Gastrectomy with or without omentectomy for cT3–4 gastric cancer: a multicentre cohort study

Background

Omentectomy is performed widely for locally advanced gastric cancer to prevent disease recurrence. However, its clinical benefit is unknown.

Methods

This retrospective cohort study compared the outcome of gastrectomy with preservation of the omentum (GPO) and gastrectomy with resection of the omentum (GRO) among patients with cT3–T4 gastric cancer who underwent gastrectomy between 2006 and 2012 in one of five participating institutions. A consensus conference identified 28 variables potentially associated with outcome after gastrectomy for the estimation of propensity scores, and propensity score matching (PSM) was undertaken to control for possible confounders. Postoperative surgical outcomes, overall survival and disease recurrence were compared between GPO and GRO.

Results

A total of 1758 patients were identified, of whom 526 remained after PSM, 263 in each group. Median follow-up was 4·9 (i.q.r. 3·1–5·9) years in the GRO group and 5·0 (2·5–6·8) years in the GPO group. The incidence of postoperative complications of Clavien–Dindo grade III or more was significantly higher in the GRO group (17·5 versus 10·3 per cent; P = 0·016). Five-year overall survival rates were 77·1 per cent in the GRO group and 79·4 per cent in the GPO group (P = 0·749). There were no significant differences in recurrence rate or pattern of recurrence between the groups.

Conclusion

Overall survival and disease recurrence were comparable in patients with cT3–4 gastric cancer who underwent GPO or GRO.

Impact of the Number of Lymph Nodes Examined on Differences in Survival for Surgically Treated Gastric Cancer Patients Between the US and Japan Using Nationwide Databases

Background: Although incidence and mortality have decreased, gastric cancer (GC) is still a public health issue globally. The international collaborative study for cancer survival using population-based cancer registry showed that the survival of GC was higher in Korea and Japan than other countries, including the United States of America (US). Aim: We examined the determinant factors of the high survival in Japan, compared with the US, with particular focus on the impact of the number of lymph nodes (LNs) examined for surgically treated patients. Methods: We obtained data on 88,447 cases from the nationwide GC registration project, the Japanese Gastric Cancer Association (JGCA), from 2004-2007. We also obtained 18,995 GC cases from US population-based cancer registry data from the Surveillance, Epidemiology, and End Results Program (SEER), diagnosed from 2004-2010. We estimated five-year relative survival and applied a multivariate excess hazard model to compare the two countries. We considered the effect of LNs examined on differences in survival. Results: Five-year relative survival in Japan was 79.8%, compared with 40.1% in the US. After controlling for confounding factors, we still observed significantly higher survival in Japan. The distribution of number of LNs examined showed notable differences between two countries. In over 50% of patients in the US, only 1 to 15 LNs were examined. A higher number of LNs examined showed better survival in both countries. The differences in excess death from cancer between countries were reduced in the category when more than 30 LNs were examined. Conclusion: Although it is difficult to remove biases to compare the two countries, stage migration, related to the more detailed retrieving strategy for LNs in Japan, is a key explanation for high survival in Japan.

12-OH-17,18-Epoxyeicosatetraenoic acid alleviates eosinophilic airway inflammation in murine lungs

BACKGROUND

Asthma is characterized by airway inflammation and obstruction with eosinophil infiltration into the airway. Arachidonic acid, an omega-6 fatty acid, is metabolized into cysteinyl leukotriene with pro-inflammatory properties for allergic inflammation, whereas the omega-3 fatty acid eicosapentaenoic acid (EPA) and its downstream metabolites are known to have anti-inflammatory effects. In this study, we investigated the mechanism underlying the counter-regulatory roles of EPA in inflamed lungs.

METHODS

Male C57BL6 mice were sensitized and challenged by ovalbumin (OVA). After EPA treatment, we evaluated the cell count of Bronchoalveolar lavage fluid (BALF), mRNA expressions in the lungs by q-PCR, and the amounts of lipid mediators by liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based lipidomics. We investigated the effect of the metabolite of EPA by in vivo and in vitro studies.

RESULTS

Eicosapentaenoic acid treatment reduced the accumulation of eosinophils in the airway and decreased mRNA expression of selected inflammatory mediators in the lung. Lipidomics clarified the metabolomic profile in the lungs. Among EPA-derived metabolites, 12-hydroxy-17,18-epoxyeicosatetraenoic acid (12-OH-17,18-EpETE) was identified as one of the major biosynthesized molecules; the production of this molecule was amplified by EPA administration and allergic inflammation. Intravenous administration of 12-OH-17,18-EpETE attenuated airway eosinophilic inflammation through downregulation of C-C chemokine motif 11 (CCL11) mRNA expression in the lungs. In vitro, this molecule also inhibited the release of CCL11 from human airway epithelial cells stimulated with interleukin-4.

CONCLUSION

These results demonstrated that EPA alleviated airway eosinophilic inflammation through its conversion into bioactive metabolites. Additionally, our results suggest that 12-OH-17,18-EpETE is a potential therapeutic target for the management of asthma.

Circulatory CNP Rescues Craniofacial Hypoplasia in Achondroplasia

Achondroplasia is the most common genetic form of human dwarfism, characterized by midfacial hypoplasia resulting in occlusal abnormality and foramen magnum stenosis, leading to serious neurologic complications and hydrocephalus. Currently, surgery is the only way to manage jaw deformity, neurologic complications, and hydrocephalus in patients with achondroplasia. We previously showed that C-type natriuretic peptide (CNP) is a potent stimulator of endochondral bone growth of long bones and vertebrae and is also a potent stimulator in the craniofacial region, which is crucial for midfacial skeletogenesis. In this study, we analyzed craniofacial morphology in a mouse model of achondroplasia, in which fibroblast growth factor receptor 3 (FGFR3) is specifically activated in cartilage ( Fgfr3^ach mice), and investigated the mechanisms of jaw deformities caused by this mutation. Furthermore, we analyzed the effect of CNP on the maxillofacial area in these animals. Fgfr3^ach mice exhibited midfacial hypoplasia, especially in the sagittal direction, caused by impaired endochondral ossification in craniofacial cartilage and by premature closure of the spheno-occipital synchondrosis, an important growth center in craniomaxillofacial skeletogenesis. We crossed Fgfr3^ach mice with transgenic mice in which CNP is expressed in the liver under the control of the human serum amyloid-P component promoter, resulting in elevated levels of circulatory CNP ( Fgfr3^ach/SAP-Nppc-Tg mice). In the progeny, midfacial hypoplasia in the sagittal direction observed in Fgfr3^ach mice was improved significantly by restoring the thickness of synchondrosis and promoting proliferation of chondrocytes in the craniofacial cartilage. In addition, the foramen magnum stenosis observed in Fgfr3^ach mice was significantly ameliorated in Fgfr3^ach/SAP-Nppc-Tg mice due to enhanced endochondral bone growth of the anterior intraoccipital synchondrosis. These results clearly demonstrate the therapeutic potential of CNP for treatment of midfacial hypoplasia and foramen magnum stenosis in achondroplasia.

Development and external validation of a nomogram for overall survival after curative resection in serosa-negative, locally advanced gastric cancer

BACKGROUND

Few nomograms can predict overall survival (OS) after curative resection of advanced gastric cancer (AGC), and these nomograms were developed using data from only a few large centers over a long time period. The aim of this study was to develop and externally validate an elaborative nomogram that predicts 5-year OS after curative resection for serosa-negative, locally AGC using a large amount of data from multiple centers in Japan over a short time period (2001-2003).

PATIENTS AND METHODS

Of 39 859 patients who underwent surgery for gastric cancer between 2001 and 2003 at multiple centers in Japan, we retrospectively analyzed 5196 patients with serosa-negative AGC who underwent Resection A according to the 13th Japanese Classification of Gastric Carcinoma. The data of 3085 patients who underwent surgery from 2001 to 2002 were used as a training set for the construction of a nomogram and Web software. The data of 2111 patients who underwent surgery in 2003 were used as an external validation set.

RESULTS

Age at operation, gender, tumor size and location, macroscopic type, histological type, depth of invasion, number of positive and examined lymph nodes, and lymphovascular invasion, but not the extent of lymphadenectomy, were associated with OS. Discrimination of the developed nomogram was superior to that of the TNM classification (concordance indices of 0.68 versus 0.61; P < 0.001). Moreover, calibration was accurate.

CONCLUSIONS

We have developed and externally validated an elaborative nomogram that predicts the 5-year OS of postoperative serosa-negative AGC. This nomogram would be helpful in the assessment of individual risks and in the consideration of additional therapy in clinical practice, and we have created freely available Web software to more easily and quickly predict OS and to draw a survival curve for these purposes.

Recanalization of post-transplant late-onset long segmental portal vein thrombosis with bidirectional transhepatic and transmesenteric approach

PV complications are the most frequent vascular complications in pediatric LT. We have experienced a case with chronic postoperative PVT that necessitates combined transhepatic and transmesenteric approach and have confirmed mid-term patency. An eight-yr-old boy had successful LDLT with a left lateral segment graft at the age of two months for HBV-related acute liver failure. Seven years after transplantation, the patient suddenly showed a melena with hypovolemic shock. Doppler ultrasound and CT revealed intrahepatic bile duct dilatation and main PVT with collateral formation at hepatic hilus and mesenterium of the Roux-en-Y jejunal loop. Urgent splenic artery embolization was performed to control the bleeding and was temporarily effective. Therefore, recanalization of PVO was attempted. Because of long segmental PVO and steep angle between the intrahepatic PV and the portal trunk, bidirectional transhepatic and transmesenteric approach was selected and resulted in deploying three metallic stents necessitating additional infusion thrombolytic therapy. The patient is now followed as an outpatient with patent stents for two yr since the procedure. For the rescue of these patients, recanalization of obstructed PV trunk with bidirectional approach would be feasible with better graft survival and less invasiveness than conventional surgical interventions.

The effects of C-type natriuretic peptide on craniofacial skeletogenesis

C-type natriuretic peptide (CNP) is a potent stimulator of long bone and vertebral development via endochondral ossification. In the present study, we investigated the effects of CNP on craniofacial skeletogenesis, which consists of both endochondral and membranous ossification. Morphometric analyses of crania from CNP knockout and transgenic mice revealed that CNP stimulates longitudinal growth along the cranial length, but does not regulate cranial width. CNP markedly increased the length of spheno-occipital synchondrosis in fetal murine organ cultures, and the thickness of cultured murine chondrocytes from the spheno-occipital synchondrosis or nasal septum, resulting in the stimulation of longitudinal cranial growth. Mandibular growth includes endochondral and membranous ossification; although CNP stimulated endochondral bone growth of condylar cartilage in cultured fetal murine mandibles, differences in the lengths of the lower jaw between CNP knockout or transgenic mice and wild-type mice were smaller than those observed for the lengths of the upper jaw. These results indicate that CNP primarily stimulates endochondral ossification in the craniofacial region and is crucial for midfacial skeletogenesis.

Sialyl-lewis-x antigen immunoreaction of colorectal-cancer and its relationship to hematogenous metastasis

The adhesion of cancer cells to endothelial cells of the target organ is one of the most important steps of hematogenous metastasis. Especially, sialyl Le(X) plays an important role in defining the metastasis. The expression of sialyl Le(X) antigen in colorectal cancer and its usefulness not only as an indicator of metastatic potential but also as a prognostic factor was studied immunohistochemically. Fifty-five (32.4%) sialyl Le(X) antigen-positive tumors were found in 170 colorectal cancers. There was a significant correlation between the expression of sialyl Le(X) antigen and the histological tumor type, venous invasion, lymph node metastasis, as well as liver metastasis. Hematogenous metastases were significantly more frequent in patients with sialyl Le(X)-positive tumor than in those with sialyl Le(X)-negative tumor; and prognosis was significantly poorer in the former. The results suggest that sialyl Le(X) antigen plays a role in hematogenous metastasis of colorectal cancer, and that the expression of sialyl Le(X) is associated with poor prognosis.

Central nervous system is a sanctuary site for chronic myelogenous leukaemia treated with imatinib mesylate

Imatinib mesylate (IM) is currently used as the first therapeutic choice against chronic myelogenous leukaemia (CML). Because IM poorly penetrates the blood-brain barrier, IM-treated CML patients may have a potential risk of central nervous system (CNS) involvement. Here we report a case with lymphoid blast crisis isolated only in CNS after bacterial meningitis, although the patient achieved and maintained complete cytogenetic response by IM therapy. It is important to consider isolated CNS blast crisis as a possible event in IM-treated CML patients.

Frequent STAT3 activation is associated with Mcl-1 expression in nasal NK-cell lymphoma

Nasal natural killer (NK)-cell lymphoma was resistant to various antitumor agents. Although high expression of p-glycoprotein has been reported, other molecular mechanism of the chemo-resistance is largely unknown. Activation of STAT3 and expression of major apoptosis-related proteins Bcl-2, Bcl-x, and Mcl-1 were analyzed by immunohistochemistry. Effects of STAT3 inhibitor AG490 on NK-YS cell line were analyzed by Western blotting and flow cytometric apoptosis assay. STAT3 was activated in six of the nine nasal NK-cell lymphomas (67%). In contrast, STAT3 activation was detected in 35% of diffuse large B-cell lymphoma (DLBCL) and in 10% of follicular lymphoma (FL). Frequent activation of STAT3 was significantly correlated with Mcl-1 expression in nasal NK-cell lymphoma, i.e., Mcl-1 was positive in five of six STAT3-active cases and negative in all three STAT3-inactive ones. In DLBCL, not only six out of seven STAT3-active cases (86%) but also eight out of thirteen STAT3-inactive cases (62%) were positive for Mcl-1 expression. Latent membrane protein-1 was positive in four nasal NK-cell lymphomas, among which three cases showed intermediate STAT3 activation. Inhibition of STAT3 activation by JAK inhibitor AG490 decreased Mcl-1 expression and induced apoptosis in STAT3-active NK-YS cells. Serum starvation rather increased the Mcl-1 level in NK-YS cells, and this effect was also canceled by AG490. These results suggest that activation of STAT3-Mcl-1 axis may play a role in the chemotherapy resistance of nasal NK-cell lymphoma. The pathway may be one of the future therapeutic targets of this intractable disease.

Spontaneous regression of natural killer cell lymphoma

Spontaneous tumour regression is extremely rare in aggressive lymphoma. A case of natural killer (NK) cell lymphoma with cutaneous manifestation showed an indolent clinical course, and the relapsed nodular lesion disappeared spontaneously without any treatment. Although only small number of T cells were present in the primary skin lesion, there was massive CD8-positive cytotoxic T cell infiltration in the relapsed lesion. This is believed to be the first report of an abscopal effect on NK cell lymphoma. Infiltration of cytotoxic T cells strongly suggests immunological attack against the lymphoma cells.

Phase I/II study of concurrent chemoradiotherapy for localized nasal NK/T-cell lymphoma: Final results of JCOG0211

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Background: Nasal NK/T-cell lymphoma is rare and its standard therapy has not been established. Tumor cells express P-glycoprotein concerning multi-drug resistance (MDR). Anthracycline-containing chemotherapy is not effective and %2-yr overall survival (OS) of radiotherapy (RT) alone is only 45%. Methods: To explore a more effective treatment for localized nasal NK/T-cell lymphoma, we conducted a phase I/II study of concurrent chemoradiotherapy consisted of 50 Gy of RT and 3 courses of DeVIC [carboplatin (CBDCA), etoposide (ETP), ifosfamide (IFM), dexamethasone (DMS)]. Patients (Pts) with newly-diagnosed, localized (IE & contiguous IIE with cervical node involvement) diseases, 20–69 years of age and PS 0–2 were eligible. The 3-D conformal RT planning was required to cover adequately target volumes (2 cm margin to gross tumor, entire nasal cavities and nasopharynx) and to minimize doses to organs at risk. Primary endpoint of the phase II portion was 2-yr OS and the enrollment of 24 pts to the phase II portion was planned. Based on the results of the phase I portion (ASH 2005, #2685), 2/3-dose of DeVIC (CBDCA 200mg/m2 d1 IV, ETP 67mg/m2 d1–3 IV, IFM 1.0g/m2 d1–3 IV, DMS 40mg/body d1–3 IV; every 3 wks) was applied for the phase II portion. RT quality assurance review confirmed no protocol violation (ASTRO 2008, #2682). Results: From Sep 2003 to Dec 2006, 33 pts were enrolled in the phase I/II study. 27 pts evaluated in the phase II portion showed the following features: age 21–68 yrs (median 56), M:F=17:10, stage IE 18, stage IIE 9, B symptom (+) 10, elevated serum LDH 5, PS2 2. With a median follow-up of 32 months (range, 24–62), %2-yr OS was 78% (95% CI, 57–89). Of 26 pts evaluable for response, 20 achieved CR, 1 PR, 2SD, and 3PD. %CR and %ORR were 77% (95% CI, 56–91) and 81%, respectively. The most common grade 3 non-hematologic toxicities were mucositis due to RT (30%) and infection (30%). Grade 4 hyponatremia and dermatitis due to RT were observed in each 1 pt. No treatment-related death was observed. Conclusions: Concurrent chemoradiotherapy using MDR-non-related agents and ETP is a safe and effective treatment for localized nasal NK/T-cell lymphoma, providing the basis for subsequent studies.

No significant financial relationships to disclose.

Potential prognostic benefits of radiotherapy as an initial treatment for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels

OBJECTIVES

To examine the efficacy and prognostic benefits of radiotherapy (RT) in patients who have unresectable advanced hepatocellular carcinoma (HCC) with invasion to intrahepatic large vessels (IHLVs).

METHODS

Sixty-eight patients who had advanced HCC with invasion to IHLVs were studied. Thirty-two consecutive patients initially received 3-dimensional conformal RT for HCC invasion to IHLVs. Tumor response, prognostic factors, and survival were studied in the patients given RT. Prognostic factors and survival were assessed in the study group as a whole. Data were analyzed using the Kaplan-Meier method, univariate analysis, and a Cox model.

RESULTS

The rate of objective response to RT was 48%. Predictors of survival in the patients who received RT were a hepatic function of Child-Pugh class A (p = 0.0263) and a response to RT (p = 0.0121). In the study group as a whole, independent predictors of survival in a Cox model were multinodular HCC (p = 0.007), inferior vena caval invasion (p = 0.001), a serum alpha-fetoprotein level of >1,000 ng/ml (p = 0.032), and the performance of RT (p < 0.001). Notably, the median survival of the nonresponders to RT (n = 15) was significantly longer than that of the patients who received no treatment for HCC (n = 21; 7.0 vs. 3.4 months, p = 0.0014).

CONCLUSION

RT is considered an effective initial treatment for HCC invasion to IHLVs, and may offer survival benefits, even in nonresponders, because of the induction of stable disease.

Superior mesenteric venous thrombosis treated by direct aspiration thrombectomy

A 69-year-old man, with hepatits C virus-related liver cirrhosis and hemophilia B, developed massive ascites and watery diarrhea after endoscopic injection sclerotherapy for esophageal varices. A multi detector row computed tomography revealed a superior mesenteric venous thrombus without bowel infarction. It was assumed that the thrombus was caused by transient congestion of the portal system after retrograde propagation of the sclerosant agent, in a condition where anticoagulation proteins, such as proteins C and S, had decreased. Because long systemic thrombolytic therapy was hazardous for the patient with hemorrhagic diathesis due to impaired coagulation, a direct thrombolysis was performed with urokinase followed by aspiration thrombectomy, with cannulation of the portal venous system using a transjugular intrahepatic approach. The patient had no complications in this procedure and subsequently diarrhea and refractory ascites were resolved. Direct thrombectomy via the transjugular intrahepatic route may be a useful therapy for mesenteric venous thrombus in the cirrhotic patient.

Stent-graft to treat intrahepatic portosystemic venous shunt causing encephalopathy

Spontaneous intrahepatic portosystemic venous shunts (IPSVS) are rare, and angiographic intervention to treat IPSVS has been limited. To our knowledge, we present the first case of an IPSVS between the right portal vein and inferior vena cava accompanied by intractable encephalopathy that was successfully obliterated using a stent-graft deployed in the inferior vena cava to disconnect the portal and systemic venous circulation. Our patient, a 58-year-old woman, has shown no evidence of recurrent portosystemic venous shunt or encephalopathy for 30 months. We believe this intervention to be a useful alternative therapy for this type of shunt.

Hsp90-inhibitor geldanamycin abrogates G2 arrest in p53-negative leukemia cell lines through the depletion of Chk1

Checkpoint protein Chk1 has been identified as an Hsp90 client. Treatment with 100 nM geldanamycin (GM) for 24 h markedly reduced the Chk1 amount in Jurkat and ML-1 leukemia cell lines. Because Chk1 plays a central role in G2 checkpoint, we added GM to G2-arrested Jurkat and HL-60 cells pretreated with 50 nM doxorubicin for 24 h. GM slowly released both cell lines from doxorubicin-induced G2 arrest into G1 phase. GM also abrogated ICRF-193-induced decatenation G2 checkpoint in Jurkat and HL-60 cells. Western blot analysis showed that addition of GM attenuates doxorubicin- and ICRF-193-induced Chk1 phosphorylation at Ser345. GM, however, failed to abrogate G2 arrest in p53-positive ML-1 cells maybe due to the p21 induction. GM released HeLa cells from doxorubicin-induced G2 arrest but trapped them at M phase. Flow cytometric analysis showed that addition of GM converted doxorubicin-induced necrosis into apoptosis in Jurkat cells. Colony assay indicated that although GM has a weak cytotoxic effect as a single agent, it dramatically intensifies the cytotoxicity of doxorubicin and ICRF-193 in Jurkat and HL-60 cells. These results suggest that abrogation of G2 checkpoint by GM may play a central role in sensitizing p53-negative tumor cells to DNA-damaging and decatenation-inhibiting agents.

Intraperitoneal bleeding due to rupture of the left gastric vein (LGV) in a patient with liver cirrhosis: a case report

Intraperitoneal bleeding from ruptured ectopic varices is a rare and fatal complication in patients with portal hypertension. Although laparotomy with high mortality is performed, it is difficult to detect correct bleeding site and save the patient. This is probably the first case report of rupture from left gastric vein revealed by transjugular intrahepatic portosystemic shunt (TIPS). We propose the use of TIPS for diagnosing and treating intraperitoneal bleeding from ectopic varices.

Hepatic hyperplastic nodules showing stains by portal blood flow: hemodynamics revealed by CTAP and CTHA

The hepatic hyperplastic nodule associated with idiopathic portal hypertension is classified as portal blood flow and hepatic arterial blood flow dominant types. These nodular lesions are considered attributable to abnormal blood flow in the liver. We describe a rare case of hepatic hyperplastic nodules showing stains by portal blood flow.

Telangiectatic focal nodular hyperplasia of the liver in the perinatal period: case report

We report a case of congenital telangiectatic focal nodular hyperplasia, a rare variant form of the disease. The patient was a 2-month-old boy whose parents noticed abdominal distention about 2 weeks after birth, and ultrasonogram revealed a large mass in the liver. He underwent right lobectomy, and gross findings showed an ill-defined mass without any central scar. Histologic findings demonstrated proliferating hepatocytes without atypia arranged in cords of 1- or 2-cell thickness with marked sinusoidal dilatation and extramedullary hematopoiesis. In addition, a significantly increased Ki-67 labeling index in the tumor compared with non-tumor liver cells, and cytogenetic analysis of 23 G-banded metaphase preparations revealed 3 abnormal karyotypes, suggesting hyperplastic or neoplastic features. To the best of our knowledge, the present case is only the third documented case of congenital telangiectatic focal nodular hyperplasia.

New diagnostic imaging of gastointestinal tumors: a preliminary study of three-dimensional tumor structure and volumetry

BACKGROUND

The aim of the present report was to present preliminary results of the pre-operative evaluation of three-dimensional tumor structure and volumetry using three-dimensional computed tomography (3-D CT) and three-dimensional endoscopic ultrasonography (3-D EUS).

MATERIALS AND METHODS

Diagnostic imaging was performed for 2 patients (one with gastric cancer, one with a rectal tumor) using virtual endoscopy, 3-D CT for the patient with gastric cancer and 3-D EUS for the patient with the rectal tumor, for the pre-operative evaluation of tumor structure and volumetry. Computer-generated image analysis of resected tumors was also performed.

RESULTS

The gastric tumor was successfully visualized using 3-D CT and the rectal tumor was successfully visualized using 3-D EUS. The values obtained for volume of the stomach tumor, calculated using 3-D CT and resected materials, were 15.1 cm3 and 11.4 cm3, respectively. The values obtained for volume of the rectal tumor, calculated using 3-D EUS and resected materials, were 2.3 cm3 and 3.9 cm3, respectively.

CONCLUSION

The present findings demonstrate that clinically useful results can be obtained by using 3-D CT and 3-D EUS for the pre-operative evaluation of 3-D tumor structure and volumetry of gastrointestinal tumors. We expect that further studies of these methods will lead to the establishment of new diagnostic criteria for gastrointestinal tumors based on tumor volume in the near future.

Hepatic encephalopathy due to intrahepatic portosystemic venous shunt successfully treated by interventional radiology

We treated a 66-year-old woman with hepatic encephalopathy secondarily induced by an intrahepatic portosystemic venous shunt (IPSVS). In serial observations, the volume of the liver became smaller and encephalopathy could not be controlled with conservative therapy. We occluded the IPSVS successfully using percutaneous transcatheter embolization with micro coils. Following embolization, encephalopathy disappeared and blood flow of all branches of portal vein improved. In cases with an IPSVS without liver cirrhosis, blood flow in the portal vein and liver volume must be followed carefully, and interventional radiology may be considered effective in those who do not show a satisfactory response to conservative therapy.

DNA microarray analysis of natural killer cell-type lymphoproliferative disease of granular lymphocytes with purified CD3-CD56+ fractions

Natural killer (NK) cell-type lymphoproliferative disease of granular lymphocytes (LDGL) is characterized by the outgrowth of CD3(-)CD16/56(+) NK cells, and can be further subdivided into two distinct categories: aggressive NK cell leukemia (ANKL) and chronic NK lymphocytosis (CNKL). To gain insights into the pathophysiology of NK cell-type LDGL, we here purified CD3(-)CD56(+) fractions from healthy individuals (n=9) and those with CNKL (n=9) or ANKL (n=1), and compared the expression profiles of >12 000 genes. A total of 15 'LDGL-associated genes' were identified, and a correspondence analysis on such genes could clearly indicate that LDGL samples share a 'molecular signature' distinct from that of normal NK cells. With a newly invented class prediction algorithm, 'weighted distance method', all 19 samples received a clinically matched diagnosis, and, furthermore, a detailed cross-validation trial for the prediction of normal or CNKL status could achieve a high accuracy (77.8%). By applying another statistical approach, we could extract other sets of genes, expression of which was specific to either normal or LDGL NK cells. Together with sophisticated statistical methods, gene expression profiling of a background-matched NK cell fraction thus provides us a wealth of information for the LDGL condition.

Emergent endovascular stent-graft placement to treat ruptured Stanford type B acute aortic dissection

Uncomplicated Stanford type B acute aortic dissection, for which medical treatments are effective in most cases, is associated with a better prognosis than Stanford type A dissection. However, ruptured Stanford type B dissection still is associated with high mortality, because of the risks of open surgery and the complications of the disease. We report successful stent-graft placement in two patients with acute type B dissection with rupture, and discuss the advantages of stent-graft placement to treat ruptured acute type B dissection.

[Dose investigation of superparamagnetic iron oxide (SPIO) SH U 555 A in liver MR imaging]

SH U 555 A, a new superparamagnetic iron oxide (SPIO) contrast agent for liver MR imaging, was investigated in terms of safety and efficacy. Eighty-four patients with suspected malignant liver tumor were randomly allocated to two groups: the L dose group (8 mumol Fe/kg) and H dose group (12 mumol Fe/kg). Efficacy was qualitatively evaluated through blinded reading of the MR images. Assessment of the images revealed no consistent differences between the L and H dose groups. During the 3- to 4-day observation period, a total of 16 adverse events were observed in 11 patients: 8 patients in the L dose group and 3 patients in the H dose group. Nasal bleeding occurred in 2 of these cases in the H dose group 2 and 4 days, respectively, after injection. Although patients in the H dose group showed a significantly larger transient decrease in Coagulation Factor XI at 4-6 hr post-injection (p.i.) than patients in the L dose group, analysis of covariance revealed an estimated 6.5% difference. There was no prolongation of APTT or change in Factor XI at 72-96 hr p.i. Because there were no clinically significant differences between the L and H doses, both were considered to be safe and effective.

Restoration of thrombopoietin production after partial splenic embolization leads to resolution of thrombocytopenia in liver cirrhosis

The aim of this study was to evaluate the relation between thrombopoietin (TPO) and thrombocytopenia in patients with liver cirrhosis and those with idiopathic portal hypertension (IPH) before and after partial splenic embolization (PSE). We examined changes in platelet counts, liver function, megakaryocyte function, and plasma TPO levels after PSE in 30 patients (20 with liver cirrhosis, and 10 with IPH). Platelet counts in both cirrhosis and IPH increased significantly 2 months after PSE (cirrhosis group, 4.0+/-1.9 vs. 7.5+/-4.4x10(4)/&mgr;l: P=0.0002; IPH group, 4.0+/-1.7 vs. 6.5+/-2.3x10(4)/&mgr;l: P=0.0042). Plasma TPO level and prothrombin time increased significantly and alanine aminotransferase level (ALT) and total bilirubin level decreased significantly 2 months after PSE in the cirrhosis group (plasma TPO level, 0.57+/-0.30 vs. 0.72+/-0.27 fmol/ml: P=0.024), but not in the IPH group (0.56+/-0.21 vs. 0.55+/-0.34 fmol/ml: P=0.94). Moreover, the score of megakaryocytes with platelet production, an index of platelet production by megakaryocytes in bone marrow, increased significantly in the cirrhosis group. TPO production in cirrhotic patients is restored after PSE, leading to the resolution of thrombocytopenia. But patients with IPH had no change in liver function, indicating that only decreased spleen volume was responsible for the improvement in platelet count.

Circadian rhythm of melatonin release in pineal gland culture: arg-vasopressin inhibits melatonin release

The mammalian pineal gland is known to receive a noradrenergic sympathetic efferent signal from the suprachiasmatic nucleus (SCN) via the superior cervical ganglion. Arg-vasopressin (AVP) containing neurons in the SCN is one of the output paths of circadian information to the other brain areas. AVP release from the SCN is suppressed by melatonin. In turn, we determined the direct effect of AVP on melatonin release using pineal gland explant culture. AVP (1 microM) suppressed melatonin release. Noradrenaline stimulated melatonin release was attenuated by AVP. In turn, the expression of the melatonin synthesis enzyme arylalkylamine N-acetyltransferase mRNA in the rat SCN was reported. We measured melatonin content in the SCN in rats kept under the light-dark cycle and constant dim light. Melatonin in the SCN was higher during the dark period than that in the light. A similar tendency was also observed in the SCN of animals kept under a constant dim light. It was suggested that the reciprocal regulation of melatonin release and AVP release occurs in the SCN and pineal gland.

Taste-enhancing effects of glycine on the sweetness of glucose: a gustatory aspect of symbiosis between the ant, Camponotus japonicus, and the larvae of the lycaenid butterfly, Niphanda fusca

The lycaenid butterfly, Niphanda fusca, has a parasitic relationship with its host ant, Camponotus japonicus: the caterpillars may use chemical mimicry to enter the ant nest where they are fed mouth-to-mouth by the adult ants until pupation. Nevertheless, larvae offer their host ants a nutritious secretion that contains 160 mM glucose and 43 mM glycine. Using glucose and glycine mixture as artificial secretions, we investigated the gustatory effect of glucose and/or glycine on the ants. Glycine induced neither feeding behavior nor gustatory response in the ants if its concentration was <500 mM. In the presence of glycine at the concentration in the secretion, however, the ants improved their preference to glucose, and the sugar receptor cell exhibited electrophysiological enhancement of response to glucose in a glycine-concentration-dependent manner. By adding glycine to glucose in their secretions, therefore, the butterfly larvae can manipulate the gustatory sense of the ants. The alluring taste of 'glycine-flavored glucose' could motivate the host ants to feed the larvae and thereby receive the secretions as a reward. The taste enhancement created by the combination of sugar and amino acid may play a role in the evolution of the parasitic relationships of these insects. The taste-enhancing effect appears to be analogous to taste enhancement by 'umami' substances in humans.

Ureteral fibroepithelial polyp associated with urolithiasis induced by steroid therapy in a child: a case report

A 14-year-old boy complained of left flank pain. He had been given high-dose corticosteroid therapy for chronic inflammatory demyelinating polyneuropathy (CIDP). Retrograde pyelography revealed irregular defects at the left ureteropelvic junction (UPJ), and ureteroscopy demonstrated ureteral polyp. The polyp was removed and histologically diagnosed as fibroepithelial polyp. Hypercalciuria due to the corticosteroids and bedridden was assumed to have been a causative factor in the stone formation. To our knowledge, this is the first report of a ureteral fibroepithelial polyp in children associated with urolithiasis, and associated with CIDP.

Entactin-induced inhibition of human amyloid beta-protein fibril formation in vitro

Amyloid beta-protein (Abeta) fibril in senile plaques may possibly be related to the pathogenesis of Alzheimer's disease (AD). Basement membrane (BM) components are localized to the plaques. Entactin binds the plaque associated BM components. We investigated the potential of entactin to prevent Abeta fibril formation. Thioflavin T fluorometric assay and electron microscopy revealed that entactin significantly inhibited Abeta1-40 (Abeta40) fibril formation at an Abeta40:entactin molar ratio of 50:1. The inhibitory effect of entactin was displayed in a dose-dependent manner. Circular dichroism spectroscopy data indicated that entactin induced a random coil structure in Abeta40. We propose that the ability of entactin to induce random structure is linked to the inhibition of Abeta fibril formation. Entactin may be related to the pathogenesis of AD by regulating Abeta40 fibril formation.

Pharmacological characterization of a novel 5-HT4 receptor agonist, TS-951, in vitro

The pharmacological effect of a novel selective 5-HT4 receptor agonist, TS-951 (N-[endo-8-(3-hydroxypropyl)-8-azabicyclo[3.2.1]oct-3-yl]-1-isopropyl-2-oxo-1,2-dihydro-3-quinolinecarboxamide) was investigated in vitro. TS-951 potently inhibited specific [3H]GR113808 binding both in guinea-pig striatum and in mouse brain. The affinity of TS-951 for the 5-HT4 receptor was higher than those of other agonists, 5-HT, cisapride, mosapride and renzapride. On the longitudinal muscle of the guinea-pig ileum, TS-951 caused a concentration-dependent increase in the amplitude of electrically induced submaximal twitch contractions. On the longitudinal muscle of the guinea-pig distal colon, TS-951 also caused concentration-dependent contractions. TS-951 is a high-affinity, selective and potent 5-HT4 receptor agonist. This compound therefore can be considered as a useful pharmacological tool for investigating 5-HT4 receptor-mediated events.

Properties of an extracellular polysaccharide produced by a strain of enterobacter isolated from pond water

A bacterium which was isolated from pond water and identified as Enterobacter cloacae produced a viscous extracellular polysaccharide when it was grown aerobically in a medium containing sucrose as a sole source of carbon. The maximum molecular weight of the polysaccharide was about 9.0 x 10(5). The polysaccharide was composed of fucose, galactose, glucose, and glucuronic acid in a molar ratio of 2:3:2:1, but the molecular weight and the molar ratio of the sugar component were different from those of the polysaccharide produced by the same species reported elsewhere.

β-amyloid induces caspase-dependent early neurotoxic change in PC12 cells: correlation with H2O2 neurotoxicity

We examined neurotoxic effects of Abeta(25-35), an active fragment of beta-amyloid (Abeta), and compared the effect with H2O2 neurotoxicity in PC12 cells. Abeta(25-35) induced the loss of mitochondria function as detected using a tetrazolium salt (WST-1) reduction assay and decreased the number of cells adhering to collagen type 1-coated plates. Abeta(25-35) did not induce cell death, as detected by Hoechst 33342/propidium iodide staining. The caspase tetrapeptide inhibitor z-IETD-fluoromethylketone (FMK) and z-LEHD-FMK inhibited the attenuation of WST-1 reduction induced by Abeta(25-35) and H2O2, while the caspase-3 inhibitor z-DEVD-FMK afforded protection only against H2O2 neurotoxicity. Caspase-3 protease activity was increased by treatment of H2O2 but not Abeta(25-35). Thus, Abeta(25-35) induces early neurotoxic events by activating caspases other than caspase-3. H2O2 -induced oxidative stress may not be implicated in Abeta-induced neurotoxic pathways.

Circadian rhythm of drinking and running-wheel activity in rats with 6-hydroxydopamine lesions of the ventral tegmental area

Circadian rhythms in drinking and running-wheel (locomotor) activity of rats with 6-hydroxydopamine (6-OHDA, 4 microg/2 microl per rat)-induced lesions in the ventral tegmental area (VTA) were examined under a light-dark (LD) cycle and constant dim light (5 lux). Under the LD cycle, the length of the locomotor activity period was decreased during the dark, and increased during the light period in the lesioned rats. Under the constant dim light conditions, the free-running circadian period (tau) of drinking and activity rhythm was longer in lesioned rats than in sham-operated controls. The elongation of the circadian period was accompanied by decrements in activity. These observations suggest that the mesolimbic dopaminergic system modulates rhythms in circadian drinking and locomotor activity.

Improving the freeze tolerance of bakers' yeast by loading with trehalose

We examined the freeze tolerance of bakers' yeast loaded with exogenous trehalose. Freeze-tolerant and freeze-sensitive compressed bakers' yeast samples were soaked at several temperatures in 0.5 M and 1 M trehalose and analyzed. The intracellular trehalose contents in both types of bakers' yeast increased with increasing soaking period. The initial trehalose-accumulation rate increased with increasing exogenous trehalose concentration and soaking temperature. The maximum trehalose content was almost identical (200-250 mg/g of dry cells) irrespective of the soaking temperature and the type of bakers' yeast, but depended on the exogenous trehalose concentration. The leavening ability of both types of bakers' yeast loaded with trehalose was almost identical to that of the respective original cells, irrespective of the soaking conditions. The freeze-tolerant ratio (FTR) of both types of bakers' yeast increased with increasing intracellular trehalose content. However, FTR decreased during over-soaking after the maximum amount of trehalose had accumulated. FTR of the freeze-sensitive bakers' yeast was more efficiently improved than that of the freeze-tolerant type.

Structure-activity relationships of quinazoline derivatives: dual-acting compounds with inhibitory activities toward both TNF-alpha production and T cell proliferation

We synthesized 4-chlorophenethylaminoquinazoline derivatives and evaluated their inhibitory activities toward both TNF-alpha production and T cell proliferation responses. Compound 2f, containing a piperazine ring at the C(7)-position of the quinazoline ring, exhibited more potent inhibitory activities toward both than the lead compound la. A smaller N-substituent in the piperazine ring was required for inhibition of TNF-alpha production.

Synthesis and structure-activity relationship of diarylamide derivatives as selective inhibitors of the proliferation of human coronary artery smooth muscle cells

A series of diarylamide derivatives were synthesized and evaluated for their inhibitory activities against human coronary artery smooth muscle cells (SMCs) and human coronary artery endothelial cells (ECs). Compound 2w was superior to the lead compound, Tranilast, in terms of the potency of the activity and cell selectivity.

Effects of 5-HT(4) receptor agonist prokinetic agents on the action potential parameters of isolated rabbit myocardium

The effects of TS-951, a novel gastrointestinal prokinetic agent with 5-HT(4) receptor agonistic action, on the action potential parameters of isolated rabbit Purkinje fiber, ventricular muscle and sinoatrial node, and on the spontaneously beating rates of isolated rabbit right atria were compared with those of cisapride. TS-951 had no effect on the action potential parameters in both rabbit Purkinje fiber and ventricular muscle preparations. However, cisapride significantly prolonged action potential duration (APD) in both preparations. Both TS-951 and cisapride produced a negative chronotropic effect in rabbit right atria; TS-951 and cisapride at 3 x 10(-5) mol/l reduced the beating rate by about 20 and 40%, respectively. In the sinoatrial node preparations, TS-951 (3 x 10(-5) mol/l) as well as cisapride (10(-6) mol/l) prolonged cycle length and APD and reduced the diastolic depolarization rate. These results indicate that TS-951 does not appear to possess electrophysiological features leading to cardiotoxicity such as QT prolongation and, thus, torsades de pointes in common with cisapride.