Preoperative N stage evaluation in advanced gastric cancer patients using multidetector CT: can the sum of the diameters of metastatic LNs be used for N stage evaluation?

AIM

To compare the diagnostic performance of total counts of metastatic lymph nodes (LN-sum) and conventional multidetector (MD) computed tomography (CT) staging in the nodal evaluation of advanced gastric cancer (AGC) patients.

MATERIALS AND METHODS

In total, 127 consecutive patients who underwent preoperative MDCT and gastrectomy for AGC were identified. Metastatic LNs on MDCT were defined as LNs with a short axis ≥8 mm, marked or heterogeneous enhancement, and morphological features (central necrosis, round shape, clustering). The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the N-stage using LN-sum and conventional MDCT staging were generated and compared. In addition, metastatic LN counts between the MDCT and the histopathological examinations and correlation between LN-sum and histopathological nodal status were analysed.

RESULTS

The total counts of metastatic LNs on MDCT was significantly smaller than those detected in histopathological assessments (p<0.0001). LN-sum showed significant correlation with the pathological N stage and the number of metastatic LNs (rho=0.69, 0.73, p<0.0001). The areas under the receiver operating characteristic curve were 0.896, and 0.835, for N stage ≥N2 and N3, with cut-off values of 12.5 and 23.5 mm, respectively. LN-sum provided better diagnostic performance than conventional MDCT staging for discriminating N0-2 versus N3; sensitivity, accuracy, PPV and NPV of LN-sum were significantly higher (80.4 versus 52.2%, 81.1 versus 68.5%, 71.2 versus 57.1%, and 88 versus 74.1%).

CONCLUSION

LN-sum may be sufficiently useful in assessing the N3 stage of AGC and may help to plan appropriate therapy for AGC patients.

A fluorometric assay for tyrosinase activity and its inhibitor screening based on graphene quantum dots

Pristine graphene quantum dots (GQDs) without any functionalization were used as probes to develop a sensitive and selective fluorescence sensing platform for the detection of tyrosinase (TYR) activity and its inhibitor screening for the first time.

First Report of Gray Mold of Rhizoma paridis Caused by Botrytis cinerea in China

Rhizoma paridis is a perennial, traditional Chinese medicinal herb. In May 2013, a disease was observed in an approximately 10 ha cultivated field in Enshi, Hubei Province, China. Approximately 80% of plants in the field were affected. Symptoms were visible on the basal leaves of affected plants. Chlorosis followed by necrosis started at the leaf tips and margins and gradually spread inward until the entire leaf was necrotic. Thick, gray mycelium and conidia were visible on both sides surface of leaves under wet, humid conditions. The leading edge of the chlorotic leaves was excised from 20 plant samples surface disinfested with 1% NaOCl solution for 1 min, rinsed in sterile water, air dried, and placed on potato dextrose agar (PDA). Plates were incubated at 22°C in the dark. Mycelia were initially hyaline and white, and became dark gray after 72 h. Mycelia were septate with dark branched conidiophores. Conidia were smooth, hyaline, ovoid, aseptate, and ranged from 8 to 14.5 × 7 to 8.5 μm. Numerous hard, small, irregular, and black sclerotia that were 1 to 3 × 2 to 5 mm were visible on PDA plates after 12 days. The fungus was identified as Botrytis cinerea on the basis of these characters (1). The internal transcribed spacer (ITS) region of rDNA was amplified using the ITS1 and ITS4 primer and sequenced (GenBank Accession No. KF265499). BLAST analysis of the PCR product showed 99% identity to Botryotinia fuckeliana (perfect stage of B. cinerea) (EF207415.1, EF207414.1). The pathogen was further identified to the species level as B. cinerea using gene sequences from glyceraldehyde-3-phosphate dehydrogenase (G3PDH), heat-shock protein 60 (HSP60), and DNA-dependent RNA polymerase subunit II (RPB2) (2) (KJ638600, KJ638602, and KJ638601). Pathogenicity was tested by spraying the foliage of 40 two-year-old plants with a suspension of 10⁶ conidia per ml of sterile distilled water. Each plant received 30 ml of the inoculum. Ten healthy potted plants were inoculated with sterilized water as control. All plants were covered with plastic bags for 5 days after inoculation to maintain high relative humidity and were placed in a growth chamber at 22°C. The first foliar lesions developed on leaves 7 days after inoculation and were similar to those observed in the field. No symptoms developed on the control plants. B. cinerea was consistently re-isolated from all artificially inoculated plants. The pathogenicity test was completed twice. To our knowledge, this is the first report of gray mold of R. paridis caused by B. cinerea in China. The root of R. paridis is the most commonly used Chinese herbal medicine to treat viper bites. In recent years, cultivation of this herb has increased in China because of its high value. Consequently, the economic importance of this disease is likely to increase with the greater prevalence of this host species. References: (1) H. L. Barnett and B. B. Hunter. Illustrated Genera of Imperfect Fungi. Burgess Publishing Company, Minneapolis, MN, 1972. (2) M. Staats et al. Mol. Biol. Evol. 22:333, 2005.

First Report of Root Rot on Atractylodes macrocephala (Largehead Atractylodes Rhizome) Caused by Ceratobasidium sp. in China

Atractylodes macrocephala is a perennial herbaceous plant (family Asteraceae) native to China. The biennial root, Largehead Atractylodes Rhizome (LAR), is the most commonly used Chinese herbal medicine to prevent early pregnancy loss due to miscarriage. From summer 2010 to spring 2012, symptoms of root rot were observed on LAR in Xianfeng county, Enshi city, Hubei Province, China. White mold on the root of LAR could be observed at an early growth stage in the field and the white mold spread over the entire plant after 10 days, which differs from root rot of LAR caused by Fusarium oxysporum and Rhizoctonia solani, neither of which are characterized as having mycelium spreading over the whole plant (4). Where root rot symptoms were present, rhizome yield was reduced by 15% on average, with up to 40% yield loss in some fields. Under humid conditions in mid-June, the disease in the field spread quickly and the rhizomes of LAR were completely rotted. After rainfall and increasing temperature from 16 to 35°C, white mycelium appeared and plants withered within a few weeks. In April 2011 and 2012, a fungus was consistently recovered from symptomatic rhizome samples after they were surface sterilized with 0.1% mercuric chloride solution and plated onto potato dextrose agar (PDA). Pale gray colonies with short aerial mycelia and brown sclerotia formed on PDA after 7 days incubation at 28°C. Binucleate cells were observed using light microscopy and the characteristics were matched with morphological characteristics of a Ceratobasidium sp (3). Genomic DNA of the culture was extracted, and the rDNA-internal transcribed spacer sequence (GenBank Accession No. JQ926741) showed 99% identity to Ceratobasidium sp (GenBank No. H269825.1). Mycelial plugs of the culture taken from PDA were inoculated onto 40 rhizomes of 1-year-old seedlings and plants were incubated with a 16-h photoperiod at 28°C and 90% relative humidity in an artificial climate chamber where they developed typical disease symptoms after 2 days. Ten rhizomes of 1-year-old seedlings and were treated with PDA plugs only. All seedlings inoculated with the pathogen were withered and the rhizomes were completely covered with gray mycelium 2 days after inoculation, which was similar to the symptoms observed in the field. After 7 days, the symptoms were more severe than those observed in the field, with seedlings rotted completely. The main stalk of all inoculated plants was covered with gray mycelia in 4 days, and the stalk became withered, which was similar to the symptoms observed in the field. No symptoms were observed on control seedlings and plants. Koch's postulates were fulfilled by successful reisolation of Ceratobasidium sp. from diseased seedlings. The pathogenicity tests were carried out twice. Ceratobasidium sp. has been reported to cause root rot of canola in Washington (2). It has also been observed on Rehmannia in China (1). To our knowledge, this is the first report of Ceratobasidium sp. causing root rot on LAR. References: (1) B. B. Chen et al. Chin. J. Chin. Material Medica (In Chinese) 9:1137, 2011. (2) K. L. Schroeder et al. Plant Dis. 96:591, 2012. (3) B. Sneh et al. Page 39 in: Identification of Rhizoctonia Species. The American Phytopathological Society, 1991. (4) S. X. Zang et al. J. Agric. Univ. Hebei (In Chinese) 28:73, 2005.

Adsorptive stripping voltammetric determination of antimony

A new method is described for the determination of antimony based on the cathodic adsorptive stripping of Sb(III) complexed with 2',3,4',5,7-pentahydroxyflavone(morin) at a static mercury drop electrode (SMDE). The reduction current of the adsorbed antimony complex was measured by 1.5th-order derivative linear-sweep adsorption voltammetry. The peak potential is at -0.51 V (vs. SCE). The effects of various parameters on the response are discussed. The optimized analytical conditions were found to be: supporting electrolyte, chloroacetic acid (0.04 mol/l, pH 2.3); concentration of morin, 5x10(-6) mol/l; accumulation potential, -0.25 V (vs. SCE); scan rate, 100 mV/s. The limit of detection and the linear range were 7x10(-10) mol/l and 1.0x10(-9) approximately 3.0x10(-7) mol/l Sb(III) for a 2-min accumulation time, respectively. This method has been applied to the determination of Sb(III) in steel and brass samples and satisfactory results were obtained. The adsorptive voltammetric characteristics and composition of the Sb(III)-morin complex were studied.

P5-23-01: The Impact of Primary Tumor Resection on the Survival of Patients with Stage IV Breast Cancer According to Molecular Subtype

Purpose: The main treatment for stage IV breast cancer is currently systemic therapy. Surgical resection of the primary tumor is usually done for treating the tumor-related complications. Recent studies have suggested that surgery may improve the long-term survival of stage IV breast cancer patients. We evaluated the impact of the primary surgical resection site on the survival of stage IV breast cancer patients according to molecular subtype using nationwide Korean breast cancer registry data.

Methods: We analyzed the records of the stage IV breast cancer patients from Korean Central Cancer Registry (KCCR) between 1999 and 2008. We used clinical assays to distinguish luminal A (HR+/HER2−, n=290), luminal B (HR+/HER2+, n=154), Basal-like (HR-/HER2−, n=107) and HER2 (HR-/HER2+, n=145). The clinical and tumor characteristics, the type of treatments and the overall survival were compared between the surgically versus nonsurgically treated patients according to molecular subtype.

Results: Of the 1091 identified patients, 719 (65.9%) received surgical excision of their primary tumor and 372 (34.1%) did not. The mean survival was 86 months versus 43 months for the surgically treated patients vs. the patients without surgery, respectively (p&lt;0.001). On a multivariate analysis with using the Cox model and after adjusting for tumor size, visceral metastases, the number of metastatic sites and bone only metastases, surgery was an independent factor for improved survival in patients with luminal A type (Hazard Ratio, 0.505; 95% Confidence Interval, 0.265−0.962, p=0.038) but not in those with luminal B (p=0.192), basal-like (p=0.128) and HER2 subtype (p=0.114).

Conclusion: Surgical resection of the primary tumor in stage IV breast cancer patients was independently associated with improved survival only in luminal A subtype.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-23-01.

Chemotherapy-induced amennorrhea: Predictive markers of response to neoadjuvant chemotherapy in breast cancer

281

Background: There is controversy about the benefit of chemotherapy-induced amenorrhea (CIA) in breast cancer. We investigated significance of CIA after neoadjuvant chemotherapy for predicting response to neoadjuvant chemotherapy in breast cancer patients.

Methods: We reviewed the records of 198 premenopausal patients with breast cancer treated with neoadjuvant chemotherapy between January 2005 and December 2010. Chemotherapy-induced amenorrhea (CIA) was defined as serum FSH level ≥40 IU/L after completion of all scheduled neoadjuvant chemotherapy and prior to definitive surgery.

Results: Among 198 breast cancer patients, 132 pts (66.7%) developed CIA after neoadjuvant chemotherapy. 156 pts (78%) underwent DA chemotherapy. The age of CIA patients was older than non-CIA patients (41.55±5.55 vs. 38.27± 6.86 years, p=0.001). The incidence of CIA after neoadjuvant chemotherapy was significantly higher in responder group (responder vs. nonresponder: 87 pts (74.4%) vs. 45 pts (55.6%); p=0.006). Additionally, FSH level after all scheduled neoadjuvant chemotherapy was significantly higher in responder group (FSH 56.41±32.41 mIU/ml vs. 45.76±30.31 mIU/ml; p=0.021). In univariate analysis, CIA (p=0.006) and total number of chemotherapy cycle regardless of chemotherapy regimen (p=0.04) were significantly predictive of tumor response. CIA was only significant predictive factor for tumor response after neoadjuvant chemotherapy on multivariate analysis (p=0.012).

Conclusions: CIA is independent predictive markers of response to neoadjuvant chemotherapy in locally advanced breast cancer.

Bioefficacy of L-lysine·H2SO4relative to L-lysine·HCl in broiler chickens, estimated by slope-ratio model

1. A broiler experiment was conducted to assess the effectiveness of L-lysine.H2SO4 relative to L-lysine.HCl. Four concentrations of L-lysine.H2SO4 and L-lysine.HCl (0.9, 1.8, 2.7 and 3.6 g/kg diet) were each added to a basal diet that met the nutrient requirements of broilers except for lysine. 2. Birds responded significantly to the supplements in daily gain, feed intake, feed conversion efficiency, nitrogen retention and plasma urea nitrogen during each period (d 4 to 21, d 22 to 42 and d 4 to 42). 3. Regression analysis showed that the bioefficacy of L-lysine.H2SO4 relative to L-lysine.HCl was 0.93, 0.86 and 0.95 for daily gain, feed conversion efficiency and nitrogen retention, respectively, during the starter period (d 4 to 21), and was 1.01, 1.36 and 1.06, respectively, during the grower period (d 22 to 42). It was 0.99, 1.07 and 1.03, respectively, for the overall period (d 4 to 42), when the bioefficacy of L-lysine.HCl was set at 1.0. 4. The bioefficacy of L-lysine.H2SO4 differed with different response criteria. The average bioavailability of L-lysine.H2SO4 relative to L-lysine.HCl was 1.03 on an equimolar basis in the present study. In conclusion, L-lysine.H2SO4 and L-lysine.HCl are equally efficacious to broiler chickens.

[Synthesis and application of sulfonated beta-cyclodextrins as chiral additives in capillary electrophoresis]

Three new kinds of the sodium salt of sulfonated beta-cyclodextrins with different degrees of substitution were synthesized and characterized. A simple synthesis method was employed by direct sulfonating reaction with concentrated sulfuric acid. Sulfonated beta-cyclodextrins were used as chiral resolving agents for the capillary electrophoretic separation of enantiomers in high pH and low pH background electrolytes. In different electrophoretic polarity mode, the effects of the type and concentration of sulfonated beta-cyclodextrin were investigated. Sulfonated beta-cyclodextrins were proved to be strong complexing agents for basic and neutral analytes.

Effect of pressure on myocardial function after 6-hour preservation with blood cardioplegia

BACKGROUND

This study examined the return of cardiac function in pig hearts after 6 hours' preservation by continuous perfusion with blood cardioplegia at two perfusion pressures compared with preservation with crystalloid solutions.

METHODS

Isolated pig hearts were randomly divided into five groups (n = 8 per group) according to the following treatments: group 1 = fresh hearts (control); group 2 = hearts arrested with Queen's cocktail cardioplegia and then immersion in 0 degrees C saline solution (QS group); group 3 = hearts arrested with (5 degrees C) and simple immersion in 0 degrees C University of Wisconsin solution (UW group); and groups 4 and 5 = hearts arrested with blood cardioplegia at 10 degrees C and then continuously perfused at a pressure of 80 cm H2O or 40 cm H2O, respectively (groups BC80 and BC40). After preservation for 6 hours, donor hearts were reperfused by a cross-circulation support pig. Thereafter, cardiac function and metabolism were examined every half hour for 2 hours. A three-way mixed general linear model was used to analyze data with repeated measures. Bonferroni test was used to determine differences (p < or = 0.05) between groups.

RESULTS

Only 4 hearts recovered electric activity in the BC80 group (p < or = 0.05 versus other groups). There was poor recovery of left ventricular work in the BC80 group compared with the other groups (p < 0.001). Left ventricular work in the QS and UW groups was also lower than in the control and BC40 groups. Left ventricular work in the BC40 group fully recovered. Maximum elastance did not differ between groups. Compliance was reduced in the QS, BC80, and BC40 groups versus controls after preservation (p < 0.006). Coronary flow decreased and coronary vascular resistance increased in the BC80 group versus the other groups (p < or = 0.001). Coronary flow in the QS, UW, and BC40 groups was lower than in the control group (p < 0.001). The magnitude of lactate release was much higher in the BC80 group than in the other groups (p < or = 0.001).

CONCLUSIONS

Continuous perfusion with 10 degrees C blood cardioplegia at 40 cm H2O pressure for 6 hours provided adequate preservation of systolic function in this model. University of Wisconsin solution provided the best protection of diastolic function.

Delayed stimulation of the latissimus dorsi may result in disuse atrophy

BACKGROUND

The latissimus dorsi is usually left unstimulated for 2 weeks after cardiomyoplasty to allow the muscle to recover from the loss of the collateral circulation. To determine whether the 2-week delay may cause muscle atrophy, we randomized 15 mongrel dogs to a control group or a disuse atrophy group.

METHODS

The collateral circulation to the latissimus dorsi was ligated in all animals before cardiomyoplasty to reduce the risk of ischemic injury to the muscle during mobilization. Two weeks after collateral ligation, the atrophy group had the tendinous attachment of the latissimus dorsi severed and then 2 weeks later underwent cardiomyoplasty. The control group had a 2-week delay after collateral ligation followed by cardiomyoplasty. Biopsies were performed before collateral ligation and before cardiomyoplasty. After heart failure was induced, hemodynamic function was assessed during synchronized contraction of the latissimus dorsi by measuring the maximum systolic elastance, stroke volume, preload recruitable stroke work index, and diastolic compliance.

RESULTS

Comparison of muscle morphology between the two groups demonstrated the presence of muscle atrophy in those animals that had been randomized to the atrophy protocol. During synchronized contraction of the latissimus dorsi, there was no significant increase in maximum systolic elastance in either group. However, both stroke volume and pulmonary recruitable stroke work index were significantly higher in the control animals during assisted beats. The left ventricle was less compliant in the atrophy group, suggesting that muscle atrophy had adversely affected diastolic function.

CONCLUSIONS

Delayed electrical stimulation of the latissimus dorsi may result in atrophy and loss of function.

Expression of insulin-like growth factor-II mRNA in fetal kidney and Wilms' tumor. An in situ hybridization study

The pattern of insulin-like growth factor II (IGF-II) mRNA expression in developing kidney and Wilms' tumor was examined with in situ hybridization. In developing kidney, IGF-II was primarily expressed in blastemal cells and lost with their differentiation. In triphasic Wilms' tumor, a similar relationship was found. But in a monomorphous Wilms', tumor cells with epithelial differentiation expressed IGF-II mRNA. These data suggest that IGF-II may be involved in fetal nephrogenesis, that its expression is inversely coupled to normal epithelial differentiation, and that this differentiation may be aberrantly regulated in Wilms' tumor.