The Feasibility of Fast, Four-Dimensional Computed Tomography-Based O-Ring Linac Plans for Stereotactic Body Radiotherapy in Patients with Poor Performance Status

PURPOSE/OBJECTIVE(S)

As patients with poor performance status cannot endure long treatment times, it can lead to unplanned and prolonged radiation treatment or discontinuation of treatment. Moreover, prolonged radiation treatment appears to negatively affect survival for patients. We aimed to verify the feasibility of fast 4DCT-based O-ring linear accelerator (LINAC) treatment in lung 4D stereotactic body radiotherapy (SBRT).

MATERIALS/METHODS

This study included data of 38 patients who received lung 4D-SBRT. Gating20-70% plans were based on 4DCT data obtained at phase values ranging from 20-70% using a C-arm LINAC. Non-GatingFB plans were retrospectively established based on 4DCT data obtained at phase values of 0-90% using an O-ring LINAC. The prescribed dose of 4,800 cGy was delivered to PTV in four fractions. The conformity index (CI), homogeneity index (HI), and gradient measurement (GM) of the PTV were analyzed to compare dosimetric data between Gating20-70% and Non-GatingFB plans. Organs at risks (OARs) were analyzed in accordance with the RTOG 0915 protocol. Treatment delivery time and total monitor units (MU) were analyzed to compare the efficiency of treatment delivery. Statistical comparisons were performed using the Wilcoxon signed-rank test (p<0.05).

RESULTS

For the PTV, there was no significant difference in the CI or HI between Gating20-70% and Non-GatingFB plans (CI: 1.337±0.137, 1.335±0.174, HI: 0.939±0.015, 0.939±0.016, all at p>0.05). However, there was a significant difference in GM between Gating20-70% and Non-GatingFB plan (1.528±0.206 cm, 1.381±0.222 cm, p<0.001). For OARs, all plans met the criteria for dose constraint. There was a significant difference between Gating20-70% and Non-GatingFB plans except in the spinal cord. In particular, D1000cc and D1500cc values for the ipsilateral lung for Gating20-70% plans were 31.6% and 59.9% lower than those for Non-GatingFB plans (D1000cc: 50.780±132.061 cGy, 34.755±102.480 cGy, p<0.001, D1500cc: 6.641±14.598 cGy, 2.666±7.926 cGy, p<0.001). Treatment delivery time was 92% longer for Gating20-70% plans than for Non-GatingFB plans (5.0±0.4 min, 9.6±3.3 min, p = 0.043). The total MU value for Gating20-70% plans was 9.6% higher than that for Non-GatingFB plans (3665.8±230.7, 4016±236.9, p = 0.039).

CONCLUSION

When compared to OARs both plans were acceptable per RTOG-0915 protocol, but significant differences were between Non-GatingFB and Gating20-70% plans. However, treatment delivery time of Non-GatingFB plans decreased by 47.9% than Gating20-70% plans. We verified the feasibility of fast 4DCT-based O-ring LINAC treatment for patients who cannot endure long treatment times due to poor performance status in lung 4D-SBRT. In further study, we will analyze dosimetric differences and treatment delivery efficiency considering tumor motion according to tumor location.

Perceived social loafing congruence between leaders and members: Effect on performance

I measured social loafing as perceived by leaders and members independently, and assessed the effect of each party's perception of members' social loafing on the leader–member exchange relationship, in-role performance, organizational citizenship behavior, and knowledge-sharing behavior. Participants were 333 leader–member dyads from 12 organizations in South Korea, and data were collected in two waves. I performed polynomial regression and response surface analyses and tested the mediating effect of leader–member exchange. As hypothesized, perceived social loafing congruence had a direct effect on leader–member exchange, and an indirect effect via leader–member exchange on in-role performance, organizational citizenship behavior, and knowledge-sharing behavior. Theoretical and practical implications of congruence in perceptions of social loafing are discussed.

Psychological Well-Being, Knowledge Management Behavior and Performance: The Moderating Role of Leader-Member Exchange

Knowledge is considered an essential resource and key to competitiveness. The behavior of sharing knowledge is an essential activity for the prosperity of the organization. For individuals, however, sharing knowledge can present a dilemma by giving up the exclusive right to certain knowledge that they own. This study identifies the psychological well-being as a leading factor in facilitating knowledge-sharing in dilemma situations. The author classified knowledge management behavior into sharing, hiding, and manipulating behavior, and studied them as mediators linking psychological well-being and performance. And to check the influence of the quality of the exchange relationship, leader-member exchange was used as a moderator. For the empirical analysis, 333 members from 12 organizations were surveyed by using different sources and times. Hierarchical regression analysis and bootstrapping analysis were conducted for verification of hypothesis. Results demonstrated that the psychological well-being influence directly on knowledge-sharing, -hiding, and -manipulating behaviors and indirectly on performance. In the multi-mediation test, only knowledge-sharing behavior mediated the relationship between psychological well-being and performance. And the moderating effect of leader-member exchange was significant only in the relationship between psychological well-being and knowledge-sharing behavior. This study contributes to the performance, knowledge management and positive psychology research fields, and suggests practical implications.

Increased compliance with tumor treating fields therapy is prognostic for improved survival in the treatment of glioblastoma: a subgroup analysis of the EF-14 phase III trial

BACKGROUND

Tumor treating fields (TTFields) is a non-invasive, antimitotic therapy. In the EF-14 phase 3 trial in newly diagnosed glioblastoma, TTFields plus temozolomide (TTFields/TMZ) improved progression free (PFS) and overall survival (OS) versus TMZ alone. Previous data indicate a ≥ 75% daily compliance improves outcomes. We analyzed compliance data from TTFields/TMZ patients in the EF-14 study to correlate TTFields compliance with PFS and OS and identify potential lower boundary for compliance with improved clinical outcomes.

METHODS

Compliance was assessed by usage data from the NovoTTF-100A device and calculated as percentage per month of TTFields delivery. TTFields/TMZ patients were segregated into subgroups by percent monthly compliance. A Cox proportional hazard model controlled for sex, extent of resection, MGMT methylation status, age, region, and performance status was used to investigate the effect of compliance on PFS and OS.

RESULTS

A threshold value of 50% compliance with TTFields/TMZ improved PFS (HR 0.70, 95% CI 0.47-1.05) and OS (HR 0.67, 95% CI 0.45-0.99) versus TMZ alone with improved outcome as compliance increased. At compliance > 90%, median survival was 24.9 months (28.7 months from diagnosis) and 5-year survival rate was 29.3%. Compliance was independent of gender, extent of resection, MGMT methylation status, age, region and performance status (HR 0.78; p = 0.031; OS at compliance ≥ 75% vs. < 75%).

CONCLUSION

A compliance threshold of 50% with TTFields/TMZ correlated with significantly improved OS and PFS versus TMZ alone. Patients with compliance > 90% showed extended median and 5-year survival rates. Increased compliance with TTFields therapy is independently prognostic for improved survival in glioblastoma.

Augmentation of Butyrate-induced Differentiation of Human Hepatocyte by Cyclin E Over-expression

In mammalian cells, cellular differentiation into specific cell types is usually preceded by growth arrest. On the other hand, the induced differentiation may also be preceded by an enhanced G1–S transition of the cell cycle prior to the growth arrest. This suggests that an early increase in proliferation is in some way a prerequisite for subsequent differentiation. We therefore attempted to assess whether we could produce human hepatocytes with further differentiated functions by promoting G1-S transition in a butyrate-treated human hepatocyte cell line. A cyclin E-over-expressing cell line was established by transfecting human cyclin E cDNA. Upon butyrate treatment, the cyclin E-over-expressing cells exhibited a significantly increased albumin-secreting and ammonia-detoxifying capacity when compared to the control cells. In particular, the ornithine transcarbamylase activity was increased in these cells. Collectively, these results implicate that the cyclin E over-expression may augment the hepatocyte-specific functions during the butyrate-induced differentiation process of human hepatocytes by enhancing G1-S cell cycle transition.

Hemorrhage risk with transjugular intrahepatic portosystemic shunt (TIPS) insertion at the main portal vein bifurcation with stent grafts

PURPOSE

The purpose of this study was to assess the incidence of major hemorrhage after transjugular intrahepatic portosystemic shunt (TIPS) insertion using a stent graft at the main portal vein bifurcation.

PATIENTS AND METHODS

TIPS insertion using stent grafts was performed in 215 patients due to non-variceal hemorrhage indications. There were 137 men and 78 women, with a mean age of 57 years±10.6 (SD) (range: 19-90 years). Based on retrospective review of portal venograms, TIPS inserted within 5mm from the portal vein bifurcation were considered "bifurcation TIPS", while those inserted 2cm or greater from the bifurcation were considered intrahepatic. Suspicion for acute major periprocedural hemorrhage were categorized as low, moderate, and high, based on the number of signs of hemorrhage.

RESULTS

Of 215 TIPS inserted for purposes other than hemorrhage, the TIPS was inserted at the portal bifurcation in 41 patients (29 men, 12 women; mean age, 55.9±11.7 (SD); range: 26-79 years) and intrahepatic in 62 patients (37 men, 25 women; mean age, 57.6±10.6 (SD), range: 34-82 years), whereas 112 were indeterminate in location. No active extravasations were identified on post-TIPS portal venograms. Suspicion for acute major hemorrhage was moderate or high in 3/41 (7%) of patients in the TIPS bifurcation group compared to 5/62 (8%) in the intrahepatic TIPS group (P>0.99). There were no significant differences in 30-day mortality rates (1/41 [2%] and 3/62 [5%] respectively; P> 0.99). No deaths or interventions were attributed to acute hemorrhage.

CONCLUSION

TIPS insertion at the portal bifurcation with stent grafts did not incur an elevated risk of hemorrhagic complications.

Onion (Allium cepa L.) peel extract (OPE) regulates human sperm motility via protein kinase C-mediated activation of the human voltage-gated proton channel

Onion (Allium cepa L.) and quercetin protect against oxidative damage and have positive effects on multiple functional parameters of spermatozoa, including viability and motility. However, the associated underlying mechanisms of action have not yet been identified. The aim of this study was to investigate the effect of onion peel extract (OPE) on voltage-gated proton (Hv1) channels, which play a critical role in rapid proton extrusion. This process underlies a wide range of physiological processes, particularly male fertility. The whole-cell patch-clamp technique was used to record the changes in Hv1 currents in HEK293 cells transiently transfected with human Hv1 (HVCN1). The effects of OPE on human sperm motility were also analyzed. OPE significantly activated the outward-rectifying proton currents in a concentration-dependent manner, with an EC₅₀ value of 30 μg/mL. This effect was largely reversible upon washout. Moreover, OPE induced an increase in the proton current amplitude and decreased the time constant of activation at 0 mV from 4.9 ± 1.7 to 0.6 ± 0.1 sec (n = 6). In the presence of OPE, the half-activation voltage (V_1/2 ) shifted in the negative direction, from 20.1 ± 5.8 to 5.2 ± 8.7 mV (n = 6), but the slope was not significantly altered. The OPE-induced current was profoundly inhibited by 10 μm Zn²⁺ , the most potent Hv1 channel inhibitor, and was also inhibited by treatment with GF109203X, a specific protein kinase C (PKC) inhibitor. Furthermore, sperm motility was significantly increased in the OPE-treated groups. OPE exhibits protective effects on sperm motility, at least partially via regulation of the proton channel. Moreover, similar effects were exerted by quercetin, the major flavonoid in OPE. These results suggest OPE, which is rich in the potent Hv1 channel activator quercetin, as a possible new candidate treatment for human infertility.

Effects of eupatilin on the contractility of corpus cavernosal smooth muscle through nitric oxide-independent pathways

Eupatilin (5,7-dihydroxy-3,4,6-trimethoxyflavone) is one of the main compounds present in Artemisia species. Eupatilin has both antioxidative and anti-inflammatory properties and a relaxation effect on vascular contraction regardless of endothelial function. We evaluated the relaxant effects of eupatilin on the corpus cavernosum (CC) of rabbits and the underlying mechanisms of its activity in human corpus cavernosum smooth muscle (CCSM) cells. Isolated rabbit CC strips were mounted in an organ bath system. A conventional whole-cell patch clamp technique was used to measure activation of calcium-sensitive K⁺ -channel currents in human CCSM cells. The relaxation effect of eupatilin was evaluated by cumulative addition (10^-5  m ~ 3 × 10^-4  m) to CC strips precontracted with 10^-5  m phenylephrine. Western blotting analysis was performed to measure myosin phosphatase targeting subunit 1 (MYPT1) and protein kinase C-potentiated inhibitory protein for heterotrimeric myosin light chain phosphatase of 17-kDa (CPI-17) expression and to evaluate the effect of eupatilin on the RhoA/Rho-kinase pathway. Eupatilin effectively relaxed the phenylephrine-induced tone in the rabbit CC strips in a concentration-dependent manner with an estimated EC₅₀ value of 1.2 ± 1.6 × 10^-4  m (n = 8, p < 0.05). Iberiotoxin and tetraethylammonium significantly reduced the relaxation effect (n = 8, p < 0.001 and p = 0.003, respectively). Removal of the endothelium or the presence of L-NAME or indomethacin did not affect the relaxation effect of eupatilin. In CCSM cells, the extracellular application of eupatilin 10^-4  m significantly increased the outward currents, and the eupatilin-stimulated currents were significantly attenuated by treatment with 10^-7  m iberiotoxin (n = 13, p < 0.05). Eupatilin reduced the phosphorylation level of MYPT1 at Thr853 of MLCP and CPI-17 at Thr38. Eupatilin-induced relaxation of the CCSM cells via NO-independent pathways. The relaxation effects of eupatilin on CCSM cells were partially due to activation of BK_Ca channels and inhibition of RhoA/Rho-kinase.

Chronologic Trends in Studies on Fluoride Mechanisms of Action

Fluoride has been widely used for the prevention of dental caries since the mid-20th century. The aim of this study was to investigate the chronologic trends in studies on fluoride mechanisms of action against dental caries during the years 1950 to 2015. To this aim, queries such as "fluoride," "fluoride and demineralization," "fluoride and remineralization," "fluoride and (plaque or biofilms)," and "fluoride and (bacteria or microbials)" were submitted to PubMed to collect research article information, including titles, abstracts, publication dates, author affiliations, and publication journals. The article information that PubMed produced was then collected by an automatic web crawler and examined through informetrics and linguistic analyses. We found that the number of articles concerned with fluoride mechanisms of action against dental caries was 6,903 and gradually increased over time during the years 1950 to 2015. They were published by 1,136 journals-most notably, Caries Research and Journal of Dental Research. Of the articles published, those related to bacteria/microbials had a higher percentage (44%) than those dealing with plaque/biofilms, demineralization, and remineralization. With regard to the geographic distribution of authors, Europe and North America accounted for 65% of the articles during the years 1987 to 2015, although the number of authors in Asia sharply increased in recent years. Among the fluoride compounds, NaF was mentioned more frequently than SnF₂, Na₂PO₃F, amine fluoride, and acidulated phosphate fluoride during the years 1986 to 2015. Water fluoridation received the most attention among the various fluoride application methods (toothpastes, mouthwashes, fluoride varnishes, and fluoride gels) during the same period. These results, obtained from employing informetrics and linguistic analyses, suggest that in studies on fluoride mechanisms of action, 1) the unbalanced geographic distribution of articles and 2) the heavy concentration of articles on particular fluoride compounds and application methods should be overcome in future research.

Abstract P3-12-17: Can radiation dosimetric parameters explain severe skin reaction during adjuvant whole breast irradiation applying field-in-field technique?

Aim: Although modern radiotherapy such as field-in-field technique decreased the radiation toxicity, skin reaction is still frequent and main problem during adjuvant whole breast irradiation. Our study investigated various radiation dosimetric and clinical parameters as the risk factors of severe skin reaction.

Methods: From January 2012 to December 2014, total 219 patients with breast conserving surgery and adjuvant whole breast irradiation were retrospectively reviewed. All patients took both whole breast irradiation (50 Gy/25 fractions) and boost to the tumor bed (10 - 15 Gy). Skin reaction was measured by comparing the photography of radiation field between the first day of whole breast irradiation and boost therapy. For each axilla and inferior fold, the intensity (score 1 to 5) and extent (score 0 to 1) of erythema were recorded and summed. The severe skin reaction was defined as score 5 or 6. The relations of various radiation dosimetric parameters for radiotherapy planning, personal breast characteristics and clinical factors to severe skin reaction were evaluated using the Logistic regression tests.

Results: Total 75 (34%) and 57 (26%) patients showed the severe skin reaction to axilla and inferior fold, respectively. The variables of P &lt; 0.2 in univariate analyses including age, the body mass index, the breast height, the V100, the calculated point dose in radiation planning system, the breast separation, the field size, and the gradient of inferior fold entered the multivariate analyses. Age (P=0.013 (OR = 0.950, 95% CI 0.913 - 0.989)), the body mass index (P = 0.015 (OR = 1.123, 95% CI 1.023 - 1.233)), the calculated axilla point dose (P = 0.091 (OR = 1.064, 95% CI 0.990 - 1.142)), and the gradient of inferior fold (P = 0.073 (OR = 1.029, 95% CI 0.997 - 1.063)) were risk factors for severe axilla skin reaction, whereas age (P = 0.018 (OR = 0.948, 95% CI 0.907 - 0.991)) and the V100 (P &lt; 0.001 (OR = 1.005, 95% CI 1.003 - 1.007)) were for severe inferior fold skin reaction.

Conclusion: In addition to clinical factor and personal breast characteristics, the radiation dosimetric parameters such as calculated point dose and V100 could be another predictive factors of severe skin reaction.

Citation Format: Yoon WS, Lee NK, Lee JA, Yang DS, Kim CY, Son GS, Chang YW. Can radiation dosimetric parameters explain severe skin reaction during adjuvant whole breast irradiation applying field-in-field technique?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-17.

Emotionally Exhausted Employees' Affective Commitment: Testing Moderating Effects Using Three-Way Interactions

We investigated the joint effect of employees' emotional exhaustion, transactional leadership, and leader–member exchange (LMX) on employees' affective commitment and in-role performance. With the inclusion of the antecedents and the consequences of affective commitment, we constructed a comprehensive framework for examining how employees' organizational affective commitment and emotional exhaustion jointly affected their in-role performance. Using the stimuli theory, vulnerability–stress theory, and job demands–resources model, we tested hypotheses regarding the 3-way interaction effects of the independent and moderating factors with 332 employees of a South Korean firm. All hypotheses were supported. We concluded that employees' in-role performance could be poor when emotionally exhausted employees are working with a leader whose style is transactional and where there is high LMX.

Additive effects of Artemisia capillaris extract and scopoletin on the relaxation of penile corpus cavernosum smooth muscle

The objective was to investigate the cellular effect and action mechanism of Artemisia capillaris extract (ACE) and its component, scopoletin, on penile corpus cavernosum smooth muscle (PCCSM). In vitro study with PCCSM, the precontracted PCCSM with phenylephrine was treated with ACE or scopoletin. Cyclic nucleotides in the perfusate were measured by radioimmunoassay and expression of protein and mRNA of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase in the perfused PCCSM were measured by western blot and real-time PCR, respectively. The interaction of ACE or scopoletin with udenafil was also evaluated. ACE and scopoletin exerted a significant and concentration-dependent relaxation in PCCSM. The perfusion with ACE or scopoletin significantly increased cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) and the perfusion with ACE or scopoletin increased the expression of eNOS mRNA and protein. Furthermore, ACE or scopoletin enhanced udenafil-inducing relaxation in PCCSM. ACE and scopoletin relaxed the PCCSM mainly by activating nitric oxide-cGMP system and cAMP pathway and they may be additive therapeutic candidates for ED patients who do not completely respond to udenafil.

The effectiveness of gadolinium MRI to improve target delineation for radiotherapy in hepatocellular carcinoma: a comparative study of rigid image registration techniques

To achieve consistent target delineation in radiotherapy for hepatocellular carcinoma (HCC), image registration between simulation CT and diagnostic MRI was explored. Twenty patients with advanced HCC were included. The median interval between MRI and CT was 11 days. CT was obtained with shallow free breathing and MRI at exhale phase. On each CT and MRI, the liver and the gross target volume (GTV) were drawn. A rigid image registration was taken according to point information of vascular bifurcation (Method[A]) and pixel information of volume of interest only including the periphery of the liver (Method[B]) and manually drawn liver (Method[C]). In nine cases with an indefinite GTV on CT, a virtual sphere was generated at the epicenter of the GTV. The GTV from CT (VGTV[CT]) and MRI (VGTV[MR]) and the expanded GTV from MRI (V+GTV[MR]) considering geometrical registration error were defined. The underestimation (uncovered V[CT] by V[MR]) and the overestimation (excessive V[MR] by V[CT]) were calculated. Through a paired T-test, the difference between image registration techniques was analyzed. For method[A], the underestimation rates of VGTV[MR] and V+GTV[MR] were 16.4 ± 8.9% and 3.2 ± 3.7%, and the overestimation rates were 16.6 ± 8.7% and 28.4 ± 10.3%, respectively. For VGTV[MR] and V+GTV[MR], the underestimation rates and overestimation rates of method[A] were better than method[C]. The underestimation rates and overestimation rates of the VGTV[MR] were better in method[B] than method[C]. By image registration and additional margin, about 97% of HCC could be covered. Method[A] or method[B] could be recommended according to physician preference.

Relationship between polymorphisms near the IL28B gene and spontaneous HBsAg seroclearance: a systematic review and meta-analysis

Polymorphisms near the interleukin (IL) 28B gene have been proposed to be associated with spontaneous clearance of the hepatitis C virus. The purpose of this study was to assess the relationship between IL28B polymorphisms and the rate of spontaneous hepatitis B surface antigen (HBsAg) seroclearance by means of meta-analysis. MEDLINE/PubMed and EMBASE were utilized to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were analysed together to assess the strength of the association. Subgroup analyses were mainly performed according to ethnicity. A total of 4028 cases with persistent chronic hepatitis B and 2327 spontaneously recovered controls were included from 11 studies. The single nucleotide polymorphism (SNP), rs12979860, had no significant association with HBsAg seroclearance (OR = 0.98, 95% CI: 0.84-1.14 in the dominant model; OR = 1.00, 95% CI: 0.68-1.46 in the recessive model; and OR = 0.95, 95% CI: 0.82-1.09 in the allelic model). The SNP, rs12980275, had no significant association either (OR = 1.03, 95% CI: 0.84-1.26 in the dominant model; OR = 1.17, 95% CI: 0.46-2.96 in the recessive model; and OR = 1.04, 95% CI: 0.86-1.26 in the allelic model), nor did the SNP, rs8099917 (OR = 0.94, 95% CI: 0.77-1.15 in the dominant model; OR = 0.74, 95% CI: 0.34-1.62 in the recessive model; and OR = 0.93, 95% CI: 0.77-1.13 in the allelic model). Similarly, the results of subgroup analyses by ethnicity also showed no association in either the Asian group or non-Asian group. We concluded that there was no significant association between common IL28B polymorphisms and the rate of spontaneous HBsAg seroclearance.

Retinal protective effects of topically administered agmatine on ischemic ocular injury caused by transient occlusion of the ophthalmic artery

Agmatine, an endogenous polyamine and putative neuromodulator, is known to have neuroprotective effects on various neurons in the central nervous system. We determined whether or not topically administered agmatine could reduce ischemic retinal injury. Transient ocular ischemia was achieved by intraluminal occlusion of the middle cerebral artery of ddY mice (30-35 g) for 2 h, which is known to also induce occlusion of the ophthalmic artery. In the agmatine group (N = 6), a 1.0 mM agmatine-containing ophthalmic solution was administered four times daily for 2 weeks before occlusion. In the control group (N = 6), a 0.1% hyaluronic acid ophthalmic solution was instilled at the same times. At 22 h after reperfusion, the eyeballs were enucleated and the retinal sections were stained by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL). Transient ocular ischemia induced apoptosis of retinal cells in the entire retinal layer, and topically administered agmatine can significantly reduce this ischemic retinal injury. The proportion of apoptotic cells was definitely decreased (P < 0.001; Kruskal-Wallis test). Overall, we determined that topical agmatine application effectively decreases retinal damage in an in vivo ocular ischemic injury model. This implies that agmatine is a good candidate as a direct neuroprotective agent for eyes with ocular ischemic diseases.

Risk factors related to interfractional variation in whole pelvic irradiation for locally advanced pelvic malignancies

PURPOSE

The goal of the present study was to demonstrate risk factors affecting the interfractional variation in whole pelvic irradiation.

PATIENTS AND METHODS

Daily image acquisitions of 101 patients with locally advanced pelvic malignancy were undertaken using a kilo-voltage orthogonal on-board imager. The baseline deviation (the shift between the initial treatment and each fraction; Value(Base)) and day-to-day variation (the shift between the previous treatment and each fraction; Value(DD)) were measured. The standard deviations (SD) along the x- (right-left), y- (cranial-caudal), and z- (anterior-posterior) axes (SD[x], SD[y], and SD[z], respectively), the 3D vector of the SD (SD[3D]), and the mean of 3D shift (mean[3D]) were calculated in each patient. Various clinical factors, lumbar pelvic balance and rotation, and the shift of 5 consecutive fractions from the initial treatment (Value(5Fx)) were investigated as risk factors.

RESULTS

The prone set-up showed a larger mean(Base)[3D] than in the supine position (p =0 .063). A body mass index (BMI) ≥ 30 kg/m(2) resulted in the largest mean(DD)[3D] (p = 0.078) and SD(DD)[3D] (p = 0.058). All the SD(5Fx) along the x-, y-, and z-axes had moderate linear relationships with SD(Base) and SD(DD) (p < 0.001). The SD(5Fx)[3D] also had a moderate linear relationship with the mean(Base)[3D], mean(DD)[3D], SD(Base)[3D], and SD(DD)[3D] (p < 0.001). In multivariate analysis, the SD(5Fx) had the same significant relationship with SD(Base) and SD(DD) (p < 0.001). A BMI ≥ 30 kg/m(2) was associated with the largest SD(DD)[x] (p = 0.003).

CONCLUSION

Close surveillance through high-quality and frequent image guidance is recommended for patients with extensive variations of the initial five consecutive fractions or obesity.

Investigations of mechanical vibrations for beamlines at the Canadian Light Source

Vibration is often a problem causing poor quality of photon beams at synchrotron radiation facilities, since beamlines are quite sensitive to vibrations. Therefore, vibration analysis and control at synchrotron radiation facilities is crucial. This paper presents investigations on mechanical vibrations at four beamlines and endstations at the Canadian Light Source, i.e. the Canadian Macromolecular Crystallography Facility 08ID-1 beamline, the Hard X-ray MicroAnalysis 06ID-1 beamline, the Resonant Elastic and Inelastic Soft X-ray Scattering 10ID-2 beamline, and the Scanning Transmission X-ray Microscope endstation at the Spectromicroscopy 10ID-1 beamline. This study identifies vibration sources and investigates the influence of mechanical vibrations on beamline performance. The results show that vibrations caused by movable mechanical equipment significantly affect the data acquired from beamlines.

Negative refraction power causes underestimation of peripapillary retinal nerve fibre layer thickness in spectral-domain optical coherence tomography

BACKGROUND/AIMS

Although studies using optical coherence tomography (OCT) reported that the retinal nerve fibre layer (RNFL) thickness of myopic eyes was thinner than those of normal controls, it was unclear if this finding indicated the difference in actual structural thickness or that created by sources affecting accuracy of OCT measurement. This study's aim was to evaluate the effect of refraction power on the measurement of the RNFL thickness using spectral-domain OCT.

METHODS

OCT scans to measure RNFL thickness were repeated in 15 cycloplegic eyes of 15 participants, while different refraction powers were induced by wearing soft contact lenses of eight different dioptres (-6 to +8).

RESULTS

Measured RNFL thicknesses decreased significantly with soft contact lenses of higher plus dioptres and increased with those of more minus dioptres. This finding was consistent with or without controlling factors including the signal strength and test-retest variability of the machine. Measurement of peripapillary RNFL thicknesses was not varied between scans performed with and without plano contact lenses.

CONCLUSIONS

In spectral-domain OCT, RNFL thickness was underestimated in eyes with increasing negative refraction power and overestimated with increasing positive refraction power.

Wear performance of self-mating contact pairs of TiN and TiAlN coatings on orthopedic grade Ti-6Al-4V

Both titanium nitride (TiN) and titanium aluminum nitride (TiAlN) have shown great wear resistance potential in metallic medical devices as protective, hard thin film coatings. In the present study, the effects of TiN and TiAlN coating layers on the wear performance of Ti-6Al-4V were compared and analyzed. TiN and TiAlN coatings with a thickness of 3 microm were deposited by a cathodic vacuum arc ion plating technique on the surface of Ti-6Al-4V. Wear tests were conducted by using a pin-on-disk-type tribotester with a point contact self-mating pair in a linear reciprocal motion. A sliding distance of 20 mm per cycle at 1 Hz was used under a load of 15 N under ambient conditions with no lubricant. The wear resistance of TiN and TiAlN coatings is superior to that of uncoated Ti-6Al-4V at the early stage of sliding contact. Until a measurable amount of wear was detected, the number of sliding cycles of the TiAlN coating pair was longer than TiN. After the first detection of wear from the coating layers, the rate of wear of the TiN coating pairs was significantly higher than that of TiAlN (p < 0.05), and it was close to that of the uncoated pairs. In conclusion, the TiAlN coating is superior to TiN from the viewpoint of wear resistance under the test conditions used in this study.

Putative association of transforming growth factor-alpha polymorphisms with clearance of hepatitis B virus and occurrence of hepatocellular carcinoma in patients with chronic hepatitis B virus infection

Previous studies showed that several genetic polymorphisms might influence the clinical outcome of chronic hepatitis B virus (HBV) infection, including HBV clearance or development of hepatocellular carcinoma (HCC). The aim of this study was to determine whether polymorphisms of the transforming growth factor-alpha (TGF-alpha) gene are associated with clinical outcome of HBV infection. A total of 1096 Korean subjects having either present or past evidence of HBV infection were prospectively enrolled between January 2001 and August 2003. Among 16 genetic variants in TGFA gene, nine variants were genotyped using TaqMan assay and the genetic association with HBV clearance and HCC occurrence was analysed. Statistical analyses revealed that TGFA+103461T>C, TGFA+106151C>G and TGFA-ht2 were marginally associated with clearance of HBV infection. However, only TGFA-ht2 retained significance after multiple correction (OR = 0.39, P(corr) = 0.007 in recessive model). Although no variants were significant after multiple correction, TGFA+88344G>A and TGFA+103461T>C were weakly associated in recessive model in the analysis of HCC occurrence. In addition, Cox relative hazards model also revealed that TGFA+88344G>A was associated with onset age of HCC occurrence in subjects (RH = 1.46, P(corr) = 0.04). TGF-alpha polymorphisms might be an important factor in immunity, progression of inflammatory process and carcinogenesis, which explains the variable outcome of HBV infection at least in part. Further biological evidence is warranted in the future to support these suggestive associations.

The development of a national surveillance system for monitoring blood use and inventory levels at sentinel hospitals in South Korea

We developed a web-based program for a national surveillance system to determine baseline data regarding the supply and demand of blood products at sentinel hospitals in South Korea. Sentinel hospitals were invited to participate in a 1-month pilot-test. The data for receipts and exports of blood from each hospital information system were converted into comma-separated value files according to a specific conversion rule. The daily data from the sites could be transferred to the web-based program server using a semi-automated submission procedure: pressing a key allowed the program to automatically compute the blood inventory level as well as other indices including the minimal inventory ratio (MIR), ideal inventory ratio (IIR), supply index (SI) and utilisation index (UI). The national surveillance system was referred to as the Korean Blood Inventory Monitoring System (KBIMS) and the web-based program for KBIMS was referred to as the Blood Inventory Monitoring System (BMS). A total of 30 256 red blood cell (RBC) units were submitted as receipt data, however, only 83% of the receipt data were submitted to the BMS server as export data (25 093 RBC units). Median values were 2.67 for MIR, 1.08 for IIR, 1.00 for SI, 0.88 for UI and 5.33 for the ideal inventory day. The BMS program was easy to use and is expected to provide a useful tool for monitoring hospital inventory levels. This information will provide baseline data regarding the supply and demand of blood products in South Korea.

Morphological comparison of small nerve fibres in gastric mucosa in non-diabetic and Type 2 diabetic subjects

AIM

To determine changes in small nerve fibres in gastric mucosa in patients with Type 2 diabetes by morphological observation.

METHODS

In twenty-five non-diabetic and 21 Type 2 diabetic participants, gastric mucosal biopsy under endoscopy was performed. Innervation in gastric mucosa was detected using immunohistochemical staining. Anti-protein gene product (PGP) 9.5 positive nerves underwent morphological observation and quantitative analysis.

RESULTS

Small nerve fibres in gastric mucosa were shortened in the diabetic subjects. The ratio of gastric mucosal protrusions maintaining nerve fibres between gastric pits to total observed protrusions was lower in patients with Type 2 diabetes compared with the non-diabetic subjects (ratio of innervated protrusion/total protrusion: 0.49 +/- 0.12 vs. 0.89 +/- 0.06, P < 0.05).

CONCLUSIONS

This study sets the scene for further research to investigate the relationship between gastric mucosal nerves and autonomic neuropathy or diabetic peripheral neuropathy.

Four flavonoids from Echinosophora koreensis and their effects on alcohol metabolizing enzymes

A new prenylated dihydroflavonol, 3-hydroxy-kenusanone B 1, as well as three other known isoflavanones, sophoronol 2, sophoraisoflavanone A 3 and kenusanone H 4, were isolated from the rhizomes of Echinosophora koreensis. The structures of these compounds were elucidated using spectroscopic analyses that included extensive 2D NMR, optical rotation spectrometry and mass spectrometry. All four flavonoids enhanced the activities of alcohol metabolizing enzymes such as alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) at micromolar concentrations. Sophoronol 2 showed a nine-fold increased activation of alcohol dehydrogenase and aldehyde dehydrogenase than a negative control group at concentrations of 100 microg/mL and 50 microg/mL, respectively. This study suggests that prenylated flavonoids have the potential to prevent 'hangovers' after alcohol intake.

Efficacy of a High-Dose Aprotinin Regimen for Reducing Transfusion Requirements and Inflammatory Responses in Adult Cardiac Surgery

This study evaluated and compared the risks and effects to the inflammatory response of low- and high-dose aprotinin regimens. Between January and June 2006, patients scheduled for cardiac surgery using cardiopulmonary bypass were enrolled and randomly allocated to either low- ( n = 15) or high-dose ( n = 13) aprotinin groups. The incidences of mortality and adverse events were comparable in both groups. Post-operative creatinine levels and blood loss were not significantly different between the two groups. With the exception of platelets, the counts of transfused allogenic blood products were not significantly different between the groups. Interleukin (IL)-6, IL-10, soluble tumour necrosis factor II receptor, and interferon-γ levels increased in both groups compared with baseline, but no significant intergroup differences were detected. In conclusion, high- and low-dose aprotinin had similar effects in the reduction of mediastinal bleeding and attenuation of systemic inflammatory responses, and high-dose aprotinin therapy could be used without any increased adverse effects.

Change in the interfacial reaction of Hf-silicate film as a function of thickness and stoichiometry

Medium energy ion scattering and high-resolution transmission electron microscopy are used to investigate the depth of the interfacial reaction of Hf-silicate film. The interfacial reaction is critically affected by the film thickness and the mole fraction of HfO(2) in silicate film. The interfacial compressive strain generated at the surface of the Si substrate is dependent on the film thickness during the postannealing process in film with a thickness of approximately 4 nm. Finally, the phase separation phenomenon demonstrates critically different behaviors at different film thicknesses and stoichiometries because the diffusion of Si from interface to surface is dependent on these factors. Moreover, the oxidation by oxygen impurity in the inert ambient causes SiO(2) top formation.

Relationship between Plasma B-type Natriuretic Peptide and Ventricular Function in Adult Cardiac Surgery Patients

Plasma concentrations of B-type natriuretic peptide (BNP) were analysed during the peri- and post-operative periods in cardiac surgery patients, and the relationship between plasma BNP concentrations and various clinical parameters was explored. Thirty patients (17 women, 13 men) of age 54.5 ± 17.1 years undergoing cardiac surgery between June 2004 and March 2005 were enrolled. Plasma BNP concentrations were measured pre-operatively, immediately post-operatively, and on the first, second, fourth and seventh post-operative days. On the first post-operative day, the BNP level was significantly increased but levels returned to baseline values by the seventh post-operative day. The pre-operative BNP level correlated with left ventricular ejection fraction and age, and the level 24 h after surgery correlated with left ventricular end-diastolic dimension and pre-operative BNP levels. These results showed that the plasma BNP concentration becomes markedly and acutely elevated after cardiac surgery, reflecting temporary ventricular dysfunction.

Phacoemulsification using iris hooks and scleral fixation of the intraocular lens in patients with secondary glaucoma associated with lens subluxation

PURPOSE

We described the techniques and results of phacoemulsification using iris hook and scleral fixation of intraocular lens (IOL) in patients with secondary glaucoma associated with lens subluxation.

METHODS

Eight eyes of seven patients with secondary glaucoma associated with lens dislocation, who had undergone the surgery, were retrospectively reviewed.

RESULTS

At a mean of 23.5 months+/-13.6 (SD) after the surgery, the mean best-corrected visual acuity improved from 0.24+/-0.21 to 0.83+/-0.3, and mean intraocular pressure (IOP) was changed from 38.4+/-11.4 to 15.5+/-1.8 mmHg at the final examination. There were no vitreoretinal complications except cystoid macular oedema in one eye.

CONCLUSION

The technique appears to be safe and effective in terms of visual rehabilitation and controlling IOP in patients with secondary glaucoma associated with lens subluxation.

Endoscopic ultrasound for the evaluation of Nissen fundoplication integrity: a blinded comparison with conventional testing

BACKGROUND

For patients whose symptoms develop after Nissen fundoplication, the precise mechanism of anatomic failure can be difficult to determine. The authors have previously reported the endosonographic hallmarks defining an intact Nissen fundoplication in swine and the known causes of failure. The current clinical trial tested the hypothesis that a defined set of endosonographic criteria can be applied to determine fundoplication integrity in humans.

METHODS

The study enrolled seven symptomatic and nine asymptomatic subjects at a mean of 6 years (range, 1-30 years) after Nissen fundoplication. A validated gastroesophageal reflux disease (GERD)-specific questionnaire and medication history were completed. Before endoscopic ultrasound (EUS), all the patients underwent complete conventional testing (upper endoscopy, esophagram, manometry, 24-h pH). A diagnosis was rendered on the basis of combined test results. Then EUS was performed by an observer blinded to symptoms, medication use, and conventional testing diagnoses. Because EUS and esophagogastroduodenoscopy (EGD) are uniformly performed in combination, the EUS diagnosis was rendered on the basis of previously established criteria combined with the EGD interpretation. The diagnoses then were compared to examine the contribution of EUS in this setting.

RESULTS

The technique and defined criteria were easily applied to all subjects. All symptomatic patients had heartburn and were taking proton pump inhibitors (PPI). No asymptomatic patients were taking PPI. All diagnoses established with combined conventional testing were detected on EUS with upper endoscopy. Additionally, EUS resolved the etiology of a low lower esophageal sphincter pressure in two symptomatic patients and detected the additional diagnoses of slippage in two subjects. Among asymptomatic subjects, EUS identified additional diagnoses in two subjects considered to be normal by conventional testing methods.

CONCLUSION

According to the findings, EUS is a feasible method for evaluating post-Nissen fundoplication hiatal anatomic relationships. The combination of EUS and EGD allows the mechanism of failure to be detected in patients presenting with postoperative symptoms after Nissen fundoplication.

Electronic structure of NPB and BCP molecules probed by x-ray emission spectroscopy

Soft x-ray absorption and emission spectroscopies have been employed to investigate the electronic structure and chemical bonding of two prototypical molecules, N,N(')-bis-(1-naphthyl)-N,N(')-diphenyl-1,1(')-biphenyl-4,4(')-diamine (NPB) and bathocuproine (BCP), which are frequently chosen because of their hole-transporting and hole-blocking properties, respectively. The resulting resonant C Kalpha x-ray emission spectra of these materials reveal different spectral features depending on the resonant excitation energy. According to the N absorption and emission spectra, the contribution of N atoms to the highest occupied and lowest unoccupied molecular orbitals is different for in NPB and in BCP. Detailed knowledge of these materials will allow tailoring charge transport properties of organic devices in order to develop high performance organic light-emitting diodes and photovoltaic cells.

Genetic and environmental interactions determine seizure susceptibility in epileptic EL mice

Gene identification has progressed rapidly for monogenic epilepsies, but complex gene-environmental interactions have hindered progress in gene identification for multifactorial epilepsies. We analyzed the role of environmental risk factors in the inheritance of multifactorial idiopathic generalized epilepsy in the EL mouse. Seizure susceptibility was evaluated in the EL (E) and seizure-resistant ABP/LeJ (A) parental mouse strains and in their AEF1 and AEF2 hybrid offspring using a handling-induced seizure test. The seizure test was administered in three environments (environments I, II and III) that differed with respect to the number of seizure tests administered (one test or four tests) and the age of the mice when tested (young or old). The inheritance of seizure susceptibility appeared dominant after repetitive seizure testing in young or old mice, but recessive after a single test in old mice. Heritability was high (0.67-0.77) in each environment. Significant quantitative trait loci (QTL) that were associated with environments I and III (repetitive testing) were found on chromosomes 2 and 9 and colocalized with previously mapped El2 and El4, respectively. The El2 QTL found in environment I associated only with female susceptibility. A novel QTL, El-N, for age-dependent predisposition to seizures was found on proximal chromosome 9 only in environment II. The findings indicate that environmental risk factors determine the genetic architecture of seizure susceptibility in EL mice and suggest that QTL for complex epilepsies should be defined in terms of the environment in which they are expressed.

Intraocular pressure measurement in mice: a comparison between Goldmann and rebound tonometry

PURPOSE

The development of mouse models of glaucoma requires methods to accurately measure the intraocular pressure (IOP) in this species. The aim of this study was to compare the accuracy of IOP measurements in mice between modified Goldmann and rebound tonometers.

METHODS

IOP was measured either with a modified Goldmann or a rebound tonometer while simultaneously measuring the IOP using invasive manometry in enucleated eyes and in vivo. The level of IOP was controlled hydrostatically. The agreement and correlation between the IOP determined by invasive manometry and by either noninvasive method was evaluated. In addition, the IOP was determined by both noninvasive methods in a cohort of mice with laser-induced ocular hypertension (OHT), and the agreement and correlation between the two tonometry methods were evaluated.

RESULTS

Measured IOP by either noninvasive tonometer correlated well with those recorded simultaneously by invasive manometry (r=0.98 for rebound and r=0.94 for Goldmann). In mice with OHT, the IOP correlation between rebound and modified Goldmann was moderate (r=0.71); the IOP measured by modified Goldmann tonometry was consistently higher than that by rebound by approximately 5 mmHg. However, the relative per cent increases in IOP were similar between the two methods.

CONCLUSION

Both noninvasive methods of IOP measurements in mice are suitable to detect changes in IOP although rebound tonometry correlated better with the invasive manometry readings. The results suggest that the relative, rather than absolute, IOP offers a more reliable means of correlating findings from studies using different tonometers.

Inhibitory activity on HIV-1 reverse transcriptase and integrase of a carmalol derivative from a brown Alga, Ishige okamurae

The bioassay-directed isolation of a marine brown alga, Ishige okamurae, afforded a carmalol derivative, diphlorethohydroxycarmalol. This compound exhibited inhibitory effects on HIV-1 reverse transcriptase and integrase with IC(50) values of 9.1 microM and 25.2 microM, respectively. However, diphlorethohydroxycarmalol did not show an inhibitory activity against HIV-1 protease. Moreover, diphlorethohydroxycarmalol nonaacetate obtained by acetylation and fucosterol failed to show any inhibitory activity against these viral enzymes.

Subacute toxicity evaluation of a new camptothecin anticancer agent CKD-602 administered by intravenous injection to rats

The subacute toxicity of a new camptothecin anticancer agent, CKD-602, was investigated after 4-week repeated intravenous administration of the chemical in Sprague-Dawley rats. The test chemical was administered intravenously to rats at dose levels of 0, 0.003, 0.013, or 0.067 mg/kg/day for males and 0, 0.004, 0.018, or 0.089 mg/kg/day for females. At the end of the treatment period, 10 rats/sex/group were sacrificed. The remaining 5 rats/sex in the vehicle control and high dose groups continued the study without treatment for 2 weeks (recovery period). During the test period, clinical signs, mortality, body weights, food and water consumption, ophthalmoscopy, urinalysis, hematology, serum biochemistry, gross findings, organ weights, and histopathology were examined. In both sexes of the high dose group, an increase in the incidence of abnormal clinical signs and paleness of the eyes, a reduction in the body weight gain, food consumption and urine protein, and an increase in the water consumption were observed. Hematological investigations revealed a decrease in the red blood cells, hemoglobin and hematocrit and an increase in the mean corpuscular volume, mean corpuscular hemoglobin, platelets, and reticulocytes in a dose-dependent manner. Serum total cholesterol and total protein values were lower in females than those of controls, but not in males. An increase in the heart and liver weights and a decrease in the thymus weight were also found. Histopathological alterations included an increase in the incidence of atrophy of the sternal marrow, atrophy, fibrosis and mast cell hyperplasia of the femoral marrow, atrophy of the white pulp and extramedullary hematopoiesis of the spleen, atrophy of the thymus, auricular hypertrophy of the heart, extramedullary hematopoiesis and centriacinar telangiectasis of the liver, follicular degeneration of the ovary, and inflammation of the tail. The major treatment-related effects were not recovered at the end of 2-week recovery period. There were no adverse effects in the low and middle dose groups of both genders. In the present experimental conditions, the target organs were determined to be bone marrow, blood cells, spleen, liver, thymus, and heart. The no-observed-adverse-effect level was considered to be 0.013 mg/kg/day for males and 0.018 mg/kg/day for females.

Measuring the burden of premature death due to smoking in Korea from 1990 to 1999

This study estimated the burden of premature death due to smoking in Korea between 1990 and 1999 using the years of life lost (YLL) due to premature death method. To implement this study, age-group-specific YLL due to premature death were calculated by employing the standard expected years of life lost method. YLL due to smoking were calculated based on assumptions and methods developed by the Global Burden of Disease Study Group. The burden of premature death due to smoking was estimated by multiplying the population attributable risk by the YLL of smoking-related diseases. In 1999, the burden of premature death due to smoking was 57.7% in males and 11.4% in females in Korea. The burden of premature death due to smoking increased from 1643 person years per 100,000 in 1990 to 1888 person years in 1999 for males, and increased from 151 person years in 1990 to 225 person years in 1999 for females in Korea. Our results suggest that the method employed in this study, generated in quantified terms, enabled the burden of premature death due to smoking to be obtained comparably with methods used by other international studies in this field, and thus can provide a rational basis for national health policy planning regarding premature death from smoking and the related risk factors in Korea.

Factors predicting concurrent cholangiocarcinomas associated with hepatolithiasis

BACKGROUND/AIMS

Hepatolithiasis is a risk factor for cholangiocarcinoma. However, it is difficult to detect early cholangiocarcinoma that occurs as a complication of hepatolithiasis. To identify the factors, which can be used for predicting cholangiocarcinomas in patients with hepatolithiasis, we compared the clinical characteristics of patients who had cholangiocarcinoma associated with hepatolithiasis with those of patients with hepatolithiasis only.

METHODOLOGY

Forty patients with cholangiocarcinoma associated with hepatolithiasis (group HC) and 73 patients with hepatolithiasis only (group H) were randomly selected for this study. Mean tumor size was 6.1 +/- 2.4 cm in diameter.

RESULTS

Patients of group HC were older (56.7 +/- 8.9 yr) than those of group H (49.2 +/- 12.9 yr) (p < 0.001). Weight loss was more frequent in group HC (51.5%) than in group H (5.5%) (p < 0.001) and serum alkaline phosphatase levels were higher in group HC (181 +/- 184 IU/L) than in group H (426 +/- 385 IU/L) (p < 0.001). The proportion of the patients who had hepatolithiasis in the right or both lobes of the liver was higher in group HC (72.5%) than in group H (50.6%) (p = 0.024). The optimal cutoff value of serum CEA level for cholangiocarcinoma detection was set at 4.2 ng/mL using ROC cure to give a sensitivity of 67.6% and a specificity of 90.5%. Group HC differed from group H because of its lower rates of both abdominal pain and cholangitis, longer duration of stone history, and lower serum albumin level. Factors that did not predict cholangiocarcinoma included sex ratio, white blood cell count, serum bilirubin level, and hepatic atrophy.

CONCLUSIONS

Cholangiocarcinoma should be suspected in patients with hepatolithiasis, especially when, the patient is over 40 years old, has a long history of hepatolithiasis with weight loss, a higher level of serum alkaline phosphatase, a lower level of serum albumin, a serum carcinoembryonic antigen level exceeding 4.2 ng/mL, and hepatolithiasis that is located either in the right or both lobes of the liver.

Enhanced expression of transglutaminase 2 in anterior polar cataracts and its induction by TGF-beta in vitro

BACKGROUND/AIMS

Transglutaminase activity has long been implicated in the cataract formation. However, the precise mechanism of how it is produced and involved in this process remains unclear. Here the authors sought to examine whether transglutaminase 2 (TGase 2) is expressed in lens epithelial cells from patients with anterior polar cataracts, to determine whether TGase 2 expression is induced by transforming growth factor (TGF-beta) in cultured lens epithelial cells, and to determine whether TGase 2 participates in the crosslinking of fibronectin in lens epithelial cells in vitro.

METHODS

Lens epithelial cells from anterior polar cataracts, nuclear cataracts, and non-cataractous clear lenses were examined for the expression of TGase 2 using reverse transcription-polymerase chain reaction, western blot analysis, and immunohistochemical analysis. The modulation of extracellular TGase 2 activity by TGF-beta was measured by the formation of fibronectin polymers and the incorporation of fluorescein cadaverine into extracellular matrix proteins. The effect of TGase 2 overexpression was analysed by immunofluorescence staining and western blot analysis of human lens epithelial (HLE) B-3 cells transiently transfected with TGase 2 gene.

RESULTS

The expression of TGase 2 mRNA and its protein was markedly enhanced in lens epithelial cells from patients with anterior polar cataracts. Treatment of HLE B-3 cells with TGF-beta caused an increase in TGase 2 protein, its extracellular activity, and the crosslinking of fibronectin. Transient transfection of HLE B-3 cells with the TGase 2 gene led to the increased production of fibronectin monomers and polymers.

CONCLUSIONS

This study shows that TGase 2 is overexpressed in lens epithelial cells from anterior polar cataracts and that TGF-beta may be a causative factor in the induction of TGase 2. The enhanced expression of TGase 2 might cause the accumulation and crosslinking of the extracellular matrix proteins and might play a part in anterior polar cataract development.

Short term surgical outcomes of modified deep sclerectomy with catgut implant

We compared the effectiveness of and complications resulting from modified deep sclerectomy with catgut implant (modified-DSCI) with those of standard deep sclerectomy with collagen implant (DSCI) in the short term following surgery. In this retrospective study, standard-DSCI was performed on thirteen patients (17 eyes), and modified-DSCI was performed on seven patients (11 eyes). After dissection of a 5x5 mm sized superficial scleral flap, a 3x4 mm sized rectangular deep scleral flap was constructed in DSCI and a 2x3 mm sized triangular deep scleral flap in modified DSCI. A collagen implant was placed on the scleral bed in DSCI and # 0 CHROMIC Catgut Absorbable Suture was used in modified DSCI. The mean follow up was 11.0+/-6.1 months in DSCI and 9.3+/-4.7 months in modified DSCI. The mean preoperative intraocular pressure (IOP) was 38.6+/-10.9 mmHg in DSCI and 34.8+/-8.6 mmHg in modified DSCI. In the DSCI group, the IOP was 13.4+/-3.0 mmHg at final follow up, and was 11.4+/-3.2 mmHg in the modified DSCI group. The number of Nd:YAG goniopuncture was 3 cases (25%) in the modified DSCI group, and 3 cases (21.4%) in the DSCI group. The number of intraoperative microperforations was 3 in the DSCI group and 2 in the modified DSCI group. Temporary hypotony was encountered in 8 eyes (57.1%) of the DSCI group and 4 eyes (50%) of the modified DSCI group. There was no significant difference observed between the two groups in regards to the effectiveness or rate of complications seen during short term follow up.

Association between polymorphisms of ethanol-metabolizing enzymes and susceptibility to alcoholic cirrhosis in a Korean male population

Alcohol is oxidized to acetaldehyde by alcohol dehydrogenase (ADH) and cytochrome P-4502E1 (CYP2E1), and then to acetate by aldehyde dehydrogenase (ALDH). Polymorphisms of these ethanol-metabolizing enzymes may be associated with inter-individual difference in alcohol metabolism and susceptibility to alcoholic liver disease. We determined genotype and allele frequencies of ALDH2, CYP2E1, ADH2, and ADH3 in male Korean patients with alcoholic cirrhosis (n=56), alcoholics without evidence of liver disease (n=52), and nondrinkers (n=64) by using PCR or PCR-directed mutagenesis followed by restriction enzyme digestion. The prevalences of heterozygous ALDH2*1/*2 plus homozygous ALDH2*2/*2 in patients with alcoholic cirrhosis (7.1%) and alcoholics without evidence of liver disease (3.8%) were significantly lower than that in nondrinkers (45.3%). The c2 allele frequencies of the CYP2E1 in alcoholic cirrhosis, alcoholics without evidence of liver disease, and nondrinkers were 0.21, 0.20, and 0.20, respectively. Allele frequencies of ADH2*2 in the three groups were 0.78, 0.74, and 0.77 and those of ADH3*1 were 0.94, 0.98, and 0.95. Therefore, we confirmed the observation that the ALDH2*2 gene protects against the development of alcoholism. However, the development of cirrhosis in Korean alcoholic patients was not associated with polymorphisms of ethanol-metabolizing enzymes.

Surgical outcomes of deep sclerectomy with collagen implant

We evaulated the effectiveness and adverse effects of deep sclerectomy with collagen implant (DSCI), which is a kind of nonpenetrating filtering surgery. In this retrospective study, DSCI was performed in 15 eyes of 11 glaucoma patients. An trabeculo-Descemet's membrane (TDM) window is created by a deep sclerokeratectomy, and the collagen implant is placed in the sclera bed under a superficial flap (deep sclerectomy with collagen implant). In 3 of 15 eyes the DSCI was intraoperatively converted to conventional filtering surgery for a large perforation of the TDM. These eyes were not included in the results of the surgical outcomes. The mean age of the patients was 50.3 +/- 14.4 years, and the mean follow-up period was 11.1 +/- 5.9 months. A diagnosis of chronic open angle glaucoma was made in 7 eyes and a diagnosis of secondary glaucoma in 5 eyes. The mean preoperative IOP was 25.8 +/- 11.9 mmHg, the immediate postoperative IOP was 6.4 +/- 2.9 mmHg, and at the final follow-up, the IOP was 11.9 +/- 2.5 mmHg. The IOP in 5 eyes was under 6 mmHg temporarily. However, there was no serious complication such as shallow anterior chamber. DSCI is considered to be a good surgical procedure that has similar surgical outcomes to a conventional trabeculectomy without serious complications.

In vitro antimicrobial activity of a chitooligosaccharide mixture against Actinobacillus actinomycetemcomitans and Streptococcus mutans

The purpose of this study was to evaluate the in vitro antibacterial activity of a chitooligosaccharide mixture (MW 2000-30000 Da) with a deacetylation degree of 91.5% against two representative oral pathogens, Actinobacillus actinomycetemcomitans and Streptococcus mutans. A 0.1% concentration of the chitooligosaccharides (derived from the exoskeletons of marine crustaceans) was used to estimate antibacterial activity. Approximately 2 logcolony forming units (CFU)/ml of A. actinomycetemcomitans were inactivated by 0.1% chitosan after 30 min, while 120 min exposure inactivated about 4.5 logCFU/ml of this organism. In contrast, the level of inactivation against S. mutans was less than 0.5 logCFU/ml after an exposure of up to 120 min. Electron microscopy showed that the exposure of A. actinomycetemcomitans to the chitooligosaccharides resulted in the disruption of cell membranes and that it could be considered for the treatment of periodontal diseases associated with A. actinomycetemcomitans.