Postoperative host responses in elderly patients after gastrointestinal surgery

BACKGROUND/AIMS

The age-associated dysregulation of hemodynamic, metabolic and immune responses contributes to the high incidence of complications after major abdominal surgery.

METHODOLOGY

Ninety-five patients who underwent gastric resection (n=51) and colorectal resection (n=44) were divided according to age into Groups A (n=45, less than 70 years old), B (n=30, 70-79 years) and C (n=20, over 80 years). Flow cytometric analysis of CD4+ lymphocytes for interferon (IFN)-gamma and interleukin (IL)-4 production determined the Th1/2 balance. Energy expenditure was measured by indirect calorimetry, and hemodynamics were studied using pulse dye densitometry.

RESULTS

Surgical procedures, operating time, blood loss and morbidity did not significantly differ among the three groups. The cardiac index (CI) in group A and B increased significantly over preoperative levels until POD 3, but there were no significant perioperative changes in the CI levels of group C. Resting energy expenditure levels changed similarly to those of CI. The postoperative Th1/2 ratio decreased from young to elderly to very elderly patients, although no differences were significant before surgery. The postoperative percentage of CD4+IFN-gamma +T cells (Th1) in group C decreased significantly despite of no significant changes in that of group A and B. In contrast, the ratio of CD4+IL-4+T cells (Th2) in the all groups significantly increased after surgery.

CONCLUSIONS

Host responses in elderly patients after major abdominal surgery were more hyperdynamic and hypermetabolic than those of young patients. Postoperative dysregulation of the Th1/2 balance was also associated with aging. However, host responses appear to significantly differ between elderly and very elderly patients.

Costs and benefits of laparoscopic cholecystectomy: abdominal wall lifting vs. pneumoperitoneum procedure

BACKGROUND/AIMS

Gasless laparoscopic surgery using the abdominal wall lifting (AWL) method was first developed in Japan and has been used in various surgical fields. The AWL method allows the use of conventional reusable surgical instruments. The purpose of this study was to compare the cost-effectiveness of laparoscopic cholecystectomy (LSC) using the AWL method in relation to that using pneumoperitoneum (P) method.

METHODOLOGY

Retrospective analysis of 431 LSC procedures between 1991 and 2004 was performed. The two surgical groups consisted of consecutively operated patients with a diagnosis of cholecystolithiasis or gallbladder polyps. One group consisted of 224 LSC procedures performed using the P method from 1992 to 1998 and the other group comprised 207 LSC performed using the AWL method from 1998 to 2004. All instruments used in the P method were disposable, whereas trocars, scissors, dissectors, graspers and L-hook electrodes (excluding clips) used in the AWL method were reusable. Hospital expenses, length of hospital admission and complication rates were analyzed.

RESULTS

Mean hospital cost per case for LSC using the AWL method (dollars 6743) was 7% less expensive than that using the P method (dolars 7215). Costs of operative equipment contributed to the difference (mean dollars 912 per case) in total cost. Conversion to open cholecystectomy occurred in 6 cases (2.9%) using the AWL method and 7 cases (3.1%) using the P method. There were no significant differences in length of hospital admission or complication rates between the two groups.

CONCLUSIONS

LSC using AWL method was less expensive than that using P method. This is mainly due to the use of reusable instruments in the AWL method. If LSC is performed using the AWL method instead of using disposable equipment, considerable savings can be achieved without compromising patient safety.

Inducible virus-mediated expression of a foreign protein in suspension-cultured plant cells

Although suspension-cultured plant cells have many potential merits as sources of useful proteins, the lack of an efficient expression system has prevented using this approach. In this study, we established an inducible tomato mosaic virus (ToMV) infection system in tobacco BY-2 suspension-cultured cells to inducibly and efficiently produce a foreign protein. In this system, a modified ToMV encoding a foreign protein as replacement of the coat protein is expressed from stably transformed cDNA under the control of an estrogen-inducible promoter in transgenic BY-2 cells. Estrogen added to the culture activates an estrogen-inducible transactivator expressed constitutively from the transgene and induces transcription and replication of viral RNA. In our experiments, accumulation of viral RNA and expression of green fluorescent protein (GFP) encoded in the virus were observed within 24 h after induction. The amount of GFP reached approximately 10% of total soluble protein 4 d after induction. In contrast, neither viral RNA nor GFP were detected in uninduced cells. The inducible virus infection system established here should be utilized not only for the expression of foreign proteins, but also for investigations into the viral replication process in cultured plant cells.

Overexpression of p16 INK4a as an indicator for human papillomavirus oncogenic activity in cervical squamous neoplasia

Overexpression of p16(INK4a) has been observed when retinoblastoma protein is inactivated by high-risk human papillomavirus (HPV) oncoprotein E7. We investigated overexpression of p16(INK4a) and HPV infection in cervical squamous neoplasia to evaluate the oncogenic potential among various HPV subtypes. The high-risk HPV was detected by PCR in 69.8% (37/53), 97.5% (39/40), 91.7% (44/48), and 100% (16/16) of cervical intraepithelial neoplasia (CIN)1, CIN2, CIN3, and squamous cell carcinoma (SCC), respectively. The p16(INK4a) overexpression was investigated immunohistochemically using a p16(INK4a)-specific monoclonal antibody (clone E6H4). In high-risk HPV positive cases, 32.4% (12/37) of CIN1, 82.1% (32/39) of CIN2, 93.2% (41/44) of CIN3, and all (16/16) SCC showed p16(INK4a) overexpression. The incidence of p16(INK4a) overexpression was significantly different between CIN1 and CIN2, suggesting that the disorder of cell cycle regulation by HPV frequently occurred from CIN2. As for CIN1 cases, p16(INK4a) overexpression was observed more frequently in HPV16 and HPV52 than in HPV51 and HPV35. Using p16(INK4a) as a bio marker of HPV oncogenic activity, we demonstrate that the level of pRb dysfunction by high-risk HPV varied from subtypes and was getting more frequent from CIN2.

Prostate cancer incidence varies among males from different Y-chromosome lineages

The incidence rate of prostate cancer in African-American males is two times higher than Caucasian men and ten times higher than Japanese men. The geographical specificity of Y haplogroups implies that males from different ethnic groups undoubtedly have various Y lineages with different Y-chromosomal characteristics that may affect their susceptibility or resistance to such a male-specific cancer. To confirm this hypothesis we studied the Y-chromosomal haplogroups of 92 Japanese prostate cancer patients comparing them with randomly selected 109 unrelated healthy Japanese male controls who were confirmed to be residents of the same geographical area. Males could be classified using three binary Y-chromosome markers (sex-determining region Y (SRY), YAP, 47z) into four haplogroups DE, O2b(*), O2b1, and untagged group. Our results confirmed that prostate cancer incidence varies among males from different Y-chromosome lineages. Males from DE and the untagged haplogroups are at a significantly higher risk to develop prostate cancer than O2b(*) and O2b1 haplogroups (P=0.01), odds ratio 2.17 and 95% confidence interval (1.16-4.07). Males from haplogroup DE are over-represented in the patient group showing a percentage of 41.3%. The underlying possible causes of susceptibility variations of different Y lineages for such a male-specific cancer tumorigenesis are discussed. These findings explain the lower incidence of prostate cancer in Japanese and other South East Asian males than other populations. To our knowledge, this is the first reliable study examining the association between prostate cancer and Y-chromosomal haplogroups, comparing prostate cancer patients with carefully selected matched controls.

Changes in the soleus muscle architecture after exhausting stretch-shortening cycle exercise in humans

This study focused on the architectural changes in the muscle-tendon complex during the immediate and secondary (delayed) reductions of performance (bimodal recovery) caused by an exhaustive rebound type stretch-shortening cycle (SSC) exercise. The isometric plantar flexor torque during maximum voluntary contraction (MVC) was measured together with recording of electromyography (EMG) and ultrasonography from the soleus muscle before (BEF), after (AFT), 2 h (2H), 2 and 8 days (2D, 8D) after the SSC exercise (n=8). The performance variables (MVC torque and EMG activation) followed the bimodal recovery patterns. This was not the case in the changes of the fascicle length and muscle thickness. The relative torque changes in MVC correlated positively (R=0.78, P=0.02) to the corresponding averaged EMG changes between BEF and 2H (BEF-->2H); the significance disappeared in the comparison between 2H and 2D (2H-->2D), during which period MVC showed a secondary reduction. The relative torque changes in MVC showed no correlation with the changes in muscle thickness between BEF-2H. However, this correlation between 2H-2D was negative (R=-0.85, P<0.01). The fascicle shortening/average EMG ratio in MVC increased at 2H, and then decreased more at 2D than 2H (P<0.05). Thus, the secondary performance decline was not related to the corresponding EMG reduction but to the increased muscle thickness, which peaked at 2D. The results suggest clearly that the secondary decline in MVC could be related to the increase in muscle volume.

Involvement of brain protein kinase C in nitrous oxide-induced antinociception in mice

Exposure of mice to the anesthetic gas nitrous oxide (N(2)O) produces a marked antinociceptive effect. Protein kinase C is a key regulatory enzyme that may be targeted by general anesthetics. However, a relationship between N(2)O-induced antinociception and protein kinase C has yet to be established. The present study was conducted to identify whether protein kinase C might influence N(2)O-induced antinociception in mice. Regular exposure (11 min) to N(2)O produced concentration-dependent antinociception in mice, as determined using the abdominal constriction test. N(2)O-induced antinociception was attenuated by i.c.v. pretreatment with phorbol 12,13-dibutyrate, a protein kinase C activator. This phorbol 12,13-dibutyrate antagonism of N(2)O-induced antinociception was reversed by i.c.v. pretreatment with calphostin C, a protein kinase C inhibitor. Long-term exposure (41 min in total, including 30 min prior to, and 11 min of analgesic testing) to 70% N(2)O produced reduced analgesic effects, compared with regular exposure to 70% N(2)O, thus indicating acute tolerance to N(2)O-induced antinociception. However, mice pretreated with calphostin C, chelerythrine, which is another protein kinase C inhibitor, and phorbol 12,13-dibutyrate, did not develop acute tolerance. Regarding activation of protein kinase C, regular exposure to 70% N(2)O did not increase protein kinase C within the membrane fraction of brain tissue, as determined by immunoblot analysis, but long-term exposure to 70% N(2)O did. The i.c.v. pretreatment with calphostin C and phorbol 12,13-dibutyrate prevented the increase in protein kinase C observed with long-term exposure to 70% N(2)O. These results suggest that brain protein kinase C negatively regulates the antinociceptive effect of N(2)O, and that activation of brain protein kinase C is related to the development of acute tolerance to N(2)O-induced antinociception in mice.

Postoperative metabolic and circulatory responses in patients that express SIRS after major digestive surgery

BACKGROUND/AIMS

Systemic inflammatory response syndrome (SIRS) includes a number of pathologic states because of its loose definition. This study assessed differences in metabolic and circulatory host responses in various patients with SIRS perioperatively.

METHODOLOGY

Fifty-four patients who underwent abdominal surgeries [gastric resection (n=20), colorectal resection (n=24), hepatic resection (n=8)] were divided into two groups: Group A; SIRS (+) on 1 postoperative day (POD), (n=29), B; SIRS (-) on 1 POD, (n=25). The other eight non-operated patients with SIRS caused by infection were enrolled in Group C, as common SIRS. Indirect calorimetry, body impedance measurement to assess water compartments and pulse dye-densitometry for hemodynamic examination were performed in subjects until 14 POD.

RESULTS

The ratio of energy expenditure to basal energy expenditure (%REE) was significantly increased postoperatively, and there were significant differences on %REE from 3 POD to 14 POD between groups A and B. However, %REE in group C was 162+/-23%, which was significantly increased compared with that at 1 POD of groups A (130 +/- 17%) and B (125+/-18%). Cardiac output in group A showed a significant increase until 3 POD compared with that in group B but was significantly lower than that in group C.

CONCLUSIONS

Subjects with common SIRS caused by infection were significantly more hypermetabolic than subjects with postoperative SIRS. Adequate energy intake and circulatory management should be cautiously determined according to the severity of SIRS.

Snare-assisted Trans-brachial Stenting for the Cervical Internal Carotid Artery Stenosis of Patient with Aorto-Iliac Occlusion. Technical Case Report

SUMMARY

We describe a case of endo-luminal stent placement with Snare-assist for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the brachial artery. A 68-year-old man with known disease of the carotid, peripheral, and coronary arteries, with Human T-cell Lymphotrophic Virus type-1 (HTLV-1) Associated Myelopathy (HAM) presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis, but with aorto-iliac occlusion. Transfemoral access was complicated by an aorto-iliac occlusion. A trans-brachial approach was successfully attempted, and a SMARTer stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 7-French Shuttle-SL guide sheath (Cook, Bloomington) under Snare-assist. The trans-brachial approach is becoming an increasingly viable alternative route for stent placement in patients with contra-indicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the trans-brachial route will be used with increasing frequency in the select patient population for stenting of both the cervical and intracranial circulation.

Lead isotope ratios in urban road runoff

Lead isotopic analyses of road runoff and airborne particulate matter have been carried out to elucidate sources of lead pollution at urban and suburban sites. While lead is often observed in road runoff in suspended form, suspended particle size had no relation to the lead isotopic distribution, as a result of comparison between runoff samples with total suspended solids and those with minute particles passed through a 75 microm sieve. Lead isotope ratios in airborne particulate matter in urban areas fell within a wider range than those in road runoff. Since there was little difference of the ratios between a heavy traffic-flow site and residential sites, airborne lead derived from vehicle exhaust was found to make little contribution to the contamination of road runoff. On the other hand, the ratios in road runoff at a suburban site showed the same range as those at an urban site. Lead in road runoff was therefore suggested to be produced on site by traffic related substances, such as tire wear, other than vehicle exhaust.

Successive changes in tissue migration capacity of developing larvae of an intestinal nematode, Strongyloides venezuelensis

Infective larvae of an intestinal nematode, Strongyloides venezuelensis, enter rodent hosts percutaneously, and migrate through connective tissues and lungs. Then they arrive at the small intestine, where they reach maturity. It is not known how S. venezuelensis larvae develop during tissue migration. Here we demonstrate that tissue invasion ability of S. venezuelensis larvae changes drastically during tissue migration, and that the changes are associated with stage-specific protein expression. Infective larvae, connective tissue larvae, lung larvae, and mucosal larvae were used to infect mice by various infection methods, including percutaneous, subcutaneous, oral, and intraduodenal inoculation. Among different migration stages, only infective larvae penetrated mouse skin. Larvae, once inside the host, quickly lost skin penetration ability, which was associated with the disappearance of an infective larva-specific metalloprotease. Migrating larvae had connective tissue migration ability until in the lungs, where larvae became able to settle down in the intestinal mucosa. Lung larvae and mucosal larvae were capable of producing and secreting adhesion molecules.

Malignant mixed mullerian tumor of primary mesenteric origin

Malignant mixed müllerian tumor (MMMT) is a rare tumor. A literature search revealed very few reports on MMMT, especially those arising in the peritoneum. We recently encountered an MMMT of primary mesenteric origin associated with left fallopian tube cancer. There have been no previous reports about its occurrence in the mesentery. When cases of peritoneal MMMT were reviewed, the disease was found to be associated with synchronous or metachronous gynecologic tumors of müllerian duct origin (ie, ovarian tumors, primary serous carcinoma of the peritoneum, fallopian tube cancer, endometrial cancer, and adenocarcinoma of the cervix) in 12 out of 32 patients (37.5%). Peritoneal MMMT are frequently associated with gynecologic tumors.

Development of real-time thermal neutron monitor using boron-loaded plastic scintillator with optical fiber for boron neutron capture therapy

A new thermal neutron monitor for boron neutron capture therapy was developed in this study. We called this monitor equipped boron-loaded plastic scintillator that uses optical fiber for signal transmission as an [scintillator with optical fiber] SOF detector. A water phantom experiment was performed to verify how the SOF detector compared with conventional method of measuring thermal neutron fluence. Measurements with a single SOF detector yielded indistinguishable signals for thermal neutrons and gamma rays. To account for the gamma ray contribution in the signal recorded by the SOF detector, a paired SOF detector system was employed. This was composed of an SOF detector with boron-loaded scintillator and an SOF detector with a boron-free scintillator. The difference between the recorded counts of these paired SOF detectors was used as the measure of the gamma ray contribution in the measured neutron fluence. The paired SOF detectors were ascertained to be effective in measuring thermal neutron flux in the range above 10(6)(n/cm(2)/s). Clinical trials using paired SOF to measure thermal neutron flux during therapy confirmed that paired SOF detectors were effective as a real-time thermal neutron flux monitor.

[Traumatic rupture of the ascending aorta]

A 42-year-old male was diagnosed as having a traumatic rupture of the ascending aorta 24 hours after traffic accident. On admission, the patient was in a state of shock, but he was successfully treated by emergency surgery. Traumatic rupture of the ascending aorta is a serious condition and the mortality may be very high. Although physicians rarely encounter patients with this condition, it is relatively common among autopsy cases with multiple trauma. Urgent diagnosis and treatment are mandatory.

Replica multichannel polymer chips with a network of sacrificial channels sealed by adhesive printing method

Replica microchips for capillary array electrophoresis containing 10 separation channels (50 microm width, 50 microm depth and 100 microm pitch) and a network of sacrificial channels (100 microm width and 50 microm depth) were successfully fabricated on a poly(methyl methacrylate) (PMMA) substrate by injection molding. The strategy involved development of moving mask deep X-ray lithography to fabricate an array of channels with inclined channel sidewalls. A slight inclination of channel sidewalls, which can not be fabricated by conventional deep X-ray lithography, is highly required to ensure the release of replicated polymer chips from a mold. Moreover, the sealing of molded PMMA multichannel chips with a PMMA cover film was achieved by a novel bonding technique involving adhesive printing and a network of sacrificial channels. An adhesive printing process enables us to precisely control the thickness of an adhesive layer, and a network of sacrificial channels makes it possible to remove air bubbles and an excess adhesive, which are crucial to achieving perfect sealing of replica PMMA chips with well-defined channel and injection structures. A CCD camera equipped with an image intensifier was used to simultaneously monitor electrophoretic separations in ten micro-channels with laser-induced fluorescence detection. High-speed and high-throughput separations of a 100 bp DNA ladder and phi X174 Hae III DNA restriction fragments have been demonstrated using a 10-channel PMMA chip. The current work establishes the feasibility of mass production of PMMA multichannel chips at a cost-effective basis.

Interaction between fascicle and tendinous tissues in short-contact stretch-shortening cycle exercise with varying eccentric intensities

The interaction between fascicle and tendinous tissues (TT) in short-contact drop jumps (DJ) with three different drop heights [low (Low), optimal (OP), and high (High)] was examined with 11 subjects. The ground reaction force (F(z)) and ankle and knee joint angles were measured together with real-time ultrasonography (fascicle length) and electromyographic activities of the medial gastrocnemius (MG) and vastus lateralis (VL) muscles during the movement. With increasing drop height, the braking force and flight time increased from Low to OP (P < 0.05). In High, the braking force increased but the flight time decreased compared with OP (P < 0.05). During contact of Low and OP conditions, the length of muscle-tendon unit and TT underwent lengthening before shortening in both MG and VL muscles. However, the two muscles differed in the fascicle behaviors. The MG fascicles behaved isometrically or shortened, and the VL fascicles underwent lengthening before shortening during contact. In High, the TT lengthening in both muscles decreased compared with OP (P < 0.05). The rapid stretch occurred in the MG fascicles but not in VL fascicles during the braking phase. The elastic recoil ratio decreased in both muscles with increasing the intensity during DJ. These findings demonstrated that TT underwent lengthening before shortening during DJ. However, the efficacy of elastic recoil decreased with increasing the drop intensity. The effective catapult action in TT can be limited by the drop intensity. In addition, the measured muscles behaved differently during DJ, providing evidence that each muscle may have a specific means of fascicle-TT interaction.

A pilot study of weekly docetaxel therapy for recurrent ovarian cancer, tubal cancer, and primary peritoneal cancer

We investigated the efficacy and toxicity of salvage chemotherapy with weekly docetaxel for recurrent ovarian cancer, tubal cancer, and primary peritoneal cancer after treatment with regimens containing platinum or paclitaxel. The 15 subjects were managed as outpatients and received at least two courses of docetaxel therapy (35 mg/m2 on days 1, 8 and 15). Antitumour activity was assessed radiologically and from the CA-125 level. Among five patients with measurable lesions, one showed partial remission and three showed stable disease. Based on CA-125 levels, there were three partial remissions and five patients with stable disease (progression-free survival was 7.5 months and 7.6 months, respectively). During 61 courses, the severe toxicities were grade 3 leukopaenia/neutropaenia (6.7%) or grade 2 oedema and pleural effusion (13.3%). Weekly docetaxel may be useful salvage chemotherapy for recurrent ovarian cancer, tubal cancer, and peritoneal cancer, especially as tumour dormancy therapy.

A stylized computational model of the head for the reference Japanese male

Computational models of human anatomy, along with Monte Carlo radiation transport simulations, have been used by Snyder et al. [MIRD Pamphlet No. 5, revised (The Society of Nuclear Medicine, New York, 1978)], Cristy and Eckerman [ORNL/TM-8381/VI, Oak Ridge National Laboratory, Oak Ridge, TN (1987)] and Zubal et al. [Med. Phys. 21, 299-302 (1994)] to estimate internal organ doses from internal and external radiation sources. These were created using physiological data from Caucasoid subjects but not from other races. There is a need for research to determine whether the obvious differences from the Caucasoid anatomy make these models unsuitable for estimating the absorbed dose in other races such as the Mongoloid. We used the cranial region of the adult Japanese male to represent the Mongoloid race. This region contains organs that are highly sensitive to radiation. The cranial region of a physical phantom produced by KYOTO KAGAKU Co., LTD. using numerical data from a Japanese Reference Man [Tanaka, Nippon Acta. Radiol. 48, 509-513 (1988)] was used to supply the data for the geometry of a stylized computational model. Our computational model was constructed with equations rather than voxel-based, in order to deal with as small a number of parameters as possible in the computer simulation experiment. The accuracy of our computational model was checked by comparing simulated experimental results obtained with MCNP4C with actual doses measured with thermoluminescence dosimeters (TLDs) inside the physical phantom from which our computational model was constructed. The TLDs, whose margin of error is less than +/-10%, were arranged at six positions. Co-60 was used as the radiation source. The irradiated dose was 2 Gy in terms of air kerma. In the computer simulation experiments, we used our computational model and Cristy's computational model, whose component data are those of the tissue substitute materials and of the human body as published in ICRU Report 46. The observed absorbed dose values (Gy) at all six points were calculated as the percentage difference between MCNP4C simulation and the TLDs. In our computational model, the average values of all the percentage differences were 6.0+/-4.0% (tissue substitute materials) and 7.6+/-6.6% (ICRU Report 46), respectively. In Cristy's model, the corresponding values were 20.4+/-3.8% (tissue substitute materials) and 21.0+/-4.1% (ICRU Report 46), respectively. Considering the margin of error in the radiation sensitivity of the TLDs, this study validates our computational model as a test object for radiation dosimetry studies.

Hepatic resection leads to predominance of the T helper-2 lymphocyte phenotype

Recent studies have shown that the type 1/2 T helper (Th1/2) cell balance is shifted toward a Th2-type immune response not only by malignancy but also by surgical stress. This study evaluates in immune responses to surgical stress from liver surgery in comparison with other major abdominal surgeries. PATIENTS AND METHODS:: Eighty-five patients who underwent abdominal surgeries were divided into three groups: hepatic resection (n = 17), gastric resection (n = 38), and colorectal resection (n = 30). Blood sampling was performed before surgery, and on postoperative days (POD) 2 and 14. Cell surface markers were used to characterize Th1/2 balance by flow cytometry and a ratio of the percent IFN-gamma-producing (Th1) cells to IL-4-producing (Th2) cells were expressed as the Th1/2 balance. RESULTS:: The postoperative ratio of Th1 to Th2 was decreased significantly in all subjects to 4.5 +/- 3.0 on POD 2 from 6.7 +/- 4.2. The ratio of Th1 to Th2 in patients who underwent hepatic resection markedly decreased to 2.8 +/- 1.6 on POD 2, significantly different from those in patients undergoing gastric resection or colorectal resection. However, on POD 14 there were no longer any significant differences among the three surgical groups. CONCLUSIONS:: This study shows that hepatic resection induces a more marked shift of the Th1/2 balance toward Th2 than other major abdominal surgeries.

Hepatic resection induces a shift in the Th 1/2 balance toward Th 2 and produces hypermetabolic and hyperhemodynamic states

BACKGROUND/AIMS

Recent studies have shown that the type 1/2 T-helper (Th 1/2) cell balance is shifted toward a Th 2-type immune response not only by malignancy but also by surgical stress. The present study evaluated surgical stress as a result of liver surgery in comparison with that of other major abdominal surgeries. Immune, metabolic and circulatory responses to surgery were measured for determination of surgical stress.

METHODOLOGY

Eighty-five patients who underwent abdominal surgeries were divided into three groups: hepatic resection (n=17), gastric resection (n=38), colorectal resection (n= 30). Blood sampling was performed before surgery, and on postoperative days (POD) 2 and 14. The Th 1/2 helper T cell balance was determined by flow cytometric analysis of interferon-gamma and interleukin-4 expression. Energy expenditure was measured by indirect calorimetry, and hemodynamics was studied using pulse dye densitometry until POD 14.

RESULTS

Following surgery Th 1/2 ratios decreased significantly. Additionally, the Th 1/2 balance in patients with hepatic resection on POD 2 was significantly lower than that of patients with other major surgeries. However, on POD 14 there were no significant differences among the three groups. Resting energy expenditure and cardiac index on postoperative days 1 and 3 in patients with hepatic resection increased significantly above levels in the other surgical groups. Conversely, blood volume in the hepatic resection patients was significantly lower than that of other patients until POD 3. Ten patients who developed postoperative complications had significantly lower Th 1/2 ratios and more hypermetabolism.

CONCLUSIONS

This study reveals that hepatic resection induces a more marked shift toward a Th 2 helper T cell response and significantly more hypermetabolism than other major surgeries. A distinct pattern of Th 1/2 ratio changes during the early phase of the postoperative course in hepatic resection may be related to changes in metabolism and circulation. Therefore, determination of Th 1/2 balance may be of help in evaluating different surgical procedures, and management of energy intake and circulatory management may be cautiously determined based on the shift in Th 1/2 balance.

A new automatic device for measuring the spinnbarkeit of saliva: the Neva Meter

OBJECTIVES

We have recently developed a new device for measuring the spinnbarkeit of saliva called the Neva Meter. The purpose of this study was to evaluate this device and to measure spinnbarkeit as well as viscosity, another important property, in the resting saliva of 24 healthy adults.

METHODS

We used polyvinyl alcohol (PVA) as a standard solution to establish the reproducibility of spinnbarkeit tests. We collected resting saliva from 24 employees of a business office (16 males and 8 females, average age: 37.8) and investigated the relationship between spinnbarkeit and viscosity.

RESULTS

The spinnbarkeit of PVA increased along with the concentration of the solution, and the reproducibility of the values was acceptable. Spinnbarkeit of resting saliva showed a positive correlation with viscosity at a shear rate of 76.6 s(-1) (r = 0.55, P < 0.05) and 191.5 s(-1) (r = 0.59, p < 0.05).

CONCLUSIONS

The newly developed Neva Meter was suitable for measuring the spinnbarkeit of saliva quickly and easily at the chair-side in the dental clinic. Results obtained using this new device may be important for understanding and evaluating the condition of the oral cavity.

Microarray analysis of brassinosteroids- and gibberellin-regulated gene expression in rice seedlings

In order to understand the molecular mechanisms by which two types of phytohormones, brassinosteroids (BRs) and gibberellins (GAs), regulate plant growth and development, a cDNA microarray was made containing 4000 clones randomly selected from a rice cDNA library constructed from RNA isolated from seedlings treated with GA(3) and brassinolide (BL). The array was then probed to identify differences in expression using labelled cDNAs prepared from treated and control seedlings. Nine and 29 unique cDNA clones were up-regulated, while 32 and 42 unique cDNA clones were down-regulated by BL and GA(3), respectively. The predicted products of these BL- and GA-regulated genes fall into such functional categories as signal transduction, transcription, metabolism, cellular organization, and defense or anti-stress responses. Northern analysis of the selected BL- and GA(3)-regulated genes not only confirmed their BL or GA(3) dose dependent expression, but also revealed significant differences in the degree of expression in different organs and in response to other phytohormones. These results demonstrate that BR and GA influence growth and development by coordinately regulating the expression of specific groups of genes.

Chemiluminescent analysis of the antioxidant and immunomodulation effects of several psychotropic drugs on peritoneal macrophages

The present study describes the application of several chemiluminescent (CL) methods for evaluation of antioxidant and immunomodulation effects of psychotropic drugs upon phagocytes: KO2-induced luminal-dependent CL for detection of superoxide anion radicals in a pure chemical system; PMA- and A23187-induced CL of peritoneal macrophages for detection of free radicals in cell suspension; and CL, produced by the luciferase-catalyzed luciferin + ATP reaction, for evaluation of cell viability before and after drug application. These methods provide also a way to investigate the location of drug action. It was found that the psychotropic drugs in fluence the 'oxidative burst' of macrophages through two mechanisms: by expression of drug antioxidant properties and/or by a direct immunomodulation effect.

Microdosimetry of neutron field for boron neutron capture therapy at Kyoto university reactor

Microdosimetric single event spectrum in a human body simulated by an acrylic phantom has been measured for the clinical BNCT field at the Kyoto University Reactor (KUR). The recoil particles resulting from the initial reaction and subsequent interactions, namely protons, electrons, alpha particles and carbon nuclei are identified in the microdosimetric spectrum. The relative contributions to the neutron dose from proton, alpha particles and carbon are estimated to be about 0.9, 0.07 and 0.3, respectively, four depths between 5 and 41 mm. We estimate that the dose averaged lineal energy, yD decreased with depth from 64 to 46 keV microm(-1). Relative biological effectiveness (RBE) of this neutron field using a response function for the microdosimetric spectrum was estimated to decrease from 3.6 to 2.9 with increasing depth.

Longevity-associated mitochondrial DNA 5178 A/C polymorphism and blood pressure in the Japanese population

It has been reported that the mitochondrial DNA 5178 adenine/cytosine (mt5178 A/C) polymorphism, also called NADH dehydrogenase subunit 2-237 methionine/leucine (ND2-237 Met/Leu) polymorphism, may be associated with longevity in Japanese individuals, and that the mt5178A genotype may have an antiatherogenic influence. To determine whether mt5178 A/C polymorphism influences blood pressure, we genotyped 412 healthy Japanese individuals and performed a cross-sectional study investigating the relationship between genotype and blood pressure. In women with mt5178A, the mean diastolic blood pressure was higher than in those with mt5178C by 3.2 mmHg (P=0.040). In men, no statistically significant difference in systolic or diastolic blood pressure was observed between mt5178 A/C genotypes. However, a significant correlation between mt5178 A/C genotypes and the effects of habitual drinking on blood pressure was found. After adjustment for several factors, in men carrying mt5178C, both systolic and diastolic blood pressure were significantly higher in daily drinkers than in occasional (P=0.002 and 0.002, respectively) as well as nondrinkers (P<0.001 and 0.001, respectively), whereas in men carrying mt5178A, no significant differences in blood pressure were detected, irrespective of alcohol consumption. These results suggest that mt5178 A/C (=ND2-237 Met/Leu) polymorphism may influence both diastolic blood pressure in Japanese women and the blood-pressure-increasing effect of drinking in Japanese men.

Residual contrast medium in the cortex of the kidney around an infected renal cyst on CT: case report

We present a case of a patient with an infected renal cyst. Delayed computed tomography showed residual contrast medium in the cortex of the kidney around it. Delayed computed tomography might be useful to identify an infected renal cyst.

Method for stretching DNA molecules on mica surface in one direction for AFM imaging

An efficient method was developed to stretch DNA molecules on an atomically flat surface for AFM imaging. This method involves anchoring DNA molecules from their 5' ends to amino silanized mica surfaces. N-Succinimidyl6-[3'-(2-pyridyldithio) propionamido]hexanoate (LC-SPDP), a heterobifunctional cross-linker with a flexible spacer arm was used for this purpose. The immobilization process was carried out by introducing a thiol group to the 5' end of DNA by PCR. Thiolated molecules were then reacted with the cross linker to conjugate with its 2-pyridyl disulphide group via sulfhydryl exchange. The resulting complex was deposited on amino silanized mica where NHS-ester moiety of the cross linker reacted with the primary amino group on the surface. Samples were washed by a current of water and dried by an air jet in one direction parallel to the surface. DNA molecules were shown to be fully stretched in one direction on imaging them by AFM.

RecA-double stranded DNA complexes studied by atomic force microscopy

RecA-double stranded (ds) DNA complexes have been studied by atomic force microscopy (AFM). When the complexes were prepared in the presence of ATP gamma S, fully covered RecA-dsDNA filaments were observed by AFM. When the concentration of RecA proteins was lower, various lengths of filaments were found. The variation of the observed structures may directly reflect the real distribution of the intermediate complexes in the reaction mixture, as the mixture was simply deposited on a mica surface for AFM observation without special fixation or staining. The use of a carbon nanotube (CNT) AFM tip enabled high resolution to reveal the periodicity of RecA-dsDNA filaments. Our observations demonstrated the potential of the AFM method for the structural studies of the RecA-dsDNA complexes, especially their intermediate states.

Long-term body weight variability is associated with elevated C-reactive protein independent of current body mass index among Japanese men

OBJECTIVE

To elucidate the effect of long-term weight variability on C-reactive protein (CRP) levels.

DESIGN

Cross-sectional study of the circulating CRP.

SUBJECTS

A total of 637 Japanese men aged 40-49 y in1997.

MEASUREMENTS

Serum CRP levels, body mass index in 1997 (current BMI), the slope of weight on age (weight-slope) representing an individual's weight trend of direction and magnitude, and the root mean square error around the slope of weight on age (weight-RMSE) representing the weight fluctuation magnitude, as calculated by a simple linear regression model in which each value of the subject's five actual weights (aged 20, 25, 30 y, five years ago, and current) was a dependent variable and the subject's ages independent variables.

RESULTS

After adjustment for age and confounders, including smoking and health status, the odds ratios of elevated CRP (> or =0.06 mg/dl) were 1.83 (95% CI: 1.25-2.69), 2.63 (1.69-4.11), and 10.31 (2.17-48.98) for upper normal-weight (BMI: 22-<25 kg/m(2)), overweight (25-<30), and obese (> or =30) persons, respectively, compared with lower normal-weight persons (18.5-<22). Adjusting for age, confounders, and current BMI, weight-slope was positively associated with CRP level especially among subjects with BMI> or =25 kg/m(2) (trend P<0.01), and weight-RMSE was positively associated with CRP level particularly among subjects with BMI <25 kg/m(2) (trend P<0.05).

CONCLUSION

Our results suggest a state of low-grade systemic inflammation not only in overweight and obese persons, but also in normal-weight persons with large weight fluctuation, possibly explaining in part the positive association between weight fluctuation and CVD.