Emodin induces chloride secretion in rat distal colon through activation of mast cells and enteric neurons

BACKGROUND AND PURPOSE

Emodin (1,3,8-trihydroxy-6-methylanthraquinone) is an active component of many herb-based laxatives. However, its mechanism of action is unclear. The aim of the present study was to investigate the role of mast cells and enteric neurons in emodin-induced ion secretion in the rat colon.

EXPERIMENTAL APPROACH

Short-circuit current (I(SC)) recording was used to measure epithelial ion transport. A scanning ion-selective electrode technique was used to directly measure Cl(-) flux (J(Cl)-) across the epithelium. RIA was used to measure emodin-induced histamine release.

KEY RESULTS

Basolateral addition of emodin induced a concentration-dependent increase in I(SC) in colonic mucosa/submucosa preparations, EC(50) 75 µM. The effect of emodin was blocked by apically applied glibenclamide, a Cl(-) channel blocker, and by basolateral application of bumetanide, an inhibitor of the Na(+) -K(+) -2Cl(-) cotransporter. Emodin-evoked J(Cl)- in mucosa/submucosa preparations was measured by scanning ion-selective electrode technique, which correlated to the increase in I(SC) and was significantly suppressed by glibenclamide and bumetanide. Pretreatment with tetrodotoxin and the muscarinic receptor antagonist atropine had no effect on emodin-induced ΔI(SC) in mucosa-only preparations, but significantly reduced emodin-induced ΔI(SC) and J(Cl)- in mucosa/submucosa preparations. The COX inhibitor indomethacin, the mast cell stabilizer ketotifen and H(1) receptor antagonist pyrilamine significantly reduced emodin-induced ΔI(SC) in mucosa and mucosa/submucosa preparations. The H(2) receptor antagonist cimetidine inhibited emodin-induced ΔI(SC) and J(Cl)- only in the mucosa/submucosa preparations. Furthermore, emodin increased histamine release from the colonic mucosa/submucosa tissues.

CONCLUSIONS AND IMPLICATIONS

The results suggest that emodin-induced colonic Cl(-) secretion involves mast cell degranulation and activation of cholinergic and non-cholinergic submucosal neurons.

[Two-stage revision for prostheses infection in patients with bone tumor after knee prosthetic replacement]

OBJECTIVE

To evaluate the outcome of two-stage revision for prostheses infection in patients with bone tumor after knee prosthetic replacement.

METHODS

Between August 2003 and August 2010, 22 patients with prostheses infection, who underwent knee prosthetic replacement in limb salvage treatment because of bone tumor, received two-stage revision. There were 11 males and 11 females with an average age of 29.6 years (range, 15-55 years). Prosthetic infection occurred after primary replacement in 20 patients and after revision surgery in 2 patients from 15 days to 89 months after operation. According to Coventry and Fitzgerald classification, type I was found in 3 cases, type II in 15 cases, and type III in 4 cases. The time from infection to admission was 5-47 months (mean, 10.2 months). The results of bacterial culture were positive in 9 cases and negative in 13 cases. Two patients had fever and leukocytosis. In one-stage, the implants and infected tissue were removed, and an antibiotic cement spacer with an intramedullary nail was implanted. In two-stage, a new endoprosthesis was inserted after infection was controlled.

RESULTS

The C-reactive protein and erythrocyte sedimentation rate before one-stage debridement were significantly higher than those before two-stage revision (P < 0.05). All patients were followed up 5-63 months (mean, 23.6 months). Infection was controlled after one-stage debridement in 18 cases (81.8%); two-stage revision was performed in 17 cases, and 1 case refused to receive two-stage revision. Of 17 patients, 1 patient was amputated because of infection at 5 months after revision. Four patients (18.2%) underwent amputation because of failure to control infection after one-stage debridement. The limb salvage rate was 77.3% (17/22). One case of renal cell carcinoma with bone metastasis died of original disease after 1 year and 6 months of operation. The Musculoskeletal Tumor Society (MSTS 93) score was 69.4 +/- 12.7 at last follow-up.

CONCLUSION

Two-stage revision should be performed in time and it has good results in the treatment of prostheses infection in patients with bone sarcomas after knee prosthetic replacement.

Reconstruction with modular hemipelvic prosthesis for the resection of solitary periacetabular metastasis

BACKGROUND

The outcomes of patients with solitary metastasis around the acetabulum who received en bloc resection and reconstruction are unclear. The purpose is to evaluate the oncologic results, complications, and functional outcomes in these patients.

METHODS

Fifteen patients who underwent periacetabular resection and modular endoprosthetic reconstruction were reviewed retrospectively.

RESULTS

Eleven patients were alive and four had died of their respective diseases. The mean follow-up time for the living patients and the non-surviving patients was 32 and 11 months, respectively. One of the three patients presented with local recurrence received hindquarter amputation. Five patients with superficial wound problem were treated with debridement and were healed eventually. Two patients who had hip dislocation received closed reduction. Pain was relieved in most patients, and ten patients were able to walk outside their house. The average MSTS 93 score was 20.9 of a total of 30 points (69.7%). When evaluated according to the modified Allan scoring system, postoperative scores on pain, independence, and mobility had significant improvement.

CONCLUSION

En bloc tumor resection and reconstruction with modular hemipelvic prosthesis in patients who had a solitary periacetabular metastasis can provide long-term survive, tumor local control, low complication rate, and good functional recovery.

A jugulotympanic paraganglioma with craniocervical extension

Jugulotympanic paragangliomas (JTPs) are rarely encountered benign diseases derived embryonically from the autonomic nervous system. Although JTPs may originate extracranially or intracranially, little has been reported in the literature about large JTPs involving several anatomical structures in the craniofacial regions. Management of large JTPs is controversial. The authors describe a large JTP invading the cranial bones and extending through the neck to the left clavicle. Doppler sonography, computed tomography and magnetic resonance imaging were performed preoperatively to confirm the diagnosis. Combined therapeutic approaches were undertaken with preoperative selective embolization followed by craniofacial resection in cooperation with neurosurgeons.

The Effect of Boundary Condition on the Biomechanics of a Human Pelvic Joint Under an Axial Compressive Load: A Three-Dimensional Finite Element Model

The finite element (FE) model of the pelvic joint is helpful for clinical diagnosis and treatment of pelvic injuries. However, the effect of an FE model boundary condition on the biomechanical behavior of a pelvic joint has not been well studied. The objective of this study was to study the effect of boundary condition on the pelvic biomechanics predictions. A 3D FE model of a pelvis using subject-specific estimates of intact bone structures, main ligaments and bone material anisotropy by computed tomography (CT) gray value was developed and validated by bone surface strains obtained from rosette strain gauges in an in vitro pelvic experiment. Then three FE pelvic models were constructed to analyze the effect of boundary condition, corresponding to an intact pelvic joint, a pelvic joint without sacroiliac ligaments and a pelvic joint without proximal femurs, respectively. Vertical load was applied to the same pelvis with a fixed prosthetic femoral stem and the same load was simulated in the FE model. A strong correlation coefficient (R2=0.9657) was calculated, which indicated a strong correlation between the FE analysis and experimental results. The effect of boundary condition changes on the biomechanical response depended on the anatomical location and structure of the pelvic joint. It was found that acetabulum fixed in all directions with the femur removed can increase the stress distribution on the acetabular inner plate (approximately double the original values) and decrease that on the superior of pubis (from 7 MPa to 0.6 MPa). Taking sacrum and ilium as a whole, instead of sacroiliac and iliolumber ligaments, can influence the stress distribution on ilium and pubis bone vastly. These findings suggest pelvic biomechanics is very dependent on the boundary condition in the FE model.

Reconstruction with constrained prosthesis after total scapulectomy

HYPOTHESIS

Scapular prosthetic replacement after total scapulectomy can result in oncologic salvage and good postoperative function with a low rate of complications.

MATERIALS AND METHODS

Ten patients who underwent constrained scapular prosthetic replacement after total scapulectomy between 2003 and 2009 were reviewed retrospectively.

RESULTS

At a mean follow-up of 36 months, 2 patients died of their disease. One patient showed recurrence and metastasis. Complications, including dislocation and superficial wound infection, occurred in 2 patients. The mean Musculoskeletal Tumor Society 93 score was 23.2 of 30 points. High scores were achieved for most items except hand position; only 5 patients can raise their hands above their waist. The ranges of active shoulder abduction and forward flexion motion were 20° to 45° and 40° to 65°, respectively. All patients retained normal hand and elbow functions.

CONCLUSION

Although there are limitations in the shoulder's active motion, reconstruction with a scapular prosthesis can provide oncologic salvage and result in good postoperative function with a low rate of complications.

The fate of 4-hydroxycarbazole metabolite: metabolism and carcinogenicity assessment of a β-adrenergic receptor modulator containing carbazole structure

LY377604 has a potential to form 4-hydroxycarbazole, which was reported in the literature as a mutagen. This safety concern led to our investigation of the metabolism and carcinogenicity of LY377604. In in vitro studies with LY377604, 4-hydroxycarbazole was detected in the presence of liver microsomes prepared from different species. When incubated with liver slices, only the conjugate of 4-hydroxycarbazole was detected. Subsequent in vivo radio-labelled studies were conducted to characterise the formation of 4-hydroxycarbazole from LY377604. Free 4-hydroxycarbazole was not detected in vivo, but the O-glucuronide conjugate was identified as a minor metabolite in urine samples, representing 0.2% and 0.9% of the radioactive dose in rats and monkeys. The low level of circulating 4-hydroxycarbazole glucuronide conjugate was also detected in plasma. LY377604 was negative in all genetic toxicology assays and was not associated with tumour induction in a 6-month carcinogenicity study using RasH2+/- mouse model. The exposure to free 4-hydroxycarbazole was not measurable after one dose and was about 0.1%-0.2% of the parent exposure at the end of the 6-month study. These data suggested that 4-hydroxycarbazole was formed as a minor metabolite in vivo, but it was primarily conjugated and excreted in urine as the glucuronide conjugate. The absence of tumours in the carcinogenicity study combined with the exposure data suggested that the low level of free 4-hydroxycarbazole did not represent a carcinogenic risk.

Clinical outcome and quality of life after surgery for peri-acetabular metastases

We set out to determine the impact of surgery on quality of life and function in patients who had undergone surgery for symptomatic peri-acetabular metastases. From a prospective database we retrospectively reviewed 46 consecutive patients who had been treated operatively between June 2003 and June 2009. The mean age of the patients was 56.4 years (20 to 73) and the mean post-operative follow-up was 19.2 months (4 to 70). Functional evaluation and quality-of-life assessments were performed. At the most recent follow-up, 26 patients (56.5%) were alive. Their median survival time was 25.0 months. Ten major postoperative complications had occurred in eight patients (17.4%). The mean post-operative Musculoskeletal Tumor Society score (MSTS 93) was 56.3% (6.7% to 90.0%). Improvement in the Eastern Cooperative Oncology Group (ECOG) performance status was seen in 32 patients (69.6%). On the European Organisation for Research and Treatment of Cancer core quality-of-life questionnaire (QLQ-C30) measure of global health status there was a statistically significant improvement from the patients’ pre-operative status (42.8 (sd 13.7)) to that found at the latest follow-up (58.0 (sd 12.5)) (p = 0.001). The only statistically significant change in the nine symptom domains of the QLQ-C30 was a reduction in the mean level of pain (from 59.1 to 29.5 (out of 100)) (p < 0.001).

Surgery for patients with peri-acetabular metastases reduces pain and improves their quality of life, and has a low rate of surgical complications.

Entacapone promotes cAMP-dependent colonic Cl(-) secretion in rats

BACKGROUND

Entacapone is a promising drug used widely for the treatment of Parkinson's disease (PD) as a catechol-O-methyl transferase (COMT) inhibitor. However, entacapone has gastrointestinal side effects. The aim of this study was to investigate the effects of entacapone on the epithelial ion transport in rat distal colon, and explore the underlying mechanism.

METHODS

The study was performed on freshly isolated colonic mucosa-only, submucosa-only and mucosa-submucosa preparations in rat. The short circuit current (I(SC) ) was measured to determine electrogenic ion transport, and a scanning ion-selective electrode technique (SIET) was used to directly measure Cl(-) flux across the epithelium. The content of intracellular cAMP was measured with radioimmunoassay (RIA).

KEY RESULTS

Entacapone increased mucosal I(SC) in the rat distal colon. I(SC) was inhibited significantly by apical addition of diphenylamine-2,2'-dicarboxylic acid (DPC), a blocker of the Cl(-) channel, basolateral application of bumetanide, an inhibitor of Na(+) -K(+) -2Cl(-) co-transporter (NKCC), removal of Cl(-) from the bathing solution, and pretreatment with MDL 12330A, an inhibitor of adenylate cyclase. Inhibiting endogenous prostaglandin (PG) synthesis with indomethacin, and eliminating submucosal enteric neural activity with tetrodotoxin (TTX)-inhibited entacapone-evoked I(SC) increases. Similar results were also obtained when Cl(-) flux was measured with SIET. Entacapone significantly increased intracellular cAMP content, which was greatly inhibited by either indomethacin or TTX in the tissues containing submucosal plexus, and by only indomethacin in the mucosa-only preparations.

CONCLUSIONS & INFERENCES

Entacapone stimulates cAMP-dependent Cl(-) secretion in the rat colon, and this process is regulated by endogenous PG and the submucosal enteric nervous system.

Decreased expression of profilin 2 in oral squamous cell carcinoma and its clinicopathological implications

Profilins are small proteins essential for many normal cellular dynamics and constitute one of the crucial components of actin-based cellular motility. Several recent studies have implicated a role for the profilin (PFN) family in cancer pathogenesis and progression. However, their expression and promising functions are largely unknown in oral squamous cell carcinoma (OSCC). In this study, we analyzed the correlation between PFN1 and PFN2 expression in vitro and in vivo. The protein expression levels were roughly compared between cell lines (HIOEC, HB96) with the employment of mass spectrometry. PFN2 was singled out as one of the significantly down-regulated genes in the cancerous HB96 cells. The expression levels of PFN1 and PFN2 in vitro were validated by RT-PCR, real-time PCR and Western blotting. Laser scanning confocal microscopy was used for the first time to assess the localization of PFN2 expression. In subsequent experiments, we observed the relationship between PFN2 expression levels and the proliferation of transfected HB96 cancer cells. VASP, N-WASP and P27 expression was also examined in the PFN2-transfected or non-transfected HB96 cells. In vivo, antigen expression was determined by immunohistochemical analyses in 88 paired tissue specimens. Decreased protein expression was confirmed in cancerous tissues from 88 OSCC patients compared with paracancerous normal mucous epithelia. Tumors with weak PFN2 expression were associated with a significantly worse prognosis than strongly expressed tumours (P<0.001). Other statistical analyses were performed to assess the differences in expression and their clinical and pathological significance. In conclusion, PFN2 can be utilized as both a potential suppressor marker and a prognostic protein for OSCC. The function of PFN2 may be to regulate the N-WASP/Arp2/3 signaling pathway.

Expression and activation of β-adrenoceptors in the colorectal mucosa of rat and human

BACKGROUND

The functions of the distal colon are regulated by local and extrinsic neural pathways. In previous studies, we have found that dopamine (DA) and norepinephrine (NE) could evoke colonic ion transport by activating β-adrenoceptors. The present study aims to investigate the segmental differences in expression and activation of β-adrenoceptors in the distal colon in physiological and pathophysiological conditions.

METHODS

Real-time PCR, immunofluorescence, and Western blotting were used to detect the expression of β-adrenoceptors in the rat and human distal colon. Short-circuit current measurements (Isc) were used to assess the role of β-adrenoceptors in ion transport.

KEY RESULTS

DA and NE caused greater suppression of baseline Isc in distal colon adjacent to the rectum than in segments further away from the anus. These responses were inhibited by selective antagonists of β₁- and β₂-adrenoceptors, but not β₃-adrenoceptor. The expression levels of β₁- and β₂-adrenoceptors in colonic mucosa were higher in colorectum than the regions away from the anus of rats and humans. In wrap-restraint stress (2 h), DA-, NE-induced ΔIsc and the expression of β-adrenoceptors in the colorectum were significantly reduced. However, when endogenous catecholamines were depleted by 6-hydroxydopamine (75 mg kg(-1), i.p., 3 days), DA-, NE-induced ΔIsc as well as the expression of β-adrenoceptors were significantly enhanced in the rat colorectum but not in more proximal regions of the distal colon.

CONCLUSIONS & INFERENCES

β₁- and β₂-adrenoceptors are predominantly expressed in the colorectal mucosa. Perturbation of endogenous catecholamine levels influences the expression and activation of β-adrenoceptors in the colorectal region.

[Short-term outcome of reconstruction for defect after removal of tumor with global modular replacement system]

OBJECTIVE

To identify the postoperative function and short-term outcome of Global Modular Replacement System (GMRS) for reconstruction of defect after removal of tumor so as to supply information for clinical application.

METHODS

Between March 2007 and May 2009, 30 limb-salvage cases reconstructed with GMRS were retrospectively reviewed, including 18 males and 12 females with a median age of 25 years (range, 11-57 years). The preoperative diagnoses were osteosarcoma in 15 cases, malignant fibro-histiocytoma in 4, giant cell tumor in 3, chondrosarcoma in 2, and Ewing's sarcoma and angiosarcoma in 1 respectively. The duration of symptom ranged from 1 to 15 months with an average of 5.6 months. There were 4 revision cases at mean time of 3.4 years after index surgeries. The locations were the proximal femur in 3 cases, distal femur in 22 cases, and proximal tibia in 5 cases. According to Enneking stage, 2 cases were rated as stage IB, 1 as stage IIA, and 27 as stage IIB. Four cases were complicated by pathologic fracture.

RESULTS

The average operation time was 165 minutes (range, 120-240 minutes); the mean blood loss was 448.3 mL (range, 100-1500 mL); and the mean resection length was 14.1 cm (range, 7.5-22.5 cm). All the wounds healed by first intention. All 30 patients were followed up 10-35 months (22.3 months on average). Local recurrence occurred in 2 cases (6.7%) at 5 and 14 months respectively and distal metastasis occurred in 5 cases (16.7%) at 4-12 months (7.3 months on average) postoperatively. One patient died of multiple lung metastases at 10 months postoperatively. Twenty-nine patients survived at last follow-up, including 25 cases of tumor-free survival and 4 cases of tumor bearing survival. Aseptic loosening occurred in 2 cases (6.7%) at 1.5 years and 2 years postoperatively respectively. Deep infection occurred in 1 case (3.3%) at 1 year postoperatively. At last follow-up, the Musculoskeletal Tumor Society (MSTS) 93 scores were 4.6% +/- 0.7% for pain, 3.7% +/- 0.9% for function, 3.2% +/- 1.3% for satisfactory degree, 4.3% +/- 0.9% for orthosis, 3.7% +/- 0.7% for walking, 3.3% +/- 1.0% for gait; total score was 75.9% +/- 14.2%. The Toronto Extremity Salvage Score (TESS) score was 87.0 +/- 7.0.

CONCLUSION

Reconstruction for defect after removal of tumor with GMRS has satisfactory short-term outcome with good function recovery and low complication rate.

[Evaluation of surgical treatment of pelvic osteosarcoma]

OBJECTIVES

To investigate the clinical outcome of consecutive pelvic osteosarcoma treated with surgery and chemotherapy in a single institution, and to discuss the surgical strategy, resection and reconstruction.

METHODS

Twenty-one consecutive cases with pelvic osteosarcoma underwent surgical procedures between June 2000 and June 2009. There were 12 male and 9 female with a mean age of 32 years. According to Enneking and Dunham pelvic classification system, type Iwas 3 cases, type I+IV 3 cases, type I+II 4 cases, type II+III 4 cases, type I+II+III 1 case, type III 1 case, and type I+II+IV 5 cases. Among the 21 cases, 19 were diagnosed as classical osteosarcoma and 2 were diagnosed as low-grade pathologically. All the tumors were stage IIB. All the patients received en-bloc resection with 13 wide resection and 8 marginal resection. Thirteen patients underwent modular hemi-pelvic endoprosthesis reconstruction, and 5 patients underwent rod-screw system reconstruction combined with autograft. Two patients received hemipelvectomy and one type III patients had resection without reconstruction. The mean follow-up period was 30.3 months (range, 6.0-87.0).

RESULTS

Thirteen patients out of 21 survived after treatment. The overall survival rate was 61.9%, and 23.8% patients were alive without disease. The estimated 5-year survival rate was 44.2% based on Kaplan-Meier curve. The local recurrence rate was 28.6%, among which 4 cases were type II resection, 1 was type I resection, 1 was type I+IV resection.No local relapse was found on the hemipelvectomy and type III resection cases. The local recurrence rate after wide resection was 23.1%, and 37.5% for marginal resection.Nine patients had lung metastases and one patient was found bone and lymph node metastases. The MSTS 93 function score was 20.6 ± 5.4 for 13 patients, and 22.5 ± 2.1 for rod-screw reconstruction cases. The function score was 17.7 ± 5.5 for hemi-pelvic prosthetic reconstruction.

CONCLUSION

Limb salvage procedures could be performed on most pelvic osteosarcoma cases, and satisfying function outcome could be achieved with proper reconstruction, however, the overall survival is still lower compared with those in extremities.

[Ewing's sarcoma of bone:treatment results and prognostic factors]

OBJECTIVE

To determine the prognostic factors from the view of clinic and pathology.

METHODS

A retrospective analysis was performed on a data set of 78 patients with Ewing's sarcoma treated at Peking University People's Hospital Musculoskeletal tumor center between July 1998 and July 2007. Five-year overall survival (OS), recurrence rate and prognostic factors were analyzed in this study. Univariate and multivariate analysis were performed to determine the prognostic factors for OS.

RESULTS

Fifty-three cases were followed up, follow-up time ranged from 8.0 to 101.0 months (median 37.6 months). The 5-year overall survival rate and local recurrence rate were 33.7% and 20.8% respectively. Univariate showed age < 20 years, metastases free at diagnosis, tumor located at extremities, tumor size < 10 cm, adequate surgical margin had better survival rate (all P < 0.05). Multivariate analysis demonstrated that metastases at diagnosis, primary site and tumor size were independent prognostic factors for OS.

CONCLUSION

The independent prognostic factors Ewing's sarcoma are metastases at diagnosis, primary site, tumor size.

[Finite element analysis for modular hemipelvic endoprosthesis during loaded gait cycle]

OBJECTIVE

To analyze the biomechanical characteristics of modular hemipelvic endoprosthesis in gait cycle using finite element analysis method, and the effect of pubic connection plate on stress distribution.

METHODS

Three dimensional finite element model of periacetabular defect reconstructed with modular hemipelvic endoprosthesis was established. The hip contact forces, which were published from Free University of Berlin, under gait cycle were applied in the load of Abaqus 6.7. Then the simulation was conducted and four characteristic time points were identified, 17%, 36%, 43% and 86% of gait cycle. The von Mises stress distribution of the prosthesis was calculated. Stress concentration was ascertained and the difference of stress distribution between reconstruction with and without pubic connection plate was analyzed. The displacement and stress peak value of iliac fixation part under the four points of gait cycle were recorded; Comparison of stress on the four transverse iliac fixation screws was studied and the effect of pubic connection plate ascertained.

RESULTS

During the gait cycle, both the stress peak and maximum displacement occurred in the single-leg stance phase, according to 17%-36% of gait cycle. More rational stress distribution could be achieved under the reconstruction with pubic connection plate at 17% and 86% of gait cycle, representing ipsilateral and contralateral single-leg stance respectively, resulting in more even distribution. The maximum stresses of the iliac fixation part were 148.5 MPa and 270.1 MPa under the reconstruction with and without pubic connection plate, with significant difference (P=0.04); The mean displacements of the iliac fixation part were 9.3 mm and 11.7 mm with and without pubic connection plate reconstruction (P=0.03). The average stress level of iliac fixation part could be decreased to 50% and 24% for the iliac fixation screws. However, no micromotions were decreased under the reconstruction with pubic connection plate. Also no significant difference was observed for the relative shift of the iliac fixation part with and without pubic connection plate (P=0.41).

CONCLUSION

The stability of the implant could satisfy the normal walk activity. The pubic connection plate played an important role in the stability of the endoprosthesis, decreasing the stress peak and elongation of the durability.

Abstract 2649: Whole body vibration effects on binding kinetics and targeting of near-infrared dye conjugated bisphosphonate

A non-invasive means of targeting bisphophonate to specific skeletal sites, along with the passive binding/decay kinetics of the near-infrared bisphosphanate analog to the skeleton are determined. Bone is the third common site where breast, lung, and prostate cancer cells spread and metastasize. Debilitating pain is the major complication resulting from bone metastases in nearly 70% of the patients. The palliative bone pain management includes the bisphosphanate therapy. Bisphosphonates, a potent inhibitor of bone resorption, gives both pain relief and improves bone health. However these medications result in complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). Combinations of low-risk exercise programs along with reduced drug dosage are a likely alternative to counter such drug-related side effects. Site-selective skeletal targeting of bisphosphonates, if feasible, is however ideal to overcome drug-related side effects. We utilized whole body vibration (WBV), to target NIR dye conjugate bisphosphonate to specific skeletal sites. Using near-infrared (NIR) fluorescence imaging, both the targeting and the passive binding of the bisphosphonate in vivo was determined. Vibration loading, utilizing whole body vibration (WBV) was performed on twelve mice by subjecting them to vibration frequency of 35 Hz for fifteen min (5-10 times/week) duration. Alendronate was conjugated to near-infrared tricarbocyanine, cyclic enamine-functionalized dye, and was injected intravenously after 21-day exercise regime. Yet to be reported, we show that NIR-alendronate probe bound to the lumbar L6 vertebrae, resultant of direct high-frequency WBV stimulation. This is besides several other specific targeting sites. Further, both the passive binding and the decay kinetics of the NIR signal at the skeleton was determined in a six-week non-invasive longitudinal study of mouse pups. This provides opportunity to utilize such approaches in future translational studies in assessing the role of bisphosphonates in preventing spreading of cancer cells at other secondary sites, especially bone. The targeted drug binding in response to the vibratory protocol also provides hope in the development of whole body vibration (WBV) as a bisphosphonate-therapeutic aid. Further, to develop strategies in reducing the drug dosage in treatment of other morbidity factors that stem from complications from bone metastases.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2649.

Activation of submucosal 5-HT(3) receptors elicits a somatostatin-dependent inhibition of ion secretion in rat colon

BACKGROUND AND PURPOSE

5-Hydroxytryptamine (5-HT) is a key regulator of the gastrointestinal system and we have shown that submucosal neuronal 5-HT(3) receptors exerted a novel inhibitory effect on colonic ion transport. The aim of the present study was to investigate the precise mechanism(s) underlying this inhibitory effect.

EXPERIMENTAL APPROACH

Mucosa/submucosa or mucosa-only preparations from rat distal colon were mounted in Ussing chambers for measurement of short-circuit current (I(sc)) as an indicator of ion secretion. Somatostatin release was determined with radioimmunoassay. Intracellular cAMP content was measured with enzyme-linked immunoadsorbent assay (elisa). Immunohistochemical techniques were used to study the expression of 5-HT(3) receptors, somatostatin and somatostatin receptors in colonic tissue.

KEY RESULTS

In rat distal colonic mucosa/submucosa preparations, pretreatment with 5-HT(3) receptor antagonists enhanced 5-HT-induced increases in I(sc). However, in mucosa-only preparations without retained neural elements, pretreatment with 5-HT(3) receptor antagonists inhibited 5-HT-induced DeltaI(sc). Pretreatment with a somatostatin-2 (sst(2)) receptor antagonist in mucosa/submucosa preparations augmented 5-HT-induced DeltaI(sc). Combination of sst(2) and 5-HT(3) receptor antagonists did not cause further enhancement of 5-HT-induced DeltaI(sc). Moreover, both sst(2) and 5-HT(3) receptor antagonists enhanced 5-HT-induced increase in intracellular cAMP concentration in the mucosa/submucosa preparations. 5-HT released somatostatin from rat colonic mucosa/submucosa preparations, an effect prevented by pretreatment with 5-HT(3) receptor antagonists. Immunohistochemical staining demonstrated the presence of 5-HT(3) receptors on submucosal somatostatin neurons and of sst(2) receptors on colonic mucosa.

CONCLUSION AND IMPLICATIONS

Activation of neuronal 5-HT(3) receptors in the submucosal plexus of rat colon suppressed 5-HT-induced ion secretion by releasing somatostatin from submucosal neurons.

Increased sensitivity in antigen detection with fluorescent latex nanosphere-IgG antibody conjugates

IgG antibodies were conjugated to Kodak X-Sight nanospheres to develop fluorescent-labeled antibodies using two different synthetic routes: one involving the DTT reduction method, and the other involving Traut's Reagent modification method. These two methods result in different conjugation efficiencies and different performances in antigen detection. Western blotting shows that the nanosphere-IgG antibody conjugates synthesized using the DTT reduction method are more immunospecific than the conjugates synthesized using Traut's Reagent modification method. In addition, the conjugates synthesized using DTT reduction also show higher antigen detection sensitivity than other commercially available fluorescent-IgG antibody conjugates, including Alexa Fluor, Qdot, and CyDye conjugates.

[The surgical treatment of metastatic periacetabular tumors]

OBJECTIVE

To retrospectively review the experience with different surgical procedures for periacetabular metastasis.

METHODS

The data of 43 patients with periacetabular metastasis between July 2000 and July 2007 was reviewed. There were 21 patients with primary malignant tumors at the beginning, and 10 patients diagnosed metastasis by preoperative biopsy. The other 12 patients presented skeletal involved as initial manifestations of metastasis prior to the pathological diagnosis of the primary tumor. Twelve patients had solitary metastasis, and the others had multiple bone metastasis. The surgical procedure included curettage (35 cases) and en-blot excision (8 cases). The techniques of reconstruction of acetabular defect included total hip replacement (THR) with cemented components or titanium acetabular reconstruction cup (12 cases), THR with partial pelvis replacement with Candal Hook (16 cases), THR with Steinmann pins and cement augmented or titanium cup reconstruction (7 cases), and modular hemipelvic prosthesis reconstruction (8 cases).

RESULTS

All the patients received successful operations. The average score for preoperative pain of 7.2 was assessed. Forty-one patients (95.4%) were evaluated for relief of pain and resumption of walking, and the pain score improved to 3.5 after surgery. The average functional score was 24.5 postoperatively. Six of 32 patients had local recurrence. Fourteen patients died of diseases. The average blood loss during the operation was 1600 ml in 43 patients and the bleeding exceeded 3000 ml was in 3 patients with renal carcinomas. Major complications included two superficial wound infections, one multiple organ failure and two dislocations.

CONCLUSIONS

Although surgery will not typically cure patients of their metastatic disease, surgery that is well planned and well executed can help many people by relieving their suffering and improving their quality of life.

Expression of NKCC2 in the rat gastrointestinal tract

NKCC2, an isoform of Na+-K+-2Cl(-) cotransporter, is principally present in the kidney and plays a critical role in salt reabsorption. Expression of NKCC2 has been found in the apical membrane of intestinal epithelial cells in a number of marine fish, however, details for expression in the mammalian gastrointestinal tract are lacking. RT-PCR, Western blotting and immunohistochemistry were used to study the expression and localization of NKCC2 in the rat gastrointestinal tract. We found that mRNA transcripts, protein and immunoreactivity (IR) for NKCC2 were expressed in the stomach, small and large intestine of adult rats. NKCC2 IR was localized to the base of the gastric glands, intestinal epithelia, myenteric and submucosal plexuses. NKCC2 IR was expressed strongly in the apical membranes and weakly in the basolateral membranes of intestinal epithelial cells. In the enteric nervous system, NKCC2 IR was widely distributed and localized to enteric neurons with cholinergic, calretinin and nitrergic neuronal immunochemical codes in the myenteric plexus. It was localized to non-cholinergic secretomotor neurons in the submucosal plexus. In conclusion, this study for the first time clearly detected the expression of NKCC2 in the gastrointestinal tract of a mammalian species. Expression of NKCC2 in gastrointestinal epithelial cells suggested that this cation chloride cotransporter might be involved in gastrointestinal ion transport. Expression of NKCC2 in enteric neurons might contribute to the accumulation of Cl(-) and a more depolarized E(Cl)(-) in enteric neurons.

Sorafenib induces growth inhibition and apoptosis in human synovial sarcoma cells via inhibiting the RAF/MEK/ERK signaling pathway

Synovial sarcoma is a soft tissue sarcoma with poor prognosis and lack of response to conventional cytotoxic chemotherapy. The regulatory mechanisms for the rapid proliferation of synovial sarcoma cells and the particular aggressiveness of this sarcoma remain poorly understood. Mitogen-activated protein kinase (MAPK) cascades have been shown to play important roles in synovial sarcoma survival. Sorafenib (Nexavar, BAY 43-9006), a potent recombinant activated factor (RAF) inhibitor, inhibits the MAPK signaling pathway both in vitro and in vivo. In this study, we examined the inhibitory proliferation effects of sorafenib in synovial sarcoma growth and evaluated whether sorafenib modulates MAPK and tumor apoptosis cascades in human synovial sarcoma cell lines SW982 and HS-SY-II. Our results indicated that sorafenib effectively inhibited cellular proliferation and induces apoptosis of these two cells. Sorafenib inhibited the phosphorylation of MEK and ERK, downregulated cyclin D1 and Rb levels, caused G(1) arrest and S phase decrease, and induced apoptosis as confirmed by flow cytometry and the TUNEL assay. Furthermore, Bcl-xl and Mcl-1 levels significantly decreased, whereas expression levels of the proteins bcl-2 and bax were unchanged in response to sorafenib treatment in SW982 and HS-SY-II cells. In conclusion, our findings demonstrate that sorafenib is effective for growth inhibition of synovial sarcoma cell lines in vitro and suggest that sorafenib may be a new therapeutic option for patients with synovial sarcoma.

[Culture optimization and characterization of an alginate-lyase from Pseudoalteromonas sp. LJ1]

OBJECTIVES

The present work aimed to optimize the culture conditions to produce extracellular alginate-lyase by Pseudoalteromonas sp. LJ1.

METHODS

A bacterial alginate-lyase producing strain LJ1 was isolated from Laminaria japonica by enrichment culture technique. The strain was identified based on phenotypic characters, fatty acid compositions and 16S rRNA gene sequencing. Culture conditions were optimized to produce the extracellular alginate-lyase by the single factor and orthogonal tests.

RESULTS

Strain LJ1 was identified as Pseudoalteromonas sp.. The optimal medium components were: sodium alginate 3 g/L, (NH4)2SO4 3 g/L, NaCl 20 g/L, KH2PO4 0.1 g/L, CaCl2 0.1 g/L; The optimal culture conditions were: 25 ml medium in 250 mL Erlenmeyer flask, inoculum's volume 3%, shaking speed of 150 r/min, initial pH 7.5, at 28 degrees C for 24 h. The enzyme exhibited maximal activity at pH 7.6, 40 degrees C and NaCl 0.3 mol/L. The enzyme activity was improved by Mg2+, and inhibited by Co2+ and Zn2+ at 1 mol/L.

CONCLUSIONS

Strain LJ1 was a novel alginate-lyase producing bacterium of Pseudoalteromonas.

Risk factors for blood loss during sacral tumor resection

Extensive hemorrhage is a serious complication during sacral tumor resection. Identifying the risk factors predicting the possibility of extensive hemorrhage would be important to predict which patients would need large amounts of transfused blood intraoperatively and postoperatively and which patients would need blood control by vascular occlusion. We retrospectively reviewed 173 patients who underwent sacral tumor resection performed at our institute between 2003 and 2007. Patients with an estimated total blood loss greater than 3000 mL were classified as having a large amount of blood loss. Sixty-nine (39.88%) patients had blood loss greater than 3000 mL. Male gender, excessive tumor blood supply, tumors involving the S2 body and cephalad to the S2 body, tumor volume greater than 200 cm(3), aorta occlusion, surgical approach, reconstruction, and operative time were associated with a large amount of blood loss. Tumors cephalad to the S2-S3 disc space (odds ratio, 3.840), tumor volume greater than 200 cm(3) (odds ratio, 3.381), and excessive blood supply (odds ratio, 2.281) independently predicted a large amount of blood loss. Sacral tumors that invaded cephalad to the S2-S3 disc space with a volume greater than 200 cm(3) and an excessive blood supply were likely to have a large amount of blood loss during resection.

LEVEL OF EVIDENCE

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Evaluation of blood loss during limb salvage surgery for pelvic tumours

As a large amount of blood loss is sometimes encountered in limb salvage procedures for pelvic tumours, it is essential to identify risk factors predicting the possibility of extensive haemorrhage. We retrospectively reviewed 137 patients who underwent pelvic tumour resections. Patients with an estimated blood loss greater than 3,000 ml were classified as having a large amount of blood loss. Sixty-one (44.53%) patients had blood loss greater than 3,000 ml. Tumours involving the acetabulum or sacrum, tumour volume greater than 400 cm(3), aorta occlusion, resection method, reconstruction and operative time were all associated with a large amount of blood loss. Pelvic tumours involving the acetabulum or sacrum (odds ratio: 4.837), tumour volume greater than 400 cm(3) (odds ratio: 3.005) and planned operation time of more than 200 min (odds ratio: 3.784) independently predicted a large amount of blood loss. Pelvic tumours with these characteristics were likely to have a large amount of blood loss during surgery.

[Reconstruction of bony defect after resection of malignant pelvic tumor involvement of sacrum]

OBJECTIVES

To review the patients with malignant pelvic tumors involving sacrum treated surgically and to discuss the methods of resection of tumors and reconstruction of defects.

METHODS

Nineteen patients with malignant pelvic tumors involving the sacrum were treated surgically in People's Hospital between July 1999 and July 2007. The series comprised 12 males and 7 females. Five patients were diagnosed with chondrosarcoma, 4 with Ewing sarcoma, 4 with osteosarcoma, 1 with malignant fibrohistiocytoma (MFH), 1 with giant cell tumor (GCT), and 4 with metastatic bone tumors. Acetabulum was preserved after resection of the iliac and sacral tumor and reconstructed with screw and rod system in 10 patients. Among this 10 patients, 5 of them were also done bone graft. Acetabulum was not preserved after resection of the iliac and sacral tumor and the defect was reconstructed with modular hemipelvic prosthesis in 9 patients.

RESULTS

Oncology result: 7 patients (7/19, 36.9%) had local relapse, including of 2 osteosarcoma, 2 chondrosarcoma, 2 Ewing sarcoma and 1 metastatic tumor. Two of 4 osteosarcoma, 2 of 4 Ewing sarcoma, 1 of 5 chondrosarcoma and 1 MFH patients died of lung metastasis. Two patients with metastatic lung cancer died of the disease 1 year after surgery. One patient with kidney carcinoma and 1 with thyroid carcinoma alive without of disease. Functional result: 8 patients with acetabular reconstruction after resection of pelvic and sacral tumors could walk with a cane 2 months after surgery. Average ISOLS function score was 20, including good in 3, fair in 5 and poor in 1 patient. One of the patient with modular hemipelvic prosthetic reconstruction occurred dislocation treated with 1 month after surgery and experienced open reduction. Hemipelvic prosthesis was took out in 1 patient because of the deep infection.

CONCLUSIONS

For patients with acetabulum preserved after resection of the iliac and sacral tumor, reconstructed with screw and rod system combining with bone graft is an ideal method for restoration. Bone graft with resected femoral head and neck on residual sacrum and modular hemipelvic prosthetic reconstruction after resection of the pelvic tumor involving of the secrum is a good choose.

[Total elbow arthroplasty after resection of tumors at the elbow]

OBJECTIVE

To explore the effects and complications of the total elbow arthroplasty after the resection of the peri-elbow tumor.

METHODS

Between June 1998 to June 2007, 19 patients underwent total elbow arthroplasty after resection of tumors at the authors department, which involved 13 males and 6 females, including 6 patients with metastatic tumor, 1 with giant cell tumor of bone (GCT), 2 with malignant fibrous histiocytoma (MFH), 4 with osteosarcoma, 3 with Ewing sarcoma, l with lymphoma, 1 with synovial sarcoma, and 1 with desmoid fibroma of the bone. The age of patients ranged from 15 to 71 years (mean 43 years).

LOCATION

distal humerus in 9 cases, proximal ulna in 5 and the tumor involving both distal humerus and proximal ulna in 5 patients.

RESULTS

Patients were evaluated according to the Mayo Elbow Performance Score. Pain scores decreased from a mean of 3.6 to 2.0. Mean arc of elbow motion from extention to flexion improved from 30 to 80 (range, 55 - 105). Fourteen elbows had excellent or good result (14/19, 77.8%), and 4 elbows had a poor result (22.2%). There was no wound infection or other complication after surgery. During the following up time, 2 patients with metastatic lung cancer, 1 with metastatic rectal cancer and 1 with ovarian cancer died in 2 years after surgery. Two Ewing sarcoma, 1 MFH and 1 osteosarcoma patients occurred lung metastasis (4/18, 22.2%), and two patients had local recurrence (11.1%). Three patients occurred complication during the following time (3/18, 16.7%), the stem of humerus prosthesis came out of channel in 1 case 5 years after surgery, the stem of ulna prosthesis came out of channel in 1 case 4 years after surgery, and both cases did revision surgery. The stem loosening was in 1 humerus prosthesis 4 years after surgery.

CONCLUSIONS

The results show that total elbow arthroplasty after resection of tumors can decrease the pain, and improve the function substantially. For metastatic tumors, this technique also can be used if there is no other good option.

Endoprosthetic replacement for primary tumours around the knee: experience from Peking University

In developing countries locally-made low-cost prostheses are mainly used in limb-salvage surgery to alleviate the economic burden. We retrospectively collected data on 104 patients treated by limb-salvage surgery between July 1997 and July 2005. We used a locally-designed and fabricated stainless-steel endoprosthesis in each case. Oncological and functional outcomes were evaluated at a mean follow-up of 47 months (12 to 118). A total of 73 patients (70.2%) were free from disease, nine (8.7%) were alive with disease, 19 (18.2%) had died from their disease and three (2.9%) from unrelated causes. According to the Musculoskeletal Tumor Society scoring system, the mean functional score was 76.3% (SD 17.8). The five-year survival for the implant was 70.5%. There were nine cases (8.7%) of infection, seven early and two late, seven (6.7%) of breakage of the prosthesis, three (2.9%) of aseptic loosening and two (1.9%) of failure of the polyethylene bushing. Multivariate analysis showed that a proximal tibial prosthesis and a resection length of 14 cm or more were significant negative prognostic factors. Our survival rates and Musculoskeletal Tumor Society functional scores are similar to those reported in the literature. Although longer follow-up is needed to confirm our results, we believe that a low-cost custom-made endoprosthesis is a cost-effective and reliable reconstructive option for limb salvage in developing countries.

Decreased nerve distribution in mixed venous-lymphatic malformation

In order to investigate the nerve distribution in mixed venous-lymphatic malformations (MVLMs), 57 postoperative patients diagnosed with MVLMs of the tongue were selected. Immunohistochemistry staining for neurofilament (NF) was used to detect sensory nerve fibers. Distribution of NF in samples from MVLMs was compared with distribution of NF in normal tongue tissue, venous malformations, lymphatic malformations and venular malformations. Results showed that the number of NF-positive nerve fibers in MVLMs was comparable to that in venous malformations and lymphatic malformations. The number of nerve fibers in MVLMs was significantly lower than in normal tissues. NF distribution in MVLMs was not affected by the patient's age or the coexistence of infection. These data suggest that the decreased distribution of sensory nerve fibers in MVLMs may be involved in the pathogenesis of MVLM of the tongue.

Effects of tumor necrosis factor-α inhibitor on cell apoptosis and expression of Caspase-3 in rats with severe acute pancreatitis

AIM: To investigate the relationship between the pancreatitis cell apoptosis , Caspase-3 expression and disease severity in severe acute pancreatitis (SAP) rats.

METHODS: Forty SD rats were randomly divided into SAP group treated with retrograde injection of sodium taurocholate (n = 20), and experimental group (intervention group, SAP animal model was developed, the recombinant human necrosis factor-alpha receptor II: IgG Fc fusion protein was injected, n = 20). Serum amylase and TNF-α were detected. And Caspase-3 expression was measured using immunohistochemitry. And the apoptosis of pancreatic cells were detected using TUNEL and the pathological score of pancreatic tissue was estimated.

RESULTS: Serum amylase, TNF-α and pathological scores of pancreatic tissues were lower (6868.80 ± 595.50 U/L vs 5434.20 ± 481.52 U/L, 258.46 ± 38.57 ng/L vs 182.00±19.67 ng/L, 15.54 ± 2.30 vs 11.06 ± 1.09, all P < 0.05), and the positive rate of Caspase-3 and the apoptotic index of pancreatic cells increased significantly in the intervention group than in the SAP group (20.06 ± 2.17 vs 28.52 ± 3.74, 10.42 ± 1.27 vs 16.23 ± 2.43, both P < 0.05).

CONCLUSION: Pancreatic cell apoptosis is associated with increased expression of the Caspase-3, improved the inflammatory response and lowered pancreatic tissue pathological score in rats with severe acute pancreatitis.

Benzyl 2,5-dioxopyrrolidin-1-yl carbonate

The asymmetric unit of the title compound, C₁₂H₁₁NO₅, contains two independent mol­ecules with similar geometric parameters but different orientations of the phenyl rings. The mol­ecular packing is stabilized by weak nonclassical C—H⋯O hydrogen-bonding inter­actions.

Protein targets of reactive metabolites of thiobenzamide in rat liver in vivo

Thiobenzamide (TB) is a potent hepatotoxin in rats, causing dose-dependent hyperbilirubinemia, steatosis, and centrolobular necrosis. These effects arise subsequent to and appear to result from the covalent binding of the iminosulfinic acid metabolite of TB to cellular proteins and phosphatidylethanolamine lipids [ Ji et al. ( 2007) Chem. Res. Toxicol. 20, 701- 708 ]. To better understand the relationship between the protein covalent binding and the toxicity of TB, we investigated the chemistry of the adduction process and the identity of the target proteins. Cytosolic and microsomal proteins isolated from the livers of rats treated with a hepatotoxic dose of [ carboxyl- (14)C]TB contained high levels of covalently bound radioactivity (25.6 and 36.8 nmol equiv/mg protein, respectively). These proteins were fractionated by two-dimensional gel electrophoresis, and radioactive spots (154 cytosolic and 118 microsomal) were located by phosphorimaging. Corresponding spots from animals treated with a 1:1 mixture of TB and TB- d 5 were similarly separated, the spots were excised, and the proteins were digested in gel with trypsin. Peptide mass mapping identified 42 cytosolic and 24 microsomal proteins, many of which appeared in more than one spot on the gel; however, only a few spots contained more than one identifiable protein. Eighty-six peptides carrying either a benzoyl or a benzimidoyl adduct on a lysine side chain were clearly recognized by their d 0/ d 5 isotopic signature (sometimes both in the same digest). Because model studies showed that benzoyl adducts do not arise by hydrolysis of benzimidoyl adducts, it was proposed that TB undergoes S-oxidation twice to form iminosulfinic acid 4 [PhC(NH)SO 2H], which either benzimidoylates a lysine side chain or undergoes hydrolysis to 9 [PhC(O)SO 2H] and then benzoylates a lysine side chain. The proteins modified by TB metabolites serve a range of biological functions and form a set that overlaps partly with the sets of proteins known to be modified by several other metabolically activated hepatotoxins. The relationship of the adduction of these target proteins to the cytotoxicity of reactive metabolites is discussed in terms of three currently popular mechanisms of toxicity: inhibition of enzymes important to the maintenance of cellular energy and homeostasis, the unfolded protein response, and interference with kinase-based signaling pathways that affect cell survival.

Characterization of free flavor compounds in traminette grape and their relationship to vineyard training system and location

Free volatile flavor compounds in Traminette grape were characterized and compared to those in benchmark white cultivars by gas chromatography-mass spectrometry with headspace solid phase microextraction. In addition, the effects of vineyard site location (hot compared with cool based on growing degree days) and various training systems on yield components, standard characteristics (Brix, pH, and TA), and flavor compounds in Traminette grape juice were also evaluated for 2 seasons. Twenty-two free volatiles were identified in Traminette juice. The most abundant volatile compounds included hexanal, trans-2-hexenal, linalool, nerol, and geraniol. These compounds were quantified and compared with those in Chardonnay, Gewürztraminer, and Riesling juice. The hexanal concentration was the highest in Chardonnay, and trans-2-hexenal concentration was the lowest in Riesling. Traminette contained the highest amount of monoterpenes, especially geraniol. Concentrations of free volatile compounds in Traminette varied between the hot site and the cool site. In fact, the concentrations of 6-carbon aldehydes were higher in Traminette grown in the cool site than those grown in the hot site, whereas monoterpenes were higher in the hot site than in the cool site. Among the 5 training systems, vines on the vertical shoot-positioned produced the highest amount of monoterpenes, specifically geraniol. Our study suggests that Traminette is a flavorful cultivar that contains free volatile flavor compounds similar to the parent Gewürztraminer, but at much higher concentrations. The accumulation of odor chemicals in Traminette was affected by vineyard location and training system. Finally, geraniol was the most characteristic odor in Traminette, and its presence can be used as a quality indicator for this cultivar.

[Surgical treatment and outcome of pelvic metastases]

OBJECTIVE

To retrospectively review the different types of surgical procedures for pelvic metastases, especially for periacetabular metastases.

METHODS

Eighty-eight patients with pelvic metastasis received surgical treatment between July 1997 and July 2005. The series included 40 females and 48 males, with an average age of 54 years. The original sites of carcinoma included 23 from breast, 15 from lung, 13 form kidney, 3 from thyroid, 2 from bladder, 3 from prostate, 3 form liver, 7 from gastro intestine, and 3 from gynecological viscera Thirteen cases were diagnosed as unknown primary metastases. Thirty-two patients had solitary metastasis and 56 patients had multiple bone metastases. Eighteen patients had Type I pelvic resections, 50 had type II, and 10 patients had Type III and Type IV each. Surgical treatments included 72 intralesional curettages and 16 en bloc resections. In 29 patients, the bone defect after tumor resection was reconstructed with methyl acrylate alone or combined with Steinmann pins and screw-rod system. Acetabular reconstructions underwent in 50 patients. Local resections with no reconstructions were done in 5 patients, and hemipelvectomy in 4 patients.

RESULTS

The mean time of follow-up was 13 months, ranging from 6 to 24 months. Twenty-nine patients were lost follow-up. Postoperative improvements in 86 (97.8%) patients were seen in pain and mobility scores. The average VAS pain scores were 7.2 points preoperatively and 3.5 points postoperatively. Postoperative function was evaluated according to Enneking's criteria, with a mean score of 19.2 points, including 16.4 points for periacetabular lesions and 23.5 for others. Local recurrence was seen in 11 patients, the average recurrence time was 5.6 months after surgery. Surgical complications occurred in 12 patients, including 8 wound complications, 2 multi-organ function failures, 1 pulmonary embolism, and 2 dislocations.

CONCLUSIONS

The indications of surgical intervention for pelvic metastasis are severe pain and difficulty in ambulation. The surgical objective is alleviation of pain, restore the mobility and stability of the hip. The surgical procedure for most metastases is curettage and cement filling. Wide resection is an alternative method for solitary pelvic metastasis with good prognosis.

[The analysis of the treatment of giant cell tumor of the pelvis and sacrum]

OBJECTIVE

To discuss the surgical management, local recurrence rate and complications of giant cell tumor (GCTs) of the pelvic and sacrum.

METHODS

From December 1997 to December 2005 the data of 46 patients of GCTs of pelvic and sacrum treated were reviewed. There were 25 men and 21 women with the average age of 32 years old ranging from 17 to 64. Out of 46 patients,there were 24 tumors involved the sacrum and the others at the pelvis. According to the site of the tumors on the bone, they was classified into three regions: 8 patients involved region I (ilium), 10 region II (acetabulum) and 4 region III (ischiopubic). Two patients had lesions located at S(1-5), 4 at S(1-4), 12 at S(1-3), 5 at S(1-2) and 1 at S(3-5). Surgical management: 2 patients received 3 times of operations and 7 underwent 2 operations. There were 19 patients managed with intralesional marginal excision and 2 patients with intralesional marginal excision and adjuvant radiotherapy, another 3 patients with widely marginal excision as the treatment of sacral lesions. Nineteen patients underwent the enbloc excision except 2 involved ischium and 1 involved ilium for the managements of pelvic lesions.

RESULTS

One recurrent patient with the large, ragged tumor died of serious infection in 2 weeks after the second surgery. The remain 45 patients had followed-up durations ranging from 12 months to 8 years. One patient of malignant giant cell tumor of sacrum died at 15 months after surgery. One patient with postoperation sarcoma underwent reoperation and radiotherapy but died at the 13th month. One patient with sacral lesion occurred pulmonary metastases in two years after surgery, and received chemotherapy with ADM, DDP and IFO. One year later there was no much change in metastatic tumor. One patient with acetabular lesion underwent curettage before local recurrence and pulmonary metastases were found in 2 years. The patient was treated with pulmonary radiation, widely marginal excision and hemi-pelvic prostheses reconstruction. There was no progression in metastatic lesion during the following up. The local recurrence rate of GCT at sacrum was 9/24 (37.5%), and at pelvis was 2/22 (9.1%). However, 2 patients with ischium lesions both recurred after curettage. Nineteen lesions with enbloc excision showed no recurrence at all.

CONCLUSIONS

The treatment for GCT of the pelvic and sacrum should be more aggressive because of high incidence of local recurrence after intralesional excision. Although it might induce sacral nerve deficit, widely marginal excision is the best surgical procedure because of its low recurrence rate.

Reconstruction with modular hemipelvic prostheses for periacetabular tumor

Periacetabular resections for primary bone sarcoma and metastatic disease require reconstruction to restore weight-bearing along anatomic axes. We designed a modular hemipelvic prosthetic system to reconstruct the pelvis and evaluated the early clinical outcome of the prosthesis using 3-year survival rate, local recurrence rate, Musculoskeletal Tumor Society (MSTS) 93 function score, and complications. We retrospectively reviewed 28 patients who had pelvic tumor resections and reconstructions using the new hemipelvic prostheses between 2001 and 2005. Sixteen (57.1%) patients had Types II and III (periacetabular and pubis) pelvic resections, seven had Types I and II (periacetabular and ilium) pelvic resections, and five had Type II (periacetabular) pelvic resection. Six patients with osteosarcoma had chemotherapy. None received radiation therapy. Patient survival status, function, and complications were evaluated at a mean followup of 30 months (range, 10-59 months). Fifteen patients were free of disease, eight patients died of disease, and five patients were alive with disease. The overall survival rate was 67.1% at 3 years. Twenty-five percent had local recurrence and 21% had metastasis. The mean MSTS 93 score was 60. Deep infection occurred in four patients; dislocation occurred in one patient. The results are encouraging because of the acceptable complication rate and satisfactory functional outcome.

[Limb salvage surgery for osteosarcoma around the knee in children and adolescent patients]

OBJECTIVE

To discuss the reconstruction methods and treatment effects of osteosarcoma around the knee in skeletal immature children and adolescent patients.

METHODS

Between October 1996 and December 2005, 89 children and adolescent patients with osteosarcoma around the knee received limb salvage surgery. The average age was 13 years old. Tumor involved distal femur in 52 cases, proximal tibia in 36 cases, and both parts in one patient. Different limb salvage methods, including tumor recycle bone reimplantation (n = 20), partial endoprosthesis (n = 19) and total knee megaprosthesis replacement (n = 50) were chosen according to both the age of the patient and the skeletal. Expandable and special designed pediatric prosthesis some times might also be considered.

RESULTS

After average follow up of 42 months, 4 cases of local recurrence and 11 of metastasis occurred in tumor recycle bone group; 1 case of local recurrence and 4 of metastasis in partial endoprosthesis group; another 4 cases of local recurrence and 9 patients died of disease in total knee megaprosthesis group. The five-year survival rate was 47.1%, 71.7% and 68.2% in 3 groups respectively. There were 3 deep infections in all the cases, 2 subluxations and 1 amputation after operation for limb ischemia in partial endoprosthesis group. The average functional score of MSTS 93 was 21.43 point, 23.40 point and 25.32 point; and the average leg length discrepancy was 5.48, 4.50 and 3.12 cm in 3 groups respectively.

CONCLUSIONS

Partial-joint prosthesis or other methods which can avoid injury of the opposite epiphysis should be used to decrease the possibility of limb length discrepancy and ease the following revised arthroplasty. For patient with almost mature skeletal, total knee megaprosthesis may be a proper choice for better function result.

[Endoprosthetic reconstruction after resection of the tumor of the proximal femur]

OBJECTIVE

To evaluate the outcome and complications of endoprosthetic reconstruction after wide tumor excision on the patients with neoplasms at the proximal femur.

METHODS

Between July 1998 and July 2005, 81 patients with tumor of the proximal femur were treated by wide excision and endoprosthetic reconstruction. Nine cases received devitalized bone and prosthesis composite reconstruction (among them, 3 patients of fibrous dysplasia had long stem bipolar hip replacement) and 5 cases had allograft prosthesis composite replacement. Two cycles of neoadjuvant chemotherapy were given to all the cases of osteosarcoma and Ewing sarcoma. The functional outcomes were evaluated by MSTS 93 score.

RESULTS

Among the 30 patients with metastatic tumor, because all of them were transferred to related department to receive chemotherapy or radiotherapy after surgery, the follow-up was not doing well and the rate of local recurrence was not confirmed. Five patients with metastatic tumors died in 3 months after surgery. Most patients had excellent or good function postoperatively, the average MSTS 93 score was 25 in 6 months after surgery. Among the 51 patients with primary tumor, 2 patients had chronic infection and 2 patients had loosening of the prosthesis during the following time. Allograft bone and host bone nonunion were seen in 2 cases. Two patients with bipolar hip replacement had severe acetabulum abrasion. The other 3 patients also received total hip replacement for hip pain after walk. Five patients had local recurrence 6 months to 2 years postoperatively.

CONCLUSIONS

Because of low complication rate and good postoperative function, endoprosthetic replacement is a good option for reconstruction of the proximal femur after tumor resection.

Covalent modification of microsomal lipids by thiobenzamide metabolites in vivo

Thiobenzamide (TB) is hepatotoxic in rats causing centrolobular necrosis, steatosis, cholestasis, and hyperbilirubinemia. It serves as a model compound for a number of thiocarbonyl compounds that undergo oxidative bioactivation to chemically reactive metabolites. The hepatotoxicity of TB is strongly dependent on the electronic character of substituents in the meta- and para-positions, with Hammett rho values ranging from -4 to -2. On the other hand, ortho substituents that hinder nucleophilic addition to the benzylic carbon of S-oxidized TB metabolites abrogate the toxicity and protein covalent binding of TB. This strong linkage between the chemistry of TB and its metabolites and their toxicity suggests that this model is a good one for probing the overall mechanism of chemically induced biological responses. While investigating the protein covalent binding of TB metabolites, we noticed an unusually large amount of radioactivity associated with the lipid fraction of rat liver microsomes. Thin-layer chromatography showed that most of the radioactivity was contained in a single spot more polar than the neutral lipids but less polar than the phospholipid fractions. Mass spectral analyses aided by the use of synthetic standards identified the material as N-benzimidoyl derivatives of typical microsomal phosphatidylethanolamine (PE) lipids. Quantitative analysis indicated that up to 25% of total microsomal PE became modified within 5 h after a hepatotoxic dose of TB. Further studies will be required to determine the contribution of lipid modification to the hepatotoxicity of TB.