Immunohistochemical expression of receptor-tyrosine kinase c-kit protein and TGF-beta1 in invasive ductal carcinoma of the pancreas

BACKGROUND

The receptor tyrosine kinase c-kit is known to play an important role in the progression of gastrointestinal stromal tumors, but its biological significance in other solid malignancies is unclear. Recent publications have suggested a regulatory role for TGF-beta1 in c-kit-mediated cell growth. The present study assessed the clinicopathological significance of c-kit protein (KIT) and TGF-beta1 expression in resectable invasive ductal carcinomas (IDCs) of the pancreas.

PATIENTS AND METHODS

This study included 91 pancreatic IDC patients who received a pancreatectomy between 1982 and 2003. The expression of KIT and TGF-beta1 was analyzed by immunohistochemistry.

RESULTS

KIT and TGF-beta1 were expressed in 77% (70/91) and 59% (54/91) of the IDC, respectively. The expression of KIT was not correlated with that of TGF-beta1. TGF-beta1 expression correlated inversely with nodal involvement, but KIT expression did not correlate with any clinicopathological factors. KIT expression had no significant influence on the survival of the patients, whereas the survival rate of TGF-beta1 (+) IDC patients was significantly higher than that of TGF-beta1 (-) IDC patients. Co-expression analysis of KIT and TGF-beta1 indicated that, in patients with KIT (+) IDC, the TGF-beta1 (+) group showed a significantly better survival rate than the TGF-beta1 (-) group. Neither KIT expression nor TGF-beta1 expression had a significant effect on the efficacy of adjuvant chemotherapy (ACT). In multivariate analysis, TGF-beta1 expression was one of the significant variables for survival in IDC patients overall, but KIT expression was not.

CONCLUSION

TGF-beta1 expression is suggested to have a significant influence on c-kit-mediated cell proliferation in human pancreatic IDCs.

Phase II study on low dose gemcitabine plus oral chemotherapy with uracil-tegafur and cyclophosphamide in combination with radiotherapy against recurrent and advanced pancreatic cancer

The present study assessed the anti-tumor effects and clinical benefits of intravenous (i.v.) or intra-arterial (i.a.) gemcitabine (GEM) at low dose plus oral chemotherapy with uracil-tegafur (UFT) and cyclophosphamide (CPA) in combination with radiotherapy (RT) against recurrent and advanced pancreatic cancers. A total of 22 patients with 15 advanced or 7 recurrent pancreatic cancer were enrolled. The target lesions included 15 primary tumors, 9 liver metastases, 3 local recurrences, 1 lung metastasis and 1 pleural effusion. The patients were each given GEM at 200-400 mg weekly or biweekly, UFT at 300 mg/day daily and CPA at 50 mg/day every other day in combination with RT at a total dose of 40-60 Gy. The primary efficacy measures were the overall response rate (RR) and survival. Furthermore, the clinical benefit response (CBR) was classified by measuring the pain intensity, analgesic consumption, Karnofsky performance status and body weight. The regimen was well tolerated, and the major side effects included anorexia, general malaise and myelo-suppression. In each case, dose reduction was effective in resolving these side effects. The dose limiting side effect was thrombocytopenia. Eleven patients received i.v. GEM alone, 6 patients received i.a. GEM alone and 5 patients received both. The objective responses were evaluated in all patients, and the overall RR was 27% (2 complete responses, 4 partial responses, 6 stable diseases and 10 progressive diseases). A CBR was experienced in 22.7% of the patients. The mean survival period was 10.6 months (2-20 months), and the 1-year survival rate was 42.2%. There were no differences in RR and survival among the different administration methods of GEM. In conclusion, i.v. or i.a. GEM at low dose, UFT and CPA in combination with RT is a well-tolerated regimen with beneficial clinical efficacy, and is worthy of further study.

A clinical study of Japanese patients with ulcer induced by low-dose aspirin and other non-steroidal anti-inflammatory drugs

BACKGROUND

The incidence and severity of non-steroidal anti-inflammatory drugs (NSAIDs)-induced gastro-duodenal ulcer have not been extensively studied in Japan.

AIM

We performed a prospective study to clarify NSAIDs-induced gastro-duodenal injury, focusing especially on low-dose aspirin (L-A).

METHODS

Two hundred and thirty-eight patients with bleeding peptic ulcers admitted to our hospital. History of taking NSAIDs and anti-ulcer drugs was obtained from all patients who underwent endoscopic examinations. The lesion scores of patients taking L-A were classified numerically from zero (no lesion) to five (ulcer).

RESULTS

The NSAIDs were associated with 28.2% of hemorrhagic ulcers. The rates of patients using L-A, loxoprofen, diclofenac, and combination of two of these drugs were 27, 16, 10 and 9%, respectively. Co-administered anti-ulcer drugs were cytoprotective anti-ulcer drugs (27%), H2 receptor antagonists (16%), PPI (4%), and none (53%). In patients taking L-A, H2 receptor antagonists were used most frequently. The HP was positive in 63% of L-A-induced ulcer cases and in 69% of NSAIDs other than low-dose aspirin-induced ulcer cases. The lesion scores of patients taking L-A with H2 receptor antagonists or PPI were significantly lower than those of patients who were taking only L-A (P < 0.05).

CONCLUSIONS

Approximately one-third of hospitalized patients with NSAIDs-induced hemorrhagic ulcer showed an association with L-A. Prospective randomized controlled trials including H2 receptor antagonists are required to establish preventive efforts aimed at L-A-induced gastro-duodenal injury.

Electrochemical characterization of cast Ti-Hf binary alloys

This study characterized the electrochemical behavior of Ti-Hf binary alloys in a simulated oral environment. Ti-Hf alloys (10, 20, 25, 30, 35 and 40 mass% Hf) were prepared by arc-melting titanium sponge and hafnium sponge. Specimens of each alloy (n = 4) were prepared using a dental titanium casting system with a MgO-based investment. Specimens were inspected with X-ray radiography to ensure minimal internal porosity. Castings (n = 4) made from pure titanium and commercially pure titanium were used as controls. The ground flat surface (10 mm x 10 mm) on each specimen where approximately 30 microm was removed was used for the characterization. Sixteen-hour open-circuit potential (OCP) measurement, linear polarization and potentiodynamic cathodic polarization were performed sequentially in aerated (air + 10% CO2) MTZ synthetic saliva at 37 degrees C. Potentiodynamic anodic polarization was conducted in the same medium but deaerated (N2 + 10% CO2) 2 h before and during testing. Polarization resistance (R(P)) and Tafel slopes were determined, as were corrosion current density (I(CORR)) and passive current density (I(PASS)). Results were subjected to nonparametric statistical analysis (alpha = 0.05). The OCP stabilized (mean values -229 mV to -470 mV vs. SCE) for all specimens after the 16-h immersion. Similar passivation was observed for all the metals on their anodic polarization diagrams. The Kruskal-Wallis test showed significant differences in OCP among the test groups (p = 0.006). No significant differences were found in R(P), I(CORR) or I(PASS) among all the metals (p>0.3). Results indicate that the electrochemical behavior of the Ti-Hf alloys examined resembles that of pure titanium.

Expression of retinoblastoma and p53 pathway-related proteins in resectable invasive ductal carcinoma of the pancreas: potential cooperative effects on clinical outcome

BACKGROUND

The retinoblastoma protein (RB) is an important cell cycle regulator. RB also plays an important role in the regulation of apoptosis, which is mediated by interaction of p53 signaling mediators. The present study was designed to assess the clinicopathological significance of RB and p53 pathway-related proteins (p53, p21WAF1/CIP1 and Bax) expression in resectable invasive ductal carcinoma (IDC) of the pancreas.

MATERIALS AND METHODS

The present study included 79 pancreatic IDC patients, who received surgery between 1982 and 2002. The expression of RB and p53 pathway-related proteins (p53, p21WAF1/CIP1 and Bax) were analyzed by immunohistochemistry.

RESULTS

RB was expressed in 45 (57%) of the 79 patients. RB expression correlated significantly with histological grade and grade of nodal involvement. The positive rate of p53, p21WAF1/CIP1 and Bax expression was 49%, 48% and 67%, respectively. RB expression alone did not have a significant effect on patient survival. However, coexpression analysis of RB and p53 pathway-related proteins indicated that, in the patients with RB (+) IDC, the p21WAF1/CIP1 (+) group had a significantly higher survival rate than the p21WAF1/CIP1 (-) group. On the other hand, in the patients with RB (-) IDC, the Bax (+) group had a significantly higher survival rate than the Bax (-) group. Multivariate analysis indicated that, in the RB (-) group, pTNM stage, adjuvant chemotherapy and Bax expression were significant variables.

CONCLUSION

The evaluation of RB expression combined with the mediators of the p53 pathway, p21WAF1/CIP1 and Bax, may provide more accurate information regarding clinical outcome, beyond that which is provided by RB expression alone.

Treatment of Three Pancreaticoduodenal Artery Aneurysms Associated with CœLiac Artery Occlusion and Splenic Artery Aneurysm: A Case Report and Review of the Literature

A case of three pancreaticoduodenal artery (PDA) aneurysms associated with coeliac artery occlusion and a concomitant splenic arterial aneurysm is described. Surgical treatment was used because it was anticipated that the hepatic blood supply would be obstructed completely if percutaneous transluminal embolization for three PDA aneurysms were performed. Splenectomy in continuity with the splenic artery aneurysm and PDA aneurysmectomies were performed, and infrarenal abdominal aorto-splenic artery bypass was accomplished using a 6mm ringed expanded polytetrafluoroethylene graft. The postoperative course was uneventful. Graft patency and successful aneurysm ablation were confirmed using MRA and intravenous DSA. Arterial histology revealed segmental arterial mediolysis. At 2-year follow-up, the patient was well and asymptomatic. A literature review of PDA aneurysms is presented.

Model for the drug-drug interaction responsible for CYP3A enzyme inhibition. I: evaluation of cynomolgus monkeys as surrogates for humans

1. Anti-human cytochrome P450 (CYP) 3A4 antiserum completely inhibited midazolam metabolism in monkey liver microsomes, suggesting that midazolam was mainly metabolized by CYP3A enzyme(s) in monkey liver microsomes. 2. Midazolam metabolism was also inhibited in vitro by typical chemical inhibitors of CYP3A, such as ketoconazole, erythromycin and diltiazem, and the apparent K(i) values for ketoconazole, erythromycin and diltiazem were 0.127, 94.2 and 29.6 microM, respectively. 3. CYP3A inhibitors increased plasma midazolam concentrations when midazolam and CYP3A inhibitors were co-administered orally. However, the pharmacokinetic parameters of midazolam were not changed by treatment with CYP3A inhibitors when midazolam was given intravenously. This suggests that CYP3A inhibitors modified the first-pass metabolism in the liver and/or intestine, but not systemic metabolism. 4. The drug-drug interaction responsible for CYP3A enzyme(s) inhibition was observed when midazolam and inhibitors were co-administrated orally. Therefore, it was concluded that monkeys given midazolam orally could be useful models for predicting drug-drug interactions in man based on CYP3A enzyme inhibition.

Factors influencing the sustained participation of farmers in participatory forestry: a case study in central Sal forests in Bangladesh

Wide acceptance of sustainable development as a concept and as the goal of forest management has shifted forest management policies from a traditional to a people-oriented approach. Consequently, with its multiple new objectives, forest management has become more complex and an information gap exits between what is known and what is utilized, which hinders the sustained participation of farmers. This gap arose mainly due to an interrupted flow of information. With participatory forestry, the information flow requires a broad approach that goes beyond the forest ecosystem and includes the different stakeholders. Thus in participatory forest management strategies, policymakers, planners and project designers need to incorporate all relevant information within the context of the dynamic interaction between stakeholders and the forest environment. They should understand the impact of factors such as management policies, economics and conflicts on the sustained participation of farmers. This study aimed to use primary cross-sectional data to identify the factors that might influence the sustained participation of farmers in participatory forestry. Using stratified random sampling, 581 participants were selected to take part in this study, and data were collected through a structured questionnaire by interviewing the selected participants. To identify the dominant factors necessary for the sustained participation of farmers, logistic regression analyses were performed. The following results were observed: (a) sustained participation is positively and significantly correlated with (i) satisfaction of the participants with the tree species planted on their plots; (ii) confidence of the participants that their aspired benefits will be received; (iii) provision of training on different aspects of participatory forestry; (iv) contribution of participants' money to Tree Farming Funds. (b) The sustained participation of farmers is negatively and significantly correlated with the disruption of local peoples' interests through implementation of participatory forestry programs, and long delays in the harvesting of trees after completion of the contractual agreement period.

Binding of Cu(II) or Zn(II) in a de novo designed triple-stranded alpha-helical coiled-coil toward a prototype for a metalloenzyme

We previously reported the IZ-3adH peptide, which formed a triple-stranded coiled-coil after binding Ni(II), Cu(II), or Zn(II). In this paper, we report the peptide, IZ-3aH, having a new metal binding specificity. The IZ-3aH peptide was found to bind Cu(II) and Zn(II) and form a triple-stranded coiled-coil. However, it did not bind Ni(II). Metal ion titrations monitored by circular dichroism revealed that the dissociation constants, K(d) were 9 microm for Zn(II) and 10 microm for Cu(II). The bound Cu(II) ion has a planar tetragonal geometry, where the coordination positions are three nitrogens of the His residues and one H(2)O.

[A case of liver metastases of breast cancer successfully treated by combination chemotherapy using hepatic arterial infusion of docetaxel and systemic administration of trastuzumab]

A 43-year-old woman underwent breast-conserving therapy for right breast cancer with multiple liver metastases (pT3N3aM1, stage IV, ER (-), PgR (-), HER2 (3+)), in November, 2002. Following surgery, she received combination chemotherapy using hepatic arterial infusion of docetaxel and systemic administration of trastuzumab weekly. During therapy, no serious side effects and only grade 1 nausea were observed; after 3 courses, therapy was safely continued on an outpatient basis. Metastatic liver tumors responded to the treatment, and they completely disappeared on an abdominal CT 5 months later. In addition, all elevated tumor markers in serum decreased to the normal range. No new metastatic or recurrent lesions were found 14 months after surgery. We conclude that this combination chemotherapy is safe and may be very useful for the treatment of breast cancer patients with liver metastasis.

Initial mercury evaporation from experimental Ag–Sn–Cu amalgams containing Pd

This study examined the Hg evaporation during setting from experimental Ag-Sn-Cu alloy powders with and without Pd. Four series of alloy powders were fabricated to examine the effect on the Hg evaporation of the alloy compositions (all percentages in this report are weight percents): Pd (0-1.5), Cu (9.0-14.0), Ag (57.0-63.7), and Sn (24.9-29.5). These variations in composition produced alloy powders with gamma-Ag3Sn to beta-AgSn ratios varying from 0.0 to 23.9. The total amounts of Hg released from 10 min after trituration were measured from cylindrical specimens (4 x 8mm; n = 4 ) at 37 degrees C using a Hg vapor analyzer. The results were compared to those from commercial alloys (one high-Cu and one low-Cu alloy). All amalgams made from alloys containing 1.5% Pd exhibited lower Hg vapor release than any other amalgams, with the exception of the low-Cu amalgam. The results clearly showed that the alloy formulation affected the mercury evaporation behavior during setting of the resultant amalgams. A small addition of Pd to the alloy can produce amalgams with 50-60% less Hg vapor release during setting than a leading commercial high-Cu amalgam, Tytin.

A randomized consent design trial of neoadjuvant chemotherapy with tegafur plus uracil (UFT) for gastric cancer--a single institute study

OBJECTIVE

Various forms of neoadjuvant chemotherapy (NAC) have been applied in the treatment of gastric cancer. The present study was designed to assess the survival benefits of NAC with UFT (tegafur plus uracil) for gastric cancer, as a randomized consent trial as described by Zelen.

PATIENTS AND METHODS

The present study included 295 patients with resectable gastic cancer between 1991 and 1999. After the patients had been pre-randomized into two groups, a control (no-NAC) group (n=120) and a treatment group (n=175), the treatment group patients were then further stratified into two groups, namely those who wished to join the control group and those who wished to receive NAC with UFT (NAC-UFT group). Patient outcome was surveyed in January 2003.

RESULTS

Randomization did not necessarily result in an appropriate registration of the patients, and ultimately 193 patients were included in the control group and 102 patients received NAC-UFT. The NAC-UFT was well tolerated by the patients and side-effects were not severe. However, the NAC-UFT group included the patients with significantly higher stages of cancers than the control group. The survival benefit of NAC-UFT was seen in stage 2 or 3 patients, and multivariate analysis also revealed that NAC-UFT was a significant prognostic variable, as were pT, pN, M and the level of nodal dissection, but patient age, gentler and histological grade were not significant variables.

CONCLUSION

NAC-UFT may be beneficial in the improvement of survival rate after gastric cancer surgery and this treatment modality is worthy of further study with a larger patient sample size.

PDX1 homeobox protein expression in pseudopyloric glands and gastric carcinomas

BACKGROUND AND AIMS

Although it has been reported that intestinal metaplasia implicated in gastric carcinogenesis is induced by the ParaHox gene CDX2, it is unclear which genes are responsible for the formation of pseudopyloric glands and whether they play a role in gastric carcinogenesis. Pancreatic-duodenal homeobox 1 (PDX1) is also a ParaHox gene which contributes to the genesis and development of the pancreas, duodenum, and antrum. To clarify its significance for the formation of pseudopyloric glands and gastric carcinogenesis, we investigated expression of PDX1 and mucin in gastric carcinomas and surrounding mucosa.

METHODS

Gastric carcinoma tissues from 95 patients were used for immunohistochemical analyses of PDX1, and mucins MUC6 and MUC5AC.

RESULTS

PDX1 was found to be frequently expressed in pseudopyloric glands and intestinal metaplasia. MUC6 was more abundant than MUC5AC in pseudopyloric glands while higher levels of MUC5AC than MUC6 were evident in intestinal metaplasia. The frequency of PDX1 positive reactivity was higher in differentiated type carcinomas (39/43, 90.7%) and T1 carcinomas (42/43, 97.7%) than in undifferentiated type (33/52, 63.5%) and T2-4 (30/52, 57.7%) carcinomas. PDX1 and MUC6 double positive expression was observed in carcinomas, respectively, including the corpus, and also correlated with histological type and depth of invasion. In contrast, no link was apparent between PDX1 and MUC5AC double positive reactivity and histological type.

CONCLUSION

Our study suggests that PDX1 plays an important role in the development of pseudopyloric glands, and that pseudopyloric glands may reflect a condition associated with gastric carcinogenesis.

Corrosion behavior of cast titanium with reduced surface reaction layer made by a face-coating method

This study characterized the corrosion behavior of cast CP titanium made with a face-coating method. Wax patterns were coated with oxide slurry of Y(2)O(3) or ZrO(2) before investing with a MgO-based investment. Three surface preparations were tested: ground, sandblasted, and as-cast. Uncoated castings served as controls. Sixteen-hour open circuit potential (OCP) measurement, linear polarization and potentiodynamic cathodic polarization were performed in an aerated modified Tani-Zucchi synthetic saliva at 37 degrees C. Anodic polarization was conducted in the same deaerated medium. Polarization resistance (R(p)) and Tafel slopes were determined. Corrosion current density was calculated for each specimen. Results (n=4) were subjected to nonparametric statistical analysis (alpha=0.05). Cross sections of cast specimens were examined by optical microscopy. Energy dispersive spectroscopy (EDS) spot analysis was performed at various depths below the surface. The OCP stabilized within several hours for all the specimens. Apparent differences in anodic polarization behavior were observed among the different surfaces. A distinctive wide passive region followed by breakdown was seen on specimens with ground and sandblasted surfaces. There were no significant differences in the corrosion resistance among the control and the two face-coating groups for each group. The Mann-Whitney test showed significantly lower OCP and higher R(p) values for ground surfaces. The surface condition significantly affected the corrosion behavior more than the face coating methods. In most cases, specimens with as-cast surfaces exhibited the least corrosion resistance during the potentiodynamic anodic polarization.

[Non-compromised grafting policy in off-pump coronary artery bypass]

BACKGROUND

The off-pump coronary artery bypass (OPCAB) has been prevalent around the world. However the most optimal selection of graft conduits has still been controversial.

METHODS

Between January 2002 and April 2003, 126 consecutive isolated coronary artery bypass procedures were attempted to performed without cardiopulmonary bypass. A mean age of the patients was 69.3 (47-90). Fifteen patients were operated on emergently and 16 were urgently, including 15 patients requiring preoperative intra-aortic balloon pumping (IABP). Five patients underwent reoperative coronary bypass.

RESULTS

All procedures were completed without cardiopulmonary bypass. The mean number of grafts per patient was 3.23 (range, 1 to 6). The skeletonized arterial conduits were aggressively used [117 left internal mammary artery (LIMA) to 155 sites, 70 right internal mammary artery (RIMA) to 79 sites, 57 right gastro-epiploic artery (RGEA) to 82 sites and 49 saphenous vein (SV) to 91 sites]. Cardiac-related hospital mortality was none. Angiographic assessment of grafts demonstrated that patency of LIMA, RIMA, RGEA and SV were 98.6%, 100%, 100%, and 97.6% respectively.

CONCLUSION

OPCAB with skeletonized in situ arterial conduits is secure and feasible.

Adhesive bonding of super-elastic titanium-nickel alloy castings with a phosphate metal conditioner and an acrylic adhesive

The purpose of the current study was to evaluate the bonding characteristics of super-elastic titanium-nickel (Ti-Ni) alloy castings. Disk specimens were cast from a Ti-Ni alloy (Ti-50.85Ni mol%) using an arc centrifugal casting machine. High-purity titanium and nickel specimens were also prepared as experimental references. The specimens were air-abraded with alumina, and bonded with an adhesive resin (Super-Bond C & B). A metal conditioner containing a phosphate monomer (Cesead II Opaque Primer) was also used for priming the specimens. Post-thermocycling average bond strengths (MPa) of the primed groups were 41.5 for Ti-Ni, 30.4 for Ti and 19.5 for Ni, whereas those of the unprimed groups were 21.6 for Ti, 19.3 for Ti-Ni and 9.3 for Ni. Application of the phosphate conditioner elevated the bond strengths of all alloy/metals (P < 0.05). X-ray fluorescence analysis revealed that nickel was attached to the debonded resin surface of the resin-to-nickel bonded specimen, indicating that corrosion of high-purity nickel occurred at the resin-nickel interface. Durable bonding to super-elastic Ti-Ni alloy castings can be achieved with a combination of a phosphate metal conditioner and a tri-n-butylborane-initiated adhesive resin.

Search for nu(e) from the sun at Super-Kamiokande-I

We present the results of a search for low energy nu(e) from the Sun using 1496 days of data from Super-Kamiokande-I. We observe no significant excess of events and set an upper limit for the conversion probability to nu(e) of the 8B solar neutrino. This conversion limit is 0.8% (90% C.L.) of the standard solar model's neutrino flux for total energy=8-20 MeV. We also set a flux limit for monochromatic nu(e) for E(nu(e))=10-17 MeV.