Analgesic benefits and clinical role of the posterior suprascapular nerve block in shoulder surgery: a systematic review, meta-analysis and trial sequential analysis

The posterior suprascapular nerve block has been proposed as an analgesic alternative for shoulder surgery based on the publication of several comparisons with interscalene block that failed to detect differences in analgesic outcomes. However, quantification of the absolute treatment effect of suprascapular nerve block on its own, in comparison with no block (control), to corroborate the aforementioned conclusions has been lacking. This study examines the absolute analgesic efficacy of suprascapular nerve block compared with control for shoulder surgery. We systematically sought electronic databases for studies comparing suprascapular nerve block with control. The primary outcomes included postoperative 24-h cumulative oral morphine consumption and the difference in area under the curve for 24-h pooled pain scores. Secondary outcomes included the incidence of opioid-related side-effects (postoperative nausea and vomiting) and patient satisfaction. Data were pooled using random-effects modelling. Ten studies (700 patients) were analysed; all studies examined landmark-guided posterior suprascapular nerve block performed in the suprascapular fossa. Suprascapular nerve block was statistically but not clinically superior to control for postoperative 24-h cumulative oral morphine consumption, with a weighted mean difference (99%CI) of 11.41 mg (-21.28 to -1.54; p = 0.003). Suprascapular nerve block was also statistically but not clinically superior to control for area under the curve of pain scores, with a mean difference of 1.01 cm.h. Nonetheless, suprascapular nerve block reduced the odds of postoperative nausea and vomiting and improved patient satisfaction. This review suggests that the landmark-guided posterior suprascapular nerve block does not provide clinically important analgesic benefits for shoulder surgery. Investigation of other interscalene block alternatives is warranted.

Cancer cell death induced by novel small molecules degrading the TACC3 protein via the ubiquitin-proteasome pathway

The selective degradation of target proteins with small molecules is a novel approach to the treatment of various diseases, including cancer. We have developed a protein knockdown system with a series of hybrid small compounds that induce the selective degradation of target proteins via the ubiquitin–proteasome pathway. In this study, we designed and synthesized novel small molecules called SNIPER(TACC3)s, which target the spindle regulatory protein transforming acidic coiled-coil-3 (TACC3). SNIPER(TACC3)s induce poly-ubiquitylation and proteasomal degradation of TACC3 and reduce the TACC3 protein level in cells. Mechanistic analysis indicated that the ubiquitin ligase APC/C^CDH1 mediates the SNIPER(TACC3)-induced degradation of TACC3. Intriguingly, SNIPER(TACC3) selectively induced cell death in cancer cells expressing a larger amount of TACC3 protein than normal cells. These results suggest that protein knockdown of TACC3 by SNIPER(TACC3) is a potential strategy for treating cancers overexpressing the TACC3 protein.

P2-09-13: The Value of FDG PET/CT in Screening Detected Breast Cancer Patients

Background. To evaluate the diagnostic value of FDG PET/CT for initial staging of screening detected breast cancer.

Methods. Between January 2008 and June 2010, a total of 77 women (mean age 54 years, range 31–77 years) with screening detected primary breast cancer (mean invasive tumor size 1.65cm, range 1–70mm) underwent whole body fluorine-18 fluorodeoxyglucose (FDG) PET/CT for initial staging and were included in this retrospective study. Two patients had bilateral breast cancer. The sensitivity of FDG PET/CT for the detection of primary tumor and the sensitivity, specificity, PPV and NPV for the detection of axillary lymph node metastases were determined. Systemic staging with whole body FDG PET/CT was also performed. For analysis of diagnostic performance of FDG PET/CT, quantitative measurement of the maximum standardized uptake value (SUVmax) criteria 1.0 was used. The final histopathology following surgery served as the gold standard.

Results. The primary tumor was FDG PET/CT positive in 65 of 79 lesions (82%). Depending on the tumor size, there was a variation in diagnostic sensitivity (63% in ≤ 1cm tumor, n=19 vs. 88% in > 1cm tumor, n=60) and the uptake of FDG was significantly higher in > 1cm tumor than in ≤ 1cm tumor (mean SUVmax 2.85 vs. 1.11, p<0.05). The uptake of FDG was significantly higher in ductal carcinomas compared to lobular carcinomas (median SUVmax 2.0, n=72 vs. 1.3, n=7, p<0.05). Of the 77 patients included in this study, 16 patients were found to have axillary node metastasis. The sensitivity, specificity, PPV and NPV of FDG PET/CT for detection of LN metastasis were 63% (10/16), 89% (54/61), 59% (10/17) and 90% (54/60), respectively. FDG PET/CT showed distant uptake in 9 patients and 8 of 9 were false positive results. 4 lesions were confirmed histopathologically as benign and 4 lesions were evaluated with radiologic methods. One of nine was true positive result. Distant involvement was skeletal and visible on the conventional bone scintigraphy. The patient staged as cT1N3M1.

Conclusion. FDG PET/CT has limited value for the initial staging of screening detected breast cancer patients. Considering high costs, radiation exposure and false positivity, FDG PET-CT is not recommended for the preoperative evaluation of screening detected breast cancer patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-09-13.

P2-08-12: Additional Lesion Found in Preoperative Breast MRI; Is Routine Use Justified?

Preoperative breast MRI has been increasingly performed in patients with newly diagnosed breast cancer due to its high sensitivity in assessing the extent and additional malignant foci. But due to it's low specificity, role of routine preoperative breast MRI has become an issue. In this study we aught to analyze the characteristics of the additional lesion found in preoperative breast MRI and to evaluate the clinicopathological factors in association with likelihood of having additional malignancy.

We retrospectively reviewed 2491 patients who undergone surgery due to breast cancer in Seoul National University Hospital(SNUH) between Jan 2006 and Dec 2010. Neoadjuvant chemotherapy cases, patients undergone initial sonography in other center or ones with prior excision were excluded and total 1068 patients were analyzed. The additional lesion was defined as the lesion not found in initial sonography and detected in preoperative breast MRI. The pathology of the additional lesion was reviewed and the association between the clinicopathologic factors and additional malignancy were evaluated. Accuracy of breast MRI was estimated regarding cancer yield, positive predictive value(PPV).

Mean age at diagnosis was 50.9 years (21 to 85 years). Overall detection rate of additional lesion was 26.2%(280 out of 1068). Mean size of the additional lesion was 9.8mm(3-51). Additional lesions consist of 99(35.4% of 280) C4 or higher, 174(62.1% of 280) below C4, 7(2.5% of 280) C0 lesions. Among them 100 patients undergone onstage surgery. 5(55% of 100) lesions were in ipsilateral breast and 45(45% of 100) in contralateral breast. Breast conserving surgery and mastectomy rate of the 100 onstage-operation group was 36% versus 64% and 64.6% versus 35.4% in total 1068 patients, showing no significant change of operation method of the primary cancer owing to additional lesion.

Among the 100 patients, 54(19.3% of 280) were benign, 3(1.1% of 280) were atypical ductal hyperplasia, 13(4.6% of 280) were in situ carcinoma, 19(6.8% of 280) were invasive carcinoma and 11(3.9% of 280) were unknown. Cancer yield was 2.99%(32 out of 1068) and PPV of preoperative breast MRI was 39.0%(31 out of 82).

In univariate analysis, young age and premenopausal patients showed to have higher rate of additional cancer found in MRI(p=0.022, p=0.036). Breast density, size and LN status of the primary cancer didn't show significancy and neither the hormone receptor status with each p value 0.705, 0.381, 0.973, 0.375 respectively. Lobular carcinoma(ILC or mixed IDC with ILC) and low grade carcinoma showed significancy of having additional malignancy (p=0.019, 0.022). In multivariate analysis age, low grade carcinoma and lobular carcinoma showed independent association with p value 0.014, 0.039, 0.035 respectively(HR 0.95, 95%CI:0.94 o 0.99),(HR 0.39, 95%CI:0.16 to 0.96),(HR 5.66, 95%CI:1.13 to 28.39).

Routine preoperative breast MRI use can result in overtreatment also with delay in surgical management. In our data, younger age, low grade carcinoma, lobular carcinoma showed independent association having additional malignant foci in breast MRI. With the basis of mammography and sonography, preoperative breast MRI should only be done when additional gain is considered to overcome the flaws.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-12.

Abstract P2-09-36: Role of ABCB1 Polymorphisms as Predictive Markers in Patients with HER-2 FISH Positive Metastatic Breast Cancer Who Were Treated with Taxane Plus Trastuzumab First Line Chemotherapy

Background: ABCB1 polymorphisms could predict treatment results of taxane therapy in several malignancies. FCGR2A and FCGR3A polymorphisms were associated with clinical outcomes in several diseases after treatment with monoclonal antibody drugs which had antibody-dependent cell-mediated cytotoxicity activity. These polymorphisms could be possible predictive markers after taxane plus trastuzumab (TH) chemotherapy in patients with HER-2-positive metastatic breast cancer (MBC).

Methods: Fifty-seven patients with HER-2 FISH positive MBC who received TH chemotherapy as the 1st-line treatment were enrolled. We analyzed 5 polymorphisms using DNA from peripheral blood mononuclear cells: ABCB1 1236C>T (rs1128503), ABCB1 2677G>T/A (rs2032582), ABCB1 3435C>T (rs1045642), FCGR2A 131H/R (rs1801274), and FCGR3A 158V/F (rs396991), then correlated them to treatment results of patients.

Results: Among 57 patients, 22 patients (38.6%) received weekly paclitaxel plus trastuzumab, 26 patients (45.6%) tri-weekly paclitaxel plus trastuzumab, and 9 patients (15.8%) tri-weekly docetaxel plus trastuzumab. After a median follow-up of 30.6 (range, 0.6-75.9) months, median progression-free survival (PFS) was 15.1 (95% confidence interval (CI), 10.3-19.8) months. ABCB1 2677T allele carriers had longer PFS than the others (42.1 (95% CI, 12.7-71.4) months vs. 13.0 (95% CI, 10.6-15.4) months; p=0.037) along with a tendency toward higher response rate (RR) (86.4% vs. 76.0%; p=0.470) and longer overall survival (OS) (54.7 (95% CI, 43.0-66.4) months vs. 38.9 (95% CI, 18.1-59.7) months; p=0.057). In addition, ABCB1 3435CC genotype carriers had shorter PFS than the others (13.0 (95% CI, 10.8-15.2) months vs. 19.1 (95% CI, 0.0-38.5) months; p=0.039) along with a tendency toward lower RR (78.6% vs. 100%; p=0.567) and shorter OS (38.9 (95% CI, 19.7-58.1) months vs. 54.7 (95% CI, 43.0-66.4) months; p=0.093). ABCB1 1236C>T, FCGR2A 131H/R, and FCGR3A 158V/F were not significantly associated with RR, PFS, and OS. None of these polymorphisms were associated with any grades of hematologic or cardiac toxicities.

Conclusions: Our results support that ABCB1 2677G>T/A and 3435C>T may have predictive roles after the 1st-line TH chemotherapy in patients with HER-2-positive MBC. In contrast, ABCB1 1236C>T, FCGR2A 131H/R, and FCGR3A 158V/F could not predict response after TH treatment.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-36.

Single Nucleotide Polymorphism (SNP) in RASSF1 and Clinical Outcomes of Breast Cancer Patients Treated with Neoadjuvant Docetaxel/Doxorubicin Chemotherapy

PurposeThe tumor suppressor gene RASSF1 (Ras association domain family member 1) regulates cell cycle, progression, apoptosis, and microtubule stability, and is inactivated by promoter hypermethylation in breast cancer. We analyzed the SNPs in RASSF1 and their predictive and prognostic value in stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapyMethodsA total of 139 stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. The patients received three cycles of neoadjuvant chemotherapy followed by curative surgery, and received additional three cycles of docetaxel/doxorubicin chemotherapy as an adjuvant. Germline DNA from peripheral blood mononuclear cells was extracted. The genotypes were performed using Illumina GoldenGate® Assay. We analyzed 3 SNPs in RASSF1 genes: rs3213621 T>C in 3'UTR, rs2073499 G>A in intron, and rs2073498 C>A in exon 3 Ala133Ser.ResultsThe overall radiologic response rate (RR) for neoadjuvant chemotherapy was 79.8% and 10 patients (7.2%) achieved a pathologic complete remission (pCR). None of the SNPs were correlated with radiologic RR or pCR rate. SNP in intron of RASSF1 (rs2073499) was associated with relapse free survival (RFS). RFS was longer in GA/AA genotype than GG genotype (Hazard ratio [HR]=0.374, p=0.034) After adjusting age and hormone status, prognostic value of RASSF1 SNP remained significant (HR=0.393, p=0.050). Other two SNPs were not significantly associated with RFS.ConclusionsThe GA/AA genotype in SNP of RASSF1 (rs2073499) is associated with significantly longer RFS than the GG genotype. Further research is warranted to identify the biologic characteristics of RASSF1.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6061.

Caregiver's burden, depression and support as predictors of post-stroke depression: a cross-sectional survey

To examine the effects of caregiver's burden, depression, and support on post-stroke depression (PSD), cross-sectional data were obtained from an epidemiologic survey of 225 stroke survivors and their caregivers living in Seoul, Korea. Multivariate analyses showed that, taking the clinical status of patients into account, caregiver's burden, depression and support were related to higher PSD. Perceived burden exerts adverse effects on PSD through its influence on the depression in caregivers. Hence, the care of stroke survivors that incorporates the care of caregivers is likely to reduce the risk of post-stroke depression in patients.

Effect of PK11195, a peripheral benzodiazepine receptor agonist, on insulinoma cell death and insulin secretion

Functional role of peripheral benzodiazepine receptor on mitochondrial membrane in apoptosis and insulin secretion from insulinoma cells was studied. A prototypic peripheral benzodiazepine receptor agonist PK11195 induced insulinoma cell apoptosis, while a central benzodiazepine receptor agonist did not. Death of insulinoma cells by PK11195 was inhibited by cyclosporin A, a blocker of mitochondrial permeability transition pore. Caspase inhibitors further inhibited MIN6N8 cell death. PK11195 induced dissipation of mitochondrial potential and cytochrome c translocation to cytoplasm. PK11195 induced an increase in cytoplasmic [Ca(2+)], which was reversed by cyclosporin A. Rhod-2 staining showed decreased mitochondrial [Ca(2+)] after PK11195 treatment. PK11195 potentiated glucose-induced insulin secretion probably due to the increased cytoplasmic [Ca(2+)]. Calpain was activated following Ca(2+) release, and calpain inhibitors attenuated death of insulinoma cells by PK11195. These results suggest that PK11195 induces mitochondrial potential loss, cytochrome c translocation, increased insulin secretion in conjunction with an increase in cytoplasmic [Ca(2+)] and calpain activation, which collectively leads to apoptosis of insulinoma cells.

Migrated foreign body granulomas on mammography after injection in the cervicofacial area

AIM

The purpose of this study was to describe the mammographic findings of localized foreign body granulomas in women who were injected with a foreign body in the cervicofacial area to flatten wrinkles.

MATERIALS AND METHODS

The teaching files of our institutions were searched, and nine mammograms of migrated foreign body granulomas located. The mammograms were analysed, including the location, shape, size, distribution and depth of the high-density nodules. All these cases had undergone sonography.

RESULTS

The migrated foreign body granulomas appeared bilateral (n = 6) or unilateral (n = 3), as oval or round high-density nodules, in the upper inner and/or upper central locations. The average size of the lesions was less than 5 mm in all cases. All nine sonograms showed multiple, round cystic nodules, less than 5 mm in size, with strong posterior shadowing from far upper central to the upper inner breast. Sonography of the lower neck revealed the anatomy could not be visualized due to the strong posterior shadowing in the skin and subcutaneous fat layer.

CONCLUSION

Migrated foreign body granulomas appeared on mammograms as localized, multiple oval or round high-density nodules, less than 0.5 cm in size, in the upper inner and/or upper central breast. Breast sonography, including the sonography of the suspected cervicofacial area, is helpful in verifying migrated foreign body granulomas.

Pyruvate inhibits zinc-mediated pancreatic islet cell death and diabetes

AIMS/HYPOTHESIS

We have shown that zinc ion (Zn2+) in secretory granules of pancreatic beta cells could act as a paracrine death effector in streptozotocin-induced diabetes. As Zn2+ has been reported to perturb glycolysis, we studied if pyruvate could inhibit Zn(2+)-mediated islet cell death in vitro and streptozotocin-induced diabetes in vivo by normalizing intracellular energy metabolism.

METHODS

Cell death was measured by quantitative viable cell staining and Hoechst/propidium iodide staining. ATP was measured by bioluminescence determination. Pyruvate was infused through the tail vein 1 h before streptozotocin administration. Beta-cell volume was measured by point counting of the insulin-containing cells.

RESULTS

Zn2+ induced classical necrosis on MIN6N8 insulinoma cells which was associated with a rapid decline of intracellular ATP levels. Pyruvate inhibited Zn(2+)-induced necrosis of insulinoma cells and depletion of intracellular ATP by Zn2+. Pyruvate did not inhibit other types of necrosis or apoptosis. Energy substrates such as oxaloacetate, alpha-ketoglutarate and succinic acid dimethylester also attenuated Zn(2+)-induced insulinoma cell death. Methylpyruvate that does not generate NAD+ in the cytoplasm or alpha-ketoisocaproate that stimulates ATP generation exclusively in mitochondria also protected insulinoma cells from Zn(2+)-induced necrosis. Pyruvate infusion inhibited the development of diabetes by protecting beta-cell mass after streptozotocin administration.

CONCLUSION/INTERPRETATION

These results indicate that pyruvate inhibits Zn(2+)-induced necrosis of beta cells in vitro by protecting intracellular ATP levels and also streptozotocin-induced diabetes in vivo where Zn2+ has been reported to act as a paracrine death effector.

Dual role of inflammatory stimuli in activation-induced cell death of mouse microglial cells. Initiation of two separate apoptotic pathways via induction of interferon regulatory factor-1 and caspase-11

We have previously shown that mouse microglial cells undergo apoptosis upon inflammatory activation and that nitric oxide (NO) is the major autocrine mediator in this process (Lee, P., Lee, J., Kim, S., Yagita, H., Lee, M. S., Kim, S. Y., Kim, H., and Suk, K. (2001) Brain Res. 892, 380-385). Here, we present evidence that interferon regulatory factor-1 (IRF-1) and caspase-11 are the essential molecules in activation-induced cell death of microglial cells. The apoptogenic action of inflammatory stimuli such as lipopolysaccharide (LPS) and interferon-gamma (IFNgamma) was mediated through the induction of IRF-1 and caspase-11 expression in two separate events. Although IRF-1 was required for NO synthesis, caspase-11 induction was necessary for NO-independent apoptotic pathway. Microglial cells from IRF-1-deficient mice showed markedly decreased NO production, and they were partially resistant to apoptosis in response to LPS/IFNgamma but were sensitive to NO donor exposure. LPS/IFNgamma treatment resulted in the induction of caspase-11 followed by activation of caspase-11, -1, and -3. Inactivation of caspase-11 by the transfection of dominant-negative mutant or treatment with the caspase inhibitors rendered microglial cells partially resistant to LPS/IFNgamma-induced apoptosis. Inhibition of both NO synthesis and caspase-11 completely blocked LPS/IFNgamma-induced cytotoxicity. These results indicated that LPS/IFNgamma not only induced the production of cytotoxic NO through IRF-1 but also initiated the NO-independent apoptotic pathway through the induction of caspase-11 expression.

Radiologic findings of Behçet syndrome involving the gastrointestinal tract

Behçet syndrome is characterized by the histopathologic finding of nonspecific vasculitis in multiple organs. The diagnosis is usually made on the basis of the combination of clinical signs and symptoms. This disease involves the gastrointestinal tract in 10%-50% of patients, and the terminal ileum and cecum are chiefly affected. Barium study is useful in demonstrating the characteristic radiographic features of Behçet syndrome involving the gastrointestinal tract. The presence of deep, penetrating ulcers results in a high rate of complications, such as perforation, fistula, hemorrhage, and peritonitis. Furthermore, recurrence of disease adjacent to or at the surgical anastomosis is common. Computed tomography is useful in determining the extent of the lesions and in identifying cases in which complications are likely to occur. Familiarity with the various radiologic findings of Behçet syndrome involving the gastrointestinal tract helps in making an early diagnosis, as well as in establishing an appropriate treatment strategy.

Layer-specific intracolumnar and transcolumnar functional connectivity of layer V pyramidal cells in rat barrel cortex

Layer V pyramidal cells in rat barrel cortex are considered to play an important role in intracolumnar and transcolumnar signal processing. However, the precise circuitry mediating this processing is still incompletely understood. Here we obtained detailed maps of excitatory and inhibitory synaptic inputs onto the two major layer V pyramidal cell subtypes, intrinsically burst spiking (IB) and regular spiking (RS) cells, using a combination of caged glutamate photolysis, whole-cell patch-clamp recording, and three-dimensional reconstruction of biocytin-labeled cells. To excite presynaptic neurons with laminar specificity, the release of caged glutamate was calibrated and restricted to small areas of 50 x 50 microm in all cortical layers and in at least two neighboring barrel-related columns. IB cells received intracolumnar excitatory input from all layers, with the largest EPSP amplitudes originating from neurons in layers IV and VI. Prominent transcolumnar excitatory inputs were provided by presynaptic neurons also located in layers IV, V, and VI of neighboring columns. Inhibitory inputs were rare. In contrast, RS cells received distinct intracolumnar inhibitory inputs, especially from layers II/III and V. Intracolumnar excitatory inputs to RS cells were prominent from layers II-V, but relatively weak from layer VI. Conspicuous transcolumnar excitatory inputs could be evoked solely in layers IV and V. Our results show that layer V pyramidal cells are synaptically driven by presynaptic neurons located in every layer of the barrel cortex. RS cells seem to be preferentially involved in intracolumnar signal processing, whereas IB cells effectively integrate excitatory inputs across several columns.

The DNA replication-related element (DRE)-DRE-binding factor (DREF) system may be involved in the expression of the Drosophila melanogaster TBP gene

The TATA box binding protein (TBP) is a general transcription factor required for initiation by all three eukaryotic RNA polymerases. Previously, we found that the promoter region of the Drosophila melanogaster TBP gene contains three sequences similar to the DNA replication-related element (DRE) (5'-TATCGATA). In the present study, we found that the DRE-like sequences are also present in the promoter of the Drosophila virilis TBP gene, suggesting a role for these sequences in TBP expression. Band mobility shift assays revealed that oligonucleotides containing sequences similar to the DRE of D. melanogaster TBP gene promoter form specific complexes with a factor in a Kc cell nuclear extract and with recombinant DRE-binding factor (DREF). Furthermore, these complexes were either supershifted or diminished by monoclonal antibodies to DREF. Transient luciferase assays demonstrated that induction of mutations in two DRE-related sequences at positions -223 and -63 resulted in an extensive reduction of promoter activity. Thus, the DRE-DREF system appears to be involved in the expression of the D. melanogaster TBP gene.

[A study of the guideline of case management for persons with mental disorders analyzed with fidelity index. The conditions of effective implementation]

OBJECTIVE

The present study examines the condition of effective case management based on the guideline of case management for persons with mental disorders.

METHODS

A total of 295 clients were admitted to a case management trial for about 2 months. A fidelity index of program implementation and outcome measures of case management were developed. The relationship between implementation of critical program components measured by fidelity index, and outcome was analyzed.

RESULTS

Fidelity Index was significantly correlated with outcome measures of clients, staffs and the care system. Effective but not-easily-feasible elements of program were having case-conference, application, of informal support and development of services.

CONCLUSION

It is necessary to facilitate application of informal support with liaison with public health nurses, to standardize case-conference and to place development of care services in the core of programs for ensuring effective implementation of case management for persons with mental disorders in Japan.

An element with palindromic structure is required for the expression of TBP (TATA box-binding protein) gene in Drosophila melanogaster

Previously we showed that the 5'-flanking regions between -261 and -207 of the Drosophila melanogaster TBP (TATA box binding protein) gene is important for its expression. We further made serial deletion mutants in this region and analyzed their promoter activities using the transient transfection assay. We found that the 16 bp deletion from -261 to -245 greatly reduces the promoter activity of the Drosophila TBP gene. The 16 bp DNA element contains half of a 11 bp long palindromic sequence, CTTTT-GAAAAG. Disruption of the palindromic sequence by site-directed mutagenesis severely affected promoter activity. In addition, the electrophoretic mobility shift assay showed that the oligonucleotide containing the palindromic sequence can make specific DNA/protein complexes when it was mixed with the Drosophila nuclear extract, suggesting that it interacts with nuclear protein(s). Our data suggest that the palindromic sequence has a critical role in the expression of the Drosophila TBP gene.

Stereotactic radiosurgery for brain metastases using a linac system: evaluation of initial local response by imaging

PURPOSE

We analyzed the efficacy of initial local response of MBT by imaging obtained within two months after treatment, to determine if there are factors that may be important for the initial local response of the disease. If an earlier local tumor response can be expected from SRS, patients with a poor prognosis should be treated with this modality.

METHODS

Thirty-six patients with 59 lesions were treated by linac radiosurgery. The primary tumor, peripheral dose, tumor volume, and CT enhancement pattern of the tumor before treatment (homogeneous or ring-enhancing) were chosen as factors related to local tumor response and were used in the statistical analysis.

RESULTS

1) The initial local response of radiation-resistant tumors to conventional EBRT was worse than that of other tumors. The initial local responses of MBT from breast carcinoma, colon carcinoma, and pulmonary carcinoma were good. 2) Excluding radioresistant tumors, the cases irradiated at 25 Gy or more tended to show good local control. 3) No statistically significant differences were found between local response and factors such as the enhancement pattern and tumor volume in the analysis of MBT.

Anatomical reconstruction of the patellar tendon: a new technique with hamstring tendons and iliotibial tract

A new technique of patellar tendon reconstruction was performed in a patient who lost tendon and tibial tuberosity during wide excision surgery for a malignancy. In this procedure, the tendon was anatomically replaced by a graft composed of ipsilateral hamstring tendons and iliotibial tract, with the biomechanical conditions considered. Both ends of the graft were secured in the size-matched bone tunnels in the patella and tibia by screw post fixation, which is a technique established in ligament reconstruction surgery in the knee joint. At the twenty-month follow-up, the result was deemed successful.

Surface interactions of a homologous series of alpha,omega-amino acids on colloidal silver and gold

Surface enhanced Raman spectroscopy (SERS) was used to characterize a homologous series of alpha,omega-amino acids on colloidal gold and silver. Raman and SER spectra of the alpha,omega-amino acids, NH2(CH2)nCOOH (n = 3-7), are presented and analyzed, revealing the probable conformations of the molecules on the metal surfaces. The alpha,omega-amino acids interact with silver and gold through both the amine and carboxylate end groups, and modify the conformation of the molecular backbone in order to maximize these interactions. An odd-even effect is observed for backbone conformations of molecules adsorbed to the silver substrate. The anomolous SER spectrum of 5-aminopentanoic acid on gold suggests the possibility of condensation polymerization at the gold surface.

Promoter analysis of the Drosophila genes encoding TFIIB and TATA box-binding protein

We have analyzed the 5'-flanking regions of the Drosophila genes encoding the TFIIB and TATA box-binding proteins (TBP) and mapped the regulatory regions required for their efficient expression. We found that the 500 bp long region (-439 to +60) and the 401 bp long region (-261 to +138) are required for the efficient expression of TFIIB and TBP genes, respectively. In the TFIIB promoter region, the upstream DNA between -439 and -280 and the downstream DNA between +8 and +60 are necessary for the stimulation of promoter activity. The upstream DNA between -439 and -280 stimulates transcription in an orientation dependent manner. In the TBP promoter region, the upstream DNA between -261 and -207, and the downstream DNA between +15 and +138 are necessary for the stimulation of promoter activity. The upstream DNA (-261 to -207) required for TBP promoter activity contains a 11 bp long palindromic sequence and a DNA replication-related element sequence. Particularly, we could find that the downstream promoter regions of TFIIB and TBP genes contain the conserved nucleotide sequences, suggesting the presence of a common regulatory mechanism for the expression of these two genes.

Acute cholecystitis: comparison of MR cholangiography and US

PURPOSE

To evaluate the clinical usefulness of magnetic resonance (MR) cholangiography in the assessment of acute cholecystitis by comparing the diagnostic accuracy of MR cholangiography with that of ultrasonography (US).

MATERIALS AND METHODS

Thirty-five patients with symptoms of acute cholecystitis underwent both US and MR cholangiography before cholecystectomy, which helped confirm acute cholecystitis. Two reviewers evaluated US and MR cholangiographic images for evidence of calculi and gallbladder wall thickening and compared these findings with surgical findings.

RESULTS

MR cholangiography depicted all 21 (100%) calculi and one false-positive calculus in the cystic duct and gallbladder neck, but US depicted only one (14%) of seven cystic duct calculi and 12 (86%) of 14 gallbladder neck calculi. In the diagnosis of cystic duct obstruction, MR cholangiography had a sensitivity of 100%, a specificity of 93%, and an accuracy of 97%. US had a sensitivity of 62%, a specificity of 100%, and an accuracy of 77%. In the diagnosis of gallbladder wall thickening, MR cholangiography had a sensitivity of 69%, a specificity of 83%, and an accuracy of 71%. US had a sensitivity of 96%, a specificity of 83%, and an accuracy of 94%.

CONCLUSION

In the assessment of acute cholecystitis, US is superior to MR cholangiography in the evaluation of gallbladder wall thickening. However, MR cholangiography is superior to US in the depiction of cystic duct and gallbladder neck calculi at the evaluation of cystic duct obstruction.

Thieno[2,3-d]pyrimidine-3-acetic acids. A new class of nonpeptide endothelin receptor antagonists

On the basis of structural information for the cyclic hexapeptide endothelin (ET) receptor antagonist, TAK-044, a series of thieno[2,3-d]pyrimidine-2,4-dione derivatives bearing a carboxyl group and aromatic rings that were important for receptor binding were designed, synthesized, and evaluated for ET receptor binding affinities and inhibitory activities against ET-induced vasoconstriction. Optimization of each substituent in the thieno[2,3-d]pyrimidine ring led to the discovery of a novel and potent nonpeptide ET receptor antagonist, 6-(4-methoxymethoxyphenyl)-5-methylsulfonylaminomethyl-1-(2- methylthiobenzyl)-2,4-dioxo-1,2,3,4-tetrahydrothieno[2,3-d]p yrimidine-3- acetic acid (32 g), which binded to human ETA and ETB receptor subtypes with affinities (IC50) of 7.6 and 100 nM, respectively. Compound 32 g effectively antagonized ET-induced vasoconstriction and the inhibitory effect mediated by the ETB receptor was more potent than that of bosentan, while the inhibitory effect mediated by the ETA receptor was slightly less potent than that of bosentan.

Capsaicin-responsive NADH oxidase activities from urine of cancer patients

NADH oxidases of low specific activities from urine of cancer patients were found to be inhibited or stimulated by the vanilloid capsaicin (8-methyl-N-vanillyl-6-noneamide). Similar activities, inhibited or stimulated by capsaicin, were reported previously for sera of cancer patients but not for sera of normal volunteers or for patients with disorders other than cancer. Like those from sera, the activities from urine were resistant to heat and to digestion with proteinase K. Two different fractions with capsaicin-responsive NADH oxidase activities were obtained by FPLC. One fraction in which the 33-kDa band was the major component exhibited NADH oxidase activity stimulated by capsaicin. Another fraction in which 66-kDa and 45-kDa bands were major components exhibited NADH oxidase activities inhibited by capsaicin. A monoclonal antibody generated to a ca 34-kDa form of the NADH oxidase from sera reacted with a urine protein of a ca 33-kDa band in the capsaicin-stimulated fraction. The 33-kDa protein was of low abundance and was estimated to be present in amounts between 5 and 100 microgram/L, depending on the particular patient.

Analysis of the structure and expression fo the TFIIB gene in Drosophila melanogaster

We have isolated and characterized a genomic clone encoding the Drosophila melanogaster transcription factor IIB (TFIIB). The coding region of the TFIIB gene is interrupted by three short introns. The 5'-flanking region of the gene lacks the typical TATA box sequence like those of other known genes encoding the general transcription factors. In addition, the 5'-flanking region of the gene contains several common DNA sequences present in Drosophila TBP and TFIIS genes, suggesting the common regulation mechanism of gene expression. RNA blot analysis revealed that the gene expresses 1.6 kb, 1.3 kb and 1.2 kb mRNAs throughout development and in adults. Deletion analysis of the promoter region shows that the minimal promoter necessary for efficient expression is located between -698 (PstI) and +60 relative to the transcription start point. Within this minimal promoter region, the upstream regulatory element responsible for the stimulation of gene expression may exist in the DNA fragment between -698 (PsfI) and -351 (StuI).

The simian T-lymphotropic/leukemia virus from Pan paniscus belongs to the type 2 family and infects Asian macaques

The proviral DNA of the simian T-leukemia/lymphotropic virus (STLV) isolate, originally obtained from a captive colony of pygmy chimpanzees (Pan paniscus) (STLV(pan-p)), was cloned from the DNA of the chronically infected human T-cell line L93-79B. The entire proviral DNA sequence was obtained and compared with sequences of the known genotypes of STLV and human T-leukemia/lymphotropic virus types 1 and 2 (HTLV-1 and -2). Phylogenetic analysis indicates that STLV-2(pan-p) is an early divergence within the type 2 lineage and should be referred to as STLV-2(pan-p). Since STLV-2(pan-p) has been found in African nonhuman primates, we investigated its infectiousness and pathogenicity in Asian monkeys. Pigtailed macaques were inoculated with human cells harboring STLV(pan-p), and infection was assessed by virus isolation, PCR analysis of peripheral blood mononuclear cells, and seroconversion against viral antigens in HTLV-1/HTLV-2 and Western blot assay. Pigtailed macaques became persistently infected by STLV-2(pan-p), and the virus could be transferred by blood transfusion from an infected pigtailed macaque to a rhesus macaque. In addition, like HTLV-1 and HTLV-2, STLV-2(pan-p) was infectious in rabbits. In summary, STLV-2(pan-p) is a novel retrovirus distantly related to HTLV-2 and displays a host range similar to that demonstrated for other HTLV and STLV strains.

Unilateral megalencephaly in linear nevus sebaceous syndrome: a neuroradiological case report

We report a case of linear nevus sebaceous syndrome with seizure, mental retardation, and hemiparesis. Magnetic resonance imaging (MRI) clearly demonstrated associated brain malformations of unilateral megalencephaly with cortical dysplasia and white matter change ipsilateral to the sebaceous nevi of the face and neck. Although magnetic resonance angiography (MRA) demonstrated only distortion of the main cerebral arteries without any occlusive or dysplastic findings, single photon emission computed tomography (SPECT) using [123I]N-Isopropyl-p-iodoamphetamine (IMP) revealed hypoperfusion in the affected cerebral hemisphere.

Isolation and identification of a protein with capsaicin-inhibited NADH oxidase activity from culture media conditioned by growth of HeLa cells

A ca. 33.5-kDa protein has been identified as a soluble NADH oxidase activity of culture media conditioned by growth of HeLa cells. The protein appears to be derived from a 34-kDa protein of the HeLa plasma membrane. Both proteins are characterized by an ability to oxidize NADH in the absence of exogenous electron acceptors. The activity is inhibited by 8-methyl-N-vanillyl-6-noneamide (capsaicin). The soluble and the plasma membrane forms of the activity exhibit a similar EC50 of about 5 nM for inhibition of the activity by capsaicin. The activity was purified from culture media conditioned by growth of HeLa cells using DEAE ion exchange chromatography, G-200 size exclusion chromatography, and preparative SDS-PAGE. Purification was monitored on the basis of the capsaicin-inhibited oxidation of NADH, including the final electrophoretic purification. Activity was restored following SDS-PAGE by reduction with dithiothreitol or reduced glutathione in the presence of NADH followed by the addition of 0.03% hydrogen peroxide and preincubation in the presence of NADH for 5-15 min. For affinity purification, the vanillylamine portion of capsaicin was linked to agarose. The agarose-linked vanillylamine bound a ca. 33.5-kDa protein band with capsaicin-inhibited NADH activity from total defined culture media conditioned by growth of HeLa cells. The NADH oxidase activity of both the soluble and the plasma membrane-associated form of the activity was inhibited by antisera corresponding to the 33.5-kDa protein. The antisera also immunoprecipitated and reacted on Western blots with both the soluble (33.5 kDa) and plasma membrane (34 kDa)-associated forms of the capsaicin-inhibited activity. The results identify the capsaicin-inhibited NADH oxidase of the conditioned media of HeLa cells as being a ca. 33.5-kDa shed form of the previously reported capsaicin-inhibited NADH oxidase of the HeLa cell plasma membrane.

Usefulness and problems of stereotactic radiosurgery using a linear accelerator

Since the introduction of linac radiosurgery in October 1994, we have treated 27 patients with 36 lesions. We treated nine AVM, 12 metastatic brain tumors, two malignant lymphomas, one anaplastic astrocytoma, two meningiomas, and one brain tumor of unknown pathology. In the follow-up examinations at least five months after treatment, the local control rate was 83% for the metastatic tumors, and two malignant lymphomas disappeared completely. In addition, satisfactory results have been obtained with AVM and other brain tumors without any side effects. In comparison with gamma-knife radiosurgery, linac radiosurgery has some disadvantages such as longer treatment time and cumbersome accuracy control, but if accuracy control is performed periodically, accuracies of 1 mm or less can be obtained. There is some strengths of linac radiosurgery as follow. 1) The acquisition cost is relatively low. 2) Dose distribution are equivalent to gamma-knife. 3) There is no field size limitation. 4) There is great flexibility in beam delivery and linac systems. Radiosurgery using linear accelerators seems to become widely accepted in the future.

Antitumor sulfonylurea-inhibited NADH oxidase of cultured HeLa cells shed into media

Conditioned culture media of HeLa S cells contain a soluble NADH oxidase activity inhibited by the antitumor sulfonylurea, N-(4-methylphenylsulfonyl)-N' -(4-chlorophenyl)urea (LY181984) similar to that associated with the outer surface of the plasma membrane. This activity was absent from media in which cells had not been grown and was present in conditioned culture media from which cells had been removed by centrifugation both for serum-containing and serum-free media. The Km with respect to NADH and response to thiol reagents were similar to those of the corresponding activity of the plasma membrane of HeLa cells. The conditioned HeLa culture media bound [3H]LY181984 with high affinity. Both antitumor sulfonylurea-inhibited and -resistant forms of the NADH oxidase were isolated by free-flow electrophoresis. The antitumor sulfonylurea-inhibited activity was purified to apparent homogeneity and was identified with a 33.5 kDa protein with an isoelectric point of about pH 4.5. The 33.5 kDa protein from conditioned HeLa culture medium both bound [3H]LY181984 and retained an LY181984-inhibited NADH oxidase activity. A polyclonal antisera was raised in rabbits to the purified 33.5 kDa constituent from conditioned HeLa culture medium. The antisera blocked the activity of the LY181984-inhibited NADH oxidase activity, immunoprecipitated the activity and reacted with a 33.5 kDa protein on Western blots while preimmune sera did not. Also inhibited and immunoprecipitated was NADH oxidase activity from HeLa plasma membranes. The findings are consistent with the 33.5 kDa drug-inhibited NADH oxidase activity of the culture media being a shed form of the corresponding native 34 kDa antitumor sulfonylurea-inhibited NADH oxidase activity of the HeLa cell plasma membrane.

Identification of antitumor sulfonylurea binding proteins of HeLa plasma membranes

Plasma membranes of cultured HeLa S cells bound the tritiated antitumor sulfonylurea [3H]LY181984 with high affinity (Kd of about 25 nM). The number of binding sites, estimated to represent 30 to 35 pmol/mg protein, would represent a low abundance protein of the total plasma membrane proteins. The binding proteins appeared to contain one or more thiols in the binding site as high affinity binding of [3H]LY181984 was reduced by treatment with the covalent thiol blocking reagent, N-ethylmaleimide (NEM), or by oxidation with dilute hydrogen peroxide but was protected by glutathione or dithiothreitol. Elimination of binding of [3H]LY181984 by NEM was prevented by excess unlabeled LY181984 (an active sulfonylurea) but less so by excess LY181985 (an inactive sulfonylurea). The binding proteins were specifically labeled with thiol reagents following reaction of unprotected thiols with unlabeled thiol reagents. Binding proteins at ca. 34 kDa were labeled. Plasma membrane proteins after solubilization with SDS under strongly reducing conditions still bound sulfonylurea. [3H]LY181984 binding to plasma membrane proteins resolved on SDS-PAGE correlated as well with proteins in the 30-40 kDa range.

Sexual differentiation and preimplantation cell growth

Growth rates of human preimplantation embryos fertilized in vitro were assessed and compared to the sex of the pregnancy outcome. The likelihood of a liveborn male was significantly greater than that of a female if the mean number of cells/embryo was four or greater at the scheduled time of transfer (odds ratio of 6:1). This finding suggested that the Y chromosome expresses factors which influence embryonic growth rates immediately after fertilization.

UV resonance Raman and excited-state relaxation rate studies of hemoglobin

We have measured the UV resonance Raman (UVRR) spectra of human methemoglobin fluoride (metHbF) and examined the Raman saturation behavior of the metHbF trytophyl (Trp) and tyrosyl (Tyr) residues. Our high-quality UVRR spectra devoid of Raman saturation with 229- and 238.3-nm CW laser excitation allow us to determine small changes in Trp and Tyr residue Raman band frequencies and intensities caused by the hemoglobin R-T quaternary structural change induced by the allosteric effector inositol hexaphosphate. At 238.3-nm excitation, we observe a ca. 15 and 8% intensity increase for the Trp and Tyr bands, respectively, upon the R-T transition. In contrast, a small intensity decrease is observed with 225-nm excitation. These intensity alterations result from Trp and Tyr absorption and Raman excitation profile red-shifts which correlate with a strong 231.5-nm R-T absorption spectral change. These absorption and Raman excitation profile red-shifts and our model compound absorption studies together suggest a T-state increase in the hydrogen bond donation of the Trp-beta(2)37 and Tyr-alpha(1)42 residues at the alpha 1 beta 2 subunit interface. The Tyr-alpha 42 residue appears to be a hydrogen bond donor, rather than an acceptor. We determined the electronic excited-state relaxation rates of the Trp and Tyr residues in hemoglobin by using Raman saturation spectroscopy with 225-nm pulsed laser excitation. The observed average excited-state relaxation rate of the Trp residues is ca. 1/120 ps and is independent of the quaternary structure. This rate is slower that that observed for Trp residues of horse myoglobin. The average excited-state relaxation rate of the Tyr residues is ca. 1/60 ps for both the R and T quaternary forms. These are the first Tyr relaxation rates measured for any heme protein.