Doppler spectroscopy and D-alpha emission diagnostics for the C-2 FRC plasma

Two Doppler spectroscopy diagnostics with complementary capabilities are developed to measure the ion temperatures and velocities of FRC plasmas in the C-2 device. First, the multichord ion doppler diagnostic can simultaneously measure 15 chords of the plasma using an image intensified camera. Second, a single-chord fast-response ion Doppler diagnostic provides much higher faster time response by using a 16-channel photo-multiplier tube array. To study the neutral density of deuterium under different wall and plasma conditions, a highly sensitive eight-channel D-alpha diagnostic has been developed and calibrated for absolute radiance measurements. These spectroscopic diagnostics capabilities, combined with other plasma diagnostics, are helping to understand and improve the field reversed configuration plasmas in the C-2 device.

Dimethyl Trisulfide as a Characteristic Odor Associated with Fungating Breast Cancer Wounds

Background: Some advanced cancer patients suffer from unpleasant odor from their fungating wounds. The fungating wounds have been reported to occur in about 5% of patients with cancer. These wounds are usually superinfected with bacteria, and therefore, the infected area tends to emit malodor. However, the odorant(s) causing the malodor has not been revealed. Here we aim to determine the chemical identity of the cancer wound-derived odor(s). Results: We examined three female patients with breast cancer (B1; stage IV, B2; stage IIIB, B3; stage IV) and two male patients with head and neck cancer (H1; stage III, H2; stage IVA). First, we evaluated the intensity and quality of body odors emitted from the fungating wounds of patients. All of them had a similar pungent sulfury odor. In addition to the sulfury odor, B1and B2 had a cheese-like odor and B3, H1 and H2 had a rotten fish odor. Next, we analyzed the malodor emitted from the wounds of each patient. Sterile gauze pads were placed on fungating wounds of the patients for 6-12h. The head-space volatiles of pads were extracted onto SPME fibers for 2h. The compounds on the SPME fibers were then analyzed by gas chromatography-mass spectrometry-olfactometry (GC-MS-O) that enabled us to examine mass spectra and odor qualities of individual GC-separated odorants simultaneously. GC-MS-O analysis and evaluation of body odors were performed by three persons. As a result, the sulfury odor, which was the same as the odor we identified in body odors of all patients, came out at the retention time (RT) of 19.46min. Cheese-like odors in B1 and B2 patients came out at RT=24.01min, 25.47min and 26.08min. The structure of dimethyl trisulfide (DMTS) was predicted by the mass spectrum of the peak around 19.5min. The mass spectrum and the RT of authentic DMTS were identical to those of the peak compound, demonstrating that the sulfury odor at 19.46min was DMTS. Comparing the odor quality and intensity of various concentrations of DMTS solutions and cancer samples, we conclude that DMTS is emitted from the cancer wounds at the level significant enough to make ones feel uncomfortable. We also identified the structure of compounds with cheese-like odors: isobutyric acid for the cheese odor (24.01min), butyric acid for the cheese and vomit odor (25.47min), and isovaleric acid for the cheese and feet odor (26.08min). Discussion: We identified DMTS as the main odorant that caused the severe malodor in some advanced cancer patients. DMTS has been found in volatiles emitted from vegetables such as cooked onion. DMTS is also reported to be produced by aerobes such as Pseudomonas aeruginosa that reside in leg ulcers. Thus, although the source of DMTS found in the fungating cancer wounds in this study remains to be elucidated, DMTS may be a product of infected bacteria in fungating wounds. To improve the QOL of patients, the development of the way to prevent or reduce the DMTS odor is awaited. Indeed, almost all patients with fungating wounds are suffering from this malodor. Our results provide new insights into the better strategies toward the treatment of malodor in cancer patients.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5042.

Development and significance of a fetal electrocardiogram recorded by signal-averaged high-amplification electrocardiography

Although ultrasonic diagnostic imaging and fetal heart monitors have undergone great technological improvements, the development and use of fetal electrocardiograms to evaluate fetal arrhythmias and autonomic nervous activity have not been fully established. We verified the clinical significance of the novel signal-averaged vector-projected high amplification ECG (SAVP-ECG) method in fetuses from 48 gravidas at 32-41 weeks of gestation and in 34 neonates. SAVP-ECGs from fetuses and newborns were recorded using a modified XYZ-leads system. Once noise and maternal QRS waves were removed, the P, QRS, and T wave intervals were measured from the signal-averaged fetal ECGs. We also compared fetal and neonatal heart rates (HRs), coefficients of variation of heart rate variability (CV) as a parasympathetic nervous activity, and the ratio of low to high frequency (LF/HF ratio) as a sympathetic nervous activity. The rate of detection of a fetal ECG by SAVP-ECG was 72.9%, and the fetal and neonatal QRS and QTc intervals were not significantly different. The neonatal CVs and LF/HF ratios were significantly increased compared with those in the fetus. In conclusion, we have developed a fetal ECG recording method using the SAVP-ECG system, which we used to evaluate autonomic nervous system development.

Analysis of soluble vascular endothelial growth factor receptor-1 secreted from cultured corneal and oral mucosal epithelial cell sheets in vitro

BACKGROUND

In clinical trials, eyes transplanted with cultured oral mucosal epithelial cell sheets have shown increased neovascularisation compared with eyes treated with cultured corneal epithelial cell sheets. As reported recently, soluble vascular endothelial growth factor receptor-1 (soluble VEGFr-1) is a main factor to maintain a corneal avascularity.

AIM

To investigate soluble VEGFr-1 of cultured corneal epithelial cells (CCE) and cultured oral mucosal epithelial cells (COE) in vitro.

METHODS

Rabbit corneal and oral mucosal epithelial cells were co-cultured with mitomycin C-treated NIH/3T3 cells on culture plates. After CCE and COE were multilayered, culture medium was replaced by basal medium and incubated. Protein secretion of soluble VEGFr-1 was assessed in conditioned medium from CCE and COE by ELISA. Angiogenic potential was examined by invasion, migration assays with human umbilical vein endothelial cells (HUVECs) in addition to recombinant soluble VEGFr-1.

RESULTS

CCE secreted a significantly higher amount of soluble VEGFr-1 than did COE. Recombinant soluble VEGFr-1 significantly suppressed HUVEC migration induced by COE, without suppression in CCE. In conclusion, these findings suggest that low protein levels of soluble VEGFr-1 may lead to corneal neovascularisation after COE sheet transplantation.

[Development of three-dimensional analysis of current density distribution by 64-ch magentocardiography and clinical application]

Magnetocardiography (MCG) using a SQUID sensor is characterized by three dimensional cardiac electrical phenomena from magnetic fields, because it is hard to be affected by organ constitution of lungs and torso configuration. We have developed three-dimensional (3D) electric current density distribution analysis by a spatial filter method. At this symposium, we report clinical utility of 64-channel (64-ch) MCG. Subjects consisted of 20 normal volunteers, 10 cases with old myocardial infarction, 13 cases with atrial fibrillation (AFIB) who received surgical pulmonary (PV) isolation, and representative case with fetus premature ventricular complex (PVC). We recorded 10-min MCG data of magnetic field composition (a Bz ingredient) which was perpendicular to body surface in a magnetism shield, using 64-ch SQUID sensors (17.5 x 17.5 cm) built-in in MCG instrumentation(sampling; 500ms, total frequency characteristic; 0.1-200 Hz). We conducted 3D heart outline from electric current density calculated by magnetic field distribution. We also generated 3D functional images of the RT (activation recovery time) dispersion and spatial spectral distribution of a fibrillation wave. Increased fluctuation on RT dispersion map corresponded with space location of myocardial infarction. The mean frequency of 3D spectral map in persistent AFIB showed a higher value than that with restored a sinus rhythm (7.7 +/- 0.5 Hz vs. 6.5 +/- 0.7 Hz). We also demonstrated a fetus PVC. We concluded that 64-ch MCG can evaluate 3D spatial location of myocardial injury, 3D spectral map and characteristic frequency, and fetus arrhythmia. In future, further technical development in the fields of MCG measurement would be necessary for avoiding the used of unshielded room or liquid He.

Early outcomes after allogeneic hematopoietic SCT in pediatric patients with hematologic malignancies following single fraction TBI

Fractionated TBI (FTBI) followed by allogeneic hematopoietic SCT results in donor engraftment and improves survival in children with high-risk hematologic malignancies. However, acute toxicities (skin, lung and mucosa) are common after FTBI. Late complications include cataracts, endocrine dysfunction, sterility and impaired neurodevelopment. Instead of FTBI, we used low-dose single fraction TBI (550 cGy) with CY as transplant conditioning for pediatric hematologic malignancies. GVHD prophylaxis included CYA and short-course MTX; methylprednisolone was added for unrelated donor transplants. A total of 55 children in first (40%) or second remission and beyond (60%) underwent transplantation from BM (65%) or peripheral blood; 62% from unrelated donors; 22% were mismatched. Median follow-up was 18.5 months (1-68). Overall survival and disease-free survival at 1 year were 60 and 47%, respectively. Acute toxicities included grade 3-4 mucositis (18%), invasive infections (11%), multiorgan failure/shock (11%), hemolytic anemia (7%), veno-occlusive disease (4%) and renal failure (4%). TRM was 11% at 100 days. Non-relapse mortality was 6% thereafter. Graft rejection occurred in 2%. Three patients (5%) died of GVHD. The regimen was well tolerated even in heavily pretreated children and supported donor cell engraftment; long-term follow up is in progress.

In vivo local administration of osteogenic protein-1 increases structural properties of the overstretched anterior cruciate ligament with partial midsubstance laceration

We report the effects of local administration of osteogenic protein-1 on the biomechanical properties of the overstretched anterior cruciate ligament in an animal model. An injury in the anterior cruciate ligament was created in 45 rabbits. They were divided into three equal groups. In group 1, no treatment was applied, in group II, phosphate-buffered saline was applied around the injured ligament, and in group III, 12.5 μg of osteogenic protein-1 mixed with phosphate-buffered saline was applied around the injured ligament. A control group of 15 rabbits was assembled from randomly-selected injured knees from among the first three groups. Each rabbit was killed at 12 weeks.

The maximum load and stiffness of the anterior cruciate ligament was found to be significantly greater in group III than either group 1 (p = 0.002, p = 0.014) or group II (p = 0.032, p = 0.025). The tensile strength and the tangent modulus of fascicles from the ligament were also significantly greater in group III than either group I (p = 0.002, p = 0.0174) or II (p = 0.005, p = 0.022).

The application of osteogenic protein-1 enhanced the healing in the injured anterior cruciate ligament, but compared with the control group the treated ligament remained lengthened. The administration of osteogenic protein-1 may have a therapeutic role in treating the overstretched anterior cruciate ligament.

Allogeneic hematopoietic cell transplantation (HCT) in Hurler's syndrome using a reduced intensity preparative regimen

Allogeneic hematopoietic cell transplantation (HCT) in patients with Hurler's syndrome can improve survival and ameliorate many aspects of Hurler's syndrome including neurologic decline and cardiac compromise. Unfortunately, the toxicity of traditional preparative regimens to organs affected by the syndrome may have deleterious effects. Additionally, despite the intensity of these regimens, achieving stable donor chimerism can be difficult. We report transplant outcomes following a reduced intensity, highly immunosuppressive preparative regimen consisting of alemtuzumab, fludarabine and melphalan prior to HCT in seven patients with Hurler's syndrome treated at two centers. Six patients received grafts from unrelated donors and one received a sibling donor graft. The preparative regimen was well tolerated. All patients had initial donor engraftment at 100 days; one patient had delayed loss of donor chimerism. There was no severe acute GVHD (no GI GVHD of grade II or more, no grade IV skin GVHD). Six of the seven children are surviving at a median of 1014 (726-2222) days post transplant. This reduced intensity preparative regimen has the potential to support engraftment and improve survival and outcome in patients with Hurler's syndrome undergoing HCT.

Deletion of entire HLA-A gene accompanied by an insertion of a retrotransposon

Unusual HLA-A'null' alleles because of an entire gene deletion were found in three apparently unrelated Japanese families with leukemia patients. Inclusion of the entire HLA-A gene in the deletion was confirmed by polymerase chain reaction direct sequencing of the surrounding regions of HLA-A. Further localization of the breakpoints of the HLA-A deletion at the centromeric and telomeric sides was performed, and these families were shown to possess the identical deletion. We then determined the genomic sequence of the HLA-A-deleted haplotype. Surprisingly, the haplotype turned out to carry an insertion of an SVA (SINE-VNTR-Alu) retrotransposon of 2 kb as well as the 14 kb deletion that included the entire HLA-A gene.

Dental health of long-term survivors of childhood cancer: The childhood cancer survivor study (CCSS)

9017

Background: This study describes the frequencies of and risk factors for altered oral health and dental development in pediatric patients who have survived childhood cancer. Methods: We identified 8,522 participants and 2,831 siblings in the CCSS with information on dental health. Dental outcomes of treatment and socioeconomic-demographic (SED) data, were analyzed using univariate and multivariate logistic regression models to estimate odds ratios (OR). Results: Survivors included 4,249 females (49.9%), 7,367 white non-Hispanic (86.5%). Median age at cancer diagnosis, 6.8y (range, 0–20 y); time from diagnosis to interview, 31.4 y (range, 17–54 y). Overall, 30% of survivors self-reported ≥ 1 oral-dental abnormality: microdontia (10%), hypodontia (8%), > 5 caries (55%), root stunting (6%), enamel hypoplasia (13%), gingivitis (7%). Compared to siblings, survivors were at increased risk of ≥ 1 oral-dental abnormalities when adjusted for SED (OR = 2.0, p<0.001). Increased risk of abnormalities was associated with being female (p<0.001) or white non-Hispanic (p=0.001), having an income < $20K (p=0.001) or lower education (p=0.004), and lack of health insurance (p=0.02). Patients with central nervous system tumors, neuroblastoma and soft tissue sarcoma had highest risk of abnormality (all P-values < 0.001). In multivariate models adjusted for SED, radiation dose to jaw, and exposure to increasing doses of alkylating agents increased risk of oral-dental abnormalities (radiation dose = 20 Gy OR = 5.6, p < 0.001; alkylating agent score OR=1.6, p<0.0001). Conclusions: Childhood cancer therapy results in adverse long- term oral-dental sequelae and is associated with specific treatment factors.

No significant financial relationships to disclose.

Immediate maxillary reconstruction after malignant tumor extirpation

AIMS

Immediate maxillary reconstruction after malignant tumor extirpation differs from other types of maxillary reconstruction. Our reconstruction algorithm is described in this article.

METHODS

One hundred ninety-four patients who had undergone maxillectomy for malignant tumors were reviewed, and maxillectomy defects were classified with the method of Cordeiro and Santamaria.

RESULTS

Mean total blood loss was 848 ml, and 71 patients died within 2 years after surgery. For type IIIa defects of the orbital floor, titanium mesh or vascularized bone or cartilage was used for reconstruction, but the rate of postoperative complications did not differ between titanium and autografts. Therefore, to reconstruct orbital floor defects we have recently used only titanium mesh. For type I or II defects, we use autografts for only selected cases.

CONCLUSIONS

We strive to perform less-invasive reconstructive surgery after resection for maxillary malignancy.

Akt activation induces epidermal hyperplasia and proliferation of epidermal progenitors

Various common signaling pathways maintain tissue stem cells, including Notch and Wnt/beta-catenin signals. Phosphoinositide-3 kinase (PI3K)/Akt signaling regulates the 'stemness' of several stem cells in culture, specifically in maintaining embryonic stem and neural stem cells, and in deriving embryonic germ cells from primordial germ cells. We examined the effect of Akt signaling in epidermal cells in transgenic mice expressing an Akt-Mer fusion protein whose kinase activity was conditionally activated by treatment with 4-hydroxytamoxifen (4OHT). The topical application of 4OHT to adult skin of the transgenic mice induced new hair growth in resting phase follicles. In addition, the mice showed hyperplasia in interfollicular epidermis (IFE) and hair follicles, which was presumably caused by the extensive proliferation of keratinocytes in basal layer of IFE and outer root sheath of hair follicles, respectively. The progenitor cell population increased consistently in 4OHT-treated transgenic mice. Our results show that PI3K/Akt signaling induces epidermal hyperplasia and proliferation of epidermal progenitors.