Effect of early dose increase of evocalcet for intractable hypercalcemia caused by parathyroid carcinoma

Summary

Hypercalcemia due to parathyroid carcinoma (PC) is safely and quickly controlled with rapidly increasing evocalcet doses. Most parathyroid carcinomas are detected because of hypercalcemia due to primary hyperparathyroidism (PHPT). Hypercalcemia becomes more severe in patients with PC than those with parathyroid adenoma or hyperplasia. Hypercalcemia often causes renal dysfunction, gastrointestinal symptoms, and psychiatric symptoms. Consequently, the serum calcium level needs to be promptly corrected. Here, we report a case of PC with remarkably persistent hypercalcemia, which we safely and quickly controlled with rapidly increasing evocalcet doses. A 77-year-old female presented with renal dysfunction. Her serum calcium (Ca) and intact parathyroid hormone serum levels were 13.9 mg/dL and 1.074 pg/mL, respectively. Her renal function worsened because of hypercalcemia due to PHPT. Technetium-99 m methoxy-isobutyl-isonitrile parathyroid scintigraphic examination revealed an accumulation below the right thyroid lobe. CT examination showed a 35-mm mass. Hypercalcemia needed to be immediately corrected because of the patient's worsening renal function. Evocalcet treatment at a gradually increasing dose of up to 20 mg over 3 weeks allowed her serum Ca level to be maintained below 11 mg/dL. Only mild nausea was observed at the beginning of the treatment. The mass was suspected as PC because the hypercalcemia was refractory to high-dose evocalcet. The patient was treated with parathyroidectomy and ipsilateral thyroidectomy. PC was diagnosed based on the pathological findings of capsular and venous invasion. The patient's renal function improved and surgery could be safely performed by promptly correcting hypercalcemia.

Learning points

Hypercalcemia due to parathyroid carcinoma (PC) is often more severe than that caused by parathyroid adenoma or hyperplasia. PC is a rare disease, but it should be considered if the patient has intractable hypercalcemia due to primary hyperparathyroidism (PHPT). Evocalcet, which is used to treat hypercalcemia due to PHPT, does not interact with P450 (CYP) and causes few side effects. Complications, including renal dysfunction, were improved and the surgery could be safely performed by promptly correcting hypercalcemia. PC has a high recurrence rate. En-block excision is necessary when PC is suspected.

Primary signet‐ring cell carcinoma of the renal pelvis: An autopsy case

Introduction

Signet‐ring cell carcinoma is an extremely rare histological variant of upper urinary tract carcinoma, associated with poor prognosis.

Case presentation

We report a case of a 75‐year‐old female diagnosed with left primary upper urinary tract signet‐ring cell carcinoma, initially treated with surgery. Post‐surgical development of multifocal metastases was followed by a devastating clinical course. An autopsy confirmed the tumor's primary origin in the upper urinary tract.

Conclusion

We experienced a case of upper urinary tract signet‐ring cell carcinoma, with a rare opportunity to thoroughly confirm its primary site with an autopsy.

Long-term response on letrozole for gastric cancer: A case report

RATIONALE

Hormone therapies, particularly those targeting estrogen and its receptors, are a key treatment modality for patients with estrogen receptor (ER)-positive breast or ovarian cancer. Some gastric cancers (GCs) express ERs, and preclinical studies suggest the potential of estrogen-targeting hormone therapy on GC; however, the clinical relevance of this hormone therapy on GC treatment has not been well elucidated.

PATIENT CONCERNS

An 80-year-old female was admitted to our department with hypogastric pain and vomiting. Computed tomography demonstrated small bowel obstruction, and laparotomy after bowel decompression revealed peritoneal dissemination consisting of a poorly-differentiated adenocarcinoma. Intestinal bypass between the ileum and transverse colon was performed.

DIAGNOSES

The tumor was ER- and mammaglobin-positive, indicating that it originated from a breast cancer. Diagnostic imaging revealed no evidence of breast cancer; however, right axillary ER- and mammaglobin-positive lymphadenopathy was found.

INTERVENTIONS

The patient received hormone therapy using letrozole based on a clinical diagnosis of occult breast cancer with peritoneal dissemination and right axillary lymph node metastasis.

OUTCOMES

The patient remained disease free until 37 months but deceased at 53 months from the onset of disease. An autopsy revealed no tumor cells in the right breast tissue; however, there was a massive invasion of cancer cells in the stomach.

LESSONS

A patient with ER positive GC with peritoneal dissemination and right axillary lymph node metastasis presented remarkable response to letrozole. The long-term survival obtained using letrozole for a patient with GC with distant metastasis suggests the potential of estrogen targeting hormone therapies for GC.

Relationship between ethanol consumption and TBL2 rs17145738 on LDL-C concentration in Japanese adults: a four season 3-day weighed diet record study

Background

LDL cholesterol (LDL-C) concentration is modified by dietary and genetic factors; however, little is known about the details of this relationship. Our aim was to investigate the associations taking into account dietary assessment methods, seasonal effects and missing values.

Methods

Study subjects completed food frequency questionnaires (FFQ) and supplied 3-day weighed dietary records (WDRs) and blood samples in four seasons. Approximately 660,000 single nucleotide polymorphisms (SNPs) were measured. Candidate SNPs related to LDL-C concentration were systematically selected. Multiple imputation was applied for missing values. A total of 312 repeated measures data were used for analyses. After adjusting for season and subjects as fixed and random effects, effects of nutrient intake and SNPs on LDL-C concentration were assessed according to three dietary assessment methods: the FFQ and first and four season 3-day WDRs (4 s-3d WDRs).

Results

For LDL-C concentration, ethanol consumption derived from all three dietary assessment methods was consistently associated (P < 0.09 for all). Positive and negative relationships were consistently shown with rs651007 and rs1160985 in the first and four seasons; but the latter remained after adjusting for total dietary fiber intake derived from the FFQ and 4 s-3d WDRs (P < 0.05, excepting the first 3-day WDRs). rs599839 was negatively associated after cholesterol intakes derived from the first and 4 s-3d WDRs were considered (P < 0.05 and 0.07, respectively). Each rs17145738 and ethanol consumption based on the 4 s-3d WDRs was related to LDL-C concentration (P < 0.05). Seasonal variations of LDL-C concentration were observed only in summer.

Conclusions

In contrast to nutrient intake, ethanol consumption was shown to be comprehensively related to LDL-C concentration, regardless of dietary assessment methods. Taking into account seasonal effects, critical relationships with LDL-C concentration for some SNPs, after adjustment for specific nutrients, were revealed. Our findings can be used to help to interpret the relationships between dietary and genetic factors on LDL-C concentration in large-scale epidemiological studies.

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A case of pulmonary histoplasmosis diagnosed after lung lobectomy

BACKGROUND

Histoplasmosis is considered a fairly rare imported mycosis in Japan. Here we report a case of histoplasmosis describing the preoperative findings, histopathological findings, supposed infection route, and appropriate treatment, including the postoperative management.

CASE PRESENTATION

A healthy 65-year-old man was found at routine medical check-up to have an abnormal opacity on chest radiography. A chest computed tomography (CT) scan showed a nodular lesion in the posterior basal segment of the right lung, as well as two smaller nodules in the same lobe. This was highly suggestive of primary lung cancer with pulmonary metastases in the same lobe. We thus performed a right lower lobectomy with hilar and mediastinal lymph node dissection via thoracotomy. The lesions were diagnosed as pulmonary histoplasmosis on histopathology. At 6-month follow-up examination, the patient was free from fungal infection without any postoperative medication.

CONCLUSIONS

We describe a patient with pulmonary histoplasmosis diagnosed following surgical lobectomy. The possibility of pulmonary histoplasmosis should be considered in the differential diagnosis of pulmonary nodular lesions.

A case of unique endoscopic findings of intestinal endometriosis exposed to the mucosa: aggregation of papillary protruded bulges from the submucosal elevation of the rectum

Intestinal endometriosis exposed to the mucosa is relatively rare. Therefore, its endoscopic findings with pit pattern and magnifying endoscopy with narrow-band imaging and clinicopathological features of intestinal endometriosis exposed to the mucosa have not been well documented until now. A 44-year-old woman was suspected to have gastrointestinal bleeding by positive fecal occult blood test. Colonoscopy revealed a hemicircular submucosal tumor whose surface was covered with easy-bleeding papillary bulges in the rectum. Pit pattern analysis and magnifying endoscopy with narrow-band imaging revealed straight microvessels among the straight pits arranged in a radial manner, and the avascular area with no pit pattern of the top of the bulge. These findings were different from those of polyps or cancer. Biopsy specimens from the protruded lesions were diagnosed as rectal mucosal endometriosis by hematoxylin-eosin staining and immunohistochemical examination. Surgical resection was suggested to the patient, but the patient did not favor surgical treatment. After the diagnosis dienogest treatment started and successfully relieved her abdominal pain. Malignant transformation of the endometriotic lesion has not arisen to this date.

"Pure" Suprasellar Schwannoma Presented with Communicating Hydrocephalus: A Case Report

Schwannoma is a benign peripheral nerve sheath tumor originating from Schwann cells. Most intracranial schwannomas arise from vestibular nerve and schwannoma in the suprasellar region is extremely rare. A 64-year-old man presented with walking disturbance and blurred vision for three months. Lateral hemianopsia in the left eye and brachybasia were observed. Magnetic resonance imaging revealed a suprasellar tumor with strong contrast enhancement associated with communicating hydrocephalus. The cerebrospinal fluid tap test improved gait disturbance. Hypothalamic stimulation test revealed hypo-reaction of GH, FSH and LH. After ventriculo-peritoneal shunting, the tumor was totally removed via a bilateral front-basal approach with a clinical diagnosis of craniopharyngioma. No adhesion was observed between the tumor and surrounding structures such as meninges and brain. The histopathological diagnosis was schwannoma. Here we report a case of suprasellar schwannoma associated with communicating hydrocephalus that has not ever been previously reported, with special reference to its pathogenesis.

The Resection of Thyroid Cancer Was Associated with the Resolution of Hyporesponsiveness to an Erythropoiesis-stimulating Agent in a Hemodialysis Patient with Aceruloplasminemia

We herein report the case of a hemodialysis patient whose response to an erythropoiesis-stimulating agent (ESA) improved following the resection of thyroid cancer. Her hemoglobin level remained below 7 g/dL, despite the use of ESA. During the search for the causes of her hyporesponsiveness to ESA, papillary thyroid cancer and aceruloplasminemia were found. The existence of other potential causes, such as iron deficiency, infectious disease, severe hyperparathyroidism and malnutrition were ruled out. Following the resection of the thyroid cancer tumor, her hemoglobin level increased to 10.2 g/dL over a period of 4 months. This is the first report to demonstrate the resolution of hyporesponsiveness to ESA following the resection of a malignant tumor.

Poorly Differentiated Gastric Adenocarcinoma Can Mimic Hilar Cholangiocarcinoma

This report describes two cases with obstructive jaundice caused by poorly differentiated gastric adenocarcinoma. Computed tomography scans showed circumferential stenosis in the hilar bile ducts. Endoscopic retrograde cholangiopancreatography showed dilatation of the bilateral hepatic ducts and stenosis of the common hepatic ducts from the bifurcation of the bilateral hepatic ducts. The first diagnoses were hilar cholangiocarcinoma and biliary drainage decreased serum bilirubin; however, both patients died of cancer within a short period of time. Autopsies revealed lymphatic vessel invasion and possible subepithelial invasion by gastric adenocarcinoma into the hilar bile ducts. A differential diagnosis should thus be required in suspected cases of hilar cholangiocarcinoma.

A case of primary adrenal diffuse large B cell lymphoma presenting with severe hyponatremia

We herein report a case of primary adrenal lymphoma with severe hyponatremia. The patient was admitted for an evaluation of severe hyponatremia and an enlarged bilateral adrenal mass, which were found in a previous examination for causes of general fatigue and anorexia. Laboratory data, including the serum levels of sodium (115 mEq/L), osmolality (239 mOsm/kgH₂O), ADH (5.8 pg/mL), cortisol (11.6 μg/dL), free T3 (2.42 pg/mL), urinary Na (117 mEq/L) and urine osmolality (490 mOsm/kgH₂O), fulfilled the diagnostic criteria for the syndrome of inappropriate secretion of ADH (SIADH). An abdominal computed tomography scan revealed a large bilateral adrenal mass. A biopsy of the enlarged left adrenal mass revealed diffuse large B cell lymphoma, which was negative for ADH protein. Hydrocortisone treatment normalized the patient's body temperature and serum sodium concentration. In this case, hyponatremia developed when both adrenal glands were involved and was normalized with hydrocortisone. These findings suggest that adrenal insufficiency was the cause of hyponatremia, although the basal serum cortisol was normal. The current case suggests that the administration of hydrocortisone is recommended if suspicious clinical signs or symptoms are found in severe hyponatremia, even if hyponatremia is associated with a normal serum cortisol level and fulfills the diagnostic criteria for SIADH.

[A case of intravascular large B-cell lymphoma that presented with recurrent multiple cerebral infarctions and followed an indolent course]

A 66-year-old woman presented with vertigo and deafness. Diffusion-weighted magnetic resonance imaging of the head showed multiple cerebral infarctions involving several blood vessel regions. A diagnosis of cardiogenic embolism was made, and anticoagulation therapy was begun. The woman had no additional symptoms until suddenly developing left hemiparesis one year later. She was again found to have multiple cerebral infarctions. The hemiparesis gradually improved, but ataxic gait and apraxia appeared and progressed over two weeks. Holter ECG, carotid ultrasound, and transthoracic/transesophageal echocardiography revealed no evidence of cardiogenic embolism. However, serum lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL2R) levels were elevated (LDH, 782 IU/l; sIL2R, 1,396 IU/ml), which suggested malignant lymphoma. Contrast chest/abdominal CT scan and gallium-67 scintigraphy revealed no evident lesions; however, random skin biopsy and open brain biopsy showed that blood vessels were infiltrated by CD20-positive atypical lymphocytes. These findings were consistent with intravascular large B-cell lymphoma. This type of lymphoma is known as a rapidly progressive disease with poor prognosis, but this case followed an indolent course, with a one-year interruption in disease progression.

Superior mediastinal paraganglioma associated with von Hippel-Lindau syndrome: report of a case

Extra-adrenal pheochromocytomas are termed paragangliomas. Paragangliomas in the mediastinum, especially the superior mediastinum, are extremely rare. It is known that paragangliomas or pheochromocytomas occur in combination with von Hippel-Lindau syndrome. We present the case of a non-functional superior mediastinal paraganglioma in a patient with von Hippel-Lindau syndrome, without a familial history suggestive of the condition. This case highlights that we should be aware of possible sporadic von Hippel-Lindau syndrome in patients with a mediastinal paraganglioma.

Polyarteritis nodosa diagnosed by surgically resected jejunal necrosis following acute abdomen

The differential diagnosis of acute abdomen is typically extremely broad in range, with vasculitis posing a rare but potentially life-threatening cause of acute abdomen. Here, we report a case of acute abdomen with bowel wall thickening limited to jejunum, accompanied by unexplained renal dysfunction. Later, the patient was diagnosed as having polyarteritis nodosa based on surgically resected jejunal necrosis. Despite aggressive treatment, including the use of steroid pulse therapy and continuous hemodiafiltration, the patient died. Although polyarteritis nodosa is extremely rare in patients with acute abdomen, acute abdomen is relatively common manifestation of that. And it is reported that involvement of small intestine suggests poorer prognosis. Our case highlights the importance of vasculitis as a differential diagnosis of patients with atypical acute abdomen. In this report, we not only review possible clues that might have led to an earlier diagnosis in this case, but also attempt to draw some lessons for treating similar cases in the future.

Enhanced chemiluminescent detection scheme for trace vapor sensing in pneumatically-tuned hollow core photonic bandgap fibers

We demonstrate an in-fiber gas phase chemical detection architecture in which a chemiluminescent (CL) reaction is spatially and spectrally matched to the core modes of hollow photonic bandgap (PBG) fibers in order to enhance detection efficiency. A peroxide-sensitive CL material is annularly shaped and centered within the fiber's hollow core, thereby increasing the overlap between the emission intensity and the intensity distribution of the low-loss fiber modes. This configuration improves the sensitivity by 0.9 dB/cm compared to coating the material directly on the inner fiber surface, where coupling to both higher loss core modes and cladding modes is enhanced. By integrating the former configuration with a custom-built optofluidic system designed for concomitant controlled vapor delivery and emission measurement, we achieve a limit-of-detection of 100 parts per billion (ppb) for hydrogen peroxide vapor. The PBG fibers are produced by a new fabrication method whereby external gas pressure is used as a control knob to actively tune the transmission bandgaps through the entire visible range during the thermal drawing process.

Genetic diversity of two selected antigen loci in Babesia gibsoni Asian genotype obtained from Japan and Jeju island of South Korea

Previous reports have shown that the secreted antigen 1 of Babesia gibsoni (BgSA1) and the thrombospondin-related adhesive protein of B. gibsoni (BgTRAP) are promising diagnostic reagents and vaccine candidates. Therefore, we determined the extent of nucleotide sequence variation in the BgSA1 and BgTRAP genes, obtained from eight isolates of B. gibsoni got from clinically infected dogs in geographically distinct areas of Japan and one isolate from Jeju island of South Korea. Sequence analyses have revealed that nucleotide diversity is lower in BgSA1 than that in BgTRAP. The mean number of non-synonymous (dn) nucleotide substitutions was significantly greater than that of synonymous (ds) ones per site in region II of BgTRAP. Overall, the results predict more allele-specific immunity to BgTRAP than that to BgSA1, which could be useful in designing and testing efficacy of diagnostic reagents as well as vaccine candidates for the B. gibsoni isolates from Japan and Jeju island of South Korea.

Changes of ROS during a two-day ultra-marathon race

To assess oxidative stress (OS) induced by endurance exercise, concentrations of serum reactive oxygen species (ROS) were determined in 70 Japanese male amateur runners completing a two-day ultra-marathon race. Serum ROS levels were analyzed at three time points: before the race (baseline), after the 1st day race (mid-race), and after the 2nd day race (goal) (post-race). The means (SE) of ROS were 151.4(3.7) (U. CARR.), 168.7(4.4), and 156.8(4.4), respectively. Significant positive trends were noted between age and serum ROS concentrations at the three race points (p<0.05 for all). After adjusting for age, BMI and average monthly running distance, the baseline serum ROS concentrations were positively associated with completion times of the first-day race, in particular (p<0.05), suggesting that the concentrations may predict physical performance. The ROS production increased at mid-race (p<0.05), but the levels returned to baseline levels at post-race, indicating that an antioxidant defense system may develop post-race to reduce OS.

[Pericardial effusion due to metastatic prostate cancer: a case report]

We describe a patient whose complaints were related to pericardial effusion due to prostatic carcinoma. An 80-year-old man was admitted to our hospital because of chest discomfort and dyspnea. The chest radiograph revealed cardiomegaly and computed tomographic scan showed a large pericardial effusion. Pericardiocentesis revealed sanguinous exudates. Cytologic study suggested metastatic adenocarcinoma or malignant mesothelioma. He died suddenly because of ventricular tachycardia. At autopsy, the major finding was poorly differentiated adenocarcinoma of the prostate with metastases to the mediastinum.

Changes of Urinary 8-Hydroxydeoxyguanosine Levels during a Two-Day Ultramarathon Race Period in Japanese Non-Professional Runners

Using the urinary 8-hydroxydeoxyguanosine (8-OHdG) concentration, effects of participation in a two-day ultramarathon race period on oxidative DNA damage were investigated in Japanese nonprofessional runners. Before the first day (baseline), after the first day (mid-race) of 40-km running, and after the second day (post-race) of 90 km running, biomaterials were successfully sampled from 95 participants (males, 79; females, 16) who completed the full race. We analyzed urine for 8-OHdG and blood for aspartate aminotransferase (AST), creatine phosphokinase (CPK) and myoglobin, and evaluated fluctuation in the values at three sampling time points. Adjusted baseline urinary 8-OHdG levels (microg/g creatinine) (mean +/- standard deviation) showed no significant differences between males and females, at 2.85 +/- 1.17 and 3.04 +/- 1.56, respectively. In males, mid-race urinary 8-OHdG levels rose to 3.29 +/- 1.15 (p < 0.01), but then returned to 2.73 +/- 1.16 at the post-race time point (p < 0.01). In females, a similar increase to 3.32 +/- 1.47 and subsequent decline to 2.80 +/- 1.47 were noted. In contrast, AST, CPK and myoglobin were increased at both mid- and post-time points and particularly the latter, independent of the sex. Extreme prolonged exercise in a two-day ultramarathon race period causes oxidative DNA damage but antioxidant repair systems are apparently induced to protect against oxidative DNA stress with physical exercise.

A novel 57-kDa merozoite protein of Babesia gibsoni is a prospective antigen for diagnosis and serosurvey of canine babesiosis by enzyme-linked immunosorbent assay

We isolated a novel single copy gene encoding a 57-kDa merozoite protein of Babesia gibsoni (BgP57). The nucleotide sequence of the cDNA was 2387 bp with an open reading frame (ORF) of 1644 bp encoding a 57-kDa predicted polypeptide having 547 amino acid residues. The recombinant BgP57 (rBgP57) without a predicted signal peptide was expressed in Escherichia coli as a soluble glutathione S-transferase (GST) fusion protein. Western blotting showed that the corresponding native protein was 57-kDa, consistent with molecular weight of predicted mature polypeptide. An indirect enzyme-linked immunosorbent assay (ELISA) using the rBgP57 detected specific antibodies in the sequential sera from a dog experimentally infected with B. gibsoni. Moreover, the antigen did not cross-react with antibodies to B. canis sub-species and closely related apicomplexan parasites indicating that the rBgP57 was a specific antigen for B. gibsoni antibodies. The diagnostic performance of ELISA based on rBgP57 using 107 sera from B. gibsoni-naturally infected dogs was the same as the previously identified rBgP32 but performed better than the previously studied rBgP50. Although, seminested PCR detected higher proportions (82%) of positive samples than the ELISAs, the Mcnemar's chi-square test showed that there was no significant difference in relative effectiveness of rBgP57-ELISA and seminested PCR (chi(2)=2.70; P=0.1003) in identifying positive samples. The rBgP57-ELISA when used in combination with rBgP32-ELISA and rBgP50-ELISA appeared to improve sensitivity of the rBgP57-ELISA for detection of B. gibsoni antibodies. Overall, the rBgP57-ELISA and seminested PCR when used in combination, could improve epidemiological surveys and clinical diagnosis of B. gibsoni infection.

Identification and characterization of a novel germ line p53 mutation in familial gastric cancer in the Japanese population

Germ line mutations of the p53 gene are known to cause Li-Fraumeni syndrome, and a germ line p53 mutation has recently been reported in a small subset of familial gastric cancer (FGC) in Europe and Korea. Although the incidence of gastric cancer is very high in Japan and familial clustering is not uncommon, there has been little information on the genetic factors of FGC. Therefore, to determine the role of germ line p53 mutations in FGC in the Japanese population in this study, we used sequencing analysis to examine 80 individuals from 35 Japanese FGC families without germ line CDH1 mutations for germ line p53 mutations. One missense (c.91G>A: p.Val31Ile) and two intronic germ line mutations were found, and transcriptional activity of the Ile31 mutant on p53-responsive genes was examined to determine the functional effect of the novel p.Val31Ile germ line mutation. A luciferase reporter assay showed that the transcriptional activity of p21 (CDKN1A) and MDM2 promoters but not of the BAX promoter was significantly lower in the Ile31-type p53 than in the wild-type (wt) p53. Next, doxycycline-regulated p53-inducible H1299 cell lines were established by applying a retrovirus-mediated gene transfer system to a p53-null human H1299 cell line. Under similar p53 expression conditions shown by western blot and immunofluorescence analyses, a cell proliferation assay showed that the Ile31-type p53 had significantly lower cell proliferation suppressing activity than wt p53. These results suggest that Ile31-type p53 may be partly involved in FGC because of its low transcriptional activity and low cell proliferation suppressing activity.

Towards multimaterial multifunctional fibres that see, hear, sense and communicate

Virtually all electronic and optoelectronic devices necessitate a challenging assembly of conducting, semiconducting and insulating materials into specific geometries with low-scattering interfaces and microscopic feature dimensions. A variety of wafer-based processing approaches have been developed to address these requirements, which although successful are at the same time inherently restricted by the wafer size, its planar geometry and the complexity associated with sequential high-precision processing steps. In contrast, optical-fibre drawing from a macroscopic preformed rod is simpler and yields extended lengths of uniform fibres. Recently, a new family of fibres composed of conductors, semiconductors and insulators has emerged. These fibres share the basic device attributes of their traditional electronic and optoelectronic counterparts, yet are fabricated using conventional preform-based fibre-processing methods, yielding kilometres of functional fibre devices. Two complementary approaches towards realizing sophisticated functions are explored: on the single-fibre level, the integration of a multiplicity of functional components into one fibre, and on the multiple-fibre level, the assembly of large-scale two- and three-dimensional geometric constructs made of many fibres. When applied together these two approaches pave the way to multifunctional fabric systems.

Molecular characterization of a novel 32-kDa merozoite antigen of Babesia gibsoni with a better diagnostic performance by enzyme-linked immunosorbent assay

We cloned and expressed a novel gene encoding a 32-kDa merozoite protein of Babesia gibsoni (BgP32). The length of nucleotide sequence of the cDNA was 1464 bp with an open reading frame of 969 bp. The truncated recombinant BgP32 (rBgP32) without a signal peptide and C-terminal hydrophobic sequence was expressed in Escherichia coli as a soluble glutathione-S-transferase (GST) fusion protein. Western blotting demonstrated that the native protein was 32-kDa, consistent with molecular weight of the predicted mature polypeptide. Enzyme-linked immunosorbent assay (ELISA) using rBgP32 detected specific antibodies from 8 days to 541 days post-infection in the sequential sera from a dog experimentally infected with B. gibsoni. Moreover, the antigen did not cross-react with B. canis subspecies and closely related protozoan parasites, indicating that rBgP32 is a specific diagnostic antigen. Analysis of 47 sera taken from dogs with anaemic signs revealed that rBgP32 detected a higher proportion of B. gibsoni seropositive samples (77%) than its previously identified rBgP50 (68%) homologue. These results indicate that the BgP32 is a novel immunodominant antigen of B. gibsoni, and rBgP32 might be useful for diagnosis of B. gibsoni infection.

Detection of Transcript for Brain-Type Fatty Acid-Binding Protein in Tumor and Urine of Patients with Renal Cell Carcinoma

OBJECTIVES

To clarify the gene expression patterns of fatty acid-binding protein (FABP) and evaluate it as a potential marker for the diagnosis of renal cell carcinoma (RCC). RCC is the most common renal neoplasm.

METHODS

The expression of eight FABP genes in normal human tissues, tumor cell lines, and surgically resected RCC tissues (n = 54) was evaluated by reverse transcriptase-polymerase chain reaction. Additionally, the gene expression of FABPs in the urine of healthy volunteers (n = 12) and patients with RCC (n = 5) was investigated.

RESULTS

In these results, the carcinoma tissues but not the noncancerous (normal) parts of the kidney samples resected from patients with RCC expressed the transcript for brain-type FABP (B-FABP), indicating that expression of the B-FABP gene is a novel marker for RCC. Furthermore, the B-FABP cDNA fragment was not amplified by reverse transcriptase-polymerase chain reaction in the urine samples of healthy donors or patients with RCC after surgical operation. However, B-FABP cDNA was amplified in the patients' urine samples collected before surgery.

CONCLUSIONS

This novel method can be used as a powerful ancillary in the diagnosis of RCC.

Surface-emitting fiber lasers

All fiber lasers to date emit radiation only along the fiber axis. Here a fiber that exhibits laser emission that is radially directed from its circumferential surface is demonstrated. A unique and controlled azimuthally anisotropic optical wave front results from the interplay between a cylindrical photonic bandgap fiber resonator, anisotropic organic dye gain, and a linearly polarized axial pump. Low threshold (86nJ) lasing at nine different wavelengths is demonstrated throughout the visible and near-infrared spectra. We also report the experimental realization of unprecedented layer thicknesses of 29.5 nm maintained throughout meter-long fibers. Such a device may have interesting medical applications ranging from photodynamic therapy to in vivo molecular imaging, as well as textile fabric displays.

Dynamic all-optical tuning of transverse resonant cavity modes in photonic bandgap fibers

Photonic bandgap fibers for transverse illumination containing half-wavelength microcavities have recently been designed and fabricated. We report on the fabrication and characterization of an all-optical tunable microcavity fiber. The fiber is made by incorporating a photorefractive material inside a Fabry-Perot cavity structure with a quality factor Q >200 operating at 1.5 microm. Under short-wavelength transverse external illumination, a 2 nm reversible shift of the cavity resonant mode is achieved. Dynamic all-optical tuning is reported at frequencies up to 400 Hz. Experimental results are compared with simulations based on the amplitude and kinetics of the transient photodarkening effect measured in situ in thin films.

Successfully treated idiopathic rectosigmoid perforation 7 years after renal transplantation

Colon perforation (CP) is still a critical complication after renal transplantation (RT), and idiopathic perforation is extremely rare. Here we describe a successfully treated case of idiopathic rectosigmoid perforation that occurred 7 years after RT. In our research this is the tenth reported case of idiopathic CP after RT and the second case that has occurred in the rectosigmoid. The patient was a 51-year-old Japanese male RT recipient still receiving immunosuppressive medication. He was admitted to the hospital for sudden onset of abdominal pain during defecation. Emergency laparotomy was performed 5 h after the onset, and a longitudinal 1.5 cm perforation with a clear margin was observed in the rectosigmoid, 8 cm above the peritoneal reflection. Hartmann's operation was performed. Macroscopic and histological examination did not reveal any specific findings that may have caused perforation, so the case was diagnosed as idiopathic rectosigmoid perforation.

Hollow multilayer photonic bandgap fibers for NIR applications

Here we report the fabrication of hollow-core cylindrical photonic bandgap fibers with fundamental photonic bandgaps at near-infrared wavelengths, from 0.85 to 2.28 microm. In these fibers the photonic bandgaps are created by an all-solid multilayer composite meso-structure having a photonic crystal lattice period as small as 260 nm, individual layers below 75 nm and as many as 35 periods. These represent, to the best of our knowledge, the smallest period lengths and highest period counts reported to date for hollow PBG fibers. The fibers are drawn from a multilayer preform into extended lengths of fiber. Light is guided in the fibers through a large hollow core that is lined with an interior omnidirectional dielectric mirror. We extend the range of materials that can be used in these fibers to include poly(ether imide) (PEI) in addition to the arsenic triselenide (As(2)Se(3)) glass and poly(ether sulfone) (PES) that have been used previously. Further, we characterize the refractive indices of these materials over a broad wavelength range (0.25 - 15 microm) and incorporated the measured optical properties into calculations of the fiber photonic band structure and a preliminary loss analysis.

Observation of fluorescence in an optically pumped erbium-containing perfluorinated medium at 1.5 microm

We report what is to our knowledge the first observation of erbium fluorescence at the optical communication wavelength of 1.5 microm in a perfluorinated medium. Using a Nd:YAG (355-nm) source, we observed fluorescence of the 4I(13/2) - 4I(15/2) transition with a peak wavelength of 1.535 microm and with a full width at half-maximum of 28 nm. These results can lead to new active devices that use all-fluorinated polymers.

Severe strongyloidiasis complicated by meningitis and hydrocephalus in an HTLV-1 carrier with increased proviral load

We report a 47-year-old Japanese man who was a human T-cell leukemia virus type 1 (HTLV-1) carrier with strongyloidiasis, and who was born in an area endemic for both Strongyloides stercoralis ( S. stercoralis) and HTLV-1. He presented with edema of both legs. Laboratory examination on admission revealed hypoalbuminemia, and S. stercoralis rhabditiform larvae were found by stool microscopy. Purulent meningitis, which was suspected to be due to disseminated strongyloidiasis, developed during the first and second treatment for S. stercoralis infection. After the meningitis was alleviated, hydrocephalus with gait disturbance developed, and these features were attenuated by a ventriculo-peritoneal shunt. Impaired immunity and increased HTLV-1 proviral load, with an increased titer of HTLV-1 antibody, were observed in this patient. These results suggest that HTLV-1 proviral load and/or antibody titer of HTLV-1 can be used for the identification of carriers who are at increased risk of developing severe strongyloidiasis among those patients who are infected with both S. stercoralis and HTLV-1.

Discrepancies in dietary intakes and plasma concentrations of fatty acids according to age among Japanese female dietitians

OBJECTIVE

To clarify the influences of age on dietary intakes and plasma concentrations of fatty acids (FAs) in Japanese female dietitians.

SUBJECTS AND METHODS

In autumn 1996, we estimated dietary FA intakes based on 7 day weighed diet records and analyzed plasma FA concentrations in 79 healthy Japanese female dietitians, and investigated their relationships with age, dividing into three age groups (young (32-42 y), middle-aged (43-50 y) and elderly (51-66 y)).

RESULTS

Dietary intakes of total FA, saturated FAs, monounsaturated FAs, n-3 polyunsaturated FAs (PUFAs) and alpha-linolenic acid (18:3n-3) were significantly highest in the middle-aged group, and lowest in the elderly. Similar trends were observed for dietary intakes of n-6 PUFAs and linoleic acid (18:2n-6), but there were no differences with regard to eicosapentaenoic acid (EPA; 20:5n-3), docosahexaenoic acid (DHA; 22:6n-3) and n-3 highly unsaturated FAs (HUFAs=EPA+22:5n-3+DHA). On the other hand, plasma concentrations of all FAs except for arachidonic acid (20:4n-6) demonstrated positive correlations with age. Moreover, plasma concentrations of EPA in all age groups, DHA in the elderly and n-3 HUFAs in the middle-aged and the elderly were all positively correlated with dietary intakes.

CONCLUSIONS

We should take into account the influence of age on dietary habit and lipid metabolism when interpreting associations between dietary FA intakes and plasma FA concentrations.

Predominant expression of fibroblast growth factor (FGF) 8, FGF4, and FGF receptor 1 in nonseminomatous and highly proliferative components of testicular germ cell tumors

Nonseminomatous components within testicular germ cell tumors affect patient prognosis to varying degrees. These components are well known to mimic early embryonic totipotential tissues. Prompted by the recent observation that fibroblast growth factor (FGF) 8, FGF4, and FGF receptor (FGFR) 1 are required for the growth of early postimplantational embryonic tissues, we investigated the expressions of FGF8, FGF4, and FGFRI in surgically resected specimens of primary testicular germ cell tumors using an immunohistochemical method. All cases of embryonal carcinoma (14 cases), yolk sac tumor (3 cases), and choriocarcinoma (3 cases) showed positive immunostaining for FGF8, FGF4, and FGFR1. In contrast, out of 13 cases of seminoma, immunostaining was negative for FGF8, FGF4, and FGFR1 in 8 cases (61.5%), 6 cases (46.1%), and 7 cases (53.8%), respectively. In 7 cases of mature and immature teratoma, most areas showed negative immunostaining. In addition, the Ki-67 labeling index showed extremely high mitogenic activity in embryonal carcinoma, yolk sac tumor, and choriocarcinoma, which are precisely the carcinomas with the highest expressions of FGF8, FGF4, and FGFR1. It is in keeping with the immunohistochemical result that murine teratocarcinoma P19 cells were shown to express FGF8, FGF4, and FGFRI only under undifferentiated growth conditions. Taken together, these findings confirm the involvement of FGF8, FGF4, and FGFR1 in highly proliferative conditions of nonseminomatous germ cell tumors.

Extensive neuronal localization and neurotrophic function of fibroblast growth factor 8 in the nervous system

Fibroblast growth factor (FGF) 8 has been well established to play a critical role in the early development of the central nervous system (CNS). We report here extensive neuronal localization and neurotrophic function of FGF8 in the nervous system. In sections of mouse embryos at E10.5, FGF8 was immunohistochemically found in neurons at the marginal zones of the CNS and in the dorsal root ganglia (DRG). Neuronal localization of FGF8 was marked at later embryonic stages and in adults, involving most of the central and peripheral neurons, including intermuscular enteric neurons, DRGs, and paraaortic sympathetic ganglia. Functionally, FGF8 promoted neurite outgrowth in human neuroblastoma SK-N-MC cells as well as in rat pheochromocytoma PC12 cells, suggesting that FGF8 acts as a neurotrophic factor. FGF8 also supported neuronal survival and differentiation in cultured human neural progenitor cells. In a cell growth assay, treatment with 50 ng/ml FGF8 on human cultured neuroblastoma SK-N-MC and IMR32 cells attenuated the growth of both. In accordance with these in vitro findings, the immunohistochemical analysis on human neurological diseases showed that FGF8 expression is evident in differentiating histological types of neuroblastoma and ganglioneuroblastoma, and that the levels of FGF8 immunoreactivity in the substantia nigra from Parkinson's disease are significantly lower than those in age-matched controls. Taken together, the present findings strongly suggest that FGF8 acts as a more generalized neurotrophic factor than previously reported.

Marked atherosclerosis in a patient with familiar lecithin: cholesterol acyltransferase deficiency associated with end-stage renal disease and diabetes mellitus

Familial lecithin:cholesterol acyltransferase (LCAT) deficiency is a rare genetic disorder of the lipid metabolism caused by the absence of LCAT activity in plasma. It is not generally accompanied by atherosclerosis in spite of low high-density lipoprotein cholesterol levels nor by diabetes mellitus. However, reports of long-term follow-up or autopsy findings are rare, and the true incidence of atherosclerosis in LCAT deficiency is not clear. We report on the long-term observation of a patient with familial LCAT deficiency who developed renal failure, diabetes mellitus, and marked atherosclerosis. The patient died of sepsis from foot ulcers 7 years after starting hemodialysis and 13 years after the diagnosis. Marked atherosclerosis characterized by medial calcification in small arteries was observed at autopsy. The genesis of the atherosclerosis seemed to be on the basis of a combination of factors.

Relative validity of a semi-quantitative food frequency questionnaire versus 28 day weighed diet records in Japanese female dietitians

OBJECTIVE

To assess the relative validity of a semi-quantitative food frequency questionnaire (SQFFQ) against 28 day weighed diet records (WDRs).

SUBJECTS AND METHODS

The SQFFQ was administered to 106 (21 male and 85 female) Japanese dietitians in Aichi Prefecture in autumn, 1996 and four-season consecutive 7 day WDRs were carried out during 1996-1997. We evaluated validity of intakes of 15 foods and 31 macro- and micro-nutrients based on the SQFFQ against those according to 28 day WDRs among 79 Japanese female dietitians.

RESULTS

Mean daily intakes of selected foods and nutrients determined by the SQFFQ were generally equivalent to those measured by 28 day WDRs. Pearson's de-attenuated correlation coefficients (CCs) with log-transformation and energy-adjustment between intakes of selected foods and nutrients quantified by the SQFFQ and 28 day WDRs (minimum-median-maximum) ranged from 0.17 (beverages)-0.52 to 0.74 (rice), and Spearman's rank CCs with energy-adjustment ranged from 0.28 (confectionery)-0.42 to 0.68 (rice). Respective Pearson's CCs for intakes of nutrients were 0.28 (PUFAs)-0.51 to 0.73 (magnesium), and Spearman's rank CCs ranged from 0.23 (n-3 PUFAs)-0.45 to 0.71 (magnesium). Favorably higher agreement for intakes of foods/nutrients was achieved along with lower disagreement.

CONCLUSIONS

Satisfactorily higher relative validity was attained in Japanese female dietitians with the SQFFQ. This calibrated questionnaire seems therefore appropriate for administration to Japanese dietitians to clarify associations between diet and health/disease.

SPONSORSHIP

A grant-in-aid from the Ministry of Education, Science, Sports and Culture (06454242).

Purification of activins from androgen-independent Shionogi carcinoma cells demonstrates enhanced expression of activin betaB-subunit under androgen-depleted cell conditions in vitro and in vivo

Here, we report characterization of growth factors secreted from androgen-independent mouse mammary Shionogi carcinoma cells. Previous isolation of fibroblast growth factor 8 (FGF8) from androgen-dependent Shionogi carcinoma SC-3 cells prompted us to characterize growth factors secreted from the androgen-independent cells. After several purification procedures, mitogens for NIH3T3 cells from the androgen-independent cells were identified as activins on the grounds that activin betaA- and betaB-subunits are detected in the active fractions by Western blotting and that the growth-promoting effects by the active fractions are specifically inhibited in the presence of follistatin. In addition, exogenous activins, but not inhibin, stimulated the growth of NIH3T3 cells in a dose-dependent manner. Interestingly, transcripts of activin betaB-subunit were predominantly found in the androgen-independent cells while its betaA-subunit was universally expressed in both androgen-dependent and -independent Shionogi carcinoma cells. In concordant with this in vitro finding, transcripts of activin betaB-subunit were enhanced in murine prostates after castration. Therefore, expression of activin betaB-subunit, but not its betaA-subunit, is likely to be related with androgen-depleted cell conditions in prostates, and possibly in androgen-related cancers.

Isolation of an androgen-inducible novel lipocalin gene, Arg1, from androgen-dependent mouse mammary Shionogi carcinoma cells

Here we report isolation of an androgen-regulated novel gene from an androgen-dependent mouse mammary Shionogi carcinoma SC-3 cell line. Using a polymerase chain reaction-based subtraction method and Northern blotting analysis, we isolated four androgen-inducible genes from SC-3 cells. Nucleotide sequencings identified three of the genes as cyclin D1, beta-catenin, and fatty acid synthase, respectively, but the fourth, a gene tentatively named as Arg1 (androgen-regulated gene 1), remained undefined. The cloned 2.0-kb sized Arg1 cDNA encoded 414 amino acid sequences. The deduced amino acid sequences, sharing about 30% homology with cathepsin family members at a protein level, had relatively conserved residues around the three proteinase active sites reported earlier. In Northern blotting, Arg1 mRNA was found in kidney, heart, lung, and to a lesser degree, in spleen and liver. Its transcripts were also detected in male reproductive organs on RT-PCR. In addition, its expression levels in prostate were markedly reduced after castration. Unexpectedly, Arg1-expressing COS1 cells showed no significant proteinase activity to various synthesized substrates under neutral or acidic conditions in this study. This might have been due to the replacement of the cysteinyl active site for proteinase to serine residue in the Arg1 amino acid sequences. Given that Arg1 also contains a lipocaline signature known as a binding motif for small hydrophobic molecules at the center of its amino acid sequences, Arg1 is a lipocalin family gene regulated by androgens in prostate and Shionogi carcinoma cells.

Effects of lifestyle factors on ultrasonographically determined bone health in Japanese women

The objective of this study was to determine by ultrasonographic measurements, an inexpensive and radiation-free technique, the association between bone health and lifestyle factors among a large population of Japanese women. Two hundred and fifty-six pre-menopausal women and 585 post-menopausal women who underwent a voluntary medical check-up for osteoporosis in 1996-1997 were analyzed. There were significant positive correlations between the bone density (designated as the stiffness value) vs the weight, the height and the body mass index of the subjects only in the post-menopausal group. Negative correlations were also found between the bone density vs the age and the years since menopause. Our data using ultrasonographic technique agree well with previous studies using other devices. In both groups, subjects with current or past exercise habits had higher stiffness values. Dietary habits had no effects on the stiffness value. Smoking habits had a trend towards negative effects and alcohol consumption seemed to have a trend towards positive effects on the stiffness value in post-menopausal women, but these effects did not reach statistical significance. Positive effects of current exercise on bone density were maintained after adjustment for past exercise habits. These results support the effectiveness of exercise begun in adulthood. Having a good exercise habit is one of the most effective ways of maintaining good bone health.

Immunotactoid glomerulopathy characterized by steroid-responsive massive subendothelial deposition

We report a case of immunotactoid glomerulopathy with unique histologic findings in serial biopsies. A 73-year-old man complained of developing general edema. Laboratory data on admission presented moderate renal dysfunction with nephrotic syndrome. There was no evidence of systemic disease that might cause secondary glomerulopathy. Light microscopy of the renal specimen revealed lobulation of glomerular tufts and massive endothelial deposition of hyaline-like periodic acid-Schiff-positive substance with neutrophilic infiltration. The deposits were positive for immunoglobulin by immunohistochemical stains but negative for Congo red stain. Electron microscopy disclosed the deposition of microtubular structure (60 nm in diameter) predominantly in the subendothelial area and to some extent in the subepithelial and mesangial areas. Some of the tubules were extremely large (100 to 130 nm in diameter) and displayed a unique scroll structure in cross-section. The patient was treated with two sessions of plasma exchange and subsequent oral prednisolone (30 mg/d). Proteinuria and renal dysfunction improved significantly in the following 2 months. Second and third renal biopsies revealed disappearance of the deposit along with the improvement of proteinuria and renal dysfunction. Because similar microtubular structures were found in neutrophils in the glomerulus as well as in the urinary sediment, phagocytosis was suggested as a possible mechanism for removal of the deposit.