Blockade of glucagon increases muscle mass and alters fiber type composition in mice deficient in proglucagon-derived peptides

AIMS/INTRODUCTION

Glucagon is secreted from pancreatic α-cells and plays an important role in amino acid metabolism in liver. Various animal models deficient in glucagon action show hyper-amino acidemia and α-cell hyperplasia, indicating that glucagon contributes to feedback regulation between the liver and the α-cells. In addition, both insulin and various amino acids, including branched-chain amino acids and alanine, participate in protein synthesis in skeletal muscle. However, the effect of hyperaminoacidemia on skeletal muscle has not been investigated. In the present study, we examined the effect of blockade of glucagon action on skeletal muscle using mice deficient in proglucagon-derived peptides (GCGKO mice).

MATERIALS AND METHODS

Muscles isolated from GCGKO and control mice were analyzed for their morphology, gene expression and metabolites.

RESULTS

GCGKO mice showed muscle fiber hypertrophy, and a decreased ratio of type IIA and an increased ratio of type IIB fibers in the tibialis anterior. The expression levels of myosin heavy chain (Myh) 7, 2, 1 and myoglobin messenger ribonucleic acid were significantly lower in GCGKO mice than those in control mice in the tibialis anterior. GCGKO mice showed a significantly higher concentration of arginine, asparagine, serine and threonine in the quadriceps femoris muscles, and also alanine, aspartic acid, cysteine, glutamine, glycine and lysine, as well as four amino acids in gastrocnemius muscles.

CONCLUSIONS

These results show that hyperaminoacidemia induced by blockade of glucagon action in mice increases skeletal muscle weight and stimulates slow-to-fast transition in type II fibers of skeletal muscle, mimicking the phenotype of a high-protein diet.

Pancreas transplantation improves the quality of life of Japanese type 1 diabetes patients with diabetic kidney disease

OBJECTIVES

Type 1 diabetes mellitus (T1DM) patients with diabetic kidney disease-induced kidney failure have a significantly impaired quality of life (QOL), resulting in a high level of physical, mental, and social anxiety. In this study, we evaluated the QOL of T1DM patients on the list for pancreas transplantation (PTx) at their registration, and determined whether PTx improved their QOL.

METHODS

There were 58 patients (men/women, 22/36; mean age, 42.8±8.0 years) with T1DM and who were registered on the waiting list for PTx. Quantitative QOL assessment was performed using the Medical Health Survey Short Form (SF-36) version 2. Changes in the QOL before and after PTx were also examined in 24 of these patients.

RESULTS

The mean value of each endpoint and the summary score of the SF-36 physical (PCS), mental (MCS), and role (RCS) components were all below the national normal level at PTx registration. No significant difference in QOL scores was observed in the intergroup comparison of 35 patients on dialysis, 13 patients without dialysis, and ten patients after kidney transplantation. The 24 patients who underwent PTx showed improvement in PCS, MCS, and most SF-36 scores.

CONCLUSION

T1DM patients waiting for PTx had a decreased QOL, regardless of dialysis, and PTx improved their QOL.

Terminal differentiation of keratinocytes was damaged in type 2 diabetic mice

AIMS

Although skin manifestations are common in diabetic patients, its characteristics are poorly identified. This study explored the differentiation process of keratinocytes in type 2 diabetes mellitus (T2DM) in vivo.

METHODS

Back skin of T2DM model KKAy/TaJcl mice (KKAy) and C57BL/6JJcl mice (control) aged 8 and 12 weeks was used. The mRNA expression of differentiation markers of keratinocytes was measured by quantitative real-time polymerase chain reaction (qRT-PCR). The expression of each marker in situ was examined immunohistochemically.

RESULTS

KKAy mice showed hyperglycemia versus control mice. The histological findings showed increased thickness and structural impairment of epidermal tissue in KKAy mice. The qRT-PCR revealed that the expression of integrin beta 1 and keratin 14 in KKAy and control mice was identical. However, the expression of involucrin at 8 weeks, keratin 10 at 12 weeks, and filaggrin and loricrin at 8 and 12 weeks was decreased in KKAy mice. Immunohistochemical findings showed that filaggrin was markedly decreased in KKAy mice, though Ki-67 remained unchanged.

CONCLUSION

The terminal differentiation process was impaired in the diabetic skin, while keratinocyte proliferation was preserved. Damaged terminal differentiation of keratinocytes may contribute to impairment of the skin barrier function in diabetic dermatoses.

Identifying patients with atrial fibrillation during sinus rhythm on ECG: confirming the utility of artificial intelligence algorithm in a small-scale cohort without structural heart diseases

Background

Detection of atrial fibrillation (AF) out of electrocardiograph (ECG) on sinus rhythm (SR) using artificial intelligence (AI) algorithm has been widely studied within recent couple of years. Generally, it is believed that a huge number of ECGs are necessary for developing an AI-enabled ECG to be adequate to correspond to a lot of minor variations of ECGs. For example, structural heart diseases have typical ECG characteristics, but they could be a noise for the purpose of detecting the small signs of electrocardiographic signature of AF. We hypothesized that when patients with structural heart diseases are excluded, AI-enabled ECG for identifying patients with AF can be developed with a small number of ECGs.

Methods

We developed an AI-enabled ECG using a convolutional neural network to detect the electrocardiographic signature of AF present during normal sinus rhythm (NSR) using a digital, standard 10-second, 12-lead ECGs. We included all patients who newly visited the Cardiovascular Institute with at least one NSR ECG between Feb 1, 2010, and March 31, 2018. We classified patients with at least one ECG with a rhythm of AF as positive for AF (AF label) and others as negative for AF (SR label). We allocated ECGs to the training, internal validation, and testing datasets in a 7:1:2 ratio. We calculated the area under the curve (AUC) of the receiver operating characteristic curve for the internal validation dataset to select a probability threshold, which we applied to the testing dataset. We evaluated model performance on the testing dataset by calculating the AUC and the sensitivity, specificity, F1 score, and accuracy with two-sided 95% confidence intervals (CIs).

Results

We totally included 19170 patients with 12-lead ECG. After excluding patients with structural heart diseases, 12825 patients with NSR ECGs at the initial visit were identified (1262 were clinically diagnosed as AF anytime during the time course and 11563 were never diagnosed as AF). Of 11563 non-AF patients, 1818 patients who were followed over 1095 days were selected for the analysis with the SR label, to secure the robustness for maintaining SR. Of 1262 AF patients, 251 patients were selected for the analysis with the AF label, of whom a NSR ECG within 31 days before or after the index AF ECG (the first AF ECG during the time course) could be obtained. In the patients with AF label, the NSR ECG of which the date was the nearest to the index AF ECG was selected for the analysis. The AI-enabled ECG showed an AUC of 0.88 (0.84–0.92) with sensitivity 81% (72–88), specificity 80% (77–83), F1 score 50% (43–57), and overall accuracy 80% (78–83).

Conclusion

An AI-enabled ECG acquired during NSR allowed identification of patients with AF in a small population without structural heart diseases.

Funding Acknowledgement

Type of funding sources: None.

Vasopressin escape and memory impairment in a model of chronic syndrome of inappropriate secretion of antidiuretic hormone in mice

Recently, chronic hyponatremia, even mild, has shown to be associated with poor quality of life and high mortality. The mechanism by which hyponatremia contributes to those symptoms, however, remains to be elucidated. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a primary cause of hyponatremia. Appropriate animal models are crucial for investigating the pathophysiology of SIADH. A rat model of SIADH has been generally used and mouse models have been rarely used. In this study, we developed a mouse model of chronic SIADH in which stable and sustained hyponatremia occurred after 3-week continuous infusion of the vasopressin V2 receptor agonist 1-desamino-8-D-arginine vasopressin (dDAVP) and liquid diet feeding to produce chronic water loading. Weight gain in chronic SIADH mice at week 2 and 3 after starting dDAVP injection was similar to that of control mice, suggesting that the animals adapted to chronic hyponatremia and grew up normally. AQP2 expression in the kidney, which reflects the renal action of vasopressin, was decreased in dDAVP-infused water-loaded mice as compared with control mice that received the same dDAVP infusion but were fed pelleted chow. These results suggest that "vasopressin escape" occurred, which is an important process for limiting potentially fatal severe hyponatremia. Behavioral analyses using the contextual and cued fear conditioning test and T-maze test demonstrated cognitive impairment, especially working memory impairment, in chronic SIADH mice, which was partially restored after correcting hyponatremia. Our results suggest that vasopressin escape occurred in chronic SIADH mice and that chronic hyponatremia contributed to their memory impairment.

Low-carbohydrate diet by staple change attenuates postprandial GIP and CPR levels in type 2 diabetes patients

AIMS

The aim of this study is to investigate the effects of a low-carbohydrate staple food (i.e., low-carbohydrate bread) on glucose and lipid metabolism and pancreatic and enteroendocrine hormone secretion in comparison with meals containing normal-carbohydrate bread, without consideration of the carbohydrate content of the side dishes.

METHODS

T2DM patients (n = 41) were provided meals containing low-carbohydrate bread (LB) together with side dishes or normal-carbohydrate bread (NB) together with side dishes every other day as a breakfast. Blood glucose levels were evaluated by using a continuous glucose monitoring system; blood samples were collected before and 1 and 2 h after the breakfast.

RESULTS

Postprandial blood glucose levels, plasma insulin, plasma glucose-dependent insulinotropic polypeptide (GIP) and plasma triglyceride were significantly lower and plasma glucagon levels were significantly higher in LB compared with those in NB. Plasma glucagon-like peptide-1 (GLP-1) levels did not differ in the LB and NB groups.

CONCLUSIONS

These results indicate that changing only the carbohydrate content of the staple food has benefits on glucose and lipid metabolism in T2DM patients concomitant with the decrease of insulin and GIP secretion, which ameliorate body weight gain and insulin resistance.

Short-Term High-Starch, Low-Protein Diet Induces Reversible Increase in β-cell Mass Independent of Body Weight Gain in Mice

Long-term exposure to a high starch, low-protein diet (HSTD) induces body weight gain and hyperinsulinemia concomitantly with an increase in β-cell mass (BCM) and pancreatic islets number in mice; however, the effect of short-term exposure to HSTD on BCM and islet number has not been elucidated. In the present study, we investigated changes in body weight, plasma insulin levels, BCM and islet number in mice fed HSTD for 5 weeks followed by normal chow (NC) for 2 weeks. BCM and islet number were increased in mice fed HSTD for 5 weeks compared with those in mice fed NC. On the other hand, mice fed HSTD for 5 weeks followed by NC for 2 weeks (SN) showed decreased BCM and insulin levels, compared to mice fed HSTD for 7 weeks, and no significant differences in these parameters were observed between SN and the control NC at 7 weeks. No significant difference in body weight was observed among HSTD, NC and SN fed groups. These results suggest that a high-starch diet induces an increase in BCM in a manner independent of body weight gain, and that 2 weeks of NC feeding is sufficient for the reversal of the morphological changes induced in islets by HSTD feeding.

Risedronate Attenuates Podocyte Injury in Phosphate Transporter-Overexpressing Rats

Osteoporosis patients with chronic kidney disease (CKD) are becoming common in our superaging society. Renal dysfunction causes phosphorus accumulation in the circulating plasma and leads to the development of CKD-mineral bone disorder (MBD). We have previously reported that type III Pi transporter-overexpressing transgenic (Pit-1 TG) rats manifest phosphate (Pi)-dependent podocyte injury. In the present study, we explored the effect of risedronate on Pi-induced podocyte injury in vivo. Pit-1 TG rats and wild-type rats at 5 weeks old were divided into a risedronate-treated group and an untreated group. We subcutaneously administered 5 μg/kg body weight of risedronate or saline twice a week during the experimental period. Risedronate did not alter serum creatinine levels at 5, 8, and 12 weeks of age. However, electron microscopy images showed that thickening of the glomerular basement membrane was improved in the risedronate treatment group. Furthermore, immunostaining for podocyte injury markers revealed that both desmin- and connexin43-positive areas were smaller in the risedronate-treated group than in the untreated group, suggesting that bisphosphonates could rescue Pi-induced podocyte injury. In conclusion, our findings suggest that risedronate could maintain glomerular barrier function by rescuing Pi-induced podocyte injury.

Changes in Serum Immunoglobulin G4 Levels in Patients with Newly Diagnosed Graves' Disease

OBJECTIVE

Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated condition that can affect almost any organ. We investigated the association between IgG4-RD and the main characteristics of Graves' disease (GD) at the time of diagnosis. Additionally, we evaluated whether serum IgG4 levels change during treatment.

DESIGN AND PATIENTS

Twenty-eight patients with newly diagnosed GD were enrolled into this longitudinal follow-up study. Serum IgG4 levels and thyroid function were measured in all the participants at the time of diagnosis. Further, the serum IgG4 levels of nine of 28 patients with untreated GD were measured after the achievement of euthyroid state (through the use of methimazole).

RESULTS

Two (7.1%) of 28 patients with untreated GD had elevated serum IgG4 levels of >135 mg/dL. There was no significant difference in the average IgG4 levels before and after the achievement of euthyroid state (66.2±74.0 mg/dL vs. 50.5±47.3 mg/dL). In two patients, the elevated serum IgG4 levels returned to normal after treatment. However, one patient had an elevated serum IgG4 level of 136.6 mg/dL after treatment.

CONCLUSIONS

This study showed that serum IgG4 levels varied with treatment in patients with GD, independent of thyroid function, suggesting that IgG4 might be indirectly related to GD.

Aripiprazole increases NADPH level in PC12 cells: the role of NADPH oxidase

In aripiprazole-treated PC12 cells, we previously showed that the mitochondrial membrane potential (Δψm) was rather increased in spite of lowered cytochrome c oxidase activity. To address these inconsistent results, we focused the NADPH generation by glucose-6-phosphate dehydrogenase (G6PD), a rate-limiting enzyme of the pentose phosphate pathway (PPP), to titrate reactive oxygen species (ROS) that results in the Δψm maintenance. G6PD may be also involved in another inconsistent result of lowered intracellular lactate level in aripiprazole-treated PC12 cells, because PPP competes glucose-6-phosphate with the glycolytic pathway, resulting in the downregulation of glycolysis. Therefore, we assayed intracellular amounts of NADPH, ROS, and the activities of the enzymes generating or consuming NADPH (G6PD, NADP(+)-dependent isocitrate dehydrogenase, NADP(+)-dependent malic enzyme, glutathione reductase, and NADPH oxidase [NOX]) and estimated glycolysis in 50 μM aripiprazole-, clozapine-, and haloperidol-treated PC12 cells. NADPH levels were enhanced only in aripiprazole-treated ones. Only haloperidol increased ROS. However, the enzyme activities did not show significant changes toward enhancing NADPH level except for the aripiprazole-induced decrease in NOX activity. Thus, the lowered NOX activity could have contributed to the aripiprazole-induced increase in the NADPH level by lowering ROS generation, resulting in maintained Δψm. Although the aforementioned assumption was invalid, the ratio of fructose-1,6-bisphosphate to fructose-6-phosphate was decreased by all antipsychotics examined. Pyruvate kinase activity was enhanced only by aripiprazole. In summary, these observations indicate that aripiprazole possibly possesses the pharmacological superiority to clozapine and haloperidol in the ROS generation and the adjustment of glycolytic pathway.

Ovarian cancer presenting as a metastasis to a trocar tract used for a gasless lift-laparoscopy to resect a benign ovarian cyst: an unusual case report

BACKGROUND

Metastasis to a trocar tract (port-site metastasis, PSM) is an uncommon but serious complication that possibly compromises the prognosis of cancer patients treated laparoscopically.

CASE

A 42-year-old Japanese woman had a 20-cm benign right ovarian cyst resected using gasless lift-laparoscopy. Five years and eight months postoperatively, she noticed a three-cm subcutaneous tumor involving the trocar tract. She was also found to have a pelvic mass and an exploratory laparotomy revealed left ovarian cancer. Based on the histopathological findings, the subcutaneous tumor was diagnosed as a metastasis from the ovarian cancer.

CONCLUSIONS

This case suggested that PSM could occur without direct or indirect wound contamination during laparoscopic surgery.

Antitumor effect of the angiogenesis inhibitor agm-1470 and its combination effect with tamoxifen in dmba induced mammary-tumors in rats

AGM-1470 is known to inhibit angiogenesis. It inhibited the mitogen induced cell growth in microvascular endothelial cells in vitro. Ten ng/ml AGM-1470 completely inhibited both basic fibroblast growth factor induced cell growth, and interleukin-4 induced cell growth. In an in vivo study, we invesigated the antitumor effect of AGM-1470 in dimethylbenz[a]anthracene (DMBA) induced rat mammary tumors. A dose dependent growth inhibition was seen between administered doses 10 mg/kg and 40 mg/kg. Forty mg/kg 2-week administration of AGM-1470 totally suppressed the tumor growth. In addition, an additive inhibitory effect of AGM-1470 with an antiestrogen tamoxifen was found (p<0.01). It is suggested that the combination of these two drugs might be effective for the treatment of breast cancer.

MO-F-213AB-04: Biological Effect of Dose Shadowing by Fiducial Markers in Spot Scanning Proton Therapy with a Limited Number of Fields

PURPOSE

In spot scanning proton therapy, accurate patient positioning before and during treatment is essential. A small gold ball marker is suitable as a fiducial for prostate treatment. However, it has been pointed out that the marker causes dose shadowing because the protons are scattered with their energy quickly diminished. In this research we explore the possibility that the biological effect of dose shadowing can be mitigated with a limited number of fields.

METHODS

The proton dose distribution in prostate was simulated using Geant4. The simulations include the Hokkaido University spot scanning nozzle and a water phantom positioned isocentrically. The PTV was delineated at the center of the phantom and a gold ball of 2 mm in diameter was placed at the middle of the PTV. The plan was created by single-field optimization and each of the following beam arrangements was investigated; (1) single lateral field (2) two lateral fields (3) two lateral + one anterior fields (4) four-field box. The dose prescription was D95 = 74 GyE (37 fr). The minimum dose and tumor control probability (TCP) were compared for the four beam arrangements.

RESULTS

For (1)-(4), the minimum dose values were 55%, 77%, 78%, and 84% of the prescribed dose, respectively. The reduction of the TCP values from those in the absence of the gold marker were 50%, 2%, 1.1%, and 0.7%, using the TCP model by Wang et al. (Int.J.Radiat.Oncol.Biol.Phys. 55, 2003) and 2%, 0.7%, 0.5%, and 0.4%, using the biological parameters in Levegrün et al. (Int.J.RadiatOncol.Biol.Phys. 51, 2001), respectively.

CONCLUSIONS

Although dose shadowing by the gold marker is locally non-negligible, the size of the affected domain is tiny. It was found that with a minimum number of fields, the TCP nearly recovers to the value without the gold marker.

Effects of aripiprazole and clozapine on the treatment of glycolytic carbon in PC12 cells

Aripiprazole is the only atypical antipsychotic drug known to cause the phosphorylation of AMP-activated protein kinase (AMPK) in PC12 cells. However, the molecular mechanisms underlying this phosphorylation in aripiprazole-treated PC12 cells have not yet been clarified. Here, using PC12 cells, we show that these cells incubated for 24 h with aripiprazole at 50 μM and 25 mM glucose underwent a decrease in their NAD⁺/NADH ratio. Aripiprazole suppressed cytochrome c oxidase (COX) activity but enhanced the activities of pyruvate dehydrogenase (PDH), citrate synthase and Complex I. The changes in enzyme activities coincided well with those in NADH, NAD⁺, and NAD⁺/NADH ratio. However, the bioenergetic peril judged by the lowered COX activity might not be accompanied by excessive occurrence of apoptotic cell death in aripiprazole-treated cells, because the mitochondrial membrane potential was not decreased, but rather increased. On the other hand, when PC12 cells were incubated for 24 h with clozapine at 50 μM and 25 mM glucose, the NAD⁺/NADH ratio did not change. Also, the COX activity was decreased; and the PDH activity was enhanced. These results suggest that aripiprazole-treated PC12 cells responded to the bioenergetic peril more effectively than the clozapine-treated ones to return the ATP biosynthesis back toward its ordinary level. This finding might be related to the fact that aripiprazole alone causes phosphorylation of AMPK in PC12 cells.

Metastatic gastric cancer mimicking an advanced cervical cancer: a case report

BACKGROUND

Metastasis to the uterine cervix from non-gynecologic neoplasms is rare. However, metastatic tumors sometimes precede the diagnosis of a primary tumor, and may lead to diagnosis of the primary tumor.

CASE

A 50-year-old woman was referred to us complaining of increasing right flank pain. Computed tomography scan demonstrated an enlarged uterus with right-sided hydronephrosis and hydroureter. Cervical cytology revealed adenocarcinoma. She was considered to have a Stage IIIB cervical adenocarcinoma. Although no cervical lesion was seen colposcopically, histopathology from biopsies of the uterine cervix revealed poorly differentiated adenocarcinoma infiltrating around the normal endocervical glands. A metastasis from the gastrointestinal tract was suspected. The patient underwent gastroscopy and was found to have Borrmann type IV gastric cancer. Biopsies confirmed a poorly differentiated adenocarcinoma with signet ring cells.

CONCLUSION

Physicians should bear in mind that metastatic tumors may precede the diagnosis of a primary tumor and could manifest by mimicking advanced cervical cancer.

Growing teratoma syndrome of the ovary after fertility-sparing surgery and successful pregnancy

BACKGROUND

Growing teratoma syndrome (GTS) is rare and is defined as an enlarging mature teratoma that arises during or after chemotherapy for a malignant germ cell tumor, with normalization of previously elevated serum tumor markers.

CASE

A 30-year-old nulliparous Japanese woman was diagnosed as having a stage IIIa immature teratoma. After fertility-sparing surgery, she received 4 cycles of chemotherapy consisting of cisplatin, etoposide and bleomycin. Thereafter, she successfully gave birth twice. Eight years after the initial surgery, a mass mimicking an adrenal tumor was resected laparoscopically. Surgical specimens revealed a mature teratoma, and she was diagnosed as having GTS postoperatively.

CONCLUSION

Clinicians should consider that GTS may present late, even after pregnancy. Therefore, long-term follow-up of patients treated for ovarian immature teratoma should be mandatory.

Ectopic pregnancy following emergency contraception with ethinyloestradiol-levonorgestrel: a case report

BACKGROUND

Emergency contraception with ethinyloestradiol-levonorgestrel is effective, and ectopic pregnancy following its failure is rare.

CASE

A 21-year-old nulligravid Japanese woman with regular menstrual periods took ethinyloestradiol-levonorgestrel pills for emergency contraception (EC) 36 and 48 hours after a coitus complicated by retention of the condom in the vagina. She started bleeding vaginally 24 days after that intercourse. As the bleeding continued for three weeks she consulted a gynaecologist. The pregnancy test was positive. Two weeks later she complained of lower abdominal pain, and transvaginal ultrasonography suggested a pelvic blood collection. At emergency surgery, she was found to have a left tubal pregnancy.

CONCLUSION

Although ectopic pregnancy after failure of EC is rare, one should be alert to its possible occurrence.

[Video-assisted thoracoscopic lobectomy for lung cancer patients with severe incomplete fissures or emphysema; intralobar no-touch access technique (INTACT)]

OBJECTIVES

Severe air leak after lobectomy is one of well-known complications in lung cancer patients with severe emphysema or incomplete fissure. A developing air leak or persistent air leak in those patients may occur postoperative pneumonia or empyema.

MATERIALS AND METHODS

For those patients, we have operated with intralobar no-touch access technique (INTACT) assisted with thoracoscopy. INTACT is a surgical procedure of lobectomy without interlobar access, a procedure of prior dissection of lobar bronchus and stapling all the fissure. From January 2004 to December 2005, we performed surgery in 227 patients with primary lung cancer, and 12 patients were performed with lobectmy with INTACT among them. Mean age was 68 +/- 7 years.

RESULTS

Distribution of lobectomies was as follows: right upper lobe, 7 patients; right upper lobe and S6 segment, 1; right middle lobe and right lower lobe, 1; left upper lobe, 2; left lower lobe, 1. The length of major skin incision was 5-15 (average 9.2 +/- 3.0) cm. Pathological stage were IA in 3 patients, IB in 7, IIIA in 1 and IIIB in 1. The backgrounds of those patients were severely emphysema in 7 patients, incomplete fissure in 2, both emphysema and incomplete fissure in 2 and emphysema and huge sized tumor in 1. The postoperative air leak stopped 1.8 +/- 0.8 days.

CONCLUSIONS

For carefully selected patients video-assisted thoracoscopic lobectomy by INTACT for lung cancer patients with emphysema or incomplete fissure could be a safe and valuable procedure.

Positron Emission Tomography in Relation to Noguchi’s Classification for Diagnosis of Peripheral Non-Small-Cell Lung Cancer 2 cm or Less in Size

BACKGROUND

F-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) scanning has become a critically important tool in diagnosis and management of non-small-cell lung cancer. However, the effectiveness of (18)F-FDG-PET as a diagnostic tool for small-sized lung cancer is controversial. The purpose of this study was to examine the accuracy of( 18)F-FDG-PET in relation to Noguchi's classification in the diagnosis of small peripheral non-small-cell lung cancer.

METHODS

Between January 2003 and April 2006, 150 patients with peripheral lung lesions who were undergoing chest computed tomography (CT),( 18)F-FDG-PET, and operation were analyzed.

RESULTS

Eighty-three patients had malignant lesions, and 67 patients had benign lesions. PET had a sensitivity, specificity, positive predictive value, and negative predictive value of 75.9%, 64.1%, 72.4%, and 68.3%, respectively. In 37 patients with peripheral lung cancer measuring 2.0 cm or less in the greatest diameter, the sensitivity was 51.4% and the specificity was 51.9%. Among them, all 4 cases of Noguchi type A adenocarcinoma [localized bronchioloalveolar carcinoma (LBAC)], 4 of 5 type B and 8 of 17 type C were false negative, while 9 of 11 (81.8%) types D, E, and F (invasive carcinomas without a BAC component) were true positive.

CONCLUSION

The accuracy of( 18)F-FDG-PET is generally low in distinguishing malignancy from benign lesions in small lesions (<2.0-cm diameter). The significance of PET as a diagnostic tool is small, especially when the tumor has a ground-glass component at a high rate. The sensitivity of PET is high in small invasive carcinomas without a BAC component, but it is difficult to distinguish carcinoma from benign tumor from its image.

Novel catalytic oxidative coupling reaction of N,N-dimethyl-p-phenylenediamine with 1,3-phenylenediamine and its applications to the determination of copper and iron at trace levels by flow injection technique

A new catalytic oxidative coupling reaction of N,N-dimethyl-p-phenylenediamine (DPD) with 1,3-phenylenediamine (mPD) in the presence of hydrogen peroxide has been developed for trace metals analysis. The rate of the oxidation/coupling reaction can be enhanced significantly by iron, copper and cobalt. These metal ions can catalyze the oxidation reaction of DPD to form an oxidized product; the oxidized DPD was then coupled with mPD to give a blue-colored product which was measured spectrophotometrically at 650 nm. On the basis of such a reaction scheme, two simple flow injection analysis methods for the determination of copper and iron have been developed. Detailed studies on chemical and FIA variables affecting the sensitivity of the detection were carried out. Interferences from several ionic species were examined for the determination of copper: the interference effect by Fe(III) and Fe(II) up to 1.5 mg L(-1) was successfully suppressed by pretreating sample with ammonium acetate buffer solution (pH 8.4). Good linearity of a standard calibration graph was obtained over the ranges of 0-8 and 0-2 microg L(-1) of copper and iron, respectively, and the detection limits were 0.05 and 0.02 microg L(-1) for copper and iron, respectively. The precision of the methods in terms of relative standard deviation were 1.4 and 1.5% of R.S.D. which were obtained from 10 injections of 2.0 and 1.0 microg L(-1) of standard copper and iron, respectively. The proposed methods were successfully applied to the determination of copper and iron in tap and river water samples. The accuracy of the proposed methods was assessed by the analysis of certified reference material of river water.

Development of an apparatus for monitoring protoplast isolation from plant tissues based on both dielectric and optical methods

In order to develop a method allowing objective determination of the optimal conditions for the isolation of protoplasts, the process of protoplast isolation from plant tissues was quantitatively evaluated. First, a specialized spectrophotometer cuvette (working volume = 2.0 ml) was designed for the continuous monitoring of protoplast isolation from plant tissues based on the optical method. Homogeneous mixing of tissue sections and the protoplast suspension in the cuvette was accomplished by means of a magnetic bar. The cuvette was divided into upper and lower parts by a nylon mesh. Since tissue sections in the upper part could not pass through the mesh, they did not affect the optical path in the lower part, and only isolated protoplasts were able to move freely between the two parts. At the optimal agitation speed (200 rpm), mechanical damage to protoplasts of Catharanthus roseus did not occur. Increases in the protoplast concentration during their isolation from tissue sections (leaf and petal) could be continuously monitored by measuring the optical density (O.D.), making it possible to estimate the end of protoplast isolation. Degassing treatment of the tissues markedly enhanced protoplast isolation. In order to monitor the viable protoplast concentration, a larger specialized spectrophotometer cuvette (working volume = 25 ml) was developed which enabled simultaneous measurement of the permittivity and O.D. of the suspension to be carried out during protoplast isolation. Permittivity is a measure of the viable protoplast concentration, while the O.D. shows protoplast characteristics such as color. Using this large cuvette, the time courses of protoplast isolation from leaf and petal sections were monitored and large amounts of viable protoplasts were obtained. The protoplast isolation process after degassing treatment was described by a simple first-order reaction model and the viable protoplast isolation rate was quantitatively evaluated from the rate constant (k) on the basis of permittivity changes.

A mathematical analysis of the interactions between immunogenic tumor cells and cytotoxic T lymphocytes

Recent developments of biotechnology have enabled us to use immunotherapy against certain kinds of tumors in patients. However, it is reasonable to doubt if the immunotherapy can completely aid the rejection of tumors that have escaped from the immune system. In this paper, we propose a new mathematical model of tumor immunity by tumor-specific cytotoxic T lymphocytes (CTLs), since tumor-specific CTLs play an important role in tumor immunity. Using this model, we have mathematically investigated the interactions between immunogenic tumor cells (TCs) and tumor-specific CTLs and evaluated the availability of immunotherapies for tumors. The findings herein demonstrate that three kinds of dynamics of tumor immunity exist: i.e. (1) TCs continue to proliferate with CTLs; (2) TCs are rejected by CTLs; and (3) TCs equilibrate with CTLs, but with little possibility of the equilibrium. The findings also demonstrate that a sufficient increase in CTLs by immunotherapy can aid the rejection of TCs, but an insufficient increase in CTLs by immunotherapy causes only a transient regression of TCs. Clinically the findings mean that increasing tumor-specific CTLs, e.g., by vaccination or adoptive transfer of tumor-specific CTLs expanded ex vivo, can theoretically aid the rejection of TCs.

Complex formation analysis of water-soluble calixarenes by capillary zone electrophoresis

The equilibria of complex formation reactions between various kinds of cations and anionic calixarenes in an aqueous solution were analyzed by capillary zone electrophoresis on the basis of the change in electrophoretic mobility of the calixarenes. The apparent electrophoretic mobility of the calixarenes decreased with increasing concentrations of alkali metal ions and quaternary ammonium ions. Equilibrium constants were determined by a non-liner least-squares analysis using the changes in apparent electrophoretic mobility. The complex formation constants obtained with alkali metal ions were in the order of 10(2.3) - 10(3.0), and those with quaternary ammonium ions were 10(2.9) - 10(4.2), providing less selectivity among them. The selectivity of the calixarene toward alkali metal and quaternary ammonium ions in aqueous solution involves flexible structure, and compensative interactions of electrostatic and hydrophobic interactions. From the results obtained in this work, the electrophoretic method has proved to be useful for analyzing the reactivity of anionic calixarene in aqueous solution.

Separation and determination of n-alkylamines and histamine by capillary zone electrophoresis using salicylaldehyde-5-sulfonate as a derivatizing reagent

Sodium salicylaldehyde-5-sulfonate (SAS) was investigated as a derivatizing reagent for the separation and determination of primary amines by capillary zone electrophoresis (CZE). The amines were derivatized with SAS to the corresponding Schiff bases before their determination. Optimal conditions for the formation reactions of the Schiff bases and the CZE analysis were investigated in details. The Schiff bases were formed almost completely within 9 min in 40%(v/v) ethanol solution at 40 degrrees C. A migrating solution containing 40%(v/v) ethanol and 20 mM phosphate buffer (pH 7.8) was found to be preferable for the stability of the Schiff bases. Eight kinds of n-alkylamines were derivatized with SAS under the optimal conditions and the derivatives were successfully separated by a CZE analysis. The proposed method allows simultaneous, sensitive and sufficiently precise determination of the n-alkylamines with the alkyl chain length from 3 to 12 of methylene groups. The derivatization process with SAS was successfully applied to the detection of histamine at a very low level. The detection limit was 2.5-10(-6) M, and it was improved in the order of 8 times compared with the CZE analysis without derivatization.

Highly sensitive determination method for total carbonate in water samples by flow injection analysis coupled with gas-diffusion separation

A spectrophotometric method for the determination of total carbonate in water samples was developed. The method is based on the color change of an acid-base indicator in relation to the concentration of permeable gas substances through a membrane. By using a new portable FIA system equipped with a gas-diffusion unit, a highly sensitive and on-site determination of total carbonate in aqueous solutions was investigated. A new color-change system with 4-(2',4'-dinitrophenylazo)-1-naphthol-5-sulfonic acid (DNN5S) was developed. Absorbance changes of the reagent solution were measured at 450 nm with a light-emitting diode (LED) as a light source. A new type of gas-diffusion unit was used, and was constructed with double tubing: the inner tubing was a micro porous PTFE (polytetrafluoroethylene) tubing (1.0 mm inner diameter and 1.8 mm outer diameter, pore size 2 microns, porosity 50%); the outer tubing was made of glass with 2.0 mm inner diameter. The optimized system conditions were as follows: the sample size was 200 microliters, the temperature of the air bath for the gas-diffusion unit was 25 degrees C, and the length of the gas-diffusion unit was 15 cm; each flow rate was 0.3 ml min-1. For measuring carbonate at low concentrations, a method for preparing water with less carbonate was proposed: the carbonate content of the water was decreased down to 5 x 10(-7) M. The calibration graph was rectilinear from 1 x 10(-6) M to 10(-3) M, and the detection limit (corresponding to a signal-to-noise ratio of 3) was 1 x 10(-6) M of carbonate. The relative standard deviation (RSD) of ten measurements of 2.3 x 10(-5) M Na2CO3 solution was 1.9%. The total carbonate in various kinds of water (such as river, sea, rain, distilled and ultra purified) was determined.

Analysis of complex formation between crown ethers and potassium ion by determining retention factors in reversed-phase high-performance liquid chromatography

Retention factors in reversed-phase high-performance liquid chromatography (RP-HPLC) were utilized for the analysis of complex formation reaction of four crown ethers with potassium ion in water-methanol media. The crown ethers were injected as analytes, potassium ion was present in the eluent, and three types of reversed-phase columns were used. The retention factor of the crown ethers decreased with increasing concentrations of potassium ion in the eluent, which is attributed to the change in the species of the crown ether from a neutral ligand to a positively charged complex. The complex formation constants were determined by analyzing the changes in the retention factor with a non-linear least-squares method.

Severe cervical kyphosis in osteopathia striata with cranial sclerosis: case report

We report a 29-month-old girl with osteopathia striata with cranial sclerosis (OS-CS), who showed several unusual manifestations, including short stature, muscular hypotonia, short lingual frenulum, an accessory ear and a granuloma at the oral edge. The most unusual distressing finding was severe cervical kyphosis with a dysplastic cervical spine. MRI revealed impingement of the upper spinal cord. To clarify the mode of inheritance of this disease in this patient, we performed a methylation-specific PCR analysis. It eventually showed random inactivation of X-chromosomes, suggesting an autosomal dominant trait.

[Survey of consciousness of community residents regarding the community life of disabled persons with service dogs]

PURPOSE

Service dogs have received much attention as effective choices for promoting participation in society of disabled persons. The purpose of this study was to obtain the fundamental data to prepare guidelines regarding service dogs use in community life, by making clear the problems in terms of public health and community welfare through a survey of attitudes towards service dogs in community residents.

METHODS

Study 1 was conducted as follows. The subjects were 423 community residents between their teens and seventies who participated in health and welfare lectures in 4 metropolitan areas. A questionnaire survey was conducted just after watching a promotion video about service dogs, including several items on aspects not accept, were anxious about or were unpleasant in the case of community life of a disabled person and a service dog. Study 2 was as follows. A questionnaire survey was conducted inside a supermarket in the central part of Tokyo. One group of subjects were 103 shopping customers who witnessed a shopping scene featuring a disabled person with her service dog, and the other subjects were 84 customers who were not witnessed to the scene. The same survey was simultaneously performed for impression about the shopping scene.

RESULTS

Study 1 showed that 31.8% of all the respondents replied that they had some knowledge of service dogs before watching the video. A total of 20.4% (32.5% of the elderly) replied that there were places where service dogs should not enter. Concretely speaking, these included restaurants for 7.3-22.5% and medical institutions for 8.5-12.5% of the respondents. A third of all the respondents (51.3% of older persons) replied they could not endure some actions by service dogs, concretely "carrying food in the mouth" was highly pointed out by 27.3%. Zoonosis (15.3-19.0%), hair scattering (9.5-21.3%), injuries (4.4-7.4%) were also pointed out as main sources of anxiety or uncomfortable feelings. Such negative opinions were especially apparent among those aged 60 years and older. Also, 44.1% knew some disabled person. Cross tabulation showed those who had experience of taking care of a dog were significant less anxious about "vague anxiety or discomfort," and "zoonosis" than those who had not (P < 0.01). On the other hand, most of both witness (79.6%), and non-witness groups (81.0%) replied that it was heartwarming that the service dog assisted with shopping. None expressed discomfort about the presence of "service dog" inside the supermarket. In terms of carrying a commodity in the mouth, 92.2% and 89.1% in both groups replied that they don't mind, especially if safety was guaranteed for public health, and 91.3% and 95.2% in both groups replied that they had no other problems. Moreover, none of them would not entering stores. Significant differences were seldom in replies between the witness and non-witness groups.

CONCLUSION

Although the respondents were extremely affirmative regarding the image of service dogs, it became clear that anxiety about public health aspects such as "zoonosis" or "utilization of medical institutions" was persisting. On the whole, negative opinions were more apparent in the elderly.

Expression of constitutively active c-MET receptor in human choriocarcinoma

OBJECTIVE

The c-MET oncogene encodes the transmembrane tyrosine kinase receptor for hepatocyte growth factor (HGF). Recently, either HGF or c-MET has been knocked out in the mouse, and the mutation is associated with defects in the development of the placenta by means of the reduction of trophoblast cells. We examined the role of c-MET in malignant transformation of trophoblast cells.

METHODS

In four human choriocarcinoma cell lines, GCH-1, GCH-1m, NUC-1 and SCH, the expression of HGF and c-MET was analyzed by RT-PCR and Western blotting using anti-c-MET antibody and antiphosphotyrosine antibody.

RESULTS

RT-PCR analysis showed that no cell lines expressed HGF, however all the cell lines revealed the expression of c-MET mRNA. c-MET receptor was expressed and also tyrosine-phosphorylated constitutively in these cell lines by Western blotting.

CONCLUSION

These results suggest that c-MET may be involved in the growth and behavior of human choriocarcinoma although an autocrine fashion of HGF is unlikely.

Separation and determination of haloperidol, parabens and some of their degradation products by micellar electrokinetic chromatography

A micellar solution containing phosphate buffer, anionic surfactant, and water-miscible organic solvent was employed as a migration solution for the separation and the quantification of eleven analytes by micellar electrokinetic chromatography (MEKC): the analytes examined were haloperidol, methylparaben, ethylparaben, n-propylparaben, iso-propylparaben, n-butylparaben, iso-butylparaben, sec-butylparaben, 4-(4-chlorophenyl)-4-hydroxypiperidine, 4-fluorobenzoic acid and 4-hydroxybenzoic acid. In order to provide good separation between micelle and haloperidol, which showed strongest interaction with the micelle among the analytes, surfactant concentrations and organic modifier percentages were studied with phosphate buffer at pH 7.0. All the analytes were successfully resolved when 10 mM sodium dodecylsulfate and 15% ethanol were contained in the migration solution; the time window was very wide in the range from 14.8 to 65.5 min. Optimized applied voltage at 30 kV and capillary temperature at 45 degrees C enable analyze all compounds in less than 17 min with the best resolution, the shorter migration time window, the highest precision and lowest detection limit.

[A case of antiphospholipid antibody syndrome with cerebral infarction showing slowly progressive pure motor monoparesis in unilateral upper extremity]

We reported a 68-year-old man with anti-phospholipid antibody syndrome who presented slowly progressive pure motor monoparesis(PMM) in left upper extremity as a sign of cerebral infarction. He had history of hypertension and hyperlipidemia. He first noticed clumsiness in left fingers, then weakness of left fingers with drop hand developing gradually in 2 to 6 weeks. He began to feel difficulty in raising left upper arm in 8 weeks and was admitted to our hospital. On admission, he exhibited severe weakness in distal portion and moderate weakness in proximal portion of left upper extremity. Deep tendon reflexes were slightly hyperactive in left side. Muscle strength of right upper extremity and bilateral lower extremities were normal. There was no sensory and autonomic abnormality. Laboratory examination revealed high titer of anti-cardiolipin IgM antibody. Brain MRI demonstrated a small cortical infarction in the right precentral gyrus. Cerebral angiography revealed severe stenosis in right common carotid artery. Other examinations including EMG were unremarkable. PMM in left upper extremity was considered to be caused by the ischemic lesion in the precentral motor cortex. Slowly progressive course might be explained by the hypovolemic factor due to the marked stenosis in right common carotid artery, poor collateral circulation, and abnormal coagulation caused by anti-phospholipid antibody syndrome.