Anatomical attention can help to segment the dilated pancreatic duct in abdominal CT

PURPOSE

Pancreatic duct dilation is associated with an increased risk of pancreatic cancer, the most lethal malignancy with the lowest 5-year relative survival rate. Automatic segmentation of the dilated pancreatic duct from contrast-enhanced CT scans would facilitate early diagnosis. However, pancreatic duct segmentation poses challenges due to its small anatomical structure and poor contrast in abdominal CT. In this work, we investigate an anatomical attention strategy to address this issue.

METHODS

Our proposed anatomical attention strategy consists of two steps: pancreas localization and pancreatic duct segmentation. The coarse pancreatic mask segmentation is used to guide the fully convolutional networks (FCNs) to concentrate on the pancreas' anatomy and disregard unnecessary features. We further apply a multi-scale aggregation scheme to leverage the information from different scales. Moreover, we integrate the tubular structure enhancement as an additional input channel of FCN.

RESULTS

We performed extensive experiments on 30 cases of contrast-enhanced abdominal CT volumes. To evaluate the pancreatic duct segmentation performance, we employed four measurements, including the Dice similarity coefficient (DSC), sensitivity, normalized surface distance, and 95 percentile Hausdorff distance. The average DSC achieves 55.7%, surpassing other pancreatic duct segmentation methods on single-phase CT scans only.

CONCLUSIONS

We proposed an anatomical attention-based strategy for the dilated pancreatic duct segmentation. Our proposed strategy significantly outperforms earlier approaches. The attention mechanism helps to focus on the pancreas region, while the enhancement of the tubular structure enables FCNs to capture the vessel-like structure. The proposed technique might be applied to other tube-like structure segmentation tasks within targeted anatomies.

Portable dynamic ultrasonography is a useful tool for the evaluation of suspected syndesmotic instability: a cadaveric study

PURPOSE

Portable ultrasonography (P-US) is increasingly used to diagnose syndesmotic instability. The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P-US with progressive stages of syndesmotic ligamentous transection under external rotation stress.

METHODS

Ten fresh lower leg cadaveric specimens amputated above the proximal tibiofibular joint were used. Using P-US, the TFCS was evaluated in the intact stage and after progressive sectioning of the (1) anterior-inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), and (3) posterior-inferior tibiofibular ligament (PITFL). The TFCS was measured in both the unstressed (0 Nm) state and with 4.5, 6.0, 7.5, and 9.0 Nm of external rotation stress using a bone hook placed on the first metatarsal bone at each stage of ligamentous transection stage using both P-US and fluoroscopy.

RESULTS

When assessed with P-US, partial syndesmotic injury encompassing the AITFL and IOL resulted in significant TFCS widening at 4.5 Nm of external rotation torque when compared to intact state with a TFCS-opening of 2.6 ± 2 mm, p = 0.01. In contrast, no significant differences in TFCS were detected using fluoroscopy. Only a moderate correlation was found between P-US and fluoroscopy.

CONCLUSION

P-US is a useful tool in diagnosing syndesmotic instability during external rotation stress examination. TFCS-opening increased as additional ligaments of the syndesmosis were transected, and application of 4.5 Nm torque was sufficient to detect a difference of 2.6 mm after the IOL cut.

A cascaded fully convolutional network framework for dilated pancreatic duct segmentation

PURPOSE

Pancreatic duct dilation can be considered an early sign of pancreatic ductal adenocarcinoma (PDAC). However, there is little existing research focused on dilated pancreatic duct segmentation as a potential screening tool for people without PDAC. Dilated pancreatic duct segmentation is difficult due to the lack of readily available labeled data and strong voxel imbalance between the pancreatic duct region and other regions. To overcome these challenges, we propose a two-step approach for dilated pancreatic duct segmentation from abdominal computed tomography (CT) volumes using fully convolutional networks (FCNs).

METHODS

Our framework segments the pancreatic duct in a cascaded manner. The pancreatic duct occupies a tiny portion of abdominal CT volumes. Therefore, to concentrate on the pancreas regions, we use a public pancreas dataset to train an FCN to generate an ROI covering the pancreas and use a 3D U-Net-like FCN for coarse pancreas segmentation. To further improve the dilated pancreatic duct segmentation, we deploy a skip connection on each corresponding resolution level and an attention mechanism in the bottleneck layer. Moreover, we introduce a combined loss function based on Dice loss and Focal loss. Random data augmentation is adopted throughout the experiments to improve the generalizability of the model.

RESULTS

We manually created a dilated pancreatic duct dataset with semi-automated annotation tools. Experimental results showed that our proposed framework is practical for dilated pancreatic duct segmentation. The average Dice score and sensitivity were 49.9% and 51.9%, respectively. These results show the potential of our approach as a clinical screening tool.

CONCLUSIONS

We investigate an automated framework for dilated pancreatic duct segmentation. The cascade strategy effectively improved the segmentation performance of the pancreatic duct. Our modifications to the FCNs together with random data augmentation and the proposed combined loss function facilitate automated segmentation.

Qualitative analysis of actual Standard for Exchange of Nonclinical Data (SEND) datasets for Data Domains: Proposition from Japan Pharmaceutical Manufacturers Association SEND Taskforce Team on standardization of nonclinical data

The Standard for Exchange of Nonclinical Data (SEND) has been adopted by the US FDA, which has required pharmaceutical companies who are developing new drugs for the US market to implement SEND. The Japan Pharmaceutical Manufacturers Association (JPMA) SEND Taskforce Team responded to this situation by starting a project to better understand the contents of SEND datasets. The project focused on domains generally included in the SEND domains for single- and repeat-dose general toxicology studies, and surveyed what kind of information are populated in which domains and in what way. The qualitative analysis of the results indicated that variations exist based on whether or not an individual variable was populated and on how the variable was populated. The Taskforce Team recommends reducing variations not only in the SEND datasets but also in the descriptions in the study protocol and/or final study report. Reduction of such variations should lead to higher quality datasets with powerful and increased searchability so that accumulated SEND datasets should become more valuable. These efforts would provide regulatory agencies with easier review of SEND datasets, which contributes to efficient development of new drug candidates.

A fundamental study on how holding a helium-filled balloon affects stability in human standing

Various studies have been conducted in the field of the development/deterioration of standing and walking ability. In standing and walking control strategy, the relationship linking visual/somatosensory/vestibular-system information and physical movement is important. Researchers have previously sought to evaluate attitude control based on human sensory information. The authors have also reported that the body sway of a walking infant is mitigated when the subject holds a helium-filled balloon, with results suggesting that this approach can be applied to extend walking distance. This study was conducted to clarify how holding a balloon influences standing control strategy. A novel system was developed to quantitatively monitor and evaluate the standing state of subjects holding such a balloon. The results of the experiments conducted indicate that attitude control strategy changes in response to somatosensory information provided by the physical connection with the balloon.

Revision of the Massarineae (Pleosporales, Dothideomycetes)

We here taxonomically revise the suborder Massarineae (Pleosporales, Dothideomycetes, Ascomycota). Sequences of SSU and LSU nrDNA and the translation elongation factor 1-alpha gene (tef1) are newly obtained from 106 Massarineae taxa that are phylogenetically analysed along with published sequences of 131 taxa in this suborder retrieved from GenBank. We recognise 12 families and five unknown lineages in the Massarineae. Among the nine families previously known, the monophyletic status of the Dictyosporiaceae, Didymosphaeriaceae, Latoruaceae, Macrodiplodiopsidaceae, Massarinaceae, Morosphaeriaceae, and Trematosphaeriaceae was strongly supported with bootstrap support values above 96 %, while the clades of the Bambusicolaceae and the Lentitheciaceae are moderately supported. Two new families, Parabambusicolaceae and Sulcatisporaceae, are proposed. The Parabambusicolaceae is erected to accommodate Aquastroma and Parabambusicola genera nova, as well as two unnamed Monodictys species. The Parabambusicolaceae is characterised by depressed globose to hemispherical ascomata with or without surrounding stromatic tissue, and multi-septate, clavate to fusiform, hyaline ascospores. The Sulcatisporaceae is established for Magnicamarosporium and Sulcatispora genera nova and Neobambusicola. The Sulcatisporaceae is characterised by subglobose ascomata with a short ostiolar neck, trabeculate pseudoparaphyses, clavate asci, broadly fusiform ascospores, and ellipsoid to subglobose conidia with or without striate ornamentation. The genus Periconia and its relatives are segregated from the Massarinaceae and placed in a resurrected family, the Periconiaceae. We have summarised the morphological and ecological features, and clarified the accepted members of each family. Ten new genera, 22 new species, and seven new combinations are described and illustrated. The complete ITS sequences of nrDNA are also provided for all new taxa for use as barcode markers.

Analysis of Chinese rabies virus isolates from 2003-2007 based on P and M protein genes

Phylogenetic analysis of nucleotide sequences or deduced amino acid sequences of phosphoprotein (P protein), matrix (M) protein, and glycoprotein (G protein) genes of 18 Chinese isolates of Rabies virus (RABV) from 2003-2007 showed that these isolates formed a separate monophyletic lineage consisting of sub-lineages A and B. Compared with laboratory-fixed strains, recent Chinese isolates of sub-lineage B contained Val or Ala instead of Met69 in P protein, which is involved in generating truncated P proteins. In addition, one of these isolates CHpg3 had Pro instead of Ser63 and Leu instead of Ser64. Importantly, all functional domains of P and M proteins of all recent Chinese isolates were similar to those of laboratory-fixed strains. This study showed that although the recent Chinese RABV isolates belonged to a distinct lineage, their functional domains of P and M proteins were highly conserved.

KEYWORDS

rabies virus; glycoprotein; phosphoprotein; matrix protein; China.

Molecular Growth Requirements of Single Mammalian Cells

The molecular nutritional requirements exhibited by mammalian cells can vary with the following conditions: whether the cells are plated singly or in massive inoculum; whether a clonal strain or a mixture of different genotypes is employed; whether the macromolecular fraction of serum used as a supplement was previously exposed to prolonged dialysis or other procedures which may release bound micromolecules. In addition, the nature of the medium in which the cells were previously grown, the time permitted for incubation of the cells in the test medium, and the presence of substances or conditions which may specifically introduce the need for certain molecules to preserve balance can strongly influence nutritional requirements. This great versatility may reflect the ability of the mammalian cell to assume different metabolic states characteristic of specific types of differentiation. Under certain conditions, growth of single HeLa cells of the S3 clonal strain requires the presence of cholesterol at a level of 0.5 to 1 microgram per milliliter.

CARACTERIZAÇÃO GENÉTICA E DISTRIBUIÇÃO GEOGRÁFICA DO VÍRUS RÁBICO ISOLADO DE BOVINOS NO ESTADO DE MATO GROSSO, BRASIL

RESUMO Foram caracterizados, geneticamente e geograficamente, o sequenciamento parcial da nucleoproteína (gene N) de 53 isolados do vírus da raiva (VR) originários do Estado de Mato Grosso, Brasil. Os isolados de bovinos, que se encontravam no grupo do VR relacionado a morcegos hematófagos, foram posteriormente subdivididos em sete subgrupos genéticos. Estes subgrupos foram distribuídos em regiões de terras planas, com alguns subgrupos separados por formações de pequenas montanhas e hidrografia. Estes resultados indicam que a raiva em bovinos é derivada de diversas variantes regionalmente definidas, o que sugere que sua distribuição geográfica está relacionada as populações de morcegos hematófagos.

Genetic diversity of bat rabies viruses in Brazil

Thirty-three Brazilian bat rabies viruses (RVs) were studied by sequence analysis and were compared against sequences of bat-related RVs from other regions of the Americas. Phylogenetic analysis revealed that bat-related RVs formed several monophyletic lineages and that these were associated with bat species. Brazilian bat RVs were found to include nine major lineages, one of which grouped with RVs isolated from Lasiurus spp. from different regions of the Americas. These results suggest that there is considerable diversity among Brazilian bat RV variants and that some of these RV variants may be associated with bats from other countries.

A study for establishment of individualized chemotherapy for colorectal cancer based on the individual 50% inhibitory area under the concentration curve (AUCIR50) using the collagen gel droplet embedded culture-drug sensitivity test (CD- DST)

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Background: The drug sensitivity of tumor cells is one of the key issues to explore in individualized 5-fluorouracil (5-FU) based chemotherapy for colorectal cancer patients. We reported that growth inhibition rate (IR) and area under the concentration curve (AUC) approximated to a logarithmic curve using the collagen gel droplet embedded culture-drug sensitivity test (CD-DST) in ASCO 2003 (#1283). We also reported that the individual 50% inhibitory area under the concentration curve (AUC IR50) could be obtained using the individual AUC-IR curve in ASCO 2006 (#13560). The aim of this study was to evaluate the achievement of the individual AUCIR50 in 5-FU based adjuvant chemotherapy for the establishment of individualized chemotherapy. Methods: Surgical specimen was obtained from resectable 33 CRC patients without any preoperative chemotherapy during 2001 to 2005. 5-FU based adjuvant chemotherapy was administered in all patients. CD-DST was performed under 6–9 different conditions. The individual AUCIR50 was obtained from the individual AUC-IR curve. The patients were divided into 2 groups, the achieved group and the non-achieved group. In the achieved group, total administered AUC was more than the individual AUCIR50 and in non-achieved group, the total administered AUC was less than the individual AUCIR50. Recurrence rates were evaluated from the 2 groups. Results: In all patients, the recurrence rates were 6.7% (1/15) in the achieved group and 27.8% (5/18) in the non-achieved group. In the colon cancer patients, the recurrence rates were 8.3% (1/12) in the achieved group and 10.0% (1/10) in the non-achieved group. In the rectal cancer patients, the recurrence rates were 0% (0/3) in the achieved group and 50.0% (4/8) in the non-achieved group. Conclusions: The recurrence rate of the achieved group was lower than that of the non-achieved group. Therefore, this study demonstrated that the achievement of the individual AUCIR50 could be a prerequisite of individualized 5-FU based adjuvant chemotherapy.

No significant financial relationships to disclose.

Predicting risk of estrogen receptor positive breast cancers in postmenopausal women

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Background: Chemoprevention strategies for estrogen receptor positive (ER+) breast cancers are emerging, especially for postmenopausal women, but require methods of targeting appropriate populations. Our objective was to improve the Breast Cancer Risk Assessment Tool [Gail Model (GM)] for estimating ER+ breast cancer risk. Methods: A prospective cohort involving 161,809 postmenopausal women aged 50–79 years, (93,676 in the observational study (OS) and 68,132 in clinical trials (CT)) at Women’s Health Initiative (WHI) Clinical Centers had comprehensive assessment of lifestyle, medication use and breast cancer risk factors. Breast cancer risk from the GM and other models incorporating additional or fewer risk factors and five year incidence of ER + and ER negative (ER-) invasive breast cancers were determined. Main outcome measures were concordance statistics for models predicting breast cancer risk. Results: Of 148,266 women meeting eligibility criteria, (no prior breast cancer and/or mastectomy), 3,236 developed breast cancer. Chronological age and age at menopause, both GM components, were significantly associated with only ER+ but not ER- breast cancer risk (p<0.05 for heterogeneity test). The GM predicted population-based ER+ cancer risk with reasonable accuracy (concordance statistic 0.60, 95% confidence interval (CI) 0.58 to 0.62) but for ER- cancers, the results were equivalent to chance allocation (concordance statistic 0.49, 95% CI 0.45 to 0.54). For ER+ cancers, no additional risk factors improved the GM prediction. However, a simpler model, developed in the OS and tested in the CT population, including only age, family history, and benign breast biopsy was comparable to GM in ER+ breast cancer prediction (concordance statistics 0.58, 95% CI 0.56 to 0.60). Using this model, all women ≥ 55 years old (or ≥ 60 year old if African American) with either a prior breast biopsy or first degree breast cancer family history had five year breast cancer risk of ≥ 1.8%. Conclusions: In postmenopausal women with comprehensive mammography use, the GM identifies populations at increased risk for ER+ breast cancer but not for ER- cancer. A model with fewer variables provides a simpler alternative for identifying populations appropriate for breast cancer chemoprevention interventions.

No significant financial relationships to disclose.

Molecular epidemiology of rabies from Maranhão and surrounding states in the northeastern region of Brazil

Although many outbreaks of rabies have been reported in northern Brazil, few epidemiological studies of these outbreaks have been undertaken. In this study, molecular epidemiological analyses were performed using 41 rabies virus samples isolated in the Maranhão (MA), Pará (PA), and Tocantins (TO) states of northeastern Brazil. A 599-bp region of the glycoprotein (G) gene was first amplified from each sample by RT-PCR, then sequenced and subjected to phylogenetic analysis. A phylogenetic tree divided the 41 isolates into two clades: Clade I was associated with terrestrial carnivores and Clade II was associated with vampire bats. The Clade I isolates were further sub-divided into two groups. The first group was closer to carnivore isolates that predominate in central Brazil, whereas the second group more closely resembled wild fox isolates from the northeastern coastal state of Paraíba (PB). MA isolates of Clade II formed an entirely separate group. These results demonstrate that bat- and dog-transmitted rabies occur in northwestern Brazil.

Genetic and phylogenetic characterization of rabies virus isolates from wildlife and livestock in Paraiba, Brazil

Thirty-four rabies virus (RV) isolates from foxes (8), insectivore bats (9), cattle (14), sheep (1), a goat (1) and a donkey (1) from Paraiba state, northeastern Brazil, were genetically characterized. Sequences of 890 nts of nucleoprotein (N) genes of these isolates were analyzed and compared with those of other Brazilian isolates characterized earlier. Phylogenetic analysis revealed three genetical lineages of RV co-existing in this region. Each lineage was found to be associated with particular host species and to circulate independently of each other. The first lineage was found in foxes (Dusicyon sp.) and could be discriminated from domestic carnivore isolates from Sao Paulo, Goias and Minas Gerais in the southern and central Brazil. The second lineage was associated with insectivorous bats (Molossus spp.) and differed from vampire bat-associated RV isolates. The third lineage was found in livestock and clustered with vampire bat-associated RV isolates from Sao Paulo, Tocantins, Goias and Matto Grosso. These results indicate that RV of these genetic lineages are cocirculating in the Paraiba state and that livestock in this region are infected with vampire bat-associated RV, suggesting that the vampire bat is the main reservoir of livestock rabies in this region.

A short γ-ray burst apparently associated with an elliptical galaxy at redshift z = 0.225

Gamma-ray bursts (GRBs) come in two classes: long (> 2 s), soft-spectrum bursts and short, hard events. Most progress has been made on understanding the long GRBs, which are typically observed at high redshift (z approximately 1) and found in subluminous star-forming host galaxies. They are likely to be produced in core-collapse explosions of massive stars. In contrast, no short GRB had been accurately (< 10'') and rapidly (minutes) located. Here we report the detection of the X-ray afterglow from--and the localization of--the short burst GRB 050509B. Its position on the sky is near a luminous, non-star-forming elliptical galaxy at a redshift of 0.225, which is the location one would expect if the origin of this GRB is through the merger of neutron-star or black-hole binaries. The X-ray afterglow was weak and faded below the detection limit within a few hours; no optical afterglow was detected to stringent limits, explaining the past difficulty in localizing short GRBs.

A giant γ-ray flare from the magnetar SGR 1806–20

Two classes of rotating neutron stars-soft gamma-ray repeaters (SGRs) and anomalous X-ray pulsars-are magnetars, whose X-ray emission is powered by a very strong magnetic field (B approximately 10(15) G). SGRs occasionally become 'active', producing many short X-ray bursts. Extremely rarely, an SGR emits a giant flare with a total energy about a thousand times higher than in a typical burst. Here we report that SGR 1806-20 emitted a giant flare on 27 December 2004. The total (isotropic) flare energy is 2 x 10(46) erg, which is about a hundred times higher than the other two previously observed giant flares. The energy release probably occurred during a catastrophic reconfiguration of the neutron star's magnetic field. If the event had occurred at a larger distance, but within 40 megaparsecs, it would have resembled a short, hard gamma-ray burst, suggesting that flares from extragalactic SGRs may form a subclass of such bursts.

Extracerebral ectopic mass with huge cysts in the anterior cranial cavity

In the present study, an unusual example of malformation in a 9-day-old-girl, in whom an extracerebral ectopic mass with cysts was found in the anterior cranial cavity, is reported. The brain proper was well developed. The mass was connected to the cerebral base and consisted of neuroglial tissue showing various characteristics of differentiation, including cerebellar cortex and monoaminergic neurons. The ectopia may have developed from the mediobasal portion of the embryonic telencephalon.

Detection of prepro-ET-1 mRNA in normal rat kidney by in situ RT-PCR

BACKGROUND

Available evidence has shown that endothelin-1 (ET-1) acts in an autocrine/paracrine fashion rather than as a hormone or cytokine. Therefore, the analysis of local ET-1 production is a crucial step toward understanding its physiological and pathophysiological importance. In this study, in situ RT-PCR was utilized to detect tubular expression of prepro-ET-1 mRNA in normal rat kidney.

METHODS

Kidneys were taken from normal Sprague-Dawley rats weighing approximately 200 g. In situ RT-PCR was carried out using the preparations embedded in paraffin and cut at a thickness of 8 microm. Furthermore, we tried semiquantitation of the prepro-ET-1 mRNA expression along different nephron segments by densitometric analysis.

RESULTS

Prepro-ET-1 mRNA expression was detected in all tubular segments of the kidney from normal rats. Densitometric analysis demonstrated its highest expression in cortical collecting duct (CCD) and outer medullary collecting duct (OMCD). The expression was the lowest in thin descending limb of Henle's loop (TDL).

CONCLUSION

This study showed that all tubular segments have the ability to synthesize ET-1 in rat kidney. It would be worth evaluating the levels prepro-ET-1 mRNA expression in various diseases by in situ RT-PCR to understand its pathophysiological role in such settings.

Immunohistochemical analysis of myelination following hemicranial irradiation in neonatal rats

The mechanism of radiation-induced diffuse brain injury was investigated in a neonatal rat hemicranial irradiation model using immunohistochemistry. Neonatal Fischer 344 rats received hemicranial irradiation with a single dose of 15 Gy, and appropriate combinations of myelin markers were used to assess the myelin damage at various stages of myelin development. Antibodies against myelin basic protein, 2',3'-cyclic nucleotide 3'-phosphodiesterase and myelin oligodendrocyte glycoprotein were used, and the density of the antibody-positive fibers was classified into five categories. Statistical analysis showed significant differences between irradiated and unirradiated hemispheres. The differences decreased and myelination approached normality by postnatal day 70. These results show that myelination in the neonatal rat can recover from the developmental delay caused by a single 15 Gy dose of hemicranial irradiation.

Decreased expression of brain nitric oxide synthase in macula densa cells and glomerular epithelial cells of rats with mercury chloride-induced acute renal failure

To elucidate the mechanisms responsible for the development of HgCl(2)-induced acute renal failure (ARF), we examined the expression of brain type (b) nitric oxide synthase (NOS), which is involved in the generation of the vasodilator nitric oxide (NO), in the renal cortex of rats at 20 h after exposure to 7.5 mg/kg HgCl(2). Both blood urea nitrogen and serum creatinine were significantly increased in rats exposed to HgCl(2) relative to control rats, indicating the induction of ARF resulting from HgCl(2) exposure. Histopathological analysis demonstrated that, in addition to necrosis of proximal tubule epithelial cells, necrosis of macula densa cells and swelling of glomerular epithelial cells were observed in the renal cortex of rats with HgCl(2)-induced ARF. Consequently, the number of pars maculata segments was decreased by 42% in rats with HgCl(2)-induced ARF compared to control rats. The primary sites of bNOS mRNA and protein expression were macula densa cells and glomerular epithelial cells in the renal cortex of control rats and rats with HgCl(2)-induced ARF. The abundance of the bNOS mRNA and protein was significantly decreased in rats with HgCl(2)-induced ARF relative to control rats. These observations suggest that the production of the vasodilator NO derived from bNOS is decreased at the glomerulus level in the HgCl(2)-induced ARF setting. Thus, the reduction in bNOS expression may in part contribute to the progression of HgCl(2)-induced ARF through the deterioration of glomerular hemodynamics. In addition, the decrease in bNOS expression may be primarily the result of cell injury caused by the cytotoxic effect of HgCl(2).

Expression of nucleolar protein p120 predicts poor prognosis in patients with stage I lung adenocarcinoma

BACKGROUND

P120 is a proliferation-associated nucleolar protein found in most human malignant tumors, but not in resting normal cells. In our previous studies, the expression of p120 was statistically correlated with the proliferation capacity in human lung cancer cells and could be a prognostic marker for resected lung adenocarcinoma.

PATIENTS AND METHODS

The expression levels of p120 in tumors were assessed by immunohistochemistry in 59 patients with stage I lung adenocarcinoma who underwent radical resection. Using clinical follow-up data, the prognostic significance of p120 calculated by labeling indices was evaluated using Cox's proportional hazard model.

RESULTS

A mean +/- SD of the labeling index of p120 was 35.3+/-14.4%. No significant correlation was found between the expression levels of p120 and clinicopathological factors. Using a cutoff value of 35% in the labeling index of p120, patients with high expression of p120 experienced early recurrence and shorter survival compared with those having low expression of p120 (P = 0.04). Multivariate analysis revealed that p120 served as an independent and strongest prognostic factor for resected lung adenocarcinoma (P = 0.033).

CONCLUSION

This article provides the first evidence that the expression levels of p120 in tumor tissues can be used as an independent and powerful prognostic marker for resected stage I lung adenocarcinoma.

Protection from drug-induced hepatocellular changes by pretreatment with conjugating enzyme inhibitors in rats

The present paper describes the role of conjugating enzymes in the development of hepatotoxicity after administration of repeated doses of a novel monoamine oxidase type-A (MAO-A) inhibitor, (5R)-3-[2-(( 1S)-3-cyano-1-hydroxypropyl)benzothiazol-6-yl]-5-methoxymethyl-2-oxazolidinone (E2011). The effects of pretreatment with three kinds of conjugating enzyme inhibitors on hepatic lesions induced by E2011 were evaluated in female Sprague-Dawley rats. The inhibitors used were 2,6-dichloro-4-nitrophenol (DCNP; inhibitor of sulfotransferase (ST)), pentachlorophenol (PCP; inhibitor of both ST and acetyltransferase (AT)) or ranitidine (inhibitor of UDP-glucuronosyltransferase (UDP-GT)). Two weeks treatment of E2011 alone at an oral dosage of 150 mg/kg induced hepatocellular changes characterized by nuclear enlargement. Daily pretreatment with DCNP (10 mg/kg, i.p.) enhanced the E2011-induced hepatocellular changes accompanied by single cell necrosis. On the other hand, the hepatotoxicity was clearly diminished by PCP (5 mg/kg, i.p.). Ranitidine pretreatment had no effect. Protection by PCP was attributed to the inhibitory effects of AT in addition to ST; it was considered that the hepatocellular changes caused by E2011 were largely dependent on the formation of acetyl conjugate(s).

Hemodynamics in the left gastric vein after endoscopic ligation of esophageal varices combined with sclerotherapy

BACKGROUND AND METHODS

We examined the changes in portal hemodynamics after endoscopic variceal ligation (EVL) combined with endoscopic injection sclerotherapy (EIS) in relation to post-treatment relapse. The present study included 93 patients who underwent EVL-EIS combination therapy. Portal hemodynamics were examined by Doppler ultrasonography and percutaneous transhepatic portography (PTP).

RESULTS

Therapy with EVL-EIS resulted in the complete disappearance of varices in 89 of 93 patients. Cumulative relapse-free rates (Kaplan-Meier method) were 75.8 and 50.2%, respectively, 1 and 3-5 years after treatment. At the end of treatment, the flow in the left gastric vein was examined by Doppler ultrasonography. In 50 of 63 patients, the flow remained hepatofugal. In 23 of these patients, PTP was performed at the end of treatment; selective left gastric venography did not reveal any palisade zone vessels or varices. However, fine blood vessels were seen around the lower esophagus in nine patients, only the paraesophageal vein was found in 10 patients and these two findings were present in four patients, indicating that collateral blood flow remained in the lower esophagus in 13 of 23 patients. These findings suggest that frequent relapse of varices results from insufficient blockage of blood flow from the left gastric vein to the lower esophagus. However, in patients with a patent paraesophageal vein, long-term effects obtained by EVL-EIS combination therapy were satisfactory.

CONCLUSIONS

The pattern of the development of collateral left gastric veins represents important hemodynamic changes that predict the long-term prognosis of patients after treatment.

Assessment of potential mutagenic activities of a novel benzothiazole MAO-A inhibitor E2011 using Salmonella typhimurium YG1029

The potential initiation activities of a novel monoamine oxidase type-A (MAO-A) inhibitor E2011, which induced preneoplastic foci in the rat liver, were investigated by comparing the mutagenic activity of E2011, 6-aminobenzothiazole (6-ABT, a structural scaffold of E2011) and its derivatives, which are suggested primary reactive metabolites for E2011-induced hepatotoxicity in the rats in vivo, in the Ames assay system employing two Salmonella tester strains, TA100 and YG1029, a bacterial O-acetyltransferase-overproducing strain of TA100. E2011, a tertiary amine, showed no mutagenic activity both in the Salmonella typhimurium TA100 and YG1029 with and without S9 mix. On the other hand, a secondary aromatic amine ER-174238-00, a typical decarbonated metabolite of E2011, showed weak but significant mutagenicity in YG1029 in the presence of S9 mix, and a primary aromatic amine ER-174237-00, an N-dealkylated derivative of ER-174238-00, exhibited S9-dependent potent mutagenicity in YG1029. Thus, it appears that primary and secondary amino moieties of benzothiazole derivatives at C(6)-position are the specific structures contributing to their mutagenic activity. In addition, the alkyl group at C(2)-position of E2011, ER-174237-00 and ER-174238-00 is suggested to intensify the mutagenic activity, since the mutagenicity of ER-174237-00 is approximately two-fold higher than that of 6-ABT, which has hydrogen at C(2)-position in the place of the alkyl group. These results strongly suggest that E2011 has potential initiation activities in the rat liver in vivo after undergoing decarbonation, one of the metabolic pathways, at the carbonyl moiety of oxazolidinone ring to form mutagenic amine(s).

Induction of antitumor immunity by combined immunogene therapy using IL-2 and IL-12 in low antigenic Lewis lung carcinoma

Interleukin-2 (IL-2) and interleukin-12 (IL-12) are crucial cytokines that induce potent antitumor responses in a variety of animal cancer models. Although single gene transfer of either IL-2 or IL-12 exhibits limited antitumor effects, the combination of IL-2 and IL-12 has been shown to induce a stronger antitumor response and to cure tumor-bearing mice. To examine the conditions necessary for tumor rejection, we varied the local concentration of IL-2 and IL-12 by introducing these genes into Lewis lung carcinoma (LLC) cells via retroviral vectors and/or an adenoviral vector and evaluated the growth of inoculated LLC cells (5 x 10(5) cells). In contrast to the result when using a stepwise dose increase of IL-2 either without or with a fixed production of IL-12 (4-5 ng/5 x 10(5) cells/24 hours, insufficient for tumor rejection by itself), rejection of the tumor was achieved in 75% of the mice when the IL-12 secretion was combined with high and transient IL-2 production (42 ng/5 x 10(5) cells/24 hours) using additional adenoviral vector transduction (100 multiplicities of infection). An abundant infiltration of both CD4+ (47.4/mm2) and CD8+ (85.6/mm2) T cells was a characteristic finding in the dual gene-transfected LLC tumors. Importantly, consistent with the rejection of rechallenged parental cells, tumor-specific cytotoxic T lymphocytes were induced only from the splenocytes of mice inoculated with the dual gene-transduced LLC cells, suggesting the existence of protective antitumor memory. In addition, only vaccination of dual gene-transduced LLC cells inhibited the growth of pre-established LLC tumors. These results indicate that generation of a pivotal antitumor response likely depends on the synergistic combination and concentration of IL-2 and IL-12 in the local milieu by which tumor-specific immune memory is established.

EUS changes predictive for recurrence of esophageal varices in patients treated by combined endoscopic ligation and sclerotherapy

BACKGROUND

Recurrence of varices is still common after endoscopic treatment of esophageal varices. In this study, predictive signs of variceal recurrence were investigated by ultrasonic (US) miniature probe in patients treated by combined endoscopic ligation and sclerotherapy.

METHODS

Detectability of vessels by US miniature probe was evaluated first in rats. In 41 patients treated by combined therapy, the esophagus and the cardia region were examined by US miniature probe. In 25 patients examined by percutaneous transhepatic portography, the relationship between US miniature probe and percutaneous transhepatic portography findings was evaluated.

RESULTS

The smallest vessel detected by US miniature probe was 0.3 mm in diameter in the study using intra-abdominal vessels of rat. After variceal eradication, US miniature probe showed intramural vessels in the cardia that were classified as follows: grade I, a few vessels (19 patients, 46%); grade II, uniformly scattered vessels (11, 27%); grade III, abundant vessels resembling a honeycomb (11, 27%). As the sonographic grade increased, the rate of variceal recurrence increased. As the venographic grade of staining in the distal esophagus increased, the esophageal wall became thicker and the sonographic grade at the cardia increased.

CONCLUSIONS

Endosonographic evaluation of the distal esophagus and cardia is predictive of variceal recurrence.

L-Arginine treatment may prevent tubulointerstitial nephropathy caused by germanium dioxide

BACKGROUND

Long-term oral ingestion of germanium dioxide (GeO2) causes progressive renal failure derived from tubulointerstitial nephropathy in humans and animals. The characteristic of GeO2-induced nephropathy is the renal tissue injury persisting for a long time, even after cessation of GeO2 ingestion. However, a treatment that can suppress the long-lasting renal tissue injury has not yet been established.

METHODS

Using the methods of immunohistochemistry and reverse transcription-polymerase chain reaction, we examined the expression of ED1-positive cells (macrophages/monocytes), transforming growth factor (TGF)-beta1 mRNA and protein and collagen type IV mRNA and protein in the kidneys of rats with GeO2-induced nephropathy. Concomitantly, the effects of L-arginine treatment on their expression was explored in the kidneys of rats with GeO2-induced nephropathy.

RESULTS

Chronic administration of GeO2 caused tubulointerstitial nephropathy characterized by leukocyte invasion into the enlarged tubulointerstitial space in rats. The expression of ED1-positive cells, TGF-beta1 protein and collagen type IV protein was markedly increased in the tubulointerstitium of the renal cortex from rats with GeO2-induced nephropathy. Similarly, TGF-beta1 and collagen type IV mRNA were significantly enhanced in the renal cortex of rats with GeO2-induced nephropathy. A small number of tubulointerstitial cells expressing TGF-beta1 protein were also observed in the renal cortex of rats with GeO2-induced nephropathy. However, L-arginine treatment led to a parallel decrease in the expression of ED1-positive cells, TGF-beta1 mRNA and collagen type IV mRNA and protein in rats with GeO2-induced nephropathy.

CONCLUSIONS

In general, collagen synthesis is driven by TGF-beta1 in the fibrotic process associated with a variety of renal disorders. TGF-beta1 is secreted by TGF-beta1 producing cells such as macrophages, fibroblasts and myofibroblasts. Thus, the present study indicates that the expression of collagen type IV may be mediated by TGF-beta1 released from invading macrophages and, to a lesser extent, released from tubulointerstitial cells, presumably fibroblasts and/or myofibroblasts in GeO2-induced nephropathy. L-Arginine treatment inhibits collagen type IV synthesis possibly by suppressing macrophage invasion and the resultant TGF-beta1 expression in this nephropathy. L-Arginine treatment may be beneficial in the prevention of tubulointerstitial fibrosis, which is considered to be the terminal stage of GeO2-induced nephropathy.

Enhanced color flow images in small hepatocellular carcinoma

BACKGROUND

Features of enhanced color flow images in small hepatocellular carcinoma (HCC) are not fully elucidated. The purpose of this study was to clarify the characteristic vascular images in small HCC observed by enhanced color Doppler.

METHODS

Enhanced color Doppler using the contrast agent Levovist was performed on 13 patients with HCC smaller than 30 mm. Enhanced color flow appearance was compared with angiographic findings. Time-intensity changes after injection of the contrast agent were analyzed in HCC nodules.

RESULTS

Significant improvement in the detection of color flow signals was obtained in small HCC using Levovist, from 33% in precontrast to 92% in postcontrast (p < 0.005). Three patterns of enhanced color flow images, which were related to the angiographic findings, were observed. The time-intensity curve was classified into two types by "time to peak" and "time on plateau" and was associated with the patterns of enhanced images.

CONCLUSION

Enhanced color flow imaging promises to be a useful method for evaluating tumor vascularity noninvasively and to contribute to the elucidation of the hemodynamics in small HCC.

Prognostic value of nucleolar protein p120 in patients with resected lung adenocarcinoma

PURPOSE

In this study we investigated the prognostic significance of proliferation-associated nucleolar protein p120 in primary resected lung adenocarcinoma because it reflects tumor growth fractions in vitro.

PATIENTS AND METHODS

Expression levels of p120 in tumors were assessed by immunohistochemistry in 74 patients who underwent radical resection. With clinical follow-up data, the prognostic significance of p120 calculated by labeling indices was evaluated using the Cox proportional hazards model.

RESULTS

p120 protein was clearly detected in nucleoli of adenocarcinoma cells. Its expression levels widely varied in each sample from 8.5% to 67. 2%, with a mean +/- SD of 35.2% +/- 15.1%. No significant correlation was found between expression levels of p120 and clinicopathologic factors. However, the expression levels of p120 were negatively correlated with the tumor doubling time calculated with retrospective chest roentgenograms. Using a cutoff value of 35% in the labeling index of p120, patients with high expression of p120 experienced early recurrence and shorter survival compared with those who had low expression of p120. Multivariate analysis showed that p120 served as an independent, as well as the strongest, prognostic factor for resected lung adenocarcinoma.

CONCLUSION

This report provides the first evidence that expression levels of p120 in tumor tissues can be used as an independent and powerful prognostic marker for resected lung adenocarcinoma.

Toxicological response of rats to a novel monoamine oxidase type-A inhibitor, (5R)-3-[2-((1S)-3-cyano-1-hydroxypropyl)benzothiazol-6-yl]-5- methoxymethyl-2-oxazolidinone (E2011), orally administered for 13 weeks

(5R)-3-[2-((1S)-3-cyano-1-hydroxypropyl)benzothiazol-6-yl]-5- methoxymethyl-2-oxazolidinone (E2011) is a novel monoamine oxidase type-A (MAO-A) inhibitor. In order to assess toxicological profiles of E2011, doses of 0 (as controls), 30, 100 mg/kg of E2011 were administered to male and female Sprague-Dawley rats once a day for 13 weeks orally by gavage. No mortality or any toxic signs except salivation occurred due to E2011 treatment. Decreased body weight gain and food consumption, increases of alkaline phosphatase and increases of liver weight were the major treatment-related findings observed predominantly in the 100 mg/kg group. Histological examination revealed nuclear enlargement of hepatocytes with appearance of altered cell foci in some cases, and acinar atrophy in Harderian glands in the 100 mg/kg group. Since the histopathological findings in the liver were indicative of an ongoing carcinogenic process, glutathione S-transferase placental form (GST-P) positive hepatic foci were identified immunohistochemically and examined morphometrically. Although GST-P positive hepatic foci were detected in all groups including controls, the number and area of GST-P positive hepatic foci were significantly higher in female rats treated with 100 mg/kg than those in controls. In this paper, possible mechanisms of specific lesions in the liver and Harderian glands will be discussed.

White ball appearance in endoscopic ligation of bleeding esophageal varices

BACKGROUND

Endoscopic variceal ligation is useful in the control of bleeding from esophageal varices. However, confirmation of ligation precisely at the site of bleeding is usually difficult when treating massive variceal bleeding. Characteristic endoscopic findings that appeared when ligation was performed at the site of bleeding are reported in this article.

METHODS

Emergency endoscopic variceal ligation was performed in 14 patients with active bleeding from esophageal varices. Endoscopic findings after variceal ligation at the site of bleeding were compared with those at sites without bleeding.

RESULTS

Active bleeding ceased just after endoscopic ligation at the site of bleeding in all patients. After ligation of the bleeding site of the varix, an unusual white-colored ball-like appearance (white ball appearance) was observed in all patients. This finding was markedly different from the purple-colored ball-like appearance that is usually observed after ligation of a varix at a site without bleeding.

CONCLUSIONS

White ball appearance was a characteristic finding that appeared after ligation of a varix at the site of bleeding. This finding may be useful in the confirmation of successful ligation of a varix at its bleeding site.

Status of Salmonella gallinarum-pullorum infections in poultry in Zambia

Ten outbreaks of Salmonella gallinarum-pullorum infections on poultry farms in Zambia were investigated. Three cases were seen in day-old broiler chickens and were diagnosed by culture as S. gallinarum-pullorum and characterized as pullorum disease because the mortality was only in the first few weeks. Another case was diagnosed by culture from broiler parent stock. Day-old chicks from two of the three cases were supplied by a hatchery. Five cases in 5-to-18-month-old layer chickens were diagnosed by culture as S. gallinarum-pullorum and characterized as fowl typhoid because of the clinical disease appearing after 5 months of age and the typical lesions of fowl typhoid. The last case was in 5-month-old village-bred fowls and was diagnosed by culture and clinical manifestation as fowl typhoid. Outbreaks of S. gallinarum-pullorum are still manifest in Zambia. Clinically, both pullorum disease and fowl typhoid were observed, and it was indicated that hatchery infection plays an important role in the transmission of S. gallinarum-pullorum.

Selective determination of haloperidol in human serum: surface ionization mass spectrometry and gas chromatography with surface ionization detection

Surface ionization organic mass spectrometry (SIOMS) has been performed on the clinically important drug haloperidol using quadrupole mass spectrometry in which the thermal ion source has a rhenium oxide emitter. The surface ionization (SI) mass spectrum is presented, interpreted in a purely empirical way by means of evidence from previous investigations, and then compared to results from conventional electron impact (EI) ionization. An approach to detection of this drug in serum by gas chromatography (GC) with a surface ionization detector (SID) and GC-SIOMS is described. This approach demonstrates that (a) haloperidol is efficiently surface-ionized, giving a unique SI mass spectrum, (b) experimental results rationalize the combined sensitivity and selectivity of the GC-SID for the examined drug, (c) the detection limit for haloperidol in serum is 1.1 ng/ml (S/N = 3) by GC-SID (the coefficients of variation of the assay are generally low, i.e., below 8.5%) and (d) the GC-SIOMS coupling can be used for sensitive and selective detection of haloperidol in serum.

A critical role of IL-2 for the production and gene transcription of IL-5 in allergen-specific human T cell clones

The role of IL-2 in IL-5 synthesis of human helper T cells was investigated. All of the Der f II (a major allergen of house dust mite)-specific T cell clones established from atopic asthmatic patients produced both IL-2 and IL-4 upon activation (Th0 phenotypes). Recombinant IL-2 induced gene expression and protein synthesis of IL-5 in T cell clones that produced IL-5 upon antigenic stimulation. Human IL-5 promoter/enhancer-luciferase gene construct transfected to T cell clones was clearly transcribed in response to IL-2, indicating that the approximately 500 bp gene segment 5' upstream of the coding region was functionally sufficient for the gene transcription induced by IL-2. IL-2-induced IL-5 synthesis as well as proliferation was dependent on tyrosine kinases. Moreover, IL-5 production by T cell clones stimulated with immobilized anti-CD3 antibody was completely abrogated by anti-IL-2 neutralizing antibody, suggesting that IL-5 (a Th2 cytokine) synthesis of human helper T cells is dependent on IL-2 (a Th1 cytokine). Our present findings clearly demonstrated that IL-2, known as a T cell growth factor, exerts a cytokine promoting activity on T cells. IL-2 produced at the site of allergic inflammation might facilitate eosinophilic inflammation by inducing IL-5 production in T cells.

IL-15 promotes cytokine production of human T helper cells

IL-15 is a newly identified cytokine that has T cell and B cell growth factor activity similar to that of IL-2. In this study, a novel biologic function of IL-15 to promote cytokine production by human Th cells has been elucidated. Dermatophagoides farinae 11 (a major allergen of house dust mite)-specific human T cell clones produced IL-5 in response to recombinant human IL-15 as well as to either anti-CD3 or IL-2 stimulation. IL-5 mRNA became detectable 3 h after IL-15 stimulation and reached a maximum at 9 h. Human IL-5 promoter/enhancer-luciferase gene construct transfected to T cell clones was clearly transcribed in response to IL-15, indicating that the approximately 500-bp human IL-5 promoter/enhancer segment 5' upstream of the coding region sufficiently responded to IL-15. IL-15-induced IL-5 synthesis was completely inhibited by the tyrosine kinase inhibitor, herbimycin A, suggesting the involvement of tyrosine kinases in the signal transduction leading to IL-5 synthesis as well as to proliferation of T cells induced by IL-15. Whereas IL-5 production by human peripheral T cells was abolished by the addition of anti-IL-2-neutralizing Abs into the culture, IL-15 restored the IL-5 synthesis despite effective IL-2 neutralization. IL-15 produced at the site of allergic inflammation may play a role in the recruitment and activation of eosinophils by inducing IL-5 (a Th2 cytokine) production by T cells.

IL-15 promotes cytokine production of human T helper cells

IL-15 is a newly identified cytokine that has T cell and B cell growth factor activity similar to that of IL-2. In this study, a novel biologic function of IL-15 to promote cytokine production by human Th cells has been elucidated. Dermatophagoides farinae 11 (a major allergen of house dust mite)-specific human T cell clones produced IL-5 in response to recombinant human IL-15 as well as to either anti-CD3 or IL-2 stimulation. IL-5 mRNA became detectable 3 h after IL-15 stimulation and reached a maximum at 9 h. Human IL-5 promoter/enhancer-luciferase gene construct transfected to T cell clones was clearly transcribed in response to IL-15, indicating that the approximately 500-bp human IL-5 promoter/enhancer segment 5' upstream of the coding region sufficiently responded to IL-15. IL-15-induced IL-5 synthesis was completely inhibited by the tyrosine kinase inhibitor, herbimycin A, suggesting the involvement of tyrosine kinases in the signal transduction leading to IL-5 synthesis as well as to proliferation of T cells induced by IL-15. Whereas IL-5 production by human peripheral T cells was abolished by the addition of anti-IL-2-neutralizing Abs into the culture, IL-15 restored the IL-5 synthesis despite effective IL-2 neutralization. IL-15 produced at the site of allergic inflammation may play a role in the recruitment and activation of eosinophils by inducing IL-5 (a Th2 cytokine) production by T cells.

[Molecular biological analysis of house dust mite allergens]

Using a host-vector system of Escherichia coli, we could produce one of major house dust mite allergens, Der f II in large quantity for therapeutic and diagnostic purposes. About 5 mg of purified and biologically active rDer f II was obtained from one liter culture, which was corresponding to the amount in about 30 g of live mite. The rDer f II was almost identical with native Der f II with respects to biological and physicochemical view points. Native mite Der f II is a mixture of several kinds of Der f II molecule with a few amino acid substitutions, which were due to polymorphisms among individual mite gene sequence. We had cloned three kinds of Der f II cDNAs from mite culture and expressed in E. coli and prepared three kinds of rDer f II in this system. As a result of comparison of IgE binding activity among three rDer f IIs and nDer f II, there was no significant difference observed.

[Recent progress in the diagnosis of gastroesophageal varices]

Recent advances in the diagnosis of gastroesophageal varices are reviewed in this paper. Endoscopy, angiography, ultrasound, and ultrasound Doppler are now employed in the diagnosis of varices. As for endoscopic diagnosis, new criteria for the evaluation of gastroesophageal varices have been applied. Angiography is now not only used to demonstrate the varices and collateral circulations in portal hypertension but also used in the embolization therapy for large gastric varices or intractable esophageal varices. Ultrasound and color Doppler are now widely used in the diagnosis of portal hypertension because of its noninvasiveness and conveniency. Furthermore, in its use in endoscopy, varical vessels and blood flow in the wall of the esophagus and the stomach can be directly demonstrated. Recent advances in these diagnostic modalities will made it possible to diagnose gastroesophageal varices and evaluate the pathophysiology in patients with portal hypertension more precisely.