Strength of CAR signaling reveals bifurcation of T and ILC2 lineage differentiation from pluripotent stem cells

T cells and type 2 innate lymphoid cells (ILC2) are two closely related lymphoid lineages that share certain developmental and transcriptional programs, including a requirement for Notch and IL-7 signaling during differentiation. We recently developed an artificial thymic organoid (ATO) system that supports in vitro differentiation of human pluripotent stem cells (PSCs) to mature αβT cells. We show here that lentiviral introduction of a CD19-targeted chimeric antigen receptor (CAR) into PSCs surprisingly resulted in ILC2-biased lymphopoiesis from PSCs at the expense of T cell differentiation. PSC-derived ILC2s expressed the classical ILC2 markers CD25, CD200R, and CRTH2 as well GATA3, ID2, and TCF7, and responded to both cytokine stimuli and antigen-dependent CAR signaling by producing IL-5 and IL-13. To understand CAR-mediated lineage diversion from T to ILC2, we performed single cell RNAseq of PSC-derived hematopoietic progenitor cells before the phenotypic onset of either T or ILC2 differentiation. This revealed a gene signature of T cell receptor signaling, suggesting aberrant CAR activation at the earliest stages of lymphocyte development. We established that CAR signaling in ATOs was antigen-independent and thus likely driven by tonic signaling. We applied this finding to rationally modulate the T/ILC2 lineage decision by fine-tuning CAR signaling strength during lymphocyte development from PSCs, permitting restoration of conventional CAR-T cell differentiation or, conversely, directed differentiation of isogenic antigen-specific CAR-ILC2s. Taken together, our findings shed light on human ILC2 development and inform the applied differentiation of both ILC2s and conventional CAR-T cells from PSCs.

Supported by Tobacco-Related Disease Research Program Predoctoral Award (SL), Broad Stem Cell Research Center UCLA Fellowship (SL, CSS), CIRM Bridges Program (CB), NIH T32 (ST), NIH K08CA235525 (CSS).

Induced overexpression of OCT4A in human embryonic stem cells increases cloning efficiency

Our knowledge of the molecular mechanisms underlying human embryonic stem cell (hESC) self-renewal and differentiation is incomplete. The level of octamer-binding transcription factor 4 (Oct4), a critical regulator of pluripotency, is precisely controlled in mouse embryonic stem cells. However, studies of human OCT4 are often confounded by the presence of three isoforms and six expressed pseudogenes, which has complicated the interpretation of results. Using an inducible lentiviral overexpression and knockdown system to manipulate OCT4A above or below physiological levels, we specifically examine the functional role of the OCT4A isoform in hESC. (We also designed and generated a comparable series of vectors, which were not functional, for the overexpression and knockdown of OCT4B.) We show that specific knockdown of OCT4A results in hESC differentiation, as indicated by morphology changes, cell surface antigen expression, and upregulation of ectodermal genes. In contrast, inducible overexpression of OCT4A in hESC leads to a transient instability of the hESC phenotype, as indicated by changes in morphology, cell surface antigen expression, and transcriptional profile, that returns to baseline within 5 days. Interestingly, sustained expression of OCT4A past 5 days enhances hESC cloning efficiency, suggesting that higher levels of OCT4A can support self-renewal. Overall, our results indicate that high levels of OCT4A increase hESC cloning efficiency and do not induce differentiation (whereas OCT4B expression cannot be induced in hESC), highlighting the importance of isoform-specific studies in a stable and inducible expression system for human OCT4. Additionally, we demonstrate the utility of an efficient method for conditional gene expression in hESC.

Faraday instability-based micro droplet ejection for inhalation drug delivery

We report here the technology and the underlying science of a new device for inhalation (pulmonary) drug delivery which is capable of fulfilling needs unmet by current commercial devices. The core of the new device is a centimeter-size clog-free silicon-based ultrasonic nozzle with multiple Fourier horns in resonance at megahertz (MHz) frequency. The dramatic resonance effect among the multiple horns and high growth rate of the MHz Faraday waves excited on a medicinal liquid layer together facilitate ejection of monodisperse droplets of desirable size range (2-5 µm) at low electrical drive power (<1.0 W). The small nozzle requiring low drive power has enabled realization of a pocket-size (8.6 × 5.6 × 1.5 cm³) ultrasonic nebulizer. A variety of common pulmonary drugs have been nebulized using the pocket-size unit with desirable aerosol sizes and output rate. These results clearly provide proof-of-principle for the new device and confirm its potential for commercialization.

Molecular characterization of the human NANOG protein

NANOG is a key transcriptional regulator of pluripotent stem cell (PSC) self-renewal. NANOG occupies promoters that are active and others that are repressed during self-renewal; however, the mechanisms by which NANOG regulates transcriptional repression and activation are unknown. We hypothesized that individual protein domains of NANOG control its interactions with both the promoters and its coregulators. We performed a detailed characterization of the functional domains in the human (h) NANOG protein, using a panel of deletion-mutant and point-mutant constructs. We determined that six amino acids in the homeodomain ((136)YKQVKT(141)) are sufficient for the nuclear localization of hNANOG. We also determined that the tryptophan-rich region (W) of hNANOG contains a CRM1-independent signal for nuclear export, suggesting a possible cellular shuttling behavior that has not been reported for hNANOG. We also show that at least four tryptophans are required for nuclear export. We also determined that similar to murine (m) NANOG, the W region of hNANOG contains a homodimerization domain. Finally, in vitro transactivation analyses identified distinct regions that enhance or diminish activity at gene promoters that are active during self-renewal. Specifically, the N-terminal region interferes with transcription and removal of this region that produced a "super-active" hNANOG with enhanced transcriptional activity. We also confirmed that the transcriptional activator in hNANOG is contained in the C-terminal region, similar to murine NANOG. In summary, this study has characterized the structure and function of hNANOG protein leading to an increased understanding of the mechanism by which hNANOG regulates both transcriptional activation and repression during PSC self-renewal.

Short-term effects of hyposmotic shock on Na+/K+-ATPase expression in gills of the euryhaline milkfish, Chanos chanos

Changes in expression of gill Na+/K+ -ATPase (NKA) on a short-term (96 h) time-course following hyposmotic shock (direct transfer to fresh water) of the euryhaline, marine milkfish were studied on gene, protein, and cell levels in this paper. Plasma osmolality and [Na+] responded with rapid declines in 3 h post-transfer yet, thereafter, remained constant. Plasma [Cl-] gradually fell to a significantly lower level at 6 h post-transfer. Gills responded to hyposmotic shock by a dual phase enhancement of NKA activity and protein abundance; (a) Before 24 h: NKA activity increased as early as 3 h and reached a maximum level from 6 to 12 h post-transfer coincided with the sustained lower levels of plasma osmolality, [Na+], and [Cl-] since 3 h post-transfer. This was followed by a gradual rise in alpha-subunit protein levels that peaked at 12 h post-transfer. Meanwhile, alpha-mRNA of NKA did no show significant change. (b) After 24 h: NKA activity as well as the amounts of alpha-subunit mRNA and protein increased significantly. Direct freshwater transfer induced a prompt and significant decrease of NKA immunoreactive (NKIR) cell abundance in filaments before 24 h, followed by a significant increase after 24 h due to their development in filaments and lamellae. Increased number of NKIR cells after 24 h of hyposmotic shock may occur in conjunction with rise of NKA activity as well as alpha-subunit mRNA and protein abundance. In conclusion, milkfish is able to avoid an excessive drop in plasma ions immediately upon hyposmotic shock and maintain plasma ions on a marginal lower level in fresh water. Notably, the initial increase in NKA activity (adjustive phase; 3-12 h) and delayed increase in NKA mRNA and protein abundance (regulatory phase; 48-96 h) indicate the importance of a higher level of the gill enzyme in milkfish upon hyposmotic shock.

Poor agreement between dipyridamole-stress technetium-99m-tetrofosmin myocardial perfusion single photon emission computed tomography and two-dimensional echocardiography in Kawasaki disease

To establish a noninvasive diagnostic method for early assessment of cardiac involvement in Kawasaki disease (KD), 28 children with KD were included in this study. Two-dimensional echocardiography (2D-Echo) to detect the aneurysms of coronary arteries (CA), as well as rest and dipyridamole-stress technetium-99m tetrofosmin (Tc-TF) myocardial perfusion single photon emission computed tomography (SPECT) to detect abnormal myocardial perfusion were performed in all of the 28 children with KD and to compare each other. The results showed that (1). 42.9% of cases had no aneurysm and 57.1% had significant aneurysms detected by 2D-Echo; (2). 42.9% of cases had normal perfusion and 57.1% of cases had abnormal myocardial perfusion assessed by Tc-TF myocardial perfusion SPECT; (3). 25.0% of cases showed both normal 2D-Echo and Tc-TF myocardial perfusion SPECT findings and 39.3% of cases showed both abnormal 2D-Echo and Tc-TF myocardial perfusion SPECT findings; and (4). there was poor agreement between 2D-Echo and Tc-TF myocardial perfusion SPECT findings (P>0.05). We concluded that poor agreement exists between aneurysms and abnormal myocardial perfusion detected by 2D-Echo and Tc-TF myocardial perfusion SPECT findings in patients with KD.

Detection of chromosomal instability in paired breast surgery and ductal lavage specimens by interphase fluorescence in situ hybridization

PURPOSE

Ductal lavage is a new modality for collecting exfoliated breast cells with the goal of detecting early neoplasia. The purpose of our study was to evaluate the correlation between cancer-associated abnormalities in breast lesions and exfoliated breast cells collected by ductal lavage.

EXPERIMENTAL DESIGN

We performed histopathologic, cytologic, and molecular cytogenetic analyses on 39 paired cases of surgically excised breast lesions and ductal lavage specimens collected immediately before surgery.

RESULTS

Abnormal cytology was detected in 7 of 15 (47%) of the evaluable lavages collected from malignant cases, versus 4 of 19 (21%) of the evaluable lavages harvested from benign cases for a sensitivity and specificity of 47 and 79%, respectively. Interphase fluorescence in situ hybridization analysis of all evaluable lavages revealed numeric changes on chromosomes 1, 8, 11, and/or 17 in 10 of 14 (71%) specimens from malignant cases versus 2 of 18 (11%) from benign cases for a sensitivity and specificity of 71 and 89%, respectively.

CONCLUSIONS

Our study demonstrates that cytologic and genetic abnormalities associated with breast cancer progression can be detected in ductal lavage cells collected from women with in situ and invasive breast cancer and suggests that fluorescence in situ hybridization may have superior sensitivity and specificity compared with conventional cytology.

Immunocytochemical analysis of breast cells obtained by ductal lavage

BACKGROUND

Intraductal breast fluids containing exfoliated mammary epithelial cells can be harvested from the breast by ductal lavage to screen for disease-associated cytologic abnormalities. In addition to epithelial cells, breast fluids contain large numbers of mammary foam cells, and the tissue of origin of these foam cells has been the subject of controversy for many years. Immunocytochemical, morphologic, and molecular studies variously have supported a mammary epithelial origin versus a histiocytic origin for this cell type. In the current study, the authors performed immunocytochemical analysis with epithelial specific and macrophage specific antibodies to characterize and quantify breast cells obtained by ductal lavage.

METHODS

Breast fluids were harvested from 19 individual breast ducts in 15 female patients by ductal lavage. Cells from each specimen were processed for immunocytochemical staining using the AE1/AE3 multicytokeratin and CD68 (clone KP1) monoclonal antibodies. Cells were classified as mammary epithelial cells or mammary foam cells on the basis of morphologic criteria, and the cells were counted and evaluated for immunoreactivity with epithelial specific and macrophage specific antibodies.

RESULTS

The CD68 macrophage specific antibody stained all ductal lavage cells that exhibited foam cell morphology. The AE1/AE3 multicytokeratin antibody demonstrated strong, positive staining of cells that exhibited epithelial morphology but failed to demonstrate significant staining of mammary foam cells. The lavage specimens contained a range of 3040-278,850 epithelial cells and 2230-90,480 foam cells. The median numbers of epithelial cells and foam cells per lavage sample were 15,680 and 29,200, respectively. The ratio of epithelial cells to foam cells varied among specimens ranging from 3.4 to 0.09 (median, 0.8). Seven of 19 lavage specimens contained more epithelial cells than foam cells, whereas 12 samples contained a greater proportion of foam cells.

CONCLUSIONS

Immunocytochemical analysis using the AE1/AE3 multicytokeratin and CD68 antibodies supports a histiocytic origin for the majority of mammary foam cells harvested from the ductal system of the human breast by ductal lavage. Although mammary foam cells constitute a significant proportion of the cellular population obtained by ductal lavage, thousands of epithelial cells also are harvested.

Technetium-99m tetrofosmin chest imaging related to p-glycoprotein expression for predicting the response with paclitaxel-based chemotherapy for non-small cell lung cancer

Our aim was to use technetium-99m tetrofosmin (Tc-TF) uptake in non-small cell lung cancer (NSCLC) for predicting the chemotherapeutic response of NSCLC to paclitaxel and to compare the results with the expression of multidrug resistance (MDR) - P-glycoprotein (Pgp). Twenty patients with advanced NSCLC were enrolled in this study before chemotherapy with paclitaxel. Tc-TF chest imaging was performed to calculate early and delayed tumor-to-normal lung (T/NL) count-density ratios, as well as washout indexes (WIs). Immunohistochemical analyses were performed on multiple nonconsecutive sections of the biopsy specimens to detect Pgp expression. The response to chemotherapy was evaluated by clinical and radiological methods in the third month after completion of treatment. The early and delayed T/NL count-density ratios of patients with good response were significantly higher than those of patients with poor response (p <0.05). However, no significant difference in WI between the two groups of patients was found (p > 0.05). A significantly higher incidence of good response was found in patients with negative Pgp expression (100%) than in patients with positive Pgp expression (40%) (p <0.05). Significantly higher early and delayed T/NL count-density ratios as well as decreased WIs were found in patients with negative Pgp expression than in patients with positive Pgp expression. However, other prognostic factors (age, sex, body weight loss, performance status, tumor stage, and tumor cell type) were not significantly different between the patients with good response and those with poor response. Because Tc-TF chest images can correctly represent the expression of Pgp in NSCLC, it can accurately predict the chemotherapeutic response to paclitaxel.

Detecting parathyroid adenoma using technetium-99m tetrofosmin: comparison with P-glycoprotein and multidrug resistance related protein expression--a preliminary report

The aim of this study was to investigate the relationships among technetium-99m tetrofosmin (Tc-TF) accumulation in parathyroid adenoma and the expression of P-glycoprotein (Pgp) or multidrug resistance related protein (MRP). Before operation, 33 patients with parathyroid adenomas (larger than 1.5 gm) were studied with parathyroid scintigraphy 10 minutes and 2 hours after intravenous injection of Tc-TF before operation. Immunohistochemical analyses (IHA) were performed on multiple nonconsecutive sections of operative parathyroid specimens to detect Pgp or MRP expression. According to the results of IHA, the 33 parathyroid adenomas were separated into four groups: (1) 2 adenomas with both positive Pgp and positive MRP expression, (2) 1 adenomas with positive Pgp but negative MRP expression, (3) 2 adenomas with negative Pgp but positive MRP expression, and (4) 28 adenomas with both negative Pgp and negative MRP expression. All of 28 adenomas in the group 4 could be detected by Tc-TF parathyroid imaging. All of 5 adenomas in the groups 1 to 3 could not be detected by TcTF parathyroid imaging (p < 0.05). Not only the size of parathyroid adenomas, but also significant Pgp or MRP expression limited the sensitivity of Tc-TF parathyroid imaging to localize parathyroid adenomas before operation.

Crystal structure of the macrocycle-forming thioesterase domain of the erythromycin polyketide synthase: versatility from a unique substrate channel

As the first structural elucidation of a modular polyketide synthase (PKS) domain, the crystal structure of the macrocycle-forming thioesterase (TE) domain from the 6-deoxyerythronolide B synthase (DEBS) was solved by a combination of multiple isomorphous replacement and multiwavelength anomalous dispersion and refined to an R factor of 24.1% to 2.8-A resolution. Its overall tertiary architecture belongs to the alpha/beta-hydrolase family, with two unusual features unprecedented in this family: a hydrophobic leucine-rich dimer interface and a substrate channel that passes through the entire protein. The active site triad, comprised of Asp-169, His-259, and Ser-142, is located in the middle of the substrate channel, suggesting the passage of the substrate through the protein. Modeling indicates that the active site can accommodate and orient the 6-deoxyerythronolide B precursor uniquely, while at the same time shielding the active site from external water and catalyzing cyclization by macrolactone formation. The geometry and organization of functional groups explain the observed substrate specificity of this TE and offer strategies for engineering macrocycle biosynthesis. Docking of a homology model of the upstream acyl carrier protein (ACP6) against the TE suggests that the 2-fold axis of the TE dimer may also be the axis of symmetry that determines the arrangement of domains in the entire DEBS. Sequence conservation suggests that all TEs from modular polyketide synthases have a similar fold, dimer 2-fold axis, and substrate channel geometry.

Giant tear retinal detachment after laser in situ keratomileusis--a case report

A 42-year-old woman with a refractive error of -10.00S - 2.00C x 105 degrees in the right eye underwent laser in situ keratomileusis (LASIK) at our hospital. LASIK was performed using the Schwind excimer laser (Keratom Multiscan, Schwind, Kleinostheim, Germany) and Moria LSK--One manual microkeratome with a 130 microns ablation plate. The uncorrected visual acuity improved postoperatively, and the patient was very satisfied. However, nine months later, she complained of sudden loss of visual acuity in the right eye. Indirect ophthalmoscopy revealed a giant retinal tear extending from 10:00 to 2:00 o'clock position with retinal detachment and vitreous hemorrhage. We performed scleral buckling procedure (with silicone band encircling), vitrectomy, and fluid-gas exchange with air/SF6 mixture. The retina attached postoperatively and remained so during 3-month follow-up period, but cellophane maculopathy was noted.

Synthesis of 1-benzyl-3-(5'-hydroxymethyl-2'-furyl)indazole analogues as novel antiplatelet agents

1-Benzyl-3-(5'-hydroxymethyl-2'-furyl)indazole (28, YC-1) was selected as the lead compound for systemic structural modification. After screening for antiplatelet activity, SARs of YC-1 analogues were established. Among these potent active derivatives, compounds 29, 30, 31, 44, and 45 functioned as potent activators of sGC and inhibitors of PDE5 with potency comparable to that of YC-1. In addition, compound 58 was found to be a selective and potent inhibitor of protease-activated receptor type 4 (PAR4)-dependent platelet activation.

Comparison of the uptake and clearance of Tc-99m MIBI, Tl-201 and Ga-67 in drug-resistant lymphoma cell lines

Tc-99m sestamibi (MIBI) has been used as a tumor-seeking agent. However, its role in detecting lymphomas has not been widely investigated. The aim of the present study was to determine the uptake and clearance characteristics of Tc-99m MIBI in vincristine-resistant lymphoma cell lines. In addition, thallium-201 (Tl-201) and gallium-67 (Ga-67) uptake and clearance characteristics were evaluated for comparison with Tc-99m MIBI. Drug-resistant lymphoma cell lines (monocyte-like, histiocytic lymphoma, human; B-lymphoma cell line, American Burkitt lymphoma, lymphoblastoid, human; Hodgkin's disease, lymphoid, human) were selected by multistep vincristine treatment up to 50 nM. After incubation of the radiotracers, Tc-99m MIBI, Tl-201 and Ga-67, in medium for 0, 10, 20, 30, 60 or 120 min, the uptake and clearance of each radiotracer were measured in the drug-resistant lymphoma cell lines. In addition, P-glycoprotein expression was determined by immunohistochemical study. In a comparison of the three radiotracers, the uptake of Tc-99m MIBI was the greatest in the studied wild-type lymphoma cell lines. Tc-99m MIBI uptake was much lower in drug-resistant tumor cell lines than in non-resistant cell lines. On the other hand, the uptake characteristics of Tl-201 did not differ between drug-resistant and non-resistant cells. Immunohistochemistry analyses of Ab-1 or JSB indicated that tumor cells expressed MDR-1 protein in all three cell lines. Tc-99m MIBI is a good radiotracer for detecting drug resistance in lymphoma cell lines.

The role of technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) in the detection of cardiovascular involvement in systemic lupus erythematosus patients with non-specific chest complaints

OBJECTIVES

Systemic lupus erythematosus (SLE) can affect multiple organs. Coronary artery disease has received increasing recognition as a major cause of morbidity and mortality in SLE in recent years. The purpose of this study was to evaluate the utility of technetium-99m sestamibi single-photon emission computed tomography ((99m)Tc-sestamibi SPECT) in the detection of cardiovascular involvement in SLE patients with non-specific clinical chest symptoms such as chest discomfort and/or dyspnoea and/or occasional palpitation.

METHODS

Thirty-three SLE female patients (age range: 22-45 yr) with non-specific complaints such as chest discomfort and/or dyspnoea and/or occasional palpitation were investigated using a (99m)Tc-sestamibi myocardial perfusion SPECT scan at rest and after dipyridamole infusion in a stress study. The age- and sex-matched healthy group (24 cases) and SLE patients without any cardiovascular symptoms/signs (28 cases) were also included as controls in this study. The results of the uptake pattern of (99m)Tc-sestamibi were classified into four types including normal, persistent perfusion defect, reversible perfusion defect and reverse redistribution.

RESULTS

Perfusion abnormalities were detected in 27 cases (seven patients had persistent perfusion defects, 15 patients had reversible perfusion defects, one patient had both persistent and reversible perfusion defects, two patients showed a reverse redistribution pattern and two patients had both reversible perfusion defects and a reverse redistribution pattern). The results of the SPECT in the healthy group were all normal. However, perfusion abnormalities were detected in 12 cases in the group of asymptomatic SLE patients.

CONCLUSIONS

(99m)Tc-sestamibi myocardial perfusion SPECT is a useful non-invasive imaging modality to detect cardiovascular involvement in SLE patients with non-specific clinical complaints of heart disease.

Ga-67 scan to detect intra-abdominal infection in patients after colorectal surgery

PURPOSE

Intra-abdominal infection is still an important issue in colorectal surgery. The Ga-67 scan is relatively inexpensive, but the delay in diagnosis and the intense physiologic bowel activity are considerable drawbacks to its use in abdominal investigations. In this study, the authors performed 24-hour Ga-67 scans and read the images with the surgeon to detect abdominal infection in patients who underwent colorectal surgery.

METHODS

Sixty-one patients who underwent colorectal surgery were enrolled in this study. Ga-67 scintigraphy was performed 24 hours, and later as needed, after the injection of 111 MBq (3 mCi) Ga-67 citrate. All scans were interpreted together by a nuclear medicine specialist and the surgeon. The intensity of Ga-67 uptake was recorded as grade 0: no uptake; grade 1: less than liver uptake; grade 2: equal to liver uptake; or grade 3: greater than liver uptake. When the intensity of Ga-67 uptake was equal to or greater than grade 2, the pattern of Ga-67 uptake was classified as changing or unchanging. A positive Ga-67 scan was defined as having an intensity of grade 2 or 3 with an unchanging pattern.

RESULTS

Nineteen abdominal infections were diagnosed, all by Ga-67 scans, for a diagnostic sensitivity rate of 100%. Of the 42 patients with no intra-abdominal infection, only 2 had positive Ga-67 scans. This resulted in a specificity rate of 95.2%. The overall accuracy of the Ga-67 scan in the detection of intra-abdominal infection after colorectal surgery was 96.7%.

CONCLUSIONS

The Ga-67 scan is useful for detecting intra-abdominal infection after colorectal surgery. Reading the images with the surgeon and using a lateral view can decrease the false-positive rate. A negative Ga-67 scan can rule out intra-abdominal infection, whereas a positive Ga-67 scan indicates the need for further patient evaluation after colorectal surgery.

Predicting chemotherapy response and comparing with P-glycoprotein expression using technetium-99m tetrofosmin scan in untreated malignant lymphomas

The purposes of this study were to predict the chemotherapy response of untreated malignant lymphomas (ML) using a technetium-99m tetrofosmin (Tc-TF) scan and to compare Tc-TF results with P-glycoprotein (Pgp) expression. Before undergoing chemotherapy, 25 patients with ML were enrolled in this study. Tc-TF scan was performed 10 min after intravenous injection of Tc-TF. Immunohistochemical analyses were performed on multiple sections of ML specimens to evaluate Pgp expression. The chemotherapy response was evaluated in the first 1-2 years after the completion of treatment. The mean tumor-to-background ratio of the 15 patients with good responses (3.23+/-0.56) was significantly higher than that of the ten patients with poor responses (1.18+/-0.11). All of the 15 patients with good responses had positive Tc-TF scan results, but negative Pgp expression. Among the ten patients with poor responses, all had negative Tc-TF scan results, but six had positive Pgp expression and four had negative Pgp expression. Significant differences in the incidences of good and poor responses were found between patients with positive Tc-TF scan results and patients with negative Tc-TF scan results and between patients with positive Pgp expression and patients with negative Pgp expression. No significant differences in the incidences of good and poor responses were found between Hodgkin's disease patients and non-Hodgkin's lymphoma patients, stage I-II patients and III-IV patients, patients aged >40 and patients aged < or =40 years, and patients with and without B symptoms. Compared with other prognostic factors, Tc-TF scan results and Pgp expression more accurately predict the chemotherapy response in patients with ML.

Abdominal abscesses in patients having surgery: an application of Ga-67 scintigraphic and computed tomographic scanning

PURPOSE

Early detection of occult abscesses is important in patients with persistent fever after colorectal surgery. In this study, the authors evaluated the relative merits of computed tomographic (CT) and Ga-67 scans in the detection of intra-abdominal abscesses in patients who had just undergone colorectal surgery.

MATERIALS AND METHODS

Thirty-four patients who underwent colorectal surgery were enrolled in the study. Ga-67 and CT scans were obtained in all patients. Ga-67 scintigraphy was performed 24 hours, and later as needed, after the injection of 111 MBq (3 mCi) Ga-67 citrate.

RESULTS

Intra-abdominal abscesses were diagnosed in 16 of the 34 (47%) patients who had colorectal surgery. For CT scans, the overall accuracy, sensitivity, and specificity rates were 97.1%, 93.7%, and 100%, respectively. For the Ga-67 scans, the diagnostic accuracy, sensitivity, and specificity rates were 91.2%, 100%, and 95.2%, respectively. In addition, the whole-body Ga-67 scans successfully detected two cases of extra-abdominal infection, one case of pneumonia, and one case of cellulitis.

CONCLUSIONS

Computed tomographic and Ga-67 scans offer complementary information and play an important role in the investigation of sources of infection in patients after colorectal surgery.

To predict chemotherapy response using technetium-99m tetrofosmin and compare with p-glycoprotein and multidrug resistance related protein-1 expression in patients with untreated small cell lung cancer

The aim of this study was to investigate the relationships among technetium-99m tetrofosmin (Tc-TF) accumulation in untreated small cell lung cancer (SCLC), the expression of P-glycoprotein (Pgp) and multidrug resistance related protein-1 (MRP1), and the response to chemotherapy in patients with untreated SCLC. Thirty patients with SCLC were studied with chest scintigraphy 15 to 30 min after intravenous injection of Tc-TF before chemotherapeutic induction. Tc-TF chest scans were interpreted both visually and quantitatively. The response to chemotherapy was evaluated upon completion of chemotherapy. Immunohistochemical analyses were performed on multiple non-consecutive sections of biopsy specimens to detect Pgp and MRP1 expression. Fifteen patients with good response to chemotherapy had a significantly higher incidence (100.0%) of positive Tc-TF chest single photon emission computed tomography (SPECT) findings and negative Pgp or MPR expression than 15 patients with poor response (20%) (P<0.05). The tumor/background (T/B) ratios were 1.8+/-0.3 and 1.2+/-0.3 for patients with good response and poor response, respectively (P<0.05). However, other prognostic factors (performance status, tumor size and stage) were not significantly related to Tc-TF chest scan findings and response to chemotherapy. Tc-TF chest scintigraphy correlated well with Pgp or MRP1 expression and accurately predicted the response to chemotherapy in patients with SCLC.

The higher likelihood of developing cardiomegaly during follow-up in patients with syndrome X and abnormal thallium-201 myocardial perfusion SPECT

'Syndrome X' describes patients with exertional chest pain and a normal coronary arteriogram. In some patients, acute myocardial ischemia can be demonstrated by regional myocardial perfusion defects on thallium-201 exercise test. However, some patients with typical angina have normal perfusion on thallium-201 heart scintigraphy. It is not clear whether there are different prognoses for patients with normal and abnormal thallium studies. In this study, the clinical features, long term follow-up and clinical results of syndrome X patients with normal and abnormal thallium studies were evaluated to determine the differences between these two groups. Fifty-nine patients (52 males, seven females, mean age 62+/-6 years) with syndrome X were enrolled and divided into two groups on the basis of results of thallium-201 heart scintigraphy. Group I was comprised of 22 patients with normal thallium-201 perfusion scan and group II was comprised of 37 patients with abnormal thallium-201 heart scan. All subjects received coronary arteriography, exercise test, thallium-201 myocardial SPECT, ejection fraction of left ventricle, echocardiography, blood analysis and long term follow-up with questionnaire for 10 years. Lower maximal rate-pressure product and higher angina scores were found in group II. More patients developed cardiomegaly (nine of 33 patients) in group II than in group I (one of 21 patients). Both groups, however, were at low risk for cardiac events (cardiac death or myocardial infarction).

Comparison of CYFRA 21-1 and squamous cell carcinoma antigen in detecting nasopharyngeal carcinoma

CYFRA 21-1 is a newly developed tumor marker that is especially useful for detecting squamous cell carcinoma (SCC) of the lung. Squamous cell carcinoma antigen is a proven tumor marker that is especially useful for detecting SCC of the cervix. Our aim in this study was to compare the clinical value of CYFRA 21-1 and SCC antigen in the detection of nasopharyngeal carcinoma (NPC). Serum levels of CYFRA 21-1 and SCC antigen were measured in 80 untreated NPC patients and 77 healthy controls. The cutoff values of CYFRA 21-1 and SCC antigen, determined at the 95th percentile of the 77 healthy controls, were 2.48 ng/mL and 1.49 ng/mL, respectively. The results revealed that the mean serum value of only CYFRA 21-1 was significantly higher in the 80 NPC patients than in the 77 healthy controls, and the detection sensitivity of CYFRA 21-1 for NPC was significantly higher than that of SCC antigen. In conclusion, our results suggest that CYFRA 21-1 is a better tumor marker than SCC antigen for detection of NPC.

Evaluation of chemotherapy response using technetium-99M-sestamibi scintigraphy in untreated adult malignant lymphomas and comparison with other prognosis factors: a preliminary report

The purpose of this study was to predict chemotherapy response using technetium-99m methoxyisobutylisonitrile (Tc-MIBI) scintigraphy in untreated adult malignant lymphomas (ML) and compare the response with other prognosis factors. Before chemotherapy, 25 adult patients with ML were enrolled in this study. Tc-MIBI scintigraphy was performed 10 min after intravenous injection of Tc-MIBI to calculate tumor-to-background (T/B) uptake ratio and interpret the results visually. Chemotherapy response was evaluated in the first 1 to 2 years after completion of treatment by clinical and radiological methods. The mean T/B uptake ratio of the 15 patients with good response (3.3 +/- 0.6) was significantly higher than that of the 10 patients with poor response (1.2 +/- 0.1). All of the 15 patients with good response had positive Tc-MIBI scintigraphic results. All of the 10 patients with poor response had negative Tc-MIBI scintigraphic results. However, there were no significant differences in the incidences of good and poor responses for other prognosis factors. In our preliminary study, when compared with other prognosis factors, Tc-MIBI scintigraphy was the best tool to predict chemotherapy response in adult patients with ML.

Comparing 18-fluoro-2-deoxyglucose positron emission tomography with a combination of technetium 99m tetrofosmin single photon emission computed tomography and computed tomography to detect recurrent or persistent nasopharyngeal carcinomas after radiotherapy

BACKGROUND

The diagnostic accuracy of combined computed tomography (CT) and technetium 99m tetrofosmin (Tc-TF) single photon emission computed tomography (SPECT) of head and neck to differentiate recurrent or residual nasopharyngeal carcinomas (NPCs) from benign lesions after radiotherapy was evaluated and compared with positron emission tomography (PET) with 18-fluoro-2-deoxyglucose (FDG).

METHODS

Four months after radiotherapy, 36 patients with NPC underwent Tc-TF SPECT and CT of head and neck to differentiate recurrent or residual NPC from benign lesions. Histopathologic examinations were performed on nasopharyngeal biopsies of all 36 patients.

RESULTS

Based on the biopsy results, the sensitivity, specificity, and accuracy of Tc-TF SPECT were 64%, 96%, and 86%, respectively, for differentiation of recurrent or persistent NPC from benign lesions. For CT and FDG-PET, the sensitivity, specificity, and accuracy were 73%, 88%, and 83% and 100%, 96%, 97%, respectively. For the 27 patients with NPC whose Tc-TF SPECT and CT results were congruent, the combination of Tc-TF SPECT and CT had the same sensitivity, specificity, and accuracy (100%, 96%, and 96%) as FDG-PET. For the nine patients with NPC with incongruent Tc-TF SPECT and CT results, FDG-PET correctly differentiated two benign lesions from seven recurrent/residual NPCs.

CONCLUSIONS

Although, FDG-PET is the best tool for detecting recurrent or residual NPC, combined congruent Tc-TF SPECT and CT results achieved the same accuracy as FDG-PET. Therefore, we concluded that FDG-PET could be considered only when Tc-TF SPECT and CT give incongruent results.

Coexpression of Mutant p53 and p193 Renders Embryonic Stem Cell–Derived Cardiomyocytes Responsive to the Growth-Promoting Activities of Adenoviral E1A

Abstract —Expression of adenoviral E1A in cardiomyocytes results in the activation of DNA synthesis followed by apoptosis. In contrast, expression of simian virus 40 large T antigen induces sustained cardiomyocyte proliferation. Previous studies have shown that T antigen binds to 2 proapoptotic proteins in cardiomyocytes, namely the p53 tumor suppressor and p193 (a new member of the BH3-only proapoptosis subfamily). Structure-function analyses identified a p193 C-terminal truncation mutant that encodes prosurvival activity. This mutant was used to test the role of p193 in E1A-induced cardiomyocyte apoptosis. E1A induced apoptosis in cardiomyocytes derived from differentiating embryonic stem cells. Expression of the prosurvival p193 mutant alone or a mutant p53 alone did not block E1A-induced apoptosis. In contrast, combinatorial expression of mutant p193 and mutant p53 blocked E1A-induced apoptosis, resulting in a proliferative response indistinguishable from that seen with T antigen. These results confirm the hypothesis that there are 2 proapoptotic pathways, encoded by p53 and p193, respectively, which restrict cardiomyocyte cell cycle activity in differentiating embryonic stem cell cultures. Furthermore, these results explain in molecular terms the phenotypic differences of E1A versus T-antigen gene transfer in cardiomyocytes.

Comparison of technetium-99m methoxyisobutylisonitrile single photon emission computed tomography and computed tomography to detect recurrent or residual nasopharyngeal carcinomas after radiotherapy

The diagnostic accuracy of technetium-99m methoxyisobutylisonitrile (Tc-MIBI) single photon emission computed tomography (SPECT) of head and neck to differentiate between recurrent or residual nasopharyngeal carcinomas (NPC) and benign lesions after radiotherapy was evaluated, and compared with computed tomography (CT). Thirty-six NPC patients 4 months after radiotherapy underwent Tc-MIBI SPECT and CT of head and neck, as well as histopathological examination of nasopharyngeal biopsies. Based on the biopsy results, the sensitivity, specificity, and accuracy of CT were 73%, 88%, and 83%, respectively. The sensitivity, specificity, and accuracy of Tc-MIBI SPECT were 64%, 96%, and 86%, respectively. The sensitivity, specificity, and accuracy of combined Tc-MIBI SPECT and CT were 100%, 88%, and 92%, respectively. Tc-MIBI SPECT had a better specificity and a lower sensitivity to differentiate benign lesions from recurrent/residual NPC when compared with CT The combined use of CT and Tc-MIBI SPECT significantly increased accuracy compared with the single use of either Tc-MIBI SPECT or CT to differentiate benign lesions recurrent/residual NPC.

Technetium-99m-sestamethoxyisobutylisonitrile scan as a predictor of chemotherapy response in malignant lymphomas compared with P-glycoprotein expression, multidrug resistance-related protein expression and other prognosis factors

The purpose of the present study was to predict the response of malignant lymphomas (MLs) to chemotherapy using technetium-99m methoxyisobutylisonitrile (Tc-MIBI) scan and to compare it with the predictive ability of P-glycoprotein (P-gp) expression, multidrug resistance-related protein (MRP) expression and other prognosis factors. Twenty-five ML patients were enrolled in this study prior to initiation of chemotherapy. Images were obtained 10 min after intravenous injection of Tc-MIBI, interpreted visually and the tumour-to-background (T/B) ratios calculated. Immunohistochemical analyses were performed on sections of the biopsy specimens to determine P-gp and MRP expression. Chemotherapy response was evaluated in the first 1-2 years after completion of chemotherapy. The mean T/B ratio of the 15 patients with a good response (3.3 +/- 0.6) was significantly higher than that of the 10 patients with a poor response (1.2 +/- 0.1). All 15 patients with a good chemotherapy response had positive Tc-MIBI scan results and negative P-gp and MRP expression. All 10 patients with a poor response had negative Tc-MIBI scan results and either positive P-gp or MRP expression. Other prognosis factors showed no significant difference in the incidence of good and poor responses. Tc-MIBI scan results represent P-gp or MRP expression more accurately than other prognosis factors and predict the chemotherapy response in ML patients.

Evaluation of hepatobiliary function by hepatobiliary scintigraphy in hepatoma patients after transcatheter arterial embolization

BACKGROUND

Transcatheter arterial embolization (TAE) is the treatment of choice for inoperable hepatocellular carcinoma. However, altered and impaired gallbladder function due to gallbladder infarction and bile duct necrosis following TAE have been reported.

METHODS

Hepatobiliary function was evaluated using quantitative Tc-99m DISIDA hepatobiliary scintigraphy in 40 hepatoma patients before and after TAE. The patients were separated into two groups: group 1 (20 patients), who received pre-cystic artery TAE, and group 2 (also 20 patients), who received post-cystic artery TAE.

RESULTS

After TAE, there were no significant changes in liver or bile duct function in the patients of either group. However, for group I patients, significantly decreased gallbladder function was found after TAE.

CONCLUSIONS

Altered and impaired gallbladder function is common in hepatoma patients who receive pre-cystic artery TAE, and Tc-99m DISIDA cholescintigraphy may be useful for evaluating hepatobiliary function in hepatoma patients who receive TAE.

RBP1 recruits the mSIN3-histone deacetylase complex to the pocket of retinoblastoma tumor suppressor family proteins found in limited discrete regions of the nucleus at growth arrest

Retinoblastoma (RB) tumor suppressor family pocket proteins induce cell cycle arrest by repressing transcription of E2F-regulated genes through both histone deacetylase (HDAC)-dependent and -independent mechanisms. In this study we have identified a stable complex that accounts for the recruitment of both repression activities to the pocket. One component of this complex is RBP1, a known pocket-binding protein that exhibits both HDAC-dependent and -independent repression functions. RB family proteins were shown to associate via the pocket with previously identified mSIN3-SAP30-HDAC complexes containing exclusively class I HDACs. Such enzymes do not interact directly with RB family proteins but rather utilize RBP1 to target the pocket. This mechanism was shown to account for the majority of RB-associated HDAC activity. We also show that in quiescent normal human cells this entire RBP1-mSIN3-SAP30-HDAC complex colocalizes with both RB family members and E2F4 in a limited number of discrete regions of the nucleus that in other studies have been shown to represent the initial origins of DNA replication following growth stimulation. These results suggest that RB family members, at least in part, drive exit from the cell cycle by recruitment of this HDAC complex via RBP1 to repress transcription from E2F-dependent promoters and possibly to alter chromatin structure at DNA origins.

Cerebral perfusion in patients with syndrome X: a single photon emission computed tomography study

OBJECTIVE

To test the hypothesis that syndrome X is a systemic vascular disorder, the authors studied 40 patients with this diagnosis using technetium-99m hexamethylpropylene amine oxime and single photon emission computed tomography (SPECT) brain images. Twenty-three of 25 cases with definite myocardial perfusion defects diagnosed by thallium-201 myocardial perfusion SPECT also had multiple hypoperfusion areas in the brain versus 2 of 15 patients without thallium myocardial defects. The parietal lobes were the most common hypoperfusion areas, and cerebellum was the least common. Syndrome X is a systemic vascular disorder with a high incidence of hypoperfusion lesions of the brain and is usually coincident with myocardial defects.

The simulation effects of mountain climbing training on selected endocrine responses

The simulation effects of mountain climbing exercise training on plasma testosterone, cortisol and luteinizing hormone (LH) levels were examined in ten recreational mountain male climbers. Subjects underwent a simulating mountain climbing exercise training 3 times a week for a total of eight weeks before an expedition to Mount Muztag Ata (7546 m, Xingian, China). During training, each subject carried a 40 kg back pack while walking on a treadmill at a speed of 1.9 mph for 60 min at sea level. Subjects completed an incremental treadmill test to exhaustion prior to training, after training, and one week after returning from Mount Muztag Ata. Blood samples were collected from antecubital vein at rest and at 5, 60, and 120 min post testing to determine the plasma testosterone, cortisol and LH levels. The basal plasma testosterone and cortisol concentrations were lower in both post-training and after-climbing conditions compared with that in the pre-training condition (p<0.01). The basal plasma LH concentration was remained unchanged after training and after the mountain climbing compared with levels measured in the pre-training phase. No correlation could be established between plasma LH and testosterone level. These results suggest that an eight-week period of mountain climbing training protocol may be beneficial in maintaining normal endocrine function during and after high altitude mountain expedition. Our results also indicate the decrease of plasma testosterone was LH independent.

Uptake of gallium-67 citrate in clean surgical incisions after colorectal surgery

Non-specific accumulation of gallium-67 citrate (gallium) in uncomplicated surgical incisions is not uncommon. It is important to know the normal pattern of gallium uptake at surgical incision sites in order to properly interpret the gallium scan when investigating possible wound infection in patients who have undergone abdominal surgery. We studied 42 patients without wound infection after colorectal surgery and performed gallium scans within 40 days after surgery. Patients were divided into three groups according to the interval between the operation and the scan. In group A (26 patients) gallium scan was performed within 7 days after surgery, in group B (8 patients) between 8 and 14 days after surgery, and in group C (8 patients) between 15 and 40 days after surgery. Our data showed that in group A, 61.5% had gallium accumulation at the surgical incision site. In group B, 50% had accumulation of gallium at the surgical incision site, while in group C only one patient (12.5%) showed gallium uptake. It is concluded that the incidence of increased gallium uptake at clean surgical incision sites is high after colorectal surgery. Nuclear medicine physicians should bear in mind the high incidence of non-specific gallium uptake at such sites during the interpretation of possible wound infection in patients after colorectal surgery.

Whole body 18F-2-deoxyglucose positron emission tomography to restage non-small cell lung cancer

The helpfulness of 18F-2-deoxyglucose positron emission tomography (FDG-PET) in restaging non-small cell lung cancer (NSCLC) has not been extensively evaluated. A total of 156 patients referred for restaging of NSCLC were retrospectively evaluated. According to the classification of American Joint Committee on Cancer, stages I and II were defined as conventionally resectable, stage IIIA as locally advanced but resectable, stage IIIB as locally advanced but unresectable, and stage IV as absolutely unresectable. Compared to initial staging by chest computed tomographic findings, FDG-PET down-staged 45/156 (29%) and up-staged 52/156 (33%) NSCLCs. In addition, 37/156 (23%) patients were reclassified from resectable to unresectable and 22/156 (14%) patients were reclassified from unresectable to resectable. Our results prove the helpfulness of whole body FDG-PET for restaging NSCLC.

Value of 18F-fluoro-2-deoxyglucose positron emission tomography in the evaluation of recurrent colorectal cancer

To evaluate the clinical value of positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) in recurrent colorectal cancer, the records of 33 patients who underwent 34 FDG-PET scans were reviewed and compared with computed tomography (CT) and carcinoembryonic antigen (CEA). The final diagnosis was based on operative, histopathological findings or clinical follow-up > 1 year. FDG-PET detected all 15 patients with recurrent diseases (9 local recurrences, 4 lymphatic metastases, 2 hepatic metastases and 8 pulmonary metastases) and 1 primary lung cancer. However, there were 3 false positive cases. The overall sensitivity and specificity of FDG-PET were 100% and 83%, respectively. The sensitivity and specificity of CEA were 33% and 86%, respectively, for detecting recurrent colorectal cancer. Abdominal CT had a sensitivity and specificity of 78% and 61% for detecting local recurrence and detected one lymphatic and one hepatic metastasis. In conclusion, the FDG-PET was more accurate than CT and CEA for the detection of recurrent colorectal cancer. In addition, it accurately detected distant metastases or occult secondary malignancy and may affect clinical management.

Technetium-99m tetrofosmin scintigraphy for detecting malignant lymphoma

The aim of this study was to assess the use of Tc-99m tetrofosmin (Tc-TF) scintigraphy for detecting malignant lymphomas. In the study, before any chemotherapy, 50 patients with malignant lymphoma underwent Tc-TF scintigraphy, which was performed 10 minutes after intravenous injection of 20 mCt Tc-TF. Tc-TF scintigraphy detected malignant lymphoma in 44 (88%) patients. However, there were no significant differences in the incidences of positive and negative Tc-TF scintigraphic results between female versus male patients, HD versus NHL patients, stage I-II versus stage III-IV patients, age > 40 years versus < or = 40 years patients and patients with B symptoms false-negative results occurred in 4 (8%) infradiaphragmatic malignant lymphoma. We conclude patients with that Tc-TF scintigraphy appears suitable for detecting malignant lymphoma, especially supradiaphragmatic lesions.

Effect of imaging time on gallium renal scan

AIM

Gallium renal imaging has been reported to be useful in monitoring disease activity and predicting the response to therapy in lupus nephritis. Gallium renal images are usually obtained 48 h after the injection of 67Ga citrate, but 72-h images sometimes are the only available pictures. The aim of the present study was to determine whether the time intervals from injection to imaging had any effect on the grading of gallium renal scintigraphy.

METHODS

Fifty-five patients with lupus nephritis underwent gallium renal imaging at both 48 h and 72 h post-injection of 111 MBq of 67Ga citrate. The relative uptakes of 67Ga by the kidneys and the spine was judged visually on the analog images. Renal uptake was rated on a scale of 0-3.

RESULTS

Fifty-three patients (96.3%) had the same grading of renal uptake in the 48-h and the 72-h images. Only two patients (3.7%) had a different grading in the 72-h images when compared to the 48-h images. The correlation between the 48-h renal uptake and 72-h renal uptake was excellent, with a Spearman R value of 0.94. No significant difference was noted between these two groups, with a P value of 0.76 (using a Wilcoxon matched pairs test).

CONCLUSION

A gallium renal scan can be obtained either 48 h or 72 h after injecting 67Ga citrate. The imaging time did not interfere with the grading of renal uptake in lupus nephritis.

Detection of cervical lymph node metastases in nasopharyngeal carcinomas: comparison between technetium-99m methoxyisobutylisonitrile single photon emission computed tomography and computed tomography

The aim of this study was to compare the effectiveness of technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) single photon emission computed tomography (SPECT) and computed tomography (CT) of head and neck in evaluating cervical lymph node (LN) metastasis in nasopharyngeal carcinomas (NPC). Fifty NPC patients with suspected cervical LN metastases underwent Tc-99m MIBI SPECT and CT of the head and neck to evaluate cervical LN metastases. Among the 50 patient.s cervical LN lesion were confirmed by biopsy histopathological results in 40 patients. For 22 LN lesions with discordant results between Tc-99m MIBI SPECT and CT Tc-99m MIBI SPECT could correctly detect 5 metastatic and 7 benign LN lesions, while could correctly detect 5 metastatic and 6 benign LN lesions. Tc-99m MIBI SPECT and CT could correctly detect all of the 18 metastatic LN lesions. Tc-99m MIBI SPECT showed a better specificity but a lower sensitivity for detecting cervical LN metastases in NPC when compared with CT. The combined use of Tc-99m MIBI SPECT and CT could increase the accuracy, compared with the single use of either Tc-99m MIBI SPECT or CT, to detect cervical LN metastases in NPC.

Evidence of gallbladder function changes in hepatoma after transcatheter arterial embolization by quantitative Tc-99m DISIDA cholescintigraphy

BACKGROUND/AIMS

Transcatheter arterial embolization is the treatment of choice for inoperable hepatocellular carcinoma. Gallbladder infarction following transcatheter arterial embolization has been reported, therefore, the gallbladder functions were studied using the quantitative Tc-99m DISIDA cholescintigraphy in the present study.

METHODOLOGY

The gallbladder functions which were presented as the filling fraction and the ejection fraction in 24 patients with hepatoma before and after transcatheter arterial embolization. The patients were separated into two groups. Group 1: 12 patients received precystic artery transcatheter arterial embolization and group 2: 12 patients received postcystic artery transcatheter arterial embolization.

RESULTS

After transcatheter arterial embolization, significantly decreased both gallbladder functions of filling fraction (61.2 +/- 7.4% and 48.3 +/- 6.5%) and ejection fraction (47.8 +/- 6.0% and 36.5 +/- 5.3%) were found in group 1 patients. However, no significant change of filling fraction (59.0 +/- 5.0% and 58.8 +/- 7.4%) and ejection fraction (49.9 +/- 2.4% and 49.3 +/- 5.7%) in group 2 patients.

CONCLUSIONS

Impaired gallbladder functions were common in hepatoma patients who received precystic artery transcatheter arterial embolization, and Tc-99m DISIDA cholescintigraphy may be useful for evaluating the gallbladder functions in hepatoma patients who received transcatheter arterial embolization.