histologic findings in the nonsentinel nodes. The SLN was identified in 62 (88%) of 72 patients. Evaluation of the SLN on the permanent sections yielded a diagnostic accuracy of 95%, a sensitivity of 89%, and a specificity of 100%, although the reliability of SLN diagnosis using frozen sections or imprint cytology is limited. Therefore, it may be concluded that SLND with multiple sectioning and histopathologic examination of the SLNs can predict the presence or absence of axillary-node metastases in patients with breast cancer. However, further studies will be needed to investigate the value of SLND in respect to the long-term regional control and any possible detriment or benefit to survival, before it can replace routine ALND as the preferred staging operation for operable breast cancer.

[A case report: modified PMUE therapy might be effective for advanced gastric carcinoma with pulmonary carcinomatous lymphangitis]

A regimen featuring a combination of CDDP, MMC, 5-FU and ETP (Modified-PMUE) was given to a patient with advanced gastric cancer containing pulmonary carcinomatous lymphangitis. This procedure made his carcinomatous lymphangitis disappear and primary and metastatic lesions reduce in size. The subsequent palliative reduction surgery for gastric carcinoma, proximal gastrectomy was feasible. Nevertheless, postoperative Modified-PMUE was ineffective: carcinomatous lymphangitis reappeared and progressed to death of respiratory failure postoperative 68 days. The SDI test, a sensitivity test for carcinostatic agent showed neither CDDP, MMC, 5-FU nor ETP sensitive to resected carcinoma cells. Therefore, we concluded that the Modified PMUE kills carcinoma cells sensitive to the agents and allows carcinoma cells resistant to the agents to grow.

A new surgical approach (peritonectomy) for the treatment of peritoneal dissemination

BACKGROUND/AIMS

Despite the improvements of chemotherapy and surgical techniques, treatment results of peritoneal dissemination still remain pessimistic.

METHODOLOGY

During a 10-year period, 106 patients with peritoneal dissemination from gastric cancer were treated with chemo-hyperthermic peritoneal perfusion (CHPP), peritonectomy + CHPP, systemic PMUE therapy, and surgery alone in 51, 15, 13, and 27 patients, respectively. In peritonectomy, disseminated nodules were resected as much as possible in combination with the combined resection of the abdominal organs and parietal peritoneum covering diaphragm, pelvis and abdominal wall. After resection, the abdominal cavity was treated with heated saline at 42-43 degrees, containing cisplatinum (CDDP), Mitomycin C (MMC), and etoposide for 1 hour. PMUE therapy was administered with one course of i.v. infusion of 75 mg/m2 of CDDP and 30 mg/body of MMC on the 1st day, followed by etoposide 50 mg/body on the 3rd, 4th, and 5th day, and with oral intake of 400 mg/body of UFT every day from the 1st day.

RESULTS

No post-operative or chemotherapeutic deaths were observed. Systemic PMUE therapy showed no survival improvement, and survival of the peritonectomy + CHPP group was the best, following CHPP, systemic PMUE and surgery alone.

CONCLUSIONS

Peritonectomy and CHPP may be the best choice for the treatment of peritoneal dissemination.

Sentinel lymphadenectomy in breast cancer: identification of sentinel lymph node and detection of metastases

Sentinel lymphadenectomy is a useful way of assessing axillary status and obviating axillary dissection in patients with node-negative breast cancer. However, controversies remain concerning the optimal method to identify the sentinel lymph node (SLN) and detect micrometastases in this lymph node. We reviewed the literature concerning sentinel lymphadenectomy in breast cancer and reached the following conclusions: (a) A combination of preoperative lymphoscintigraphy with intraoperative dye-guided and gamma probe-guided methods achieves a higher rate of identification of SLN than any of these techniques alone. (b) Immediate and reliable intraoperative assessment of sentinel node status is vital to the technique's success. However, the reliability of sentinel node diagnosis using frozen sections is questionable, because micrometastatic foci cannot always be identified. (c) Hematoxylin and eosin (H&E) staining and/or immunohistochemistry on permanent sections are useful for the detection of micrometastases in the sentinel node. Although a reverse transcriptase-polymerase chain reaction (RT-PCR) method is more sensitive than H&E staining and immunohistochemistry, it would not distinguish benign from malignant epithelial cells in the SLN. Therefore, further study is required before sentinel lymphadenectomy gains general acceptance for patients with primary breast cancer.

Immunohistochemical study of MT-MMP tissue status in gastric carcinoma and correlation with survival analyzed by univariate and multivariate analysis

Matrix metalloproteinase (MMP) expression is associated with advanced-stage cancer and contributes to tumor progression, invasion, and metastasis. Membrane type matrix metalloproteinase (MT-MMP) has a potential transmembrane domain at the C terminus and activates pro-MMP-2, which is mainly produced from interstitial fibroblasts. Its expression on the membrane of invasive tumor cells results in the pericellular space degradation at cell-matrix contact sites and renders cancer cells more invasive at the migration front. To elucidate the relationship between MT-MMP expression and metastasis and prognosis in gastric cancer patients, MT-MMP expression was analyzed immunohistochemically in 127 primary tumors and results were correlated with several prognostic parameters and patient's survival. MT-MMP immunoreactivity was stained on the cell membrane of cancer cells and fibroblasts in the invasion front. MT-MMP was detected in 72 tumors (57%) (MT-MMP-positive). MT-MMP expression was closely associated with macroscopically invasive type, nodal involvement, lymphatic invasion, vessel invasion, and peritoneal dissemination. Patients with MT-MMP-positive tumor had a significantly worse prognosis than those with MT-MMP-negative tumor (p<0.001). Multivariate analysis showed MT-MMP overexpression as an independent prognostic factor in gastric cancer patients. Immunohistochemical analysis for MT-MMP may be an indicator of metastatic potential or the prognosis of gastric cancer patients.

Dye-Guided Sentinel Lymphadenectomy in Clinically Node-Negative and Node-Positive Breast Cancer Patients

BACKGROUND: Sentinel lymphadenectomy has been used to assess the axillary nodal status in patients with breast cancer in an attempt to avoid unnecessary axillary dissection. Most studies have examined the utility of this procedure in clinically node-negative patients. However, the clinical evaluation of axillary nodes is often inaccurate for both clinically node-negative and clinically node-positive patients. METHODS: We performed dye-guided sentinel lymphadenectomy in both clinically node-negative and clinically node-positive patients with breast cancer. All patients also underwent a formal axillary dissection. The results of imprint cytology, frozen sections, and permanent sections of the sentinel lymph node (SLN) werecompared with each other and with histologic findings of the nonsentinel nodes. RESULTS: The SLN was identified in 30 (79%) of 38 patients with clinically negative nodes, and in 11 (92%) of 12 patients with clinically positive nodes. Forclinically node-negative patients, SLN evaluation yielded a diagnostic accuracyof 90%, a sensitivitiy of 72%, and a specificity of 100%. For clinically node-positive patients, these values were 100%, 100% and 100%, respectively. These values were not significantly different for the two groups of patients. CONCLUSION: Sentinel lymphadenectomy may be useful in assessing the axillarynodal status of both clinically node-positive and clinically node-negative breast cancer patients.

The effect of light premature occlusal contact on tooth pain threshold in humans

The purpose of this study was to assess the influence of an experimentally induced light premature occlusal contact on tooth sensation. This assessment involved monitoring the electric tooth pain threshold (TPT) at multiple times before and after altering the occlusal contact. This alteration was produced by placing high inlays, which were measured with a custom made measuring device in maximum intercuspation. Data were collected on 10 teeth in 5 subjects, all whom were male and between the ages of 24 and 30 years. The contact area of the high inlays varied from 75 microm to 193 microm. The TPT changes in these teeth ranged from -43 to +21% of their baseline level. Seven of these teeth showed a significant decrease (P < 0.05) in the TPT, one showed an increase and two did not show a significant change. Two of the teeth with a decreased TPT had cold water triggered occlusal pain, and 2 teeth had only occlusal pain. After several inlay adjustments to eliminate interference in maximum intercuspation, all tested teeth returned to their TPT baseline level and all symptoms disappeared. These results suggested that a light premature occlusal contact may change tooth sensation.

Metabolic engineering of cultured tobacco cells

Construction of a gene expression system in tobacco cultured cells (BY2) was studied. A 925 bp promoter fragment of a heat-shock protein gene (HSP18.2) of Arabidopsis thaliana showed clear heat-shock response of expression of the beta-glucuronidase (GUS) reporter gene in BY2 cells. Similar results were observed in a 500 mL flask and 3-L jar fermentor. Isolation of strong promoters in BY2 cells was tried. cDNA clones, in which the mRNA level is high in log-phase cells and the copy number in the genome is low, were isolated. These clones showed high homology with F1-ATPase (mitochondria type), elongation factor 1-alpha, and a gene with an unknown function of A. thaliana (clone 27), respectively. A 5'-flanking region of clone 27 showed 6.2 times the promoter activity of the CaMV35S promoter in BY2 cells. Three cDNA clones, which are expressed in the stationary growth phase of BY2 cells, were isolated by a differential screening. These clones showed high sequence homologies to alcohol dehydrogenase, pectin esterase, and extensin. Promoters of these genes will be useful in gene expression in high cell-density culture.

Study of jaw movement and masticatory muscle activity during unilateral chewing with and without balancing side molar contacts

This research evaluated the relationship between balancing side molar contacts and chewing patterns measured with a jaw movement analyser and multi-channel electromyography (EMG) of the masticatory muscles. Nine healthy subjects with relatively normal occlusions participated in the experiment and were divided into those with balancing side molar contacts and those without. The block gum chewing task was performed on each side of the mouth for 10 s. The results showed more asymmetrical levels of jaw closing muscle activity during unilateral chewing in the group with balancing side molar contacts when compared with the group without these contacts.

Influence of occlusal force and mandibular position on tooth contacts in lateral excursive movements

The diagnosis and treatment of occlusal disharmonies requires an understanding of the variables that affect occluding tooth contacts. Quantitative recordings of tooth contacts and near tooth contacts are necessary for detailed analysis of occlusion. In this study, different thicknesses of registration strips were used to assess the influence of occlusal force and mandibular position on tooth contacts and clearance. This assessment was made for nonworking side molars and working side premolars. There was a significant decrease in clearance with increased occlusal force on both the nonworking and the working sides. A significant increase of clearance was noted as the mandible moved to the most lateral position on the nonworking side. These results indicate that the variables of occlusal force and mandibular position represent potential sources of disparity in the recording of tooth contacts. These variables should be considered when occlusal examination procedures are conducted.

Evaluation of three occlusal examination methods used to record tooth contacts in lateral excursive movements

Accurate and repeatable methods for recording tooth contacts are required for the clinical management of problems related to occlusion. A thorough understanding of the materials and procedures used in these methods is important to achieve desirable results in the treatment of such problems. This study compared three occlusal examination methods to determine the influence of materials and procedures on the number of tooth contacts recorded. Tooth contacts were analyzed at two lateral mandibular positions with each method. It was found that the method that uses black silicone recorded the highest number of tooth contacts. Thus the most frequent type of occlusal pattern observed was full-balanced occlusion. This study suggested that the disparities of results reported in literature on occlusal contact patterns could be the result of the different materials and methods used for occlusal registration.

Effect of altered occlusal guidance on lateral border movement of the mandible

The purpose of this study was to evaluate the effects of a change in the lateral anterior guidance pathway on the lateral border movement pathway of mandible. The results showed that altered occlusal guidance reproducibly and reversibly changed (increased) the lateral border movement area in two subjects who had unilaterally restricted lateral border movements.

The relationship between lateral border movements of the mandible and the determinants of occlusion

Border movements of the mandible were measured with a jaw movement analyzer in nine subjects. This instrument records movement with 6 degrees of freedom and has the ability to accurately and linearly record the full range of jaw movement. The result of this study showed a relationship between the presence of balancing-side molar contacts and restricted contralateral jaw border movements. This restriction is probably due to aberrant external pterygoid muscle activity.

Fatigue fracture of the ulna occurring in pitchers of fast-pitch softball

We have reported three cases of fatigue fracture of the ulna in male pitchers of fast-pitch softball. To elucidate the etiology of injury, we first selected three healthy male and three healthy female pitchers from a well-trained college team and analyzed their forearm movement by high-speed cinematography. This showed slight flexion of the elbow joints during wind-up motion, dorsal flexion of the hand joints upon releasing the ball, and extreme pronation of the forearms during the follow-through. We then took 8 mm CT scanning sections of the forearms. Using these images, we investigated shapes and areas of cross-sections of the ulna and its cortical and cancellous bones from the elbow to the hand joints. Our results reveal that the shapes of the sections are significantly different from circles at around the center of the ulna, and the cross-sectional areas are smaller in the middle one-third of the ulna than in other parts. These observations imply that fatigue fractures of the ulna in pitchers of fast-pitch softball must be torsionally induced, tending to occur at the middle one-third of the bone.

Hemorrhagic protease from the venom of Calloselasma rhodostoma

1. A hemorrhagic protease I (HP-I) was isolated from Calloselasma rhodostoma venom by Sephadex G-75, DEAE-Sephacel and Q-Sepharose column chromatographies. 2. Homogeneity was established by the formation of a single band in acrylamide gel electrophoresis. 3. HP-I has a molecular weight of 34,800 and possesses hemorrhagic and proteolytic activities. Both activities are inhibited by ethylenediaminetetraacetic acid (EDTA), 1,10-phenanthroline, ethyleneglycolbis-(beta-aminoethyl ether) N,N'-tetraacetic acid (EGTA), and tetraethylenepentamine (TEP). However neither soybean trypsin inhibitor nor p-chlorobenzoic acid (PCMB) were found to have any effect. 4. The toxin contains 311 amino acid residues and exhibits an isoelectric point of 4.5. 5. The A alpha chain of fibrinogen was cleaved first, followed later by the B beta chain.

An auscultatory recording method for blood pressure measurement during exercise

For inspective determination of blood pressure at rest and during exercise, simultaneous recordings of cuff pressure, Korotkov's sounds, and ECG by an electromagnetic oscillograph were necessary. We devised an apparatus in line with the requirement. Results obtained using this apparatus demonstrate that the auscultatory recording method is suitable to determine the blood pressure during submaximal bicycle exercise.

Removing dowels in difficult teeth

An improved method for removing dowels from endodontically treated teeth has been presented. It includes a cast supplementary device that supports the tooth while the dowel is being removed. Although the procedure requires more than one appointment, it provides a safe method for removing the dowel from the tooth.

Occlusion of full cast crown at the intercuspal position

The IP-Checker type MS capable of measuring the height of a crown at the intercuspal position (IP) was invented. The following observations were obtained. 1. The intercuspal position is stable within 5 micrometers. 2. The intercuspal positions shows a higher stability under slight biting than under heavy biting. Under this condition, the teeth show a displacement of about 20 micrometers by the distortion of the periodontal membrane. 3. The crown made by the ordinary procedure is about 30 micrometers higher at the intercuspal position. Therefore, an occlusal adjustment is always necessary. 4. With the current method of occlusal adjustment, adjustment of the crown to a definite height with the maximum error of 10 micrometers is possible in the oral cavity.