The Incidence of Severe Radiation-Induced Lymphopenia during Chemoradiotherapy for Stage Ⅲ Non-Small Cell Lung Cancer: A Comparative Study of Proton Versus Photon-Based Radiotherapy

PURPOSE/OBJECTIVE(S)

To investigate the incidence of severe radiation-induced lymphopenia (SRL) and the survival in patients with stage Ⅲ non-small cell lung cancer treated with concurrent chemoradiotherapy with passive scattering proton beam (PSPT) or photon-based radiotherapy (XRT) including 3D-CRT and IMRT.

MATERIALS/METHODS

We conducted a retrospective cohort study including 355 patients who received definitive concurrent chemoradiotherapy with PSPT (n = 38) or XRT (n = 317) at our institution between January 2010 and December 2020. SRL during concurrent chemoradiotherapy was defined as absolute lymphocyte counts (ALCs) of <500 cells/mm3. Propensity score matching (PSM) analysis was performed to adjust for the patient characteristics between the PSPT and XRT groups. Propensity scores were calculated using age, sex, PS (0-1 vs. 2), primary tumor location (upper/middle vs. lower lobe), pathology (Adeno vs. Others), PTV volume, ALCs at pretreatment, year of treatment (before vs. after July 2018, when durvalumab approved in Japan), and platinum-based chemotherapy regimen (CDDP based vs. CBDCA based). After PSM, the incidence of SRL and the overall survival (OS) were analyzed.

RESULTS

The GTV and PTV volumes were significantly lower in the PSPT group than in the XRT group (median, 57 vs. 103 mm3; p < 0.05, 322 vs. 399 mm3; p < 0.05, respectively). ALCs at pretreatment were significantly lower in the PSPT group than in the XRT group (median, 1531 vs. 1718 cells/mm3; p < 0.05). SRL was observed in 275 patients (87%) in the XRT group and 27 patients (71%) in the PSPT group (p < 0.05). After PSM, PSPT significantly reduced the incidence of SRL compared to XRT (68.6 % vs. 88.6 %, p < 0.05), and the patients without SRL may have better 3-year OS than those with SRL (71.1 % vs. 55.3 %; p = 0.062).

CONCLUSION

Compared with XRT, PSPT significantly reduced the incidence of SRL, and the patients without SRL had a good prognosis.

Accurate axillary staging by superparamagnetic iron oxide-enhanced MRI at 1.5 T with fat-suppression sequence as an alternative to sentinel node biopsy in breast cancer

Superparamagnetic iron oxide (SPIO)-enhanced MRI at 1.5 T with fat-suppression sequence is useful for the detection of metastases in sentinel nodes localized by CT lymphography in patients with breast cancer. SPIO-enhanced MRI may offer an alternative to sentinel node biopsy and avoid axillary surgery itself for patients with breast cancer who have negative sentinel nodes on SPIO-enhanced MRI.

Predictors of the usefulness of mirogabalin for neuropathic pain: a single-institution retrospective study

Mirogabalin is a novel, preferentially selective α2δ-1 ligand to treat neuropathic pain. However, this agent is not always effective for patients with neuropathic pain. We therefore attempted to identify factors that could predict the efficacy of mirogabalin. The study comprised 133 patients given mirogabalin for alleviation of neuropathic pain between April and November 2019 at our hospital. Variables were extracted from medical records for regression analysis of factors associated to alleviation of neuropathic pain. We evaluated the effect of mirogabalin at two weeks after administration. Groups were categorized according to degree of improvement: poor, effective, or very effective. Multivariate ordered logistic regression analysis was conducted to identify predictors for the usefulness of mirogabalin. Threshold measures were analysed using receiver operating characteristic (ROC) curves. Maintenance dose [odds ratio (OR) = 0.90; 95% confidence interval (CI) = 0.84-0.98; P = 0.01], concomitant use of opioids (OR = 0.26, 95% CI = 0.08-0.83; P = 0.023) and Neurotropin^® (NTP) (OR = 4.78, 95% CI =1.04-21.93; P = 0.044) were factors significantly correlated to the effect of mirogabalin. ROC curve analysis of the effective group indicated a threshold maintenance dose of≤ 20 mg/day (area under the curve [AUC] = 0.53). In conclusion, maintenance dose (≤ 20 mg), concomitant use of opioids and NTP were identified as predictors for the utility of mirogabalin.

Dissipation-Based Quantum Sensing of Magnons with a Superconducting Qubit

Hybrid quantum devices expand the tools and techniques available for quantum sensing in various fields. Here, we experimentally demonstrate quantum sensing of a steady-state magnon population in a magnetostatic mode of a ferrimagnetic crystal. Dispersively coupling the magnetostatic mode to a superconducting qubit allows for the detection of magnons using Ramsey interferometry with a sensitivity on the order of 10^{-3}  magnons/sqrt[Hz]. The protocol is based on dissipation as dephasing via fluctuations in the magnetostatic mode reduces the qubit coherence proportionally to the number of magnons.

Breaking the trade-off between fast control and long lifetime of a superconducting qubit

The rapid development in designs and fabrication techniques of superconducting qubits has made coherence times of qubits longer. In the future, however, the radiative decay of a qubit into its control line will be a fundamental limitation, imposing a trade-off between fast control and long lifetime of the qubit. Here, we break this trade-off by strongly coupling another superconducting qubit along the control line. This second qubit, which we call “Josephson quantum filter” (JQF), prevents the first qubit from emitting microwave photons and thus suppresses its relaxation, while transmitting large-amplitude control microwave pulses due to the saturation of the quantum filter, enabling fast qubit control. This device functions as an automatic decoupler between a qubit and its control line and could help in the realization of a large-scale superconducting quantum processor by reducing the heating of the qubit environment and the crosstalk between qubits.

The trade-off between long lifetime and inevitable radiative decay to a control line has become a key limitation for superconducting qubits. Here, the authors break the trade-off by coupling another qubit to the control line of the first one to suppress its relaxation, while enabling fast qubit control.

SAT0349 CTLA4-IG DECREASES TH17 CELL LEVELS BUT MAINTAINS ILC3S WITH AN INCREASE IN THE ILC3/ILC1 RATIO IN THE GUT OF SKG MICE AS A MODEL OF SPONDYLOARTHRITIS

Background:

SKG mice have been known for their autoreactive Th17 cells resulting from the insufficient thymic negative selection due to a Zap70 mutation1,2). Under specific pathogen-free conditions, they acquire features of spondyloarthritis (SpA) by intraperitoneal injection of curdlan, a (1,3)-β-glucan3). Several reports have shown that Th17 cells also increase in human SpA4). However, CTLA4-Ig, which ameliorates rheumatoid arthritis by suppressing pathogenic cells such as effector T cells, was unable to show adequate efficacy as much as expected in SpA patients5). Around the same time, innate lymphocytes began to be focused on, in the pathogenesis of SpA, including innate lymphoid cells (ILCs), which abundantly reside in the gut6).

Objectives:

This study aimed to clarify the effects of CTLA4-Ig on the pathogenesis of SpA by using curdlan-treated SKG mice, focusing on type 3 immunity such as Th17 cells and ILC3s.

Methods:

Two- to three-month-old female SKG mice were injected intraperitoneally with 3mg of curdlan or PBS at the beginning and with 500 µg of CTLA4-Ig or PBS every other week (n=5 per group). The body weight and arthritis score were measured weekly for a month. Then, the changes in the proportion of T cells and ILCs in the spleen and Peyer’s patches (PPs) were analysed by flow cytometry (FCM). BALB/c mice, without treatment, were also examined by FCM as a control cohort. In addition, a next-generation analysis of their feces was performed on 16S ribosomal coding genes before curdlan and CTLA4-Ig treatment.

Results:

SKG mice contained not only more Th17 cells but also more ILC1s and ILC3s than BALB/c mice, in their guts (the PPs). The feces of SKG mice intrinsically showed a decrease in the number of bacterial species, suggesting a dysbiosis. Then, in curdlan-treated SKG mice, CTLA4-Ig administration decreased the proportion of both Th17 cells and ILC3s in the spleen, but did not decrease the proportion of ILC3s in the PPs. Moreover, the ILC3/ILC1 ratio in the PPs was from low to high in the order of SKG mice without treatment, SKG mice injected with curdlan, and SKG mice injected with both curdlan and CTLA4-Ig. The phenotype corresponding to SpA features, in curdlan-treated SKG mice, continued after repeated CTLA4-Ig administration.

Conclusion:

Curdlan provoked SpA features in SKG mice with an intrinsic dysbiosis. Additional CTLA4-Ig injection decreased the proportion of Th17 cells but maintained that of ILC3s with increased ILC3/ILC1 ratio in the gut. This result supports the hypothesis that in the SpA pathophysiology, a weakened acquired immunity in the gut might lead to ILC3 activation, via dysbiosis, and its continuous disease progression, suggesting that ILC3s are a promising therapeutic target in SpA.

References:

[1]Sakaguchi N, Sakaguchi S, et al. Altered thymic T-cell selection due to a mutation of the ZAP-70 gene causes autoimmune arthritis in mice.Nature2003;426:454-460.

[2]Hirota K, Sakaguchi S, et al. T cell self-reactivity forms a cytokine milieu for spontaneous development of IL-17+ Th cells that cause autoimmune arthritis.J Exp Med2007;204:41-47.

[3]Ruutu M, Thomas R, et al. β-glucan triggers spondylarthritis and Crohn’s disease–like ileitis in SKG mice.Arthritis Rheum2012;64:2211-2222.

[4]Shen H, Gaston JS, et al. Frequency and phenotype of peripheral blood Th17 cells in ankylosing spondylitis and rheumatoid arthritis.Arthritis Rheum2009;60:1647-1656.

[5]Song I-H, Sieper J, et al. Treatment of active ankylosing spondylitis with abatacept: an open-label, 24-week pilot study.Ann Rheum Dis2011;70:1108-1110.

[6]Ciccia F, Triolo G, et al. Type 3 innate lymphoid cells producing IL-17 and IL-22 are expanded in the gut, in the peripheral blood, synovial fluid and bone marrow of patients with ankylosing spondylitis.Ann Rheum Dis2015;74:1739-1747.

Disclosure of Interests:

Yuya TABUCHI Paid instructor for: Astellas Pharma, GlaxoSmithKline, Mitsubishi Tanabe Pharma, and Nippon Shinyaku., Speakers bureau: AbbVie, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Shinyaku, and Novartis Pharma., Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Syuji Akizuki: None declared, Ran Nakashima Grant/research support from: Takeda Pharmaceutical. (Outside the field of the present study.), Speakers bureau: Astellas Pharma, Medical & Biological Laboratories, AstraZeneca, and Boehringer Ingelheim. (Outside the field of the present study.), Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Hajime Yoshifuji Grant/research support from: Astellas Pharma. (Outside the field of the present study.), Speakers bureau: Chugai Pharmaceutical. (Outside the field of the present study.), Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

THU0285 ANALYSIS OF THE RELATIONSHIP BETWEEN ORGAN DAMAGE AND QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus (SLE) is an autoimmune disease that can not only cause systemic symptoms, such as fever and arthritis, but can also damage important organs, such as those of the central nervous system and the kidneys. Prevention of irreversible organ damage is important for better prognosis [1]. Additionally, the importance of maintaining the quality of life (QOL) of patients has recently been emphasized. However, only a few studies have examined the relationship between irreversible organ damage and patient QOL.

Objectives:

To assess the relationship between organ damage and QOL, and to survey which organs have more significant effects on QOL.

Methods:

We conducted a questionnaire-based survey of 183 patients with SLE at Kyoto University Hospital from September to December 2019. We used the SLICC/ACR Damage Index (SDI) to evaluate organ damage [2]. The following five scales were employed to evaluate QOL: the physical (PCS) and mental component summary (MCS) of the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey version 2.0 (SF-36v2) [3], health (HRQOL) and non-health-related QOL (N-HRQOL) of LupusPRO [4], and SLE Symptom Checklist (SSC) [5].

Results:

Linear regression analysis showed significant correlation between the SDI score and all QOL scales except for N-HRQOL, suggesting negative effects of organ damage on QOL (Table 1). Next, we analysed whether there was a significant difference in the SF-36 score between those who were positive and negative for each SDI item (41 in total), using the Wilcoxon rank sum test. Muscle atrophy or weakness (p= 3.0×10-10), osteoporosis with fracture or vertebral collapse (p= 9.7×10-8), claudication (p= 7.4×10-5), and cognitive impairment or major psychosis (p= 9.9×10-5) significantly correlated (p< 1.2×10-3) with PCS, and scarring chronic alopecia (p= 3.4×10-4) with MCS (Table 2). In addition, the five SDI items significantly correlated with the remaining three QOL scales (HRQOL, N-HRQOL, and SSC;p< 0.05).

Table 1.

Relationship between the SDI score and QOL

SF-36LupusPROSSCPCSMCSHRQOLN-HRQOLp-value<2.0×10-161.7×10-32.2×10-110.231.9×10-8Table 2.

Relationship between each SDI item and the SF-36 score (p< 1.2×10-3

SDI itemPCS scorep-valuePositive(Median (IQR))Negative(Median (IQR))Muscle atrophy/weakness33 (19-45)50 (43-54)3.0×10-10Osteoporosis with fracture/vertebral collapse24 (12-32)49 (38-54)9.7×10-8Claudication31 (19-35)49 (38-54)7.4×10-5Cognitive impairment/psychosis27 (17-33)49 (38-54)9.9×10-5SDI itemMCS scorep-valuePositive(Median (IQR))Negative(Median (IQR))Scarring chronic alopecia42 (29-51)49 (39-54)3.4×10-4

Conclusion:

We demonstrated that organ damage has negative effects on patient QOL, indicating the importance of preventing irreversible organ damage for maintaining QOL. Moreover, muscle atrophy/weakness, osteoporosis with fracture/vertebral collapse, claudication, cognitive impairment/major psychosis, and scarring chronic alopecia significantly correlated with QOL deterioration, suggesting that these items should be examined with special care in clinical practice.

References:

[1]Lopez R, et al. Rheumatology (Oxford). 2012; 51:491-498.

[2]Gladman D, et al. Arthritis Rheum. 1996; 39:363-369.

[3]Fukuhara S, et al. J Clin Epidemiol. 1998; 51:1037-1044.

[4]Inoue M, et al. Lupus. 2017; 26:849-856.

[5]Grootscholten C, et al. Qual Life Res. 2003; 12:635–644.

Disclosure of Interests:

Yudai Takase: None declared, Hiroshi Doi: None declared, Takeshi Iwasaki: None declared, Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Ryuta Inaba: None declared, Tomohiro Kozuki: None declared, Masashi Taniguchi: None declared, Yuya Tabuchi Paid instructor for: Astellas Pharma, GlaxoSmithKline, Mitsubishi Tanabe Pharma, and Nippon Shinyaku., Speakers bureau: AbbVie, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Shinyaku, and Novartis Pharma. (Outside the field of the present study.), Koji Kitagori: None declared, Syuji Akizuki: None declared, Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Ran Nakashima Grant/research support from: Takeda Pharmaceutical. (Outside the field of the present study.), Speakers bureau: Astellas Pharma, Medical & Biological Laboratories, AstraZeneca, and Boehringer Ingelheim. (Outside the field of the present study.), Hajime Yoshifuji Grant/research support from: Astellas Pharma. (Outside the field of the present study.), Speakers bureau: Chugai Pharmaceutical. (Outside the field of the present study.), Wataru Yamamoto: None declared, Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

Regulatory T and B cells in peripheral blood of subcutaneous immunotherapy-treated Japanese cedar pollinosis patients

AIM

The aim of this study was to clarify whether there are more regulatory T (Treg) and regulatory B (Breg) cells, and higher levels of IL-10-related transcription factors in subcutaneous immunotherapy (SCIT)-treated pollinosis patients than in non-SCIT-treated patients.

METHODS

Japanese cedar pollinosis patients undergoing SCIT had received treatment for at least 2.8 years. Peripheral blood mononuclear cells were used for flow cytometer analyses and mRNA measurement.

RESULTS

The numbers of type 1 regulatory T (Tr1)-like cells and Breg cells, and expression of E4BP4 mRNA by peripheral blood mononuclear cells in SCIT-treated patients were higher than those in non-SCIT-treated patients.

CONCLUSION

Tr1-like cells, Breg cells and E4BP4 may be involved in the effectiveness of SCIT.

Safety and efficacy of PD-1/PD-L1 blockade in patients with preexisting antinuclear antibodies

PURPOSE

Immune checkpoint inhibitors (ICIs) show promising clinical activity in advanced cancers. However, the safety and efficacy of PD-1/PD-L1 blockade in patients with preexisting antinuclear antibodies (ANA) are unclear.

METHODS

191 patients treated with nivolumab, pembrolizumab, atezolizumab, or durvalumab for unresectable advanced cancers between September 2014 and December 2018 were identified retrospectively. Patients were divided into positive (ANA titers ≥ 1:160) and negative ANA groups (ANA titers < 1:160). Development of immune-related adverse events (irAEs), the overall response rate (ORR), and disease control rate (DCR) were monitored.

RESULTS

Positive ANA titers were seen in 9 out of 191 patients. Four patients in the positive ANA group and 69 patients in the negative group developed irAEs of any grade without a significant difference between the groups. The development of endocrine, pulmonary, and cutaneous irAEs was not significant, whereas positive ANA was significantly higher in patients who developed colitis (2/9) than in patients who did not (3/182, P = 0.0002). DCR in the positive and negative ANA group was 37.5% and 67.5%, respectively, and was not statistically significant, but had better efficacy in patients without ANA (P = 0.08). ANA-related autoimmune diseases such as SLE, Sjögren's syndrome, MCTD, scleroderma, dermatomyositis, and polymyositis was not induced in either group. However, one patient with preexisting dermatomyositis had a flare up after initiation of atezolizumab.

CONCLUSION

Further studies to identify predictive factors for the development of irAEs are required to provide relevant patient care and maximize the therapeutic benefits of ICIs.

Modified clot waveform analysis to measure plasma coagulation potential in the presence of the anti-factor IXa/factor X bispecific antibody emicizumab

Essentials The activated partial prothrombin time (aPTT) cannot predict the activity of emicizumab (Emi). Adjusted clot waveform analyses using a prothrombin time (PT)/aPTT initiator were developed. Activity of Emi in the co-presence of factor VIII or bypassing agents was quantified. This assay is useful for assessing coagulation potential in Emi-treated hemophilia A.

SUMMARY

Background Emicizumab is an anti-activated factor IX/FX bispecific antibody that mimics activated FVIII cofactor function. Emicizumab does not require activation by thrombin, and its effect on shortening the activated partial thromboplastin time (APTT) is much greater than that of FVIII. Therefore, the APTT has limited utility in hemophilia A (HA) patients treated with emicizumab. Aim To evaluate the global coagulation potential of emicizumab. Methods Clot waveform analysis (CWA) with prothrombin time (PT)/APTT mixed reagents was used to define hemostatic monitoring protocols in HA patients. A modified parameter, adjusted-|min1| (Ad|min1|), was developed. Maximum and minimum percentage transmittance were defined as 100% and 0% in the precoagulation and postcoagulation phases, respectively. Ad|min1| was calculated as an index of the maximum velocity of the coagulation process. Results Ad|min1| obtained with mixed-trigger reagent (PT/APTT/buffer, 1 : 15 : 135) in the presence of emicizumab optimally corresponded to the conversion rate estimated in animals; 0.2-0.4 IU dL-1 equivalent FVIII per 1 μg mL-1 emicizumab). Ex vivo addition of emicizumab to HA plasma with or without inhibitors resulted in concentration-dependent increases in Ad|min1|, with some individual variations. The addition of various concentrations of FVIII to HA plasma mixed with emicizumab resulted in dose-dependent increases in Ad|min1|. Similarly, mixtures of activated prothrombin complex concentrate and emicizumab added to HA plasma resulted in dose-dependent increases in Ad|min1|. In contrast, enhanced coagulation potential appeared to be better defined by the clot time than by Ad|min1| in experiments using recombinant activated FVII. Conclusion The PT/APTT reagent-triggered adjusted CWA could provide a useful means of assessing global coagulation potential in emicizumab-treated HA patients, with enhanced activity neither masking nor being masked by FVIII or bypassing agents.

Increased expression of CysLT2 receptors in the lung of asthmatic mice and role in allergic responses

Compared with CysLT₁ receptors, the functional role of CysLT₂ receptors in asthma has not been clarified. The purpose of this study was to determine 1) whether CysLT₂ receptors are expressed in the lung of mice and if expression increases in asthmatic mice, and 2) whether CysLT₂ receptors are involved in allergic leukocyte infiltration into the lung and in the development of airway remodeling in asthmatic mice. BALB/c mice were sensitized with ovalbumin (OVA) + Al(OH)₃, and intratracheally challenged with OVA 4 times. Lung tissue was isolated before and after the 4th OVA challenge for detection of CysLT₂ receptors by immunohistochemistry and flow cytometry. The effect of a CysLT₂ receptor antagonist BayCysLT₂RA on multiple antigen challenge-induced leukocyte infiltration into the lung and the development of airway remodeling was evaluated. Even in non-challenged mice, CysLT₂ receptors were expressed in bronchial smooth muscle. After multiple challenges, expression was also observed in leukocytes infiltrating into alveolar spaces. CysLT₂R⁺ leukocytes included alveolar macrophages, conventional dendritic cells, and eosinophils. BayCysLT₂RA significantly inhibited multiple antigen challenge-induced increases in eosinophils and mononuclear cells in the lung. The development of airway remodeling was tended to be suppressed by CysLT₂ receptor antagonist. In conclusion, CysLT₂ receptors were constitutively expressed in the lung, and expression was strengthened in asthmatic mice. Activation of CysLT₂ receptors was functionally involved in allergic leukocyte infiltration into the lung. The CysLT₂ receptor can be a molecular target for the development of new pharmacotherapies for asthma.

Information-to-work conversion by Maxwell's demon in a superconducting circuit quantum electrodynamical system

Information thermodynamics bridges information theory and statistical physics by connecting information content and entropy production through measurement and feedback control. Maxwell’s demon is a hypothetical character that uses information about a system to reduce its entropy. Here we realize a Maxwell’s demon acting on a superconducting quantum circuit. We implement quantum non-demolition projective measurement and feedback operation of a qubit and verify the generalized integral fluctuation theorem. We also evaluate the conversion efficiency from information gain to work in the feedback protocol. Our experiment constitutes a step toward experimental studies of quantum information thermodynamics in artificially made quantum machines.

Maxwell’s demon is a hypothetical character that uses information about a system to reduce its entropy, highlighting the link between information and thermodynamic entropies. Here the authors experimentally realise a Maxwell's demon controlling a quantum system and explore how it affects thermodynamic laws.

Nonclassical Photon Number Distribution in a Superconducting Cavity under a Squeezed Drive

A superconducting qubit in the strong dispersive regime of circuit quantum electrodynamics is a powerful probe for microwave photons in a cavity mode. In this regime, a qubit excitation spectrum is split into multiple peaks, with each peak corresponding to an individual photon number in the cavity (discrete ac Stark shift). Here, we measure the qubit spectrum in a cavity that is driven continuously with a squeezed vacuum generated by a Josephson parametric amplifier. By fitting the obtained spectrum with a model which takes into account the finite qubit excitation power, we determine the photon number distribution, which reveals an even-odd photon number oscillation and quantitatively fulfills Klyshko's criterion for nonclassicality.

Comparison of biological effects of modulated electro-hyperthermia and conventional heat treatment in human lymphoma U937 cells

Loco-regional hyperthermia treatment has long history in oncology. Modulated electro-hyperthermia (mEHT, trade name: oncothermia) is an emerging curative treatment method in this field due to its highly selective actions. The impedance-matched, capacitive-coupled modulated radiofrequency (RF) current is selectively focused in the malignant cell membrane of the cancer cells. Our objective is studying the cell-death process and comparing the cellular effects of conventional water-bath hyperthermia treatment to mEHT. The U937 human histiocytic lymphoma cell line was used for the experiments. In the case of conventional hyperthermia treatment, cells were immersed in a thermoregulated water bath, whereas in the case of mEHT, the cells were treated using a special RF generator (LabEHY, Oncotherm) and an applicator. The heating dynamics, the maximum temperature reached (42 °C) and the treatment duration (30 min) were exactly the same in both cases. Cell samples were analysed using different flow cytometric methods as well as microarray gene expression assay and western blot analysis was also used to reveal the molecular basis of the induced effects. Definite difference was observed in the biological response to different heat treatments. At 42 °C, only mEHT induced significant apoptotic cell death. The GeneChip analysis revealed a whole cluster of genes, which are highly up-regulated in case of only RF heating, but not in conventional heating. The Fas, c-Jun N-terminal kinases (JNK) and ERK signalling pathway was the dominant factor to induce apoptotic cell death in mEHT, whereas the cell-protective mechanisms dominated in case of conventional heating. This study has clearly shown that conventional hyperthermia and RF mEHT can result in different biological responses at the same temperature. The reason for the difference is the distinct, non-homogenous energy distribution on the cell membrane, which activates cell death-related signalling pathways in mEHT treatment but not in conventional heat treatment.

Cavity Optomagnonics with Spin-Orbit Coupled Photons

We experimentally implement a system of cavity optomagnonics, where a sphere of ferromagnetic material supports whispering gallery modes (WGMs) for photons and the magnetostatic mode for magnons. We observe pronounced nonreciprocity and asymmetry in the sideband signals generated by the magnon-induced Brillouin scattering of light. The spin-orbit coupled nature of the WGM photons, their geometrical birefringence, and the time-reversal symmetry breaking in the magnon dynamics impose the angular-momentum selection rules in the scattering process and account for the observed phenomena. The unique features of the system may find interesting applications at the crossroad between quantum optics and spintronics.

Terpenoids, Flavonoids and Acetogenins from Some Malagasy Plants

Humulanes, drimanes, ent-kaurane, lupane, cycloartane, flavanone, flavones and quinol derivatives were isolated from Malagasy Cussonia vantsilana, Helichrysum gymnocephalum, Phyllarthron madagascariense, Gomphocarpus fructicosus, Cinnamosma sp. and C. fragrans, and their structures elucidated by using extensive NMR analysis. A mixture of a few flavones and/or lupane triterpene showed antimicrobial activity against Mycobacterium smegmatis and Pseudomonas aeruginosa.

Terpenoids, Flavonoids and Acetogenins from Some Malagasy Plants

Humulanes, drimanes, ent-kaurane, lupane, cycloartane, flavanone, flavones and quinol derivatives were isolated from Malagasy Cussonia vantsilana, Helichrysum gymnocephalum, Phyllarthron madagascariense, Gomphocarpus fructicosus, Cinnamosma sp. and C. fragrans, and their structures elucidated by using extensive NMR analysis. A mixture of a few flavones and/or lupane triterpene showed antimicrobial activity against Mycobacterium smegmatis and Pseudomonas aeruginosa.

Total compensation of pulse transients inside a resonator

The profile of rf pulses that nuclear spins experience inside a resonator deviates from that of rf voltage signals generated by a NMR spectrometer according to users' pulse programming, when change of the profile in time is comparable to or shorter than the time constant of the resonator. In our previous work [Takeda et al., J. Magn. Reson. 197 (2009) 242-244], we proposed active compensation of rf pulse transients, in which the amplitude transient of the rf pulse can be suppressed without sacrificing the Q factor of the probe. Here we extend the idea of active compensation toward total compensation of the amplitude as well as phase transients. By measuring the transient response of the probe to a given excitation using a pickup coil, the response function determining the transient behavior of the probe is numerically obtained. Then, by numerically solving the convolution equation with the help of Laplace transformation, one can obtain the amplitude and phase profiles of the pulse that should be programmed in the spectrometer in order to apply the rf pulses to the nuclear spins as intended. Accurate rf pulsing based on this idea is experimentally demonstrated, and prospect and requirements for coping with the receiver dead-time problem are discussed.

Clinical usefulness of CEA-mRNA determination in minor effusion

Malignant pleural effusion of lung cancer is an important prognostic factor, even in minor effusions. Previous studies reported that cytological examination could not detect malignant cells in pleural dissemination cases. Therefore, we used real-time PCR as a more sensitive test to detect malignant cells. The subjects were selected from 132 primary lung cancer patients and 8 benign tumor patients as negative control. These subjects had no apparent pleural effusion or distant metastasis. All subjects were negative on cytological examination and without exfoliation evidence. The follow-up duration was 18.1 +/- 7.1 months (mean +/- SD). In the real-time PCR, the CEA-mRNA and GAPDH-mRNA parameters were measured simultaneously, and the CEA-mRNA ratio was obtained as normalized values of CEA-mRNA divided by GAPDH-mRNA. The CEA-mRNA ratio in our study was correlated with lymph node metastasis (N-factor: p = 0.0948) and lymphatic invasion (Ly-factor: p = 0.0520). Using a proportional hazard model, with recurrence or death as terminal point, the CEA-mRNA ratio affected the recurrence risk by 1.920 (95% CI: 1.104-3.340) in Stage 1a. Using log rank testing, we found significant differences in the recurrence rate between the CEA-mRNA-positive and -negative cases (p = 0.0039) at cut-off point 0.1.

Analysis of gene expression in apoptosis of human lymphoma U937 cells induced by heat shock and the effects of α-phenyl N-tert-butylnitrone (PBN) and its derivatives

Hyperthermia, a modality of cancer therapy, has been known as a stress to induce apoptosis. However, the molecular mechanism of heat shock-induced apoptosis, especially on roles of intracellular oxidative stress, is not fully understood. First, when human lymphoma U937 cells were treated with heat shock (44 degrees C, 30 min), the fraction of apoptosis, revealed by phosphatidylserine externalization, increased gradually and peaked at 6 hr after the treatment. In contrast, intracellular superoxide formation increased early during the heat shock treatment and peaked at 30 min after the treatment. When the cells were treated with heat shock in the presence of alpha -phenyl-N-tert-butylnitrone (PBN) and its derivatives, which are potent antioxidants, the DNA fragmentation was inhibited in an order according to the agents' hydrophobicity. PBN showing the highest inhibitory effects suppressed not only intracellular superoxide formation but also various apoptosis indicators. cDNA microarray was employed to analyze gene expression associated with heat shock-induced apoptosis, and the time-course microarray analysis revealed 5 groups showing changes in their pattern of gene expression. Among these genes, c-jun mRNA expression showed more than 40 fold increase 2 hr after heat treatment. The expression level of c-jun mRNA verified by quantitative real-time PCR was about 20 fold increase, and c-jun expression was similarly suppressed by PBN and its derivatives. These results suggest that the change of c-jun expression is an excellent molecular marker for apoptosis mediated by intracellular oxidative stress induced by heat shock.

The effects of anesthesia and surgery on count and function of neutrophils

The effects of anesthesia and surgery on neutrophil count, chemotaxis and neutrophil alkaline phosphatase (NAP) score were investigated in 10 patients who had elective spine surgery. Plasma levels of adrenaline, noradrenaline and cortisol were measured and correlations between hormonal levels and neutrophil count and function were assessed. Neutrophil count started increasing after the initiation of surgery, reached the highest level at 3 hours after surgery, and decreased gradually toward preanesthetic level on 3rd postoperative day. The increase in band cell: segment cell ratio is prominent, whereas lymphocytes decreased significantly. Neutrophil chemotaxis and spontaneous migration were increased significantly from the end of operation to 1st postoperative day. NAP score, assumed to reflect the neutrophil phagocytic activity, lowered transiently during anesthesia, then increased 1.6 times more than preanesthetic level on 1st postoperative day. It was indicated that the increased cortisol release rather than adrenaline due to body response to surgical stress might induce neutrophilia, and that the elective spine surgery might not be deleterious to the neutrophil function.

DNA microarray analysis of genes involved in the process of differentiation in mouse Leydig cell line TTE1

A Leydig cell line, TTE1, was established from the temperature-sensitive simian virus 40 large T-antigen transgenic mice. The cells showed temperature-sensitive growth characteristics and a differentiated phenotype at a nonpermissive temperature. To identify differentially expressed genes in the process of Leydig cell differentiation, the authors carried out microarray analysis of TTE1 cells cultured at permissive and nonpermissive temperatures. The resulting fluorescence-labeled cDNAs synthesized from mRNAs were hybridized with Clontech's Atlas glass mouse 1.0 microarrays. Of the 1081 genes analyzed, the levels of 31 genes were changed, with 24 genes showing increased levels of expression and the remaining 7 genes showing decreased levels. Tie2 was the most changed transcript, with a 13.5-fold upregulation under the differentiated condition. The authors believe this to be the first report of broadscale gene expression in Leydig cell differentiation using the microarray technology. The ability to analyze broadscale gene expression in this manner provides a powerful tool for investigating the molecular mechanisms of Leydig cell functions.

Establishment of Leydig cell line, TTE1, from transgenic mice harboring temperature-sensitive simian virus 40 large T-antigen gene

A Leydig cell line, TTE1, has been established from transgenic mice harboring a temperature-sensitive simian virus 40 (tsSV40) large T-antigen gene. The cells grew at a permissive temperature (33 degrees C), but growth was markedly prevented at a nonpermissive temperature (39 degrees C). T-antigen was expressed in the nuclei at 33 degrees C but disappeared at 39 degrees C, indicating that the cells show a temperature-sensitive growth phenotype reflected by the tsSV40 large T-antigen. TTE1 cells did not show any colony-forming activity in soft agar and form tumors in subcutaneous tissue in nude mice, indicating that the cells were not transformed. Alkaline phosphatase and 3beta-hydroxysteroid dehydrogenase (HSD) activities or expression of cytokeratin and vimentin were observed. Reverse transcription-polymerase chain reaction (RT-PCR) analysis indicated that TTE1 cells expressed mRNAs encoding 17beta-HSD types 1 and 3, and inhibin-alpha. The cells with unique characteristics, therefore, should serve useful model study the function of Leydig cell.

Cibenzoline, an ATP-sensitive K(+) channel blocker, binds to the K(+)-binding site from the cytoplasmic side of gastric H(+),K(+)-ATPase

1. Cibenzoline, (+/-)-2-(2,2-diphenylcyclopropyl-2-imidazoline succinate, has been clinically used as one of the Class I type antiarrhythmic agents and also reported to block ATP-sensitive K(+) channels in excised membranes from heart and pancreatic beta cells. In the present study, we investigated if this drug inhibited gastric H(+),K(+)-ATPase activity in vitro. 2. Cibenzoline inhibited H(+),K(+)-ATPase activity of permeabilized leaky hog gastric vesicles in a concentration-dependent manner (IC(50): 201 microM), whereas no effect was shown on Na(+),K(+)-ATPase activity of dog kidney (IC(50): >1000 microM). Similarly, cibenzoline inhibited H(+),K(+)-ATPase activity of HEK-293 cells (human embryonic kidney cell line) co-transfected with rabbit gastric H(+),K(+)-ATPase alpha- and beta-subunit cDNAs (IC(50): 183 microM). 3. In leaky gastric vesicles, inhibition of H(+),K(+)-ATPase activity by cibenzoline was attenuated by the addition of K(+) (0.5 - 5 mM) in a concentration-dependent manner. The Lineweaver-Burk plot of the H(+),K(+)-ATPase activity shows that cibenzoline increases K(m) value for K(+) without affecting V(max), indicating that this drug inhibits H(+),K(+)-ATPase activity competitively with respect to K(+). 4. The inhibitory effect of H(+),K(+)-ATPase activity by cibenzoline with normal tight gastric vesicles did not significantly differ from that with permeabilized leaky gastric vesicles, indicating that this drug reacted to the ATPase from the cytoplasmic side of the membrane. 5. These findings suggest that cibenzoline is an inhibitor of gastric H(+),K(+)-ATPase with a novel inhibition mechanism, which inhibits gastric H(+),K(+)-ATPase by binding its K(+)-recognition site from the cytoplasmic side.

[The influence of age on hemodynamics and the dose requirements of propofol and buprenorphine in total intravenous anesthesia combined with continuous epidural anesthesia]

A retrospective study was performed to determine the influence of age on hemodynamics and awakening time in total intravenous anesthesia (TIVA) using propofol and buprenorphine combined with continuous epidural anesthesia for abdominal surgery. Thirty-five patients (36-87 yr) were allocated to the following five groups by age: 36-49 yr, 50-59 yr, 60-69 yr, 70-79 yr and 80-87 yr. All patients were premedicated with midazolam i.m. Anesthesia was maintained with propofol infusion with 40% oxygen in air, intravenous buprenorphine plus vecuronium and continuous epidural anesthesia using 2% mepivacaine. After extubation, the epidural bolus dose (buprenorphine 0.1-0.2 mg with droperidol 1.25-2.5 mg) and epidural infusion (buprenorphine 17 micrograms.h-1 with droperidol 0.1 mg.h-1) were administered. Intraoperative heart rate (HR) and mean arterial pressure (MAP) decreased but remained within 30% of preanesthetic level. HR did not differ in five groups, although MAP decreased significantly in patients above 50 yr of age. The doses of midazolam (1-5 mg), propofol (2.7-7.4 mg.kg-1.h-1) and buprenorphine (40-200 micrograms) decreased with age (P < 0.01), while the maintenance doses of mepivacaine (40-140 mg.h-1) and vecuronium (0.03-0.09 mg.kg-1.h-1) showed no significant decrease. Awakening time was not significantly prolonged with age (r = 0.27, P = 0.12). Two patients in each group required analgesics within 20 hours. Neither nausea, respiratory depression nor awareness was found. We suggest that the combination of TIVA and continuous epidural anesthesia would be useful to maintain stable hemodynamic state and to obtain early recovery time, especially in the elderly.

Optimal duration of oral adjuvant chemotherapy with Carmofur in the colorectal cancer patients: the Kansai Carmofur Study Group trial III

A multi-institutional study was performed to evaluate the appropriate duration of oral administration of Carmofur (1-hexylcarbamoyl-5-fluorouracil, HCFU), a 5-fluorouracil (5-FU) derivative, for postoperative adjuvant chemotherapy in patients with colorectal cancer undergoing curative operation. Patients were divided into two: i) short duration group receiving 6 months of HCFU administration and ii) long duration group receiving 1 year of the administration, using a centralized registration system. Among 364 patients entered in this study, 293 evaluable cases were analyzed to investigate the appropriate duration of adjuvant oral chemotherapy. No statistical differences were found in the cumulative 5-year disease-free or survival rates between the groups. However, the actual duration of oral HCFU administration differed in the patients of short and long duration groups from the protocol. Namely, more than 70% of the patients received a different duration of oral adjuvant chemotherapy in each of the groups. Therefore, apart from this division of two groups, correlation between the actual duration of oral HCFU administration and the prognosis was examined in these patients. As a result, it was suggested that oral adjuvant chemotherapy with HCFU would be effective in colon cancer patients when the duration of administration exceeded 330 days. In rectal cancer patients, however, adjuvant chemotherapy with HCFU alone was considered to be not sufficient to affect the prognosis.

Characterization of the mouse TFF1 (pS2) gene promoter region

Trefoil peptides (TFFs) with a unique trefoil domain(s) are presumed to function in protection and repair of the gastrointestinal epithelial layer. Three peptide family members are differently distributed in the mouse gastrointestinal tract: TFF1/pS2 specifically in stomach, TFF2/SP mainly in stomach, pancreas and duodenum, and TFF3/ITF in intestine. We cloned and sequenced the mouse TFF1 gene 5'-upstream region by means of the genomic walking procedure. The cloned region was ligated to the luciferase reporter gene and then introduced into mouse gastric surface mucous GSM10 cells which express TFF1 and TFF2. The minimum promoter was located in the region containing the TATA-box between -39 and the transcriptional start site. Further upstream regions stimulated (-2192-- -1630bp, -641-- -243bp, -137-- -39bp) and inhibited (-1630-- -641bp, -243-- -137 bp) luciferase gene expression. These regions as well as short segments conserved in the mouse and human 5'-upstream sequences may be important for modulation of the mRNA level of the TFF1 gene.

Characterization and application of a gastric surface mucous cell line GSM06 established from temperature-sensitive simian virus 40 large T-antigen transgenic mice

It has been indicated that transgenic mouse harboring a temperature-sensitive simian virus 40 large T-antigen gene is useful for establishing cell lines from tissues that have proved difficult to culture in vitro. The gastric surface mucous cell line GSM06 was established from a primary culture of gastric fundic mucosal cells of the transgenic mice. GSM06 cells showed temperature-sensitive growth in culture and expressed large T-antigen at a permissive temperature (33 degrees C) but not at a nonpermissive temperature (39 degrees C). At 39 degrees C, the cells produced periodic acid-Schiff positive glycoconjugates that formed a mucous sheet like the gastric surface mucosa in the stomach. Insulin markedly increased the production of glycoconjugates. In addition, proprotein-processing endoprotease furin suppression retarded cell growth, but accelerated cell differentiation. An air-liquid interface promoted the differentiation of GSM06 cells in a reconstruction culture with nitrocellulose membrane and collagen gel. The gastric surface mucous cell line GSM06 with unique characteristics, therefore, should be useful as an in vitro model of the gastric mucosa for physiological and pharmacological investigations. Moreover, experiments using immortalized cells established in vitro and having specific functions may offer an alternative to experiments using living animals and thereby offer a solution to this ethical issue.

[The influence of age on hemodynamics and the dose requirements of propofol and buprenorphine in total intravenous anesthesia]

A retrospective study was performed to determine the influence of age on hemodynamics and awakening time in total intravenous anesthesia (TIVA) with propofol and buprenorphine for spinal surgery. Twenty patients (26-79 yr) were studied and allocated into following four groups by age: 26-49 yr, 50-59 yr, 60-69 yr, and elderly 70-79 yr. All patients were premedicated with midazolam (2.5-5 mg) i.m. Anesthesia was induced (60-180 ml.h-1) and maintained (20-60 ml.h-1) with propofol infusion with 40% oxygen in air, added with vecuronium and one single dose of buprenorphine (0.08-0.2 mg; 1.37-2.63 micrograms.kg-1) before incision. Mean arterial pressure was stable and did not differ in four groups. Heart rate was decreased (P < 0.01) in the elderly group compared with the group younger than 50 yr. Bradycardia (below 50 beat.min-1) occurred in 60% of the elderly group. An adequate dose of buprenorphine (microgram) was proposed as: 208 - 1.8 x age (yr) + 0.3 x weight (kg) (r = 0.90, P < 0.01). The induction and maintenance rates (ml.h-1) of propofol were decreased with age and increased with weight (P < 0.05). However, the maintenance dose of propofol (3.9-8.5 mg.kg-1.h-1) did not correlate with age. Awakening time was prolonged (P < 0.05) in the elderly group (17.0 +/- 7.2 min) as compared with the group of younger than 50 yr (8.0 +/- 3.9 min). The three patients requiring postoperative analgesics were younger than 60 yr. This study suggests that we should reduce the dose of buprenorphine with age in TIVA using propofol. About 50% of the dose given to the patient younger than 50 yr was considered adequate in the elderly group.

Establishment and characterization of a colonic epithelial cell line MCE301 from transgenic mice harboring temperature-sensitive simian virus 40 large T-antigen gene

We produced an immortalized colonic epithelial cell line, MCE301, using fetal mice transgenic for the temperature-sensitive simian virus 40 large T-antigen gene. MCE301 cells showed epithelial-like morphology and maintained tight connections with neighboring cells. The cells grew at a permissive temperature (33 degrees C), but the growth of the cells was significantly prevented at the nonpermissive temperature (39 degrees C). The cells expressed large T-antigen at 33 degrees C but not at 39 degrees C. MCE301 cells were not transformed, as judged by the absence of anchorage-independent growth in soft agar gel and lack of tumor formation in nude mice. Electron microscopic studies showed that the cells formed microvilli-like structures on the cell surface and junctional complexes such as tight junctions and desmosomes between the cells. The cells expressed cytosketal (acidic cytokeratins and actin), basement membrane (laminin and collagen type IV) and junctional complex proteins (ZO-1 and desmoplakin I + II), as judged by specific antibodies. Fetal bovine serum, epidermal growth factor, insulin-like growth factor and insulin significantly increased the cell growth at 33 degrees C. Moreover, MCE301 cells expressed colonic mucin Muc2 mRNA as demonstrated by reverse transcriptase-polymerase chain reaction, indicating that the cells originate from mucus-secreting cells. Alkaline phosphatase, a brush border-associated enzyme, was detected in the cells. Sodium butyrate (2 mM), an inducer of cellular differentiation, markedly elevated alkaline phosphatase activity. Thus, the present mouse colonic epithelial cell line MCE301 possessing these unique characteristics should provide a useful in vitro model of colonic epithelium.

Significance of lysine/glycine cluster structure in gastric H+,K+-ATPase

Gastric H+,K+-ATPase consists of alpha- and beta-subunits. The catalytic alpha-subunit contains a very unique structure consisting of lysine and glycine clusters, KKK(or KKKK)AG(G/R)GGGK-(K/R)K, in the amino-terminal cytoplasmic region. This structure is well conserved in all gastric H+,K+-ATPases from different animal species, and was postulated to be the site controlling the access of cations (or proton) to its binding site. In this report, we studied the role of this unique structure by expressing several H+,K+-ATPase mutants of the alpha-subunit together with the wild-type beta-subunit in HEK-293 cells. Even after replacing all the positively-charged amino acid residues (six lysines and one arginine) in the cluster with alanine or removing all the glycine residues in the cluster, the mutants preserved the H+,K+-ATPase activity, and showed similar affinity for ATP and K+ as well as similar pH profiles as those of wild-type H+,K+-ATPase, indicating that the cluster is not indispensable for H+,K+-ATPase activity and not directly involved in determination of the affinity for cation (proton).

Appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ: report of a case

Appendiceal intussusception is an uncommon pathologic condition; however, villous adenoma of the appendix is a distinctly rare entity. We report herein a case of appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ. A 67-year-old man was admitted to our hospital with a 1-year history of lower abdominal pain for investigation. Barium enema showed a filling defect with an irregular surface in the cecum, and colonoscopy revealed a cecal tumor with a granular surface. Pathological examination of biopsy samples revealed tubulovillous adenoma with well-differentiated adenocarcinoma, and a diagnosis of cecal cancer in tubulovillous adenoma was made. Surgery was performed and the resected specimen was found to contain a tumor arising from the appendix. The tumor was 5.5 x 4.5 cm in size in the cecal cavity, and the appendix had invaginated into the cecum at its base. The cut surface of the appendix showed the villous tumor filling the appendiceal lumen and projecting into the cecal cavity. Microscopic examination revealed well-differentiated adenocarcinoma in tubulovillous adenoma. To the best of our knowledge, this is the first report of appendiceal intussusception caused by tubulovillous adenoma with carcinoma of the appendix.

[A comparison of fentanyl and buprenorphine in total intravenous anesthesia using propofol during spinal surgery]

A retrospective study was performed to compare the hemodynamic effect and postoperative pain relief of fentanyl (Group F, n = 11) and buprenorphine (Group B, n = 11) in total intravenous anesthesia (TIVA) using propofol during spinal surgery. All patients were premedicated with midazolam (3-5 mg) i.m. Anesthesia was maintained with propofol infusion, and increments of fentanyl or single dose of buprenorphine with 40% oxygen in air. Total doses of fentanyl and buprenorphine were 7.6 +/- 1.0 micrograms.kg-1 and 2.0 +/- 0.4 micrograms.kg-1, respectively. Maintenance doses of propofol (Group F: 5.5 +/- 0.8 mg.kg-1.h-1, Group B: 5.9 +/- 1.1 mg.kg-1.h-1) and vecuronium were not significantly different. Mean arterial pressures from 2 hours after incision to the end of surgery were elevated significantly in Group F than in Group B. Recovery time (Group F 12.5 +/- 6.1 min vs Group B 11.8 +/- 6.1 min) and extubation time (Group F 19.5 +/- 10.3 min vs Group B 15.0 +/- 7.0 min) were not different. At the end of anesthesia, seven patients in Group F and one patient in Group B (P < 0.01) complained of severe pain. All patients in Group F, and only two in Group B (P < 0.02) received analgesics within 20 hours. Neither nausea nor respiratory depression was found in both groups. This study suggests that buprenorphine would provide a more stable hemodynamic state and better postoperative pain relief than fentanyl in TIVA using propofol.

Deletion polymorphism of angiotensin-converting enzyme gene is associated with postprandial hyperglycaemia in individuals undergoing general check-up

1. Deletion polymorphism, DD, of the angiotensin-converting enzyme (ACE) gene is reported to be related to cardiovascular disease, which is frequently based on insulin resistance. 2. To clarify the relationship between the ACE genotype DD and plasma glucose increases after an oral glucose load, we performed 75 g oral glucose tolerance test (OGTT) in 301 nondiabetic men (age range 30-60 years) undergoing general check-up. 3. Insertion/deletion (I/D) polymorphism of the ACE gene was explored using a polymerase chain reaction. The frequency of the II, ID and DD genotypes was 0.43, 0.43 and 0.14, respectively. 4. There were no differences in baseline clinical characteristics between subjects with each ACE genotype. 5. The mean (+/- SEM) plasma glucose level at 60 min of the OGTT was significantly higher in subjects with the DD genotype (170.8 +/- 6.9 mg/dL) than in subjects with either the II or ID genotype (mean value for two groups 156.6 +/- 2.7 mg/dL; P < 0.05). Moreover, the mean percentage change of plasma glucose after 60 min of the OGTT, a marker of plasma glucose increase, was significantly higher in individuals with the DD genotype than in individuals with either the II or ID genotypes. 6. In contrast, the mean fasting plasma glucose level, the plasma glucose level at 120 min, the glucose response area and the fasting insulin level were not different between individuals with the DD genotype and individuals with other genotypes. 7. In conclusion, subjects with the DD genotype showed transiently higher levels of plasma glucose after an oral glucose load than subjects with other genotypes. Further studies are required to determine whether the association between ACE genotype and postprandial hyperglycaemia influences the incidence of cardiovascular disease and diabetes mellitus.

Telemedicine for evaluation of brain function by a metacomputer

A method of evaluating brain function using the metacomputer concept of the Globus system combined with a message-passing interface is described. The proposed method has the ability to exploit various geographically distributed resources and parallel computing linked to a high-technology medical instrumentation system, magnetoencephalography, to analyze the functional state of the brain. It is envisaged that the method will lead to the realization of an efficient telemedicine system for health care.

[Perioperative management for hemicolectomy using propofol infusion in an elderly patient with a mechanical heart valve prosthesis]

An 81-year-old female (145 cm, 39 kg) with a mechanical heart valve prosthesis underwent right hemicolectomy for cecal cancer under total intravenous anesthesia. She had received anticoagulation therapy [international normalized ratio (INR) 4.3] with warfarin for two years before surgery due to replaced aortic valve and atrial fibrillation. Three days before surgery warfarin was switched to heparin infusion (400 U.h-1) continued until 3 hours before the surgery. The activated partial thromboplastin time (APTT) was maintained above 1.5 times of the control (45 sec). Before induction of anesthesia, the activated clotting time (ACT) was 166 seconds. Following propofol infusion (50 ml.h-1; 38 mg) and vecuronium, anesthesia was maintained with propofol infusion (5.9 mg.kg-1.h-1), buprenorphine i.v. (0.08 mg) and appropriate doses of vecuronium. The total dose of propofol used was 950 mg. Heparin infusion (80 U.h-1) was restarted at the onset of surgery. Intraoperative ACT levels were between 148 and 156 seconds. However, at the end of surgery, APTT was prolonged (60.7 sec). Heparin infusion was reduced to 40 U.h-1 and APTT became normal 3 hours after the surgery. On the 4th postoperative day, heparin infusion was returned to 400 U.h-1 (APTT 32-38 sec). Two days after warfarin restoration on the 15th postoperative day, heparin was discontinued (INR 2.1-2.5). The thromboembolism and bleeding tendency did not occur. This case suggests that despite the suspected bleeding tendency via platelet inhibition under propofol infusion, the reduced heparin infusion can be continued with close coagulation monitoring.

[Perioperative bleeding tendency in a hemodialysis patient during gastrectomy under total intravenous anesthesia using propofol infusion]

A 64-year-old female receiving hemodialysis (HD) underwent subtotal gastrectomy for gastric cancer under total intravenous anesthesia. Anesthesia was performed using continuous infusion of propofol (5-8 mg.kg-1.h-1), buprenorphine i.v. (2.5 micrograms.kg-1), 2% mepivacaine epidural infusion (7 ml.h-1) and appropriate doses of vecuronium. The blood pressure and heart rate were stable within 120% of the preoperative level. However, 3 and half hours after propofol anesthesia, increased bleeding from the surgical field was observed. The activated clotting time (ACT) was 144 seconds. Furthermore, at the end of the operation (5 hours after propofol anesthesia), the ACT (219 sec), PT (14.8 sec), PT-INR (1.94) and APTT (102.5 sec) were significantly prolonged. The platelet count was unchanged. The intraoperative total bleeding was 844 g. The total propofol infusion time and dose were 310 minutes and 1,580 mg, respectively. Immediate recovery with spontaneous ventilation was observed. Postoperative bleeding from the wound continued. Finally, 7 hours after the surgery, the bleeding ceased and the ACT (125 sec), PT (12.4 sec), PT-INR (1.34) and APTT (22.5 sec) were normalized. The total postoperative bleeding was 404 g. Despite the advantage of short-acting anesthetic agent, we suspect that propofol induced the bleeding tendency via platelet inhibition. This platelet inhibition may gradually increase with time and the dose of propofol. We should utilize propofol cautiously for patients receiving HD or with bleeding tendency.

Synthesis of phenoxyacetic acid derivatives as highly potent antagonists of gastrin/cholecystokinin-B receptors. III

In order to improve the biological characteristics of DA-3934 (5), a novel gastrin/cholecystokinin (CCK)-B receptor antagonist, phenoxyacetic acid derivatives replacing the N-methyl-N-phenylcarbamoylmethyl moiety of 5 with various alkyl chains have been synthesized and their biological activity evaluated. The relationship between the structure of these compounds and their human gastrin receptor binding affinity showed that there should be the optimal size among the various N-alkyl chains. Also a significant increase in the receptor binding affinity was achieved by several compounds. Among those compounds, 2-[3-[3- [N-cyclohexylmethyl-N-[2-(N-methyl- N-phenylcarbamoylmethoxy)phenyl]carbamoylmethyl]ureido]pheny l]acetic acid (22c) and (+/-)-2-[3-[3-[N-[2-(N-methyl-N- phenylcarbamoylmethoxy)phenyl]-N-(3-methylpentyl)carbamoy lmethyl]ureido] phenyl]acetic acid (22h) exhibited high affinity for human gastrin receptors and were also more potent inhibitors in a pentagastrin-induced gastric acid secretion model than the parent compound, 5. The ED50 values of these compounds when administered intraduodenally to rats were 0.12 and 0.63 mg/kg, respectively.

[Anesthetic management of patients with malignant pleural effusion undergoing hyperthermic perfusion under thoracoscopy]

Nine patients with malignant pleural effusion due to lung cancer had been scheduled for hyperthermic treatment with warmed distilled water (40 degrees C) under thoracoscopy. This treatment aims to produce adhesion of the lungs to reduce pleural effusion. To evaluate the risk of general anesthesia for patients with lung cancer at the end stage, we examined the problems of perioperative management. Seven out of nine patients were classified into ASA physical status > or = III and seven patients into Hugh Jones > or = III Shapiro's score was > or = 5 in four patients. The average %VC was 60 +/- 16 and % FEV1.0 was 41 +/- 18% (means +/- SE). A double lumen endotracheal tube was inserted and anesthesia was maintained with inhalational anesthetics. In two cases, one-lung ventilation could not be maintained because of severe hypoxemia during hyperthermic perfusion. Hypertension occurred in three cases and hypotension in one by direct heat stimulation of the cardiopulmonary system. Although their preoperative risk was poor, there were no major complications and the quality of life was improved. We stress that careful anesthetic management is important for avoiding hypoxemia and hemodynamic instability during this treatment.

Clinicopathologic variables affecting survival of distal colorectal cancer patients with macroscopic invasion into the adjacent organs

A total of 506 distal colorectal cancer patients were classified into two groups, to clarify the variables affecting survival of the patients with macroscopic invasion into the adjacent organs: 47 cases showed invasion (invasive group) while the other did not show invasion (noninvasive group). Differences between the invasive and noninvasive groups were found in eight variables; female, large tumor size, gross types 3 and 4, moderately or poorly differentiated adenocarcinomas and signet-ring cell or mucinous carcinomas, deep cancer invasion, lymphatic invasion, peritoneal and liver metastases, and curability B-C were found significantly more frequently in the invasive group. The survival curve of the former was significantly (P < 0.05) lower than that of the latter. However, no significant difference was found between the survival curves of the patients with curability A (no residual tumors) in both groups. A multivariate analysis in the invasive groups revealed six variables to be significantly related to a good prognosis including a young age, females, a location above the peritoneal reflection, well differentiated adenocarcinoma, negative lymphatic invasion, and curability A. Surgery with curability A should be performed to improve the survival in distal colorectal cancer patients with macroscopic invasion into the adjacent organs.

Cucumber cotyledon lipoxygenase during postgerminative growth. Its expression and action on lipid bodies

In cucumber (Cucumis sativus), high lipoxygenase-1 (LOX-1) activity has been detected in the soluble fraction prepared from cotyledons of germinating seeds, and the involvement of this enzyme in lipid turnover has been suggested (K. Matsui, M. Irie, T. Kajiwara, A. Hatanaka [1992] Plant Sci 85: 23-32; I. Fuessner, C. Wasternack, H. Kindl, H. Kühn [1995] Proc Natl Acad Sci USA 92: 11849-11853). In this study we have investigated the expression of the gene lox-1, corresponding to the LOX-1 enzyme. LOX-1 expression is highly coordinated with that of a typical glyoxysomal enzyme, isocitrate lyase, during the postgerminative stage of cotyledon development. In contrast, although icl transcripts accumulated in tissue during in vitro senescence, no accumulation of lox-1 mRNA could be observed, suggesting that lox-1 plays a specialized role in fat mobilization. LOX-1 is also known to be a major lipid body protein. The partial peptide sequences of purified LOX-1 and lipid body LOX-1 entirely coincided with that deduced from the lox-1 cDNA sequence. The data strongly suggest that LOX-1 and lipid body LOX-1 are derived from a single gene and that LOX-1 can exist both in the cytosol and on the lipid bodies. We constructed an in vitro oxygenation system to address the mechanism of this dual localization and to investigate the action of LOX-1 on lipids in the lipid bodies. LOX-1 cannot act on the lipids in intact lipid bodies, although degradation of lipid body proteins, either during seedling growth or by treatment with trypsin, allows lipid bodies to become susceptible to LOX-1. We discuss the role of LOX-1 in fat mobilization and its mechanism of action.

Expression of nm23-H1 in colorectal cancer: no association with metastases, histological stage, or survival

The correlations of nm23-H1 expression in primary cancer lesions with the already confirmed 14 prognostic variables and survival were examined in 52 advanced colorectal cancer patients, because the clinical roles of nm23-H1 expression in the cancer lesions remain controversial. An immunohistochemical expression of nm23-H1 was found in 23 lesions (positive group) but not found in 29 lesions (negative group). No significant difference between the positive and negative groups was found according to 12 clinicopathological variables including vascular invasion, lymph node and liver metastases, and histological stage. The carcinoembryonic antigen levels (21.5+/-33.4 ng/ml) of the draining venous blood and argyrophilic nucleolar organizer regions score (3.35+/-1.36 per nucleus) of the cancer cells in the positive group were not significantly diffeent from those (34.1+/-102.9 ng/ml and 3.32+/-1.00 per nucleus, respectively) in the negative group. In addition, no significant difference was found in the survival curves or the 5-year survival rates of the positive and negative groups. From these results, it may be concluded that the nm23-H1 expression was not associated with the aforementioned prognostic variables and the prognosis of advanced colorectal cancer patients.

Immunohistochemical evaluation of thymidylate synthase in gastric carcinoma using a new polyclonal antibody: the clinical role of thymidylate synthase as a prognostic indicator and its therapeutic usefulness

BACKGROUND

Before this study was conducted, the clinical and therapeutic significance of immunohistochemical evaluation of thymidylate synthase (TS) in patients with gastric carcinoma had not yet been clarified.

METHODS

TS was immunohistochemically evaluated in 134 gastric carcinomas using anti-TS antibody. TS expression, 11 clinicopathologic variables, and survival were studied, and the correlations among them were investigated.

RESULTS

The groups with high and low TS levels consisted of 56 and 78 patients, respectively. Granular cytoplasmic staining patterns of tumor cells were produced by immunohistochemical staining of the gastric carcinoma tissues. The grade of TS staining was significantly correlated with three clinicopathologic variables: depth of invasion, peritoneal metastasis, and stage of the carcinoma (P < 0.05). A univariate analysis revealed that the 5-year survival was significantly better for the low TS group than for the high TS group (P < 0.05): 65.2% for the low TS group and 43.2% for the high TS group. The group with high grade TS staining who received chemotherapy because of the advanced stage of their disease had worse prognoses even if they received adjuvant chemotherapy. A multivariate analysis revealed that four variables (peritoneal metastasis, lymphatic invasion, liver metastasis, and TS staining grade) independently contributed to survival (P < 0.05). The hazard ratio for the group with low grade TS staining was 0.464 compared with the group with high grade staining.

CONCLUSIONS

The immunohistochemical evaluation of TS using this anti-TS antibody may be clinically and therapeutically useful in determining the prognosis of gastric carcinoma patients.

Evaluation of argyrophilic nucleolar organizer region and proliferating cell nuclear antigen in colorectal cancer

BACKGROUND AND OBJECTIVES

Information on cellular proliferation is gaining importance for predicting prognosis in several cancers. To clarify the clinicopathological significance of argyrophilic nucleolar organizer region (AgNOR), proliferating cell nuclear antigen (PCNA), and DNA ploidy pattern, we studied their correlations with clinicopathological factors in colorectal cancer.

METHODS

Fifty-two patients with colorectal cancer were examined by AgNOR staining, immunohistochemical study of PCNA expression, and DNA flow cytometry.

RESULTS

The AgNOR score and the PCNA labeling rate (PCNA LR) were significantly higher in patients with deep invasion (P = 0.0072, P = 0.0355), liver metastasis (P = 0.0022, P = 0.0001), and Dukes D classification (P = 0.0002, P = 0.0001) than in patients without these factors. In patients with high AgNOR score (>3.83) or with high PCNA LR (>48.8), prognosis was significantly worse (P = 0.0002, P = 0.0123) than in those with low AgNOR score (<3.83) or in those with low PCNA LR (<48.8), respectively. No significant association was observed between AgNOR score and PCNA LR. Combined analysis revealed that the survival curve for patients with high AgNOR score and high PCNA LR was significantly lower (P = 0.0156) than that for patients with high AgNOR score and low PCNA LR. There was no significant correlation between DNA ploidy pattern and clinicopathological findings.

CONCLUSIONS

PCNA LR and AgNOR score were correlated not only with local progression but also with metastasis. Their determination provided useful prognostic information, and these parameters are probably independent. Their simultaneous determination was useful for accurate evaluation of prognosis. The value of DNA ploidy pattern was uncertain.