Primary Central Nervous System Lymphoma in a Patient with Down Syndrome

Intracranial tumors are rare in persons with Down syndrome. Although germ cell tumors and gliomas have been reported in Down syndrome, primary central nervous system lymphoma (PCNSL) has not. We report a case of PCNSL in a 48-year-old man with Down syndrome and no history of malignant tumors. He visited our hospital for evaluation of left hemiparesis and gait disturbance. A thorough examination revealed brain tumors, and analysis of a biopsy specimen of the tumor confirmed a diagnosis of PCNSL. The final pathological diagnosis was diffuse large B-cell lymphoma of the central nervous system. Chemotherapy with rituximab, methotrexate, procarbazine, and vincristine was administered, and whole-brain irradiation was planned in conjunction with chemotherapy. It is unclear whether chromosomal abnormalities related to Down syndrome were involved in the development of PCNSL. Further molecular biological analysis may clarify the mechanism of combined Down syndrome and PCNSL.

Antitumor effect of memantine is related to the formation of the splicing isoform of GLG1, a decoy FGF‑binding protein

Drug repositioning is a strategy for repurposing the approved or investigational drugs that are outside the scope of the original medical indication. Memantine is used as a non‑competitive N‑methyl‑D‑aspartate receptor antagonist to prevent glutamate‑mediated excitotoxicity in Alzheimer's disease, and is one of the promising agents which is utilized for the purpose of cancer therapy. However, the association between memantine and Golgi glycoprotein 1 (GLG1), an intracellular fibroblast growth factor receptor, in cancers has not yet been clarified. The present study analyzed the expression and location of GLG1 in tumor cells treated with memantine. Memantine was found to suppress the growth of malignant glioma and breast cancer cells in a concentration‑dependent manner. The mRNA expression of GLG1 was upregulated in a concentration‑dependent manner, and the splicing variant profiles were altered in all cell lines examined. The results of western blot analysis revealed an increase in the full‑length and truncated forms of GLG1. Moreover, GLG1 spread in the cytosol of memantine‑treated cells, whereas it localized in the Golgi apparatus in control cells. Since GLG1 functions as a decoy FGF receptor, the modulation of GLG1 may prove to be one of the mechanisms underlying the cancer‑suppressive effects of memantine.

Preliminary Clinical Surgical Experience with Temporary Simultaneous Use of an Endoscope during Exoscopic Neurosurgery: An Observational Study

The use of an endoscope in exoscopic transcranial neurosurgery for skull-base lesions has not yet been investigated. Thus, this study aimed to investigate the advantages, disadvantages, and safety of “simultaneous temporary use of an endoscope during exoscopic surgery” (exo-endoscopic surgery (EES)). Consecutive exo-endoscopic surgeries performed by experienced neurosurgeons and assistants were analyzed. Surgical complications and time were compared with previous consecutive microsurgeries performed by the same surgeon. A questionnaire survey was conducted on 16 neurosurgeons with experience in both “temporary simultaneous use of endoscope during microscopic surgery” (micro-endoscopic surgery (MES)) and EES. EES was performed in 18 of 76 exoscopic surgeries, including tumor removal (n = 10), aneurysm clipping (n = 5), and others (n = 3). There were no significant differences in operative time, anesthesia time, or complications from microsurgery by the same operator. According to the questionnaire survey results, compared with MES, EES had a wider field of view due to its lack of an eyepiece, was easier when loading and unloading instruments into and out of the surgical field, and was more suitable for the simultaneous observation of two fields of view. Overall, 79.2% of surgeons indicated that EES may be better suited than MES to simultaneously observe two fields of view.

MPC-8 Serum anti-zinc finger FYVE domain-containing protein 21 (ZFYVE21) autoantibody as a novel biomarker for oligodendroglioma IDH-mutant and 1p/19q co-deletion

Background: Glioma is one of the most challenging diseases to cure, and it would be beneficial to discover new serum biomarkers for early diagnosis. Moreover, zinc finger FYVE domain-containing protein 21 (ZFYVE21) was a regulator of tumor invasion and migration. In this study, we examined the levels of serum anti-ZFYVE21 antibodies in patients with glioma.

Methods: This is a multicenter observational prospective study to discover a novel serum autologous antibody marker. We analyzed 286 pre-surgically collected sera of CNS tumors and compared them to healthy donors(HD). Bacterially expressed glutathione-S-transferase-fused ZFYVE21 protein was purified, and its antibody levels were measured by amplified luminescent proximity homogeneous assay-linked immunosorbent assay (AlphaLISA).

Results: The anti-ZFYVE21 antibody levels were significantly elevated in patients with gliomas (P<0.001) than those in HD, instead of patients with other CNS tumors. Among gliomas, the highest sensitivity was observed for oligodendroglioma containing IDH mutation and 1p/19q co-deletion to HD (sensitivity: 72.00%, specificity: 67.71%, AUC: 0.7565, P<0.0001), while there is no significance in astrocytoma containing only IDH mutation. In comparing 1p/19q co-deleted oligodendroglioma with IDH-mutated astrocytoma, the sensitivity and specificity were 50% and 100%, respectively.

Conclusion: Serum anti-ZFYVE21 antibodies might be a novel diagnostic marker distinguishing 1p/19q co-deleted oligodendroglioma from IDH-mutant astrocytoma.

BRMP-05. Intraoperative neural tract positioning method for the maximal safe resection of tumors

Brain mapping is a gold standard for the surgery of tumors in eloquent area. Especially subcortical mapping is an essential method for the preservation of important neural fibers conveying motor, sensory and even higher brain functions such as language control. The efforts to estimate the fiber localizations in brain white matter sometimes result in the unprecise identification that is caused by several factors including electrical heterogeneity of brain tissues. To solve this long-standing problem, NY Tract Finder (Yamaguchi Tract Finder) was invented and has been used for intraoperative brain mappings. Now this electrode and method is used in more than 30 major hospitals in Japan, China, Taiwan and Russia. The novel and unique neural fiber positioning technique and our efforts for the maximal preservation of patients’ QOL will be introduced.

Snowfall reduces the risk of chronic subdural hematoma onset: Analysis of an administrative database in Japan

Background:

Chronic subdural hematoma (CSDH) is a frequently observed disease in neurosurgical practice. Although first snowfall has been considered to increase the onset of CSDH, few reports have assessed the relationship between snowfall and CSDH. In this study, we aimed to investigate the relationship between CSDH onset and first snowfall events.

Methods:

This retrospective study was based on the Japanese Diagnosis Procedure Combination inpatient database from July 1, 2010, to March 31, 2016, and on the global observation of snowfall events in Japan obtained from the Japan Meteorological Agency. We used a binomial approximation to evaluate the average number of CSDH patients after first snowfall events compared with that before first snowfall events. We calculated the odds ratio of CSDH onset on the first snowfall.

Results:

We identified 8526 CSDH patients from the database. A total of 5573 (65.4%) were observed before first snowfall events, and 2953 (34.6%) after first snowfall events. The first snowfall of winter was significantly associated with a reduction in the occurrence of CSDH (odds ratio, 0.53; 95% confidence interval; 0.51–0.55). In subgroup analysis, only the first snowfall in October was not associated with reduction in the occurrence of CSDH.

Conclusion:

First snowfall events did not affect the onset of CSDH in Japan.

BT-09 Anhidrosis in neurohypophyseal germinoma treated with CBDCA and VP-16

Introduction: Acquired generalized anhidrosis (AGA) is the disease with non-congenital, non-segmented diffuse sweating dysfunction and is associated with neurological signs and dysautonomia except for anhidrosis. Here we have experienced 2 cases of AGA in the patient with neurohypophyseal germinoma after carboplatin (CBDCA) plus etoposide (VP-16) (CARE) therapy. Relationship of AGA to neurohypophyseal germinomas and their treatment is discussed. Cases: We experienced two young (26 y/o and 27 y/o) female neurohypophyseal germinoma cases of anhidrosis. They received CARE as chemotherapy and whole ventricular irradiation. They showed heat retention 2 to 3 years after initial treatment without recurred germinoma. Because acetylcholine sweating test was negative and skin biopsy revealed normal sweat gland structure, the diagnosis of acquired idiopathic generalized anhidrosis (AIGA), idiopathic pure sudomotor failure subtype, was initially made. After steroid pulse therapy, sweat function recovered partially and completely. Discussion: AIGA and germinoma are both rare diseases. So, the present 2 cases have similar clinical settings, that anhidrosis may not be idiopathic but secondary. Affected responsible site of anhidrosis in the present cases is thought to be acetylcholine receptor in the sweat cells. The present cases did not have any known disease with anhidrosis and did not receive any medication which cause anhidrosis written in the statement of the virtues of a medicine. Commonly used drugs in both cases are infusion solutions, CARE and related drugs, hormone stimulating test agents. Recently anhidrosis is reported in a case of cancer of unknown primary tumor site after using CBDCA and PTX. Both of the present cases are used CBDCA, which may cause anhidrosis. Conclusion: CBDCA may attributed to the occurrence of AGA based on hypothalamic vulnerability.

Preliminary Clinical Microneurosurgical Experience With the 4K3-Dimensional Microvideoscope (ORBEYE) System for Microneurological Surgery: Observation Study

BACKGROUND

The exoscope has been reported as a novel neurosurgical instrumentation in clinical practice.

OBJECTIVE

To investigate the possibility that ORBEYE (OE), a novel instrument that excludes eyepiece lenses and allows for microsurgery by observation of the 4K3D monitor, could replace microscopes.

METHODS

We report 22 clinical cases by 5 experienced neurosurgeons and the comparative results of training 10 residents. An observation study with questionnaire survey was conducted on usability. Twelve items including image quality, eyestrain, and function of the arm were evaluated.

RESULTS

The following 22 clinical procedures were conducted: surgery for intracranial hemorrhage (n = 2) and brain tumor (n = 8), laminectomy (n = 3), aneurysm clipping (n = 3), vascular anastomosis (n = 2), carotid endarterectomy (n = 2), and nerve decompression (n = 1). No complications were observed. The fluorescent study, including indocyanine-green and 5-aminolevunic acid, allowed for clear depiction on the 4K monitor. The surgeon could operate in a comfortable posture. Similar to the microscope, it was possible to change the optical and viewing axes with the OE, but the OE was switched to the microscope or endoscope in hematoma removal and pituitary surgery. Residents judged that eyestrain was strong (P = .0096). Experienced neurosurgeons acting as assistants judged that the scope arm's range of movement was narrow (P = .0204). Sixty percent of residents judged that the OE was superior to the microscope.

CONCLUSION

Although based on limited experience, it was not possible to substitute the microscope with the OE in all operations; however, the OE surpasses the microscope in terms of ergonomic features.

Ultrasound Modulates Fluorescence Strength and ABCG2 mRNA Response to Aminolevulinic Acid in Glioma Cells

BACKGROUND

5-Aminolevulinic Acid (5-ALA) photodiagnosis (PD) is an effective method to detect residual tumors during glioma surgery. However, fluorescence strength differs in malignant gliomas, and false-negative fluorescence may result in tumor residue. We investigated the effect of ultrasound on the intracellular level of protoporphyrin IX (PpIX) and expression level of ATP-binding cassette transporter 2 (ABCG2), which is thought to act as a membrane efflux pump of PpIX from cytosol.

METHODS

The malignant glioma cell lines SNB19, U87MG, and T98G were used for in vitro experiments. Cultured cells underwent ultrasound irradiation (1 MHz, 3 W/cm², duty cycle 10%) after administration of 5-ALA, and morphological changes in tumor cells were observed. PpIX levels and ABCG2 expression were evaluated.

RESULTS

The glioma tumor cells showed transient morphological changes and detachment from the culture dish; however, most cells survived and reverted to their original morphology within 6 hours. PpIX expression levels increased in glioma cells after ultrasound irradiation, and the increase was earlier and greater than that for 5-ALA alone. ABCG2 expressions increased after 5-ALA administration but were lower in ultrasound-irradiated glioma cells.

CONCLUSIONS

Ultrasound irradiation of malignant gliomas contributes to stronger 5-ALA-induced fluorescence by elevating intracellular PpIX levels. Suppression of ABCG2 expression by ultrasound may contribute to PpIX accumulation in glioma cells.

ET-11 ANALYSIS OF ANTI-GLIOMA EFFECT BY PROINFLAMMATORY CYTOKINES

OBJECT

Antiglioma activity of proinflammatory cytokines, (TNF-alpha, IL-2, IL-12 related cytokines, IL-18, IL-32) are analyzed. Most effective combinations of cytokines are investigated.

MATERIAL & METHOD

Antitumor activity against U373MG, U87MG were measured by co-culture with PBMC and by nude mouse subcutaneous transplantation model. Cytokine receptors on PBMC and glioma cell lines were examined by IHC and mRNA expression. Anti-tumor activity was measured by local injection and systemic administration of proinflammatory cytokines. Cell cycle alteration and expression of apoptosis-related genes after cytokine administration was analyzed. Serum concentraion of cytokines is measured by ELISA.

RESULT

Cytokine receptors were not expressed on glioma cells but were present on intratmoral mononuclear cells. Anti-tumor activity against transplanted tumor is strongly observed by focal administration. Expression of apoptosis-related genes were augmented. IFN-gamma was strongly induced by TNF-alpha, IL-2 and IL-12 administration. IFN-gamma, IL-17, TNF-alpha were also induced. IL-27 and IL-32 per se did not induce IFN-gamma. Simultaneous IL-27 and IL-12 induced strong IFN-gamma induction. Anti-glioma activity of IL-12 and IL-23 were higher than the same dose of exogenous IFN-gamma. IFN-gamma, IL-2 plus IL-12 in U373MG, and IFN-gamma, IL-2 plus IL-18 in U87MG seemed to be the best combination.

CONCLUSIONS

Strong anti-glioma activity was induced by proinflammatory cytokines at least partially through IFN-gamma. There may be another factors. IL-2 and IL-23 showed anti-tumor activity through IFN-gamma, IL-17, TNF-alpha. IFN-gamma + IL-2 + IL-12/-18 seems to be the best combination.

Prediction of recovery from supplementary motor area syndrome after brain tumor surgery: preoperative diffusion tensor tractography analysis and postoperative neurological clinical course

OBJECTIVE Previous studies have suggested a correlation between interhemispheric sensorimotor networks and recovery from supplementary motor area (SMA) syndrome. In the present study, the authors examined the hypothesis that interhemispheric connectivity of the primary motor cortex in one hemisphere with the contralateral SMA may be important in the recovery from SMA syndrome. Further, they posited that motor cortical fiber connectivity with the SMA is related to the severity of SMA syndrome. METHODS Patients referred to the authors' neurological surgery department were retrospectively analyzed for this study. All patients with tumors involving the unilateral SMA region, without involvement of the primary motor area, and diagnosed with SMA syndrome in the postoperative period were eligible for inclusion. Preoperative diffusion tensor imaging tractography (DTT) was used to examine the number of fiber tracts (NFidx) connecting the contralateral SMA to the ipsilateral primary motor area via the corpus callosum. Complete neurological examination had been performed in all patients in the pre- and postoperative periods. All patients were divided into two groups: those who recovered from SMA syndrome in ≤ 7 days (early recovery group) and those who recovered in ≥ 8 days (late recovery group). Differences between the two groups were assessed using the Student t-test and the chi-square test. RESULTS Eleven patients (10 men, 1 woman) were included in the study. All patients showed transient postoperative motor deficits because of SMA syndrome. Tractography data revealed NFidx from the contralateral SMA to the ipsilateral primary motor area via the corpus callosum. The mean tumor volume (early 27.87 vs late 50.91 cm³, p = 0.028) and mean NFidx (early 8923.16 vs late 4726.4, p = 0.002) were significantly different between the two groups. Fisher exact test showed a significant difference in the days of recovery from SMA syndrome between patients with an NFidx > 8000 and those with an NFidx < 8000. CONCLUSIONS Diffusion tensor imaging tractography may be useful for predicting the speed of recovery from SMA syndrome. To the authors' knowledge, this is the first DTT study to identify interhemispheric connectivity of the SMA in patients with brain tumors.

Occipital lobe epilepsy was presented in a patient with intracerebral schwannoma: a case report and literature review

Schwannoma arising within brain parenchyma is a rare scenario. So far, only 70 cases were reported. We reported a case of intracerebral schwannoma presented with occipital lobe epilepsy, which has never been reported before. A 19-year-old man suffered from intermittent blurred vision and headache. Neuroradiological findings showed a left occipital lesion with cystic and solid components. Histological and electron micrograph features confirmed the diagnosis of schwannoma after the tumor was totally removed. The theories and literature related to this case were reviewed and the possible developmental origin was discussed. We found that this kind of schwannoma is more often in adolescent and young adults.

An intraoperative motor tract positioning method in brain tumor surgery: technical note

Intraoperative 3D recognition of the motor tract is indispensable to avoiding neural fiber injury in brain tumor surgery. However, precise localization of the tracts is sometimes difficult with conventional mapping methods. Thus, the authors developed a novel brain mapping method that enables the 3D recognition of the motor tract for intrinsic brain tumor surgeries. This technique was performed in 40 consecutive patients with gliomas adjacent to motor tracts that have a risk of intraoperative pyramidal tract damage. Motor tracts were electrically stimulated and identified by a handheld brain-mapping probe, the NY Tract Finder (NYTF). Sixteen-gauge plastic tubes were mounted onto the NYTF and inserted in the estimated direction of the motor tract with reference to navigational information. Only the NYTF was removed, leaving the plastic tubes in their places, immediately after muscle motor evoked potentials were recorded at the minimum stimulation current. Motor tracts were electrically identified in all cases. Three-dimensional information on the position of motor tracts was given by plastic tubes that were neurophysiologically placed. Tips of tubes showed the resection limit during tumor removal. Safe tumor resection with an arbitrary safety margin can be performed by adjusting the length of the plastic tubes. The motor tract positioning method enabled the 3D recognition of the motor tract by surgeons and provided for safe resection of tumors. Tumor resections were performed safely before damaging motor tracts, without any postoperative neurological deterioration.

[A Case of Meralgia Paresthetica Treated with Neurolysis]

A 60-year-old woman presented with a 1-year history of pain and numbness in the left anterolateral thigh. The symptoms aggravated on walking and standing. Her visual analogue scale(VAS)score was 7.1/10. Tinel's like sign was positive over the lateral femoral cutaneous nerve(LFCN), in the inguinal ligament region. LFCN block at the trigger point, in the inguinal ligament, resulted in relief of the symptoms and we diagnosed meralgia paresthetica(MP), which is the entrapment neuropathy of the LFCN. Initially, we performed observation therapy with oral medication and LFCN blocks. However, these treatments failed to relieve the symptoms. Therefore, we performed neurolysis with a microscope under local anesthesia. The symptoms improved immediately after surgery and her VAS score of thigh symptom improved from 7.1 to 1.9 after 3 months. Conservative and surgical treatment for MP generally yield good outcome and we should pay attention to the MP as a differential diagnosis for thigh numbness and pain.

Hyperthermotherapy enhances antitumor effect of 5-aminolevulinic acid-mediated sonodynamic therapy with activation of caspase-dependent apoptotic pathway in human glioma

Sonodynamic therapy (SDT) has shown great potential as an approach for cancer treatment, and hyperthermotherapy (HT) is also a promising cancer therapy. Here, we investigate whether HT could improve the efficacy of SDT and to make a preliminary exploration on potential mechanism. Xenograft tumor was established in nude mice model, and SNB19 and U87MG glioma cell lines were utilized for in vitro experiment. Alamar blue assay was performed to assess cell viability. Optical microscope was used to characterize the morphology changes of the glioma cells induced by SDT and HT treatments. Apoptotic rate, mitochondrial membrane potential (MMP), and intracellular production of reactive oxygen species (ROS) were examined by flow cytometer. The cell apoptosis of tumor tissues were detected by TUNEL assay. Furthermore, the expression of apoptosis-related proteins was detected with Western blot in vitro and immunohistochemistry in vivo. SDT plus HT group could significantly reduce the cell viability with circular-cell morphological change, compared with SDT group, and cell viability was decreased depending on raise of 5-ALA concentration, ultrasound exposure time, and temperature. The results also indicate that HT increased a conspicuous apoptosis, ROS production, and a remarkable loss in MMP induced by 5-ALA-SDT in vitro. Meanwhile, our data also demonstrated that the combined treatment could significantly induce apoptosis and delay tumor growth in vivo. Furthermore, in both in vitro and in vivo experiments, SDT plus HT group expressed significantly higher protein levels of Bax and cleaved caspase-3, 8, and 9 compared to SDT, HT, and control groups and significantly lower protein level of bcl-2 than the other three groups, while the expression of these proteins was unchanged between HT and control groups. HT may provide an important promotion on 5-ALA-SDT and further propose that SDT in combination with HT is a new potential application for the treatment of human glioma.

Anti-allergic Activity of Naringenin Chalcone from a Tomato Skin Extract

The anti-allergic activity of a tomato extract was studied by using an in vitro histamine-release assay. The tomato skin extract exerted the strongest inhibition of histamine release. Chlorogenic acid, rutin and naringenin were identified in the 60% ethanol extract of tomato skin. However, the extract contained an unknown compound which strongly inhibited histamine release. This active compound in tomato skin was identified as naringenin chalcone (trans-2'4'6'4-tetrahydroxychalcone). Naringenin chalcone inhibited histamine release with an IC(50) value of 68 microg/ml. The anti-allergic activity of the tomato skin extract was next investigated by the in vivo mouse ear-swelling response. We found that naringenin chalcone showed the strongest inhibitory effect of the polyphenols of the tomato skin extract. These results indicate that a tomato skin extract could inhibit allergic reactions.

Neuroimaging of primary central nervous system lymphoma in immunocompetent patients: comparison of recent and previous findings

The typical neuroimaging features of primary central nervous system lymphoma (PCNSL) have been described as single or multiple intra-axial, homogenous, contrast-enhancing lesions with marked perilesional edema and restricted diffusion, usually contacting the cerebrospinal fluid surface. Necrosis, peripheral enhancement, hemorrhages, and calcifications are unusual. Recently, some of our patients with PCNSL have had atypical neuroimaging features even before treatment. In this article, we review the neuroimaging characteristics of PCNSL in immunocompetent patients and analyzed how imaging findings over the last 10 years differ from those from more than 10 years ago. Neuroimaging findings suggest that PCNSL is a disease that affects the entire brain. Although some imaging findings are characteristic of PCNSL, the frequency of atypical findings on conventional neuroimaging is increasing. Atypical neuroimaging findings do not rule out PCNSL, even in immunocompetent patients.

A transfection method for short interfering RNA with the lipid-like self-assembling nanotube, A6K

The aim of the present study was to develop a novel transfection method for short interfering RNA (siRNA). A nanotube with surfactant activity, A6K, consisting of six alanine residues and a hydrophilic head, lysine, was compared to the conventional cationic transfectant reagents siFECTOR and Lipofectamine 2000. Cytotoxicity for the human glioblastoma cell lines U87MG, A172, and T98G was examined with the MTS assay. Transfection efficiency was analyzed with FITC-labeled siRNA targeting matrix metalloproteinase (MMP)-2 mRNA by fluorescent activity on microscopy. The ultrastructure of A6K was evaluated by electron microscopy. The level of cytotoxicity associated with A6K in the U87MG cells was significantly lower than with siFECTOR and Lipofectamine 2000. Transfection efficiency for siRNA was increased in a dose- and time-dependent fashion. The relative expression of MMP-2 mRNA to β-actin was reduced in a dose-dependent manner by real-time RT-PCR analysis. The ultrastructure of the A6K was transformed to micelle formation when mixed with the siRNA. The lipid-like self-assembling peptide, A6K, has genes in the micelle associated with the hydrophilic tail. This transfection method is a novel and stable technique with lower cytotoxicity than the current standard methods.

Phosphatase and tensin homolog deleted on chromosome 10 regulates sensory cell proliferation and differentiation of hair bundles in the mammalian cochlea

Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is a tumor suppressor gene that regulates cell proliferation, differentiation and growth. It regulates neural and glioma stem/progenitor cell renewal and PTEN deletion can drive expansion of epithelial progenitors in the lung, enhancing their capacity for regeneration. Because it is expressed at relatively high levels in developing mammalian auditory hair cells we have analyzed the phenotype of the auditory epithelium in PTEN knock-out mice. PTEN(+/-) heterozygous littermates have only one functional copy of the gene and show clear evidence for haploinsufficiency in the organ of Corti. Auditory sensory epithelial progenitors withdraw from the cell cycle later than in wild-type animals and this is associated with increases in the numbers of both inner and outer hair cells. The cytoskeletal differentiation of hair cells was also affected. While many hair bundles on the hair cells appeared to develop normally, others were structurally disorganized and a number were missing, apparently lost after they had been formed. The results show that PTEN plays a novel role in regulating cell proliferation and differentiation of hair bundles in auditory sensory epithelial cells and suggest that PTEN signaling pathways may provide therapeutic targets for auditory sensory regeneration.

Intra-operative detection of motor pathways using a simple electrode provides safe brain tumor surgery

Preservation of motor function is very important in patients who require resection of tumors adjacent to the primary motor cortex and pyramidal tract. Resection of tumors in the white matter adjacent to motor cortices routinely requires electrical stimulation of the tumor cavity. However, efforts to detect the pyramidal tract often result in postoperative neurological deterioration. To overcome this problem, a novel bipolar needle electrode was developed which enabled the identification of motor pathways by inserting it into the white matter. Motor-evoked potentials were induced by electrical stimulation with this electrode when it was inserted toward the estimated motor pathway from the resected tumor cavity. The scale on the needle indicated the approximate distance from the tumor cavity wall to the pyramidal tract. We conclude that the motor pathways can be preserved by detecting them neurophysiologically before they are destroyed by tumor resection.

Hybrid quantum repeater using bright coherent light

We describe a quantum repeater protocol for long-distance quantum communication. In this scheme, entanglement is created between qubits at intermediate stations of the channel by using a weak dispersive light-matter interaction and distributing the outgoing bright coherent-light pulses among the stations. Noisy entangled pairs of electronic spin are then prepared with high success probability via homodyne detection and postselection. The local gates for entanglement purification and swapping are deterministic and measurement-free, based upon the same coherent-light resources and weak interactions as for the initial entanglement distribution. Finally, the entanglement is stored in a nuclear-spin-based quantum memory. With our system, qubit-communication rates approaching 100 Hz over 1280 km with fidelities near 99% are possible for reasonable local gate errors.

Long-term outcome and reconsideration of intracystic chemotherapy with bleomycin for craniopharyngioma in children

OBJECT

We first reported postoperative intratumoral chemotherapy with bleomycin for craniopharyngiomas in 1985. However, this local bleomycin chemotherapy has not yet been used very frequently. It seems to be necessary for us to report long-term outcome and reconsideration of this treatment.

METHODS AND RESULTS

Local bleomycin chemotherapy was performed on 7 children (to 1985) and 11 children (from 1988 to 2004). A total of 11 pediatric patients with recurrent cystic craniopharyngioma was treated by intracystic injection of bleomycin after 1988 and followed up from 3 to 16 years. After 1985, 1 of 7 children whose clinical outcome was fair underwent intracystic injection of bleomycin again. This patient has never had recurrent tumor until now. The children whose clinical outcomes were excellent have no recurrence during follow-up from 21 to 26 years. After 1988, the results showed that cystic recurrences of 7 children have almost disappeared and the children have achieved a good school life, and 3 children are also achieving a good life after additional stereotactic radiosurgery.

CONCLUSION

Our results indicate that local bleomycin chemotherapy is effective and that recurrence does not occur after follow-up, which ranged in duration from 3 to 16 years.

Dietary garcinol inhibits 4-nitroquinoline 1-oxide-induced tongue carcinogenesis in rats

The effects of dietary feeding with a polyisoprenylated benzophenone, garcinol, isolated from Garcinia indica fruit rind on the development of 4-nitroquinoline 1-oxide (4-NQO)-induced oral carcinogenesis were investigated in male F344 rats. At 7 weeks of age, animals were given 4-NQO at 20 ppm in the drinking water for 8 weeks to induce tongue neoplasms. They also received the diets containing 100 or 500 ppm garcinol either during (for 10 weeks) or after (for 22 weeks) the carcinogen exposure. The other rats were given tap water without 4-NQO throughout the experiment, and fed garcinol (500 ppm)-containing diet or basal diet alone. At the end of the study (week 32), incidences of tongue neoplasms and preneoplastic lesions, cell proliferation activity in the normal-like tongue epithelium estimated by 5-bromodeoxyurideine (BrdU)-labeling index and cyclin D1-positive cell ratio, and immunohistochemical expression of cyclooxygenase-2 (COX-2) in the tongue lesions were determined. Dietary garcinol significantly decreased the incidence and multiplicity of 4-NQO-induced tongue neoplasms and/or preneoplasms as compared to the control diet. Dietary administration of garcinol also significantly reduced the BrdU-labeling index and cyclin D1-positive cell ratio, suggesting reduction in cell proliferation activity in the tongue by garcinol. The COX-2 expression in the tongue lesions was also suppressed by feeding with garcinol. These results indicate that dietary administration of garcinol inhibited 4-NQO-induced tongue carcinogenesis through suppression of increased cell proliferation activity in the target tissues and/or COX-2 expression in the tongue lesions.

Radio-guided brain tumorectomy using a gamma detecting probe and a mobile solid-state gamma camera

BACKGROUND

We herein report a technique to distinguish brain tumors from normal brain tissue during surgery using a gamma probe and a solid-state mobile gamma camera after (99m)Tc-hexakis-2-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) is administered to patients immediately before operation.

METHODS

We examined 13 patients with brain tumors. Before the operation, (99m)Tc-MIBI single photon emission computed tomography (SPECT) was performed to assess accumulation in the tumors. On the day of the operation, (99m)Tc-MIBI was administered intravenously and craniotomy for tumor resection was performed. During the operation, the tumor was localized with a gamma probe and preremoval scintigraphy images were taken with a mobile gamma camera. After tumor resection was completed, residual tumors were confirmed using it again. We compared accumulation found in the preoperative SPECT images and intraoperative scintigraphy images, performed a histologic examination of adjacent tissues, and measured the dose the personnel was exposed to per operation.

RESULTS

In all patients, tumors were confirmed by a gamma probe and scintigraphy during the operation. Intraoperative accumulation in tumors was significantly related to accumulation found in the preoperative (99m)Tc-MIBI SPECT images. In 9 out of 13 patients, accumulation disappeared in the postremoval scintigraphy images, and no tumor tissue was found by histologic examination. Residual tumor tissue was found in 4 patients. Average exposure of the personnel per operation was 22.9 +/- 4.0 microSv.

CONCLUSION

Resection of brain tumors with a gamma probe and a mobile gamma camera was very useful since the area to be removed was easily identified and residual tumors could be detected.

Evaluation of the NO scavenging activity of procyanidin in grape seed by use of the TMA-PTIO/NOC 7 ESR system

The nitrogen monoxide (NO) scavenging activity of grape seed extract (GSE) was studied in the TMA-PTIO/NOC 7 system. The procyanidin-rich (>95%) GSE showed strong NO scavenging activity in the system. The activity was found to depend on the condensation rate of cyanidin when synthetic oligomers were tested. Investigation of the NO scavenging activities of other polyphenols (catechin, epicatechin, epigallocatechin, and epigallocatechin gallate) in the TMA-PTIO/NOC 7 system revealed that gallocatechin, epigallocatechin, and epigallocatechin gallate exhibited strong activities. From the results, it was suggested that the high condensation rate of and the gallate ester moiety in procyanidin in GSE may play an important role in the NO scavenging activity. The mechanism of the NO scavenging activity of phenolic compounds such as GSE is speculated to be as follows: NO reacts with phenolic compounds directly to generate phenoxy radicals.

Identification of MG-160, a FGF binding medial Golgi sialoglycoprotein, in brain tumors: an index of malignancy in astrocytomas

Malignant astrocytomas are highly invasive, vascular neoplasms that comprise the majority of nervous system tumors in humans. A strong association has previously been made between malignancy in human astrocytic tumors and increased expression of certain fibroblast growth factor (FGF) family members. MG-160 is an intrinsic type I cysteine-rich membrane sialoglycoprotein that resides in the medial cisternae of the Golgi apparatus, highly homologous to CFR, chicken fibroblast growth factor receptor, and ESL-1, E-selectin ligand. MG-160 binds fibroblast growth factors (FGFs) and may be involved in the intracellular trafficking of FGFs and the regulation of cellular response to FGFs. In the present study MG-160 expression was evaluated in human brain tumors exhibiting varying degrees of malignancy. At the mRNA level MG-160 expression was inversely correlated with the histological grade of astrocytomas such that high levels of MG-160 were observed in low-grade astrocytomas and low levels in malignant astrocytomas. This differential expression of MG-160 mRNA was verified at the protein level using immunohistochemistry. Grade II astrocytomas displayed consistent and intense staining for MG-160 as seen in normal brain. In contrast to the lower grade tumors, grade IV astrocytomas exhibited variable and weaker expression of MG-160. Our results suggest that, MG-160 may participate in malignant progression in astrocytomas. In addition, other brain tumors and human astrocytoma cell lines were characterized for MG-160 expression.

[BIS monitoring is useful for reliable intraoperative cortical mapping during brain tumor operations]

Poor detection of muscle motor evoked potential (m-MEP) by electrical cortical stimulation has often been encountered during neurosurgical operations, although widely known optimal factors for reliable detection have been put into practice. We hypothesized that the depth of anesthesia influenced the detection of m-MEP. Bispectral Index (BIS) monitoring was used to assess the depth of anesthesia for 16 patients during brain tumor operations. The doses of intravenous anesthetics, propofol, were titrated according to BIS indices during operations. When BIS indices were 40 or below, detection was difficult and higher intensities of electrical stimulation were necessary to evoke m-MEPs. Furthermore, risk of seizure was relatively high due to stronger electrical stimulation. Our results suggested that a BIS index above 50 and below 70 was optimal range. BIS monitoring is a useful method for setting the optimal dose of anesthetics for reliable intraoperative cortical mapping.

[A study of usefulness of chemotherapy in long-term survival choroid plexus carcinoma case of childhood]

We report a girl who was diagnosed with choroid plexus carcinoma at the age of 7 and has had an active daily life in the 11 years after onset. She underwent two tumor excision operations and received radiotherapy followed by intensive chemotherapy using cisplatin, carboplatin, and etoposide. In general, the prognosis of choroid plexus carcinoma is very poor, especially in the childhood cases, since no optimal treatment for choroid plexus carcinoma has yet been established. However, the results of analyses of the present long-term survival case, and similar long-term survival cases in the literature, strongly suggest the usefulness of chemotherapy in the treatment of choroid plexus carcinoma in children.

All-silicon quantum computer

A solid-state implementation of a quantum computer composed entirely of silicon is proposed. Qubits are 29Si nuclear spins arranged as chains in a 28Si (spin-0) matrix with Larmor frequencies separated by a large magnetic field gradient. No impurity dopants or electrical contacts are needed. Initialization is accomplished by optical pumping, algorithmic cooling, and pseudo-pure state techniques. Magnetic resonance force microscopy is used for ensemble measurement.

Electron entanglement via a quantum dot

This Letter presents a method of electron entanglement generation. The system under consideration is a single-level quantum dot with one input and two output leads. The leads are arranged such that the dot is empty, single-electron tunneling is suppressed by energy conservation, and two-electron virtual cotunneling is allowed. Such a configuration effectively filters the singlet-state portion of a two-electron input, yielding a nonlocal spin-singlet state at the output leads. Coulomb interaction mediates the entanglement generation, and, in its absence, the singlet state vanishes. This approach is a four-wave mixing process analogous to the photon entanglement generated by a chi((3)) parametric amplifier.

Simultaneous removal of phenol and ammonia by an activated sludge process with cross-flow filtration

Attempts were made for removing ammonia from synthetic wastewater under the presence of phenol, which is inhibitory to nitrification, by using a single-stage activated sludge process with cross-flow filtration. Activated sludge biomass which had been acclimated with phenol for over 15 years was used for the inoculum, and synthetic wastewater was continuously supplied to the process retaining biomass at 8000 mg VSS l(-1). Phenol was completely removed, and ammonia was simultaneously nitrified to nitrate; nitrification rate reached 200 mg N l(-1) d(-1) when phenol was removed at a rate up to 300 mg l(-1) d(-1). It was observed that 0-13% of the ammonia was removed via denitrification. Intermittent aeration enhanced the denitrification rate to 160 mg N l(-1) d(-1) by utilizing phenol. and approximately 24% of the denitrified nitrogen was recovered as nitrous oxide. Methanol, which is the most commonly used electron donor in conventional nitrogen removal processes, did not enhance the denitrification rate of the phenol-acclimated activated sludge used in this study, however phenol did. The results suggest that this process potentially works as a space- and energy-saving nitrogen removal process by utilizing substances inhibitory to nitrifiers as electron donors for denitrification.