High accuracy spectroscopy of 3- and 4-body Λ hypernuclei at Jefferson Lab

JLab E12-19-002 Experiment is planned to measure the Λ-binding energies of 3ΛH [Jπ = 1/2+ or 3/2+(T = 0)] and 4ΛH (1+) at JLab Hall C. The expected accuracy for the binding-energy measurement is |ΔBtotal Λ | ≃ 70 keV. The accurate spectroscopy for these light hypernuclei would shed light on the puzzle of the small binding energy and short lifetime of 3ΛH, and the chargesymmetry breaking in the ΛN interaction. We aim to perform the experiment in 2025.

High resolution spectroscopy of 𝚵 hypernuclei with active fiber target

We are planning to carry out a high-resolution spectroscopy of Ξ hypernucleus at the J-PARC K1.8 beamline, which provides a highintensity K− beam (J-PARC E70 experiment). The high-resolution spectroscopy aims to be realized by introducing a new magnetic spectrometer S-2S and an active fiber target AFT. In this article, the role of the AFT in this experiment and its development status are described.

Larotrectinib in adult patients with solid tumours: a multi-centre, open-label, phase I dose-escalation study

BACKGROUND

NTRK1, NTRK2 and NTRK3 gene fusions (NTRK gene fusions) occur in a range of adult cancers. Larotrectinib is a potent and highly selective ATP-competitive inhibitor of TRK kinases and has demonstrated activity in patients with tumours harbouring NTRK gene fusions.

PATIENTS AND METHODS

This multi-centre, phase I dose escalation study enrolled adults with metastatic solid tumours, regardless of NTRK gene fusion status. Key inclusion criteria included evaluable and/or measurable disease, Eastern Cooperative Oncology Group performance status 0-2, and adequate organ function. Larotrectinib was administered orally once or twice daily, on a continuous 28-day schedule, in increasing dose levels according to a standard 3 + 3 dose escalation scheme. The primary end point was the safety of larotrectinib, including dose-limiting toxicity.

RESULTS

Seventy patients (8 with tumours with NTRK gene fusions; 62 with tumours without a documented NTRK gene fusion) were enrolled to 6 dose cohorts. There were four dose-limiting toxicities; none led to study drug discontinuation. The maximum tolerated dose was not reached. Larotrectinib-related adverse events were predominantly grade 1; none were grade 4 or 5. The most common grade 3 larotrectinib-related adverse event was anaemia [4 (6%) of 70 patients]. A dose of 100 mg twice daily was recommended for phase II studies based on tolerability and antitumour activity. In patients with evaluable TRK fusion cancer, the objective response rate by independent review was 100% (eight of the eight patients). Eight (12%) of the 67 assessable patients overall had an objective response by investigator assessment. Median duration of response was not reached. Larotrectinib had limited activity in tumours with NTRK mutations or amplifications. Pharmacokinetic analysis showed exposure was generally proportional to administered dose.

CONCLUSIONS

Larotrectinib was well tolerated, demonstrated activity in all patients with tumours harbouring NTRK gene fusions, and represents a new treatment option for such patients.

CLINCALTRIALS.GOV NUMBER

NCT02122913.

Selective RET kinase inhibition for patients with RET-altered cancers

Background

Alterations involving the RET kinase are implicated in the pathogenesis of lung, thyroid and other cancers. However, the clinical activity of multikinase inhibitors (MKIs) with anti-RET activity in RET-altered patients appears limited, calling into question the therapeutic potential of targeting RET. LOXO-292 is a selective RET inhibitor designed to inhibit diverse RET fusions, activating mutations and acquired resistance mutations.

Patients and methods

Potent anti-RET activity, high selectivity, and central nervous system coverage were confirmed preclinically using a variety of in vitro and in vivo RET-dependent tumor models. Due to clinical urgency, two patients with RET-altered, MKI-resistant cancers were treated with LOXO-292, utilizing rapid dose-titration guided by real-time pharmacokinetic assessments to achieve meaningful clinical exposures safely and rapidly.

Results

LOXO-292 demonstrated potent and selective anti-RET activity preclinically against human cancer cell lines harboring endogenous RET gene alterations; cells engineered to express a KIF5B-RET fusion protein -/+ the RET V804M gatekeeper resistance mutation or the common RET activating mutation M918T; and RET-altered human cancer cell line and patient-derived xenografts, including a patient-derived RET fusion-positive xenograft injected orthotopically into the brain. A patient with RET M918T-mutant medullary thyroid cancer metastatic to the liver and an acquired RET V804M gatekeeper resistance mutation, previously treated with six MKI regimens, experienced rapid reductions in tumor calcitonin, CEA and cell-free DNA, resolution of painful hepatomegaly and tumor-related diarrhea and a confirmed tumor response. A second patient with KIF5B-RET fusion-positive lung cancer, acquired resistance to alectinib and symptomatic brain metastases experienced a dramatic response in the brain, and her symptoms resolved.

Conclusions

These results provide proof-of-concept of the clinical actionability of RET alterations, and identify selective RET inhibition by LOXO-292 as a promising treatment in heavily pretreated, multikinase inhibitor-experienced patients with diverse RET-altered tumors.

Effect of an Iso-Osmolar Contrast Medium on Pulmonary Arterial Pressure at Pulmonary Angiography

A clinical comparison of the effects on pulmonary arterial pressure induced by contrast media with various osmolalities, iohexol 140 mg I/ml (300 mosm/kg H2O), iohexol 300 mg I/ml (690 mosm/kg H2O), and diatrizoate 292 mg I/ml (1480 mosm/kg H2O) following selective pulmonary angiography was made in 12 patients with normal pulmonary arterial pressure. A double-blind crossover study was performed and the contrast media were administered in random order. The pulmonary arterial pressure was recorded continuously before, during, and for 3 min after the injection. The effect of iohexol 140 on the pulmonary arterial pressure was significantly less marked than that of diatrizoate 292, whereas no statistical significance was shown between iohexol 140 and iohexol 300. These results indicate that iso-osmolar contrast medium (iohexol 140), as well as iohexol 300, would be better tolerated than diatrizoate 292, and is therefore a safer contrast medium for selective pulmonary angiography.

Dispersive Mixing Performance Evaluation of Special Rotor Segments in an Intermeshing Co-Rotating Twin-Screw Extruder by Using Weighted Probability Distributions

An intermeshing co-rotating twin-screw extruder is widely used for producing polymer composites. In order to satisfy properties of the composites, it is important to understand mixing performance of segments. In this study, we discussed mixing performance of special rotor segments commercially named VCMT (various clearance mixing technology) by using a numerical analysis method. The several tip clearances of VCMT work for achievement of both self-cleaning and effective mixing. We adopted a particle tracking method to obtain the following two evaluation indices; 1) residence time for the evaluation of its uniformity and 2) maximum 1st principal stress for the evaluation of dispersive mixing. And we evaluated mixing performance of VCMT by using probability distributions of each index. Moreover, we proposed weighted probability distributions as theoretically better evaluation. The probability distributions of VCMT were compared with those of two kinds of kneading disk segments (KDs). From the comparison, it was found that the probability of VCMT in large 1st principal stress region is higher than those of KDs. As a conclusion, VCMT has better mixing performance than KDs for the geometries and operating conditions that were investigated.

[Marginal zone lymphoma associated with Sjögren's syndrome and hepatitis C virus infection]

A 64-year-old female was admitted in May 1997, because of salivary gland swelling. Histology of the right parotid gland revealed malignant lymphoma, diffuse medium-sized B-cell type, and she was treated with local radiotherapy and chemotherapy. She was rehospitalized in April 1998, because of recurrence of lymphoma in the stomach and the sigmoid colon. She had splenomegaly and lymphadenopathy (neck and inguinal). Laboratory findings revealed marked elevation of rheumatoid factor and RNA of hepatitis C virus. A diagnosis of Sjogren's syndrome was made by dryness and the histological findings of labial biopsy. Marginal zone B-cell lymphoma mainly consisted of centrocyte-like cells and lymphoepithelial lesions, and CD 20 and IgM-kappa were positive with immunohistochemical staining. Lymphoma involved the gut and spleen. We discuss the correlation of malignant lymphoma with Sjogren's syndrome and HCV infection.

T-Cell Type Acute Lymphoblastic Leukemia Following Cyclosporin A Therapy for Aplastic Anemia

Cyclosporin A (CsA) is used to prevent rejection in transplantation and to treat autoimmune and hematologic diseases such as aplastic anemia. However, the tumor growth-promoting effect of CsA remains controversial. We report the case of a 24-year-old man who developed acute lymphoblastic leukemia of precursor-T-cell origin after 75 months of treatment with CsA for aplastic anemia. The surface antigen phenotype of his leukemic cells was CD2+, CD3+, CD5+, CD7+, CD4-, CD8-, CD10-, CD20-, CD34-, CD41-, and CD56-. Southern blot analysis revealed a monoclonal rearrangement of T-cell receptor-Jgamma nongermline fragments in HindIII digestion.

Mental health in Asia: social improvements and challenges

Remarkable improvements in economic conditions and a considerable upgrade in the quality of life have been observed in many parts of Asia during the past several decades. At the same time, many mental health challenges face the people of Asia. Various social mental health indexes are reviewed here, with available data from China, Japan, Korea, Singapore, Malaysia, and other Asian societies. The data are compared with data from the United States, Australia in the Pacific Rim, and some other Western countries to examine patterns of similarity or difference between East and West in the process of modernization. Common trends in mental health issues associated with rapid sociocultural change observed in different Asian societies are discussed, as well as the relative shortage of mental health personnel available in many Asian societies. It is emphasized that, in addition to expanding psychiatric services, there is an even more urgent need to promote mental health knowledge and concern through education in the general population. Mental health needs to be cultivated and maintained by social forces and cultural strengths. It is stressed that there is a challenge for Asian people to advance mental health beyond economic development in the 21st century.

Random number generation deficit in schizophrenia characterized by oral vs written response modes

To characterize the deficit in random number generation in schizophrenia with respect to control of sensory information processing, the present study employed a random number generation task using 10 digits (0 to 9) and compared two response modes (oral and written) with different amounts of sensory availability about the previous choices of the subject. Analysis indicated that the increased availability of previous information in the written response mode may exacerbate an aspect of the deficit in random number generation in schizophrenia reflecting the disturbance in control of sensory information processing. The comparison of performance in written and oral response modes may be useful in assessing schizophrenic psychopathology.

[Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto's disease) accompanied by hemophagocytosis and salivary gland swelling in a patient with systemic lupus erythematosus]

After 2 years of steroid therapy that had effectively controlled her systemic lupus erythematosus, a 37-year-old woman presented with fever, erythema (face, upper chest), and low CH50. Increased oral steroid (prednisolone from 15 mg to 40 mg) and intravenous methylprednisolone (mPSL) (80 mg for 3 days) alleviated these symptoms except for the fever. Subsequently, the patient's fever worsened and leukocytopenia, abnormal liver function, lymphadenopathy (neck, axilla), and salivary gland swelling developed. Lymph node histology revealed features characteristic of Kikuchi-Fujimoto's disease (KFD). Laboratory examinations showed WBC 600/microliter, Hb 9.5 g/dl, platelets 90,000/microliter, GOT 766 IU/l, GPT 646 IU/l, LDH 4,228 IU/l, TG 1,622 mg/dl, and ferritin 6,330 ng/ml. Serum interferon gamma was also elevated (673 U/ml). Because a bone marrow smear revealed hemophagocytosis, mPSL pulse therapy (1 g for 3 days) was started for treatment of hemophagocytic syndrome. The fever promptly disappeared, and the patient's clinical symptoms resolved within 2 weeks. The abnormal laboratory data related to KFD and hemophagocytosis returned to normal within 4 weeks after the initiation of mPSL pulse therapy. We speculated that the hemophagocytosis and salivary gland involvement in this patient were also symptoms of KFD. This case indicated that corticosteroid pulse therapy is effective for KFD with serious clinical symptoms.

Optimization of excimer-forming two-probe nucleic acid hybridization method with pyrene as a fluorophore

A previously presented homogeneous assay method, named the excimer-forming two-probe nucleic acid hybridization (ETPH) method, is based on specific excimer formation between two pyrenes attached at the neighboring terminals of two sequential probe oligonucleotides complementary to a single target. In this study, we investigated assay conditions and optimal molecular design of probes for intense excimer emission using a pyrenemethyliodoacetamide-introduced 16mer probe, a pyrene butanoic acid-introduced 16merprobe and a target 32mer. The length of the linker between the pyrene residue and the terminal sugar moiety remarkably influenced the quantum efficiency of excimer emission; the pair of linker arms of these two probes was optimal. The quantum efficiency was also dependent upon the concentrations of dimethylformamide and NaCl added to the assay solution. Spectroscopic measurements and T m analysis showed that an optimal configuration of the two pyrene residues for intense excimer emission might be affected by pyrene-pyrene interaction, pyrene-duplex interaction (intercalation/stacking) and solvent conditions as a whole. We then demonstrated the practicality of the ETPH method with the optimal hybridization conditions thus attained by determining that the concentration of 16S rRNA in extracts from Vibrio mimicus ATCC 33655 cells in exponential growth phase is 18 500 16S rRNA molecules/cell on average.

Clinical experience of functional electrical stimulation in complete paraplegia

Percutaneous intramuscular electrodes and a portable multichannel system were used to restore the function of the paralyzed lower extremities in six patients with complete paraplegia. The total number of inserted electrodes was 168. All of the patients could stand, two could walk in parallel bars, and two could walk with a walker. The rate of breakage of electrodes was only 0.6% in our series. There were 10 (6.0%) superficial infections, and 10 (6.0%) movement of electrodes which required reimplantation. The results suggest that the ultrafine intramuscular electrode is practical for long term use with paraplegic patients. Although the system can be used for paraplegic patients during the activities of daily living, it will be necessary to develop a closed-loop controller to reduce the amount of stimulation to the extensor muscles and extend the endurance of upright activity to reduce fatigue.

Nucleic acid hybridization accompanied with excimer formation from two pyrene-labeled probes

We developed a novel nucleic acid hybridization method based on excimer formation. We used two different 16-mer oligonucleotide probes that had a combined continuous-sequence run that was complementary to a target 32-mer. Prior to hybridization, the adjacent terminal ends (i.e. the 3'-terminal of one probe and the 5'-terminal of the other probe) were each labeled with one pyrene residue. When these probes simultaneously hybridized to the target, a 495 nm broad fluorescence band was produced. The intensity of this band increased as the intensity of the pyrene monomer bands decreased, indicating that the 495 nm band was attributed to the pyrene excimer. The excimer fluorescence, easily differentiated from the monomer bands for emission wavelength, opens up a new way to perform homogeneous hybridization assays and in vivo imaging of nucleic acids.

Restoration and analysis of standing-up in complete paraplegia utilizing functional electrical stimulation

OBJECTIVE

Restoration of stand-up motion in patients with complete paraplegia utilizing multichannel functional electrical stimulation, and analysis of the restored motion.

DESIGN

Nonrandomized control trial.

SETTING

General community, a referral center, institutional practice, and ambulatory care:

PATIENTS

Twelve volunteer samples were used for the collection of normal data. Two complete paraplegics received treatment for the restoration of stand-up motion.

MAIN OUTCOME MEASURES

The electromyogram, joint angle, and floor reaction force were investigated during standing-up with arms crossed in front of the chest, and hands-assisted standing-up using parallel bars. The maximum knee joint torque during standing-up without hands-assists was calculated using a three-segment link model. Standing-up motion in complete paraplegics was restored, and then analyzed using the three-dimensional floor reaction force and the hip, knee, and ankle angles.

RESULTS

Main muscles used to stand up were the quadriceps, tibialis anterior, and paraspinal muscles. Hands-assists reduced the muscle activity and the vertical floor reaction force. Peak muscle activity was less during hands-assisted standing-up, except for the rectus femoris and the iliopsoas muscle. The maximum knee joint torque during standing-up was 1.6Nm/kg for both knees. Two complete paraplegics were able to stand up smoothly from a wheelchair based on stimulation data obtained from normal subjects. The characteristic pattern during standing-up was knee flexion preceding extension.

CONCLUSION

Stand-up motion was restored utilizing electromyogram data and knee joint torque data from normal subjects.

The effect of an aldose reductase inhibitor (Epalrestat) on diabetic nephropathy in rats

In order to clarify the possible contribution of the abnormal polyol pathway to the development of diabetic nephropathy, the effect of aldose reductase inhibitor on renal function and morphology was examined in streptozotocin (STZ)-induced diabetic rats. Six months after STZ injection, glomerular filtration rate and renal plasma flow showed marked decline with significant increase in nuclear-free mesangial area (MA) and relative mesangial area (RMA; MA per glomerular area) in diabetic rats. Oral administration of an aldose reductase inhibitor, Epalrestat, prevented renal hypofunction and mesangial expansion in diabetic rats without influencing the levels of blood glucose. These results suggest that the abnormal polyol pathway in diabetic rats is closely related to the development of mesangial expansion, a morphologic representative of diabetic glomerulopathy, and renal hypofunction.

Evaluation of the radiographic efficacy of iomeprol

Iomeprol, a new nonionic contrast medium, was administered at concentrations of 300 mgI/ml, 350 mgI/ml, and 400 mgI/ml to 1939 Japanese patients. The radiographic efficacy, the incidence of heat sensation and the incidence of pain were evaluated. The radiographic efficacy was rated as excellent in 80.6% and good in 17.5% of 1017 cases of conventional arteriography, excellent in 75.6% and good in 22.2% of 267 cases of IADSA or IVDSA, excellent in 78.3% and good in 19.6% of 384 cases of intravenous urography and excellent in 68.6% and good in 28.8% of 271 cases of CT enhancement. There was no statistical difference in radiographic efficacy between the sites of arteriography. Heat sensation was mild or moderate in 43.4% and severe in 0.2% of cases requiring intra-arterial injection, and mild or moderate in 50.7% of cases requiring intravenous injection. There were no cases of severe heat sensation following intravenous injection. The incidence of pain was low (mild 4.2%, moderate 0.7% and severe 0.1%) with intra-arterial injections. It is concluded that iomeprol is an excellent radiographic contrast medium for intravenous urography, CT enhancement and various forms of angiography.

Assessment of the side-effects of iomeprol

Adverse reactions were investigated in a group of 1918 patients enrolled in a study for the clinical assessment of iomeprol. The incidence of adverse reactions in the group was 5.3%. Dermatological symptoms were the principal adverse reactions. No previously unreported side-effects from iodinated contrast media were detected. Most adverse reactions were of slight or moderate intensity and most appeared within 3 h of the injection. The examinations which elicited a comparatively high frequency of adverse reactions were cerebral angiography, abdominal angiography, peripheral angiography, intravenous urography and thoracic angiography. No significant sex differences were noted with respect to the occurrence of adverse reactions, but such effects were more frequent among younger patients, among patients with allergic conditions and among patients who had previously received iodinated contrast media. As regards the manner of injection of iomeprol, there were no definite trends in terms of the iodine concentration used or the quantity of contrast medium injected, but the incidence of adverse reactions was comparatively high for intravenous as compared with intra-arterial injection.

[Measurement of the center of gravity using the link model for controlling functional electrical stimulation]

The purpose of this study is to better understand the reliability of using the link model when determining the center of gravity. We measured the centers of gravity using both the link model and the floor reaction force in 11 healthy subjects. Dempster's and Clauser's anthropometric data were used in measuring the center of gravity by the link model, and these results were compared with those measured by the floor reaction force. The motion area of the center of gravity during quiet standing was determined by experimental data, using the link model calculation. Joint torque was measured using Cybex II in one paraplegic patient who was treated by functional electrical stimulation (FES). We discuss whether the paraplegic patient can stand safely in a determined center of gravity motion area. Displacements of the center of gravity measured by the link model were very close to those obtained by the floor reaction force. The parameters of body segments proposed by Dempster were more reasonable than those of Clauser. The maximum differences of the center of gravity between those measured by the link model using Dempster's data and those measured by the floor reaction force, were 1.47 cm for the fore-aft direction, 1.85 cm for the lateral direction, and 2.34 cm for the vertical direction. The torque caused by electrical stimulation was stronger than that calculated by the link model during quiet standing. Our results suggest that the link model system that measures displacement of the center of gravity using Dempster's data, is clinically applicable for the closed-loop control system of FES.

Effects of collagen concentration on epithelial differentiation: in vitro analysis with a mucosal tissue model

Using collagen, epithelial cells, and fibroblasts isolated from the rabbit oral mucosa, a mucosal tissue model was prepared in vitro. Using this model, the effects of the collagen concentration on growth and differentiation of epithelial cells were studied. A positive correlation was found to exist between the collagen concentration and growth as well as the differentiation of epithelial cells. Further, above a 8.6% concentration of collagen, formation of the epithelial process and the basement membrane at the border between the epithelial layer and the connective tissue was noted. A conclusion was drawn that the collagen concentration in the extracellular matrix is deeply related to the growth and differentiation of mucosal epithelial cells. At the same time, it can be said that the successful completion of this research project endorsed the reliability of our methodology for the study of mucosa.

[A roentgenological study of Chilaiditi's syndrome]

The studies on Chilaiditi's syndrome reported in Japan have been mostly case reports on one or two cases. There have been studies on 356 cases in all. We have selected 262 cases with detailed data takes from the above 356 cases, together with 116 further cases of Chilaiditi's syndrome that we have encountered up to 1990, i.e. since our previous report in 1965. We also investigated roentgenograms, complications, interpositions and age distribution. The syndrome was mostly found in middle-aged and elderly patients of 50 years or older. More male patients were involved than female, however this is not necessarily true if the total number of patients under study is taken into account. Among the complications, gastric and duodenal diseases (ulcer and carcinoma) were most frequently found, accounting for 20.6% of the total reported cases in Japan. In our own study, the percentage was as high as 33.7% because radiography with contrast medium was positively conducted on the digestive tract. Of the interpositions, the colon accounted for 93.1% of our cases, and 72.9% of the total reported cases in Japan. The involved sites were mostly the right hepatic flexure of the colon and the transverse colon. From the reports by other researchers in the past and our data from 1965, 1975 and 1977, it appears that the incidence is about 0.003-0.03%. There were no subjective symptom specific to Chlaiditi's syndrome, and there may be various factors accounting for the occurrence of the syndrome. The symptoms were primarily based on the underlying diseases, and Chilaiditi's syndrome merely indicates the condition where the digestive tract interposes between the diaphragm and liver. Therefore, we regard this as a radiographical sign rather than a syndrome, and we propose that this should be called "Chilaiditi's sign". We also emphasize that the digestive tract must be strictly examined if this sign is to be noted.

[Utility of SCG (screening colonography) and combined sigmoidoscopy-SCG in thorough physical checkups]

Given the increasing incidence of colon cancer in recent years, it is important to establish a diagnostic system for early detection and introduce it into clinical practice. A double contrast examination that uses a disposable tip and tube with an enema reservoir filled with 200 ml of 60 w/v% barium sulfate, known as SCG (screening colonography) was used in this study. In order to assess its utility SCG was performed on 1,554 patients, and 2,004 patients were examined by a within 24 hours combination of sigmoidoscopy and SCG by way of screening for colon cancer. Given the brief duration of SCG, which ranged from 10 to 13 min in most patients in the study, the efficiency of the examinations was considered to be rather high. Furthermore, the barium reached the cecum in as many as 98.7% of the patients. Overall, SCG proved to have an excellent diagnostic capability. Sigmoidoscopy-SCG, on the other hand, detected colon cancer in 114 patients (5.7%) and colon polyps in 658 patients (32.8%). The rates of detection of colon cancers and polyps were higher in the patients who tested positive in immunological fecal examinations for occult blood. Judging from our results, it may be said that for many patients receiving thorough physical checkups to screen for colon cancer, our system will provide for efficient screening whereby patients are first examined for fecal occult blood and those who test positive undergo sigmoidoscopy and SCG within the same day.

[Measurement of renal plasma flow and glomerular filtration rates in diabetic subjects]

To clarify the problem in the measurement of renal plasma flow and glomerular filtration rates in diabetes, the effect of glucose on the determination of para-aminohippuric acid (PAH) and inulin was examined. The concentration of urinary PAH in glucosuric diabetic subjects decreased after the storage of urine samples because of the glycation of PAH. Therefore, glucose must be removed by the acid treatment before the determination of the concentrations of urinary PAH. Since glucose can interfere with the assay of inulin, the sample must be treated with NaOH prior to the determination of the inulin concentration. GFR of the subjects with type 2 diabetes was next examined. GFR in the subjects with a duration of diabetes less than 10 years was significantly higher than that in the subjects with a duration of diabetes more than 10 years. Thus, the subjects with short-term type 2 diabetes may present with hyperfiltration similar to the subjects with short-term type 1 diabetes.

[Multi-institutional trials of radiation and Furtulon combination therapy for malignant tumors]

The efficacy of the response and safety in combination therapy of radiation and furtulon, a derivative of fluoropyrimidine, for malignant tumors were tested on a multi-institutional basis. Patients in this study were given daily 800 mg of oral furtulon and also irradiations. Twenty-three out of 30 evaluable cases showed CR or PR response (response rate was 77%). The response rates of the cases classified into regions of primary sites were 67% of stomach (4/6), 57% of colorectum (4/7), 100% of breast (9/9), 67% of esophagus (4/6), 100% of ovary (1/1) and 100% of lung (1/1). Four out of 36 cases were not given the full scheduled treatments due to grade 3 side effects, consisting of one diarrhea case suspected due to furtulon side effect, 2 impaired general condition cases according to the progression of diseases, and one case showing radiation dermatitis, dysphagia due to radiation mucositis and leukocytopenia. These results show that the combination therapy of radiation and furtulon is an efficacious and safe modality for primary and metastatic tumors.

In vitro fabrication of bioartificial mucosa for reconstruction of oral mucosa: basic research and clinical application

Bioartificial mucosa can be fabricated with living cells in vitro and used for mucosal grafting. In this report, we describe our culturing methods for preparation of bioartificial mucosa and its morphological characteristics. Bioartificial mucosa has bilayered components, namely, mucosal epithelium and submucosal tissue. Submucosal tissue was composed of fibroblasts and type I collagen lattice. Mucosal epithelium was formed by an epithelial segment grafted on the submucosal tissue surface. Between epithelial and submucosal tissues, basement membrane was observed under a transmission electron microscope. In animal experiments, the bioartificial mucosa was well vascularized and survived completely without immunological rejections. Based on the findings from these animal experiments, we applied this bioartificial mucosa to humans and succeeded in reconstructing their mucosal defects. We also present an overview of the problems relevant to the use of such methods.

[Value of "additional arterial embolization" to bilateral internal iliac TAE in patients with severe pelvic fractures]

Transcatheter arterial embolization (TAE) of the bilateral internal iliac arteries has been shown to be of great value in controlling retroperitoneal massive hemorrhage associated with pelvic fractures. It has recently been reported, however, that TAE of only the bilateral internal iliac arteries sometimes fails to stabilize the patient's hemodynamics. The purpose of the present study was to evaluate "additional arterial embolization" to the bilateral internal iliac TAE in hemodynamically unstable cases. Sixty-eight patients who underwent emergency TAE following severe pelvic fractures were reviewed. Additional arterial embolization of the lumbar arteries in four patients, middle sacral arteries in two and inferior epigastric artery in one was carried out following bilateral internal iliac TAE. The damage to these arteries was associated with fractures of the lumbar costal process, sacrum, pubis, etc. The patients were in stable condition after the procedure, and no significant complication was experienced. When fractures and dislocations of the above-mentioned bones are seen on plain X-ray films and arterial bleeding is identified by angiography, additional embolization of the arteries should be performed immediately.

Effect of an iso-osmolar contrast medium on pulmonary arterial pressure at pulmonary angiography

A clinical comparison of the effects on pulmonary arterial pressure induced by contrast media with various osmolalities, iohexol 140 mg I/ml (300 mosm/kg H2O), iohexol 300 mg I/ml (690 mosm/kg H2O), and diatrizoate 292 mg I/ml (1480 mosm/kg H2O) following selective pulmonary angiography was made in 12 patients with normal pulmonary arterial pressure. A double-blind crossover study was performed and the contrast media were administered in random order. The pulmonary arterial pressure was recorded continuously before, during, and for 3 min after the injection. The effect of iohexol 140 on the pulmonary arterial pressure was significantly less marked than that of diatrizoate 292, whereas no statistical significance was shown between iohexol 140 and iohexol 300. These results indicate that iso-osmolar contrast medium (iohexol 140), as well as iohexol 300, would be better tolerated than diatrizoate 292, and is therefore a safer contrast medium for selective pulmonary angiography.

[Clinical assessment of rotational digital angiography for the diagnosis of aortic dissection]

Rotational digital angiography was performed in five patients with aortic dissection. Intimal tears, intimal flap and involvement of major branches were clearly demonstrated in two patients with opacified false lumen. Ulcer-like projections were also identified in three patients with thrombosed false lumen. The device has, therefore, been found to be of great value in diagnosing aortic dissection particularly for the detection of intimal tear sites and ulcer-like projections.

[Change of renal function immediately after angiography]

Abdominal angiography using ioxaglate (3.0-4.5 ml/kg) was performed in 10 patients with normal renal function. Ccr, FENa, CH2O were compared before and immediately after angiography. There was no significant change in Ccr and CH2O level, while FENa increased remarkably after angiography. This study suggested that the osmotic diuresis and the proximal tubular stress were induced by administrated low osmolality contrast material during conventional abdominal angiography.

[Hemangioma of the hypopharynx; a case report and value of MRI]

A case of 23-year-old female with histologically verified hemangioma of the hypopharynx was reported. MRI revealed slight hyper-intense mass on T1-weighted image while it was very high-signal intensity on T2-weighted image. The dynamic MRI showed peak contrast at 80 seconds after administration of Gd-DTPA. In the present paper the value of MRI for diagnosing hemangioma of the hypopharynx is discussed.

Transethnic adoption and personality traits: a lesson from Japanese orphans returned from China to Japan

The authors interviewed 25 Japanese who had been left as orphans in China at the end of World War II and who had recently returned to Japan with their Chinese spouses after almost four decades. It was found that even though they had been raised as Chinese culturally for almost their entire lives, most of these subjects had retained certain Japanese personality traits and social behavior from early childhood, and these characteristics distinguished them from their Chinese counterparts.

Preoperative assessment of the length of the stomach for esophageal substitution

This method is easily applied and useful for the estimation of the actual length of the gastric tube in situations of reconstruction after subtotal esophagectomy. The actual length of the gastric tube was almost identical to that of the stomach which was measured from the preoperative roentgenogram. In the end, a safe reconstruction by this approach will decrease the operative mortality rate caused by the leakage of the anastomosis.

Glucose inhibits myo-inositol uptake and reduces myo-inositol content in cultured rat glomerular mesangial cells

Although activation of polyol pathway has been proposed as one of the etiologic factors of diabetic complications, precise mechanism of the effect of polyol accumulation is still unclear. In order to test the hypothesis that there is an association of polyol pathway with myo-inositol metabolism, we measured myo-inositol content in cultured rat glomerular mesangial cells. By exposing the cells to high concentrations of glucose, intracellular myo-inositol content was reduced from 12.39 +/- 0.64 nmol/mg protein at 0 mmol/L glucose to 6.54 +/- 0.38 nmol/mg protein at 27.5 mmol/L glucose and 4.88 +/- 0.43 nmol/mg protein at 55 mmol/L glucose. This decrease of myo-inositol content was partially prevented by co-incubation with aldose reductase inhibitor, sorbinil. To examine further the mechanism of myo-inositol depletion, myo-inositol uptake by mesangial cells was studied. Major myo-inositol uptake process was sodium-dependent, saturable, and ouabain sensitive with Vmax of 171 pmol/mg protein/20 min and Km of 33 mumol/L. Sodium-dependent myo-inositol uptake was significantly inhibited by glucose in a dose-dependent manner only when glucose was present during uptake experiment, and kinetic analysis revealed the inhibition was competitive. Aldose reductase inhibition failed to prevent inhibitory effect of glucose on myo-inositol uptake. These data suggest that myo-inositol content of glomerular mesangial cells, which is reduced by high concentrations of glucose, is maintained by two processes: a glucose-sensitive but sorbitol-insensitive process, sodium-dependent myo-inositol uptake; and a sorbitol (aldose reductase) sensitive process, myo-Inositol depletion under high glucose condition may induce dysfunction of mesangial cells seen in diabetes.

[Rupture of right gastric artery aneurysm--a case report and the usefulness of TAE]

A case of a 39-year-old male with ruptured right gastric artery aneurysm was reported. An emergency angiography was carried out followed by transarterial embolization. The TAE was of great value for the control of massive bleeding and for getting out of the urgent surgical operation. In the present report the clinical value of TAE as well as frequency and some diagnostic imagings on this disease was discussed.

Microalbuminuria associated with a rise in blood pressure in non-insulin-dependent diabetes

The association between microalbuminuria and systemic blood pressure was investigated in 80 nonproteinuric subjects with non-insulin-dependent diabetes. Seventeen of 80 diabetics had urinary albumin excretion rates (AER) over 20 micrograms/min and were defined as microalbuminuric. The microalbuminuric diabetics showed a higher incidence of proliferative retinopathy and neuropathy than the normoalbuminurics. Moreover, the former group had significantly higher values of systolic blood pressure compared to the latter, although the creatinine clearance was not significantly different between the two groups. These results suggest that microalbuminuria is strongly associated with a rise of systemic blood pressure in non-insulin-dependent diabetics.

[A case of multiple peripheral hepatic artery aneurysms after chemoembolization]

A case of 57-year-old man with multiple peripheral hepatic artery aneurysms is reported. The patient was admitted with liver dysfunction and detected hepatoma in the right lobe. Chemoembolization was performed for the treatment of hepatoma. After 35 days, reangiography revealed multiple peripheral hepatic artery aneurysms in the region of chemoembolization. The etiology of aneurysms were presumably drug induced arteritis.