Long waiting time before tooth extraction may increase delayed wound healing in elderly Japanese

In osteoporosis patients receiving antiresorptive medications, stopping the drug and delaying tooth extraction has been suggested to reduce the risk of osteonecrosis of the jaw (ONJ). However, postponing tooth extraction for ≥ 2 months was associated with an increased risk of delayed wound healing beyond 8 weeks after extraction, a risk factor for developing ONJ.

INTRODUCTION

A long waiting time before tooth extraction could result from concern about a potential increased risk of osteonecrosis of the jaw (ONJ) in osteoporosis patients. We clarified whether a long waiting time before tooth extraction during the past year may be associated with an increased risk of delayed wound healing beyond 8 weeks after tooth extraction, which may be a risk factor of ONJ.

METHODS

Of 5639 patients aged ≥ 60 years who visited our 20 clinics or hospitals and answered a structured questionnaire, 426 patients (151 men, 275 women) aged 60-96 years comprised the final participants in this study. Self-reported kyphosis was used as a surrogate marker of vertebral fractures. Stepwise logistic regression analysis, adjusted for covariates, was used to calculate the odds ratio (OR) and the 95% confidence interval (CI) for the presence of delayed wound healing longer than 8 weeks after tooth extraction during the past year based on the duration before extraction.

RESULTS

Subjects who had waited > 2 months for tooth extraction had a significantly higher risk of delayed wound healing compared with those whose tooth was extracted within 1 month (OR = 7.23; 95% CI = 2.19-23.85, p = 0.001) regardless if antiresorptive medications for osteoporosis were used. The presence of self-reported kyphosis was significantly associated with an increased risk of delayed wound healing (OR = 5.08; 95% CI = 1.11-23.32, p = 0.036).

CONCLUSIONS

A long waiting time before tooth extraction may be a risk factor for delayed wound healing beyond 8 weeks after extraction in patients aged ≥ 60 years.

Abstract OT1-05-03: Efficacy and safety of scalp cooling device for prevention of alopecia in patients with breast cancer

Background

Chemotherapy for breast cancer causes alopecia as a side effect. Some patients refuse chemotherapy because of alopecia, resulting in the omission of a standard therapy. It is believed that a scalp cooling device can prevent alopecia by promoting vasoconstriction of the scalp and reducing exposure of the hair root cells to anticancer agents. There are phenotypic differences of the efficacy of a scalp cooling device for alopecia. In fact, a Dutch scalp cooling registry reported that the success rate of scalp cooling was 51% in European women and 33% in Asian women. Therefore, we aimed to investigate the efficacy of scalp cooling device for chemotherapy-induced alopecia among Asian women with breast cancer.

Trial design

This is a phase II trialto evaluate the efficacy and safety of scalp cooling device for risk reduction of alopecia in women with stage I/II/III breast cancer treated with adjuvant/neoadjuvant chemotherapy in a single institute.

Eligibility criteria

Women diagnosed with Stage I to III breast cancer who are scheduled to receive preoperative or postoperative adjuvant chemotherapy containing anthracycline and/or taxanes are enrolled. Patients who have blood malignancies (leukemia, non-Hodgkin lymphoma, other systemic lymphoma), and cold allergy, are excluded.

Specific aims

The primary endpoint is the proportion of patients with Common Terminology Criteria for Adverse Events (CTCAE) grade 0-1 alopecia after the completion of all cycles of chemotherapy (success rate). Secondary endpoints are safety, quality of life, use of wig or cap, and success rates after the completion of all cycles of chemotherapy distinguished by anthracycline(AC) and taxane.

The cooling device is the Paxman scalp cooling system. Scalp cooling was performed from 30 mins before initiation until 90 mins (25 min for taxane) after chemotherapy. Pictures of the scalp were taken at the time of the initiation of each course.

Statistical methods

Successful treatment was defined as the presence of less than 50% of hair-loss area. The sample size was calculated using the Simon method, with a type I error of 10% (two-sided) and a study power of 80%.The expected success rate is 30%, with a threshold success rate of 10%, and the required number of patients was estimated to be 19.

Present and target accrual

Patient accrual was started in April 2018 and present accrual is 3. We plan to enroll a total of 20 patients in the trial.

Citation Format: Kodera A, Ogura K, Hattori A, Yukawa H, Sakaguchi S, Matsuoka A, Tanaka N, Kamimura M, Jibiki N, Naritaka Y, Hirano A. Efficacy and safety of scalp cooling device for prevention of alopecia in patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-05-03.

Abstract OT1-01-03: A phase II trial of neoadjuvant epirubicin/cyclophosphamide followed by weekly nanoparticle albumin-bound paclitaxel with trastuzumab for HER2-positive breast cancer

Background

Paclitaxel (PTX) is a standard treatment for metastatic breast cancer (MBC) and it is often used as adjuvant and neoadjuvant chemotherapy for patients with early-stage disease. Nanoparticle albumin-bound (Nab)-PTX was also effective in patients with metastatic and early-stage. A comparison of weekly and triweekly nab-PTX regimens suggested that weekly nab-PTX resulted in superior progression-free survival. However, the optimal dose and schedule of weekly nab-PTX have not been determined. The efficacy and tolerability of epirubicin/cyclophosphamide (EC) followed by weekly nab-PTX (125 mg/m2) ± trastuzumab in node-positive breast cancer was determined in our previous trial. A high pathologic complete response (pCR) rate was obtained in HER2-positive patients. However, because nab-PTX administration was frequently postponed and discontinued, the optimal dose needs to be determined. In the previous trial, the median relative dose intensity of nab-PTX was 80% among patients with pCR. Therefore the dose of nab-PTX was reduced by 20% in this newly designed trial.

Trial design

This phase II trial aimed to evaluate the efficacy and toxicity of neoadjuvant EC followed by weekly nab-PTX with trastuzumab in patients with HER2-positive breast cancer. Patients will receive 4 cycles of epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks, followed by 4 cycles of nab-PTX (100 mg/m2) on days 1, 8, and 15, over a 28-day cycle. Fifteen cycles of trastuzumab (2 mg/kg, loading dose: 4 mg/kg) will be added to the nab-PTX regimen.

Eligibility criteria

Surgery and chemotherapy-naïve patients with pathologically confirmed T2-4 N0-3 invasive breast cancer, as diagnosed by core needle biopsy, are included. Eligibility criteria include age 20–70 years, a performance status of 0–2, and adequate organ function.

Specific aims

The primary endpoint is the pCR rate in the breast and axilla. Secondary endpoints include the breast conservation rate, toxicities, relative dose intensities, feasibility, and overall survival. A pCR is defined as the disappearance of invasive cancer cells, including in the axilla; residual intraductal cancer is acceptable.

Statistical methods

The sample size was calculated using the Simon method, with a type I error of 5% and a study power of 80%. The expected rate of pCR is 72% with a threshold pCR rate of 45%. The required number of patients was estimated to be 25.

Present and target accrual

Patient accrual within two medical centers began in May 2014. A final study population of 30 patients is expected (Trial registration: UMIN000013886).

Citation Format: Kodera A, Hirano A, Inoue H, Ogura K, Hattori A, Sakaguchi S, Yukawa H, Matsuoka A, Tanaka N, Kamimura M, Jibiki N, Fujibayasi M, Naritaka Y, Shimizu T. A phase II trial of neoadjuvant epirubicin/cyclophosphamide followed by weekly nanoparticle albumin-bound paclitaxel with trastuzumab for HER2-positive breast cancer [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 OT1-01-03.

Abstract P3-13-13: Breast-conserving surgery plus hormone therapy without irradiation in elderly women with early breast cancer

Background

The meta-analysis of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) revealed that whole-breast irradiation after breast conserving surgery (BCS) decreased ipsilateral breast tumor recurrence (IBTR) and breast cancer-related death. However, elderly patients can find daily hospital attendance difficult, and their IBTR risk is low. A randomized control trial was performed in women aged ≥70 years with hormone-positive breast cancer to investigate the usefulness of breast-conserving therapy without irradiation (Hughes et al. N Engl J Med 2004). Since September 2001, we have offered BCS plus hormone therapy without irradiation in patients who satisfy the following criteria: age ≥60 years; pathologically node negative, hormone-positive breast cancer; a negative surgical margin; and no lymphovascular invasion. We assessed prognosis in patients who chose this option.

Patients and methods

Between September 2001 and December 2014, 219 patients met the inclusion criteria; 90 and 129 patients underwent BCS plus hormone therapy with or without irradiation, respectively. The cumulative IBTR incidence and overall survival (OS) for the groups was evaluated. A negative surgical margin was defined as a margin of ≥5 mm.

Results

The median ages at operation were 73 years (range, 60–88 years) and 65 years (range, 60–80 years) for the without and with irradiation groups, respectively (p <0.001). There were no significant differences in tumor size, lymph node metastasis, or adjuvant therapy between the groups. The median follow-up duration is presently 4.6 years. IBTR was observed in 5 (3.9%) and 1 (1.1%) patient(s) in the without and with irradiation groups, respectively (p = 0.192). The 5-year IBTR cumulative incidences were 0.9% and 2.2%, and the 10-year were 6.7% and 2.2%, for the without and with irradiation groups, respectively (p = 0.390). The 5-year OS rates were 93.8% and 98.5%, and the 10-year OS rates were 89.7% and 94.0 for the without and with irradiation groups, respectively (p = 0.205).

Conclusion

BCS plus hormone therapy without irradiation in elderly patients is an appropriate option.

Citation Format: Inoue H, Hirano A, Ogura K, Hattori A, Yukawa H, Sakaguchi S, Matsuoka A, Tanaka N, Kodera A, Kamimura M, Fujibayashi M, Naritaka Y, Shimizu T. Breast-conserving surgery plus hormone therapy without irradiation in elderly women with early breast cancer [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 P3-13-13.

Significant improvement of bone mineral density and bone turnover markers by denosumab therapy in bisphosphonate-unresponsive patients

Bone mineral density (BMD) sometimes cannot be improved by long-term bisphosphonate (BP) therapy in osteoporosis (OP). This study showed that lumbar as well as hip BMD significantly increased after denosumab treatment in patients not responsive to BPs. Thus, denosumab may be a strong OP treatment option for BP-unresponsive patients.

INTRODUCTION

BMD sometimes cannot be improved by long-term BP therapy.

METHODS

We administered denosumab to osteoporotic patients with a poor response to BPs who had been taking them for 2 years or longer. Ninety-eight women with BP-poor responsive OP were enrolled in this study. Mean (standard deviation [SD]) age was 71.2 (6.9) years and mean (SD) duration of BP treatment was 59.9 (34.3) months. We distinguished BP responders from non-responders based on changes in BMD values at denosumab commencement (baseline) from 2 years beforehand.

RESULTS

There were no significant differences in age, duration of BP use, bone turnover markers, or BMD at baseline between the groups. Prior to denosumab, BMD had increased significantly in responders and decreased significantly in non-responders. Bone turnover markers had decreased significantly at 4 months of denosumab treatment (P < 0.001) and lumbar and hip BMD were significantly increased at 1 year of therapy in both groups (P < 0.001). Simple correlation coefficients were -0.337 for lumbar and -0.339 for hip BMD changes (both P = 0.001) before and after denosumab treatment. Both at the lumbar spine and hips, decreased BMD before denosumab therapy was significantly associated with an increase in BMD at 1 year of treatment (spine, t value = -3.502, P = 0.001, R = 0.113; hip, t value = -3.526, P = 0.001, R = 0.115).

CONCLUSIONS

These results suggest that denosumab may be a strong OP treatment option for BP-unresponsive patients.

Acquired Downregulation of Donor-Specific Antibody Production After ABO-Incompatible Kidney Transplantation

The mechanism of long-term B cell immunity against donor blood group antigens in recipients who undergo ABO-incompatible (ABOi) living-donor kidney transplantation (LKTx) is unknown. To address this question, we evaluated serial anti-A and anti-B antibody titers in 50 adult recipients. Donor-specific antibody titers remained low (≤1:4) in 42 recipients (84%). However, antibodies against nondonor blood group antigens were continuously produced in recipients with blood type O. We stimulated recipients' peripheral blood mononuclear cells in vitro to investigate whether B cells produced antibodies against donor blood group antigens in the absence of graft adsorption in vivo. Antibodies in cell culture supernatant were measured using specific enzyme-linked immunosorbent assays (ELISAs). Thirty-five healthy volunteers and 57 recipients who underwent ABO-compatible LKTx served as controls. Antibody production in vitro against donor blood group antigens by cells from ABOi LKTx patients was lower than in the control groups. Immunoglobulin deposits were undetectable in biopsies of grafts of eight recipients with low antibody titers (≤1:4) after ABOi LKTx. One patient with blood type A1 who received a second ABOi LKTx from a type B donor did not produce B-specific antibodies. These findings suggest diminished donor-specific antibody production function in the setting of adult ABOi LKTx.

Establishment of transgenic silkworms expressing GAL4 specifically in the haemocyte oenocytoid cells

Insect haemocytes play significant roles in innate immunity. The silkworm, a lepidopteran species, is often selected as the model for studies into the functions of haemocytes in immunity; however, our understanding of the role of haemocytes remains limited because the lack of haemocyte promoters for transgene expression makes genetic manipulations difficult. In the present study, we aimed to establish transgenic silkworm strains expressing GAL4 in their haemocytes. First, we identified three genes with strong expression in haemocytes, namely, lp44, Haemocyte Protease 1 (HP1) and hemocytin. Transgenic silkworms expressing GAL4 under the control of the putative promoters of these genes were then established and expression was examined. Although GAL4 expression was not detected in haemocytes of HP1-GAL4 or hemocytin-GAL4 strains, lp44-GAL4 exhibited a high level of GAL4 expression, particularly in oenocytoids. GAL4 expression was also detected in the midgut but in no other tissues, indicating that GAL4 expression in this strain is mostly oenocytoid-specific. Thus, we have identified a promoter that enables oenocytoid expression of genes of interest. Additionally, the lp44-GAL4 strain could also be used for other types of research, such as the functional analysis of genes in oenocytoids, which would facilitate advances in our understanding of insect immunity.

Abstract OT1-1-01: A phase II study of neoadjuvant epirubicin/cyclophosphamide (EC) followed by weekly nanoparticle albumin-bound paclitaxel with or without trastuzumab for node-positive breast cancer

Background: Paclitaxel is considered standard treatment for metastatic breast cancer (MBC) and is often used as adjuvant and neoadjuvant chemotherapy for patients with early-stage disease. Conventional paclitaxel requires solvents such as polyoxyethylated castor oil; however, such solvents are associated with toxicity including peripheral neuropathy and hypersensitivity reaction. Moreover, the use of the drug requires special tubing and in-line filters. Therefore, nanoparticle albumin-bound paclitaxel (nab-PTX) requiring no solvent has been developed. Nab-PTX was effective in patients with MBC and as a neoadjuvant therapy. A comparison between weekly and triweekly nab-PTX suggested that weekly nab-PTX was superior in progression-free survival.

Trial design: This is a phase II trial to evaluate the efficacy and toxicity of neoadjuvant epirubicin/cyclophosphamide (EC) (epirubicin/cyclophosphamide) followed by weekly nab-PTX with or without trastuzumab for node-positive breast cancer. Patients receive four cycles of epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks, followed by four cycles of nab-PTX (125 mg/m2) on days 1, 8 and 15 in a 28-day cycle. Fifteen cycles of trastuzumab (2 mg/kg, loading 4 mg/kg) are added to the nab-PTX regimen in HER2-positive patients every week.

Eligibility criteria: Patients with histologically diagnosed invasive breast cancer based on a core needle biopsy of the T1-4 N1-3 without previous operation or chemotherapy are included in this trial. Eligible patients are aged between 20 years and 70 years with a performance status of 0 to 2 and adequate organ functions.

Specific aims: The primary endpoint is the pathologic complete response (pCR) rate in the breast and axilla, and the secondary endpoints are the breast conserving rate, toxicities, feasibility and overall survival.

Statistical methods: The sample size was calculated using the Simon method, with a type I error of 10% and a study power of 80%. 1. HER2-negative patients

The expected rate of pCR was 25% and the required number of patients was estimated to be 33. 2. HER2-positive patients

The expected rate of pCR was 50%, and the required number of patients was estimated to be 21.

Present and target accrual: Patient accrual within two medical centers started in April 2011 with 20 patients being on study to date (2012, June 12). A total of 56 patients (22 are HER2-positive and 34 are HER2-negative) are planned to be enrolled in the trial.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr OT1-1-01.

Carpal tunnel pressure measurement during two-portal endoscopic carpal tunnel release

BACKGROUND

Although there remain concerns of median nerve damage during endoscopic carpal tunnel release for carpal tunnel syndrome, carpal tunnel pressure variations during Chow's two-portal technique have not been well investigated.

METHODS

We performed a modified two-portal endoscopic carpal tunnel release on 30 patients by inserting a catheter pressure transducer into the carpal tunnel for continuous pressure measurement during the procedure. Grip and pinch strengths, Semmes-Weinstein monofilament test, and nerve conduction studies were examined preoperatively and at postoperative 1, 3, and 6 months. Numbness and the Disabilities of the Arm, Shoulder and Hand score were also evaluated pre and postoperatively.

FINDINGS

Subjective symptoms and nerve conduction study findings improved uneventfully. The pressure was always observed to be maximum pressure immediately before the cannula was withdrawn from the exit portal, and carpal tunnel pressure >300 mm Hg was recorded in most of the patients.

INTERPRETATION

A transient increase in the carpal tunnel pressure occurred in all the patients; however, it did not correlate with their clinical outcome or with increased risk of peri-operative complications. Since time-pressure threshold of the median nerve during endoscopic carpal tunnel release is still unknown, our results did not guarantee its safety.

Pseudomonas putida bacteremia in adult patients: five case reports and a review of the literature

Pseudomonas putida belongs to the fluorescent group of Pseudomonas species, a group of opportunistic pathogens that primarily cause nosocomial infections. However, few cases of P. putida bacteremia in adult patients have been reported. We report five cases of P. putida bacteremia in adult patients and review 23 previously reported cases. Our five patients consisted of three cases of catheter-related bloodstream infection (CRBSI), one case of indwelling biliary drainage tube-related cholangitis, and one case of cholecystitis. Many of the 23 previously reported cases also included CRBSI. Of the clinical backgrounds, in all 28 reported cases including ours, 24 (85.7%) were immunocompromised. Of the clinical management, in CRBSI, devices were removed in almost all cases (92.9%). Antibiotic susceptibility data of our five cases and another previous case showed that patients with bacteremia had a high susceptibility of P. putida to anti-pseudomonal β-lactams. The prognosis for bacteremia with P. putida was good, as 26 (92.9%) of the total 28 cases were cured.

Five-body cluster structure of the double-Λ hypernucleus (ΛΛ)(11)Be

Energy levels of the double Λ hypernucleus (ΛΛ)(11)Be are calculated within the framework of a ααnΛΛ five-body model. Interactions between constituent particles are determined so as to reproduce reasonably the observed low-energy properties of the αα, ααn nuclei and the existing data for Λ-binding energies of the αΛ, ααΛ, αnΛ, and ααnΛ systems. An effective ΛΛ interaction is constructed so as to reproduce, within the αΛΛ three-body model, the B(ΛΛ) of (ΛΛ)(6)He, which was extracted from the emulsion experiment, the NAGARA event. With no adjustable parameters for the ααnΛΛ system, B(ΛΛ) of the ground and bound excited states of (ΛΛ)(11)Be are calculated with the Gaussian expansion method. The Hida event, recently observed at KEK-E373 experiment, is interpreted as an observation of the ground state of the (ΛΛ)(11)Be.

Epirubicin and cyclophosphamide (EC) followed by weekly paclitaxel with/without trastuzumab as primary systemic therapy in locally advanced breast cancer: Phase II study

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Background: Primary systemic therapy (PST) has become a standard therapy for locally advanced breast cancer (LABC). The aim of this study was to evaluate the activity and toxicity of EC (epirubicin/cyclophosphamide) followed by weekly paclitaxel with/without trastuzumab as PST in LABC. Methods: Primary endpoint was pathologic complete response (pCR) rate in the breast and axilla, and secondary endpoints were breast conserving rate and toxicities. Patients with histologically diagnosed invasive breast cancer by core needle biopsy of the T2–4 (>3 cm) or N1–3 were included in this study. Eligible patients were age >20 years, had a performance status of 0 to 1, and had adequate organ functions. It was determined that the expected rate of pCR in the trial was 25%, and the sample size was calculated using the Simon method, with a type I error of 5% and a study power of 80%. The target enrollment was estimated to be 40 evaluable patients. Treatment: Patients received epirubicin (100 mg/m2) and cyclophosphamide (600mg/m2 ) every 3 weeks for four cycles followed by paclitaxel (80 mg/m2 ) every week for 12 cycles. Trastuzumab (2mg/kg) was added to paclitaxel in HER2-positive patients. Results: Forty-three patients were enrolled into this study and 3 patients withdrew. pCR were observed in 8 patients and pCR rate was 20.0% (95% confidence interval, 7.6- 32.4). Twenty-four patients (60.0%) underwent breast conserving surgery. In particular, patients with HER2 positive tumor had significantly higher rate of pCR than the others (62.5% vs. 8.6%; p=0.0014). Grade 4 neutropenia was recorded in 27.5% of the patients, and febrile neutropenia occurred in 4 patients (10.0%). No heart failure was seen. Conclusions: EC followed by weekly paclitaxel with/without trastuzumab was an active and well-tolerated treatment for LABC.

No significant financial relationships to disclose.

[HIV infection/AIDS]

HIV infection is known as one of sexually transmitted infection and number of new HIV-infected patients is increasing in Japan. It' s still difficult to detect HIV-infected career because HIV career has no symptoms for several years after HIV infection. HIV treatment is progressing and made HIV-infection controllable disease, although HIV can not be eradicated from body. This therapy is needed life-long continuance because HIV can easily achieve mutation that decrease efficacy of antiretroviral drugs. Thus, we should perform HIV screening test more actively to prevent the further spread of infection and if detected, must educate importance of adherence of therapy.

Successful absorption of antiretroviral drugs after gastrojejunal bypass surgery following failure of therapy through a jejunal tube

Lopinavir, an antiretroviral drug against human immunodeficiency virus (HIV), was administered through various routes to an HIV-infected patient with duodenal malignant lymphoma. Antiretroviral drugs were first administered through a jejunal tube, and then through bypass route between the stomach and jejunum that was 20 cm distal from the ligament of Treitz after surgery. Oral administration through the bypass achieved sufficient serum concentrations of lopinavir, whereas administration through the jejunal tube did not.

Characterization of core promoter elements for ecdysone receptor isoforms of the silkworm, Bombyx mori

Two ecdysone receptor (EcR) isoforms, EcR-A and EcR-B1, are expressed in a tissue- and stage-specific manner, although the details of their transcription mechanisms are unknown. We determined the transcription start sites of EcR-A and EcR-B1 isoforms of Bombyx mori and found that both core promoter regions consist of initiator (Inr) and downstream promoter elements (DPE) but not TATA boxes. Promoter truncation analysis performed using the luciferase reporter assays and BmN cells showed that, in both isoforms, the regions -296 to -74 for BmEcR-B1, -104 to -61 for BmEcR-A and downstream regions of +1 are essential for basal transcriptional activity. Mutation experiments revealed that both DPE and its 5'-flanking CGCGCG sequence are crucial but DPE of BmEcR-B1 is not important for BmEcR-A transcription. These results indicate that the basal promoter activities differ between the two BmEcR isoforms.

Molecular genetic cascades for external genitalia formation: an emerging organogenesis program

External genitalia are anatomical structures located at the posterior embryonic region as part of several urogenital/reproductive organs. The embryonic anlage of the external genitalia, the genital tubercle (GT) develops as a bud-shaped structure with an initial urethral plate and later urethra. Embryonic external genitalia are considered to be one of the appendages. Recent experiments suggest that essential regulatory genes possess similar functions for the outgrowth regulation of the GT and limb appendages. The transient embryonic epithelia located in the distal GT are called the distal urethral epithelium (DUE) regulating, at least in part, the (distal) GT development. This review covers the available data about early patterning of GT and discusses the molecular developmental similarities and points of divergence between the different appendages. Development of the male and female external genitalia is also reviewed.

A phase I/II trial of irinotecan-cisplatin combined with an anti-late-diarrhoeal programme to evaluate the safety and antitumour response of this combination therapy in patients with advanced non-small-cell lung cancer

We conducted a phase I/II study in patients with advanced non-small-cell lung cancer (NSCLC) to increase the therapeutic index of the cisplatin–irinotecan combination by institution of an anti-late-diarrhoeal program (ADP). A total of 77 chemotherapy-naive patients with advanced NSCLC were enrolled. The cisplatin dose was fixed at 60 mg m⁻² (Day 1). Irinotecan was escalated in 5 mg m⁻² increments, starting from 60 mg m⁻² (Days 1 and 8). ADP consisted of oral sodium bicarbonate, magnesium oxide, basic water, and ursodeoxycholic acid, and was administered orally for 4 days with each dose of irinotecan. In the phase I portion, irinotecan pharmacokinetics was also examined. After the recommended dose of irinotecan with ADP was determined, a phase II study was conducted to evaluate the response. Maximum tolerated dose was reached at an irinotecan dose of 80 mg m⁻² (Grade 4 diarrhoea and neutropenia). Pharmacokinetic studies show that the maximum concentration and the area under the curve of both irinotecan and SN38 (active metabolite of irinotecan) tend to increase in the dose-dependent manner of irinotecan. The phase II portion of the study included 48 patients, who were treated with 75 mg m⁻² of irinotecan. Grade 3/4 toxicities included neutropenia in 65%, leucopenia in 33%, and late diarrhoea in 6% of the patients. During this treatment, PS did not change in 65% of patients. At the end of the chemotherapy, PS did not decline in 90% of patients. In the phase II portion, a response occurred in 63% (95% confidential interval (CI), 47–76%) of patients. Median time to progression was 19 weeks (95% CI, 15–22 weeks), and median survival was 52 weeks (95% CI, 39–64 weeks). This regimen of irinotecan and cisplatin with ADP resulted in promising efficacy with acceptable toxicity for patients with advanced NSCLC. This regimen is a candidate for the experimental arm towards future phase III studies.

Quantitative MRI of the wrist and nerve conduction studies in patients with idiopathic carpal tunnel syndrome

OBJECTIVE

To correlate morphological findings of idiopathic carpal tunnel syndrome (CTS) with the function of the median nerve.

METHODS

In this study, 105 wrists of 105 women patients with idiopathic CTS, and 36 wrists of 36 female volunteers were subjected to nerve conduction studies and MRI. Cross sectional area, signal intensity ratio, and the flattening ratio of the median nerve, carpal tunnel area, flexor tendon area, synovial area, and intersynovial space, and the palmar bowing of the transverse carpal ligament (TCL) were quantified by MRI and correlated with the severity of the disease determined by nerve conduction studies.

RESULTS

Cross sectional areas of the median nerve, flexor tendons, and carpal tunnel, and the palmar bowing of the TCL of the CTS groups were greater than in the control group, but differences were not detected among the CTS groups for the area of the flexor tendons and the carpal tunnel. Enlargement, flattening, and high signal intensity of the median nerve at the distal radioulnar joint level were more significant in the advanced than in the earlier stages of the disease. Increase in palmar bowing of the TCL was less prominent in the most advanced group. Linear correlation between the area of the carpal tunnel and palmar bowing of the TCL was noted.

CONCLUSION

Severity of the disease could be judged by evaluating not only longitudinal changes of signal intensity and configuration of the median nerve, but also palmar bowing of the TCL. Increased palmar bowing of the TCL was found to be associated with an increase in the area of the carpal tunnel.

Hormonal control of a metamorphosis-specific transcriptional factor Broad-Complex in silkworm

Insect metamorphosis is induced by the steroid 20-hydroxyecdysone (20E) in the absence of sesquiterpenoid juvenile hormone (JH). In Drosophila melanogaster, the Broad-Complex (BR-C) transcriptional factor plays critical roles during metamorphosis. We isolated cDNAs encoding BR-C in the silkworm Bombyx mori and examined their mRNA expression. cDNAs for three BR-C isoforms with zinc finger pairs (Z1, Z2 and Z4) and four isoforms lacking them were cloned. Their mRNAs were expressed in multiple tissues at the larval-pupal metamorphosis. In the anterior silk gland, BR-C mRNAs were expressed at the end of the last larval instar but not expressed during the penultimate instar. 20E administration induced BR-C mRNA expression and JH suppressed 20E-induced BR-C expression in this tissue both in vivo and in vitro. Thus, BR-C mRNAs are inducible by 20E only in the absence of JH, a finding that explains their metamorphosis-specific expression.

Molecular cloning, expression analysis and functional confirmation of two ecdysone receptor isoforms from the rice stem borer Chilo suppressalis

PCR techniques were used to clone and identify cDNAs for ecdysone receptor A and B1 (EcR-A and EcR-B1) isoforms from the rice stem borer, Chilo suppressalis. They differ only in the N-terminal A/B regions and show high sequence identities to other insects' EcRs. At the wandering stage, EcR-B1 mRNA was expressed more abundantly in the midgut than in the epidermis and fat body, whereas expression levels of EcR-A mRNA were similar in the three tissues. In the epidermis of the last instar larvae, the maximal mRNA expression of both EcR-A and EcR-B1 was observed from the wandering to prepupal stages prior to the peak of ecdysteroid titer in the hemolymph. In gel mobility shift assays, in vitro translated C. suppressalis EcR-B1 (CsEcR-B1) and Bombyx mori ultraspiracle (BmUSP) proteins bound to the Pal 1 and Drosophila melanogaster hsp27 ecdysone response element as a heterodimer. These results indicate that the cDNAs isolated here encode functional ecdysone receptors.

cDNA cloning and characterization of Bombyx mori juvenile hormone esterase: an inducible gene by the imidazole insect growth regulator KK-42

The insect growth regulator (IGR) imidazole KK-42 induces hemolymph juvenile hormone esterase activity and precocious metamorphosis in Bombyx mori. As an initial step to understand the molecular action of KK-42, we isolated a full-length of juvenile hormone esterase cDNA from B. mori (BmJHE). The deduced amino acid sequence of BmJHE showed high identity to JHEs of Heliothis virescens (54%) and Choristoneura fumiferana (52%). Recombinant BmJHE protein expressed in the baculovirus expression system hydrolyzed 3H-JH III and JH analog, HEPTAT, indicating that BmJHE cDNA encodes functional JH esterase. Northern blot analysis showed that the BmJHE transcript was present predominantly in the fat body at the beginning of the last larval instar. During this instar, BmJHE transcript increased gradually until day 7, then decreased, and increased again on day 10 in the fat body. This temporary expression pattern was similar to that of JHE enzyme activity in hemolymph. In contrast, in the 4th instar, the BmJHE transcript was present in the fat body even though hemolymph JHE activity was very low. Western blot analysis using anti-BmJHE antiserum showed BmJHE protein was present in hemolymph during the 5th instar but not during the 4th instar. These results indicate that BmJHE protein is secreted into hemolymph at the metamorphic stage. Hemolymph JHE activity was high in precociously metamorphosed 4th instar larvae (treated KK-42) but low in normal 4th and extra-molted 6th instar larvae (fed 20E). KK-42-treated larvae showed high expression level of BmJHE transcript in the fat body, suggesting that KK-42 enhances BmJHE gene expression in the fat body.

Postoperative nerve conduction changes after open and endoscopic carpal tunnel release

OBJECTIVE

To assess the improvement of motor distal latency (MDL), sensory nerve conduction velocity (SCV) of the median nerve and the amplitudes of compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) in patients with idiopathic carpal tunnel syndrome subjected to surgical treatment according to the open carpal tunnel release method and the endoscopic carpal tunnel release.

METHODS

Sixty-six hands of sixty-six patients were divided into two groups: the ECTR group and the OCTR group. The patients were evaluated preoperatively, and at 1, 3, 6, and 12 months postoperatively.

RESULTS

Although no statistically significant difference of the recovery of MDL and the amplitude of CMAP and SNAP was detected between the two groups at any time point during follow-up, one patient in the ECTR group in whom the operation had been converted to OCTR, showed delay of MDL and decrease in the amplitude of CMAP.

CONCLUSIONS

There is a risk of nerve damage in patients undergoing ECTR. Although statistical analysis suggests that nerve conduction improves by about the same degree 12 months after ECTR or OCTR, slightly faster improvement after OCTR cannot be excluded.

Development of a simulator for ozone/UV reactor based on CFD analysis

A new CFD (Computational Fluid Dynamics) simulator for an O3/UV reactor where ozone dissolved water flows under the irradiation of UV, has been developed by combining a fluid dynamics model with a complex radical reaction model. The radical reaction model used in this simulator was found to be reasonable, because the results obtained from the simulation of a completely stirred tank reactor (CSTR) system were in good agreement with the experimental results, e.g., the concentrations of total organic carbon (TOC), hydrogen peroxide and dissolved ozone obtained from a lab-scale CSTR. Furthermore, by using this CFD simulator, the distributions of substances such as hydroxyl radical (OH*) and hydrogen peroxide in the O3/UV reactor have been investigated. These distributions showed that this CFD simulator was considered to be reasonable. In addition, the simulation results suggested that conventional reactors were not optimized.

Double filtration plasmapheresis for the treatment of bullous pemphigoid: a three case report

Bullous pemphigoid (BP) is an autoimmune disease caused by an antidermal basal lamina antibody. In recent years double filtration plasmapheresis (DFPP) has been reported to be an effective therapy for BP. We experienced 3 cases of BP treated by DFPP. DFPP resulted in an improvement in clinical symptoms and remission allowing a decrease in the required dose of corticosteroid. DFPP was found to be an effective treatment for all 3 patients without noticeable adverse events resulting from DFPP. From these results it is concluded that DFPP is worth considering as an option as treatment for BP patients who were unresponsive to conventional steroid therapy, those in whom corticosteroids should be reduced or discontinued because of complications such as diabetes mellitus and/or osteoporosis.

[Hyperphosphatemia and hypoparathyroidism]

There are great differences in causes and treatments of hypoparathyroidism between patients with normal renal function and those with impaired renal function (dialysis patient). In patients with normal renal function, hypocalcemia and hyperphosphatemia develop because of the decrease in PTH synthesis or PTH function, and major target for treatment is hypocalcemia. In dialysis patients, hyperphosphatemia inevitably develops by the decrease in urinary excretion of phosphate and about three to six times greater concentration of PTH is required to maintain the normal bone metabolism. Hyperphosphatemia should be strictly treated, but it remains still unsure what is the real pathogenesis of hypoparathyroidism, and whether hypoparathyroidism should be treated or not in dialysis patient.

Evaluation of thoracic myelopathy by transcranial magnetic stimulation

It is sometimes difficult to determine the appropriate surgical site in patients with thoracic myelopathy with diffuse or multisegmental lesions. To solve this problem, a magnetic stimulation study was carried out. Seven patients with myelopathy and 10 healthy control subjects were examined. Transcranial magnetic stimulation was applied and the motor evoked potentials (MEPs) of the intercostal muscles were recorded. The MEP latencies for the two groups were then compared. In patients with thoracic myelopathy, the MEP latencies caudal to the lesion were more extended than those of the control subjects. This method could identify the levels at which myelopathy originates in patients with a radiologically visible lesion. This method has the potential to be used for deciding the surgical site at the level responsible for myelopathy in cases with multiple or diffused compression.

Ecdysone-inducible foreign gene expression in stably-transformed lepidopteran insect cells

Cultured cell lines that can be stably transformed with inducible gene constructs could prove extremely valuable for the continuous and economical production of recombinant proteins. Toward this goal, we have established 11 clones (designated NISES-BoMo-DK1 to 11) from a previously reported silkworm cell line, NISES-BoMo-DZ. Nine of these clonal lines showed a distinct morphological change. i.e., cell aggregation, in response to treatment with 1 microM 20-hydroxyecdysone (20E). DK10 cells transfected with various reporter assay plasmids under optimal conditions (i.e., 20-30% transfection efficiency) showed inducibility of gene expression by 20E. The 20E treatment of the prototypical DK10 cells resulted in a simultaneous, transient increase of the nuclear ecdysone (E) receptor levels. Further, this inducibility was also observed in a DK10 cell line stably transformed with the reporter plasmid that carries the hygromycin-resistance gene. This offers an opportunity to achieve efficient, continuous production of recombinant proteins. It could also allow high throughput screening for potential E agonists.

Molecular cloning of silkworm paralytic peptide and its developmental regulation

The silkworm paralytic peptide (PP) is a member of the ENF peptide family that exerts multiple biological activities involved in defense reaction and growth regulation. We isolated its cDNA and examined mRNA expression profiles. cDNA encoded 131 amino acids from which the 23-residue PP sequence was found at the C-terminal portion. Immunoblot analysis and paralytic activity assay indicated that inactive pro-protein in larval hemolymph was processed into active peptide immediately after bleeding. In the last larval instar, 0.6-kb PP mRNA was expressed in various tissues, of which the fat body was predominant. Its expression in the fat body decreased during the feeding period and then increased during metamorphic process. Juvenile hormone and 20-hydroxyecdysone upregulated its expression. At the embryonic stage, 1.5-kb mRNA, in addition to 0.6-kb mRNA, was expressed from 1 day after oviposition to hatching. PP was thus expressed stage-specifically under hormonal control.

Early-phase enhanced inflammatory reaction after spinal instrumentation surgery

STUDY DESIGN

The erythrocyte sedimentation rate, C-reactive protein, white blood cell count, and body temperature were measured prospectively in patients after two types of spinal surgery without complications and three cases of infection after spinal instrumentation surgery.

OBJECTIVES

To investigate the effects of instrumentation on postoperative inflammatory reaction, and to describe early detection of postoperative wound infection.

SUMMARY OF BACKGROUND DATA

In thoracic and abdominal surgery as well as hip arthroplasty, C-reactive protein has proved more valuable than erythrocyte sedimentation rate for early detection of postoperative infectious complications. It has not yet been established, however, how inflammatory parameters change after surgery when spinal instruments have been inserted into the body.

METHODS

For this study, two groups of patients were examined: a control group that underwent spinal decompression surgery without instrumentation (n = 36) and another group that underwent spinal decompression and fusion surgery with spinal instrumentation (n = 37). The erythrocyte sedimentation rate, C-reactive protein, white blood cell count, and body temperature were recorded 1 day before surgery and on days 0 to 4, 7, 11, 14, 21, 28, and 42 after surgery.

RESULTS

Inflammatory indexes (i.e., C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and body temperature) were significantly higher for the surgery with instrumentation than for the spinal decompression surgery without instrumentation. Multiple regression analysis showed that C-reactive protein and erythrocyte sedimentation rate peaks significantly correlated with the use of instrumentation (C-reactive protein: P = 0.000257, erythrocyte sedimentation rate: P = 0.000132). In the patients with infection after spinal instrumentation surgery, C-reactive protein, white blood cell count, and body temperature started to increase again 4 to 11 days after surgery. The elevation of erythrocyte sedimentation rate levels was prolonged.

CONCLUSIONS

Erythrocyte sedimentation rate and C-reactive protein display a significantly higher reaction after spinal surgery with instrumentation. Renewed elevation of C-reactive protein, white blood cell count, and body temperature after postoperative days 4 to 7 may be a critical sign of postoperative infection.

The juvenile hormone binding protein of silkworm haemolymph: gene and functional analysis

A cDNA fragment of haemolymph juvenile hormone binding protein (hJHBP) from larvae of Bombyx mori was amplified by RT-PCR using degenerate primers based on the N-terminal amino acid sequence of purified hJHBP and a conserved region near the C-terminus of other lepidopteran hJHBPs. 5'- and 3'-ends were amplified by RACE to yield cDNAs, hJHBP1 and hJHBP2, encoding 225 amino acids with three substitutions. hJHBP-mRNA levels in the fat body were constant in the 4th instar, but decreased in the 5th. JHBP protein was constant until wandering, then declined. Recombinant hJHBP1 expressed in E. coli migrated on SDS-PAGE with a Mr of 32 kDa and showed a Kd of 4.5 x 10-7 M with JH III, both similar to those of native hJHBP.

Mucosa-associated lymphoid tissue in middle ear and eustachian tube

The presence of mucosa-associated lymphoid tissue (MALT) was investigated histopathologically in every 20th section from 99 vertically cut, celloidin-embedded temporal bone-eustachian tube (ET) specimens. Among specimens from infants and children between 1 month and 7 years of age, MALT was found in 22 of 44 (50%). However, in 26 adults over 18 years of age, MALT was found in only 2 specimens (7.7%), a significantly lower incidence than that in infants and children. Moreover, MALT did not appear in any of the 21 neonates under the age of 1 month. All 99 specimens were classified into 2 groups: 41 specimens with otitis media (OM) and 58 specimens without OM. The presence of MALT was significantly higher in specimens with OM (43.9%) than in specimens without OM (13.8%). Mucosa-associated lymphoid tissue was found in the ET, middle ear, and mastoid process in 18 specimens (43.9%). 5 specimens (12.2%), and 1 specimen (2.4%) with OM, respectively, and in 8 (13.8%), 0, and 0 specimens without OM. In regard to the distribution of MALT, it occurred more frequently in the pharyngeal half of the cartilaginous portion of the ET than in the rest of the ET, middle ear, and mastoid; the presence was significantly greater in the inferior half of the cartilaginous portion of the ET than in the superior half. Inflammatory cell infiltration in the cartilaginous and bony portions of the ET was significantly greater in specimens with OM than in specimens without OM with no MALT. However, even in some specimens without OM, inflammatory cells were found in the ET, particularly in the pharyngeal half of the cartilaginous portion of the ET. These findings suggest that MALT has a close relationship to OM and that it may be a local response to repeated infection.

Biological and mechanical properties of PMMA-based bioactive bone cements

We reported previously that a bioactive PMMA-based cement was obtained by using a dry method of silanation of apatite-wollastonite glass ceramic (AW-GC) particles, and using high molecular weight PMMA particles. But handling and mechanical properties of the cement were poor (Mousa et al., J Biomed Mater Res 1999;47:336-44). In the present study, we investigated the effect of the characteristics of PMMA powder on the cement. Different cements containing different PMMA powders (CMW1, Surgical Simplex, Palacos-R and other two types of PMMA powders with Mw 270,000 and 1,200,000) and AW-GC filler in 70 wt% ratio except Palacos-R (abbreviated as B-CMW1 and B-Surg Simp, B-Palacos 50 [50 wt% AW-GC filler] and B-Palacos 70 [70 wt% AW-GC filler], B-270 and B-1200) were made. Dough and setting times of B-CMW1, B-Surg Simp B-270 and B-1200 were similar to the commercial CMW1 cement which did not contain bioactive powder (C-CMW1), but B-palacos which contained large PMMA beads with high Mw had delayed setting time. B-270 had the highest bending strength among the tested cements. After 4 and 8 weeks of implantation in the medullary canals of rat tibiae, the bone-cement interface was examined using SEM. The affinity index of B-1200 was significantly higher than the other types of cements. B-270 showed good combination of handling properties, high mechanical properties and showed higher bioactivity with minimal soft tissue interposition between bone and cement compared with commercial PMMA bone cement. This may increase the strength of the bone-cement interface and increase the longevity of cemented arthroplasties.

Eosinophilic granuloma of the spine: early spontaneous disappearance of tumor detected on magnetic resonance imaging. Case report

Two cases of eosinophilic granuloma (EG) of the spine associated with neurological deficits are presented. The patients were treated conservatively by using external fixation with a brace as well as bed rest. Neurological deficits and pain diminished and finally disappeared as the tumor mass decreased in size, as seen on magnetic resonance (MR) imaging. During the 5-year follow-up period no recurrence of the tumors was detected on MR images. Surgical treatment for spinal EG in children presenting with typical vertebra plana is not recommended except for those with severe or progressive palsy and for those in whom the disease requires differential diagnosis.