Induction chemotherapy with S-1 plus cisplatin in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN)

15501

Background: This study was to assess the efficacy and safety profiles of the combination treatment with S-1 and Cisplatin in patients with locally advanced SCCHN. Methods: Eligible patients were defined as histologically confirmed SCCHN, stage III or IV with no evidence of distant metastasis, evaluable lesions, adequate organ function, age of 20–80 years, and performance status 0,1 or 2. Cisplatin was infused over 1 hour on day 1 (75 mg/m2) and S-1 was administered orally for 14 consecutive days (day 2–15). The dosages of S-1 were assigned according to the patients’ body surface area (BSA): 50 mg twice a day (BSA < 1.5m2), 60 mg twice a day (BSA > 1.5m2). Each course was repeated every 3 weeks. After 2 course, tumor response were evaluated by CT scan and laryngoscopy. If the patients achieved a response (complete response: CR, or partial response: PR), they received one more course of chemotherapy before undergoing the radiotherapy or operation as a definitive local treatment. Results: All 22 patients were assessable for response and toxicity. The overall response was 80.9% (CR: 3, PR: 14). The adverse reactions occurred 120 times in 54 courses of 22 cases. The most common grade 3/4 adverse events were neutropenia, which occurred in 8 patients. Non-hematological toxicity of grade 3 and 4 included nausea and vomiting in 4 patients, fever in one patient and, fatigue in one patient. Since the observation period is short, the analysis about survival rate is not obtained so far. Conclusions: S-1 plus Cisplatin combination chemotherapy is effective against locally advanced SCCHN with mild toxicity.

No significant financial relationships to disclose.

Multicenter study of intravenous busulfan, cyclophosphamide, and etoposide (IV Bu/Cy/VP-16) as conditioning regimen for autologous stem cell transplantation in patients with non-Hodgkin’s lymphoma

17544

Background: The current study aimed to evaluate the efficacy and toxicity of the combination of intravenous busulfan, cyclophosphamide, and etoposide (IV Bu/Cy/VP-16) as a preparative regimen prior to autologous hematopoietic stem cell transplantation (ASCT) in patients with non-Hodgkin’s lymphoma (NHL). Methods: Forty patients with relapsed (n = 24) or high-risk (n = 16) lymphoma were enrolled into the study. High-dose chemotherapy consisted of intravenous busulfan (0.8 mg/kg i.v. q 6 hr from day-7 to day-5), cyclophosphamide (50 mg/kg i.v. on day-3 and day-2), and etoposide (400 mg/m2 i.v. on day-5 and day-4). Results: The median age of patients was 34 years (range, 17–63 years), and 21 (52.5%) patients were male. Pathologic subtypes were as follows: diffuse large B cell (n = 20), peripheral T cell, unspecified (n = 8), extranodal NK/T cell (n = 4), angioimmunoblastic T cell (n = 3), anaplastic large cell (n = 4), nodal marginal zone B cell (n = 2), and lymphoblastic (n = 3). The median dose of infused CD34+ cells and MNC was 3.95 (range, 0.7–20.6) × 106 and 8.12 (range, 3.0–13.6) × 108, respectively. WBC and platelet were successfully engrafted after ASCT in all patients, and the median days of engraftment of WBC and platelet was 12 (range, 9–48) and 27 (range, 8–263) days, respectively. After the ASCT, 34 complete responses (CR; 85.0%) and 4 partial responses (PR; 10.0%) were confirmed. Thirty-three (82.5%) patients experienced a fever without documented infection, while 2 patient developed fungal infection. However, there was no treatment-related death. After median follow-up duration of 360 (range, 83–639) days, 33 patients are in continuous complete remission, 4 patients are alive in relapse, and 3 patients died of disease. The estimated event-free and overall survival rate at 1.5-year was 80.9 ± 10.0 % and 92.5 ± 5.7 %, respectively. Conclusions: IV Bu/Cy/VP-16 was found to be well-tolerated and effective as a conditioning regimen in patients with NHL. Accordingly, this regimen can be regarded as an alternative high-dose treatment option in the ASCT for NHL.

No significant financial relationships to disclose.

Phase II study of capecitabine and irinotecan combination chemotherapy in patients with advanced gastric cancer

14037

Background: Several studies have shown the efficacy of capecitabine and irinotecan combination chemotherapy for advanced colorectal cancer, while no results have yet been reported for advanced gastric cancer. Accordingly, the current study evaluated the efficacy and safety of a combination regimen of capecitabine plus irinotecan in patients with advanced gastric cancer. Methods: Patients with previously untreated metastatic or recurrent, measurable gastric cancer received oral capecitabine 1000 mg/m2 twice daily from day 1 to 14 and intravenous irinotecan 100 mg/m2 on days 1 and 8, based on a 3-week cycle. Results: Forty-one patients were enrolled in the current study, among whom 38 were assessable for efficacy and 40 assessable for toxicity. Three complete responses and 16 partial responses were confirmed, giving an overall response rate of 46.3%. At a median follow-up of 269 days, the median time to progression and overall survival were 5.1 months and 8.6 months, respectively. Grade 3/4 neutropenia occurred in 4 patients and grade 3 febrile neutropenia was observed in 2 patients. Grade 3 diarrhea and grade 2 hand-foot syndrome occurred in 6 patients and 8 patients, respectively. Conclusions: The combination of capecitabine and irinotecan was found to be well tolerated and effective in patients with advanced gastric cancer. Accordingly, this regimen can be regarded as an important first-line treatment option for advanced gastric cancer.

No significant financial relationships to disclose.

CT-basierte Lebervolumetrie im Tiermodell: Bedeutung für die klinische Volumetrie im Rahmen der Leberlebendspende

PURPOSE

Exact preoperative determination of the liver volume is of great importance prior to hepatobiliary surgery, especially in living donated liver transplantation (LDLT). In the current literature, a strong correlation between preoperatively calculated and intraoperatively measured liver volumes has been described. Such accuracy seems questionable, primarily due to a difference in the perfusion state of the liver in situ versus after explantation. Purpose of the study was to asses the influence of the perfusion state on liver volume and the validity of the preoperative liver volumetry prior to LDLT.

METHODS

In an experimental study, 20 porcine livers were examined. The livers were weighted and their volumes were determined by water displacement prior and after fluid infusion to achieve a pressure physiologically found in the liver veins. The liver volumes in the different perfusion states were calculated based on CT-data. The calculated values were compared with the volume measured by water displacement and the weight of the livers.

RESULTS

Assessment of calculated CT volumes and water displacements at identical perfusion states showed a tight correlation and differed on average by 4 +/- 5 %. However, livers before and after fluid infusion showed a 33 +/- 8 % (350 +/- 150 ml) difference in volume.

CONCLUSION

CT-volumetry acquires highly accurate data as confirmed by water displacement studies. However, the perfusion state has major impact on liver volume, which has to be accounted for in clinical use.

Neurotrophin potentiation of iron-induced spinal cord injury

Previous studies have shown that pretreatment with neurotrophins can potentiate the vulnerability of cultured neurons to excitotoxic and free radical-induced necrosis, in contrast to their well known neuroprotective effects against apoptosis. Here we tested the hypothesis that this unexpected injury-potentiating effect of neurotrophins would also take place in the adult rat spinal cord. Fe(3+)-citrate was injected stereotaxically into spinal cord gray matter in adult rats in amounts sufficient to produce minimal tissue injury 24 h later. Twenty-four-hour pretreatment with brain-derived neurotrophic factor, neurotrophin-3, or neurotrophin-4/5, but not nerve growth factor, markedly enhanced tissue injury in the gray matter as evidenced by an increase in the damaged area, as well as the loss of neurons and oligodendrocytes. Consistent with maintained free radical mediation, the neurotrophin-potentiated iron-induced spinal cord damage was blocked by co-application of the antioxidant N-tert-butyl-(2-sulfophenyl)-nitrone. These data support the hypothesis that the overall neuroprotective properties of neurotrophins in models of acute injury to the spinal cord may be limited by an underlying potentiation of free radical-mediated necrosis.

Interactive PC-based volume rendering of CT datasets

In radiology, the reading of large CT volumes is a time consuming task. Interactive volume rendering (iVRT) is a promising new technique. Using dedicated hardware (VP1000, Terarecon Inc.) it can now be realized on a standard PC in a cost effective manner. For this purpose, a program built using the Visualization Toolkit with integrated functionality for the VP 1000 is used for almost real-time iVRT (8-9 frames/second). It is possible to embed opaque and translucent polygon surfaces (e.g., segmented structures). By interactively varying the opacity, color and gradient transfer functions as well as using freely placable cutting planes, the visualization can easily be adapted to different diagnostic needs.

Performance and membrane fouling in a pilot scale SBR process coupled with membrane

The performance of the pilot-scale submerged membrane coupled with sequencing batch reactor (SM-SBR) for upgrading effluent quality was investigated in this study. The reactor was operated with 3-hour cycle with alternating anoxic and aerobic conditions to treat organics, nitrogen and phosphate. Despite various influent characteristics, COD removal was always higher than 95%. Sufficient nitrification was obtained within a few weeks after start-up and during the stable period, complete nitrification occurred despite short aeration time. Total nitrogen (TN) removal efficiency was reached up to 85%. Membrane flux was critical for TN removal so that the decrease of flux by membrane fouling led to increase of HRT, and it caused the endogenous respiration of microorganisms such as nitrifying bacteria. The stirred cell test revealed the significant role of the soluble fraction in membrane permeability and dissolved solids played a major role in the short-term fouling mechanism. The cake resistance by the soluble COD fraction of supernatant or soluble microbial products (SMP) was investigated as a major part of total resistance.

Inhibitory effects of long-chain fatty acids on VFA degradation and beta-oxidation

The inhibitory effects of major long-chain fatty acids (LCFA), which have 16 or 18 carbons, not only on acetate degradation, but also on propionate degradation and beta-oxidation were examined in anaerobic serum bottle tests at 35 degrees C with the acclimated granular sludges. A modified Gompertz equation described cumulative methane production to assess the rates of VFA degradation and beta-oxidation, which were applied to a simplified noncompetitive model and a simplified substrate inhibition model, respectively. The specific methane production rates on acetate decreased as LCFA concentration increased, which was in good agreement with the noncompetitive inhibition model. Unsaturated oleate (C18:1) and linoleate (C18:2) were more inhibitory than saturated stearate (C18:0) and palmitate (C16:0) on acetate degradation. LCFA inhibition on propionate degradation was similar to that for acetate; however, propionate degradation was less inhibited than acetate degradation. Beta-oxidation was the rate-limiting step in LCFA degradation in most cases. As LCFA concentration increased, beta-oxidation rate reached the maximum value, and then decreased, which confirmed the substrate inhibition of LCFA. Oleate, the most abundant LCFA in wastewater, could be degraded more quickly than saturated LCFA containing the same or even less carbon in spite of relatively high toxicity on acetate degradation.

Modification of oligo(poly(ethylene glycol) fumarate) macromer with a GRGD peptide for the preparation of functionalized polymer networks

A novel macromer, oligo(poly(ethylene glycol) fumarate) (OPF), was synthesized by the reaction between poly(ethylene glycol) (PEG) of molecular weight 1000 (PEG 1.0K) and fumaryl chloride. The oligo(PEG fumarate) (OPF 1.0K) was modified with a peptide known to modulate cellular functions, Gly-Arg-Gly-Asp (GRGD), after being activated with 4-nitrophenyl chloroformate (NPC). The determined yield of the GRGD modification in 0.1 M sodium bicarbonate buffer of pH 8.3 was 83% as determined by NMR measurements. The OPF 1.0K and the OPF 1.0K modified with GRGD were cross-linked with an unsaturated biodegradable polyester, poly(propylene fumarate) (PPF), by photopolymerization. The cross-linked PPF was characterized by Fourier transform infrared (FT-IR) spectroscopy and contact angle measurements. The equilibrium contact angle of water on the cross-linked PPF surface decreased with the incorporation of OPF 1.0K and the OPF 1.0K modified with GRGD. The results suggest that the OPF macromer can be used for the preparation of functionalized networks incorporating cell adhesion specific sequences.

[Interactive direct volume rendering of CT-data: technical principle and applications]

The advantages of interactive Volume Rendering Technique (VRT) for routine diagnostics of CT and particularly Multislice CT data are unquestionable. However, with apart from Virtual Endoscopy, where besides Shaded Surface Display, perspective Volume Rendering is used in some cases, VRT at present is only playing a minor role in routine diagnostics. One reason is time consuming calculation, so far requiring powerful computers. Due to the variety of possible parameter settings and the poorly predictable outcome of the resulting images, there also exists a certain discomfort in using the technique. In this paper the underlying principles of VRT are illustrated. Different parameter settings and their impact on the final images are explained. Possible pitfalls in VRT and also suitable parameter settings and indications for VRT are shown.

Human kinesin superfamily member 4 is dominantly localized in the nuclear matrix and is associated with chromosomes during mitosis

In a previous study, we identified the human counterpart of murine kinesin superfamily member 4 (KIF4), a microtubule-based motor protein [Oh, Hahn, Torrey, Shin, Choi, Lee, Morse and Kim (2000) Biochim. Biophys. Acta 1493, 219-224]. As an initial step to understand the function(s) of human KIF4, its subcellular localization in HeLa cells was examined by using immunocytochemical and subcellular fractionation methods, and it was found that most KIF4 is localized in the nucleus. Since murine KIF4 is known to transport cytoplasmic vesicles, dominant nuclear localization of the human counterpart was somewhat surprising. Subsequent subnuclear fractionation revealed predominant association of KIF4 with the nuclear matrix. These results clearly indicate that human KIF4 is, at least, a nuclear protein. In further confirmation of this conclusion, the hexapeptide PKLRRR (amino acids 773-778) in the molecule was found to function as a nuclear localization signal. During the mitotic phase of the cell cycle, human KIF4 was associated with the chromosomes, suggesting that human KIF4 might be a microtubule-based mitotic motor, with DNA as its cargo.

Efficiency of an air filter at the drainage site in a closed circuit with a centrifugal blood pump: an in vitro study

In a closed circuit with a centrifugal blood pump, one of the serious obstacles to clinical application is sucking of air bubbles into the drainage circuit. The goal of this study was to investigate the efficiency of an air filter at the drainage site. We used whole bovine blood and the experimental circuit consisted of a drainage circuit, two air filters, a centrifugal blood pump, a membrane oxygenator, a return circuit, and a reservoir. Air was injected into the drainage circuit with a roller pump, and the number and size of air bubbles were measured. The air filter at the drainage site could remove the air bubbles (>40 microm) by itself, but adding a vacuum removed more bubbles (>40 microm) than without vacuum. Our results suggest that an air filter at the drainage site could effectively remove air bubbles, and that adding the filter in a closed circuit with a centrifugal blood pump would be safer.

Intraoperative assessment of coronary artery bypass graft: transit-time flowmetry versus angiography

BACKGROUND

Transit-time flowmetry has been used to assess graft status intraoperatively. This study examines the validity of this method by comparing its results with the findings of simultaneously performed graft angiography.

METHODS

The left internal thoracic artery (LITA) anastomosed to the left anterior descending artery (LAD) was assessed intraoperatively with both transit-time flowmetry and graft angiography in 30 patients. The patients were stratified into two groups based on intraoperative angiographic findings. In 18 patients (group A), the LITA and the LAD were well filled with contrast medium and the anastomosis was widely patent. In the other 12 patients (group B), spastic LITA or LAD was observed. Postoperative angiography was also performed before discharge from the hospital.

RESULTS

The mean graft flow was 44.0 +/- 25.4 mL/min in group A and 23.4 +/- 10.0 mL/min in group B (p = 0.0129). Diastolic-dominant flow pattern was observed in both groups, and the ratio of peak diastolic flow to peak systolic flow and the percent diastolic time-flow integral were not statistically different between the groups. The pulsatility index was almost the same between the two groups and was acceptable in both. Postoperative angiography revealed that all grafts were patent without spasm or anastomotic stenosis.

CONCLUSIONS

LITA graft status is satisfactory when high graft flow with diastolic dominance is obtained. When there is vasospasm but no anastomotic problems, decreased graft flow with an acceptable pulsatility index and diastolic augmentation is observed.

Clinical features of vivax malaria

Plasmodium vivax malaria reemerged in the Republic of Korea in 1993 near the Demilitarized Zone (DMZ). We reviewed clinical features of 101 symptomatic patients with vivax malaria. Of the patients, 77 patients (76.3%) were veterans who had served near the DMZ; their median age was 23 years. The duration of the minimum latent period was > 6 months in 66.2% (51 of 77) of the patients (median, 278 days). Tertian fever developed in 69 patients (68.3%). Severe thrombocytopenia with platelet counts < 60,000/microL was common (29.6% of patients). The parasite densities ranged 32-52,127 parasites per microliter of blood (geometric mean, 1,287). The only complication was a splenic rupture in one patient. All patients responded promptly to chloroquine therapy. Our data suggest that the clinical features of reemerging vivax malaria may be similar to those of Korean vivax malaria reported in the past.

Detection and management of concomitant coronary artery disease in patients undergoing thoracic aortic surgery

OBJECTIVES

No method has been established to detect and manage coronary artery disease in patients undergoing thoracic aortic surgery.

METHODS

Subjects were 192 patients scheduled for elective thoracic aortic surgery. Selection criteria for coronary angiography included a history of coronary artery disease or a positive dipyridamole myocardial perfusion imaging test.

RESULTS

Four patients were inoperable due to complications associated with coronary angiography or aneurysm rupture following coronary revascularization. A total of 55 patients with coronary angiography (group A) underwent 57 thoracic aortic operations and 133 patients without coronary angiography (group B) underwent 143 similar operations. Of 13 group A patients with significant coronary stenosis, 9 underwent either preoperative percutaneous transluminal coronary angioplasty (n = 3) or concomitant coronary artery bypass (n = 6). Perioperative myocardial infarction occurred in 3 group A patients (5%) and in 4 group B patients (1%, ns). The incidence of cardiac events--perioperative myocardial infarction or cardiac death--in group A (11%, 6/57) was higher than that in group B (3%, 4/143; p < 0.05). Multivariate analysis demonstrated incomplete revascularization of major coronary arteries with significant stenosis as a risk factor for cardiac events (p = 0.0106).

CONCLUSIONS

Although dipyridamole myocardial perfusion imaging was useful, additional selection criteria for coronary angiography is needed. Complete revascularization of major coronary arteries with significant stenosis is essential to reduce postoperative cardiac events.

Free right internal thoracic artery as a second arterial conduit: modification of proximal anastomosis for improvement of graft patency

The applicability of the right internal thoracic artery (RITA) for coronary artery bypass grafting is higher when used as a free graft than as a pedicled graft. However, the technical difficulty of directly connecting the proximal end of the free RITA to the much larger aorta leads to poor patency. To overcome this technical limitation, we have used a modification that places the proximal end of this artery onto the hood of an accompanying vein graft at the aortic anastomosis instead of directly onto the aorta. We performed isolated coronary artery bypass grafting on 43 patients using the free RITA as a second arterial graft following pedicled left internal thoracic artery grafting. The mean patient age was 60 years and 38 patients were male. There was no mortality and no incidence of morbidity related to free RITA use. Postoperative coronary angiography performed in all patients revealed that all proximal anastomoses were widely patent, making the patency rate of the free RITA 100%. With these encouraging results, the free RITA graft with the described modification is thought to be a more promising second arterial graft with greater versatility than the pedicled graft. The long-term evaluation of a large patient population will determine the significance of this modification.

Port-access cardiac surgery. Experience with 34 cases at Keio University Hospital

OBJECTIVES

We reviewed our experience with port-access cardiac surgery and evaluated the medical effects and benefits of this technique in view of postoperative quality of life and medical expenses incurred during hospitalization.

METHODS

From June 1998 to August 2000, port-access cardiac surgery was conducted on 34 patients--22 with atrial septal defect, 6 with mitral regurgitation, 2 with coronary artery disease, 2 with partial endocardial cushion defect, 1 with ventricular septal defect, and 1 with atrial and ventricular septal defects. Two types of endoaortic-balloon catheters were used to execute aortic cross-clamping. Skin incisions were 5 cm long.

RESULTS

No hospital or late deaths were observed. Patients with atrial septal defect were discharged on postoperative day 3.7, patients of mitral regurgitation on postoperative day 4.2, and patient of ventricular septal defect on postoperative day 4.0 on the average. None were readmitted. Patients appeared undisturbed by early discharge and were able to resume physical work on day 22 on the average after discharge.

CONCLUSION

Patients undergoing port-access cardiac surgery recovered quickly from surgery and resumed work quickly. This technique thus proved satisfactory both physically and mentally to patients and improved their quality of life. Medically and economically this technique proved extremely beneficial. We confirmed it to constitute a viable approach and option for cardiac surgery in selected patients.

A putative plant homolog of the yeast beta-1,3-glucan synthase subunit FKS1 from cotton (Gossypium hirsutum L.) fibers

A novel plant gene CFL1 was cloned from cotton (Gossypium hirsutum L.) fibers by expressed sequence tag (EST) database searching and 5'-RACE (rapid amplification of cDNA ends). This gene shows sequence homology with FKS1 which has been identified as the putative catalytic subunit of the yeast beta-1,3-glucan synthase. It encodes a protein (CFL1p) of 219 kDa with 13 deduced transmembrane helices and 2 large hydrophilic domains, one of which is at the N-terminus and the other in the internal region of the polypeptide. CFL1 displays 21% identity and 41% similarity to FKS1 at the amino acid level over its entire length, with 31% identity and 52% similarity for the hydrophilic central domain. Using RNA and protein blot analysis, CFL1 was found to be expressed at higher levels in cotton fibers during primary wall development. CFL1 also had a strong expression in young roots. Using a calmodulin (CaM)-gel overlay assay, the hydrophilic N-terminal domain of CFL1p was shown to bind to CaM, while the hydrophilic central domain did not. A putative CaM-binding domain, 16 amino acids long, was predicted in the hydrophilic N-terminal domain. Moreover, a product-entrapment assay demonstrated that a protein associated with an in vitro-synthesized callose pellet could be labeled by anti-CFL1 antibodies. Our finding suggests that CFL1 is a putative plant homolog of the yeast beta-1,3-glucan synthase subunit FKS1 and could be involved in callose synthesis.

Optimal positioning of temporary epicardial atrial pacing leads after cardiac surgery

OBJECTIVES

Atrial pacing plays an important role in preventing low output syndrome and arrhythmia after cardiac surgery. We studied the optimal positioning for temporary epicardiac atrial pacing.

METHODS

The performance of temporary epicardiac atrial pacing leads was examined after 13 cases of elective coronary artery bypass grafting between October 1999 and January 2000. Two bipolar electrode leads were used--1 on the cephalic atrial wall between the left and right atrial appendages, where the Bachmann bundle indwells (site A), and the other on the interatrial groove (site B). To assess pacing performance on postoperative days 1, 2, and 7, we measured 3 pacing patterns--bipolar use of sites A and B leads, and combined use of the 2 with the site A lead acting as the negative electrode and the site B lead as the ground. The pacing threshold was measured at a 0.5 ms pulse width, using the P wave amplitude and slew rate as indicators of sensing performance.

RESULTS

Bipolar pacing both at sites A and A-B was superior to that at site B in pacing threshold and sensing parameters.

CONCLUSIONS

The negative electrode at site A is mandatory for high atrial pacing and sensing performance.

A New Endo Aortic Occlusion Balloon for Limited Access Cardiac Surgery: Development and Clinical Evaluation

In recent years, minimally invasive cardiac surgery (MICS), or limited access cardiac surgery, has been presented as a promising operative procedure. We developed a new balloon device that is inserted directly into the ascending aorta to stop the heart during limited access cardiac surgery. The balloon has a three lumen structure: balloon lumen port, cardioplegia/vent lumen port, and aortic root lumen port. This direct EAC balloon catheter, designed to be inserted directly into the ascending aorta, is different from the Heartport system. The Heartport EAC balloon catheter is inserted into the aorta via an artery in the lower limb, making lower limb arterial disease a key concern. Our Direct Endo Aortic Clamp (EAC) balloon overcomes this problem. The device was clinically used in seven cardiac cases. All patients were discharged within 5 postoperative days, confirming the utility of the device.

Precise determination of aortic length in patients with aortic stent grafts: in vivo evaluation of a thinning algorithm applied to CT angiography data

The aim of this study was to develop a technique for precise determination of the aortic length using volumetric CT data for potential use prior to endovascular stent-graft placement. The study population consisted of 20 patients (38 measurements) with already performed endoluminal grafting. This allowed for in vivo evaluation of our technique. Its length according to the graft specifications served as a gold standard for our own measurements. The implemented graft length varied between 120 and 195 mm. Computed tomography angiography was performed with 3-mm slice collimation, 5-mm table feed and a reconstruction interval of 2 mm. Following semi-automatic segmentation of the aorta and its large side branches, the median centerline (skeleton) of the vessels was determined employing a modified three-dimensional thinning algorithm. The algorithm was validated by comparing the calculated length of the resulting skeleton with the specifications of the grafts. The calculated length was sufficiently precise despite the limiting reconstruction interval of 2 mm of our CT data which only permitted an assessment of stent length in 2-mm steps. The differences in the measured length and graft length were in the range between 0 and 8 mm (< 5%) with a mean fractional error of 2.46 +/- 2.37 mm. The use of an intelligent region growing algorithm capable of coping with variable arterial enhancement significantly reduced operator post-processing time. The average time necessary for segmentation was 7 min (range 3-10 min). Our algorithm provides a non-invasive method for objective and precise measurement of aortic length apparently even in tortuous vessels. It has the potential to replace angiography for aortic and iliac length measurements with calibrated catheters prior to endovascular intervention.

The dependence receptor DCC (deleted in colorectal cancer) defines an alternative mechanism for caspase activation

The expression of DCC (deleted in colorectal cancer) is often markedly reduced in colorectal and other cancers. However, the rarity of point mutations identified in DCC coding sequences and the lack of a tumor predisposition phenotype in DCC hemizygous mice have raised questions about its role as a tumor suppressor. DCC also mediates axon guidance and functions as a dependence receptor; such receptors create cellular states of dependence on their respective ligands by inducing apoptosis when unoccupied by ligand. We now show that DCC drives cell death independently of both the mitochondria-dependent pathway and the death receptor/caspase-8 pathway. Moreover, we demonstrate that DCC interacts with both caspase-3 and caspase-9 and drives the activation of caspase-3 through caspase-9 without a requirement for cytochrome c or Apaf-1. Hence, DCC defines an additional pathway for the apoptosome-independent caspase activation.

Sinus node function after mitral valve surgery using the superior septal approach

BACKGROUND; Sinus node function after the superior septal approach (SSA) in mitral valve surgery is controversial. We assessed sinus node function after this approach based on electrophysiological examinations and electrocardiographic change.

METHODS

Forty-six patients underwent successful mitral valve surgery via the SSA. Preoperatively, 25 patients were in atrial fibrillation (AF), 20 were in normal sinus rhythm (SR), and 1 patient was paced. Thirteen patients who demonstrated no sinus node dysfunction preoperatively underwent postoperative electrophysiological studies. Peripostoperative cardiac rhythm was monitored using a portable four-lead electrocardiograph, and late cardiac rhythm was examined using standard 12-lead electrocardiography in the outpatient clinic.

RESULTS

Twelve of 20 patients with preoperative SR experienced early postoperative supraventricular arrhythmias, but all spontaneously recovered SR. Electrophysiological studies revealed a basic cycle length of 767 +/- 74 ms, sinoatrial conduction time of 72 +/- 34 ms, sinus node recovery time of 1,119 +/- 139 ms, and corrected sinus node recovery time of 349 +/- 114 ms, thus demonstrating a lack of sinus node dysfunction. During the postoperative period (34 +/- 24 months), 2 of the 20 patients with preoperative SR developed persistent AF, and 3 of the 25 patients with preoperative AF achieved normal SR.

CONCLUSIONS

The SSA does not appear to cause longterm adverse effects on sinus node function, although temporary effects may occur.

Pattern recognition for road traffic accident severity in Korea

An increasing number of road traffic accidents (RTA) in Korea has emerged as being harmful both for the economy and for safety. An accurately estimated classification model for several severity types of RTA as a function of related factors provides crucial information for the prevention of potential accidents. Here, three data-mining techniques (neural network, logistic regression, decision tree) are used to select a set of influential factors and to build up classification models for accident severity. The three approaches are then compared in terms of classification accuracy. The finding is that accuracy does not differ significantly for each model and that the protective device is the most important factor in the accident severity variation.

An efficient color representation for image retrieval

A compact color descriptor and an efficient indexing method for this descriptor are presented. The target application is similarity retrieval in large image databases using color. Colors in a given region are clustered into a small number of representative colors. The feature descriptor consists of the representative colors and their percentages in the region. A similarity measure similar to the quadratic color histogram distance measure is defined for this descriptor. The representative colors can be indexed in the three-dimensional (3-D) color space thus avoiding the high-dimensional indexing problems associated with the traditional color histogram. For similarity retrieval, each representative color in the query image or region is used independently to find regions containing that color. The matches from all of the query colors are then combined to obtain the final retrievals. An efficient indexing scheme for fast retrieval is presented. Experimental results show that this compact descriptor is effective and compares favorably with the traditional color histogram in terms of overall computational complexity.

Identification of the human homologue of mouse KIF4, a kinesin superfamily motor protein

A combination of RT-PCR with cDNA library screening led to the identification of the human homologue of murine KIF4 (mKIF4), a microtubule-based motor protein. The nucleotide sequence of human KIF4 (hKIF4) comprised part of the 5' untranslated region (UTR), a long open reading frame (ORF) encoding 1232 amino acids, and the entire 3' UTR. Homologies with mKIF4 were 82% and 85% for nucleotides and amino acids, respectively. A single transcript of 5. 0 kb was highly expressed in hematopoietic tissues including fetal liver, spleen, and thymus, and adult thymus and bone marrow. Comparison of the ORF with that of mKIF4 revealed some dissimilarities in the putative cargo binding domain which might affect binding specificities.

Complications associated with clamping the aorta between the left common carotid artery and left subclavian artery

BACKGROUND

Hypothermic circulatory arrest using a left thoracotomy has recently been recommended for repair of distal arch lesions to prevent the atheroembolism that often results from clamp injury. The recommendation holds even for cases in which aortic cross-clamping between the left common carotid artery and left subclavian artery is possible.

METHODS

Over the last 16 years, 69 patients underwent repair of the distal arch or descending thoracic aorta using distal perfusion with the proximal aortic clamp placed between the left common carotid and left subclavian artery. The average age of the patients was 61+/-12 years; 18 of them (26%) were older than 70 years. Forty-four patients (64%) had atherosclerotic true aneurysms.

RESULTS

The surgical procedures used included patch closure of saccular aneurysms in 20 patients (29%) and graft replacement in 47 (71%). The left subclavian artery was reattached in 7 patients (10%). Although there were 3 hospital deaths (4%), no cerebral complications occurred aside from temporary neurologic dysfunction in 4 patients (6%).

CONCLUSIONS

An acceptably low incidence of cerebral complications is associated with cross-clamping the aorta between the left common carotid artery and left subclavian artery.

Zinc increases the excitability of dopaminergic neurons in rat substantia nigra

The effect of zinc ions (Zn(2+)) on the neuronal excitability of substantia nigra (SN) where the zinc level is known higher in Parkinsonian brains than that in normal brains has not yet been elucidated. We, therefore, examined the effect of Zn(2+) on the intrinsic electrical properties of dopaminergic SN neurons, using a whole-cell recording method. Zn(2+) hyperpolarized dopaminergic SN neurons at resting state. Also Zn(2+) shortened the duration of evoked spikes, developed a fast afterhyperpolarization, and increased their firing frequency. Voltage-clamp studies showed that Zn(2+) decreased 4-aminopyridine-sensitive outward currents, suggesting that a transient A-like potassium channel be one of the major targets Zn(2+) can modulate in the SN neurons.

Development of a completely closed circuit using an air filter in a drainage circuit for minimally invasive cardiac surgery

The completely closed circuit system is the future direction of cardiopulmonary bypass because of its compactness and superior biocompatibility. The most serious obstacle for clinical application is the sucking of air bubbles into the drainage circuit. The purpose of this study was to remove the air bubbles from the drainage circuit. Infusing 50 ml/min of air bubbles into the drainage circuit of the usual closed circuit, and infusing 50, 100, and 150 ml/min of air into the drainage circuit of a newly developed closed circuit (drainage circuit using an air filter), the number and size of air bubbles were observed at the outlet of the arterial filter. In the usual closed circuit, many air bubbles of over 40 microm were detected within 5 s at a blood flow of 4 L/min because the centrifugal pump decreased the size of the bubbles, which then passed through the oxygenator and arterial filter. Air bubbles of over 40 micro were not detected in the newly developed closed circuit within 5 min at a blood flow of 4 L/min. The removal of air mixed into the completely closed circuit was possible with a drainage circuit using an air filter that was developed. The clinical use of the completely closed circuit for minimally invasive cardiac surgery (MICS) became possible based on this development.

Transformation of Medicago truncatula via infiltration of seedlings or flowering plants with Agrobacterium

Two rapid and simple in planta transformation methods have been developed for the model legume Medicago truncatula. The first approach is based on a method developed for transformation of Arabidopsis thaliana and involves infiltration of flowering plants with a suspension of Agrobacterium. The second method involves infiltration of young seedlings with Agrobacterium. In both cases a proportion of the progeny of the infiltrated plants is transformed. The transformation frequency ranges from 4.7 to 76% for the flower infiltration method, and from 2.9 to 27.6% for the seedling infiltration method. Both procedures resulted in a mixture of independent transformants and sibling transformants. The transformants were genetically stable, and analysis of the T2 generation indicates that the transgenes are inherited in a Mendelian fashion. These transformation systems will increase the utility of M. truncatula as a model system and enable large-scale insertional mutagenesis. T-DNA tagging and the many adaptations of this approach provide a wide range of opportunities for the analysis of the unique aspects of legumes.

Closed circuit cardiopulmonary bypass with centrifugal pump for open-heart surgery: new trial for air removal

The purpose of this study is to examine the efficiency of venous air removal with a new cardiopulmonary bypass (CPB) circuit design for conventional open-heart surgeries. A main concern with a closed circuit for open-heart surgeries is air entrainment into the venous line. A venous filter was placed proximal to the centrifugal pump. The circuit proximal to the centrifugal pump was divided into two lines; one line was attached to the venous reservoir outlet. By clamping the line to the reservoir, this circuit becomes closed. Negative pressure was applied to the purge line connected to the venous reservoir for venous air removal. Micro bubbles were measured at two locations, both distal to the venous and arterial filters. When the injection rate reached 100 ml/min, with the air-injection over 30 s, micro bubbles greater than 40 micro were observed at the outlet of venous filter. However, there was no micro bubble greater than 40 micro detected at the outlet of arterial filter. Although micro bubbles greater than 40 micro were not detected at the outlet of the arterial filter up to the injection rate of 300 ml/min, when the injection rate reached 400 ml/min, micro bubbles greater than 50 microm were detected distal to the arterial filter. From this examination, we determined that air entrained in the venous line up to approximately 300 ml/min is automatically removed by this method with the pressure-balanced condition. This pressure balance means that resistance of venous return, gravity siphon, negative pressure by centrifugal pump, and negative pressure applied to the air-purge line of the filter are balanced; that is, the venous return is sufficient, and the venous reservoir volume is kept stable. From this study we determined that this circuit design efficiently removes the entrained air in the venous line.

Vacuum assisted cardiopulmonary bypass in minimally invasive cardiac surgery: its feasibility and effects on hemolysis

The present study describes a cardiopulmonary bypass (CPB) technique that incorporates vacuum assisted venous drainage and arterial return using a centrifugal pump in minimally invasive cardiac surgery (MICS). The technique was performed on 40 patients scheduled to undergo MICS. The proposed CPB technique enables a good operative field to be obtained even through a limited incision through the use of peripheral cannulation using small cannulae. Vacuum pressure was applied to the venous reservoir (-43 +/- 14 mm Hg) to maintain adequate CPB flow (>2.4 L x min-1 x M-2). The effects of CPB on hemolysis were subsequently compared between patients who underwent the proposed procedure (MICS group; n = 6) and a control group who underwent coronary arterial bypass grafting (CABG group; n = 6) with conventional CPB. Plasma free hemoglobin (FHb) increased and plasma haptoglobin (Hp) decreased during CPB in both groups, with no significant difference between the groups. By the next day, FHb had returned to pre-CPB levels whereas Hp remained lower in both groups. Again, these values did not differ significantly between groups. Thus, we conclude that the proposed CPB technique is useful in MICS with acceptable effects on hemolysis.

An intramolecular interaction between Src homology 3 domain and guanylate kinase-like domain required for channel clustering by postsynaptic density-95/SAP90

Members of the postsynaptic density-95 (PSD-95)/SAP90 family of membrane-associated guanylate kinase (MAGUK) proteins function as multimodular scaffolds that organize protein-signaling complexes at neuronal synapses. MAGUK proteins contain PDZ, Src homology 3 (SH3), and guanylate kinase (GK)-like domains, all of which can function as sites for specific protein-protein interactions. We report here a direct protein-protein interaction between the SH3 domain and the GK region in the PSD-95 family of MAGUKs. The SH3 domain of the PSD-95 family appears to have an atypical binding specificity, because the classical SH3 binding (-P-X-X-P-) motif is absent from the GK domain. Although SH3-GK binding can occur in either an intramolecular or intermolecular manner, the intramolecular mode is preferred, possibly because of additional tertiary interactions available when the SH3 and GK domains are adjacent in the same polypeptide. Mutations disrupting the intramolecular SH3-GK interaction do not interfere with PSD-95 association with the K(+) channel Kv1.4 or with the GK domain-binding protein GKAP. The same mutations, however, inhibit the clustering of Kv1.4 by PSD-95, suggesting that the intramolecular SH3-GK interaction may modulate the clustering activity of PSD-95.

Acute ischemic hepatic failure resulting from intraaortic balloon pump malposition

We describe a rare intraaortic balloon pump (IABP) vascular complication as a result of malpositioning of the IABP. A 61-year-old man with unstable angina underwent emergency coronary artery bypass grafting soon after the insertion of an IABP. Postoperative hemodynamics were stable, but acute hepatic dysfunction occurred on the second postoperative day. Doppler echography revealed the absence of hepatic arterial flow. The IABP was removed, and arterial flow was immediately restored. Thereafter, the hepatic function recovered rapidly. This is a rare case that demonstrates how IABP can cause mechanical abdominal arterial branch obstruction. Evaluations using Doppler echography are useful in detecting such IABP complications.

[Individual planning of liver surgery interventions with a virtual model of the liver and its associated structures]

BACKGROUND

In an interdisciplinary approach, HepaVision (MEVIS, Bremen), a software tool specifically developed for 3D visualization of the liver, was employed for individual planning of extensive liver resections and evaluation of living-relative donations. So far there is experience with more than 50 biphasic spiral CT examinations.

RESULTS

The spatial relationship of large tumors to crucial hepatic structures, the demonstration and evaluation of anatomic variants regarding vascular supply and the risk stratification of liver failure by volumetric analysis on the basis of portal venous drainage supported precise indication for surgery. Surgical safety is increased by preoperative planning and simulation of necessary vessel reconstructions. By hiding selective areas of portal venous drainage or applying freely selectable clip planes, segmental as well as non-anatomical resections can be simulated and their effects analyzed. The virtual preoperative situs was confirmed intraoperatively in all 17 patients of our study population who underwent segmental liver resection for either a tumor or living-relative donation.

[Basic principles of data acquisition and data processing for construction of high quality virtual models]

Creating models for virtual reality subdivides into several steps. The aim of the data acquisition is the extraction of nearly isotropic (same solution in all three axes) data sets with low noise content. An approximate isotropy can be achieved by suitable choice of scan parameters. For raw data reconstruction, the application of high-resolution reconstruction algorithms is prohibited due to increased noise. A missing isotropy can computationally be approximated by interpolation. Further noise suppression is achieved by applying filters. Additionally, the contrast of the object for segmentation can be increased by image processing operators. The correct choice of the segmentation method and the editing tools is essential for a precise segmentation with minimal user interaction. Prior to visualization, smoothing the shape of the segmented model (shape-based or morphological interpolation, polygon reduction of wire frame model) further improves the visual appearance of the 3D model.

Toxoplasmic encephalitis in patients with acquired immunodeficiency syndrome--four case reports

Four patients, all males aged 40-64 years, presented with toxoplasmic encephalitis associated with human immunodeficiency virus (HIV) infection manifesting as nonspecific neurological deficits such as epilepsy or hemiparesis. Magnetic resonance imaging showed single or multiple lesions with ring enhancement, mimicking metastatic brain tumor or brain abscess. Marked eosinophilia was noted in three patients. Two patients who received anti-toxoplasma chemotherapy in the early stage had a good outcome. However, the other two patients suffered rapid neurological deterioration and needed decompressive surgery, resulting in a poor outcome. Toxoplasma diffusely infects the whole central nervous system from the early stage. The outcome for patients who needed emergency surgery was poor. Therefore, this rare but increasingly common infectious disease must be considered in the differential diagnosis of a patient with neuroimaging findings similar to those of metastatic tumor or brain abscess. Appropriate chemotherapy should be started immediately after HIV-positive reaction is identified in patients with single or multiple mass lesions with ring enhancement.

Bisprasin, a novel Ca(2+) releaser with caffeine-like properties from a marine sponge, Dysidea spp., acts on Ca(2+)-induced Ca(2+) release channels of skeletal muscle sarcoplasmic reticulum

Bisprasin, a unique bromotyrosine derivative containing a disulfide linkage, was isolated from a marine sponge of Dysidea spp. This compound caused a concentration-dependent (from 10 to 30 microM) increase in the (45)Ca(2+) release from the heavy fraction of skeletal muscle sarcoplasmic reticulum (HSR) of rabbit skeletal muscle in the same way as does caffeine. The 50% effective concentrations of bisprasin and caffeine were approximately 18 microM and 1.2 mM, respectively, indicating that the (45)Ca(2+)-releasing activity of bisprasin was approximately 70 times more potent than that of caffeine in HSR. The bell-shaped profile of Ca(2+) dependence for bisprasin was almost the same as that for caffeine. Typical blockers of Ca(2+)-induced Ca(2+) release channels, such as Mg(2+), procaine, and ruthenium red, inhibited markedly bisprasin- and caffeine-induced (45)Ca(2+) release from HSR. This compound, like caffeine, significantly enhanced [(3)H]ryanodine binding to HSR. Scatchard analysis of [(3)H]ryanodine binding to HSR revealed that bisprasin and caffeine decreased the K(D) value without affecting the B(max) value, suggesting that both the drugs facilitate the opening of ryanodine receptor channels. The bisprasin- and caffeine-induced increases in [(3)H]ryanodine binding were further enhanced by adenosine-5'-(beta, gamma-methylene)triphosphate. These results suggest that the pharmacological properties of bisprasin are almost similar to those of caffeine, except for its 70-fold higher potency. Here, we present the first report on the pharmacological properties of bisprasin, which, like caffeine, induces Ca(2+) release from skeletal muscle SR mediated through the ryanodine receptor.

An application of polarized domains in ferroelectric thin films using scanning probe microscope

The feasibility of utilizing PZT films as future data storage media was investigated using a modified AFM. Applying voltages between a conductive AFM tip and the PZT films causes the switching of ferroelectric domains. The domains are observed using an EFM imaging technique. The experimental results and calculations revealed that the electrostatic force generated between the polarized area and the tip is a main contributor for the imaging of the polarized domains. The written features on ferroelectric films were less than 100 nm in diameter, implying the possibility of realizing data storage devices with ultra-high area density. The disappearance of the polarized images without any applied voltage was observed, which is a drawback in this application of PZT thin films.

TRAF family proteins interact with the common neurotrophin receptor and modulate apoptosis induction

The common neurotrophin receptor, p75(NTR), has been shown to signal in the absence of Trk tyrosine kinase receptors, including induction of neural apoptosis and activation of NF-kappaB. However, the mechanisms by which p75(NTR) initiates these intracellular signal transduction pathways are unknown. Here we report interactions between p75(NTR) and the six members of TRAF (tumor necrosis factor receptor-associated factors) family proteins. The binding of different TRAF proteins to p75(NTR) was mapped to distinct regions in p75(NTR). Furthermore, TRAF4 interacted with dimeric p75(NTR), whereas TRAF2 interacted preferentially with monomeric p75(NTR). TRAF2-p75(NTR), TRAF4-p75(NTR), and TRAF6-p75(NTR) interactions modulated p75(NTR)-induced cell death and NF-kappaB activation with contrasting effects. Coexpression of TRAF2 with p75(NTR) enhanced cell death, whereas coexpression of TRAF6 was cytoprotective. Furthermore, overexpression of TRAF4 abrogated the ability of dimerization to prevent the induction of apoptosis normally mediated by monomeric p75(NTR). TRAF4 also inhibited the NF-kappaB response, whereas TRAF2 and TRAF6 enhanced p75(NTR)-induced NF-kappaB activation. These results demonstrate that TRAF family proteins interact with p75(NTR) and differentially modulate its NF-kappaB activation and cell death induction.

Supercritical fluid extraction of microcystins from cyanobacteria

A new method for the fast extraction of microcystins RR and LR in cyanobacterium was developed using supercritical CO2. The microcystins were successfully extracted with aqueous methanol modified supercritical fluid (90% CO2, 9.0% methanol, 1.0% water). The method developed here has several advantages over solid-phase extraction sample preparation for the analysis of microcystins. Sample handling steps are minimized, thus reducing possible losses of analytes and saving analysis time. No organic solvent extractions are involved in this method, and no cleanup steps are employed.

Right ventricular infarction complicating coronary artery bypass grafting

Intraoperative right ventricular infarction immediately after coronary artery bypass grafting is a rare and potentially serious complication. We report a case in which an additional coronary artery bypass graft to a right ventricular branch with 99% stenosis brought about recovery from profound acute right ventricular failure. This case shows that complete revascularization to all graftable vessels, including even the right ventricular branch, is mandatory for successful coronary artery bypass grafting.