Surgical treatment for non-tuberculous mycobacterial pulmonary disease: analysis of prognostic factors

BACKGROUND: The surgical treatment for non-tuberculous mycobacterial pulmonary disease (NTM-PD) has an important adjunctive role and reported outcomes have been generally good; however, the prognostic factors remain unclear.METHODS: Sixty-one patients with NTM-PD who underwent surgical resection for a therapeutic purpose from January 2000 to March 2017 at five affiliated institutions were enrolled. We explored the factors that influence complications and prognosis by retrospectively referring to the medical records.RESULTS: The mean age of the present cohort was 61.8 ± 11.4 years. The pathogen was Mycobacterium avium complex in 49 patients, M. abscessus in 5. The most common indications were refractory to medication in 39. The surgical techniques employed were lobectomy or further resection in 49, sublobar resection in 8, with video-assisted thoracoscopic surgery in 21. Sputum culture conversion rate was 95.1%. Univariate analysis of factors associated with deterioration revealed significant differences related to age (P = 0.025), pre-operative albumin level (P = 0.001) and development of postoperative complications (P = 0.037), while pre-operative albumin level alone was a significant factor in multivariate analysis (P = 0.009).CONCLUSION: Outcomes after resection were generally good in the present cases. Nutritional status, as indicated by albumin level, may affect prognosis after surgical treatment.

Successful treatment of an elderly patient with an uncommon L861Q epidermal growth factor receptor mutation with low-dose afatinib: A case report

There are limited data on the clinical efficiency of afatinib in non-small cell lung cancer (NSCLC) patients with uncommon epidermal growth factor receptor (EGFR) mutations. Moreover, the efficacy and safety of afatinib in elderly patients with these mutations has not been established. Here, we describe a case of successful treatment of a patient aged >80 years with lung adenocarcinoma positive for the uncommon EGFR L861Q mutation with low-dose afatinib. An 83-year-old woman presented with cough and dyspnea. A chest computed tomography (CT) scan revealed tumors in the left upper lobe, left pleural effusion, and multiple lung metastases in both lungs. The patient was diagnosed with lung adenocarcinoma with an EGFR L861Q mutation based on cytological findings. The patient received 30 mg/day of afatinib and experienced no severe adverse events. Two weeks later, partial response was observed based on a CT scan. The results of the present case support the effectiveness and safety of low-dose afatinib in elderly patients with EGFR L861Q mutation-positive NSCLC.

P4704The efficacy of intravascular ultrasound for patients with peripheral artery diseases presenting aorto-iliac artery disease

Background

The use of intravascular ultrasound (IVUS) promotes better clinical outcomes for intervention in complex lesions. However, the data demonstrating whether use of IVUS improves primary patency following stenting for aorto-iliac lesions in patients with peripheral artery disease (PAD) are limited.

Purpose

The purpose of the current study was to investigate the impact of IVUS use on primary patency 12 months after stent implantation for aorto-iliac lesions.

Methods

We analyzed a clinical database of the OMOTENASHI registry (Observational prospective Multicenter registry study on Outcomes of peripheral arTErial disease patieNts treated by AngioplaSty tHerapy in aortoIliac artery), registering symptomatic PAD patients (Rutherford category 2, 3, or 4) undergoing endovascular therapy for aorto-iliac lesions between January 2014 and April 2016 in Japan. The current study analyzed 803 patients who underwent self-expandable stent implantation at 61 centers with the institutional volume known. The primary endpoint was 12-month restenosis, defined as ≥50% stenosis on computed tomography or angiography, or a peak systolic velocity ratio ≥2.5 on duplex ultrasound. When treatment strategies, endovascular procedures and clinical outcomes were compared between the patients treated with IVUS use and those treated without IVUS use, the propensity score matching was performed to minimize the inter-group difference in baseline characteristics.

Results

A total of 545 patients (67.9%) underwent IVUS-supported stent implantation. Patients treated with IVUS use had a lower prevalence of regular dialysis, whereas they had a higher prevalence of TASC II class D and chronic total occlusion. In patients treated with IVUS use, carbon dioxide contrast agent were more often used, and 0.035-inch guidewire was less frequently selected. Implanted stents in these patients were longer and smaller in diameter. The propensity score matching extracted 138 pairs, with no remarkable intergroup difference in baseline characteristics. Procedure time ≤1 hour was less frequent in patients treated with IVUS use; their radiation time was longer. Endovascular strategies, as well as postoperative medication were not significantly different between patients with and without IVUS use. The 12-month restenosis risk was not significantly different between patients with and without IVUS use (10.2% [6.9 to 14.9%] versus 10.3% [5.4 to 18.6%], P=0.99).

Conclusion

IVUS use in aorto-iliac stenting for patients with PAD was not associated with primary patency at 12 months.

Acknowledgement/Funding

None

P5601High pulse wave velocity is associated with poor shrinkage of abdominal aortic aneurysm in endovascular aneurysm repair patients

Background

Endovascular aneurysm repair (EVAR) has widely spread for treatment of abdominal aortic aneurysm (AAA). However, the effects of EVAR on vascular function remain to be clarified. According to several reports, changes in aortic stiffness after EVAR reflect badly on future cardiovascular events. Recently, brachial-ankle pulse wave velocity (baPWV) is accepted as the most simple and reproducible method to determine the aortic stiffness.

Purpose

We aimed to evaluate the change of baPWV following EVAR and investigate the relationship between the aortic stiffness and the long-term outcomes following EVAR.

Methods

We enrolled 172 patients who underwent primary EVAR between January 2009 and December 2017 in our University hospital. Patients with saccular aneurysm, iliac aneurysm and pseudo aneurysm were excluded from the analysis. PWV data were collected before and 1 week after EVAR. PWV was measured as the mean baPWV values of both lower limbs. The long-term outcomes were evaluated with the cardiovascular event and AAA changing rate (mm/year) which was calculated by computed tomographic scanning at the preoperative and latest imaging studies. The cardiovascular event was defined as the expansion of thoracic or abdominal aortic aneurysm (>10 mm or >5 mm/year), central nervous system disorder, acute heart failure, new arrhythmia, peripheral arterial disease. Receiver operating characteristic (ROC) curve analysis was used to evaluate the cut off values of preoperative baPWV (pre-PWV) and postoperative baPWV (post-PWV) for the risk factor of cardiovascular event.

Results

The mean age was 76.6±7.5 years and 149 patients (86.7%) were male. The mean follow-up period was 41.6±27.0 months. The mean AAA changing rate was −1.84±4.72 mm/year. Post-PWV was significantly increased compared to pre-PWV (pre-PWV v.s. post-PWV; 1885±382 cm/s vs. 2060±528 cm/s, p<0.0001). The optimal cut-off values of the pre and post PWV for predicting cardiovascular events were 1900 cm/s and 2100 cm/s, respectively. The Kaplan-Meier curves indicate that 5 year-cardiovascular event free rates were 45.9% in the patients with pre PWV ≥1900 cm/s and 73.2% in the patients with pre PWV <1900 cm/s (p=0.0185). Similarly, 5 year-cardiovascular event free rates were 46.6% in the patients with post-PWV ≥2100cm/s and 73.4% in the patients with post PWV <2100 cm/s (p=0.0162). Furthermore, the linear regression analysis indicated that post-PWV values correlated positively with the AAA changing rate (r=0.1811, p=0.0195) while pre-PWV was not associated with AAA changing rate (r=0.1211, p=0.1201).

Conclusions

Our results show that EVAR increase aortic stiffness in the acute phases and high post-baPWV is associated with poor shrinkage of abdominal aortic aneurysm in EVAR patients. This is the first study to demonstrate the association between high PWV and poor long-term outcome in endovascular aneurysm repair patients.

Lung Transplantation for Lymphangioleiomyomatosis in a Single Japanese Institute, With a Focus on Late-onset Complications

BACKGROUND

Although late-onset complications are important factors related to inadequate outcomes of lung transplantation (LTx), little is known about them. The results of LTx for lymphangioleiomyomatosis (LAM) patients, which is a large cohort of LTx recipients in Japan, especially with late-onset complications, are reported.

METHODS

Thirteen consecutive LTx cases with LAM at our institute were evaluated, and those with late-onset complications were identified.

RESULTS

The 5-year survival rate was 69.2%. There were 4 cases with late-onset complications. Case 1: A 35-year-old woman who underwent right single LTx and sustained uncontrollable massive chylous ascites. She underwent placement of a peritoneal-venous shunt, and the ascites was controlled. Unfortunately, she died of small cell cervical cancer (SCCC) 43 months after the LTx. Case 2: A 50-year-old woman who underwent left single LTx had pneumothorax of the native lung 16 months after the LTx. She underwent operative repair of the right lung with a polyglycolic acid (PGA) sheet. She had no recurrence of pneumothorax 1 year after the operation. Case 3: A 33-year-old woman, who underwent left single LTx, had recurrence of LAM in the transplanted lung 2 years after the LTx. She was started on sirolimus. Case 4: A 47-year-old woman, who underwent right single LTx, developed repeated high fevers. She developed an acute abdomen, and swollen subcutaneous lymph nodes were found. After lymph node biopsy, she was diagnosed as having post-transplant lymphoproliferative disorder, and she died 8 months after the LTx.

CONCLUSION

It is hoped that these reports and the knowledge gained from them help improve the outcomes of LTx recipients.

Serum eosinophil-derived neurotoxin: correlation with persistent airflow limitation in adults with house-dust mite allergic asthma

BACKGROUND

The serum level of eosinophil-derived neurotoxin (EDN), a protein present in eosinophil granules, correlates with the severity of childhood asthma. However, the relationship between the serum EDN level and the severity of adult asthma has not been sufficiently investigated.

OBJECTIVE

This study aimed to elucidate the correlation between the serum EDN level and markers of severity in adult asthma.

METHODS

The subjects comprised 83 adult patients who had asthma and who were undergoing treatment. Of these patients, 40 were positive for house-dust-specific immunoglobulin E (IgE) antibodies; 9 patients with severe adult asthma who were treated with omalizumab were included in the study. We measured the blood eosinophil count, serum EDN, and eosinophil cationic protein levels before investigating the correlations of these parameters with lung function and symptom score.

RESULTS

There were no significant correlations between the blood eosinophil count or serum EDN or eosinophil cationic protein level with lung function and the symptom score in patients with asthma. However, serum EDN level was inversely correlated with the decrease percentage forced expiratory volume in 1 second (%FEV1) in patients positive for house-dust-specific IgE antibody (R = -0.54; p < 0.05), whereas no such correlation was observed in patients with negative results for house-dust-specific IgE antibody (R = 0.11; p = 0.468). A significant correlation was observed between a decrease in serum EDN level from baseline and lung function improvement after 8 weeks of omalizumab therapy (R = -0.77; p = 0.015).

CONCLUSION

Serum EDN level may be a useful marker for monitoring persistent airflow limitation in adult patients with asthma who had positive results for house-dust-specific IgE antibodies.

Myeloid differentiation-2 is a potential biomarker for the amplification process of allergic airway sensitization in mice

BACKGROUND

Allergic sensitization is a key step in the pathogenesis of asthma. However, little is known about the molecules that are critical regulators for establishing allergic sensitization of the airway. Thus, we conducted global gene expression profiling to identify candidate genes and signaling pathways involved in house dust mite (HDM)-induced allergic sensitization in the murine airway.

METHODS

We sensitized and challenged mice with HDM or saline as a control through the airway on days 1 and 8. We evaluated eosinophilia in bronchoalveolar lavage fluid (BALF), airway inflammation, and mucus production on days 7 and 14. We extracted total RNA from lung tissues of HDM- and saline-sensitized mice on days 7 and 14. Microarray analyses were performed to identify up-regulated genes in the lungs of HDM-sensitized mice compared to the control mice. Data analyses were performed using GeneSpring software and gene networks were generated using Ingenuity Pathways Analysis (IPA).

RESULTS

We identified 50 HDM-mediated, stepwise up-regulated genes in response to allergic sensitization and amplification of allergic airway inflammation. The highest expressed gene was myeloid differentiation-2 (MD-2), a lipopolysaccharide (LPS)-binding component of Toll-like receptor (TLR) 4 signaling complex. MD-2 protein was expressed in lung vascular endothelial cells and was increased in the serum of HDM-sensitized mice, but not in the control mice.

CONCLUSIONS

Our data suggest MD-2 is a critical regulator of the establishment of allergic airway sensitization to HDM in mice. Serum MD-2 may represent a potential biomarker for the amplification of allergic sensitization and allergic inflammation.

Nuclear factor erythroid 2-related factor 2 (Nrf2) regulates airway epithelial barrier integrity

BACKGROUND

Inhaled corticosteroids enhance airway epithelial barrier integrity. However, the mechanism by which they accomplish this is unclear. Therefore, we investigated steroid-inducible genes and signaling pathways that were involved in enhancing airway epithelial barrier integrity.

METHODS

A human bronchial epithelial cell line (16HBE cells) was cultured with 10(-6) M dexamethasone (DEX) for 3 days to enhance epithelial barrier integrity. After measuring transepithelial electrical resistance (TER) and paracellular permeability, we extracted total RNA from 16HBE cells and performed microarray and pathway analysis. After we identified candidate genes and a canonical pathway, we measured TER and immunostained for tight junction (TJ) and adherent junction (AJ) proteins in cells that had been transfected with specific small interfering RNAs (siRNAs) for these genes.

RESULTS

We identified a nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated oxidative stress response pathway which was primarily involved in the steroid-induced enhancement of airway epithelial barrier integrity. Transfecting cells with Nrf2 specific siRNA reduced the steroid-induced enhancement of airway epithelial barrier integrity and the accumulation of TJ and AJ proteins at sites of cell-cell contact. Moreover, based on pathway analysis, aldehyde oxidase 1 (AOX1) was identified as a downstream enzyme of Nrf2. Transfecting cells with AOX1-specific siRNA also reduced the steroid-induced enhancement of airway epithelial barrier integrity.

CONCLUSIONS

Our results indicated that the Nrf2/AOX1 pathway was important for enhancing airway epithelial barrier integrity. Because the airway epithelium of asthmatics is susceptible to reduced barrier integrity, this pathway might be a new therapeutic target for asthma.

Results of surveillance bronchoscopy after cadaveric lung transplantation: a Japanese single-institution study

BACKGROUND

The prevention and early detection of post-transplantation rejection and infection are key clinical points to achieve long-term survival after lung transplantation. Although surveillance bronchoscopy (SB) is performed in many transplantation centers, it is still controversial because of its undefined clinical significance and its possible complications. We evaluated the clinical utility of SB after cadaveric lung transplantation in Japan, where bilateral transplantation is officially limited to patients medically requiring bilateral grafts.

PATIENTS AND METHODS

Twenty-eight patients who underwent cadaveric lung transplantation followed by SB were retrospectively analyzed with reference to the results of bronchoscopy. SB is routinely performed at 1, 2, 3, 6, and 12 months after lung transplantation and annually thereafter. Clinically indicated bronchoscopy (CIB) is considered in patients with suspected rejection or airway infection, and for follow-up examination after treatment for acute rejection.

RESULTS

There were 206 bronchoscopies, including 189 SBs and 17 CIBs, performed in 28 patients who underwent cadaveric lung transplantation between 2000 and 2013 at Osaka University Hospital. Among SBs, 92 (49%) showed positive results of transbronchial lung biopsy (TBLB) or bronchoalveolar lavage (BAL), and intervention was applied following 34 SBs (18%). Among CIBs, 8 (47%) showed positive results of TBLB or BAL, with intervention performed in 3 patients (18%). A2-3 and B2R findings according to the revised International Society for Heart and Lung Transplantation (ISHLT) rejection score and airway infection/colonization were frequently observed within a year following lung transplantation. Cytomegalovirus infection was found in 7 SBs (6%) by TBLB only within 2 months after transplantation. Regarding complications, moderate bleeding occurred in 21 (11%), pneumothorax in 2 (1%), prolonged hypoxemia in 1 (0.5%), and pneumonia in 1 (0.5%) among the 189 SBs.

CONCLUSION

SB frequently detects rejection and airway infection or colonization with minimum complications, especially within 12 months after cadaveric lung transplantation.

Chronic eosinophilic pneumonia presenting with acute onset

A 44-year-old woman was hospitalized with a 2-day history of cough, sputum, and fever. There was no history of atopic dermatitis or asthma. On admission, the chest X-ray revealed scattered infiltration in the left upper lung fields. Further examination revealed peripheral blood and bronchoalveolar lavage fluid eosinophilia. Transbronchial lung biopsy revealed eosinophilic pneumonia, with eosinophil infiltration of the alveoli, destroyed basal lumina, and connecting intraluminal fibrosis of the alveolar walls. Based on the findings, we made the diagnosis of chronic eosinophilic pneumonia. Treatment with prednisolone at 60 mg/day resulted in dramatic improvement of both the symptoms and the radiologic abnormalities.

Anatomical predictors of major adverse limb events after infrapopliteal angioplasty for patients with critical limb ischaemia due to pure isolated infrapopliteal lesions

OBJECTIVE

To identify anatomical factors associated with major adverse limb events (MALE) after angioplasty as the basis for a novel morphology-driven classification of infrapopliteal lesions.

DESIGN

Retrospective-multicenter study.

MATERIALS AND METHODS

Between March 2004 and October 2010, 1057 limbs from 884 patients with CLI due to isolated infrapopliteal lesions were studied. Freedom-from MALE, defined as major amputation or any reintervention, was assessed out to 2 years by the Kaplan-Meier methods. Anatomical predictors and risk stratification for MALE were analyzed by multivariate analysis.

RESULTS

Freedom-from MALE was 47 ± 1% at 2 years. Lesion calcification, target vessel diameter<3.0 mm, lesion length>300 mm and no below-the-ankle (BA) run-off were positively associated with MALE by multivariate-analysis. The total number of risk factors was used to calculate the risk score for each limbs for subsequent categorization into 3 groups with 0 or 1 (low-risk), 2 (moderate-risk) and 3 or 4 (high-risk) factors. Freedom-from MALE at 2 year-rates was 59% in low-risk, 46% in moderate-risk, and 29% in high-risk, respectively.

CONCLUSION

Target vessel diameter <3.0 mm, lesion calcification, lesion length > 300 mm and no-BA run-off were associated with MALE after infrapopliteal angioplasty. Risk stratification based on these predictors allows estimation of future incidence of MALE in CLI with isolated infrapopliteal lesions.

MicroRNA-mediated downregulation of mTOR/FGFR3 controls tumor growth induced by Src-related oncogenic pathways

The tyrosine kinase c-Src is upregulated in various human cancers, but the molecular mechanisms underlying c-Src-mediated tumor growth remain unclear. Here we examined the involvement of microRNAs in the c-Src-mediated tumor growth. Microarray profiling revealed that c-Src activation downregulates a limited set of microRNAs, including miR-99a, which targets oncogenic mammalian target of rapamycin (mTOR) and fibroblast growth factor receptor 3 (FGFR3). Re-expression of miR-99a suppressed tumor growth of c-Src-transformed cells, and this effect was restored by the overexpression of mTOR. The downregulation of miR-99a was also observed in epidermal growth factor- and Ras-transformed cells, and it was suppressed by inhibiting the mitogen-activated protein kinase (MAPK) pathway. Furthermore, miR-99a downregulation is associated with mTOR/FGFR3 upregulation in various human lung cancer cells/tissues. The tumorigenicity of these cells was suppressed by the introduction of miR-99a. These findings suggest that the miR-99a-mTOR/FGFR3 pathway is crucial for controlling tumor growth in a wide range of human cancers that harbor upregulation of the Src-related oncogenic pathways.

Serum magnesium, ambulatory blood pressure, and carotid artery alteration: the Ohasama study

BACKGROUND

To investigate the associations of 24-h ambulatory blood pressure (ABP) and serum magnesium level (sMg) with risk of carotid artery alteration in a general population.

METHODS

sMg and ABP, monitored every 30 min, were measured in 728 subjects (mean age, 67 years) from the Japanese general population. The extent of carotid artery alteration was evaluated according to mean common carotid intima-media thickness (IMT) and the presence of focal carotid plaque. To determine the association of sMg and carotid artery alteration, analysis of covariance (ANCOVA) (for adjusted mean IMT) or multiple logistic regression analysis (for odds ratio (OR) for the presence of carotid plaques) was used.

RESULTS

Lower sMg was significantly associated with mean IMT (P = 0.004) and risk of ≥2 carotid plaques (P = 0.03) after adjusting for possible confounding factors, including 24-h ABP (systolic), creatinine clearance (Ccr) (estimated using the Cockcroft-Gault equation), and serum minerals (sodium, potassium, calcium, and inorganic phosphorus). Even when 24-h ABP values were within normal range (<130/80 mm Hg), lower sMg levels (<2.2 mg/dl) were significantly associated with mean IMT (P = 0.007) and risk of ≥2 carotid plaques (OR, 2.14; 95% confidence interval, 1.18-3.85; P = 0.01).

CONCLUSIONS

Both 24-h ABP and lower sMg were closely and independently associated with risk of carotid artery alteration. Further investigations are needed to examine the relationship between sMg levels and the incidence of cardiovascular disease.

Hexabromocyclododecane determination in seafood samples collected from Japanese coastal areas

The levels of three hexabromocyclododecane (HBCD) isomers and ΣHBCDs in 54 wild and 11 farmed seafood samples collected from four regions of Japan were determined by LC/MS/MS. For the fish classified as Anguilliformes, Perciformes, Clupeiformes and farmed Salmoniformes, the medians (ranges) of ΣHBCDs are 2.09 (0.05-36.9), 0.75 (ND-26.2), 0.12 (0.09-77.3) and 1.29 (1.09-1.34) ng g(-1)ww, respectively. However, HBCDs were not detected in samples classified as Crustacea, Mollusca, Pleuronectiformes and Scorpaeniformes, or if detected, the levels were very low. The rank correlation between ΣHBCDs (or α-HBCD) and fat content could not be found except for the Japanese sea bass of the Tohoku region. In HBCD isomer profiles, for fish samples above 20 ng g(-1)ww, the trend was found that γ-HBCD was predominant, which suggests the influence of discharge from a nearby industrial plant. In the other wild fish and the farmed fish samples, on the other hand, α-HBCD was mostly predominant, which suggests biomagnification via the food chain. Additionally, to assess the risk to human health, based on the determined HBCD median concentrations for Anguilliformes, farmed Salmoniformes and Perciformes, the daily intake of HBCDs from fish by an average Japanese adult was tentatively calculated to be 3.7, 2.3 and 1.3 ng (kg body weight)(-1) d(-1), respectively.

[Long-term results of aortic root replacement with a composite graft]

We analyzed the long-term results of aortic root replacement with a composite graft. Since 1992, 127 patients had undergone aortic root replacement with a composite graft. There were 92 men and 35 women with a mean age of 56.5 years. There were 69 patients with annuloaortic ectasia, 17 aortic dissections, and 41 ascending aortic dilatation due to aortic valve disease. Marfan syndrome was diagnosed in 19 patients. As surgical procedure, button technique was used in 90 patients, Cabrol technique in 11, and Piehler technique in 26. Open distal anastomosis was performed in 82 patients to avoid clamp injury of rest aorta. Early mortality was 3.1% and no major morbid events had occurred. Follow-up was completed in 95.9% of the patients and the mean follow-up period was 6.1 years. Actuarial survival at 5, 10, and 15 years was 86.2%, 83.4%, and 83.4%, respectively. Actuarial freedom from aortic valve reoperation at 10 and 15 years was 99.2% and 95.7%, respectively. The results of aortic root replacement with a composite graft were excellent. This procedure should be the 1st choice for surgical treatment of the aortic root disease.

Identification of the genes associated with a virulent strain of Porphyromonas gingivalis using the subtractive hybridization technique

BACKGROUND/AIMS

Porphyromonas gingivalis, a major etiological organism implicated in periodontal disease, can be classified into virulent and avirulent strains. Our aim was to identify a gene for the virulence of P. gingivalis.

METHODS

The subtractive hybridization technique was employed to identify the genes specific to P. gingivalis W83, a virulent strain. In this study, P. gingivalis W83 was used as the tester strain, and P. gingivalis ATCC 33277 was the driver strain. The prevalence of W83-specific genes was determined by Southern blot analysis of several P. gingivalis strains.

RESULTS

We obtained 575 colonies using the subtractive hybridization technique. From among these, 26 DNA fragments were subjected to a homology search using the BLAST program. Compared with strain ATCC 33277, strain W83 contained 12 unique clones. The specificities of the isolated DNA fragments were analyzed among four P. gingivalis strains by Southern blot analysis. Five genes showed specificity for strain W83 compared with strain ATCC 33277. All five genes were also identified in strain W50.

CONCLUSIONS

The subtractive hybridization technique was effective in screening the two strains for specific DNA sequences, some of which might be responsible for determining virulence. The results suggested that several genes specific to strain W83 were associated with its virulence. Further analysis of these DNA fragments will provide important information on the pathogenesis of virulent P. gingivalis strains.

Association of microalbuminuria with brachial-ankle pulse wave velocity: the Ohasama study

BACKGROUND

Microalbuminuria is recognized as a marker of generalized vascular dysfunction. However, the associations between microalbuminuria and pulse wave velocity (PWV), carotid intima-media thickness (IMT), and ambulatory blood pressure (ABP), respectively, have not been investigated.

METHODS

Brachial-ankle PWV (baPWV), IMT, and ABP were determined in 328 individuals (mean age, 65.7 +/- 6.4 years) from the general population of Ohasama, a rural Japanese community. The participants were assigned to groups with microalbuminuria and with normoalbuminuria, and their characteristics were compared. We also examined the association between microalbuminuria and baPWV, IMT, and ABP, respectively, using multivariate analyses.

RESULTS

Seventy-nine participants (24%) with microalbuminuria had significantly higher baPWV (P < 0.001) and 24-h systolic BP (SBP) (P = 0.006) than those with normoalbuminuria, although 24-h pulse pressure and mean IMT did not significantly differ between the groups. Multiple logistic regression analyses showed that baPWV, but not 24-h ABP, was independently associated with microalbuminuria (P = 0.002) when adjusted for various confounding factors. After further adjustment for 24-h SBP, the association between baPWV and microalbuminuria remained significant (P = 0.012). The trend was significant even when daytime or nighttime SBP was used instead of 24-hour SBP in this model.

CONCLUSIONS

Microalbuminuria appears to be associated with baPWV more closely than with IMT and ABP, and its association with baPWV is independent of ABP and other cardiovascular risk factors.

Evaluation of grey-scale standard display function as a calibration tool for diagnostic liquid crystal display monitors using psychophysical analysis

The digital imaging and communications in medicine (DICOM) standard proposed the grey-scale standard display function (GSDF) as a calibration tool for making the gradation characteristic of a radiographic output image consistent. This is designed in such a manner that the contrast visually recognised by observers (called psychophysical contrast) becomes a constant for all digital driving levels. The DICOM standard calls such an ideal characteristic perceptual linearisation. The psychophysical gradient that can express the psychophysical contrast was introduced for the evaluation of the GSDF using a liquid crystal display monitor. Investigations regarding its ability to yield a constant psychophysical contrast, independent of the digital driving level change and under an actual observation environment, such as for clinical radiographic diagnosis in hospital, were carried out. The psychophysical gradients of the GSDF were obtained for two kinds of observation environment: one was a restricted environment such as in a dark room, under steady-state adaptation, using the sinusoidal grading pattern corresponding to the peak frequency of the human eye response. The other was an actual environment reflecting that encountered during clinical diagnosis in a hospital. As a result, the psychophysical gradient under the restricted environment became almost constant and independent of the change in digital driving level, i.e. perceptual linearisation could be satisfied. Furthermore, under the actual observation environment, the psychophysical gradient decreased gradually with the increase in digital driving level, i.e. the perceptual linearisation could not be satisfied. The percentage decrease in the value of the psychophysical gradient at the maximum luminance area was approximately 60% compared with that at the minimum luminance area. Accordingly, the GSDF is unsuitable as a calibration tool for the liquid crystal display monitor, which will be used in actual clinical diagnosis, as it cannot achieve 'perceptual linearisation' under the actual environment. For the purpose of clinical diagnosis, it is necessary to enlarge the physical gradient of GSDF further in the high digital driving level range (which relates to a high luminance area) to give an approximation that is as close to the idealised form as possible.

Absence of mutations in the Wilms' tumor gene wt1 in de novo non-small cell lung cancers

We recently demonstrated that the WT1 gene was overexpressed in the majority of de novo lung cancers regardless of cancer subtypes. Here, we examined WT1 genomic DNA in 38 cases of de novo non-small cell lung cancers (NSCLC) for mutations using direct sequencing. The sequencing analysis showed no mutations of WT1 genomic DNA in any of 38 de novo non-small cell lung cancers examined. These results indicated that the non-mutated, wild-type WT1 gene played an important role in de novo NSCLC.

LIGHT, a member of the TNF superfamily, induces morphological changes and delays proliferation in the human rhabdomyosarcoma cell line RD

LIGHT is a member of the tumor necrosis factor (TNF) superfamily, which binds two known receptors, lymphotoxin-beta receptor (LTbetaR) and the herpesvirus entry mediator (HVEM)/TR2. We investigated the effects of LIGHT on the human rhabdmyosarcoma cell line RD. LIGHT delayed cell proliferation and induced morphological changes of the cells. These effects were not shown by other TNF family ligands such as TNFalpha and LTalpha, which induced the transcriptional activity of nuclear factor-kappaB (NF-kappaB) and NF-kappaB-responsible chemokine productions in the same manner as did LIGHT. LTalpha1beta2, another TNF family ligand for LTbetaR, was shown to have similar activities in RD cells as LIGHT. Both LIGHT and LTalpha1beta2 induced the expression of muscle-specific genes such as smooth muscle (SM) alpha-actin, while TNFalpha and LTalpha did not. These findings indicate that LIGHT may be a novel inducer of RD cell differentiation associated with SM alpha-actin expression through the LTbetaR.

Thymic carcinoma successfully resected with superior vena cava after chemoradiotherapy

A 57-year-old woman hospitalized for thymic cancer invading the superior vena cava and left brachiocephalic vein evidenced both pleural and pericardial effusion. After chemotherapy with cisplatin and docetaxel and concurrent radiotherapy, the entire tumor was successfully resected along with the pericardium, superior vena cava, and left brachiocephalic vein, followed by vascular reconstruction. Pathologically, viable tumor cells were identified only in the center of the tumor as anaplastic cell carcinoma. Induction chemoradiotherapy thus appears useful in enabling complete resection of advanced thymic carcinoma.