A case of gallbladder carcinoma diagnosed preoperatively by the detection of human telomerase reverse transcriptase mRNA in endoscopically obtained gallbladder bile

It is difficult to accurately diagnose the nature of polypoid lesions in the gallbladder. To increase diagnostic accuracy, we have developed an endoscopic technique for obtaining gallbladder bile, termed endoscopic transpapillary catheterization into the gallbladder (ETCG). We describe here a case of gallbladder carcinoma diagnosed preoperatively by the detection of human telomerase reverse transcriptase (hTERT) mRNA, a catalytic subunit of telomerase, in gallbladder bile obtained using the ETCG technique. A patient with a polypoid lesion 15 mm in diameter in the gallbladder was admitted to our hospital for further examinations. Gallbladder bile collected by the ETCG technique was evaluated cytologically and also analyzed for telomerase activity and hTERT mRNA. Although the results for cytology and telomerase activity were negative, that for hTERT mRNA was positive. Open surgery was carried out and it was confirmed that the lesion was an adenocarcinoma invading the subserosa. The molecular biological analysis of gallbladder bile collected using the ETCG technique was shown to be effective for diagnosing the nature of the polypoid lesion in the gallbladder.

Threshold values of visceral fat measures and their anthropometric alternatives for metabolic derangement in Japanese obese boys

OBJECTIVE

To determine whether the direct measure of visceral adipose tissue (VAT) by computed tomography (CT) is a superior diagnostic criterion to the anthropometric surrogates and more classical criteria of obesity.

DESIGN

Cross-sectional, clinical study. Obese boys were classified according to the occurrence of abnormal values in either serum triglyceride, alanine aminotransferase or insulin level. A threshold value of each criterion for such metabolic derangement was calculated, using the analysis of receiver operating characteristic (ROC) curve.

SUBJECTS

Seventy-five consecutive outpatient Japanese obese boys, ranging in age from 6 to 14 y, were studied.

MEASUREMENTS

Anthropometric indices measured were height, body weight, waist girth, hip girth, triceps and subscapular skinfold thicknesses. Classical criteria for obesity used were percentage overweight (POW), body mass index (BMI) and percentage body fat. Waist girth, sagittal diameter by CT and waist-hip ratio (WHR) were evaluated as anthropometric surrogates for VAT. The areas of total abdominal fat (TAF), VAT and subcutaneous adipose tissue (SAT) were measured by CT at the level of the umbilicus. Clinical blood biochemistry was analyzed in fasting blood samples of obese boys.

RESULTS

Thirty-three boys were classified into a no-complication group, and 42 into a complication group. TAF, VAT and SAT areas were closely associated with age, body size and degree of overweight and adiposity, while VAT/SAT was not. VAT area, sagittal diameter, TAF area and waist girth were closely correlated with alanine aminotransferase, insulin, TG and HDL-C. VAT/SAT, BMI, SAT area, WHR, percentage body fat and POW were less closely associated with these biochemical indices. The descending order of the values of area under the curve for the ROC curves were as follows: VAT>sagittal diameter>TAF>VAT/SAT>waist girth>BMI>WHR>percentage body fat>POW. Both VAT area and VAT/SAT gave >80% of sensitivity and specificity. Among the anthropometric indices studied, the sagittal diameter was the best surrogate of visceral fat measure. The sensitivity and specificity for the rest of the anthropometric indices were in an unsatisfactory range. The threshold values for VAT area, VAT/SAT and sagittal diameter were 58.0 cm(2), 0.276 and 19.2 cm, respectively.

CONCLUSION

The threshold values for VAT area, VAT/SAT and sagittal diameter for detecting biochemical complication in Japanese obese boys were lower than the respective values reported in adults. These values can be used for classifying the obese boys into two types: those with medical problem and those without.

Casimir effect in fluids above the isotropic-lamellar transition

We study fluctuation-induced interaction in confined fluids above the isotropic-lamellar transition. At an ideally continuous transition, the disjoining pressure has the asymptotic form Pi(d-->infinity) approximately -Ck(B)Tq(2)(0)/d, where d is the interwall distance, q(0) is the wave number of the scattering peak, and C = 1/4pi in the strong anchoring limit. The long-rangedness is enhanced due to continuous distribution of soft modes in the q space. An unconventionally strong Casimir force with a range of several lamella thicknesses is realistic above the transition. We also find an oscillatory force profile near a surface-induced transition.

Immunosuppressive therapy for patients with refractory anemia

Trials of immunosuppressive therapy have been reported in some case reports of hypoplastic myelodysplastic syndrome (MDS). In this study, we gave immunosuppressive therapies to eight patients with normo- or hyperplastic MDS of refractory anemia subtype without karyotypic abnormalities and analyzed the HLA-DRB1 type or the presence of paroxysmal nocturnal hemoglobinuria (PNH) neutrophils in these patients. Cyclosporin A (CyA) therapy was effective for improving cytopenia in four of the eight MDS patients. While the side effects of CyA were mostly mild and transient, one patient demonstrated karyotypic abnormality following CyA therapy and accelerated to refractory anemia with an excess of blasts. Additional antithymocyte globulin (ATG) therapy was effective in one of three nonresponders to CyA therapy. One patient died due to leukemic transformation after ATG therapy. When we analyzed the correlation between the response to CyA therapy and the HLA-DRB1 type, there were more responders with DRB1*1501 (three of four patients) than without (one of four patients), but a statistically significant difference was not evident between the two groups. In addition, the presence of PNH neutrophils was not correlated with the response to CyA and/or ATG therapy. These results indicate the usefulness of immunosuppressive therapies even for normo- or hyperplastic MDS patients. Further trials using more patients with a long follow-up period would be worthwhile in order to clarify the possibility of disease progression and in order to predict the response of patients.

Clinical and experimental observation of glistening in acrylic intraocular lenses

PURPOSE

To determine whether or not glistening particles in implanted acrylic intraocular lenses (IOL) increase with the passage of time.

METHODS

Prospective clinical study: Glistenings were evaluated in 31 patients (49 eyes) with implanted acrylic IOL, the emphasis being on when glistening first became evident and subsequent changes in the number of glistening particles.

EXPERIMENT

IOLs were monitored for any changes that occurred with the passage of time as they were immersed first in a 50 degrees C saline solution and then in another saline solution with a temperature of 35 degrees C.

RESULTS

Prospective clinical study: Glistening phenomenon was observed in 28 IOLs (57%) 2 to 16 months after implantation (mean = 6.6 months). Glistenings reached their peak in number within a few months of formation in all cases, showing no further increase thereafter.

EXPERIMENT

Glistening particles first appeared on the 10th day of the experiment in sizes ranging from 3 to 10 microm in diameter. They remained at the same level for the next 60 days without showing any increase.

CONCLUSIONS

Glistening formation in acrylic IOLs was found to stabilize within a few months after appearance. The method of our experiment proved reliable in producing, in a relatively short period of time, glistening similar to that found in patients.

Sequence-dependent antitumor efficacy of combination chemotherapy with nedaplatin, a newly developed platinum, and paclitaxel

We evaluated the sequence dependency of antitumor efficacy and toxicity in combination therapy of nedaplatin (NDP) with paclitaxel (TXL) against Lewis lung carcinoma. The sequential administration of NDP prior to TXL (NT therapy) resulted in severe body weight loss followed by frequent toxic death of mice. In contrast, the sequential dosing of TXL prior to NDP (TN therapy) resulted in synergistically enhanced inhibition of tumor growth with less toxicity compared with the NT therapy. Comparing the antitumor activity of NDP plus TXL with that of cisplatin (CDDP) plus TXL or carboplatin (CBDCA) plus TXL, the combination effect of NDP plus TXL was significantly higher than that of CDDP plus TXL or CBDCA plus TXL. These results indicate that the TN therapy may have significant potential in clinical use.

Transplantable hematopoietic stem cells in human fetal liver have a CD34(+) side population (SP)phenotype

Cells with a verapamil-sensitive ability to efflux Hoechst 33342 (termed side population [SP] cells) have been identified in adult marrow from several species including humans and in several tissues from adult mice. In mice, the SP phenotype appears to be a common feature of stem cells, but human SP cells have been less well characterized. We show here, for the first time to our knowledge, that SP cells are present in the second-trimester human fetal liver. They include all of the transplantable human hematopoietic stem cell activity detectable in NOD/SCID mice and also certain other, more differentiated hematopoietic cell types. Notably, the stem cell activity was confined to the CD34(+)CD38(-) SP(+) population, and isolation of these cells gave an approximately tenfold enrichment of transplantable stem cells. This subset was not, however, coenriched in hematopoietic progenitors detectable by either short- or long-term in vitro assays, indicating most of these to be distinct from transplantable stem cells. These findings suggest that the SP phenotype is an important and distinguishing property of human hematopoietic stem cells and that early in ontogeny they express CD34.

Polymorphism and allelic loss at the AS3 locus on 13q12-13 in esophageal squamous cell carcinoma

Our previous studies of esophageal squamous cell carcinoma (ESC) revealed that frequent loss of heterozygosity (LOH) on 13q12-13 was associated with lymph node metastasis. These results suggest that 13q12-13 may harbor a tumor suppressor gene which regulates lymph node metastasis. Recently, a new tumor suppressor candidate, AS3, was identified in this region. We therefore examined AS3 alterations by PCR-SSCP and RT-PCR. Although polymorphisms were found in exon 10 and introns 21, 23, 25 and 29, a possible tumor specific mutation in exon 6 was identified in only one of 31 ESC-derived cell lines, indicating that the remaining allele of AS3 was rarely inactivated by mutational events. Interestingly, ESC patients with rare alleles frequently exhibited lymph node metastasis. These results suggest that polymorphic variation and LOH at the AS3 locus might be associated with lymph node involvement in ESC.

Effect of obesity and troglitazone on expression of two glutathione peroxidases: cellular and extracellular types in serum, kidney and adipose tissue

To determine the effect of obesity on expression of cellular- (C-) and extracellular (EC-) glutathione peroxidase (GPX) in serum, kidney and adipose tissue, we measured GPX in serum, kidneys and adipose tissue of the obese Otsuka-Long-Evans-Tokushima Fatty (OLETF) rat and its lean counterpart (LETO). We also investigated the effect of troglitazone. Five each of OLETF and LETO rats were fed diet with or without 0.2% troglitazone for 10 days. Final body weight, kidney weight, blood glucose and serum tumor necrosis factor-alpha (TNF-alpha) level were higher in OLETF rats than in LETO rats. Serum and kidney GPX activities were higher, but adipose tissue GPX activity was lower, in OLETF rats than in LETO rats. Troglitazone treatment decreased adipose tissue GPX activity and abolished overproduction of TNF-alpha in OLETF rats. Immunoblot analysis, for the first time, revealed that both obesity and troglitazone suppressed the protein signals for C-GPX and EC-GPX in adipose tissue. Serum protein carbonyl groups were increased in OLETF rats and troglitazone completely blocked this increase. Increased serum GPX activity in obese rat was due to the increased secretion of EC-GPX from the kidney. Troglitazone protected against the enhanced oxidative stress induced by obesity independently of the serum GPX concentration.

Mismatch repair and microsatellite instability in esophageal cancer cells

Using in vitro mismatch repair (MMR) assay, we have identified 3 of 22 esophageal cancer cell lines exhibiting reduced MMR activity. By means of gel-shift assay, decreased binding ability to GT mismatch and CA loop was observed in these 3 cell lines. However, we could not find any mutations in the hMSH2, hMSH3 and hMSH6 genes, the protein products of which exhibit mismatch binding activity in human cells. In addition, when using antibodies against 5 MMR-related proteins (hMSH2, hMSH3, hMSH6, hPMS2 and hMLH1), no aberrant expression was detected in any of them. When we examined 9 microsatellite loci in endogenous genomic DNA, these 3 esophageal cancer cell lines, deficient in MMR, did not exhibit microsatellite instability. However, when we examined the repetitious sequence on exogenous plasmid DNA which was introduced into these 3 esophageal cancer cells, the results suggested that MMR deficiency in esophageal cancer cells could result in moderate instability of the exogenous sequence.

Improved reliability of repetitive RF interstitial heating in combination with brachytherapy: the effective use of water

Interstitial heating and brachytherapy are often combined in the treatment of cancer. In such instances, a needle-type internal electrode is inserted into the RALS (remotely controlled afterloading system) catheter instead of a radioactive source. A problem with this approach, however, is that the temperature distribution pattern generated by the inserted electrode varies at any given target region in each heating treatment, which makes it difficult to accurately replicate the heating treatment protocol. This variation is suspected to be caused by non-uniformity in the small gap between the internal electrode and the inner surface of the surrounding catheter, causing electric currents to flow between the electrode and the heating material, which differs from procedure to procedure. To solve this problem, the gap was filled with water of high permittivity, and the temperature distribution was investigated using phantoms. With this method, a stable and reproducible temperature rise distribution was obtained in the phantom experiment.

Direct isolation of human central nervous system stem cells

Stem cells, which are clonogenic cells with self-renewal and multilineage differentiation properties, have the potential to replace or repair damaged tissue. We have directly isolated clonogenic human central nervous system stem cells (hCNS-SC) from fresh human fetal brain tissue, using antibodies to cell surface markers and fluorescence-activated cell sorting. These hCNS-SC are phenotypically 5F3 (CD133)(+), 5E12(+), CD34(-), CD45(-), and CD24(-/lo). Single CD133(+) CD34(-) CD45(-) sorted cells initiated neurosphere cultures, and the progeny of clonogenic cells could differentiate into both neurons and glial cells. Single cells from neurosphere cultures initiated from CD133(+) CD34(-) CD45(-) cells were again replated as single cells and were able to reestablish neurosphere cultures, demonstrating the self-renewal potential of this highly enriched population. Upon transplantation into brains of immunodeficient neonatal mice, the sorted/expanded hCNS-SC showed potent engraftment, proliferation, migration, and neural differentiation.

Lamivudine therapy for a hepatitis B surface antigen (HBsAg)-positive leukemia patient receiving myeloablative chemotherapy and autologous stem cell transplantation

Hepatitis B virus (HBV) can be a cause of fatal liver failure after chemotherapy for viral carrier patients and limits the indication of myeloablative therapy for them. We describe an HBsAg-positive leukemia patient who successfully underwent autologous PBSC transplant. After chemotherapeutic treatment his serum HBV DNA level rose in association with hepatitis. To prevent progression to fulminant hepatitis, we administered lamivudine, a viral reverse transcriptase inhibitor, during the transplantation procedure. The patient did not show any increase of HBV DNA or a worsening of his hepatitis. Thus, lamivudine may be a promising treatment for HBsAg-positive patients receiving myeloablative chemotherapy and autologous stem cell transplantation.

Improved in vivo antitumor efficacy and reduced systemic toxicity of carboxymethylpullulan-peptide-doxorubicin conjugates

The antitumor efficacy of the conjugate of doxorubicin (DXR) and carboxymethylpullulan (CMPul) with Phe-Gly spacer (CMPul-FG-DXR) was evaluated using murine tumor models and compared with that of DXR. The conjugate exhibited higher antitumor efficacy against Lewis lung carcinoma than DXR. Complete tumor regression followed by long-term tumor-free survival was frequently observed when CMPul-FG-DXR was administered i.v. three times at a dose equivalent to 10 mg / kg of DXR. The superior survival as well as anti-metastatic effect of CMPul-FG-DXR in comparison with DXR was also demonstrated with the M5076 murine reticulosarcoma model. Body weight loss in mice treated with the conjugate was less than that in the DXR-treated group, indicating lower systemic toxicity of CMPul-FG-DXR. Simply mixing CMPul with DXR did not enhance the antitumor activity of DXR, showing that the conjugation of DXR with CMPul is necessary for improved antitumor activity. However, no enhanced antitumor efficacy of the conjugates was observed against a non-solid tumor model such as P388 leukemia. In summary, improved antitumor efficacy with reduced systemic toxicity of CMPul-FG-DXR was demonstrated in the present study. CMPul-FG-DXR may be useful as a cancer chemotherapy agent against solid tumors and metastases.

Phenotypes of fission yeast defective in ubiquinone production due to disruption of the gene for p-hydroxybenzoate polyprenyl diphosphate transferase

Ubiquinone is an essential component of the electron transfer system in both prokaryotes and eukaryotes and is synthesized from chorismate and polyprenyl diphosphate by eight steps. p-Hydroxybenzoate (PHB) polyprenyl diphosphate transferase catalyzes the condensation of PHB and polyprenyl diphosphate in ubiquinone biosynthesis. We isolated the gene (designated ppt1) encoding PHB polyprenyl diphosphate transferase from Schizosaccharomyces pombe and constructed a strain with a disrupted ppt1 gene. This strain could not grow on minimal medium supplemented with glucose. Expression of COQ2 from Saccharomyces cerevisiae in the defective S. pombe strain restored growth and enabled the cells to produce ubiquinone-10, indicating that COQ2 and ppt1 are functional homologs. The ppt1-deficient strain required supplementation with antioxidants, such as cysteine, glutathione, and alpha-tocopherol, to grow on minimal medium. This suggests that ubiquinone can act as an antioxidant, a premise supported by our observation that the ppt1-deficient strain is sensitive to H(2)O(2) and Cu(2+). Interestingly, we also found that the ppt1-deficient strain produced a significant amount of H(2)S, which suggests that oxidation of sulfide by ubiquinone may be an important pathway for sulfur metabolism in S. pombe. Ppt1-green fluorescent protein fusion proteins localized to the mitochondria, indicating that ubiquinone biosynthesis occurs in the mitochondria in S. pombe. Thus, analysis of the phenotypes of S. pombe strains deficient in ubiquinone production clearly demonstrates that ubiquinone has multiple functions in the cell apart from being an integral component of the electron transfer system.

Three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) as an outpatient procedure to assess infertile women: a pilot study

OBJECTIVES

This study aimed to assess the use of three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) as a routine outpatient procedure for evaluating infertile women.

METHODS

In 25 unselected infertile patients, tubal patency and uterine cavity were investigated by 3D-HyCoSy with saline as a contrast medium. The efficacy of the procedure was evaluated with X-ray hysterosalpingography (XHSG) as reference.

RESULTS

The positive predictive value, negative predictive value, sensitivity, and specificity of predicting tubal patency by 3D-HyCoSy were 100, 33.3, 84.4, and 100%, respectively. The full contour of the uterine cavity was depicted in 96% of cases by 3D-HyCoSy and 64% by XHSG (P < 0.005). The uterine cavity area measured on 3D-HyCoSy correlated well with the volume of contrast medium required on XHSG (r2 = 0.8166).

CONCLUSIONS

3D-HyCoSy provided advantages of better assessment of uterine cavity over XHSG. Compared with conventional XHSG, the efficacy of 3D-HyCoSy to assess tubal patency was acceptable. In addition, the procedure of 3D-HyCoSy appears to be better tolerated, requiring no sedation or anesthesia and a reduced examination time. Thus, 3D-HyCoSy with saline as a contrast medium is feasible and could comprise a routine outpatient procedure in the initial evaluation of infertile women.

Clinical and Experimental Observation of Glistening in Acrylic Intraocular Lenses

Purpose: To study whether the glistening on implanted acrylic intraocular lenses increases or not.Method: 1. Prospective study: We studied the glistening on 49 implanted acrylic intraocular lenses, particularly the time of appearance and increase after glistening appeared. 2. Experiment: We kept an intraocular lens immersed in saline solution at 50 degrees centigrade for 2 hours and then moved this lens into saline solution at 35 degrees centigrade, and observed this lens during immersion.Results: 1. Prospective study: Glistening was present in 28 eyes (57%), and appeared from 2 to 16 months postoperatively. A few months after appearance it become stable and did not increase further. 2. Experiment: On the 10th day after observation, we could see glistening on the lenses. The points of glistening were 10 µm or less in size, and did not change during 60 days of observation.Conclusion: The glistening in acrylic intraocular lenses seemed to become stable a few months after appearance. This our experimental method is useful, because it gives us glistening similar to clinical cases in a short time.

Induction of MTG8-specific cytotoxic T-cell lines: MTG8 is probably a tumour antigen that is recognized by cytotoxic T cells in AML1-MTG8-fused gene-positive acute myelogenous leukaemia

Several reports have demonstrated the persistent detection of AML1-MTG8 fusion products, representing minimal residual disease (MRD), in patients with t(8;21) acute myelogenous leukaemia (AML) who are in long-term remission. It is probable that immune-mediated mechanisms that are able to suppress the expansion of MRD may result in the continuance of remission. It was previously shown that some t(8;21) AML patients had high anti-MTG8 antibody titres. MTG8 expression in normal adult tissues is limited to the brain or heart in which human leucocyte antigen (HLA) class I cell-surface antigens are either not or are only faintly detectable. We hypothesized that the overexpression of the MTG8 gene in t(8;21) AML cells could act as a possible tumour antigen, which might be able to induce the immune-mediated suppression of the expansion of MRD. We were able to induce HLA-A0201-restricted cytotoxic T-lymphocyte (CTL) lines against an MTG8 peptide (MTG8b amino acids 182-191) using monocyte-derived dendritic cells from a healthy donor. T-cell receptor (TCR)Valpha17, TCRVbeta14 and 15, and TCRJbeta2.1 and 2.3 are predominantly used in these CTL lines. Our data, which suggest that the MTG8 protein could be one of the tumour antigens recognized by CTLs, may be helpful in further investigations of TCR analysis in t(8;21) AML patients with HLA-A0201 who are in long-term remission.

Soft and nonsoft structural transitions in disordered nematic networks

Properties of disordered nematic elastomers and gels are theoretically investigated with emphasis on the roles of nonlocal elastic interactions and crosslinking conditions. Networks originally crosslinked in the isotropic phase lose their long-range orientational order by the action of quenched random stresses, which we incorporate into the affine-deformation model of nematic rubber elasticity. We present a detailed picture of mechanical quasi-Goldstone modes, which accounts for an almost completely soft polydomain-monodomain (PM) transition under strain as well as a "four-leaf clover" pattern in depolarized light scattering intensity. Dynamical relaxation of the domain structure is numerically studied using a simple model. The peak wave number of the structure factor obeys a power-law-type slow kinetics and goes to zero in true mechanical equilibrium. The effect of quenched disorder on director fluctuation in the monodomain state is analyzed. The random frozen contribution to the fluctuation amplitude dominates the thermal one, at long wavelengths and near the PM transition threshold. We also study networks obtained by crosslinking polydomain nematic polymer melts. The memory of the initial director configuration acts as correlated and strong quenched disorder, which renders the PM transition nonsoft. The spatial distribution of the elastic free energy is strongly dehomogenized by external strain, in contrast to the case of isotropically crosslinked networks.

Odor maps in the mammalian olfactory bulb: domain organization and odorant structural features

Psychophysical studies indicate that structural features of odorants differentially influence their perceived odor. In the olfactory bulb (OB), odorants are represented by ensembles of activated glomeruli. Here we used optical imaging of intrinsic signals to examine how these structural features are represented spatially in the sensory map of the rat OB. We found that the dorsal OB contained two topographically fixed domains; constituent glomeruli in each domain could be activated by odorants with particular functional groups. Within each domain, other structural features such as carbon chain length and branching were represented by local differences in patterns. These results suggest that structural features are categorized into two classes, primary features (functional groups) that characterize each domain, and secondary features that are represented by local positions within each domain. Such hierarchical representations of different structural features correlate well with psychophysical structure-odor relationships.