Unresectable esophageal cancer treated with multiple chemotherapies in combination with chemoradiotherapy: A case report

BACKGROUND

Definitive chemoradiotherapy (dCRT) using cisplatin plus 5fluorouracil (CF) with radiation is considered the standard treatment for unresectable locally advanced T4 esophageal squamous cell carcinoma (ESCC). Recently, induction chemotherapy has received attention as an effective treatment strategy.

CASE SUMMARY

We report a successful case of a 59-year-old female with unresectable locally advanced T4 ESCC treated by two additional courses of chemotherapy with CF after induction chemotherapy with docetaxel, cisplatin and fluorouracil (DCF) followed by dCRT. Initial esophagogastroduodenoscopy (EGD) detected a type 2 advanced lesion located on the middle part of the esophagus, with stenosis. Computed tomography detected the primary tumor with suspected invasion of the left bronchus and 90° of direct contact with the aorta, and upper mediastinal lymph node metastasis. Pathological findings from biopsy revealed squamous cell carcinoma. We initially performed induction chemotherapy using three courses of DCF, but the lesion was still evaluated unresectable after DCF chemotherapy. Therefore, we subsequently performed dCRT treatment (CF and radiation). After dCRT, prominent reduction of the primary tumor was recognized but a residual tumor with ulceration was detected by EGD. Since the patient had some surgical risk, we performed two additional courses of CF and achieved a clinically complete response. After 14 mo from last administration of CF chemotherapy, recurrence has not been detected by computed tomography and EGD, and biopsy from the scar formation has revealed no cancer cells.

CONCLUSION

We report successful case with tumor remnants even after DCF and subsequent dCRT, for whom a complete response was finally achieved with two additional courses of CF chemotherapy. Additional CF chemotherapy could be one radical treatment option for residual ESCC after treatment with induction DCF followed by dCRT to avoid salvage surgery, especially for high-risk patients.

A combination of ultrasound-guided rectus sheath and transversus abdominis plane blocks is superior to either block alone for pain control after gynecological transumbilical single incision laparoscopic surgery

PURPOSE

To investigate the efficacy of the combination of ultrasound-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks compared with TAP or RS block alone in gynecological single-incision laparoscopic surgery (SILS).

MATERIALS AND METHODS

Bilateral TAP blocks (Group A, n = 12), TAP and RS blocks (Group B, n = 12), and RS blocks (Group C, n = 12) with 40 ml ropivacaine/patient were performed for ovarian tumor SILS. The analgesic effects were evaluated using a numerical rating scale (NRS) at zero, six, 12, 24, and 48 hours post-surgery.

RESULTS

Umbilical pain on completion of general anesthesia was significantly less frequent in Group B (1/12) than Group A (7/12) (p = 0.03). The postoperative NRS scores were significantly lower in Group B than Group A at zero (p = 0.02) and six (p = 0.03) hours and Group C at zero (p = 0.001), six (p = 0.02), and 12 (p = 0.004) hours.

CONCLUSION

The combination of RS and TAP blocks reduced early postoperative pain compared with RS or TAP block alone for gynecological SILS.

Adjuvant radiotherapy after prostatectomy for prostate cancer in Japan: a multi-institutional survey study of the JROSG

In Japan, the use of adjuvant radiotherapy after prostatectomy for prostate cancer has not increased compared with the use of salvage radiotherapy. We retrospectively evaluated the outcome of adjuvant radiotherapy together with prognostic factors of outcome in Japan. Between 2005 and 2007, a total of 87 patients were referred for adjuvant radiotherapy in 23 institutions [median age: 64 years (54-77 years), median initial prostate-specific antigen: 11.0 ng/ml (2.9-284 ng/ml), Gleason score (GS): 6, 7, 8, 9, 10 = 13.8, 35.6, 23.0, 27.6, 0%, respectively]. Rates of positive marginal status, seminal vesicle invasion (SVI) and extra-prostatic extension (EPE) were 74%, 26% and 64%, respectively. Median post-operative PSA nadir: 0.167 ng/ml (0-2.51 ng/ml). Median time from surgery to radiotherapy was 3 months (1-6 months). A total dose of ≥ 60 Gy and <65 Gy was administered to 69% of patients. The median follow-up time was 62 months. The 3- and 5-year biochemical relapse-free survival (bRFS) rates for all patients were 66.5% and 57.1%, respectively. The GS and marginal status (P = 0.019), GS and SVI (P = 0.001), marginal status and EPE (P = 0.017), type of hormonal therapy and total dose (P = 0.026) were significantly related. The 5-year bRFS rate was significantly higher in SVI-negative patients than SVI-positive patients (P = 0.001), and significantly higher in patients with post-operative PSA nadir ≤ 0.2 than in patients with post-operative PSA nadir >0.2 (P = 0.02), and tended to be more favorable after radiotherapy ≤ 3 months from surgery than >3 months from surgery (P = 0.069). Multivariate analysis identified SVI and post-operative PSA nadir as independent prognostic factors for bRFS (P = 0.001 and 0.018, respectively).

Effectiveness of ultrasound-guided transversus abdominis plane block and rectus sheath block in pain control and recovery after gynecological transumbilical single-incision laparoscopic surgery

PURPOSE

To evaluate the effectiveness of ultrasound-guided transversus abdominis plane (TAP) and rectus sheath (RS) blocks in pain management and recovery after gynecological single-incision laparoscopic surgery (SILS).

MATERIALS AND METHODS

Abilateral TAP block (Group A, n = 9), bilateral TAP and RS blocks (Group B, n = 10), and a bilateral RS block (Group C, n = 9) with 40 ml ropivacaine per patient were conducted in 28 patients undergoing SILS for ovarian tumors. A pain score and walking distance in a 6-minute walk test (6MWT) were examined.

RESULTS

Pain scores were significantly lower on postoperative day (POD) 3 than on POD 1 in Groups B (p = 0.03) and C (p = 0.02). The walking distance on POD 3 was comparable with that before surgery in Group C (p = 0.75), but shorter in Groups A (p = 0.004) and B (p = 0.02).

CONCLUSIONS

The RS block alone was the most effective in relieving pain and accelerating general recovery after gynecological SILS.

Clinical characteristics of brain metastases from lung cancer according to histological type: Pretreatment evaluation and survival following whole-brain radiotherapy

The histological type of lung cancer in patients with brain metastases may affect response to treatment and survival. We evaluated the clinical characteristics of brain metastases from lung cancer according to histological type in 70 consecutive patients with brain metastases from histologically confirmed lung cancer, who had been previously treated with whole-brain radiotherapy (WBRT). Histological type was divided into three categories: adenocarcinoma, small-cell lung carcinoma (SCLC) and other non-small cell lung cancer (NSCLC). The number, size and maximum diameter of brain metastases, the size and maximum diameter of peritumoral edema, the ratio of tumor and peritumoral edema, the asymptomatic ratio, the tumor size reduction rate, the complete response (CR) rate, the intracranial progression-free survival (PFS) and the overall survival (OS) were also evaluated. The median survival time for all patients was 26.2 weeks. Patients with SCLC exhibited a significantly smaller edema size and maximum diameter of edema compared to patients with other NSCLC (P=0.016 and 0.010, respectively). The ratio of tumor and peritumoral edema was also significantly lower in patients with SCLC compared to that in patients with adenocarcinoma and other NSCLC (P= 0.001). Significant differences in intracranial PFS and OS between adenocarcinoma and other NSCLC were also observed (P=0.018 and 0.004, respectively). Patients with adenocarcinoma who were treated with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) following WBRT, demonstrated a significant improvement in intracranial PFS and OS (P=0.008 and 0.004, respectively). The findings presented in this study may provide useful information for the management of brain metastases. Patients with SCLC exhibit a tendency to develop peritumoral edema to a lesser extent, compared to patients with other histological tumor types. Findings in the present study suggest that patients with adenocarcinoma, particularly those treated with EGFR-TKIs, exhibit improved survival rates.

Re-irradiation for metastatic brain tumors with whole-brain radiotherapy

OBJECTIVE

To determine whether second whole-brain irradiation is beneficial for patients previously treated with whole-brain irradiation.

METHODS

A retrospective analysis was done for 31 patients with brain metastases who had undergone re-irradiation. Initial whole-brain irradiation was performed with 30 Gy/10 fractions for 87% of these patients. Whole-brain re-irradiation was performed with 30 Gy/10 fractions for 42% of these patients (3-40 Gy/1-20 fractions). Three patients underwent a third whole-brain irradiation.

RESULTS

The median interval between the initial irradiation and re-irradiation was 10 months (range: 2-69 months). The median survival time after re-irradiation was 4 months (range: 1-21 months). The symptomatic improvement rate after re-irradiation was 68%, and the partial and complete tumor response rate was 55%. Fifty-two percent of the patients developed Grade 1 acute reactions. On magnetic resonance imaging, brain atrophy was observed in 36% of these patients after the initial irradiation and 74% after re-irradiation. Grade ≥2 encephalopathy or cognitive disturbance was observed in 10 patients (32%) after re-irradiation. Based on univariate analysis, significant factors related to survival after re-irradiation were the location of the primary cancer (P = 0.003) and the Karnofsky performance status at the time of re-irradiation (P = 0.008). A Karnofsky performance status ≥70 was significant based on multivariate analysis (P = 0.050).

CONCLUSIONS

Whole-brain re-irradiation for brain metastases placed only a slight burden on patients and was effective for symptomatic improvement. However, their remaining survival time was limited and the incidence of cognitive disturbance was rather high.

Dietary intake of vitamin B12 and folic acid is associated with lower blood pressure in Japanese preschool children

BACKGROUND

An elevated plasma homocysteine level is an independent risk factor for high blood pressure and cardiovascular disease, and its level is regulated by three vitamins; vitamin B6, B12, and folic acid. Until now, the association between the intake of these vitamins and blood pressure has been examined only in adult populations. We purposed to examine the association between dietary intake of these three vitamins and blood pressure of young children.

METHODS

We conducted a cross-sectional study at Japanese preschools in 2006. Blood pressure was measured among 418 children aged 3-6 years. Diets including vitamins were assessed by a 3-day dietary record. We compared the blood pressure levels among the four groups defined according to quartile of energy-adjusted vitamin intake by using analysis of covariance after controlling for age, sex, and body mass index.

RESULTS

The mean systolic blood pressure was 6.6 mm Hg lower and the mean diastolic blood pressure was 5.7 mm Hg lower in the highest quartile than in the lowest quartile of vitamin B12 intake (P for trend was <0.001 and 0.006, respectively). The mean systolic blood pressure was 4.1 mm Hg lower in the highest quartile than in the lowest quartile of folic acid intake (P for trend = 0.004). Vitamin B6 intake was not significantly associated with blood pressure.

CONCLUSIONS

The data suggest that high intakes of folic acid and vitamin B12 are associated with lower levels of blood pressure among preschool children.

Definitive chemoradiotherapy of limited-disease small cell lung cancer: Retrospective analysis of new predictive factors affecting treatment results

The aim of this study was to evaluate potential predictive factors in the treatment of limited-disease small cell lung cancer (LD-SCLC). A total of 33 patients with LD-SCLC who underwent definitive chemoradiotherapy at our institute between April 1996 and May 2007 were enrolled in our retrospective study. The relationship between a range of potential predictive factors and the initial response, time to progression and pattern of failure was analyzed. The factors evaluated included the tumor markers Pro-gastrin-releasing peptide (Pro-GRP) and neuron-specific enolase; net tumor size (sum of each lesion mass on computed tomography at 1-cm intervals); total radiation dose; biological effective dose (BED); overall treatment time (OTT); time between the start of any type of treatment and the end of radiation therapy (SER). In addition, the novel factors of radiation dose-intensity (RDI = BED/OTT) and RDI/NTS (= RDI/net tumor size) were defined. Of the 33 patients evaluated in our study, 22 (67%) achieved a complete response (CR) and 27 (82%) experienced treatment failure or recurrence. High RDI/NTS values showed a significant correlation with CR (P=0.043). Prolonged OTT and lower values of RDI and RDI/NTS showed a significant correlation with recurrence within 12 months (P=0.022, 0.033 and 0.015, respectively). The lower values of RDI and RDI/NTS showed a significant correlation with distant metastasis as a first failure site (P=0.038 and 0.044, respectively). Patients with RDI/NTS ≥0.08 had a more favorable prognosis (P=0.045). Thus, RDI and RDI/NTS may become beneficial predictive factors in the treatment of LD-SCLC. However, further studies are required to confirm our preliminary results.

Relationship of intake of plant-based foods with 6-n-propylthiouracil sensitivity and food neophobia in Japanese preschool children

BACKGROUND/OBJECTIVES

Diets rich in plant-based foods such as vegetables, fruits and soy foods have been suggested to have beneficial effects on health. However, phytochemicals contained in plant-based foods are generally bitter and acrid. We investigated whether intake of vegetables, fruits and soy foods is associated with sensitivity to bitterness and reluctance to eat new foods (food neophobia) in Japanese preschool children.

SUBJECTS/METHODS

Subjects of this cross-sectional study were healthy Japanese, 167 boys and 156 girls, aged 4-6 years. Intake of vegetables, fruits and soy foods was estimated from 3-day dietary records. Subjects were classified as either tasters or non-tasters of 6-n-propylthiouracil (PROP) based on their ability to taste 0.56 mmol/l PROP. Information on each child's age, height, weight, food neophobia status and food variety, as well as maternal diet and parental control over the child's eating, was obtained by a parent-administered questionnaire. Food neophobia was assessed using the Child Food Neophobia Scale (CFNS).

RESULTS

A high intake of vegetables was significantly associated with a low CFNS score in boys after controlling for covariates (P=0.0008). Among the boys, soy food intake was significantly higher in PROP non-tasters than in tasters, except those with low CFNS scores (P=0.0019). High intake of soy foods was significantly associated with a low neophobia score in PROP tasters but not in non-tasters (P=0.0024).

CONCLUSIONS

These data suggest that sensitivity to bitter taste and food neophobia may influence the consumption of vegetables and soy foods among Japanese preschool boys.

Concurrent chemoradiotherapy with docetaxel for T2 laryngeal carcinoma

OBJECTIVE

To evaluate the efficacy and safety of concurrent chemoradiotherapy with docetaxel (DOC) for T2 laryngeal carcinoma.

METHOD

Twelve patients with T2 laryngeal cancer received concurrent chemoradiotherapy (60-70Gy) with weekly DOC (10 mg/m2) (CCRT group). The clinical files of the patients were retrospectively reviewed and survival rates and laryngeal preservation rates were analyzed compared with the group treated with conventional radiation therapy alone (RT group).

RESULTS

Complete response was observed in 11 of 12 patients (91.7%) in the CCRT group. Overall 5-year survival rates by Kaplan-Meier's method were 90% for the CCRT group and 78% for the RT group. The disease free survival with anterior commisure involvement was 90% in CCRT group and 53% in RT group, respectively. Toxicity over grade III was noticed in 3 patients.

CONCLUSION

Concurrent chemoradiotherapy with DOC is a feasible and effective treatment modality for organ preservation in T2 laryngeal cancer in the outpatient setting. Efficacy and safety of this treatment modality in an outpatient setting were discussed.

Activation of central 5HT2A receptors reduces the craniofacial nociception of rats

We assessed the contribution of central 5HT2A receptors to the craniofacial tissue nociception in naïve male rats. First, we tested whether activation of central 5HT2A receptors affected nociceptive neural activities recorded from superficial laminae of the trigeminal subnucleus caudalis (Vc)/upper cervical spinal cord junction (Vc/C2) region. Two types of units, such as deep-nociceptive or skin-wide dynamic range (WDR) units were identified from extracellular recordings. Topical administration of 5HT2A receptor agonist, (+/-)-2,5-dimethoxy-4-iodoamphetamine (DOI) onto the Vc/C2 region significantly reduced deep-nociceptive unit discharges evoked by formalin injection into the masseter muscle. Noxious pinch stimulation to the facial skin-evoked skin-WDR unit discharges was significantly reduced by topical administration of 0.1 mg/rat DOI onto the Vc/C2 region. Second, we tested whether i.c.v. administration of DOI affected Fos-like immunoreactivity (-LI) evoked by formalin injection into the masseter muscle. Fos-LI was significantly induced mainly at the ventrolateral (vl) area of trigeminal subnucleus interpolaris (Vi)/Vc junction (vl-Vi/Vc) region and Vc/C2 region in vehicle-treated rats. Formalin-evoked Fos-LI was significantly reduced in laminae I-II of the Vc/C2, but not vl-Vi/Vc region after i.c.v. administration of DOI. Finally, orofacial nocifensive behavioral activities evoked by formalin injection into the masseter muscle were significantly reduced by intracisternal administration of DOI. These results suggest that 5HT2A receptors in the Vc/C2 region mediate antinociceptive effects in the craniofacial nociception.

Efferent connections of the ventral auditory area in the rat cortex: implications for auditory processing related to emotion

In the rat auditory cortex, ventral (VA) and posterodorsal (PD) areas are the two major auditory fields that receive thalamic afferents from the dorsal division of the medial geniculate body (MGD). VA and PD are presumed to serve distinct functions in tandem as the pair of major cortical recipients of extralemniscal thalamic inputs. To deduce the functional significance of VA, efferent connections of VA were examined with the anterograde tracer biocytin. VA lies primarily in the ventral margin of area Te1 and represents frequencies primarily < 15 kHz [Donishi, T., Kimura, A., Okamoto, K. & Tamai, Y. (2006) Neuroscience, 141, 1553-1567.] Biocytin was iontophoretically injected into cortical regions which were defined as VA based on histological location, auditory response and thalamocortical connectivity. Anterograde labelling revealed two important aspects of cortical projections. First, VA sent a projection to a well-confined region in the caudal end of the insular cortex (Ins) pivotal for fear memory formation during aversive conditioning. Second, VA sent parallel projections to cortical regions that probably comprise the other nonprimary auditory fields, including PD. The results suggest that VA relays auditory input from the MGD to the Ins for affective memory formation and at the same time dispatches the auditory signal, which may represent emotional content, to the remaining nonprimary auditory fields. PD is assumed to play a pivotal role in auditory spatial processing for directed attention (Kimura et al., 2004). As the counterpart of PD, VA is assumed to give rise to another major stream of cortical information processing, most probably related to emotion.

Contribution of peripheral 5-HT2A or 5-HT3 receptors to Fos expression in the trigeminal spinal nucleus produced by acute injury to the masseter muscle during persistent temporomandibular joint inflammation in rats

We investigated the contribution of peripheral 5-HT2A or 5-HT3 receptors to Fos expression in the trigeminal spinal nucleus (VSP) following acute masseter muscle injury in male rats with or without temporomandibular joint (TMJ) inflammation persisting for 7 days. TMJ inflammation was evoked by an injection of complete Freund's adjuvant (CFA). Two hours after formalin injection into the masseter muscle produced Fos-like immunoreactivity (Fos-LI) in several regions of the VSP and upper cervical spinal cord (C2), such as ventrolateral (vl) area of the trigeminal subnucleus caudalis (Vc)/subnucleus interpolaris (Vi) transition (vl-Vi/Vc), paratrigeminal nucleus (dPa5), middle portion of the Vc (mid-Vc) and Vc/C2 transition (Vc/C2) regions in both groups. Significant increases in the number of Fos-LI were observed in these areas in CFA group compared with non-CFA group. TMJ inflammation alone did not induce a significant level of Fos-LI in the VSP. In order to assess the effect of antagonizing 5-HT2A or 5-HT3 receptors on formalin-induced Fos-LI, rats were pre-treated with local (masseter muscle) administration of ketanserin or tropisetron (0.01, 0.1 mg/rat) 20 min prior to formalin injection. In CFA group, these antagonists given locally reduced the Fos-LI response in the laminae I-II at the mid-Vc and Vc/C2 regions. These antagonists reduced the Fos-LI response in the dPa5, but not in the vl-Vi/Vc region. The Fos-LI response was not affected by i.v. administration of ketanserin (0.01, 0.1 mg/rat) or tropisetron (0.01 mg/rat). In non-CFA group, these antagonists given locally did not reduce the Fos-LI response. These results suggest that peripheral 5-HT2A and 5-HT3 receptors contribute to nociceptive processing in the masseter muscle in TMJ inflammatory conditions.

Efficient preparation of cationized gelatin for gene transduction

We previously reported gene therapy using cationized gelatin microspheres of φ20-32 μm, prepared from pig skin, as a transducing agent, but although the gelatin offered various advantages, its yield was extremely low (only 0.1%). In this study, we markedly improved the yield of φ20-32 μm cationized gelatin microspheres and prepared a newly less than φ20 μm cationized gelatin. Conventionally, cationized gelatin is prepared by cationization, particulation by agitation, and cross-linking. The yield is determined by the particulation step, for which we had used a three-necked distillation flask of 500 mL and an agitation speed of 420 rpm. The yield was significantly increased from 0.13 ± 0.02% to 8.80 ± 1.90% by using a smaller flask of 300 mL and an agitation speed of 25000 rpm (p ＜ 0.01). We could also prepare cationized gelatin of less than φ20 μm, which had not been possible previously. We confirmed that efficient gene introduction into peritoneal macrophages could be achieved with the new cationized gelatin.

Central serotonin 3 receptors play an important role in the modulation of nociceptive neural activity of trigeminal subnucleus caudalis and nocifensive orofacial behavior in rats with persistent temporomandibular joint inflammation

The role of central serotonin 3 receptors on neural activities recorded from superficial laminae of trigeminal subnucleus caudalis/upper cervical spinal cord junction region was investigated using rats with (Complete Freund's Adjuvant day 7 group) or without (non-Complete Freund's Adjuvant group) persistent temporomandibular joint inflammation evoked by Complete Freund's Adjuvant for 7 days. We identified two types of units, Deep-wide dynamic range units and Skin-wide dynamic range units from extracellular recordings. Deep-wide dynamic range units have mechanoreceptive fields in the deep craniofacial tissues including masseter muscle but do not have cutaneous mechanoreceptive fields. Deep-wide dynamic range unit discharges evoked by the formalin injection into masseter muscle were significantly enhanced in the late phase in Complete Freund's Adjuvant day 7 group. Discharges of Skin-wide dynamic range units evoked by the noxious pinch stimulation to facial skin in Complete Freund's Adjuvant day 7 group were significantly enhanced compared with those in non-Complete Freund's Adjuvant group. Topical administration of central serotonin 3 receptor antagonist, tropisetron, onto trigeminal subnucleus caudalis/upper cervical spinal cord junction region significantly reduced both formalin-evoked Deep-wide dynamic range unit and pinch-evoked Skin-wide dynamic range unit discharges in non-Complete Freund's Adjuvant and Complete Freund's Adjuvant day 7 groups significantly. The inhibitory effects of tropisetron on pinch-evoked Skin-wide dynamic range unit discharges were prolonged in Complete Freund's Adjuvant day 7 group compared with those in non-Complete Freund's Adjuvant group. The role of central serotonin 3 receptors in trigeminal subnucleus caudalis/upper cervical spinal cord junction region was also tested by orofacial formalin test in Complete Freund's Adjuvant day 7 group. Intracisternal administration of tropisetron decreased the orofacial nocifensive behavior in the late phase evoked by the injection of formalin into the masseter muscle. These results suggest that central serotonin 3 receptors in trigeminal subnucleus caudalis/upper cervical spinal cord junction region are involved in mediating pronociceptive effects in both superficial and deep craniofacial tissues nociception during persistent temporomandibular joint inflammation.

“Ventral” area in the rat auditory cortex: A major auditory field connected with the dorsal division of the medial geniculate body

The rat auditory cortex is made up of multiple auditory fields. A precise correlation between anatomical and physiological areal extents of auditory fields, however, is not yet fully established, mainly because non-primary auditory fields remain undetermined. In the present study, based on thalamocortical connection, electrical stimulation and auditory response, we delineated a non-primary auditory field in the cortical region ventral to the primary auditory area and anterior auditory field. We designated it as "ventral" area after its relative location. At first, based on anterograde labeling of thalamocortical projection with biocytin, ventral auditory area was delineated as a main cortical terminal field of thalamic afferents that arise from the dorsal division of the medial geniculate body. Cortical terminal field (ventral auditory area) extended into the ventral margin of temporal cortex area 1 (Te1) and the dorsal part of temporal cortex area 3, ventral (Te3V), from 3.2-4.6 mm posterior to bregma. Electrical stimulation of the dorsal division of the medial geniculate body; evoked epicortical field potentials confined to the comparable cortical region. On the basis of epicortical field potentials evoked by pure tones, best frequencies were further estimated at and around the cortical region where electrical stimulation of the dorsal division of the medial geniculate body evoked field potentials. Ventral auditory area was found to represent frequencies primarily below 15 kHz, which contrasts with our previous finding that the posterodorsal area, the other major recipient of the dorsal division of the medial geniculate body; projection, represents primarily high frequencies (>15 kHz). The posterodorsal area is thought to play a pivotal role in auditory spatial processing [Kimura A, Donishi T, Okamoto K, Tamai Y (2004) Efferent connections of "posterodorsal" auditory area in the rat cortex: implications for auditory spatial processing. Neuroscience 128:399-419]. The ventral auditory area, as the other main cortical region that would relay auditory input from the dorsal division of the medial geniculate body to higher cortical information processing, could serve an important extralemniscal function in tandem with the posterodorsal area. The results provide insight into structural and functional organization of the rat auditory cortex.

Pyruvate decarboxylase encoded by the PDC1 gene contributes, at least partially, to the decarboxylation of alpha-ketoisocaproate for isoamyl alcohol formation in Saccharomyces cerevisiae

Isoamyl alcohol is an important flavor component of yeast-fermented alcoholic beverages. To identify the enzyme and gene involved in the decarboxylation of alpha-ketoisocaproate (alpha-KIC) for isoamyl alcohol formation, the enzyme was partially purified and analyzed by mass spectrometry. The pyruvate decarboxylase encoded by the PDC1 gene was considered a likely candidate enzyme. Genetic analysis showed that the activity of alpha-KIC decarboxylase and production of isoamyl alcohol partially decreased in a pdc1 null mutant and increased in a transformant with a multi-copy plasmid carrying the PDC1 gene. These results indicate that pyruvate decarboxylase encoded by the PDC1 gene contributes, at least partially, to the decarboxylation of alpha-KIC for isoamyl alcohol formation.

Topography of projections from the primary and non-primary auditory cortical areas to the medial geniculate body and thalamic reticular nucleus in the rat

The functional significance of parallel and redundant information processing by multiple cortical auditory fields remains elusive. A possible function is that they may exert distinct corticofugal modulations on thalamic information processing through their parallel connections with the medial geniculate body and thalamic reticular nucleus. To reveal the anatomical framework for this function, we examined corticothalamic projections of tonotopically comparable subfields in the primary and non-primary areas in the rat auditory cortex. Biocytin was injected in and around cortical area Te1 after determining best frequency at the injection site on the basis of epicortical field potentials evoked by pure tones. The rostral part of area Te1 (primary auditory area) and area temporal cortex, area 2, dorsal (Te2D) (posterodorsal auditory area) dorsal to the caudal end of area Te1, which both exhibited high best frequencies, projected to the ventral zone of the ventral division of the medial geniculate body. The caudal end of area Te1 (auditory area) and the rostroventral part of area Te1 (a part of anterior auditory field), which both exhibited low best frequencies, projected to the dorsal zone of the ventral division of the medial geniculate body. In contrast to the similar topography in the projections to the ventral division of the medial geniculate body, collateral projections to the thalamic reticular nucleus terminated in the opposite dorsal and ventral zones of the lateral and middle tiers of the nucleus in each pair of the tonotopically comparable cortical subfields. In addition, the projections of the non-primary cortical subfields further arborized in the medial tier of the thalamic reticular nucleus. The results suggest that tonotopically comparable primary and non-primary subfields in the auditory cortex provide corticofugal excitatory effects to the same part of the ventral division of the medial geniculate body. On the other hand, corticofugal inhibition via the thalamic reticular nucleus may operate in different parts of the ventral division of the medial geniculate body or different thalamic nuclei. The primary and non-primary cortical auditory areas are presumed to subserve distinct gating functions for auditory attention.

The role of peripheral 5HT2A and 5HT1A receptors on the orofacial formalin test in rats with persistent temporomandibular joint inflammation

The role of peripheral serotonin (5HT) 2A and 5HT1A receptors on the orofacial nocifensive behavioral activities evoked by the injection of formalin into the masseter muscle was evaluated in the rats with persistent temporomandibular joint (TMJ) inflammation evoked by Complete Freund's Adjuvant (CFA). The orofacial nocifensive behavioral activities evoked by the injection of formalin into masseter muscle were significantly enhanced at 1 day (CFA day 1 group) or 7 days (CFA day 7 group) during TMJ inflammation. Pretreatment with local administration of 5HT2A receptor antagonist, ketanserin (0.01, 0.1 mg/rat) into the masseter muscle or systemic administration of ketanserin via i.p. injection (1 mg/kg) reduced the orofacial nocifensive behavioral activities of the late phase evoked by formalin injection into masseter muscle on the side of TMJ inflammation (CFA day 7 group). However, local (0.001-0.1 mg/rat) or systemic (1 mg/kg) administration of 5HT1A receptor antagonist, propranolol, into masseter muscle did not produce the antinociceptive effect in CFA day 7 group. Moreover, local administration of ketanserin (0.1 mg) or propranolol (0.1 mg) into masseter muscle did not inhibit nocifensive orofacial behavior in rats without TMJ inflammation. These data suggest that persistent TMJ inflammation causes the elevation of the orofacial nocifensive behavior, and peripheral 5HT2A receptors play an important role in mediating the deep craniofacial tissue nociception in rats with TMJ inflammation.

Allocation of 14C-carbon in two species of larch seedlings infected with ectomycorrhizal fungi

The flow of labeled carbon in ectomycorrhizal and non-ectomycorrhizal seedlings of Japanese larch (Larix kaempferi Sarg.) and its F1 hybrid (Larix gmelinii Rupr. x L. kaempferi) was studied. Larch seedlings were grown in a greenhouse for 110 days with larch forest soil (FM) or Suillus grevillei (SM) inoculum, or in the absence of ectomycorrhizal fungi (NM). Shoots of colonized and NM seedlings were exposed to a pulse of 14CO2 for 1 h under natural light. Seedlings were harvested following 0, 6 and 24 h of exposure to 14CO2. At the final harvest, SM seedlings of Japanese larch and hybrid larch allocated 2.6 and 2.5% more 14C, respectively, to roots than NM seedlings. In contrast, FM seedlings of Japanese larch and hybrid larch allocated 6.5 and 18.0% more 14C, respectively, to the stem than NM seedlings. Of the total 14C detected in needle, stem and root fractions, FM and SM seedlings allocated a greater proportion than NM seedlings, perhaps because FM and SM seedlings had significantly (P < 0.05) higher photosynthetic rates than NM seedlings. As a result, FM and SM seedlings had greater dry masses than NM seedlings. Concentrations of nitrogen and phosphorus in FM and SM seedlings were significantly (P < 0.05) higher than in NM seedlings, as was stomatal conductance.

Prediction of tumor control by tumor regression at 40 Gy/4 weeks of external beam irradiation for oropharyngeal carcinoma

PURPOSE

To predict tumor control on the basis of tumor regression at 40 Gy/4 weeks of external beam radiotherapy (EBRT) for oropharyngeal carcinoma.

METHODS

From 1990 to 1997, 55 patients (9 Stage I+II, 15 Stage III, and 31 Stage IV) with squamous cell carcinoma of the oropharynx were treated with curative EBRT (median dose, 66 Gy). Tumor response at 4 weeks was compared with loco-regional control.

RESULTS

The five-year loco-regional control rate was 52%. Regression of primary tumors was more rapid and occurred at a rate higher than that of nodal lesions; however, nodal response served as a superior predictor of tumor control. Predictive factors for loco-regional control were tumor stage, loco-regional response at 4 weeks, and pathological differentiation. Stage III and non-well-differentiated stage IV tumors demonstrating >50% regression at 4 weeks were controlled initially at 74% (17/23) and ultimately at 83% (19/23) by salvage therapy. In contrast, stage III+IV tumors displaying <50% regression and well-differentiated stage IV tumors exhibiting >50% regression were controlled initially at 9% (2/23) and ultimately at 22% (5/23).

CONCLUSION

Tumor regression at 40 Gy/4 weeks of EBRT is an important parameter in terms of prediction of loco-regional control for stage III and IV disease.

Topography of corticothalamic projections from the auditory cortex of the rat

Corticothalamic projections from cortical auditory field to the medial geniculate body (MG) in the rat were systematically examined by making small injections of biocytin in cortical area Te1. All injections, confined to 400 microm in diameter, resulted in two projections terminating in the ventral (MGV) and dorsal divisions (MGD) of the MG. The projections to the MGV were evidently topographic. The rostral and caudal portions of area Te1 projected to the ventromedial and dorsolateral parts of the MGV, respectively, forming narrow bands of terminal axons that extended in the mediolateral direction in the coronal plane of the MGV. The minimum dorsoventral width of the bands ranged approximately from 100 to 300 microm. Besides, the more rostral portion of area Te1 tended to project to the more rostral side of the MGV. The projections to the MGD consistently arborized in its ventral margin made up of the deep dorsal nucleus of the MGD. A similar weak topography along the rostrocaudal direction was observed in the projections to the MGD. Large terminals were occasionally found in the MGD after the injections involving cortical layer V. The distribution of large terminals also appeared topographic along with small terminals that were the major component of labeling. Collaterals of labeled axons produced slabs of terminal field in the thalamic reticular nucleus, which also exhibited a weak topography of distribution. These results provide insights into the structural basis of corticofugal modulations related to the tonotopic organizations in the cortex and MG.

Simultaneous expression of COX-2 and mPGES-1 in mouse gastrointestinal hamartomas

Cyclo-oxygenase (COX)-2 is induced in various types of cancer tissues. Here, we demonstrate stromal expression of both COX-2 and microsomal prostaglandin E₂ synthase (mPGES)-1 in gastrointestinal hamartomas developed in Lkb1^+/−, Smad4^+/− and Cdx2^+/−mice. These results suggest that PGE₂ produced by COX-2 and mPGES-1 plays an important role in hamartoma development regardless of the mutated genes causing hamartomas.

Efferent connections of “posterodorsal” auditory area in the rat cortex: Implications for auditory spatial processing

We examined efferent connections of the cortical auditory field that receives thalamic afferents specifically from the suprageniculate nucleus (SG) and the dorsal division (MGD) of the medial geniculate body (MG) in the rat [Neuroscience 117 (2003) 1003]. The examined cortical region was adjacent to the caudodorsal border (4.8-7.0 mm posterior to bregma) of the primary auditory area (area Te1) and exhibited relatively late auditory response and high best frequency, compared with the caudal end of area Te1. On the basis of the location and auditory response property, the cortical region is considered identical to "posterodorsal" auditory area (PD). Injections of biocytin in PD revealed characteristic projections, which terminated in cortical areas and subcortical structures that play pivotal roles in directed attention and space processing. The most noticeable cortical terminal field appeared as dense plexuses of axons in area Oc2M, the posterior parietal cortex. Small terminal fields were scattered in area frontal cortex, area 2 that comprises the frontal eye field. The subcortical terminal fields were observed in the pontine nucleus, the nucleus of the brachium inferior colliculus, and the intermediate and deep layers of the superior colliculus. Corticostriatal projections targeted two discrete regions of the caudate putamen: the top of the middle part and the caudal end. It is noteworthy that the inferior colliculus and amygdala virtually received no projection. Corticothalamic projections terminated in the MGD, the SG, the ventral zone of the ventral division of the MG, the ventral margin of the lateral posterior nucleus (LP), and the caudodorsal part of the posterior thalamic nuclear group (Po). Large terminals were found in the MGD, SG, LP and Po besides small terminals, the major component of labeling. The results suggest that PD is an auditory area that plays an important role in spatial processing linked to directed attention and motor function. The results extend to the rat findings from nonhuman primates suggesting the existence of a posterodorsal processing stream for auditory spatial perception.

Auditory thalamic nuclei projections to the temporal cortex in the rat

Thalamocortical projections from the auditory thalamic nuclei were examined systematically in the rat, including those from the dorsal division (MGD) of the medial geniculate body (MG), which were less clearly determined in previous studies. Injections of biocytin confined in each thalamic nucleus revealed characteristic features of projections in terms of cortical areas and layers of termination. In contrast to exclusively selective projections to cortical area Te1 from the ventral division (MGV) of the MG, diffuse and selective terminations were observed in the projections from the dorsal (MGD) and medial divisions (MGM) of the MG and the suprageniculate nucleus (SG). Diffuse termination was continuous in layer I or VI of the temporal cortex, while selective termination was in layers III and IV of discrete cortical areas. In addition to diffuse termination in the upper half of layer I of cortical areas Te1, Te2d and Te3v, the MGD and SG projections formed plexuses of axons selectively in lower layer III and layer IV of Te2d and Te3v. The SG projections targeted further the dorsal bank of the perirhinal cortex (PRh), while the MGD projections targeted in part the ventral fringe of Te1. The MGM projections terminated diffusely in layer VI of Te1 and Te3v, and selectively in lower layer III and layer IV of the rostral part of Te3v. Diffuse projections to layers I and VI from the SG and MGM extended in cortical regions over the dorsal fringe of Te1. Selective dense projections to middle cortical layers of Te2d and Te3v (especially its rostral part) indicate the existence of auditory areas, which could be involved in cross-modal interaction with visual and somatosensory system, respectively. Diffuse projections are supposed to bind information processings in these areas and the primary auditory area (Te1).

Peptides from the N-terminal end of bovine lactoferrin induce apoptosis in human leukemic (HL-60) cells

To determine the effects of the multifunctional iron-binding glycoprotein, lactoferrin (LF) and related compounds on the growth of leukemic cells, human myeloid leukemic cells (HL-60) were exposed to bovine lactoferrin (bLF) and proteolytic hydrolysates of bLF. Pepsin hydrolysates of bLF showed a greater growth suppressive effect than tryptic hydrolysates or mature bLF. Four peptides with proliferation inhibition activity were purified from pepsin hydrolysates by ion-exchange chromatography, reverse-phase HPLC, and gel-filtration. All peptides were from the N-terminal end, in a region where lactoferricin B (Lfcin B), an antibacterial peptide, is located. Among the four peptides, peptide 1 (pep1) was found to exhibit highest activity and corresponded to residues 17 to 38 of bLF, with a molecular weight of 2753.88. The IC50 value of this peptide was 6.3 micrograms/ml. Three other peptides were less active and corresponded to sequences 1 to 16 and 45 to 48, linked by disulfide-bridge (pep2, molecular mass of 2430.13), 1 to 15 and 45 to 46 linked by disulfide bridge (pep3, molecular mass of 2017,92) and from residues 1 to 13 (pep4, molecular mass of 1558.73). Cell proliferation inhibition activity of the peptides was thought to be due to induction of apoptosis, which was evaluated by DNA ladder formation, DNA fragmentation, enhanced expression of phosphatidyl serine, and morphological changes. The IC50 values of the three peptides were confirmed using synthetic peptides and were consistent with those of purified peptides.

Prognostic factors of reirradiation for recurrent head and neck cancer

We analyzed outcomes and prognostic factors to assess the value of reirradiation for recurrent head and neck cancer. Forty-four patients with recurrent squamous-cell carcinoma had undergone external beam reirradiation with cumulative dosing of more than 80 Gy. Six and 38 cases exhibited recurrent stage III and stage IV cancers, respectively. The complete response rate was 32%. Median relapse-free survival time was 4 months, and the 5-year survival was 6%. The major prognostic factor was anatomical location (p < 0.0001). Favorable sites were the nasopharynx, larynx, or oropharynx; unfavorable sites were the oral cavity, nasal cavity, or hypopharynx. Poorly differentiated cancer, no prior surgery, cumulative dose more than 125 Gy, and overlapping field less than 40 cm2 between the initial and reirradiation fields were also favorable factors. Multivariate analysis revealed that anatomical location and overlapping field were significant (0.001 and 0.019, respectively) in relapse-free survival. On exclusion of anatomical location from the analysis, history of prior surgery, and cumulative dose were significant (p = 0.002 and p = 0.023, respectively). Severe late complications occurred in only 1 of 14 (7%) patients followed up for longer than 1 year. Reirradiation would be indicative for nasopharyngeal, oropharyngeal, or laryngeal cancer with small overlapping field, or cancer receiving a cumulative dose more than 125 Gy without prior surgery.

Complications following re-irradiation for head and neck cancer

PURPOSE

Re-irradiation may induce serious complications because of overdosage to previously irradiated areas. A few reports do exist that describe the incidence and factors related to late complications. In the present study we analyze complications following re-irradiation for head and neck cancers.

MATERIALS AND METHODS

Between 1984 and 1998, 91 patients presenting with squamous cell carcinoma of the head and neck were re-irradiated with a total dose of 80-144 Gy and overlap fields of 4-128 cm(2). Re-irradiation was administered exclusively with external beam irradiation with conventional (n = 47), hyper- (n = 10), or hypofractionation (n = 34). Chemotherapy was combined with the initial course of irradiation (n = 34) or re-irradiation (n = 18). Follow-up time ranged from 3 to 84 months.

RESULTS

Severe acute reactions occurred in 6.6% of patients. Moreover, incidence was significantly higher (40%) in elderly patients older than 80 years. Severe late complications developed 3-10 months after re-irradiation. The incidence was 13% in 78 patients followed for more than 3 months and 21% in 42 patients with tumor-free status. The complications were observed in 19% of patients previously receiving locoregional irradiation, compared with those receiving local irradiation alone (0%), and in 20% of patients undergoing re-irradiation to the neck, compared with those receiving re-irradiation to the head (3%). These factors were all significant by multivariate analysis. Radiation dose, fractionation method, and overlap area were not significant.

CONCLUSION

Care should be exercised with respect to the potential for acute complications in elderly patients and late complications in those patients having previously received locoregional irradiation and re-irradiation to the neck.

Repetitive administration of tetrabenazine induces irreversible changes in locomotion and morphology of the substantia nigra in rats

We investigated the effects of a 7 day repetitive administration of tetrabenazine (TBZ), which depletes monoamines, on both locomotor behavior and histomorphometrial findings of substantia nigra in rats. These results were compared with the effects of a single dose of TBZ, which is a common paradigm in animal models of depression. A single dose of TBZ causes reversible decrease of voluntary movement and no histological changes. In contrast, as for repetitive administration, this experiment demonstrated irreversible and significant decrease in spontaneous locomotion, as well as histological changes in the neurons of the substantia nigra pars compacta. These results have led us to propose that prolonged TBZ administration could provide a novel and useful model for the behavioral characteristics and anatomical pathology of Parkinson's disease as one of the oxidative stress models induced by abnormal dopamine metabolism.

Outcome of acute lymphoblastic leukemia in children with AL90 regimen: impact of response to treatment and sex difference on prognostic factors

BACKGROUND

In our previous studies, the outcome of high-risk ALL was still poor. In the present study, all children with ALL were classified into three groups and treated with a new regimen (AL90).

PATIENTS AND METHODS

Between 1990 and 1996, 220 children with ALL, treated with the AL90 regimen, were classified into three risk groups: low, intermediate, and high: LR, IR, and HR, respectively. The protocol consisted of three- to five-drug induction, consolidation with intermediate-dose methotrexate and/or cytarabine, mercaptopurine and cyclophosphamide, four-drug intensification, and sequential maintenance therapies. Only intrathecal chemotherapy was used for CNS prophylaxis in the LR group, whereas cranial irradiation was added for the IR and HR groups.

RESULTS

The number of eligible patients was 91: LR group, 71: IR group, and 58: HR group. Complete remission (CR) was obtained in > 98% of the LR and IR groups, while only 88% achieved CR in the HR group. The 5-year event-free survival (EFS) rate was 67.4% in all patients: 70.4% in the LR group, 71.7% in the IR group, and 57.5% in the HR group. With respect to the previous study, EFS in the HR group who showed positive residual leukemia at 14 days was improved, whereas EFS in boys versus girls was significantly lower (48.8% : 85.7%, P = 0.02).

CONCLUSIONS

In high-risk ALL, the rate of induction failure was high and boys had a worse outcome, calling for improvements in induction therapy and a specific approach for boys.

Suppression of CYP3A2 mRNA expression in the warfarin-resistant roof rat, Rattus rattus: possible involvement of cytochrome P450 in the warfarin resistance mechanism

1. The continual use of warfarin as a rodenticide has caused the development of populations of warfarin-resistant roof rat. To study the biochemical mechanism of warfarin resistance, the mRNA expression levels of the major P450 forms in the warfarin-resistant and -susceptible roof rat liver following exposure to warfarin were quantified by competitive RT-PCR. 2. The constitutive levels of CYP2C11 and CYP3A2 mRNAs in the warfarin-resistant and -susceptible roof rat were extremely low compared with those in the STD rat. In response to warfarin administration, the CYP3A2 mRNA level in the warfarin-susceptible rat increased to about 3-fold of that before the treatment, whereas in the warfarin-resistant roof rat, CYP3A2 mRNA remained at a low level. 3. The present results suggest the possibility that reduced synthesis of CYP3A2 mRNA is involved in the warfarin-resistant mechanism in the roof rat.

Cloning of glycerol-3-phosphate dehydrogenase genes (ZrGPD1 and ZrGPD2) and glycerol dehydrogenase genes (ZrGCY1 and ZrGCY2) from the salt-tolerant yeast Zygosaccharomyces rouxii

The ZrGPD1 and ZrGPD2 genes encoding putative glycerol-3-phosphate dehydrogenases were isolated from the salt-tolerant yeast, Zygosaccharomyces rouxii. Both genes are homologous to GPD1 of Saccharomyces cerevisiae and are constitutively expressed in Z. rouxii cells. Putative glycerol dehydrogenase genes, ZrGCY1 and ZrGCY2, which are highly homologous to GCY1 of S. cerevisiae, were also isolated. Since the level of transcripts of ZrGCY1 and ZrGCY2 increased in Z. rouxii cells subjected to salt stress, it is suggested that the pathway of the signal transduction of salt stress controls the expression of these genes. The Accession Nos of these sequences in GenBank are as follows: ZrGPD1, AB047394; ZrGPD2, AB047395; ZrGCY1, AB047396; ZrGCY2, AB047397.

A gene encoding a hydrophobin, fvh1, is specifically expressed after the induction of fruiting in the edible mushroom Flammulina velutipes

A cDNA clone of the gene fvh1 was previously isolated from a preprimordial cDNA library made from the basidiomycete Flammulina velutipes. Sequence analysis showed that fvh1 encoded for a hydrophobin, a small fungal protein usually secreted by filamentous fungi. FVH1 had a highly conserved arrangement of eight cysteine residues, a putative N-terminal signal sequence and a hydropathy pattern characteristics of class I hydrophobin. A genomic fvh1 clone was isolated from a F. velutipes genomic DNA library and sequenced. Several putative promoter elements and three small introns of fvh1 were identified in this clone. Southern blot analysis of genomic DNA showed that fvh1 was a single copy gene. Northern analysis indicated that fvh1 was specifically and abundantly expressed in mycelia after the induction of fruiting and during fruit body initiation. It was not expressed in mycelia before the induction of fruiting or in mature fruit bodies.

HO gene polymorphism in Saccharomyces industrial yeasts and application of novel HO genes to convert homothallism to heterothallism in combination with the mating-type detection cassette

Southern blot analysis of industrial yeasts showed that all top-fermenting yeasts, distiller's yeasts and a proportion of wine yeasts tested in the present study produced a hybridization signal (approximately 7 kb), corresponding to a Saccharomyces cerevisiae-type HO gene (Sc-HO). It also showed that bottom-fermenting yeasts gave rise to 7-kb and 4-kb hybridization signals, corresponding to the Sc-HO gene and the lager yeast HO gene (Lg-HO), respectively. Two wine yeasts produced a 4-kb hybridization signal, corresponding to Lg-HO; and one wine yeast produced 2.5-kb and 1.5-kb hybridization bands, corresponding to a S. uvarum-type HO gene (Uv-HO). Partial nucleotide sequences of HO genes amplified from these wine yeasts perfectly matched those of Lg-HO and Uv-HO, respectively. HO disruption vectors were constructed by inserting a dominant selective marker PGK1p-neo and the mating-type detection cassette MFalpha1p-PHO5 within the Lg-HO or Uv-HO gene. From transformants carrying a single-disrupted ho gene, mating-competent progenies were easily obtained through meiosis. Moreover, mating-competent derivatives appearing at very low frequency could be obtained from a double-disrupted ho transformant without meiosis (even from a wine yeast lacking sporulation ability), because the sensitive phosphatase-staining method allowed detection of the Pho+ mating-competent derivatives from confluent colonies by the random spore method. Our study describes a rapid and convenient method for isolating mating-competent clones from industrial yeasts.

Long-term outcome of treatment with protocols AL841, AL851, and ALHR88 in children with acute lymphoblastic leukemia: results obtained by the Kyushu-Yamaguchi Children's Cancer Study Group

We analyzed the long-term outcome and late effects of treatment in 187 patients with childhood acute lymphoblastic leukemia (ALL) diagnosed between 1984 and 1990. Overall survival and event-free survival rates were 68.2% +/- 3.7% and 63.2% +/- 3.6% at 15 years, respectively. Of 55 patients who relapsed after achieving the first complete remission (CR), only 17.4% were rescued by salvage therapy. The advantage of stem cell transplantation over chemotherapy was observed only in those patients with bone marrow relapse during therapy. The SD for score height in patients maintaining the first CR significantly decreased at the time of final follow-up compared with that at diagnosis: 0.059 to -0.800 (P < .0001). The decrease was remarkable in patients younger than 5 years at diagnosis. Other late effects included mild liver dysfunction in 18% and hepatitis C virus infection in 9%. Congestive heart failure was observed in only 2.9% of patients despite the high cumulative dose of daunorubicin (450 mg/m2). Although the survival rates of patients on our protocols were comparable to those of other study groups, some modification, including reduction in dose of cranial irradiation and/or anticancer drugs, should be considered to reduce late adverse effects in survivors of childhood ALL.

Neurotrophic effects of FPF-1070 (Cerebrolysin) on cultured neurons from chicken embryo dorsal root ganglia, ciliary ganglia, and sympathetic trunks

We examined the effect of FPF-1070 (Cerebrolysin) on neurite outgrowth in explant cultures of dorsal root ganglia (DRG), sympathetic trunks (ST), and ciliary ganglia (CG) from 10- to 11-day chicken embryos. FPF-1070 significantly promoted neurite outgrowth in DRG and ST neurons at all concentrations examined, in comparison with phosphate buffered saline-treated negative controls; however, this effect on neurite outgrowth was not as significant as that observed for nerve growth factor-treated positive controls on DRG and ST neurons. Additionally, FPF-1070 exhibited an inverted U relationship between concentration and effectiveness in DRG and ST neurons. In contrast, FPF-1070 did not affect neurite outgrowth in CG neurons although ciliary neurotrophic factor-treated positive controls showed striking neurite outgrowth. Our results demonstrate that FPF-1070 has different neurotrophic effects depending on the subpopulation of neurons. This study clarifies a role for neurotrophic activity in the mechanism of action of FPF-1070.

Mouse Wnt receptor gene Fzd5 is essential for yolk sac and placental angiogenesis

Wnts are secreted signaling molecules implicated in various developmental processes and frizzled proteins are the receptors for these Wnt ligands. To investigate the physiological roles of frizzled proteins, we isolated and characterized a novel mouse frizzled gene Fzd5. Fzd5 mRNA was expressed in the yolk sac, eye and lung bud at 9.5 days post coitum. Fzd5 specifically synergized with Wnt2, Wnt5a and Wnt10b in ectopic axis induction assays in Xenopus embryos. Using homologous recombination in embryonic stem cells, we have generated Fzd5 knockout mice. While the heterozygotes were viable, fertile and appeared normal, the homozygous embryos died in utero around 10.75 days post coitum, owing to defects in yolk sac angiogenesis. At 10.25 days post coitum, prior to any morphological changes, endothelial cell proliferation was markedly reduced in homozygous mutant yolk sacs, as measured by BrdU labeling. By 10.75 days post coitum, large vitelline vessels were poorly developed, and the capillary plexus was disorganized. At this stage, vasculogenesis in the placenta was also defective, although that in the embryo proper was normal. Because Wnt5a and Wnt10b co-localized with Fzd5 in the developing yolk sac, these two Wnts are likely physiological ligands for the Fzd5-dependent signaling for endothelial growth in the yolk sac.