Abstract P4-13-16: Impact of immediate breast reconstruction after mastectomy on the outcome of patients receiving neoadjuvant chemotherapy

Background and purpose

In breast cancer patients receiving neoadjuvant chemotherapy (NAC), immediate breast reconstruction (IBR) is controversial. IBR might favor recurrences and metastases due to delayed adjuvant radiation therapy.

We retrospectively investigated whether IBR after mastectomy influenced the outcome of patients receiving neoadjuvant chemotherapy.

Patients and methods

Between 2006 and 2016, 243 breast cancer patients received total mastectomy after NAC, 48 of whom underwent IBR. Patients receiving IBR (IBR group) were compared to patients who did not receive IBR (no-IBR group) over a prolonged median follow-up time (72.3 moths).

The regimen was 4 cycles of epirubicin (100 or 75 mg/m2), 5-fluorouracil (500 mg/m2), and cyclophosphamide (500 mg/m2) followed by 4 cycles of docetaxel (75 mg/m2). Post-mastectomy radiation was applied in cases treated by IBR following the same selection criteria as for standard mastectomy regardless of the reconstruction approach.

Results

Patients in the IBR group were on average younger than patients in no-IBR

group (p<0.001). The percentage of patients with clinical T1/2 tumor was 81.2% in the IBR group and 58.4% in no-IBR group (p=0.0042). 2 patients (4.2%) in the IBR group and 9 patients (4.6%) in no-IBR group showed the locoregional recurrences. 2 patients (4.2%) in the IBR group and 20 patients (10.3%) showed distant metastases. There were no significant differences.

Conclusions

IBR after total mastectomy was not associated with worse rate of locoregional recurrences in patients receiving NAC.

Citation Format: Nogi H, Tomita S, Kamio M, Shioya H, Toriumi Y, Takeyama H. Impact of immediate breast reconstruction after mastectomy on the outcome of patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-16.

Impairment of DYRK2 augments stem-like traits by promoting KLF4 expression in breast cancer

Whereas accumulating studies have supported the cancer stem cell theory, a specific therapy targeting a cancer stem cell subpopulation has not been established. Here, we show that dual-specificity tyrosine phosphorylation-kinase 2 (DYRK2) is a novel negative regulator for formation of breast cancer stem cells. Downregulation of DYRK2 promotes cancer stem-like traits in vitro, tumourigenesis in vivo and the proportion of the cancer stem cell population in human breast cancer tissues. We found that Krupple-like factor 4 (KLF4) serves as a key mediator of DYRK2's control over the cancer stem phenotype. Reduced DYRK2 expression increases KLF4 expression, which induces cancer stem-like properties. We identified androgen receptor (AR) as a transcription factor binding to the KLF4 promoter region; this process is dependent on DYRK2 kinase activity. Our findings delineate a mechanism of cancer stem cell regulation by the DYRK2-AR-KLF4 axis in breast cancer. Targeting of this pathway may be a promising strategy against breast cancer stem cells.

Abstract P5-07-07: DYRK2 contributes to the generation of breast cancer stem cells through KLF4

<Introduction>

Cancer stem cells (CSCs) have been defined by the potential to self-renew and to differentiate. CSCs pose a major hurdle in the treatment of cancer. However, the mechanisms by which cells acquire CSC properties such as drug resistance remain unclear.

Dual-specificity tyrosine-regulated kinase 2 (DYRK2) is a protein kinase that phosphorylates its substrates on serine/threonine. Initially, we found that DYRK2 phosphorylates p53 at Ser 46 to regulate apoptotic cell death in response to DNA damage. Recently, we have shown that DYRK2 controls Snail degradation in breast cancer and ovarian serous adenocarcinoma. We also found that knockdown of DYRK2 in luminal-type breast cancer MCF-7 cells increased the cancer stem cell population.

Kruppel-like factor 4 (KLF4) is one of the Yamanaka factors. It has been reported that pluripotent stem cells from mouse embryonic or adult fibroblasts are induced by introducing four factors, Oct3/4, Sox2, c-Myc, and Klf4. This finding led us to determine if KLF4 is indispensable for the maintenance of CSCs.

The aim of this study is to clarify whether DYRK2 regulates CSCs through KLF4 in breast cancer.

<Methods>

Cell lines: MCF-7 (human mammary carcinoma: ATCC) cells were grown according to standard protocols.

We established stable DYRK2-depleted cells. MCF-7 cells were transfected with pSuper-puro vector (pSuper control) or pSuper-puro DYRK2 shRNAs (shDYRK2) with puromycin to isolate stable cell lines.

In turn, we established both stable DYRK2- and KLF4-depleted cells. shDYRK2 cells were transfected with pSuper-neo vector (pSuper-neo control) or pSuper-neo KLF4 shRNAs (shKLF4) with puromycin and G418. Knockdown of DYRK2 or KLF4 was confirmed by real-time RT-PCR and immunoblotting.

The depleted cells were compared with the control cells using real-time RT-PCR, immunoblotting, flow cytometric analysis, mammosphere assay, xenograft models and immunohistological staining.

<Results>

We analyzed the population of breast cancer stem cells by flow cytometric analysis and in vitro mammosphere assay. The results showed that knockdown of DYRK2 was associated with the increase of CD44+/CD24- cells. While pSuper control cells formed mammospheres, they did in a lesser extent compared to shDYRK2 cells.

In real-time RT-PCR and immunoblotting analysis, stable DYRK2 depletion in MCF-7 cells induced KLF4 accumulation.

We then investigated the effect of KLF4 on stemness by flow cytometric analysis and in vitro mammosphere assay. The results showed that knockdown of KLF4 in shDYRK2 cells reduced the proportion of CD44+/CD24- cells. Whereas shDYRK2/shKLF4 cells formed mammospheres, they did in a lesser extent compared to shDYRK2/pSuper-neo control cells. Moreover, the scale of the mammospheres formed in shDYRK2/shKLF4 cells was significantly smaller, as compared with that in shDYRK2/pSuper-neo control cells.

In xenograft models, the loss of KLF4 protein expression significantly decreased tumor formation.

Immunohistological staining of fifty-nine samples from surgically treated breast cancer patients showed an inverse correlation between DYRK2 and KLF4 expression.

<Conclusion>

These findings revealed that DYRK2 contributes to the generation of breast cancer stem cells through KLF4.

Citation Format: Imawari Y, Mimoto RK, Yamaguchi N, Kamio M, Kato K, Nogi H, Toriumi Y, Uchida K, Takeyama H, Yoshida K. DYRK2 contributes to the generation of breast cancer stem cells through KLF4 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-07-07.

Abstract P2-07-16: Alcohol consumption increases mammographic density in women aged ≥55 years

Background: Incresed mammographic density is a significant risk factor for breast cancer and decreses the sensitivity of mammography screening. The aim of this study is to examine the factors affecting breast density in Japanese women.

Data sources and methods: Between Apr. 2014 and Mar. 2016, 3492 women were received mammography screening. According to the results of mammography, breast density was categorized as non-dense(BI-RADS 1 and 2, n=1670) and dense(BI-RADS 3 and 4, n=2222) . Logistic regression was used to estimate the odds of having dense breasts by age, body mass index(BMI), alcohol consumption, smoking, parity, menopausal status, dysmenorrhea, hormone use, family history of breast cancer, physical activity, fried foods intake, brightly colored vegetables intake, coffee intake and tea or green tea intake. All statistical tests were two-sided.

Results: There was a statistically significant negative interaction of age(OR=0.97, <0.001), BMI(OR=0.78, <0.001), number of live birth (one; OR=0.77, <0.030, two or more; OR0.37, <0.001), post-menopause(OR=0.6, <0.001) on breast density. On the other, there was a statistically significant positive interaction of alcohol intake(20g or more a day, OR=1.62, 0.026) in dense breast women aged ≥55 years. A trend of bone mineral density ≥80% and dense breast was seen in women aged ≥40 years(OR=0.63, <0.086, n=510).

Results of analysis of factors influencing breast density among all study participants  Odds ratio95% CIPAgeContinuoous variables0.970.95-0.98<0.001BMIContinuoous variables0.780.76-0.80<0.001Alcohol intakenone1.00 0.325 <20g a day1.120.94-1.350.209 ≥20g a day1.210.91-1.600.186Smokingno1.00   yes0.940.71-1.230.644Birth01.00 <0.001 once0.770.61-0.970.030 ≥20.370.31-0.45<0.001Menopausepre1.00   post0.600.47-0.77<0.001Dysminorrheano1.00   yes0.780.41-1.480.446Family history of breast cancerno1.00   yes1.000.81-1.240.991Physical activityno1.00   yes0.890.74-1.070.207Fried foods intakenone1.00 0.087 once two days0.780.60-1.020.068 ≥once a day0.760.51-1.120.166Brightly coloredd vegetablesnone1.00 0.910 once two days0.950.70-1.280.737 ≥once a day0.950.73-1.220.666Coffee intakenone1.00 0.105 once two days1.060.75-1.510.729 ≥once a day1.221.01-1.470.040Tea/Green tea intakenone1.001.01-1.470.098 once two days0.760.55-1.050.097 ≥once a day0.840.70-1.000.055bone mineral density(n=510)<80%1.00    ≥80%0.630.38-1.070.068

Results of analysis of factors influencing breast density in women aged ≥55 years (n=1382)  Odds ratio95% CIPBMI<25kg/m21.00   ≥25kg/m20.300.21-0.44<0.001Birth0  Trend P<0.001 once0.690.46-1.040.0076 ≥two0.310.23-0.41<0.001Alcohol intakenone  0.052 <20g/day1.260.98-1.620.074 ≥20g/day1.621.06-2.480.026

Conclusion: Alcohol consumption increase mammographic breast density in women aged ≥55 years. As both of increased breast density and alcohol consumption have been suggested to increase risk of breast cancer, more cautious mammographic screening should be considered for those women aged ≥55 years.

Citation Format: Uchida K, Ohashi H, Kitano N, Tsunoda K, Nagamatsu T, Sekine C, Imawari Y, Nogi H, Takeyama H. Alcohol consumption increases mammographic density in women aged ≥55 years [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-07-16.

Interleukin-6 released by colon cancer-associated fibroblasts is critical for tumour angiogenesis: anti-interleukin-6 receptor antibody suppressed angiogenesis and inhibited tumour-stroma interaction

Background:

Interleukin-6 (IL-6) has an important role in cancer progression, and high levels of plasma IL-6 are correlated with a poor prognosis in a variety of cancers. It has also been reported that tumour stromal fibroblasts are necessary for steps in cancer progression, such as angiogenesis. There have been few reports of a correlation between fibroblast actions and IL-6 levels. In this study, we examined the correlation between cancer stromal fibroblasts and IL-6 and the utility of IL-6 as a therapeutic target in human colon cancer.

Methods:

The expression levels of IL-6 and VEGF of fibroblasts and cancer cell lines were evaluated using real-time PCR and ELISA. The anti-angiogenic effect of inhibiting IL-6 signalling was measured in an angiogenesis model and animal experiment.

Results:

We demonstrate that stromal fibroblasts isolated from colon cancer produced significant amounts of IL-6 and that colon cancer cells enhanced IL-6 production by stromal fibroblasts. Moreover, IL-6 enhanced VEGF production by fibroblasts, thereby inducing angiogenesis. In vivo, anti-IL6 receptor antibody targeting stromal tissue showed greater anti-tumour activity than did anti-IL6 receptor antibody targeting xenografted cancer cells.

Conclusion:

Cancer stromal fibroblasts were an important source of IL-6 in colon cancer. IL-6 produced by activated fibroblasts induced tumour angiogenesis by stimulating adjacent stromal fibroblasts. The relationship between IL-6 and stromal fibroblasts offers new approaches to cancer therapy.

Abstract P4-06-11: HER2 type DCIS acquires histological diversity by p53 mutation

[Introduction]

It is widely known that breast cancer is a heterogeneous disease of various phenotypes and biological characteristics.

Several studies have identified distinct subtypes of invasive ductal carcinoma by gene expression profiling or staining pattern of estrogen receptor (ER), progesterone receptor (PR), and HER2/neu protein.

Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer, and is thought to be the precursor of invasive breast cancer.

One of the most well-known hypothesis shows that breast cancer occurs in a normal terminal duct lobular unit, and a histological continuity exists between the precursor and breast cancer.

The aim of this analysis is to reveal how DCIS acquires histological diversity and progresses to invasive ductal carcinoma.

We hypothesized that p53 gene mutation is responsible for this acquisition of histological diversity, and performed immunohistochemical analysis to pursue this hypothesis.

[Material and methods]

The participants of this study were taken from a database established by Jikei University School of Medicine. Between the period of April 2000 and April 2011, 84 cases of pure DCIS patients underwent operation.

Patients were classified into 4 subtypes by a combination of hormone receptor (HR) status and HER2 status.

The status of ER, PR, HER2, and p53 was determined by immunohistochemical staining.

Tumors with Allred score above 2 ER / PR nuclear staining were classified as ER / PR positive. Tumors with HER2 membranous staining equivalent to 3+ intensity with Hercep test in more than 30% of the cells were scored as overexpression. p53 was defined as positive when nuclear staining was equal to or greater than 10%.

We evaluated histological nuclear atypia to assess histological diversity of DCIS. When DCIS included different type of atypia cells more than 10%, we judged the histological diversity as positive.

[Results]

Patient characteristics are presented in table1.

Patient characteristics number%Age  median (range)55 (31-83)    Receptor status  ER / PR  positive6780negative1720HER2  positive1821negative6679   Subtype  HR+ / HER2-6274HR+ / HER2+56HR- / HER2+1315HR- / HER2-45

The classifications by the immunohistochemical subtype of DCIS are as follows: HR+/HER2- 62 cases (74%), HR+/HER2+ 5 cases (6%), HR-/HER2+ 13 cases (15%), HR-/HER2- 4 cases (5%).

p53 expression in HR-/HER2+ and HR-/HER2- subtype was significantly higher than HR+/HER2- and HR+/HER2+ subtype (p<0.001).

The frequency of histological diversity by nuclear atypia was high in HR+/HER2- and HR-HER2+ subtype (p = 0.009).

In HR-HER2+ subtype, p53 expression was associated with histological diversity (p = 0.021). But in HR-HER2+ subtype, there was no association with p53 expression and histological diversity.

p53 status and histological diversity of DCIS HR+/HER2-HR+/HER2+HR-/HER2+HR-/HER2-pp53     positive5193<0.001negative57441       histological diversity     positive481910.009negative14443       p0.3310.5760.0210.501 

[Conclusion]

This analysis demonstrates that HR-HER2+ subtype DCIS acquires histological diversity by p53 mutation.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-06-11.

Abstract P1-08-17: Impact of claudin-3 and basal-markers expressions on pathological complete response to neoadjuvant chemotherapy and prognosis in triple negative breast cancer

Background

Triple negative breast cancer (TNBC) has responded well in the neoadjuvant setting, with rates of pathologic complete response (pCR) commonly higher than for other breast tumor types. However, more than half of TNBC patients do not achieve a pCR and have a very poor prognosis. Cluster analysis identified 6 TNBC subtypes displaying unique gene expression, including basal-like and a mesenchymal stem-like (claudin-low) subtype. The object of this study was to evaluate the clinical utility of claudin-3 and basal-markers expressions in the prediction of pCR and prognosis in a cohort of breast cancer patients receiving the combination of taxane and anthracycline as neoadjuvant chemotherapy.

Materials and Methods

A prospective data base of 412 Japanese women with stage I/II/III breast cancer who received neoadjuvant chemotherapy was analyzed. The regimens were 6 cycles of concurrent administration of doxorubicin (50 mg/m2) and docetaxel (60 mg/m2) or 4 cycles of epirubicin (100 mg/m2), 5-fluorouracil (500 mg/m2), and cyclophosphamide (500 mg/m2) followed by 4 cycles of docetaxel (100 mg/m2). We performed immunohistochemical staining for ER, PgR, HER2, epidermal growth factor receptor (EGFR), cytokeratin 5/6 and claudin-3 using specimens obtained at diagnosis by core needle biopsy. Based on immunoreactivity, TNBC tumors were classified into basal/claudin-high (BCH), basal/claudin-low (BCL), non-basal/claudin-high (NBCH) and non-basal/claudin-low (NBCL).

Results

The overall pCR of this patient cohort was 19%. pCR was observed 30 cases of 84 TNBC (36%) and 50 cases of 328 non-TNBC (15%)(p<0.0001). Among the TNBC tumors, pCR rate was significantly different between subgroups. BCH 50%, BCL 23%, NBCH 83% and NBCL 43% (p = 0.039). The 5-year overall survival rate was significantly different between TNBC and non-TNBC. TNBC 81% and non-TNBC 94% (p = 0.0017). The 5-year overall survival rate was different between triple-negative subgroups. BCH 92%, BCL 78%, NBCH 83% and NBCL 46%.

Conclusions

This study indicated that claudin-3 and basal-markers might be predictive biomarkers of pCR and prognosis in triple negative breast cancer patients treated with neoadjuvant chemotherapy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-17.

NOTCH1 expression predicts patient prognosis in esophageal squamous cell cancer

PURPOSE

The prognosis of patients with esophageal cancer remains poor, and the classification of tumor node metastasis has proven insufficient to predict patient prognosis. Therefore, novel predictive markers of esophageal cancer prognosis are needed. Notch receptors and their ligands have been reported to be upregulated in cervical, lung, colon, renal, and pancreatic cancers, but NOTCH1 expression has not been studied in esophageal cancer.

METHODS

Expression of NOTCH1 was quantified by real-time reverse transcription-polymerase chain reaction in 55 primary esophageal squamous cell carcinomas (ESCCs) and their paired normal esophageal mucosa. We then examined the correlations between NOTCH1 expression, clinicopathological factors, and prognosis in patients with ESCC.

RESULTS

The probability of overall survival was significantly lower for patients with high NOTCH1 expression (p = 0.0028; log-rank test). Overexpression of NOTCH1 was identified as a significant and independent prognostic factor (p = 0.0061) in patients who had undergone surgical treatment for ESCCs. The hazard ratio for predicting early death was 4.298 (95% confidence interval 1.515-12.195) for high versus low NOTCH1 expression.

CONCLUSIONS

Our data indicate that NOTCH1 may be a candidate molecular prognostic marker and a molecular target for the development of an effective therapeutic intervention for patients with ESCC.

Abstract P4-03-10: Sonographic-pathological correlation in contrast-enhanced ultrasonography in the diagnosis of breast cancers

Background: As contrast-enhanced ultrasonography (CEUS) in the diagnosis of breast masses has been performed less frequently than other imaging modalities, it's efficacy evaluation has not been established. CEUS with Sonazoid, which is microbubble-based contrast agent, allows visualization of the mass bloodstream, therefore the classification of enhancement patterns in CEUS could increase diagnostic yield for breast masses. To achieve this, a clear standard for the CEUS evaluation is needed. The purpose of this study was to identify CEUS findings for malignancies and clarify sonographic-pathological correlation of breast cancers.

Material and Method: Present study included 20 patients with invasive ductal cancer who underwent operation for primary therapy without any chemotherapy or hormonal therapy. We contrasted CEUS features with Sonazoid with surgical specimens retrospectively. As malignant findings, the presence of focal perfusion defects inside masses and enhancement of outside masses were chosen.

Result: All of the 20 cases displayed focal perfusion defects. 9 cases of those could be successfully assessed in the same sections histopathologically and ultrasonographically. Histopathological findings showed those defects to be fibrotic foci inside masses in 7cases (77.7%). While, 6 cases of all (30%) showed stains outside tumor, and only one case was found out to be fibrotic growth with cancer cells.

Conclusion: focal perfusion defects of breast masses in CEUS were considered to be specific for malignancy, and they seemed to be fibrotic foci histopathologically. Desmoplastic reaction has been observed in epithelial solid tumor biology, and if those defects reflect the desmoplasia defects could be the proof of malignancy.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-03-10.

Abstract P5-04-02: DYRK2 regulates breast cancer invasion via Snail/E-cadherin pathway

Introduction: Epithelial-Mesenchymal Transition (EMT) is characterized by the loss of cellular adhesion molecule E-cadherin, and plays a fundamental role during early steps of breast cancer invasion. An important regulator of E-cadherin expression is Snail, a zinc finger transcriptional repressor. Snail is posphorylated by GSK3β and then degraded by βTrCP mediated ubiquitination. Here we found another kinase, DYRK2, regulates the stability of Snail. Knockdown of DYRK2 promoted the EMT and cancer invasion both in vitro and in vivo experiments.

Methods: Cell lines: MCF-7 cells were transfected with pSuper vector (pSuper control) and pSuper shRNA DYRK2 (shRNA-DYRK2) with G418 to isolate stable cell lines.

Immunoblotting: Expression of pertinent molecular markers was determined by western blotting.

RT-PCR: RNA was extracted using TRIsure and 500 ng of total RNA was amplified using Primer Script One Step RT-PCR Kit Ver.2.

Invasion assay: Various cancer cell lines were seeded on the top of the upper chamber with serum free medium while the bottom chambers were filled with medium containing 10% FBS.

In vivo metastasis assay: Cells in PBS were injected into the left ventricle of 7-week-old female nude mice. Metastases to distant organs were confirmed by IVIS2000.

Immunohistochemistry: We acquired paraffin-embedded tissue sections from primary breast tumor cores and from Jikei University of Medicine. Immunohistochemistry for DYRK2 was performed.

Results: In MCF-7 cells, knockdown of DYRK2 increased Snail in the protein level but not in mRNA level. Upon DYRK2 knockdown, MG132 treatment had no effect on additional increase in Snail. DYRK2 knockdown decreased Snail ubiquitination. Stable DYRK2 depletion led to Snail accumulation and E-cadherin abrogation. Fibroblast marker, Vimentin, emerged in DYRK2 depleted cells. For further analysis, we carried out invasion assays. The invasion potential in DYRK2-depleted cells was substantially higher than that in control cells. In xenograft model, we used nude mice received intracardial injections of pSuper control or shRNA-DYRK2 cells. 6 weeks after injections, a significant increase in bone and lung metastasis was observed in shRNA-DYRK2 group. The patients with tumors expressed low DYRK2 showed significantly poor prognosis.

Conclusion: In breast cancer cells, Snail is phosphorylated by DYRK2 and then acquires the ability to be ubiquitinated. In the absence of DYRK2, Snail is unable to be degraded by ubiquitin-proteasome machinery. Accumulation of Snail promotes EMT and cancer invasion, so low expression of DYRK2 leads to poor prognosis in breast cancer.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-04-02.

Production of antioxidant vitamins, beta-carotene, vitamin C, and vitamin E, by two-step culture of Euglena gracilis Z

Euglena gracilis Z is one of the few microorganisms which simultaneously produces antioxidant vitamins such as beta-carotene and vitamins C and E. Photoheterotrophically cultured E. gracilis Z produced larger levels of biomass but with a lower content of antioxidant vitamins than photoautotrophically grown cultures. For efficient production of these vitamins, a two-step culture was performed. Cells were grown photoheterotrophically and then transferred to photoautotrophic conditions. When E. gracilis Z cells were grown in fed-batch culture under photoheterotrophic conditions, their density reached 19 g/L after 145 h. Subsequent transfer of these cells to photoautotrophic conditions increased vitamin content, enhancing the total vitamin yields, which were 71.0 mg/L of beta-carotene, 30.1 mg/L of vitamin E, and 86.5 mg/L of vitamin C. (c) 1997 John Wiley & Sons, Inc.

P2-01-24: Triple-Negative Breast Cancer Emerges from the Luminal Progenitor Compartment

Background: Triple-negative breast cancers (TNBC) are defined as tumors that lack expression of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor type 2 (HER2). Majority of TNBC (approximately 80%) are basal-like breast cancers. The question of whether there is a specific, identifiable cell in the normal breast form which basal-like breast cancers arise is controversial. We evaluated the frequency and receptor status of ductal carcinoma in situ (DCIS) and ductal components associated with T1 invasive ductal carcinoma (IDC) to clarify the developmental pathway of TNBC.

Methods: From our institutional archives between April 2000 and April 2011, we retrieved 758 cases of DCIS and T1 invasive ductal carcinoma without prior operative treatment. Immunohistochemistry for ER, PgR and HER2 was performed on ductal components and invasive components. Statistical analysis was performed using Fisher Extract Test.

Results: The frequencies of triple-negative (TN) subtype at each size were not seen significant differences. Ductal components were seen in 51 (84%) TN-IDC cases. Within 51 cases, the ductal components were TN in 49 cases. The remaining 3 cases were positive for ER and PgR, but negative HER2.

Preliminary analysis of length and GC content variation in the ribosomal first internal transcribed spacer (ITS1) of marine animals

Length and guanine-cytosine (GC) content of the ribosomal first internal transcribed spacer (ITS1) were compared across a wide variety of marine animal species, and its phylogenetic utility was investigated. From a total of 773 individuals representing 599 species, we only failed to amplify the ITS1 sequence from 87 individuals by polymerase chain reaction with universal ITS1 primers. No species was found to have an ITS1 region shorter than 100 bp. In general, the ITS1 sequences of vertebrates were longer (318 to 2,318 bp) and richer in GC content (56.8% to 78%) than those of invertebrates (117 to 1,613 bp and 35.8% to 71.3%, respectively). Specifically, gelatinous animals (Cnidaria and Ctenophora) were observed to have short ITS1 sequences (118 to 422 bp) with lower GC content (35.8% to 61.7%) than the other animal taxa. Mollusca and Crustacea were diverse groups with respect to ITS1 length, ranging from 108 to 1,118 and 182 to 1,613 bp, respectively. No universal relationship between length and GC content was observed. Our data indicated that ITS1 has a limited utility for phylogenetic analysis as obtaining confident sequence alignment was often impossible between different genera of the same family and even between congeneric species.

Sentinel node biopsy for follicular tumours of the thyroid gland

BACKGROUND

It is difficult to differentiate histologically between benign and malignant follicular-type tumours of the thyroid gland. The present study evaluated whether sentinel lymph node (SLN) biopsy was helpful in obtaining the correct diagnosis of malignant follicular-type tumours, as metastasis to the lymph nodes is sufficient evidence for a diagnosis of cancer.

METHODS

SLN biopsy was performed for 37 follicular-type tumours suspected to be malignant on the basis of preoperative examinations, but for which the diagnosis had not been confirmed.

RESULTS

SNs were identified in 32 of 37 procedures. SLN metastases were found in four of 12 patients with a malignant tumour identified by intraoperative frozen-section analysis. There was one false-negative but no false-positive diagnoses. Frozen-section analysis of the tumour itself identified only one follicular cancer. The accuracies of preoperative imaging methods were lower than that of SLN detection.

CONCLUSION

Detection of SLN metastasis was helpful in diagnosing follicular thyroid cancer and thus enabling one-stage surgery.

A new technique for intestinal isoperistaltic anastomosis utilizing a linear stapler for enlargement after anastomosis performed with a circular stapler

BACKGROUND

The high incidence of anastomotic stenosis after gastrointestinal surgery using circular staplers is a major problem. In response, we have developed a new technique that uses a linear stapler to enlarge an anastomotic opening made using a circular stapler.

METHODS

Anastomoses were created by the new technique or by the conventional approach using a circular stapler in pig small intestine. The method was also applied in treatment of a colon cancer patient.

RESULTS

The area of the anastomotic opening obtained with the new technique was more than 3 times that in the control (p < 0.001), with no significant difference between the methods in a leak test. Follow-up of the patient undergoing surgery with this approach revealed an uneventful course with a widely patent anastomosis confirmed after 3 months.

CONCLUSIONS

This procedure provides a larger anastomotic opening than conventional anastomosis with circular staplers, without impairing the integrity of the anastomosis.

Significance of additional high-dose cytarabine in combination with cyclophosphamide plus total body irradiation regimen for allogeneic stem cell transplantation

The combination of cyclophosphamide (CY) and total body irradiation (TBI) has been used as a standard conditioning regimen for allogeneic transplantation. Several studies showed an advantage of adding high-dose cytarabine (HDCA) to this regimen. To clarify the significance of additional HDCA, we conducted a retrospective multicenter study and compared the clinical results of these two regimens. From June 1985 to March 2003, 219 patients with hematological malignancies underwent allogeneic transplantation after conditioning with CY+TBI 12Gy (n=73) or CA+CY+TBI 12Gy (n=146). Engraftment, overall survival, transplant-related mortality (TRM), relapse rate and incidence of graft-versus-host disease (GVHD) were compared according to risks and donors. Addition of HDCA had no impact on the relapse rate in all subgroups, and it was associated with lower TRM among standard-risk patients after related transplantation, and with higher TRM and worse survival among standard-risk patients after unrelated transplantation. The incidence of acute GVHD was not significantly different between the two regimens, and HDCA resulted in a higher incidence of chronic GVHD among standard-risk patients after related transplantation. In summary, addition of HDCA is not beneficial for high-risk patients, and is not recommended for standard-risk patients receiving unrelated transplantation.

Integrin-linked kinase activity is associated with interleukin-1α-induced progressive behavior of pancreatic cancer and poor patient survival

Cancer cell adhesion and invasion into extracellular matrix are regulated by integrin-linked kinase (ILK) activity in a phosphatidylinositol 3-kinase (PI3-K)-dependent manner. In this study, we demonstrated that ILK and beta(1)-integrin play important roles in interleukin (IL)-1alpha-induced enhancement of adhesion and invasion of pancreatic cancer cells through p38 mitogen-activated protein kinase (MAPK) signaling pathway and activator protein-1 (AP-1) activation. Alteration of ILK kinase activity controlled IL-1alpha-induced p38 MAPK phosphorylation and its downstream AP-1 activation with subsequent regulation of pancreatic cancer cell adhesion and invasion. Overexpressed ILK enhances the IL-1alpha-induced p38 MAPK phosphorylation more strongly through glycogen synthase kinase 3 (GSK-3) activation, and subsequently induces AP-1 activation, which promotes aggressive capabilities of pancreatic cancer cells. In contrast, knockdown of ILK kinase activity inhibits the IL-1alpha-induced activation of MAPK/AP-1 pathway via inhibition of GSK-3 phosphorylation. In immunohistochemical analysis, statistically significant association between strong expression of ILK and poor prognosis of pancreatic cancer patients were observed, and strong expression of ILK in cancerous tissues can be a significant prognostic indicator of pancreatic cancer patients. Our results suggest that ILK is involved with aggressive capability in pancreatic cancer and that these regulations can be helpful to understand biological processes for a better translational treatment for pancreatic cancer patients.

Iron feeding optimization and plasmid stability in production of recombinant bacterial magnetic particles by Magnetospirillum magneticum AMB-1 in fed-batch culture

The production of bacterial magnetic particles (BMPs) by recombinant Magnetospirillum magneticum AMB-1 harboring the plasmid pKML was enhanced in pH-regulated fed-batch culture. The addition of fresh nutrients was feedback-controlled as a function of the pH of the culture. The yield of BMPs was optimized by adjusting the rate of ferric iron addition. Feeding ferric quinate at 15.4 microg/min resulted ina BMP yield of 7.5 mg/l, which is the highest yield so far reported. Expression of a plasmid-encoded fusion protein and segregation of the plasmid during bacterial growth here both stable during, fed-batch culture. More than 75 % of the cells retained the plasmid for 130 h under antibiotic-free conditions. In addition, the fusion protein permitting the display of a specific protein on the BMP surface was also stably expressed.

Cancer immunotherapy by fusions of dendritic and tumour cells and rh-IL-12

BACKGROUND

Vaccination with fusion cells (FCs) comprising dendritic cells and tumour cells as well as administration of interleukin-12 (IL-12) showed a significant therapeutic effect against established tumours in mouse experimental models. We conducted immunotherapy against various malignant tumours using the FCs and rhIL-12, and investigated the safety and efficacy of the therapy.

MATERIALS AND METHODS

Patients' DCs were mixed with autologous irradiated tumour cells and treated with 50% polyethylene glycol to generate FCs. The FCs were inoculated intradermally, and then 30 ng kg(-1) of rhIL-12 was injected at the same sites 2 and 6 days later. This process was carried out as one cycle, and three of these cycles were repeated at 1-week intervals to comprise one course. After completing the course, its safety and therapeutic effects were estimated.

RESULTS

The most frequently observed adverse event was fever, observed in 26% of patients in the first cycle. Decrease in white blood cell and an increase in serum ALT were observed in 28% and 25%, respectively. Three out of 12 patients with a malignant brain tumour (25%) achieved a partial response (PR), but other patients with a malignant tumour showed no regression of their tumours. Thirteen out of 16 patients with a brain tumour (81%) showed cutaneous delayed hypersensitivity responses. However, only one of 16 patients (6%) with a malignant tumour other than a brain tumour developed such responses.

CONCLUSIONS

Immunotherapy using a FC vaccine and rhIL-12 induced no serious adverse reactions, and provided good therapeutic responses in some of the patients with a brain tumour.

Effects of shift schedules on fatigue and physiological functions among firefighters during night duty

To examine the effects of shift schedules on fatigue and physiological functions among firefighters a 17-day field study at a fire station was carried out. Eleven firefighters, who were engaged in firefighting emergency services, participated in this study. At the fire station, night duty (22:00-07:00) was divided into 5 periods (P1: 22:00-00:00; P2: 23:45-01:45; P3: 01:30-03:30; P4: 03:15-05:15; P5: 05:00-07:00). The participants were assigned to one of these 5 periods and awakened to answer calls from the city's central information centre. They took naps in individual rooms during night duty, except when on night shift or when called out on an emergency. Subjective complaints of fatigue, critical flicker fusion frequencies, 3-choice reaction times, and oral temperature were measured before and after work and following breaks during their 24 working hours. Heart rate variability was also recorded to evaluate autonomic nerve activity. The results show that during P3 and P4, participants who had to wake up at midnight took shorter naps. The rates of subjective complaints regarding P3 and P4 tended to be higher than those for P1, P2, and P5. The ratios of the low frequency component of heart rate variability to the high frequency component during P4 were significantly lower than those during P5. It is assumed that such an irregular sleeping pattern causes many complaints of subjective fatigue, and adversely affects physiological functions. A night-duty shift schedule ensuring undisturbed naps should be considered.

Simultaneous measurement of T-helper 1 cytokines in tuberculous pleural effusion

OBJECTIVE

Tuberculosis, the leading cause of death among infectious diseases worldwide, is a major cause of lymphocytic exudative pleural effusion. T-helper 1 cytokines, including interferon-gamma (IFN-gamma), interleukin (IL)-12p40 and IL-18 are predominantly associated with cell-mediated immune responses, and play an important role in immunity to Mycobacterium tuberculosis.

DESIGN

We studied 55 patients presenting with pleural effusion at the National Sanyo Hospital between April 2000 and September 2001 (42 men and 13 women; mean age 67 years). Twenty patients (36%) had tuberculous pleurisy, while 18 (33%) had malignant effusions and 17 (31%) had an effusion with another aetiology. Pleural fluid concentrations of IL-12p40 and IL-18 as well as IFN-gamma measured by enzyme-immunoassays.

RESULTS

Concentrations of all three cytokines were significantly higher in tuberculous than other pleural effusions. Significant correlations were evident between IFN-gamma and IL-12. We found particularly high concentrations of IL-12p40 and IFN-gamma in tuberculous patients with high fever.

CONCLUSION

The results indicate that T-helper 1 cytokines are involved in intrapulmonary cellular immune responses to M. tuberculosis, and suggest that the interactions between them may play an important role in the pathogenesis and severity of the pleural effusion. Understanding the development of this response may enhance our understanding of the pathogenesis of tuberculous pleural effusion and suggest new therapies.

Pneumonitis induced by rifampicin

An 81-year-old man was admitted to hospital with pulmonary Mycobacterium tuberculosis infection and was treated with rifampicin (RFP), isoniazid (INH), and ethambutol (EB). On day 9 he developed fever and dyspnoea. Chest radiographs showed new infiltration shadows in the right lung. Bronchoalveolar lavage (BAL) was performed and increased numbers of lymphocytes were recovered. Drug induced pneumonitis was suspected so the antituberculous regimen was discontinued and methylprednisolone was administered. The symptoms and infiltration shadows improved. INH and EB were reintroduced without any recurrence of the abnormal shadows. T cell subsets in the BAL fluid and a positive lymphocyte stimulation test for RFP suggest that RFP induced pneumonitis may be related to a complex immunological response.

Development of high-performance and rapid immunoassay for model food allergen lysozyme using antibody-conjugated bacterial magnetic particles and fully automated system

A high-performance and rapid chemiluminescence immunoassay for model food allergen lysozyme, one of the major allergenic components in egg white, using antibody-conjugated bacterial magnetic particles and a fully automated system was developed. This system contains a reaction station, tip rack, and an eight-tip pipettor that is able to attach and detach a strong magnet to the tip surface. The immunoreaction time was shortened to 5 min, and the assay was completed within 20 min. The lower detection limit for lysozyme was 10 ng/mL. This system can be used to perform 24 samples in 60 min within 10% coefficient of variation.

Isolation of Magnetospirillum magneticum AMB-1 mutants defective in bacterial magnetic particle synthesis by transposon mutagenesis

Nonmagnetic mutants of Magnetospirillum magneticum AMB-1 were recovered following mini-Tn5 transposon mutagenesis. Transconjugants with kanamycin resistance were obtained at a frequency of 2.7 x 10(-7) per recipient. Of 3327 transconjugants, 62 were defective for bacterial magnetic particle (BMP) synthesis. The frequency of independent transposition events for nonmagnetic mutants was about 1.4% in transconjugants. Further analysis of DNA sequences flanking transposon by inverted polymerase chain reaction allowed isolation of at least 10 genes or DNA sequences involved in BMP synthesis in M. magneticum AMB-1.

Synthesis of bacterial magnetic particles during cell cycle of Magnetospirillum magneticum AMB-1

We investigated the relationship between the synthesis of bacterial magnetic particles (BMPs) and the transcription of magA gene-encoding iron transport protein using synchronous culture of Magnetospirillum magneticum AMB-1. Synchronously cultured cells were subjected to transmission electron microscopic observation and fluorescence in situ hybridization. The average number of BMPs slowly increased in the cell with increasing cell size. A sharp increase in BMPs occurred just before cell division and resulted in maximum BMP production of 30 particles/cell. The transcription of magA was regulated immediately before and after cell division.

A magnetosome-specific GTPase from the magnetic bacterium Magnetospirillum magneticum AMB-1

Magnetic bacteria produce intracellular vesicles that envelope single domain magnetite crystals. Although many proteins are present in this intracellular vesicle membrane, five are specific to this membrane. A 16-kDa protein, designated Mms16, is the most abundant of the magnetosome-specific proteins, and to establish its function we cloned and sequenced its gene from Magnetospirillum magneticum AMB-1. This was achieved by determination of the N-terminal amino acid sequence of the protein following two dimensional polyacrylamide gel electrophoresis, and sequencing of the gene was performed by gene walking using anchored polymerase chain reaction. Mms16 contains a putative ATP/GTP binding motif (P-loop). Recombinant Mms16 with a hemagglutinin tag, was expressed in Escherichia coli and purified. Recombinant Mms16 protein could bind GTP and showed GTPase activity. GTP was the preferred substrate for Mms16-catalyzed nucleotide triphosphate hydrolysis. These results suggest that a novel protein specifically localized on the magnetic particle membrane, Mms16, is a GTPase. Mms16 protein showed similar characteristics to small GTPases involved in the formation of intracellular vesicles. Furthermore, addition of the GTPase inhibitor AlF(4)- also inhibited magnetic particle synthesis, suggesting that GTPase is required for magnetic particles synthesis.

Use of digirad 2020tc Imager, a multi-crystal scintillation camera with solid-state detectors in one case for the imaging of autografts of parathyroid glands

99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy with Digirad 2020tc ImagerTM (2020tc), which was a multi-crystal scintillation camera with solid-state detectors was performed for patients with secondary hyperparathyroidism having autografts of parathyroid glands in the right arm. With the 2020tc camera, three abnormal accumulations were found in the right arm. The images obtained with this camera were superior in resolution to those obtained with a conventional NaI crystal gamma camera (ZLC7500, Siemens, Germany). The next day, resection of autografts of parathyroid glands was done. Four hyperplastic parathyroid glands were resected and all were hyperplastic in pathological findings.

Alteration of integrins by interleukin-1alpha in human pancreatic cancer cells

INTRODUCTION

Adhesion of tumor cells to extracellular matrix (ECM) proteins plays an important role in tumor invasion and metastasis.

AIMS

To investigate the expression of integrins in human pancreatic cancer cell lines and its alteration by interleukin (IL)-1alpha to examine the mechanism of adhesion of metastatic human pancreatic cancer cells to ECM proteins.

METHODOLOGY

The expression of integrin subunits and their alteration by IL-1alpha were examined by flow-cytometric analysis and cellular enzyme-linked immunosorbent assay in three metastatic human pancreatic cancer cell lines (AsPC-1, BxPC-3, and SW1990) and two nonmetastatic cancer cell lines (PaCa-2 and PANC-1). In addition, assays of cancer cell adhesion to ECM proteins were performed to investigate if increased integrin expression actually affected the adhesive interaction between cancer cells and the putative integrin ECM ligands.

RESULTS

The alpha(6) subunit expressed in metastatic cancer cells was enhanced by IL-1alpha. Metastatic cancer cells also showed preferential adherence to laminin compared with nonmetastatic cancer cells, and this was enhanced by IL-1alpha.

CONCLUSION

In pancreatic cancer, the enhancement of alpha(6)beta(1) integrin by IL-1alpha through IL-1 receptor type I, as well as the expression of alpha(6)beta(1) integrin, plays an important role in metastasis formation.

[Orchiectomy for tuberculous epididymitis: a report of two cases with intractable to antituberculosis treatment]

This paper describes two cases with tuberculous epididymitis. The first case was a 69-year-old man who was admitted to our hospital because of ulceration or right scrotum. Physical examination revealed a hard, rounded, a little bigger than egg-sized mass in the right scrotum. The second case was a 40-year-old man who was admitted to our hospital because of cough, fever and body weight loss. He was treated for pulmonary tuberculosis with isoniazid, rifampicin, streptomycin and pyrazinamide. Six months after admission, he complained of a painless swelling of the right scrotum. Physical examination revealed a hard, rounded, more than egg-sized mass in the right scrotum. Right orchiectomy was performed in these two cases, and they were cured.

[Bacteria isolated from surgical infections and their susceptibilities to antimicrobial agents. Special references to bacteria isolated between April 1998 and March 1999]

The annual multicenter studies on isolated bacteria from infections in general surgery and their antimicrobial susceptibility have been conducted in Japan since July 1982. This paper describes the results obtained in fiscal 1998 (from April 1998 to March 1999). The number of cases investigated as objectives was 225 for one year. A total of 429 strains (121 strains from primary infections and 308 strains from postoperative infections) were isolated from 183 cases (81.3% of total cases). In primary infections, the isolation rates of anaerobes and Escherichia coli were higher than in postoperative infections, while in postoperative infections, those of Gram-positive aerobes and Pseudomonas aeruginosa were higher than in primary infections. On the whole, among Gram-positive aerobes, the isolation rate of Enterococcus faecalis was the highest, followed by Staphylococcus aureus with high frequency in isolation from postoperative infections. Among Gram-positive anaerobes, Peptostreptococcus spp. and Streptococcus spp. were predominantly isolated. Among Gram-negative aerobes, E. coli, P. aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae were frequently isolated. Among Gram-negative anaerobes, Bacteroides fragilis group was the majority of isolates. In primary infections, the percentage of Gram-negative aerobes has gradually increased since fiscal 1995 or 1996 with these years as the turning point, while those of Gram-positive and Gram-negative anaerobes have gradually declined. In postoperative infections, the percentage of Gram-negative anaerobes has increased continuously since the mid-1980s. The percentage of MRSA among S. aureus rose to 89.7%, which was the highest level since the beginning of this study. The susceptibilities of B. fragilis, which did not show apparent changes, were recognized to have decreased against cephems in fiscal 1998. Among other bacteria in B. fragilis group, development of resistance to cephems has continued on a long-term basis since the mid-1980s. E. coli and K. pneuminiae have obviously not changed in susceptibilities, however, the susceptibilities of isolated strains in fiscal 1998 against high-generation cephems, oxacephems and monobactams have declined. We found neither vancomycin-resistant nor teicoplanin-resistant strains of S. aureus and Enterococcus spp.

[Efficacy of intraperitoneal chemotherapy for peritoneal recurrence of gastric carcinoma]

We report a patient in whom intraperitoneal chemotherapy was effective against peritoneal recurrence of gastric carcinoma. A 74-year-old woman underwent total gastrectomy with splenectomy and transverse colectomy for Borrmann type IV gastric carcinoma (curability B) in January 2000. The diagnosis was Stage IV gastric carcinoma (T4, N2, P1, H0, M0 and CY0). In July 2000, peritoneal recurrence occurred along with slight elevation of CEA. In September, two ports were inserted into the upper and lower peritoneal cavity for intraperitoneal chemotherapy with low-dose CDDP and 5-FU plus MMC. She was followed-up for four months as an outpatient and received intraperitoneal chemotherapy biweekly with good control of peritoneal metastasis. However, she died of bone and lung metastases in January 2001. Intraperitoneal chemotherapy was effective in this patient for peritoneal recurrence of gastric carcinoma and could be delivered on an outpatient basis while maintaining the patient's quality of life.

Effects of Y-27632 on acetylcholine-induced contraction of intact and permeabilized intrapulmonary bronchial smooth muscles in rats

In the present study, the effects of a selective Rho-associated coiled-coil forming protein kinase (ROCK) inhibitor, Y-27632 [(+)-(R)-trans-4-(1-aminoethyl)-(4-pyridyl)cyclohexanecarboxamide dihydrochloride] on acetylcholine-induced contraction and Ca(2+) sensitization of rat bronchial smooth muscle were examined. Intact and beta-escin-permeabilized muscles of the third branch of intrapulmonary bronchi were used. In intact muscles, Y-27632 (10(-6)-10(-4) M) concentration-dependently inhibited acetylcholine-induced contractile responses. In acetylcholine (10(-3) M)-precontracted intact muscles, the maximal relaxation (about 50% inhibition of contraction) was obtained by a concentration of 10(-4) M Y-27632, which had no effect on the resting tone. In beta-escin-permeabilized muscles, addition of acetylcholine (10(-5)-10(-3) M) plus GTP (100 microM) induced a further contraction, i.e., Ca(2+) sensitization at a constant Ca(2+) concentration of pCa=6.0. The acetylcholine-induced Ca(2+) sensitization was completely blocked in the presence of 10(-4) M Y-27632, whereas the Ca(2+)-induced contraction itself was not affected by Y-27632. Immunoblot study revealed the expression of ROCK-I and ROCK-II proteins in the intrapulmonary bronchi of rats. These findings suggest that Y-27632 dilates acetylcholine-mediated contraction of rat bronchial smooth muscle by inhibiting RhoA/ROCK-mediated Ca(2+) sensitization.

Pulmonary lymphoma of large B-cell type mimicking Wegener's granulomatosis

A 27-year-old man with a primary pulmonary lymphoma of large B-cell type is described. Symptoms involved both the upper and lower respiratory tract. A chest roentgenogram showed a dense mass with cavitation. Transbronchial biopsy specimens revealed no atypical cells, rather they demonstrated granulomatous infiltration and vasculitis consistent with but not conclusively diagnostic of Wegener's granulomatosis. The pulmonary mass became smaller after sulfamethoxazole-trimethoprim therapy. These features suggested Wegener's granulomatosis. However, an open biopsy specimen was diagnostic for diffuse lymphoma of large B-cell type. High-grade pulmonary lymphoma should be considered in the differential diagnosis of patients with clinical and pathologic features suggesting Wegener's granulomatosis.

Posttreatment nadir M-protein level is a stronger discriminator of survival following plateau attainment than is percent reduction in M-protein in patients with IgG myeloma

We conducted a retrospective study of patients with IgG or IgA myeloma who attained plateau to evaluate the relationships between survival and posttreatment nadir M-protein levels and between survival and the response to treatment evaluated by the percent reduction in M-protein. Of the 127 patients comprising 92 IgG and 35 IgA myeloma patients with disease stages II or III, 51 (40.2%) attained plateau. For IgG myeloma patients who attained plateau, survival time was not affected by the percent reduction in M-protein (median survival, 59.5 months for responding patients versus 54.4 months for nonresponding patients, P = .6910). Posttreatment nadir M-protein level, however, did affect survival time (median survival, 61.2 months for <3000 mg/dL versus 25.7 months for >3000 mg/dL, P = .0439). These findings suggest that the posttreatment nadir M-protein level is a stronger discriminator of survival following plateau attainment than the percent reduction of M-protein in patients with IgG myeloma.

Effects of growth medium composition, iron sources and atmospheric oxygen concentrations on production of luciferase-bacterial magnetic particle complex by a recombinant Magnetospirillum magneticum AMB-1

Growth conditions for mass production of luciferase-bacterial magnetic particles (BMPs) by a recombinant Magnetospirillum magneticum AMB-1 were investigated in a pH-regulated fed-batch culture system. Enrichment of growth medium with L-cysteine, yeast extract and polypeptone enhanced both bacterial growth and BMP production. The presence of L-cysteine in the medium was useful for induction of cell growth. Strict anaerobic conditions led to a prolonged lag phase and limited the final cell density. Trace oxygen enhanced cell growth with increasing BMP production. As iron sources, ferrous sulfate and ferric gallate dramatically enhanced BMP yield as compared with ferric quinate, an iron chelate conventionally used. The optimized conditions increased cell density to 0.59 +/- 0.03 g cell dry weight/liter and BMP production to 14.8 +/- 0.5 mg dry weight/liter in fed-batch culture for four days.

[A case of advanced gastric cancer that was resectable after asctic fluid had disappeared following administration of TS-1]

A 60-year-old man who had suffered from epigastic pain and general malaise from November 1999 was admitted to our hospital due to Borrmann type 3 gastric cancer with ascites on December 7, 1999. We considered a radical B operation impossible, and placed the patient on neoadjuvant TS-1 chemotherapy consisting of 1 M tegafur, 0.4 M gimestat, and 1 M otastat potassium. There were no side effects other than Grade 1 nausea and mild loss of appetite throughout the chemotherapy. After 8 weeks of administration, the primary lesion was reduced in size, and ascitic fluid had disappeared on abdominal computed tomography images. Therefore, a total gastrectomy with splenectomy and D2 lymph node dissection was performed on March 31, 2000. This was a radical B operation that was not possible earlier. The pathological diagnosis was tub2, SE, N1, CY0, H0, P0, M0, INF gamma, ly1, v1, PM (-), DM (-) and the antitumor efficacy of TS-1 was Grade 2 histologically. The patient remains alive and in good condition with no relapse of the gastric cancer 8 months after surgery.