Factorial validation analysis of the Baby and Children's Eating Behavior Questionnaires in Samoa

Survey instruments for assessing eating behaviors in infancy and early childhood have yet to be validated among Pacific Islanders, among whom the prevalence of pediatric obesity is steadily increasing. This study aimed to evaluate Baby Eating Behavior Questionnaire (BEBQ) and Children's Eating Behavior Questionnaire (CEBQ) factor structures against data collected from mother-infant dyads in Samoa. The BEBQ was administered across two time points: approximately 2 months (mean = 2.37 [SD = 0.34]; N = 105) and 4 months postpartum (mean = 4.22 [SD = 0.44]; N = 117). The CEBQ was administered at approximately 21 months postpartum (mean = 21.45 [SD = 1.72]; N = 113). Both the original four-factor BEBQ and seven-factor CEBQ models failed to replicate in confirmatory factor analyses. BEBQ data from 2 and 4 months demonstrated acceptable fit to a nine-item, two factor model, generated by elimination of factors with low internal reliability. A series of exploratory factor analyses on CEBQ data from 21 months postpartum ultimately revealed 16-item, three-factor structure. There was little correlation between BEBQ and CEBQ scores, suggesting either that infant feeding behaviors before and after weaning are not strongly associated, or that the BEBQ and CEBQ function better in cross-sectional, rather than longitudinal analyses. Newly derived CEBQ factors raise concerns regarding whether original CEBQ items and factors were sufficiently theoretically distinct. Study results suggest that demographic and cultural differences may impact both BEBQ and CEBQ factor structure. Further qualitative research is necessary to address these issues.

Impact of obesity on short-term outcomes of laparoscopic colorectal surgery for Japanese patients with colorectal cancer: A multicenter study

INTRODUCTION

The impact of obesity on short-term outcomes after laparoscopic colorectal surgery (LAC) in Asian patients is unclear. The purpose of the present multicenter study was to evaluate the safety and feasibility of LAC in obese Japanese patients.

METHODS

We retrospectively reviewed 1705 patients who underwent LAC between April 2016 and February 2019. Patients were classified according to body mass index (BMI): non-obese (BMI < 25 kg/m² , n = 1335), obese I (BMI 25-29.9 kg/m² , n = 313), and obese II (BMI ≥30 kg/m² , n = 57). Clinical characteristics and surgical outcomes were compared among the three groups.

RESULTS

The proportion of patients with comorbidities (non-obese, 58.1%; obese I, 69.6%; obese II, 75.4%; P < .001) and median operation time (non-obese, 224 minutes; obese I, 235 minutes; obese II, 258 minutes; P = .004) increased significantly as BMI increased. The conversion rate was similar among the groups (P = .715). Infectious complications were significantly high in obese II patients (non-obese, 10.4%; obese I, 8.3%; obese II, 28.1%; P < .001). Multivariate analysis revealed that in obese II patients, BMI was an independent predictive factor of infectious postoperative complications (odds ratio 2.648; 95% confidence interval, 1.421-4.934; P = .002).

CONCLUSION

LAC has an increased risk of postoperative infectious complications in obese II patients, despite improvements in surgical technique. Management of obese II colorectal cancer patients requires meticulous perioperative management.

Evaluation of adverse events associated with filgrastim originator and biosimilar using a spontaneous reporting system database

Biosimilar products of filgrastim have become available for improved sustainability of cancer care; however, the real-world safety profile remains unknown. The purpose of this study was to clarify the adverse events associated with filgrastim originator and its biosimilar using the Japanese Adverse Drug Event Report (JADER) database. Adverse event reports submitted to the Pharmaceuticals and Medical Devices Agency between 2014-2018 were extracted. We calculated the reporting odds ratio and 95% confidence interval for each adverse event. We obtained 584 reports of adverse events associated with filgrastim originator and 102 reports with its biosimilar. Signals were detected for bone marrow failure and febrile neutropenia with both filgrastim originator and its biosimilar; whereas those for drug resistance and hypoxia only involved filgrastim originator, and those for interstitial lung disease only involved its biosimilar. The safety profiles of filgrastim originator and its biosimilar were partly different. Further studies are needed to confirm these findings.

Human lung microvascular endothelial cells as potential alternatives to human umbilical vein endothelial cells in bio-3D-printed trachea-like structures

BACKGROUND

We have been trying to produce scaffold-free structures for airway regeneration using a bio-3D-printer with spheroids, to avoid scaffold-associated risks such as infection. Previous studies have shown that human umbilical vein endothelial cells (HUVECs) play an important role in such structures, but HUVECs cannot be isolated from adult humans. The aim of this study was to identify alternatives to HUVECs for use in scaffold-free structures.

METHODS

Three types of structure were compared, made of chondrocytes and mesenchymal stem cells with HUVECs, human lung microvascular endothelial cells (HMVEC-Ls), and induced pluripotent stem cell (iPSC)-derived endothelial cells.

RESULTS

No significant difference in tensile strength was observed between the three groups. Histologically, some small capillary-like tube formations comprising CD31-positive cells were observed in all groups. The number and diameters of such formations were significantly lower in the iPSC-derived endothelial cell group than in other groups. Glycosaminoglycan content was significantly lower in the iPSC-derived endothelial cell group than in the HUVEC group, while no significant difference was observed between the HUVEC and HMVEC-L groups.

CONCLUSIONS

HMVEC-Ls can replace HUVECs as a cell source for scaffold-free trachea-like structures. However, some limitations were associated with iPSC-derived endothelial cells.

MM-111: a novel bispecific antibody targeting ErbB3 with potent anti-tumor activity in ErbB2 over-expressing malignancies

Abstract #4166

ErbB3 has been identified as a preferred dimerization partner of ErbB2, critical for driving the proliferation of ErbB2 over-expressing breast tumors. We have designed a bispecific antibody, MM-111, which inhibits ligand-induced phosphorylation of ErbB3 with sub-nanomolar potency by exploiting the abundant expression of its dimerization partner, ErbB2, for specific targeting to cancer cells that express both receptors. We employed computational physicochemical modeling to guide the kinetic optimization of the monovalent binding affinities to the ErbB2 and ErbB3 receptors to increase the potency and specificity of MM-111 for tumor cells. We have demonstrated that MM-111 inhibits activation of the phosphatidylinositol 3-kinase pathway in vitro and in vivo, resulting in attenuation of tumor proliferation. Inhibition of growth by MM-111 has been observed in several murine xenograft models including BT474 and MDA-MB-361 breast tumors. While the antitumor activity of MM-111 is positively correlated with ErbB2 expression levels, MM-111's potent inhibition of ErbB3 phosphorylation and signaling downstream from this receptor differs markedly from currently available therapies targeting ErbB2 over-expressing breast tumors and thus provides a novel approach to treatment for these malignancies. In conclusion, our data demonstrate that the combination of computational biology with antibody engineering has resulted in the development of a promising, novel therapeutic, MM-111, that has potent antitumor activity in malignancies driven by the ErbB2/3 oncogenic unit.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4166.

Can immune-enhancing nutrients reduce postoperative complications in patients undergoing esophageal surgery?

Postoperative infection of esophageal neoplasm surgery is the major cause of prolonged postoperative hospitalization, as well as morbidity. The clinical benefits of administering immune-enhancing nutrients (IEN) to critically ill patients and those undergoing elective surgery were clarified. However, the benefits of preoperative administration of IEN for patients with esophageal cancer remain unclear. The present study was designed to clarify the clinical efficacy of administration of IEN prior to esophageal surgery. A total of 123 patients undergoing esophagectomy in single institute were retrospectively investigated. All patients received postoperative enteral nutrition by use of ordinal nutrients. Preoperative IEN were also given to 84 patients (IEN group), while the other 39 received an ordinary diet (control). Postoperative courses and laboratory data were compared between the two groups. The incidences of infectious complications in the IEN and control groups were 18% and 38%, respectively (P < 0.05). Pneumonia developed in 5 (6%) IEN and 7 (18%) control patients (P < 0.05). Postoperative hospitalization was shorter in the IEN group (P < 0.01). Prealbumin levels, retinal binding protein levels and the lymphocyte count were significantly higher in the IEN group on postoperative day 3. These results suggest that preoperative administration of IEN in patients undergoing esophagectomy reduces infectious complications, mainly pneumonia, and shortens postoperative hospitalization.

Celiac lymph nodes: distant or regional for thoracic esophageal carcinoma?

Involvement of celiac nodes is defined as distant metastasis in the TNM classification for thoracic esophageal carcinoma. Some textbooks, however, describe dissection of these nodes as a standard technique. The present study was, therefore, undertaken to clarify which celiac nodes are regional for thoracic esophageal carcinoma and whether or not celiac node dissection would provide a survival benefit. Eight hundred and five patients who underwent R0 resection (no residual tumor) with systematic lymphadenectomy including the celiac axis area for thoracic esophageal carcinoma were retrospectively investigated. The frequency of metastasis and the therapeutic value of dissecting celiac nodes were compared to those associated with the left gastric artery area. The frequencies of left gastric and celiac nodal involvement were 15.4% and 9.6%, respectively, for thoracic esophageal carcinoma. As for tumor location, the incidences of metastasis around left gastric artery and celiac axis from the upper, middle and lower portion were 6.7% and 1.0%; 12.3% and 7.7%; and 25.7% and 17.4%, respectively. The 5-year survivals of patients with celiac but not left gastric metastasis were 36.3% and 41.8% for the middle and lower portions, respectively, while the corresponding values with left gastric involvement but no celiac metastasis were 24.1% and 27.9%. These differences were not significant. The frequency of celiac node involvement was not low. And, their dissection has equivalent therapeutic value to that of left gastric nodes. Revision of the TNM classification to account for celiac node involvement in thoracic esophageal carcinoma, especially of the middle and lower portions, is needed.

A new reconstructive procedure after segmental pancreatectomy: an experimental study of pancreatic end-to-end (duct-to-duct) anastomosis

We produced experimental models of pancreatic end-to-end anastomosis, including ductal end-to-end anastomosis (with or without stent) and pancreaticojejunostomy, using mongrel dogs, with a view to evaluating reconstructive procedures after segmental pancreatectomy. We examined macroscopic findings, pancreatograms, and microangiographic and histopathological findings to determine whether pancreatic end-to-end anastomosis was as practicable as pancreaticojejunostomy. Macroscopic findings showed no suture failure in any animal in the end-to-end anastomosis group. Pancreatography revealed obstruction of the stent tube in the stent subgroup, but good patency in the no-stent subgroup. On the imaging of the microvasculature in the end-to-end anastomosis group, proliferation of neovascular vessels and formation of communicating vessels were detected. Histopathologically, no suture failure was detected, and the viability of the pancreatic end-to-end anastomosis was confirmed. From this experiment, we concluded it that it was possible to employ pancreatic end-to-end anastomosis after segmental pancreatectomy in the clinical situation.

A new reconstructive procedure after segmental pancreatectomy: an experimental study of pancreatic end-to-end (duct-to-duct) anastomosis

We produced experimental models of pancreatic end-to-end anastomosis, including ductal end-to-end anastomosis (with or without stent) and pancreaticojejunostomy, using mongrel dogs, with a view to evaluating reconstructive procedures after segmental pancreatectomy. We examined macroscopic findings, pancreatograms, and microangiographic and histopathological findings to determine whether pancreatic end-to-end anastomosis was as practicable as pancreaticojejunostomy. Macroscopic findings showed no suture failure in any animal in the end-to-end anastomosis group. Pancreatography revealed obstruction of the stent tube in the stent subgroup, but good patency in the no-stent subgroup. On the imaging of the microvasculature in the end-to-end anastomosis group, proliferation of neovascular vessels and formation of communicating vessels were detected. Histopathologically, no suture failure was detected, and the viability of the pancreatic end-to-end anastomosis was confirmed. From this experiment, we concluded it that it was possible to employ pancreatic end-to-end anastomosis after segmental pancreatectomy in the clinical situation.

Density and Distribution of Citemene Fields in a Miombo Woodland Environment in Zambia

/ The Bemba people of northern Zambia practice citemene shifting cultivation. We utilized Landsat satellite images from 1984 and 1992 to map the distribution of citemene fields in those two years and to assess changes in the spatial sustainability of citemene cultivation in a miombo woodland study area. The citemene fields were concentrated within about 5-6 km of roads. Between 1984 and 1992, there was a decrease in the number of fields, and an increase in the average distance from the road. These changes may have been due to the introduction of semipermanent maize farming in the intervening years. The estimated cycle times for woodland utilization may have been long enough to maintain sustainability under traditional citemene cultivation practices. However, cycle times may be too short to maintain sustainability within the woodlands along roads.KEY WORDS: Shifting agriculture; GIS; Sustainability; Citemene; Miombo; Zambiahttp://link.springer-ny.com/link/service/journals/00267/bibs/24n2p273.html

[Analysis of air pollution and prevalence rate of allergic diseases among elementary school children in Kawaguchi and Hatogaya city]

Kawaguchi and Hatogaya City are located on the northern edge of Tokyo. We analysed between air pollution and prevalence rate of allergic diseases among elementary school children in this area. A prevalence rate of allergic diseases in 1996 May and June was as follows; bronchial asthma 13.5%, atopic dermatitis 24.5%, allergic rhinitis and/or conjunctivitis 22.8%, urticaria 12.4%, food allergy 7.8% and drug allergy 2.2%, respectively. Air pollution of this area was analysed to check the levels of nitrogen dioxide (NO2), sulfur dioxide (SO2) and suspended particulate matters (SPM). NO2 pollution was relatively high in urban area, and SPM pollution was especially high around the highways. SO2 pollution was lower than the environmental standard. No relationship was found between the prevalence rate of bronchial asthma, atopic dermatitis, allergic rhinitis and/or conjunctivitis and air pollution, but it was found that these diseases are slightly related to population density (p < 0.1, p < 0.01, p < 0.1, respectively).

Selective inhibition of platelet-derived growth factor (PDGF) receptor autophosphorylation and PDGF-mediated cellular events by a quinoline derivative

This report describes the biological effects of our original compound, Ki6783 ((3,4-dimethoxy)-4-phenoxy-6,7-dimethoxyquinoline), a potent and selective inhibitor of platelet-derived growth factor (PDGF) receptor autophosphorylation. This compound strongly inhibited autophosphorylation of the PDGF beta-receptor in cultured rat glomerular mesangial cells (MC) bearing this receptor (IC50 0.1 microM), although it did not inhibit autophosphorylation of other growth factor receptors even at 100 microM. In a cell-free kinase experiment, it showed selective inhibition of PDGF beta-receptor tyrosine kinase. A kinetic study of the compound to this tyrosine kinase revealed a competitive mode of action to ATP. [3H]Thymidine incorporation and cell proliferation of MC were inhibited by Ki6783 in a dose-dependent manner after Ki6783 and PDGF-BB were added to the culture medium. Furthermore, this compound normalized the fibrotic cell shape of v-sis-transformed NIH3T3 cells, which grow in an autocrine manner via the PDGF receptor. These effects could be explained by the inhibition of intracellular signal transduction triggered by PDGF receptor autophosphorylation, in which activation of mitogen-activated protein kinase occurs. These results suggest that Ki6783 is one of the more potent and selective inhibitors of PDGF receptor autophosphorylation and that it may be useful in ameliorating cell abnormalities due to excess action of PDGF and its receptor systems in several diseases.

[Efficacy of rectal diazepam suppository in the prophylaxis of febrile seizures: comparison with rectal chloral hydrate suppository]

We evaluated the efficacy of diazepam and chloral hydrate given rectally for the prophylaxis of recurrence of febrile seizure. The dose were 0.4 mg/kg for diazepam and 250 mg (for children younger than 3 years old) or 500 mg (for over 3 years old) for chloral hydrate. Another dose was given after an interval of 8 hours if body temperature continued to exceed 38.0 degrees C. Among the 452 patients with febrile seizures who visited our hospital from Jan. 1993 to Jun. 1995, 113 were studied who had at least one febrile episode in the follow-up period that extended over 6 months. These patients were divided into two groups: Group D (72 patients given diazepam) and Group C (41 patients given chloral hydrate). In group D and C, the numbers of febrile episodes were 238 and 167, and those of recurrent seizures 8 (3.8%) and 29 (20.4%), respectively. The recurrences rate was significantly higher in the latter group (p < 0.005). There was no statistical difference as to the mean dosage of diazepam or chloral hydrate between the patients with and without recurrence. The numbers of patients with seizure recurrence were 8 (11.1%) in group D and 12 (29.3%) in group C, being significantly larger in the latter (p < 0.005). Diazepam produced more adverse effects than chloral hydrate did. Thus diazepam suppositories for the prevention of recurrence of febrile seizures were more effective than chloral hydrate suppositories.

Construction of a contiguous 874-kb sequence of the Escherichia coli -K12 genome corresponding to 50.0-68.8 min on the linkage map and analysis of its sequence features

The contiguous 874.423 base pair sequence corresponding to the 50.0-68.8 min region on the genetic map of the Escherichia coli K-12 (W3110) was constructed by the determination of DNA sequences in the 50.0-57.9 min region (360 kb) and two large (100 kb in all) and five short gaps in the 57.9-68.8 min region whose sequences had been registered in the DNA databases. We analyzed its sequence features and found that this region contained at least 894 potential open reading frames (ORFs), of which 346 (38.7%) were previously reported, 158 (17.7%) were homologous to other known genes, 232 (26.0%) were identical or similar to hypothetical genes registered in databases, and the remaining 158 (17.7%) showed no significant similarity to any other genes. A homology search of the ORFs also identified several new gene clusters. Those include two clusters of fimbrial genes, a gene cluster of three genes encoding homologues of the human long chain fatty acid degradation enzyme complex in the mitochondrial membrane, a cluster of at least nine genes involved in the utilization of ethanolamine, a cluster of the secondary set of 11 hyc genes participating in the formate hydrogenlyase reaction and a cluster of five genes coding for the homologues of degradation enzymes for aromatic hydrocarbons in Pseudomonas putida. We also noted a variety of novel genes, including two ORFs, which were homologous to the putative genes encoding xanthine dehydrogenase in the fly and a protein responsible for axonal guidance and outgrowth of the rat, mouse and nematode. An isoleucine tRNA gene, designated ileY, was also newly identified at 60.0 min.

Combined intensive chemotherapy and radical surgery for incurable gastric cancer

BACKGROUND

To improve the poor prognosis of patients with advanced incurable gastric cancer, intensive chemotherapy combined with radical surgery was used.

PATIENTS AND METHODS

Thirty patients with incurable gastric cancer were treated with a combination of 5-fluorouracil (370 mg/m2) and leucovorin (30 mg/person), given intravenously for five consecutive days, followed by cisplatinum (70 mg/m2) and etoposide (70 mg/m2) on days 6 and 20, delivered through a catheter placed either in the aorta with its tip at the level of the ninth thoracic vertebra or in the celiac artery. This treatment (FLEP therapy) was repeated twice every 5 weeks. Radical or palliative surgery followed chemotherapy.

RESULTS

The overall response rate to the chemotherapy was 50.0% (15 of 30 patients, 95% confidence limit 0.305-0.671). Nineteen patients (15 with a partial response, three showing no change, and one with progressive disease) underwent surgery. Of these, nine underwent curative surgery and 10 palliative surgery. The median survival time was 6.5 months overall, 12.7 months for responders, and 4.7 months for nonresponders. Long-term survivors were exclusively found among patients with distant lymph node metastasis treated by curative surgery (55.6% at 5 years).

CONCLUSIONS

Favorable results of this small phase II study justify a phase III trial.

Mitogenic activity of peptides related to the sequence of human fibroblast growth factor-1

Linear synthetic peptides related to the human Fibroblast Growth Factor-1 (hFGF-1) segment [112-147] were tested for their capacity of mimicking FGF mitogenic activity, binding to heparin-Sepharose columns, stimulating DNA synthesis and competing with hFGF-1 for the cellular receptors. The results obtained indicated that the activity of these compounds is dependent on the presence of the sequence WFVGLK in their structures. The affinity for the cellular receptors increased when this sequence was elongated in order to incorporate amino acid residues that are important for FGF-heparin binding.

Mobile tongue reconstruction with the free dorsalis pedis flap

Reconstruction of the mobile tongue needs soft and thin tissue not to disturb tongue movement, and therefore a free forearm flap has usually been used for this kind of reconstruction. However, it entails a cosmetic problem, especially for young people. We have detained good results with tongue reconstructions using free dorsalis pedis flaps. The donor site of the dorsalis pedis flap is inconspicuous. The dorsalis pedis flap is thin (even among obese persons), has a long vessel pedicle, and stable blood supply. In cases of head and neck reconstruction, two teams can easily operate simultaneously. This flap is not as large as a forearm flap but it is large enough for hemitongue reconstruction. We measured the thickness of the soft tissue of both the dorsalis pedis and the forearm among obese volunteers. Dorsalis pedis was not as thick as the forearm.

[A case report of 16-year-old gastric cancer patient with a rapid recurrence after curative gastrectomy]

A 16-year-old female patient with gastric cancer was recently treated at our institute. She had macroscopically curative surgery, but relapsed to die 7 months after surgery due to peritoneal dissemination. We experienced three teen-agers over past 45 years, who were 0.019% of all cases treated in our institute. Histological type of these cases was undifferentiated adenocarcinoma, exposing to serosa. Though they had suffered abdominal discomfort for long time, proper diagnosis was not done due to their young age. Even the teen-ager who has abdominal complaints should be subjected to a thorough examination of gastrointestinal tract. Oncogene analysis should be done for the familial strain of gastric cancer.

[Meta-analysis of 10 postoperative adjuvant chemotherapies for gastric cancer in CIH]

Six adjuvant chemotherapy protocols with 10 chemotherapy regimens were subjected to meta-analysis with an aim to clarify the survival benefits of adjuvant chemotherapy in gastric cancer. All adjuvant chemotherapies were compared with surgery alone, in cases from 1959 to 1982 in the Cancer Institute Hospital, Tokyo in the setting of controlled randomized study; and 1,177 gastric cancer patients with curative surgery were entered the studies. Pooled odds ratio and its 95% confidence interval was 0.63(0.51-0.78). The results suggested the survival benefits of adjuvant chemotherapy with mitomycin C and/or 5-fluorouracil in gastric cancer.

[The changes in the treatment of early gastric cancer--endoscopic mucosal resection and limited (nerve preserving) operation]

We have been trying to perform endoscopic mucosal resection (ER) since 1987, and limited operation since 1985 (nerve preserving operation since 1991) for early gastric cancer. 205 patients were performed ER from 1978 to 1990, 78 patients were performed limited operation from 1985 to 1993. We perform ER according to the indication as follows: 1) differentiated IIa type, size approximately 2 cm, 2) differentiated IIc type, size approximately 1cm, Ul(-), 3) undifferentiated IIc type, size approximately 5mm, Ul(-). And the indication of limited operation is the patients with intramucosal cancer and tumor size approximately 2cm. Up to date, we have never experienced recurrence of these patients undergone ER or limited operation. As to QOL, these therapy will be expected to improve QOL of early gastric cancer patients, especially per os and body weight loss after surgery.

[Indication for the lymph node dissection of gastric cancer based on the pattern analysis small of lymphatic spread]

A total of 8,230 cases of gastric cancer treated at CIH were subjected to the analysis of the pattern of lymphatic spread with an aim of getting indication for the lymph node dissection of Small gastric cancer. Modified dissection (D1-alpha) is indicated for the patients with following conditions: 1) every elevated or flat type mucosal cancer, 2) excavated (IIc) type mucosal cancer less than 10mm in diameter, 3) elevated or flat type submucosal cancer less than 10mm in diameter, 4) excavated submucosal cancer less than 5mm in diameter. Extended dissection (D2 + alpha) is indicated for small cancer which exposed to serosa. Cancer in the upper thirds needs total gastrectomy or cardiectomy according to the state of #5 and 6 nodes, with complete dissection of #1 to 11 nodes associated with sampling of #16 nodes. Total gastrectomy with complete dissection of #1 to 11 nodes and sampling of #16 nodes is indicated for the advanced small cancer in the middle thirds, and total gastrectomy with complete dissection of #1 to 13 nodes and sampling of #14, 16 nodes is indicated for cancer in the lower thirds.

[The treatment and clinical issue of gastric cancer with infiltrating the adjacent organs]

We discussed the advances and clinical issue including complications in the treatment of gastric cancer infiltrating the adjacent organs. Recent years, the proportion of the patients with gastric cancer infiltrating the adjacent organs are decreasing, but there isn't remarkable advances in the treatment result of them. That is due to the fact that about one half of them has distant metastasis, such as peritoneal dissemination or liver metastasis. Whatever the survival rate of the patients who was performed combined resection is better than unresected cases. The postoperative complications of the combined resection cases is two times as much as the uncombined resected cases. Therefore we should perform combined radical resection for the patients without distant metastasis, and for the patients with distant metastasis, we should perform palliative surgery for the purpose of improving QOL.

[Left upper abdominal evisceration for advanced gastric cancer]

To evaluate the clinical significance of the surgical procedure of left upper abdominal evisceration (LUAE), we analysed the prognosis of patients who received LUAE in the Cancer Institute Hospital from 1980 to 1990 using pair matching analysis. Survival benefits were observed in the patients with the tumor located in the upper or middle part of the stomach, and especially in those with Borrmann type 4 gastric cancer. Even in cases of peritoneal dissemination, patients who received LUAE survived longer than those with conventional total gastrectomy. These results indicated that LUAE should be a standard surgical approach for Bormann type 4 gastric cancer.

[Progress of the treatment of gastric cancer in Cancer Institute Hospital, Tokyo]

From 1946 to 1990, a total of 10,485 cases of gastric cancer patients were treated at the Cancer Institute Hospital (CIH), Tokyo. During the past 46 years, CIH contributed to various aspects of surgical treatment of gastric cancer; extensive radical surgery for advanced cancer, safe reconstruction methods after total gastrectomy, modified surgery for early stage cancer, and multimodality therapy for moderately advanced cancer. Five-year survival rate was 20% for all cases in 1940s, and 66.5% for 1980s. Improvement in the treatment results could be attributed to the relative increase in the number of early stage cancers, the increase in the rate of curative surgery (R0), and incorporation of multi-modality therapy before or after curative surgery. Stage-oriented therapy is mandatory for further improvement in the treatment results and the patient's quality of life after surgery.

[Treatment of recurrent gastric cancer]

The recurrence rate of resected gastric cancer was 31.9%. The rate was in creasingly higher in proportion to the lack of radicality. The most common type of recurrence was peritoneal dissemination, followed by hematogeneous metastasis, local recurrence, and distant lymph node metastasis. The treatments for recurrence were surgery (9.3%) and chemotherapy (16.1%). Systemic chemotherapy (intravenous iv) was common, and local chemotherapy (intraarterial ia, intraperitoneal ip) was rate. The efficacy of systemic chemotherapy (iv) for recurrent gastric cancer without local recurrence was suggested. The efficacy of local chemotherapy (ia) was suggested for peritoneal dissemination and local recurrence.

[The analysis of prognosis of patients with gastric cancer with the nodal stage(N, n) and the number of involved lymph nodes]

Now we use the nodal grade (N, n) as a prognostic indicator in patients with gastric cancer according to the general rules for the gastric cancer study. But there are both of patients with good and poor prognosis in the same nodal grade. Then we analyzed the survival of patients with gastric cancer based on the nodal grade and the number involved lymph nodes, and discussed the new prognostic indicator with both of them. We classified the three groups based on the number of involved nodes as follows: 0.1-4.5-. There is the differences in survival between each pair of groups statistically. The relationship between the nodal grade (N, n) and the number of lymph node metastasis is that the survival of patients with involved nodes more than five is equal to the survival of the patients with high nodal grade and involved nodes 1-4. Therefore it suggest that the new grading consisting of them will be more better prognostic indicator.

[Prognostic factors of the gastric cancer patients without distant metastasis]

From 1946 to 1990, 10,485 patients with gastric cancer were been surgically treated in the Cancer Institute Hospital, Tokyo. Retrospectively, we analyzed prognostic factors, especially in those without distant metastasis. Prognosis of the patients with tumors which invaded the proper muscle layer improved dramatically (from 70% to 90%). However, patients who had advanced tumors with serosal invasion did not show good survived (from 20% to 40%). To improve the prognosis of patients with serosal positive gastric cancer, a new and effective prophylactic therapy for peritoneal recurrence is needed.

[Cell cycle analysis of endometrial cancer cells in vitro treated with growth factor and steroid hormone]

The aim of this study was to overtake the mechanism of the control system in endometrial cancer cell line in vitro. Ishikawa cell (IK cell) and HEC-1 cell (HEC cell) derived from endometrial cancers were cultured with serum free medium (SFM-101). IK cell possessed Estrogen receptor (ER), Progesterone receptor (PR), Epidermal growth factor (EGF) and its receptor (EGFR). HEC cell had PR, EGF, and EGFR, however HEC cell did not keep ER. EGF stimulated the growth of IK cell, but the growth of HEC cell was not stimulated by EGF. S phase cells were increased by EGF in IK cell, but were not increased by EGF in HEC cell. The growth of IK cell was stimulated significantly by EGF and Estradiol-17 beta (E2) +EGF than control. However, E2+EGF did not stimulate the growth of IK cell than EGF significantly. Danazol (D) and D+EGF inhibited the growth of IK cell significantly than control. S phase cells were decreased by the treatment of D and D+EGF. From our results, EGF stimulated the growth of ER positive endometrial cancer cell, but EGF did not stimulate ER negative endometrial cancer cell. E2+EGF and EGF stimulated the growth of IK cell as a same. However, D inhibited the growth of IK cell that was stimulated by EGF.

[In vitro chemosensitivity test using collagen gel matrix for human gastric carcinomas]

The usefulness of an in vitro human tumor culture system using a specialized collagen gel matrix derived from pig skin was retrospectively evaluated as a chemosensitivity test for human gastric carcinomas. Seven xenograft tumors derived from human gastric cancers were examined by this system (CGM assay) and compared with the data obtained by a nude mice assay (NM assay) and a succinic dehydrogenase inhibition test (SDI test). Xenograft tumors had three-dimensional growth on the collagen gel matrix like that in vivo. There was increasing cell kill with rising cytotoxic drug concentration. When drug sensitivity was evaluated as effective based on an inhibition rate of 40% or more in the CGM assay, drug sensitivity as measured by the CGM assay corresponded with that measured by the NM assay for all xenograft tumors but not the SDI test. This system could be applied for chemosensitivity test of scirrhous gastric carcinomas. It was suggested that the CGM assay may be more like an in vivo like chemosensitivity test and clinically useful testing for the patients with gastric cancer, including scirrhous one.

Antigenic analysis of recent H1N1 influenza viruses with monoclonal antibodies

Antigenic analysis of recently isolated H1 influenza viruses was performed using haemagglutination inhibition (HI) assay with monoclonal antibodies to the haemagglutinin (HA) subunit. Tests using monoclonal antibodies against the HA of the A/England/333/80 (H1N1) and A/Yamagata/120/86 (H1N1) viruses revealed that the major antigenic drift occurred in 1985 or 1986 and A/Dunedin/6/83-like virus became a major strain after 1986.

Epitope changes on the haemagglutinin molecule of recently isolated H1N1 influenza viruses

We have studied changes of epitopes on the haemagglutinin molecule (HA) of H1N1 influenza viruses isolated between 1977 and 1986. For this purpose monoclonal antibodies (MAbs) were raised against the HA of the influenza A/England/333/80 and A/Yamagata/120/86 strain viruses. In order to define the amino acid residues responsible for the change of epitopes, we prepared several HA cDNAs modified by site-directed mutagenesis and cloned them into a simian virus 40 expression vector (SVHA). The substitution of glycine with serine at position 125c (suffix indicates presence in H1 but not in H3 subtype HAs) on the HA of the influenza A/USSR/90/77 strain virus resulted in the loss of epitope 110 (epitopes were named after MAbs) and created new epitopes 139 and 15, which were observed on the HA of A/England/333/80 and a few isolates from 1983. These new epitopes disappeared from the HA in some of the isolates in 1983 and most of the isolates in 1984 and 1986. The disappearance of epitopes 139 and 15 seems to be associated with the loss of epitope W18, which was identified on the HA of A/USSR/90/77. We suggested previously that amino acid residue 189 was involved in epitope W18. We therefore expressed an HA protein with two amino acid substitutions at positions 189 and 125c and found that the conversion of glutamine to lysine at position 189 in SVHA-67 prevented the expression of epitopes 139 and 15.

[Effect of UFT on nuclear DNA distribution of gastric and colorectal carcinomas]

To evaluate the effect of UFT on nuclear DNA distribution of carcinoma, we measured the DNA content of biopsy specimens and resected specimens obtained from 18 patients by microfluorometry. The tumors consisted of 7 gastric and 11 colorectal carcinomas. Five patients who received administration of 400mg of UFT (400mg of tegafur) were classified as the chemotherapy group and another 13 patients were classified as the control group. 1) DNA indices of biopsy specimens and resected specimens of the same patients showed almost the same values both in the control group (r = 0.81) and in the chemotherapy group (r = 0.89) (p less than 0.05). 2) S and S + G2M fractions of resected specimens showed almost the same values as compared with those of corresponding biopsy specimen in the control group. However, in the chemotherapy group S and S + G2M fractions of resected specimens showed a tendency to be higher than those of corresponding biopsy specimen (0.05 less than p less than 0.1). This study indicates that the biopsy specimens are sufficient for DNA analysis and that UFT-induced DNA change may be increase of S and S + G2M fraction.

[A clinicopathological studies on gastrointestinal leiomyosarcomas, with special reference to prognosis]

Twenty-five cases of gastrointestinal leiomyosarcomas were subjected to clinico-pathological studies in an attempt to correlate the prognosis with tumor size, mitosis, cellularity and DNA ploidy pattern. Leiomyosarcomas greater than 5cm in diameter had poorer prognosis. Those with mitotic index larger than 3.0/mm2, cellularity larger than 3.0/0.0004mm2, DNA aneuploidy had poorer prognosis. By multiple regression analysis, mitotic index was useful for the prediction of tumor recurrence in earlier postoperative period, but cellularity, tumor size were useful for the prediction of recurrence in later postoperative period. As for the type of tumor recurrence, hematogenous metastasis was observed in 7 cases, peritoneal dissemination in 2 and local recurrence in 4. Four cases with local recurrence had all hematogenous metastasis. Two cases of gastric leiomyosarcomas developing local recurrence were greater than 10cm in diameter and gastric local resection was done for them. One case was diagnosed benign leiomyoma in the rectum histologically, but after trans-anal tumor resection local recurrence and metastasis to the lung occurred. We must pay attention to the surgical margin and the surface of tumor dissection during of the tumor, especially in larger tumors. Aggressive surgical resection is efficient for the treatment of recurrent tumors.

Human chorionic gonadotropin in gastric carcinoma. A useful marker for bone metastasis

Twenty patients with bone metastases from gastric carcinoma resected during the 13 years from 1974 through 1987 were investigated in relation to the serum and tissue carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). The incidence of bone metastases was 2.1% (20/933). The serum AFP, CEA and hCG positive rates were found to be 14.3, 42.9 and 69.2% for patients with bone metastases and 18.3, 19.4 and 14.1% for those without bone metastases, respectively. In addition, the tissue AFP, CEA and hCG positive rates were 11.1, 100 and 77.8% for such patients with bone metastases, and 8.0, 80.8 and 21.1% for those without bone metastases. Only the serum and tissue hCG positive rate was significantly higher for the patients with bone metastases than those without bone metastases. The bone metastatic lesions were investigated for tissue hCG in four cases, and found to be positive in all the four bone lesions. In four of the patients with metachronous bone metastases, serum hCG levels were elevated before or at the time when bone metastases were diagnosed. Furthermore, serum hCG levels fell in response to chemotherapy or tumor resection. On the contrary, the serum AFP or CEA levels did not correlate with the clinical course in patients with bone metastases. These results indicate that the measurement of the tissue and serum hCG in patients with gastric carcinomas could be of extreme value in the search for bone metastases and the serum hCG level could be a useful marker for the prediction of bone metastases in gastric carcinoma.

Properties and distribution of inorganic pyrophosphatase in rabbit dental pulp

Some properties and the intracellular distriubtion of inorganic pyrophosphatase in rabbit dental pulp were determined. This enzyme was sensitive to Mg2+, and not inhibited by imidazol and CN- which are inhibitors of alkaline phosphatase. Inorganic pyrophosphatase was found predominantly in the supernatant fraction.