Prevalence and topography of small hypointense foci suggesting microbleeds on 3T susceptibility-weighted imaging in various types of dementia

BACKGROUND AND PURPOSE

The prevalence and topography of small hypointense foci suggesting microbleeds on 3T SWI in various types of dementia have not been systematically investigated. The purpose of this study was to determine the prevalence and topography of SHF on 3T SWI in patients with different dementia subtypes.

MATERIALS AND METHODS

We included 347 consecutive patients (217 women, 130 men; age range, 42-93 years; mean age, 74 years) who attended our memory clinic and underwent 3T SWI. They were divided into 6 groups: subjective complaints, MCI, AD, DLB, VaD, and FTLD. Two neuroradiologists evaluated the number and location of SHF on SWIs. Statistical analyses were performed to evaluate inter- and intragroup differences.

RESULTS

Of the 347 patients, 160 (46.1%) exhibited at least 1 small hypointense focus. This was true in 86% with VaD, 54% with DLB, 48% with AD, 41% with MCI, 27% with FTLD, and 22% with subjective complaints. With the subjective complaints group as a reference, the odds ratio adjusted by age, sex, and arterial hypertension was 9.2 (95% CI, 2.0-43.6) for VaD; 5.4 (95% CI, 1.2-24.3) for AD; 3.1 for DLB (95% CI, 1.1-8.8); 2.0 for MCI (95% CI, 0.5-8.1); and 1.5 for FTLD (95% CI, 0.4-5.4). There was a significant lobar predilection for AD, DLB, and FTLD groups (P < .05).

CONCLUSIONS

On 3T SWI, patients with VaD, AD, and DLB manifested a high SHF prevalence. In patients with AD, DLB, and FTLD, the SHF exhibited a lobar predilection.

Characterization of nitric oxide-inducing lipid A derived from Mesorhizobium loti lipopolysaccharide

Mesorhizobium loti is a member of the rhizobia and forms nitrogen-fixing symbioses with several Lotus species. Recently, it was reported that M. loti bacterial cells and their lipopolysaccharide (LPS) preparations transiently induced nitric oxide (NO) production in the roots of L. japonicus. We subsequently found that polysaccharides and the lipid A moiety were responsible for this NO induction. In this study, we elucidated the chemical structure of M. loti lipid A and characterized its NO-inducing activity in response to structural modifications. M. loti LPS were partially hydrolyzed with hydrazine or aqueous hydrofluoric acid to obtain O-deacylated or dephosphorylated LPS, respectively. The untreated and treated LPS fractions were subjected to weak acid hydrolysis to obtain lipid A fractions. The chemical structure of M. loti lipid A was elucidated by chemical composition analysis, MALDI-TOF-MS, and NMR spectra to be P-4-β-GlcNN(1-6)α-GlcNN(1-1)α-GalA, in which positions 2 and 3 of β-GlcNN are substituted for 3-acyloxy-fatty amides, and positions 2 and 3 of α-GlcNN are substituted for 3OH-fatty amides. The partial hydrolysis of lipid A appeared to reduce its NO-inducing activity. These results suggest that L. japonicus root cells recognize the lipid A structure as a means of controlling NO production.

Circulating tumor cells as a potential biomarker in selecting patients for pulmonary metastasectomy from colorectal cancer: report of a case

Pulmonary metastasectomy is indicated for selected patients with metastatic colorectal cancer. A 43-year-old woman presented with solitary pulmonary metastasis from descending colon cancer and pulmonary metastasectomy was performed because of absence of any other active metastasis as well as normal serum carcinoembryonic antigen value. However, she died due to early development of nodal and bone metastases within 6 months after thoracotomy. The presence of circulating tumor cells (CTCs) in the peripheral blood (6 CTCs/7.5 ml) was the only factor to predict such a poor prognosis, suggesting that the CTC test is useful in selecting patients for pulmonary metastasectomy.

Successful closure of intractable tracheoesophageal fistula using a combination of a modified silicon stent and metallic stents

Although surgery is the usual management strategy for acquired benign tracheoesophageal fistula, sometimes this approach is contraindicated or the patient declines surgical management. In this report, we describe a case of a patient with tracheoesophageal fistula at the level of the carina due to bronchial arterial infusion chemotherapy. Closure could not be achieved in response to multiple treatment strategies, including airway stenting, esophageal stenting, occlusion with microcoils, or cyanoacrylate glue. We subsequently achieved closure of this fistula through the combination of a modified silicon stent and metallic stents.

Intrapartum care at a tertiary hospital in Cambodia: a survey using the Bologna Score

BACKGROUND

developing countries strive to reduce maternal- and child mortality, partly through establishing health centres/hospitals with skilled birth attendants. The aim of this study was to describe childbirth care, by the use of the Bologna Score at a tertiary hospital in Cambodia with approximately 8,500 births per year.

METHODS

a prospective cross-sectional study. The Bologna Score instrument, which reflects the adaption of evidence-based care and attitudes of caregivers, was used for data collection and three study specific questions. The midwives collected data from 177 consecutive childbirths.

RESULTS

all women were assisted by a skilled birth attendant, the majority by a midwife (63%) and the remaining women by a physician (35%) or midwife student under supervision. A spontaneous vaginal birth was planned for 82% of the women. All women seeking care at the hospital survived the childbirth. A full 5-point Bologna Score, suggesting evidence-based management for women with spontaneous vaginal birth, was not achieved for any of the women. The use of supine position and lack of an accompanying person in the birth room, were items responsible for loss of points. Partogram and skin-to-skin contact between baby and mother were items noted for three quarters of the planned vaginal births, and the item 'Absence of labour augmentation', was affirmed to a great extent. Little more than half of the women had an episiotomy and almost 16% of the children had an Apgar score <7 at 5 mins.

CONCLUSION

the Bologna Score was easy to use and pointed at items that could be improved. It was satisfying that all women survived, but alarming that 16% of the children had a low Apgar score. The findings suggest that childbirth care can be improved at the hospital.

Hidden itinerant-spin phase in heavily overdoped La(2-x)Sr(x)CuO4 superconductors revealed by dilute Fe doping: a combined neutron scattering and angle-resolved photoemission study

We demonstrated experimentally a direct way to probe a hidden propensity to the formation of a spin-density wave in a nonmagnetic metal with strong Fermi surface nesting. Substituting Fe for a tiny amount of Cu (1%) induced an incommensurate magnetic order below 20 K in heavily overdoped La(2-x)Sr(x)CuO(4). Elastic neutron scattering suggested that this order cannot be ascribed to the localized spins on Cu or doped Fe. Angle-resolved photoemission revealed a strong Fermi surface nesting inherent in the pristine La(2-x)Sr(x)CuO(4) that likely drives this order. Our finding presents the first example of the long-sought "itinerant-spin extreme" of cuprates, where the spins of itinerant doped holes define the magnetic ordering ground state; it complements the current picture of cuprate spin physics that highlights the predominant role of localized spins at lower dopings.

[Does the bilateral internal thoracic artery harvesting increase wound infection?]

The aim of this study is to compare the frequency of wound infection between bilateral and single internal thoracic artery (ITA) harvesting in coronary artery bypass grafting (CABG) cases. Two hundreds and thirty-four consecutive CABG cases performed harvesting either bilateral ITA (BITA) or single ITA (SITA) from January 2004 to December 2008, with or without concomitant surgery were studied. Harmonic Scalpel was used for the harvesting with skeletonization technique. The cases were divided into 2 groups: BITA group (n = 180) and SITA group (n = 54). The frequencies of wound infection were 3.7% in SITA group and 6.1% in BITA group. As to deep sternal infection, they were 1.9% in SITA group and 1.1% in BITA group. There was no significant difference between the 2 groups. Multivariate analysis of all patients showed that emergency cases, hypertension, congestive heart failure, and reopening for bleeding were identified as independent risk factors for wound infection. There were 113 diabetes mellitus (DM) patients out of all patients ; SITA group (n = 22) and BITA group (n = 91). Their wound infection rates were 4.5% and 6.6%, and those of deep sternal infection were 0% and 2.2%, respectively. There was no significant difference between them. In conclusion, BITA harvesting with skeletonized technique may be used as safely as SITA harvesting even in DM patients.

Neurosarcoidosis: Radiologic Features in Five Patients

This paper describes the radiological features in five biopsy-confirmed cases of neurosarcoidosis. The imaging appearance of neurosarcoidosis is highly variable, making the diagnosis difficult on the basis of intracranial images alone. However, if there is evidence of spread along the pia mater, and meningeal mass formation with a lower intensity in the central area and higher intensity in the peripheral area on T2-weighted and FLAIR images, neurosarcoidosis can be considered.

Reaffirming the d(x2-y2) superconducting gap using the autocorrelation angle-resolved photoemission spectroscopy of Bi1.5Pb0.55Sr1.6La0.4CuO(6+δ)

Knowledge of the gap function is important to understand the pairing mechanism for high-temperature (T(c)) superconductivity. However, Fourier transform scanning tunneling spectroscopy (FT STS) and angle-resolved photoemission spectroscopy (ARPES) in the cuprates have reported contradictory gap functions, with FT-STS results deviating strongly from a canonical d(x2-y2) form. By applying an "octet model" analysis to autocorrelation ARPES, we reveal that a contradiction occurs because the octet model does not consider the effects of matrix elements and the pseudogap. This reaffirms the canonical d(x2-y2) superconducting gap around the node, which can be directly determined from ARPES. Further, our study suggests that the FT-STS reported fluctuating superconductivity around the node at far above T(c) is not necessary to explain the existence of the quasiparticle interference at low energy.

From a single-band metal to a high-temperature superconductor via two thermal phase transitions

The nature of the pseudogap phase of cuprate high-temperature superconductors is a major unsolved problem in condensed matter physics. We studied the commencement of the pseudogap state at temperature T* using three different techniques (angle-resolved photoemission spectroscopy, polar Kerr effect, and time-resolved reflectivity) on the same optimally doped Bi2201 crystals. We observed the coincident, abrupt onset at T* of a particle-hole asymmetric antinodal gap in the electronic spectrum, a Kerr rotation in the reflected light polarization, and a change in the ultrafast relaxational dynamics, consistent with a phase transition. Upon further cooling, spectroscopic signatures of superconductivity begin to grow close to the superconducting transition temperature (T(c)), entangled in an energy-momentum-dependent manner with the preexisting pseudogap features, ushering in a ground state with coexisting orders.

Nitric oxide production induced in roots of Lotus japonicus by lipopolysaccharide from Mesorhizobium loti

Lipopolysaccharide (LPS) is a bacterial molecule that induces nitric oxide (NO) production and triggers defense systems in plant-pathogen interactions. NO production is induced in the roots of Lotus japonicus after inoculation of the roots with its microsymbiont Mesorhizobium loti. However, the rhizobial molecule that induces NO production has not yet been identified. We investigated NO production in the roots of L. japonicus by treatment with LPS of M. loti. LPS was prepared by phenol-hot water extraction and separated into several fractions: polysaccharide, lipooligosaccharide, oligosaccharide and lipid A. In the roots of L. japonicus, NO production was observed with an NO-specific fluorescent dye 4, 10 and 24 h after treatment with each fraction of LPS. NO production was detected 4 h after treatment with all fractions. NO production was also detectable 24 h after treatment, except after treatment with the polysaccharide and oligosaccharide fractions. Expression of a class 1 hemoglobin gene and application of an NO scavenger showed that the treatment with LPS and LOS induced a similar response to inoculation with M. loti. These data suggest that LPS of M. loti induces NO production after inoculation with M. loti.

Creation and control of a two-dimensional electron liquid at the bare SrTiO3 surface

Many-body interactions in transition-metal oxides give rise to a wide range of functional properties, such as high-temperature superconductivity, colossal magnetoresistance or multiferroicity . The seminal recent discovery of a two-dimensional electron gas (2DEG) at the interface of the insulating oxides LaAlO(3) and SrTiO(3) (ref. 4) represents an important milestone towards exploiting such properties in all-oxide devices. This conducting interface shows a number of appealing properties, including a high electron mobility, superconductivity and large magnetoresistance, and can be patterned on the few-nanometre length scale. However, the microscopic origin of the interface 2DEG is poorly understood. Here, we show that a similar 2DEG, with an electron density as large as 8×10(13)  cm(-2), can be formed at the bare SrTiO(3) surface. Furthermore, we find that the 2DEG density can be controlled through exposure of the surface to intense ultraviolet light. Subsequent angle-resolved photoemission spectroscopy measurements reveal an unusual coexistence of a light quasiparticle mass and signatures of strong many-body interactions.

Carboxymethyl-chitin promotes chondrogenesis by inducing the production of growth factors from immune cells

Many techniques have been tested for their ability to restore cartilage defects, but several problems still remain in the complete healing of injured cartilage. In our previous study, we found that a carboxymethyl-chitin/beta-tricalcium phosphate (CM-chitin/beta-TCP) composite induced cartilage regeneration in the osteochondral defects of rabbits in vivo. We also found that CM-chitin stimulated peritoneal exudate cells (PEC) in mice and induced several kinds of inflammatory cytokines and transforming growth factor beta-1 (TGF-beta1). In this study, we examined whether CM-chitin is responsible for the induction of chondrogenesis via the production of TGF-beta1 in vitro. The murine pluripotent cell line C3H10T1/2 was maintained as a micromass culture in conditioned medium prepared from PEC stimulated with and without CM-chitin. CM-chitin-conditioned medium induced RNA expression of the chondrogenic-factor Sox9 and the matrix proteins aggrecan, Col2a1, and Comp. Their expression levels were decreased in the presence of anti-TGF-beta1 antibody. The micromass tissues cultured in CM-chitin conditioned medium at day 21 were clearly stained by Toluidine blue or Alcian blue (histological staining) and collagen II antibody (immunohistological staining), showing the expression of acidic glycosaminoglycan and type II collagen. Similar results were observed in micromass tissue stimulated with TGF-beta1 as a positive control. However, no chondrogenesis occurred when CM-chitin was added directly to a C3H10T1/2 cell culture. These results indicated that CM-chitin is a potent inducer of chondrogenesis via the induction of TGF-beta1 in immune cells.

The peptide sequence of diacyl lipopeptides determines dendritic cell TLR2-mediated NK activation

Natural killer (NK) cells are lymphocyte effectors that are activated to control certain microbial infections and tumors. Many NK-activating and regulating receptors are involved in regulating NK cell function. In addition, activation of naïve NK cells is fundamentally triggered by cytokines or myeloid dendritic cells (mDC) in various modes. In this study, we synthesized 16 S-[2,3-bis(palmitoyl)propyl]cysteine (Pam2Cys) lipopeptides with sequences designed from lipoproteins of Staphylococcus aureus, and assessed their functional properties using mouse (C57BL/6) bone marrow-derived DC (BMDC) and NK cells. NK cell activation was evaluated by three criteria: IFN-γ production, up-regulation of NK activation markers and cytokines, and NK target (B16D8 cell) cytotoxicity. The diacylated lipopeptides acted as TLR2 ligands, inducing up-regulation of CD25/CD69/CD86, IL-6, and IL-12p40, which represent maturation of BMDC. Strikingly, the Pam2Cys lipopeptides induced mouse NK cell activation based on these criteria. Cell-cell contact by Pam2Cys peptide-stimulated BMDC and NK cells rather than soluble mediators released by stimulated BMDC induced activation of NK cells. For most lipopeptides, the BMDC TLR2/MyD88 pathway was responsible for driving NK activation, while some slightly induced direct activation of NK cells via the TLR2/MyD88 pathway in NK cells. The potential for NK activation was critically regulated by the peptide primary sequence. Hydrophobic or proline-containing sequences proximal to the N-terminal lipid moiety interfered with the ability of lipopeptides to induce BMDC-mediated NK activation. This mode of NK activation is distinctly different from that induced by polyI:C, which is closely associated with type I IFN-inducing pathways of BMDC. These results imply that the MyD88 pathway of BMDC governs an alternative NK-activating pathway in which the peptide sequence of TLR2-agonistic lipopeptides critically affects the potential for NK activation.

Enhanced superconducting gaps in the trilayer high-temperature Bi2Sr2Ca2Cu3O(10+δ) cuprate superconductor

We report the first observation of the multilayer band splitting in the optimally doped trilayer cuprate Bi2Sr2Ca2Cu3O(10+δ) (Bi2223) by angle-resolved photoemission spectroscopy. The observed energy bands and Fermi surfaces are originated from the outer and inner CuO2 planes (OP and IP). The OP band is overdoped with a large d-wave gap around the node of Δ0∼43  meV while the IP is underdoped with an even large gap of Δ0∼60  meV. These energy gaps are much larger than those for the same doping level of the double-layer cuprates, which leads to the large Tc in Bi2223. We propose possible origins of the large superconducting gaps for the OP and IP: (1) minimal influence of out-of-plane disorder and a proximity effect and (2) interlayer tunneling of Cooper pairs between the OP and IP.

Intraperitoneal administration of telomerase-specific oncolytic adenovirus sensitizes ovarian cancer cells to cisplatin and affects survival in a xenograft model with peritoneal dissemination

Despite tremendous development in chemotherapy for ovarian cancer over the past few decades, the prognosis of advanced cases with massive peritoneal dissemination is still unsatisfactory, and novel treatment modalities that can combine with chemotherapy are urgently needed. We recently developed virotherapy for solid tumors using telomerase-specific replication-selective adenoviruses (Telomelysin: OBP-301), in which the human telomerase reverse transcriptase (hTERT) gene promoter has been inserted to direct tumor-specific E1 gene expression. In this study, we investigated the anti-tumor effects of OBP-301, combined with cisplatin (CDDP), on ovarian cancer cells. In vitro treatment of SKOV3 cells with OBP-301 at a multiplicity of infection (MOI) of 0.01–100 induced significant cell death in a dose-dependent manner, with moderate cytotoxicity at an MOI of 1–10 and maximal cytotoxicity at an MOI of 100. In contrast, OBP-301 treatment of normal human cells showed no significant cell death at an MOI of 1–10 and exhibited modest cytotoxicity at an MOI of 100. The effects of low-dose CDDP at 0.5–1 μM, which induced only 20% cell death, were significantly augmented by combination with OBP-301 at an MOI of 1–10, finally achieving 40% cell death. Such enhancement of CDDP sensitivity was also observed in CDDP-resistant ovarian cancer cells. The combinatorial effects were further tested using a xenograft mouse model of SKOV3 with peritoneal dissemination. After intraperitoneal administration of OBP-301, we confirmed that injected OBP-301 fused with the green fluorescent protein (GFP) gene (OBP-401) was preferentially localized to peritoneal disseminations, as determined by fluorescence imaging. Treatment of mice with CDDP at low dose (0.5 mg kg^–1) had modest effects, showing a 10% decrease in disseminations, whereas combination with intraperitoneal administration of OBP-301 at an MOI of 10 led to enhanced effects, achieving an approximately 80% decrease in disseminations. Kaplan–Meier analysis showed improved overall survival of mice treated with CDDP plus OBP-301 compared with CDDP alone. These findings support the therapeutic potential of intraperitoneal administration of OBP-301 to sensitize ovarian cancer cells to CDDP.

Oxidative degradation of 2,4-dichlorophenoxyacetic acid (2,4-D) in subcritical and supercritical waters

Presence of chlorinated organic compounds in water bodies has become a concern among governments, health authorities and general public. Oxidation of organic compounds in water under high temperature and pressure is considered as a promising technique, but usefulness of the technique to mineralize 2,4-dichlorophenoxyacetic acid (2,4-D) is not well understood. This article aimed to elucidate degradation characteristics of 2,4-D in both subcritical and supercritical waters by laboratory batch experiments. 2,4-D degradation, total organic carbon (TOC) removal and dechlorination increased with increasing reaction time and temperature especially in subcritical waters, while dechlorination was a major step. 2,4-dichlorophenol (2,4-DCP) and acetic acid were the main degradation intermediates both in subcritical and supercritical waters. Though 2,4-D disappeared almost completely in subcritical waters near critical region ( approximately 99%), significant amounts of TOC and organic chlorine still remained as 2,4-DCP and acetic acid. But TOC removal and dechlorination were significantly enhanced ( approximately 95 and 91% respectively) in supercritical waters. Complete mineralization of 2,4-D in subcritical waters required a considerably longer reaction period, while the mineralization was almost complete within a short reaction period in supercritical waters. This is an important information of practical significance for oxidative degradation of chlorinated pesticides similar to 2,4-D.

Percutaneous radiofrequency lung ablation combined with transbronchial saline injection: an experimental study in swine

To evaluate the efficacy of radiofrequency lung ablation with transbronchial saline injection. The bilateral lungs of eight living swine were used. A 13-gauge bone biopsy needle was inserted percutaneously into the lung, and 1 ml of muscle paste was injected to create a tumor mimic. In total, 21 nodules were ablated. In the saline injection group (group A), radiofrequency ablation (RFA) was performed for 11 nodules after transbronchial saline injection under balloon occlusion with a 2-cm active single internally cooled electrode. In the control group (group B), conventional RFA was performed for 10 nodules as a control. The infused saline liquid showed a wedge-shaped and homogeneous distribution surrounding a tumor mimic. All 21 RFAs were successfully completed. The total ablation time was significantly longer (13.4 +/- 2.8 min vs. 8.9 +/- 3.5 min; P = 0.0061) and the tissue impedance was significantly lower in group A compared with group B (73.1 +/- 8.8 Omega vs. 100.6 +/- 16.6 Omega; P = 0.0002). The temperature of the ablated area was not significantly different (69.4 +/- 9.1 degrees C vs. 66.0 +/- 7.9 degrees C; P = 0.4038). There was no significant difference of tumor mimic volume (769 +/- 343 mm(3) vs. 625 +/- 191 mm(3); P = 0.2783). The volume of the coagulated area was significantly larger in group A than in group B (3886 +/- 1247 mm(3) vs. 2375 +/- 1395 mm(3); P = 0.0221). Percutaneous radiofrequency lung ablation combined with transbronchial saline injection can create an extended area of ablation.

Universal versus material-dependent two-gap behaviors of the high-Tc cuprate superconductors: angle-resolved photoemission study of La2-xSrxCuO4

We have investigated the doping and temperature dependences of the pseudogap and superconducting gap in the single-layer cuprate La2-xSrxCuO4 by angle-resolved photoemission spectroscopy. The results clearly exhibit two distinct energy and temperature scales, namely, the gap around (pi, 0) of magnitude Delta* and the gap around the node characterized by the d-wave order parameter Delta0. In comparison with Bi2212 having higher Tc's, Delta0 is smaller, while Delta* and T* are similar. This result suggests that Delta* and T* are approximately material-independent properties of a single CuO2 plane, in contrast to the material-dependent Delta0, representing the pairing strength.

[Metastatic lung cancer origin from osteosarcoma of mandible invading tracheal lumen]

A 52-year-old woman underwent the surgical treatment for osteosarcoma of the left mandible in 2003 and was followed up afterward. She suffered from dry cough and bloody sputum, and was admitted to our hospital in April 2007. Computed tomography (CT) revealed several nodules in bilateral lung, and bronchofiberscopy showed the endobronchial tumor obstructing in the right main bronchus. The metastatic tumor progressed in the right main bronchus from the right S6 lung segment. The tumor rapidly progressed in the right bronchus in comparison with the CT findings in about 2 weeks, and the possibility of the tracheal obstruction was considered. She underwent the right middle and lower lobectomy, and the endobronchial tumor was pulled through the right main bronchus. The postoperative course was uneventful, the patient was discharged on 14th postoperative day, and the chemotherapy using cisplatin (CDDP) and adriamycin (ADR) is on-going.

Circulating tumor cells (CTCs) and endothelial cells (CECs) in primary lung cancer

11066

Background: Circulating tumor cell (CTC), a surrogate of distant metastasis, and circulating endothelia cell (CEC), a surrogate of angiogenesis, are potentially useful in the diagnosis of malignant tumors, but clinical significance of CTC/CEC in primary lung cancer (LC) remains unclear. Methods: A total of 342 cases who presented at our institute from August 2007 through December 2008 were included in the study. CTC/CEC in the peripheral blood (7.5mL/4.0mL) were captured and quantitatively evaluated with the “CellSearch” system without knowledge of clinical characteristics of each case. Results: In 42 (30.7%) of 137 LC cases, CTC in the peripheral blood was positive (CTC-count, more than 1 cell/7.5mL), and the maximum CTC-count was 62 cells. In 11 (18.3%) of 145 cases with non-malignant (NM) diseases, CTC was also positive; however, in NM cases, CTC-count was 1 (cell/7.5mL) in most CTC-positive cases and the maximun CTC-count was 2. Among LC cases, the incidence of case with CTC-positive (CTC-count, 1 or more) was highest in small cell carcinoma cases (7/10, 70.0%), followed by squamous cell carcinoma (9/22, 40.9%) and adenocarcinoma (23/94, 24.5%) cases; the incidence of CTC-positive case was significantly higher in stage IV cases (68.6%; p<0.001), but it should be noted that CTC was positive in 17.4% of stage I cases and 15.4% of stage II cases. The mean CEC number (/4.0mL) was significantly higher in LC cases than in NM cases (97.5 versus 52.5, respectively; p=0.023), Among LC cases, the mean CEC significantly increased along with tumor progression (mean CEC for stage I, II, III, and IV cases: 58.7, 57.9, 83.4, and 178.4, respectively; p=0.002). Conclusions: CTC and CEC are useful clinical markers in LC, and its clinical value should be validated in future clinical trials. [Table: see text]

No significant financial relationships to disclose.

Circulating tumor cells (CTCs) and endothelial cells (CECs) in the diagnosis of malignant pleural mesothelioma (MPM): A single institutional prospective study

e22107

Background: Circulating tumor cell (CTC), a surrogate of distant metastasis, and circulating endothelia cell (CEC), a surrogate of angiogenesis, are potentially useful in the diagnosis of malignant tumors. Following a promising result of our preliminary study showing the diagnostic value of CTC/CEC in malignant pleural mesothelioma (MPM)(Tanaka F, et al. ASCO 2008), we conducted a prospective study. Methods: Patients (pts), who presented at our institute with suspicion or diagnosis of MPM, were eligible in the study. CTCs and CECs in peripheral blood (7.5mL and 4.0mL, respectively) were captured and quantitatively evaluated with the “CellSearch” system without knowledge of clinical characteristics of patients. Results: A total of 92 pts were enrolled into the study, and the final diagnosis was MPM in 68, other malignant tumors in 7, and non-malignant diseases in 17 pts ( Table ). CTC was positive (CTC-count, 1 or more per 7.5mL of the peripheral blood) in 35%(24/68) of MPM pts (range of CTC-count, 0–27 cells/7.5 mL). Among non-malignant pts, 3 pts (18%) showed a positive-CTC, but no patient showed 2 or more CTCs in 7.5mL of the peripheral blood. The mean CEC-count (/4.0mL) was significantly higher in MPM pts than in non-malignant pts (105.1 versus 40.2; p=0.047). When the cut-off value of CEC-count for the diagnosis of MPM was defined as 50(cells/4.0mL), the sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of malignant diseases were 66%, 70%, 93%, and 26%, respectively. There was no correlation between CTC-positivity and clinical stage of MPM pts, but was a trend of increase in the mean CEC-count along with tumor progression (mean CEC-count for stage I, II, III, and IV pts: 63.0, 82.4, 95.6, and 116.7, respectively). Conclusions: CTC and CEC are useful clinical markers in the diagnosis of MPM.

[Table: see text]

No significant financial relationships to disclose.

The Culdotomy FourS Two U procedure for transvaginal access to the peritoneal cavity

A reliable method of transvaginal access is needed for natural orifice transluminal endoscopic surgery. We introduce a new culdotomy procedure, using a technique for the creation of space in the cul-de-sac, transvaginal ultrasound, and a newly developed umbrella Hakko needle. An artificially developed, saline-containing space in the cul-de-sac was punctured by an umbrella Hakko needle from the vagina under the guidance of ultrasound. The vaginal walls on both sides of the needle were incised with an electric scalpel. In five cases with benign gynecological tumors, culdotomy was successfully performed. Operating time was less than 10 minutes and blood loss was less than 10 mL. There were no culdotomy-associated complications. This procedure, named Culdotomy FourS Two U, is a simple, safe, and reliable method for entry into the cul-de-sac in transvaginal gynecological surgeries and may have future applications in transluminal endoscopic surgery through the vagina.

[Thymic carcinoma involving aortic arch; report of a case]

Adenocarcinoma of the thymus is a very rare malignant tumor. The standard treatment for advanced thymic carcinoma has not yet been established, and the prognosis is poor. We report a case of thymic carcinoma that involving the aortic arch and the innominate vein. A 78-year-old woman was admitted to our hospital complaining of hoarseness in April 2007. The computed tomography (CT) scan showed an anterior mediastinal tumor contiguous to the aortic arch and the innominate vein with swelling lymphnodes. Microspcopic examinations of specimens obtained by CT-guided needle biopsy revealed poorly differenciated adenocarcinoma. The carcinoembryonic antigen (CEA) level of serum elevated at 54.9 ng/ml. Thymic carcinoma was diagnosed. The chemoradiotherapy [concurrent, carboplatin (CBDCA) + paclitaxel(TXL)-->vinorelbine (NVB), 60 Gy] was performed, but the effect of the therapy was limited. The resection of the tumor with a part of aortic arch and other peripheral tissues was performed in Augast 2007. The postoperative course was uneventful and the CEA level of serum lowered to the normal. She was discharged 30 days after surgery.

Characterization of N-terminal structure of TLR2-activating lipoprotein in Staphylococcus aureus

Staphylococcus aureus is known to activate mammalian immune cells through Toll-like receptor 2 (TLR2). We recently demonstrated that a lipoprotein fraction obtained from S. aureus by Triton X-114 phase partitioning is a potent activator of TLR2. In this study, we separated TLR2-activating lipoproteins expressed in S. aureus and characterized an N-terminal structure. The lipoprotein fraction of S. aureus was prepared by glass bead disruption followed by Triton X-114 phase partitioning. The TLR2-activating molecules were mainly detected in the mass range of 30-35 kDa. Seven lipoproteins were identified by the mass spectra of their tryptic digests. Among them, three lipoproteins were separated by preparative SDS-PAGE and proved to activate TLR2. After digestion with trypsin in the presence of sodium deoxycholate, the N terminus of the lipopeptide was isolated from lipoprotein SAOUHSC_02699 by normal phase high pressure liquid chromatography and characterized as an S-(diacyloxypropyl)cystein-containing peptide using tandem mass spectra. The synthetic lipopeptide counterpart also stimulated the cells via TLR2. These results showed that the diacylated lipoprotein from S. aureus acts as a TLR2 ligand in mammalian cells.

Docosahexaenoic acid promotes neuronal differentiation by regulating basic helix-loop-helix transcription factors and cell cycle in neural stem cells

Recent studies have suggested that docosahexaenoic acid (DHA) enhances neuronal differentiation of neural stem cells (NSCs) isolated from rat embryonic day 14.5. However the underlying mechanism remains largely unknown. One hypothesis supported by DHA controls the expression level of basic helix-loop-helix (bHLH) transcription factors, such as hairy and enhancer of split 1 (Hes1), Mash1, neurogenin1, and NeuroD; another is that previous studies in retinal progenitor cells DHA affects the cell cycle. In this study, we show that treatment with DHA under differentiation conditions without basic fibroblast growth factor, (1) increases Tuj-1 and MAP2 positive cells in NSCs, (2) that the expression level of Hes1 mRNA and protein decreased significantly from day 1 to day 4, on the other hand, the NeuroD mRNA expression level increased from day 1 to day 4 after treatment with DHA and (3) decreased the percentage of S-phase cells, which correlated with prolonged expression of cyclin-dependent kinase inhibitor p27(kip1), suggesting that DHA enhances neuronal differentiation of NSCs, in part, by controlling the bHLH transcription factors and promoting cell cycle exit. We therefore speculate that DHA is one of the essential key molecules for neuronal differentiation of NSCs.