Prognostic significance of vascular invasion in patients with bladder cancer who underwent radical cystectomy

BACKGROUND

The objective of this study was to determine whether vascular invasion (i.e. lymphatic and blood vessel invasion) could be a useful prognostic predictor in patients with locally invasive transitional cell carcinoma (TCC) of the bladder who underwent radical cystectomy.

METHODS

This series included 114 consecutive patients undergoing radical cystectomy for primary TCC of the bladder between November 1989 and July 2003. Several clinicopathological characteristics of these patients were analyzed, focusing on the association between vascular invasion and disease recurrence after radical cystectomy.

RESULTS

Lymphatic and blood vessel invasions were detected in 55 (48.2%) and 33 (29.8%) specimens, respectively. Lymphatic invasion was significantly associated with pathological stage, tumor grade, lymph node metastasis, blood vessel invasion and disease recurrence, whereas blood vessel invasion was significantly related to pathological stage, lymph node metastasis, lymphatic invasion and disease recurrence. Recurrence-free survival in patients with lymphatic invasion was significantly lower than that in those without lymphatic invasion, and a similar significant difference in recurrence-free survival was observed between patients with and without blood vessel invasion. However, multivariate analysis using the Cox proportional hazards model showed that only pathological stage and lymph node metastasis could be used as independent predictors for disease recurrence after radical cystectomy.

CONCLUSIONS

Despite a significant association between several prognostic parameters, vascular invasion was not an independent predictor of disease recurrence; therefore, if there are other conventional parameters available, there might not be any additional advantage to considering the presence of vascular invasion when predicting the prognosis of patients undergoing radical cystectomy for TCC of the bladder.

Preoperative prediction of final pathological features is not improved by the free-to-total prostate-specific antigen ratio in Japanese men with clinically localized prostate cancer

BACKGROUND

The objective of the present study was to determine whether the percentage of free/total prostate-specific antigen (f/tPSA) in patients scheduled to undergo radical prostatectomy for clinically localized prostate cancer can preoperatively predict organ-confined versus extraprostatic disease.

METHODS

Serum levels of fPSA and tPSA were measured in 97 patients with clinically organ-confined disease before they underwent radical prostatectomy. The relationships of tPSA, f/tPSA and the pathological stage of the prostatectomy specimens were analyzed. Furthermore, the ability of f/tPSA to predict the pathological features was compared with those of tPSA and systematic biopsy findings.

RESULTS

Organ-confined and extraprostatic extension diseases were present in 51 and 46 men, respectively. tPSA in patients with extraprostatic diseases was significantly higher than that in those with organ-confined diseases; however, there was no significant difference in f/tPSA between these two groups. There was also a significant difference in tPSA levels at each pathological stage, while f/tPSA did not parallel the pathological stage. Furthermore, there was no additional information concerning the extent of prostate cancer obtained when f/tPSA was combined with tPSA or with the percent of positive biopsy cores, which is the most significant predictor of the extent of prostate cancer among factors associated with systematic biopsy.

CONCLUSION

f/tPSA could not predict the final pathological features in patients with clinically localized prostate cancer before radical prostatectomy. Moreover, the predictive value provided by tPSA or systematic biopsy findings was not improved by combined analysis with f/tPSA.

Prognostic Significance of the Tumor Volume in Radical Prostatectomy Specimens after Neoadjuvant Hormonal Therapy

INTRODUCTION

The objective of this study was to determine whether the tumor volume in radical prostatectomy specimens of patients with prostate cancer who underwent neoadjuvant hormonal therapy (NHT) could be used as a prognostic predictor.

PATIENTS AND METHODS

In this study, we included 96 patients who underwent NHT followed by radical prostatectomy between January 1995 and July 2003 in our institutions. Several clinicopathological factors of these patients were analyzed, focusing on the association between tumor volume in radical prostatectomy specimens and disease recurrence.

RESULTS

The tumor volume in radical prostatectomy specimens after NHT was significantly associated with capsular penetration, seminal vesicle invasion, and lymph node metastases, among the factors examined in this study. The biochemical recurrence-free survival rates in patients with tumor volumes <1.0 cm(3) were significantly higher than in those having tumor volumes > or =1.0 cm(3). However, multivariate analysis showed that the tumor volume could not be used as an independent predictor for biochemical recurrence.

CONCLUSIONS

In patients who received NHT prior to radical prostatectomy, the tumor volume was shown to correlate with other prognostic indicators. Furthermore, a higher probability of biochemical recurrence was noted, when there was a residual tumor volume > or =1.0 cm(3) after NHT. Thus, careful follow-up and, if necessary, additional treatment should be considered in cases demonstrating tumor volumes > or =1.0 cm(3) after NHT.

Clinicopathological features of recurrence after radical surgery for nonmetastatic renal cell carcinoma

BACKGROUND

The objective of this study was to clarify the clinicopathological features of recurrent renal cell carcinoma (RCC) in patients who had undergone curative surgical resection of primary disease.

METHODS

The study included 171 patients treated by radical surgery for nonmetastatic RCC in our institution. Several clinicopathological factors were analyzed to determine differences between patients with and without disease recurrence. We further investigated predictive factors for disease recurrence, as well as prognostic factors after disease recurrence, using univariate and multivariate analyses.

RESULTS

Thirty-four of the 171 patients (19.9%) developed recurrence, and the median time from surgery to recurrence was 11 months (range, 1 to 146 months). The incidence of disease recurrence was significantly associated with sex, mode of detection, tumor size, pathological stage, tumor grade, and microvascular invasion (MVI). Univariate analysis showed that five factors--mode of detection, tumor size, pathological stage, tumor grade, and MVI--were found to be significant risk factors for recurrence after surgery, while only the pathological stage was an independent predictor of recurrence by multivariate analysis. After disease recurrence, the 1-, 3-, and 5-year cancer-specific survival rates were 66.3%, 45.9%, and 13.4%, respectively. Despite the absence of independent prognostic predictors after recurrence, recurrence more than 1 year after surgery and complete resection of recurrent lesions were shown to be significant prognostic factors by univariate analysis.

CONCLUSION

These findings suggest that careful follow-up should be performed for patients showing a high pathological stage after radical surgery for nonmetastatic RCC, because of the higher probability of disease recurrence, and that after recurrence, intensive treatment should be considered, particularly for patients with unresectable recurrent disease occurring within 1 year after initial radical surgery.

Long-term results of adjuvant hormonal therapy plus radiotherapy following radical prostatectomy for patients with pT3N0 or pT3N1 prostate cancer

BACKGROUND

The objective of the present study was to evaluate the efficacy of adjuvant androgen suppression in conjunction with external beam irradiation after radical prostatectomy in patients with pathologically confirmed extraprostatic disease.

METHODS

Between July 1988 and October 1999, 38 patients with pT3N0 or pT3N1 prostate cancer received adjuvant hormonal therapy and external beam irradiation following radical retropubic prostatectomy and pelvic lymphadenectomy. Administration of luteinizing hormone-releasing hormone analog or castration were initiated as an adjuvant androgen suppression within 4 weeks after surgery, whereas pelvic irradiation was performed at a median dose of 50 G within 3 months after surgery. The prognostic advantage of this combined adjuvant therapy was analyzed.

RESULTS

During the median observation period of 92 months, biochemical recurrence occurred in four of the 38 patients and five patients died. Of these five patients, only one died of prostate cancer progression. The 10-year biochemical recurrence-free, cancer-specific and overall survival rates of the 38 patients were 86.7%, 90.9% and 78.7%, respectively. Among several factors examined, only tumor grade was significantly associated with biochemical recurrence-free survival in these patients; however, there were no factors that were independent predictors for biochemical recurrence, based on multivariate analysis. Furthermore, biochemical recurrence-free survival in the 38 patients was significantly superior to that in 54 patients with locally advanced disease who did not receive any postoperative therapies until biochemical recurrence; however, there was no significant difference in cancer-specific and overall survival between these two groups.

CONCLUSION

Despite retrospective analysis with a relatively small number of patients, results of the present study suggest favorable effects of the combined adjuvant treatments with androgen ablation and pelvic irradiation on cancer control for patients with pT3N0 or pT3N1 disease. However, considering the absence of a significant difference in cancer-specific and overall survival between patients with and without adjuvant treatments, it might not be necessary to routinely perform combined hormonal and radiation therapies in an adjuvant setting for pT3N0 or pT3N1 prostate cancer.

Increased detection of clinically significant prostate cancer by additional sampling from the anterior lateral horns of the peripheral zone in combination with the standard sextant biopsy

BACKGROUND

The objective of the present study was to investigate whether obtaining an increased number of biopsy cores by sampling additional areas, along with the standard sextant biopsy, results in a higher rate of detection of potentially insignificant prostate cancer.

METHODS

We included 130 patients who underwent radical retropubic prostatectomy at our institution between January 1999 and June 2003 after being diagnosed as having prostate cancer based on systematic prostate biopsies that included the areas examined by standard sextant biopsies and the bilateral anterior lateral horns (ALHs) of the peripheral zone (PZ). Several clinicopathological factors were analyzed, focusing on the significance of additional sampling from ALHs in relation to the incidence of potentially insignificant cancer, which was defined as organ confined disease with tumor volume less than 0.5 cc and Gleason scores <7.

RESULTS

According to the location of positive biopsy results, these 130 patients were divided into three groups as follows: 61 patients (46.9%) with cancer detected from the cores taken by standard sextant biopsy only (group A), 15 (11.6%) from ALHs of the PZ only (group B), and 54 (41.5%) from both sites (group C). There were no significant differences in age, incidence of abnormal digital rectal examination, prostate volume, or biopsy Gleason score among these three groups; however, pretreatment serum PSA value in group C was significantly higher than that in groups A or B. Pathological examinations of radical prostatectomy specimens demonstrated that there were no significant differences in the incidence of lymphatic invasion, vascular invasion and perineural invasion, or Gleason score among the three groups; however, group C had a significantly larger tumor volume than groups A or B. Furthermore, insignificant tumor was detected in eight patients in group A (13.1%), two in group B (13.3%), and four in group C (7.4%).

CONCLUSION

These findings suggest that the additional sampling of biopsy cores from ALHs does not appear to increase the detection of potentially insignificant cancer, and that biological tumor characteristics seem to be similar irrespective of cancer location on the needle biopsy.

FLJ10849, a septin family gene, fuses MLL in a novel leukemia cell line CNLBC1 derived from chronic neutrophilic leukemia in transformation with t(4;11)(q21;q23)

A t(4;11)(q21;q23) has been described in 50-70% of cases of infant acute lymphoblastic leukemia and, less frequently, in cases of pediatric and adult acute lymphoblastic leukemia and acute myeloid leukemia (AML). In t(4;11)(q21;q23) leukemias, the AF4 gene has been cloned as a fusion partner of the MLL gene. A human myeloid leukemia cell line, chronic neutrophilic leukemia (CNL)BC1, was established from a peripheral blood specimen of a patient with CNL in leukemic transformation. As with the original leukemia cells, the established line had a t(4;11)(q21;q23). We showed that the MLL gene on 11q23 was fused to the FLJ10849 gene on 4q21. The protein encoded by FLJ10849 belongs to the septin family, sharing highest homology with human SEPT6, which is one of the fusion partners of MLL in t(X;11)(q13;q23) AML. Our results suggest that FLJ10849 might define a new septin family particularly involved in the pathogenesis of 11q23-associated leukemia. The established cell line, CNLBC1, could provide a useful model for analyzing the pathogenesis of MLL-septin leukemias and chronic neutrophilic leukemia.

Microscopic venous invasion in renal cell carcinoma as a predictor of recurrence after radical surgery

BACKGROUND

The objective of the present study was to investigate the significance of microscopic venous invasion (MVI) as a prognostic factor for patients with renal cell carcinoma (RCC) who underwent radical surgery.

METHODS

The study included a total of 157 consecutive patients with non-metastatic RCC who underwent radical surgery between January 1986 and December 2002. The median follow-up period was 45 months (range 6-162 months). Microscopic venous invasion was defined by the presence of a cancer cell in blood vessels based on the examination of hematoxylin-eosin stained specimens. Other prognostic variables were assessed by multivariate analysis to determine whether there was a significant impact on cancer-specific and recurrence-free survivals.

RESULTS

Microscopic venous invasion was found in 70 patients, and of this number, 17 (24.7%) developed a tumor recurrence and 12 (17.1%) died of cancer progression, while only six (6.9%) of the remaining 87 patients without MVI presented with disease-recurrence and three (3.5%) died of cancer. Among the factors examined, the presence of MVI was significantly associated with age, mode of detection, tumor size, pathological stage and tumor grade; however, only pathological stage was an independent predictor for disease-recurrence, and none of these factors were available to predict cancer-specific survival in multivariate analyses. In 120 patients with pT1 or pT2 disease, MVI was noted in 36 patients. In this subgroup, recurrence-free survival rates in patients with MVI were significantly lower than those in patients without MVI, and MVI was the only independent prognostic predictor for disease-recurrence in a multivariate analysis.

CONCLUSION

Microscopic venous invasion is not an independent prognostic factor in patients with non-metastatic RCC who underwent radical surgery; however, it could be the only independent predictor of disease-recurrence after radical surgery for patients with pT1 or pT2 disease.

Achievement of ultralow emittance beam in the accelerator test facility damping ring

For high luminosity in electron-positron linear colliders, it is essential to generate low vertical emittance beams. We report on the smallest vertical emittance achieved in single-bunch-mode operation of the Accelerator Test Facility, which satisfies the requirement of the x-band linear collider. The emittances were measured with a laser-wire beam-profile monitor installed in the damping ring. The bunch length and the momentum spread of the beam were also recorded under the same conditions. The smallest vertical rms emittance measured at low intensity is 4 pm at a beam energy of 1.3 GeV, which corresponds to the normalized emittance of 1.0x1.0(-8) m. It increases by a factor of 1.5 for a bunch intensity of 10(10) electrons. The measured data agreed to the calculation of intrabeam scattering within much better than a factor of 2.

Limited usefulness of the free-to-total prostate-specific antigen ratio for the diagnosis and staging of prostate cancer in Japanese men

BACKGROUND

The objective of this study was to evaluate the clinical significance of measuring the free-to-total (f/t) prostate-specific antigen (PSA) ratio for the differentiation of prostate cancer from benign prostatic hypertrophy (BPH) and for the staging of prostate cancer in Japanese men.

METHODS

Before treatment, tPSA and fPSA were measured in 147 patients with prostate cancer and in 253 with BPH, using immunofluorometric techniques. Furthermore, the f/t PSA ratio and the tPSA density of the whole prostate (PSAD) were calculated.

RESULTS

The tPSA and PSAD levels in patients with prostate cancer paralleled the clinical stage, and were significantly higher than the levels in patients with BPH, while the f/t PSA ratio was not associated with clinical stage, despite the significantly lower values in prostate cancer patients than in BPH patients. Furthermore, the tPSA and PSAD values, but not the f/t PSA ratio, were significantly different between patients with pathologically extraprostatic disease and those with organ-confined disease. Calculation of the specificity of each assay within the range of 80%-95% sensitivity showed that tPSA and PSAD provided better specificities than the f/t PSA ratio. However, there was no significant difference in specificities among these three assays. In prostate cancer and BPH patients with PSA values of 4.1-10 ng/ml, the specificities of tPSA and PSAD were also superior to that of the f/t PSA ratio.

CONCLUSION

These findings suggest that measurement of the f/t PSA ratio does not provide any significant additional information for the diagnosis and staging of prostate cancer in Japanese men when tPSA and PSAD values are available.

Clinical outcome of transrectal ultrasound-guided prostate biopsy, targeting eight cores, for detecting prostate cancer in Japanese men

BACKGROUND

The objective of this study was to evaluate the clinical usefulness of transrectal ultrasound (TRUS)-guided eight-core prostate biopsy for detecting prostate cancer in Japanese men.

METHODS

Between January 1998 and September 2002, a total of 628 consecutive patients underwent TRUS-guided biopsy of the prostate. As a rule, eight cores were taken from each patient; that is, standard sextant cores from the peripheral zone and two additional cores from the bilateral anterior lateral horns (ALHs). The present study included 428 patients who underwent an initial biopsy, whose age was between 50 and 79 years, and whose prostate-specific antigen (PSA) value was less than 20.0 ng/ml. The cancer detection rate was calculated according to age, PSA, digital rectal examination (DRE) and TRUS findings, prostate volume, and PSA density (PSAD). We also assessed whether the sampling of the two extra cores from the ALHs increased the cancer detection rate.

RESULTS

Of the 428 patients, 101 (23.6%) were diagnosed as having cancer by eight-core prostate biopsies. The cancer detection rate was significantly associated with the PSA value (ng/ml; < or =4 versus 4-10, versus 10-20), DRE findings (normal versus abnormal), TRUS findings (normal versus abnormal), and PSAD (ng/ml2; < or =0.15 versus >0.15). but not with age (years: < or =70 versus >70) on prostate volume (ml; < or =30 versus 30-50, versus >50). Of the 101 patients diagnosed as having prostate cancer, 11 had positive cores only in the ALH; that is, the increase in the cancer detection rate yielded by obtaining two extra cores from the ALHs was 10.9%.

CONCLUSION

Despite the reasonable strategy, systematic prostate biopsy targeting eight cores did not significantly improve the cancer detection rate compared with that of standard sextant biopsy in Japanese men. However, the increased cancer detection rate yielded by additional sampling from the ALHs was comparatively prominent in the subgroup whose PSA value was in the gray zone (4-10 ng/ml) or whose prostate volume was greater than 50 ml.

T-cell large granular lymphocytic leukemia occurring after autologous peripheral blood stem cell transplantation

A 61-year-old man with angioimmunoblastic lymphoma in first complete remission underwent autologous peripheral blood stem cell transplantation. At 1 month post transplant, asymptomatic large granular lymphocytosis developed. The surface marker profile of the cells was CD3+CD8+CD56-CD57+. The disease course was chronic and indolent. The patient remains in complete remission from angioimmunoblastic lymphoma more than 6 months post transplant with persistent large granular lymphocytosis (lymphocyte count, 5-15 x 10(9)/l). Although post transplantation T-cell lymphoproliferative disorders have mostly occurred in allogeneic transplantation recipients and presented as aggressive lymphomas/leukemias, we suggest that chronic indolent T-cell large granular lymphocytic leukemia can occur after autologous stem cell transplantation.

Significance of cancer detection in the anterior lateral horn on systematic prostate biopsy: the effect on pathological findings of radical prostatectomy specimens

OBJECTIVE

To clarify the significance of cancer detection in the anterior lateral horn (ALH) on systematic prostate biopsy in relation to its effect on the pathological findings from retropubic radical prostatectomy (RRP) specimens.

PATIENTS AND METHODS

The study included 84 consecutive patients who underwent RRP at our institution between January 1999 and December 2002, after being diagnosed as having prostate cancer, based on systematic prostate biopsies that included the areas taken by standard sextant biopsies and the bilateral ALHs. Several clinicopathological factors of these patients were analysed in relation to the presence or absence of cancer in the ALH on systematic biopsy.

RESULTS

Of the 84 patients, cancer was detected in the ALH in 44 (group A), but not in the remaining 40 (group B). There were no significant differences in age, preoperative serum prostate-specific antigen level, or prostate volume between the groups. However, the incidence of bilateral positive cores and the percentage of positive biopsy cores in group A were significantly higher than those in group B. Pathological examinations of RRP specimens showed no significant differences in the incidence of lymphatic invasion, vascular invasion and perineural invasion, or Gleason score between the groups, but group A had a significantly larger tumour volume and higher incidence of extraprostatic disease than group B.

CONCLUSIONS

Despite similar biological tumour characteristics and irrespective of the cancer location in the ALH, advanced and extensive disease frequently involves the ALH. Therefore, more aggressive treatment should be considered if cancer is detected in the ALH by systematic prostate biopsy.

Polarimetry of short-pulse gamma rays produced through inverse Compton scattering of circularly polarized laser beams

We have developed a polarimetry of ultrashort pulse gamma rays based on the fact that gamma rays penetrating in the forward direction through a magnetized iron carry information on the helicity of the original gamma rays. Polarized, short-pulse gamma rays of (1.1+/-0.2)x10(6)/bunch with a time duration of 31 ps and a maximum energy of 55.9 MeV were produced via Compton scattering of a circularly polarized laser beam of 532 nm off an electron beam of 1.28 GeV. The first demonstration of asymmetry measurements of short-pulse gamma rays was conducted using longitudinally magnetized iron of 15 cm length. It is found that the gamma-ray intensity is in good agreement with the simulated value of 1.0x10(6). Varying the degree of laser polarization, the asymmetry for 100% laser polarization was derived to be (1.29+/-0.12)%, which is also consistent with the expected value of 1.3%.

Extremely low vertical-emittance beam in the accelerator test facility at KEK

Electron beams with the lowest, normalized transverse emittance recorded so far were produced and confirmed in single-bunch-mode operation of the Accelerator Test Facility at KEK. We established a tuning method of the damping ring which achieves a small vertical dispersion and small x-y orbit coupling. The vertical emittance was less than 1% of the horizontal emittance. At the zero-intensity limit, the vertical normalized emittance was less than 2.8 x 10(-8) rad m at beam energy 1.3 GeV. At high intensity, strong effects of intrabeam scattering were observed, which had been expected in view of the extremely high particle density due to the small transverse emittance.

Lung image changes during bronchopulmonary lavage estimated using transoesophageal echocardiography

Pulmonary alveolar proteinosis is often treated with bronchopulmonary lavage. Transoesophageal echocardiography has been used to detect lung atelectasis in critical situations. A 68-yr-old male with pulmonary alveolar proteinosis underwent bronchopulmonary lavage and was examined using transoesophageal echocardiography. His dependent left-lung area was observed through the descending aorta. Following saline infusion, no bright areas containing air were observed. The average area of the air-free region following instillation was 37.4 +/- 1.8 cm2, which decreased to 22.8 +/- 2.6 cm2 after drainage (P < 0.001). There was a significant relationship between the percentage venous admixture and air-free area during lavage (P < 0.05, r = -0.76). The image of the right lung was unclear. Transoesophageal echocardiography can yield useful information about the lung during bronchopulmonary lavage.

Type-specific regulation of adenylyl cyclase. Selective pharmacological stimulation and inhibition of adenylyl cyclase isoforms

Crystallographic studies have elucidated the binding mechanism of forskolin and P-site inhibitors to adenylyl cyclase. Accordingly, computer-assisted drug design has enabled us to identify isoform-selective regulators of adenylyl cyclase. After examining more than 200 newly synthesized derivatives of forskolin, we found that the modification at the positions of C6 and C7, in general, enhances isoform selectivity. The 6-(3-dimethylaminopropionyl) modification led to an enhanced selectivity for type V, whereas 6-[N-(2-isothiocyanatoethyl) aminocarbonyl] and 6-(4-acrylbutyryl) modification led to an enhanced selectivity for type II. In contrast, 2'-deoxyadenosine 3'-monophosphate, a classical and 3'-phosphate-substituted P-site inhibitor, demonstrated a 27-fold selectivity for inhibiting type V relative to type II, whereas 9-(tetrahydro-2-furyl) adenine, a ribose-substituted P-site ligand, showed a markedly increased, 130-fold selectivity for inhibiting type V. Consequently, on the basis of the pharmacophore analysis of 9-(tetrahydro-2-furyl) adenine and adenylyl cyclase, a novel non-nucleoside inhibitor, 2-amino-7-(2-furanyl)-7,8-dihydro-5(6H)-quinazolinone (NKY80), was identified after virtual screening of more than 850,000 compounds. NKY80 demonstrated a 210-fold selectivity for inhibiting type V relative to type II. More importantly, the combination of a type III-selective forskolin derivative and 9-(tetrahydro-2-furyl) adenine or NKY80 demonstrated a further enhanced selectivity for type III stimulation over other isoforms. Our data suggest the feasibility of adenylyl cyclase isoform-targeted regulation of cyclic AMP signaling by pharmacological reagents, either alone or in combination.

Phospholipase Cbeta4 and protein kinase Calpha and/or protein kinase CbetaI are involved in the induction of long term depression in cerebellar Purkinje cells

Activation of the type-1 metabotropic glutamate receptor (mGluR1) signaling pathway in the cerebellum involves activation of phospholipase C (PLC) and protein kinase C (PKC) for the induction of cerebellar long term depression (LTD). The PLC and PKC isoforms that are involved in LTD remain unclear, however. One previous study found no change in LTD in PKCgamma-deficient mice, thus, in the present study, we examined cerebellar LTD in PLCbeta4-deficient mice. Immunohistochemical and Western blot analyses of cerebellum from wild-type mice revealed that PLCbeta1 was expressed weakly and uniformly, PLCbeta2 was not detected, PLCbeta3 was expressed predominantly in caudal cerebellum (lobes 7-10), and PLCbeta4 was expressed uniformly throughout. In PLCbeta4-deficient mice, expression of total PLCbeta, the mGluR1-mediated Ca(2+) response, and LTD induction were greatly reduced in rostral cerebellum (lobes 1-6). Furthermore, we used immunohistochemistry to localize PKCalpha, -betaI, -betaII, and -gamma in mouse cerebellar Purkinje cells during LTD induction. Both PKCalpha and PKCbetaI were found to be translocated to the plasmamembrane under these conditions. Taken together, these results suggest that mGluR1-mediated activation of PLCbeta4 in rostral cerebellar Purkinje cells induced LTD via PKCalpha and/or PKCbetaI.

[A case of polyarteritis nodosa limited to both calves with a low titer of MPO-ANCA]

A-57-year-old woman had suffered from high fever, general malaise, and loss of weight (6 kg) since January, 2000. She was admitted to our hospital in May, 2000, because of gait disturbance following to swelling of bilateral calves with severe pain beside the above symptoms. Laboratory data showed leukocytosis (WBC 10,000/microliter), high ESR (98 mm/hr), positive CRP (3.43 mg/dl), positive ANA (x160), high titer of RA (266 IU/l), and a low titer of MPO-ANCA (18 EU). T 2-weighted magnetic resonance image (MRI) showed intensity area of the M. gastrocnemius. Skin biopsy specimens of the right leg demonstrated necrotizing arteritis of small-sized arteries. These findings supported the diagnosis of limited type of polyarteritis nodosa (PN). In this report, we demonstrate a rare case of PN limited to both calves with characteristic MRI findings and a low titer of MPO-ANCA.

Development of interferon-alpha resistant subline from human chronic myelogenous leukemia cell line KT-1

OBJECTIVE

Interferon-alpha (IFN-alpha) is one of the most effective therapeutic agents for a number of hematological malignancies, including chronic myelogenous leukemia (CML). Nevertheless, its efficacy is limited because of the development of resistance to IFN-alpha therapy. Previously, we established the novel human CML cell line KT-1, which is sensitive to the antiproliferative effects of IFN-alpha. Here, we report the establishment of an IFN-alpha-resistant subline, KT-1/A3R alpha 1000, by culturing KT-1/A3 cells (IFN-alpha-sensitive subline of KT-1) with increasing concentrations of IFN-alpha, in order to analyze the mechanism of acquisition of IFN-alpha resistance in CML cells after IFN-alpha therapy.

SUBJECTS AND METHODS

We developed an IFN-alpha-resistant tumor cell variant, KT-1/A3R alpha 1000, from the KT-1/A3 cell line by culturing cells with increasing concentrations of IFN-alpha. This subline was examined for its ability to proliferate and its resistance to apoptosis in high concentrations of IFN-alpha. The induction of the ISGF3 complex in response to IFN-alpha alpha in KT-1/A3R alpha 1000 was compared with that in the parental cell.

RESULTS

The levels of interferon-stimulated gene factor 3 components (STAT1, STAT2, and p48) proteins and STAT2 tyrosine phosphorylation induced after IFN-alpha treatment were unchanged, but formation of the ISGF3 complex was remarkably reduced in KT-1/A3R alpha 1000 cells compared to parental cells.

CONCLUSION

The KT-1/A3R alpha 1000 subline is a useful model for studying the mechanism of IFN-alpha resistance after IFN-alpha therapy.

Ketamine and midazolam kinetics during continuous hemodiafiltration in patients with multiple organ dysfunction syndrome

OBJECTIVE

To assess the effect of continuous hemodiafiltration (CHDF) on ketamine and midazolam kinetics in multiple organ dysfunction syndrome (MODS).

DESIGN AND SETTING

Consecutive clinical study in a general intensive care unit of a university hospital.

PATIENTS

Twelve adult patients with MODS requiring CHDF.

MEASUREMENTS AND RESULTS

A total of 68 samples were collected during CHDF for ketamine, norketamine, and midazolam assays. The clearance values for ketamine and norketamine were 10.8 +/- 6.6 and 10.9 +/- 11.5 ml/min and their daily extractions were 21.4 +/- 7.1 and 10.2 +/- 11.5 mg/day, respectively. Midazolam was not eliminated through the filter during CHDF. There were no changes in Ramsay Sedation Score or Glasgow Coma Scale during CHDF.

CONCLUSIONS

Small fractions of ketamine and norketamine were eliminated during CHDF in MODS. Midazolam was not eliminated during CHDF. CHDF did not affect the sedation using ketamine and midazolam even in MODS patients.

Expression of the Gfi-1 gene in HTLV-1-transformed T cells

Human T-cell leukemia virus type I (HTLV-I) is the causative agent of adult T-cell leukemia/lymphoma (ATLL) and immortalizes human T cells interleukin-2 (IL-2)-dependently in vitro. Protracted culture of HTLV-I-infected T cells enables them to grow IL-2-independently. Although acquisition of IL-2-independent growth has been correlated with activation of signal transducers and activators of transcription (STATs), the precise mechanism of IL-2-independent growth is unknown. We found that expression of the Gfi-1 (growth factor independence-1) gene was elevated in most HTLV-I-transformed IL-2-independent cell lines but in few HTLV-I-infected IL-2-dependent cell lines. We also found elevated expression of Gfi-1 in fresh leukemic cells of ATLL patients. Although expression of Gfi-1 is correlated with activation of STAT3, induction of the dominant negative form of STAT3 in the HUT102 cell line does not alter the level of Gfi-1 expression. Furthermore, MT2 cells treated with Gfi-1 antisense oligonucleotide had reduced [3H]thymidine uptake compared with MT2 cells treated with Gfi-1 sense oligonucleotide. These findings indicate that Gfi-1 activation is involved in the IL-2-independent growth of HTLV-I-transformed T cells in vitro and in the development of ATLL in vivo, but is not induced by STAT activation.