Encouraging Regular Aortic Valve Opening for EVAHEART 2 LVAD Support Using Virtual Patient Hemodynamic Speed Modulation Analysis

This study focuses on investigating the EVAHEART 2 left ventricular assist device (LVAD) toward designing optimal pump speed modulation (PSM) algorithms for encouraging aortic valve (AV) flow. A custom-designed virtual patient hemodynamic model incorporating the EVAHEART 2 pressure-flow curves, cardiac chambers, and the systemic and pulmonary circulations was developed and used in this study. Several PSM waveforms were tested to evaluate their influence on the mean arterial pressure (MAP), cardiac output (CO), and AV flow for representative heart failure patients. Baseline speeds were varied from 1,600 to 2,000 rpm. For each baseline speed, the following parameters were analyzed: 1) PSM ratio (reduced speed/baseline speed), 2) PSM duration (3-7 seconds), 3) native ventricle contractility, and 4) patient MAP of 70 and 80 mm Hg. More than 2,000 rpm virtual patient scenarios were explored. A lower baseline speed (1,600 and 1,700 rpm) produced more opportunities for AV opening and more AV flow. Higher baseline speeds (1,800 and 2,000 rpm) had lower or nonexistent AV flow. When analyzing PSM ratios, a larger reduction in speed (25%) over a longer PSM (5+ seconds) duration produced the most AV flow. Lower patient MAP and increased native ventricle contractility also contributed to improving AV opening frequency and flow. This study of the EVAHEART 2 LVAD is the first to focus on leveraging PSM to enhance pulsatility and encourage AV flow. Increased AV opening frequency can benefit aortic root hemodynamics, thereby improving patient outcomes.

Imaging phonon eigenstates and elucidating the energy storage characteristics of a honeycomb-lattice phononic crystal cavity

We extend gigahertz time-domain imaging to a wideband investigation of the eigenstates of a phononic crystal cavity. Using omnidirectionally excited phonon wave vectors, we implement an ultrafast technique to experimentally probe the two-dimensional acoustic field inside and outside a hexagonal cavity in a honeycomb-lattice phononic crystal formed in a microscopic crystalline silicon slab, thereby revealing the confinement and mode volumes of phonon eigenstates-some of which are clearly hexapole in character-lying both inside and outside the phononic-crystal band gap. This allows us to obtain a quantitative measure of the spatial acoustic energy storage characteristics of a phononic crystal cavity. We also introduce a numerical approach involving toneburst excitation and the monitoring of the acoustic energy decay together with the integral of the Poynting vector to calculate the Q factor of the principal in-gap eigenmode, showing it to be limited by ultrasonic attenuation rather than by phonon leakage to the surrounding region.

Giant extraordinary transmission of acoustic waves through a nanowire

Wave concentration beyond the diffraction limit by transmission through subwavelength structures has proved to be a milestone in high-resolution imaging. Here, we show that a sound wave incident inside a solid over a diameter of 110 nm can be squeezed through a resonant meta-atom consisting of a nanowire with a diameter of 5 nm equal to λ/23, where λ is the incident acoustic wavelength, corresponding to a transmission efficiency of 500 or an energy densification of ~14,000. This remarkable level of extraordinary acoustic transmission is achieved in the absence of ultrasonic attenuation by connecting a tungsten nanowire between two tungsten blocks, the block on the input side being furnished with concentric grooves. We also demonstrate that these "solid organ pipes" exhibit Rayleigh end corrections to their effective longitudinal resonant lengths notably larger than their in-air analogs. Grooves on the output side lead to in-solid directed acoustic beams, important for nanosensing.

Broadband evolution of phononic-crystal-waveguide eigenstates in real- and k-spaces

Control of sound in phononic band-gap structures promises novel control and guiding mechanisms. Designs in photonic systems were quickly matched in phononics, and rows of defects in phononic crystals were shown to guide sound waves effectively. The vast majority of work in such phononic guiding has been in the frequency domain, because of the importance of the phononic dispersion relation in governing acoustic confinement in waveguides. However, frequency-domain studies miss vital information concerning the phase of the acoustic field and eigenstate coupling. Using a wide range of wavevectors k, we implement an ultrafast technique to probe the wave field evolution in straight and L-shaped phononic crystal surface-phonon waveguides in real- and k-space in two spatial dimensions, thus revealing the eigenstate-energy redistribution processes and the coupling between different frequency-degenerate eigenstates. Such use of k-t space is a first in acoustics, and should have other interesting applications such as acoustic-metamaterial characterization.

Vibrations of microspheres probed with ultrashort optical pulses

We use ultrashort optical pulses to excite and detect vibrations of single silica spheres with a diameter of 5 microm placed at the surface of an acoustically mismatched substrate. In addition to the photoelastic detection of picosecond longitudinal acoustic pulses propagating inside the bulk, we detect gigahertz acoustic resonances of the sphere through probe beam defocusing. The mode frequencies are in close accord with those calculated from the elastic vibrations of a free sphere. We also record a resonant enhancement in the amplitude of specific modes of two touching spheres.

[Epidural anesthesia for a patient with catamenial pneumothorax]

Endometriosis extending into the thoracic cage or the lung might induce defect of the tissue and show catamenial symptoms, such as pneumothorax or hemothorax. These events usually occur 48 to 72 hours after menstruation. A 37-year-old woman with ten year history of recurrent catamenial pneumothorax was scheduled for removal of ovarian cyst. Since intermittent positive pressure ventilation or pneumoperitoneum might induce pneumothorax, we selected epidural anesthesia for laparotomy. Epidural cannulations were performed at Th 9/10 and L 4/5 interspaces. After administration of 2% mepivacaine (400 mg) and fentanyl (0.1 mg), the block extended from Th 6 to S 5. The surgery was done without any complication. In this case epidural anesthesia for laparotomy was useful for the patient with catamenial pneumothorax.

[General anesthesia for a patient with Cornelia de Lange syndrome]

Cornelia de Lange syndrome involves anomalies in cardio-vascular and musculo-skeletal systems, and mental retardation. In addition, a patient with this syndrome shows a peculiar look. A 22-year-old woman with Cornelia de Lange syndrome underwent general anesthesia twice. She has a small mouth, thin lips, a short neck, short limbs, and stiffness of the neck and some joints associated with slight mental retardation. She was scheduled for arthroscopy and then for rotational acetabular osteotomy and valgus osteotomy. The maximum distance between the upper and lower incisors was 34 mm, when she opened her mouth. Anesthesia was induced with sevoflurane increased slowly to 7.0% in oxygen 6 l.min-1 in both procedures. After the administration of 4% lidocaine 3.5 ml into the pharynx, orotracheal intubation was attempted, but was not successful. Then blind naso-tracheal intubation was performed successfully under spontaneous respiration under sevoflurane-oxygen inhalation. The induction of anesthesia with sevoflurane under spontaneous respiration was useful for blind naso-tracheal intubation in a case with difficult intubation such as in Cornelia de Lange syndrome.

Time of useful consciousness determination in aircrew members with reference to prior altitude chamber experience and age

BACKGROUND

Hypoxia tolerance has been evaluated by the secondary responses to oxyhemoglobin deoxygenation: the time of useful consciousness (TUC), subjective symptoms, ventilatory responses, and cardiovascular changes. It is not clear whether the deoxygenation rate per se reflects hypoxia tolerance or how it relates to the former parameters.

METHODS

In Study 1, we monitored arterial oxygen saturation (SaO2) by pulse oximetry in the nonsmoking subjects experiencing hypoxia at the simulated altitude of 25,000 ft. Male subjects were divided into two groups: junior (< or =39 yr, n = 108) and senior (> or =40 yr, n = 44). The duration from mask-off to mask-on (TUC), the duration from mask-off to the time of SaO2 of 90%(T90), the duration from 90% to 70% of SaO2(T70), and the SaO2 value at mask-on (bottom SaO2) were compared between the two groups. (In a separate, but related study, 10 medical variables were analyzed by stepwise regression to investigate the contributing factors to hypoxia tolerance in 77 other subjects, including 11 female subjects.) In study 2, 12 subjective hypoxic symptoms at 25,000 ft were compared between junior (n = 369) and senior (n = 160) groups.

RESULTS

TUC was significantly longer in the junior group, but T70 was longer and bottom SaO2 was higher in the senior group. Age was adopted as a contributing variable in three out of six dependent parameters. Subjective symptoms were in the similar rank order for both groups.

CONCLUSION

Pulse oximetry reconfirmed that age is a major influencing factor for acute hypoxia tolerance. This may be due not only to the physiological effect but also to the training experience to recognize hypoxic deterioration more quickly.

[Perioperative management of vagotomy for treatment of frequent syncope]

A 66-year-old man was admitted to our hospital because of frequent chest pain and loss of consciousness. He had a 6-year history of angina and has taken nitroglycerin. He had received total laryngo-pharyngoectomy with the graft by jejunum for pharyngeal cancer seven months ago. The tumor, however, recurred at the neck lymphnodes. Against the increased episodes of severe bradycardia and loss of consciousness, he was scheduled to undergo subemergent vagotomy at proximal and distal side of the cancer since the cancer surrounded the nutrition vessels of the graft. Atropine 0.25 mg i.m. and 0.25 mg i.v. were administered to treat bradycardia and hypotension in the morning of operation. As a premedication atropine 0.5 mg p.o. was given. Anesthesia was induced with midazolam 3 mg, sevoflurane 5%, nitrous oxide 8 l.min-1 in oxygen 4 l.min-1. Intubation through tracheostomy was facilitated with fentanyl 100 micrograms. When the operator touched the neck, heart rate and blood pressure decreased suddenly to 35 beats.min-1 and 62 mmHg/20 mmHg, respectively. Atropine 1 mg i.v. and ephedrine 8 mg i.v. were effective. This was the only episode during surgery. After surgery all bradycardiac episodes have gone away without atropine or any other treatment. His frequent attack of bradycardia and hypotension with syncope was due to vagal reflex by the recurrent tumor.

Thymidine phosphorylase activity and angiogenesis in gastric cancer

Angiogenesis has an important role in the growth and metastasis of solid tumors. Several angiogenic factors have been identified, one being platelet-derived endothelial cell growth factor (PD-ECGF), which is identical to thymidine phosphorylase (dThdPase). We investigated the activity of dThdPase in 84 samples of 42 human gastric cancers, by liquid chromatography. The dThdPase activity significantly correlated to the microvessel density assessed by immunostaining to CD-31 antigen (P<0.05). Expression of dThdPase has an important role in the promotion of angiogenesis in human gastric cancer.

New animal model for human ocular toxocariasis: ophthalmoscopic observation

BACKGROUND/AIMS

Although human ocular toxocariasis causes severe vision defect, little is known about its aetiology, diagnosis, and treatment. To develop a new animal model for human ocular toxocariasis, ophthalmological findings of fundi in Mongolian gerbils, Meriones unguiculatus, and BALB/c mice were investigated following infection with Toxocara canis.

METHODS

Using an ophthalmoscope, which was specifically developed to observe the fundi of small animals, ocular changes of fundi of 20 gerbils and 11 mice were monitored after oral infection with embryonated eggs of T canis.

RESULTS

Vitreous, choroidal, and retinal haemorrhages were consistently observed in Mongolian gerbils, but rarely in mice. Severe exudative lesions and vasculitis were often present in gerbils but not in mice. Migrating larvae were also frequently observed in gerbils.

CONCLUSION

Mongolian gerbils are more appropriate animal model for human ocular toxocariasis than previously used experimental animal such as mice, guinea pigs, rabbits, and monkeys because of its high susceptibility of ocular infection.

Intratumoral neovascularization and growth pattern in early gastric carcinoma

BACKGROUND

The growth pattern of early gastric carcinoma, based on a volumetric analysis, reflects biologic characteristics of the tumor. The authors investigated the microvessel density (MVD), expression of vascular endothelial growth factor (VEGF), and growth patterns in early gastric carcinoma.

METHODS

Ninety-four tissue specimens resected from patients with early gastric carcinoma invading the submucosal layer were examined. Microvessel quantification was performed immunohistochemically using a monoclonal antibody against factor VIII-related antigen. VEGF expression was studied using an anti-VEGF polyclonal antibody. Growth patterns were defined as follows: Pen A type: expansively penetrating growth; Pen B type: infiltratively penetrating growth; Super type: superficially spreading growth.

RESULTS

The mean MVD was 16.9 (range, 5.2-43.0). MVD was significantly higher in tumors with venous invasion (P<0.01), lymphatic vessel invasion (P<0.05), and lymph node metastases (P<0.05) compared with MVD in tumors without venous or lymphatic vessel invasion or lymph node metastases. The VEGF-positive rate of Pen A type tumors was 66.7% (18 of 27), that Pen B type was 10.0% (1 of 10), that of Super type was 19.4% (6 of 31), and that of the unclassified type was 15.4% (4 of 26). The VEGF-positive rate in patients with Pen A type tumors was significantly higher than that in patients with the other three growth patterns(P<0.01). MVD in patients with Pen A type tumors (25.9+/-9.2) was significantly higher than that in patients with Super type tumors (12.6+/-5.4) (P<0.01). Patients with Pen A type tumors had a poorer prognosis than patients whose tumors had other growth patterns (P<0.05). According to multivariate analysis, VEGF expression and lymphatic vessel invasion were significant prognostic factors.

CONCLUSIONS

Pen A type gastric carcinoma tends to secrete VEGF, thus inducing tumor angiogenesis and resulting in venous invasion. Intensive follow-up is necessary for patients with Pen A type tumors, because this tumor type has a greater propensity for hematogenous metastasis.

Intratumoral neovascularization and growth pattern in early gastric carcinoma

BACKGROUND

The growth pattern of early gastric carcinoma, based on a volumetric analysis, reflects biologic characteristics of the tumor. The authors investigated the microvessel density (MVD), expression of vascular endothelial growth factor (VEGF), and growth patterns in early gastric carcinoma.

METHODS

Ninety-four tissue specimens resected from patients with early gastric carcinoma invading the submucosal layer were examined. Microvessel quantification was performed immunohistochemically using a monoclonal antibody against factor VIII-related antigen. VEGF expression was studied using an anti-VEGF polyclonal antibody. Growth patterns were defined as follows: Pen A type: expansively penetrating growth; Pen B type: infiltratively penetrating growth; Super type: superficially spreading growth.

RESULTS

The mean MVD was 16.9 (range, 5.2-43.0). MVD was significantly higher in tumors with venous invasion (P<0.01), lymphatic vessel invasion (P<0.05), and lymph node metastases (P<0.05) compared with MVD in tumors without venous or lymphatic vessel invasion or lymph node metastases. The VEGF-positive rate of Pen A type tumors was 66.7% (18 of 27), that Pen B type was 10.0% (1 of 10), that of Super type was 19.4% (6 of 31), and that of the unclassified type was 15.4% (4 of 26). The VEGF-positive rate in patients with Pen A type tumors was significantly higher than that in patients with the other three growth patterns(P<0.01). MVD in patients with Pen A type tumors (25.9+/-9.2) was significantly higher than that in patients with Super type tumors (12.6+/-5.4) (P<0.01). Patients with Pen A type tumors had a poorer prognosis than patients whose tumors had other growth patterns (P<0.05). According to multivariate analysis, VEGF expression and lymphatic vessel invasion were significant prognostic factors.

CONCLUSIONS

Pen A type gastric carcinoma tends to secrete VEGF, thus inducing tumor angiogenesis and resulting in venous invasion. Intensive follow-up is necessary for patients with Pen A type tumors, because this tumor type has a greater propensity for hematogenous metastasis.

Total gastrectomy

Total gastrectomy with lymph node dissection is one of the standard operations for gastric malignancies without distant metastases. Surgical procedures of total gastrectomy are described with illustrations easy to understand anatomy. Practical application and survival of patients are also shown.

Prognostic value of p53 protein expression for patients with gastric cancer--a multivariate analysis

Mutations in the p53 gene, one of the most common genetic alterations in human cancer, are implicated in tumorigenesis and tumour progression. Although p53 protein expression appears to be correlated to prognosis in patients with malignancy, its prognostic role in gastric cancer has remained controversial. We examined the clinical significance of p53 overexpression in 427 patients with gastric cancer, using multivariate analysis. Tumour sections of gastric cancer tissues from these 427 Japanese patients were stained immunohistochemically with monoclonal antibody PAb1801. The presence of p53 expression was statistically compared with clinicopathological features and post-operative survival, using univariate and multivariate analyses. p53 expression was detected in 38.6% (165 out of 427) of these gastric cancers and immunoreactivity was not observed in normal mucosa adjacent to the tumour. A higher rate of p53 detection was observed among large tumours and in those with a prominent depth of invasion, lymphatic and vascular invasion and lymph node involvement. Prognosis was significantly worse for patients with p53-positive-staining tumours. The 5-year survival rate was 62.5% for patients with p53-negative tumours and 43.3% for those with positive malignancies. p53 expression was a significant prognostic factor for node-positive gastric cancers in subjects undergoing treatment with curative resection, as assessed by Cox regression analysis. Thus, the expression of p53 was closely related to the potential for tumour advance and a poorer post-operative prognosis for patients with gastric cancer.

Laparoscopic repair of a perforated duodenal ulcer in two patients

The laparoscopic repair of a perforated duodenal ulcer was effectively done in two patients both of whom were poor risks for surgery. One was a 39-year-old woman with a history of bronchial asthma since she was 20 years of age, while the other was a 76-year-old man with hepatocellular carcinoma, lung cancer, and diabetes mellitus. The postoperative course of these patients was uneventful. Based on these findings, the laparoscopic repair of a perforated duodenal ulcer should thus be considered as a first choice of treatment for a perforated duodenal ulcer, even in poor-risk patients.

Long-term survival of patients with stage IV gastric carcinoma

BACKGROUND

Survival of patients with Stage IV (based on general rules established by the Japanese Research Society for Gastric Cancer) gastric carcinoma often is unfavorable. Among patients with a poor prognosis, a few do survive > 5 years. The authors examined pathologic and biologic features of tumors of long term survivors.

METHODS

The authors analyzed data from 442 patients with Stage IV gastric carcinoma, including 20 surviving for > 5 years after gastrectomy (Group A) and 422 who died of gastric carcinoma within 5 years (Group B). Mutant p53 was immunohistochemically stained using the monoclonal antibody PAb1801. Proliferative activity was estimated by argyrophilic nuclear organizer region (AgNOR) staining and proliferating cell nuclear antigen (PCNA) staining.

RESULTS

Group A had smaller and more localized tumors than Group B (P < 0.05 and P < 0.01, respectively). Lymphatic or venous invasion and peritoneal dissemination were less frequent in Group A than in Group B (P < 0.01). Abnormalities of p53 expression were found in 3 of the 14 tumors in Group A (21%), a value significantly lower than the 58 of 118 tumors in Group B (49%; P < 0.05). AgNOR count and percentage of PCNA labeling were not significantly different between Groups A and B. A multivariate analysis showed that lymph node dissection, liver metastasis, gastric resection, venous invasion, and tumor size were independent prognostic factors.

CONCLUSIONS

Even in patients with Stage IV gastric carcinoma, radical gastrectomy and extensive lymph node dissection can lead to long term survival. The authors believe that combination analysis of pathologic features and p53 overexpression predict length of survival for patients with Stage IV gastric carcinoma.

Stimulation of interleukin-8 production by acidic polysaccharides from the root of Panax ginseng

The root of Panax ginseng C.A. Meyer, is a well-known important Chinese traditional medicine used as a stomachic, tonic, sedative and as an elixir called Ginseng in China and Japan. The precise mechanism of the biological actions of this plant is not fully understood. In order to elucidate the immunomodulating activities of this plant, we examined the direct effects of four of its components, acidic polysaccharides isolated in previous studies, on cytokine (interleukin-8; IL-8) production by a human monocytic cell line, THP-1, and human blood monocytes in vitro, as IL-8 is a potent inflammatory cytokine involved in neutrophil chemotaxis and activation. We found that one component, ginsenan S-IIA, is a potent inducer of IL-8 production by human monocytes and THP-1 cells, and this induction is accompanied by increased IL-8 mRNA expression.

Surgical treatment and outcome for node-negative gastric cancer

BACKGROUND

The clinicopathologic characteristics and prognosis for patients with node-negative gastric cancer have heretofore remained to be determined.

METHODS

We analyzed data on 730 of our patients with node-negative gastric cancer who underwent curative gastric resection in the Department of Surgery II, Kyushu University Hospital, between 1965 and 1990, with reference to prognostic factors. The presence of lymph node metastasis was determined by means of routine hematoxylin-eosin staining of excised tissues.

RESULTS

The 5-year survival rate was 91.7% and the 10-year rate was 88.5%; thus the prognosis was good for patients with node-negative gastric cancer. When the prognosis was analyzed by stratification of each clinicopathologic factor, the survival time was shorter for older patients when the size of the tumor was larger, when the tumor involved the entire stomach, and when-tissues revealed infiltrative growth, serosal invasion, and lymphatic invasion. Extensive lymph node dissection was performed for 86.6% of the patients, and for these patients the prognosis was better, with a statistical difference. In a multivariate analysis, tumor size, serosal invasion, and extensive lymph node dissection proved to be independent prognostic factors for patients with node-negative gastric cancer.

CONCLUSIONS

Prophylactic lymph node dissection for patients with gastric cancer will prolong the survival time.

Improved surgical results after combining preoperative hyperthermia with chemotherapy and radiotherapy for patients with carcinoma of the rectum

PURPOSE

The aim of this study is to evaluate long-term results of preoperative hyperthermia combined with chemotherapy and irradiation (HCR therapy) in patients with carcinoma of the rectum.

METHODS

Postoperative prognoses were compared among 36 patients with carcinoma of the rectum, who were given preoperative HCR therapy followed by surgery, and 52 patients undergoing surgery alone without any preoperative therapy.

RESULTS

There were significant differences in the prognosis between patients given preoperative HCR therapy plus surgery and those having surgery alone, and five-year survival rates were 91.3 and 64 percent, respectively. Particularly, for patients with tumors invading beyond the muscularis propria and/or with positive lymph node metastasis, a significantly longer survival was obtained with HCR plus surgery than in surgery alone (86.5 vs. 50.9 percent and 92.9 vs. 51.7 percent, respectively). However, no significant differences were observed in the postoperative prognosis for cases with no lymph node metastasis and/or with tumors limited to the muscularis propria between these two groups.

CONCLUSIONS

These data clearly demonstrated the effectiveness of preoperative HCR therapy for improving long-term results of patients with carcinoma of the rectum, especially those demonstrating an advanced stage of disease.

Significance of routine annual esophagram for early detection of carcinoma of the esophagus

BACKGROUND/AIMS

In order to achieve increased survival rates for patients with carcinoma of the esophagus, early detection of the disease is vital. Serial esophagrams were evaluated to clarify which interval would be effective for early detection of carcinoma of the esophagus during routine examination.

MATERIALS AND METHODS

One hundred eighty-nine patients with carcinoma of the esophagus were grouped into three, according to the experience and the time of the previous roentgenograms before the definite diagnosis.

RESULTS

Five patients were in Group 1, in which roentgenographic examination had been done within 12 months prior to the diagnosis. Retrospective observation revealed a slight but certain abnormal shadow at the same location as the esophageal tumor seen on the second films. In Group 2, seven had received an esophagram between 12 and 24 months before the diagnosis. In contrast to Group 1, neither abnormality nor findings indicating esophageal tumors were detected on the former x-ray films, in all seven cases. Group 2 was characterized by relatively small tumors and low stage of the disease. Mean tumor length was 4.1 +/- 2.9 cm, and three of seven were classified as Stage I and two as Stage IIA. On the other hand, most of the 177 patients in Group 3, with no previous examination of the esophagus within 24 months before the diagnosis, had far advanced disease. Mean tumor length was 6.3 +/- 2.6 cm. Only nine (5.1%) were classified as Stage I, whereas 115 (65.0%) were classified as Stage III or IV.

CONCLUSION

In light of these data, for populations in which esophageal cancer frequently occurs, esophageal examination every 12 months will no doubt contribute towards the early detection of lesions.

An integrated microsatellite length analysis using an automated fluorescent DNA sequencer

Analyzing microsatellite instability (MI) in malignant tumors is thought to be useful for screening cancer patients to identify those patients with a higher risk of developing second malignant tumors. In this paper, we report a new, accurate, and efficient method of detecting MI using an automated fluorescent DNA sequencer and a computer that automatically calculates the size, height, and area of each fluorescent product, making it possible to assess MI more accurately and more rapidly. The primers for amplification of each microsatellite locus are labeled by two different fluorescent dyes, rox (red) and fam (blue). The rox-labeled primer was used for the tumor, whereas the fam-labeled primer was used for the corresponding normal tissue. Two amplified products from both the tumor and the normal tissue were co-loaded into a single lane of the sequencing gel and were analyzed. MI could be detected based on the presence of different waving patterns. Furthermore, several loci could also be analyzed simultaneously for MI in a single lane. Using this method, we examined the frequency of MI in gastric cancer. The results showed that 5 of 22 (22.7 %) gastric cancers were MI-positive, which corresponds to the findings of previous reports that used the radioisotopic method. The improved method may open up the possibility of performing routine examination of MI in many cancer patients and offers hope for the potential clinical application of Ml analysis as a follow-up evaluation of cancer patients.

Macroscopic appearance and biological character of gastric cancer invading the muscularis propria

BACKGROUND/AIMS

The natural history of gastric cancer, as to how an early gastric cancer develops into an advanced lesion, is still an open question. In this study, we focused on the gastric cancer invading the muscularis propria, and analyzed the relationship between gross appearance and the biological characteristics of gastric cancer.

MATERIALS AND METHODS

One hundred and forty six patients with gastric cancer invading the muscularis propria (pm) were studied with special reference to the macroscopic appearance of the primary tumor; Borrmann type vs. EGC type (advanced gastric cancer simulating early gastric cancer), and to the biologic characteristics such as p53 expression and mitotic activity.

RESULTS

Borrmann type comprised 59.6% (87/146) and EGC type comprised 40.4% (59/146) of the cases. Borrmann type cancer was located more commonly in the antral region (71.3%), tended to grow expansively, and had higher rate of vascular vessel invasion and lymph node metastasis. The type of recurrence varied, and the prognosis was poor in patients with Borrmann type cancer. Incidence of p53 overexpression in Borrmann type cancer was 44.1% (15/34), and significantly higher than 25.8% (8/31) in EGC type cancer. Proliferating activity measured by MIB-1 labeling percentage was also higher in Borrmann type (49.8 +/- 11.6 vs. 38.9 +/- 10.9).

CONCLUSIONS

These results suggest that Borrmann type and EGC type pm gastric cancers are distinct in their inherent biological nature, and possibly represent the advanced form of penetrating growth (Pen) type and superficially-spreading growth (Super) type, respectively, of early gastric cancers.

Lesser sac herniation through the greater omentum and gastro-pancreatic ligament: report of a case

We report herein the case of a woman who developed a lesser sac hernia which was especially unusual in that the small bowel prolapsed through a defect in the greater omentum and was thereafter strangulated by a hole in the gastro-pancreatic ligament. The gastro-pancreatic ligament has never before been documented as causing an internal hernia. In our patient, a plain abdominal X-ray demonstrated as soft-tissue mass displacing the stomach to the left while abdominal computed tomography and ultrasonography showed a sac-like encapsulation of the small bowel loops between the liver and stomach. Careful evaluation of these radiographic findings allowed for the preoperative diagnosis of a lesser sac hernia to be made.

Characterization of an acidic polysaccharide with immunological activities from the tuber of Pinellia ternata

An acidic polysaccharide, called pinellian PA, was isolated from the tuber of Pinellia ternata Breit. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 11.8 x 10(4). Pinellian PA is composed of L-arabinose: D-galactose: L-rhamnose: D-galacturonic acid: D-glucuronic acid in the molar ratio of 5:15:1:3:3, in addition to small amounts of O-acetyl groups and peptide moieties. Reduction of carboxyl groups, methylation analysis and nuclear magnetic resonance studies show that the core structural features include a backbone chain composed of beta-1,3-linked D-galactose units. Some of the galactose units in the backbone carry beta-1,6-linked D-galactosyl side-chains at position 6. Pinellian PA produces significant potentiation of the reticuloendothelial system, as shown by a carbon clearance test, and also exhibits potent anti-complementary activity.

A glucan with immunological activities from the tuber of Alisma orientale

A glucan, called alisman SI, was isolated from the tuber of Alisma orientale Juzepcz. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was 1.1 x 10(4). It is composed solely of D-glucose. Methylation analysis, nuclear magnetic resonance and enzymic degradation studies indicated that it has a high-branched glucan type structure mainly composed of alpha-1,4-linked D-glucopyranosyl residues with partially alpha-1,6-linked units and both 3,4- and 4,6-branching points. The polysaccharide exhibited significant reticuloendothelial system-potentiating activity in a carbon clearance test, as well as a pronounced anti-complementary activity.

Two acidic polysaccharides having reticuloendothelial system-potentiating activity from the raw root of Rehmannia glutinosa

Two acidic polysaccharides, called rehmannan FS-I and rehmannan FS-II, were isolated from the raw root of Rehmannia glutinosa LIBOSCHITZ. They were homogeneous on electrophoresis and gel chromatography, and their molecular masses were estimated to be 5.8 x 10(4) and 6.6 x 10(4), respectively. Rehamannan FS-I is composed of L-arabinose: D-galactose: L-rhamnose: D-galacturonic acid: D-glucuronic acid in the molar ratio of 68:40:4:84:3; rehmannan FS-II is composed of L-arabinose: D-galactose: L-rhamnose: D-galacturonic acid in the molar ratio of 18:15:4:33, in addition to small amounts of O-acetyl groups. About two-thirds (rehmannan FS-I) and about one half (rehamannan FS-II) of the hexuronic acid residues exist as methyl esters. Methylation analysis of the carboxyl-reduced derivatives and nuclear magnetic resonance studies indicated that their structural features include mainly both arabino-3,6-galactan and rhamno-galacturonan type structural units. Both polysaccharides showed remarkable reticuloendothelial system-potentiating activity in a carbon clearance test.

An acidic polysaccharide with immunological activities from the root of Paeonia lactiflora

An acidic polysaccharide, called peonan PA, was isolated from the root of Paeonia lactiflora PALLAS. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 6.0 x 10(4). Peonan PA is composed of L-arabinose: D-galactose: D-galacturonic acid in the molar ratio of 2:1:10, in addition to small amounts of O-acetyl groups and peptide moieties. About forty percent of the hexuronic acid residues in peonan PA exist as methyl esters. Reduction of carboxyl groups, methylation analysis, lithium degradation and nuclear magnetic resonance studies indicated that its main structural features involve both alpha-1,5-linked L-arabino-beta-3,6-branched D-galactan type and alpha-1,4-linked D-galacturonan type structural units. The polysaccharide exhibited remarkable reticuloendothelial system-potentiating activity in a carbon clearance test and considerable anti-complementary activity.

The core structure of ginsenan PA, a phagocytosis-activating polysaccharide from the root of Panax ginseng

Controlled Smith degradation and limited hydrolysis of ginsenan PA, the main phagocytosis-activating polysaccharide isolated from the root of Panax ginseng C. A. Meyer, were performed. The reticuloendothelial system-potentiating and anti-complementary activities of the degradation products were investigated. Methylation analysis of the primary and secondary Smith degradation products indicated that the core structural features of ginsenan PA include a backbone chain mainly composed of beta-1,3-linked D-galactose. Almost half of the galactose units in the backbone carry side-chains composed of beta-1,6-linked D-galactosyl residues at position 6. Further 3,6-branching of D-galactose units was observed in a part of the side-chains. alpha-L-Arabinose units are connected mainly to the core galactose moieties via position 6. Removal of most of the arabinose units had a considerable effect on immunological activity.

Structural features and anti-complementary activity of rehmannan SA, a polysaccharide from the root of Rehmannia glutinosa

The structural features of rehmannan SA, a polysaccharide with remarkable reticuloendothelial system-potentiating activity obtained from the root of Rehmannia glutinosa, were investigated by methylation analysis and periodate oxidation. Rehmannan SA is mainly made up of arabino-3,6-galactan type structural units. Both rehmannan SA and rehmannan SB showed pronounced anti-complementary activity.

Characterization of a novel heteroglucan from the rhizome of Cnidium officinale exhibiting high reticuloendothelial system-potentiating and anti-complementary activities

A novel beta-heteroglucan, called cnidirhan SIIA, was isolated from the rhizome of Cnidium officinale MAKINO. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was more than 1 x 10(7). It was composed of D-glucose, D-galactose and L-arabinose in the molar ratio of 85:5:8, in addition to small numbers of O-acetyl groups. Methylation analysis and nuclear magnetic resonance studies indicated its main structural features composed of beta-1,6-linked D-glucopyranosyl residues with both 3,6- and 4,6-branching points. In addition, it has both beta-1,4-linked L-arabinopyranosyl and beta-1,6-linked D-galactopyranosyl residues. The polysaccharide showed very pronounced reticuloendothelial system-potentiating activity in a carbon clearance test, as well as a marked anti-complementary activity.

A glucan having reticuloendothelial system-potentiating and anti-complementary activities from the tuber of Pinellia ternata

A glucan, called pinellian G, was isolated from the tuber of Pinellia ternata BREIT. It was homogenous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 1.5 x 10(4). It is composed solely of D-glucose, in addition to a few O-acetyl groups. Methylation analysis, nuclear magnetic resonance and enzymic degradation studies indicated that it is a branched glucan mainly composed of alpha-1,4-linked D-glucopyranose residues with partially alpha-1,3-linked units and 4,6-branching points. The glucan showed significant reticuloendothelial system-potentiating activity in a carbon clearance test, as well as pronounced anti-complementary activity.

Characterization of an acidic polysaccharide having immunological activities from the tuber of Alisma orientale

An acidic polysaccharide, called alisman PII, was isolated from the tuber of Alisma orientale Juzepcz. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 5.25 x 10(4). It is composed of L-arabinose:D-galactose:D-glucuronic acid in the molar ratio of 4:9:2, in addition to some of O-acetyl groups. Reduction of carboxyl groups, methylation analysis, nuclear magnetic resonance and controlled Smith degradation indicated that the core structural features include a backbone chain composed of beta-1,3-linked D-galactose units. Some of the galactose units in the backbone carry beta-D-galactosyl side chains at position 6. Both alpha-1,5-linked L-arabinosyl side chains and terminal beta-D-glucuronic acid residues are linked to the core galactan units. Alisman PII showed significant potentiation of the reticuloendothelial system using a carbon clearance test and also potent anti-complementary activity.

Characterization of a novel glucan, which exhibits reticuloendothelial system-potentiating and anti-complementary activities, from the rhizome of Cnidium officinale

A novel glucan, called cnidirhan SI, was isolated from the rhizome of Cnidium officinale Makino. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 1.3 x 10(4). It is composed of D-glucose alone, in addition to small numbers of O-acetyl groups. Methylation analysis, nuclear magnetic resonance and enzymic degradation studies indicated it has a high-branched glucan type structure composed of alpha-1,4-linked D-glucopyranose residues with both 3,4- and 4,6-branching points. The glucan showed significant reticuloendothelial system-potentiating activity in a carbon clearance test, as well as pronounced anti-complementary activity. This substance is the first example of a branched alpha-glucan with phagocytosis-stimulating and anti-complementary activities.

Characterization of two polysaccharides having activity on the reticuloendothelial system from the root of Rehmannia glutinosa

Two acidic polysaccharides, called rehmannan SA and rehmannan SB, were isolated from the dried root of Rehmannia glutinosa Liboschitz. They were homogeneous on electrophoresis and gel chromatography, and their molecular masses were estimated to be 6.4 x 10(4) and 7.9 x 10(4), respectively. They were commonly composed of L-arabinose:D-galactose:L-rhamnose:D-galacturonic acid in the molar ratios of 10:10:1:1 (rehmannan SA) and 14:7:3:8 (rehmannan SB), in addition to small amounts of peptide moieties. About eighty percent (rehmannan SA) and about thirty percent (rehmannan SB) of the hexuronic acid residues exist as methyl esters. Reduction of carboxyl groups, methylation analysis, nuclear magnetic resonance and the controlled Smith degradation studies indicated the structural features of rehmannan SB, the major one in terms of the yield. It has a core structural unit of a characteristic rhamnose-rich arabino-3,6-galactan type. Both polysaccharides showed remarkable reticulo-endothelial system-potentiating activity in a carbon clearance test.

Characterization of a neutral and an acidic polysaccharide having immunological activities from the root of Paeonia lactiflora

A neutral and an acidic polysaccharide, called peonan SA and peonan SB, were isolated from the root of Paeonia lactiflora Pallas. They were homogeneous on electrophoresis and gel chromatography, and their molecular masses were estimated to be 11.2 x 10(4) and 25.0 x 10(4), respectively. Peonan SA is composed of L-arabinose: D-galactose: D-glucose in the molar ratio of 1:1:28, and peonan SB is composed of L-arabinose: D-galactose: D-galacturonic acid in the molar ratio of 4:3:2, in addition to small amounts of peptide moieties. About forty percent of the hexuronic acid residues in peonan SB exist as methyl esters. Reduction of carboxyl groups, methylation analysis, nuclear magnetic resonance and periodate oxidation studies indicated that their structural features include mainly 3,4- and 4,6-branched alpha-D-glucan type units (peonan SA) and principally alpha-1,5-linked L-arabino-beta-3,6-branched D-galactan type structural units (peonan SB). Both polysaccharides, especially in peonan SB, showed remarkable reticuloendothelial system-potentiating activity in a carbon clearance test and considerable anti-complementary activity.

Characterization of two novel polysaccharides having immunological activities from the root of Panax ginseng

Two acidic polysaccharides, called ginsenan S-IA and ginsenan S-IIA, were isolated from the root of Panax ginseng C. A. Meyer. They were homogeneous on electrophoresis and gel chromatography, and their molecular masses were estimated to be 5.6 x 10(4) and 1.0 x 10(5), respectively. Ginsenan S-IA is composed of L-arabinose: D-galactose: D-galacturonic acid in the molar ratio of 8:8:1, and ginsenan S-IIA is composed of L-arabinose: D-galactose: D-glucose: D-galacturonic acid in the molar ratio of 15:10:2:5, in addition to small amounts of O-acetyl groups. About a half (ginsenan S-IA) and about a quarter (ginsenan S-IIA) of the hexuronic acid residues exist as methyl esters. Reduction of carboxyl groups, methylation analysis, nuclear magnetic resonance and periodate oxidation studies indicated that their structural features include mainly alpha-1,5-linked L-arabino-beta-3,6-branched D-galactan type structural units. Both polysaccharides showed remarkable reticuloendothelial system-potentiating activity in a carbon clearance test and pronounced anti-complementary activity. These substances are the first examples having a relatively high content of both alpha-3,5-branched L-arabinose and beta-1,4-linked D-galactose units among the acidic arabinogalactans with activities on phagocytosis and anti-complement.

Plant mucilages. XLIII. A representative mucilage with biological activity from the leaves of Hibiscus rosa-sinensis

A representative mucilage, called Hibiscus-mucilage RL, was isolated from the leaves of Hibiscus rosa-sinensis L. It was homogeneous on electrophoresis, and its molecular mass was estimated to be roughly 1.0 x 10(7). Its intrinsic viscosity value in aqueous solution was 23.2. The major constituent is an acidic polysaccharide composed of L-rhamnose: D-galactose: D-galacturonic acid: D-glucuronic acid in the molar ratio of 5:8:3:2. Methylation analysis, partial hydrolysis and nuclear magnetic resonance studies indicated its main structural features including a unique backbone chain composed of alpha-1,4-linked D-galactosyl alpha-1,2-linked L-rhamnosyl alpha-1,4-linked D-galacturonic acid units. The mucilage showed considerable anti-complementary activity.

Arabinogalactan core structure and immunological activities of ukonan C, an acidic polysaccharide from the rhizome of Curcuma longa

Controlled Smith degradation of ukonan C, a phagocytosis-activating polysaccharide isolated from the rhizome of Curcuma longa L., was performed. The reticuloendothelial system-potentiating, anti-complementary and alkaline phosphatase-inducing activities of ukonan C and its degradation products were investigated. Methylation analyses of the primary and secondary Smith degradation products and of a de-arabinosylated product indicated that structural features of the arabinogalactan core of ukonan C include a backbone chain composed of beta-1,3-linked D-galactose and beta-1,4-linked D-xylose. All of the galactose units in the backbone carry side chains composed of beta-1,6-linked D-galactosyl residues with or without terminal alpha-L-arabinose units at position 3. Ukonan C showed remarkable effects on both reticuloendothelial system-potentiating and alkaline phosphatase-inducing activities. Periodate oxidation caused a decrease in or disappearance of the immunological activities, but the controlled Smith degradation product having the arabinogalactan core structure of polysaccharide showed a pronounced effect on anti-complementary activity.

Determination of acidic saponins in crude drugs by high-performance liquid chromatography on octadecylsilyl porous glass

High-performance liquid chromatographic (HPLC) analysis on octadecylsilyl porous glass was investigated for acidic saponins in ginseng, bupleurum root and senega. The acidic saponins, malonyl-ginsenosides, malonyl-saikosaponins and senegins, as well as neutral saponins in the crude drugs were separated rapidly by HPLC on this column with aqueous acetonitrile containing KH2PO4 as the mobile phase at room temperature.

Characterization of two acidic polysaccharides having immunological activities from the root of Panax ginseng

Two acidic polysaccharides, named ginsenan PA and ginsenan PB, were isolated from the root of Panax ginseng C. A. Meyer. They were homogeneous on electrophoresis and gel chromatography, and their molecular masses were estimated to be 1.6 x 10(5) and 5.5 x 10(4), respectively. They are composed of L-arabinose: D-galactose: L-rhamnose: D-galacturonic acid: D-glucuronic acid in the molar ratios of 11:22:1:6:1 (ginsenan PA) and 3:7:2:8:1 (ginsenan PB), in addition to small amounts of O-acetyl groups. Almost all (ginsenan PA) and part (ginsenan PB) of the hexuronic acid residues exist as methyl esters. Reduction of carboxyl groups, methylation analysis, nuclear magnetic resonance and periodate oxidation studies indicated that their structural features include mainly both alpha-arabino-beta-3,6-galactan type and rhamnogalacturonan type structural units. Both polysaccharides showed remarkable reticuloendothelial system-potentiating activity in a carbon clearance test, pronounced anti-complementary activity and alkaline phosphatase-inducing activity in a dose dependent manner.

An acidic polysaccharide having immunological activities from the rhizome of Cnidium officinale

An acidic polysaccharide, designated as cnidirhan AG, was isolated from the rhizomes of Cnidium officinale Makino. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 5.1 x 10(4). It showed pronounced reticuloendothelial system-potentiating activity in a carbon clearance test, and had a remarkable effect on both anti-complementary and alkaline phosphatase-inducing activities. It is composed of L-arabinose: D-galactose: D-glucuronic acid in the molar ratio of 2:6:1, in addition to small amounts of O-acetyl groups. Methylation analysis, carbon-13 nuclear magnetic resonance, controlled Smith degradation and limited acid hydrolysis indicated that the core structural features of cnidirhan AG include a backbone chain composed of beta-1,3-linked D-galactose residues. Some of the galactose units in the backbone carry beta-D-galactosyl side chains at position 6. Both alpha-L-arabinosyl arabinose side chains and terminal beta-D-glucuronic acid residues are linked to the core galactan units.

Core structure of glycyrrhizan GA, the main polysaccharide from the stolon of Glycyrrhiza glabra var. glandulifera; anti-complementary and alkaline phosphatase-inducing activities of the polysaccharide and its degradation products

The controlled Smith degradation and limited hydrolysis of glycyrrhizan GA, a representative polysaccharide with remarkable phagocytosis-enhancing activity isolated from the stolon of Glycyrrhiza glabra L. var. glandulifera Reg. et Herd. were carried out. Methylation analyses of the primary and the secondary Smith degradation products and of the limited hydrolysis product indicated that the core structural features of glycyrrhizan GA include a backbone chain composed of beta-1,3-linked D-galactose residues. Three-fifths of the galactose units in the backbone carry side chains composed of beta-1,3- and beta-1,6-linked D-galactosyl residues at position 6. Anti-complementary and alkaline phosphatase-inducing activities of the polysaccharide, periodate oxidation-reduction and the controlled Smith degradation products were investigated, and the controlled Smith degradation product showed significant activity.

The core structure and immunological activities of glycyrrhizan UA, the main polysaccharide from the root of Glycyrrhiza uralensis

The controlled Smith degradation and limited hydrolysis of glycyrrhizan UA, the main phagocytosis-activating polysaccharide isolated from the root of Glycyrrhiza uralensis FISCHER, was performed. The reticuloendothelial system-potentiating, anti-complementary and alkaline phosphatase-inducing activities of glycyrrhizan UA and its degradation products were investigated. Methylation analyses of primary, secondary and tertiary Smith degradation products and of the limited hydrolysis product indicated that the core structural features of glycyrrhizan UA include a backbone chain composed of beta-1,3-linked D-galactose. All of the galactose units in the backbone carry side chains composed of mainly alpha-1,5-linked L-arabino-beta-1,6- or 1,3-linked D-galactose residues at position 6. Removal of the arabinosyl side chains caused a pronounced decrease in immunological activity.

Constituents of the seed of Malva verticillata. VIII. Smith degradation of MVS-VI, the major acidic polysaccharide, and anti-complementary activity of products

The controlled Smith degradation of MVS-VI, the major acidic polysaccharide having remarkable anti-complementary activity isolated from the seeds of Malva verticillata L., was performed. Methylation analysis of both the primary and the secondary Smith degradation products indicated that the core structural features of MVS-VI include a backbone chain composed of beta-1,3-linked D-galactose residues. The majority of galactose units in the backbone carry side chains composed of beta-1,3- and beta-1,6-linked D-galactosyl residues at position 6. The controlled Smith degradation products showed considerable anti-complementary activity.