Efficient subtractive cloning of genes activated by lipopolysaccharide and interferon γ in primary-cultured cortical cells of newborn mice

Innate immune responses play a central role in neuroprotection and neurotoxicity during inflammatory processes that are triggered by pathogen-associated molecular pattern-exhibiting agents such as bacterial lipopolysaccharide (LPS) and that are modulated by inflammatory cytokines such as interferon γ (IFNγ). Recent findings describing the unexpected complexity of mammalian genomes and transcriptomes have stimulated further identification of novel transcripts involved in specific physiological and pathological processes, such as the neural innate immune response that alters the expression of many genes. We developed a system for efficient subtractive cloning that employs both sense and antisense cRNA drivers, and coupled it with in-house cDNA microarray analysis. This system enabled effective direct cloning of differentially expressed transcripts, from a small amount (0.5 µg) of total RNA. We applied this system to isolation of genes activated by LPS and IFNγ in primary-cultured cortical cells that were derived from newborn mice, to investigate the mechanisms involved in neuroprotection and neurotoxicity in maternal/perinatal infections that cause various brain injuries including periventricular leukomalacia. A number of genes involved in the immune and inflammatory response were identified, showing that neonatal neuronal/glial cells are highly responsive to LPS and IFNγ. Subsequent RNA blot analysis revealed that the identified genes were activated by LPS and IFNγ in a cooperative or distinctive manner, thereby supporting the notion that these bacterial and cellular inflammatory mediators can affect the brain through direct but complicated pathways. We also identified several novel clones of apparently non-coding RNAs that potentially harbor various regulatory functions. Characterization of the presently identified genes will give insights into mechanisms and interventions not only for perinatal infection-induced brain damage, but also for many other innate immunity-related brain disorders.

ADAR1 protein induces adenosine-targeted DNA mutations in senescent Bcl6 gene-deficient cells

Somatic mutations accumulate in senescent cells. Bcl6, which functions as a transcriptional repressor, has been identified as a potent inhibitor of cell senescence, but a role of Bcl6 in the accumulation of somatic mutations has remained unclear. Ig class-switch recombination simultaneously induces somatic mutations in an IgM class-switch (Ig-Sμ) region of IgG B cells. Surprisingly, mutations were detected in the Ig-Sμ region of Bcl6-deficient IgM B cells without class-switch recombination, and these mutations were mainly generated by conversion of adenosine to guanosine, suggesting a novel DNA mutator in the B cells. The ADAR1 (adenosine deaminase acting on RNA1) gene was overexpressed in Bcl6-deficient cells, and its promoter analysis revealed that ADAR1 is a molecular target of Bcl6. Exogenous ADAR1 induced adenosine-targeted DNA mutations in IgM B cells from ADAR1-transgenic mice and in wild-type mouse embryonic fibroblasts (MEFs). These mutations accumulated in senescent MEFs accompanied with endogenous ADAR1 expression, and the frequency in senescent Bcl6-deficient MEFs was higher than senescent wild-type MEFs. Thus, Bcl6 protects senescent cells from accumulation of adenosine-targeted DNA mutations induced by ADAR1.

Genetic variations within the insulin gene region are associated with accelerated fetal growth

Size at birth has been proposed to be associated with the risk of type 2 diabetes and cardiovascular disease later in life. It is, however, unclear whether this association is attributed to an unfavorable intrauterine environment or to specific genotypes predisposing both altered fetal growth and common diseases in adult life. The aim of this study was to investigate the associations between the neonatal birth size and the genotypes of polymorphic loci within the insulin gene (INS) region, which is susceptible to diabetes mellitus. We analyzed the genotypes of two polymorphic loci; -23HphI and HUMTH01, in 520 pairs of normal Japanese mothers and their neonates, and compared with the somatoscopic characteristics at birth converted into standard deviation scores (SDS) according to sex, parity and gestational weeks at delivery. It was revealed that neonatal -23HphI T allele and HUMTH01 allele10, which are linked to the INS variable number of tandem repeats (VNTR) class III allele, were associated with increased weight, head circumstance, and length at birth. These associations confirmed that variation within the INS region, most probably at the INS-VNTR, influences fetal growth. Furthermore, the finding that the paternally transmitted -23HphI T allele was exclusively correlated with increased size at birth indicates the involvement of an imprinting mechanism. In conclusion, the INS-VNTR class III allele might accelerate fetal growth in a parent-specific manner.

Insulin-like growth factor 2 (IGF2) and IGF2 receptor gene variants are associated with fetal growth

AIM

Normal variation in size at birth is a result of the interaction between fetal genetic factors and the maternal uterine environment. It is, however, unclear how genetic factors contribute to fetal growth. The insulin-like growth factor (IGF) system regulates uterine, placental and fetal development, thereby partially controlling the rate of fetal growth. The aim of this study was to investigate the associations between the neonatal birth weight and the genotypes of polymorphic loci in the IGF2 and IGF2 receptor (IGF2R) genes.

METHODS

We determined the genotypes of two polymorphic loci in the IGF2 gene and four loci in the IGF2R gene in 884 pairs of normal Japanese mothers and their neonates, and compared the genotypes with the birth weight converted into standard deviation scores (SDSs) according to sex, parity and gestational weeks at delivery.

RESULTS

There was a significant difference in birth weight SDSs among the three neonatal +3123/ApaI genotypes of the IGF2 gene; AA, AG and GG. There was also a significant difference in birth weight among the three neonatal c.901C > G genotypes of the IGF2R gene; CC, CG and GG.

CONCLUSION

These findings indicate that both IGF2 and IGF2R gene variants are associated with fetal growth.

Recent changes of the incidence of complete and partial mole in Chiba prefecture

AIMS

To study the changes of the incidence of complete mole (CM) and partial mole (PM) by 10-year age groups in Chiba Prefecture.

METHODS

All women registered as CM and PMs in Chiba Prefecture during these 18 years were included in this study. The diagnosis of CM and PM was based on the macroscopic and/or microscopic findings. The annual numbers of pregnancy were obtained from the Division of Statistics in Chiba Prefecture Government.

RESULTS

The incidence of CM at the upper and lower extremes of maternal age is higher than that of PM. The incidence of CM has decreased constantly at all maternal ages and significantly decreased in women of middle reproductive age (20-39 years old) since 1991, while that of PM has stayed constant during these 18 years.

CONCLUSIONS

The incidence of CM and PM in Chiba Prefecture has become as low as that in Europe or the USA. These recent changes suggest that Japanese women may have lost the increased risk to ovulate a nuclear or inactive oocytes, or the differential diagnosis between CM and PM may be obscured with the macroscopic and/or microscopic findings.

Increased expression of GRP94 protein is associated with decreased sensitivity to X-rays in cervical cancer cell lines

PURPOSE

Radiation therapy is one of the standard treatments for cervical cancer. Glucose regulated protein 94 (GRP94) is a molecular chaperone, which increases in amount after X-ray irradiation. This study examined the involvement of GRP94 in radio-resistance in human cervical cancer cells.

MATERIALS AND METHODS

Seven human cervical carcinoma cell lines (HeLa, SKG-I, SKG-IIIb, QG-U, Caski, SiHa and C33A) were examined for basal levels of GRP94 protein by western blotting analysis. Sensitivity to X-ray irradiation of these cell lines was determined with a colony survival assay. The suppression of GRP94 expression was performed using specific small-interfering RNA (siRNA) in HeLa and Caski cells.

RESULTS

HeLa cells and QG-U cells, with higher basal levels of GRP94, exhibited a low sensitivity to X-ray cell killing. In HeLa cells, the sensitivity increased when protein GRP94 levels were reduced by specific siRNA transfection. However, a reduction in GRP94 protein had little effect on the X-ray sensitivity of Caski cells, which expressed low basal GRP94 protein levels but showed a low sensitivity to X-rays.

CONCLUSIONS

High basal protein levels of GRP94 were correlated with a modest decrease in sensitivity to X-ray cell death in some cervical cancer cell lines. These results suggest that higher GRP94 protein expression is one of the molecular mechanisms causing resistance to radiation, and therefore GRP94 siRNA might be useful in tumor-specific gene therapy by reversing radio-resistance prior to radiation in cervical cancer.

IgG antibodies to HPV16, 52, 58 and 6 L1-capsids and spontaneous regression of cervical intraepithelial neoplasia

To identify the predictive markers for spontaneous regression of cervical intraepithelial neoplasia (CIN), we examined whether IgG antibody responses to common human papillomavirus (HPV) L1-capsids correlate with CIN regression. In a cohort study, a total of 116 Japanese women with CIN grade I/II were tested for cervical HPV DNA and serum IgG antibodies to HPV16/52/58/6 L1-capsids. Our data suggest that baseline IgG reactivities to HPV L1-capsids do not serve as a predictive marker of CIN regression, in contrast to histological CIN grades and HPV DNA status.

Tamoxifen and the Risk of Endometrial Cancer in Japanese Women with Breast Cancer

PURPOSE

There is ongoing debate about whether tamoxifen for breast cancer is associated with a risk of endometrial cancer in Japanese women. We conducted a study to investigate this further.

METHODS

We conducted a retrospective hospital-based cohort study. A total of 674 consecutive patients underwent surgery for primary breast cancer between January 1989 and December 1998. By December 2003, endometrial cancers had been diagnosed in six of these patients. Based on medical records, we evaluated the potential risk factors for endometrial cancer, including age, menopausal status, obesity, parity, diabetes mellitus, hypertension, and tamoxifen. The 674 patients were divided into three groups based on the cumulative duration of tamoxifen use (A, <2 years vs B, 2-5 years vs C, >5 years). To examine the relationships between endometrial cancer and tamoxifen (and other factors), the hazards ratio (HR), 95% confidence interval (CI), and two-sided P value for endometrial cancer associated with each variable were calculated by the Cox regression method.

RESULTS

Endometrial cancer was found in 1/318 (0.31%) patients in group A, 3/247 in group B, and 2/109 in group C. In a multivariate analysis no variable was significant, but tamoxifen use for longer than 5 years (group C) was closely correlated with endometrial cancer (HR = 7.92, CI = 0.69-90.89, P = 0.096).

CONCLUSION

Although our data did not reach significance, they support a link between long-term tamoxifen and the development of endometrial cancer in Japanese women with breast cancer.

Accelerated Bone Turnover in Pregnant Women with McCune-Albright Syndrome

Bone turnover in pregnant women with McCune-Albright syndrome may be affected by both the syndrome and pregnancy. This study evaluated changes in biochemical bone turnover markers in pregnant women with the syndrome. Serum calcium, phosphorus, 1,25-dihydroxyvitamin D (1,25-(OH)2D), intact osteocalcin (I-OC) and alkaline phosphatase (ALP), and urinary pyridinoline (Pyr), deoxypyridinoline (D-Pyr) and hydroxyproline (HPR) were measured during pregnancy and postpartum in 2 women with McCune-Albright syndrome. Serum calcitonin (CT), and plasma intact parathyroid hormone (I-PTH) and parathyroid hormone-related protein (PTHrP) were also measured in 1 patient. Serum corrected Ca levels were normal or low-normal; phosphorus levels were normal, and 1,25-(OH)2D levels increased toward term and decreased thereafter, similar to normal pregnant women. Urinary Pyr, D-Pyr and HPR were elevated during pregnancy compared to normal pregnant women, peaked just after delivery, and decreased thereafter. Serum I-OC and ALP levels were high during pregnancy and postpartum. Intact PTH levels were increased during pregnancy and postpartum compared to normal pregnant women, whereas serum CT and PTHrP levels were not elevated. Both bone formation and absorption appear to be more enhanced during pregnancy and postpartum in women with McCune-Albright syndrome than in normal pregnant women. Additional or amplified cyclic AMP synthesis in bone cells through activation of the alpha subunit of G protein, independent of hormonal control, may explain the high local bone turnover.

Oncolytic viral therapy for cervical and ovarian cancer cells by Sindbis virus AR339 strain

PURPOSE

Recently, the application of replication-competent viruses has been studied as anticancer agents. Sindbis virus (SIN) is an RNA virus that belongs to the Alphavirus genus in the Togaviridae virus family. The AR339 strain of SIN has not been reported to induce any serious disease to humans.

EXPERIMENTAL DESIGN

In this study, we evaluated the feasibility of the replication-competent SIN AR339 strain as an agent for cervical and ovarian cancer therapy.

RESULTS

SIN infection was able to induce cytopathic effects and apoptosis in two cervical cancer cells (HeLaS3 and C33A) and three ovarian cancer cells (HOC-1, HAC-2, and OMC-3) but not in normal human keratinocytes in vitro. The analysis of cell viability, virus protein synthesis, and viral growth showed the cancer-specific cytotoxicity and virus growth of SIN. In nude mice, i.t. and i.v. inoculation of SIN resulted in significant regression of established cervical tumors implanted at their backs. Histologic studies revealed that systemic treatment with the single injection of SIN induces necrosis within tumors at a remote site. In the metastasis model of ovarian cancer, suppression of ascites formation was observed in nude mice with i.p. SIN treatment. By using an in vivo green fluorescent protein imaging system, we also showed that systemic treatment with SIN targeted tumors specifically.

CONCLUSIONS

Our study suggested that SIN AR339 strain has a possibility as a novel agent for human cervical and ovarian cancer therapy.

Discordance Between Serum Level and Tissue Immunohistochemical Staining of CA125 in Endometrioid Adenocarcinoma of the Uterine Corpus

This study was designed to correlate tissue expression of CA125 with the corresponding serum value in endometrial cancer. The records of 52 endometrioid adenocarcinomas diagnosed were reviewed. Serum CA125 levels were examined before definitive surgery, and 20 U/ml was used as the cutoff value. Immunohistochemical staining for CA125 was assessed according to the ImmunoReactive Score. Statistical analyzes were performed to identify independent factor for high serum CA125 levels, including CA125 staining and the conventional pathologic features. Elevated serum CA125 levels were found in 15 of 52 patients (29%) (range, 0.1-172.1; mean 22.6 U/ml). The frequency of positive CA125 tissue staining (35/52, 67%) tended to be higher than that of elevated serum levels (p = 0.046). Fifteen patients with elevated serum CA125 levels statistically differed from the remaining 37 patients with normal serum CA125 level with respect to International Federation of Gynecology and Obstetrics (FIGO) stage (p = 0.027) and lymph node metastasis (p = 0.024), and tended to have positive washing cytology (p = 0.052). In multivariate analysis, elevated serum CA125 significantly correlated only with FIGO stage III, but not with tumor size or CA125 tissue staining. Intrauterine tumor may not be the main source of serum CA125 in endometrial cancer, and elevated serum level is closely related to the presence of disseminated cancer cells in the peritoneal cavity.

Relapse rate of patients with low-risk gestational trophoblastic tumor initially treated with single-agent chemotherapy

OBJECTIVE

To determine the factors for relapse in patients with low-risk gestational trophoblastic tumor (GTT) treated with single-agent chemotherapy.

METHODS

Between 1974 and 2000, 272 consecutive patients with low-risk GTT were initially treated with methotrexate (MTX), actinomycin D (Act-D) or etoposide chemotherapy. The primary remission rate, change of chemotherapy because of drug resistance or toxicity, and relapse rate were compared.

RESULTS

Overall survival rate and primary remission rate for 272 patients were 100% and 75.7%, respectively. Primary remission rate was significantly higher in patients given etoposide than those given conventional MTX (P < 0.0001) or MTX-folinic acid (MTX-CF) (P = 0.0005). Twenty-four (8.8%) patients required a change of chemotherapy because of drug resistance. The frequency of drug resistance was significantly higher in patients treated with MTX-CF than those treated with etoposide (P = 0.006). Although maternal age, presence of metastasis, high pretreatment hCG titer, and planned hysterectomy did not influence the development of drug resistance, the new FIGO scores were significantly higher in patients who developed drug resistance. Relapse rate increased significantly in patients who had high FIGO scores and who required change of chemotherapy due to drug resistance.

CONCLUSIONS

All patients with low-risk GTT eventually attained complete remission, even though some developed drug resistance to the first-line chemotherapy. The relapse rate was significantly higher in patients with drug resistance than those with primary remission. Chemotherapy regimen that induces little drug resistance is desirable from the viewpoint of long-term prognosis.

Genetic origin and imprinting in hydatidiform moles. Comparison between DNA polymorphism analysis and immunoreactivity of p57KIP2

OBJECTIVE

To evaluate whether p57KIP2 expression is concordant with the result of DNA polymorphism analysis in molar pregnancy.

STUDY DESIGN

Eleven molar pregnancies diagnosed by pathologic findings between October 2002 and April 2004 were studied. Histopathologic diagnosis, DNA polymorphism analysis and p57KIP2 immunohistochemistry were investigated.

RESULTS

DNA polymorphism analysis identified 3 biparental conceptuses as well as 4 dispermic androgenetic complete moles (CMs) and 4 suggestive monospermic CMs. Distinctly positive nuclear immunoreactivity of p57KIP2 was observed in a significant proportion of the villous cytotrophoblast and mesenchyme (30-60% of cells positive) in 3 cases of biparental conceptuses proven by DNA polymorphism. In contrast, p57KIP2 expression was negative (< 5% positive cells) in either the villous cytotrophoblast or mesenchyme in 8 cases of androgenetic conceptuses proven by DNA polymorphism. In all 11, p57KIP2 immunostaining was observed in the nuclei of extravillous trophoblasts that served as internal positive controls.

CONCLUSION

Negative p57KIP2 immunoreactivity (paternally imprinted, maternally expressed gene) was in perfect concordance with the androgenetic origin of molar pregnancies proven by DNA polymorphism. The results suggest that p57KIP2 immunoreactivity, which can be performed in routine pathologic examinations, is a promising ancillary diagnostic tool to differentiate androgenetic CM from biparental conceptuses.

Serum vascular endothelial growth factor (VEGF) and VEGF-C levels as tumor markers in patients with cervical carcinoma

BACKGROUND

Vascular endothelial growth factor (VEGF) and VEGF-C play a crucial role in the regulation of tumor growth and metastasis. The current study examined the significance of serum VEGF and VEGF-C levels in relation to conventional clinicopathologic parameters, response to treatment, and survival in patients with cervical carcinoma.

METHODS

Between December 1999 and March 2004, serum VEGF and VEGF-C levels were analyzed in 78 patients with cervical carcinoma undergoing primary treatment (primary surgery [n=40] and radiotherapy [n=38]), as well as in 30 healthy controls. Serum VEGF and VEGF-C levels were assessed by enzyme-linked immunosorbent assay before and within 2 weeks after treatment.

RESULTS

Serum VEGF and VEGF-C levels were higher in patients with cervical carcinoma than in the healthy control (P=0.0002 and P=0.0007, respectively). Both VEGF and VEGF-C concentrations increased significantly in patients with squamous cell carcinoma (SCC vs. normal control: P<0.0001 and P=0.0001, respectively), but not in adenocarcinoma (vs. normal control: P=0.2982 and P=0.7766, respectively). In an analysis of SCC, the pretherapeutic serum levels of VEGF and VEGF-C correlated significantly with advanced International Federation of Gynecology and Obstetrics stage and large tumor size, but not with lymph node metastasis. The pretherapeutic serum level of VEGF-C also correlated significantly with disease recurrence or persistence after treatment. Both serum VEGF and VEGF-C levels decreased significantly after treatment.

CONCLUSIONS

The serum levels of both VEGF and VEGF-C have potential usefulness as biologic markers of SCC of the uterine cervix.

Phase I study of daily cisplatin and concurrent radiotherapy in patients with cervical carcinoma

OBJECTIVE

Chemoradiation based on cisplatin is the standard treatment for locally advanced cervical carcinoma; however, the optimal scheduling and dosing have still not been established. This study was conducted to determine the maximum-tolerated dose (MTD) of cisplatin for daily administration during pelvic radiotherapy (RT).

METHODS

Fourteen patients with locally advanced cervical carcinoma and 13 who required postoperative RT were registered. A low dose of cisplatin was given daily concurrently with RT. Cisplatin dosing was started at 6.0 mg/m(2)/day, which was incremented by 0.5 mg/m(2)/day. RT was delivered at 2 Gy/day to a total dose of 50 Gy. The MTD was defined as the dose level immediately below that causing dose-limiting toxicity (DLT) in over one-third of treated patients.

RESULTS

Twenty-five patients were treated with a maximum of six escalating dose levels. In 22/25 patients (88%), cisplatin was administered continuously as planned without interruption. The MTD was determined to be 8 mg/m(2) and the DLT was indicated by the onset of neutropenia.

CONCLUSION

Daily cisplatin, at 8 mg/m(2)/day, is a well-tolerated radiosensitizer in cervical carcinoma patients.

Advances in the clinical laboratory detection of gestational trophoblastic disease

BACKGROUND

Gestational trophoblastic disease (GTD) consists of a spectrum of disorders that are characterized by an abnormal proliferation of trophoblastic tissue. Gestational trophoblastic neoplasia (GTN) refers to a subset of GTD with a persistently elevated serum hCG in the absence of a normal pregnancy and with a history of normal or abnormal pregnancy. Although previously a lethal disease, GTN is considered today the most curable gynecologic cancer. However, a delay in the diagnosis may increase the patient's risk of developing malignant GTN, and therefore the prompt identification of GTN is important.

SERUM MARKERS

hCG test is essential for detection of GTN. It has emerged that there are problems with hCG tests. In addition to regular hCG, at least five major variants of hCG are present in serum samples. False-positive hCG (phantom hCG) can occur in the absence of GTN. Low-level real hCG may occasionally persist in the absence of clinical evidence of pregnancy or GTD. Alternatively, low-level real hCG may be due to pituitary hCG. Other placental hormones, human placental lactogen (hPL), inhibin and activin, and progesterone have also been evaluated as tumor markers for GTD.

CONCLUSION

hCG has high diagnostic sensitivity, approaching 100% sensitivity, for managing the treatment of GTN and for detecting recurrences of disease. It is recommended to use hCG test that recognizes all forms of the hCG molecule. In cases where low-level hCG persists, it must be differentiated whether it is real or false. Real-hCG may be due to quiescent gestational trophoblastic disease or pituitary hCG. It has not yet been established whether measurement of markers other than hCG (hPL, inhibin, activin, and progesterone) is useful in the detection and follow-up of GTD.

Multi-Minicore Disease with Susceptibility to Malignant Hyperthermia in Pregnancy

Multi-minicore disease (MmD) is a congenital non-progressive or slowly progressive myopathy associated with multifocal degeneration of muscle fibers. Obstetric management for patients with MmD has not been described previously. A 25-year-old primigravida with a history of muscular weakness from birth was diagnosed with MmD and found to be susceptible to malignant hyperthermia (MH) by muscle biopsy at 28 weeks of gestation. Pregnancy proceeded uneventfully and she had a successful vaginal delivery under sufficient preparation for the possible occurrence of MH. Pregnant women who exhibit myopathic symptoms from childhood should consult an anesthesiologist prior to delivery.

Early pregnancy outcomes after chemotherapy for gestational trophoblastic tumor

OBJECTIVE

To analyze the outcome of the first pregnancy following chemotherapy for gestational trophoblastic tumor (GTT).

STUDY DESIGN

A total of 393 patients with GTT (87 with high-risk and 306 with low-risk GTT) underwent chemotherapy at Chiba University Hospital between 1974 and 2000. Of them, 137 (19 with high-risk and 118 with low-risk GTT) who achieved primary remission and had at least 1 conception following chemotherapy were included in the study.

RESULTS

The overall outcomes of the first subsequent pregnancies in the 137 women treated with chemotherapy were comparable to those in the general Japanese population. However, the incidence of abnormal pregnancies (spontaneous abortion, stillbirth, repeat mole) was significantly higher in women who conceived within 6 months of completing chemotherapy (6 of 16, 37.5%) than in those who conceived after the recommended waiting period, > 12 months (11 of 99, 10.5%) (P=.014).

CONCLUSION

Patients who achieved primary remission with various kinds of chemotherapy may anticipate a normal future reproductive outcome. As pregnancies occurring within 6 months following remission are at risk of abnormality, a waiting period of at least 6 months after chemotherapy for GTT is recommended.

Quantitative and Qualitative Evaluations of Fetal Lung with MR Imaging

PURPOSE

To measure both volume and signal intensity of the fetal lung at magnetic resonance (MR) imaging and to evaluate the clinical use of this method to predict fetal pulmonary hypoplasia.

MATERIALS AND METHODS

A total of 87 fetuses evaluated with MR imaging at 24-39 weeks of gestation were classified into a control group with good respiratory outcome (group A, n = 58) or a poor outcome group with severe respiratory disturbance after birth (group B, n = 29). Planimetric measurement of total lung volume and calculation of the ratio of lung signal intensity to spinal fluid signal intensity (L/SF) were performed on MR images by using region-of-interest analysis. Regression analysis, analysis of covariance, analysis of variance, and receiver operating characteristic (ROC) analysis were performed.

RESULTS

The best fit for group A lung volume was represented by the regression line V = (2.41 x G) - 37.6 (r = 0.537, P <.001), in which V is lung volume and G is gestational weeks; that for group B, by V = (0.97 x G) - 14.0 (r = 0.378, P <.05). Results of analysis of covariance with gestational weeks used as a covariate showed a significant difference in lung volume between the two groups (P <.001). Mean +/- SEM for L/SF ratio was 0.817 +/- 0.013 and 0.598 +/- 0.019 in groups A and B, respectively (P <.001). For prediction of postnatal respiratory outcome, the area under the ROC curve for lung volume and L/SF ratio combined was 0.990, significantly higher than that for lung volume alone (P <.05).

CONCLUSION

Simultaneous measurement of fetal lung volume and signal intensity on MR images is a promising method for predicting fetal pulmonary hypoplasia.

Salvage chemotherapy for high-risk gestational trophoblastic tumor

OBJECTIVE

To evaluate the efficacy and safety of etoposide/methotrexate/actinomycin D (MEA regimen) as initial chemotherapy and 5-fluorouracil/actinomycin D (FA regimen) as salvage chemotherapy for high-risk gestational trophoblastic tumor (GTT).

STUDY DESIGN

From 1985 to 2001, 36 patients with World Health Organization (WHO)--defined high-risk GTT were treated with MEA or FA at Chiba University Hospital. Thirty-three patients were initially treated with MEA. FA was administered to 11 patients; 1 had had no previous chemotherapy, 7 had developed drug resistance to MEA, 1 had relapsed following MEA, and 2 had relapsed following etoposide/methotrexate/actinomycin D/ cyclophosphamide/vincristine (EMA/CO) combination chemotherapy.

RESULTS

The primary remission rate with MEA was 69.7% (23 of 33). With FA the survival rate was 81.8% (9 of 11) for a mean follow-up period of 11.5 years. Two patients died due to multidrug resistance, and 2 patients relapsed subsequently. The 2 relapse cases were successfully salvaged again with MEA. The toxicity of FA was evaluated in 89 cycles. Myelosuppression seemed to be the dose-limiting toxicity, and the incidence of WHO grade 4 leukocytopenia and thrombocytopenia were 5.6% and 3.4%, respectively.

CONCLUSION

Although etoposide-containing chemotherapy is currently the most effective and well tolerated regimen for high-risk GTT, 20-30% of patients develop drug resistance to these regimens. Salvage combination chemotherapy with FA is effective for refractory patients, and the toxicity is predictable and manageable.

Correlation between MUC5AC expression and the prognosis of patients with adenocarcinoma of the uterine cervix

BACKGROUND

Mucin expression shows some correlation with prognosis in patients with various cancers. However, few studies have been conducted on adenocarcinomas of the uterine cervix.

METHODS

An immunohistochemical study with a monoclonal anti-MUC5AC antibody, 45M1, was performed on 47 adenocarcinomas of the uterine cervix and on 40 specimens of normal endocervical epithelium. The correlations between clinicopathologic variables and MUC5AC expression were evaluated in the cervical adenocarcinomas.

RESULTS

A significant reduction of MUC5AC expression was evident in the adenocarcinomas of the cervix in comparison with that in the normal endocervical epithelium (53.2% vs. 100%; P <.001). MUC5AC expression was correlated with paracervical invasion and histological type. Patients with negative MUC5AC expression showed poorer survival than those with positive MUC5AC expression (P =.03). However, multivariate analysis revealed that only the depth of invasion was an independent prognostic variable.

CONCLUSIONS

MUC5AC expression was suppressed in adenocarcinoma of the uterine cervix. Absence of MUC5AC expression seems correlated with worse survival.

Pregnancy after Limb-Sparing Hemipelvectomy for Ewing’s Sarcoma

Ewing's sarcoma of the bone is a malignant bone tumor occurring mostly in adolescence and was considered to have poor prognosis. With recent advances in multi-agent combined chemotherapy, prognosis has improved, and more patients with primary lesions in the pelvis opt for limb-saving surgeries. In the present case, Ewing's sarcoma in the left pelvis was diagnosed at the age of 11 and the patient underwent multi-agent chemotherapy combined with limb-sparing hemipelvectomy. She became pregnant at the age of 22. After an uneventful pregnancy, she delivered a healthy child at 37 weeks of gestation by cesarean section because of pelvic distortion. This is the first reported case of pregnancy and delivery after limb-sparing hemipelvectomy due to Ewing's sarcoma. Since the multi-modality treatment improves survival, the number of women with Ewing's sarcoma who desire pregnancy is expected to increase in the future. This is a valuable case that will provide useful information for such patients.

Placental mesenchymal dysplasia initially diagnosed as partial mole

Placental mesenchymal dysplasia is a rare condition of pregnancy that presents as macroscopic features of molar change in the placenta and normal karyotype fetus. These cases are often misdiagnosed as partial mole. We report a new case of mesenchymal dysplasia. A 27-year-old Japanese primigravida delivered an 820 g female baby (46XX karyotype) without congenital anomalies at 27 weeks gestation due to massive bleeding with placenta previa. The placenta had mimicking partial moles, grape-like vesicles and normal villi that diffusely occupied the area on the maternal surface of the placenta. Pathologically, enlarged stem villi contained loose, moderately cellular connective tissue with focal cistern-like formation, and peripherally located vessels. Abnormal trophoblastic proliferation and trophoblastic inclusions were not observed in any of the sections examined. Some villi contained chorioangiomatoid changes. The mother and child were followed up for more than 5 years and showed no sign of trophoblastic disease or Beckwith-Wiedemann syndrome features.

Analysis of aptamer binding site for HCV-NS3 protease by alanine scanning mutagenesis

Nonstructural protein 3 (NS3) of Hepatitis C virus (HCV) is a multifunctional protein and possesses protease, nucleotide triphosphatase and helicase activities. The N-terminal domain of NS3 (amino acids 1027-1218; delta NS3) has a trypsin-like protease activity and is essential for processing of viral polyprotein. Accordingly it is a potential target for anti-HCV drugs and we isolated RNA aptamers (Kd = 10 nM, Ki = 100 nM) using in vitro selection strategy. To study the interaction between delta NS3 and its aptamer, we applied alanine scanning mutagenesis and constructed seven mutant proteins at positive amino acid residues on the surface of delta NS3. Binding and inhibitory activities of the NS3 aptamer against mutant proteins were kinetically analyzed. These results clarified that especially Arg161 and Arg130 are important for interaction with the NS3 aptamer.

Analysis of interaction between RNA aptamer and protein using nucleotide analogs

Non-structural protein 3 (NS3) derived from Hepatitis C virus (HCV) is essential for viral proliferation and has two functional domains; trypsin-like serine protease and helicase. Recently we obtained three types of RNA aptamers (G9-I, -II and -III) bound to NS3 protease domain (delta NS3) by in vitro selection and confirmed their strong inhibition for protease activity. These aptamers have a common sequence, 5'-GA(A/U)UGGGAC-3', forming a loop structure by Mulfold secondary structure modeling. G9-I shows a three-way junction and G9-II and -III have four-way junction structures. To characterize the active structure of these aptamers, we applied modification interference analysis using nucleotide analogs and identified common important nucleotides in these three aptamers.

Construction of the dual-functional RNA ligand against HCV NS3 protease and helicase

Non-structural protein 3 (NS3) of hepatitis C virus (HCV) contains two distinct activities, protease and helicase which are essential for the HCV replication. In the previous study, we succeeded to obtain RNA aptamers, G9-I, G9-II and G9-III specific for the NS3 protease domain (delta NS3) by in vitro selection (1). As the result of mutational analysis in G9-I, we could obtain the minimum length of RNA structure, delta NEO-III maintaining the full inhibitional activity as shown in G9-I. Furthermore, we created a bi-functional novel RNA ligand, NEO-III-14U which was constructed by connecting delta NEO-III with (U)14 at the 3' terminal. NEO-III-14U was able to inhibit the unwinding of duplex DNA catalyzed by the Full-NS3 helicase activity as well as the protease activity in vitro. Consequently, we could obtain the dual-functional RNA ligand which could inhibit both NS3 protease and helicase activities essential for the HCV proliferation.

Detection of epidermal growth factor receptor mRNA in peripheral blood of cervical cancer patients

OBJECTIVE

Epidermal growth factor receptor (EGFR) has been reported to be expressed by immunohistochemistry in invasive cervical cancers. We evaluated the feasibility of detecting EGFR mRNA by EGFR-based reverse transcription polymerase chain reaction (RT-PCR) in peripheral blood of patients with cervical cancer.

METHODS

Expression of EGFR mRNA, cytokeratin (CK)-19 mRNA, and CK-20 mRNA was examined by RT-PCR in 12 human cervical cancer cell lines. All 12 cell lines expressed both EGFR mRNA and CK-19 mRNA, but only 4 of 12 (33.3%) cell lines expressed CK-20 mRNA. Peripheral blood samples from 20 healthy donors and 45 cervical cancer patients were also examined.

RESULTS

In peripheral blood from 20 healthy donors, neither EGFR mRNA nor CK-20 mRNA was expressed, but CK-19 mRNA was expressed in 13 of 20 (65%). In contrast, EGFR mRNA was expressed in 12 of 45 (26.7%) patients with cervical cancer (P = 0.0071, 2 test, patient vs control). On the other hand, expression of EGFR was observed in 98% of tumor tissues by immunohistochemistry. CK-19 mRNA and CK-20 mRNA were found in 35 of 45 (77.8%) and 0 of 45 (0%) patients, respectively (NS, chi(2) test, patient vs control). The rate of detection of EGFR mRNA in peripheral blood correlated with FIGO stage (P = 0.049).

CONCLUSION

Both CK-19 mRNA and CK-20 mRNA showed no diagnostic value as markers of circulating tumor cells in cervical cancers. However, EGFR mRNA in blood might be a useful marker of circulating tumor cells in cervical cancers.

Profile of neurokinin B concentrations in maternal and cord blood in normal pregnancy

OBJECTIVE

Neurokinin B (NKB) is a neuropeptide with a vasopressor effect belonging to the tachykinin family. This neuropeptide has attracted attention since recent reports indicated that it is also secreted in the placenta and is probably a cause of pre-eclampsia. To provide a basis for elucidation of the relationship between pre-eclampsia and NKB, this study aimed to clarify the trend of changes in blood NKB levels during normal pregnancy by measuring NKB concentrations in maternal blood during various gestational periods and in umbilical blood.

METHODS

Fifty-nine normal pregnant women, 12 normal puerperal women and 24 nonpregnant women were studied. The normal pregnant women comprised of 24 at 8-20 weeks' gestation (early), 11 at 28-34 weeks (middle) and 24 at 35-40 weeks (late). Plasma was separated from peripheral blood samples, umbilical venous blood samples (n = 24) and umbilical arterial blood samples (n = 9). Peptide fractions were extracted from each plasma sample and NKB concentrations were measured by the radioimmunoassay method.

RESULTS

The NKB concentration in early pregnancy was not significantly different from that in the nonpregnant state. During pregnancy, the blood NKB concentration increased with advance in gestational week, and a correlation was demonstrated by a linear regression equation. The concentration during puerperium was significantly lower than that in late pregnancy. The umbilical blood concentration was significantly higher than the maternal blood concentration in late pregnancy. There was no significant difference between umbilical venous and arterial blood.

CONCLUSION

This study demonstrated that NKB secreted from the placenta during pregnancy enters both the maternal and fetal circulation. These results suggest that NKB may modulate fetoplacental haemodynamics through a paracrine mechanism.

Circulating inhibin forms in patients with hydatidiform mole

Circulating inhibin forms have not been evaluated in patients with hydatidiform mole (HM) before evacuation of the mole. Serum inhibin A, inhibin B, pro-alphaC and hCG levels were determined by enzyme-linked immunosorbent assay in HM before and after evacuation of the mole (inhibin B only before evacuation). Before evacuation, inhibin B levels in HM were undetectable, and inhibin A levels were similar to those in normal women at the corresponding weeks of pregnancy. Pro-alphaC and hCG levels were higher in molar pregnancy than in normal pregnancy. After evacuation, pro-alphaC levels significantly fell in the patients with spontaneous resolution, but not in those who developed persistent trophoblastic disease (PTD). Both pro-alphaC and hCG levels were higher in the patients with PTD than in those with spontaneous resolution after evacuation, reflecting continued stimulation of the corpus luteum by lower, but still effective hCG levels, persistent trophoblastic tissues secreting pro-alphaC or both.

A case-control study of endometrial cancer after antipsychotics exposure in premenopausal women

OBJECTIVE

Most endometrial cancers are related to hormonal imbalance, and antipsychotics are a common cause of hyperprolactinemia. We investigated the possible relation between the use of antipsychotics and the risk of endometrial cancer.

METHODS

A case-control study was conducted on premenopausal women at the Chiba University Hospital between 1989 and 2000. The cases were 41 patients with histologically confirmed endometrial cancer. For each case, there were 3 controls matched by age and date of visit. Subsequently 123 women without endometrial cancer were enrolled as controls. Detailed information including obesity, parity, hypertension, diabetes mellitus, use of exogenous estrogen and use of antipsychotics was analyzed. Odds ratios, two-sided p values and 95% confidence intervals were estimated by a conditional logistic regression analysis. Radioimmunoassays of serum luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol and progesterone were performed in 4 of 5 patients with endometrial cancer who were using antipsychotics.

RESULTS

Use of antipsychotics, diabetes mellitus and obesity were identified as independent variables with risk estimates of 5.4, 9.3 and 4.9, respectively. Serum progesterone, estradiol and prolactin levels ranged from 0.4 to 0.7 ng/ml, 32 to 110 pg/ml and 34 to 258 ng/ml, respectively.

CONCLUSIONS

Use of antipsychotics is a risk factor for endometrial cancer, and hyperprolactinemia associated with antipsychotics may impart the risk of endometrial cancer in premenopausal women.

Significance of perivascular lymphocytic infiltrates on survival of patients with invasive cervical cancer

The authors retrospectively reviewed the medical records of 129 patients with stage IB and II cervical cancer (93 squamous cell carcinomas, 30 adenocarcinomas, and 6 adenosquamous carcinomas) who underwent primary surgery between 1989 and 2000. Vascular invasion is the predictor of recurrence, and lymphocytic infiltrates within the tumor is associated with favorable outcome in cervical cancer. Hence, 129 patients were divided into three groups according to the presence or absence of vascular invasion (VI) and perivascular lymphocytic infiltrates (PLI); VI- (n = 77), VI+PLI- (n = 26), and VI+PLI+ (n = 26), to evaluate the significance of PLI. Age, clinical stage, histology, tumor grade, depth of stromal invasion, VI and PLI, tumor size, ovarian metastasis, pelvic lymph node metastasis, postoperative irradiation, and chemotherapy were assessed statistically for recurrence of the disease by Cox regression analysis. Disease-free survival was analyzed using Kaplan-Meier survival analysis. Recurrence was observed in 32 (25%) of all 129 cases. In a multivariate analysis, VI ( = 0.003) and histology ( = 0.006) remained significantly associated with recurrence. When divided into three groups, the hazard ratio for recurrence was higher in the absence of PLI (2.95 in VI+PLI- group versus 2.07 in VI+PLI+ group), and value became significant in the absence of PLI (0.008 in VI+PLI- group versus 0.106 in VI+PLI+ group). In Kaplan-Meier survival analysis, only the VI+PLI- group ( = 0.006) was significantly associated with worse survival compared with the VI- group. These results suggest that the coexistence of perivascular lymphocytic infiltrates is associated with a better prognosis in cases with vascular invasion.

Risk of abnormal pregnancy completing chemotherapy for gestational trophoblastic tumor

OBJECTIVE

This study analyzed the outcome of the first pregnancy following chemotherapy for gestational trophoblastic tumor (GTT).

METHODS

A total of 387 patients with GTT (85 patients with high-risk GTT and 302 patients with low-risk GTT) underwent chemotherapy at Chiba University Hospital between 1974 and 2000. Of these patients, 130 women (18 with high-risk GTT and 112 with low-risk GTT), who achieved remission and had at least one conception following chemotherapy, were included in the study.

RESULTS

The outcomes of all the first subsequent pregnancies in women treated with methotrexate, actinomycin-D, or etoposide (including those switched to other regimens), or combination therapy, were comparable to those in the Japanese general population. However, the incidence of abnormal pregnancies (spontaneous abortion, still birth, repeat mole) was significantly higher in women who conceived within 6 months of completing chemotherapy (4/15; 40%) than in those who conceived after the recommended waiting period of more than 12 months (10/95; 10.5%) (P = 0.028).

CONCLUSION

Patients with GTT who achieved remission after chemotherapy with methotrexate, actinomycin-D, or etoposide, or combination therapy, may anticipate a normal future reproductive outcome. As pregnancies occurring within 6 months following remission are at risk of abnormalities, a waiting period of at least 6 months after chemotherapy for GTT is suggested.

Impact of maintenance chemotherapy on disease-free survival in patients with stage Ic and II epithelial ovarian cancer

PURPOSE OF INVESTIGATION

To evaluate the impact on disease free survival (DFS) with maintenance chemotherapy following complete surgery and adjuvant chemotherapy in patients with stage Ic and II epithelial ovarian cancer by a retrospective study.

METHODS

One hundred and forty patients with stage Ic and stage II epithelial ovarian cancer were classified into three groups according to the modality of maintenance chemotherapy (no therapy, oral or intravenous administration of anti-cancer drugs). DFS was compared among the three groups, and independent predictive factors for relapse were analyzed.

RESULTS

There were no statistically significant differences in DFS among the three groups for either stage Ic or II cancers, stage Ic and stage II. Multivariate analysis revealed that independent predictive factors for relapse were stage II (p = 0.004) in all patients and less than three cycles of adjuvant chemotherapy in stage II patients (p = 0.015).

CONCLUSION

Maintenance chemotherapy had no impact on DFS in patients with stage Ic or II epithelial ovarian cancer.

Overexpression of the c-fos gene perturbs functional maturation of M1 cells into macrophages

Expression of the proto-oncogene c-fos is induced in normal myelopoiesis. However, functions of c-Fos in the process of differentiation towards macrophages are still controversial. To explore the functions, we used the murine myeloblastic leukemia cell line M1. Stimulation of M1 cells with bacterial LPS promotes their terminal differentiation into functional macrophages. Overexpression of c-fos in M1 cells dramatically increased sensitivity of the cells for LPS-induced differentiation and generation of morphologically differentiated cells. However, the overexpression did not modulate phagocytotic functions, surface expression of macrophage markers such as CD16/CD32 (Fcgamma Receptor) and CD54 (ICAM-1), and expression of lysozyme, esterase and c-fms mRNA. Surprisingly, induction of the MHC class II expression on M1 cells after stimulation was inhibited by the overexpression. Expression of CIITA, as an essential transcription factor for the expression, was also reduced in the M1 cells. These results suggest that overexpression of c-fos in differentiating M1 cells perturbs their functional maturation.

Sebaceous carcinoma of the uterine cervix: a case report

Sebaceous carcinoma is an uncommon neoplasm that usually arises in the head and neck region. A few cases of sebaceous carcinoma of the female genital tract have been reported, most of which arose in the vulva. We report the first case of sebaceous carcinoma of the uterine cervix. A 25-year-old, nulligravida woman presented with genital bleeding; there was a history of systemic lupus erythematosus but not Fordyce's disease. A 3.8-cm exophytic lesion on the cervix was biopsied and staged FIGO stage IB1. A radical hysterectomy was performed. On pathological examination, the tumor replaced the entire cervix and extended into the left parametrium and posterior vaginal fornix. On microscopic examination, the tumor was a sebaceous carcinoma, similar to those described in other sites. Postoperative radiotherapy was administered, but the patient died of tumor 8 months postoperatively.

Criteria for Initiating Chemotherapy in Patients after Evacuation of Hydatidiform Mole

OBJECTIVES

To evaluate the spontaneous regression curve of serum human chorionic gonadotropin (hCG) in patients with an uneventful course after evacuation of hydatidiform mole and to compare the criteria for initiating chemotherapy in patients after evacuation of mole.

METHODS

From 1986 to 2001, 608 patients were followed at our department after evacuation of mole. The spontaneous regression curves of serum hCG in 432 patients with an uneventful course were established.

RESULTS

After evacuation of mole, the titers of serum hCG decreased constantly, and 90% of patients with an uneventful course were within normal range within 16 weeks. In 432 patients with an uneventful course, the upper 95% confidence limit of serum hCG at 5, 8 and 20 weeks was 753.7, 422.9 and 14.8 mIU/ml, respectively. Moreover, 39 (9.0%) and 15 patients (3.5%) with an uneventful course might have been diagnosed with gestational trophoblastic tumor and received needless chemotherapy based on the normal regression curve established by the Japan Society of Obstetrics and Gynecology or the US criteria of 4 consecutive plateauing or rising hCG values, respectively.

CONCLUSIONS

Our more selective criteria for initiating chemotherapy in patients after evacuation of mole, i.e. hCG of 10,000 mIU/ml at 5 weeks, 1,000 mIU/ml at 8 weeks and nondetectable levels at 24 weeks after evacuation of mole, may be safe and acceptable in the management of patients after evacuation of mole.

Changes in the incidence of molar pregnancies. A population-based study in Chiba Prefecture and Japan between 1974 and 2000

BACKGROUND

The aim of this population-based retrospective study was to evaluate the trend in the incidence of molar pregnancy.

METHODS

Questionnaires about the occurrence of hydatidiform mole were mailed to all clinics and hospitals in Chiba Prefecture between 1974 and 2000. The diagnosis of hydatidiform mole was based on the post-operative morphological and/or pathological findings. Data of live births were collected from the annual reports of maternal and child health statistics. A total of 3778 women with hydatidiform mole and 1 661 579 women with live births were analysed.

RESULTS

The incidence of hydatidiform mole per 1000 live births was constant from 1974 to 1990, while it decreased significantly after 1991 (chi(2)-test for trend, P < 0.0001). The incidence of complete mole also decreased after 1991 (chi(2)-test for trend, P = 0.0001), though the incidence of partial mole remained unchanged.

CONCLUSIONS

The incidence of hydatidiform mole in Chiba Prefecture has become as low as that in Europe or the USA, and it is attributed to the decreasing incidence of complete mole. A number of environmental factors that prevent the ovulation of 'empty' oocytes might have contributed to the decreasing incidence of complete mole.

Positive association of maternal G protein beta3 subunit 825T allele with reduced head circumference at birth

G protein beta3 subunit C825T polymorphism, which has previously been studied in association with common disorders in adults such as hypertension and obesity, has been focused upon recently for a possible important role in fetal metabolism. Japanese are characterized by having equal allele frequencies for this polymorphism. In this study, we determined the maternal and infantile genotypes in 342 pairs of normal healthy mothers and their infants, and compared the genotype frequencies with various infantile somatoscopic characteristics converted into SD units according to sex, parity and gestational weeks. We observed an association of the maternal (but not infantile) G protein beta3 subunit 825T allele with reduced head circumference but not with reduced birth weight of the neonate. No association was observed between G protein beta3 subunit C825T polymorphism and various maternal somatoscopic characteristics. Although detailed mechanism of this association requires further research, our results suggest that expression of the beta3 subunit 825T allele in the mother may exert influence on fetal metabolic environment, perhaps through changes in the maternal uterine environment, or on maternal metabolism.

Profile of trace element concentrations in the feto-placental unit in relation to fetal growth

BACKGROUND

During pregnancy, trace elements are indispensable for life maintenance not only for the mother but also for the fetus. The purpose of this study was to examine whether fetal growth is associated with altered levels of trace elements in maternal blood, fetal blood, and placenta tissue.

METHODS

Twenty-one pairs of healthy mothers and their newborns with intrauterine growth restriction delivered after 34 weeks of gestation were recruited for the study. In addition, 30 pairs of healthy mothers and their appropriate for gestational age newborns were included as controls. Maternal venous blood, umbilical cord venous and arterial blood, and placenta tissue were collected immediately after delivery. Six essential elements, magnesium, manganese, iron, copper, zinc, and selenium, and four other elements, rubidium, strontium, cadmium, and cesium, in those samples were determined by inductively coupled plasma mass spectrometry or inductively coupled plasma atomic emission spectrometry.

RESULTS

Compared with appropriate for gestational age cases, intrauterine growth restriction cases showed higher magnesium, copper, and selenium concentrations in umbilical cord arterial sera, and higher magnesium and selenium concentrations in placenta tissue, but no significant differences appeared for the elements measured in maternal and umbilical cord venous sera. The umbilical cord venous vs. maternal sera concentration ratio was elevated for copper, and the umbilical cord arterial vs. umbilical cord venous sera concentration ratios were elevated for copper and zinc, but there were no differences in placenta tissue vs. maternal sera concentration ratios in intrauterine growth restriction cases.

CONCLUSIONS

Among the trace elements evaluated, magnesium, copper, zinc, and selenium showed elevated concentrations in umbilical cord arterial blood, or elevated umbilical cord arterial vs. umbilical cord venous blood concentration ratios in intrauterine growth restriction cases. Reduced consumption efficiency of these four essential trace elements may be closely associated with retarded fetal development.

HPV 16-E6-mediated degradation of intrinsic p53 is compensated by upregulation of p53 gene expression in normal cervical keratinocytes

In this study we investigated the relationship between the development of either HSILs (high-grade squamous intraepithelial lesions) or invasive cancers of the uterine cervix and the p53 codon 72 polymorphisms consisting of arginine (Arg)- or proline (Pro)-encoded allele in Japanese populations. Furthermore, we determined if intrinsic p53 is affected by the p53-degradation activities of human papillomavirus type 16 (HPV 16)-E6 in normal cervical keratinocytes with each p53 codon 72 genotype. Using PCR with p53 codon 72 polymorphic allele-specific primers, p53 genotypes of 112 normal cervical specimens and 88 cervical lesions including 44 HSILs and 44 invasive cancers were determined. The expression levels of p53 proteins and mRNAs in keratinocytes following the expression of HPV 16-E6 from an HPV 16-E6-expressing recombinant adenovirus were analyzed. The frequencies of p53 genotypes, Pro/Pro, Arg/Pro and Arg/Arg were, respectively, 12, 49 and 39% in controls; and 18, 55 and 27% in HSILs; and 11, 41 and 48% in invasive cancers. The expression levels of the p53 proteins in normal human keratinocytes of each p53 codon 72 genotype were not affected by the introduction of HPV 16-E6, whereas the p53 mRNAs were found to be upregulated regardless of the p53 genotypes when HPV 16-E6 was expressed. In statistical analysis, no relationships between p53 genotypes and the development of cervical neoplasias were found. Furthermore, we demonstrated that p53 protein expression levels in normal cervical keratinocytes is not affected by the p53-degradation activities of HPV E6, probably due to a tight transcriptional regulation of p53.

Salvage combination chemotherapy with 5-fluorouracil and actinomycin D for patients with refractory, high-risk gestational trophoblastic tumors

BACKGROUND

The objective of this study was to evaluate the efficacy and toxicity of a high-dose 5-fluorouracil and actinomycin D regimen (the FA regimen) as salvage chemotherapy for patients with high-risk gestational trophoblastic tumors (GTTs).

METHODS

From 1985 to 1997, 10 patients with refractory, high-risk GTTs were treated with the FA regimen at Chiba University Hospital. Of those 10 patients, 7 patients developed drug resistance to methotrexate, etoposide, and actinomycin D combination chemotherapy (the MEA regimen); 1 patient developed recurrent disease after receiving the MEA regimen; and 2 patients developed recurrent disease after receiving combination chemotherapy with etoposide, methotrexate, and actinomycin D alternating with cyclophosphamide and vincristine (the EMA/CO regimen). The hematologic toxicity of the FA regimen was graded at every chemotherapy course.

RESULTS

With the FA regimen, the survival rate was 80.0% (8 of 10 patients) for a mean follow-up of 10 years. Two patients died due to multidrug resistance, and two patients subsequently developed recurrent disease. The two patients with recurrent disease were successfully salvaged again with the MEA regimen. The toxicity of the FA regimen was evaluated in 78 cycles. Myelosuppression seemed to be the dose-limiting toxicity, and the incidences of World Health Organization Grade 4 leukocytopenia and thrombocytopenia were 6.4% and 3.8%, respectively, of 78 cycles.

CONCLUSIONS

Although etoposide-containing chemotherapy is currently the most effective and well-tolerated regimen for patients with high-risk GTTs, 20-30% of patients develop resistance to etoposide-containing regimens. Salvage combination chemotherapy with FA is effective for these patients with refractory disease, and the toxicity is predictable and manageable.

Application of lung volume measurement by three-dimensional ultrasonography for clinical assessment of fetal lung development

OBJECTIVE

To prepare nomograms for normal fetal lung volume using three-dimensional ultrasonography and to evaluate the possibility of clinical applications of this procedure.

METHODS

One hundred twenty-five healthy neonates with birth weights within +/-1.5 SD (group A), 9 neonates with intrauterine growth restriction (birth weight less than -1.5 SD) but no severe respiratory disturbance at birth (group B), and 10 neonates with severe respiratory disturbance but no intrauterine growth restriction (group C) were studied. With the use of a three-dimensional ultrasonographic device, continuous B-mode images centering on the fetal thorax were acquired as volume data. Analytical software was used to repeatedly trace the contours of bilateral fetal lungs on transverse slices to calculate the lung volume.

RESULTS

In group A, the total volume of normal fetal lungs can be expressed by the second-degree regression equation: 0.08 x (gestational week - 30.1)2 + 3.28 x gestational week - 67.2 (R = 0.909; P < .001). The lung volumes of groups B and C were below the 25th and 2.5th percentiles, respectively, of this regression curve. For the same case, the lung volume increased with gestational week in group B but remained unchanged or even decreased in group C. The total volume of normal fetal lungs can also be expressed by the linear regression equation: 0.02 x estimated fetal weight + 0.29 (R = 0.902). The lung volumes of groups B and C were distributed below and above, respectively, the 2.5th percentile of the regression line.

CONCLUSIONS

This analytical method may be applied to evaluate lung development.