Comparison between hangeshashinto and dexamethasone for IL-1α and β-defensin 1 production by human oral keratinocytes

OBJECTIVE

Human β-defensin 1 (hBD-1) is a antimicrobial peptide that is constantly secreted by oral tissues. Hangeshashinto (HST), a traditional Japanese medicine, has been reported to be effective against stomatitis. This study aimed to clarify the profile of HST by comparing the system of production of interleukin-1α (IL-1α) and hBD-1 in human oral mucosal epithelial cells with dexamethasone (DEX), a steroid used for the treatment of stomatitis.

METHODS

Human oral keratinocytes (HOK) were treated with HST, DEX, or HST components (baicalein, baicalin, berberine, and glycyrrhizin) for 24 h, and subsequently cultured for 24 h with or without Pam3CSK4 or lipopolysaccharide (LPS). The cell supernatants, total RNA, and intracellular proteins were collected, and changes in IL-1α and hBD-1 protein production and gene expression were evaluated using ELISA and RT-PCR. The phosphorylation of NF-kB and the cell proliferative ability of HOK were evaluated by western blotting and XTT assay, respectively.

RESULTS

DEX (0.01-10 μM) significantly suppressed IL-1α and hBD-1 production induced by either Pam3CSK4 or LPS, and also decreased cell growth. In contrast, HST inhibited Pam3CSK4- and LPS-induced IL-1α production at a concentration range of 12.5-100 μg/mL without affecting the cell proliferative capacity and hBD-1 production of HOK. Baicalein and baicalin, which are flavonoid ingredients of HST, showed anti-IL-1α production.

CONCLUSION

HST may be useful as a therapeutic agent for stomatitis and other inflammatory diseases of the oral cavity.

Branch-duct Intraductal Papillary Mucinous Neoplasm with Rapidly Developing Intracystic Xanthogranulomatous Nodules

We herein report a case of a branch-duct intraductal papillary mucinous neoplasm (IPMN) with rapidly developing intracystic xanthogranulomatous nodules. A unilocular cystic lesion without a mural nodule was found in the pancreatic tail of a 69-year-old man. Ten months later, multiple mural nodules emerged unexpectedly within the cyst, and the patient underwent distal pancreatectomy. Based on immunohistochemical studies and a molecular analysis, we diagnosed him with branch-duct IPMN of the gastric immunophenotype. Fragility of the pancreatic duct mucosa and consequent exposure of the wall to pancreatic juice might have caused marked granulation nodule formation in the cyst lumen.

Efficacy of laparoscopic surgery for loop colostomy: a propensity-score-matched analysis

PURPOSE

Colostomy is a common procedure for fecal diversion, but the optimal colostomy approach is unclear in terms of surgical outcomes and stoma-related complications. The purpose of this study was to examine the efficacy and feasibility of laparoscopic loop colostomy.

METHODS

This retrospective cohort study included patients who underwent loop colostomy at Shizuoka Cancer Center in Japan between April 2010 and March 2022. Patients were divided into two groups based on surgical approach: the laparoscopic (LAP) and open (OPEN) groups. Surgical outcomes and the incidences of stoma-related complications such as stomal prolapse (SP), parastomal hernia (PSH), and skin disorders (SD) were compared with and without propensity score matching.

RESULTS

Of the 388 eligible patients, 180 (46%) were in the LAP group and 208 (54%) were in the OPEN group. The male-to-female ratio was 5.5:4.5 in the Lap group and was 5.3:4.7 in the OPEN group, respectively. The median age was 68 years (range, 31-88 years) in the LAP group and 65 years (range, 23-93 years) in the OPEN group, respectively. The LAP group, compared with the OPEN group, had a shorter operative time and lower incidences of surgical site infection (3.9% versus 16.3%, respectively; p < 0.01) and SD (11.7% versus 24.5%, respectively; p < 0.01). There was no significant difference between the LAP and OPEN groups in the incidence of SP (17.3% versus 17.3%, respectively) or PSH (8.9% versus 6.7%, respectively). After propensity score matching, the incidences of surgical site infection and SD were significantly lower in the LAP group than in the OPEN group, while there were no significant differences in the operative time or the incidences of SP and PSH.

CONCLUSION

Our results suggest that laparoscopic surgery could be beneficial and feasible in loop colostomy.

GATA6 and CK5 Stratify the Survival of Patients With Pancreatic Cancer Undergoing Neoadjuvant Chemotherapy

Relevant protein expression of GATA6, CK5, vimentin, and mucins using immunohistochemistry was assessed for predicting the prognosis of and chemotherapy efficacy in patients with pancreatic cancers (PCs). The protein expression was examined in 159 PCs resected after neoadjuvant chemotherapy (NAC-PCs) and compared with that of 120 matched biopsy specimens taken before NAC. KRAS mutations were assessed by digital PCR. NAC-PCs were classified by GATA6 expression initially and CK5 expression subsequently into 4 types: classical-type (n = 22) with GATA6-high (≥50%)/CK5-low (<10%) PCs; hybrid-type (n = 45) with GATA6-high/CK5-high (≥10%) PCs; basal-like-type (n = 53) with GATA6-low (<50%)/CK5-high (≥30%) PCs; and null-type (n = 39) with GATA6-low/CK5-low (<30%) PCs, which resulted in clear stratification of patient prognosis. The classical-type was associated with the most favorable prognosis, whereas the null-type was associated with the worst prognosis (multivariate hazard ratio: 3.56; 95% CI: 1.63-7.77; P = .0015). The hybrid and basal-like types correlated with in-between levels of prognosis. The risk of hepatic recurrence was lower in the classical-type than in null (multivariate odds ratio [mOR]: 0.18; 95% CI: 0.04-0.96; P = .0449) and basal-like (mOR: 0.24; 95% CI: 0.05-1.16; P =.0750) types. By contrast, the risk of locoregional recurrence was higher in the classical-type than in the basal-like-type (mOR: 5.03; 95% CI: 1.20-21.1; P = .0272). The hybrid-type was subclassified into transition and coexpression patterns with different gastric mucin expression levels. High levels of vimentin (≥10%, n = 30) in pre-NAC-PC tissues was associated with poor prognosis (P = .0256). Phenotypic transitions between pre-NAC and post-NAC-PCs were common (73/120; 61%). PCs with NAC regression grades 2 and 3 showed a transition to poorer prognostic phenotypes (P = .0497). KRAS mutations were not associated with these phenotypes. In conclusion, GATA6 and CK5 immunohistochemical expression phenotypes may stratify the survival of patients with NAC-PCs and reflect post-NAC phenotypic transitions associated with poor prognosis. Prompt evaluation of immunohistochemical phenotypes may contribute to designing a precision therapeutic strategy for patients with PCs.

Mutant GNAS limits tumor aggressiveness in established pancreatic cancer via antagonizing the KRAS-pathway

BACKGROUND

Mutations in GNAS drive pancreatic tumorigenesis and frequently occur in intraductal papillary mucinous neoplasm (IPMN); however, their value as a therapeutic target is yet to be determined. This study aimed at evaluating the involvement of mutant GNAS in tumor aggressiveness in established pancreatic cancer.

METHODS

CRISPR/Cas9-mediated GNAS R201H silencing was performed using human primary IPMN-associated pancreatic cancer cells. The role of oncogenic GNAS in tumor maintenance was evaluated by conducting cell culture and xenograft experiments, and western blotting and transcriptome analyses were performed to uncover GNAS-driven signatures.

RESULTS

Xenografts of GNAS wild-type cells were characterized by a higher Ki-67 labeling index relative to GNAS-mutant cells. Phenotypic alterations in the GNAS wild-type tumors resulted in a significant reduction in mucin production accompanied by solid with massive stromal components. Transcriptional profiling suggested an apparent conflict of mutant GNAS with KRAS signaling. A significantly higher Notch intercellular domain (NICD) was observed in the nuclear fraction of GNAS wild-type cells. Meanwhile, inhibition of protein kinase A (PKA) induced NICD in GNAS-mutant IPMN cells, suggesting that NOTCH signaling is negatively regulated by the GNAS-PKA pathway. GNAS wild-type cells were characterized by a significant invasive property relative to GNAS-mutant cells, which was mediated through the NOTCH regulatory pathway.

CONCLUSIONS

Oncogenic GNAS induces mucin production, not only via MUC2 but also via MUC5AC/B, which may enlarge cystic lesions in the pancreas. The mutation may also limit tumor aggressiveness by attenuating NOTCH signaling; therefore, such tumor-suppressing effects must be considered when therapeutically inhibiting the GNAS pathway.

Time-saving method for directly amplifying and capturing a minimal amount of pancreatic tumor-derived mutations from fine-needle aspirates using digital PCR

It is challenging to secure a cytopathologic diagnosis using minute amounts of tumor fluids and tissue fragments. Hence, we developed a rapid, accurate, low-cost method for detecting tumor cell-derived DNA from limited amounts of specimens and samples with a low tumor cellularity, to detect KRAS mutations in pancreatic ductal carcinomas (PDA) using digital PCR (dPCR). The core invention is based on the suspension of tumor samples in pure water, which causes an osmotic burst; the crude suspension could be directly subjected to emulsion PCR in the platform. We examined the feasibility of this process using needle aspirates from surgically resected pancreatic tumor specimens (n = 12). We successfully amplified and detected mutant KRAS in 11 of 12 tumor samples harboring the mutation; the positive mutation frequency was as low as 0.8%. We used residual specimens from fine-needle aspiration/biopsy and needle flush processes (n = 10) for method validation. In 9 of 10 oncogenic KRAS pancreatic tumor samples, the "water-burst" method resulted in a positive mutation call. We describe a dPCR-based, super-sensitive screening protocol for determining KRAS mutation availability using tiny needle aspirates from PDAs processed using simple steps. This method might enable pathologists to secure a more accurate, minimally invasive diagnosis using minute tissue fragments.

Age-dependent decrease in desflurane concentration for maintaining bispectral index below 50

BACKGROUND

We examined the hypothesis that the minimum alveolar concentration of desflurane for maintaining bispectral index (BIS) below 50 (MACBIS 50 ) decreases with advance of age.

METHODS

Sixty young (20-30 year), middle-aged (31-65 year) and elderly (66-80 year) patients were included (n = 20, each group). Five minutes following the start of continuous intravenous administration of remifentanil at 0.25 μg/kg/min, general anaesthesia was induced with propofol 2 mg/kg and rocuronium 0.8 mg/kg to facilitate tracheal intubation. Infusion of remifentanil was stopped immediately after tracheal intubation. When BIS began to increase > 60, maintenance of anaesthesia was started with an end-tidal desflurane concentration of 4.0% and maintained for 10 min followed by 1-min assessment of BIS taken at 10-s intervals. MACBIS 50 of each age group was estimated by up-down methodology.

RESULTS

MACBIS 50 of desflurane in young, middle-aged and elderly patients was 4.25% end-tidal (95% confidence intervals 4.04-4.46), 3.58% (3.38-3.79) and 2.75% (2.50-3.00) respectively. MACBIS 50 was higher (P = 0.011) in young patients and lower (P = 0.012) in elderly patients than those in middle-aged patients.

CONCLUSIONS

Advance in age significantly decreased the concentrations of desflurane required to maintain BIS below 50. BIS reflected age-associated decrease in end-tidal concentrations of desflurane required for maintaining adequate depth of anaesthesia during resting state.

[Social development of twins: the need for intervention to avoid adverse effects of twin language]

Social competence is one of the most important accomplishments of human development, and this skill in human relationships is learned through communication. Therefore, it is considered that delays in language development could be a barrier to building human relationships and social competence. Although it is well known that there are delays in language development in twins compared with that of singletons, little is known about how these linguistic delays affect the development of social competence. Because twin language is a language that is unique to each pair of twins and cannot be understood by either their mother or others, it may be assumed that the social competence of twins who have a twin language is less than that of twins who don't have a twin language. Therefore, in this prospective longitudinal study we also investigated the relationship between twin language and social competence. A mailed questionnaire survey was conducted in 958 mothers as a follow-up of a study conducted in 2004. As a result, 522 respondents returned the questionnaire (53.9%). In this study, we used only 256 twins aged 6- 12-years-old (school-age children) for analysis, excluding those with missing values. Multiple logistic regression analysis was employed. In the second child of twins, a low birth weight, the appearance of twin language and gestosis of the mother were positively related with social unbalance (OR = 1.846, 2.022 and 1.903). On the other hand, with the first child, however, there was no such link. The present results indicate that twin language might influence social competence in school-age children. It has been believed that linguistic intervention is unnecessary, because most twin language disappears spontaneously. However, early intervention, for example linguistic assistance by public health nurses or psychologists and early enrollment in a preschool may be necessary for twins with a twin language, to avoid adverse consequences in social competence at school-age.

Reductive metabolism of stilbene oxide and styrene oxide to the olefins in rats

The present study provides the first evidence that stilbene oxide and styrene oxide are reductively metabolized to the corresponding olefins in rats. When cis- or trans-stilbene oxide was given orally to rats, both cis- and trans-stilbene were isolated from the urine and feces. Styrene was also isolated from the urine and feces of rats given styrene oxide. These metabolites were identified unequivocally by UV and mass spectral comparison with authentic samples, and on the basis of their TLC and HPLC behavior. However, these olefins were not detected in the urine or feces of antibiotics-treated rats dosed with cis- or trans-stilbene oxide. Cecal contents of the untreated rats exhibited olefin oxide reductase activities toward cis- and trans-stilbene oxides under anaerobic conditions. The results suggest that intestinal bacteria play an important role in the reduction of olefin oxides to the corresponding olefins in the animal body.

Utility of colorimetric end-tidal carbon dioxide detector for monitoring during prehospital cardiopulmonary resuscitation

The purpose of this study was to evaluate a colorimetric end-tidal CO2 (ETCO2) detector (EASY CAP) as a monitor during prehospital cardiopulmonary resuscitation (CPR) without tracheal intubation. This detector was used for 121 patients during CPR with a laryngeal mask airway or face mask by authorized emergency lifesaving technicians. At 7 to 15 minutes after the initiation of CPR, ETCO was <0.5% in 30 cases (group A), 0.5% to 2.0% in 46 cases (group B) and >2.0% in 45 cases (group C). The rate of return of spontaneous circulation was 17% in group A, 24% in group B, and 48% in group C (groups A v C, P < .01). There was a significant difference in the rate of hospital admission between groups A and C. The ETCO2 value may be useful for monitoring during prehospital CPR with a laryngeal mask airway or face mask.

Alpha fetoprotein-producing acinar cell carcinoma of the pancreas showing multiple lines of differentiation

An alpha fetoprotein (AFP)-producing tumour occurring in the head of the pancreas of a 30-year-old woman is reported. Histological examination revealed a markedly solid proliferation of tumour cells with prominent nucleoli and occasional luminal structures, some of which contained mucinous material stained with mucicarmine and alcian blue. No squamoid corpuscles were recognized. Immunohistochemistry showed intense positivity for lipase trypsin, and AFP basically, and single cells were also positive for carcino-embryonic antigen, CA19-9, synaptophysin and neuron-specific enolase. Pancreatic hormone-positive cells were absent. Electron microscopical examination revealed numerous granules of variable sizes in the tumour cells, which were considered to be zymogen. The tumour is an acinar cell carcinoma with multi-directional differentiation including the ability to produce AFP. Among AFP-positive pancreatic tumours, acinar cell carcinoma and pancreatoblastoma seem to be the most frequent.

Oleanane and ursane glycosides from Schefflera octophylla

Twelve triterpene glycosides were isolated from the bark of Schefflera octophylla of Vietnamese origin. Three of them were identified as asiaticoside, cauloside D and 3 alpha-hydroxyurs-12-ene-23,28-dioic acid 28-O-alpha-L-rhamnopyranosyl (1-->4)-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranoside. The structures of nine new glycosides were elucidated by chemical and spectroscopic evidence. Including the known compounds, the 12 glycosides consisted of six pairs of corresponding ursene and oleanene glycosides and all of them had the same triose moiety at the C-28 position. The names scheffurosides A-F and scheffoleosides B-F were proposed for corresponding pairs of ursene and oleanene glycosides, respectively.

[The significance of endoscopic treatment of early gastric cancer]

Gastric endoscopy could be an useful procedure in treating patients with early gastric cancer in certain conditions. We treated 24 patients with gastric cancer for whom no surgery was indicated because of serious complications or patient's refusal. Endoscopic local injection (ELI) with Mitomycin C (MMC), 5-fluorouracil (5-FU), and Picibanil (OK-432) was performed in 16 patients and polypectomy in 8 patients as radical treatment for primary gastric cancer. Of the 16 cases, ELI was effective in 9 cases of early gastric cancers, consisting of 4 cases with complete response (CR), additional 4 with a partial response (PR), but was ineffective in the remaining of all 3 cases of advanced cancers. ELI with MMC + 5FU was performed in 8 cases with an excellent response; 3 cases with CR and 3 cases with PR; 5 patients are alive, with the longest survival period of 54 months, and 2 patients died of other diseases. On the other hand, ELI with OK-432 was carried out in remaining 8 cases with no effective results, showing only 1 case with CR and another case with PR. Polypectomy was effective for 8 protruding type of early gastric cancers with the longest cancer-free period of 31 months. At present, although preoperative evaluation of the depth and range of cancer invasion is difficult, we would like to emphasize that ELI and polypectomy are procedures worthy to be attempted in patients with early gastric cancers with no nodal metastases for surgery is not indicated.

[Balloon occluded arterial infusion therapy for malignant hepatic tumors]

A number of reports of regional intraarterial infusion chemotherapy for malignant tumors have been published. Balloon occluded arterial infusion was newly developed by us. Balloon catheter is used for temporal occlusion of the hepatic artery during intraarterial infusion of anticancer drugs. Interruption of the arterial blood flow keeps the drugs at high concentration for a long time in the distal artery to the occluded portion. This procedure has been performed in 87 cases of hepatomas and metastatic liver cancers with the sufficiently good results.