NCOG-05. A BRAIN METASTASES SURVIVAL MODEL USING AN ENSEMBLE TREE APPROACH

PURPOSE/OBJECTIVE(S)

The primary purpose of this study is to determine whether a machine learning approach can estimate survival in patients with brain metastases undergoing stereotactic radiosurgery or fractionated stereotactic radiotherapy (SRS/SRT). The secondary purpose is to identify covariates of importance.

MATERIALS/METHODS

Data were collected for 377 SRS/SRT treatments in 291 patients done between the years 2008-2021. If a patient was treated with more than one course of SRS/SRT within 30 days, they were counted only once. Twenty-five clinically-relevant variables were identified as covariates and the primary outcome of time from brain metastasis diagnoses to death was used to build a random survival forest model. Brain metastasis location was categorized as infratentorial, supratentorial, or both. An 80/20 split was used for training (n = 302) and test (n = 75) sets. Missing data points were imputed using a just-in-time adaptive tree approach. Minimal depth and variable importance (VIMP) approaches were used to identify prognostic factors. Model performance was assessed using time-dependent area under the receiver operating characteristics curve (tAUC).

RESULTS

Median survival time was 16 months. The most important variables according to minimal depth analysis (depth threshold 5.23) were Karnofsky Performance Status (KPS), extracranial status, age, insurance status, metastases volume, histology, number of metastases, and location. Error rate on the test set was 0.38. tAUC was found to increase continuously over time and at 6, 12, 24, and 36 months was 0.56, 0.63, 0.74, and 0.84 respectively.

CONCLUSION

An ensemble tree approach can provide good survival prediction for patients with brain metastases undergoing SRS/SRT. Model performance, as measured by tAUC, increases over time suggesting better predictive capability at longer time intervals. Future directions include collecting more data to increase model performance, comparing to other models, and validating with external data.

Race as a prognostic factor in high-risk prostate cancer: An NCDB analysis

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Background: It is commonly held that race serves as a significant prognosticator in prostate cancer. However, it is unclear if race affects all risk groups similarly. We sought to analyze whether race, either African American (AfA) or Caucasian (C), impacted overall survival of men receiving standard of care treatment using a large national database. Materials and Methods: All data was obtained from the NCDB (National Cancer Database), a collaborative effort between the American Cancer Society and Commission on Cancer. The database initially contained 1,294,126 cases of prostate cancer diagnosed between 2004 and 2014. Those with documented race and minimum follow up of 4 years were analyzed in this study. Patients were eliminated from the study if they had metastatic or nodal disease, received chemotherapy, or had non-invasive disease. Patients were grouped into two cohorts as per NCCN criteria: favorable risk and unfavorable risk. All patients received definitive therapy appropriate for their risk group. AfA and C men were matched 1:1 within each risk cohort using propensity scores, and multivariate analysis was conducted on these matched cohorts. Results: The final analyzed cohort included 75,217 patients with median follow-up time of 5 years. 10-year OS for favorable risk and unfavorable risk cohorts were 78% and 73% respectively (log rank, p < 0.001). In the favorable risk cohort, 5,422 C cases were matched to 5,422 AfA cases. C men had superior OS compared to AfA men, 89% versus 86% at 8 years and 79% versus 79% at 10 years (HR 0.688, 95% CI 0.571-0.872, p = 0.0025). In the unfavorable risk cohort, 3,870 C cases were matched to 3,870 AfA cases. Race was not a significant prognostic factor for OS, 83% versus 83% at 8 years and 73% versus 71% at 10 years in C and AfA men, respectively (HR 0.961, 95%CI 0.837-1.103, p = 0.572). Conclusions: Race has no effect on overall survival in unfavorable disease while AfA race is a predictor for worse survival in favorable risk prostate cancer, independent of socioeconomic and demographic factors. This suggests that the biology of disease plays a significant role in favorable risk cohorts, but with more advanced higher risk disease, other factors besides race may play a more significant role.

Rectal balloon use limits vaginal displacement, rectal dose, and rectal toxicity in patients receiving IMRT for postoperative gynecological malignancies

Pelvic radiotherapy for gynecologic malignancies traditionally used a 4-field box technique. Later trials have shown the feasibility of using intensity-modulated radiotherapy (IMRT) instead. But vaginal movement between fractions is concerning when using IMRT due to greater conformality of the isodose curves to the target and the resulting possibility of missing the target while the vagina is displaced. In this study, we showed that the use of a rectal balloon during treatment can decrease vaginal displacement, limit rectal dose, and limit acute and late toxicities. Little is known regarding the use of a rectal balloon (RB) in treating patients with IMRT in the posthysterectomy setting. We hypothesize that the use of an RB during treatment can limit rectal dose and acute and long-term toxicities, as well as decrease vaginal cuff displacement between fractions. We performed a retrospective review of patients with gynecological malignancies who received postoperative IMRT with the use of an RB from January 1, 2012 to January 1, 2015. Rectal dose constraint was examined as per Radiation Therapy Oncology Group (RTOG) 1203 and 0418. Daily cone beam computed tomography (CT) was performed, and the average (avg) displacement, avg magnitude, and avg magnitude of vector were calculated. Toxicity was reported according to RTOG acute radiation morbidity scoring criteria. Acute toxicity was defined as less than 90 days from the end of radiation treatment. Late toxicity was defined as at least 90 days after completing radiation. Twenty-eight patients with postoperative IMRT with the use of an RB were examined and 23 treatment plans were reviewed. The avg rectal V40 was 39.3% ± 9.0%. V30 was65.1% ± 10.0%. V50 was 0%. Separate cone beam computed tomography (CBCT) images (n = 663) were reviewed. The avg displacement was as follows: superior 0.4 + 2.99 mm, left 0.23 ± 4.97 mm, and anterior 0.16 ± 5.18 mm. The avg magnitude of displacement was superior/inferior 2.22 ± 2.04 mm, laterally 3.41 ± 3.62 mm, and anterior/posterior 3.86 ± 3.45 mm. The avg vector magnitude was 6.60 ± 4.14 mm. For acute gastrointestinal (GI) toxicities, 50% experienced grade 1 toxicities and 18% grade 2 GI toxicities. For acute genitourinary (GU) toxicities, 21% had grade 1 and 18% had grade 2 toxicities. For late GU toxicities, 7% had grade 1 and 4% had grade 2 toxicities. RB for gynecological patients receiving IMRT in the postoperative setting can limit V40 rectal dose and vaginal displacement. Although V30 constraints were not met, patients had limited acute and late toxicities. Further studies are needed to validate these findings.

Stereotactic body radiotherapy for pancreatic cancer: Analysis of toxicity

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Background: Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis, with significant morbidity and mortality from local progression. Radiotherapy can be administered for local control, with stereotactic body radiotherapy (SBRT) increasingly being utilized. We aim to compare the toxicity of SBRT with intensity-modulated radiotherapy (IMRT) in this setting. Methods: A retrospective analysis of patients with PDAC receiving IMRT or SBRT at our institution between April 2011 and November 2015 was performed. 81 patients were identified. Clinical notes were reviewed for treatment details and acute and late toxicities. Late toxicity data was available for 62 patients. Toxicity was assessed using Common Terminology Criteria for Adverse Events version 4.0. Radiology reports were reviewed to assess for the presence of recurrence and/or progression. Results: Median follow-up from RT was 29 months (95% CI 22-36 months), and median survival from RT was 25 months (95% CI 22-34 months). IMRT patients received 37.5-54 Gy in 15-30 fractions. SRBT patients received 19.8-39.6 Gy in 3-6 fractions. 45% of IMRT and 29% of SBRT patients had local failure (p = 0.1329). IMRT patients were significantly more likely to have Grade ≥2 acute gastrointestinal (GI) toxicity than SBRT patients (RR 1.70; 95% CI 0.98-2.96, p = 0.0489), although one SBRT patient had to have treatment stopped due to extrahepatic stricture. There were no significant differences in late GI toxicity (67% Grade 2 or higher vs. 57%, respectively, p = 0.4244), although one IMRT patient died due to late GI bleeding.IMRT patients were more likely to lose weight during RT(Median -0.03% vs. -0.004%, p = 0.0001) and have moreEmergency Department (ED) visits after RT (Range 0-8 vs. 0-3, p = 0.0019). There were no significant differences in dermatitis, fatigue, or hematologic toxicity. Conclusions: Patients with locally advanced PDAC treated with IMRT versus SBRT had significantly more acute gastrointestinal toxicity, median weight loss, and ED visits after RT, but no significant differences in late gastrointestinal toxicity, dermatitis, fatigue, or hematologic toxicity. SBRT is a relatively tolerable and more convenient alternative for patients with pancreatic cancer.

Correlation of autophagy type in podocytes with histopathological diagnosis of IgA nephropathy

OBJECTIVE

IgA nephropathy (IgA-N) frequently leads to progressive renal failure, thus estimation of the degree of progression is important for patient management. Autophagy is a mechanism that facilitates clearance of waste products to preserve renal function. The aim of this study was to assess autophagy in podocytes in children with progressive IgA-N at initial diagnosis by electron microscopy and investigate the relationship between the types of autophagy and severity of the disease.

METHODS

Renal biopsies from 16 children with established progressive IgA-N were examined by light and transmission electron microscopy with reference to autophagy types in the podocytes and histopathological diagnosis of IgA-N.

RESULTS

Two autophagy types were found. Type I rarely transformed to autophagic vacuoles and did not dissolve, thus possibly impairing cell function. However, type II frequently transformed to autophagosomes and autophagic vacuoles thus facilitating protein and lipid clearance. Of the 16 children studied, 8 (50%) with type I autophagy at initial diagnosis showed focal proliferative glomerulosclerosis (GN) of mild type (3 cases, 37.5%), mild/moderate type (2 cases, 25%) and moderate type (3 cases, 37.5%). In contrast, the remaining 8 children with type II autophagy at initial diagnosis showed focal proliferative GN of mild type in 7 (87.5%) and mild/moderate type in 1 (12.5%) case.

CONCLUSION

In IgA-N children, the occurrence of type I autophagy is correlated with histopathologically more progressive disease, possibly reflecting a tendency to a poorer prognosis.

Tacrolimus (FK506) attenuates biphasic cytochrome c release and Bad phosphorylation following transient cerebral ischemia in mice

Tacrolimus (FK506) has a neuroprotective action on cerebral infarction produced by cerebral ischemia, however, detailed mechanisms underlying this action have not been fully elucidated. We examined temporal profiles of survival-and death-related signals, Bad phosphorylation, release of cytochrome c (cyt.c), activation of caspase 3 and DNA fragmentation in the brain during and after middle cerebral artery occlusion (MCAo) in mice, and then examined the effect of tacrolimus on these signals. C57BL/6J mice were subjected to transient MCAo by intraluminal suture insertion for 60 min. Tacrolimus (1 mg/kg, i.p.) was administered immediately after MCAo. There were biphasic increases in the release of cyt.c in the ischemic core and penumbra; with the first increase toward the end of the occlusion period and the second increase 3-12 h after reperfusion. Tacrolimus significantly inhibited the increase of cytosolic cyt.c during ischemia and reperfusion. Phosphorylated Bad, Ser-136 (P-Bad(136)) and Ser-155 (P-Bad(155)) were detected 30 min after MCAo and after reperfusion in the ischemic cortex, respectively. Tacrolimus increased P-Bad(136) during ischemia and prolonged P-Bad(155) expression after reperfusion. Tacrolimus also decreased caspase-3 and terminal deoxynucleotidyl transferase-mediated DNA nick-end labeling-positive cells, and reduced the size of infarct 24 h after reperfusion. Our study provided the first evidence that the neuroprotective action of tacrolimus involved inhibition of biphasic cyt.c release from mitochondria, possibly via up-regulation of Bad phosphorylation at different sites after focal cerebral ischemia and reperfusion.

Regional N-acetyl-aspartate level and immunohistochemical damage in the hippocampus after transient forebrain ischemia in gerbils

We investigated changes in regional N-acetyl-aspartate (NAA) levels in the vulnerable CA1 and resistant CA3 areas of the hippocampus after transient forebrain ischemia in gerbils. Under light ether anesthesia, bilateral common carotid arteries of adult male Mongolian gerbils (60-80 g) were occluded for 5 min and reperfused for 7 days. Brains from experimental and control gerbils (n = 4 each) were frozen in situ, and frozen sections (20 microm) were prepared using cryostat (-20 degrees C). After overnight lyophilization, the CA1 and CA3 areas were dissected out separately, weighed (50-200 microg), and the supernatant of the perchloric acid extract was used for assay of NAA using HPLC. Adjacent 10 microm-thick sections were used for immunohistochemical analysis using antiserum against microtubule-associated protein I and II. The preischemic NAA levels were not significantly different between CA1 and CA3 areas. After transient ischemia, a significant (P < 0.01) decrease in the NAA level was observed in the CAI area, but not in the CA3 area of the hippocampus. Immunohistochemical ischemic damage evolved only in the CA1 area. Thus, the decrease of the regional NAA level was associated with development of immunohistochemical neuronal damage.

A functional MRI study of somatotopic representation of somatosensory stimulation in the cerebellum

Somatotopic representation in the cerebral cortex of somatosensory stimulation has been widely reported, but that in the cerebellum has not. We investigated the latter in the human cerebellum by functional MRI (fMRI). Using a 1.5 tesla imager, we obtained multislice blood oxygen level-dependent fMRI with single-shot gradient-echo echoplanar imaging in seven right-handed volunteers during electrical stimulation of the left index finger and big toe. In the anterior and posterior cerebellum, activated pixels for the index finger were separate from those for the toe. This suggests that somatosensory stimulation of different parts of the body may involve distinct areas of in the cerebellum as well as the cerebral cortex.

Plasma adrenomedullin levels in pregnancies with appropriate for gestational age and small for gestational age infants

AIMS

To evaluate whether maternal and fetal plasma adrenomedullin levels in pregnancies with small for gestational age (SGA) infants are different from those in pregnancies with appropriate for gestational age (AGA) infants.

METHODS

Maternal and fetal circulating adrenomedullin levels were compared between 62 pregnancies with AGA (43 delivered vaginally and 19 delivered by elective cesarean section) and 28 pregnancies with SGA (20 delivered vaginally and 8 delivered by elective cesarean section) at birth. Plasma adrenomedullin levels were measured from maternal and cord venous blood samples using a radioimmunoassay. Umbilical artery blood pH was also measured.

RESULTS

There were no significant differences for maternal total adrenomedullin levels, mature adrenomedullin levels, and its ratio among the groups. There were also no significant differences for fetal total adrenomedullin levels, mature adrenomedullin levels, and its ratio among the groups. In the AGA group delivered vaginally, fetal mature/total adrenomedullin ratio (mean +/- standard error, 16.6 +/- 0.7%) was significantly higher than the maternal ratio (13.8 +/- 0.6%) (p < 0.05). In the SGA group delivered vaginally, fetal mature/total adrenomedullin ratio (18.5 +/- 1.0%) was also significantly higher than the maternal ratio (14.5 +/- 0.6%) (p < 0.05). There was no significant difference in umbilical artery blood pH among the groups.

CONCLUSIONS

These results suggest that maternal and fetal plasma circulating adrenomedullin levels may play a role in maternal and fetal cardiovascular adaptation during delivery in pregnancies with both AGA and SGA infants.

Comparison of three-dimensional, two-dimensional and color Doppler ultrasound in predicting the presence of a nuchal cord at birth

OBJECTIVES

To compare the use of two-dimensional, color Doppler and three-dimensional ultrasound for predicting the presence of a nuchal cord at birth.

METHODS

Eighty-five singleton pregnancies without nuchal cord and 35 with nuchal cord (30 with a single coil of cord, four with a double coil, and one in which the cord was coiled around the neck three times) were studied within 1 week before delivery using transabdominal three-dimensional sonography. Two-dimensional and color Doppler ultrasound were also conducted for comparison.

RESULTS

Two-dimensional, color Doppler and three-dimensional sonography identified in utero 24 (69%), 29 (83%) and 25 (71%), respectively, of the cases of nuchal cord found at birth. There were no significant differences in overall diagnostic indices of each diagnostic modality for detecting nuchal cord. However, the ability to view the nuchal cord (subjective assessment of the ease of visualization of nuchal cord) was better with three-dimensional sonography than with two-dimensional or color Doppler ultrasound.

CONCLUSIONS

Three-dimensional surface imaging does not provide more useful diagnostic information compared with two-dimensional and color Doppler ultrasound for detecting nuchal cord in utero.

Pergolide mesilate may improve fatigue in patients with Parkinson's disease

OBJECTIVES

Fatigue is a complaint frequently encountered among patients with Parkinson's disease (PD). Considering the possible relationship between fatigue and dopaminergic dysfuncion, we investigated the effect of pergolide mesilate (a D2 and D1 dopamine receptor agonist) and bromocriptine (a D2 selective dopamine receptor) in patients with PD.

METHODS

We evaluated 41 patients with PD and controls. We assessed the degree of fatigue by using a fatigue scale. The severity of PD was evaluated by the Hoehn and Yahr Scale and the unified Parkinson's disease rating scale (UPDRS).

RESULTS

After five weeks from prescription, patients taking pergolide mesilate showed significant improvement in the fatigue scale (from 5.1 +/- 0.7 to 4.4 +/- 0.55, p < 0.05, ) but patients taking bromocriptine did not (from 4.8 +/- 0.9 to 4.7 +/- 0.8).

CONCLUSIONS

Our study suggested the possibility of functional correlation between fatigue and D1 receptor in patients with PD.

Three-dimensional sonographic assessment of fetal behavior in the early second trimester of pregnancy

OBJECTIVE

To evaluate the fetal behavior pattern in the early second trimester of pregnancy by use of specially developed abdominal dynamic three-dimensional sonography.

METHODS

Dynamic three-dimensional sonographic examinations were performed on 11 healthy pregnant women at 14 to 18 weeks of gestation. This imaging system provided continuous three-dimensional sonographic images every 1 to 2 seconds. Fetal movements were recorded continuously for 60 minutes in each fetus. The rate of occurrence of head, mouth, arm, trunk, and leg movements was evaluated. All fetal behavioral patterns were observed during the period studied.

RESULTS

The active phase (time with fetal movements) was 59.4%, and the resting phase was 40.6%. The most active fetal behavior pattern was an arm movement, whereas the least was a mouth movement. Moreover, each fetal movement was synchronized and harmonized with other fetal movements (a few movement patterns were found to be generated simultaneously).

CONCLUSIONS

Dynamic three-dimensional sonography provides a novel means for evaluation of fetal behavior in the early second trimester of pregnancy. These results suggest that dynamic three-dimensional sonography may be an important modality in future early fetal behavior research and in evaluation of early fetal well-being.

Phosphorylation of cAMP response element-binding protein in hippocampal neurons as a protective response after exposure to glutamate in vitro and ischemia in vivo

Although accumulating evidence indicates that cAMP response element-binding protein (CREB) phosphorylation mediates not only synaptic plasticity but also survival of certain neurons, it remains uncertain whether CREB phosphorylation induced after metabolic insult leads to CRE-mediated gene transcription and is involved in cell survival or not. In the present study, we clarified that (1) CREB phosphorylation and ischemic tolerance induced after preconditioning ischemia in the hippocampal neurons was abolished by MK801 administration in gerbil global ischemia model, (2) CREB phosphorylation induced after exposure to glutamate in cultured neurons was inhibited by removal of extracellular calcium, by MK801 and by an inhibitor of calcium-calmodulin-dependent protein kinase (CaMK) II and IV, (3) inhibitor of CaMK II-IV or CRE-decoy oligonucleotide suppressed upregulation of BCL-2 expression and accelerated neuronal damage after exposure to glutamate, and (4) CREB phosphorylation induced in the hippocampal neurons after ischemia and in cultured neurons after exposure to glutamate was followed by CRE-mediated gene transcription in transgenic mice with a CRE-LacZ reporter. Our results suggest that CREB phosphorylation in neurons after ischemia and exposure to glutamate is induced by NMDA receptor-gated calcium influx and subsequent activation of CaMK II-IV and that CREB phosphorylation after metabolic stress might show a neuroprotective response through CRE-mediated gene induction.

Morphological differences between glomerular epithelial cells (GEC) excreted during chemotherapy with antineoplastic drugs and GEC excreted in renal diseases

BACKGROUND

To better understand the mechanisms of glomerular epithelial cell (GEC) injuries in various diseases, we compared GEC excreted during chemotherapy (antineoplastic drugs) and GEC excreted in renal diseases.

METHODS

For 19 patients undergoing chemotherapy (85 courses), 69 patients with IgA nephropathy and 16 patients with Henoch-Schölein purpura nephritis, the number of excreted GEC and GEC casts were counted by an immunofluorescent study. The morphological features of GEC were also studied in an immunofluorescent study combined with Hoechst stain.

RESULTS

Glomerular epithelial cells were detected in 78% of the chemotherapy courses and in 94% of the patients with renal diseases. The GEC casts were observed in 2% of chemotherapy courses, while in renal diseases GEC casts were observed in 60% of the patients. Proteinuria (>30 mg/dL) and hematuria were not identified in any of the chemotherapy courses. The morphology and size of GEC were more variable than that in patients with nephropathy. Furthermore, GEC in patients undergoing chemotherapy often showed small nuclei and fragmented nuclei, which were rarely observed in patients with nephropathy.

CONCLUSIONS

These results showed that the detachment of podocytes was not directly associated with proteinuria or hematuria. The findings also suggest that GEC are damaged via an apoptotic process by chemotherapy. On the contrary, GEC may be detached through a non-apoptotic process in renal diseases.

Stabilization of mutant Cu/Zn superoxide dismutase (SOD1) protein by coexpressed wild SOD1 protein accelerates the disease progression in familial amyotrophic lateral sclerosis mice

Transgenic mice carrying familial amyotrophic lateral sclerosis (FALS)-linked mutant Cu/Zn superoxide dismutase (SOD1) genes such as G93A (G93A-mice) and G85R (G85R-mice) genes develop limb paresis. Introduction of human wild type SOD1 (hWT-SOD1) gene, which does not cause motor impairment by itself, into different FALS mice resulted in different effects on their clinical courses, from no effect in G85R-mice to acceleration of disease progression in G93A-mice. However, the molecular mechanism which causes the observed difference, has not been clarified. We hypothesized that the difference might be caused by the stability of mutant SOD1 proteins. Using a combination of mass spectrometry and enzyme-linked immunosorbent assay, we found that the concentration of G93A-SOD1 protein was markedly elevated in tissues of transgenic mice carrying both G93A- and hWT-SOD1 genes (G93A/hWT-mice) compared to that in G93A-mice, and also found that the concentration of G93A-SOD1 protein had a close relation to the disease duration. The concentration of metallothionein-I/II in the spinal cord, reflecting the degree of copper-mediated oxidative stress, was highest in G93A/hWT-mice, second in G93A-mice, and normal in the mice carrying hWT-SOD1 gene. These results indicated that the increase of G93A-SOD1 protein was responsible for the increase of oxidative stress and disease acceleration in G93A/hWT-mice. We speculate that coexpression of hWT-SOD1 protein is deleterious to transgenic mice carrying a stable mutant such as G93A-SOD1, because this mutant protein is stabilized by hWT-SOD1 protein, but not to transgenic mice carrying an unstable mutant such as G85R-SOD1, because this mutant protein is not stabilized by hWT-SOD1.

Urinary podocytes in primary focal segmental glomerulosclerosis

BACKGROUND/AIM

Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome. Although the pathogenesis is not known, recent studies suggest that FSGS may be a podocyte disease. The aim of this study was to look for podocyte injury in this disease, using measurements of urinary podocytes.

METHODS

We examined the first morning urine of the day collected from 71 patients (45 men and 26 women, median age and range 11.2 and 3-29 years) diagnosed as having nephrotic syndrome. Freshly voided urine samples were examined by immunofluorescence labeling using monoclonal antibodies against human podocalyxin. Renal histological examinations were performed in 58 of the 71 patients: 28 had minimal-change disease, 20 had FSGS, and 10 had membranous nephropathy.

RESULTS

Median and range of urinary podocytes measured were 0.2 and 0-40.8 cells/ml for 71 patients with nephrotic syndrome and 0 and 0-0.8 cells/ml for normal healthy control subjects (n = 200). Patients with FSGS had significantly higher levels of urinary podocytes (median and range 1.3 and 0-40.8 cells/ml) than those with minimal-change disease (median and range 0 and 0-6.9 cells/m; p = 0.003) or membranous nephropathy (median and range 0 and 0-1.4 cells/ml; p = 0.02).

CONCLUSIONS

The urinary excretion of podocytes is significantly higher in patients with FSGS as compared with those having membranous nephropathy or minimal-change disease. These findings suggest that podocyte injury and loss in the urine may have an important role in the pathogenesis of FSGS.

A potent AMPA/kainate receptor antagonist, YM90K, attenuates the loss of N-acetylaspartate in the hippocampal CA1 area after transient unilateral forebrain ischemia in gerbils

By analyzing histological damages and the regional N-acetylaspartate (NAA) level simultaneously, we evaluated the effect of an alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA)/kainate receptor antagonist, YM90K [6-(1H-imidazol-1-yl)-7-nitro-2,3-(1H,4H)-quinoxalinedione monohydrochloride], in unilateral forebrain ischemia in gerbils. The right common carotid artery was clipped for 5 min under ether anesthesia, and reperfused for 7 days. The frozen brain sections were lyophilized and the hippocampal CA1 area was dissected out for HPLC assay of NAA. An adjacent section was stained with hematoxylin-eosin for counting survived neurons per 1 mm pyramidal layer of the hippocampal CA1 area. Postischemic administration of YM90K at 20 mg/kg and 25 mg/kg attenuated the decrease of both the number of survived neurons and the NAA level on the ischemic side in a dose-dependent manner. A significant linear correlation was observed between the NAA level and the number of intact neurons. These results indicated that the NAA level could be used as an index of neuroprotective effects of pharmacological agents in global cerebral ischemia.

Influence of prolonged corticosteroid therapy on the outcome of steroid-responsive nephrotic syndrome

Eighty-six patients (59 males and 27 females) diagnosed with steroid-responsive nephrotic syndrome during childhood were identified. The patients were 20-40 years of age (mean 27.0 +/- 5.0) with a mean follow-up period of 19.5 +/- 5.9 years. All patients had been treated with a long-term tapering corticosteroid therapy. Thirty patients had also received a course of cyclophosphamide (2 mg/kg/day for 12 weeks). Sixty-six had achieved sustained remission off corticosteroids, while 20 were still receiving corticosteroids to maintain remission. None of the 86 patients had proteinuria or renal insufficiency at the time of the study. Mean final heights in males and females were similar (-0.51 +/- 1.21 and -0.23 +/- 1.16 standard deviation score). Mean final height of 20 steroid-dependent patients was significantly less than that of 66 in remission off corticosteroids (p < 0.005). Ten cyclophosphamide-treated patients got married and 9 had at least 1 healthy child. In children with steroid-responsive nephrotic syndrome, the need for corticosteroid therapy to maintain remission may be associated with decreased adult height. Patients who received a 12-week course of cyclophosphamide are likely to be normally fertile as adults.

Fatigue in patients with Parkinson's disease

Purpose: Fatigue is a complaint frequently encountered among patients with Parkinson's disease (PD), however, the pathophysiological mechanism remains unclear. Methods: We evaluated fatigue in 26 patients clinically diagnosed to have PD (16 men, 10 women) and age- and sex- matched 26 controls (16 men, 10 women) without neurological deficits by using a fatigue scale. In addition to neurological and neuropsychological examinations, all patients underwent MRI and SPECT using 99mTc-HMPAO. Results: Patients with PD had normal cognitive function as judged by the MMSE, but showed significantly high scores with the fatigue and depression scales in comparison to controls (p<0.05). There was no significant correlation between the depression scale and the fatigue scale, or between the degree of disability and the fatigue scale in patients with PD, although a significant correlation existed between the depression scale and the fatigue scale in controls. With SPECT, a significant correlation was found between the fatigue scale and the reduction of perfusion in the frontal lobe (p<0.05) in patients with PD. Conclusions: The present study suggested that sense of fatigue in patients with PD might be associated with frontal lobe dysfunction.

Decrease in N-acetylaspartate/creatine ratio in the motor area and the frontal lobe in amyotrophic lateral sclerosis

We studied whether N-acetylaspartate (NAA), a neuronal marker, is reduced in the brain of 14 patients with clinically definite amyotrophic lateral sclerosis (ALS) and whether NAA levels in the motor area and frontal lobe correlate with the clinical features, including frontal lobe function. We also studied 14 normal controls were evaluated. We obtained peak integrals in 1H magnetic resonance spectroscopy (MRS) for NAA, creatine (Cr), and choline-containing compounds (Cho). Severity of the disease was determined using the manual muscle strength test, and the Norris limb and bulbar scales. In the patients, the NAA/Cr ratio was reduced in the motor area and frontal lobe, while the Cho/Cr ratio was normal throughout the brain. There were significant correlations between the NAA/Cr ratio in the motor area and the Norris limb scale (r = 0.50; P < 0.01) and between the NAA/Cr ratio in the frontal lobe and the number of categories achieved in the Wisconsin Card Sorting test (r = 0.71; P < 0.05), implying frontal lobe dysfunction. These correlations suggest that a reduced NAA/Cr ratio is a marker of cortical neuronal loss and dysfunction in ALS.

Glomerular CD8+ cells predict progression of childhood IgA nephropathy

The aim of this study was to evaluate whether the infiltrating T-lymphocyte can be a predictor in the disease progression of IgA nephropathy (IgAN). Twenty children with IgAN, followed for more than 5 years, were divided into progressive (n=5) and non-progressive groups (n=15). We assessed glomerular and interstitial infiltration of T-lymphocytes (CD4+ and CD8+ cells) and expression of alpha-smooth muscle actin (alpha-SMA) and transforming growth factor-beta (TGF-beta) using an indirect immunofluorescence method on the renal biopsies. We analyzed their relationship to the degree of proteinuria, histological changes, and prognosis. The number of CD8+ cells in glomeruli and in interstitium was higher in the progressive group than in the non-progressive group. The glomerular alpha-SMA staining was more intensive in the progressive group than in the non-progressive group. Urinary protein and the degree of histological changes were also higher in the progressive group than in the non-progressive group. Among these markers, the number of glomerular CD8+ cells was the most apparent difference between the two groups. In conclusion, these results indicate that the number of glomerular CD8+ cells is the most sensitive predictor of disease progression in childhood IgAN.

Antenatal three-dimensional sonographic features of Pierre-Robin syndrome. Case report

A case of Pierre-Robin syndrome with polyhydramnios is described. Three-dimensional sonography clearly showed fetal micrognathia and hypoplastic ear antenatally. The benefits and advantages of the use of three-dimensional sonography to diagnose Pierre-Robin syndrome in utero are discussed.

[Strip immunoblot assay (SIA) with recombinant antigens and synthetic peptide for detection of anti HIV-1 and HIV-2 antibodies]

The serodiagnosis of human immunodeficiency virus (HIV) infection has widely been established by the screening test and the confirmatory test. At present, Western blot (WB) assay is mostly used as the confirmatory test. However, this method has the problem in that the sensitivity and the specificity are not enough. A new confirmatory test "CHIRON RIBA HIV-1/HIV-2 SIA" developed by Chiron Corporation uses an immunoblot enzyme immunoassay technique for detection of anti HIV-1 and/or HIV-2 antibodies. This assay employs four recombinant viral antigens (gp120, gp41, p24/p26 and p31) and a synthetic viral antigen (HIV-2 envelope peptide). The characteristic of this method is that the HIV-1 infection and the HIV-2 infection can be differentiated from each other. We therefore compared this SIA method with the WB1 assay for detection of anti HIV-1 antibodies and with the WB2 assay for detection of anti HIV-2 antibodies. Eighty samples from normal adults without HIV infection and known to be negative by three HIV screening tests, respectively, were tested by SIA, WB1 and WB2 assays. The negative rates (specificities) were 97.5%, 80.0% and 87.5% by the SIA, WB1 assay and WB2 assay, respectively. With forty samples from patients without HIV infection but known to be positive by at least one HIV screening test, the negative rates (specificities) were 97.5%, 72.5% and 85.5% by the SIA, WB1 assay and WB2 assay, respectively. The results indicated that the SIA method was more specific than two WB assays. Forty samples from patients with HIV-1 infection and known to be positive by three HIV screening tests, were tested by the SIA and WB1 assay. The positive rates (sensitivities) were 97.5% and 75.0% by the SIA and WB1 assay, respectively. With thirteen samples from patients with HIV-2 infection and known to be positive by three HIV screening test, the positive rates (sensitivities) were 100% and 92.3% by the SIA and WB1 assay, respectively. The results indicated that the SIA method was more sensitive than the WB1 assay. Three sets of sera, which were collected during seroconversion for HIV-1 antibody, were used to compare the positive readings by the SIA and WB1 assay. The SIA method indicated the positive readings earlier than the WB1 assay. The present findings indicated that the SIA method was more specific and sensitive than the WB assay, and would be useful as a confirmatory test.

Influence of thoracoabdominal movement on pulmonary function in patients with Parkinson's disease: comparison with healthy subjects

Patients with Parkinson's disease (PD) may develop pulmonary dysfunction, but the pathogenesis remains unclear. We investigated a correlation between thoracoabdominal movements and pulmonary function in seven patients with PD and 14 healthy controls. We measured vital capacity (VC) and forced vital capacity (FVC) using an autospirometer, and measured chest and abdominal movements using a respiratory inductance plethysmography by fixing transducers on the rib cage and umbilicus. Patients with PD had significantly decreased % VC (90.3 +/- 17.1 vs 105.8 +/- 13.9%), chest movement (271.3 +/- 79.6 vs. 375.2 +/- 126.7% VT) and abdominal movement (217.6 +/- 93.5 vs. 247.4 +/- 100.2% VT) with 100% VT being an average volume of chest and abdomen at rest during measurement of VC. Patients with PD also had significantly decreased % FVC (74.4 +/- 20.6 vs. 97.6 +/- 14.1%), chest movement (246.2 +/- 115.2 vs. 344.5 +/- 126.4% VT) and abdominal movement (160.3 +/- 105.6 vs 207.6 +/- 104.7% VT) with 100% VT being an average volume of chest and abdomen at rest during forced maximal inspiration. Based on the results, we conclude that a reduction of % VC in patients with PD correlated with chest movements, while a reduction of % FVC correlated with abdominal movement in patients with PD.

Reduction of metallothioneins promotes the disease expression of familial amyotrophic lateral sclerosis mice in a dose-dependent manner

We previously reported that abnormal copper release from mutated Cu, Zn-superoxide dismutase (SOD1) proteins might be a common toxic gain-of-function in the pathogenesis of familial amyotrophic lateral sclerosis (FALS) [Ogawa et al. (1997) Biochem. Biophys. Res. Commun., 241, 251-257.]. In the present study, we first examined metallothioneins (MTs), known to bind copper ions and decrease oxidative toxicity, and found a twofold increase in MTs in the spinal cord of the SOD1 transgenic mice with a FALS-linked mutation (G93A), but not in the spinal cord of wild-type SOD1 transgenic mice. We then investigated whether the clinical course of FALS mice could be modified by the reduced expression of MTs, by crossing the FALS mice with MT-I- and MT-II-deficient mice. FALS mice clearly reached the onset of clinical signs and death significantly earlier in response to the reduction of protein expression. These results indicated that the copper-mediated free radical generation derived from mutant SOD1 might be related to the degeneration of motor neurons in FALS and that MTs might play a protective role against the expression of the disease.

Late second-trimester nonstress test characteristics in preterm delivery before 32 weeks of gestation

OBJECTIVE

To clarify electronic fetal heart rate (FHR) monitoring characteristics in pregnancies with preterm delivery before 32 weeks of gestation, using the late second-trimester nonstress test.

METHODS

Among 953 children born from 1993 to 1996, we identified 100 singleton infants born before 32 weeks of gestation in whom second-trimester (24-27 weeks of gestation) electronic fetal monitoring (EFM) records were obtained. Individual components of the FHR patterns [baseline rate, baseline FHR variability, presence of acceleration (at least 10 beats/min for at least 10 s) and periodic or episodic deceleration (at least 25 beats/min for at least 15 s)] and birth characteristics were compared between pregnancy with or without second-trimester decelerations.

RESULTS

Among 100 infants, 65 had and 35 did not have second-trimester decelerations. There were no significant differences in gestational age at birth, birth weight, cord arterial blood pH, Apgar score and meconium staining between pregnancies with second-trimester decelerations and those without second-trimester decelerations. There were no significant differences in baseline rate and baseline variability between pregnancies with or without second-trimester decelerations. The number of accelerations in pregnancies with second-trimester decelerations was significantly more frequent than that in pregnancies without second-trimester decelerations (p < 0.001). There was a significant increase in the occurrence of premature rupture of the membranes (PROM; 60.0%) in pregnancies with second-trimester decelerations, when compared with events (37.1%) related to pregnancies without second-trimester decelerations (p < 0.05). There were no significant differences in the onset of breech presentation, cervical incompetency, preeclampsia and abnormal FHR pattern at birth between pregnancies with second-trimester decelerations and those without second-trimester decelerations. Pregnancies with PROM after second-trimester EFM were significantly more likely to have second-trimester decelerations than those without PROM (75.0 vs. 54.2%, p < 0.05).

CONCLUSION

Periodic or episodic decelerations during late second-trimester EFM were associated with an increased risk of the occurrence of PROM in pregnancies with preterm delivery before 32 weeks of gestation.