T1-Hypersignal Foci in Cerebral Toxoplasmosis after Stem Cell Transplantation

We present here the unique image of toxoplasma encephalitis in a transplant recipient, characterized by the finding of T1-hypersignal foci. It is emphasized that cerebral toxoplasmosis after stem cell transplantation may show a high signal on T1-weighted images even without any hemorrhagic or calcified lesions.

Quantitative real-time PCR (qPCR)--based tool for detection and quantification of Cordyceps militaris in soil

A quantitative real-time PCR using a primer pair CM2946F/CM3160R was developed for specific detection and quantification of Cordyceps militaris from soil. Standard curves were obtained for genomic DNA and DNA extracts from autoclaved soil with a certain dose of C. militaris suspension. C. militaris was detected from two forest soil samples out of ten that were collected when fruit bodies of C. militaris were found. This method seemed effective in detection of C. militaris in the soil and useful for rapid and reliable quantification of C. militaris in different ecosystems.

A comparative study of single-incision versus conventional multiport laparoscopic ileocecal resection for Crohn's disease with strictures

INTRODUCTION

Single-incision laparoscopic surgery (SILS) offers excellent cosmetic results compared with conventional multiport laparoscopic surgery. Recently, this technique has been applied to colorectal disease. However, there have been few reports about its application to Crohn's disease (CD) in the literature. The aim of this study is to describe our early experience with SILS for 11 patients with CD and make comparisons with the conventional multiport laparoscopic surgery.

METHODS

We reviewed all patients with CD who underwent laparoscopic surgery for the presence of ileocolic strictures at our institution between January 2006 and March 2011. Data from consecutive patients undergoing SILS were analyzed and compared with those from conventional multiport laparoscopic surgeries.

RESULTS

During the study period, 11 patients underwent SILS. All surgeries were completed with SILS. Operative time, blood loss and conversions were not significantly different between the two groups. Postoperative complications and length of hospital stay also had no significant difference.

CONCLUSION

In conclusion, SILS for CD may be safe and feasible in selected patients, and have better cosmetic results than conventional multiport laparoscopic surgery. Further studies are needed to evaluate the outcome of SILS compared to that of conventional laparoscopic surgery.

Expression and possible immune-regulatory function of ghrelin in oral epithelium

Originally found in stomach mucosa, ghrelin is a peptide appetite hormone that has been implicated as an immuno-modulatory factor. Ghrelin has also been found in salivary glands and saliva; however, its expression patterns and biological properties in the oral cavity remain unclear. Therefore, we investigated the expression patterns of ghrelin in saliva, gingival crevicular fluid (GCF), and gingival tissue, as well as its in vitro effects on IL-8 production by TNF-α or LPS-stimulated oral epithelial cells. In the clinical samples obtained from 12 healthy volunteers, the concentration of ghrelin in GCF remarkably exceeded that detected in saliva. The expression of ghrelin mRNAs and growth hormone secretagogue (GHS) receptors could be detected in human oral epithelial cells. Immunohistochemical analysis revealed the expression of ghrelin in gingival epithelium, as well as in fibroblasts in the lamina propria. Ghrelin increased intracellular calcium mobilization and cAMP levels in oral epithelial cells, suggesting that ghrelin acts on epithelial cells to induce cell signaling. Furthermore, synthetic ghrelin inhibited the production of IL-8 from TNF-α or LPS-stimulated oral epithelial cells. These results indicate that ghrelin produced in the oral cavity appears to play a regulatory role in innate immune responses to inflammatory infection.

Increased numbers of immature plasma cells in peripheral blood specifically overexpress chemokine receptor CXCR3 and CXCR4 in patients with ulcerative colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disease featuring infiltration by plasma cells producing immunoglobulins. We have reported previously the specific and significant proliferation of immature plasma cells in the inflamed colonic and pouch mucosa of UC patients. The aim of this study was to characterize peripheral blood immature plasma cells and the migration mechanisms of such immature plasma cells to inflamed sites in UC. The characteristics of peripheral blood immature plasma cells and chemokine receptor expression were examined by flow cytometry. Expression of mucosal chemokine was quantified using real-time reverse transcription-polymerase chain reaction and immunohistochemistry. The number of peripheral blood immature plasma cells was significantly higher in patients with active UC and active Crohn's disease (CD) than in healthy controls. The proportion of immature plasma cells was correlated positively with clinical activities of UC and CD. Many peripheral blood immature plasma cells were positive for CXCR3, CXCR4, CCR9 and CCR10. Expression of CXCR3 and CXCR4 in UC patients was significantly higher than in controls. CXCL9, CXCL10 and CXCL11 mRNA levels in colonic mucosa of inflamed IBD were higher than in controls. Immunofluorescence study also showed abundant CXCR3-positive immature plasma cells in the inflamed colonic mucosa of UC. Increased numbers of immature plasma cells may migrate towards inflammatory sites of UC via the CXCR3 axis, and may participate in UC pathogenesis.

Wound healing effects of gingival fibroblasts cultured in animal-free medium

OBJECTIVE

The purpose of this study was to develop a graft material made of gingival fibroblasts cultured in animal-free medium (HFDM1).

METHODS

We examined the effects of human serum (HS) on cell growth and wound healing capability, demonstrated by cytokine production, of gingival fibroblasts cultured in HFDM1. Subsequently, the capability of fibroblasts cultured in HFDM1 with 2% HS to promote the healing of skin defects was evaluated using nude mice.

RESULTS

The proliferation of human gingival fibroblasts was increased when HS at a concentration of 0.5-2% was added to HFDM1. Wound healing cytokines, including transforming growth factor-beta, keratinocyte growth factor, hepatocyte growth factor, vascular endothelial growth factor, and IL-6 produced by gingival fibroblasts were increased by adding 2% HS to HFDM1. In addition, gingival fibroblasts cultured in HFDM1 with 2% HS improved wound healing of mouse skin defects as well as those cultured in Dulbecco's modified Eagle's medium with 10% fetal calf serum.

CONCLUSION

Gingival fibroblasts cultured in HFDM1 with 2% HS may be useful as a graft material for reconstruction.

Can MRCP replace ERCP for the diagnosis of autoimmune pancreatitis?

BACKGROUND

It is of utmost importance that autoimmune pancreatitis (AIP) be differentiated from pancreatic cancer. Irregular narrowing of the main pancreatic duct is a characteristic finding in AIP; it is useful for differentiating AIP from pancreatic cancer stenosis. This study evaluated the usefulness of magnetic resonance cholangiopancreatography (MRCP) for the diagnosis of AIP and assessed whether MRCP could replace endoscopic retrograde cholangiopancreatography (ERCP) for diagnosing AIP.

METHODS

The MRCP and ERCP findings of 20 AIP patients were compared.

RESULTS

On MRCP, the narrowed portion of the main pancreatic duct was not visualized, while the noninvolved segments of the pancreatic duct were visualized. The degree of upstream dilatation of the proximal main pancreatic duct was milder in AIP than in pancreatic cancer patients. In the skipped type, only skipped narrowed lesions were not visualized. After steroid therapy for AIP, the nonvisualized main pancreatic duct became visualized.

CONCLUSIONS

MRCP cannot replace ERCP for the diagnosis of AIP, since narrowing of the main pancreatic duct in AIP was not visualized on MRCP. MRCP findings of segmental or skipped nonvisualized main pancreatic duct accompanied by a less dilated upstream main pancreatic duct may suggest the presence of AIP. MRCP is useful for following AIP patients.

Amphiregulin induces proliferative activities in osseous dysplasia

Human osseous dysplasia (OD) is a benign fibro-osseous neoplasm of periodontal ligament origin in which normal bone is replaced with fibrous connective tissue containing abnormal bone or cementum. However, cellular differentiation and proliferation in OD have not been fully elucidated. In vitro culture systems have distinct advantages for analytical studies. Therefore, we established immortalized cell lines (OD-1) from OD lesions of the jaw from an individual with gnathodiaphyseal dysplasia (GDD). We hypothesized that OD-1 had a characteristic growth mechanism different from that of mineralized-associated cells such as osteoblasts. To clarify the difference of gene expression patterns between OD-1 and osteoblasts, we compared the profiles of genes expressed in the 2 cell types by microarray analysis. We identified amphiregulin to be highly expressed in OD-1 compared with osteoblasts and gingival fibroblasts. OD-1 showed proliferative activities regulated in an autocrine manner by amphiregulin, and amphiregulin may play a significant role in the proliferation of OD.

Regulation of CXCL9/10/11 in Oral Keratinocytes and Fibroblasts

Th1 and Th2 cytokines such as interferon-γ (IFN-γ ) , tumor necrosis factor- α (TNF-α ), and IL-4 are expressed in T-cell-mediated inflammation in the oral cavity. We tested the hypothesis that those cytokines may act on CXCR3-agonistic chemokines, T-cell recruiting factors, and on neighboring cells, including oral keratinocytes and fibroblasts. Human immortalized oral keratinocytes (RT7) and fibroblasts (GT1) after 24-hour stimulation with IFN-γ showed increased mRNA levels of CXCL9 (600- and 700-fold), CXCL10 (10,000- and 150-fold), and CXCL11 (5000- and 300-fold), respectively. In contrast, TNF-α caused an increase in CXCL9 (300-fold), CXCL10 (2000-fold), and CXCL11 (2000-fold) mRNA levels in GT1, but not RT7 cells, at 24 hrs. IL-4 reinforced the promotion of CXCL9, CXCL10, and CXCL11 expression by IFN-γ in RT7 cells, whereas IL-4 inhibited the increased levels by IFN-γ and TNF-α in GT1 cells. Thus, IFN-γ , TNF-α , and IL-4 appear cooperatively to regulate CXCR3-agonistic chemokines in oral keratinocytes and fibroblasts in T-cell-mediated oral inflammation sites.

Finger movement improves ankle control for gait initiation in patients with Parkinson's disease

The purpose of this study was to investigate the effect of finger movement on ankle control for gait initiation in patients with Parkinson's disease (PD patients). The subjects were 13 PD patients and 6 age-matched healthy adults. The subjects moved fingers before or after gait initiation, or initiated gait without finger movement. Ankle joint movement in the stance leg was recorded to estimate the duration of ankle dorsiflexion (DIF duration), which reflects the degree of disturbance in ankle control for gait initiation in PD patients. In the PD patients with prolonged D/F duration, finger movement that preceded gait initiation shortened the D/F duration, but in the PD patients without prolonged D/F duration and in healthy subjects, the effect was not found. Accordingly, finger movement that precedes gait initiation improves ankle control for gait initiation in PD patients who suffer disturbance in ankle control for gait initiation.

MRCP of congenital pancreaticobiliary malformation

BACKGROUND

Congenital pancreaticobiliary malformations are sometimes associated with acute or chronic pancreatitis and biliary carcinoma. Currently, magnetic resonance cholangiopancreatography (MRCP) is one of the first choices for investigating and diagnosing pancreaticobiliary diseases noninvasively. We compared the accuracy of conventional MRCP and endoscopic retrograde cholangiopancreatography (ERCP) in making the diagnosis of congenital pancreaticobiliary malformations.

METHODS

In patients with pancreas divisum (n = 17), pancreaticobiliary maljunction (n = 12), choledochocele (n = 2), and annular pancreas (n = 1) who underwent ERCP and MRCP, the diagnostic accuracy and findings on MRCP were compared with those on ERCP.

RESULTS

Of the 32 patients with congenital pancreaticobiliary malformations diagnosed on ERCP, 23 (72%) presented the same diagnosis on MRCP. Complete pancreas divisum was diagnosed in 73% on MRCP based on the finding of a dominant dorsal pancreatic duct crossing the lower bile duct and emptying into the duodenum without communicating with the ventral pancreatic duct. Pancreaticobiliary maljunction was diagnosed in 75% on MRCP based on the finding of an anomalous union between the common bile duct and the pancreatic duct and the existence of a long common channel.

CONCLUSIONS

Conventional MRCP is a useful, noninvasive tool for diagnosing congenital pancreaticobiliary malformations; and the diagnostic accuracy can be increased with three-dimensional MRCP or dynamic MRCP with secretin stimulation.

Clinical features of allogeneic hematopoietic stem cell transplantation-associated organizing pneumonia

We describe the clinical courses and outcomes of allogeneic hematopoietic stem cell transplantation-associated organizing pneumonia (HOP) observed in our institution over the past 20 years. Charts and chest radiographs of 603 allogeneic transplant recipients were retrospectively reviewed for HOP. In total, 12 cases of HOP were identified (2.0%) at a median interval of 148 days after transplantation (range, 53-475 days), presenting with low-grade fever, nonproductive cough and dyspnea at onset. Initial antibiotic treatment did not ameliorate symptoms, but most patients responded well to 0.5-1 mg/kg of prednisolone. HOP flare-up occurred after discontinuing treatment or while tapering doses in 9 of 12 patients, but responded to re-treatment with the initial dose of steroid. Although three patients died, no deaths were attributable to pulmonary failure. The remaining nine patients displayed no relapse of primary disease and 5-year survival rate was 74.1%. Clinical features of the 12 patients were similar in that all underwent irradiation-containing conditioning and most had a prior history of acute graft-versus-host disease (GVHD) and cytomegalovirus (CMV) infection. Furthermore, eight patients had active chronic GVHD at onset of HOP. These findings suggest that factors such as irradiation-containing regimens, previous CMV infection and allogeneic immune reaction may contribute to HOP occurrence.

PRTFDC1, a possible tumor-suppressor gene, is frequently silenced in oral squamous-cell carcinomas by aberrant promoter hypermethylation

Array-based comparative genomic hybridization (array-CGH) has good potential for the high-throughput identification of genetic aberrations in cell genomes. In the course of a program to screen a panel of oral squamous-cell carcinoma (OSCC), cell lines for genomic copy-number aberrations by array-CGH using our in-house arrays, we identified a 3-Mb homozygous deletion at 10p12 in 1 of 18 cell lines (5.6%). Among seven genes located within this region, expression of PRTFDC1 mRNA was not detected in 50% (9/18) or decreased in 5.6% (1/18) of OSCC cell lines, but detected in normal oral epithelia and restored in gene-silenced OSCC cells without its homozygous loss after treatment with 5-aza-2'-deoxycytidine. Among 17 cell lines without a homozygous deletion, the hypermethylation of the PRTFDC1 CpG island, which showed promoter activity, was observed in all nine cell lines with no or reduced PRTFDC1 expression (52.9%). Methylation of this CpG island was also observed in primary OSCC tissues (8/47, 17.0%). In addition, restoration of PRTFDC1 in OSCC cells lacking its expression inhibited cell growth in colony-formation assays, whereas knockdown of PRTFDC1 expression in OSCC cells expressing the gene promoted cell growth. These results suggest that epigenetic silencing of PRTFDC1 by hypermethylation of the CpG island leads to a loss of PRTFDC1 function, which might be involved in squamous cell oral carcinogenesis.

Reg IV is a serum biomarker for gastric cancer patients and predicts response to 5-fluorouracil-based chemotherapy

Regenerating gene family, member 4 (Reg IV), a secreted protein, is overexpressed in several cancers, including gastric cancer (GC). In the present study, we measured Reg IV levels in sera from patients with GC by enzyme-linked immunosorbent assay. We also examined the effect of forced Reg IV expression on the apoptotic susceptibility to 5-fluorouracil (5-FU). Forced expression of Reg IV inhibited 5-FU-induced apoptosis. Induction of Bcl-2 and dihydropyrimidine dehydrogenase was involved in inhibition of apoptosis. Among 36 GC patients treated with a combination chemotherapy of low-dose 5-FU and cisplatin, all 14 Reg IV-positive patients showed no change or disease progression. The serum Reg IV concentration was similar between healthy individuals (mean+/-s.e., 0.52+/-0.05 ng/ml) and patients with chronic-active gastritis (0.36+/-0.09 ng/ml). However, the serum Reg IV concentration in presurgical GC patients was significantly elevated (1.96+/-0.17 ng/ml), even at stage I. The diagnostic sensitivity of serum Reg IV (36.1%) was superior to that of serum carcinoembryonic antigen (11.5%) or carbohydrate antigen 19-9 (13.1%). These results indicate that expression of Reg IV is a marker for prediction of resistance to 5-FU-based chemotherapy in patients with GC. Serum Reg IV represents a novel biomarker for GC.

Effect of dietary anti-Helicobacter pylori-urease immunoglobulin Y on Helicobacter pylori infection

Recently, chicken egg yolk was recognized as an inexpensive antibody source, and the therapeutic usefulness of egg yolk immunoglobulin Y (IgY) in oral passive immunization has been investigated. Although multiple antibiotic treatments eradicate most Helicobacter pylori (H. pylori) infections, therapy fails in 10-15% of cases due to the development of drug resistance. Consequently, it is important that new, more broadly based therapies for the treatment of H. pylori infection should be identified. The present study evaluated the effect, on H. pylori infection, of IgY prepared from egg yolk of hens immunized with H. pylori urease (anti-HpU IgY). Seventeen asymptomatic volunteers diagnosed as H. pylori-positive by the 13C-urea breath test (UBT) were orally administered anti-HpU IgY for 4 weeks. Four weeks later, UBT values were significantly decreased although no case showed H. pylori eradication. An H. pylori-positive 53-year-old female gastritis patient administered anti-HpU IgY plus lansoprazole for 8 weeks showed a decrease in serum pepsinogen (PG) I and UBT values as well as an increase in the PG I/II ratio. In conclusion, anti-HpU IgY may mitigate H. pylori-associated gastritis and partially attenuate gastric urease activity. Furthermore, anti-HpU IgY combined with antacids appears to ameliorate gastric inflammation. These encouraging results may represent a novel approach to the management of H. pylori-associated gastroduodenal disease.

Gene expression of telomerase related proteins in human normal oral and ectocervical epithelial cells

We analyzed telomerase activities and gene expressions of telomerase components: hTERT, hTR, hTEP1, telomeric repeat binding factors: TRF1, TRF2, and c-myc, Max and Mad in human normal oral and ectocervical epithelial keratinocytes, comparing with those of squamous carcinoma cells and HPV16- or SV40-immortalized cells. Significant telomerase activity and hTERT expression were detected in primary keratinocytes. However, both were dramatically down-regulated during serial passages. The down-regulation of hTERT mRNA was associated with augmented expression of TRF1. Expression of c-myc was slightly decreased, whereas Mad was expressed in parallel with that of hTERT during passages. We also detected an alternate splicing of hTERT transcript in two of four cancer cells and normal aged epithelial cells. These results suggest that the senescence of normal oral and ectocervical keratinocytes is accompanied with up-regulation of TRF1 and down-regulation of telomerase activity due to transcriptional suppression of active form of hTERT in vitro.

Contribution of the combination of (201)Tl SPECT and (99m)T(c)O(4)(-) SPECT to the differential diagnosis of brain tumors and tumor-like lesions. A preliminary report

This study was undertaken to assess the contribution of the combination of (201)Tl SPECT and (99m)TcO(4)(-)SPECT to the differential diagnosis of brain tumors and tumor-like lesions. In the 8 patients selected for this study, both (201)Tl SPECT and (99m)TcO(4)(-) SPECT were performed because of clinical or radiological suspicion of brain tumor, no therapy was initiated before either SPECTs, diagnosis was based on biopsy, and MRI findings were stable in the interval between SPECTs. Histological diagnoses consisted of low grade glioma (n=1), high grade glioma (n=2), lymphoma (n=1), metastasis (n=1), multiple sclerosis (n=2) and cavernous angioma (n=1). Two high grade astrocytomas, one malignant lymphoma and one metastatic tumor showed (201)Tl accumulation and were diagnosed as tumor. The combination of (201)Tl and (99m)TcO(4)(-) did not change the diagnosis. One cavernous angioma showed no (201)Tl accumulation and was diagnosed as non-tumor. The combination of (201)Tl and (99m)TcO(4)(-) did not change the diagnosis. One low grade astrocytoma showed faint (201)Tl accumulation and was diagnosed as non-tumor. As (201)Tl uptake was higher than (99m)TcO(4)(-) uptake, the combination of (201)Tl and (99m)TcO(4)(-) changed the diagnosis to tumor. Two multiple sclerosis showed (201)Tl accumulation and were diagnosed as tumor. As (99m)TcO(4)(-) uptake was higher than (201)Tl uptake, the combination of (201)Tl and (99m)TcO(4)(-) changed the diagnosis to non-tumor. In three of the eight patients (38%), the combination of (201)Tl SPECT and (99m)TcO(4)(-) SPECT altered the diagnosis made by (201)Tl SPECT alone. In all of these three cases, the diagnosis made by the combination of (201)Tl SPECT and (99m)TcO(4)(-) SPECT was correct.

Ultrasonographic evaluation of congenital dislocation of the knee

The authors describe ultrasonographic findings in a newborn girl with congenital dislocation of the knee (CDK). Ultrasonography showed a hyperechoic area and focal narrowing of the distal quadriceps as compared to the unaffected contralateral side, indicating the presence of fibrosis, which is the main pathologic feature of congenital dislocation of the knee. The hyperechoic area decreased after reduction of the dislocation and with patient growth. Ultrasonography was useful in evaluating CDK because it provided a direct view of the pathologic lesion, was painless, and did not involve exposure to X-rays. Further, we were able to serially evaluate the abnormal findings and provide advice regarding daily activity to the parents of the patient with CDK.

Outbreaks of forest defoliating insects in Japan, 1950-2000

In Japan, several forest-defoliating insects reach outbreak levels and cause serious defoliation. Stand mortality sometimes occurs after severe defoliation. However, in general, tree mortality caused by insect defoliation is low because of the prevailing moist climate in Japan. Evergreen conifers are more susceptible to tree mortality as a result of insect defoliation whereas deciduous broad-leaved trees are seldom killed. Insect defoliation occurs more frequently in man-made environments such as among shade trees, orchards, and plantations than in natural habitats. Outbreaks of some defoliators tend to occur in stands of a particular age: e.g. outbreaks of the pine caterpillar, Dendrolimus spectabilis Butler (Lepidoptera: Lasiocampidae) occur more frequently in young pine plantations. In contrast, defoliation caused by outbreaks of lepidopterous and hymenopterous pests in larch plantations is more frequent with stand maturation. There is a relationship between outbreaks of some defoliators and altitude above sea level. Most outbreaks of forest defoliators were terminated by insect pathogens that operated in a density-dependent fashion. Since the 1970s, Japan has been prosperous and can afford to buy timber from abroad. More recently, there has been an increasing demand for timber in Japan, that coincides with a huge demand internationally, so that the country will need to produce more timber locally in the future. The increasing pressure on the forestry industry to meet this demand will require more sophisticated methods of pest control coupled with more sustainable methods of silviculture.

Potential impact of global warming on deciduous oak dieback caused by ambrosia fungus Raffaelea sp. carried by ambrosia beetle Platypus quercivorus (Coleoptera: Platypodidae) in Japan

Deciduous oak dieback in Japan has been known since the 1930s, but in the last ten years epidemics have intensified and spread to the island's western coastal areas. The symbiotic ambrosia fungus Raffaelea sp. is the causal agent of oak dieback, and is vectored by Platypus quercivorus (Murayama). This is the first example of an ambrosia beetle fungus that kills vigorous trees. Mortality of Quercus crispula was approximately 40% but much lower for associated species of Fagaceae, even though each species had a similar number of beetle attacks. It is likely that other oaks resistant to the fungus evolved under a stable relationship between the tree, fungus and beetle during a long evolutionary process. Quercus crispula was probably not part of this coevolution. This hypothesis was supported by the fact that P. quercivorus showed the least preference for Q. crispula yet exhibited highest reproductive success in this species. Therefore, P. quercivorus could spread more rapidly in stands with a high composition of Q. crispula. The present oak dieback epidemic in Japan probably resulted from the warmer climate that occurred from the late 1980s which made possible the fateful encounter of P. quercivorus with Q. cripsula by allowing the beetle to extend its distribution to more northerly latitudes and higher altitudes. Future global warming will possibly accelerate the overlapping of the distributions of P. quercivorus and Q. crispula with the result that oak dieback in Q. crispula will become more prevalent in Japan.

Expression of telomerase components in oral keratinocytes and squamous cell carcinomas

Telomerase activity was measured using a telomeric repeat amplification protocol (TRAP), and expressions of the telomerase components, telomerase associated protein 1 (hTEP1), human telomerase RNA component (hTR), and human telomerase reverse transcriptase (hTERT) were measured by reverse transcriptase-polymerase chain reaction (RT-PCR) in cultured normal oral keratinocytes and oral squamous cell carcinoma (SCC) cells. Telomerase localization was analyzed by in situ hybridization (ISH) in normal, precancerous and cancerous oral tissues. There was a strong correlation of telomerase activity with the expression levels of hTERT but not with hTEP1 or hTR mRNA in the cultured cells. Not only hTEP1 and hTR but also hTERT expression were detected in the basal cells of normal oral mucosa, and the cells expressing these mRNAs were also seen in the upper layer of leukoplakia of gingiva, and a heterogeneous pattern of expression was observed in the oral SCC tissues. These results indicate that there are at least two steps in the increase of telomerase activity during carcinogenesis in oral squamous cells; a change in distribution of cells expressing these telomerase components and the over-expression of hTERT gene in individual cells.

Cyst of the ligamentum flavum

We report the case of a patient with sciatica resulting from a cyst of the ligamentum flavum.

Reverse correlation of E-cadherin and snail expression in oral squamous cell carcinoma cells in vitro

The loss of E-cadherin expression has been shown to correlate to the invasion and metastasis of many types of carcinomas. We established E-cadherin positive (HOC719-PE) and negative (HOC719-NE) clones from an oral squamous cell carcinoma (SCC). HOC719-PE cells showed epithelial morphology with E-cadherin expression in the cell membrane, whereas HOC719-NE cells demonstrated fibroblastic morphology without E-cadherin expression. In invasion assay and three dimensional culture, HOC719-NE showed much higher invasive ability than HOC719-PE cells. These cells expressed similar levels of mRNAs for alpha- and beta-catenin. However, HOC719-NE cells, but not HOC719-PE cells, showed strong expression of snail, a transcription factor implicated in the differentiation of epithelial cells into mesenchymal phenotype. This reverse expression of snail and E-cadherin was further observed in other SCC cells including HOC313, and TSU cells that we previously reported to show no expression of E-cadherin protein. These results indicated that the expression of snail has a key role for the acquisition of more invasive and metastatic phenotypes of SCC and the clones we reported here will be useful tools for understanding the mechanism of the transition from epithelial to mesenchymal SCC cells.

Clinical significance of ventilation/perfusion scans in collagen disease patients

The purpose of this study was to detect disturbances in pulmonary circulation in collagen disease patients by means of a non-invasive technique.

METHODS

Ventilation/perfusion scans with 133Xe gas and 99mTc-macroaggregated albumin (MAA) were performed in 109 patients with various collagen diseases. Functional images of V, Vol, Q and V/Q ratio were obtained at total lung capacity. Wash-out time was calculated from the wash-out curve. Whole body scans were performed in 65 patients to evaluate intra-pulmonary shunts.

RESULTS

Increased V/Q areas were observed in 74 patients (67.9%), suggesting some impairment of pulmonary perfusion. Decreased perfusion, probably due to vasculitis or intravascular microcoagulation, was observed often, even in patients without pulmonary fibrosis. Shunt ratios over 10% were observed in 8 of the 65 patients (12.3%), indicating formation of PA-PV shunts secondary to peripheral vascular impairment. Wash-out time was prolonged in 37 patients (33.9%), shortened in 18 (16.5%), and within the normal range in 54 (49.6%). The prolonged and normal wash-out times in the patients with pulmonary fibrosis may represent obstructive changes in the small airways superimposed on the fibrosis.

CONCLUSION

Ventilation/perfusion scans are a very useful tool for evaluating collagen lung diseases, and they might contribute to treatment decisions for the patients.

Role of macrophage scavenger receptor in endotoxin shock

Lipopolysaccharide (LPS) is known to bind to several receptors on macrophages, including CD14 and macrophage scavenger receptor class A types I and II (MSR-A), and stimulates macrophages to release various inflammatory mediators. MSR-A recognizes a broad range of polyanionic ligands such as chemically modified lipoproteins, LPS of Gram-negative bacteria, and lipoteichoic acid of Gram-positive bacteria, suggesting a role in host defence. In this study, mice lacking MSR-A were used to elucidate the role of MSR-A in endotoxin shock. Peritoneal macrophages from MSR-A-deficient (MSR-A(-/-)) mice bound less remarkably to LPS than those from wild-type (MSR-A(+/+)) mice and the binding activity of MSR-A(+/+) macrophages to LPS was reduced by the addition of an anti-MSR-A antibody. Clearance of LPS in serum was retarded in MSR-A(-/-) mice after intraperitoneal administration of LPS. LPS-induced expression of cytokines in the liver was similar in MSR-A(+/+) and MSR-A(-/-) mice, but levels of interleukin (IL)-1beta expression and serum IL-1beta were lower in MSR-A(-/-) mice. Administration of large doses of LPS resulted in a higher mortality of MSR-A(+/+) mice and pretreatment with an IL-1 receptor antagonist reduced the mortality. Thus, MSR-A-mediated macrophage activation plays a negative role in protecting mice from endotoxin shock by enhancing IL-1beta production by macrophages.

Intraoral free flap monitoring with a laser Doppler flowmeter

The blood flow in 37 free flaps used for intraoral reconstruction was measured by laser Doppler flowmetry before and after elevation of the flap during surgery, immediately after the completion of reconstruction and on the 1st, 2nd and 3rd postoperative days (1 POD, 2 POD, 3 POD). Although the blood flow decreased temporarily after the flap elevation, it began to increase immediately after reconstruction and continued a gradual increase thereafter, reaching a peak on 2 POD. The flap survived in all cases where the blood flow on 3 POD was equal to or greater than that before flap elevation. Total necrosis of the flap occurred in one patient, and partial necrosis in another. In both patients, abnormal laser flow-metric measurements preceded the manifestation of the clinical signs. Using laser Doppler flowmetry to monitor free flaps both during surgery and for three days thereafter is thus a useful way of determining their viability.

Positive and negative oral contrast agents for combined abdominal and pelvic helical CT: first iodinated agent and second water

Combined abdominal and pelvic helical computed tomography (CT) with intravenous contrast media was performed on 19 patients with 400 mL of diluted iodine solution 60 minutes before and 400 mL of water just before CT. The distal small bowel was opacified by the positive contrast agent, and the stomach by the negative contrast agent in all patients. The gastric contents were homogenous, and the density was a mean +/- standard deviation 2.5+/-7.3 HU. The difference between the densities of the gastric contents and of the gastric wall (mean +/- s.d. 80.8+/-20.9 HU) was statistically significant (p<.05). There were no pseudotumors. Thus our protocol, first diluted iodine solution and second water, can be used as a method for the oral administration of contrast agents for combined abdominal and pelvic helical CT with intravenous contrast media.

Growth of normal oral keratinocytes and squamous cell carcinoma cells in a novel protein-free defined medium

A novel protein-free synthetic medium was developed for the culture of normal human oral keratinocytes. This medium, designated PFM-7, supports the serial cultivation of primary or secondary normal oral keratinocytes in protein-free, chemically defined conditions. Normal oral keratinocytes in PFM-7 exhibited nearly equal growth in mass culture without noticeable changes in morphology, response to added growth factors, or gene expression of growth factors and their receptors, compared to cells in Keratinocyte-SFM containing epidermal growth factor and bovine pituitary extract. Furthermore, PFM-7 supported the serial subcultivation of human squamous cell carcinoma cells and enabled both normal and malignant oral squamous cells derived from the same patient to grow under the same protein-free defined conditions. These results indicate that PFM-7 can be used for precise investigations of growth mechanisms, cell products, and gene expression associated with carcinogenesis of human epidermal cells.

Effects of an anti-angiogenic agent, TNP-470, on the growth of oral squamous cell carcinomas

Anti-tumor effects of an anti-angiogenic agent, TNP-470, on the growth of oral squamous cell carcinomas (SCCs) were evaluated in vivo and in vitro. The growth of an oral SCC cell line, HSC-2, inoculated subcutaneously in severe combined immuno-deficiency (SCID) mice was inhibited in a dose-dependent manner by the treatment with this agent. A reduction of microvessels surrounding tumor tissues treated with TNP-470 was observed by immunohistochemistry. Significant side-effects were not observed except for weight loss during the period of treatment with high dose (50 mg/kg) of TNP-470. The direct effects of TNP-470 on oral SCC cell lines were also evaluated in culture. The growth of all eight SCC cell lines tested was inhibited by TNP-470, but the sensitivity of the oral SCC cell lines to TNP-470 was about 1700 times less than that of endothelial cells. These results suggest that TNP-470 inhibits the growth of oral SCC by anti-angiogenic activities and that it may be effective as a new therapy of oral cancer.

A novel recognition motif of human NKT antigen receptor for a glycolipid ligand

Murine NKT cells can recognize alpha-galactosylceramide (alpha-GalCer) in the context of a class Ib CD1d molecule. Here we show that alpha-GalCer can selectively activate freshly isolated human Valpha24(+)Vbeta11(+) cells, functionally defining the human NKT cells. The naive human NKT cell repertoire consisted of cells expressing an invariant Valpha24JalphaQ chain and a diverse array of beta chains derived from a single Vbeta11 gene segment. Stimulation with alpha-GalCer expanded a polyclonal subset of the human NKT cell repertoire carrying a novel complementarity-determining region (CDR) 3beta consensus motif that may directly interact with the sugar moiety of alpha-GalCer. Our data suggest that certain redundancy is allowed for CDR3beta of NKT antigen receptor to interact with the ligand and provide a first clue to understand the novel protein-carbohydrate interaction mechanisms.

Transcranial Doppler pattern after intracarotid papaverine and prostaglandin E1 incorporated in lipid microsphere in patients with vasospasm

We studied the effects of intracarotid papaverine and prostaglandin E1 incorporated in lipid microsphere (Lipo-PGE1) in relation with transcranial Doppler parameters such as mean flow velocity (MFV) and pulsatile index (PI) of the proximal segment of the middle cerebral artery. Eighty patients with subarachnoid hemorrhage (SAH) were included in this study. In the case of angiographic vasospasm, papaverine at 7 mg/min with total dose below 300 mg per artery and 10-20 micrograms of Lipo-PGE1 were injected in the supraclinoid portion of the internal carotid artery. Vasospasm was improved in 24 patients (63%), however, it was unchanged in 14 patients (37%). The former patients had more favorable outcomes than the latter patients (p < 0.005). After intracarotid injection therapy, the correlation between MFV and PI was classified into three types: type 1, both MFV and PI decreased; type 2, MFV decreased but PI increased; and type 3, both MFV and PI fluctuated. The Glasgow Outcome Scale 3 months after SAH was as follows: type 1 (n = 15), good in 14 (93%) and moderate disability in one (7%); type 2 (n = 9), good in eight (89%) and vegetative state in one (11%); and type 3 (n = 14), moderate disability in five (36%), severe disability in seven (50%), and death in two (14%). Chi-square analysis showed significant differences between type 1 and type 3 (p < 0.005), and type 2 and type 3 (p < 0.005). In conclusion, intracarotid papaverine combined with Lipo-PGE1 was effective for vasospasm but type 3 patients require a different treatment protocol.

Pseudomyxoma retroperitonei

We report a rare case of pseudomyxoma retroperitonei in a 58-year-old woman with a past history of severe appendicitis. The imaging showed a multicystic mass similar to pseudomyxoma peritonei, but the tumor was located in the retroperitoneal space.

Expression of E-cadherin in oral cancer cell lines and its relationship to invasiveness in SCID mice in vivo

We examined the expression of E-cadherin in nine oral cancer cell lines. HSC-4, NA, ZA, HOC927 and Ca9-22 cells strongly expressed E-cadherin [E-CD(++) cell line] and HSC-2 and HSC-3 cells weakly expressed E-cadherin [E-CD(+) cell line]. All the cell lines that expressed E-cadherin were of cuboidal morphology and formed cobblestone colonies. In contrast, TSU and HOC313 cells had spindle shapes, formed dispersed colonies, and were completely negative for E-cadherin [E-CD(-) cell line]. Moreover, all cell lines that expressed E-cadherin showed tumorgenicity in SCID mice, but E-CD(-) cell lines did not show tumorgenicity. The tumors derived from E-CD(+) cell lines invaded deeper into the connective tissues than those from E-CD(++) cell lines. In immunohistochemical analysis, the difference was more marked at the edges of the cancer nests. These results suggest that E-cadherin expression was relevant to the cell forms and the differential grade of cultured cells and that reduced E-cadherin in oral cancer may be associated with invasiveness in vivo.

[A clinical and portal hemodynamic analysis for obliteration of gastric-renal shunt communicated with gastric fundic varices]

To clear the efficacy of treatment for large porto-systemic shunts, changes of liver function and portal hemodynamics after obliteration of gastric-renal shunt (GRS) or gastric-inferior phrenic vein shunt (GIS) communicated with gastric fundic varies in 24 patients treated with balloon-occluded retrograde transvenous obliteration (B-RTO) were studied. 1) The wedged hepatic venous pressure and the hepatic venous pressure gradient were statistically not significant changed after obliteration of GRS or GIS. 2) Serum albumin value was significantly increased (p < 0.005) and ICGR15 was significantly improved (p < 0.005) at one year after treatment in patients that, not only whose GRS or GIS were larger than 10mm in diameter, but also whose superior mesenteric arterial venography before treatment showed hepatofugal flow. 3) At a mean follow-up abdominal angiography of 23.3 months in 20 cases, GRS or GIS was yet obliterated respectively. And more, superior mesenteric arterial venography revealed hepatopetal flow alone in 43% of patients that, whose superior mesenteric arterial venography before treatment showed hepatofugal flow. 4) During a mean follow-up of 32.5 months, gastric fundic varies were not recurrent in all patients, but the other hand, cumulative red color sign positive esophageal varies apparent rates were high (16.7% at before treatment, 38.4% at 2-years, 54.4% at 4-years). According to their hemodynamic characteristics, cumulative red color sign positive esophageal varies apparent rates in patients with another collaterals besides GRS or GIS before treatment (26.7% at before treatment, 61.1% at 2-years, 74.1% at 4-years) were significantly higher (p < 0.05) than those in patients without another collateral except GRS or GIS (0% at 2-years, 16.7% at 4-years). We conclude that, 1) Increment of portal flom and improvement of liver function can be expected by obliteration of GRS or GIS in patients that, whose superior mesenteric venous blood flow into large GRS or GIS. 2) After obliteration of GRS or GIS, the incidence of aggravation of esophageal varies in patients with another collaterals besides GRS or GIS before treatment is high, while that in cases without another collateral is low.

[High-resolution CT findings in cytomegalovirus pneumonitis after bone marrow transplantation]

In order to explore the high-resolution CT (HRCT) findings of cytomegalovirus (CMV) pneumonitis after bone marrow transplantation, we retrospectively reviewed the HRCT findings in nine patients with CMV pneumonitis cytologically proven by bronchoalveolar lavege. In 67% of cases, HRCT showed ground-glass attenuation. Consolidation and bronchial wall thickening were demonstrated in 33%, pleural effusion in 22%, and micro centrilobular nodules, bronchiectasis, and reticulation in 11%, respectively. Lymphadenopathy and masses were not seen. The areas of ground-glass attenuation were distributed bilaterally in all cases, diffusely in 67%, centrilobularly in 50%, and panlobularly in 50%. Subpleural lung regions were spared in 83%. The areas of consolidation were bilateral in 67%, nonsegmental in 67%, and involved the lower lobe in all cases. A total of 25 follow-up HRCT were performed in six patients. Small centrilobular ground-glass opacities disappeared after treatment in one patient. Micro centrilobular nodules vanished after treatment in one patient. Small centrilobular ground-glass opacities developed into consolidation and resolved after treatment in one patient. In one patient, diffuse ground-glass opacities progressed to consolidation, and the patient died due to respiratory failure. No abnormal findings were observed in two patients. It may be considered that in the early phase of CMV pneumonitis HRCT shows small or micro centrilobular ground-glass opacities and nodules and that in the advanced phase these lesions progress to dense alveolar opacities as CMV infection advances, although a variety of HRCT appearances is observed in the course of CMV pneumonitis.

Immunoadsorption for the treatment of bullous pemphigoid

We treated 2 intractable patients with pemphigoid by absorbent plasmapheresis using dextran sulfate conjugated cellulose columns with an automated regenerating unit. During a 2 week period, this plasmapheresis was performed 4 to 6 times for Cases 1 and 2, respectively. Clinical findings including skin eruptions were remarkably improved, and the titers of antibasement membrane zone antibodies were decreased after the treatment of 1.8 to 4.2 L of plasma. These results suggest that the absorbent column is effective for intractable pemphigoid.

Increased coronary vasomotor tone in acute myocardial infarction patients with spontaneous coronary recanalization

To clarify the role of coronary spasm or dynamic coronary obstruction in the development of acute myocardial infarction (AMI) with spontaneous recanalization (SR), symptoms in 296 patients with AMI admitted within 24 h after the onset of chest pain were analyzed just before and after onset, and coronary angiograms were analyzed soon after onset. Patients were divided into 3 groups according to the initial angiographic findings in the infarct-related coronary artery (IRCA): group 1 comprised 172 patients with total occlusion (TIMI O); group 2 comprised 57 patients with subtotal occlusion (TIMI 1,2); and group 3 comprised 67 patients with SR (TIMI 3). The incidence of SR was 20.3% at 0-4 h after onset, 22.2% at 4-6 h, 19.7% at 6-12 h, 24.0% at 12-24 h, and 36.0% at 24 h or later. The incidence of SR did not increase significantly as time elapsed. The incidence of angina at rest and variable-threshold angina before the onset of infarction was only 16.2% in group 1, but was significantly higher in groups 2 (64.3%) and 3 (61.9%). The incidence of intermittent chest pain at onset in group 1 (8.4%) was significantly lower than in groups 2 (54.5%) and 3 (38.8%). Vasodilation of the proximal normal segment adjacent to the stenotic site of the IRCA induced by intracoronary nitroglycerin was significantly higher in groups 2 (11.7 +/- 1.2%) and 3 (20.7 +/- 2.6%) than in group 1 (4.0 +/- 0.6%). These results suggest that coronary spasm or dynamic obstruction may be involved in the pathogenesis of thrombus formation or coronary obstruction causing AMI in many Japanese patients.

DNA damage-associated dysregulation of the cell cycle and apoptosis control in cells with germ-line p53 mutation

Lymphoblastoid cell lines (LCLs) with heterozygous p53 mutations at residues 286A, 133R, 282W, 132E, and 213ter were established from five independent Li-Fraumeni syndrome families. When cell cycle regulation in response to gamma-irradiation was studied, these LCLs showed an abnormal G1 checkpoint associated with defective inhibition of cyclin E/cyclin-dependent kinase 2 activity in all cases except for 282W LCL, which showed a normal G1 checkpoint. On the other hand, the control of S-phase-G2 as determined by cyclin A/cyclin-dependent kinase 2 activity was defective in all these LCLs. The mitotic checkpoint was also defective in the two LCLs analyzed as either competent or incompetent for G1 arrest. When radiation-induced apoptosis, which requires wild-type p53 function under optimal conditions, was studied, all of these LCLs showed significant failure compared to normal LCLs. These findings indicate that although p53-dependent transactivation and G1-S-phase cell cycle control are variably dysregulated, the induction of apoptosis and control of the cell cycle at S-phase-G2 and the mitotic checkpoint in response to DNA-damaging agents are consistently dysregulated in heterozygous mutant LCLs. This suggests that these dysfunctions underlie, at least in part, the susceptibility of Li-Fraumeni syndrome families to cancer. Furthermore, the approach presented is a potentially useful method for studying individual carriers of different germ-line p53 mutations and different biological features.